Lifestyle intervention in obese pregnancy and cardiac remodelling in 3-year olds: children of the UPBEAT RCT

Paul D. Taylor; Haotian Gu; Hannah Saunders; Federico Fiori; Kathryn V. Dalrymple; Priyanka Sethupathi; Liana Yamanouchi; Faith Miller; Bethany Jones; Matias C. Vieira; Claire Singh; Annette Briley; Paul T. Seed; Dharmintra Pasupathy; Paramala J. Santosh; Alan M. Groves; Manish D. Sinha; Philip J. Chowienczyk; Lucilla Poston; UPBEAT Consortium; Sarah Lee; Vicky Jones

doi:10.1038/s41366-022-01210-3

Lifestyle intervention in obese pregnancy and cardiac remodelling in 3-year olds: children of the UPBEAT RCT

Paul D. Taylor, Haotian Gu, Hannah Saunders, Federico Fiori, Kathryn V. Dalrymple, Priyanka Sethupathi, Liana Yamanouchi, Faith Miller, Bethany Jones, Matias C. Vieira, Claire Singh, Annette Briley, Paul T. Seed, Dharmintra Pasupathy, Paramala J. Santosh, Alan M. Groves, Manish D. Sinha, Philip J. Chowienczyk, Lucilla Poston, UPBEAT ConsortiumSarah Lee, Vicky Jones

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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.

Original language	English
Pages (from-to)	2145-2155
Number of pages	11
Journal	International Journal of Obesity
Volume	46
Issue number	12
Early online date	12 Oct 2022
DOIs	https://doi.org/10.1038/s41366-022-01210-3
Publication status	Published - Dec 2022
Externally published	Yes

Keywords

Obesity
pregnancy
cardiac
cardiometabolic
childhood
life expectancy
diet
physical activity
Cardiovascular

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Final published versionFinal published version, 665 KBLicence: CC BY

Cite this

Taylor, P. D., Gu, H., Saunders, H., Fiori, F., Dalrymple, K. V., Sethupathi, P., Yamanouchi, L., Miller, F., Jones, B., Vieira, M. C., Singh, C., Briley, A., Seed, P. T., Pasupathy, D., Santosh, P. J., Groves, A. M., Sinha, M. D., Chowienczyk, P. J., Poston, L., ... Jones, V. (2022). Lifestyle intervention in obese pregnancy and cardiac remodelling in 3-year olds: children of the UPBEAT RCT. International Journal of Obesity, 46(12), 2145-2155. https://doi.org/10.1038/s41366-022-01210-3

@article{2b13f543150c437abca768b26b874243,

title = "Lifestyle intervention in obese pregnancy and cardiac remodelling in 3-year olds: children of the UPBEAT RCT",

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.",

keywords = "Obesity, pregnancy, cardiac, cardiometabolic, childhood, life expectancy, diet, physical activity, Cardiovascular",

author = "Taylor, {Paul D.} and Haotian Gu and Hannah Saunders and Federico Fiori and Dalrymple, {Kathryn V.} and Priyanka Sethupathi and Liana Yamanouchi and Faith Miller and Bethany Jones and Vieira, {Matias C.} and Claire Singh and Annette Briley and Seed, {Paul T.} and Dharmintra Pasupathy and Santosh, {Paramala J.} and Groves, {Alan M.} and Sinha, {Manish D.} and Chowienczyk, {Philip J.} and Lucilla Poston and {UPBEAT Consortium} and Andrew Shennan and Jane Sandall and Thomas Sanders and Nashita Patel and Angela Flynn and Shirlene Badger and Suzanne Barr and Bridget Holmes and Louise Goff and Clare Hunt and Judy Filmer and Jeni Fetherstone and Laura Scholtz and Hayley Tarft and Anna Lucas and Tsigerada Tekletdadik and Deborah Ricketts and Carolyn Gill and Ignatian, {Alex Seroge} and Catherine Boylen and Funso Adegoke and Elodie Lawley and James Butler and Rahat Maitland and Eugene Oteng-Ntim and Nina Khazaezadeh and Jill Demilew and Sile O{\textquoteright}Connor and Yvonne Evans and Susan O{\textquoteright}Donnell and Llera, {Ari de la} and Georgina Gutzwiller and Linda Hagg and Stephen Robson and Ruth Bell and Louise Hayes and Tarja Kinnunen and Catherine McParlin and Nicola Miller and Alison Kimber and Jill Riches and Carly Allen and Claire Boag and Fiona Campbell and Andrea Fenn and Sarah Ritson and Alison Rennie and Robin Durkin and Gayle Gills and Roger Carr and Scott Nelson and Naveed Sattar and Therese McSorley and Hilary Alba and Kirsteen Paterson and Janet Johnston and Suzanne Clements and Maxine Fernon and Savannah Bett and Laura Rooney and Sinead Miller and Paul Welsh and Lynn Cherry and Melissa Whitworth and Natalie Patterson and Sarah Lee and Rachel Grimshaw and Christine Hughes and Jay Brown and Kim Hinshaw and Gillian Campbell and Joanne Knight and Diane Farrar and Vicky Jones and Gillian Butterfield and Jennifer Syson and Jennifer Eadle and Dawn Wood and Merane Todd and Asma Khalil and Deborah Brown and Paola Fernandez and Emma Cousins and Melody Smith and Jane Wardle and Helen Croker and Laura Broomfield and Weight Concern and Keith Godfrey and Sian Robinson and Sarah Canadine and Lynne Greenwood",

year = "2022",

month = dec,

doi = "10.1038/s41366-022-01210-3",

language = "English",

volume = "46",

pages = "2145--2155",

journal = "International Journal of Obesity",

issn = "0307-0565",

publisher = "Nature Group Publishing",

number = "12",

}

Taylor, PD, Gu, H, Saunders, H, Fiori, F, Dalrymple, KV, Sethupathi, P, Yamanouchi, L, Miller, F, Jones, B, Vieira, MC, Singh, C, Briley, A, Seed, PT, Pasupathy, D, Santosh, PJ, Groves, AM, Sinha, MD, Chowienczyk, PJ, Poston, L, UPBEAT Consortium, Lee, S & Jones, V 2022, 'Lifestyle intervention in obese pregnancy and cardiac remodelling in 3-year olds: children of the UPBEAT RCT', International Journal of Obesity, vol. 46, no. 12, pp. 2145-2155. https://doi.org/10.1038/s41366-022-01210-3

TY - JOUR

T1 - Lifestyle intervention in obese pregnancy and cardiac remodelling in 3-year olds

T2 - children of the UPBEAT RCT

AU - Taylor, Paul D.

AU - Gu, Haotian

AU - Saunders, Hannah

AU - Fiori, Federico

AU - Dalrymple, Kathryn V.

AU - Sethupathi, Priyanka

AU - Yamanouchi, Liana

AU - Miller, Faith

AU - Jones, Bethany

AU - Vieira, Matias C.

AU - Singh, Claire

AU - Briley, Annette

AU - Seed, Paul T.

AU - Pasupathy, Dharmintra

AU - Santosh, Paramala J.

AU - Groves, Alan M.

AU - Sinha, Manish D.

AU - Chowienczyk, Philip J.

AU - Poston, Lucilla

AU - UPBEAT Consortium

AU - Shennan, Andrew

AU - Sandall, Jane

AU - Sanders, Thomas

AU - Patel, Nashita

AU - Flynn, Angela

AU - Badger, Shirlene

AU - Barr, Suzanne

AU - Holmes, Bridget

AU - Goff, Louise

AU - Hunt, Clare

AU - Filmer, Judy

AU - Fetherstone, Jeni

AU - Scholtz, Laura

AU - Tarft, Hayley

AU - Lucas, Anna

AU - Tekletdadik, Tsigerada

AU - Ricketts, Deborah

AU - Gill, Carolyn

AU - Ignatian, Alex Seroge

AU - Boylen, Catherine

AU - Adegoke, Funso

AU - Lawley, Elodie

AU - Butler, James

AU - Maitland, Rahat

AU - Oteng-Ntim, Eugene

AU - Khazaezadeh, Nina

AU - Demilew, Jill

AU - O’Connor, Sile

AU - Evans, Yvonne

AU - O’Donnell, Susan

AU - Llera, Ari de la

AU - Gutzwiller, Georgina

AU - Hagg, Linda

AU - Robson, Stephen

AU - Bell, Ruth

AU - Hayes, Louise

AU - Kinnunen, Tarja

AU - McParlin, Catherine

AU - Miller, Nicola

AU - Kimber, Alison

AU - Riches, Jill

AU - Allen, Carly

AU - Boag, Claire

AU - Campbell, Fiona

AU - Fenn, Andrea

AU - Ritson, Sarah

AU - Rennie, Alison

AU - Durkin, Robin

AU - Gills, Gayle

AU - Carr, Roger

AU - Nelson, Scott

AU - Sattar, Naveed

AU - McSorley, Therese

AU - Alba, Hilary

AU - Paterson, Kirsteen

AU - Johnston, Janet

AU - Clements, Suzanne

AU - Fernon, Maxine

AU - Bett, Savannah

AU - Rooney, Laura

AU - Miller, Sinead

AU - Welsh, Paul

AU - Cherry, Lynn

AU - Whitworth, Melissa

AU - Patterson, Natalie

AU - Lee, Sarah

AU - Grimshaw, Rachel

AU - Hughes, Christine

AU - Brown, Jay

AU - Hinshaw, Kim

AU - Campbell, Gillian

AU - Knight, Joanne

AU - Farrar, Diane

AU - Jones, Vicky

AU - Butterfield, Gillian

AU - Syson, Jennifer

AU - Eadle, Jennifer

AU - Wood, Dawn

AU - Todd, Merane

AU - Khalil, Asma

AU - Brown, Deborah

AU - Fernandez, Paola

AU - Cousins, Emma

AU - Smith, Melody

AU - Wardle, Jane

AU - Croker, Helen

AU - Broomfield, Laura

AU - Concern, Weight

AU - Godfrey, Keith

AU - Robinson, Sian

AU - Canadine, Sarah

AU - Greenwood, Lynne

PY - 2022/12

Y1 - 2022/12

N2 - 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.

AB - 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.

KW - Obesity

KW - pregnancy

KW - cardiac

KW - cardiometabolic

KW - childhood

KW - life expectancy

KW - diet

KW - physical activity

KW - Cardiovascular

UR - http://www.scopus.com/inward/record.url?scp=85139779698&partnerID=8YFLogxK

U2 - 10.1038/s41366-022-01210-3

DO - 10.1038/s41366-022-01210-3

M3 - Article

C2 - 36224375

AN - SCOPUS:85139779698

SN - 0307-0565

VL - 46

SP - 2145

EP - 2155

JO - International Journal of Obesity

JF - International Journal of Obesity

IS - 12

ER -

Lifestyle intervention in obese pregnancy and cardiac remodelling in 3-year olds: children of the UPBEAT RCT

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Keywords

UN SDGs

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