Diet and exercise for preeclampsia prevention in overweight and obese pregnant women: systematic review and meta-analysis

Syngelaki, Argyro; Campos, Miguel Sequeira; Roberge, Stéphanie; Andrade, W.; Nicolaides, Kypros H.

doi:10.1080/14767058.2018.1481037

Cited by 38 publications

(45 citation statements)

References 44 publications

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“…13 However, this result is consistent with prior findings of lifestyle intervention in pregnancy which demonstrate a reduced risk for GDM but not preeclampsia. 19,20 These results are also consistent with a study by Sweeting et al, which found a high rate of HDP (26.3%) in women with GDM onset before 12 weeks of gestation and borderline hemoglobin A1c (mean AE SD, 5.7% AE 1.3) despite intervention (diet, exercise, monitoring, AE insulin as indicated). 21 However, these results somewhat contrast a recent subgroup analysis of the lifestyle in pregnancy (LiP) study by Vinter et al 22 and a recent feasibility study by Hughes et al 15 Specifically, Vinter et al assessed a subgroup of women from the LiP study with early-onset GDM.…”

Section: Discussionsupporting

confidence: 91%

Review of Prediabetes and Hypertensive Disorders of Pregnancy

Carris

Nwabuobi

et al. 2019

Am J Perinatol

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Obesity and diabetes increase hypertensive disorders of pregnancy (HDP) risk, thus preventive interventions are heavily studied. How pregestational prediabetes and related interventions impact HDP risk is less characterized. Therefore, we searched and reviewed the literature to assess the impact on HDP risk of prediabetes and varied interventions. We identified 297 citations related to pregnancy, prediabetes, and early pregnancy interventions. We also reviewed the references and citations of included articles. We included five studies assessing HDP outcomes in women with first trimester hemoglobin A1c in the prediabetes range (5.7–6.4%). One prospective observational study demonstrated first trimester hemoglobin A1c (5.9–6.4%) is associated with increased HDP risk, while another prospective observational study and one retrospective observational study had similar trends without statistical significance. A small and underpowered randomized controlled trial demonstrated initiating gestational diabetes mellitus treatment (i.e., diet, monitoring, ± insulin) in response to first trimester hemoglobin A1c (5.7–6.4%) did not statistically reduce HDP compared with standard care. One retrospective observational study suggested metformin, when started early, may reduce HDP risk in patients with prediabetes. Pregestational prediabetes appears to increase HDP risk. Interventions (i.e., metformin, diet/glucose monitoring, and/or exercise) to reduce HDP risk require additional study with long-term follow-up.

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Section: Discussionsupporting

confidence: 91%

Review of Prediabetes and Hypertensive Disorders of Pregnancy

Carris

Nwabuobi

et al. 2019

Am J Perinatol

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“…The title and abstract of a subset of 265 citations were double screened, with over 98% agreement. Of the 75 full text articles screened, 16 (covering 15 separate reviews) were included 12,26–40 . Table S3 provides reasons for exclusion at full text.…”

Section: Resultsmentioning

confidence: 99%

“…The majority of reviews only included RCTs of women with overweight or obesity prior to pregnancy or when booking for antenatal care 27–34,36,37,40 . The other four reviews incorporated women of all BMIs but providing subgroup analysis for women with overweight or obesity 12,26,38,39 .…”

Section: Resultsmentioning

confidence: 99%

A meta‐review of systematic reviews of lifestyle interventions for reducing gestational weight gain in women with overweight or obesity

Fair

Soltani

2021

Obesity Reviews

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Summary Women with overweight or obesity are twice as likely to gain excessive gestational weight than women of normal weight. Identifying effective interventions to support this group achieve healthy gestational weight gain is important. An overview of systematic reviews regarding the effectiveness of lifestyle interventions on gestational weight gain in women with overweight or obesity was undertaken, including searching eight electronic databases. Quality of included reviews was assessed by two independent researchers. A narrative data synthesis was undertaken, with subgroup and sensitivity analyses by type of intervention and quality of the included reviews. A total of 15 systematic reviews were included within this meta‐review. A small reduction in gestational weight gain of between 0.3 and 2.4 kg was noted with lifestyle interventions compared with standard care. There was some evidence that dietary only or physical activity only interventions may reduce the odds of gestational diabetes. No differences were noted in the odds of other maternal or infant health outcomes. Although lifestyle interventions appeared to decrease gestational weight gain, current evidence does not show a clear benefit on maternal and infant outcomes from the small nature of the reduction in gestational weight gain produced by lifestyle interventions in women with overweight or obesity.

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“…This Journal alone has published 8 articles in the past 2 years related to the topic of obesity or excessive gestational weight gain 1‐8 . There were 9 systematic reviews on the topic, limited to maternal and early infant effects, in 2019 9‐17 . However, what is frequently left out of studies, especially intervention studies, are any outcomes that pregnant women themselves may care about or that are now commonly called patient‐reported outcomes.…”

Section: Dadouch R Hall C Du Mont J D'souza R Obesity In Pregnancmentioning

confidence: 99%