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BMC Med. 2012; 10: 47.
Published online May 10, 2012. doi:  10.1186/1741-7015-10-47
PMCID: PMC3355057
Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis
Eugene Oteng-Ntim,corresponding author1,2,3 Rajesh Varma,1,3 Helen Croker,4 Lucilla Poston,3 and Pat Doyle2
1Department of Women's Health, Guy's and St Thomas' NHS Foundation Trust (King's Health Partners), St Thomas' Hospital, Westminster Bridge Road, London, SE 1 7EH, UK
2London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
3School of Medicine, King's College London, Strand, London, WC2R 2LS, UK
4Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, UK
corresponding authorCorresponding author.
Eugene Oteng-Ntim: Eugene.oteng-ntim/at/gstt.nhs.uk; Rajesh Varma: drbobbyvarma/at/gmail.com; Helen Croker: h.croker/at/ucl.ac.uk; Lucilla Poston: Lucilla.poston/at/kcl.ac.uk; Pat Doyle: pat.doyle/at/lshtm.ac.uk
Received December 23, 2011; Accepted May 10, 2012.
Abstract
Background
Overweight and obesity pose a big challenge to pregnancy as they are associated with adverse maternal and perinatal outcome. Evidence of lifestyle intervention resulting in improved pregnancy outcome is conflicting. Hence the objective of this study is to determine the efficacy of antenatal dietary, activity, behaviour or lifestyle interventions in overweight and obese pregnant women to improve maternal and perinatal outcomes.
Methods
A systematic review and meta-analyses of randomised and non-randomised clinical trials following prior registration (CRD420111122 http://www.crd.york.ac.uk/PROSPERO) and PRISMA guidelines was employed. A search of the Cochrane Library, EMBASE, MEDLINE, CINAHL, Maternity and Infant care and eight other databases for studies published prior to January 2012 was undertaken. Electronic literature searches, study selection, methodology and quality appraisal were performed independently by two authors. Methodological quality of the studies was assessed according to Cochrane risk of bias tool. All appropriate randomised and non-randomised clinical trials were included while exclusions consisted of interventions in pregnant women who were not overweight or obese, had pre-existing diabetes or polycystic ovarian syndrome, and systematic reviews. Maternal outcome measures, including maternal gestational weight gain, gestational diabetes and Caesarean section, were documented. Fetal outcomes, including large for gestational age and macrosomia (birth weight > 4 kg), were also documented.
Results
Thirteen randomised and six non-randomised clinical trials were identified and included in the meta-analysis. The evidence suggests antenatal dietary and lifestyle intervention in obese pregnant women reduces maternal pregnancy weight gain (10 randomised clinical trials; n = 1228; -2.21 kg (95% confidence interval -2.86 kg to -1.59 kg)) and a trend towards a reduction in the prevalence of gestational diabetes (six randomised clinical trials; n = 1,011; odds ratio 0.80 (95% confidence interval 0.58 to 1.10)). There were no clear differences reported for other outcomes such as Caesarean delivery, large for gestational age, birth weight or macrosomia. All available studies were assessed to be of low to medium quality.
Conclusion
Antenatal lifestyle intervention is associated with restricted gestational weight gain and a trend towards a reduced prevalence of gestational diabetes in the overweight and obese population. These findings need to be interpreted with caution as the available studies were of poor to medium quality.
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