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Pouliot A, Elmahboubi R, Adam C. Incidence and Outcomes of Gestational Diabetes Mellitus Using the New International Association of Diabetes in Pregnancy Study Group Criteria in Hôpital Maisonneuve-Rosemont. Can J Diabetes 2019; 43:594-599. [PMID: 31787245 DOI: 10.1016/j.jcjd.2019.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 10/06/2019] [Accepted: 10/07/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES At 1 Canadian university hospital, pregnant women were routinely screened for gestational diabetes mellitus (GDM) with a 75-g oral glucose tolerance test (OGTT). Diagnostic plasma glucose thresholds were as follows: fasting: ≥5.3 mmol/L, 1 h: ≥10.6 mmol/L and 2 h: ≥9.0 mmol/L. In 2015, diagnostic thresholds were reduced to those recommended by the International Association of Diabetes in Pregnancy Study Group (IADPSG) as follows: fasting: ≥5.1 mmol/L, 1 h: ≥10.0 mmol/L and 2 h: ≥8.5 mmol/L. However, subsequent Diabetes Canada guidelines state that further evidence is required before recommending those thresholds. Our objectives were to compare pregnancy outcomes of all pregnant women who underwent a 75-g OGTT before and after the adoption of the IADPSG criteria. METHODS Pregnancy outcomes of all women (N=2,830) that had a pregnancy OGTT at the Hôpital Maisonneuve-Rosemont between July 1, 2014 and March 1, 2015 (pre-IADPSG group) were compared with women who were screened between March 1, 2015 and January 1, 2016 (post-IADPSG group). Medical files were reviewed to compare outcomes. RESULTS Women in the post-IADPSG group had a higher early body mass index (26.3 vs 25.5 kg/m2, p=0.01) and more chronic hypertension (3.7% vs 1.2%, p<0.0001), respectively. OGTT results were similar, but rates of GDM were 10.8% (141 of 1,295) in the pre-IADPSG group and 17.6% (271 of 1,535) in the post-IADPSG group. In the post-IADPSG group, pre-eclampsia rates were lower (1.0% vs 2.2%, p=0.021), as was labour induction (25.6% vs 32.8%, p<0.0001) and neonatal intensive care unit admission (4.8% vs 8.5%, p<0.001), respectively. CONCLUSIONS Adopting IADPSG criteria for GDM improved pregnancy outcomes in our obstetric population.
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Affiliation(s)
- Alexandra Pouliot
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Riham Elmahboubi
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Catherine Adam
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
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"…or else I close my ears" How women with obesity want to be approached and treated regarding gestational weight management: A qualitative interview study. PLoS One 2019; 14:e0222543. [PMID: 31536545 PMCID: PMC6752788 DOI: 10.1371/journal.pone.0222543] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/01/2019] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The importance of helping pregnant women maintain a healthy lifestyle and prevent excessive gestational weight gain is well recognized, but pregnant women do not always perceive communication about body weight as respectful or helpful. Furthermore, fear of inducing shame or guilt can prohibit some midwives from talking about body weight, especially if the woman has obesity. We aimed to explore what women of reproductive age with obesity regard to be the most important and relevant aspects when discussing gestational weight management. METHODS Qualitative interview study using focus groups and individual semi-structured interviews with 17 women of reproductive age (19-39 y) with obesity. Thematic analysis was used to analyze the data. RESULTS We identified three themes: 1) Importance of obtaining vital medical information; 2) A wish to feel understood and treated with respect; 3) Midwives' approach is crucial in sensitive key situations, which include bringing up the subject of body weight, weighing, providing weight-related information, coaching lifestyle modification, dealing with emotional reactions and ending a conversation. CONCLUSIONS A majority of the interviewed women wished to receive information about risks about obesity and gestational weight gain, and recommendations on weight management. However, the risk of midwives offending someone by raising the topic may be increased if the pregnant woman believe that gestational weight gain is uncontrollable by the individual. Also, several situations during maternity care meetings can be stigmatizing and make women less receptive to advice or support. Women suggest that a good working alliance is likely to be achieved if midwives have knowledge about the causes of obesity, take interest in the patients' background, have a non-judgmental approach and refrain from giving unsolicited advice.
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103
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Patient Attitudes toward Gestational Weight Gain and Exercise during Pregnancy. J Pregnancy 2019; 2019:4176303. [PMID: 31637057 PMCID: PMC6766150 DOI: 10.1155/2019/4176303] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/30/2019] [Indexed: 02/08/2023] Open
Abstract
Body mass index (BMI) and gestational weight gain (GWG) are important factors for neonatal and maternal health. Exercise helps women moderate their BMI and GWG, and provides health benefits to mother and child. This survey study assessed patients' perceptions of counseling they received during pregnancy, their sources of information about GWG, and their attitudes toward exercise during pregnancy. We distributed an anonymous survey to 200 pregnant women over the age of 18 at a tertiary care center in Danville, Pennsylvania. Survey questions included demographics, discussions with medical providers regarding GWG and exercise, and their exercise habits before and during pregnancy. 182 women (91%) responded. Most reported their provider discussed weight and diet (78.8%), expected GWG (81.6%), and exercise during pregnancy (79.8%); however, 28% of obese women and 25% of women who did not plan to exercise during pregnancy reported not receiving exercise counseling. Approximately 20% of women did not plan to exercise during pregnancy. Women decreased the number of days per week they exercised (40.6% with 3 or more days prepregnancy versus 30.7% during pregnancy, P = 0.002). Some patients who did not exercise prior to pregnancy (12%) expressed interest in a personal training session. Among women in the eight month or later, 42.4% were above GWG recommendations. Our study found barriers to adequate activity during pregnancy; 20% of pregnant women not receiving/remembering counseling regarding exercise. Interest in personal training from patients that did not exercise suggests they would benefit from increased efforts to encourage physical activity. Exercise and GWG counseling based in medical science as well as patient psychological needs will help efforts to reduce GWG and improve pregnancy outcomes.
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104
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Urolithin Metabotypes can Anticipate the Different Restoration of the Gut Microbiota and Anthropometric Profiles during the First Year Postpartum. Nutrients 2019; 11:nu11092079. [PMID: 31484413 PMCID: PMC6769946 DOI: 10.3390/nu11092079] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 01/05/2023] Open
Abstract
The metabolism of dietary polyphenols ellagitannins by the gut-microbiota allows the human stratification in urolithin metabotypes depending on the final urolithins produced. Metabotype-A only produces urolithin-A, metabotype-B yields urolithin-B and isourolithin-A in addition to urolithin-A, and metabotype 0 does not produce urolithins. Metabotype-A has been suggested to be ‘protective’, and metabotype-B dysbiotic-prone to cardiometabolic impairments. We analyzed the gut-microbiome of 40 healthy women and determined their metabotypes and enterotypes, and their associations with anthropometric and gut-microbial changes after 3 weeks, 4, 6, and 12 months postpartum. Metabotype-A was predominant in mothers who lost weight (≥2 kg) (75%) versus metabotype-B (54%). After delivery, the microbiota of metabotype-A mothers changed, unlike metabotype-B, which barely changed over 1 year. The metabotype-A discriminating bacteria correlated to the decrease of the women’s waist while some metabotype-B bacteria were inversely associated with a reduction of body mass index (BMI), waist, and waist-to-hip ratio. Metabotype-B was associated with a more robust and less modulating microbial and anthropometric profiles versus metabotype-A, in which these profiles were normalized through the 1-year follow-up postpartum. Consequently, urolithin metabotypes assessment could be a tool to anticipate the predisposition of women to normalize their anthropometric values and gut-microbiota, significantly altered during pregnancy and after childbirth.
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105
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Nartea R, Mitoiu BI, Nica AS. Correlation between Pregnancy Related Weight Gain, Postpartum Weight loss and Obesity: a Prospective Study. J Med Life 2019; 12:178-183. [PMID: 31406521 PMCID: PMC6685304 DOI: 10.25122/jml-2019-0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Weight gain during pregnancy can be a real risk factor for long-term obesity which has implications in all areas of medicine. This study is designed to assess pregnancy-related weight gain and postpartum weight loss, to identify a possible correlation between weight gain during pregnancy and the risk of obesity in the late postpartum period. The batch comprised 306 women, hospitalized in the Obstetrics and Gynecology Section of the “Nicolae Malaxa” Clinical Hospital between June - November 2017. During this study, we assessed the weight status using the Weight, Body Mass Index, Height, and Abdominal Circumference. These parameters were clinically assessed in three periods pre-pregnancy, early postpartum period, late postpartum period. We also collected data on the evolution of the pregnancy using the anamnesis and the personal pregnancy monitoring sheet. Pregnancy and postpartum period represent a key moment in women’s lives in which the risk of obesity is real. Understanding women experiences with weight changes during pregnancy and postpartum period can improve the management of losing weight following pregnancy, avoid long-term weight gain and so reduce the risk for obesity. Also, the correct management of obesity should include the assessment of somatic disorders that may cause major dysfunction, requiring complex rehabilitation programs.
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Affiliation(s)
- Roxana Nartea
- National Institute of Rehabilitation and Balneology, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Brindusa Ilinca Mitoiu
- National Institute of Rehabilitation and Balneology, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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106
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Guan P, Tang F, Sun G, Ren W. Effect of maternal weight gain according to the Institute of Medicine recommendations on pregnancy outcomes in a Chinese population. J Int Med Res 2019; 47:4397-4412. [PMID: 31342872 PMCID: PMC6753580 DOI: 10.1177/0300060519861463] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective This study aimed to analyze the effects of maternal weight on adverse
pregnancy outcomes. Methods Data were retrospectively collected from a hospital in Wuhan, China. A total
of 1593 pregnant women with singletons were included. Adverse outcomes
during pregnancy, such as small for gestational age (SGA), large for
gestational age (LGA), and hypertensive disorders in pregnancy (HDP) were
analyzed. Results The risks of low birth weight, SGA, and preterm birth were significantly
higher in the inadequate gestational weight gain (GWG) group compared with
the adequate GWG group. GWG over the guidelines was related to a higher risk
of macrosomia, LGA, cesarean section, and HDP than GWG within the
guidelines. The risks of low birth weight (OR = 5.082), SGA (OR = 3.959),
preterm birth (OR = 3.422), and gestational diabetes mellitus (OR = 1.784)
were significantly higher in women with a normal pre-pregnancy body mass
index (BMI) and inadequate GWG compared with women with a normal
pre-pregnancy BMI and adequate GWG. The risks of macrosomia (OR = 3.654) and
HDP (OR = 1.992) were increased in women with normal pre-pregnancy BMI and
excessive GWG. Conclusion Women with an abnormal BMI and inappropriate GWG have an increased risk of
adverse maternal and infant outcomes. Weight management during the perinatal
period is required.
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Affiliation(s)
- Ping Guan
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Wuhan City, Hubei Province, P.R. China
| | - Fei Tang
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Wuhan City, Hubei Province, P.R. China
| | - Guoqiang Sun
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Wuhan City, Hubei Province, P.R. China
| | - Wei Ren
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Wuhan City, Hubei Province, P.R. China
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Abstract
Pregnancy complications provide insight into women's future health risks and have long term implications for maternal and child health. Obesity has been associated with adverse perinatal outcomes and is a risk factor for chronic disease. Excessive weight gain during pregnancy often translates into postpartum weight retention, increasing women's risk for obesity. Pregnancy and the postpartum period provides a unique opportunity to discuss health beyond pregnancy, emphasize interconception care, and implement appropriate prevention strategies. We aim to review the impact of obesity, gestational weight gain, postpartum weight retention, and role of nutrition and exercise on pregnancy and lifelong health.
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108
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Zou Z, Yang Z, Yang Z, Wang X, Gao D, Dong Y, Ma J, Ma Y. Association of high birth weight with overweight and obesity in Chinese students aged 6-18 years: a national, cross-sectional study in China. BMJ Open 2019; 9:e024532. [PMID: 31122966 PMCID: PMC6538056 DOI: 10.1136/bmjopen-2018-024532] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The prevalence of childhood overweight and obesity in China has drastically increased 57 times over the past 30 years, and to control birth weight is an effective way to reduce the risk of overweight and obesity across the life course. OBJECTIVE This paper aimed to evaluate the association of high birth weight (HBW) with overweight and obesity in Chinese students aged 6-18 years. METHODS All students with HBW (n=4981) aged 6-18 years were selected from a cross-sectional survey from seven provinces of China, and 4981 other students with normal birth weight (NBW) were randomly sampled with matched gender, age and province. Anthropometric parameters were measured and characteristics were collected by questionnaires. Multiple logistic regression was used to estimate the OR of overweight and obesity with HBW, unadjusted and adjusted for confounding factors. RESULTS Participants with HBW revealed higher body mass index in childhood. The prevalence of overweight and obesity was significantly higher in the HBW group than in the NBW group (overweight 15.3% vs 13.1%, p<0.05; obesity 16.9% vs 10.6%, p<0.05), and the results were similar for overweight in all age groups except age 6-7, age 14-15 and age 16-18. Additionally, HBW was positively associated with overweight (OR=1.230; 95% CI 1.056 to 1.432) and obesity (OR=1.611; 95% CI 1.368 to 1.897) after adjustment for covariates. CONCLUSIONS HBW leads to an increased risk of overweight and obesity in childhood; thus, measures to control birth weight, such as controlling gestational weight gain, should be taken from the earliest beginning of life. TRIAL REGISTRATION NUMBER NCT02343588; Post-results.
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Affiliation(s)
- Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Zhongping Yang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Zhaogeng Yang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Xijie Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Di Gao
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Yinghua Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
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Skouteris H, Teede HJ, Thangaratinam S, Bailey C, Baxter JA, Bergmeier HJ, Harrison C, Hill B, Jack B, Jorgensen L, Lim S, Matsaseng T, Montanaro C, Steegers E, Stephenson J, Sundseth H, Vilela Borges AL, Walker R, Redman L, Boyle J. Commentary: Obesity and Weight Gain in Pregnancy and Postpartum: an Evidence Review of Lifestyle Interventions to Inform Maternal and Child Health Policies. Front Endocrinol (Lausanne) 2019; 10:163. [PMID: 30972021 PMCID: PMC6443924 DOI: 10.3389/fendo.2019.00163] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/26/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Clayton, VIC, Australia
| | - Helena J. Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Clayton, VIC, Australia
- Monash Partners Advanced Health Research Translation Centre, Clayton, VIC, Australia
- Monash Health, Clayton, VIC, Australia
| | - Shakila Thangaratinam
- Women's Health Research Unit, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Blizard Institute, London, United Kingdom
| | - Cate Bailey
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Clayton, VIC, Australia
| | - Jo-Anna Baxter
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Heidi J. Bergmeier
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Clayton, VIC, Australia
| | - Cheryce Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Clayton, VIC, Australia
| | - Briony Hill
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Clayton, VIC, Australia
| | - Brian Jack
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, United States
| | | | - Siew Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Clayton, VIC, Australia
| | - Thabo Matsaseng
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Eric Steegers
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre – Sophia Children's Hospital, Rotterdam, Netherlands
| | - Judith Stephenson
- Institute for Women's Health, University College, London, United Kingdom
| | | | | | - Ruth Walker
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Clayton, VIC, Australia
| | - Leanne Redman
- Reproductive Endocrinology and Women's Health Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Clayton, VIC, Australia
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110
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Ostafiichuk SO. Genetic aspects of metabolic disorders in pregnant women with pathological weight gain. REGULATORY MECHANISMS IN BIOSYSTEMS 2019. [DOI: 10.15421/021941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Polymorphism of the leptin receptor gene (LEPR) has been shown to be linked to obesity-related metabolic markers and phenotype. Therefore, we hypothesized that the Gln233Arg LEPR polymorphism is related to metabolic changes in pregnancy and the risk of excessive gestational weight gain (GWG). A total of 97 pregnant women with a singleton gestation were enrolled from April 2016 until December 2018. Genetic variants of LEPR were analyzed by real-time polymerase chain reaction, leptin by enzyme-linked immunosorbent assay, lipid profile, and carbohydrate status were assessed in the first, and third trimesters of pregnancy. The recommended GWG was diagnosed in 34.0%, insufficient in 19.6%, and excessive in 46.4% patients. Statistical analysis revealed that 20.6% patients were with AA genotype, 50.5% – AG genotype, and 28.9% – GG genotype. The frequency of GG-alleles carriers of the LEPR Gln233Arg gene in the group of excessive GWG patients was 3 times higher compared to recommended GWG patients. Thus, the inheritance of pathological G-homozygotes increases the risk of excessive weight gain by 7 times, compared to carriers of the AA genotype. LEPR GG polymorphism was significantly associated with high levels of triglycerides, total cholesterol, lipoprotein low and very low density, and leptin compared to homozygous А-carriers in the third trimester of pregnancy. In pregnant women with GG polymorphism, the glucose level, insulin level, and HOMO-IR index were significantly increased compared to women with AA genotype in late pregnancy. In the group with excessive GWG, the presence of GG-alleles of the LEPR gene was accompanied by a higher level of hyperleptinemia, compared to carriers of AA-genotype. Inheritance of pathological G-homozygotes was associated with hyperlipidemia, leptin resistance with high leptin serum levels, and increased insulin resistance, which was especially manifested in excessive GWG. In our opinion, excessive GWG can be seen as a marker of the mother's genotype and genetic predisposition to the development of metabolic diseases after delivery.
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