34: Effect of a randomized controlled trial of an intensive medically supervised exercise program designed to improve maternal glucose control on gestational weight gain

Daly, Niamh; Farren, Maria; McKeating, Aoife; O’Higgins, Amy; Mullaney, L.

doi:10.1016/j.ajog.2016.11.926

Cited by 5 publications

(30 citation statements)

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“…67686970717273747576777879808182838485868788 A further 45 trials (9945 women)8990919293949596979899100101102103104105106107108109110111112113114115116117118119120121122123124125126127128129130131132133 were identified after the IPD acquisition timeline until February 2017.…”

Section: Resultsmentioning

confidence: 99%

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

2017

BMJ

268

184

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ObjectiveTo 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. DESIGNSystematic review and meta-analysis of individual participant data (IPD). DATA SOURCESMajor electronic databases from inception to February 2017 without language restrictions. ELIGIBILITY CRITERIA FOR SELECTING STUDIESRandomised trials on diet and physical activity based interventions in pregnancy. DATA SYNTHESISStatistical 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 CONCLUSIONDiet 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.

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Section: Resultsmentioning

confidence: 99%

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

2017

BMJ

268

184

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“…Study characteristics are presented in Table 2. Intervention types were structured diet in 13 studies, 25,27,31,44,59,60,80,86,106,114,118,120,123 structured physical activity in 42 studies, [32][33][34][35][36][37][38][39][40][41][42][43]46,[53][54][55]57,58,63,64,67,71,79,82,83,8588,90,93,94,[96][97][98]104,105,[107][108][109][111]…”

Section: Resultsmentioning

confidence: 99%

Implementation of Antenatal Lifestyle Interventions Into Routine Care

et al. 2022

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ImportanceLifestyle interventions in pregnancy optimize gestational weight gain and improve pregnancy outcomes, with implementation recommended by the US Preventive Services Task Force. Yet, implementation research taking these efficacy trials into pragmatic translation remains limited.ObjectiveTo evaluate success factors for implementing pregnancy lifestyle interventions into antenatal care settings in a meta-analysis, using the penetration, implementation, participation, and effectiveness (PIPE) impact metric.Data SourcesData from a previous systematic review that searched across 9 databases, including MEDLINE, Embase, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Health Technology Assessment Database, were obtained, in 2 stages, up to May 6, 2020.Study SelectionRandomized clinical trials reporting gestational weight gain in singleton pregnancies.Data Extraction and SynthesisThe association of penetration, implementation, and participation with effectiveness of antenatal lifestyle interventions in optimizing gestational weight gain was estimated using random-effects meta-analyses. The Cochrane risk of bias tool, version 1.0, was used to assess risk of bias.Main Outcomes and MeasuresPenetration (reach), implementation (fidelity), participation, and effectiveness of randomized clinical trials of lifestyle interventions in pregnancy.ResultsNinety-nine studies with 34 546 participants were included. Only 14 studies reported penetration of target populations. Overall, 38 studies (38.4%) had moderate fidelity, 25 (25.2%) had high fidelity, and 36 (36.4%) had unclear fidelity. Participation was reported in 84 studies (84.8%). Lifestyle interventions were associated with reducing gestational weight gain by 1.15 kg (95% CI, –1.40 to –0.91 kg).Conclusions and RelevanceThe findings of this systematic review and meta-analysis suggest that, despite the large body of evidence on efficacy of lifestyle interventions during pregnancy in optimizing gestational weight gain, little guidance is available to inform implementation of this evidence into practice. There is a need to better elucidate implementation outcomes in trial design alongside pragmatic implementation research to improve the health of women who are pregnant and the next generation.

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“…1 for the flow chart and Tables 2 and 3 for studies characteristics). Nine additional studies not included in the previous meta-analyses were included [ 28 , 51 , 52 , 55 , 65 , 70 , 76 , 77 , 80 ]. Most studies (12) were conducted in the USA [ 31 , 33 , 36 , 37 , 41 , 42 , 47 , 49 , 61 , 66 , 73 , 92 ]; others were from Australia and New Zealand [ 29 , 62 , 101 ], Brazil [ 43 , 52 , 53 , 63 , 68 , 74 , 81 ], Canada [ 28 , 65 ], Colombia [ 72 ], Croatia [ 80 ], Denmark [ 30 , 32 , 34 , 35 , 40 ], Finland [ 54 ], Iran [ 56 , 57 ], Kosovo [ 67 ], The Netherlands [ 69 ], Norway [ 55 , 60 , 102 ], Spain [ 44 – 46 , 48 , 50 , 70 , 79 ], Sweden [ 71 ], and the UK [ 38 , 39 , 76 ].…”

Section: Resultsmentioning

confidence: 99%

“…No study recruited previously active women, 16 recruited inactive women [ 43 , 44 , 46 , 49 , 52 , 53 , 55 – 58 , 66 – 68 , 70 , 73 , 92 , 102 ], and the rest did not use previous exercise levels as a criterion. Most studies did not consider maternal BMI in their inclusion criteria, although eight specifically recruited women with overweight and/or obesity [ 51 , 55 , 64 , 68 , 69 , 75 , 77 , 81 ], and three [ 49 , 57 , 65 ] women without overweight. The majority of experimental trials included healthy pregnant women, except five who targeted women with type 1 [ 61 ] or gestational diabetes [ 47 , 52 , 69 , 74 , 80 ], whereas observational cohorts were locally representative [ 31 , 32 , 41 , 42 ], nationally representative [ 28 , 30 , 34 , 35 , 38 – 40 ], or convenience samples [ 29 , 36 , 37 ].…”

Section: Resultsmentioning

confidence: 99%

Exercise in Pregnancy and Children’s Cardiometabolic Risk Factors: a Systematic Review and Meta-Analysis

et al. 2018

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BackgroundMaternal metabolic health during the prenatal period is an established determinant of cardiometabolic disease risk. Many studies have focused on poor offspring outcomes after exposure to poor maternal health, while few have systematically appraised the evidence surrounding the role of maternal exercise in decreasing this risk.The aim of this study is to characterize and quantify the specific impact of prenatal exercise on children’s cardiometabolic health markers, at birth and in childhood.MethodsA systematic review of Scopus, MEDLINE, EMBASE, CENTRAL, CINAHL, and SPORTDiscus up to December 2017 was conducted.Randomized controlled trials (RCTs) and prospective cohort studies of prenatal aerobic exercise and/or resistance training reporting eligible offspring outcomes were included.Four reviewers independently identified eligible citations and extracted study-level data. The primary outcome was birth weight; secondary outcomes, specified a priori, included large-for-gestational age status, fat and lean mass, dyslipidemia, dysglycemia, and blood pressure. We included 73 of the 9804 citations initially identified. Data from RCTs was pooled using random effects models. Statistical heterogeneity was quantified using the I2 test. Analyses were done between June and December 2017 and the search was updated in December 2017.ResultsFifteen observational studies (n = 290,951 children) and 39 RCTs (n = 6875 children) were included. Observational studies were highly heterogeneous and had discrepant conclusions, but globally showed no clinically relevant effect of exercise on offspring outcomes. Meta-analyzed RCTs indicated that prenatal exercise did not significantly impact birth weight (mean difference [MD] − 22.1 g, 95% confidence interval [CI] − 51.5 to 7.3 g, n = 6766) or large-for-gestational age status (risk ratio 0.85, 95% CI 0.51 to 1.44, n = 937) compared to no exercise. Sub-group analyses showed that prenatal exercise reduced birth weight according to timing (starting after 20 weeks of gestation, MD − 84.3 g, 95% CI − 142.2, − 26.4 g, n = 1124), type of exercise (aerobic only, MD − 58.7 g, 95% CI − 109.7, − 7.8 g; n = 2058), pre-pregnancy activity status (previously inactive, MD − 34.8 g, 95% CI − 69.0, − 0.5 g; n = 2829), and exercise intensity (light to moderate intensity only, MD − 45.5 g, 95% CI − 82.4, − 8.6 g; n = 2651). Fat mass percentage at birth was not altered by prenatal exercise (0.19%, 95% CI − 0.27, 0.65%; n = 130); however, only two studies reported this outcome. Other outcomes were too scarcely reported to be meta-analyzed.ConclusionsPrenatal exercise does not causally impact birth weight, fat mass, or large-for-gestational-age status in a clinically relevant way. Longer follow up of offspring exposed to prenatal exercise is needed along with measures of relevant metabolic variables (e.g., fat and lean mass).Protocol RegistrationProtocol registration number: CRD42015029163.Electronic supplementary materialThe online version of this article (10.1186/s40798-018-0148-x) contains supplementar...

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34: Effect of a randomized controlled trial of an intensive medically supervised exercise program designed to improve maternal glucose control on gestational weight gain

Cited by 5 publications

References 0 publications

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

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

Implementation of Antenatal Lifestyle Interventions Into Routine Care

Exercise in Pregnancy and Children’s Cardiometabolic Risk Factors: a Systematic Review and Meta-Analysis

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