Linda Reme Sagedal

• Allotey, John; Coomar, Dyuti; Ensor, Joie; Ruiz-Calvo, Gabriel; Boath, Anna & Ogwulu, Chidubem Okeke [Show all 103 contributors for this article] (2026). Effects of lifestyle interventions in pregnancy on gestational diabetes: individual participant data and network meta-analysis. The BMJ. 392. doi: 10.1136/bmj-2025-084159. Full text in Research Archive
• Oommen, Hanna; Sagedal, Linda Reme; Infanti, Jennifer Jean; Byrskog, Ulrika; Severinsen, Marit Stene & Lukasse, Mirjam (2025). Impact of multicultural doula support on pregnant migrant women’s healthcare service utilisation in Norway: a multi-centre case–control study. BMJ Public Health. 3(2). doi: 10.1136/bmjph-2025-002801. Full text in Research Archive Show summary

  Introduction Newly arrived migrant women face barriers to accessing childbirth-related care, delaying necessary treatment and negatively affecting birth outcomes. Multicultural doula (MCD) support may help women overcome these barriers. This study aimed to evaluate the impact of MCD support on the use of hospital healthcare services during pregnancy and postpartum. Methods This case-control study included 339 MCD-supported women and 339 controls (women who did not receive MCD support) from all nine Norwegian hospitals implementing the MCD programme (2018–2023). Cases met MCD programme’s inclusion criteria, whereas controls met similar criteria but did not receive MCD support. Data from hospital records were analysed using binary logistic regression with crude and adjusted associations reported. Adjustments included parity, age, education, employment, maternal region of birth, reason for migration, delivery site in Norway, acute consultations, labour induction, preterm birth, mode of delivery, estimated blood loss ≥1000 mL and admission for newborn to intensive care. Results Women in the MCD case and control groups were similar in age, marital status, parity and interpreter needs (95% vs 96%). Compared with controls, MCD-supported women more often had limited education (63% vs 42%, p<0.01) or were asylum seekers (82% vs 66%, p<0.01). They were more likely to consult for reduced foetal movement (adjusted OR (aOR) 1.86, 95% CI 1.22 to 2.84), other pregnancy-related concerns (aOR 1.46, CI 1.05 to 2.03), telephone before admission (aOR 3.21, 95% CI 2.26 to 4.58), had fewer unplanned out-of-hospital births (OR 0.06, CI 0.01 to 0.43) and reduced ambulance use (aOR 0.32, CI 0.18 to 0.58) and had fewer postpartum stays ≥4 days (aOR 0.58, CI 0.39 to 0.87), with a greater proportion discharged within 2 days after delivery (aOR 1.87, CI 1.26–2.78). Conclusion MCD support was associated with increased antenatal hospital consultations and timely labour admission among migrant women in vulnerable circumstances. This assistance may improve the childbirth experience and positively influence migrant maternal health, birth outcomes and children’s well-being.

• Osestad, Toril Margrethe; Lilleholt, Kristin; Skadberg, Øyvind; Sagedal, Linda Reme; Vistad, Ingvild & Hundhausen, Thomas Eckhard (2024). Glycated albumin in pregnancy correlates negatively with body mass index and contributes to the risk of gestational diabetes mellitus. Practical Laboratory Medicine. 42. doi: 10.1016/j.plabm.2024.e00439. Full text in Research Archive
• Oommen, Hanna; Sagedal, Linda Reme; Byrskog, Ulrika; Infanti, Jennifer Jean; Severinsen, Marit Stene & Lukasse, Mirjam (2024). Multicultural doula support and obstetric and neonatal outcomes: a multi-centre comparative study in Norway. BMC Pregnancy and Childbirth. 24(1), p. 1–11. doi: 10.1186/s12884-024-07073-y. Full text in Research Archive Show summary

  Background Migrant women face an increased risk of poor obstetric and neonatal outcomes. Norway implemented a multicultural doula (MCD) program in 2018, which was designed to improve pregnancy care for this group in vulnerable circumstances. This study aimed to assess the impact of MCD support, provided in addition to standard care, on obstetric and neonatal outcomes for selected newly arrived migrants. Methods This was a multi-centre case–control study involving all nine hospitals actively running the MCD program, which covers four of Norway’s five regions. Women who received MCD support at the time of childbirth (n = 339), from 2018–2023, were compared to similar newly arrived immigrant women who did not receive MCD support (n = 339) and gave birth within the same timeframe. Hospital records were reviewed, and outcomes were analysed using binary logistic regression. The results are expressed as crude and adjusted associations with 95% confidence intervals (CIs). Results Women receiving MCD support exhibited a 41% lower likelihood of undergoing emergency caesarean sections (adjusted odds ratio [aOR] 0.59, 95% Cl 0.34–0.98) and those giving birth vaginally had a 75% lower risk of estimated blood loss ≥1000 ml (aOR 0.25, 95% Cl 0.12–0.52) compared with women without MCD support. Additionally, MCD support was associated with more use of pain-relief (aOR 2.88, 95% Cl 1.93–4.30) in labour and increased rates of exclusive breastfeeding at discharge (aOR 2.26, 95% Cl 1.53–3.36). Conclusions Our study suggests that MCD support may contribute to improved outcomes for migrants in vulnerable circumstances, potentially impacting their future reproductive health and children’s well-being.

• Hillesund, Elisabet Rudjord; Sagedal, Linda Reme & Øverby, Nina Cecilie (2024). Early-life family meal participation and anthropometric measures at 4 years of age. Journal of Developmental Origins of Health and Disease. ISSN 2040-1744. 15, p. 1–9. doi: 10.1017/S2040174424000217. Full text in Research Archive
• Rai, Anam Shakil; Sletner, Line; Jenum, Anne Karen; Øverby, Nina Cecilie; Stafne, Signe Nilssen & Qvigstad, Elisabeth [Show all 8 contributors for this article] (2023). Employing fasting plasma glucose to safely limit the use of oral glucose tolerance tests in pregnancy: a pooled analysis of four Norwegian studies. Frontiers in Endocrinology. 14. doi: 10.3389/fendo.2023.1278523. Full text in Research Archive Show summary

  Background/objective: There is no international consensus about the optimal approach to screening and diagnosis of gestational diabetes mellitus (GDM). Fasting plasma glucose (FPG) has been proposed as an alternative universal screening test to simplify the diagnosis of GDM. We investigate the ability of the FPG to predict a 2-hour glucose value below the cut-off for GDM, thereby “ruling out” the necessity of a full OGTT and assess the proportion of GDM-related complications associated with the identified FPG level. Materials and methods: This study included secondary data from four Norwegian pregnancy cohorts (2002-2013), encompassing 2960 women universally screened with late mid-pregnancy 75g OGTT measuring FPG and 2-hour glucose. For a range of FPG thresholds, we calculated sensitivity to predict elevated 2-hour glucose, number of OGTTs needed and percentage of GDM cases missed, applying modified World Health Organization (WHO) 2013 criteria (2013WHO) and 2017 Norwegian criteria (2017Norwegian). We analyzed pregnancy outcomes for women above and below our selected threshold. Results: The prevalence of GDM was 16.6% (2013WHO) and 10.1% (2017Norwegian). A FPG threshold of 4.7 mmol/L had a sensitivity of 76% (2013WHO) and 80% (2017Norwegian) for detecting elevated 2-hour glucose, with few missed GDM cases (2.0% of those ruled out and 7.5% of all GDM cases for 2013WHO, and 1.1% of those ruled out and 7% of all GDM cases for 2017Norwegian). When excluding women with FPG <4.7mmol/l and those with GDM based on FPG, only 24% (2013WHO) and 29% (2017Norwegian) would require OGTT. Women with FPG <4.7mmol/l, including missed GDM cases, had low risk of large-for-gestational-age newborns, cesarean section and operative vaginal delivery. Conclusion: A FPG threshold of 4.7mmol/l as a first step when screening for GDM could potentially eliminate the need for OGTT in 70-77% of pregnancies. Women with FPG below this threshold appear to carry low risk of GDM-associated adverse pregnancy outcomes.

• Stalheim, Astrid Melteig; Iversen, Marjolein M.; Jenum, Anne Karen; Sletner, Line; Stafne, Signe Nilssen & Qvigstad, Elisabeth [Show all 10 contributors for this article] (2023). Seasonal variation in gestational diabetes mellitus among women in Norway: a national population-based study. BMJ Open. 13(3), p. 1–8. doi: 10.1136/bmjopen-2022-063725. Full text in Research Archive Show summary

  Objectives Previous research on seasonal variation in the incidence of gestational diabetes mellitus (GDM) has shown inconclusive results. Furthermore, little is known about whether a seasonal variation in GDM might be associated with the maternal country of birth. We examined whether there was seasonal variation in GDM incidence by the maternal country background. Design National population-based registry study. Setting and participants We used national population-based data from the Medical Birth Registry of Norway (MBRN), n=1 443 857 (1990–2016) and data from four merged community-based studies (4GDM) with universal screening for GDM, n=2 978 (2002–2013). Outcome measures The association between season of pregnancy onset with incidence of GDM was examined separately in both datasets using logistic regression analyses, stratified by the mother’s country background using two broad geographical categories (MBRN: Norwegian and immigrant; 4GDM: European and African/Asian ethnicity). Winter season was used as reference category. Results The incidence of GDM in MBRN was highest when the pregnancy started during the winter (Norwegian-born: 1.21%; immigrants: 3.32%) and lowest when pregnancy started during the summer for both Norwegian and immigrant women (Norwegian-born: 1.03% (OR 0.85, 95% CI 0.81 to 0.98); immigrants: 2.99% (OR 0.90, 95% CI 0.84 to 0.96)). The 4GDM data showed that women with European ancestry had the highest incidence of GDM when pregnancy started during autumn (10.7%, OR 1.01, 95% CI 0.69 to 1.46) and winter (10.6%), while ethnic African and Asian women had the highest incidence when pregnancy onset was during the summer (15.3%, OR 1.17, 95% CI 0.54 to 2.53). Conclusions Based on national population-based data, this study suggests that GDM incidence varies by season in both Norwegian-born and immigrant women. The 4GDM dataset did not show a clear seasonal variation in GDM incidence, possibly due to the relatively small sample. Causes for the seasonal variation in GDM should be explored further.

• Rai, Anam Shakil; Sletner, Line; Jenum, Anne Karen; Øverby, Nina Cecilie; Stafne, Signe Nilssen & Qvigstad, Elisabeth [Show all 8 contributors for this article] (2023). Adverse pregnancy outcomes among women in Norway with gestational diabetes using three diagnostic criteria. PLOS ONE. 18(7). doi: 10.1371/journal.pone.0280750. Full text in Research Archive Show summary

  Introduction The aim of this study was to examine the risk of adverse perinatal outcomes in women diagnosed with GDM by the World Health Organization (WHO) 1999 criteria, and in those retrospectively identified by the Norwegian-2017 and WHO-2013 criteria but not by WHO-1999 criteria. We also examine the effect of maternal overweight/obesity and ethnicity. Material and methods We used pooled data from four Norwegian cohorts (2002–2013), encompassing 2970 mother-child pairs. Results from universally offered 75-g oral glucose tolerance tests measuring fasting plasma glucose (FPG) and 2-hour glucose (2HG) were used to assign women into three diagnostic groups: Diagnosed and treated by WHO-1999 (FPG≥7.0 or (2HG ≥7.8 mmol/L), identified by WHO-2013 (FPG ≥5.1 or 2HG ≥8.5 mmol/L), and identified by Norwegian-2017 criteria (FPG ≥5.3 or 2HG ≥9.0 mmol/L). Perinatal outcomes included large-for-gestational-age (LGA) infants, cesarean section, operative vaginal delivery, preterm birth and preeclampsia. Results Compared to the non-GDM group, women diagnosed with GDM by either of the three criteria had an increased risk of large-for-gestational-age infants (adjusted odds ratios (OR) 1.7–2.2). Those identified by the WHO-2013 and Norwegian-2017 criteria but not diagnosed and treated by WHO-1999 criteria had an additional increased risk of cesarean section (OR 1.36, 95% CI 1.02,1.83 and 1.44, 95% CI 1.03,2.02, respectively) and operative vaginal delivery (OR 1.35, 95% CI 1.1,1.7 and 1.5, 95% CI 1.1,2.0, respectively). The proportions of LGA neonates and cesarean section were higher for women with GDM in both normal-weight and overweight/obese women. Asians had a lower risk of delivering large-for-gestational-age infants than Europeans applying national birthweight references, but maternal glucose values were similarly positively associated with birthweight in all ethnic groups. Conclusions Women who met the WHO-2013 and Norwegian-2017 criteria, but were not diagnosed by the WHO-1999 criteria and therefore not treated, had an increased risk of LGA, cesarean section and operative vaginal delivery compared to women without GDM.

• Hillesund, Elisabet Rudjord; Sagedal, Linda R.; Bere, Elling & Øverby, Nina Cecilie (2021). Family meal participation is associated with dietary intake among 12-month-olds in Southern Norway. BMC Pediatrics. 21. doi: 10.1186/s12887-021-02591-6. Full text in Research Archive
• Rai, Anam Shakil; Sletner, Line; Jenum, Anne Karen; Øverby, Nina Cecilie; Stafne, Signe Nilssen & Lekva, Tove [Show all 8 contributors for this article] (2021). Identifying women with gestational diabetes based on maternal characteristics: an analysis of four Norwegian prospective studies. BMC Pregnancy and Childbirth. 21. doi: 10.1186/s12884-021-04086-9. Full text in Research Archive Show summary

  Background There is still no worldwide agreement on the best diagnostic thresholds to define gestational diabetes (GDM) or the optimal approach for identifying women with GDM. Should all pregnant women perform an oral glucose tolerance test (OGTT) or can easily available maternal characteristics, such as age, BMI and ethnicity, indicate which women to test? The aim of this study was to assess the prevalence of GDM by three diagnostic criteria and the predictive accuracy of commonly used risk factors. Methods We merged data from four Norwegian cohorts (2002–2013), encompassing 2981 women with complete results from a universally offered OGTT. Prevalences were estimated based on the following diagnostic criteria: 1999WHO (fasting plasma glucose (FPG) ≥7.0 or 2-h glucose ≥7.8 mmol/L), 2013WHO (FPG ≥5.1 or 2-h glucose ≥8.5 mmol/L), and 2017Norwegian (FPG ≥5.3 or 2-h glucose ≥9 mmol/L). Multiple logistic regression models examined associations between GDM and maternal factors. We applied the 2013WHO and 2017Norwegian criteria to evaluate the performance of different thresholds of age and BMI. Results The prevalence of GDM was 10.7, 16.9 and 10.3%, applying the 1999WHO, 2013WHO, and the 2017Norwegian criteria, respectively, but was higher for women with non-European background when compared to European women (14.5 vs 10.2%, 37.7 vs 13.8% and 27.0 vs 7.8%). While advancing age and elevated BMI increased the risk of GDM, no risk factors, isolated or in combination, could identify more than 80% of women with GDM by the latter two diagnostic criteria, unless at least 70–80% of women were offered an OGTT. Using the 2017Norwegian criteria, the combination “age≥25 years or BMI≥25 kg/m2” achieved the highest sensitivity (96.5%) with an OGTT required for 93% of European women. The predictive accuracy of risk factors for identifying GDM was even lower for non-European women. Conclusions The prevalence of GDM was similar using the 1999WHO and 2017Norwegian criteria, but substantially higher with the 2013WHO criteria, in particular for ethnic non-European women. Using clinical risk factors such as age and BMI is a poor pre-diagnostic screening method, as this approach failed to identify a substantial proportion of women with GDM unless at least 70–80% were tested.

• Munk, Ane Cecilie Dæhli; Sagedal, Linda Reme; Krogedal, Turid Stavseth; McFadzean, Ida & Oommen, Hanna (2020). Fødende risikopasient med covid-19. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 140(11), p. 1–4. doi: 10.4045/tidsskr.20.0425. Full text in Research Archive
• O'Brien, Eileen C.; Segurado, Ricardo; Geraghty, Aisling A.; Alberdi, Goiuri; Rogozinska, Ewelina & Astrup, Arne [Show all 50 contributors for this article] (2019). Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: individual participant data meta-analysis. BMJ Open. 9:e025620(8), p. 1–12. doi: 10.1136/bmjopen-2018-025620. Full text in Research Archive Show summary

  Objectives: To identify if maternal educational attainment is a prognostic factor for gestational weight gain (GWG), and to determine the differential effects of lifestyle interventions (diet based, physical activity based or mixed approach) on GWG, stratified by educational attainment. Design: Individual participant data meta-analysis using the previously established International Weight Management in Pregnancy (i-WIP) Collaborative Group database (https://iwipgroup.wixsite.com/collaboration). Preferred Reporting Items for Systematic reviews and Meta-Analysis of Individual Participant Data Statement guidelines were followed. Data sources: Major electronic databases, from inception to February 2017. Eligibility criteria: Randomised controlled trials on diet and physical activity-based interventions in pregnancy. Maternal educational attainment was required for inclusion and was categorised as higher education (≥tertiary) or lower education (≤secondary). Risk of bias: Cochrane risk of bias tool was used. Data synthesis: Principle measures of effect were OR and regression coefficient. Results: Of the 36 randomised controlled trials in the i-WIP database, 21 trials and 5183 pregnant women were included. Women with lower educational attainment had an increased risk of excessive (OR 1.182; 95% CI 1.008 to 1.385, p =0.039) and inadequate weight gain (OR 1.284; 95% CI 1.045 to 1.577, p =0.017). Among women with lower education, diet basedinterventions reduced risk of excessive weight gain (OR 0.515; 95% CI 0.339 to 0.785, p = 0.002) and inadequate weight gain (OR 0.504; 95% CI 0.288 to 0.884, p=0.017), and reduced kg/week gain (B −0.055; 95% CI −0.098 to −0.012, p=0.012). Mixed interventions reduced risk of excessive weight gain for women with lower education (OR 0.735; 95% CI 0.561 to 0.963, p=0.026). Among women with high education, diet based interventions reduced risk of excessive weight gain (OR 0.609; 95% CI 0.437 to 0.849, p=0.003), and mixed interventions reduced kg/week gain (B −0.053; 95% CI −0.069 to −0.037,p<0.001). Physical activity based interventions did not impact GWG when stratified by education. Conclusions: Pregnant women with lower education are at an increased risk of excessive and inadequate GWG. Diet based interventions seem the most appropriate choice for these women, and additional support through mixed interventions may also be beneficial.

• Hillesund, Elisabet Rudjord; Seland, Siv; Bere, Elling; Sagedal, Linda Reme; Torstveit, Monica Klungland & Lohne-Seiler, Hilde [Show all 8 contributors for this article] (2018). Preeclampsia and gestational weight gain in the Norwegian Fit for Delivery trial. BMC Research Notes. 11(282). doi: 10.1186/s13104-018-3396-4. Full text in Research Archive
• Haakstad, Lene Annette Hagen; Vistad, Ingvild; Sagedal, Linda Reme; Lohne-Seiler, Hilde & Torstveit, Monica Klungland (2018). How does a lifestyle intervention during pregnancy influence perceived barriers to leisure-time physical activity? The Norwegian fit for delivery study, a randomized controlled trial. BMC Pregnancy and Childbirth. 18(127). doi: 10.1186/s12884-018-1771-8. Full text in Research Archive Show summary

  Background: To develop effective health promotional and preventive prenatal programs, it is important to understand perceived barriers to leisure-time physical activity during pregnancy, including exercise and sport participation. The aims of the present study was 1) to assess the effect of prenatal lifestyle intervention on the perceived barrier to leisure-time physical activity during pregnancy and the first year after delivery and 2) identify the most important perceived barriers to leisure-time physical activity at multiple time points during and after pregnancy. Methods: This secondary analysis was part of the Norwegian Fit for Delivery study, a combined lifestyle intervention evaluated in a blinded, randomized controlled trial. Healthy, nulliparous women with singleton pregnancy of ≤20 gestational weeks, age ≥ 18 years and body mass index ≥19 kg/m2 were recruited via healthcare clinics in southern Norway, including urban and rural settings. Participants were randomized to either twice-weekly supervised exercise sessions and nutritional counselling (n = 303) or standard prenatal care (n = 303). The principal analysis was based on the participants who completed the standardized questionnaire assessing their perceived barriers to leisure-time physical activity at inclusion (gestational week 16, n = 589) and following intervention (gestational week 36, n = 509), as well as six months (n = 470) and 12 months (n = 424) postpartum. Results: Following intervention (gestation week 35.4 ± 1.0), a significant between-group difference in perceived barriers to leisure-time physical activity was found with respect to time constraints: “... I do not have the time” (intervention: 22 vs. control: 38, p = 0.030), mother-child safety concerns: “... afraid to harm the baby” (intervention: 8 vs. control: 25, p = 0.002) and self-efficacy: “... I do not believe/think that I can do it” (intervention: 3 vs. control: 10, p = 0.050). No positive effect was seen at postpartum follow-up. Intrapersonal factors (lack of time, energy and interest) were the most frequently perceived barriers, and consistent over time among all participants. Conclusion: The intervention had effect on intrapersonal perceived barriers in pregnancy, but not in the postpartum period. Perceived barriers to leisure-time physical activity were similar from early pregnancy to 12 months postpartum.

• Sanda, Birgitte; Vistad, Ingvild; Sagedal, Linda Reme; Haakstad, Lene Annette Hagen; Lohne-Seiler, Hilde & Torstveit, Monica Klungland (2018). What is the effect of physical activity on duration and mode of delivery? Secondary analysis from the Norwegian Fit for Delivery trial. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 97(7), p. 861–871. doi: 10.1111/aogs.13351. Full text in Research Archive Show summary

  Introduction: The beneficial effects of physical activity during pregnancy for the mother and offspring have been reported by several studies but there are conflicting results concerning the possible effect of physical activity on the course of labor and risk of cesarean delivery. This study presents secondary analyses from the Norwegian Fit for Delivery randomized controlled trial, aiming at studying the effect of a lifestyle intervention including group exercise classes, as well as the possible influence of physical activity level in late pregnancy, on labor outcomes. Material and methods: Healthy nulliparous women with singleton pregnancy were randomized to an intervention group, n = 303 (dietary counseling and twice‐weekly exercise classes) or a control group, n = 303 (standard care). The participants were analyzed both by randomization and as a cohort comparing women with lowest (quartile 1, 0 metabolic equivalent of task‐hours moderate‐to‐vigorous physical activity/week) (n = 140) vs. highest (quartile 4, ≥16 metabolic equivalent of task‐hours moderate‐to‐vigorous physical activity/week) (n = 131) physical activity level in late pregnancy, assessed with the International Physical Activity Questionnaire. Result: The intervention group had a longer first stage of labor compared with the control group (293 ± 202 min vs. 257 ± 181 min, p = 0.030). No differences between the randomization groups were seen for time spent in second stage of labor, prolonged labor or mode of delivery. In the total sample, women with the highest physical activity level had lower odds ratio (OR) of acute cesarean delivery (OR 0.33, 95% CI 0.11–0.97, p = 0.044) than did those with the lowest physical activity‐level. Conclusion: A significantly longer first stage of labor was observed in the intervention group than in the control group. A high physical activity level in late pregnancy was associated with lower odds of acute cesarean delivery compared with a low physical activity level.

• Hillesund, Elisabet Rudjord; Bere, Elling Tufte; Sagedal, Linda Reme; Vistad, Ingvild; Lohne-Seiler, Hilde & Torstveit, Monica Klungland [Show all 7 contributors for this article] (2018). Pre-pregnancy and early pregnancy dietary behavior in relation to maternal and newborn health in the Norwegian Fit for Delivery study - a post hoc observational analysis. Food & Nutrition Research (FNR). ISSN 1654-6628. 62. doi: 10.29219/fnr.v62.1273. Full text in Research Archive
• Sanda, Birgitte; Vistad, Ingvild; Haakstad, Lene Annette Hagen; Berntsen, Sveinung; Sagedal, Linda Reme & Lohne-Seiler, Hilde [Show all 7 contributors for this article] (2017). Reliability and concurrent validity of the International Physical Activity Questionnaire short form among pregnant women. BMC sports science, medicine and rehabilitation. 9:7(7), p. 1–10. doi: 10.1186/s13102-017-0070-4. Full text in Research Archive Show summary

  Background: The International Physical Activity Questionnaire short-form (IPAQ-SF) is frequently used to assess physical activity (PA) level in the general adult population including pregnant women. However, the reliability and validity of the questionnaire in pregnancy is unknown. Therefore, the aims of the present study were to investigate test-retest reliability and concurrent validity of IPAQ-SF among pregnant women, and whether PA is reported differently among those who fulfill (active) vs. do not fulfill (inactive) recommendations of ≥150 min of weekly moderate intensity PA in pregnancy. Method: Test-retest reliability was examined by answering IPAQ-SF twice, two weeks apart (n = 88). To assess validity, IPAQ-SF was compared to the physical activity monitor SenseWear Armband® (SWA) (n = 64). The participants wore SWA for 8 consecutive days before answering IPAQ-SF. PA level was reported as time spent in moderate-, vigorous- and moderate-to-vigorous intensity PA (MPA, VPA and MVPA) corresponding to the cut-off points 3–6, >6 and >3 Metabolic Equivalents (METs), respectively. Results: Test-retest intraclass-correlation of MPA, VPA and MVPA ranged from 0.81-0.84 (95% Confidence Intervals: 0.69,0.90). Comparing time spent performing PA at various intensities; the mean differences and limits of agreement (±1.96 Standard Deviation) from Bland-Altman plots were−84 ± 402 min/week for MPA,−85 ± 452 min/week for MVPA and 26 ± 78 min/week for VPA, illustrating that the total group under-reported MPA by 72% and MVPA by 52%, while VPA was over-reported by 1400%. For the inactive group corresponding numbers were 44 ± 327 min/week for MPA, 52 ± 355 min/week for MVPA and 16 ± 33 min/week for VPA, illustrating that the inactive group over-reported MPA by 13% and MVPA by 49%, while VPA was not detected by SWA, but participants reported 16 min of VPA/week. In contrast, corresponding numbers for the active group were−197 ± 326 min/week for MPA,−205 ± 396 min/week for MVPA and 35 ± 85 min/week for VPA, illustrating that the active group under-reported MPA by 81% and MVPA by 60%, while they over-reported VPA by 975%. Conclusion: IPAQ-SF had good test-retest reliability, but low to fair concurrent validity for MPA, VPA and MVPA compared to an objective criterion measure among pregnant women. Further, women fulfilling PA guidelines in pregnancy under-reported, while inactive women over-reported PA level.

• Sagedal, Linda Reme; Sanda, Birgitte; Øverby, Nina Cecilie; Bere, Elling; Torstveit, Monica Klungland & Seiler, Hilde Lohne [Show all 10 contributors for this article] (2017). The effect of prenatal lifestyle intervention on weight retention 12 months postpartum: results of the Norwegian Fit for Delivery randomised controlled trial. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 124(1), p. 111–121. doi: 10.1111/1471-0528.13863. Full text in Research Archive
• Sagedal, Linda Reme; Øverby, Nina Cecilie; Bere, Elling; Torstveit, Monica Klungland; Seiler, Hilde Lohne & Småstuen, Milada Cvancarova [Show all 9 contributors for this article] (2017). Lifestyle intervention to limit gestational weight gain: the Norwegian Fit for Delivery randomised controlled trial. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 124(1), p. 97–109. doi: 10.1111/1471-0528.13862. Full text in Research Archive
• Sanda, Birgitte; Vistad, Ingvild; Sagedal, Linda Reme; Haakstad, Lene Annette Hagen; Lohne-Seiler, Hilde & Torstveit, Monica Klungland (2017). Effect of a prenatal lifestyle intervention on physical activity level in late pregnancy and the first year postpartum. PLOS ONE. 12(11). doi: 10.1371/journal.pone.0188102. Full text in Research Archive Show summary

  Background: Despite documented health benefits for mother and baby, physical activity (PA)-level tends to decline in pregnancy. Overweight/obese and physically inactive women are two selected groups at increased risk of pregnancy complications. Thus, efficient strategies to maintain or increase PA-level in pregnancy and the postpartum period, especially among these women, are warranted. This secondary analysis examined the effect of a prenatal lifestyle-intervention on PA-level in late pregnancy and the first year postpartum, with subanalysis on initially physically active versus inactive and normal-weight versus overweight/obese women. Method: The Norwegian Fit for Delivery (NFFD) randomized controlled trial included healthy primiparous women with singleton pregnancies and body mass index (BMI) ≥19 kg/m2 assigned to an intervention group, n = 303 (twice weekly group-exercises and dietary counseling) or a control group, n = 303 (standard prenatal care). The International Physical Activity Questionnaire short-form was used to assess PA-levels at inclusion (mean gestational week (GW) 16), GW 36, and six and 12 months postpartum. Results: At GW 36, a positive intervention-effect with a significant between-group difference in total PA-level compared to time of inclusion was found for the total group (530 MET-min/week, p = 0.001) and the subgroups of normal-weight (533 MET-min/week, p = 0.003) and initially active women (717 MET-min/week, p<0.001). Intervention-effect was dependent on exercise-adherence among overweight/obese and inactive women. Compared to time of inclusion, the intervention groups maintained total PA-level at GW 36, while total PA-level decreased in the control groups. The PA-levels increased postpartum, but with no significant differences between the randomization groups. Conclusion: The NFFD prenatal combined lifestyle intervention had a significant effect on TPA-level in late pregnancy among women entering pregnancy normal-weight or physically active, thereby preventing the downward trend typically seen during pregnancy. Intervention-effect among overweight/obese and physically inactive women was, however, dependent on exercise-adherence. Long-term intervention-effect was not observed in the postpartum period.

• Haakstad, Lene Annette Hagen; Sanda, Birgitte; Vistad, Ingvild; Sagedal, Linda Reme; Lohne-Seiler, Hilde & Torstveit, Monica Klungland (2017). Evaluation of implementing a community-based exercise intervention during pregnancy. Midwifery. ISSN 0266-6138. 46, p. 45–51. doi: 10.1016/j.midw.2017.01.010. Full text in Research Archive Show summary

  Objective: To evaluate the implementation of a community-based exercise intervention (the Norwegian Fit for Delivery study) during pregnancy. Design: Descriptive, explorative. Setting: Healthcare clinics in southern Norway, including urban and rural settings. Participants: Healthy, nulliparous women with singleton pregnancy of ≤20 gestational weeks, age ≥18 years and body mass index ≥19 kg/m2. Methods: Women were randomized to either twice-weekly supervised exercise sessions combined with nutritional counselling (n=303) or standard prenatal care (n=303). The exercise program was based on ACOG guidelines, with the same low-impact workout for all participants, including 60 minutes of moderate-intensity cardiovascular and strength training, performed in a group of maximum 25 women. The aim of the present secondary analysis was to report on the intervention group's experience with participating in an exercise program in the 2nd and 3rd trimester, including satisfaction, adherence, adverse effects, as well as motives and barriers for attending the classes. Results: Of 303 women randomized to exercise, 274 (92.6%) attended at least one class and 187 (68.2%) completed a questionnaire after completion of the trial assessing their experience with the group sessions. For 71.7%, self-reported exercise dosage was ≥75% of the twice-weekly exercise program and more than seven out of 10 reported to be satisfied or very satisfied with the exercise sessions. A total of 95.1% answered that they would recommend this type of exercise for pregnant friends. Reported motives and health benefits included better aerobic capacity, increased energy levels and exercise enjoyment. No harmful effects of the exercise intervention were noted in the mother or the fetus. Key conclusions and implications for practice: Results demonstrated that regular group exercise was feasible, safe, and well tolerated in pregnancy, which may encourage incorporating this program into a routine health care setting.

• Rogozińska, Ewelina; Marlin, Nadine; Jackson, Louise; Rayanagoudar, Girish; Ruifrok, Anneloes E. & Dodds, Julie [Show all 57 contributors for this article] (2017). Effects of antenatal diet and physical activity on maternal and fetal outcomes: Individual patient data meta-analysis and health economic evaluation. Health Technology Assessment. ISSN 1366-5278. 21:41, p. 1–194. doi: 10.3310/hta21410. Full text in Research Archive Show summary

  Abstract Background Diet- and physical activity-based interventions in pregnancy have the potential to alter maternal and child outcomes. Objectives To assess whether or not the effects of diet and lifestyle interventions vary in subgroups of women, based on maternal body mass index (BMI), age, parity, Caucasian ethnicity and underlying medical condition(s), by undertaking an individual patient data (IPD) meta-analysis. We also evaluated the association of gestational weight gain (GWG) with adverse pregnancy outcomes and assessed the cost-effectiveness of the interventions. Data sources MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Health Technology Assessment database were searched from October 2013 to March 2015 (to update a previous search). Review methods Researchers from the International Weight Management in Pregnancy Collaborative Network shared the primary data. For each intervention type and outcome, we performed a two-step IPD random-effects meta-analysis, for all women (except underweight) combined and for each subgroup of interest, to obtain summary estimates of effects and 95% confidence intervals (CIs), and synthesised the differences in effects between subgroups. In the first stage, we fitted a linear regression adjusted for baseline (for continuous outcomes) or a logistic regression model (for binary outcomes) in each study separately; estimates were combined across studies using random-effects meta-analysis models. We quantified the relationship between weight gain and complications, and undertook a decision-analytic model-based economic evaluation to assess the cost-effectiveness of the interventions. Results Diet and lifestyle interventions reduced GWG by an average of 0.70 kg (95% CI –0.92 to –0.48 kg; 33 studies, 9320 women). The effects on composite maternal outcome [summary odds ratio (OR) 0.90, 95% CI 0.79 to 1.03; 24 studies, 8852 women] and composite fetal/neonatal outcome (summary OR 0.94, 95% CI 0.83 to 1.08; 18 studies, 7981 women) were not significant. The effect did not vary with baseline BMI, age, ethnicity, parity or underlying medical conditions for GWG, and composite maternal and fetal outcomes. Lifestyle interventions reduce Caesarean sections (OR 0.91, 95% CI 0.83 to 0.99), but not other individual maternal outcomes such as gestational diabetes mellitus (OR 0.89, 95% CI 0.72 to 1.10), pre-eclampsia or pregnancy-induced hypertension (OR 0.95, 95% CI 0.78 to 1.16) and preterm birth (OR 0.94, 95% CI 0.78 to 1.13). There was no significant effect on fetal outcomes. The interventions were not cost-effective. GWG, including adherence to the Institute of Medicine-recommended targets, was not associated with a reduction in complications. Predictors of GWG were maternal age (summary estimate –0.10 kg, 95% CI –0.14 to –0.06 kg) and multiparity (summary estimate –0.73 kg, 95% CI –1.24 to –0.23 kg). Limitations The findings were limited by the lack of standardisation in the components of intervention, residual heterogeneity in effects across studies for most analyses and the unavailability of IPD in some studies. Conclusion Diet and lifestyle interventions in pregnancy are clinically effective in reducing GWG irrespective of risk factors, with no effects on composite maternal and fetal outcomes. Future work The differential effects of lifestyle interventions on individual pregnancy outcomes need evaluation. Study registration This study is registered as PROSPERO CRD42013003804. Funding The National Institute for Health Research Health Technology Assessment programme.

• Skreden, Marianne; Bere, Elling; Sagedal, Linda Reme; Vistad, Ingvild & Øverby, Nina Cecilie (2017). Changes in fruit and vegetable consumption habits from pre-pregnancy to early pregnancy among Norwegian women. BMC Pregnancy and Childbirth. 17(1). doi: 10.1186/s12884-017-1291-y. Full text in Research Archive Show summary

  Background: A healthy diet is important for pregnancy outcome and the current and future health of woman and child. The aims of the study were to explore the changes from pre-pregnancy to early pregnancy in consumption of fruits and vegetables (FV), and to describe associations with maternal educational level, body mass index (BMI) and age. Methods: Healthy nulliparous women were included in the Norwegian Fit for Delivery (NFFD) trial from September 2009 to February 2013, recruited from eight antenatal clinics in southern Norway. At inclusion, in median gestational week 15 (range 9–20), 575 participants answered a food frequency questionnaire (FFQ) where they reported consumption of FV, both current intake and recollection of pre-pregnancy intake. Data were analysed using a linear mixed model. Results: The percentage of women consuming FV daily or more frequently in the following categories increased from pre-pregnancy to early pregnancy: vegetables on sandwiches (13 vs. 17%, p <0.01), other vegetables (11 vs. 14%, p = 0.01), fruits (apples, pears, oranges or bananas) (24 vs. 41%, p < 0.01), other fruits and berries (8 vs. 15%, p < 0.01) and fruits and vegetables as snacks (14 vs. 28%, p < 0.01). The percentage of women who reported at least daily consumption of vegetables with dinner (22% at both time points) was stable. A higher proportion of older women increased their consumption of vegetables and fruits as snacks from pre-pregnancy to early pregnancy compared to younger women (p=0.04). Conclusions: We found an increase in the proportion of women consuming FV daily or more frequently from pre-pregnancy to early pregnancy. Trial registration: ClinicalTrials.gov database, NCT01001689. https://clinicaltrials.gov/ct2/show/ NCT01001689?term=NCT01001689&rank=1. Keywords: Fruits, Preconception, Pregnancy, Vegetables

• Sagedal, Linda Reme; Vistad, Ingvild; Øverby, Nina Cecilie; Bere, Elling; Torstveit, Monica Klungland & Lohne-Seiler, Hilde [Show all 9 contributors for this article] (2017). The effect of a prenatal lifestyle intervention on glucose metabolism: Results of the Norwegian Fit for Delivery randomized controlled trial. BMC Pregnancy and Childbirth. 17:167, p. 1–12. doi: 10.1186/s12884-017-1340-6. Full text in Research Archive Show summary

  Background: The effectiveness of prenatal lifestyle intervention to prevent gestational diabetes and improve maternal glucose metabolism remains to be established. The Norwegian Fit for Delivery (NFFD) randomized, controlled trial studied the effect of a combined lifestyle intervention provided to a general population, and found significantly lower gestational weight gain among intervention participants but no improvement in obstetrical outcomes or the proportion of large infants. The aim of the present study is to examine the effect of the NFFD intervention on glucose metabolism, including an assessment of the subgroups of normal-weight and overweight/obese participants. Methods: Healthy, non-diabetic women expecting their first child, with pre-pregnancy body mass index (BMI) ≥19 kg/m2, age ≥ 18 years and a singleton pregnancy of ≤20 gestational-weeks were enrolled from healthcare clinics in southern Norway. Gestational weight gain was the primary endpoint. Participants (n = 606) were individually randomized to intervention (two dietary consultations and access to twice-weekly exercise groups) or control group (routine prenatal care). The effect of intervention on glucose metabolism was a secondary endpoint, measuring glucose (fasting and 2-h following 75-g glucose load), insulin, homeostatic assessment of insulin resistance (HOMA-IR) and leptin levels at gestational-week 30. Results: Blood samples from 557 (91.9%) women were analyzed. For the total group, intervention resulted in reduced insulin (adj. Mean diff −0.91 mU/l, p = 0.045) and leptin levels (adj. Mean diff -207 pmol/l, p = 0.021) compared to routine care, while glucose levels were unchanged. However, the effect of intervention on both fasting and 2-h glucose was modified by pre-pregnancy BMI (interaction p = 0.030 and p = 0.039, respectively). For overweight/obese women (n = 158), intervention was associated with increased risk of at least one glucose measurement exceeding International Association of Pregnancy and Diabetes Study Group thresholds (33.7% vs. 13.9%, adj. OR 3.89, p = 0.004). Conclusions: The Norwegian Fit for Delivery intervention lowered neither glucose levels nor GDM incidence, despite reductions in insulin and leptin. Prenatal combined lifestyle interventions designed for a general population may be unsuited to reduce GDM risk, particularly among overweight/obese women, who may require earlier and more targeted interventions. Trial registration: ClinicalTrials.gov ID NCT01001689, registered July 2, 2009, confirmed completed October 26, 2009 (retrospectively registered). Keywords: Gestational diabetes, Intervention, Lifestyle, Overweight, Obesity

• Skreden, Marianne; Øverby, Nina Cecilie; Sagedal, Linda Reme; Vistad, Ingvild; Torstveit, Monica Klungland & Seiler, Hilde Lohne [Show all 7 contributors for this article] (2016). Change in active transportation and weight gain in pregnancy. International Journal of Behavioral Nutrition and Physical Activity. 13(10). doi: 10.1186/s12966-016-0332-7. Full text in Research Archive Show summary

  Background: Pregnancy is characterised by large weight gain over a short period, and often a notable change in mode of transportation. This makes pregnancy suitable for examining the plausible, but in the scientific literature still unclear, association between active transportation and weight gain. We hypothesize that women continuing an active mode of transportation to work or school from pre- to early pregnancy will have a lower gestational weight gain (GWG) than those who change to a less active mode of transportation. Methods: We analysed prospective data from the Norwegian Fit for Delivery (NFFD) trial. Between September 2009 and February 2013 606 women were consecutively enrolled in median gestational week 16 (range; 8–20). Of 219 women who used an active mode of transportation (biking, walking, public transportation) pre-pregnancy, 66 (30 %) converted to a less active mode in early pregnancy (“active-less active” group), and 153 (70 %) continued with active transportation (“active-active” group). Pre-pregnancy weight was self-reported. Weight at gestational (GA) weeks 16, 30, 36, and at term delivery was objectively measured. Weight gain was compared between the two groups. Linear mixed effects analysis of the repeated weight measures was performed including the group*time interaction. Results: A significant overall group effect was observed for the four time points together (“active-active” group: 77.3 kg vs. “active-less active” group: 78.8 kg, p = 0.008). The interaction term group*time was significant indicating different weight gain throughout pregnancy for the two groups; the mean differences between the groups were 0.7 kg at week 16, 1.4 kg at week 30, 2.1 kg at week 36, and 2.2 kg at term delivery, respectively. Conclusion: The findings indicate that active transportation is one possible approach to prevent excessive weight gain in pregnancy. Keywords: Active transportation, Biking, BMI, Pregnancy, Public transportation, Walking, Weight gain

• Flynn, Angela C.; Dalrymple, Kathryn; Barr, Suzanne; Poston, Lucilla; Goff, Louise M. & Rogozińska, Ewelina [Show all 35 contributors for this article] (2016). Dietary interventions in overweight and obese pregnant women: A systematic review of the content, delivery, and outcomes of randomized controlled trials. Nutrition reviews. ISSN 0029-6643. 74(5), p. 312–328. doi: 10.1093/nutrit/nuw005. Full text in Research Archive
• Hillesund, Elisabet Rudjord; Bere, Elling; Sagedal, Linda Reme; Vistad, Ingvild & Øverby, Nina Cecilie (2016). Effect of a diet intervention during pregnancy on dietary behavior in the randomized controlled Norwegian Fit for Delivery study. Journal of Developmental Origins of Health and Disease. ISSN 2040-1744. 7(5), p. 538–547. doi: 10.1017/S2040174416000258. Full text in Research Archive
• Øverby, Nina Cecilie; Hillesund, Elisabet Rudjord; Sagedal, Linda Reme; Vistad, Ingvild & Bere, Elling (2015). The Fit for Delivery study: rationale for the recommendations and test-retest reliability of a dietary score measuring adherence to 10 specific recommendations for prevention of excessive weight gain during pregnancy. Maternal & Child Nutrition. ISSN 1740-8695. 11(1), p. 20–32. doi: 10.1111/mcn.12026. Full text in Research Archive Show summary

  Aiming at preventing excessive weight gain during pregnancy, ten specific dietary recommendations are given to pregnant women in the intervention arm of the Norwegian Fit for Delivery (FFD) study. This paper presents the rationale and test-retest reliability of the food frequency questionnaire (FFQ) and a dietary score measuring adherence to the recommendations. The study is part of the ongoing FFD study, a randomized controlled intervention study in nulliparous pregnant women. A 43-item FFQ was developed for the FFD study. A dietary score was constructed from ten subscales corresponding to the ten dietary recommendations. Adding the subscales yielded a score from 0 to 10 with increasing score indicating healthier dietary behavior. The score was divided into tertiles, grouping participants into low, medium and high adherence to the dietary recommendations. Pregnant women attending ultrasound screening at about week 19 of pregnancy were asked to complete the FFQ twice, two weeks apart. Of 154 pregnant women completing the first questionnaire, 106 (69%) completed the form on both occasions and was included in the study. The test-retest correlations of the score and subscales were r=0.68 and r=0.56-0.84 respectively (both p≤0.001). There was 68% test-retest correct classification of the score and 70-87% of the subscales. In conclusion, acceptable test-retest reliability of the FFQ and the dietary score was found. The score will be used in the FFD study to measure adherence to the dietary recommendations throughout pregnancy and in the following year post-partum.

• Skreden, Marianne; Bere, Elling; Sagedal, Linda Reme; Vistad, Ingvild & Øverby, Nina Cecilie (2015). Changes in beverage consumption from pre-pregnancy to early pregnancy in the Norwegian Fit for Delivery study. Public Health Nutrition (PHN). ISSN 1368-9800. 18(7), p. 1187–1196. doi: 10.1017/S136898001400189X. Full text in Research Archive Show summary

  Objective: To describe changes in consumption of different types of beverages from pre-pregnancy to early pregnancy, and to examine associations with maternal age, educational level and BMI. Design: Cross-sectional design. Participants answered an FFQ at inclusion into a randomized controlled trial, the Fit for Delivery (FFD) trial, in median gestational week 15 (range: 9–20), reporting current consumption and in retrospect how often they drank the different beverages pre-pregnancy. Setting: Eight local antenatal clinics in southern Norway from September 2009 to February 2013. Subjects: Five hundred and seventy-five healthy pregnant nulliparous women. Results: Pre-pregnancy, 27% reported drinking alcohol at least once weekly, compared with none in early pregnancy (P<0·001). The percentage of women drinking coffee (38 % v. 10 %, P < 0·001), sugar-sweetened beverages (10 % v. 6 %, P=0·011) and artificially sweetened beverages (12% v. 9%, P=0·001) at least daily decreased significantly from pre-pregnancy to early pregnancy, while the percentage of women who reported to drink water (85% v. 92%, P<0·001), fruit juice (14% v. 20%, P=0·001) and milk (37% v. 42%, P=0·001) at least daily increased significantly. From pre-pregnancy to early pregnancy higher educated women reduced their consumption frequency of coffee significantly more than women with lower education. Older women reduced their consump- tion frequency of coffee and artificially sweetened beverages and increased their consumption frequency of fruit juice and milk significantly more than younger women. Conclusions: There is a significant change in beverage consumption from pre-pregnancy to early pregnancy among Norwegian nulliparous women. Keywords Beverage consumption Dietary change Pregnant women

• Skreden, Marianne; Øverby, Nina Cecilie; Sagedal, Linda Reme; Vistad, Ingvild; Torstveit, Monica Klungland & Seiler, Hilde Lohne [Show all 7 contributors for this article] (2015). Changes in mode of transportation to work or school from pre-pregnancy to early pregnancy in the Norwegian Fit for Delivery study. Preventive Medicine Reports. 2, p. 429–435. doi: 10.1016/j.pmedr.2015.05.002. Full text in Research Archive Show summary

  Objective To describe changes in mode of transportation to work or school from pre-pregnancy to early pregnancy, to describe levels of physical activity related to mode of transportation to work or school, and to examine associations between changes in mode of transportation to work or school and educational level, body mass index (BMI) and age. Methods Between September 2009 and February 2013, 575 healthy pregnant nulliparous women were included into the Norwegian Fit for Delivery (NFFD) trial. At inclusion they reported their current and their pre-pregnancy mode of transportation to work or school. Data were analysed by multilevel mixed models with dichotomized modes of transportation as dependent variables. Results There was a significant change towards less active transportation to work or school and a decrease in level of physical activity from pre-pregnancy to early pregnancy. Pre-pregnancy, 58% used private transportation to work or school, compared to 64% in early pregnancy (p = 0.001). The percentage of women who biked (11% v. 5%, p < 0.001) decreased significantly from pre-pregnancy to early pregnancy. Conclusions In this sample of Norwegian women there was a significant change towards less active transportation to work or school and lower levels of physical activity from pre-pregnancy to early pregnancy. Keywords: Active transportation, Biking, Commuting, IPAQ, MET-score, Physical activity, Pregnancy, Private transportation, Public transportation, Walking

• Ruifrok, Anneloes E.; Rogozinska, Ewelina; Poppel, Mireille N.M. Van; Rayanagoudar, Girish; Kerry, Sally & Groot, Christianne J.M. De [Show all 21 contributors for this article] (2014). Study protocol: Differential effects of diet and physical activity based interventions in pregnancy on maternal and fetal outcomes-individual patient data (IPD) meta-analysis and health economic evaluation. Systematic Reviews. 3(1). doi: 10.1186/2046-4053-3-131. Full text in Research Archive
• Sagedal, Linda Reme; Øverby, Nina Cecilie; Seiler, Hilde Lohne; Bere, Elling; Torstveit, Monica Klungland & Henriksen, Tore [Show all 7 contributors for this article] (2013). Study protocol: fit for delivery - can a lifestyle intervention in pregnancy result in measurable health benefits for mothers and newborns? A randomized controlled trial. BMC Public Health. 13. doi: 10.1186/1471-2458-13-132. Full text in Research Archive Show summary

  Background The global obesity epidemic has led to increased attention on pregnancy, a period when women are at risk of gaining excessive weight. Excessive gestational weight gain is associated with numerous complications, for both mother and child. Though the problem is widespread, few studies have examined the effect of a lifestyle intervention in pregnancy designed to limit maternal weight gain. The Fit for Delivery study will explore the effectiveness of nutritional counseling coupled with exercise classes compared with standard prenatal care. The aims of the study are to examine the effect of the intervention on maternal weight gain, newborn birth weight, glucose regulation, complications of pregnancy and delivery, and maternal weight retention up to 12 months postpartum. Methods/design Fit for Delivery is a randomized controlled trial that will include 600 women expecting their first child. To be eligible, women must be 18 years of age or older, of less than 20 weeks gestational age, with a singleton pregnancy, and have a Body Mass Index (BMI) ≥ 19 kg/m2. The women will be randomly allocated to either an intervention group or a control group. The control group will receive standard prenatal care. The intervention group will, in addition, receive nutritional counseling by phone, access to twice-weekly exercise sessions, and information on healthy eating and physical activity provided in pamphlets, evening meetings and an interactive website. Both groups will be monitored by weighing (including bioimpedance measurements of percent body fat), blood tests, self-report questionnaires and hospital record review. Discussion Weight gained in pregnancy affects the health of both the mother and her unborn child, and simple models for efficient intervention are in high demand. The Fit for Delivery intervention provides concrete advice on limiting energy intake and practical training in increasing physical activity. This lifestyle intervention is simple, reproducible, and inexpensive. The design of the study reflects the realities of clinical practice, where patients are free to choose whether or not they respond to health initiatives. If we find measurable health benefits associated with the intervention, it may be an easily adopted supplement to routine prenatal care, in the prevention of obesity.

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• O’Reilly, Sharleen L.; McDonnell, Thérèse; Sagedal, Linda Reme; Bermúdez, Mercedes G.; Herrmann, Florian & Jasiak-Jóźwik, Hanna [Show all 22 contributors for this article] (2026). Bump2Baby & Me+ (B2B&Me+): Protocol for a multi-country, European hybrid type 3 implementation-effectiveness study to reduce the incidence of gestational diabetes mellitus and improve maternal and child health. doi: 10.1371/journal.pone.0354394. Full text in Research Archive Show summary

  Background Gestational diabetes mellitus (GDM) affects 1-in-7 pregnancies globally and is associated with significant short- and long-term health consequences. Although health behaviour change interventions can effectively reduce these risks, a significant implementation gap exists in translating this evidence into routine practice. Bump2Baby and Me (B2B&Me) was a mobile health (mHealth) coaching intervention provided to women at-risk of GDM from early pregnancy through to 1-year postpartum. B2B&Me Plus (B2B&Me+) aims to refine, implement and evaluate the implementation of this personalised intervention across 4 countries (Ireland, Spain, Poland and Norway) with differing health systems and population profiles. Methods This study employs a hybrid type 3 implementation-effectiveness design using a non-randomised ABA block approach within a longitudinal cohort. Participants will be screened using the Monash machine learning GDM screening tool (MMLGDST). During the intervention (Block B), women at risk of developing GDM will be offered access to a smartphone-based coaching application featuring 1:1 synchronous sessions, asynchronous text and video messaging along with a Bluetooth-enabled weighing scale for self-monitoring. Support continues from early pregnancy through to nine months postpartum. The study’s primary objective is to evaluate reach, adoption, implementation and maintenance of the B2B&Me+ intervention programme when delivered within routine maternity care. Implementation success will be assessed using the RE-AIM framework, while secondary outcomes will assess intervention effectiveness. The study will examine population-level uptake at each site, evaluate the benefits and costs of implementation across varying contexts, and analyse how four different referral methods, randomised at the site level, affect uptake. In addition, a European implementation toolkit will be developed to provide health services with scalable strategies to bridge the evidence-to-practice gap. Discussion This study will contribute to a growing literature on the implementation of a successfully trialled mHealth intervention in a real-world context. Understanding variation in both intervention and implementation success within a routine maternity care context across diverse settings will inform the development of an implementation toolkit to support health services in reducing the incidence of GDM and improving maternal and child health outcomes. This study was registered with ClinicalTrials.gov (NCT07189221) on 28 August 2025 ( https://clinicaltrials.gov/study/NCT07189221?cond=diabetes ).

• Oommen, Hanna; Sagedal, Linda Reme; Infanti, Jennifer Jean & Lukasse, Mirjam (2026). European Journal of Midwifery - Issue Abstract book of the 34th ICM Triennial Congress Supplement 1/2026 vol. 10. European Journal of Midwifery (EJM). 10. doi: https:/www.europeanjournalofmidwifery.eu/Improving-birth-outcomes-and-experiences-The-impact-of-multicultural-doulas-for-newly,222787,0,2.html. Full text in Research Archive
• Stalheim, Astrid M.; Iversen, Marjolein M.; Jenum, Anne Karen; Sletner, Line; Stafne, Signe Nilssen & Qvigstad, Elisabeth [Show all 10 contributors for this article] (2022). Seasonal variation in gestational diabetes mellitus. Full text in Research Archive
• Hillesund, Elisabet Rudjord; Valand, Ida Ulrikke; Bere, Elling Tufte; Vistad, Ingvild; Sagedal, Linda Reme & Øverby, Nina Cecilie (2019). Meals eaten with family in relation to dietary quality in 12-month-olds. A sub-study in the Norwegian Fit for Delivery study. Full text in Research Archive
• Hillesund, Elisabet Rudjord; Bere, Elling; Sagedal, Linda Reme; Vistad, Ingvild & Øverby, Nina Cecilie (2017). Associations between dietary behavior and preterm birth in the Norwegian Fit for Delivery study – interaction with offspring gender. Full text in Research Archive
• Hillesund, Elisabet Rudjord; Bere, Elling; Sagedal, Linda Reme; Vistad, Ingvild & Øverby, Nina Cecilie (2016). Dietary behavior in early pregnancy and subsequent risk of preeclampsia - an observationa study performed within the Norwegian Fit for Delivery study. Full text in Research Archive
• Sanda, Birgitte; Vistad, Ingvild; Haakstad, Lene Annette Hagen; Berntsen, Sveinung; Sagedal, Linda Reme & Lohne-Seiler, Hilde [Show all 7 contributors for this article] (2016). Validity and reliability of physical activity questionnaire in pregnancy; does physical activity level matter? Full text in Research Archive
• Sanda, Birgitte; Sagedal, Linda Reme; Vistad, Ingvild; Lohne-Seiler, Hilde; Hakestad, Lene AH. & Torstveit, Monica Klungland (2015). A lifestyle intervention including an exercise program helps women increase physical activity level in pregnancy. Full text in Research Archive
• Sagedal, Linda Reme; Henriksen, Tore; Øverby, Nina Cecilie; Lohne-Seiler, Hilde; Torstveit, Monica Klungland & Bere, Elling [Show all 8 contributors for this article] (2015). Effect of a lifestyle intervention in pregnancy on infant size up to 1 year of age: results of Norwegian Fit for Delivery randomized controlled trial. Full text in Research Archive
• Skreden, Marianne; Øverby, Nina C; Sagedal, Linda Reme; Vistad, Ingvild; Torstveit, Monica Klungland & Lohne-Seiler, Hilde [Show all 7 contributors for this article] (2015). Changes in mode of transportation to work or school from pre-pregnancy to early pregnancy in the Norwegian Fit for Delivery study. Full text in Research Archive
• Hillesund, Elisabet Rudjord; Bere, Elling; Sagedal, Linda Reme; Vistad, Ingvild & Øverby, Nina Cecilie (2015). Adherence to ten dietary principles and risk of preterm delivery - a study performed in the Norwegian Fit for Delivery study. Full text in Research Archive
• Larsen, Arne Martin; Hillesund, Elisabet Rudjord; Øverby, Nina Cecilie & Sagedal, Linda Reme (2015). Fit for fødsel. [Internet]. www.forskningsdagene.no. Full text in Research Archive
• Skreden, Marianne; Bere, Elling; Vistad, Ingvild; Sagedal, Linda Reme & Øverby, Nina Cecilie (2015). Changes in vegetables, fruits and berries consumption habits from pre-pregnancy to early pregnancy among Norwegian women. Full text in Research Archive
• Hillesund, Elisabet Rudjord; Bere, Elling; Sagedal, Linda Reme; Vistad, Ingvild & Øverby, Nina Cecilie (2014). Compliance with the dietary recommendations in the Norwegian Fit for Delivery Study. Full text in Research Archive
• Skreden, Marianne; Bere, Elling; Vistad, Ingvild; Sagedal, Linda Reme & Øverby, Nina Cecilie (2014). Changes in beverage consumption habits from pre-pregnancy through pregnancy. Full text in Research Archive
• Skreden, Marianne; Bere, Elling; Vistad, Ingvild; Sagedal, Linda Reme & Øverby, Nina Cecilie (2014). Changes in beverage consumption habits from pre-pregnancy to early pregnancy among Norwegian women. Full text in Research Archive
• Sagedal, Linda Reme; Henriksen, Tore; Øverby, Nina Cecilie; Torstveit, Monica Klungland; Seiler, Hilde Lohne & Bere, Elling [Show all 7 contributors for this article] (2014). Who are we missing? Examining non-participants in "Fit for Delivery", a randomised, controlled trial of a lifestyle intervention in pregnancy. Full text in Research Archive
• Sagedal, Linda Reme; Henriksen, Tore; Øverby, Nina Cecilie; Torstveit, Monica Klungland; Seiler, Hilde Lohne & Bere, Elling [Show all 7 contributors for this article] (2014). The problem of non-participation: Who declined to participate in "Fit for Delivery", a randomised, controlled trial of a lifestyle intervention in pregnancy? Full text in Research Archive
• Torstveit, Monica Klungland; Vale, Anne Hilde; Lohne-Seiler, Hilde; Sagedal, Linda Reme & Vistad, Ingvild (2013). Hvem ønsker ikke bli med og hvorfor? Ikke-deltakere versus deltakere i «fit for fødsel» studien. Full text in Research Archive
• Sagedal, Linda Reme; Øverby, Nina Cecilie; Lohne-Seiler, Hilde; Bere, Elling; Torstveit, Monica Klungland & Henriksen, Tore [Show all 7 contributors for this article] (2012). Fit for fødsel: hvem takker ja til å delta? Full text in Research Archive
• Hillesund, Elisabet Rudjord; Bere, Elling; Sagedal, Linda Reme; Vistad, Ingvild & Øverby, Nina Cecilie (2012). Test-retest reliability of a questionnaire measuring adherence to ten specific dietary recommendations for prevention of excess weight gain during pregnancy – the Norwegian Fit for Delivery (FFD) Nutrition Score. Full text in Research Archive
• Øverby, Nina Cecilie; Sagedal, Linda Reme; Vistad, Ingvild; Lohne-Seiler, Hilde & Bere, Elling (2010). Project Fit for Delivery - 10 specific dietary recommendations for pregnant women, to prevent excessive weight gain. Full text in Research Archive
• Sagedal, Linda Reme; Vistad, Ingvild; Øverby, Nina Cecilie & Henriksen, Tore (2017). Antenatal lifestyle intervention for the limitation of gestational weight gain: The Norwegian Fit for Delivery Trial. Faculty of Medicine, University of Oslo. ISSN 9788283770360. Full text in Research Archive

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