Infant adiposity following a randomised controlled trial of a behavioural intervention in obese pregnancy.
Infant adiposity following a randomised controlled trial of a behavioural intervention in obese pregnancy.
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DOI：
10.1038/ijo.2017.44
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发表时间：
2017-07
期刊：
影响因子：
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通讯作者：
Poston L
中科院分区：
文献类型：
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作者：
Patel N;Godfrey KM;Pasupathy D;Levin J;Flynn AC;Hayes L;Briley AL;Bell R;Lawlor DA;Oteng-Ntim E;Nelson SM;Robson SC;Sattar N;Singh C;Wardle J;White SL;Seed PT;Poston L
需要进行随机对照试验来解决所报告的母体影响与后代肥胖之间的因果关系。本研究的目的是确定肥胖孕妇的产前生活方式干预与改善母亲饮食和减少妊娠期体重增加是否会导致婴儿肥胖症的减少和产后6个月母亲生活方式行为的持续改善。我们对一项随机对照试验（UPBEAT）进行了计划的产后随访，该试验针对1555名肥胖孕妇的母体饮食（血糖负荷和饱和脂肪摄入量）和体力活动进行了复杂的行为干预。主要的结果测量是婴儿肥胖，通过肩胛下和三头肌皮褶厚度进行评估。母亲的饮食和体力活动，家庭生活方式环境的指数，通过问卷调查进行了评估。698例（45.9%）婴儿（342例干预，356例标准产前护理）接受了随访，平均年龄5.92个月。干预组与标准治疗组之间的三头肌皮褶厚度z评分无差异（差异-0.14 SD，95% CI -0.38至0.10，p=0.246），但肩胛下皮褶厚度z评分为0.26 SD（-0.49至-0.02; p=0.03）干预组较低。产后6个月时，干预组的平均体重（-35.34; -48.0至-22.67; p<0.001）和饱和脂肪摄入量（-1.93%能量; -2.64至-1.22; p<0.001）减少。因果中介分析表明，较低的婴儿肩胛下皮褶厚度介导的变化，产前母亲的饮食和妊娠期体重增加，而不是出生后的饮食。这项研究提供了一项随机对照试验的随访证据，表明肥胖孕妇的母亲行为干预有可能减少婴儿肥胖，并在产后6个月持续改善母亲的饮食。
Randomised controlled trials are required to address causality in the reported associations between maternal influences and offspring adiposity. The aim of this study was to determine whether an antenatal lifestyle intervention in obese pregnant women associated with improved maternal diet and reduced gestational weight gain leads to a reduction in infant adiposity and sustained improvements in maternal lifestyle behaviours at 6 months postpartum. We conducted a planned postnatal follow up of a randomised controlled trial (UPBEAT) of a complex behavioural intervention targeting maternal diet (glycemic load and saturated fat intake) and physical activity in 1555 obese pregnant women. The main outcome measure was infant adiposity, assessed by subscapular and triceps skinfold thicknesses. Maternal diet and physical activity, indices of the familial lifestyle environment, were assessed by questionnaire. 698 (45.9%) infants (342 intervention, 356 standard antenatal care) were followed up at mean age 5.92 months. There was no difference in triceps skinfold thickness z-scores between the intervention vs. standard care arms (difference -0.14 SD, 95% CI -0.38 to 0.10, p=0.246), but subscapular skinfold thickness z-score was 0.26 SD (-0.49 to -0.02; p=0.03) lower in the intervention arm. Maternal dietary glycemic load (-35.34; -48.0 to -22.67; p<0.001) and saturated fat intake (-1.93% energy; -2.64 to -1.22; p<0.001) were reduced in the intervention arm at 6 months postpartum. Causal mediation analysis suggested that lower infant subscapular skinfold thickness was mediated by changes in antenatal maternal diet and gestational weight gain rather than postnatal diet. This study provides evidence from follow-up of a randomised controlled trial that a maternal behavioural intervention in obese pregnant women has the potential to reduce infant adiposity and to produce a sustained improvement in maternal diet at 6 months postpartum.