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Section/topic #Checklist item Reported on page # TITLE Title 1Identify the report as a systematic review, meta-analysis, or both. 1ABSTRACT Structured summary 2Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number. 3INTRODUCTION Rationale 3Describe the rationale for the review in the context of what is already known. 4
A previous review by Headen et al. examined the associations between racial/ethnic identities and GWG ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.3945/an.111.000984", "ISSN" : "2156-5376 (Electronic)", "PMID" : "22332106", "abstract" : "This review examines published literature to answer 2 questions: 1) Are there racial-ethnic differences in excessive or inadequate gestational weight gain (GWG) and postpartum weight retention (PPWR)? and 2) Is there evidence that approaches to promote healthy weight during and after pregnancy should vary by race-ethnicity? We identified a limited number of articles that explicitly looked at racial-ethnic differences in either GWG or PPWR after controlling for relevant covariates. These studies suggest that black and Hispanic women are more likely to gain inadequately based on the Institute of Medicine's pregnancy weight gain guidelines compared to white women. Black women are more likely to retain considerable amounts of weight postpartum compared to both Hispanic and white mothers. Studies were inconclusive as to whether Hispanic women retained more or less weight postpartum, so more research is needed. Interventions to increase GWG were few and those designed to reduce GWG and PPWR showed mixed results. Future studies should address the methodological and conceptual limitations of prior research as well as investigate biological mechanisms and behavioral risk factors to determine the reasons for the racial-ethnic differences in pregnancy-related weight outcomes. Interventions would benefit from a mixed-methods approach that specifically identifies race-relevant barriers to weight management during and after pregnancy. Attention to the greater social context in which pregnancy-related weight exists is also needed.", "author" : [ { "dropping-particle" : "", "family" : "Headen", "given" : "Irene E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Davis", "given" : "Esa M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mujahid", "given" : "Mahasin S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Abrams", "given" : "Barbara", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Advances in Nutrition", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2012", "1" ] ] }, "language" : "eng", "page" : "83-94", "publisher-place" : "United States", "title" : "Racial-ethnic differences in pregnancy-related weight.", "type" : "article-journal", "volume" : "3" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=0d0540a0-cd48-44b1-8c32-01d925073baf" ] } ], "mendeley" : { "formattedCitation" : "(Headen et al., 2012)", "plainTextFormattedCitation" : "(Headen et al., 2012)", "previouslyFormattedCitation" : "(Headen et al. 2012)" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }(Headen et al., 2012). This narrative was limited in its inclusion criteria, with a focus on White, Black and/or Hispanic women within the United States (U.S.), it only compared GWG to the 1990 IOM guidelines, and excluded pregnancies complicated by adverse maternal-fetal health outcomes. The conclusion of their review identified that greater research surrounding the social context of race and GWG was needed ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.3945/an.111.000984", "ISSN" : "2156-5376 (Electronic)", "PMID" : "22332106", "abstract" : "This review examines published literature to answer 2 questions: 1) Are there racial-ethnic differences in excessive or inadequate gestational weight gain (GWG) and postpartum weight retention (PPWR)? and 2) Is there evidence that approaches to promote healthy weight during and after pregnancy should vary by race-ethnicity? We identified a limited number of articles that explicitly looked at racial-ethnic differences in either GWG or PPWR after controlling for relevant covariates. These studies suggest that black and Hispanic women are more likely to gain inadequately based on the Institute of Medicine's pregnancy weight gain guidelines compared to white women. Black women are more likely to retain considerable amounts of weight postpartum compared to both Hispanic and white mothers. Studies were inconclusive as to whether Hispanic women retained more or less weight postpartum, so more research is needed. Interventions to increase GWG were few and those designed to reduce GWG and PPWR showed mixed results. Future studies should address the methodological and conceptual limitations of prior research as well as investigate biological mechanisms and behavioral risk factors to determine the reasons for the racial-ethnic differences in pregnancy-related weight outcomes. Interventions would benefit from a mixed-methods approach that specifically identifies race-relevant barriers to weight management during and after pregnancy. Attention to the greater social context in which pregnancy-related weight exists is also needed.", "author" : [ { "dropping-particle" : "", "family" : "Headen", "given" : "Irene E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Davis", "given" : "Esa M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mujahid", "given" : "Mahasin S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Abrams", "given" : "Barbara", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Advances in Nutrition", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2012", "1" ] ] }, "language" : "eng", "page" : "83-94", "publisher-place" : "United States", "title" : "Racial-ethnic differences in pregnancy-related weight.", "type" : "article-journal", "volume" : "3" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=0d0540a0-cd48-44b1-8c32-01d925073baf" ] } ], "mendeley" : { "formattedCitation" : "(Headen et al., 2012)", "plainTextFormattedCitation" : "(Headen et al., 2012)", "previouslyFormattedCitation" : "(Headen et al. 2012)" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }(Headen et al., 2012).Objectives 4Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS). 5-6
Under headings found on lines 106-125METHODS Protocol and registration 5Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number. 5
This systematic review was prospectively registered on the PROSPERO database (#CRD42015023399) and the protocol has been published elsewhere ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Background: A significant proportion of women exceeds or does not meet the Institute of Medicine's gestational weight gain (GWG) guidelines. Inadequate, excessive GWG or weight loss during pregnancy is associated with an increased risk of negative maternal and fetal outcomes. Among the many determinants of GWG identified in the 2009 Institute of Medicine guidelines, culture was named as one of the few whose influence has not been fully explored. Some cultural beliefs may erroneously promote overeating as \"eating for two\" and discourage physical activity during pregnancy, but there is lack of empirical evidence on how culture affects GWG. The purpose of this systematic review is to examine the effects of culture on GWG. Methods/design: Ten electronic databases will be searched to identify studies reporting on the effects of culture on GWG. Grey literature, published conference abstracts, websites of relevant organizations and reference lists of included studies will also be searched. Studies that report on effects of culture, acculturation, ethnicity, race, nationality, ancestry and identity on GWG in adult women will be included. Quality of evidence will be evaluated using the grading of recommendations, assessment, development and evaluations (GRADE) approach to rating evidence. Study selection, data extraction and risk of bias assessment will be conducted by two independent reviewers, with disagreements being resolved by consensus or third party adjudication as needed. Formal meta-analyses will be conducted among included studies that are sufficiently statistically and clinically homogeneous. Discussion: This review will provide a comprehensive assessment and synthesis of current evidence and will draw attention to potential gaps where future research on the effects of culture on guideline discordant gestational weight gain remains to be conducted. Systematic review registration: PROSPERO CRD42015023399", "author" : [ { "dropping-particle" : "", "family" : "Manyanga", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Silva", "given" : "DF", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ferraro", "given" : "ZM", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harvey", "given" : "ALJ", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wilson", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ockenden", "given" : "HN", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Systematic Reviews", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "publisher" : "BioMed Central Ltd.", "publisher-place" : "a", "title" : "The effects of culture on guideline discordant gestational weight gain: A systematic review protocol", "type" : "article", "volume" : "4" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=d2cb61a3-cda4-4c54-ac3a-6d865af716df", "http://www.mendeley.com/documents/?uuid=2063b5e6-c638-40af-a70f-dcfb55e2ed17" ] } ], "mendeley" : { "formattedCitation" : "(Manyanga et al., 2015)", "plainTextFormattedCitation" : "(Manyanga et al., 2015)", "previouslyFormattedCitation" : "(Manyanga et al. 2015)" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }(Manyanga et al., 2015).Eligibility criteria 6Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale. 5-6
This review systematically identified prospective and retrospective observational and cohort studies. The language of publication was not an exclusion factor and relevant translation was procured as necessary (NA and DFdS).Information sources 7Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched. 4
Ten bibliographic databases were searched including: Ovid MEDLINE; EMBASE; Clinicaltrials.gov; Cochrane Central Register of Controlled Trials; CINAHL; PsycINFO; Sociological Abstracts; Literature Latino-Americana e do Caribe em Ciencias da Saude (LILACS), IBECS; and, Cuba Medicina (CUMED).Search 8Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated. Table S1Study selection 9State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis). 6
Studies were included if they compared at least two different cultural groups. When a study looked at the outcome in only one cultural population, it was excluded.
8
When five or more studies were available to describe the rates of GWG under a specific racial/ethnic group, a meta-analysis was conducted.Data collection process 10Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators. 7
The results of the search were imported into Covidence (Cochrane, Melbourne, Australia), and then duplicates were removed prior to initial screening. Two independent reviewers (original search: TM and DfdS, update: NA and KD) screened the titles and abstracts of the search results and marked each as include, exclude or unsure based on the eligibility criteria. The full texts of the studies classified as unsure or include were then reviewed by the same two reviewers based on each of the eligibility criteria. Conflicts were resolved through consensus and discussion with a third reviewer (ZMF).Data items 11List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made. 6
The primary outcome was inadequate or excessive GWG (hereafter referred to as discordant GWG), as defined by the IOM. Studies that used the 1990 guidelines were included but analyzed separately from studies that compared GWG to the updated 2009 guidelines. Secondary outcomes include maternal-fetal health outcomes such as large-for-gestational age (LGA), macrosomia, gestational diabetes mellitus (GDM), and hypertension.
Risk of bias in individual studies 12Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis. 9
A modified Cochrane Risk of Bias Tool was used to assess the level of bias in each study included in the quantitative analysis. The Tool was modified for use in the evaluation of bias in prospective and retrospective study designs ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1139/apnm-2015-0663", "ISSN" : "1715-5312", "abstract" : "Moderate-to-vigorous physical activity (MVPA) is essential for disease prevention and health promotion. Emerging evidence suggests other intensities of physical activity (PA), including light-intensity activity (LPA), may also be important, but there has been no rigorous evaluation of the evidence. The purpose of this systematic review was to examine the relationships between objectively measured PA (total and all intensities) and health indicators in school-aged children and youth. Online databases were searched for peer-reviewed studies that met the a priori inclusion criteria: population (apparently healthy, aged 5\u201317 years), intervention/exposure/comparator (volumes, durations, frequencies, intensities, and patterns of objectively measured PA), and outcome (body composition, cardiometabolic biomarkers, physical fitness, behavioural conduct/pro-social behaviour, cognition/academic achievement, quality of life/well-being, harms, bone health, motor skill development, psychological distress, self-esteem)....", "author" : [ { "dropping-particle" : "", "family" : "Poitras", "given" : "Veronica Joan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gray", "given" : "Casey Ellen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Borghese", "given" : "Michael M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Carson", "given" : "Valerie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chaput", "given" : "Jean-Philippe", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Janssen", "given" : "Ian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Katzmarzyk", "given" : "Peter T.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pate", "given" : "Russell R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Connor Gorber", "given" : "Sarah", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kho", "given" : "Michelle E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sampson", "given" : "Margaret", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tremblay", "given" : "Mark S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Applied Physiology, Nutrition, and Metabolism", "id" : "ITEM-1", "issue" : "6 (Suppl. 3)", "issued" : { "date-parts" : [ [ "2016", "6" ] ] }, "page" : "S197-S239", "publisher" : "NRC Research Press", "title" : "Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth", "type" : "article-journal", "volume" : "41" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=ef375259-9525-4d4d-b6f0-31c969b11ba9" ] } ], "mendeley" : { "formattedCitation" : "(Poitras et al., 2016)", "plainTextFormattedCitation" : "(Poitras et al., 2016)", "previouslyFormattedCitation" : "(Poitras et al. 2016)" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }(Poitras et al., 2016).Summary measures 13State the principal summary measures (e.g., risk ratio, difference in means). 8
Meta-analyses were completed to compare the proportion (and 95% confidence intervals [CIs]) of women in each study who experienced excessive or inadequate GWG within a racial/ethnic group. A random effects meta-analysis was conducted to provide an overall measure of effect (proportion with excessive/inadequate GWG) and 95% CIs for each population group (i.e. White, Black, Hispanic, Asian).Synthesis of results 14Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis. 8
Cochranes Q statistic and the I2 statistic were used to assess heterogeneity between studies.
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Section/topic #Checklist item Reported on page # Risk of bias across studies 15Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies). 9
A modified Cochrane Risk of Bias Tool was used to assess the level of bias in each study included in the quantitative analysis. The Tool was modified for use in the evaluation of bias in prospective and retrospective study designs ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1139/apnm-2015-0663", "ISSN" : "1715-5312", "abstract" : "Moderate-to-vigorous physical activity (MVPA) is essential for disease prevention and health promotion. Emerging evidence suggests other intensities of physical activity (PA), including light-intensity activity (LPA), may also be important, but there has been no rigorous evaluation of the evidence. The purpose of this systematic review was to examine the relationships between objectively measured PA (total and all intensities) and health indicators in school-aged children and youth. Online databases were searched for peer-reviewed studies that met the a priori inclusion criteria: population (apparently healthy, aged 5\u201317 years), intervention/exposure/comparator (volumes, durations, frequencies, intensities, and patterns of objectively measured PA), and outcome (body composition, cardiometabolic biomarkers, physical fitness, behavioural conduct/pro-social behaviour, cognition/academic achievement, quality of life/well-being, harms, bone health, motor skill development, psychological distress, self-esteem)....", "author" : [ { "dropping-particle" : "", "family" : "Poitras", "given" : "Veronica Joan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gray", "given" : "Casey Ellen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Borghese", "given" : "Michael M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Carson", "given" : "Valerie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chaput", "given" : "Jean-Philippe", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Janssen", "given" : "Ian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Katzmarzyk", "given" : "Peter T.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pate", "given" : "Russell R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Connor Gorber", "given" : "Sarah", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kho", "given" : "Michelle E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sampson", "given" : "Margaret", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tremblay", "given" : "Mark S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Applied Physiology, Nutrition, and Metabolism", "id" : "ITEM-1", "issue" : "6 (Suppl. 3)", "issued" : { "date-parts" : [ [ "2016", "6" ] ] }, "page" : "S197-S239", "publisher" : "NRC Research Press", "title" : "Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth", "type" : "article-journal", "volume" : "41" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=ef375259-9525-4d4d-b6f0-31c969b11ba9" ] } ], "mendeley" : { "formattedCitation" : "(Poitras et al., 2016)", "plainTextFormattedCitation" : "(Poitras et al., 2016)", "previouslyFormattedCitation" : "(Poitras et al. 2016)" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }(Poitras et al., 2016).Additional analyses 16Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified. 9
A priori secondary outcomes including weight loss, GDM, gestational hypertension, pre-eclampsia, mode of delivery, length of stay in hospital, LGA, SGA, shoulder dystocia, and prematurity were extracted. When two or more studies compared t h e s a m e c u l t u r a l g r o u p f o r a g i v e n v a r i a b l e , t h e y w e r e a n a l y z e d a n d r e p o r t e d .
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A s u b g r o u p a n a l y s i s w a s c o n d u c t e d t o c o m p a r e d i f f e r e n c e s b e t w e e n s t u d i e s w i t h l a r g e ( N e"1 0 0 0 ) o r s m a l l ( N <