Prepregnancy weight change associated with high gestational weight gain

Gestational weight gain trajectories in patients with gestational diabetes mellitus: a retrospective cohort study

Aims/Background Gestational diabetes mellitus is a common pregnancy complication that affects approximately 14% of pregnancies worldwide and can lead to adverse maternal and neonatal outcomes. This study aimed to investigate the trajectories of gestational weight gain among gestational diabetes mellitus patients and to inform the development of effective weight management strategies. Methods Demographic and antenatal examination data from 1421 pregnant women diagnosed with gestational diabetes mellitus were retrospectively analysed. Quantitative data comparisons were performed using Chi-square tests, Fisher's exact test, t-tests, and one-way analysis of variance. Group-based trajectory modelling was employed to identify the trajectories of gestational weight gain among patients with gestational diabetes mellitus. Results This study revealed that pre-pregnancy body mass index and types of gestational diabetes mellitus significantly influence gestational weight gain (p < 0.05). Group-based trajectory modelling identified three distinct gestational weight gain trajectories. Patients with gestational diabetes mellitus demonstrated a continuous weight gain throughout pregnancy, while women who were overweight or obese before pregnancy were more likely to follow a low-speed growth trajectory. Women in the rapid growth trajectory group were more inclined to deliver by caesarean section and were more likely to give birth to macrosomic infants. Conclusion Our research underscores the importance of identifying and distinguishing between different gestational weight gain trajectories in pregnant women, thereby identifying high-risk groups, which is crucial for improving the health conditions of both mothers and newborns.

Association between mindful and practical eating skills and eating behaviors among racially diverse pregnant women in four selected clinical sites in the United States

Background: Mindful eating is a promising strategy to address problematic eating behaviors; however, little is known about its applicability during pregnancy. No studies have examined the combined effects of mindful and practical eating skills on eating behaviors. Aim: We examined associations between mindful and practical eating skills and eating behaviors (nutritional intake and emotional eating) among pregnant women who received psychoeducation on healthy eating and pregnancies. Methods: Participants were racially-diverse pregnant women (14-42 years) from four clinical sites in Detroit, Michigan, and Nashville, Tennessee (N = 741). We conducted multiple linear regression to examine associations between mindful (hunger cues, satiety cues, mindful check-ins) and practical (food diary/journal, MyPlate method) eating skills and nutritional intake. We calculated residualized change scores to represent changes in the quality of nutritional intake from second to third trimester. We performed multiple logistic regression to examine associations between mindful and practical eating skills and emotional eating. Results: Women improved over time in eating behaviors (better nutrition, less emotional eating). Regular use of MyPlate was associated with better nutritional intake (unstandardized coefficient [B] = -0.61), but food diaries were not. We found a significant interaction in predicting emotional eating: For those regularly paying attention to hunger cues, some use of MyPlate (Adjusted Odds Ratio [AOR] = 0.39) and especially regular use of MyPlate (AOR = 0.13) reduced the likelihood of emotional eating during pregnancy. Conclusion: Enhancing both mindful and practical eating skills, such as paying attention to hunger cues, and using the MyPlate method, may facilitate pregnant women's ability to improve their eating behaviors.

Association of prepregnancy body mass index and gestational weight gain trajectory with adverse pregnancy outcomes-a prospective cohort study in Shanghai

OBJECTIVES

The objective was to investigate the associations of maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) trajectories with adverse pregnancy outcomes (APOs).

DESIGN

This was a prospective cohort study.

SETTING

This study was conducted in Shanghai Pudong New Area Health Care Hospital for Women and Children, Shanghai, China.

PRIMARY AND SECONDARY OUTCOME MEASURES

A cohort study involving a total of 2174 pregnant women was conducted. Each participant was followed to record weekly weight gain and pregnancy outcomes. The Institute of Medicine classification was used to categorise prepregnancy BMI, and four GWG trajectories were identified using a latent class growth model.

RESULTS

The adjusted ORs for the risks of large for gestational age (LGA), macrosomia, gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) were significantly greater for women with prepregnancy overweight/obesity (OR=1.77, 2.13, 1.95 and 4.24; 95% CI 1.3 to 2.42, 1.32 to 3.46, 1.43 to 2.66 and 2.01 to 8.93, respectively) and lower for those who were underweight than for those with normal weight (excluding HDP) (OR=0.35, 0.27 and 0.59; 95% CI 0.22 to 0.53, 0.11 to 0.66 and 0.36 to 0.89, respectively). The risk of small for gestational age (SGA) and low birth weight (LBW) was significantly increased in the underweight group (OR=3.11, 2.20; 95% CI 1.63 to 5.92, 1.10 to 4.41; respectively) compared with the normal-weight group; however, the risk did not decrease in the overweight/obese group (p=0.942, 0.697, respectively). GWG was divided into four trajectories, accounting for 16.6%, 41.4%, 31.7% and 10.3% of the participants, respectively. After adjustment for confounding factors, the risk of LGA was 1.54 times greater for women in the slow GWG trajectory group than for those in the extremely slow GWG trajectory group (95% CI 1.07 to 2.21); the risk of SGA and LBW was 0.37 times and 0.46 times lower for women in the moderate GWG trajectory group and 0.14 times and 0.15 times lower for women in the rapid GWG trajectory group, respectively; the risk of macrosomia and LGA was 2.65 times and 2.70 times greater for women in the moderate GWG trajectory group and 3.53 times and 4.36 times greater for women in the rapid GWG trajectory group, respectively; and the women in the other three trajectory groups had a lower risk of GDM than did those in the extremely slow GWG trajectory group, but there was not much variation in the ORs. Notably, different GWG trajectories did not affect the risk of HDP.

CONCLUSIONS

As independent risk factors, excessively high and low prepregnancy BMI and GWG can increase the risk of APOs.

Dose-Response Relationship between Gestational Weight Gain and Neonatal Birthweight in Chinese Women with Excess Weight/Obesity and Gestational Diabetes Mellitus

Total gestational weight gain (GWG) is identified as a strong and potentially controllable predictor of long-term health outcomes in women with gestational diabetes mellitus (GDM) and infants. When the total GWG of women with excess weight/obesity and GDM does not exceed the Institute of Medicine (IOM) suggested range, neonatal birthweight outcomes may be favorable, but the evidence is limited. Therefore, the objective of this study was to evaluate the dose-response relationship between increased total GWG and the risk of neonatal birthweight in Chinese women with excess weight/obesity and GDM. This study obtained electronic medical records (EMR) from the hospital information system (HIS) of the Chongqing Health Center for Women and Children between July 2017, and June 2020. A retrospective study analyzed the effect of the total GWG of women with excess weight/obesity and GDM on neonatal birthweight. The dose-response relationship between total GWG and neonatal birthweight was studied using a generalized linear model and embedded restricted cubic splines (RCS). The average age of all women with GDM was 31.99 ± 4.47 years, and 27.61% were advanced maternal age (≥35 years). The total GWG among women with excess weight and obesity and GDM greater than the IOM recommendations were found in 42.96% and 58.62% of cases, respectively. Total GWG in women with excess weight and excessing the IOM recommended range is a risk factor for large gestational age (LGA) [adjusted odds ratio (aOR) 0.1.47, 1.08-2.01] and macrosomia (aOR 1.55, 1.04-2.31). In the obesity above group, excessive weight gain increased the risk of LGA (aOR 2.92, 1.33-6.41) and macrosomia (aOR 2.83, 1.03-7.72). We used an RCS to examine pregnant women with excess weight and GDM and discovered a linear dose-response relationship between total GWG and LGA/macrosomia. In women with excess weight and obesity, increases in total GWG above the lowest end of the IOM recommendations range (7 kg and 5 kg) were associated with an increased risk of LGA and macrosomia. Therefore, research is urgently needed to support maternal and newborn health to provide recommendations for the ideal weight increase in women with excess weight/obesity and GDM.

Estradiol cycling drives female obesogenic adipocyte hyperplasia

White adipose tissue (WAT) distribution is sex dependent. Adipocyte hyperplasia contributes to WAT distribution in mice driven by cues in the tissue microenvironment, with females displaying hyperplasia in subcutaneous and visceral WAT, while males and ovariectomized females have visceral WAT (VWAT)-specific hyperplasia. However, the mechanism underlying sex-specific hyperplasia remains elusive. Here, transcriptome analysis in female mice shows that high-fat diet (HFD) induces estrogen signaling in adipocyte precursor cells (APCs). Analysis of APCs throughout the estrous cycle demonstrates increased proliferation only when proestrus (high estrogen) coincides with the onset of HFD feeding. We further show that estrogen receptor α (ERα) is required for this proliferation and that estradiol treatment at the onset of HFD feeding is sufficient to drive it. This estrous influence on APC proliferation leads to increased obesity driven by adipocyte hyperplasia. These data indicate that estrogen drives ERα-dependent obesogenic adipocyte hyperplasia in females, exacerbating obesity and contributing to the differential fat distribution between the sexes.

Women's Reproductive Milestones and Cardiovascular Disease Risk: A Review of Reports and Opportunities From the CARDIA Study

In 1985 to 1986, the CARDIA (Coronary Artery Risk Development in Young Adults) study enrolled 5115 Black or White participants, including 2788 women, aged 18 to 30 years. Over the following 35 years, the CARDIA study amassed extensive longitudinal data on women's reproductive milestones, spanning menarche to menopause. Although not initially conceived as a study of women's health, >75 CARDIA study publications address relationships between reproductive factors and events with cardiovascular and metabolic risk factors, subclinical and clinical cardiovascular disease, and social determinants of health. The CARDIA study was one of the earliest population-based reports to note Black-White differences in age at menarche and associations with cardiovascular risk factors. Adverse pregnancy outcomes, particularly gestational diabetes and preterm birth, have been assessed along with postpartum behaviors, such as lactation. Existing studies have examined risk factors for adverse pregnancy outcomes and lactation, as well as their relationship to future cardiovascular and metabolic risk factors, diagnoses, and subclinical atherosclerosis. Ancillary studies examining components of polycystic ovary syndrome and ovarian biomarkers, such as anti-Müllerian hormone, have facilitated examination of reproductive health in a population-based cohort of young adult women. As the cohort transitioned through menopause, examination of the importance of premenopausal cardiovascular risk factors along with menopause has improved our understanding of shared mechanisms. The cohort is now aged in the 50s to mid-60s, and women will begin to experience a greater number of cardiovascular events as well as other conditions, such as cognitive impairment. Thus, in the next decade, the CARDIA study will provide a unique resource for understanding how the women's reproductive life course epidemiology informs cardiovascular risk, as well as reproductive and chronological aging.

Patterns of gestational weight gain among women with obesity and its correlation with hypertensive disorders of pregnancy in Chinese women

Gestational weight management in obese women is critical in clinical work. Adverse pregnancy outcomes are associated with improper gestational weight gain (GWG). However, the pattern of GWG (PGWG) and its correlation with hypertensive disorders of pregnancy (HDP) in obesity are still unclear in China. This retrospective cohort study evaluates clinical data from 799 women through multivariate analyses and trajectory analyses. All the participants are stratified per first trimester weight gain category into three groups (Inadequate-1st, <0.5 kg; Adequate-1st, 0.5-2.0 kg; Excessive-1st, >2.0 kg) and PGWG refers to the weekly weight gain during each gestational period. GWG is positively associated with first trimester weight gain. 78.4% of the Excessive-1st participants have excessive total GWG, in contrast to Inadequate-1st (32.7%) and Adequate-1st (48.2%). After 20 weeks, the weekly weight gain rapidly accelerates, and 77.3% have a weekly weight gain exceeding the Institute of Medicine recommendations. Trajectory analysis of weekly weight gain based on HDP shows two separate weight gain curves after 20 weeks in women with and without a high risk of HDP. Especially in Excessive-1st participants, weekly weight gain after 20 weeks over 0.32 kg/w is positively related to the risk of HDP (<0.32 kg/w vs. 0.32-0.61 kg/w, adjusted odds ratios [aOR]: 2.999, 95% confidence interval [CI]: 1.054-8.537; <0.32 kg/w vs. >0.61 kg/w, aOR: 5.362, 95% CI: 1.719-16.729). In summary, the first trimester is critical for gestational weight management in obesity. Excessive weight gain during the first trimester and after 20 weeks predicts a high risk of HDP, which should be noted in clinical practice.