Adiposity and cardiovascular outcomes in three‐year‐old children of participants inUPBEAT, anRCTof a complex intervention in pregnant women with obesity

Abstract

Summary Background Maternal obesity is associated with offspring cardiometabolic risk. UPBEAT was a randomised controlled trial of an antenatal diet and physical activity intervention in 1555 women with obesity. The intervention was associated with lower gestational weight gain, healthier diet and metabolic profile in pregnancy, and reduced infant adiposity at six months. Objective We have investigated whether the UPBEAT intervention influenced childhood cardiometabolic outcomes or was associated with sustained improvements in maternal lifestyle 3‐years after delivery. Methods In UPBEAT mother‐child dyads at the 3‐year follow‐up, we assessed childhood blood pressure, resting pulse rate, and adiposity (body mass index, skinfold thicknesses, body fat, waist and arm circumferences) and maternal diet, physical activity, and anthropometry. Results 514 three‐year‐old children attended the appointment (49% intervention, 51% standard care). There was no difference in the main outcome of interest, subscapular skinfold thickness, between the trial arms (−0.30 mm, 95% confidence interval: −0.92, 0.31). However, the intervention was associated with a lower resting pulse rate (−5 bpm [−8.41, −1.07]). There was also a non‐significant lower odds of overweight/obesity (OR 0.73; 0.50, 1.08). Maternal dietary improvements observed in the UPBEAT trial, including glycaemic load and saturated fat were maintained 3‐years postpartum. Conclusion This study has demonstrated that an antenatal dietary and physical activity intervention in women with obesity is associated with lower offspring pulse rate and sustained improvement in maternal diet. Whilst larger than previous cohorts, there remains potential for bias from attrition and these findings require validation in future cohorts.

Effect of prenatal lifestyle intervention on maternal postpartum weight retention and child body mass index z-score at 36 months

“…The effective prenatal gestational weight gain intervention had no overall effect on child BMIz or skinfold thicknesses through 36 months. The observed BMIz and skinfold values and changes over time were highly consistent with other studies of pediatric populations of women with obesity [18][19][20][21][22]. The observational literature and developmental origins of disease hypothesis suggest that reducing excess weight gain during pregnancy should lower offspring risk of obesity [3].…”

“…However, to date, prenatal lifestyle interventions have yielded mixed results on obesity risk during childhood [6]. Some positive effects were observed in a UK-based prenatal intervention targeting glycemic index, which also reduced gestational weight gain; the prenatal intervention reduced infant adiposity at 6 months [23] and had suggestive effects of lower odds of overweight/obesity at 3 years [22]. Also, a Finnish prenatal probiotic intervention designed to prevent allergic diseases in children reported a tendency for lower BMI in offspring at 4 years [9].…”

Modifiable early life exposures associated with adiposity and obesity in 3‐year old children born to mothers with obesity

“…Attrition of the study population may have resulted in selection bias. However, the UPBEAT population studied at the 3‐year visit was a representative sample of the main UPBEAT cohort 34 . Furthermore, while the findings are generalizable for clinical practice amongst women with obesity, they are not directly generalizable to the general population.…”

“…We have previously reported that the UPBEAT intervention did not affect any measure of adiposity/obesity in the 3‐year old children, 34 therefore, the data was treated as a cohort. Demographic results were expressed as mean ± SD (SD), median and interquartile range or percent and number as appropriate.…”

The association of a low glycaemic index diet in pregnancy with child body composition at 5 years of age: A secondary analysis of theROLOstudy

“…The on‐going UPBEAT (UK Pregnancies Better Eating and Activity Trial) trial succeeded in reducing gestational dietary GI, however, there were no significant reductions observed in birthweight 20 . Similar to the ROLO cohort, this longitudinal study is assessing potential lasting impacts of behavioural pregnancy intervention, recently reporting a positive reduction in adiposity among the intervention children at 3 years of age 21,22 …”