Lifestyle Interventions for Obese and Overweight Pregnant Women to Improve Pregnancy Outcome: a Systematic Review and Meta-analysis

Abstract: Background: Obesity in pregnancy increases health risks for both mother and child during and after pregnancy, but reducing maternal obesity remains a major public health challenge. Evidence for lifestyle interventions resulting in improved pregnancy outcome in obese pregnancies is conflicting. This study aimed to determine the effectiveness of antenatal dietary, activity, or lifestyle interventions in obese and overweight pregnant women to improve maternal and perinatal outcome. Methods: A systematic search for articles published between Jan 1, 1990, and Feb 1, 2014, was undertaken. We searched mainstream databases (Cochrane Library, Medline, Embase, CINAHL, Maternity and Infant Care, opensigle.inist.fr ), and did targeted searches of nine other databases. The searches were unrestricted by language and were limited to human studies and clinical trials. Search terms were: “overweight or obesity”, “pregnancy or pregnancy complications”, “lifestyle”, “early intervention”, “health education”, “patient education”, “exercise”, “exercise therapy”, “health promotion”, “diet”, “carbohydrate-restricted diet”, “fat-restricted diet”, “diet therapy”, “weight loss”. Two reviewers working independently assessed studies for methodological quality and appropriateness for inclusion. Disagreements between reviewers were resolved by consensus. The quality of the studies was assessed on the basis of how the studies had minimised bias in their methods. We categorised the studies according to criteria based on PRISMA guidelines and the Cochrane Library. We carried out the meta-analyses by calculating risk ratios using a random-effects model and where appropriate we measured mean difference. Randomised controlled trials (RCTs) and non-RCTs were analysed separately. Findings: 21 studies were included in the analysis (15 RCTs, six non-RCTs), and all were from developed countries. One RCT was judged to be high quality, six medium quality, and eight low quality. All six non-RCTs were classified as low quality. RCTs provided data on 4835 participants and non-RCTs 1534 participants. Meta-analysis of RCTs and non-RCTs showed that lifestyle interventions had a borderline effect on restricting gestational weight gain (–1·67 kg, 95% CI –3·34 to 0·01). There was no significant difference in the prevalence of gestational diabetes in overweight and obese women. There was no robust evidence that lifestyle interventions were associated with a lower prevalence of caesarean delivery, large for gestational age fetus, or birth weight. Interpretation: Existing evidence on the effectiveness of lifestyle interventions for obese and overweight women during pregnancy shows no, or only borderline, reduction in adverse outcome. Funding: National Institute for Health Research, Tommys Charity, and Guy’s and St Thomas’ Charity.

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