Systematic Review
Obstetrics
A systematic review and metaanalysis of energy intake and weight gain in pregnancy

https://doi.org/10.1016/j.ajog.2015.12.049Get rights and content

Background

Gestational weight gain within the recommended range produces optimal pregnancy outcomes, yet many women exceed the guidelines. Official recommendations to increase energy intake by ∼ 1000 kJ/day in pregnancy may be excessive.

Objective

To determine by metaanalysis of relevant studies whether greater increments in energy intake from early to late pregnancy corresponded to greater or excessive gestational weight gain.

Data Sources

We systematically searched electronic databases for observational and intervention studies published from 1990 to the present. The databases included Ovid Medline, Cochrane Library, Excerpta Medica DataBASE (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Science Direct. In addition we hand-searched reference lists of all identified articles.

Study Eligibility Criteria

Studies were included if they reported gestational weight gain and energy intake in early and late gestation in women of any age with a singleton pregnancy. Search also encompassed journals emerging from both developed and developing countries.

Study Appraisal and Synthesis Methods

Studies were individually assessed for quality based on the Quality Criteria Checklist obtained from the Evidence Analysis Manual: Steps in the academy evidence analysis process. Publication bias was plotted by the use of a funnel plot with standard mean difference against standard error. Identified studies were meta-analyzed and stratified by body mass index, study design, dietary methodology, and country status (developed/developing) by the use of a random-effects model.

Results

Of 2487 articles screened, 18 studies met inclusion criteria. On average, women gained 12.0 (2.8) kg (standardized mean difference = 1.306, P < .0005) yet reported only a small increment in energy intake that did not reach statistical significance (∼475 kJ/day, standard mean difference = 0.266, P = .016). Irrespective of baseline body mass index, study design, dietary methodology, or country status, changes in energy intake were not significantly correlated to the amount of gestational weight gain (r = 0.321, P = .11).

Conclusion

Despite rapid physiologic weight gain, women report little or no change in energy intake during pregnancy. Current recommendations to increase energy intake by ∼ 1000 kJ/day may, therefore, encourage excessive weight gain and adverse pregnancy outcomes.

Section snippets

Search strategy

A systematic literature search was undertaken in August to October 2014 by 2 independent student dietitians (J.M. and H.J.). A starting date of 1990 was specified so that the outcomes reflected the current generation of women whose pregnancy advice may have been influenced by the IOM guidelines.20 We searched Ovid Medline, Cochrane Library, Excerpta Medica DataBASE (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Science Direct for studies that reported energy

Results

The electronic search revealed 2440 articles with a further 47 identified by hand-searching. Of these, 2301 did not meet inclusion criteria because they did not report energy intake at 2 time points at least 12 weeks apart. Three potential studies were excluded because of missing data.28, 29, 30 The screening and selection process resulted in 18 studies of 2644 women published between 1992 and 2013 (Figure 1). Fourteen studies were observational studies,23, 24, 31, 32, 33, 34, 35, 36, 37, 38, 39

Comment

To our knowledge, this is the first study to use metaanalysis to explore the relationship between changes in food energy intake in pregnancy and maternal weight gain. In a comprehensive body of literature from developed and developing countries, we found no relationship between the increment in energy intake from early to late pregnancy and the amount of GWG. Indeed, despite a large highly significant increase in body weight (+12.0 kg), there was only a small, nonsignificant increase in

Conclusions

Despite a period of uniquely rapid weight gain, women appear to consume only one quarter of the theoretical requirement for additional energy (2000 kJ/day in trimester 3) during pregnancy. Given the high prevalence of obesity and excessive GWG in the current generation of women of reproductive age, dietary guidelines for pregnancy may need to be revised.

Acknowledgments

This research project was undertaken by 2 students J.M. and H.J. as part of their MNUTRDIET degree with special thanks to T.P. for her work on statistical analysis and to supervisors J.C.Y.L. and J.C.B.M. for their time, guidance, and overall contribution to this research project. J.C.Y.L. and J.C.B.M. conceptualized the metaanalysis. J.M. and H.J. developed the search strategy under the guidance of J.C.Y.L. and J.C.B.M. J.M. and H.J. carried out the systematic search, screened and reviewed the

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    The authors report no conflict of interest.

    1

    These authors contributed equally to this work.

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