Diet or exercise, or both, for preventing excessive weight gain in pregnancy

Muktabhant, Benja; Lawrie, Theresa A; Lumbiganon, Pisake; Laopaiboon, Malinee

doi:10.1002/14651858.cd007145.pub3

Cited by 448 publications

(493 citation statements)

References 186 publications

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“…11,12 Subgroup effects are rarely reported in sufficient detail, especially to derive differences in intervention effect between subgroups ('treatment-covariate interactions'). Meta-regression examining the across-trial association between overall treatment effect and average patient characteristics (e.g.…”

Section: Differential Effect Of Interventions On Gestational Weight Gmentioning

confidence: 99%

“…The most common outcomes available in studies that contributed IPD were preterm delivery (11,731 women, 34 studies), Caesarean section (11,585 women, 34 studies) and SGA (11,682 women, 34 studies) and LGA (12,078 women, 36 studies) fetuses. This was followed by GWG (9320 women, 33 studies), PE (8350 women, 20 studies), PIH (9065 women, 25 studies) and GDM (9882 women, 30 studies).…”

Section: Network Meta-analysismentioning

confidence: 99%

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Effects of antenatal diet and physical activity on maternal and fetal outcomes: individual patient data meta-analysis and health economic evaluation

Rogozińska

Marlin

Jackson

et al. 2017

Health Technol Assess

217

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BackgroundDiet- and physical activity-based interventions in pregnancy have the potential to alter maternal and child outcomes.ObjectivesTo assess whether or not the effects of diet and lifestyle interventions vary in subgroups of women, based on maternal body mass index (BMI), age, parity, Caucasian ethnicity and underlying medical condition(s), by undertaking an individual patient data (IPD) meta-analysis. We also evaluated the association of gestational weight gain (GWG) with adverse pregnancy outcomes and assessed the cost-effectiveness of the interventions.Data sourcesMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Health Technology Assessment database were searched from October 2013 to March 2015 (to update a previous search).Review methodsResearchers from the International Weight Management in Pregnancy Collaborative Network shared the primary data. For each intervention type and outcome, we performed a two-step IPD random-effects meta-analysis, for all women (except underweight) combined and for each subgroup of interest, to obtain summary estimates of effects and 95% confidence intervals (CIs), and synthesised the differences in effects between subgroups. In the first stage, we fitted a linear regression adjusted for baseline (for continuous outcomes) or a logistic regression model (for binary outcomes) in each study separately; estimates were combined across studies using random-effects meta-analysis models. We quantified the relationship between weight gain and complications, and undertook a decision-analytic model-based economic evaluation to assess the cost-effectiveness of the interventions.ResultsDiet and lifestyle interventions reduced GWG by an average of 0.70 kg (95% CI –0.92 to –0.48 kg; 33 studies, 9320 women). The effects on composite maternal outcome [summary odds ratio (OR) 0.90, 95% CI 0.79 to 1.03; 24 studies, 8852 women] and composite fetal/neonatal outcome (summary OR 0.94, 95% CI 0.83 to 1.08; 18 studies, 7981 women) were not significant. The effect did not vary with baseline BMI, age, ethnicity, parity or underlying medical conditions for GWG, and composite maternal and fetal outcomes. Lifestyle interventions reduce Caesarean sections (OR 0.91, 95% CI 0.83 to 0.99), but not other individual maternal outcomes such as gestational diabetes mellitus (OR 0.89, 95% CI 0.72 to 1.10), pre-eclampsia or pregnancy-induced hypertension (OR 0.95, 95% CI 0.78 to 1.16) and preterm birth (OR 0.94, 95% CI 0.78 to 1.13). There was no significant effect on fetal outcomes. The interventions were not cost-effective. GWG, including adherence to the Institute of Medicine-recommended targets, was not associated with a reduction in complications. Predictors of GWG were maternal age (summary estimate –0.10 kg, 95% CI –0.14 to –0.06 kg) and multiparity (summary estimate –0.73 kg, 95% CI –1.24 to –0.23 kg).LimitationsThe findings were limited by the lack of standardisation in the components of intervention, residual heterogeneity in effects across studies for most analyses and the unavailability of IPD in some studies.ConclusionDiet and lifestyle interventions in pregnancy are clinically effective in reducing GWG irrespective of risk factors, with no effects on composite maternal and fetal outcomes.Future workThe differential effects of lifestyle interventions on individual pregnancy outcomes need evaluation.Study registrationThis study is registered as PROSPERO CRD42013003804.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Differential Effect Of Interventions On Gestational Weight Gmentioning

confidence: 99%

Section: Network Meta-analysismentioning

confidence: 99%

Effects of antenatal diet and physical activity on maternal and fetal outcomes: individual patient data meta-analysis and health economic evaluation

Rogozińska

Marlin

Jackson

et al. 2017

Health Technol Assess

217

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“…27,28 Líkamsþyngdarstuðull er víða notaður til að meta þörf fyrir lífsstílsíhlutanir á meðgöngu, það er að segja aðgerðir sem fela í sér baett mataraeði og aukna hreyfingu sem geta skilað árangri sem er maelanlegur á formi minni þyngdaraukn-ingar á meðgöngu. 29,30 Hins vegar eru verndandi áhrif lífsstíls-íhlutana með tilliti til haettu á meðgöngusykursýki ekki eins skýr. 31 Nýlega voru birtar niðurstöður úr einni staerstu íhlutunarrann-sókn (n=1555) sem hefur verið framkvaemd meðal barnshafandi kvenna.…”

Section: Umraeðaunclassified

Fæðuval og næring kvenna á meðgöngu með tilliti til líkamsþyngdar

Gunnarsdóttir¹,

Tryggvadóttir²,

Birgisdóttir³

et al. 2016

LBL

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InngangurRannsóknir síðastliðinna 20 ára, baeði meðal manna og dýra, benda til þess að umhverfi fósturs í móðurkviði geti haft umtalsverð áhrif á heilsu afkvaemisins allt fram á fullorðinsár.1 Naeringarástand fyrir og á með-göngu getur ekki aðeins haft áhrif á heilsu móðurinn-ar heldur einnig á þroska, vöxt og heilsu barnsins til skemmri og lengri tíma. [2][3][4] Mataraeði mismunandi samfélagshópa hefur verið rannsakað hérlendis undanfarin ár. 5,6 Þekkingin hefur meðal annars nýst við stefnumótun í lýðheilsumálum. Mataraeði barnshafandi kvenna hefur verið rannsakað þrisvar sinnum síðastliðin 15 ár. 7-9 Tíðnispurningalisti var notaður til að kanna mataraeði í öllum þessum rannsóknum. Þrátt fyrir að reynslan af notkun slíks spurningalista sé góð í stórum faraldsfraeðilegum rannsókn-um þar sem aetlunin er að flokka einstaklinga í hópa eftir faeðuvali og tengja við heilsufarsþaetti 10-13 hentar þessi aðferðafraeði illa ef markmiðið er að magngreina neyslu matvaela og einstakra naeringarefna. Nákvaem-ar upplýsingar um neyslu matvaelategunda eru meðal annars mikilvaegar við að meta haettu á of mikilli eða lítilli neyslu naeringarefna miðað við ráðleggingar.14 Markmið rannsóknarinnar var að kanna faeðuval og naeringargildi faeðu meðal barnshafandi kvenna á höfuðborgarsvaeðinu, með áherslu á naeringarefni sem er talið að geti tengst fósturþroska. Notuð var vigtuð skráning alls matar og drykkjar sem konurnar neyttu í fjóra samfellda daga, sem er ein nákvaemasta aðferð sem völ er á við könnun á mataraeði einstaklinga. 10Tilgangur: Naeringarástand fyrir og á meðgöngu getur haft áhrif á þroska, vöxt og heilsu barnsins til skemmri og lengri tíma. Markmið rannsóknar-innar var að rannsaka naeringargildi faeðu hjá barnshafandi konum á höfuðborgarsvaeðinu og að kanna hvort mataraeði kvenna í kjörþyngd fyrir þungun vaeri frábrugðið því sem er hjá konum sem voru yfir kjörþyngd. Efniviður/aðferðir: Þátttakendur voru konur á aldrinum 18-40 ára (n=183), sem höfðu búsetu á höfuðborgarsvaeðinu. Mataraeði var kannað með fjögurra daga vigtaðri skráningu í 19.-24. viku meðgöngu (n=98 með líkamsþyngdarstuðull (LÞS) <25 kg/m 2 ); n=46 með LÞS 25-29,9 kg/m 2 og n=39 með LÞS ≥30 kg/m 2 ). Niðurstöður: Einungis 20% kvennanna náðu lágmarksviðmiðum trefjaneyslu sem eru 25 g á dag. Viðbaettur sykur veitti að jafnaði 12% (SF ± 5%) af heildarorku faeðisins. Um fjórðungur kvennanna gaeti hafa átt á haettu að fullnaegja ekki þörf fyrir joð, D-vítamín og DHA (dókósahexen-sýru ). Ofneysla vítamína og steinefna (úr faeði og baetiefnum) sást ekki. Miðgildi neyslu á mjólk og mjólkurvörum (346 g/dag miðað við 258 g/dag, p<0,05), gos-og svaladrykkjum (200 g/dag miðað við 122 g/dag, p<0,05) og kartöfluflögum og poppi (13 g/dag miðað við 0 g/dag, p<0,05) var haerra meðal kvenna með LÞS ≥30 kg/m 2 fyrir þungun heldur en kvenna sem voru í kjörþyngd fyrir þungun. Ályktanir: Huga þarf betur að faeðuvali kvenna fyrir og á meðgöngu, ekki síst meðal kvenna yfir kjörþyngd. Hluti barnshafandi kvenna fullnaegir ekki þörf fyrir naeringarefni á borð við joð, D-vítamín og...

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“…Increased physical activity in pregnant women in conjunction with a proper diet was connected with a lower risk of excessive weight gain in pregnancy, cesarean delivery, macrosomia, and neonatal respiratory morbidity [2], had a positive effect on the concentration of cholesterol, C-reactive protein (CRP), and blood pressure [3], and reduced the risk of preeclampsia [4] and gestational diabetes [5]. Regular exercise helped to maintain cardiovascular fitness levels throughout pregnancy, recovery of shape after childbirth [6], and improved sleep quality in pregnant women [7].…”

Section: Introductionmentioning

confidence: 99%

Validation of the Pregnancy Physical Activity Questionnaire (PPAQ)

Suliga¹,

Sobaś²,

Król³

2017

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Introduction: The results of many studies confirm the positive effect of physical activity during pregnancy on the health of both mother and child. Due to this, it is important to use standardised methods of its assessment. In 2004, Chasan-Taber et al. developed the Pregnancy Physical Activity Questionnaire (PPAQ ), taking into account household/caregiving activities, occupational activities, sports/exercise activities, transportation activities, and inactivity. Aim of the research: The validation of the Pregnancy Physical Activity Questionnaire (PPAQ ) by determination of its reproducibility. Material and methods:The questionnaire was validated from June 2014 to February 2015 among 164 women. The respondents were surveyed twice in a 2-week interval. The repeatability of the questionnaire was verified by determining the Pearson correlation coefficient between the results obtained for the same people in the first and second interview, thus determining the intra-subject variability. Inter-subject variability was analysed by comparing the average values of physical activity for the whole group using the Student's t-test for dependent samples. Results: For all levels of physical activity, a high correlation between the results obtained in both interviews was found. The correlation coefficient for total physical activity was r = 0.96. The reproducibility of the results obtained from PPAQ questionnaire was the highest for inactivity and moderate activity (r = 0.96). The analysis according to the type of activity showed that the reproducibility was the highest for occupational activity (r = 0.98). Conclusions: High reproducibility of results obtained using PPAQ questionnaire was found. This allows the assessed questionnaire to be considered as an accurate measurement tool that can be a source of reliable information about physical activity in pregnant women.

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Diet or exercise, or both, for preventing excessive weight gain in pregnancy

Cited by 448 publications

References 186 publications

Effects of antenatal diet and physical activity on maternal and fetal outcomes: individual patient data meta-analysis and health economic evaluation

Effects of antenatal diet and physical activity on maternal and fetal outcomes: individual patient data meta-analysis and health economic evaluation

Fæðuval og næring kvenna á meðgöngu með tilliti til líkamsþyngdar

Validation of the Pregnancy Physical Activity Questionnaire (PPAQ)

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