A reduction in sedentary behaviour in obese women during pregnancy reduces neonatal adiposity: the DALI randomised controlled trial

Abstract

Aims/hypothesis Offspring of obese women are at increased risk of features of the metabolic syndrome, including obesity and diabetes. Lifestyle intervention in pregnancy might reduce adverse effects of maternal obesity on neonatal adiposity. Methods In the Vitamin D And Lifestyle Intervention for Gestational Diabetes Mellitus (GDM) Prevention (DALI) lifestyle trial, 436 women with a BMI ≥29 kg/m 2 were randomly assigned to counselling on healthy eating (HE), physical activity (PA) or HE&PA, or to usual care (UC). In secondary analyses of the lifestyle trial, intervention effects on neonatal outcomes (head, abdominal, arm and leg circumferences and skinfold thicknesses, estimated fat mass, fat percentage, fat-free mass and cord blood leptin) were assessed using multilevel regression analyses. Mediation of intervention effects by lifestyle and gestational weight gain was assessed. Results Outcomes were available from 334 neonates. A reduction in sum of skinfolds (−1.8 mm; 95% CI −3.5, −0.2; p = 0.03), fat mass (−63 g; 95% CI −124, −2; p = 0.04), fat percentage (−1.2%; 95% CI −2.4%, −0.04%; p = 0.04) and leptin (−3.80 μg/l; 95% CI −7.15, −0.45; p = 0.03) was found in the HE&PA group, and reduced leptin in female neonates in the PA group (−5.79 μg/l; 95% CI −11.43, −0.14; p = 0.05) compared with UC. Reduced sedentary time, but not gestational weight gain, mediated intervention effects on leptin in both the HE&PA and PA groups. Conclusions/interpretation The HE&PA intervention resulted in reduced adiposity in neonates. Reduced sedentary time seemed to drive the intervention effect on cord blood leptin. Implications for future adiposity and diabetes risk of the offspring need to be elucidated. Trial registration ISRCTN70595832. Electronic supplementary material The online version of this article (10.1007/s00125-019-4842-0) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

Temporal relationships between maternal metabolic parameters with neonatal adiposity in women with obesity differ by neonatal sex: Secondary analysis of the DALI study

“…In both sexes, the early pregnancy period is relevant for neonatal adiposity, although for different metabolic parameters (ie, insulin resistance in boys and lipid levels in girls). Although a later intervention was effective in reducing neonatal adiposity, our data suggest that ideally maternal metabolism shall be normalized already early in pregnancy to reduce the risk of neonatal adiposity. Hence, interventions beginning prior to or in very early pregnancy might be even more effective than those initiated later, and achieved a 9% reduction in neonatal fat .…”

Effects of maternal lifestyle interventions on child neurobehavioral development: Follow‐up of randomized controlled trials

“…No other similar follow‐up studies have been published about the development of older children or about children's behavior and therefore we have no basis for comparison of these findings. Two lifestyle interventions during pregnancy in obese women that examined offspring anthropometrics, showed that the intervention reduced neonatal adiposity (van Poppel, Simmons, Devlieger et al ., ) and infant adiposity (Patel et al ., ). Conversely, other studies of prenatal lifestyle interventions showed no intervention effects on child anthropometrics or other early life metabolic risk factors (Ronnberg, Hanson & Nilsson, ; Tanvig, Vinter, Jorgensen et al ., ).…”

How Can Maternal Lifestyle Interventions Modify the Effects of Gestational Diabetes in the Neonate and the Offspring? A Systematic Review of Meta-Analyses

“…In a recent RCT that included 334 neonates, counselling pregnant women with a BMI ≥29 kg/m 2 on both healthy eating and physical activity resulted in a significant reduction of neonatal adiposity (−63 g for fat mass, and −1.2% for fat percentage), although birth weight was not different between groups. Interestingly, these changes were not mediated by GWG alone, but a reduction in sedentary time (notably sitting time) drove the effect of the intervention on neonatal adiposity [38].…”