Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: individual participant data meta-analysis

Eileen C O'Brien; Ricardo Segurado; Aisling A Geraghty; Goiuri Alberdi; Ewelina Rogozinska; Arne Astrup; Rubenomar Barakat Carballo; Annick Bogaerts; Jose Guilherme Cecatti; Arri Coomarasamy; Christianne J M de Groot; Roland Devlieger; Jodie M Dodd; Nermeen El Beltagy; Fabio Facchinetti; Nina Rica Wium Geiker; Kym Guelfi; Lene Haakstad; Cheryce Harrison; Hans Hauner; Dorte M Jensen; Khalid Khan; Tarja Inkeri Kinnunen; Riitta Luoto; Ben Willem Mol; Siv Mørkved; Narges Motahari-Tabari; Julie A Owens; Maria Perales; Elisabetta Petrella; Suzanne Phelan; Lucilla Poston; Kathrin Rauh; Girish Rayanagoudar; Kristina M Renault; Anneloes E Ruifrok; Linda Sagedal; Kjell Å Salvesen; Tania T Scudeller; Gary Shen; Alexis Shub; Signe N Stafne; Fernanda G Surita; Shakila Thangaratinam; Serena Tonstad; Mireille N M van Poppel; Christina Vinter; Ingvild Vistad; SeonAe Yeo; Fionnuala M McAuliffe; i-WIP (International Weight Management in Pregnancy) Collaborative Group

doi:10.1136/bmjopen-2018-025620

Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: individual participant data meta-analysis

Eileen C O'Brien, Ricardo Segurado, Aisling A Geraghty, Goiuri Alberdi, Ewelina Rogozinska, Arne Astrup, Rubenomar Barakat Carballo, Annick Bogaerts, Jose Guilherme Cecatti, Arri Coomarasamy, Christianne J M de Groot, Roland Devlieger, Jodie M Dodd, Nermeen El Beltagy, Fabio Facchinetti, Nina Rica Wium Geiker, Kym Guelfi, Lene Haakstad, Cheryce Harrison, Hans HaunerDorte M Jensen, Khalid Khan, Tarja Inkeri Kinnunen, Riitta Luoto, Ben Willem Mol, Siv Mørkved, Narges Motahari-Tabari, Julie A Owens, Maria Perales, Elisabetta Petrella, Suzanne Phelan, Lucilla Poston, Kathrin Rauh, Girish Rayanagoudar, Kristina M Renault, Anneloes E Ruifrok, Linda Sagedal, Kjell Å Salvesen, Tania T Scudeller, Gary Shen, Alexis Shub, Signe N Stafne, Fernanda G Surita, Shakila Thangaratinam, Serena Tonstad, Mireille N M van Poppel, Christina Vinter, Ingvild Vistad, SeonAe Yeo, Fionnuala M McAuliffe^*, i-WIP (International Weight Management in Pregnancy) Collaborative Group

^*Corresponding author for this work

Obesity Research

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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.

Original language	English
Article number	e025620
Journal	B M J Open
Volume	9
Issue number	8
Number of pages	12
ISSN	2044-6055
DOIs	https://doi.org/10.1136/bmjopen-2018-025620
Publication status	Published - 1 Aug 2019

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O'Brien et al_B M J Open_2019_Vol 9(8)_e025620Final published version, 492 KBLicence: CC BY

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O'Brien, E. C., Segurado, R., Geraghty, A. A., Alberdi, G., Rogozinska, E., Astrup, A., Barakat Carballo, R., Bogaerts, A., Cecatti, J. G., Coomarasamy, A., de Groot, C. J. M., Devlieger, R., Dodd, J. M., El Beltagy, N., Facchinetti, F., Geiker, N. R. W., Guelfi, K., Haakstad, L., Harrison, C., ... i-WIP (International Weight Management in Pregnancy) Collaborative Group (2019). Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: individual participant data meta-analysis. B M J Open, 9(8), [e025620]. https://doi.org/10.1136/bmjopen-2018-025620

O'Brien, EC, Segurado, R, Geraghty, AA, Alberdi, G, Rogozinska, E, Astrup, A, Barakat Carballo, R, Bogaerts, A, Cecatti, JG, Coomarasamy, A, de Groot, CJM, Devlieger, R, Dodd, JM, El Beltagy, N, Facchinetti, F, Geiker, NRW, Guelfi, K, Haakstad, L, Harrison, C, Hauner, H, Jensen, DM, Khan, K, Kinnunen, TI, Luoto, R, Willem Mol, B, Mørkved, S, Motahari-Tabari, N, Owens, JA, Perales, M, Petrella, E, Phelan, S, Poston, L, Rauh, K, Rayanagoudar, G, Renault, KM, Ruifrok, AE, Sagedal, L, Salvesen, KÅ, Scudeller, TT, Shen, G, Shub, A, Stafne, SN, Surita, FG, Thangaratinam, S, Tonstad, S, van Poppel, MNM, Vinter, C, Vistad, I, Yeo, S, McAuliffe, FM & i-WIP (International Weight Management in Pregnancy) Collaborative Group 2019, 'Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: individual participant data meta-analysis', B M J Open, vol. 9, no. 8, e025620. https://doi.org/10.1136/bmjopen-2018-025620

@article{61b5354afc2144d4aaf1e03975c94e5e,

title = "Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: individual participant data meta-analysis",

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.",

author = "O'Brien, {Eileen C} and Ricardo Segurado and Geraghty, {Aisling A} and Goiuri Alberdi and Ewelina Rogozinska and Arne Astrup and {Barakat Carballo}, Rubenomar and Annick Bogaerts and Cecatti, {Jose Guilherme} and Arri Coomarasamy and {de Groot}, {Christianne J M} and Roland Devlieger and Dodd, {Jodie M} and {El Beltagy}, Nermeen and Fabio Facchinetti and Geiker, {Nina Rica Wium} and Kym Guelfi and Lene Haakstad and Cheryce Harrison and Hans Hauner and Jensen, {Dorte M} and Khalid Khan and Kinnunen, {Tarja Inkeri} and Riitta Luoto and {Willem Mol}, Ben and Siv M{\o}rkved and Narges Motahari-Tabari and Owens, {Julie A} and Maria Perales and Elisabetta Petrella and Suzanne Phelan and Lucilla Poston and Kathrin Rauh and Girish Rayanagoudar and Renault, {Kristina M} and Ruifrok, {Anneloes E} and Linda Sagedal and Salvesen, {Kjell {\AA}} and Scudeller, {Tania T} and Gary Shen and Alexis Shub and Stafne, {Signe N} and Surita, {Fernanda G} and Shakila Thangaratinam and Serena Tonstad and {van Poppel}, {Mireille N M} and Christina Vinter and Ingvild Vistad and SeonAe Yeo and McAuliffe, {Fionnuala M} and {i-WIP (International Weight Management in Pregnancy) Collaborative Group}",

note = "CURIS 2019 NEXS 253 {\textcopyright} Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.",

year = "2019",

month = aug,

day = "1",

doi = "10.1136/bmjopen-2018-025620",

language = "English",

volume = "9",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "8",

}

TY - JOUR

T1 - Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain

T2 - individual participant data meta-analysis

AU - O'Brien, Eileen C

AU - Segurado, Ricardo

AU - Geraghty, Aisling A

AU - Alberdi, Goiuri

AU - Rogozinska, Ewelina

AU - Astrup, Arne

AU - Barakat Carballo, Rubenomar

AU - Bogaerts, Annick

AU - Cecatti, Jose Guilherme

AU - Coomarasamy, Arri

AU - de Groot, Christianne J M

AU - Devlieger, Roland

AU - Dodd, Jodie M

AU - El Beltagy, Nermeen

AU - Facchinetti, Fabio

AU - Geiker, Nina Rica Wium

AU - Guelfi, Kym

AU - Haakstad, Lene

AU - Harrison, Cheryce

AU - Hauner, Hans

AU - Jensen, Dorte M

AU - Khan, Khalid

AU - Kinnunen, Tarja Inkeri

AU - Luoto, Riitta

AU - Willem Mol, Ben

AU - Mørkved, Siv

AU - Motahari-Tabari, Narges

AU - Owens, Julie A

AU - Perales, Maria

AU - Petrella, Elisabetta

AU - Phelan, Suzanne

AU - Poston, Lucilla

AU - Rauh, Kathrin

AU - Rayanagoudar, Girish

AU - Renault, Kristina M

AU - Ruifrok, Anneloes E

AU - Sagedal, Linda

AU - Salvesen, Kjell Å

AU - Scudeller, Tania T

AU - Shen, Gary

AU - Shub, Alexis

AU - Stafne, Signe N

AU - Surita, Fernanda G

AU - Thangaratinam, Shakila

AU - Tonstad, Serena

AU - van Poppel, Mireille N M

AU - Vinter, Christina

AU - Vistad, Ingvild

AU - Yeo, SeonAe

AU - McAuliffe, Fionnuala M

AU - i-WIP (International Weight Management in Pregnancy) Collaborative Group

PY - 2019/8/1

Y1 - 2019/8/1

N2 - 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.

AB - 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.

U2 - 10.1136/bmjopen-2018-025620

DO - 10.1136/bmjopen-2018-025620

M3 - Journal article

C2 - 31375602

SN - 2044-6055

VL - 9

JO - BMJ Open

JF - BMJ Open

IS - 8

M1 - e025620

ER -

Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: individual participant data meta-analysis

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