Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial

Jodie M Dodd, Deborah Turnbull, Andrew J McPhee, Andrea R Deussen, Rosalie M Grivell, Lisa N Yelland, Caroline A Crowther, Gary Wittert, Julie A Owens, Jeffrey S Robinson, LIMIT Randomised Trial Group, M Gillman, L Moran, C Cramp, A Newman, L Kannieappian, S Hendrijanto, M Kelsey, J Beaumont, C Danz, J Koch, A Webber, C Holst, K Robinson, S Zhang, V Ball, K Ball, H Deussen, N Salehi, R Bartley, R Stafford-Green, S Ophel, M Cooney, M Szmeja, A Short, A Melrose, S Han, I Mohamad, L Chapple, J Svigos, V Bhatia, N Manton, J McGavigan, R Bryce, S Coppi, C Fanning, G Hannah, M Ignacio, H Pollard, F Schmidt, Y Shinners, G Dekker, S Kennedy-Andrews, R Beaven, J Niven, S Burgen, J Dalton, N Dewhurst, L Forst, V Mugg, C Will, H Stone, C Wilkinson, H Purcell, J Wood, D Press, K Ralph, S Donleavy, S Seager, F Gately, A Jolly, L Lahnstein, S Harding, K Daw, M Hedges, R Fraser-Trumble, Jodie M Dodd, Deborah Turnbull, Andrew J McPhee, Andrea R Deussen, Rosalie M Grivell, Lisa N Yelland, Caroline A Crowther, Gary Wittert, Julie A Owens, Jeffrey S Robinson, LIMIT Randomised Trial Group, M Gillman, L Moran, C Cramp, A Newman, L Kannieappian, S Hendrijanto, M Kelsey, J Beaumont, C Danz, J Koch, A Webber, C Holst, K Robinson, S Zhang, V Ball, K Ball, H Deussen, N Salehi, R Bartley, R Stafford-Green, S Ophel, M Cooney, M Szmeja, A Short, A Melrose, S Han, I Mohamad, L Chapple, J Svigos, V Bhatia, N Manton, J McGavigan, R Bryce, S Coppi, C Fanning, G Hannah, M Ignacio, H Pollard, F Schmidt, Y Shinners, G Dekker, S Kennedy-Andrews, R Beaven, J Niven, S Burgen, J Dalton, N Dewhurst, L Forst, V Mugg, C Will, H Stone, C Wilkinson, H Purcell, J Wood, D Press, K Ralph, S Donleavy, S Seager, F Gately, A Jolly, L Lahnstein, S Harding, K Daw, M Hedges, R Fraser-Trumble

Abstract

Objective: To determine the effect of antenatal dietary and lifestyle interventions on health outcomes in overweight and obese pregnant women.

Design: Multicentre randomised trial. We utilised a central telephone randomisation server, with computer generated schedule, balanced variable blocks, and stratification for parity, body mass index (BMI) category, and hospital.

Setting: Three public maternity hospitals across South Australia.

Participants: 2212 women with a singleton pregnancy, between 10+0 and 20+0 weeks' gestation, and BMI ≥ 25.

Interventions: 1108 women were randomised to a comprehensive dietary and lifestyle intervention delivered by research staff; 1104 were randomised to standard care and received pregnancy care according to local guidelines, which did not include such information.

Main outcome measures: Incidence of infants born large for gestational age (birth weight ≥ 90th centile for gestation and sex). Prespecified secondary outcomes included birth weight >4000 g, hypertension, pre-eclampsia, and gestational diabetes. Analyses used intention to treat principles.

Results: 2152 women and 2142 liveborn infants were included in the analyses. The risk of the infant being large for gestational age was not significantly different in the two groups (lifestyle advice 203/1075 (19%) v standard care 224/1067 (21%); adjusted relative risk 0.90, 95% confidence interval 0.77 to 1.07; P=0.24). Infants born to women after lifestyle advice were significantly less likely to have birth weight above 4000 g (lifestyle advice 164/1075 (15%) v standard care 201/1067 (19%); 0.82, 0.68 to 0.99; number needed to treat (NNT) 28, 15 to 263; P=0.04). There were no differences in maternal pregnancy and birth outcomes between the two treatment groups.

Conclusions: For women who were overweight or obese, the antenatal lifestyle advice used in this study did not reduce the risk delivering a baby weighing above the 90th centile for gestational age and sex or improve maternal pregnancy and birth outcomes.

Trial registration: Australian and New Zealand Clinical Trials Registry (ACTRN12607000161426).

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4793589/bin/dodj014527.f1_default.jpg

References

    1. World Health Organization. Obesity: preventing and managing the global epidemic. World Health Organ Tech Rep Ser 2000;894:1-253.
    1. Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ, for the Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease. Lancet 2002;360:1347-60.
    1. Scheil, W, Scott J, Catcheside B, Sage L. Pregnancy outcome in South Australia 2010. Pregnancy Outcome Unit SA Health, Government of South Australia, Adelaide, 2012.
    1. Chu SY, Kim SY, Bish CL. Prepregnancy obesity prevalence in the United States, 2004-2005. Maternal Child Health J 2008;13:614-20.
    1. Callaway LK, Prins JB, Chang AM, McIntyre HD. The prevalence and impact of overweight and obesity in an Australian obstetric population. Med J Aust 2006;184:56-9.
    1. Dodd JM, Grivell RM, Nguyen A-M, Chan A, Robinson JS. Maternal and perinatal health outcomes by body mass index category. Aust N Z J Obstet Gynaecol 2011;51:136-40.
    1. Abenhaim HA, Kinch RA, Morin L, Benjamin A, Usher R. Effect of prepregnancy body mass index categories on obstetrical and neonatal outcomes. Arch Gynecol Obstet 2007;275:39-43.
    1. Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 2004;103:219-24.
    1. Cnattingius S, Bergstrom R, Lipworth L, Kramer MS. Prepregnancy weight and the risk of adverse pregnancy outcomes. N Engl J Med 1998;338:147-52.
    1. Tikellis G, Ponsonby AL, Wells JC, Pezic A, Cochrane J, Dwyer T. Maternal and infant factors associated with neonatal adiposity: results from the Tasmanian Infant Health Survey. Int J Obestet 2012;36:496-504.
    1. Fraser A, Tilling K, Macdonald-Wallis C, Sattar N, Brion MJ, Benfield L, et al. Association of maternal weight gain in pregnancy with offspring obesity and metabolic and vascular traits in childhood. Circulation 2010;121:2557-64.
    1. Rasmussen KM, Yaktine AL, eds. Weight gain during pregnancy: reexamining the guidelines. Institute of Medicine, 2009.
    1. Cedergren MI. Effects of gestational weight gain and body mass index on obstetric outcomes in Sweden. Int J Gynecol Obstet 2006;93:269-74.
    1. Cedergren MI. Optimal gestational weight gain for body mass index categories. Obstet Gynecol 2007;110:759-64.
    1. Nohr EA, Bech BH, Davies MJ, Frydenberg M, Henriksen TB, Olsen J. Prepregnancy obesity and fetal death: a study within the Danish National Birth Cohort. Obstet Gynecol 2005;106:250-9.
    1. Kiel DW, Dodson EA, Artal R, Boehmer TK, Leet TL. Gestational weight gain and pregnancy outcomes in obese women: how much is enough? Obstet Gynecol 2007;110:752-8.
    1. Dodd JM, Grivell RM, Crowther CA, Robinson JS. Antenatal interventions for overweight or obese pregnant women: a systematic review of randomised trials. Br J Obstet Gynaecol 2010;117:1316-26.
    1. Oteng-Ntim E, Varma R, Croker H, Poston L, Doyle P. Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis. BMC Med 2012;10:10:47.
    1. Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson JW, et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ 2012;344:e2088.
    1. Dodd JM, Turnbull DA, McPhee AJ, Wittert G, Crowther CA, Robinson JS. Limiting weight gain in overweight and obese women during pregnancy to improve health outcomes: the LIMIT randomised controlled trial. BMC Pregnancy Childbirth 2011;11:79.
    1. Australian Guide to Healthy Eating. Australian Government Department of Health, 2008. .
    1. Royal College of Obstetricians and Gynaecologists. Recreational exercise and pregnancy: information for you. RCOG Press, 2006.
    1. Bennett P, Murphy S. Psychology and health promotion. Open University Press, 1997.
    1. South Australian Perinatal Practice Guidelines: normal pregnancy, labour and puerperium. Government of Australia, SA Health, 2013. .
    1. South Australian Perinatal Practice Guidelines: diabetes mellitus and abnormal glucose tolerance Government of Australia, SA Health, 2013. .
    1. Beeby PJ, Bhutap T, Taylor LK. New South Wales population based birthweight percentile charts. J Paediatr Child Health 1996;32:512-8.
    1. Brown MA, Hague WM, Higgins J, Lowe S, McCowan L, Oats J, et al. The detection, investigation and management of hypertension in pregnancy: full consensus statement. Aust N Z J Obstest Gynaecol 2000;40:139-55.
    1. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS, et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005;352:2477-86.
    1. Vinter CA, Jensen DM, Ovesen P, Beck-Nielsen H, Jørgensen JS. The LiP (Lifestyle in Pregnancy) study: a randomized controlled trial of lifestyle intervention in 360 obese pregnant women. Diabetes Care 2011;34:2502-7.
    1. Lawlor DA, Relton C, Sattar N, Nelson SM. Maternal adiposity—a determinant of perinatal and offspring outcomes? Nat Rev Endocrinol 2012;8:679-88.
    1. Donahue SM, Rifas-Shiman SL, Gold DR, Jouni ZE, Gillman MW, Oken E. Prenatal fatty acid status and child adiposity at age 3 y: results from a US pregnancy cohort. Am J Clin Nutr 2011;93:780-8.
    1. Moon RJ, Harvey NC, Robinson SM, Ntani G, Davies JH, Inskip HM, et al. Maternal plasma polyunsaturated fatty acid status in late pregnancy is associated with offspring body composition in childhood. J Clin Endocrinol Metab 2013;98:299-307.
    1. Sebire NJ, Harris JP, Wadsworth J, Joffe M, Beard RW, Regan L, et al. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 2001;25:1175-82.
    1. UPBEAT Trial. 2012. .
    1. Dodd JM, Catcheside B, Scheil W. Can shoulder dystocia be reliably predicted? Aust N Z J Obstet Gynaecol 2012;52:248-52.
    1. Schellong K, Schulz S, Harder T, Plagemann A. Birth weight and long term overweight risk: systematic review and meta-analysis including 643,902 persons from 66 studies and 26 countries globally. PLoS One 2012;7:e47776.
    1. Yu ZB, Han SP, Zhu GZ, Zhu C, Wang XJ, Cao XG, et al. Birth weight and subsequent risk of obesity: a systematic review and meta-analysis. Obestet Rev 2011;12:525-42.
    1. Kitsantas P, Gaffney KF. Risk profiles for overweight/obesity among preschoolers. Early Hum Dev 2010;86:563-8.
    1. Rooney BL, Mathiason MA, Schauberger CW. Predictors of obesity in childhood, adolescence, and adulthood in a birth cohort. Matern Child Health J 2010;15:1166-75.
    1. Catalano PM. Obesity and pregnancy—the propagation of a viscous cycle? J Clin Endocrinol Metab 2003;88:3505-6.
    1. Poston L, Chappell LC. How should women be advised on weight management in pregnancy? BMJ 2012;344:e2774.
    1. Norman JE. Efficacy of metformin in pregnant obese women: a randomised controlled trial, EMPOWaR. ISRCTN Register, 2011. .
    1. Dodd JM. Metformin and dietary advice to improve insulin sensitivity and promote gestational restriction of weight in pregnant women who are obese: the GroW Randomised trial. ANZCTR Register, 2013 .

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren