title: Dietary patterns in obese pregnant women; influence of a behavioral intervention of diet and physical activity in the UPBEAT randomized controlled trial.
abstract: BACKGROUND
  Understanding dietary patterns in obese pregnant women will inform future intervention strategies to improve pregnancy outcomes and the health of the child. The aim of this study was to investigate the effect of a behavioral intervention of diet and physical activity advice on dietary patterns in obese pregnant woman participating in the UPBEAT study, and to explore associations of dietary patterns with pregnancy outcomes.
  
  
  METHODS
  In the UPBEAT randomized controlled trial, pregnant obese women from eight UK multi-ethnic, inner-city populations were randomly assigned to receive a diet/physical activity intervention or standard antenatal care. The dietary intervention aimed to reduce glycemic load and saturated fat intake. Diet was assessed using a food frequency questionnaire (FFQ) at baseline (15+0-18+6weeks' gestation), post intervention (27+0-28+6weeks) and in late pregnancy (34+0-36+0weeks). Dietary patterns were characterized using factor analysis of the baseline FFQ data, and changes compared in the control and intervention arms. Patterns were related to pregnancy outcomes in the combined control/intervention cohort (n = 1023).
  
  
  RESULTS
  Four distinct baseline dietary patterns were defined; Fruit and vegetables, African/Caribbean, Processed, and Snacks, which were differently associated with social and demographic factors. The UPBEAT intervention significantly reduced the Processed (-0.14; 95% CI -0.19, -0.08, P <0.0001) and Snacks (-0.24; 95% CI -0.31, -0.17, P <0.0001) pattern scores. In the adjusted model, baseline scores for the African/Caribbean (quartile 4 compared with quartile 1: OR = 2.46; 95% CI 1.41, 4.30) and Processed (quartile 4 compared with quartile 1: OR = 2.05; 95% CI 1.23, 3.41) patterns in the entire cohort were associated with increased risk of gestational diabetes.
  
  
  CONCLUSIONS
  In a diverse cohort of obese pregnant women an intensive dietary intervention improved Processed and Snack dietary pattern scores. African/Caribbean and Processed patterns were associated with an increased risk of gestational diabetes, and provide potential targets for future interventions.
  
  
  BACKGROUND
  Current controlled trials; ISRCTN89971375.
authors.affiliation: Division of Women's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, UK.|Division of Diabetes and Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, UK.
authors.forename: Angela C
authors.initials: AC
authors.lastname: Flynn
authors.affiliation: Division of Women's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, UK.
authors.forename: Paul T
authors.initials: PT
authors.lastname: Seed
authors.affiliation: Division of Women's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, UK.
authors.forename: Nashita
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Cardiovascular Medicine, Imperial College London, London, UK.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Barr
authors.affiliation: Institute of Health & Society Newcastle University, UK Baddiley-Clark Building Richardson Road, Newcastle upon Tyne, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: Bell
authors.affiliation: Division of Women's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, UK.
authors.forename: Annette L
authors.initials: AL
authors.lastname: Briley
authors.affiliation: MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Mailpoint 95, Southampton, UK.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Godfrey
authors.affiliation: School of Medicine, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Nelson
authors.affiliation: Guys and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, UK.
authors.forename: Eugene
authors.initials: E
authors.lastname: Oteng-Ntim
authors.affiliation: MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Mailpoint 95, Southampton, UK.
authors.forename: Sian M
authors.initials: SM
authors.lastname: Robinson
authors.affiliation: Division of Diabetes and Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, UK.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Sanders
authors.affiliation: Institute of Cardiovascular and Medical Sciences, RC214 Level C2, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.affiliation: Health Behaviour Research Centre, Institute of Epidemiology and Health, University College London, 1-19 Torrington Place, London, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle
authors.affiliation: Division of Women's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, UK.
authors.forename: Lucilla
authors.initials: L
authors.lastname: Poston
authors.affiliation: Division of Diabetes and Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, UK. louise.goff@kcl.ac.uk.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Goff
mesh_terms: D000328:Adult; D001521:Behavior Therapy; D016640:Diabetes, Gestational / Q000209:etiology / Q000517:prevention & control; D004032:Diet; D015444:Exercise; D057140:Fast Foods; D005247:Feeding Behavior; D005260:Female; D005865:Gestational Age; D006801:Humans; D009765:Obesity / Q000150:complications / Q000628:therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011256:Pregnancy Outcome; D011295:Prenatal Care; D062410:Snacks
keywords: Dietary patterns; Gestational diabetes; Obesity; Pregnancy