Table 1 Nutrition intervention

1.

Training on weight monitoring and delivery of messages for health professionals:

a. 1-day course for dietitians, midwifes and nurses: revision of references, maternal and offspring nutrition assessment, use of charts, referral criteria to dietitian, dietary recommendations, how to communicate nutrition messages effectively

b. Online re-training (email and web page)

c. Procedural manual

d. Technical support by the study coordinator

e. Short brochure with nutrition messages

2.

Installation of a computer-assisted system for maternal weight monitoring based on IOM (Institute Of Medicine) guidelines in midwives´ consultation rooms

3.

At each midwife visit (pregnant women):

a. Assessment of maternal weight gain. Education and feedback about weight gain.

b. Delivery of at least two nutrition messages: Avoid the consumption of sugar-sweetened beverages (including fruit juice); Restrict the consumption of white bread to two pieces/day; Replace fatty meats (pork, veal, lamb) by lean meat (poultry, turkey) and fish; Eat a variety of vegetables and fruits each day (at least 5 portions), in place of foods higher in fat and calories; Breastfeeding promotion; Invitation to physical activity classes.

c. Timely referral to dietitian according to defined criteria

4.

Physical activity program for pregnant women of moderate-intensity exercise supervised by physical activity instructors lasting 60 min and performed three times per week.