Systematic review of the effect of individual and combined nutrition and exercise interventions on weight, adiposity and metabolic outcomes after delivery: evidence for developing behavioral guidelines for post-partum weight control

Alexander Arkin Berger, Rachel Peragallo-Urrutia, Wanda K Nicholson, Alexander Arkin Berger, Rachel Peragallo-Urrutia, Wanda K Nicholson

Abstract

Background: 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.

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.

Methods: We 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.

Results: Nine 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.

Conclusions: Combined nutrition and exercise interventions can achieve weight loss, but evidence is limited due to a small number of trials and limitations in study design.

Figures

Figure 1
Figure 1
Summary of the literature search and review process (number of articles). *Total may exceed the number in the corresponding box because articles could be excluded for more than one reason at this level. CINAHL (Cumulative Index to Allied Health and Nursing Literature).

References

    1. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012;307(5):491–497. doi: 10.1001/jama.2012.39.
    1. Gunderson EP. Gestational diabetes and nutritional recommendations. Curr Diab Rep. 2004;4(5):377–386. doi: 10.1007/s11892-004-0041-5.
    1. Gore SA, Brown DM, West DS. The role of postpartum weight retention in obesity among women: a review of the evidence. Ann Behav Med. 2003;26(2):149–159. doi: 10.1207/S15324796ABM2602_07.
    1. Rooney BL, Schauberger CW, Mathiason MA. Impact of perinatal weight change on long-term obesity and obesity-related illnesses. Obstet Gynecol. 2005;106(6):1349–1356. doi: 10.1097/01.AOG.0000185480.09068.4a.
    1. Kral JG. Preventing and treating obesity in girls and young women to curb the epidemic. Obes Res. 2004;12(10):1539–1546. doi: 10.1038/oby.2004.193.
    1. Smith DE, Lewis CE, Caveny JL, Perkins LL, Burke GL, Bild DE. Longitudinal changes in adiposity associated with pregnancy. The CARDIA study. coronary artery risk development in young adults study. JAMA. 1994;271(22):1747–1751. doi: 10.1001/jama.1994.03510460039030.
    1. Appel LJ, Champagne CM, Harsha DW, Cooper LS, Obarzanek E, Elmer PJ, Stevens VJ, Vollmer WM, Lin PH, Svetkey LP, Stedman SW, Young DR. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA. 2003;289(16):2083–2093.
    1. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM. Diabetes Prevention Program Research G. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403. doi: 10.1056/NEJMoa012512.
    1. Steinberg DM, Tate DF, Bennett GG, Ennett S, Samuel-Hodge C, Ward DS. Daily self-weighing and adverse psychological outcomes: a randomized controlled trial. Am J Prev Med. 2014;46(1):24–29. doi: 10.1016/j.amepre.2013.08.006.
    1. Mari G, Deprest J, Schenone M, Jackson S, Samson J, Brocato B, Tate D, Sullivan R, White G, Dhanireddy R, Mandrell T, Gupta S, Skobowjat C, Slominski A, Cohen HL, Schlabritz-Loutsevitch N. A novel translational model of percutaneous fetoscopic endoluminal tracheal occlusion - baboons (Papio spp.) Fetal Diagn Ther. 2014;35(2):92–100. doi: 10.1159/000357139.
    1. Bombardier CH, Fann JR, Wilson CS, Heinemann AW, Richards JS, Warren AM, Brooks L, Warms CA, Temkin NR, Tate DG. A randomized controlled trial of venlafaxine XR for major depressive disorder after spinal cord injury: methods and lessons learned. J Spinal Cord Med. 2014;37(3):247–263. doi: 10.1179/2045772313Y.0000000138.
    1. Artal R, O’Toole M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Br J Sports Med. 2003;37(1):6–12. doi: 10.1136/bjsm.37.1.6.
    1. van der Pligt P, Willcox J, Hesketh KD, Ball K, Wilkinson S, Crawford D, Campbell K. Systematic review of lifestyle interventions to limit postpartum weight retention: implications for future opportunities to prevent maternal overweight and obesity following childbirth. Obes Rev. 2013;14(10):792–805. doi: 10.1111/obr.12053.
    1. Sesso HD, Wang L, Buring JE, Ridker PM, Gaziano JM. Comparison of interleukin-6 and C-reactive protein for the risk of developing hypertension in women. Hypertension. 2007;49(2):304–310. doi: 10.1161/01.HYP.0000252664.24294.ff.
    1. Schmidt MI, Duncan BB, Sharrett AR, Lindberg G, Savage PJ, Offenbacher S, Azambuja MI, Tracy RP, Heiss G. Markers of inflammation and prediction of diabetes mellitus in adults (Atherosclerosis Risk in Communities study): a cohort study. Lancet. 1999;353(9165):1649–1652. doi: 10.1016/S0140-6736(99)01046-6.
    1. Pradhan AD, Cook NR, Buring JE, Manson JE, Ridker PM. C-reactive protein is independently associated with fasting insulin in nondiabetic women. Arterioscler Thromb Vasc Biol. 2003;23(4):650–655. doi: 10.1161/01.ATV.0000065636.15310.9C.
    1. Liu S, Manson JE, Buring JE, Stampfer MJ, Willett WC, Ridker PM. Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women. Am J Clin Nutr. 2002;75(3):492–498.
    1. Cseh K, Baranyi E, Melczer Z, Csakany GM, Speer G, Kovacs M, Gero G, Karadi I, Winkler G. The pathophysiological influence of leptin and the tumor necrosis factor system on maternal insulin resistance: negative correlation with anthropometric parameters of neonates in gestational diabetes. Gynecol Endocrinol. 2002;16(6):453–460. doi: 10.1080/713603159.
    1. Kirwan JP, Hauguel-De Mouzon S, Lepercq J, Challier JC, Huston-Presley L, Friedman JE, Kalhan SC, Catalano PM. TNF-alpha is a predictor of insulin resistance in human pregnancy. Diabetes. 2002;51(7):2207–2213. doi: 10.2337/diabetes.51.7.2207.
    1. Ilmonen J, Isolauri E, Poussa T, Laitinen K. Impact of dietary counselling and probiotic intervention on maternal anthropometric measurements during and after pregnancy: a randomized placebo-controlled trial. Clin Nutr. 2011;30(2):156–164. doi: 10.1016/j.clnu.2010.09.009.
    1. Harris RPHM, Woolf SH, Lohr K, Mulrow CD, Teutsch SM, Atkins D. Current methods of the US preventive services task force: a review of the process. Am J Prev Med. 2001;20(3 Suppl):21–35. doi: 10.1016/S0749-3797(01)00261-6.
    1. Atkins DBD, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D, Hill S, Jaeschke R, Leng G, Liberati A, Magrini N, Mason J, Middleton P, Mrukowicz J, O’Connell D, Oxman AD, Phillips B, Schünemann HJ, Edejer T, Varonen H, Vist GE, Williams JW, Jr, Zaza S. Grading quality of evidence and strength of recommendations. BMJ. 2004;328(7454):1490. doi: 10.1136/bmj.328.7454.1490.
    1. Centre for Reviews and Dissemination . Systematic Reviews in Centre for Reviews and Dissemination’s guidance for undertaking reviews in healthcare. England: York; 2009.
    1. Guide for Effectiveness and Comparative Effectiveness Reviews. AHRQ Publication No. 10(11)-EHC063-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2011. Chapters available at:
    1. Huang TTYC, Tsai YC. A diet and physical activity intervention for preventing weight retention among Taiwanese childbearing women: a randomized controlled trial. Midwifery. 2011;27(2):257–264. doi: 10.1016/j.midw.2009.06.009.
    1. Maturi SMAP, Abedi P. Effect of physical activity intervention based on a pedometer on physical activity level and anthropometric measures after childbirth: a randomized controlled trial. BMC Pregnancy Childbirth. 2011;11(10):103. doi: 10.1186/1471-2393-11-103.
    1. Zourladani A, Tsaloglidou A, Tzetzis G, Tsorbatzoudis C, Matziari C. The effect of a low impact exercise training programme on the well-being of Greek postpartum women: A randomised controlled trial. Int SportMed J. 2001;12(1):30–38.
    1. Craigie AMMM, Barton KL, Treweek S, Anderson AS. Supporting postpartum weight loss in women living in deprived communities: design implications for a randomized control trial. Eur J Clin Nutr. 2011;65:952–958. doi: 10.1038/ejcn.2011.56.
    1. Ostbye T, Krause KM, Lovelady CA, Morey MC, Bastian LA, Peterson BL, Swamy GK, Brouwer RJ, McBride CM. Active mothers postpartum: a randomized controlled weight-loss intervention trial. Am J Prev Med. 2009;37(3):173–180. doi: 10.1016/j.amepre.2009.05.016.
    1. Bertz F, Brekke HK, Ellegard L, Rasmussen KM, Wennergren M, Winkvist A. Diet and exercise weight-loss trial in lactating overweight and obese women. Am J Clin Nutr. 2012;96(4):698–705. doi: 10.3945/ajcn.112.040196.
    1. Leermakers EAAK, Wing RR. Reducing postpartum weight retention through a correspondence intervention. Int J Obes Relat Metab Disord. 1998;22:1103–1109. doi: 10.1038/sj.ijo.0800734.
    1. Colleran HL, Lovelady CA. Use of mypyramid menu planner for moms in a weight-loss intervention during lactation. J Acad Nutr Diet. 2012;112(4):553–558. doi: 10.1016/j.jand.2011.12.004.
    1. Davenport MHGI, Sopper MM, Mottola MF. Postpartum exercise regardless of intensity improves chronic disease risk factors. Med Sci Sports Exerc. 2011;43(6):951–958. doi: 10.1249/MSS.0b013e3182051155.
    1. Dewey KGLC, Nommsen-Rivers LA, McCory MA, Lonnerdal B. A randomized study of the effects of aerobic exercise by lactating women on breast-milk volume and composition. N Engl J Med. 1994;330:449–453. doi: 10.1056/NEJM199402173300701.
    1. Krummel D, Semmens E, MacBride AM, Fisher B. Lessons learned from the mothers’ overweight management study in 4 West Virginia WIC offices… women, infants, and children. J Nutr Educ Behav. 2010;42(3S):S52–S58. doi: 10.1016/j.jneb.2010.02.012.
    1. O’Toole ML, Sawicki MA, Artal R. Structured diet and physical activity prevent postpartum weight retention. J Women’s Health (15409996) 2003;12(10):991–998. doi: 10.1089/154099903322643910.
    1. Lovelady CAGK, Moreno KL, Williams JP. The effect of weight loss in overweight, lactating women on the growth of their infants. N Engl J Med. 2000;342:449–453. doi: 10.1056/NEJM200002173420701.
    1. Ostbye TKK, Lovelady CA, Morey MC, Bastian LA, Peterson BL, Swamy GK, Brower RJ, McBride CM. Active mothers postpartum. A randomized controlled weight-loss intervention trial. Am J Prev Med. 2009;7(30):173. doi: 10.1016/j.amepre.2009.05.016.
    1. American Congress of Obstetricians and Gynecologists Practice Bulletin Exercise during pregnancy and the postpartum period. ACOG Committee opinion. Number 267. Obstet Gynecol. 2002;99(6):975–991.
    1. Davies GAWL, Mottola MF, MacKinnon C. Joint SOGC/CSEP clinical practice guideline: exercise in pregnancy and the postpartum period. Can J Appl Physiol. 2003;28:330–341. doi: 10.1139/h03-024.
    1. National Institute for Health and Clinical Excellence (NICE) NICE Public Health Guidance 27. UK: London; 2010. Weight Management Before, During and After Pregnancy.
    1. Clinical Trials Registry
Pre-publication history
    1. The pre-publication history for this paper can be accessed here:

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir