Phipps Jennifer E, D'Souza Indira, Satish Nikita, Ketchersid Audriana, Whipps Mackenzie D M, Van Noord Megan, Ebong Imo, Khemet Taiwo Tanya, Sudhof Leanna S, Keeton Victoria, Hedriana Herman L, Simmons Leigh Ann
Health Equity Across the Lifespan Laboratory, Betty Irene Moore School of Nursing, University of California Davis Health, Sacramento, California.
Community Health Sciences Division, School of Public Health, University of California, Berkeley, Berkeley, California.
medRxiv. 2025 Jul 21:2025.07.18.25331742. doi: 10.1101/2025.07.18.25331742.
Adverse pregnancy outcomes (APOs), including hypertensive disorders, gestational diabetes, and preterm birth, affect 10-20% of U.S. pregnancies and substantially increase long-term cardiovascular disease (CVD) risk. While behavioral interventions during pregnancy may reduce risk factors for APOs, evidence remains limited on which strategies are effective for high-risk women. This systematic review addresses this gap by examining patterns in intervention design, outcome reporting, and areas where research fails to meet the needs of at-risk pregnant populations.
We searched PubMed and the Cochrane Central Register of Controlled Trials for articles published from January 1, 2005, to June 30, 2024. Following PRISMA guidelines, we included U.S.-based randomized controlled trials of behavioral interventions: diet, physical activity, sleep, mindfulness, or self-monitoring, delivered during pregnancy to women at high risk of APOs. See Supplemental Figure S4 for the PRISMA Checklist. Two reviewers independently performed screening, data extraction, and risk-of-bias assessment using the Cochrane Risk of Bias Tool.
Of 3,261 studies screened, 43 met inclusion criteria. Most interventions focused on individuals with prepregnancy overweight or obesity, often excluding those with other CVD risk factors. Thirty-six trials reported improvements in outcomes such as gestational weight gain (GWG), postpartum weight retention, blood pressure, or biomarkers. Interventions combining diet and physical activity showed the greatest benefit. However, only four trials demonstrated improvements in clinical outcomes like gestational diabetes, hypertensive disorders, or lipid profiles. Outcome measures and timelines varied widely, and few trials included postpartum follow-up or assessed outcomes beyond GWG.
Although behavioral interventions during pregnancy are growing in number, trials are limited by heterogeneous designs, narrow inclusion criteria, and inconsistent outcome reporting. The focus on GWG and exclusion of women with complex risk profiles reduce generalizability. Inclusive research with standardized outcomes is urgently needed to improve maternal health and reduce long-term CVD risk.
不良妊娠结局（APO），包括高血压疾病、妊娠期糖尿病和早产，影响着10%至20%的美国孕妇，并显著增加长期心血管疾病（CVD）风险。虽然孕期行为干预可能会降低APO的风险因素，但对于哪些策略对高危女性有效，证据仍然有限。本系统综述通过研究干预设计模式、结果报告以及研究未能满足高危孕妇群体需求的领域，来填补这一空白。
我们在PubMed和Cochrane对照试验中央注册库中检索了2005年1月1日至2024年6月30日发表的文章。按照PRISMA指南，我们纳入了在美国进行的关于行为干预的随机对照试验：饮食、体育活动、睡眠、正念或自我监测，这些干预在孕期提供给有APO高危风险的女性。PRISMA清单见补充图S4。两名评审员使用Cochrane偏倚风险工具独立进行筛选、数据提取和偏倚风险评估。
在筛选的3261项研究中，43项符合纳入标准。大多数干预措施针对孕前超重或肥胖个体，通常排除有其他CVD风险因素的个体。36项试验报告了妊娠体重增加（GWG）、产后体重滞留、血压或生物标志物等结果的改善。饮食和体育活动相结合的干预措施显示出最大益处。然而，只有四项试验证明了妊娠期糖尿病、高血压疾病或血脂谱等临床结局有所改善。结局测量方法和时间线差异很大，很少有试验包括产后随访或评估GWG以外的结局。
尽管孕期行为干预的数量在增加，但试验受到设计异质性、纳入标准狭窄和结果报告不一致的限制。对GWG的关注以及对具有复杂风险特征女性的排除降低了研究结果的普遍性。迫切需要开展具有标准化结局的包容性研究，以改善孕产妇健康并降低长期CVD风险。
