Antenatal dietary and lifestyle advice for women who are overweight or obese and the effect on fetal growth and adiposity: the LIMIT randomised trial

et al. 2019

Aust NZ J Obst Gynaeco

Introduction The aim of this study was to evaluate the association between fetal ultrasound and newborn biometry and adiposity measures in the setting of maternal obesity. Material and Methods The study population involved 845 overweight or obese pregnant women, who participated in the Standard Care Group of the LIMIT randomised trial (ACTRN12607000161426, 9/03/2007). At 36 weeks gestation, fetal biometry, estimated fetal weight (EFW) and adiposity measures including mid‐thigh fat mass (MTFM), subscapular fat mass (SSFM), and abdominal fat mass (AFM) were undertaken using ultrasound. Neonatal anthropometric measurements obtained after birth included birthweight, head circumference (HC), abdominal circumference (AC) and skinfold thickness measurements (SFTM) of the subscapular region and abdomen. Results At 36 weeks gestation, every 1 g increase in EFW was associated with a 0.94 g increase in birthweight (95% CI 0.88–0.99; P < 0.001). For every 1 mm increase in the fetal ultrasound measure, there was a 0.69 mm increase in birth HC (95% CI 0.63–0.75, P < 0.001) and 0.69 mm increase in birth AC (95% CI 0.60–0.79, P < 0.001). Subscapular fat mass in the fetus and the newborn (0.29 mm, 95% CI 0.20–0.39, P < 0.001) were moderately associated, but AFM measurements were not (0.06 mm, −0.03 to 0.15, P = 0.203). There is no evidence that these relationships differed by maternal body mass index. Conclusion In women who are overweight or obese, fetal ultrasound accurately predicts neonatal HC and AC along with birthweight.

Section: Discussionmentioning

confidence: 70%

“…For each fetal biometry measure, z ‐scores were calculated using ultrasound growth charts in clinical use . Fetal body composition measurements included mid‐thigh lean mass, mid‐thigh fat mass (MTFM), abdominal fat mass (AFM), and subscapular fat mass (SSFM) using techniques we have previously reported …”

Section: Methodsmentioning

confidence: 99%

In overweight and obese women, fetal ultrasound biometry accurately predicts newborn measures

O’Brien

Louise

et al. 2019

Aust NZ J Obst Gynaeco

“…We have previously reported that increased maternal BMI is associated with increased fetal growth as measured by ultrasound fetal biometry . The aim of this secondary analysis from the LIMIT randomised trial was to evaluate, among overweight and obese pregnant women, the degree to which the association between maternal BMI and fetal growth and adiposity was mediated via diagnosed and treated GDM.…”

Section: Introductionmentioning

confidence: 99%

The mediating effects of gestational diabetes on fetal growth and adiposity in women who are overweight and obese: secondary analysis of the LIMIT randomised trial

Poprzeczny

Louise

et al. 2018

BJOG

Self Cite

“…Fetal growth and wellbeing at 28 and 36 weeks’ gestation assessed by ultrasound (fetal biometry, estimated weight, liquor volume, umbilical artery Doppler waveform, and adiposity) [34]. …”

Section: Methodsmentioning

confidence: 99%

Metformin and dietary advice to improve insulin sensitivity and promote gestational restriction of weight among pregnant women who are overweight or obese: the GRoW Randomised Trial

Dodd

Grivell

BMC Pregnancy Childbirth

et al. 2016

BackgroundObesity is a significant global health problem, with approximately 50% of women entering pregnancy having a body mass index greater than or equal to 25 kg/m2. Obesity during pregnancy is associated with a well-recognised increased risk of adverse health outcomes both for the woman and her infant. Currently available data from large scale randomised trials and systematic reviews highlight only modest effects of antenatal dietary and lifestyle interventions in limiting gestational weight gain, with little impact on clinically relevant pregnancy outcomes. Further information evaluating alternative strategies is required.The aims of this randomised controlled trial are to assess whether the use of metformin as an adjunct therapy to dietary and lifestyle advice for overweight and obese women during pregnancy is effective in improving maternal, fetal and infant health outcomes.MethodsDesign: Multicentre randomised, controlled trial.Inclusion Criteria: Women with a singleton, live gestation between 10+0-20+0 weeks who are obese or overweight (defined as body mass index greater than or equal to 25 kg/m2), at the first antenatal visit.Trial Entry & Randomisation: Eligible, consenting women will be randomised between 10+0 and 20+0 weeks gestation using an online computer randomisation system, and randomisation schedule prepared by non-clinical research staff with balanced variable blocks. Stratification will be according to maternal BMI at trial entry, parity, and centre where planned to give birth.Treatment Schedules: Women randomised to the Metformin Group will receive a supply of 500 mg oral metformin tablets. Women randomised to the Placebo Group will receive a supply of identical appearing and tasting placebo tablets. Women will be instructed to commence taking one tablet daily for a period of one week, increasing to a maximum of two tablets twice daily over four weeks and then continuing until birth. Women, clinicians, researchers and outcome assessors will be blinded to the allocated treatment group.All women will receive three face-to-face sessions (two with a research dietitian and one with a trained research assistant), and three telephone calls over the course of their pregnancy, in which they will be provided with dietary and lifestyle advice, and encouraged to make change utilising a SMART goals approach.Primary Study Outcome: infant birth weight >4000 grams.Sample Size: 524 women to detect a difference from 15.5% to 7.35% reduction in infants with birth weight >4000 grams (p = 0.05, 80% power, two-tailed).DiscussionThis is a protocol for a randomised trial. The findings will contribute to the development of evidence based clinical practice guidelines.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12612001277831, prospectively registered 10th of December, 2012.