The risk factors for childhood overweight and obesity are known and can be identified antenatally or during infancy, however, the majority of effective interventions are designed for older children. This review identified interventions designed to reduce the risk of overweight/obesity that were delivered antenatally or during the first 2 years of life, with outcomes reported from birth to 7 years of age. Six electronic databases were searched for papers reporting randomised controlled trials of interventions published from January 1990 to September 2013. A total of 35 eligible studies were identified, describing 27 unique trials of which 24 were behavioural and three were non‐behavioural. The 24 behavioural trials were categorised by type of intervention: (1) nutritional and/or responsive feeding interventions targeted at parents of infants, which improved feeding practices and had some impact on child weight (n = 12); (2) breastfeeding promotion and lactation support for mothers, which had a positive effect on breastfeeding but not child weight (n = 5); (3) parenting and family lifestyle (n = 4); and (4) maternal health (n = 3) interventions that had some impact on feeding practices but not child weight. The non‐behavioural trials comprised interventions manipulating formula milk composition (n = 3). Of these, lower/hydrolysed protein formula milk had a positive effect on weight outcomes. Interventions that aim to improve diet and parental responsiveness to infant cues showed most promise in terms of self‐reported behavioural change. Despite the known risk factors, there were very few intervention studies for pregnant women that continue during infancy which should be a priority for future research.

Worldwide more than 40 million children under the age of five were overweight or obese in 2011 1 . The risk factors for childhood overweight and obesity can be identified antenatally and during infancy. These include maternal pre-pregnancy BMI, paternal BMI, smoking during pregnancy, high birth weight and rapid weight gain 2 . A meta-analysis found breastfeeding decreased the odds of childhood overweight by 15%. There is conflicting evidence regarding the protective effects of later introduction of solid foods and longer durations of breastfeeding on childhood overweight 2 .A systematic review conducted in 2010, identified only five obesity prevention interventions for children <2 years old, all of which reported some positive impact on feeding practices but not weight outcomes 3 . This finding may be at least partially attributable to the restricted focus on the review which only included behavioural studies and excluded some interventions that potentially modify rapid weight gain such as breastfeeding.In order to inform the development of a guideline for the management of infants at risk of obesity the present systematic review was conducted to identify all randomised controlled trials of behavioural and non-behavioural interventions delivered during infancy or the antenatal period. Studies were selected that aimed to reduce the risk of developing childhood overweight and obesity that included infant weight outcomes (e.g. weight-for-length, weight-for-age, BMI) or outcomes related to obesity risk (breastfeeding, physical activity, timing of weaning).Electronic searches identified 1784 titles, a further 27 were identified through hand searches of the literature. 604 articles were identified as duplicates and removed. 1206 titles and abstracts were screened by two reviewers (BE, SR), 1064 did not meet the eligibility criteria. The remaining 142 were subjected to full text review. 46 eligible articles were identified, describing 35 trials.The wide range of interventions, process and outcome measures used in the identified studies made it impossible to calculate an effect size. Therefore the studies were grouped thematically. 1. Breastfeeding and lactation support 2. Formula and bottle-feeding interventions 3. Dietary supplement interventions 4. Feeding behaviour interventions 5. Parenting and family health interventions 6. Maternal health interventions.