Cardiovascular Journal of Africa: Vol 28 No 6 (November/December 2017)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 6, November/December 2017

402

AFRICA

weight gain in both overweight and normal-weight women

has been shown to increase obesity in the offspring in both

childhood

and adolescence.

For the mother, obesity-related

complications and gestational diabetes mellitus may predispose

her to the risk of metabolic and vascular diseases later on in life.

Therefore, with the current epidemic of obesity, maternal obesity

has serious implications on the health of both current and future

generations.

Due to the potential health consequences of maternal obesity,

pregnancy is a pivotal period to implement health interventions,

however, little research exists on health promotion during

this period.

A previous systematic review by Thangaratinam

et al

found 44 randomised, controlled trials, conducted in

developed countries, which implemented dietary or physical

activity interventions to influence maternal weight during

pregnancy. In their review, 14 studies implemented physical

activity interventions, while 10 looked at dietary interventions

and 10 addressed a mixed approach. Similarly, in our study,

the majority of interventions focused on physical activity over

dietary programmes. It is interesting to note that Thangaratinam

et al

found that diet was more cost effective than physical

activity in the management of weight in this population.

The type of interventions used to limit weight gain during

pregnancy appears to vary widely between studies. In their

systematic review of lifestyle interventions in pregnancy,

Oteng-Ntim

et al

found a variety of individual, group and

seminar interventions, while in the review by Thangaratinam

et al

interventions varied from a balanced diet and exercise

prescription to counselling and educational sessions. In our

study, six out of the seven interventions focused on physical

activity, while only one used a nutritional intervention.

Although previous systematic reviews have analysed the

literature dealing with interventions during pregnancy for

limiting excessive weight gain,

12,26,27

ours is the first review of such

studies performed solely in developing countries. Changes in diet

and activity levels resulting from globalisation and movement of

populations from rural to urban environments have led to a rapid

rise in the prevalence of obesity in developing countries,

and

have caused this disease to move to the top of the public health

agenda in many of these countries.

Although there have been calls to focus interventions on

maternal nutrition in order to reduce the risk of obesity later

on in life,

our review found only seven articles covering

maternal obesity interventional studies, with only one specifically

addressing nutrition. In addition, although the rate of obesity is

high and affects many developing countries, our study showed

that only three countries (Brazil, Iran and Argentina) have

reported on interventions to curb obesity during pregnancy.

Despite the growing prevalence of obesity in developing

countries and the well-recognised detrimental effects of maternal

obesity on both maternal and foetal outcomes, this review

demonstrates the lack of pertinent research in this area within

developing countries. Two of the studies in our review found an

increase in weight

and fat percentage

in their control groups,

and weight or weight gain was often a secondary outcome

measure within the studies reviewed, the majority of which

(six of seven studies) were not targeted to overweight women.

Other reviews have demonstrated the effectiveness and safety of

lifestyle interventions for reducing gestational weight gain,

but

this was not strongly demonstrated in the current study.

Very few studies exist to address the issues of intervention for

obesity and weight gain during pregnancy in developing countries.

This review summarises the existing literature, of which 71%

were of poor quality. Although our review focused on lifestyle

interventions for overweight and obesity during pregnancy, the

search yielded only one study that aimed the intervention at

overweight women, and 50% of the studies were not primarily

measuring weight gain as an outcome. In addition, the studies

varied significantly from type of intervention to outcome measure,

and additionally, the methodology was often poorly described,

making comparative and accumulative analysis difficult.

Conclusion

Dietary and lifestyle interventions during pregnancy may well

be the key to addressing the prevention of obesity in future

generations.

Physical activity

and dietary

interventions

have been shown to play an effective role in maternal weight

management in the developed world. To our knowledge, this

review is the first to address interventions for weight gain and

obesity in developing countries, and few articles appear to have

addressed this important issue. Lifestyle interventions may be a

cost-effective and useful way to curb the growing epidemic of

nutrition-related non-communicable diseases. Despite maternal

health and obesity being a public health priority, few robust

studies have addressed this critical area.

This review has highlighted the need for further research,

and in particular, carefully designed randomised, controlled

trials, addressing primarily the issues of weight gain and

obesity in pregnancy. Such studies are essential to determine

the effectiveness and safety of appropriate lifestyle interventions

during pregnancy in resource-limited settings.

KL and SP were funded by Wits/NIH Non-Communicable Diseases

Leadership Programme, funded through the Fogarty International Centre

of the NIH Millennium Promise Awards: Non-communicable Chronic

Diseases Research Training Programme (NCoD) (D43), grant number:

1D43TW008330-01A1. KL was also funded by the NRF Scarce Skills

Awards. EW is supported in part by the National Research Foundation of

South Africa for the grant no: 87944. Any opinion, finding and conclusion

or recommendation expressed in this material is that of the author(s) and the

NRF does not accept any liability in this regard.

Key messages:

•

Lifestyle interventions may be a cost-effective and

useful way to manage maternal overweight and obesity

as well as gestational weight gain

•

Few good-quality studies assessing the efficacy of life-

style interventions on maternal body composition have

been conducted in developing countries

•

In this systematic review of seven studies, two suggested

that a physical activity intervention during pregnancy

may significantly reduce maternal weight gain; and five

were scored as being of poor quality.

•

Future, well-designed lifestyle-intervention studies

aimed at managing maternal body composition are

much needed in developing countries