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Kracht CL, Drews KL, Flanagan EW, Keadle SK, Gallagher D, Van Horn L, Haire-Joshu D, Phelan S, Pomeroy J, Redman LM. Maternal 24-h movement patterns across pregnancy and postpartum: The LIFE-Moms consortium. Prev Med Rep 2024; 42:102740. [PMID: 38707249 PMCID: PMC11068928 DOI: 10.1016/j.pmedr.2024.102740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 05/07/2024] Open
Abstract
Objective Time spent among the 24-h movement behaviors (physical activity [PA], sleep, sedentary behavior [SB]) in the perinatal period is important for maternal and child health. We described changes to 24-h movement behaviors and behavior guideline attainment during pregnancy and postpartum and identified correlates of behavior changes. Methods This secondary data analysis included the standard of care group (n = 439) from the U.S.-based Lifestyle Interventions For Expectant Moms (LIFE-Moms) consortium, including persons with overweight and obesity. Wrist-worn accelerometry was used to measure movement behaviors early (9-15 weeks) and late (35-36 weeks) pregnancy, and ∼ 1-year postpartum. Sleep and moderate-to-vigorous PA (MVPA) were compared to adult and pregnancy-specific guidelines, respectively. SB was classified into quartiles. PA and SB context were quantified using questionnaires. Mixed models were used to examine changes in behaviors and guidelines and identify correlates. Results Participants were 31.3 ± 3.5 years, 53.5 % were Black or Hispanic, and 45.1 % had overweight. Sleep duration decreased across time, but participants consistently met the guideline (range: 85.0-93.6 %). SB increased during pregnancy and decreased postpartum, while light PA and MVPA followed the inverse pattern. Participants met slightly fewer guidelines late pregnancy (1.2 ± 0.7 guidelines) but more postpartum (1.7 ± 0.8 guidelines) than early pregnancy (1.4 ± 0.8 guidelines). Black or Hispanic race/ethnicity, higher pregravid body mass index, and non-day work-shift (e.g., night-shift) were identified correlates of lower guideline adherence and varying PA and SB context. Conclusion Perinatal interventions should consider strategies to prevent SB increase and sustain MVPA to promote guideline adherence.
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Affiliation(s)
- Chelsea L. Kracht
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
- University of Kansas Medical Center, Kansas City, KS 66160, USA
| | | | | | - Sarah K. Keadle
- California Polytechnic State University, San Luis Obispo, CA, USA
| | | | | | | | - Suzanne Phelan
- California Polytechnic State University, San Luis Obispo, CA, USA
| | - Jeremy Pomeroy
- Marshfield Clinic Research Institute, Marshfield, WI, USA
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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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3
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Raab R, Geyer K, Zagar S, Hauner H. App-Supported Lifestyle Interventions in Pregnancy to Manage Gestational Weight Gain and Prevent Gestational Diabetes: Scoping Review. J Med Internet Res 2023; 25:e48853. [PMID: 37948111 PMCID: PMC10674147 DOI: 10.2196/48853] [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: 05/09/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM) are common pregnancy complications that have been shown to be preventable through the use of lifestyle interventions. However, a significant gap exists between research on pregnancy lifestyle interventions and translation into clinical practice. App-supported interventions might aid in overcoming previous implementation barriers. The current status in this emerging research area is unknown. OBJECTIVE This scoping review aims to provide a comprehensive overview of planned, ongoing, and completed studies on eHealth and mobile health (mHealth) app-supported lifestyle interventions in pregnancy to manage GWG and prevent GDM. The review assesses the scope of the literature in the field; describes the population, intervention, control, outcomes, and study design (PICOS) characteristics of included studies as well as the findings on GWG and GDM outcomes; and examines app functionalities. METHODS The scoping review was conducted according to a preregistered protocol and followed established frameworks. Four electronic databases and 2 clinical trial registers were systematically searched. All randomized and quasi-randomized controlled trials (RCTs) of app-supported lifestyle interventions in pregnancy and related qualitative and quantitative research across the different study phases were considered for inclusion. Eligible studies and reports of studies were included until June 2022. Extracted data were compiled in descriptive analyses and reported in narrative, tabular, and graphical formats. RESULTS This review included 97 reports from 43 lifestyle intervention studies. The number of published reports has steadily increased in recent years; of the 97 included reports, 38 (39%) were trial register entries. Of the 39 identified RCTs, 10 efficacy or effectiveness trials and 8 pilot trials had published results on GWG (18/39, 46%); of these 18 trials, 7 (39%) trials observed significant intervention effects on GWG outcomes. Of all 39 RCTs, 5 (13%) efficacy or effectiveness trials reported GDM results, but none observed significant intervention effects on GDM. The RCTs included in the review were heterogeneous in terms of their PICOS characteristics. Most of the RCTs were conducted in high-income countries, included women with overweight or obesity and from all BMI categories, delivered multicomponent interventions, delivered interventions during pregnancy only, and focused on diet and physical activity. The apps used in the studies were mostly mHealth apps that included features for self-monitoring, feedback, goal setting, prompts, and educational content. Self-monitoring was often supported by wearable activity monitors and Bluetooth-connected weight scales. CONCLUSIONS Research in this field is nascent, and the effectiveness and implementability of app-supported interventions have yet to be determined. The complexity and heterogeneity of intervention approaches pose challenges in identifying the most beneficial app features and intervention components and call for consistent and comprehensive intervention and outcome reporting.
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Affiliation(s)
- Roxana Raab
- Institute of Nutritional Medicine, Else Kröner Fresenius Centre for Nutritional Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Kristina Geyer
- Institute of Nutritional Medicine, Else Kröner Fresenius Centre for Nutritional Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Sophia Zagar
- Institute of Nutritional Medicine, Else Kröner Fresenius Centre for Nutritional Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Hans Hauner
- Institute of Nutritional Medicine, Else Kröner Fresenius Centre for Nutritional Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
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Pérez-Muñoz A, Hare ME, Andres A, Klesges RC, Wayne Talcott G, Little MA, Waters TM, Harvey JR, Bursac Z, Krukowski RA. A Postpartum Weight Loss-focused Stepped-care Intervention in a Military Population: A Randomized Controlled Trial. Ann Behav Med 2023; 57:836-845. [PMID: 37061829 PMCID: PMC10498817 DOI: 10.1093/abm/kaad014] [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] [Indexed: 04/17/2023] Open
Abstract
OBJECTIVE Postpartum weight retention is associated with adverse health among both civilian and military women. PURPOSE The current study evaluated a stepped-care weight management intervention, Moms Fit 2 Fight, adapted for use in a pregnant and postpartum military population. METHODS Active duty women and other TRICARE beneficiaries (N = 430) were randomized to one of three conditions: gestational weight gain only (GWG-only) intervention (n =144), postpartum weight loss only (PPWL-only) intervention (n =142), or a combined GWG + PPWL intervention (n = 144). Those participants who received the PPWL intervention (i.e., the PPWL-only and GWG+PPWL conditions) were combined consistently with the pre-registered protocol and compared to those participants who did not receive the PPWL intervention in the primary analyses. Primary outcome data (i.e., postpartum weight retention) were obtained at 6-months postpartum by unblinded data collectors, and intent-to-treat analyses were conducted. RESULTS Retention at 6-months postpartum was 88.4%. Participants who received the PPWL intervention retained marginally less weight (1.31 kg) compared to participants that received the GWG-only intervention (2.39 kg), with a difference of 1.08 kg (p = .07). None of the measured covariates, including breastfeeding status, were significantly associated with postpartum weight retention. Of the participants who received the PPWL intervention, 48.1% participants returned to their pre-pregnancy weight at 6-months postpartum, with no significant differences compared to those who received the GWG-only intervention. CONCLUSIONS A behavioral intervention targeting diet and physical activity during the postpartum period had a trend for reduced postpartum weight retention. CLINICAL TRIAL INFORMATION The trial is registered on clinicaltrials.gov (NCT03057808).
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Affiliation(s)
| | - Marion E Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Aline Andres
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children’s Nutrition Center, Little Rock, AR, USA
| | - Robert C Klesges
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Gerald Wayne Talcott
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
- Wilford Hall Ambulatory Surgical Center, San Antonio, TX, USA
| | - Melissa A Little
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Teresa M Waters
- Department of Health Management and Policy, University of Kentucky, Lexington, KY, USA
| | - Jean R Harvey
- Department of Nutrition and Food Sciences, University of Vermont, Burlington, VT, USA
| | - Zoran Bursac
- Department of Biostatistics, Florida International University, Miami, FL, USA
| | - Rebecca A Krukowski
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
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5
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Carreira NP, de Lima MC, Sartorelli DS, Crivellenti LC. Relationship between diet quality and biochemical profile in Brazilian overweight pregnant women. Nutrition 2023; 113:112056. [PMID: 37354652 DOI: 10.1016/j.nut.2023.112056] [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: 12/19/2022] [Revised: 03/19/2023] [Accepted: 04/18/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the relationship between the Adapted Diet Quality Index for Pregnant Women (IQDAG) and the biochemical profile of overweight pregnant adult women. METHODS This was a cross-sectional study, using baseline data from a randomized controlled clinical trial conducted with 239 pregnant women in Brazil. The usual diet was obtained through two dietary recalls and the Multiple Source Method. Diet quality was assessed using the IQDAG, which has nine components: eight for adequacy and one for moderation. Fasting blood glucose, insulin, total cholesterol, low-density lipoprotein, high-density lipoprotein, triacylglycerols, and C-reactive protein were measured to evaluate the biochemical profile. Adjusted linear regression models were used to evaluate the association between the score of the IQDAG (and its components) and the biochemical profile. The significance level considered was P ≤ 0.05. RESULTS The mean index score was 75.4 points. An inverse association was observed between the consumption of legumes and total cholesterol level (β = -4.76; 95% confidence interval [CI], -9.16 to -0.35; P = 0.03) and low-density lipoprotein (β = -4.13; 95% CI, -7.56 to -0.69; P = 0.02), and a direct association between calcium intake and total cholesterol (β = 0.02; 95% CI, 0.002-0.41; P = 0.03). No other associations were observed between the investigated variables. CONCLUSIONS The data from the present study suggest that higher consumption of legumes is associated with lower levels of total cholesterol and low-density lipoprotein. A higher intake of calcium was directly associated with total cholesterol . Further research is required to fully understand how diet quality affects pregnant women's biochemical profiles and what that means for the health of the mother and the fetus.
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Affiliation(s)
- Natalia Posses Carreira
- Graduate Program in Public Health, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Maria Carolina de Lima
- Graduate Program in Public Health, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Daniela Saes Sartorelli
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Lívia Castro Crivellenti
- Graduate Program in Public Health, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
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6
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Sartorelli DS, Crivellenti LC, Baroni NF, de Andrade Miranda DEG, da Silva Santos I, Carvalho MR, de Lima MC, Carreira NP, Chaves AVL, Manochio-Pina MG, Franco LJ, Diez-Garcia RW. Effectiveness of a minimally processed food-based nutritional counselling intervention on weight gain in overweight pregnant women: a randomized controlled trial. Eur J Nutr 2023; 62:443-454. [PMID: 36087136 PMCID: PMC9463499 DOI: 10.1007/s00394-022-02995-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/31/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aimed at evaluating the effectiveness of a nutritional counselling intervention based on encouraging the consumption of unprocessed and minimally processed foods, rather than ultra-processed products, and the practice of physical activities to prevent excessive gestational weight gain in overweight pregnant women. METHODS This was a two-armed, parallel, randomized controlled trial conducted in primary health units of a Brazilian municipality from 2018 to 2021. Overweight, adult pregnant women (n = 350) were randomly assigned to control (CG) or intervention groups (IG). The intervention consisted of three individualized nutritional counselling sessions based on encouraging the consumption of unprocessed and minimally processed foods rather than ultra-processed products, following the NOVA food classification system, and the practice of physical activities. The primary outcome was the proportion of women whose weekly gestational weight gain (GWG) exceeded the Institute of Medicine guidelines. Adjusted logistic regression models were employed. RESULTS Complete data on weight gain were available for 121 women of the IG and 139 of the CG. In modified intention-to-treat analysis, there was a lower chance of the IG women having excessive GWG [OR 0.56 (95% CI 0.32, 0.98), p = .04], when compared to the CG. No between-group differences were observed for the other maternal outcomes investigated. CONCLUSION The present study was unprecedented in demonstrating that nutritional counselling based on the NOVA food classification system, together with encouraging the practice of physical activity, is effective in preventing excessive weight gain in overweight pregnant women. TRIAL REGISTRATION Registered on July 30th 2018 at Brazilian Registry of Clinical Trials (RBR-2w9bhc).
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Affiliation(s)
- Daniela Saes Sartorelli
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Lívia Castro Crivellenti
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Naiara Franco Baroni
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Izabela da Silva Santos
- Programa de Pós-Graduação em Nutrição e Metabolismo, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Mariana Rinaldi Carvalho
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Maria Carolina de Lima
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Natália Posses Carreira
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Ana Vitória Lanzoni Chaves
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Laércio Joel Franco
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Rosa Wanda Diez-Garcia
- Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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7
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Nagpal N, Messito MJ, Katzow M, Gross RS. Obesity in Children. Pediatr Rev 2022; 43:601-617. [PMID: 36316265 DOI: 10.1542/pir.2021-005095] [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] [Indexed: 11/05/2022]
Abstract
Child obesity is widely prevalent, and general pediatricians play an important role in identifying and caring for patients with obesity. Appropriate evaluation and treatment require an understanding of the complex etiology of child obesity, its intergenerational transmission, and its epidemiologic trends, including racial/ethnic and socioeconomic disparities. The American Academy of Pediatrics has published screening, evaluation, and treatment guidelines based on the best available evidence. However, gaps in evidence remain, and implementation of evidence-based recommendations can be challenging. It is important to review optimal care in both the primary care and multidisciplinary weight management settings. This allows for timely evaluation and appropriate referrals, with the pediatrician playing a key role in advocating for patients at higher risk. There is also a role for larger-scale prevention and policy measures that would not only aid pediatricians in managing obesity but greatly benefit child health on a population scale.
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Affiliation(s)
- Nikita Nagpal
- New York University Grossman School of Medicine, New York, NY.,Bellevue Hospital Center, New York, NY
| | - Mary Jo Messito
- New York University Grossman School of Medicine, New York, NY.,Bellevue Hospital Center, New York, NY
| | - Michelle Katzow
- Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Rachel S Gross
- New York University Grossman School of Medicine, New York, NY.,Bellevue Hospital Center, New York, NY
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Whyte K, Contento I, Wolf R, Guerra L, Martinez E, Pi-Sunyer X, Gallagher D. A secondary analysis of maternal ultra-processed food intake in women with overweight or obesity and associations with gestational weight gain and neonatal body composition outcomes. JOURNAL OF MOTHER AND CHILD 2022; 25:244-259. [PMID: 35325513 PMCID: PMC9444195 DOI: 10.34763/jmotherandchild.20212504.d-21-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/05/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study is an observational secondary analysis of the Lifestyle Intervention for Two (LIFT) randomised controlled trial data. There is a paucity of data related to mechanisms of health effects and dietary intake of ultra-processed foods (UPF). Earlier studies demonstrate associations between greater UPF intake and weight gain. The purpose of the study was to describe associations among maternal UPF intake with gestational weight gain (GWG) and neonatal body composition. MATERIAL AND METHODS Women with overweight or obesity (n=156) and offspring (n=126) with complete energy intake, anthropometrics and body composition measures were selected. Maternal weights and diet recalls (Automated Self-Administered 24) were measured at weeks 14 and 35 gestational age (GA). Body composition was assessed by infant quantitative magnetic resonance (infant-QMR) and air displacement plethysmography (ADP) at birth. Dependent variables were GWG and neonatal fat mass, fat-free mass, and lean mass at birth; covariates were dietary, socioeconomic and biological. Stepwise linear regressions were used to test associations. RESULTS Highest quartile of percentage of energy intake from UPF (PEI-UPF) was not significantly correlated with maternal GWG (p=0.215), infant QMR fat (p=0.816) and lean mass (p=0.423) or ADP fat (p=0.482) or fat-free mass (p=0.835). CONCLUSIONS While no significant associations with UPF were observed in this smaller size cohort, further investigations would be justified in larger cohorts on the relationships of maternal UPF intake and GWG and offspring outcomes. Clinical Trial NCT01616147.
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Affiliation(s)
- Kathryn Whyte
- New York Nutrition Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America, E-mail:
| | - Isobel Contento
- Program of Nutrition, Department of Health and Behavior Studies, Teachers College Columbia University New York, New York, New YorkUnited States of America
| | - Randi Wolf
- Program of Nutrition, Department of Health and Behavior Studies, Teachers College Columbia University New York, New York, New YorkUnited States of America
| | - Laura Guerra
- Program of Nutrition, Department of Health and Behavior Studies, Teachers College Columbia University New York, New York, New YorkUnited States of America
| | - Euridice Martinez
- Department of Nutrition, School of Public Health, University of Sao Paolo, Sao Paolo, Brazil
| | - Xavier Pi-Sunyer
- New York Nutrition Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America,Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University New York, New York, United States of America
| | - Dympna Gallagher
- New York Nutrition Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America,Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University New York, New York, United States of America
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9
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Gopalakrishnamoorthy M, Whyte K, Horowitz M, Widen E, Toro-Ramos T, Johnson J, Gidwani S, Paley C, Rosenn B, Lin S, Thornton J, Pi-Sunyer X, Gallagher D. Anthropometric models to estimate fat mass at 3 days, 15 and 54 weeks. Pediatr Obes 2022; 17:e12855. [PMID: 34558804 PMCID: PMC8821135 DOI: 10.1111/ijpo.12855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/19/2021] [Accepted: 09/01/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Currently available infant body composition measurement methods are impractical for routine clinical use. The study developed anthropometric equations (AEs) to estimate fat mass (FM, kg) during the first year using air displacement plethysmography (PEA POD® Infant Body Composition System) and Infant quantitative magnetic resonance (Infant-QMR) as criterion methods. METHODS Multi-ethnic full-term infants (n = 191) were measured at 3 days, 15 and 54 weeks. Sex, race/ethnicity, gestational age, age (days), weight-kg (W), length-cm (L), head circumferences-cm (HC), skinfold thicknesses mm [triceps (TRI), thigh (THI), subscapular (SCP), and iliac (IL)], and FM by PEA POD® and Infant-QMR were collected. Stepwise linear regression determined the model that best predicted FM. RESULTS Weight, length, head circumference, and skinfolds of triceps, thigh, and subscapular, but not iliac, significantly predicted FM throughout infancy in both the Infant-QMR and PEA POD models. Sex had an interaction effect at 3 days and 15 weeks for both the models. The coefficient of determination [R2 ] and root mean square error were 0.87 (66 g) at 3 days, 0.92 (153 g) at 15 weeks, and 0.82 (278 g) at 54 weeks for the Infant-QMR models; 0.77 (80 g) at 3 days and 0.82 (195 g) at 15 weeks for the PEA POD models respectively. CONCLUSIONS Both PEA POD and Infant-QMR derived models predict FM using skinfolds, weight, head circumference, and length with acceptable R2 and residual patterns.
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Affiliation(s)
| | - Kathryn Whyte
- New York Nutrition Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center
| | - Michelle Horowitz
- New York Nutrition Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center
| | - Elizabeth Widen
- New York Nutrition Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center,Institute of Human Nutrition, Vagelos College of Physicians and Surgeons, Columbia University,Department of Nutritional Sciences, The University of Texas at Austin
| | - Tatiana Toro-Ramos
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - Jill Johnson
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - Sonia Gidwani
- Department Pediatrics, Mount Sinai West Hospital, Mount Sinai Health System, Icahn School of Medicine
| | - Charles Paley
- Department Pediatrics, Mount Sinai West Hospital, Mount Sinai Health System, Icahn School of Medicine
| | - Barak Rosenn
- Department of Obstetrics and Gynecology, Mount Sinai West Hospital, Mount Sinai Health System, Icahn School of Medicine
| | - Susan Lin
- Center for Family and Community Medicine, Columbia University
| | | | - Xavier Pi-Sunyer
- New York Nutrition Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center,Institute of Human Nutrition, Vagelos College of Physicians and Surgeons, Columbia University
| | - Dympna Gallagher
- New York Nutrition Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center,Institute of Human Nutrition, Vagelos College of Physicians and Surgeons, Columbia University
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10
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Awoke MA, Skouteris H, Makama M, Harrison CL, Wycherley TP, Moran LJ. The Relationship of Diet and Physical Activity with Weight Gain and Weight Gain Prevention in Women of Reproductive Age. J Clin Med 2021; 10:2485. [PMID: 34199753 PMCID: PMC8199997 DOI: 10.3390/jcm10112485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022] Open
Abstract
Reproductive-age women often see increased weight gain, which carries an increased risk of long-term overweight and obesity and adverse maternal and child health outcomes. Supporting women to achieve optimal weight through lifestyle modification (diet and physical activity) is of critical importance to reduce weight gain across key reproductive life-stages (preconception, pregnancy and postpartum). This review comprehensively summarizes the current state of knowledge on the contribution of diet and physical activity to weight gain and weight gain prevention in reproductive-aged women. Suboptimal diets including a higher proportion of discretionary choices or energy intake from fats, added sugars, sweets or processed foods are associated with higher weight gain, whereas increased consumption of core foods including fruits, vegetables and whole grains and engaging in regular physical activity are associated with reduced weight gain in reproductive age women. Diet and physical activity contributing to excessive gestational weight gain are well documented. However, there is limited research assessing diet and physical activity components associated with weight gain during the preconception and postpartum period. This review highlights the need for further research to identify key dietary and physical activity components targeting the critical windows of reproductive life-stages in women to best guide interventions to prevent weight gain.
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Affiliation(s)
- Mamaru Ayenew Awoke
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC 3168, Australia; (M.A.A.); (M.M.); (C.L.H.)
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
| | - Maureen Makama
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC 3168, Australia; (M.A.A.); (M.M.); (C.L.H.)
| | - Cheryce L. Harrison
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC 3168, Australia; (M.A.A.); (M.M.); (C.L.H.)
| | - Thomas Philip Wycherley
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, SA 5001, Australia;
| | - Lisa J. Moran
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC 3168, Australia; (M.A.A.); (M.M.); (C.L.H.)
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11
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Phelan S, Marquez F, Redman LM, Arteaga S, Clifton R, Grice BA, Haire-Joshu D, Martin CK, Myers CA, Pomeroy J, Vincent E, Van Horn L, Peaceman A, Ashby-Thompson M, Gallagher D, Pi-Sunyer X, Boekhoudt T, Drews K, Brown G. The moderating role of the built environment in prenatal lifestyle interventions. Int J Obes (Lond) 2021; 45:1357-1361. [PMID: 33637948 PMCID: PMC8164971 DOI: 10.1038/s41366-021-00782-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/07/2021] [Accepted: 02/01/2021] [Indexed: 11/25/2022]
Abstract
This study examined whether the neighborhood built environment moderated gestational weight gain (GWG) in LIFE-Moms clinical trials. Participants were 790 pregnant women (13.9 weeks' gestation) with overweight or obesity randomized within four clinical centers to standard care or lifestyle intervention to reduce GWG. Geographic information system (GIS) was used to map the neighborhood built environment. The intervention relative to standard care significantly reduced GWG (coefficient = 0.05; p = 0.005) and this effect remained significant (p < 0.03) after adjusting for built environment variables. An interaction was observed for presence of fast food restaurants (coefficient = -0.007; p = 0.003). Post hoc tests based on a median split showed that the intervention relative to standard care reduced GWG in participants living in neighborhoods with lower fast food density 0.08 [95% CI, 0.03,0.12] kg/week (p = 0.001) but not in those living in areas with higher fast food density (0.02 [-0.04, 0.08] kg/week; p = 0.55). Interaction effects suggested less intervention efficacy among women living in neighborhoods with more grocery/convenience stores (coefficient = -0.005; p = 0.0001), more walkability (coefficient -0.012; p = 0.007) and less crime (coefficient = 0.001; p = 0.007), but post-hoc tests were not significant. No intervention x environment interaction effects were observed for total number of eating establishments or tree canopy. Lifestyle interventions during pregnancy were effective across diverse physical environments. Living in environments with easy access to fast food restaurants may limit efficacy of prenatal lifestyle interventions, but future research is needed to replicate these findings.
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Affiliation(s)
- Suzanne Phelan
- Department of Kinesiology & Public Health and Center for Health Research, Cal Poly, San Luis Obispo, CA, USA.
| | - Fred Marquez
- Department of Anthropology & Geography and Center for Health Research, Cal Poly, San Luis Obispo, CA, USA
| | | | - Sonia Arteaga
- The Environmental influences on Child Health Outcomes (ECHO) Program, The National Institutes of Health, Bethesda, MD, USA
| | - Rebecca Clifton
- The Biostatistics Center, George Washington University, Washington, DC, USA
| | - Brian A Grice
- Indiana University, School of Medicine, Indianapolis, IN, USA
| | - Debra Haire-Joshu
- Center for Diabetes Translation Research, Washington University in St. Louis, St. Louis, MO, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | | | - Jeremy Pomeroy
- Clinical Research Center, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA
| | - Eileen Vincent
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Alan Peaceman
- Department of Obstetrics & Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Maxine Ashby-Thompson
- New York Nutrition Obesity Research Center, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Dympna Gallagher
- New York Nutrition Obesity Research Center, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Xavier Pi-Sunyer
- New York Nutrition Obesity Research Center, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Trisha Boekhoudt
- The Biostatistics Center, George Washington University, Washington, DC, USA
| | - Kimberly Drews
- The Biostatistics Center, George Washington University, Washington, DC, USA
| | - Greg Brown
- Department of Natural Resources Management and Environmental Sciences, Cal Poly, San Luis Obispo, CA, USA
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12
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Phelan S, Hart CN, Jelalian E, Muñoz-Christian K, Alarcon N, McHugh A, Ventura AK, Wing RR. Effect of prenatal lifestyle intervention on maternal postpartum weight retention and child body mass index z-score at 36 months. Int J Obes (Lond) 2021; 45:1133-1142. [PMID: 33627776 PMCID: PMC8081654 DOI: 10.1038/s41366-021-00784-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND/OBJECTIVES We previously reported results from a randomized trial showing that a behavioral intervention during pregnancy reduced excess gestational weight gain but did not impact maternal weight at 12 months. We now examine the longer-term effects of this prenatal intervention on maternal postpartum weight retention and toddler body-mass-index z scores (BMIz) over 36 months. SUBJECTS/METHODS Pregnant women (N = 264; 13.7 weeks' gestation; 41.6% Hispanic) with overweight or obesity were randomized into usual care or prenatal intervention. Anthropometric assessments in mothers and toddlers occurred at baseline, 35 weeks' gestation and after delivery at 6, 12, 18, 24, and 36 months. RESULTS At 36 months, prenatal intervention vs. usual care had no significant effect on the proportion of participants who returned to their early pregnancy weight or below (33.3% vs. 39.5%; p = 0.12) and had no effect on the magnitude of weight retained (2.8 [0.8, 4.8] vs 3.0 kg [1.0, 4.9], respectively; mean difference = 0.14 [-3.0, 2.7]). There was also no statistically significant intervention vs. usual care effect on infant BMIz or skinfold changes over time; toddler BMIz increased by 1.4 [-1.7, 1.0] units in the intervention group and 1.6 [-1.2, 1.8] units in the usual care group from delivery to 36 months (difference = 0.16 [-0.32. 0.63]). The proportion of toddlers at risk for obesity at 36 months was similar in intervention and usual care groups (28/77 [36.4%] vs 30/80 [37.5%]; p = 0.77). CONCLUSIONS Compared with usual care, lifestyle intervention during pregnancy resulted in similar maternal and toddler anthropometric outcomes at 36-months postpartum in a diverse US sample of women with overweight and obesity. To sustain improved maternal weight management initiated during pregnancy, continued intervention during the postpartum years may be needed.
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Affiliation(s)
- Suzanne Phelan
- California Polytechnic State University, Department of Kinesiology & Public Health, Center for Health Research, San Luis Obispo, CA, USA.
| | - Chantelle N Hart
- Temple University Center for Obesity Research and Education Department of Social and Behavioral Sciences, Philadelphia, PA, USA
| | - Elissa Jelalian
- Warren Alpert Medical School at Brown University Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Karen Muñoz-Christian
- California Polytechnic State University World Languages & Cultures Department, San Luis Obispo, CA, USA
| | - Noemi Alarcon
- California Polytechnic State University, Department of Kinesiology & Public Health, Center for Health Research, San Luis Obispo, CA, USA
| | - Angelica McHugh
- Warren Alpert Medical School at Brown University Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Alison K Ventura
- California Polytechnic State University, Department of Kinesiology & Public Health, Center for Health Research, San Luis Obispo, CA, USA
| | - Rena R Wing
- Warren Alpert Medical School at Brown University Department of Psychiatry and Human Behavior, Providence, RI, USA
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13
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Redman LM, Drews KL, Klein S, Horn LV, Wing RR, Pi-Sunyer X, Evans M, Joshipura K, Arteaga SS, Cahill AG, Clifton RG, Couch KA, Franks PW, Gallagher D, Haire-Joshu D, Martin CK, Peaceman AM, Phelan S, Thom EA, Yanovski SZ, Knowler WC. Attenuated early pregnancy weight gain by prenatal lifestyle interventions does not prevent gestational diabetes in the LIFE-Moms consortium. Diabetes Res Clin Pract 2021; 171:108549. [PMID: 33238176 PMCID: PMC9041868 DOI: 10.1016/j.diabres.2020.108549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/29/2020] [Accepted: 11/06/2020] [Indexed: 12/30/2022]
Abstract
AIMS To examine the effect of lifestyle (diet and physical activity) interventions on the prevalence of GDM, considering the method of GDM ascertainment and its association with early pregnancy characteristics and maternal and neonatal outcomes in the LIFE-Moms consortium. METHODS LIFE-Moms evaluated the effects of lifestyle interventions to optimize gestational weight gain in 1148 pregnant women with BMI ≥ 25 kg/m2 and without known diabetes at enrollment, compared with standard care. GDM was assessed between 24 and 31-weeks gestation by a 2-hour, 75-gram OGTT or by local clinical practice standards. RESULTS Lifestyle interventions initiated prior to 16 weeks reduced early excess GWG compared with standard care (0.35 ± 0.24 vs 0.43 ± 0.26 kg per week, p=<0.0001) but did not affect GDM diagnosis (11.1% vs 11.6%, p = 0.91). Using the 75-gram, 2-hour OGTT, 13. 0% of standard care and 11.0% of the intervention group had GDM by the IADPSG criteria (p = 0.45). The 'type of diagnostic test' did not change the result (p = 0.86). Women who developed GDM were significantly heavier, more likely to have obesity, and more likely to have dysglycemia at baseline. CONCLUSION Moderate-to-high intensity lifestyle interventions grounded in behavior change theory initiated between 9 and 16-weeks gestation did not affect the prevalence of GDM despite reducing early GWG. CLINICALTRIALS.GOV: NCT01545934, NCT01616147, NCT01771133, NCT01631747, NCT01768793, NCT01610752, NCT01812694.
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Affiliation(s)
- Leanne M Redman
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
| | - Kimberly L Drews
- The Biostatistics Center, George Washington University, Washington, DC, USA
| | - Samuel Klein
- Center for Human Nutrition, Washington University in St. Louis, St. Louis, MO, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Xavier Pi-Sunyer
- New York Obesity Research Center, Dept. of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Disease, Bethesda, MD, USA
| | - Kaumudi Joshipura
- Center for Clinical Research and Health Promotion, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico; Department of Epidemiology, Harvard T.H. Chan Public Health School, Harvard University, Boston, MA, USA
| | - S Sonia Arteaga
- Division of Cardiovascular Diseases, The National Heart, Lung, and Blood Institute, Bethesda, MD, USA; The Environmental Influences on Child Health Outcomes (ECHO) Program Office, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Alison G Cahill
- Department of Women's Health, Dell Medical School, The University of Texas at Austin, TX, USA
| | - Rebecca G Clifton
- The Biostatistics Center, George Washington University, Washington, DC, USA
| | - Kimberly A Couch
- Phoenix Indian Medical Center, Indian Health Service, Phoenix, AZ, USA
| | - Paul W Franks
- Department of Nutrition, Harvard T.H. Chan Public Health School, Harvard University, Boston, MA, USA; Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital Malmö, Malmö, Sweden
| | - Dympna Gallagher
- New York Obesity Research Center, Dept. of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Debra Haire-Joshu
- Center for Diabetes Translation Research, Washington University in St. Louis, St. Louis, MO, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Alan M Peaceman
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Suzanne Phelan
- Department of Kinesiology, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Elizabeth A Thom
- The Biostatistics Center, George Washington University, Washington, DC, USA
| | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Disease, Bethesda, MD, USA
| | - William C Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
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14
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Lau CHE, Taylor-Bateman V, Vorkas PA, Graça G, Vu THT, Hou L, Chekmeneva E, Ebbels TMD, Chan Q, Van Horn L, Holmes E. Metabolic Signatures of Gestational Weight Gain and Postpartum Weight Loss in a Lifestyle Intervention Study of Overweight and Obese Women. Metabolites 2020; 10:metabo10120498. [PMID: 33291639 PMCID: PMC7761920 DOI: 10.3390/metabo10120498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Overweight and obesity amongst women of reproductive age are increasingly common in developed economies and are shown to adversely affect birth outcomes and both childhood and adulthood health risks in the offspring. Metabolic profiling in conditions of overweight and obesity in pregnancy could potentially be applied to elucidate the molecular basis of the adverse effects of gestational weight gain (GWG) and postpartum weight loss (WL) on future risks for cardiovascular disease (CVD) and other chronic diseases. Methods: Biofluid samples were collected from 114 ethnically diverse pregnant women with body mass index (BMI) between 25 and 40 kg/m2 from Chicago (US), as part of a randomized lifestyle intervention trial (Maternal Offspring Metabolics: Family Intervention Trial; NCT01631747). At 15 weeks, 35 weeks of gestation, and at 1 year postpartum, the blood plasma lipidome and metabolic profile of urine samples were analyzed by liquid chromatography mass spectrometry (LC-MS) and 1H nuclear magnetic resonance spectroscopy (1H NMR) respectively. Results: Urinary 4-deoxyerythronic acid and 4-deoxythreonic acid were found to be positively correlated to BMI. Seventeen plasma lipids were found to be associated with GWG and 16 lipids were found to be associated with WL, which included phosphatidylinositols (PI), phosphatidylcholines (PC), lysophospholipids (lyso-), sphingomyelins (SM) and ether phosphatidylcholine (PC-O). Three phospholipids found to be positively associated with GWG all contained palmitate side-chains, and amongst the 14 lipids that were negatively associated with GWG, seven were PC-O. Six of eight lipids found to be negatively associated with WL contained an 18:2 fatty acid side-chain. Conclusions: Maternal obesity was associated with characteristic urine and plasma metabolic phenotypes, and phospholipid profile was found to be associated with both GWG and postpartum WL in metabolically healthy pregnant women with overweight/obesity. Postpartum WL may be linked to the reduction in the intake of linoleic acid/conjugated linoleic acid food sources in our study population.
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Affiliation(s)
- Chung-Ho E. Lau
- Section of Nutrition, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK;
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK;
- Correspondence: (C.-H.E.L.); (E.H.)
| | - Victoria Taylor-Bateman
- Section of Nutrition, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK;
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Panagiotis A. Vorkas
- Section of Biomolecular Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK;
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, 57001 Thessaloniki, Greece
| | - Gonçalo Graça
- Section of Bioinformatics, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK; (G.G.); (T.M.D.E.)
| | - Thanh-Huyen T. Vu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (T.-H.T.V.); (L.H.); (L.V.H.)
| | - Lifang Hou
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (T.-H.T.V.); (L.H.); (L.V.H.)
| | - Elena Chekmeneva
- National Phenome Centre and Section of Bioanalytical Chemistry, Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Campus, IRDB Building, London W12 0NN, UK;
| | - Timothy M. D. Ebbels
- Section of Bioinformatics, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK; (G.G.); (T.M.D.E.)
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK;
- MRC Centre for Environment and Health, Imperial College London, London W2 1PG, UK
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (T.-H.T.V.); (L.H.); (L.V.H.)
| | - Elaine Holmes
- Section of Nutrition, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK;
- Centre for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Perth, WA 6150, Australia
- Correspondence: (C.-H.E.L.); (E.H.)
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15
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Blau LE, Hormes JM. Preventing Excess Gestational Weight Gain and Obesity in Pregnancy: the Potential of Targeting Psychological Mechanisms. Curr Obes Rep 2020; 9:522-529. [PMID: 33145706 DOI: 10.1007/s13679-020-00415-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW Overweight and obesity are now the most common high-risk conditions in pregnancy in the United States and increase risk of adverse outcomes during pregnancy, delivery, and the postpartum. Importantly, excess gestational weight gain is highly predictive of maternal postpartum weight retention and risk of overweight and obesity in mothers and their children later in life. This makes pregnancy a unique window of opportunity in the fight against obesity across the lifespan. This narrative review critically evaluates research on the efficacy of interventions targeting excess gestational weight gain, highlighting the potential of targeting psychological mechanisms to facilitate positive weight-related behavior change specifically in pregnancy. The PUBMED and PsycInfo databases were searched for relevant articles, including meta-analyses, systematic reviews, and randomized controlled trials with the primary or secondary aim of reducing gestational weight gain. RECENT FINDINGS There is currently no gold standard for preventing excess gestational weight gain, especially in women with pre-pregnancy overweight and obesity. Existing interventions primarily target diet and physical activity but lack broad empirical support and typically have only modest effects on weight gain in pregnancy, with few successfully preventing excess weight gain. Furthermore, interventions that successfully target gestational weight gain have minimal positive impact on weight- and diet-related maternal and fetal health outcomes. A growing evidence points to the utility of targeting psychological mechanisms in the prevention of excess gestational weight gain, including cognitive and affective factors, food cravings, and self-efficacy. Given the lack of broad evidence to support the efficacy of interventions targeting diet and physical activity, there is a notable need for research to develop and evaluate interventions targeting psychological factors that could positively impact diet- and weight-related behavioral change in pregnancy.
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Affiliation(s)
- Lauren E Blau
- Department of Psychology, Social Sciences 399, University at Albany, State University of New York, 1400 Washington Ave, Albany, NY, 12222, USA.
| | - Julia M Hormes
- Department of Psychology, Social Sciences 399, University at Albany, State University of New York, 1400 Washington Ave, Albany, NY, 12222, USA
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16
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Coughlin JW, Martin LM, Henderson J, Dalcin AT, Fountain J, Wang N, Appel LJ, Clark JM, Bennett W. Feasibility and acceptability of a remotely-delivered behavioural health coaching intervention to limit gestational weight gain. Obes Sci Pract 2020; 6:484-493. [PMID: 33082990 PMCID: PMC7556432 DOI: 10.1002/osp4.438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/27/2020] [Accepted: 05/30/2020] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Gestational weight gain (GWG) and postpartum weight retention (PPWR) are significant, potentially modifiable, contributors to women's future weight and health trajectories. There is a need for feasible and patient-centered (i.e., convenient, remotely-delivered, technology-enhanced, and accessible through the prenatal care setting) behavioural interventions that limit GWG and PPWR. This study tests the feasibility and acceptability of a remotely-delivered behavioural health coaching intervention to limit gestational weight gain and postpartum weight retention. METHODS Pregnant women (11-16 weeks gestation) were recruited from two prenatal clinics and randomized to the active intervention or health education comparison group. Completion of the program was monitored and perceived helpfulness was rated (0-100). RESULTS Twenty-six women were randomized (n = 13 per arm; mean age = 31.6 years, SD = 3.6; mean BMI = 26.7 kg/m2, SD = 7.4). Participants completed a median of 18 coaching calls and 16/19 learning activities during pregnancy, and a median of 6 calls and 5/6 learning activities postpartum. They logged weights at least once/week for a median of 36/38 expected weeks and tracked daily calories and exercise for a median of 154/266 days and 72/266 days, respectively. Median (Q1, Q3) helpfulness ratings of the program during pregnancy were 80 (64, 91) and 62 (50, 81) postpartum; helpfulness ratings of coaching calls were 85 (58, 98). At 37 weeks gestation, 77% of participants achieved IOM weight gain recommendations compared to 54% in the comparison group. CONCLUSIONS This study provides evidence for the feasibility and acceptability of a remotely-delivered behavioural weight control intervention in pregnancy and postpartum.
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Affiliation(s)
- J. W. Coughlin
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMDUSA
- Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMDUSA
| | - L. M. Martin
- Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - J. Henderson
- Department of Obstetrics and GynecologyJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - A. T. Dalcin
- Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMDUSA
- Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - J. Fountain
- Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - N.‐Y. Wang
- Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMDUSA
- Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - L. J. Appel
- Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMDUSA
- Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - J. M. Clark
- Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMDUSA
- Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - W. Bennett
- Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMDUSA
- Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA
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17
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Tabak RG, Furtado K, Schwarz CD, Haire-Joshu D. Neighborhood Perceptions Among Pregnant African American Women in St. Louis, Missouri, Before and After the Shooting of Michael Brown. Health Equity 2020; 4:353-361. [PMID: 32908956 PMCID: PMC7473163 DOI: 10.1089/heq.2019.0125] [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] [Accepted: 07/27/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: This study aims to examine perceptions of neighborhood quality and safety before and after the death of Michael Brown and the unrest that followed. Methods: In this secondary analysis of baseline data from one site in The Lifestyle Interventions for Expectant Moms (LIFE-Moms) Consortium, pregnant African American women in the St. Louis region completed a survey of neighborhood perceptions. Logistic regression was used to explore associations between perceptions among those completing baseline surveys and entering the study before and after August 9, 2014 (range: 2012-2015), adjusted for demographic characteristics. Results: Of 267 participants, half (n=134) completed the survey after August 9, 2014. Thirty-four percent of participants completing the survey after this date felt "The crime rate in my neighborhood makes it unsafe to go on walks during the day" compared with 21% of those completing the survey before (adjusted odds ratio=2.0, 95% confidence interval: 1.1-3.7). There were no consistently significant differences in demographic characteristics or in the remaining 16 neighborhood items. Conclusions: This study is an example of how an unexpected shift in the community context in the wake of a profound event may impact health behaviors and outcomes in a measurable way. Clinical Trials Registration: NCT01768793.
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Affiliation(s)
- Rachel G. Tabak
- Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, St. Louis, Missouri, USA
- Center for Diabetes Translation Research, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Karishma Furtado
- Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, St. Louis, Missouri, USA
| | - Cynthia D. Schwarz
- Center for Obesity Prevention and Policy Research, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Debra Haire-Joshu
- Center for Diabetes Translation Research, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
- Center for Obesity Prevention and Policy Research, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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Haslam DE, Li J, Liang L, Martinez M, Palacios C, Trak-Fellermeier MA, Franks PW, Joshipura K, Bhupathiraju SN. Changes in Metabolites During an Oral Glucose Tolerance Test in Early and Mid-Pregnancy: Findings from the PEARLS Randomized, Controlled Lifestyle Trial. Metabolites 2020; 10:metabo10070284. [PMID: 32664282 PMCID: PMC7408149 DOI: 10.3390/metabo10070284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 02/07/2023] Open
Abstract
The oral glucose tolerance test (OGTT) is used to diagnose gestational and other types of diabetes. We examined metabolite changes during an OGTT, and how a comprehensive diet and physical activity intervention may influence these changes in a population of overweight/obese Hispanic pregnant women. Integration of changes in metabolites during an OGTT may help us gain preliminary insights into how glucose metabolism changes during pregnancy. Among women from the Pregnancy and EARly Lifestyle improvement Study (PEARLS), we measured metabolites during a multipoint OGTT (fasting, 30, 60 and 120 min) at early and mid-pregnancy. Metabolite levels were measured by liquid chromatography-mass spectrometry in plasma samples in the lifestyle intervention (n = 13) and control (n = 16) arms of the study. A total of 65 candidate metabolites were selected that displayed changes during an OGTT in previous studies. Paired and unpaired t-tests were used to examine differences in Δfast-120 min: (1) at early and mid-pregnancy; and (2) by intervention assignment. We applied principal component analysis (PCA) to identify those metabolites that differed by intervention assignment and OGTT time points. Most of the characteristic changes in metabolites post-OGTT were similar at both gestational time points. PCA identified characteristic metabolite patterns associated with OGTT time points at both early and mid-pregnancy. These metabolites included ketone bodies, tryptophan, acyl carnitines, polyunsaturated fatty acids, and biomarkers related to bile acid, urea cycle, arginine, and proline metabolism. PCA identified distinct Δfast-120 min in fatty acid, acyl carnitine, bile acid, ketone body, and amino acid levels at mid- compared to early pregnancy. Participants in the intervention group did not display mean decreases in Δfast-120 min of several long-chain acyl carnitines that were observed in the control group. These findings provide preliminary insight into metabolites, whose role in increased insulin resistance during pregnancy, should be explored further in future studies.
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Affiliation(s)
- Danielle E. Haslam
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA;
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Boston, MA 02115, USA;
- Correspondence:
| | - Jun Li
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Boston, MA 02115, USA;
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Boston, MA 02115, USA; (L.L.); (K.J.)
| | - Liming Liang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Boston, MA 02115, USA; (L.L.); (K.J.)
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Boston, MA 02115, USA
| | - Marijulie Martinez
- Center for Clinical Research and Health Promotion, University of Puerto Rico Medical Sciences Campus, San Juan, PR 00936-5067, Puerto Rico;
| | - Cristina Palacios
- Dietetics and Nutrition Department, Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th Street AHC5, Miami, FL 33199, USA; (C.P.); (M.A.T.-F.)
| | - Maria A. Trak-Fellermeier
- Dietetics and Nutrition Department, Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th Street AHC5, Miami, FL 33199, USA; (C.P.); (M.A.T.-F.)
| | - Paul W. Franks
- Lund University Diabetes Centre, CRC, SUS Malmö, Jan Waldenströms gata 35, House 91:12, SE-214 28 Malmö, Sweden;
| | - Kaumudi Joshipura
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Boston, MA 02115, USA; (L.L.); (K.J.)
- Center for Clinical Research and Health Promotion, University of Puerto Rico Medical Sciences Campus, San Juan, PR 00936-5067, Puerto Rico;
| | - Shilpa N. Bhupathiraju
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA;
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Boston, MA 02115, USA;
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Effect of Behavioural Interventions for Obesity Prevention in Pregnancy on the Adequacy of Gestational Weight Gain and Retention: Metabolic Health of Indian Women. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2020. [DOI: 10.2478/sjecr-2018-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The aim of this study was to measure the adequacy of gestational weight gain (GWG) in Indian women using various behavioural interventions during pregnancy, which primarily aim to observe the effects on obesity markers and weight retention.
In this experimental study, one hundred and forty pregnant women underwent interventions in 5 groups, control (C), diet (D), home exercise (HE), supervised exercise (SE) and supervised exercise with diet (SED), from pregnancy through delivery with 2 months follow-up post-delivery. The outcome measures were GWG and baby birth weight.
A one-way ANOVA indicated no differences in the mean GWG between groups (12.39±4.71 kg, p=0.947). The control group had the most (50%) and both the supervised exercise groups had the fewest (32%) women who gained above the recommended GWG, followed by the diet group (33.3%). The D and HE groups had the most women who gained within the GWG range, while both the SE and SED groups had the most women who gained below the GWG range. However, these results did not affect the birth weight between the groups (mean 2.96 kg±0.40, p=0.203). In women with normal BMIs, (18.5-22.9 kg/m2), the diet group had the most effective maintenance of adequate GWG, with 15%, 55%, and 30% of the women gaining above, within, and below the recommended GWG, respectively. The SE and SED groups had the least postpartum weight retention (PPWR) at 2 months, followed by the HM, D and C groups; i.e., the results showed a trend in the desired direction clinically, although they were not statistically significant (p=0.12).
Supervised exercise can be effectively used as a pregnancy intervention to prevent excess GWG in Indian women. Diet counselling was found to be the next best intervention in combination with exercise, as well as for women with normal BMI.
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Janumala I, Toro-Ramos T, Widen E, Rosenn B, Crane J, Horowitz M, Lin S, Gidwani S, Paley C, Thornton J, Pi-Sunyer FX, Gallagher D. Increased Visceral Adipose Tissue Without Weight Retention at 59 Weeks Postpartum. Obesity (Silver Spring) 2020; 28:552-562. [PMID: 32030911 PMCID: PMC7042094 DOI: 10.1002/oby.22736] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/18/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aimed to determine whether controlling maternal gestational weight gain (GWG) influences adipose tissue distribution at 1 year postpartum. METHODS Women with overweight or obesity (n = 210, BMI ≥ 25 or ≥ 30) were randomized to a lifestyle intervention (LI) designed to control GWG or to usual obstetrical care (UC). Measures included anthropometry, whole-body magnetic resonance imaging for visceral (VAT), intermuscular, and subcutaneous adipose tissue, and cardiometabolic risk factors in pregnancy (15 and 35 weeks) and after delivery (15 and 59 weeks). RESULTS Baseline (15 weeks) characteristics were similar (mean [SD]: age, 33.8 [4.3] years; weight, 81.9 [13.7] kg; BMI, 30.4 [4.5]; gestational age at randomization, 14.9 [0.8] weeks). LI had less GWG (1.79 kg; P = 0.003) and subcutaneous adipose tissue gain at 35 weeks gestation (P < 0.01). UC postpartum weight (2.92 kg) was higher at 15 weeks but not different from baseline or LI at 59 weeks postpartum. Postpartum VAT increased from baseline in LI by 0.23 kg at 15 weeks and 0.55 kg at 59 weeks; in UC, it increased by 0.34 kg at 15 and 59 weeks. Intermuscular adipose tissue remained elevated in LI (0.22 kg) at 59 weeks. VAT was associated with several cardiometabolic risk factors at 59 weeks. CONCLUSIONS Despite no weight retention at 59 weeks postpartum, women had increased VAT by ~30%. Postpartum modifiable behaviors are warranted to lower the risk of VAT retention.
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Affiliation(s)
- Isaiah Janumala
- New York Obesity Research Center, Dept. of Medicine, College of Physicians and Surgeons, Columbia University
| | - Tatiana Toro-Ramos
- New York Obesity Research Center, Dept. of Medicine, College of Physicians and Surgeons, Columbia University
| | - Elizabeth Widen
- New York Obesity Research Center, Dept. of Medicine, College of Physicians and Surgeons, Columbia University
- Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University
- Department of Nutritional Sciences, University of Texas at Austin
| | - Barak Rosenn
- Department Obstetrics and Gynecology, Mount Sinai West Hospital, Mount Sinai Health System, Icahn School of Medicine
| | - Janet Crane
- New York Obesity Research Center, Dept. of Medicine, College of Physicians and Surgeons, Columbia University
| | - Michelle Horowitz
- New York Obesity Research Center, Dept. of Medicine, College of Physicians and Surgeons, Columbia University
| | - Susan Lin
- Center for Family and Community Medicine, Columbia University
| | - Sonia Gidwani
- Department of Pediatrics, Mount Sinai West Hospital, Mount Sinai Health System, Icahn School of Medicine
| | - Charles Paley
- Department of Pediatrics, Mount Sinai West Hospital, Mount Sinai Health System, Icahn School of Medicine
| | | | - F. Xavier Pi-Sunyer
- New York Obesity Research Center, Dept. of Medicine, College of Physicians and Surgeons, Columbia University
- Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University
| | - Dympna Gallagher
- New York Obesity Research Center, Dept. of Medicine, College of Physicians and Surgeons, Columbia University
- Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University
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21
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Sartorelli DS, Crivellenti LC, Manochio-Pina MG, Baroni NF, Carvalho MR, Diez-Garcia RW, Franco LJ. Study Protocol effectiveness of a nutritional intervention based on encouraging the consumption of unprocessed and minimally processed foods and the practice of physical activities for appropriate weight gain in overweight, adult, pregnant women: a randomized controlled trial. BMC Pregnancy Childbirth 2020; 20:24. [PMID: 31910819 PMCID: PMC6947817 DOI: 10.1186/s12884-019-2672-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/11/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Evidence from observational studies suggests that a greater intake of ultra-processed foods during pregnancy is associated with a higher chance of obesity, increased gestational weight gain, and neonatal adiposity. The aim of the present study is to evaluate the effectiveness of a nutritional intervention based on encouraging the consumption of unprocessed and minimally processed foods and the practice of physical activities for appropriate weight gain in overweight, adult, pregnant women. Additionally, the effect of the intervention on pregnancy outcomes, neonatal adiposity, and the child's weight and height will be investigated. METHODS This is a two-armed parallel randomized controlled trial that will be conducted at primary health units in Ribeirão Preto, SP, Brazil. Adult pregnant women who are overweight and receiving prenatal care in the public health system will be included. The women will be randomly allocated into control (standard care) or intervention groups. Those enrolled in the intervention group will participate in three individualized nutritional counselling sessions based on encouraging the consumption of unprocessed and minimally processed foods and the practice of physical activities. The recruitment of the participants will be carried out at seven health facilities over 12 months, with a sample of 300 women expected. Maternal anthropometric, sociodemographic, blood pressure, biochemical, and lifestyle data will be obtained at baseline (up to the 16th week of gestation), and during a second assessment (34th to 36th gestational week). The neonate body composition will be estimated after birth, and data on pregnancy outcomes, weight and height of children at 6, 12 and 24 months of age will be further obtained from medical records. DISCUSSION This will be the first randomized controlled trial to test the effectiveness of a nutritional intervention based on encouraging the consumption of unprocessed and minimally processed foods and the practice of physical activities for appropriate weight gain in adult, overweight, pregnant women. Furthermore, the effect of the intervention on pregnancy outcomes, neonatal adiposity and the child's weight and height will be evaluated. TRIAL REGISTRATION Registro Brasileiro de Ensaios Clínicos (Rebec) RBR-2w9bhc July 30th 2018 (http://www.ensaiosclinicos.gov.br/rg/?q=RBR-2w9bhc+), and RBR-7yx36h June 4th 2019 (http://www.ensaiosclinicos.gov.br/rg/?q=RBR-7yx36h+0.
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Affiliation(s)
- Daniela Saes Sartorelli
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Brazil, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil.
| | - Lívia Castro Crivellenti
- Graduate Program of Public Health, Ribeirão Preto Medical School, University of São Paulo, Brazil, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Marina Garcia Manochio-Pina
- Program in Health Promotion, University of Franca, Avenida Dr. Armando Salles Oliveira, 201, Franca, SP, 14404-600, Brazil
| | - Naiara Franco Baroni
- Graduate Program of Public Health, Ribeirão Preto Medical School, University of São Paulo, Brazil, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Mariana Rinaldi Carvalho
- Graduate Program of Public Health, Ribeirão Preto Medical School, University of São Paulo, Brazil, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Rosa Wanda Diez-Garcia
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Brazil, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Laércio Joel Franco
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Brazil, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
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22
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Herring SJ, Albert JJ, Darden N, Bailer B, Cruice J, Hassan S, Bennett GG, Goetzl L, Yu D, Kilby LM, Foster GD. Targeting pregnancy-related weight gain to reduce disparities in obesity: Baseline results from the Healthy Babies trial. Contemp Clin Trials 2019; 87:105822. [PMID: 31400513 PMCID: PMC7265899 DOI: 10.1016/j.cct.2019.105822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/31/2019] [Accepted: 08/05/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Obesity affects African American women more than any other group in the US. Pregnancy represents a critical life stage of heightened vulnerability for new or persistent obesity, yet few interventions have been effective in reducing excessive gestational weight gain among African American women. We describe the design and baseline findings of Healthy Babies, a two-arm randomized controlled trial testing a mobile health intervention to minimize excessive gestational weight gain versus usual care in this high risk group. METHODS African American women in early pregnancy were recruited from two large obstetric practices as well as Philadelphia Women, Infants, and Children's clinics. Participants randomized to the intervention received behavior change goals, daily text messages with feedback, web-based weight gain graphs, health coaching, and a Facebook support group. Data collection included baseline (<22 weeks' gestation), 36-38 weeks' gestation, and 6-month postpartum anthropometric measures and assessments of demographics, contextual factors and behavioral targets. The primary outcome was prevalence of excessive gestational weight gain. RESULTS Among participants at baseline (n = 262), the majority met criteria for obesity (63%), were multiparous (62%), single (77%), and were on average 25.6 ± 5.4 years old with a gestational age of 13.9 ± 4.1 weeks. While 82% completed high school, 61% met criteria for inadequate health literacy. Nearly 20% were food insecure. Eighty-eight percent reported a gestational weight gain goal discordant with Institute of Medicine guidelines. There were no significant differences in baseline characteristics between study arms. CONCLUSIONS Participants represent a high-risk group for excessive gestational weight gain with demonstrated need for intervention.
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Affiliation(s)
- Sharon J Herring
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States of America; Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America; Department of Obstetrics, Gynecology, and Reproductive Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America; Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America.
| | - Jessica J Albert
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States of America; Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America
| | - Niesha Darden
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States of America; Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America
| | - Brooke Bailer
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States of America; Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Jane Cruice
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States of America; Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America
| | - Sarmina Hassan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America
| | - Gary G Bennett
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States of America; Duke Digital Health Science Center, Duke Global Health Institute, Durham, NC, United States of America
| | - Laura Goetzl
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Center at Houston, Houston, TX, United States of America
| | - Daohai Yu
- Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America
| | - Linda M Kilby
- Philadelphia Women, Infants and Children Program, Philadelphia, PA, United States of America
| | - Gary D Foster
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States of America; Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America; Weight Watchers International, New York, NY, United States of America
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One-year postpartum anthropometric outcomes in mothers and children in the LIFE-Moms lifestyle intervention clinical trials. Int J Obes (Lond) 2019; 44:57-68. [PMID: 31292531 DOI: 10.1038/s41366-019-0410-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 05/09/2019] [Accepted: 05/12/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Excess gestational weight gain (GWG) is a risk factor for maternal postpartum weight retention and excessive neonatal adiposity, especially in women with overweight or obesity. Whether lifestyle interventions to reduce excess GWG also reduce 12-month maternal postpartum weight retention and infant weight-for-length z score is unknown. Randomized controlled trials from the LIFE-Moms consortium investigated lifestyle interventions that began in pregnancy and tested whether there was benefit through 12 months on maternal postpartum weight retention (i.e., the difference in weight from early pregnancy to 12 months) and infant-weight-for-length z scores. SUBJECTS/METHODS In LIFE-Moms, women (N = 1150; 14.1 weeks gestation at enrollment) with overweight or obesity were randomized within each of seven trials to lifestyle intervention or standard care. Individual participant data were combined and analyzed using generalized linear mixed models with trial entered as a random effect. The 12-month assessment was completed by 83% (959/1150) of women and 84% (961/1150) of infants. RESULTS Compared with standard care, lifestyle intervention reduced postpartum weight retention (2.2 ± 7.0 vs. 0.7 ± 6.2 kg, respectively; difference of -1.6 kg (95% CI -2.5, -0.7; p = 0.0003); the intervention effect was mediated by reduction in excess GWG, which explained 22% of the effect on postpartum weight retention. Lifestyle intervention also significantly increased the odds (OR = 1.68 (95% CI, 1.26, 2.24)) and percentage of mothers (48.2% vs. 36.2%) at or below baseline weight at 12 months postpartum (yes/no) compared with standard care. There was no statistically significant treatment group effect on infant anthropometric outcomes at 12 months. CONCLUSIONS Compared with standard care, lifestyle interventions initiated in pregnancy and focused on healthy eating, increased physical activity, and other behavioral strategies resulted in significantly less weight retention but similar infant anthropometric outcomes at 12 months postpartum in a large, diverse US population of women with overweight and obesity.
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Phelan S, Abrams B, Wing RR. Prenatal Intervention with Partial Meal Replacement Improves Micronutrient Intake of Pregnant Women with Obesity. Nutrients 2019; 11:nu11051071. [PMID: 31091748 PMCID: PMC6567022 DOI: 10.3390/nu11051071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 12/28/2022] Open
Abstract
A behavioral lifestyle intervention with partial meal replacement reduced excess gestational weight gain in ethnically diverse women with overweight/obesity, but the effects on micronutrient intake remained unknown. A secondary analysis of a randomized, controlled trial tested whether the intervention improved micronutrient intake relative to usual care. Pregnant women (n = 211; 30.5 years of age, body mass index, BMI, of 32.0 kg/m2) were enrolled and randomized within site and ethnicity (40% were Hispanic) into intervention (n = 102) or usual care (n = 109) groups. Two 24 h dietary recalls were conducted on random days at study entry and late pregnancy (35–36 weeks gestation). Nutrient adequacy was defined using the Estimated Average Requirement cut-point method. At study entry and including prenatal vitamins, ≥90% of participants reported inadequate intake of vitamins D and E and iron; 40–50% reported inadequate intake of calcium, protein, vitamins A, C, B6, folate, magnesium, and zinc. From study entry to late pregnancy, the behavioral intervention with partial meal replacement increased the overall intake of vitamins A, E, and D and copper and reduced the odds of inadequate intake of calcium (odds ratio (OR) = 0.37 (0.18, 0.76)), vitamins A (OR = 0.39 (0.21, 0.72)) and E (OR = 0.17 (0.06, 0.48)), and magnesium (OR = 0.36 (0.20, 0.65)). A behavioral intervention with partial meal replacement during pregnancy improved the intake of several micronutrients in Hispanic and non-Hispanic women with overweight/obesity.
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Affiliation(s)
- Suzanne Phelan
- Department of Kinesiology & Public Health, California Polytechnic State University, 1 Grand Ave, San Luis Obispo, CA 93407, USA.
| | - Barbara Abrams
- Division of Epidemiology, University of California at Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA 94720-7360, USA.
| | - Rena R Wing
- Warren Alpert Medical School at Brown University Department of Psychiatry and Human Behavior, 197 Richmond Street, Providence, RI 02906, USA.
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25
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Vinturache A, Winn A, Mannion C, Tough S. Women's recall of health care provider counselling on gestational weight gain (GWG): a prospective, population-based study. BMC Pregnancy Childbirth 2019; 19:136. [PMID: 31023254 PMCID: PMC6485057 DOI: 10.1186/s12884-019-2283-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prenatal care has been validated to provide medical and educational counselling intended to reduce the risk of adverse pregnancy conditions and improve the maternal and fetal outcomes. Prenatal targeted information regarding nutrition, lifestyle, and weight gain is predictive of meeting Institute of Medicine (IOM) 2009 gestational weight gain (GWG) guidelines. There is limited information about women's experiences with these prenatal counselling domains, particularly in women who do not meet GWG recommendations. The objective of this study was to evaluate the impact of women's recall of prenatal counselling and its effect on meeting their GWG within guidelines in a prospective, community-based pregnancy cohort. METHODS A sample of 2909 women with singleton pregnancies was drawn from the prospective community-based pregnancy cohort All Our Families from Alberta, Canada. Women were stratified into three GWG groups, adequate, inadequate, and excessive GWG, based on pre-pregnancy BMI and the adherence to the Institute of Medicine weight gain in pregnancy guidelines. At less than 25 and 34 to 36 weeks' gestation, maternal socio-demographic information and women's recall of prenatal counselling experiences was collected through self-administered questionnaires. Multivariate logistic regression analyses tested GWG strata impact on women's recall of the prenatal counselling advice in eight domains of nutrition, lifestyle, and weight management during pregnancy. RESULTS Adequate GWG was reached by 35.9% of women, 46.5% gained excessive and 17.6% gained inadequate weight. Women who were overweight and obese prior to pregnancy were more likely to gain excessive weight than women who were normal weight (OR 3.3, 95% CI 2.6-4.1; and OR 2.9, 95% CI 2.1-3.9, respectively). Most women reported having no difficulties in finding prenatal care, felt comfortable with their health care provider and were satisfied with the answers received. There was no difference in the recall of prenatal advice received in any of the eight domains of prenatal counselling assessed among women with appropriate and non-optimal GWG. CONCLUSION Women with adequate and non-optimal GWG received comparable prenatal counselling on nutrition, weight gain, and lifestyle modifications. There remain missed opportunities in targeting prenatal counselling advice to women at risk for suboptimal or excessive GWG.
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Affiliation(s)
- Angela Vinturache
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Department of Obstetrics & Gynaecology, St. George's University Hospitals NHS Foundation Trust, London, UK.
| | - Anika Winn
- Faculty of Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia Mannion
- Faculty of Nursing, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne Tough
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community of Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Haire-Joshu D, Cahill AG, Stein RI, Cade WT, Woolfolk CL, Moley K, Mathur A, Schwarz CD, Schechtman KB, Klein S. Randomized Controlled Trial of Home-Based Lifestyle Therapy on Postpartum Weight in Underserved Women with Overweight or Obesity. Obesity (Silver Spring) 2019; 27:535-541. [PMID: 30900408 PMCID: PMC6526535 DOI: 10.1002/oby.22413] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/21/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aimed to assess the efficacy of a home-based lifestyle intervention delivered through Parents as Teachers (PAT), a national home-visiting organization, designed to minimize excessive weight gain through 12 months post partum in socioeconomically disadvantaged (SED) African American women with overweight or obesity. METHODS This randomized controlled trial was conducted at a single center as part of the Lifestyle Interventions for Expectant Moms (LIFE-Moms) consortium. Analysis was conducted with 185 SED African American women (BMI 25.0-45.0 kg/m2 at pregnancy onset) retained from an original sample of 267 randomized to standard PAT or PAT+Lifestyle, which embedded lifestyle therapy within standard PAT delivered prenatally and for 12 months post partum. RESULTS Compared with standard PAT, the PAT+Lifestyle group gained less weight (2.5 kg vs. 5.7 kg; P = 0.01) and were more likely to return to their baseline weight (38.0% vs. 21.5%; P = 0.01) from baseline to 12 months post partum. There were no differences between groups in cardiometabolic outcomes, indices of glycemic control and insulin sensitivity, and plasma lipid profile. The estimated cost of PAT+Lifestyle was $81 more to deliver per family than standard PAT. CONCLUSIONS PAT+Lifestyle decreases weight gain during pregnancy through 12 months post partum in SED African American women with overweight or obesity at the start of pregnancy with minimal additional cost.
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Affiliation(s)
- Debra Haire-Joshu
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Alison G Cahill
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Richard I Stein
- Center for Human Nutrition, Washington University in St. Louis, St. Louis, Missouri, USA
| | - W Todd Cade
- Program in Physical Therapy, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Candice L Woolfolk
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kelle Moley
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Amit Mathur
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Cynthia D Schwarz
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kenneth B Schechtman
- Department of Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Samuel Klein
- Center for Human Nutrition, Washington University in St. Louis, St. Louis, Missouri, USA
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27
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Vesco KK. Reducing Postpartum Weight Retention and Interpregnancy Weight Gain, an Important Goal Not Yet Realized. Obesity (Silver Spring) 2019; 27:188. [PMID: 30624865 DOI: 10.1002/oby.22398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Kimberly K Vesco
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
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28
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Phelan S, Wing RR, Brannen A, McHugh A, Hagobian T, Schaffner A, Jelalian E, Hart CN, Scholl TO, Muñoz-Christian K, Yin E, Phipps MG, Keadle S, Abrams B. Does Partial Meal Replacement During Pregnancy Reduce 12-Month Postpartum Weight Retention? Obesity (Silver Spring) 2019; 27:226-236. [PMID: 30421864 PMCID: PMC8142600 DOI: 10.1002/oby.22361] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/12/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This randomized trial tested whether a behavioral intervention with meal replacements in pregnancy could increase the proportion of women who returned to prepregnancy weight and reduce postpartum weight retention by 12 months after delivery. METHODS Women (N = 264; 13.7 weeks' gestation) with overweight or obesity were randomly assigned to usual care or intervention. The intervention reduced excess gestational weight gain and was discontinued at delivery. At follow-up, 83.7% completed the 12-month assessment. RESULTS Compared with usual care, prenatal intervention had no significant effect on odds of achieving prepregnancy weight (38/128 [29.7%] vs. 41/129 [31.8%]; P = 0.98) or in reducing the magnitude of weight retained (3.3 vs. 3.1 kg; P = 0.82) at 12 months. After delivery, significant (P < 0.0001) declines in meal replacements, practice of weight control behaviors, and dietary restraint were observed in the intervention group. Independent of group, lower gestational weight gain was the strongest predictor of achieving prepregnancy weight at 12 months (P = 0.0008). CONCLUSIONS A prenatal behavioral intervention with meal replacements that reduced pregnancy weight gain had no significant effect on 12-month postpartum weight retention.
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Affiliation(s)
- Suzanne Phelan
- Department of Kinesiology & Public Health, California Polytechnic State University, San Luis Obispo, California, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Anna Brannen
- Department of Kinesiology & Public Health, California Polytechnic State University, San Luis Obispo, California, USA
| | - Angelica McHugh
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Todd Hagobian
- Department of Kinesiology & Public Health, California Polytechnic State University, San Luis Obispo, California, USA
| | - Andrew Schaffner
- Statistics Department, California Polytechnic State University, San Luis Obispo, California, USA
| | - Elissa Jelalian
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Chantelle N Hart
- Department of Social and Behavioral Sciences, Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania, USA
| | - Theresa O Scholl
- Department of Obstetrics and Gynecology, Rowan University, Glassboro, New Jersey, USA
| | - Karen Muñoz-Christian
- Modern Languages Department, California Polytechnic State University, San Luis Obispo, California, USA
| | - Elaine Yin
- Pacific Central Coast Health Centers, Santa Maria Women's Health, Santa Maria, California, USA
| | - Maureen G Phipps
- Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Department of Obstetrics and Gynecology, Women & Infants Hospital, Providence, Rhode Island, USA
| | - Sarah Keadle
- Department of Kinesiology & Public Health, California Polytechnic State University, San Luis Obispo, California, USA
| | - Barbara Abrams
- Division of Epidemiology, School of Public Health, University of California at Berkeley, Berkeley, California, USA
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Altazan AD, Redman LM, Burton JH, Beyl RA, Cain LE, Sutton EF, Martin CK. Mood and quality of life changes in pregnancy and postpartum and the effect of a behavioral intervention targeting excess gestational weight gain in women with overweight and obesity: a parallel-arm randomized controlled pilot trial. BMC Pregnancy Childbirth 2019; 19:50. [PMID: 30696408 PMCID: PMC6352352 DOI: 10.1186/s12884-019-2196-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 01/18/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Intensive lifestyle interventions in pregnancy have shown success in limiting gestational weight gain, but the effects on mood and quality of life in pregnancy and postpartum are less known. The purpose was to quantify changes in mental and physical quality of life and depressive symptoms across pregnancy and the postpartum period, to determine the association between gestational weight gain and change in mood and quality of life, and to assess the effect of a behavioral intervention targeting excess gestational weight gain on these outcomes. METHODS A three group parallel-arm randomized controlled pilot trial of 54 pregnant women who were overweight or obese was conducted to test whether the SmartMoms® intervention decreased the proportion of women with excess gestational weight gain. Individuals randomized to Usual Care (n = 17) did not receive any weight management services from interventionists. Individuals randomized to the SmartMoms® intervention (n = 37) were provided with behavioral weight management counseling by interventionists either in clinic (In-Person, n = 18) or remotely through a smartphone application (Phone, n = 19). In a subset of 43 women, mood and mental and physical quality of life were assessed with the Beck Depression Inventory-II and the Rand 12-Item short form, respectively, in early pregnancy, late pregnancy, 1-2 months postpartum, and 12 months postpartum. RESULTS The SmartMoms® intervention and Usual Care groups had higher depressive symptoms (p < 0.03 for SmartMoms® intervention, p < 0.01 for Usual Care) and decreased physical health (p < 0.01) from early to late pregnancy. Both groups returned to early pregnancy mood and physical quality of life postpartum. Mental health did not change from early to late pregnancy (p = 0.8), from early pregnancy to 1-2 months (p = 0.5), or from early pregnancy to 12 months postpartum (p = 0.9), respectively. There were no significant intervention effects. Higher gestational weight gain was associated with worsened mood and lower physical quality of life across pregnancy. CONCLUSION High depressive symptoms and poor quality of life may be interrelated with the incidence of excess gestational weight gain. The behavioral gestational weight gain intervention did not significantly impact these outcomes, but mood and quality of life should be considered within future interventions and clinical practice to effectively limit excess gestational weight gain. TRIAL REGISTRATION NCT01610752 , Expecting Success, Registered 31 May 2012.
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Affiliation(s)
- Abby D. Altazan
- Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808 USA
| | - Leanne M. Redman
- Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808 USA
| | - Jeffrey H. Burton
- Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808 USA
| | - Robbie A. Beyl
- Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808 USA
| | - Loren E. Cain
- Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808 USA
| | - Elizabeth F. Sutton
- Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808 USA
| | - Corby K. Martin
- Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808 USA
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Trak-Fellermeier MA, Campos M, Meléndez M, Pomeroy J, Palacios C, Rivera-Viñas J, Méndez K, Febo I, Willett W, Gillman MW, Franks PW, Joshipura K. PEARLS randomized lifestyle trial in pregnant Hispanic women with overweight/obesity: gestational weight gain and offspring birthweight. Diabetes Metab Syndr Obes 2019; 12:225-238. [PMID: 30858715 PMCID: PMC6385743 DOI: 10.2147/dmso.s179009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Inappropriate gestational weight gain (GWG) has been associated with adverse perinatal events. High rates of GWG have been reported among Hispanic women. Observational studies indicate that dietary and physical activity interventions during the prenatal period may improve maternal and infant health, but very few randomized trials have been conducted among high-risk overweight/obese Hispanic women. Accordingly, we conducted a lifestyle intervention among high-risk pregnant women and evaluated its impact on achieving appropriate GWG and on improving birthweight. METHODS Eligible overweight/obese women presenting at the University Hospital in Puerto Rico with a singleton pregnancy before 16 gestational weeks were recruited and randomized to lifestyle intervention (n=15) or control group (n=16). The lifestyle intervention focused on improving physical activity and diet quality and optimizing caloric intake. We evaluated the impact of the lifestyle intervention on achieving appropriate GWG and on infant birthweight. Poisson and linear regression analyses were performed. RESULTS The primary intent to treat analysis showed no significant effect on achievement of appropriate GWG/week through 36 weeks in the intervention group (4/15 women) when compared with the control group (3/16 women) (adjusted incidence rate ratio =1.14; 95% CI: 0.20, 6.67). Although not statistically significant, women in the intervention group (6/15) were 1.7 times more likely to achieve appropriate weekly GWG until delivery when compared with controls (4/16 women) (adjusted incidence rate ratio = 1.67; 95% CI: 0.40, 6.94). We observed lower adjusted birthweight-for-length z-scores in the intervention compared with the control group among male newborns with z-score difference -1.74 (-3.04, -0.43), but not among females -0.83 (-3.85, 2.19). These analyses were adjusted for age and baseline body mass index. CONCLUSION Although larger studies are required to determine whether women with obesity may benefit from prenatal lifestyle interventions targeting GWG, our results are suggestive of the intervention improving adherence to established Institute of Medicine guidelines.
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Affiliation(s)
- María A Trak-Fellermeier
- Center for Clinical Research and Health Promotion, School of Dental Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA,
| | - Maribel Campos
- Center for Clinical Research and Health Promotion, School of Dental Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA,
| | - Marytere Meléndez
- Center for Clinical Research and Health Promotion, School of Dental Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA,
| | - Jeremy Pomeroy
- Clinical Research Center, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA
| | - Cristina Palacios
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Juana Rivera-Viñas
- Department of Obstetrics and Gynecology, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
| | - Keimari Méndez
- Department of Obstetrics and Gynecology, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
| | - Irma Febo
- Department of Pediatrics, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
| | - Walter Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Mathew W Gillman
- Division of Chronic Disease Research Across the Life Course, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Paul W Franks
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Kaumudi Joshipura
- Center for Clinical Research and Health Promotion, School of Dental Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA,
- Department of Epidemiology, Harvard T.H. Chan Public Health School, Harvard University, Boston, MA, USA,
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Arteaga SS, Esposito L, Osganian SK, Pratt CA, Reedy J, Young-Hyman D. Childhood obesity research at the NIH: Efforts, gaps, and opportunities. Transl Behav Med 2018; 8:962-967. [PMID: 30329138 PMCID: PMC6454453 DOI: 10.1093/tbm/iby090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Childhood obesity is a major public health challenge. This article describes an overview of the National Institutes of Health (NIH) behavioral and social sciences childhood obesity research efforts. The overview will highlight five areas of childhood obesity research supported by the NIH: (a) basic behavioral and social sciences; (b) early childhood; (c) policies, programs, and environmental strategies; (d) health disparities; and (e) transagency and public-private collaboration. The article also describes potential gaps and opportunities in the areas of childhood obesity and severe obesity, measurement, and sleep.
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Affiliation(s)
- S Sonia Arteaga
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Layla Esposito
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Stavroula K Osganian
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Charlotte A Pratt
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jill Reedy
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Deborah Young-Hyman
- Office of Behavioral and Social Science Research, National Institutes of Health, Bethesda, MD, USA
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Fahey MC, Wayne Talcott G, Cox Bauer CM, Bursac Z, Gladney L, Hare ME, Harvey J, Little M, McCullough D, Hryshko-Mullen AS, Klesges RC, Kocak M, Waters TM, Krukowski RA. Moms fit 2 fight: Rationale, design, and analysis plan of a behavioral weight management intervention for pregnant and postpartum women in the U.S. military. Contemp Clin Trials 2018; 74:46-54. [PMID: 30291998 PMCID: PMC6289301 DOI: 10.1016/j.cct.2018.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/25/2018] [Accepted: 09/28/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Margaret C Fahey
- Department of Psychology, The University of Memphis, Memphis, TN, USA.
| | - G Wayne Talcott
- Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Callie M Cox Bauer
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Zoran Bursac
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Leslie Gladney
- Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Marion E Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jean Harvey
- Department of Nutrition and Food Sciences, The University of Vermont, Burlington, VT, USA
| | - Melissa Little
- Center for Addition and Prevention Research, University of Virginia, School of Medicine, Charlottesville, VA, USA
| | - Deirdre McCullough
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Ann S Hryshko-Mullen
- Defense Institute for Medical Operations, Joint Base San Antonio-Lackland Air Force Base, San Antonio, TX, USA
| | - Robert C Klesges
- Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Teresa M Waters
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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Van Horn L, Peaceman A, Kwasny M, Vincent E, Fought A, Josefson J, Spring B, Neff LM, Gernhofer N. Dietary Approaches to Stop Hypertension Diet and Activity to Limit Gestational Weight: Maternal Offspring Metabolics Family Intervention Trial, a Technology Enhanced Randomized Trial. Am J Prev Med 2018; 55:603-614. [PMID: 30262148 DOI: 10.1016/j.amepre.2018.06.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 06/09/2018] [Accepted: 06/15/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Technology-enhanced antenatal diet and lifestyle intervention could prevent excess gestational weight gain and benefit mother and child. STUDY DESIGN A randomized clinical trial. SETTING/PARTICIPANTS Overweight and obese ethnically diverse pregnant women in Chicago, Illinois, were enrolled between October 2012 and December 2015, with antenatal data collection completed by July 2016. Analysis was completed June 2017. INTERVENTION Participants were randomized when their fetus was gestational age 16 weeks to dietitian-led Dietary Approaches to Stop Hypertension diet and physical activity coaching that was received as three individual and six group counseling sessions by phone and webinar. A commercially available smartphone application was used for self-monitoring diet and physical activity. Telephone, text message prompts, and e-mail reminders encouraged adherence and website viewing. Usual-care, "web-watcher" participants were e-mailed biweekly newsletters and publicly available maternity website links. MAIN OUTCOME MEASURES The primary outcome was gestational weight gain measured at baseline, 24 weeks, and 35.0-36.6 weeks. Secondary outcomes included weekly rate of gestational weight gain, newborn anthropometrics, maternal diet quality, physical activity, and blood pressure. RESULTS Among 281 participants randomized (n=140 in intervention, n=141 in usual care, BMI 25 to <40, and age range 18-40 years), 37% were non-white and 274 completed antenatal data collection (n=139 in the intervention group and n=135 in the usual-care group). Gestational weight gain differed significantly by intervention group (difference, 1.7kg, p=0.01) and rate of weight gain was 0.4 (SD=0.2) vs 0.5 (SD=0.2) kg/week. No significant differences were noted in birth weight, percentage body fat, or adverse pregnancy outcomes, but more cesarean sections (55 [40%] vs 37 [27%]) occurred among the intervention group. CONCLUSIONS Technology-enhanced Dietary Approaches to Stop Hypertension diet and lifestyle intervention resulted in significantly less total gestational weight gain over 35 weeks with no adverse infant outcomes. Nutrient quality improved without an adverse impact on rate of prematurity. Increased cesarean delivery requires further exploration. The National Academy of Medicine goals were not achieved by the majority of participants. Obesity prevention preconception is needed. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01631747.
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Affiliation(s)
- Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Alan Peaceman
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mary Kwasny
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eileen Vincent
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Angela Fought
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jami Josefson
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lisa M Neff
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Niki Gernhofer
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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34
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Peaceman AM, Clifton RG, Phelan S, Gallagher D, Evans M, Redman LM, Knowler WC, Joshipura K, Haire-Joshu D, Yanovski SZ, Couch KA, Drews KL, Franks PW, Klein S, Martin CK, Pi-Sunyer X, Thom EA, Van Horn L, Wing RR, Cahill AG. Lifestyle Interventions Limit Gestational Weight Gain in Women with Overweight or Obesity: LIFE-Moms Prospective Meta-Analysis. Obesity (Silver Spring) 2018; 26:1396-1404. [PMID: 30230252 PMCID: PMC6148360 DOI: 10.1002/oby.22250] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 08/22/2016] [Accepted: 10/31/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVE This study aimed to evaluate the effects of varied lifestyle intervention programs designed to ameliorate excess gestational weight gain (GWG) in pregnant women with overweight or obesity compared with standard care, including effects on pregnancy outcomes. METHODS Seven clinical centers conducted separate randomized clinical trials to test different lifestyle intervention strategies to modify GWG in diverse populations. Eligibility criteria, specific outcome measures, and assessment procedures were standardized across trials. The results of the separate trials were combined using an individual-participant data meta-analysis. RESULTS For the 1,150 women randomized, the percent with excess GWG per week was significantly lower in the intervention group compared with the standard care group (61.8% vs. 75.0%; odds ratio [95% CI]: 0.52 [0.40 to 0.67]). Total GWG from enrollment to 36 weeks' gestation was also lower in the intervention group (8.1 ± 5.2 vs. 9.7 ± 5.4 kg; mean difference: -1.59 kg [95% CI:-2.18 to -0.99 kg]). The results from the individual trials were similar. The intervention and standard care groups did not differ in preeclampsia, gestational diabetes, cesarean delivery, or birth weight. CONCLUSIONS Behavioral lifestyle interventions focusing primarily on diet and physical activity among women with overweight and obesity resulted in a significantly lower proportion of women with excess GWG. This modest beneficial effect was consistent across diverse intervention modalities in a large, racially and socioeconomically diverse US population of pregnant women.
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Affiliation(s)
- Alan M Peaceman
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rebecca G Clifton
- The Biostatistics Center, George Washington University, Washington, DC, USA
| | - Suzanne Phelan
- Department of Kinesiology, California Polytechnic State University, San Luis Obispo, California, USA
| | - Dympna Gallagher
- New York Obesity Research Center, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Leanne M Redman
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - William C Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA
| | - Kaumudi Joshipura
- Center for Clinical Research and Health Promotion, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Debra Haire-Joshu
- Center for Diabetes Translation Research, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Kimberly A Couch
- Phoenix Indian Medical Center, Indian Health Service, Phoenix, Arizona, USA
| | - Kimberly L Drews
- The Biostatistics Center, George Washington University, Washington, DC, USA
| | - Paul W Franks
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital Malmö, Malmö, Sweden
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Samuel Klein
- Center for Human Nutrition, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Xavier Pi-Sunyer
- New York Obesity Research Center, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Elizabeth A Thom
- The Biostatistics Center, George Washington University, Washington, DC, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Alison G Cahill
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri, USA
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Tabak RG, Schwarz CD, Carter E, Haire-Joshu D. Context for implementing a gestational weight gain program nationally. HEALTH BEHAVIOR AND POLICY REVIEW 2018; 5:77-89. [PMID: 30775399 PMCID: PMC6374035 DOI: 10.14485/hbpr.5.5.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Use the Consolidated Framework for Implementation Research to describe the context in which a gestational weight gain (GWG) intervention, embedded within Parents as Teachers (PAT), will be implemented at PAT sites nationwide. METHODS Ten site leaders and six parent educators from ten PAT sites in eight states participated in semi-structured interviews and a survey. Audio-recordings and systematic notes were used in a deductive analysis. Scales were descriptively analyzed. RESULTS Surveys demonstrated positive perspectives of PAT+GWG. In interviews, participants described PAT+GWG filling a need for prenatal health education and confidence delivering this content, valued integration of PAT+GWG within the PAT curriculum, and recommended materials to meet their clients' needs. CONCLUSIONS Contextual information can help maximize PAT+GWG's impact.
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Affiliation(s)
- Rachel G Tabak
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA, phone: 314-935-0153, ,
| | - Cynthia D Schwarz
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA, phone: 314-935-3063, ,
| | - Ebony Carter
- Washington University School of Medicine in St. Louis, Washington University in St. Louis, 660 S. Euclid Ave., CB8064, St. Louis, MO, 63110, USA, phone: 314-362-8280, ,
| | - Debra Haire-Joshu
- The Brown School and The School of Medicine, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA, phone: 314-935-3963, ,
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Herring SJ. Pooled Findings from the LIFE-Moms Randomized Trials: Where Do We Go from Here? Obesity (Silver Spring) 2018; 26:1391. [PMID: 30226006 PMCID: PMC6488035 DOI: 10.1002/oby.22285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 07/26/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Sharon J Herring
- Department of Medicine, Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania, USA
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Lewkowitz AK, López JD, Stein RI, Rhoades JS, Schulz RC, Woolfolk CL, Macones GA, Haire-Joshu D, Cahill AG. Effect of a Home-Based Lifestyle Intervention on Breastfeeding Initiation Among Socioeconomically Disadvantaged African American Women with Overweight or Obesity. Breastfeed Med 2018; 13:418-425. [PMID: 29912571 PMCID: PMC6065521 DOI: 10.1089/bfm.2018.0006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Socioeconomically disadvantaged (SED) African American women with overweight or obesity are less likely to breastfeed. OBJECTIVE To test whether a home-based lifestyle intervention impacts breastfeeding initiation rates in SED African American women with overweight or obesity. STUDY DESIGN This was a secondary analysis of a randomized controlled trial from October 2012 to March 2016 at a university-based hospital within the LIFE-Moms consortium. SED African American women with overweight or obesity and singleton gestations were randomized by 16 weeks to Parents as Teachers (PAT)-a home-based parenting support and child development educational intervention-or PAT+, PAT with additional content on breastfeeding. Participants completed a breastfeeding survey. Outcomes included breastfeeding initiation and reasons for not initiating or not continuing breastfeeding. RESULTS One hundred eighteen women were included: 59 in PAT+; 59 in PAT. Breastfeeding initiation rates were similar in each group (78.00% in PAT+; 74.58% in PAT). On a one to four scale, with four denoting "very important," women in PAT+ and PAT were equally likely to rate their beliefs that formula was better than breast milk or breastfeeding would be too inconvenient as the most important reasons to not initiate breastfeeding. On the same scale, women similarly rated their difficulty latching or concern for low milk supply as the most important reasons for breastfeeding cessation. CONCLUSION SED African American women with overweight or obesity who received a home-based educational intervention had higher breastfeeding rates than is reported nationally for black women (59%). However, the intervention with more breastfeeding content did not further increase breastfeeding rates or impact reasons for breastfeeding cessation. TRIAL REGISTRATION ClinicalTrials.gov : NCT01768793.
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Affiliation(s)
- Adam K. Lewkowitz
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
| | - Julia D. López
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
| | - Richard I. Stein
- Center for Human Nutrition, Washington University in St. Louis, St. Louis, Missouri
| | - Janine S. Rhoades
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
| | - Rosa C. Schulz
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
| | - Candice L. Woolfolk
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
| | - George A. Macones
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
| | - Debra Haire-Joshu
- School of Public Health and Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Alison G. Cahill
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
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Most J, Vallo PM, Gilmore LA, St Amant M, Hsia DS, Altazan AD, Beyl RA, Ravussin E, Redman LM. Energy Expenditure in Pregnant Women with Obesity Does Not Support Energy Intake Recommendations. Obesity (Silver Spring) 2018; 26:992-999. [PMID: 29797559 PMCID: PMC5978753 DOI: 10.1002/oby.22194] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/26/2018] [Accepted: 03/27/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE This study aimed to identify factors that may predispose women to excess gestational weight gain (GWG). METHODS Seventy-two healthy women with obesity (30 class I, 24 class II, 18 class III) expecting a singleton pregnancy were studied at 13 to 16 weeks gestation. Energy expenditure (EE) was measured during sleep (SleepEE, average EE from 0200-0500 hours) in a whole-room calorimeter, and total daily EE (TDEE) over 7 days using doubly labeled water. Glucose, insulin, thyroid hormones, and catecholamines were measured. RESULTS Body composition explained 70% variability in SleepEE, and SleepEE accounted for 67% to 73% of TDEE. Though there was no evidence of consistent low metabolism, there was considerable variability. Low SleepEE was associated with insulin resistance and low triiodothyronine concentrations (both P = 0.01). Physical activity level was 1.47 ± 0.02. For women with SleepEE within 100 kcal/d of their predicted EE, TDEE was significantly less than the estimate (2,530 ± 91 vs. 2,939 kcal/d; P < 0.001) provided from the most recent gestational energy requirement model. CONCLUSIONS Pregnant women with obesity are inactive, possibly predisposing them to excess GWG. Current energy requirement models overestimate activity and may promote excess GWG in women with obesity. Furthermore, the observed large interindividual variability in basal metabolism may be important to consider when assessing the risk for excess GWG.
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Affiliation(s)
- Jasper Most
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Porsha M Vallo
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - L Anne Gilmore
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Marshall St Amant
- LSU Health Sciences Center, Louisiana State University, New Orleans, Louisiana, USA
- Woman's Hospital, Baton Rouge, Louisiana, USA
| | - Daniel S Hsia
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Abby D Altazan
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Robbie A Beyl
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Eric Ravussin
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Leanne M Redman
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
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Olson CM, Groth SW, Graham ML, Reschke JE, Strawderman MS, Fernandez ID. The effectiveness of an online intervention in preventing excessive gestational weight gain: the e-moms roc randomized controlled trial. BMC Pregnancy Childbirth 2018; 18:148. [PMID: 29743026 PMCID: PMC5944067 DOI: 10.1186/s12884-018-1767-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 04/24/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Excessive gestational weight gain (GWG) is common and contributes to the development of obesity in women and their offspring. Electronic or e-health interventions have the potential to reach large groups of women and prevent excessive GWG, but their effectiveness has not been demonstrated. The purpose of this study was to evaluate, in a real-world setting, the effectiveness of a self-directed, integrated online and mobile phone behavioral intervention in preventing excessive GWG. METHODS This effectiveness trial was a double-blind, three-arm trial with a parallel group design. Two arms received the same e-health intervention during pregnancy with the third arm serving as the placebo control. The intervention was based on a previously efficacious non-digital intervention that was adapted to electronic format. It included three behavior change tools: a weight gain tracker, and separate diet and physical activity goal-setting and self-monitoring tools. Both treatment conditions received access to informational tools, event reminders, and a blogging feature. Healthy pregnant women age 18-35 years with body mass indexes (BMI) ≥18.5 and < 35, at ≤20 weeks gestation, and an e-mail address were eligible. The proportion of women with excessive total GWG, as defined by the Institute of Medicine (IOM), was the primary outcome. 1689 randomized women were analyzed in the intent-to-treat (ITT) analysis. The study was designed to have 87% power to detect a 10 percentage point reduction from a control rate of 55% with a sample of 1641 (p = 0.0167, two-sided). RESULTS In the ITT sample, 48.1% (SD = 2.0%) gained excessively in the intervention group as did 46.2% (SD = 2.4%) in the placebo control group. These proportions were not significantly different (RR 1.09; 95% CI 0.98, 1.20, p = 0.12). The results were not altered in several sensitivity analyses. CONCLUSION The addition of three behavior change tools to an informational placebo control did not result in a difference in the proportion of women with excessive total GWG compared to the placebo control in this effectiveness trial of an online, self-directed intervention. The similarity of intervention and control treatments and low usage of the behavior change tools in the intervention group are possible explanations. TRIAL REGISTRATION NCT01331564 , ClinicalTrials.gov.
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Affiliation(s)
- Christine M Olson
- Division of Nutritional Sciences, 406 Savage Hall, Cornell University, Ithaca, NY, 14853, USA.
| | - Susan W Groth
- School of Nursing, University of Rochester, Box SON, 601 Elmwood Ave., Rochester, NY, 14642, USA
| | - Meredith L Graham
- Division of Nutritional Sciences, 352 MVR Hall, Cornell University, Ithaca, NY, 14853, USA
| | - Jennifer E Reschke
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd, CU420644, Rochester, NY, 14642, USA
| | - Myla S Strawderman
- Division of Nutritional Sciences, 352 MVR Hall, Cornell University, Ithaca, NY, 14853, USA
| | - Isabel Diana Fernandez
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd, CU420644, Rochester, NY, 14642, USA
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Van Horn L, Vincent E, Perak AM. Preserving Cardiovascular Health in Young Children: Beginning Healthier by Starting Earlier. Curr Atheroscler Rep 2018; 20:26. [PMID: 29696447 DOI: 10.1007/s11883-018-0729-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW The goals of this paper are to review current literature regarding maternal-fetal-pediatric diet and nutritional factors related to preserving cardiovascular health in the very young child and the emerging data implicating nutritional influences on neurodevelopmental factors. Questions related to maternal diet and influences of human milk on child's growth, neurodevelopment, and risk of developing obesity were addressed. RECENT FINDINGS The majority of US women in their reproductive years have overweight or obese status thereby increasing the risk of developing obesity in their children. Efforts to restrict gestational weight gain, perpetuate breast-feeding, and introduce heart-healthy complementary feeding after 6 months of age are now more commonly recommended and offer practical translational approaches to prevent pediatric obesity and encourage neurodevelopment intended to support cognitive and executive function. There is growing literature on the role of maternal-fetal-pediatric nutrition on cardiometabolic and neurodevelopmental health in children. Potential influences of maternal diet quality and obesity on not only birth outcomes but subsequent risk factor development in the child are increasingly apparent. Further investigation of these factors has become a major research focus in developing future diet recommendations to better inform underlying potential mechanisms and identify opportunities for primary prevention starting in utero.
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Affiliation(s)
- Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 North Lake Shore Drive, #1400, Chicago, IL, 60611, USA.
| | - Eileen Vincent
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 North Lake Shore Drive, #1400, Chicago, IL, 60611, USA
| | - Amanda M Perak
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 North Lake Shore Drive, #1400, Chicago, IL, 60611, USA.,Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 680 N Lake Shore Drive, #1400, Chicago, IL, 60611, USA
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Cahill AG, Haire-Joshu D, Cade WT, Stein RI, Woolfolk CL, Moley K, Mathur A, Schechtman K, Klein S. Weight Control Program and Gestational Weight Gain in Disadvantaged Women with Overweight or Obesity: A Randomized Clinical Trial. Obesity (Silver Spring) 2018; 26:485-491. [PMID: 29464907 PMCID: PMC5826625 DOI: 10.1002/oby.22070] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/17/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study aimed to evaluate the efficacy of a home-based lifestyle intervention delivered through Parents as Teachers (PAT) to reduce excessive gestational weight gain (GWG). METHODS This was a single-blinded randomized controlled trial conducted as part of the LIFE-Moms consortium at a single university-based tertiary care institution from October 2012 to March 2016. There were 267 socioeconomically disadvantaged (SED) African American women with overweight or obesity (BMI 25.0-45.0 kg/m2 before pregnancy. Participants were randomized to therapy with standard PAT alone (n = 134) or PAT plus a lifestyle intervention program embedded within the standard PAT program (PAT+) (n = 133). Both interventions were delivered in 10 biweekly home visits during pregnancy. The primary outcome was the percentage of women whose GWG exceeded the Institute of Medicine guidelines, and secondary outcomes included both weekly and total GWG. RESULTS Compared with the standard PAT group in the intent-to-treat analysis, the PAT + group gained less weekly (0.4 kg vs. 0.5 kg/wk; P = 0.04) and total (8.0 kg vs. 9.6 kg; P = 0.02) weight during gestation. Fewer participants in the PAT + group had excessive total GWG (36.1% vs. 45.9%), but the difference between groups was not statistically significant (P = 0.11). CONCLUSIONS PAT + reduced the weekly and total GWG in SED African American women with overweight or obesity at the start of pregnancy.
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Affiliation(s)
- Alison G. Cahill
- Department of Obstetrics and Gynecology, Washington University in St. Louis, 4566 Scott Avenue, Campus Box 8064, St. Louis, Missouri, 63110
| | - Debra Haire-Joshu
- School of Public Health and Medicine, Washington University in St. Louis, One Bookings Drive, Campus Box 1196, St. Louis, Missouri, 63130
| | - W. Todd Cade
- Program in Physical Therapy, Washington University in St. Louis, 4444 Forest Park Avenue, Suite 1101, St. Louis, Missouri 63108
| | - Richard I. Stein
- Center for Human Nutrition, Washington University in St. Louis, 507 South Euclid Avenue, St. Louis, Missouri 63110
| | - Candice L. Woolfolk
- Department of Obstetrics and Gynecology, Washington University in St. Louis, 4566 Scott Avenue, Campus Box 8064, St. Louis, Missouri, 63110
| | - Kelle Moley
- Department of Obstetrics and Gynecology, Washington University in St. Louis, 4566 Scott Avenue, Campus Box 8064, St. Louis, Missouri, 63110
| | - Amit Mathur
- Department of Pediatrics, Washington University in St. Louis, 4566 Scott Avenue, Campus Box 8116, St. Louis, Missouri 63110
| | - Kenneth Schechtman
- Department of Biostatistics, Washington University in St. Louis, 4523 Clayton Road, St. Louis, Missouri 63110
| | - Samuel Klein
- Program in Physical Therapy, Washington University in St. Louis, 4444 Forest Park Avenue, Suite 1101, St. Louis, Missouri 63108
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Montazeri P, Vrijheid M, Martinez D, Basterrechea M, Fernandez-Somoano A, Guxens M, Iñiguez C, Lertxundi A, Murcia M, Tardon A, Sunyer J, Valvi D. Maternal Metabolic Health Parameters During Pregnancy in Relation to Early Childhood BMI Trajectories. Obesity (Silver Spring) 2018; 26:588-596. [PMID: 29399981 DOI: 10.1002/oby.22095] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 11/15/2017] [Accepted: 11/19/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the associations between maternal metabolic parameters and early childhood BMI trajectories. METHODS Two thousand two hundred fifty-one children born in Spain between 2004 and 2008 were analyzed. Five BMI z score trajectories from birth to age 4 years were identified by using latent class growth analysis. Multinomial regression assessed the associations between maternal metabolic parameters and offspring's BMI trajectories. RESULTS Children in the reference BMI trajectory had average size at birth followed by a slower BMI gain. Maternal prepregnancy obesity was associated with trajectories of accelerated BMI gain departing from either higher (relative risk ratio [RRR] = 1.77; 95% CI: 1.07-2.91) or lower size at birth (RRR = 1.91; 95% CI: 1.17-3.12). Gestational weight gain (GWG) above clinical guidelines was associated with a trajectory of higher birth size followed by accelerated BMI gain (RRR = 2.14; 95% CI: 1.53-2.97). Maternal serum triglycerides were negatively associated with BMI trajectories departing from lower birth sizes. Gestational diabetes, maternal serum cholesterol, and C-reactive protein were unrelated to children's BMI trajectories. CONCLUSIONS Maternal prepregnancy obesity, GWG, and serum triglycerides are associated with longitudinal BMI trajectories in early childhood that may increase disease risk in later life. Health initiatives should promote healthy weight status before and during pregnancy to improve maternal and child health.
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Affiliation(s)
- Parisa Montazeri
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
- Center for Biomedical Research in the Network of Epidemiology and Public Health, Madrid, Spain
| | - Martine Vrijheid
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
- Center for Biomedical Research in the Network of Epidemiology and Public Health, Madrid, Spain
| | - David Martinez
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
- Center for Biomedical Research in the Network of Epidemiology and Public Health, Madrid, Spain
| | - Mikel Basterrechea
- Center for Biomedical Research in the Network of Epidemiology and Public Health, Madrid, Spain
- Public Health Division of Gipuzkoa, Basque Government, San Sebastián, Spain
- Biodonostia Health Research Institute, San Sebastián, Spain
| | - Ana Fernandez-Somoano
- Center for Biomedical Research in the Network of Epidemiology and Public Health, Madrid, Spain
- University Institute of Oncology of the Principality of Asturias and Area of Preventive Medicine and Public Health, Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
| | - Monica Guxens
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
- Center for Biomedical Research in the Network of Epidemiology and Public Health, Madrid, Spain
| | - Carmen Iñiguez
- Center for Biomedical Research in the Network of Epidemiology and Public Health, Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, Foundation for the Promotion of Health and Biomedical Research of the Valencia Region, Jaume I University, and University of Valencia, Valencia, Spain
| | - Aitana Lertxundi
- Center for Biomedical Research in the Network of Epidemiology and Public Health, Madrid, Spain
- Public Health Division of Gipuzkoa, Basque Government, San Sebastián, Spain
- Biodonostia Health Research Institute, San Sebastián, Spain
| | - Mario Murcia
- Center for Biomedical Research in the Network of Epidemiology and Public Health, Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, Foundation for the Promotion of Health and Biomedical Research of the Valencia Region, Jaume I University, and University of Valencia, Valencia, Spain
| | - Adonina Tardon
- Center for Biomedical Research in the Network of Epidemiology and Public Health, Madrid, Spain
- University Institute of Oncology of the Principality of Asturias and Area of Preventive Medicine and Public Health, Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
| | - Jordi Sunyer
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
- Center for Biomedical Research in the Network of Epidemiology and Public Health, Madrid, Spain
| | - Damaskini Valvi
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
- Center for Biomedical Research in the Network of Epidemiology and Public Health, Madrid, Spain
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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Olson CM, von Kries R. Interventions During Pregnancy Reduce Excessive Gestational Weight Gain but Yield Unexpected Effects on Neonatal Body Composition. Obesity (Silver Spring) 2018; 26:459-460. [PMID: 29464906 DOI: 10.1002/oby.22122] [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] [Received: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Christine M Olson
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Rüdiger von Kries
- Institute of Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
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Gallagher D, Rosenn B, Toro-Ramos T, Paley C, Gidwani S, Horowitz M, Crane J, Lin S, Thornton J, Pi-Sunyer X. Greater Neonatal Fat-Free Mass and Similar Fat Mass Following a Randomized Trial to Control Excess Gestational Weight Gain. Obesity (Silver Spring) 2018; 26:578-587. [PMID: 29464905 PMCID: PMC5824435 DOI: 10.1002/oby.22079] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/25/2017] [Accepted: 10/30/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to determine the effectiveness of controlling maternal gestational weight gain (GWG) in the second and third trimesters on neonate body composition. METHODS Two hundred ten healthy women with overweight (25 > BMI < 30) or obesity (BMI ≥ 30) were randomly assigned to a lifestyle intervention (LI) program focused on controlling GWG through nutrition and activity behaviors or to usual obstetrical care (UC). Infant fat and fat-free mass (FFM) at birth were measured by using air displacement plethysmography (PEA POD) and by using quantitative magnetic resonance (QMR). RESULTS At baseline, there were no between-group differences in maternal characteristics (mean [SD]): age: 33.8 (4.3) years, weight: 81.9 (13.7) kg, BMI: 30.4 (4.5), and gestational age at randomization: 14.9 (0.8) weeks. GWG was less in the LI group by 1.79 kg (P = 0.003) or 0.0501 kg/wk (P = 0.002). Compared with UC infants, LI infants had greater weight (131 ± 59 g P = 0.03), FFM (98 ± 45 g; P = 0.03) measured by PEA POD, and lean mass (105 ± 38 g; P = 0.006) measured by QMR. Fat mass and percent fat were not significantly different. CONCLUSIONS Intervening in women with overweight and obesity through behaviors promoting healthy diet and physical activity to control GWG resulted in neonates with similar fat and greater FFM.
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Affiliation(s)
- Dympna Gallagher
- New York Obesity Research Center, Dept. of Medicine, College of Physicians and Surgeons, Columbia University
- Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University
| | - Barak Rosenn
- Department Obstetrics and Gynecology, Mount Sinai West Hospital, Mount Sinai Health System, Icahn School of Medicine
| | - Tatiana Toro-Ramos
- New York Obesity Research Center, Dept. of Medicine, College of Physicians and Surgeons, Columbia University
| | - Charles Paley
- Department of Pediatrics, Mount Sinai West Hospital, Mount Sinai Health System, Icahn School of Medicine
| | - Sonia Gidwani
- Department of Pediatrics, Mount Sinai West Hospital, Mount Sinai Health System, Icahn School of Medicine
| | - Michelle Horowitz
- New York Obesity Research Center, Dept. of Medicine, College of Physicians and Surgeons, Columbia University
| | - Janet Crane
- New York Obesity Research Center, Dept. of Medicine, College of Physicians and Surgeons, Columbia University
| | - Susan Lin
- Center for Family and Community Medicine, Columbia University
| | | | - Xavier Pi-Sunyer
- New York Obesity Research Center, Dept. of Medicine, College of Physicians and Surgeons, Columbia University
- Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University
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Phelan S, Wing RR, Brannen A, McHugh A, Hagobian TA, Schaffner A, Jelalian E, Hart CN, Scholl TO, Munoz-Christian K, Yin E, Phipps MG, Keadle S, Abrams B. Randomized controlled clinical trial of behavioral lifestyle intervention with partial meal replacement to reduce excessive gestational weight gain. Am J Clin Nutr 2018; 107:183-194. [PMID: 29529157 PMCID: PMC6455030 DOI: 10.1093/ajcn/nqx043] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/21/2017] [Indexed: 12/24/2022] Open
Abstract
Background Behavioral lifestyle interventions during pregnancy can prevent excessive gestational weight gain (GWG) in women with normal weight; however, effective interventions to reduce GWG in ethnically diverse women with obesity are lacking. Objective A randomized controlled trial was conducted to test whether a behavioral lifestyle intervention with partial meal replacement reduces GWG rate in Hispanic and non-Hispanic women with overweight or obesity relative to enhanced usual care. Design Participants (n = 257) were recruited in San Luis Obispo, California, and Providence, Rhode Island, between November 2012 and May 2016. Participants were pregnant (mean ± SD: 13.6 ± 1.8 wk of gestation) with overweight or obesity and had a mean age of 30.3 y; 41.6% of participants were Hispanic. Women were randomly assigned within site and by ethnicity to enhanced usual care (n = 128) or to a behavioral lifestyle intervention with partial meal replacement (n = 129). The primary outcome was GWG per week of observation. Secondary outcomes were proportions exceeding Institute of Medicine (IOM) guidelines for total GWG, changes in weight-control behaviors and cardiovascular disease risk factors, and incidence of pregnancy complications. Study retention was 99.6% (256 of 257). Results The intervention compared with usual care resulted in less mean ± SD weekly GWG (0.33 ± 0.25 compared with 0.39 ± 0.23 kg/wk; P = 0.02) and total GWG (9.4 ± 6.9 compared with 11.2 ± 7.0 kg; P = 0.03) and reduced the proportion of women who exceeded IOM guidelines for total GWG (41.1% compared with 53.9%; P = 0.03). No significant group × time × demographic subgroup (ethnicity, BMI, age, parity, and income) interactions were observed. Among intervention participants, greater meal replacement intake was related to reduced GWG rate (β = -0.07; 95% CI:-0.12, -0.03; P = 0.002). The intervention compared with usual care increased weight-control strategies (P < 0.0001) and cognitive restraint (P < 0.0001) and reduced triglycerides (P = 0.03). Conclusion Prenatal behavioral intervention with partial meal replacement significantly reduced GWG in Hispanic and non-Hispanic women with overweight or obesity. This trial was registered at www.clinicaltrials.gov as NCT01545934.
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Affiliation(s)
- Suzanne Phelan
- Departments of Kinesiology, Statistics, and Modern Languages, California Polytechnic State University, San Luis Obispo, CA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, RI
| | - Anna Brannen
- Departments of Kinesiology, Statistics, and Modern Languages, California Polytechnic State University, San Luis Obispo, CA
| | - Angelica McHugh
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, RI
| | - Todd A Hagobian
- Departments of Kinesiology, Statistics, and Modern Languages, California Polytechnic State University, San Luis Obispo, CA
| | - Andrew Schaffner
- Departments of Statistics, and Modern Languages, California Polytechnic State University, San Luis Obispo, CA
| | - Elissa Jelalian
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, RI
| | - Chantelle N Hart
- Department of Social and Behavioral Sciences, Temple University Center for Obesity Research and Education, Philadelphia, PA
| | - Theresa O Scholl
- Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey (now Rowan), Glassboro, NJ
| | - Karen Munoz-Christian
- Departments of Modern Languages, California Polytechnic State University, San Luis Obispo, CA
| | - Elaine Yin
- Pacific Central Coast Health Centers, Santa Maria Women's Health, Santa Maria, CA
| | - Maureen G Phipps
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI
| | - Sarah Keadle
- Departments of Kinesiology, Statistics, and Modern Languages, California Polytechnic State University, San Luis Obispo, CA
| | - Barbara Abrams
- Division of Epidemiology, University of California at Berkeley School of Public Health, Berkeley, CA
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Estampador AC, Franks PW. Precision Medicine in Obesity and Type 2 Diabetes: The Relevance of Early-Life Exposures. Clin Chem 2018; 64:130-141. [DOI: 10.1373/clinchem.2017.273540] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/29/2017] [Indexed: 12/11/2022]
Abstract
Abstract
BACKGROUND
Type 2 diabetes is highly prevalent and devastating. Obesity is a diabetogenic factor, driving insulin resistance and a compensatory demand for increased insulin secretion from the pancreatic β cells; a failure to address this demand results in diabetes. Accordingly, primary and secondary prevention of obesity are at the core of diabetes prevention programs. The development of obesity and declining β-cell function often span many years or decades before diabetes is clinically manifest. Thus, characterizing the early-life process and risk factors that set disease trajectories may yield novel targets for early intervention and help improve the accuracy of prediction algorithms, factors germane to the emerging field of precision medicine.
CONTENT
Here, we overview the concepts of precision medicine and fetal programming. We discuss the barriers to preventing obesity and type 2 diabetes in adulthood and present the rationale for considering early-life events in this context. In so doing, we discuss proof-of-concept studies and cutting-edge technological developments that are likely to transform current thinking on the etiology and pathogenesis of obesity and type 2 diabetes. We also review the factors hampering progress, including the success and failures of pregnancy intervention trials.
SUMMARY
Obesity and type 2 diabetes are among the major health and economic burdens of our time. Defeating these diseases is likely to require life-course approaches, which may include aggressive interventions informed by biomarker profiling undertaken during early life.
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Affiliation(s)
- Angela C Estampador
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital Malmö, Malmö, Sweden
- Danish Diabetes Academy, Odense, Denmark
| | - Paul W Franks
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital Malmö, Malmö, Sweden
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Department of Nutrition, Harvard School of Public Health, Boston, MA
- Oxford Center for Diabetes, Endocrinology, and Metabolism, Radcliff Department of Medicine, University of Oxford, Oxford, UK
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Shepherd E, Gomersall JC, Tieu J, Han S, Crowther CA, Middleton P. Combined diet and exercise interventions for preventing gestational diabetes mellitus. Cochrane Database Syst Rev 2017; 11:CD010443. [PMID: 29129039 PMCID: PMC6485974 DOI: 10.1002/14651858.cd010443.pub3] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with a wide range of adverse health consequences for women and their infants in the short and long term. With an increasing prevalence of GDM worldwide, there is an urgent need to assess strategies for GDM prevention, such as combined diet and exercise interventions. This is an update of a Cochrane review that was first published in 2015. OBJECTIVES To assess the effects of diet interventions in combination with exercise interventions for pregnant women for preventing GDM, and associated adverse health consequences for the mother and her infant/child. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (27 November 2016) and reference lists of retrieved studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs, comparing combined diet and exercise interventions with no intervention (i.e. standard care), that reported on GDM diagnosis as an outcome. Quasi-RCTs were excluded. Cross-over trials were not eligible for inclusion. We planned to include RCTs comparing two or more different diet/exercise interventions, however none were identified. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data, assessed the risk of bias of the included trials and assessed quality of evidence for selected maternal and infant/child outcomes using the GRADE approach. We checked data for accuracy. MAIN RESULTS In this update, we included 23 RCTs (involving 8918 women and 8709 infants) that compared combined diet and exercise interventions with no intervention (standard care). The studies varied in the diet and exercise programs evaluated and health outcomes reported. None reported receiving funding from a drug manufacturer or agency with interests in the results. Overall risk of bias was judged to be unclear due to the lack of methodological detail reported. Most studies were undertaken in high-income countries.For our primary review outcomes, there was a possible reduced risk of GDM in the diet and exercise intervention group compared with the standard care group (average risk ratio (RR) 0.85, 95% confidence interval (CI) 0.71 to 1.01; 6633 women; 19 RCTs; Tau² = 0.05; I² = 42%; P = 0.07; moderate-quality evidence). There was also a possible reduced risk of caesarean section (RR 0.95, 95% CI 0.88 to 1.02; 6089 women; 14 RCTs; moderate-quality evidence). No clear differences were seen between groups for pre-eclampsia (RR 0.98, 95% CI 0.79 to 1.22; 5366 participants; 8 RCTs; low-quality evidence), pregnancy-induced hypertension and/or hypertension (average RR 0.78, 95% CI 0.47 to 1.27; 3073 participants; 6 RCTs; Tau² = 0.19; I² = 62%; very low-quality evidence), perinatal mortality (RR 0.82, 95% CI 0.42 to 1.63; 3757 participants; 2 RCTs; low-quality evidence) or large-for-gestational age (RR 0.93, 95% CI 0.81 to 1.07; 5353 participants; 11 RCTs; low-quality evidence). No data were reported for infant mortality or morbidity composite.Subgroup analyses (based on trial design, maternal body mass index (BMI) and ethnicity) revealed no clear differential treatment effects. We were unable to assess the impact of maternal age, parity and specific features of the diet and exercise interventions. Findings from sensitivity analyses (based on RCT quality) generally supported those observed in the main analyses. We were not able to perform subgroup analyses based on maternal age, parity or nature of the exercise/dietary interventions due to the paucity of information/data on these characteristics and the inability to meaningfully group intervention characteristics.For most of the secondary review outcomes assessed using GRADE, there were no clear differences between groups, including for perineal trauma (RR 1.27, 95% CI 0.78 to 2.05; 2733 participants; 2 RCTs; moderate-quality evidence), neonatal hypoglycaemia (average RR 1.42, 95% CI 0.67 to 2.98; 3653 participants; 2 RCTs; Tau² = 0.23; I² = 77%; low quality evidence); and childhood adiposity (BMI z score) (MD 0.05, 95% CI -0.29 to 0.40; 794 participants; 2 RCTs; Tau² = 0.04; I² = 59%; low-quality evidence). However, there was evidence of less gestational weight gain in the diet and exercise intervention group compared with the control group (mean difference (MD) -0.89 kg, 95% CI -1.39 to -0.40; 5052 women; 16 RCTs; Tau² = 0.37; I² = 43%;moderate-quality evidence). No data were reported for maternal postnatal depression or type 2 diabetes; childhood/adulthood type 2 diabetes, or neurosensory disability. AUTHORS' CONCLUSIONS Moderate-quality evidence suggests reduced risks of GDM and caesarean section with combined diet and exercise interventions during pregnancy as well as reductions in gestational weight gain, compared with standard care. There were no clear differences in hypertensive disorders of pregnancy, perinatal mortality, large-for-gestational age, perineal trauma, neonatal hypoglycaemia, and childhood adiposity (moderate- tovery low-quality evidence).Using GRADE methodology, the evidence was assessed as moderate to very low quality. Downgrading decisions were predominantly due to design limitations (risk of bias), and imprecision (uncertain effect estimates, and at times, small sample sizes and low event rates), however two outcomes (pregnancy-induced hypertension/hypertension and neonatal hypoglycaemia), were also downgraded for unexplained inconsistency (statistical heterogeneity).Due to the variability of the diet and exercise components tested in the included studies, the evidence in this review has limited ability to inform practice. Future studies could describe the interventions used in more detail, if and how these influenced behaviour change and ideally be standardised between studies. Studies could also consider using existing core outcome sets to facilitate more standardised reporting.
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Affiliation(s)
- Emily Shepherd
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Judith C Gomersall
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteWomen’s and Children’s Hospital7th Floor, 72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Joanna Tieu
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Shanshan Han
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Caroline A Crowther
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
- The University of AucklandLiggins InstitutePrivate Bag 9201985 Park RoadAucklandNew Zealand
| | - Philippa Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteWomen’s and Children’s Hospital7th Floor, 72 King William RoadAdelaideSouth AustraliaAustralia5006
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Phillips JK, Higgins ST. Applying behavior change techniques to weight management during pregnancy: Impact on perinatal outcomes. Prev Med 2017; 104:133-136. [PMID: 28757450 PMCID: PMC5735012 DOI: 10.1016/j.ypmed.2017.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 07/18/2017] [Accepted: 07/24/2017] [Indexed: 12/19/2022]
Abstract
Unhealthy behaviors and lifestyle choices are contributing to the obesity epidemic and associated morbidities. Among reproductive aged women, obesity adversely affects perinatal outcomes and longer term maternal and child health. Interventions utilizing strategies of behavior change have the potential to improve outcomes, especially during pregnancy. Antenatal interventions to improve adherence to gestational weight gain guidelines are one such example. Although behaviorally-based intervention trials have been associated with modest decreases in gestational weight gain, the effect on short term perinatal outcomes has thus far been minimal. This commentary aims to discuss possible reasons behind the failure to improve perinatal outcomes as well as to encourage future areas of study.
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Affiliation(s)
- Julie K Phillips
- Vermont Center on Behavior and Health, University of Vermont, United States; Departments of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont, United States.
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, United States; Psychiatry, University of Vermont, United States; Psychological Science, University of Vermont, United States
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49
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Abstract
Clinical research in the pregnant population allows for delivery of quality, evidence-based care in obstetrics. However, in recent years, the field of obstetrics has faced severe challenges in the recruitment of the pregnant population into clinical trials, a struggle also shared by several other medical disciplines. We candidly describe our failure to recruit a healthy population of overweight and obese pregnant women in their first trimester. We were then able to glean unsuccessful and successful recruitment approaches and improve our recruitment effort by autopsy of failed strategies and with guidance from a survey disseminated to improve our understanding of community feelings about participating in research while pregnant. These "lessons learned" taught us that active recruitment within this population is a necessity; that is, direct (face-to-face discussions at obstetric appointments) compared with indirect (flyers and general emails) modalities and that prenatal care provider support of the proposed research study is vital to a patient's willingness to participate. By implementation of "lessons learned," we describe how we successfully recruited a similar pregnant population 1 year later. The Clinical Trials related to our article are as follows: 1) Expecting Success: NCT01610752, https://clinicaltrials.gov/ct2/show/NCT01610752; 2) MomEE: NCT01954342, https://clinicaltrials.gov/ct2/show/NCT01954342; and 3) Participate While Pregnant Survey: NCT02699632, https://clinicaltrials.gov/ct2/show/NCT02699632.
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50
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Al Wattar BH, Dodds J, Placzek A, Spyreli E, Higgins S, Moore A, Hooper R, Beresford L, Roseboom TJ, Bes-Rastrollo M, Hitman G, Khan KS, Thangaratinam S. Mediterranean diet based intervention in pregnancy to improve maternal and fetal outcomes: Methodological challenges and lessons learned from the multicentre ESTEEM study. Contemp Clin Trials Commun 2017; 6:72-77. [PMID: 29740638 PMCID: PMC5936842 DOI: 10.1016/j.conctc.2017.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 02/02/2017] [Accepted: 02/28/2017] [Indexed: 11/16/2022] Open
Abstract
Introduction Evaluating complex dietary interventions such as Mediterranean diet in pregnancy presents unique methodological challenges. We present the challenges and the lessons learned from a multicentre randomised trial (ESTEEM) on Mediterranean-based dietary intervention in pregnancy. Methods We recruited pregnant women who met our predefined inclusion criteria and randomised those with metabolic risk factors to the Mediterranean-based dietary intervention or routine antenatal care. We evaluated the effect of the ESTEEM intervention on composite maternal and fetal outcomes. Challenges and solutions The main challenges were encountered in recruiting to ESTEEM, delivering the intervention, engaging clinical staff, assessing adherence and choosing the outcome measures. The large sample size coupled with the slow recruitment rate forced us to extend the recruitment period by 4 months. The limitation in available resources was overcome by opening sites in a step-wise approach. Engaging healthcare providers was promoted by embedding the recruitment and the follow-up activities into current clinical practice, and promoting research skills training. We delivered the intervention early on in the pregnancy to promote the dietary effect on healthy placentation and reduce metabolic risk factors. Participants and their families were actively involved in the dietary intervention to improve adherence through a series of group teaching sessions. A user-friendly short dietary questionnaire was developed and validated to assess adherence to the intervention. The trial composite primary outcome was chosen in consensus based on input from a panel of experts. Conclusion The ESTEEM experience offers an insight into future pragmatic nutritional studies in pregnancy. Trial registration number NCT02218931.
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Affiliation(s)
- Bassel H Al Wattar
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Julie Dodds
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anna Placzek
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Eleni Spyreli
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sally Higgins
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Amanda Moore
- Diabetes & Nutritional Sciences Division, Faculty of Life Sciences & Medicine, King's College, London, UK
| | - Richard Hooper
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Lee Beresford
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Tessa J Roseboom
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,CIBERobn, Instituto de Salud Carlos III, Madrid, Spain.,IDISNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Graham Hitman
- Centre for Diabetes and Metabolic Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Khalid S Khan
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Multidisciplinary Evidence Synthesis Hub (mEsh), Barts and the London School of Medicine, Queen Mary University London, London, UK
| | - Shakila Thangaratinam
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Multidisciplinary Evidence Synthesis Hub (mEsh), Barts and the London School of Medicine, Queen Mary University London, London, UK
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