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Am J Obstet Gynecol. 2019 Mar 13. pii: S0002-9378(19)30478-8. doi: 10.1016/j.ajog.2019.03.003. [Epub ahead of print]

Effect of antenatal dietary interventions in maternal obesity on pregnancy weight-gain and birthweight: Healthy Mums and Babies (HUMBA) randomized trial.

Author information

1
Senior Lecturer Department of Obstetrics and Gynaecology; University of Auckland; Obstetrician and Gynaecologist, Middlemore Hospital, South Auckland, NEW ZEALAND; South Auckland Clinical School, Level 3, Esme Green Building, Middlemore Hospital, Postal Address: Private Bag 93311 Otahuhu, Auckland 1640, New Zealand. Electronic address: k.okesene-gafa@auckland.ac.nz.
2
Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, University of Auckland, Postal Address: Private Bag 92019, Auckland 1142, New Zealand.
3
Kidz First Neonatal Care, Counties Manukau Health, Liggins Institute and Department of Paediatrics: Child and Youth Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
4
Department of Obstetrics & Gynaecology, Faculty of Medical and Health Science, University of Auckland. Private Bag 92019, Auckland 1142, New Zealand.
5
Faculty of Health and Environmental Science, Auckland University of Technology, Private Bag 92006 Auckland 1142.
6
Faculty of Medical and Health Science, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
7
Department: Paediatrics, Child and Youth Health, Faculty of Medical and Health Sciences, Private Bag 92019, Auckland 1142, New Zealand.
8
Department of Medicine, School of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
9
Department of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
10
Paediatrics, Child and Youth Health, Faculty of Medical and Health Science, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
11
Liggins Institute, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
12
Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.

Abstract

BACKGROUND:

Pregnancy interventions that improve maternal and infant outcomes are urgently needed in populations with high rates of obesity. We undertook the Healthy Mums and Babies (HUMBA) randomized controlled trial to assess the effect of dietary interventions and or probiotics in a multiethnic population of pregnant women with obesity, living in an area of high deprivation.

OBJECTIVES:

To determine whether a culturally-tailored dietary intervention and or daily probiotic capsules in pregnant women with obesity reduces the co-primary outcomes of a) excessive gestational weight-gain (mean >0.27 kg/week) and b) birthweight.

STUDY DESIGN:

We conducted a 2x2 factorial, randomized controlled trial in women without diabetes at pregnancy booking, BMI ≥30 kg/m2 and a singleton pregnancy. At 12+0 to 17+6 weeks' gestation, eligible women were randomized to a dietary intervention (four tailored educational sessions at ≤28 weeks' gestation by a community health worker trained in key aspects of pregnancy nutrition plus text messaging until birth) or to routine dietary advice; and to daily capsules containing either (Lactobacillus rhamnosus GG and Bifidobacterium lactis BB12 at 6.5 x109 colony forming units) or placebo, until birth. Analysis was by intention to treat with adjustment for maternal baseline BMI. Infant outcomes were additionally adjusted for ethnicity, sex and gestational age at birth.

RESULTS:

230 women were recruited between April 2015 and June 2017 (dietary intervention N=116 vs routine dietary advice N=114; probiotics N=115 vs placebo N=115). Baseline characteristics and demographic variables were similar across all groups. There was no significant difference between intervention groups, for the co-primary outcomes of a) proportion of women with excessive gestational weight-gain, (dietary intervention versus routine advice: 79/107 (73.8%) vs 90/110 (81.8%), adjusted relative risk (RR_ 0.92, 95% CI 0.80 to 1.05; probiotics versus placebo: 89/108 (82.4%) and 80/109 (73.4%), RR 1.14, 95% CI 0.99 to 1.31) or b) birthweight (dietary intervention versus routine advice: 3,575 vs 3,612 g, adjusted mean difference (MD) -24 g, 95% CI -146 to 97; probiotics vs placebo: 3,685 vs 3,504 g, adjusted MD 107 g, 95% CI -14 to 228). Total maternal weight-gain, a secondary outcome, was lower with dietary intervention compared with routine dietary advice (9.7 vs 11.4 kg, adjusted MD -1.76, 95% CI -3.55 to 0.03). There were no significant differences between intervention groups in other secondary maternal or neonatal outcomes.

CONCLUSION:

Although dietary education and or probiotics did not alter rates of excessive gestational weight-gain or birthweight in this multi-ethnic high deprivation population of pregnant women with obesity, dietary education was associated with a modest reduction in total weight gain with potential future benefit for the health of mothers and their offspring if sustained..

KEYWORDS:

Community health worker; Gestational weight-gain; Probiotics; Text messaging

PMID:
30878323
DOI:
10.1016/j.ajog.2019.03.003

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