An evaluation of the impact of lifestyle interventions on body weight in postpartum women: A systematic review and meta‐analysis

Abstract

Summary The established efficacy in postpartum lifestyle interventions has not been translated into better outcomes. This systematic review and meta‐analysis assess the penetration (the proportion of women invited within the target population), implementation (fidelity), participation (the proportion of those invited who enrolled), and effect (weight loss compared to controls) (PIPE) of randomized controlled trials of lifestyle interventions in postpartum women (within two years after birth). MEDLINE, EMBASE, Pubmed, and other databases and clinical trial registries were searched up to the 3rd of May 2019. Data was extracted from published reports and missing data was obtained from study authors. The quality of the studies was appraised using the Cochrane Risk of Bias tool (2·0). Main outcomes were the PIPE impact metrics and changes in body weight. Thirty‐six trials (49 publications) were included (n=5,315 women). One study provided sufficient information to calculate the population penetration rate (2·5%). All studies provided implementation (fidelity) information, but over half had low program fidelity. The participation rate was calculated for nine studies (0·94% to 86%). There was significant change in body weight (mean difference (MD) (95% confidence interval, CI) of ‐2·33 (‐3·10 to ‐1·56). This highlights the inadequacy of conventional RCTs to inform implementation. Future research should broaden methods to pragmatic trials.

Barriers and facilitators to a healthy lifestyle in postpartum women: A systematic review of qualitative and quantitative studies in postpartum women and healthcare providers

“…We included studies reporting the barriers and facilitators, experiences and perceptions to engaging in a healthy lifestyle (diet, physical activity and weight management) in women within 2 years postpartum or their HPs. Previous studies have shown the need for interventions in women within this timeframe as they face unique barriers relating to the newborn, young baby or toddler 18,23 . Qualitative, quantitative and mixed‐methods studies were included.…”

The effectiveness of pediatric obesity prevention policies: a comprehensive systematic review and dose–response meta-analysis of controlled clinical trials

“…This systematic review and meta-analysis is the first, to our knowledge, to evaluate the quantitative effects of various childhood obesity prevention policies on children's BMI and BMI-Z score in an interventional design. There are many systematic reviews or meta-analysis studies that have been performed in specific settings such as schools only [ 12 , 13 , 60 ] or were performed for single-axis interventions such as physical activity only [ 10 , 61 ], diet only [ 13 ] or with limited duration of intervention [ 62 ] or follow-up [ 63 , 64 ] and different age ranges [ 9 , 10 , 60 , 64 ]. The current comprehensive meta-analysis evaluated the isolated effects of settings, intervention materials, duration and length of follow up, with a focus on the adiposity-related outcome of BMI or BMI-Z score .…”

Preventing Type 2 Diabetes in Women with Previous Gestational Diabetes: Reviewing the Implementation Gaps for Health Behavior Change Programs

“…77 A similar lack of data exists for the reach of health behavior change programs in postpartum women, with or without histories of GDM, which is reflective of the fact that very few interventions were conducted under real-world conditions using pragmatic trial designs. 78 Participation rates among women with a history of GDM varies greatly, but the highest rates are reported by studies that incorporate the intervention within existing activities such as a parents' group or existing health services for postpartum women. 62,78 Recruitment conducted in person, particularly during pregnancy or early postpartum periods, is also more successful at engaging women.…”

“…78 Participation rates among women with a history of GDM varies greatly, but the highest rates are reported by studies that incorporate the intervention within existing activities such as a parents' group or existing health services for postpartum women. 62,78 Recruitment conducted in person, particularly during pregnancy or early postpartum periods, is also more successful at engaging women. 62 Penetration and participation challenges are still greater among ethnic minority groups.…”

“…Systematic reviews of lifestyle programs in postpartum women with or without history of GDM reported a large range of effect sizes. 17,78 Differences between interventions on who delivers the intervention, what the intervention involves, the timing, frequency, and setting of the intervention could affect the effectiveness of the intervention. 87,88 We have previously reported that in postpartum women with and without history of GDM, lifestyle interventions that were delivered by health professionals and included behavior change techniques that focus on self-regulation such as goal setting and monitoring were more effective.…”