OBESITY PREVENTION (A MUST, SECTION EDITOR) Prevention of Excessive Gestational Weight Gain and Postpartum Weight Retention Nemencio A. Nicodemus Jr 1,2,3,4,5 # Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Purpose of Review The purpose of this review is to summarize the current evidence on the prevention of excessive gestational weight gain (GWG) and reduction of postpartum weight retention (PPWR) by lifestyle intervention and pharmacotherapy. Recent Findings Recent findings demonstrate that tailored nutrition counseling and adapting certain eating patterns, supervised exercise programs aiming at achieving at least moderate level of physical activity, and interactive and monitored behavior change interventions are effective in reducing excessive GWG and PPWR. Among the pharmacologic agents, Metformin has been shown to reduce GWG. Summary Excessive GWG and PPWR are associated with adverse maternal and neonatal outcomes. Recent evidence shows that weight during gestation and the postpartum period can be significantly reduced by more frequent nutrition counseling sessions on balanced diet focusing on healthier food choices and eating patterns, supervised moderate-intensity exercise for at least 30 min three times a week, and interactive behavior change interventions with regular feedback and follow-up. The benefits on weight are seen when these interventions are utilized together in a multimodality approach. Metformin is effective in preventing excessive GWG but has no impact on neonatal outcomes. Keywords Obesity . Gestational weight gain . Postpartum weight retention . Dietary counseling . Physical activity . Behavior change . Pharmacotherapy Introduction Pregnancy is a major time point in a woman’ s life when she develops weight gain. The gain in weight is contributed by both the products of conception (placenta, fetus, amniotic flu- id) and the changes in maternal physiology during pregnancy, including protein, fat, and water deposition in the uterus, mammary gland, blood, and adipose tissue [1]. In the first half of pregnancy, this gestational weight gain (GWG) is largely due to maternal fat deposition; while in the later part of ges- tation, it is due to the growth of the fetus. Overall, however, maternal contribution to GWG plays a major part not just physiologically but also molecularly as shown in a genome- wide association study where approximately 20% of the var- iability in GWG was contributed by common maternal genetic variants associated with increased body mass index (BMI), fasting glucose, and type 2 diabetes [rs481396 (TMEM163), rs9995522 (UGDH), and rs310087 (SYT4)] while the fetal genome provided only a minor contribution [2]. However, the effect of genes on GWG is not independent and is modi- fied by diet as shown in a cohort study where there was sig- nificant interaction between a gene variant (KCTD15) associ- ated with excessive GWG and the amount of dietary fat intake [3]. This effect of environmental influences in modulating genetic predisposition is crucial in planning interventions. Although weight gain during gestation is variable in differ- ent women, the Institute of Medicine (IOM) has recommend- ed a range of acceptable weight gain during pregnancy This article is part of the Topical Collection on Obesity Prevention * Nemencio A. Nicodemus, Jr 1 College of Medicine, University of the Philippines, Manila, Philippines 2 University of the Philippines-Philippine General Hospital, Manila, Philippines 3 Philippine Association for the Study of Overweight and Obesity, Pasig, Philippines 4 Philippine Society of Endocrinology, Diabetes & Metabolism, Pasig, Philippines 5 Manila, Philippines Current Obesity Reports https://doi.org/10.1007/s13679-018-0312-0