Lifestyle interventions during pregnancy are associated with reduced maternal risk

Reference

Teede HJ, Bailey C, Moran LJ, et al. Association of antenatal diet and physical activity-based interventions with gestational weight gain and pregnancy outcomes: A systematic review and meta-analysis. JAMA Intern Med 2022;182(2):106-114.

Synopsis

The authors of this paper conducted a systematic review and meta-analysis from 1990 through May 2020 of lifestyle interventions during pregnancy to reduce maternal and/or neonatal adverse outcomes. They identified 117 studies with 34,546 participants that met their inclusion criteria of interventions regarding structured diet (n = 14); structured physical activity (n = 53); both structured interventions (n = 19); or a mix of one structured and one unstructured intervention (n = 31). The authors excluded studies if the interventions were exclusively unstructured lifestyle support, written information with weight monitoring, behavioral support alone, or insufficiently described. They assessed studies for quality and found none with a low risk of bias; 73 (62%) had a high risk of boas and 44 (38%) had an unclear risk of bias. Reduction in mean gestational weight gain versus control was the primary outcome and was statistically significant, but small: -1.15 kg (95% CI -1.4 to -0.91). Overall, interventions were associated with a reduced risk of gestational diabetes mellitus (GDM) versus routine care (odds ratio [OR] 0.79; 0.70 - 0.89). Diet interventions performed better versus control for the following outcomes: GDM, preterm delivery, and total adverse maternal outcomes. Physical activity interventions were associated with a lower risk of GDM (OR 0.60; 47 - 0.75), hypertensive disorders of pregnancy (OR 0.66; 0.48 - 0.90), cesarean delivery (OR 0.85; 0.75 - 0.95), and total adverse maternal outcomes (OR 0.78; 0.71 - 0.86). Structured interventions with both diet and physical activity components also reduced the risks of GDM and total adverse maternal outcomes. Mixed interventions were not associated with reductions in either maternal or neonatal adverse outcomes. Diet interventions compared with control were associated with a reduction in neonatal intensive care admissions (OR 0.68; 0.48 - 0.95), large-for-gestational-age neonate (OR 0.19; 0.08 - 0.47), and total adverse neonatal outcomes (OR 0.44; 0.26 - 0.72). Other intervention types were not associated with neonatal outcomes. No harms were noted with lifestyle interventions.