Abstract
BackgroundThe increasing prevalence of obesity in pregnant women is associated with adverse maternal and neonatal outcomes, and increased costs to healthcare, the economy and broader society.ObjectivesTo assess the efficacy of behavioural interventions for managing gestational weight gain (GWG) in the pre-conceptual and pregnancy period in overweight, obese and morbidly obese women.Search MethodsA search was performed for published studies in the English language, from date? 2000–31 December 2012 in five electronic databases; PubMed, Scopus, Cochrane Library, CINAHL and PsycINFO.Selection criteriaStudies were included if they compared the efficacy or effectiveness of a particular behavioural intervention in pregnant or pre-conceptual women with standard maternity care. Studies that included women with co-morbid conditions such as diabetes mellitus and polycystic ovarian syndrome were excluded to help isolate the effect of the intervention.ResultsFifteen studies involving 3,426 participants were included. One study (n = 692) focused on the pre-conceptual period and the remaining 14 (n = 2,734) in the pregnancy period. Pooled mean difference for GWG indicated a lower GWG in the intervention groups when compared to standard maternity care groups (n = 1771, mean difference (MD) −1.66 kg, 95% CI −3.12 to −0.21 kg). With respect to the types of participants, considerable heterogeneity between studies was shown in the obese subgroup [Tau2 = 15.61; Chi2 = 40.80, df = 3 (P<0.00001); I2 = 93%].ConclusionsBehavioural interventions in pregnancy may be effective in reducing GWG in obese women without comorbid conditions, but not overweight or morbidly obese women. Behavioural interventions had no effect on postpartum weight loss or retention, gestation week of delivery and infant birth weight in overweight, obese and morbidly obese women.
Highlights
Overweight (Body mass index or BMI $25 kg/m2) and obesity (BMI $30 kg/m2) is a risk factor for; cardiovascular diseases (CVD), diabetes, musculoskeletal disorders and certain cancers [1,2]
(2) In pre-conceptual and pregnant women, what is the effect of a particular behavioural intervention on excessive gestational weight gain (GWG) compared with standard maternity care or no care, and what is the methodological quality of the evidence?
Excessive GWG was defined as GWG beyond that normally expected as part of the pregnancy as defined in Institute of Medicine (IOM) guidelines
Summary
Overweight (Body mass index or BMI $25 kg/m2) and obesity (BMI $30 kg/m2) is a risk factor for; cardiovascular diseases (CVD), diabetes, musculoskeletal disorders and certain cancers [1,2]. The World Health Organisation (WHO) has described overweight and obesity as the fifth most important risk factor for global deaths [3]. Less GWG is associated with better maternal outcomes [5]. Increased GWG is associated with improvements in some infant health outcomes, such as full-term birth and infant mortality, but greater risk for others, including increased foetal growth [6,7]. The increasing prevalence of obesity in pregnant women is associated with adverse maternal and neonatal outcomes, and increased costs to healthcare, the economy and broader society
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