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Nutrition and metabolism
Research
Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: individual participant data meta-analysis
  1. Eileen C O’Brien1,
  2. Ricardo Segurado2,
  3. Aisling A Geraghty1,
  4. Goiuri Alberdi1,
  5. Ewelina Rogozinska3,4,
  6. Arne Astrup5,
  7. Rubenomar Barakat Carballo6,
  8. Annick Bogaerts7,8,9,
  9. Jose Guilherme Cecatti10,
  10. Arri Coomarasamy11,
  11. Christianne J M de Groot12,
  12. Roland Devlieger7,13,
  13. Jodie M Dodd14,
  14. Nermeen El Beltagy15,
  15. Fabio Facchinetti16,
  16. Nina Geiker17,
  17. Kym Guelfi18,
  18. Lene Haakstad19,
  19. Cheryce Harrison20,
  20. Hans Hauner21,
  21. Dorte M Jensen22,
  22. Khalid Khan3,4,
  23. Tarja Inkeri Kinnunen23,
  24. Riitta Luoto23,
  25. Ben Willem Mol24,
  26. Siv Mørkved25,26,
  27. Narges Motahari-Tabari27,
  28. Julie A Owens14,
  29. Maria Perales6,
  30. Elisabetta Petrella16,
  31. Suzanne Phelan28,
  32. Lucilla Poston29,
  33. Kathrin Rauh30,
  34. Girish Rayanagoudar3,
  35. Kristina M Renault31,32,
  36. Anneloes E Ruifrok33,
  37. Linda Sagedal34,
  38. Kjell Å Salvesen35,36,
  39. Tania T Scudeller37,
  40. Gary Shen38,
  41. Alexis Shub39,
  42. Signe N Stafne25,26,
  43. Fernanda G Surita10,
  44. Shakila Thangaratinam3,4,
  45. Serena Tonstad40,
  46. Mireille N M van Poppel41,
  47. Christina Vinter42,
  48. Ingvild Vistad34,
  49. SeonAe Yeo43,
  50. Fionnuala M McAuliffe1
  51. i-WIP (International Weight Management in Pregnancy) Collaborative Group
  1. 1 UCD Perinatal Research Centre, Obstetrics and Gynaecology, UCD School of Medicine, University College Dublin, Dublin, Ireland
  2. 2 Centre for Support and Training in Analysis and Research (CSTAR), School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
  3. 3 Women’s Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  4. 4 Multidisciplinary Evidence Synthesis Hub (mEsh), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  5. 5 Department of Nutrition, Exercise and Sports, Univesity of Copenhagen, Copenhagen, Denmark
  6. 6 Facultad de Ciencias de la Actividad Fısica y del Deporte (INEF), Universidad Politecnica de Madrid, Madrid, Spain
  7. 7 Department of Development and Regeneration KU Leuven, University of Leuven, Leuven, Belgium
  8. 8 Faculty of Health and Social Work, UC Leuven-Limburg, Leuven, Belgium
  9. 9 Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Belgium
  10. 10 Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
  11. 11 School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  12. 12 Obstetrics and Gynaecology, Faculty of Medicine, VU University Medical Center, Amsterdam, The Netherlands
  13. 13 Department of Obstetrics and Gynecology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
  14. 14 Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, The Unversity of Adelaide, Adelaide, Australia
  15. 15 Department of Obstetrics and Gynecology, Alexandria University, Alexandria, Egypt
  16. 16 Mother-Infant Department, University of Modena and Reggio Emilia, Modena, Italy
  17. 17 Clinical Nutrition Research, Copenhagen University Hospital Herlev-Gentofte, Gentofte, Denmark
  18. 18 School of Human Sciences, The University of Western Australia, Perth, Australia
  19. 19 Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  20. 20 Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  21. 21 Else Kroener-Fresenius-Center for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
  22. 22 Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
  23. 23 Health Sciences, Faculty of Social Sciences, University of Tampere, Tampere, Finland
  24. 24 Robinson Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia
  25. 25 Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
  26. 26 Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
  27. 27 Midwifery Department, Faculty of Nursing and Midwifery, Mazandaran University of Medical Science, Sari, Iran
  28. 28 Kinesiology Department, College of Science and Mathematics, California Polytechnic State University, San Luis Obispo, California, USA
  29. 29 Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
  30. 30 Nutrition Information and Knowledge Transfer, Competence Centre for Nutrition (KErn), Freising, Germany
  31. 31 Department of Obstetrics and Gynecology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
  32. 32 Obstetric Clinic, Juliane Marie Centret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
  33. 33 Department of Obstetrics and Gynaecology, Academisch Medisch Centrum Universiteit van Amsterdam, Amsterdam, The Netherlands
  34. 34 Department of Obstetrics and Gynecology, Sorlandet Hospital, Kristiansand, Norway
  35. 35 Department of Obstetrics and Gynaecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
  36. 36 Department of Laboratory Medicine Children’s and Women’s Health, Norwegian University of Science and Technology, Trondheim, Norway
  37. 37 Department of Management and Health Care, Universidade Federal de Sao Paulo, São Paulo, Brazil
  38. 38 Department of Internal Medicine, University of Manitoba College of Medicine, Winnipeg, Canada
  39. 39 Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
  40. 40 Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
  41. 41 Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
  42. 42 Department of Obstetrics and Gynecology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
  43. 43 School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  1. Correspondence to Professor Fionnuala M McAuliffe; fionnuala.mcauliffe{at}ucd.ie

Abstract

Objectives To identify if maternal educational attainment is a prognostic factor for gestational weight gain (GWG), and to determine the differential effects of lifestyle interventions (diet based, physical activity based or mixed approach) on GWG, stratified by educational attainment.

Design Individual participant data meta-analysis using the previously established International Weight Management in Pregnancy (i-WIP) Collaborative Group database (https://iwipgroup.wixsite.com/collaboration). Preferred Reporting Items for Systematic reviews and Meta-Analysis of Individual Participant Data Statement guidelines were followed.

Data sources Major electronic databases, from inception to February 2017.

Eligibility criteria Randomised controlled trials on diet and physical activity-based interventions in pregnancy. Maternal educational attainment was required for inclusion and was categorised as higher education (≥tertiary) or lower education (≤secondary).

Risk of bias Cochrane risk of bias tool was used.

Data synthesis Principle measures of effect were OR and regression coefficient.

Results Of the 36 randomised controlled trials in the i-WIP database, 21 trials and 5183 pregnant women were included. Women with lower educational attainment had an increased risk of excessive (OR 1.182; 95% CI 1.008 to 1.385, p =0.039) and inadequate weight gain (OR 1.284; 95% CI 1.045 to 1.577, p =0.017). Among women with lower education, diet basedinterventions reduced risk of excessive weight gain (OR 0.515; 95% CI 0.339 to 0.785, p = 0.002) and inadequate weight gain (OR 0.504; 95% CI 0.288 to 0.884, p=0.017), and reduced kg/week gain (B −0.055; 95% CI −0.098 to −0.012, p=0.012). Mixed interventions reduced risk of excessive weight gain for women with lower education (OR 0.735; 95% CI 0.561 to 0.963, p=0.026). Among women with high education, diet based interventions reduced risk of excessive weight gain (OR 0.609; 95% CI 0.437 to 0.849, p=0.003), and mixed interventions reduced kg/week gain (B −0.053; 95% CI −0.069 to −0.037,p<0.001). Physical activity based interventions did not impact GWG when stratified by education.

Conclusions Pregnant women with lower education are at an increased risk of excessive and inadequate GWG. Diet based interventions seem the most appropriate choice for these women, and additional support through mixed interventions may also be beneficial.

  • pregnancy
  • lifestyle interventions
  • socioeconomic status
  • inequalities
  • nutrition

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

http://dx.doi.org/10.1136/bmjopen-2018-025620

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    Footnotes

    • Contributors ECOB, FMMcA: wrote a proposal to the i-WIP data access committee; set the objectives, study design and data analysis plan. ECOB, FMMcA, RS, AAG and GA: analysis and interpretation of data; drafting of manuscript; critical revision; final approval of version to be published; agreeable to be accountable for all aspects of the work. ER: i-WIP IPD database manager; study conception and design; critical revision; final approval of version to be published; agreeable to be accountable for all aspects of the work. AA, RBC, AB, JGC, AC, CJMdG, RD, JMD, NEB, FF, NG, KG, LH, CH, HH, DMJ, KK, TIK, RL, BWM, SM, NM-T, JAO, MP, EP, SP, LP, KR, GR, KMR, AER, LS, KÅS, TTS, GS, AS, SNS, FGS, ShT, SeT, MNMvP, CV, IV and SY: study conception and design; critical revision; final approval of version to be published; agreeable to be accountable for all aspects of the work.

    • Funding The data come from a National Institute for Health Research (NIHR) funded project (HTA-12/01/50) and the Queen Mary University of London is its legal sponsor. The database was initially funded by the NIHR and is currently funded by WHO. This work was also supported by the Health Research Board, Health Research Centre for Health and Diet Research, Ireland.

    • Competing interests None declared.

    • Ethics approval IPD meta-analysis. Research ethics was approved for each study included.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The Queen Mary University of London is the legal custodian of the i-WIP dataset. The access to the dataset is regulated by prespecified terms and conditions (available on request) and overseen by Data Access Committee. For further information visit: https://iwipgroup.wixsite.com/collaboration/related-projects

    • Patient consent for publication Not required.