Association of Antenatal Diet and Physical Activity–Based Interventions With Gestational Weight Gain and Pregnancy Outcomes

Abstract

IMPORTANCE Excessive gestational weight gain (GWG) is common and associated with adverse pregnancy outcomes. Antenatal lifestyle interventions limit GWG; yet benefits of different intervention types and specific maternal and neonatal outcomes are unclear. OBJECTIVE To evaluate the association of different types of diet and physical activity-based antenatal lifestyle interventions with GWG and maternal and neonatal outcomes.DATA SOURCES A 2-stage systematic literature search of 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 was conducted from February 1, 2017, to May 31, 2020. Search results from the present study were integrated with those from a previous systematic review from 1990 to February 2017. STUDY SELECTION Randomized trials reporting GWG and maternal and neonatal outcomes.DATA EXTRACTION AND SYNTHESIS Data were extracted for random-effects meta-analyses to calculate the summary effect estimates and 95% CIs. MAIN OUTCOMES AND MEASURESOutcomes were clinically prioritized, with mean GWG as the primary outcome. Secondary outcomes included gestational diabetes, hypertensive disorders of pregnancy, cesarean section, preterm delivery, large or small for gestational age neonates, neonatal intensive care unit admission, or fetal death.RESULTS A total of 117 randomized clinical trials of antenatal lifestyle interventions (involving 34 546 women) were included. Overall lifestyle intervention was associated with reduced GWG (−1.15 kg; 95% CI, −1.40 to −0.91), risk of gestational diabetes (odds ratio [OR], 0.79; 95% CI, 0.70-0.89), and total adverse maternal outcomes (OR, 0.89; 95% CI, 0.84-0.94) vs routine care. Compared with routine care, diet was associated with less GWG (−2.63 kg; 95% CI, −3.87 to −1.40) than physical activity (−1.04 kg; 95% CI, −1.33 to −0.74) or mixed interventions (eg, unstructured lifestyle support, written information with weight monitoring, or behavioral support alone) (−0.74 kg; 95% CI, −1.06 to −0.43). Diet was associated with reduced risk of gestational diabetes (OR, 0.61; 95% CI, 0.45-0.82), preterm delivery (OR, 0.43; 95% CI, 0.22-0.84), large for gestational age neonate (OR, 0.19; 95% CI, 0.08-0.47), neonatal intensive care admission (OR, 0.68; 95% CI, 0.48-0.95), and total adverse maternal (OR, 0.75; 95% CI, 0.61-0.92) and neonatal outcomes (OR, 0.44; 95% CI, 0.26-0.72). Physical activity was associated with reduced GWG and reduced risk of gestational diabetes (OR, 0.60; 95% CI, 0.47-0.75), hypertensive disorders (OR, 0.66; 95% CI, 0.48-0.90), cesarean section (OR, 0.85; 95% CI, 0.75-0.95), and total adverse maternal outcomes (OR, 0.78; 95% CI, 0.71-0.86). Diet with physical activity was associated with reduced GWG (−1.35 kg; 95% CI, −1.95 to −0.75) and reduced risk of gestational diabetes (OR, 0.72; 95% CI, 0.54-0.96) and total adverse maternal outcomes (OR, 0.81; 95% CI, 0.69-0.95). Mixed interventions were associated with reduced GWG on...

Childbirth and Perinatal Outcomes of Healthy, Low-risk Pregnant Women With Abnormal Total Gestational Weight Gain.

“…Importantly, pregnancy is a time when women are more motivated to improve their health behaviors. [47] Of note, our data suggest that adherence to the 2009 NAM weight gain recommendations can be helpful in reducing risk of adverse outcomes among low-risk pregnant women. Thus, adequate training of clinicians to effectively counsel these women on achieving healthy weight gain targets appears mandatory.…”

Integrating multiple lines of evidence to assess the effects of maternal BMI on pregnancy and perinatal outcomes in up to 497,932 women

“…Recent systematic reviews of randomised controlled trials (RCTs) of diet and physical activity during pregnancy (N range: 12,526-34,546) reported some evidence of reduced risk of GDM, LGA, caesarean section in those randomised to the intervention, but no effect or mixed results of the intervention on HDP, PTB, NICU admission. 43–45 Of note, these studies aimed at managing weight gain during pregnancy rather than targeting weight reduction prior to pregnancy with a modest mean difference of −0.7 to −1.2 kg between women in the intervention compared to those randomised to standard care. In addition, evidence for many outcomes is uncertain due to the relatively small number of cases.…”

Optimising Cardiometabolic Risk Factors in Pregnancy: A Review of Risk Prediction Models Targeting Gestational Diabetes and Hypertensive Disorders

“…Maternal pre-existing obesity is a modifiable risk factor and represents an important opportunity for dietary and physical activity interventions at the preconception or early pregnancy stages. The risk of GDM and HDP may be partially mitigated through healthy lifestyle in pregnancy and limiting excessive GWG, based on a systematic review and meta-analysis of 117 randomised controlled trials with over 34,000 women [85]. Identifying those at high risk of metabolic complications enables targeted prevention before, during and beyond pregnancy.…”