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Thangaratinam S, Rogozińska E, Jolly K, et al. Interventions to Reduce or Prevent Obesity in Pregnant Women: A Systematic Review. Southampton (UK): NIHR Journals Library; 2012 Jul. (Health Technology Assessment, No. 16.31.)
Interventions to Reduce or Prevent Obesity in Pregnant Women: A Systematic Review.
Show details| Quality assessment | Summary of findings | Importance | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No. of patients | Effect | Quality | ||||||||||
| No. of studies | Design | Limitations | Inconsistency | Indirectness | Imprecision | Other considerations | Mixed approach | Control | Relative (95% CI) | Absolute | ||
| Gestational weight gain (kg) (better indicated by lower values) | ||||||||||||
| 6 | Randomised trials | No serious limitationsa,b | No serious inconsistency | No serious indirectness | Seriousc | Reporting biasd | 506 | 488 | – | MD 0.36 lower (1.4 lower to 0.68 higher) | ⊕⊕⊖⊖ Low | Important |
| Birthweight (kg) (better indicated by lower values) | ||||||||||||
| 5 | Randomised trials | No serious limitationsa,b | No serious inconsistency | No serious indirectness | Seriousc | Reporting biasd | 264 | 245 | – | MD 0.02 lower (0.1 lower to 0.07 higher) | ⊕⊕⊖⊖ Low | Important |
| LGA | ||||||||||||
| 5 | Randomised trials | No serious limitationsa,b | No serious inconsistency | Seriouse | No serious imprecision | None | 18/237 (7.6%) | 22/223 (9.9%) | RR 0.75 (0.41 to 1.38) | 25 fewer per 1000 (from 58 fewer to 37 more) | ⊕⊕⊕⊖ Moderate | Critical |
| SGA | ||||||||||||
| 2 | Randomised trials | No serious limitationsa,b | No serious inconsistency | No serious indirectness | No serious imprecision | None | 14/181 (7.7%) | 17/164 (10.4%) | RR 0.76 (0.39 to 1.48) | 25 fewer per 1000 (from 63 fewer to 50 more) | ⊕⊕⊕⊕ High | Critical |
| Pre-eclampisa | ||||||||||||
| 3 | Randomised trials | No serious limitationsa,b | Seriousf | No serious indirectness | Seriousc | None | 10/193 (5.2%) | 6/176 (3.4%) | RR 1.48 (0.56 to 3.94) | 16 more per 1000 (from 15 fewer to 100 more) | ⊕⊕⊖⊖ Low | Critical |
| Gestational hypertension | ||||||||||||
| 3 | Randomised trials | No serious limitationsa,b | Seriousf | No serious indirectness | Seriousc | None | 28/223 (12.6%) | 23/207 (11.1%) | RR 1.19 (0.74 to 1.9) | 21 more per 1000 (from 29 fewer to 100 more) | ⊕⊕⊖⊖ Low | Critical |
| GDM | ||||||||||||
| 3 | Randomised trials | No serious limitationsa,b | No serious indirectness | Seriousc | None | 16/205 (7.8%) | 15/185 (8.1%) | RR 0.96 (0.49 to 1.86) | 3 fewer per 1000 (from 41 fewer to 70 more) | ⊕⊕⊕⊖ Moderate | Critical | |
| Preterm delivery | ||||||||||||
| 3 | Randomised trials | No serious limitationsa,b | No serious inconsistency | Seriouse | No serious imprecision | Noned | 12/198 (6.1%) | 11/181 (6.1%) | RR 1.02 (0.47 to 2.21) | 1 more per 1000 (from 32 fewer to 74 more) | ⊕⊕⊕⊖ Moderate | Critical |
| Caesarean section | ||||||||||||
| 5 | Randomised trials | No serious limitationsa,b | No serious inconsistency | Seriouse | No serious imprecision | Reporting biasg | 66/297 (22.2%) | 62/267 (23.2%) | RR 0.95 (0.7 to 1.28) | 12 fewer per 1000 (from 70 fewer to 65 more) | ⊕⊕⊖⊖ Low | Critical |
| Induction of labour | ||||||||||||
| 1 | Randomised trials | No serious limitations | No serious inconsistencyh | No serious indirectnessi | Seriousc | None | 24/42 (57.1%) | 21/43 (48.8%) | RR 1.17 (0.78 to 1.75) | 83 more per 1000 (from 107 fewer to 366 more) | ⊕⊕⊕⊖ Moderate | Critical |
| Post-partum haemorrhage: not reported | ||||||||||||
| 0 | – | – | – | – | – | None | 0/0 (0%) | 0/0 (0%) | – | – | Critical | |
| Intrauterine death: not reported | ||||||||||||
| 1k | Observational studies | Very serious1 | No serious inconsistency | Seriouse | No serious impression | None | 3/88 (3.4%) | 3/86 (3.5%) | OR 098 (0.19 to 2.56) | 1 fewer per 1000 (from 28 fewer to 50 more) | ⊕⊖⊖⊖ Very low | Critical |
| Admission to NICU: not reported | ||||||||||||
| 1k | Observational studies | Very serious1 | No serious inconsistency | Seriouse | No serious impression | None | 21/88 (23.9%) | 42/86 (48.8%) | OR 0.33 (0.17 to 0.63) | 249 fewer per 1000 (from 113 fewer to 349 fewer) | ⊕⊖⊖⊖ Very low | Critical |
| Shoulder dystocia | ||||||||||||
| 1 | Randomised trials | No serious limitationsa,b | No serious inconsistency | No serious indirectness | Seriousc | None | 1/124 (0.8%) | 1/111 (0.9%) | RR 0.9 (0.06 to 14.14) | 1 fewer per 1000 (from 8 fewer to 118 more) | ⊕⊕⊕⊖ Moderate | Critical |
| Birth trauma: not measured | ||||||||||||
| 0 | – | – | – | – | – | None | 0/0 (0%) | 0/0 (0%) | – | – | Critical | |
| Neonatal hypoglycaemia | ||||||||||||
| 2 | Randomised trials | No serious limitations | No serious inconsistency | No serious indirectness | Seriousc | Reporting biasj | 5/141 (3.5%) | 2/128 (1.6%) | RR 2.35 (0.47 to 11.76) | 19 more per 1000 (from 172 more to 9 fewer) | ⊕⊕⊖⊖ Low | Critical |
- a
Poor information about allocation concealment, which was assessed as not strongly significant.
- b
Poor information about blinding of subjective outcomes, which was assessed as not strongly significant.
- c
Wide CI crossing line of no effect.
- d
Slight skew in funnel plot for given outcome.
- e
Women with GDM.
- f
Differences in range of interventions (intervention programme, behavioural intervention, advisory concerning adequate weight gain).
- g
Meaningful skew in funnel plot for given outcome.
- h
Single study.
- i
Small sample size.
- j
Difficult to interpret as only two studies.
- k
Data from observational studies Penchar 2009.82
- l
Study of low quality (Penchart 200982); weakness in cohort representativeness, selection of exposed cohort, asscertainment of exopsure and cohorts comparability.
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