Behnam Susann, Timmesfeld Nina, Arabin Birgit
Clara Angela Foundation, Berlin, Germany.
Department of Obstetrics, HELIOS Horst Schmidt Klinikum, Wiesbaden, Germany.
Geburtshilfe Frauenheilkd. 2022 Nov 3;82(11):1249-1264. doi: 10.1055/a-1926-6636. eCollection 2022 Nov.
To compare the impact of lifestyle interventions for overweight and obese pregnant women a systematic review and meta-analysis was conducted using pre-registration and audit of the interventions as selection criteria. PubMed, Web of Science and CENTRAL were searched for randomized controlled trials examining diet, exercise, combined interventions or associated behavioral therapy. Trials were selected if they reported one of the primary outcomes (gestational diabetes, hypertensive disorders, perinatal mortality, admission to neonatal intensive care unit). Results were established from the total group and separately from pre-registered or clinically audited studies. Out of 1304 titles, 28 randomized controlled trials were included. Among the primary outcomes only hypertensive disorders were significantly reduced by exercise in the total group: odds ratio 0.52 (95% confidence interval 0.28 to 0.96, four trials, 1324 participants). When behavioral therapy supported combined interventions, maternal weight gain, (Standardized Mean Difference -0.16 kilogram; 95% confidence interval -0.28 to -0.04, four trials, 2132 participants) and neonatal birthweight, (Standardized Mean Difference -0.4 gram; 95% confidence interval -0.62 to -0.18, five trials, 1058 participants), were significantly reduced within the total group and both specified meta-analyses. Higher frequencies of physical activity improved the results. Risk of bias, assessed with the Cochrane Tool, was low to moderate. Elements of behavioral therapy might better prevent adverse effects of maternal obesity when combined with lifestyle interventions. Unfortunately, high heterogeneity due to different intervention and population characteristics was a limiting factor. Future studies should also focus on increased intensities of physical activity.
为比较生活方式干预对超重和肥胖孕妇的影响，我们以干预措施的预注册和审核为选择标准，进行了一项系统评价和荟萃分析。在PubMed、科学网和Cochrane系统评价数据库中检索了关于饮食、运动、联合干预或相关行为疗法的随机对照试验。如果试验报告了以下主要结局之一（妊娠期糖尿病、高血压疾病、围产期死亡率、入住新生儿重症监护病房），则将其纳入。结果从总体组中得出，并分别从预注册或临床审核的研究中得出。在1304篇标题中，纳入了28项随机对照试验。在主要结局中，仅总体组中运动显著降低了高血压疾病：优势比为0.52（95%置信区间为0.28至0.96，四项试验，1324名参与者）。当行为疗法支持联合干预时，总体组以及两项特定的荟萃分析中，孕妇体重增加（标准化均数差为-0.16千克；95%置信区间为-0.28至-0.04，四项试验，2132名参与者）和新生儿出生体重（标准化均数差为-0.4克；95%置信区间为-0.62至-0.18，五项试验，1058名参与者）均显著降低。更高频率的体育活动改善了结果。使用Cochrane工具评估的偏倚风险为低到中度。行为疗法的要素与生活方式干预相结合时，可能能更好地预防孕妇肥胖的不良影响。不幸的是，由于不同的干预措施和人群特征导致的高度异质性是一个限制因素。未来的研究还应关注体育活动强度的增加。
