Interventions to reduce or prevent obesity in pregnant women: a systematic review.

Thangaratinam, Shakila; Rogozińska, Ewelina; Jolly, Kate; Glinkowski, S; Duda, W; Borowiack, E; Roseboom, Tessa J.; Tomlinson, J W; Walczak, J; Kunz, Regina; Mol, Ben Willem J.; Coomarasamy, Arri; Khan, Khalid S.

doi:10.3310/hta16310

Cited by 208 publications

(225 citation statements)

References 79 publications

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“…7 However, aggregate data meta-analysis was limited because of the inability to explain heterogeneity of effects for important maternal and fetal/neonatal outcomes. This heterogeneity might be a result of variation in maternal characteristics, such as BMI, age, ethnicity and parity with varied weight gain.…”

Section: Differential Effect Of Interventions On Gestational Weight Gmentioning

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

231

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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%

“…7 We identified 3551 potentially relevant citations (Figure 2). We also identified 57 potential papers from references of included studies and four from oral communications.…”

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

231

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“…a good energy balance, persist a long time after the study participation. Therefore, MI seems to be one effective method but also dietary and physical interventions during pregnancy have shown to be effective reducing gestational weight gain (Thangaratinam et al, 2012).…”

Section: Control Groupmentioning

confidence: 99%

Weight six years after childbirth: A follow-up of obese women in a weight-gain restriction programmme

2014

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Objective: to compare weight development in an intervention group and a control group, six years after participation in a gestational weight-gain restriction programme.Design: follow-up of a prospective intervention study.Settings: antenatal care clinics.Participants: a total of 129 women (88.4 %) from the original intervention group and 166 women (88.8 %) from the original control group.Measurements: the women answered a study specific questionnaire, covering sociodemographic data and health-and weight status. Findings:After adjusting for socio-demographic factors, the mean weight was lower (4.1 kg) among the women in the intervention group, compared to the controls (p=0.028).Furthermore, the mean weight change, e.g. the weight at the six year assessment compared with the weight at the start of the intervention at the first antenatal care visit, was greater in the intervention group than in the control group. The women in the intervention group had a larger mean weight change (-5.2 kg), e.g. weighed less than the women in the control group (-1.9 kg) (p=0.046). Mean weight change expressed in 5 kg classes also showed a significant difference between the two groups (p=0.030).Key conclusions: the results indicate that attending a gestational weight-gain-restriction programme can have a positive effect on weight up to six years after the intervention.Implication for practise: a restrictive gestational weight gain can result in a positive weight development during the first years after childbirth. It might provide both short-and long term medical health benefits for the mother as well as the child.

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“…7 However, much of this evidence is drawn from observational studies prone to selection biases, and randomised controlled trials have generally been under-powered to detect effects on mortality outcomes.…”

Section: Perinatal Conditionsmentioning

confidence: 99%

Child death in high-income countries

2014

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Interventions to reduce or prevent obesity in pregnant women: a systematic review.

Cited by 208 publications

References 79 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

Weight six years after childbirth: A follow-up of obese women in a weight-gain restriction programmme

Child death in high-income countries

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