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Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials.

Abstract 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, I(2)=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, I(2)=26.7%; 24 studies, 8852 women) and offspring (0.94, 0.83 to 1.08, I(2)=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, I(2)=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, I(2)=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.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title bmj (clinical research ed.)
Publication Year Start




PMID- 28724518
OWN - NLM
STAT- MEDLINE
DA  - 20170720
DCOM- 20170724
LR  - 20170724
IS  - 1756-1833 (Electronic)
IS  - 0959-535X (Linking)
VI  - 358
DP  - 2017 Jul 19
TI  - Effect of diet and physical activity based interventions in pregnancy on
      gestational weight gain and pregnancy outcomes: meta-analysis of individual
      participant data from randomised trials.
PG  - j3119
LID - 10.1136/bmj.j3119 [doi]
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.
CI  - 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.
CN  - International Weight Management in Pregnancy (i-WIP) Collaborative Group
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20170719
PL  - England
TA  - BMJ
JT  - BMJ (Clinical research ed.)
JID - 8900488
SB  - AIM
SB  - IM
MH  - Diet
MH  - Exercise Therapy/*methods
MH  - Female
MH  - Humans
MH  - Obesity/*therapy
MH  - Pregnancy
MH  - Pregnancy Complications/diet therapy/physiopathology/*therapy
MH  - Pregnancy Outcome
MH  - Randomized Controlled Trials as Topic
MH  - Weight Gain/*physiology
COI - Competing interests: All authors have completed the ICMJE uniform disclosure form
      at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation
      for the submitted work. HH reports grants from the German Ministry of Education
      and Research, the Bavarian Ministry of Agriculture and Nutrition, the Bavarian
      Ministry of Health, the Helmholtz Center Munich, the Else Kroner-Fresenius
      Foundation, AOK Bavaria, Amway, and the German Research Foundation outside the
      submitted work. BWJM reports funding from ObsEva during the conduct of the study.
EDAT- 2017/07/21 06:00
MHDA- 2017/07/25 06:00
CRDT- 2017/07/21 06:00
PST - epublish
SO  - BMJ. 2017 Jul 19;358:j3119. doi: 10.1136/bmj.j3119.