title: The effects of culture on guideline discordant gestational weight gain: a systematic review protocol.
abstract: BACKGROUND
  A significant proportion of women exceeds or does not meet the Institute of Medicine's gestational weight gain (GWG) guidelines. Inadequate, excessive GWG or weight loss during pregnancy is associated with an increased risk of negative maternal and fetal outcomes. Among the many determinants of GWG identified in the 2009 Institute of Medicine guidelines, culture was named as one of the few whose influence has not been fully explored. Some cultural beliefs may erroneously promote overeating as "eating for two" and discourage physical activity during pregnancy, but there is lack of empirical evidence on how culture affects GWG. The purpose of this systematic review is to examine the effects of culture on GWG.
  
  
  METHODS
  Ten electronic databases will be searched to identify studies reporting on the effects of culture on GWG. Grey literature, published conference abstracts, websites of relevant organizations and reference lists of included studies will also be searched. Studies that report on effects of culture, acculturation, ethnicity, race, nationality, ancestry and identity on GWG in adult women will be included. Quality of evidence will be evaluated using the grading of recommendations, assessment, development and evaluations (GRADE) approach to rating evidence. Study selection, data extraction and risk of bias assessment will be conducted by two independent reviewers, with disagreements being resolved by consensus or third party adjudication as needed. Formal meta-analyses will be conducted among included studies that are sufficiently statistically and clinically homogeneous.
  
  
  CONCLUSIONS
  This review will provide a comprehensive assessment and synthesis of current evidence and will draw attention to potential gaps where future research on the effects of culture on guideline discordant gestational weight gain remains to be conducted.
  
  
  BACKGROUND
  PROSPERO CRD42015023399.
authors.affiliation: Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. tmanyanga@cheo.on.ca.|School of Human Kinetics, University of Ottawa, Faculty of Health Sciences, Ottawa, ON, K1H 8L6, Canada. tmanyanga@cheo.on.ca.
authors.forename: Taru
authors.initials: T
authors.lastname: Manyanga
authors.affiliation: Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. dadasilva@cheo.on.ca.|Department of Physical Education, State University of Maringa, Maringa, PR, 87020-900, Brazil. dadasilva@cheo.on.ca.
authors.forename: Danilo F
authors.initials: DF
authors.lastname: da Silva
authors.affiliation: Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. zach.ferraro@gmail.com.|Division of Maternal-Fetal Medicine, The Ottawa Hospital, General Campus, Ottawa, ON, K1H 8L6, Canada. zach.ferraro@gmail.com.|Faculty of Medicine, University of Ottawa, Ottawa, ON, K1H 8L6, Canada. zach.ferraro@gmail.com.
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Ferraro
authors.affiliation: Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. aharvey@cheo.on.ca.|School of Human Kinetics, University of Ottawa, Faculty of Health Sciences, Ottawa, ON, K1H 8L6, Canada. aharvey@cheo.on.ca.
authors.forename: Alysha L J
authors.initials: AL
authors.lastname: Harvey
authors.affiliation: Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. shwilson@cheo.on.ca.
authors.forename: Shanna
authors.initials: S
authors.lastname: Wilson
authors.affiliation: Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. hockenden@cheo.on.ca.|School of Human Kinetics, University of Ottawa, Faculty of Health Sciences, Ottawa, ON, K1H 8L6, Canada. hockenden@cheo.on.ca.
authors.forename: Holly N
authors.initials: HN
authors.lastname: Ockenden
authors.affiliation: Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. kristi.adamo@uottawa.ca.|School of Human Kinetics, University of Ottawa, Faculty of Health Sciences, Ottawa, ON, K1H 8L6, Canada. kristi.adamo@uottawa.ca.|Department of Pediatrics, University of Ottawa, Faculty of Medicine, Ottawa, ON, K1H 8L6, Canada. kristi.adamo@uottawa.ca.
authors.forename: Kristi B
authors.initials: KB
authors.lastname: Adamo
mesh_terms: D003469:Culture; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D011247:Pregnancy; D012107:Research Design; D000078202:Systematic Reviews as Topic; D015430:Weight Gain / Q000208:ethnology*