title: A systematic review and metaanalysis of energy intake and weight gain in pregnancy.
abstract: BACKGROUND
  Gestational weight gain within the recommended range produces optimal pregnancy outcomes, yet many women exceed the guidelines. Official recommendations to increase energy intake by ∼ 1000 kJ/day in pregnancy may be excessive.
  
  
  OBJECTIVE
  To determine by metaanalysis of relevant studies whether greater increments in energy intake from early to late pregnancy corresponded to greater or excessive gestational weight gain.
  
  
  METHODS
  We systematically searched electronic databases for observational and intervention studies published from 1990 to the present. The databases included Ovid Medline, Cochrane Library, Excerpta Medica DataBASE (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Science Direct. In addition we hand-searched reference lists of all identified articles.
  
  
  METHODS
  Studies were included if they reported gestational weight gain and energy intake in early and late gestation in women of any age with a singleton pregnancy. Search also encompassed journals emerging from both developed and developing countries.
  
  
  METHODS
  Studies were individually assessed for quality based on the Quality Criteria Checklist obtained from the Evidence Analysis Manual: Steps in the academy evidence analysis process. Publication bias was plotted by the use of a funnel plot with standard mean difference against standard error. Identified studies were meta-analyzed and stratified by body mass index, study design, dietary methodology, and country status (developed/developing) by the use of a random-effects model.
  
  
  RESULTS
  Of 2487 articles screened, 18 studies met inclusion criteria. On average, women gained 12.0 (2.8) kg (standardized mean difference = 1.306, P < .0005) yet reported only a small increment in energy intake that did not reach statistical significance (∼475 kJ/day, standard mean difference = 0.266, P = .016). Irrespective of baseline body mass index, study design, dietary methodology, or country status, changes in energy intake were not significantly correlated to the amount of gestational weight gain (r = 0.321, P = .11).
  
  
  CONCLUSIONS
  Despite rapid physiologic weight gain, women report little or no change in energy intake during pregnancy. Current recommendations to increase energy intake by ∼ 1000 kJ/day may, therefore, encourage excessive weight gain and adverse pregnancy outcomes.
authors.affiliation: School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Camperdown NSW Australia.
authors.forename: Hiba
authors.initials: H
authors.lastname: Jebeile
authors.affiliation: School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Camperdown NSW Australia.
authors.forename: Jovana
authors.initials: J
authors.lastname: Mijatovic
authors.affiliation: School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Camperdown NSW Australia.
authors.forename: Jimmy Chun Yu
authors.initials: JCY
authors.lastname: Louie
authors.affiliation: Department of Statistics, Faculty of Science and Engineering, Macquarie University, Sydney NSW Australia.
authors.forename: Tania
authors.initials: T
authors.lastname: Prvan
authors.affiliation: School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Camperdown NSW Australia. Electronic address: jennie.brandmiller@sydney.edu.au.
authors.forename: Jennie C
authors.initials: JC
authors.lastname: Brand-Miller
mesh_terms: D004032:Diet; D019587:Dietary Supplements; D002149:Energy Intake; D005260:Female; D006801:Humans; D018977:Micronutrients / Q000008:administration & dosage; D011247:Pregnancy; D011295:Prenatal Care; D015430:Weight Gain
chemical_list: D018977:Micronutrients
keywords: energy intake; first trimester; gestational weight gain; pregnancy; third trimester