Evidence-based recommendations for energy intake in pregnant women with obesity
Jasper Most, … , Eric Ravussin, Leanne M. Redman
Jasper Most, … , Eric Ravussin, Leanne M. Redman
Published November 1, 2019; First published August 1, 2019
Citation Information: J Clin Invest. 2019;129(11):4682-4690. https://doi.org/10.1172/JCI130341.
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Categories: Clinical Medicine Metabolism Reproductive biology

Evidence-based recommendations for energy intake in pregnant women with obesity

Abstract

BACKGROUND In women with obesity, excess gestational weight gain (≥270 g/week) occurs in 2 out of 3 pregnancies and contributes to metabolic impairments in both mother and baby. To improve obstetrical care, objectively assessed information on energy balance is urgently needed. The objective of this study was to characterize determinants of gestational weight gain in women with obesity.METHODS This was a prospective, observational study of pregnant women with obesity. The primary outcome was energy intake calculated by the energy intake-balance method. Energy expenditure was measured by doubly labeled water and whole-room indirect calorimetry and body composition as a 3-compartment model by air displacement plethysmography and isotope dilution in early (13–16 weeks) and late (35–37 weeks) pregnancy.RESULTS In pregnant women with obesity (n = 54), recommended weight gain (n = 8, 15%) during the second and third trimesters was achieved when energy intake was 125 ± 52 kcal/d less than energy expenditure. In contrast, women with excess weight gain (67%) consumed 186 ± 29 kcal/d more than they expended (P < 0.001). Energy balance affected maternal adiposity (recommended: –2.5 ± 0.8 kg fat mass; excess: +2.2 ± 0.5; inadequate: –4.5 ± 0.5; P < 0.001) but not fetal growth. Weight gain was not related to demographics, activity, metabolic biomarkers, or diet quality. We estimated that energy intake requirements for recommended weight gain during the second and third trimesters were not increased as compared with energy requirements early in pregnancy (34 ± 53 kcal/d, P = 0.83).CONCLUSION We here provide what we believe are the first evidence-based recommendations for energy intake in pregnant women with obesity. Contrary to current recommendations, energy intake should not exceed energy expenditure.TRIAL REGISTRATION ClinicalTrials.gov, NCT01954342.FUNDING This study was funded by the National Institutes of Health (R01DK099175) and the Clinical Research Cores at Pennington Biomedical Research Center (U54GM104940 and P30DK072476).

Authors

Jasper Most, Marshall St Amant, Daniel S. Hsia, Abby D. Altazan, Diana M. Thomas, L. Anne Gilmore, Porsha M. Vallo, Robbie A. Beyl, Eric Ravussin, Leanne M. Redman

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Figure 4

Change in energy intake estimates for gestational weight gain.

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Change in energy intake estimates for gestational weight gain. Associati...
Association between gestational weight gain and change in energy intake (Change EI), calculated as calculated energy intake during pregnancy minus measured baseline total daily energy expenditure for each individual in the present study (A, n = 54), and for intervention groups in lifestyle intervention studies for pregnant women with obesity (B, by first author). The association is defined by measured data in this study and defined as Change EI [kcal/d] = 1.178 ± 0.108*GWG [g/week] –225 ± 46; R2 = 0.70, in which Change EI is change in energy intake relative to early pregnancy total daily energy expenditure and GWG is gestational weight gain during the second and third trimesters. The regression line is presented with 95% confidence intervals. REC, recommended gestational weight gain (170–270 g/week).