Diet or exercise, or both, for weight reduction in women after childbirth

 

Abstract

Background

Weight retention after pregnancy may contribute to obesity. It is known that diet and exercise are recommended components of any weight loss programme in the general population. However, strategies to achieve healthy body weight among postpartum women have not been adequately evaluated.

Objectives

The objectives of this review were to evaluate the effect of diet, exercise or both for weight reduction in women after childbirth, and to assess the impact of these interventions on maternal body composition, cardiorespiratory fitness, breastfeeding performance and other child and maternal outcomes.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2006) and LILACS. We scanned secondary references and contacted experts in the field.

Selection criteria

All published and unpublished randomised controlled trials (RCT) and quasi-randomised trials of diet or exercise or both, among women during the postpartum period.

Data collection and analysis

Three review authors independently assessed trial quality and extracted data. Results are presented using relative risk for categorical data and weighted mean difference (WMD) for continuous data. Data were analysed with a fixed-effect model. A random-effects model was used in the presence of heterogeneity.

Main results

Six trials involving 245 women were included. Women who exercised did not lose significantly more weight than women in the usual care group (one trial; n = 33; WMD 0.00 kg; 95% confidence interval (CI) -8.63 to 8.63). Women who took part in a diet (one trial; n = 45; WMD -1.70 kg; 95% CI -2.08 to -1.32), or diet plus exercise programme (four trials; n = 169; WMD -2.89 kg; 95% CI -4.83 to -0.95), lost significantly more weight than women in the usual care. There was no difference in the magnitude of weight loss between diet and diet plus exercise group (one trial; n = 43; WMD 0.30 kg; 95% CI -0.60 to 0.66). The interventions seemed not to affect breastfeeding performance adversely.

Authors' conclusions

Preliminary evidence from this review suggests that both diet and exercise together and diet alone help women to lose weight after childbirth. Nevertheless, it may be preferable to lose weight through a combination of diet and exercise as this improves maternal cardiorespiratory fitness and preserves fat-free mass, while diet alone reduces fat-free mass. This needs confirmation in large trials. For women who are breastfeeding, more evidence is required to confirm whether diet or exercise, or both, is not detrimental for either mother or baby.

 

Plain language summary

Diet or exercise, or both, for weight reduction in women carrying excess weight after childbirth

Women naturally gain weight during pregnancy and many gradually lose it afterwards. Some women, though, find it difficult to lose the pregnancy-related weight during postpartum and there is concern that this may be a health risk. The retention of weight gained during pregnancy may contribute to obesity. Obesity in the general population increases the risk of diabetes, heart disease and high blood pressure. It is suggested that women who return to their pre-pregnancy weight by about six months have a lower risk of being overweight ten years later. The review looked for studies to assess the impact of dieting or exercise, or both, on women's weight loss in the months after giving birth. It paid particular attention to breastfeeding women to be sure that breastfeeding was not compromised. The review of trials found six studies involving only 245 women. Preliminary findings suggest that diet combined with exercise or diet alone compared to usual care seemed to enhance weight loss during postpartum. Thus, there is potential for this to play a role in preventing future maternal obesity. However, there was insufficient evidence to be sure and a lack of sufficient data for women who are breastfeeding. In addition, it seems preferable to lose weight through a combination of dieting and exercise to dieting alone because exercise is thought to improve circulation and heart fitness, and to preserve lean body mass. Further research is needed.

 

摘要

背景

對於產後孕婦減重，應飲食控制或運動、或兩種方式都採用

懷孕後體重不變會造成肥胖，已知節食和運動是一般人常見的減重建議，不過，產後婦女達到健康體重的策略尚未曾適當評估。

目標

回顧目標是評估節食、運動或同時用這兩種方法對於產後婦女減重的效果，評估這些方式對於母親身體組成、心肺適能、哺餵母乳之表現和其他關於兒童及母親嬰預後的影響。

搜尋策略

我們搜尋Cochrane Pregnancy和Childbirth Group's Trials Register (2006年9月)以及LILACS。我們搜尋第二層之參考文獻和連絡該領域的專家。

選擇標準

所有刊登和未刊登的、有關產後婦女節食或運動或同時用這兩種方法的隨機控制試驗(randomised controlled trials (RCT))以及半隨機試驗。

資料收集與分析

3位回顧作者獨立評估試驗品質和摘錄資料。使用相對風險(RR)來代表類別資料，使用加權平均差(weighted mean difference (WMD))代表連續性資料。使用固定效果模式來分析資料，使用隨機效果模式來分析異質性。

主要結論

納入6篇試驗、245名婦女。運動組婦女減輕的體重並未比一般照護組多(1篇試驗；人數 33人；WMD 0.00 kg; 95% CI為 8.63 至8.63)。節食的婦女(1篇試驗；人數 45人；WMD −1.70 kg; 95% CI為 2.08至−1.32)或節食加運動計畫者(4篇試驗；人數 = 169人；WM 2.89 kg; 95% CI為 −4.83至−0.95)，減輕的體重比一般照護組多。節食組和節食加運動組之間，體重減輕程度沒有差異(1篇試驗；人數 43人；WMD 0.30 kg; 95% CI為 0.60至0.66)。這些方法對哺餵母乳之表現似乎不會有負面影響。

作者結論

本回顧顯示之初步證據認為，節食加運動比單純節食更有效幫助產後婦女減重，因為前者改善母親的心肺適能但是保留了非脂肪體重，而單純節食則減少了非脂肪體重。對於哺餵母乳之婦女，需要更多證據以確認節食、運動或同時用這兩種方法不會對母親或嬰兒有害。因為資料有限，需要更多樣本數之大型研究來確認結果。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

節食、運動或同時用這兩種方法，用於產後婦女減體。婦女在懷孕期間一般會體重增加，多數在產後會漸漸減輕。不過，有些婦女在產後難以將懷孕時增加的體重降低，這被視為對健康有風險，懷孕期間增加的體重若一直保持，會造成肥胖，肥胖會增加一般人的糖尿病、心臟病和高血壓之風險。一般認為，婦女在產後6個月左右之前恢復到懷孕前體重，10年以後會有過重的風險較低。本回顧探討節食、運動或同時用這兩種方法用於產後婦女減重的影響之研究，特別注意哺乳婦，以確認不會影響哺餵母乳。此回顧包括6篇研究、245名婦女。初步發現認為，節食加運動或單純節食可以比一般照護能更促進產後減重，因此，對於預防母親後續肥胖有幫助。不過，對於哺餵母乳之婦女，缺乏足夠資料也沒有足夠證據，此外，似乎併用節食和運動來減重比單獨節食還要好，因為運動可改善循環和心臟適能，而且能夠保留瘦肌肉群(Lean body mass)。後續研究是需要的。