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Delivering optimal weight gain advice to pregnant women - the DOT study

Researcher profiles:

Weight gain in pregnancy

A certain amount of weight gain during pregnancy is normal, but a high pre-pregnancy body mass index (BMI) or excessive gestational weight gain is associated with a number of adverse outcomes for both mother and baby. These include gestational diabetes, pre-eclampsia, postpartum weight retention, large for gestational age babies, high birth weight, and childhood obesity.

The Institute of Medicine (IOM) guidelines for weight gain in pregnancy are used in New Zealand. The guidelines recommend total and average rate of gestational weight gain for different pre-pregnancy BMI categories. Recommended gestational weight gain decreases as BMI increases, with the minimum weight gain being 5kg.

Dietary guidance in pregnancy

In New Zealand, pregnant women choose a Lead Maternity Carer (LMC) who co-ordinates their maternity care from the first trimester through until 6 weeks after their baby is born. Most LMCs are midwives. LMCs are contracted by the Ministry of Health to provide a complete maternity service to pregnant women, including dietary advice.

In 2014, the Guidance of Healthy Weight Gain in Pregnancy resource was published by the Ministry of Health, to provide up-to-date advice on weight gain during pregnancy for health practitioners, along with resources for women.

Despite this guidance, many pregnant women do not achieve their recommended gestational weight gain.

Can we increase the proportion of women achieving optimal weight gain in pregnancy?

We have developed and are assessing the feasibility of a midwife-led weight management intervention designed to facilitate, inform and guide dietary advice for pregnant women to achieve optimal weight gain. The intervention includes a suitable ‘user-friendly’ written nutrition resource, which we developed with the input from pregnant women using a citizens’ jury approach.

Does a modified popular Diabetes NZ booklet aimed at preventing excess weight gain in pregnancy meet the needs of pregnant women? (PDF)

We are working with eight LMC midwives in the feasibility study. These LMCs attended a training session, have recruited 27 pregnant women and have delivered the intervention as part of antenatal care. The babies of the participating women will all be delivered by November 2017.

We plan to utilise the information from the feasibility study to plan and conduct a multicentre cluster randomised controlled trial to assess the effectiveness of the intervention.

Trial registration details

Australian New Zealand Clinical Trials Registry (ANZCTR)
Trial ID: ACTRN12616001358437


Coppell KJ, Paterson H, Norton J, Jeffs E, Hay-Smith JC. Using a citizens' jury to determine whether a modified popular Diabetes New Zealand booklet is a good nutrition resource for pregnant women. Public Health Nutrition 2020; 23(11);1916-1923.

Stamm RA, Coppell KJ, Paterson H. Minimization of bias in measures of gestational weight gain. Obesity Reviews 2020;  Accompanying Editorial: Goldstein RF, Harrison CL, Teede HJ. The importance of gestational weight gain. Obesity Reviews 2020;