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Sullivan EA, Dickinson JE, Vaughan GA, Peek MJ, Ellwood D, Homer CSE, Knight M, McLintock C, Wang A, Pollock W, Jackson Pulver L, Li Z, Javid N, Denney-Wilson E, Callaway L. Maternal super-obesity and perinatal outcomes in Australia: a national population-based cohort study. BMC Pregnancy Childbirth 2015; 15:322. [PMID: 26628074 PMCID: PMC4667490 DOI: 10.1186/s12884-015-0693-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 10/05/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Super-obesity is associated with significantly elevated rates of obstetric complications, adverse perinatal outcomes and interventions. The purpose of this study was to determine the prevalence, risk factors, management and perinatal outcomes of super-obese women giving birth in Australia. METHODS A national population-based cohort study. Super-obese pregnant women (body mass index (BMI) >50 kg/m(2) or weight >140 kg) who gave birth between January 1 and October 31, 2010 and a comparison cohort were identified using the Australasian Maternity Outcomes Surveillance System (AMOSS). Outcomes included maternal and perinatal morbidity and mortality. Prevalence estimates calculated with 95% confidence intervals (CIs). Adjusted odds ratios (ORs) were calculated using multivariable logistic regression. RESULTS 370 super-obese women with a median BMI of 52.8 kg/m(2) (range 40.9-79.9 kg/m(2)) and prevalence of 2.1 per 1 000 women giving birth (95% CI: 1.96-2.40). Super-obese women were significantly more likely to be public patients (96.2%), smoke (23.8%) and be socio-economically disadvantaged (36.2%). Compared with other women, super-obese women had a significantly higher risk for obstetric (adjusted odds ratio (AOR) 2.42, 95% CI: 1.77-3.29) and medical (AOR: 2.89, 95% CI: 2.64-4.11) complications during pregnancy, birth by caesarean section (51.6%) and admission to special care (HDU/ICU) (6.2%). The 372 babies born to 365 super-obese women with outcomes known had significantly higher rates of birthweight ≥ 4500 g (AOR 19.94, 95 % CI: 6.81-58.36), hospital transfer (AOR 3.81, 95 % CI: 1.93-7.55) and admission to Neonatal Intensive Care Unit (NICU) (AOR 1.83, 95% CI: 1.27-2.65) compared to babies of the comparison group, but not prematurity (10.5% versus 9.2%) or perinatal mortality (11.0 (95% CI: 4.3-28.0) versus 6.6 (95% CI: 2.6- 16.8) per 1 000 singleton births). CONCLUSIONS Super-obesity in pregnancy in Australia is associated with increased rates of pregnancy and birth complications, and with social disadvantage. There is an urgent need to further address risk factors leading to super-obesity among pregnant women and for maternity services to better address pre-pregnancy and pregnancy care to reduce associated inequalities in perinatal outcomes.
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Affiliation(s)
- Elizabeth A Sullivan
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
- School of Women's and Children's Health, The University of New South Wales, Sydney, Australia.
| | - Jan E Dickinson
- School of Women's and Infants' Health, The University of Western Australia, Perth, Australia.
| | - Geraldine A Vaughan
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Michael J Peek
- Department of Obstetrics and Gynaecology Medical School College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia.
- Obstetrics and Gynaecology, Centenary Hospital for Women and Children, Canberra, Australia.
| | - David Ellwood
- School of Medicine, Griffith University, Queensland, Australia.
- Gold Coast University Hospital, Queensland, Australia.
| | - Caroline S E Homer
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom.
| | - Claire McLintock
- Obstetrics and Gynaecology, National Women's Health, Auckland City Hospital, Auckland, New Zealand.
| | - Alex Wang
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Wendy Pollock
- Judith Lumley Centre, La Trobe University, Melbourne, Australia.
- Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia.
| | - Lisa Jackson Pulver
- Muru Marri Indigenous Health Unit, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia.
| | - Zhuoyang Li
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Nasrin Javid
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Elizabeth Denney-Wilson
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Leonie Callaway
- Royal Brisbane and Women's Hospital, Brisbane, Australia.
- School of Medicine, The University of Queensland, Brisbane, Australia.
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102
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[Prevention of shoulder dystocia risk factors before delivery]. ACTA ACUST UNITED AC 2015; 44:1248-60. [PMID: 26527026 DOI: 10.1016/j.jgyn.2015.09.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 09/18/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether it is possible to prevent the occurrence of risk factors for shoulder dystocia before or during pregnancy. METHODS The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. Studied measures were exercise before or during pregnancy, dietary management, and gestational diabetes management in obese and non-obese patients. RESULTS No study has proven that the correction of these risk factors (except gestational diabetes) would reduce the risk of shoulder dystocia. In the general population, physical exercise is recommended either before or during pregnancy to reduce the risk of gestational diabetes (physical activity before pregnancy) (grade B), fetal macrosomia (grade C) or maternal weight gain during pregnancy (grade C). No dietary regimen is recommended to reduce these issues (grade B). In overweight or obese (body mass index [BMI]>25), physical activity coupled with dietary management is recommended (grade A) because it reduces fetal macrosomia (EL1). In addition, it allows a modest reduction in maternal weight gain during pregnancy (EL2), but did have an effect on the occurrence of gestational diabetes (EL1). In case of gestational diabetes, diabetes care is recommended (diabetic diet, glucose monitoring, insulin if needed) (grade A) as it reduces the risk of macrosomia and shoulder dystocia (EL1). The recommended weight gain during pregnancy is 11.5 kg to 16 kg for normal BMI patients (grade B). Obese patients should be aware of the importance of controlling their weight gain during pregnancy (professional consensus). It is recommended that patients regain their pre-conception weight, and ideally a BMI between 18 and 25 kg/m(2), 6 months postpartum (grade B) to reduce the risk of gestational diabetes and macrosomia in a subsequent pregnancy (EL2). CONCLUSION Physical activity is recommended before and during pregnancy to reduce the occurrence of risk factors for shoulder dystocia. In obese patients, physical activity should be coupled with dietary measures to reduce fetal macrosomia and weight gain during pregnancy.
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Lim S, O'Reilly S, Behrens H, Skinner T, Ellis I, Dunbar JA. Effective strategies for weight loss in post-partum women: a systematic review and meta-analysis. Obes Rev 2015; 16:972-87. [PMID: 26313354 DOI: 10.1111/obr.12312] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/14/2015] [Accepted: 07/17/2015] [Indexed: 12/31/2022]
Abstract
Post-partum weight loss is critical to preventing and managing obesity in women, but the results from lifestyle interventions are variable and the components associated with successful outcomes are not yet clearly identified. This study aimed to identify lifestyle intervention strategies associated with weight loss in post-partum women. MEDLINE, EMBASE, PubMed, CINAHL and four other databases were searched for lifestyle intervention studies (diet or exercise or both) in post-partum women (within 12 months of delivery) published up to July 2014. The primary outcome was weight loss. Subgroup analyses were conducted for self-monitoring, individual or group setting, intervention duration, intervention types, the use of technology as a support, and home- or centre-based interventions. From 12,673 studies, 46 studies were included in systematic review and 32 randomized controlled trials were eligible for meta-analysis (1,892 women, age 24-36 years). Studies with self-monitoring had significantly greater weight lost than those without (-4.61 kg [-7.08, -2.15] vs. -1.34 kg [-1.66, -1.02], P = 0.01 for subgroup differences). Diet and physical activity when combined were significantly more effective on weight loss compared with physical activity alone (-3.24 kg [-4.59, -1.90] vs. -1.63 kg [-2.16, -1.10], P < 0.001 for subgroup differences). Lifestyle interventions that use self-monitoring and take a combined diet-and-exercise approach have significantly greater weight loss in post-partum women.
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Affiliation(s)
- S Lim
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Hamilton, Vic., Australia
| | - S O'Reilly
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, Vic., Australia
| | - H Behrens
- School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - T Skinner
- School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, NT, Australia
| | - I Ellis
- School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - J A Dunbar
- Deakin Population Health Strategic Research Centre, Deakin University, Warrnambool, Victoria, Australia
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Haire-Joshu DL, Schwarz CD, Peskoe SB, Budd EL, Brownson RC, Joshu CE. A group randomized controlled trial integrating obesity prevention and control for postpartum adolescents in a home visiting program. Int J Behav Nutr Phys Act 2015; 12:88. [PMID: 26112041 PMCID: PMC4499890 DOI: 10.1186/s12966-015-0247-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 06/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescence represents a critical period for the development of overweight that tracks into adulthood. This risk is significantly heightened for adolescents that become pregnant, many of whom experience postpartum weight retention. The aim of this study was to evaluate Balance Adolescent Lifestyle Activities and Nutrition Choices for Energy (BALANCE), a multicomponent obesity prevention intervention targeting postpartum adolescents participating in a national home visiting child development-parent education program. METHODS A group randomized, nested cohort design was used with 1325 adolescents, 694 intervention and 490 control, (mean age = 17.8 years, 52 % underrepresented minorities) located across 30 states. Participatory methods were used to integrate lifestyle behavior change strategies within standard parent education practice. Content targeted replacement of high-risk obesogenic patterns (e.g. sweetened drink and high fat snack consumption, sedentary activity) with positive behaviors (e.g. water intake, fruit and vegetables, increased walking). Parent educators delivered BALANCE through home visits, school based classroom-group meetings, and website activities. Control adolescents received standard child development information. Phase I included baseline to posttest (12 months); Phase II included baseline to follow-up (24 months). RESULTS When compared to the control group, BALANCE adolescents who were ≥12 weeks postpartum were 89 % more likely (p = 0.02) to maintain a normal BMI or improve an overweight/obese BMI by 12 months; this change was not sustained at 24 months. When compared to the control group, BALANCE adolescents significantly improved fruit and vegetable intake (p = .03). In stratified analyses, water intake improved among younger BALANCE teens (p = .001) and overweight/obese BALANCE teens (p = .05) when compared to control counterparts. There were no significant differences between groups in sweetened drink and snack consumption or walking. CONCLUSION Prevention of postpartum weight retention yields immediate health benefits for the adolescent mother and may prevent the early development or progression of maternal obesity, which contributes to the intergenerational transmission of obesity to her offspring. Implementing BALANCE through a national home visiting organization may hold promise for promoting positive lifestyle behaviors associated with interruption of the progression of maternal obesity. TRIAL REGISTRATION Clinical Trials Registry NCT01617486 .
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Affiliation(s)
- Debra L Haire-Joshu
- Washington University in St. Louis, The Brown School of Social Work and Public Health, and The School of Medicine, 1 Brookings Dr, St. Louis, MO, 63130, USA.
| | - Cynthia D Schwarz
- Washington University in St. Louis, The Brown School of Social Work and Public Health, and The School of Medicine, 1 Brookings Dr, St. Louis, MO, 63130, USA.
| | - Sarah B Peskoe
- Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Elizabeth L Budd
- Washington University in St. Louis, The Brown School of Social Work and Public Health, and The School of Medicine, 1 Brookings Dr, St. Louis, MO, 63130, USA.
| | - Ross C Brownson
- Washington University in St. Louis, The Brown School of Social Work and Public Health, and The School of Medicine, 1 Brookings Dr, St. Louis, MO, 63130, USA.
| | - Corinne E Joshu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21218, USA.
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105
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Peacock AS, Bogossian FE, Wilkinson SA, Gibbons KS, Kim C, McIntyre HD. A Randomised Controlled Trial to Delay or Prevent Type 2 Diabetes after Gestational Diabetes: Walking for Exercise and Nutrition to Prevent Diabetes for You. Int J Endocrinol 2015; 2015:423717. [PMID: 26089886 PMCID: PMC4452189 DOI: 10.1155/2015/423717] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 10/22/2014] [Indexed: 01/11/2023] Open
Abstract
Aims. To develop a program to support behaviour changes for women with a history of Gestational Diabetes Mellitus (GDM) and a Body Mass Index (BMI) > 25 kg/m(2) to delay or prevent Type 2 Diabetes Mellitus. Methods. Women diagnosed with GDM in the previous 6 to 24 months and BMI > 25 kg/m(2) were randomized to an intervention (I) (n = 16) or a control (C) (n = 15) group. The intervention was a pedometer program combined with nutrition coaching, with the primary outcome increased weight loss in the intervention group. Secondary outcomes included decreased waist and hip measurements, improved insulin sensitivity and body composition, increased physical activity, and improved self-efficacy in eating behaviours. Results. Median (IQR) results were as follows: weight: I -2.5 (2.3) kg versus C +0.2 (1.6) kg (P = 0.009), waist: I -3.6 (4.5) cm versus C -0.1 (3.6) cm (P = 0.07), and hip: I -5.0 (3.3) cm versus C -0.2 (2.6) cm (P = 0.002). There was clinical improvement in physical activity and eating behaviours and no significant changes in glucose metabolism or body composition. Conclusion. A pedometer program and nutrition coaching proved effective in supporting weight loss, waist circumference, physical activity, and eating behaviours in women with previous GDM.
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Affiliation(s)
- A. S. Peacock
- School of Nursing and Midwifery, The University of Queensland, Brisbane, QLD 4067, Australia
- Mater Research Institute, The University of Queensland, Brisbane, QLD 4101, Australia
| | - F. E. Bogossian
- School of Nursing and Midwifery, The University of Queensland, Brisbane, QLD 4067, Australia
| | - S. A. Wilkinson
- Mater Research Institute, The University of Queensland, Brisbane, QLD 4101, Australia
- Mater Health Services, Brisbane, QLD 4101, Australia
| | - K. S. Gibbons
- Mater Research Institute, The University of Queensland, Brisbane, QLD 4101, Australia
| | - C. Kim
- University of Michigan, Ann Arbor, MI 48109, USA
| | - H. D. McIntyre
- Mater Health Services, Brisbane, QLD 4101, Australia
- School of Medicine, The University of Queensland, Brisbane, QLD 4067, Australia
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106
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Abstract
Maternal obesity is inextricably linked to adverse health outcomes for the mother and her children. The peripartum period is a critical period of risk. In this chapter, we examine the importance of maternal prepregnancy weight status, gestational weight gain, breastfeeding, and postpartum weight loss in relation to subsequent risk for maternal obesity and obesity in the offspring. Promoting optimal maternal weight during the preconception, pregnancy, and postpartum periods will provide lifelong benefits for maternal health and the health of her progeny.
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107
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Kirkegaard H, Stovring H, Rasmussen KM, Abrams B, Sørensen TIA, Nohr EA. Maternal weight change from prepregnancy to 7 years postpartum--the influence of behavioral factors. Obesity (Silver Spring) 2015; 23:870-8. [PMID: 25820258 DOI: 10.1002/oby.21022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/11/2014] [Accepted: 12/15/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We studied the influence of maternal behavior on weight change from prepregnancy to 7 years postpartum. METHODS We used linear regression to study the independent and combined associations between self-reported behavior in pregnancy (dietary intake, leisure-time exercise, sedentary activity, smoking) and postpartum (breastfeeding duration and smoking) on weights at 6 months, 18 months, and 7 years postpartum. RESULTS Women's average 7-year weight gain was 2.07 kg, with 23% gaining >5 kg. Multivariable analyses suggested that women with healthier dietary intake, more leisure-time exercise, less sedentary behavior, and longer duration of breastfeeding on average gained 1.66 kg [95% confidence interval (CI): 1.40; 1.91] with a significantly reduced odds [OR 0.56 (95% CI: 0.49; 0.64)] of gaining >5 kg from prepregnancy to 7 years postpartum compared to women with none or one of these behaviors [mean gain 3.03 kg (95% CI: 2.68; 3.39)]. Women who ceased smoking had higher long-term weight gain than nonsmokers, but not smokers. CONCLUSIONS Adherence to healthy behaviors during pregnancy lowered long-term weight gain considerably by lowering postpartum weight retention and subsequent weight gain. Public health efforts to help mothers achieve healthy behaviors might prevent childbearing-related weight gain.
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Affiliation(s)
- Helene Kirkegaard
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
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108
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Shah MK, Kieffer EC, Choi H, Schumann C, Heisler M. Mediators and Moderators of the Effectiveness of a Community Health Worker Intervention That Improved Dietary Outcomes in Pregnant Latino Women. HEALTH EDUCATION & BEHAVIOR 2015; 42:593-603. [PMID: 25636316 DOI: 10.1177/1090198114568307] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pregnancy is an opportune time to initiate diabetes prevention strategies for minority and underserved women, using culturally tailored interventions delivered by community health workers. A community-partnered randomized controlled trial (RCT) with pregnant Latino women resulted in significantly improved vegetable, fiber, added sugar, and total fat consumption compared to a minimal intervention group. However, studying RCT intervention effects alone does not explain the mechanisms by which the intervention was successful or help identify which participants may have benefitted most. PURPOSE To improve the development and targeting of future community health worker interventions for high-risk pregnant women, we examined baseline characteristics (moderators) and potential mechanisms (mediators) associated with these dietary changes. METHOD Secondary analysis of data for 220 Latina RCT participants was conducted. A linear regression with effects for intervention group, moderator, and interaction between intervention group and moderator was used to test each hypothesized moderator of dietary changes. Sobel-Goodman mediation test was used to assess mediating effects on dietary outcomes. RESULTS Results varied by dietary outcome. Improvements in vegetable consumption were greatest for women who reported high spousal support at baseline. Women younger than age 30 were more likely to reduce added sugar consumption than older women. Participants who reported higher baseline perceived control were more likely to reduce fat consumption. No examined mediators were significantly associated with intervention effects. CONCLUSION Future interventions with pregnant Latinas may benefit from tailoring dietary goals to consider age, level of spousal support, and perceived control to eat healthy.
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Affiliation(s)
| | | | | | - Christina Schumann
- Community Health and Social Services Center (CHASS), Inc., Detroit, MI, USA
| | - Michele Heisler
- University of Michigan, Ann Arbor, MI, USA Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI, USA
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109
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Abstract
Obesity in pregnancy is the leading cause of maternal and fetal morbidity, and gestational weight gain (GWG) is one modifiable risk factor that improves pregnancy outcomes. Most pregnant women gain more than the 2009 Institute of Medicine recommendations, particularly overweight and obese women. GWG even less than the 2009 IOM guidelines in obese women may improve pregnancy outcomes and reduce large-for-gestational-age (LGA) infants, an independent risk factor for childhood obesity, without increasing small-for-gestational-age (SGA) infants. Unfortunately, despite the fact that over 50 interventional trials designed to decrease excess GWG have been conducted, these interventions have been only modestly effective, and interventions designed to facilitate weight postpartum weight loss have also been disappointing. Successful interventions are of paramount importance not only to improve pregnancy outcomes but also for the future metabolic health of the mother and her infant, and may be key in attenuating the trans-generational risk on childhood obesity.
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Affiliation(s)
- Jacinda M. Nicklas
- Division of General Internal Medicine, University of Colorado School of Medicine, 12348 E. Montview Blvd, C263, Aurora, CO 80045, 303-724-9028 (work phone), 617-510-7273 (cell phone), 303-724-9976 (fax)
| | - Linda A. Barbour
- Professor of Medicine and Obstetrics and Gynecology, Divisions of Endocrinology, Metabolism, and Diabetes and Maternal-Fetal Medicine, University of Colorado School of Medicine, Mail Stop 8106, 12801 E. 17 Avenue, Aurora, CO 80045, 303-724-3921 (work phone), 303-594-0474 (cell phone), 303-724-3920 (fax)
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110
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Xiao RS, Kroll-Desrosiers AR, Goldberg RJ, Pagoto SL, Person SD, Waring ME. The impact of sleep, stress, and depression on postpartum weight retention: a systematic review. J Psychosom Res 2014; 77:351-8. [PMID: 25306538 PMCID: PMC4252881 DOI: 10.1016/j.jpsychores.2014.09.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 09/22/2014] [Accepted: 09/24/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To review the impact of sleep, stress, and/or depression on postpartum weight retention. METHODS We searched three electronic databases, PubMed, ISI Web of Science, and PsycInfo. Studies were included if they were published between January 1990 and September 2013 in English, measured sleep, stress, and/or depression in the postpartum period, and assessed the association of these factors with postpartum weight retention. Two reviewers reviewed included articles and rated study quality using a modified version of the Downs and Black scale. RESULTS Thirteen studies met our pre-defined eligibility criteria, reporting on 9 study samples. Two were cross-sectional studies and eleven were longitudinal studies. The study sample size ranged from 74 to 37,127. All four studies examining short sleep duration and postpartum weight retention reported a positive association. The four studies examining postpartum stress and weight retention reported non-significant associations only. Of 7 studies examining postpartum depression and weight retention, 3 reported non-significant associations, and 4 reported positive associations. CONCLUSION Research investigating the impact of postpartum sleep, stress, depression on weight retention is limited. Future longitudinal studies are needed.
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Affiliation(s)
- Rui S. Xiao
- Clinical and Population Health Research Program, University of Massachusetts Medical School, Worcester, MA,Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Aimee R. Kroll-Desrosiers
- Clinical and Population Health Research Program, University of Massachusetts Medical School, Worcester, MA,Division of Biostatistics and Health Services Research, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Robert J Goldberg
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Sherry L. Pagoto
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Sharina D. Person
- Division of Biostatistics and Health Services Research, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Molly E. Waring
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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111
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Harrison CL, Lombard CB, Teede HJ. Limiting postpartum weight retention through early antenatal intervention: the HeLP-her randomised controlled trial. Int J Behav Nutr Phys Act 2014; 11:134. [PMID: 25358909 PMCID: PMC4221718 DOI: 10.1186/s12966-014-0134-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 10/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnancy is a recognised high risk period for excessive weight gain, contributing to postpartum weight retention and obesity development long-term. We aimed to reduce postpartum weight retention following a low-intensity, self-management intervention integrated with routine antenatal care during pregnancy. METHODS 228 women at increased risk of gestational diabetes, <15 weeks gestation were randomised to intervention (4 self-management sessions) or control (generic health information). Outcomes, collected at baseline and 6 weeks postpartum, included anthropometrics (weight and height), physical activity (pedometer) and questionnaires (health behaviours). RESULTS Mean age (32.3 ± 4.7 and 31.7 ± 4.4 years) and body mass index (30.4 ± 5.6 and 30.3 ± 5.9 kg/m2) were similar between intervention and control groups, respectively at baseline. By 6 weeks postpartum, weight change in the control group was significantly higher than the intervention group with a between group difference of 1.45 ± 5.1 kg (95% CI: -2.86,-0.02; p < 0.05) overall, with a greater difference in weight found in overweight, but not obese women. Intervention group allocation, higher baseline BMI, GDM diagnosis, country of birth and higher age were all independent predictors of lower weight retention at 6 weeks postpartum on multivariable linear regression. Other factors related to weight including physical activity, did not differ between groups. CONCLUSIONS A low intensity intervention, integrated with standard antenatal care is effective in limiting postpartum weight retention. Implementation research is now required for scale-up to optimise antenatal health care. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry Number: ACTRN12608000233325. Registered 7/5/2008.
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112
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Zwickert K, Rieger E. A qualitative investigation of obese women's experiences of effective and ineffective social support for weight management. Clin Obes 2014; 4:277-86. [PMID: 25825860 DOI: 10.1111/cob.12072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/12/2014] [Accepted: 06/19/2014] [Indexed: 12/16/2022]
Abstract
An obese individual's social context influences the extent to which they engage in weight control behaviors. Although the available literature acknowledges the importance of social support for weight management, detailed analyses of obese individuals' experiences of social support for weight loss and/or weight loss maintenance have not been undertaken. Using a qualitative approach, this study presents 22 Australian obese women's perspectives of the availability and effectiveness of social support for weight control. Three superordinate categories, namely, ineffective support, effective support and personal barriers to accessing support, and 12 subcategories were identified. Participants reported minimal access to quality support for weight management, while also suggesting ways in which obese women themselves may hamper significant others' provision of effective support. The results support the investigation of interventions designed to enhance the skills of significant others in assisting obese individuals with weight management.
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Affiliation(s)
- K Zwickert
- Research School of Psychology, Australian National University, Canberra, ACT, Australia
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113
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Berger AA, Peragallo-Urrutia R, Nicholson WK. Systematic review of the effect of individual and combined nutrition and exercise interventions on weight, adiposity and metabolic outcomes after delivery: evidence for developing behavioral guidelines for post-partum weight control. BMC Pregnancy Childbirth 2014; 14:319. [PMID: 25208549 PMCID: PMC4176850 DOI: 10.1186/1471-2393-14-319] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 08/17/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Post-partum weight retention contributes to the risk of chronic obesity and metabolic alterations. We conducted a systematic review of randomized controlled trials (RCTs) on the effect of post-partum nutrition and exercise interventions on weight loss and metabolic outcomes. DATA SOURCES Four electronic databases were searched from inception to January, 2012. Two investigators reviewed titles and abstracts, performed data abstraction on full articles and assessed study quality. METHODS We included RCTs comparing nutrition, exercise or combined nutrition and exercise interventions with a control condition. Thirteen studies met our inclusion criteria (N = 1,310 participants). Data were abstracted on study characteristics, intervention components, enrollment period, and length of follow-up. Outcomes of interest included weight, adiposity, cardio-metabolic measures (glucose, lipids) and obesity-related inflammatory markers. RESULTS Nine trials compared combined interventions to standard post-partum care; three trials assessed the effect of exercise interventions, one trial evaluated a nutrition-only intervention. Four good quality RCTs on combined interventions had inconsistent findings, with the larger RCT (N = 450) reporting no difference in weight between groups. Four fair-to good quality RCTs reported greater weight loss in the combined intervention group vs. standard care, ranging from 0.17 kg to 4.9 kg. Results from exercise only interventions were inconclusive. Evidence for nutrition only interventions was insufficient. There was insufficient evidence for the effect of post-partum interventions on metabolic risk factors and inflammatory biomarkers. CONCLUSIONS Combined nutrition and exercise interventions can achieve weight loss, but evidence is limited due to a small number of trials and limitations in study design.
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Affiliation(s)
- Alexander Arkin Berger
- />Public Health Leadership Program, University of North Carolina Gillings Global School of Public Health, 135 Dauer Drive, Chapel Hill, NC USA
| | - Rachel Peragallo-Urrutia
- />Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, 321 South Columbia Street, Chapel Hill, NC USA
| | - Wanda K Nicholson
- />Department of Obstetrics & Gynecology, Division of Women’s Primary Health, 3027 Old Clinic Building, CB # 7570, Chapel Hill, NC USA
- />Diabetes and Obesity Core, Center for Women’s Health Research, University of North Carolina School of Medicine, 3027 Old Clinic Building, CB # 7570, Chapel Hill, NC USA
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Miller M, Hearn L, van der Pligt P, Wilcox J, Campbell KJ. Preventing maternal and early childhood obesity: the fetal flaw in Australian perinatal care. Aust J Prim Health 2014; 20:123-7. [PMID: 24176286 DOI: 10.1071/py13080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 09/02/2013] [Indexed: 01/15/2023]
Abstract
Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30-50% reported in early pregnancy. Maternal adiposity is a costly challenge for Australian obstetric care, with associated serious maternal and neonatal complications. Excess gestational weight gain is an important predictor of offspring adiposity into adulthood and higher maternal weight later in life. Current public health and perinatal care approaches in Australia do not adequately address excess perinatal maternal weight or gestational weight gain. This paper argues that the failure of primary health-care providers to offer systematic advice and support regarding women's weight and related lifestyle behaviours in child-bearing years is an outstanding 'missed opportunity' for prevention of inter-generational overweight and obesity. Barriers to action could be addressed through greater attention to: clinical guidelines for maternal weight management for the perinatal period, training and support of maternal health-care providers to develop skills and confidence in raising weight issues with women, a variety of weight management programs provided by state maternal health services, and clear referral pathways to them. Attention is also required to service systems that clearly define roles in maternal weight management and ensure consistency and continuity of support across the perinatal period.
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Affiliation(s)
- Margaret Miller
- Child Health Promotion Research Centre, Edith Cowan University, 2 Bradford St, Mount Lawley, WA 6050, Australia
| | - Lydia Hearn
- Child Health Promotion Research Centre, Edith Cowan University, 2 Bradford St, Mount Lawley, WA 6050, Australia
| | - Paige van der Pligt
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia
| | - Jane Wilcox
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia
| | - Karen J Campbell
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia
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115
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Low Rates of Postpartum Glucose Screening Among Indigenous and non-Indigenous Women in Australia with Gestational Diabetes. Matern Child Health J 2014; 19:651-63. [DOI: 10.1007/s10995-014-1555-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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116
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Thomson JL, Tussing-Humphreys LM, Goodman MH. Delta Healthy Sprouts: A randomized comparative effectiveness trial to promote maternal weight control and reduce childhood obesity in the Mississippi Delta. Contemp Clin Trials 2014; 38:82-91. [DOI: 10.1016/j.cct.2014.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/15/2014] [Accepted: 03/21/2014] [Indexed: 02/08/2023]
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117
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Falciglia G, Piazza J, Ritcher E, Reinerman C, Lee SY. Nutrition education for postpartum women: a pilot study. J Prim Care Community Health 2014; 5:275-8. [PMID: 24695771 DOI: 10.1177/2150131914528515] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This pilot study examined the effectiveness of a 4-month clinic-based dietary intervention emphasizing the intake of deep yellow and dark green vegetables versus usual care on improving diet quality in postpartum women. The intervention group (n = 31) received 1 face-to-face nutrition education session with a registered dietitian, 2 follow-up phone calls, and 3 pamphlets distributed by mail. The usual care group (n = 25) received handouts with guidelines on healthy eating. Dietary outcomes were assessed from 3-day food recalls and evaluated using paired and independent t tests. Intervention women exhibited a significant increase in total vegetable intake (P < .001) and in dark green and deep yellow vegetables (P < .001). In comparison, the control group increased the intake of total vegetables (P < .001), but did not increase the consumption of dark green and deep yellow vegetables. When comparing the change in intake between study groups for both types of vegetables, the difference was not significant. Furthermore, 61% of the intervention women met the goals for total vegetable intake compared with 12% for the usual care group (P < .001). The intervention group also had a greater percentage of women (25.8%) that met the goal for deep yellow and dark green vegetable intake when compared with the usual care group (8%; P < .08). These results suggest that postpartum women are receptive to nutrition education and that nutrition education can influence vegetable intake.
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118
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Jaakkola J, Isolauri E, Poussa T, Laitinen K. Benefits of repeated individual dietary counselling in long-term weight control in women after delivery. MATERNAL AND CHILD NUTRITION 2014; 11:1041-8. [PMID: 24521459 DOI: 10.1111/mcn.12115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
As pregnancy may trigger overweight in women, new means for its prevention are being sought. The aim here was to investigate the effect of individual dietary counselling during and after pregnancy on post-partum weight and waist circumference up to 4 years post-partum. A cohort of women (n = 256) were randomized to receive repeated individual dietary counselling by a nutritionist during and after pregnancy, or as controls not receiving dietary counselling, from the first trimester of pregnancy until 6 months after delivery. Counselling aimed to bring dietary intake into line with recommendations, with particular focus on the increase in the intake of unsaturated fatty acids instead of saturated. Pre-pregnancy weight was taken from welfare clinic records. Weight and waist circumference were measured at 4 years after delivery. The proportion of overweight women increased from 26% prior to pregnancy to 30% at 4 years after delivery among women receiving dietary counselling, as against considerably more, from 32% to 57%, among controls. The prevalence of central adiposity was 31% in women receiving dietary counselling, 64% in controls. Likewise, both the risk of overweight (odds ratio: 0.23, 0.08-0.63, P = 0.005) and central adiposity (odds ratio: 0.18, 0.06-0.52, P = 0.002) were lower in women receiving dietary counselling compared with controls. Repeated dietary counselling initiated in early pregnancy can be beneficial in long-term weight control after delivery.
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Affiliation(s)
- Johanna Jaakkola
- Department of Clinical Sciences, University of Turku, Finland.,Functional Foods Forum, University of Turku, Finland
| | - Erika Isolauri
- Department of Clinical Sciences, University of Turku, Finland.,Department of Paediatrics, Turku University Hospital, Turku, Finland
| | | | - Kirsi Laitinen
- Functional Foods Forum, University of Turku, Finland.,Institute of Biomedicine, University of Turku, Finland
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Chamberlain C, Fredericks B, Davis B, Mein J, Smith C, Eades S, Oldenburg B. Postpartum care for Aboriginal and non-Aboriginal women with Gestational Diabetes Mellitus across urban, rural and remote locations: a protocol for a cohort linkage study. SPRINGERPLUS 2013; 2:576. [PMID: 25674406 PMCID: PMC4320232 DOI: 10.1186/2193-1801-2-576] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 10/28/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is increasing, along with obesity and type 2 diabetes (T2DM), with Aboriginal and Torres Strait Islander (Aboriginal(a)) women in Australia particularly affected. GDM causes serious complications in pregnancy, birth, and the longer term, for women and their infants. Women with GDM have an eightfold risk of developing T2DM after pregnancy, compared to women without GDM. Indigenous women have an even higher risk, at a younger age, and progress more quickly from GDM to T2DM, compared to non-Indigenous women. If left undetected and untreated, T2DM increases risks in subsequent pregnancies, and can lead to heart disease, stroke, kidney failure, limb amputations and blindness for the woman in the longer term. A GDM diagnosis offers a 'window of opportunity' to provide acceptable and effective prevention, treatment, and postpartum care. Low rates of postpartum T2DM screening are reported among non-Aboriginal women in Australia and Indigenous women in other countries, however, data for Aboriginal women in Australia are scarce. A healthy diet, exercise and breastfeeding can delay the onset of T2DM, and together with T2DM screening are recommended elements of postpartum care for women with GDM. This paper describes methods for a study evaluating postpartum care among Aboriginal and non-Aboriginal women with GDM. METHODS/DESIGN This retrospective cohort includes all women who gave birth at Cairns Hospital in far north Queensland, Australia, from 2004 to 2010, coded as having GDM in the Cairns Hospital Clinical Coding system. Data is being linked with the Midwives Perinatal Data Collection, and the three local laboratories. Hospital medical records are being reviewed to validate accuracy of GDM case ascertainment, and gather information on breastfeeding and provision of dietary advice. Survival analysis is being used to estimate time to screening, and rates of progression from GDM to T2DM. Logistic regression is being used to compare postpartum care between Aboriginal and non-Aboriginal women, and assess factors that may be associated with provision of postpartum care. DISCUSSION There are challenges to collecting postpartum data for women with GDM, however, this research is urgently needed to ensure adequate postpartum care is provided for women with GDM.
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Affiliation(s)
- Catherine Chamberlain
- Global Health and Society Unit, Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, L3/89 Commercial Rd, Prahan, Victoria, 3181 Australia
| | - Bronwyn Fredericks
- Office of Indigenous Engagement, Central Queensland University, Bruce Highway, North Rockhampton, Queensland, 4701 Australia
| | - Bronwyn Davis
- Cairns Diabetes Centre, PO Box 902, Cairns, Queensland 4870 Australia
| | - Jacqueline Mein
- Apunipima Cape York Health Council, 186 McCoombe Street, Cairns, Queensland 4870 Australia
| | - Catherine Smith
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, L6/96 Commercial Rd, Prahan, Victoria, 3181 Australia
| | - Sandra Eades
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales 2006 Australia
| | - Brian Oldenburg
- Global Health and Society Unit, Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, L3/89 Commercial Rd, Prahan, Victoria, 3181 Australia
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