McCarthy et al.
Supporting slide set prepared
THE BLUE JOURNAL CLUB
PAPER FOR DISCUSSION
McCarthy E, Walker SP, Ugoni A,
Lappas M, Leong O, Shub A. Self-
weighing and simple dietary advice
for overweight and obese pregnant
women to reduce obstetric
complications without impact on
quality of life: a randomised
controlled trial. BJOG 123:965–973.
To view this article visit http://
dx.doi.org/10.1111/1471-0528.13919.
SCENARIO
A nulliparous woman visits her
obstetrician at 13+0 weeks. Her body
mass index (BMI) is 35 kg/m2, but she
has no other medical history. Her
dating ultrasound scan was normal.
Her obstetrician explained the risks of
obesity on her pregnancy.
She asks: ‘what can I do to minimise
these risks?’.
DESCRIPTION OF RESEARCH
Participants
Overweight or obese pregnant
women at <20 weeks with a
singleton pregnancy, without pre-
existing diabetes.
..............................................
Intervention
Simple dietary advice, written
personalised weight gain targets,
encouragement of regular self-
weighing and discussions of weight
gain with the obstetric care
provider.
..............................................
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974
Comparison
Written personalised weight gain
targets only.
..............................................
Outcomes
Composite primary outcome including
any of: gestational diabetes; pregnancy-
induced hypertension and pre-
eclampsia; mode of birth other than
spontaneous vertex; postpartum
haemorrhage; 3rd or 4th degree
perineal tear; admission to adult
intensive care/high-dependence units,
maternal death.
..............................................
Study design
Randomised controlled trial (RCT;
Trial registration number:
ACTRN12611000881932).
DISCUSSION POINTS
 What are the risks of obesity in
pregnancy for mothers and babies?
..............................................
 How would you manage the
woman in the scenario, compared
with women with normal weight?
..............................................
 What are the strengths and
weaknesses of this RCT?
..............................................
 How do the demographics of the
study participants compare with
those of women in your practice
(see Table 1)?
..............................................
 Analysis of covariance (ANCOVA)
was used to analyse the difference
in gestational weight gain. What is
ANCOVA and was its use
appropriate?
..............................................
These discussion points were written
by BJOG’s Journal Club Coordinator,
Elaine Leung. For a list of all journal
club papers and resources, scan the QR
code or visit www.bjog.org "
ª 2016 Royal College of Obstetricians and Gynaecologists
by the author available online.
 Are the outcomes of women who
were overweight different from
those who were obese (see
Figures S2 and S4)?
..............................................
 How did the authors assess the
impact of missing data (18%) in
this study (see Figure S3)?
..............................................
 How does this RCT enhance your
practice, in view of the existing
evidence (see suggested reading)?
SUGGESTED READING
 Critical Appraisal Skill Programme
(CASP). CASP checklist for
Randomised Controlled Trials
(http://www.casp-uk.net/).
..............................................
 Thangaratinam S, Rogozinska
E, Jolly K, Glinkowski S, Roseboom
T, Tomlinson JW, et al. Effects of
interventions in pregnancy on
maternal weight and obstetric
outcomes: meta-analysis of
randomised evidence. BMJ
2012;344:e2088.
..............................................
 Brownfoot FC, Davey MA,
Kornman L. Routine weighing to
reduce excessive antenatal weight
gain: a randomised controlled trial.
BJOG 2016.
..............................................
 Sagedal LR, Øverby NC, Bere E,
Torstveit MK, Lohne-Seiler H,
Sm astuen M, et al. Lifestyle
intervention to limit gestational
weight gain: the Norwegian Fit for
Delivery randomised controlled
trial. BJOG 2016.