肥胖孕期行为干预随机对照试验后的婴儿肥胖情况
Infant adiposity following a randomised controlled trial of a behavioural intervention in obese pregnancy.
作者信息
Patel N, Godfrey K M, Pasupathy D, Levin J, Flynn A C, Hayes L, Briley A L, Bell R, Lawlor D A, Oteng-Ntim E, Nelson S M, Robson S C, Sattar N, Singh C, Wardle J, White S L, Seed P T, Poston L
机构信息
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.
MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
出版信息
Int J Obes (Lond). 2017 Jul;41(7):1018-1026. doi: 10.1038/ijo.2017.44. Epub 2017 Feb 20.
OBJECTIVES
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.
SUBJECTS AND METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
目的
需要通过随机对照试验来探究孕产妇因素与后代肥胖之间已报道关联的因果关系。本研究旨在确定一项产前生活方式干预措施，即改善肥胖孕妇的孕期饮食并减少孕期体重增加（GWG），是否会降低婴儿肥胖程度，并使产后6个月时孕产妇的生活方式行为得到持续改善。
研究对象与方法
我们对一项针对1555名肥胖孕妇的复杂行为干预随机对照试验（英国孕期更好饮食与活动试验（UPBEAT））进行了计划中的产后随访。该干预措施针对孕产妇饮食（血糖负荷（GL）和饱和脂肪摄入量）及身体活动。主要结局指标为婴儿肥胖程度，通过肩胛下和肱三头肌皮褶厚度进行评估。通过问卷调查评估孕产妇饮食和身体活动，这是家庭生活方式环境的指标。
结果
共有698名（45.9%）婴儿（342名接受干预，356名接受标准产前护理）在平均年龄5.92个月时接受了随访。干预组与标准护理组之间肱三头肌皮褶厚度z评分无差异（差值-0.14标准差，95%置信区间-0.38至0.10，P = 0.246），但干预组的肩胛下皮褶厚度z评分低0.26标准差（-0.49至-0.02；P = 0.03）。产后6个月时，干预组的孕产妇饮食GL（-35.34；-48.0至-22.67；P < 0.001）和饱和脂肪摄入量（-1.93%能量；-2.64至-1.22；P < 0.001）降低。因果中介分析表明，婴儿肩胛下皮褶厚度降低部分是由产前孕产妇饮食和GWG的变化介导的，而非产后饮食。
结论
本研究通过对一项随机对照试验的随访提供了证据，表明对肥胖孕妇进行孕产妇行为干预有可能降低婴儿肥胖程度，并使产后6个月时孕产妇饮食得到持续改善。
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