Does Delivery of a Nutrition and Exercise Intervention Simultaneously or Sequentially Prevent Excessive Gestational Weight Gain? The NELIP Trial.

Abstract

Objective: To evaluate the effectiveness of sequential vs simultaneous introduction of nutrition and exercise behaviour intervention strategies at preventing early or late excessive gestational weight gain (EGWG).

Methods: Parallel group randomised trial at a single centre (London, Canada) included 84 healthy pregnant individuals (mean age: 32.4 ± 3.4 years; pre-pregnancy body mass index: 26.0 ± 5.1 kg/m2) randomly allocated at 12-18 weeks' gestational age (GA; baseline) to either NE (nutrition and exercise delivered simultaneously; n = 25), N + E (nutrition first and exercise added at 25 weeks' GA; n = 29) or E + N (exercise first and nutrition added at 25 weeks' GA; n = 30). Early weight gain was analysed weekly from baseline up to 25 weeks' GA (midpoint) and later from midpoint to 36 weeks' GA.

Results: From baseline to 25 weeks, no differences were found for the amount of EGWG (NE: 1.6 ± 1.4 kg, N + E: 1.9 ± 1.7 kg, E + N: 1.3 ± 1.3 kg; p = 0.62) or for the number of those who gained excessively (p = 0.38). However, from midpoint to final assessment, N + E gained more excessive weight (2.9 ± 2.3 kg; NE 2.5 ± 1.7 kg; E + N 1.6 ± 1.3 kg; p = 0.002, respectively) with more participants (n = 21; p = 0.03) gaining excessively than NE (n = 11) and E + N (n = 12).

Conclusions: Delivering the components of a nutrition and exercise intervention sequentially or simultaneously equally influences early EGWG. However, after 25 weeks' GA, introducing nutrition sequentially into an exercise program (E + N) or the continuation of combined nutrition and exercise (NE), mitigated EGWG compared to introducing exercise sequentially to a nutrition program (N + E). Sequencing of components may be an important factor to consider for intervention success, specifically by introducing an exercise component first followed by nutrition led to superior overall program adherence, with the least amount of EGWG.