BMJ Open (Aug 2019)

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

  • Arne Astrup,
  • Ingvild Vistad,
  • Aisling A Geraghty,
  • Eileen C O’Brien,
  • Ricardo Segurado,
  • Goiuri Alberdi,
  • Ewelina Rogozinska,
  • Rubenomar Barakat Carballo,
  • Annick Bogaerts,
  • Christianne J M de Groot,
  • Nermeen El Beltagy,
  • Fabio Facchinetti,
  • Nina Geiker,
  • Kym Guelfi,
  • Lene Haakstad,
  • Cheryce Harrison,
  • Dorte M Jensen,
  • Tarja Inkeri Kinnunen,
  • Riitta Luoto,
  • Ben Willem Mol,
  • Narges Motahari-Tabari,
  • Julie A Owens,
  • Maria Perales,
  • Elisabetta Petrella,
  • Suzanne Phelan,
  • Kathrin Rauh,
  • Girish Rayanagoudar,
  • Kristina M Renault,
  • Anneloes E Ruifrok,
  • Linda Sagedal,
  • Kjell Å Salvesen,
  • Tania T Scudeller,
  • Gary Shen,
  • Mireille N M van Poppel,
  • Christina Vinter,
  • SeonAe Yeo

DOI
https://doi.org/10.1136/bmjopen-2018-025620
Journal volume & issue
Vol. 9, no. 8

Abstract

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ObjectivesTo 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.DesignIndividual 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 sourcesMajor electronic databases, from inception to February 2017.Eligibility criteriaRandomised 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 biasCochrane risk of bias tool was used.Data synthesisPrinciple measures of effect were OR and regression coefficient.ResultsOf 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.ConclusionsPregnant 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.