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Proportion of women with gestational weight gain outside the Institute of Medicine recommendations (2009) by kilogram. Number and proportion of women by each kilogram of GWG above (A) or below (B) the Institute of Medicine recommendations (2009) - overall and by baseline BMI category (DOCX 19 kb)

Adverse pregnancy outcomes according to adherence to the Institute of Medicine recommendations (2009). Proportion of adverse pregnancy outcomes according to adherence to the Institute of Medicine recommendations (2009) overall and by baseline BMI category (DOCX 18 kb)

Additional file 1. Search string.

Characteristics of women classified according to the Institute of Medicine recommendations (2009). Table with baseline characteristics of women from the control arms of randomised trials used in the analyses classified by adherence to the Institute of Medicine (2009) recommendations (DOCX 21 kb)

Lists of potential confounders. Tables with confounders considered for individual models depending on the outcome of interest (DOCX 20 kb)

PRISMA-P 2015 Checklist. (DOCX 30Â kb)

AIM: Trials on diet and physical activity in pregnancy report on various outcomes. We aimed to assess the variations in outcomes reported and their quality in trials on lifestyle interventions in pregnancy.METHODS: We searched major databases without language restrictions for randomized controlled trials on diet and physical activity-based interventions in pregnancy up to March 2015. Two independent reviewers undertook study selection and data extraction. We estimated the percentage of papers reporting 'critically important' and 'important' outcomes. We defined the quality of reporting as a proportion using a six-item questionnaire. Regression analysis was used to identify factors affecting this quality.RESULTS: Sixty-six randomized controlled trials were published in 78 papers (66 main, 12 secondary). Gestational diabetes (57.6%, 38/66), preterm birth (48.5%, 32/66) and cesarian section (60.6%, 40/66), were the commonly reported 'critically important' outcomes. Gestational weight gain (84.5%, 56/66) and birth weight (87.9%, 58/66) were reported in most papers, although not considered critically important. The median quality of reporting was 0.60 (interquartile range 0.25, 0.83) for a maximum score of one. Study and journal characteristics did not affect quality.CONCLUSION: Many studies on lifestyle interventions in pregnancy do not report critically important outcomes, highlighting the need for core outcome set development.

Aim: Obese women undergoing caesarean section are at increased risk of surgical wound infection, which may lead to reduced quality of life, and increased health care cost. The aim is to evaluate the effect of incisional Negative Pressure Wound Therapy applied prophylactically in obese women undergoing caesarean section.Method: This study is designed as an unblinded, randomised trial. Women with a pre-gestational BMI ≥30 undergoing planned or emergency caesarean section are allocated into one of two groups (incisional Negative Pressure Wound Therapy vs. standard dressing), stratified by centre and type of caesarean section. The dressing is applied immediately following the surgical procedure. In the intervention group the therapy will be left in situ for five days. In the control group the dressing will be left in situ for at least 24 hours as standard procedure. Follow-up is 30 days.Conclusion: The study is on-going. We expect to find a 50% reduction of wound infection when using iNPWT compared to standard dressings in this high-risk subpopulation.

Aim: Postoperative wound complications make many surgical procedures unnecessarily complex, particularly in high-risk patients. Negative Pressure Wound Therapy is well recognized in the management of open wounds. In recent years, it has been introduced as well in the management of closed surgical incisions to reduce postoperative wound complications, though the evidence base to support this intervention is limited. The aim of this study was to assess if Negative Pressure Wound Therapy (NPWT) reduces postoperative complications when applied on closed surgical incisions.Method: A systematic review and meta-analysis of randomized controlled trials of NPWT compared to standard postoperative dressings on closed incisions. Results: Ten studies met the inclusion criteria, reporting on 1344 incisions (1121 patients). NPWT was associated with a significant reduction of wound infection (46%), and seroma formation (52%) compared to standard care. The reduction in wound dehiscence was not statistically significant. The numbers needed to treat were 3 (seroma), 17 (dehiscence), and 25 (infection). Methodical heterogeneity across studies led to downgrading quality of evidence to moderate for infection and seroma, and low for dehiscence. Conclusion: Compared with standard postoperative dressings, NPWT significantly reduces the rate of wound infection and seroma when applied to closed surgical wounds, but diversity in clinical and methodological aspects of the included studies means that no absolute or general recommendations can be made. Aim: Postoperative wound complications make many surgical procedures unnecessarily complex, particularly in high-risk patients. Negative Pressure Wound Therapy is well recognized in the management of open wounds. In recent years, it has been introduced as well in the management of closed surgical incisions to reduce postoperative wound complications, though the evidence base to support this intervention is limited. The aim of this study was to assess if Negative Pressure Wound Therapy (NPWT) reduces postoperative complications when applied on closed surgical incisions.Method: A systematic review and meta-analysis of randomized controlled trials of NPWT compared to standard postoperative dressings on closed incisions. Results: Ten studies met the inclusion criteria, reporting on 1344 incisions (1121 patients). NPWT was associated with a significant reduction of wound infection (46%), and seroma formation (52%) compared to standard care. The reduction in wound dehiscence was not statistically significant. The numbers needed to treat were 3 (seroma), 17 (dehiscence), and 25 (infection). Methodical heterogeneity across studies led to downgrading quality of evidence to moderate for infection and seroma, and low for dehiscence. Conclusion: Compared with standard postoperative dressings, NPWT significantly reduces the rate of wound infection and seroma when applied to closed surgical wounds, but diversity in clinical and methodological aspects of the included studies means that no absolute or general recommendations can be made.

Background: Obese women undergoing caesarean section are at increased risk of surgical wound complications, which may lead to delayed recovery, pain, reduced quality of life, and increased health care cost. The aim of this study is to evaluate the effect of incisional Negative Pressure Wound Therapy (iNPWT) applied prophylactically following caesarean section compared with standard postoperative dressings in obese women undergoing caesarean section.Method: This study is designed as an unblinded, pragmatic, parallel randomised multicenter trial, with a 1:1 allocation. A computer random number generator are used to allocate the participants into one of two groups (iNPWT vs. standard dressing), stratified by centre and type of CS. The study is conducted at five public hospitals located in three regions of Denmark. Interim analyses will be preformed along the trial using the group sequential method. The analyses will be performed when sample size reaches 179, 357, 535, 713, and 891, respectively. Population: women with a pre-gestational BMI ≥ 30 undergoing planned or emergency caesarean section. The iNPWT or standard dressings is applied immediately following operation. In the intervention group the therapy will be left in situ for five days. In the control group the dressing will be left in situ for at least 24 hours as standard procedure. Follow-up is 30 days.Results: The study is on going. The first 179 participants are about to be analysed. Overall we expect to find a 50% reduction of wound infection when using iNPWT compared to standard postoperative dressings in this high-risk subpopulation.

One third of the pregnant Danish women are overweight or obese. Maternal obesity is an independent risk factor for adverse maternal and foetal outcomes including infertility, miscarriage, congenital malformations, preeclampsia, gestational diabetes, complicated deliveries, caesarean section, macrosomia and childhood obesity. This article reviews the effect of maternal obesity on obstetric and neonatal outcomes and provides recommendations for management of obesity in pregnancy.

To study the effects of lifestyle intervention on gestational weight gain (GWG) and obstetric outcomes.

Udgivelsesdato: 10.06