Maternal obesity and offspring health Nutritional, Metabolic, Endocrine Obesity
Conditions
Interventions
Standard Care Control Group:
Those women randomised to standard care will receive the normal prenatal care as recommended by their health care practitioner and Health Canada's "A Sensible Guide to a
Sponsors
Children?s Hospital of Eastern Ontario Research Institute (CHEORI) (Canada)
Eligibility
Sex/Gender
Female
Inclusion criteria
Inclusion criteria: Current inclusion criteria as of 03/08/2012: 1. Normal weight, overweight or obese pregnant women (pre-pregnancy BMI greater than 18.5 kg/m2) 2. Aged 18 years or older 3. Known to be carrying a singleton foetus 4. Plans to deliver locally and keep the infant 5. Given medical clearance by their health care provider, based on their PARmed-X for Pregnancy questionnaire Previous inclusion criteria until 03/08/2012 1. Overweight or obese pregnant primparous (i.e., first-time mothers) women (pre-pregnancy BMI greater than 25 kg/m^2)
Exclusion criteria
Exclusion criteria: 1. Smokers 2. Have medical conditions that might impact body weight (untreated thyroid disease, insulin treated diabetes, hypertension requiring medication) 3. Have known contraindications to exercise as outlined in the joint Society of Obstetricians and Gynaecologists of Canada (SOGC)/ Canadian Society for Exercise Physiology (CSEP) clinical practice guidelines 4. Present absolute contraindications such as: 4.1. Ruptured membranes 4.2. Preterm labour 4.3. Hypertensive disorders of pregnancy 4.4. Incompetent cervix 4.5. Restricted foetal growth 4.6. Placental previa after 28th week 4.7. Persistent 2nd or 3rd trimester bleeding 4.8. Any serious cardiovascular, respiratory or systemic disorder 5. Presenting the following relative contraindications: 5.1. Second trimester abortion or greater than two abortions 5.2. Moderate/significant cardiovascular or respiratory disorders 5.3. Anaemia (Hb less than 100 g/L) 5.4. Malnutrition/eating disorder 5.5. Twin pregnancy after 28th week 5.6. Any other significant medical condition Warning signs to terminate exercise while pregnant include vaginal bleeding, significant dyspnoea prior to exertion, dizziness, headache, chest pain, muscle weakness, calf pain or swelling (rule out thrombophlebitis), preterm labour, and amniotic fluid leakage.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 1. Gestational weight gain will be calculated by subtracting weight at the first prenatal visit in the first trimester from weight at her last prenatal visit before delivery. This will be logged as an absolute value. We will also record the average weekly weight gain to account for the variable length of the observation period (i.e., gestational age at recruitment and delivery). 2. Infant birth weight (grams) will be obtained from obstetrical records and recorded as a continuous variable in grams and further categorised as: 2.1. Small for gestational age (less than 10th percentile) 2.2. Normal for gestational age 2.3. Large for gestational age otherwise known as macrosomia (birth weight greater than 90th percentile), based on weeks gestation | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. GWG will be further categorised as gaining less than recommended, the recommended amount, or more than recommended according to the IOM gestational weight gain guidelines. For obese women, the upper limit of the recommended range will be set at 11.5 kg. Weight will also be measured at the end of each trimester over the course of the intervention to monitor the pattern of weight gain. 2. Data on other complications during pregnancy or delivery will be obtained as recorded at prenatal visits and from obstetrical records during delivery: 2.1. Gestational Diabetes (Yes or No) will be defined as an abnormal glucose tolerance test (2-hour 75 g glucose tolerance test [GTT] after fasting with sampling at 0 hours, 1 hour and 2 hours) following initial screening collected through prenatal obstetrical records 2.2. Pre-eclampsia (Yes or No) will be defined as: systolic blood pressure greater than 140 mm Hg or diastolic greater than 90 mm Hg on at least two readings and/or the presence of HEELP syndrome (haemolysis, elevated liver enzymes, and lowered platelets) 2.3. Instrumental delivery collected through obstetrical records (vacuum, forceps etc.) 2.4. C-section collected through obstetrical records (yes or no, scheduled or emergent) 2.5. NICU admission collected through obstetrical records 2.6. Foetal distress collected through obstetrical records 2.7. Low APGAR (less than or equal to 3 at 5 minutes) scores collected through obstetrical records 3. Biomarkers: As it is exceptionally difficult, and in most cases not possible to actually measure the intrauterine environment in humans we will take blood samples, at study intake and at the end of each trimester, to measure biomarkers as surrogates of intrauterine environment. Foetal growth is largely determined by nutrient transfer across the placenta, which is dependent on maternal nutrient levels and placenta transport capacity. Hormones such as insulin, leptin, and insulin-like growth factor-1 (IGF-1) have been shown to sti | — |
Countries
Canada
Outcome results
None listed