Las mujeres embarazadas que tienen una dieta saludable y realizan ejercicio moderado tienen menos probabilidades de tener una cesárea, ganar peso excesivo o desarrollar diabetes en el embarazo, según ha mostrado un estudio dirigido por la Queen Mary University of London (QMUL) (Reino Unido), en el que han participado más de 12.000 mujeres.
El trabajo, publicado en «The BMJ», es el mayor proyecto de investigación del mundo que ha analizado las intervenciones de estilo de vida en el embarazo, con la participación de más de 50 investigadores de 41 instituciones.
En concreto, los investigadores han analizado los datos 12.526 mujeres embarazadas que habían participado en 36 ensayos en 16 países. Los resultados los compararon con los efectos de la dieta (incluyendo la restricción de las bebidas azucaradas, la promoción de productos lácteos bajos en grasa, el aumento de frutas y hortalizas) y actividad física (intensidad moderada incluyendo clases aeróbicas y ciclismo estacionario, y entrenamiento de resistencia para grupos musculares).
De esta forma, los expertos comprobaron que la combinación de dieta y ejercicio físico había reducido significativamente el aumento de peso de la madre durante el embarazo en un promedio de 0,7 kilogramos, en comparación con el grupo control, y en un 10% las probabilidades de que la madre tuviera una cesárea.
Abstract
Objective To synthesise the evidence on the overall and differential effects of interventions based on diet and physical activity during pregnancy, primarily on gestational weight gain and maternal and offspring composite outcomes, according to women’s body mass index, age, parity, ethnicity, and pre-existing medical condition; and secondarily on individual complications.
Design Systematic review and meta-analysis of individual participant data (IPD).
Data sources Major electronic databases from inception to February 2017 without language restrictions.
Eligibility criteria for selecting studies Randomised trials on diet and physical activity based interventions in pregnancy.
Data synthesis Statistical models accounted for clustering of participants within trials and heterogeneity across trials leading to summary mean differences or odds ratios with 95% confidence intervals for the effects overall, and in subgroups (interactions).
Results IPD were obtained from 36 randomised trials (12 526 women). Less weight gain occurred in the intervention group than control group (mean difference −0.70 kg, 95% confidence interval −0.92 to −0.48 kg, I2=14.1%; 33 studies, 9320 women). Although summary effect estimates favoured the intervention, the reductions in maternal (odds ratio 0.90, 95% confidence interval 0.79 to 1.03, I2=26.7%; 24 studies, 8852 women) and offspring (0.94, 0.83 to 1.08, I2=0%; 18 studies, 7981 women) composite outcomes were not statistically significant. No evidence was found of differential intervention effects across subgroups, for either gestational weight gain or composite outcomes. There was strong evidence that interventions reduced the odds of caesarean section (0.91, 0.83 to 0.99, I2=0%; 32 studies, 11 410 women), but not for other individual complications in IPD meta-analysis. When IPD were supplemented with study level data from studies that did not provide IPD, the overall effect was similar, with stronger evidence of benefit for gestational diabetes (0.76, 0.65 to 0.89, I2=36.8%; 59 studies, 16 885 women).
Conclusion Diet and physical activity based interventions during pregnancy reduce gestational weight gain and lower the odds of caesarean section. There is no evidence that effects differ across subgroups of women.
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