Attenuating Pregnancy Weight Gain—What Works and Why: A Systematic Review and Meta-Analysis

Walker, Ruth; Bennett, Christie; Blumfield, Michelle; Gwini, Stella May; Ma, Jianhua; Wang, Fenglei; Wan, Yi; Truby, Helen

doi:10.3390/nu10070944

Cited by 72 publications

(59 citation statements)

References 150 publications

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“…103 Study characteristics and methodological quality have been reported previously. 22 For individual results reported in this review, see Tables 1-5.…”

Section: Resultsmentioning

confidence: 99%

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Attenuation of maternal weight gain impacts infant birthweight: systematic review and meta-analysis

Bennett

Walker

Blumfield

et al. 2018

J Dev Orig Health Dis

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Despite many interventions aiming to reduce excessive gestational weight gain (GWG), it is currently unclear the impact on infant anthropometric outcomes. The aim of this review was to evaluate offspring anthropometric outcomes in studies designed to reduce GWG. A systematic search of seven international databases, one clinical trial registry and three Chinese databases was conducted without date limits. Studies were categorised by intervention type: diet, physical activity (PA), lifestyle (diet + PA), other, gestational diabetes mellitus (GDM) (diet, PA, lifestyle, metformin and other). Meta-analyses were reported as weighted mean difference (WMD) for birthweight and birth length, and risk ratio (RR) for small for gestational age (SGA), large for gestational age (LGA), macrosomia and low birth weight (LBW). Collectively, interventions reduced birthweight, risk of macrosomia and LGA by 71 g (WMD: −70.67, 95% CI −101.90 to −39.43,P<0.001), 16% (RR: 0.84, 95% CI 0.73–0.98,P=0.026) and 19% (RR: 0.81, 95% CI 0.69–0.96,P=0.015), respectively. Diet interventions decreased birthweight and LGA by 99 g (WMD −98.80, 95% CI −178.85 to −18.76,P=0.016) and 65% (RR: 0.35, 95% CI 0.17–0.72,P=0.004). PA interventions reduced the risk of macrosomia by 51% (RR: 0.49, 95% CI 0.26–0.92,P=0.036). In women with GDM, diet and lifestyle interventions reduced birthweight by 211 and 296 g, respectively (WMD: −210.93, 95% CI −374.77 to −46.71,P=0.012 and WMD:−295.93, 95% CI −501.76 to −90.10,P=0.005, respectively). Interventions designed to reduce excessive GWG lead to a small reduction in infant birthweight and risk of macrosomia and LGA, without influencing the risk of adverse outcomes including LBW and SGA.

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“…103 Study characteristics and methodological quality have been reported previously. 22 For individual results reported in this review, see Tables 1-5.…”

Section: Resultsmentioning

confidence: 99%

“…10 In contrast, inadequate GWG The details of the inclusion exclusion criteria have been previously outlined. 22 Briefly, studies were eligible if they were randomized controlled trials, conducted in humans with a primary or secondary aim to reduce excessive GWG. Studies that aimed to encourage GWG were excluded.…”

Section: Introductionmentioning

confidence: 99%

Attenuation of maternal weight gain impacts infant birthweight: systematic review and meta-analysis

Bennett

Walker

Blumfield

et al. 2018

J Dev Orig Health Dis

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“…Evidence synthesis has shown that antenatal diet and physical activity lifestyle interventions for women have been successful in limiting excessive gestational weight gain [12,13]. However, the effect of lifestyle interventions on reducing adverse maternal events has been difficult to measure at an individual trial level due to sample size limitations and insufficient power.…”

Section: Introductionmentioning

confidence: 99%

Cost Effectiveness of Antenatal Lifestyle Interventions for Preventing Gestational Diabetes and Hypertensive Disease in Pregnancy

Bailey

Skouteris

Harrison

et al. 2020

PharmacoEconomics Open

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Background Lifestyle interventions (diet, physical activity and/or behavioural) to optimise gestational weight gain can prevent adverse maternal outcomes such as gestational diabetes, pre-eclampsia and caesarean section. Objective We aimed to model the cost effectiveness of lifestyle interventions during pregnancy on reducing adverse maternal outcomes. Methods Decision tree modelling was used to determine the cost effectiveness of lifestyle interventions compared with usual care on preventing cases of gestational diabetes and hypertensive disease in pregnancy. Participants were pregnant women receiving routine antenatal care in secondary and tertiary care hospitals. The main outcome measures were cases of gestational diabetes and/or hypertensive disease in pregnancy prevented, costs, and incremental cost-effectiveness ratios. Analysis was conducted from the perspective of the Australian healthcare system, with a time horizon of early pregnancy to discharge after birth. Results Women in the intervention group were 2.25% less likely to have gestational diabetes and/or hypertensive disease in pregnancy (9.53%) compared with the control group (11.78%). Intervention costs were Australian dollars (AUD) 228 per person. Costs were AUD33 per person higher in the intervention group (AUD8281) than the control group (AUD8248). The incremental cost-effectiveness ratio was AUD1470 per case prevented. Sensitivity analysis showed that base-case results were robust. In the probabilistic sensitivity analysis, 44.8% of data points fell within the northeast quadrant, and 52.2% in the southeast quadrant (cost saving), with a 95% confidence interval ranging from AUD − 50,018 to 32,779 per case prevented. Conclusions While there is no formally accepted cost-effectiveness threshold for willingness-to-pay to prevent an adverse maternal event, the cost per person receiving a lifestyle intervention compared with controls was close to neutral, and therefore likely to be cost effective. Exploration of the cost effectiveness of different lifestyle delivery modes across various models of antenatal care is now required. Future cost-effectiveness studies should investigate longer time horizons, qualityadjusted life-years and productivity loss. Trial Registration Not applicable. Helena Teede and Zanfina Ademi shared joint senior authorship.

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“…Excess weight gain during pregnancy is associated with numerous complications, e.g. gestational diabetes, arterial hypertension [19,23,28], and fetal macrosomia [14,29,34]. Currently, it is believed that excess neonatal weight intensifies the problem of obesity both, in childhood and later in life [3-5, 10, 14].…”

Section: Introductionmentioning

confidence: 99%

Pre-pregnancy nutritional status versus maternal weight gain and neonatal size

Wierzejska

Wojda

2019

Rocz Panstw Zakl Hig

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Background. Maternal weight during pregnancy may affect both, the course of pregnancy and the anthropometric parameters of the newborn. The steadily growing problem of excessive weight in reproductive-age women is associated with the risk for gestational obesity and its negative consequences for the infant. Objectives. The aims of the study were to analyze the following: (i) maternal weight gain as compared to the pre-pregnancy BMI, and (ii) the link between maternal weight and other environmental factors versus neonatal size. Material and methods. The study was conducted among 94 women in singleton term pregnancy, who delivered at the Department of Obstetrics, Gynecology and Oncology, Medical University of Warsaw. The American Institute of Medicine criteria for the recommended weight gain were followed. Multivariate logistic regression model and multiple regression analysis were used for statistical analysis. Results. Normal weight gain was observed in only one-third of the subjects, while excess weight gain was detected in as many as 42.5% of the women. Active smokers were at a 4-fold higher risk for excess weight gain as compared to nonsmokers (OR 4.13, 95% CI 1.19 - 14.34, p = 0.026). Infants born to mothers with insufficient weight gain (24.5% of the mothers) were lighter by 302 g (p=0.0405) and shorter by 2.4 cm (p=0.0025) as compared to those born to mothers with normal weight gain. Conclusions. Maternal weight gain in most of our subjects was not compliant with the current recommendations, regardless of the pre-pregnancy BMI. Inadequate pregnancy weight gain negatively affects the anthropometric parameters of the newborn.

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Attenuating Pregnancy Weight Gain—What Works and Why: A Systematic Review and Meta-Analysis

Cited by 72 publications

References 150 publications

Attenuation of maternal weight gain impacts infant birthweight: systematic review and meta-analysis

Attenuation of maternal weight gain impacts infant birthweight: systematic review and meta-analysis

Cost Effectiveness of Antenatal Lifestyle Interventions for Preventing Gestational Diabetes and Hypertensive Disease in Pregnancy

Pre-pregnancy nutritional status versus maternal weight gain and neonatal size

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