Antenatal interventions for overweight or obese pregnant women: a systematic review of randomised trials

Abstract

Background Overweight and obesity during pregnancy is an increasing health problem.Objective A systematic review to assess the benefits and harms of antenatal dietary or lifestyle interventions for pregnant women who are overweight or obese.Search strategy The Cochrane Controlled Trials Register (CENTRAL) was searched (last search January 2010). Reference lists of retrieved studies were searched by hand. No date or language restrictions were used.Selection criteria Randomised controlled trials comparing antenatal dietary and/or lifestyle or other interventions with no treatment for overweight or obese women were considered. Studies were evaluated independently for appropriateness for inclusion and methodological quality. The primary outcome was large-for-gestational-age infants.Data collection and analysis Nine randomised controlled trials were included involving 743 women who were overweight or obese during pregnancy. Seven trials compared a dietary intervention with standard antenatal care.Main results There were no statistically significant differences identified between women who received an antenatal intervention and those who did not for the large-for-gestational-age infant outcome (three studies; 366 women; risk ratio 2.02; 95% CI 0.84, 4.86) or mean gestational weight gain [four studies; 416 women; weighted mean difference )3.10 kg; 95% CI )8.32, 2.13 (randomeffects model)]. There were no statistically significant differences identified for other reported outcomes.Author's conclusions The effect of providing an antenatal dietary intervention for overweight or obese pregnant women on maternal and infant health outcomes remains unclear.

Maternal abdominal subcutaneous fat thickness as a predictor for adverse pregnancy outcome: a longitudinal cohort study

“…Most studies have assessed changes in weight gain throughout pregnancy, not change in subcutaneous fat. In a review of the literature on weight gain in pregnancy, Dodd (2010) was unable to demonstrate any statistical difference in perinatal outcomes when weight gain was restricted. 40 We have shown a correlation between BMI and SFT2, consistent with a previous report.…”

“…In a review of the literature on weight gain in pregnancy, Dodd (2010) was unable to demonstrate any statistical difference in perinatal outcomes when weight gain was restricted. 40 We have shown a correlation between BMI and SFT2, consistent with a previous report. 29 Our research has also demonstrated that there is a wide variation in SFT1 and SFT2 for any given BMI in the overweight/obese categories ( Figure 1).…”

“If she wants to eat…and eat and eat…fine! It's gonna feed the baby”: Pregnant women and partners' perceptions and experiences of pregnancy with a BMI >40 kg/m 2

“…In women with a BMI > 40 kg/m 2 (very severely obese), for whom pregnancy risks are incrementally greater (CMACE/RCOG, 2010), limiting gestational weight gain may reduce the risk of adverse pregnancy outcomes (Crane et al, 2009). A number of randomised-controlled trials have sought to examine the efficacy of pregnancy intervention approaches such as diet and exercise programmes, cognitive behavioural therapy (CBT), and social (cognitive) learning theory, on maternal weight gain and fetal growth (Dodd et al, 2010;Smith and Lavender 2011;Thangaratinam et al, 2012). However, recent RCTs of behaviour change interventions have experienced low uptake (Dodd et al, 2014;Poston et al, 2015), indicating poor acceptability.…”

“…However, recent RCTs of behaviour change interventions have experienced low uptake (Dodd et al, 2014;Poston et al, 2015), indicating poor acceptability. Multiple systematic reviews (Dodd et al, 2010;Campbell et al, 2011) and meta-analyses (Oteng-Ntim et al, 2012;Agha et al, 2014) have concluded that behaviour change interventions to date which have focused on limiting GWG via a combination of dietary counselling, weight monitoring, and exercise programmes for all categories of women with a BMI > 30 kg/m 2 have had moderate to no influence on GWG, and no effect on other perinatal outcomes.…”

Improving pregnancy outcome in obese women

“…pre-eclampsia, gestational diabetes, caesarean section, fetal macrosomia and/or offspring obesity) consequences of obesity? Many trials use limitation of maternal weight gain during pregnancy as their primary outcome (11) . Maternal obesity is a significant determinant of gestational weight gain, which if excessive is an independent predictor of adverse maternal and fetal outcome for pregnancy, with consequent lifelong health implications.…”