A systematic review of 70 randomised controlled trials found that well-structured antenatal interventions—including micronutrient supplementation, food supplementation, behavioural counselling, and physical activity—can effectively help pregnant women in low and middle-income countries achieve optimal gestational weight gain when initiated before 20 weeks of gestation.
- Micronutrient supplementation reduced risk of inadequate weight gain during pregnancy compared to iron-only supplements
- Behavioural counselling and physical activity reduced excessive weight gain among pregnant women with overweight or obesity
- Interventions work best when started before 20 weeks of pregnancy and tailored to local cultural contexts
How this compares to prior research
Gestational weight gain has long been recognized as important for maternal and child health, but inadequate weight gain and excessive weight gain remain overlooked challenges in low and middle-income countries. While previous research established the importance of appropriate weight gain during pregnancy, comprehensive evidence on which specific interventions work best in resource-limited settings was lacking. This review synthesizes evidence from 70 randomised controlled trials to provide clarity on effective approaches.
Prevalence trends in maternal health indicators, global, 1990–1999
Key findings
- Multiple micronutrient supplementation reduced the risk of severely inadequate or inadequate gestational weight gain compared to iron only or iron and folic acid supplementation
- Food supplementation resulted in higher mean gestational weight gain among undernourished pregnant women and greater likelihood of achieving recommended ranges
- Behavioural interventions including counselling and education significantly reduced excessive gestational weight gain among pregnant women with overweight or obesity
What this means in practice
- Ask your prenatal care provider about multiple micronutrient supplements if you are at risk of inadequate weight gain during pregnancy
- Consider behavioural counselling or structured physical activity programs if you have overweight or obesity and are pregnant
- Start interventions early in pregnancy, ideally before 20 weeks, for the best chance of achieving healthy weight gain
Frequently asked questions
What types of interventions help pregnant women gain the right amount of weight?
Micronutrient and food supplementation, behavioural counselling, physical activity, and combined dietary and exercise programs have all shown effectiveness in helping pregnant women achieve optimal weight gain during pregnancy.
When should interventions for gestational weight gain start?
Interventions are most effective when initiated before 20 weeks of gestation and continued beyond this period, tailored to local cultural contexts and available resources.
Do these interventions work in low-resource settings?
Yes, the review found that well-structured antenatal interventions can effectively help pregnant women in low and middle-income countries achieve optimal gestational weight gain when adapted to local contexts.
Key terms explained
Gestational weight gain
The amount of weight a woman gains during pregnancy, which affects both maternal and child health outcomes
Multiple micronutrient supplementation
Supplements containing several vitamins and minerals, beyond just iron and folic acid, given during pregnancy
Antenatal interventions
Medical, nutritional, or behavioural programs provided to pregnant women before childbirth to improve health outcomes
Source: The effects of antenatal interventions on gestational weight gain in low and middle-income countries: a systematic review. · DOI: pii: e019344. doi: 10.1136/bmjgh-2025-019344