Effect of Lifestyle Interventions on Gestational Weight Gain Among Pregnant Women with Overweight: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background/Objectives: Excessive gestational weight gain (GWG) among pregnant women with overweight is associated with adverse maternal and neonatal outcomes. Previous reviews have often combined women with overweight and obesity, limiting overweight-specific evidence. This systematic review and meta-analysis evaluated the effects of lifestyle interventions on GWG among pregnant women with pre-pregnancy overweight. Methods: PubMed, Embase, Scopus, and CINAHL were searched for randomized controlled trials (RCTs) published between January 2015 and December 2025. Eligible studies included pregnant women aged ≥ 18 years with pre-pregnancy overweight who received lifestyle interventions incorporating dietary and physical activity (PA) components compared with usual antenatal care. Risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for RCTs. Random-effects meta-analysis was performed to calculate pooled mean differences (MDs) with 95% confidence intervals (CIs). Results: Seventeen reports representing 15 unique RCTs involving 6256 participants were included in the systematic review, of whom 2216 were included in overweight subgroup analyses. Twelve studies contributing data from 1728 women with overweight were included in the meta-analysis. Common support strategies included behavioral support through goal setting and self-monitoring, as well as digital or remote follow-up. Lifestyle interventions were associated with a significant reduction in total GWG compared with usual antenatal care (MD = −1.44 kg; 95% CI: −2.34 to −0.55; p < 0.05). Substantial heterogeneity was observed across studies (I² = 76%). Limitations included substantial heterogeneity in intervention characteristics, limited reporting of blinding procedures, and the relatively small number of studies available for subgroup analyses. Conclusions: Lifestyle interventions incorporating dietary and PA components were associated with significant reductions in GWG among pregnant women with overweight. These findings support the integration of lifestyle interventions into antenatal care to promote appropriate GWG. Further research is needed to identify the most effective intervention components and optimize intervention implementation in this population. Registration: PROSPERO CRD42023473693.