Lifestyle intervention in obese pregnancy and cardiac remodelling in 3-year olds: children of the UPBEAT RCT
Paul Taylor, Haotian Gu, Hannah Saunders, Federico Fiori, Kathryn V. Dalrymple, Priyanka Sethupathi, Liana Yamanouchi, Faith Miller, Bethany A. Jones, Matias C. Vieira, Claire Singh, Annette Briley, Paul T. Seed, Dharmintra Pasupathy, Paramala Santosh, Alan Groves, Manish D. Sinha, Phil Chowienczyk, Lucilla Poston, Lucilla Poston, Andrew Shennan, Annette Briley, Claire Singh, Paul T. Seed, Jane Sandall, T. A. B. Sanders, Nashita Patel, Angela C. Flynn, Shirlene Badger, Suzanne Barr, Bridget Holmes, Louise M. Goff, Clare Hunt, Judy Filmer, Jeni Fetherstone, Laura Scholtz, Hayley Tarft, Anna Lucas, Tsigerada Tekletdadik, Deborah Ricketts, Carolyn Gill, Alex Seroge Ignatian, Catherine Boylen, Funso Adegoke, Elodie Lawley, James Butler, Rahat Maitland, Matias C. Vieira, Dharmintra Pasupathy, Eugene Oteng‐Ntim, Nina Khazaezadeh, Jill Demilew, Síle O'Connor, Yvonne Evans, Susan O’Donnell, Ari de la Llera, Georgina Gutzwiller, Linda Hagg, Stephen C. Robson, Ruth Bell, Louise Hayes, Tarja I. Kinnunen, Catherine McParlin, Nicola Miller, Alison Kimber, Jill Riches, Carly Grace Allen, Claire Boag, Fiona Campbell, Andrea Fenn, Sarah Ritson, Alison Rennie, Robin Durkin, Gayle Gills, Roger Carr, Scott M. Nelson, Naveed Sattar, Therese McSorley, Hilary Alba, Kirsteen Paterson, Janet Johnston, Suzanne Clements, Maxine Fernon, Savannah Bett, Laura Rooney, Sinead Miller, Paul Welsh, Lynn Cherry, Melissa Whitworth, Natalie Patterson, Sarah Lee, Rachel Grimshaw, Christine A. Hughes, Jay Brown, Kim Hinshaw, Gillian Campbell, Jo Knight, Diane Farrar, Vicky Jones, Gillian Butterfield
Abstract
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.