Dietary interventions in overweight and obese pregnant women: a systematic review of the content, delivery, and outcomes of randomized controlled trials

Flynn, Angela C.; Dalrymple, Kathryn V.; Barr, Suzanne; Poston, Lucilla; Goff, Louise; Rogozińska, Ewelina; Poppel, Mireille N. M. van; Rayanagoudar, Girish; Yeo, SeonAe; Carballo, Ruben Barakat; Perales, Marı́a; Bogaerts, Annick; Cecatti, José Guilherme; Dodd, Jodie M; Owens, Julie A.; Devlieger, Roland; Teede, Helena; Haakstad, Lene Annette Hagen; Motahari-Tabari, Narges; Tonstad, Serena; Luoto, Riitta; Guelfi, Kym J.; Petrella, Elisabetta; Phelan, Suzanne; Scudeller, Tânia Terezinha; Hauner, Hans; Renault, Kristina; Sagedal, Linda Reme; Stafne, Signe Nilssen; Vinter, Christina Anne; Astrup, Arne; Geiker, Nina Rica Wium; McAuliffe, Fionnuala M.; Mol, Ben Willem; Thangaratinam, Shakila

doi:10.1093/nutrit/nuw005

Cited by 93 publications

(133 citation statements)

References 80 publications

Supporting

Mentioning

126

Contrasting

Order By: Relevance

“…Most of these intervention studies, however, have not been of adequate size to provide sufficient statistical power to address pregnancy outcomes. A review of the strategies used has shown a lack of conformity and infrequent attempts to measure the impact of the interventions on diet or physical activity [38]. In a review of 12 randomized controlled trials involving a total of 2,713 pregnant women of normal BMI, EarlyNutrition researchers found that pregnant women of normal BMI who received a dietary and lifestyle intervention were likely to experience less GWG (4 studies, 446 women; mean difference -1.25 kg; 95% CI -2.39 to -0.11), less often reached a GWG exceeding the U.S. Institute of Medicine (IOM) guidelines (4 studies, 446 women; risk ratio 0.66; 95% CI 0.53-0.83) and reduced the incidence of hypertension (2 studies; 243 women; risk ratio 0.34; 95% CI 0.13-0.91).…”

Section: Recommendations On Nutrition During Preconceptionmentioning

confidence: 99%

Nutrition During Pregnancy, Lactation and Early Childhood and its Implications for Maternal and Long-Term Child Health: The Early Nutrition Project Recommendations

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background: A considerable body of evidence accumulated especially during the last decade, demonstrating that early nutrition and lifestyle have long-term effects on later health and disease (“developmental or metabolic programming”). Methods: Researchers involved in the European Union funded international EarlyNutrition research project consolidated the scientific evidence base and existing recommendations to formulate consensus recommendations on nutrition and lifestyle before and during pregnancy, during infancy and early childhood that take long-term health impact into account. Systematic reviews were performed on published dietary guidelines, standards and recommendations, with special attention to long-term health consequences. In addition, systematic reviews of published systematic reviews on nutritional interventions or exposures in pregnancy and in infants and young children aged up to 3 years that describe effects on subsequent overweight, obesity and body composition were performed. Experts developed consensus recommendations incorporating the wide-ranging expertise from additional 33 stakeholders. Findings: Most current recommendations for pregnant women, particularly obese women, and for young children do not take long-term health consequences of early nutrition into account, although the available evidence for relevant consequences of lifestyle, diet and growth patterns in early life on later health and disease risk is strong. Interpretation: We present updated recommendations for optimized nutrition before and during pregnancy, during lactation, infancy and toddlerhood, with special reference to later health outcomes. These recommendations are developed for affluent populations, such as women and children in Europe, and should contribute to the primary prevention of obesity and associated non-communicable diseases.

show abstract

Section: Recommendations On Nutrition During Preconceptionmentioning

confidence: 99%

Nutrition During Pregnancy, Lactation and Early Childhood and its Implications for Maternal and Long-Term Child Health: The Early Nutrition Project Recommendations

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…Longerterm followups will be required to determine whether children receiving metformin treatment in utero develop less visceral fat and, potentially, increased insulin sensitivity. Previous evidence suggests that dietbased interventions are effective in achieving a reduction in gestational weight gain in pregnant women with GDM who are overweight or obese, but result in no substantial effect on birth weight, as reviewed elsewhere 216,217 . However, a promising approach in women with GDM is the use of a diet higher in complex carbohydrates and lower in fats; a study in pregnant women with GDM showed improved maternal and infant outcomes after only 7 weeks of treatment 218,219 .…”

Section: Targeting the Gut–liver Axismentioning

confidence: 99%

Developmental origins of NAFLD: a womb with a clue

Wesolowski

Kasmi

Jonscher

et al. 2016

Nat Rev Gastroenterol Hepatol

176

167

View full text Add to dashboard Cite

Changes in the maternal environment leading to an altered intrauterine milieu can result in subtle insults to the fetus, promoting increased lifetime disease risk and/or disease acceleration in childhood and later in life. Particularly worrisome is that the prevalence of NAFLD is rapidly increasing among children and adults, and is being diagnosed at increasingly younger ages, pointing towards an early-life origin. A wealth of evidence, in humans and non-human primates, suggests that maternal nutrition affects the placenta and fetal tissues, leading to persistent changes in hepatic metabolism, mitochondrial function, the intestinal microbiota, liver macrophage activation and susceptibility to NASH postnatally. Deleterious exposures in utero include fetal hypoxia, increased nutrient supply, inflammation and altered gut microbiota that might produce metabolic clues, including fatty acids, metabolites, endotoxins, bile acids and cytokines, which prime the infant liver for NAFLD in a persistent manner and increase susceptibility to NASH. Mechanistic links to early disease pathways might involve shifts in lipid metabolism, mitochondrial dysfunction, pioneering gut microorganisms, macrophage programming and epigenetic changes that alter the liver microenvironment, favouring liver injury. In this Review, we discuss how maternal, fetal, neonatal and infant exposures provide developmental clues and mechanisms to help explain NAFLD acceleration and increased disease prevalence. Mechanisms identified in clinical and preclinical models suggest important opportunities for prevention and intervention that could slow down the growing epidemic of NAFLD in the next generation.NAFLD is a general term used to describe a broad spectrum of liver abnormalities, ranging from simple, uncomplicated hepatic steatosis to NASH, accompanied by different degrees of Correspondence to J.E.F. jed.friedman@ucdenver.edu. Author contributionsAll authors researched data for the article, provided a substantial contribution to discussion of content, wrote the article, and reviewed and edited the manuscript before submission. Competing interests statementThe authors declare no competing interests. HHS Public AccessAuthor manuscript Nat Rev Gastroenterol Hepatol. Author manuscript; available in PMC 2017 December 12. Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript inflammation and fibrosis. NAFLD is increasing in prevalence, especially in adolescents 1 , despite the levellingoff of the obesity epidemic from 2003-2004 to 2013-2014 in children and adolescents aged 2-19 years (REF.2). The most common chronic liver disease worldwide, NAFLD increases the risk of cardiovascular events eightfold and type 2 diabetes mellitus (T2DM) threefold 3 , and is a strong risk factor for hepatocellular carcinoma (HCC) 4 . At the time of paediatric NAFLD diagnosis, 25-50% of children have NASH and 10-25% have advanced fibrosis 5 . For many decades, it was thought that NAFLD was predominantly driven by obesity in the setting of genetic suscep...

show abstract

“…Other stakeholders have been specifically addressed with targeted communication. Evidence-based recommendations on optimized practice of nutrition before and during pregnancy, during the breast feeding period and the early life of infants, have been developed based on the project results and on systematic reviews of available evidence [35,36,37,38,39,40,41,42], in close collaboration with a broad group of stakeholders (prepared for publication). These recommendations are of considerable importance because most of the current guidance for pregnant women, particularly obese women, and for young children does not take into account the long-term programming consequences of early nutrition.…”

Section: Further Disseminationmentioning

confidence: 99%

Long-Term Health Impact of Early Nutrition: The Power of Programming

Koletzko

Brands²,

Grote³

et al. 2017

Ann Nutr Metab

110

View full text Add to dashboard Cite

The Power of Programming conference 2016 at Ludwig-Maximilians-Universität Munich brought together about 600 researchers and other stakeholders from around the world who reviewed the recent evidence on the lasting health impact of environment and nutrition during early life, from pre-pregnancy to early childhood. The conference was hosted by the Early Nutrition Project, a multidisciplinary research collaboration funded by the European Commission with collaborating researchers from 35 institutions in 15 countries in Europe, the United States and Australia. The project explores the early origins of obesity, adiposity and associated non-communicable diseases, underlying mechanisms and opportunities for prevention. The project also proactively supports translational application of research findings. In fact, some existing evidence has already been rapidly adopted into policy, regulatory standards and practice. Further, broad dissemination of findings is achieved through the established digital eLearning platform of the Early Nutrition eAcademy, video clip-based learning and graphically supported messaging to consumers. The project demonstrated powerful effects of early metabolic programming on later health. Compared to other common prevention strategies, modifying risk trajectories in early life can achieve a much larger risk reduction and be more cost-effective. While some effective prevention strategies have been promptly implemented in policy and guidelines, legislation and practice, in other areas, the uptake is limited by a paucity of quality human intervention trials and insufficient evaluation of the feasibility of implementation and econometric impact. This needs to be strengthened by future collaborative research work.

show abstract

Dietary interventions in overweight and obese pregnant women: a systematic review of the content, delivery, and outcomes of randomized controlled trials

Cited by 93 publications

References 80 publications

Nutrition During Pregnancy, Lactation and Early Childhood and its Implications for Maternal and Long-Term Child Health: The Early Nutrition Project Recommendations

Nutrition During Pregnancy, Lactation and Early Childhood and its Implications for Maternal and Long-Term Child Health: The Early Nutrition Project Recommendations

Developmental origins of NAFLD: a womb with a clue

Long-Term Health Impact of Early Nutrition: The Power of Programming

Contact Info

Product

Resources

About