title: Pragmatic controlled trial to prevent childhood obesity in maternity and child health care clinics: pregnancy and infant weight outcomes (the VACOPP Study).
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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Clinical Trials gov: NCT00970710.
authors.affiliation: Seinäjoki Central Hospital, Hanneksenrinne 7, 60220 Seinäjoki, Finland. taina.mustila@fimnet.fi
authors.forename: Taina
authors.initials: T
authors.lastname: Mustila
authors.forename: Jani
authors.initials: J
authors.lastname: Raitanen
authors.forename: Päivi
authors.initials: P
authors.lastname: Keskinen
authors.forename: Antti
authors.initials: A
authors.lastname: Saari
authors.forename: Riitta
authors.initials: R
authors.lastname: Luoto
mesh_terms: D000328:Adult; D001942:Breast Feeding; D002662:Child Health Services; D016640:Diabetes, Gestational / Q000517:prevention & control; D004032:Diet; D037001:Directive Counseling; D015444:Exercise; D005260:Female; D018149:Glucose Intolerance / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D063766:Pediatric Obesity / Q000517:prevention & control*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods*; D039401:Prenatal Nutritional Physiological Phenomena; D016896:Treatment Outcome; D015430:Weight Gain