Poster Presentation Australian and New Zealand Obesity Society Annual Scientific Conference 2024

Preconception lifestyle interventions for women – a systematic review and meta-analysis of intervention characteristics and behaviour change techniques (#273)

Sophia Torkel 1 , Evangeline Mantzioris 2 , Anthony Villani 3 , Nicole Kellow 4 , Dhruv Bhatnagar 1 , Elaine Osei-Safo 1 , Margaret McGowan 1 , Nur Abdul Jafar 1 , Nadia Bogatzke 5 , Simon Alesi 1 , Tuba Astarcioglu 1 , Ben Mol 6 , Robert J Norman 7 , Stephanie Cowan 1 , Rui Wang 6 , Lisa Moran 1
  1. Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
  2. Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
  3. School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
  4. Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, Victoria, Australia
  5. Monash Health, Clayton, Victoria, Australia
  6. Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
  7. Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia

Background: The time before conception is an important opportunity to improve maternal lifestyle health, in order to improve the chances of a healthy pregnancy and long-term health. However, the optimal components of preconception lifestyle interventions are not well understood.

Aim: To assess the effects of intervention characteristics in preconception lifestyle (diet and/or physical activity) interventions on fertility, obstetric, foetal, anthropometric and metabolic outcomes in women planning a pregnancy.

Methods: We searched MEDLINE, PsycINFO, CINAHL, EMBASE and EBM Reviews (30th May 2023). We included randomised controlled trials on women planning a pregnancy which assessed the effect of lifestyle intervention compared to standard minimal care or no intervention on fertility, obstetric, foetal, anthropometric and metabolic outcomes. We performed meta-analysis as well as subgroup analysis by participant characteristics, intervention characteristics and behaviour change techniques. Risk of bias was assessed using version two of the Cochrane Risk of Bias tool.

Results: We identified 21 eligible studies (n=7444 women). Overall, there was a greater reduction in weight (11 studies, 2596 women, mean difference [95% CI]: -3.87 kg [-5.76, -1.97]) with lifestyle intervention but no difference in pregnancy (16 studies, 2949 women, odds ratio [95% CI] 1.12, [0.89, 1.40]) or live birth (7 studies, 658 women, odds ratio [95% CI] 1.37 [0.79, 2.38]). The odds of pregnancy was higher for weight loss compared to non-weight loss interventions (1.24 [0.95, 1.62] vs 0.81 [0.60, 1.10], p=0.04 for subgroup differences). Women with infertility lost more weight with lifestyle intervention than women without infertility (-5.30 kg [-7.61, -3.00] vs -1.42 kg [-3.02, 0.17], p=0.01 for subgroup differences).

Conclusion: Preconception lifestyle interventions are effective in reducing weight, particularly for women experiencing infertility. While there was no evidence of effect on pregnancy or live birth, the effectiveness on fertility may be enhanced by including a weight loss component where clinically appropriate.