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El Masri D, Alemayohu MA, Loperfido F, Bianco I, Ferrara C, Cerbo RM, Ghirardello S, Monti MC, Maccarini B, Sottotetti F, Civardi E, Garofoli F, Angelini M, Cena H, De Giuseppe R. Associations of maternal lifestyle factors with inadequate pregnancy weight gain: findings from the baseline data of the LIMIT prospective cohort study. Eur J Nutr 2024:10.1007/s00394-024-03473-0. [PMID: 39167177 DOI: 10.1007/s00394-024-03473-0] [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: 02/13/2024] [Accepted: 07/22/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND/OBJECTIVES Gestational Weight Gain (GWG) impacts maternal and fetal health; deviations from optimal ranges pose health risks. Maternal lifestyle before and during pregnancy strongly influences GWG. This study explores factors linked to inadequate GWG, focusing on Mediterranean Diet (MD) adherence and specific food consumption. SUBJECTS/METHODS 178 pregnant women were enrolled at Fondazione IRCCS Policlinico San Matteo (Pavia) during pre-hospital care before birth meeting inclusion/exclusion criteria. Sociodemographic data, pre-pregnancy BMI, GWG, MD adherence, physical activity (PA) levels, and smoking habits were retrospectively collected. Validated questionnaires adapted for the target group, assessed MD adherence and PA level. Participants were classified into adequate (AGWG) and inadequate GWG groups following IOM guidelines. RESULTS Among 200 pregnant women (aged 30-36), 37.1% experienced low GWG and 24.1% excessive GWG. Our study revealed a significant association between inadequate GWG and educational level (P = 0.011); pre-pregnancy BMI (P = 0.005); MD adherence (P = 0.008), and daily average consumption of vegetables (P < 0.001). Our results also showed that a lower risk of EGWG vs. AGWG was associated with daily average consumption of vegetables (RRR = 0.279, P = 0.004), while a higher risk of EGWG vs. AGWG was associated with high daily meat product consumption (> 1.5 portions/day) (RRR = 7.83, P = 0.03). CONCLUSION These findings emphasize the importance of promoting lifestyle changes before and during pregnancy to tackle the increasing incidence of inadequate GWG and improve the health outcomes of both mother and child.
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Affiliation(s)
- Dana El Masri
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100, Italy
| | - Mulubirhan Assefa Alemayohu
- Biostatistics and Clinical Epidemiology Unit, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100, Italy
- Department of Epidemiology, School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Federica Loperfido
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100, Italy.
| | - Irene Bianco
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100, Italy
| | - Chiara Ferrara
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100, Italy
| | - Rosa Maria Cerbo
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Stefano Ghirardello
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Maria Cristina Monti
- Biostatistics and Clinical Epidemiology Unit, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100, Italy
| | - Beatrice Maccarini
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100, Italy
| | - Francesca Sottotetti
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100, Italy
| | - Elisa Civardi
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Francesca Garofoli
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Micol Angelini
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100, Italy
- Clinical Nutrition Unit, Department of General Medicine, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, 27100, Italy
| | - Rachele De Giuseppe
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100, Italy
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Butler J, Sawaya Y, Seabrook JA, Madill J, Twynstra J. Canadian Midwives' Experiences with Nutrition in Their Training and Practice: A Cross-Sectional Study. J Midwifery Womens Health 2024. [PMID: 39104149 DOI: 10.1111/jmwh.13665] [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] [Revised: 06/14/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION Midwives are primary prenatal care providers well-positioned to offer nutrition advice to pregnant individuals; however, no Canadian study has assessed midwives' experience with nutrition education. The objective of this study was to investigate Canadian midwives' experiences with nutrition in their practice, their level of nutrition education, and their recommendations on select nutrition topics. METHODS This cross-sectional study used an anonymous online survey consisting of 4 sections: demographics, opinions on the importance of nutrition, nutrition recommendations for pregnancy, and nutrition topics that midwives would like more information on. Responses were recorded using Likert-type scales, multiple choice, or open-ended questions. Eligible participants, registered Canadian midwives, were recruited through advertisements in e-newsletters via national and provincial midwifery associations, social media posts, and emails to midwifery clinics. An independent samples t test compared differences in means for continuous outcomes, the χ2 test compared categorical variables, and the Mann-Whitney U test compared ordinal variables. A P < .05 was considered statistically significant. RESULTS In total, 161 midwives completed the online survey. Most midwives (92.5%) indicated that nutrition for pregnancy was important, and 83.2% believed their role in providing nutrition information to pregnant women was important. Almost two-thirds (63.8%) of midwives received nutrition education. Comfort levels were highest (median = 4) when providing nutrition advice on healthy eating, weight gain, Listeria, anemia, heartburn, safe food handling, nutrition for breastfeeding, and weight gain for women with obesity. Almost all the midwives (99.4%) had provided nutrition information to pregnant women, and 85.2% of their recommendations aligned with Canadian guidelines and literature. DISCUSSION Canadian midwives valued the importance of nutrition during pregnancy and their role in providing nutrition information to pregnant women. The level of comfort in advising on nutrition ranged from uncomfortable to very comfortable depending on the topic, and most (85.2%) of their advice aligned with Canadian guidelines and relevant literature.
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Affiliation(s)
- Jordyn Butler
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada
| | - Yvana Sawaya
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Jamie A Seabrook
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Human Environments Analysis Laboratory, Western University, London, Ontario, Canada
- Department of Paediatrics, Western University, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Janet Madill
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada
| | - Jasna Twynstra
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
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Hand LK, Taylor MK, Sullivan DK, Siengsukon CF, Morris JK, Martin LE, Hull HR. Pregnancy as a window of opportunity for dementia prevention: a narrative review. Nutr Neurosci 2024:1-13. [PMID: 38970804 DOI: 10.1080/1028415x.2024.2371727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2024]
Abstract
Dementia is a debilitating condition with a disproportionate impact on women. While sex differences in longevity contribute to the disparity, the role of the female sex as a biological variable in disease progression is not yet fully elucidated. Metabolic dysfunctions are drivers of dementia etiology, and cardiometabolic diseases are among the most influential modifiable risk factors. Pregnancy is a time of enhanced vulnerability for metabolic disorders. Many dementia risk factors, such as hypertension or blood glucose dysregulation, often emerge for the first time in pregnancy. While such cardiometabolic complications in pregnancy pose a risk to the health trajectory of a woman, increasing her odds of developing type 2 diabetes or chronic hypertension, it is not fully understood how this relates to her risk for dementia. Furthermore, structural and functional changes in the maternal brain have been reported during pregnancy suggesting it is a time of neuroplasticity for the mother. Therefore, pregnancy may be a window of opportunity to optimize metabolic health and support the maternal brain. Healthy dietary patterns are known to reduce the risk of cardiometabolic diseases and have been linked to dementia prevention, yet interventions targeting cognitive function in late life have largely been unsuccessful. Earlier interventions are needed to address the underlying metabolic dysfunctions and potentially reduce the risk of dementia, and pregnancy offers an ideal opportunity to intervene. This review discusses current evidence regarding maternal brain health and the potential window of opportunity in pregnancy to use diet to address neurological health disparities for women.
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Affiliation(s)
- Lauren K Hand
- Department of Dietetics and Nutrition, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
| | - Matthew K Taylor
- Department of Dietetics and Nutrition, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
| | - Catherine F Siengsukon
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jill K Morris
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Laura E Martin
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - Holly R Hull
- Department of Dietetics and Nutrition, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
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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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O'Reilly SL, McAuliffe FM, Geraghty AA, Burden C, Davies A. Implementing weight management during and after pregnancy to reduce diabetes and CVD risk in maternal and child populations. Proc Nutr Soc 2023:1-12. [PMID: 38037711 DOI: 10.1017/s0029665123004883] [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] [Indexed: 12/02/2023]
Abstract
Maintaining a healthy weight during pregnancy is critical for both women's and children's health. Excessive gestational weight gain (GWG) can lead to complications such as gestational diabetes, hypertension and caesarean delivery. Insufficient GWG can cause fetal growth restriction and increase infant mortality risk. Additionally, postpartum weight retention raises risk of obesity, type 2 diabetes and other chronic diseases for both mother and child. This review seeks to identify current obstacles in weight management research during and after pregnancy and explore evidence-based strategies to overcome them. Pregnancy offers a window of opportunity for health behaviour changes as women are more receptive to education and have regular contact with health services. Staying within Institute of Medicine's recommended GWG ranges is associated with better maternal and fetal outcomes. Systematic review evidence supports structured diet and physical activity pregnancy interventions, leading to reduced GWG and fewer complications. Health economic evaluation indicates significant returns from implementation, surpassing investment costs due to decreased perinatal morbidity and adverse events. However, the most effective way to implement interventions within routine antenatal care remains unclear. Challenges increase in the postpartum period due to competing demands on women physically, mentally and socially, hindering intervention reach and retention. Flexible, technology-supported interventions are needed, requiring frameworks such as penetration-implementation-participation-effectiveness and template-for-intervention-description-and-replication for successful implementation. Greater research efforts are necessary to inform practice and investigate fidelity aspects through pragmatic implementation trials during the pregnancy and postpartum periods. Understanding the best ways to deliver interventions will empower women to maintain a healthy weight during their reproductive years.
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Affiliation(s)
- Sharleen L O'Reilly
- School of Agriculture and Food Science, University College Dublin College of Health Sciences, Dublin, Ireland
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin School of Medicine, Dublin 2, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin School of Medicine, Dublin 2, Ireland
| | - Aisling A Geraghty
- School of Agriculture and Food Science, University College Dublin College of Health Sciences, Dublin, Ireland
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin School of Medicine, Dublin 2, Ireland
| | - Christy Burden
- Academic Women's Health Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anna Davies
- Academic Women's Health Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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McGill B, Lees D, Salisbury J, Reynolds T, Davidson S, Dorney E, Jeong SYS, O’Hara BJ. Impact Evaluation of the Get Healthy in Pregnancy Program: Evidence of Effectiveness. Healthcare (Basel) 2023; 11:2414. [PMID: 37685448 PMCID: PMC10487457 DOI: 10.3390/healthcare11172414] [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: 06/07/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
The efficacy of lifestyle interventions for reduced gestational weight gain (GWG) is established, but evidence of their effectiveness is limited. The Get Healthy in Pregnancy (GHiP) program is a telephone health coaching program supporting healthy GWG delivered state-wide in New South Wales, Australia. This evaluation explores the impact of GHiP on behavioural outcomes and GWG, analysing GHiP participant data (n = 3702 for 2018-2019). We conducted McNamar's tests to explore within-individual change for behavioural outcomes and logistic regression to assess associations between demographic characteristics, participant engagement and behavioural and weight outcomes for women who completed the program. Participants who completed ten coaching calls made significant improvements (all p < 0.001) in more health-related behaviours (walking, vigorous physical activity, vegetable consumption, takeaway meals and sweetened drink consumption) than those who completed fewer calls. Among women with valid weight change data (n = 245), 31% gained weight below, 33% gained weight within, and 36% gained weight above GWG guidelines. Pre-pregnancy BMI was the only factor significantly associated with meeting GWG guidelines. Women with pre-pregnancy overweight and obesity had lower odds than those with a healthy weight of having GWG within the guidelines. The majority of these women did not gain weight above the guidelines. A higher proportion of women with pre-pregnancy obesity gained weight below the guidelines (33.8%) than above the guidelines (28.5%). GHiP has the potential to support all pregnant women, including those with pre-pregnancy obesity, to achieve a healthier pregnancy.
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Affiliation(s)
- Bronwyn McGill
- Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Dominic Lees
- Biostatistics Training Program, NSW Ministry of Health, St Leonards, NSW 2065, Australia
| | - Justine Salisbury
- Centre for Population Health, NSW Ministry of Health, St Leonards, NSW 2065, Australia
| | - Tahlia Reynolds
- Centre for Population Health, NSW Ministry of Health, St Leonards, NSW 2065, Australia
| | - Sandy Davidson
- Centre for Population Health, NSW Ministry of Health, St Leonards, NSW 2065, Australia
| | - Edwina Dorney
- Centre for Population Health, NSW Ministry of Health, St Leonards, NSW 2065, Australia
| | - Sarah Yeun-Sim Jeong
- Centre for Population Health, NSW Ministry of Health, St Leonards, NSW 2065, Australia
- Charles Perkins Centre, Sydney School of Nursing, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Blythe J. O’Hara
- Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
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