Interventions for reducing gestational weight gain in obese and overweight women

Gestational weight gain is a natural part of pregnancy. Excessive gestational weight gain, more common among obese and overweight pregnant women, may lead to negative health effects for mother and child. Exercise and diet therapy interventions are used to reduce excess gestational weight gain in obese and overweight women.

Question

What systematic reviews are there on interventions to reduce excessive gestational weight gain in obese and overweight women?

Identified literature

Table 1. Systematic reviews with low/medium risk of bias.
RCT = Randomised Controlled Trial; MD = Mean Difference; IPD = Individual Participant Data; WMD = Weighted Mean Difference
Included studies Population/Intervention Outcome
Muhammad et al, 2020 [13]
The safety and efficacy of supervised exercise on pregnant women with overweight/obesity: A systematic review and meta-analysis of randomized controlled trials
11 studies, all RCTs
9 studies reporting gestational weight gain
Population: Overweight and/or obese pregnant women.

Intervention: Supervised exercise, individual or in group.
Difference in gestational weight gain (kg)
MD: –0.88 (95% CI, –1.73 to –0.03)
n=745 participants
Authors' conclusion: “Supervised exercise may have beneficial effects to prevent excessive GWG [gestational weight gain], attenuate post-prandial glucose and insulin resistance. However, no effect was observed regarding GDM [gestational diabetes mellitus] incident and gestational hypertension/pre-eclampsia incident.”
Du et al, 2019 [14]
Effects of physical exercise during pregnancy on maternal and infant outcomes in overweight and obese pregnant women: A meta-analysis
13 studies, all RCTs
12 studies reporting gestational weight gain
Population: Overweight and/or obese pregnant women.

Intervention: Physical activity interventions. Both supervised and unsupervised, home- and gymbased included.
Difference in gestational weight gain (kg):
>MD: –1.14 (95% CI, –1.67 to –0.62)
n=1172 participants
Authors' conclusion:
“The findings of the current meta-analysis demonstrated that prenatal exercise in overweight and obese pregnant women reduced gestational weight gain by 1.14 kg and risk of gestational diabetes by 29%. However, there was no significant effect of prenatal exercise on other important clinical maternal and infant outcomes (gestational hypertension, preeclampsia, caesarean delivery, birthweight, large for gestational age, small for gestational age, macrosomia, and preterm birth).”
Lau et al, 2017 [15]
Electronic-based lifestyle interventions in overweight or obese perinatal women: a systematic review and meta-analysis
14 studies, all RCTs
7 studies reporting on gestational weight gainPopulation: Overweight and/or obese women during the perinatal period, starting from pregnancy (9 studies) to 1 year postpartum (5 studies).

Population:
Overweight and/or obese women during the perinatal period, starting from pregnancy (9 studies) to 1 year postpartum (5 studies).

Intervention:
E-based lifestyle interventions comprising at least one component of dietary control, physical activity and weight management that were delivered through at least one of: website, Internet, Apps, SMS, email, computer, or video player.
Difference in gestational weight gain (kg)
All interventions:
MD: –0.63 (95% CI, –1.07 to –0.20)
n=7 studies, 1652 participants
E-based platform:
MD: 1.42 (95% CI, –1.12 to 3.97)
n=2 studies, 78 participants
E-based platform + in person:
MD: –0.85 (95% CI, –1.67 to –0.03)
n=2 studies, 248 participants
E-based platform + phone:
MD: –3.60 (95% CI, –7.01 to –0.19)
n=1 study, 46 participants
E-based platform + in person + phone:
MD: –0.56 (95% CI, –1.09 to –0.03)
n=2 studies, 1270 participants
Authors' conclusion:
“The current meta-analysis indicates that women receiving e-based lifestyle interventions are more likely to limit GWG [gestational weight gain] than those in the comparator groups […].”

“Our meta-analyses showed a trend toward greater weight loss when in-person and phone sessions were added to the e-based platform […]. These results suggest that synchronous interpersonal interactions generate interactional benefits that intensify the effect of e-based lifestyle interventions.”
The International Weight Management in Pregnancy (i-WIP) Collaborative Group, 2017 [16]
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
103 studies, all RCTs
81 studies reporting on gestational weight gain
33 of 81 studies reported individual participant data and were included in subgroup analysis differentiated on weight
Population: Pregnant women, regardless of weight. Subgroup analysis on overweight (28 studies; 2574 participants) and obese (31 studies; 3335 participants) pregnant women.

Intervention: Diet, physical activity and/or mixed interventions (including diet, physical activity and/or behavioural change components).
Difference in gestational weight gain (kg)
All weight categories, all intervention types, studies with individual participant data:
MD: –0.70 (95% CI, –0.92 to –0.48
n=33 studies, 9320 participants
All weight categories, all intervention types, both IPD and non-IPD:
MD: –1.10 (95% CI, –1.46 to –0.74)
n=81 studies, 17530 participants
Overweight, all intervention types, studies with IPD:
MD: –0.75 (95% CI, –1.22 to –0.27)
n=28 studies, 2574 participants
Obese, all intervention types, studies with IPD:
MD: –0.85 (95% CI, –1.41 to –0.29)
n=31 studies, 3335 participants
Authors' conclusion:
“Our large, collaborative individual participant data (IPD) meta-analysis confirms that diet and physical activity based interventions in pregnancy reduce gestational weight gain. This beneficial effect was consistently observed irrespective of maternal body mass index (BMI), age, parity, ethnicity, or pre-existing medical condition; and remained when studies at high risk of bias were excluded. The findings are generalisable, with the 95% prediction interval suggesting a beneficial effect on gestational weight gain when the intervention is applied in a new population or setting.

There is no strong evidence that interventions reduce the risk of maternal and offspring composite outcomes [gestational diabetes, hypertensive disorders of pregnancy, preterm birth and caesarean section; still birth, small for gestational age, large for gestational age, admission to NICU], with no variation in effect observed across the subgroups.”
Flynn et al, 2016 [17]
Dietary interventions in overweight and obese pregnant women: a systematic review of the content, delivery, and outcomes of randomized controlled trials
13 studies, all RCTs
All studies reported gestational weight gain
Population: Overweight and/or obese pregnant women (>18 years).

Intervention: Diet and/or lifestyle interventions with a defined diet component.
Diet only intervention:
3 of 3 studies reported significant reduction of gestational weight gain compared to control.
n=232 participants
Combined diet and physical activity intervention:
6 of 10 studies reported significant reduction of gestational weight gain compared to control.
n=1295 participants
4 of 10 studies found no difference in weight gain between groups.
n=2575 participants
Authors' conclusion:
“The available literature indicates that diet and/or lifestyle interventions effectively increase health dietary behaviors but are inadequate for improving clinical outcomes in overweight and obese pregnant women, despite being able to reduce GWG [gestational weight gain].”
Choi et al, 2013 [18]
The effects of physical activity and physical activity plus diet interventions on body weight in overweight and obese women who are pregnant or in postpartum: a systematic review and meta analysis of randomized controlled trials
11 studies, all RCTs.
7 studies reporting on gestational weight gain.
Population: Overweight and/or obese pregnant (7 trials) or postpartum (4 trials) women.

Intervention: Interventions targeting increased physical activity. 2 of the seven studies on pregnant women provided supervised physical activity sessions; 2 studies provided supervised physical activity sessions along dietary and gestational weight gain guidance; 3 studies implemented guidance on physical activity, diet and gestational weight gain.
Overall change in weight, pregnant women (kg)
All interventions:
WMD: –0.91 (95% CI, –1.76 to –0.06)
n=7 studies, 721 participants
Supervised physical activity:
WMD: –1.74 (95% CI, –3.66 to 0.19)
n=2 studies, 52 participants
Supervised physical activity and diet: WMD: –1.17 (95% CI, –2.14 to –0.21)
n=2 studies, 372 participants
Unsupervised physical activity and diet:
WMD: 0.44 (95% CI, –1.86 to 2.74)
n=3 studies, 297 participants
Authors' conclusion:
“The evidence suggests supervised physical activity plus diet programs were most effective in managing weight among OW/OB [overweight/obese] pregnant and postpartum women. However, advice alone to promote physical activity without a personalized physical activity prescription/goal in physical activity plus diet interventions was not effective enough to prevent excessive gestational weight gain or postpartum weight retention for OW/OB women.”
Oteng-Nim, 2012 [19]
Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis
19 studies: 13 RCTs, 6 non-RCTs.
16 studies (10 RCTs and 6 non-RCTs) reporting on gestational weight gain.
Population: Obese and/or overweight pregnant women

Intervention: Antenatal dietary and lifestyle interventions. 2 studies with only nutritional guidance, 17 using dietary and physical activity guidance.
Difference in gestational weight gain (kg)
RCTs:
MD: –2.21 (95% CI, –2.86 to –1.57)
n=10 studies, 1228 participants
Non-randomised trials:
MD: –0.42 (95% CI, –1.03 to 0.19)
n=6 studies, 1534 participants
Authors' conclusion:
“The reduction in gestational weight gain was observed to be statistically significant in the meta-analysis of randomised trials […] but non-significant in the meta-analysis of non-randomised trials.”

“There is evidence to suggest antenatal lifestyle interventions may restrict gestational weight gain and a trend towards a reduced prevalence of gestational diabetes, but there was no statistical effect on other important clinical outcomes, possibly due to inadequate power of the combined sample size. The effect on restricted weight gain and gestational diabetes was not consistent across all the trial populations and therefore cannot be generalised.”

References

  1. Muhammad HFL, Pramono A, Rahman MN. The safety and efficacy of supervised exercise on pregnant women with overweight/obesity: A systematic review and meta-analysis of randomized controlled trials. Clinical obesity. 2020:e12428. Available from: https://doi.org/10.1111/cob.12428.
  2. Du M-C, Ouyang Y-Q, Nie X-F, Huang Y, Redding SR. Effects of physical exercise during pregnancy on maternal and infant outcomes in overweight and obese pregnant women: A meta-analysis. Birth (Berkeley, Calif). 2019;46(2):211-21. Available from: https://doi.org/https://dx.doi.org/10.1111/birt.12396.
  3. Lau Y, Klainin-Yobas P, Htun TP, Wong SN, Tan KL, Ho-Lim ST, et al. Electronic-based lifestyle interventions in overweight or obese perinatal women: a systematic review and meta-analysis. Obesity Reviews. 2017;18(9):1071-87. Available from: https://doi.org/10.1111/obr.12557.
  4. International Weight Management in Pregnancy Collaborative G. 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. BMJ (Clinical research ed). 2017;358:j3119. Available from: https://doi.org/10.1136/bmj.j3119.
  5. Flynn AC, Dalrymple K, Barr S, Poston L, Goff LM, Rogozińska E, et al. Dietary interventions in overweight and obese pregnant women: A systematic review of the content, delivery, and outcomes of randomized controlled trials. Nutrition Reviews. 2016;74(5):312-28. Available from: https://doi.org/10.1093/nutrit/nuw005.
  6. Choi J, Fukuoka Y, Lee JH. The effects of physical activity and physical activity plus diet interventions on body weight in overweight or obese women who are pregnant or in postpartum: A systematic review and meta-analysis of randomized controlled trials. Preventive Medicine. 2013;56(6):351-64. Available from: https://doi.org/10.1016/j.ypmed.2013.02.021.
  7. Oteng-Ntim E, Varma R, Croker H, Poston L, Doyle P. Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: Systematic review and meta-analysis. BMC Medicine. 2012;10. Available from: https://doi.org/10.1186/1741-7015-10-47.

SBU Enquiry Service Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Published: 5/12/2021
Report no: ut202110
Registration no: SBU 2020/855