Interventions designed to limit gestational weight gain: a systematic review of theory and meta‐analysis of intervention components

Abstract

Limiting gestational weight gain (GWG) to recommended levels is important to optimize health outcomes for mother and baby. Surprisingly, a recent review revealed that theory-based interventions to limit GWG were less effective than interventions that did not report a theory-base; however, strict criteria were used to identify theory-informed studies. We extended this review and others by systematically evaluating the theories of behaviour change informing GWG interventions using a generalized health psychology perspective, and meta-analysing behaviour change techniques reported in the interventions. Interventions designed to limit GWG were searched for using health, nursing and psychology databases. Papers reporting an underpinning theory were identified and the CALO-RE taxonomy was used to determine individual behaviour change techniques. Nineteen studies were identified for inclusion. Eight studies were informed by a behaviour change theory; six reported favourable effects on GWG. Overall, studies based on theory were as effective as non-theory-based studies at limiting GWG. Furthermore, the provision of information, motivational interviewing, behavioural self-monitoring and providing rewards contingent on successful behaviour appear to be key strategies when intervening in GWG. Combining these behaviour change techniques with dietary interventions may be most effective. Future research should focus on determining the exact combination of behaviour change techniques, or which underpinning theories, are most useful for limiting GWG.

Can a health coaching intervention delivered during pregnancy help prevent excessive gestational weight gain?

“…Despite this, given the limited overall success of GWG interventions to date, the findings regarding our primary outcomes of GWG are not totally unexpected. In a review of the use of psychological theory in GWG interventions, theory-based interventions were shown to be as effective at limiting GWG as interventions that were not based on theory, however when considering all types of studies together, intervention effectiveness was limited (Hill et al, 2013a). Furthermore, of the theory-based studies that were reviewed, intervention effectiveness was often restricted to total GWG but not classifications of excessive GWG, and in two studies the intervention was not effective.…”

“…Several reviews have attempted to discern effective BCTs from GWG interventions, with provision of information on the consequences of behaviour to the individual, motivational interviewing, self-monitoring of behaviour, providing rewards contingent on successful behaviour (Hill et al, 2013a), and goal setting (Brown et al, 2012) potentially useful strategies to help women achieve optimal GWG. It is interesting to note that despite the inclusion of 11 BCTs in HIPP (see Skouteris et al, 2015), including BCTs that have previously been found to be effective, efficacy was not established in this study.…”

“…To date, overall efficacy of interventions designed to limit or prevent excessive GWG has been limited; on average intervention women gain only 1.2-1.5 kg less than control participants (Gardner et al, 2011;Hill et al, 2013a). It has been suggested that ineffectiveness of these interventions may be due a lack of consideration of psychosocial factors (Gardner et al, 2011;Institute of Medicine, 2007).…”

“…Such factors include motivation, mood, body image, and coping skills, which have been shown to play a role in the gestational weight trajectory (Hill et al, 2013b;Morling et al, 2003). While some GWG interventions have been informed by psychological theories, use of theory has been inconsistent (Hill et al, 2013a). Gestational weight gain interventions that are grounded in theory and focus on psychosocial factors in order to achieve behaviour change are clearly warranted.…”

Determinants of gestational weight gain with special respect to maternal stature height and its consequences for newborn vital parameters

“…Inadequate gestational weight gain mainly results in small for gestational age newborns (Johansson et al 2007, Kiel et al 2007, Han et al 2011, Jeric et al 2013, and consequently with increased newborn morbidity and mortality (Savitz et al 2011). Excessive gestational weight gain in contrast, has been associated with increased rates of pregnancy complications such as large for gestational age newborns, preeclampsia, gestational diabetes, gestational hypertension, increased rates of caesarean sections, but also long term effects such as increased rates of obesity among mothers and offspring (Rössner 1997, Gunderson & Abrams 2000, Kac et al 2004, Cedergren 2006, Kabali & Werler 2007, Wrotinak et al 2008, Chung et al 2013, Hill et al 2013. Although nobody denies the importance of an appropriate gestational weight gain for female reproductive success, the appropriate amount of gestational weight gain is still discussed controversial (Ronnberg & Nilson 2010,Zilko et al 2010, Daemers et al 2013.…”