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.

Published on Jun 2, 2021in BMC Medicine6.782
· DOI :10.1186/S12916-021-01995-6
Jennie Louise11
Estimated H-index: 11
(University of Adelaide),
Amanda Poprzeczny3
Estimated H-index: 3
(University of Adelaide)
+ 13 AuthorsJodie M Dodd50
Estimated H-index: 50
(University of Adelaide)
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.
#1Kathryn V. Dalrymple ('KCL': King's College London)H-Index: 6
#2Florence Tydeman (UoB: University of Bristol)H-Index: 1
Last. Lucilla Poston (HealthPartners)H-Index: 103
view all 19 authors...
Background: Maternal obesity is associated with offspring cardiometabolic risk. UPBEAT was a randomised controlled trial of an antenatal diet and physical activity intervention in 1555 women with obesity. The intervention was associated with lower gestational weight gain, healthier diet and metabolic profile in pregnancy, and reduced infant adiposity at six months. Objective: We have investigated whether the UPBEAT intervention influenced childhood cardiometabolic outcomes or was associated with...
2 CitationsSource
#1Richard D Riley (Keele University)H-Index: 70
#2Amardeep Legha (Keele University)H-Index: 4
Last. D Burke (Keele University)H-Index: 10
view all 8 authors...
: A one-stage individual participant data (IPD) meta-analysis synthesizes IPD from multiple studies using a general or generalized linear mixed model. This produces summary results (eg, about treatment effect) in a single step, whilst accounting for clustering of participants within studies (via a stratified study intercept, or random study intercepts) and between-study heterogeneity (via random treatment effects). We use simulation to evaluate the performance of restricted maximum likelihood (R...
1 CitationsSource
#1Richard D Riley (Keele University)H-Index: 70
#2Thomas P.A. Debray (UU: Utrecht University)H-Index: 31
Last. Joie Ensor (Keele University)H-Index: 17
view all 12 authors...
Precision medicine research often searches for treatment-covariate interactions, which refers to when a treatment effect (eg, measured as a mean difference, odds ratio, hazard ratio) changes across values of a participant-level covariate (eg, age, gender, biomarker). Single trials do not usually have sufficient power to detect genuine treatment-covariate interactions, which motivate the sharing of individual participant data (IPD) from multiple trials for meta-analysis. Here, we provide statisti...
5 CitationsSource
#1M.A.K.A. Braeken (Katholieke Universiteit Leuven)H-Index: 3
#2Annick Bogaerts (Katholieke Universiteit Leuven)H-Index: 20
INTRODUCTION: Maternal obesity and excessive gestational weight gain are related to adverse outcomes in women and children. Lifestyle interventions during pregnancy showed positive effects on decreasing weight gain during pregnancy, but effects on offspring's health and wellbeing are unclear. We aimed to assess the effect of lifestyle intervention programmes on offspring mental health, temperament, eating habits and anthropometric and cardiovascular measures. METHODS: Ninety-six offspring of pre...
1 CitationsSource
#1Jodie M Dodd (University of Adelaide)H-Index: 50
#2Andrea R. Deussen (University of Adelaide)H-Index: 16
Last. Jennie Louise (University of Adelaide)H-Index: 11
view all 3 authors...
While the effects of an antenatal dietary intervention for women with obesity or overweight on pregnancy and newborn health have been extensively studied, the longer-term effects into childhood are unknown. We followed children born to women who participated in the LIMIT randomised trial, where pregnant women were randomised to an antenatal dietary and lifestyle intervention or standard antenatal care. Our aim was to assess the effect of the intervention, on child outcomes at 3–5 years of age on...
5 CitationsSource
#1Vincent AudigierH-Index: 6
#1Nicola Heslehurst (Newcastle University)H-Index: 18
#2Rute Vieira (Newcastle University)H-Index: 8
Last. Judith Rankin (Newcastle University)H-Index: 66
view all 8 authors...
Background There is a global obesity crisis, particularly among women and disadvantaged populations. Early-life intervention to prevent childhood obesity is a priority for public health, global health, and clinical practice. Understanding the association between childhood obesity and maternal pre-pregnancy weight status would inform policy and practice by allowing one to estimate the potential for offspring health gain through channelling resources into intervention. This systematic review and m...
57 CitationsSource
#1Marco K. McVey (UCD: University College Dublin)H-Index: 2
#2Aisling A. Geraghty (UCD: University College Dublin)H-Index: 9
Last. Fionnuala M. McAuliffe (UCD: University College Dublin)H-Index: 57
view all 8 authors...
Abstract Serum 25-hydroxyvitamin D (25OHD) is the main circulating form of vitamin D in the blood. Vitamin D status in adults is determined by numerous factors such as oral intake, skin generation, and body composition. However, there is limited understanding regarding determinants of 25OHD in young children. The aim of this study was to identify modifiable factors that may act as determinants of 25OHD at five years of age. Analysis conducted on 79 children from the ROLO Kids study. Dietary inta...
2 CitationsSource
#1Matteo QuartagnoH-Index: 9
#2Simon GrundH-Index: 9
Last. James R. CarpenterH-Index: 59
view all 3 authors...
16 CitationsSource
#1Matthieu Resche-Rigon (French Institute of Health and Medical Research)H-Index: 14
#1Matthieu Resche-Rigon (French Institute of Health and Medical Research)H-Index: 37
Last. Ian R. WhiteH-Index: 103
view all 2 authors...
In multilevel settings such as individual participant data meta-analysis, a variable is ‘systematically missing’ if it is wholly missing in some clusters and ‘sporadically missing’ if it is partly missing in some clusters. Previously proposed methods to impute incomplete multilevel data handle either systematically or sporadically missing data, but frequently both patterns are observed. We describe a new multiple imputation by chained equations (MICE) algorithm for multilevel data with arbitrary...
59 CitationsSource
Cited By0