Table 3.

Strength of evidence for effect of postpartum lifestyle interventions on weight, adiposity, metabolic and biological markers

Outcome	Strength of evidence	Intervention	Conclusions
Weight	Low	Nutrition and Exercise	Four good quality RCTs had inconsistent findings. Three of the four fair-to-good quality studies reported greater weight loss in the intervention group compared to standard postpartum care, but the RCTs were short (≤9 months) in duration and had limited generalizability to racial and ethnic minority groups.
	Low	Exercise only	Results were inconclusive for comparison of exercise-only interventions with standard postpartum care, with low risk for bias, but moderate imprecision and inconsistency in the dire study findings.
	Insufficient	Nutrition only	Only one RCT for comparison of diet-only with standard postpartum care, with high attrition rates and differential loss to follow-up between treatment groups.
Adiposity	Low	All interventions	Few studies included adiposity and there is inconsistency in adiposity measures across studies. One comparison showed a reduction in skinfold thickness; two comparisons reported a statistically significant reduction in waist-to-hip ratios, but estimate of effect were imprecise due to small sample sizes.
Cardio-metabolic	Insufficient	All interventions	One RCT compared lipid and glucose levels between women receiving a nutrition and exercise intervention and historical controls
Biological markers	Insufficient	All interventions	Only one RCT was included for the outcome of adiponectin. Findings from the intervention group were compared to non-randomized historical controls.