INTRODUCTION: Pregnancy presents a critical window for excessive gestational weight gain (GWG). Sufficient research demonstrates GWG can be optimised for improved maternal and infant health outcomes. A crucial gap that remains therefore is, not what, but rather how to best implement antenatal interventions using the most effective components, to guide scale-up for broad, real-world impact. This study aimed to evaluate intervention characteristics associated with GWG prevention using the Template for Intervention Description and Replication (TIDieR) framework.
METHODS: The International Women in Pregnancy (iWIP) collaborative is the largest international project to synthesise the evidence of the efficacy of lifestyle interventions to optimise GWG in pregnancy. Within the iWIP project we interrogated 117 international studies, extracting study level information contained within, or modified from, the TIDieR Framework. Components included theoretical underpinning, type, intensity, duration, setting, facilitator, resources provided, degree of personalisation and provision of ongoing support.
RESULTS: Dietary based interventions had significantly optimised GWG compared with physical activity or combined interventions (−2.46 kg [−3.74, −1.17] vs −0.93 kg [−1.24, -0.62] and -1.21 [-1.66, -0.76], respectively, P = 0.001 for subgroup differences). Interventions delivered individually had significantly greater GWG prevention than group based interventions (mean difference, 95% confidence interval: (−1.44 kg [−1.94, −0.94] vs −0.87 kg [−1.24, −0.51], P=0.001 for subgroup differences). Intervention effectiveness was not influenced by intervention intensity (number of sessions) or the degree of personalisation of content. Resources to self-monitor GWG were associated with significantly better outcomes compared with informational resources.
CONCLUSIONS: Our analysis utilising a comprehensive framework for identifying effective intervention components provides critical information to inform what components are most associated with optimised GWG to better guide implementation design and broad scale-up within national and international antenatal settings.