Lifestyle Interventions to Improve Pregnancy Outcomes: a Systematic Review and Specified Meta-Analyses

Abstract

To compare the impact of lifestyle interventions for overweight and obese pregnant women a systematic review and meta-analysis was conducted using pre-registration and audit of the interventions as selection criteria.

PubMed, Web of Science and CENTRAL were searched for randomized controlled trials examining diet, exercise, combined interventions or associated behavioral therapy. Trials were selected if they reported one of the primary outcomes (gestational diabetes, hypertensive disorders, perinatal mortality, admission to neonatal intensive care unit). Results were established from the total group and separately from pre-registered or clinically audited studies.

Out of 1304 titles, 28 randomized controlled trials were included. Among the primary outcomes only hypertensive disorders were significantly reduced by exercise in the total group: odds ratio 0.52 (95% confidence interval 0.28 to 0.96, four trials, 1324 participants). When behavioral therapy supported combined interventions, maternal weight gain, (Standardized Mean Difference −0.16 kilogram; 95% confidence interval −0.28 to −0.04, four trials, 2132 participants) and neonatal birthweight, (Standardized Mean Difference −0.4 gram; 95% confidence interval −0.62 to −0.18, five trials, 1058 participants), were significantly reduced within the total group and both specified meta-analyses. Higher frequencies of physical activity improved the results. Risk of bias, assessed with the Cochrane Tool, was low to moderate.

Elements of behavioral therapy might better prevent adverse effects of maternal obesity when combined with lifestyle interventions. Unfortunately, high heterogeneity due to different intervention and population characteristics was a limiting factor. Future studies should also focus on increased intensities of physical activity.

Zusammenfassung

Das Ziel war, die Auswirkungen von Lebensstil-Interventionen auf übergewichtige und adipöse Schwangere zu vergleichen. Dazu wurde eine systematische Auswertung der Literatur mit spezifizierten Metaanalysen durchgeführt; Auswahlkriterien waren Registrierung vor Studiendurchführung und Prüfung von Interventionen.

Die Datenbanken PubMed, Web of Science und CENTRAL wurden nach randomisierten kontrollierten Studien durchsucht, welche die Auswirkungen von Ernährung, körperlicher Betätigung, kombinierten Interventionen sowie damit assoziierten Verhaltenstherapien untersuchten. Studien wurden in die Auswertung aufgenommen, wenn sie Informationen über Primärergebnisse (Gestationsdiabetes, Hypertonie, perinatale Sterblichkeit, Aufnahme auf eine Intensivstation für Früh- und Neugeborene) enthielten. Die Ergebnisse wurden für die Gesamtgruppe sowie separat für im Vorfeld registrierte oder klinisch geprüfte Studien ermittelt.

Aus insgesamt 1304 Publikationen wurden 28 randomisierte kontrollierte Studien ausgewählt und in die Auswertung aufgenommen. Bei den Primärergebnissen zeigte sich, dass in der Gesamtgruppe nur die Hypertonie durch mehr körperliche Betätigung signifikant reduziert werden konnte: Odds Ratio (OR) 0,52 (95%-Konfidenzintervall [KI] 0,28–0,96, 4 Studien, 1324 Teilnehmer). Wenn kombinierte Interventionen durch eine Verhaltenstherapie unterstützt wurden, kam es innerhalb der Gesamtgruppe sowie in den spezifizierten Metaanalysen zu einer deutlichen Reduzierung der mütterlichen Gewichtszunahme, (standardisierter Mittelwertdifferenz −0,16 Kg; 95%-KI −0,28 bis −0,04, 4 Studien, 2132 Teilnehmer) und des neonatalen Geburtsgewichts (standardisierter Mittelwertdifferenz −0,4 g; 95%-KI −0,62 bis −0,18, 5 Studien, 1058 Teilnehmer). Höhere Häufigkeiten bei der körperlichen Betätigung verbesserten die Ergebnisse. Das mit dem Cochrane-Tool bewertete Verzerrungspotenzial war gering bis mäßig.

Elemente der Verhaltenstherapie können die negativen Auswirkungen einer mütterlichen Adipositas besser verhindern, wenn sie mit Lebensstil-Interventionen kombiniert werden. Leider war die hohe Heterogenität infolge der unterschiedlichen Interventionen und Bevölkerungscharakteristiken ein limitierender Faktor. Künftige Studien sollten ihr Augenmerk auch auf die Intensität der körperlichen Betätigung richten.

Schlüsselwörter

Übergewicht - HELLP-Syndrom - Präeklampsie - Diabetes mellitus - körperliche Betätigung - Ernährung

Keywords

obesity - HELLP syndrome - preeclampsia - diabetes mellitus - exercise - diet

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