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Health Technol Assess. 2017 Aug;21(41):1-158. doi: 10.3310/hta21410.

Effects of antenatal diet and physical activity on maternal and fetal outcomes: individual patient data meta-analysis and health economic evaluation.

Author information

1
Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
2
Multidisciplinary Evidence Synthesis Hub, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
3
Pragmatic Clinical Trials Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK.
4
Health Economics Unit, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
5
Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, the Netherlands.
6
Department of Obstetrics and Gynaecology, Faculty of Medicine, VU University Medical Center, Amsterdam, the Netherlands.
7
Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK.
8
Department of Public and Occupational Health, EMGO Institute for Health and Care Research (EMGO+), VU University Medical Center, Amsterdam, the Netherlands.
9
Institute of Sport Science, University of Graz, Graz, Austria.
10
Division of Women's Health, Women's Health Academic Centre, King's College London, St Thomas' Hospital, London, UK.
11
Department of Obstetrics and Gynecology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
12
School of Medicine & Medical Science, UCD Institute of Food and Health, Dublin, Ireland.
13
The Robinson Research Institute, School of Medicine, Department of Obstetrics & Gynaecology, University of Adelaide, SA, Australia.
14
Women's and Children's Health Network, Women's and Babies Division, North Adelaide, SA, Australia.
15
Facultad de Ciencias de la Actividad Física y del Deporte, Universidad Politecnica de Madrid, Madrid, Spain.
16
Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.
17
School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
18
Research Unit Healthy Living, University Colleges Leuven-Limburg, Leuven, Belgium.
19
Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium.
20
Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg, Hasselt and University Hospitals KU Leuven, Leuven, Belgium.
21
Monash Centre for Health Research and Implementation, School of Public Health, Monash University, Melbourne, VIC, Australia.
22
Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo, Norway.
23
Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
24
Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia.
25
Department of Obstetrics and Gynecology, Alexandria University, Alexandria, Egypt.
26
Department of Sport Physiology, Faculty of Physical Education and Sport Sciences, Mazandaran University, Babolsar, Iran.
27
Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway.
28
UKK Institute for Health Promotion Research, Tampere, Finland.
29
School of Health Sciences, University of Tampere, Tampere, Finland.
30
School of Sport Science, Exercise and Health, University of Western Australia, Perth, WA, Australia.
31
Mother-Infant Department, University of Modena and Reggio Emilia, Modena, Italy.
32
Kinesiology Department, California Polytechnic State University, San Luis Obispo, CA, USA.
33
Department of Management and Health Care, São Paulo Federal University, Santos, Brazil.
34
Else Kröner-Fresenius-Center for Nutritional Medicine, Technische Universität München, Munich, Germany.
35
Competence Centre for Nutrition, Freising, Germany.
36
Departments of Obstetrics and Gynecology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
37
Department of Obstetrics and Gynecology, Sorlandet Hospital Kristiansand, Kristiansand, Norway.
38
Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
39
Clinical Services, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
40
Department of Obstetrics and Gynaecology, Clinical Sciences, Lund University, Lund, Sweden.
41
Department of Laboratory Medicine Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
42
Department of Endocrinology, Odense University Hospital, Odense, Denmark.
43
Department of Nutrition and the Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
44
Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.
45
Nutritional Research Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark.
46
Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.
47
School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
48
The South Australian Health and Medical Research Institute, Adelaide, SA, Australia.

Abstract

BACKGROUND:

Diet- and physical activity-based interventions in pregnancy have the potential to alter maternal and child outcomes.

OBJECTIVES:

To assess whether or not the effects of diet and lifestyle interventions vary in subgroups of women, based on maternal body mass index (BMI), age, parity, Caucasian ethnicity and underlying medical condition(s), by undertaking an individual patient data (IPD) meta-analysis. We also evaluated the association of gestational weight gain (GWG) with adverse pregnancy outcomes and assessed the cost-effectiveness of the interventions.

DATA SOURCES:

MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Health Technology Assessment database were searched from October 2013 to March 2015 (to update a previous search).

REVIEW METHODS:

Researchers from the International Weight Management in Pregnancy Collaborative Network shared the primary data. For each intervention type and outcome, we performed a two-step IPD random-effects meta-analysis, for all women (except underweight) combined and for each subgroup of interest, to obtain summary estimates of effects and 95% confidence intervals (CIs), and synthesised the differences in effects between subgroups. In the first stage, we fitted a linear regression adjusted for baseline (for continuous outcomes) or a logistic regression model (for binary outcomes) in each study separately; estimates were combined across studies using random-effects meta-analysis models. We quantified the relationship between weight gain and complications, and undertook a decision-analytic model-based economic evaluation to assess the cost-effectiveness of the interventions.

RESULTS:

Diet and lifestyle interventions reduced GWG by an average of 0.70 kg (95% CI -0.92 to -0.48 kg; 33 studies, 9320 women). The effects on composite maternal outcome [summary odds ratio (OR) 0.90, 95% CI 0.79 to 1.03; 24 studies, 8852 women] and composite fetal/neonatal outcome (summary OR 0.94, 95% CI 0.83 to 1.08; 18 studies, 7981 women) were not significant. The effect did not vary with baseline BMI, age, ethnicity, parity or underlying medical conditions for GWG, and composite maternal and fetal outcomes. Lifestyle interventions reduce Caesarean sections (OR 0.91, 95% CI 0.83 to 0.99), but not other individual maternal outcomes such as gestational diabetes mellitus (OR 0.89, 95% CI 0.72 to 1.10), pre-eclampsia or pregnancy-induced hypertension (OR 0.95, 95% CI 0.78 to 1.16) and preterm birth (OR 0.94, 95% CI 0.78 to 1.13). There was no significant effect on fetal outcomes. The interventions were not cost-effective. GWG, including adherence to the Institute of Medicine-recommended targets, was not associated with a reduction in complications. Predictors of GWG were maternal age (summary estimate -0.10 kg, 95% CI -0.14 to -0.06 kg) and multiparity (summary estimate -0.73 kg, 95% CI -1.24 to -0.23 kg).

LIMITATIONS:

The findings were limited by the lack of standardisation in the components of intervention, residual heterogeneity in effects across studies for most analyses and the unavailability of IPD in some studies.

CONCLUSION:

Diet and lifestyle interventions in pregnancy are clinically effective in reducing GWG irrespective of risk factors, with no effects on composite maternal and fetal outcomes.

FUTURE WORK:

The differential effects of lifestyle interventions on individual pregnancy outcomes need evaluation.

STUDY REGISTRATION:

This study is registered as PROSPERO CRD42013003804.

FUNDING:

The National Institute for Health Research Health Technology Assessment programme.

PMID:
28795682
PMCID:
PMC5572115
DOI:
10.3310/hta21410
[Indexed for MEDLINE]
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