Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Institute of Sport Science, University of Graz, Mozartgasse 14, 8010, Graz, Austria.
Diabetologia. 2019 Jun;62(6):915-925. doi: 10.1007/s00125-019-4842-0. Epub 2019 Mar 6.
AIMS/HYPOTHESIS: Offspring of obese women are at increased risk of features of the metabolic syndrome, including obesity and diabetes. Lifestyle intervention in pregnancy might reduce adverse effects of maternal obesity on neonatal adiposity.
In the Vitamin D And Lifestyle Intervention for Gestational Diabetes Mellitus (GDM) Prevention (DALI) lifestyle trial, 436 women with a BMI ≥29 kg/m were randomly assigned to counselling on healthy eating (HE), physical activity (PA) or HE&PA, 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. Mediation of intervention effects by lifestyle and gestational weight gain was assessed.
Outcomes were available from 334 neonates. A reduction in sum of skinfolds (-1.8 mm; 95% CI -3.5, -0.2; p = 0.03), fat mass (-63 g; 95% CI -124, -2; p = 0.04), fat percentage (-1.2%; 95% CI -2.4%, -0.04%; p = 0.04) and leptin (-3.80 μg/l; 95% CI -7.15, -0.45; p = 0.03) was found in the HE&PA group, and reduced leptin in female neonates in the PA group (-5.79 μg/l; 95% CI -11.43, -0.14; p = 0.05) compared with UC. Reduced sedentary time, but not gestational weight gain, mediated intervention effects on leptin in both the HE&PA and PA groups.
CONCLUSIONS/INTERPRETATION: The HE&PA intervention resulted in reduced adiposity in neonates. Reduced sedentary time seemed to drive the intervention effect on cord blood leptin. Implications for future adiposity and diabetes risk of the offspring need to be elucidated.
ISRCTN70595832.
目的/假设：肥胖女性的后代患代谢综合征特征的风险增加，包括肥胖和糖尿病。孕期生活方式干预可能会降低母亲肥胖对新生儿肥胖的不利影响。
在维生素 D 和生活方式干预妊娠糖尿病（GDM）预防（DALI）生活方式试验中，436 名 BMI≥29kg/m2 的妇女被随机分配到健康饮食（HE）、身体活动（PA）或 HE&PA 咨询组，或常规护理（UC）组。在生活方式试验的二次分析中，使用多水平回归分析评估干预对新生儿结局（头围、腹围、臂围和腿围及皮褶厚度、估计脂肪量、脂肪百分比、无脂肪量和脐血瘦素）的影响。评估了生活方式和妊娠期体重增加对干预效果的中介作用。
334 名新生儿的结果可用。HE&PA 组的皮褶总和减少（-1.8mm；95%CI-3.5，-0.2；p=0.03）、脂肪量减少（-63g；95%CI-124，-2；p=0.04）、脂肪百分比减少（-1.2%；95%CI-2.4%，-0.04%；p=0.04）和瘦素减少（-3.80μg/l；95%CI-7.15，-0.45；p=0.03），而 PA 组的女性新生儿瘦素减少（-5.79μg/l；95%CI-11.43，-0.14；p=0.05）与 UC 组相比。HE&PA 和 PA 组中，减少久坐时间而非妊娠期体重增加，介导了干预对瘦素的影响。
结论/解释：HE&PA 干预导致新生儿肥胖减少。减少久坐时间似乎是干预对脐血瘦素的影响的驱动因素。需要阐明对后代未来肥胖和糖尿病风险的影响。
ISRCTN70595832。
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