Lifestyle intervention in obese pregnancy and cardiac remodelling in 3-year olds: children of the UPBEAT RCT.
Journal
International journal of obesity (2005)
ISSN: 1476-5497
Titre abrégé: Int J Obes (Lond)
Pays: England
ID NLM: 101256108
Informations de publication
Date de publication:
12 2022
12 2022
Historique:
received:
22
08
2021
accepted:
05
08
2022
revised:
20
07
2022
pubmed:
13
10
2022
medline:
24
11
2022
entrez:
12
10
2022
Statut:
ppublish
Résumé
Obesity in pregnancy has been associated with increased childhood cardiometabolic risk and reduced life expectancy. The UK UPBEAT multicentre randomised control trial was a lifestyle intervention of diet and physical activity in pregnant women with obesity. We hypothesised that the 3-year-old children of women with obesity would have heightened cardiovascular risk compared to children of normal BMI women, and that the UPBEAT intervention would mitigate this risk. Children were recruited from one UPBEAT trial centre. Cardiovascular measures included blood pressure, echocardiographic assessment of cardiac function and dimensions, carotid intima-media thickness and heart rate variability (HRV) by electrocardiogram. Compared to offspring of normal BMI women (n = 51), children of women with obesity from the trial standard care arm (n = 39) had evidence of cardiac remodelling including increased interventricular septum (IVS; mean difference 0.04 cm; 95% CI: 0.018 to 0.067), posterior wall (PW; 0.03 cm; 0.006 to 0.062) and relative wall thicknesses (RWT; 0.03 cm; 0.01 to 0.05) following adjustment. Randomisation of women with obesity to the intervention arm (n = 31) prevented this cardiac remodelling (intervention effect; mean difference IVS -0.03 cm (-0.05 to -0.008); PW -0.03 cm (-0.05 to -0.01); RWT -0.02 cm (-0.04 to -0.005)). Children of women with obesity (standard care arm) compared to women of normal BMI also had elevated minimum heart rate (7 bpm; 1.41 to 13.34) evidence of early diastolic dysfunction (e prime) and increased sympathetic nerve activity index by HRV analysis. Maternal obesity was associated with left ventricular concentric remodelling in 3-year-old offspring. Absence of remodelling following the maternal intervention infers in utero origins of cardiac remodelling. The UPBEAT trial is registered with Current Controlled Trials, ISRCTN89971375.
Sections du résumé
BACKGROUND/OBJECTIVES
Obesity in pregnancy has been associated with increased childhood cardiometabolic risk and reduced life expectancy. The UK UPBEAT multicentre randomised control trial was a lifestyle intervention of diet and physical activity in pregnant women with obesity. We hypothesised that the 3-year-old children of women with obesity would have heightened cardiovascular risk compared to children of normal BMI women, and that the UPBEAT intervention would mitigate this risk.
SUBJECTS/METHODS
Children were recruited from one UPBEAT trial centre. Cardiovascular measures included blood pressure, echocardiographic assessment of cardiac function and dimensions, carotid intima-media thickness and heart rate variability (HRV) by electrocardiogram.
RESULTS
Compared to offspring of normal BMI women (n = 51), children of women with obesity from the trial standard care arm (n = 39) had evidence of cardiac remodelling including increased interventricular septum (IVS; mean difference 0.04 cm; 95% CI: 0.018 to 0.067), posterior wall (PW; 0.03 cm; 0.006 to 0.062) and relative wall thicknesses (RWT; 0.03 cm; 0.01 to 0.05) following adjustment. Randomisation of women with obesity to the intervention arm (n = 31) prevented this cardiac remodelling (intervention effect; mean difference IVS -0.03 cm (-0.05 to -0.008); PW -0.03 cm (-0.05 to -0.01); RWT -0.02 cm (-0.04 to -0.005)). Children of women with obesity (standard care arm) compared to women of normal BMI also had elevated minimum heart rate (7 bpm; 1.41 to 13.34) evidence of early diastolic dysfunction (e prime) and increased sympathetic nerve activity index by HRV analysis.
CONCLUSIONS
Maternal obesity was associated with left ventricular concentric remodelling in 3-year-old offspring. Absence of remodelling following the maternal intervention infers in utero origins of cardiac remodelling.
CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER
The UPBEAT trial is registered with Current Controlled Trials, ISRCTN89971375.
Identifiants
pubmed: 36224375
doi: 10.1038/s41366-022-01210-3
pii: 10.1038/s41366-022-01210-3
pmc: PMC9678793
doi:
Types de publication
Randomized Controlled Trial
Multicenter Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2145-2155Subventions
Organisme : British Heart Foundation
ID : SP/14/8/31352
Pays : United Kingdom
Organisme : British Heart Foundation
ID : PG/13/38/30289
Pays : United Kingdom
Organisme : British Heart Foundation
ID : FS/17/71/32953
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/L002477/1
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/M016560/1
Pays : United Kingdom
Investigateurs
Lucilla Poston
(L)
Andrew Shennan
(A)
Annette Briley
(A)
Claire Singh
(C)
Paul Seed
(P)
Jane Sandall
(J)
Thomas Sanders
(T)
Nashita Patel
(N)
Angela Flynn
(A)
Shirlene Badger
(S)
Suzanne Barr
(S)
Bridget Holmes
(B)
Louise Goff
(L)
Clare Hunt
(C)
Judy Filmer
(J)
Jeni Fetherstone
(J)
Laura Scholtz
(L)
Hayley Tarft
(H)
Anna Lucas
(A)
Tsigerada Tekletdadik
(T)
Deborah Ricketts
(D)
Carolyn Gill
(C)
Alex Seroge Ignatian
(AS)
Catherine Boylen
(C)
Funso Adegoke
(F)
Elodie Lawley
(E)
James Butler
(J)
Rahat Maitland
(R)
Matias Vieira
(M)
Dharmintra Pasupathy
(D)
Eugene Oteng-Ntim
(E)
Nina Khazaezadeh
(N)
Jill Demilew
(J)
Sile O'Connor
(S)
Yvonne Evans
(Y)
Susan O'Donnell
(S)
Ari de la Llera
(A)
Georgina Gutzwiller
(G)
Linda Hagg
(L)
Stephen Robson
(S)
Ruth Bell
(R)
Louise Hayes
(L)
Tarja Kinnunen
(T)
Catherine McParlin
(C)
Nicola Miller
(N)
Alison Kimber
(A)
Jill Riches
(J)
Carly Allen
(C)
Claire Boag
(C)
Fiona Campbell
(F)
Andrea Fenn
(A)
Sarah Ritson
(S)
Alison Rennie
(A)
Robin Durkin
(R)
Gayle Gills
(G)
Roger Carr
(R)
Scott Nelson
(S)
Naveed Sattar
(N)
Therese McSorley
(T)
Hilary Alba
(H)
Kirsteen Paterson
(K)
Janet Johnston
(J)
Suzanne Clements
(S)
Maxine Fernon
(M)
Savannah Bett
(S)
Laura Rooney
(L)
Sinead Miller
(S)
Paul Welsh
(P)
Lynn Cherry
(L)
Melissa Whitworth
(M)
Natalie Patterson
(N)
Sarah Lee
(S)
Rachel Grimshaw
(R)
Christine Hughes
(C)
Jay Brown
(J)
Kim Hinshaw
(K)
Gillian Campbell
(G)
Joanne Knight
(J)
Diane Farrar
(D)
Vicky Jones
(V)
Gillian Butterfield
(G)
Jennifer Syson
(J)
Jennifer Eadle
(J)
Dawn Wood
(D)
Merane Todd
(M)
Asma Khalil
(A)
Deborah Brown
(D)
Paola Fernandez
(P)
Emma Cousins
(E)
Melody Smith
(M)
Jane Wardle
(J)
Helen Croker
(H)
Laura Broomfield
(L)
Weight Concern
(W)
Keith Godfrey
(K)
Sian Robinson
(S)
Sarah Canadine
(S)
Lynne Greenwood
(L)
Informations de copyright
© 2022. The Author(s).
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