A Systematic Review and Bayesian Network Meta-Analysis Comparing In-Person, Remote, and Blended Interventions in Physical Activity, Diet, Education, and Behavioral Modification on Gestational Weight Gain among Overweight or Obese Pregnant Individuals

IF 8 1区 医学 Q1 NUTRITION & DIETETICS
Hongli Yu , Mingmao Li , Guoping Qian , Shuqi Yue , Zbigniew Ossowski , Anna Szumilewicz
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引用次数: 0

Abstract

Background

Despite the well-documented adverse outcomes associated with obesity during pregnancy, this condition remains a promising modifiable risk factor.

Objectives

The aim of this study was to ascertain the most effective treatment modalities for gestational weight gain (GWG) in pregnant women classified as overweight or obese.

Methods

A systematic search was conducted across 4 electronic databases: Embase, EBSCOhost, PubMed, and Web of Science. To assess the quality of evidence, the Confidence In Network Meta-Analysis (CINeMA) approach, grounded in the Grading of Recommendations Assessment, Development, and Evaluation framework, was employed. A Bayesian network meta-analysis was conducted to synthesize the comparative effectiveness of treatment modalities based on GWG outcomes.

Results

The analysis incorporated 60 randomized controlled trials, encompassing 16,615 participants. Modes of intervention administration were classified as remote (R: eHealth [e] and mHealth [m]), in-person (I), and a combination of both (I+R). The interventions comprised 5 categories: education (E), physical activity (PA), dietary (D), behavior modification (B), and combinations thereof. The quality of the evidence, as evaluated by CINeMA, ranged from very low to high. Compared to the control group, the I-D intervention (mean difference [MD]: −1.27; 95% confidence interval [CI]: −2.23, −0.32), I-PADB (MD: −0.60, 95% CI: −1.19, −0.00), and I-B (MD: −0.34, 95% CI: −0.57, −0.10) interventions showed significant efficacy in reducing GWG.

Conclusions

Preliminary findings suggest that the I-D intervention is the most efficacious in managing GWG among pregnant women who are overweight or obese, followed by I-PADB and I-B+R-B(m) treatments. These conclusions are drawn from evidence of limited quality and directness, including insufficient data on PA components used in the interventions. Owing to the absence of robust, direct evidence delineating significant differences among various GWG management strategies, it is tentatively proposed that the I-D intervention is likely the most effective approach.

This study was registered with PROSPERO as CRD42023473627.

系统性综述和贝叶斯网络元分析:比较面对面、远程和混合干预对超重或肥胖孕妇妊娠体重增加的影响。
背景:尽管孕期肥胖带来的不良后果已得到充分证实,但这种情况仍然是一种很有希望改变的风险因素:本研究旨在确定治疗超重或肥胖孕妇妊娠体重增加(GWG)的最有效方法:方法:在四个电子数据库中进行了系统检索:方法:在四个电子数据库中进行了系统检索:Embase、EBSCOhost、PubMed 和 Web of Science。为了评估证据的质量,采用了基于建议评估、发展和评价分级(GRADE)框架的信心网络荟萃分析(CINeMA)方法。通过贝叶斯网络荟萃分析,综合了基于 GWG 结果的各种治疗方法的比较效果:分析纳入了 60 项 RCT,涉及 16,615 名参与者。干预管理模式分为远程(R:电子健康(e)和移动健康(m))、面对面(I)和两者结合(I+R)。干预措施包括五类:教育(E)、体育锻炼(PA)、饮食(D)、行为矫正(B)以及这些措施的组合。经 CINeMA 评估,证据的质量从很低到很高不等。与对照组相比,I-D 干预(平均差 (MD) =-1.27,95% CI [-2.23,-0.32])、I-PADB(MD =-0.60,95% CI [-1.19,-0.00])和 I-B 干预(MD =-0.34,95% CI [-0.57,-0.10])在降低 GWG 方面显示出显著疗效:初步研究结果表明,I-D 干预疗法对控制超重或肥胖孕妇的 GWG 最有效,其次是 I-PADB 和 I-B+R-B(m)疗法。这些结论是根据质量和直接性有限的证据得出的,包括干预措施中使用的 PA 成分数据不足。由于缺乏有力的直接证据来说明各种 GWG 管理策略之间的显著差异,因此初步认为 I-D 干预可能是最有效的方法。系统综述或荟萃分析的登记处和登记号:国际前瞻性系统综述注册表,CRD42023473627 意义声明:本研究提出了新的方法,利用系统综述和贝叶斯荟萃分析,结合直接和间接证据,评估管理超重和肥胖孕妇妊娠体重增加的有效干预措施。这种方法通过评估各种干预方法的有效性和管理过程,弥补了之前的不足;为这一特殊孕妇群体提供了更全面的分析。
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来源期刊
Advances in Nutrition
Advances in Nutrition 医学-营养学
CiteScore
17.40
自引率
2.20%
发文量
117
审稿时长
56 days
期刊介绍: Advances in Nutrition (AN/Adv Nutr) publishes focused reviews on pivotal findings and recent research across all domains relevant to nutritional scientists and biomedical researchers. This encompasses nutrition-related research spanning biochemical, molecular, and genetic studies using experimental animal models, domestic animals, and human subjects. The journal also emphasizes clinical nutrition, epidemiology and public health, and nutrition education. Review articles concentrate on recent progress rather than broad historical developments. In addition to review articles, AN includes Perspectives, Letters to the Editor, and supplements. Supplement proposals require pre-approval by the editor before submission. The journal features reports and position papers from the American Society for Nutrition, summaries of major government and foundation reports, and Nutrient Information briefs providing crucial details about dietary requirements, food sources, deficiencies, and other essential nutrient information. All submissions with scientific content undergo peer review by the Editors or their designees prior to acceptance for publication.
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