Background/Objectives Obesity in pregnancy has been associated with increased childhood cardiometabolic risk and reduced life expectancy. The UK UPBEAT multicentre randomised control trial was a lifestyle intervention of diet and physical activity in pregnant women with obesity. We hypothesised that the 3-year-old children of women with obesity would have heightened cardiovascular risk compared to children of normal BMI women, and that the UPBEAT intervention would mitigate this risk. Subjects/Methods Children were recruited from one UPBEAT trial centre. Cardiovascular measures included blood pressure, echocardiographic assessment of cardiac function and dimensions, carotid intima-media thickness and heart rate variability (HRV) by electrocardiogram. Results Compared to offspring of normal BMI women (n = 51), children of women with obesity from the trial standard care arm (n = 39) had evidence of cardiac remodelling including increased interventricular septum (IVS; mean difference 0.04 cm; 95% CI: 0.018 to 0.067), posterior wall (PW; 0.03 cm; 0.006 to 0.062) and relative wall thicknesses (RWT; 0.03 cm; 0.01 to 0.05) following adjustment. Randomisation of women with obesity to the intervention arm (n = 31) prevented this cardiac remodelling (intervention effect; mean difference IVS −0.03 cm (−0.05 to −0.008); PW −0.03 cm (−0.05 to −0.01); RWT −0.02 cm (−0.04 to −0.005)). Children of women with obesity (standard care arm) compared to women of normal BMI also had elevated minimum heart rate (7 bpm; 1.41 to 13.34) evidence of early diastolic dysfunction (e prime) and increased sympathetic nerve activity index by HRV analysis. Conclusions Maternal obesity was associated with left ventricular concentric remodelling in 3-year-old offspring. Absence of remodelling following the maternal intervention infers in utero origins of cardiac remodelling. Clinical trial registry name and registration number The UPBEAT trial is registered with Current Controlled Trials, ISRCTN89971375.

ObjectivesA third of pregnant women in the UK are vitamin D deficient, which may confer deleterious consequences, including an increased risk of pre-eclampsia, gestational diabetes mellitus and intrauterine growth restriction. This study aims to determine the proportion of women that met National Institute for Health and Care Excellence (NICE) standards for vitamin D supplementation in pregnancy and compare biochemical and obstetrical outcomes according to supplementation status.Design and settingThis is a single-centre cross-sectional study in an antenatal centre in Birmingham, UK. Participants received a questionnaire regarding their experiences with vitamin D supplementation during their pregnancy with their general practitioner. Serum 25-hydroxyvitamin D and bone profile results were obtained during the same appointment and obstetrical outcomes were collected retrospectively once participants had delivered.Results41.8% of participants (n=61) received written and/or verbal advice about supplementation, (NICE standards=100%). 72.6% (n=106) had one or more risk factors for vitamin D deficiency, of which 38.7% (n=41, NICE standards=100%) were asked about supplementation. Among those asked, 85.4% (n=41, NICE standards=100%) received the correct dosage. Compared with the supplementation group, the non-supplementation group had offspring that were 1.40 cm (95% CI 0.01 to 2.80, p=0.04) longer at birth; which was significant after adjusting for confounding factors. No significant differences in any biochemical parameters were observed between supplementation categories (p>0.05).ConclusionsAdherence to NICE standards was suboptimal. This may be attributed to insufficient training for general practitioners on the importance of supplementation, causing them to underestimate the consequences of gestational vitamin D deficiency. Recommendations include implementing a mandatory screening tool to identify ‘at-risk’ women and providing more clinician training to ensure that supplementation during pregnancy is standard of care.

AimsChildren with well-controlled asthma can exercise safely and asthma management guidelines recommend physical activity (PA), yet many children with asthma fail to achieve recommended levels of PA. Some barriers to PA might specifically affect children and young people with asthma, so tailored interventions are likely needed to improve this patient group’s access to the benefits associated with PA. To inform future interventions, we systematically reviewed studies exploring barriers and facilitators to PA for children and young people with asthma.MethodsMultiple databases were searched for ‘asthma’, ‘children’, ‘exercise’, ‘physical activity’ and their derivatives. All study designs were considered. Studies focused on athletes, published before 1995 or without an English translation were excluded. Two researchers independently selected studies, extracted data and appraised quality (EPPI-Centre weight of evidence frame-work). A third researcher reviewed disagreements. This review is PROSPERO registered, number CRD42015030067.ResultsThe search returned 5161 results. 166 abstracts and 33 studies satisfied the inclusion criteria. Subjects of included studies were children and young people aged 6–20 years, parents/caregivers and teachers. Twenty studies used quantitative methods, including three intervention studies; ten studies used qualitative methods and three used mixed methods. Qualitative interviews revealed that children with asthma identify positive benefits of PA and feel they should be physically active. Identified barriers and facilitators to PA included patient, family, healthcare professional (HCPs), environmental, psychosocial, school and medication factors. Five qualitative studies discussed HCPs. These suggested that doctors often do not provide specific advice for PA, contributing to children not participating in PA. One quantitative study provided supporting data; 58.7% of students undertaking high levels of PA had a doctor who approved their activity, compared with only 33.8% of students with low levels of PA. Four quantitative studies examined the effect of parental activity restrictions. Restrictions had no influence on children’s activity levels in two studies and were associated with lower PA levels in the other two.ConclusionPA barriers and facilitators were identified within medical, home and school domains. HCPs might influence children with asthma’s PA participation by promoting good asthma control and by educating and supporting parents and school staff.

Glycated haemoglobin (HbA1c) is a time‐series measure subject to variability; quantifying the difference between the first and last readings over a defined period may have little value in measuring success in service evaluation models. Identifying a composite measure for outcome would be an invaluable tool for service providers. We demonstrate the efficacy of survival modelling as a composite measure of outcome. This was a retrospective observational cohort analysis of patients with type 1 diabetes on insulin pump therapy. From these data, a service evaluation project was undertaken. Survival (time‐to‐event) analysis was undertaken for two HbA1c values – 58 and 64mmol/mol (7.5% and 8.0%); analyses were based on time taken to reach the index HbA1c value (58 or 64mmol/mol) for the first time from start of pump therapy. A total of 113 patients were treated with the insulin pump. The median time to reach an HbA1c of 58 and 64mmol/mol was 25 and 13.9 months, respectively. Cox regression using gender, HbA1c, weight and age prior to pump therapy as factor variables identified HbA1c as the only predictor that significantly influenced the time‐to‐event (HR 0.94, p=0.001 for HbA1c 58mmol/mol, and HR 0.97, p=0.008 for HbA1c 64mmol/mol). Survival modelling appears to be a robust statistical tool to evaluate performance. Furthermore, adjusting for covariates identifies factors that may influence outcome. Pump therapy is considered a high cost area by commissioners, therefore having auditable outcome measures would be useful to inform authorities on the effectiveness of the service. Copyright © 2020 John Wiley & Sons.