The effect of a preconception and antenatal nutritional supplement on children's BMI and weight gain over the first 2 years of life: findings from the NiPPeR randomised controlled trial.

Jaz Lyons-Reid, José G B Derraik, Timothy Kenealy, Benjamin B Albert, J Manuel Ramos Nieves, Cathriona R Monnard, Phil Titcombe, Heidi Nield, Sheila J Barton, Sarah El-Heis, Elizabeth Tham, Keith M Godfrey, Shiao-Yng Chan, Wayne S Cutfield

Journal: The Lancet. Global health 2023;11 Suppl 1():S11-S12

PMID: 36866469

Free Full Text on Elsevier Science View on PubMed

Plain Language Summary

Rapid weight gain in infancy is associated with future adverse metabolic health. Nutrition intervention before and during pregnancy may promote healthy weight gain in infants, however evidence is lacking. The purpose of this study was to see whether preconception and antenatal supplementation effects the size and growth of children from birth until 2 years of age. 1729 women were recruited for the study and divided into two groups. The intervention group took myo-inositol, probiotics and additional micronutrients, the control group took a standard micronutrient supplement. Measurements of weight and length were obtained from 576 children at multiple intervals during the first 2 years of life. Differences in age and sex standardised BMI at age 2 years (WHO standards) and the change in weight from birth were examined. The results show that the infants where the mother took the intervention supplement before and throughout pregnancy had a lower risk of rapid weight gain and high BMI at age 2 years. Long-term follow-up is required to assess the longevity of these benefits.

Abstract

BACKGROUND

Nutritional intervention before and throughout pregnancy might promote healthy infant weight gain; however, clinical evidence is scarce. Therefore, we examined whether preconception and antenatal supplementation would affect the body size and growth of children in the first 2 years of life.

METHODS

Women were recruited from the community before conception in the UK, Singapore, and New Zealand, and randomly allocated to either the intervention (myo-inositol, probiotics, and additional micronutrients) or control group (standard micronutrient supplement) with stratification by site and ethnicity. Measurements of weight and length were obtained from 576 children at multiple timepoints in the first 2 years of life. Differences in age and sex standardised BMI at age 2 years (WHO standards) and the change in weight from birth were examined. Written informed consent was obtained from the mothers, and ethics approval was granted by local committees. The NiPPeR trial was registered with ClinicalTrials.gov (NCT02509988) on July 16, 2015 (Universal Trial Number U1111-1171-8056).

FINDINGS

1729 women were recruited between Aug 3, 2015, and May 31, 2017. Of the women randomised, 586 had births at 24 weeks or more of gestation between April, 2016, and January, 2019. At age 2 years, adjusting for study site, infant sex, parity, maternal smoking, maternal prepregnancy BMI, and gestational age, fewer children of mothers who received the intervention had a BMI of more than the 95th percentile (22 [9%] of 239 vs 44 [18%] of 245, adjusted risk ratio 0·51, 95% CI 0·31-0·82, p=0·006). Longitudinal data revealed that the children of mothers who received the intervention had a 24% reduced risk of experiencing rapid weight gain of more than 0·67 SD in the first year of life (58 [21·9%] of 265 vs 80 [31·1%] of 257, adjusted risk ratio 0·76, 95% CI 0·58-1·00, p=0·047). Risk was likewise decreased for sustained weight gain of more than 1·34 SD in the first 2 years (19 [7·7%] of 246 vs 43 [17·1%] of 251, adjusted risk ratio 0·55, 95% CI 0·34-0·88, p=0·014).

INTERPRETATION

Rapid weight gain in infancy is associated with future adverse metabolic health. The intervention supplement taken before and throughout pregnancy was associated with lower risk of rapid weight gain and high BMI at age 2 years among children. Long-term follow-up is required to assess the longevity of these benefits.

FUNDING

National Institute for Health Research; New Zealand Ministry of Business, Innovation and Employment; Société Des Produits Nestlé; UK Medical Research Council; Singapore National Research Foundation; National University of Singapore and the Agency of Science, Technology and Research; and Gravida.

Address: Liggins Institute, University of Auckland, Auckland, New Zealand. Electronic address: [email protected].; Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Environmental-Occupational Health Sciences and Non-communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.; Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Medicine, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.; Liggins Institute, University of Auckland, Auckland, New Zealand.; Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé, Lausanne, Switzerland.; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.; Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Obstetrics & Gynaecology, National University Hospital, Singapore.; Liggins Institute, University of Auckland, Auckland, New Zealand; A Better Start-National Science Challenge, University of Auckland, Auckland, New Zealand.

DOI: 10.1016/S2214-109X(23)00095-5