Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: individual participant data meta-analysis
Authors: O’Brien Eileen C , Segurado Ricardo , Geraghty Aisling A , Alberdi Goiuri , Rogozinska Ewelina , Astrup Arne , Barakat Carballo Rubenomar , Bogaerts Annick , Cecatti Jose Guilherme , Coomarasamy Arri , de Groot Christianne J M , Devlieger Roland , Dodd Jodie M , El Beltagy Nermeen , Facchinetti Fabio , Geiker Nina , Guelfi Kym , Haakstad Lene , Harrison Cheryce , Hauner Hans , Jensen Dorte M , Khan Khalid , Kinnunen Tarja Inkeri , Luoto Riitta , Willem Mol Ben , Mørkved Siv , Motahari-Tabari Narges , Owens Julie A , Perales Maria , Petrella Elisabetta , Phelan Suzanne , Poston Lucilla , Rauh Kathrin , Rayanagoudar Girish , Renault Kristina M , Ruifrok Anneloes E , Sagedal Linda , Salvesen Kjell Å , Scudeller Tania T , Shen Gary , Shub Alexis , Stafne Signe N , Surita Fernanda G , Thangaratinam Shakila , Tonstad Serena , van Poppel Mireille N M , Vinter Christina , Vistad Ingvild , Yeo SeonAe , McAuliffe Fionnuala M 
Published: August 2019

ObjectivesTo identify if maternal educational attainment is a prognostic factor for gestational weight gain (GWG), and to determine the differential effects of lifestyle interventions (diet based, physical activity based or mixed approach) on GWG, stratified by educational attainment.DesignIndividual participant data meta-analysis using the previously established International Weight Management in Pregnancy (i-WIP) Collaborative Group database (https://iwipgroup.wixsite.com/collaboration). Preferred Reporting Items for Systematic reviews and Meta-Analysis of Individual Participant Data Statement guidelines were followed.Data sourcesMajor electronic databases, from inception to February 2017.Eligibility criteriaRandomised controlled trials on diet and physical activity-based interventions in pregnancy. Maternal educational attainment was required for inclusion and was categorised as higher education (≥tertiary) or lower education (≤secondary).Risk of biasCochrane risk of bias tool was used.Data synthesisPrinciple measures of effect were OR and regression coefficient.ResultsOf the 36 randomised controlled trials in the i-WIP database, 21 trials and 5183 pregnant women were included. Women with lower educational attainment had an increased risk of excessive (OR 1.182; 95% CI 1.008 to 1.385, p =0.039) and inadequate weight gain (OR 1.284; 95% CI 1.045 to 1.577, p =0.017). Among women with lower education, diet basedinterventions reduced risk of excessive weight gain (OR 0.515; 95% CI 0.339 to 0.785, p = 0.002) and inadequate weight gain (OR 0.504; 95% CI 0.288 to 0.884, p=0.017), and reduced kg/week gain (B −0.055; 95% CI −0.098 to −0.012, p=0.012). Mixed interventions reduced risk of excessive weight gain for women with lower education (OR 0.735; 95% CI 0.561 to 0.963, p=0.026). Among women with high education, diet based interventions reduced risk of excessive weight gain (OR 0.609; 95% CI 0.437 to 0.849, p=0.003), and mixed interventions reduced kg/week gain (B −0.053; 95% CI −0.069 to −0.037,p<0.001). Physical activity based interventions did not impact GWG when stratified by education.ConclusionsPregnant women with lower education are at an increased risk of excessive and inadequate GWG. Diet based interventions seem the most appropriate choice for these women, and additional support through mixed interventions may also be beneficial.