Interventions during pregnancy to reduce excessive gestational weight gain: a systematic review assessing current clinical evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.
BACKGROUND
Excessive weight gain during pregnancy is common in developed countries and increases the risk of complications during pregnancy, delivery and the postpartum period, which can affect both maternal and fetal outcome. Interventions to reduce excessive gestational weight gain have previously not been systematically evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.


OBJECTIVE
To determine whether published trials of interventions to reduce excessive gestational weight gain are of sufficient quality and provide sufficient data to enable evidence-based recommendations to be developed for clinical practice in antenatal care.


METHODS
A literature search was conducted in the scientific databases PubMed, Cochrane Library, Cinhal and Pedro, and the reference lists of relevant articles were reviewed. The literature search was concluded on 15 August 2009.


METHODS
All randomised controlled trials (RCTs) were considered for inclusion. As the number of published RCTs was limited, we also considered for inclusion all nonrandomised intervention studies that included a control group. Systematic reviews were examined to identify additional original studies.


METHODS
Two reviewers independently assessed the quality of the methods and results of all included articles. Extracted data were classified using the GRADE system.


RESULTS
Four intervention studies with a randomised controlled design and four intervention trials with a nonrandomised controlled design met the inclusion criteria. As a consequence of important limitations in study design, inconsistency and lack of directness, the overall quality of evidence was judged to be very low using the GRADE system.


CONCLUSIONS
The results of published intervention trials are of insufficient quality to enable evidence-based recommendations to be developed for clinical practice in antenatal care.
Ronnberg
A K
AK
Department of Obstetrics and Gynaecology, Orebro University Hospital, Orebro, Sweden. ann-kristin.ronnberg@orebroll.se
Nilsson
K
K
D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D018849:Controlled Clinical Trials as Topic / Q000592:standards; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D009765:Obesity / Q000178:diet therapy / Q000517:prevention & control*; D010353:Patient Education as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000178:diet therapy / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D012107:Research Design; D015430:Weight Gain / Q000502:physiology*; D055815:Young Adult