Health coaching interventions across Global Maternity services; A Systematic Review and Meta-analysis

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Its ability to improve diet, life-style habits and stress management can all improve maternity outcomes. Despite this potential the use of health and well-being coaching in maternity service is in its’ infancy though is beginning to increase. We conducted a systematic review and meta-analysis to understand existing evidence and suggest how it might inform its future implementation in maternity services. Methods We developed a systematic methodology and, used PubMed and ScienceDirect to gather peer review publications linked to our study eligibility criteria. Randomised and non-randomised clinical trials published in English from the 30th of April 1980-30th of December 2023’ were included. A meta-analysis was used to report the findings. Results A total of 8 studies were systematically included. Of these four were used in a meta-analysis all of which explored the influence of health and wellbeing coaching on gestational weight gain. The mean difference in GWG (kg) in those groups receiving health and well-being coaching was − 0.76 (95% CI: -2.55 to 1.04) indicating no significant statistical difference among the groups. The odds ratio of GWG within the target range was 4.17 (95% CI: 0.55 to 31.64) for the remote health coaching group compared to the conventional group, which indicates no difference between the groups. The sensitivity analysis compared the Copas selection model to a random effects model showed p-values exceeding 0.05, indicating a lack of statistical significance. Thus, the results are consistent and provide robust conclusions. Conclusion Health coaching’s ability to empower individuals, foster support, and promote healthy behaviours, appears to positively impact maternal health outcomes by reducing GWG. More research is needed to substantiate this finding and to understand its impact on other health outcomes and its acceptability to patients and healthcare professionals. Maternal & Fetal Medicine Maternity-services Health coaching interventions Systematic Review Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Introduction Chronic medical conditions are prevalent among the global population with nearly 75% experiencing one or more chronic conditions ( 1 ). Optimising beneficial health behaviours such as medication adherence, adopting health diets, engaging in regular physical activity and improving weight management could enhance health outcomes. However, initiating and maintain one or more health behavioural changes can be challenging, particularly for those with multiple health conditions or pregnant women ( 1 , 2 ). A shift towards proactive and preventive health systems, supporting patients in self-care has become a priority for the National Health Service (NHS). For instance, the Five Year Forward View highlights the need to 'support people to manage their own health – staying healthy, making informed choices of treatment, managing conditions, and avoiding complications ( 3 ). One way engaged self-management might be supported is through the use of health and well-being coaching (HWBC), a patient-centred intervention approach that utilises shared decision making and solution-focused techniques to enhance motivation and encourage positive actions ( 4 ). It uses a collaborative approach to identify shared goals informed by the patient’s values, strengths and preferences in the belief that everyone possesses some level of inner resourcefulness ( 4 , 5 , 7 , 8 ). The health and well-being coach focuses on motivational processes, support, and accountability to bolster patient self-efficacy for positive change ( 9 , 10 ). Their use is growing in a range of health systems and circumstances and evidence is emerging that they improve patient satisfaction and adherence, a range of improved health behaviours and outcomes, such as weight management, diet, nutrition, and smoking cessation, and potentially enhanced care cost efficiencies ( 6 , 11 ). More specifically evidence suggests that HWBC can improve health outcomes in patients with multiple diabetes, cardiovascular disease, and pain management effects ( 12 – 15 ). There is also preliminary evidence that suggests HWBC can provide a number of benefits in maternal health where targets for a variety of outcomes and mortality rates remain unmet, particularly in low and middle income countries ( 7 , 16 ) , . These purported benefits included better weight control, maintaining or increasing physical activity, reducing smoking, and managing gestational diabetes ( 1 , 17 ). To further explore these positive effects in maternal health this work presents the first attempt that we are aware of to systematically review and produce a meta-analysis of research exploring the impact of HWBC in maternal health. We then place our findings in the context of our understanding of HWBC and their future deployment in maternal care. Methods Study design A study protocol was developed and published on PROSPERO (CRD42024506473). We used the PICO (Population/Participant, Intervention(s), Comparison and Outcome) approach to extract data alongside of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) to report the findings. Search strategy Electronic databases of PubMed and Science Direct were used to gather peer reviewed and published studies that reported on health coaching linked to maternity care. Key words of healthcare coaching, health care coaching, maternity care health care coaching and maternity care were used. For the purpose of this study health and well-being coaching was defined as the application of evidence-based, skilful conversation, clinical interventions, and strategies to actively and safely engage clients/patients in changing health behaviours . We aimed to assess the current health and well-being coaching interventions linked to maternity services. Eligibility criteria and study selection All studies that were randomised clinical trials and non-clinical trials published in English were included. The study period covered the from the reviewed, and published in English from the 30th of April 1980 to the 30th of December 2023. Data extraction Data was extracted by reading titles and abstracts in the first instance, followed by screening against the eligibility criteria. Data was extracted following full-text review. Study details such as the title, citation, demographics, methods including study design, limitations and statistical details such as standard deviation (SD), standard error (SE), mean, sample size, p-values were extracted using a Microsoft Excel sheet. The extracted data was independently reviewed by two authors and discrepancies were resolved following a discussion. Data analysis We conducted 2 meta-analyses with a descriptive analysis. A meta-analysis was conducted using either a random-effects model or a fixed effect model to examine the efficacy of health coaching practices. Risk of bias quality assessment Risk of bias (RoB) was conducted using the Newcastle-Ottawa Scale (NOS) to assess the quality of the included studies prior to finalising the data set for analysis (Fig. 1, Table 1 Table 2 ). Results A total of 8 studies were systematically identified and the key characteristics shown in Table 1 . Of the pooled studies, four were included in the initial meta-analysis. Of the 4 studies, one study lacked experimental data and three focused on gestational weight gain in pregnant women ( 3 ). We used these three studies to calculate the mean difference of Gestational Weight Gain (GWG) in kilogrammes (Kg); two were used to report odds ratio of GWG within target range and two were used to report odds ratio of Excessive GWG between perinatal women who are enrolled in health coaching program and those who were not. Table 1 Characteristics of the studies included in the systematic review Study ID Author Study type Sample size Patient Cohort Region Coaching Method Outcome included in the analysis 1 Rissel C. et al Pilot Pragmatic Stratified Clustered RCT 923 Pregnant women with excessive gestational weight gain Australia Telephone based health coaching Uterine size, uterine bulk, histological uterine weight, post op. complication, blood loss, operating time, blood transfusions, pain at D0 &D1 Yes 2 Helen B. T. et al Non-randomised RCT 23 Mothers of children with disabilities America Vaginal hysterectomy with bilateral salpingectomy. Benign surgical conditions such as prolapse, menorrhagia and fibroids Proportion of successfully completed Salpingectomies, operating time, blood loss, complications No 3 Michael W. S. et al Pilot RCT 30 Mother 16 weeks’ gestation age America Behavioural intervention (phone call) to support pregnant women Surgical complication, Reoperation, Yes 4 Linda T. et al Pilot randomised, sequential mixed methods study 265 people at risk for or living with type 2 diabetes Sweden Telephone Heath coaching operation times, anaesthesia times, estimated blood loss, middle-term outcomes, perioperative and postoperative complications No 5 Tong W. Y. et al RCT 340 Women diagnosed with gestational diabetes mellitus between 12 and 30 weeks Singapore Phone Application Coaching Program proportion of EGWG, Absolute GWG, blood glucose readings, other maternal outcomes Yes 6 Justine D. et al RCT 171 Primiparous & Multiparous postpartum mother Canada Postpartum Text Message Program self-efficacy, postpartum anxiety, postpartum depression, social support scores No 7 Julia T. et al RCT 97 Mother less than 20 gestation age Germany Structural health coaching sessions including physical activity and healthy nutrition Physical Activity Measures, Absolute Weight Gain, below/within/ excessive GWG Yes 8 Vanessa C. et al RCT 710 Singleton pregnant mother less than 18 weeks Australia Telephone based health coaching No result disclosed No Table 2 Quality assessment of the included studies using the Newcastle Ottawa Scale Study ID Authors Selection (S) Comparability (C) Exposure/ Outcome (E/O) Total Stars S C E/O Conclusion 1 2 3 4 1 1 2 3 1. Rissel C. et al * * * * * ***** Fair Good Good Fair 2. Helen B. T. et al * * * * * * * ******* Good Good Good Good 3. Michael W. S. et al * * * * * ***** Fair Good Good Fair 4. Linda T. et al * * * * * * ****** Good Good Good Good 5. Tong W. Y. et al * * * * * * * ******* Good Good Good Good 6. Justine D. et al * * * * * * ****** Good Good Good Good 7. Julia T. et al * * * * * * ****** Good Good Good Good 8. Vanessa C. et al * * * * * ***** Fair Good Good Fair Meta analyses The first meta-analysis compared the mean difference in GWG (kg) between women who enrolled in a remote health coaching program and those who did not receive professional coaching during pregnancy across three studies. The mean difference of GWG(kg) was − 0.76 (95%CI: -2.55 to 1.04) indicating no statistical difference among the groups (Fig. 2 ). The second meta-analysis reported the odds ratio of GWG within target range or excessive GWG between pregnant women who are enrolled in health coaching program had those who were not. The odds ratio of GWG within target range comparing pregnant women in remote health coaching group with conventional group was 4.17(95%CI: 0.55 to 31.64) indicating no difference between the two groups. However, further research is necessary to confirm these findings since there are only two studies in this meta-analysis (Fig. 3 ). The Excessive GWG odds ratio between pregnant women in remote health coaching group and conventional group was 0.8(95%CI: 0.19 to 3.27) indicating no difference between the two groups. Notably, the analysis revealed a high heterogeneity (= 86%) among the studies, attributed to variations in study type, covariates, assessment tools, ethnicities, and other contributing factors (Fig. 3 ). Only one study conducted a single-arm trial using overweight pregnant women. All of these women had undergone a remote health coaching intervention but the efficacy and effectiveness was not reported in comparison to those that did not use the intervention. The proportion of Excessive GWG was 35.7%, which was less than the overall proportion of overweight women in national report based on CDC data. Subgroup Analysis A subgroup analysis was conducted based on geographical regions. Three studies from Australia, Germany and Singapore reported GWG. In Fig. 5 , the mean difference in GWG among women who have and haven’t had remote health coaching during pregnancy in Western countries was − 1.75 (95%CI: -3.28 to -0.21), which indicated a significant statistical difference between the two studies. The mean difference was 0.59 (95%CI: -0.30 to 1.48) for Singapore, indicating no significant difference between these subgroups. In Figs. 6 and 7 , each analysis includes only two studies, with each study corresponding to a distinct geographical region. Singapore and Australia comprise of vastly different healthcare systems and the use of health coaching may vary although within the scope of the studies, the population remains the same. The funnel plots indicated the presence of heterogeneity, with some studies falling outside the 95% confidence interval (CI), making it challenging to detect bias (Fig. 8 –12). Egger’s test was used to evaluate publication bias in the first meta-analysis focusing on the Mean Difference of Absolute GWG. Publication bias Egger’s test was used to determine publication bias. The p-value was calculated based on Egger’s test. As shown in Table 3 , studies reporting absolute gestational weight gain have no significant bias, so we accept the null hypothesis of symmetry in the funnel plot. Table 3 Summarized p-values of Egger’s tests of meta-analysis on Absolute Gestational Weight Gain Index Number of studies P value of Egger’s test Absolute GWG(kg) 3 0.1244 Sensitivity Analysis Some studies remained external to the 95% CI as demonstrated within the funnel plots although there were only two studies that were included. Therefore, a sensitivity analysis was conducted using a Copas selection mode to adjust the mean difference of absolute gestational weight gain (Table 4 ) to derive tangible conclusions and better understand the reliability of the study findings Table 4 Summarized results of sensitivity analysis for meta-analysis on Absolute Gestational Weight Gain among women who have and haven’t had remote health coaching during pregnancy of meta-analysis on Absolute Gestational Weight Gain Index N of study Model Probability of publishing study with largest standard error MD(kg) Lower(%) Upper(%) p-value for differences between two conclusions Absolute GWG(kg) 3 Copas selection model 46.86% 0.1697 -0.805 1.1445 0.1114 The result from the Copas selection model was compared to a random effects model that showed the p-values exceeding 0.05, demonstrating a lack of statistical significance. Therefore, the results of this analysis are consistent and provide robust conclusions. Discussion Summary findings From the studies invited we were able to conduct a meta-analysis with three studies and our findings suggest that HWBC can support pregnant women by reducing their GWG. This provides opportunity to use HWBC in maternity services provided well-designed steps are used to develop a program and inclusive approaches are used to cater to the extensive needs of a diverse female population. Below we consider some of the issues uncovered within the studies identified and how they might shape the future delivery of HWBC in maternity services. A shared definition and understanding of health and well-being coaching In the studies we identified it became apparent that there were conflicting definitions of HWBC (3 )This inconsistency can lead to issues with commissioning, service delivery, client care quality, and patient understanding, highlighting the need for standardised definitions and training ( 5 , 19 ). This has been observed in other reviews that have explored HWBC ( 4 , 12 ). The definition of health coaching can be confused with that of mentorship using healthcare professionals such as nurses which to support and encourage people to manage their own health ( 17 ). Community health workers, non-clinical roles that offer advocacy and advice in community settings ( 20 ), or peer supporters that are also provide advice and support but based on their own lived experience of recovery from a mental health condition, substance use disorder, or both. They provide support to others experiencing similar challenges ( 21 ). Although health coaching contains elements of all of these roles and there international contrasts in their scope, formal definitions and prescribed qualifications are emerging in individual health systems such as the UK ( 19 ). Evidence of influence of HWBCs Health coaching in maternal healthcare enhances prenatal care through education and support, improving health behaviours and compliance, particularly in GWG, as observed within our meta-analysis. This is potentially significant considering the risks associated with excessive weight gain include caesarean deliveries and postpartum weight retention for the mother and large-for-gestational-age infants, macrosomia, and childhood overweight or obesity for the offspring ( 22 ). There are also other considerations of excessive weight gain including implications for mental health ( 23 , 24 ). It is also important when considering previously published evidence that the risk of GDM increases with increasing rates of gestational weight gain ( 25 ) which in turn increases the risk of the mother developing Type 2 Diabetes Mellitus ( 26 ). More broadly there is evidence that HWBC can improve a range of physical and mental health outcomes ( 9 , 10 , 12 – 15 , 27 – 31 ). Though the degree of benefit evidenced from HWBC appears dependent upon the coaching model used, the duration and intensity of coaching, and the qualifications of the coach ( 9 , 10 ). Similarly results from specific populations may not be generalizable to all groups, particularly those with different cultural or socioeconomic backgrounds ( 17 , 30 , 32 ). However, the longevity of their effect and their cost effectiveness is yet to be explored ( 33 ). HWBC vs underserved populations The HWBC in our review were situated in high income countries and the breakdown of the particular population where the intervention was delivered was unclear in terms of their demographics and socio-cultural status. What we do know is that adverse maternal health outcomes are more prevalent in underserved populations i.e. those from ethnic minorities or of lower socio-economic status in both high, and low- and middle-income countries ( 34 – 36 ). It is also acknowledged that if long-term health inequalities within these groups are to be reduced then some of the broader socio-determinants of health and the wide range of barriers to access and engagement with health and care need to be addressed ( 37 , 38 ). Although it’s unrealistic to assume that HWBCs alone can address all of these issues, their appropriate use appears to offer several significant advantages in engaging hard-to-reach communities; it’s flexible in its timing and location of its delivery, and adopting personalised and shared goal-setting can overcome some of the cultural and structural barriers to health and care ( 39 ). When cultural values and practices are acknowledged, patients are more likely to participate actively in their care and adhere to medical advice ( 10 , 32 , 40 ). Health and well being coaches have a particular advantage in this regards when they are drawn from or sensitive to, the communities they serve, increasing the socio-cultural specificity of their service offer through their understanding of localised environments and religious and cultural expectations of local populations ( 41 – 45 ). Limitations: Our systematic review and meta-analysis has provided timely evidence of the benefits of HWBC in reducing GWG. The review was hindered by heterogeneity in study designs and research methodologies. Although only three studies were included in the metanalysis they were of high quality. The review was inhibited by the lack of precision in defining the nature of the HWBC and a lack of ethnic representation in the studies identified limits the generalisability and, increases the bias favouring the majority group, and health disparities. The identified studies also failed to report an accurate assessment of fidelity of the HWBC intervention reducing the reliability, validity, replicability, and scalability of the results. Conclusion Although limited, existing evidence indicates that HWBC can be a valuable tool in promoting healthy behaviours in a range of circumstances and health systems, including managing chronic conditions, and improving mental health. Our meta-analysis suggests that it also has a valuable role to play in improving maternal health outcomes in particular reducing GWG. However, more high-quality research is needed to further confirm our findings, particularly that which better defines the intervention, the population involved and in particular explores maternal health in underserved populations. Abbreviations Health and well-being coaching- HWBC National Health Service- NHS Confidence Interval- CI Population/Participant, Intervention, Comparison, Outcome- PICO Preferred reporting items for systematic reviews and meta-analysis- PRISMA Risk of bias- RoB Newcastle-Ottawa Scale- NOS Gestational Weight Gain- GWG Kilogrammes- Kg Declarations Ethics approval and consent to participate: Not applicable Consent for publication: All authors consented to publish this manuscript. Availability of data and material: Not applicable Competing interests: All authors report no conflict of interest. The views expressed are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health and Social Care or the Academic institutions. Funding: Birmingham Health Partners Evaluation Service Author contributions: GD conceptualised the evidence synthesis and developed the methodology.GD and IL conceptualised this manuscript. GD, SY and JQS conducted the analysis. SY, GD, NG, LH, HL, JS, IL critically appraised and commented on the manuscript. SY, GD, NG, LH, HL, JS, IL read and approved the final manuscript. Acknowledgements : N/A References Mohammadian F, Delavar MA, Behmanesh F, Azizi A, Esmaeilzadeh S (2023) The impact of health coaching on the prevention of gestational diabetes in overweight/obese pregnant women: a quasi-experimental study. 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Clin Psychol Rev 31(1):79–88 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6079038","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":419477310,"identity":"305a872e-02af-4533-bf65-ea5b029adb22","order_by":0,"name":"Siqi Yan","email":"","orcid":"","institution":"Southern University of Science and Technology, Shenzhen, China","correspondingAuthor":false,"prefix":"","firstName":"Siqi","middleName":"","lastName":"Yan","suffix":""},{"id":419477311,"identity":"bc844699-7a32-408b-9054-4b4635401721","order_by":1,"name":"Gayathri Delanerolle","email":"","orcid":"","institution":"University of Birmingham, Birmingham, United Kingdom","correspondingAuthor":false,"prefix":"","firstName":"Gayathri","middleName":"","lastName":"Delanerolle","suffix":""},{"id":419477312,"identity":"876f4d75-2ebc-488e-8626-23e0ea61cac3","order_by":2,"name":"Nabila Gardner","email":"","orcid":"","institution":"Ways for Well-being, Birmingham, Birmingham, United Kingdom","correspondingAuthor":false,"prefix":"","firstName":"Nabila","middleName":"","lastName":"Gardner","suffix":""},{"id":419477313,"identity":"6619d90e-bf8e-4b97-b3bc-0c856d26baef","order_by":3,"name":"Lorraine Harper","email":"","orcid":"","institution":"University of Birmingham, Birmingham, United Kingdom","correspondingAuthor":false,"prefix":"","firstName":"Lorraine","middleName":"","lastName":"Harper","suffix":""},{"id":419477314,"identity":"4ff9b0f1-23d2-4934-bbf4-c8b4eb6941e3","order_by":4,"name":"Hamid Lea","email":"","orcid":"","institution":"Hampshire and Isle of Wight Healthcare NHS Foundation Trust, Southampton, United 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Litchfield","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIie2PsWoCQRCGZzlYm4tpV664J7AIgYCI5FXuEKxiFRALkT0O5qo8gI+RZrGcY8A0R+qANjbWmyZg5x623nlliv2qn2E+5h8Aj+cfIiHQBECPdVC/db6StChCEwEN0IXBposCbhNqRbsQPXRR+iAytquD6veybD/ZHuKhDo5W4OxOsd1JybDMx/Pq9GRIPiuBb+1KqXktVYrRHFkYghcQuLyrKBkfMRohvxrq/XVUXJlIIKeGwvpKS7HAKdXOKWGajz4qnhoO31Xy3fx+XORslytWccHlz3nLE/NVfFq7mDYqENycJM2Cx+PxeDpwAZedXQzQINsoAAAAAElFTkSuQmCC","orcid":"","institution":"University of Birmingham, Birmingham, United Kingdom","correspondingAuthor":true,"prefix":"","firstName":"Ian","middleName":"","lastName":"Litchfield","suffix":""}],"badges":[],"createdAt":"2025-02-21 11:24:10","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6079038/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6079038/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":77305839,"identity":"806ee941-13b4-4711-b4e8-428ffbcda647","added_by":"auto","created_at":"2025-02-27 09:05:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":41432,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePRISMA flow diagram\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-6079038/v1/c30b7af00d1ea85deada7b44.png"},{"id":77305138,"identity":"ad4f2e4c-e312-4230-a5d7-5ccfb5e6d001","added_by":"auto","created_at":"2025-02-27 08:57:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":20438,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest plot showing the mean difference in gestational weight gain (GWG) (kg) among women that have and haven’t had a remote health coaching during pregnancy. *Typo-Teoule, J et al is Julie, T et al).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-6079038/v1/ad86d73160fdd18412551528.png"},{"id":77305141,"identity":"3ed454d8-dfc6-4006-b8f4-0d9f5610d3b2","added_by":"auto","created_at":"2025-02-27 08:57:52","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":16730,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest plot showing the odds ratio of GWG within target range among women that have and haven’t had a remote health coaching during pregnancy.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-6079038/v1/a950cd8f313e0e78fbdfa065.png"},{"id":77305140,"identity":"1eaec618-827b-46cb-b704-fa964cebba91","added_by":"auto","created_at":"2025-02-27 08:57:52","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":16764,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest plot showing the odds ratio of Excessive GWG among women that have and haven’t had a remote health coaching during pregnancy.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-6079038/v1/161027c6bc0d3357c2af61a5.png"},{"id":77305840,"identity":"644076d0-d2ff-4bf1-908f-78470e44965a","added_by":"auto","created_at":"2025-02-27 09:05:52","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":31510,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest plot showing the MD in gestational weight gain (GWG) (kg) among women that have and haven’t had remote health coaching during pregnancy in different geographical regions.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-6079038/v1/5785cb7e87fd9f9f63e7e84b.png"},{"id":77305853,"identity":"e878f5e7-d8da-4456-bb2f-d56266b13c34","added_by":"auto","created_at":"2025-02-27 09:05:54","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":21651,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest plot showing the odds ratio of Excessive GWG among women that have and haven’t had remote health coaching during pregnancy in different geographical countries.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"image6.png","url":"https://assets-eu.researchsquare.com/files/rs-6079038/v1/689d1e9a8f7b0216290c685f.png"},{"id":77305147,"identity":"aedce9c6-0464-4128-b1fb-4f07acf297dc","added_by":"auto","created_at":"2025-02-27 08:57:52","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":21852,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest plot showing the odds ratio of Excessive GWG among women that have and haven’t had remote health coaching during pregnancy in different geographical countries.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"image7.png","url":"https://assets-eu.researchsquare.com/files/rs-6079038/v1/58131beeac3ba7b1fc8565d3.png"},{"id":77305143,"identity":"32a9a4cd-3301-4ddb-aa05-90c16d3f1cf1","added_by":"auto","created_at":"2025-02-27 08:57:52","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":5952,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFunnel plot for meta-analysis of 3 studies on Mean Difference of Absolute GWG\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"image8.png","url":"https://assets-eu.researchsquare.com/files/rs-6079038/v1/5bd20c261d4547a104c330dc.png"},{"id":77305146,"identity":"4f4c335d-059d-4053-aaaa-218bb967fe85","added_by":"auto","created_at":"2025-02-27 08:57:52","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":5508,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFunnel plot for meta-analysis of 2 studies on Odds Ratio of Normal GWG\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"image9.png","url":"https://assets-eu.researchsquare.com/files/rs-6079038/v1/3ca213fd1b3cd7534685348f.png"},{"id":77305142,"identity":"6bd11543-3d6c-4d04-9a75-b71dd2f2f6e2","added_by":"auto","created_at":"2025-02-27 08:57:52","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":5503,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFunnel plot for meta-analysis of 2 studies on Odds Ratio of Excessive GWG\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"image10.png","url":"https://assets-eu.researchsquare.com/files/rs-6079038/v1/fd201103e6ee8c0df51d1df3.png"},{"id":77307046,"identity":"6285488e-3027-465c-a0be-cc8c7298b349","added_by":"auto","created_at":"2025-02-27 09:13:52","extension":"png","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":9668,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ep-values for residual selection bias of meta-analysis on Absolute Gestational Weight Gain\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"image11.png","url":"https://assets-eu.researchsquare.com/files/rs-6079038/v1/a70dc39a80abbd707f355da5.png"},{"id":77307396,"identity":"01e49cc7-00c6-4fe8-993f-ad975ac67d0b","added_by":"auto","created_at":"2025-02-27 09:21:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1713502,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6079038/v1/6dc16bc9-a6d2-4414-b616-001fc93287f8.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eHealth coaching interventions across Global Maternity services; A Systematic Review and Meta-analysis\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChronic medical conditions are prevalent among the global population with nearly 75% experiencing one or more chronic conditions (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Optimising beneficial health behaviours such as medication adherence, adopting health diets, engaging in regular physical activity and improving weight management could enhance health outcomes. However, initiating and maintain one or more health behavioural changes can be challenging, particularly for those with multiple health conditions or pregnant women (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). A shift towards proactive and preventive health systems, supporting patients in self-care has become a priority for the National Health Service (NHS). For instance, the Five Year Forward View highlights the need to 'support people to manage their own health \u0026ndash; staying healthy, making informed choices of treatment, managing conditions, and avoiding complications (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOne way engaged self-management might be supported is through the use of health and well-being coaching (HWBC), a patient-centred intervention approach that utilises shared decision making and solution-focused techniques to enhance motivation and encourage positive actions (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). It uses a collaborative approach to identify shared goals informed by the patient\u0026rsquo;s values, strengths and preferences in the belief that everyone possesses some level of inner resourcefulness (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The health and well-being coach focuses on motivational processes, support, and accountability to bolster patient self-efficacy for positive change (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Their use is growing in a range of health systems and circumstances and evidence is emerging that they improve patient satisfaction and adherence, a range of improved health behaviours and outcomes, such as weight management, diet, nutrition, and smoking cessation, and potentially enhanced care cost efficiencies (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). More specifically evidence suggests that HWBC can improve health outcomes in patients with multiple diabetes, cardiovascular disease, and pain management effects (\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere is also preliminary evidence that suggests HWBC can provide a number of benefits in maternal health where targets for a variety of outcomes and mortality rates remain unmet, particularly in low and middle income countries (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003csup\u003e,\u003c/sup\u003e. These purported benefits included better weight control, maintaining or increasing physical activity, reducing smoking, and managing gestational diabetes (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). To further explore these positive effects in maternal health this work presents the first attempt that we are aware of to systematically review and produce a meta-analysis of research exploring the impact of HWBC in maternal health. We then place our findings in the context of our understanding of HWBC and their future deployment in maternal care.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eA study protocol was developed and published on PROSPERO (CRD42024506473). We used the PICO (Population/Participant, Intervention(s), Comparison and Outcome) approach to extract data alongside of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) to report the findings.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSearch strategy\u003c/h3\u003e\n\u003cp\u003eElectronic databases of PubMed and Science Direct were used to gather peer reviewed and published studies that reported on health coaching linked to maternity care. Key words of \u003cem\u003ehealthcare coaching, health care coaching, maternity care health care coaching and maternity care\u003c/em\u003e were used. For the purpose of this study health and well-being coaching was defined as \u003cem\u003ethe application of evidence-based, skilful conversation, clinical interventions, and strategies to actively and safely engage clients/patients in changing health behaviours\u003c/em\u003e. We aimed to assess the current health and well-being coaching interventions linked to maternity services.\u003c/p\u003e\n\u003ch3\u003eEligibility criteria and study selection\u003c/h3\u003e\n\u003cp\u003eAll studies that were randomised clinical trials and non-clinical trials published in English were included. The study period covered the from the reviewed, and published in English from the 30th of April 1980 to the 30th of December 2023.\u003c/p\u003e\n\u003ch3\u003eData extraction\u003c/h3\u003e\n\u003cp\u003eData was extracted by reading titles and abstracts in the first instance, followed by screening against the eligibility criteria. Data was extracted following full-text review. Study details such as the title, citation, demographics, methods including study design, limitations and statistical details such as standard deviation (SD), standard error (SE), mean, sample size, p-values were extracted using a Microsoft Excel sheet. The extracted data was independently reviewed by two authors and discrepancies were resolved following a discussion.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eWe conducted 2 meta-analyses with a descriptive analysis. A meta-analysis was conducted using either a random-effects model or a fixed effect model to examine the efficacy of health coaching practices.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eRisk of bias quality assessment\u003c/h2\u003e \u003cp\u003eRisk of bias (RoB) was conducted using the Newcastle-Ottawa Scale (NOS) to assess the quality of the included studies prior to finalising the data set for analysis (Fig.\u0026nbsp;1, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 8 studies were systematically identified and the key characteristics shown in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. Of the pooled studies, four were included in the initial meta-analysis. Of the 4 studies, one study lacked experimental data and three focused on gestational weight gain in pregnant women (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e). We used these three studies to calculate the mean difference of Gestational Weight Gain (GWG) in kilogrammes (Kg); two were used to report odds ratio of GWG within target range and two were used to report odds ratio of Excessive GWG between perinatal women who are enrolled in health coaching program and those who were not.\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCharacteristics of the studies included in the systematic review\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStudy ID\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAuthor\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStudy type\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSample size\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePatient Cohort\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRegion\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCoaching Method\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOutcome\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eincluded in the analysis\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRissel C. \u003cem\u003eet al\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePilot Pragmatic Stratified Clustered RCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e923\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePregnant women with excessive gestational weight gain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAustralia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTelephone based health coaching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUterine size, uterine bulk, histological uterine weight, post op. complication, blood loss, operating time, blood transfusions, pain at D0 \u0026amp;D1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHelen B. T. \u003cem\u003eet al\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-randomised RCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMothers of children with disabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAmerica\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVaginal hysterectomy with bilateral salpingectomy. Benign surgical conditions such as prolapse, menorrhagia and fibroids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProportion of successfully completed Salpingectomies, operating time, blood loss, complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMichael W. S. \u003cem\u003eet al\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePilot RCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMother 16 weeks\u0026rsquo; gestation age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAmerica\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBehavioural intervention (phone call) to support pregnant women\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgical complication, Reoperation,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLinda T. \u003cem\u003eet al\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePilot randomised, sequential mixed methods study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003epeople at risk for or living with type 2 diabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSweden\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTelephone Heath coaching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eoperation times, anaesthesia times, estimated blood loss, middle-term outcomes, perioperative and postoperative complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTong W. Y. et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e340\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWomen diagnosed with gestational diabetes mellitus between 12 and 30 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingapore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhone Application Coaching Program\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eproportion of EGWG, Absolute GWG, blood glucose readings, other maternal outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJustine D. et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimiparous \u0026amp; Multiparous postpartum mother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCanada\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePostpartum Text Message Program\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eself-efficacy, postpartum anxiety, postpartum depression, social support scores\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJulia T. et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMother less than 20 gestation age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGermany\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStructural health coaching sessions including physical activity and healthy nutrition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysical Activity Measures, Absolute Weight Gain, below/within/ excessive GWG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVanessa C. et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e710\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingleton pregnant mother less than 18 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAustralia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTelephone based health coaching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo result disclosed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eQuality assessment of the included studies using the Newcastle Ottawa Scale\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eStudy ID\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eAuthors\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eSelection (S)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eComparability (C)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eExposure/\u003c/p\u003e\n \u003cp\u003eOutcome (E/O)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eTotal Stars\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eE/O\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eConclusion\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRissel C. \u003cem\u003eet al\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*****\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFair\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHelen B. T. \u003cem\u003eet al\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*******\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMichael W. S. \u003cem\u003eet al\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*****\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFair\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLinda T. \u003cem\u003eet al\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e******\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTong W. Y. et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*******\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJustine D. et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e******\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJulia T. et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e******\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVanessa C. et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*****\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFair\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eMeta analyses\u003c/p\u003e\n\u003cp\u003eThe first meta-analysis compared the mean difference in GWG (kg) between women who enrolled in a remote health coaching program and those who did not receive professional coaching during pregnancy across three studies. The mean difference of GWG(kg) was \u0026minus;\u0026thinsp;0.76 (95%CI: -2.55 to 1.04) indicating no statistical difference among the groups (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe second meta-analysis reported the odds ratio of GWG within target range or excessive GWG between pregnant women who are enrolled in health coaching program had those who were not. The odds ratio of GWG within target range comparing pregnant women in remote health coaching group with conventional group was 4.17(95%CI: 0.55 to 31.64) indicating no difference between the two groups. However, further research is necessary to confirm these findings since there are only two studies in this meta-analysis (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe Excessive GWG odds ratio between pregnant women in remote health coaching group and conventional group was 0.8(95%CI: 0.19 to 3.27) indicating no difference between the two groups. Notably, the analysis revealed a high heterogeneity (=\u0026thinsp;86%) among the studies, attributed to variations in study type, covariates, assessment tools, ethnicities, and other contributing factors (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eOnly one study conducted a single-arm trial using overweight pregnant women. All of these women had undergone a remote health coaching intervention but the efficacy and effectiveness was not reported in comparison to those that did not use the intervention. The proportion of Excessive GWG was 35.7%, which was less than the overall proportion of overweight women in national report based on CDC data.\u003c/p\u003e\n\u003ch3\u003eSubgroup Analysis\u003c/h3\u003e\n\u003cp\u003eA subgroup analysis was conducted based on geographical regions. Three studies from Australia, Germany and Singapore reported GWG. In Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e, the mean difference in GWG among women who have and haven\u0026rsquo;t had remote health coaching during pregnancy in Western countries was \u0026minus;\u0026thinsp;1.75 (95%CI: -3.28 to -0.21), which indicated a significant statistical difference between the two studies. The mean difference was 0.59 (95%CI: -0.30 to 1.48) for Singapore, indicating no significant difference between these subgroups.\u003c/p\u003e\n\u003cp\u003eIn Figs.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e and \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e, each analysis includes only two studies, with each study corresponding to a distinct geographical region. Singapore and Australia comprise of vastly different healthcare systems and the use of health coaching may vary although within the scope of the studies, the population remains the same.\u003c/p\u003e\n\u003cp\u003eThe funnel plots indicated the presence of heterogeneity, with some studies falling outside the 95% confidence interval (CI), making it challenging to detect bias (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e8\u003c/span\u003e\u0026ndash;12). Egger\u0026rsquo;s test was used to evaluate publication bias in the first meta-analysis focusing on the Mean Difference of Absolute GWG.\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003ePublication bias\u003c/h2\u003e\n \u003cp\u003eEgger\u0026rsquo;s test was used to determine publication bias. The p-value was calculated based on Egger\u0026rsquo;s test. As shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, studies reporting absolute gestational weight gain have no significant bias, so we accept the null hypothesis of symmetry in the funnel plot.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSummarized p-values of Egger\u0026rsquo;s tests of meta-analysis on Absolute Gestational Weight Gain\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIndex\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber of studies\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value of Egger\u0026rsquo;s test\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbsolute GWG(kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.1244\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eSensitivity Analysis\u003c/h2\u003e\n \u003cp\u003eSome studies remained external to the 95% CI as demonstrated within the funnel plots although there were only two studies that were included. Therefore, a sensitivity analysis was conducted using a Copas selection mode to adjust the mean difference of absolute gestational weight gain (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e) to derive tangible conclusions and better understand the reliability of the study findings\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSummarized results of sensitivity analysis for meta-analysis on Absolute Gestational Weight Gain among women who have and haven\u0026rsquo;t had remote health coaching during pregnancy of meta-analysis on Absolute Gestational Weight Gain\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIndex\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN of study\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eProbability of publishing study with largest standard error\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMD(kg)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLower(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUpper(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value for differences between two conclusions\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbsolute GWG(kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCopas selection model\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.86%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.1697\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.805\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.1445\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.1114\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThe result from the Copas selection model was compared to a random effects model that showed the p-values exceeding 0.05, demonstrating a lack of statistical significance. Therefore, the results of this analysis are consistent and provide robust conclusions.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSummary findings\u003c/h2\u003e \u003cp\u003eFrom the studies invited we were able to conduct a meta-analysis with three studies and our findings suggest that HWBC can support pregnant women by reducing their GWG. This provides opportunity to use HWBC in maternity services provided well-designed steps are used to develop a program and inclusive approaches are used to cater to the extensive needs of a diverse female population. Below we consider some of the issues uncovered within the studies identified and how they might shape the future delivery of HWBC in maternity services.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eA shared definition and understanding of health and well-being coaching\u003c/h2\u003e \u003cp\u003eIn the studies we identified it became apparent that there were conflicting definitions of HWBC (3 )This inconsistency can lead to issues with commissioning, service delivery, client care quality, and patient understanding, highlighting the need for standardised definitions and training (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis has been observed in other reviews that have explored HWBC (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The definition of health coaching can be confused with that of \u003cem\u003ementorship\u003c/em\u003e using healthcare professionals such as nurses which to support and encourage people to manage their own health (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Community health workers, non-clinical roles that offer advocacy and advice in community settings (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), or peer supporters that are also provide advice and support but based on their own lived experience of recovery from a mental health condition, substance use disorder, or both. They provide support to others experiencing similar challenges (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Although health coaching contains elements of all of these roles and there international contrasts in their scope, formal definitions and prescribed qualifications are emerging in individual health systems such as the UK (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eEvidence of influence of HWBCs\u003c/h2\u003e \u003cp\u003eHealth coaching in maternal healthcare enhances prenatal care through education and support, improving health behaviours and compliance, particularly in GWG, as observed within our meta-analysis. This is potentially significant considering the risks associated with excessive weight gain include caesarean deliveries and postpartum weight retention for the mother and large-for-gestational-age infants, macrosomia, and childhood overweight or obesity for the offspring (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). There are also other considerations of excessive weight gain including implications for mental health (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). It is also important when considering previously published evidence that the risk of GDM increases with increasing rates of gestational weight gain (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) which in turn increases the risk of the mother developing Type 2 Diabetes Mellitus (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMore broadly there is evidence that HWBC can improve a range of physical and mental health outcomes (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan additionalcitationids=\"CR28 CR29 CR30\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Though the degree of benefit evidenced from HWBC appears dependent upon the coaching model used, the duration and intensity of coaching, and the qualifications of the coach (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Similarly results from specific populations may not be generalizable to all groups, particularly those with different cultural or socioeconomic backgrounds (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). However, the longevity of their effect and their cost effectiveness is yet to be explored (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eHWBC vs underserved populations\u003c/h2\u003e \u003cp\u003eThe HWBC in our review were situated in high income countries and the breakdown of the particular population where the intervention was delivered was unclear in terms of their demographics and socio-cultural status. What we do know is that adverse maternal health outcomes are more prevalent in underserved populations i.e. those from ethnic minorities or of lower socio-economic status in both high, and low- and middle-income countries (\u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). It is also acknowledged that if long-term health inequalities within these groups are to be reduced then some of the broader socio-determinants of health and the wide range of barriers to access and engagement with health and care need to be addressed (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough it\u0026rsquo;s unrealistic to assume that HWBCs alone can address all of these issues, their appropriate use appears to offer several significant advantages in engaging hard-to-reach communities; it\u0026rsquo;s flexible in its timing and location of its delivery, and adopting personalised and shared goal-setting can overcome some of the cultural and structural barriers to health and care (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhen cultural values and practices are acknowledged, patients are more likely to participate actively in their care and adhere to medical advice (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Health and well being coaches have a particular advantage in this regards when they are drawn from or sensitive to, the communities they serve, increasing the socio-cultural specificity of their service offer through their understanding of localised environments and religious and cultural expectations of local populations (\u003cspan additionalcitationids=\"CR42 CR43 CR44\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLimitations:\u003c/h2\u003e \u003cp\u003eOur systematic review and meta-analysis has provided timely evidence of the benefits of HWBC in reducing GWG. The review was hindered by heterogeneity in study designs and research methodologies. Although only three studies were included in the metanalysis they were of high quality. The review was inhibited by the lack of precision in defining the nature of the HWBC and a lack of ethnic representation in the studies identified limits the generalisability and, increases the bias favouring the majority group, and health disparities. The identified studies also failed to report an accurate assessment of fidelity of the HWBC intervention reducing the reliability, validity, replicability, and scalability of the results.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAlthough limited, existing evidence indicates that HWBC can be a valuable tool in promoting healthy behaviours in a range of circumstances and health systems, including managing chronic conditions, and improving mental health. Our meta-analysis suggests that it also has a valuable role to play in improving maternal health outcomes in particular reducing GWG. However, more high-quality research is needed to further confirm our findings, particularly that which better defines the intervention, the population involved and in particular explores maternal health in underserved populations.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eHealth and well-being coaching-\u0026nbsp;\u003c/strong\u003eHWBC\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNational Health Service-\u003c/strong\u003eNHS\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConfidence Interval-\u0026nbsp;\u003c/strong\u003eCI\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePopulation/Participant, Intervention, Comparison, Outcome-\u003c/strong\u003ePICO\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePreferred reporting items for systematic reviews and meta-analysis-\u003c/strong\u003ePRISMA\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRisk of bias-\u003c/strong\u003eRoB\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNewcastle-Ottawa Scale-\u003c/strong\u003eNOS\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGestational Weight Gain-\u003c/strong\u003eGWG\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKilogrammes-\u003c/strong\u003eKg\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eAll authors consented to publish this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eAll authors report no conflict of interest. The views expressed are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health and Social Care or the Academic institutions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eBirmingham Health Partners Evaluation Service\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u0026nbsp;\u003c/strong\u003eGD conceptualised the evidence synthesis and developed the methodology.GD and IL conceptualised this manuscript. GD, SY and JQS conducted the analysis. SY, GD, NG, LH, HL, JS, IL critically appraised and commented on the manuscript. SY, GD, NG, LH, HL, JS, IL read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e: N/A\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMohammadian F, Delavar MA, Behmanesh F, Azizi A, Esmaeilzadeh S (2023) The impact of health coaching on the prevention of gestational diabetes in overweight/obese pregnant women: a quasi-experimental study. BMC Womens Health 23(1):619\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePamungkas RA, Usman AM, Chamroonsawasdi K (2022) A smartphone application of diabetes coaching intervention to prevent the onset of complications and to improve diabetes self-management: A randomized control trial. 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Public Health Rev 41:1\u0026ndash;24\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAjayi Sotubo O A perspective on health inequalities in BAME communities and how to improve access to primary care. 2021(2514\u0026ndash;6645 (Print)).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGilliland JA, Shah TI, Clark A, Sibbald S, Seabrook JA (2019) A geospatial approach to understanding inequalities in accessibility to primary care among vulnerable populations. PLoS ONE 14(1):e0210113\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams DR, Priest N, Anderson NB Understanding associations among race, socioeconomic status, and health: Patterns and prospects. 2016(1930\u0026ndash;7810 (Electronic)).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOliveira JS, Sherrington C, Amorim AB, Dario AB, Tiedemann A (2017) What is the effect of health coaching on physical activity participation in people aged 60 years and over? 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Afr J Prim Health Care Family Med 9(1):1\u0026ndash;8\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUK and International Health Coaching Association (2022) Towards a Healthier, Happier Britain: The Case for Health Coaching\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eActive Health Group (2023) Health Coaching: A Path to Wellness and Cost Savings for the NHS Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.activehealthgroup.co.uk/post/the-transformative-power-of-health-coaching#:~:text=Health%20Coaching%20has%20the%20potential%20to%20address%20health,can%20contribute%20to%20a%20more%20equitable%20healthcare%20landscape\u003c/span\u003e\u003cspan address=\"https://www.activehealthgroup.co.uk/post/the-transformative-power-of-health-coaching#:~:text=Health%20Coaching%20has%20the%20potential%20to%20address%20health,can%20contribute%20to%20a%20more%20equitable%20healthcare%20landscape\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGearing RE, El-Bassel N, Ghesquiere A, Baldwin S, Gillies J, Ngeow E (2011) Major ingredients of fidelity: A review and scientific guide to improving quality of intervention research implementation. Clin Psychol Rev 31(1):79\u0026ndash;88\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of Birmingham, Birmingham, United Kingdom","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Maternity-services, Health coaching interventions, Systematic Review","lastPublishedDoi":"10.21203/rs.3.rs-6079038/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6079038/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHealth and well-being coaching is a patient-centred approach that supports the achievement of health and wellness by way of guidance, motivation and behavioural change. Its ability to improve diet, life-style habits and stress management can all improve maternity outcomes. Despite this potential the use of health and well-being coaching in maternity service is in its\u0026rsquo; infancy though is beginning to increase. We conducted a systematic review and meta-analysis to understand existing evidence and suggest how it might inform its future implementation in maternity services.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe developed a systematic methodology and, used PubMed and ScienceDirect to gather peer review publications linked to our study eligibility criteria. Randomised and non-randomised clinical trials published in English from the 30th of April 1980-30th of December 2023\u0026rsquo; were included. A meta-analysis was used to report the findings.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 8 studies were systematically included. Of these four were used in a meta-analysis all of which explored the influence of health and wellbeing coaching on gestational weight gain. The mean difference in GWG (kg) in those groups receiving health and well-being coaching was \u0026minus;\u0026thinsp;0.76 (95% CI: -2.55 to 1.04) indicating no significant statistical difference among the groups. The odds ratio of GWG within the target range was 4.17 (95% CI: 0.55 to 31.64) for the remote health coaching group compared to the conventional group, which indicates no difference between the groups. The sensitivity analysis compared the Copas selection model to a random effects model showed p-values exceeding 0.05, indicating a lack of statistical significance. Thus, the results are consistent and provide robust conclusions.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eHealth coaching\u0026rsquo;s ability to empower individuals, foster support, and promote healthy behaviours, appears to positively impact maternal health outcomes by reducing GWG. More research is needed to substantiate this finding and to understand its impact on other health outcomes and its acceptability to patients and healthcare professionals.\u003c/p\u003e","manuscriptTitle":"Health coaching interventions across Global Maternity services; A Systematic Review and Meta-analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-27 08:57:47","doi":"10.21203/rs.3.rs-6079038/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"420150c9-9281-4c24-980e-2d2b54379fd6","owner":[],"postedDate":"February 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":44724951,"name":"Maternal \u0026 Fetal Medicine"}],"tags":[],"updatedAt":"2025-02-27T08:57:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-27 08:57:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6079038","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6079038","identity":"rs-6079038","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}