Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany.
Int J Behav Nutr Phys Act. 2021 Jan 7;18(1):8. doi: 10.1186/s12966-020-01075-7.
Maternal health and lifestyle during pregnancy may be critical for the onset and progression of childhood obesity. Prenatal lifestyle interventions have been shown to positively affect maternal behaviors, gestational weight gain, and anthropometric outcomes in infants at birth. The influence of such interventions on child weight or growth beyond birth is unknown. We therefore examined the association between lifestyle interventions during pregnancy and anthropometric outcomes during childhood.
A systematic literature search was conducted in three electronic databases, two clinical trial registers and further sources, without language or publication status restrictions. Additionally, 110 study authors were contacted to obtain unpublished data. Randomized controlled trials comparing any antenatal lifestyle or behavioral intervention to standard prenatal care, in women of any body mass index (BMI), with offspring anthropometric data at 1 month of age or older, were considered. Two reviewers independently extracted data and assessed the risk of bias using the Cochrane Collaboration's updated tool. Data on weight, length, and BMI, and corresponding z-scores, were stratified into six age ranges and weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated in univariate and multivariate random-effects meta-analytical models.
Twenty trials comprising 11,385 women were included in this systematic review, of which 19 were combined in meta-analyses. Overall, lifestyle interventions during pregnancy were not associated with differences in weight, length, BMI, or corresponding z-scores, in children aged 1 month to 7 years (e.g. weight in 5 to 6 month old children, WMD: 0.02 kg; 95% CI: - 0.05 to 0.10 kg, I = 38%; 13 studies, 6667 participants). Findings remained consistent when studies were stratified by maternal baseline BMI or other risk factors, and intervention content and duration. Based on the GRADE criteria, the strength of the body of evidence was considered moderate.
Prenatal lifestyle interventions were not shown to influence childhood weight or growth. Nevertheless, women should be encouraged to pursue a healthy lifestyle during pregnancy. Further efforts to establish early prevention strategies for childhood obesity are urgently needed. Thus, large, high-quality studies with pre-planned, long-term follow-ups are warranted.
PROSPERO CRD42018118678 .
孕妇的健康状况和生活方式可能对儿童肥胖的发生和发展起关键作用。研究表明，产前生活方式干预可以积极影响孕妇的行为、妊娠体重增加和婴儿出生时的人体测量结果。但此类干预对出生后儿童体重或生长的影响尚不清楚。因此，我们研究了妊娠期间的生活方式干预与儿童期人体测量结果之间的关系。
我们在三个电子数据库、两个临床试验注册处和其他来源中进行了系统文献检索，未对语言或出版状态进行限制。此外，我们还联系了 110 位研究作者以获取未发表的数据。我们纳入了比较任何产前生活方式或行为干预与标准产前护理的随机对照试验，纳入研究的孕妇无论其体重指数（BMI）如何，且其后代在 1 个月或以上时具有人体测量数据。两位评审员独立提取数据，并使用 Cochrane 协作组织更新的工具评估偏倚风险。将体重、身长和 BMI 以及相应的 z 分数数据按六个年龄范围进行分层，并在单变量和多变量随机效应荟萃分析模型中计算加权均数差（WMD）及其 95%置信区间（CI）。
本系统评价共纳入了 20 项试验，涉及 11385 名女性，其中 19 项试验被纳入荟萃分析。总体而言，在 1 个月至 7 岁的儿童中，妊娠期间的生活方式干预与体重、身长、BMI 或相应的 z 分数均无差异（例如，5-6 个月大的儿童的体重，WMD：0.02kg；95%CI：-0.05 至 0.10kg，I=38%；13 项研究，6667 名参与者）。当按孕妇基线 BMI 或其他危险因素、干预内容和持续时间对研究进行分层时，结果仍然一致。根据 GRADE 标准，证据质量被认为是中等强度。
产前生活方式干预并未显示出会影响儿童体重或生长。尽管如此，仍应鼓励孕妇在怀孕期间保持健康的生活方式。迫切需要进一步努力制定儿童肥胖症的早期预防策略。因此，需要进行大型、高质量的研究，并进行预先计划的长期随访。
PROSPERO CRD42018118678 。
