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Physical Exercise vs. Metformin to Improve Delivery- and Newborn-Related Outcomes Among Pregnant Women With Overweight: A Network Meta-Analysis.

ABSTRACT: Background: Overweight/obesity is associated with the risk of delivery- and newborn-related complications in pregnancy. Interventions such as exercise or metformin could reduce the risk of these complications. Objective: To estimate and compare the effects of different types of exercise interventions (i.e., aerobic, resistance, combined exercise) and metformin on delivery- and newborn-related outcomes among pregnant women with overweight/obesity. Methods: MEDLINE, Scopus, Web of Science, Cochrane Library databases and the gray literature were searched from inception to September 2021. This systematic review was registered in PROSPERO (CDR: 42019121715). Randomized controlled trials (RCTs) of metformin or an exercise intervention aimed at preventing cesarean section, preterm birth, macrosomia, or birth weight among pregnant women with overweight/obesity were included. Random effects meta-analyses and frequentist network meta-analyses (NMA) were conducted for each outcome. Results: Fifteen RCTs were included. In the NMA, metformin reduced the risk of cesarean section (RR = 0.66, 95% CI: 0.46, 0.95), combined exercise reduced the risk of macrosomia (RR = 0.37, 95% CI: 0.14, 0.95), and aerobic exercise reduced birth weight (mean difference = -96.66 g, 95% CI: -192.45, -0.88). In the subgroup among pregnant women with obesity, metformin reduced the risk of cesarean section (RR = 0.66, 95% CI: 0.45, 0.97). Conclusions: Combined exercise could reduce the risk of macrosomia in pregnant women with overweight, whereas metformin could reduce the risk of cesarean section in pregnant women with obesity. However, previous evidence suggests a larger effect of physical exercise in other outcomes for this population group. Therefore, the medicalization of healthy pregnant women with obesity is not justified by the current evidence. Systematic Review Registration: PROSPERO: CRD42019121715; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019121715.

SUBMITTER: Pascual-Morena C

PROVIDER: S-EPMC8696129 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:INTRODUCTION:Despite well-established guidelines and benefits to exercise, the majority of pregnant women in the USA fail to meet recommended activity levels. Studies need to determine feasible ways to translate clinical interventions to community settings by engaging pregnant women in widely accessible locations to ensure benefits to more women. The aim of this study is to adapt and determine feasibility, acceptability and fidelity of the research clinic-based Expecting intervention (NCT02125149) with pregnant women with obesity in community settings. METHODS AND ANALYSIS:We will use the Replicating Effective Programs (REP) to guide the adaptation and implementation of the research clinic-based intervention into the community. REP provides a four-phase process for implementing evidence-based interventions including collection of feedback from community stakeholders, iterative piloting of the intervention in the community and a process for standardising the intervention across community settings. Following adaptation, the updated intervention will be piloted. The pilot study will include 60 expecting women. We will randomise half to receive the community-adapted Expecting intervention (intervention, N=30) and half to receive standard of care (control, N=30). Feasibility and Acceptability of Intervention Measures are primary outcomes as key indicators of feasibility. Secondary outcomes will include the number of intervention sessions completed, the change in the number of minutes of physical activity as measured by accelerometer, as well as change in health indicators from enrolment to time of delivery and 6 months post-delivery (ie, body mass index, blood pressure and total cholesterol). ETHICS AND DISSEMINATION:This study has been approved by the Institutional Review Board (#260132). Findings will be shared with study participants and stakeholder advisors through written summaries and in-person presentations; results will also be shared through presentations at scientific conferences and publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER:NCT04298125; Pre-results.

Project description:INTRODUCTION:Increasing evidence suggests obesity has its origins prior to birth. There is clear correlation between maternal obesity, high birthweight and offspring risk of obesity in later life. It is also clear that women who are obese during pregnancy are at greater risk of adverse outcomes, including gestational diabetes and stillbirth. The mechanism(s) by which obesity causes these problems is unknown, although hyperglycaemia and insulin resistance are strongly implicated. We present a protocol for a study to test the hypothesis that metformin will improve insulin sensitivity in obese pregnant women, thereby reducing the incidence of high birthweight babies and other pregnancy complications. METHODS AND ANALYSIS:The Efficacy of Metformin in Pregnant Obese Women, a Randomised controlled (EMPOWaR) trial is a double-masked randomised placebo-controlled trial to determine whether metformin given to obese (body mass index >30?kg/m(2)) pregnant women from 16?weeks' gestation until delivery reduces the incidence of high birthweight babies. A secondary aim is to test the mechanism(s) of any effect. Obese women with a singleton pregnancy and normal glucose tolerance will be recruited prior to 16?weeks' gestation and prescribed study medication, metformin or placebo, to be taken until delivery. Further study visits will occur at 28 and 36?weeks' gestation for glucose tolerance testing and to record anthropometric measurements. Birth weight and other measurements will be recorded at time of delivery. Anthropometry of mother and baby will be performed at 3?months postdelivery. As of January 2014, 449 women had been randomised across the UK. ETHICS AND DISSEMINATION:The study will be conducted in accordance with the principles of Good Clinical Practice. A favourable ethical opinion was obtained from Scotland A Research Ethics Committee, reference number 10/MRE00/12. Results will be disseminated at conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER:ISRCTN51279843.

Project description:BackgroundGestational diabetes mellitus (GDM) is one of the most common complications of pregnancy and its prevalence worldwide is increasing along with enhancing type two of diabetes. Contrary results have been found in some review articles that examine the effect of exercise activities on preventing GDM, regardless of obesity. Therefore, the aim of this study was to systematically review the articles on the effect of exercise activities on the prevention of GDM in obese and overweight pregnant women.Main textLiterature was retrieved by formally searching PubMed, Embase, Cochrane library, Web of Science, Scopus, Proquest and by hand searching of reference lists of related articles. Finally, a total of eight literatures included, and Review manager 5.3 and STATA 14.0 statistical software were utilized for processing. In order to investigate the effect of sports activities on the incidence of GDM, the risk ratio (RR), and for quantitative indices, the standardized mean difference (SMD) with 95% confidence interval (CI) for each study was calculated. Out of 5107 papers identified, eight papers with 1441 participants included in meta-analysis (intervention group 727, control group 714). In the intervention group, 143 (19.66%, 95% CI 76.83 to 22.74) and in the control group, 196 (27.45%, 95% CI 20.24 to 30.88%), pregnant women had diabetes. The RR of gestational diabetes was 0.76 (95% CI 0.56 to 1.03, I2?=?50%, P?=?0.05). In studies that the time for the intervention was three times a week or less, effect of intervention was significant in reducing the incidence of diabetes (RR: 0.59, 95% CI 0.46 to 0.76, I2?=?0%, P?=?0.47). However, in studies with repeat of intervention was more than three times a week, the effect of intervention between two intervention and control groups was not different (RR: 1.03, 95% CI 0.78 to 1.35, I2?=?0%, P?=?0.46).ConclusionsThe exercise activities, alone, in obese or overweight pregnant women did not have a significant effect on the overall incidence of GDM, but considering the effect measure, the incidence of GDM was 24% lower in the intervention group than control group. This difference is considerable in the two groups. As the systematic review literatures both represent the information gap on the research subject and pave the way for further studies so it seems that there is a need for more randomized controlled trials so that we can make a complete conclusion on the type, intensity and duration of exercise in preventing GDM.

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Physical Exercise vs. Metformin to Improve Delivery- and Newborn-Related Outcomes Among Pregnant Women With Overweight: A Network Meta-Analysis.

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