Introduction
Postpartum weight retention is a significant contributor to obesity in women of reproductive age. While a number of randomised controlled trials (RCTs) have looked at reducing weight retention in postpartum women, the impact of implementation characteristics on effectiveness is not known.
Methods
MEDLINE, CINAHL, EMBASE, PsycInfo, and EBM databases were searched to identify lifestyle intervention RCTs in postpartum women (within 2 years post-delivery) published up to January 2018. The primary outcome was weight change. Population penetration and participation rates were calculated. Subgroup analyses were performed for intervention provider, intervention duration, number of sessions, self-monitoring, use of technology, group or individual setting, attrition, fidelity and intervention types (diet/physical activity/combined).
Results
From 4512 studies, 34 studies were included in the systematic review and meta-analysis (n=5000 women, age 18-34 years). One study reported their penetration rate (2.5%) and five studies reported their participation rate (0.94% to 86%). Studies with self-monitoring had significantly greater weight loss than those without (mean difference -2.93 kg, 95% confidence interval [4.12, -1.74] vs -1.29 kg [-2.35, -0.23], P=0.04 for subgroup differences). Diet and physical activity combined were significantly more effective for weight loss compared with physical activity only interventions (-3.29 kg [-4.51, -2.06] vs -0.53 kg [-1.52, 0.46], P=0.003 for subgroup differences). Health professional delivered interventions were more effective for weight loss than those that were not (-4.45 kg [-7.16, -1.75] vs -0.76 kg [-1.41, -0.12], P=0.009 for subgroup differences). Intervention duration, number of sessions, individual or group setting were not associated with weight loss.
Conclusion
Despite the large number of RCTs conducted in postpartum women, a lack of information on the population penetration and participation in these interventions exists. Self-monitoring, delivery by health professionals and combining diet and physical activity increases the effectiveness of lifestyle interventions on weight loss in postpartum women.