Evidence of lifestyle interventions in a pregnant population with chronic hypertension and/or pre-existing diabetes: A systematic review and narrative synthesis.

Lucy Goddard, Rajan Patel, Nerys M Astbury, Katherine Tucker, Richard J McManus

Journal: Pregnancy hypertension 2023;31():60-72

PMID: 36608587

Free Full Text on Elsevier Science View on PubMed

Plain Language Summary

Chronic hypertension complicates ≤5 % of pregnancies, and those entering pregnancy with a pre-existing diagnosis of diabetes has a global prevalence of between 0.5 % and 2.6 %. The aim of this study was to collate the evidence around lifestyle interventions during pregnancy for women with chronic hypertension and/or pre-existing diabetes (type 1 and type 2). This study is a systematic review and meta-analysis of nine randomised controlled trials. Results show lack of clarity and data on the effect of lifestyle interventions in pregnant women with chronic hypertension and/or pre-existing diabetes, thereby exposing key gaps in the literature. Authors conclude that there is a shortage of primary interventional studies examining the effect of lifestyle interventions in high-risk pregnant populations who enter pregnancy with chronic conditions.

Abstract

BACKGROUND

Pregnant people with chronic hypertension, pre-existing diabetes or both are at high risk of developing cardiovascular disease. Lifestyle interventions play an important role in disease management in non-pregnant populations.

AIM

To review the existing evidence of randomised controlled trials (RCTs) that examine lifestyle interventions in pregnant people with chronic hypertension and/or pre-existing diabetes.

METHODS

A systematic review and narrative synthesis was conducted. Five electronic databases were searched from inception to April 2021 for RCTs evaluating antenatal lifestyle interventions in people with chronic hypertension and/or pre-existing diabetes with outcomes to include weight or blood pressure change.

RESULTS

Nine randomised controlled trials including 7438 pregnant women were eligible. Eight studies were mixed pregnant populations that included women with chronic hypertension and/or pre-existing diabetes. One study included only pregnant women with pre-existing diabetes. Intervention characteristics and procedures varied and targeted diet, physical activity and/or gestational weight. All studies reported weight and one study reported blood pressure change. Outcome data were frequently unavailable for the subset of women of interest, including subgroup data on important pregnancy and birth complications. Eligibility criteria were often ambiguous and baseline data on chronic hypertension was often omitted.

CONCLUSION

A lack of primary interventional trials examining the effect of lifestyle interventions on weight and blood pressure outcomes in pregnant populations with chronic hypertension and/or pre-existing diabetes was evident. Lifestyle modification has the potential to alter disease progression. Future trials should address the ambiguity and frequent exclusion of these important populations.

Address: Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford OX2 6GG, United Kingdom. Electronic address: [email protected].; Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford OX2 6GG, United Kingdom. Electronic address: [email protected].; Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford OX2 6GG, United Kingdom. Electronic address: [email protected].; Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford OX2 6GG, United Kingdom. Electronic address: [email protected].; Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford OX2 6GG, United Kingdom. Electronic address: [email protected].

DOI: 10.1016/j.preghy.2022.12.004

Patient Centred Factor

Triggers: Lifestyle interventions

Clinical Imbalances

Hormonal Immune and inflammation

Modifiable Lifestyle Factors

Diet Exercise and movement

Nutrition Evidence Keywords

Diabetes Obesity Hypertension Body mass index Pre-eclampsia Type 2 diabetes mellitus Type 1 diabetes mellitus Cardiovascular disease Weight loss Weight management Pregnant

Link outs

Free resources

Full Text Sources:

https://linkinghub.elsevier.com/retrieve/pii/S2210...

Medical:

https://medlineplus.gov/diabetes.html

Miscellaneous:

https://assays.cancer.gov/CPTAC-1595

Subscription / membership required

Full Text Sources:

https://www.clinicalkey.com/content/playBy?issn=&v...

MeSH Terms: Pregnancy, Female, Humans, Pre-Eclampsia, Diabetes Mellitus, Pregnant People, Hypertension, Life Style, Randomized Controlled Trials as Topic