Secondary Logo

Interventions including a nutrition component aimed at managing gestational weight gain or postpartum weight retention

a systematic review and meta-analysis

Vincze, Lisa1; Rollo, Megan2,3; Hutchesson, Melinda2,3; Hauck, Yvonne4,5; MacDonald-Wicks, Lesley2,3; Wood, Lisa6,7; Callister, Robin2,6; Collins, Clare2,3,8

JBI Database of Systematic Reviews and Implementation Reports: March 2019 - Volume 17 - Issue 3 - p 297–364
doi: 10.11124/JBISRIR-2017-003593
SYSTEMATIC REVIEWS
Free

Objectives: The objective of this systematic review was to evaluate the effectiveness of interventions that include a nutrition component aimed at improving gestational weight gain and/or postpartum weight retention.

Introduction: Excessive gestational weight gain and postpartum weight retention increase the risk of adverse maternal and neonatal outcomes. Current evidence comprises many interventions targeting gestational weight gain and postpartum weight retention that incorporate a nutrition component. To date, no review has synthesized evidence from pregnancy through the postpartum period or described the intervention approaches in detail.

Inclusion criteria: The review included women (≥18 years) during pregnancy and/or up to 12 months postpartum. Studies were included if they involved a weight management intervention with a nutrition component and had the primary objective of determining the impact of gestational weight gain and/or postpartum weight change. Interventions were compared to usual care (i.e. control conditions with no intervention or wait-list control or standard pregnancy or postpartum care) or “other” (alternative intervention). The review considered randomized controlled trials published between 1980 and January 21, 2016. Studies that included a weight related primary outcome measured during pregnancy and/or postpartum were included.

Methods: Seven databases were searched and the reference lists of included studies were searched for additional studies not previously identified. Two independent reviewers assessed the methodological quality of studies using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI SUMARI). The JBI SUMARI standardized data extraction tool was used to extract data. A narrative synthesis was undertaken to qualitatively synthesize included studies, with meta-analyses used to pool weight outcome data from studies conducted separately for pregnancy and postpartum. Effect sizes for meta-analyses have been expressed as weighted mean differences (95% confidence intervals).

Results: The search yielded 4063 articles of which 48 articles from 39 studies were included. Eleven of 20 studies during pregnancy reported significant reductions in gestational weight gain with the intervention when compared to control groups. One of five studies where the intervention was conducted during both pregnancy and postpartum reported statistically significant reductions in gestational weight gain, and postpartum weight retention between intervention and control groups. Nine of 14 studies conducted after childbirth reported statistically significant intervention effects, indicating lesser postpartum weight retention. Random effects meta-analyses indicated that despite considerable heterogeneity, interventions conducted during pregnancy (−1.25 kg; 95% CI: −2.10 kg, −0.40 kg; p = 0.004), and postpartum (−3.25 kg; 95% CI: −4.69 kg, −1.82 kg; p < 0.001) were significantly more effective at improving weight outcomes compared to usual care or other interventions. Most studies were of moderate quality due to lack of clarity in describing study details required for appraising methodological quality. Few interventions were conducted from pregnancy through the postpartum period (n = 5). Limited interventions adopted online modalities in intervention delivery (n = 4). Intention-to-treat analysis was used in only 12 studies.

Conclusions: The pregnancy and postpartum period presents a unique opportunity to engage women in interventions to help optimize lifestyle behaviors for weight management, however the optimal approach is unclear. Improving consistency in intervention implementation and reporting will improve future evidence synthesis.

1School of Allied Health Sciences, Griffith University, Gold Coast, Australia

2Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Australia

3School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Australia

4School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia

5Department Nursing Midwifery Education and Research, King Edward Memorial Hospital, Perth, Australia

6School of Biomedical Sciences, Faculty of Health and Medicine, University of Newcastle, Australia

7Priority Research Centre Grow Up Well and Priority Research Centre Healthy Lungs, University of Newcastle, Australia

8The University of Newcastle Centre for Evidence Based Healthcare Informing Research (CEBHIR): a Joanna Briggs Institute Centre of Excellence

Correspondence: Lisa Vincze, L.Vincze@griffith.edu.au

There is no conflict of interest in this project.

Back to Top | Article Outline

Summary of Findings

Back to Top | Article Outline

Introduction

Overweight and obesity in childbearing women have increased substantially over the past few decades,1 with at least half of all women now entering pregnancy overweight.2 This global increase in the prevalence of maternal overweight and obesity is a serious concern for both mothers and their offspring due to associated complications. Entering pregnancy above a healthy weight and gestational weight gain in excess of Institute of Medicine (2009) recommendations increase the risk of developing a number of pregnancy-related complications including gestational diabetes mellitus (GDM), hypertensive disorders, emergency caesareans and shoulder dystocia.1,3,4 In addition to these complications, the early life environment has consequences for the later health of the offspring including pathways to childhood and adult obesity.1,5-7 Excessive gestational weight gain (GWG) increases the risk of postpartum weight retention.8,9 Up to one third of women who have a healthy BMI before pregnancy are overweight or obese at 12 months postpartum.8 Women who do not return to their pre-pregnancy weight by six and 12 months postpartum have an increased risk for being overweight and obese later in life.10,11 Further, increases in BMI between consecutive pregnancies increases the risk of pre-eclampsia, gestational hypertension, gestational diabetes, stillbirth and a large-for-gestational-age neonate in the subsequent pregnancy.12 Given this impact, the perinatal period, including pregnancy and the first year postpartum, is a critical time-period during which a woman's weight trajectory can be positively influenced.

Poor diet, sedentary behavior and low physical activity levels are linked with overweight. Many women do not meet dietary and physical activity recommendations before pregnancy, with these lifestyle patterns often worsening during pregnancy and after delivery.13-15 Adherence to dietary recommendations during pregnancy has been associated with reduced postpartum weight retention (PPWR).16 As poor dietary and physical activity habits influence weight management, supporting women during pregnancy and following childbirth to achieve optimal lifestyle patterns is of critical importance.

A systematic review published in 2011 investigated the impact of dietary interventions on GWG.17 Based on GWG data from the 10 studies, it was concluded that, compared to control conditions, dietary advice during pregnancy is effective in reducing GWG (WMD = −1.92 kg; 95% CI = −3.65/−0.19; p=0.03).17 Tanentsapf et al. 17 is the only previous review that included only interventions with a dietary component, however in 2012, Thangaratinam et al. 18 reported further on interventions including dietary, physical activity or a mixed approach to GWG management. Dietary interventions were found to be the most effective (−3.84 kg, −5.22 to −2.45) in limiting GWG compared to physical activity interventions (−0.72 kg, −1.20 to −0.25) or a combined (−1.06, −1.67 to −0.46) approach.18 No review evaluating PPWR has included only interventions with a dietary component, however Lim et al. concluded in their 2015 systematic review that combined diet and physical activity interventions were more effective for weight loss compared to physical activity alone (−3.24 kg, −4.59 to −1.90 vs. −1.63 kg, −2.16 to −1.10).19 This evidence suggests that inclusion of a dietary component in lifestyle interventions for weight management in pregnancy17,18,20,21 and postpartum19,22 improves efficacy. Therefore, this review focused on interventions that included a nutrition component.

Previous reviews have included studies from either pregnancy or the postpartum period but none have included and compared the evidence from interventions spanning both of these periods (i.e. pregnancy only, postpartum only and studies conducted across both).17-22 Given how closely these life stages are linked, this is a significant gap in the literature. Previous reviews have not summarized in detail the intervention components (i.e. intensity, mode of delivery, content, interventionist and theory base), making interpretation of effectiveness and translation into practice difficult. Identifying intervention characteristics is an important step forward for designing more engaging and successful interventions for women at this life stage. This review builds on previously published reviews, which were only conducted in pregnancy or postpartum periods.

The review protocol was peer reviewed by the Joanna Briggs Institute and published in January 2015 (doi: 10.11124/jbisrir-2015–1812).23

Back to Top | Article Outline

Objectives

The primary objective of this systematic review was to evaluate the effectiveness of weight management interventions which included a diet component aimed at limiting gestational weight gain and/or postpartum weight retention in women. The secondary objective was to investigate included intervention components with respect to effect on weight-related outcomes (i.e. length of intervention, delivery mode and other content in addition to nutrition [e.g. physical activity, counselling or breastfeeding support]).

Back to Top | Article Outline

Inclusion criteria

Participants

The review included studies that examined pregnant or postpartum (up to 12 months after delivery) women (aged 18 years or over) in all pre-pregnancy BMI categories. Studies were included if participants had the co-morbidities of gestational diabetes or diabetes; all other medical conditions were excluded (i.e. including but not limited to hypertensive disorders of pregnancy).

Back to Top | Article Outline

Intervention(s)/phenomena of interest

Studies were eligible for inclusion if they included any kind of intervention with a dietary component aimed at managing gestational weight gain or reducing postpartum weight retention. There were no limitations for inclusion with regard to dietary content, mode of delivery, interventionist and/or frequency of contact. The interventions had to be conducted across the antenatal and/or postpartum period, with intervention initiation at any point in pregnancy up to 12 months after delivery.

Back to Top | Article Outline

Comparator

Interventions were compared to usual care (i.e. control conditions with no intervention or wait-list control or received standard pregnancy or postpartum care) or “other” (provided with alternative intervention).

Back to Top | Article Outline

Outcomes

Studies that included a weight related primary outcome, measured during pregnancy and/or postpartum, were considered. Weight related outcomes could be obtained via self-report or objective measurements and reported as weight (kg or lb), body mass index (BMI), waist or hip circumference and/or percentage body fat.

Back to Top | Article Outline

Types of studies

The review considered randomized controlled trials (RCTs) only (Level II evidence) published between 1980 and January 21, 2016. Given the extensive number of studies include in this review, it was not possible to locate and include unpublished results.

Back to Top | Article Outline

Methods

Search strategy

To facilitate the development of an appropriate search strategy for this review, a previously published review in the area of dietary interventions for gestational weight management17 was examined (i.e. reviewed and search-strategy adapted to meet the primary aim of this review). Following this, a three-step search to identify published studies in the English language was undertaken. The search did not attempt to find earlier studies so as to focus on literature published from the time obesity rates escalated in the 1980s.24 A preliminary search of MEDLINE and CINAHL using initial keywords was undertaken. A second search using all identified keywords and index terms was then undertaken across all included databases: MEDLINE, MEDLINE In-Process, Embase, CINAHL, the Cochrane Central database, Scopus and PsycINFO. Thirdly, the reference list of all included studies was searched for additional references not previously identified.

Three comprehensive search strings were developed for the search strategy: i) terms relating to gestational or postpartum period; ii) terms relating to diet or nutrition; iii) terms relating to weight management. These three search strings were combined using the Boolean “AND” operator, and were used in combination with the standardized search terms for RCTs, studies limited to the English language and humans. The full search strategy is available in Appendix I.

Back to Top | Article Outline

Study selection

The reporting adheres to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement.25

Following initial identification of articles to be screened for eligibility, duplicates were removed. In a two-stage process, two reviewers then evaluated all articles independently. All identified titles and abstracts were reviewed for relevance in the first stage. Articles that met inclusion criteria in stage one, or if eligibility was uncertain, were retrieved in the second stage. A third reviewer resolved any disagreements in inclusion of an article.

Back to Top | Article Outline

Assessment of methodological quality

To evaluate the methodological quality of included studies, two independent reviewers assessed articles using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI SUMARI).26 In instances where multiple articles reported on one study, the methodological quality was reported as a single study. Any disagreements were resolved using a third reviewer.

Back to Top | Article Outline

Data extraction

One reviewer initially extracted data from the included papers using the JBI-SUMARI standardized data extraction tool,26 and a second reviewer checked the extraction. Additional components relating to study design (i.e. intervention length, delivery mode, interventionist, intensity and content) and outcomes (i.e. weight change and standard deviation [SD]) were added to the data extraction tool as per the objectives of this review. Interpretation and data extraction differences were resolved through discussion.

Back to Top | Article Outline

Data synthesis

A comparative narrative synthesis was undertaken to qualitatively synthesize included studies. Extracted data and quality appraisal assessments were used to describe studies in terms of their study design, intervention content, sample characteristics and study outcomes.

Quantitative data from studies conducted in either pregnancy or postpartum were, where possible, pooled in statistical meta-analysis using RevMan Version 5.3.5 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). The weighted mean difference (MD) [95% confidence interval (CI)] was computed using random effects models. Studies were eligible for meta-analysis if they reported adequate data for the calculation of absolute change in weight. Four studies reported insufficient data to calculate absolute change and SD.27-30 One study was converted from pounds to kilograms.31 For three studies,32-34 median and range values were converted to mean and SD values.35 Heterogeneity was quantified using I2, for which values of 25%, 50% and 75% approximately indicated a low, moderate and substantial heterogeneity. Sensitivity analyses were conducted to assess whether any single study had undue influence on the overall weighted MD result. Analyses have been reported by sub-group for interventions versus control or “other” (i.e. provided with alternative intervention) as the comparison group. Sub-groups from within studies were reported and included in the GWG meta-analysis for four studies.36-39 Guelincky et al. included two intervention (I) groups: I1 involved provision of written materials and I2 involved written materials plus group sessions.36 Polley et al.,39 Phelan et al. 38 and Hui et al. 37 reported results by BMI classification. These are described in Figure 2. Sub-groups from within studies were reported and included in the postpartum meta-analysis for two studies.40,41 Bertz et al. included two intervention groups: I1 involved provision of a dietary intervention only and I2 involved diet and exercise interventions.40 Davenport et al. included two intervention groups: I1 included a dietary intervention and moderate intensity exercise prescription and I2 included the same dietary intervention with low intensity exercise prescription.41 These are described in Figure 3. Meta-analysis was not conducted in interventions conducted in both pregnancy and postpartum due to the limited number of studies in this group.

Back to Top | Article Outline

Results

Study inclusion

The study selection and inclusion process for the systematic review is reported in Figure 1. The initial database search identified 8211 records with 4063 citations once duplicates were removed. Following title and abstract screening, 3752 records were excluded. Full text articles were retrieved for 311 citations, of which 263 were excluded. One additional article was included through reference list searching.42 Forty-eight articles representing 39 RCTs were included in the review; 20 RCTs were conducted on participants during pregnancy only,29,31-34,36-39,42-57 five commenced during pregnancy and continued post childbirth58-63 (one of which compared participants who commenced the intervention during pregnancy to those recruited up to 48 hours post birth),59 and 14 commenced after childbirth.27,28,30,40,41,64-75 Three of the postpartum interventions specifically recruited women ≤6 weeks after childbirth,66,71,72 one intervention recruited women from two weeks to 12 months after childbirth,68 and the remaining 10 interventions targeted women >6 weeks post childbirth.27,28,30,40,41,67,70,73-75 Bertz et al.,40 Brekke et al.,64 and Huseinovic et al. 69 all reported outcomes from the LEVA study (Swedish: Livsstil för Effektiv Viktminskning under Amning [English: lifestyle for effective weight loss during lactation]). Collaren et al. 65 presented additional dietary outcome data from the intervention reported in Collaren et al. 66 Dodd et al. 45 reported additional anthropometry outcomes from a sub-sample of participants in the intervention reported in Dodd et al. 46 Harrison et al. 47 and Vinter et al. 56 reported six months postpartum weight outcomes following the pregnancy interventions from Harrison et al. 42 and Vinter et al.,34 respectively. Jaakola et al. 61 presented long-term follow-up data on participants from the intervention from Ilmonen et al. 60 Phelan et al. 52 and Rauh et al. 54 presented 12 months outcomes data from the original trials by Phelan at al.38 and Rauh et al.,53 respectively.

Figure 1

Figure 1

The characteristics of the 39 included studies are summarized and described in Table 1. Publication dates ranged from 1998 to 2016.48 Thirty included studies were published from 2011 onwards. Studies varied considerably in origin with, 13 different countries reported. The United States of America was the most common location (n = 15),27,29,31,38,39,48,52,55,65,66,68,70-75 followed by Australia (n = 5),28,42,45-47,62,63 Canada (n = 4)37,41,49,58 and Denmark (n = 3).33,34,56,57 Finland,50,60,61 Italy43,51 and Sweden32,40,64,69 reported two studies each, with Turkey,44 Belgium,36 Germany,53,54 Taiwan,59 UK67 and Malaysia30 contributing one study each. The number of participants recruited for individual studies ranged from 1868 to 2212.46 Retention varied across studies, from 44%32 to 100%.44 Eight of the 20 studies conducted during pregnancy had retention rates less than 80%.29,31,32,36,38,42,43,57 Comparatively, 11 of 19 studies whose post-intervention follow-up occurred after childbirth (i.e. Intervention commenced or continued post-birth) had retention rates less than 80%.27,28,59,60,62,63,67,70,73-75 Seven of the 20 studies conducted during pregnancy had an additional follow-up beyond conclusion of the gestational intervention period39,47,52,54-57 ranging from two weeks55 to four years61 postpartum. Of those seven studies, only two had a retention rate greater than 80% for the follow-up time-point.53-55 Table 2 provides further description of the included studies. Excluded studies are listed in Appendix II.

Table 1

Table 1

Table 2

Table 2

Table 2

Table 2

Table 2

Table 2

Table 2

Table 2

Table 2

Table 2

Table 2

Table 2

Table 2

Table 2

Back to Top | Article Outline

BMI required for participation

For studies in which recruitment occurred during pregnancy, one specifically included women with a healthy BMI (18.5–24.9 kg/m2),32 seven studies29,42,45-48,51,62,63 recruited women with a BMI ≥25 kg/m2, one36 targeted women with a BMI >29 kg/m2 and four33,34,55-57 with BMI ≥30 kg/m2. Six studies specifically recruited women from all BMI categories,31,37-39,43,52-54 and a further six did not specify any BMI as an inclusion criterion.44,49,58-61

For studies commencing after childbirth, only one had no BMI restrictions for inclusion.74 Davenport and colleagues recruited women with a BMI ≥25 kg/m2 and/or those who had retained ≥5 kg from their recalled pre-pregnancy weight.41 Shyam et al. recruited women with a history of GDM and the presence of one high risk factor (which included BMI ≥23 kg/m2 or waist circumference >80 cm)30 and Leermakers et al. recruited women with a BMI ≥22 kg/m2 with ≥6.8 kg of weight retention compared to pre pregnancy.70 All remaining studies (n = 10) recruited women who were overweight or obese BMI (≥25 kg/m2).27,28,40,64-69,71-73,75

Six studies specifically targeted women who had abnormal blood glucose levels,44 were at risk of GDM (defined by presence of stated risk factors)42,47,50 or had a history of GDM pregnancy.28,30

Back to Top | Article Outline

Intervention duration

Recruitment ranged from six31 to 3663 weeks for studies commencing during pregnancy. Of these 25, five studies specifically recruited women in their first trimester of pregnancy,32,38,43,50,51 and one study recruited women in either the second or third trimester.63 All remaining studies (n = 19) recruited women who were in their first or second trimester.29,31,33,34,36,37,39,42,44,46,48,49,53,55,57-60,62 Of the 20 studies where the intervention ceased at the end of pregnancy, 14 continued right up to delivery.31,36-39,43-46,48,49,51-54,57 The remaining six interventions ceased at 2842,47, 28–3729, 3455, 3534,56, 35–3732 or 36–3733,50 weeks gestation. Five interventions commenced during pregnancy but did not conclude until six weeks (n = 1),58 six months (n = 3)59,62,63 or 12 months postpartum (n = 1).60

Recruitment windows for studies commencing after childbirth (n = 14) ranged from 24 hours to 48 hours post birth59 to six to 24 months postpartum.28 Intervention duration ranged from 10 weeks71 to 10 months.73 Interventions were most commonly 12 weeks (n = 3),28,40,64,67,69 16 weeks (n = 3)41,65,66,74 or six months (n = 3)27,30,70 in duration.

Back to Top | Article Outline

Intervention delivery: Mode

The main mode of intervention delivery was via individual in-person sessions with 29 studies using this delivery approach (Appendix III: Supplementary Table S1).30-34,37-43,45,46,48-51,53-57,59-66,69,71-74 The second most utilized delivery mode was group-based in-person sessions (n = 13)27,28,34,36,37,49,50,55,56,67,70,72,73,75 and telephone consultations (n = 13).32,33,38,39,45,46,48,52,62,67,68,70,72,74,75 Seven studies utilized short message service (SMS)29,30,33,40,47,48,68 and four studies utilized some kind of online modality (i.e. web-based resource or social media support page).28,48,65,66,68 Most studies included two delivery modes (n = 18),28,30,32,34,36,40,45,46,49,50,55,56,59-66,69,73,74 but nine studies opted for one delivery mode only.27,29,31,41,43,51,53,54,57,71

Eighteen of the 25 studies (72%) with part, or all, of the interventions conducted during pregnancy included a dietitian in some aspect of delivery.31-34,36-38,43,44,46,49,51,55,57,58,60,62,63 Of the pregnancy studies which did not include a dietitian, one study was delivered via SMS only29 and two studies were delivered primarily by nurses50,59 or health coaches.42,47,48 Comparatively, half (n = 7) of the studies commenced in the postpartum period (n = 14) had a dietitian involved in some aspect of intervention delivery.28,41,66,70,73-75

Back to Top | Article Outline

Intervention delivery: Intensity

Only 11 studies (28%) provided information on both intervention duration and intensity for all included components.27-29,36,40,42,48,53,63,66,68 Most studies (n = 21) did not report any information on the length of the consultations provided in their intervention.30-34,37,39,41,43,44,46,49,50,57,58,60,62,67,70,73,74 Two studies (n = 2) reported the duration of the initial session, but not the follow-up sessions.51,59 Four studies (n = 4) reported the duration for one but not all delivery modes included in the intervention design.38,55,72,75 For example, Phelan et al. provided one initial session with the study interventionist, weekly mailed postcards and three telephone calls during their intervention. Telephone calls were 10–15 minutes long, however no duration information was provided for the initial in-person session with the interventionist.38,52 One study was delivered via short message service (SMS) only, and did not report duration.29 The intervention intensity was unclear in one study as dietary prescription advice was provided but not described in terms of delivery method.71

Of the four studies that reported the length of group sessions, three were 60 minutes 27,28,36 and one was 90 minutes.55 Five studies reported the length of phone consultations; one was 10–15 minutes,38 three were 15–20 minutes48,68,72 and one was 20–30 minutes.75 Individual in-person sessions ranged from 3059,65,66 to 9040 minutes. Three studies had a 60-minute initial session.51,53,63 Only three studies reported the length of their follow-up consultation; two were 30 minutes53,65,66 and one was 60 minutes.40

Of the seven studies that utilized short message service (SMS),29,30,33,40,47,48,68 three sent messages more than three days per week and the same three studies prompted participants to reply to SMSs to obtain additional feedback. 29,48,68

Frequency of contact varied considerably between studies, and between modalities. Contact was as regular as daily via SMS,48,68 weekly for group sessions27,49,55,73 and up to three times per week for individual consultations. 65,66 One study reported minimal contact, with only one individual session for the whole intervention period,62 with two studies providing additional input from other modalities (i.e. weekly mailed postcards38 or SMS/email sent twice per month30).

Back to Top | Article Outline

Intervention delivery: Content in addition to nutrition

Intervention content is reported in Appendix III: Supplementary Table S2. Of the 20 studies conducted solely during pregnancy, only three did not include components in addition to dietary prescription and advice (n = 3).32,43,57 In addition to diet, one study which included women with abnormal glucose challenge tests, set fasting and post prandial glucose targets (n = 1),44 and the remaining 16 studies provided some level of physical activity and/or pregnancy weight gain advice (n = 16).29,31,33,34,36-39,42,46,48-51,53,55 Five studies (n = 5) described providing physical activity advice only (i.e. provided participants with advice regarding benefits of exercise in pregnancy or encouraged them to achieve national physical activity recommendations),31,36,39,46,53 and a further four studies provided participants with a pedometer in addition to advice, although no monitoring or feedback for pedometer use was described.38,42,51,55 Seven studies included a specific physical activity intervention with some level of feedback or monitoring (i.e. SMS regarding physical activity goals or offered attendance at group exercise classes).29,33,34,37,48-50 Twelve studies also provided weight gain in pregnancy advice (i.e. information on appropriate weight gain and/or IOM guidelines for weight gain in pregnancy). Nine studies specifically described monitoring GWG through charts/graphs33,38,39,47,50,53,55 or SMS.29,68

Of the five studies conducted over both pregnancy and postpartum periods, four included a physical activity component,58-60,63 two included breastfeeding advice62,63 and only one study included GWG and PPWR goals.59 Gray-Donald et al. provided walking groups, Wilkinson et al. posted educational material to promote physical activity and Ilmonen et al. asked women to report their weekly frequency of 30-minute bouts of moderate intensity exercise. Huang et al. provided an individualized physical activity plan, with women required to complete three-day physical activity diaries for review at sessions.59

All but one74 of the 14 studies commencing after childbirth included components in addition to diet. Two studies included specific content on stress management75 or problem solving and coping skills.27 Breastfeeding support and/or education was not included in any study commencing after childbirth. Five studies specifically reported including weight monitoring (self-monitoring or at in-person visits) throughout the study40,41,67,68,70 and 12 studies included a physical activity component.27,28,30,40,41,65-68,70-73 Ten of those studies included a specific physical activity intervention (i.e. supervised home exercise program) and/or monitoring of physical activity (i.e. weekly SMS report of physical activity completed).28,40,41,65-68,70-73 Two studies provided education and advice regarding physical activity recommendations with no further specified monitoring of participation.27,30

Back to Top | Article Outline

Weight data collection

Method of measuring weight and time point of recording or measuring weight outcome data for studies collecting GWG are reported in Appendix III: Supplementary Table S3. In calculating total GWG for interventions commencing during pregnancy (n = 25), 10 studies used self-reported pre-pregnancy weight as the baseline weight31,36,38,39,50,53,57,58,60,62 and 11 studies used measured weight at enrolment or baseline.29,32-34,37,42,43,46,48,51,55 Three studies did not report how pre-pregnancy weight was collected44,49,63 and one study did not report how GWG was calculated.59

The GWG endpoint was described as: just before delivery,31,57 at delivery,43,51,58 day of delivery,36,37,49 last measured weight before delivery,48 last clinic visit,38,39,50,53 and one week before delivery,60 abstracted from clinical records29 or measured at a specific week of gestation (26–28,42 34,55 35,34,62 36,46 35–37,32 36–3733). Two studies did not specifically describe the timing of the endpoint.44,59

Back to Top | Article Outline

Anthropometric outcomes

Only two studies conducted in pregnancy reported anthropometric outcomes in addition to weight. Bosaeus et al. used air-displacement plethysmography to measure body composition and subsequently reported changes in fat mass and fat free mass.32 Dodd et al. reported percentage body fat using skin fold thickness measurements (from biceps, triceps and subscapular), upper arm circumference and participant height.45

Of the 14 studies commencing after childbirth, eight reported waist circumference outcomes,27,28,30,41,65-67,69,74 five reported percentage body fat outcomes,28,67,71,73,74 three reported fat mass outcomes41,69,71 and two reported skeletal muscle mass outcomes.28,69 Eight studies reported changes in BMI.27,28,30,41,67,69,71,74

Back to Top | Article Outline

Methodological quality

Appraisal results for included studies (n = 39) are outlined in Table 3 . Most studies were of moderate quality due to lack of clarity in describing study details necessary for appraising methodological quality. Seven studies did not clearly describe the randomization process29,36,39,50,67,70,75 and a further three did not undertake a truly random assignment procedure.43,44,58 Due to the nature of the intervention, only one study blinded participants to treatment allocation.60,61 This study involved probiotic or placebo supplements in addition to dietary counselling or usual care.60,61 Only nine articles clearly described outcomes of participants who withdrew and included them in the analysis.30,37,38,44,53,60,61,68,72 Seven studies adequately described blinding outcome measures for assessors.38,42,46,55,59,60,67 All but five articles clearly reported measuring outcomes in a reliable way.31,43,44,67,69 Most studies did not use appropriate statistical analysis, with intention-to-treat analysis only being conducted in nine studies. Two of these papers used a last observation carried forward approach,30,68 seven studies conducted the intention-to-treat analysis on less participants than the original assignment due to excluding women for reasons relating to pregnancy complications (n = 4) (i.e. miscarriage, termination)29,38,46,48 or for being pregnant at follow-up (n = 3).60,70,72 An additional three papers reported no dropouts.37,44,51

Table 3

Table 3

Table 3

Table 3

Back to Top | Article Outline

Review findings

Weight change by pregnancy status and comparator

Pregnancy interventions: outcome change in GWG

Meta-analysis of 19 studies in pregnancy was conducted, of which 11 described the comparator as being “usual or routine” care and eight described the comparator group as being given an alternative intervention (i.e. “other”). Figure 2 presents results of the meta-analysis of all included gestational weight gain studies, and by comparator sub-group. A weighted mean difference of these studies gave an overall weight mean effect of −1.25 kg (95% CI: −2.10 kg, −0.40 kg; p = 0.004), meaning that pregnant women in the intervention groups gained 1.25 kg less on average than those in the comparator groups. However, there was evidence of substantial heterogeneity across studies, as indicated by an I2 value of 85%. Removal of the study by Renault and colleagues resulted in an overall increase in the effect size (WMD −1.56 kg; 95% CI −2.35 kg, −0.76 kg) and an increase in the statistical significance attributed to the remaining studies (p = <0.001).

Back to Top | Article Outline

Pregnancy interventions versus “usual care”

Eleven studies conducted during pregnancy described the comparator as usual or routine care.31-33,36,39,44,46,48,50,53,57 Two of these studies specifically described the time points of obstetric care appointments,32,48 two studies described the guidelines to which the routine care adhered to: American College of Obstetricians and Gynecologists31 and South Australian state-wide practice.46 Three studies described delivery of nutrition information as a part of usual care (i.e. single dietitian session,33 booklet on healthy lifestyle in pregnancy53 and nutrition counselling by healthcare providers39). Four studies did not define what routine prenatal care involved.36,44,50,57

Six of the 11 studies comparing the intervention to usual care reported significantly less GWG for the intervention group.31,33,44,48,53,57 Asbee et al. 31 involved one individual session with a dietitian at baseline and Rauh et al. 53 involved two individual sessions with trained researchers at 20 and 30 weeks gestation. The remaining four interventions included substantially more contact occasions. Deveer et al. 44 (six to 12 contact occasions) and Wolff et al. 57 (10 contact occasions) both provided regular individual in-person sessions, and Herring et al. 48 and Renault et al. 33 included both individual in-person and telephone contacts ranging from eight to 13 times (depending on gestation period).

All 11 studies with a “usual care” comparator were included in the sub-group meta-analysis (Figure 2). The weighted mean difference for interventions compared with “usual care” was −0.76 kg (95% CI: −2.01 kg, −0.49 kg; p = 0.23), meaning pregnant women in the intervention groups did not have statistically significant different GWGs compared to those in the comparator groups. However, there was evidence of substantial heterogeneity across studies, as indicated by an I2 value of 86%. Removal of the study by Renault et al. resulted in an overall increase in the effect size (WMD −1.30 kg; 95% CI −2.41 kg, −0.18 kg) and an increase in the statistical significance attributable to the remaining studies (p = 0.02).

Figure 2

Figure 2

Back to Top | Article Outline

Pregnancy interventions versus “other” intervention

Nine studies conducted during pregnancy described providing the comparator group with an alternative “other” intervention.29,34,37,38,42,43,49,51,55 Four studies reported providing the comparison group with a single session with either the dietitian or43,55 study interventionist,38 or did not report the provider.42 Phelan et al. 38 also mailed second monthly newsletters to the comparison group. Carlo et al. 43 provided individual sessions with the dietitian at baseline and at monthly follow-ups and reported significantly less GWG at delivery compared to the comparator. Harrison et al. 42 provided four individual sessions with a health coach, mailed two postcards and sent SMS (details on intensity not reported), and reported significantly less GWG at 28 weeks gestation. The significant difference persisted up to the passive follow-up at six weeks postpartum with the intervention group reporting less PPWR.47 Vesco et al. 55 included two individual sessions with a dietitian, in addition to 16 weekly group sessions; significant between group differences were reported for GWG at 34 weeks and PPWR at two weeks post-delivery. Phelan at al.38 reported no between group differences for GWG, however passive follow-up to 12 months postpartum showed significantly less weight retention for the intervention versus the comparison group.

Three studies compared the intervention to the provision of written materials; Hui et al. 37,49 provided healthy lifestyle information from Health Canada in both of their interventions and Petrella et al. 51 provided a nutrition booklet in agreement with Italian guidelines. Hui et al. 37 was the only study to report a significantly lower GWG for the intervention group, however the difference was only observed in those with a BMI≤24.9 kg/m2.

Pollak et al.'s29 SMS based intervention reduced the frequency of messages and changed the content delivered to their comparison group. No significant between group differences were reported. Vinter et al. 34 provided access to a website with advice on diet and physical activity in pregnancy for their comparison group. GWG was significantly less for the intervention group who received four individual sessions with a dietitian in addition to weekly exercise classes at a gym, however, passive follow-up to six months postpartum did not result in significant between group differences.56

Eight studies were included in the sub-group meta-analysis for interventions with an alternative “other” comparator (Figure 2). The weighted mean difference for interventions compared with an alternative “other” group was −1.82 kg (95% CI: −3.01 kg, −0.63 kg; p = 0.004), meaning that pregnant women in the intervention groups had 1.82 kg less GWG compared to those in the comparator groups. However, there was evidence of substantial heterogeneity across studies, as indicated by an I2 value of 83%. Sensitivity analyses resulted in minimal changes in the effect sizes and p-values.

Back to Top | Article Outline

Components included in successful pregnancy interventions

Of the 11 studies reporting significantly less GWG for intervention versus comparator groups, nine provided contact at least monthly with either, individual, group, SMS, postal or a combination of these modalities.33,34,42-44,49,55,57,68 However seven of the nine unsuccessful interventions also provided some kind of monthly contact, with at least one of these being an in-person individual session.29,32,39,46,49-51 Eight of the successful studies included individual in-person sessions with a dietitian (73%)31,33,34,43,44,49,55,57 compared with only four of the nine unsuccessful interventions (44%). Five of the successful interventions targeted women with healthy weight, overweight or obese BMI,31,43,44,49,53 two targeted only overweight or obese women42,68 and four exclusively targeted obese women.33,34,55,57 In addition to dietary advice, the successful interventions included the following: physical activity advice only,31,53 physical activity advice plus a pedometer,42,55 a structured physical activity intervention,33,34,37,48 blood glucose targets.44 Two successful interventions did not include any additional content to the nutrition component.43,57 Four successful interventions specifically described monitoring GWG.33,42,53,55

Back to Top | Article Outline

Pregnancy and postpartum interventions versus “usual care”

Two studies commencing during pregnancy with post-test in the postpartum period described the comparator as usual or routine care.58,59 Gray-Donald et al. 58 did not describe usual care conditions. Huang et al. 59 described time-points and personnel for usual care. Of these two studies, only Huang et al. reported significant between group differences for both GWG and PPWR at six months. Huang et al. compared usual care to two groups: women who received individual sessions with a nurse during pregnancy and postpartum, and those who only received the sessions in the postpartum period. Given the limited number of studies conducted from pregnancy through to postpartum with a “usual care” comparator group, no meta-analysis was conducted.

Back to Top | Article Outline

Pregnancy and postpartum interventions versus “other” intervention

Three studies commencing during pregnancy with post-test in the postpartum period described providing the comparator group with an alternative “other” intervention.60,62,63 One study reported providing the comparison group with a brochure at 36 weeks gestation and compared this to one session with the dietitian in pregnancy, and written goal sheets posted fortnightly to six months postpartum.63 One study provided the waitlisted control group with the intervention at three months postpartum, with post-test occurring at six months postpartum.62 Neither of these studies reported significant between group differences. Ilmonen et al. 60 compared a placebo supplement group to either probiotic or placebo supplements with dietary counselling. Individual dietary counselling occurred six times with a nutritionist up to 12 months postpartum. There were no significant between-group differences reported at 12 months postpartum, however a passive follow-up at four years found significantly less PPWR for intervention groups.61 Given the limited number of studies conducted from pregnancy through to postpartum with an alternative “other” comparator group, no meta-analysis was conducted.

Back to Top | Article Outline

Components included in successful pregnancy and postpartum interventions

Huang et al. 59 was the only study to report successful GWG and PPWR differences versus comparator groups for interventions conducted from pregnancy through to postpartum. Also this was the only study to report an individualized physical activity plan with GWG and PPWR goal-setting in addition to the dietary intervention. The intervention was conducted until six months postpartum, however two unsuccessful interventions were also conducted in the same time period.62,63 The Huang et al. study included two intervention groups; one was provided with three individual sessions with a nurse during pregnancy and three sessions following childbirth, and the second intervention group only received the postpartum sessions. Ilmonen et al. 60 provided the same level of contact (six sessions) with a nutritionist but their results at 12 months postpartum were not significantly different from control, however follow-up at four years postpartum reported significantly less PPWR.61

Back to Top | Article Outline

Postpartum interventions: outcome change in PPWR

Meta-analysis was conducted of 11 postpartum studies, of which three described the comparator as usual or routine care and eight described the comparator group as being an alternative “other” intervention. Figure 3 presents the results of the meta-analysis of all included postpartum studies, and by comparator sub-group. The weighted mean difference across all included studies was −3.25 kg (95% CI: −4.69 kg, −1.82 kg; p < 0.001), meaning postpartum women in the intervention group lost 3.25 kg more on average than those in the comparator group. However, there was evidence of substantial heterogeneity across studies as indicated by an I2 value of 86%. Sensitivity analyses resulted in minimal changes in effect sizes and p-values.

Figure 3

Figure 3

Back to Top | Article Outline

Postpartum interventions versus control or “usual care”

Five studies which commenced postpartum described the comparator as being usual care or a control group27,28,40,68,71 and four of these reported significantly greater weight loss for the intervention group.28,40,68,71 Herring et al. 68 included bi-weekly phone calls, a Facebook support group and daily SMS for 14 weeks. Lovelady et al. 71 provided four sessions per week of monitored exercise with the provision of six commercial frozen dinners per week for 10 weeks. Bertz et al. 40 compared three groups to usual care: individual dietitian counselling only (two sessions), physical therapy counselling only (two sessions) and both dietitian and physical therapy counselling (four sessions). Diet-related outcome main effects were reported to be significant between groups at both 12 weeks post intervention and the 12 months postpartum follow-up.40 Peacock et al.'s28 study consisted of four group nutrition sessions with a dietitian and weekly log-ins to a web-based program over 12 weeks.

Three studies were included in the sub-group meta-analysis for interventions compared with “usual care” groups (Figure 3). The weighted mean difference across interventions compared with “usual care” groups was −5.58 kg (95% CI: −7.40 kg, −3.75 kg; p < 0.001), meaning postpartum women in the intervention group lost significantly more weight compared to those in the usual care or control groups. There was evidence of low to moderate heterogeneity across studies as indicated by an I2 value of 38%. Sensitivity analyses resulted in minimal changes to effect sizes and p-values.

Back to Top | Article Outline

Postpartum interventions versus “other”

Nine studies which commenced postpartum described providing the comparator group with an alternative “other” intervention.30,41,66,67,70,72-75 Six studies compared the intervention to the provision of written materials;41,66,67,70,72,75 four of these reported significantly greater weight loss for the intervention versus comparator.41,66,67,70 Craigie et al. 67 provided fortnightly contact via individual in-person or telephone sessions with a lifestyle counsellor (six contact occasions over 12 weeks). Davenport et al. 41 compared two different exercise intensities to the comparator with one monitored exercise session per week for 16 weeks, with the addition of an individual session with the dietitian at baseline. Collaren et al. 66 provided an initial individual dietitian session at baseline and weekly monitored home visits for exercise with a research assistant. Leermakers et al. 70 ran a six-month intervention involving mailed materials, in-person group sessions and phone calls.

One study compared the intervention to a single one hour education session.73 O’Toole et al. 73 reported that the intervention group weighed significantly less than the comparator at 12 months postpartum. The final two studies delivered the same intervention intensity (i.e. mode of delivery and frequency of contact) to the intervention and comparator groups, however the content was changed for the comparator (i.e. low glycemic Index versus conventional recommendations from the Malaysian Ministry of Health30 and Mediterranean diet versus US dietary recommendations74). Neither of these studies reported significant between group differences.

Eight studies were included in the sub-group meta-analysis for interventions compared with alternative “other” groups (Figure 3). The weighted mean difference across interventions compared with alternative “other” groups was −2.17 kg (95% CI: −3.47 kg, −0.87 kg; p < 0.001), meaning postpartum women in the intervention groups lost significantly more weight compared to those in the “other” groups. However, there was evidence of substantial heterogeneity across studies, as indicated by an I2 value of 78%. Sensitivity analyses resulted in minimal changes to effect sizes and p-values.

Back to Top | Article Outline

Components included in successful postpartum interventions

Five28,40,41,65,73 of the nine successful postpartum interventions after childbirth included at least one interaction with a dietitian or nutritionist compared with only two30,75 of five unsuccessful interventions. All nine interventions who reported successful PPWR results versus comparator groups included a structured physical activity intervention in addition to dietary content,28,40,41,66-68,70,71,73 and five also reported specifically monitoring weight.40,41,67,68,70 Seven28,40,41,66-68,71 of the nine successful interventions were conducted for ≤ 6 months compared to only one74 of five unsuccessful interventions. There was no consistency with mode of delivery or combination of modes.

Back to Top | Article Outline

Discussion

This systematic review narratively and quantitatively synthesized the characteristics and effectiveness of interventions that included a dietary component and were aimed at improving gestational weight gain and postpartum weight retention. The evidence for the effectiveness of interventions that included a dietary component to manage GWG and PPWR is promising but inconsistent, likely due to the large variation in the approaches used and high heterogeneity.

The pregnancy and postpartum periods present a unique opportunity to engage women in interventions to help optimize lifestyle behaviors. This meta-analysis reports overall statistically significant improvements in both GWG and PPWR for interventions that include a dietary component. However, the most effective approach to support women during these two life stages remains unclear, as indicated by only 12 of the 25 studies, with an intervention component during pregnancy (48%) reporting significant reductions in GWG and nine of 14 studies (64%) after childbirth reporting less PPWR versus the comparator group. The effectiveness of interventions continuing from pregnancy to postpartum is even less clear with such a limited number of studies (n = 5) addressing both periods, and only one reporting significant differences in GWG and PPWR versus a comparator.59 Successful interventions targeting GWG and PPWR varied in the modality used to deliver the intervention, number of modalities included, qualifications and experience of the interventionist, BMI of recruited women, and gestation criteria for recruitment and thus intervention length. The substantial heterogeneity reported (I2 >75%) and diversity in study design and intervention components makes it difficult to draw conclusions about the most successful approach to weight management during the pregnancy and postpartum periods.

The meta-analysis results indicate that interventions which include a dietary component result in statistically and clinically significant reductions in women's GWG compared with other comparator interventions. This means that pregnant women who receive these interventions gain less weight. Previous meta-analysis of lifestyle interventions aimed at improving weight management in pregnancy have reported similar results.18,19,76 Yeo et al. included only overweight and obese women receiving lifestyle interventions (diet and/or physical activity) and reported an overall mean difference of −1.71 kg (95% CI −2.55 kg, −0.86 kg; p < 0.001), meaning women receiving the lifestyle interventions gain 1.71 kg less than the comparator group.76 Thangaratinam et al. also reported significantly reduced GWG for any lifestyle interventions (diet and/or physical activity) compared with control (MD −1.42 kg; 95% CI −1.89 kg, −0.95 kg; p < 0.001).18 Similarly, interventions delivered in the postpartum period were found to achieve statistically and clinically significant reductions in weight compared to other intervention groups. Lim et al. also reported significantly greater weight loss for combined diet and lifestyle interventions (diet and/or physical activity) in postpartum women (MD −3.24 kg; 95% CI −4.59 kg, −1.90 kg; p < 0.001).19 Whilst the meta-analyses from this review indicate that any dietary intervention provided to women during pregnancy and in the first 12 months postpartum results in significant benefits for weight management at this life-stage, the substantial heterogeneity and diversity in the approaches used warrants caution in interpretation of the most effective approach.

Lim et al.'s systematic review concluded that combined diet and exercise interventions were more successful in reducing PPWR compared to comparator groups.19 In support of this, the current review found that all studies reporting successful PPWR outcomes for intervention groups included a structured physical activity component in addition to the dietary components. However, the two studies which provided physical activity advice only, recommending exercise for 30 minutes five times a week without a structured plan or any monitoring procedure for the advice, did not report significantly different outcomes. An earlier review focusing on physical exercise strategies for postpartum weight management reported that the most effective interventions were those where exercise programs had objectively defined goals.77 From the current review, it can be seen that it may not just be the inclusion of physical activity advice which contributes to postpartum intervention success but rather the implementation of a structured plan, which may also include physical activity monitoring. Indeed, we observed that all interventions after childbirth that implemented a weight monitoring strategy (whether self-monitored or as a part of study sessions) reported significantly less weight retention versus comparator groups. Exclusive and mixed breastfeeding are inversely related to postpartum weight retention,78 however breastfeeding support was only included in two studies with all or part of the intervention in the postpartum period (2/19; 11%). The potential benefit of breastfeeding support is a current gap in knowledge and an area that needs to be addressed in future postpartum weight management research.

There is less clarity for interventions conducted during pregnancy as to which components, in addition to diet, lead to greater success in GWG management. For example, weight monitoring (self-monitoring or via reported study procedure) was more common amongst pregnancy interventions compared to postpartum interventions, however of the nine pregnancy interventions reporting weight monitoring, only four reported significantly less GWG versus comparator groups. Additionally, no clear pattern was observed regarding the addition of physical activity advice or structured physical activity components.

Limiting excessive GWG is important to reduce the risk of maternal and neonatal complications.79-81 The majority of women gain excessive weight during pregnancy.82 Specifically, almost three quarters of women with a healthy BMI may be gaining weight above IOM guidelines.82 Despite this, only seven of the 25 studies in this review that commenced in pregnancy specifically stated a recruitment BMI range that included healthy weight women.32,37-39,43,50,53 A further five studies were not clear in their baseline BMI recruitment target and may also have included healthy weight women.44,49,58-60 This trend continues in postpartum studies with only three studies included in the current review providing an opportunity for healthy weight women to be recruited. Davenport et al. 41 included women who had retained ≥5 kg over their pre-pregnancy weight, Leermakers at al.70 included women who had retained ≥6.8 kg of pre-pregnancy weight with a BMI ≥22 kg/m2 and Shyam et al. 30 recruited women with a BMI ≥23 kg/m2 or waist circumference ≥80 cm. Knowing that just under half (43.8%) of women who retain >2.2 kg at 12 months postpartum move from a healthy pre pregnancy BMI to an overweight BMI 15 years later10 and up to one third of women who have a healthy pre-pregnancy BMI become overweight or obese by 12 months postpartum, weight management following childbirth is not only important for women who are overweight or obese, but also women who are of a healthy weight. Interventions targeting GWG and PPWR need to include women from all BMI groups, regardless of their pre-pregnancy BMI, given the health risks associated with excessive GWG and PPWR for women from all BMI groups.

Although the ideal time to intervene to manage maternal weight is unclear, the established link between excessive GWG and PPWR indicates there is an opportunity to engage women across both life stages. Pregnancy presents an ideal time for recruitment, given the increased health-practitioner contact and motivation to improve the health of their growing baby.83 Engaging women early may also help to improve the poor retention seen in studies conducted after childbirth. Weight gain between subsequent pregnancies increases the risk of maternal and neonatal complications,12 and given that many women go on to have another child, supporting and engaging women throughout this life-stage is important. Despite this, only five interventions investigated providing support from pregnancy through to the postpartum period.58-60,62,63 The limited studies crossing from pregnancy to the postpartum period highlights a need for future research studies to address this gap.

Excessive GWG increases the risk of PPWR at 12 months following childbirth.8 However, only seven of the 20 studies conducted solely in pregnancy included a passive postpartum follow-up (i.e. intervention ceased in pregnancy, however outcomes continue to be collected postpartum), and only five interventions were conducted in both pregnancy and postpartum periods. Without longer term follow-up, it is difficult to assess the true impact of pregnancy interventions. This can be seen in the study by Phelan et al. 38 where GWG following the 12-week intervention was not significant between groups, however the passive follow-up at 12 months revealed significantly less PPWR versus the comparator.52 Similarly, Ilmonen et al. 60 demonstrated that intervention participants who completed the study retained significantly less weight four years after delivery despite no significant difference between groups at 12 months postpartum. If the GWG results were viewed in isolation to the follow-up data, the intervention may have been deemed ineffective. However, limiting PPWR has important implications for future risk of obesity and pregnancy weight-related outcomes for mother and infant.

Only 11 studies reported mode, duration and intensity information for all included intervention components.27-29,36,40,42,48,53,63,66,68 To support replication and accumulation of evidence for studies aiming to change behavior and impact GWG and PPWR, better reporting of implemented behavioral strategies and intervention components is required.84,85 The Consolidated Standards of Reporting Trials (CONSORT) checklist aims to improve reporting of RCTs to facilitate replication.86 Additionally, the Template for Intervention Description and Replication (TIDieR) checklist further improves completeness of reporting and can be used in conjunction with the CONSORT checklist (at item 5).85 To further this field, future interventions should aim to adhere to the CONSORT and TIDieR checklists when reporting outcomes.

Self-reported pre-pregnancy weight and gestational weight gain are prone to error, however this is a common method of data collection employed in this area of research.87 Of the 24 studies reporting gestational weight gain in this review, 10 used self-reported pre-pregnancy weight as the basis to calculate gestational weight gain. Although measured weight is preferable, self-reported weight is practical and cost-effective in the obstetric setting. However, in a recent review reporting on the accuracy of self-reported pregnancy related weight, Headen et al. recommended researchers develop bias correction techniques when self-reported data are used.87 Further, in calculation of GWG, studies use a variety of time points and methods which makes comparison of results across studies difficult. Consistent reporting of GWG would assist in more accurate comparison and interpretation of intervention results.

Following childbirth, women face many barriers in making positive lifestyle changes; this is reflected in 11 of 19 studies that had post-intervention follow-up in the postpartum period, reporting retention of less than 80%.27,28,59,60,62,63,67,70,73-75 Specifically, the issue of time is commonly cited as an obstacle, making dietary and lifestyle changes difficult at this life stage.88 Despite this, postpartum interventions have yet to capitalize on less time intensive intervention delivery modes. All but one41 of the 19 studies which had parts of the intervention conducted in the postpartum period were multimodal. More than half included in-person individual sessions (12/19; 63%)30,40,41,59,60,62,63,66,71,73,74 and seven (7/19; 37%) included in-person group sessions,27,28,67,70,72,73,75 despite the barriers new mothers have in attending in-person sessions. Telephone calls were used to supplement the in-person session in seven studies,62,67,68,70,72,74,75 however web-based programs28,66 or social media support68 were only used in three studies. Only one study was delivered without an in-person modality; Herring et al. 68 reported significantly lower PPWR in the intervention group who received telephone calls, SMS and involvement in a Facebook group. Whilst retention in studies during pregnancy was better (8/20 studies reported retention less than 80%29,31,32,36,38,42,43,57), potentially due to interventions recruiting patients during usual obstetric care, the use of online intervention modalities was also sparse (one study included social media support48). Nutrition support within a dietary intervention lends itself to remote delivery89 and application in the pregnant and postpartum population is warranted. Online delivery of dietary and lifestyle support, which reduces participation burden for women during pregnancy and following childbirth, presents an opportunity for further research.

Few studies in this review conducted intention-to-treat analysis (9/38; 24%), despite the Cochrane Systematic Review Handbook90 recommending participants be included, regardless of whether their outcomes are actually collected. Pregnant and postpartum women present researchers with complicated scenarios for post-intervention follow-up when a number of unique circumstances arise. Four studies excluded women from intention-to-treat analysis due to pregnancy-related complications like miscarriage and a further three studies excluded women who were pregnant at post-intervention follow-up. A standardized approach to manage these unique circumstances with respect to intention-to-treat analysis is needed. One third of studies (13/39) also lacked clarity in describing whether outcomes measures were consistently collected across participants and treatment groups. This may be due to outcome measures being extracted from medical records or being collected as part of routine obstetric care without describing if usual staff received training in outcome measure collection methodology. Future research should improve reporting of outcome measure collection.

Reporting intervention fidelity is also an important factor which assists researchers to interpret study outcomes. Despite reporting of fidelity being an item on the TIDieR checklist, only 17 included studies reported some kind of engagement or adherence data. Reporting intervention fidelity will help to understand how various study factors may have influenced published outcomes, and assist in developing more successful interventions in the future.

Previously published reviews evaluating lifestyle interventions for weight management in pregnancy or postpartum have investigated the topic, however they have not asked an identical research question nor had the same inclusion criteria as the current review. Studies could only be included in this review if the intervention's primary objective was to determine its impact on GWG and/or PPWR. This is a strength of the review as previously published reviews have included interventions with weight as a secondary outcome.20 Further, interventions must have included a dietary component. Thangaratinam et al.,18 Lim et al. 19 and van der Pligt et al. 22 all included studies with diet only, physical activity only or mixed approach interventions. Studies included in these reviews with physical activity only approaches were excluded from this review. The Tanentsapf et al. 17 review, published in 2011, also focused on dietary interventions, however quasi-randomized controlled trials were included. This review extends the evidence base by exclusively reviewing studies with RCT designs. This review is also unique in including studies conducted only in pregnancy, only in postpartum, and studies commencing in pregnancy and continuing through 12 months postpartum. The differences discussed here in the inclusion criteria form the rationale for the review, given that no other previously published review had included only RCTs from both pregnancy and postpartum with a focus on dietary components and with the primary aim of evaluating weight management outcomes within and across these key life stages.

Back to Top | Article Outline

Limitations of the review

This review has identified a large variety of approaches implemented in lifestyle interventions that include a dietary component in pregnancy and postpartum weight management research. Inconsistencies with outcome measure data collection and calculation, recruitment windows, intervention lengths and BMI of participants recruited make synthesis and interpretation difficult. Recommendations for research should include more consistent intervention implementation and outcome reporting to allow for appropriate pooling of average results, and sub-group analysis of specific intervention approaches. Improved consistency will also assist with interpretation and generalizability of results for application to clinical practice. Further, this review only considered published RCTs and did not include other study designs or unpublished data.

Back to Top | Article Outline

Conclusion

Improving GWG and PPWR is possible using lifestyle approaches that include a nutrition component, although the most effective intervention components remain unclear. Greater success is seen in interventions in the postpartum period, particularly those that include weight monitoring and a structured physical activity component in addition to diet/nutrition content. More consistent implementation and reporting of interventions at this life- stage is needed to improve the quality of evidence synthesis.

Back to Top | Article Outline

Recommendations for practice

Internationally, it is recommended that women receive advice on appropriate weight management during pregnancy and following childbirth.3 This includes the provision of dietary and lifestyle advice to support healthy weight attainment.91,92 Evidence from this review leads to the recommendation that when women are provided with an intervention that includes a nutrition component, they have clinically and statistically better weight outcomes (i.e. lower GWG and less PPWR), compared to usual care. However, the substantial heterogeneity in included studies and the variety of approaches used for the dietary interventions makes it difficult to recommend the most effective dietary approach in both pregnancy or postpartum.

Back to Top | Article Outline

Recommendations for research

This systematic review provides evidence for the efficacy of interventions including a dietary component to improve GWG and PPWR outcomes for women at this life stage, however improving consistency in intervention implementation and reporting will enable future pooling of study results and allow for further sub-group comparisons between study designs. Adoption of the TIDieR checklist,85 in addition to the CONSORT guidelines,86 may help to achieve this. Consensus on how best to report intention-to-treat analysis and the appropriateness of this approach in maternal weight management research should be determined. Online delivery modalities could address some of the barriers to participation faced by women at this life stage, such as participation burden, and should be addressed in future research. Given the link between GWG and PPWR, future studies should include longer term follow-up in their design in order to investigate the full impact of the intervention over the post-partum period. There is a need for additional interventions across pregnancy and postpartum, given the link between GWG and PPWR; currently this area is poorly studied. Future research should include women from all BMI groups as excessive GWG and PPWR increase the risk of complications, irrespective of pre-pregnancy BMI. The inclusion of breastfeeding support is a research gap and future research should address this, given its link with reduced PPWR. Online delivery of nutrition and lifestyle support to manage GWG and PPWR may assist in overcoming participation burden for women at this life stage and warrants further investigation. As this research field grows, it is hoped that the limitations and inconsistencies identified in this review will be addressed. This would strengthen the evidence for dietary interventions to improve weight management during pregnancy and following childbirth.

Back to Top | Article Outline

Acknowledgements

LV undertook this research as part of a requirement for the degree of PhD (Nutrition and Dietetics), The University of Newcastle, Australia. LV was supported by an Australian Postgraduate Award Scholarship and the Emlyn and Jennie Thomas Postgraduate Medical Research Scholarship through Hunter Medical Research Institute. CEC is supported by a National Health and Medical Research Council of Australia Senior Research Fellowship.

Back to Top | Article Outline

Appendix I: Search strategy

Database(s): MEDLINE 1946 to present (January 21, 2016) with daily updates

Figure

Figure

Database(s): MEDLINE In-Process and other non-indexed citations (searched on January 21, 2016)

Figure

Figure

Database(s): PsycINFO 1806 to January Week 2 2016 (searched on January 21, 2016)

Figure

Figure

Database(s): Embase Classic+Embase 1947 to 2016 January 19

Figure

Figure

Figure

Figure

CINAHL (searched on January 21, 2016)

Figure

Figure

Figure

Figure

COCHRANE Library (searched on January 21, 2016)

‘Pregnan * or antenatal or postnatal or postpartum or perinatal or “post natal” or “post partum” or “ante natal” or “peri natal” or gestation * in Title, Abstract, Keywords and bodyweight or overweight or “body mass index” or bmi or weight or obes * in Title, Abstract, Keywords and diet * or nutrition * or eat * or “caloric restriction” or “energy intake” or “food intake” in Title, Abstract, Keywords, Publication Year from 1980 to 2016

Cochrane Reviews – 79

Other Reviews – 34

Trials 1580

Methods Studies – 4

Scopus (searched on January 21, 2016)

(ABS (pregnan * OR antenatal OR postnatal OR postpartum OR perinatal OR “post natal” OR “post partum” OR “ante natal” OR “peri natal” OR gestation *) AND ABS (bodyweight OR overweight OR “body mass index” OR bmi OR weight OR obes *) AND ABS (diet * OR nutrition * OR eat * OR “caloric restriction” OR “energy intake” OR “food intake”) AND ABS (random * OR trial)) AND PUBYEAR > 1979 AND (LIMIT-TO (EXACTKEYWORD, “Human”))

Back to Top | Article Outline

Appendix II: List of excluded studies after full-text eligibility assessment

Adair LS, Pollitt E. Outcome of maternal nutritional supplementation: A comprehensive review of the Bacon Chow study. Am J Clin Nutr. 1985;41(5):948–78.

Reason for exclusion: Ineligible type of intervention.

Adair LS, Pollitt E, Mueller WH. The Bacon Chow study: effect of nutritional supplementation on maternal weight and skinfold thicknesses during pregnancy and lactation. Br J Nutr. 1984;51(3):357–69.

Reason for exclusion: Ineligible type of intervention.

Akter SM, Roy SK, Thakur SK, Sultana M, Khatun W, Rahman R, et al. Effects of third trimester counseling on pregnancy weight gain, birthweight, and breastfeeding among urban poor women in Bangladesh. Food and Nutrition Bulletin. 2012;33(3):194–201.

Reason for exclusion: Ineligible study type/design.

Althuizen E, Wijden CL, Mechelen W, Seidell JC, Poppel MN. The effect of a counselling intervention on weight changes during and after pregnancy: a randomised trial. BJOG 2013; 120(1):92–99.

Reason for exclusion: Ineligible study type/design.

Aroda VR, Christophi CA, Edelstein SL, Zhang P, Herman WH, Barrett-Connor E, et al. The effect of lifestyle intervention and metformin on preventing or delaying diabetes among women with and without gestational diabetes: The diabetes prevention program outcomes study 10-year follow-up. Journal of Clinical Endocrinology and Metabolism. 2015;100(4):1646–53.

Reason for exclusion: Ineligible participants.

Asbee SM, Jenkins TR, Butler JR, White J, Elliot M, Rutledge A. Dietary counseling prevents excessive weight gain during pregnancy, a randomized controlled trial. Obstetrics and Gynecology. 2008; 111(4 Suppl).

Reason for exclusion: Ineligible study type/design.

Asemi Z, Samimi M, Tabassi Z, Esmaillzadeh A. The effect of DASH diet on pregnancy outcomes in gestational diabetes: A randomized controlled clinical trial. Eur J Clin Nutr. 2014; 68(4):490–495.

Reason for exclusion: Ineligible type of intervention.

Asemi Z, Samimi M, Tabassi Z, Esmaillzadeh A. Multivitamin versus multivitamin-mineral supplementation and pregnancy outcomes: A single-blind randomized clinical trial. International journal of preventive medicine. 2014; 5(4):439–446.

Reason for exclusion: Ineligible type of intervention.

Asemi Z, Samimi M, Tabassi Z, Sabihi S-s, Esmaillzadeh A. A randomized controlled clinical trial investigating the effect of DASH diet on insulin resistance, inflammation, and oxidative stress in gestational diabetes. Nutrition. 2013;29(4):619–24.

Reason for exclusion: Ineligible outcomes reported.

Barakar R, Pelaez M, Lopez C, Cordero Y, Perales M, Lucia A, et al. Exercise-based intervention to prevent excessive gestational weight gain: A randomized controlled trial. Ann Nutr Metab. 2013; 63:723–724.

Reason for exclusion: Ineligible study type/design.

Barengo NC, Tuomilehto J. Increasing challenge of primary and secondary prevention of gestational diabetes mellitus. Primary Care Diabetes. 2012;6(4):251–2.

Reason for exclusion: Ineligible study type/design.

Berks D, Hoedjes M, Franx A, Duvekot HJ, Raat H, Steegers EA. Lifestyle intervention after complicated pregnancy successfully improves cardiovascular and metabolic health: Results of the pro-active study. Pregnancy hypertension. 2012; 2(3):192–193.

Reason for exclusion: Ineligible study type/design.

Berks D, Hoedjes M, Franx A, Habbema D, Raat H, Duvekot H, et al. Postpartum lifestyle intervention after complicated pregnancy proves feasible. Pregnancy Hypertension. 2010;1:S25.

Reason for exclusion: Ineligible study type/design.

Berks D, Hoedjes M, Raat H, Duvekot HJ, Steegers EAP. Effects of lifestyle intervention after complicated pregnancy: Results of the Pro-Active study. Pregnancy Hypertension. 2015;5 (1):36–7.

Reason for exclusion: Ineligible study type/design.

Berry DC, Neal M, Hall EG, Schwartz TA, Verbiest S, Bonuck K, et al. Rationale, design, and methodology for the optimizing outcomes in women with gestational diabetes mellitus and their infants study. BMC pregnancy and childbirth. 2013; 13.

Reason for exclusion: Ineligible study type/design.

Bertz F, Brekke H, Ellegard L, Wennergren M, Rasmussen KM, Winkvist A. Dietary restriction or dietary restriction and exercise, but not exercise intervention alone, reduces weight and fat mass in overweight and obese women postpartum. FASEB Journal. 2010; 24.

Reason for exclusion: Ineligible study type/design.

Bertz F, Winkvist A, Brekke HK. Sustainable Weight Loss among Overweight and Obese Lactating Women Is Achieved with an Energy-Reduced Diet in Line with Dietary Recommendations: Results from the LEVA Randomized Controlled Trial. J Acad Nutr Diet. 2015;115(1):78–86.

Reason for exclusion: Ineligible outcomes reported.

Bish CL, Chu SY, Shapiro-Mendoza CK, Sharma AJ, Blanck HM. Trying to lose or maintain weight during pregnancy-United States, 2003. Matern Child Health J. 2009;13(2):286–92.

Reason for exclusion: Ineligible study type/design.

Bo S, Rosato R, Ciccone G, Canil S, Gambino R, Poala CB, et al. Simple lifestyle recommendations and the outcomes of gestational diabetes. A 2 × 2 factorial randomized trial. Diabetes Obes Metab. 2014; 16(10):1032–1035.

Reason for exclusion: Ineligible type of intervention.

Bogaerts A, Devlieger R, Nuyts E, Witters I, Bergh B. Effect of psycho-education in obese pregnant women on pregnancy outcomes, randomized controlled trial. Reproductive sciences. 2012; 19(3 suppl. 1:114.

Reason for exclusion: Ineligible study type/design.

Bogaerts A, Devlieger R, Nuyts E, Witters I, Gyselaers W, Guelinckx I, et al. Psycho-education reduces gestational weight gain in obese pregnant women: Randomized controlled trial. Obesity Facts. 2012;5:53.

Reason for exclusion: Ineligible study type/design.

Brazeau AS, Leong A, Meltzer SJ, Cruz R, DaCosta D, Hendrickson-Nelson M, et al. Group-based activities with on-site childcare and online support improve glucose tolerance in women within 5 years of gestational diabetes pregnancy. Cardiovasc. 2014:104.

Reason for exclusion: Ineligible participants.

Brekke HK, Bertz F, Rasmussen KM, Bosaeus I, Ellegard L, Win kvist A. Dietary behavior modification, with or without exercise, improves risk factors for CVD over one year in overweight and obese lactating women. Faseb J. 2013; 27.

Reason for exclusion: Ineligible study type/design.

Briley AL, Barr S, Badger S, Bell R, Croker H, Godfrey KM, et al. A complex intervention to improve pregnancy outcome in obese women; the UPBEAT randomised controlled trial. BMC pregnancy and childbirth. 2014; 14(1).

Reason for exclusion: Ineligible study type/design.

Briley C, Flanagan NL, Lewis N. In-home prenatal nutrition intervention increased dietary iron intakes and reduced low birthweight in low-income African-American women. J Am Diet Assoc. 2002;102(7):984–7.

Reason for exclusion: Ineligible type of intervention.

Buchanan TA, Kjos SL, Montoro MN, Wu PY, Madrilejo NG, Gonzalez M, et al. Use of fetal ultrasound to select metabolic therapy for pregnancies complicated by mild gestational diabetes. Diabetes Care. 1994; 17(4):275–283.

Reason for exclusion: Ineligible type of intervention.

Buul BJ, Steegers EA, Jongsma HW, Rijpkema AL, Eskes TK, Thomas CM, et al. Dietary sodium restriction in the prophylaxis of hypertensive disorders of pregnancy: effects on the intake of other nutrients. Am J Clin Nutr. 1995; 62(1):49–57.

Reason for exclusion: Ineligible type of intervention.

Buul BJA, Steegers EAP, Maten GD, Delemarre FMC, Jongsma HW, Oosterbaan HP. Dietary sodium restriction does not prevent gestational hypertension: a dutch two-center randomized trial. Hypertens. 1997; 16(3):335–346.

Reason for exclusion: Ineligible type of intervention.

Caan B, Horgen DM, Margen S, King JC, Jewell NP. Benefits associated with WIC supplemental feeding during the interpregnancy interval. Am J Clin Nutr. 1987;45(1):29–41.

Reason for exclusion: Ineligible type of intervention.

Casey B. Effect of treatment of mild gestational diabetes on longterm maternal outcomes. American Journal of Obstetrics and Gynecology. 2015;1):S3.

Reason for exclusion: Ineligible study type/design.

Catalano P, Haghiac M, Smith S, Dettlebach S, Gunzler D, Groh-Wargo S, et al. OMEGA -3 poly-unsaturated fatty acid supplementation in overweight and obese women: a pilot RCT to improve inflammation, insulin sensitivity and decrease fetal adiposity. American journal of obstetrics and gynecology. 2014; 210(1 suppl. 1):S43.

Reason for exclusion: Ineligible study type/design.

Changamire FT, Mwiru RS, Peterson KE, Msamanga GI, Spiegelman D, Petraro P, et al. Effect of multivitamin supplements on weight gain during pregnancy among HIV-negative women in Tanzania. Maternal and Child Nutrition. 2015;11(3):297–304.

Reason for exclusion: Ineligible outcomes reported.

Chasan-Taber L, Marcus BH, Rosal MC, Tucker KL, Hartman SJ, Pekow P, et al. Estudio Parto: Postpartum diabetes prevention program for hispanic women with abnormal glucose tolerance in pregnancy: A randomised controlled trial - study protocol. BMC Pregnancy and Childbirth. 2014; 14(1).

Reason for exclusion: Ineligible study type/design.

Chasan-Taber L, Marcus BH, Rosal MC, Tucker KL, Hartman SJ, Pekow P, et al. Proyecto Mama: a lifestyle intervention in overweight and obese Hispanic women: a randomised controlled trial--study protocol. BMC Pregnancy Childbirth. 2015;15:157.

Reason for exclusion: Ineligible study type/design.

Clapp IJF. Diet, exercise, and fete-placental growth. Archives of gynecology and obstetrics. 1997; 260(1–4):101–108.

Reason for exclusion: Ineligible study type/design.

Colleran HL, Sorvillo A, Cooney P, Wideman L, Lovelady CA. Effects of energy restriction and exercise on bone mineral density and hormones in overweight lactating women. Faseb J. 2011; 25.

Reason for exclusion: Ineligible study type/design.

Cramp CS, Moran LJ, Deussen AR, Yelland LN, Dodd JM. Evaluation of printed nutrition education material in overweight and obese women during pregnancy-findings from the limit randomised trial. Journal of Paediatrics and Child Health. 2013;49:118.

Reason for exclusion: Ineligible study type/design.

Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005; 352(24):2477–2486.

Reason for exclusion: Ineligible type of intervention.

Czech-Kowalska J, Latka-Grot J, Bulsiewicz D, Jaworski M, Pludowski P, Wygledowska G, et al. Impact of vitamin D supplementation during lactation on vitamin D status and body composition of mother-infant pairs: a MAVID randomized controlled trial. PLoS ONE. 2014;9(9):e107708.

Reason for exclusion: Ineligible type of intervention.

Davenport BH. Target Weight Program of Pregnancy for Improved Prenatal Care. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing. 2011;40:S101-S.

Reason for exclusion: Ineligible study type/design.

Demment MM, Graham ML, Olson CM. How an online intervention to prevent excessive gestational weight gain is used and by whom: a randomized controlled process evaluation. J Med Internet Res. 2014;16(8):e194-e.

Reason for exclusion: Ineligible type of intervention.

deRosset L, Berry DC, Sanchez-Lugo L, Ritter K, Purdum C, Santolim V, et al. Mama Sana... Usted Sana: Lessons learned from a postpartum weight loss intervention for Hispanic women with infants six months or less. Hispanic Health Care International. 2013;11(2):78–86.

Reason for exclusion: Ineligible type of intervention.

Dewey KG. Effects of maternal caloric restriction and exercise during lactation. J Nutr. 1998;128(2 SUPPL.):386S–9S.

Reason for exclusion: Ineligible study type/design.

Dewey KG, Lovelady CA, Nommsen-Rivers LA, McCrory MA, Lönnerdal B. A randomized study of the effects of aerobic exercise by lactating women on breast-milk volume and composition. N Engl J Med. 1994; 330(7):449–453.

Reason for exclusion: Ineligible study type/design.

Dharkar-Surber S, Fortmann A, Euyoque J, Ruiz M, Hernandez M, Araujo R, et al. Results of peer-led DM prevention program for high risk latino women with gestational diabetes (GDM). Diabetes. 2012;61:A196.

Reason for exclusion: Ineligible study type/design.

Dodd JM. Dietary and Lifestyle Advice for Pregnant Women Who Are Overweight or Obese: The LIMIT Randomized Trial. Ann Nutr Metab. 2014;64(3/4):197–202.

Reason for exclusion: Ineligible study type/design.

Dodd JM. Pregnancy: Managing obesity during pregnancy - What are the options? Nature Reviews Endocrinology. 2015;11(12):691–2.

Reason for exclusion: Ineligible study type/design.

Dodd JM, Cramp C, Sui Z, Yelland LN, Deussen AR, Grivell RM, et al. The effects of antenatal dietary and lifestyle advice for women who are overweight or obese on maternal diet and physical activity: The LIMIT randomised trial. BMC Med. 2014;12(1).

Reason for exclusion: Ineligible study type/design.

Dodd JM, Deussen AR, Mohamad I, Rifas-Shiman SL, Yelland LN, Louise J, et al. The effect of antenatal lifestyle advice for women who are overweight or obese on secondary measures of neonatal body composition: The LIMIT randomised trial. BJOG: An International Journal of Obstetrics and Gynaecology. 2016;123(2):244–53.

Reason for exclusion: Ineligible outcomes reported.

Dodd JM, Grivell RM, Owens JA. Antenatal Dietary and Lifestyle Interventions for Women Who are Overweight or Obese: Outcomes from the LIMIT Randomized Trial. Current Nutrition Reports. 2014; 3(4):392–399.

Reason for exclusion: Ineligible study type/design.

Dodd JM, O’Brien CM, Grivell RM. Modifying diet and physical activity to support pregnant women who are overweight or obese. Current Opinion in Clinical Nutrition and Metabolic Care. 2015;18(3):318–23.

Reason for exclusion: Ineligible study type/design.

Dodd JM, Turnbull DA, McPhee AJ, Wittert G, Crowther CA, Robinson JS. Limiting weight gain in overweight and obese women during pregnancy to improve health outcomes: the LIMIT randomised controlled trial. BMC pregnancy and childbirth. 2011;11:79.

Reason for exclusion: Ineligible study type/design.

Dror DK, Allen LH. Interventions with vitamins B6, B12 and C in pregnancy (Provisional abstract). Paediatr Perinat Epidemiol. 2012; 26(Supplement 1):55–74.

Reason for exclusion: Ineligible study type/design.

Eames AJ, Grivell RM, Dodd JM, Deussen A. The effect of limited gestational weight gain in overweight and obese women on maternal and infant outcomes. Journal of Paediatrics and Child Health. 2013;49:19.

Reason for exclusion: Ineligible study type/design.

Ehrlich SF, Hedderson MM, Feng J, Crites Y, Quesenberry CP, Ferrara A. Lifestyle intervention improves postpartum fasting glucose levels in women with gestational diabetes. Diabetes. 2014; 63:A95.

Reason for exclusion: Ineligible study type/design.

Ehrlich SF, Hedderson MM, Quesenberry CP, Feng J, Brown SD, Crites Y, et al. Post-partum weight loss and glucose metabolism in women with gestational diabetes: the DEBI Study. Diabetic medicine: a journal of the British Diabetic Association. 2014; 31(7):[862–867].

Reason for exclusion: Ineligible study type/design.

Falciglia G, Piazza J, Ritcher E, Reinerman C, Lee SY. Nutrition education for postpartum women: a pilot study. J. 2014;5(4):275–8.

Reason for exclusion: Ineligible outcomes reported.

Fallah F, Pourabbas A, Delpisheh A, Veisani Y, Shadnoush M. Effects of nutrition education on levels of nutritional awareness of pregnant women in Western iran. Int J Endocrinol Metab. 2013;11(3):175–8.

Reason for exclusion: Ineligible study type/design.

Fälth-Magnusson K, Oman H, Kjellman NI. Maternal abstention from cow milk and egg in allergy risk pregnancies. Effect on antibody production in the mother and the newborn. Allergy. 1987; 42(1):64–73.

Reason for exclusion: Ineligible type of intervention.

Ferrara A, Ehrlich SF, Feng J, Quesenberry CP, Moore SD, Hedderson MM. Postpartum weight loss is associated with improved glucose and insulin homeostasis in women with a history of gestational diabetes (GDM). Diabetes. 2012; 61:A339.

Reason for exclusion: Ineligible study type/design.

Ferrara A, Hedderson MM, Albright CL, Brown SD, Ehrlich SF, Caan BJ, et al. A pragmatic cluster randomized clinical trial of diabetes prevention strategies for women with gestational diabetes: design and rationale of the Gestational Diabetes’ Effects on Moms (GEM) study. BMC Pregnancy Childbirth. 2014;14(1):21.

Reason for exclusion: Ineligible study type/design.

Flynn A, Kader S, Poston L, Goff LM. Improvements in diet quality in the UK Pregnancies Better Eating and Activity Trial (UPBEAT): A lifestyle intervention to reduce gestational diabetes in obese pregnancy. Diabet Med. 2015;32:79.

Reason for exclusion: Ineligible study type/design.

Fraser A, Tilling K, Macdonald-Wallis C, Hughes R, Sattar N, Nelson SM, et al. Associations of gestational weight gain with maternal body mass index, waist circumference, and blood pressure measured 16 y after pregnancy: the Avon Longitudinal Study of Parents and Children (ALSPAC). Am J Clin Nutr. 2011;93(6):1285–92.

Reason for exclusion: Ineligible study type/design.

Fraser RB, Ford FA, Milner RDG. A controlled trial of a high dietary fibre intake in pregnancy- effects in plasma glucose and insulin levels. Diabetologia. 1983; 25(3):238–41.

Reason for exclusion: Ineligible outcomes reported.

Garg A, Kashyap S. Effect of counseling on nutritional status during pregnancy. Indian J Pediatr. 2006; 73(8):687–92.

Reason for exclusion: Ineligible type of intervention.

Garmendia ML, Corvalan C, Araya M, Casanello P, Kusanovic JP, Uauy R. Effectiveness of a normative nutrition intervention (diet, physical activity and breastfeeding) on maternal nutrition and offspring growth: the Chilean maternal and infant nutrition cohort study (CHiMINCs). BMC Pregnancy Childbirth. 2015;15:175.

Reason for exclusion: Ineligible study type/design.

Gillen LJ, Tapsell LC. Advice that includes food sources of unsaturated fat supports future risk management of gestational diabetes mellitus. J Am Diet Assoc. 2004;104(12):1863–7.

Reason for exclusion: Ineligible outcomes reported.

Gonai M, Nakadaira I, Kurasaki K, Hamano K. The effects of lactobacilli on glycemic control and the secretion of glucagon-like peptide-1 in Japanese gestational diabetes mellitus patients. Diabetes. 2014; 63:A333.

Reason for exclusion: Ineligible study type/design.

Gossage CP, Deyhim M, Yamini S, Douglass LW, Moser-Veillon PB. Carotenoid composition of human milk during the first month postpartum and the response to β-carotene supplementation. Am J Clin Nutr. 2002;76(1):193–7.

Reason for exclusion: Ineligible type of intervention.

Graham ML, Uesugi KH, Niederdeppe J, Gay GK, Olson CM. The theory, development, and implementation of an e-intervention to prevent excessive gestational weight gain: e-Moms Roc. Telemedicine and e-Health. 2014;20(12):1135–42.

Reason for exclusion: Ineligible outcomes reported.

Grant S, Wolever TMS, O’Connor DL, Josse RG. The effect of a low glycemic index diet on gestational hyperglycemia: A pilot trial. Faseb J. 2010; 24.

Reason for exclusion: Ineligible study type/design.

Grant SM, Wolever TM, O’Connor DL, Nisenbaum R, Josse RG. Effect of a low glycaemic index diet on blood glucose in women with gestational hyperglycaemia. Diabetes research and clinical practice. 2011; 91(1):15–22.

Reason for exclusion: Ineligible type of intervention.

Guelinckx I, Devlieger R, Vansant G. Pregnancies complicated by obesity: clinical approach and nutritional management. Verh K Acad Geneeskd Belg. 2010;72(5–6):253–76.

Reason for exclusion: Ineligible study type/design.

Hagberg LA, Brekke HK, Bertz F, Winkvist A. Cost-utility analysis of a randomized controlled weight loss trial among lactating overweight/obese women. BMC Public Health. 2014;14:38.

Reason for exclusion: Ineligible study type/design.

Hawkins M, Hosker M, Marcus BH, Rosal MC, Braun B, Stanek EJ, et al. A pregnancy lifestyle intervention to prevent gestational diabetes risk factors in overweight Hispanic women: A feasibility randomized controlled trial. Diabet Med. 2014;32(1):108–15.

Reason for exclusion: Ineligible type of intervention.

Hayes L, Bell R, Robson S, Poston L. Association between physical activity in obese pregnant women and pregnancy outcomes: The upbeat pilot study. Annals of Nutrition and Metabolism. 2014;64:239–46.

Reason for exclusion: Ineligible study type/design.

Hayes L, Kinnunen T, Robson S, McParlin C, Poston L, Bell R. Factors associated with level of physical activity in obese pregnant women participating in the upbeat pilot trial. Archives of Disease in Childhood: Fetal and Neonatal Edition. 2012; 97:A41.

Reason for exclusion: Ineligible study type/design.

Helland IB, Reseland JE, Saugstad OD, Drevon CA. Leptin levels in pregnant women and newborn infants: gender differences and reduction during the neonatal period. Pediatrics. 1998; 101(3):E12.

Reason for exclusion: Ineligible type of intervention.

Hernandez TL, Anderson MA, Vanpelt RE, Reece MS, Reynolds R, De La Houssaye B, et al. Women with gestational diabetes randomized to a low-carbohydrate/ higher fat diet demonstrate greater insulin resistance and infant adiposity. Diabetes. 2013;62:A18.

Reason for exclusion: Ineligible type of intervention.

Hernandez TL, Van Pelt RE, Anderson MA, Reece MS, Reynolds RM, de la Houssaye BA, et al. Women With Gestational Diabetes Mellitus Randomized to a Higher-Complex Carbohydrate/Low-Fat Diet Manifest Lower Adipose Tissue Insulin Resistance, Inflammation, Glucose, and Free Fatty Acids: A Pilot Study. Diabetes Care. 2016;39(1):39–42.

Reason for exclusion: Ineligible study type/design.

Hoppu U, Isolauri E, Koskinen P, Laitinen K. Maternal dietary counseling reduces total and LDL cholesterol postpartum. Nutrition. 2014;30(2):159–64.

Reason for exclusion: Ineligible type of intervention.

Horan MK, McGowan CA, Donnelly J, Gibney E, McAuliffe FM. Maternal diet and weight at 3 months partum following a pregnancy intervention with a low glycaemic index diet: Results from the ROLO randomised control trial. Archives of Disease in Childhood: Fetal and Neonatal Edition. 2014;99:A129-A30.

Reason for exclusion: Ineligible type of intervention.

Horan MK, McGowan CA, Doyle O, McAuliffe FM. Well-being in pregnancy: an examination of the effect of socioeconomic, dietary and lifestyle factors including impact of a low glycaemic index dietary intervention. Eur J Clin Nutr. 2014;68(1):19–24.

Reason for exclusion: Ineligible study type/design.

Horan MK, McGowan CA, Gibney ER, Donnelly JM, McAuliffe FM. Maternal diet and weight at 3 months postpartum following a pregnancy intervention with a low glycaemic index diet: Results from the ROLO randomised control trial. Nutrients. 2014; 6(7):2946–55.

Reason for exclusion: Ineligible study type/design.

Hu G, Tian H, Zhang F, Liu H, Zhang C, Zhang S, et al. Tianjin Gestational Diabetes Mellitus Prevention Program: Study design, methods, and 1-year interim report on the feasibility of lifestyle intervention program. Diabetes Res Clin Pract. 2012;98(3):508–17.

Reason for exclusion: Ineligible type of intervention.

Hu G, Tian H, Zhang F, Liu H, Zhang S, Liu G, et al. Tianjin gestational diabetes mellitus prevention program: Study design, methods, and 1-year interim report on the feasibility of lifestyle intervention program. Diabetes. 2012;61:A39.

Reason for exclusion: Ineligible study type/design.

Hui A, Back L, Ludwig S, Gardiner P, Sevenhuysen G, Dean H, et al. Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a randomized controlled trial. Obstet Gynecol Surv. 2012; 67(5):263–264.

Reason for exclusion: Ineligible study type/design.

Hui A, Back L, Ludwig S, Gardiner P, Sevenhuysen G, Dean H, et al. Exercise and dietary intervention increases physical activity, promotes healthy diet and reduces excessive gestational weight gain in pregnant women: A randomized controlled trial in Urban community. Diabetes. 2011; 60:A351.

Reason for exclusion: Ineligible study type/design.

Hui AL, Ludwig S, Gardiner P, Sevenhuysen G, Dean H, Sellers E, et al. Exercise and dietary intervention during pregnancy results in reduced excessive gestational weight gain 2010.

Reason for exclusion: Ineligible study type/design.

Hui AL, Ludwig SM, Gardiner P, Sevenhuysen G, Murray R, Morris M, et al. Community-based exercise and dietary intervention during pregnancy: a pilot study. Canadian Journal of Diabetes. 2006;30(2):169–75.

Reason for exclusion: Ineligible type of intervention.

Huseinovic E, Winkvist A, Bertz F, Brekke H. Dietary changes during a successful weight loss trial in postpartum women. Faseb J. 2014;1.

Reason for exclusion: Ineligible study type/design.

Huseinovic E, Winkvist A, Bertz F, Brekke HK. Changes in food choice during a successful weight loss trial in overweight and obese postpartum women. Obesity. 2014;22(12):2517–23.

Reason for exclusion: Ineligible outcomes reported.

Imhoff-Kunsch B, Martorell R. Nutrition interventions during pregnancy and maternal, newborn and child health outcomes. Paediatr Perinat Epidemiol. 2012;26(SUPPL. 1):1–3.

Reason for exclusion: Ineligible study type/design.

Infanti JJ, Dunne FP, O’Dea A, Gillespie P, Gibson I, Glynn LG, et al. An evaluation of Croi MyAction community lifestyle modification programme compared to standard care to reduce progression to diabetes/pre-diabetes in women with prior gestational diabetes mellitus (GDM): Study protocol for a randomised controlled trial. Trials. 2013; 14(1).

Reason for exclusion: Ineligible study type/design.

Inskip H, Baird J, Barker M, Briley AL, D’Angelo S, Grote V, et al. Influences on adherence to diet and physical activity recommendations in women and children: Insights from six european studies. Annals of Nutrition and Metabolism. 2014;64(3–4):332–9.

Reason for exclusion: Ineligible study type/design.

Jackson RA, Stotland NE, Caughey AB, Gerbert B. Improving diet and exercise in pregnancy with Video Doctor counseling: A randomized trial. Patient Education and Counseling. 2011;83(2):203–9.

Reason for exclusion: Ineligible type of intervention.

Jahan K, Roy SK, Israt S, Ferdouse K, Salam SB. Impact of nutrition education on pregnancy weight gain and birth outcome. Annals of Nutrition and Metabolism. 2013;63:756.

Reason for exclusion: Ineligible study type/design.

Jahan K, Roy SK, Mihrshahi S, Sultana N, Khatoon S, Roy H, et al. Short-term nutrition education reduces low birthweight and improves pregnancy outcomes among urban poor women in Bangladesh. Food and nutrition bulletin. 2014;35(4):414–21.

Reason for exclusion: Ineligible type of intervention.

Jelsma JGM, van Poppel MNM, Galjaard S, Desoye G, Corcoy R, Devlieger R, et al. DALI: Vitamin D and lifestyle intervention for gestational diabetes mellitus (GDM) prevention: An European multicentre, randomised trial - study protocol. BMC Pregnancy and Childbirth. 2013;13.

Reason for exclusion: Ineligible study type/design.

Jing W, Huang Y, Liu X, Luo B, Yang Y, Liao S. The effect of a personalized intervention on weight gain and physical activity among pregnant women in China. International Journal of Gynecology and Obstetrics. 2015;129(2):138–41.

Reason for exclusion: Ineligible type of intervention.

Kafatos AG, Tsitoura S, Pantelakis SN, Doxiadis SA. Maternal and infant health education in a rural Greek community. Hygie. 1991;10(1):32–7.

Reason for exclusion: Ineligible study type/design.

Kafatos AG, Vlachonikolis IG, Codrington CA. Nutrition during pregnancy: the effects of an educational intervention program in Greece. Am J Clin Nutr. 1989;50(5):970–9.

Reason for exclusion: Ineligible type of intervention.

Kajale N, Khadilkar A, Chiponkar S, Unni J, Mansukhani N. Effect of traditional food supplements on nutritional status of lactating mothers and growth of their infants. Nutrition. 2014;30(11–12):1360–5.

Reason for exclusion: Ineligible study type/design.

Kannieappan LM, Deussen AR, Moran LJ, Grivell RM, Yelland LN, Dodd JM. The effect of antenatal dietary advice on maternal body composition in women who are overweight or obese - findings from the limit randomised trial. Journal of paediatrics and child health. 2013; 49:94.

Reason for exclusion: Ineligible study type/design.

Kardjati S, Kusin JA, Schofield WM, With C. Energy supplementation in the last trimester of pregnancy in East Java, Indonesia: effect on maternal anthropometry. Am J Clin Nutr. 1990; 52(6):987–994.

Reason for exclusion: Ineligible type of intervention.

Kennedy-Oji C, Coutsoudis A, Kuhn L, Pillay K, Mburu A, Stein Z, et al. Effects of vitamin A supplementation during pregnancy and early lactation on body weight of South African HIV-infected women. Journal of health, population, and nutrition. 2001; 19(3):167–176.

Reason for exclusion: Ineligible participants.

Khoramabadi M, Dolatian M, Hajian S, Zamanian M, Taheripanah R, Sheikhan Z, et al. Effects of Education Based on Health Belief Model on Dietary Behaviors of Iranian Pregnant Women. Glob J Health Sci. 2015;8(2):46495.

Reason for exclusion: Ineligible outcomes reported.

Khoury J, Henriksen T, Christophersen B, Tonstad S. Effect of a cholesterol-lowering diet on maternal, cord, and neonatal lipids, and pregnancy outcome: a randomized clinical trial. Am J Obstet Gynecol. 2005;193(4):1292–301.

Reason for exclusion: Ineligible type of intervention.

Kieffer EC, Sinco B, Kim C. Health behaviors among women of reproductive age with and without a history of gestational diabetes mellitus. Diabetes Care. 2006;29(8):1788–93 6p.

Reason for exclusion: Ineligible study type/design.

Kim C, Draska M, Hess ML, Wilson EJ, Richardson CR. A web-based pedometer programme in women with a recent history of gestational diabetes. Diabet Med. 2012;29(2):278–83.

Reason for exclusion: Ineligible type of intervention.

Kinnunen T, Puhkala J, Raitanen J, Ahonen S, Aittasalo M, Virtanen S, et al. Effects of dietary counseling on dietary habits and nutrient intakes of finnish pregnant women at increased risk for gestational diabetes-a cluster-randomized controlled trial. Obesity facts. 2012; 5:28.

Reason for exclusion: Ineligible study type/design.

Kinnunen TI, Aittasalo M, Koponen P, Ojala K, Mansikkamäki K, Weiderpass E, et al. Feasibility of a controlled trial aiming to prevent excessive pregnancy-related weight gain in primary health care. BMC pregnancy and childbirth. 2008; 8:37.

Reason for exclusion: Ineligible outcomes reported.

Kinnunen TI, Pasanen M, Aittasalo M, Fogelholm M, Weiderpass E, Luoto R. Reducing postpartum weight retention - A pilot trial in primary health care. Nutr J. 2007;6.

Reason for exclusion: Ineligible study type/design.

Kinnunen TI, Puhkala J, Raitanen J, Ahonen S, Aittasalo M, Virtanen SM, et al. Effects of dietary counselling on food habits and dietary intake of Finnish pregnant women at increased risk for gestational diabetes - a secondary analysis of a cluster-randomized controlled trial. Matern Child Nutr. 2014;10(2):184–97.

Reason for exclusion: Ineligible outcomes reported.

Kizirian N, Garnett S, Brand-Miller J. Body composition in infants born to pregnant mothers at risk of gestational diabetes. Obesity Facts. 2013;6:187.

Reason for exclusion: Ineligible study type/design.

Kizirian N, Garnett S, Markovic T, Ross G, Louie J, Muirhead R, et al. Effects of a low-glycaemic index diet during pregnancy on offspring body composition: A pilot study. Obesity research & clinical practice. 2013; 7:e103.

Reason for exclusion: Ineligible study type/design.

Klebanoff M. Treatment of gestational diabetes (GDM), weight gain and perinatal outcome-marginal structural model (MSM) analysis. Am J Epidemiol. 2011; 173:S41.

Reason for exclusion: Ineligible study type/design.

Knight-Agarwal C, Davis DL, Williams L, Davey R, Cox R, Clarke A. Development and Pilot Testing of the Eating 4 two Mobile Phone App to Monitor Gestational Weight Gain. JMIR Mhealth Uhealth. 2015;3(2):e44.

Reason for exclusion: Ineligible study type/design.

Koivusalo SB, Rono K, Klemetti MM, Roine RP, Lindstrom J, Erkkola M, et al. Gestational Diabetes Mellitus Can Be Prevented by Lifestyle Intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL): A Randomized Controlled Trial. Diabetes Care. 2016;39(1):24–30.

Reason for exclusion: Ineligible type of intervention.

Korpi-Hyövälti E, Schwab U, Laaksonen DE, Linjama H, Heinonen S, Niskanen L. Effect of intensive counselling on the quality of dietary fats in pregnant women at high risk of gestational diabetes mellitus. Br J Nutr. 2012; 108(5):910–907.

Reason for exclusion: Ineligible type of intervention.

Krummel D, Semmens E, MacBride AM, Fisher B. Lessons learned from the mothers’ overweight management study in 4 West Virginia WIC offices. J Nutr Educ Behav. 2010;42(3 Suppl):S52–8.

Reason for exclusion: Ineligible study type/design.

Krummel DA, Semmens E, Boury J, Gordon PM, Larkin KT. Stages of change for weight management in postpartum women. J Am Diet Assoc. 2004; 104(7):1102–1108.

Reason for exclusion: Ineligible study type/design.

Laitinen K, Ilmonen J, Isolauri E. Dietary counselling and probiotic intervention during pregnancy modify postpartum adiposity. Ann Nutr Metab. 2011; 58:87.

Reason for exclusion: Ineligible study type/design.

Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009;361(14):1339–48.

Reason for exclusion: Ineligible type of intervention.

Lanou H, Huybregts L, Roberfroid D, Kolsteren P. Effect of prenatal lipid-based nutrient supplementation on gestational weight gain. Annals of Nutrition and Metabolism. 2013;63:783.

Reason for exclusion: Ineligible study type/design.

Lindholm ES, Norman M, Kilander CP, Altman D. Weight control program for obese pregnant women. Acta Obstet Gynecol Scand. 2010;89(6):840–3.

Reason for exclusion: Ineligible study type/design.

Lindsay K, Brennan L, Kennelly M, Curran S, Coffey M, Smith T, et al. Influence of maternal metabolic response to gestational diabetes treatment on neonatal outcomes. American Journal of Obstetrics and Gynecology. 2015;1):S247-S8.

Reason for exclusion: Ineligible study type/design.

Lindsay KL, Brennan L, Kennelly MA, Maguire OC, Smith T, Curran S, et al. Impact of probiotics in women with gestational diabetes mellitus on metabolic health: A randomized controlled trial. American Journal of Obstetrics and Gynecology. 2015;212(4):496.e1-.e11.

Reason for exclusion: Ineligible type of intervention.

Lipscombe L. In high-risk pregnant women, an individualized lifestyle intervention reduced gestational diabetes mellitus. Ann Intern Med. 2015;163(12):JC7.

Reason for exclusion: Ineligible study type/design.

Liu L, Mirza M, Thomas H. Effectiveness of interventions to prevent excessive weight gain during pregnancy (Provisional abstract). Database of Abstracts of Reviews of Effects. 2005; (2):35.

Reason for exclusion: Ineligible study type/design.

Lombard C, Deeks A, Jolley D, Teede HJ. Preventing weight gain: the baseline weight related behaviors and delivery of a randomized controlled intervention in community based women. BMC Public Health. 2009; 9:2.

Reason for exclusion: Ineligible participants.

Louie JC, Markovic TP, Perera N, Foote D, Petocz P, Ross GP, et al. A randomized controlled trial investigating the effects of a low-glycemic index diet on pregnancy outcomes in gestational diabetes mellitus. Diabetes Care. 2011;34(11):2341–6.

Reason for exclusion: Ineligible type of intervention.

Louie JCY, Markovic TP, Ross GP, Foote D, Brand-Miller JC. Effect of a low glycaemic index diet in gestational diabetes mellitus on post-natal outcomes after 3 months of birth: A pilot follow-up study. Maternal and Child Nutrition. 2015;11(3):409–14.

Reason for exclusion: Ineligible type of intervention.

Lovelady CA, Stephenson KG, Kuppler KM, Williams JP. The effects of dieting on food and nutrient intake of lactating women. J Am Diet Assoc. 2006; 106(6):908–912.

Reason for exclusion: Ineligible type of intervention.

Luerssen MA, Winsch AL. Diabetes under control: Identifying and treating gestational diabetes mellitus. American Journal of Nursing. 2005;105(4):65–72.

Reason for exclusion: Ineligible study type/design.

Luoto R, Kharazmi E, Saarinen NM, Smeds AI, Mäkelä S, Fallah M, et al. Effect of dietary intervention on serum lignan levels in pregnant women - a controlled trial. Reproductive Health. 2010;7:6p.

Reason for exclusion: Ineligible outcomes reported.

Luoto R, Kinnunen TI, Aittasalo M, Kolu P, Raitanen J, Ojala K, et al. Primary prevention of gestational diabetes mellitus and large-for-gestational-age newborns by lifestyle counseling: a cluster-randomized controlled trial. PLoS medicine. 2011; 8(5):e1001036.

Reason for exclusion: Ineligible type of intervention.

Luoto R, Laitinen K, Nermes M, Isolauri E. Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study. Br J Nutr. 2010; 103(12):1792–1799.

Reason for exclusion: Ineligible outcomes reported.

Luoto RM, Kinnunen TI, Aittasalo M, Ojala K, Mansikkamäki K, Toropainen E, et al. Prevention of gestational diabetes: design of a cluster-randomized controlled trial and one-year follow-up. BMC pregnancy and childbirth. 2010; 10:39.

Reason for exclusion: Ineligible study type/design.

Ly CT, Diallo A, Simondon F, Simondon KB. Early short-term infant food supplementation, maternal weight loss and duration of breast-feeding: a randomised controlled trial in rural Senegal. Eur J Clin Nutr. 2006;60(2):265–71.

Reason for exclusion: Ineligible type of intervention.

Ma WJ, Huang ZH, Huang BX, Qi BH, Zhang YJ, Xiao BX, et al. Intensive low-glycaemic-load dietary intervention for the management of glycaemia and serum lipids among women with gestational diabetes: a randomized control trial. Public Health Nutr. 2015;18(8):1506–13.

Reason for exclusion: Ineligible type of intervention.

Magee MS, Knopp RH, Benedetti TJ. Metabolic effects of 1200-kcal diet in obese pregnant women with gestational diabetes. Diabetes. 1990; 39(2):234–40.

Reason for exclusion: Ineligible type of intervention.

Mahomed K, Gülmezoglu AM. Vitamin D supplementation in pregnancy. Cochrane database of systematic reviews. 2011;2.

Reason for exclusion: Ineligible study type/design.

Maitland RA, Barr S, Briley A, Seed P, Poston L. Incidence of gestational diabetes in an obese population using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria in the UK Pregnancies Better Eating and Activity Trial (UPBEAT) pilot study. Diabet Med. 2012; 29:152.

Reason for exclusion: Ineligible study type/design.

Marcinkevage J, Correa A, Ramakrishnan U, Sharma A, Venkat Narayan KM, Umpierrez G. Reducing sedentary behavior and increasing physical activity during pregnancy: A feasibility study. Diabetes. 2012; 61:A344.

Reason for exclusion: Ineligible study type/design.

Marcinkevage J, Narayan KMV, Correa A, Hennink M, Ramakrishnan U, Sharma A, et al. Lifestyle intervention during early pregnancy improves glucose and insulin indices in women at risk for gestational diabetes. Diabetes. 2013; 62:A19-a20.

Reason for exclusion: Ineligible study type/design.

Mardones-Santander F, Rosso P, Stekel A, Ahumada E, Llaguno S, Pizarro F, et al. Effect of a milk-based food supplement on maternal nutritional status and fetal growth in underweight Chilean women. Am J Clin Nutr. 1988; 47(3):413–9.

Reason for exclusion: Ineligible type of intervention.

Markovic TP, Muirhead R, Overs S, Kizirian N, Louie J, Sweeting A, et al. Predictors of birthweight in women at high risk of gestational diabetes mellitus. Obesity research & clinical practice. 2013; 7:e3-e4.

Reason for exclusion: Ineligible study type/design.

Maten GD, Raaij JM, Visman L, Heijden LJ, Oosterbaan HP, Boer R, et al. Low-sodium diet in pregnancy: effects on blood pressure and maternal nutritional status. Br J Nutr. 1997; 77(5):703–20.

Reason for exclusion: Ineligible type of intervention.

Mathiesen ER, Ringholm L, Damm P. Pregnancy management of women with pregestational diabetes. Endocrinology and Metabolism Clinics of North America. 2011;40(4):727–38.

Reason for exclusion: Ineligible study type/design.

Maxwell JD, Ang L, Brooke OG, Brown IRF. Vitamin D supplements enhance weight gain and nutritional status in pregnant Asians. British Journal of Obstetrics and Gynaecology. 1981;88(10):987–91.

Reason for exclusion: Ineligible type of intervention.

McCrory MA. Does dieting during lactation put infant growth at risk? Nutr Rev. 2001; 59(1 Pt 1):18–21.

Reason for exclusion: Ineligible type of intervention.

McCrory MA, Nommsen-Rivers LA, Mole PA, Lonnderdal B, Dewey KG. Randomized trial of the short-term effects of dieting compared with dieting plus aerobic exercise on lactation performance. Am J Clin Nutr. 1999;69(5):959–67.

Reason for exclusion: Ineligible type of intervention.

McGowan CA, Walsh JM, Byrne J, Curran S, McAuliffe FM. The influence of a low glycemic index dietary intervention on maternal dietary intake, glycemic index and gestational weight gain during pregnancy: A randomized controlled trial. Nutr J. 2013;12(1).

Reason for exclusion: Ineligible study type/design.

McIntyre DH, Oats JJN. Gestational diabetes needs to be managed. Med J Aust. 2013;198(2):78–9.

Reason for exclusion: Ineligible study type/design.

Metcoff J, Costiloe P, Crosby WM, Dutta S, Sandstead HH, Milne D, et al. Effect of food supplementation (WIC) during pregnancy on birth weight. Am J Clin Nutr. 1985; 41(5):933–47.

Reason for exclusion: Ineligible type of intervention.

Monteiro S, Jancey J, Howat P, Dhaliwal S. Impact of the REFRESH randomised controlled trial on the physical activity behaviours of mothers with young children. Journal of science and medicine in sport. 2012; 15:S342.

Reason for exclusion: Ineligible study type/design.

Moran LJ, Tsagareli V, Noakes M, Norman R. Altered Preconception Fatty Acid Intake Is Associated with Improved Pregnancy Rates in Overweight and Obese Women Undertaking in Vitro Fertilisation. Nutrients. 2016;8(1).

Reason for exclusion: Ineligible participants.

Moreno-Castilla C, Hernandez M, Bergua M, Alvarez MC, Arce MA, Rodriguez K, et al. Low-carbohydrate diet for the treatment of gestational diabetes mellitus: a randomized controlled trial. Diabetes Care. 2013; 36(8)

Reason for exclusion: Ineligible type of intervention.

Moses RG, Casey S, Cleary J, Milosavljevic M, Quinn E, Tapsell L, et al. Effect of low glycaemic index dietary advice in normal pregnancy: The PREGGIO study. Obesity research & clinical practice. 2013; 7:e34-e5.

Reason for exclusion: Ineligible study type/design.

Much D, Brunner S, Vollhardt C, Schmid D, Sedlmeier EM, Brüderl M, et al. Breast milk fatty acid profile in relation to infant growth and body composition: Results from the INFAT study. Pediatr Res. 2013;74(2):230–7.

Reason for exclusion: Ineligible type of intervention.

Mujsindi W, Habash D, Childs G. Impact of nutrition education on gestational weight gain in obese pregnant women. American journal of obstetrics and gynecology. 2014; 210(1 suppl. 1):S188.

Reason for exclusion: Ineligible study type/design.

Mumtaz Z, Shahab S, Butt N, Rab MA, DeMuynck A. Daily iron supplementation is more effective than twice weekly iron supplementation in pregnant women in Pakistan in a randomized double-blind clinical trial. J Nutr. 2000;130(11):2697–702.

Reason for exclusion: Ineligible type of intervention.

Mustila T, Keskinen P, Luoto R. Behavioral counseling to prevent childhood obesity - study protocol of a pragmatic trial in maternity and child health care. BMC Pediatr. 2012;12.

Reason for exclusion: Ineligible study type/design.

Nagle C, Skouteris H, Hotchin A, Bruce L, Patterson D, Teale G. Continuity of midwifery care and gestational weight gain in obese women: a randomised controlled trial. BMC Public Health. 2011; 11:174.

Reason for exclusion: Ineligible study type/design.

Nagle C, Skouteris H, Morris H, Nankervis A, Rasmussen B, Mayall P, et al. Primary prevention of gestational diabetes for women who are overweight and obese: A randomised controlled trial. BMC pregnancy and childbirth. 2013; 13.

Reason for exclusion: Ineligible study type/design.

Nascimento SL, Surita FGC, Parpinelli MA, Cecatti JG. Physical exercise, weight gain, and perinatal outcomes in overweight and obese pregnant women: A systematic review of clinical trials. Cadernos de Saude Publica. 2011;27(3):407–16.

Reason for exclusion: Ineligible study type/design.

Newman AK, Deussen AR, Moran LJ, Grivell RM, Yelland LN, Turnbull D. The effect of antenatal dietary and lifestyle advice on maternal psychological health in women who are overweight or obese-findings from the limit randomised trial. Journal of Paediatrics and Child Health [abstracts of the 17th Congress of the Perinatal Society of Australia and New Zealand, PSANZ 2013; Apr 14–17; Adelaide, SA Australia]. 2013; 49:119.

Reason for exclusion: Ineligible study type/design.

Ney D, Hollingsworth DR, Cousins L. Decreased insulin requirement and improved control of diabetes in pregnant women given a high-carbohydrate, high-fiber, low-fat diet. Diabetes Care. 1982; 5(5):529–33.

Reason for exclusion: Ineligible type of intervention.

Nicklas JM, Miller LJ, Zera CA, Davis RB, Levkoff SE, Seely EW. Factors associated with depressive symptoms in the early postpartum period among women with recent gestational diabetes mellitus. Maternal and Child Health Journal. 2013;17(9):1665–72.

Reason for exclusion: Ineligible type of intervention.

O’Brien CM, Grivell RM, Dodd JM. Systematic review of antenatal dietary and lifestyle interventions in women with a normal body mass index. Acta Obstetricia et Gynecologica Scandinavica. 2016;95(3):259–69.

Reason for exclusion: Ineligible study type/design.

O’Dea A, Tierney M, McGuire B, Newell JN, Glynn L, Gibson I, et al. An evaluation of Croi MyAction community lifestyle modification programme compared to standard care to reduce progression to diabetes/prediabetes in women with prior gestational diabetes mellitus (GDM). Irish Journal of Medical Science. 2014;1:S461.

Reason for exclusion: Ineligible study type/design.

Osmundson S, Norton M, El-Sayed Y, Faig J, Carter S, Kitzmiller J. Early treatment of women with prediabetes in pregnancy: A randomized controlled trial. AJOG. 2015; 212(1 suppl. 1):S23.

Reason for exclusion: Ineligible study type/design.

Ostbye T, Krause KM, Brouwer RJ, Lovelady CA, Morey MC, Bastian LA, et al. Active Mothers Postpartum (AMP): Rationale, design, and baseline characteristics. J Womens Health (Larchmt). 2008;17(10):1567–75.

Reason for exclusion: Ineligible study type/design.

Ostbye T, Zucker NL, Krause KM, Lovelady CA, Evenson KR, Peterson BL, et al. Kids and Adults Now! Defeat Obesity (KAN-DO): Rationale, design and baseline characteristics. Contemp Clin Trials. 2011;32(3):461–9.

Reason for exclusion: Ineligible study type/design.

Ouladsahebmadarek E, Sayyah-Melli M, Taghavi S, Abbasalizadeh S, Seyedhejazie M. The effect of supplemental iron elimination on pregnancy outcome. Pak J Med Sci. 2011; 27(3):641–5.

Reason for exclusion: Ineligible type of intervention.

Park HW, Lee NM, Kim JH, Kim KS, Kim SN. Parenteral fish oil-containing lipid emulsions may reverse parenteral nutrition-associated cholestasis in neonates: A systematic review and meta-analysis. J Nutr. 2015;145(2):277–83.

Reason for exclusion: Ineligible study type/design.

Paul KH, Olson CM. Moving beyond quantity of participation in process evaluation of an intervention to prevent excessive pregnancy weight gain. Int. 2013;10:23.

Reason for exclusion: Ineligible type of intervention.

Pellonpera O, Ronnemaa T, Ekblad U, Vahlberg T, Tertti K. The effects of metformin treatment of gestational diabetes on maternal weight and glucose tolerance postpartum - a prospective follow-up study. Acta Obstet Gynecol Scand. 2016;95(1):79–87.

Reason for exclusion: Ineligible study type/design.

Perez-Ferre N, Del Valle L, Torrejon MJ, Barca I, Calvo MI, Matia P, et al. Diabetes mellitus and abnormal glucose tolerance development after gestational diabetes: A three-year, prospective, randomized, clinical-based, Mediterranean lifestyle interventional study with parallel groups. Clin Nutr. 2015;34(4):579–85.

Reason for exclusion: Ineligible type of intervention.

Perichart-Perera O, Balas-Nakash M, Parra-Covarrubias A, Rodriguez-Cano A, Ramirez-Torres A, Ortega-Gonzalez C, et al. A medical nutrition therapy program improves perinatal outcomes in Mexican pregnant women with gestational diabetes and type 2 diabetes mellitus. Diabetes Educ. 2009;35(6):1004–13.

Reason for exclusion: Ineligible type of intervention.

Perichart-Perera O, Balas-Nakash M, Rodriguez-Cano A, Legorreta-Legorreta J, Parra-Covarrubias A, Vadillo-Ortega F. Low glycemic index carbohydrates versus all types of carbohydrates for treating diabetes in pregnancy: A randomized clinical trial to evaluate the effect of glycemic control. International journal of endocrinology. 2012.

Reason for exclusion: Ineligible study type/design.

Peterson CM, Jovanovic-Peterson L. Randomized crossover study of 40% vs. 55% carbohydrate weight loss strategies in women with previous gestational diabetes mellitus and non-diabetic women of 130–200% ideal body weight. J Am Coll Nutr. 1995; 14(4):369–75.

Reason for exclusion: Ineligible participants.

Petrella E, Facchinetti F, Bertarini V, Pignatti L, Neri I, Battistini NC. Occurrence of pregnancy complications in women with BMI >25 submitted to a healthy lifestyle and eating habits program. American journal of obstetrics and gynecology. 2013; 208(1 suppl.1):S33-S34.

Reason for exclusion: Ineligible study type/design.

Phelan S, Brannen A, Erickson K, Diamond M, Schaffner A, Muñoz-Christian K, et al. “Fit Moms/Mamás Activas” internet-based weight control program with group support to reduce postpartum weight retention in low-income women: Study protocol for a randomized controlled trial. Trials. 2015;16(1).

Reason for exclusion: Ineligible study type/design.

Phelan S, Phipps MG, Abrams B, Darroch F, Schaffner A, Wing RR. Factors associated with success in the “fit for delivery” intervention to reduce excessive gestational weight gain. Obesity (Silver Spring, Md). 2011; 19:S95.

Reason for exclusion: Ineligible study type/design.

Phelan S, Phipps MG, Abrams B, Darroch F, Schafner A, Wing RR. Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: The fit for delivery study. Obesity (Silver Spring). 2010;18:S68.

Reason for exclusion: Ineligible study type/design.

Poppel M, Oostdam N, Wouters M, Eekhoff M, Mechelen W. FitFor2: Effects of an exercise training program on the incidence of gestational diabetes. Journal of science and medicine in sport. 2012; 15:S342-S343.

Reason for exclusion: Ineligible study type/design.

Poppel MN, Oostdam N, Wouters MG, Eekhoff MM, Mechelen W. A training program for women at risk for gestational diabetes. Diabetes. 2011; 60:A636.

Reason for exclusion: Ineligible study type/design.

Poston L, Bell R, Croker H, Flynn AC, Godfrey KM, Goff L, et al. Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): A multicentre, randomised controlled trial. The Lancet Diabetes and Endocrinology. 2015;3(10):767–77.

Reason for exclusion: Ineligible type of intervention.

Poston L, Briley AL, Barr S, Bell R, Croker H, Coxon K, et al. Developing a complex intervention for diet and activity behaviour change in obese pregnant women (the UPBEAT trial); assessment of behavioural change and process evaluation in a pilot randomised controlled trial. BMC Pregnancy Childbirth. 2013;13:148.

Reason for exclusion: Ineligible outcomes reported.

Poston L, Holmes B, Kinnunen T, Croker H, Bell R, Sanders T, et al. A complex intervention to improve outcome in obese pregnancies; the upbeat study. Archives of Disease in Childhood: Fetal and Neonatal Edition. 2011;96:Fa97.

Reason for exclusion: Ineligible study type/design.

Quinlivan JA. Dietary component of lifestyle interventions helps obese pregnant women. Evidence-Based Medicine. 2013;18(1):e4.

Reason for exclusion: Ineligible study type/design.

Quinlivan JA, Lam LT, Fisher J. A randomised trial of a four-step multidisciplinary approach to the antenatal care of obese pregnant women. Aust N Z J Obstet Gynaecol. 2011; 51(2):141–6.

Reason for exclusion: Ineligible type of intervention.

Ramakrishnan U, González-Cossío T, Neufeld LM, Rivera J, Martorell R. Effect of prenatal multiple micronutrient supplements on maternal weight and skinfold changes: a randomized double-blind clinical trial in Mexico. Food and nutrition bulletin. 2005; 26(3):273–80.

Reason for exclusion: Ineligible type of intervention.

Rauh K, Kunath J, Rosenfeld E, Kick L, Ulm K, Hauner H. Healthy living in pregnancy: A cluster-randomized controlled trial to prevent excessive gestational weight gain - rationale and design of the GeliS study. BMC pregnancy and childbirth. 2014; 14(1).

Reason for exclusion: Ineligible study type/design.

Rawdin AC, Duenas A, Chilcott JB. The cost-effectiveness of weight management programmes in a postnatal population. Public Health. 2014;128(9):804–10.

Reason for exclusion: Ineligible study type/design.

Reader D, Splett P, Gunderson EP. Impact of gestational diabetes mellitus nutrition practice guidelines implemented by registered dietitians on pregnancy outcomes. J Am Diet Assoc. 2006; 106(9):1426–33.

Reason for exclusion: Ineligible type of intervention.

Reinhardt JA, Van Der Ploeg HP, Grzegrzulka R, Timperley JG. Implementing lifestyle change through phone-based motivational interviewing in rural-based women with previous gestational diabetes mellitus. Health Promot J Aust. 2012;23(1):5–9.

Reason for exclusion: Ineligible type of intervention.

Renzo GC, Brillo E, Romanelli M, Porcaro G, Capanna F, Kanninen TT, et al. Potential effects of chocolate on human pregnancy: a randomized controlled trial. The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 2012; 25(10):1860–7.

Reason for exclusion: Ineligible type of intervention.

Rhodes ET, Pawlak DB, Takoudes TC, Ebbeling CB, Feldman HA, Lovesky MM, et al. Effects of a low-glycemic load diet in overweight and obese pregnant women: a pilot randomized controlled trial. Am J Clin Nutr. 2010;92(6):1306–15.

Reason for exclusion: Ineligible type of intervention.

Rönö K, Stach-Lempinen B, Klemetti MM, Kaaja RJ, Pöyhönen-Alho M, Eriksson JG, et al. Prevention of gestational diabetes through lifestyle intervention: study design and methods of a Finnish randomized controlled multicenter trial (RADIEL). BMC Pregnancy Childbirth. 2014;14(1):70.

Reason for exclusion: Ineligible study type/design.

Ross SM, Nel E, Naeye RL. Differing effects of low and high bulk maternal dietary supplements during pregnancy. Early Hum Dev. 1985; 10(3–4):295–302.

Reason for exclusion: Ineligible type of intervention.

Rotheram-Borus MJ, Tomlinson M, Le Roux IM, Harwood JM, Comulada S, O’Connor MJ, et al. A cluster randomised controlled effectiveness trial evaluating perinatal home visiting among South African mothers/infants. PLoS ONE. 2014;9(10).

Reason for exclusion: Ineligible type of intervention.

Ruchat SM, Davenport MH, Giroux I, Hillier M, Batada A, Sopper MM, et al. Walking Program of Low or Vigorous Intensity During Pregnancy Confers an Aerobic Benefit. Int J Sports Med. 2012;33(8):661–6.

Reason for exclusion: Ineligible type of intervention.

Ruchat S-M, Davenport MH, Giroux I, Hillier M, Betada A, Sopper MM, et al. Nutrition and Exercise Reduce Excessive Weight Gain in Normal-Weight Pregnant Women. Med Sci Sports Exerc. 2012;44(8):1419–26.

Reason for exclusion: Ineligible type of intervention.

Sagedal LR, Øverby NC, Lohne-Seiler H, Bere E, Torstveit MK, Henriksen T, et al. Study protocol: fit for delivery - can a lifestyle intervention in pregnancy result in measurable health benefits for mothers and newborns? A randomized controlled trial. BMC Public Health. 2013; 13:132.

Reason for exclusion: Ineligible study type/design.

Schneeberger C, Flynn A, Barr S, Seed PT, Inskip HM, Poston L. Maternal diet patterns and glycaemic load in obese pregnant women taking part in a pilot trial of a lifestyle intervention (the upbeat trial). Diabetes. 2014;63:A342.

Reason for exclusion: Ineligible study type/design.

Shivalli S, Srivastava RK, Singh GP. Trials of Improved Practices (TIPs) to Enhance the Dietary and Iron-Folate Intake during Pregnancy- A Quasi Experimental Study among Rural Pregnant Women of Varanasi, India. PLoS ONE. 2015;10(9):e0137735.

Reason for exclusion: Ineligible study type/design.

Shyam S, Arshad F, Abdul Ghani R, Abdul Wahab N, Barakatun Nisak M, Safii N, et al. Women with previous gestational diabetes mellitus achieve clinically significant weight loss on low glycaemic index diets. Obes Rev. 2014; 15:92.

Reason for exclusion: Ineligible study type/design.

Silvani G, Albonetti A, Acquati S, Zanasi P, Inostroza Velozo HN. How to improve worse pregnancy outcomes in immigrant pregnant women such as in comparable Italian ones by insulin treatment and/or education. Diabetologia. 2015;1):S485-S6.

Reason for exclusion: Ineligible study type/design.

Simmons D, Jelsma JG, Galjaard S, Devlieger R, van Assche A, Jans G, et al. Results From a European Multicenter Randomized Trial of Physical Activity and/or Healthy Eating to Reduce the Risk of Gestational Diabetes Mellitus: The DALI Lifestyle Pilot. Diabetes Care. 2015;38(9):1650–6.

Reason for exclusion: Ineligible study type/design.

Simmons D, Van Poppel M, Corcoy R, Devlieger R, Kautzky-Willer A, Damm P, et al. DALI: Vitamin D and lifestyle intervention to prevent gestational diabetes: Early findings from the DALI pilot study. Diabet Med. 2015;32:176.

Reason for exclusion: Ineligible study type/design.

Simmons D, van Poppel MNM. UPBEAT, RADIEL, and DALI: What's the difference? The Lancet Diabetes and Endocrinology. 2015;3(10):761.

Reason for exclusion: Ineligible type of intervention.

Simpson SA, Cassidy D, John E, team Hs. “Healthy Eating and Lifestyle in Pregnancy (HELP)” trial: Process evaluation framework. Pregnancy Hypertension. 2014;4(3):233.

Reason for exclusion: Ineligible study type/design.

Simpson SA, John E, Cohen D, Newcombe R, Cassidy D, Playle B, et al. The healthy eating and lifestyle in pregnancy (HELP) Study: Design, baseline data and qualitative findings. Obesity Facts. 2013;6:196–7.

Reason for exclusion: Ineligible outcomes reported.

Skouteris H, McCabe M, Milgrom J, Kent B, Bruce LJ, Mihalopoulos C, et al. Protocol for a randomized controlled trial of a specialized health coaching intervention to prevent excessive gestational weight gain and postpartum weight retention in women: the HIPP study. BMC Public Health. 2012; 12:78.

Reason for exclusion: Ineligible study type/design.

Smith DM, Whitworth M, Sibley C, Taylor W, Gething J, Chmiel C, et al. The design of a community lifestyle programme to improve the physical and psychological well-being of pregnant women with a BMI of 30 kg/m2 or more. BMC Public Health. 2010;10.

Reason for exclusion: Ineligible study type/design.

Sollid CP, Wisborg K, Hjort J, Secher NJ. Eating disorder that was diagnosed before pregnancy and pregnancy outcome. Am J Obstet Gynecol. 2004;190(1):206–10.

Reason for exclusion: Ineligible study type/design.

Soltani H. Dietary interventions more effective than physical activity or mixed interventions for weight management during pregnancy. Evidence-Based Medicine. 2013;18(2):e12.

Reason for exclusion: Ineligible study type/design.

Soltani H, Duxbury AMS, Arden MA, Dearden A, Furness PJ, Garland C. Maternal obesity management using mobile technology: A feasibility study to evaluate a text messaging based complex intervention during pregnancy. J Obes. 2015;2015.

Reason for exclusion: Ineligible study type/design.

Steegers EAP, Van L, Jongsma HW, Fast JH, De B, Eskes T, et al. (Patho)physiological implications of chronic dietary sodium restriction during pregnancy; a longitudinal prospective randomzied study. Br J Obstet Gynaecol. 1991; 98(10):980–7.

Reason for exclusion: Ineligible outcomes reported.

Stendell-Hollis NR, Thompson P, Laudermilk M, Winzerling J, Daines M, Thomson C. A Mediterranean diet intervention rich in walnuts among lactating women: Study design and baseline characteristics. Faseb J. 2010;24.

Reason for exclusion: Ineligible study type/design.

Sununta Y, Sasitorn P, Thitiporn I. The effects of mindfulness eating and yoga exercise on blood sugar levels of pregnant women with gestational diabetes mellitus. Applied Nursing Research. 2014;27(4):227–30.

Reason for exclusion: Ineligible outcomes reported.

Szmeja MA, Cramp C, Grivell RM, Deussen AR, Yelland LN, Dodd JM. Use of a DVD to provide dietary and lifestyle information to pregnant women who are overweight or obese: A nested randomised trial. BMC pregnancy and childbirth. 2014; 14(1).

Reason for exclusion: Ineligible study type/design.

Szmeja MA, Grivell RM, Deussen AR, Dodd JM. Evaluation of information provision to women who are overweight or obese during pregnancy. Journal of paediatrics and child health. 2011; 47:78.

Reason for exclusion: Ineligible type of intervention.

Tanvig M. Offspring body size and metabolic profile - effects of lifestyle intervention in obese pregnant women. Dan Med J. 2014;61(7):B4893.

Reason for exclusion: Ineligible study type/design.

Taveras EM, Blackburn K, Gillman MW, Haines J, McDonald J, Price S, et al. First steps for mommy and me: a pilot intervention to improve nutrition and physical activity behaviors of postpartum mothers and their infants. Matern Child Health J. 2011;15(8):1217–27.

Reason for exclusion: Ineligible study type/design.

Taylor BJ, Heath AL, Galland BC, Gray AR, Lawrence JA, Sayers RM, et al. Prevention of Overweight in Infancy (POI.nz) study: a randomised controlled trial of sleep, food and activity interventions for preventing overweight from birth. BMC Public Health. 2011; 11:942.

Reason for exclusion: Ineligible study type/design.

Thangaratinam S. Randomised controlled trial: Lifestyle interventions in obese and overweight pregnant women do not reduce the risk of large-for-gestational age babies. Evidence-Based Medicine. 2014;19(5):187.

Reason for exclusion: Ineligible study type/design.

Thangaratinam S. Diet and lifestyle interventions for obese pregnant women. The Lancet Diabetes and Endocrinology. 2015;3(10):748–9.

Reason for exclusion: Ineligible study type/design.

Thomson JL, Tussing-Humphreys LM, Goodman MH. Delta Healthy Sprouts: A randomized comparative effectiveness trial to promote maternal weight control and reduce childhood obesity in the Mississippi Delta. Contemp Clin Trials. 2014; 38(1):82–91.

Reason for exclusion: Ineligible study type/design.

Thornton YS, Smarkola C, Kopacz SM, Ishoof SB. Perinatal outcomes in nutritionally monitored obese pregnant women: a randomized clinical trial. J Natl Med Assoc. 2009;101(6):569–77.

Reason for exclusion: Ineligible type of intervention.

Tontisirin K, Booranasubkajorn U, Hongsumarn A, Thewtong D. Formulation and evaluation of supplementary foods for Thai pregnant women. Am J Clin Nutr. 1986; 43(6):931–9.

Reason for exclusion: Ineligible type of intervention.

Vahamiko S, Isolauri E, Laitinen K. Weight status and dietary intake determine serum leptin concentrations in pregnant and lactating women and their infants. Br J Nutr. 2013;110(6):1098–106.

Reason for exclusion: Ineligible type of intervention.

van der Maten GD. Low sodium diet in pregnancy: effects on maternal nutritional status. Eur J Obstet Gynecol Reprod Biol. 1995;61(1):63–4.

Reason for exclusion: Ineligible study type/design.

Vega-Lopez S, Pignotti GAP, Todd M, Keller C. Egg intake and dietary quality among overweight and obese Mexican-American postpartum women. Nutrients. 2015;7(10):8402–12.

Reason for exclusion: Ineligible study type/design.

Vesco K, Leo M, Gillman M, King J, McEvoy C, Karanjaa N, et al. Impact of a weight management intervention on pregnancy outcomes among obese women: The Healthy Moms Trial. American journal of obstetrics and gynecology. 2013; 208(1 suppl.1):S352.

Reason for exclusion: Ineligible study type/design.

Vesco KK, Karanja N, King JC, Gillman MW, Perrin N, McEvoy C, et al. Healthy Moms, a randomized trial to promote and evaluate weight maintenance among obese pregnant women: study design and rationale. Contemp Clin Trials. 2012; 33(4):777–85.

Reason for exclusion: Ineligible study type/design.

Viegas OA, Scott PH, Cole TJ, Eaton P, Needham PG, Wharton BA. Dietary protein energy supplementation of pregnant Asian mothers at Sorrento, Birmingham. II: Selective during third trimester only. Br Med J (Clin Res Ed). 1982;285(6342):592–5.

Reason for exclusion: Ineligible type of intervention.

Viegas OA, Scott PH, Cole TJ, Mansfield HN, Wharton P, Wharton BA. Dietary protein energy supplementation of pregnant Asian mothers at Sorrento, Birmingham. I: Unselective during second and third trimesters. Br Med J (Clin Res Ed). 1982;285(6342):589–92.

Reason for exclusion: Ineligible type of intervention.

Villamor E, Aboud S, Koulinska IN, Kupka R, Urassa W, Chaplin B, et al. Zinc supplementation to HIV-1-infected pregnant women: Effects on maternal anthropometry, viral load, and early mother-to-child transmission. Eur J Clin Nutr. 2006;60(7):862–9.

Reason for exclusion: Ineligible participants.

Villamor E, Msamanga G, Spiegelman D, Antelman G, Peterson KE, Hunter DJ, et al. Effect of multivitamin and vitamin A supplements on weight gain during pregnancy among HIV-1-infected women. Am J Clin Nutr. 2002;76(5):1082–90.

Reason for exclusion: Ineligible participants.

Villar J, Merialdi M, Gulmezoglu AM, Abalos E, Carroli G, Kulier R, et al. Nutritional interventions during pregnancy for the prevention or treatment of maternal morbidity and preterm delivery: An overview of randomized controlled trials. J Nutr. 2003;133(5 SUPPL. 1):1606S–25S.

Reason for exclusion: Ineligible study type/design.

Vinter C, Jensen D, Ovesen P, Beck-Nielsen H, Lamont R, Jorgensen J. Postpartum weight retention and breastfeeding among obese women from the LiP (Lifestyle in Pregnancy) Study. Acta Obstet Gynecol Scand. 2012;91:141–2.

Reason for exclusion: Ineligible study type/design.

Vinter CA, Jensen DM, Ovesen PG, Beck-Nielsen H, JS JO. Lifestyle and pregnancy (LIP) study: The clinical effect of lifestyle intervention during pregnancy in obese women. Diabetes. 2011; 60:A348-a9.

Reason for exclusion: Ineligible study type/design.

Vinter CA, Jorgensen JS, Ovesen P, Beck-Nielsen H, Skytthe A, Jensen DM. Metabolic effects of lifestyle intervention in obese pregnant women. Results from the randomized controlled trial “Lifestyle in Pregnancy” (LiP). Diabet Med. 2014;31(11):1323–30.

Reason for exclusion: Ineligible study type/design.

Vinter CA, Jørgensen JS, Ovesen P, Beck-Nielsen H, Skytthe A, Jensen DM. Metabolism metabolic effects of lifestyle intervention in obese pregnant women. results from the randomized controlled trial “lifestyle in pregnancy” (LiP). Diabet Med. 2014;31(11):1323–30.

Reason for exclusion: Ineligible type of intervention.

Walsh CE, Coffey M, Daniel U, Byrne E, Gavin C, Firth R, et al. Lifestyle intervention reduces the need for insulin therapy and macromia in gestational diabetes mellitus. Archives of Disease in Childhood: Fetal and Neonatal Edition. 2013;98.

Reason for exclusion: Ineligible study type/design.

Walsh J, Mahony R, Foley M, McAuliffe F. ROLO study: A randomized control trial of low glycemic index diet to prevent macrosomia in euglycemic women. American Journal of Obstetrics and Gynecology. 2012;1:S4.

Reason for exclusion: Ineligible study type/design.

Walsh J, McGowan C, Byrne J, Foley M, Mahony R, McAuliffe F. The influence of a low glycaemic index dietary intervention on maternal glycaemic index, dietary intake and gestational weight gain. American journal of obstetrics and gynecology. 2013; 208(1 suppl.1):S33.

Reason for exclusion: Ineligible study type/design.

Walsh J, McGowan C, Mahony R, Foley M, McAuliffe F. Identification of those most likely to benefit from a low glycaemic index dietary intervention in pregnancy. American Journal of Obstetrics and Gynecology. 2014;1):S176.

Reason for exclusion: Ineligible study type/design.

Walsh JM, Mahony RM, Canty G, Foley ME, McAuliffe FM. Identification of those most likely to benefit from a low-glycaemic index dietary intervention in pregnancy. Br J Nutr. 2014;112(4):583–9.

Reason for exclusion: Ineligible type of intervention.

Walsh JM, McAuliffe FM. Impact of maternal nutrition on pregnancy outcome - Does it matter what pregnant women eat? Best Practice and Research: Clinical Obstetrics and Gynaecology. 2015;29(1):63–78.

Reason for exclusion: Ineligible type of intervention.

Walsh JM, McGowan CA, Mahony R, Foley ME, McAuliffe FM. Low glycaemic index diet in pregnancy to prevent macrosomia (ROLO study): randomised control trial. BMJ (Clinical research ed). 2012; 345:e5605.

Reason for exclusion: Ineligible type of intervention.

Wang S, Ma JM, Yang HX. Lifestyle intervention for gestational diabetes mellitus prevention: A cluster-randomized controlled study. Chronic Diseases and Translational Medicine. 2015;1(3):169–74.

Reason for exclusion: Ineligible type of intervention.

Weisman CS, Hillemeier MM, Downs DS, Feinberg ME, Chuang CH, Botti JJ, et al. Improving women's preconceptional health: Long-term effects of the Strong Healthy Women behavior change intervention in the Central Pennsylvania women's Health Study. Women's Health Issues. 2011;21(4):265–71.

Reason for exclusion: Ineligible study type/design.

Wen LM, Simpson JM, Rissel C, Baur LA. Maternal “junk food” diet during pregnancy as a predictor of high birthweight: findings from the healthy beginnings trial. Birth (Berkeley, Calif). 2013;40(1):46–51.

Reason for exclusion: Ineligible type of intervention.

Widga AC, Lewis NM. Defined, in-home, prenatal nutrition intervention for low-income women. J Am Diet Assoc. 1999; 99(9):1058–62

Reason for exclusion: Ineligible type of intervention.

Wilkinson SA, McIntyre HD. Evaluation of the ‘healthy start to pregnancy” early antenatal health promotion workshop: a randomized controlled trial. BMC pregnancy and childbirth. 2012; 12:131.

Reason for exclusion: Ineligible outcomes reported.

Willcox JC, Campbell KJ, McCarthy EA, Wilkinson SA, Lappas M, Ball K, et al. Testing the feasibility of a mobile technology intervention promoting healthy gestational weight gain in pregnant women (txt4two) - study protocol for a randomised controlled trial. Trials. 2015;16:209.

Reason for exclusion: Ineligible study type/design.

Wosje KS, Kalkwarf HJ. Lactation, weaning, and calcium supplementation: Effects on body composition in postpartum women. American Journal of Clinical Nutrition. 2004;80(2):423–429.

Reason for exclusion: Ineligible type of intervention.

Yao J, Cong L, Zhu B, Wang T. Effect of dietary approaches to stop hypertension diet plan on pregnancy outcome patients with gestational diabetes mellitus. Bangladesh Journal of Pharmacology. 2015;10(4):732–8.

Reason for exclusion: Ineligible type of intervention.

Ziaei S, Hantoshzadeh S, Rezasoltani P, Lamyian M. The effect of garlic tablet on plasma lipids and platelet aggregation in nulliparous pregnants at high risk of preeclampsia. European journal of obstetrics, gynecology, and reproductive biology. 2001; 99(2):201–6.

Reason for exclusion: Ineligible type of intervention.

Back to Top | Article Outline

Appendix III: Supplementary results

Supplementary Table S1: Mode of intervention delivery

Figure

Figure

Supplementary Table S2: Intervention content (diet/nutrition and other)

Figure

Figure

Figure

Figure

Figure

Figure

Figure

Figure

Figure

Figure

Supplementary Table S3: Method and time point of weight measurement for interventions in pregnancy

Figure

Figure

Figure

Figure

Back to Top | Article Outline

References

1. Leddy MA, Power ML, Schulkin J. The Impact of Maternal Obesity on Maternal and Fetal Health. Reviews in Obstet Gynecol 2008; 1 4:170–178.
2. Branum A, Kirmeyer SE, ECW G. Prepregnancy body mass index by maternal characteristics and state: Data from the birth certificate, 2014. Hyattsville, MD: National Centre for Health Statistics; 2016.
3. Institute of Medicine (US). Weight gain during pregnancy: reexamining the guidelines. Washington DC: National Academies Press; 2009.
4. Goldstein RF, Abell SK, Ranasinha S, Misso M, Boyle JA, Black MH, et al. Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis. JAMA 2017; 317 21:2207–2225.
5. Armitage JA, Poston L, Taylor PD. Developmental origins of obesity and the metabolic syndrome: the role of maternal obesity. Front Horm Res 2008; 36:73–84.
6. Kemp MW, Kallapur SG, Jobe AH, Newnham JP. Obesity and the developmental origins of health and disease. J Paediatr Child Health 2012; 48:86–90.
7. Williams CB, Mackenzie KC, Gahagan S. The Effect of Maternal Obesity on the Offspring. Clinical Obstet and Gynecol 2014; 57 3:508–515.
8. Endres LK, Straub H, McKinney C, Plunkett B, Minkovitz CS, Schetter CD, et al. Postpartum weight retention risk factors and relationship to obesity at 1 year. Obstet Gynecol 2015; 125 1:144–152.
9. Vesco KK, Dietz PM, Rizzo J, Stevens VJ, Perrin NA, Bachman DJ, et al. Excessive gestational weight gain and postpartum weight retention among obese women. Obstet Gynecol 2009; 114 5:1069–1075.
10. Linne Y, Dye L, Barkeling B, Rossner S. Long-term weight development in women: A 15-year follow-up of the effects of pregnancy. Obes Res 2004; 12 7:1166–1178.
11. Rooney BL, Schauberger CW. Excess pregnancy weight gain and long-term obesity: one decade later. Obstet Gynecol 2002; 100 2:245–252.
12. Villamor E, Cnattingius S. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. Lancet 2006; 368 9542:1164–1170.
13. Wennberg AL, Isaksson U, Sandström H, Lundqvist A, Hörnell A, Hamberg K. Swedish women's food habits during pregnancy up to six months post-partum: A longitudinal study. Sex Reprod Healthc 2016; 8:31–36.
14. Durham HA, Morey MC, Lovelady CA, Namenek Brouwer RJ, Krause KM, Østbye T. Postpartum Physical Activity in Overweight and Obese Women. J Phys Act Health 2011; 8 7:988–993.
15. Hesketh KR, Evenson KR. Prevalence of U.S. Pregnant Women Meeting 2015 ACOG Physical Activity Guidelines. Am J Prev Med 2016; 51 3:e87–e89.
16. von Ruesten A, Brantsaeter AL, Haugen M, Meltzer HM, Mehlig K, Winkvist A, et al. Adherence of pregnant women to Nordic dietary guidelines in relation to postpartum weight retention: results from the Norwegian Mother and Child Cohort Study. BMC Public Health 2014; 14:75.
17. Tanentsapf I, Heitmann BL, Adegboye ARA. Systematic review of clinical trials on dietary interventions to prevent excessive weight gain during pregnancy among normal weight, overweight and obese women. BMC Pregnancy Childbirth 2011; 11:81.
18. Thangaratinam S, Rogoziska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson JW, et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ 2012; 344: 12-.
19. Lim S, O’Reilly S, Behrens H, Skinner T, Ellis I, Dunbar JA. Effective strategies for weight loss in post-partum women: a systematic review and meta-analysis. Obes Rev 2015; 16 11:972–987.
20. Hill B, Skouteris H, Fuller-Tyszkiewicz M. Interventions designed to limit gestational weight gain: a systematic review of theory and meta-analysis of intervention components. Obes Rev 2013; 14 6:435–450.
21. Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database of Syst Rev 2015; 6:CD007145.
22. van der Pligt P, Willcox J, Hesketh KD, Ball K, Wilkinson S, Crawford D, et al. Systematic review of lifestyle interventions to limit postpartum weight retention: implications for future opportunities to prevent maternal overweight and obesity following childbirth. Obes Rev 2013; 14 10:792–805.
23. Spencer L, Rollo M, Hauck Y, MacDonald-Wicks L, Wood L, Hutchesson M, et al. The effect of weight management interventions that include a diet component on weight-related outcomes in pregnant and postpartum women: a systematic review protocol. JBI Database System Rev Implement Rep 2015; 13 1:88–98.
24. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 2011; 377 9765:557–567.
25. Moher D, Liberati A, Tetzlaff J, Altman DG. The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 2009; 6 6:e1000097.
26. Aromataris E, Munn Z. Joanna Briggs Institute Reviewer's Manual. The Joanna Briggs Institute, 2017. Available from https://reviewersmanual.joannabriggs.org/.
27. Berry D, Verbiest S, Hall EG, Dawson I, Norton D, Willis S, et al. A Postpartum Community-Based Weight Management Intervention Designed for Low-Income Women: Feasibility and Initial Efficacy Testing. J Natl Black Nurses Assoc 2015; 26 1:29–39.
28. Peacock AS, Bogossian FE, Wilkinson SA, Gibbons KS, Kim C, McIntyre HD. A Randomised Controlled Trial to Delay or Prevent Type 2 Diabetes after Gestational Diabetes: Walking for Exercise and Nutrition to Prevent Diabetes for You. Int J Endocrinol 2015; 2015:423717.
29. Pollak KI, Alexander SC, Bennett G, Lyna P, Coffman CJ, Bilheimer A, et al. Weight-related SMS texts promoting appropriate pregnancy weight gain: A pilot study. Patient Educ Couns 2014; 97 2:256–260.
30. Shyam S, Arshad F, Abdul Ghani R, Wahab NA, Safii NS, Nisak MYB, et al. Low glycaemic index diets improve glucose tolerance and body weight in women with previous history of gestational diabetes: a six months randomized trial. Nutr J 2013; 12: 68-.
31. Asbee SM, Jenkins TR, Butler JR, White J, Elliot M, Rutledge A. Preventing excessive weight gain during pregnancy through dietary and lifestyle counseling: a randomized controlled trial. Obstet Gynecol 2009; 113 (2 Pt 1):305–312.
32. Bosaeus M, Hussain A, Karlsson T, Andersson L, Hulthen L, Svelander C, et al. A randomized longitudinal dietary intervention study during pregnancy: effects on fish intake, phospholipids, and body composition. Nutr J 2015; 14:1.
33. Renault KM, Norgaard K, Nilas L, Carlsen EM, Cortes D, Pryds O, et al. The Treatment of Obese Pregnant Women (TOP) study: A randomized controlled trial of the effect of physical activity intervention assessed by pedometer with or without dietary intervention in obese pregnant women. Am Journal Obstet Gynecol 2014; 210 2: 134.e1-.e9.
34. Vinter CA, Jensen DM, Ovesen P, Beck-Nielsen H, Jørgensen JS. The LiP (Lifestyle in Pregnancy) study: a randomized controlled trial of lifestyle intervention in 360 obese pregnant women. Diabetes Care 2011; 34 12:2502–2507.
35. Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 2014; 14:135.
36. Guelinckx I, Devlieger R, Mullie P, Vansant G. Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial. Am J Clin Nutr 2010; 91 2:373–380.
37. Hui AL, Back L, Ludwig S, Gardiner P, Sevenhuysen G, Dean HJ, et al. Effects of lifestyle intervention on dietary intake, physical activity level, and gestational weight gain in pregnant women with different pre-pregnancy Body Mass Index in a randomized control trial. BMC Pregnancy Childbirth 2014; 14:331.
38. Phelan S, Phipps MG, Abrams B, Darroch F, Schaffner A, Wing RR. Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study. Am J Clin Nutr 2011; 93 4:772–779.
39. Polley B, Wing R, Sims C. Randomized controlled trial to prevent excessive weight gain in pregnant women. Int J Obesity 2002; 26 11:1494–1502.
40. Bertz F, Brekke HK, Ellegård L, Rasmussen KM, Wennergren M, Winkvist A. Diet and exercise weight-loss trial in lactating overweight and obese women. Am J Clin Nutr 2012; 96 4:698–705.
41. Davenport MH, Girouox I, Sopper MM, Mottola MF. Postpartum Exercise Regardless of Intensity Improves Chronic Disease Risk Factors. Med Sci Sports Exerc 2011; 43 6:951–958.
42. Harrison CL, Lombard CB, Strauss BJ, Teede HJ. Optimizing healthy gestational weight gain in women at high risk of gestational diabetes: a randomized controlled trial. Obesity 2013; 21 5:904–909.
43. Carlo C, Iannotti G, Sparice S, Chiacchio MP, Greco E, Tommaselli GA, et al. The role of a personalized dietary intervention in managing gestational weight gain: A prospective, controlled study in a low-risk antenatal population. Arch Gynecol Obstet 2014; 289 4:765–770.
44. Deveer R, Deveer M, Akbaba E, Engin-Üstün Y, Aydo?an P, Celikkaya H, et al. The effect of diet on pregnancy outcomes among pregnant with abnormal glucose challenge test. Eur Rev Med Pharmacol Sci 2013; 17 9:1258–1261.
45. Dodd JM, Kannieappan LM, Grivell RM, Deussen AR, Moran LJ, Yelland LN, et al. Effects of an antenatal dietary intervention on maternal anthropometric measures in pregnant women with obesity. Obesity 2015; 23 8:1555–1562.
46. Dodd JM, Turnbull D, McPhee AJ, Deussen AR, Grivell RM, Yelland LN, et al. Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial. BMJ 2014; 348:g1285.
47. Harrison CL, Lombard CB, Teede HJ. Limiting postpartum weight retention through early antenatal intervention: the HeLP-her randomised controlled trial. Int J Behav Nutr Phys Act 2014; 11:134.
48. Herring SJ, Cruice JF, Bennett GG, Rose MZ, Davey A, Foster GD. Preventing excessive gestational weight gain among African American women: A randomized clinical trial. Obesity 2016; 24 1:30–36.
49. Hui A, Back L, Ludwig S, Gardiner P, Sevenhuysen G, Dean H, et al. Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a randomised controlled trial. BJOG 2012; 119 1:70–77.
50. Kinnunen TI, Raitanen J, Aittasalo M, Luoto R. Preventing excessive gestational weight gain-a secondary analysis of a cluster-randomised controlled trial. Eur J Clin Nut 2012; 66 12:1344–1350.
51. Petrella E, Malavolti M, Bertarini V, Pignatti L, Neri I, Battistini NC, et al. Gestational weight gain in overweight and obese women enrolled in a healthy lifestyle and eating habits program. J Matern Fetal Neonatal Med 2014; 27 13:1348–1352.
52. Phelan S, Phipps MG, Abrams B, Darroch F, Grantham K, Schaffner A, et al. Does behavioral intervention in pregnancy reduce postpartum weight retention? Twelve-month outcomes of the Fit for Delivery randomized trial. Am J Clin Nut 2014; 99 2:302–311.
53. Rauh K, Gabriel E, Kerschbaum E, Schuster T, Kries R, Amann-Gassner U, et al. Safety and efficacy of a lifestyle intervention for pregnant women to prevent excessive maternal weight gain: A cluster-randomized controlled trial. BMC Pregnancy Childbirth 2013; 13:151.
54. Rauh K, Gunther J, Kunath J, Stecher L, Hauner H. Lifestyle intervention to prevent excessive maternal weight gain: mother and infant follow-up at 12 months postpartum. BMC Pregnancy Childbirth 2015; 15:265.
55. Vesco KK, Karanja N, King JC, Gillman MW, Leo MC, Perrin N, et al. Efficacy of a group-based dietary intervention for limiting gestational weight gain among obese women: A randomized trial. Obesity 2014; 22 9:1989–1996.
56. Vinter CA, Jensen DM, Ovesen P, Beck-Nielsen H, Tanvig M, Lamont RF, et al. Postpartum weight retention and breastfeeding among obese women from the randomized controlled Lifestyle in Pregnancy (LiP) trial. Acta Obstet Gynecol Scand 2014; 93 8:794–801.
57. Wolff S, Legarth J, Vangsgaard K, Toubro S, Astrup A. A randomized trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women. Int J Obesity 2008; 32 3:495–501.
58. Gray-Donald K, Robinson E, Collier A, David K, Renaud L, Rodrigues S. Intervening to reduce weight gain in pregnancy and gestational diabetes mellitus in Cree communities: an evaluation. Can Med Assoc J 2000; 163 10:1247–1251.
59. Huang T-t, Yeh C-Y, Tsai Y-C. A diet and physical activity intervention for preventing weight retention among Taiwanese childbearing women: a randomised controlled trial. Midwifery 2011; 27 2:257–264.
60. Ilmonen J, Isolauri E, Poussa T, Laitinen K. Impact of dietary counselling and probiotic intervention on maternal anthropometric measurements during and after pregnancy: A randomized placebo-controlled trial. Clinical Nutrition 2011; 30 2:156–164.
61. Jaakkola J, Isolauri E, Poussa T, Laitinen K. Benefits of repeated individual dietary counselling in long-term weight control in women after delivery. Maternal & Child Nutrition 2015; 11:1041–1048.
62. Martin J, MacDonald-Wicks L, Hure A, Smith R, Collins CE. Reducing postpartum weight retention and improving breastfeeding outcomes in overweight women: A pilot randomised controlled trial. Nutrients 2015; 7 3:1465–1479.
63. Wilkinson SA, Pligt P, Gibbons KS, McIntyre HD. Trial for Reducing Weight Retention in New Mums: a randomised controlled trial evaluating a low intensity, postpartum weight management programme. J Hum Nutr Diet 2015; 28 (Suppl 1):15–28.
64. Brekke HK, Bertz F, Rasmussen KM, Bosaeus I, Ellegard L, Winkvist A. Diet and exercise interventions among overweight and obese lactating women: Randomized trial of effects on cardiovascular risk factors. PloS One 2014; 9 2:e88250.
65. Colleran HL, Lovelady CA. Use of MyPyramid Menu Planner for Moms in a weight-loss intervention during lactation. J Acad Nutr Diet 2012; 112 4:553–558.
66. Colleran HL, Wideman L, Lovelady CA. Effects of energy restriction and exercise on bone mineral density during lactation. Med Sci Sport Ex 2012; 44 8:1570–1579.
67. Craigie AM, Macleod M, Barton KL, Treweek S, Anderson AS. Supporting postpartum weight loss in women living in deprived communities: design implications for a randomised control trial. Eur J Clin Nutr 2011; 65 8:952–958.
68. Herring SJ, Cruice JF, Bennett GG, Davey A, Foster GD. Using Technology to Promote Postpartum Weight Loss in Urban, Low-Income Mothers: A Pilot Randomized Controlled Trial. J Nutr Educ Behav 2014; 46 6:610–615.
69. Huseinovic E, Winkvist A, Bertz F, Bertéus Forslund H, Brekke HK. Eating frequency, energy intake and body weight during a successful weight loss trial in overweight and obese postpartum women. Eur J Clin Nut 2014; 68 1:71–76.
70. Leermakers EA, Anglin K, Wing RR. Reducing postpartum weight retention through a correspondence intervention. Int J Obes Relat Metab Disord 1998; 22 11:1103–1109.
71. Lovelady CA, Garner KE, Moreno KL, Williams JP. The effect of weight loss in overweight, lactating women on the growth of their infants. New Engl J Med 2000; 342 7:449–453.
72. Ostbye T, Krause KM, Lovelady CA, Morey MC, Bastian LA, Peterson BL, et al. Active Mothers Postpartum. A Randomized Controlled Weight-Loss Intervention Trial. Am J Prev Med 2009; 37 3:173–180.
73. O’Toole ML, Sawicki MA, Artal R. Structured diet and physical activity prevent postpartum weight retention. J Womens Health 2003; 12 10:991–998.
74. Stendell-Hollis NR, Thompson PA, West JL, Wertheim BC, Thomson CA. A comparison of Mediterranean-style and MyPyramid diets on weight loss and inflammatory biomarkers in postpartum breastfeeding women. J Womens Health 2013; 22 1:48–57.
75. Wiltheiss GA, Lovelady CA, West DG, Brouwer RJ, Krause KM, Østbye T. Diet quality and weight change among overweight and obese postpartum women enrolled in a behavioral intervention program. J Acad Nutr Diet 2013; 113 1:54–62.
76. Yeo S, Walker JS, Caughey MC, Ferraro AM, Asafu-Adjey JK. What characteristics of nutrition and physical activity interventions are key to effectively reducing weight gain in obese or overweight pregnant women? A systematic review and meta-analysis. Obes Rev 2017; 18 4:385–399.
77. Nascimento S, Pudwell J, Surita F, Adamo K, Smith G. The effect of physical exercise strategies on weight loss in postpartum women: a systematic review and meta-analysis. Int J Obes 2014; 38 5:626–635.
78. Jiang M, Gao H, Vinyes-Pares G, Yu K, Ma D, Qin X, et al. Association between breastfeeding duration and postpartum weight retention of lactating mothers: A meta-analysis of cohort studies. Clin Nutr 2018; 37 4:1224–1231.
79. Chung JG, Taylor RS, Thompson JM, Anderson NH, Dekker GA, Kenny LC, et al. Gestational weight gain and adverse pregnancy outcomes in a nulliparous cohort. Eur J Obstet Gynecol Reprod Biol 2013; 167 2:149–153.
80. Gaillard R, Durmus B, Hofman A, Mackenbach JP, Steegers EA, Jaddoe VW. Risk factors and outcomes of maternal obesity and excessive weight gain during pregnancy. Obesity 2013; 21 5:1046–1055.
81. Hung TH, Hsieh TT. Pregestational body mass index, gestational weight gain, and risks for adverse pregnancy outcomes among Taiwanese women: A retrospective cohort study. Taiwan J Obstet Gynecol 2016; 55 4:575–581.
82. Johnson J, Clifton RG, Roberts JM, Myatt L, Hauth JC, Spong CY, et al. Pregnancy Outcomes With Weight Gain Above or Below the 2009 Institute of Medicine Guidelines. Obstet Gynecol 2013; 121 5:969–975.
83. Phelan S. Pregnancy: a “teachable moment” for weight control and obesity prevention. Am J Obstet Gynecol 2010; 202 2:135.e1–8.
84. Michie S, Ashford S, Sniehotta FF, Dombrowski SU, Bishop A, French DP. A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: the CALO-RE taxonomy. Psychol Health 2011; 26 11:1479–1498.
85. Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 2014; 348:g1687.
86. Schulz KF, Altman DG, Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMJ 2010; 340:c322.
87. Headen I, Cohen AK, Mujahid M, Abrams B. The accuracy of self-reported pregnancy-related weight: a systematic review. Obes Rev 2017; 18 3:350–369.
88. Vincze L, Rollo ME, Hutchesson MJ, Burrows TL, MacDonald-Wicks L, Blumfield M, et al. A cross sectional study investigating weight management motivations, methods and perceived healthy eating and physical activity influences in women up to five years following childbirth. Midwifery 2017; 49:124–133.
89. Rollo ME, Hutchesson MJ, Burrows TL, Krukowski RA, Harvey JR, Hoggle LB, et al. Video Consultations and Virtual Nutrition Care for Weight Management. J Acad Nutr Diet 2015; 115 8:1213–1225.
90. Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions 2011 [Version 5.1.0 [updated March 2011]: [Available from: www.handbook.cochrane.org].
91. National Institute for Health and Care Excellence. Weight management before, during and after pregnancy. 2017. [Internet]. [Cited in November 2017]. Available from: https://www.nice.org.uk/guidance/ph27/chapter/1-recommendations#recommendation-3-supporting-women-after-childbirth.
92. Stang J, Huffman LG. Position of the Academy of Nutrition and Dietetics: Obesity, Reproduction, and Pregnancy Outcomes. J Acad Nutr Diet 2016; 116 4:677–691.
Keywords:

Antenatal; diet; postpartum; pregnancy; weight

© 2019 by Lippincott williams & Wilkins, Inc.