A Systematic Review and Bayesian Network Meta-Analysis Comparing In-Person, Remote, and Blended Interventions in Physical Activity, Diet, Education, and Behavioral Modification on Gestational Weight Gain Among Overweight or Obese Pregnant Individuals

Abstract

BackgroundDespite the well-documented adverse outcomes associated with obesity during pregnancy, this condition remains a promising modifiable risk factor. ObjectiveThe aim of this study was to ascertain the most effective treatment modalities for gestational weight gain (GWG) in pregnant women classified as overweight or obese. MethodsA systematic search was conducted across four electronic databases: Embase, EBSCOhost, PubMed, and Web of Science. To assess the quality of evidence, the Confidence In Network Meta-Analysis (CINeMA) approach, grounded in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, was employed. A Bayesian network meta-analysis was conducted to synthesize the comparative effectiveness of treatment modalities based on GWG outcomes. ResultsThe analysis incorporated 60 RCTs, encompassing 16,615 participants. Modes of intervention administration were classified as remote (R: eHealth (e) and mHealth (m)), in-person (I), and a combination of both (I+R). The interventions comprised five categories: education (E), physical activity (PA), dietary (D), behavior modification (B), and combinations thereof. The quality of the evidence, as evaluated by CINeMA, ranged from very low to high. Compared to the control group, the I-D intervention (mean difference (MD) = -1.27, 95% CI [-2.23, -0.32]), I-PADB (MD = -0.60, 95% CI [-1.19, -0.00]), and in I-B (MD = -0.34, 95% CI [-0.57, -0.10]) interventions showed significant efficacy in reducing GWG. ConclusionsPreliminary findings suggest that the I-D intervention is the most efficacious in managing GWG among pregnant women who are overweight or obese, followed by I-PADB and I-B+R-B(m) treatments. These conclusions are drawn from evidence of limited quality and directness, including insufficient data on PA components used in the interventions. Owing to the absence of robust, direct evidence delineating significant differences among various GWG management strategies, it is tentatively proposed that the I-D intervention is likely the most effective approach. Registry and registry number for systematic reviews or meta-analysesInternational Prospective Register of Systematic Reviews, CRD42023473627 Statement of SignificanceThis study presents new methods using systematic review and Bayesian meta-analysis combined with direct and indirect evidence, to evaluate effective interventions for managing gestational weight gain in overweight and obese pregnant women. This approach addresses prior gaps by assessing various intervention methods' effectiveness and administration processes; providing more comprehensive analyses for this specific group of pregnant women.