Maternal diet synthesis

Research gaps from Cochrane Reviews

(Cochrane Library Issue 3, 2006)

Instructions

The faces indicate the direction of findings in each review:

JLikely to be effective

KBenefits and risks balanced

? Uncertain or limited effect

LLikely to be ineffective or potentially harmful

 

? Thus, important research implications are more likely to arise from reviews with uncertain findings.

JIf a review shows an intervention to be beneficial,

K  or that the risks and benefits are reasonably balanced,there may be less need for further research (at least for the major review question).

L If a review indicates that the intervention is likely to be ineffective or potentially harmful, or has been superseded, then this will often indicate that these research questions are of lower importance. 

During pregnancy

KDietary advice can increase pregnant women's energy and protein intakes but is unlikely to significantly benefit infant or maternal health (Kramer 2003)

• The modest benefits indicate that nutritional advice in this area is not an important topic for further research

J Balanced energy/protein supplementation improves fetal growth and may reduce the risk of fetal and neonatal death (Kramer 2003)

• Future energy/protein supplementation trials should focus on confirming the evidence of reduced risk of stillbirth and neonatal death

• Any future trials should also assess the effects on women, including duration of labour, caesarean section, and postpartum weight retention

L High-protein or balanced protein supplementation alone is not beneficial and may be harmful to the infant (Kramer 2003)

• Future trials of high protein supplementation or isocaloric protein supplementation during pregnancy are not indicated

L Protein/energy restriction of pregnant women who are overweight or exhibit high weight gain is unlikely to be beneficial and may be harmful to the infant (Kramer 2003)

• Future trials of protein/energy restriction during pregnancy are not indicated

? Low salt diet during pregnancy unlikely to prevent pre-eclampsia (Duley 2005)

• Future trials not seen as a priority

? Advice to lower dietary salt during pregnancy unlikely to prevent pre-eclampsia (Duley 1999)

• Future trials not seen as a priority

JFibre supplements to relieve constipation in pregnancy (Jewell 2001)

• Need to compare daily fibre supplements with common treatments such as increased exercise

? Antigen avoidance diet during pregnancy for preventing atopic disease in the child (Kramer 2006)

• Need larger trials with longer follow-up with more information on potential adverse effects

• Need more information on women’s experiences and adherence with diet

? Maternal hydration for increasing amniotic fluid volume (Hofmeyr 2002)

• Investigating potential benefits and harms of maternal hydration for oligohydramnios is worthwhile

• Use of maternal hydration prior to external cephalic version at term is worth investigating

• Need to investigate the possible negative effect of starvation (and decreased water intake) during labour on amniotic fluid level

During labour

? Restricting oral fluid and food intake during labour (Singata 2002)

• Cochrane protocol, Cochrane review in progress

? Hydration (oral or intravenous) in preterm labour for preventing preterm birth (Stan 2002)

• Sample sizes of the included trials were too small to assess substantive outcomes such as perinatal mortality and morbidity

Postpartum

? Diet, exercise or both for postpartum weight loss (Amorim 2006)

• Cochrane protocol, Cochrane review in progress      

? Antigen avoidance diet during lactation for preventing/treating atopic disease in the child (Kramer 2006)

• Need larger trials with longer follow-up with more information on potential adverse effects

• Need more information on women’s experiences and adherence with diet

References

1. Amorim AR, Linne YM, Lourenco PMC. Diet or exercise, or both, for weight reduction in women after childbirth. (Protocol) Cochrane Database of Systematic Reviews 2006, Issue 1

2. Duley L, Henderson-Smart D, Meher S. Altered dietary salt for preventing pre-eclampsia, and its complications. Cochrane Database of Systematic Reviews 2005, Issue 4

3. Duley L, Henderson-Smart D. Reduced salt intake compared to normal dietary salt, or high intake, in pregnancy. Cochrane Database of Systematic Reviews 1999, Issue 3

4. Hofmeyr GJ, Gülmezoglu AM. Maternal hydration for increasing amniotic fluid volume in oligohydramnios and normal amniotic fluid volume. Cochrane Database of Systematic Reviews 2002, Issue 1

5. Jewell DJ, Young G. Interventions for treating constipation in pregnancy. Cochrane Database of Systematic Reviews 2001, Issue 2

6. Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Cochrane Database of Systematic Reviews 2006, Issue 3

7. Kramer MS, Kakuma R. Energy and protein intake in pregnancy. Cochrane Database of Systematic Reviews 2003, Issue 4

8. Singata M, Tranmer JE. Restricting oral fluid and food intake during labour. (Protocol) Cochrane Database of Systematic Reviews 2002, Issue 4

9. Stan C, Boulvain M, Hirsbrunner-Amagbaly P, Pfister R. Hydration for treatment of preterm labour. Cochrane Database of Systematic Reviews 2002, Issue 2