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

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

Child Anthropometrics and Neurodevelopment at 2 and 3 Years of Age Following an Antenatal Lifestyle Intervention in Routine Care—A Secondary Analysis from the Cluster-Randomised GeliS Trial

“…Compared to this cohort data, however, we observed a higher rate of children with underweight, and a slightly lower rate of children with obesity (extremely underweight: 1.4%, underweight: 3.8%, obese: 2.9%) [ 41 ]. The missing evidence of a reduction in the rate of childhood overweight at 2 and 3 years of age by antenatal lifestyle counselling in the GeliS study is in accordance with findings from other studies [ 19 , 20 , 42 , 43 , 44 ], and supported by findings from two recent meta-analyses [ 23 , 24 ]. Louise et al [ 24 ] performed an individual patient meta-analysis on randomised controlled trials (RCTs) including women with overweight or obesity on childhood outcomes at 3–5 years of age.…”

“…The missing evidence of a reduction in the rate of childhood overweight at 2 and 3 years of age by antenatal lifestyle counselling in the GeliS study is in accordance with findings from other studies [ 19 , 20 , 42 , 43 , 44 ], and supported by findings from two recent meta-analyses [ 23 , 24 ]. Louise et al [ 24 ] performed an individual patient meta-analysis on randomised controlled trials (RCTs) including women with overweight or obesity on childhood outcomes at 3–5 years of age. Furthermore, a recent meta-analysis from our research group investigated RCTs including women from all BMI categories, and including offspring data from 1 month to 7 years of age [ 23 ].…”

“…However, the evidence for the long-term influence of maternal lifestyle interventions on offspring overweight and obesity risk is less clear [ 18 ], and the results of studies investigating their impact on child neurodevelopment are heterogeneous [ 19 , 20 , 21 , 22 ]. Two recent meta-analyses found that lifestyle interventions in pregnancy had no impact on either short- or long-term weight and growth outcomes in children [ 23 ], nor on early childhood obesity risk [ 24 ]. However, most studies had rather small sample sizes and were performed in community settings or academic institutions.…”

Iron deficiency during the first 1000 days of life: are we doing enough to protect the developing brain?

“…Lifestyle and behavioural interventions amongst pregnant women with overweight and obesity have been shown to improve dietary intakes and physical activity levels (107)(108)(109) . However, for the most part, such interventions have not resulted in improved clinical outcomes in the mothers or their offspring (109,110) . A life course approach has been suggested as a better alternative, whereby the prevention of obesity prior to conception is recommended, with a focus on a healthy weight status beginning in adolescence and right through the childbearing years (111,112) .…”

Effects of probiotic supplementation on glucose metabolism in pregnant women without diabetes: a systematic review and meta-analysis

“…8 On the other hand, lifestyle interventions, including diet and exercise, have been demonstrated to be able to prevent GDM. 9 However, it has been proven to be challenging, with low compliance and limited efficacy. 10 Therefore, feasible and safer alternatives are warranted for the prevention of GDM.…”