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Meta-Analysis
. 2015 Jun 15;2015(6):CD007145.
doi: 10.1002/14651858.CD007145.pub3.

Diet or exercise, or both, for preventing excessive weight gain in pregnancy

Benja Muktabhant  1 , Theresa A Lawrie, Pisake Lumbiganon, Malinee Laopaiboon
Affiliations
Meta-Analysis

Diet or exercise, or both, for preventing excessive weight gain in pregnancy

Benja Muktabhant et al. Cochrane Database Syst Rev. .

Abstract

Background: This is an update of a Cochrane review first published in 2012, Issue 4. Excessive weight gain during pregnancy is associated with poor maternal and neonatal outcomes including gestational diabetes, hypertension, caesarean section, macrosomia, and stillbirth. Diet or exercise interventions, or both, may reduce excessive gestational weight gain (GWG) and associated poor outcomes; however, evidence from the original review was inconclusive.

Objectives: To evaluate the effectiveness of diet or exercise, or both, interventions for preventing excessive weight gain during pregnancy and associated pregnancy complications.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (5 November 2014), contacted investigators of the previously identified ongoing studies and scanned reference lists of retrieved studies.

Selection criteria: Randomised controlled trials (RCTs) of diet or exercise, or both, interventions for preventing excessive weight gain in pregnancy.

Data collection and analysis: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We organised RCTs according to the type of interventions and pooled data using the random-effects model in the Review Manager software. We also performed subgroup analyses according to the initial risk of adverse effects related to poor weight control. We performed sensitivity analysis to assess the robustness of the findings.

Main results: We included 65 RCTs, out of which 49 RCTs involving 11,444 women contributed data to quantitative meta-analysis. Twenty studies were at moderate-to-high risk of bias. Study interventions involved mainly diet only, exercise only, and combined diet and exercise interventions, usually compared with standard care. Study methods varied widely; therefore, we estimated the average effect across studies and performed sensitivity analysis, where appropriate, by excluding outliers and studies at high risk of bias.Diet or exercise, or both, interventions reduced the risk of excessive GWG on average by 20% overall (average risk ratio (RR) 0.80, 95% confidence interval (CI) 0.73 to 0.87; participants = 7096; studies = 24; I² = 52%). This estimate was robust to sensitivity analysis, which reduced heterogeneity, therefore we graded this evidence as high-quality. Interventions involving low glycaemic load diets, supervised or unsupervised exercise only, or diet and exercise combined all led to similar reductions in the number of women gaining excessive weight in pregnancy.Women receiving diet or exercise, or both interventions were more likely to experience low GWG than those in control groups (average RR 1.14, 95% CI 1.02 to 1.27; participants = 4422; studies = 11; I² = 3%; moderate-quality evidence). We found no difference between intervention and control groups with regard to pre-eclampsia (RR 0.95, 95% CI 0.77 to 1.16; participants = 5330; studies = 15; I² = 0%; high-quality evidence); however, maternal hypertension (not a pre-specified outcome) was reduced in the intervention group compared with the control group overall (average RR 0.70, 95% CI 0.51 to 0.96; participants = 5162; studies = 11; I² = 43%; low-quality evidence).There was no clear difference between groups with regard to caesarean delivery overall (RR 0.95, 95% CI 0.88 to 1.03; participants = 7534; studies = 28; I² = 9%; high-quality evidence); although the effect estimate suggested a small difference (5%) in favour of the interventions. In addition, for combined diet and exercise counselling interventions there was a 13% (-1% to 25%) reduction in this outcome (borderline statistical significance).We found no difference between groups with regard to preterm birth overall (average RR 0.91, 95% CI 0.68 to 1.22; participants = 5923; studies = 16; I² = 16%; moderate-quality evidence); however limited evidence suggested that these effect estimates may differ according to the types of interventions, with a trend towards an increased risk for exercise-only interventions.We found no clear difference between intervention and control groups with regard to infant macrosomia (average RR 0.93, 95% CI 0.86 to 1.02; participants = 8598; studies = 27; I² = 0%; high-quality evidence), although the effect estimate suggested a small difference (7% reduction) in favour of the intervention group. The largest effect size occurred in the supervised exercise-only intervention group (RR 0.81, 95% CI 0.64 to 1.02; participants = 2445; studies = 7; I² = 0%), which approached statistical significance (P = 0.07). Furthermore, in subgroup analysis by risk, high-risk women (overweight or obese women, or women with or at risk of gestational diabetes) receiving combined diet and exercise counselling interventions experienced a 15% reduced risk of infant macrosomia (average RR 0.85, 95% CI 0.73 to 1.00; participants = 3252; studies = nine; I² = 0; P = 0.05; moderate-quality evidence)There were no differences in the risk of poor neonatal outcomes including shoulder dystocia, neonatal hypoglycaemia, hyperbilirubinaemia, or birth trauma (all moderate-quality evidence) between intervention and control groups; however, infants of high-risk women had a reduced risk of respiratory distress syndrome if their mothers were in the intervention group (RR 0.47, 95% CI 0.26 to 0.85; participants = 2256; studies = two; I² = 0%; moderate-quality evidence).

Authors' conclusions: High-quality evidence indicates that diet or exercise, or both, during pregnancy can reduce the risk of excessive GWG. Other benefits may include a lower risk of caesarean delivery, macrosomia, and neonatal respiratory morbidity, particularly for high-risk women receiving combined diet and exercise interventions. Maternal hypertension may also be reduced. Exercise appears to be an important part of controlling weight gain in pregnancy and more research is needed to establish safe guidelines. Most included studies were carried out in developed countries and it is not clear whether these results are widely applicable to lower income settings.

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Conflict of interest statement

None known.

Figures

1
1
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 1 Excessive weight gain.
1.2
1.2. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 2 Weight gain (kg).
1.3
1.3. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 3 Low weight gain.
1.4
1.4. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 4 Preterm birth.
1.5
1.5. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 5 Pre‐eclampsia.
1.6
1.6. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 6 Hypertension (not prespecified).
1.7
1.7. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 7 Induction of labour.
1.8
1.8. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 8 Caesarean delivery.
1.9
1.9. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 9 Postpartum weight retention (kg).
1.10
1.10. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 10 Postpartum weight retention (n/N; investigator defined time frame).
1.11
1.11. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 11 Energy intake (kj).
1.12
1.12. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 12 Fibre intake (g).
1.13
1.13. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 13 Physical activity score (26‐29 weeks).
1.14
1.14. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 14 Macrosomia Infant birthweight > 4000 g.
1.15
1.15. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 15 Infant birthweight > 90th centile.
1.16
1.16. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 16 Birthweight (g) (not prespecified).
1.17
1.17. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 17 Infant birthweight < 2500 g.
1.18
1.18. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 18 Infant birthweight < 10th centile.
1.19
1.19. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 19 Shoulder dystocia.
1.20
1.20. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 20 Neonatal hypoglycaemia.
1.21
1.21. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 21 Birth trauma.
1.22
1.22. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 22 Neonatal hyperbilirubinaemia.
1.23
1.23. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 23 Neonatal respiratory distress syndrome.
1.24
1.24. Analysis
Comparison 1 All diet and/or exercise interventions vs standard/other care, Outcome 24 Postpartum hemorrhage.
2.1
2.1. Analysis
Comparison 2 Diet intervention (low GI diet) vs standard/other care, Outcome 1 Excessive weight gain.
2.2
2.2. Analysis
Comparison 2 Diet intervention (low GI diet) vs standard/other care, Outcome 2 Weight gain (kg).
2.3
2.3. Analysis
Comparison 2 Diet intervention (low GI diet) vs standard/other care, Outcome 3 Low weight gain.
2.4
2.4. Analysis
Comparison 2 Diet intervention (low GI diet) vs standard/other care, Outcome 4 Preterm birth.
2.5
2.5. Analysis
Comparison 2 Diet intervention (low GI diet) vs standard/other care, Outcome 5 Caesarean delivery.
2.6
2.6. Analysis
Comparison 2 Diet intervention (low GI diet) vs standard/other care, Outcome 6 Macrosomia (Infant birthweight > 4000 g).
3.1
3.1. Analysis
Comparison 3 Diet and exercise counselling vs standard/other care, Outcome 1 Excessive weight gain.
3.2
3.2. Analysis
Comparison 3 Diet and exercise counselling vs standard/other care, Outcome 2 Weight gain (kg).
3.3
3.3. Analysis
Comparison 3 Diet and exercise counselling vs standard/other care, Outcome 3 Low weight gain.
3.4
3.4. Analysis
Comparison 3 Diet and exercise counselling vs standard/other care, Outcome 4 Preterm birth.
3.5
3.5. Analysis
Comparison 3 Diet and exercise counselling vs standard/other care, Outcome 5 Pre‐eclampsia.
3.6
3.6. Analysis
Comparison 3 Diet and exercise counselling vs standard/other care, Outcome 6 Caesarean delivery.
3.7
3.7. Analysis
Comparison 3 Diet and exercise counselling vs standard/other care, Outcome 7 Macrosomia (Infant birthweight > 4000 g).
4.1
4.1. Analysis
Comparison 4 Exercise vs standard/other care, Outcome 1 Excessive weight gain.
4.2
4.2. Analysis
Comparison 4 Exercise vs standard/other care, Outcome 2 Weight gain (kg).
4.3
4.3. Analysis
Comparison 4 Exercise vs standard/other care, Outcome 3 Low weight gain.
4.4
4.4. Analysis
Comparison 4 Exercise vs standard/other care, Outcome 4 Preterm birth.
4.5
4.5. Analysis
Comparison 4 Exercise vs standard/other care, Outcome 5 Pre‐eclampsia.
4.6
4.6. Analysis
Comparison 4 Exercise vs standard/other care, Outcome 6 Caesarean delivery.
4.7
4.7. Analysis
Comparison 4 Exercise vs standard/other care, Outcome 7 Macrosomia (Infant birthweight > 4000 g).
5.1
5.1. Analysis
Comparison 5 Diet and supervised exercise vs standard/other care, Outcome 1 Excessive weight gain.
5.2
5.2. Analysis
Comparison 5 Diet and supervised exercise vs standard/other care, Outcome 2 Weight gain (kg).
5.3
5.3. Analysis
Comparison 5 Diet and supervised exercise vs standard/other care, Outcome 3 Low weight gain.
5.4
5.4. Analysis
Comparison 5 Diet and supervised exercise vs standard/other care, Outcome 4 Pre‐eclampsia.
5.5
5.5. Analysis
Comparison 5 Diet and supervised exercise vs standard/other care, Outcome 5 Caesarean delivery.
5.6
5.6. Analysis
Comparison 5 Diet and supervised exercise vs standard/other care, Outcome 6 Macrosomia (Infant birthweight > 4000 g).
6.1
6.1. Analysis
Comparison 6 Diet counselling/other vs standard/other care, Outcome 1 Excessive weight gain.
6.2
6.2. Analysis
Comparison 6 Diet counselling/other vs standard/other care, Outcome 2 Weight gain (kg).
6.3
6.3. Analysis
Comparison 6 Diet counselling/other vs standard/other care, Outcome 3 Low weight gain.
6.4
6.4. Analysis
Comparison 6 Diet counselling/other vs standard/other care, Outcome 4 Preterm birth.
6.5
6.5. Analysis
Comparison 6 Diet counselling/other vs standard/other care, Outcome 5 Pre‐eclampsia.
6.6
6.6. Analysis
Comparison 6 Diet counselling/other vs standard/other care, Outcome 6 Caesarean delivery.
6.7
6.7. Analysis
Comparison 6 Diet counselling/other vs standard/other care, Outcome 7 Macrosomia (Infant birthweight > 4000 g).
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Update of

References

References to studies included in this review

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    1. Aittasalo M, Raitanen J, Kinnunen TI, Ojala K, Kolu P, Luoto R. Is intensive counseling in maternity care feasible and effective in promoting physical activity among women at risk for gestational diabetes? Secondary analysis of a cluster randomized NELLI study in Finland. International Journal of Behavioral Nutrition and Physical Activity 2012;9:104. - PMC - PubMed
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    1. Luoto R, Kinnunen TI, Aittasalo M, Kolu P, Raitanen J, Ojala K, et al. Primary prevention of gestational diabetes mellitus and large‐for‐gestational‐age newborns by lifestyle counseling: a cluster‐randomized controlled trial. PLoS Medicine 2011;8(5):1‐11. - PMC - PubMed
    1. Luoto RM, Kinnunen TI, Aittasalo M, Ojala K, Mansikkamaki K, Toropainen E, et al. Prevention of gestational diabetes: design of a cluster‐randomized controlled trial and one‐year follow‐up. BMC Pregnancy and Childbirth 2010;10:39. - PMC - PubMed
    1. Puhkala J, Luoto R, Ahotupa M, Raitanen J, Vasankari T. Postpartum weight retention is associated with elevated ratio of oxidized LDL lipids to HDL‐cholesterol. Lipids 2013;48(12):1227‐35. - PubMed
Magee 1990 {published data only}
    1. Magee MS, Knopp RH, Benedetti TJ. Metabolic effects of 1200‐kcal diet in obese pregnant women with gestational diabetes. Diabetes 1990; Vol. 39:234‐40. - PubMed
Marcinkevage 2012 {published data only}
    1. Marcinkevage J, Correa A, Ramakrishnan U, Sharma A, Venkat KM, Umpierrez G. Reducing sedentary behavior and increasing physical activity during pregnancy: A feasibility study. Diabetes 2012;61 Suppl 1:A344.
    1. Umpierrez G. Lifestyle intervention to limit excessive weight gain during pregnancy in minority women. ClinicalTrials.gov (accessed 21 May 2013). NCT01084941 2010.
Moses 2009 {published data only}
    1. Moses RG, Barker M, Winter M, Petocz P, Brand‐Miller JC. Can a low‐glycemic index diet reduce the need for insulin in gestational diabetes mellitus? A randomized trial. Diabetes Care 2009;32(6):996‐1000. - PMC - PubMed
Moses 2014 {published data only}
    1. Brand‐Miller J. A pregnancy intervention to reduce postprandial glucose excursions in the primary prevention of paediatric obesity. Current Controlled Trials (www.controlled‐trials.com/) [accessed 31 October 2010].
    1. Moses RG, Casey S, Cleary J, Milosavljevic M, Quinn E, Tapsell L, et al. Effect of low glycaemic index dietary advice in normal pregnancy: The PREGGIO study. Obesity Research and Clinical Practice 2013;7:e34‐5.
    1. Moses RG, Casey SA, Quinn EG, Cleary JM, Tapsell LC, Milosavljevic M, et al. Pregnancy and Glycemic Index Outcomes study: effects of low glycemic index compared with conventional dietary advice on selected pregnancy outcomes. American Journal of Clinical Nutrition 2014;99(3):517‐23. - PubMed
Mujsindi 2014 {published data only}
    1. Mujsindi W, Habash D, Childs G. Impact of nutrition education on gestational weight gain in obese pregnant women. American Journal of Obstetrics and Gynecology 2014;210(1 Suppl):S188.
Murtezani 2014 {published data only}
    1. Murtezani A, Pacarada M, Ibraimi Z, Nevzati A, Abazi N. The impact of exercise during pregnancy on neonatal outcomes: a randomised controlled trial. Journal of Sports Medicine and Physical Fitness 2014;54(6):802‐8. - PubMed
Nascimento 2012 {published data only}
    1. Nascimento KLK, Surita SLN, Parpinelli FGS, Kasawara MAP. Type of delivery and neonatal outcome in overweight and obese pregnant women with excessive weight gain. Journal of Maternal‐Fetal and Neonatal Medicine 2012;25(S2):73‐4.
    1. Nascimento SL, Surita FG, Parpinelli MA, Siani S, Pinto e Silva JL. The effect of an antenatal physical exercise programme on maternal/perinatal outcomes and quality of life in overweight and obese pregnant women: a randomised clinical trial. BJOG: an International Journal of Obstetrics & Gynaecology 2011;118(12):1455‐63. - PubMed
    1. Surita F. Physical exercise influence among overweight and obese pregnant women. ClinicalTrials.gov (http://clinicaltrials.gov/) [accessed 21 May 2013] 2010.
Oostdam 2012 {published data only}
    1. Oostdam N, Bosmans J, Wouters MGAJ, Eekhoff EMW, Mechelen W, Poppel MNM. Cost‐effectiveness of an exercise program during pregnancy to prevent gestational diabetes: Results of an economic evaluation alongside a randomised controlled trial. BMC Pregnancy and Childbirth 2012;12:64. - PMC - PubMed
    1. Oostdam N, Poppel MN, Eekhoff EM, Wouters MG, Mechelen W. Design of FitFor2 study: the effects of an exercise program on insulin sensitivity and plasma glucose levels in pregnant women at high risk for gestational diabetes. BMC Pregnancy and Childbirth 2009;9:1. - PMC - PubMed
    1. Oostdam N, Poppel MNM, Wouters MGAJ, Eekhoff EMW, Bekedam DJ, Kuchenbecker WKH, et al. No effect of the FitFor2 exercise programme on blood glucose, insulin sensitivity, and birthweight in pregnant women who were overweight and at risk for gestational diabetes: Results of a randomised controlled trial. BJOG: an International Journal of Obstetrics and Gynaecology 2012;119(9):1098‐107. - PubMed
    1. Poppel M, Oostdam N, Wouters M, Eekhoff M, Mechelen W. FitFor2: Effects of an exercise training program on the incidence of gestational diabetes. Journal of Science and Medicine in Sport 2012;15 Suppl 1:S342‐S343.
Petrella 2013 {published data only}
    1. Facchinetti F. Pregnancy complications in women with BMI > 25kg/m2 enrolled in a healthy lifestule and eating habits program. ClinicalTrials.gov (accessed 21 May 2013). NCT01783210 2013.
    1. Petrella E, Facchinetti F, Bertarini V, Pignatti L, Neri I, Battistini NC. Occurrence of pregnancy complications in women with BMI > 25 submitted to a healthy lifestyle and eating habits program. American Journal of Obstetrics and Gynecology 2013;208(1 Suppl):S33‐4.
    1. Petrella E, Malavolti M, Bertarini V, Pignatti L, Neri I, Battistini NC, et al. Gestational weight gain in overweight and obese women enrolled in a healthy lifestyle and eating habits program. Journal of Maternal‐Fetal and Neonatal Medicine 2014;27(13):1348‐52. - PubMed
Petrov Fieril 2014 {published data only}
    1. Petrov Fieril K, Glantz A, Fagevik Olsen M. The efficacy of moderate‐to‐vigorous resistance exercise during pregnancy: A randomized controlled trial. Acta Obstetricia et Gynecologica Scandinavica 2014 Oct 7 [Epub ahead of print]. - PubMed
Phelan 2011 {published data only}
    1. Phelan S, Phipps MG, Abrams B, Darroch F, Grantham K, Schaffner A, et al. Does behavioral intervention in pregnancy reduce postpartum weight retention? Twelve‐month outcomes of the Fit for Delivery randomized trial. American Journal of Clinical Nutrition 2014;99(2):302‐11. - PMC - PubMed
    1. Phelan S, Phipps MG, Abrams B, Darroch F, Schaffner A, Wing RR. Factors associated with success in the "fit for delivery" intervention to reduce excessive gestational weight gain. Obesity 2011;19(Suppl 1):S95. - PMC - PubMed
    1. Phelan S, Phipps MG, Abrams B, Darroch F, Schaffner A, Wing RR. Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study. American Journal of Clinical Nutrition 2011;93(4):772‐9. - PMC - PubMed
Pinzon 2012 {published data only}
    1. Pinzon DC, Zamora K, Martinez JH, Florez‐Lopez ME, Plata AC, Mosquera M, et al. Type of delivery and gestational age is not affected by pregnant Latin‐American women engaging in vigorous exercise: a secondary analysis of data from a controlled randomized trial. Revista de Salud Publica 2012;14(5):731‐43. - PubMed
    1. Ramirez‐Velez R. Aerobic exercise in pregnant Latina women: Effect on metabolic and body composition outcomes. A randomized clinical trial. FASEB Journal 2014;28(1 Suppl 1):886.6.
    1. Ramirez‐Velez R. Combined aerobic and resistance exercise on metabolic and body composition outcomes in primigravid Latina women. Obesity Reviews 2014;15(Suppl 2):201‐2.
    1. Ramirez‐Velez R, Aguilar de Plata AC, Escudero MM, Echeverry I, Ortega JG, Salazar B, et al. Influence of regular aerobic exercise on endothelium‐dependent vasodilation and cardiorespiratory fitness in pregnant women. Journal of Obstetrics and Gynaecology Research 2011;37(11):1601‐8. - PubMed
Pollak 2014 {published data only}
    1. Pollak KI, Alexander SC, Bennett G, Lyna P, Coffman CJ, Bilheimer A, et al. Weight‐related SMS texts promoting appropriate pregnancy weight gain: A pilot study. Patient Education and Counselling 2014;97:256‐60. - PMC - PubMed
Polley 2002 {published data only}
    1. Polley BA, Wing RR, Sims CJ. Randomized controlled trial to prevent excessive weight gain in pregnant women. International Journal of Obesity & Related Metabolic Disorders: Journal of the International Association for the Study of Obesity 2002;26(11):1494‐502. - PubMed
Poston 2013 {published data only}
    1. Briley AL, Barr S, Badger S, Bell R, Croker H, Godfrey KM, et al. A complex intervention to improve pregnancy outcome in obese women; the UPBEAT randomised controlled trial. BMC Pregnancy and Childbirth 2014;14(1):74. - PMC - PubMed
    1. Hayes L, Bell R, Robson S, Poston L. Association between physical activity in obese pregnant women and pregnancy outcomes: The UPBEAT Pilot Study. Annals of Nutrition & Metabolism 2014;64(3‐4):239‐46. - PubMed
    1. Maitland RA, Barr S, Briley A, Seed P, Poston L. Incidence of gestational diabetes in an obese population using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria in the UK Pregnancies Better Eating and Activity Trial (UPBEAT) pilot study. Diabetic Medicine 2012;29(Suppl 1):152.
    1. Poston L. Improving pregnancy outcome in obese women: a feasibility study. Current Controlled Trials (http://controlled‐trials.com/) (accessed 31 October 2010).
    1. Poston L, Briley AL, Barr S, Bell R, Croker H, Coxon K, et al. Developing a complex intervention for diet and activity behaviour change in obese pregnant women (the UPBEAT trial); assessment of behavioural change and process evaluation in a pilot randomised controlled trial. BMC Pregnancy and Childbirth 2013;13(1):148. - PMC - PubMed
Price 2012 {published data only}
    1. Price B, Amini B, Kappeler K. Exercise in pregnancy: Effect on fitness and obstetric outcomes ‐ a randomized trial. Medicine & Science in Sports & Exercise 2012;44(12):2263‐9. - PubMed
Quinlivan 2011 {published data only}
    1. Quinlivan JA, Lam LT, Fisher J. A randomised trial of a four‐step multidisciplinary approach to the antenatal care of obese pregnant women. Australian and New Zealand Journal of Obstetrics and Gynaecology 2011;51:141‐6. - PubMed
Rae 2000 {published data only}
    1. Rae A, Bond D, Evans S, North F, Roberman B, Walters B. A randomised controlled trial of dietary energy restriction in the management of obese women with gestational diabetes. Australian & New Zealand Journal of Obstetrics & Gynaecology 2000;40(4):416‐22. - PubMed
Rauh 2013 {published data only}
    1. Rauh K, Gabriel E, Kerschbaum E, Schuster T, Kries R, Amann‐Gassner U, et al. Safety and efficacy of a lifestyle intervention for pregnant women to prevent excessive maternal weight gain: a cluster‐randomized controlled trial. BMC Pregnancy and Childbirth 2013;13(1):151. - PMC - PubMed
Renault 2014 {published data only}
    1. Renault KM, Norgaard K, Nilas L, Carlsen EM, Cortes D, Pryds O, et al. The Treatment of Obese Pregnant Women (TOP) study: A randomized controlled trial of the effect of physical activity intervention assessed by pedometer with or without dietary intervention in obese pregnant women. American Journal of Obstetrics and Gynecology 2014;210(2):134.e1‐9. - PubMed
Rhodes 2010 {published data only}
    1. Pawlak DB. Glycemic load and infant birth weight in pregnant overweight/obese women. ClinicalTrials.gov (http://clinicaltrials.gov/) (accessed 31 October 2010).
    1. Rhodes ET, Pawlak DB, Takoudes TC, Ebbeling CB, Feldman HA, Lovesky MM, et al. Effects of a low‐glycemic load diet in overweight and obese pregnant women: a pilot randomized controlled trial. American Journal of Clinical Nutrition 2010;92(6):1306‐15. - PMC - PubMed
ROLO 2012 {published data only}
    1. Donnelly J, Horan M, Walsh J, McGowan C, Byrne J, Molloy EJ, et al. Impact of a low GI diet on neonatal body composition (ROLO Kids). Pediatric Academic Societies Annual Meeting; 2013 May 4‐7; Washington DC, USA. 2013.
    1. Donnelly JM, Walsh JM, Byrne J, Molloy E, McAuliffe FM. Altered neonatal anthropometric measurements following maternal low GI diet in pregnancy (ROLO study). Acta Obstetricia et Gynecologica Scandinavica 2013;92(s160):13.
    1. Horan M, McGowan C, Donnelly J, Gibney E, McAuliffe F. Maternal diet and weight at 3 months partum following a pregnancy intervention with a low glycaemic index diet: Results from the ROLO randomised control trial. Archives of Disease in Childhood. Fetal and Neonatal Edition 2014;99(Suppl 1):A129‐A130, Abstract no: PMM.20. - PMC - PubMed
    1. Horan MK, McGowan CA, Donnelly J, Gibney E, McAuliffe FM. The association of maternal characteristics and macronutrient intake in pregnancy with neonatal body composition. Archives of Disease in Childhood. Fetal and Neonatal Edition 2014;99(Suppl 1):A11.
    1. Horan MK, McGowan CA, Doyle O, McAuliffe FM. Well‐being in pregnancy: An examination of the effect of socioeconomic, dietary and lifestyle factors including impact of a low glycaemic index dietary intervention. European Journal of Clinical Nutrition 2014;68(1):19‐24. - PubMed
Ronnberg 2014 {published data only}
    1. Nilsson K. Weight gain during pregnancy ‐ a randomized controlled trial of intervention to prevent excessive gestational weight gain. ClinicalTrials.gov (http://clinicaltrials.gov/) [accessed 5 September 2014] 2009.
    1. Ronnberg A, Ostlund I, Fadl H, Gottvall T, Nilsson K. Intervention during pregnancy to reduce excessive gestational weight gain‐a randomised controlled trial. BJOG :an International Journal of Obstetrics and Gynaecology 2014 Nov 4 [Epub ahead of print]. - PubMed
Ruchat 2012 {published data only}
    1. Ruchat SM, Davenport MH, Giroux I, Hillier M, Batada A, Sopper MM, et al. Nutrition and exercise reduce excessive weight gain in normal‐weight pregnant women. Medicine and Science in Sports and Exercise 2012;44(8):1419‐26. - PubMed
Ruiz 2013 {published data only}
    1. Ruiz R, Perales M, Pelaez M, Lopez C, Lucia A, Barakat R. Supervised exercise‐based intervention to prevent excessive gestational weight gain: a randomized controlled trial. Mayo Clinic Proceedings 2013;88(12):1388‐97. - PubMed
    1. Santaella MP. The role of a supervised physical exercise program as an alternative on the control of maternal gestational weight gain. ClinicalTrials.gov (accessed 21 May 2013). NCT01790347 2013.
Santos 2005 {published data only}
    1. Santos IA, Stein R, Fuchs SC, Duncan BB, Ribeiro JP, Kroeff LR, et al. Aerobic exercise and submaximal functional capacity in overweight pregnant women: a randomized trial. Obstetrics & Gynecology 2005;106(2):243‐9. - PubMed
Stafne 2012 {published data only}
    1. Morkved S. Effects of regular exercise during pregnancy. ClinicalTrials.gov (www.clinicaltrials.gov) (accessed 31 October 2010).
    1. Stafne SN, Salvesen KÅ, Romundstad PR, Eggebø TM, Carlsen SM, Mørkved S. Regular exercise during pregnancy to prevent gestational diabetes: a randomized controlled trial. Obstetrics & Gynecology 2012;119(1):29‐36. - PubMed
Szmeja 2011 {published data only}
    1. Szmeja MA, Grivell RM, Deussen AR, Dodd JM. Evaluation of information provision to women who are overweight or obese during pregnancy. Journal of Paediatrics and Child Health 2011;47(Suppl 1):78.
Thornton 2009 {published data only}
    1. Thornton YS, Smarkola C, Kopacz SM, Ishoof SB. Perinatal outcomes in nutritionally monitored obese pregnant women: a randomized clinical trial. Journal of the National Medical Association 2009;101:569‐77. - PubMed
Vesco 2013 {published data only}
    1. Vesco K, Leo M, Gillman M, King J, McEvoy C, Karanjaa N, et al. Impact of a weight management intervention on pregnancy outcomes among obese women: The Healthy Moms Trial. American Journal of Obstetrics and Gynecology 2013;208(1 Suppl 1):S352.
    1. Vesco KK, Karanja N, King JC, Gillman MW, Leo MC, Perrin N, et al. Efficacy of a group‐based dietary intervention for limiting gestational weight gain among obese women: A randomized trial. Obesity (Silver Spring, Md.) 2014;22(9):1989‐96. - PMC - PubMed
    1. Vesco KK, Karanja N, King JC, Gillman MW, Perrin N, McEvoy C, et al. Healthy Moms, a randomized trial to promote and evaluate weight maintenance among obese pregnant women: study design and rationale. Contemporary Clinical Trials 2012;33(4):777‐85. - PMC - PubMed
Vinter 2012 {published data only}
    1. Tanvig M. Lifestyle in pregnancy and offspring (LiPO). ClinicalTrials.gov (http://clinicaltrials.gov/) [accessed 6 February 2014] 2013.
    1. Tanvig M. Lifestyle in pregnancy and offspring ‐ comparison between children born to obese women and children born to normal weight women (LiPO). ClinicalTrials.gov (http://clinicaltrials.gov/) [accessed 6 February 2014] 2013.
    1. Tanvig M. Offspring body size and metabolic profile ‐ Effects of lifestyle intervention in obese pregnant women. Danish Medical Journal 2014;61(7):B4893. - PubMed
    1. Tanvig M, Vinter CA, Jorgensen JS, Wehberg S, Ovesen PG, Beck‐Nielsen H, et al. Effects of lifestyle intervention in pregnancy and anthropometrics at birth on offspring metabolic profile at 2.8 years ‐ results from the Lifestyle in Pregnancy and Offspring (LiPO) study. Journal of Clinical Endocrinology and Metabolism 2015;100(1):175‐83. - PubMed
    1. Vinter A. Lifestyle and pregnancy: the clinical effect of lifestyle intervention during pregnancy in obese women. ClinicalTrials.gov (www.clinicaltrials.gov) [accessed 31 October 2010].
Vitolo 2011 {published data only}
    1. Vitolo MR. Impact of a nutritional intervention program for weight control during pregnancy. ClinicalTrials.gov (www.clinicaltrials.gov) [accessed 31 October 2010].
    1. Vitolo MR, Fraga Bueno MS, Mendes Gama C. Impact of a dietary counseling program on the gain weight speed of pregnant women attended in a primary care service. Revista Brasileira de Ginecologia e Obstetricia 2011;33(1):13‐9. - PubMed
Wilkinson 2012 {published data only}
    1. Wilkinson SA, McIntyre HD. Evaluation of the 'healthy start to pregnancy' early antenatal health promotion workshop: a randomized controlled trial. BMC Pregnancy and Childbirth 2012;12:131. - PMC - PubMed
Wolff 2008 {published data only}
    1. Wolff S, Legarth J, Vangsgaard K, Toubro S, Astrup A. A randomized trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women. International Journal of Obesity 2008;32(3):495‐501. - PubMed

References to studies excluded from this review

Asemi 2011 {published data only}
    1. Asemi Z, Esmaillzadeh A. Effect of daily consumption of probiotic yoghurt on serum levels of calcium, Iron and liver enzymes in pregnant women. International Journal of Preventive Medicine 2013;4(8):949‐55. - PMC - PubMed
    1. Asemi Z, Jazayeri S, Najafi M, Samimi M, Mofid V, Shidfar F, et al. Effect of daily consumption of probiotic yogurt on oxidative stress in pregnant women: A randomized controlled clinical trial. Annals of Nutrition and Metabolism 2012;60(1):62‐8. - PubMed
    1. Asemi Z, Jazayeri S, Najafi M, Samimi M, Mofid V, Shidfar F, et al. Effects of daily consumption of probiotic yoghurt on inflammatory factors in pregnant women: a randomized controlled trial. Pakistan Journal of Biological Sciences 2011;14(8):476‐82. - PubMed
    1. Asemi Z, Samimi M, Tabasi Z, Talebian P, Azarbad Z, Hydarzadeh Z, et al. Effect of daily consumption of probiotic yoghurt on lipid profiles in pregnant women: a randomized controlled clinical trial. Journal of Maternal‐Fetal & Neonatal Medicine 2012;25(9):1552‐6. - PubMed
    1. Asemi Z, Samimi M, Tabassi Z, Naghibi M, Rahimi A, Khorammian H, et al. Effect of daily consumption of probiotic yoghurt on insulin resistance in pregnant women: A randomized controlled trial. European Journal of Clinical Nutrition 2013;67(1):71‐4. - PubMed
Bechtel‐Blackwell 2002 {published data only}
    1. Bechtel‐Blackwell DA. Computer‐assisted self‐interview and nutrition education in pregnant teens. Clinical Nursing Research 2002;11(4):450‐62. - PubMed
Boileau 1968 {published data only}
    1. Boileau PA. Control of weight‐gain during pregnancy: use of diethylpropion hydrochloride. Applied Therapeutics 1968;10:763‐5. - PubMed
Breslow 1963 {published data only}
    1. Breslow S, Belafsky HA, Shangold JE, Hirsch LM, Stahl MB. Control of weight gain in pregnancy: double blind study of a dieting aid. Clinical Medicine 1963;70:931‐8. - PubMed
Campbell 2004 {published data only}
    1. Campbell MK, Carbone E, Honess‐Morreale L, Heisler‐Mackinnon J, Demissie S, Farrell D. Randomized trial of a tailored nutrition education CD‐ROM program for women receiving food assistance. Journal of Nutrition Education & Behavior 2004;36(2):58‐66. - PubMed
Daley 2014 {published data only}
    1. Daley A, Jolly K, Lewis A, Clifford S, Kenyon AK, Roalfe SJ, et al. The feasibility and acceptability of regular weighing of pregnant women by community midwives to prevent excessive weight gain: RCT. Pregnancy Hypertension 2014;4(3):233. - PubMed
Davenport 2011 {published data only}
    1. Davenport H. Target weight program of pregnancy for improved prenatal care. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing 2011;40(Suppl 1):S101.
Faucher 2008 {published data only}
    1. Faucher MA. Promotoras de salud and portion control: a community intervention aimed at weight loss in low‐income Mexican‐American women. Journal of Midwifery and Women's Health 2008;53(5):482. - PubMed
Graham 2014 {published data only}
    1. Graham ML, Uesugi KH, Niederdeppe J, Gay GK, Olson CM. The theory, development, and implementation of an e‐intervention to prevent excessive gestational weight gain: e‐moms roc. Telemedicine Journal and E‐Health 2014;20(12):1135‐42. - PMC - PubMed
Gray‐Donald 2000 {published data only}
    1. Gray‐Donald K, Robinson E, Collier A, David K, Renaud L, Rodrigues S. Intervening to reduce weight gain in pregnancy and gestational diabetes mellitus in Cree communities: an evaluation. CMAJ: Canadian Medical Association Journal 2000;163(10):1247‐51. - PMC - PubMed
Hauner 2012 {published data only}
    1. Hauner H, Much D, Vollhardt C, Brunner S, Schmid D, Sedlmeier E‐M, et al. Effect of reducing the n26:n23 long‐chain PUFA ratio during pregnancy and lactation on infant adipose tissue growth within the first year of life: an open‐label randomized controlled trial. American Journal of Clinical Nutrition 2012;95(2):383‐94. - PubMed
Hausenblas 2008 {published data only}
    1. Hausenblas HA, Brewer BW, Raalte JL, Cook B, Downs DS, Weis CA, et al. Development and evaluation of a multimedia CD‐ROM for exercise during pregnancy and postpartum. Patient Education and Counseling 2008;70(2):215‐9. - PMC - PubMed
Ismail 1990 {published data only}
    1. Ismail MA, Nelson KE, Larson P, Moses VK. Selective effect of cefoxitin prophylaxis on post‐cesarean‐section microbial flora. Journal of Reproductive Medicine 1990;35:168‐74. - PubMed
Kinnunen 2007 {published data only}
    1. Aittasalo M, Pasanen M, Fogelholm M, Kinnunen TI, Ojala K, Luoto R. Physical activity counseling in maternity and child health care ‐ a controlled trial. BMC Women's Health 2008;8:14. - PMC - PubMed
    1. Kinnunen TI, Pasanen M, Aittasalo M, Fogelholm M, Hilakivi‐Clarke L, Weiderpass E, et al. Preventing excessive weight gain during pregnancy ‐ a controlled trial in primary health care. European Journal of Clinical Nutrition 2007;61(7):884‐91. - PubMed
    1. Luoto R. Physical activity and dietary counseling and supervised group exercises for first‐time pregnant women ‐ a feasibility study of a controlled trial. Current Controlled Trials (www.controlled‐trials.com/) [accessed 21 June 2007].
    1. Luoto R, Kharazmi E, Saarinen NM, Smeds AI, Makela S, Fallah M, et al. Effect of dietary intervention on serum lignan levels in pregnant women ‐ a controlled trial. Reproductive Health. ISRCTN21512277 2010; Vol. 7, issue 1:26. - PMC - PubMed
    1. Mustila T, Raitanen J, Keskinen P, Saari A, Luoto R. Lifestyle counseling during pregnancy and offspring weight development until four years of age: follow‐up study of a controlled trial. Journal of Negative Results in Biomedicine 2012;11:11. - PMC - PubMed
Lindsay 2014 {published data only}
    1. Lindsay K, Kennelly M, Smith T, Maguire O, Shanahan F, Brennan L, et al. Probiotics in obese pregnancy to reduce maternal fasting glucose: A randomised controlled trial. Archives of Disease in Childhood. Fetal and Neonatal Edition 2014;99(Suppl 1):A156, Abstract no: PPO.19.
Maitland 2014 {published data only}
    1. Maitland RA, Patel NR, Sherry C, Marriage B, Barr S, Lopez‐pedrosa JM, et al. A pilot study to evaluate the effects of a dietary supplement with slow digesting‐low GI carbohydrates in obese pregnant women using continuous glucose monitoring. Diabetes 2014;63(Suppl 1):A342, Abstract no: 1311‐P.
Mohebi 2009 {published data only}
    1. Mohebi S. Effect of nutrition education program on the recommended weight gain during pregnancy in pregnant women; application of health belief model. Iranian Registry of Clinical Trials (http://www.irct.ir/) [accessed 6 December 2010].
Moses 2006 {published data only}
    1. Moses RG, Luebcke M, Davis WS, Coleman KJ, Tapsell LC, Petocz P, et al. Effect of a low‐glycemic‐index diet during pregnancy on obstetric outcomes. American Journal of Clinical Nutrition 2006;84(4):807‐12. - PubMed
    1. Moses RG, Luebke M, Petocz P, Brand‐Miller JC. Maternal diet and infant size 2 y after the completion of a study of a low‐glycemic‐index diet in pregnancy. American Journal of Clinical Nutrition 2007;86(6):1806. - PubMed
Mottola 2010 {published data only}
    1. Mottola MF, Giroux I, Gratton R, Hammond J, Hanley A, Harris S, et al. Nutrition and exercise prevent excess weight gain in overweight pregnant women. Medicine and Science in Sports and Exercise 2010;42(2):265‐72. - PMC - PubMed
Olson 2004 {published data only}
    1. Olson CM, Strawderman MS, Reed RG. Efficacy of an intervention to prevent excessive gestational weight gain. American Journal of Obstetrics and Gynecology 2004;191(2):530‐6. [PUBMED: 15343232] - PubMed
Silverman 1971 {published data only}
    1. Silverman M, Okun R. The use of an appetite suppressant (diethylpropion hydrochloride) during pregnancy. Current Therapeutic Research, Clinical and Experimental 1971;13:648‐53. - PubMed
Stutzman 2010 {published data only}
    1. Stutzman SS, Brown CA, Hains SM, Godwin M, Smith GN, Parlow JL, et al. The effects of exercise conditioning in normal and overweight pregnant women on blood pressure and heart rate variability. Biological Research for Nursing 2010;12(2):137‐48. - PubMed
Te Morenga 2011 {published data only}
    1. Morenga L. A randomised, controlled dietary intervention to evaluate the effect of a high protein diet compared with a high carbohydrate, high fibre diet on individual components of the metabolic syndrome and marks of cardiovascular disease risk in overweight and obese women. Australian New Zealand Clinical Trials Registry (www.anzctr.org.au) [accessed 16 February 2011].
Walker 1966 {published data only}
    1. Walker JL. Methylclothiazide in excessive weight gain and edema of pregnancy. Obstetrics & Gynecology 1966;27:247‐51. - PubMed
Wisner 2006 {published data only}
    1. Wisner KL, Hanusa BH, Perel JM, Peindl KS, Piontek CM, Sit DK, et al. Postpartum depression: a randomized trial of sertraline versus nortriptyline. Journal of Clinical Psychopharmacology 2006;26(4):353‐60. - PubMed

References to studies awaiting assessment

Shakeri 2012 {published data only}
    1. Shakeri M, Fekri S, Shahnavaz A, Shakibazadeh E. Effectiveness of a group‐based educational program on physical activity among pregnant women. HAYAT 2012;18(3):1‐9.

References to ongoing studies

Astrup 2013 {published data only}
    1. Astrup AV. An optimized programming of healthy children (APPROACH). ClinicalTrials.gov (http://clinicaltrials.gov/) [accessed 5 February 2014] 2013.
Atkinson 2013 {published data only}
    1. Atkinson SA. Be healthy in pregnancy (B‐HIP): a trial to study nutrition and exercise approaches for healthy (B‐HIP). ClinicalTrials.gov [accessed 21 May 2013] 2013.
Barakat 2012 {published data only}
    1. Barakat R. Effect of a supervised exercise program in obese and overweight pregnant women on outcomes and level of depression. A randomized controlled trial. ClinicalTrials.gov (http://clinicaltrials.gov/) [accessed 21 May 2013] 2012.
Brownfoot 2011 {published data only}
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Peccei 2010 {published data only}
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Rauh 2014 {published data only}
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Roberts 2012 {published data only}
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Seneviratne 2014 {published data only}
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Shen 2010 {published data only}
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Skouteris 2012 {published data only}
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Thangaratinam 2014 {published data only}
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Thomson 2014 {published data only}
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Uauy 2013 {published data only}
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References to other published versions of this review

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