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

Lookup NU author(s): Professor Steve RobsonORCiD, Dr Ruth Bell, Dr Louise HayesORCiD, Dr Tarja Kinnunen, Cath McParlin, Dr Nicola Miller, Jill Riches, Dr Fiona CampbellORCiD, Andrea Fenn



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2022, The Author(s).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.

Publication metadata

Author(s): 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, Poston L, Shennan A, Briley A, Singh C, Seed P, Sandall J, Sanders T, Patel N, Flynn A, Badger S, Barr S, Holmes B, Goff L, Hunt C, Filmer J, Fetherstone J, Scholtz L, Tarft H, Lucas A, Tekletdadik T, Ricketts D, Gill C, Ignatian AS, Boylen C, Adegoke F, Lawley E, Butler J, Maitland R, Vieira M, Pasupathy D, Oteng-Ntim E, Khazaezadeh N, Demilew J, O'Connor S, Evans Y, O'Donnell S, Llera A, Gutzwiller G, Hagg L, Robson S, Bell R, Hayes L, Kinnunen T, McParlin C, Miller N, Kimber A, Riches J, Allen C, Boag C, Campbell F, Fenn A, Ritson S, Rennie A, Durkin R, Gills G, Carr R, Nelson S, Sattar N, McSorley T, Alba H, Paterson K, Johnston J, Clements S, Fernon M, Bett S, Rooney L, Miller S, Welsh P, Cherry L, Whitworth M, Patterson N, Lee S, Grimshaw R, Hughes C, Brown J, Hinshaw K, Campbell G, Knight J, Farrar D, Jones V, Butterfield G, Syson J, Eadle J, Wood D, Todd M, Khalil A, Brown D, Fernandez P, Cousins E, Smith M, Wardle J, Croker H, Broomfield L, Concern W, Godfrey K, Robinson S, Canadine S, Greenwood L

Publication type: Article

Publication status: Published

Journal: International Journal of Obesity

Year: 2022

Volume: 46

Pages: 2145-2155

Print publication date: 01/12/2022

Online publication date: 12/10/2022

Acceptance date: 05/08/2022

Date deposited: 23/06/2023

ISSN (print): 0307-0565

ISSN (electronic): 1476-5497

Publisher: Springer Nature


DOI: 10.1038/s41366-022-01210-3

PubMed id: 36224375


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Funder referenceFunder name
British Heart Foundation
European Union’s 7th Framework Programme
Tommy’s charity