{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T17:06:24Z","timestamp":1775149584388,"version":"3.50.1"},"reference-count":100,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"unspecified","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006369","name":"George Mason University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100006369","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2026,2,9]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Gestational weight gain (GWG) during pregnancy is a critical factor that affects maternal and child health outcomes. The considerable burden of inadequate GWG and the rising tide of excessive GWG are overlooked challenges in low and middle-income countries (LMICs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This systematic review assessed the impact of antenatal interventions on GWG in LMICs. Randomised controlled trials (RCTs) on antenatal interventions on GWG in LMICs were included. These interventions included educational, behavioural, nutritional supplementation and pharmacological therapies. A systematic literature search was conducted using PubMed, Embase, Web of Science, CINAHL and the Cochrane Library from the start of each database through September 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of the 33\u2009642 unique articles identified, 70 articles were included in our systematic review, with 59 individual RCTs and 11 cluster RCTs. Nutritional interventions (31 studies) included food and micronutrient supplementations. Micronutrient supplementation such as multiple micronutrient supplementations was found to reduce the risk of severely inadequate or inadequate GWG among pregnant women compared to iron only or iron and folic acid supplementation (Grading of Recommendations Assessment, Development and Evaluation [GRADE]: moderate certainty). Food supplementation showed mixed results, although most trials demonstrated higher mean GWG among undernourished pregnant women and a greater likelihood of achieving Institute of Medicine-recommended ranges (GRADE: moderate certainty). Behavioural (counselling\/education) interventions (20 studies) were associated with significant reductions in excessive GWG among pregnant women with overweight or obesity and improved adequacy of GWG (GRADE: moderate certainty). Physical activity (seven studies) was found to reduce the risk of excessive GWG (GRADE: moderate certainty). Combined dietary and physical activity interventions (six studies) were found to reduce the risk of excessive GWG among pregnant women (GRADE: low certainty).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Well-structured antenatal interventions, initiated before 20\u2009weeks of gestation and continuing beyond this period, tailored to local cultural contexts and available resources, can effectively help pregnant women in LMICs in achieving optimal GWG.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42022366354.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjgh-2025-019344","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T16:05:19Z","timestamp":1775145919000},"page":"e019344","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["The effects of antenatal interventions on gestational weight gain in low and middle-income countries: a systematic review"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5712-611X","authenticated-orcid":false,"given":"Priscilla Aba","family":"Aggrey","sequence":"first","affiliation":[{"name":"Department of Global and Community Health, George Mason University College of Public Health, Fairfax, Virginia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine H","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Global and Community Health, George Mason University College of Public Health, Fairfax, Virginia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anahita","family":"Asghari-Kamrani","sequence":"additional","affiliation":[{"name":"Department of Global and Community Health, George Mason University College of Public Health, Fairfax, Virginia, USA"},{"name":"Department of Family Science, University of Maryland School of Public Health, College Park, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wafaie W","family":"Fawzi","sequence":"additional","affiliation":[{"name":"Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA"},{"name":"Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA"},{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3369-5972","authenticated-orcid":false,"given":"Dongqing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Global and Community Health, George Mason University College of Public Health, Fairfax, Virginia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"2026040209051048000_11.4.e019344.1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2022-072249","article-title":"Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: individual participant data meta-analysis","volume":"382","author":"Perumal","year":"2023","journal-title":"BMJ"},{"key":"2026040209051048000_11.4.e019344.2","doi-asserted-by":"crossref","DOI":"10.2196\/48234","article-title":"The Effects of Antenatal Interventions on Gestational Weight Gain in Low- and Middle-Income Countries: Protocol for a Systematic Review","volume":"12","author":"Wang","year":"2023","journal-title":"JMIR Res Protoc"},{"key":"2026040209051048000_11.4.e019344.3","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0231889","article-title":"Gestational weight gain and its effect on birth outcomes in sub-Saharan Africa: Systematic review and meta-analysis","volume":"15","author":"Asefa","year":"2020","journal-title":"PLoS ONE"},{"key":"2026040209051048000_11.4.e019344.4","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-003423","article-title":"Gestational weight gain in low-income and middle-income countries: a modelling analysis using nationally representative data","volume":"5","author":"Wang","year":"2020","journal-title":"BMJ Glob Health"},{"key":"2026040209051048000_11.4.e019344.5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.3635"},{"key":"2026040209051048000_11.4.e019344.6","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph17041221","article-title":"Maternal Prepregnancy Body Mass Index, Gestational Weight Gain, and Risk of Adverse Perinatal Outcomes in Taiwan: A Population-Based Birth Cohort Study","volume":"17","author":"Chen","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"2026040209051048000_11.4.e019344.7","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1004236","article-title":"Risk factors for inadequate and excessive gestational weight gain in 25 low- and middle-income countries: An individual-level participant meta-analysis","volume":"20","author":"Darling","year":"2023","journal-title":"PLoS Med"},{"key":"2026040209051048000_11.4.e019344.8","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-023-16558-y","article-title":"Interventions to enhance healthcare utilisation among pregnant women to reduce maternal mortality in low- and middle-income countries: a review of systematic reviews","volume":"23","author":"Mzembe","year":"2023","journal-title":"BMC Public Health"},{"key":"2026040209051048000_11.4.e019344.9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0252247","article-title":"Gestational weight gain in sub-Saharan Africa: Estimation based on pseudo-cohort design","volume":"16","author":"Gebremedhin","year":"2021","journal-title":"PLoS ONE"},{"key":"2026040209051048000_11.4.e019344.10","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ijo.0803582"},{"key":"2026040209051048000_11.4.e019344.11","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1038\/s43247-024-01398-4","article-title":"Global and local perspectives on food security and food systems","volume":"5","author":"Fanzo","year":"2024","journal-title":"Commun Earth Environ"},{"key":"2026040209051048000_11.4.e019344.12","unstructured":"Arora A . 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