Interventions to reduce or prevent obesity in pregnant women: A systematic review

Health Technology Assessment

Volumn 16, Issue 31, 2012, Pages 1-191

  Thangaratinam, S ^a,b   Rogozinska E ^a,c   Jolly, K ^b   Glinkowski, S ^c   Duda, W ^c   Borowiack, E ^c   Roseboom, T ^d   Tomlinson, J ^b   Walczak, J ^c   Kunz, R ^e   Mol, B W ^d   Coomarasamy, A ^b   Khan, K S ^a  

^a QUEEN MARY UNIVERSITY OF LONDON   (United Kingdom)

^b UNIVERSITY OF BIRMINGHAM   (United Kingdom)

^c Arcana Institute   (Poland)

^d ACADEMIC MEDICAL CENTER   (Netherlands)

^e UNIVERSITY HOSPITAL BASEL   (Switzerland)

Author keywords

[No Author keywords available]

Indexed keywords

ADVERSE OUTCOME; BODY MASS; CESAREAN SECTION; CLINICAL EFFECTIVENESS; DELPHI STUDY; DIET THERAPY; FETUS OUTCOME; FETUS WEIGHT; HIGH RISK PREGNANCY; HUMAN; INTERVENTION STUDY; LIFESTYLE MODIFICATION; MATERNAL CARE; MATERNAL HYPERTENSION; NEWBORN MORBIDITY; NEWBORN MORTALITY; OBESITY; OUTCOME ASSESSMENT; PHYSICAL ACTIVITY; PREECLAMPSIA; PREGNANCY DIABETES MELLITUS; PREGNANCY OUTCOME; PREGNANT WOMAN; PREMATURE LABOR; REVIEW; RISK ASSESSMENT; RISK BENEFIT ANALYSIS; RISK FACTOR; RISK REDUCTION; SHOULDER DYSTOCIA; SYSTEMATIC REVIEW; THERAPY EFFECT; VAGINAL DELIVERY; WEIGHT CHANGE; WEIGHT CONTROL; WEIGHT REDUCTION;

DATABASES, BIBLIOGRAPHIC; FEMALE; FOOD HABITS; HUMANS; LIFE STYLE; MOTOR ACTIVITY; OBESITY; OUTCOME ASSESSMENT (HEALTH CARE); PREGNANCY; PREGNANCY COMPLICATIONS; PREGNANCY OUTCOME;

EID: 84864503998     PISSN: 13665278     EISSN: 20464924     Source Type: Journal    
DOI: 10.3310/hta16310     Document Type: Review

References (152)

1. Kanagalingam MG, Forouhi NG, Greer IA, Sattar N. Changes in booking body mass over a decade: retrospective analysis from a Glasgow Maternity Hospital. BJOG 2005;112:1431-3.
2. Cedergren M. Effects of gestational weight gain and body mass index on obstetric outcome in Sweden. Int J Gynaecol Obstet 2006;93:269-74.
3. Thangaratinam S, Jolly K. Obesity in pregnancy: a review of reviews on the effectiveness of interventions. BJOG 2010;117:1309-12.
4. Lewis G, editor. The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving mothers' lives: reviewing maternal deaths to make motherhood safer-2003-2005. The Seventh Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. London: CEMACH; 2007.
5. Ramachenderan J, Bradford J, McLean J. Maternal obesity and pregnancy complications: a review. Aust N Z J Obstet Gynaecol 2008;48:228-45.
6. Dodd JM, Crowther CA, Robinson JS. Dietary and lifestyle interventions to limit weight gain during pregnancy for obese or overweight women: a systematic review. Acta Obstet Gynecol 2008;87:702-6.
7. Okens K, Taveras EM, Kleinman KP, Rich Edwards JW, Gillman MW. Maternal weight gain during pregnancy and child adiposity at age 3 years. Am J Obstet Gynecol 2007;322:e1-8.
8. Sharma AJ, Cogswell ME, Grummer Strawn LM. The association between pregnancy weight gain and childhood overweight is modified by mother's pre pregnancy BMI. Pediatr Res 2005;58:1038 (abstract).
9. Linne Y, Dye L, Barkeling B, Rossner S. Long term weight development in women: a 15 year follow up of the effects of pregnancy. Obes Res 2004;12:1166-78.
10. Rooney BL, Scahuberger CW. Excess pregnancy weight gain and long term obesity: one decade later. Obstet Gynecol 2002;100:252.
11. Villamar E, Cnattingius S. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population based study. Lancet 2006;368:1164-70.
12. Drake AJ, Reynolds RM. Impact of maternal obesity on offspring obesity and cardiometabolic disease risk. Reproduction 2010;140:387-98.
13. Centre for Maternal and Child Enquires and the Royal College of Obstetricians and Gynaecologists. Joint guideline-management of women with obesity in pregnancy. London: CMACE and the Royal College of Obstetricians and Gynaecologists; 2010.
14. National Institute for Health and Clinical Excellence (NICE). Dietary interventions and physical activity interventions for weight management before, during and after pregnancy. NICE public health guidance 27. London: NICE; 2010.
15. Galtier-Dereure F, Boegner C, Bringer J. Obesity and pregnancy: complications and cost. Am J Clin Nutr 2000;71:1242-8S.
16. Royal College of Obstetricians and Gynaecologists. URL: www.rcog.org.uk/news/cmacerelease-cmace-publishes-information-obesity-pregnancy 2010 (accessed 18 April 2012).
17. Jackson RA, Stotland NE, Caughey AB, Gerbert B. Improving diet and exercise in pregnancy with Video Doctor counseling: a randomized trial. Patient Educ Couns 2011;83:203-9.
18. Royal College of Obstetricians and Gynaecologists. Obesity and reproductive health-study group statement. Consensus views arising from the 53rd study group: obesity and reproductive health. London: RCOG; 2007.
19. American College of Obstetricians and Gynaecologists. ACOG committee opinion number 315, September 2005: obesity in pregnancy. Obstet Gynecol 2005;106:671-5.
20. Rasmussen KM, Yaktine AL, editors. Weight gain during pregnancy: re-examining the guidelines. Washington, DC: National Academies Press; 2009.
21. US Department of Health and Human Services. Healthy eating and physical activity across your life span: fit for two: tips for pregnancy: NIDDK Weight Control Information Network. NIH Publication No 02-5130, 2002.
22. Campbell F, Messina J, Johnson M, Guillaume L, Madan J, Goyder E. Systematic review of dietary and/or physical activity interventions for weight management in pregnancy. Sheffield: NICE Centre for Public Health Excellence; 2009.
23. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009;339:b2700.
24. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson D, Rennie D, et al. Meta analysis of observational studies in epidemiology: a proposal for reporting. Meta analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000;283:2008-12.
25. Wells G. The Newcastle Ottawa Scale (NOS) for assessing the quality of non-randomised studies in meta-analysis. Proceedings of the Third Symposium on Systematic Reviews. Beyond the basics: improving quality and impact. Oxford, 3-5 July, 2000.
26. Latthe PM, Foon R, Khan KS. Non surgical treatment of stress urinary continence (SUI): grading of evidence in systematic reviews. BJOG 2008;115:435-44.
27. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924-6.
28. Cochrane Adverse Effects Methods Group. URL: http//aemg.cochrane.org/resources-reviewauthors (accessed 18 April 2012).
29. Deeks JJ, Dinnes J, D'Amico R, Sowden AJ, Sakarovitch C, Song F, et al. Evaluating nonrandomised intervention studies. Health Technol Assess 2003;7(27).
30. Khan KS, ter Riet G, Glanville J, Sowden AJ, Kleijnen J. Undertaking systematic reviews of research on effectiveness. CRD's guidance for carrying out or commissioning reviews. CRD Report No. 4, 2nd edn. York: NHS Centre for Reviews and Dissemination, University of York; 2001.
31. Khan KS, Kunz R, Kleijnen J, Antes G. Systematic reviews to support evidence-based medicine: how to review and apply findings of systematic reviews. London: Royal Society of Medicine; 2003.
32. Loke YK, Price D, Herxheimer A for the Cochrane Adverse Effects Methods Group. Systematic reviews of adverse effects: framework for a structured approach. BMC Med Res Methodol 2007;7:32.
33. Wilson A, Lissauer D, Thangaratinam S, Khan KS, MacArthur C, Coomarasamy A. Clinical officers versus medical doctors for Caesarean surgery in the developing world: a metaanalysis of controlled studies. BMJ 2011;342:2600. DOI:10.1136/bmj.d2600
34. National Institute for Health and Clinical Excellence (NICE). Methods for the development of NICE public health guidance (second edition). London: NICE; April 2009.
35. Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration; 2011. URL: www.cochrane-handbook.org (accessed 18 April 2012).
36. Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottowa Hospital Research Institute. URL: www.ohri.ca/programs/clinical_epidemiology/oxford.asp (accessed 18 April 2012).
37. Ross SD. Drug-related adverse events-a readers' guide to assessing literature reviews and meta-analyses. Arch Intern Med 2001;161:1041-6.
38. Bagnall A-M, Jones L, Ginnelly L, Lewis R, Glanville J, Gilbody S, et al. A systematic review of atypical antipsychotic drugs in schizophrenia. Health Technol Assess 2003;7(13).
39. Royal Society of Medicine. Systematic reviews to support evidence-based medicine: how to review and apply findings of systematic reviews. London: Royal Society of Medicine; 2003.
40. Downs S, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 1998;52:377-84.
41. Glasziou P, Irwig L, Bain C, Colditz G. Frequency and rate. In Systematic reviews in healthcare: a practical guide, 2nd edn. Cambridge, Cambridge University Press; 2001. pp. 67-73.
42. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Schunemenn HJ. GRADE: what is 'quality of evidence' and why is it important to clinicians? BMJ 2008;336:995-8.
43. Khan KS, Borowiack E, Roos C, Kowalska M, Zapalska A, Mol BW, et al.; for the EBMCONNECT Collaboration. Making GRADE accessible: a proposal for graphic display of evidence quality assessments. Evid Based Med 2011;16:65-9.
44. Artal R, Catanzaro RB, Gavard JA, Mostello DJ, Friganza JC. A lifestyle intervention of weight-gain restriction: diet and exercise in obese women with gestational diabetes mellitus. Appl Physiol Nutr Metab 2007;32:596-601.
45. Borberg C, Gillmer MD, Brunner EJ, Gunn PJ, Oakley NW, Beard RW. Obesity in pregnancy: the effect of dietary advice. Diabetes Care 1980;3:476-81.
46. Campbell DM, MacGillivray I. The effect of a low calorie diet or a thiazide diuretic on the incidence of pre-eclampsia and on birth weight. Br J Obstet Gynaecol 1975;82:572-7.
47. Campbell DM. Dietary restriction in obesity and its effect on neonatal outcome. In Campbell DM, Gillmer MDG, editors. Nutrition in pregnancy. Proceedings of the 10th Study Group of the RCOG. London: 1983. pp. 243-50.
48. Casanueva E, Legarreta D, Diaz-Barriga M, Soberanis Y, Cardenas T, Iturriaga A, et al. Weight gain during pregnancy in adolescents: evaluation of a non-nutritional intervention. Rev Invest Clin 1994;46:157-61.
49. Claesson I-M, Sydsjo G, Brynhildsen J, Cedergren M, Jeppsson A, Nystrom F, et al. Weight gain restriction for obese pregnant women: a case-control intervention study. BJOG 2008;115:44-50.
50. Claesson I-M, Brynhildsen J, Cedergren M, Jeppsson A, Sydsjo A, Josefsson A. Weight gain restriction during pregnancy is safe for both the mother and neonate. Acta Obstet Gynecol Scand 2009;88:1158-62.
51. Clapp JF, Little KD. Effect of recreational exercise on pregnancy weight gain and subcutaneous fat deposition. Med Sci Sports Exerc 1995;27:170-7.
52. Collings CA, Curet LB, Mullin JP. Maternal and fetal responses to a maternal aerobic exercise programme. Am J Obstet Gynecol 1983;145:702-7.
53. El Hiday MM, Zumrawi FY. The effect of a nutrition education programme on pregnant women attending Khartoum model clinic. Ahfad J 1992;9:23-36.
54. Gray-Donald K, Robinson E, Collier A, David K, Renaud L, Rodrigues S. Intervening to reduce weight gain in pregnancy and gestational diabetes mellitus in Cree communities: an evaluation. Can Med Assoc J 2000;163:1247-51.
55. Hall DC, Kaufmann DA. Effects of aerobic and strength conditioning on pregnancy outcomes. Am J Obstet Gynecol 1987;157:1199-203.
56. Kardel KR, Kase T. Training in pregnant women: effects on fetal development and birth. Am J Obstet Gynecol 1998;178:280-6.
57. Kinnunen TI, Pasanen M, Aittasalo M, Fogelholm M, Hilakivi-Clarke L, Weiderpass E, et al. Preventing excessive weight gain during pregnancy-a controlled trial in primary health care. Eur J Clin Nutr 2007;61:884-91.
58. Moses RG, Luebcke M, Davis WS, Coleman KJ, Tapsell LC, Petocz P, et al. Effect of a low-glycemic-index diet during pregnancy on obstetric outcomes. Am J Clin Nutr 2006;84:807-12.
59. Narendran S, Nagarathna R, Narendran V, Gunasheela S, Nagendra HR. Efficacy of yoga on pregnancy outcome. J Altern Complement Med 2005;11:237-44.
60. Bell RJ, Palma SM, Lumley JM. The effect of vigorous exercise during pregnancy on birthweight. Aust N Z J Obstet Gynaecol 1995;35:46-51.
61. Bungum TJ, Peaslee DL, Jackson AW, Perez MA. Exercise during pregnancy and type of delivery in nulliparae. J Obstet Gynecol Neonatal Nurs 2000;29:258-64.
62. Clapp JF III, Dickstein S. Endurance exercise and pregnancy outcome. Med Sci Sports Exerc 1984;16:556-62.
63. Clapp JF III, Capeless EL. Neonatal morphometrics after endurance exercise during pregnancy. Am J Obstet Gynecol 1990;163:1805-11.
64. Clapp JF III. The course of labor after endurance exercise during pregnancy. Am J Obstet Gynecol 1990;163:1799-805.
65. Cogswell ME, Scanlon KS, Fein SB, Schieve LA. Medically advised, mother's personal target, and actual weight gain during pregnancy. Obstet Gynecol 1999;94:616-22.
66. Conway R, Reddy S, Davies J. Dietary restraint and weight gain during pregnancy. Eur J Clin Nutr 1999;53:849-53.
67. Dale E, Mullinax KM, Bryan DH. Exercise during pregnancy: effects on the fetus. Can J Appl Sport Sci 1982;7:98-103.
68. de Rooij SR, Painter RC, Holleman F, Bossuyt PM, Roseboom TJ. The metabolic syndrome in adults prenatally exposed to the Dutch famine. Am J Clin Nutr 2007;86:1219-24.
69. Dempsey JC, Sorensen TK, Williams MA, Lee IM, Miller RS, Dashow EE, et al. Prospective study of gestational diabetes mellitus risk in relation to maternal recreational physical activity before and during pregnancy. Am J Epidemiol 2004;159:663-70.
70. Hatch MC, Shu XO, McLean DE, Levin B, Begg M, Reuss L, et al. Maternal exercise during pregnancy, physical fitness, and fetal growth. Am J Epidemiol 1993;137:1105-14.
71. Horns PN, Ratcliffe LP, Leggett JC, Swanson MS. Pregnancy outcomes among active and sedentary primiparous women. J Obstet Gynecol Neonatal Nurs 1996;25:49-54.
72. Jackson MR, Gott P, Lye SJ, Ritchie JW, Clapp JF. The effects of maternal aerobic exercise on human placental development: placental volumetric composition and surface areas. Placenta 1995;16:179-91.
73. Knudsen VK, Orozova-Bekkevold IM, Mikkelsen TB, Wolff S, Olsen SF. Major dietary patterns in pregnancy and fetal growth. Eur J Clin Nutr 2008;62:463-70.
74. Lenders CM, Hediger ML, Scholl TO, Khoo CS, Slap GB, Stallings VA. Effect of highsugar intake by low-income pregnant adolescents on infant birth weight. J Adolesc Health 1994;15:596-602.
75. Lenders CM, Hediger ML, Scholl TO, Khoo CS, Slap GB, Stallings VA. Gestational age and infant size at birth are associated with dietary sugar intake among pregnant adolescents. J Nutr 1997;127:1113-17.
76. Lumey LH, Stein AD, Kahn HS, Romijn JA. Lipid profiles in middle-aged men and women after famine exposure during gestation: the Dutch Hunger Winter Families Study. Am J Clin Nutr 2009;89:1737-43.
77. Magann EF, Evans SF, Weitz B, Newnham J. Antepartum, intrapartum, and neonatal significance of exercise on healthy low-risk pregnant working women. Obstet Gynecol 2002;99:466-72.
78. Melzer K, Schutz Y, Soehnchen N, Othenin-Girard V, Martinez de TB, Irion O, et al. Effects of recommended levels of physical activity on pregnancy outcomes. Am J Obstet Gynecol 2010;202:266. e1-6. Epub 2009 Dec 22.
79. Mottola MF, Giroux I, Gratton R, Hammond JA, Hanley A, Harris S, et al. Nutrition and exercise prevent excess weight gain in overweight pregnant women. Med Sci Sports Exerc 2010;42:265-72.
80. Neugebauer R, Hoek HW, Susser E. Prenatal exposure to wartime famine and development of antisocial personality disorder in early adulthood. JAMA 1999;282:455-62.
81. Olson CM, Strawderman MS, Reed RG. Efficacy of an intervention to prevent excessive gestational weight gain. Am J Obstet Gynecol 2004;191:530-6.
82. Perichart PO, Balas NM, Parra CA, Rodriguez CA, Ramirez TA, Ortega GC, et al. A medical nutrition therapy programme improves perinatal outcomes in Mexican pregnant women with gestational diabetes and type 2 diabetes mellitus. Diabetes Educ 2009;35:1004-13.
83. Piravej K, Saksirinukul R. Survey of patterns, attitudes, and the general effects of exercise during pregnancy in 203 Thai pregnant women at King Chulalongkorn Memorial Hospital. J Med Assoc Thailand 2001;84(Suppl. 1):S276-82.
84. Shirazian T, Monteith S, Friedman F, Rebarber A. Lifestyle modification programme decreases pregnancy weight gain in obese women. Am J Perinatol 2010;27:411-14.
85. Stein AD, Kahn HS, Rundle A, Zybert PA, van der Pal-de Bruin, Lumey LH. Anthropometric measures in middle age after exposure to famine during gestation: evidence from the Dutch famine. Am J Clin Nutr 2007;85:869-76.
86. Berkowitz GS, Kelsey JL, Holford TR, Berkowitz RL. Physical activity and the risk of spontaneous preterm delivery. J Reprod Med 1983;28:581-8.
87. Dempsey JC, Butler CL, Sorensen TK, Lee IM, Thompson ML, Miller RS, et al. A case-control study of maternal recreational physical activity and risk of gestational diabetes mellitus. Diabetes Res Clin Pract 2004;66:203-15.
88. Dye TD, Knox KL, Artal R, Aubry RH, Wojtowycz MA. Physical activity, obesity, and diabetes in pregnancy. Am J Epidemiol 1997;146:961-5.
89. Gregory PB, Rush D. Iatrogenic caloric restriction in pregnancy and birthweight. Am J Perinatol 1987;4:365-71.
90. Oken E, Ning Y, Rifas-Shiman SL, Radesky JS, Rich-Edwards JW, Gillman MW. Associations of physical activity and inactivity before and during pregnancy with glucose tolerance. Obstet Gynecol 2006;108:1200-7.
91. Sorensen TK, Williams MA, Lee IM, Dashow EE, Thompson ML, Luthy DA. Recreational physical activity during pregnancy and risk of preeclampsia. Hypertension 2003;41:1273-80.
92. Badrawi H, Hassanein MK, Badraoui MHH, Wafa YA, Shawky HA, Badrawi N. Pregnancy outcome in obese pregnant mothers. J Perinat Med 1992;20:203.
93. Bechtel-Blackwell DA. Computer-assisted self-interview and nutrition education in pregnant teens. Clin Nurs Res 2002;11:450-62.
94. Briley C, Flanagan NL, Lewis N. In-home prenatal nutrition intervention increased dietary iron intakes and reduced low birthweight in low-income African-American women. J Am Diet Assoc 2002;102:984-7.
95. Clapp JF. Diet, exercise, and feto-placental growth. Arch Gynecol Obstet 1997;260:101-8.
96. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005;352:2477-86.
97. Gomez TG, Delgado JG, Agudelo AA, Hurtado H. Diet effects on the perinatal result of obese pregnant patient. [Spanish]. Rev Colomb Obstet Ginecol 1994;45:313-6.
98. Khoury J, Henriksen T, Christophersen B, Tonstad S. Effect of a cholesterol-lowering diet on maternal, cord, and neonatal lipids, and pregnancy outcome: a randomised clinical trial. Am J Obstet Gynecol 2005;193:1292-301.
99. Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al. A multicenter, randomised trial of treatment for mild gestational diabetes. N Engl J Med 2009;361:1339-48.
100. Ney D, Hollingsworth DR, Cousins L. Decreased insulin requirement and improved control of diabetes in pregnant women given a high-carbohydrate, high-fiber, low-fat diet. Diabetes Care 1982;5:529-33.
101. Rae A, Bond D, Evans S, North F, Roberman B, Walters B. A randomised controlled trial of dietary energy restriction in the management of obese women with gestational diabetes. Aust N Z J Obstet Gynaecol 2000;40:416-22.
102. Thornton YS, Smarkola C, Kopacz SM, Ishoof SB. Perinatal outcomes in nutritionally monitored obese pregnant women: a randomised clinical trial. J Natl Med Assoc 2009;101:569-77.
103. Wolff S, Legarth J, Vangsgaard K, Toubro S, Astrup A. A randomised trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women. Int J Obes 2008;32:495-501.
104. Baciuk EP, Pereira RI, Cecatti JG, Braga AF, Cavalcante SR. Water aerobics in pregnancy: cardiovascular response, labor and neonatal outcomes. Reprod Health 2008;5:10. DOI:10.1186/1742-4765-5-10.
105. Barakat R, Lucia A, Ruiz JR. Resistance exercise training during pregnancy and newborn's birth size: a randomised controlled trial. Int J Obes 2009;33:1048-57.
106. Cavalcante SR, Cecatti JG, Pereira RI, Baciuk EP, Bernardo AL, Silveira C. Water aerobics II: maternal body composition and perinatal outcomes after a programme for low risk pregnant women. Reprod Health 2009;6:1.
107. Clapp JF III, Kim H, Burciu B, Lopez B. Beginning regular exercise in early pregnancy: effect on fetoplacental growth. Am J Obstet Gynecol 2000;183:1484-8.
108. Clapp JF III, Kim H, Burciu B, Schmidt S, Petry K, Lopez B. Continuing regular exercise during pregnancy: effect of exercise volume on fetoplacental growth. Am J Obstet Gynecol 2002;186:142-7.
109. Erkkola R. The influence of physical exercise during pregnancy upon physical work capacity and circulatory parameters. Scand J Clin Lab Invest 1976;36:747-59.
110. Erkkola R, Makela M. Heart volume and physical fitness of parturients. Ann Clin Res 1976;8:15-21.
111. Garshasbi A, Faghih ZS. The effect of exercise on the intensity of low back pain in pregnant women. Int J Gynaecol Obstet 2005;88:271-5.
112. Haakstad L, Bo K. Effect of supervised aerobic dance exercise in prevention of excessive weight gain in pregnancy: a single blind randomised controlled trial. Int J Gynaecol Obstet 2009;107:S198.
113. Hopkins SA, Baldi JC, Cutfield WS, McCowan L, Hofman PL. Exercise training in pregnancy reduces offspring size without changes in maternal insulin sensitivity. J Clin Endocrinol Metab 2010;95:2080-8.
114. Khaledan A, Mirdar Sh, Motahari Tabari NS, Ahmad Shirvani M. Effect of an aerobic exercise programme on fetal growth in pregnant women. HAYAT 2010;16:78.
115. Lee G, Challenger S, McNabb M, Sheridan M. Exercise in pregnancy. Mod Midwife 1996;6:28-33.
116. Marquez-Sterling S, Perry AC, Kaplan TA, Halberstein RA, Signorile JF. Physical and psychological changes with vigorous exercise in sedentary primigravidae. Med Sci Sports Exerc 2000;32:58-62.
117. Ong MJ, Guelfi KJ, Hunter T, Wallman KE, Fournier PA, Newnham JP. Supervised homebased exercise may attenuate the decline of glucose tolerance in obese pregnant women. Diabetes Metab 2009;35:418-21.
118. Prevedel T, Calderon I, De Conti M, Consonni E, Rudge M. Maternal and perinatal effects of hydrotherapy in pregnancy. Rev Bras Ginecol Obstet 2003;25:53-9.
119. Santos IA, Stein R, Fuchs SC, Duncan BB, Ribeiro JP, Kroeff LR, et al. Aerobic exercise and submaximal functional capacity in overweight pregnant women: a randomised trial. Obstet Gynecol 2005;106:243-9.
120. Sedaghati P, Ziaee V, Ardjmand A. The effect of an ergometric training programme on pregnants weight gain and low back pain. Gazz Med Ital Arch Sci Med 2007;166:209-13.
121. Yeo S, Steele NM, Chang MC, Leclaire SM, Ronis DL, Hayashi R. Effect of exercise on blood pressure in pregnant women with a high risk of gestational hypertensive disorders. J Reprod Med 2000;45:293-8.
122. Yeo S, Davidge S, Ronis DL, Antonakos CL, Hayashi R, O'Leary S. A comparison of walking versus stretching exercises to reduce the incidence of preeclampsia: a randomised clinical trial. Hypertens Pregnancy 2008;27:113-30.
123. Yeo S. Adherence to walking or stretching, and risk of preeclampsia in sedentary pregnant women. Res Nurs Health 2009;32:379-90.
124. Asbee SM, Jenkins TR, Butler JR, White J, Elliot M, Rutledge A. Preventing excessive weight gain during pregnancy through dietary and lifestyle counseling: a randomised controlled trial. Obstet Gynecol 2009;113:305-12.
125. Bung P, Artal R, Khodiguian N, Kjos S. Exercise in gestational diabetes. An optional therapeutic approach? Diabetes 1991;40(Suppl. 2):182-5.
126. Guelinckx I, Devlieger R, Mullie P, Vansant G. Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomised controlled trial. Am J Clin Nutr 2010;91:373-80.
127. Hui AL, Ludwig SM, Gardiner P, Sevenhuysen G, Murray R, Morris M, et al. Communitybased exercise and dietary intervention during pregnancy: a pilot study. Can J Diabetes 2006;30:169-75.
128. Jeffries K, Shub A, Walker SP, Hiscock R, Permezel M. Reducing excessive weight gain in pregnancy: a randomised controlled trial. Med J Aust 2009;191:429-33.
129. Kulpa PJ, White BM, Visscher R. Aerobic exercise in pregnancy. Am J Obstet Gynecol 1987;156:1395-403.
130. Polley BA, Wing RR, Sims CJ. Randomised controlled trial to prevent excessive weight gain in pregnant women. Int J Obes 2002;26:1494-502.
131. Institute of Medicine Subcommittee on Nutritional Status and Weight Gain in Pregnancy. Nutrition during pregnancy. Washington, DC: National Academy Press; 1990.
132. Bell R, Palma S. Antenatal exercise and birthweight. Aust N Z J Obstet Gynaecol 2000;40:70-3.
133. Carmichael SL, Shaw GM, Schaffer DM, Laurent C, Selvin S. Dieting behaviors and risk of neural tube defects. Am J Epidemiol 2003;158:1127-31.
134. de Rooij SR, Painter RC, Phillips DI, Osmond C, Tanck MW, Bossuyt PM, et al. Cortisol responses to psychological stress in adults after prenatal exposure to the Dutch famine. Psychoneuroendocrinology 2006;31:1257-65.
135. Painter RC, Osmond C, Gluckman P, Hanson M, Phillips DIW, Roseboom TJ. Transgenerational effects of prenatal exposure to the Dutch famine on neonatal adiposity and health in later life. BJOG 2008;115:1243-9.
136. Ravelli GP, Stein ZA, Susser MW. Obesity in young men after famine exposure in utero and early infancy. N Engl J Med 1976;295:349-53.
137. Ravelli AC, van der Meulen JH, Michels RP, Osmond C, Barker DJ, Hales CN, et al. Glucose tolerance in adults after prenatal exposure to famine. Lancet 1998;351:173-7.
138. Roseboom TJ, van der Meulen JH, Osmond C, Barker DJ, Ravelli AC, Bleker OP. Plasma lipid profiles in adults after prenatal exposure to the Dutch famine. Am J Clin Nutr 2000;72:1101-6.
139. Roseboom TJ, van der Meulen JH, Osmond C, Barker DJ, Ravelli AC, Schroeder-Tanka JM, et al. Coronary heart disease after prenatal exposure to the Dutch famine, 1944-45. Heart 2000;84:595-8.
140. Schramm WF, Stockbauer JW, Hoffman HJ. Exercise, employment, other daily activities, and adverse pregnancy outcomes. Am J Epidemiol 1996;143:211-18.
141. Stanner SA, Bulmer K, Andrès C, Lantseva OE, Borodina V, Poteen VV, et al. Does malnutrition in utero determine diabetes and coronary heart disease in adulthood? Results from the Leningrad siege study, a cross sectional study. BMJ 1997;315:1342-8.
142. Vujkovic M, Ocke MC, Van Der Spek PJ, Yazdanpanah N, Steegers EA, Steegers-Theunissen RP. Maternal western dietary patterns and the risk of developing a cleft lip with or without a cleft palate. Obstet Gynecol 2007;110:378-84.
143. Yazdy MM, Liu S, Mitchell AA, Werler MM. Maternal dietary glycemic intake and the risk of neural tube defects. Am J Epidemiol 2010;171:407-14.
144. Dodd JM, Crowther CA, Robinson JS. Dietry and lifestyle interventions to limit weight gain during pregnancy for obese or overweight women: a systematic review. Acta Obstet Gynecol Scand 2008;87:702-6.
145. Dodd J, Grivell R, Crowther C, Robinson J. Antenatal interventions for overweight or obese pregnant women: a systematic review of randomised trials. BJOG 2010;117:1316-26.
146. Kuhlmann AKS, Dietz PM, Galavotti C, England LJ. Weight-management interventions for pregnant or postpartum women. Am J Prev Med 2008;34:523-8.
147. Leet T, Flick L. Effect of exercise on birthweight. Clin Obstet Gynecol 2003;46:423-31.
148. Liu L, Mirza M, Thomas H. Effectiveness of interventions to prevent excessive weight gain during pregnancy. Effective Public Health Practice Project (EPHPP), Epidemiology and Evaluation. City of Hamilton, Public Health Services.
149. Ronnberg AK, Nilsson K. Interventionsduring 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. BJOG 2010;117:1327-34.
150. Schlüssel MM, Bicalho de Souza E, Reichenheim ME and Kac G. Physical activity during pregnancy and maternal-child health outcomes: a systematic literature review. Cad Saude Publica 2008;24(Suppl. 4):S531-S544.
151. Skouteris H, Hartley-Clark L, McCabe M, Milgrom J, Kent B, Herring SJ, et al. Preventing excessive gestational weight gain: a systematic review of interventions. Obes Rev 2010;11:757-68.
152. Widga AC, Lewis NM, Defined, in-home prenatal nutrition intervention for low-income women. J am Diet Assoc 1999;99:1058-62.