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Obesity and pregnancy is not a good combination. Evidence is solid on the increased risk of all manner of pregnancy complications when pregnancy is accompanied by obesity. This is from the well known problems of gestational diabetes, pre-eclampsia, increased risk of operative delivery to the less known problems of pre-term delivery and even small for gestational age (underweight) babies.

Whether antenatal interventions for overweight or obesity during pregnancy have any effect on maternal and infant health is unclear, say the authors of a systematic literature review.

"At present it is not possible to generate reliable clinical recommendations for care providers and women relating to the provision of additional dietetic counselling during pregnancy," lead investigator Dr. Jodie M. Dodd, of the University of Adelaide, Australia, told Reuters Health.

Dr. Dodd and colleagues identified nine randomised controlled trials, involving 743 women, that compared antenatal dietary or lifestyle interventions with no treatment for overweight or obese pregnant women. Seven of the trials compared a dietary intervention with standard antenatal care. The main outcome was large-for-gestational-age infants.

In their report published online March 29th, 2010 in the British Journal of Obstetrics and Gynaecology, the researchers report that three studies involving 366 women showed no significant difference for the large-for-gestational-age infant outcome between those who received an antenatal intervention and those who did not. Four studies with 416 women showed no significant difference in mean gestational weight gain between the groups.

Rates of other outcomes-including preterm birth, preeclampsia, gestational diabetes, Caesarean section, postpartum infection or hemorrhage, and mean infant birthweight-also did not differ between intervention and control groups.

Dr. Dodd noted that high-quality randomized trials are needed to assess the effect of dietetic counseling during pregnancy for women who are overweight or obese. "In particular," she said, "information is required about the effect on maternal and infant health outcomes, as well as any potential longer term benefits for children."

"There is increasing information relating to modification of the maternal diet during pregnancy and its effect on metabolic pathways, including energy expenditure and appetite control, through genetic and epigenetic changes," Dr. Dodd said. "As part of our study and ongoing follow-up of infants and children, we are evaluating the genetic contribution to the development of obesity."

Obesity and Pregnancy: Effective intervention remains elusive