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Infant adiposity following a randomised controlled trial of a behavioural intervention in obese pregnancy

International Journal of Obesity volume 41, pages 1018–1026 (2017)Cite this article

Subjects

Abstract

Objectives:

Randomised controlled trials are required to address causality in the reported associations between maternal influences and offspring adiposity. The aim of this study was to determine whether an antenatal lifestyle intervention, associated with improvements in maternal diet and reduced gestational weight gain (GWG) in obese pregnant women leads to a reduction in infant adiposity and sustained improvements in maternal lifestyle behaviours at 6 months postpartum.

Subjects and methods:

We conducted a planned postnatal follow-up of a randomised controlled trial (UK Pregnancies Better Eating and Activity Trial (UPBEAT)) of a complex behavioural intervention targeting maternal diet (glycaemic load (GL) and saturated fat intake) and physical activity in 1555 obese pregnant women. The main outcome measure was infant adiposity, assessed by subscapular and triceps skinfold thicknesses. Maternal diet and physical activity, indices of the familial lifestyle environment, were assessed by questionnaire.

Results:

A total of 698 (45.9%) infants (342 intervention and 356 standard antenatal care) were followed up at a mean age of 5.92 months. There was no difference in triceps skinfold thickness z-scores between the intervention vs standard care arms (difference −0.14 s.d., 95% confidence interval −0.38 to 0.10, P=0.246), but subscapular skinfold thickness z-score was 0.26 s.d. (−0.49 to −0.02; P=0.03) lower in the intervention arm. Maternal dietary GL (−35.34; −48.0 to −22.67; P<0.001) and saturated fat intake (−1.93% energy; −2.64 to −1.22; P<0.001) were reduced in the intervention arm at 6 months postpartum. Causal mediation analysis suggested that lower infant subscapular skinfold thickness was partially mediated by changes in antenatal maternal diet and GWG rather than postnatal diet.

Conclusions:

This study provides evidence from follow-up of a randomised controlled trial that a maternal behavioural intervention in obese pregnant women has the potential to reduce infant adiposity and to produce a sustained improvement in maternal diet at 6 months postpartum.

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Acknowledgements

We are particularly grateful to the women and children who participated in UPBEAT. We acknowledge Jennie Louise PhD (Senior Statistician at the University of Adelaide) for her statistical advice, and all the UPBEAT staff. This work was supported by the European Union's 7th Framework Programme (FP7/2007–2013), project EarlyNutrition under grant agreement no. 289346 and the National Institute for Health Research (NIHR) (UK) Programme Grants for Applied Research Programme (RP-0407-10452). The views expressed in this paper are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health or any other listed funders. Support was also provided from the Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, the Chief Scientist Office Scotland, Guy’s and St Thomas’ Charity and Tommy’s Charity (registered charity no. 1060508). Professor Godfrey is supported by the National Institute for Health Research through the NIHR Southampton Biomedical Research Centre. Professor Lawlor’s contribution to this paper is supported by a grant from the European Research Council (ObesityDevelop; grant number 669545) the MRC Integrative Epidemiology Unit (MC_UU_1201/5) and Professor Lawlor and Professor Poston are National Institute of Health Research Senior Investigators. Mr Seed and Dr Briley were supported by the Tommy's Charity and National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King’s College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The UPBEAT trial is registered with Current Controlled Trials, ISRCTN89971375.

Author contributions

Dr Nashita Patel, Mr Paul Seed, Dr Dharmintra Pasupathy and Professor Lucilla Poston conceptualised and designed the study, drafted and carried out the initial analyses, critically reviewed the manuscript, and approved the final manuscript as submitted. Dr Louise Hayes, Ms Julia Levin, Dr Sara White and Dr Angela Flynn carried out the initial dietary and physical activity analyses. All these authors critically reviewed and approved the final manuscript as submitted. Dr Annette Briley, Dr Eugene Oteng-Ntim, Professor Stephen Robson, Professor Scott M Nelson, Ms Claire Singh designed the data collection instruments, and coordinated and supervised data collection, critically reviewed the manuscript and approved the final manuscript as submitted. Professors Ruth Bell, Keith Godfrey, Debbie Lawlor, Naveed Sattar and Jane Wardle designed the data collection instruments, critically reviewed the manuscript and approved the final manuscript as submitted.

Disclaimer

The funders had no role in study design, data collection, data analysis, data interpretation or writing of the final report. The corresponding author had access to all the data in the study and had final responsibility for the decision to submit for publication.

Author information

Author notes

  1. J Wardle: Deceased.

Authors and Affiliations

  1. Division of Women’s Health, Women’s Health Academic Centre, Faculty of Life Sciences and Medicine, King’s College London, St Thomas’ Hospital, London, UK

    N Patel, D Pasupathy, A C Flynn, A L Briley, S L White, P T Seed & L Poston

  2. MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK

    K M Godfrey

  3. Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK

    J Levin

  4. Division of Diabetes and Nutritional Sciences, King’s College London, London, UK

    A C Flynn

  5. Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK

    L Hayes & R Bell

  6. MRC Integrative Epidemiology Unit at the University of Bristol and School of Social and Community Medicine, Bristol, UK

    D A Lawlor

  7. Department of Obstetrics and Gynaecology, Guys and St Thomas’ NHS Foundation Trust, London, UK

    E Oteng-Ntim & C Singh

  8. School of Medicine, University of Glasgow, Glasgow, UK

    S M Nelson

  9. Institute of Cellular Medicine Uterine Cell Signalling Group Newcastle University, Newcastle, UK

    S C Robson

  10. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK

    N Sattar

  11. Health Behaviour Research Centre, Institute of Epidemiology and Health, University College London, London, UK

    J Wardle

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Correspondence to N Patel.

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Patel, N., Godfrey, K., Pasupathy, D. et al. Infant adiposity following a randomised controlled trial of a behavioural intervention in obese pregnancy. Int J Obes 41, 1018–1026 (2017). https://doi.org/10.1038/ijo.2017.44

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