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PRE-Pregnancy Weight Loss And the Reducing Effect on CHILDhood Overweight - Copenhagen (PREPARE CHILD)

Primary Purpose

Overweight and Obesity, Weight Loss, Pregnancy Related

Status
Recruiting
Phase
Not Applicable
Locations
Denmark
Study Type
Interventional
Intervention
Weight loss intervention
Sponsored by
Christian Mølgaard
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Overweight and Obesity

Eligibility Criteria

18 Years - 38 Years (Adult)All SexesAccepts Healthy Volunteers

Maternal inclusion Criteria: Maternal pre-pregnancy BMI 27.0-44.9 kg/m^2 Maternal age range 18-38 years Connected to Hvidovre Hospital as place of birth Not pregnant or breastfeeding Paternal Inclusion Criteria: Paternal pre-pregnancy BMI 18.5-44.9 kg/m^2 Paternal age range 18-55 years Parental Inclusion Criteria: Couples (male and female) Planning pregnancy within 1 year Provided voluntary informed consent Danish or English speaking Intention to permit the planned offspring to participate in the follow-up study Able to store biological samples from the offspring at home in the freezer in a box given by the study personnel Parental Exclusion Criteria: Diabetes mellitus (Type 1 or 2) Previous or present eating disorder Allergy towards ingredients in the very low calorie diet products Severe heart, liver or kidney disease Conception by in vitro fertilization ≥4 consecutive spontaneous pregnancy loss (female) Having tried to conceive or prior time to pregnancy of more than 12 months Any medical condition or concomitant medication as judged by the medical responsible Adherence to vegan diets or other diets interfering with the dietary guidelines in the study Participation in other clinical trial Engagement in elite sports or similar strenuous exercise ≥5 h/week Blood donation or transfusion within the past month before baseline Blood donation during the study Inability or unwillingness to follow the study protocol and instructions given by the study personnel Pregnancy registered at baseline visit (urinary analysis with dipstick) A detailed description of the exclusion criteria is given below: Medical conditions as known by the participant: Diabetes mellitus (type 1 and 2) History or diagnosis of eating disorder (e.g. restrained eating, disinhibition, emotional eating) Any significant medical condition as assessed by the investigator (e.g. dysregulated thyroid disease or reproductive diseases) Any significant psychiatric disorder (i.e. schizophrenia, bipolar disease or depression) as assessed by the investigator Severe chronic heart, liver and kidney disease Polycystic ovary syndrome with irregular cycle Amenorrhea Severely reduced semen quality incl. azoospermia Medication: - Current use of medication or use within the previous three months with a potential to affect body weight or pregnancy as judged by the investigator (e.g. systemic corticoids) Personal/other: Having tried to conceive or prior time to pregnancy of more than 12 months Weight changes ± 5% three months prior to inclusion Severe food allergies, food intolerances or dislike expected to interfere with the study, including allergy towards ingredients in the VLCD products Engagement in elite sports or similar strenuous exercise ≥5 h/week Blood donation or transfusion within the past month before baseline Planned blood donation for other purpose than this study during participation Alcohol abuse, as judged by the investigator, within the previous 12 months Drug abuse, as judged by the investigator, within the previous 12 months Psychological or behavioral problems which, in the judgement of the investigator, would lead to difficulty in complying with the study protocol Participation in other clinical trials within the past three months or intention to do so during the study, which are judged by the investigator to affect the present study Unable to consume the interventional product for religious reasons, swallowing disorders, other physiological reasons or any other reasons for not being able to follow the recommended diet Inability or unwillingness to give written informed consent or communicate with study personnel Inability or unwillingness to follow the study protocol and instructions given by the study personnel Illiteracy or inadequate understanding of Danish or English language. Any other condition that judged by the investigator may interfere with the adherence to the study protocol

Sites / Locations

  • University of CopenhagenRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

Intervention

Standard of care

Arm Description

Rapid moderate weight loss (at least 10% of body weight at baseline over 8-10 weeks or BMI 23 kg/m^2 is achieved) by very low-calorie diet (VLCD), reintroduction (4 weeks), weight loss maintenance until pregnancy (up to 12 months), and a high protein, high fiber diet during pregnancy (n=120 couples).

The control group will not receive any dietary advice prior to pregnancy. During pregnancy control subjects will receive dietary advice similar to the intervention group, i.e. a high protein, high fiber diet (n=120 couples).

Outcomes

Primary Outcome Measures

Neonatal fat mass
Offspring's neonatal fat mass (grams) assessed by air displacement plethysmography (Pea POD)

Secondary Outcome Measures

Obstetrics outcome - length of gestational age
Length of gestational age.
Obstetric - medication use
Medication use during labor
Obstetric - delivery mode
Delivery mode (rupture of membranes or premature contractions, vaginal, cesarean section, instrumental delivery, miscarriage and stillbirth).
Obstetric - pregnancy complications
Pregnancy complications e.g. miscarriage, abortion (induced and indication for abortion), hydramnios, gestational hypertension, preeclampsia, need for maternal corticosteroid treatment for fetal lung maturation, urinary tract infection).
Obstetric - Neonatal unit admissions
Neonatal unit admissions.
Obstetric - obstetrics complications
Obstetrics complications (e.g. preterm prelabour rupture of the membranes, shoulder dystocia, birth trauma (perinatal rupture), postpartum hemorrhage, maternal infections, maternal hospitalization).
Obstetrics - birth defects/abnormalities
Birth defects/abnormalities
Neonatal morbidities
Neonatal morbidity (e.g. major congenital malformations (ICD10 Q00-Q99 or requiring medical or surgical treatment), birth injury, respiratory distress, transient tachypnoea, neonatal hypoglycemia, systemic infections, admission to neonatal intensive care unit, number of admission days, hyperbilirubinemia), deaths.
Fetal and offspring growth - body weight
Fetal body weight will be measured with ultrasound during pregnancy and offspring body weight will be measured using an electronic scale.
Fetal and offspring growth - length
Fetal length will be measured with ultrasound during pregnancy and offspring length will be measured using using an infantometer as appropriate for measuring infant, baby and toddler length.
Fetal and offspring growth - abdominal circumference
Abdominal circumference will be measured with ultrasound during pregnancy and offspring abdominal circumference will be measured three times to the nearest 0.1 cm using a stretch-resistant measuring tape
Fetal and offspring growth - crown circumference
Crown circumference will be measured with ultrasound during pregnancy and offspring crown circumference will be measured three times to the nearest 0.1 cm using a stretch-resistant measuring tape
Fetal and offspring growth - femur length
Femur length will be measured with ultrasound during pregnancy and offspring thigh will be measured three times to the nearest 0.1 cm using a stretch-resistant measuring tape.
Fetal growth - fractional limb volume
Fractional limb volume will be measured with ultrasound during pregnancy.
Offspring growth - BMI z-score
Offspring body mass index (BMI) z-score (BMI adjusted for age and sex).
Offspring growth - weight for gestational age
Weight for gestational age. Measured as percent of normal weight related to gestational age.
Offspring growth - large for gestational age
Large for gestational age. Prevalence of infants being LGA.
Offspring growth - small for gestational age
Small for gestational age. Prevalence of offspring being small for gestational age (SGA).
Offspring growth - apgar score
Apgar score (0-10). The higher the score, the better health condition of the offspring)
Offspring growth
Offspring circumference (upper arm and hip) and 5 points skinfold (bi- and triceps, subscapularis, belly and waist). Circumferences will be measured to the nearest 0.1 cm using a stretch-resistant measuring tape and skinfolds are measured to the nearest 0.02 cm using a caliper to lightly pinch the skin and the underlying fat
Offspring growth - body composition by the POD system
Offspring fat free mass (g) and fat mass (g) will be assessed by air displacement plethysmography using the POD system (either the Pea POD or the Bod POD system depending on the most appropriate for age)
Offspring growth - body composition by DEXA scan
Offspring fat free mass (g) and fat mass (g) will be assessed by a Dual-energy X-ray absorptiometry-scan (DEXA).
Offspring growth - bone markers by DEXA scan
Offspring bone area (cm^2), bone mineral density (g/cm^2) and bone mineral content (g) will be assessed by a Dual-energy X-ray absorptiometry-scan (DEXA).
Offspring blood pressure
Offspring blood pressure (diastolic and systolic blood pressure) will be measured three times after 5-10 minutes rest using an automated device placed on the arm and in direct contact with the skin.
Offspring heart rate
Offspring heart rate will be measured three times after 5-10 minutes rest using an automated device placed on the arm and in direct contact with the skin.
Offspring growth - self-reported body weight
Self-reported body weight
Offspring growth - self-reported height
Self-reported height
Adult weight
Adult body weight is measured to the nearest 0.1 kg using a calibrated scale
Adult self-reported body weight (control group)
The control group will be instructed to self-report their body weight in a fasting state (no food or drink besides a maximum of 500 mL of water from 10 pm the night before) by using their own personal weight scale at home after having emptied their bladder at time point 9 and approximately monthly from time point 9 until registration of pregnancy.
Adult Height
Adult height will be measured to the nearest 0.5 cm using a wall-mounted stadiometer.
Adult BMI
Calculated ad weight (kg)/height(m)^2
Adult anthropometric
Waist- and hip circumference will be measured to the nearest 0.5 cm. During pregnancy and at birth the waist of the female will not be measured.
Adult body composition by DEXA scan
Lean mass (g), fat mass (g), abdominal fat (g), visceral fat (g) assessed by a Dual-energy X-ray absorptiometry-scan.
Adult bone markers by DEXA scan
Bone area (cm^2), bone mineral density (g/cm^2) and bone mineral content (g) assessed by a Dual-energy X-ray absorptiometry-scan.
Adult blood pressure
Blood pressure (diastolic and systolic blood pressure) will be measured three times with two minutes apart after 5-10 minutes rest using a validated automatic device.
Adult heart rate
Heart rate will be measured three times with two minutes apart after 5-10 minutes rest using a validated automatic device.
Adult resting metabolic rate
Resting metabolic rate (calories/24-h) and respiratory quotient will be measured by indirect calorimetry using a ventilated hood system. Participants will lie in the supine position and rest for at least 5 min before measurements commence. The measurement will be performed twice and last for 25 min with 5 min between measurements.
Adult resting respiratory quotient
Resting respiratory quotient will be measured by indirect calorimetry using a ventilated hood system. Participants will lie in the supine position and rest for at least 5 min before measurements commence. The measurement will be performed twice and last for 25 min with 5 min between measurements.
Adult medication use
Use of medication will be collected throughout the study.
Offspring medication use
Use of medication will be collected throughout the study.
Adult reproduction - Time to pregnancy
Duration of time to conception defined from time point allowed to conceive to registration of pregnancy.
Adult reproduction - Success rate
Success rate of pregnancy defined as number of achieved pregnancies.
Reproduction (male) - Sperm motility
Sperm motility (%).
Reproduction (male) - Sperm concentration
Concentration (in million sperm cells/ml).
Reproduction (male) - Sperm morphology
Morphology (%).
Reproduction (male) - Sperm acrosomal status
Acrosomal status (%).
Reproduction (male) - Sperm DNA fragmentation
DNA fragmentation (%)
Adult glucose metabolism (OGTT, only female)
2-h oral glucose tolerance test (OGTT) will be performed at gestational age~20 and ~28 or only ~28.
Adult glucose metabolism (CGM, only female)
A continuous glucose monitoring system will be attached to the designated area on the upper body as stated by the manufacture.
Adult glucose metabolism
All blood samples will be collected by venous puncture in the antecubital vein after an overnight fast from at least 10 pm the night before. Samples will be analysed for fasting glucose, insulin, C-peptide and HbA1c
Adult lipid profile
All blood samples will be collected by venous puncture in the antecubital vein after an overnight fast from at least 10 pm the night before. Samples will be analysed for triglycerides, low-density lipoprotein (LDL), high-density lipoprotein (HDL), very-low-density lipoprotein VLDL and total cholesterol
Adult inflammation markers
All blood samples will be collected by venous puncture in the antecubital vein after an overnight fast from at least 10 pm the night before. Samples will be analysed for hsCRP, Tumor necrosis factor alpha (TNF-α) and interleukin (IL6).
Offspring glucose metabolism
Total amount of venous blood will be drawn at 6-, 12- and 18-months follow-up visit. Parents will be instructed that the offspring should not have eaten two hours prior to the assessment. Samples will be analysed for glucose, insulin, C-peptide and HbA1c
Offspring lipid profile
Total amount of venous blood will be drawn at 6-, 12- and 18-months follow-up visit. Parents will be instructed that the offspring should not have eaten two hours prior to the assessment. Samples will be analysed for triglycerides, LDL, HDL, VLDL and total cholesterol.
Offspring inflammation markers
Total amount of venous blood will be drawn at 6-, 12- and 18-months follow-up visit. Parents will be instructed that the offspring should not have eaten two hours prior to the assessment. Samples will be analysed for hsCRP, TNF-α and IL6.
Offspring growth factors and hormones
Total amount of venous blood will be drawn at 6-, 12- and 18-months follow-up visit. Parents will be instructed that the offspring should not have eaten two hours prior to the assessment. Samples will be analysed for Insulin-like Growth Factor 1 (IGF-1) and growth hormone (GH).

Full Information

First Posted
November 3, 2022
Last Updated
August 4, 2023
Sponsor
Christian Mølgaard
Collaborators
Dept. of Obstetrics and Gynecology, Hvidovre Hospital, Denmark, Department of Growth and Reproduction Rigshospitalet, Denmark, Center for Healthy Childhood, Denmark, University of Copenhagen
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1. Study Identification

Unique Protocol Identification Number
NCT05621109
Brief Title
PRE-Pregnancy Weight Loss And the Reducing Effect on CHILDhood Overweight - Copenhagen
Acronym
PREPARE CHILD
Official Title
PRE-Pregnancy Weight Loss And the Reducing Effect on CHILDhood Overweight - a Randomized Controlled Study in Copenhagen
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
December 15, 2022 (Actual)
Primary Completion Date
December 31, 2027 (Anticipated)
Study Completion Date
December 31, 2032 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Christian Mølgaard
Collaborators
Dept. of Obstetrics and Gynecology, Hvidovre Hospital, Denmark, Department of Growth and Reproduction Rigshospitalet, Denmark, Center for Healthy Childhood, Denmark, University of Copenhagen

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The study is a single site parallel randomized controlled study. The study will be assessing the effect of a 10% weight loss intervention vs a control group among healthy couples where the prospective mother is overweight or obese (BMI 27-45 kg/m^2) and between 18-38 years. The investigators will recruit a total of 240 healthy couples who will be randomized 1:1 to either intervention or control, stratified according to maternal pre-pregnancy BMI. The overall objective is to test whether a comprehensive pre-conceptional parental weight loss intervention effectively reduces the risk of offspring overweight and adiposity and its complications compared to a control group. The investigators hypothesize that parental weight loss intervention, initiated before conception, will facilitate lower parental insulin resistance, inflammation, body weight and adiposity, incretin responses compared to usual care. For the offspring the investigators hypothesize that the intervention will reduce adverse pregnancy outcomes with a reduction in offspring neonatal adiposity, reduced risk of being born large for gestational age (LGA) and with lower BMI z-score at 18 months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Overweight and Obesity, Weight Loss, Pregnancy Related

7. Study Design

Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Care Provider
Allocation
Randomized
Enrollment
480 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Intervention
Arm Type
Experimental
Arm Description
Rapid moderate weight loss (at least 10% of body weight at baseline over 8-10 weeks or BMI 23 kg/m^2 is achieved) by very low-calorie diet (VLCD), reintroduction (4 weeks), weight loss maintenance until pregnancy (up to 12 months), and a high protein, high fiber diet during pregnancy (n=120 couples).
Arm Title
Standard of care
Arm Type
No Intervention
Arm Description
The control group will not receive any dietary advice prior to pregnancy. During pregnancy control subjects will receive dietary advice similar to the intervention group, i.e. a high protein, high fiber diet (n=120 couples).
Intervention Type
Behavioral
Intervention Name(s)
Weight loss intervention
Intervention Description
Subjects will receive very low-calorie diet for 8-10 weeks to introduce a rapid weight loss of at least 10%. Once target weight is achieved, participants will be reintroduced to foods to introduce weight stability. The male will follow the maternal randomization, i.e. weight loss if BMI ≥25 until a BMI of 23 or a weight loss of at least 10% is obtained. During weight loss maintenance, subjects will receive dietary counseling to follow a diet high in protein (corresponding to 22-25E%), high fiber and wholegrain while fulfilling the requirements for essential fatty acids, micronutrients and trace elements in accordance with Nordic Nutrition Recommendations (NNR) 2012. Throughout the study period participants will be encouraged to follow the official recommendations for physical activity as recommended by the Danish health authorities 2022.
Primary Outcome Measure Information:
Title
Neonatal fat mass
Description
Offspring's neonatal fat mass (grams) assessed by air displacement plethysmography (Pea POD)
Time Frame
Assessed at birth (strived <24 hours, but allow <48 hours)
Secondary Outcome Measure Information:
Title
Obstetrics outcome - length of gestational age
Description
Length of gestational age.
Time Frame
Assessed at birth of offspring.
Title
Obstetric - medication use
Description
Medication use during labor
Time Frame
Collected from initiation of labor until completed birth of offspring.
Title
Obstetric - delivery mode
Description
Delivery mode (rupture of membranes or premature contractions, vaginal, cesarean section, instrumental delivery, miscarriage and stillbirth).
Time Frame
Collected at birth of offspring.
Title
Obstetric - pregnancy complications
Description
Pregnancy complications e.g. miscarriage, abortion (induced and indication for abortion), hydramnios, gestational hypertension, preeclampsia, need for maternal corticosteroid treatment for fetal lung maturation, urinary tract infection).
Time Frame
Collected at registration of pregnancy, in gestational age (GA) 8, GA13, GA20, GA28, GA36 and GA39).
Title
Obstetric - Neonatal unit admissions
Description
Neonatal unit admissions.
Time Frame
Collected at birth and until 6 months after birth of offspring.
Title
Obstetric - obstetrics complications
Description
Obstetrics complications (e.g. preterm prelabour rupture of the membranes, shoulder dystocia, birth trauma (perinatal rupture), postpartum hemorrhage, maternal infections, maternal hospitalization).
Time Frame
Collected at birth of offspring
Title
Obstetrics - birth defects/abnormalities
Description
Birth defects/abnormalities
Time Frame
Collected at birth of offspring
Title
Neonatal morbidities
Description
Neonatal morbidity (e.g. major congenital malformations (ICD10 Q00-Q99 or requiring medical or surgical treatment), birth injury, respiratory distress, transient tachypnoea, neonatal hypoglycemia, systemic infections, admission to neonatal intensive care unit, number of admission days, hyperbilirubinemia), deaths.
Time Frame
Collected at birth of offspring
Title
Fetal and offspring growth - body weight
Description
Fetal body weight will be measured with ultrasound during pregnancy and offspring body weight will be measured using an electronic scale.
Time Frame
Collected in gestational age (GA)11-13, GA19-21 and GA28, at birth and 3, 6, 12 and 18 months after birth.
Title
Fetal and offspring growth - length
Description
Fetal length will be measured with ultrasound during pregnancy and offspring length will be measured using using an infantometer as appropriate for measuring infant, baby and toddler length.
Time Frame
Collected in gestational age (GA) 11-13, GA19-21 and GA28, at birth and 3, 6, 12 and 18 months after birth.
Title
Fetal and offspring growth - abdominal circumference
Description
Abdominal circumference will be measured with ultrasound during pregnancy and offspring abdominal circumference will be measured three times to the nearest 0.1 cm using a stretch-resistant measuring tape
Time Frame
Collected in gestational age (GA) 11-13, GA19-21 and GA28, at birth and 3, 6, 12 and 18 months after birth.
Title
Fetal and offspring growth - crown circumference
Description
Crown circumference will be measured with ultrasound during pregnancy and offspring crown circumference will be measured three times to the nearest 0.1 cm using a stretch-resistant measuring tape
Time Frame
Collected in gestational age (GA) 11-13, GA19-21 and GA28, at birth and 3, 6, 12 and 18 months after birth.
Title
Fetal and offspring growth - femur length
Description
Femur length will be measured with ultrasound during pregnancy and offspring thigh will be measured three times to the nearest 0.1 cm using a stretch-resistant measuring tape.
Time Frame
Collected in gestational age (GA) 11-13, GA19-21 and GA28, at birth and 3, 6, 12 and 18 months after birth.
Title
Fetal growth - fractional limb volume
Description
Fractional limb volume will be measured with ultrasound during pregnancy.
Time Frame
Collected in gestational age 28.
Title
Offspring growth - BMI z-score
Description
Offspring body mass index (BMI) z-score (BMI adjusted for age and sex).
Time Frame
Collected at birth and 3, 6, 12 and 18 months after birth of offspring.
Title
Offspring growth - weight for gestational age
Description
Weight for gestational age. Measured as percent of normal weight related to gestational age.
Time Frame
Collected at birth and 3, 6, 12 and 18 months after birth of offspring.
Title
Offspring growth - large for gestational age
Description
Large for gestational age. Prevalence of infants being LGA.
Time Frame
Collected at birth and 3, 6, 12 and 18 months after birth of offspring.
Title
Offspring growth - small for gestational age
Description
Small for gestational age. Prevalence of offspring being small for gestational age (SGA).
Time Frame
Collected at birth and 3, 6, 12 and 18 months after birth of offspring.
Title
Offspring growth - apgar score
Description
Apgar score (0-10). The higher the score, the better health condition of the offspring)
Time Frame
Collected at birth of offspring
Title
Offspring growth
Description
Offspring circumference (upper arm and hip) and 5 points skinfold (bi- and triceps, subscapularis, belly and waist). Circumferences will be measured to the nearest 0.1 cm using a stretch-resistant measuring tape and skinfolds are measured to the nearest 0.02 cm using a caliper to lightly pinch the skin and the underlying fat
Time Frame
Collected at birth and 3, 6, 12 and 18 months after birth of offspring.
Title
Offspring growth - body composition by the POD system
Description
Offspring fat free mass (g) and fat mass (g) will be assessed by air displacement plethysmography using the POD system (either the Pea POD or the Bod POD system depending on the most appropriate for age)
Time Frame
Collected at birth (strived <24 hours, but allow <48 hours), 3, 6, 12 and 18 months after birth of offspring.
Title
Offspring growth - body composition by DEXA scan
Description
Offspring fat free mass (g) and fat mass (g) will be assessed by a Dual-energy X-ray absorptiometry-scan (DEXA).
Time Frame
Collected at 6, 12 and 18 months after birth of offspring.
Title
Offspring growth - bone markers by DEXA scan
Description
Offspring bone area (cm^2), bone mineral density (g/cm^2) and bone mineral content (g) will be assessed by a Dual-energy X-ray absorptiometry-scan (DEXA).
Time Frame
Collected at 6, 12 and 18 months after birth of offspring.
Title
Offspring blood pressure
Description
Offspring blood pressure (diastolic and systolic blood pressure) will be measured three times after 5-10 minutes rest using an automated device placed on the arm and in direct contact with the skin.
Time Frame
Collected 6, 12 and 18-months after birth of offspring
Title
Offspring heart rate
Description
Offspring heart rate will be measured three times after 5-10 minutes rest using an automated device placed on the arm and in direct contact with the skin.
Time Frame
Collected 6, 12 and 18-months after birth of offspring
Title
Offspring growth - self-reported body weight
Description
Self-reported body weight
Time Frame
18 months after birth the study staff will make an annual follow-up phone call to the parents to collect information about the offspring's self-reported body weight until the offspring is 14 of age.
Title
Offspring growth - self-reported height
Description
Self-reported height
Time Frame
18 months after birth the study staff will make an annual follow-up phone call to the parents to collect information about the offspring's self-reported body weight until the offspring is 14 of age.
Title
Adult weight
Description
Adult body weight is measured to the nearest 0.1 kg using a calibrated scale
Time Frame
The intervention: each visit(V) throughout the study (baseline to 18mo. after birth). The control: before pregnancy (baseline, V11 and V14), all visits during pregnancy, at birth, at V27≤6days after birth and 3,6,12 and 18mo. after birth
Title
Adult self-reported body weight (control group)
Description
The control group will be instructed to self-report their body weight in a fasting state (no food or drink besides a maximum of 500 mL of water from 10 pm the night before) by using their own personal weight scale at home after having emptied their bladder at time point 9 and approximately monthly from time point 9 until registration of pregnancy.
Time Frame
From baseline to registration of pregnancy (4, 8, 12, 16, 20, 24, 30, 36, 42, 48, and 52 weeks after baseline)
Title
Adult Height
Description
Adult height will be measured to the nearest 0.5 cm using a wall-mounted stadiometer.
Time Frame
Collected at baseline (V0).
Title
Adult BMI
Description
Calculated ad weight (kg)/height(m)^2
Time Frame
Collected baseline, visit (V)1-19, registration of pregnancy, in gestational age (GA)8, GA13, GA20, GA28, GA36, GA39, when giving birth and at 3, 6, 12 and 18 months after birth.
Title
Adult anthropometric
Description
Waist- and hip circumference will be measured to the nearest 0.5 cm. During pregnancy and at birth the waist of the female will not be measured.
Time Frame
Collected prior to pregnancy (at baseline, visit(V)5, V6, V7, V8, V12, and V16 (V5-V16 only the intervention)), during pregnancy (at registration of pregnancy, in gestational age(GA)13 and GA36), and at 3, 6, 12, and 18 months after birth of offspring.
Title
Adult body composition by DEXA scan
Description
Lean mass (g), fat mass (g), abdominal fat (g), visceral fat (g) assessed by a Dual-energy X-ray absorptiometry-scan.
Time Frame
Collected at baseline (visit (V)0), at registration of pregnancy (only male) and after birth (≤6 days after birth of offspring). Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult bone markers by DEXA scan
Description
Bone area (cm^2), bone mineral density (g/cm^2) and bone mineral content (g) assessed by a Dual-energy X-ray absorptiometry-scan.
Time Frame
Collected at baseline (visit (V)0), at registration of pregnancy (only male) and after birth (≤6 days after birth of offspring). Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult blood pressure
Description
Blood pressure (diastolic and systolic blood pressure) will be measured three times with two minutes apart after 5-10 minutes rest using a validated automatic device.
Time Frame
Collected at baseline (visit (V)0) and in gestational age (GA)36. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult heart rate
Description
Heart rate will be measured three times with two minutes apart after 5-10 minutes rest using a validated automatic device.
Time Frame
Collected at baseline (visit (V)0) and in gestational age (GA)36. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult resting metabolic rate
Description
Resting metabolic rate (calories/24-h) and respiratory quotient will be measured by indirect calorimetry using a ventilated hood system. Participants will lie in the supine position and rest for at least 5 min before measurements commence. The measurement will be performed twice and last for 25 min with 5 min between measurements.
Time Frame
Collected at baseline visit (V)0. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult resting respiratory quotient
Description
Resting respiratory quotient will be measured by indirect calorimetry using a ventilated hood system. Participants will lie in the supine position and rest for at least 5 min before measurements commence. The measurement will be performed twice and last for 25 min with 5 min between measurements.
Time Frame
Collected at baseline visit (V)0. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult medication use
Description
Use of medication will be collected throughout the study.
Time Frame
Use of medication will be collected at all visits.
Title
Offspring medication use
Description
Use of medication will be collected throughout the study.
Time Frame
Birth, after 3, 6, 12, and 18 months after birth of offspring.
Title
Adult reproduction - Time to pregnancy
Description
Duration of time to conception defined from time point allowed to conceive to registration of pregnancy.
Time Frame
Registration of pregnancy
Title
Adult reproduction - Success rate
Description
Success rate of pregnancy defined as number of achieved pregnancies.
Time Frame
Registration of pregnancy
Title
Reproduction (male) - Sperm motility
Description
Sperm motility (%).
Time Frame
Collected baseline and at visit (V) 11. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Reproduction (male) - Sperm concentration
Description
Concentration (in million sperm cells/ml).
Time Frame
Collected baseline and at visit (V) 11. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Reproduction (male) - Sperm morphology
Description
Morphology (%).
Time Frame
Collected baseline and at visit (V) 11. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Reproduction (male) - Sperm acrosomal status
Description
Acrosomal status (%).
Time Frame
Collected baseline and at visit (V) 11. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Reproduction (male) - Sperm DNA fragmentation
Description
DNA fragmentation (%)
Time Frame
Collected baseline and at visit (V) 11. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult glucose metabolism (OGTT, only female)
Description
2-h oral glucose tolerance test (OGTT) will be performed at gestational age~20 and ~28 or only ~28.
Time Frame
Collected at gestational age (GA)20 and 28 or only 28 (only female)
Title
Adult glucose metabolism (CGM, only female)
Description
A continuous glucose monitoring system will be attached to the designated area on the upper body as stated by the manufacture.
Time Frame
Collected at gestational age (GA)28+GA29
Title
Adult glucose metabolism
Description
All blood samples will be collected by venous puncture in the antecubital vein after an overnight fast from at least 10 pm the night before. Samples will be analysed for fasting glucose, insulin, C-peptide and HbA1c
Time Frame
Collected at baseline (visit(V)0) and during pregnancy in gestational age (GA)36 (only female). Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult lipid profile
Description
All blood samples will be collected by venous puncture in the antecubital vein after an overnight fast from at least 10 pm the night before. Samples will be analysed for triglycerides, low-density lipoprotein (LDL), high-density lipoprotein (HDL), very-low-density lipoprotein VLDL and total cholesterol
Time Frame
Collected at baseline (visit(V)0) and during pregnancy in gestational age (GA)36 (only female). Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult inflammation markers
Description
All blood samples will be collected by venous puncture in the antecubital vein after an overnight fast from at least 10 pm the night before. Samples will be analysed for hsCRP, Tumor necrosis factor alpha (TNF-α) and interleukin (IL6).
Time Frame
Collected at baseline (visit(V)0) and during pregnancy in gestational age (GA)36 (only female). Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Offspring glucose metabolism
Description
Total amount of venous blood will be drawn at 6-, 12- and 18-months follow-up visit. Parents will be instructed that the offspring should not have eaten two hours prior to the assessment. Samples will be analysed for glucose, insulin, C-peptide and HbA1c
Time Frame
Collected at 6, 12 and 18 months after birth
Title
Offspring lipid profile
Description
Total amount of venous blood will be drawn at 6-, 12- and 18-months follow-up visit. Parents will be instructed that the offspring should not have eaten two hours prior to the assessment. Samples will be analysed for triglycerides, LDL, HDL, VLDL and total cholesterol.
Time Frame
Collected at 6, 12 and 18 months after birth
Title
Offspring inflammation markers
Description
Total amount of venous blood will be drawn at 6-, 12- and 18-months follow-up visit. Parents will be instructed that the offspring should not have eaten two hours prior to the assessment. Samples will be analysed for hsCRP, TNF-α and IL6.
Time Frame
Collected at 6, 12 and 18 months after birth
Title
Offspring growth factors and hormones
Description
Total amount of venous blood will be drawn at 6-, 12- and 18-months follow-up visit. Parents will be instructed that the offspring should not have eaten two hours prior to the assessment. Samples will be analysed for Insulin-like Growth Factor 1 (IGF-1) and growth hormone (GH).
Time Frame
Collected at 6, 12 and 18 months after birth
Other Pre-specified Outcome Measures:
Title
Cord blood - epigenetics
Description
Cord blood will be drawn immediately after birth and analysed for epigenetic profile.
Time Frame
Collected at birth
Title
Cord blood - pH
Description
Cord blood will be drawn immediately after birth. pH will be assessed.
Time Frame
Collected at birth
Title
Cord tissue
Description
A sample of cord tissue will be collected immediately after birth and analysed for epigenetic profile.
Time Frame
Collected at birth
Title
Placenta
Description
Placenta weight (gram).
Time Frame
Collected at birth
Title
Placenta - biopsies
Description
Eight biopsies will be collected, four on the maternal site and four on the fetal side - one in each quadrant. The samples will be analyzed for protein expression patterns, placental markers, metabolomics, proteomics, markers of inflammation, immune markers and exosomes.
Time Frame
Collected at birth
Title
Vaginal swab (female) - Microbiome
Description
The females will be instructed how to perform the vaginal swab at the study site. Changes in microbiome will be assessed from vaginal swab samples.
Time Frame
Collected at baseline, at gestional age(GA) 13 and GA36. Additionally, the intervention group will collect a sample at visit (V)8 during the intervention period.
Title
Vaginal swab (female) - pH
Description
The females will be instructed how to perform the vaginal swab at the study site. Changes in pH will be assessed from vaginal swab samples.
Time Frame
Collected at baseline, at gestional age(GA) 13 and GA36. Additionally, the intervention group will collect a sample at visit (V)8 during the intervention period.
Title
Offspring feces - Microbiom
Description
Will be analysed for microbiome.
Time Frame
Collected at birth (the 4 th day after birth or as soon as possible thereafter) and at 1, 3, 6, 12 and 18 months after birth.
Title
Offspring feces - Short chain fatty acids
Description
Will be analysed for short chain fatty acids.
Time Frame
Collected at birth (the 4 th day after birth or as soon as possible thereafter) and at 1, 3, 6, 12 and 18 months after birth.
Title
Offspring feces - Metabolomics
Description
Will be analysed for metabolomics.
Time Frame
Collected at birth (the 4 th day after birth or as soon as possible thereafter) and at 1, 3, 6, 12 and 18 months after birth.
Title
Offspring feces - Proteomics
Description
Will be analysed for proteomics.
Time Frame
Collected at birth (the 4 th day after birth or as soon as possible thereafter) and at 1, 3, 6, 12 and 18 months after birth.
Title
Offspring feces - pH
Description
Will be assessed for pH.
Time Frame
Collected at birth (the 4 th day after birth or as soon as possible thereafter) and at 1, 3, 6, 12 and 18 months after birth.
Title
Offspring feces - Inflammation markers
Description
Will be analysed for inflammation markers.
Time Frame
Collected at birth (the 4 th day after birth or as soon as possible thereafter) and at 1, 3, 6, 12 and 18 months after birth.
Title
Offspring feces - consistency and frequency
Description
Whenever a fecal sample is collected stool consistency of the collected sample, and an estimate of stool frequency will be collected with a questionnaire.
Time Frame
Collected at birth (the 4 the day after birth or as soon as possible thereafter) and at 1, 3, 6, 12 and 18 months after birth.
Title
Offspring urine
Description
Parents will be instructed to collect offspring's urine samples. Offspring urine will be analyzed for metabolomics.
Time Frame
Collected at birth and at 1, 3, 6, 12 and 18 months of age.
Title
Adult feces - Microbiome
Description
Participants will collect a fecal spot sample at home maximum 24 hours before the planned visit. Will be analysed for microbiome.
Time Frame
Collected at baseline (visit(V)0), during pregnancy (gestational age (GA)36, only female) and 12 months after birth of offspring. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult feces - Short chain fatty acids
Description
Participants will collect a fecal spot sample at home maximum 24 hours before the planned visit. Will be analysed for short chain fatty acids.
Time Frame
Collected at baseline (visit(V)0), during pregnancy (gestational age (GA)36, only female) and 12 months after birth of offspring. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult feces - Metabolomics
Description
Participants will collect a fecal spot sample at home maximum 24 hours before the planned visit. Will be analysed for metabolomics
Time Frame
Collected at baseline (visit(V)0), during pregnancy (gestational age (GA)36, only female) and 12 months after birth of offspring. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult feces - Proteomics
Description
Participants will collect a fecal spot sample at home maximum 24 hours before the planned visit. Will be analysed for proteomics.
Time Frame
Collected at baseline (visit(V)0), during pregnancy (gestational age (GA)36, only female) and 12 months after birth of offspring. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult feces - Inflammation markers
Description
Participants will collect a fecal spot sample at home maximum 24 hours before the planned visit. Will be analysed for inflammation markers.
Time Frame
Collected at baseline (visit(V)0), during pregnancy (gestational age (GA)36, only female) and 12 months after birth of offspring. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult feces - pH
Description
Participants will collect a fecal spot sample at home maximum 24 hours before the planned visit. Will be assessed for pH.
Time Frame
Collected at baseline (visit(V)0), during pregnancy (gestational age (GA)36, only female) and 12 months after birth of offspring. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult feces - consistency and frequency
Description
Whenever a fecal sample is collected stool consistency of the collected sample, and an estimate of stool frequency will be collected with a questionnaire.
Time Frame
Collected at baseline (visit(V)0), during pregnancy (gestational age (GA)36, only female) and 12 months after birth of offspring. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult urine
Description
Participants will collect a urine spot sample at the study site. Adult urine will be analyzed for metabolomics.
Time Frame
Collected at baseline (visitV)0), during pregnancy (GA36, only female) and 12 months after birth of offspring. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult dietary intake
Description
24-h dietary recall performed by trained personnel.
Time Frame
Collected at baseline (visit(V)0), during pregnancy (GA13 and GA36) and 12 and 18 months after birth of offspring. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Offspring dietary intake
Description
At birth (< 48 hours after birth) and at 3 months after offspring birth of offspring we will collect information on offspring dietary intake including breast feeding, use of formula and type as well as use of antibiotics. The offspring's dietary intake will be registered (either as 24-h dietary recall performed by trained personnel or by electronic software) at each follow-up visit (6, 12 and 18 months).
Time Frame
Collected at birth, after 3, 6, 12 and 18 months after offspring birth.
Title
Semen epigenetics marks
Description
Epigenetic profile based on array-measurements. Analysed for methylation changes.
Time Frame
Collected at baseline (visit(V)0) and at V11. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Cognitive development of offspring
Description
Offspring cognitive development will be assessed by a Habituation and Free Play Test.
Time Frame
Collected at 6, 12 and 18 months after birth.
Title
Offspring development
Description
Diet, physical activity and sleep will be assessed by validated questionnaires.
Time Frame
3, 6, 12 and 18 months after offspring birth.
Title
Offspring language development
Description
Offspring language development will be assessed by validated questionnaires.
Time Frame
Collected 12 and 18 months after offspring birth.
Title
Epigenetics
Description
Epigenetics analyses from whole blood. Will be analysed for methylation changes.
Time Frame
Collected at baseline (visit(V)0) and at V8 (only intervention group) and in gestational age (GA)36 - only female). Collected at birth for offspring.
Title
Adult physical activity
Description
Physical activity and sleep will be assessed by an accelerometer and the females and males will wear the accelerometer for 7 days and 8 nights.
Time Frame
Collected at baseline (visit(V)0), at gestational age (GA)13 and GA36 (only females during pregnancy). Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult physical activity
Description
Physical activity will be assessed by the International Physical Activity Questionnaire (IPAQ).
Time Frame
Collected at baseline (visit(V)0), at gestational age (GA)13 and GA36 and 3, 6, 12 and 18 months after birth of offspring. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult background
Description
Demographic information.
Time Frame
Collected prior baseline V0
Title
Adult wellbeing - Depression
Description
Depression will be assessed by Major depression questionnaire (ICD-10).
Time Frame
Collected at baseline (visit(V)0), at gestational age (GA)13 and GA36 and 3, 6, 12 and 18 months after birth of offspring. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult wellbeing - Quality of life
Description
Quality of life will be assessed by the validated tool, Short form-36 (SF-36).
Time Frame
Collected at baseline (visit(V)0), at gestational age (GA)13 and GA36 and 3, 6, 12 and 18 months after birth of offspring. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult wellbeing - Stress
Description
Stress will be assessed by validated tool, Perceived Stress Scale.
Time Frame
Collected at baseline (visit(V)0), at gestational age (GA)13 and GA36 and 3, 6, 12 and 18 months after birth of offspring. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult sleep
Description
Sleep will be assessed by the validated tool, Pittsburgh sleep quality index questionnaire (PSQI).
Time Frame
Collected at baseline (visit(V)0), at gestational age (GA)13 and GA36 and 3, 6, 12 and 18 months after birth of offspring. Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adult sexual score
Description
Sexual score assessed by questionnaire.
Time Frame
Collected at baseline (visit(V)0). Additionally, at V8 (prior to pregnancy) for the intervention group.
Title
Adults liver steatosis and stiffness by Liver ultrasound elastography (FibroScan)
Description
Measured by Liver ultrasound elastography (FibroScan)
Time Frame
Collected at baseline (Visit(v)0), prior to pregnancy for the intervention group (v8), week 52 in the pre-pregnancy period if pregnancy is not achieved (v19), at gestational age (GA)20 (v23), and 3 months after birth of offspring (v28).
Title
Offspring liver steatosis and stiffness by Liver ultrasound elastography (FibroScan)
Description
Measured by Liver ultrasound elastography (FibroScan)
Time Frame
Measured at 3 and 18 months after offspring birth.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
38 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Maternal inclusion Criteria: Maternal pre-pregnancy BMI 27.0-44.9 kg/m^2 Maternal age range 18-38 years Connected to Hvidovre Hospital as place of birth Not pregnant or breastfeeding Paternal Inclusion Criteria: Paternal pre-pregnancy BMI 18.5-44.9 kg/m^2 Paternal age range 18-55 years Parental Inclusion Criteria: Couples (male and female) Planning pregnancy within 1 year Provided voluntary informed consent Danish or English speaking Intention to permit the planned offspring to participate in the follow-up study Able to store biological samples from the offspring at home in the freezer in a box given by the study personnel Parental Exclusion Criteria: Diabetes mellitus (Type 1 or 2) Previous or present eating disorder Allergy towards ingredients in the very low calorie diet products Severe heart, liver or kidney disease Conception by in vitro fertilization ≥4 consecutive spontaneous pregnancy loss (female) Having tried to conceive or prior time to pregnancy of more than 12 months Any medical condition or concomitant medication as judged by the medical responsible Adherence to vegan diets or other diets interfering with the dietary guidelines in the study Participation in other clinical trial Engagement in elite sports or similar strenuous exercise ≥5 h/week Blood donation or transfusion within the past month before baseline Blood donation during the study Inability or unwillingness to follow the study protocol and instructions given by the study personnel Pregnancy registered at baseline visit (urinary analysis with dipstick) A detailed description of the exclusion criteria is given below: Medical conditions as known by the participant: Diabetes mellitus (type 1 and 2) History or diagnosis of eating disorder (e.g. restrained eating, disinhibition, emotional eating) Any significant medical condition as assessed by the investigator (e.g. dysregulated thyroid disease or reproductive diseases) Any significant psychiatric disorder (i.e. schizophrenia, bipolar disease or depression) as assessed by the investigator Severe chronic heart, liver and kidney disease Polycystic ovary syndrome with irregular cycle Amenorrhea Severely reduced semen quality incl. azoospermia Medication: - Current use of medication or use within the previous three months with a potential to affect body weight or pregnancy as judged by the investigator (e.g. systemic corticoids) Personal/other: Having tried to conceive or prior time to pregnancy of more than 12 months Weight changes ± 5% three months prior to inclusion Severe food allergies, food intolerances or dislike expected to interfere with the study, including allergy towards ingredients in the VLCD products Engagement in elite sports or similar strenuous exercise ≥5 h/week Blood donation or transfusion within the past month before baseline Planned blood donation for other purpose than this study during participation Alcohol abuse, as judged by the investigator, within the previous 12 months Drug abuse, as judged by the investigator, within the previous 12 months Psychological or behavioral problems which, in the judgement of the investigator, would lead to difficulty in complying with the study protocol Participation in other clinical trials within the past three months or intention to do so during the study, which are judged by the investigator to affect the present study Unable to consume the interventional product for religious reasons, swallowing disorders, other physiological reasons or any other reasons for not being able to follow the recommended diet Inability or unwillingness to give written informed consent or communicate with study personnel Inability or unwillingness to follow the study protocol and instructions given by the study personnel Illiteracy or inadequate understanding of Danish or English language. Any other condition that judged by the investigator may interfere with the adherence to the study protocol
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Faidon Magkos, PhD
Phone
+4535333671
Email
fma@nexs.ku.dk
First Name & Middle Initial & Last Name or Official Title & Degree
Malene Nygaard, MSC
Phone
+45 35 32 02 66
Email
nygaard@nexs.ku.dk
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Christian Mølgaard, MD
Organizational Affiliation
University of Copenhagen
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Copenhagen
City
Frederiksberg
State/Province
DK
ZIP/Postal Code
1958
Country
Denmark
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Faidon Magkos, PhD
Phone
+4535333671
Email
fma@nexs.ku.dk
First Name & Middle Initial & Last Name & Degree
Malene Nygaard, MSC
Phone
+4535320266
Email
nygaard@nexs.ku.dk
First Name & Middle Initial & Last Name & Degree
Christian Mølgaard, MD

12. IPD Sharing Statement

Learn more about this trial

PRE-Pregnancy Weight Loss And the Reducing Effect on CHILDhood Overweight - Copenhagen

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