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Combined dietary-exercise intervention for gestational weight gain and birthweight: a meta-analysis.

BACKGROUND AND OBJECTIVES
Excessive gestational weight gain has been associated with higher risk for large for gestational age newborns. This systematic review and meta-analysis aims to assess whether an intensive diet and exercise intervention has an effect in reducing gestational weight gain and large for gestational age newborns.


METHODS AND STUDY DESIGN
The search was conducted on PubMed and Cochrane database. Through PRISMA flow diagram, clinical trials which met the inclusion criteria were selected. Risk of bias, sensitivity analysis, and quality of evidence assessment were conducted using adequate statistical tests, and the quality of evidence was performed by GRADE method. A random-effect model was used to estimate the statistical significance of the meta- analysis.


RESULTS
Ten clinical trials met the inclusion criteria. Using the random-effect model and a sensitivity analysis, it was found that an intensive patient-centered intervention reduced gestational weight gain when compared with standard prenatal care (Z=6.21 (p<0.00001); Tau²=0.00; Chi²=3.90, df=4 (p=0.42); I²=0%), and the quality of evidence was moderate. An intensive diet and exercise intervention decreased the number of large for gestational age newborns (Z=2.20 (p=0.03); Tau²=0.14; Chi²=7.84, df=4 (p=0.10); I²=49%), and the quality of evidence using the GRADE approach was moderate.


CONCLUSION
The present review and meta-analysis indicates that an intensive diet and exercise intervention reduced gestational weight gain and large for gestational age newborns.