Aims of the study
- To determine the effect of the UPBEAT (RCT) on childhood cardiovascular and metabolic function at 10 years of age.
- To define relationships between in utero exposures, postnatal depression and childhood cardiovascular outcomes, with appropriate adjustment for environmental factors such as child’s diet physical activity and socioeconomic status.
The study will provide evidence to support public health policy around the management of obesity in pregnancy, particularly prevalent in south London and towards a life-course approach to prevention of cardiovascular and metabolic disease, such as high blood pressure and type 2 diabetes in the next generation.
How the study will be carried out
The research team will track cardiovascular and metabolic risk in UPBEAT children at 10 years of age to determine whether the positive effects of the intervention persist. They will carry out deep cardiovascular phenotyping (looking at genetic traits) in UPBEAT children. Measures will include cardiac function (echocardiography [ECG]), intima-media thickness, arterial stiffness (vascular ultrasound), blood pressure and heart rate variability (HRV). The role of the maternal metabolome, infant epigenome, shared family environment, diet, childhood physical activity and adiposity (how much fatty tissue is in the body) will be assessed as potential mediators/confounders in any relationships between maternal obesity and childhood cardiovascular function observed. Blood samples will be stored for future metabolic phenotyping. Measures will include BMI (weight and height), maternal diet (FFQ), eating behaviours, clinical history and Edinburgh postnatal depression scale questionnaire.
How patients and the public are involved in this research
The UPBEAT PPI group (UPBEAT Women’s Group, n=20) will be consulted from the start of the study until completion, this will include online questionnaires and focus groups. The focus groups will be consulted on the study design and participant involvement. They will also be involved in development of an UPBEAT video which will be played to all UPBEAT families at the hospital study visit when assessments are carried out. The premise of this video will be to illustrate the research procedures that will take place during the visit to the mothers and children.
This is a multi-centre study lead by King’s College London and involving Glasgow Royal Infirmary, Newcastle Royal Infirmary and St Mary’s Hospital, Manchester.
Potential benefits of the study
This study will provide unique insights into the relationship between maternal metabolic health in pregnancy and cardiovascular risk in the child. The in-depth phenotyping of this large and unique cohort of children has several potentially important outcomes. Firstly, it will either provide strong evidence for or against the primary hypothesis that maternal obesity is an independent determinant of cardiovascular risk in children.
Secondly it will address the relevance of rodent models of maternal obesity to the human condition regarding developmental origins of cardiovascular disease, particularly regarding autonomic control of blood pressure. If proven this will provide support to the mechanisms, we and others have extensively characterised in these models.
Thirdly, and of the most importance, should a maternal intervention of a low glycaemic index diet and physical activity continue to reduce cardiovascular risk in children of obese women, this study will provide new insights into the early origins of cardiovascular disease, and directly inform public health strategies to improve the cardiovascular health of the next generation.
This 3-year study is funded by the British Heart Foundation. It was adopted by ARC South London Executive in January 2022 and will be completed by March 2025.