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A preconception lifestyle intervention in women with obesity and cardiovascular health in their children

Pediatric Research (2023)Cite this article

Abstract

Background

Maternal obesity during pregnancy is associated with poorer cardiovascular health (CVH) in children. A strategy to improve CVH in children could be to address preconception maternal obesity by means of a lifestyle intervention. We determined if a preconception lifestyle intervention in women with obesity improved offspring’s CVH, assessed by magnetic resonance imaging (MRI).

Methods

We invited children born to women who participated in a randomised controlled trial assessing the effect of a preconception lifestyle intervention in women with obesity. We assessed cardiac structure, function and geometric shape, pulse wave velocity and abdominal fat tissue by MRI.

Results

We included 49 of 243 (20.2%) eligible children, 24 girls (49%) girls, mean age 7.1 (0.8) years. Left ventricular ejection fraction was higher in children in the intervention group as compared to children in the control group (63.0% SD 6.18 vs. 58.8% SD 5.77, p = 0.02). Shape analysis showed that intervention was associated with less regional thickening of the interventricular septum and less sphericity. There were no differences in the other outcomes of interest.

Conclusion

A preconception lifestyle intervention in women with obesity led to a higher ejection fraction and an altered cardiac shape in their offspring, which might suggest a better CVH.

Impact

  • A preconception lifestyle intervention in women with obesity results in a higher ejection fraction and an altered cardiac shape that may signify better cardiovascular health (CVH) in their children.

  • This is the first experimental human evidence suggesting an effect of a preconception lifestyle intervention in women with obesity on MRI-derived indicators of CVH in their children.

  • Improving maternal preconception health might prevent some of the detrimental consequences of maternal obesity on CVH in their children.

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Fig. 1: Flowchart of participants selection.
Fig. 2: Results form the statistical shape model (SSM).

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author upon reasonable request. The 3D meshes included for analyses are available on FigShare https://doi.org/10.6084/m9.figshare.19944362.

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Acknowledgements

We would like to thank all children and parents who participated in the study. Also, this follow-up would not have been possible without the original LIFEstyle trial, so we would like to thank the whole LIFEstyle group, including all participating centres and researchers that have contributed to the original trial. We would like to thank Raschel van Luijk, Sandra van den Berg and Gert-Jan Ebbers for their scanning assistance. Tineke Willems and Jesse Medema facilitated the cardiac MRIs in the UMC Groningen and we would also like to thank them for their help. Finally, we would like to thank Robert Hemke for his help and expertise regarding the abdominal fat quantifications. A.W.v.D. is funded by a ZonMW Rubicon grant (452183001) and a European Society of Cardiology Fellowship. PL holds a Wellcome Trust Senior Research Fellowship (209450/Z/17/Z). This research was supported by the European Commission (EC H2020—g.a. 764738), a grant of the Dutch Heart Foundation (2013T085) and a Postdoc Stipend of Amsterdam Reproduction & Development. The initial LIFEstyle trial was supported by a grant from ZonMW, the Dutch Organisation for Health Research and Development (120620027).

Author information

Authors and Affiliations

  1. Department of Epidemiology and Data Science, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, the Netherlands

    Tamara den Harink, Karen A. Voet, Tessa J. Roseboom & Arend W. van Deutekom

  2. Amsterdam Reproduction and Development, Amsterdam, the Netherlands

    Tamara den Harink & Tessa J. Roseboom

  3. Department of Radiology and Nuclear Medicine, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, the Netherlands

    Joost Schuppen & R. Nils Planken

  4. Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK

    Maciej Marciniak & Pablo Lamata

  5. Department of Reproductive Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands

    Annemieke Hoek

  6. Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands

    Henk Groen

  7. Department of Paediatrics, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, the Netherlands

    Reinoud J. B. J. Gemke

  8. Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia

    Ben Willem Mol

  9. Aberdeen Centre for Women’s Health Research, Institute of Applied Health Sciences School of Medicine, University of Aberdeen, Aberdeen, UK

    Ben Willem Mol

  10. Department of Paediatric Cardiology, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, the Netherlands

    Nico A. Blom

  11. Department of Paediatrics, Division of Paediatric Cardiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands

    Arend W. van Deutekom

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  1. Tamara den Harink
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Contributions

A.W.v.D. designed the research protocol. T.d.H. was responsible for planning the C.M.R’s, safely storing all data, extracting and analyzing the data and writing the article. K.V., N.P. and J.S. were responsible for part of the data extraction. M.M. and P.L. performed and analyzed the S.S.M. A.W.v.D., A.H., H.G., B.W.M., N.A.B., T.J.R., R.J.B.J.G., N.P., K.V., M.M. and P.L. all carefully reviewed the article. A.H., H.G., B.W.M., R.J.B.J.G., T.J.R. and A.W.v.D. were involved in the set-up of the original intervention study and follow-up study. All authors provided intellectual input and were involved in the writing of the article.

Corresponding author

Correspondence to Tamara den Harink.

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Competing interests

A.H. reports that she is involved as a consultant for the design of a lifestyle App by Ferring Pharmaceutical company, The Netherlands. All other authors declare no competing interests.

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All parents or legal guardians gave written consent for inclusion of the child in our study.

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den Harink, T., Schuppen, J., Marciniak, M. et al. A preconception lifestyle intervention in women with obesity and cardiovascular health in their children. Pediatr Res (2023). https://doi.org/10.1038/s41390-022-02443-8

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