Article | Published:

Clinical Research

Prenatal education of overweight or obese pregnant women to prevent childhood overweight (the ETOIG study): an open-label, randomized controlled trial

International Journal of Obesity (2018) | Download Citation

Subjects

Abstract

Background

We aimed to evaluate whether pre and perinatal education of pregnant women would reduce childhood overweight.

Methods

Four French centers included women at ≤21 gestational weeks (GWs) with body mass index (BMI) >25 kg/m2 before pregnancy. Patients were randomized to a control group (routine care including at least one dietary visit) or an intervention group (2 individuals (26 and 30 GW) and 4 group sessions (21, 28, 35 GW, 2 months postpartum)) aimed at educating the future mother regarding infant and maternal nutrition. The primary objective was to reduce post-natal excessive weight gain in the infant from birth to 2 years (NCT00804765). This project was funded by a grant from the National Programme for Hospital Research (PHRC-2007 French Ministry of Health).

Results

We included 275 women (BMI: 32.5 kg/m2). The rate of post-natal excessive weight gain was similar in the intervention (n = 132) and control (n = 136) groups by intention to treat (ITT: 59.1% vs 60.3% respectively, p = 0.84) in available data (AD, n = 206) and by per-protocol analysis (PP, n = 177). Two years after delivery, normalization of maternal BMI and number of infants with BMI < 19 kg/m2 were not significantly different in the interventional group in ITT and in the control group. Although not significantly different in ITT, normalization of maternal BMI was more frequent in AD (n = 149: 12.9% vs 3.8%, p = 0.04) and 2-year-old infant BMIs were less likely to be >19 kg/m2 in the intervention group in AD (n = 204: 0% vs 6.8%, p = 0.014) and PP (n = 176: 0% vs 6.4%, p = 0.03).

Conclusions

An education and nutritional counseling program for overweight women, starting after 3 months of gestation, did not significantly change post-natal excessive weight gain of infants or prevent overweight in mothers and children 2 years after delivery.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    Bjorge T, Engeland A, Tverdal A, Smith GD. Body mass index in adolescence in relation to cause-specific mortality: a follow-up of 230,000 Norwegian adolescents. Am J Epidemiol. 2008;168:30–7.

  2. 2.

    Salanave B, Peneau S, Rolland-Cachera MF, Hercberg S, Castetbon K. Stabilization of overweight prevalence in French children between 2000 and 2007. Int J Pediatr Obes. 2009;4:66–72.

  3. 3.

    Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2011;07:CD001871.

  4. 4.

    Woo Baidal JA, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM. Risk factors for childhood obesity in the first 1,000 days: a systematic review. Am J Prev Med. 2016;50:761–79.

  5. 5.

    Yu Z, Han S, Zhu J, Sun X, Ji C, Guo X. Pre-pregnancy body mass index in relation to infant birth weight and offspring overweight/obesity: a systematic review and meta-analysis. PLoS ONE. 2013;8:e61627.

  6. 6.

    Mamun AA, Mannan M, Doi SA. Gestational weight gain in relation to offspring obesity over the life course: a systematic review and bias-adjusted meta-analysis. Obes Rev. 2014;15:338–47.

  7. 7.

    Hillier TA, Pedula KL, Schmidt MM, Mullen JA, Charles MA, Pettitt DJ. Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia. Diabetes Care. 2007;30:2287–92.

  8. 8.

    Riedel C, Schönberger K, Yang S, Koshy G, Chen YC, Gopinath B, et al. Parental smoking and childhood obesity: higher effect estimates for maternal smoking in pregnancy compared with paternal smoking: a meta-analysis. Int J Epidemiol. 2014;43:1593–606.

  9. 9.

    Yu ZB, Han SP, Zhu GZ, Zhu C, Wang XJ, Cao XG, et al. Birth weight and subsequent risk of obesity: a systematic review and meta-analysis. Obes Rev. 2011;12:525–42.

  10. 10.

    Peneau S, Hercberg S, Rolland-Cachera MF. Breastfeeding, early nutrition, and adult body fat. J Pediatr. 2014;164:1363–8.

  11. 11.

    Shloim N, Edelson LR, Martin N, Hetherington MM. Parenting styles, feeding styles, feeding practices, and weight status in 4-12 year-old children: a systematic review of the literature. Front Psychol. 2015;6:1849.

  12. 12.

    Ong KK, Loos RJ. Rapid infancy weight gain and subsequent obesity: systematic reviews and hopeful suggestions. Acta Paediatr. 2006;95:904–8.

  13. 13.

    Druet C, Stettler N, Sharp S, Simmons RK, Cooper C, Smith GD, et al. Prediction of childhood obesity by infancy weight gain: an individual-level meta-analysis. Paediatr Perinat Epidemiol. 2012;26:19–26.

  14. 14.

    Kral JG, Biron S, Simard S, Hould FS, Lebel S, Marceau S, et al. Large maternal weight loss from obesity surgery prevents transmission of obesity to children who were followed for 2 to 18 years. Pediatrics. 2006;118:e1644–9.

  15. 15.

    Polley BA, Wing RR, Sims CJ. Randomized controlled trial to prevent excessive weight gain in pregnant women. Int J Obes Relat Metab Disord. 2002;26:1494–502.

  16. 16.

    Zelen M. A new design for randomized clinical trials. N Engl J Med. 1979;300:1242–5.

  17. 17.

    Ware J Jr., Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–33.

  18. 18.

    Mamelle N, Munoz F, Grandjean H. [Fetal growth from the AUDIPOG study. I. Establishment of reference curves]. J Gynecol Obstet Biol Reprod. 1996;25:61–70.

  19. 19.

    Salomon LJ, Bernard JP, de Stavola B, Kenward M, Ville Y. [Birth weight and size: charts and equations]. J Gynecol Obstet Biol Reprod. 2007;36:50–6.

  20. 20.

    Sempe M, Capron JP. [“Chronos”: analysis of bone maturation by an automated numerical method]. Pediatrie. 1979;34:833–45.

  21. 21.

    McEachan RR, Santorelli G, Bryant M, Sahota P, Farrar D, Small N, et al. The HAPPY (Healthy and Active Parenting Programmme for early Years) feasibility randomised control trial: acceptability and feasibility of an intervention to reduce infant obesity. BMC Public Health. 2016;16:211.

  22. 22.

    Wen LM, Baur LA, Simpson JM, Xu H, Hayes AJ, Hardy LL, et al. Sustainability of effects of an early childhood obesity prevention trial over time: a further 3-year follow-up of the healthy beginnings trial. JAMA Pediatr. 2015;169:543–51.

  23. 23.

    Vesco KK, Leo MC, Karanja N, Gillman MW, McEvoy CT, King JC, et al. One-year postpartum outcomes following a weight management intervention in pregnant women with obesity. Obesity. 2016;24:2042–9.

  24. 24.

    Hanson M, Barker M, Dodd JM, Kumanyika S, Norris S, Steegers E, et al. Interventions to prevent maternal obesity before conception, during pregnancy, and post partum. Lancet Diabetes Endocrinol. 2017;5:65–76.

  25. 25.

    Blake-Lamb TL, Locks LM, Perkins ME, Woo Baidal JA, Cheng ER, Taveras EM. Interventions for childhood obesity in the first 1,000 days: a systematic review. Am J Prev Med. 2016;50:780–9.

  26. 26.

    Morandi A, Meyre D, Lobbens S, Kleinman K, Kaakinen M, Rifas-Shiman SL, et al. Estimation of newborn risk for child or adolescent obesity: lessons from longitudinal birth cohorts. PLoS ONE. 2012;7:e49919.

  27. 27.

    Robinson SM, Crozier SR, Harvey NC, Barton BD, Law CM, Godfrey KM, et al. Modifiable early-life risk factors for childhood adiposity and overweight: an analysis of their combined impact and potential for prevention. Am J Clin Nutr. 2015;101:368–75.

  28. 28.

    Tanvig M, Vinter CA, Jorgensen JS, Wehberg S, Ovesen PG, Lamont RF, et al. Anthropometrics and body composition by dual energy X-ray in children of obese women: a follow-up of a randomized controlled trial (the Lifestyle in Pregnancy and Offspring [LiPO] study). PLoS ONE. 2014;9:e89590.

  29. 29.

    Daniels LA, Mallan KM, Battistutta D, Nicholson JM, Perry R, Magarey A. Evaluation of an intervention to promote protective infant feeding practices to prevent childhood obesity: outcomes of the NOURISH RCT at 14 months of age and 6 months post the first of two intervention modules. Int J Obes. 2012;36:1292–8.

  30. 30.

    Campbell KJ, Lioret S, McNaughton SA, Crawford DA, Salmon J, Ball K, et al. A parent-focused intervention to reduce infant obesity risk behaviors: a randomized trial. Pediatrics. 2013;131:652–60.

Download references

Acknowledgements

The authors thank Christelle Auger, Valérie Jolaine, Christelle Turuban, and France Binet (Paris Descartes Clinical Research Unit) for their help in managing the protocol and collecting the data. Fiona Ecarnot (EA3920, University Hospital Besancon, France) participated in the writing of the paper.

Author information

Author notes

  1. These authors contributed equally: Sophie Parat, Véronique Nègre.

Affiliations

  1. AP-HP, Department of Medecine and Neonatal Reanimation, Hôpital Cochin-Port Royal, Paris, France

    • Sophie Parat
  2. RePPOP-Franche Comte Network for Pediatric Obesity, Obesity Specialized Center CHU Nice, Paris, France

    • Véronique Nègre
  3. URC/CIC Paris Descartes Necker Cochin, Paris, France

    • Amandine Baptiste
    • , Jean-Marc Tréluyer
    •  & Caroline Elie
  4. AP-HP, CRNH-IdF, CINFO, COMUE Sorbonne-Paris-Cité, Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, Bondy, France

    • Paul Valensi
    •  & Emmanuel Cosson
  5. Department of Pediatric Endocrinology, CHRU, Besançon, France

    • Anne-Marie Bertrand
  6. Childhood Hospital and RePPOP Midi Pyrenees Network for Pediatric Obesity, Toulouse, France

    • Christine Chollet
  7. AP-HP, Nutrition Obesity Unit, Necker Hospital, Paris, France

    • Myriam Dabbas
  8. AP-HP, Department of Diabetology, HEGP, Paris, France

    • Jean-Jacques Altman
  9. AP-HP, Department of Neonatology, Paris Descartes University, Hôpital Necker, Paris, France

    • Alexandre Lapillonne
  10. Department of Pediatric Endocrinology, Childhood Hospital and RePPOP Midi Pyrenees Network for Pediatric Obesity, Toulouse, France

    • Maithé Tauber
  11. Department of Endocrinology, Paule Viguier Hospital, Toulouse, France

    • Françoise Lorenzini
  12. Université Paris 13, Inserm (U1153), Inra (U1125), Centre d’Epidémiologie et Statistiques Paris Cité, Cnam, COMUE Sorbonne-Paris-Cité, F-93017, Bobigny, France

    • Emmanuel Cosson

Authors

  1. Search for Sophie Parat in:

  2. Search for Véronique Nègre in:

  3. Search for Amandine Baptiste in:

  4. Search for Paul Valensi in:

  5. Search for Anne-Marie Bertrand in:

  6. Search for Christine Chollet in:

  7. Search for Myriam Dabbas in:

  8. Search for Jean-Jacques Altman in:

  9. Search for Alexandre Lapillonne in:

  10. Search for Jean-Marc Tréluyer in:

  11. Search for Caroline Elie in:

  12. Search for Maithé Tauber in:

  13. Search for Françoise Lorenzini in:

  14. Search for Emmanuel Cosson in:

Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Sophie Parat.

Electronic supplementary material

About this article

Publication history

Received

Revised

Accepted

Published

DOI

https://doi.org/10.1038/s41366-018-0205-z