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Dodd JM, Deussen AR, Poprzeczny AJ, Slade LJ, Mitchell M, Louise J. Investigating discrepancies in findings between rigorous randomized trials and meta-analyses evaluating pregnancy interventions to limit gestational weight gain. Obes Rev 2024:e13826. [PMID: 39363588 DOI: 10.1111/obr.13826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 07/26/2024] [Accepted: 08/18/2024] [Indexed: 10/05/2024]
Abstract
INTRODUCTION Robust randomized trials consistently demonstrate little impact from diet and physical activity interventions on gestational weight gain (GWG) and clinical outcomes, although meta-analyses report some benefit. Our aim was to evaluate the effect of trial quality on treatment effect estimates and review conclusions. METHODS We conducted a systematic review of dietary and/or physical activity interventions for pregnant women with a body mass index ≥18.5 kg/m2. We assessed studies for risk of bias and methodological features impacting reliability. Outcomes included GWG; gestational diabetes mellitus (GDM); pre-eclampsia; caesarean birth; and birth weight measures. For each outcome, a sequence of meta-analyses was performed based on intervention group and level of potential bias in the effect estimate. RESULTS We identified 128 eligible studies. The most robust estimate from a combined diet and physical activity behavioral intervention, with only studies at negligible risk of bias, was a difference in GWG of 1.10 kg (95% CI -1.62 to -0.58; 17,755 women). There was no evidence of an effect on any clinical outcomes. CONCLUSIONS Our findings highlight discrepancies produced by the indiscriminate inclusion of studies with methodological flaws in previous systematic reviews. Regular weighing of pregnant women is futile in the absence of clinical benefit.
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Affiliation(s)
- Jodie M Dodd
- Department of Obstetrics and Gynaecology and The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Obstetrics and Gynaecology, The Women's and Children's Hospital, Women's and Babies Division, Adelaide, South Australia, Australia
| | - Andrea R Deussen
- Department of Obstetrics and Gynaecology and The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Amanda J Poprzeczny
- Department of Obstetrics and Gynaecology and The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Obstetrics and Gynaecology, The Women's and Children's Hospital, Women's and Babies Division, Adelaide, South Australia, Australia
| | - Laura J Slade
- Department of Obstetrics and Gynaecology and The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Obstetrics and Gynaecology, The Women's and Children's Hospital, Women's and Babies Division, Adelaide, South Australia, Australia
| | - Megan Mitchell
- Department of Obstetrics and Gynaecology and The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jennie Louise
- Women's and Children's Hospital Research Centre, Adelaide, South Australia, Australia
- Biostatistics Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Takele WW, Vesco KK, Josefson J, Redman LM, Hannah W, Bonham MP, Chen M, Chivers SC, Fawcett AJ, Grieger JA, Habibi N, Leung GKW, Liu K, Mekonnen EG, Pathirana M, Quinteros A, Taylor R, Ukke GG, Zhou SJ, Lim S. Effective interventions in preventing gestational diabetes mellitus: A systematic review and meta-analysis. COMMUNICATIONS MEDICINE 2024; 4:75. [PMID: 38643248 PMCID: PMC11032369 DOI: 10.1038/s43856-024-00491-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/22/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Lifestyle choices, metformin, and dietary supplements may prevent GDM, but the effect of intervention characteristics has not been identified. This review evaluated intervention characteristics to inform the implementation of GDM prevention interventions. METHODS Ovid, MEDLINE/PubMed, and EMBASE databases were searched. The Template for Intervention Description and Replication (TIDieR) framework was used to examine intervention characteristics (who, what, when, where, and how). Subgroup analysis was performed by intervention characteristics. RESULTS 116 studies involving 40,940 participants are included. Group-based physical activity interventions (RR 0.66; 95% CI 0.46, 0.95) reduce the incidence of GDM compared with individual or mixed (individual and group) delivery format (subgroup p-value = 0.04). Physical activity interventions delivered at healthcare facilities reduce the risk of GDM (RR 0.59; 95% CI 0.49, 0.72) compared with home-based interventions (subgroup p-value = 0.03). No other intervention characteristics impact the effectiveness of all other interventions. CONCLUSIONS Dietary, physical activity, diet plus physical activity, metformin, and myoinositol interventions reduce the incidence of GDM compared with control interventions. Group and healthcare facility-based physical activity interventions show better effectiveness in preventing GDM than individual and community-based interventions. Other intervention characteristics (e.g. utilization of e-health) don't impact the effectiveness of lifestyle interventions, and thus, interventions may require consideration of the local context.
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Affiliation(s)
- Wubet Worku Takele
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Kimberly K Vesco
- Kaiser Permanente Northwest, Kaiser Permanente Center for Health Research, Oakland, USA
| | - Jami Josefson
- Northwestern University/ Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Wesley Hannah
- Madras Diabetes Research Foundation Chennai, Chennai, India
- Deakin University, Melbourne, Australia
| | - Maxine P Bonham
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
| | - Mingling Chen
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Sian C Chivers
- Department of Women and Children's Health, King's College London, London, UK
| | - Andrea J Fawcett
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Clinical & Organizational Development, University of Chicago, Chicago, IL, USA
| | - Jessica A Grieger
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Nahal Habibi
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Gloria K W Leung
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
| | - Kai Liu
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
| | | | - Maleesa Pathirana
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Alejandra Quinteros
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Rachael Taylor
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Gebresilasea G Ukke
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Shao J Zhou
- School of Agriculture, Food and Wine, The University of Adelaide, Adelaide, Australia
| | - Siew Lim
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.
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Liu G, Zhang J, Zhou C, Zhang H, Shen H. Effect of excessive gestational weight gain before and after 28 weeks on trial of labor after cesarean stratified by pre-pregnancy body mass index: a retrospective cohort study. Front Med (Lausanne) 2023; 10:1157967. [PMID: 37636572 PMCID: PMC10447909 DOI: 10.3389/fmed.2023.1157967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
This study aimed to assess the effect of excessive gestational weight gain (GWG) before and after 28 weeks on the mode of delivery in women who attempted a trial of labor after cesarean (TOLAC), stratified by pre-pregnancy BMI. A retrospective analysis of the outcomes of eligible women who attempted trial of labor after cesarean (TOLAC) in a Chinese hospital from January 2016 to October 2022 was performed. GWG before and after 28 weeks was categorized as 'excessive' or 'non-excessive' based on the guideline of Institute of Medicine (IOM). Multivariable logistic regression analyses were used to estimate the effect of excessive GWG before and after 28 weeks on mode of delivery in women who underwent TOLAC, stratified by pre-pregnancy BMI. Of the 512 women who underwent term trial of labor, 71.1% achieved a vaginal birth. No correlation was found between excessive GWG before 28 weeks and the rate of vaginal birth after cesarean (VBAC). Among women with or without excessive GWG before 28 weeks, excessive GWG after 28 weeks was significantly associated with a reduced rate of VBAC. When stratified by pre-pregnancy BMI, women who had excessive gestational weight gain after 28 weeks gestation had lower rates of VBAC than those who did not, regardless of being underweight, normal or overweight (aOR 0.23, 95% CI 0.06-0.88; aOR 0.42, 95% CI 0.25, 0.70; and aOR 0.12, 95% CI 0.04-0.36; respectively). Excessive weight gain after 28 weeks of pregnancy was related to decreased rates of VBAC, irrespective of pre-pregnancy weight status and weight gain before 28 weeks.
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Affiliation(s)
- Guangpu Liu
- Department of Obstetrics and Gynecology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jingya Zhang
- Department of Obstetrics and Gynecology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Chaofan Zhou
- Department of Neurology, Children’s Hospital of Hebei Province, Shijiazhuang, Hebei, China
| | - Huixin Zhang
- Department of Obstetrics and Gynecology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Haoran Shen
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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Xie E, Tao H, Liu M, Li C, Zhao Q. The effect of exercise on the prevention of gestational hypertension in obese and overweight pregnant women: An updated meta-analysis. Front Public Health 2022; 10:923161. [PMID: 36045739 PMCID: PMC9420989 DOI: 10.3389/fpubh.2022.923161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/25/2022] [Indexed: 01/22/2023] Open
Abstract
Background Gestational hypertension (GH) is a common disease that seriously threatens the safety and health of pregnant women and their newborns. Physical exercise (PE) is widely recognized as a health maintenance method and it has numerous benefits. Studies on the association between PE and the risk of GH in obese and overweight pregnant women have generated controversial findings. This updated meta-analysis was performed to reassess the effects of PE on GH. Methods The articles from inception to April 2022, presenting studies investigating exercise intervention and pregnancy outcomes were explored across several online databases. Heterogeneity among the included studies was estimated and tested by Q test and I 2 statistic. Risk ratios (RRs) and 95% confidence intervals (CI) were calculated through either random-effect or fixed-effect models. Subgroup analyses, sensitivity analyses, and publication bias diagnoses were also conducted. Results Twelve with 1,649 subjects were included. PE was associated with a reduced risk of GH in obese and overweight pregnant women (Pooled RR = 0.58, 95% CI = 0.42-0.81, P = 0.001; I 2 = 24.3%). Subgroup analysis found significant trends amongst Eastern countries (RR = 0.59, 95% CI = 0.36-0.96, P = 0.033). Sensitivity analysis suggested the results were stable. No publication bias was detected based on Begg's test and Egger's test. Conclusion PE was associated with reduced risk of GH in obese and overweight pregnant women, especially in Eastern countries. More well-designed studies are still needed to further elaborate on these associations. Systematic review registration CRD42022326183.
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Affiliation(s)
- Enli Xie
- Department of Sports Training, Nanjing Sport Institute, Nanjing, China,*Correspondence: Enli Xie
| | - Huimin Tao
- Department of Sports Training, Nanjing Sport Institute, Nanjing, China
| | - Mengqing Liu
- Department of Chaohu Clinical Medicine, Anhui Medical University, Hefei, China
| | - Changchun Li
- School of Physical Education, Spots Institute of Jingdezhen University, Jingdezhen, China,Changchun Li
| | - Qi Zhao
- Department of Sports Training, Nanjing Sport Institute, Nanjing, China,Qi Zhao
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