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Preventing childhood obesity with combined hypothetical interventions on interpregnancy maternal smoking and weight: applying the parametric g-formula to a UK population-based cohort

Preventing childhood obesity with combined hypothetical interventions on interpregnancy maternal smoking and weight: applying the parametric g-formula to a UK population-based cohort
Preventing childhood obesity with combined hypothetical interventions on interpregnancy maternal smoking and weight: applying the parametric g-formula to a UK population-based cohort
Background
Maternal exposures during pregnancy have been linked to offspring adiposity, and the interpregnancy period is an opportunity to intervene on modifiable risk factors. We considered combinations of interpregnancy interventions and effects on rates of childhood obesity (≥95th centile) in second children.

Methods
We examined records of 5612 women from a population-based cohort of routinely collected antenatal health-care records at University Hospital Southampton (2003–2014), linked to measured child body-mass index (BMI) at age 4–5 years from the National Childhood Measurement Programme. We applied the parametric g-formula to estimate the effects of interventions between first (P1) and second (P2) pregnancies and to calculate estimated second child obesity and population risk ratio reduction (PRRR), compared with the estimated natural-course scenario (without intervention). Analysis was undertaken using the gfoRmula package in R This analysis is part of the SLOPE study which has been approved by the National Health Service Health Research Authority.

Findings
Observed frequency of obesity in the second child at age 4–5 years was 8·5% (479 of 5612 children). We estimated that if all mothers started P2 with a BMI of 18·5–24·9 kg/m2 and all smokers stopped smoking by confirmation of P2, then, compared with a natural course estimate of 8·3% (95% CI 7·6–9·1), there would be a PRRR of second child obesity of 25·8% (21·0–30·8) to a second child obesity prevalence of 6·2% (5·5–7·0). For mothers who started P1 with BMI 18·5–24·9 kg/m2, if all smokers stopped smoking, then, compared with a natural course estimate of 5·9% (5·0–6·7), there would be a PRRR of second child obesity of 16·6% (10·0–23·2) to a prevalence of 4·9% (4·1–5·7). If BMI was also maintained between 18·5 and 24·9 kg/m2 there would be a PRRR of 21·3% (15·3–28·2) to a prevalence of 4·6% (3·9–5·4). For mothers who started P1 with BMI of 30 kg/m2 or greater, if weight was reduced to being either 18·5–24·9 kg/m2 or 25–29·9 kg/m2 by the start of P2, then, compared with a natural course estimate of 17·7% (15·1–20·9), there would be PRRRs of second child obesity of 29·4% (4·7–53·4) to a prevalence of 12·5% (8·3–17·4) and 17·6% (2·6–35·1) to a prevalence of 14·6% (11·1–17·7), respectively.

Interpretation
Interventions between pregnancies could reduce obesity rates in the second child, with the most effective interventions varying by maternal BMI during the first pregnancy.
Taylor, Elizabeth
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Ziauddeen, Nida
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Godfrey, Keith
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Berrington, Ann
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Alwan, Nisreen
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Taylor, Elizabeth
880bd662-b8bb-46a2-8db1-7fe31bd540ae
Ziauddeen, Nida
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Godfrey, Keith
0931701e-fe2c-44b5-8f0d-ec5c7477a6fd
Berrington, Ann
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Alwan, Nisreen
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Taylor, Elizabeth, Ziauddeen, Nida, Godfrey, Keith, Berrington, Ann and Alwan, Nisreen (2021) Preventing childhood obesity with combined hypothetical interventions on interpregnancy maternal smoking and weight: applying the parametric g-formula to a UK population-based cohort. Lancet 2021 Public Health Science Conference. 1 pp . (doi:10.1016/S0140-6736(21)02627-1).

Record type: Conference or Workshop Item (Other)

Abstract

Background
Maternal exposures during pregnancy have been linked to offspring adiposity, and the interpregnancy period is an opportunity to intervene on modifiable risk factors. We considered combinations of interpregnancy interventions and effects on rates of childhood obesity (≥95th centile) in second children.

Methods
We examined records of 5612 women from a population-based cohort of routinely collected antenatal health-care records at University Hospital Southampton (2003–2014), linked to measured child body-mass index (BMI) at age 4–5 years from the National Childhood Measurement Programme. We applied the parametric g-formula to estimate the effects of interventions between first (P1) and second (P2) pregnancies and to calculate estimated second child obesity and population risk ratio reduction (PRRR), compared with the estimated natural-course scenario (without intervention). Analysis was undertaken using the gfoRmula package in R This analysis is part of the SLOPE study which has been approved by the National Health Service Health Research Authority.

Findings
Observed frequency of obesity in the second child at age 4–5 years was 8·5% (479 of 5612 children). We estimated that if all mothers started P2 with a BMI of 18·5–24·9 kg/m2 and all smokers stopped smoking by confirmation of P2, then, compared with a natural course estimate of 8·3% (95% CI 7·6–9·1), there would be a PRRR of second child obesity of 25·8% (21·0–30·8) to a second child obesity prevalence of 6·2% (5·5–7·0). For mothers who started P1 with BMI 18·5–24·9 kg/m2, if all smokers stopped smoking, then, compared with a natural course estimate of 5·9% (5·0–6·7), there would be a PRRR of second child obesity of 16·6% (10·0–23·2) to a prevalence of 4·9% (4·1–5·7). If BMI was also maintained between 18·5 and 24·9 kg/m2 there would be a PRRR of 21·3% (15·3–28·2) to a prevalence of 4·6% (3·9–5·4). For mothers who started P1 with BMI of 30 kg/m2 or greater, if weight was reduced to being either 18·5–24·9 kg/m2 or 25–29·9 kg/m2 by the start of P2, then, compared with a natural course estimate of 17·7% (15·1–20·9), there would be PRRRs of second child obesity of 29·4% (4·7–53·4) to a prevalence of 12·5% (8·3–17·4) and 17·6% (2·6–35·1) to a prevalence of 14·6% (11·1–17·7), respectively.

Interpretation
Interventions between pregnancies could reduce obesity rates in the second child, with the most effective interventions varying by maternal BMI during the first pregnancy.

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Published date: 1 November 2021
Venue - Dates: Lancet 2021 Public Health Science Conference, 2021-11-26

Identifiers

Local EPrints ID: 452836
URI: http://eprints.soton.ac.uk/id/eprint/452836
PURE UUID: c86a58de-afef-409b-ab5f-6ac759ce58aa
ORCID for Elizabeth Taylor: ORCID iD orcid.org/0000-0002-7680-2865
ORCID for Nida Ziauddeen: ORCID iD orcid.org/0000-0002-8964-5029
ORCID for Keith Godfrey: ORCID iD orcid.org/0000-0002-4643-0618
ORCID for Ann Berrington: ORCID iD orcid.org/0000-0002-1683-6668
ORCID for Nisreen Alwan: ORCID iD orcid.org/0000-0002-4134-8463

Catalogue record

Date deposited: 21 Dec 2021 17:52
Last modified: 23 Mar 2022 02:54

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Contributors

Author: Elizabeth Taylor ORCID iD
Author: Nida Ziauddeen ORCID iD
Author: Keith Godfrey ORCID iD
Author: Ann Berrington ORCID iD
Author: Nisreen Alwan ORCID iD

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