Discussion
obesity
OBESITY, CHILDHOOD OBESITY, EARLY PREGNANCY
This current study has shown that there were no differences in any anthropometric or behavioural measures of the 8–10 year old children born to women participating in the LIMIT Trial. However the children remain at high risk of childhood obesity with more than 45% of the entire cohort having a BMI above the 85th percentile for their age and sex. Initial findings of the LIMIT trial showed a significant reduction in the proportion of infants with birth weight > 4 kg following the provision of an antenatal intervention. We have followed and reported health outcome on these children at 6 months [Our findings are concerning for the future risk of obesity of our cohort of children, and are consistent with other cohort studies reported in the literature. A review of longitudinal cohort studies identified that whilst 70% of adults who have obesity did not have obesity in childhood, approximately 55% of children with obesity will have obesity in adolescence and 80% of adolescents with obesity will have obesity in adulthood [There are a number of strengths to our follow-up study. The LIMIT Trial remains the largest RCT to evaluate a diet and lifestyle intervention in pregnant women with overweight and obesity. We have accurately measured early pregnancy weight, height, and BMI; detailed maternal dietary and physical activity history; and consistent provision of the intervention to participants. We have also achieved comprehensive childhood follow-up at multiple time points using robust and well described methodology, including standardised assessment of anthropometric measures, and consistent evaluation of dietary, physical activity, sedentary behaviour, and sleep patterns, all of which are well-recognised early life factors contributing to child overweight and obesity [Our study is not without limitations, including the potential risk of selection bias with data available for 48% of the original LIMIT RCT cohort. However, we do not consider the risk of bias to be significant, with the potential impact on the validity of our findings considered to be low. Baseline and clinical characteristics of women and children for whom data were available and who participated in the follow-up study were similar between the two randomised treatment groups, and similar to the full randomised cohort. (11) We performed analyses through multiple imputation for all children eligible for 8–10 year follow-up (96% of those randomised) to address issues of missing data. The imputation models utilised were robust, incorporating data available from our 6-month [The dietary assessment did not use a questionnaire that had been validated for this age group, therefore description of the diet quality in this cohort should be viewed with caution. In addition, more accurate assessment of physical activity could have been achieved with comprehensive questionnaires or accelerometers, however costs and participant burden were prohibitive at this scale.