Skip to main content
Top
Published in: BMC Medicine 1/2021

Open Access 01-12-2021 | Obesity | Research article

The effects of dietary and lifestyle interventions among pregnant women with overweight or obesity on early childhood outcomes: an individual participant data meta-analysis from randomised trials

Authors: Jennie Louise, Amanda J. Poprzeczny, Andrea R. Deussen, Christina Vinter, Mette Tanvig, Dorte Moller Jensen, Annick Bogaerts, Roland Devlieger, Fionnuala M. McAuliffe, Kristina M. Renault, Emma Carlsen, Nina Geiker, Lucilla Poston, Annette Briley, Shakila Thangaratinam, Jodie M. Dodd

Published in: BMC Medicine | Issue 1/2021

Login to get access

Abstract

Background

The impact of maternal obesity extends beyond birth, being independently associated with an increased risk of child obesity. Current evidence demonstrates that women provided with a dietary intervention during pregnancy improve their dietary quality and have a modest reduction in gestational weight gain. However, the effect of this on longer-term childhood obesity-related outcomes is unknown.

Methods

We conducted an individual participant data meta-analysis from RCTs in which women with a singleton, live gestation between 10+0 and 20+0 weeks and body mass index (BMI) ≥ 25 kg/m2 in early pregnancy were randomised to a diet and/or lifestyle intervention or continued standard antenatal care and in which longer-term maternal and child follow-up at 3–5 years of age had been undertaken. The primary childhood outcome was BMI z-score above the 90th percentile. Secondary childhood outcomes included skinfold thickness measurements and body circumferences, fat-free mass, dietary and physical activity patterns, blood pressure, and neurodevelopment.

Results

Seven primary trials where follow-up of participants occurred were identified by a systematic literature search within the International Weight Management in Pregnancy (i-WIP) Collaborative Group collaboration, with six providing individual participant data. No additional studies were identified after a systematic literature search. A total of 2529 children and 2383 women contributed data. Approximately 30% of all child participants had a BMI z-score above the 90th percentile, with no significant difference between the intervention and control groups (aRR 0.97; 95% CI 0.87, 1.08; p=0.610). There were no statistically significant differences identified for any of the secondary outcome measures.

Conclusions

In overweight and obese pregnant women, we found no evidence that maternal dietary and/or lifestyle intervention during pregnancy modifies the risk of early childhood obesity. Future research may need to target the pre-conception period in women and early childhood interventions.

Trial registration

PROSPERO, CRD42016047165
Appendix
Available only for authorised users
Literature
1.
go back to reference World Health Organization: Taking action on childhood obesity. 2018 report In.; 2018. World Health Organization: Taking action on childhood obesity. 2018 report In.; 2018.
4.
go back to reference The International Weight Management in Pregnancy (i-WIP) Collaborative Group. Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials. BMJ. 2017;358:j3119 https://doi.org/10.1136/bmj.j3119.CrossRef The International Weight Management in Pregnancy (i-WIP) Collaborative Group. Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials. BMJ. 2017;358:j3119 https://​doi.​org/​10.​1136/​bmj.​j3119.CrossRef
7.
go back to reference Dodd JM, Grivell RM, Louise J, Deussen AR, Giles L, Mol BW, Vinter CA, Tanvig M, Jensen DM, Bogaerts A et al. The effects of dietary and lifestyle interventions among pregnant women who are overweight or obese on longer-term maternal and early childhood outcomes: an individual participant data (IPD) meta-analysis. Syst Rev. 2017;6:51. Dodd JM, Grivell RM, Louise J, Deussen AR, Giles L, Mol BW, Vinter CA, Tanvig M, Jensen DM, Bogaerts A et al. The effects of dietary and lifestyle interventions among pregnant women who are overweight or obese on longer-term maternal and early childhood outcomes: an individual participant data (IPD) meta-analysis. Syst Rev. 2017;6:51.
10.
go back to reference Bricker D, Squires J, Mounts L. Ages and Stages Questionnaire: 12 month: a parent completed child monitoring system. USA: Paul H Brookes Publishing Co; 1995. Bricker D, Squires J, Mounts L. Ages and Stages Questionnaire: 12 month: a parent completed child monitoring system. USA: Paul H Brookes Publishing Co; 1995.
12.
14.
go back to reference van Buuren S, Groothuis-Oudshoorn K. mice: multivariate imputation by chained equations in R. J Stat Software. 2011;45(3):1–67.CrossRef van Buuren S, Groothuis-Oudshoorn K. mice: multivariate imputation by chained equations in R. J Stat Software. 2011;45(3):1–67.CrossRef
18.
go back to reference Bates D, Maechler M, Bolker B, Walker S. Fitting linear mixed-effects models using lme4. J Stat Software. 2015;67(1):1–48.CrossRef Bates D, Maechler M, Bolker B, Walker S. Fitting linear mixed-effects models using lme4. J Stat Software. 2015;67(1):1–48.CrossRef
19.
go back to reference Grund S, Robitzsch A, Luedtke O: mitml: tools for multiple imputation in multilevel modeling. R package version 03-7 https://CRAN.R-project.org/package=mitml 2019. Grund S, Robitzsch A, Luedtke O: mitml: tools for multiple imputation in multilevel modeling. R package version 03-7 https://​CRAN.​R-project.​org/​package=​mitml 2019.
20.
go back to reference Renault KM, Nørgaard K, Nilas L, Carlsen EM, Cortes D, Pryds O, et al. The Treatment of Obese Pregnant Women (TOP) study: a randomized controlled trial of the effect of physical activity intervention assessed by pedometer with or without dietary intervention in obese pregnant women. Am J Obstet Gynecol. 2014;210(2):134 e131-139.CrossRefPubMed Renault KM, Nørgaard K, Nilas L, Carlsen EM, Cortes D, Pryds O, et al. The Treatment of Obese Pregnant Women (TOP) study: a randomized controlled trial of the effect of physical activity intervention assessed by pedometer with or without dietary intervention in obese pregnant women. Am J Obstet Gynecol. 2014;210(2):134 e131-139.CrossRefPubMed
21.
go back to reference Bogaerts AF, Devlieger R, Nuyts E, Witters I, Gyselaers W, Van den Bergh BR. Effects of lifestyle intervention in obese pregnant women on gestational weight gain and mental health: a randomized controlled trial. Int J Obes (Lond). 2012;37(6):814–21. https://doi.org/10.1038/ijo.2012.162. [Epub ahead of print].CrossRef Bogaerts AF, Devlieger R, Nuyts E, Witters I, Gyselaers W, Van den Bergh BR. Effects of lifestyle intervention in obese pregnant women on gestational weight gain and mental health: a randomized controlled trial. Int J Obes (Lond). 2012;37(6):814–21. https://​doi.​org/​10.​1038/​ijo.​2012.​162. [Epub ahead of print].CrossRef
24.
go back to reference Hua H, Burke DL, Crowther MJ, Ensor J, Tudur Smith C, Riley RD. One-stage individual participant data meta-analysis models: estimation of treatment-covariate interactions must avoid ecological bias by separating out within-trial and across-trial information. Stat Med. 2017;36(5):772–89. https://doi.org/10.1002/sim.7171.CrossRefPubMed Hua H, Burke DL, Crowther MJ, Ensor J, Tudur Smith C, Riley RD. One-stage individual participant data meta-analysis models: estimation of treatment-covariate interactions must avoid ecological bias by separating out within-trial and across-trial information. Stat Med. 2017;36(5):772–89. https://​doi.​org/​10.​1002/​sim.​7171.CrossRefPubMed
26.
go back to reference Poston L, Bell R, Croker H, Flynn AC, Godfrey KM, Goff L, Hayes L, Khazaezadeh N, Nelson SM, Oteng-Ntim E et al: Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. Lancet Diabetes Endocrinol 2015. https://doi.org/10.1016/S2213-8587(15)00227-2. Poston L, Bell R, Croker H, Flynn AC, Godfrey KM, Goff L, Hayes L, Khazaezadeh N, Nelson SM, Oteng-Ntim E et al: Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. Lancet Diabetes Endocrinol 2015. https://​doi.​org/​10.​1016/​S2213-8587(15)00227-2.
31.
go back to reference Tanvig M, Vinter CA, Jørgensen JS, Wehberg S, Ovesen PG, Beck-Nielsen H, et al. Effects of lifestyle intervention in pregnancy and anthropometrics at birth on offspring metabolic profile at 2.8 years: results from the Lifestyle in Pregnancy and Offspring (LiPO) study. J Clin Endocrinol Metab. 2015;100(1):175–83. https://doi.org/10.1210/jc.2014-2675.CrossRefPubMed Tanvig M, Vinter CA, Jørgensen JS, Wehberg S, Ovesen PG, Beck-Nielsen H, et al. Effects of lifestyle intervention in pregnancy and anthropometrics at birth on offspring metabolic profile at 2.8 years: results from the Lifestyle in Pregnancy and Offspring (LiPO) study. J Clin Endocrinol Metab. 2015;100(1):175–83. https://​doi.​org/​10.​1210/​jc.​2014-2675.CrossRefPubMed
36.
39.
go back to reference Horan MK, McGowan CA, Gibney ER, Byrne J, Donnelly JM, McAuliffe FM: Maternal nutrition and glycaemic index during pregnancy impacts on offspring adiposity at 6 months of age--analysis from the ROLO Randomised Controlled Trial. Nutrients. 2016;8(1). doi: https://doi.org/10.3390/nu8010007. Horan MK, McGowan CA, Gibney ER, Byrne J, Donnelly JM, McAuliffe FM: Maternal nutrition and glycaemic index during pregnancy impacts on offspring adiposity at 6 months of age--analysis from the ROLO Randomised Controlled Trial. Nutrients. 2016;8(1). doi: https://​doi.​org/​10.​3390/​nu8010007.
44.
go back to reference Dalrymple K, Flynn A, Seed PT, Poston L, O’Keeffe M, White S, et al. Adiposity and cardiovascular outcomes in three-year-old children of participants in UPBEAT, an RCT of a complex intervention in pregnant women with obesity. Pediatr Obes. 2020; In Press. Dalrymple K, Flynn A, Seed PT, Poston L, O’Keeffe M, White S, et al. Adiposity and cardiovascular outcomes in three-year-old children of participants in UPBEAT, an RCT of a complex intervention in pregnant women with obesity. Pediatr Obes. 2020; In Press.
45.
go back to reference AIHW. A picture of overweight and obesity in Australia 2017. Cat no PHE 216. Canberra: AIHW; 2017. AIHW. A picture of overweight and obesity in Australia 2017. Cat no PHE 216. Canberra: AIHW; 2017.
46.
go back to reference Jones RE, Jewell J, Saksena R, Ramos Salas X, Breda J. Overweight and obesity in children under 5 years: surveillance opportunities and challenges for the WHO European Region. Front Public Health. 2017;13(5):58. Jones RE, Jewell J, Saksena R, Ramos Salas X, Breda J. Overweight and obesity in children under 5 years: surveillance opportunities and challenges for the WHO European Region. Front Public Health. 2017;13(5):58.
47.
go back to reference NHMRC: Australian dietary guidelines. 2013. NHMRC: Australian dietary guidelines. 2013.
48.
go back to reference Australian Government Department of Health: Australia’s physical activity and sedentary behviour guidelines. In. Edited by Health AGDo; 2010. Australian Government Department of Health: Australia’s physical activity and sedentary behviour guidelines. In. Edited by Health AGDo; 2010.
50.
go back to reference Kim SA, Moore LV, Galuska D. Vital signs: fruit and vegetable intake among children – United States, 2003–2010. Morb Mortal Wkly Rep. 2014;63(31):671–6. Kim SA, Moore LV, Galuska D. Vital signs: fruit and vegetable intake among children – United States, 2003–2010. Morb Mortal Wkly Rep. 2014;63(31):671–6.
52.
go back to reference Institute of Medicine. Weight gain during pregnancy: reexamining the guidelines. In. Edited by Rasmussen KM, Yaktine AL. Washington D.C.: National Academies Press (US); 2009. Institute of Medicine. Weight gain during pregnancy: reexamining the guidelines. In. Edited by Rasmussen KM, Yaktine AL. Washington D.C.: National Academies Press (US); 2009.
Metadata
Title
The effects of dietary and lifestyle interventions among pregnant women with overweight or obesity on early childhood outcomes: an individual participant data meta-analysis from randomised trials
Authors
Jennie Louise
Amanda J. Poprzeczny
Andrea R. Deussen
Christina Vinter
Mette Tanvig
Dorte Moller Jensen
Annick Bogaerts
Roland Devlieger
Fionnuala M. McAuliffe
Kristina M. Renault
Emma Carlsen
Nina Geiker
Lucilla Poston
Annette Briley
Shakila Thangaratinam
Jodie M. Dodd
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2021
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-021-01995-6

Other articles of this Issue 1/2021

BMC Medicine 1/2021 Go to the issue