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A Randomized Trial of Weight Change in a National Home Visiting Program. Am J Prev Med 2018; 54:341-351. [PMID: 29455756 PMCID: PMC5826618 DOI: 10.1016/j.amepre.2017.12.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 11/14/2017] [Accepted: 12/07/2017] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Clinical trials have demonstrated significant impact in reducing weight and incidence of type 2 diabetes mellitus. However, the intensity of these trials limits their scalability to real world settings. The purpose of this study was to embed a lifestyle intervention for overweight and obese mothers within the routine practice of a parent education, home visiting organization. DESIGN Pragmatic trial that used a stratified random design. SETTING/PARTICIPANTS Overweight or obese mothers of preschool children located across St. Louis, Missouri, enrolled in Parents As Teachers, a home visiting organization reaching women and children nationwide. INTERVENTION A lifestyle intervention derived from the Diabetes Prevention Program was embedded within Parents As Teachers entitled Healthy Eating and Active Living Taught at Home (HEALTH). MAIN OUTCOME MEASURES Outcomes included the proportion of women that achieved 5% weight loss at 24 months and improvements in clinical and behavioral outcomes at 12 and 24 months. Participants were enrolled from 2012 to 2014 and data analysis began in 2016. RESULTS Women in the usual care versus intervention group were significantly less likely to achieve 5% weight loss at 24 months (11% vs 26%, p=0.01). At 12 months, there was a 2.8-kg difference in weight between groups (p=0.0006), and by 24 months a 4.7-kg difference in weight (3.2 [SD=7.6] kg vs -1.5 [SD=8.3] kg, p=0.002); group differences in waist circumference were also evident by 12 months (2.1 [SD=8.4] cm vs -0.7 [SD=9.8] cm, p=0.04) and 24 months (3.8 [SD=10.6] cm vs -2.5 [SD=9.1] cm, p=0.005), as were improvements in behavioral outcomes. There was no difference in blood pressure between groups. CONCLUSIONS HEALTH achieved modest but clinically significant weight loss outcomes, and reduced weight gain in mothers of young children. The scalability of this embedded intervention offers the potential to reach mothers in Parents As Teachers programs nationally. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01567033.
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102
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Ojeda ML, Nogales F, Muñoz Del Valle P, Díaz-Castro J, Murillo ML, Carreras O. Metabolic syndrome and selenium in fetal programming: gender differences. Food Funct 2018; 7:3031-8. [PMID: 27334401 DOI: 10.1039/c6fo00595k] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Since Selenium (Se) forms part of glutathione peroxidase (GPx), which appears to have a dual role in Metabolic Syndrome (MS), this study evaluates the implication of Se in the transmission of this pathology to the progeny. METHODS Se body distribution, glucose, triglycerides, cholesterol, insulin and metabolic hormones [glucagon, leptin, gastric inhibitory polypeptide (GIP), and triiodothyronine (T3)], growth factors, receptor activator of nuclear factor kappa-B ligand (RANK-L) and osteopontin, as well as oxidative hepatic balance in the offspring of dams exposed to a fructose-rich diet (65%) with normal Se content (0.01 ppm) during gestation and lactation, were measured according to sex. RESULTS Fructose pups had lower body weight; however, male pups had a lower body mass index and growth indicators in serum. Fructose pups, especially females, had lower levels of serum insulin and HOMA-IR. With regard to Se homeostasis, fructose pups presented a depletion of Se in heart and muscle, and repletion in kidneys, pancreas and thyroid, although only female pups showed a repletion of Se in the liver. Fructose pups presented lower superoxide dismutase activity and only female fructose pups had higher GPx activity, which provoked hepatic oxidation. CONCLUSIONS Se balance and Se tissue deposits in MS pups during lactation are altered by gender. This difference is focused on hepatic Se deposits that affect GPx activity, which could be related to a disruption in the insulin-signaling cascade in females. Furthermore, although female fructose pups had greater metabolic disorders, only the males' growth and development were affected. Particularly relevant is the depletion of Se found in the heart of fructose pups, as this element is essential for correct heart function.
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Affiliation(s)
- M Luisa Ojeda
- Department of Physiology, Faculty of Pharmacy, Seville University, 41012 Seville, Spain.
| | - Fátima Nogales
- Department of Physiology, Faculty of Pharmacy, Seville University, 41012 Seville, Spain.
| | | | - Javier Díaz-Castro
- Department of Physiology, Faculty of Pharmacy and Institute of Nutrition and Food Technology 'José Mataix', University of Granada, 18071 Granada, Spain
| | - M Luisa Murillo
- Department of Physiology, Faculty of Pharmacy, Seville University, 41012 Seville, Spain.
| | - Olimpia Carreras
- Department of Physiology, Faculty of Pharmacy, Seville University, 41012 Seville, Spain.
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103
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Morais SS, Nascimento SL, Godoy-Miranda AC, Kasawara KT, Surita FG. Body Mass Index Changes during Pregnancy and Perinatal Outcomes - A Cross-Sectional Study. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2018; 40:11-19. [PMID: 29253913 PMCID: PMC10467363 DOI: 10.1055/s-0037-1608885] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To evaluate the relation between changes the body mass index (BMI) percentile, reflected in the Atalah curve, and perinatal outcomes. METHODS A cross-sectional study with 1,279 women was performed. Data regarding gestational weight, sociodemographic characteristics and perinatal outcomes were collected through medical charts, prenatal card and interviews in the postpartum period. Women could be classified according to the Atalah curve in the following categories: low weight, adequate weight, overweight, and obese. The BMI was calculated at the first and at the last prenatal care visits, and these values were compared. RESULTS An increase in the BMI category according to the Atalah classification occurred in 19.9% of pregnant women, and an increase of 3.4, 5.8 and 6.4 points of BMI were found for women respectively classified in the adequate weight, overweight and obese categories at the first prenatal visit. Women with high school education presented a lower chance of increasing their BMI (odds ratio [OR] 0:47 [0.24- 0.95]). Women who evolved with an increase in the the Atalah classification were associated with cesarean section (OR 1.97-2.28), fetal macrosomia (OR 4.13-12.54) and large for gestational age newborn (OR 2.88-9.83). CONCLUSION Pregnant women who gained enough weight to move up in their BMI classification according to the Atalah curve had a higher chance of cesarean section and macrosomia. Women classified as obese, according to the Atalah curve, at the first prenatal visit had a high chance of cesarean section and delivering a large for gestational age newborn.
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104
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Farpour-Lambert NJ, Ells LJ, Martinez de Tejada B, Scott C. Obesity and Weight Gain in Pregnancy and Postpartum: an Evidence Review of Lifestyle Interventions to Inform Maternal and Child Health Policies. Front Endocrinol (Lausanne) 2018; 9:546. [PMID: 30319539 PMCID: PMC6168639 DOI: 10.3389/fendo.2018.00546] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/28/2018] [Indexed: 12/16/2022] Open
Abstract
Background: Maternal obesity, excessive gestational weight gain (GWG) and post-partum weight retention (PPWR) constitute new public health challenges, due to the association with negative short- and long-term maternal and neonatal outcomes. The aim of this evidence review was to identify effective lifestyle interventions to manage weight and improve maternal and infant outcomes during pregnancy and postpartum. Methods: A review of systematic reviews and meta-analyses investigating the effects of lifestyle interventions on GWG or PPWR was conducted (Jan 2009-2018) via electronic searches in the databases Medline, Pubmed, Web of Science and Cochrane Library using all keywords related to obesity/weight gain/loss, pregnancy or postpartum and lifestyle interventions;15 relevant reviews were selected. Results: In healthy women from all BMI classes, diet and physical activity interventions can decrease: GWG (mean difference -1.8 to -0.7 kg, high to moderate-quality evidence); the risks of GWG above the IOM guidelines (risk ratio [RR] 0.72 to 0.80, high to low-quality evidence); pregnancy-induced hypertension (RR 0.30 to 0.66, low to very low-quality evidence); cesarean section (RR 0.91 to 0.95; high to moderate-quality evidence) and neonatal respiratory distress syndrome (RR 0.56, high-quality evidence); without any maternal/fetal/neonatal adverse effects. In women with overweight/obesity, multi-component interventions can decrease: GWG (-0.91 to -0.63 kg, moderate to very low-quality evidence); pregnancy-induced hypertension (RR 0.30 to 0.66, low-quality evidence); macrosomia (RR 0.85, 0.73 to 1.0, moderate-quality evidence) and neonatal respiratory distress syndrome (RR 0.47, 0.26 to 0.85, moderate-quality evidence). Diet is associated with greater reduction of the risks of GDM, pregnancy-induced hypertension and preterm birth, compared with any other intervention. After delivery, combined diet and physical activity interventions reduce PPWR in women of any BMI (-2.57 to -2.3 kg, very low quality evidence) or with overweight/obesity (-3.6 to -1.22, moderate to very low-quality-evidence), but no other effects were reported. Conclusions: Multi-component approaches including a balanced diet with low glycaemic load and light to moderate intensity physical activity, 30-60 min per day 3-5 days per week, should be recommended from the first trimester of pregnancy and maintained during the postpartum period. This evidence review should help inform recommendations for health care professionals and women of child-bearing age.
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Affiliation(s)
- Nathalie J. Farpour-Lambert
- Obesity Prevention and Care Program “Contrepoids,” Service of Therapeutic Education for Chronic Diseases, Department of Community Medicine, Primary Care and Emergency, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Pediatric Sports Medicine Consultation, Service of General Pediatrics, Department of Child and Adolescent, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- *Correspondence: Nathalie J. Farpour-Lambert
| | - Louisa J. Ells
- School of Health and Social Care, Teesside University, Middlesbrough, United Kingdom
| | - Begoña Martinez de Tejada
- Service of Obstetrics, Department of Gynaecology and Obstetrics, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Courtney Scott
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
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105
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106
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Verbiest S, Bonzon E, Handler A. Postpartum Health and Wellness: A Call for Quality Woman-Centered Care. Matern Child Health J 2017; 20:1-7. [PMID: 27757754 DOI: 10.1007/s10995-016-2188-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction The first 3 months after giving birth can be a challenging time for many women. The Postpartum Health and Wellness special issue explores this period, one that is often overlooked and under-researched. Methods This issue is designed to bring greater focus to the need for woman-centered care during the postpartum period. Articles in this issue focus on four key areas: (1) the postpartum visit and access to care, (2) the content of postpartum care and postpartum health concerns, (3) interconception care including contraception, and (4) policy, systems, and measurement. Results The submissions highlight deficits in the provision of comprehensive care and services during a critical period in women's lives. The research highlighted in this issue supports the recommendation that Maternal and Child Health leaders collaborate to create woman-centered postpartum services that are part of a coordinated system of care. Conclusion In order to achieve optimal health care in the postpartum period it is becoming more apparent that increased flexibility of services, cross-training of providers, a "no wrong door" approach, new insurance and work-place policy strategies, improved communication, and effective coordinated support within a system that values all women and families is required.
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Affiliation(s)
- Sarah Verbiest
- School of Social Work, University of North Carolina at Chapel Hill, Campus Box 3550, Chapel Hill, NC, 27599-3550, USA. .,Center for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, Campus Box 7181, Chapel Hill, NC, 27599-7181, USA.
| | - Erin Bonzon
- ZERO TO THREE, 1255 23rd St NW, Suite 350, Washington, DC, 20037, USA
| | - Arden Handler
- Community Health Sciences, University of Illinois School of Public Health Center of Excellence in Maternal and Child Health, 1603 W. Taylor, Chicago, IL, 60612, USA
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O'Brien KO, Ru Y. Iron status of North American pregnant women: an update on longitudinal data and gaps in knowledge from the United States and Canada. Am J Clin Nutr 2017; 106:1647S-1654S. [PMID: 29070557 PMCID: PMC5701721 DOI: 10.3945/ajcn.117.155986] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Pregnant women are particularly vulnerable to iron deficiency due to the high iron demands of pregnancy. To avoid the adverse birth outcomes that are associated with maternal iron deficiency anemia, both Canada and the United States recommend universal iron supplementation for pregnant women. Although the benefits of iron supplementation in anemic women are well recognized, insufficient data are currently available on the maternal and neonatal benefits and harms of universal iron supplementation in developed countries as evidenced by the recent conclusions of the US Preventive Services Task Force on the need for further data that address existing gaps. As part of an effort to evaluate the impact of the current North American prenatal iron supplementation policy, this review highlights the lack of national data on longitudinal changes in iron status in pregnant North American women, emphasizes possible limitations with the original longitudinal hemoglobin data used to inform the current CDC reference hemoglobin values, and presents additional normative data from recent longitudinal research studies of iron status in North American pregnant women. Further longitudinal data in North American pregnant women are needed to help identify those who may benefit most from supplementation as well as to help determine whether there are adverse effects of iron supplementation in iron-replete women.
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Affiliation(s)
| | - Yuan Ru
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
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108
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Kominiarek MA, Peaceman AM. Gestational weight gain. Am J Obstet Gynecol 2017; 217:642-651. [PMID: 28549978 DOI: 10.1016/j.ajog.2017.05.040] [Citation(s) in RCA: 209] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/04/2017] [Accepted: 05/16/2017] [Indexed: 12/23/2022]
Abstract
Prenatal care providers are advised to evaluate maternal weight at each regularly scheduled prenatal visit, monitor progress toward meeting weight gain goals, and provide individualized counseling if significant deviations from a woman's goals occur. Today, nearly 50% of women exceed their weight gain goals with overweight and obese women having the highest prevalence of excessive weight gain. Risks of inadequate weight gain include low birthweight and failure to initiate breast-feeding whereas the risks of excessive weight gain include cesarean deliveries and postpartum weight retention for the mother and large-for-gestational-age infants, macrosomia, and childhood overweight or obesity for the offspring. Prenatal care providers have many resources and tools to incorporate weight and other health behavior counseling into routine prenatal practices. Because many women are motivated to improve health behaviors, pregnancy is often considered the optimal time to intervene for issues related to eating habits and physical activity to prevent excessive weight gain. Gestational weight gain is a potentially modifiable risk factor for a number of adverse maternal and neonatal outcomes and meta-analyses of randomized controlled trials report that diet or exercise interventions during pregnancy can help reduce excessive weight gain. However, health behavior interventions for gestational weight gain have not significantly improved other maternal and neonatal outcomes and have limited effectiveness in overweight and obese women.
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Morris J, Nikolopoulos H, Berry T, Jain V, Vallis M, Piccinini-Vallis H, Bell RC. Healthcare providers' gestational weight gain counselling practises and the influence of knowledge and attitudes: a cross-sectional mixed methods study. BMJ Open 2017; 7:e018527. [PMID: 29138209 PMCID: PMC5695303 DOI: 10.1136/bmjopen-2017-018527] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To understand current gestational weight gain (GWG) counselling practices of healthcare providers, and the relationships between practices, knowledge and attitudes. DESIGN Concurrent mixed methods with data integration: cross-sectional survey and semistructured interviews. PARTICIPANTS Prenatal healthcare providers in Canada: general practitioners, obstetricians, midwives, nurse practitioners and registered nurses in primary care settings. RESULTS Typically, GWG information was provided early in pregnancy, but not discussed again unless there was a concern. Few routinely provided women with individualised GWG advice (21%), rate of GWG (16%) or discussed the risks of inappropriate GWG to mother and baby (20% and 19%). More routinely discussed physical activity (46%) and food requirements (28%); midwives did these two activities more frequently than all other disciplines (P<0.001). Midwives interviewed noted a focus on overall wellness instead of weight, and had longer appointment times which allowed them to provide more in-depth counselling. Regression results identified that the higher priority level that healthcare providers place on GWG, the more likely they were to report providing GWG advice and discussing risks of GWG outside recommendations (β=0.71, P<0.001) and discussing physical activity and food requirements (β=0.341, P<0.001). Interview data linked the priority level of GWG to length of appointments, financial compensation methods for healthcare providers and the midwifery versus medical model of care. CONCLUSIONS Interventions for healthcare providers to enhance GWG counselling practices should consider the range of factors that influence the priority level healthcare providers place on GWG counselling.
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Affiliation(s)
- Jill Morris
- Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Hara Nikolopoulos
- Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Tanya Berry
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Venu Jain
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Vallis
- Department of Family Medicine, Behaviour Change Institute, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Rhonda C Bell
- Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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110
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Morais SS, Ide M, Morgan AM, Surita FG. A novel body mass index reference range - an observational study. Clinics (Sao Paulo) 2017; 72:698-707. [PMID: 29236917 PMCID: PMC5706065 DOI: 10.6061/clinics/2017(11)09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 09/04/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To generate a new body mass index curve of reference values and ranges for body mass index and weight gain during pregnancy and to compare the new curve and weight gain ranges with the currently used references. METHODS A prospective observational study was conducted with a total of 5,656 weight and body mass index measurements in 641 women with single pregnancy who attended their first prenatal visit before 12 weeks. All the women were over 18 years old and had no medical conditions that would influence body mass index. Data were collected using prenatal charts and medical records during hospitalization for childbirth. A linear regression method was used for standard curve smoothing in the general population and for specific curves according to the baseline body mass index classification. Curves were obtained for the 5th, 10th, 50th, 85th, 90th and 95th percentiles. Concordance between the classification of women using the newly generated and currently used curves was evaluated by percentages and kappa coefficients. The weight gain was compared with the reference values of the Institute of Medicine using Student's T test. The data were analyzed using SAS software version 9.2, and the significance level was set at 5%. RESULTS A general reference curve of percentiles of body mass index by gestational age was established. Additionally, four specific curves were generated according to the four baseline body mass index categories. The new general curve offered percentile limits for women according to their initial body mass index and according to the Centers for Disease Control and Prevention limits, showing poor agreement with the currently used curve (48.3%). Women who were overweight or obese when starting prenatal care had higher weight gain than the Institute of Medicine recommendation. CONCLUSIONS The new proposed curve for body mass index during pregnancy showed weak agreement with the currently used curve. The new curve provided more information regarding body mass index increase using percentiles for general and specific groups of body mass index. Overweight pregnant women showed an upward body mass index trend throughout pregnancy that increased more dramatically than those of other groups of pregnant women, and they also presented a major mean difference between weight gain and the Institute of Medicine recommendation.
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Affiliation(s)
- Sirlei Siani Morais
- Departamento de Ginecologia e Obstetricia, Faculdade de Ciencias Medicas, Universidade de Campinas (UNICAMP), Campinas, SP, BR
- *Corresponding author. E-mail:
| | - Mirena Ide
- Departamento de Ginecologia e Obstetricia, Faculdade de Ciencias Medicas, Universidade de Campinas (UNICAMP), Campinas, SP, BR
| | - Andrea Moreno Morgan
- Departamento de Ginecologia e Obstetricia, Faculdade de Ciencias Medicas, Universidade de Campinas (UNICAMP), Campinas, SP, BR
| | - Fernanda Garanhani Surita
- Departamento de Ginecologia e Obstetricia, Faculdade de Ciencias Medicas, Universidade de Campinas (UNICAMP), Campinas, SP, BR
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111
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Psychosocial predictors of gestational weight gain and the role of mindfulness. Midwifery 2017; 56:86-93. [PMID: 29096284 DOI: 10.1016/j.midw.2017.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 09/17/2017] [Accepted: 10/14/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To identify the psychosocial factors (i.e., stress, anxiety, depression, social support) that are associated with gestational weight gain (GWG) and the relationship of mindfulness with GWG during each trimester of pregnancy. DESIGN In this cross-sectional study, an online survey that assessed physical and mental health and wellness practices was administered to pregnant women. PARTICIPANTS Pregnant women ≥8 weeks gestation, ≥18 years old, and could read and write in English. MEASUREMENT AND FINDINGS Women who responded to the survey (N=1,073) were on average 28.7±4.6 years old. Findings from a regression analysis suggest that increased levels of depression may be predictive of increased GWG in the second trimester and decreased levels of mindfulness may be predictive of increased GWG in the first trimester. Anxiety, stress, and overall social support were not associated with GWG in any trimester. KEY CONCLUSIONS Mindfulness-based strategies (e.g., yoga) may have the potential to manage both depression and excessive GWG and may beneficial for and preferred by pregnant women. More research is warranted to determine clear relationships between psychosocial health, mindfulness, and GWG. IMPLICATIONS FOR PRACTICE Health care providers are encouraged to screen for depression in early pregnancy (i.e., first or second trimester) and provide resources to manage symptoms of depression and GWG to promote optimal birth outcomes. Health care providers may want to counsel patients on how to manage depression and/or GWG by suggesting mindfulness-based approaches.
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112
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Bellavia A, Hauser R, Seely EW, Meeker JD, Ferguson KK, McElrath TF, James-Todd T. Urinary phthalate metabolite concentrations and maternal weight during early pregnancy. Int J Hyg Environ Health 2017; 220:1347-1355. [PMID: 28939183 DOI: 10.1016/j.ijheh.2017.09.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 08/29/2017] [Accepted: 09/11/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Phthalates are a class of chemicals that may be associated with obesity in non-pregnant populations. Little is known about the association between pregnancy phthalate exposure and maternal obesity. OBJECTIVE We evaluated the association between early-pregnancy urinary concentrations of specific phthalate metabolites and the distribution of body mass index (BMI, cross-sectional), and early gestational weight gain (GWG, prospective). METHODS We measured 1st trimester urinary phthalate metabolite concentrations (median 9.9 weeks gestation) in 347 women from the LIFECODES pregnancy cohort (Boston, MA), who delivered term births. All measures were adjusted for specific-gravity and log-transformed. We used quantile regression to evaluate shifts in the entire outcome distributions, calculating multivariable-adjusted differences in the associations between these phthalate metabolites and BMI and GWG at the 25th, 50th, and 75th percentiles of these anthropometric outcomes. RESULTS Higher concentrations of mono-ethyl phthalate (MEP) were associated with a rightward shift of 2.8kg/m2 at the 75th percentiles of BMI (lowest vs highest quartile, 95% CI: 0.2-5.4) and 1.3kg at the 75th percentiles of early GWG (lowest vs second quartiles, 95% CI: 0.3-2.4). A significant right-shift in the upper tail of BMI was also observed at higher concentrations of mono-benzyl (MBzP), mono-3-carboxypropyl (MCPP), and a summary measure of di-(2-ethylhexyl) phthalate metabolites (∑DEHP). ∑DEHP was also associated with lower GWG. CONCLUSIONS Certain phthalates may be associated with shifts in maternal obesity measures, with MEP, MBzP, MCPP, and ∑DEHP being cross-sectionally associated with 1st trimester BMI and MEP and ∑DEHP being positively and inversely associated with early GWG, respectively.
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Affiliation(s)
- Andrea Bellavia
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, United States
| | - Ellen W Seely
- Division of Endocrine, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, United States
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, United States
| | - Kelly K Ferguson
- Epidemiology Branch, National Institute of Environmental Health Sciences,Research Triangle Park, NC 27709, United States
| | - Thomas F McElrath
- Division of Maternal Fetal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, United States
| | - Tamarra James-Todd
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, United States; Division of Women's Health, Department of Medicine, Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, United States.
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Jelsma JGM, Simmons D, Gobat N, Rollnick S, Blumska K, Jans G, Galjaard S, Desoye G, Corcoy R, Juarez F, Kautzky-Willer A, Harreiter J, van Assche A, Devlieger R, Timmerman D, Hill D, Damm P, Mathiesen ER, Wender-Ożegowska E, Zawiejska A, Lapolla A, Dalfrà MG, Del Prato S, Bertolotto A, Dunne F, Jensen DM, Andersen L, Snoek FJ, van Poppel MNM. Is a motivational interviewing based lifestyle intervention for obese pregnant women across Europe implemented as planned? Process evaluation of the DALI study. BMC Pregnancy Childbirth 2017; 17:293. [PMID: 28882133 PMCID: PMC5590191 DOI: 10.1186/s12884-017-1471-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 08/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Process evaluation is an essential part of designing and assessing complex interventions. The vitamin D and lifestyle intervention study (DALI) study is testing different strategies to prevent development of gestational diabetes mellitus among European obese pregnant women with a body mass index ≥29 kg/m2. The intervention includes guidance on physical activity and/or healthy eating by a lifestyle coach trained in motivational interviewing (MI). The aim of this study was to assess the process elements: reach, dose delivered, fidelity and satisfaction and to investigate whether these process elements were associated with changes in gestational weight gain (GWG). METHODS Data on reach, dose delivered, fidelity, and satisfaction among 144 participants were collected. Weekly recruitment reports, notes from meetings, coach logs and evaluation questionnaires (n = 110) were consulted. Fidelity of eight (out of twelve) lifestyle coach practitioners was assessed by analysing audio recorded counselling sessions using the MI treatment integrity scale. Furthermore, associations between process elements and GWG were assessed with linear regression analyses. RESULTS A total of 20% of the possible study population (reach) was included in this analysis. On average 4.0 (of the intended 5) face-to-face sessions were delivered. Mean MI fidelity almost reached 'expert opinion' threshold for the global scores, but was below 'beginning proficiency' for the behavioural counts. High variability in quality of MI between practitioners was identified. Participants were highly satisfied with the intervention, the lifestyle coach and the intervention materials. No significant associations were found between process elements and GWG. CONCLUSION Overall, the intervention was well delivered and received by the study population, but did not comply with all the principles of MI. Ensuring audio recording of lifestyle sessions throughout the study would facilitate provision of individualized feedback to improve MI skills. A larger sample size is needed to confirm the lack of association between process elements and GWG. TRIAL REGISTRATION ISRCTN registry: ISRCTN70595832 ; Registered 12 December 2011.
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Affiliation(s)
- Judith G M Jelsma
- Department of Public and Occupational Health and, Amsterdam Public Health research institute, VU University Medical Centre, Van der Boechorststraat 7, 1081BT Amsterdam, Amsterdam, The Netherlands
| | - David Simmons
- Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, England, UK.,Macarthur Clinical School, University of Western Sydney, Campbelltown, NSW, Australia
| | - Nina Gobat
- School of Medicine, Cardiff University, Cardiff, Wales, UK
| | | | - Kinga Blumska
- Medical Faculty I, Poznan University of Medical Sciences, Poznan, Poland
| | - Goele Jans
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Sander Galjaard
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology Division of Obstetrics and Prenatal Medicine Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Gernot Desoye
- Department of Obstetrics and Gynecology, Medizinische Universität Graz, Graz, Austria
| | - Rosa Corcoy
- Institut de Recerca de L'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Madrid, Spain
| | - Fabiola Juarez
- Institut de Recerca de L'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Andre van Assche
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Roland Devlieger
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Timmerman
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - David Hill
- Recherche en Santé Lawson SA, St. Gallen, Switzerland
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | | | | | | | | | - Frank J Snoek
- Department of Medical Psychology, Amsterdam Public Health research institute, VU University Medical Centre, Amsterdam, The Netherlands.,Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Mireille N M van Poppel
- Department of Public and Occupational Health and, Amsterdam Public Health research institute, VU University Medical Centre, Van der Boechorststraat 7, 1081BT Amsterdam, Amsterdam, The Netherlands. .,Institute of Sport Science, University of Graz, Graz, Austria.
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Widen EM, Kahn LG, Cirillo P, Cohn B, Kezios KL, Factor-Litvak P. Prepregnancy overweight and obesity are associated with impaired child neurodevelopment. MATERNAL AND CHILD NUTRITION 2017. [PMID: 28635158 DOI: 10.1111/mcn.12481] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The authors examined the relationship of prepregnancy body mass index (BMI) and gestational weight gain (GWG) with child neurodevelopment. Mother-child dyads were a subgroup (n = 2,084) of the Child Health and Development Studies from the Oakland, California, area enrolled during pregnancy from 1959 to 1966 and followed at child age 9 years. Linear regression was used to examine associations between prepregnancy BMI, GWG, and standardized Peabody Picture Vocabulary Test and Raven Progressive Matrices scores and to evaluate effect modification of GWG by prepregnancy BMI. Before pregnancy, 77% of women were normal weight, 8% were underweight, 11% were overweight, and 3% were obese. Associations between GWG and child outcomes did not vary by prepregnancy BMI, suggesting no evidence for interaction. In multivariable models, compared to normal prepregnancy BMI, prepregnancy overweight and obesity were associated with lower Peabody scores (b: -1.29; 95% CI [-2.6, -0.04] and b: -2.7; 95% CI [-5.0, -0.32], respectively). GWG was not associated with child Peabody score [b: -0.03 (95% CI: -0.13, 0.07)]. Maternal BMI and GWG were not associated with child Raven score (all P >0.05). Maternal prepregnancy overweight and obesity were associated with lower scores for verbal recognition in mid-childhood. These results contribute to evidence linking maternal BMI with child neurodevelopment. Future research should examine the role of higher prepregnancy BMI values and the pattern of pregnancy weight gain in child cognitive outcomes.
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Affiliation(s)
- Elizabeth Marie Widen
- Department of Nutritional Sciences, University of Texas at Austin, Austin, Texas, USA.,Department of Medicine, Columbia University Medical Center, New York, New York, USA.,Department of Epidemiology, Columbia University Medical Center, New York, New York, USA
| | - Linda Gross Kahn
- Department of Pediatrics, New York University School of Medicine, New York, New York, USA
| | - Piera Cirillo
- Child Health and Development Studies, Berkeley, California, USA
| | - Barbara Cohn
- Child Health and Development Studies, Berkeley, California, USA
| | - Katrina Lynn Kezios
- Department of Epidemiology, Columbia University Medical Center, New York, New York, USA
| | - Pam Factor-Litvak
- Department of Epidemiology, Columbia University Medical Center, New York, New York, USA
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115
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Morisset AS, Dubois L, Colapinto CK, Luo ZC, Fraser WD. Prepregnancy Body Mass Index as a Significant Predictor of Total Gestational Weight Gain and Birth Weight. CAN J DIET PRACT RES 2017; 78:66-73. [DOI: 10.3148/cjdpr-2016-035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: We aimed to describe adherence to gestational weight gain (GWG) recommendations and identify determinants of excessive GWG in a sample of women from Quebec, Canada. Methods: Data were collected from the multi-centre 3D (Design, Develop, Discover) pregnancy cohort study, which included women who delivered between May 2010 and August 2012 at 9 obstetrical hospitals in Quebec, Canada. GWG was calculated for 1145 women and compared to the 2009 Institute of Medicine (IOM) recommendations. Results: Overall, 51% of participants exceeded the recommendations. Approximately 68% of women with obesity gained weight in excess of the IOM recommendations. The corresponding numbers were 75%, 44%, and 27% in overweight, normal weight, and underweight women, respectively. A prepregnancy BMI of 25 kg/m2 or more was the only significant predictor of exceeding GWG recommendations (OR 3.35, 95% CI 2.44–4.64) in a multivariate model. Birth weight was positively associated with GWG. GWG and prepregnancy BMI could explain 3.13% and 2.46% of the variance in birth weight, respectively. Conclusion: About half of women exceeded GWG recommendations, and this was correlated with infant birth weight. This reinforces the need to develop and evaluate strategies, including nutritional interventions, for pregnant women to achieve optimal GWG.
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Affiliation(s)
- Anne-Sophie Morisset
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC
- Sainte Justine University Hospital Research Center, University of Montreal, Montreal, QC
| | - Lise Dubois
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON
| | - Cynthia K. Colapinto
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC
| | - Zong-Chen Luo
- Sainte Justine University Hospital Research Center, University of Montreal, Montreal, QC
- Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, Huangpu
| | - William D. Fraser
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC
- Sainte Justine University Hospital Research Center, University of Montreal, Montreal, QC
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Gilmore LA, Klempel MC, Martin CK, Myers CA, Burton JH, Sutton EF, Redman LM. Personalized Mobile Health Intervention for Health and Weight Loss in Postpartum Women Receiving Women, Infants, and Children Benefit: A Randomized Controlled Pilot Study. J Womens Health (Larchmt) 2017; 26:719-727. [PMID: 28338403 DOI: 10.1089/jwh.2016.5947] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prepregnancy maternal obesity and excessive weight gain during pregnancy lead to significant morbidities in mothers and their children. Mothers who never return to their prepregnancy weight begin subsequent pregnancies at a greater weight and have a larger propensity for excess gestational weight gain and postpartum weight retention. METHODS In this pilot study, 40 postpartum women credentialed to receive postpartum women, infants, and children (WIC) service were randomized to usual care ("WIC Moms") or a personalized health intervention delivered via a SmartPhone ("E-Moms"). Assessments, including body weight, vital signs, circumferences, and body composition, were completed at week 0 (6-8 weeks postpartum), week 8, and week 16. RESULTS Results are presented as change from week 0 at 16. As per the completers analysis, body weight change was not different between the groups (WIC Moms vs. E-Moms; 1.8 ± 0.9 vs. -0.1 ± 0.9 kg; p = 0.10), neither was the change in percent body fat (1.7 ± 0.6 vs. 0.1% ± 0.6%; p = 0.90) or waist/hip ratio (-0.01 ± 0.01 vs. -0.02 ± 0.01 cm; p = 0.60). However, due to notable variability in intervention adherence as the study progressed, participants were classified post hoc as having low (<40% adherence), medium (40%-70% adherence), or high adherence (>70% adherence). Participants with high intervention adherence (n = 5) had a significant reduction in body weight (-3.6 ± 1.6 vs. 1.8 ± 0.9 kg; p = 0.005) and percent body fat (-2.5 ± 1.0 vs. 1.7% ± 0.6%; p = 0.001) when compared to WIC Moms. CONCLUSIONS Overall, the E-Moms intervention was not able to decrease postpartum weight retention in women receiving WIC benefits compared to usual care received through the current WIC program. However, there is some evidence to suggest improved adherence to the intervention would improve weight management.
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Affiliation(s)
- L Anne Gilmore
- Pennington Biomedical Research Center , Baton Rouge, Louisiana
| | | | - Corby K Martin
- Pennington Biomedical Research Center , Baton Rouge, Louisiana
| | - Candice A Myers
- Pennington Biomedical Research Center , Baton Rouge, Louisiana
| | | | | | - Leanne M Redman
- Pennington Biomedical Research Center , Baton Rouge, Louisiana
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117
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Puhkala J, Raitanen J, Kolu P, Tuominen P, Husu P, Luoto R. Metabolic syndrome in Finnish women 7 years after a gestational diabetes prevention trial. BMJ Open 2017; 7:e014565. [PMID: 28298369 PMCID: PMC5353289 DOI: 10.1136/bmjopen-2016-014565] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Risk for developing metabolic syndrome (MeS) after delivery is high among women with gestational diabetes mellitus (GDM), but little is known about development of MeS among women with risk factors for GDM during pregnancy. In the present study, we studied the prevalence of MeS 7 years postpartum among women with GDM risk factors during pregnancy, women with early GDM diagnosis and women without GDM risk factors. We also analysed the early pregnancy risk factors associated with MeS. METHODS A Finnish cluster randomised controlled GDM prevention trial was conducted in 2007-2009. The prevalence of MeS according to International Diabetes Federation criteria was determined in the follow-up study 7 years after original trial. Eligible participants (n=289) in 4 study groups (intervention (n=83) and usual care (n=87) with GDM risk factors; early GDM (n=51), and healthy control without GDM risk factors (n=68)) were evaluated for MeS. Binary logistic regression models were used to analyse risk factors associated with MeS. RESULTS 7 years postpartum, the MeS prevalence was 14% (95% CI 8% to 25%) in the intervention group; 15% (CI 8% to 25%) in the usual care group; 50% (CI 35% to 65%) in the early GDM group and 7% (CI 2% to 18%) in the healthy control group. OR for MeS in women with GDM risk factors did not differ from the healthy control group. Body mass index (BMI)-adjusted OR for MeS was 9.18 (CI 1.82 to 46.20) in the early GDM group compared with the healthy control group. Increased prepregnancy BMI was associated with MeS (OR, 1.17, CI 1.08 to 1.28, adjusted for group). CONCLUSIONS Increased prepregnancy BMI and early GDM diagnosis were the strongest risk factors for developing MeS 7 years postpartum. Overweight and obese women and especially those with early GDM should be monitored and counselled for cardiometabolic risk factors after delivery.
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Affiliation(s)
- Jatta Puhkala
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Jani Raitanen
- UKK Institute for Health Promotion Research, Tampere, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Päivi Kolu
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Pipsa Tuominen
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Pauliina Husu
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Riitta Luoto
- UKK Institute for Health Promotion Research, Tampere, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
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118
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Garland M. Physical Activity During Pregnancy: A Prescription for Improved Perinatal Outcomes. J Nurse Pract 2017. [DOI: 10.1016/j.nurpra.2016.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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119
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Effectiveness and Cost-Effectiveness of a Cluster-Randomized Prenatal Lifestyle Counseling Trial: A Seven-Year Follow-Up. PLoS One 2016; 11:e0167759. [PMID: 27936083 PMCID: PMC5147978 DOI: 10.1371/journal.pone.0167759] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/18/2016] [Indexed: 11/19/2022] Open
Abstract
There is a link between the pregnancy and its long-term influence on health and susceptibility to future chronic disease both in mother and offspring. The objective was to determine whether individual counseling on physical activity and diet and weight gain at five antenatal visits can prevent type 2 diabetes mellitus (T2DM) and overweight or improve glycemic parameters, among all at-risk-mothers and their children. Another objective was to evaluate whether gestational lifestyle intervention was cost-effective as measured with mother's sickness absence and quality-adjusted life years (QALY). This study was a seven-year follow-up study for women, who were enrolled to the antenatal cluster-randomized controlled trial (RCT). Analysis of the outcome included all women whose outcome was available, in addition with subgroup analysis including women adherent to all lifestyle aims. A total of 173 women with their children participated to the study, representing 43% (173/399) of the women who finished the original RCT. Main outcome measures were: T2DM based on medication use or fasting blood glucose or oral glucose tolerance test (OGTT), body mass index (BMI), glycosylated hemoglobin (HbA1c). None of the women were diagnosed to have T2DM. HbA1c or fasting blood glucose differences were not found among mothers or children. Differences in BMI were non-significant among mothers (Intervention 27.3, Usual care 28.1 kg/m2, p = 0.33) and children (I 21.3 vs U 22.5 kg/m2, p = 0.07). Children's BMI was significantly lower among adherent group (I 20.5 vs U 22.5, p = 0.04). The mean total cost per person was 30.6% lower in the intervention group than in the usual care group (I €2,944 vs. U €4,243; p = 0.74). Intervention was cost-effective in terms of sickness absence but not in QALY gained i.e. if society is willing to pay additional €100 per one avoided sickness absence day; there is a 90% probability of the intervention arm to be cost-effective. Long-term effectiveness of antenatal lifestyle counseling was not shown, in spite of possible effect on children's BMI. Cost-effectiveness of the intervention in terms of sickness absence may have larger societal impact.
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Abstract
OBJECTIVE To describe nutrient intakes, characterize dietary patterns and analyse their associations with sociodemographic characteristics among pregnant women in Shaanxi, China. DESIGN Population-based cross-sectional survey. SETTING Twenty counties and ten districts in Shaanxi Province of Northwest China, 2013. SUBJECTS Women (n 7462) were recruited using a stratified multistage random sampling method to report diets during pregnancy, at 0-12 months (median 3 months; 10th-90th percentile, 0-7 months) after delivery. RESULTS Pregnant women had higher intakes of fat, niacin and vitamin E than the nutrient reference values, while most micronutrients such as vitamin A, folate, Ca and Zn were reportedly low. Women in the highest education, occupation and household income groups had higher nutrient intakes than those in the lowest groups. Nutrient intake differences also existed by geographic area, residence and maternal age at delivery. Three dietary patterns were identified: balanced pattern, vegetarian pattern and snacks pattern. Participants with high balanced pattern scores tended to be better educated, wealthier, 25-29 years old at delivery, working outside and living in urban areas and central Shaanxi. Women with high scores on the vegetarian pattern and snacks pattern tended to be in low balanced pattern score groups, and had lower nutrient intakes than those in the high balanced pattern score groups. CONCLUSIONS The study suggested that pregnant women in Shaanxi, China had low intakes of most nutrients such as vitamin A, folate and Ca. Dietary patterns and most nutrient intakes varied by sociodemographic characteristics. Targeted programmes are needed to improve dietary intakes and dietary patterns among sociodemographically disadvantaged groups.
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Obesity in Women: The Clinical Impact on Gastrointestinal and Reproductive Health and Disease Management. Gastroenterol Clin North Am 2016; 45:317-31. [PMID: 27261901 DOI: 10.1016/j.gtc.2016.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Approximately 36% of adult women in the United States are obese. Although obesity affects women similarly to men in terms of prevalence, there seem to be gender-specific differences in the pathophysiology, clinical manifestations, and treatment of obesity. Obesity is linked to comorbid diseases involving multiple organ systems, including the gastrointestinal tract, like gastroesophageal reflux disease, fatty liver disease, and gallstones. This article focuses on obesity in women, specifically the impact of obesity on gastrointestinal diseases and reproductive health, as well as the treatment of obesity in women.
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123
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Hutcheon JA, Oken E. Towards Defining Optimal Gestational Weight Gain. CURR EPIDEMIOL REP 2016. [DOI: 10.1007/s40471-016-0062-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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