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Poston L, Bell R, Croker H, Flynn AC, Godfrey KM, Goff L, Hayes L, Khazaezadeh N, Nelson SM, Oteng-Ntim E, Pasupathy D, Patel N, Robson SC, Sandall J, Sanders TAB, Sattar N, Seed PT, Wardle J, Whitworth MK, Briley AL. Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. Lancet Diabetes Endocrinol 2015; 3:767-77. [PMID: 26165396 DOI: 10.1016/s2213-8587(15)00227-2] [Citation(s) in RCA: 451] [Impact Index Per Article: 50.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Behavioural interventions might improve clinical outcomes in pregnant women who are obese. We aimed to investigate whether a complex intervention addressing diet and physical activity could reduce the incidence of gestational diabetes and large-for-gestational-age infants. METHODS The UK Pregnancies Better Eating and Activity Trial (UPBEAT) is a randomised controlled trial done at antenatal clinics in eight hospitals in multi-ethnic, inner-city locations in the UK. We recruited pregnant women (15-18 weeks plus 6 days of gestation) older than 16 years who were obese (BMI ≥30 kg/m(2)). We randomly assigned participants to either a behavioural intervention or standard antenatal care with an internet-based, computer-generated, randomisation procedure, minimising by age, ethnic origin, centre, BMI, and parity. The intervention was delivered once a week through eight health trainer-led sessions. Primary outcomes were gestational diabetes (diagnosed with an oral glucose tolerance test and by criteria from the International Association of Diabetes in Pregnancy Study Groups) and large-for-gestational-age infants (≥90th customised birthweight centile). Analysis was by intention to treat. This trial is registered with Current Controlled Trials, ISCRTN89971375. Recruitment and pregnancy outcomes are complete but childhood follow-up is ongoing. FINDINGS Between March 31, 2009, and June 2, 2014, we assessed 8820 women for eligibility and recruited 1555, with a mean BMI of 36·3 kg/m(2) (SD 4·8). 772 were randomly assigned to standard antenatal care and 783 were allocated the behavioural intervention, of which 651 and 629 women, respectively, completed an oral glucose tolerance test. Gestational diabetes was reported in 172 (26%) women in the standard care group compared with 160 (25%) in the intervention group (risk ratio 0·96, 95% CI 0·79-1·16; p=0·68). 61 (8%) of 751 babies in the standard care group were large for gestational age compared with 71 (9%) of 761 in the intervention group (1·15, 0·83-1·59; p=0·40). Thus, the primary outcomes did not differ between groups, despite improvements in some maternal secondary outcomes in the intervention group, including reduced dietary glycaemic load, gestational weight gain, and maternal sum-of-skinfold thicknesses, and increased physical activity. Adverse events included neonatal death (two in the standard care group and three in the intervention group) and fetal death in utero (ten in the standard care group and six in the intervention group). No maternal deaths were reported. Incidence of miscarriage (2% in the standard care group vs 2% in the intervention group), major obstetric haemorrhage (1% vs 3%), and small-for-gestational-age infants (≤5th customised birthweight centile; 6% vs 5%) did not differ between groups. INTERPRETATION A behavioural intervention addressing diet and physical activity in women with obesity during pregnancy is not adequate to prevent gestational diabetes, or to reduce the incidence of large-for-gestational-age infants. FUNDING National Institute for Health Research, Guys and St Thomas' Charity, Chief Scientist Office Scotland, Tommy's Charity.
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Affiliation(s)
- Lucilla Poston
- Division of Women's Health, King's College London, St Thomas' Hospital, London, UK.
| | - Ruth Bell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Helen Croker
- Health Behaviour Research Centre, Institute of Epidemiology and Health, University College London, London, UK
| | - Angela C Flynn
- Division of Diabetes and Nutritional Sciences, King's College London, London, UK
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Louise Goff
- Division of Diabetes and Nutritional Sciences, King's College London, London, UK
| | - Louise Hayes
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Dharmintra Pasupathy
- Division of Women's Health, King's College London, St Thomas' Hospital, London, UK
| | - Nashita Patel
- Division of Women's Health, King's College London, St Thomas' Hospital, London, UK
| | - Stephen C Robson
- Institute of Cellular Medicine, Uterine Cell Signalling Group, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Jane Sandall
- Division of Women's Health, King's College London, St Thomas' Hospital, London, UK
| | - Thomas A B Sanders
- Division of Diabetes and Nutritional Sciences, King's College London, London, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Paul T Seed
- Division of Women's Health, King's College London, St Thomas' Hospital, London, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Institute of Epidemiology and Health, University College London, London, UK
| | - Melissa K Whitworth
- Maternity Services, Central Manchester University Hospitals NHS Foundation Trust, St Mary's Hospital, Manchester, UK
| | - Annette L Briley
- Division of Women's Health, King's College London, St Thomas' Hospital, London, UK
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302
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Thangaratinam S. Diet and lifestyle interventions for obese pregnant women. Lancet Diabetes Endocrinol 2015; 3:748-9. [PMID: 26165397 DOI: 10.1016/s2213-8587(15)00253-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 06/26/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Shakila Thangaratinam
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK.
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303
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Daley AJ, Jolly K, Jebb SA, Lewis AL, Clifford S, Roalfe AK, Kenyon S, Aveyard P. Feasibility and acceptability of regular weighing, setting weight gain limits and providing feedback by community midwives to prevent excess weight gain during pregnancy: randomised controlled trial and qualitative study. BMC OBESITY 2015; 2:35. [PMID: 26401345 PMCID: PMC4572649 DOI: 10.1186/s40608-015-0061-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 07/30/2015] [Indexed: 12/02/2022]
Abstract
Background Regular weighing in pregnant women is not currently recommended in many countries but has been suggested to prevent excessive gestational weight gain. This study aimed to establish the feasibility and acceptability of incorporating regular weighing, setting maximum weight gain targets and feedback by community midwives. Methods Low risk pregnant women cared for by eight community midwives were randomised to usual care or usual care plus the intervention at 10–14 weeks of pregnancy. The intervention involved community midwives weighing and plotting weight on a weight gain chart, setting weight gain limit targets, giving brief feedback at each antenatal appointment and encouraging women to weigh themselves weekly between antenatal appointments. Women and midwives were interviewed about their views of the intervention. The focus of the study was on process evaluation. Results Community midwives referred 123 women and 115 were scheduled for their dating scan within the study period. Of these, 84/115 were approached at their dating scan and 76/84 (90.5 %) randomised. Data showed a modest difference favouring the intervention group in the percentage of women gaining excessive gestational weight (23.5 % versus 29.4 %). The intervention group consistently reported smaller increases in depression and anxiety scores throughout pregnancy compared with usual care. Most women commented the intervention was useful in encouraging them to think about their weight and believed it should be part of routine antenatal care. Community midwives felt the intervention could be implemented within routine care without adding substantially to consultation length, thus not perceived as adding substantially to their workload. Conclusions The intervention was feasible and acceptable to pregnant women and community midwives and was readily implemented in routine care. Trial registration ISRCTN81605162
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Affiliation(s)
- A J Daley
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT West Midlands
| | - K Jolly
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, B15 2TT West Midlands
| | - S A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - A L Lewis
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS South West England
| | - S Clifford
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT West Midlands
| | - A K Roalfe
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT West Midlands
| | - S Kenyon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - P Aveyard
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT West Midlands
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304
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Abeysekera MV, Morris JA, Davis GK, O'Sullivan AJ. Alterations in energy homeostasis to favour adipose tissue gain: A longitudinal study in healthy pregnant women. Aust N Z J Obstet Gynaecol 2015; 56:42-8. [PMID: 26817524 DOI: 10.1111/ajo.12398] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 07/21/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Pregnancy is associated with an increase in body fat; however, excessive gestational weight gain predisposes to significant maternal and neonatal morbidity and mortality. It remains unclear whether alterations in energy homeostasis have a major influence on fat storage. AIMS To evaluate longitudinal changes in body composition and energy metabolism in healthy pregnant women. MATERIALS AND METHODS Body composition, energy expenditure and energy intake were measured longitudinally in 26 women with singleton pregnancies at 12-14 weeks, 24-26 weeks and 34-36 weeks of gestation. Fat mass (FM) and lean body mass (LBM) were measured using bio-impedance analysis, total energy expenditure (TEE) using the Sensewear Armband and energy intake through a 3-day food recall diary. RESULTS Throughout pregnancy, all women remained healthy. Body weight increased by 10.8 ± 3.9 kg, from 67.3 ± 14.1 kg to 78.1 ± 13.8 kg from the first to the third trimester (P < 0.001). Body fat percentage increased by 4.5 ± 4.2% (P < 0.001). LBM also increased throughout pregnancy, by 3.9 ± 2.4 kg (P < 0.001). TEE increased significantly from the first to the third trimesters (9514 kJ/day to 10 263 kJ/day; P < 0.05). In contrast, energy expenditure due to physical activity, energy intake and macronutrient intake did not change significantly throughout pregnancy. CONCLUSION Healthy women increase FM during pregnancy despite slight increases in TEE and no change in energy intake. This suggests that energy storage efficiency improves during pregnancy, which may be related to alterations in gut microbiota and activation of anabolic pathways during pregnancy. Clarifying factors leading to this more efficient fat and energy storing state, and the role of the pregnancy-related changes in gut microbiota, may be important for managing gestational weight gain.
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Affiliation(s)
- Minoli V Abeysekera
- Departments of Endocrinology and Medicine, Department of Women's Health, St George and Sutherland Clinical School, St. George Hospital and UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Jack A Morris
- Departments of Endocrinology and Medicine, Department of Women's Health, St George and Sutherland Clinical School, St. George Hospital and UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Gregory K Davis
- Departments of Endocrinology and Medicine, Department of Women's Health, St George and Sutherland Clinical School, St. George Hospital and UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Anthony J O'Sullivan
- Departments of Endocrinology and Medicine, Department of Women's Health, St George and Sutherland Clinical School, St. George Hospital and UNSW Medicine, University of New South Wales, Sydney, Australia
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305
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Simmons D. Prevention of gestational diabetes mellitus: Where are we now? Diabetes Obes Metab 2015; 17:824-34. [PMID: 25974384 DOI: 10.1111/dom.12495] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/12/2015] [Accepted: 05/12/2015] [Indexed: 12/12/2022]
Abstract
Gestational diabetes mellitus (GDM) is increasing at a rapid rate, driven by the increasing proportion of the population that is overweight/obese from a young age. More than 25 randomized controlled trials testing whether GDM can be prevented have now reported their findings, but only four different interventions have shown a reduction in the proportion of women with GDM (healthy eating alone, healthy eating with physical activity, myoinositol supplementation and probiotic treatment), and these results have not been replicated. The interventions tested to date include different diets and different forms of physical activity, in combination or alone, vitamin D, myoinositol, probiotics and metformin. Studies could be improved by using the International Association of Diabetes and Pregnancy Study Group criteria for GDM (which are probably more sensitive to change because of their multiple time points), targeting and tailoring interventions to subgroups most likely to benefit, and separating those with GDM early in pregnancy from those developing GDM de novo. The greatest societal benefit is likely to arise from population-based lifestyle approaches which include those women yet to become pregnant and those who are already pregnant and their families; an approach that is yet to be fully tested.
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Affiliation(s)
- D Simmons
- Macarthur Clinical School, University of Western Sydney, Campbelltown, New South Wales, Australia
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306
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Mahizir D, Briffa JF, Hryciw DH, Wadley GD, Moritz KM, Wlodek ME. Maternal obesity in females born small: Pregnancy complications and offspring disease risk. Mol Nutr Food Res 2015; 60:8-17. [DOI: 10.1002/mnfr.201500289] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/05/2015] [Accepted: 07/07/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Dayana Mahizir
- Department of Physiology; The University of Melbourne; Parkville Victoria Australia
| | - Jessica F. Briffa
- Department of Physiology; The University of Melbourne; Parkville Victoria Australia
| | - Deanne H. Hryciw
- Department of Physiology; The University of Melbourne; Parkville Victoria Australia
| | - Glenn D. Wadley
- Centre for Physical Activity and Nutrition Research; School of Exercise and Nutrition Sciences; Deakin University; Burwood Victoria Australia
| | - Karen M. Moritz
- School of Biomedical Sciences; University of Queensland; St. Lucia Queensland Australia
| | - Mary E. Wlodek
- Department of Physiology; The University of Melbourne; Parkville Victoria Australia
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307
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Isolauri E, Rautava S, Collado MC, Salminen S. Role of probiotics in reducing the risk of gestational diabetes. Diabetes Obes Metab 2015; 17:713-9. [PMID: 25885278 DOI: 10.1111/dom.12475] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 04/12/2015] [Accepted: 04/13/2015] [Indexed: 12/11/2022]
Abstract
Overweight and obesity currently constitute a major threat to human well-being. Almost half of the female population are currently overweight. Pregnant overweight women are at risk of gestational diabetes affecting the health of the mother and the child, in both the short and long term. Notwithstanding the extensive scientific interest centred on the problem, research efforts have thus far been unable to devise preventive strategies. Recent scientific advances point to a gut microbiota dysbiosis, with ensuing low-grade inflammation as a contributing element, in obesity and its comorbidities. Such findings would suggest a role for specific probiotics in the search for preventive and therapeutic adjunct applications in gestational diabetes. The aim of the present paper was to critically review recent demonstrations of the role of intestinal microbes in immune and metabolic regulation, which could be exploited in nutritional management of pregnant women by probiotic bacteria. By modulating specific target functions, probiotic dietary intervention may exert clinical effects beyond the nutritional impact of food. As this approach in pregnancy is new, an overview of the role of gut microbiota in shaping host metabolism, together with the definition of probiotics are presented, and finally, specific targets and potential mechanisms for probiotics in pregnancy are discussed. Pregnancy appears to be the most critical stage for interventions aiming to reduce the risk of non-communicable disease in future generations, beyond the immediate dangers attributable to the health of the mother, labour and the neonate. Specific probiotic interventions during pregnancy provide an opportunity, therefore, to promote the health not only of the mother but also of the child.
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Affiliation(s)
- E Isolauri
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Department of Clinical Sciences, Faculty of Medicine, University of Turku, Turku, Finland
| | - S Rautava
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Department of Clinical Sciences, Faculty of Medicine, University of Turku, Turku, Finland
| | - M C Collado
- Instituto de Agroquímica y Tecnología de Alimentos (IATA-CSIC), Burjassot, Valencia, Spain
| | - S Salminen
- Functional Foods Forum, Faculty of Medicine, University of Turku, Turku, Finland
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308
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Dodd JM, Kannieappan LM, Grivell RM, Deussen AR, Moran LJ, Yelland LN, Owens JA. Effects of an antenatal dietary intervention on maternal anthropometric measures in pregnant women with obesity. Obesity (Silver Spring) 2015; 23:1555-62. [PMID: 26175260 PMCID: PMC5054850 DOI: 10.1002/oby.21145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/11/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The effect of providing antenatal dietary and lifestyle advice on secondary measures of maternal anthropometry was evaluated and their correlation with both gestational weight gain and infant birth weight was assessed. METHODS In a multicenter, randomized controlled trial, pregnant women with BMI of ≥25 kg/m(2) received either Lifestyle Advice or Standard Care. Maternal anthropometric outcomes included arm circumference, biceps, triceps, and subscapular skinfold thickness measurements (SFTM), percentage body fat (BF), gestational weight gain, and infant birth weight. The intention to treat principles were utilized by the analyses. RESULTS The measurements were obtained from 807 (74.7%) women in the Lifestyle Advice Group and 775 (72.3%) women in the Standard Care Group. There were no statistically significant differences identified between the treatment groups with regards to arm circumference, biceps, triceps, and subscapular SFTM, or percentage BF at 36-week gestation. Maternal anthropometric measurements were not significantly correlated with either gestational weight gain or infant birth weight. CONCLUSIONS Among pregnant women with a BMI of ≥25 kg/m(2) , maternal SFTM were not modified by an antenatal dietary and lifestyle intervention. Furthermore, maternal SFTM correlate poorly with both gestational weight gain and infant birth weight.
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Affiliation(s)
- Jodie M. Dodd
- School of Paediatrics and Reproductive Health Discipline of Obstetrics and Gynaecology, The University of AdelaideAdelaideAustralia
- The Robinson Research Institute, The University of AdelaideAdelaideAustralia
- Department of Perinatal MedicineWomen's and Babies DivisionThe Women's and Children's HospitalNorth AdelaideAustralia
| | - Lavern M. Kannieappan
- School of Paediatrics and Reproductive Health Discipline of Obstetrics and Gynaecology, The University of AdelaideAdelaideAustralia
- The Robinson Research Institute, The University of AdelaideAdelaideAustralia
| | - Rosalie M. Grivell
- School of Paediatrics and Reproductive Health Discipline of Obstetrics and Gynaecology, The University of AdelaideAdelaideAustralia
- The Robinson Research Institute, The University of AdelaideAdelaideAustralia
- Department of Perinatal MedicineWomen's and Babies DivisionThe Women's and Children's HospitalNorth AdelaideAustralia
| | - Andrea R. Deussen
- School of Paediatrics and Reproductive Health Discipline of Obstetrics and Gynaecology, The University of AdelaideAdelaideAustralia
- The Robinson Research Institute, The University of AdelaideAdelaideAustralia
| | - Lisa J. Moran
- School of Paediatrics and Reproductive Health Discipline of Obstetrics and Gynaecology, The University of AdelaideAdelaideAustralia
- The Robinson Research Institute, The University of AdelaideAdelaideAustralia
| | - Lisa N. Yelland
- School of Paediatrics and Reproductive Health Discipline of Obstetrics and Gynaecology, The University of AdelaideAdelaideAustralia
- The Robinson Research Institute, The University of AdelaideAdelaideAustralia
- Women's and Children's Health Research InstituteNorth AdelaideAustralia
- School of Population HealthDiscipline of Public HealthThe University of AdelaideAdelaideAustralia
| | - Julie A. Owens
- School of Paediatrics and Reproductive Health Discipline of Obstetrics and Gynaecology, The University of AdelaideAdelaideAustralia
- The Robinson Research Institute, The University of AdelaideAdelaideAustralia
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309
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Khoramabadi M, Dolatian M, Hajian S, Zamanian M, Taheripanah R, Sheikhan Z, Mahmoodi Z, Seyedi-Moghadam A. Effects of Education Based on Health Belief Model on Dietary Behaviors of Iranian Pregnant Women. Glob J Health Sci 2015; 8:230-9. [PMID: 26383208 PMCID: PMC4803956 DOI: 10.5539/gjhs.v8n2p230] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 04/22/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction: Mothers and children are the most vulnerable members of every society. As a result many deaths occur in these two groups, so caring for these two groups is very important. Today, it is believed that the health of an infant is related to the health of their mother. Maintaining a healthy weight before pregnancy, and optimal weight gain during pregnancy by appropriate and sufficient nutrition, are two effective measures for the prevention of low birth weight.To provide successful health interventions, it is essential to design and implement effective health education programs. Successful education also depends on the proper use of theories and models in health education. The Health Belief Model is a model that illustrates the relationship between beliefs and health, and it is based on the hypothesis that preventive health behavior consists of personal beliefs. The aim of this study was to assess the effects of training on the Health Belief Model on dietary behaviors of a sample of pregnant Iranian women. Materials and Methods: This study was a randomized controlled clinical trial, involving 130 pregnant women who attended two health care centers of Shahid Beheshti University of Medical Sciences. Data was collected by a structured questionnaire in three parts and seven sub-scales (including demographic characteristics, knowledge and dietary behaviors) based on the Health Belief Model. Principles of education were based on the Health Belief Model and performed twice during two-hour sessions in the intervention group. Women in the control group received routine care and did not receive training on the above model. In order to evaluate the intervention, the previously mentioned questionnaire was administered one month after completion of the intervention, and filled by participants in both groups. Data were analyzed by SPSS software and reported with diagrams and tables. Results: The mean score for each variable before the intervention, except for the performance guide variable, was not significantly different between the two groups (p<0.05). A month after the intervention, the mean scores of the knowledge, perceived severity, perceived benefits in each group, were significantly different. These results demonstrated that there were significant differences between the two groups in terms of mean scores of knowledge, perceived severity, perceived barriers, performance guide and individual performance, and the means of these variables in the intervention group were also higher than the control group. On the other hand, after the intervention, there was no statistically significant difference found in the mean scores of perceived benefits and perceived susceptibility between the two groups (two independent samples t-test, P <0/001). Conclusion: Educational interventions based on health promotion patterns can be effective in enhancing awareness, better understanding of risks, reducing barriers to healthy behavior and ultimately, improving women’s health and nutritional performance during pregnancy.
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310
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Abstract
OBJECTIVE To examine the association between weight loss in obese pregnant women and relevant maternal and neonatal outcomes. METHODS All liveborn singleton term (37 weeks of gestation or greater) births in obese women between 2009 and 2011 in Flanders (the northern part of Belgium) were included (N=18,053). Outcomes assessed included gestational hypertension, low (2,500 g or less) birth weight, small-for-gestational-age (less than the 10th percentile) neonates, macrosomia (birth weight 4,000 g or greater), large-for-gestational-age (greater than 90th percentile) neonates, emergency caesarean delivery, and admission to a neonatal intensive care unit. Risk for adverse outcomes was calculated by multiple logistic regression analysis for weight change categories (greater weight loss [5 kg or greater], lesser weight loss [between 0 and 5 kg], low gestational weight gain [0 or greater and less than 5 kg], adequate gestational weight gain [5 or greater to 9 kg or less, reference], and excessive gestational weight gain [greater than 9 kg]) in each obesity class (I 30-34.9, II 35-39.9, III 40 or greater) adjusted for parity and maternal and gestational age. RESULTS In the total population, 854 (4.7%) obese pregnant women reported weight loss. Weight loss and low weight gain were associated with a decreased incidence of gestational hypertension for women with class I obesity (greater weight loss adjusted odds ratio [OR] 0.31, 95% confidence interval [CI] 0.11-0.84; lesser weight loss adjusted OR 0.46 95% CI 0.21-0.99; low gain adjusted OR 0.71 95% CI 0.54-0.93), a reduction in the rate of emergency cesarean delivery, but only in those with class II obesity (greater weight loss adjusted OR 0.24, 95% CI 0.07-0.78; lesser weight loss adjusted OR 0.50, 95% CI 0.26-0.97; low gain adjusted OR 0.55, 95% CI 0.38-0.79), and decreased macrosomia and large-for-gestational-age neonates in women in all classes of obesity, with the highest decrease for women with class III obesity (greater weight loss adjusted OR 0.15, 95% CI 0.05-0.49; lesser weight loss adjusted OR 0.37, 95% CI 0.15-0.90 for macrosomia). No association between weight loss and low birth weight, small-for-gestational-age neonates, or admission to the neonatal intensive care unit was shown in the different obesity classes. CONCLUSION Weight loss in obese pregnant women was associated with reduced perinatal risks but not with the rate of low birth weight or small-for-gestational-age neonates in obese women from class III in this affluent region. Stratification of recommended gestational weight gain ranges in obese women should be considered. LEVEL OF EVIDENCE II.
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Inflammatory and Other Biomarkers: Role in Pathophysiology and Prediction of Gestational Diabetes Mellitus. Int J Mol Sci 2015; 16:13442-73. [PMID: 26110385 PMCID: PMC4490503 DOI: 10.3390/ijms160613442] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/04/2015] [Indexed: 12/24/2022] Open
Abstract
Understanding pathophysiology and identifying mothers at risk of major pregnancy complications is vital to effective prevention and optimal management. However, in current antenatal care, understanding of pathophysiology of complications is limited. In gestational diabetes mellitus (GDM), risk prediction is mostly based on maternal history and clinical risk factors and may not optimally identify high risk pregnancies. Hence, universal screening is widely recommended. Here, we will explore the literature on GDM and biomarkers including inflammatory markers, adipokines, endothelial function and lipids to advance understanding of pathophysiology and explore risk prediction, with a goal to guide prevention and treatment of GDM.
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312
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Martin KE, Grivell RM, Yelland LN, Dodd JM. The influence of maternal BMI and gestational diabetes on pregnancy outcome. Diabetes Res Clin Pract 2015; 108:508-13. [PMID: 25796512 DOI: 10.1016/j.diabres.2014.12.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 10/21/2014] [Accepted: 12/28/2014] [Indexed: 01/04/2023]
Abstract
AIMS To evaluate the effect of maternal body mass index (BMI) on gestational diabetes (GDM) and the risk of adverse pregnancy outcomes in women who are overweight or obese. METHODS A prospective cohort study nested within the LIMIT randomised controlled trial. A total of 1030 women were recruited between 10 and 20 weeks' gestation, with a BMI≥25 kg/m(2), and were grouped into BMI subclasses utilising World Health Organisation criteria. Women underwent a fasting oral glucose tolerance test at 26-28 weeks' gestation, and a diagnosis of GDM was made if fasting blood glucose was ≥5.5 mmol/L or ≥7.8 mmol/L after 2h. Maternal and neonatal health outcomes were evaluated. RESULTS The prevalence of GDM increased with increasing maternal BMI (6.74% overweight vs 13.42% obese subclass 1 vs 12.79% obese subclass 2 vs 20.00% obese subclass 3). Women who were diagnosed with GDM were significantly less likely to give birth to an infant with birth weight above 4 kg (RR 0.60; 95% CI 0.36 to 1.00; p=0.05). The need for caesarean delivery (RR 1.27; 95% CI 1.07 to 1.50; p=0.006) and incidence of birth weight >90% (RR 1.38; 95% CI 1.07 to 1.77; p=0.01) was significantly increased in women who were obese, independent of GDM. CONCLUSION Increasing maternal BMI is a significant risk factor for the development of GDM, and our findings demonstrate a considerably higher prevalence than has been previously described. Raised maternal BMI is a risk factor for high infant birth weight, which may be modified by lifestyle intervention.
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Affiliation(s)
- Kate E Martin
- The University of Adelaide, Robinson Institute, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide 5006, SA, Australia; Discipline of Obstetrics & Gynaecology, Women's and Children's Hospital, 72 King William Road, North Adelaide 5006, SA, Australia.
| | - Rosalie M Grivell
- The University of Adelaide, Robinson Institute, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide 5006, SA, Australia; Discipline of Obstetrics & Gynaecology, Women's and Children's Hospital, 72 King William Road, North Adelaide 5006, SA, Australia
| | - Lisa N Yelland
- The University of Adelaide, Robinson Institute, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide 5006, SA, Australia
| | - Jodie M Dodd
- The University of Adelaide, Robinson Institute, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide 5006, SA, Australia; Discipline of Obstetrics & Gynaecology, Women's and Children's Hospital, 72 King William Road, North Adelaide 5006, SA, Australia
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313
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Abstract
The theory of developmental programming is supported by accumulating evidence, both observational and experimental. The direct application of the principles of developmental programming by clinicians to benefit pregnant women remains an area of limited attention. Examining a selection of inpatients at an obstetric referral center, I searched for situations in which clinical decision making could be driven by the principles of developmental programming. I also looked for situations in which the clinical research agenda could be dictated by these concepts. In the decision to undertake preventive measures to avoid preeclampsia, the offspring’s perspective may support more liberal application of calcium and aspirin. Consideration of the long-term health perspective of the offspring could drive choices in the management of obesity and diabetes in pregnancy. The administration of corticosteroids in women delivering by elective cesarean at term may have modest short-term benefits, but additional trials are necessary to investigate long-term offspring health. The offspring of women suffering hyperemesis gravidarum may benefit from nutritional therapy. The long-term health of the offspring could affect couples’ choice for IVF or expectant management. Applying the principles of developmental programming to the management of pregnant women could drive clinical decision making and is driving the clinical research agenda. Increasingly, developmental programming concepts are becoming an integral part of clinical practice, as well as determining the choice of outcomes in trials in obstetrics and fertility medicine. The presented cases underscore the need for more research to guide clinical practice.
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314
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Dodd JM, O'Brien CM, Grivell RM. Modifying diet and physical activity to support pregnant women who are overweight or obese. Curr Opin Clin Nutr Metab Care 2015; 18:318-23. [PMID: 25807350 DOI: 10.1097/mco.0000000000000170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Overweight and obesity represent a significant health burden during pregnancy, placing women and their infants at increased risk of adverse health outcomes. Although there is considerable observational literature describing the effect of gestational weight gain in pregnancy, research efforts have focused on limiting gestational weight gain among pregnant women who are overweight or obese, with limited reporting of clinical outcomes. RECENT FINDINGS The LIMIT randomized trial recruited 2212 pregnant women with a BMI at least 25 kg/m2. Providing an antenatal dietary and lifestyle intervention was associated with significant improvements in maternal diet and physical activity patterns, and a significant reduction in the risk of infants being born with high birth weight. SUMMARY The findings of the LIMIT randomized trial provide the first evidence that changes in maternal diet and physical activity during pregnancy can reduce the risk of high infant birth weight among women who are overweight or obese, and from a public health perspective, may represent a significant strategy to tackle the increasing problem of childhood and adulthood obesity.
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Affiliation(s)
- Jodie M Dodd
- aSchool of Paediatrics and Reproductive Health, Robinson Research Institute, University of Adelaide, Adelaide bDepartment of Perinatal Medicine, Women's and Babies Division, Women's and Children's Hospital, North Adelaide, Australia
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315
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Bain E, Crane M, Tieu J, Han S, Crowther CA, Middleton P. Diet and exercise interventions for preventing gestational diabetes mellitus. Cochrane Database Syst Rev 2015:CD010443. [PMID: 25864059 DOI: 10.1002/14651858.cd010443.pub2] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with a wide range of adverse health consequences for women and their babies in the short and long term. With an increasing prevalence of GDM worldwide, there is an urgent need to assess strategies for GDM prevention, such as combined diet and exercise interventions. OBJECTIVES To assess the effects of combined diet and exercise interventions for preventing GDM and associated adverse health consequences for women and their babies. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (11 February 2014) and reference lists of retrieved studies. We updated the search in February 2015 but these results have not yet been incorporated and are awaiting classification. SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster-RCTs assessing the effects of interventions that included diet and exercise components. We included studies where combined diet and exercise interventions were compared with no intervention (i.e. standard care).We planned to also compare diet and exercise interventions with alternative diet and/or exercise interventions but no trials were identified for this comparison. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of the included studies. Data were checked for accuracy. MAIN RESULTS We included 13 randomised controlled trials (involving 4983 women and their babies). We assessed the included trials as being of moderate risk of bias overall.When comparing women receiving a diet and exercise intervention with those receiving no intervention, there was no clear difference in the risk of developing GDM (average risk ratio (RR) 0.92, 95% confidence interval (CI) 0.68 to 1.23; 11 trials, 3744 women), caesarean section (RR 0.92, 95% CI 0.83 to 1.01; seven trials, 3246 women), or large-for-gestational age (RR 0.90, 95% CI 0.77 to 1.05; 2950 infants). Only one trial reported on perinatal mortality, and found no clear difference in the risk of stillbirth (RR 0.99, 95% CI 0.29 to 3.42; 2202 fetuses) or neonatal death (RR 0.99, 95% CI 0.06 to 15.85; 2202 neonates).Very few differences were shown between groups for the review's secondary outcomes, including for induction of labour, perineal trauma, pre-eclampsia, postpartum haemorrhage and infection, macrosomia, birthweight, small-for-gestational age, ponderal index, neonatal hypoglycaemia requiring treatment, hyperbilirubinaemia requiring treatment, shoulder dystocia, bone fracture or nerve palsy. Women receiving a combined diet and exercise intervention were, however, found to have a reduced risk of preterm birth compared with women receiving no intervention (RR 0.71, 95% CI 0.55 to 0.93; five trials, 2713 women).A trend towards reduced weight gain during pregnancy was shown for women receiving the combined diet and exercise intervention (mean difference (MD) -0.76 kg, 95% CI -1.55 to 0.03; eight trials, 2707 women; P = 0.06, random-effects); but no clear difference in postnatal weight retention was observed overall.In relation to adherence to the interventions, a number of trials that reported on behaviour modifications showed benefits in diet- (5/8 trials) and physical activity- (4/8 trials) related behaviours for women receiving the combined diet and exercise intervention, compared with women receiving no intervention; however there was notable variation across trials in outcomes measured and results observed. Only two trials reported on well-being and quality of life of women, and did not observe differences between groups for these outcomes.Very few trials reported on outcomes relating to the use of health services, although one trial suggested a reduced length of antenatal hospital stay for women receiving a combined diet and exercise intervention (MD -0.27 days, 95% CI -0.49 to -0.05; 2153 women).No information was available on outcomes for the infant as a child or adult, or for most longer-term outcomes for the mother. AUTHORS' CONCLUSIONS There are limitations associated with the available RCT evidence on the effects of combined diet and exercise interventions during pregnancy for preventing GDM. Results from 13 RCTs (of moderate quality) suggest no clear difference in the risk of developing GDM for women receiving a combined diet and exercise intervention compared with women receiving no intervention. However, the ability to draw firm conclusions was limited by variations in the quality of trials, characteristics of the interventions and populations assessed, and outcome definitions between trials.Based on the data currently available, conclusive evidence is not available to guide practice. Further large, well-designed RCTs, addressing the limitations of previous studies, are needed to assess the effects of combined interventions on preventing GDM and other relevant pregnancy outcomes including caesarean birth, large-for-gestational age and perinatal mortality. Health service utilisation and costs, and longer-term outcomes for mothers and their babies should be included. We identified another 16 trials which are ongoing and we will consider these for inclusion in the next update of this review.
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Affiliation(s)
- Emily Bain
- ARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, South Australia, Australia, 5006
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Catalano P, deMouzon SH. Maternal obesity and metabolic risk to the offspring: why lifestyle interventions may have not achieved the desired outcomes. Int J Obes (Lond) 2015; 39:642-9. [PMID: 25777180 PMCID: PMC4700513 DOI: 10.1038/ijo.2015.15] [Citation(s) in RCA: 171] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 01/22/2015] [Accepted: 02/01/2015] [Indexed: 12/16/2022]
Abstract
Obesity during pregnancy is associated with an increased risk of short- and long-term metabolic dysfunction in the mother and her offspring. Both higher maternal pregravid body mass index (kg m(-2)) and excessive gestational weight gain (GWG) have been associated with adverse pregnancy outcomes such as gestational diabetes, preeclampsia and fetal adiposity. Multiple lifestyle intervention trials consisting of weight management using various diets, increased physical activity and behavioral modification techniques have been employed to avoid excessive GWG and improve perinatal outcomes. These randomized controlled trials (RCTs) have achieved modest success in decreasing excessive GWG, although the decrease in GWG was often not within the current Institute of Medicine guidelines. RCTs have generally not had any success with decreasing the risk of maternal gestational diabetes (GDM), preeclampsia or excessive fetal growth often referred to as macrosomia. Although the lack of success for these trials has been attributed to lack of statistical power and poor compliance with study protocols, our own research suggests that maternal pregravid and early pregnancy metabolic condition programs early placenta function and gene expression. These alterations in maternal/placental function occur in the first trimester of pregnancy prior to when most intervention trials are initiated. For example, maternal accrural of adipose tissue relies on prior activation of genes controlling lipogenesis and low-grade inflammation in early pregnancy. These metabolic alterations occur prior to any changes in maternal phenotype. Therefore, trials of lifestyle interventions before pregnancy are needed to demonstrate the safety and efficacy for both the mother and her offspring.
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Affiliation(s)
- P Catalano
- Reproductive Biology, Case Western Reserve University, Center for Reproductive Health in the Department of Obstetrics and Gynecology MetroHealth Medical Center, Cleveland, OH, USA
| | - S H deMouzon
- Reproductive Biology, Case Western Reserve University, Center for Reproductive Health in the Department of Obstetrics and Gynecology MetroHealth Medical Center, Cleveland, OH, USA
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317
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Dodd JM, Ahmed S, Karnon J, Umberger W, Deussen AR, Tran T, Grivell RM, Crowther CA, Turnbull D, McPhee AJ, Wittert G, Owens JA, Robinson JS. The cost-effectiveness of providing antenatal lifestyle advice for women who are overweight or obese: the LIMIT randomised trial. BMC OBESITY 2015. [PMID: 26217529 PMCID: PMC4511432 DOI: 10.1186/s40608-015-0046-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Overweight and obesity during pregnancy is common, although robust evidence about the economic implications of providing an antenatal dietary and lifestyle intervention for women who are overweight or obese is lacking. We conducted a health economic evaluation in parallel with the LIMIT randomised trial. Women with a singleton pregnancy, between 10+0-20+0 weeks, and BMI ≥25 kg/m2 were randomised to Lifestyle Advice (a comprehensive antenatal dietary and lifestyle intervention) or Standard Care. The economic evaluation took the perspective of the health care system and its patients, and compared costs encountered from the additional use of resources from time of randomisation until six weeks postpartum. Increments in health outcomes for both the woman and infant were considered in the cost-effectiveness analysis. Mean costs and effects in the treatment groups allocated at randomisation were compared, and incremental cost effectiveness ratios (ICERs) and confidence intervals (95%) calculated. Bootstrapping was used to confirm the estimated confidence intervals, and to generate acceptability curves representing the probability of the intervention being cost-effective at alternative monetary equivalent values for the outcomes avoiding high infant birth weight, and respiratory distress syndrome. Analyses utilised intention to treat principles. Results Overall, the increase in mean costs associated with providing the intervention was offset by savings associated with improved immediate neonatal outcomes, rendering the intervention cost neutral (Lifestyle Advice Group $11261.19±$14573.97 versus Standard Care Group $11306.70±$14562.02; p=0.094). Using a monetary value of $20,000 as a threshold value for avoiding an additional infant with birth weight above 4 kg, the probability that the antenatal intervention is cost-effective is 0.85, which increases to 0.95 when the threshold monetary value increases to $45,000. Conclusions Providing an antenatal dietary and lifestyle intervention for pregnant women who are overweight or obese is not associated with increased costs or cost savings, but is associated with a high probability of cost effectiveness. Ongoing participant follow-up into childhood is required to determine the medium to long-term impact of the observed, short-term endpoints, to more accurately estimate the value of the intervention on risk of obesity, and associated costs and health outcomes. Trials registration Australian and New Zealand Clinical Trials Registry (ACTRN12607000161426).
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Affiliation(s)
- Jodie M Dodd
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia ; Department of Perinatal Medicine, Women's and Babies Division, The Women's and Children's Hospital, North Adelaide, Australia
| | - Sharmina Ahmed
- Agricultural and Food Economics, Global Food Studies, Faculty of the Professions, The University of Adelaide, Adelaide, Australia ; Women's and Children's Health Research Institute, North Adelaide, Australia
| | - Jonathan Karnon
- School of Population Health, The University of Adelaide, Adelaide, Australia
| | - Wendy Umberger
- Agricultural and Food Economics, Global Food Studies, Faculty of the Professions, The University of Adelaide, Adelaide, Australia ; Women's and Children's Health Research Institute, North Adelaide, Australia
| | - Andrea R Deussen
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Thach Tran
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Rosalie M Grivell
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia ; Department of Perinatal Medicine, Women's and Babies Division, The Women's and Children's Hospital, North Adelaide, Australia
| | - Caroline A Crowther
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia ; Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Deborah Turnbull
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Andrew J McPhee
- Department of Neonatal Medicine, Women's and Babies Division, The Women's and Children's Hospital, North Adelaide, Australia
| | - Gary Wittert
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Julie A Owens
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Jeffrey S Robinson
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia
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318
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Abstract
Pregnancy is a time when women may be receptive to health advice and interventions. This article considers the evidence for interventions to affect body weight in obese and overweight women delivered either or both pre- and post-natally. The increasing prevalence of obesity across the adult population has affected many sectors of society and increasing numbers of obese and overweight pregnant women are evident. Obesity in pregnancy is frequently associated with excessive gestational weight gains and increases the risk of developing adverse pregnancy outcomes in terms of both maternal and infant health. Pregnancy has been described as providing "a teachable moment" when women may be receptive to health advice. Some lifestyle approaches, largely incorporating strategies to alter dietary and physical activity to challenge excess body weight before and during pregnancy, have been developed and tested. While a few have shown promise with limited success in reducing body weight prior to pregnancy and post-natally, and minimising excessive weight gains during pregnancy, all interventions are not sufficiently robust and effective to justify routine inclusion in clinical practice. Weight management pre- and post-natally appears largely overlooked in usual care.
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Affiliation(s)
- Catherine R Hankey
- Human Nutrition, University of Glasgow, Level 2, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.
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319
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Olander EK, Berg M, McCourt C, Carlström E, Dencker A. Person-centred care in interventions to limit weight gain in pregnant women with obesity - a systematic review. BMC Pregnancy Childbirth 2015; 15:50. [PMID: 25885178 PMCID: PMC4350295 DOI: 10.1186/s12884-015-0463-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/30/2015] [Indexed: 11/17/2022] Open
Abstract
Background Person-centred care, asserting that individuals are partners in their care, has been associated with care satisfaction but the value of using it to support women with obesity during pregnancy is unknown. Excessive gestational weight gain is associated with increased risks for both mother and baby and weight gain therefore is an important intervention target. The aims of this review was to 1) explore to what extent and in what manner interventions assessing weight in pregnant women with obesity use person-centred care and 2) assess if interventions including aspects of person-centred care are more effective at limiting weight gain than interventions not employing person-centred care. Methods Ten databases were systematically searched in January 2014. Studies had to report an intervention offered to pregnant women with obesity and measure gestational weight gain to be included. All included studies were independently double coded to identify to what extent they included three defined aspects of person-centred care: 1) “initiate a partnership” including identifying the person’s circumstances and motivation; 2) “working the partnership” through sharing the decision-making regarding the planned action and 3) “safeguarding the partnership through documentation” of care preferences. Information on gestational weight gain, study quality and characteristics were also extracted. Results Ten studies were included in the review, of which five were randomised controlled trials (RCT), and the remaining observational studies. Four interventions included aspects of person-centred care; two observational studies included both “initiating the partnership”, and “working the partnership”. One observational study included “initiating the partnership” and one RCT included “working the partnership”. No interventions included “safeguarding the partnership through documentation”. Whilst all studies with person-centred care aspects showed promising findings regarding limiting gestational weight gain, so did the interventions not including person-centred care aspects. Conclusions The use of an identified person-centred care approach is presently limited in interventions targeting gestational weight gain in pregnant women with obesity. Hence to what extent person-centred care may improve health outcomes and care satisfaction in this population is currently unknown and more research is needed. That said, our findings suggest that use of routines incorporating person-centredness are feasible to include within these interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0463-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ellinor K Olander
- Centre for Maternal and Child Health Research, School of Health Sciences, City University London, London, UK.
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
| | - Christine McCourt
- Centre for Maternal and Child Health Research, School of Health Sciences, City University London, London, UK.
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
| | - Anna Dencker
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
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320
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Rogozińska E, Chamillard M, Hitman GA, Khan KS, Thangaratinam S. Nutritional manipulation for the primary prevention of gestational diabetes mellitus: a meta-analysis of randomised studies. PLoS One 2015; 10:e0115526. [PMID: 25719363 PMCID: PMC4342242 DOI: 10.1371/journal.pone.0115526] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 11/25/2014] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The rise in gestational diabetes (GDM), defined as first onset or diagnosis of diabetes in pregnancy, is a global problem. GDM is often associated with unhealthy diet and is a major contributor to adverse outcomes maternal and fetal outcomes. Manipulation of nutrition has the potential to prevent GDM. METHODS We assessed the effects of nutritional manipulation in pregnancy on GDM and relevant maternal and fetal outcomes by a systematic review of the literature. We searched MEDLINE, EMBASE, and Cochrane Database from inception to March 2014 without any language restrictions. Randomised controlled trials (RCT) of nutritional manipulation to prevent GDM were included. We summarised dichotomous data as relative risk (RR) and continuous data as standardised mean difference (SMD) with 95% confidence interval (CI). RESULTS From 1761 citations, 20 RCTs (6,444 women) met the inclusion criteria. We identified the following interventions: diet-based (n = 6), mixed approach (diet and lifestyle) interventions (n = 13), and nutritional supplements (myo-inositol n = 1, diet with probiotics n = 1). Diet based interventions reduced the risk of GDM by 33% (RR 0.67; 95% CI 0.39, 1.15). Mixed approach interventions based on diet and lifestyle had no effect on GDM (RR 0.95; 95% CI 0.89, 1.22). Nutritional supplements probiotics combined with diet (RR 0.40; 95% CI 0.20, 0.78) and myo-inositol (RR 0.40; 95% CI 0.16, 0.99) were assessed in one trial each and showed a beneficial effect. We observed a significant interaction between the groups based on BMI for diet-based intervention. The risk of GDM was reduced in obese and overweight pregnant women for GDM (RR 0.40, 95% CI 0.18, 0.86). CONCLUSIONS Nutritional manipulation in pregnancy based on diet or mixed approach do not appear to reduce the risk of GDM. Nutritional supplements show potential as agents for primary prevention of GDM.
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Affiliation(s)
- Ewelina Rogozińska
- Women's Health Research Unit, Centre of Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; Multidisciplinary Evidence Synthesis Hub (mEsh), Centre of Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom
| | | | - Graham A Hitman
- Centre of Diabetes, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Khalid S Khan
- Women's Health Research Unit, Centre of Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; Multidisciplinary Evidence Synthesis Hub (mEsh), Centre of Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom
| | - Shakila Thangaratinam
- Women's Health Research Unit, Centre of Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; Multidisciplinary Evidence Synthesis Hub (mEsh), Centre of Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom
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321
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Dekker Nitert M, Barrett HL, Denny KJ, McIntyre HD, Callaway LK. Exercise in pregnancy does not alter gestational weight gain, MCP-1 or leptin in obese women. Aust N Z J Obstet Gynaecol 2015; 55:27-33. [DOI: 10.1111/ajo.12300] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 11/11/2014] [Indexed: 01/10/2023]
Affiliation(s)
- Marloes Dekker Nitert
- School of Medicine; The University of Queensland; Herston Queensland Australia
- UQ Centre for Clinical Research; The University of Queensland; Herston Queensland Australia
| | - Helen L. Barrett
- School of Medicine; The University of Queensland; Herston Queensland Australia
- UQ Centre for Clinical Research; The University of Queensland; Herston Queensland Australia
| | - Kerina J. Denny
- School of Biomedical Science; The University of Queensland; St Lucia Queensland Australia
| | - H. David McIntyre
- School of Medicine; The University of Queensland; Herston Queensland Australia
- Mater Health Services; South Brisbane Queensland Australia
| | - Leonie K. Callaway
- School of Medicine; The University of Queensland; Herston Queensland Australia
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322
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Abdi J, Eftekhar H, Mahmoodi M, Shojaeizade D, Sadeghi R. Lifestyle of the employees working in hamadan public sectors: application of the trans-theoretical model. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e25269. [PMID: 25838939 PMCID: PMC4376983 DOI: 10.5812/ircmj.25269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 12/10/2014] [Accepted: 12/31/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND A healthy lifestyle is a valuable source to reduce the prevalence of health problems, and promoteehealth. OBJECTIVES The current study aimed to evaluate the lifestyle and obesity status of Hamadan public employees and their status based on the trans-theoretical model (TTM). PATIENTS AND METHODS This analytical cross-sectional study was performed in 2014 on 1200 public employees in Hamadan city, Iran selected through proportional stratified random sampling. Data collection was performed using a three-section questionnaire including demographic characteristics, The FANTASTIC lifestyle questionnaire, and the five-part algorithm. Data were analyzed by SPSS-20 using linear regression, Chi-square, Fisher exact test, and ANOVA. RESULTS The mean age of the employees was 38.12 ± 8.04 years. Most of the employees (61.7%) had favorable lifestyle. About half of the employees were at the preparation stage of TTM. Most of the employees were in a poor condition regarding the physical activity and healthy eating habits. In most of the evaluated items, females got higher scores than males. The associations between lifestyle and age, gender, work experience, income satisfaction, and marital status were significant. Moreover, the associations between obesity and work experience, marital status, number of offspring, and gender were significant (P < 0. 05). Significant predicting variables of obesity were age and work experience; they explained 31.2% variance of obesity (adjusted R(2) = 0.312, R(2) change = 0.01). CONCLUSIONS Planning health education interventions for employees through effective approaches seems necessary.
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Affiliation(s)
- Jalal Abdi
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Hassan Eftekhar
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mahmood Mahmoodi
- Department of Epidemiology and Biostatics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Davod Shojaeizade
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Roya Sadeghi
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
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Chiswick CA, Reynolds RM, Denison FC, Whyte SA, Drake AJ, Newby DE, Walker BR, Forbes S, Murray GD, Quenby S, Wray S, Norman JE. Efficacy of metformin in pregnant obese women: a randomised controlled trial. BMJ Open 2015; 5:e006854. [PMID: 25588785 PMCID: PMC4298109 DOI: 10.1136/bmjopen-2014-006854] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Increasing evidence suggests obesity has its origins prior to birth. There is clear correlation between maternal obesity, high birthweight and offspring risk of obesity in later life. It is also clear that women who are obese during pregnancy are at greater risk of adverse outcomes, including gestational diabetes and stillbirth. The mechanism(s) by which obesity causes these problems is unknown, although hyperglycaemia and insulin resistance are strongly implicated. We present a protocol for a study to test the hypothesis that metformin will improve insulin sensitivity in obese pregnant women, thereby reducing the incidence of high birthweight babies and other pregnancy complications. METHODS AND ANALYSIS The Efficacy of Metformin in Pregnant Obese Women, a Randomised controlled (EMPOWaR) trial is a double-masked randomised placebo-controlled trial to determine whether metformin given to obese (body mass index >30 kg/m(2)) pregnant women from 16 weeks' gestation until delivery reduces the incidence of high birthweight babies. A secondary aim is to test the mechanism(s) of any effect. Obese women with a singleton pregnancy and normal glucose tolerance will be recruited prior to 16 weeks' gestation and prescribed study medication, metformin or placebo, to be taken until delivery. Further study visits will occur at 28 and 36 weeks' gestation for glucose tolerance testing and to record anthropometric measurements. Birth weight and other measurements will be recorded at time of delivery. Anthropometry of mother and baby will be performed at 3 months postdelivery. As of January 2014, 449 women had been randomised across the UK. ETHICS AND DISSEMINATION The study will be conducted in accordance with the principles of Good Clinical Practice. A favourable ethical opinion was obtained from Scotland A Research Ethics Committee, reference number 10/MRE00/12. Results will be disseminated at conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN51279843.
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Affiliation(s)
- Carolyn A Chiswick
- Tommy's Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Rebecca M Reynolds
- Endocrinology Unit, University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Fiona C Denison
- Tommy's Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Sonia A Whyte
- Tommy's Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Amanda J Drake
- Endocrinology Unit, University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Brian R Walker
- University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Shareen Forbes
- Endocrinology Unit, University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Gordon D Murray
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Siobhan Quenby
- Department of Reproductive Health, Clinical Science Research Institute, Warwick Medical School, University Hospital, Coventry, UK
| | - Susan Wray
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Jane E Norman
- Tommy's Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
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Soltani H, Duxbury AMS, Arden MA, Dearden A, Furness PJ, Garland C. Maternal Obesity Management Using Mobile Technology: A Feasibility Study to Evaluate a Text Messaging Based Complex Intervention during Pregnancy. J Obes 2015; 2015:814830. [PMID: 25960889 PMCID: PMC4415456 DOI: 10.1155/2015/814830] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/04/2015] [Accepted: 03/25/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Maternal obesity and excessive gestational weight gain (GWG) are on the rise with negative impact on pregnancy and birth outcomes. Research into managing GWG using accessible technology is limited. The maternal obesity management using mobile technology (MOMTech) study aimed at evaluating the feasibility of text messaging based complex intervention designed to support obese women (BMI ≥ 30) with healthier lifestyles and limit GWG. METHODS Participants received two daily text messages, supported by four appointments with healthy lifestyle midwife, diet and activity goal setting, and self-monitoring diaries. The comparison group were obese mothers who declined to participate but consented for their routinely collected data to be used for comparison. Postnatal interviews and focus groups with participants and the comparison group explored the intervention's acceptability and suggested improvements. RESULTS Fourteen women completed the study which did not allow statistical analyses. However, participants had lower mean GWG than the comparison group (6.65 kg versus 9.74 kg) and few (28% versus 50%) exceeded the Institute of Medicine's upper limit of 9 kg GWG for obese women. CONCLUSIONS MOMTech was feasible within clinical setting and acceptable intervention to support women to limit GWG. Before further trials, slight modifications are planned to recruitment, text messages, and the logistics of consultation visits.
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Affiliation(s)
- Hora Soltani
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield S10 2BP, UK
- *Hora Soltani:
| | - Alexandra M. S. Duxbury
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield S10 2BP, UK
| | - Madelynne A. Arden
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, Collegiate Crescent, Sheffield S10 2BP, UK
| | - Andy Dearden
- Communication and Computing Research Centre, Sheffield Hallam University, Arundel Street, Sheffield S1 2NU, UK
| | - Penny J. Furness
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, Collegiate Crescent, Sheffield S10 2BP, UK
| | - Carolyn Garland
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Armthorpe Road, Doncaster DN2 5LT, UK
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Fetal growth is associated with maternal fasting plasma glucose at first prenatal visit. PLoS One 2014; 9:e116352. [PMID: 25551824 PMCID: PMC4281143 DOI: 10.1371/journal.pone.0116352] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 12/05/2014] [Indexed: 01/21/2023] Open
Abstract
Aims Fasting plasma glucose (FPG) concentration measured at the first prenatal visit is a predictor of gestational diabetes mellitus (GDM); however, whether this test is indicative of fetal growth has not been clarified. Thus, the purpose of this study was to determine whether birth weight and birth length were related to FPG levels at the first prenatal visit. Materials and Methods Research samples were collected from pregnant women who took an FPG test at their first prenatal visit (10–24 gestational weeks), received regular prenatal care, and delivered in our center. FPG value, maternal pre-gravid BMI, weight gain before FPG test, before and after Oral Glucose Tolerance Test (OGTT), neonatal birthweight, birth length, Ponderal Index and birthing method were recorded for analysis. Data were analyzed by independent sample t test, Pearson correlation, and Chi-square test, followed by partial correlation or logistic regression to confirm differences. Statistical significance level was α = 0.05. Results 2284 pregnant women, including 462 GDM and 1822 with normal glucose tolerance (NGT) were recruited for the present study. FPG concentration at the first prenatal visit was associated with neonatal birth weight (partial correlation coefficient r′ = 0.089, P<0.001) and birth length (partial correlation coefficient r′ = 0.061, P = 0.005), but not with Ponderal Index or birthing method. Maternal pre-gravid BMI was associated with FPG value (partial correlation coefficient r′ = 0.113, P<0.001). FPG concentration at the first prenatal visit (OR = 2.945, P<0.001), weight gain before OGTT test (OR = 1.039, P = 0.010), and age (OR = 1.107, P<0.001) were independent related factors of GDM. Conclusion Fasting plasma glucose concentration at the first prenatal visit is associated with fetal growth. Maternal pre-gravid BMI and weight gain are related to glucose metabolism.
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Szmeja MA, Cramp C, Grivell RM, Deussen AR, Yelland LN, Dodd JM. Use of a DVD to provide dietary and lifestyle information to pregnant women who are overweight or obese: a nested randomised trial. BMC Pregnancy Childbirth 2014; 14:409. [PMID: 25495459 PMCID: PMC4280000 DOI: 10.1186/s12884-014-0409-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 11/28/2014] [Indexed: 12/02/2022] Open
Abstract
Background We conducted a nested randomised trial to evaluate the effect of an educational DVD, providing information about healthy food choices and exercise during pregnancy, on diet and physical activity, among pregnant women who were overweight or obese. Methods We conducted a nested randomised trial within the context of the LIMIT randomised trial. Women were eligible with a singleton pregnancy between 10 and 20 weeks gestation, and body mass index at the time of their first antenatal appointment of ≥25 kg/m2. All women who were randomised to the Lifestyle Advice Group of the LIMIT trial received a series of consultations with both research dieticians and research assistants, in addition to standard written dietary and exercise materials (Standard Materials Group). Women randomised to the DVD Group received the same consultations and written materials, and additionally received an educational DVD (DVD Group). The primary study outcome was the Healthy Eating Index. Other study outcomes included physical activity, and gestational weight gain. Women completed a qualitative evaluation of all the materials provided. Results 1,108 women in the LIMIT Lifestyle Advice Group participated in the nested trial, with 543 women randomised to the DVD Group, and 565 women to the Standard Materials Group. Women who received the DVD compared with those who did not, had a higher mean Healthy Eating Index at 36 weeks gestation (73.6 vs 72.3; adjusted mean difference 1.2; 95% CI 0.2 to 2.3; p = 0.02), but not at 28 weeks gestation (73.2 vs 73.5; adjusted mean difference −0.1; 95% CI −1.1 to 0.9; p = 0.82). There were no statistically significant differences in physical activity or total gestational weight gain. While most women evaluated the materials positively, frequency of utilisation was poor. Conclusions Ongoing attention to the delivery of information is required, particularly with the increased use and availability of digital and multi-media interactive technologies. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12607000161426
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Affiliation(s)
- Malgorzata A Szmeja
- The University of Adelaide, Discipline of Obstetrics & Gynaecology and The Robinson Research Institute, Women's & Children's Hospital, 72 King William Road, North Adelaide, South Australia, 5006, Australia.
| | - Courtney Cramp
- The University of Adelaide, Discipline of Obstetrics & Gynaecology and The Robinson Research Institute, Women's & Children's Hospital, 72 King William Road, North Adelaide, South Australia, 5006, Australia.
| | - Rosalie M Grivell
- The University of Adelaide, Discipline of Obstetrics & Gynaecology and The Robinson Research Institute, Women's & Children's Hospital, 72 King William Road, North Adelaide, South Australia, 5006, Australia. .,Department of Perinatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
| | - Andrea R Deussen
- The University of Adelaide, Discipline of Obstetrics & Gynaecology and The Robinson Research Institute, Women's & Children's Hospital, 72 King William Road, North Adelaide, South Australia, 5006, Australia.
| | - Lisa N Yelland
- Women's and Children's Health Research Institute, North Adelaide, South Australia, Australia. .,The University of Adelaide, School of Population Health, Adelaide, South Australia, Australia.
| | - Jodie M Dodd
- The University of Adelaide, Discipline of Obstetrics & Gynaecology and The Robinson Research Institute, Women's & Children's Hospital, 72 King William Road, North Adelaide, South Australia, 5006, Australia. .,Department of Perinatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
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Muhlhausler BS, Vithayathil MA. Impact of maternal obesity on offspring adipose tissue: lessons for the clinic. Expert Rev Endocrinol Metab 2014; 9:615-627. [PMID: 30736199 DOI: 10.1586/17446651.2014.956088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Maternal obesity is a major risk factor for the subsequent development of obesity and Type 2 diabetes in the child. This relationship appears to be driven largely by the exposure of the fetus to an increased nutrient supply during critical periods of development, which results in persistent changes in the structure and function of key systems involved in the regulation of energy balance, appetite and fat deposition. One of the key targets is the fat cell, or adipocyte, in which prenatal overnutrition programs a heightened capacity for fat storage. The increasing prevalence of maternal obesity has led to an urgent need for strategies to break the resulting intergenerational cycle of obesity and metabolic disease. This review will discuss the relationship between maternal obesity and poor metabolic health of the offspring, with a particular focus on the involvement of adipose tissue, recent clinical studies examining potential strategies for intervention and priority areas for further research.
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Affiliation(s)
- Beverly S Muhlhausler
- a FOODplus Research Centre, School of Agriculture Food and Wine, University of Adelaide, Adelaide 5064, Australia
- b Sansom Institute for Health Research, School of Pharmacy and Medical Science, University of South Australia, Adelaide 5001, Australia
| | - Mini A Vithayathil
- a FOODplus Research Centre, School of Agriculture Food and Wine, University of Adelaide, Adelaide 5064, Australia
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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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329
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Olsen SF, Nielsen HS. Focus on fetal programming--contributions from a Copenhagen symposium. Acta Obstet Gynecol Scand 2014; 93:1073-4. [PMID: 25329924 DOI: 10.1111/aogs.12519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dodd JM, Cramp C, Sui Z, Yelland LN, Deussen AR, Grivell RM, Moran LJ, Crowther CA, Turnbull D, McPhee AJ, Wittert G, Owens JA, Robinson JS. The effects of antenatal dietary and lifestyle advice for women who are overweight or obese on maternal diet and physical activity: the LIMIT randomised trial. BMC Med 2014; 12:161. [PMID: 25315237 PMCID: PMC4194375 DOI: 10.1186/s12916-014-0161-y] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 08/26/2014] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Overweight and obesity is a significant health concern during pregnancy. Our aim was to investigate the effect of providing antenatal dietary and lifestyle advice to women who are overweight or obese on components of maternal diet and physical activity. METHODS We conducted a randomised controlled trial, in which pregnant women with a body mass index≥25 kg/m2, and singleton gestation between 10(+0) to 20(+0) weeks were recruited and randomised to Lifestyle Advice (involving a comprehensive dietary and lifestyle intervention over their pregnancy) or Standard Care. Within the intervention group, we conducted a nested randomised trial in which a subgroup of women were further randomised to receive access to supervised group walking sessions in addition to the standard information presented during the intervention contacts (the Walking group) or standard information only. The outcome measures were maternal dietary intake, (including food groups, macronutrient and micronutrient intake, diet quality (using the Healthy Eating Index; HEI), dietary glycaemic load, and glycaemic index) and maternal physical activity. Women completed the Harvard Semi-Structured Food Frequency Questionnaire, and the Short Questionnaire to Assess Health-enhancing Physical Activity (SQUASH), at trial entry, 28 and 36 weeks' gestational age, and 4 months postpartum. Analyses were performed on an intention-to-treat basis, using linear mixed effects models with adjustment for the stratification variables. RESULTS Women randomised to Lifestyle Advice demonstrated a statistically significant increase in the number of servings of fruit and vegetables consumed per day, as well as increased consumption of fibre, and reduced percentage energy intake from saturated fats (P<0.05 for all). Maternal HEI was significantly improved at both 28 (73.35±6.62 versus 71.86±7.01; adjusted difference in means 1.58; 95% CI 0.89 to 2.27; P<0.0001) and 36 (72.95±6.82 versus 71.17±7.69; adjusted difference in means 1.77; 95% CI 1.01 to 2.53; P<0.0001) weeks. There were no differences in dietary glycaemic index or glycaemic load. Women randomised to Lifestyle Advice also demonstrated greater total physical activity (adjusted difference in means 359.76 metabolic equivalent task units (MET) minutes/week; 95% CI 74.87 to 644.65; P=0.01) compared with women receiving Standard Care. The supervised walking group was poorly utilised. CONCLUSIONS For women who are overweight or obese, antenatal lifestyle advice improves maternal diet and physical activity during pregnancy. Please see related articles: http://www.biomedcentral.com/1741-7015/12/163 and http://www.biomedcentral.com/1741-7015/12/201. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ( ACTRN12607000161426).
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Affiliation(s)
- Jodie M Dodd
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
- Department of Perinatal Medicine, Women's and Babies Division, The Women's and Children's Hospital, North Adelaide, Australia.
| | - Courtney Cramp
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
| | - Zhixian Sui
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
| | - Lisa N Yelland
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
- Women's and Children's Health Research Institute, North Adelaide, Australia.
- School of Population Health, The University of Adelaide, Adelaide, Australia.
| | - Andrea R Deussen
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
| | - Rosalie M Grivell
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
- Department of Perinatal Medicine, Women's and Babies Division, The Women's and Children's Hospital, North Adelaide, Australia.
| | - Lisa J Moran
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
| | - Caroline A Crowther
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
- Liggins Institute, The University of Auckland, Auckland, New Zealand.
| | - Deborah Turnbull
- School of Psychology, The University of Adelaide, Adelaide, AUSTRALIA.
| | - Andrew J McPhee
- Department of Neonatal Medicine, Women's and Babies Division, The Women's and Children's Hospital, North Adelaide, Australia.
| | - Gary Wittert
- School of Medicine, The University of Adelaide, Adelaide, Australia.
| | - Julie A Owens
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
| | - Jeffrey S Robinson
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
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Dodd JM, McPhee AJ, Turnbull D, Yelland LN, Deussen AR, Grivell RM, Crowther CA, Wittert G, Owens JA, Robinson JS. The effects of antenatal dietary and lifestyle advice for women who are overweight or obese on neonatal health outcomes: the LIMIT randomised trial. BMC Med 2014; 12:163. [PMID: 25315325 PMCID: PMC4194368 DOI: 10.1186/s12916-014-0163-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 08/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overweight and obesity during pregnancy represents a considerable health burden. While research has focused on interventions to limit gestational weight gain, there is little information describing their impact on neonatal health. Our aim was to investigate the effect on a range of pre-specified secondary neonatal outcomes of providing antenatal dietary and lifestyle advice to women who are overweight or obese. METHODS We report a range of pre-specified secondary neonatal outcomes from a large randomised trial in which antenatal dietary and lifestyle advice was provided to women who were overweight or obese. Pregnant women were eligible for participation with a body mass index of 25 kg/m(2) or over, and singleton gestation between 10(+0) and 20(+0) weeks. Outcome measures included gestational age at birth; Apgar score below 7 at 5 minutes of age; need for resuscitation at birth; birth weight above 4.5 kg or below 2.5 kg; birth weight, length and head circumference (and Z-scores); admission to the nursery; respiratory distress syndrome; and postnatal length of stay. Data relating to the primary outcome (large for gestational age infants defined as birth weight above the 90th centile) and birth weight above 4 kg have been reported previously. Analyses used intention-to-treat principles. RESULTS In total, 2,142 infants were included in the analyses. Infants born to women following lifestyle advice were significantly less likely to have birth weight above 4.5 kg (2.15% versus 3.69%; adjusted risk ratio (aRR)=0.59; 95% confidence interval (CI) 0.36 to 0.98; P=0.04), or respiratory distress syndrome (1.22% versus 2.57%; aRR=0.47; 95% CI 0.24 to 0.90; P=0.02), particularly moderate or severe disease, and had a shorter length of postnatal hospital stay (3.94±7.26 days versus 4.41±9.87 days; adjusted ratio of means 0.89; 95% CI 0.82 to 0.97; P=0.006) compared with infants born to women who received Standard Care. CONCLUSIONS For women who are overweight or obese, antenatal dietary and lifestyle advice has health benefits for infants, without an increase in the risk of harm. Continued follow-up into childhood will be important to assess the longer-term effects of a reduction in high infant birth weight on risk of child obesity. Please see related articles: http://www.biomedcentral.com/1741-7015/12/161 and http://www.biomedcentral.com/1741-7015/12/201 . CLINICAL TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ( ACTRN12607000161426 ).
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Affiliation(s)
- Jodie M Dodd
- The University of Adelaide, School of Paediatrics and Reproductive Health, Robinson Research Institute, Adelaide, South Australia, Australia. .,The Women's and Children's Hospital, Women's and Babies Division, Department of Perinatal Medicine, North Adelaide, South Australia, Australia.
| | - Andrew J McPhee
- The Women's and Children's Hospital, Women's and Babies Division, Department of Neonatal Medicine, Adelaide, South Australia, Australia.
| | - Deborah Turnbull
- The University of Adelaide, School of Psychology, Adelaide, South Australia, Australia.
| | - Lisa N Yelland
- The University of Adelaide, School of Paediatrics and Reproductive Health, Robinson Research Institute, Adelaide, South Australia, Australia. .,Women's and Children's Health Research Institute, North Adelaide, South Australia, Australia. .,The University of Adelaide, School of Population Health, Adelaide, South Australia, Australia.
| | - Andrea R Deussen
- The University of Adelaide, School of Paediatrics and Reproductive Health, Robinson Research Institute, Adelaide, South Australia, Australia.
| | - Rosalie M Grivell
- The University of Adelaide, School of Paediatrics and Reproductive Health, Robinson Research Institute, Adelaide, South Australia, Australia. .,The Women's and Children's Hospital, Women's and Babies Division, Department of Perinatal Medicine, North Adelaide, South Australia, Australia.
| | - Caroline A Crowther
- The University of Adelaide, School of Paediatrics and Reproductive Health, Robinson Research Institute, Adelaide, South Australia, Australia. .,Liggins Institute, The University of Auckland, Auckland, New Zealand.
| | - Gary Wittert
- The University of Adelaide, School of Medicine, Adelaide, South Australia, Australia.
| | - Julie A Owens
- The University of Adelaide, School of Paediatrics and Reproductive Health, Robinson Research Institute, Adelaide, South Australia, Australia.
| | - Jeffrey S Robinson
- The University of Adelaide, School of Paediatrics and Reproductive Health, Robinson Research Institute, Adelaide, South Australia, Australia.
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Abstract
The increased prevalence of obesity has led to major health care issues in obstetric practice. Nevertheless, despite a major international effort, there is little evidence for interventions which can improve clinical outcome. Two reports from the LIMIT randomised controlled trial of more than 2,000 overweight and obese women, recently reported in BMC Medicine, show how a lifestyle intervention in Australian women changes dietary and physical activity behaviours without any evidence of harm to the health of the newborn infant and with some suggestion of benefit. The improvements in maternal lifestyle, albeit modest, may account for a previously reported reduction in the number of macrosomic infants born to LIMIT participants randomised to the intervention arm of the trial. Please see related articles: http://www.biomedcentral.com/1741-7015/12/161 and http://www.biomedcentral.com/1741-7015/12/163.
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Poston L, Patel N. Dietary recommendations for obese pregnant women: current questions and controversies. Acta Obstet Gynecol Scand 2014; 93:1081-4. [DOI: 10.1111/aogs.12507] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 09/12/2014] [Indexed: 12/30/2022]
Affiliation(s)
- Lucilla Poston
- Division of Women's Health; Women's Health Academic Centre; King's College London; King's Health Partners; London UK
| | - Nashita Patel
- Division of Women's Health; Women's Health Academic Centre; King's College London; King's Health Partners; London UK
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Hayes L, Bell R, Robson S, Poston L. Association between physical activity in obese pregnant women and pregnancy outcomes: the UPBEAT pilot study. ANNALS OF NUTRITION AND METABOLISM 2014; 64:239-46. [PMID: 25300266 DOI: 10.1159/000365027] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Obesity in pregnancy is associated with fetal macrosomia, a raised neonatal fat mass and an increased risk of obesity and poor metabolic health in childhood which persists into adulthood. The offspring of obese women are more likely to be obese than the offspring of lean women when they become pregnant themselves, perpetuating a cycle of obesity and its associated negative metabolic consequences. Increasing physical activity during pregnancy could improve insulin sensitivity and reduce the risk of maternal and offspring adverse outcomes. The UK Pregnancy Better Eating and Activity Trial (UPBEAT) is a trial of a complex intervention designed to improve pregnancy outcomes through dietary changes and physical activity. Data from the pilot trial of 183 women were available for analysis. The relationship between the time spent at different physical activity levels and maternal and infant pregnancy outcomes was examined. KEY MESSAGES Strong evidence exists that physical activity improves insulin sensitivity in non-pregnant populations, and lifestyle interventions of proven effectiveness in non-pregnant populations have been developed. Women who are active in pregnancy demonstrate better glucose control and favourable pregnancy outcomes. There is a lack of effective interventions to support obese pregnant women to be physically active. CONCLUSIONS No difference was detected in objectively measured physical activity between women randomised to the intervention and control arms of the UPBEAT pilot trial. Light-intensity physical activity was lower in early pregnancy in women who delivered macrosomic infants. Maternal sedentary time at 35-36 weeks' gestation was positively associated and moderate-intensity physical activity was inversely associated with neonatal abdominal circumference. Maternal physical activity is associated with infant birth weight and abdominal circumference and is an appropriate target for intervention to improve infant outcomes. The challenge remains to develop an effective intervention to support obese pregnant women to be physically active.
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Affiliation(s)
- Louise Hayes
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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335
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Koletzko B, Brands B, Chourdakis M, Cramer S, Grote V, Hellmuth C, Kirchberg F, Prell C, Rzehak P, Uhl O, Weber M. The Power of Programming and the EarlyNutrition project: opportunities for health promotion by nutrition during the first thousand days of life and beyond. ANNALS OF NUTRITION AND METABOLISM 2014; 64:187-339. [PMID: 25300259 DOI: 10.1159/000365017] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
At The Power of Programming 2014 Conference, researchers from multiple disciplines presented and discussed the effects of early nutrition and other environmental cues during the first thousand days of life and beyond on the lifelong risk of noncommunicable diseases. This paper aims to summarize the concepts and some of the first achievements of the EarlyNutrition research project that initiated the conference. The EarlyNutrition consortium is a multinational, multidisciplinary research collaboration of researchers from Europe, the USA, and Australia. A focus is placed on exploration of the developmental origins of obesity, adiposity, and related health outcomes. Here we report on the first findings of experimental approaches, cohort studies, randomized clinical trials, and systematic reviews of current information, as well as position papers, which have all been developed with the involvement of project partners. We conclude that the EarlyNutrition project has successfully established itself during the first 2 project years as a very strong platform for collaborative research on early programming effects. The first results, available already at this early stage of the project, point to great opportunities for health prevention strategies via the implementation of dietary and lifestyle modifications, with large effect sizes. Further results are expected which should support improved recommendations and related policies for optimized nutrition and lifestyle choices before and during pregnancy, in infancy, and in early childhood.
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Affiliation(s)
- Berthold Koletzko
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany
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336
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Dodd JM. Dietary and lifestyle advice for pregnant women who are overweight or obese: the LIMIT randomized trial. ANNALS OF NUTRITION AND METABOLISM 2014; 64:197-202. [PMID: 25300260 DOI: 10.1159/000365018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Overweight and obesity during pregnancy are common and are associated with an increased risk of adverse health outcomes for both the mother and the infant. However, robust evidence about the effect of antenatal dietary and lifestyle interventions on health outcomes is lacking. We conducted a multicenter, randomized trial, recruiting 2,212 women (from 3 public maternity hospitals across South Australia) with a singleton pregnancy between 10⁺⁰ and 20⁺⁰ weeks' gestation and a BMI ≥25. The women were randomized to lifestyle advice (n = 1,108) or standard care (n = 1,104). Women randomized to lifestyle advice participated in a comprehensive dietary and lifestyle intervention over the course of their pregnancy (delivered by research staff), while women randomized to standard care received pregnancy care according to local guidelines, which did not include such information. Provision of the lifestyle intervention was associated with a significant 18% relative risk reduction in the chance of infants being born with a birth weight above 4 kg. No other significant differences were identified in maternal pregnancy and birth outcomes between the two treatment groups. Observational studies highlight the association between a high infant birth weight and the subsequent risk of childhood and adulthood obesity. Antenatal interventions that are effective in reducing high infant birth weights therefore represent a significant strategy to tackle obesity from a population health perspective, while ongoing interrogation of the biospecimens and measurements, including ongoing childhood follow-up, will provide a unique opportunity to evaluate the mechanistic pathways of maternal-to-infant/childhood obesity.
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Affiliation(s)
- Jodie M Dodd
- School of Paediatrics and Reproductive Health, The University of Adelaide, and The Robinson Institute, Adelaide, S.A., Australia
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337
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Dodd JM, Grivell RM, Owens JA. Antenatal Dietary and Lifestyle Interventions for Women Who are Overweight or Obese: Outcomes from the LIMIT Randomized Trial. Curr Nutr Rep 2014. [DOI: 10.1007/s13668-014-0101-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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338
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Walsh JM, McAuliffe FM. Impact of maternal nutrition on pregnancy outcome--does it matter what pregnant women eat? Best Pract Res Clin Obstet Gynaecol 2014; 29:63-78. [PMID: 25438930 DOI: 10.1016/j.bpobgyn.2014.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/12/2014] [Indexed: 01/06/2023]
Abstract
Pregnancy presents a unique époque in life with considerable potential to influence not only maternal health but also the health of the next generation. Nutritional interventions in pregnancy can influence maternal, foetal and infant health. This chapter describes the findings of a large randomised controlled trial on the impact of a low glycaemic index diet on maternal and foetal health and discusses areas of future research in this important area.
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Affiliation(s)
- Jennifer M Walsh
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland.
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339
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Bell R. Maternal body mass index increasing above 20 is associated with increased risk of miscarriage, stillbirth, neonatal death and postneonatal death. ACTA ACUST UNITED AC 2014; 19:237-8. [PMID: 25053642 DOI: 10.1136/ebmed-2014-110034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Ruth Bell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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340
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Marx-Deseure A, Pigeyre M, Deruelle P. [Are lifestyle interventions for overweight and obese pregnant women useful?]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2014; 42:526-527. [PMID: 24953311 DOI: 10.1016/j.gyobfe.2014.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Indexed: 06/03/2023]
Affiliation(s)
- A Marx-Deseure
- Pôle femme mère nouveau-né, clinique d'obstétrique, maternité Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France; EA4489, environnement périnatal et croissance, faculté de médecine. université Lille 2, Lille, France
| | - M Pigeyre
- Service de nutrition, hôpital Huriez, CHRU de Lille, 59037 Lille cedex, France
| | - P Deruelle
- Pôle femme mère nouveau-né, clinique d'obstétrique, maternité Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France; EA4489, environnement périnatal et croissance, faculté de médecine. université Lille 2, Lille, France.
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341
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John E, Cassidy DM, Playle R, Jewell K, Cohen D, Duncan D, Newcombe RG, Busse M, Owen-Jones E, Williams N, Longo M, Avery A, Simpson SA. Healthy eating and lifestyle in pregnancy (HELP): a protocol for a cluster randomised trial to evaluate the effectiveness of a weight management intervention in pregnancy. BMC Public Health 2014; 14:439. [PMID: 24886352 PMCID: PMC4018969 DOI: 10.1186/1471-2458-14-439] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 05/01/2014] [Indexed: 11/10/2022] Open
Abstract
Background Approximately 1 in 5 pregnant women in the United Kingdom are obese. In addition to being associated generally with poor health, obesity is known to be a contributing factor to pregnancy and birth complications and the retention of gestational weight can lead to long term obesity. This paper describes the protocol for a cluster randomised trial to evaluate whether a weight management intervention for obese pregnant women is effective in reducing women’s Body Mass Index at 12 months following birth. Methods/design The study is a cluster randomised controlled trial involving 20 maternity units across England and Wales. The units will be randomised, 10 to the intervention group and 10 to the control group. 570 pregnant women aged 18 years or over, with a Body Mass Index of +/=30 (kg/m2) and between 12 and 20 weeks gestation will be recruited. Women allocated to the control group will receive usual care and two leaflets giving advice on diet and physical activity. In addition to their usual care and the leaflets, women allocated to the intervention group will be offered to attend a weekly 1.5 hour weight management group, which combines expertise from Slimming World with clinical advice and supervision from National Health Service midwives, until 6 weeks postpartum. Participants will be followed up at 36 weeks gestation and at 6 weeks, 6 months and 12 months postpartum. Body Mass Index at 12 months postpartum is the primary outcome. Secondary outcomes include pregnancy weight gain, quality of life, mental health, waist-hip ratio, child weight centile, admission to neonatal unit, diet, physical activity levels, pregnancy and birth complications, social support, self-regulation and self-efficacy. A cost effectiveness analysis and process evaluation will also be conducted. Discussion This study will evaluate the effectiveness of a theory-based intervention developed for obese pregnant women. If successful the intervention will equip women with the necessary knowledge and skills to enable them to make healthier choices for themselves and their unborn child. Trial registration Current Controlled Trials: ISRCTN25260464 Date of registration: 16th April 2010.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Sharon A Simpson
- South East Wales Trials Unit, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
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342
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McGiveron A, Foster S, Pearce J, Taylor MA, McMullen S, Langley-Evans SC. Limiting antenatal weight gain improves maternal health outcomes in severely obese pregnant women: findings of a pragmatic evaluation of a midwife-led intervention. J Hum Nutr Diet 2014; 28 Suppl 1:29-37. [DOI: 10.1111/jhn.12240] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- A. McGiveron
- Lincolnshire Community Health Services NHS Trust; Lincoln UK
| | - S. Foster
- Lincolnshire Community Health Services NHS Trust; Lincoln UK
| | - J. Pearce
- School of Biosciences; University of Nottingham; Loughborough UK
| | - M. A. Taylor
- School of Life Sciences; University of Nottingham; Nottingham UK
| | - S. McMullen
- School of Biosciences; University of Nottingham; Loughborough UK
- National Childbirth Trust; London UK
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