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Hand RK, Schofield MK. Expanding Time Covered for Medical Nutrition Therapy: A Need for Clear Reporting on the Intensity of Nutrition Interventions. J Acad Nutr Diet 2024; 124:797-803. [PMID: 38286250 DOI: 10.1016/j.jand.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 01/10/2024] [Accepted: 01/23/2024] [Indexed: 01/31/2024]
Affiliation(s)
- Rosa K Hand
- Department of Nutrition, Case Western Reserve University, Cleveland, Ohio.
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Schon SB, Cabre HE, Redman LM. The impact of obesity on reproductive health and metabolism in reproductive-age females. Fertil Steril 2024:S0015-0282(24)00270-X. [PMID: 38704081 DOI: 10.1016/j.fertnstert.2024.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024]
Abstract
Obesity is a highly prevalent chronic disease that impacts >40% of reproductive-aged females. The pathophysiology of obesity is complex and can be understood simply as a chronic energy imbalance whereby caloric intake exceeds caloric expenditure with an energy surplus stored in adipose tissue. Obesity may be categorized into degrees of severity as well as different phenotypes on the basis of metabolic health and underlying pathophysiology. Obesity and excess adiposity have a significant impact on fertility and reproductive health, with direct effects on the hypothalamic-pituitary-ovarian axis, the ovary and oocyte, and the endometrium. There are significant adverse pregnancy outcomes related to obesity, and excess weight gain before, during, and after pregnancy that can alter the lifelong risk for metabolically unhealthy obesity. Given the high prevalence and pervasive impact of obesity on reproductive health, there is a need for better and individualized care for reproductive-aged females that considers obesity phenotype, underlying pathophysiology, and effective and sustainable interventions to treat obesity and manage weight gain before, during, and after pregnancy.
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Affiliation(s)
- Samantha B Schon
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
| | - Hannah E Cabre
- Reproductive Endocrinology and Women's Health Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Leanne M Redman
- Reproductive Endocrinology and Women's Health Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana
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3
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Kung WJ, Kuo HY, Chang CF, Zen YH, Lin CC. Investigation and Comparison of Maternal Pre-Pregnancy Body Mass Index Coupled with Gestational Weight Gain on Maternal-Fetal Complications Based on US and Chinese Guidelines: A Retrospective Study. Reprod Sci 2024:10.1007/s43032-024-01525-8. [PMID: 38594584 DOI: 10.1007/s43032-024-01525-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
Compared to Western populations, Chinese and Asians possess distinct genetics, lifestyles, and dietary habits. They tend to have shorter stature, lower Body Mass Index (BMI), and higher body fat percentages than Western populations. The aim of this study was to compare disparities in maternal-fetal outcomes by combining pre-pregnancy BMI and gestational weight gain (GWG) based on distinct US and Chinese guidelines. A total of 2,271 pregnant women who received perinatal care at Fooyin University Hospital from 2016 to 2021 were included. Logistic regression analysis categorized women into twelve groups based on the two criteria to explore the relationships between BMI and GWG, and maternal-fetal outcomes. Among the subjects, only 23.2% and 21.8% women had a normal weight BMI and adequate GWG, based on US and Chinese criteria, respectively. As BMI and GWG increase, the likelihood of developing complications such as gestational diabetes, gestational hypertension or preeclampsia, Cesarean section, and Large for Gestational Age also rises. Conversely, underweight women with excessive GWG exhibited lower risk of preterm birth either by US or Chinese guidelines. Two criteria exhibited similar odds for investigated outcomes, except for gestational hypertension or preeclampsia. Women had more than double the odds of developing gestational hypertension or preeclampsia when using US criteria compared to Chinese criteria. Therefore, it is essential for Asian, especially Chinese women, to be aware of the differences in adverse outcomes such as gestational hypertension or preeclampsia when using US criteria.
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Affiliation(s)
- Wan-Ju Kung
- Department of Laboratory Medicine, Fooyin University Hospital, Pingtung, Taiwan
| | - Hsin-Yi Kuo
- Department of Midwifery and Maternal-Infant Health Care, Fooyin University, Kaohsiung, Taiwan
| | | | - Yeong-Hwa Zen
- Department of Obstetrics and Gynecology, Fooyin University Hospital, Pingtung, Taiwan
| | - Ching-Chiang Lin
- Department of Education and Research, Fooyin University Hospital, Pingtung, Taiwan.
- Department of Medical Laboratory Science and Biotechnology, Fooyin University, 151 Jinxue Rd., Daliao Dist, Kaohsiung City, 83102, Taiwan, Republic of China.
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Sparks JR, Redman LM, Drews KL, Sims CR, Krukowski RA, Andres A. Healthful Eating Behaviors among Couples Contribute to Lower Gestational Weight Gain. Nutrients 2024; 16:822. [PMID: 38542733 PMCID: PMC10974170 DOI: 10.3390/nu16060822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/08/2024] [Accepted: 03/10/2024] [Indexed: 04/01/2024] Open
Abstract
Through longitudinal analysis from the GLOWING cohort study, we examined the independent and joint relationships between couples' eating behaviors and gestational weight gain (GWG). Pregnant persons (n = 218) and their non-pregnant partners (n = 157) completed an Eating Inventory. GWG was calculated as gestation weight at 36 weeks minus that at 10 weeks. General linear models were used to examine the relationships between GWG and the pregnant persons, non-pregnant partners, and couples (n = 137; mean of pregnant persons and non-pregnant partners) cognitive restraint (range 0-21), dietary disinhibition (range 0-18), and perceived hunger (range 0-14), with higher scores reflecting poorer eating behaviors. The adjusted models included race/ethnicity, education, income, marital status, and age. The pregnant persons and their non-pregnant partners' cognitive restraint, dietary disinhibition, and perceived hunger scores were 9.8 ± 4.7, 4.8 ± 3.2, and 4.4 ± 2.5 and 6.6 ± 4.6, 5.4 ± 3.4, and 4.7 ± 3.2, respectively. Higher cognitive restraint scores among the pregnant persons and couples were positively associated with GWG (p ≤ 0.04 for both). Stratified analyses revealed this was significant for the pregnant persons with overweight (p ≤ 0.04). The non-pregnant partners' eating behaviors alone were not significantly associated with GWG (p ≥ 0.31 for all). The other explored relationships between GWG and the couples' eating behaviors were insignificant (p ≥ 0.12 for all). Among the pregnant persons and couples, reduced GWG may be achieved with higher levels of restrained eating. Involving non-pregnant partners in programs to optimize GWG may be beneficial.
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Affiliation(s)
- Joshua R. Sparks
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA 70808, USA; (J.R.S.); (L.M.R.); (K.L.D.)
- Expeditionary and Cognitive Sciences Research Group, Department of Warfighter Performance, Naval Health Research Center, Leidos Inc. (Contract), San Diego, CA 92152, USA
| | - Leanne M. Redman
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA 70808, USA; (J.R.S.); (L.M.R.); (K.L.D.)
| | - Kimberly L. Drews
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA 70808, USA; (J.R.S.); (L.M.R.); (K.L.D.)
| | - Clark R. Sims
- Arkansas Children’s Nutrition Center, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | | | - Aline Andres
- Arkansas Children’s Nutrition Center, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
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5
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Mattson R, Barger MK. Feasibility of Telehealth and Innovative Technologies to Limit Excessive Gestational Weight Gain. Nurs Womens Health 2024; 28:30-40. [PMID: 37989496 DOI: 10.1016/j.nwh.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/03/2023] [Accepted: 10/19/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE To test the feasibility of using telehealth to deliver nutritional counseling by tracking gestational weight gain remotely using Bluetooth weight scales. DESIGN Quasi-experimental feasibility study. SETTING One-on-one nutritional counseling was conducted remotely via a telehealth platform using a registered dietitian. PARTICIPANTS Twenty-nine pregnant individuals ages 18 years or older, between 12 and 27 weeks' gestation, with a prepregnancy body mass index of ≥30 kg/m2, singleton fetus, and English proficiency were recruited for the study. Among the 29 potential participants, 20 completed the initial survey and met the criteria; 11 completed the study. METHODS This study tested the feasibility of using telehealth to deliver nutritional counseling for 30 minutes, once a week, for 6 weeks. Self-weighing was tracked through a preconfigured Bluetooth scale given to study participants that enabled weight data to be automatically uploaded each time the scale was used. RESULTS Among the 11 study participants receiving Bluetooth scales, adherence to self-weighing was high (81%). All five participants randomized to nutritional counseling found that telehealth visits with a registered dietitian were easy to use and helpful. Although participants who received nutritional counseling gained 2.5 lb less than those who did not receive nutritional counseling (p = .523), there was no significant difference between the intervention group and historical control individuals (p = .716). CONCLUSION Incorporating telehealth for nutrition counseling and accurate remote weight data collection may be part of a comprehensive strategy to address gestational weight gain in high-risk pregnant populations. Further research with larger samples is needed.
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Mavroeidi I, Manta A, Asimakopoulou A, Syrigos A, Paschou SA, Vlachaki E, Nastos C, Kalantaridou S, Peppa M. The Role of the Glycemic Index and Glycemic Load in the Dietary Approach of Gestational Diabetes Mellitus. Nutrients 2024; 16:399. [PMID: 38337683 PMCID: PMC10857473 DOI: 10.3390/nu16030399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
Gestational diabetes mellitus (GDM) is a common metabolic disorder that often develops during pregnancy, characterized by glucose intolerance and insulin resistance (IR). To ensure the well-being of both the mother and the fetus, the body undergoes multiple metabolic and immunological changes that result in peripheral IR and, under certain hereditary or acquired abnormalities, GDM in predisposed women. The adverse short- and long-term effects of GDM impact both the mother and the fetus. Nutrition seems to play an important role to prevent GDM or improve its evolution. An emphasis has been given to the proportion of carbohydrates (CHO) relative to protein and lipids, as well as dietary patterns, in GDM. The effects of CHO on postprandial glucose concentrations are reflected in the glycemic index (GI) and glycemic load (GL). Diets rich in GI and GL may induce or exacerbate IR, whereas diets low in GI and GL appear to enhance insulin sensitivity and improve glycemic control. These positive outcomes may be attributed to direct interactions with insulin and glucose homeostasis or indirect effects through improved body composition and weight management. This comprehensive narrative review aims to explore the significance of nutrition, with a focus on the critical evaluation of GI and GL in the dietary management of women with GDM.
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Affiliation(s)
- Ioanna Mavroeidi
- Endocrine Unit, 2nd Propaedeutic Department of Internal Medicine, Research Institute and Diabetes Center, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12461 Athens, Greece
| | - Aspasia Manta
- Endocrine Unit, 2nd Propaedeutic Department of Internal Medicine, Research Institute and Diabetes Center, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12461 Athens, Greece
| | - Athina Asimakopoulou
- 3rd Department of Internal Medicine, Sotiria General Hospital, 11527 Athens, Greece
| | - Alexandros Syrigos
- 3rd Department of Internal Medicine, Sotiria General Hospital, 11527 Athens, Greece
| | - Stavroula A Paschou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Efthimia Vlachaki
- Hematological Laboratory, 2nd Department of Internal Medicine, Hippokrateion Hospital, Aristotle University, 54640 Thessaloniki, Greece
| | - Constantinos Nastos
- 3rd Department of Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12461 Athens, Greece
| | - Sophia Kalantaridou
- Department of Obstetrics and Gynecology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12461 Athens, Greece
| | - Melpomeni Peppa
- Endocrine Unit, 2nd Propaedeutic Department of Internal Medicine, Research Institute and Diabetes Center, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12461 Athens, Greece
- 3rd Department of Internal Medicine, Sotiria General Hospital, 11527 Athens, Greece
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Brown SD, Kiernan M, Ehrlich SF, Zhu Y, Hedderson MM, Daredia S, Feng J, Millman A, Quesenberry CP, Ferrara A. Intrinsic motivation for physical activity, healthy eating, and self-weighing in association with corresponding behaviors in early pregnancy. Prev Med Rep 2023; 36:102456. [PMID: 37854666 PMCID: PMC10580041 DOI: 10.1016/j.pmedr.2023.102456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/18/2023] [Accepted: 10/01/2023] [Indexed: 10/20/2023] Open
Abstract
Healthy lifestyle behaviors influence maternal cardiovascular health, but motivation for them in pregnancy is poorly understood. We examined whether intrinsic motivation (assessed on 5-point scales for each behavior) is associated with three lifestyle behaviors in early pregnancy: physical activity, by intensity level; healthy eating, quantified with the Alternate Healthy Eating Index for Pregnancy (AHEI-P); and weight self-monitoring, a standard weight management technique. Participants in the Northern California Pregnancy, Lifestyle and Environment Study (PETALS) population-based cohort completed validated surveys in early pregnancy (2017-18; N = 472; 22 % Asian, 6 % Black, 30 % Hispanic, 13 % multiracial, 30 % White). Cross-sectional data were analyzed in 2021-22. Overall, 40.7 % (n = 192) met United States national physical activity guidelines; the average AHEI-P score was 62.3 out of 130 (SD 11.4); and 36.9 % reported regular self-weighing (≥once/week; n = 174). In models adjusted for participant characteristics, 1-unit increases in intrinsic motivation were associated with increased likelihood of meeting physical activity guidelines (risk ratio [95 % CI]: 1.66 [1.48, 1.86], p < 0.0001); meeting sample-specific 75th percentiles for vigorous physical activity (1.70 [1.44, 1.99], p < 0.0001) and AHEI-P (1.75 [1.33, 2.31], p < 0.0001); and regular self-weighing (2.13 [1.92, 2.37], p < 0.0001). A 1-unit increase in intrinsic motivation lowered the risk of meeting the 75th percentile for sedentary behavior (0.79 [0.67, 0.92], p < 0.003). Intrinsic motivation was not associated with reaching 75th percentiles for total, light, or moderate activity. Intrinsic motivation is associated with physical activity, healthy eating, and self-weighing among diverse individuals in early pregnancy. Results can inform intervention design to promote maternal health via increased enjoyment of lifestyle behaviors.
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Affiliation(s)
- Susan D. Brown
- Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
- Center for Upstream Prevention of Adiposity and Diabetes Mellitus (UPSTREAM), Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Michaela Kiernan
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Monique M. Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
- Center for Upstream Prevention of Adiposity and Diabetes Mellitus (UPSTREAM), Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Saher Daredia
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Juanran Feng
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Andrea Millman
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Center for Upstream Prevention of Adiposity and Diabetes Mellitus (UPSTREAM), Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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8
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Hinkle SN, Mumford SL, Grantz KL, Mendola P, Mills JL, Yeung EH, Pollack AZ, Grandi SM, Sundaram R, Qiao Y, Schisterman EF, Zhang C. Gestational weight change in a diverse pregnancy cohort and mortality over 50 years: a prospective observational cohort study. Lancet 2023; 402:1857-1865. [PMID: 37866371 PMCID: PMC10721111 DOI: 10.1016/s0140-6736(23)01517-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/30/2023] [Accepted: 07/18/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND High weight gain in pregnancy is associated with greater postpartum weight retention, yet long-term implications remain unknown. We aimed to assess whether gestational weight change was associated with mortality more than 50 years later. METHODS The Collaborative Perinatal Project (CPP) was a prospective US pregnancy cohort (1959-65). The CPP Mortality Linkage Study linked CPP participants to the National Death Index and Social Security Death Master File for vital status to 2016. Adjusted hazard ratios (HRs) with 95% CIs estimated associations between gestational weight gain and loss according to the 2009 National Academy of Medicine recommendations and mortality by pre-pregnancy BMI. The primary endpoint was all-cause mortality. Secondary endpoints included cardiovascular and diabetes underlying causes of mortality. FINDINGS Among 46 042 participants, 20 839 (45·3%) self-identified as Black and 21 287 (46·2%) as White. Median follow-up time was 52 years (IQR 45-54) and 17 901 (38·9%) participants died. For those who were underweight before pregnancy (BMI <18·5 kg/m2; 3809 [9·4%] of 40 689 before imputation for missing data]), weight change above recommendations was associated with increased cardiovascular mortality (HR 1·84 [95% CI 1·08-3·12]) but not all-cause mortality (1·14 [0·86-1·51]) or diabetes-related mortality (0·90 [0·13-6·35]). For those with a normal pre-pregnancy weight (BMI 18·5-24·9 kg/m2; 27 921 [68·6%]), weight change above recommendations was associated with increased all-cause (HR 1·09 [1·01-1·18]) and cardiovascular (1·20 [1·04-1·37]) mortality, but not diabetes-related mortality (0·95 [0·61-1·47]). For those who were overweight pre-pregnancy (BMI 25·0-29·9 kg/m2; 6251 [15·4%]), weight change above recommendations was associated with elevated all-cause (1·12 [1·01-1·24]) and diabetes-related (1·77 [1·23-2·54]) mortality, but not cardiovascular (1·12 [0·94-1·33]) mortality. For those with pre-pregnancy obesity (≥30·0 kg/m2; 2708 [6·7%]), all associations between gestational weight change and mortality had wide CIs and no meaningful relationships could be drawn. Weight change below recommended levels was associated only with a reduced diabetes-related mortality (0·62 [0·48-0·79]) in people with normal pre-pregnancy weight. INTERPRETATION This study's novel findings support the importance of achieving healthy gestational weight gain within recommendations, adding that the implications might extend beyond the pregnancy window to long-term health, including cardiovascular and diabetes-related mortality. FUNDING National Institutes of Health.
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Affiliation(s)
- Stefanie N Hinkle
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Sunni L Mumford
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine L Grantz
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Pauline Mendola
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - James L Mills
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Edwina H Yeung
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Anna Z Pollack
- Global and Community Health Department, College of Public Health, George Mason University, Fairfax, VA, USA
| | - Sonia M Grandi
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Yan Qiao
- The Prospective Group, Fairfax, VA, USA
| | - Enrique F Schisterman
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Cuilin Zhang
- Global Center for Asian Women's Health and Bia-Echo Asia Centre for Reproductive Longevity & Equality, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Neves RO, Rocha ADS, de Vargas BO, Kretzer DC, de Matos S, Goldani MZ, von Diemen L, Magalhães JADA, Bernardi JR. Obesity Cut-Off Points Using Prepregnancy Body Mass Index according to Cardiometabolic Conditions in Pregnancy. J Pregnancy 2023; 2023:6669700. [PMID: 38026545 PMCID: PMC10667054 DOI: 10.1155/2023/6669700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Aim To suggest cut-off points for body mass index (BMI) using gestational hypertension, preeclampsia, and gestational diabetes mellitus (GDM) as cardiometabolic conditions in pregnancy. Methods In this prospective study, singleton pregnant women from the fetal medicine service of the Brazilian Unified Health System were included. The pregnancy, perinatal, and newborn data were obtained from the clinical medical records. Maternal anthropometry included an assessment of weight and height and the prepregnancy BMI evaluation categorized according to the World Health Organization cut-off points. The area under the curve and confidence interval values from receiver operator curves were generated to identify the optimal cut-off points using prepregnancy BMI with better sensitivity and specificity. Results Data on 218 pregnancies were analyzed, with 57.9% (n = 124) being classified as overweight/obese, 11% (n = 24) with GDM, 6.9% (n = 15) with preeclampsia, and 11.0% (n = 24) with gestational hypertension. The BMI cut-off points for predicting cardiometabolic conditions were 27.52 kg/m2 (S: 66.7%; E: 63.8%) for women with GDM; 27.40 kg/m2 (S: 73.3%; E: 62.4%; S: 79.2%; E: 64.9%; S: 70.3%; E: 66.3%) for women with preeclampsia, gestational hypertension, and gestational hypertension plus preeclampsia, respectively; and 27.96 kg/m2 (S: 69.6%; E: 65.6%) for women with preeclampsia plus GDM. Conclusion The findings suggest that the optimal prepregnancy BMI cut-off point is around 27 kg/m2 for pregnant women with maternal cardiometabolic conditions.
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Affiliation(s)
- Renata O. Neves
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alexandre da S. Rocha
- Graduate Program in Health Sciences: Gynaecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruna O. de Vargas
- Undergraduate Nutrition Course, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Daniela C. Kretzer
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Salete de Matos
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcelo Z. Goldani
- Department of Pediatric, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Lisia von Diemen
- Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - José A. de A. Magalhães
- Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Department of Obstetrics and Gynaecology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliana R. Bernardi
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Food, Nutrition and Health, Universidade Federal do Rio Grande do Sul, Medical School, Porto Alegre, Brazil
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10
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Katzow MW, Messito MJ, Mendelsohn AL, Scott MA, Gross RS. Protective Effect of Prenatal Social Support on the Intergenerational Transmission of Obesity in Low-Income Hispanic Families. Child Obes 2023; 19:382-390. [PMID: 36112108 PMCID: PMC10468550 DOI: 10.1089/chi.2021.0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Prepregnancy overweight/obesity (OW/OB) is a strong risk factor for child obesity. Few studies have identified modifiable factors that mitigate this risk. Objective: The objective of this study was to determine if prenatal social support buffers the effect of prepregnancy OW/OB on child birth weight z-score (BWz) and weight-for-age z-score (WFAz) trajectory. Methods: We performed a longitudinal secondary analysis of 524 mother-infant pairs enrolled in a randomized controlled trial of the Starting Early Program, a child obesity prevention program for Hispanic families with low income. Social support was assessed in the third trimester of pregnancy; maternal prepregnancy OW/OB and child WFAz from birth to age 3 years were obtained from medical records. Linear regression and multilevel modeling tested the effects of maternal prepregnancy OW/OB on child weight outcomes, and whether prenatal social support moderated these effects. Results: Prepregnancy OW/OB was associated with significantly higher child BWz (B = 0.23, p = 0.01) and WFAz trajectories (B = 0.19, 0.01). The interaction between social support and prepregnancy OW/OB was negatively related to child BWz (B = -0.26, p = 0.02) and WFAz trajectory (B = -0.40, p = 0.047). Conclusions: Prenatal social support may be protective against the intergenerational transmission of obesity risk. Interventions for the prevention of child obesity should consider incorporating social support into their design. Clinical Trial Registration Number: NCT01541761.
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Affiliation(s)
- Michelle W. Katzow
- Division of General Pediatrics, Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Mary Jo Messito
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Alan L. Mendelsohn
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Marc A. Scott
- Department of Applied Statistics, Social Science, and Humanities, New York University Steinhardt School of Culture, Education, and Human Development, New York, NY, USA
| | - Rachel S. Gross
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
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11
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Strobel KM, Juul SE, Hendrixson DT. Maternal Nutritional Status and the Microbiome across the Pregnancy and the Post-Partum Period. Microorganisms 2023; 11:1569. [PMID: 37375071 DOI: 10.3390/microorganisms11061569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/03/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Appropriate nutrition during pregnancy and the post-partum period is vital for both the mothers and their offspring. Both under- and over-nourished status may have important microbial implications on the maternal and infant gut microbiomes. Alterations in the microbiome can have implications for a person's risk of obesity and metabolic diseases. In this review, we examine alterations in the maternal gut, vaginal, placental, and milk microbiomes in the context of pre-pregnancy BMI, gestational weight gain, body composition, gestational diabetes, and maternal diet. We also investigate how the infant gut microbiome may be altered by these different parameters. Many of the microbial changes seen in under- and over-nourished states in birthing parents may result in long-term implications for the health of offspring. Differences in diet appear to be a major driver of the maternal and subsequently milk and offspring microbiomes. Further prospective longitudinal cohort studies are needed to examine nutrition and the microbiome to better understand its implications. Additionally, trials involving dietary interventions in child-bearing age adults should be explored to improve the mother and child's risks for metabolic diseases.
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Affiliation(s)
- Katie M Strobel
- Department of Pediatrics, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA 98195, USA
| | - Sandra E Juul
- Department of Pediatrics, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA 98195, USA
| | - David Taylor Hendrixson
- Department of Pediatrics, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA 98195, USA
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12
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Abstract
Pregnancy is commonly referred to as a window into future CVH (cardiovascular health). During pregnancy, physiological adaptations occur to promote the optimal growth and development of the fetus. However, in approximately 20% of pregnant individuals, these perturbations result in cardiovascular and metabolic complications, which include hypertensive disorders of pregnancy, gestational diabetes, preterm birth, and small-for-gestational age infant. The biological processes that lead to adverse pregnancy outcomes begin before pregnancy with higher risk of adverse pregnancy outcomes observed among those with poor prepregnancy CVH. Individuals who experience adverse pregnancy outcomes are also at higher risk of subsequent development of cardiovascular disease, which is largely explained by the interim development of traditional risk factors, such as hypertension and diabetes. Therefore, the peripartum period, which includes the period before (prepregnancy), during, and after pregnancy (postpartum), represents an early cardiovascular moment or window of opportunity when CVH should be measured, monitored, and modified (if needed). However, it remains unclear whether adverse pregnancy outcomes reflect latent risk for cardiovascular disease that is unmasked in pregnancy or if adverse pregnancy outcomes are themselves an independent and causal risk factor for future cardiovascular disease. Understanding the pathophysiologic mechanisms and pathways linking prepregnancy CVH, adverse pregnancy outcomes, and cardiovascular disease are necessary to develop strategies tailored for each stage in the peripartum period. Emerging evidence suggests the utility of subclinical cardiovascular disease screening with biomarkers (eg, natriuretic peptides) or imaging (eg, computed tomography for coronary artery calcium or echocardiography for adverse cardiac remodeling) to identify risk-enriched postpartum populations and target for more intensive strategies with health behavior interventions or pharmacological treatments. However, evidence-based guidelines focused on adults with a history of adverse pregnancy outcomes are needed to prioritize the prevention of cardiovascular disease during the reproductive years and beyond.
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Affiliation(s)
- Sadiya S. Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Natalie A. Cameron
- Department of Medicine, Northwestern University Feinberg School of Medicine
| | - Kathryn J. Lindley
- Department of Medicine, Vanderbilt University Medical Center
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center
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13
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Jamshidi A, Abedi P, Hamid N, Haghighizadeh M. Effect of group cognitive behavioural therapy on self-efficacy and anthropometric indices among overweight and obese postpartum women. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2023. [DOI: 10.1080/16070658.2023.2172707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Arezo Jamshidi
- Midwifery Department, Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Parvin Abedi
- Midwifery Department, Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Najmeh Hamid
- Clinical Psychology Department, Shahid Chamran University of Ahvaz, Ahvaz, Iran
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14
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Samuel L, Fera J, Basch CH. Readability Analysis of Online Health Information on Gestational Diabetes. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2023. [DOI: 10.1080/15398285.2023.2171240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Lalitha Samuel
- Department of Health Promotion and Nutrition Sciences, Lehman College, The City University of New York, Bronx, NY, USA
| | - Joseph Fera
- Department of Mathematics, Lehman College, The City University of New York, Bronx, NY, USA
| | - Corey H. Basch
- Department of Public Health, William Paterson University, Wayne, NJ, USA
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15
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Strobel KM, Kafali SG, Shih SF, Artura AM, Masamed R, Elashoff D, Wu HH, Calkins KL. Pregnancies complicated by gestational diabetes and fetal growth restriction: an analysis of maternal and fetal body composition using magnetic resonance imaging. J Perinatol 2023; 43:44-51. [PMID: 36319757 PMCID: PMC9840659 DOI: 10.1038/s41372-022-01549-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Maternal body composition may influence fetal body composition. OBJECTIVE The objective of this pilot study was to investigate the relationship between maternal and fetal body composition. METHODS Three pregnant women cohorts were studied: healthy, gestational diabetes (GDM), and fetal growth restriction (FGR). Maternal body composition (visceral adipose tissue volume (VAT), subcutaneous adipose tissue volume (SAT), pancreatic and hepatic proton-density fat fraction (PDFF) and fetal body composition (abdominal SAT and hepatic PDFF) were measured using MRI between 30 to 36 weeks gestation. RESULTS Compared to healthy and FGR fetuses, GDM fetuses had greater hepatic PDFF (5.2 [4.2, 5.5]% vs. 3.2 [3, 3.3]% vs. 1.9 [1.4, 3.7]%, p = 0.004). Fetal hepatic PDFF was associated with maternal SAT (r = 0.47, p = 0.02), VAT (r = 0.62, p = 0.002), and pancreatic PDFF (r = 0.54, p = 0.008). When controlling for maternal SAT, GDM increased fetal hepatic PDFF by 0.9 ([0.51, 1.3], p = 0.001). CONCLUSION In this study, maternal SAT, VAT, and GDM status were positively associated with fetal hepatic PDFF.
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Affiliation(s)
- Katie M. Strobel
- Department of Pediatrics, Division of Neonatology & Developmental Biology, University of California Los Angeles, Los Angeles, CA, USA
| | - Sevgi Gokce Kafali
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Shu-Fu Shih
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Rinat Masamed
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - David Elashoff
- University of California Los Angeles, Los Angeles, CA, USA
| | - Holden H. Wu
- Department of Medicine, Biostatistics and Computational Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kara L. Calkins
- Department of Pediatrics, Division of Neonatology & Developmental Biology, University of California Los Angeles, Los Angeles, CA, USA
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16
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Wang X, Zhu C, Liu H, Sun L, Zhu W, Gu C. The effects of a midwife-led weight management program for pregnant women: A randomized controlled trial. Int J Nurs Stud 2023; 137:104387. [PMID: 36435003 DOI: 10.1016/j.ijnurstu.2022.104387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Inappropriate weight gain during pregnancy may present risks for maternal and newborn health. Pregnancy is considered the optimal time to intervene on women's health behaviors such as eating habits and physical activity. However, current clinical practice guidelines for weight management during pregnancy were not fully based on randomized trials, thus lacking specific "active intervention ingredients" that are proven effective in achieving appropriate gestational weight gain. Therefore it is essential to develop and implement an evidence-based weight management program for pregnant women. OBJECTIVE To examine the effects of a midwife-led weight management program on improving appropriate gestational weight gain, health literacy, experience of antenatal care, and maternal and neonatal outcomes among Chinese pregnant women. DESIGN A two-group randomized controlled trial. SETTINGS AND PARTICIPANTS A total of 426 pregnant women were recruited from a tertiary women's hospital in eastern China. METHODS Participants were randomly allocated to either intervention group (n = 213) or control group (n = 213). Women in the intervention group participated in a midwife-led weight management program during pregnancy, while women in the control group received the conventional obstetrician-led antenatal care. We assessed women at the first antenatal contact, 35-36 weeks gestation and 2-3 days postpartum. Data on gestational weight gain, health literacy, experience of antenatal care, and maternal and neonatal outcomes were compared between the two groups. Dummy variable analysis was conducted to reveal the effect of weight management program on gestational weight gain. RESULTS The overall gestational weight gain between the two groups was not statistically different (t = -1.377, P = 0.170). Compared with women in the control group, the odds of having inappropriate gestational weight gain was lower in the intervention group (OR = 0.270, 95%CI 0.169, 0.431). Further subgroup analyses showed that women in the intervention group had lower risk of inadequate gestational weight gain (OR = 0.305, 95%CI 0.180, 0.515) and excessive gestational weight gain (OR = 0.236, 95%CI 0.138, 0.404) than those in the control group. The score of experience of antenatal care was significantly higher in the midwife-led weight management group than that in the control group (193.70 ± 18.51 versus 165.70 ± 28.23, P < 0.001). Women's health literacy score was higher in the intervention group than control group [74.41 (69.57, 81.77) versus 71.88 (66.23, 77.18), P = 0.004]. CONCLUSION Compared with the conventional antenatal care, the midwife-led weight management program could facilitate appropriate gestational weight gain, enhance health literacy, and promote positive experience of antenatal care for Chinese pregnant women.
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Affiliation(s)
- Xiaojiao Wang
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Chunxiang Zhu
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Hongyan Liu
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; School of Nursing, Fudan University, Shanghai,China
| | - Liping Sun
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Wenli Zhu
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; School of Nursing, Fudan University, Shanghai,China
| | - Chunyi Gu
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
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17
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Estevez Burns R, Hare ME, Andres A, Klesges RC, Talcott GW, LeRoy K, Little MA, Hyrshko‐Mullen A, Waters TM, Harvey JR, Bursac Z, Krukowski RA. An interim analysis of a gestational weight gain intervention in military personnel and other TRICARE beneficiaries. Obesity (Silver Spring) 2022; 30:1951-1962. [PMID: 36041980 PMCID: PMC9804329 DOI: 10.1002/oby.23523] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Despite military fitness regulations, women in the military frequently experience overweight/obesity, excessive gestational weight gain (GWG), and the postpartum implications. This interim analysis of the Moms Fit 2 Fight study examines GWG outcomes among active-duty personnel and other TRICARE beneficiaries who received a stepped-care GWG intervention compared with those who did not receive a GWG intervention. METHOD Participants (N = 430; 32% identified with an underrepresented racial group, 47% were active duty) were randomized to receive a GWG intervention or the comparison condition, which did not receive a GWG intervention. RESULTS Retention was 88% at 32 to 36 weeks' gestation. Participants who received the GWG intervention gained less weight compared with those who did not (mean [SD] = 10.38 [4.58] vs. 11.80 [4.87] kg, p = 0.0056). Participants who received the intervention were less likely to have excessive GWG compared with those who did not (54.6% vs. 66.7%, p = 0.0241). The intervention effects were significant for participants who identified as White, but not for those of other racial identities. There were no significant differences between the conditions in maternal/neonatal outcomes. CONCLUSIONS The intervention successfully reduced excessive GWG, particularly among participants who identified as White. Should this intervention be found cost-effective, it may be sustainably integrated throughout the military prenatal care system.
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Affiliation(s)
| | - Marion E. Hare
- Department of Preventive MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
| | - Aline Andres
- University of Arkansas for Medical Sciences and Arkansas Children's Nutrition CenterLittle RockArkansasUSA
| | - Robert C. Klesges
- Department of Public Health SciencesUniversity of Virginia Cancer Center, School of Medicine, University of VirginiaCharlottesvilleVirginiaUSA
| | - Gerald Wayne Talcott
- Wilford Hall Ambulatory Surgical CenterLackland Air Force BaseTexasUSA
- Department of Public Health SciencesUniversity of Virginia Cancer Center, School of Medicine, University of VirginiaCharlottesvilleVirginiaUSA
| | - Karen LeRoy
- Wilford Hall Ambulatory Surgical CenterLackland Air Force BaseTexasUSA
- Department of Public Health SciencesUniversity of Virginia Cancer Center, School of Medicine, University of VirginiaCharlottesvilleVirginiaUSA
| | - Melissa A. Little
- Department of Public Health SciencesUniversity of Virginia Cancer Center, School of Medicine, University of VirginiaCharlottesvilleVirginiaUSA
| | | | - Teresa M. Waters
- Department of Health Management and PolicyUniversity of KentuckyLexingtonKentuckyUSA
| | - Jean R. Harvey
- Department of Nutrition and Food SciencesUniversity of VermontBurlingtonVermontUSA
| | - Zoran Bursac
- Department of BiostatisticsFlorida International UniversityMiamiFloridaUSA
| | - Rebecca A. Krukowski
- Department of Preventive MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
- Department of Public Health SciencesUniversity of Virginia Cancer Center, School of Medicine, University of VirginiaCharlottesvilleVirginiaUSA
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18
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Perea V, Simó-Servat A, Quirós C, Alonso-Carril N, Valverde M, Urquizu X, Amor AJ, López E, Barahona MJ. Role of Excessive Weight Gain During Gestation in the Risk of ADHD in Offspring of Women With Gestational Diabetes. J Clin Endocrinol Metab 2022; 107:e4203-e4211. [PMID: 36073965 DOI: 10.1210/clinem/dgac483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Although attention-deficit/hyperactivity disorder (ADHD) has been associated with gestational diabetes mellitus (GDM) and maternal obesity, excessive weight gain (EWG) during pregnancy has scarcely been evaluated. OBJECTIVE This study aimed to assess the joint effect of maternal weight and EWG on the risk of ADHD in offspring of GDM pregnancies. METHODS In this cohort study of singleton births >22 weeks of gestation of women with GDM between 1991 and 2008, gestational weight gain above the National Academy of Medicine (NAM) recommendations was classified into EWG. Cox-regression models estimated the effect of maternal pregestational weight and EWG on the risk of ADHD (identified from medical records), adjusted for pregnancy outcomes and GDM-related variables. RESULTS Of 1036 children who were included, with a median follow-up of 17.7 years, 135 (13%) were diagnosed with ADHD. ADHD rates according to pregestational maternal weight were 1/14 (7.1%) for underweight, 62/546 (11.4%) for normal weight, 40/281 (14.2%) for overweight, and 32/195 (16.4%) for obesity. Only maternal obesity was independently associated with ADHD (HRadjusted 1.66 [95% CI, 1.07-2.60]), but not maternal overweight or EWG. On evaluating the joint contribution of maternal weight and EWG, maternal obesity with EWG was associated with the highest risk of ADHD (vs normal weight without EWG; HRadjusted 2.13 [95% CI, 1.14-4.01]). Pregestational obesity without EWG was no longer associated (HRadjusted 1.36 [95% CI, 0.78-2.36]). CONCLUSION Among GDM pregnancies, pregestational obesity was associated with a higher risk of ADHD in offspring. Nonetheless, when gestational weight gain was taken into account, only the joint association of obesity and EWG remained significant.
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Affiliation(s)
- Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain
| | - Andreu Simó-Servat
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain
| | - Carmen Quirós
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain
| | - Nuria Alonso-Carril
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain
| | - Maite Valverde
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain
| | - Xavier Urquizu
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain
| | - Antonio J Amor
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Eva López
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain
| | - Maria-José Barahona
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain
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19
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Lee WL, Lee FK, Wang PH. Pre-pregnancy body mass index and outcome of preeclampsia. Taiwan J Obstet Gynecol 2022; 61:737-738. [PMID: 36088036 DOI: 10.1016/j.tjog.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Wen-Ling Lee
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan; Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan
| | - Fa-Kung Lee
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
| | - Peng-Hui Wang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Female Cancer Foundation, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
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20
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Cantor AG, Nelson HD, Pappas M, Atchison C. Preventing Obesity in Midlife Women: A Systematic Review for the Women's Preventive Services Initiative. Ann Intern Med 2022; 175:1275-1284. [PMID: 35914258 DOI: 10.7326/m22-0160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite high prevalence rates of obesity in the United States, no clinical guidelines exist for obesity prevention in midlife women who commonly experience weight gain. PURPOSE To evaluate evidence on the effectiveness and harms of behavioral interventions to reduce weight gain and improve health outcomes for women aged 40 to 60 years without obesity. DATA SOURCES English-language searches of Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (inception to 26 October 2021); ClinicalTrials.gov (October 2021); and reference lists of studies and reviews. STUDY SELECTION Randomized controlled trials (RCTs) enrolling predominantly midlife women comparing behavioral interventions to prevent weight gain with control groups and reporting health outcomes and potential harms. DATA EXTRACTION Dual extraction and quality assessment of individual studies. DATA SYNTHESIS Seven RCTs in 12 publications (n = 51 638) were included. Four RCTs showed statistically significant favorable differences in weight change for counseling interventions versus control groups (mean difference of weight change, -0.87 to -2.5 kg), whereas 1 trial of counseling and 2 trials of exercise showed no differences; 1 of 2 RCTs reported improved quality-of-life measures. Interventions did not increase measures of depression or stress in 1 trial; self-reported falls (37% vs. 29%; P < 0.001) and injuries (19% vs. 14%; P = 0.03) were higher with exercise counseling in 1 trial. LIMITATION Trials were generally small, heterogeneous, and lacked data on harms, long-term health outcomes, and specific patient populations. CONCLUSION Counseling interventions to prevent weight gain in women during midlife may result in modest differences in weight change without causing important harms. More research is needed to determine optimal content, frequency, length, and number of sessions required and should include additional patient populations. PRIMARY FUNDING SOURCE Health Resources and Services Administration.
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Affiliation(s)
- Amy G Cantor
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, and Departments of Family Medicine and Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (A.G.C.)
| | - Heidi D Nelson
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California (H.D.N.)
| | - Miranda Pappas
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (M.P., C.A.)
| | - Chandler Atchison
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (M.P., C.A.)
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21
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Lloyd M, Teede H, Bailey C, Callander E, Ademi Z. Projected Return on Investment From Implementation of a Lifestyle Intervention to Reduce Adverse Pregnancy Outcomes. JAMA Netw Open 2022; 5:e2230683. [PMID: 36066890 PMCID: PMC9449797 DOI: 10.1001/jamanetworkopen.2022.30683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Structured antenatal diet and physical activity interventions have been shown to be associated with reduced adverse pregnancy outcomes and recommended to be routinely offered to all pregnant women. The health cost implications of population-level implementation are unclear. OBJECTIVE To estimate the budget impact associated with integrating structured diet and physical activity interventions into routine antenatal care. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation was conducted from the perspective of Australian health funders. An open-source decision-tree model was constructed to compare the projected budget outcomes of implementing lifestyle intervention vs usual care. Scenario, deterministic, and probabilistic sensitivity analysis were completed. The study setting was Australian health services, and the study population was all Australian women projected to give birth in the years 2022 to 2026 (approximately 330 000 per year). INTERVENTIONS Structured diet and physical activity intervention provided by trained health professionals, integrated into routine antenatal care. Comparator was usual care, which currently in Australia does not include routine structured lifestyle interventions. MAIN OUTCOMES AND MEASURES Return on investment (ROI) ratio for lifestyle intervention (cost of intervention divided by cost savings attributable to reduced maternal and infant adverse events) from the perspective of Australian health care funders. Adverse events were obtained from a published meta-analysis and population data. Costs were estimated from aggregate trial data and clinical pathways and valued at the year incurred. RESULTS Intervention offered an ROI ratio of 4.75 over the 5-year program; hence every Australian dollar spent on implementation produced an estimated return of A$4.75. The projected total 5-year intervention cost was A$205 million ($151 million), with cost offsets (from reduced incidence of adverse pregnancy outcomes) of A$1022 million ($755 million), and health budget savings of A$807 million (95% CI, A$129 million to A$1639 million) ($596 million [95% CI, $95 million to $1211 million]); 93.3% of the 10 000 iterations were within cost saving, and results were robust to scenario and sensitivity analyses. CONCLUSIONS AND RELEVANCE This economic evaluation found that providing access to structured diet and physical activity lifestyle interventions for all pregnant Australian women was estimated to provide strong return on investment for health funders. The open-source model developed can be used by other jurisdictions and health services to explore cost implications of implementation within their patient population.
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Affiliation(s)
- Melanie Lloyd
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helena Teede
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Cate Bailey
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Emily Callander
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
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22
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Teede HJ, Goldstein R, Harrison C. Comparison of Chinese vs US Gestational Weight Gain Guidelines for Chinese Women. JAMA Netw Open 2022; 5:e2233256. [PMID: 36149659 DOI: 10.1001/jamanetworkopen.2022.33256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Helena J Teede
- Monash Centre for Health Research and Implementation, Monash University, Monash Endocrine and Diabetes Units, Monash Health, Clayton, Melbourne, Victoria, Australia
| | - Rebecca Goldstein
- Monash Centre for Health Research and Implementation, Monash University, Monash Endocrine and Diabetes Units, Monash Health, Clayton, Melbourne, Victoria, Australia
| | - Cheryce Harrison
- Monash Centre for Health Research and Implementation, Monash University, Monash Endocrine and Diabetes Units, Monash Health, Clayton, Melbourne, Victoria, Australia
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23
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Chelmow D, Gregory KD, Witkop C, Hoffstetter S, Humphrey L, Picardo C, Stevermer JJ, Cantor AG, Nelson HD, Son S, Conry JA, Garcia F, Kendig SM, O'Reilly N, Qaseem A, Ramos D, Salganicoff A, Wood JK, Zahn C. Preventing Obesity in Midlife Women: A Recommendation From the Women's Preventive Services Initiative. Ann Intern Med 2022; 175:1305-1309. [PMID: 35914264 DOI: 10.7326/m22-0252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION The Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient advocacy representatives, developed a recommendation for counseling midlife women aged 40 to 60 years with normal or overweight body mass index (BMI; 18.5 to 29.9 kg/m2) to maintain weight or limit weight gain to prevent obesity with the long-term goals of optimizing health, function, and well-being. This recommendation is intended to guide clinical practice and coverage of clinical preventive health services for the Health Resources and Services Administration and other stakeholders. Clinicians providing preventive health care to women in primary care settings are the target audience for this recommendation. METHODS The WPSI developed this recommendation after evaluating results of a systematic review of the effectiveness and harms of interventions to prevent weight gain and obesity in women aged 40 to 60 years without obesity. Seven randomized clinical trials including 51 638 participants and using various counseling and behavioral interventions were included. Trials indicated favorable weight changes with interventions that were statistically significantly different from control groups in 4 of 5 trials of counseling, but not in 2 trials of exercise. Few harms were reported. RECOMMENDATION The WPSI recommends counseling midlife women aged 40 to 60 years with normal or overweight BMI (18.5 to 29.9 kg/m2) to maintain weight or limit weight gain to prevent obesity. Counseling may include individualized discussion of healthy eating and physical activity.
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Affiliation(s)
- David Chelmow
- Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, Virginia (D.C.)
| | - Kimberly D Gregory
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California (K.D.G.)
| | - Catherine Witkop
- Departments of Preventive Medicine and Gynecologic Surgery & Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland (C.W.)
| | - Susan Hoffstetter
- Department of Obstetrics, Gynecology and Women's Health, Saint Louis University School of Medicine, St. Louis, Missouri (S.H.)
| | | | - Carla Picardo
- Women's Wellness & Gynecology, Erie, and Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (C.P.)
| | - James J Stevermer
- Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, Missouri (J.J.S.)
| | - Amy G Cantor
- Departments of Medical Informatics and Clinical Epidemiology, Family Medicine, and Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (A.G.C.)
| | - Heidi D Nelson
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California (H.D.N.)
| | - Sarah Son
- American College of Obstetricians and Gynecologists, Washington, DC (S.S., N.O., C.Z.)
| | - Jeanne A Conry
- American College of Obstetricians and Gynecologists, Granite Bay, California (J.A.C.)
| | | | - Susan M Kendig
- Nurse Practitioners in Women's Health, Washington, DC (S.M.K.)
| | - Nancy O'Reilly
- American College of Obstetricians and Gynecologists, Washington, DC (S.S., N.O., C.Z.)
| | - Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
| | - Diana Ramos
- University of Southern California Keck School of Medicine, Los Angeles, California (D.R.)
| | | | - Julie K Wood
- American Academy of Family Physicians, Leawood, Kansas (J.K.W.)
| | - Christopher Zahn
- American College of Obstetricians and Gynecologists, Washington, DC (S.S., N.O., C.Z.)
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Dalfra' MG, Burlina S, Lapolla A. Weight gain during pregnancy: A narrative review on the recent evidences. Diabetes Res Clin Pract 2022; 188:109913. [PMID: 35568262 DOI: 10.1016/j.diabres.2022.109913] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 12/24/2022]
Abstract
Gestational weight gain is necessary for the normal fetus development, in fact a series of studies have evidenced that both low and excessive gestational weight gain is associated with negative fetal-neonatal outcomes. So, evidences on the optimal gestational weight gain across the ranges of the pre-pregnancy maternal body mass index are necessary. In this context, while for normal weight and underweight the recommendations of IOM are clearly stated and supported by well designed and conducted clinical studies, those for the obese pregnant women are even today debated. Pre-pregnancy obesity is associated with high risk to develop hypertension, gestational diabetes, cesarean section and high birth weight. The Institute of Medicine guidelines, in 2009, recommended that women with obesity gain 11-20 lb at a rate of 0.5 lb/week during the second and third trimesters of pregnancy. Successively, taking into account a series of meta-analysis, the American College of Obstetricians and Gynecologists emphasized that the IOM weight gain targets for obese pregnant women are too high. However the high risk to have babies small for gestational age, related to a low weight gain or a losing of weight during pregnancy, has also been demonstrated. More recent studies have taken into consideration the maternal and fetal outcomes of obese pregnant women with different obesity class (I,II,III) and different weight gain during pregnancy. The analysis of these studies, discussed in this narrative review, show that the appropriate gestational weight gain should be personalized considering the three obesity class; furthermore both an upper and lower limit of gestational weight gain should be reconsidered in order to prevent the negative maternal and fetal outcomes in these women.
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Thakkar A, Hailu T, Blumenthal RS, Martin SS, Harrington CM, Yeh DD, French KA, Sharma G. Cardio-Obstetrics: the Next Frontier in Cardiovascular Disease Prevention. Curr Atheroscler Rep 2022; 24:493-507. [PMID: 35524915 PMCID: PMC9076812 DOI: 10.1007/s11883-022-01026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 12/05/2022]
Abstract
Purpose of Review Internationally, cardiovascular disease (CVD) is the leading cause of death in women. With risk factors for CVD continuing to rise, early identification and management of chronic diseases such as hypertension, diabetes, and obstructive sleep apnea is necessary for prevention. Pregnancy is a natural stress test for women with risk factors who may be predisposed to CVD and offers a unique opportunity to not only recognize disease but also implement effective and long-lasting strategies for prevention. Recent Findings Prevention begins before pregnancy, as preconception screening, counseling, and optimization of chronic diseases can improve maternal and fetal outcomes. Throughout pregnancy, women should maintain close follow-up, continued reevaluation of risk factors, with counseling when necessary. Continued healthcare engagement during the “fourth trimester,” 3 months following delivery, allows clinicians to continue monitoring the evolution of chronic diseases, encourage ongoing lifestyle counseling, and connect women with primary care and appropriate specialists if needed. Unfortunately, this postpartum period represents a major care gap, as a significant proportion of most women do not attend their scheduled visits. Social determinants of health including decreased access to care and economic instability lead to increased risk factors throughout pregnancy but particularly play a role in poor compliance with postpartum follow-up. The use of telemedicine clinics and remote monitoring may prove to be effective interventions, bridging the gap between physicians and patients and improving follow-up for at-risk women. Summary While many clinicians are beginning to understand the impact of CVD on women, screening and prevention strategies are not often implemented until much later in life. Pregnancy creates an opportunity to begin engaging women in cardiovascular protective strategies before the development of the disease.
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Affiliation(s)
- Aarti Thakkar
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 559, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Tigist Hailu
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 559, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 559, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 559, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Colleen M Harrington
- Division of Cardiovascular Medicine, University of Massachusetts Memorial Healthcare, Worcester, MA, USA
| | - Doreen DeFaria Yeh
- Division of Cardiology, Adult Congenital Heart Disease Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Katharine A French
- Lifespan Cardiovascular Institute, Division of Cardiology, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 559, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
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26
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The importance of nutrition in pregnancy and lactation: lifelong consequences. Am J Obstet Gynecol 2022; 226:607-632. [PMID: 34968458 PMCID: PMC9182711 DOI: 10.1016/j.ajog.2021.12.035] [Citation(s) in RCA: 131] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022]
Abstract
Most women in the United States do not meet the recommendations for healthful nutrition and weight before and during pregnancy. Women and providers often ask what a healthy diet for a pregnant woman should look like. The message should be “eat better, not more.” This can be achieved by basing diet on a variety of nutrient-dense, whole foods, including fruits, vegetables, legumes, whole grains, healthy fats with omega-3 fatty acids that include nuts and seeds, and fish, in place of poorer quality highly processed foods. Such a diet embodies nutritional density and is less likely to be accompanied by excessive energy intake than the standard American diet consisting of increased intakes of processed foods, fatty red meat, and sweetened foods and beverages. Women who report “prudent” or “health-conscious” eating patterns before and/or during pregnancy may have fewer pregnancy complications and adverse child health outcomes. Comprehensive nutritional supplementation (multiple micronutrients plus balanced protein energy) among women with inadequate nutrition has been associated with improved birth outcomes, including decreased rates of low birthweight. A diet that severely restricts any macronutrient class should be avoided, specifically the ketogenic diet that lacks carbohydrates, the Paleo diet because of dairy restriction, and any diet characterized by excess saturated fats. User-friendly tools to facilitate a quick evaluation of dietary patterns with clear guidance on how to address dietary inadequacies and embedded support from trained healthcare providers are urgently needed. Recent evidence has shown that although excessive gestational weight gain predicts adverse perinatal outcomes among women with normal weight, the degree of prepregnancy obesity predicts adverse perinatal outcomes to a greater degree than gestational weight gain among women with obesity. Furthermore, low body mass index and insufficient gestational weight gain are associated with poor perinatal outcomes. Observational data have shown that first-trimester gain is the strongest predictor of adverse outcomes. Interventions beginning in early pregnancy or preconception are needed to prevent downstream complications for mothers and their children. For neonates, human milk provides personalized nutrition and is associated with short- and long-term health benefits for infants and mothers. Eating a healthy diet is a way for lactating mothers to support optimal health for themselves and their infants.
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Bennett WL, Coughlin JW, Henderson J, Martin S, Yazdy GM, Drabo EF, Showell NN, McKinney C, Martin L, Dalcin A, Sanders R, Wang NY. Healthy for Two/Healthy for You: Design and methods for a pragmatic randomized clinical trial to limit gestational weight gain and prevent obesity in the prenatal care setting. Contemp Clin Trials 2022; 113:106647. [PMID: 34896296 PMCID: PMC8844210 DOI: 10.1016/j.cct.2021.106647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the effect of Healthy for Two/Healthy for You (H42/H4U), a health coaching program, in prenatal care clinics that serve a racially and economically diverse population, on total gestational weight gain (GWG) (vs. usual care). We hypothesize that compared to usual prenatal care, intervention participants will have lower GWG and lower rates of gestational diabetes mellitus (GDM). METHODS We report the rationale and design of a pragmatic, parallel arm randomized clinical trial with 380 pregnant patients ≤15 weeks gestation with overweight or obesity from one of 6 academic and community-based obstetrics practices, randomized to either H42/H4U or usual prenatal care in a 1:1 ratio. The study duration is early pregnancy to 6 months postpartum. The primary outcome is total GWG, calculated as the difference between first clinic-assessed pregnancy weight and the weight at 37 weeks gestation. Key maternal and infant secondary outcomes include GDM incidence, weight retention at 6 months postpartum, infant weight, maternal health behaviors and wellness. CONCLUSIONS This pragmatic clinical trial embeds a pregnancy health coaching program into prenatal care to allow parallel testing compared to usual prenatal care on the outcome of total GWG. The real-world design provides an approach to enhance its sustainability beyond the trial to ultimately improve maternal/child health outcomes and reduce future obesity. TRIAL REGISTRATION The study was first registered at clinicaltrials.gov on 1/26/21 (NCT04724330).
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Affiliation(s)
- Wendy L Bennett
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA..
| | | | - Janice Henderson
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, USA
| | - Stephen Martin
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, USA
| | - Golsa M Yazdy
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, USA
| | - Emmanuel F Drabo
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, USA
| | | | - Christine McKinney
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Lindsay Martin
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Arlene Dalcin
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Rachel Sanders
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Nae-Yuh Wang
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA
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Olerich K, Soper D, Delaney S, Sterrett M. Pregnancy Care for Patients With Super Morbid Obesity. Front Pediatr 2022; 10:839377. [PMID: 35928678 PMCID: PMC9343711 DOI: 10.3389/fped.2022.839377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
The patient with obesity represents unique challenges to the medical community and, in the setting of pregnancy, additional risks to both mother and fetus. This document will focus on the risks and considerations needed to care for the women with obesity and her fetus during the antepartum, intrapartum, and immediate postpartum stages of pregnancy. Specific attention will be given to pregnancy in the setting of class III and super morbid obesity.
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Affiliation(s)
- Kelsey Olerich
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - David Soper
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, United States
| | - Shani Delaney
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Mary Sterrett
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States.,Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, United States
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Dodd JM, Dalrymple K, Louise J. Systematic Review of Counseling and Behavioral Interventions for Healthy Weight and Weight Gain in Pregnancy From the US Preventive Services Task Force. JAMA 2021; 326:1634-1635. [PMID: 34698792 DOI: 10.1001/jama.2021.13992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Jodie M Dodd
- Department of Obstetrics and Gynaecology, University of Adelaide, Adelaide, Australia
| | - Kathryn Dalrymple
- Division of Women and Children's Health, King's College London, London, England
| | - Jennie Louise
- Department of Obstetrics and Gynaecology, University of Adelaide, Adelaide, Australia
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Bovbjerg ML. Current Resources for Evidence-Based Practice, November 2021. J Obstet Gynecol Neonatal Nurs 2021; 50:789-800. [PMID: 34653377 DOI: 10.1016/j.jogn.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of autonomy and respect in maternity care and commentaries on reviews focused on whether to induce women who present with mild preeclampsia in the late preterm period and the extent to which urinary incontinence symptoms prevent women from participating in exercise. It also includes a brief update about the USPSTF guidelines on screening for gestational diabetes.
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Eating Behaviors and Dietary Patterns of Women during Pregnancy: Optimizing the Universal 'Teachable Moment'. Nutrients 2021; 13:nu13093298. [PMID: 34579175 PMCID: PMC8471126 DOI: 10.3390/nu13093298] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 01/13/2023] Open
Abstract
Understanding women’s perceptions of eating behaviors and dietary patterns can inform the ‘teachable moment’ model of pregnancy. Our objectives were to describe eating behaviors and dietary patterns in pregnancy. This was a cross-sectional, national electronic survey. Women were ≥18 years of age, living in the United States, currently pregnant or less than two years postpartum, and had internet access. Age, education, race, and marriage were included as covariates in ordinal and binary logistic regressions (significance p < 0.05). Women (n = 587 eligible) made positive or negative changes to their diets, while others maintained pre-existing eating behaviors. The majority of women did not try (84.9 to 95.1% across diets) and were unwilling to try (66.6 to 81%) specific dietary patterns during pregnancy. Concerns included not eating a balanced diet (60.1 to 65.9%), difficulty in implementation without family (63.2 to 64.8%), and expense (58.7 to 60.1%). Helpful strategies included being provided all meals and snacks (88.1 to 90.6%) and periodic consultations with a dietitian or nutritionist (85 to 86.7%). Responses differed across subgroups of parity, body mass index, and trimester, notably in women with obesity who reported healthier changes to their diet (p < 0.05). Our study underscores the importance of tailoring care early to individual needs, characteristics, and circumstances.
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Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Kubik M, Li L, Ogedegbe G, Pbert L, Silverstein M, Stevermer J, Tseng CW, Wong JB. Screening for Gestational Diabetes: US Preventive Services Task Force Recommendation Statement. JAMA 2021; 326:531-538. [PMID: 34374716 DOI: 10.1001/jama.2021.11922] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Gestational diabetes is diabetes that develops during pregnancy. Prevalence of gestational diabetes in the US has been estimated at 5.8% to 9.2%, based on traditional diagnostic criteria, although it may be higher if more inclusive criteria are used. Pregnant persons with gestational diabetes are at increased risk for maternal and fetal complications, including preeclampsia, fetal macrosomia (which can cause shoulder dystocia and birth injury), and neonatal hypoglycemia. Gestational diabetes has also been associated with an increased risk of several long-term health outcomes in pregnant persons and intermediate outcomes in their offspring. OBJECTIVE The USPSTF commissioned a systematic review to evaluate the accuracy, benefits, and harms of screening for gestational diabetes and the benefits and harms of treatment for the pregnant person and infant. POPULATION Pregnant persons who have not been previously diagnosed with type 1 or type 2 diabetes. EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that there is a moderate net benefit to screening for gestational diabetes at 24 weeks of gestation or after to improve maternal and fetal outcomes. The USPSTF concludes that the evidence on screening for gestational diabetes before 24 weeks of gestation is insufficient, and the balance of benefits and harms of screening cannot be determined. RECOMMENDATION The USPSTF recommends screening for gestational diabetes in asymptomatic pregnant persons at 24 weeks of gestation or after. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for gestational diabetes in asymptomatic pregnant persons before 24 weeks of gestation. (I statement).
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Affiliation(s)
| | - Karina W Davidson
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York
| | | | | | | | | | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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Affiliation(s)
- Huann-Cheng Horng
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wen-Ling Lee
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
- Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan, ROC
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
- Female Cancer Foundation, Taipei, Taiwan, ROC
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34
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Zhou YB, Liu JM. Optimal gestational weight gain. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 13:100207. [PMID: 34527990 PMCID: PMC8403894 DOI: 10.1016/j.lanwpc.2021.100207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Yu-bo Zhou
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd, Haidian District, Beijing 100191, China
| | - Jian-meng Liu
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd, Haidian District, Beijing 100191, China
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