Diet And Exercise Behavioral Interventions To Modify Obesity Risk In The Post-Partum Period: A Systematic Review

Background: Obesity is a growing health problem and is closely associated with the leading causes of death and illness in the US. The reproductive years and specifically pregnancy are a critical period for the development of obesity in women. Objectives: To review the literature on the effects of exercise, dietary, and exclusive breastfeeding interventions in the post-partum period on women at managing their weight over one year. Eligibility Criteria: English language, human randomized controlled trials with >50% of women within one year of pregnancy were included with any length of follow-up. Data Sources: The review was conducted from December 2011 to May 2012. MEDLINE, Cochrane, CINAHL, EMBASE were systematically searched for relevant articles from database inception to December 2011; authors and experts were queried to find other relevant studies and reference lists to review. Data Extraction: The review of the literature yielded 122 unique abstracts. Study Selection: Two reviewers independently screened 122 abstracts and 26 full-text articles to identify randomized controlled trials (RCTs) of exercise, dietary, exclusive breastfeeding interventions among post-partum women that reported weight related outcomes. Trials were independently critically appraised by two reviewers to include only good- or fair-quality trials. Interventions: The authors considered behavioral interventions that included at least one of exclusive breastfeeding, diet, or exercise components. Study Appraisal and Synthesis Methods: Overall, the included evidence was of fair to good quality. Results: We included 12 studies. One RCT (n=141) reviewed breastfeeding interventions, three (n=139) examined exercise only interventions, one (n=151) examined nutrition/diet only interventions and seven (n=922) examined combination nutrition/diet and exercise interventions. The exclusive breastfeeding intervention and nutrition only study were of poor quality and were excluded from our review. The evidence was mixed for exercise interventions with only one of the three reported a statistically significant reduction in weight that was greater in the intervention group compared to the control. All seven combination interventions led to greater weight loss in the intervention group versus the control with varying levels of weight loss (0.17 to7.3 kg weight loss) compared to control lost over varying periods of time (12 weeks to 12 months). Limitations: Interventions, subjects, and methods of intervention were heterogeneous. Data on potential harms of interventions were scant and often not reported, and there was little discussion of adherence or the theoretical basis for interventions or if the interventions were evidence based. Conclusions and Implications of Key Findings: The results of this review suggest that there is minimal evidence for exercise interventions, insufficient evidence for exclusive breastfeeding interventions, insufficient evidence for nutrition/diet interventions, and moderate evidence supporting combination nutrition/diet and exercise interventions for weight management in post-partum women. Behavioral interventions that combine counseling with exercise and diet are a potentially useful strategy for reducing post-partum women’s risk of developing obesity.Master of Public Healt