The effect of a lifestyle intervention in obese pregnant women on gestational metabolic profiles: Findings from the UK Pregnancies Better Eating and Activity Trial (UPBEAT) randomised controlled trial

Harriet L. Mills; Nashita Patel; Sara L. White; Dharmintra Pasupathy; Annette L. Briley; Diana L. Santos Ferreira; Paul T. Seed; Scott M. Nelson; Naveed Sattar; Kate Tilling; Lucilla Poston; Deborah A. Lawlor

doi:10.1186/s12916-018-1248-7

The effect of a lifestyle intervention in obese pregnant women on gestational metabolic profiles: Findings from the UK Pregnancies Better Eating and Activity Trial (UPBEAT) randomised controlled trial

Harriet L. Mills, Nashita Patel, Sara L. White, Dharmintra Pasupathy, Annette L. Briley, Diana L. Santos Ferreira, Paul T. Seed, Scott M. Nelson, Naveed Sattar, Kate Tilling, Lucilla Poston, Deborah A. Lawlor

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Abstract

Background: Pregnancy is associated with widespread change in metabolism, which may be more marked in obese women. Whether lifestyle interventions in obese pregnant women improve pregnancy metabolic profiles remains unknown. Our objectives were to determine the magnitude of change in metabolic measures during obese pregnancy, to indirectly compare these to similar profiles in a general pregnant population, and to determine the impact of a lifestyle intervention on change in metabolic measures in obese pregnant women. Methods: Data from a randomised controlled trial of 1158 obese (BMI ≥ 30 kg/m ² ) pregnant women recruited from six UK inner-city obstetric departments were used. Women were randomised to either the UPBEAT intervention, a tailored complex lifestyle intervention focused on improving diet and physical activity, or standard antenatal care (control group). UPBEAT has been shown to improve diet and physical activity during pregnancy and up to 6-months postnatally in obese women and to reduce offspring adiposity at 6-months; it did not affect risk of gestational diabetes (the primary outcome). Change in the concentrations of 158 metabolic measures (129 lipids, 9 glycerides and phospholipids, and 20 low-molecular weight metabolites), quantified three times during pregnancy, were compared using multilevel models. The role of chance was assessed with a false discovery rate of 5% adjusted p values. Results: All very low-density lipoprotein (VLDL) particles increased by 1.5-3 standard deviation units (SD) whereas intermediate density lipoprotein and specific (large, medium and small) LDL particles increased by 1-2 SD, between 16 and 36 weeks' gestation. Triglycerides increased by 2-3 SD, with more modest changes in other metabolites. Indirect comparisons suggest that the magnitudes of change across pregnancy in these obese women were 2- to 3-fold larger than in unselected women (n = 4260 in cross-sectional and 583 in longitudinal analyses) from an independent, previously published, study. The intervention reduced the rate of increase in extremely large, very large, large and medium VLDL particles, particularly those containing triglycerides. Conclusion: There are marked changes in lipids and lipoproteins and more modest changes in other metabolites across pregnancy in obese women, with some evidence that this is more marked than in unselected pregnant women. The UPBEAT lifestyle intervention may contribute to a healthier metabolic profile in obese pregnant women, but our results require replication.

Original language	English
Article number	15
Number of pages	12
Journal	BMC Medicine
Volume	17
DOIs	https://doi.org/10.1186/s12916-018-1248-7
Publication status	Published - 21 Jan 2019
Externally published	Yes

Bibliographical note

This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Keywords

lifestyle intervention
metabolomics
obesity
Pregnancy
RCT

UN SDGs

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

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Mills, H. L., Patel, N., White, S. L., Pasupathy, D., Briley, A. L., Santos Ferreira, D. L., Seed, P. T., Nelson, S. M., Sattar, N., Tilling, K., Poston, L., & Lawlor, D. A. (2019). The effect of a lifestyle intervention in obese pregnant women on gestational metabolic profiles: Findings from the UK Pregnancies Better Eating and Activity Trial (UPBEAT) randomised controlled trial. BMC Medicine, 17, Article 15. https://doi.org/10.1186/s12916-018-1248-7

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abstract = " Background: Pregnancy is associated with widespread change in metabolism, which may be more marked in obese women. Whether lifestyle interventions in obese pregnant women improve pregnancy metabolic profiles remains unknown. Our objectives were to determine the magnitude of change in metabolic measures during obese pregnancy, to indirectly compare these to similar profiles in a general pregnant population, and to determine the impact of a lifestyle intervention on change in metabolic measures in obese pregnant women. Methods: Data from a randomised controlled trial of 1158 obese (BMI ≥ 30 kg/m 2 ) pregnant women recruited from six UK inner-city obstetric departments were used. Women were randomised to either the UPBEAT intervention, a tailored complex lifestyle intervention focused on improving diet and physical activity, or standard antenatal care (control group). UPBEAT has been shown to improve diet and physical activity during pregnancy and up to 6-months postnatally in obese women and to reduce offspring adiposity at 6-months; it did not affect risk of gestational diabetes (the primary outcome). Change in the concentrations of 158 metabolic measures (129 lipids, 9 glycerides and phospholipids, and 20 low-molecular weight metabolites), quantified three times during pregnancy, were compared using multilevel models. The role of chance was assessed with a false discovery rate of 5% adjusted p values. Results: All very low-density lipoprotein (VLDL) particles increased by 1.5-3 standard deviation units (SD) whereas intermediate density lipoprotein and specific (large, medium and small) LDL particles increased by 1-2 SD, between 16 and 36 weeks' gestation. Triglycerides increased by 2-3 SD, with more modest changes in other metabolites. Indirect comparisons suggest that the magnitudes of change across pregnancy in these obese women were 2- to 3-fold larger than in unselected women (n = 4260 in cross-sectional and 583 in longitudinal analyses) from an independent, previously published, study. The intervention reduced the rate of increase in extremely large, very large, large and medium VLDL particles, particularly those containing triglycerides. Conclusion: There are marked changes in lipids and lipoproteins and more modest changes in other metabolites across pregnancy in obese women, with some evidence that this is more marked than in unselected pregnant women. The UPBEAT lifestyle intervention may contribute to a healthier metabolic profile in obese pregnant women, but our results require replication. ",

keywords = "lifestyle intervention, metabolomics, obesity, Pregnancy, RCT",

author = "Mills, {Harriet L.} and Nashita Patel and White, {Sara L.} and Dharmintra Pasupathy and Briley, {Annette L.} and {Santos Ferreira}, {Diana L.} and Seed, {Paul T.} and Nelson, {Scott M.} and Naveed Sattar and Kate Tilling and Lucilla Poston and Lawlor, {Deborah A.}",

note = "This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.",

year = "2019",

month = jan,

day = "21",

doi = "10.1186/s12916-018-1248-7",

language = "English",

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Mills, HL, Patel, N, White, SL, Pasupathy, D, Briley, AL, Santos Ferreira, DL, Seed, PT, Nelson, SM, Sattar, N, Tilling, K, Poston, L & Lawlor, DA 2019, 'The effect of a lifestyle intervention in obese pregnant women on gestational metabolic profiles: Findings from the UK Pregnancies Better Eating and Activity Trial (UPBEAT) randomised controlled trial', BMC Medicine, vol. 17, 15. https://doi.org/10.1186/s12916-018-1248-7

The effect of a lifestyle intervention in obese pregnant women on gestational metabolic profiles: Findings from the UK Pregnancies Better Eating and Activity Trial (UPBEAT) randomised controlled trial. / Mills, Harriet L.; Patel, Nashita; White, Sara L. et al.
In: BMC Medicine, Vol. 17, 15, 21.01.2019.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - The effect of a lifestyle intervention in obese pregnant women on gestational metabolic profiles

T2 - Findings from the UK Pregnancies Better Eating and Activity Trial (UPBEAT) randomised controlled trial

AU - Mills, Harriet L.

AU - Patel, Nashita

AU - White, Sara L.

AU - Pasupathy, Dharmintra

AU - Briley, Annette L.

AU - Santos Ferreira, Diana L.

AU - Seed, Paul T.

AU - Nelson, Scott M.

AU - Sattar, Naveed

AU - Tilling, Kate

AU - Poston, Lucilla

AU - Lawlor, Deborah A.

N1 - This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

PY - 2019/1/21

Y1 - 2019/1/21

N2 - Background: Pregnancy is associated with widespread change in metabolism, which may be more marked in obese women. Whether lifestyle interventions in obese pregnant women improve pregnancy metabolic profiles remains unknown. Our objectives were to determine the magnitude of change in metabolic measures during obese pregnancy, to indirectly compare these to similar profiles in a general pregnant population, and to determine the impact of a lifestyle intervention on change in metabolic measures in obese pregnant women. Methods: Data from a randomised controlled trial of 1158 obese (BMI ≥ 30 kg/m 2 ) pregnant women recruited from six UK inner-city obstetric departments were used. Women were randomised to either the UPBEAT intervention, a tailored complex lifestyle intervention focused on improving diet and physical activity, or standard antenatal care (control group). UPBEAT has been shown to improve diet and physical activity during pregnancy and up to 6-months postnatally in obese women and to reduce offspring adiposity at 6-months; it did not affect risk of gestational diabetes (the primary outcome). Change in the concentrations of 158 metabolic measures (129 lipids, 9 glycerides and phospholipids, and 20 low-molecular weight metabolites), quantified three times during pregnancy, were compared using multilevel models. The role of chance was assessed with a false discovery rate of 5% adjusted p values. Results: All very low-density lipoprotein (VLDL) particles increased by 1.5-3 standard deviation units (SD) whereas intermediate density lipoprotein and specific (large, medium and small) LDL particles increased by 1-2 SD, between 16 and 36 weeks' gestation. Triglycerides increased by 2-3 SD, with more modest changes in other metabolites. Indirect comparisons suggest that the magnitudes of change across pregnancy in these obese women were 2- to 3-fold larger than in unselected women (n = 4260 in cross-sectional and 583 in longitudinal analyses) from an independent, previously published, study. The intervention reduced the rate of increase in extremely large, very large, large and medium VLDL particles, particularly those containing triglycerides. Conclusion: There are marked changes in lipids and lipoproteins and more modest changes in other metabolites across pregnancy in obese women, with some evidence that this is more marked than in unselected pregnant women. The UPBEAT lifestyle intervention may contribute to a healthier metabolic profile in obese pregnant women, but our results require replication.

AB - Background: Pregnancy is associated with widespread change in metabolism, which may be more marked in obese women. Whether lifestyle interventions in obese pregnant women improve pregnancy metabolic profiles remains unknown. Our objectives were to determine the magnitude of change in metabolic measures during obese pregnancy, to indirectly compare these to similar profiles in a general pregnant population, and to determine the impact of a lifestyle intervention on change in metabolic measures in obese pregnant women. Methods: Data from a randomised controlled trial of 1158 obese (BMI ≥ 30 kg/m 2 ) pregnant women recruited from six UK inner-city obstetric departments were used. Women were randomised to either the UPBEAT intervention, a tailored complex lifestyle intervention focused on improving diet and physical activity, or standard antenatal care (control group). UPBEAT has been shown to improve diet and physical activity during pregnancy and up to 6-months postnatally in obese women and to reduce offspring adiposity at 6-months; it did not affect risk of gestational diabetes (the primary outcome). Change in the concentrations of 158 metabolic measures (129 lipids, 9 glycerides and phospholipids, and 20 low-molecular weight metabolites), quantified three times during pregnancy, were compared using multilevel models. The role of chance was assessed with a false discovery rate of 5% adjusted p values. Results: All very low-density lipoprotein (VLDL) particles increased by 1.5-3 standard deviation units (SD) whereas intermediate density lipoprotein and specific (large, medium and small) LDL particles increased by 1-2 SD, between 16 and 36 weeks' gestation. Triglycerides increased by 2-3 SD, with more modest changes in other metabolites. Indirect comparisons suggest that the magnitudes of change across pregnancy in these obese women were 2- to 3-fold larger than in unselected women (n = 4260 in cross-sectional and 583 in longitudinal analyses) from an independent, previously published, study. The intervention reduced the rate of increase in extremely large, very large, large and medium VLDL particles, particularly those containing triglycerides. Conclusion: There are marked changes in lipids and lipoproteins and more modest changes in other metabolites across pregnancy in obese women, with some evidence that this is more marked than in unselected pregnant women. The UPBEAT lifestyle intervention may contribute to a healthier metabolic profile in obese pregnant women, but our results require replication.

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The effect of a lifestyle intervention in obese pregnant women on gestational metabolic profiles: Findings from the UK Pregnancies Better Eating and Activity Trial (UPBEAT) randomised controlled trial

Abstract

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Keywords

UN SDGs

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