What Are the Most Effective Behavioural Strategies in Changing Postpartum Women's Physical Activity and Healthy Eating Behaviours? A Systematic Review and Meta-Analysis

Successful implementation of postpartum lifestyle interventions first requires the identification of effective core components, such as strategies for behavioural change. This systematic review and meta-analysis aimed to describe the associations between behavioural strategies and changes in weight, diet, and physical activity in postpartum women. Databases MEDLINE, CINAHL, EMBASE, and PsycINFO were searched for randomised controlled trials of lifestyle interventions in postpartum women (within 2 years post-delivery). Strategies were categorised according to the Behaviour Change Technique Taxonomy (v1). Forty-six articles were included (n = 3905 women, age 23-36 years). Meta-analysis showed that postpartum lifestyle interventions significantly improved weight (mean difference -2.46 kg, 95%CI -3.65 to -1.27) and physical activity (standardised mean difference 0.61, 95%CI 0.20 to 1.02) but not in energy intake. No individual strategy was significantly associated with weight or physical activity outcomes. On meta-regression, strategies such as problem solving (beta = -1.74, P = 0.045), goal setting of outcome (beta = -1.91, P = 0.046), reviewing outcome goal (beta = -3.94, P = 0.007), feedback on behaviour (beta = -2.81, P = 0.002), self-monitoring of behaviour (beta = -3.20, P = 0.003), behavioural substitution (beta = -3.20, P = 0.003), and credible source (beta = -1.72, P = 0.033) were associated with greater reduction in energy intake. Behavioural strategies relating to self-regulation are associated with greater reduction in energy intake.