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

Implementing weight management during and after pregnancy to reduce diabetes and CVD risk in maternal and child populations

Maintaining a healthy weight during pregnancy is critical for both women's and children's health. Excessive gestational weight gain (GWG) can lead to complications such as gestational diabetes, hypertension and caesarean delivery. Insufficient GWG can cause fetal growth restriction and increase infant mortality risk. Additionally, postpartum weight retention raises risk of obesity, type 2 diabetes and other chronic diseases for both mother and child. This review seeks to identify current obstacles in weight management research during and after pregnancy and explore evidence-based strategies to overcome them. Pregnancy offers a window of opportunity for health behaviour changes as women are more receptive to education and have regular contact with health services. Staying within Institute of Medicine's recommended GWG ranges is associated with better maternal and fetal outcomes. Systematic review evidence supports structured diet and physical activity pregnancy interventions, leading to reduced GWG and fewer complications. Health economic evaluation indicates significant returns from implementation, surpassing investment costs due to decreased perinatal morbidity and adverse events. However, the most effective way to implement interventions within routine antenatal care remains unclear. Challenges increase in the postpartum period due to competing demands on women physically, mentally and socially, hindering intervention reach and retention. Flexible, technology-supported interventions are needed, requiring frameworks such as penetration-implementation-participation-effectiveness and template-for-intervention-description-and-replication for successful implementation. Greater research efforts are necessary to inform practice and investigate fidelity aspects through pragmatic implementation trials during the pregnancy and postpartum periods. Understanding the best ways to deliver interventions will empower women to maintain a healthy weight during their reproductive years.

Association between gestational weight gain and perinatal outcomes among twin gestations based on the 2009 Institute of Medicine (IOM) guidelines: a systematic review

BACKGROUND

Gestational weight gain (GWG) has been understudied among twin pregnancies. This systematic review aimed to review the data on the associations between GWG, based on the 2009 Institute of Medicine (IOM) guidelines and pregnancy outcomes among twin gestations.

METHODS

A systematic review was performed according to the PRISMA guidelines. A search for eligible studies published from January 2010 to August 2020 was conducted in the EMBASE, PubMed, Web of Science, ScienceDirect, and Cochrane databases. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. Data on study characteristics and main findings were extracted independently by two reviewers using a standard form. Outcomes of interest included (spontaneous) preterm birth (PTB), gestational hypertensive disorder (gestational hypertension and eclampsia), and small for gestational age (SGA).

RESULTS

Eighteen observational studies of twin gestations met the inclusion criteria. GWG below the IOM recommendations was reported to be associated with increased PTB and SGA while GWG above the recommendation was associated with increased gestational hypertensive disorder. However, the results were inconsistent. Methodological limitations, such as a retrospective design, the use of weekly GWG, a small sample size and insufficient adjustment, impeded the clarification of the association between GWG and perinatal outcomes. In addition, the optimal GWG for underweight women was not fully studied.

CONCLUSIONS

The maintenance of weight gain within the 2009 IOM guidelines would decrease the risks of adverse outcomes among twin pregnancies. However, rigorous studies are warranted to provide robust evidence to refine the optimal GWG among twin gestations.

Strengthening maternal nutrition counselling during routine health services: a gap analysis to guide country programmes

OBJECTIVE

The WHO recommends counselling on healthy eating, weight gain, and physical activity during antenatal care (ANC) and postnatal care (PNC), yet advice and information are often not tailored to women's nutritional needs and contexts. The purpose of the gap analysis was to identify key elements related to the provision of maternal nutrition counselling during routine health contacts and provide programme considerations to strengthen quality service delivery.

DESIGN

A search of PubMed, Cochrane Library, CINAHL Plus and Scopus databases was conducted to retrieve studies from January 2010 to December 2021. Using inclusion criteria, quantitative, qualitative and mixed methods studies were included in the final gap analysis.

SETTING

Low-, middle- and high-income country contexts.

PARTICIPANTS

Following application of gap analysis criteria, thirty-seven articles from sixteen countries were included in the analysis.

RESULTS

Gaps in delivery of maternal nutrition counselling include provider capacity building, frequency, content and delivery platforms. Globally, counselling on appropriate weight gain during pregnancy is often not delivered with the desired content nor quality, while targeted counselling to overweight and obese women was provided in several high-income country contexts. Delivery of maternal nutrition counselling through multiple delivery platforms demonstrated improvements in maternal diet and/or weight gain during pregnancy.

CONCLUSIONS

Strengthening the integration of maternal nutrition counselling into pre- and in-service curricula, routine health provider training, supportive supervision and provider mentoring is needed. Future efforts may consider generating global and regional weight gain guidelines and incorporating maternal nutrition counselling indicators as part of quality-of-care ANC/PNC standards and routine health systems.

A Virtual Exercise Program throughout Pregnancy during the COVID-19 Pandemic Modifies Maternal Weight Gain, Smoking Habits and Birth Weight—Randomized Clinical Trial

The intrauterine environment is key to health from a short- and long-term perspective. Birth weight is an important indicator that may influence the fetal environment due to epigenetics. Considering physical inactivity, in parallel with higher levels of stress, affecting smoking patterns and the physical and emotional health of the pregnant population, maintaining the health of future generations is crucial. A randomized clinical trial (NCT04563065) was conducted. One-hundred and ninety-two healthy pregnant individuals were assigned to the intervention (IG) or control (CG) group. Overall, significant differences were found between groups when stratified by birth weight (χ2 (1) = 6.610; p = 0.037) with low birth weight and macrosomia found more often in the CG (4% vs. 14% and 3% vs. 9%, respectively) and higher admissions to the neonatal intensive care unit (χ2 (1) = 5.075; p = 0.024) in the CG (20/28.6%) compared to the IG (9/13.0). Smoking during pregnancy was also found more often in the CG (12/17.1%) compared to the IG (3/4.4%) (p = 0.016). A virtual program of supervised exercise throughout pregnancy during the ongoing pandemic could help to maintain adequate birth weights, modify maternal smoking habits, and lower admissions to the neonatal intensive care unit.

Association between pre-pregnancy body mass index and gestational weight gain on pregnancy outcomes: a cohort study in Indonesian pregnant women

Background

Pre-pregnancy BMI (PP BMI) and gestational weight gain (GWG) are prominent anthropometric indicators for maternal nutritional status and are related to an increased risk of adverse pregnancy outcomes. This study aimed to determine the factors affecting total GWG, PP BMI and pregnancy outcomes among pregnant women in West Sumatra, Indonesia.

Methods

This observational analysis was conducted among healthy women in the Vitamin D Pregnant Mother (VDPM) cohort study. A total of 195 pregnant women and their newborn babies were enrolled, and information regarding their socio-demographic characteristics, obstetric history, dietary intake and anthropometric data were assessed through direct interviews. Furthermore, the Institute of Medicine (IOM) 2009 guidelines were used to obtain the total GWG.

Results

PP BMI was used to categorise the 195 pregnant women as overweight/obese (43.1%), normal (46.7%) and underweight (10.2%). There were 53.3%, 34.4% and 12.3% of women who had inadequate, adequate and excessive GWG, respectively. The multinomial logistic regression model indicated that overweight or obese women at the pre-pregnancy stage were 4.09 times more likely to have an excessive rate of GWG (AOR = 4.09, 95% CI: 1.38–12.12, p = 0.011) than those whose weight was normal. Furthermore, women with excessive GWG were 27.11 times more likely to have a baby with macrosomia (AOR = 27.11, 95% CI: 2.99–245.14) (p = 0.001) and those with inadequate GWG were 9.6 times more likely to give birth to a baby with low birth weight (LBW) (AOR = 9.60, 95% CI; 0.88–105.2) (p = 0.002).

Conclusions

This study demonstrates that the malnutrition status prior to pregnancy and inadequate or excessive GWG status during pregnancy as significant risk factors for developing adverse pregnancy outcomes. These findings highlight the importance of providing information, preconception counselling and health education on weight management for healthy pregnancies.

Supplementary information

The online version contains supplementary material available at 10.1186/s12884-022-04815-8.

Influence of gestational weight gain on baby's birth weight in Addis Ababa, Central Ethiopia: a follow-up study

BACKGROUND

Gestational weight gain (GWG) is an important indicator of fetal well-being during pregnancy. Inadequate or excessive GWG could have undesirable effects on birth weight. However, information regarding the influence of GWG on birth weight is lacking from the Ethiopian setting.

OBJECTIVE

This study aimed to determine the influence of GWG and other maternal-related factors on birth weight in Addis Ababa, Ethiopia.

DESIGN AND METHODS

A cohort of pregnant women who received the first antenatal care before or at 16 weeks of gestation in health centres in Addis Ababa were followed from 10 January 2019 to 25 September 2019. Data were collected using a structured questionnaire and medical record reviews. We conducted a multivariable linear regression analysis to determine the independent effect of gestational weight on birth weight.

RESULTS

Of the 395 women enrolled in the study, the participants' pregnancy outcome was available for 329 (83.3%). The mean birth weight was 3130 (SD, 509) g. The proportion of low birth weight (<2500 g) was 7.5% (95% CI 4.8% to 11.0%). Babies born to underweight women were 150.9 g (95% CI 5.8 to 308.6 g, p=0.049) lighter than babies born to normal-weight women. Similarly, babies whose mothers gained inadequate weight were 248 g (95% CI 112.8 to 383.6 g, p<0.001) lighter than those who gained adequate weight. Moreover, babies whose mothers had a previous history of abortion or miscarriages or developed gestational hypertension in the current pregnancy were 147.2 g (95% CI 3.2 to 291.3 g, p=0.045) and 310.7 g (95% CI 62.7 to 552.8 g, p=0.012) lighter, respectively, compared with those whose mothers had not.

CONCLUSIONS

Prepregnancy weight, GWG, having had a previous history of abortion or miscarriages, and developing gestational hypertension during a current pregnancy were independently associated with birth weight. Pregnancy-related weight management should be actively promoted through intensive counseling during routine antenatal care contacts.

Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: a narrative review

The global prevalence of overweight and obesity in pregnancy is rising and this represents a significant challenge for the management of pregnancy and delivery. Women who have a pre‐pregnancy body mass index greater than 25 kg m^–2 are more likely than those with a body mass index in the ideal range (20–24.99 kg m^–2) to have problems conceiving a child and are at greater risk of miscarriage and stillbirth. All pregnancy complications are more likely with overweight, obesity and excessive gestational weight gain, including those that pose a significant threat to the lives of mothers and babies. Labour complications arise more often when pregnancies are complicated by overweight and obesity. Pregnancy is a stage of life when women have greater openness to messages about their lifestyle and health. It is also a time when they come into greater contact with health professionals. Currently management of pregnancy weight gain and the impact of overweight tends to be poor, although a number of research studies have demonstrated that appropriate interventions based around dietary change can be effective in controlling weight gain and reducing the risk of pregnancy complications. The development of individualised and flexible plans for avoiding adverse outcomes of obesity in pregnancy will require investment in training of health professionals and better integration into normal antenatal care.

Overweight and obesity before pregnancy and excessive gestational weight gain are major determinants of risk for pregnancy loss, gestational diabetes, hypertensive conditions, labour complications and maternal death.

Pregnancy is regarded as a teachable moment when women are at their most receptive to messages about their health. However, unclear guidance on diet and physical activity, weight stigma from health professionals, inexperience and reluctance among professionals about raising issues about weight, and stretched resources put the health of women and babies at risk.

Excessive weight gain in pregnancy and post‐partum weight retention compromise future fertility and increase risk for future pregnancies.

Large randomised controlled trials have had little success in addressing excessive gestational weight gain or antenatal complications. Individualised, culturally sensitive and responsive interventions appear to have greater success.

Artificial intelligence and automation of systematic reviews in women's health

PURPOSE OF REVIEW

Evidence-based women's healthcare is underpinned by systematic reviews and guidelines. Generating an evidence synthesis to support guidance for clinical practice is a time-consuming and labour-intensive activity that delays transfer of research into practice. Artificial intelligence has the potential to rapidly collate, combine, and update high-quality medical evidence with accuracy and precision, and without bias.

RECENT FINDINGS

This article describes the main fields of artificial intelligence with examples of its application to systematic reviews. These include the capabilities of processing natural language texts, retrieving information, reasoning, and learning. The complementarity and interconnection of the various artificial intelligence techniques can be harnessed to solve difficult problems in automation of reviews. Computer science can advance evidence-based medicine through development, testing, and refinement of artificial intelligence tools to deploy automation, creating 'living' evidence syntheses.

SUMMARY

Groundbreaking, high-quality, and impactful artificial intelligence will accelerate the transfer of individual research studies seamlessly into evidence syntheses for contemporaneously improving the quality of healthcare.