Key Components of Antenatal Lifestyle Interventions to Optimize Gestational Weight Gain

Abstract

ImportanceRandomized clinical trials have found that antenatal lifestyle interventions optimize gestational weight gain (GWG) and pregnancy outcomes. However, key components of successful interventions for implementation have not been systematically identified.ObjectiveTo evaluate intervention components using the Template for Intervention Description and Replication (TIDieR) framework to inform implementation of antenatal lifestyle interventions in routine antenatal care.Data SourcesIncluded studies were drawn from a recently published systematic review on the efficacy of antenatal lifestyle interventions for optimizing GWG. The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, MEDLINE, and Embase were searched from January 1990 to May 2020.Study SelectionRandomized clinical trials examining efficacy of antenatal lifestyle interventions in optimizing GWG were included.Data Extraction and SynthesisRandom effects meta-analyses were used to evaluate the association of intervention characteristics with efficacy of antenatal lifestyle interventions in optimizing GWG. The results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Data extraction was performed by 2 independent reviewers.Main Outcomes and MeasuresThe main outcome was mean GWG. Measures included characteristics of antenatal lifestyle interventions comprising domains related to theoretical framework, material, procedure, facilitator (allied health staff, medical staff, or researcher), delivery format (individual or group), mode, location, gestational age at commencement (<20 wk or ≥20 wk), number of sessions (low [1-5 sessions], moderate [6-20 sessions], and high [≥21 sessions]), duration (low [1-12 wk], moderate [13-20 wk], and high [≥21 wk]), tailoring, attrition, and adherence. For all mean differences (MDs), the reference group was the control group (ie, usual care).ResultsOverall, 99 studies with 34 546 pregnant individuals were included with differential effective intervention components found according to intervention type. Broadly, interventions delivered by an allied health professional were associated with a greater decrease in GWG compared with those delivered by other facilitators (MD, −1.36 kg; 95% CI, −1.71 to −1.02 kg; P < .001). Compared with corresponding subgroups, dietary interventions with an individual delivery format (MD, −3.91 kg; 95% CI −5.82 to −2.01 kg; P = .002) and moderate number of sessions (MD, −4.35 kg; 95% CI −5.80 to −2.89 kg; P < .001) were associated with the greatest decrease in GWG. Physical activity and mixed behavioral interventions had attenuated associations with GWG. These interventions may benefit from an earlier commencement and a longer duration for more effective optimization of GWG.Conclusions and RelevanceThese findings suggest that pragmatic research may be needed to test and evaluate effective intervention components to inform implementation of interventions in routine antenatal care for broad public health benefit.

Remote lifestyle intervention to reduce postpartum weight retention: Protocol for a community-engaged hybrid type I effectiveness-implementation trial (Preprint)

“…As an effectiveness trial, we apply the broadest eligibility criteria to enhance generalizability: Evidence shows that starting an intervention early in pregnancy has the greatest impact on pregnancy outcomes and GWG [47,48]. However, many home visiting programs rely on several steps to occur before services can begin, i.e., entry in prenatal care, referrals from clinic, screening by outside agency for eligibility, and outreach by home visiting program.…”

Impact Evaluation of the Get Healthy in Pregnancy Program: Evidence of Effectiveness

“…Systematic review evidence for the optimal dose of health coaching for obesity and type 2 diabetes interventions has identified that on average, 12-15 sessions of 35-40 min across 7-9 months are used in practice [31]. Moreover, a recent systematic review has identified six or more sessions as optimal in efficacious antenatal lifestyle interventions [32]. Given the emerging best practice guidelines for the dose of lifestyle interventions during pregnancy, further investigation into the optimal number of calls and gestational age for enrolment in the GHiP program is warranted.…”

Healthful Eating Behaviors among Couples Contribute to Lower Gestational Weight Gain

“…According to the National Academy of Medicine (NAM) report in 2009, GWG associated with the lowest risk of adverse maternal and neonatal health outcomes is dependent on pre-gravid BMI [ 5 , 6 ]. Programs during pregnancy centered around diet, which include individual-level considerations for dietary intake and eating behaviors, have been shown to be the most effective interventions to reduce GWG [ 7 , 8 ]. As excess GWG is associated with more energy intake compared with energy expenditure [ 9 , 10 , 11 , 12 ], it is imperative to understand how eating behaviors contribute to GWG to advance effective program strategies to achieve the recommended GWG.…”