Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial
Open accessAbstract
BACKGROUND: Behavioural interventions might improve clinical outcomes in pregnant women who are obese. We aimed to investigate whether a complex intervention addressing diet and physical activity could reduce the incidence of gestational diabetes and large-for-gestational-age infants. METHODS: The UK Pregnancies Better Eating and Activity Trial (UPBEAT) is a randomised controlled trial done at antenatal clinics in eight hospitals in multi-ethnic, inner-city locations in the UK. We recruited pregnant women (15-18 weeks plus 6 days of gestation) older than 16 years who were obese (BMI ≥30 kg/m(2)). We randomly assigned participants to either a behavioural intervention or standard antenatal care with an internet-based, computer-generated, randomisation procedure, minimising by age, ethnic origin, centre, BMI, and parity. The intervention was delivered once a week through eight health trainer-led sessions. Primary outcomes were gestational diabetes (diagnosed with an oral glucose tolerance test and by criteria from the International Association of Diabetes in Pregnancy Study Groups) and large-for-gestational-age infants (≥90th customised birthweight centile). Analysis was by intention to treat. This trial is registered with Current Controlled Trials, ISCRTN89971375. Recruitment and pregnancy outcomes are complete but childhood follow-up is ongoing. FINDINGS: Between March 31, 2009, and June 2, 2014, we assessed 8820 women for eligibility and recruited 1555, with a mean BMI of 36·3 kg/m(2) (SD 4·8). 772 were randomly assigned to standard antenatal care and 783 were allocated the behavioural intervention, of which 651 and 629 women, respectively, completed an oral glucose tolerance test. Gestational diabetes was reported in 172 (26%) women in the standard care group compared with 160 (25%) in the intervention group (risk ratio 0·96, 95% CI 0·79-1·16; p=0·68). 61 (8%) of 751 babies in the standard care group were large for gestational age compared with 71 (9%) of 761 in the intervention group (1·15, 0·83-1·59; p=0·40). Thus, the primary outcomes did not differ between groups, despite improvements in some maternal secondary outcomes in the intervention group, including reduced dietary glycaemic load, gestational weight gain, and maternal sum-of-skinfold thicknesses, and increased physical activity. Adverse events included neonatal death (two in the standard care group and three in the intervention group) and fetal death in utero (ten in the standard care group and six in the intervention group). No maternal deaths were reported. Incidence of miscarriage (2% in the standard care group vs 2% in the intervention group), major obstetric haemorrhage (1% vs 3%), and small-for-gestational-age infants (≤5th customised birthweight centile; 6% vs 5%) did not differ between groups. INTERPRETATION: A behavioural intervention addressing diet and physical activity in women with obesity during pregnancy is not adequate to prevent gestational diabetes, or to reduce the incidence of large-for-gestational-age infants. FUNDING: National Institute for Health Research, Guys and St Thomas' Charity, Chief Scientist Office Scotland, Tommy's Charity.
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Studies that tested the effectiveness of lifestyle interventions provided during pregnancy on GDM have shown mixed results.
“However, studies that tested the effectiveness of lifestyle interventions provided during pregnancy on GDM have shown mixed results [14, 17–21].”
From Effectiveness of pre-pregnancy lifestyle in preventing gestational diabetes mellitus—a systematic review and meta-analysis of 257,876 pregnancies (2023) · cites this paper as [20]
In UPBEAT, GDM and other pregnancy complications were not impacted by the intervention.
“The UPBEAT trial in the UK (2202 participants) had reduction of GDM as the primary outcome and although GWG was reduced by 0.55 kg by the intervention, GDM and other pregnancy complications were not impacted by the intervention. 129”
From Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review (2022) · cites this paper as [129]
The UPBEAT trial in the UK had reduction of GDM as the primary outcome.
“The UPBEAT trial in the UK (2202 participants) had reduction of GDM as the primary outcome and although GWG was reduced by 0.55 kg by the intervention, GDM and other pregnancy complications were not impacted by the intervention. 129”
From Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review (2022) · cites this paper as [129]
In UPBEAT, GWG was reduced by 0.55 kg by the intervention.
“The UPBEAT trial in the UK (2202 participants) had reduction of GDM as the primary outcome and although GWG was reduced by 0.55 kg by the intervention, GDM and other pregnancy complications were not impacted by the intervention. 129”
From Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review (2022) · cites this paper as [129]
The overall analysis found that GWG reductions could greatly exceed those attained by UPBEAT.
“The overall analysis found that GWG reductions could greatly exceed those attained by UPBEAT. 129”
From Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review (2022) · cites this paper as [129]
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- Authors
- Poston, L., Bell, R., Croker, H., Flynn, A. C., Godfrey, K. M., Goff, L., Hayes, L., Khazaezadeh, N., Nelson, S. M., Oteng-Ntim, E., Pasupathy, D., Patel, N., Robson, S. C., Sandall, J., Sanders, T. A. B., Sattar, N., Seed, P. T., Wardle, J., Whitworth, M. K., & Briley, A. L.
- Affiliations
- St Thomas' Hospital (GB)
- Newcastle University (GB)
- University College London (GB)
- King's College London (GB)
- University Hospital Southampton NHS Foundation Trust (GB)
- Guy's and St Thomas' NHS Foundation Trust (GB)
- Glasgow Royal Infirmary (GB)
- British Heart Foundation (GB)
- St Mary's Hospital (GB)
- Corresponding author
- Poston, Lucilla
- ORCID
- Venue
- The Lancet Diabetes & Endocrinology
- Publisher
- Elsevier BV
- Published
- 2015-10
- Volume
- 3
- Issue
- 10
- Pages
- 767-777
- ISSN
- 2213-8587 (ISSN-L)
- OpenAlex
- W1863728472
- Cited by
- 642
- References
- 8
- Citations by year
- 2026: 19 · 2025: 39 · 2024: 42 · 2023: 44 · 2022: 58 · 2021: 64 · 2020: 83 · 2019: 58 · 2018: 84 · 2017: 71 · 2016: 64 · 2015: 13 · 2014: 1
- FWCI
- 88.00
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Lancet Diabetes & Endocrinology (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, cc-by-nc-nd)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- ANU Open Research (Australian National University) (submittedVersion, cc-by-nc-nd)
- UCL Discovery (University College London) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion, cc-by-nc-nd)
- Newcastle University ePrints (Newcastle Univesity) (cc-by-nc-nd)
- Funders
- Cancer Research UK (14133)
- National Institute for Health and Care Research (CL-2010-17-007, FP7/2007–2013, NF-SI-0514-10145, RP-PG-0407-10452, 289346)
- King's College London
- European Commission (2007–2013, FP7 2007-2013, FP7/2007, 289346)
- Norges Forskningsråd (289346)
- Tommy's
- National Institute for Health Research Southampton Biomedical Research Centre (289346)
- Medical Research Council (MR/K02325X/1, MC_UU_12011/4, MR/L002477/1)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- maternal obesity, gestational diabetes mellitus, large for gestational age, behavioral interventions, prenatal care, diet, physical activity, gestational weight gain, pregnancy outcomes, ethnic minority women, inner-city women, gestational hypertension, gestational diabetes screening
- MeSH terms
- Adult, Feeding Behavior, Female, Fetal Macrosomia, Gestational Age, Glucose Tolerance Test, United Kingdom, Humans, Infant, Newborn, Life Style, Motor Activity, Obesity, Pregnancy, Pregnancy Complications, Pregnancy Trimester, Second, Prenatal Care, Weight Gain, Diabetes, Gestational
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