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Meta-Analysis
. 2017 Nov 13;11(11):CD010443.
doi: 10.1002/14651858.CD010443.pub3.

Combined diet and exercise interventions for preventing gestational diabetes mellitus

Emily Shepherd  1 , Judith C Gomersall, Joanna Tieu, Shanshan Han, Caroline A Crowther, Philippa Middleton
Affiliations
Meta-Analysis

Combined diet and exercise interventions for preventing gestational diabetes mellitus

Emily Shepherd et al. Cochrane Database Syst Rev. .

Abstract

Background: Gestational diabetes mellitus (GDM) is associated with a wide range of adverse health consequences for women and their infants in the short and long term. With an increasing prevalence of GDM worldwide, there is an urgent need to assess strategies for GDM prevention, such as combined diet and exercise interventions. This is an update of a Cochrane review that was first published in 2015.

Objectives: To assess the effects of diet interventions in combination with exercise interventions for pregnant women for preventing GDM, and associated adverse health consequences for the mother and her infant/child.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (27 November 2016) and reference lists of retrieved studies.

Selection criteria: We included randomised controlled trials (RCTs) and cluster-RCTs, comparing combined diet and exercise interventions with no intervention (i.e. standard care), that reported on GDM diagnosis as an outcome. Quasi-RCTs were excluded. Cross-over trials were not eligible for inclusion. We planned to include RCTs comparing two or more different diet/exercise interventions, however none were identified.

Data collection and analysis: Two review authors independently assessed study eligibility, extracted data, assessed the risk of bias of the included trials and assessed quality of evidence for selected maternal and infant/child outcomes using the GRADE approach. We checked data for accuracy.

Main results: In this update, we included 23 RCTs (involving 8918 women and 8709 infants) that compared combined diet and exercise interventions with no intervention (standard care). The studies varied in the diet and exercise programs evaluated and health outcomes reported. None reported receiving funding from a drug manufacturer or agency with interests in the results. Overall risk of bias was judged to be unclear due to the lack of methodological detail reported. Most studies were undertaken in high-income countries.For our primary review outcomes, there was a possible reduced risk of GDM in the diet and exercise intervention group compared with the standard care group (average risk ratio (RR) 0.85, 95% confidence interval (CI) 0.71 to 1.01; 6633 women; 19 RCTs; Tau² = 0.05; I² = 42%; P = 0.07; moderate-quality evidence). There was also a possible reduced risk of caesarean section (RR 0.95, 95% CI 0.88 to 1.02; 6089 women; 14 RCTs; moderate-quality evidence). No clear differences were seen between groups for pre-eclampsia (RR 0.98, 95% CI 0.79 to 1.22; 5366 participants; 8 RCTs; low-quality evidence), pregnancy-induced hypertension and/or hypertension (average RR 0.78, 95% CI 0.47 to 1.27; 3073 participants; 6 RCTs; Tau² = 0.19; I² = 62%; very low-quality evidence), perinatal mortality (RR 0.82, 95% CI 0.42 to 1.63; 3757 participants; 2 RCTs; low-quality evidence) or large-for-gestational age (RR 0.93, 95% CI 0.81 to 1.07; 5353 participants; 11 RCTs; low-quality evidence). No data were reported for infant mortality or morbidity composite.Subgroup analyses (based on trial design, maternal body mass index (BMI) and ethnicity) revealed no clear differential treatment effects. We were unable to assess the impact of maternal age, parity and specific features of the diet and exercise interventions. Findings from sensitivity analyses (based on RCT quality) generally supported those observed in the main analyses. We were not able to perform subgroup analyses based on maternal age, parity or nature of the exercise/dietary interventions due to the paucity of information/data on these characteristics and the inability to meaningfully group intervention characteristics.For most of the secondary review outcomes assessed using GRADE, there were no clear differences between groups, including for perineal trauma (RR 1.27, 95% CI 0.78 to 2.05; 2733 participants; 2 RCTs; moderate-quality evidence), neonatal hypoglycaemia (average RR 1.42, 95% CI 0.67 to 2.98; 3653 participants; 2 RCTs; Tau² = 0.23; I² = 77%; low quality evidence); and childhood adiposity (BMI z score) (MD 0.05, 95% CI -0.29 to 0.40; 794 participants; 2 RCTs; Tau² = 0.04; I² = 59%; low-quality evidence). However, there was evidence of less gestational weight gain in the diet and exercise intervention group compared with the control group (mean difference (MD) -0.89 kg, 95% CI -1.39 to -0.40; 5052 women; 16 RCTs; Tau² = 0.37; I² = 43%;moderate-quality evidence). No data were reported for maternal postnatal depression or type 2 diabetes; childhood/adulthood type 2 diabetes, or neurosensory disability.

Authors' conclusions: Moderate-quality evidence suggests reduced risks of GDM and caesarean section with combined diet and exercise interventions during pregnancy as well as reductions in gestational weight gain, compared with standard care. There were no clear differences in hypertensive disorders of pregnancy, perinatal mortality, large-for-gestational age, perineal trauma, neonatal hypoglycaemia, and childhood adiposity (moderate- tovery low-quality evidence).Using GRADE methodology, the evidence was assessed as moderate to very low quality. Downgrading decisions were predominantly due to design limitations (risk of bias), and imprecision (uncertain effect estimates, and at times, small sample sizes and low event rates), however two outcomes (pregnancy-induced hypertension/hypertension and neonatal hypoglycaemia), were also downgraded for unexplained inconsistency (statistical heterogeneity).Due to the variability of the diet and exercise components tested in the included studies, the evidence in this review has limited ability to inform practice. Future studies could describe the interventions used in more detail, if and how these influenced behaviour change and ideally be standardised between studies. Studies could also consider using existing core outcome sets to facilitate more standardised reporting.

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Conflict of interest statement

Emily Shepherd: none known.

Judith Gomersall: none known.

Joanna Tieu has received funding for work outside of the scope of this review‐ NHMRC postgraduate scholarship, Ken Muirden fellowship (administered by Arthritis Australia; jointly funded by Australian Rheumatology Association and Roche).

Shanshan Han: Shanshan Han was an investigator on one of the excluded trials (Crowther 2012). Assessment of eligibility for inclusion was carried out by other members of the review team who were not directly involved in the trial.

Caroline Crowther: Caroline Crowther was an investigator on one of the included trials (Dodd 2014), and one of the excluded trials (Crowther 2012). All tasks relating to these trials (assessment of eligibility for inclusion, and if applicable, data extraction and assessment of risk of bias) were carried out by other members of the review team who were not directly involved in the trials.

Philippa Middleton: Philippa Middleton was an investigator on one of the excluded trials (Crowther 2012). Assessment of eligibility for inclusion was carried out by other members of the review team who were not directly involved in the trial.

Figures

1
1
Study flow diagram for previous version of the review (Bain 2015)
2
2
Update study flow diagram.
3
3
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included trials.
4
4
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included trial.
5
5
Funnel plot of comparison: 1 Diet and exercise interventions versus control, outcome: 1.1 Gestational diabetes.
6
6
Funnel plot of comparison: 1 Diet and exercise interventions versus control, outcome: 1.4 Caesarean section.
7
7
Funnel plot of comparison: 1 Diet and exercise interventions versus control, outcome: 1.6 Large‐for‐gestational age.
8
8
Funnel plot of comparison: 1 Diet and exercise interventions versus control, outcome: 1.13 Gestational weight gain (kg).
9
9
Funnel plot of comparison: 1 Diet and exercise interventions versus control, outcome: 1.16 Gestational weight gain (above IOM recommendations).
10
10
Funnel plot of comparison: 1 Diet and exercise interventions versus control, outcome: 1.31 Gestational age at birth (weeks).
11
11
Funnel plot of comparison: 1 Diet and exercise interventions versus control, outcome: 1.33 Preterm birth.
12
12
Funnel plot of comparison: 1 Diet and exercise interventions versus control, outcome: 1.35 Macrosomia.
13
13
Funnel plot of comparison: 1 Diet and exercise interventions versus control, outcome: 1.37 Birthweight (g).
1.1
1.1. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 1 Gestational diabetes.
1.2
1.2. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 2 Pre‐eclampsia.
1.3
1.3. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 3 Pregnancy‐induced hypertension and/or hypertension.
1.4
1.4. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 4 Caesarean section.
1.5
1.5. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 5 Perinatal mortality.
1.6
1.6. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 6 Large‐for‐gestational age.
1.7
1.7. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 7 Operative vaginal birth.
1.8
1.8. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 8 Induction of labour.
1.9
1.9. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 9 Perineal trauma.
1.10
1.10. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 10 Placental abruption.
1.11
1.11. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 11 Postpartum haemorrhage.
1.12
1.12. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 12 Postpartum infection.
1.13
1.13. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 13 Gestational weight gain (kg).
1.14
1.14. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 14 Gestational weight gain (various times reported) (kg).
1.15
1.15. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 15 Gestational weight gain (kg/week).
1.16
1.16. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 16 Gestational weight gain (above IOM recommendations).
1.17
1.17. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 17 Gestational weight gain (within IOM recommendations).
1.18
1.18. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 18 Gestational weight gain (below IOM recommendations).
1.22
1.22. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 22 Breastfeeding (exclusive).
1.23
1.23. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 23 Breastfeeding (partial).
1.25
1.25. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 25 Postnatal weight retention (latest time reported) (kg).
1.26
1.26. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 26 Return to pre‐pregnancy weight (latest time reported).
1.27
1.27. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 27 Postnatal BMI (latest time reported).
1.29
1.29. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 29 Stillbirth.
1.30
1.30. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 30 Neonatal mortality.
1.31
1.31. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 31 Gestational age at birth (weeks).
1.33
1.33. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 33 Preterm birth.
1.34
1.34. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 34 Apgar score less than seven at five minutes.
1.35
1.35. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 35 Macrosomia.
1.36
1.36. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 36 Small‐for‐gestational age.
1.37
1.37. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 37 Birthweight (g).
1.39
1.39. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 39 Birthweight z score.
1.40
1.40. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 40 Head circumference (cm).
1.41
1.41. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 41 Head circumference z score.
1.42
1.42. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 42 Length (cm).
1.43
1.43. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 43 Length z score.
1.44
1.44. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 44 Ponderal index (kg/m3).
1.45
1.45. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 45 Adiposity (sum of skinfold thickness) (mm).
1.46
1.46. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 46 Adiposity (abdominal circumference) (cm).
1.48
1.48. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 48 Shoulder dystocia.
1.49
1.49. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 49 Nerve palsy.
1.50
1.50. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 50 Bone fracture.
1.51
1.51. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 51 Respiratory distress syndrome.
1.52
1.52. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 52 Hypoglycaemia.
1.53
1.53. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 53 Hyperbilirubinaemia.
1.54
1.54. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 54 Childhood weight (latest time reported) (kg).
1.55
1.55. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 55 Childhood weight z score (latest time reported).
1.56
1.56. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 56 Childhood height (latest time reported) (cm).
1.57
1.57. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 57 Childhood height z score (latest time reported).
1.58
1.58. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 58 Childhood head circumference (latest time reported) (cm).
1.59
1.59. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 59 Childhood adiposity (latest time reported) (BMI z score).
1.60
1.60. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 60 Childhood adiposity (latest time reported) (abdominal circumference) (cm).
1.61
1.61. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 61 Childhood adiposity (latest time reported) (subscapular skinfold thickness) (mm).
1.62
1.62. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 62 Childhood adiposity (latest time reported) (triceps skinfold thickness) (mm).
1.63
1.63. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 63 Childhood adiposity (latest time reported) (total body fat) (%).
1.66
1.66. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 66 Antenatal visits.
1.67
1.67. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 67 Antenatal admissions.
1.68
1.68. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 68 Length of antenatal stay (days).
1.69
1.69. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 69 Neonatal intensive care unit admission.
1.70
1.70. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 70 Length of postnatal stay (mother) (days).
1.71
1.71. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 71 Length of postnatal stay (baby) (days).
1.72
1.72. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 72 Costs to families associated with the management provided (unit cost, €).
1.73
1.73. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 73 Costs associated with the intervention (unit cost, €).
1.74
1.74. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 74 Cost of maternal care (unit cost, €).
1.75
1.75. Analysis
Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 75 Cost of infant care (unit cost, €).
2.1
2.1. Analysis
Comparison 2 Combined diet and exercise interventions versus standard care: subgroups based on study design, Outcome 1 Gestational diabetes.
2.2
2.2. Analysis
Comparison 2 Combined diet and exercise interventions versus standard care: subgroups based on study design, Outcome 2 Pre‐eclampsia.
2.3
2.3. Analysis
Comparison 2 Combined diet and exercise interventions versus standard care: subgroups based on study design, Outcome 3 Caesarean section.
2.4
2.4. Analysis
Comparison 2 Combined diet and exercise interventions versus standard care: subgroups based on study design, Outcome 4 Large‐for‐gestational age.
3.1
3.1. Analysis
Comparison 3 Combined diet and exercise interventions versus standard care: subgroups based on maternal BMI, Outcome 1 Gestational diabetes.
3.2
3.2. Analysis
Comparison 3 Combined diet and exercise interventions versus standard care: subgroups based on maternal BMI, Outcome 2 Pre‐eclampsia.
3.3
3.3. Analysis
Comparison 3 Combined diet and exercise interventions versus standard care: subgroups based on maternal BMI, Outcome 3 Pregnancy‐induced hypertension or hypertension.
3.4
3.4. Analysis
Comparison 3 Combined diet and exercise interventions versus standard care: subgroups based on maternal BMI, Outcome 4 Caesarean section.
3.5
3.5. Analysis
Comparison 3 Combined diet and exercise interventions versus standard care: subgroups based on maternal BMI, Outcome 5 Perinatal mortality.
3.6
3.6. Analysis
Comparison 3 Combined diet and exercise interventions versus standard care: subgroups based on maternal BMI, Outcome 6 Large‐for‐gestational age.
4.1
4.1. Analysis
Comparison 4 Combined diet and exercise interventions versus standard care: subgroups based on ethnicity, Outcome 1 Gestational diabetes.
4.2
4.2. Analysis
Comparison 4 Combined diet and exercise interventions versus standard care: subgroups based on ethnicity, Outcome 2 Pre‐eclampsia.
4.3
4.3. Analysis
Comparison 4 Combined diet and exercise interventions versus standard care: subgroups based on ethnicity, Outcome 3 Pregnancy‐induced hypertension or hypertension.
4.4
4.4. Analysis
Comparison 4 Combined diet and exercise interventions versus standard care: subgroups based on ethnicity, Outcome 4 Caesarean section.
4.5
4.5. Analysis
Comparison 4 Combined diet and exercise interventions versus standard care: subgroups based on ethnicity, Outcome 5 Perinatal mortality.
4.6
4.6. Analysis
Comparison 4 Combined diet and exercise interventions versus standard care: subgroups based on ethnicity, Outcome 6 Large‐for‐gestational age.
5.1
5.1. Analysis
Comparison 5 Combined diet and exercise interventions versus standard care: sensitivity analyses, Outcome 1 Gestational diabetes.
5.2
5.2. Analysis
Comparison 5 Combined diet and exercise interventions versus standard care: sensitivity analyses, Outcome 2 Pre‐eclampsia.
5.3
5.3. Analysis
Comparison 5 Combined diet and exercise interventions versus standard care: sensitivity analyses, Outcome 3 Pregnancy‐induced hypertension.
5.4
5.4. Analysis
Comparison 5 Combined diet and exercise interventions versus standard care: sensitivity analyses, Outcome 4 Caesarean section.
5.5
5.5. Analysis
Comparison 5 Combined diet and exercise interventions versus standard care: sensitivity analyses, Outcome 5 Perinatal mortality.
5.6
5.6. Analysis
Comparison 5 Combined diet and exercise interventions versus standard care: sensitivity analyses, Outcome 6 Large‐for‐gestational age.
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Luoto 2011 {published data only}
    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
    1. ISRCTN33885819. Primary prevention of gestational diabetes among women at risk: a cluster‐randomized controlled trial. isrctn.com/ISRCTN33885819 (first received 12 September 2007).
    1. Kinnunen TI, Puhkala J, Raitanen J, Ahonen S, Aittasalo M, Virtanen SM, et al. Effects of dietary counselling on food habits and dietary intake of Finnish pregnant women at increased risk for gestational diabetes ‐ a secondary analysis of a cluster‐randomized controlled trial. Maternal and Child Nutrition 2014;10(2):184‐97. - PMC - PubMed
    1. Kolu P, Raitanen J, Luoto R. Physical activity and health‐related quality of life during pregnancy: a secondary analysis of a cluster‐randomised trial. Maternal and Child Health Journal 2014;18(9):2098‐105. - PubMed
    1. Kolu P, Raitanen J, Rissanen P, Luoto R. Cost‐effectiveness of lifestyle counselling as primary prevention of gestational diabetes mellitus: findings from a cluster‐randomised trial. PLOS One 2013;8(2):e56392. - PMC - PubMed
Petrella 2013 {published data only}
    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
Phelan 2011 {published data only}
    1. Hagobian TA, Phelan S, Gorin AA, Phipps MG, Abrams B, Wing RR. Effects of maternal lifestyle intervention during pregnancy on untreated partner weight: results from fit for delivery study. Obesity 2016;24(1):23‐5. - PMC - PubMed
    1. NCT01117961. Promoting healthy weight gain during pregnancy. clinicaltrials.gov/ct2/show/NCT01117961 (first received 15 April 2010).
    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):302‐12. - 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
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 and Related Metabolic Disorders 2002;26(11):1494‐502. - PubMed
Poston 2013 {published data only}
    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 and Metabolism 2014;64(3‐4):239‐46. - PubMed
    1. Hayes L, Mcparlin C, Kinnunen TI, Poston L, Robson SC, Bell R. Change in level of physical activity during pregnancy in obese women: findings from the UPBEAT pilot trial. BMC Pregnancy and Childbirth 2015;15:52. - PMC - 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, 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
    1. Poston L, Holmes B, Kinnunen T, Croker H, Bell R, Sanders T, et al. A complex intervention to improve outcome in obese pregnancies; the upbeat study. Archives of Disease in Childhood: Fetal and Neonatal Edition 2011;96(Suppl 1):Fa97.
Poston 2015 {published data only}
    1. Briley A, Seed P, Singh C, Patel N, Poston L. Gestational weight gain in obese pregnant women, the impact of a lifestyle intervention and implications for guidelines (UPBEAT trial). BJOG: an international journal of obstetrics and gynaecology 2016;123(Suppl 1):55‐6.
    1. Briley A, Seed PT, Singh C, Patel N, Poston L. Gestational weight gain, BMI and pregnancy outcomes in obese pregnant women in the UPBEAT behavioural intervention RCT. Reproductive Sciences 2016;23(1 Suppl 1):277A.
    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. Briley AL, Barr S, Badger S, Bell R, Croker H, Godfrey KM, et al. Erratum: A complex intervention to improve pregnancy outcome in obese women; the UPBEAT randomised controlled trial. BMC Pregnancy and Childbirth 2015;15:111. - PMC - PubMed
    1. Hayes L, Bell R, Robson S, Poston L. UPBEAT study: Association between physical activity in obese pregnant women and health of the offspring. The Power of Programming 2014: International Conference on Developmental Origins of Adiposity and Long‐Term Health; 2014 March 13‐15; Munich, Germany. 2014:48.
Rauh 2013 {published data only}
    1. DRKS00003801. Feasibility of a lifestyle intervention in pregnancy to optimize maternal weight development. drks‐neu.uniklinik‐freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DR... (first received 24 April 2012).
    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
    1. Rauh K, Gunther J, Kunath J, Stecher L, Hauner H. Lifestyle intervention to prevent excessive maternal weight gain: mother and infant follow‐up at 12 months postpartum. BMC Pregnancy and Childbirth 2015;15:265. - PMC - PubMed
Sagedal 2017 {published data only}
    1. Hillesund ER, Bere E, Sagedal LR, Vistad I, Overby NC. Effect of a diet intervention during pregnancy on dietary behavior in the randomized controlled Norwegian Fit for Delivery study. Journal of Developmental Origins of Health and Disease 2016;7(5):538‐47. - PubMed
    1. NCT01001689. Fit for delivery: a study of the effect of exercise sessions and nutritional counselling on pregnancy outcome (FFF). clinicaltrials.gov/ct2/show/NCT01001689 (first received 26 October 2009).
    1. Sagedal LR. Who are we missing? Examining non‐participants in "Fit for Delivery", a randomized, controlled trial of a lifestyle intervention in pregnancy. Pregnancy Hypertension 2014;4(3):237. - PubMed
    1. Sagedal LR, Henriksen T, Overby NC, Lohne‐Seiler H, Torstveit MK, Bere E, et al. The problem of non‐participation: Who declined to participate in "Fit for Delivery", a randomized, controlled trial of a lifestyle intervention in pregnancy?. The Power of Programming 2014: International Conference on Developmental Origins of Adiposity and Long‐Term Health; 2014 March 13‐15; Munich, Germany. 2014:63.
    1. Sagedal LR, Overby N, Lohne‐Seiler H, Bere E, Torstveit M, Henriksen T, et al. Study protocol: Fit for Delivery ‐ can a lifestyle intervention in pregnancy result in measurable health benefits for mothers and newborns? A randomized controlled trial. BMC Public Health 2013;13:132. - PMC - PubMed
Vinter 2011 {published data only}
    1. NCT00530439. Lifestyle and pregnancy: the clinical effect of lifestyle intervention during pregnancy in obese women (LiP). clinicaltrials.gov/ct2/show/NCT00530439 (first received 13 September 2007).
    1. NCT01918319. Lifestyle in pregnancy and offspring (LiPO). https://clinicaltrials.gov/ct2/show/NCT01918319 (first received 2 August 2013).
    1. NCT01918423. Lifestyle in pregnancy and offspring ‐ comparison between children born to obese women and children born to normal weight women (LiPO). clinicaltrials.gov/ct2/show/NCT01918423 (first received 2 August 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, Vinte CA, Jorgensen JS, Wehberg S, Ovesen PG, Lamont RF, et al. Anthropometrics and body composition by dual energy X‐ray in children of obese women: a follow‐up of a randomized controlled trial (the Lifestyle in Pregnancy and Offspring [LiPO] study). PLOS One 2014;9(2):e89590. - PMC - PubMed
Wang 2015 {published data only}
    1. Wang S, Ma JM, Yang HX. Lifestyle intervention for gestational diabetes mellitus prevention: A cluster‐randomized controlled study. Chronic Diseases and Translational Medicine 2015;1(3):169‐74. - PMC - PubMed

References to studies excluded from this review

Barakat 2006 {published data only}
    1. Barakat Carballo R, Alonso Merino G, Rodriguez Cabrero MR, Rojo Gonzalez JJ. Physical exercise and pregnancy outcome [Ejercicio fisico y los resultados del embarazo]. Progresos de Obstetricia y Ginecologia 2006;49(11):630‐8.
Bo 2014 {published data only}
    1. Bo S, Rosato R, Ciccone G, Canil S, Gambino R, Botto Poala C, et al. Simple lifestyle recommendations and the outcomes of gestational diabetes. A 2x2 factorial randomized trial. Diabetes, Obesity and Metabolism 2014;16(10):1032‐5. - PubMed
    1. NCT01506310. Efficacy of behavioral therapy and exercise in gestational diabetes mellitus (GDM). clinicaltrials.gov/ct2/show/NCT01506310 (first received 26 December 2011).
Clapp 1997 {published data only}
    1. Clapp JF. Diet, exercise, and feto‐placental growth. Archives of Gynecology and Obstetrics 1997;260:101‐8.
    1. Clapp JF 3rd. Effect of dietary carbohydrate on the glucose and insulin response to mixed caloric intake and exercise in both nonpregnant and pregnant women. Diabetes Care 1998;21 Suppl 2:B107‐12. - PubMed
    1. Clapp JF 3rd, Kim H, Burciu B, Schmidt S, Petry K, Lopez B. Continuing regular exercise during pregnancy: effect of exercise volume on fetoplacental growth. American Journal of Obstetrics and Gynecology 2002;186(1):142‐7. - PubMed
    1. Clapp JF III. Maternal carbohydrate intake and pregnancy outcome. Proceedings of the Nutrition Society 2002;61(1):45‐50. - PubMed
Crowther 2012 {published data only}
    1. ACTRN12607000174482. The IDEAL randomised controlled trial. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=81643 (first received 12 October 2006).
    1. Crowther CA, Hague WM, Middleton PF, Baghurst PA, McPhee AJ, Tran TS, et al. The IDEAL study: investigation of dietary advice and lifestyle for women with borderline gestational diabetes: a randomised controlled trial ‐ study protocol. BMC Pregnancy and Childbirth 2012;12(1):106. - PMC - PubMed
    1. Han S, Crowther CA, Middleton PF, Tran T, Zhang Y. Women with pregnancy hyperglycaemia: How well are lifestyle information booklets used?. Journal of Paediatrics and Child Health 2013;49(Suppl 2):93‐4.
    1. Han S, Middleton PF, Crowther CA. 4 month follow‐up study of weight and body composition for women after receiving lifestyle advice for treatment of borderline gestational diabetes. Journal of Paediatrics and Child Health 2015;51(Suppl 1):38.
    1. Han S, Middleton PF, Tran T, Crowther CA. A printed lifestyle intervention tool for women with borderline gestational diabetes: Assessing use and achievement of dietary goals set. Journal of Paediatrics and Child Health 2015;51(Suppl 1):106.
Luoto 2010 {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. ISRCTN21512277. Physical activity and dietary counseling and supervised group exercises for first‐time pregnant women ‐ a feasibility study of a controlled trial. isrctn.com/ISRCTN21512277 (first received 23 February 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 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
McGowan 2013 {published data only}
    1. ISRCTN54392969. A comparison of low glycaemic index carbohydrate diet versus no dietary intervention in pregnancy to prevent recurrence of a large baby. http://www.isrctn.com/ISRCTN54392969 (first received 22 April 2009).
    1. McGowan CA, Walsh JM, Byrne J, Curran S, McAuliffe FM. The influence of a low glycemic index dietary intervention on maternal dietary intake, glycemic index and gestational weight gain during pregnancy: a randomized controlled trial. Nutrition Journal 2013;12(1):140. - PMC - 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.
NCT00924599 {published data only}
    1. NCT00924599. Prevention of gestational diabetes pilot study. clinicaltrials.gov/ct2/show/NCT00924599 (first received 4 May 2009).
Parat 2015 {published data only}
    1. NCT00804765. Impact of education during pregnancy in overweight pregnant women (ETOIG). clinicaltrials.gov/ct2/show/NCT00804765 (first received 8 December 2008).
    1. Parat S, Negre V, Baptiste A, Tauber M‐T, Valensi P, Bertrand A‐M, et al. A randomized trial of the effects of prenatal education of overweight or obese pregnant women to prevent childhood overweight: The ETOIG study. Diabetes 2015;64:A375. - PubMed
Peacock 2014 {published data only}
    1. Peacock A, McIntyre, Bogossian F. Walking for exercise and nutrition to prevent diabetes for you (WENDY) project. International Confederation of Midwives 30th Triennial Congress. Midwives: Improving Women’s Health; 2014 June 1‐4; Prague, Czech Republic. 2014:C115.
Quinlivan 2011 {published data only}
    1. ACTRN12605000709640. A randomised trial of a multidisciplinary teamcare approach involving obstetric, dietary and clinical psychological input in obese pregnant women to reduce the incidence of gestational diabetes. anzctr.org.au/Trial/Registration/TrialReview.aspx?id=821&isReview=true (first received 7 October 2005).
    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(2):141‐6. - 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
Simmons 2015 {published data only}
    1. Jans G, Ameye L, Matthys C, Galjaard S, Jelsma J, Simmons D, et al. Does lifestyle coaching affect diet and physical activity stage of change scores in obese pregnant women? Pilot observations from the European DALI project. Obesity Facts 2014;7(Suppl 1):132.
    1. Simmons D, Jelmsa J, Galjaard S, Desoye G, Corcoy R, Devlieger R, et al. Results from a European multicentre, randomised trial of physical activity and/or healthy eating to reduce the risk of gestational diabetes mellitus (GDM): The DALI pilot study. Diabetes 2015;64:A38. - PubMed
    1. Simmons D, Jelsma JGM, Galjaard S, Devlieger R, Assche A, Jans G, et al. Results from a European multicenter randomized trial of physical activity and/or healthy eating to reduce the risk of gestational diabetes mellitus (GDM): the DALI lifestyle pilot. Diabetes Care 2015;38:1650‐6. - PubMed
    1. Simmons D, Van M, Corcoy R, Devlieger R, Kautzky‐Willer A, Damm P, et al. Dali: vitamin d and lifestyle intervention to prevent gestational diabetes: early findings from the DALI pilot study. Diabetic Medicine 2015;32(Suppl 1):174.
Sun 2016 {published data only}
    1. Sun Y, Zhao H. The effectiveness of lifestyle intervention in early pregnancy to prevent gestational diabetes mellitus in Chinese overweight and obese women: a quasi‐experimental study. Applied Nursing Research 2016;30:125‐30. - PubMed
Youngwanichsetha 2014 {published data only}
    1. Youngwanichsetha S, Phumdoung S, Ingkathawornwong T. The effects of mindfulness eating and yoga exercise on blood sugar levels of pregnant women with gestational diabetes mellitus. Applied Nursing Research 2014;27(4):227‐30. - PubMed

References to studies awaiting assessment

Althuizen 2013 {published data only}
    1. Althuizen E, Poppel MN, Seidell JC, Wijden C, Mechelen W. Design of the new life(style) study: a randomised controlled trial to optimise maternal weight development during pregnancy. BMC Public Health 2006;6:168. - PMC - PubMed
    1. Althuizen E, Wijden C, Mechelen W, Seidell J, Poppel M. The effect of a counselling intervention on weight changes during and after pregnancy: a randomised trial. BJOG: an international journal of obstetrics and gynaecology 2013;120(1):92‐9. - PubMed
    1. Broekhuizen K, Althuizen E, Poppel MNM, Donker M, Mechelen W. From theory to practice: intervention fidelity in a randomized controlled trial aiming to optimize weight development during pregnancy. Health Promotion Practice 2012;13(6):816‐25. - PubMed
    1. ISRCTN85313483. An intervention aimed at the prevention of excessive weight gain during pregnancy. isrctn.com/ISRCTN85313483 (first received 16 May 2005).
Asci 2016 {published data only}
    1. Asci O, Rathfisch G. Effect of lifestyle interventions of pregnant women on their dietary habits, lifestyle behaviors, and weight gain: a randomized controlled trial. Journal of Health, Population, and Nutrition 2016;35(1):7. - PMC - PubMed
Kieffer 2014 {published data only}
    1. Kieffer EC, Caldwell CH, Welmerink DB, Welch KB, Sinco BR, Guzman JR. Effect of the healthy MOMs lifestyle intervention on reducing depressive symptoms among pregnant Latinas. American Journal of Community Psychology 2013;51(1‐2):76‐89. - PubMed
    1. Kieffer EC, Welmerink DB, Sinco BR, Welch KB, Rees Clayton EM, Schumann CY, et al. Dietary outcomes in a Spanish‐language randomized controlled diabetes prevention trial with pregnant Latinas. American Journal of Public Health 2014;104(3):526‐33. - PMC - PubMed
    1. NCT01584063. Healthy mothers on the move (Healthy MOMs). clinicaltrials.gov/ct2/show/NCT01584063 (first received 20 April 2012).
    1. Shah MK, Kieffer EC, Choi H, Schumann C, Heisler M. Mediators and moderators of the effectiveness of a community health worker intervention that improved dietary outcomes in pregnant Latino women. Health Education and Behavior 2015;42(5):593‐603. - PMC - PubMed
Kim 2015 {published data only}
    1. Kim HK, Niederdeppe J, Guillory J, Graham M, Olson C, Gay G. Determinants of pregnant women's online self‐regulatory activities for appropriate gestational weight gain. Health Communication 2015;30(9):922‐32. - PMC - PubMed
Marcinkevage 2013 {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. Marcinkevage J, Narayan KMV, Correa A, Hennink M, Ramakrishnan U, Sharma A, et al. Lifestyle intervention during early pregnancy improves glucose and insulin indices in women at risk for gestational diabetes. Diabetes 2013; Vol. 62, issue Suppl:A19‐20.
    1. Marcinkevage J, Narayan KMV, Correa A, Hennink M, Ramakrishnan U, Sharma A, et al. Lifestyle intervention during early pregnancy improves glucose and insulin indices in women at risk for gestational diabetes. Diabetes 2013;62(Suppl):A97.
    1. NCT01084941. Lifestyle intervention to limit excessive weight gain during pregnancy in minority women. clinicaltrials.gov/ct2/show/NCT01084941 (first received 9 March 2010).
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(Suppl 1):S188.
Santos‐Rocha 2015 {published data only}
    1. Santos‐Rocha R, Portela C, Santos T. Active pregnancy: effects of a physical exercise and nutritional counselling program on pregnant women’s lifestyle and new‐born’s health (pilot study). Journal of Perinatal Medicine 2015;43(Suppl 1):Abstract no: O‐0149.
Skouteris 2016 {published data only}
    1. ACTRN12611000331932. Health in pregnancy and post birth: the HIPP study. anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336286 (first received 28 March 2011).
    1. Skouteris H, McCabe M, Milgrom J, Kent B, Bruce LJ, Mihalopoulos C, et al. Protocol for a randomized controlled trial of a specialized health coaching intervention to prevent excessive gestational weight gain and postpartum weight retention in women: the HIPP study. BMC Public Health 2012;12:78. - PMC - PubMed
    1. Skouteris H, McPhie S, Hill B, McCabe M, Milgrom J, Kent B, et al. Health coaching to prevent excessive gestational weight gain: A randomized‐controlled trial. British Journal of Health Psychology 2016;21(1):31‐51. - PubMed
Torres 2016 {published data only}
    1. Clifton R, Cahill A, Franks P, Gallagher D, Phelan S, Pomeroy J, et al. Design of lifestyle intervention trials to prevent excessive gestational weight gain in women with overweight or obesity. Obesity 2016;24:305‐13. - PMC - PubMed
    1. NCT01771133. Pregnancy and early lifestyle improvement study (PEARLS). clinicaltrials.gov/ct2/show/NCT01771133 (first received 15 January 2013).
    1. Torres R, Soltero S, Trak MA, Tucker CM, Mendez K, Campos M, et al. Lifestyle modification intervention for overweight and obese Hispanic pregnant women: development, implementation, lessons learned and future applications. Contemporary Clinical Trials Communications 2016;3:111‐6. - PMC - PubMed
Wilkinson 2012 {published data only}
    1. ACTRN12611000867998. The Healthy Start to Pregnancy study ‐ an evaluation of a new early antenatal health promotion model of care for improving maternal health behaviours. anzctr.org.au/Trial/Registration/TrialReview.aspx?id=343318 (first received 9 August 2011).
    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

References to ongoing studies

Chasan‐Taber 2015 {published data only}
    1. Chasan‐Taber L, Marcus BH, Rosal MC, Tucker KL, Hartman SJ, Pekow P, et al. Proyecto Mama: A lifestyle intervention in overweight and obese Hispanic women: a randomised controlled trial ‐ study protocol. BMC Pregnancy and Childbirth 2015;15:157. - PMC - PubMed
    1. NCT01868230. Lifestyle intervention in overweight and obese pregnant Hispanic women. clinicaltrials.gov/ct2/show/NCT01868230 (first received 29 May 2013).
Clements 2016 {published data only}
    1. ACTRN12615000397516. A cluster randomised trial to evaluate the effectiveness of a telephone based coaching program in reducing excessive gestational weight gain amongst pregnant women. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368304 (first received 2 April 2015).
    1. Clements V, Leung K, Khanal S, Raymond J, Maxwell M, Rissel C. Pragmatic cluster randomised trial of a free telephone‐based health coaching program to support women in managing weight gain during pregnancy: the Get Healthy in Pregnancy Trial. BMC Health Services Research 2016;16:454. - PMC - PubMed
    1. Clements V, Raymond J, Nicholl M, Leung K, Khanal S, Maxwell M. Help at the end of the line: Trialling a telephone‐based health‐coaching service for achieving healthy weight gain during pregnancy. Women and Birth 2015;28 Suppl:S26.
    1. Clements V, Raymond J, Nicholl M, Leung K, Khanal S, Maxwell M. Worth the weight: factors influencing recruitment to the NSW get healthy in pregnancy service trial. Journal of Paediatrics and Child Health 2015;51(Suppl 1):106.
Farajzadegan 2013 {published data only}
    1. Farajzadegan Z, Pozveh ZA. The design of maternal centered life‐style modification program for weight gain management during pregnancy ‐ a study protocol. Journal of Research in Medical Sciences 2013;18(8):683‐7. - PMC - PubMed
Garmendia 2015 {published data only}
    1. Garmendia ML, Corvalan C, Araya M, Casanello P, Kusanovic JP, Uauy R. Effectiveness of a normative nutrition intervention (diet, physical activity and breastfeeding) on maternal nutrition and offspring growth: the Chilean maternal and infant nutrition cohort study (CHiMINCs). BMC Pregnancy and Childbirth 2015;15:175. - PMC - PubMed
    1. NCT01916603. Diet, physical activity and breastfeeding intervention on maternal nutrition, offspring growth and development. clinicaltrials.gov/ct2/show/NCT01916603 (first received 4 July 2013).
Jelsma 2013 {published data only}
    1. ISRCTN70595832. DALI: vitamin D and lifestyle intervention for gestational diabetes mellitus (GDM) prevention. isrctn.com/ISRCTN70595832 (first received 21 November 2011).
    1. Jelsma JG, Poppel MN, Galjaard S, Desoye G, Corcoy R, Devlieger R, et al. DALI: Vitamin D and lifestyle intervention for gestational diabetes mellitus (GDM) prevention: an European multicentre, randomised trial ‐ study protocol. BMC Pregnancy and Childbirth 2013;13:142. - PMC - PubMed
Kennelly 2016 {published data only}
    1. ISRCTN29316280. Pregnancy, exercise and nutrition research study with app support. http://www.isrctn.com/ISRCTN29316280 (first received 11 December 2012).
    1. Kennelly M, Lindsay K, Gibney E, McCarthy M, McAuliffe F. Pregnancy, exercise and nutrition research study with smartphone app support (Pears): a randomised controlled trial study protocol. BJOG: an international journal of obstetrics and gynaecology 2015;122(Suppl S2):121.
    1. Kennelly MA, Ainscough K, Lindsay K, Gibney E, McCarthy M, McAuliffeFM. Pregnancy, exercise and nutrition research study with smart phone app support (Pears): Study protocol of a randomized controlled trial. Contemporary Clinical Trials 2016;46:92‐9. - PubMed
Nagle 2013 {published data only}
    1. ACTRN12613000125729. Primary prevention of gestational diabetes for women who are overweight and obese: a randomised controlled trial. anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363600 (first received 30 January 2013). - PMC - PubMed
    1. Nagle C, Skouteris H, Morris H, Nankervis A, Rasmussen B, Mayall P, et al. Primary prevention of gestational diabetes for women who are overweight and obese: a randomised controlled trial. BMC Pregnancy and Childbirth 2013;13(1):65. - PMC - PubMed
NCT01643356 {published data only}
    1. NCT01643356. Interventions to reduce excess weight gain in pregnancy in overweight and obese mothers. https://clinicaltrials.gov/ct2/show/NCT01643356 (first received 16 July 2012).
NCT01693510 {published data only}
    1. NCT01693510. Be healthy in pregnancy (B‐HIP): a trial to study nutrition and exercise approaches for healthy (B‐HIP). clinicaltrials.gov/ct2/show/NCT01693510 (first received 20 September 2012).
NCT01719406 {published data only}
    1. NCT01719406. The OHSU pregnancy exercise & nutrition (PEN) program. https://clinicaltrials.gov/ct2/show/NCT01719406 (first received 29 October 2012).
NCT01782105 {published data only}
    1. NCT01782105. Intervention to promote changes of healthy lifestyle (physical activity and nutrition) during gestation. clinicaltrials.gov/ct2/show/NCT01782105 (first received 18 June 2012).
Rauh 2014 {published data only}
    1. NCT01958307. Healthy Living in Pregnancy (GeLiS). clinicaltrials.gov/ct2/show/NCT01958307 (first received 4 October 2013).
    1. Rauh K, Kunath J, Rosenfeld E, Kick L, Ulm K, Hauner H. Healthy living in pregnancy: a cluster‐randomized controlled trial to prevent excessive gestational weight gain ‐ rationale and design of the GeliS study. BMC Pregnancy and Childbirth 2014;14:119. - PMC - PubMed
Spieker 2015 {published data only}
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References to other published versions of this review

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