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Cited by 802Gestational Diabetes Research and ManagementMaternal and Neonatal HealthcareObesity, Physical Activity, Diet

Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence

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Thangaratinam, S., Rogozinska, E., Jolly, K., Glinkowski, S., Roseboom, T., Tomlinson, J. W., Kunz, R., Mol, B. W. +2 more·2012·BMJ
DOI 10.1136/bmj.e2088PMC PMC3355191
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Abstract

OBJECTIVE: To evaluate the effects of dietary and lifestyle interventions in pregnancy on maternal and fetal weight and to quantify the effects of these interventions on obstetric outcomes. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Major databases from inception to January 2012 without language restrictions. STUDY SELECTION: Randomised controlled trials that evaluated any dietary or lifestyle interventions with potential to influence maternal weight during pregnancy and outcomes of pregnancy. DATA SYNTHESIS: Results summarised as relative risks for dichotomous data and mean differences for continuous data. RESULTS: We identified 44 relevant randomised controlled trials (7278 women) evaluating three categories of interventions: diet, physical activity, and a mixed approach. Overall, there was 1.42 kg reduction (95% confidence interval 0.95 to 1.89 kg) in gestational weight gain with any intervention compared with control. With all interventions combined, there were no significant differences in birth weight (mean difference -50 g, -100 to 0 g) and the incidence of large for gestational age (relative risk 0.85, 0.66 to 1.09) or small for gestational age (1.00, 0.78 to 1.28) babies between the groups, though by itself physical activity was associated with reduced birth weight (mean difference -60 g, -120 to -10 g). Interventions were associated with a reduced the risk of pre-eclampsia (0.74, 0.60 to 0.92) and shoulder dystocia (0.39, 0.22 to 0.70), with no significant effect on other critically important outcomes. Dietary intervention resulted in the largest reduction in maternal gestational weight gain (3.84 kg, 2.45 to 5.22 kg), with improved pregnancy outcomes compared with other interventions. The overall evidence rating was low to very low for important outcomes such as pre-eclampsia, gestational diabetes, gestational hypertension, and preterm delivery. CONCLUSIONS: Dietary and lifestyle interventions in pregnancy can reduce maternal gestational weight gain and improve outcomes for both mother and baby. Among the interventions, those based on diet are the most effective and are associated with reductions in maternal gestational weight gain and improved obstetric outcomes.

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  • An earlier meta-analysis of 44 RCTs found that interventions that mixed physical activity goals with dietary change were ineffective.

    “An earlier meta‐analysis of 44 RCTs found that interventions that mixed physical activity goals with dietary change were ineffective, but diet‐based interventions had the capacity to lower GWG and reduce risk of GHT, PE, GDM, preterm birth and labour induction. 132”

    From Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review (2022) · cites this paper as [132]

    Results (Study selection) identify 44 RCTs, including 13 of mixed diet-and-physical-activity interventions. The Discussion (Clinical and practical implications) reports that mixed interventions reduced gestational weight gain by about 1 kg, so calling them ineffective is too broad. The Discussion (Summary of the findings) supports the claimed benefits of diet-based interventions for weight gain, gestational hypertension, pre-eclampsia, gestational diabetes and preterm birth, but explicitly says there was no evidence that interventions reduced labour induction. (LLM, conf=0.91)

    Experimental — accuracy not yet measured

  • Diet-based interventions had the capacity to reduce risk of GHT, PE, GDM, preterm birth and labour induction.

    “An earlier meta‐analysis of 44 RCTs found that interventions that mixed physical activity goals with dietary change were ineffective, but diet‐based interventions had the capacity to lower GWG and reduce risk of GHT, PE, GDM, preterm birth and labour induction. 132”

    From Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review (2022) · cites this paper as [132]

    The Results table on secondary maternal outcomes reports reduced risks of gestational hypertension, pre-eclampsia, gestational diabetes, and preterm delivery with dietary interventions. It does not support reduced labour induction: the dietary-intervention estimate is 1.12 (95% CI 0.99–1.27), and the Discussion’s summary explicitly says there was no evidence of a reduction in induction of labour. (LLM, conf=0.93)

    Experimental — accuracy not yet measured

  • The literature does not show that physical exercise increases the risk of preterm birth.

    “The literature does not show that physical exercise increases the risk of preterm birth [5, 9–11, 29, 30].”

    From A systematic review and meta-analysis of exercise-based intervention to prevent gestational diabetes in women with overweight or obesity (2025) · cites this paper as [29]

  • Several reviews describe significant differences in reduction of weight gain, of modest magnitude close to 1 kg.

    “Several reviews [5, 11, 28, 29] describe significant differences in the reduction of weight gain, which are of modest magnitude, close to 1 kg of weight.”

    From A systematic review and meta-analysis of exercise-based intervention to prevent gestational diabetes in women with overweight or obesity (2025) · cites this paper as [29]

  • Diet-based interventions had the capacity to lower GWG.

    “An earlier meta‐analysis of 44 RCTs found that interventions that mixed physical activity goals with dietary change were ineffective, but diet‐based interventions had the capacity to lower GWG and reduce risk of GHT, PE, GDM, preterm birth and labour induction. 132”

    From Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review (2022) · cites this paper as [132]

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Authors
Thangaratinam, S., Rogozinska, E., Jolly, K., Glinkowski, S., Roseboom, T., Tomlinson, J. W., Kunz, R., Mol, B. W., Coomarasamy, A., & Khan, K. S.
Affiliations
  • Queen Mary University of London (GB)
  • University of Birmingham (GB)
  • Amsterdam UMC Location University of Amsterdam (NL)
  • University of Basel (CH)
Corresponding author
Thangaratinam, S.
ORCID
Venue
BMJ
Publisher
BMJ
Published
2012-05-16
Volume
344
Issue
may16 4
Pages
e2088-e2088
ISSN
1756-1833 (ISSN-L)
DOI
10.1136/bmj.e2088
PMC
PMC3355191
OpenAlex
W2074585667
Cited by
802
References
13
Citations by year
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FWCI
13.17
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by-nc)
  • edoc (University of Basel) (submittedVersion)
  • Pure Amsterdam UMC (submittedVersion)
Funders
National Institute for Health and Care Research (09/27/06)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords
pregnancy, dietary intervention, lifestyle intervention, gestational weight gain, maternal weight, birth weight, large for gestational age, small for gestational age, physical activity, preeclampsia, shoulder dystocia, obstetric outcomes, gestational diabetes mellitus, preterm birth
MeSH terms
Body Weight, Diet, Reducing, Female, Humans, Infant, Newborn, Motor Activity, Obesity, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Risk Factors, Weight Loss, Body Mass Index, Confidence Intervals, Randomized Controlled Trials as Topic, Risk Reduction Behavior, Premature Birth

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