Lifestyle Interventions to Improve Pregnancy Outcomes: a Systematic Review and Specified Meta-Analyses

Abstract

To compare the impact of lifestyle interventions for overweight and obese pregnant women a systematic review and meta-analysis was conducted using pre-registration and audit of the interventions as selection criteria. PubMed, Web of Science and CENTRAL were searched for randomized controlled trials examining diet, exercise, combined interventions or associated behavioral therapy. Trials were selected if they reported one of the primary outcomes (gestational diabetes, hypertensive disorders, perinatal mortality, admission to neonatal intensive care unit). Results were established from the total group and separately from pre-registered or clinically audited studies. Out of 1304 titles, 28 randomized controlled trials were included. Among the primary outcomes only hypertensive disorders were significantly reduced by exercise in the total group: odds ratio 0.52 (95% confidence interval 0.28 to 0.96, four trials, 1324 participants). When behavioral therapy supported combined interventions, maternal weight gain, (Standardized Mean Difference −0.16 kilogram; 95% confidence interval −0.28 to −0.04, four trials, 2132 participants) and neonatal birthweight, (Standardized Mean Difference −0.4 gram; 95% confidence interval −0.62 to −0.18, five trials, 1058 participants), were significantly reduced within the total group and both specified meta-analyses. Higher frequencies of physical activity improved the results. Risk of bias, assessed with the Cochrane Tool, was low to moderate. Elements of behavioral therapy might better prevent adverse effects of maternal obesity when combined with lifestyle interventions. Unfortunately, high heterogeneity due to different intervention and population characteristics was a limiting factor. Future studies should also focus on increased intensities of physical activity.

Systematic Reviews on the Prevention of Adverse Pregnancy Outcomes Related to Maternal Obesity to Improve Evidence-Based Counselling

“…Out of the 6/36 SRs comparing diet, exercise alone and a combination of both, two SRs showed a significant reduction of GDM in all three intervention arms 65 68 . One SR indicated a benefit of only exercise, whereas another suggested a benefit of a singular diet or singular exercise in contrast to a combined approach which was not successful 64 66 ; 2/6 SRs did not prove a significant effect on GDM by any intervention although all three intervention types were successful in limiting GWG or PIH 67 69 .…”

“…6/36 whereby only dietary, respectively exercise interventions were compared with a combination of both 64 65 66 67 68 69 .…”

“…The meta-analyses varied in reporting and analyzing details of the interventions. Seven meta-analyses performed detailed subgroup analyses indicating that an early initiation, high intensity and frequent performances were essential for a successful intervention 46 47 48 53 54 66 67 . Women should be motivated to accumulate at least 600 MET (metabolic equivalent of task) minutes of supervised moderate-intensity training which equals e.g.…”

Implementing weight management during and after pregnancy to reduce diabetes and CVD risk in maternal and child populations

“…Rates of women exceeding GWG recommendations (based on IOM criteria) were significantly lower after exercise-only and combined interventions during pregnancy. A separate systematic review also showed that when behavioural therapy supported combined diet and physical activity interventions, GWG was significantly reduced (standardised mean difference −0⋅16 kg; 95 % CI −0⋅28, −0⋅04, four trials, n = 2132) (87) . From an implementation perspective, the evaluation of existing pregnancy health behaviour change interventions (n = 117) using PIPE and template-for-interventiondescription-and-replication frameworks leads to some interesting findings.…”

Parental Obesity: The Pandemic of Intergenerational Physical and Mental Health Carnage

“…Behnam conducted a systematic review and meta-analysis of randomized controlled trials that examined diet, exercise, combined interventions or associated behavioral therapy to compare their impact on overweight and obese pregnant women [114]. Among the primary outcomes from the 28 trials selected for inclusion, only hypertensive disorders were significantly reduced by exercise in the total group.…”