UCD Perinatal Research Centre, Obstetrics and Gynaecology, UCD School of Medicine, University College Dublin, Dublin, Ireland.
Centre for Support and Training in Analysis and Research (CSTAR), School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
BMJ Open. 2019 Aug 1;9(8):e025620. doi: 10.1136/bmjopen-2018-025620.
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.
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.
Major electronic databases, from inception to February 2017.
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).
Cochrane risk of bias tool was used.
Principle measures of effect were OR and regression coefficient.
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.
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.
确定母亲的教育程度是否是妊娠体重增加（GWG）的预后因素，并确定生活方式干预（基于饮食、基于体力活动或混合方法）对 GWG 的差异影响，按教育程度分层。
使用先前建立的国际妊娠体重管理（i-WIP）合作组数据库（https://iwipgroup.wixsite.com/collaboration）进行个体参与者数据荟萃分析。遵循系统评价和个体参与者数据荟萃分析的首选报告项目声明指南。
主要电子数据库，从成立到 2017 年 2 月。
关于饮食和基于体力活动的干预措施的随机对照试验。纳入需要母亲的教育程度，并将其分类为高等教育（≥高等教育）或低等教育（≤中等教育）。
使用 Cochrane 偏倚风险工具。
主要效应测量指标为 OR 和回归系数。
在 i-WIP 数据库中的 36 项随机对照试验中，纳入了 21 项试验和 5183 名孕妇。教育程度较低的女性有发生过多（OR 1.182；95%CI 1.008 至 1.385，p = 0.039）和不足体重增加（OR 1.284；95%CI 1.045 至 1.577，p = 0.017）的风险增加。在教育程度较低的女性中，基于饮食的干预措施降低了过多体重增加的风险（OR 0.515；95%CI 0.339 至 0.785，p = 0.002）和不足体重增加的风险（OR 0.504；95%CI 0.288 至 0.884，p = 0.017），并减少了每周体重增加（B-0.055；95%CI-0.098 至-0.012，p = 0.012）。混合干预降低了教育程度较低的女性发生过多体重增加的风险（OR 0.735；95%CI 0.561 至 0.963，p = 0.026）。在教育程度较高的女性中，基于饮食的干预措施降低了过多体重增加的风险（OR 0.609；95%CI 0.437 至 0.849，p = 0.003），混合干预措施降低了每周体重增加（B-0.053；95%CI-0.069 至-0.037，p<0.001）。按教育程度分层，基于体力活动的干预措施对 GWG 没有影响。
教育程度较低的孕妇发生过多和不足 GWG 的风险增加。基于饮食的干预措施似乎是这些女性的最佳选择，通过混合干预措施提供额外的支持也可能是有益的。
