I am a Maternal Fetal Medicine Specialist; Clinical Director Women's and Babies, WCH; Department Head Obstetrics and Gynaeology, University of Adelaide. My research interests include reproductive health, pregnancy outcomes, overweight and obesity, child health and lifestyle factors.

As a strategy to avert the well-documented pregnancy and birth, and longer-term health consequences which exits for the woman, with overweight or obesity in pregnancy, and her child, clinical care focuses on dietary interventions to limit gestational weight gain. Direct evidence from my research program indicates this approach to be ineffective.

Findings from my research group demonstrate that gestational weight gain is the wrong target - it is not causally related to clinical pregnancy outcomes. However, a woman's body mass index before conception is directly related to adverse outcomes in pregnancy for the woman and her baby. Underpinned by these seminal findings, my program of research is now focusing on improving women's health before conception to determine the impact on pregnancy and child outcomes.

Current Projects

The Begin Better Randomised Trial

MRFF ID 1199789

Maternal health and the first 2000 days of a child’s life, from conception until their 5th birthday, are identified as critical for an individual’s long term health and well-being.

Infants born to women who are overweight or obese are more likely to have birth weight above 4.0kg. Almost 50% of women are overweight or obese on entering pregnancy. The impact of both maternal obesity and high birth weight extends beyond birth and are independently associated with an increased chance of early childhood obesity.

Our findings, from previous work, show that while dietary and lifestyle intervention in pregnancy improves maternal diet and physical activity behaviours, there is no effect on gestational weight gain (GWG), pregnancy and birth outcomes, or risk of child obesity. These findings have subsequently been replicated by others internationally. Importantly, our previous findings show that the strongest and most consistent predictor of child obesity is maternal pre-pregnancy BMI. This is an important, potentially modifiable factor impacting pregnancy, birth and child health outcomes that warrants robust evaluation through a weight loss intervention prior to pregnancy.

We will enroll approximately 800 women who are planning pregnancy in a randomised trial of a weight loss intervention before conception. We will follow the women and obtain pregnancy outcome data for women who become pregnant. Our primary outcome is birth weight of 4kg or more, an important risk factor for later childhood obesity.

The single dose of antenatal corticosteroids (SNACS) randomised trial for women at risk for preterm birth.

MRFF ID 2015329

Globally, each year 15 million babies are born preterm, <37 weeks. For babies at high risk of pre-term birth, in utero exposure to a standard two doses (administered 24 hours apart) of antenatal corticosteroids (ACS) improves fetal lung and brain development thus reducing preterm infant mortality & morbidity. However, ACS is associated with side effects such as adverse neurosensory, cognitive, cardiovascular and renal outcomes. While the benefits of ACS outweigh the risks for babies born <35 weeks, for those exposed to ACS who go on to full term birth the risks and impact of side effects are significant.

Despite ACS being used since the 1970s, the optimal dose has never been determined. Based on animal studies and limited evidence from human studies, we hypothesise that a single dose of ACS is sufficient for lung maturation in pre-term babies but has an improved side effect profile.

We will perform a multi-centre randomised clinical trial involving 1560 Australian women and babies at risk of pre-term birth, assigned to either the standard dose of ACS or to a single dose ACS (plus placebo). The primary outcome will be a composite of mortality or substantial morbidity. Secondary outcomes include neurosensory, developmental and behavioural impairment to measure whether the single ACS dose has an improved side effect profile and will be measured at the time of hospital discharge and again at 2 years of age.

This project is part of an international trial partnership led by the Population Health Research Institute in Canada and will be the first to determine the effects of single dose ACS for babies at risk of pre-term birth. Our highly experienced team will enable rapid translation of these results into clinical practice across Australia and deliver profound economic and health improvements for individuals, families and the broader community.

The First 1,000 Days: in-utero and early life exposures and their contribution to child obesity.

NHMRC, ID 1159338

Professor Dodd and her research group will evaluate the cardiometabolic, inflammatory, and epigenetic pathways linking maternal and intrauterine factors to newborn and childhood adiposity and obesity. Utilizing their uniquely harmonized, large-scale clinical trials and related bio-bank specimens they will evaluate dietary and lifestyle interventions (including metformin) in pregnant women across the BMI spectrum. The included trials are the LIMIT RCT evaluating dietary intervention vs standard antenatal care in 2,212 pregnant women with BMI ≥ 25kg/m2; the GRoW RCT evaluating metformin in addition to dietary and lifestyle advice in 524 pregnant women with BMI ≥ 25kg/m²; and the OPTIMISE RCT evaluating a dietary intervention versus standard care in 640 pregnant women; BMI 18.5-24.9kg/m2. All of these trials include follow up of the children at 6 and 18 months and 3-5 years of age. These trials offer unique power and capability, due to their large scale, intervention based design, randomization and longer-term follow-up into childhood.

This grant will facilitate follow up of the children from the LIMIT RCT at 8-10 years of age, commencing in 2019.

BMC Pediatrics https://doi.org/10.1186/s12887-023-04466-4

Recently reported research

The effects of dietary and lifestyle interventions among pregnant women who are overweight or obese on longer-term maternal and early childhood outcomes: an individual participant data (IPD) meta-analysis

(NHMRC, ID 1143773)

Professor Dodd and her research group have a unique opportunity to evaluate the effect of antenatal dietary intervention among women who are overweight or obese on longer-term maternal and child health through conducting an individual participant data meta-analysis (IPDMA).

Professor Dodd and her research have contributed to the successful completion of the international Weight management In Pregnancy (i-WIP) IPDMA to assess the effects of antenatal dietary and lifestyle interventions on pregnancy outcomes. Many of the included studies have followed women and their infants who participated in the pregnancy intervention studies into childhood. We will use IPDMA methodology to evaluate the effect of dietary and lifestyle interventions in pregnancy on the longer term health of women and their babies. Professor Dodd will lead this longer term follow up in collaboration with partners across Europe, who have evaluated the longer term impact of pregnancy interventions within their own pregnancy intervention studies.

In overweight and obese pregnant women, we found no evidence that maternal dietary and/or lifestyle intervention during pregnancy modifies the risk of early childhood obesity. Future research may need to target the pre-conception period in women and early childhood interventions.

BMC Medicine https://doi.org/10.1186/s12916-021-01995-6

Optimising gestational weight gain and improving maternal and infant health outcomes through antenatal dietary, lifestyle and physical activity advice: the OPTIMISE randomised controlled

Obesity represents a significant health burden and the World Health Organisation recognises the importance of preventing weight gain and subsequent development of obesity among adults who are within the healthy weight range. Women of reproductive age have demonstrated high rates of weight gain during pregnancy placing them at risk of becoming overweight or obese. Professor Dodd and her research group are evaluating the effects of dietary and physical activity advice on maternal, fetal and infant health outcomes, among pregnant women of normal body mass index (BMI).

The trial was conducted in Adelaide, South Australia. Pregnant women with a body mass index in the healthy weight range (18.5–24.9 kg/m²) were enrolled in a randomised controlled trial of a dietary and lifestyle intervention versus standard antenatal care. The dietitian-led dietary and lifestyle intervention over the course of pregnancy was based on the Australian Guide to Healthy Eating. Baseline characteristics of women in the two treatment groups were similar. There was no statistically significant difference in the proportion of infants with birth weight above 4.0 kg between the Lifestyle Advice and Standard Care groups (24/316 (7.59%) Lifestyle Advice versus 26/313 (8.31%) Standard Care; adjusted risk ratio (aRR) 0.91; 95% confidence interval (CI) 0.54 to 1.55; p = 0.732). Despite improvements in maternal diet quality, no significant differences between the treatment groups were observed for total GWG, or other pregnancy and birth outcomes.

Nutrients https://doi.org/10.3390/nu11122911

Effect of metformin in addition to dietary and lifestyle advice for pregnant women who are overweight or obese: the GRoW randomised, double-blind, placebo-controlled trial

(NHMRC, ID 1043181)

The aim of this randomised trial was, for the first time, to evaluate the effects of antenatal metformin as an adjuvant therapy to dietary and lifestyle advice among overweight and obese pregnant women on maternal and infant outcomes.

Pregnant women with BMI above 25kg/m2, at their first antenatal visit, were randomly allocated to receive either metformin to a maximum dose of 2000mg per day, or an identical appearing placebo, using a computer generated schedule. All women received an antenatal dietary and lifestyle intervention across the course of pregnancy. The primary outcome was the proportion of infants with birthweight above 4000grams. Secondary outcomes included gestational weight gain (GWG), maternal pregnancy, labour and birth, and infant outcomes.

In the largest pregnancy study to date evaluating metformin, 524 women were randomised (261 Metformin; 263 Placebo). There was no significant difference in the proportion of infants with birthweight above 4000g. While women who received metformin had lower weekly gestational weight gain and were more likely to have weight gain below the Institute of Medicine recommendations, total gestational weight gain was not statistically significantly different between the two treatment groups. The use of metformin was not associated with any evidence of impact on pregnancy and birth outcomes.

Although these findings provide some evidence that metformin as an adjuvant therapy to a dietary intervention in overweight and obese pregnant women reduces some measures of gestational weight gain, there was no evidence of an impact on pregnancy and birth outcomes. Use of metformin in this clinical setting is not advocated.

https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30310-3/fulltext

Nutrition During Pregnancy, Lactation and Early Childhood and its Implications for Maternal and Long-Term Child Health: The Early Nutrition Project Recommendations

Koletzko B, Godfrey KM, Poston L, Szajewska H, van Goudoever JB, · de Waard M, Brands B, · Grivell RM, Deussen AR, Dodd JM, Patro-Golab B, Zalewski BM, EarlyNutrition Project Systematic Review Group.

A considerable body of evidence accumulated especially during the last decade, demonstrating that early nutrition and lifestyle have long-term effects on later health and disease (“developmental or metabolic programming”).

Researchers involved in the European Union funded international EarlyNutrition research project consolidated the scientific evidence base and existing recommendations to formulate consensus recommendations on nutrition and lifestyle before and during pregnancy, during infancy and early childhood that take long-term health impact into account. Systematic reviews were performed on published dietary guidelines, standards and recommendations, with special attention to long-term health consequences. In addition, systematic reviews of published systematic reviews on nutritional interventions or exposures in pregnancy and in infants and young children aged up to 3 years that describe effects on subsequent overweight, obesity and body composition were performed. Experts developed consensus recommendations incorporating the wide-ranging expertise from additional 33 stakeholders.

Most current recommendations for pregnant women, particularly obese women, and for young children do not take long-term health consequences of early nutrition into account, although the available evidence for relevant consequences of lifestyle, diet and growth patterns in early life on later health and disease risk is strong. Interpretation: This work presents updated recommendations for optimized nutrition before and during pregnancy, during lactation, infancy and toddlerhood, with special reference to later health outcomes. These recommendations are developed for affluent populations, such as women and children in Europe, and should contribute to the primary prevention of obesity and associated non-communicable diseases.

https://www.karger.com/Article/FullText/496471