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Effectiveness of multimodal nutrition interventions during pregnancy to achieve 2009 Institute of Medicine gestational weight gain guidelines: a systematic review and meta-analysis

BACKGROUND: In 2009, the Institute of Medicine (IOM) published a revision to its 1990 recommendations on gestational weight gain (GWG). The objective of this review is to update a previous systematic review and meta-analysis to evaluate the effectiveness of nutrition interventions in achieving recom...

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Autores principales: Beauchesne, Andrew R., Cara, Kelly Copeland, Chen, Jiawen, Yao, Qisi, Penkert, Laura Paige, Yang, Wenfang, Chung, Mei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Taylor & Francis 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284157/
https://www.ncbi.nlm.nih.gov/pubmed/34263669
http://dx.doi.org/10.1080/07853890.2021.1947521
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author Beauchesne, Andrew R.
Cara, Kelly Copeland
Chen, Jiawen
Yao, Qisi
Penkert, Laura Paige
Yang, Wenfang
Chung, Mei
author_facet Beauchesne, Andrew R.
Cara, Kelly Copeland
Chen, Jiawen
Yao, Qisi
Penkert, Laura Paige
Yang, Wenfang
Chung, Mei
author_sort Beauchesne, Andrew R.
collection PubMed
description BACKGROUND: In 2009, the Institute of Medicine (IOM) published a revision to its 1990 recommendations on gestational weight gain (GWG). The objective of this review is to update a previous systematic review and meta-analysis to evaluate the effectiveness of nutrition interventions in achieving recommended GWG. METHODS: We conducted updated literature searches in MEDLINE(®) (2012 through 2019), Web of Science (2012 to 6 February 2017), Embase (2016 through 2019), and Cochrane Central Register of Controlled Trials (2012 through 2019). Literature published before January 2012 was identified from a published systematic review. We included controlled trials conducted in the U.S. or Canada among generally healthy pregnant women that compared nutrition interventions with or without exercise to controls (e.g., usual care) and reported total GWG or rate of GWG based on the 2009 IOM GWG guidelines. Two independent investigators conducted screening, data extraction, and risk-of-bias (ROB) assessment. Random-effects meta-analyses were conducted when data were sufficient. RESULTS: Eighteen unique studies were included, of which 11 were conducted in women with overweight or obesity. Nutrition interventions, compared to controls, had a similar effect on total GWG (mean difference = −1.24 kg; 95% CI [−2.65, 0.18]; I(2)=67.6%) but significantly decreased second and third trimester rate of GWG (−0.07 kg/week; 95% CI [−0.12, −0.03]; I(2)=54.7%). Nutrition interventions also reduced the risk of exceeding IOM’s rate of GWG targets (pooled RR = 0.71; 95% CI [0.55, 0.92]; I(2)=86.3%). Meta-analyses showed no significant differences in achieving IOM’s total GWG or any secondary outcome (e.g., preterm birth or small/large for gestational age) between groups. Most studies were assessed as having some or high ROB in at least two domains. CONCLUSION: Multimodal nutrition interventions designed to meet the 2009 IOM’s GWG targets may decrease the rate of GWG over the second and third trimesters but may not decrease total GWG. KEY MESSAGES: Excessive gestational weight gain is associated with higher risk of many adverse maternal and fetal outcomes and represents a public health concern in the United States and Canada. Nutrition interventions designed to meet the 2009 IOM GWG guidelines may decrease the rates of GWG over the second and third trimesters but may not be effective at reducing total GWG.
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spelling pubmed-82841572021-08-02 Effectiveness of multimodal nutrition interventions during pregnancy to achieve 2009 Institute of Medicine gestational weight gain guidelines: a systematic review and meta-analysis Beauchesne, Andrew R. Cara, Kelly Copeland Chen, Jiawen Yao, Qisi Penkert, Laura Paige Yang, Wenfang Chung, Mei Ann Med Pregnancy, Childbirth & Women's Health BACKGROUND: In 2009, the Institute of Medicine (IOM) published a revision to its 1990 recommendations on gestational weight gain (GWG). The objective of this review is to update a previous systematic review and meta-analysis to evaluate the effectiveness of nutrition interventions in achieving recommended GWG. METHODS: We conducted updated literature searches in MEDLINE(®) (2012 through 2019), Web of Science (2012 to 6 February 2017), Embase (2016 through 2019), and Cochrane Central Register of Controlled Trials (2012 through 2019). Literature published before January 2012 was identified from a published systematic review. We included controlled trials conducted in the U.S. or Canada among generally healthy pregnant women that compared nutrition interventions with or without exercise to controls (e.g., usual care) and reported total GWG or rate of GWG based on the 2009 IOM GWG guidelines. Two independent investigators conducted screening, data extraction, and risk-of-bias (ROB) assessment. Random-effects meta-analyses were conducted when data were sufficient. RESULTS: Eighteen unique studies were included, of which 11 were conducted in women with overweight or obesity. Nutrition interventions, compared to controls, had a similar effect on total GWG (mean difference = −1.24 kg; 95% CI [−2.65, 0.18]; I(2)=67.6%) but significantly decreased second and third trimester rate of GWG (−0.07 kg/week; 95% CI [−0.12, −0.03]; I(2)=54.7%). Nutrition interventions also reduced the risk of exceeding IOM’s rate of GWG targets (pooled RR = 0.71; 95% CI [0.55, 0.92]; I(2)=86.3%). Meta-analyses showed no significant differences in achieving IOM’s total GWG or any secondary outcome (e.g., preterm birth or small/large for gestational age) between groups. Most studies were assessed as having some or high ROB in at least two domains. CONCLUSION: Multimodal nutrition interventions designed to meet the 2009 IOM’s GWG targets may decrease the rate of GWG over the second and third trimesters but may not decrease total GWG. KEY MESSAGES: Excessive gestational weight gain is associated with higher risk of many adverse maternal and fetal outcomes and represents a public health concern in the United States and Canada. Nutrition interventions designed to meet the 2009 IOM GWG guidelines may decrease the rates of GWG over the second and third trimesters but may not be effective at reducing total GWG. Taylor & Francis 2021-07-15 /pmc/articles/PMC8284157/ /pubmed/34263669 http://dx.doi.org/10.1080/07853890.2021.1947521 Text en © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Pregnancy, Childbirth & Women's Health
Beauchesne, Andrew R.
Cara, Kelly Copeland
Chen, Jiawen
Yao, Qisi
Penkert, Laura Paige
Yang, Wenfang
Chung, Mei
Effectiveness of multimodal nutrition interventions during pregnancy to achieve 2009 Institute of Medicine gestational weight gain guidelines: a systematic review and meta-analysis
title Effectiveness of multimodal nutrition interventions during pregnancy to achieve 2009 Institute of Medicine gestational weight gain guidelines: a systematic review and meta-analysis
title_full Effectiveness of multimodal nutrition interventions during pregnancy to achieve 2009 Institute of Medicine gestational weight gain guidelines: a systematic review and meta-analysis
title_fullStr Effectiveness of multimodal nutrition interventions during pregnancy to achieve 2009 Institute of Medicine gestational weight gain guidelines: a systematic review and meta-analysis
title_full_unstemmed Effectiveness of multimodal nutrition interventions during pregnancy to achieve 2009 Institute of Medicine gestational weight gain guidelines: a systematic review and meta-analysis
title_short Effectiveness of multimodal nutrition interventions during pregnancy to achieve 2009 Institute of Medicine gestational weight gain guidelines: a systematic review and meta-analysis
title_sort effectiveness of multimodal nutrition interventions during pregnancy to achieve 2009 institute of medicine gestational weight gain guidelines: a systematic review and meta-analysis
topic Pregnancy, Childbirth & Women's Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284157/
https://www.ncbi.nlm.nih.gov/pubmed/34263669
http://dx.doi.org/10.1080/07853890.2021.1947521
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