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Limiting Postpartum Weight Retention in Culturally and Linguistically Diverse Women: Secondary Analysis of the HeLP-her Randomized Controlled Trial. Nutrients 2022; 14:nu14142988. [PMID: 35889944 PMCID: PMC9316445 DOI: 10.3390/nu14142988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 02/04/2023] Open
Abstract
Postpartum weight retention (PPWR) contributes to maternal obesity development and is more pronounced in culturally and linguistically diverse (CALD) women. Our antenatal healthy lifestyle intervention (HeLP-her) demonstrated efficacy in reducing PPWR in non-Australian-born CALD women compared with Australian-born women. In this secondary analysis, we aimed to examine differences in the intervention effect on behavioral and psychosocial outcomes between Australian-born and non-Australian-born women and explore factors associated with the differential intervention effect on PPWR. Pregnant women at risk of gestational diabetes (Australian-born n = 86, non-Australian-born n = 142) were randomized to intervention (four lifestyle sessions) or control (standard antenatal care). PPWR was defined as the difference in measured weight between 6 weeks postpartum and baseline (12–15 weeks gestation). Behavioral (self-weighing, physical activity (pedometer), diet (fat-related dietary habits questionnaire), self-perceived behavior changes), and psychosocial (weight control confidence, exercise self-efficacy, eating self-efficacy) outcomes were examined by country of birth. Multivariable linear regression analysis was conducted to assess factors associated with PPWR. The intervention significantly increased self-weighing, eating self-efficacy, and self-perceived changes to diet and physical activity at 6 weeks postpartum in non-Australian-born women, compared with no significant changes observed among Australian-born women. Intervention allocation and decreased intake of snack foods were predictors of lower PPWR in non-Australian-born women. Results indicate that the HeLP-her intervention improved dietary behaviors, contributing to the reduction of PPWR in CALD women. Future translations could prioritize targeting diet while developing more effective strategies to increase exercise engagement during pregnancy in this population.
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Dodd JM, Deussen AR, Mitchell M, Poprzeczny AJ, Louise J. Maternal overweight and obesity during pregnancy: strategies to improve outcomes for women, babies, and children. Expert Rev Endocrinol Metab 2022; 17:343-349. [PMID: 35768936 DOI: 10.1080/17446651.2022.2094366] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Women with overweight and obesity, and their children, are at increased risk of adverse pregnancy, birth, and longer term health outcomes, believed to be compounded by excessive gestational weight gain (GWG). Research to date has focused on interventions to reduce excessive GWG through changes to maternal diet and/or lifestyle. AREAS COVERED Current clinical recommendations for GWG vary according to a woman's early pregnancy body mass index, based on assumptions that associations between GWG and adverse pregnancy outcomes are causal in nature, and modifiable. While there are small differences in GWG following pregnancy interventions, there is little evidence for clinically relevant effects on pregnancy, birth, and longer term childhood outcomes. This review considers interventional studies targeting women with overweight or obesity to reduce GWG in an effort to improve maternal and infant health, and the current evidence for interventions prior to conception. EXPERT OPINION GWG is not modifiable via diet and lifestyle change, and continued efforts to find the 'right' intervention for women with overweight and obesity during pregnancy are unjustified. Researchers should focus on gathering evidence for interventions prior to pregnancy to optimize maternal health and weight to improve pregnancy, birth, and longer term health outcomes associated with obesity.
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Affiliation(s)
- Jodie M Dodd
- The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, The University of Adelaide, Adelaide, Australia
- Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, Adelaide, Australia
| | - Andrea R Deussen
- The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, The University of Adelaide, Adelaide, Australia
| | - Megan Mitchell
- The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, The University of Adelaide, Adelaide, Australia
| | - Amanda J Poprzeczny
- The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, The University of Adelaide, Adelaide, Australia
- Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, Adelaide, Australia
| | - Jennie Louise
- The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, The University of Adelaide, Adelaide, Australia
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Harrison CL, Brammall BR, Garad R, Teede H. OptimalMe Intervention for Healthy Preconception, Pregnancy, and Postpartum Lifestyles: Protocol for a Randomized Controlled Implementation Effectiveness Feasibility Trial. JMIR Res Protoc 2022; 11:e33625. [PMID: 35679115 PMCID: PMC9227652 DOI: 10.2196/33625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/15/2021] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Reproductive-aged women are a high-risk population group for accelerated weight gain and obesity development, with pregnancy recognized as a critical contributory life-phase. Healthy lifestyle interventions during the antenatal period improve maternal and infant health outcomes, yet translation and implementation of such interventions into real-world health care settings remains limited. Objective We aim to generate key implementation learnings to inform the feasibility of future scale up and determine the effectiveness of intervention delivery methods on engagement, experience, acceptability, knowledge, risk perception, health literacy, and modifiable weight-related health behaviors in women during preconception, pregnancy, and postpartum periods. Methods This randomized hybrid implementation effectiveness study will evaluate the penetration, reach, feasibility, acceptability, adoption, and fidelity of a healthy lifestyle intervention (OptimalMe) implemented into, and in partnership with, private health care. Individual health outcomes associated with implementation delivery mode, including knowledge, risk perception, health literacy, self-management, and health behaviors, are secondary outcomes. A total of 300 women aged 18 to 44 years, who are not pregnant but wish to conceive within the next 12 months, and with access to the internet will be recruited. All participants will receive the same digital lifestyle intervention, OptimalMe, which is supported by health coaching and text messages during preconception, pregnancy, and postpartum periods. We will use a parallel 2-arm design to compare telephone with videoconference remote delivery methods for health coaching. Methods are theoretically underpinned by the Consolidated Framework for Implementation Research and outcomes based on the Reach, Engagement, Adaptation, Implementation and Maintenance framework. Results The study was approved on August 16, 2019 and has been registered. Recruitment commenced in July 2020, and data collection is ongoing. Results are expected to be published in 2022. Conclusions The study’s design aligns with best practice implementation research. Results will inform translation of evidence from randomized controlled trials on healthy lifestyle interventions into practice targeting women across preconception, pregnancy, and postpartum periods. Learnings will target consumers, program facilitators, health professionals, services, and policy makers to inform future scale up to ultimately benefit the health of women across these life-phases. Trial Registration Australian and New Zealand Clinical Trial Registry ACTRN12620001053910; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378243&isReview=true International Registered Report Identifier (IRRID) DERR1-10.2196/33625
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Affiliation(s)
- Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Clayton, Australia.,Endocrine and Diabetes Unit, Monash Health, Clayton, Australia
| | - Bonnie R Brammall
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Clayton, Australia
| | - Rhonda Garad
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Clayton, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Clayton, Australia.,Endocrine and Diabetes Unit, Monash Health, Clayton, Australia
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Perry A, Stephanou A, Rayman MP. Dietary factors that affect the risk of pre-eclampsia. BMJ NUTRITION, PREVENTION & HEALTH 2022; 5:118-133. [PMID: 35814725 PMCID: PMC9237898 DOI: 10.1136/bmjnph-2021-000399] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/03/2022] [Indexed: 12/18/2022]
Abstract
Pre-eclampsia affects 3%–5% of pregnant women worldwide and is associated with a range of adverse maternal and fetal outcomes, including maternal and/or fetal death. It particularly affects those with chronic hypertension, pregestational diabetes mellitus or a family history of pre-eclampsia. Other than early delivery of the fetus, there is no cure for pre-eclampsia. Since diet or dietary supplements may affect the risk, we have carried out an up-to-date, narrative literature review to assess the relationship between nutrition and pre-eclampsia. Several nutrients and dietary factors previously believed to be implicated in the risk of pre-eclampsia have now been shown to have no effect on risk; these include vitamins C and E, magnesium, salt, ω-3 long-chain polyunsaturated fatty acids (fish oils) and zinc. Body mass index is proportionally correlated with pre-eclampsia risk, therefore women should aim for a healthy pre-pregnancy body weight and avoid excessive gestational and interpregnancy weight gain. The association between the risk and progression of the pathophysiology of pre-eclampsia may explain the apparent benefit of dietary modifications resulting from increased consumption of fruits and vegetables (≥400 g/day), plant-based foods and vegetable oils and a limited intake of foods high in fat, sugar and salt. Consuming a high-fibre diet (25–30 g/day) may attenuate dyslipidaemia and reduce blood pressure and inflammation. Other key nutrients that may mitigate the risk include increased calcium intake, a daily multivitamin/mineral supplement and an adequate vitamin D status. For those with a low selenium intake (such as those living in Europe), fish/seafood intake could be increased to improve selenium intake or selenium could be supplemented in the recommended multivitamin/mineral supplement. Milk-based probiotics have also been found to be beneficial in pregnant women at risk. Our recommendations are summarised in a table of guidance for women at particular risk of developing pre-eclampsia.
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Affiliation(s)
- Abigail Perry
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Anna Stephanou
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Margaret P Rayman
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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de Freitas NPA, Carvalho TR, Gonçalves CCRA, da Silva PHA, de Melo Romão LG, Kwak-Kim J, Cavalcante MB. The Dietary Inflammatory Index as a predictor of pregnancy outcomes: Systematic review and meta-analysis. J Reprod Immunol 2022; 152:103651. [DOI: 10.1016/j.jri.2022.103651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/20/2022] [Accepted: 06/01/2022] [Indexed: 11/28/2022]
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Krebs F, Lorenz L, Nawabi F, Alayli A, Stock S. Effectiveness of a Brief Lifestyle Intervention in the Prenatal Care Setting to Prevent Excessive Gestational Weight Gain and Improve Maternal and Infant Health Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105863. [PMID: 35627403 PMCID: PMC9141141 DOI: 10.3390/ijerph19105863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 02/04/2023]
Abstract
Research on perinatal programming shows that excessive gestational weight gain (GWG) increases the risk of overweight and obesity later in a child’s life and contributes to maternal weight retention and elevated risks of obstetrical complications. This study examined the effectiveness of a brief lifestyle intervention in the prenatal care setting, compared to routine prenatal care, in preventing excessive GWG as well as adverse maternal and infant health outcomes. The GeMuKi study was designed as a cluster RCT using a hybrid effectiveness implementation design and was conducted in the prenatal care setting in Germany. A total of 1466 pregnant women were recruited. Pregnant women in intervention regions received up to six brief counseling sessions on lifestyle topics (e.g., physical activity, nutrition, drug use). Data on GWG and maternal and infant outcomes were entered into a digital data platform by the respective healthcare providers. The intervention resulted in a significant reduction in the proportion of women with excessive GWG (OR = 0.76, 95% CI (0.60 to 0.96), p = 0.024). Gestational weight gain in the intervention group was reduced by 1 kg (95% CI (−1.56 to −0.38), p < 0.001). No evidence of intervention effects on pregnancy, birth, or neonatal outcomes was found.
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The importance of nutrition in pregnancy and lactation: lifelong consequences. Am J Obstet Gynecol 2022; 226:607-632. [PMID: 34968458 PMCID: PMC9182711 DOI: 10.1016/j.ajog.2021.12.035] [Citation(s) in RCA: 131] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022]
Abstract
Most women in the United States do not meet the recommendations for healthful nutrition and weight before and during pregnancy. Women and providers often ask what a healthy diet for a pregnant woman should look like. The message should be “eat better, not more.” This can be achieved by basing diet on a variety of nutrient-dense, whole foods, including fruits, vegetables, legumes, whole grains, healthy fats with omega-3 fatty acids that include nuts and seeds, and fish, in place of poorer quality highly processed foods. Such a diet embodies nutritional density and is less likely to be accompanied by excessive energy intake than the standard American diet consisting of increased intakes of processed foods, fatty red meat, and sweetened foods and beverages. Women who report “prudent” or “health-conscious” eating patterns before and/or during pregnancy may have fewer pregnancy complications and adverse child health outcomes. Comprehensive nutritional supplementation (multiple micronutrients plus balanced protein energy) among women with inadequate nutrition has been associated with improved birth outcomes, including decreased rates of low birthweight. A diet that severely restricts any macronutrient class should be avoided, specifically the ketogenic diet that lacks carbohydrates, the Paleo diet because of dairy restriction, and any diet characterized by excess saturated fats. User-friendly tools to facilitate a quick evaluation of dietary patterns with clear guidance on how to address dietary inadequacies and embedded support from trained healthcare providers are urgently needed. Recent evidence has shown that although excessive gestational weight gain predicts adverse perinatal outcomes among women with normal weight, the degree of prepregnancy obesity predicts adverse perinatal outcomes to a greater degree than gestational weight gain among women with obesity. Furthermore, low body mass index and insufficient gestational weight gain are associated with poor perinatal outcomes. Observational data have shown that first-trimester gain is the strongest predictor of adverse outcomes. Interventions beginning in early pregnancy or preconception are needed to prevent downstream complications for mothers and their children. For neonates, human milk provides personalized nutrition and is associated with short- and long-term health benefits for infants and mothers. Eating a healthy diet is a way for lactating mothers to support optimal health for themselves and their infants.
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Sex-specific mediating effect of gestational weight gain between pre-pregnancy body mass index and gestational diabetes mellitus. Nutr Diabetes 2022; 12:25. [PMID: 35468888 PMCID: PMC9039078 DOI: 10.1038/s41387-022-00203-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/29/2022] [Accepted: 04/12/2022] [Indexed: 11/08/2022] Open
Abstract
Background Inappropriate weight gain may increase the risk of gestational diabetes mellitus (GDM). However, the relationship between pre-pregnancy body mass index (BMI), weight gain, and GDM has not been precisely quantified. This study aimed to explore whether gestational weight gain played a mediating role between pre-pregnancy BMI and GDM and whether the mediating effect was sex specific. Methods This study established a population-based observational cohort to assess weight gain in pregnant women. Mediation analyses were performed to quantify whether weight gain mediated the association between pre-pregnancy BMI and GDM. Results A total of 67,777 pregnant women were included in the final analysis, among whom 6751 (10.0%) were diagnosed with GDM. We verified that both pre-pregnancy BMI and weight gain were associated with GDM, and that BMI negatively contributed to weight gain. We also found that weight gain had a significant mediating effect on the relationship between pre-pregnancy BMI and GDM (Za × Zb confidence intervals [CIs] 0.00234–0.00618). Furthermore, the effect was sex-specific, in that it was only significant in overweight women carrying female fetuses (Za × Zb CIs 0.00422–0.01977), but not male fetuses (Za × Zb CIs −0.00085 to 0.01236). Conclusions Weight gain during pregnancy had a fetal sex-specific mediating effect between pre-pregnancy BMI and GDM.
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Ranasinha S, Hill B, Teede HJ, Enticott J, Wang R, Harrison CL. Efficacy of behavioral interventions in managing gestational weight gain (GWG): A component network meta-analysis. Obes Rev 2022; 23:e13406. [PMID: 34927351 DOI: 10.1111/obr.13406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/04/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify the most effective behavioral components within lifestyle interventions to optimize gestational weight gain (GWG) to inform guidelines, policy and translation into healthcare. METHODS Behavioral components were identified from study level data of randomized antenatal lifestyle interventions using a behavioral taxonomy framework and analyzed using component network meta-analysis (NMA). The NMA ranked behavioral combinations hierarchically by efficacy of optimizing GWG. Direct and estimated indirect comparisons between study arms (i.e., control and intervention) and between different component combinations were estimated to evaluate component combinations associated with greater efficacy. RESULTS Overall, 32 studies with 11,066 participants were included. Each intervention contained between 3 and 7 behavioral components with 26 different behavioral combinations identified. The majority (n = 24) of combinations were associated with optimizing GWG, with standard mean differences (SMD) ranging from -1.01 kg (95% CI -1.64 to -0.37) and -0.07 kg (-0.38 to 0.24), compared with controls. The behavioral cluster identified as most effective, included components of goals, feedback and monitoring, natural consequences, comparison of outcomes, and shaping knowledge (SMD -1.01 kg [95% CI -1.64 to -0.37]). CONCLUSION Findings support the application of goal setting, feedback and monitoring, natural consequences, comparison of outcomes, and shaping knowledge as essential, core components within lifestyle interventions to optimize gestational weight gain.
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Affiliation(s)
- Sanjeeva Ranasinha
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Briony Hill
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rui Wang
- Department of Obstetrics and Gynaecology, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia
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Liu E, Wang D, Darling AM, Perumal N, Wang M, Urassa W, Pembe A, Fawzi WW. Multivitamin Supplementation Is Associated with Greater Adequacy of Gestational Weight Gain among Pregnant Women in Tanzania. J Nutr 2022; 152:1091-1098. [PMID: 34964890 PMCID: PMC8970983 DOI: 10.1093/jn/nxab448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/02/2021] [Accepted: 12/23/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Gestational weight gain (GWG) is a modifiable risk factor associated with adverse birth outcomes. Studies have shown that the provision of multiple micronutrient supplements to pregnant women reduces the risk of low birth weight. However, the effect of multiple micronutrient supplements on GWG has been understudied. OBJECTIVES We examined the effect of daily supplementation of pregnant women with multivitamins on GWG in relation to the GWG recommendation by the Institute of Medicine (IOM). METHODS Pregnant women with gestational age between 12 and 27 wk were randomly assigned to receive daily multivitamins or placebo until delivery. Weight was measured at enrollment and every follow-up visit. Percentage adequacy of GWG was calculated as actual GWG divided by the recommended GWG according to the IOM recommendation. Binary outcomes included severely inadequate (<70%), inadequate (<90%), and excessive GWG (≥125%). The analysis included 7573 women with singleton pregnancies. Multiple linear regression models were used to examine the association between multivitamin supplementation and percentage adequacy of GWG, and log-binomial models were used for binary outcomes. RESULTS The mean percentage adequacy of GWG was 96.7% in the multivitamin arm and 94.4% in the placebo arm, with a mean difference of 2.3% (95% CI: 0.3%, 4.2%; P = 0.022). Compared with women in the placebo arm, those who received multivitamins had a lower risk of severely inadequate GWG (RR: 0.90; 95% CI: 0.83, 0.97; P = 0.008) and inadequate GWG (RR: 0.95; 95% CI: 0.91, 0.99; P = 0.018). No significant difference was found in excessive GWG. CONCLUSIONS Multivitamin supplementation increased GWG and reduced the risk of severely inadequate and inadequate GWG among pregnant women in Tanzania. Together with previously reported beneficial effects of the supplements on birth outcomes in low- and middle-income countries, our findings support scaling up the use of prenatal supplements that include multivitamins in addition to iron and folic acid.This trial was registered at clinicaltrials.gov as NCT00197548.
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Affiliation(s)
- Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Dongqing Wang
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Anne Marie Darling
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Nandita Perumal
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Willy Urassa
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrea Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
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Abstract
The present paper outlines current issues in the nutritional care of women during pregnancy and potential resources to address them. Globally, overnutrition, undernutrition and nutritional imbalances are widespread among women of reproductive age; increasing the risk of pregnancy complications and non-communicable diseases in both mothers and their children. Most women do not meet dietary guidelines for pregnancy. The World Health Organisation (WHO) recommends nutrition and weight counselling during pregnancy for all women. However, clinical practices focusing on nutrition vary and there is no consensus on which outcomes are most important for pregnancy nutrition interventions, with little consideration for the 'patient voice'. The International Federation of Gynaecology and Obstetrics (FIGO) nutrition checklist is a clinical practice tool that is available for healthcare professionals that will address this issue. The pregnancy nutrition core outcome set will also support advancement of antenatal nutrition by identifying the most critical nutrition-related outcomes from the perspective of healthcare professionals, researchers and women with experience of pregnancy. While poor nutrition can result in adverse outcomes across women of all weight categories, those with obesity may require specialist care to reduce their risk. Obesity is a chronic, progressive, relapsing disease that has high individual variability in its prognosis. The use of obesity staging systems, which consider mental, physical and functional health, can stratify individuals into risk categories and aid in treatment prioritisation in pregnancy. As the prevalence of obesity continues to rise, an obesity staging approach may support clinicians, especially those in limited resource settings.
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LeBlanc ES, Boisvert C, Catlin C, Lee MH, Smith N, Vesco KK, Savage J, Mitchell DC, Gruß I, Stevens VJ. Prepare Randomized Clinical Trial: Acceptability, Engagement, and Lifestyle Effects of a Weight Loss Intervention Beginning in Pre‐pregnancy. Obes Sci Pract 2022; 8:603-616. [PMID: 36238226 PMCID: PMC9535669 DOI: 10.1002/osp4.596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 12/05/2022] Open
Abstract
Background Healthier lifestyles in early pregnancy are associated with lower rates of pregnancy complications, childhood adiposity, and maternal and child cardiovascular risks. However, it is not known whether lifestyle coaching initiated prior to pregnancy can affect behavior and attitudes during pregnancy. Methods Three hundred and twenty six women planning pregnancy within 2 years with BMI ≥27 kg/m2 were randomized to a behavioral weight loss intervention or to usual care. Analyses reported here examined the intervention’s impact on mid‐pregnancy diet quality and activity levels; program acceptability; and effects of pregnancy on intervention engagement. Results One hundred and sixty eight participants experienced pregnancy during the study (intervention: 91; usual care: 77). From randomization to mid‐pregnancy, participants who received the intervention had larger increases in fruit intake than usual care participants (+0.67 vs. +0.06 cups; p = 0.02) and engaged in more vigorous‐intensity activity (3.9 [5.5] vs. 1.2 [3.0] Met‐hr/week p = 0.002) and sports/exercise (17.0 [14.1] vs. 11.0 [9.5] Met‐hr/week; p = 0.03); the groups also differed in changes in sedentary time (−4.9 [15.0] vs. +0.5 [7.6] Met‐hr/week; p = 0.02). Intervention satisfaction was high (>80%), and experiencing pregnancy during the intervention was associated with higher engagement. Conclusion A coaching‐based intervention beginning in pre‐pregnancy successfully helped women attain healthier diet and exercise habits in mid‐pregnancy. Clinical trials registration Registered with ClinicalTrials.gov, NCT02346162, first registered on January 26, 2015, before date of initial participant enrollment (May 2015), https://clinicaltrials.gov/ct2/show/NCT02346162.
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Affiliation(s)
- Erin S LeBlanc
- Kaiser Permanente, Center for Health Research 3800 N. Interstate Ave Portland OR97227
| | - Cassie Boisvert
- Oregon Health & Science University 2720 S Moody Avenue Portland OR97201
| | - Chris Catlin
- Kaiser Permanente, Center for Health Research 3800 N. Interstate Ave Portland OR97227
| | - Mi H Lee
- Kaiser Permanente, Center for Health Research 3800 N. Interstate Ave Portland OR97227
| | - Ning Smith
- Kaiser Permanente, Center for Health Research 3800 N. Interstate Ave Portland OR97227
| | - Kimberly K. Vesco
- Kaiser Permanente, Center for Health Research 3800 N. Interstate Ave Portland OR97227
| | - Jennifer Savage
- Center for Childhood Obesity Research, The Pennsylvania State University 129Noll LaboratoryUniversity Park PA16802
| | - Diane C. Mitchell
- Department of Nutritional Sciences The Pennsylvania State University 108Chandlee LaboratoryUniversity Park PA16802
| | - Inga Gruß
- Kaiser Permanente, Center for Health Research 3800 N. Interstate Ave Portland OR97227
| | - Victor J Stevens
- Kaiser Permanente, Center for Health Research 3800 N. Interstate Ave Portland OR97227
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Teede HJ, Bailey C, Moran LJ, Bahri Khomami M, Enticott J, Ranasinha S, Rogozinska E, Skouteris H, Boyle JA, Thangaratinam S, Harrison CL. Association of Antenatal Diet and Physical Activity-Based Interventions With Gestational Weight Gain and Pregnancy Outcomes: A Systematic Review and Meta-analysis. JAMA Intern Med 2022; 182:106-114. [PMID: 34928300 PMCID: PMC8689430 DOI: 10.1001/jamainternmed.2021.6373] [Citation(s) in RCA: 99] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Excessive gestational weight gain (GWG) is common and associated with adverse pregnancy outcomes. Antenatal lifestyle interventions limit GWG; yet benefits of different intervention types and specific maternal and neonatal outcomes are unclear. OBJECTIVE To evaluate the association of different types of diet and physical activity-based antenatal lifestyle interventions with GWG and maternal and neonatal outcomes. DATA SOURCES A 2-stage systematic literature search of MEDLINE, Embase, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Health Technology Assessment Database was conducted from February 1, 2017, to May 31, 2020. Search results from the present study were integrated with those from a previous systematic review from 1990 to February 2017. STUDY SELECTION Randomized trials reporting GWG and maternal and neonatal outcomes. DATA EXTRACTION AND SYNTHESIS Data were extracted for random-effects meta-analyses to calculate the summary effect estimates and 95% CIs. MAIN OUTCOMES AND MEASURES Outcomes were clinically prioritized, with mean GWG as the primary outcome. Secondary outcomes included gestational diabetes, hypertensive disorders of pregnancy, cesarean section, preterm delivery, large or small for gestational age neonates, neonatal intensive care unit admission, or fetal death. RESULTS A total of 117 randomized clinical trials of antenatal lifestyle interventions (involving 34 546 women) were included. Overall lifestyle intervention was associated with reduced GWG (-1.15 kg; 95% CI, -1.40 to -0.91), risk of gestational diabetes (odds ratio [OR], 0.79; 95% CI, 0.70-0.89), and total adverse maternal outcomes (OR, 0.89; 95% CI, 0.84-0.94) vs routine care. Compared with routine care, diet was associated with less GWG (-2.63 kg; 95% CI, -3.87 to -1.40) than physical activity (-1.04 kg; 95% CI, -1.33 to -0.74) or mixed interventions (eg, unstructured lifestyle support, written information with weight monitoring, or behavioral support alone) (-0.74 kg; 95% CI, -1.06 to -0.43). Diet was associated with reduced risk of gestational diabetes (OR, 0.61; 95% CI, 0.45-0.82), preterm delivery (OR, 0.43; 95% CI, 0.22-0.84), large for gestational age neonate (OR, 0.19; 95% CI, 0.08-0.47), neonatal intensive care admission (OR, 0.68; 95% CI, 0.48-0.95), and total adverse maternal (OR, 0.75; 95% CI, 0.61-0.92) and neonatal outcomes (OR, 0.44; 95% CI, 0.26-0.72). Physical activity was associated with reduced GWG and reduced risk of gestational diabetes (OR, 0.60; 95% CI, 0.47-0.75), hypertensive disorders (OR, 0.66; 95% CI, 0.48-0.90), cesarean section (OR, 0.85; 95% CI, 0.75-0.95), and total adverse maternal outcomes (OR, 0.78; 95% CI, 0.71-0.86). Diet with physical activity was associated with reduced GWG (-1.35 kg; 95% CI, -1.95 to -0.75) and reduced risk of gestational diabetes (OR, 0.72; 95% CI, 0.54-0.96) and total adverse maternal outcomes (OR, 0.81; 95% CI, 0.69-0.95). Mixed interventions were associated with reduced GWG only. CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis found level 1 evidence that antenatal structured diet and physical activity-based lifestyle interventions were associated with reduced GWG and lower risk of adverse maternal and neonatal outcomes. The findings support the implementation of such interventions in routine antenatal care and policy around the world.
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Affiliation(s)
- Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Endocrinology and Diabetes Units, Monash Health, Melbourne, Victoria, Australia.,Warwick Business School, Warwick University, Coventry, United Kingdom
| | - Cate Bailey
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Endocrinology and Diabetes Units, Monash Health, Melbourne, Victoria, Australia
| | - Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sanjeeva Ranasinha
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ewelina Rogozinska
- Meta-Analysis Group, Institute of Clinical Trials and Methodology, Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Warwick Business School, Warwick University, Coventry, United Kingdom
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Monash Women's, Monash Health, Melbourne, Victoria, Australia
| | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.,Birmingham Women's and Children's National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Endocrinology and Diabetes Units, Monash Health, Melbourne, Victoria, Australia
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64
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Bennett WL, Coughlin JW, Henderson J, Martin S, Yazdy GM, Drabo EF, Showell NN, McKinney C, Martin L, Dalcin A, Sanders R, Wang NY. Healthy for Two/Healthy for You: Design and methods for a pragmatic randomized clinical trial to limit gestational weight gain and prevent obesity in the prenatal care setting. Contemp Clin Trials 2022; 113:106647. [PMID: 34896296 PMCID: PMC8844210 DOI: 10.1016/j.cct.2021.106647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the effect of Healthy for Two/Healthy for You (H42/H4U), a health coaching program, in prenatal care clinics that serve a racially and economically diverse population, on total gestational weight gain (GWG) (vs. usual care). We hypothesize that compared to usual prenatal care, intervention participants will have lower GWG and lower rates of gestational diabetes mellitus (GDM). METHODS We report the rationale and design of a pragmatic, parallel arm randomized clinical trial with 380 pregnant patients ≤15 weeks gestation with overweight or obesity from one of 6 academic and community-based obstetrics practices, randomized to either H42/H4U or usual prenatal care in a 1:1 ratio. The study duration is early pregnancy to 6 months postpartum. The primary outcome is total GWG, calculated as the difference between first clinic-assessed pregnancy weight and the weight at 37 weeks gestation. Key maternal and infant secondary outcomes include GDM incidence, weight retention at 6 months postpartum, infant weight, maternal health behaviors and wellness. CONCLUSIONS This pragmatic clinical trial embeds a pregnancy health coaching program into prenatal care to allow parallel testing compared to usual prenatal care on the outcome of total GWG. The real-world design provides an approach to enhance its sustainability beyond the trial to ultimately improve maternal/child health outcomes and reduce future obesity. TRIAL REGISTRATION The study was first registered at clinicaltrials.gov on 1/26/21 (NCT04724330).
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Affiliation(s)
- Wendy L Bennett
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA..
| | | | - Janice Henderson
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, USA
| | - Stephen Martin
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, USA
| | - Golsa M Yazdy
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, USA
| | - Emmanuel F Drabo
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, USA
| | | | - Christine McKinney
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Lindsay Martin
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Arlene Dalcin
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Rachel Sanders
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Nae-Yuh Wang
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA
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65
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Cantor AG, Jungbauer RM, Chou R. Systematic Review of Counseling and Behavioral Interventions for Healthy Weight and Weight Gain in Pregnancy From the US Preventive Services Task Force-Reply. JAMA 2021; 326:1635-1636. [PMID: 34698788 DOI: 10.1001/jama.2021.13995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Amy G Cantor
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Rebecca M Jungbauer
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Roger Chou
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
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66
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Dodd JM, Dalrymple K, Louise J. Systematic Review of Counseling and Behavioral Interventions for Healthy Weight and Weight Gain in Pregnancy From the US Preventive Services Task Force. JAMA 2021; 326:1634-1635. [PMID: 34698792 DOI: 10.1001/jama.2021.13992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Jodie M Dodd
- Department of Obstetrics and Gynaecology, University of Adelaide, Adelaide, Australia
| | - Kathryn Dalrymple
- Division of Women and Children's Health, King's College London, London, England
| | - Jennie Louise
- Department of Obstetrics and Gynaecology, University of Adelaide, Adelaide, Australia
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67
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Incorrect Group Sizes in Figure. JAMA 2021; 326:1072. [PMID: 34546318 PMCID: PMC8456381 DOI: 10.1001/jama.2021.14582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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68
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Bovbjerg ML. Current Resources for Evidence-Based Practice, September 2021. J Obstet Gynecol Neonatal Nurs 2021; 50:642-654. [PMID: 34437841 DOI: 10.1016/j.jogn.2021.08.095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes an assessment of safety of birth centers in the United States and commentaries on reviews focused on aspirin prophylaxis in pregnancy and the new gestational weight gain evidence summary from the United States Preventive Services Task Force.
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69
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Zhang C, Wang L, Sun W, Chen L, Zhang C, Li H, Yu J, Fan J, Ruan H, Zheng T, Wu D, Li S, Lu H, Wang M, Mol BW, Huang H, Wu Y. Effect of an individualised nutritional intervention on gestational diabetes mellitus prevention in a high-risk population screened by a prediction model: study protocol for a multicentre randomised controlled trial. BMC Pregnancy Childbirth 2021; 21:586. [PMID: 34429102 PMCID: PMC8385988 DOI: 10.1186/s12884-021-04039-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/09/2021] [Indexed: 12/17/2022] Open
Abstract
Background The ability of a preventive nutritional intervention to reduce the morbidity of gestational diabetes mellitus (GDM) remains controversial. We aim to assess whether GDM can be prevented by an individualised nutritional intervention in pregnant women who are at high risk for the disease based on a prediction model. Methods/design A multicentre randomised controlled trial was designed to assess the efficacy of an individualised nutritional intervention for the prevention of GDM in a high-risk population screened by a novel prediction model in the first trimester. Pregnant women evaluated to be at high risk for GDM by the prediction model at less than 14 gestational weeks will be included. Women with pre-existing chronic diseases, including pregestational diabetes, or who are currently prescribed medicines that affect glucose values will be excluded. Allocation to intervention/control at a ratio of 1:1 will be conducted by a computerized randomisation system. The intervention group will complete 3-day food records and receive 3 individualised nutritional consultations with professional dieticians before the oral glucose tolerance test. The primary intention of the intervention is to promote a long-term healthy dietary pattern and prevent excessive gestational weight gain throughout pregnancy. The control group will complete 3-day food records at designated gestational weeks and receive standard antenatal care according to local health care provisions. The primary outcome is the incidence of GDM according to the criteria of the International Association of Diabetes and Pregnancy Study Group (IADPSG). A sample of 464 participants will provide 80% power to detect a 30% reduction in GDM incidence (α = 0.05 two tailed, 10% dropout). A total of 500 participants will be recruited. Discussion To date, this is the first randomised controlled trial aimed to evaluate the protective effect of an individualised nutritional intervention against GDM based on a logistic regression prediction model. Eligibility is not limited to obese women or singleton pregnancies, as in previous studies. This pragmatic trial is expected to provide valuable information on early screening and effective GDM prevention methods. Trial registration number ChiCTR, ChiCTR1900026963. Registered 27 October 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04039-2.
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Affiliation(s)
- Chenjie Zhang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910, Hengshan Rd, Shanghai, 200030, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Lulu Wang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910, Hengshan Rd, Shanghai, 200030, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Wenguang Sun
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910, Hengshan Rd, Shanghai, 200030, China
| | - Lei Chen
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910, Hengshan Rd, Shanghai, 200030, China
| | - Chen Zhang
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, 200011, China
| | - Hong Li
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910, Hengshan Rd, Shanghai, 200030, China
| | - Jiale Yu
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910, Hengshan Rd, Shanghai, 200030, China
| | - Jianxia Fan
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910, Hengshan Rd, Shanghai, 200030, China
| | - Huijuan Ruan
- Department of Gynecology, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Tao Zheng
- Department of Gynecology, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Dongling Wu
- Department of Gynecology, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Shaojing Li
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University-Affiliated Sixth People's Hospital of Fengxian Branch, Shanghai, 201499, China
| | - Huan Lu
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University-Affiliated Sixth People's Hospital of Fengxian Branch, Shanghai, 201499, China
| | - Man Wang
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University-Affiliated Sixth People's Hospital of Fengxian Branch, Shanghai, 201499, China
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Hefeng Huang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910, Hengshan Rd, Shanghai, 200030, China. .,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China. .,Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, 200011, China.
| | - Yanting Wu
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910, Hengshan Rd, Shanghai, 200030, China. .,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China. .,Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, 200011, China.
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70
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Zhou YB, Liu JM. Optimal gestational weight gain. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 13:100207. [PMID: 34527990 PMCID: PMC8403894 DOI: 10.1016/j.lanwpc.2021.100207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Yu-bo Zhou
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd, Haidian District, Beijing 100191, China
| | - Jian-meng Liu
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd, Haidian District, Beijing 100191, China
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71
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Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Krist AH, Kubik M, Li L, Ogedegbe G, Pbert L, Silverstein M, Simon M, Stevermer J, Tseng CW, Wong JB. Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy: US Preventive Services Task Force Recommendation Statement. JAMA 2021; 325:2087-2093. [PMID: 34032823 DOI: 10.1001/jama.2021.6949] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE The prevalence of overweight and obesity is increasing among persons of childbearing age and pregnant persons. In 2015, almost half of all persons began pregnancy with overweight (24%) or obesity (24%). Reported rates of overweight and obesity are higher among Black, Alaska Native/American Indian, and Hispanic women and lower among White and Asian women. Excess weight at the beginning of pregnancy and excess gestational weight gain have been associated with adverse maternal and infant health outcomes such as a large for gestational age infant, cesarean delivery, or preterm birth. OBJECTIVE The USPSTF commissioned a systematic review to evaluate the benefits and harms of behavioral counseling interventions to prevent adverse health outcomes associated with obesity during pregnancy and to evaluate intermediate outcomes, including excess gestational weight gain. This is a new recommendation. POPULATION Pregnant adolescents and adults in primary care settings. EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy have a moderate net benefit for pregnant persons. RECOMMENDATION The USPSTF recommends that clinicians offer pregnant persons effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy. (B recommendation).
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Affiliation(s)
| | - Karina W Davidson
- Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York
| | | | | | | | | | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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