Behavioural weight management interventions for postnatal women: A systematic review of systematic reviews of randomized controlled trials

Abstract

This systematic review of systematic reviews investigated the effectiveness of lifestyle weight management interventions for postnatal women. We systematically reviewed Medline (PubMed), Embase, CINAHL Plus, The Cochrane Library, and Scopus from 2000 until January 2018, to identify systematic reviews of randomized controlled trials that evaluated the effectiveness of behavioural lifestyle interventions for weight management in postnatal women. Results were summarized both descriptively and statistically using a mega meta-analysis of data from randomized controlled trials included in previous systematic reviews. Nine systematic reviews met our inclusion criteria. Overall the reviews concluded that lifestyle interventions involving physical activity and/or dietary changes resulted in a reduction in postnatal weight. Results from the overall mega meta-analysis confirmed this finding with a mean difference of −1.7 kg (95% CI, −2.3 to −1.1). Findings for subgroup analyses gave mean differences of −1.9 kg (95% CI, −2.9 to −1.0) for combined diet and physical activity interventions, −1.6 kg (95% CI, −2.1 to −1.2) for physical activity-only interventions, and −9.3 kg (95% CI, −16.5 to −2.1) for diet-only interventions (one study). Heterogeneity varied from 0% to 68%. Interventions involving lifestyle interventions appeared to be effective in reducing weight in postnatal women, although these findings should be interpreted with some caution due to statistical heterogeneity. KEYWORDS intervention, postnatal, systematic review, weight 1 | INTRODUCTIONObesity is a key contributor to many chronic co-morbidities including type 2 diabetes, cardiovascular disease, 1 stroke, and a number of types of cancers such as colorectal and breast cancer. 1-3 These conditions can be life threatening, detrimental to quality of life, and expensive to treat.The obesity epidemic is affecting all populations, including women of reproductive age. Recent national surveys reported that approximately 66%, 56%, and 58% of women in the United States of America, Australia, and England, respectively, either have overweight (body mass index [BMI] between 25 and 30 kg/m 2 ) or obesity (BMI over 30 kg/m 2 ). 4-6 This means that most women already have overweight when they become pregnant. A period of notable weight gain for many women occurs during and after pregnancy. 7,8 Studies have reported that among women who have a healthy BMI prior to pregnancy, 30% have overweight 1 year after giving birth. 9,10 Of women who have overweight prior to conception, 44% have obesity 1 year after giving birth, while 97% of women with obesity prior to pregnancy remain so at 1 year postnatally. On average, women gain about 14 to 15 kg during pregnancy, and at 1 year after birth, 5 to 9 kg is retained. 8,11 Some women are able to return to their prepregnancy weight after childbirth, but the amount of weight women retain postnatally varies considerably, and many women never lose all of the weight gained during pregnancy. [11][12][13][14][15]

Lifestyle information and commercial weight management groups to support maternal postnatal weight management and positive lifestyle behaviour: the SWAN feasibility randomised controlled trial

“…A higher uptake would have been encouraging, however, as the sample included women from an inner‐city area with childcare and other responsibilities, who may not have encountered a similar weight management intervention before, that just under half attended at least one session could be viewed positively. Previous trials have reported similar uptake of weight management interventions among those in high‐income and low‐income areas, with potential for targeted schemes to support weight management among adults living in areas of higher social deprivation. Process evaluation findings will inform uptake and retention strategies for a future trial.…”

“…The importance of postnatal intervention is becoming clearer, given concerns about longer‐term impacts of maternal obesity, and lack of evidence of effectiveness of pregnancy‐only interventions . A recent review of reviews again showed interventions involving physical activity and/or dietary changes could be effective in managing postnatal weight, although findings should be interpreted with caution because of statistical heterogeneity …”

“…7,8 A recent review of reviews again showed interventions involving physical activity and/or dietary changes could be effective in managing postnatal weight, although findings should be interpreted with caution because of statistical heterogeneity. 39 As women with higher BMIs experience a range of persistent co-morbidities, such as diabetes and hypertensive disorders, 40,41 the timing and content of a postnatal weight management intervention has to reflect birth recovery, demands of parenthood, potential return to employment, social circumstances and mobility of the population. This study shows that women who were interested in weight management support were willing to participate and complete the study, but approaches have to be flexible and reflect each woman's decision about when she feels timing of an intervention is appropriate.…”

Protocol for the feasibility and acceptability of a brief routine weight management intervention for postnatal women embedded within the national child immunisation programme: randomised controlled cluster feasibility trial with nested qualitative study (PIMMS-WL)

“…Several systematic reviews have identified the need for high quality trials on how to best help women to lose weight after having a baby 11–16. Within these reviews, the vast majority of studies have recruited small sample sizes and evaluated intensive physical activity and/or dietary interventions delivered by specialists; while these types of interventions can be effective, they cannot be delivered to all the women who give birth each year in the UK, of whom nearly two-thirds will be living with overweight 17.…”

“…Within these reviews, the vast majority of studies have recruited small sample sizes and evaluated intensive physical activity and/or dietary interventions delivered by specialists; while these types of interventions can be effective, they cannot be delivered to all the women who give birth each year in the UK, of whom nearly two-thirds will be living with overweight 17. A recent systematic review of reviews of lifestyle interventions for postnatal weight management highlighted the lack of studies that have tested an intervention embedded within routine healthcare 16…”