OBJECTIVE: Optimizing gestational weight gain (GWG) in early pregnancy is of clinical and public health importance, especially in higher risk pregnancies. DESIGN AND METHODS: In a robustly designed, randomized controlled trial, 228 pregnant women at risk of developing gestational diabetes mellitus (GDM) were allocated to either control (written health information only) or intervention (four-session lifestyle program). All women received standard maternal care. Measures were completed at 12 to 15 and 26 to 28 weeks gestation. Measures included anthropometrics (weight and height), physical activity (pedometer and International Physical Activity Questionnaire), questionnaires (risk perception), and GDM screening. RESULTS: The mean (SD) age (31.7 (4.5) and 32.4 (4.7) years) and body mass index (BMI; 30.3 (5.9) and 30.4 (5.6) kg/m2) were similar between control and intervention groups, respectively. By 28 weeks, GWG was significantly different between control and intervention groups (6.9 (3.3) versus 6.0 (2.8) kg, p < 0.05). When stratified according to baseline BMI, overweight women in the control group gained significantly more weight compared to overweight women in the intervention group (7.8 (3.4) versus 6.0 (2.2) kg, p < 0.05), yet in obese women, GWG was similar in both groups. Physical activity levels declined by 28 weeks gestation overall (p < 0.01); however, the intervention group retained a 20% higher step count compared to controls (5,203 (3,368) versus 4,140 (2,420) steps/day, p < 0.05). Overall, GDM prevalence was 22%, with a trend toward less cases in the intervention group (p = 0.1). CONCLUSIONS: Results indicate that a low-intensity lifestyle intervention, integrated with antenatal care, optimizes healthy GWG and attenuates physical activity decline in early pregnancy. Efficacy in limiting weight gain was greatest in overweight women and in high-risk ethnically diverse women.

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