Interventions for preventing excessive weight gain during pregnancy

Abstract

Background Excessive weight gain during pregnancy is associated with multiple maternal and neonatal complications. However, interventions to prevent excessive weight gain during pregnancy have not been adequately evaluated. Objectives To evaluate the effectiveness of interventions for preventing excessive weight gain during pregnancy and associated pregnancy complications. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (20 October 2011) and MEDLINE (1966 to 20 October 2011). Selection criteria All randomised controlled trials and quasi-randomised trials of interventions for preventing excessive weight gain during pregnancy. Data collection and analysis We assessed for inclusion all potential studies we identified as a result of the search strategy. At least two review authors independently assessed trial quality and extracted data. We resolved discrepancies through discussion. We have presented results using risk ratio (RR) for categorical data and mean difference for continuous data. We analysed data using a fixed-effect model. Main results We included 28 studies involving 3976 women; 27 of these studies with 3964 women contributed data to the analyses. Interventions focused on a broad range of interventions. However, for most outcomes we could not combine data in a meta-analysis, and where we did pool data, no more than two or three studies could be combined for a particular intervention and outcome. Overall, results from this review were mainly not statistically significant, and where there did appear to be differences between intervention and control groups, results were not consistent. For women in general clinic populations one (behavioural counselling versus standard care) of three interventions examined was associated with a reduction in the rate of excessive weight gain (RR 0.72, 95% confidence interval 0.54 to 0.95); for women in high-risk groups no intervention appeared to reduce excess weight gain. There were inconsistent results for mean weight gain (reported in all but one of the included studies). We found a statistically significant effect on mean weight gain for five interventions in the general population and for two interventions in high-risk groups. Most studies did not show statistically significant effects on maternal complications, and none reported significant effects on adverse neonatal outcomes. Authors’ conclusions There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Exercise interventions for weight management during pregnancy and up to 1 year postpartum among normal weight, overweight and obese women: a systematic review and meta-analysis

“…Similarly, Choi et al 54 showed that gestational weight gain was lower following a supervised physical activity intervention (WMD=−1.74 kg, 95% CI −3.66 to +0.19, p=0.077), with two studies included in the analyses. In contrast, Muktabhant et al 55 performed a Cochrane Review on interventions for preventing excessive weight gain during pregnancy. These authors concluded that there was not enough evidence to recommend any intervention, including exercise, for preventing excessive gestational weight gain.…”

Metabolic Syndrome in Children and Adolescents

“…Hypercaloric nutrition, for instance, as well as a lack of physical activity raises the risk for both increased weight and/or gestational diabetes [38,39]. The associated maternal hyperglycemia leads to continuing fetal hyperglycemia and overstimulation of the perinatal pancreatic B cells as well as to hyperinsulinemia with an increased risk of the development of type 1 diabetes in the fetus [40].…”

Weight-related SMS texts promoting appropriate pregnancy weight gain: A pilot study

“…Excessive gestational weight gain (GWG) puts both mother and baby at risk for obesity and subsequent obesity related chronic disease [1, 3-6]. Interventions targeting GWG have only been somewhat successful, and more so for select groups[7]. For example, normal weight, higher income women, and those receiving exercise and/or nutritional counseling respond better to the interventions and are less likely to exceed GWG recommendations during pregnancy than overweight, lower income women, and those receiving no advice [8-11].…”