Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes

Obstetric and neonatal outcomes of extremely obese pregnant women after late preterm gestation

OBJECTIVE

To determine the obstetric and neonatal outcomes of pregnant women with extreme obesity at birth after late preterm gestation.

METHODS

This was a retrospective study on extremely obese pregnant women with body mass index (BMI) ≥ 40.0 kg/m2 (obesity stage III according to the BMI classification of the World Health Organization) who had delivered at Seoul National University Bundang Hospital between September 2003 and February 2023. Fetal death in utero and preterm births before 34 weeks of gestation were excluded. Obstetric and neonatal outcomes were reviewed.

RESULTS

A total of 94 extremely obese pregnant women were included and the median value of BMI at delivery was 42.4 kg/m2. When analyzed according to the obesity II category of pre-pregnancy BMI, the rate of chronic hypertension was higher in the alleged extreme obese women than those with lower pre-pregnancy BMI (34% vs. 10%, p = 0.012). However, preterm labor with tocolytics was higher in the group with lower BMI than 35.0 kg/m2 (26% vs. 5%, p = 0.007). The proportion of adverse neonatal outcomes such as neonatal intensive care unit admission, the use of respiratory support (including positive pressure ventilation, continuous positive airway pressure, and mechanical ventilator), and jaundice were higher in the group with pre-pregnancy BMI < 35.0 kg/m2 than that with BMI ≥ 35.0 kg/m2 group (all p-value < 0.05). The use of neonatal respiratory support increased as the category of pre-pregnancy BMI was lower and as the degree of weight gain during pregnancy was higher.

CONCLUSIONS

In extremely obese women (stage III) at delivery in late preterm gestation, the obstetric outcomes such as use of tocolytics for preterm labor and adverse neonatal respiratory outcomes seemed to be higher for the women who were not that much obese before pregnancy than those who were already extremely obese. Therefore, weight gain during pregnancy needs to be closely monitored for pregnant women especially when obese.

Parental high-fat diet induces upregulation of macrophage receptor with collagenous structure expression and exacerbates colorectal inflammation via the nuclear factor kappa-B pathway in offspring

Parental high-fat diet (HFD) increases offspring's susceptibility to colorectal inflammation, but the underlying mechanism remains unclear. Using mouse models, we compared colorectal inflammation between offspring of HFD-fed and normal diet-fed parents. Histological analysis and immunostaining revealed that offspring of HFD-fed parents exhibited shortened colorectal length, decreased goblet cells, and reduced tight junction protein expression, particularly when maintained on HFD. RNA sequencing of colorectal tissue identified elevated expression of macrophage receptor with collagenous structure (MARCO) in these offspring. Immunofluorescence co-localization staining confirmed increased MARCO-positive macrophages in their colorectal tissue. Notably, switching offspring to normal diet partially alleviated these inflammatory responses, although some manifestations remained. Further investigation showed that high-lipid stimulation increased MARCO expression in macrophages and promoted inflammatory cytokine secretion through nuclear factor kappa-B (NF-κB) pathway activation. In vitro experiments demonstrated that MARCO knockdown inhibited the expression of inflammatory cytokines and prevented tight junction protein destruction in cocultured intestinal cells. Our findings reveal that parental HFD induces MARCO upregulation in offspring's colorectal macrophages and exacerbates colorectal inflammation through the NF-κB pathway, providing new insights into the mechanism by which parental HFD affects offspring's intestinal health.

Maternal Gestational Weight Status and Offspring Physical Growth Status at Birth, Mid-Childhood and Early Adolescence

Maternal adiposity has been identified as a predictor of child overweight/obesity; however, it remains unclear whether the association changes as the child ages. We aimed to examine the associations between maternal weight status during pregnancy and offspring physical growth from birth to early adolescence using data from a birth cohort study in rural western China. Maternal weight measurements during the first, second and third trimesters were used to calculate body mass index (BMI) and gestational weight gain (GWG) rate, and then were classified following the Institute of Medicine recommendation. Offspring length/height and weight were measured at birth, mid-childhood (age 7-10 years) and early adolescence (age 10-14 years) and converted into z-scores using the INTERGROWTH-21st and WHO standards, respectively. Generalized linear models were applied to examine the associations of maternal BMI and GWG with offspring BMI-for-age and sex (BAZ) and length-/height-for-age and sex z-score (LAZ/HAZ) at birth, mid-childhood and early adolescence, respectively, adjusting for potential confounders. Among 411 mother-offspring pairs (62% boys), higher maternal BMI during the first trimester was associated with increased offspring BAZ at birth (adjusted mean differences [aMD]: 0.07, 95% confidence interval [CI]: 0.001-0.14), mid-childhood (aMD 0.09, 95% CI: 0.05-0.14) and early adolescence (aMD 0.11, 95% CI: 0.05-0.17). Maternal excessive GWG was associated with higher HAZ in early adolescence (aMD 0.44; 95% CI: 0.17-0.69). The strongest point estimate of maternal gestational weight status on offspring physical growth emerged in early adolescence, suggesting the potential age-dependent amplifying impact. Additionally, updated GWG guidelines should consider regional characteristics and long-term offspring growth.

Efficacy and Safety of Glucagon-like Peptide-1 Receptor Agonist Use During the First Trimester in Pregnant Women With Type 2 Diabetes

BACKGROUND

Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are a newer class of antidiabetic drugs that have proven beneficial in reducing weight loss and improving cardiometabolic profile. Literature has shown worsened glycemic control and increased risk of cardiovascular outcomes after stopping GLP-1 RAs in the adult type 2 diabetes (T2D) population; however, the effect of exposure to GLP-1 RAs in first-trimester pregnancy, followed by discontinuation, is still unclear.

OBJECTIVE

To evaluate the maternal and fetal clinical outcomes after exposure of GLP-1 RAs in a T2D first-trimester pregnant population.

METHODS

This retrospective cohort was based on a global database of electronic health records (EHRs) of more than 140 million patients. After propensity score matching (PSM), the study population included 3,652 women with T2D, divided into 2 cohorts based on their exposure to GLP-1 RAs within 1 year before and 1 month after diagnosis of first-trimester pregnancy. Exposure to GLP-1 RAs within 1 year before and 1 month after diagnosis of first-trimester pregnancy in T2D women.

RESULTS

In this study of a 3,652 first-trimester T2D population, the average age of the GLP-1 RAs exposed cohort was 36.2 years. The primary outcome of the maternal all-cause mortality rate was comparable in the GLP-1 RAs-exposed first-trimester pregnant cohort compared to the control cohort after 42 weeks of follow-up. Secondary maternal outcomes, i.e., gestational hypertension, preeclampsia, and eclampsia, were also comparable after 42 weeks of follow-up in the women with T2D exposed to GLP-1 RAs during their pregnancy as compared to the control. Similarly, the relative risk of fetal cardiac and kidney anomalies was comparable between the cohorts.

CONCLUSION

In this study, exposure to GLP-1 RAs during the first trimester of pregnancy in T2D.

Association of Gestational Weight Gain with Adverse Pregnancy Outcomes in Individuals with Obesity

This study aimed to determine optimal gestational weight gain (GWG) considering adverse infant and maternal outcomes among individuals with obesity, with detailed classification for body mass index (BMI) of 40 kg/m2 or higher.This study was a population-based retrospective cohort study, using U.S. birth certificate data from 2017 to 2021. We included nulliparous individuals with singleton pregnancies delivering live births between 370/7 and 416/7 weeks' gestation, excluding those with pregestational diabetes or hypertension, gestational diabetes, preeclampsia, major fetal anomalies, or chromosomal disorders. The study focused on three main outcomes: primary cesarean delivery, small for gestational age (SGA), and large for gestational age (LGA). GWG was evaluated in 2-kg increments, from weight loss >8 kg to gains ≥28 kg. Prepregnancy BMI was stratified into four categories: BMI of 30 to <35, 35 to <40, 40 to <50, and ≥50 kg/m2. Odds ratios and absolute risk reduction were used to identify GWG ranges with balanced risks for three outcomes within each BMI category.Among 1,677,968 individuals with obesity, increased GWG was associated with higher absolute risks of cesarean delivery and LGA and lower risk of SGA across all BMI categories. Optimal GWG ranges varied by prepregnancy BMI: >12 to ≤14 kg for BMI of 30 to <35 kg/m2; >10 to ≤12 kg for BMI of 35 to <40 kg/m2; >6 to ≤10 kg for BMI of 40 to <50 kg/m2; >0 to ≤8 kg for BMI of 50 kg/m2 or higher.We identified higher upper and lower GWG limits for individuals with BMI of 30 to 50 kg/m2, and lower limits for those with BMI ≥50 kg/m2, compared with the guidelines recommended by the U.S. National Academy of Medicine. These findings suggest the need to tailor GWG recommendations based on the severity of obesity. · Optimal GWG varies by obesity class, requiring tailored guidelines.. · Those with BMI ≥50 kg/m may need lower target for gestational gain than current recommendation.. · The optimal GWG range could be changed based on the outcomes of interest..

Sex-specific effect of maternal pre-pregnancy BMI on neuropsychiatric development of offspring

BACKGROUND/OBJECTIVE

Children of overweight and obese mothers had an increased risk of neuropsychiatric problems. It remains unclear if the association varies by child sex. This study aimed to identify the associations between maternal pre-pregnancy BMI and child sex-specific neuropsychiatric development outcomes during childhood. We aimed to examine whether maternal pre-pregnancy BMI was related to offspring's neurodevelopment and explore if associations vary by child sex.

METHODS

This was a retrospective cohort study. Overall, 2013 children conceived by assisted reproductive technology (ART) were recruited and divided into four groups categorized by maternal pre-pregnancy BMI. The neuropsychiatric development outcomes were measured using CBCL/4-16 and WISC-IV. Multiple linear regressions were used to evaluate the association between maternal BMI and the Questionnaire score of the offspring.

RESULTS

Compared with those who were conceived by normal BMI mothers, girls born to Underweight mothers have less depression (β [95%CI]: -3.98[-6.99, -0.96], P < 0.01), hyperactivity (β [95%CI]: -3.09[-6.08, -0.10)], P < 0.05), and brutality (β [95%CI]: -2.45[-4.75, -0.16], P < 0.05) problems. Among boys, maternal overweight and obese were associated with increased behavioral problems, including schizoid (obese vs normal: β [95%CI]: 7.60[1.21, 13.98], P < 0.05), depression(β [95%CI]: 7.83[2.22, 13.44], P < 0.01), social problems(β [95%CI]: 8.17[1.57, 14.77], P < 0.05), obsessive-compulsive(β [95%CI]: 7.95[0.45, 15.45], P < 0.05), social withdrawal(β [95%CI]: 5.99[1.02, 10.96], P < 0.05), hyperactivity(β [95%CI]: 12.66[8.06, 17.25], P < 0.01), aggressive behavior(β [95%CI]: 13.28[8.31, 18.26], P < 0.01), rule-breaking behavior(β [95%CI]: 9.26[2.86, 15.66], P < 0.01), and total problems(β [95%CI]: 12.14[7.27, 17.00], P < 0.01).

CONCLUSION

Maternal pre-pregnancy overweight and obesity were associated with neurobehavioral problems in boys, while underweight and overweight have protective effects in girls. Future research should examine sex differences and long-term consequences in the offspring born to maternal obesity.

Greater adherence to the Dietary Approaches to Stop Hypertension (DASH) diet during pregnancy reduces the likelihood of having a large-for-gestational-age newborn

BACKGROUND/OBJECTIVES

Studies suggest that greater maternal adherence to the Dietary Approaches to Stop Hypertension (DASH) diet reduces the risk of both maternal and fetal adverse health outcomes. The study aimed to evaluate the relationship between adherence to the DASH diet during pregnancy and the classification of birth weight according to gestational age.

SUBJECTS/METHODS

Secondary analysis of a prospective cohort of 601 mother and child pairs who attended primary healthcare in a Brazilian municipality. Dietary intake was estimated based on 24 h recall and a Food Frequency Questionnaire. Data on gestational duration, birth weight, and newborn sex were obtained from the Live Birth Information System. The relationship between adherence to the DASH diet and birth weight categories was investigated using logistic regression models adjusted for confounding factors.

RESULTS

In total, 10.3% of newborns were classified as small for gestational age (SGA), and 13.3% as large for gestational age (LGA). There was low adherence to the healthy components of the DASH diet. However, it was observed that pregnant women classified in the third tertile of the DASH diet score had a lower chance of having LGA newborns [OR 0.51 (95% CI 0.28; 0.94), p = 0.03]. There was no association between adherence to the DASH diet and SGA newborns [OR 0.87 (95% CI 0.42; 1.84), p = 0.65].

CONCLUSION

Despite the low adherence to the DASH diet between Brazilian pregnant women, higher adherence scores in its components had a lower chance of having LGA newborns.

Effect of a physical activity and healthy eating lifestyle intervention in pregnancy on fetal growth trajectories: The DALI randomised controlled trial

BACKGROUND

Obesity during pregnancy is related to fetal overgrowth. Effective interventions that can mitigate this risk are needed.

OBJECTIVES

This study aimed to investigate the effect of a lifestyle intervention for pregnant women with obesity on fetal growth trajectories.

METHODS

In the DALI trial, pregnant women with a body mass index ≥29.0 kg/m2 and without gestational diabetes at baseline were randomized to counselling on physical activity (PA), healthy eating (HE) or a combination (PA + HE), or to usual care (UC). Fetal growth trajectories were modelled based on a combination of estimated fetal weight (EFW) from repeated ultrasound scans and weight measured at birth. Differences in fetal growth trajectories between groups were assessed.

RESULTS

Three hundred eighty-four women were included. Those in the PA + HE intervention had slower EFW gain from 32 weeks onwards, with differences (PA + HE vs. UC) at 32, 36 and 40 weeks of -54.1 g (-146.7 to 38.9 g), -84.9 g (-194.0 to 24.7 g), and -99.8 g (-227.1 to 28.1 g), respectively. Effects appeared stronger in males, with a difference at 40 weeks of -185.8 g (-362.5 g to -9.2 g) versus -23.4 g (-190.4 g to 143.5 g) in females.

CONCLUSIONS

A lifestyle intervention for pregnant women with obesity resulted in attenuated fetal growth, which only reached significance in male offspring. Future larger trials are needed to confirm these findings and elucidate underlying pathways.

Estimating energy requirements from Dietary Reference Intakes for pregnant people with obesity using wearables

OBJECTIVE

Estimating physical activity levels (PAL) is difficult outside of the laboratory, and patient-reported PAL are often overestimated. Herein, we determine the importance of selecting the correct PAL when computing estimated energy requirements (EER) to determine gestational weight gain (GWG). Then, we examine whether data from a wearable can be used to select PAL and predict EER.

METHODS

PAL were measured at early and late pregnancy among 53 pregnant female individuals (BMI > 30 kg/m2) in the laboratory and from wearables. To simulate overreporting physical activity, PAL in early pregnancy were used to compute EER in late pregnancy and assess the effect on GWG.

RESULTS

PAL decreased from early to late pregnancy (p = 0.01). When simulating the effect of overestimating physical activity on EER in late pregnancy, excess GWG occured in all individuals (p < 0.001) with decreased PAL during pregnancy. Average daily step counts and activity minutes in early and late pregnancy overlapped across PAL and are not recommended for use.

CONCLUSIONS

Step count and activity minute data from wearables cannot be used to determine PAL in pregnant individuals with obesity. To minimize excess GWG risks, our outcomes suggest assuming "inactive" physical activity when estimating EER for pregnant people with obesity.

Primiparity, class 3 obesity, intention to breastfeed and breastfeeding initiation

BACKGROUND

During the 2013-21 period, 674 primiparous women with Class 3 obesity delivered in our institution. Their antenatal infant feeding preference on admission was: 518 (77%) intended to breastfeed (BF) only, 101 (15%) intended to feed formula only and 55 (8%) intended to BF and formula feed combined. Intention to BF only is a predictor of BF initiation, however, data concerning this relationship is limited.

OBJECTIVE

To determine the perinatal variables that influence success or failure of BF among primiparous women with Class 3 obesity who antenatally declared their intention to only BF.

METHODS

Retrospective cohort study of women who delivered live singletons without major malformations at ≥ 34 weeks gestation.

RESULTS

The 518 women who prenatally intended to BF only, were categorized at discharge as exclusive BF (EBF) 197 (38%), any BF (ABF) 212 (41%) and formula feeding (FF) 109 (21%). A lower prevalence of gestational diabetes (10,17 vs 17%), chronic hypertension (16,31 vs 18%), severe preeclampsia (12,22 vs 30%), cesarean delivery (37,55 vs 55%), late preterm (6,17 vs 14%), neonatal hypoglycemia (8,26 vs 22%) and NICU admission (11,25 vs 20%) was present in the EBF group as compared to ABF and FF. African American women were more likely to only FF. Regression analysis showed that the stronger predictors of failure to initiate BF were public healthcare assistance, African American race, preeclampsia, cesarean delivery, neonatal hypoglycemia, prematurity and NICU admission.

CONCLUSION

Among primiparous women with class 3 obesity who intended to BF only but failed to do so, the increased prevalence and severity of maternal and neonatal morbidities are likely obstacles to BF their first infant.

Association between gestational age-specific weight gain in pregnancy and risk of adverse perinatal outcomes: a secondary analysis of the INTERBIO-21st Fetal Study

BACKGROUND

Gestational weight gain (GWG) is a potentially modifiable factor that can influence perinatal health outcomes.

OBJECTIVES

This study aims to investigate the association between gestational age (GA)-specific weight gain and adverse perinatal outcomes.

METHODS

This study is a secondary analysis of the INTERBIO-21st Fetal Study, a prospective, longitudinal cohort conducted from 8 February, 2012 to 30 November, 2019, across 6 sites in Brazil, Kenya, Pakistan, South Africa, Thailand, and the United Kingdom. A total of 3354 pregnant females, aged ≥18 y with a body mass index (BMI) <35 kg/m2, initiated antenatal care before 14 wk of gestation. Weight was measured at 5 ± 1 wk intervals from 14 to 40 wk. GWG was assessed using the GA-specific INTERGROWTH-21st and BMI-specific Institute of Medicine (IOM) guidelines. Adverse outcomes included gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), emergency cesarean delivery, low birthweight (LBW), preterm birth, small or large for gestational age (SGA), macrosomia, and birth length or head circumference (HC) <10th or >90th centile.

RESULTS

Inadequate GWG was prevalent, with 53% (n = 1767) below the 25th centile of INTERGROWTH-21st standards and 62% (n = 2079) below IOM guidelines. Compared with GWG between 25th and 75th centile (n = 370), females with GWG <25th centile (n = 1767) had a higher odds of SGA [odds ratio (OR) = 2.7, 95% confidence interval (CI): 2.2, 3.4], birth HC < 10th centile (OR: 2.4, 95% CI: 1.8, 3.2), GDM (OR: 1.9, 95% CI: 1.3, 2.7), LBW (OR: 1.9, 95% CI: 1.5, 2.4), and birth length <10th centile (OR: 1.7, 95% CI: 1.4, 2.1). Similarly, females with GWG >75th centile (n = 458) had higher odds for emergency cesarean section (OR: 1.7, 95% CI: 1.1, 2.7) and PIH (OR: 1.5, 95% CI: 1.1, 1.9).

CONCLUSIONS

Appropriate-for-age-specific GWG between the 25th and 75th centiles standards is associated with reduced adverse outcomes, highlighting the importance of tailored guidelines for optimal maternal and neonatal health.

The Association Between Midpregnancy Food Intake Timing Patterns and Gestational Weight Gain

Background: This article aims to characterize midpregnancy food timing profiles and examine their association with gestational weight gain (GWG). Materials and Methods: This secondary data analysis of a randomized controlled trial of two gestational diabetes screening approaches included 641 individuals with primary exposures and outcomes data. Food timing indicators (i.e., first and last eating episode time, caloric midpoint time, and the total eating window) were assessed using two 24-hour dietary recalls conducted in midpregnancy. Latent profile analysis was used to identify distinct food timing profiles based on these indicators. Regression analyses explored the associations between individual food intake timing indicators, food timing profiles, and GWG. Results: We identified four food timing profiles: extended window eating (n = 133; earliest first eating episode and the longest eating window), restricted window eating (n = 120; latest first eating episode and shortest eating window), early eating (n = 188; earliest caloric midpoint), and typical eating (n = 200; food intake aligning with the sample median). Participants with a restricted window eating profile (vs. typical eating profile) had an increased risk of insufficient GWG (unadjusted relative risk [RR] = 1.85, 95% confidence interval [CI] 1.12, 3.05). Each hour increase in the timing of the last eating episode was associated with 0.39 kg (0.03, 0.75) higher GWG. Both associations were attenuated in adjusted models and no longer statistically significant in adjusted models. Conclusions: We identified four distinct midpregnancy food timing profiles, but these profiles were not independently associated with GWG. These findings suggest that midpregnancy food timing may not play a major role in GWG.

Pre-pregnancy Weight and Racial-Ethnic Disparities in Pregnancy-Associated Conditions in the State of Georgia: A Population-Based Study

INTRODUCTION

We investigate racial-ethnic disparities in pre-pregnancy obesity and pregnancy weight gain, which are known to increase the risk of pregnancy-associated conditions.

METHODS

We used 4-year (2017-2020) combined Georgia Pregnancy Risk Assessment Monitoring System data (N = 3208) to investigate racial-ethnic disparities in the incidence of gestational hypertension (GHT), gestational diabetes mellitus (GDM), and postpartum depression (PPD) and their associated risk with pre-pregnancy overweight/obesity after controlling for demographic and other confounders using regression modeling. The geographic distributions of hypertension and PPD rates at the county level were compared to the patterns of racial-ethnic populations and hospitals.

RESULTS

The PPD rates were higher among Asian (17.6), Hispanic (14.4), and Black (14.3); GDM was highest among Asian (16.0) mothers; and GHT was the highest among Black (11.7) followed by White mothers (9.0). Pre-pregnancy overweight and obese conditions increased the odds of hypertension in Black (2 ½ times) and White (> 3 ½ times) mothers. Premature birth increased the odds of hypertension (2-3 times) in all mothers. Pre-pregnancy weight also increased the odds of GDM (3-7 times) in these racial groups. Premature birth increases the odds twice as likely for PPD in Hispanic and White mothers. The convergence of high PPD and hypertension rates with high proportions of racial and ethnic minorities, and lack of hospital presence, indicates areas where healthcare interventions are required.

CONCLUSIONS

These findings underscore the importance of promoting a healthy pre-pregnancy weight to reduce the burden of maternal morbidity and pregnancy outcomes in general. More comprehensive prenatal monitoring using technological interventions for self-care has a great promise of being effective in maintaining a healthy pregnancy.

Effect of a high-protein and low-glycaemic index diet during pregnancy in women with overweight or obesity on offspring metabolic health-A randomized controlled trial

BACKGROUND

Maternal obesity and excessive weight gain during pregnancy are associated with higher birth weight and increased risk of childhood obesity.

OBJECTIVE

This study investigated the effect of a high-protein and low-glycaemic-index (HPLGI) diet during pregnancy on offspring body composition and metabolic health.

METHODS

We conducted a dietary intervention study in pregnant women with a pre-pregnancy BMI of 28-45 kg/m2 who were randomly assigned to an HPLGI diet or a moderate-protein moderate-glycaemic-index (MPMGI) diet. A total of 208 offspring born to these women were followed-up from birth to 5 years of age.

RESULTS

No differences were found on BMI z-scores at different ages; however, offspring born to women on the HPLGI diet exhibited 0.43 mmol/L higher glucose levels (p = 0.017) at birth compared with the MPMGI diet. At 3 years of age, HPLGI offspring had 0.09 mmol/L lower levels of HDL-cholesterol (p = 0.018) and 16% higher levels of triglycerides (p = 0.044). At 5 years of age, they had 0.25 mmol/L higher total cholesterol levels (p = 0.027) and 0.27 mmol/L higher LDL-cholesterol levels (p = 0.003) compared with the MPMGI diet.

CONCLUSION

An HPLGI diet during pregnancy may lead to adverse metabolic outcomes in the offspring, necessitating further investigation into long-term health implications.

Factors that shape dietary intake in children in the context of increasing risk for obesity development

The development of obesity in childhood is the result of interplay between a complex array of multi-level factors, one of which is dietary intake. However, dietary intake in childhood itself is impacted by many factors operating at different levels. This special issue brings together a collection of papers that examine various factors influencing children's dietary intake. Rather than issuing a call for papers, this collection came together organically based on regular submissions, highlighting the growing body of research dedicated to understanding how children's dietary habits can contribute to obesity risk. These papers represent studies that have focused on the external (e.g., fast-food environment, ongoing rapid proliferation of ultra-processed foods) and social (e.g., the role of parents and schools, stress and adversity) environment, behavioural factors (e.g., reward and gratification, sleeping behaviour) and genetic factors, as well as maternal factors that promote intra-generational transmission. This is summarized in Figure 1. In a time when obesity development continues to rise globally, these studies may shed light on the complexity of one of the main drivers, namely dietary intake. Below we summarize the latest research in these areas resulting from the papers in this Special Issue.

Association between gestational weight gain and perinatal outcomes among women with gestational diabetes mellitus

Objective

This study identifies the optimal gestational weight gain (GWG) range for women with gestational diabetes mellitus (GDM) in singleton pregnancies and examines the relationship between GWG patterns and perinatal outcomes.

Methods

We included 18,548 pregnant women diagnosed with GDM via a 75g glucose tolerance test at Fujian Maternal and Child Health Hospital from 2011 to 2022. Data on demographics, GWG, delivery details, and maternal and infant outcomes were collected. Subjects were divided into training and validation sets (7:3 ratio) and classified by pre-pregnancy BMI: underweight, normal weight, overweight, and obese. Logistic regression in the training set was conducted to determine optimal GWG for each group, and examined the relationship between adverse outcomes and the Institute of Medicine(IOM), Chinese nutrition society(CNS), and study-derived (AOR) standards in the validation set.

Results

Among participants, 17.0% pregnant women gained insufficient GWG, 49.2% gained appropriate GWG, and 33.9% with excessive GWG. The optimal GWG for underweight, normal weight, overweight, and women with obesity were 12-14 kg, 8-14 kg, 6-10 kg, and 2-4 kg, respectively. Insufficient GWG in IOM and AOR standard increased composite adverse outcomes among underweight women. Normal weight: Insufficient GWG per CNS and AOR increased composite adverse outcomes; excessive GWG per all standards increased adverse outcomes. Insufficient GWG per all standards reduced the risk of small-for-gestational-age (SGA) infants, while excessive GWG increased the risk of large-for-gestational-age (LGA) infants, gestational hypertension, and cesarean section. Overweight: Excessive GWG per CNS and AOR increased composite adverse outcomes; excessive GWG per all standards increased the risk of cesarean delivery. Obese: Insufficient GWG per IOM and CNS increased composite adverse outcomes.

Conclusion

GWG significantly influences adverse pregnancy outcomes. Compared to IOM guidelines, CNS recommendations and study-derived GWG ranges are more suitable for Chinese women with GDM in singleton pregnancies.

Reevaluating optimal weight changes across the stages of pregnancy

BACKGROUND

While the National Academy of Medicine, formerly known as the Institute of Medicine, recommends the optimum weight change in the second and third trimesters combined, the ideal weight change range per week according to trimesters remains unexplored.

OBJECTIVE

To determine the optimal rates of weight change per week that are associated with decreased adverse pregnancy outcomes for each trimester stratified by prepregnancy body mass index categories.

STUDY DESIGN

This was a secondary analysis of a prospective cohort study using data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (2010-2014). Our exposure was the weight change per week, defined as weight change (kg) divided by gestational weeks interval. We examined weight change per week for each trimester: weight change in early pregnancy (early first trimester to second trimester); second trimester (second trimester to third trimester); and third trimester (third trimester to delivery). Our primary outcome was a composite of adverse pregnancy outcomes including hypertensive disorders of pregnancy, preterm birth, spontaneous preterm birth, small-for-gestational-age birth, and stillbirth. To explore potential nonlinear associations between pregnancy weight change and adverse pregnancy outcomes, we applied restricted cubic spline functions with 5 knots. We calculated adjusted relative risks with 95% confidence intervals using generalized linear models with Poisson distribution and robust error variance, controlling for confounders. We estimated adjusted relative risks of adverse pregnancy outcomes for each weight change per week and identified the optimal weight change. The optimal weight change was compared with the National Academy of Medicine-recommended weight change in pregnancy.

RESULTS

Of the 8121 patients included, 4373 (53.8%) had a normal or underweight body mass index, 2002 (24.7%) had an overweight body mass index, and 1746 (21.5%) had an obese body mass index. The weight changes per week associated with the lowest adverse risks for individuals with normal/underweight, overweight, and obese body mass index were 0.7 kg/wk, 0.7 kg/wk, and 0.6 kg/wk, respectively, for the first trimester, 0.7 kg/wk, 0.5 kg/wk, and 0.5 kg/wk, respectively, for the second trimester, and 0.5 kg/wk, 0.4 kg/wk, and 0.4 kg/wk, respectively, for the third trimester. For normal/underweight, weight gain according to the National Academy of Medicine guidelines in the second trimester compared to our optimal weight gain was associated with an increased risk of adverse pregnancy outcomes and preterm birth. For normal/underweight and overweight individuals in the second trimester, weight gain according to the National Academy of Medicine guidelines, compared to our optimal weight gain, was associated with an increased risk of small for gestational age. Conversely, for individuals with obesity in the third trimester, weight gain according to the National Academy of Medicine guidelines compared to our optimal weight gain was associated with a decreased risk of cesarean delivery.

CONCLUSION

The gestational weight change rates associated with the lowest adverse risks were of higher values than those established by the National Academy of Medicine, which may suggest that the National Academy of Medicine guidelines are too strict.

Association between gestational weight change trajectories and perinatal outcomes in twin pregnancies in China

OBJECTIVE

This study aimed to identify gestational weight change trajectories and examine their association with perinatal outcomes.

METHODS

Prenatal and delivery records of 3393 twin pregnancies were obtained from the China-US Collaborative Project for Neural Tube Defects Prevention, a large population-based cohort study. Generalized gestational weight gain (GWG) was calculated by dividing the total GWG by the length of gestation in weeks and multiplying by 37 weeks. Latent class growth modeling (LCGM) was used to identify GWG patterns. Multivariable logistic regression and generalized estimating equations (GEE) were used to analyze the associations between GWG trajectories and perinatal outcomes. The included adverse perinatal outcomes were preterm birth, low birth weight (LBW), small for gestational age (SGA), and large for gestational age (LGA).

RESULTS

The mean ± SD of GWG for underweight women was 17.87 ± 5.67 kg, 16.76 ± 6.22 kg for normal weight, 14.34 ± 6.60 kg for overweight, and 14.27 ± 4.94 kg for obese. Three gestational weight change trajectory groups were identified: low-increase (32.36%), moderate-increase (56.26%), and high-increase (11.38%). Compared to the moderate-increase group, the high-increase group showed a reduced risk of LBW (aOR 0.68, 95%CI 0.56, 0.83), and SGA (aOR 0.49, 95%CI 0.40, 0.60) but an increased risk of LGA (aOR 2.23, 95%CI 1.48, 3.35). No significant change was observed in the risk of preterm birth in the high-increase group. The low-increase group had a higher risk of preterm birth (aOR 1.66 95%CI 1.42, 1.94), LBW (aOR 2.44 95%CI 2.13,2.80), and SGA (aOR 1.32 95%CI 1.16, 1.51), with no significant difference in the risk of LGA (aOR 1.11 95%CI 0.78,1.58).

CONCLUSIONS

Distinct patterns of GWG in twin pregnancies are associated with varying risks of adverse perinatal outcomes. These findings highlight the importance of monitoring and managing GWG in twin pregnancies.

Reconsideration of lowering gestational weight gain guidelines in pregnant women diagnosed with gestational diabetes: evidence from a Belgian study

BACKGROUND

The suitability of the United States National Academy of Medicine guidelines for gestational weight gain in women with gestational diabetes remains uncertain, raising global concerns. This study aimed to evaluate the association of gestational weight gain with pregnancy and birth outcomes and to determine optimal ranges for gestational weight gain per pre-pregnancy body mass index category in women with gestational diabetes.

METHODS

An epidemiological analysis between 2009-2018 analyzed a large Belgian cohort of singleton pregnancies with gestational diabetes and gestational age 38-40 weeks. Multivariate logistic regression assessed associations between gestational weight gain and relevant pregnancy and birth outcomes, with and without adjustment for confounding variables, including maternal age, origin, education, mode of conception, parity, gestational age at delivery, social deprivation, and year of delivery. Potential optimal weight gain ranges were calculated by minimizing the combined risk of small- and large-for-gestational-age infants (SGA, LGA).

RESULTS

A total of 13,060 women with gestational diabetes were included. Compared to recommended weight gain, gestational weight gain above guidelines occurred in 26.9% and was associated with an increased risk of gestational hypertension (aOR 1.41, 95% CI 1.20-1.66, p < 0.001), emergency caesarean section (aOR 1.45, 95% CI 1.25-1.69, p < 0.001), LGA infants (aOR 1.84, 95% CI 1.63-2.08, p < 0.001), and macrosomia (aOR 1.78, 95% CI 1.55-2.04, p < 0.001). Weight gain less than recommended (40.2%) was associated with a decreased risk of gestational hypertension (aOR 0.81, 95% CI 0.69-0.96, p = 0.015), LGA infants (aOR 0.58, 95% CI 0.50-0.66, p < 0.001), and macrosomia (aOR 0.57, 95% CI 0.49-0.65, p < 0.001), but at the expense of an increased risk of SGA infants (aOR 1.68, 95% CI 1.45-1.96, p < 0.001) and low birth weight (aOR 2.28, 95% CI 1.57-3.32, p < 0.001). Based on current analysis, the optimal ranges for gestational weight gain would be 9 to 14 kg for women with a normal weight, 1 to 9 kg for women with overweight, and -7 to 1 kg for women with obesity.

CONCLUSIONS

This Belgian study suggests that optimal gestational weight gain for singleton at-term pregnancies complicated by gestational diabetes should be lower than current recommendations, highlighting the need to reevaluate gestational weight gain guidelines in this context.

Healthy Mom Zone Adaptive Intervention With a Novel Control System and Digital Platform to Manage Gestational Weight Gain in Pregnant Women With Overweight or Obesity: Study Design and Protocol for a Randomized Controlled Trial

BACKGROUND

Regulating gestational weight gain (GWG) in pregnant women with overweight or obesity is difficult, particularly because of the narrow range of recommended GWG for optimal health outcomes. Given that many pregnant women show excessive GWG and considering the lack of a "gold standard" intervention to manage GWG, there is a timely need for effective and efficient approaches to regulate GWG. We have enhanced the Healthy Mom Zone (HMZ) 2.0 intervention with a novel digital platform, automated dosage changes, and personalized strategies to regulate GWG, and our pilot study demonstrated successful recruitment, compliance, and utility of our new control system and digital platform.

OBJECTIVE

The goal of this paper is to describe the study protocol for a randomized controlled optimization trial to examine the efficacy of the enhanced HMZ 2.0 intervention with the new automated control system and digital platform to regulate GWG and influence secondary maternal and infant outcomes while collecting implementation data to inform future scalability.

METHODS

This is an efficacy study using a randomized controlled trial design. HMZ 2.0 is a multidosage, theoretically based, and individually tailored adaptive intervention that is delivered through a novel digital platform with an automated link of participant data to a new model-based predictive control algorithm to predict GWG. Our new control system computes individual dosage changes and produces personalized physical activity (PA) and energy intake (EI) strategies to deliver just-in-time dosage change recommendations to regulate GWG. Participants are 144 pregnant women with overweight or obesity randomized to an intervention (n=72) or attention control (n=72) group, stratified by prepregnancy BMI (<29.9 vs ≥30 kg/m2), and they will participate from approximately 8 to 36 weeks of gestation. The sample size is based on GWG (primary outcome) and informed by our feasibility trial showing a 21% reduction in GWG in the intervention group compared to the control group, with 3% dropout. Secondary outcomes include PA, EI, sedentary and sleep behaviors, social cognitive determinants, adverse pregnancy and delivery outcomes, infant birth weight, and implementation outcomes. Analyses will include descriptive statistics, time series and fixed effects meta-analytic approaches, and mixed effects models.

RESULTS

Recruitment started in April 2024, and enrollment will continue through May 2027. The primary (GWG) and secondary (eg, maternal and infant health) outcome results will be analyzed, posted on ClinicalTrials.gov, and published after January 2028.

CONCLUSIONS

Examining the efficacy of the novel HMZ 2.0 intervention in terms of GWG and secondary outcomes expands the boundaries of current GWG interventions and has high clinical and public health impact. There is excellent potential to further refine HMZ 2.0 to scale-up use of the novel digital platform by clinicians as an adjunct treatment in prenatal care to regulate GWG in all pregnant women.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/66637.

Gestational weight trajectory and early offspring growth differed by gestational diabetes: a population-based cohort study

AIMS

To investigate the association of gestational weight gain (GWG) trajectory with early children growth, and explore whether this association varies by gestational diabetes mellitus (GDM) status.

METHODS

Maternal weight and offspring anthropometric outcomes before 36 months were extracted from Electronic Medical Record of Zhoushan, China. GWG trajectory was modeled using latent-class trajectory analysis. Multiple generalized estimating equations models were applied to analyze associations of GWG trajectory categories with early children growth.

RESULTS

Three GWG trajectory classes were identified in all participants (n = 13 424), the non-GDM (n = 10 984) and GDM (n = 2440) groups, respectively. In all participants, the Slow-Rapid pattern was significantly associated with lower length z-scores of offspring (β = -0.084; se = 0.015), compared to the Moderate pattern, while the Rapid-Slow pattern was significantly associated with higher length z-scores (β = 0.083; se = 0.022), with no significant effects on other anthropometric outcomes. Similar results were also observed in the non-GDM group. However, in the GDM group, offspring of mothers with the Rapid-Slow pattern showed significantly higher weight z-scores (β = 0.093; se = 0.046), BMI z-scores (β = 0.113; se = 0.052), and risk of overweight/obesity (OR = 1.40, 95%CI: 1.11, 1.76).

CONCLUSION

GWG trajectory significantly impacted offspring growth before 36 months, with different effects observed based on GDM status. GWG trajectory primarily affected offspring length in the non-GDM group, whereas earlier high weight gain appeared to increase offspring weight, BMI, and risk of overweight/obesity in the GDM group.

Effects of a Mobile Health Intervention Based on Behavioral Integrated Model on Cognitive and Behavioral Changes in Gestational Weight Management: Randomized Controlled Trial

BACKGROUND

The key to gestational weight management intervention involves health-related behaviors, including dietary and exercise management. Behavioral theory-based interventions are effective in improving health-related behaviors. However, evidence for mobile health interventions based on specific behavioral theories is insufficient and their effects have not been fully elucidated.

OBJECTIVE

This study aimed to examine the effects of a gestational mobile health intervention on psychological cognition and behavior for gestational weight management, using an integrated behavioral model as the theoretical framework.

METHODS

This study was conducted in a tertiary maternity hospital and conducted as a single-blind randomized controlled trial (RCT) in Changzhou, Jiangsu Province, China. Using the behavioral model, integrated with the protection motivation theory and information-motivation-behavioral skills model (PMT-IMB model), the intervention group received a mobile health intervention using a self-developed app from 14 to 37 gestational weeks, whereas the control group received routine guidance through the application. Psychological cognition and behaviors related to weight management during pregnancy were the main outcomes, which were measured at baseline, and at the second and third trimesters of pregnancy using a self-designed questionnaire. Generalized estimation and regression equations were used to compare the outcome differences between the intervention and control groups.

RESULTS

In total, 302 (302/360, 83.9%) participants underwent all measurements at 3 time points (intervention group: n=150; control group: n=152). Compared with the control group, the intervention group had significantly higher scores for information, perceived vulnerability, response cost, and exercise management in the second trimester, while their scores for perceived vulnerability, response cost, and diet management were significantly higher in the third trimester. The results of repeated measures analysis revealed that, in psychological cognition, the information dimension exhibited both the time effects (T3 β=3.235, 95% CI 2.859-3.611; P<.001) and the group effects (β=0.597, 95% CI 0.035-1.158; P=.04). Similarly, response costs demonstrated both the time effects (T3 β=0.745, 95% CI 0.199-1.291; P=.008) and the group effects (β=1.034, 95% CI 0.367-1.700; P=.002). In contrast, perceived vulnerability solely exhibited the group effects (β=0.669, 95% CI 0.050-1.288; P=.03). Regarding weight management behaviors, both time (T3 β=6, 95% CI 4.527-7.473; P<.001) and group (β=2.685, 95% CI 0.323-5.047; P=.03) had statistically significant impacts on the total points. Furthermore, the exercise management dimension also demonstrated both the time effects (T3 β=3.791, 95% CI 2.999-4.584; P<.001) and the group effects (β=1.501, 95% CI 0.232-2.771; P=.02).

CONCLUSIONS

The intervention program was effective in increasing psychological cognitions in terms of information, perceived vulnerability, and response costs, as well as promoting healthy behaviors among Chinese pregnant women. This study provides new evidence supporting the effectiveness of mobile intervention based on behavioral science theory in gestational weight management.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2100043231; https://www.chictr.org.cn/showproj.html?proj=121736.

Association between protein intake and sources in mid-pregnancy and the risk of gestational diabetes mellitus

OBJECTIVES

This study aimed to investigate the relationship between dietary protein intake and sources in the second trimester of pregnancy and the risk of gestational diabetes mellitus (GDM) and to further investigate the effects of total protein and animal protein intake on the risk of GDM.

METHODS

A case-control study was conducted, which involved 947 pregnant women in the second trimester from three hospitals in Jiangsu, China. Dietary intake was assessed using a 3-day 24-hour dietary recall and a food frequency questionnaire. Two models (leave-one-out and partition models) in nutritional epidemiology were used for substitution analysis, and logistic regression was performed to explore the relationships, adjusting for multiple confounding factors.

RESULTS

After adjusting for confounding factors, total protein intake was negatively correlated with GDM risk (OR [95% CI], 0.10 [0.04-0.27]; P<0.001). Animal protein also negatively correlated with GDM risk, but this became insignificant when total calorie, carbohydrate and fat intake were added as covariates to the analysis (0.68 [0.34-1.34]; P = 0.263). No association was found between plant protein and GDM(1.04 [0.69-1.58]; P = 0.852). Replacing carbohydrates with an equal energy ratio(5% of total energy intake) of total protein, animal protein and plant protein respectively reduced the risk of GDM by 45%, 46% and 51%.

CONCLUSIONS

The intake of total protein and animal protein, especially eggs, dairy products, and fish, can reduce the risk of GDM while consuming unprocessed red meat increases the risk. There is no significant association between the intakes of plant protein, processed meat, and poultry meat and the occurrence of GDM. The results of this study are expected to provide a basis for precise nutritional education, health guidance during pregnancy, and early prevention of GDM.

Establishment of a predictive model for spontaneous preterm birth in primiparas with grade A1 gestational diabetes mellitus

Objective

To establish a predictive model for spontaneous preterm birth (SPB) in primiparas with grade A1 gestational diabetes mellitus (GDM).

Methods

The clinical data of 1,229 primiparas with grade A1 GDM who delivered in our hospital from July 2020 to August 2023 were retrospectively analyzed, including 142 primiparas in the SPB group and 1,087 primiparas in the full-term group. Their basic information, family history, weight, cervical length (CL) measured by transvaginal ultrasound in the second trimester, and pregnancy complications were analyzed. The factors influencing SPB were explored, and a prediction model based on a random forest algorithm was constructed.

Results

Short CL in the second trimester, a family history of preterm birth, a high pre-pregnancy and prenatal body mass index, the use of assisted reproductive technology, and a high fasting blood glucose level in the first trimester were important risk factors for SPB in primiparas with grade A1 GDM. The prediction model constructed in this study has a high overall prediction angle.

Conclusions

Evaluation of the above risk factors before or during pregnancy and preventive measures and interventions targeting these risk factors will reduce the risk of SPB in primiparas with grade A1 GDM.

Hypertensive pregnancy disorder, an under-recognized women specific risk factor for heart failure?

During pregnancy, the maternal cardiovascular (CV) system undergoes major haemodynamic alterations ensuring adequate placental perfusion and a healthy pregnancy course. Hypertensive disorders of pregnancy (HDP) occur in almost 10% of gestations and preeclampsia, a more severe form, in 3-4%. Women with HDP demonstrated impaired myocardial function, biventricular chamber dysfunction and adverse biventricular remodelling. Shortly after delivery, women who experienced HDP express increased risk of classic CV risk factors such as hypertension, renal disease, abnormal lipid profile, and diabetes. Within the first two decades following a HDP, women experience increased rates of heart failure, chronic hypertension, ischaemic heart and cerebral disease. The mechanism underlying the relationship between HDP in younger women and CV disease later in life could be explained by sharing pre-pregnancy CV risk factors or due to a direct impact of HDP on the maternal CV system conferring a state of increased susceptibility to future metabolic or haemodynamic insults. Racial disparities in CV risk and social determinants of health also play an important role in their remote CV risk. Although there is general agreement that women who suffered from HDP should undertake early CV screening to allow appropriate prevention and timely treatment, a screening and intervention protocol has not been standardized due to limited available evidence. In this review, we discuss why women with hypertensive pregnancy may be disproportionately affected by heart failure with preserved ejection fraction and how cardiac remodelling during or after pregnancy may influence its development.

Attitudes, Beliefs, and Predictors of Gestational Weight Gain and Postpartum Weight Retention in South Africa: A Mixed Methods Analysis

Suboptimal gestational weight gain (GWG) is associated with pregnancy complications and postpartum weight retention (PPWR). Little data exists about GWG and PPWR attitudes and beliefs in low-and-middle-income countries (LMICs) to inform interventions. We examined GWG and PPWR attitudes, beliefs, and intentions among pregnant people, with and without HIV, in Cape Town, South Africa. Pregnant persons were enrolled between 2019 and 2022 (N = 400). Study visits were conducted at 24-28 weeks' and 33-38 weeks' gestation. Rate of GWG (kg/week) between the second and third trimesters was estimated and reported as below, above, or within the 2009 Institute of Medicine guidelines. Multivariable-multinomial regression estimated predictors of GWG. In-depth interviews among pregnant participants, community leaders and healthcare providers informed GWG attitudes, beliefs, and perceptions. Over 90% of participants experienced suboptimal rates of GWG (35% below and 47% above guidelines) during pregnancy. Living with HIV [OR 0.50, 95% CI (0.26-0.95)] was protective against GWG rate above guidelines compared to those without HIV. Being 25-29 years old was associated with GWG rate below guidelines [OR 0.28 95% CI (0.08-0.95)]. Little concordance occurred between intended and true GWG. Despite GWG category, two-thirds of participants felt it was 'very important' to monitor GWG while 44% viewed losing weight gained during pregnancy as "not important". Barriers to meeting GWG goals included lack of access to healthy foods, exercise opportunities, and education. Given rising obesity in women of reproductive age in LMIC, locally-adapted interventions are needed during pregnancy and postpartum to aide in healthy GWG and improve maternal-child health outcomes.

Protocol for a randomised controlled trial of a weight maintenance intervention to promote fat loss in pregnant individuals with obesity

INTRODUCTION

In pregnancy, people with obesity or excess adiposity are prone to excess gestational weight gain (GWG) and have the highest risks for multiple maternal morbidities. Epidemiological studies suggest that the lowest incidence of adverse maternal and infant outcomes occurs with GWG lower than current recommendations (<5 kg) and with gestational weight maintenance, resulting in fat mass loss, in those with obesity. Data from randomised clinical trials are needed to evaluate the efficacy of a fat mass loss intervention on pregnancy outcomes. The objective of this proof-of-principle randomised controlled trial is to test the effect of a gestational fat mass loss intervention in pregnant individuals with obesity on changes in weight, fat mass and cardiometabolic disease risk factors.

METHODS AND ANALYSIS

In this two-site randomised parallel group, 100 women (30% black; 30% Hispanic) with pre-existing obesity (31.0≤body mass index≤55.0 kg/m2) are randomised to usual care (Provider Directed Group) or usual care plus a fat mass loss intervention with food provision (Weight Maintenance Group). The primary outcomes of the trial (Healthy Mamas/Mamis Saludables) are weight, fat mass (via three-compartment model) and cardiometabolic disease risk factors (ie, blood pressure, lipids, glucose, insulin) from baseline (~13 weeks gestation) to ~35 weeks gestation and at 2 weeks postpartum. Secondary aims evaluate the safety of the fat mass loss intervention during pregnancy and test the hypotheses that compared with usual care, the intervention will have no significant adverse effect on fetal growth, neonatal size, infant body composition and other adverse events. Mediators (eg, eating, activity) and moderators (eg, parity, obesity grade, race/ethnicity) of intervention effects are also examined. Finally, the study will explore the effect of prenatal fat mass loss on reducing the incidence of adverse obstetrical outcomes, including non-elective caesarean delivery, gestational diabetes, hypertension and pre-eclampsia.

ETHICS AND DISSEMINATION

The trial has been approved by the Pennington Biomedical Research Center Institutional Review Board, is monitored by an independent data and safety monitoring board and will be conducted in agreement with the Declaration of Helsinki. All results, positive, negative and inconclusive, will be disseminated at national and/or international scientific meetings and in peer-reviewed scientific journals.

TRIAL REGISTRATION NUMBER

NCT04731688.

Gestational Weight Gain as a Modifiable Risk Factor in Women with Extreme Pregestational BMI

The global rise in obesity presents serious concerns, particularly due to its association with pregnancy complications such as gestational diabetes, preeclampsia, cesarean delivery, and fetal macrosomia. Maternal obesity also contributes to intergenerational health risks, increasing the likelihood of long-term issues in offspring. Preconception counseling is an essential preventive measure to reduce complications; however, many women miss this opportunity due to unplanned pregnancies. This study explores the impact of pregestational body mass index (BMI) and gestational weight gain (GWG) on pregnancy outcomes, underscoring the importance of routine monitoring of these parameters. Existing studies identify both BMI and GWG as independent risk factors for adverse maternal and neonatal outcomes, with elevated BMI combined with excessive GWG posing an even greater risk. Specifically, a BMI > 30 kg/m2 doubles the risk of complications such as gestational diabetes, hypertension, and cesarean delivery. Additionally, a review of national and international guidelines highlights a lack of consensus on managing gestational weight gain in women with obesity, particularly regarding antepartum surveillance and timing of delivery. Similarly, no specific guidelines have been established for underweight pregnant women. Additionally, few studies have thoroughly assessed the maternal and fetal risks associated with underweight during pregnancy. Despite this, numerous studies have highlighted an increased risk of preterm birth (PTB) and small-for-gestational-age (SGA) infants. This narrative review emphasizes the need for further research to develop tailored guidelines for managing pregnant women based on pregestational BMI, ultimately improving maternal and neonatal health outcomes.

The Impact of Excessive Gestational Weight Gain on Adverse Perinatal Outcomes: A Systematic Review

Background/Objectives: The purpose of this study was to systematically review the potential effects of a pregnant woman's excessive gestational weight gain on adverse perinatal outcomes affecting the mother and the fetus/neonate. Methods: Medline/PubMed, Scopus, CADTH Grey Matters and National Archive of PhD Theses were systematically searched for all relevant studies published. Assessments of the risk of bias in the included studies were made according to the tool "The Newcastle-Ottawa Scale (NOS)". Results: Five publications met all the inclusion criteria and were included in this review. The risk of bias in all the included studies was low. One study supports the detrimental effect of excessive gestational weight gain on the risk of gestational diabetes mellitus, one study on the risk of preterm birth, five studies on the risk of macrosomia-high birthweight of the neonate, three studies on the risk of a large-for-gestational-age neonate, three studies on the risk of hypertensive disorders of pregnancy, one study on the risk of gestational hypertension and preeclampsia, five studies on the risk of delivery by cesarean section and one study on the risk of neonatal hypoglycemia requiring treatment. One study supports the beneficial effect of excessive gestational weight gain on the risk of preterm birth, two studies on the risk of a small-for-gestational-age neonate and two studies on the risk of low birthweight of the neonate. Conclusions: The study presents the most recent and strong evidence regarding the negative effect of excessive gestational weight gain on most adverse perinatal outcomes. However, excessive gestational weight gain has a beneficial effect in a very limited number of outcomes.

The Dose-Dependent Effect of Obesity on Adverse Maternal and Neonatal Outcomes in a Hispanic Population

OBJECTIVE

 This study aimed to evaluate the frequency of adverse maternal and neonatal outcomes associated with maternal obesity in a Hispanic population. We hypothesized that obesity confers a dose-dependent risk associated with these outcomes.

STUDY DESIGN

 This was a retrospective cohort study of singleton pregnancies delivered between 24 and 42 weeks gestation at an urban county hospital between 2013 and 2021. Body mass index (BMI) at the first prenatal visit was used as a proxy for prepregnancy weight. Patients were excluded if their first-trimester BMI was not available. Trends in adverse outcomes across increasing obesity classes were assessed.

RESULTS

 During the study period, 58,497 patients delivered a singleton infant, of which 12,365 (21.1%), 5,429 (9.3%), and 3,482 (6.0%) were in class I, II, and III obesity, respectively. Compared with nonobese patients, obese patients were more likely to be younger and nulliparous with a higher incidence of hypertension and pregestational diabetes. Higher BMI was associated with a significant dose-dependent increase in cesarean delivery (27% for nonobese, 34% for class I, 39% for class II, and 46% for class III obesity); severe preeclampsia (8% in nonobese and 19% for class III obesity); and gestational diabetes (5% in nonobese and 15% in class III obesity). There were significant trends in increasing morbidity for infants born to patients with correspondingly higher obesity classes. Some of these adverse outcomes included respiratory distress syndrome, neonatal intensive care unit admission, fetal anomalies, and sepsis (all p < 0.001).

CONCLUSION

 Increasing body mass index is associated with a significant dose-dependent increase in multiple adverse perinatal outcomes in a Hispanic population. Associated adverse maternal outcomes include severe preeclampsia, gestational diabetes, and cesarean delivery. Infants born to patients with correspondingly higher BMI class have significantly increased associated morbidity. Often, only higher BMI classes are significantly associated with these adverse outcomes.

KEY POINTS

· As BMI increases, pregnant patients are more likely to experience adverse maternal and neonatal outcomes.. · Many adverse pregnancy outcomes are associated only with a BMI greater than 40 kg/m2.. · Obesity is associated with cesarean delivery, likely due to an increase in labor dystocia..

Impact of pre-pregnancy body mass index on preeclampsia

Background

It remains unclear how pre-pregnancy body mass index (BMI) affects preeclampsia in the Chinese population, primarily due to insufficient large-scale research on this topic.

Objective

The study aimed to determine the relationship between pre-pregnancy BMI and (severe) preeclampsia in the Chinese population, providing a detailed description of the findings.

Methods

The retrospective study included a total of 75,773 pregnant women registered between 2016 and 2020. These participants were categorized into four groups based on their pre-pregnancy BMI: underweight (BMI < 18.5 kg/m2), normal weight (BMI 18.5-<24 kg/m2), overweight (BMI 24-<28 kg/m2), and obese (BMI ≥ 28 kg/m2). The relationship between risks of preeclampsia or severe preeclampsia and pre-pregnancy BMI were further explored, with an evaluation of potential modification by maternal age.

Results

A lower risk of developing preeclampsia was observed in the underweight population, with an OR of 0.604 (95%CI, 0.507-0.719). In contrast, women who were overweight or obese during the pre-pregnancy period demonstrated a significantly higher risk of preeclampsia, with ORs of 2.211 (95%CI, 1.967-2.486) and 3.662 (95%CI, 3.026-4.431), respectively. After adjusting for confounding factors, the elevated risk of preeclampsia persisted, showing ORs of 2.152(95%CI, 1.911-2.425) for the overweight population and 3.493 (95%CI, 2.874-4.245) for those who were obese, while the risk for underweight women remained lower, with an OR of 0.609(95%CI, 0.511-0.727). For severe preeclampsia, the risk was also higher in the overweight and obese participants after adjusting for confounders, demonstrating ORs of 1.652(95%CI, 1.364-2.001) and 2.762(95%CI, 2.014-3.788), respectively. The underweight population exhibited a lower risk of severe preeclampsia, with an OR of 0.720(95%CI, 0.565-0.919). In addition, these risks were not significantly associated with maternal age.

Conclusion

Regardless of adjustment for confounders, underweight women demonstrated a lower risk of preeclampsia, whereas the overweight/obese population exhibited a higher occurrence of both preeclampsia and severe preeclampsia. These associations were not influenced by maternal age.

Association between gestational weight gain and adverse pregnancy outcomes: cohort analysis from South Asia and Sub-Saharan Africa

Introduction

Studies of gestational weight gain (GWG) and adverse pregnancy outcomes seldom focus on low-to-middle-income countries (LMICs), despite their high burden of morbidity and mortality. We examined GWG patterns and adverse pregnancy outcomes in a consortium of pregnancy cohorts from LMICs.

Methods

We analysed data from five observational pregnancy cohorts in Bangladesh (two cohorts), India, Pakistan and Zambia. The study population comprised 15 286 singleton pregnancies with two or more maternal antenatal weight measurements. We estimated reference values for GWG using longitudinal models and calculated weight gain for gestational age Z-scores. We then estimated the associated risks of preterm birth, low birth weight, and small for gestational age, stratified by maternal body mass index (BMI), using marginal generalised linear models and plotted non-linear trends in the associations.

Results

The median baseline maternal and gestational age were 24 years (IQR, 21-28) and 13 weeks (IQR 11-16), respectively, with 23% of participants having underweight BMI. The median GWG was 6.8 kg (4.2-9.4) and varied across cohorts from 6.1 kg (3.7-8.5; Bangladesh) to 7.0 kg (4.0-10.0; Zambia). The risk of preterm birth (13%) increased with lower GWG Z-scores among underweight (adjusted risk ratio (ARR), 1.4; 95% CI, 1.1 to 1.9 for lowest Z-score group) and normal BMI participants (ARR, 1.1; 95% CI, 1.0 to 1.2). The risk of low birth weight (25%) increased with lower GWG Z-scores in all BMI strata except obese participants (ARR, 1.7; 95% CI 1.5 to 1.9 among underweight). The risk of small for gestational age (36%) increased with lower GWG Z-scores in all BMI strata (ARR, 1.3; 95% CI 1.2 to 1.4 among underweight). In secondary analyses, alternative measures of GWG (adequacy ratio; INTERGROWTH-21st) had associations that were consistent with those from our study-specific Z-scores, except for a less clear association between preterm birth and INTERGROWTH-21st Z-score.

Conclusion

GWG was associated with preterm birth, low birth weight and small for gestational age. Early pregnancy BMI modified the association between GWG and outcomes in the study setting.

Associations of Sociodemographic Factors With Clusters of Obesity-Risk Behaviours Among Pregnant Women in Australia

BACKGROUND

Maternal obesity-risk behaviours during pregnancy have a direct impact on the weight trajectory of their children. Targeting these behaviours may help improve birth outcomes and child health. This study aimed to identify sociodemographic factors associated with unhealthy dietary behaviours and insufficient physical activity in pregnant women.

MATERIALS AND METHODS

We undertook a cross-sectional secondary analysis using data from the Communicating Healthy Beginnings Advice by Telephone (CHAT) trial conducted in NSW, Australia in 2017-2019. Multiple logistic regression models were built to determine associations.

RESULTS

A total of 1155 pregnant mothers attended antenatal clinics from 28 to 34 weeks gestation. Younger age (< 30 years, adjusted odds ratio [AOR] 2.01, 95% confidence interval [CI] 1.53-2.64) and paternal unemployment (AOR1.86, 95% CI1.44-2.39) were associated with a cluster of unhealthy dietary behaviours. Excessive intake of discretionary foods (processed meat, fast food, potato crisps) was associated with: younger age (AOR1.62, 95% CI 1.24-2.11), being Australian-born (AOR1.55, 95% CI 1.20-2.01), paternal unemployment (AOR1.57, 95% CI 1.01-2.43) and lower paternal education level (AOR1.77, 95% 1.37-2.28). Insufficient physical activity behaviours were associated with maternal employment (AOR1.55, 95% CI 1.21-1.98) and those with tertiary-level education (AOR1.39, 95% CI 1.08-1.79).

CONCLUSIONS

Mothers aged under 30 years and those born in Australia were more likely to have a cluster of obesity-risk behaviours. Maternal and paternal employment status, and education level were also associated with such clusters.

Adverse perinatal outcomes related to pregestational obesity or excessive weight gain in pregnancy

OBJECTIVES

To evaluate outcomes related to pregestational obesity and excessive weight gain during pregnancy.

METHODS

This retrospective cohort was conducted from August to December 2020. Participants were divided into four groups: non-obese with non-excessive weight gain (n=765, 45.9 %), obese with non-excessive weight gain (n=190, 11.4 %), non-obese with excessive weight gain (n=532, 31.9 %), and obese with excessive weight gain (n=179, 10.7 %). The outcomes were evaluated for gestational diabetes (GDM), pregnancy-induced hypertension (PIH), newborn large for gestational age (LGA) and cesarean delivery. A p-value of <0.05 was considered significant.

RESULTS

The odds of GDM were significant in groups 2 (CR, 3.6; 95 %CI, 2.5-5.2) and 4 (CR,1.9; 95 %CI, 1.3-2.9). The odds of PIH in groups 3 (CR, 1.7; 95 %CI, 1-2.6) and 4 (CR,3.1; 95 %CI, 1.9-5.2) and those of LGA newborns in groups 2 (CR, 2.0; 95 %CI, 1.2-3.3), 3 (CR, 2.6; 95 %CI, 1.9-3.7), and 4 (CR, 3.2; 95 %CI, 2-5) were high.

CONCLUSIONS

The odds of GDM were higher in participants with pregestational obesity, while the odds of PIH were higher in participants with excessive weight gain. All groups analyzed, except the reference group, had greater chances of LGA newborns. the form of delivery was not affected.

Gestational weight gain patterns as predictors of cesarean deliveries in women diagnosed with gestational diabetes mellitus

BACKGROUND

Obesity and excessive gestational weight gain (GWG) have been linked to an increased risk of cesarean section. However, existing literature primarily focuses on weight gain during individual trimesters, lacking a comprehensive assessment of GWG trajectories across all three trimesters. This study aimed to investigate the impact of pre-pregnancy BMI and changes in GWG trajectories from the first to the third trimester on cesarean section in women with confirmed gestational diabetes mellitus (GDM).

METHODS

This retrospective cohort study enrolled 947 women with GDM who delivered between January 2012 and July 2022 in northern Taiwan. GDM was diagnosed by oral glucose tolerance test (OGTT) during 24-28 weeks of gestation. Body mass index cut-offs were based on Asian-specific guidelines. The weekly GWG rate was based on baseline weight and weight at two follow-up measurements. GWG patterns were identified using group-based trajectory modeling analysis (GBTM).

RESULTS

Gestational weight gain patterns were classified into two groups during the pregnancy period: group 1 (non-rapid excessive weight gain) and group 2 (rapid excessive weight gain), comprising 70.2% and 29.8% of participants, respectively. Our study found that being pre-pregnancy underweight and experiencing rapid excessive weight gain contributed to cesarean section. Binary logistic regression analysis revealed that pre-pregnancy normal body mass index (OR = 2.06; 95% CI: 1.08-3.92) and being overweight/obese (OR = 4.04; 95%CI: 2.12-7.70) were associated with the incidence of cesarean sections. Multiparous women and women with a trajectory of rapid excessive weight gain were more likely to undergo cesarean sections.

CONCLUSIONS

Healthcare professionals should provide education on weight management from pre-pregnancy to pregnancy to reduce the incidence of cesarean sections. Particular attention should be paid to women with gestational diabetes mellitus (GDM) who exhibit rapid excessive weight gain to minimize the risk of cesarean delivery.

The association between self-reported total gestational weight gain by pre-pregnancy body mass index and moderate to late preterm birth

BACKGROUND

Inadequate and excessive gestational weight gain (GWG) defined by the Institute of Medicine (IOM) has been associated with preterm birth. However, studies demonstrate inconsistent associations.

OBJECTIVES

We examined the associations between categorical and continuous total GWG and moderate to late preterm birth (32-<37 weeks), and evaluated differences in these associations by pre-pregnancy BMI.

METHODS

We analyzed cross-sectional data from children participating in TARGet Kids! in Toronto, Canada. Parents of children < 6 years of age recalled pre-pregnancy weight, end-of-pregnancy weight, and gestational age. GWG was categorized according to the 2009 IOM guidelines as inadequate, recommended, or excessive for each pre-pregnancy BMI category. GWG was expressed as the percentage of recommendations met to account for gestational duration. Adjusted odds ratios (aORs) for moderate to late preterm birth were estimated using logistic regression models. Restricted cubic splines were used to model the adjusted predicted probability of moderate to late preterm birth against continuous GWG.

RESULTS

Of the 4,529 participants, 8.2% were born moderate to late preterm. 31.1% of parents met the GWG recommendations, 41.0% had excessive GWG, and 27.9% had inadequate GWG. Compared to recommended GWG, excessive GWG had increased odds of moderate to late preterm birth (aOR 1.68, 95% CI 1.29, 2.19). There was insufficient evidence of an association between inadequate GWG and moderate to late preterm birth (aOR 1.10, 95% CI 0.81, 1.50). For parents who were overweight or had obesity, the risk of moderate to late preterm birth did not increase substantially until a GWG > 200% of the recommendations, which is well above the IOM recommended upper limit.

CONCLUSIONS

Excessive GWG was associated with an increased risk of moderate to late preterm birth, with variation in the association by pre-pregnancy BMI. Current definitions of excessive GWG may not adequately reflect increased risk of preterm birth among those with overweight or obesity.

Maternal high BMI: Sex-dimorphic alterations in maternal and offspring stress indices

Maternal body mass index (BMI) influences pregnancy and birth outcomes along with child metabolic and neurodevelopmental health and fetal sex may be a moderating factor in these effects. Alternations in autonomic nervous system (ANS) functioning, identified in heart rate (HR) measurements, could present early markers of these prenatal programming effects in both the mother and the developing fetus. This study examines the associations between pre-pregnancy BMI and maternal and fetal ANS functioning and infant postnatal behavioral outcomes stratified by fetal sex. Pregnant women (N=176) were recruited at gestational week (GW) T1: 12-22 and categorized into Normal (BMI< 25) or High BMI (BMI > 25). Women attended laboratory sessions at T2: GW 23-28, and T3: GW 34-36 to assess maternal and fetal HR and HR variability (HRV) at baseline and after a stressor at T3. Infant behavior was assessed at 4 months using the Infant Behavior Questionnaire-Revised. Women with high BMI bearing female fetuses had higher HR and lower HRV at both gestational time points. Later in the third trimester, female fetuses of high BMI women exhibited lower HRV when challenged with a stressor. At 4 months, female infants were rated as having lower scores on the Orienting/Regulatory scale. Our findings provide evidence of female sex-specific programming of maternal pre-pregnancy BMI on maternal ANS regulation and neurodevelopment identified in-utero and continuing into early infancy.

Seeking the optimal gestational weight gain according to the pre-pregnancy body mass index: a cross-sectional study from Shanghai, China

OBJECTIVES

Maternal nutritional status is closely related to fetal intrauterine development and an abnormal birth weight increases various disease risks across life stages. To better guide pregnancy weight gain, we aimed to explore the optimal weight gain for pregnant women with different body mass indexes (BMIs).

METHODS

This retrospective cohort study included 68,981 women with singleton live birth between January 2017 and October 2021 in maternity centres in Shanghai, China. The fluctuations of the incidence of small and large for gestational age (small for gestational age (SGA) and LGA, respectively) were recorded at different maternal pre-pregnancy BMI (p-BMI) and different gestational weight gain (GWG) groups to find the lowest point of abnormal fetal weight incidence. The optimal GWG was then determined using a linear regression equation.

RESULT

The lowest risk of LGA/SGA was associated with a maternal p-BMI of 19.46 kg/m2. For pregnant women with maternal p-BMI below 24 kg/m2, we confirmed an optimal GWG linear equation: opt GWG (kg) = -1.94 × p-BMI (kg/m²) + 51, which showed an excellent degree of fit. Women who were overweight and obese could not achieve the lowest risk of LGA/SGA despite controlling their GWG; hence, their BMI should be normalized before pregnancy.

CONCLUSION

By merely using the pre-pregnancy BMI, this study has established the optimal GWG equation, with the goal of achieving the appropriate fetal gestational age. It is a practical measure to ensure desirable pregnancy outcomes and meet the health economics requirements.

Breastfeeding initiation according to the severity of Class 3 obesity

Background: Class 3 obesity is composed of morbid (BMI 40-49 kg/m2) and extreme (BMI ≥ 50 kg/m2) subgroups. Adverse perinatal outcomes have been associated with obesity; however, data on breastfeeding (BF) initiation for women in either group remains limited.Objective: To compare BF initiation rates (exclusive or partial BF) and related comorbidities of 890 women with morbid and 890 with extreme obesity matched by race, parity, and year of delivery.Methods: Retrospective cohort study of women who delivered singletons at ≥ 34 weeks gestation (2013-2021). Those who had bariatric surgery or infants with major malformations were excluded.Results: Both groups were similar in: primiparity (38%), age (29y), white race (58%), African American (36%), current (10 vs 12%) and former (25 vs 27%) smokers, gestational hypertension (15 vs 16%), polycystic ovary syndrome (5 vs 7%), gastroesophageal reflux disease (10 vs 10%), and anemia (17 vs 17%). Women in the extreme group had a higher prevalence of gestational (17 vs 12%) and pregestational diabetes (12 vs 6%), chronic hypertension (41 vs 17%), severe preeclampsia (18 vs 12%), obstructive sleep apnea (12 vs 3%), asthma (22 vs 16%), and cesarean deliveries (62 vs 44%). Intention to BF (64 vs 71%), exclusive BF (23 vs 34%), and BF initiation (57 vs 64%) rates were lower in the extreme obesity group at discharge.Conclusion: Higher frequency of comorbidities in the extreme obesity group highlights the need for antenatal, intrapartum, and postpartum targeted interventions if the benefits of BF to mothers and infants are to be realized.

The interplay of body mass index, gestational weight gain, and birthweight over 3800 g in vaginal breech birth: A retrospective study

INTRODUCTION

Optimal counseling of women for vaginal breech birth requires consideration of both established and emerging risk factors for adverse perinatal outcomes. Currently, rising prevalences of maternal obesity and impaired glucose tolerance challenge obstetric care. We aimed to investigate the effects of these parameters on the outcome of vaginal breech birth to improve counseling practices.

MATERIAL AND METHODS

A total of 361 women (without previous vaginal births) attending vaginal birth of a singleton fetus in breech presesntation between 01/2015 and 11/2021 were included in this retrospective single-center study. Data were derived from the hospital data base. We analyzed the effect of the maternal body mass index (BMI) at birth (compared to pre-pregnancy BMI), excessive weight gain, gestational diabetes, and neonatal birthweight on obstetrical and neonatal short-term outcomes (intrapartum cesarean delivery, performance of obstetric maneuvers (Løvset-, Bracht-, Veit-Smellie maneuver and Bickenbach's arm delivery), admission to the neonatal unit, Apgar score after 5 minutes <7, and arterial cord pH-value <7.10). Multivariable logistic regression was used for analysis and adjustment of variables.

RESULTS

Overall, 246 women (68.1%) had a successful vaginal birth. Intrapartum cesarean delivery (n = 115/361; 31.9%) was independently associated with maternal BMI at birth (p = 0.0283, aOR = 1.87 (1.19-3.97)) if birthweight was ≥3800 g. The rate of intrapartum cesarean delivery was also higher in women with gestational diabetes (p = 0.0030, aOR = 10.83 (2.41-60.84)). A significantly higher risk of neonatal acidosis (arterial pH-value <7.10) was observed in women with BMI at birth ≥30 kg/m2 (p = 0.0345, aOR = 1.84 (1.04-3.22)) without affecting other outcomes. Pre-pregnancy BMI, gestational weight gain and BMI-gain did not significantly affect the obstetrical and neonatal birth outcomes.

CONCLUSIONS

When neonatal birthweight is ≥3800 g, maternal BMI at birth (p = 0.0283; aOR = 1.87 (1.19-3.97)) is independently associated with the rate of intrapartum cesarean delivery. However, pre-pregnancy BMI and BMI-gain during pregnancy were not associated with the need for intrapartum cesarean delivery or other adverse outcomes. Consequently, BMI at the time of birth could be more informative than pre-pregnancy BMI and may improve counseling of women attempting vaginal breech birth.

Exploring Beliefs, Concerns, Prenatal Care Advice, and Sources of Information About Gestational Weight Gain Among Immigrant Central American Pregnant Women in the United States

Gestational weight gain (GWG) is critical for maternal and neonatal health, but excessive GWG can lead to complications such as gestational diabetes, hypertension, and increased obesity risk later in life. Minoritized and immigrant women often face higher risks of excessive GWG. This cross-sectional study assessed Central American women's beliefs and concerns about GWG, the receipt of advice from healthcare providers, and sources of information for healthy weight management during pregnancy. A cross-sectional survey was conducted with 93 pregnant women from El Salvador (31.2%), Guatemala (46.2%), and Honduras (22.6%). Most participants were married (91.4%), and 91.2% had household incomes below $40,000. Self-reported pre-pregnancy weight status varied significantly (p = 0.03), with more Guatemalans self-reporting as overweight (34.9%) compared to Salvadorans (10.3%) and Hondurans (19.1%). Beliefs about GWG varied significantly; 72.1% of Guatemalan women accepted "eating for two", while only 31.0% of Salvadorans did (p = 0.002). More Honduran women (90.5%) received weight gain recommendations from healthcare providers than Salvadorans (62.1%) and Guatemalans (60.5%) (p = 0.04). The Internet and family were common information sources on weight management, highlighting the need for culturally tailored health education. This study underscores critical differences in beliefs and access to prenatal care among pregnant Central American immigrant women, emphasizing the importance of culturally competent health education to support healthy pregnancy outcomes.

Genomic insights into gestational weight gain uncover tissue-specific mechanisms and pathways

Gestational weight gain (GWG) is linked to adverse outcomes in pregnant persons and offspring. The Early Growth Genetics Consortium previously identified genetic variants contributing to GWG from fetal and maternal genomes. However, their biologic mechanisms and tissue-specificity are unknown. We evaluated the association between genetically predicted gene expression in relevant maternal (subcutaneous and visceral adipose, breast, uterus, and whole blood) tissues from GTEx (v7) and fetal (placenta) tissue and early, late, and total GWG using S-PrediXcan. We tested for pathway enrichment using the GENE2FUNC module from Functional Mapping and Annotation of Genome-Wide Association Studies. After Bonferroni correction, we found no associations between maternal or fetal gene expression and GWG. Among nominally significant (P < 0.05) maternal genes, there was enrichment of several biological pathways, including metabolic processes, secretion, and intracellular transport, that varied across pregnancy. These results indicate the likely influence of diverse pathways, varying by tissue and weeks of gestation, on GWG.

Gestational weight gain as a mediator of the relationship between pre-pregnancy body mass index and the risk of preterm birth: A four-way decomposition analysis

OBJECTIVE

The aim of the present study was to examine and quantify whether the association between preterm birth (PTB) and pre-pregnancy body mass index (BMI) is mediated by gestational weight gain (GWG).

METHODS

This is a secondary analysis of a large randomized community non-inferiority trial using a cohort design. The data of 26 101 pregnant women in their first trimester who sought prenatal care and met eligibility criteria were included. The four-way decomposition method was applied to screen for all types of association effects of pre-pregnancy BMI on the risk of PTB. These effects include the total, direct, and various indirect effects including pure mediation via GWG, interactive effects with GWG, and mediated interaction with GWG, all adjusted for potential confounders.

RESULTS

Among the study participants, 24 461 (93.7%) had term deliveries, while 1640 (6.3%) experienced PTB. The results of the study showed that there was a positive association between pre-pregnancy BMI among those with BMI more than 25 kg/m2 and the risk of PTB and this association was negatively mediated and interacted by GWG, which differed quantitatively between those who had inadequate, adequate, or excessive GWG. The total association effect showed that the risk was lowest for those who had underweight pre-pregnancy BMI and adequate GWG (excess relative risk [RR]: 0.06, 95% CI: 0.01-0.11, P value: 0.022) and was highest for those who had obese pre-pregnancy BMI and excessive GWG (excess RR: 0.67, 95% CI: 0.35-1.00, P value <0.001).

CONCLUSION

The findings of the present prospective population-based study demonstrated that pre-pregnancy BMI >25 kg/m2 is directly and positively associated with the risk of preterm birth. The highest risk of preterm birth was observed among individuals with an obese pre-pregnancy BMI who also experienced excessive GWG.

Predictive modeling of gestational weight gain: a machine learning multiclass classification study

BACKGROUND

Gestational weight gain (GWG) is a critical factor influencing maternal and fetal health. Excessive or insufficient GWG can lead to various complications, including gestational diabetes, hypertension, cesarean delivery, low birth weight, and preterm birth. This study aims to develop and evaluate machine learning models to predict GWG categories: below, within, or above recommended guidelines.

METHODS

We analyzed data from the Araraquara Cohort, Brazil, which comprised 1557 pregnant women with a gestational age of 19 weeks or less. Predictors included socioeconomic, demographic, lifestyle, morbidity, and anthropometric factors. Five machine learning algorithms (Random Forest, LightGBM, AdaBoost, CatBoost, and XGBoost) were employed for model development. The models were trained and evaluated using a multiclass classification approach. Model performance was assessed using metrics such as area under the ROC curve (AUC-ROC), F1 score and Matthew's correlation coefficient (MCC).

RESULTS

The outcomes were categorized as follows: GWG within recommendations (28.7%), GWG below (32.5%), and GWG above recommendations (38.7%). The XGBoost presented the best overall model, achieving an AUC-ROC of 0.79 for GWG within, 0.76 for GWG below, and 0.65 for GWG above. The LightGBM also performed well with an AUC-ROC of 0.79 for predicting GWG within recommendations, 0.76 for GWG below, and 0.624 for GWG above. The most important predictors of GWG were pre-gestational BMI, maternal age, glycemic profile, hemoglobin levels, and arm circumference.

CONCLUSION

Machine learning models can effectively predict GWG categories, offering a valuable tool for early identification of at-risk pregnancies. This approach can enhance personalized prenatal care and interventions to promote optimal pregnancy outcomes.

Maternal History of Childhood Maltreatment and Pregnancy Weight Outcomes

BACKGROUND

Childhood maltreatment is associated with elevated adult weight. It is unclear whether this association extends to pregnancy, a critical window for the development of obesity.

METHODS

We examined associations of childhood maltreatment histories with prepregnancy body mass index (BMI) and gestational weight gain among women who had participated for >20 years in a longitudinal cohort. At age 26-35 years, participants reported childhood maltreatment (physical, sexual, and emotional abuse; emotional neglect) and, 5 years later, about prepregnancy weight and gestational weight gain for previous pregnancies (n = 656). Modified Poisson regression models were used to estimate associations of maltreatment history with prepregnancy BMI and gestational weight gain z -scores, adjusting for sociodemographics. We used multivariate imputation by chained equations to adjust outcome measures for misclassification using data from an internal validation study.

RESULTS

Before misclassification adjustment, results indicated a higher risk of prepregnancy BMI ≥30 kg/m 2 in women with certain types of maltreatment (e.g., emotional abuse risk ratio = 2.4; 95% confidence interval: 1.5, 3.7) compared with women without that maltreatment type. After misclassification adjustment, estimates were attenuated but still modestly elevated (e.g., emotional abuse risk ratio = 1.7; 95% confidence interval: 1.1, 2.7). Misclassification-adjusted estimates for maltreatment associations with gestational weight gain z -scores were close to the null and imprecise.

CONCLUSIONS

Findings suggest an association of maltreatment with prepregnancy BMI ≥30 kg/m 2 but not with high gestational weight gain. Results suggest a potential need for equitable interventions that can support all women, including those with maltreatment histories, as they enter pregnancy.

Comparing the different phenotypes of diabetes in pregnancy: Are outcomes worse for women with young-onset type 2 diabetes compared to type 1 diabetes?

AIMS

Pregnancies are increasingly affected by young-onset type 2 diabetes mellitus (YT2DM), an aggressive phenotype associated with a higher vascular risk profile compared to type 1 diabetes mellitus (T1DM). We compared pregnancy outcomes to illuminate areas where differing management guidance might be needed.

METHODS

This retrospective single-centre study (2010 2019) included 259 singleton pregnancies affected by pregestational T1DM (N = 124) or YT2DM (N = 135) diagnosed at < 40 years. Primary outcomes included preterm delivery, large for gestational age (LGA) infants, and pre-eclampsia.

RESULTS

The YT2DM cohort were older, with more obesity, greater apparent sociodemographic disadvantage, and lower measures of pregnancy preparedness. Overweight/obesity were also prevalent in the T1DM cohort (46 % affected). The second/third trimester mean HbA1c measurements were significantly higher in the T1DM cohort. Pre-eclampsia and preterm delivery rates were similar between the cohorts. Significantly lower rates of LGA infants, NICU admission, neonatal hypoglycaemia, and neonatal respiratory distress were seen in the YT2DM cohort (p < 0.05 for all).

CONCLUSIONS

In pregnancy, YT2DM appears to be the lower-risk cohort compared to T1DM despite higher obesity rates. Gaps in achieving glycaemic targets exist for both subtypes but particularly for T1DM. The relative impact of increasing BMI in pregnancies affected by T1DM requires further elucidation.

Maternal body mass index, gestational weight gain, and early childhood growth: A register-based cohort study

INTRODUCTION

Childhood obesity is associated with maternal obesity, but the link to gestational weight gain (GWG) is not fully elucidated. We examined the relationship between early pregnancy maternal body mass index (BMI) and GWG on early childhood growth.

MATERIAL AND METHODS

Data from 30 197 mother-child pairs from Uppsala County Mother and Child Cohort were divided into 15 groups according to maternal BMI and GWG, based on World Health Organization classification and Institute of Medicine guidelines, respectively. Postnatal growth patterns were analyzed with linear mixed regression models within maternal BMI groups. Odds ratios of overweight and obesity at 4 years of age were assessed with logistic regression analyses. We treated children of mothers with normal weight and adequate GWG as the reference group, and all analyses were adjusted for potential confounders.

RESULTS

GWG was associated with infant BMI z-score at birth, independent of potential confounding factors. Independent of GWG, we observed an overall decrease in BMI z-score from 18 months to 5 years in children of mothers who were underweight, while an increase in BMI z-score was seen in children of mothers who were overweight or obese. In children of normal- and overweight mothers, the risk of childhood overweight and obesity was associated with excessive compared to adequate GWG (adjusted odds ratio [aOR] 1.17, 95% confidence interval [CI] 1.01-1.36 for normal-weight mothers, and aOR 1.25, 95% CI 1.04-1.51 for overweight mothers, respectively). Children of mothers with obesity and excessive GWG had the highest risk of being overweight or obese at 4 years (aOR 2.88, 95% CI 2.40-3.44, and 4.38, 95% CI 3.37-5.67, respectively). Associations did not differ between children of mothers with obesity class 1 and 2-3 when comparing excessive and adequate GWG (aOR 1.33, 95% CI 0.96-1.85, and 1.12, 95% CI 0.74-1.70, respectively).

CONCLUSIONS

Maternal GWG affects infant birth size and growth until 18 months, although maternal BMI is more crucial for childhood growth beyond 18 months. Further, children of mothers who are normal- or overweight and experience excessive GWG have an increased risk of obesity at 4 years.

Maternal pre-pregnancy body mass index and gestational weight gain on adverse birth outcomes in Chinese newborns: a retrospective study

BACKGROUND

Maternal and child health is an important measure of national well-being. This study further explored the individual and combined effects of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on adverse birth weight-related outcomes.

METHODS

A retrospective study was carried out at a maternal and child health hospital from 2018 to 2021, and a total of 17,506 eligible women were invited to participate. The associations of pre-pregnancy BMI and GWG with adverse birth outcomes were examined by using restricted cubic spline regression and binary logistic regression.

RESULTS

Pre-pregnancy BMI and GWG had non-linear associations with low birth weight and macrosomia. They were associated with an increased risk of macrosomia (Pre-pregnancy BMI for OR = 1.170, 95%CI:1.144 to 1.197, P < 0.001, and GWG for OR = 1.071, 95%CI:1.054 to 1.089, P < 0.001) and large for gestational age infant (LGA) (Pre-pregnancy BMI for OR = 1.125, 95%CI:1.111 to 1.141, P < 0.001, and GWG for OR = 1.045, 95%CI:1.036 to 1.054, P < 0.001). The high risk of low birth weight and preterm birth was observed among the group of women with inadequate GWG. The risks of macrosomia and LGA increased with pre-pregnancy BMI from low weight to overweight and obesity, and GWG from inadequate to overabundance, while small for gestational age infant was more prevalent in the low pre-pregnancy BMI group.

CONCLUSIONS

Pre-pregnancy BMI and GWG exhibited non-linear associations with low birth weight and macrosomia. The various combinations of pre-pregnancy BMI and GWG had different effects on adverse birth weight-related outcomes.

Effect modification of pre-pregnancy body mass index on association of gestational weight gain with birth weight

Background

Maternal weight status, before or during pregnancy, is a significant determinant of fetus development, birth weight, and the short-term and long-term health outcomes of the offspring.

Objective

This study aimed to evaluate the effect modification of pre-pregnancy body mass index (BMI) on the associations of gestational weight gain (GWG) and birth weight, as per the latest guidelines from the Chinese Nutrition Society.

Methods

This is a retrospective cohort study performed in a tertiary hospital with the largest deliveries in Shanghai, China. This study included all women who had singleton live births from 2021 to 2022 (n = 50,391). Data on pre-pregnancy weight, GWG, and birth weight were extracted from the medical register system. Logistic regression models were used to estimate the associations of pre-pregnancy BMI and GWG with the risks of being small for gestational age (SGA) and large for gestational age (LGA). The potential for effect modification by BMI on the associations of GWG and birth weight was assessed using both additive and multiplicative scales.

Results

Pre-pregnancy BMI and GWG were consistently associated with birth weight. We observed a positive effect modification by underweight on the relationships between insufficient GWG and SGA both in multiplicative (adjusted odds ratio (OR), 2.49, 95 % confidence interval (CI): 2.06-2.99), and additive (relative excess risk due to interaction (RERI), 3.04, 95 % CI: 1.70-4.37) scales. Similarly, obesity was found to modify the effect of excessive GWG on the risk of LGA (adjusted OR, 3.82, 95 % CI, 3.14-4.63; RERI, 14.67, 95 % CI: 7.92-21.41).

Conclusion

Our findings indicate that increased GWG is associated with a higher risk of abnormal birth weight in singleton pregnancies. Additionally, there is evidence of an additive interaction between pre-pregnancy BMI and GWG on the risk of small for gestational age or large for gestational age.