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Meta-Analysis
. 2019 Aug 1;9(8):e025620.
doi: 10.1136/bmjopen-2018-025620.

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

Eileen C O'Brien  1 , Ricardo Segurado  2 , Aisling A Geraghty  1 , Goiuri Alberdi  1 , Ewelina Rogozinska  3   4 , Arne Astrup  5 , Rubenomar Barakat Carballo  6 , Annick Bogaerts  7   8   9 , Jose Guilherme Cecatti  10 , Arri Coomarasamy  11 , Christianne J M de Groot  12 , Roland Devlieger  7   13 , Jodie M Dodd  14 , Nermeen El Beltagy  15 , Fabio Facchinetti  16 , Nina Geiker  17 , Kym Guelfi  18 , Lene Haakstad  19 , Cheryce Harrison  20 , Hans Hauner  21 , Dorte M Jensen  22 , Khalid Khan  3   4 , Tarja Inkeri Kinnunen  23 , Riitta Luoto  23 , Ben Willem Mol  24 , Siv Mørkved  25   26 , Narges Motahari-Tabari  27 , Julie A Owens  14 , Maria Perales  6 , Elisabetta Petrella  16 , Suzanne Phelan  28 , Lucilla Poston  29 , Kathrin Rauh  30 , Girish Rayanagoudar  3 , Kristina M Renault  31   32 , Anneloes E Ruifrok  33 , Linda Sagedal  34 , Kjell Å Salvesen  35   36 , Tania T Scudeller  37 , Gary Shen  38 , Alexis Shub  39 , Signe N Stafne  25   26 , Fernanda G Surita  10 , Shakila Thangaratinam  3   4 , Serena Tonstad  40 , Mireille N M van Poppel  41 , Christina Vinter  42 , Ingvild Vistad  34 , SeonAe Yeo  43 , Fionnuala M McAuliffe  1 ; i-WIP (International Weight Management in Pregnancy) Collaborative Group
Affiliations
Meta-Analysis

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

Eileen C O'Brien et al. BMJ Open. .

Abstract

Objectives: To identify if maternal educational attainment is a prognostic factor for gestational weight gain (GWG), and to determine the differential effects of lifestyle interventions (diet based, physical activity based or mixed approach) on GWG, stratified by educational attainment.

Design: Individual participant data meta-analysis using the previously established International Weight Management in Pregnancy (i-WIP) Collaborative Group database (https://iwipgroup.wixsite.com/collaboration). Preferred Reporting Items for Systematic reviews and Meta-Analysis of Individual Participant Data Statement guidelines were followed.

Data sources: Major electronic databases, from inception to February 2017.

Eligibility criteria: Randomised controlled trials on diet and physical activity-based interventions in pregnancy. Maternal educational attainment was required for inclusion and was categorised as higher education (≥tertiary) or lower education (≤secondary).

Risk of bias: Cochrane risk of bias tool was used.

Data synthesis: Principle measures of effect were OR and regression coefficient.

Results: Of the 36 randomised controlled trials in the i-WIP database, 21 trials and 5183 pregnant women were included. Women with lower educational attainment had an increased risk of excessive (OR 1.182; 95% CI 1.008 to 1.385, p =0.039) and inadequate weight gain (OR 1.284; 95% CI 1.045 to 1.577, p =0.017). Among women with lower education, diet basedinterventions reduced risk of excessive weight gain (OR 0.515; 95% CI 0.339 to 0.785, p = 0.002) and inadequate weight gain (OR 0.504; 95% CI 0.288 to 0.884, p=0.017), and reduced kg/week gain (B -0.055; 95% CI -0.098 to -0.012, p=0.012). Mixed interventions reduced risk of excessive weight gain for women with lower education (OR 0.735; 95% CI 0.561 to 0.963, p=0.026). Among women with high education, diet based interventions reduced risk of excessive weight gain (OR 0.609; 95% CI 0.437 to 0.849, p=0.003), and mixed interventions reduced kg/week gain (B -0.053; 95% CI -0.069 to -0.037,p<0.001). Physical activity based interventions did not impact GWG when stratified by education.

Conclusions: Pregnant women with lower education are at an increased risk of excessive and inadequate GWG. Diet based interventions seem the most appropriate choice for these women, and additional support through mixed interventions may also be beneficial.

Keywords: inequalities; lifestyle interventions; nutrition; pregnancy; socioeconomic status.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Gestational weight gain (GWG) (kg/week), stratified by prepregnancy body mass index (BMI), intervention and educational attainment.
See this image and copyright information in PMC

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