Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding of outcome assessment).
Clinical comment: In most studies the intervention was started late in gestation or the time was not stated.
A Cochrane review [Abstract] 1 included 15 studies with a total of 4501 women and 3768 infants. The lifestyle interventions included a wide variety of components such as education, diet, exercise and self-monitoring of blood glucose. The control group included usual antenatal care or diet alone. There was no clear evidence of a difference between lifestyle intervention and control groups for the risk of hypertensive disorders of pregnancy (pre-eclampsia), caesarean section, development of type 2 diabetes, perineal trauma/tearing, or induction of labour T1. More women in the lifestyle intervention group had met postpartum weight goals one year after birth than in the control group T1. Lifestyle interventions were associated with a reduction in the risk of being born large-for-gestational age (LGA) T2. There was a trend for lower birthweight, neonatal fat mass, and the incidence of macrosomia in the lifestyle intervention group T2.
| Outcomes | Relative effect(95% CI) | Risk with usual care/control | Risk with lifestyle intervention (95% CI) | №of participants(studies) Quality of evidence |
|---|---|---|---|---|
| Hypertensive disorders of pregnancy (pre-eclampsia) | RR 0.70(0.40 to 1.22) | 129 per 1000 | 90 per 1000(51 to 157) | (4 2796) Low |
| Perineal trauma/tear | RR 1.04(0.93 to 1.18) | 498 per 1000 | 518 per 1000(463 to 588) | 1000(1) Moderate |
| Caesarean section | RR 0.90(0.78 to 1.05) | 380 per 1000 | 342 per 1000(296 to 399) | 3545(10) Low |
| Induction of labour | RR 1.20(0.99 to 1.46) | 211 per 1000 | 252 per 1000(220 to 285) | 2699(4) High |
| Postnatal depression | RR 0.49(0.31 to 0.78) | 169 per 1000 | 83 per 1000(53 to 132) | 573(1) Low |
| Postnatal weight retention or return to pre-pregnancy weight | RR 1.75(1.05 to 2.90) | 214 per 1000 | 375 per 1000(225 to 621) | 156(1) Low |
| Development of type 2 diabetes (follow-up) | RR 0.98(0.54 to 1.76) | 83 per 1000 | 81 per 1000(45 to 146) | 486(2) Low |
| Outcomes | Relative effect(95% CI) | Risk with usual care/control | Risk with lifestyle intervention (95% CI) | №of participants(studies) Quality of evidence |
|---|---|---|---|---|
| Large-for-gestational age | RR 0.60(0.50 to 0.71) | 189 per 1000 | 113 per 1000(95 to 134) | 2994(6) Moderate |
| Perinatal (fetal and neonatal death) and later infant mortality | RR 0.09(0.01 to 1.70) | 5 per 1000 | 0 per 1000(0 to 9) | 1988(2) Low |
| Neonatal hypoglycaemia | RR 0.99(0.65 to 1.52) | 75 per 1000 | 74 per 1000(49 to 114) | 3000(6) Moderate |
| Adiposity (neonatal) - Mean neonatal fat mass (g) | - | 427 g | 37.30 g fewer (63.97 fewer to 10.63 fewer) - | 958(1) Low |
| Adiposity (child) - Childhood BMI > 85th percentile | RR 0.91(0.75 to 1.11) | 350 per 1000 | 318 per 1000(262 to 388) | 767(3) Moderate |
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