scholarly journals Diet and physical activity in pregnancy to prevent gestational diabetes: a protocol for an individual participant data (IPD) meta-analysis on the differential effects of interventions with economic evaluation

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e048119
Author(s):  
Dyuti Coomar ◽  
Jonathan M Hazlehurst ◽  
Frances Austin ◽  
Charlie Foster ◽  
Graham A Hitman ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cost Effectiveness ◽  
Gestational Diabetes ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Individual Participant Data ◽  
Randomised Trials ◽  
Diet And Physical Activity ◽  
Individual Participant ◽  
In Pregnancy

IntroductionMothers with gestational diabetes mellitus (GDM) are at increased risk of pregnancy-related complications and developing type 2 diabetes after delivery. Diet and physical activity-based interventions may prevent GDM, but variations in populations, interventions and outcomes in primary trials have limited the translation of available evidence into practice. We plan to undertake an individual participant data (IPD) meta-analysis of randomised trials to assess the differential effects and cost-effectiveness of diet and physical activity-based interventions in preventing GDM and its complications.MethodsThe International Weight Management in Pregnancy Collaborative Network database is a living repository of IPD from randomised trials on diet and physical activity in pregnancy identified through a systematic literature search. We shall update our existing search on MEDLINE, Embase, BIOSIS, LILACS, Pascal, Science Citation Index, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Health Technology Assessment Database without language restriction to identify relevant trials until March 2021. Primary researchers will be invited to join the Network and share their IPD. Trials including women with GDM at baseline will be excluded. We shall perform a one and two stage random-effect meta-analysis for each intervention type (all interventions, diet-based, physical activity-based and mixed approach) to obtain summary intervention effects on GDM with 95% CIs and summary treatment–covariate interactions. Heterogeneity will be summarised using I2 and tau2 statistics with 95% prediction intervals. Publication and availability bias will be assessed by examining small study effects. Study quality of included trials will be assessed by the Cochrane Risk of Bias tool, and the Grading of Recommendations, Assessment, Development and Evaluations approach will be used to grade the evidence in the results. A model-based economic analysis will be carried out to assess the cost-effectiveness of interventions to prevent GDM and its complications compared with usual care.Ethics and disseminationEthics approval is not required. The study is registered on the International Prospective Register of Systematic Reviews (CRD42020212884). Results will be submitted for publication in peer-reviewed journals.

scholarly journals Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials

BMJ ◽  
2017 ◽  
pp. j3119 ◽  
Author(s):  
Keyword(s):  
Physical Activity ◽  
Weight Gain ◽  
Gestational Weight Gain ◽  
Meta Analysis ◽  
Individual Participant Data ◽  
Randomised Trials ◽  
Gestational Weight ◽  
Diet And Physical Activity ◽  
Individual Participant ◽  
Composite Outcomes

AbstractObjectiveTo 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.DesignSystematic review and meta-analysis of individual participant data (IPD).Data sourcesMajor electronic databases from inception to February 2017 without language restrictions.Eligibility criteria for selecting studiesRandomised trials on diet and physical activity based interventions in pregnancy.Data synthesisStatistical 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).ResultsIPD 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).ConclusionDiet 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.

scholarly journals Association of Maternal Iodine Status With Child IQ: A Meta-Analysis of Individual Participant Data

2019 ◽  
Vol 104 (12) ◽  
pp. 5957-5967 ◽  
Author(s):  
Deborah Levie ◽  
Tim I M Korevaar ◽  
Sarah C Bath ◽  
Mario Murcia ◽  
Mariana Dineva ◽  
...  
Keyword(s):  
Iodine Deficiency ◽  
Meta Analysis ◽  
Urinary Iodine ◽  
First Trimester ◽  
Individual Participant Data ◽  
Verbal Iq ◽  
Iodine Status ◽  
Child Neurodevelopment ◽  
Individual Participant ◽  
In Pregnancy

Abstract Context Although the consequences of severe iodine deficiency are beyond doubt, the effects of mild to moderate iodine deficiency in pregnancy on child neurodevelopment are less well established. Objective To study the association between maternal iodine status during pregnancy and child IQ and identify vulnerable time windows of exposure to suboptimal iodine availability. Design Meta-analysis of individual participant data from three prospective population-based birth cohorts: Generation R (Netherlands), INMA (Spain), and ALSPAC (United Kingdom); pregnant women were enrolled between 2002 and 2006, 2003 and 2008, and 1990 and 1992, respectively. Setting General community. Participants 6180 mother-child pairs with measures of urinary iodine and creatinine concentrations in pregnancy and child IQ. Exclusion criteria were multiple pregnancies, fertility treatment, medication affecting the thyroid, and preexisting thyroid disease. Main Outcome Measure Child nonverbal and verbal IQ assessed at 1.5 to 8 years of age. Results There was a positive curvilinear association of urinary iodine/creatinine ratio (UI/Creat) with mean verbal IQ only. UI/Creat <150 µg/g was not associated with lower nonverbal IQ (−0.6 point; 95% CI: −1.7 to 0.4 points; P = 0.246) or lower verbal IQ (−0.6 point; 95% CI: −1.3 to 0.1 points; P = 0.082). Stratified analyses showed that the association of UI/Creat with verbal IQ was only present up to 14 weeks of gestation. Conclusions Fetal brain development is vulnerable to mild to moderate iodine deficiency, particularly in the first trimester. Our results show that potential randomized controlled trials investigating the effect of iodine supplementation in women with mild to moderate iodine deficiency on child neurodevelopment should begin supplementation not later than the first trimester.

scholarly journals Use of heparins in patients with cancer: individual participant data meta-analysis of randomised trials study protocol

BMJ Open ◽  
2016 ◽  
Vol 6 (4) ◽  
pp. e010569 ◽  
Author(s):  
Holger J Schünemann ◽  
Matthew Ventresca ◽  
Mark Crowther ◽  
Matthias Briel ◽  
Qi Zhou ◽  
...  
Keyword(s):  
Study Protocol ◽  
Meta Analysis ◽  
Individual Participant Data ◽  
Randomised Trials ◽  
Patients With Cancer ◽  
Individual Participant
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