Total word count (excluding references, tables) - 3084 Multiple Antenatal Interventions for weight management & pregnancy complications in overweight or obese pregnant women: A systematic Review. Introduction
Obesity has detrimental health consequences. It is relatively measured in terms of Body mass index (BMI). An increase in BMI leads to increase risk of overweight and obesity. As per 2005, ≥approximately 1.6 billion adults (age 15+) were overweight and 400 million were obese1. Obesity is the fifth most important risk factor contributing to deaths worldwide2. Obesity causes cardiovascular disease, diabetes, osteoarthritis and cancer2. Obesity was considered a problem associated with high income countries, but the trend is reversing with increase prevalence in middle and low income countries particularly in urban areas. The major reason accounts to shift in eating patterns towards energy dense food which is high in sugar but low in vitamins, minerals & other micronutrients. A trend towards decrease in physical activity with sedentary lifestyle and increasing urbanisation is also a major contributing factor for obesity2. Obesity during pregnancy leads to hypertension3, gestational diabetes3,4, delivery by emergency caesarean section4, delivery of large-for-gestational age infant4. In UK, prevalence of women with a known BMI of 35, at any point of pregnancy; stands at 4.99%5. By 2050, 50% of females in United Kingdom (UK) will be obese and UK would become an obese society6. Obesity has become a national health challenge in United States of America with 35.5% adult women categorised as obese7. Maternal obesity carries significant risk for mother and foetus. At least 20 million children under the age of 5 years are overweight globally2. Pregnancy is considered a vital period in a women’s life. Interventions introduced during pregnancy will motivate women to reduce weight. The interventions should not possess any risk to the women and foetus. Maternal obesity leads to increase chances of childhood obesity in new-born8. This continues in the form of a viscous cycle affecting future generations. Obesity is closely related to lifestyle habits like overeating, lack of physical activities and alcoholism. Along with dietary modifications and increased physical activity, behavioural therapy will be very vital in motivating patients towards managing obesity in pregnancy. A review to test the effectiveness of interventions aimed at reducing obesity during pregnancy is necessary. This will help in proposing new interventions, if the current interventions are not effective. The primary objective of the review is to assess the effectiveness of different interventions used in reducing obesity during pregnancy and subsequent complications of pregnancy and childbirth. Three systematic reviews (SR) in the past have been conducted. A.K. Ronnberg et. al. 9 had a narrower scope with studies from English and Scandinavian countries only. The outcome measured only pregnancy weight gain. Dodd et. al. 10 captured multiple findings like large-for-gestational age infant and wide range of clinical outcomes, but included studies with single intervention also. F. Campbell et. al. 11 encompasses a broader range by measuring the effectiveness of interventions, their cost effectiveness and factors influencing effectiveness. Previous SR has included studies with one intervention also, but this SR will include only those studies with ≥2 interventions. Multi dimensional approach focusing on diet, exercise and behavioural change will be required in the intervention plan for effective results. A brief overview of prospective study protocol by Smith et. al. 12 stresses upon the need of a lifestyle intervention programme aimed at behavioural change therapy, addresses the need of multidimensional approach. The limitation of the programme lies in the inclusion criteria, where women till 30 weeks of gestation were included for the...
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