Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials
Top Cited Papers
Open Access
- 19 July 2017
- Vol. 358, j3119
- https://doi.org/10.1136/bmj.j3119
Abstract
Objective To synthesise the evidence on the overall and differential effects of interventions based on diet and physical activity during pregnancy, primarily on gestational weight gain and maternal and offspring composite outcomes, according to women’s body mass index, age, parity, ethnicity, and pre-existing medical condition; and secondarily on individual complications. Design Systematic review and meta-analysis of individual participant data (IPD). Data sources Major electronic databases from inception to February 2017 without language restrictions. Eligibility criteria for selecting studies Randomised trials on diet and physical activity based interventions in pregnancy. Data synthesis Statistical models accounted for clustering of participants within trials and heterogeneity across trials leading to summary mean differences or odds ratios with 95% confidence intervals for the effects overall, and in subgroups (interactions). Results IPD were obtained from 36 randomised trials (12 526 women). Less weight gain occurred in the intervention group than control group (mean difference −0.70 kg, 95% confidence interval −0.92 to −0.48 kg, I2=14.1%; 33 studies, 9320 women). Although summary effect estimates favoured the intervention, the reductions in maternal (odds ratio 0.90, 95% confidence interval 0.79 to 1.03, I2=26.7%; 24 studies, 8852 women) and offspring (0.94, 0.83 to 1.08, I2=0%; 18 studies, 7981 women) composite outcomes were not statistically significant. No evidence was found of differential intervention effects across subgroups, for either gestational weight gain or composite outcomes. There was strong evidence that interventions reduced the odds of caesarean section (0.91, 0.83 to 0.99, I2=0%; 32 studies, 11 410 women), but not for other individual complications in IPD meta-analysis. When IPD were supplemented with study level data from studies that did not provide IPD, the overall effect was similar, with stronger evidence of benefit for gestational diabetes (0.76, 0.65 to 0.89, I2=36.8%; 59 studies, 16 885 women). Conclusion Diet and physical activity based interventions during pregnancy reduce gestational weight gain and lower the odds of caesarean section. There is no evidence that effects differ across subgroups of women.This publication has 122 references indexed in Scilit:
- Safety and efficacy of a lifestyle intervention for pregnant women to prevent excessive maternal weight gain: a cluster-randomized controlled trialBMC Pregnancy and Childbirth, 2013
- Health and Economic Burden of Obesity in BrazilPLOS ONE, 2013
- The effects of yoga in prevention of pregnancy complications in high-risk pregnancies: A randomized controlled trialPreventive Medicine, 2012
- The LiP (Lifestyle in Pregnancy) StudyDiabetes Care, 2011
- Improving diet and exercise in pregnancy with Video Doctor counseling: A randomized trialPatient Education and Counseling, 2011
- Primary Prevention of Gestational Diabetes Mellitus and Large-for-Gestational-Age Newborns by Lifestyle Counseling: A Cluster-Randomized Controlled TrialPLoS Medicine, 2011
- Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery StudyThe American Journal of Clinical Nutrition, 2011
- Water aerobics in pregnancy: cardiovascular response, labor and neonatal outcomesReproductive Health, 2008
- Measuring inconsistency in meta-analysesBMJ, 2003
- Individual patient‐ versus group‐level data meta‐regressions for the investigation of treatment effect modifiers: ecological bias rears its ugly headStatistics in Medicine, 2002