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Cited by 29Gestational Diabetes Research and ManagementObesity, Physical Activity, DietMaternal and Neonatal Healthcare

Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: individual participant data meta-analysis

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O’Brien, Eileen C, Segurado, Ricardo, Geraghty, Aisling A, Alberdi, Goiuri, Rogozinska, Ewelina, Astrup, Arne, Barakat Carballo, Rubenomar, Bogaerts, Annick +42 more·2019·BMJ Open
DOI 10.1136/bmjopen-2018-025620PMC PMC6688690
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Abstract

Objectives: To identify if maternal educational attainment is a prognostic factor for gestational weight gain (GWG), and to determine the differential effects of lifestyle interventions (diet based, physical activity based or mixed approach) on GWG, stratified by educational attainment. Design: Individual participant data meta-analysis using the previously established International Weight Management in Pregnancy (i-WIP) Collaborative Group database (https://iwipgroup.wixsite.com/collaboration). Preferred Reporting Items for Systematic reviews and Meta-Analysis of Individual Participant Data Statement guidelines were followed. Data sources: Major electronic databases, from inception to February 2017. Eligibility criteria: Randomised controlled trials on diet and physical activity-based interventions in pregnancy. Maternal educational attainment was required for inclusion and was categorised as higher education (≥tertiary) or lower education (≤secondary). Risk of bias: Cochrane risk of bias tool was used. Data synthesis: Principle measures of effect were OR and regression coefficient. Results: Of the 36 randomised controlled trials in the i-WIP database, 21 trials and 5183 pregnant women were included. Women with lower educational attainment had an increased risk of excessive (OR 1.182; 95% CI 1.008 to 1.385, p =0.039) and inadequate weight gain (OR 1.284; 95% CI 1.045 to 1.577, p =0.017). Among women with lower education, diet basedinterventions reduced risk of excessive weight gain (OR 0.515; 95% CI 0.339 to 0.785, p = 0.002) and inadequate weight gain (OR 0.504; 95% CI 0.288 to 0.884, p=0.017), and reduced kg/week gain (B −0.055; 95% CI −0.098 to −0.012, p=0.012). Mixed interventions reduced risk of excessive weight gain for women with lower education (OR 0.735; 95% CI 0.561 to 0.963, p=0.026). Among women with high education, diet based interventions reduced risk of excessive weight gain (OR 0.609; 95% CI 0.437 to 0.849, p=0.003), and mixed interventions reduced kg/week gain (B −0.053; 95% CI −0.069 to −0.037,p<0.001). Physical activity based interventions did not impact GWG when stratified by education. Conclusions: Pregnant women with lower education are at an increased risk of excessive and inadequate GWG. Diet based interventions seem the most appropriate choice for these women, and additional support through mixed interventions may also be beneficial.

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  • A meta-analysis of 36 RCTs found that the success of interventions was highly dependent upon characteristics of the women recruited and whether the interventions were based upon diet, exercise or a combination of the two.

    “A meta‐analysis of 36 randomised controlled trials (RCTs) found that the success of interventions was highly dependent upon characteristics of the women recruited and whether the interventions were based upon diet, exercise or a combination of the two. 130”

    From Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review (2022) · cites this paper as [130]

    The Methods report an original dataset of 36 RCTs, but Results > Protocol, IPD obtained and study characteristics says this analysis included participants from 21 RCTs. Results > Results of syntheses reports differences by intervention type and educational group, but the intervention-by-education interactions were not statistically significant. The claim therefore overstates how strongly success depended on women's characteristics. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • Physical activity-based interventions were generally ineffective.

    “Physical activity‐based interventions were generally ineffective. Interventions appear to be more effective if delivered by clinicians rather than non‐clinical staff. 131”

    From Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review (2022) · cites this paper as [130]

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Authors
O’Brien, E. C., Segurado, R., Geraghty, A. A., Alberdi, G., Rogozinska, E., Astrup, A., Barakat Carballo, R., Bogaerts, A., Cecatti, J. G., Coomarasamy, A., de Groot, C. J. M., Devlieger, R., Dodd, J. M., El Beltagy, N., Facchinetti, F., Geiker, N., Guelfi, K., Haakstad, L., Harrison, C., Hauner, H., Jensen, D. M., Khan, K., Kinnunen, T. I., Luoto, R., Willem Mol, B., Mørkved, S., Motahari-Tabari, N., Owens, J. A., Perales, M., Petrella, E., Phelan, S., Poston, L., Rauh, K., Rayanagoudar, G., Renault, K. M., Ruifrok, A. E., Sagedal, L., Salvesen, K. Å., Scudeller, T. T., Shen, G., Shub, A., Stafne, S. N., Surita, F. G., Thangaratinam, S., Tonstad, S., van Poppel, M. N. M., Vinter, C., Vistad, I., Yeo, S., & McAuliffe, F. M.
Affiliations
  • University College Dublin (IE)
  • Women’s Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  • University of Copenhagen (DK)
  • Facultad de Ciencias de la Actividad Fısica y del Deporte (INEF), Universidad Politecnica de Madrid, Madrid, Spain
  • University of Antwerp (BE)
  • Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
  • University of Birmingham (GB)
  • Obstetrics and Gynaecology, Faculty of Medicine, VU University Medical Center, Amsterdam, The Netherlands
  • Universitair Ziekenhuis Leuven (BE)
  • The University of Adelaide (AU)
  • Department of Obstetrics and Gynecology, Alexandria University, Alexandria, Egypt
  • University of Modena and Reggio Emilia (IT)
  • Copenhagen University Hospital (DK)
  • The University of Western Australia (AU)
  • Norwegian School of Sport Sciences (NO)
  • Monash University (AU)
  • TUM Klinikum (DE)
  • University of Southern Denmark (DK)
  • Queen Mary University of London (GB)
  • Tampere University (FI)
  • Robinson Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia
  • Norwegian University of Science and Technology (NO)
  • Mazandaran University of Medical Sciences (IR)
  • California Polytechnic State University (US)
  • King's College London (GB)
  • Nutrition Information and Knowledge Transfer, Competence Centre for Nutrition (KErn), Freising, Germany
  • Amsterdam UMC Location University of Amsterdam (NL)
  • Sørlandet Sykehus (NO)
  • Department of Management and Health Care, Universidade Federal de Sao Paulo, São Paulo, Brazil
  • University of Manitoba (CA)
  • The University of Melbourne (AU)
  • Universidade Estadual de Campinas (UNICAMP) (BR)
  • Oslo University Hospital (NO)
  • Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
  • University of North Carolina at Chapel Hill (US)
Corresponding author
McAuliffe, Fionnuala M
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2019-08
Volume
9
Issue
8
Pages
e025620
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2018-025620
PMC
PMC6688690
OpenAlex
W2964787339
Cited by
29
References
5
Citations by year
2026: 1 · 2025: 1 · 2024: 3 · 2023: 1 · 2022: 7 · 2021: 10 · 2020: 6
FWCI
0.91
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
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Funders
  • Queen Mary University of London
  • Health Research Board
  • National Institute for Health and Care Research (12/01/50, NF-SI-0617-10155, RP-PG-0407-10452, 12/01)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
Keywords
maternal educational attainment, gestational weight gain, physical activity interventions, excessive weight gain, inadequate weight gain, prognostic factors, weight management in pregnancy, gestational diabetes prevention, preeclampsia
MeSH terms
Gestational Weight Gain, Pregnancy in Obesity, Obesity, Maternal, Educational Status, Female, Health Promotion, Humans, Pregnancy, Risk Reduction Behavior

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