The effect of antenatal lifestyle advice for women who are overweight or obese on secondary measures of neonatal body composition: the LIMIT randomised trial
Abstract:Objective
To evaluate the effect of providing antenatal dietary and lifestyle advice on neonatal anthropometry, and to determine the inter-observer variability in obtaining anthropometric measurements.
Design
Randomised controlled trial
Setting
Public maternity hospitals across metropolitan Adelaide, South Australia
Population
Pregnant women with a singleton gestation between 10+0–20+0, and body mass index (BMI) ≥25kg/m2.
Methods
Women were randomised to either Lifestyle Advice (comprehensive dietary a… Show more
“…While this analysis includes data from 845 women and infants (38% of the entire LIMIT cohort), we consider the risk of selection bias to be minimal. The characteristics of the current cohort did not differ significantly from either the characteristics of the Standard Care Group, or the entire LIMIT cohort . Our findings would be enhanced by the inclusion of data from women entering pregnancy with a normal BMI, which will be possible at a later date with the analysis of data from the OPTIMISE randomised trial …”
Section: Discussionmentioning
confidence: 70%
“…Birthweight was measured using calibrated electronic scales to the nearest 1 g with the newborn infant undressed. Length was measured using a length board and the infant laid supine, the head held against the top of the board and a sliding foot plate moved and rested flat against the foot of the infant with the legs fully extended, and read to the nearest 0.1 cm . LGA was defined as birthweight at or above the 90 th centile for gestational age and infant sex.…”
Section: Methodsmentioning
confidence: 99%
“…Trained research assistants obtained anthropometric measurements according to a standardised protocol as we have previously described, within the first few days of life and prior to discharge from hospital . Skinfold thickness measurements (SFTM) were obtained on the right side of the body using Harpenden Skinfold Callipers, with the infant undressed.…”
Introduction
The aim of this study was to evaluate the association between fetal ultrasound and newborn biometry and adiposity measures in the setting of maternal obesity.
Material and Methods
The study population involved 845 overweight or obese pregnant women, who participated in the Standard Care Group of the LIMIT randomised trial (ACTRN12607000161426, 9/03/2007). At 36 weeks gestation, fetal biometry, estimated fetal weight (EFW) and adiposity measures including mid‐thigh fat mass (MTFM), subscapular fat mass (SSFM), and abdominal fat mass (AFM) were undertaken using ultrasound. Neonatal anthropometric measurements obtained after birth included birthweight, head circumference (HC), abdominal circumference (AC) and skinfold thickness measurements (SFTM) of the subscapular region and abdomen.
Results
At 36 weeks gestation, every 1 g increase in EFW was associated with a 0.94 g increase in birthweight (95% CI 0.88–0.99; P < 0.001). For every 1 mm increase in the fetal ultrasound measure, there was a 0.69 mm increase in birth HC (95% CI 0.63–0.75, P < 0.001) and 0.69 mm increase in birth AC (95% CI 0.60–0.79, P < 0.001). Subscapular fat mass in the fetus and the newborn (0.29 mm, 95% CI 0.20–0.39, P < 0.001) were moderately associated, but AFM measurements were not (0.06 mm, −0.03 to 0.15, P = 0.203). There is no evidence that these relationships differed by maternal body mass index.
Conclusion
In women who are overweight or obese, fetal ultrasound accurately predicts neonatal HC and AC along with birthweight.
“…While this analysis includes data from 845 women and infants (38% of the entire LIMIT cohort), we consider the risk of selection bias to be minimal. The characteristics of the current cohort did not differ significantly from either the characteristics of the Standard Care Group, or the entire LIMIT cohort . Our findings would be enhanced by the inclusion of data from women entering pregnancy with a normal BMI, which will be possible at a later date with the analysis of data from the OPTIMISE randomised trial …”
Section: Discussionmentioning
confidence: 70%
“…Birthweight was measured using calibrated electronic scales to the nearest 1 g with the newborn infant undressed. Length was measured using a length board and the infant laid supine, the head held against the top of the board and a sliding foot plate moved and rested flat against the foot of the infant with the legs fully extended, and read to the nearest 0.1 cm . LGA was defined as birthweight at or above the 90 th centile for gestational age and infant sex.…”
Section: Methodsmentioning
confidence: 99%
“…Trained research assistants obtained anthropometric measurements according to a standardised protocol as we have previously described, within the first few days of life and prior to discharge from hospital . Skinfold thickness measurements (SFTM) were obtained on the right side of the body using Harpenden Skinfold Callipers, with the infant undressed.…”
Introduction
The aim of this study was to evaluate the association between fetal ultrasound and newborn biometry and adiposity measures in the setting of maternal obesity.
Material and Methods
The study population involved 845 overweight or obese pregnant women, who participated in the Standard Care Group of the LIMIT randomised trial (ACTRN12607000161426, 9/03/2007). At 36 weeks gestation, fetal biometry, estimated fetal weight (EFW) and adiposity measures including mid‐thigh fat mass (MTFM), subscapular fat mass (SSFM), and abdominal fat mass (AFM) were undertaken using ultrasound. Neonatal anthropometric measurements obtained after birth included birthweight, head circumference (HC), abdominal circumference (AC) and skinfold thickness measurements (SFTM) of the subscapular region and abdomen.
Results
At 36 weeks gestation, every 1 g increase in EFW was associated with a 0.94 g increase in birthweight (95% CI 0.88–0.99; P < 0.001). For every 1 mm increase in the fetal ultrasound measure, there was a 0.69 mm increase in birth HC (95% CI 0.63–0.75, P < 0.001) and 0.69 mm increase in birth AC (95% CI 0.60–0.79, P < 0.001). Subscapular fat mass in the fetus and the newborn (0.29 mm, 95% CI 0.20–0.39, P < 0.001) were moderately associated, but AFM measurements were not (0.06 mm, −0.03 to 0.15, P = 0.203). There is no evidence that these relationships differed by maternal body mass index.
Conclusion
In women who are overweight or obese, fetal ultrasound accurately predicts neonatal HC and AC along with birthweight.
“…Baseline characteristics of mothers of these infants were similar between treatment groups (Table 1), and similar to the full randomised groups 21 . Paternal (Table 2) and neonatal 23 anthropometric measurements were also similar between treatment groups. There was a statistically significant correlation between maternal and paternal BMI (Pearson correlation coefficient 0.22, p < 0.001); a higher proportion of fathers were in the obese category for the highest maternal BMI groups compared to the lowest; however more than 50% of fathers had BMI <30 in every maternal BMI category.Figure 1Flow of participants through the trial.
…”
Section: Resultsmentioning
confidence: 59%
“…We have previously reported good reproducibility with infant skin fold measurements 23 . Timing of partner measurements would ideally have been at the woman’s first pregnancy visit, however women were not enrolled until several weeks after this visit, and paternal measures were taken on average at about 90 days after randomisation.…”
The contribution of paternal obesity to pregnancy outcomes has been little described. Our aims were to determine whether the effect of an antenatal maternal dietary and lifestyle intervention among women who are overweight or obese on newborn adiposity, was modified by paternal obesity. We conducted a secondary analysis of a multicenter randomised trial. Pregnant women with BMI ≥25 kg/m2 received either Lifestyle Advice or Standard Care. Paternal anthropometric measures included height, weight, BMI; waist, hip, calf and mid-upper arm circumferences; biceps and calf skinfold thickness measurements (SFTM); and percentage body fat. Newborn anthropometric outcomes included length; weight; head, arm, abdominal, and chest circumferences; biceps, triceps, subscapular, suprailiac, thigh, and lateral abdominal wall SFTM; and percentage body fat. The effect of an antenatal maternal dietary and lifestyle intervention among women who were overweight or obese on neonatal anthropometric measures, was significantly modified by paternal BMI ≥35.0 kg/m2, with a significantly smaller infant triceps, suprailiac, and thigh SFTM, and percent fat mass, compared with that observed in offspring of lean fathers. Further research is required to determine whether our observed associations are causal, and whether paternal weight loss prior to conception is a potential strategy to reduce the intergenerational effects of obesity.
Analysis 1.4. Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 4 Caesarean section....... Analysis 1.5. Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 5 Perinatal mortality....... Analysis 1.6. Comparison 1 Combined diet and exercise interventions versus standard care, Outcome 6 Large-for-gestational age.
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