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

Abstract

BACKGROUND

Overweight 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.

METHODS

A 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.

RESULTS

Thirteen 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.

CONCLUSION

Antenatal 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.

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  • Authors+Show Affiliations

    ,

    Department of Women's Health, Guy's and St Thomas' NHS Foundation Trust (King's Health Partners), St Thomas' Hospital, Westminster Bridge Road, London, SE 1 7EH, UK. Eugene.oteng-ntim@gstt.nhs.uk

    , , ,

    Source

    BMC medicine 10: 2012 May 10 pg 47

    MeSH

    Behavior Therapy
    Clinical Trials as Topic
    Diet
    Exercise
    Female
    Humans
    Life Style
    Overweight
    Pregnancy
    Pregnancy Complications
    Pregnancy Outcome

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    22574949

    Citation

    Oteng-Ntim, Eugene, et al. "Lifestyle Interventions for Overweight and Obese Pregnant Women to Improve Pregnancy Outcome: Systematic Review and Meta-analysis." BMC Medicine, vol. 10, 2012, p. 47.
    Oteng-Ntim E, Varma R, Croker H, et al. Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis. BMC Med. 2012;10:47.
    Oteng-Ntim, E., Varma, R., Croker, H., Poston, L., & Doyle, P. (2012). Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis. BMC Medicine, 10, p. 47. doi:10.1186/1741-7015-10-47.
    Oteng-Ntim E, et al. Lifestyle Interventions for Overweight and Obese Pregnant Women to Improve Pregnancy Outcome: Systematic Review and Meta-analysis. BMC Med. 2012 May 10;10:47. PubMed PMID: 22574949.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis. AU - Oteng-Ntim,Eugene, AU - Varma,Rajesh, AU - Croker,Helen, AU - Poston,Lucilla, AU - Doyle,Pat, Y1 - 2012/05/10/ PY - 2011/12/23/received PY - 2012/05/10/accepted PY - 2012/5/12/entrez PY - 2012/5/12/pubmed PY - 2012/9/6/medline SP - 47 EP - 47 JF - BMC medicine JO - BMC Med VL - 10 N2 - BACKGROUND: Overweight 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. METHODS: A 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. RESULTS: Thirteen 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. CONCLUSION: Antenatal 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. SN - 1741-7015 UR - https://www.unboundmedicine.com/medline/citation/22574949/full_citation L2 - https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-10-47 DB - PRIME DP - Unbound Medicine ER -