Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis

Abstract

BackgroundOverweight and obesity pose a big challenge to pregnancy as they are associated with adverse maternal and perinatal outcome. Evidence of lifestyle intervention resulting in improved pregnancy outcome is conflicting. Hence the objective of this study is to determine the efficacy of antenatal dietary, activity, behaviour or lifestyle interventions in overweight and obese pregnant women to improve maternal and perinatal outcomes.MethodsA systematic review and meta-analyses of randomised and non-randomised clinical trials following prior registration (CRD420111122 http://www.crd.york.ac.uk/PROSPERO) and PRISMA guidelines was employed. A search of the Cochrane Library, EMBASE, MEDLINE, CINAHL, Maternity and Infant care and eight other databases for studies published prior to January 2012 was undertaken. Electronic literature searches, study selection, methodology and quality appraisal were performed independently by two authors. Methodological quality of the studies was assessed according to Cochrane risk of bias tool. All appropriate randomised and non-randomised clinical trials were included while exclusions consisted of interventions in pregnant women who were not overweight or obese, had pre-existing diabetes or polycystic ovarian syndrome, and systematic reviews. Maternal outcome measures, including maternal gestational weight gain, gestational diabetes and Caesarean section, were documented. Fetal outcomes, including large for gestational age and macrosomia (birth weight > 4 kg), were also documented.ResultsThirteen randomised and six non-randomised clinical trials were identified and included in the meta-analysis. The evidence suggests antenatal dietary and lifestyle intervention in obese pregnant women reduces maternal pregnancy weight gain (10 randomised clinical trials; n = 1228; -2.21 kg (95% confidence interval -2.86 kg to -1.59 kg)) and a trend towards a reduction in the prevalence of gestational diabetes (six randomised clinical trials; n = 1,011; odds ratio 0.80 (95% confidence interval 0.58 to 1.10)). There were no clear differences reported for other outcomes such as Caesarean delivery, large for gestational age, birth weight or macrosomia. All available studies were assessed to be of low to medium quality.ConclusionAntenatal lifestyle intervention is associated with restricted gestational weight gain and a trend towards a reduced prevalence of gestational diabetes in the overweight and obese population. These findings need to be interpreted with caution as the available studies were of poor to medium quality.

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

“…Of the 74 eligible studies (17,727 women), 36 (12,434 women) contributed data to the IPD meta-analysis: 33 (9320 women) evaluated GWG, 24 (8852 women) reported all four components of the composite maternal outcomes and 18 (7981 women) assessed all four components of the fetal/neonatal composite outcomes.…”

“…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.…”

Interaction between rs10830963 polymorphism in MTNR1B and lifestyle intervention on occurrence of gestational diabetes

“…The results of several intervention trials aimed at reducing GDM have been inconsistent and discouraging [7]. We hypothesised that these inconsistent results may in part be due to genetic factors, such as the rs10830963 polymorphism in MTNR1B.…”

The role of families and providers in preventing childhood obesity when we take a systems approach to ending the epidemic

“…To date, existing interventions to prevent excessive weight gain are so limited in number and effectiveness, that both the IOM [32] and the Agency for Health care Research and Quality (AHRQ) [33] have identified this as a major research gap. Interventions based on physical activity and dietary counseling, usually combined with supplementary weight monitoring [34,35], have had modest success in reducing the amount of excessive weight gained during pregnancy, but few efforts have been effective enough for women to gain within their IOM target range [36,37]. Thus, we need to design effective interventions that prevent excessive weight gain during pregnancy that are widely effective, practical, cost-effective, and have mechanisms for widespread diffusion.…”