Table 2.
A summary of the studies that met the criteria of the systematic review on lifestyle interventions in overweight and obese pregnant women: randomised trials
| 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 |
BMI: body mass index; SD: standard deviation