title: The effect of antenatal dietary and lifestyle advice for women who are overweight or obese on emotional well-being: the LIMIT randomized trial.
abstract: Our aim was to evaluate the effect of dietary and lifestyle advice given to women who were overweight or obese during pregnancy on maternal quality of life, anxiety and risk of depression, and satisfaction with care.
  
  
  
  We conducted a randomized trial, involving pregnant women with body mass index ≥25 kg/m(2) , recruited from maternity units in South Australia. Women were randomized to Lifestyle Advice or Standard Care, and completed questionnaires assessing risk of depression (Edinburgh Postnatal Depression Scale), anxiety (Spielberger State-Trait Anxiety Inventory), and quality of life (SF-36) at trial entry, 28 and 36 weeks' gestation, and 4 months postpartum. Secondary trial outcomes assessed for this analysis were risk of depression, anxiety, maternal quality of life, and satisfaction with care.
  
  
  
  One or more questionnaires were completed by 976 of 1108 (90.8%) women receiving Lifestyle Advice and 957 of 1104 (89.7%) women receiving Standard Care. The risk of depression [adjusted risk ratio 1.01; 95% confidence interval (CI) 0.82-1.24; p = 0.95], anxiety (adjusted risk ratio 1.09; 95% CI 0.93-1.27; p = 0.31), and health-related quality of life were similar between the two groups. Women receiving Lifestyle Advice reported improved healthy food choice [Lifestyle Advice 404 (68.9%) vs. Standard Care 323 (51.8%); p < 0.0001], and exercise knowledge [Lifestyle Advice 444 (75.8%) vs. Standard Care 367 (58.8%); p < 0.0001], and reassurance about their health [Lifestyle Advice 499 (85.3%) vs. Standard Care 485 (77.9%); p = 0.0112], and health of their baby [Lifestyle Advice 527 (90.2%) vs. Standard Care 545 (87.6%); p = 0.0143].
  
  
  
  Lifestyle advice in pregnancy improved knowledge and provided reassurance without negatively impacting well-being.
authors.affiliation: Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.|Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, Adelaide, South Australia, Australia.
authors.forename: Jodie M
authors.identifier: http://orcid.org/0000-0002-6363-4874
authors.initials: JM
authors.lastname: Dodd
authors.affiliation: Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Angela
authors.identifier: http://orcid.org/0000-0001-6120-905X
authors.initials: A
authors.lastname: Newman
authors.affiliation: Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Lisa J
authors.identifier: http://orcid.org/0000-0001-5772-6484
authors.initials: LJ
authors.lastname: Moran
authors.affiliation: Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Andrea R
authors.identifier: http://orcid.org/0000-0001-6210-1876
authors.initials: AR
authors.lastname: Deussen
authors.affiliation: Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.|Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, Adelaide, South Australia, Australia.
authors.forename: Rosalie M
authors.identifier: http://orcid.org/0000-0002-2447-6519
authors.initials: RM
authors.lastname: Grivell
authors.affiliation: Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.|Women's and Children's Health Research Institute, North Adelaide, South Australia, Australia.|School of Population Health, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Lisa N
authors.identifier: http://orcid.org/0000-0003-3803-8728
authors.initials: LN
authors.lastname: Yelland
authors.affiliation: Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Caroline A
authors.identifier: http://orcid.org/0000-0002-9079-4451
authors.initials: CA
authors.lastname: Crowther
authors.affiliation: Women's and Babies' Division, Department of Neonatal Medicine, The Women's and Children's Hospital, Adelaide, South Australia, Australia.
authors.forename: Andrew J
authors.identifier: http://orcid.org/0000-0003-3820-5696
authors.initials: AJ
authors.lastname: McPhee
authors.affiliation: School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Gary
authors.identifier: http://orcid.org/0000-0001-6818-6065
authors.initials: G
authors.lastname: Wittert
authors.affiliation: Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Julie A
authors.identifier: http://orcid.org/0000-0002-7498-1353
authors.initials: JA
authors.lastname: Owens
authors.affiliation: School of Psychology, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Deborah
authors.identifier: http://orcid.org/0000-0003-2136-1334
authors.initials: D
authors.lastname: Turnbull
authors.affiliation: Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Jeffrey S
authors.identifier: http://orcid.org/0000-0002-4515-6039
authors.initials: JS
authors.lastname: Robinson
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D015992:Body Mass Index; D003863:Depression / Q000453:epidemiology; D004032:Diet; D037001:Directive Counseling; D004644:Emotions; D005247:Feeding Behavior; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D008019:Life Style; D009043:Motor Activity; D009765:Obesity / Q000523:psychology*; D017060:Patient Satisfaction; D011247:Pregnancy; D011295:Prenatal Care / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Overweight/obesity; depression; dietary and lifestyle intervention; pregnancy; quality of life; randomized trial