(334) Effects of Preconception Weight Loss on Gestational Weight Gain and Obesity-Associated Maternal Morbidities

Thursday, January 30, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Richard S. Legro, MD

Chair of Ob/Gyn
Penn State College of Medicine
Hershey, PA, United States

Coauthor(s)

KH

Karl R. Hansen, MD, PhD

Chair of Ob/Gyn
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, United States
MD

Michael P. Diamond, MD

Vice Dean of Research
Augusta University/ Medical College of Georgia
Augusta, Georgia, United States
AS

Anne Steiner, MD

Professor of Ob/Gyn
UNC School of Medicine
Chapel Hill, North Carolina, United States
CC

Christos Coutifaris, MD, PhD

Professor of Ob/Gyn
U Penn School of Medicine
Philadelphia, Pennsylvania, United States
MC

Marcelle I. Cedars, MD

Chief of Reproductive Endocrinology
UCSF School of Medicine
UCSF/San Francisco, California, United States
NS

Nanette Santoro, MD

Chair of Ob/Gyn
U Colorado School of Medicine
U Colorado/Denver, Colorado, United States
HZ

Heping Zhang, PhD

Professor of Biostatistics
Yale School of Public Health
New Haven, Connecticut, United States
AK

Alllen Kunselman, MA

Instructor in Public Health Science
Penn State College of Medicine
Hershey, Pennsylvania, United States
CS

Christina Stetter, BS

Research Associate
Penn State College of Medicine
Hershey, Pennsylvania, United States

Objective:

Preconception Weight Loss(PWL) is recommended in women with obesity (OW), but the effects of PWL on gestational weight gain(GWG) and associated obesity-related maternal morbidities are poorly studied. We examined these parameters in a previous multicenter RCT(FIT-PLESE, NCT02432209) of two types of preconception lifestyle intervention(16 weeks duration) in a population of OW with unexplained infertility(N=379)

Study Design:

Secondary and subgroup analysis of singleton live birth gestations from FIT-PLESE.   Preconception(Phase 1), the intensive lifestyle group(N=32) underwent increased physical activity and weight loss(target 7%) through meal replacements and medication(Orlistat) compared to a standard group(N = 39) with increased physical activity alone without weight loss. Both groups then received standardized infertility therapy consisting of CC/IUI(Phase 2).   Singleton pregnancies including GWG were tracked to live birth. The post hoc composite outcome was the prevalence of adverse obesity-related maternal events: PTL, PET, GDM and PROM

Results:

The standardized group of singleton pregnancies had no significant mean weight loss from baseline after the lifestyle intervention[-0.5%, 95% CI(-2.4, 1.3)] while the intensive group approached the target with significant weight loss[-5.6% (-7.6, -3.7) P< .001], and significant decreases in waist circumference.   However weight in the intensive group rebounded during Phase 2 and was equivalent to the standard group by 16 wks gestation(Fig 1) and continued to have similar weights up to 32 weeks gestation.   Despite the rebound weight gain and equivalent maternal weights by this time point, there was a trend towards decreased obesity-related maternal morbidity in the intensive weight loss group(Tab 1)

Conclusion:

Weight rebound is inevitable after weight loss treatment. Pregnancy may further exacerbate weight rebound after PWL. However, there may be maternal pregnancy benefits after PWL despite weight rebound. These data provide trends towards powering a larger study and incorporating pregnancy interventions after PWL to achieve better GWG and obstetric outcomes