Impact of diet and activity on reducing cesarean rate
A recent meta-analysis published in The BMJ offers hope for reducing the risk of cesarean by lowering gestational weight gain and risk of development of diabetes over the course of pregnancy.
For the study, researchers analyzed individual participant data (IPD) from 36 randomized trials, covering a total of 12,526 women. Studies were eligible for inclusion if they assessed diet- and physical activity-based interactions in pregnancy.
The authors found that less weight gain occurred in the intervention group than the control group (mean difference −0.70 kg, 95% confidence interval [CI] −0.92 to −0.48 kg, I2=14.1%; 33 studies, 9320 women). Reductions in offspring (odds ratio [OR] 0.94, 0.83 to 1.08, I2=0%; 18 studies, 7981 women) and maternal (OR 0.90, 95% CI 0.79 to 1.03, I2=26.7%; 24 studies, 8852 women) composite outcomes were found to not be statistically significant.
Strong evidence showed that interventions reduced the risk of cesarean (OR 0.91, 0.83 to 0.99, I2=0%; 32 studies, 11 410 women), but not for other individual complications. When the IPD were combined with data from studies that did not provide IPD, the effect was similar, with stronger evidence for the benefit for gestational diabetes (OR 0.76, 0.65 to 0.89, I2=36.8%; 59 studies, 16,885 women). The researchers said the benefits of diet and exercise were consistent regardless of body mass index, age, parity, ethnicity, or pre-existing medical conditions and also remained when they excluded studies at high risk of bias.
The authors concluded that diet and physical activity intervention in pregnancy reduce gestational weight gain and lower the odds of cesarean.