Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trialsBMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3119 (Published 19 July 2017) Cite this as: BMJ 2017;358:j3119
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Endeavour of diet and exercise in pregnancy should be emphasized to reduce gestational weight gain and development of chronic hypersion
Diet and physical activity based interventions consistently reduced gestational weight gain across various subgroups of women categorised by age, parity, body mass index, ethnicity, and pre-existing medical condition. However, the reduction in odds of adverse maternal and offspring composite outcomes with diet and physical activity is not significant, and does not vary across various subgroups of women. Interventions significantly lower the odds of caesarean section alone and have no effect on offspring outcomes.1 On the other hand, a study nvestigating the association between lifestyle risk factors and chronic hypertension by history of hypertensive disorders of pregnancy (HDP: gestational hypertension and pre-eclampsia) demonstrated that being overweight or obese was the only lifestyle factor consistently associated with higher risk of chronic hypertension and there was no clear evidence of effect modification by physical activity, DASH diet, or sodium/potassium intake on the association between HDP and chronic hypertension.2
The risks of major congenital malformations in the offspring of mothers was investigated among mothers who are underweight (body mass index (BMI) <18.5), overweight (BMI 25 to <30), or in obesity classes I (BMI 30 to <35), II (35 to <40), or III (≥40) compared with offspring of normal weight mothers (BMI 18.5 to <25) in early pregnancy. Compared with offspring of normal weight mothers (risk of malformations 3.4%), the proportions and adjusted risk ratios of any major congenital malformation among the offspring of mothers with higher BMI were: overweight, 3.5% and 1.05; obesity class I, 3.8% and 1.12, obesity class II, 4.2% and 1.23, and obesity class III, 4.7% and 1.37. The risks of congenital heart defects, malformations of the nervous system, and limb defects also progressively increased with BMI from overweight to obesity class III. Malformations of the genital and digestive systems were also increased in offspring of obese mothers.3
Cardiometabolic syndrome consisting of obesity, dyslipidemia of high triglycerides or low high-density lipoprotein cholesterol, pre-hypertension, and pre-diabetes showing fasting glucose >100 mg/dl are major risk factor for cardiovascular diseases (CVD) such as hypertension, diabetes mellitus, coronary heart disease, and heart failure as well as cancer, congenital malformations, and dementia. Obesity is the most important factor among others and also can be controlled by diet and exercise.4-6 Indeed, exercise and many drug interventions are often potentially similar in terms of their mortality benefits in the secondary prevention of coronary heart disease, rehabilitation after stroke, treatment of heart failure, and prevention of diabetes.7
At the population level, it is clear that obesity is an established risk factor for the development of HDP, CVD and dementia. In addition, multiple biological mechanisms linking obesity and CVD events including HDP have been identified. Therefore, endeavour of diet and exercise in pregnancy should be emphasized to reduce gestational weight gain and development of chronic hypersion.
Funding: None, Disclosures: None
1. International Weight Management in Pregnancy (i-WIP) Collaborative Group. Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials. BMJ. 2017;358:j3119.
2. Timpka S, Stuart JJ, Tanz LJ, Rimm EB, Franks PW, Rich-Edwards JW. Lifestyle in progression from hypertensive disorders of pregnancy to chronic hypertension in Nurses' Health Study II: observational cohort study. BMJ. 2017;358:j3024.
3. Persson M, Cnattingius S, Villamor E, Söderling J, Pasternak B, Stephansson O, Neovius M. Risk of major congenital malformations in relation to maternal overweight and obesity severity: cohort study of 1.2 million singletons. BMJ. 2017;357:j2563.
4. Koh KK. To take or not to take drugs? That is the question. BMJ 2013, Published 30 December 2013, http://www.bmj.com/content/347/bmj.f5577/rr/679697
5. Koh KK. Reconfirm to follow guidelines to prevent cardiovascular diseases.
BMJ 2016, Published on 5 March 2016, http://www.bmj.com/content/352/bmj.i721/rr-0.
6. Kim SH, Després JP, Koh KK. Obesity and cardiovascular disease: friend or foe?
Eur Heart J. 2016;37:3560-3568.
7. Naci H, Ioannidis JPA. Comparative effectiveness of exercise and drug
interventions on mortality outcomes: metaepidemiological study. BMJ 2013;347:f5577
Competing interests: No competing interests
Re: Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials
It is good to read this research article, "Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials", A Systematic review and meta-analysis of individual participant data (IPD).
“Eating for two” is very common advice for increased food intake in pregnancy irrespective of the increased BMI of women. The Institute of Medicine (IOM) released the updated gestational weight gain guidelines in 2009. According to IOM guideline recommendations, weight gain greater than or less than during pregnancy (compared with weight gain within recommended levels), was associated with higher risk of adverse maternal and infant outcomes.
'Eat Well and Keep Active' intervention programme to promote healthy eating and physical activity in pregnant women will be anacceptable strategy, 2-4. Also lifestyle interventions are safe in pregnancy, and helpful in controlling weight gain, 5.
We thank the authors for an interesting & informative study.
Competing interests: No competing interests