A meta-review of systematic reviews of lifestyle interventions for reducing gestational weight gain in women with overweight or obesity

Frankie Fair, Hora Soltani, Frankie Fair, Hora Soltani

Abstract

Women with overweight or obesity are twice as likely to gain excessive gestational weight than women of normal weight. Identifying effective interventions to support this group achieve healthy gestational weight gain is important. An overview of systematic reviews regarding the effectiveness of lifestyle interventions on gestational weight gain in women with overweight or obesity was undertaken, including searching eight electronic databases. Quality of included reviews was assessed by two independent researchers. A narrative data synthesis was undertaken, with subgroup and sensitivity analyses by type of intervention and quality of the included reviews. A total of 15 systematic reviews were included within this meta-review. A small reduction in gestational weight gain of between 0.3 and 2.4 kg was noted with lifestyle interventions compared with standard care. There was some evidence that dietary only or physical activity only interventions may reduce the odds of gestational diabetes. No differences were noted in the odds of other maternal or infant health outcomes. Although lifestyle interventions appeared to decrease gestational weight gain, current evidence does not show a clear benefit on maternal and infant outcomes from the small nature of the reduction in gestational weight gain produced by lifestyle interventions in women with overweight or obesity.

Keywords: gestational weight gain; healthy lifestyle; maternal obesity.

Conflict of interest statement

No known conflicts of interests to declare.

© 2021 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.

Figures

FIGURE 1
FIGURE 1
Flowchart of study selection
FIGURE 2
FIGURE 2
Combined risk of bias from the different systematic reviews across the 55 included RCTs
FIGURE 3
FIGURE 3
Graphical representation of gestational weight gain meta‐analysis results. s = number of included studies, u = number of unique studies, n = number of participants, I2 = percentage of variability in the effect estimate due to heterogeneity, confidence = AMSTAR‐2 confidence in the results of the review. ^ compares different arms in Renault et al. 44 to other reviews. ‡ adjusted for baseline weight and clustering effect. * this review was noted to include two RCTs that incorporated women of normal BMI, despite review inclusion criteria being exclusively women with overweight/obesity. ₸ compares different arms in Bogarts et al. 45 to other reviews. ∫ this review was noted to include 1 RCT in their overweight/obese meta‐analysis that did not exclusively recruit participants with overweight/obesity
FIGURE 4
FIGURE 4
Graphical representation of other maternal outcomes (odds ratios with 95% confidence intervals) within included systematic reviews. s = number of included studies, u = number of unique studies, n = number of participants, I2 = percentage of variability in the effect estimate due to heterogeneity, confidence = AMSTAR‐2 confidence in the results of the review. ^ Systematic reviews compared different arms of Renault et al. 44 within their meta‐analyses, so taken as non‐overlapping study. ∫ this review was noted to include one RCT in their overweight/obese meta‐analysis that did not exclusively recruit participants with overweight/obesity
FIGURE 5
FIGURE 5
Graphical representation of birthweight and birthweight related outcomes within meta‐analysis results within included systematic reviews. s = number of included studies, u = number of unique studies, n = number of participants, I2 = percentage of variability in the effect estimate due to heterogeneity, confidence = AMSTAR‐2 confidence in the results of the review. * this review was noted to include two RCTs that incorporated women of normal BMI, despite review inclusion criteria being exclusively women with overweight/obesity. ∫ this review was noted to include one RCT in their overweight/obese meta‐analysis that did not exclusively recruit participants with overweight/obesity. ¶ one trial reported birthweight >4000 g not LGA. § Three included trials report birthweight >4000 g and one trial reported birthweight >4500 g rather than LGA. ∂ Three of the included trials report birthweight <2500 g not SGA. ϒ One trial reported birthweight >4500 g not >4000 g

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