The effect of prenatal lifestyle intervention on weight retention 12 months postpartum: results of the Norwegian Fit for Delivery randomised controlled trial.

OBJECTIVE: To examine the effect of a prenatal lifestyle intervention on postpartum weight retention (PPWR). DESIGN: Randomised controlled trial. SETTING: Healthcare clinics in southern Norway. POPULATION: Healthy, nulliparous women with body mass index ≥19 kg/m2 , age ≥18 years, and singleton pregnancy of ≤20 gestational weeks. METHODS: Women were randomised to intervention (dietary counselling twice by phone and access to twice-weekly exercise groups during pregnancy) or control group (standard prenatal care). Intervention compliance was defined post-factum as attending dietary counselling and ≥14 exercise classes. MAIN OUTCOME MEASURES: PPWR (weight measured postpartum minus self-reported pre-pregnancy weight) and the proportion of women returning to pre-pregnancy weight. RESULTS: Of 606 women randomised, 591 were included in an intention-to-treat analysis of pregnancy outcomes and 391 (64.5%) were analysed 12 months postpartum. Mean PPWR was not significantly different between groups (0.66 kg for intervention versus 1.42 kg for control group, mean difference -0.77 kg, 95% CI -1.81, 0.28; P = 0.149). An increased proportion of intervention participants achieved pre-pregnancy weight (53% versus 43%, OR 1.50, 95% CI 1.003, 1.471; P = 0.045). However, the difference was not statistically significant when we adjusted for missing data (adjusted odds ratio (OR) 2.23, P = 0.067) using logistic mixed-effects models analysis. Women compliant with intervention had significantly lower PPWR than control participants, also after adjusting for potential confounders (adjusted mean diff -1.54 kg, 95% CI -3.02, -0.05; P = 0.039). CONCLUSIONS: The Norwegian Fit for Delivery intervention had little effect on PPWR, although women who were compliant with the intervention demonstrated significantly lower PPWR at 12 months. TWEETABLE ABSTRACT: Norwegian Fit for Delivery RCT: little effect of lifestyle intervention on weight retention 1 year postpartum.

The rheumatoid wrist in black South African patients.

The wrist and hand X-rays of 75 black patients with rheumatoid arthritis were scored according to the Larsen criteria. The mean Larsen score for left hands was 9.6 (range 0-100) and for the right hands was 10:3 (range 0-100), whereas the score for the wrists were 2.5 (range 0-5) for the left and 2.7 (range 0-5) for the right. Our conclusion is that rheumatoid wrist involvement in black patients was more or less the same as reported in other series, but finger joint involvement was considerably less. This finding must influence surgical decision-making and also the interpretation of results of drug trials, whenever black patients are involved.