TY - JOUR
T1 - Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes
T2 - meta-analysis of individual participant data from randomised trials
AU - International Weight Management in Pregnancy (i-WIP) Collaborative Group
AU - Thangaratinam, Shakila
A2 - Jackson, Louise
A2 - Roberts, Tracy
A2 - Barton, Pelham
N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
PY - 2017/7/19
Y1 - 2017/7/19
N2 - Objective: To 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.Design: Systematic review and meta-analysis of individual participant data (IPD).Data sources: Major electronic databases from inception to February 2017 without language restrictions.Eligibility criteria for selecting studies: Randomised trials on diet and physical activity based interventions in pregnancy.Data synthesis: Statistical 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 were obtained from 36 randomised trials (12 526 women). Less weight gain occurred in the intervention group than control group (mean difference −0.70 kg, 95% confidence interval −0.92 to −0.48 kg, I2=14.1%; 33 studies, 9320 women). Although summary effect estimates favoured the intervention, the reductions in maternal (odds ratio 0.90, 95% confidence interval 0.79 to 1.03, I2=26.7%; 24 studies, 8852 women) and offspring (0.94, 0.83 to 1.08, I2=0%; 18 studies, 7981 women) composite outcomes were not statistically significant. No evidence was found of differential intervention effects across subgroups, for either gestational weight gain or composite outcomes. There was strong evidence that interventions reduced the odds of caesarean section (0.91, 0.83 to 0.99, I2=0%; 32 studies, 11 410 women), but not for other individual complications in IPD meta-analysis. When IPD were supplemented with study level data from studies that did not provide IPD, the overall effect was similar, with stronger evidence of benefit for gestational diabetes (0.76, 0.65 to 0.89, I2=36.8%; 59 studies, 16 885 women).Conclusion: Diet 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.
AB - Objective: To 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.Design: Systematic review and meta-analysis of individual participant data (IPD).Data sources: Major electronic databases from inception to February 2017 without language restrictions.Eligibility criteria for selecting studies: Randomised trials on diet and physical activity based interventions in pregnancy.Data synthesis: Statistical 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 were obtained from 36 randomised trials (12 526 women). Less weight gain occurred in the intervention group than control group (mean difference −0.70 kg, 95% confidence interval −0.92 to −0.48 kg, I2=14.1%; 33 studies, 9320 women). Although summary effect estimates favoured the intervention, the reductions in maternal (odds ratio 0.90, 95% confidence interval 0.79 to 1.03, I2=26.7%; 24 studies, 8852 women) and offspring (0.94, 0.83 to 1.08, I2=0%; 18 studies, 7981 women) composite outcomes were not statistically significant. No evidence was found of differential intervention effects across subgroups, for either gestational weight gain or composite outcomes. There was strong evidence that interventions reduced the odds of caesarean section (0.91, 0.83 to 0.99, I2=0%; 32 studies, 11 410 women), but not for other individual complications in IPD meta-analysis. When IPD were supplemented with study level data from studies that did not provide IPD, the overall effect was similar, with stronger evidence of benefit for gestational diabetes (0.76, 0.65 to 0.89, I2=36.8%; 59 studies, 16 885 women).Conclusion: Diet 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.
KW - Diet
KW - Exercise Therapy
KW - Female
KW - Humans
KW - Obesity
KW - Pregnancy
KW - Pregnancy Complications
KW - Pregnancy Outcome
KW - Randomized Controlled Trials as Topic
KW - Weight Gain
KW - Journal Article
KW - Meta-Analysis
KW - Review
U2 - 10.1136/bmj.j3119
DO - 10.1136/bmj.j3119
M3 - Review article
C2 - 28724518
SN - 1756-1833
VL - 358
JO - BMJ
JF - BMJ
M1 - j3119
ER -