Systematic Reviews on the Prevention of Adverse Pregnancy Outcomes Related to Maternal Obesity to Improve Evidence-Based Counselling

Abstract

Background

Health professionals and their patients should understand the importance of evidence. In the case of gestational diabetes mellitus, which is often associated with an abnormally high body mass index, the immediate and long-term outcome of women and their offspring depends in part on advice and implementation of lifestyle changes before, during and after pregnancy.

Methods

Up to September 2023, MEDLINE, CENTRAL, and WEB OF SCIENCE were used to identify systematic reviews and meta-analyses on the prevention of gestational diabetes. The ROBIS and AMSTAR criteria were analyzed for all systematic reviews.

Results

A total of 36 systematic reviews were identified. Dietary interventions, physical activity or a combined approach all reduced adverse pregnancy outcomes such as gestational diabetes, pregnancy-induced hypertension and related morbidities. Within the randomized controlled trials included in the 36 systematic reviews, the type, intensity and frequency of interventions varied widely. The primary outcomes, reporting and methodological quality of the 36 systematic reviews and meta-analyses also varied.

The meta-analysis with the highest ROBIS and AMSTAR-2 scores was selected to design an icon array based on a fact box simulating 100 patients.

Conclusions

We propose a methodology for selecting the best evidence and transforming it into a format that illustrates the benefits and harms in a way that can be understood by lay patients, even if they cannot read. This model can be applied to counselling for expectant mothers in low and high-income countries, regardless of socioeconomic status, provided that women have access to appropriately trained healthcare providers.

Zusammenfassung

Hintergrund

Die Bedeutung von Evidenz sollte medizinische Fachkräften und ihren Patientinnen klar sein. Bei Gestationsdiabetes mellitus, der oft mit einem ungewöhnlich hohen Body-Mass-Index assoziiert ist, hängen sowohl die direkten Schwangerschaftsausgänge als auch die Langzeitergebnisse der Frauen und Kinder teilweise von der Beratung und den Lebensstiländerungen während und nach der Schwangerschaft ab.

Methoden

Bis September 2023 wurden Recherchen in MEDLINE, CENTRAL und WEB OF SCIENCE zur Identifizierung von systematischen Übersichtsarbeiten und Metaanalysen zur Prävention von Gestationsdiabetes durchgeführt. Alle systematischen Übersichtsarbeiten wurden anhand der ROBIS- und AMSTAR-Kriterien analysiert.

Ergebnisse

Es wurden insgesamt 36 systematische Übersichtsarbeiten identifiziert. Ernährungsinterventionen, körperliche Aktivitäten oder eine Kombination beider Herangehensweisen konnten ungünstige Schwangerschaftsausgänge wie z. B. Gestationsdiabetes, schwangerschaftsinduzierte Hypertonie und die damit zusammenhängende Morbidität senken. In den randomisierten kontrollierten Studien, die in den 36 systematischen Übersichtsarbeiten eingeschlossen wurden, gab es starke Unterschiede in der Art, der Intensität und der Häufigkeit der Intervention. Die primären Endpunkte, die Berichterstattung und die methodologische Qualität der 36 systematischen Übersichtsarbeiten und Metaanalysen variierten ebenfalls stark.

Es wurde die Metaanalyse mit den höchsten ROBIS- und AMSTAR-2-Punktzahlen ausgewählt, um eine Reihe von Symbolen basierend auf einer 100 Patientinnen simulierenden Faktenbox zu entwerfen.

Schlussfolgerungen

Es wird hier eine Methode vorgeschlagen, mit der die beste Evidenz ausgewählt und in ein Format überführt werden kann, das die Vorteile und Schäden so veranschaulicht, dass sie von Patientinnen ohne medizinische Vorbildung verstanden werden können, selbst wenn diese Frauen nicht lesen können. Dieses Modell kann bei der Beratung werdender Mütter in Ländern mit niedrigem und hohem Einkommen eingesetzt werden, unabhängig vom sozioökonomischen Status der Frauen, sofern sie Zugang zu entsprechend ausgebildeten Gesundheitsdienstleistern haben.

Keywords

maternal obesity - gestational diabetes - health literacy - evidence-based medicine - counselling

Schlüsselwörter

mütterliche Adipositas - Gestationsdiabetes - Gesundheitskompetenz - evidenzbasierte Medizin - Beratung

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