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Use the link below to share a full-text version of this article with your friends and colleagues. Antenatal interventions for overweight or obese pregnant women: a systematic review of randomised trials.
BJOG ;— Objective A systematic review to assess the benefits and harms of antenatal dietary or lifestyle interventions for pregnant women who are overweight or obese. Reference lists of retrieved studies were searched by hand.
No date or language restrictions were used. Studies were evaluated independently for appropriateness for inclusion and methodological quality. Data collection and analysis Nine randomised controlled trials were included involving women who were overweight or obese during pregnancy.
Seven trials compared a dietary intervention with standard antenatal care. There were no statistically significant differences identified for other reported outcomes. It is unclear whether antenatal intervention for women who are overweight or obese is effective in limiting gestational weight gain, whether there are additional benefits in terms of improved maternal and infant health outcomes, and whether there are any sustained benefits for the infant, such as reducing the risk of child obesity.
The reference lists of the retrieved studies were searched by hand, and no date or language restrictions were placed on the search date of last search January Our review followed the methods detailed in the Cochrane Handbook.
Trials were excluded where information was available in abstract form only. Childhood outcomes of relevance relate to body size including height, weight, and BMI and body composition. The outcome definitions were those used by the individual trial authors.
This was conducted by two authors independently JD and RG. We carried out statistical analysis using R eview M anager. Ten published randomised trials were identified: 21 - 30 one study was presented only in abstract form, 31 and nine were ongoing randomised trials for consideration.
Nine randomised controlled trials were included, 21 , 22 , 24 - 30 involving women who were overweight or obese during pregnancy. One report of a randomised trial was identified in abstract form only, and did not contain sufficient information to allow an assessment of the study quality.
Nine ongoing randomised trials were identified, evaluating antenatal dietary and lifestyle interventions in obese and overweight women. Seven trials compared a dietary intervention with standard antenatal care involving no intervention. We identified significant heterogeneity across the studies related primarily to the intensity of the intervention provided, ranging from a single dietetic visit 28 to additional dietetic sessions at each antenatal visit.
This uncertainty of both the effect of an antenatal intervention and its optimal intensity significantly limits the ability to generate reliable recommendations relating to care in clinical practice. Despite the total number of women in the studies identified for this systematic review being , there is clear inconsistency in outcome reporting, particularly related to maternal and infant health outcomes, with these only being reported in a small proportion of trials to date.
Our review identified considerable variation in the nature of the intervention provided, ranging from single sessions with a dietician up to additional dietetic counselling sessions associated with each antenatal visit. Current guidelines from the American College of Obstetricians and Gynecologists 42 recommend that women be counselled prior to conception, and be encouraged to adopt lifestyle changes to minimise their risk of developing complications during pregnancy related to being overweight or obese.
For many women, however, this is not achieved, and the focus is therefore on minimising the risk of complications during pregnancy. The recently updated and published guidelines from the Institute of Medicine IOM 43 differ little from the previously published recommendations, 44 with the exception that they reflect World Health Organisation BMI categories, 45 and provide a gestational weight gain range for women who are obese.
Hence, the recommendation for women who are overweight in pregnancy is to gain between 7. Experimental manipulation of maternal diet during pregnancy in animal studies indicates a significant alteration of offspring body composition and adiposity, potentially through the modification of appetite and energy expenditure.
Although it is possible that the antecedents of obesity may develop in utero , the precise contribution of the prenatal environment, maternal overnutrition, and genetic factors remains to be determined. The ongoing research studies identified to date will contribute valuable information provided that the relevant clinical outcomes are reported.
Of greater importance is the ongoing follow up of infant and childhood participants in any such established cohorts, if the in utero contributions to childhood obesity are to be elucidated. All authors were involved in the development of the study design. JD and RG were involved in the assessment of studies for inclusion, quality assessment, and data extraction. This article is a systematic review of published randomised trials, and ethics approval was not required.
Volume , Issue If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. If the address matches an existing account you will receive an email with instructions to retrieve your username. Systematic review Free Access. Email: jodie. Tools Request permission Export citation Add to favorites Track citation. Share Give access Share full text access.
Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article. Background Overweight and obesity during pregnancy is an increasing health problem.
Data synthesis We carried out statistical analysis using R eview M anager. Figure 1 Open in figure viewer PowerPoint. Description of the studies included Nine randomised controlled trials were included, 21 , 22 , 24 - 30 involving women who were overweight or obese during pregnancy.
Figure 2 Open in figure viewer PowerPoint. Ongoing studies Nine ongoing randomised trials were identified, evaluating antenatal dietary and lifestyle interventions in obese and overweight women.
Julie Quinlivan juliequinlivan nd. Antenatal dietary intervention for women who are overweight or obese Seven trials compared a dietary intervention with standard antenatal care involving no intervention.
Figure 3 Open in figure viewer PowerPoint. Figure 4 Open in figure viewer PowerPoint. Disclosure of interests The authors have no competing interests to declare. Contribution to authorship All authors were involved in the development of the study design. Details of ethics approval This article is a systematic review of published randomised trials, and ethics approval was not required. Funding None. Selected major risk factors and global and regional burden of disease.
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Enter your email address below and we will send you your username. Women were randomised to: 1 routine antenatal care or 2 intervention dietician visit and feedback on weight gain. Women were randomised to: 1 routine antenatal care or 2 intervention three group sessions with dietician and written information. Inclusion: obese women with gestational diabetes mellitus Sample size: Women were randomised to: 1 standard antenatal care or 2 intensive intervention access to research dietician or psychologist at each antenatal visit.
Women were randomised to: 1 standard antenatal care or 2 monitored group visit to dietician and detailed diet protocol. Women are randomised to: 1 standard care or 2 intervention group detailed information including weight gain, dietetic counselling, exercise programme.
Dr Kristi Adamo kadamo cheo. Women are randomised to: 1 standard care or 2 intervention group five counselling sessions. Ellen Althuizen e. Setting: Adelaide, SA, Australia. Women are randomised to: 1 standard care or 2 intervention group written information and series of inputs from research assistants and research dieticians. Dr Jodie Dodd jodie. Associate Leonie Callaway lcallaway somc. Nicolette Oostdam n. Parat 37 NCT Women are randomised to: 1 standard care including at least one dietary consultation or 2 intervention group four educational sessions and two dietician consultations.
Dr Sophie Parat sophie. Quinlivan 38 PTR
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Vietnam - Wikipedia
With an estimated Vietnam shares its land borders with China to the north, and Laos and Cambodia to the west. Archaeological excavations indicate that Vietnam was inhabited as early as the Paleolithic age.
The ancient Vietnamese nation was annexed by China in the 2nd century BC, which subsequently made Vietnam a division of China for over a millennium.
The first independent monarchy emerged in the 10th century AD. This paved the way for successive imperial dynasties as the nation expanded geographically southward until the Indochina Peninsula was colonised by the French in the midth century.
Modern Vietnam was born upon the Declaration of Independence from France in Following Vietnamese victory against the French in the First Indochina War , which ended in , the nation was divided into two rival states: communist North and anti-communist South. Conflicts intensified in the Vietnam War , which saw extensive US intervention in support of South Vietnam and ended with North Vietnamese victory in After North and South Vietnam were reunified under a unitary socialist government in , the country became economically and politically isolated until , when the Communist Party initiated a series of economic and political reforms that facilitated Vietnamese integration into world politics and the global economy.
As a result of the successful reforms, Vietnam has enjoyed a high GDP growth rate, consistently ranked among the fastest-growing countries in the world. It nevertheless faces challenges including poverty , corruption and inadequate social welfare. By , Vietnam had established diplomatic relations with countries. The Emperor refused since the name was related to Zhao Tuo 's Nanyue, which included the regions of Guangxi and Guangdong in southern China. The Qing Emperor, therefore, decided to call the area "Viet Nam" instead.
Archaeological excavations have revealed the existence of humans in what is now Vietnam as early as the Paleolithic age. From the 16th century onward, civil strife and frequent political infighting engulfed much of Vietnam. They also had less interest in the territory than they did in China and Japan. In , the southern third of the country became the French colony of Cochinchina. The three Vietnamese entities were formally integrated into the union of French Indochina in The mutiny caused an irreparable split in the independence movement that resulted in many leading members of the organisation becoming communist converts.
Afterwards, the Japanese Empire was allowed to station its troops in Vietnam while permitting the pro- Vichy French colonial administration to continue. This led to the Vietnamese Famine of , which resulted in up to two million deaths. Earlier, in July , the Allies had decided to divide Indochina at the 16th parallel to allow Chiang Kai-shek of the Republic of China to receive the Japanese surrender in the north while Britain's Lord Louis Mountbatten received their surrender in the south.
The Allies agreed that Indochina still belonged to France. However, as the French were weakened by the German occupation , British- Indian forces together with the remaining Japanese Southern Expeditionary Army Group were used to maintain order and to help France re-establish control through the — War in Vietnam. He asked the French to withdraw their colonial administrators, and for aid from French professors and engineers to help build a modern independent Vietnam.
The colonial administration was therefore ended and French Indochina was dissolved under the Geneva Accords of into three countries—Vietnam, and the kingdoms of Cambodia and Laos. Vietnam was further divided into North and South administrative regions at the Demilitarised Zone , roughly along the 17th parallel north , pending elections scheduled for July This migration was in large part aided by the United States military through Operation Passage to Freedom.
Between and , the North Vietnamese government instituted various agrarian reforms, including "rent reduction" and " land reform ", which resulted in significant political oppression. To support South Vietnam's struggle against the communist insurgency, the United States began increasing its contribution of military advisers, using the Gulf of Tonkin incident as a pretext for such intervention.
Meanwhile, China and the Soviet Union provided North Vietnam with significant material aid and 15, combat advisers. Although the campaign failed militarily, it shocked the American establishment and turned US public opinion against the war.
This process also entailed an unsuccessful effort to strengthen and stabilise South Vietnam. Once an inlet of the Gulf of Tonkin , it has been filled in over the millennia by riverine alluvial deposits. It is criss-crossed by a maze of rivers and canals, which carry so much sediment that the delta advances 60 to 80 metres Southern Vietnam is divided into coastal lowlands, the mountains of the Annamite Range , and extensive forests.
Due to differences in latitude and the marked variety in topographical relief, Vietnam's climate tends to vary considerably for each region. As the country is located within the Indomalayan realm , Vietnam is one of twenty-five countries considered to possess a uniquely high level of biodiversity. This was noted in the country's National Environmental Condition Report in Vietnam's fauna includes: nematode species, oligochaeta , acarina , springtails , 7, insects, reptiles, and amphibians.
Vietnam is also home to 1, species of freshwater microalgae , constituting 9. However, the last individual of the species in Vietnam was reportedly shot in In Vietnam, wildlife poaching has become a major concern. In , a non-governmental organisation NGO called Education for Nature - Vietnam was founded to instill in the population the importance of wildlife conservation in the country.
Through collaboration between the NGOs and local authorities, many local poaching syndicates were crippled by their leaders' arrests. The main environmental concern that persists in Vietnam today is the legacy of the use of the chemical herbicide Agent Orange , which continues to cause birth defects and many health problems in the Vietnamese population.
Plant construction costs were funded by the company itself. The Vietnamese government began doing this at the end of the war. Apart from herbicide problems, arsenic in the ground water in the Mekong and Red River Deltas has also become a major concern.
Vietnam is a unitary Marxist-Leninist one-party socialist republic , one of the two communist states the other being Laos in Southeast Asia.
The general secretary of the CPV performs numerous key administrative functions, controlling the party's national organisation. Only political organisations affiliated with or endorsed by the CPV are permitted to contest elections in Vietnam. These include the Vietnamese Fatherland Front and worker and trade unionist parties.
The National Assembly of Vietnam is the unicameral state legislature composed of members. Headed by a chairman , it is superior to both the executive and judicial branches, with all government ministers being appointed from members of the National Assembly.
Beneath the Supreme People's Court stand the provincial municipal courts and many local courts. Military courts possess special jurisdiction in matters of national security.
Vietnam maintains the death penalty for numerous offences. Throughout its history, Vietnam's main foreign relationship has been with various Chinese dynasties.
Though China and Vietnam are now formally at peace,  significant territorial tensions remain between the two countries over the South China Sea.
It also maintains relations with over non-governmental organisations. Full diplomatic relations were also restored with New Zealand , which opened its embassy in Hanoi in ;  Vietnam established an embassy in Wellington in The VPA has an active manpower of around ,, but its total strength, including paramilitary forces, may be as high as 5,, Under the current constitution, the Communist Party of Vietnam is the only party allowed to rule, the operation of all other political parties being outlawed.
Other human rights issues concern freedom of association , freedom of speech , and freedom of the press. Throughout the history of Vietnam, its economy has been based largely on agriculture —primarily wet rice cultivation. Despite strict state control, Vietnam's economy continued to be plagued by inefficiency, corruption in state-owned enterprises , poor quality and underproduction. Private ownership began to be encouraged in industry, commerce and agriculture and state enterprises were restructured to operate under market constraints.
As a result of several land reform measures, Vietnam has become a major exporter of agricultural products. It is now the world's largest producer of cashew nuts, with a one-third global share;  the largest producer of black pepper , accounting for one-third of the world's market;  and the second-largest rice exporter in the world after Thailand since the s.
In , Vietnam's total state spending on science and technology amounted to roughly 0. The autonomy which Vietnamese research centres have enjoyed since the mids has enabled many of them to operate as quasi-private organisations, providing services such as consulting and technology development.
Many of these research centres serve as valuable intermediaries bridging public research institutions, universities, and firms. Tourism is an important element of economic activity in the country, contributing 7. Vietnam welcomed over The vast majority of visitors in , 9. China 4 million , South Korea 2.
Russia , and the United Kingdom , , followed closely by France , and Germany , were the largest source of international arrivals from Europe. Other significant international arrivals by nationality include the United States , and Australia , Much of Vietnam's modern transportation network can trace its roots to the French colonial era when it was used to facilitate the transportation of raw materials to its main ports.
It was extensively expanded and modernised following the partition of Vietnam. Road accidents remain the major safety issue of Vietnamese transportation with an average of 30 people losing their lives daily.
In , Vietnam and Japan signed a deal to build a high-speed railway — shinkansen bullet train —using Japanese technology. Tan Son Nhat is the nation's largest airport handling the majority of international passenger traffic. The planned Long Thanh International Airport will have an annual service capacity of million passengers once it becomes fully operational in As of , EVN made up about The plan was abandoned in late when a majority of the National Assembly voted to oppose the project due to widespread public concern over radioactive contamination.
In the reserve was approximately 4. Based on a survey by the Vietnam Water Supply and Sewerage Association VWSA , existing water production capacity exceeded demand, but service coverage is still sparse. It is only available to a small proportion of the population with about one third of district towns having some form of piped water supply.
In recent years, there have been some efforts and collaboration between local and foreign universities to develop access to safe water in the country by introducing water filtration systems. There is a growing concern among local populations over the serious public health issues associated with water contamination caused by pollution as well as the high levels of arsenic in groundwater sources. However, there are still about 21 million people in the country lacking access to "improved" sanitation according to a survey conducted in Inspections are to be conducted without notice since there have been many cases involving health issues caused by poor or polluted water supplies as well unhygienic conditions reported every year.
Since the early s, Vietnam has made significant progress in combating malaria. The malaria mortality rate fell to about five percent of its s equivalent by after the country introduced improved antimalarial drugs and treatment. On average between 40—50 new infections are reported daily in the country.