Abstract
BackgroundObesity during pregnancy is associated with adverse outcomes for the offspring and mother. Lifestyle interventions in pregnancy such as antenatal exercise, are proposed to improve both short- and long-term health of mother and child. We hypothesise that regular moderate-intensity exercise during the second half of pregnancy will result in improved maternal and offspring outcomes, including a reduction in birth weight and adiposity in the offspring, which may be protective against obesity in later life.Methods/DesignThe IMPROVE (Improving Maternal and Progeny Risks of Obesity Via Exercise) study is a two-arm parallel randomised controlled clinical trial being conducted in Auckland, New Zealand. Overweight and obese women (BMI ≥25 kg/m2) aged 18–40 years, with a singleton pregnancy of <20 weeks of gestation, from the Auckland region, are eligible for the trial. Exclusion criteria are ongoing smoking or medical contra-indications to antenatal exercise.Participants are randomised with 1:1 allocation ratio to either intervention or control group, using computer-generated randomisation sequences in variable block sizes, stratified on ethnicity and parity, after completion of baseline assessments. The intervention consists of a 16-week structured home-based moderate-intensity exercise programme utilising stationary cycles and heart rate monitors, commencing at 20 weeks of gestation. The control group do not receive any exercise intervention. Both groups undergo regular fetal ultrasonography and receive standard antenatal care. Due to the nature of the intervention, participants are un-blinded to group assignment during the trial.The primary outcome is offspring birth weight. Secondary offspring outcomes include fetal and neonatal body composition and anthropometry, neonatal complications and cord blood metabolic markers. Maternal outcomes include weight gain, pregnancy and delivery complications, aerobic fitness, quality of life, metabolic markers and post-partum body composition.DiscussionThe results of this trial will provide valuable insights on the effects of antenatal exercise on health outcomes in overweight and obese mothers and their offspring.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12612000932864.
Highlights
Obesity during pregnancy is associated with adverse outcomes for the offspring and mother
The main focus of this antenatal exercise trial is on offspring health, with longitudinal assessments of fetal growth and body composition during the intervention period, as well as measures of newborn anthropometry and adiposity
While a number of randomised controlled trials of prescribed antenatal exercise have been conducted over the last three decades, their primary focus has been on maternal health and there is a lack of robust evidence on the effects of antenatal exercise on offspring health (18, 23)
Summary
Obesity during pregnancy is associated with adverse outcomes for the offspring and mother. Maternal overweight and obesity are associated with adverse pregnancy outcomes, including higher risk of gestational diabetes, pre-eclampsia, operative delivery, fetal and perinatal mortality and morbidity, and excessive birth weight [6,7]. It is proposed that offspring obesity may be propagated and enhanced in early life because of the abnormal metabolic milieu in utero in overweight and obese women [13,14]. This raises the potential of in utero therapy to prevent downstream obesity and chronic disease obesity in the offspring, via lifestyle interventions targeting behaviours that lead to altered nutrient partitioning and fetal overgrowth [10,13]
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