Associations between lifestyle interventions during pregnancy and childhood weight and growth: a systematic review and meta-analysis

Abstract

Background Maternal health and lifestyle during pregnancy may be critical for the onset and progression of childhood obesity. Prenatal lifestyle interventions have been shown to positively affect maternal behaviors, gestational weight gain, and anthropometric outcomes in infants at birth. The influence of such interventions on child weight or growth beyond birth is unknown. We therefore examined the association between lifestyle interventions during pregnancy and anthropometric outcomes during childhood. Methods A systematic literature search was conducted in three electronic databases, two clinical trial registers and further sources, without language or publication status restrictions. Additionally, 110 study authors were contacted to obtain unpublished data. Randomized controlled trials comparing any antenatal lifestyle or behavioral intervention to standard prenatal care, in women of any body mass index (BMI), with offspring anthropometric data at 1 month of age or older, were considered. Two reviewers independently extracted data and assessed the risk of bias using the Cochrane Collaboration’s updated tool. Data on weight, length, and BMI, and corresponding z-scores, were stratified into six age ranges and weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated in univariate and multivariate random-effects meta-analytical models. Results Twenty trials comprising 11,385 women were included in this systematic review, of which 19 were combined in meta-analyses. Overall, lifestyle interventions during pregnancy were not associated with differences in weight, length, BMI, or corresponding z-scores, in children aged 1 month to 7 years (e.g. weight in 5 to 6 month old children, WMD: 0.02 kg; 95% CI: − 0.05 to 0.10 kg, I2 = 38%; 13 studies, 6667 participants). Findings remained consistent when studies were stratified by maternal baseline BMI or other risk factors, and intervention content and duration. Based on the GRADE criteria, the strength of the body of evidence was considered moderate. Conclusion Prenatal lifestyle interventions were not shown to influence childhood weight or growth. Nevertheless, women should be encouraged to pursue a healthy lifestyle during pregnancy. Further efforts to establish early prevention strategies for childhood obesity are urgently needed. Thus, large, high-quality studies with pre-planned, long-term follow-ups are warranted. Trial registration PROSPERO CRD42018118678.

Child Anthropometrics and Neurodevelopment at 2 and 3 Years of Age Following an Antenatal Lifestyle Intervention in Routine Care—A Secondary Analysis from the Cluster-Randomised GeliS Trial

“…Compared to this cohort data, however, we observed a higher rate of children with underweight, and a slightly lower rate of children with obesity (extremely underweight: 1.4%, underweight: 3.8%, obese: 2.9%) [ 41 ]. The missing evidence of a reduction in the rate of childhood overweight at 2 and 3 years of age by antenatal lifestyle counselling in the GeliS study is in accordance with findings from other studies [ 19 , 20 , 42 , 43 , 44 ], and supported by findings from two recent meta-analyses [ 23 , 24 ]. Louise et al [ 24 ] performed an individual patient meta-analysis on randomised controlled trials (RCTs) including women with overweight or obesity on childhood outcomes at 3–5 years of age.…”

“…Louise et al [ 24 ] performed an individual patient meta-analysis on randomised controlled trials (RCTs) including women with overweight or obesity on childhood outcomes at 3–5 years of age. Furthermore, a recent meta-analysis from our research group investigated RCTs including women from all BMI categories, and including offspring data from 1 month to 7 years of age [ 23 ]. Both meta-analyses sought to determine the effect of lifestyle interventions during pregnancy on offspring outcomes, and found no evidence of an alteration of child obesity risk and childhood weight or growth.…”

“…However, the evidence for the long-term influence of maternal lifestyle interventions on offspring overweight and obesity risk is less clear [ 18 ], and the results of studies investigating their impact on child neurodevelopment are heterogeneous [ 19 , 20 , 21 , 22 ]. Two recent meta-analyses found that lifestyle interventions in pregnancy had no impact on either short- or long-term weight and growth outcomes in children [ 23 ], nor on early childhood obesity risk [ 24 ]. However, most studies had rather small sample sizes and were performed in community settings or academic institutions.…”

Biogenic Phytochemicals Modulating Obesity: From Molecular Mechanism to Preventive and Therapeutic Approaches

“…During gestation, maternal obesity is associated with a high risk of being transferred to offspring caused by decreased methylation of developmental gene Znf483. Likewise, early gestation exposure to malnutrition increases risk factors of obesity [ 50 – 52 ]. The gut microflora dysbiosis is also the most important contributor to obesity.…”

Maternal mindful eating as a target for improving metabolic outcomes in pregnant women with obesity

“…Eating mindlessly under the influence of external cues and the rewarding value of hyperpalatable foods overrides homeostatic signals for hunger and satiety, leading to overconsumption and weight gain [ 9 ]. While classical dietary modification approaches have demonstrated some success in limiting GWG [ 10 ], they have largely failed to prevent GDM, large-for-gestational age births, [ 11 , 12 ] or to reduce childhood adiposity [ 13 ]. Past trials have also neglected to measure effects on maternal fat mass gain.…”