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Interventions during pregnancy to reduce excessive gestational weight gain: a systematic review assessing current clinical evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system
Örebro University, School of Health and Medical Sciences.
Örebro University, School of Health and Medical Sciences.
2010 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 117, no 11, p. 1327-1334Article in journal (Refereed) Published
Abstract [en]

Background Excessive weight gain during pregnancy is common in developed countries and increases the risk of complications during pregnancy, delivery and the postpartum period, which can affect both maternal and fetal outcome. Interventions to reduce excessive gestational weight gain have previously not been systematically evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Objectives To determine whether published trials of interventions to reduce excessive gestational weight gain are of sufficient quality and provide sufficient data to enable evidence-based recommendations to be developed for clinical practice in antenatal care. Search strategy A literature search was conducted in the scientific databases PubMed, Cochrane Library, Cinhal and Pedro, and the reference lists of relevant articles were reviewed. The literature search was concluded on 15 August 2009. Selection criteria All randomised controlled trials (RCTs) were considered for inclusion. As the number of published RCTs was limited, we also considered for inclusion all nonrandomised intervention studies that included a control group. Systematic reviews were examined to identify additional original studies. Data collection and analysis Two reviewers independently assessed the quality of the methods and results of all included articles. Extracted data were classified using the GRADE system. Main results Four intervention studies with a randomised controlled design and four intervention trials with a nonrandomised controlled design met the inclusion criteria. As a consequence of important limitations in study design, inconsistency and lack of directness, the overall quality of evidence was judged to be very low using the GRADE system. Authors' conclusions The results of published intervention trials are of insufficient quality to enable evidence-based recommendations to be developed for clinical practice in antenatal care.

Place, publisher, year, edition, pages
2010. Vol. 117, no 11, p. 1327-1334
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-18903DOI: 10.1111/j.1471-0528.2010.02619.xISI: 000281635900004PubMedID: 20840691Scopus ID: 2-s2.0-77956542667OAI: oai:DiVA.org:oru-18903DiVA, id: diva2:445557
Available from: 2011-10-04 Created: 2011-09-30 Last updated: 2018-02-05Bibliographically approved
In thesis
1. Gestational Weight Gain: Implications of an Antenatal Lifestyle Intervention
Open this publication in new window or tab >>Gestational Weight Gain: Implications of an Antenatal Lifestyle Intervention
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Excessive gestational weight gain (GWG) is common in developed countries and is associated with an increased risk of maternal and offspring morbidity. Evidence regarding efficacy and safety of antenatal lifestyle intervention is limited in terms of both systematic reviews and original trials. This thesis is based on the need to further explore this research area. Objectives: To assess and grade current evidence and evaluate short and long-term effects of an antenatal lifestyle intervention on women and their offspring Materials: Controlled trials of intervention publishedbefore August 2009 were systematically searched and reviewed. A randomized controlled trial (RCT) including 445 healthy women aged >18 years with a body mass index (BMI) ≥19 and ≤16 weeks pregnant and their offspring was performed during 2007-2015 in Örebro Region, Sweden. Methods: The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used for review. Our RCT (called the VIGA trial) compared standard care with a composite intervention consisting of education, application of a personalized weight graph, prescription of exercise and more frequent monitoring of weight. Standardized measures of weight and height in offspring waere analysed based on World Health Organization (WHO) Child Growth Standards. Results: Quality of evidence across the studies published pre-August 2009 was concluded to be very low. Our intervention significantly reduced mean GWG (kg) but the proportion of women with excessive GWG, according to recommendations, was not significantly reduced. Short- term postpartum weight retention (PPWR) was significantly lower after the intervention but no significant difference remained 1 year after delivery. Offspring mean BMI z-scores or proportion of obesity did not differ between study groups at either birth or age 5. Conclusions: The antenatal lifestyle intervention reduced mean GWG and short-term PPWR but no long-term effects on maternal weight retention or offspring obesity were seen. Alternative modes and timing of intervention should be considered in future research. Reducing the prevalence of pre-conception obesity must still be considered the primary means to improve maternal and fetal outcome.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2016. p. 61
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 146
Keywords
gestational weight gain, maternal health, pregnancy, prevention of obesity, lifestyle intervention, childhood obesity
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-51439 (URN)978-91-7529-148-2 (ISBN)
Public defence
2016-09-30, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2016-07-25 Created: 2016-07-25 Last updated: 2017-10-17Bibliographically approved

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Rönnberg, Ann-KristinNilsson, Kerstin

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