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Meta-Analysis
. 2012 May 16:344:e2088.
doi: 10.1136/bmj.e2088.

Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence

S Thangaratinam  1 , E Rogozinska, K Jolly, S Glinkowski, T Roseboom, J W Tomlinson, R Kunz, B W Mol, A Coomarasamy, K S Khan
Affiliations
Meta-Analysis

Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence

S Thangaratinam et al. BMJ. .

Abstract

Objective: To evaluate the effects of dietary and lifestyle interventions in pregnancy on maternal and fetal weight and to quantify the effects of these interventions on obstetric outcomes.

Design: Systematic review and meta-analysis.

Data sources: Major databases from inception to January 2012 without language restrictions.

Study selection: Randomised controlled trials that evaluated any dietary or lifestyle interventions with potential to influence maternal weight during pregnancy and outcomes of pregnancy.

Data synthesis: Results summarised as relative risks for dichotomous data and mean differences for continuous data.

Results: We identified 44 relevant randomised controlled trials (7278 women) evaluating three categories of interventions: diet, physical activity, and a mixed approach. Overall, there was 1.42 kg reduction (95% confidence interval 0.95 to 1.89 kg) in gestational weight gain with any intervention compared with control. With all interventions combined, there were no significant differences in birth weight (mean difference -50 g, -100 to 0 g) and the incidence of large for gestational age (relative risk 0.85, 0.66 to 1.09) or small for gestational age (1.00, 0.78 to 1.28) babies between the groups, though by itself physical activity was associated with reduced birth weight (mean difference -60 g, -120 to -10 g). Interventions were associated with a reduced the risk of pre-eclampsia (0.74, 0.60 to 0.92) and shoulder dystocia (0.39, 0.22 to 0.70), with no significant effect on other critically important outcomes. Dietary intervention resulted in the largest reduction in maternal gestational weight gain (3.84 kg, 2.45 to 5.22 kg), with improved pregnancy outcomes compared with other interventions. The overall evidence rating was low to very low for important outcomes such as pre-eclampsia, gestational diabetes, gestational hypertension, and preterm delivery.

Conclusions: Dietary and lifestyle interventions in pregnancy can reduce maternal gestational weight gain and improve outcomes for both mother and baby. Among the interventions, those based on diet are the most effective and are associated with reductions in maternal gestational weight gain and improved obstetric outcomes.

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Conflict of interest statement

Competing interest: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Identification of studies in systematic review of effects of dietary and lifestyle interventions in pregnancy on maternal and fetal outcomes
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Fig 2 Quality of randomised controlled trials included in systematic review of dietary and lifestyle interventions in pregnancy on maternal and fetal outcomes
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Fig 3 Mean difference in gestational weight gain (kg) with dietary and lifestyle interventions in pregnancy
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Fig 4 Mean difference in birth weight (g) with dietary and lifestyle interventions in pregnancy
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Fig 5 Relative risk of effect on size for gestational age with dietary and lifestyle interventions in pregnancy
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Fig 6 Relative risk of effects of weight management interventions in pregnancy on maternal outcomes
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Fig 7 Relative risk of effects of weight management interventions in pregnancy on fetal and neonatal outcomes
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