Background: Early-life risk factors of childhood obesity include maternal obesity; smoking, diabetes and high weight gain during pregnancy for the mother; short duration of breastfeeding and poor quality of early feeding in the infants. Perinatal life thus may be a good period for primary prevention.
Objective and hypotheses: We aimed to evaluate whether perinatal education of overweight pregnant women would reduce childhood overweight.
Method: Four French centers included before 20 weeks of gestation 268 pregnant women who were overweight before pregnancy (BMI 32.5±5.4 kg/m2, obesity 62%, age 30.4±5.0 years). They were randomized into either a control group (n=136: routine care including at least one dietary consultation) or an interventional group (n=132: intervention based on patient therapeutic education with four collective sessions at 18, 26, 33 weeks of gestation and 2 months after delivery and two individual ones) which aimed to educate the future mother for infant and maternal nutritional aspects, without weight objectives. The primary endpoint was postnatal excess weight gain from birth to 2 years ((weight SD 2 years weight SD birth) >+0.67), which is associated with obesity in childhood. Loss to follow-up was considered as a failure in the intention to treat (ITT) analysis.
Results: Events during pregnancy were similar in both groups, including incident gestational diabetes mellitus, gestational weight gain and birth weight. The rate of postnatal excess weight gain was similar in interventional and control groups: in ITT (n=268; 59.1 vs 60.3% respectively, P=0.84), and in available data (AD, n=206; 47 vs 48% respectively, P=0.88). Children feedings habits didnt significantly differ between both groups. Overweight 2 years after delivery was less likely to occur in the interventional group than in the control group for the mothers (ITT: 93.2 vs 97.8% respectively, P=0,07; AD: 87.1 vs 96.2% respectively, P=0.04) and for the children (ITT: 23.5 vs 29.4% respectively, P=0.27; AD: 0 vs 6.8% respectively, P=0.014).
Conclusion: An intervention based on patient collective therapeutic education for overweight pregnant women has no effect on postnatal excess weight gain but seems to prevent overweight in mothers and children 2 years after delivery.
Funding: French PHRC Necker K070102.
01 Oct 2015 - 03 Oct 2015