Are antenatal weight management interventions effective in preventing pre-eclampsia? Systematic review of randomised control trials

IntroductionPre-eclampsia, defined as the development of hypertension and proteinuria after 20 weeks gestation, carries significant maternal and foetal risk. Pre-pregnancy BMI is the most useful predictor of pre-eclampsia. As the prevalence of obesity increases, prevention of pre-eclampsia by weight management strategies needs to be trialed.Aims and objectivesTo review the randomised controlled trials studying clinical effectiveness of antenatal weight management interventions compared to routine care in decreasing the incidence of pre-eclampsia in women with BMI 26 kg/m2 or greater.MethodsElectronic bibliographic databases were searched using a systematic search strategy to identify relevant trials. All trials involving weight management during pregnancy were considered. Using pre-determined inclusion criteria, six trials were included in this review and were independently assessed using standardised evaluation criteria.ResultsThree studies found a significant difference in gestational weight gain; amongst the intervention groups, the smallest was 5.0 kg, whereas the largest was 13.6 kg. In sub-group analysis, one trial found a significant difference in the incidence of pre-eclampsia between adherent (2/90) and non-adherent participants (5/26). However, no significant difference was found in the overall incidence of pre-eclampsia across all intervention and control groups.ConclusionThere was no evidence to suggest that antenatal weight management interventions were effective in reducing the incidence of pre-eclampsia in women with a BMI ⩾ 26 kg/m2.