Abstract
BackgroundPost-partum weight retention contributes to the risk of chronic obesity and metabolic alterations. We conducted a systematic review of randomized controlled trials (RCTs) on the effect of post-partum nutrition and exercise interventions on weight loss and metabolic outcomes. DATA SOURCES: Four electronic databases were searched from inception to January, 2012. Two investigators reviewed titles and abstracts, performed data abstraction on full articles and assessed study quality.MethodsWe included RCTs comparing nutrition, exercise or combined nutrition and exercise interventions with a control condition. Thirteen studies met our inclusion criteria (N = 1,310 participants). Data were abstracted on study characteristics, intervention components, enrollment period, and length of follow-up. Outcomes of interest included weight, adiposity, cardio-metabolic measures (glucose, lipids) and obesity-related inflammatory markers.ResultsNine trials compared combined interventions to standard post-partum care; three trials assessed the effect of exercise interventions, one trial evaluated a nutrition-only intervention. Four good quality RCTs on combined interventions had inconsistent findings, with the larger RCT (N = 450) reporting no difference in weight between groups. Four fair-to good quality RCTs reported greater weight loss in the combined intervention group vs. standard care, ranging from 0.17 kg to 4.9 kg. Results from exercise only interventions were inconclusive. Evidence for nutrition only interventions was insufficient. There was insufficient evidence for the effect of post-partum interventions on metabolic risk factors and inflammatory biomarkers.ConclusionsCombined nutrition and exercise interventions can achieve weight loss, but evidence is limited due to a small number of trials and limitations in study design.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2393-14-319) contains supplementary material, which is available to authorized users.
Highlights
Post-partum weight retention contributes to the risk of chronic obesity and metabolic alterations
After abstract and full article review, we identified 13 unique publications related to the benefits and harms of behavioral interventions for post-partum weight loss; nine Randomized controlled trials (RCT) assessed the effects of combined diet and exercise interventions, (N = 1,015 participants); three RCTs compared exercise-only interventions to usual care (N = 139 participants); one RCT compared a dietonly intervention to usual care (N = 151 participants)
Leermakers and colleagues [31] found a statistically significantly higher percentage weight loss (10% versus 5.8%; p < 0.04) and proportion of women returning to their pre-pregnancy weight (33% versus 11.5%, p < 0.05) in the intervention group compared to the standard care group
Summary
Post-partum weight retention contributes to the risk of chronic obesity and metabolic alterations. We conducted a systematic review of randomized controlled trials (RCTs) on the effect of post-partum nutrition and exercise interventions on weight loss and metabolic outcomes. Obesity, fueled largely by excessive caloric intake and sedentary lifestyles, contributes to multiple adverse health conditions in women, including diabetes, cardiovascular disease, and certain cancers (endometrial, colon, and postmenopausal breast). Compared with weight gain during other life intervals, excess weight retained after childbirth appears to be harmful, as evidence suggests that weight retained in the post-partum tends to be distributed centrally, and may increase the risk of developing chronic disease [2,6]. Post-partum interventions that target dietary intake and exercise may help women to achieve a healthy weight after delivery and improve their overall health status
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