Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain : Individual participant data meta-Analysis

Acknowledgements The authors are also grateful to the i-WIP Network for the individual participant data shared and to Helena Teede, Janette Khoury and Márcia Vitolo for the contribution of data. Contributors ECOB, FMMcA: wrote a proposal to the i-WIP data access committee; set the objectives, study design and data analysis plan. ECOB, FMMcA, RS, AAG and GA: analysis and interpretation of data; drafting of manuscript; critical revision; final approval of version to be published; agreeable to be accountable for all aspects of the work. ER: i-WIP IPD database manager; study conception and design; critical revision; final approval of version to be published; agreeable to be accountable for all aspects of the work. AA, RBC, AB, JGC, AC, CJMdG, RD, JMD, NEB, FF, NG, KG, LH, CH, HH, DMJ, KK, TIK, RL, BWM, SM, NM-T, JAO, MP, EP, SP, LP, KR, GR, KMR, AER, LS, KÅS, TTS, GS, AS, SNS, FGS, ShT, SeT, MNMvP, CV, IV and SY: study conception and design; critical revision; final approval of version to be published; agreeable to be accountable for all aspects of the work. Funding The data come from a National Institute for Health Research (NIHR) funded project (HTA-12/01/50) and the Queen Mary University of London is its legal sponsor. The database was initially funded by the NIHR and is currently funded by WHO. This work was also supported by the Health Research Board, Health Research Centre for Health and Diet Research, Ireland.Peer reviewe

Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials

Objective To synthesise the evidence on the overall and differential effects of interventions based on diet and physical activity during pregnancy, primarily on gestational weight gain and maternal and offspring composite outcomes, according to women\u27s body mass index, age, parity, ethnicity, and pre-existing medical condition; and secondarily on individual complications.Design Systematic review and meta-analysis of individual participant data (IPD). Data sources Major electronic databases from inception to February 2017 without language restrictions.Eligibility criteria for selecting studies Randomised trials on diet and physical activity based interventions in pregnancy.Data synthesis Statistical models accounted for clustering of participants within trials and heterogeneity across trials leading to summary mean differences or odds ratios with 95% confidence intervals for the effects overall, and in subgroups (interactions).Results IPD were obtained from 36 randomised trials (12 526 women). Less weight gain occurred in the intervention group than control group (mean difference -0.70 kg, 95% confidence interval -0.92 to -0.48 kg, I2=14.1%; 33 studies, 9320 women). Although summary effect estimates favoured the intervention, the reductions in maternal (odds ratio 0.90, 95% confidence interval 0.79 to 1.03, I2=26.7%; 24 studies, 8852 women) and offspring (0.94, 0.83 to 1.08, I2=0%; 18 studies, 7981 women) composite outcomes were not statistically significant. No evidence was found of differential intervention effects across subgroups, for either gestational weight gain or composite outcomes. There was strong evidence that interventions reduced the odds of caesarean section (0.91, 0.83 to 0.99, I2=0%; 32 studies, 11 410 women), but not for other individual complications in IPD meta-analysis. When IPD were supplemented with study level data from studies that did not provide IPD, the overall effect was similar, with stronger evidence of benefit for gestational diabetes (0.76, 0.65 to 0.89, I2=36.8%; 59 studies, 16 885 women).Conclusion Diet and physical activity based interventions during pregnancy reduce gestational weight gain and lower the odds of caesarean section. There is no evidence that effects differ across subgroups of women

Dietary interventions in overweight and obese pregnant women: a systematic review of the content, delivery, and outcomes of randomized controlled trials

CONTEXT: Interventions targeting maternal obesity are a healthcare and public health priority. OBJECTIVE: The objective of this review was to evaluate the adequacy and effectiveness of the methodological designs implemented in dietary intervention trials for obesity in pregnancy. DATA SOURCES: A systematic review of the literature, consistent with PRISMA guidelines, was performed as part of the International Weight Management in Pregnancy collaboration. STUDY SELECTION: Thirteen randomized controlled trials, which aimed to modify diet and physical activity in overweight and obese pregnant women, were identified. DATA SYNTHESIS: There was significant variability in the content, delivery, and dietary assessment methods of the dietary interventions examined. A number of studies demonstrated improved dietary behavior in response to diet and/or lifestyle interventions. Nine studies reduced gestational weight gain. CONCLUSION: This review reveals large methodological variability in dietary interventions to control gestational weight gain and improve clinical outcomes in overweight and obese pregnant women. This lack of consensus limits the ability to develop clinical guidelines and apply the evidence in clinical practice