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Fair F, Soltani H. A meta-review of systematic reviews of lifestyle interventions for reducing gestational weight gain in women with overweight or obesity. Obes Rev 2021; 22:e13199. [PMID: 33459493 PMCID: PMC8047893 DOI: 10.1111/obr.13199] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/20/2020] [Accepted: 12/10/2020] [Indexed: 12/18/2022]
Abstract
Women with overweight or obesity are twice as likely to gain excessive gestational weight than women of normal weight. Identifying effective interventions to support this group achieve healthy gestational weight gain is important. An overview of systematic reviews regarding the effectiveness of lifestyle interventions on gestational weight gain in women with overweight or obesity was undertaken, including searching eight electronic databases. Quality of included reviews was assessed by two independent researchers. A narrative data synthesis was undertaken, with subgroup and sensitivity analyses by type of intervention and quality of the included reviews. A total of 15 systematic reviews were included within this meta-review. A small reduction in gestational weight gain of between 0.3 and 2.4 kg was noted with lifestyle interventions compared with standard care. There was some evidence that dietary only or physical activity only interventions may reduce the odds of gestational diabetes. No differences were noted in the odds of other maternal or infant health outcomes. Although lifestyle interventions appeared to decrease gestational weight gain, current evidence does not show a clear benefit on maternal and infant outcomes from the small nature of the reduction in gestational weight gain produced by lifestyle interventions in women with overweight or obesity.
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Affiliation(s)
- Frankie Fair
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Hora Soltani
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
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Pirotta S, Joham A, Grieger JA, Tay CT, Bahri-Khomami M, Lujan M, Lim SS, Moran LJ. Obesity and the Risk of Infertility, Gestational Diabetes, and Type 2 Diabetes in Polycystic Ovary Syndrome. Semin Reprod Med 2021; 38:342-351. [PMID: 33873233 DOI: 10.1055/s-0041-1726866] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This review describes the relationship between obesity and the most common reproductive (infertility) and metabolic (gestational diabetes mellitus [GDM] and type 2 diabetes mellitus [T2DM]) consequences in polycystic ovary syndrome (PCOS). It also describes the vital role of lifestyle management for PCOS. PCOS is a heterogeneous endocrine disorder common in reproductive-age women. Consensus on the exact etiological mechanisms of PCOS is unreached. Overweight or obesity is present in at least 60% of the PCOS population, but the condition occurs irrespective of BMI, with excess BMI increasing both the prevalence and severity of clinical features. Use of lifestyle therapies (nutrition, physical activity, and/or behavioral) for the prevention and management of excess weight gain, infertility, GDM, and T2DM is a vital component of best-practice PCOS care. Lifestyle management is recommended for all women with PCOS as the first-line treatment with or without medications. Due to a lack of high-quality trials demonstrating the efficacy of specific lifestyle approaches, PCOS lifestyle recommendations are as those for the general population. This review summarizes current knowledge relating to obesity and its impact on fertility, GDM, and T2DM. It also summarizes the lifestyle recommendations to best manage these conditions in women with PCOS and obesity.
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Affiliation(s)
- Stephanie Pirotta
- Health and Social Care Unit, SPHPM, Monash University, Victoria, Australia
| | - Anju Joham
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia.,Department of Diabetes and Vascular Medicine, Monash Health, Victoria, Australia
| | - Jessica A Grieger
- Adelaide Medical School, University of Adelaide, South Australia, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Chau Tien Tay
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
| | - Mahnaz Bahri-Khomami
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
| | - Marla Lujan
- Division of Nutritional Sciences, Cornell University, New York
| | - Siew S Lim
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
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Kirkegaard H, Bliddal M, Støvring H, Rasmussen KM, Gunderson EP, Køber L, Sørensen TIA, Nøhr EA. Maternal weight change from prepregnancy to 18 months postpartum and subsequent risk of hypertension and cardiovascular disease in Danish women: A cohort study. PLoS Med 2021; 18:e1003486. [PMID: 33798198 PMCID: PMC8051762 DOI: 10.1371/journal.pmed.1003486] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/16/2021] [Accepted: 03/17/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND One-fourth of women experience substantially higher weight years after childbirth. We examined weight change from prepregnancy to 18 months postpartum according to subsequent maternal risk of hypertension and cardiovascular disease (CVD). METHODS AND FINDINGS We conducted a cohort study of 47,966 women with a live-born singleton within the Danish National Birth Cohort (DNBC; 1997-2002). Interviews during pregnancy and 6 and 18 months postpartum provided information on height, gestational weight gain (GWG), postpartum weights, and maternal characteristics. Information on pregnancy complications, incident hypertension, and CVD was obtained from the National Patient Register. Using Cox regression, we estimated adjusted hazard ratios (HRs; 95% confidence interval [CI]) for hypertension and CVD through 16 years of follow-up. During this period, 2,011 women were diagnosed at the hospital with hypertension and 1,321 with CVD. The women were on average 32.3 years old (range 18.0-49.2) at start of follow-up, 73% had a prepregnancy BMI <25, and 27% a prepregnancy BMI ≥25. Compared with a stable weight (±1 BMI unit), weight gains from prepregnancy to 18 months postpartum of >1-2 and >2 BMI units were associated with 25% (10%-42%), P = 0.001 and 31% (14%-52%), P < 0.001 higher risks of hypertension, respectively. These risks were similar whether weight gain presented postpartum weight retention or a new gain from 6 months to 18 months postpartum and whether GWG was below, within, or above the recommendations. For CVD, findings differed according to prepregnancy BMI. In women with normal-/underweight, weight gain >2 BMI units and weight loss >1 BMI unit were associated with 48% (17%-87%), P = 0.001 and 28% (6%-55%), P = 0.01 higher risks of CVD, respectively. Further, weight loss >1 BMI unit combined with a GWG below recommended was associated with a 70% (24%-135%), P = 0.001 higher risk of CVD. No such increased risks were observed among women with overweight/obesity (interaction by prepregnancy BMI, P = 0.01, 0.03, and 0.03, respectively). The limitations of this observational study include potential confounding by prepregnancy metabolic health and self-reported maternal weights, which may lead to some misclassification. CONCLUSIONS Postpartum weight retention/new gain in all mothers and postpartum weight loss in mothers with normal-/underweight may be associated with later adverse cardiovascular health.
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Affiliation(s)
- Helene Kirkegaard
- Research Unit of Obstetrics and Gynecology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- * E-mail:
| | - Mette Bliddal
- Open Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Henrik Støvring
- Department of Public Health, Biostatistics, Aarhus University, Aarhus, Denmark
| | - Kathleen M. Rasmussen
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America
| | - Erica P. Gunderson
- Division of Research, Cardiovascular and Metabolic Conditions Section, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark
| | - Thorkild I. A. Sørensen
- Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ellen A. Nøhr
- Research Unit of Obstetrics and Gynecology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
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Long-Term IoT-Based Maternal Monitoring: System Design and Evaluation. SENSORS 2021; 21:s21072281. [PMID: 33805217 PMCID: PMC8036648 DOI: 10.3390/s21072281] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/13/2021] [Accepted: 03/20/2021] [Indexed: 12/20/2022]
Abstract
Pregnancy is a unique time when many mothers gain awareness of their lifestyle and its impacts on the fetus. High-quality care during pregnancy is needed to identify possible complications early and ensure the mother’s and her unborn baby’s health and well-being. Different studies have thus far proposed maternal health monitoring systems. However, they are designed for a specific health problem or are limited to questionnaires and short-term data collection methods. Moreover, the requirements and challenges have not been evaluated in long-term studies. Maternal health necessitates a comprehensive framework enabling continuous monitoring of pregnant women. In this paper, we present an Internet-of-Things (IoT)-based system to provide ubiquitous maternal health monitoring during pregnancy and postpartum. The system consists of various data collectors to track the mother’s condition, including stress, sleep, and physical activity. We carried out the full system implementation and conducted a real human subject study on pregnant women in Southwestern Finland. We then evaluated the system’s feasibility, energy efficiency, and data reliability. Our results show that the implemented system is feasible in terms of system usage during nine months. We also indicate the smartwatch, used in our study, has acceptable energy efficiency in long-term monitoring and is able to collect reliable photoplethysmography data. Finally, we discuss the integration of the presented system with the current healthcare system.
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The relationship between gestational weight gain, maternal upper-body subcutaneous fat changes and infant birth size: A pilot observational study amongst women with obesity. Early Hum Dev 2021; 154:105307. [PMID: 33453458 DOI: 10.1016/j.earlhumdev.2021.105307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND It is widely acknowledged that maternal obesity and excessive gestational weight gain (GWG) are associated with increased risk of fetal macrosomia and recent studies have suggested a role for the timing and composition of GWG. AIMS To examine the effect of the rate of change in GWG and maternal upper-body subcutaneous fat on neonatal anthropometric outcomes in a pilot observational study amongst women with obesity. STUDY DESIGN Expectant women with a body mass index (BMI) > 30 kg/m2 at first antenatal appointment were recruited at 12 weeks gestation. Maternal height, weight and skinfold thickness (SFT) measurements were collected at baseline and repeated at 28 and 36 weeks gestation. Following delivery, World Health Organisation (WHO)-UK infant birthweight z-scores were calculated, and infant anthropometric measurements were obtained. RESULTS The sum of upper body SFT measurements increased in mid-pregnancy (0.08 ± 0.71 mm/week) and decreased in late pregnancy (-0.04 ± 1.17 mm/week). After adjustment for maternal age, BMI and parity, mid- but not late- pregnancy GWG was positively associated with infant birthweight z-score (p<0.05), while mid- but not late-pregnancy changes in the sum of SFT were inversely associated with infant birthweight z-score (p<0.01). CONCLUSIONS The present study suggests that mid- rather than late-pregnancy changes in weight and upper-body subcutaneous fat are associated with infant birthweight. Further research is required in larger, more diverse populations to explore whether pregnancy interventions aiming to improve maternal and offspring health can be personalised beyond BMI and GWG.
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Abstract
Group prenatal care is a health care delivery model that utilizes shared medical appointments to place greater focus on patient education, mutual support, and increased time with the clinician to promote a healthy pregnancy. Several studies suggest that medically low-risk women participating in group prenatal care have improved pregnancy outcomes, but the same tenants can likely be used to help women with diabetes and obesity achieve healthy outcomes during pregnancy and throughout their life course. This chapter will review the background, care model, and evidence regarding group medical visits for pregnant women with diabetes and obesity.
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Affiliation(s)
- Bridget C Huysman
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Sara Mazzoni
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
| | - Ebony B Carter
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
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Shearer J, Klein MS, Vogel HJ, Mohammad S, Bainbridge S, Adamo KB. Maternal and Cord Blood Metabolite Associations with Gestational Weight Gain and Pregnancy Health Outcomes. J Proteome Res 2021; 20:1630-1638. [PMID: 33529033 DOI: 10.1021/acs.jproteome.0c00854] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Pre-pregnancy obesity and excessive gestational weight gain (GWG) are risk factors for future maternal and childhood obesity. Maternal obesity is potentially communicated to the fetus in part by the metabolome, altering the child's metabolic program in early development. Fasting maternal blood samples from 37 singleton pregnancies at 25-28 weeks of gestation were obtained from mothers with pre-pregnancy body mass indexes (BMIs) between 18 and 40 kg/m2. Various health measures including GWG, diet, and physical activity were also assessed. At term (37-42 weeks), a venous umbilical cord sample was obtained. Serum metabolomic profiles were measured using nuclear magnetic resonance spectroscopy as well as a gut and metabolic hormone panel. Maternal and cord serum metabolites were tested for associations with pre-pregnancy BMI, GWG, health outcomes, and gut and metabolic hormones. While cord blood metabolites showed no significant correlation to maternal obesity status or other measured health outcomes, maternal serum metabolites showed distinct profiles for lean, overweight, and obese women. Additionally, four serum metabolites, namely, glutamate, lysine, pyruvate, and valine, allowed prediction of excessive GWG when pre-pregnancy BMI was controlled. Metabolic biomarkers predictive of GWG are reported and, if validated, could aid in the guidance of prenatal weight management plans as the majority of pregnancy weight gain occurs in the third trimester.
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Affiliation(s)
- Jane Shearer
- Department of Biochemistry and Molecular Biology. Faculty of Kinesiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta T2N 1N4, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Matthias S Klein
- Department of Food Science and Technology, The Ohio State University, Columbus, Ohio 43210, United States.,Department of Biological Sciences, Faculty of Science, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Hans J Vogel
- Department of Biological Sciences, Faculty of Science, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Shuhiba Mohammad
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | - Shannon Bainbridge
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada.,Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
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Solis Paredes JM, Perichart Perera O, Montoya Estrada A, Reyes Muñoz E, Espino y Sosa S, Ortega Castillo V, Medina Bastidas D, Tolentino Dolores M, Sanchez Martinez M, Nava Salazar S, Estrada Gutierrez G. Gestational Weight Gain Influences the Adipokine-Oxidative Stress Association during Pregnancy. Obes Facts 2021; 14:604-612. [PMID: 34535612 PMCID: PMC8740011 DOI: 10.1159/000518639] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/21/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE The weight gained during pregnancy could determine the immediate and future health of the mother-child dyad. Excessive gestational weight gain (EGWG) due to abnormal adipose tissue (AT) accumulation is strongly associated with adverse perinatal outcomes as gestational diabetes, macrosomia, obesity, and hypertension further in life. Dysregulation of adipokine, AT dysfunction, and an imbalance in the prooxidant-antioxidant systems are critical features in altered AT accumulation. This study was aimed to investigate the association between adipokines and oxidative stress markers in pregnant women and the influence of the GWG on this association. METHODS Maternal blood samples were obtained in the third trimester of pregnancy (n = 74) and serum adipokines (adiponectin, leptin, and resistin), oxidative damage markers: 8-oxo-2'-deoxyguanosine (8-oxodG), lipohydroperoxides (LOOH), malondialdehyde (MDA), and carbonylated proteins (CP), and glucose a metabolic marker were measured. RESULTS Women with EGWG had low adiponectin levels than women with adequate weight gain (AWG) or insufficient weight gain (IWG). Multiple linear regression models revealed a positive association between adiponectin and 8-oxodG in women with AWG (B = 1.09, 95% CI: 164-222, p = 0.027) and IWG (B = 0.860, 95% CI: 0.199-1.52, p = 0.013) but not in women with EGWG. In women with EGWG, leptin was positively associated with LOOH (p = 0.018), MDA (p = 0.005), and CP (p = 0.010) oxidative markers. CONCLUSION Our findings suggest that concurrent mechanisms regulate adipokine production and oxidative stress in pregnant women and that this regulation is influenced by GWG, probably due to an excessive AT accumulation.
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Affiliation(s)
- Juan Mario Solis Paredes
- Department of Human Genetics and Genomics, Instituto Nacional de Perinatologia, Mexico City, Mexico
| | - Otilia Perichart Perera
- Instituto Nacional de Perinatologia, Nutrition and Bioprogramming Coordination, Mexico City, Mexico
| | - Araceli Montoya Estrada
- Instituto Nacional de Perinatologia, Coordination of Gynecological and Perinatal Endocrinology, Mexico City, Mexico
| | - Enrique Reyes Muñoz
- Instituto Nacional de Perinatologia, Coordination of Gynecological and Perinatal Endocrinology, Mexico City, Mexico
| | | | | | - Diana Medina Bastidas
- Instituto Nacional de Perinatologia– Facultad de Quimica-UNAM, Unidad de Investigación en Reproducción Humana, Mexico City, Mexico
| | | | | | - Sonia Nava Salazar
- Department of Inmunobiochemistry, Instituto Nacional de Perinatologia, Mexico City, Mexico
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Parrettini S, Caroli A, Torlone E. Nutrition and Metabolic Adaptations in Physiological and Complicated Pregnancy: Focus on Obesity and Gestational Diabetes. Front Endocrinol (Lausanne) 2020; 11:611929. [PMID: 33424775 PMCID: PMC7793966 DOI: 10.3389/fendo.2020.611929] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/02/2020] [Indexed: 12/14/2022] Open
Abstract
Pregnancy offers a window of opportunity to program the future health of both mothers and offspring. During gestation, women experience a series of physical and metabolic modifications and adaptations, which aim to protect the fetus development and are closely related to both pre-gestational nutritional status and gestational weight gain. Moreover, pre-gestational obesity represents a challenge of treatment, and nowadays there are new evidence as regard its management, especially the adequate weight gain. Recent evidence has highlighted the determinant role of nutritional status and maternal diet on both pregnancy outcomes and long-term risk of chronic diseases, through a transgenerational flow, conceptualized by the Development Origin of Health and Diseases (Dohad) theory. In this review we will analyse the physiological and endocrine adaptation in pregnancy, and the metabolic complications, thus the focal points for nutritional and therapeutic strategies that we must early implement, virtually before conception, to safeguard the health of both mother and progeny. We will summarize the current nutritional recommendations and the use of nutraceuticals in pregnancy, with a focus on the management of pregnancy complicated by obesity and hyperglycemia, assessing the most recent evidence about the effects of ante-natal nutrition on the long-term, on either maternal health or metabolic risk of the offspring.
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Affiliation(s)
- Sara Parrettini
- S. Maria della Misericordia Hospital, Division of Endocrinology and Metabolism, Perugia, Italy
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Antonella Caroli
- S. Maria della Misericordia Hospital, Division of Endocrinology and Metabolism, Perugia, Italy
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Elisabetta Torlone
- S. Maria della Misericordia Hospital, Division of Endocrinology and Metabolism, Perugia, Italy
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Parrettini S, Ranucci L, Caroli A, Bini V, Calafiore R, Torlone E. Gestational diabetes: A link between OGTT, maternal-fetal outcomes and maternal glucose tolerance after childbirth. Nutr Metab Cardiovasc Dis 2020; 30:2389-2397. [PMID: 33239164 DOI: 10.1016/j.numecd.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/03/2020] [Accepted: 08/02/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIM The relationship among distribution of pathological values at the Oral Glucose Tolerance Test (OGTT), metabolic risk factors and pregnancy outcomes in women with Gestational Diabetes (GDM), has not been clearly identified. We retrospectively compared metabolic and therapeutic parameters, maternal-fetal outcomes and post-partum OGTTs, with respect to the number and distribution of altered values of diagnostic OGTT in pregnancy. Secondly, we assessed whether insulin therapy predictive factors were identifiable. METHODS AND RESULTS This analysis included 602 pregnant women with GDM, followed in Diabetes and Pregnancy Unit of Perugia Hospital from diagnosis to childbirth. All women were diagnosed diabetic upon 75g OGTT, according IADPSG criteria. Women were divided into 3 groups, respect to distribution of diagnostic blood glucose (BG) values at OGTT: Group 1: only fasting BG (OGTT0h); Group 2: 1 and/or 2h (OGTT1-2h); Group 3: both fasting and 1 h and/or 2h (OGTT0+1-2h) BG. Pregnant women with fasting hyperglycemia at OGTT (Groups 1 and 3) had similar metabolic characteristics (weight, prevalence of obesity, gestational weight gain, HbA1c), a greater need for insulin therapy, and a higher risk of impaired glucose tolerance persistence after childbirth, as compared to Group 2. No significant differences were observed in terms of maternal and neonatal outcomes (p > 0.05), except for a greater prevalence of caesarean sections in Group 3. CONCLUSION The metabolic characteristics of GDM women are mirrored by OGTT values at diagnosis, but are not associated with adverse pregnancy outcomes. Intensive management and a tailored treatment of GDM improve maternal-neonatal outcomes, regardless of diagnostic values distribution and pre-gestational metabolic characteristics.
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Affiliation(s)
- Sara Parrettini
- Department of Medicine, Division of Endocrinology and Metabolism, University of Perugia, Hospitals and Clinics, Piazzale Menghini 1, 06129, Sant'Andrea delle Fratte, Perugia, Italy
| | - Ludovica Ranucci
- Department of Medicine, Division of Endocrinology and Metabolism, University of Perugia, Hospitals and Clinics, Piazzale Menghini 1, 06129, Sant'Andrea delle Fratte, Perugia, Italy
| | - Antonella Caroli
- Department of Medicine, Division of Endocrinology and Metabolism, University of Perugia, Hospitals and Clinics, Piazzale Menghini 1, 06129, Sant'Andrea delle Fratte, Perugia, Italy
| | - Vittorio Bini
- Department of Medicine, Division of Endocrinology and Metabolism, University of Perugia, Hospitals and Clinics, Piazzale Menghini 1, 06129, Sant'Andrea delle Fratte, Perugia, Italy
| | - Riccardo Calafiore
- Department of Medicine, Division of Endocrinology and Metabolism, University of Perugia, Hospitals and Clinics, Piazzale Menghini 1, 06129, Sant'Andrea delle Fratte, Perugia, Italy
| | - Elisabetta Torlone
- Department of Medicine, Division of Endocrinology and Metabolism, University of Perugia, Hospitals and Clinics, Piazzale Menghini 1, 06129, Sant'Andrea delle Fratte, Perugia, Italy.
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Chaggar G, Sutherland K, Han F, Fietze I, Penzel T, Benediktsdóttir B, Gislason T, Magalang U, Pack AI, Singh B, McArdle N, Bittencourt L, Li QY, Chen NH, de Chazal P, Cistulli PA, Bin YS. Is snoring during pregnancy a predictor of later life obstructive sleep apnoea? A case-control study. Sleep Med 2020; 79:190-194. [PMID: 33279414 DOI: 10.1016/j.sleep.2020.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) appears common in pregnancy. Complications of pregnancy such as gestational diabetes and hypertension predispose women to cardiometabolic disease in later life. It is unknown if snoring during pregnancy is a risk marker for later-life OSA. METHODS We analysed data from N = 897 women in the Sleep Apnea Global Interdisciplinary Consortium (SAGIC), which recruited patients attending sleep clinics at 11 sites. There were 577 cases with current OSA and 320 controls. Cases were further categorised into mild, moderate, and severe OSA based on apnoea-hypopnoea index. Retrospective self-report of snoring during pregnancy was the exposure of interest and was reported by 2.9% of cases and 3.4% of controls. RESULTS Multinomial regression demonstrated that snoring during a previous pregnancy was not significantly associated with mild (OR 0.34, 95% CI 0.09-1.25, p = 0.10), moderate (OR 0.69, 95% CI 0.21-2.19, p = 0.52), or severe OSA (OR 1.86, 95% CI 0.77-4.48, p = 0.17) compared to no snoring during pregnancy. Results were unchanged after adjustment for age, body mass index, and ethnicity. 79% of women reported current snoring but all who snored during pregnancy reported current snoring. CONCLUSIONS Women who snore during pregnancy continue snoring in later-life but do not appear more likely to develop OSA. These findings are limited by self-reported data, recall bias, and small numbers of women who reported snoring during pregnancy. A prospective study with objective measurement of sleep and snoring during pregnancy is needed to examine the links between sleep disorders in pregnancy with health in later life.
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Affiliation(s)
- Gurpreet Chaggar
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Australia
| | - Kate Sutherland
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Australia
| | - Fang Han
- Department of Respiratory Medicine, Peking University People's Hospital, Beijing, China
| | - Ingo Fietze
- Charité University Hospital, Berlin, Germany
| | - Thomas Penzel
- Charité University Hospital, Berlin, Germany; Saratov State University, Saratov, Russia
| | - Bryndís Benediktsdóttir
- University of Iceland, Faculty of Medicine, Reykjavík, Iceland; Landspitali University Hospital, Reykjavík, Iceland
| | - Thorarinn Gislason
- University of Iceland, Faculty of Medicine, Reykjavík, Iceland; Landspitali University Hospital, Reykjavík, Iceland
| | | | - Allan I Pack
- University of Pennsylvania, Philadelphia, PA, United States
| | - Bhajan Singh
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia; University of Western Australia, Perth, Australia
| | - Nigel McArdle
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia; University of Western Australia, Perth, Australia
| | | | - Qing Yun Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Philip de Chazal
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Australia
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Australia
| | - Yu Sun Bin
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Australia.
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Dude AM, Plunkett B, Grobman W, Scifres CM, Mercer BM, Parry S, Silver RM, Wapner R, Wing DA, Saade G, Reddy U, Iams J, Simhan H, Kominiarek MA. The association between personal weight gain goals, provider recommendations, and appropriate gestational weight gain. Am J Obstet Gynecol MFM 2020; 2:100231. [PMID: 33345934 PMCID: PMC10569209 DOI: 10.1016/j.ajogmf.2020.100231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/30/2020] [Accepted: 09/16/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Nearly half of all women exceed the 2009 Institute of Medicine guidelines for gestational weight gain. Excess gestational weight gain is associated with adverse pregnancy outcomes. OBJECTIVE Our objective was to determine whether having a personal gestational weight gain goal consistent with the Institute of Medicine's recommendations for appropriate gestational weight gain and whether having a discussion with one's obstetrical provider regarding that goal were associated with appropriate gestational weight gain. STUDY DESIGN This is a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be study, a prospective cohort study of nulliparous women. We asked women at their first study visit (between 6 and 13 weeks' gestation) whether they had a gestational weight gain goal and what that goal was. Furthermore, we asked whether their provider discussed a gestational weight gain goal and what that goal was. We classified personal and provider-recommended gestational weight gain goals as consistent or inconsistent with the Institute of Medicine guidelines, taking into account a woman's initial body mass index category (underweight, normal weight, overweight, and obese). We included women with live singleton term deliveries (between 37 and 43 weeks' gestation) in this analysis. We classified the primary outcome, which was gestational weight gain (defined as the difference between first visit weight and final weight before delivery), as inadequate, appropriate, or excessive, based on the Institute of Medicine guidelines and initial body mass index category. We used Student t, Wilcoxon rank-sum, and chi-square tests for bivariable analyses, and multinomial logistic regression was performed to control for confounding variables. RESULTS Of 6727 eligible women, 3799 (56.5% of all eligible women) stated they had a gestational weight gain goal. Of the 3799 women with a stated goal, 2589 (38.5% of all women) had a goal consistent with the Institute of Medicine's recommendations. In addition, of the 6727 eligible women, 2188 (32.5%) reported that they discussed gestational weight gain with their provider, and 1548 of these (23.0% of all women) recalled that their provider gave a gestational weight gain goal in accordance with the Institute of Medicine guidelines. Although having any gestational weight gain goal was not associated with appropriate gestational weight gain, having a gestational weight gain goal that was consistent with the Institute of Medicine's recommendations was associated with a reduced risk of excessive (adjusted relative risk ratio, 0.77; 95% confidence interval, 0.64-0.92) and inadequate weight gain (adjusted relative risk ratio, 0.66; 95% confidence interval, 0.53-0.82). Conversely, discussing gestational weight gain goals with a provider was not associated with either inadequate or excessive gestational weight gain even if the provider's recommendations for gestational weight gain were consistent with the guidelines. CONCLUSION Nulliparas who delivered singleton pregnancies at term who had a personal gestational weight gain goal consistent with the Institute of Medicine's recommendations were less likely to have excessive or inadequate gestational weight gain. Further study is required to evaluate the most effective way to communicate this information to patients.
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Affiliation(s)
- Annie M Dude
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL.
| | - Beth Plunkett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL
| | - William Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University, Evanston, IL
| | - Christina M Scifres
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - Brian M Mercer
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Samuel Parry
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Robert M Silver
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
| | - Ronald Wapner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University, New York City, NY
| | - Deborah A Wing
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine, Irvine, CA
| | - George Saade
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX
| | - Uma Reddy
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT
| | - Jay Iams
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
| | - Hyagriv Simhan
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA
| | - Michelle A Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University, Evanston, IL
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63
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Maternal Dietary Patterns during Pregnancy and Their Association with Gestational Weight Gain and Nutrient Adequacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217908. [PMID: 33126602 PMCID: PMC7662940 DOI: 10.3390/ijerph17217908] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/24/2020] [Accepted: 10/25/2020] [Indexed: 12/16/2022]
Abstract
Several epidemiologic studies have shown an association between Gestational Weight Gain (GWG) and offspring complications. The GWG is directly linked to maternal dietary intake and women’s nutritional status during pregnancy. The aim of this study was (1) to assess, in a sample of Spanish pregnant women, the association between maternal dietary patterns and GWG and (2) to assess maternal dietary patterns and nutrient adequate intake according to GWG. A retrospective study was conducted in a sample of 503 adult pregnant women in five hospitals in Eastern Andalusia (Spain). Data on demographic characteristics, anthropometric values, and dietary intake were collected from clinical records by trained midwives. Usual food intake was gathered through a validated Food Frequency Questionnaire (FFQ), and dietary patterns were obtained by principal component analysis. Nutrient adequacy was defined according to European dietary intake recommendations for pregnant women. Regression models adjusted by confounding factors were constructed to study the association between maternal dietary pattern and GWG, and maternal dietary patterns and nutritional adequacy. A negative association was found between GWG and the Mediterranean dietary pattern (crude β = −0.06, 95% CI: −0.11, −0.04). Independent of maternal dietary pattern, nutrient adequacy of dietary fiber, vitamin B9, D, E, and iodine was related to a Mediterranean dietary pattern (p < 0.05). A Mediterranean dietary pattern is related to lower GWG and better nutrient adequacy. The promotion of healthy dietary behavior consistent with the general advice promoted by the Mediterranean Diet (based on legumes, vegetables, nuts, olive oil, and whole cereals) will offer healthful, sustainable, and practical strategies to control GWG and ensure adequate nutrient intake during pregnancy.
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Coughlin JW, Martin LM, Henderson J, Dalcin AT, Fountain J, Wang N, Appel LJ, Clark JM, Bennett W. Feasibility and acceptability of a remotely-delivered behavioural health coaching intervention to limit gestational weight gain. Obes Sci Pract 2020; 6:484-493. [PMID: 33082990 PMCID: PMC7556432 DOI: 10.1002/osp4.438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/27/2020] [Accepted: 05/30/2020] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Gestational weight gain (GWG) and postpartum weight retention (PPWR) are significant, potentially modifiable, contributors to women's future weight and health trajectories. There is a need for feasible and patient-centered (i.e., convenient, remotely-delivered, technology-enhanced, and accessible through the prenatal care setting) behavioural interventions that limit GWG and PPWR. This study tests the feasibility and acceptability of a remotely-delivered behavioural health coaching intervention to limit gestational weight gain and postpartum weight retention. METHODS Pregnant women (11-16 weeks gestation) were recruited from two prenatal clinics and randomized to the active intervention or health education comparison group. Completion of the program was monitored and perceived helpfulness was rated (0-100). RESULTS Twenty-six women were randomized (n = 13 per arm; mean age = 31.6 years, SD = 3.6; mean BMI = 26.7 kg/m2, SD = 7.4). Participants completed a median of 18 coaching calls and 16/19 learning activities during pregnancy, and a median of 6 calls and 5/6 learning activities postpartum. They logged weights at least once/week for a median of 36/38 expected weeks and tracked daily calories and exercise for a median of 154/266 days and 72/266 days, respectively. Median (Q1, Q3) helpfulness ratings of the program during pregnancy were 80 (64, 91) and 62 (50, 81) postpartum; helpfulness ratings of coaching calls were 85 (58, 98). At 37 weeks gestation, 77% of participants achieved IOM weight gain recommendations compared to 54% in the comparison group. CONCLUSIONS This study provides evidence for the feasibility and acceptability of a remotely-delivered behavioural weight control intervention in pregnancy and postpartum.
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Affiliation(s)
- J. W. Coughlin
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMDUSA
- Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMDUSA
| | - L. M. Martin
- Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - J. Henderson
- Department of Obstetrics and GynecologyJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - A. T. Dalcin
- Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMDUSA
- Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - J. Fountain
- Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - N.‐Y. Wang
- Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMDUSA
- Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - L. J. Appel
- Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMDUSA
- Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - J. M. Clark
- Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMDUSA
- Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - W. Bennett
- Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMDUSA
- Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA
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Association of the First 1,000 Days Systems-Change Intervention on Maternal Gestational Weight Gain. Obstet Gynecol 2020; 135:1047-1057. [PMID: 32282612 DOI: 10.1097/aog.0000000000003752] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To examine the associations of a clinical and public health systems-change intervention on the prevalence of excess gestational weight gain among high-risk, low-income women. METHODS In a quasi-experimental trial, we compared the prevalence of excess gestational weight gain among women before (n=643) and after (n=928) implementation of the First 1,000 Days program in two community health centers in Massachusetts. First 1,000 Days is a systematic program starting in early pregnancy and lasting through the first 24 months of childhood to prevent obesity among mother-child pairs. The program includes enhanced gestational weight gain tracking and counseling, screening for adverse health behaviors and sociocontextual factors, patient navigation and educational materials to support behavior change and social needs, and individualized health coaching for women at high risk for excess gestational weight gain based on their prepregnancy body mass index (BMI) or excess first-trimester weight gain. The primary outcome was gestational weight gain greater than the 2009 Institute of Medicine (now known as the National Academy of Medicine) guidelines according to prepregnancy BMI. RESULTS Among 1,571 women in the analytic sample, mean (SD) age was 30.0 (5.9) years and prepregnancy BMI was 28.1 (6.1); 65.8% of women started pregnancy with BMIs of 25 or higher, and 53.2% were Hispanic. We observed a lower prevalence (55.8-46.4%; unadjusted odds ratio [OR] 0.69, 95% CI 0.49-0.97), similar to results in a multivariable analysis (adjusted OR 0.69, 95% CI 0.49-0.99), of excess gestational weight gain among women with prepregnancy BMIs between 25 and 29.9. Among women who were overweight at the start of pregnancy, the lowest odds of excess gestational weight gain were observed among those with the most interaction with the program's components. Program enrollment was not associated with reduced excess gestational weight gain among women with prepregnancy BMIs of 30 or higher. CONCLUSIONS Implementation of a systems-change intervention was associated with modest reduction in excess gestational weight gain among women who were overweight but not obese at the start of pregnancy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT03191591.
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66
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Loewen B, Collum C, Ryan GA. Exercise Benefits and Recommendations for the 6-Week Postpartum Period. Strength Cond J 2020. [DOI: 10.1519/ssc.0000000000000578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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67
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Rhodes A, Smith AD, Chadwick P, Croker H, Llewellyn CH. Exclusively Digital Health Interventions Targeting Diet, Physical Activity, and Weight Gain in Pregnant Women: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2020; 8:e18255. [PMID: 32673251 PMCID: PMC7382015 DOI: 10.2196/18255] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/30/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Interventions to promote a healthy diet, physical activity, and weight management during pregnancy are increasingly embracing digital technologies. Although some interventions have combined digital with interpersonal (face-to-face or telephone) delivery, others have relied exclusively on digital delivery. Exclusively digital interventions have the advantages of greater cost-effectiveness and broader reach and as such can be a valuable resource for health care providers. OBJECTIVE This systematic review aims to focus on exclusively digital interventions to determine their effectiveness, identify behavior change techniques (BCTs), and investigate user engagement. METHODS A total of 6 databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulated Index to Nursing and Allied Health Literature [CINAHL] Plus, Web of Science, and ProQuest) were searched for randomized controlled trials or pilot control trials of exclusively digital interventions to encourage healthy eating, physical activity, or appropriate weight gain during pregnancy. The outcome measures were gestational weight gain (GWG) and changes in physical activity and dietary behaviors. Study quality was assessed using the Cochrane Risk of Bias tool 2.0. Where possible, pooled effect sizes were calculated using a random effects meta-analysis. RESULTS In total, 11 studies met the inclusion criteria. The risk of bias was mostly high (n=5) or moderate (n=3). Of the 11 studies, 6 reported on GWG as the primary outcome, 4 of which also measured changes in physical activity and dietary behaviors, and 5 studies focused either on dietary behaviors only (n=2) or physical activity only (n=3). The meta-analyses showed no significant benefit of interventions on total GWG for either intention-to-treat data (-0.28 kg; 95% CI -1.43 to 0.87) or per-protocol data (-0.65 kg; 95% CI -1.98 to 0.67). Substantial heterogeneity in outcome measures of change in dietary behaviors and physical activity precluded further meta-analyses. BCT coding identified 7 BCTs that were common to all effective interventions. Effective interventions averaged over twice as many BCTs from the goals and planning, and feedback and monitoring domains as ineffective interventions. Data from the 6 studies reporting on user engagement indicated a positive association between high engagement with key BCTs and greater intervention effectiveness. Interventions using proactive messaging and feedback appeared to have higher levels of engagement. CONCLUSIONS In contrast to interpersonal interventions, there is little evidence of the effectiveness of exclusively digital interventions to encourage a healthy diet, physical activity, or weight management during pregnancy. In this review, effective interventions used proactive messaging, such as reminders to engage in BCTs, feedback on progress, or tips, suggesting that interactivity may drive engagement and lead to greater effectiveness. Given the benefits of cost and reach of digital interventions, further research is needed to understand how to use advancing technologies to enhance user engagement and improve effectiveness.
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Affiliation(s)
| | | | | | - Helen Croker
- University College London, London, United Kingdom
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68
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Jensen ME, Barrett HL, Peek MJ, Gibson PG, Murphy VE. Maternal asthma and gestational diabetes mellitus: Exploration of potential associations. Obstet Med 2020; 14:12-18. [PMID: 33995566 DOI: 10.1177/1753495x20926799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/14/2020] [Accepted: 04/20/2020] [Indexed: 11/17/2022] Open
Abstract
Asthma and gestational diabetes mellitus are prevalent during pregnancy and associated with adverse perinatal outcomes. The risk of gestational diabetes mellitus is increased with asthma, and more severe asthma; yet, the underlying mechanisms are unknown. This review examines existing literature to explore possible links. Asthma and gestational diabetes mellitus are associated with obesity, excess gestational weight gain, altered adipokine levels and low vitamin D levels; yet, it's unclear if these underpin the gestational diabetes mellitus-asthma association. Active antenatal asthma management reportedly mitigates asthma-associated gestational diabetes mellitus risk. However, mechanistic studies are lacking. Existing research suggests asthma management during pregnancy influences gestational diabetes mellitus risk; this may have important implications for future antenatal strategies to improve maternal-fetal outcomes by addressing both conditions. Addressing shared risk factors, as part of antenatal care, may also improve outcomes. Finally, mechanistic studies, to establish the underlying pathophysiology linking asthma and gestational diabetes mellitus, could uncover new treatment approaches to optimise maternal and child health outcomes.
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Affiliation(s)
- M E Jensen
- Priority Research Centre Grow Up Well, School of Medicine & Public Health, Faculty of Health, University of Newcastle, NSW, Australia
| | - H L Barrett
- Queensland Diabetes and Endocrine Centre, Mater Health Services, South Brisbane, QLD, Australia.,Mater Research Institute, The University of Queensland, St Lucia, QLD, Australia
| | - M J Peek
- Australian National University Medical School, The Australian National University, ACT, Australia.,Department of Obstetrics and Gynaecology, Centenary Hospital for Women and Children, ACT, Australia
| | - P G Gibson
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, NSW, Australia
| | - V E Murphy
- Priority Research Centre Grow Up Well, School of Medicine & Public Health, Faculty of Health, University of Newcastle, NSW, Australia
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69
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Sawangkum P, Louis JM. Gestational Weight Gain: Achieving a Healthier Weight Between Pregnancies. Obstet Gynecol Clin North Am 2020; 47:397-407. [PMID: 32762925 DOI: 10.1016/j.ogc.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Rates of obesity continue to be a cause of morbidity and mortality, requiring intervention. Excessive gestational weight gain is related to postpartum weight retention and subsequent development of obesity, which translates into higher risk of adverse maternal and neonatal outcomes in future pregnancies and long-term excess cardiovascular disease and cancer for the mothers. Limiting gestational weight gain to within recommended limits prevents postpartum weight retention. This article provides an overview of methods and practices aimed at helping women achieve a healthy weight between pregnancies by improving gestational weight gain. These interventions include lifestyle behavioral changes, diet and exercise, and motivational interviewing.
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Affiliation(s)
- Peeraya Sawangkum
- Department of Obstetrics and Gynecology, University of South Florida, 6th Floor, 2 Tampa General Circle, Tampa, FL 33606, USA
| | - Judette M Louis
- Department of Obstetrics and Gynecology, University of South Florida, 6th Floor, 2 Tampa General Circle, Tampa, FL 33606, USA.
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70
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Jacobson LT, Collins TC, Lucas M, Zackula R, Okut H, Nazir N, Robbins D, Stern JE, Wolfe M, Grainger DA. Electronic Monitoring Of Mom's Schedule (eMOMS™): Protocol for a feasibility randomized controlled trial to improve postpartum weight, blood sugars, and breastfeeding among high BMI women. Contemp Clin Trials Commun 2020; 18:100565. [PMID: 32346648 PMCID: PMC7183152 DOI: 10.1016/j.conctc.2020.100565] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/19/2020] [Accepted: 03/28/2020] [Indexed: 12/23/2022] Open
Abstract
Background Overweight and obesity are major risk factors for gestational diabetes among U.S. women. Evidence suggests that longer duration of breastfeeding among women with a history of gestational diabetes is associated with lower incidence of developing type 2 diabetes after pregnancy. Women may potentially benefit from a lifestyle change program that includes breastfeeding education and support. Purpose To describe the design and justification of a combined breastfeeding, national Diabetes Prevention Program (DPP)-based feasibility randomized controlled trial, the electronic Monitoring Of Mom's Schedule (eMOMSTM) study. eMOMSTM compares the feasibility and efficacy of three interventions on six-month postpartum weight loss among women with a BMI ≥25. Methods The intervention is delivered via Facebook and includes three groups: DPP and breastfeeding (eMOMS1); DPP only (eMOMS2); and Usual Care (eMOMS3). Recruitment is ongoing at two clinical sites (rural and urban). A total of 72 women, 24 per group, will be randomly assigned to one of the three groups. It is anticipated that women in eMOMS1 will have greater weight loss and increased length of breastfeeding at three and six months postpartum compared to women in eMOMS2 and eMOMS3. Additional data will be collected on metabolic markers, anthropometrics, physical activity, nutrition, breastfeeding, and depression. Program cost will be compared to that of traditionally scheduled group meetings. Expected study completion date: October 2021. Conclusions This study has the potential to define a high impact, cost effective intervention that can improve public health by reducing negative health outcomes associated with gestational diabetes among an at-risk population.
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Affiliation(s)
- Lisette T Jacobson
- University of Kansas School of Medicine-Wichita, Department of Population Health, 1010 North Kansas, Wichita, KS, 67214, USA
| | - Tracie C Collins
- University of Kansas School of Medicine-Wichita, Department of Population Health, 1010 North Kansas, Wichita, KS, 67214, USA.,The University of New Mexico, College of Population Health, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Meredith Lucas
- University of Kansas School of Medicine-Wichita, Department of Population Health, 1010 North Kansas, Wichita, KS, 67214, USA
| | - Rosey Zackula
- University of Kansas School of Medicine-Wichita, Office of Research, 1010 North Kansas, Wichita, KS, 67214, USA
| | - Hayrettin Okut
- University of Kansas School of Medicine-Wichita, Office of Research, 1010 North Kansas, Wichita, KS, 67214, USA
| | - Niaman Nazir
- University of Kansas School of Medicine-Kansas City, Department of Population Health, 3901 Rainbow Boulevard, Mailstop 1003, Kansas City, KS, 66160, USA
| | - David Robbins
- University of Kansas Medical Center-Kansas City, Diabetes Institute, 3901 Rainbow Boulevard, Mailstop 1064, Kansas City, KS, 66160, USA
| | - Judy E Stern
- Dartmouth-Hitchcock Medical Center and the Geisel School of Medicine, Department of Obstetrics and Gynecology, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Michael Wolfe
- Ascension Via Christi Hospitals Wichita, Inc., Ascension Via Christi Maternal Fetal Medicine Clinic, 1515 South Clifton Avenue, Suite 130, Wichita, KS, 67218, USA
| | - David A Grainger
- University of Kansas School of Medicine-Wichita, Department of Obstetrics and Gynecology, 1010 North Kansas, Wichita, KS, 67214, USA
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71
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Groth SW. Pregnancy Weight: What Happens After Childbirth Matters. J Womens Health (Larchmt) 2020; 29:471-472. [DOI: 10.1089/jwh.2019.8263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Susan W. Groth
- University of Rochester School of Nursing, Rochester, New York
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72
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Pregnancy and the Postpartum Period as an Opportunity for Cardiovascular Risk Identification and Management. Obstet Gynecol 2020; 134:851-862. [PMID: 31503139 DOI: 10.1097/aog.0000000000003363] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in women. Because women generally present with more atypical symptoms of CVD than do men and because underlying CVD risk factors are often present for years before the onset of CVD, it is important to use innovative ways to identify women who should undergo CVD risk screening at a younger age. Pregnancy and the postpartum period afford us that opportunity, given that the development of certain pregnancy complications (hypertensive disorders of pregnancy, gestational diabetes, preterm birth, delivery of a neonate with fetal growth restriction, and significant placental abruption) can reliably identify women with underlying, often unrecognized, CVD risk factors. Women with one or more of these pregnancy complications should be identified at the time of delivery and referred for regular follow-up. This would ideally take the form of a multidisciplinary clinic including clinicians and allied health specialists to carry out physical and biochemical screening and counseling regarding lifestyle modification and possible therapeutic interventions. Longer-term follow-up and recommendations should be individualized based on findings and risks. There is also an opportunity for future pregnancy counseling and discussion about the importance of weight loss between pregnancies, initiation of a routine involving physical activity, use of preconception folic acid, and the potential initiation of low-dose aspirin for those women at risk for future preeclampsia and fetal growth restriction or the use of progesterone for women at risk for preterm labor. The link between pregnancy complications and future CVD affords us with the earliest opportunity for CVD risk assessment for health preservation and disease prevention.
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Bohlen SM, Eckmann-Scholz C, Rath W, Maass N, Pecks U. [Does Apolipoprotein B Level in Early Pregnancy Predict Excessive Gestational Weight Gain and Adverse Pregnancy Outcome?]. Z Geburtshilfe Neonatol 2020; 224:348-354. [PMID: 32162284 DOI: 10.1055/a-1118-4084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Excessive maternal gestational weight gain (GWG) is a risk factor for maternal and fetal complications. The lipid profile changes physiologically during pregnancy. Weight gain can affect lipid metabolism. The hypothesis of the study was that apoB levels early in pregnancy are associated with excessive GWG and predictive for adverse outcomes. METHODS Out of 547 patients there were 95 women with inadequate GWG, 171 with adequate GWG, and 281 with excessive GWG. Out of 581 patients there were 14 patients with pregnancy-induced hypertonus/pre-eclampsia, 67 with small-for-gestational-age (SGA) infants, and 7 with fetal growth restriction (FGR). ApoB levels were measured by ELISA. RESULTS There was no significant difference in apoB levels between the different GWG groups. We found significantly higher levels of apoB in overweight and obese patients compared to those with normal BMI. Smoking was correlated with higher apoB levels. There were no differences either between women with PIH/PE and normotensive women or between SGA/IUGR and pregnancies without. Women with pre-existing hypertension showed significantly higher apoB levels than the control group. CONCLUSIONS ApoB cannot be used as a marker for identifying the risk of excessive GWG or adverse pregnancy outcomes early in pregnancy. However, it may be involved in the pathophysiology of adverse pregnancy outcomes in high-risk patients.
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Affiliation(s)
- Sophia-Marie Bohlen
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel
| | - Christel Eckmann-Scholz
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel
| | - Werner Rath
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel
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74
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Gontijo CA, Balieiro LCT, Teixeira GP, Fahmy WM, Crispim CA, Maia YCDP. Higher energy intake at night effects daily energy distribution and contributes to excessive weight gain during pregnancy. Nutrition 2020; 74:110756. [PMID: 32278857 DOI: 10.1016/j.nut.2020.110756] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/29/2019] [Accepted: 12/01/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the effect of nighttime energy intake on daily energy and macronutrient distribution and weight gain during pregnancy. METHODS This was a prospective cohort study carried out with 100 pregnant women and the data collection occurred once per trimester. A dietary intake was assessed by three 24-h dietary recalls in each trimester, totaling nine dietary recalls. The distribution of energy and macronutrient intake was evaluated at meals throughout the day in each trimester and overall pregnancy. Women were classified as having "lower" or "higher" nighttime intake (1900 to 0559) if consumption in this period were below or above the median of the population, respectively, for at least two trimesters. Recommendations from the Institute of Medicine were used to assess the adequacy of weight gain. Generalized estimating equation models were used to determine the effects of nighttime intake and gestational trimesters on daily energy distribution and weight gain. RESULTS In overall pregnancy, the higher group consumed a higher percentage of energy and macronutrients in the evening meals, and less energy, proteins, and lipids in morning meals when compared with the lower group. Also, women in the higher group had greater excessive weight gain in the third trimester compared with the lower group. CONCLUSION Pregnant women with a higher energy intake at night had a lower percentage of energy, protein, and lipid intake in morning meals and a higher percentage of energy and macronutrient intake in the evening meals during pregnancy. A worse standard of gestational weight gain in the third trimester was also observed in pregnant women with a higher energy intake at night.
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Affiliation(s)
- Cristiana Araújo Gontijo
- Graduate Program in Health Science, School of Medicine, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | | | - Gabriela Pereira Teixeira
- Graduate Program in Health Science, School of Medicine, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Walid Makin Fahmy
- Department of Obstetrics, Hospital and Municipal Maternity of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Cibele Aparecida Crispim
- Graduate Program in Health Science, School of Medicine, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Yara Cristina de Paiva Maia
- Graduate Program in Health Science, School of Medicine, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil.
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Puri C, Kooijman G, Masculo F, Sambeek SV, Den Boer S, Luca S, Vanrumste B. PREgDICT : Early prediction of gestational weight gain for pregnancy care. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:4274-4278. [PMID: 31946813 DOI: 10.1109/embc.2019.8857306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Excessive or inadequate Gestational Weight Gain (GWG) is considered to not only put the mothers, but also the infants at increased risks with a number of adverse outcomes. In this paper, we use self-reported weight measurements from the early days of pregnancy to predict and classify the end-of-pregnancy weight gain into an underweight, normal or obese category in accordance with the Institute of Medicine recommended guidelines. Self-reported weight measurements suffer from issues such as lack of enough data and non-uniformity. We propose and compare two novel parametric and non-parametric approaches that utilise self-training data along with population data to tackle limited data availability. We, dynamically find the subset of closest time series from the population weight-gain data to a given subject. Then, a non-parametric Gaussian Process (GP) regression model, learnt on the selected subset is used to forecast the self-reported weight measurements of given subject. Our novel approach produces mean absolute error (MAE) of 2.572 kgs in forecasting end-of-pregnancy weight gain and achieves weight-category-classification accuracy of 63.75% mid-way through the pregnancy, whereas a state-of-the-art approach is only 53.75% accurate and produces high MAE of 16.22 kgs. Our method ensures reliable prediction of the end-of-pregnancy weight gain using few data points and can assist in early intervention that can prevent gaining or losing excessive weight during pregnancy.
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76
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Guo P, Rivera DE. System Identification Approaches For Energy Intake Estimation: Enhancing Interventions For Managing Gestational Weight Gain. IEEE TRANSACTIONS ON CONTROL SYSTEMS TECHNOLOGY : A PUBLICATION OF THE IEEE CONTROL SYSTEMS SOCIETY 2020; 28:63-78. [PMID: 31903018 PMCID: PMC6941743 DOI: 10.1109/tcst.2018.2871871] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Excessive maternal weight gain during pregnancy represents a major public health concern that calls for novel and effective gestational weight management interventions. In Healthy Mom Zone (HMZ), an on-going intervention study, energy intake underreporting has been found to be an important consideration that interferes with accurate weight control assessment, and the effective use of energy balance models in an intervention setting. In this paper, a series of estimation approaches that address measurement noise and measurement losses are developed to better understand the extent of energy intake underreporting. These include back-calculating energy intake from an energy balance model developed for gestational weight gain prediction, a Kalman filtering-based approach to recursively estimate energy intake from intermittent measurements in real-time, and an approach based on semi-physical identification principles which features the capability of adjusting future self-reported energy intake by parameterizing the extent of underreporting. The three approaches are illustrated by evaluating with participant data obtained through the HMZ intervention study, with the results demonstrating the potential of these methods to promote the success of weight control. The pros and cons of the presented approaches are discussed to generate insights for users in future applications.
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Affiliation(s)
| | - Daniel E. Rivera
- Control Systems Engineering Laboratory (CSEL), School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ, 85281 USA
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77
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Abstract
The Special Issue “Pathogenetic and Therapeutic Significance of Adipokines in Diabetes” focused on adipokines as shared diagnostic biomarkers and therapeutic targets for both obesity and type 2 diabetes. Experts discussed the pathological role of adipokines in their studies associated with diabetes. It provided new insights into the role of adipokines in diabetes. In this commentary and review, these studies will be summarized and the novel roles of adipokines will be discussed. This will also confirm the role of adipokines as biomarkers for diagnosis and prediction, and as therapeutic targets of diabetes and its related pathogenic phenomena.
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78
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Chen SX, Rasmussen KM, Finkelstein J, Støvring H, Nøhr EA, Kirkegaard H. Maternal reproductive history and premenopausal risk of hypertension and cardiovascular disease: a Danish cohort study. BMJ Open 2019; 9:e030702. [PMID: 31690605 PMCID: PMC6858240 DOI: 10.1136/bmjopen-2019-030702] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES The metabolic changes of pregnancy resemble a cardiovascular risk profile and may persist postpartum, with body mass index (BMI) as a potential modifier. We examined the association between the number of live-birth pregnancies and maternal premenopausal risks of hypertension and cardiovascular disease (CVD), accounting for pre-pregnancy BMI as well as abortions and stillbirths. DESIGN A prospective cohort study. SETTING Mothers from the Danish National Birth Cohort (1996 to 2002). For each of these women, registry data on all pregnancies from 1973 to 2011 were obtained, as were self-reported pre-pregnancy weight and height. PARTICIPANTS A total of 44 552 first-time mothers in the Danish National Birth Cohort. OUTCOME MEASURES Risks of hypertension and CVD during and between live-birth pregnancies separately and combined as live-birth cycles. RESULTS After adjustment for abortions, stillbirths, pre-pregnancy BMI and other covariates, a higher risk of hypertension was observed in the first (HR 1.53, 95% CI: 1.37 to 1.72) and fourth and subsequent live-birth cycles (HR 1.72, 95% CI: 1.15 to 2.58), compared with the second. However, as number of live-birth pregnancies increased, risk of hypertension decreased during live-birth pregnancies and increased between live-birth pregnancies (tests for trend, p<0.01). For CVD, we found an overall J-shaped but non-significant association with number of live-birth pregnancies. No interaction with pre-pregnancy BMI (<25 versus ≥25 kg/m2) was observed. CONCLUSIONS Premenopausal women had the highest risk of hypertension and CVD during their first live-birth pregnancy and after their fourth live-birth pregnancy. All risks were independent of BMI before the first live-birth pregnancy and of number of abortions and stillbirths.
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Affiliation(s)
- Shannon X Chen
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | | | - Julia Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - H Støvring
- Department of Public Health, Section for Biostatistics, Aarhus University, Aarhus, Denmark
| | - Ellen Aa Nøhr
- Department of Clinical Research, the Research Unit of Gynecology and Obstetrics, University of Southern Denmark, Odense, Denmark
| | - Helene Kirkegaard
- Department of Clinical Research, the Research Unit of Gynecology and Obstetrics, University of Southern Denmark, Odense, Denmark
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79
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Parker HW, Tovar A, McCurdy K, Vadiveloo M. Associations between pre-pregnancy BMI, gestational weight gain, and prenatal diet quality in a national sample. PLoS One 2019; 14:e0224034. [PMID: 31626677 PMCID: PMC6799919 DOI: 10.1371/journal.pone.0224034] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/03/2019] [Indexed: 12/18/2022] Open
Abstract
This secondary analysis explored the association between gestational weight gain, pre-pregnancy body mass index (BMI), and prenatal diet quality in a United States national sample. The sample comprised 1322 pregnant women in the longitudinal Infant Feeding Practices Study II with Diet History Questionnaire data. Diet quality in the third trimester was assessed using the Alternative Healthy Eating Index for Pregnancy. Self-reported pre-pregnancy BMI (categorized as underweight<18.5, normal weight 18.5–24.9, overweight 25.0–29.9, and obese≥30.0) and total gestational weight gain were used to categorize adherence to the Institute of Medicine’s recommendations as inadequate, adequate, or excessive weight gain. Diet quality in pre-pregnancy BMI and gestational weight gain groups were compared using Tukey-adjusted generalized linear models adjusted for sociodemographic factors, Women, Infants, and Children participation, parity, and energy intake. Due to missing gestational weight gain data, sensitivity analyses with multiply imputed data were conducted. Women were on average 28.9 years old and of higher socioeconomic status (40% college graduates) and mostly non-Hispanic White (84%), and the mean Alternative Healthy Eating Index for Pregnancy score was 61.2 (of 130). Both pre-pregnancy BMI and gestational weight gain were inversely associated with diet quality scores (p<0.01). The interaction between pre-pregnancy BMI and gestational weight gain was significant (p = 0.04), therefore gestational weight gain models were stratified by BMI group. In stratified adjusted models, gestational weight gain was differently associated with diet quality scores (p<0.05) among women with underweight, normal weight, overweight, and obesity. The relationship between gestational weight gain and prenatal diet quality depended on pre-pregnancy BMI. For example, within women with normal weight, higher diet quality was observed in the adequate gestational weight gain group. Interventions to broadly improve prenatal diet quality are needed, however, resources can be used to target women with higher pre-pregnancy BMIs and women with inadequate or excessive gestational weight gain.
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Affiliation(s)
- Haley W. Parker
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, Rhode Island, United States of America
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, Rhode Island, United States of America
| | - Karen McCurdy
- Department of Human Development and Family Studies, University of Rhode Island, Kingston, Rhode Island, United States of America
| | - Maya Vadiveloo
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, Rhode Island, United States of America
- * E-mail:
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Czajkowski SM. Using the ORBIT Model to Design an Intervention Promoting Healthy Weight Gain During Pregnancy: the Value of an Iterative and Incremental Approach to Intervention Development. Int J Behav Med 2019; 26:457-460. [PMID: 31502085 DOI: 10.1007/s12529-019-09812-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Susan M Czajkowski
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, MSC 9761, Room 3E108, Bethesda, MD, 20892-9761, USA.
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81
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Gerveieeha Z, Siassi F, Qorbani M, Ziaeian F, Sotoudeh G. The effect of different amounts of vitamin D supplementation on serum calcidiol, anthropometric status, and body composition in overweight or obese nursing women: a study protocol for a randomized placebo-controlled clinical trial. Trials 2019; 20:542. [PMID: 31470899 PMCID: PMC6716881 DOI: 10.1186/s13063-019-3622-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/30/2019] [Indexed: 11/23/2022] Open
Abstract
Background The optimal vitamin D intake for nursing mothers with overweight or obesity has not been defined. Vitamin D concentrations are associated with body composition indices, particularly body fat mass. Few studies have investigated the relationship between hypovitaminosis D, obesity, anthropometric status, and body composition in nursing women. Thus, the present study aims to investigate whether vitamin D supplementation during lactation will improve vitamin D status, reduce body fat mass, and improve body composition. Methods/design In a double-blind, randomized, placebo-controlled, parallel-group trial, after term delivery, 90 healthy women with overweight or obesity will be selected and randomly allocated into three groups to receive 2000 IU/d cholecalciferol (vitamin D3), 4000 IU/d cholecalciferol, or placebo (lactose) for 12 weeks while nursing. Measurements of height, weight, waist circumference, and body composition (fat mass (kg), lean mass (kg), body fat (%), fat mass index, and relative fat mass index) will be taken for all subjects at baseline and after 12 weeks of intervention. In addition, serum 25-hydroxyvitamin D (25(OH)D), parathyroid hormone, calcium, and phosphorus will be measured. Discussion This study is the first investigating the effect of different amounts of vitamin D supplementation on serum calcidiol, anthropometric status, and body composition in nursing women with overweight or obesity. Our findings will contribute to the growing body of knowledge regarding the role of vitamin D supplementation in obesity, anthropometric status, and body composition in nursing women. Trial registration Iranian Registry of Clinical Trials IRCT20140413017254N6. Registered on 11 April 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3622-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zohre Gerveieeha
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Hojatdost street, Naderi street, Keshavarz Blvd, Tehran, Iran
| | - Fereydoun Siassi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Hojatdost street, Naderi street, Keshavarz Blvd, Tehran, Iran.
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Ziaeian
- Department of Health Science in Nutrition, Islamic Azad University Science and Research Branch of Tehran, Tehran, Iran
| | - Gity Sotoudeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Hojatdost street, Naderi street, Keshavarz Blvd, Tehran, Iran.
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82
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Marchioro L, Geraghty AA, Uhl O, Shokry E, O'Brien EC, Koletzko B, McAuliffe FM. Effect of a low glycaemic index diet during pregnancy on maternal and cord blood metabolomic profiles: results from the ROLO randomized controlled trial. Nutr Metab (Lond) 2019; 16:59. [PMID: 31467584 PMCID: PMC6712779 DOI: 10.1186/s12986-019-0378-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Elevated post-prandial blood glucose during pregnancy has been associated with adverse pregnancy and offspring outcomes, such as maternal gestational diabetes and excessive foetal growth. The ROLO Study is a randomized controlled trial (RCT) investigating the effect of a low glycaemic index (GI) diet in pregnancy to prevent foetal macrosomia (birth weight > 4000 g). We described the impact of a low-GI diet on the maternal and feto-placental unit metabolism by studying how the ROLO intervention affected maternal and cord blood metabolomes. Methods Fasting maternal plasma samples pre- and post-intervention of 51 pregnant women and 132 cord blood samples were measured with a targeted metabolomics approach using liquid-chromatography coupled to tandem mass spectrometry. The differences between RCT groups were explored via multivariate models with covariates correction. Significance was set at Bonferroni-corrected level of 0.05. Results A total of 262 metabolites species, sums and ratios were investigated. While no metabolite reached statistical significance after Bonferroni correction, many maternal phospholipids and acylcarnitines were elevated in the intervention group at uncorrected 0.05 alpha level. Most species contained saturated and monounsaturated fatty acid chains with 16 or 18 carbon atoms. In cord blood, no differences were identified between RCT groups. Conclusions A low-GI diet in pregnancy was associated with a trend to modest but consistent changes in maternal lipid and fatty acid metabolism. The intervention seemed not to affect foetal metabolism. Our exploratory findings may be used to direct further investigations about low GI diets before and during pregnancy, to improve patient care for pre-conceptional and pregnant women with lipid dysregulations and potentially modulate the offspring's risk for future metabolic diseases. Trial registration Current Controlled Trials ISRCTN54392969.
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Affiliation(s)
- Linda Marchioro
- Division of Metabolic and Nutritional Medicine, Department of Paediatrics, Dr. von Hauner Children's Hospital, University hospital, LMU Munich, Lindwurmstraße 4, D-80337 Munich, Germany
| | - Aisling A Geraghty
- 2UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Olaf Uhl
- Division of Metabolic and Nutritional Medicine, Department of Paediatrics, Dr. von Hauner Children's Hospital, University hospital, LMU Munich, Lindwurmstraße 4, D-80337 Munich, Germany
| | - Engy Shokry
- Division of Metabolic and Nutritional Medicine, Department of Paediatrics, Dr. von Hauner Children's Hospital, University hospital, LMU Munich, Lindwurmstraße 4, D-80337 Munich, Germany
| | - Eileen C O'Brien
- 2UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Berthold Koletzko
- Division of Metabolic and Nutritional Medicine, Department of Paediatrics, Dr. von Hauner Children's Hospital, University hospital, LMU Munich, Lindwurmstraße 4, D-80337 Munich, Germany
| | - Fionnuala M McAuliffe
- 2UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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83
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Li T, Jia Y, Wang S, Wang A, Gao L, Yang C, Zou H. Retinal Microvascular Abnormalities in Children with Type 1 Diabetes Mellitus Without Visual Impairment or Diabetic Retinopathy. Invest Ophthalmol Vis Sci 2019; 60:990-998. [PMID: 30884528 DOI: 10.1167/iovs.18-25499] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To study the characteristics and associated factors of retinal microvascular abnormalities in children with type 1 diabetes mellitus (T1DM) without visual impairment and diabetic retinopathy (DR). Methods Case-control hospital-based study including children with or without DM. Optical coherence tomography angiography (OCTA; CIRRUS HD-OCT model 5000) was used to scan 6 × 6 mm square area of posterior retina and optic disc. The indexes analyzed mainly included vascular length density (VD), perfusion density (PD), and foveal avascular zone area, perimeter, and morphology. Independent risk factors were analyzed by multifactor linear regression. Results A total of 47 children with T1DM and 44 healthy subjects were enrolled. Statistical analysis showed that VD within 1 to 3 mm (inner ring) of the macula in the case group was smaller than that in the control group (18.561 ± 1.151/mm: 19.161 ± 0.464/mm; P< 0.001), and mother's excessive weight gain during pregnancy was an independent factor (P = 0.004); VD within 3 to 6 mm (outer ring) of the macula in the case group was smaller than that in the control group (19.044 ± 0.847/mm; 19.404 ± 0.496/mm, P = 0.029), while serum creatinine level was revealed to be an independent factor (P = 0.009); PD within 3 to 6 mm of the macula in the case group was higher than that in the control group (0.456 ± 0.015: 0.442 ± 0.030) (P = 0.003), with no independent factor observed in regression analysis. Conclusion Retinal microvasculopathy had already occurred in the parafoveal area of diabetic children without visual impairment and DR; early screening and close follow-up were recommended for children with high-risk factors.
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Affiliation(s)
- Tao Li
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Eye Diseases Prevention & Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Yan Jia
- Department of Ophthalmology, Children's Hospital of Fudan University, Shanghai, China
| | - Shanshan Wang
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Eye Diseases Prevention & Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Anken Wang
- Department of Ophthalmology, Children's Hospital of Fudan University, Shanghai, China
| | - Lu Gao
- Department of Ophthalmology, Children's Hospital of Fudan University, Shanghai, China
| | - Chenhao Yang
- Department of Ophthalmology, Children's Hospital of Fudan University, Shanghai, China
| | - Haidong Zou
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Eye Diseases Prevention & Treatment Center, Shanghai Eye Hospital, Shanghai, China
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84
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Wartko PD, Weiss NS, Enquobahrie DA, Chan KCG, Stephenson-Famy A, Mueller BA, Dublin S. Antidepressant continuation in pregnancy and risk of gestational diabetes. Pharmacoepidemiol Drug Saf 2019; 28:1194-1203. [PMID: 31298445 DOI: 10.1002/pds.4799] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/30/2019] [Accepted: 04/15/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE Previous studies observed modestly higher risk of gestational diabetes (GDM) associated with antidepressant use in pregnancy, potentially due to confounding by indication. We assessed the association of antidepressant continuation in pregnancy with GDM, as well as blood glucose levels, after accounting for confounding. METHODS We conducted a retrospective cohort study of singleton live births from 2001 to 2014 to women enrolled in Kaiser Permanente Washington, an integrated health care delivery system, utilizing electronic health data and linked Washington State birth records. We required that women have ≥1 antidepressant prescription fills ≤6 months before pregnancy. Women with an antidepressant fill during pregnancy were categorized as "continuers" (n = 1634); those without a fill were "discontinuers" (n = 1211). We calculated relative risks (RRs) for GDM and mean differences in screening blood glucose levels using generalized estimating equations with inverse probability of treatment weighting to account for baseline characteristics, including mental health conditions and indicators of mental health severity. RESULTS Compared with discontinuers, antidepressant continuers had comparable risk of GDM (RR: 1.10; 95% confidence interval [CI], 0.84-1.44) and blood glucose levels (mean difference: 2.3 mg/dL; 95% CI, -1.5 to 6.1 mg/dL). We observed generally similar results for specific antidepressants, with the potential exceptions of risk of GDM associated with sertraline (RR: 1.30; 95% CI, 0.90-1.88) and venlafaxine (RR: 1.52; 95% CI, 0.87-2.68), but neither association was statistically significant. CONCLUSIONS Our study suggests that overall, women who continue antidepressants in pregnancy are not at increased risk for GDM or higher blood glucose, although further study may be warranted for sertraline and venlafaxine.
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Affiliation(s)
- Paige D Wartko
- Department of Epidemiology, University of Washington, Seattle, Washington.,Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Noel S Weiss
- Department of Epidemiology, University of Washington, Seattle, Washington
| | | | - K C Gary Chan
- Department of Biostatistics, University of Washington, Seattle, Washington
| | | | - Beth A Mueller
- Department of Epidemiology, University of Washington, Seattle, Washington.,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sascha Dublin
- Department of Epidemiology, University of Washington, Seattle, Washington.,Kaiser Permanente Washington Health Research Institute, Seattle, Washington
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85
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Gallagher K, Ralph J, Petros T, Qualls C, Leeman L, Rogers RG. Postpartum Weight Retention in Primiparous Women and Weight Outcomes in Their Offspring. J Midwifery Womens Health 2019; 64:427-434. [PMID: 31298482 DOI: 10.1111/jmwh.12986] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 03/19/2019] [Accepted: 03/28/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION To explore the effect of prepregnancy body mass index (BMI) and gestational weight gain on postpartum weight retention in nulliparous women and weight-for-length percentiles of offspring to 2 years following birth. METHODS A retrospective secondary analysis of a large, prospective longitudinal study of women conducted during pregnancy and after their first birth was completed to examine outcomes associated with postpartum weight retention. A chart review of the offspring of these women was completed to explore the relationship between maternal prepregnancy BMI and gestational weight gain on offspring weight-for-length percentiles. RESULTS Data from 652 woman-infant dyads were available for analysis. Average postpartum weight retention was 4.0 kg at one year for all groups. At 6 weeks postpartum, women who were obese prior to pregnancy retained significantly less weight than did women who were normal weight prior to pregnancy (P < .05). Women who were normal weight or overweight at the onset of pregnancy and had gestational weight gain within Institute of Medicine recommendations retained significantly less weight at 6 weeks, 6 months, and 1 year postpartum (P < .01) when compared with women in those same weight groups who had a gestational weight gain in excess of the recommended guideline. Women who entered pregnancy obese and who had a gestational weight gain within the recommended weight range during pregnancy retained significantly less weight compared with women who were obese and who gained in excess of the guideline at 6 weeks postpartum only (P < .05). No statistically significant differences were seen in offspring weight-for-length percentiles at any time point based on maternal prepregnancy BMI or weight gain within guidelines. DISCUSSION Many women retained weight up to one year postpartum. In this study, we saw no statistically significant differences between the prepregnant BMI groups or between gestational weight gain within guidelines or in excess of guidelines on offspring weight-for-length percentiles.
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Affiliation(s)
- Kelly Gallagher
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico
| | - Jody Ralph
- Faculty of Nursing, University of Windsor, Windsor, Ontario, Canada
| | - Thomas Petros
- Department of Psychology, University of North Dakota, Grand Forks, North Dakota
| | - Clifford Qualls
- Clinical and Translation Science Center, University of New Mexico, Albuquerque, New Mexico
| | - Lawrence Leeman
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico.,Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Rebecca G Rogers
- Department of Women's Health, The University of Texas at Austin Dell Medical School, Austin, Texas
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Plante AS, Lemieux S, Drouin-Chartier JP, Weisnagel SJ, Robitaille J, Drapeau V, Provencher V, Morisset AS. Changes in Eating Behaviours Throughout Pregnancy: Associations with Gestational Weight Gain and Pre-pregnancy Body Mass Index. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 42:54-60. [PMID: 31289011 DOI: 10.1016/j.jogc.2019.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Most pregnant women gain weight above recommended levels, and this weight gain affects mothers' and children's health. Factors influencing gestational weight gain (GWG) are numerous and include eating behaviours. The objective of this study was to evaluate the association between eating behaviours and GWG while considering pre-pregnancy body mass index (BMI). METHODS Fifty-three (n = 53) women were recruited at 9.4 ± 0.6 gestational weeks. At each trimester, they completed the Three-Factor Eating Questionnaire, which evaluates disinhibition, dietary restraint, and susceptibility to hunger. Using a weight gain curve, trimester-specific GWG was calculated with interpolated weights. Total GWG was calculated as the difference between maternal weight before delivery and self-reported pre-pregnancy weight (Canadian Task Force Classification II-2). RESULTS Women were aged 31.5 ± 3.5, and 81.1% had a university degree. The proportion of women who gained weight within recommendations was 21%, 28%, and 26%, at each trimester, respectively, and 38% for total pregnancy. Overall, dietary restraint score was lower in the third trimester in comparison with the first (6.1 ± 4.1 vs. 7.2 ± 4.6; P = 0.049), whereas no difference was observed for disinhibition or susceptibility to hunger. Our data suggest that variations in eating behaviours throughout pregnancy were similar among women who exhibited total GWG below, within, or above recommendations (Ptrim × GWG = NS) (NS: not significant; trim: trimester). Similar observations were reported when women were compared according to their pre-pregnancy BMI (Ptrim × BMI = NS). CONCLUSION Maintaining high levels of restraint may be challenging considering the increase in hunger, which could explain the decrease observed in dietary restraint scores. Changes in eating behaviours were not associated with total GWG or pre-pregnancy BMI.
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Affiliation(s)
- Anne-Sophie Plante
- School of Nutrition, Laval University, Québec City, QC; Endocrinology and Nephrology Unit, Centre Hospitalier Universitaire of Québec - Université Laval Research Centre, Québec City, QC; Institute of Nutrition and Functional Foods, Laval University, Québec City, QC
| | - Simone Lemieux
- School of Nutrition, Laval University, Québec City, QC; Institute of Nutrition and Functional Foods, Laval University, Québec City, QC
| | | | - S John Weisnagel
- Endocrinology and Nephrology Unit, Centre Hospitalier Universitaire of Québec - Université Laval Research Centre, Québec City, QC
| | - Julie Robitaille
- School of Nutrition, Laval University, Québec City, QC; Endocrinology and Nephrology Unit, Centre Hospitalier Universitaire of Québec - Université Laval Research Centre, Québec City, QC; Institute of Nutrition and Functional Foods, Laval University, Québec City, QC
| | - Vicky Drapeau
- Institute of Nutrition and Functional Foods, Laval University, Québec City, QC; Department of Physical Education, Laval University, Québec City, QC; Québec Heart and Lung Institute/Research Centre, Québec City, QC
| | - Véronique Provencher
- School of Nutrition, Laval University, Québec City, QC; Institute of Nutrition and Functional Foods, Laval University, Québec City, QC
| | - Anne-Sophie Morisset
- School of Nutrition, Laval University, Québec City, QC; Endocrinology and Nephrology Unit, Centre Hospitalier Universitaire of Québec - Université Laval Research Centre, Québec City, QC; Institute of Nutrition and Functional Foods, Laval University, Québec City, QC.
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87
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The duration of the interpregnancy interval in multiparous women and maternal weight gain between pregnancies: findings from a UK population-based cohort. Sci Rep 2019; 9:9175. [PMID: 31235740 PMCID: PMC6591402 DOI: 10.1038/s41598-019-45595-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 06/03/2019] [Indexed: 11/09/2022] Open
Abstract
Maternal obesity in pregnancy increases the risk of adverse long-term health outcomes in both mother and offspring. A population-based cohort of prospectively collected routine antenatal healthcare data collected between January 2003 and September 2017 at University Hospital Southampton, UK was utilised to investigate the association between duration of interpregnancy interval between successive pregnancies and gain in maternal body mass index by the start of the next pregnancy. Records of 19362 women with two or more consecutive singleton live births were analysed. Two-thirds had gained weight when presenting to antenatal care for their subsequent pregnancy with 20% becoming overweight/obese. Compared to an interval of 24–35 months, an interval of 12–23 months was associated with lowest risk of weight gain (adjusted RR 0.91, 99% CI 0.87 to 0.95, p < 0.001) and ≥36 months with greatest risk (adjusted RR 1.11, 99% CI 1.07 to 1.15, p < 0.001) for the first to second pregnancy. This study shows that most multiparous women start their pregnancy with a higher weight than their previous one. An interval of 12–23 months is associated with the lowest risk of starting the second pregnancy with a higher body weight accounting for age. In countries with high prevalence of maternal obesity, birth spacing may merit exploration as a factor impacting on perinatal morbidity.
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Abstract
Pregnancy complications provide insight into women's future health risks and have long term implications for maternal and child health. Obesity has been associated with adverse perinatal outcomes and is a risk factor for chronic disease. Excessive weight gain during pregnancy often translates into postpartum weight retention, increasing women's risk for obesity. Pregnancy and the postpartum period provides a unique opportunity to discuss health beyond pregnancy, emphasize interconception care, and implement appropriate prevention strategies. We aim to review the impact of obesity, gestational weight gain, postpartum weight retention, and role of nutrition and exercise on pregnancy and lifelong health.
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89
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Vinturache A, Winn A, Mannion C, Tough S. Women's recall of health care provider counselling on gestational weight gain (GWG): a prospective, population-based study. BMC Pregnancy Childbirth 2019; 19:136. [PMID: 31023254 PMCID: PMC6485057 DOI: 10.1186/s12884-019-2283-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prenatal care has been validated to provide medical and educational counselling intended to reduce the risk of adverse pregnancy conditions and improve the maternal and fetal outcomes. Prenatal targeted information regarding nutrition, lifestyle, and weight gain is predictive of meeting Institute of Medicine (IOM) 2009 gestational weight gain (GWG) guidelines. There is limited information about women's experiences with these prenatal counselling domains, particularly in women who do not meet GWG recommendations. The objective of this study was to evaluate the impact of women's recall of prenatal counselling and its effect on meeting their GWG within guidelines in a prospective, community-based pregnancy cohort. METHODS A sample of 2909 women with singleton pregnancies was drawn from the prospective community-based pregnancy cohort All Our Families from Alberta, Canada. Women were stratified into three GWG groups, adequate, inadequate, and excessive GWG, based on pre-pregnancy BMI and the adherence to the Institute of Medicine weight gain in pregnancy guidelines. At less than 25 and 34 to 36 weeks' gestation, maternal socio-demographic information and women's recall of prenatal counselling experiences was collected through self-administered questionnaires. Multivariate logistic regression analyses tested GWG strata impact on women's recall of the prenatal counselling advice in eight domains of nutrition, lifestyle, and weight management during pregnancy. RESULTS Adequate GWG was reached by 35.9% of women, 46.5% gained excessive and 17.6% gained inadequate weight. Women who were overweight and obese prior to pregnancy were more likely to gain excessive weight than women who were normal weight (OR 3.3, 95% CI 2.6-4.1; and OR 2.9, 95% CI 2.1-3.9, respectively). Most women reported having no difficulties in finding prenatal care, felt comfortable with their health care provider and were satisfied with the answers received. There was no difference in the recall of prenatal advice received in any of the eight domains of prenatal counselling assessed among women with appropriate and non-optimal GWG. CONCLUSION Women with adequate and non-optimal GWG received comparable prenatal counselling on nutrition, weight gain, and lifestyle modifications. There remain missed opportunities in targeting prenatal counselling advice to women at risk for suboptimal or excessive GWG.
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Affiliation(s)
- Angela Vinturache
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Department of Obstetrics & Gynaecology, St. George's University Hospitals NHS Foundation Trust, London, UK.
| | - Anika Winn
- Faculty of Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia Mannion
- Faculty of Nursing, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne Tough
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community of Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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90
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Gázquez A, Prieto-Sánchez MT, Blanco-Carnero JE, Ruíz-Palacios M, Nieto A, van Harskamp D, Oosterink JE, Schierbeek H, van Goudoever JB, Demmelmair H, Koletzko B, Larqué E. Altered materno-fetal transfer of 13C-polyunsaturated fatty acids in obese pregnant women. Clin Nutr 2019; 39:1101-1107. [PMID: 31029479 DOI: 10.1016/j.clnu.2019.04.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/08/2019] [Accepted: 04/11/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND & AIMS Maternal obesity at conception is considered a major predictor of offspring obesity. This could by driven at least in part by an altered placental fat transfer. However, the pathophysiological mechanisms involved are not fully understood. We investigated the in vivo materno-fetal transfer of fatty acids (FAs) in obese pregnant women using stable isotopes. METHODS Ten obese and ten normo-weight pregnant women (control) received orally a bolus of 13C-labeled FAs 12 h before elective caesarean section: oleic acid (13C-OA), linoleic acid (13C-LA) and docosahexaenoic acid (13C-DHA). Maternal blood samples were collected at -12 (basal), -8, -4, -2, 0 h relative to the time of cesarean section. At the time of birth, arterial and venous cord bloods as well as placental tissue were collected. FAs composition was determined by gas-liquid chromatography and isotopic enrichment by gas chromatography-combustion-isotope ratio mass spectrometry. RESULTS Maternal plasma insulin and placental weight tended to higher values in obese pregnant women although they did not present serum hyperlipidemia. Higher concentrations of 13C-LA and 13C-DHA were found in non-esterified FAs fraction in maternal plasma of obese mothers. The ratio of placental uptake for 13C-LA and 13C-DHA was lower in obese women compared to normal weight pointing toward a limited capacity of FA placental transfer, especially of essential FAs. Maternal insulin was associated to this lower placenta/maternal plasma ratio for both 13C-LA (R = -0.563, P = 0.012) and 13C-DHA (R = -0.478, P = 0.033). In addition, the ratio cord/maternal plasma of 13C-LA was significantly lower in obese women compared to controls. CONCLUSIONS In conclusion, obese mothers without hyperlipidemia showed a reduced materno-fetal transfer of polyunsaturated FAs which could affect fetal development. This affect dietary recommendation for obese pregnant women. TRIAL REGISTRY NUMBER ISRCTN69794527.
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Affiliation(s)
- A Gázquez
- LMU - Ludwig-Maximilians-Universität Munich, Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Munich, Germany; Department of Physiology, School of Biology, Biomedical Research Institute of Murcia (IMIB-Arrixaca-UMU), University Clinical Hospital "Virgen de la Arrixaca", University of Murcia, Murcia, Spain
| | - M T Prieto-Sánchez
- Obstetrics and Gynecology Service, Biomedical Research Institute of Murcia (IMIB-Arrixaca-UMU), University Clinical Hospital "Virgen de la Arrixaca", University of Murcia, Murcia, Spain
| | - J E Blanco-Carnero
- Obstetrics and Gynecology Service, Biomedical Research Institute of Murcia (IMIB-Arrixaca-UMU), University Clinical Hospital "Virgen de la Arrixaca", University of Murcia, Murcia, Spain
| | - M Ruíz-Palacios
- Department of Physiology, School of Biology, Biomedical Research Institute of Murcia (IMIB-Arrixaca-UMU), University Clinical Hospital "Virgen de la Arrixaca", University of Murcia, Murcia, Spain
| | - A Nieto
- Obstetrics and Gynecology Service, Biomedical Research Institute of Murcia (IMIB-Arrixaca-UMU), University Clinical Hospital "Virgen de la Arrixaca", University of Murcia, Murcia, Spain
| | - D van Harskamp
- Department of Paediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | - J E Oosterink
- Department of Paediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | - H Schierbeek
- Department of Paediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | - J B van Goudoever
- Department of Paediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands; Department of Paediatrics, Free University of Amsterdam, Amsterdam, the Netherlands
| | - H Demmelmair
- LMU - Ludwig-Maximilians-Universität Munich, Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Munich, Germany
| | - B Koletzko
- LMU - Ludwig-Maximilians-Universität Munich, Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Munich, Germany
| | - E Larqué
- Department of Physiology, School of Biology, Biomedical Research Institute of Murcia (IMIB-Arrixaca-UMU), University Clinical Hospital "Virgen de la Arrixaca", University of Murcia, Murcia, Spain.
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91
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Price SA, Sumithran P, Nankervis A, Permezel M, Proietto J. Preconception management of women with obesity: A systematic review. Obes Rev 2019; 20:510-526. [PMID: 30549166 DOI: 10.1111/obr.12804] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/18/2018] [Accepted: 09/18/2018] [Indexed: 12/11/2022]
Abstract
The prevalence of women of child-bearing age with obesity continues to rise at an alarming rate. This has significant implications for both the short-term and long-term health of mother and offspring. Given the paucity of evidence-based literature in this field, the preconception management of women with obesity is highly variable both between institutions and around the world. This systematic review aims to evaluate studies that inform us about the role of preconception weight loss in the fertility and pregnancy outcomes of women with obesity. Current therapeutic interventions are discussed, with a specific focus on the suitability of weight loss interventions for women with obesity planning pregnancy. There are significant knowledge gaps in the current literature; these are discussed and areas for future research are explored.
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Affiliation(s)
- Sarah A Price
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg Heights, Victoria, Australia
| | - Priya Sumithran
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg Heights, Victoria, Australia
| | | | - Michael Permezel
- Department of Obstetrics and Gynaecology (Mercy Hospital for Women), University of Melbourne, Heidelberg, Victoria, Australia
| | - Joseph Proietto
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg Heights, Victoria, Australia
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92
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Trojnar M, Patro-Małysza J, Kimber-Trojnar Ż, Czuba M, Mosiewicz J, Leszczyńska-Gorzelak B. Vaspin in Serum and Urine of Post-Partum Women with Excessive Gestational Weight Gain. ACTA ACUST UNITED AC 2019; 55:medicina55030076. [PMID: 30909620 PMCID: PMC6473861 DOI: 10.3390/medicina55030076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/14/2019] [Accepted: 03/20/2019] [Indexed: 12/30/2022]
Abstract
Background and objectives: Data concerning vaspin in obstetric aspects are limited and conflicting. The aim of the study was to evaluate vaspin concentrations in the serum and urine of women with excessive gestational weight gain (EGWG) in the early post-partum period (i.e., 48 h after delivery), when placental function no longer influences the results. Materials and Methods: The study subjects were divided into two groups of 28 healthy controls and 38 mothers with EGWG. Maternal body composition and hydration status were evaluated by the bioelectrical impedance analysis (BIA) method. Concentrations of vaspin, fatty acid-binding protein 4 (FABP4), leptin, and ghrelin were determined via enzyme-linked immunosorbent assay (ELISA). Results: Serum vaspin levels were lower in the EGWG group, whereas no significant differences were noted between the groups, with regard to the urine vaspin concentrations. In both studied groups, the serum vaspin concentrations correlated positively with the urine FABP4 levels and negatively with gestational weight gain, body mass index gain in the period from pre-pregnancy to 48 h after delivery (ΔBMI), and fat tissue index (FTI). In the multiple linear regression models, the serum vaspin concentrations were positively dependent on the serum FABP4 levels, as well as negatively dependent on triglycerides, FTI, and ΔBMI. Conclusions: Our study revealed that the EGWG mothers were characterized by significantly lower serum vaspin concentrations in the early post-partum period compared with the subjects that had appropriate gestational weight gain. Our observation supports previous hypotheses that vaspin might be used as a marker of lipid metabolism in pregnancy and maternal adipose tissue. Considering the fact that FABP4 is widely referred to as a pro-inflammatory adipokine, further research on the protective role of vaspin seems crucial, especially in the context of its relationship to FABP4.
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Affiliation(s)
- Marcin Trojnar
- Chair and Department of Internal Medicine, Medical University of Lublin, 20-081 Lublin, Poland.
| | - Jolanta Patro-Małysza
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland.
| | - Żaneta Kimber-Trojnar
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland.
| | - Monika Czuba
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland.
| | - Jerzy Mosiewicz
- Chair and Department of Internal Medicine, Medical University of Lublin, 20-081 Lublin, Poland.
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93
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Gestational weight gain and group prenatal care: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2019; 19:18. [PMID: 30626345 PMCID: PMC6327616 DOI: 10.1186/s12884-018-2148-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/12/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Group visits for chronic medical conditions in non-pregnant populations have demonstrated successful outcomes including greater weight loss compared to individual visits for weight management. It is plausible that group prenatal care can similarly assist women in meeting gestational weight gain goals. The purpose of this study was to evaluate the effect of group vs. traditional prenatal care on gestational weight gain. METHODS A keyword search of Medline, Embase, Scopus, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, clinicaltrials.gov, and Google Scholar was performed up to April 2017. Studies were included if they compared gestational weight gain in a group prenatal care setting to traditional prenatal care in either randomized controlled trials, cohort, or case-control studies. The primary and secondary outcomes were excessive and adequate gestational weight gain according to the Institute of Medicine guidelines. Heterogeneity was assessed with the Q test and I2 statistic. Pooled relative risks (RRs) and confidence intervals (CI) were reported with random-effects models from the randomized controlled trials (RCT) and cohort studies. RESULTS One RCT, one secondary analysis of an RCT, one study with "random assignment", and twelve cohort studies met the inclusion criteria for a total of 13,779 subjects. Thirteen studies used the CenteringPregnancy model, defined by 10 sessions that emphasize goal setting and self-monitoring. Studies targeted specific populations such as adolescents, African-Americans, Hispanics, active-duty military or their spouses, and women with obesity or gestational diabetes. There were no significant differences in excessive [7 studies: pooled rates 47% (1806/3582) vs. 43% (3839/8521), RR 1.09, 95% CI 0.97-1.23] or adequate gestational weight gain [6 studies: pooled rates 31% (798/2875) vs. 30% (1410/5187), RR 0.92, 95% CI 0.79-1.08] in group and traditional prenatal care among the nine studies that reported categorical gestational weight gain outcomes in the meta-analysis. CONCLUSIONS Group prenatal care was not associated with excessive or adequate gestational weight gain in the meta-analysis. Since outcomes were overall inconsistent, we propose that prenatal care models (e.g., group vs. traditional) should be evaluated in a more rigorous fashion with respect to gestational weight gain.
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94
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Kimber-Trojnar Ż, Patro-Małysza J, Trojnar M, Skórzyńska-Dziduszko KE, Bartosiewicz J, Oleszczuk J, Leszczyńska-Gorzelak B. Fatty Acid-Binding Protein 4-An "Inauspicious" Adipokine-In Serum and Urine of Post-Partum Women with Excessive Gestational Weight Gain and Gestational Diabetes Mellitus. J Clin Med 2018; 7:jcm7120505. [PMID: 30513800 PMCID: PMC6306707 DOI: 10.3390/jcm7120505] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/25/2018] [Accepted: 11/30/2018] [Indexed: 12/17/2022] Open
Abstract
The exact roles of adipokines in the pathogenesis of type 2 diabetes and obesity are still unclear. The aim of the study was to evaluate fatty acid binding protein 4 (FABP4) concentrations in the serum and urine of women with excessive gestational weight gain (EGWG) and gestational diabetes mellitus (GDM) in the early post-partum period, with reference to their laboratory test results, body composition, and hydration status. The study subjects were divided into three groups: 24 healthy controls, 24 mothers with EGWG, and 22 GDM patients. Maternal body composition and hydration status were evaluated by the bioelectrical impedance analysis (BIA) method. Concentrations of FABP4, leptin, and ghrelin were determined via enzyme-linked immunosorbent assay (ELISA). Healthy women were characterized by the lowest serum leptin concentrations and by a negative correlation between the serum and urine FABP4 levels. Serum FABP4 levels were the highest in the GDM group. Serum FABP4 and leptin concentrations correlated positively in the GDM group. The EGWG group had the highest degree of BIA disturbances in the early puerperium and positive correlations between the urine FABP4 and serum leptin and ghrelin concentrations. The physiological and pathological significance of these findings requires further elucidation.
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Affiliation(s)
- Żaneta Kimber-Trojnar
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland.
| | - Jolanta Patro-Małysza
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland.
| | - Marcin Trojnar
- Chair and Department of Internal Medicine, Medical University of Lublin, 20-081 Lublin, Poland.
| | | | - Jacek Bartosiewicz
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland.
| | - Jan Oleszczuk
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland.
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95
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de Castro MBT, Cunha DB, Araujo MC, Bezerra IN, Adegboye ARA, Kac G, Sichieri R. High protein diet promotes body weight loss among Brazilian postpartum women. MATERNAL AND CHILD NUTRITION 2018; 15:e12746. [PMID: 30381901 DOI: 10.1111/mcn.12746] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 01/07/2023]
Abstract
There is evidence in the general population that adhering to a high protein and low carbohydrate diet may help in losing weight. However, there is little evidence among postpartum women. The aim of this study is to evaluate the effect of a high protein diet on weight loss among postpartum women. A parallel-randomized controlled trial with 94 postpartum women was conducted in a maternity ward in Mesquita county (recruitment from February 2009 to December 2010) and in a polyclinic in Rio de Janeiro city (recruitment from December 2010 to December 2011). Women were randomized to the intervention group (IG) or control group (CG), and both groups received an isocaloric diet (1,800 kcal). Additionally, the IG received approximately 25 g of protein obtained from 125 g per week of sardine to increase daily dietary protein content and was advised to restrict carbohydrate intake. The CG received nutritional counselling to follow the national nutrition guidelines (15% protein, 60% carbohydrates, and 25% lipids). A linear mixed-effects model was used to test the effect of high protein intake and macronutrient intake on weight loss during the postpartum period. Body weight decreased in the IG compared with the CG (ß = -0.325; p = 0.049) among overweight and obese postpartum women. The percentage of energy intake from lipid (ß = -0.023; p = 0.050) was negatively associated with body weight, and carbohydrate intake (ß = 0.020; p = 0.026) was positively associated with body weight over time among all women. Protein intake and lower carbohydrate intake may be used as a dietary strategy to improve body weight loss during the postpartum period.
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Affiliation(s)
- Maria Beatriz Trindade de Castro
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josue de Castro (INJC), Federal University of Rio de Janeiro, Graduate Program of Nutrition/INJC, Rio de Janeiro, Brazil
| | - Diana Barbosa Cunha
- Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marina Campos Araujo
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation/Ministry of Health, Rio de Janeiro, Brazil
| | | | | | - Gilberto Kac
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josue de Castro (INJC), Federal University of Rio de Janeiro, Graduate Program of Nutrition/INJC, Rio de Janeiro, Brazil
| | - Rosely Sichieri
- Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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96
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Fahey MC, Wayne Talcott G, Cox Bauer CM, Bursac Z, Gladney L, Hare ME, Harvey J, Little M, McCullough D, Hryshko-Mullen AS, Klesges RC, Kocak M, Waters TM, Krukowski RA. Moms fit 2 fight: Rationale, design, and analysis plan of a behavioral weight management intervention for pregnant and postpartum women in the U.S. military. Contemp Clin Trials 2018; 74:46-54. [PMID: 30291998 PMCID: PMC6289301 DOI: 10.1016/j.cct.2018.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/25/2018] [Accepted: 09/28/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Margaret C Fahey
- Department of Psychology, The University of Memphis, Memphis, TN, USA.
| | - G Wayne Talcott
- Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Callie M Cox Bauer
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Zoran Bursac
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Leslie Gladney
- Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Marion E Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jean Harvey
- Department of Nutrition and Food Sciences, The University of Vermont, Burlington, VT, USA
| | - Melissa Little
- Center for Addition and Prevention Research, University of Virginia, School of Medicine, Charlottesville, VA, USA
| | - Deirdre McCullough
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Ann S Hryshko-Mullen
- Defense Institute for Medical Operations, Joint Base San Antonio-Lackland Air Force Base, San Antonio, TX, USA
| | - Robert C Klesges
- Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Teresa M Waters
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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97
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Guo P, Rivera DE, Pauley AM, Leonard KS, Savage JS, Downs DS. A "Model-on-Demand" Methodology For Energy Intake Estimation to Improve Gestational Weight Control Interventions. IFAC-PAPERSONLINE 2018; 51:144-149. [PMID: 30480263 PMCID: PMC6252043 DOI: 10.1016/j.ifacol.2018.09.105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Energy intake underreporting is a frequent concern in weight control interventions. In prior work, a series of estimation approaches were developed to better understand the issue of underreporting of energy intake; among these is an approach based on semi-physical identification principles that adjusts energy intake self-reports by obtaining a functional relationship for the extent of underreporting. In this paper, this global modeling approach is extended, and for comparison purposes, a local modeling approach based on the concept of Model-on-Demand (MoD) is developed. The local approach displays comparable performance, but involves reduced engineering e ort and demands less a priori information. Cross-validation is utilized to evaluate both approaches, which in practice serves as the basis for selecting parsimonious yet accurate models. The effectiveness of the enhanced global and MoD local estimation methods is evaluated with data obtained from Healthy Mom Zone, a novel gestational weight intervention study focused on the needs of obese and overweight women.
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Affiliation(s)
- Penghong Guo
- School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ 85281 USA
| | - Daniel E Rivera
- School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ 85281 USA
| | - Abigail M Pauley
- Exercise Psychology Laboratory, Department of Kinesiology, Penn State University, University Park, PA, USA
| | - Krista S Leonard
- Exercise Psychology Laboratory, Department of Kinesiology, Penn State University, University Park, PA, USA
| | - Jennifer S Savage
- Center for Childhood Obesity Research and the Department of Nutritional Sciences, Penn State University, University Park, PA, USA
| | - Danielle S Downs
- Exercise Psychology Laboratory, Department of Kinesiology, Penn State University, University Park, PA, USA
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, USA
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98
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Abstract
The aim of this study was to characterise changes in lean soft tissue (LST) and examine the contributions of energy intake, physical activity and breast-feeding practices to LST changes at 3 and 9 months postpartum. We examined current weight, LST (via dual-energy X-ray absorptiometry), dietary intake (3-d food diary), physical activity (Baecke questionnaire) and breast-feeding practices (3-d breast-feeding diary) in forty-nine women aged 32·9 (sd 3·8) years. Changes in LST varied from -2·51 to +2·50 kg with twenty-nine women gaining LST (1·1 (sd 0·7) kg, P<0·001) and twenty women losing LST (-0·9 (sd 0·8) kg, P<0·001). Energy intake (133 (SD 42) v. 109 (SD 33) kJ/kg, P=0·019) and % kJ from fat at 3 months postpartum was higher in women who gained LST at 9 months postpartum (gained LST=34 (sd 5) % kJ; lost LST=29 (sd 4) % kJ, P=0·002). Women who gained LST reported breast-feeding their infants more frequently (gained LST=8 (sd 3) feeds/d; lost LST=5 (sd 1) feeds/d, P=0·014) and for more time per d (gained LST=115 (sd 78) min/d; lost LST=59 (sd 34) min/d, P=0·016) at 9 months postpartum. Energy intake and % kJ from fat at 3 months were significant predictors of LST gain (β=0·08 (se 0·04) and 0·24 (se 0·09), respectively). This suggests that gain in LST may be associated with more frequent and longer episodes of breast-feeding at 9 months postpartum as well as dietary intake early in the postpartum period.
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99
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A randomized controlled trial of a web-based education intervention for women with gestational diabetes mellitus. Midwifery 2018; 68:39-47. [PMID: 30343264 DOI: 10.1016/j.midw.2018.08.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 05/04/2018] [Accepted: 08/15/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aimed to investigate changes in maternal body mass index (BMI), blood pressure and glycemic level and infant birthweight using an online educational program compared to standard clinic-based GDM education. DESIGN A preliminary randomized controlled trial of the online intervention was conducted in Melbourne, Australia between 2014 and 2015. A total of 110 women were randomized to (1) the control group and received standard clinic-based GDM education; or (2) the intervention group and received standard care plus the web-based education program. Data were collected at two time points: baseline and 12 weeks postpartum. Infant birthweight was also recorded. Chi-squared test, independent t-test and paired t-test were used to compare outcomes. PARTICIPANTS Pregnant women with newly diagnosed GDM, in the Western region of Melbourne, Australia. FINDINGS Statistically significant differences were reported between intervention and control groups in maternal weight and glycemia post-intervention (p < 0.05). More women in the intervention group than in the control group reported weight loss post-intervention (90.4% vs 48.3%, p < 0.001), and were considered a healthy weight (BMI = 18.5, 24.9kg/m2) at 12 weeks postpartum (44.2% vs 31%). More women in the intervention group had attended for follow up OGTT at 12 weeks postpartum (96.2% vs 70.7%, p < 0.001). Comparing measures pre- and post-intervention in the intervention group, maternal BMI was lower [(28.60 ± 7.93) vs (29.60 ± 8.32); p = 0.000], maternal systolic blood pressure was increased but within normal range [(108.19 ± 11.80) vs (107.29 ± 12.13); p = 0.001], and maternal glycemic level returned to within normal limits [(4.86 ± 0.42) vs (8.80 ± 2.50); p = 0.026]. Most women in both groups gave birth to normal birthweight infants (92.3% and 94.8%). These findings are offset by differences in the groups at baseline. KEY CONCLUSIONS Findings suggest that the education intervention had a positive impact on women's postpartum weight and attendance at OGTT by 12 weeks postpartum. No effect was found on maternal blood pressure or infant birthweight. Further studies with matched intervention and control groups are needed to achieve more definitive conclusions.
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100
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Pellonperä O, Koivuniemi E, Vahlberg T, Mokkala K, Tertti K, Rönnemaa T, Laitinen K. Dietary quality influences body composition in overweight and obese pregnant women. Clin Nutr 2018; 38:1613-1619. [PMID: 30224302 DOI: 10.1016/j.clnu.2018.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 06/26/2018] [Accepted: 08/25/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS Excessive adiposity and gestational weight gain (GWG) have been linked with maternal and offspring morbidity. We investigated the relation of maternal diet, physical activity and GWG on body composition in overweight and obese pregnant women. METHODS Fat mass (FM) and fat free mass (FFM) of 110 overweight and obese pregnant women were measured by air displacement plethysmography in early and late pregnancy (mean 13.5 and 35.3 gestational weeks). At the same time points, the quality of overall diet was assessed by validated index of diet quality (IDQ) questionnaire (score < 10/15 denotes poor dietary quality and score ≥ 10/15 denotes good dietary quality), nutrient intakes by 3-day food diaries, and physical activity by questionnaire. Weight gain between early and late pregnancy was compared to the gestational weight gain guidelines issued by Institute of Medicine. RESULTS Of the women, 77% gained more weight than recommended; this was related to greater dietary fat consumption (80 ± 21 g/day vs. 67 ± 11 g/day, p = 0.010) and greater increase in FM (2.7 ± 3.0 kg vs. -1.0 ± 2.4 kg, p < 0.001) compared to women with ideal GWG. Dietary protein intake (g) correlated positively with FFM at both time points (early pregnancy: r = 0.31, p < 0.002, late pregnancy: r = 0.39, p < 0.001). Women with higher dietary quality index score had more FFM, compared to women with lower dietary quality (early pregnancy FFM: 48.8 ± 5.8 kg vs. 45.8 ± 4.7 kg, p = 0.004, late pregnancy FFM: 56.1 ± 6.4 kg vs. 53.4 ± 5.6 kg, p = 0.025). No correlations were detected between total energy intake or physical activity and FM or FFM at early or late pregnancy. CONCLUSIONS Body composition changes from early to late pregnancy were related to the amount of weight gained and overall dietary quality during pregnancy. Higher dietary quality and protein intake were associated with greater FFM, while dietary fat intake was related to excess weight gain. Identification of these dietary determinants of body composition and weight offers new targets for dietary counseling of pregnant women and thus potential for ensuing health benefits through reduced adiposity.
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Affiliation(s)
- Outi Pellonperä
- University of Turku and Turku University Hospital, Department of Obstetrics and Gynecology, Finland.
| | | | - Tero Vahlberg
- University of Turku and Turku University Hospital, Department of Clinical Medicine, Biostatistics, Finland
| | - Kati Mokkala
- University of Turku, Institute of Biomedicine, Finland
| | - Kristiina Tertti
- University of Turku and Turku University Hospital, Department of Obstetrics and Gynecology, Finland
| | - Tapani Rönnemaa
- University of Turku and Turku University Hospital, Department of Medicine, Finland
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