Lifestyle intervention in pregnancy might reduce adverse effects of maternal obesity on neonatal adiposity.
Maternal obesity and excessive gestational weight gain in pregnancy are implicated in the development of neonatal obesity. Offspring of women with obesity are at increased risk of features of the metabolic syndrome, including obesity and diabetes. Lifestyle intervention in pregnant women with obesity might reduce the adverse effects of maternal obesity on offspring adiposity, possibly associated with a reduction in gestational weight gain.
In a study by M. Geserick et al that assessed the age at onset of obesity, it was found that most of the adolescents with normal weight had always had a normal weight throughout childhood and almost 90% of the children with obesity at 3 years of age had excessive weight or obesity in adolescence. Among the adolescents with obesity, the greatest acceleration in annual BMI increments had occurred between 2 and 6 years of age, with a further rise in BMI percentile thereafter. The rate of overweight or obesity in adolescence was higher among children who had been large for gestational age at birth (43.7%) than among those who had been at an appropriate weight for gestational age (28.4%) or small for gestational age (27.2%), which corresponded to a risk of adolescent obesity that was 1.55 times as high among those who had been large for gestational age as among the other groups.
In a new study, the Vitamin D and Lifestyle Intervention for Gestational Diabetes Mellitus (GDM) Prevention (DALI) lifestyle trial, that aimed to demonstrate the consequences of changing lifestyle in pregnancy on neonatal adiposity, 436 women with a BMI ≥29 kg/m2 were randomly assigned to counselling on healthy eating (HE), physical activity (PA) or healthy eating and physical activity, or to usual care (UC). In secondary analyses of the lifestyle trial, intervention effects on neonatal outcomes (head, abdominal, arm and leg circumferences and skinfold thicknesses, estimated fat mass, fat percentage, fat-free mass and cord blood leptin) were assessed using multilevel regression analyses.
They tested whether the lifestyle interventions altered neonatal anthropometry and cord blood leptin, as a marker of adiposity, both secondary outcomes of the DALI lifestyle trial. They also investigated whether changes in neonatal adiposity were primarily mediated through changes in lifestyle, gestational weight gain, or both. The findings would allow targeted counselling of pregnant women to improve the long-term weight of their offspring and, hence, address a major public health concern.
The combined healthy eating and physical activity intervention resulted in a reduction of thigh, flank skinfold thickness, sum of skinfolds, estimated fat mass, fat percentage and cord blood leptin. There was no effect on lean mass. In the physical activity intervention, a reduction in leptin was found in female neonates. Effects on leptin in both intervention groups were mediated through a reduction in sedentary behavior. Changes in gestational weight gain alone did not mediate these intervention effects. No reduction in fat free mass was found, which was previously suggested as a possible risk factor for future cardiovascular and metabolic disease.
The study concluded that the combined healthy eating and physical activity intervention resulted in less subcutaneous fat in neonates and lower cord blood leptin levels. These effects were not mediated by gestational weight gain, despite a substantial reduction of 2.0 kg in the healthy eating and physical activity group. However, reduced sedentary behavior mediated the intervention effect on leptin. The mechanisms linking sedentary behavior and neonatal adiposity, and the implications for future child obesity, need to be elucidated.
- Offspring of women with obesity are at increased risk of features of the metabolic syndrome, including obesity and diabetes.
- Combined healthy eating and physical activity intervention can result in less subcutaneous fat in neonates and lower cord blood leptin level.
- Implications for future adiposity and diabetes risk of the offspring need to be further explained.
Van Poppel MNM, Simmons D, Devlieger R, van Assche FA, Jans G, Galjaard S, Corcoy R, Adelantado JM, Dunne F, Harreiter J, Kautzky-Willer A, Damm P, Mathiesen ER, Jensen DM, Andersen LL, Tanvig M, Lapolla A, Dalfra MG, Bertolotto A, Wender-Ozegowska E, Zawiejska A, Hill D, Snoek FJ, Jelsma JGM, Desoye G. A reduction in sedentary behaviour in obese women during pregnancy reduces neonatal adiposity: the DALI randomised controlled trial. Diabetologia. 2019 Mar 6.
Geserick M, Vogel M, Gausche R, Lipek T, Spielau U, Keller E, Pfäffle R, Kiess W, Körner A. Acceleration of BMI in Early Childhood and Risk of Sustained Obesity. N Engl J Med. 2018 Oct 4;379(14):1303-1312.
Dahlia Elimairi, Pharm D Student, UC Denver Skaggs School of Pharmacy