title: The effect of an antenatal lifestyle intervention in overweight and obese women on circulating cardiometabolic and inflammatory biomarkers: secondary analyses from the LIMIT randomised trial.
abstract: BACKGROUND
  Maternal overweight and obesity during pregnancy is associated with insulin resistance, hyperglycaemia, hyperlipidaemia and a low-grade state of chronic inflammation. The aim of this pre-specified analysis of secondary outcome measures was to evaluate the effect of providing antenatal dietary and lifestyle advice on cardiometabolic and inflammatory biomarkers.
  
  
  METHODS
  We conducted a multicentre trial in which pregnant women who were overweight or obese were randomised to receive either Lifestyle Advice or Standard Care. We report a range of pre-specified secondary maternal and newborn cardiometabolic and inflammatory biomarker outcomes. Maternal whole venous blood was collected at trial entry (mean 14 weeks gestation; non-fasting), at 28 weeks gestation (fasting), and at 36 weeks gestation (non-fasting). Cord blood was collected after birth and prior to the delivery of the placenta. A range of cardiometabolic and inflammatory markers were analysed (total cholesterol, triglycerides, non-esterified fatty acids, high-density lipoprotein cholesterol, insulin, glucose, leptin, adiponectin, C-reactive protein, granulocyte macrophage-colony stimulating factor, interferon gamma, TNF-α, and interleukins 1β, 2, 4, 5, 6, 8, and 10). Participants were analysed in the groups to which they were randomised, and were included in the analyses if they had a measure at any time point.
  
  
  RESULTS
  One or more biological specimens were available from 1951 women (989 Lifestyle Advice and 962 Standard Care), with cord blood from 1174 infants (596 Lifestyle Advice and 578 Standard Care). There were no statistically significant differences in mean cardiometabolic and inflammatory marker concentrations across pregnancy and in infant cord blood between treatment groups. Estimated treatment group differences were close to zero, with 95% confidence intervals spanning a range of differences that were short of clinical relevance. There was no evidence to suggest that the intervention effect was modified by maternal BMI category.
  
  
  CONCLUSIONS
  Despite our findings, it will be worth considering potential relationships between cardiometabolic and inflammatory markers and clinical outcomes, including longer-term infant health and adiposity.
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trials Registry ( ACTRN12607000161426 ; Date Registered 09/03/2007).
authors.affiliation: The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia, Australia.|Monash University, Monash Centre for Health Research Implementation, Clayton, Victoria, Australia.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Moran
authors.affiliation: The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia, Australia.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Fraser
authors.affiliation: The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia, Australia.
authors.forename: Tulika
authors.initials: T
authors.lastname: Sundernathan
authors.affiliation: The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia, Australia.
authors.forename: Andrea R
authors.initials: AR
authors.lastname: Deussen
authors.affiliation: The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia, Australia.|The University of Adelaide, School of Population Health, Adelaide, South Australia, Australia.
authors.forename: Jennie
authors.initials: J
authors.lastname: Louise
authors.affiliation: The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia, Australia.|The University of Adelaide, School of Population Health, Adelaide, South Australia, Australia.|South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
authors.forename: Lisa N
authors.initials: LN
authors.lastname: Yelland
authors.affiliation: The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia, Australia.|Flinders University, Department of Obstetrics & Gynaecology, Bedford Park, South Australia, Australia.
authors.forename: Rosalie M
authors.initials: RM
authors.lastname: Grivell
authors.affiliation: The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia, Australia.
authors.forename: Anne
authors.initials: A
authors.lastname: Macpherson
authors.affiliation: Obesity Prevention Program, Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.|Environmental Influences on Child Health Outcomes (ECHO) Program, National Institutes of Health, Rockville, Maryland, USA.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gillman
authors.affiliation: The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia, Australia.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Robinson
authors.affiliation: The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia, Australia.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Owens
authors.affiliation: The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, 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, Adelaide, South Australia, Australia. jodie.dodd@adelaide.edu.au.
authors.forename: Jodie M
authors.initials: JM
authors.lastname: Dodd
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood*; D005260:Female; D006801:Humans; D008019:Life Style; D009765:Obesity / Q000097:blood*; D050177:Overweight / Q000097:blood*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood; D011295:Prenatal Care / Q000379:methods*
chemical_list: D015415:Biomarkers
keywords: Cardiometabolic markers; Dietary and lifestyle intervention; Inflammatory markers; Overweight and obesity; Pregnancy; Randomised trial