Prenatal Lifestyle Interventions: Key Components for Maternal and Fetal Health

Meta-analysis of studies involving nearly 35,000 expectant mothers found that interventions from allied health professionals are most effective in managing prenatal weight gain.

Importance   

Randomized clinical trials have found that prenatal lifestyle interventions optimize gestational weight gain (GWG) and pregnancy outcomes. However, the key components of successful implementation interventions have not been systematically identified.

Aim  

To evaluate intervention components using the Template for Intervention Description and Replication (TIDieR) framework to inform the implementation of prenatal lifestyle interventions in routine prenatal care.

Data sources  

Included studies were drawn from a recently published systematic review on the effectiveness of prenatal lifestyle interventions in optimizing gestational weight gain (GWG). We searched the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, MEDLINE and Embase from January 1990. until May 2020.

Study selection  

We included randomized clinical trials that examined the effectiveness of prenatal lifestyle interventions in optimizing gestational weight gain (GWG).

Data extraction and synthesis  

Random-effects meta-analyses were used to evaluate the association of intervention characteristics with the effectiveness of prenatal lifestyle interventions in optimizing gestational weight gain (GWG). Results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline . Data extraction was performed by 2 independent reviewers.

Main results and measures  

The primary outcome was mean gestational weight gain (GWG). Measures included characteristics of prenatal lifestyle interventions comprising domains related to theoretical framework, material, procedure, facilitator (allied health staff, medical staff or researcher), delivery format (individual or group), mode, location , gestational age at start (<20 weeks or ≥20 weeks), number of sessions (low [1-5 sessions], moderate [6-20 sessions], and high [≥21 sessions]), duration (low [1-12 weeks], moderate [13-20 weeks] and high [≥21 weeks]), tailoring, dropout and adherence. For all mean differences (MD), the reference group was the control group (i.e., usual care).

Results  

In general, 99 studies with 34,546 pregnant women were included and differential effective intervention components were found depending on the type of intervention. Overall, interventions delivered by an allied health professional were associated with a greater decrease in GWG compared to those delivered by other facilitators (MD, −1.36 kg; 95% CI, −1.71 to − 1.02 kg; P < 0.001).

Compared with corresponding subgroups, dietary interventions with an individual delivery format (MD, -3.91 kg; 95% CI -5.82 to -2.01 kg; P = 0.002) and a moderate number of sessions (MD, −4.35 kg; 95% CI −5.80 to −2.89 kg, P < .001) were associated with the greatest decrease in GWG. Physical activity and mixed behavioral interventions had attenuated associations with gestational weight gain (GWG). These interventions may benefit from earlier onset and longer duration for more effective optimization of GWG.

Conclusions

This meta-analysis of randomized prenatal lifestyle interventions may advance the field by defining core and adaptable intervention components to support pragmatic implementation in routine pregnancy care as a critical next step to build on the established effectiveness and cost-effectiveness of the interventions. to optimize gestational weight gain (GWG) and maternal and neonatal outcomes.

We broadly reported that delivery of the lifestyle intervention by an allied health professional appeared important with intervention content focused on diet and physical activity. Among dietary interventions, which were associated with the greatest decrease in GWG in our previous study, those with a moderate-intensity, individual delivery format were associated with the greatest change in GWG in this study.

Physical activity and mixed behavioral interventions were beneficial but associated with fewer changes in GWG; therefore, they may benefit from an earlier onset and longer duration for a more effective association with GWG reduction.

These findings suggest that future pragmatic research should focus on testing and evaluating components to inform implementation in diverse prenatal care settings, including those with limited resources, to optimize population benefit for pregnant people and the next generation.

Comments

Pregnant women can get better support from trained dietitians to manage weight gain during pregnancy, a new analysis of nearly 100 studies shows.

The meta-analysis of nearly 35,000 participants in 99 studies published in JAMA Network Open found that interventions from allied health professionals, such as dietitians, were the most beneficial in managing gestational weight gain (GWG).

Across 30 years of international evidence, the research team, including Professor Shakila Thangaratinam, a maternal health expert at the University of Birmingham, identified that between 6 and 20 individual sessions were most effective. Those sessions should consider practical elements of pregnancy, including nausea that can affect food and vegetable consumption, as well as cravings and fatigue.

The team also found less evidence of the exercise component in weight control during pregnancy and plans to control weight gain that include exercise should be carried out over a longer period of time than 20 weeks.

Professor Shakila Thangaratinam, Dame Hilda Lloyd Chair of Maternal and Perinatal Health at the University of Birmingham and co-author of the paper, said: “Weight gain during pregnancy is a normal process, but the old adage that mums-to-be “ They eat for two” and do not need to worry about the weight gain that can have consequences for the health of the mother and baby. We know that excessive gestational weight gain increases the risks of developing diabetes and other complications.

“This study set out to summarize 30 years of evidence about what works well and what doesn’t, and we found that experts in their fields, such as dietitians, were most effective in supporting healthy weight gain. “Other interventions were also found to have had some success, but they must begin early in the pregnancy journey.”

Cheryce L. Harrison, BBNSc, PhD, senior researcher and co-director of the Healthy Lifestyle Stream at the Monash Center for Health Research and Implementation at the School of Public Health and Preventive Medicine at Monash University in Melbourne, Australia, and her colleagues said: “In a secondary analysis of our 2022 systematic review reporting on the association of lifestyle interventions with effectiveness in optimizing gestational weight gain, this meta-analysis aims to elucidate and describe the components of the prenatal lifestyle interventions that are associated with optimized gestational weight gain within randomized studies published as clinical trials, providing critical and pragmatic information for trial implementation in prenatal care settings.”