Pragmatic controlled trial to prevent childhood obesity in maternity and child health care clinics: pregnancy and infant weight outcomes (The VACOPP Study)

Abstract

BackgroundAccording to current evidence, the prevention of obesity should start early in life. Even the prenatal environment may expose a child to unhealthy weight gain; maternal gestational diabetes is known to be among the prenatal risk factors conducive to obesity. Here we report the effects of antenatal dietary and physical activity counselling on pregnancy and infant weight gain outcomes.MethodsThe study was a non-randomised controlled pragmatic trial aiming to prevent childhood obesity, the setting being municipal maternity health care clinics. The participants (n = 185) were mothers at risk of developing gestational diabetes mellitus and their offspring. The children of the intervention group mothers were born between 2009 and 2010, and children of the control group in 2008. The intervention started between 10–17 gestational weeks and consisted of individual counselling on diet and physical activity by a public health nurse, and two group counselling sessions by a dietician and a physiotherapist. The expectant mothers also received a written information leaflet to motivate them to breastfeed their offspring for at least 6 months. We report the proportion of mothers with pathological glucose tolerance at 26–28 weeks’ gestation, the mother’s gestational weight gain (GWG) and newborn anthropometry. Infant weight gain from 0 to 12 months of age was assessed as weight-for-length standard deviation scores (SDS) and mixed effect linear regression models.ResultsIntervention group mothers had fewer pathological oral glucose tolerance test results (14.6% vs. 29.2%; 95% CI 8.9 to 23.0% vs. 20.8 to 39.4%; p-value 0.016) suggesting that the intervention improved gestational glucose tolerance. Mother’s GWG, newborn anthropometry or infant weight gain did not differ significantly between the groups.ConclusionSince the intervention reduced the prevalence of gestational diabetes mellitus, it may have the potential to diminish obesity risk in offspring. However, results from earlier studies suggest that the possible effect on the offspring’s weight gain may manifest only later in childhood.Trial registrationClinical Trials gov: NCT00970710

Interventions for Childhood Obesity in the First 1,000 Days A Systematic Review

“…14,19,34–36,38,39 However, behavior change counseling provided in the clinical setting is necessarily limited in its impact on individual and family lifestyles by manifold non-medical, but health-critical, influences from the social and physical environment— factors that are highlighted by the ecosocial 52 and Glass and McAtee 53 conceptual frameworks discussed above.…”

“…17,18 The Vaasa Childhood Obesity Primary Prevention Study provided education on maternal and child diet and physical activity at prenatal visits, group sessions, and well child visits, but did not demonstrate an effect on child growth measures through age 12 months. 19 …”

Infant Growth following Maternal Participation in a Gestational Weight Management Intervention

“…Similar to our study, the few studies that have reported on infant growth after prenatal interventions have found no changes in infant growth. This includes two previous European studies with null results 27,28 and one study in the United States evaluating a walking intervention during pregnancy that followed babies to 6 months postpartum. 29 Biological explanations for these null findings have been proposed.…”

Current Approaches to Preventing Childhood Obesity

“…В некоторых странах подготовлены специальные программы по профилактике ожирения для работы с беременными и матерями в женских консультаци-ях и детских поликлиниках [19]. Известно, что масса ребенка при рождении более 4 000 увеличивает риск развития ожирения у взрослых в 2 раза [20], а кон-сультирование беременных уменьшает риск рожде-ния детей с массой тела более 4 000 г.…”