Summary: In this randomised controlled trial of 202 overweight or obese pregnant women in Iran, a psychosocial-based weight-management programme improved healthier food choices (P < 0.001) and physical activity (P = 0.0001) relative to standard prenatal care. However, it produced no significant reduction in gestational diabetes (P = 0.533), preeclampsia (P = 0.948), or caesarean section (P = 0.489), so the clinically important endpoints were null.
PICO Summary
| Element | Detail |
|---|---|
| Population | 202 overweight or obese pregnant women attending healthcare centres affiliated with Jundishapur University of Medical Sciences, Iran; single-centre randomised controlled trial conducted June to December 2023. |
| Intervention | Comprehensive psychosocial-based weight-management programme delivered during pregnancy (nutrition, physical activity, and behaviour-change guidance); allocation approximately 1:1 (exact per-arm n not reported in the abstract). |
| Comparison | Standard prenatal care without the additional weight-management or psychosocial component; approximately half of the 202 participants. |
| Outcome | Significant improvements were seen in healthier food choices (P < 0.001) and physical activity, with the intervention group showing greater change (P = 0.0001). Achievement of recommended weight gain favoured the intervention numerically but was reported as raw proportions without a significance test (overweight women: 29.3% intervention vs 20.6% control; obese women: 39.3% vs 37%). No significant between-group difference was found for gestational diabetes (P = 0.533), preeclampsia (P = 0.948), or caesarean section (P = 0.489). Effect sizes, 95% confidence intervals, and ARR/NNT were not reported in the abstract. |
Pregnancy weight-management programme
RCT · overweight/obese pregnancy · Jun-Dec 2023
A psychosocial weight-management programme improved diet and activity but did not significantly lower gestational diabetes, preeclampsia, or caesarean rates. Behavioural gains did not translate into better clinical outcomes.
Expert Commentary
This trial is best read as a positive behavioural study with a negative clinical result, and that distinction should be kept in view. The intervention reliably shifted what was measured most proximally, namely dietary choices and physical activity, with p-values that are convincingly small. What it did not do was move the outcomes that matter to mother and baby: gestational diabetes, preeclampsia, and caesarean delivery were statistically indistinguishable between groups, and the differences in achieving recommended weight gain were modest and reported without a significance test, so they should not be presented as proven. The principal limitation is the gap between surrogate and clinical endpoints; an unblinded, single-centre design with behavioural self-report is also prone to performance and reporting bias, and the trial appears underpowered for the dichotomous obstetric outcomes it assessed. No effect sizes, confidence intervals, or numbers needed to treat were provided, which further limits interpretation. Can I use this with my patients? Not yet as a way to lower gestational diabetes or caesarean risk, because the evidence here does not support that; it is reasonable, however, to frame such a programme to a motivated overweight or obese pregnant patient as a means of supporting healthier eating and activity, with honest expectations about clinical outcomes. Larger, multicentre, adequately powered trials reporting effect sizes and confidence intervals are needed before any outcome claim is made.
References
Banafshe E, Javadifar N, Abbaspoor Z, Ghanbari S, Karandish M. Implementation and Evaluation of a Weight Management Programme for Overweight or Obese Pregnant Women: A Randomised Controlled Trial. Sultan Qaboos Univ Med J. 2025;25(1):580-591. doi:10.18295/2075-0528.2878