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

Taina Mustila, Jani Raitanen, Päivi Keskinen, Antti Saari, Riitta Luoto, Taina Mustila, Jani Raitanen, Päivi Keskinen, Antti Saari, Riitta Luoto

Abstract

Background: According 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.

Methods: The 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.

Results: Intervention 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.

Conclusion: Since 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 registration: Clinical Trials gov: NCT00970710.

Figures

Figure 1
Figure 1
Flow chart of the study. *Because of one year retrospective recruitment.

References

    1. Flynn MA, McNeil DA, Maloff B, Mutasingwa D, Wu M, Ford C, Tough SC. Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with ‘best practice’ recommendations. Obes Rev. 2006;7(Suppl 1):7–66.
    1. Vuorela N, Saha MT, Salo MK. Change in prevalence of overweight and obesity in Finnish children - comparison between 1974 and 2001. Acta Paediatr. 2011;100:109–115. doi: 10.1111/j.1651-2227.2010.01980.x.
    1. Wen X, Gillman MW, Rifas-Shiman SL, Sherry B, Kleinman K, Taveras E. Decreasing prevalence of obesity among young children in Massachusetts from 2004 to 2008. Pediatrics. 2012;129:823–831. doi: 10.1542/peds.2011-1833.
    1. Gardner DS, Hosking J, Metcalf BS, Jeffery AN, Voss LD, Wilkin TJ. Contribution of early weight gain to childhood overweight and metabolic health: a longitudinal study (EarlyBird 36) Pediatrics. 2009;123:e67–e73. doi: 10.1542/peds.2008-1292.
    1. Juhola J, Magnussen CG, Viikari JS, Kähönen M, Hutri-Kähönen N, Jula A, Lehtimäki T, Åkerblom HK, Pietikäinen M, Laitinen T, Jokinen E, Taittonen L, Raitakari OT, Juonala M. Tracking of serum lipid levels, blood pressure, and body mass index from childhood to adulthood: the Cardiovascular Risk in Young Finns Study. J Pediatr. 2011;159:584–590. doi: 10.1016/j.jpeds.2011.03.021.
    1. Oken E, Taveras EM, Kleinman KP, Rich-Edwards JW, Gillman MW. Gestational weight gain and child adiposity at age 3 years. Am J Obstet Gynecol. 2007;196:322. e 1–8.
    1. The HAPO Study Cooperative Research Group. Hyperglycaemias and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002.
    1. Dabelea D, Crume T. Maternal environment and the trans-generational cycle of obesity and diabetes. Diabetes. 2011;60:1849–1855. doi: 10.2337/db11-0400.
    1. Hillier TA, Pedula KL, Schmidt MM, Mullen JA, Charles MA, Pettitt DJ. Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycaemia. Diabetes Care. 2007;30:2287–2292. doi: 10.2337/dc06-2361.
    1. Chandler-Laney PC, Bush NC, Rouse DJ, Mancuso MS, Gower BA. Maternal glucose concentration during pregnancy predicts fat and lean mass of pre-pubertal offspring. Diabetes Care. 2011;34:741–745. doi: 10.2337/dc10-1503.
    1. Wen X, Shenassa ED, Paradis AD. Maternal smoking, breastfeeding, and risk of childhood overweight: Findings from a national cohort. Matern Child Health J. 2013;17:746–755. doi: 10.1007/s10995-012-1059-y.
    1. Griffiths LJ, Smeeth L, Hawkins SS, Cole TJ, Dezateux C. Effects of infant feeding practice on weight gain from birth to 3 years. Arch Dis Child. 2009;94:577–582. doi: 10.1136/adc.2008.137554.
    1. Moorcroft KE, Marshall JL, McCormick FM. Association between timing of introducing solid foods and obesity in infancy and childhood: a systematic review. Matern Child Nutr. 2011;7:3–26. doi: 10.1111/j.1740-8709.2010.00284.x.
    1. Ong KK, Loos RJ. Rapid infancy weight gain and subsequent obesity: systematic reviews and hopeful suggestions. Acta Paediatr. 2006;95:904–908. doi: 10.1080/08035250600719754.
    1. Druet C, Stettler N, Sharp S, Simmons RK, Cooper C, Smith GD, Ekelund U, Lévy-Marchal C, Jarvelin MR, Kuh D, Ong KK. Prediction of childhood obesity by infancy weight gain: an individual-level meta-analysis. Paediatr Perinat Epidemiol. 2012;26:19–26. doi: 10.1111/j.1365-3016.2011.01213.x.
    1. Buyken AE, Karaolis-Danckert N, Remer T, Bolzenius K, Landsberg B, Kroke A. Effects of breastfeeding on trajectories of body fat and BMI throughout childhood. Obesity (Silver Spring) 2008;16:389–395. doi: 10.1038/oby.2007.57.
    1. Leunissen RWJ, Kerkhof GF, Stijnen T, Hokken-Koelega A. Timing and tempo of first-year rapid growth in relation to cardiovascular and metabolic risk profile in early adulthood. JAMA. 2009;301:2234–2242. doi: 10.1001/jama.2009.761.
    1. Taveras EM, Rifas-Shiman SL, Oken E, Gunderson EP, Gillman MW. Short sleep duration in infancy and risk of childhood overweight. Arch Pediatr Adolesc Med. 2008;162:305–311. doi: 10.1001/archpedi.162.4.305.
    1. Gillman MW, Rifas-Shiman S, Berkey S, Field AE, Colditz GA. Maternal gestational diabetes, birth weight, and adolescent obesity. Pediatrics. 2003;111:221–226. doi: 10.1542/peds.111.1.221.
    1. Rogers IS, Ness AR, Steer CD, Wells JC, Emmett PM, Reilly JR, Tobias J, Smith GD. Associations of size at birth and dual-energy X-ray absorptiometry measures of lean and fat mass at 9 to 10 y of age. Am J Clin Nutr. 2006;84:739–747.
    1. Baptiste-Roberts K, Nicholson WK, Wang NY, Brancati FL. Gestational diabetes and subsequent growth patterns of offspring: the National Collaborative Perinatal Project. Matern Child Health J. 2012;16:125–132. doi: 10.1007/s10995-011-0756-2. Erratum in: Matern Child Health J 2012, 16:266.
    1. Godwin M, Ruhland L, Casson I, MacDonald S, Delva D, Birtwhistle R, Lam M, Seguin R. Pragmatic controlled clinical trials in primary care: the struggle between external and internal validity. BMC Med Res Methodol. 2003;3:28. doi: 10.1186/1471-2288-3-28.
    1. Lanigan J, Singhal A. Early nutrition and long-term health: a practical approach. Proc Nutr Soc. 2009;68:422–429. doi: 10.1017/S002966510999019X.
    1. Mennella JA, Jagnow CP, Beauchamp GK. Prenatal and postnatal flavour learning by human infants. Pediatrics. 1994;93:271–277.
    1. Patrick H, Nicklas TA. A review of family and social determinants of children’s eating patterns and diet quality. J Am Coll Nutr. 2005;24:83–92.
    1. Timmons BW, Leblanc AG, Carson V, Connor Gorber S, Dillman C, Janssen I, Kho ME, Spence JC, Stearns JA, Tremblay MS. Systematic review of physical activity and health in the early years (aged 0–4 years) Appl Physiol Nutr Metab. 2012;37:773–792. doi: 10.1139/h2012-070.
    1. Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2011;7:CD001871.
    1. Wen LM, Baur LA, Simpson JM, Rissel C, Wardle K, Flood VM. Effectiveness of home based early intervention on children’s BMI at age 2: randomised controlled trial. BMJ. 2012;344:e3732. doi: 10.1136/bmj.e3732.
    1. Mustila T, Raitanen J, Keskinen P, Saari A, Luoto R. Lifestyle counselling targeting infant’s mother during the child’s first year and offspring weight development until 4 years of age: a follow-up study of a cluster RCT. BMJ Open. 2012;2:e000624. doi: 10.1136/bmjopen-2011-000624.
    1. Hakanen M, Lagström H, Kaitosaari T, Niinikoski H, Näntö-Salonen K, Jokinen E, Sillanmäki L, Viikari J, Rönnemaa T, Simell O. Development of overweight in an atherosclerosis prevention trial starting in early childhood. The STRIP study. Int J Obes (Lond) 2006;30:618–626. doi: 10.1038/sj.ijo.0803249.
    1. Daniels LA, Mallan KM, Battistutta D, Nicholson JM, Perry R, Magarey A. Evaluation of an intervention to promote protective infant feeding practices to prevent childhood obesity: outcomes of the NOURISH RCT at 14 months of age and 6 months post the first of two intervention modules. Int J Obes (Lond) 2012;36:1292–1298. doi: 10.1038/ijo.2012.96.
    1. Mustila T, Raitanen J, Keskinen P, Saari A, Luoto R. Lifestyle counselling during pregnancy and offspring weight development until four years of age: follow-up study of a controlled trial. J Negat Results Biomed. 2012;11:11. doi: 10.1186/1477-5751-11-11.
    1. Gillman MW, Oakey H, Baghurst PA, Volkmer RE, Robinson JS, Crowther CA. Effect of treatment of gestational diabetes mellitus on obesity in the next generation. Diabetes Care. 2010;33:964–968. doi: 10.2337/dc09-1810.
    1. Pettitt DJ, McKenna S, McLaughlin C, Patterson CC, Hadden DR, McCance DR. Maternal glucose at 28 weeks of gestation is not associated with obesity in 2-year-old offspring: the Belfast Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) family study. Diabetes Care. 2010;33:1219–1223. doi: 10.2337/dc09-2384.
    1. Lindsay AC, Sussner KM, Kim J, Gortmaker S. The role of parents in preventing childhood obesity. Future Child. 2006;16:169–186. doi: 10.1353/foc.2006.0006.
    1. Birch LL, Ventura AK. Preventing childhood obesity: what works? Int J Obes. 2009;33:S74–S81.
    1. Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson JW, Kunz R, Mol BW, Coomarasamy A, Khan KS. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ. 2012;344:e2088. doi: 10.1136/bmj.e2088.
    1. Mustila T, Keskinen P, Luoto R. Behavioural counselling to prevent childhood obesity - study protocol of a pragmatic trial in maternity and child health care. BMC Pediatr. 2012;12:93. doi: 10.1186/1471-2431-12-93.
    1. Schulz KF, Grimes DA. Sample size calculations in randomised trials: mandatory and mystical. Lancet. 2005;365:1348–1353. doi: 10.1016/S0140-6736(05)61034-3.
    1. Hasunen K, Kalavainen M, Keinonen H, Lagström H, Lyytikäinen A, Nurttila A, Peltola T, Talvia S. The Child, Family and Food. Nutrition recommendations for infants and young children as well as pregnant and breastfeeding mothers. Helsinki: Publications of the Ministry of Social Affairs and Health; 2004.
    1. Aittasalo M, Pasanen M, Fogelholm M, Kinnunen TI, Ojala K, Luoto R. Physical activity counselling in maternity and child health care – a controlled trial. BMC Womens Health. 2008;8:14. doi: 10.1186/1472-6874-8-14.
    1. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(Suppl 1):S62–S69.
    1. Saari A, Sankilampi U, Hannila ML, Kiviniemi V, Kesseli K, Dunkel L. Finnish growth references for children and adolescents aged 0 to 20 years: Length/height-for-age, weight-for-length/height, and body mass index-for-age. Ann Med. 2011;43:235–248. doi: 10.3109/07853890.2010.515603.
    1. Newcombe RG. Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med. 1998;17:857–872. doi: 10.1002/(SICI)1097-0258(19980430)17:8<857::AID-SIM777>;2-E.
    1. Rasmussen KM, Yaktine AL, Institute of Medicine (US) and National Research Council (US) Committee to Re-examine IOM Pregnancy Weight Guidelines, editor. Weight Gain During Pregnancy: Re-examining the Guidelines. Washington (DC): National Academies Press (US); 2009.
    1. Luoto R, Kinnunen TI, Aittasalo M, Kolu P, Raitanen J, Ojala K, Mansikkamäki K, Lamberg S, Vasankari T, Komulainen T, Tulokas S. Primary prevention of gestational diabetes mellitus and large-for-gestational-age newborns by lifestyle counselling: a cluster-randomised controlled trial. PLoS Med. 2011;8:e1001036. doi: 10.1371/journal.pmed.1001036.
    1. Barakat R, Cordero1 Y, Coteron J, Luaces M, Montejo R. Exercise during pregnancy improves maternal glucose screen at 24–28 weeks: a randomised controlled trial. Br J Sports Med. 2012;46:656–661. doi: 10.1136/bjsports-2011-090009.
    1. Lamberg S, Raitanen J, Rissanen P, Luoto R. Increased incidence of glucose disorders during pregnancy is not explained by pre-pregnancy obesity in London, Canada. Prevalence and regional differences of gestational diabetes mellitus and oral glucose tolerance tests in Finland. Eur J Public Health. 2012;2:278–280.
    1. Salim R, Hasanein J, Nachum Z, Shalev E. Anthropometric parameters in infants of gestational diabetic women with strict glycemic control. Obstet Gynecol. 2004;104:1021–1024. doi: 10.1097/.

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