Lifestyle intervention in obese pregnancy and cardiac remodelling in 3-year olds: children of the UPBEAT RCT
Authors: Taylor Paul D. , Gu Haotian , Saunders Hannah , Fiori Federico , Dalrymple Kathryn V. , Sethupathi Priyanka , Yamanouchi Liana , Miller Faith , Jones Bethany , Vieira Matias C. , Singh Claire , Briley Annette , Seed Paul T. , Pasupathy Dharmintra , Santosh Paramala J. , Groves Alan M. , Sinha Manish D. , Chowienczyk Philip J. , Poston Lucilla ,   UPBEAT Consortium, Poston Lucilla , Shennan Andrew , Briley Annette , Singh Claire , Seed Paul , Sandall Jane , Sanders Thomas , Patel Nashita , Flynn Angela , Badger Shirlene , Barr Suzanne , Holmes Bridget , Goff Louise , Hunt Clare , Filmer Judy , Fetherstone Jeni , Scholtz Laura , Tarft Hayley , Lucas Anna , Tekletdadik Tsigerada , Ricketts Deborah , Gill Carolyn , Ignatian Alex Seroge , Boylen Catherine , Adegoke Funso , Lawley Elodie , Butler James , Maitland Rahat , Vieira Matias , Pasupathy Dharmintra , Oteng-Ntim Eugene , Khazaezadeh Nina , Demilew Jill , O’Connor Sile , Evans Yvonne , O’Donnell Susan , Llera Ari de la , Gutzwiller Georgina , Hagg Linda , Robson Stephen , Bell Ruth , Hayes Louise , Kinnunen Tarja , McParlin Catherine , Miller Nicola , Kimber Alison , Riches Jill , Allen Carly , Boag Claire , Campbell Fiona , Fenn Andrea , Ritson Sarah , Rennie Alison , Durkin Robin , Gills Gayle , Carr Roger , Nelson Scott , Sattar Naveed , McSorley Therese , Alba Hilary , Paterson Kirsteen , Johnston Janet , Clements Suzanne , Fernon Maxine , Bett Savannah , Rooney Laura , Miller Sinead , Welsh Paul , Cherry Lynn , Whitworth Melissa , Patterson Natalie , Lee Sarah , Grimshaw Rachel , Hughes Christine , Brown Jay , Hinshaw Kim , Campbell Gillian , Knight Joanne , Farrar Diane , Jones Vicky , Butterfield Gillian , Syson Jennifer , Eadle Jennifer , Wood Dawn , Todd Merane , Khalil Asma , Brown Deborah , Fernandez Paola , Cousins Emma , Smith Melody , Wardle Jane , Croker Helen , Broomfield Laura , Concern Weight , Godfrey Keith , Robinson Sian , Canadine Sarah , Greenwood Lynne 
Published: October 2022

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.