Abstract
Background: In parallel with the global obesity epidemic, rates of maternal obesity are increasing worldwide, with significant consequences for both the mother and her child. Acutely, the mother is at risk of gestational diabetes and adverse outcomes in labour associated with fetal macrosomia. In the longer-term obesity in pregnancy is associated with type 2 diabetes and cardiovascular disease. Children of women with obesity are at greater risk of developing obesity and cardiometabolic dysfunction themselves and these conditions track across the life course. Effective strategies to stem the rising trend of childhood obesity are needed and pregnancy represents an opportune window to intervene.Methods: In the UK Pregnancy Better Eating and Activity Trial (UPBEAT), pregnant women with obesity were randomised to a dietary and physical activity intervention or standard antenatal care in early pregnancy. For this thesis, a systematic review of maternal lifestyle interventions and childhood obesity was undertaken. The thesis then addressed the hypothesis that the UPBEAT antenatal intervention would reduce the risk of obesity and cardiovascular disorders in the children at three years of age. Further analyses explored the longer-term impact of the intervention on maternal lifestyle, and the determinants of obesity in the children.
Results: The UPBEAT intervention was not associated with improved offspring body composition at 3-years of age. However, it was associated with a reduction in the children’s resting pulse rate. A sustained improvement in maternal dietary intake was also evident in women randomised to the intervention arm. Analysis of the UPBEAT data as a cohort identified that lower gestational weight gain, breastfeeding, a healthier dietary intake in the child, and lower appetite responses were associated with lower measures of childhood obesity.
Conclusion: To summarise, an antenatal lifestyle intervention in women with obesity was found to improve offspring cardiovascular health. Modifiable antenatal and postnatal determinants related to improved childhood body composition were also identified. These observations could inform future public health strategies for obesity prevention in pre-school children.
| Date of Award | 1 Oct 2020 |
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| Original language | English |
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| Supervisor | Lucilla Poston (Supervisor) & Majella O'Keeffe (Supervisor) |