Table 4.
Summary of effects of lifestyle interventions during pregnancy on relative risks of maternal and neonatal outcomes.
| Systematic reviews | RCT (n) | BMI | Participants (n) | R-AMSTAR Ranking | GDM | Pregnancy-induced HTA | Pre-eclampsia | Caesarian section | Preterm delivery | LGA | Macrosomia | Neonatal RDS |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PHYSICAL ACTIVITY INTERVENTIONS DURING PREGNANCY | ||||||||||||
| Streuling et al. (97) | 12 | Any BMI | 906 | C | ||||||||
| Elliot-Sale et al. (98) | 3 | Any BMI | 214 | D | ||||||||
| da Silva et al. (99) | 18 | Any BMI | 3,203 | D | 0.67 (0.49–0.92) |
0.51 (0.30–0.87) |
||||||
| Perales et al. (100) | 57 | Any BMI | Not reported | D | Reduced risk (4/14 RCTs, aerobic + resistance training), weak. | Reduced risk (1/12 RCTs, aerobic + resistance training), weak. | Reduced risk (3/15 RCTs, aerobic + resistance training), weak. | Reduced risk (3/21 RCTs, aerobic + resistance training), weak. | ||||
| MULTI-COMPONENT DIET AND PHYSICAL ACTIVITY INTERVENTIONS DURING PREGNANCY | ||||||||||||
| Muktabhant et al. (101) | 3 | Any BMI | 444 | A | 0.70 (0.51–0.96), 5,162 women, low-quality. |
0.89 (0.80–1.0, p = 0.05), 7,534 women, moderate-quality. |
In OW/OB: 0.85 (0.73–1.0), moderate-quality |
In OW/OB: 0.47 (0.26–0.85), moderate-quality. |
||||
| Thangaratinam et al. (102) | 30 | Any BMI | Subroup analysis§, number not reported. | A | Diet* only: In OW/OB: 0.39 (0.23–0.69), low-quality. |
Diet* only: 0.30 (0.10–0.88), low-quality; In OW/OB, 0.30 (0.10–0.88), low-quality. |
Diet* only: 0.82 (0.43–1.42, NS) |
Diet* only: 0.26 (0.09–0.74), low-quality. |
||||
| Shepherd et al. (111) | 16 | Any BMI | 6,633 | A | 0.85 (0.71–1.01), 3633 women, (p = 0.07); moderate-quality. |
0.95 (0.88–1.02), 6,089 women, moderate-quality. |
0.89 (0.78–1.01, p = 0.06) |
0.56 (0.33–0) | ||||
| International Weight Management in Pregnancy Collaborative (103) | 33 | Any BMI | 11,410 | C | 0.91 (0.83–0.99), high-quality. |
|||||||
| O'Brien et al. (104) | 4 | Any BMI | 446 | D | 0.34 (0.13–0.91) |
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| Lau et al. (105) | 7 | OW/OB | 1,652 | B | ||||||||
| Choi et al. (106) | 7 | OW/OB | 721 | D | ||||||||
| Flynn et al. (107) | 13 | OW/OB | 4276 | D | ||||||||
Results are presented as risk ratios, 95% confidence intervals (in brackets) and the reported quality of evidence by authors. BMI, body mass index; OW, overweight; OB, obesity; GDM, gestational diabetes mellitus; HTA, hypertension; LGA, large for gestational age; RDS, respiratory distress syndrome; n.s., not significant. ‡significant effect at 1–2 months postpartum only;
Studies on women with pre-existing diabetes or GDM were excluded for this sub-analysis (5 RCTs were excluded), the remaining number of participants was not reported by authors;
Diet only interventions included of a balanced diet consisting of proteins (15–20%), fat (max. 30%) and carbohydrates (50–55%) including low glycemic load (beans, lentils and vegetables, fruits, unprocessed whole grains). ‡Significant effect at 1-2 months postpartum only.