title: The effects of antenatal dietary and lifestyle advice for women who are overweight or obese on neonatal health outcomes: the LIMIT randomised trial.
abstract: BACKGROUND
  Overweight and obesity during pregnancy represents a considerable health burden. While research has focused on interventions to limit gestational weight gain, there is little information describing their impact on neonatal health. Our aim was to investigate the effect on a range of pre-specified secondary neonatal outcomes of providing antenatal dietary and lifestyle advice to women who are overweight or obese.
  
  
  METHODS
  We report a range of pre-specified secondary neonatal outcomes from a large randomised trial in which antenatal dietary and lifestyle advice was provided to women who were overweight or obese. Pregnant women were eligible for participation with a body mass index of 25 kg/m(2) or over, and singleton gestation between 10(+0) and 20(+0) weeks. Outcome measures included gestational age at birth; Apgar score below 7 at 5 minutes of age; need for resuscitation at birth; birth weight above 4.5 kg or below 2.5 kg; birth weight, length and head circumference (and Z-scores); admission to the nursery; respiratory distress syndrome; and postnatal length of stay. Data relating to the primary outcome (large for gestational age infants defined as birth weight above the 90th centile) and birth weight above 4 kg have been reported previously. Analyses used intention-to-treat principles.
  
  
  RESULTS
  In total, 2,142 infants were included in the analyses. Infants born to women following lifestyle advice were significantly less likely to have birth weight above 4.5 kg (2.15% versus 3.69%; adjusted risk ratio (aRR)=0.59; 95% confidence interval (CI) 0.36 to 0.98; P=0.04), or respiratory distress syndrome (1.22% versus 2.57%; aRR=0.47; 95% CI 0.24 to 0.90; P=0.02), particularly moderate or severe disease, and had a shorter length of postnatal hospital stay (3.94±7.26 days versus 4.41±9.87 days; adjusted ratio of means 0.89; 95% CI 0.82 to 0.97; P=0.006) compared with infants born to women who received Standard Care.
  
  
  CONCLUSIONS
  For women who are overweight or obese, antenatal dietary and lifestyle advice has health benefits for infants, without an increase in the risk of harm. Continued follow-up into childhood will be important to assess the longer-term effects of a reduction in high infant birth weight on risk of child obesity. Please see related articles: http://www.biomedcentral.com/1741-7015/12/161 and http://www.biomedcentral.com/1741-7015/12/201 .
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trials Registry ( ACTRN12607000161426 ).
authors.affiliation: The University of Adelaide, School of Paediatrics and Reproductive Health, Robinson Research Institute, Adelaide, South Australia, Australia. jodie.dodd@adelaide.edu.au.|The Women's and Children's Hospital, Women's and Babies Division, Department of Perinatal Medicine, North Adelaide, South Australia, Australia. jodie.dodd@adelaide.edu.au.
authors.forename: Jodie M
authors.initials: JM
authors.lastname: Dodd
authors.affiliation: The Women's and Children's Hospital, Women's and Babies Division, Department of Neonatal Medicine, Adelaide, South Australia, Australia. Andrew.McPhee@health.sa.gov.au.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: McPhee
authors.affiliation: The University of Adelaide, School of Psychology, Adelaide, South Australia, Australia. deborah.turnbull@adelaide.edu.au.
authors.forename: Deborah
authors.initials: D
authors.lastname: Turnbull
authors.affiliation: The University of Adelaide, School of Paediatrics and Reproductive Health, Robinson Research Institute, Adelaide, South Australia, Australia. lisa.yelland@adelaide.edu.au.|Women's and Children's Health Research Institute, North Adelaide, South Australia, Australia. lisa.yelland@adelaide.edu.au.|The University of Adelaide, School of Population Health, Adelaide, South Australia, Australia. lisa.yelland@adelaide.edu.au.
authors.forename: Lisa N
authors.initials: LN
authors.lastname: Yelland
authors.affiliation: The University of Adelaide, School of Paediatrics and Reproductive Health, Robinson Research Institute, Adelaide, South Australia, Australia. andrea.deussen@adelaide.edu.au.
authors.forename: Andrea R
authors.initials: AR
authors.lastname: Deussen
authors.affiliation: The University of Adelaide, School of Paediatrics and Reproductive Health, Robinson Research Institute, Adelaide, South Australia, Australia. rosalie.grivell@adelaide.edu.au.|The Women's and Children's Hospital, Women's and Babies Division, Department of Perinatal Medicine, North Adelaide, South Australia, Australia. rosalie.grivell@adelaide.edu.au.
authors.forename: Rosalie M
authors.initials: RM
authors.lastname: Grivell
authors.affiliation: The University of Adelaide, School of Paediatrics and Reproductive Health, Robinson Research Institute, Adelaide, South Australia, Australia. caroline.crowther@adelaide.edu.au.|Liggins Institute, The University of Auckland, Auckland, New Zealand. caroline.crowther@adelaide.edu.au.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Crowther
authors.affiliation: The University of Adelaide, School of Medicine, Adelaide, South Australia, Australia. gary.wittert@adelaide.edu.au.
authors.forename: Gary
authors.initials: G
authors.lastname: Wittert
authors.affiliation: The University of Adelaide, School of Paediatrics and Reproductive Health, Robinson Research Institute, Adelaide, South Australia, Australia. julie.owens@adelaide.edu.au.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Owens
authors.affiliation: The University of Adelaide, School of Paediatrics and Reproductive Health, Robinson Research Institute, Adelaide, South Australia, Australia. jeffrey.robinson@adelaide.edu.au.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Robinson
mesh_terms: D000328:Adult; D001315:Australia; D004032:Diet; D015444:Exercise; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D008019:Life Style; D008297:Male; D009520:New Zealand; D009765:Obesity / Q000517:prevention & control*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D011256:Pregnancy Outcome; D011295:Prenatal Care; D040242:Risk Reduction Behavior; D016896:Treatment Outcome