Background
Methods
Eligibility criteria
Information sources
Search strategy
Batch | Search term (MESH) | Combination | Result |
---|---|---|---|
1 | Pregnancy Complications/OR Pregnancy/OR Pregnancy Outcome/OR Pregnancy, High Risk/ | 646,055 | |
2 | Prenatal Care/OR Pregnancy/OR Pregnancy Complications | 647,726 | |
3 | Antenatal.mp. | 18,393 | |
4 | Gestation intervention.mp. | 4 | |
5 | 1 OR 2 OR 3 OR 4 | 651,321 | |
6 | Overweight.mp. OR Obesity/OR Overweight/OR Body Weight/ | 249,097 | |
7 | Obesity/OR Obesity, Morbid/or Obesity.mp. | 145,882 | |
8 | Body Weight/OR Obesity/OR Body Mass Index/or BMI.mp. OR Overweight/ | 293,584 | |
9 | 6 OR 7 OR 8 | 328,089 | |
10 | 5 AND 9 | 21,583 | |
11 | Diet, Fat-Restricted/OR Diet/OR Diet, Protein-Restricted/OR Diet, Carbohydrate-Restricted/OR Diet.mp. OR Diet, Reducing/OR Diet Therapy/ | 255,985 | |
12 | Life Style/ | 36,837 | |
13 | Health Education/ | 48,625 | |
14 | Patient Education as Topic/ | 63,238 | |
15 | Exercise.mp. OR Exercise/OR Exercise, Therapy/ | 192,937 | |
16 | Health Promotion/ | 43,967 | |
17 | Weight Loss/ | 19,434 | |
18 | 11 OR 12 OR 13 OR 14 OR 15 OR 16 OR 17 | 601,919 | |
19 | 10 AND 18 | 3,769 | |
20 | LIMIT 19 TO ((female or humans or pregnancy) and (clinical trial, all OR clinical trial, phase i OR clinical trial, phase ii OR clinical trial, phase iii OR clinical trial, phase iv OR clinical trial OR controlled clinical trial OR randomized controlled trial)) |
154
|
Study selection
Data collection process
Data items
Author (year) | Ethnic group/Country | Participant/setting | Sample size | Intervention | Outcome measure(s) | Conclusion |
---|---|---|---|---|---|---|
Polley et al. (2002) [32] | 31% black and 61% white/USA | Recruited before 20 weeks of pregnancy (normal BMI > 19.5 to 24.9; overweight BMI ≥ 25 to < 30 kg/m2)/Hospital based | 120, including 49 overweight 59 in control arm; 61 in intervention arm | Exercise and nutrition information (oral and newsletter) Personalised graphs and behavioural counselling. | Gestational weight gain; gestational diabetes; Caesarean section; birthweight | No statistically significant reduction in gestational weight, prevalence of gestational diabetes, Caesarean section, or large for gestational age baby |
Hui et al. (2006) [33] | Predominantly Caucasian/Canada | Less than 26 weeks pregnant (community based and antenatal clinics). All BMI categories. Mean BMI of non-intervention arm = 25.7 (SD = 6.3) and for intervention arm = 23.4(SD = 3.9) | 45 21 in non-intervention arm; 24 in intervention arm | Physical exercise (group-sessions home-based exercise) Individualized nutrition plans | Gestational weight gain | No statistically significant reduction in gestational weight gain |
Wolff et al., 2008 [30] | 100% Caucasian/Denmark | Obese (BMI ≥ 30 kg/m2) women enrolled at 15 weeks' gestation | 50 analysed 23 in control arm; 27 in intervention arm | Intensive intervention with 10 one-hour visits with a dietician at each antenatal visit, dietary guidance provided | Gestational weight gain; gestational diabetes; Caesarean section; birthweight | Statistically significant reduction in gestational weight gain, no statistically significant reduction in prevalence of gestational diabetes or Caesarean section, or birthweight |
Jeffries et al., 2009 [28] | > 90% Caucasian/Australia | Women at or below 14 weeks' gestation. All BMI categories included | 286 138 in control arm; 148 in intervention arm | Personalised weight measurement card (based on Institute of Medicine guidelines). Control had only single measurement at enrolment | Gestational weight gain | No statistically significant reduction in gestational weight gain. |
Ong et al., 2009 [42] | Predominantly Caucasian/Australia | Pregnant obese women recruited at 18 weeks' gestation | 12 six in control arm; six in intervention arm | Personalised 10 weeks of home-based supervised exercise (three sessions per week) | Maternal aerobic fitness and gestational diabetes | No statistically significant difference in aerobic fitness or gestational diabetes |
Barakat et al., 2011 [41] | 100% Caucasian/Spain | All BMI categories | 160 80 in control arm; 80 in intervention arm | Three group-based sessions per week, light resistance and toning exercise from the second trimester | Gestational weight gain and birthweight | No statistically significant difference in gestational weight gain and birth weight. Exercise intervention might attenuate adverse consequences of maternal BMI on newborn birth size |
Asbee et al., 2009 [27] | 26% African American/USA | Pregnant women recruited before 16 weeks' gestation. All BMI categories except those of BMI > 40 kg/m2
| 100 43 in control arm; 53 in intervention arm | One session of dietetic counselling and activity | Gestational weight gain; pregnancy outcome | Statistically significant reduction in gestational weight gain. No effect on pregnancy outcome |
Thornton et al., 2009 [29] | 41% African American/USA | Obese pregnant women (BMI ≥ 30 kg/m2) recruited between 12 and 28 weeks' gestation | 257 randomised. 25 lost to follow up. 116 in control arm; 116 in intervention arm | Nutritional regime for gestational diabetes | Gestational weight gain; gestational diabetes; Caesarean section; pregnancy outcome | Statistically significant reduction in gestational weight gain, no statistically significant reduction in prevalence of gestational diabetes, Caesarean section or birthweight |
Guelinckx et al., 2010 [26] | 100% Caucasian/Belgium | Obese (BMI > 30 kg/m2) women enrolled at 15 weeks' gestation. | 195 randomised 85 analysed 65 in control arm; 65 in passive arm, 65 in intervention arm | Three arms: group sessions with a dietician; written brochures; and standard care Dietary and physical activity guidance provided by dietician and in written brochures | Nutritional habits; gestational weight gain; gestational diabetes; Caesarean section; birthweight | Improved nutritional habits; no statistically significant reduction in gestational weight gain, prevalence of gestational diabetes, Caesarean section or birthweight. |
Phelan et al., 2011 [34] | 67% White/USA | Pregnant women BMI between 19.8 and 40 kg/m2 recruited between 10 and 16 weeks' gestation | 401 randomised. 201 in non-intervention arm; 200 in intervention arm | Exercise and nutrition information (oral and newsletter) Personalised graphs and behavioural counselling | Gestational weight gain; gestational diabetes; Caesarean section; pregnancy outcome | Significant reduction in gestational weight gain; no statistically significant reduction in prevalence of gestational diabetes, Caesarean section or birthweight |
Quinlivan et al., 2011 [59] | 73% white, 19% Asian/Australia | Pregnant women: overweight (BMI 25 to 29.9 kg/m2) and obese (BMI ≥ 30 kg/m2) | 132 randomised. 65 in non-intervention arm; 67 in intervention arm | Attended a study- specific antenatal clinic providing continuity of care, weighing on arrival, brief dietary intervention by food technologist and psychological assessment and intervention if indicated | Gestational weight gain; gestational diabetes; birthweight | Statistically significant reduction in gestational weight gain and prevalence of gestational weight gain. No statistically significant reduction in birthweight. |
Luoto et al., 2011 [43] | Predominantly white/Finland | Pregnant women at risk of gestational diabetes. All BMI ranges | 399 cluster randomised. 219 in non-intervention arm; 180 in intervention arm | Attended a study-specific individual antenatal lifestyle counselling clinic including group exercise | Gestational diabetes; gestational weight gain; birthweight | Statistically significant reduction in birthweight and macrosomia but no statistically significant difference in gestational diabetes |
Nascimento et al., 2011 [44] | Predominantly white/Brazil | Pregnant women of all BMI categories | 82 randomised. 42 in non-intervention arm; 40 in intervention arm | Attended a group-based exercise under supervision and received a home exercise counselling | Gestational weight gain; raised blood pressure; perinatal outcome | No statistically significant difference in gestational weight gain in terms of gestational weight gain, raised blood pressure or perinatal outcome |
Author (year) | Ethnic group/country | Participants/setting | Sample size | Intervention | Outcome measure(s) | Conclusion |
---|---|---|---|---|---|---|
Gray-Donald et al. (2000) [38] | Native Americans/Canada | Recruited before the 26th week of pregnancy, non-parallel recruitment of control and intervention arms. Mean BMI = 29.6 kg/m2 (SD = 6.45) in non-intervention arm and mean BMI = 30.8 kg/m2 (SD = 6.85) in intervention arm at baseline. | 219 107 in non-intervention arm; 112 in intervention arm | Dietary and weight counselling Exercise groups provided | Gestational weight gain; gestational diabetes; Caesarean section; birthweight; postpartum weight retention | No statistically significant difference in gestational weight gain, prevalence of gestational diabetes, Caesarean section or large for gestational age baby |
Olson et al. (2004) [51] | 96% white/USA | Recruited before third trimester. Hospital and clinic setting BMI range: 19.8 to 29 kg/m2
| 498 381 in non-intervention arm; 117 in the intervention arm | Used the Institute of Medicine recommended guidelines on weight gain; 'health book' used to record diet and exercise and contained healthy eating and exercise information | Gestational weight gain; birthweight | No statistically significant reduction in gestational weight gain or prevalence of large for gestational age baby |
Claesson et al. (2007) [36] | Not stated. Predominantly Caucasian/Sweden | Obese and registered at antenatal care clinic. BMI ≥ 30 kg/m2
| 348 193 in non-intervention arm; 155 in intervention arm | Nutritional habits interview, weekly counselling and aqua aerobic sessions | Gestational weight gain; Caesarean section. | Statistically significant reduction in gestational weight gain; no difference in prevalence of Caesarean section |
Kinnunen et al. (2007) [37] | Over 90% Caucasian/Finland | First-time pregnant women who were obese (BMI ≥ 30 kg/m2) | 196 95 in non-intervention arm; 101 in intervention arm | Individual counselling at each antenatal visits. Dietary guidance and optional activity sessions. | Gestational weight gain; diet change; birthweight | No statistically significant reduction in gestational weight gain or prevalence of large for gestational age baby. Statistically significant reduction in dietary glycaemic load. |
Shirazian et al., 2010 [39] | 33% blacks; 67% Latino/USA | Singleton obese (≥ 30 kg/m2) pregnant women recruited in the first trimester. Historical non-intervention group. | 54 28 in non-parallel control arm; 28 in intervention arm) | One-to-one counselling; six structured seminars on healthy living (healthy eating and walking) | Gestational weight gain; gestational diabetes; Caesarean section | Statistically significant reduction in gestational weight gain; no difference in prevalence of gestational diabetes |
Mottola et al., (2010) [35] | Not stated/Canada | Overweight (BMI ≥ 25 to 29.9 kg/m2) and obese (BMI ≥ 30 kg/m2) pregnant women recruited before 16 weeks' gestation; historical non-intervention group. | 65 matched non-parallel control of 260 | Individualised nutrition plan; exercise consisted of walking (three to four times per week, used pedometers) | Gestational weight gain; Caesarean section; birthweight; peripartum weight retention | Possible reduction in gestational weight gain; no difference in prevalence of Caesarean section or large for gestational age baby; minimal effect on peripartum weight retention |
Risk of bias in individual studies
Author (year) | Population representativeness | Adequacy of sequence generation | Masking/selection bias | Incomplete outcome data | Contamination | Sample size | Grade of quality |
---|---|---|---|---|---|---|---|
Gray-Donald et al. (2000) [38] | Yes: Registered from clinic | No | No | No | No: non-parallel control | 219 | Low |
Olson et al. (2004) [51] | Yes | No | No | No | No: non-parallel control | 560 | Low |
Claesson et al. (2007) [36] | Yes: Registered from clinic | No | No | Yes | No: selected from nearby city | 315 | Low |
Kinnunen et al. (2007) [37] | Yes | No | No | No | Yes | 55 | Low |
Shirazian et al., (2010) [39] | Yes | No | No | Yes | No: non-parallel control | 28 | Low |
Mottola et al., (2010) [35] | Yes | No | No | Yes | No: non-parallel control | 65 | Low |
Author (year) | Population representativeness | Adequacy of sequence generation | Masking/selection bias | Intention to treat | Incomplete outcome data | Loss to follow up | Sample size | Grade of quality |
---|---|---|---|---|---|---|---|---|
Polley et al. 2002 [32] | Yes | Yes: | No | Not reported | No | Yes | 120 | Low |
Hui et al. (2006) [33] | Yes: from clinic | Exact method not described | No | Not reported | No | Yes | 52 | Low |
Wolff et al., 2008 [30] | Yes | Yes: computer generated | No | Not reported | Yes | Yes | 50 | Low |
Jeffries et al., 2009 [28] | Yes | Yes: Opaque envelope | Yes | Not reported | Yes | Yes | 286 | Low |
Ong et al., 2009 [42] | Yes | Exact method not described | No | Not reported | No | No | 12 | Low |
Barakat et al., 2011 [41] | Yes | Yes | Yes | Yes | Yes | Yes | 160 | Medium |
Asbee et al. 2009 [27] | Yes | Yes | No | Not reported | Yes | No | 100 | Low |
Thornton et al., 2009 [29] | Yes | Yes | Yes | Not reported | Yes | Yes | 257 | Medium |
Guelinckx et al., 2010 [26] | Not reported | Randomised but not reported how | Not reported | Not reported | Yes | Not reported | 99 | Low |
Phelan et al., 2011 [34] | Yes | Yes: Opaque envelope | Yes | Yes | Yes | Yes | 401 | Medium, |
Quinlivan et al., 2011 [59] | Yes | Yes: Opaque envelope | Yes | Yes | Yes | Yes | 124 | Medium |
Luoto et al., 2011 [43] | Yes | Yes | Yes | Yes | Yes | Yes | 399 | Medium |
Nascimento et al., 2011 [44] | Yes | Yes: Opaque envelope | Yes | Yes | Yes | Yes | 82 | Low |
Summary and analysis of studies that meet the criteria
Summary measures and data synthesis
Results
Study characteristics
Effects of the intervention on outcomes
Outcome or subgroup | Studies | Participants | Statistical method | Effect estimate |
---|---|---|---|---|
Large for gestational age | 6 | 1,008 | Odds ratio (Fixed, 95% CI) | 0.91 (0.62, 1.32) |
Caesarean delivery | 6 | 663 | Odds ratio (Fixed, 95% CI) | 0.96 (0.68, 1.36) |
Gestational diabetes | 6 | 1,017 | Odds ratio (M-H, Fixed, 95% CI) | 0.80 (0.58, 1.10)a
|
Gestational weight gain (kg) | 10 | 1,228 | Mean difference (Fixed, 95% CI) | -2.21 (-2.86, -1.57)a
|
Birth weight (g) | 7 | 1,133 | Mean difference (Fixed, 95% CI) | -56.64 (-120.15, 6.88) |
Outcome or subgroup | Studies | Participants | Statistical method | Effect estimate |
---|---|---|---|---|
Large for gestational age | 4 | 1,199 | Odds ratio (Fixed, 95% CI) | 0.85 (0.63, 1.16) |
Caesarean delivery | 4 | 1,246 | Odds ratio (Fixed, 95% CI) | 1.13 (0.78, 1.64) |
Gestational diabetes | 2 | 233 | Odds ratio (Fixed, 95% CI) | 1.51 (0.72, 3.16) |
Gestational weight gain (kg) | 6 | 1,534 | Mean difference (Fixed, 95% CI) | -0.42 (-1.03, 0.19) |