title: Infant adiposity following a randomised controlled trial of a behavioural intervention in obese pregnancy.
abstract: 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, associated with improvements in maternal diet and reduced gestational weight gain (GWG) in obese pregnant women 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 (UK Pregnancies Better Eating and Activity Trial (UPBEAT)) of a complex behavioural intervention targeting maternal diet (glycaemic load (GL) 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.
  
  
  
  A total of 698 (45.9%) infants (342 intervention and 356 standard antenatal care) were followed up at a mean age of 5.92 months. There was no difference in triceps skinfold thickness z-scores between the intervention vs standard care arms (difference -0.14 s.d., 95% confidence interval -0.38 to 0.10, P=0.246), but subscapular skinfold thickness z-score was 0.26 s.d. (-0.49 to -0.02; P=0.03) lower in the intervention arm. Maternal dietary GL (-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 partially mediated by changes in antenatal maternal diet and GWG 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.
authors.affiliation: Division of Women's Health, Women's Health Academic Centre, Faculty of Life Sciences and Medicine, King's College London, St Thomas' Hospital, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Patel
authors.affiliation: MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: K M
authors.initials: KM
authors.lastname: Godfrey
authors.affiliation: Division of Women's Health, Women's Health Academic Centre, Faculty of Life Sciences and Medicine, King's College London, St Thomas' Hospital, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Pasupathy
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Levin
authors.affiliation: Division of Women's Health, Women's Health Academic Centre, Faculty of Life Sciences and Medicine, King's College London, St Thomas' Hospital, London, UK.|Division of Diabetes and Nutritional Sciences, King's College London, London, UK.
authors.forename: A C
authors.initials: AC
authors.lastname: Flynn
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: L
authors.initials: L
authors.lastname: Hayes
authors.affiliation: Division of Women's Health, Women's Health Academic Centre, Faculty of Life Sciences and Medicine, King's College London, St Thomas' Hospital, London, UK.
authors.forename: A L
authors.initials: AL
authors.lastname: Briley
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: R
authors.initials: R
authors.lastname: Bell
authors.affiliation: MRC Integrative Epidemiology Unit at the University of Bristol and School of Social and Community Medicine, Bristol, UK.
authors.forename: D A
authors.initials: DA
authors.lastname: Lawlor
authors.affiliation: Department of Obstetrics and Gynaecology, Guys and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Oteng-Ntim
authors.affiliation: School of Medicine, University of Glasgow, Glasgow, UK.
authors.forename: S M
authors.initials: SM
authors.lastname: Nelson
authors.affiliation: Institute of Cellular Medicine Uterine Cell Signalling Group Newcastle University, Newcastle, UK.
authors.forename: S C
authors.initials: SC
authors.lastname: Robson
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: N
authors.initials: N
authors.lastname: Sattar
authors.affiliation: Department of Obstetrics and Gynaecology, Guys and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Singh
authors.affiliation: Health Behaviour Research Centre, Institute of Epidemiology and Health, University College London, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Wardle
authors.affiliation: Division of Women's Health, Women's Health Academic Centre, Faculty of Life Sciences and Medicine, King's College London, St Thomas' Hospital, London, UK.
authors.forename: S L
authors.initials: SL
authors.lastname: White
authors.affiliation: Division of Women's Health, Women's Health Academic Centre, Faculty of Life Sciences and Medicine, King's College London, St Thomas' Hospital, London, UK.
authors.forename: P T
authors.initials: PT
authors.lastname: Seed
authors.affiliation: Division of Women's Health, Women's Health Academic Centre, Faculty of Life Sciences and Medicine, King's College London, St Thomas' Hospital, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Poston
mesh_terms: D050154:Adiposity / Q000502:physiology*; D000328:Adult; D015992:Body Mass Index; D002657:Child Development / Q000502:physiology*; D004032:Diet; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena; D009035:Mothers; D009765:Obesity / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D049590:Postpartum Period / Q000502:physiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D039401:Prenatal Nutritional Physiological Phenomena; D040242:Risk Reduction Behavior; D012885:Skinfold Thickness; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D015430:Weight Gain / Q000502:physiology*