Objectives To identify if maternal educational attainment is a prognostic factor for gestational weight gain (GWG), and to determine the differential effects of lifestyle interventions (diet based, physical activity based or mixed approach) on GWG, stratified by educational attainment. Design Individual participant data meta-Analysis using the previously established International Weight Management in Pregnancy (i-WIP) Collaborative Group database (https://iwipgroup.wixsite.com/collaboration). Preferred Reporting Items for Systematic reviews and Meta-Analysis of Individual Participant Data Statement guidelines were followed. Data sources Major electronic databases, from inception to February 2017. Eligibility criteria Randomised controlled trials on diet and physical activity-based interventions in pregnancy. Maternal educational attainment was required for inclusion and was categorised as higher education (≥tertiary) or lower education (≤secondary). Risk of bias Cochrane risk of bias tool was used. Data synthesis Principle measures of effect were OR and regression coefficient. Results Of the 36 randomised controlled trials in the i-WIP database, 21 trials and 5183 pregnant women were included. Women with lower educational attainment had an increased risk of excessive (OR 1.182; 95% CI 1.008 to 1.385, p =0.039) and inadequate weight gain (OR 1.284; 95% CI 1.045 to 1.577, p =0.017). Among women with lower education, diet basedinterventions reduced risk of excessive weight gain (OR 0.515; 95% CI 0.339 to 0.785, p = 0.002) and inadequate weight gain (OR 0.504; 95% CI 0.288 to 0.884, p=0.017), and reduced kg/week gain (B-0.055; 95% CI-0.098 to-0.012, p=0.012). Mixed interventions reduced risk of excessive weight gain for women with lower education (OR 0.735; 95% CI 0.561 to 0.963, p=0.026). Among women with high education, diet based interventions reduced risk of excessive weight gain (OR 0.609; 95% CI 0.437 to 0.849, p=0.003), and mixed interventions reduced kg/week gain (B-0.053; 95% CI-0.069 to-0.037,p<0.001). Physical activity based interventions did not impact GWG when stratified by education. Conclusions Pregnant women with lower education are at an increased risk of excessive and inadequate GWG. Diet based interventions seem the most appropriate choice for these women, and additional support through mixed interventions may also be beneficial.

Original languageEnglish
Article numbere025620
Pages (from-to)1-12
Number of pages12
JournalBMJ Open
Issue number8
Publication statusPublished - 1 Aug 2019

Bibliographical note

Acknowledgements The authors are also grateful to the i-WIP Network for the
individual participant data shared and to Helena Teede, Janette Khoury and Márcia
Vitolo for the contribution of data.
Contributors ECOB, FMMcA: wrote a proposal to the i-WIP data access committee;
set the objectives, study design and data analysis plan. ECOB, FMMcA, RS, AAG and
GA: analysis and interpretation of data; drafting of manuscript; critical revision; final
approval of version to be published; agreeable to be accountable for all aspects of
the work. ER: i-WIP IPD database manager; study conception and design; critical
revision; final approval of version to be published; agreeable to be accountable
for all aspects of the work. AA, RBC, AB, JGC, AC, CJMdG, RD, JMD, NEB, FF, NG,
KMR, AER, LS, KÅS, TTS, GS, AS, SNS, FGS, ShT, SeT, MNMvP, CV, IV and SY: study
conception and design; critical revision; final approval of version to be published;
agreeable to be accountable for all aspects of the work.
Funding The data come from a National Institute for Health Research (NIHR)
funded project (HTA-12/01/50) and the Queen Mary University of London is its legal
sponsor. The database was initially funded by the NIHR and is currently funded by
WHO. This work was also supported by the Health Research Board, Health Research
Centre for Health and Diet Research, Ireland.


  • inequalities
  • lifestyle interventions
  • nutrition
  • pregnancy
  • socioeconomic status


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