Factors Influencing Inadequate and Excessive Weight Gain in Pregnancy: Colorado, 2000–2002

The Association between Psychosocial Stressors and Gestational Weight Gain: Analysis of the National Pregnancy Risk Assessment Monitoring System (PRAMS) Results from 2012 to 2015

OBJECTIVE

Both psychosocial stress and gestational weight gain are independently associated with adverse maternal and fetal outcomes. Studies of the association between psychosocial stress and gestational weight gain (GWG) have yielded mixed results. The objective of this study was to evaluate the association between psychosocial stress and GWG in a large population-based cohort.

METHODS

Data from the nationally representative Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 7 questionnaire 2012-2015 was utilized. Maternal psychosocial stress was assessed through response to questions designed to examine four domains of psychosocial stress (i.e., traumatic, financial, emotional, partner-related) three months prior to or during pregnancy. GWG was categorized using pre-pregnancy BMI and total GWG into inadequate, adequate, or excessive according to the Institute of Medicine's GWG guidelines. Multinomial logistic regression was used to evaluate the association between psychosocial stressors and adequacy of GWG. Analyses took into account complex survey design.

RESULTS

All respondents who delivered ≥ 37 weeks gestation with GWG information available were included in the analysis (n = 119,183). After adjusting for confounders, patients who reported financial stress were more likely to experience excessive versus adequate GWG (RRR 1.09 [95%CI: 1.02-1.17]). Exposure to any of the stressor groups did not significantly increase the risk of inadequate GWG.

CONCLUSIONS

This large, population-based study revealed that among pregnant people in the US, exposure to financial stress is associated with higher risk of excessive GWG. Understanding the role stress plays in GWG will help to inform initiatives targeting this important aspect of prenatal care.

Maternal Pregnancy and Pre-Pregnancy Weight and Behavioural Outcomes in Children

Reported associations of pre-pregnancy weight and/or gestational weight gain with offspring behavioural outcomes are inconsistent. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), this study aimed to examine these associations at five developmental stages between the ages of 3 and 16. Over 6800 mother-offspring pairs at age 3 and 3925 pairs at age 16 were included. Pre-pregnancy underweight was associated with a 22% increased risk of total behavioural difficulties (OR = 1.22, 95% CI 1.02-1.45). In separate analyses using the SDQ subscales, pre-pregnancy underweight was linked to a 37% (OR = 1.37, 95% CI 1.14-1.65) and 33% (OR = 1.33, 95% CI 1.01-1.76) increased risk of emotional symptoms and prosocial behaviour problems over time, respectively. While pre-pregnancy overweight was associated with an 11% (OR = 1.11, 95% CI 1.03-1.20) and 18% (OR = 1.18, 95% CI 1.03-1.36) increased risk of conduct and peer relationship problems, respectively, pregnancy obesity was associated with a 43% increased risk of emotional problems (OR = 1.43, 95% CI 1.16-1.77). We found no evidence of associations between gestational weight gain and child behaviour except for a reduced risk in prosocial behaviour problems (OR = 0.82, 95% CI 0.70-0.96). Our findings provide insights into the link between preconception BMI and child behaviour, underscoring the necessity for further research to validate these associations and elucidate underlying mechanisms.

Trends in Maternal Weight Disparities: Statewide Differences in Rural and Urban Minnesota Residents From 2012 to 2019

INTRODUCTION

Despite research showing substantial weight disparities along the rural-urban continuum, little work has attempted to identify differences in prepregnancy weight status or gestational weight gain (GWG) outcomes between rural and urban birthing people. As such, the goals of this research were to 1) document the prevalence of prepregnancy overweight and obesity and excessive GWG in rural and urban birthing people and 2) examine changes in rural and urban prepregnancy overweight or obesity and excessive GWG over time.

METHODS

Birth certificate data provided sociodemographic variables, prepregnancy body mass index, GWG, and rurality status on 465,709 respondents who gave birth in Minnesota from 2012 to 2019. A series of regression models estimated risk differences in 1) prepregnancy weight status and 2) excessive GWG between rural and urban respondents over time, controlling for relevant covariates.

RESULTS

Rural individuals had a 4.9 percentage-point (95% confidence interval, 4.5-5.3) higher risk of having prepregnancy overweight or obesity compared with urban individuals, and a 2.6 percentage-point (95% confidence interval, 1.9-3.3) higher risk of gaining excessive gestational weight. The disparities in prepregnancy overweight or obesity and excessive gestational weight between rural and urban individuals widened over time.

CONCLUSIONS

These findings contribute to accumulating evidence documenting notable health disparities between rural and urban individuals during the perinatal period and support the need to develop prevention and treatment efforts focused on improving the weight-related health of individuals living in rural communities.

Maternal characteristics associated with gestational weight gain in France: a population-based, nationally representative study

OBJECTIVES

To provide nationally representative estimates of gestational weight gain (GWG) and identify maternal characteristics associated with inadequate GWG in France.

DESIGN

A population-based study using data from the French National Perinatal Survey: 2010 and 2016.

SETTING

All maternity units in metropolitan, mainland France (n=535 in 2010; n=493 in 2016).

PARTICIPANTS

Singleton live births with GWG data (N=24 850).

PRIMARY OUTCOME MEASURES

GWG was calculated as end of pregnancy minus pre-pregnancy weight (kg) and categorised as 'insufficient', 'adequate', or 'excessive' using 2009 Institute of Medicine thresholds. Classification accounted for pre-pregnancy body mass index (BMI) (kg/m²; underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9), obese (≥30)) and gestational age at birth. We estimated average GWG and the percentage of women in each GWG category. Polytomous logistic regression identified characteristics associated with GWG adequacy.

RESULTS

Average GWG was 13.0 kg (SD 5.6), with 26.8% of women gaining insufficiently, 37.0% adequately and 36.1% excessively. Among other factors, insufficient GWG was associated with underweight (vs normal weight; adjusted OR (aOR) 1.4, 95% CI 1.2 to 1.5) and obese (aOR 1.5, 95% CI 1.4 to 1.7) BMI. Excessive GWG was associated with overweight (aOR 2.8, 95% CI 2.6 to 3.1) and obese BMI (aOR 3.3, 95% CI 2.9 to 3.6). Examining obesity classes separately, odds of insufficient GWG increased from obesity class I to III, while odds of excessive GWG decreased from obesity class I to III. Primiparity (insufficient: aOR 0.9, 95% CI 0.9 to 1.0; excessive: aOR 1.2, 95% CI 1.2 to 1.3), maternal characteristics indicative of lower socioeconomic status, and continuing or quitting smoking during pregnancy were also associated with inadequate GWG.

CONCLUSIONS

In France, insufficient and excessive GWG are common. For optimal outcomes, clinician education, with special attention to the needs of higher risk/vulnerable groups, is needed to ensure all women receive appropriate advice for recommended GWG.

Maternal Characteristics that Impact Postpartum Weight Retention: Results from the 2016 Los Angeles Mommy and Baby (LAMB) Follow-Up Study

OBJECTIVE

To identify maternal characteristics associated with 24-month postpartum weight retention.

METHODS

Data were collected from the 2016 Los Angeles Mommy and Baby (LAMB) Follow-Up Survey, a population-based prospective cohort study that assesses maternal and infant health in Los Angeles County. In 2014, LAMB initially surveyed 6035 women 6 months following a live birth. The 2016 LAMB Follow-Up reevaluated this same cohort after the index child's second birthday. 2679 women completed 2016 LAMB Follow-Up (52% adjusted response rate). The final sample size was 1524 after excluding subjects with subsequent pregnancies after the index child and missing information for postpartum weight. Eight predictors were included in this analysis: gestational weight gain, pre-pregnancy BMI, exercise, depressed mood since having child, age, race, education, and job loss during pregnancy. Chi-square tests and logistic regression analyses were performed using SAS 9.3.

RESULTS

Two years after delivery, women with postpartum weight retention weighed on average of 15.3 lb. more than before the index pregnancy. Women were more likely to retain postpartum weight when they exceeded gestational weight gain guidelines (AOR = 2.03, 95% CI = 1.40-2.93), did not exercise (AOR = 3.32, CI = 1.85-5.98), were between ages 20-29 (AOR = 1.54, CI = 1.01-2.36), were Hispanic (AOR = 1.51, CI = 1.02-2.24), completed high school only (AOR = 1.77, CI = 1.15-2.73), or lost a job during pregnancy (AOR = 2.62, CI = 1.39-4.93).

CONCLUSIONS

Modifiable risk factors and sociodemographic characteristics can impact maternal weight retention 24 months after pregnancy. Understanding postpartum weight retention is essential for guiding future public health research, programming, and policy. Tailoring appropriate public health interventions may help women sustain healthy weight during their reproductive years and beyond.

Weight gain during pregnancy and its associated factors: A Path analysis

Aim

Weight gain during pregnancy is an important indicator in the prediction of morbidity and mortality in infants and mothers. This study aimed to determine the association factors for weight gain during pregnancy.

Design

A longitudinal study.

Methods

A total of 734 women were selected using multistage cluster sampling. Data were collected using demographic and midwifery questionnaires, economic and social status, psychological factors, domestic violence, perceived social support and food insecurity.

Results

Of participants 28.7%, 49.6% and 21.7%, respectively, received insufficient, adequate and excessive weight gain in pregnancy respectively. Among health determinants entered in the model, mother's age, prepartum body mass index and direct and indirect prenatal care, size of households, food insecurity, stress, anxiety, stress and pregnancy-specific stress as well as violence had a positive and increasing effect on weight gain during pregnancy.

Conclusion

Considering the effect of inappropriate weight gain during pregnancy on undesirable pregnancy outcomes, related factors such as nutritional status, stress and depression in prenatal care should be assessed. Healthcare providers should consult, educate pregnant women.

Risk of adverse pregnancy outcomes by pre-pregnancy Body Mass Index among Italian population: a retrospective population-based cohort study on 27,807 deliveries

PURPOSE

To estimate the impact of increasing pre-pregnancy Body Mass Index (BMI) on the risk of adverse maternal and perinatal outcomes, in patients who delivered in an Italian tertiary care Obstetric department.

METHODS

Data, related to women who delivered at Sant'Anna Hospital, Turin, between 2011 and 2015, were collected retrospectively from the hospital database. According to BMI, women were considered as normal weight, overweight, and class 1, 2 and 3 obese (WHO criteria). Logistic regression analysis studied the impact of BMI on maternal and neonatal outcomes, adjusting results for maternal age and parity. Adjusted absolute risks of each outcome were reported according to incremental values in pre-pregnancy BMI.

RESULTS

A total of 27,807 women were included. 75.8% of pregnancies occurred among normal-weight women, whereas 16.7% were overweight, and 7.5% obese women (5.4% class 1, 1.7% class 2 and 0.4% class 3). A 10% decrease in pre-pregnancy BMI was associated with a reduction of at least 15% of Gestational diabetes mellitus (GDM), preeclampsia, maternal admission to intensive care unit (ICU), macrosomia, APGAR 5' < 6 and neonatal admission to ICU. GDM and preeclampsia resulted in the highest reduction being almost 30%. Larger differences in BMI (20-25%) corresponded to at least a 10% in reduction of risk of preterm and very preterm delivery and emergency cesarean section. Differences in maternal pre-pregnancy BMI had no impact on the frequency of shoulder dystocia and stillbirth.

CONCLUSIONS

This study offers a quantitative estimation of negative impact of pre-pregnancy obesity on the most common pregnancy and perinatal complications.

A long-term maternal diet transition from high-fat diet to normal fat diet during pre-pregnancy avoids adipose tissue inflammation in next generation

Recent studies have suggested that maternal high-fat (HF) diet caused inflammation changes in adipose tissue; however, it remains unclear if maternal diet intervention before pregnancy rescues such effects in offspring. To address this question, female mice were continued on a normal-fat (NF group), or a HF diet (HF group) or transitioned from a HF diet to a NF diet at 1 (H1N group), 5 (H5N group) or 9 weeks (H9N group) prior to pregnancy. Among the three intervention groups, the H9N offspring displayed less and steady body weight gain, and maintained glucose tolerance, whereas the H1N and H5N offspring showed exacerbate these phenotypes. The H1N and H5N, but not the H9N offspring, displayed adipocyte hypertrophy associated with increased expression of genes involved in fat deposition. The H1N and H5N, but not the H9N adipose tissue, displayed increased macrophage infiltration with enhanced expression of inflammatory cytokine genes. In addition, overactivation of the NF-κB and the JNK signaling were observed in the H1N adipose tissue. Overall, our study showed that a long-term but not a short- or medium-term diet intervention before pregnancy released offspring adipose tissue inflammation induced by maternal HF diet, which adds details in our understanding how the maternal environment either promotes or discourages onset of disease in offspring. Clinically, this study is of great value for providing evidence in the design of clinical trials to evaluate the urgently required intervention strategies to minimize the intergenerational cycle of obesity.

Addressing cultural, racial and ethnic discrepancies in guideline discordant gestational weight gain: a systematic review and meta-analysis

OBJECTIVE

To systematically review the literature and describe the discrepancies in achieving the 2009 Institute of Medicine (IOM) gestational weight gain (GWG) guidelines across cultures.

METHODS

Ten databases were searched from inception to April 2018. Observational cohort studies were included that examined adult women; reported on a measure of culture; compared cultural groups, and reported on GWG. Articles were broken down into papers that used the current 2009 IOM GWG guidelines and those that used others. A meta-analysis was conducted for studies using the 2009 guidelines examining the prevalence of discordant GWG across cultural groups.

RESULTS

The review included 86 studies. Overall, 69% of women experienced discordant GWG irrespective of culture. White women experienced excessive GWG most often, and significantly more than Asian and Hispanic women; Black women had a higher prevalence of excessive GWG than Hispanic and Asian women; however, this difference was not significant.

CONCLUSIONS

The majority of women experience excessive GWG, with White women experiencing this most often. Culturally diverse GWG guidelines are needed to individualize antenatal care and promote optimal maternal-fetal health outcomes across cultural groups.

Excessive gestational weight gain in first trimester is a risk factor for exacerbation of asthma during pregnancy: A prospective study of 1283 pregnancies

BACKGROUND

Acute exacerbation during pregnancy is the most important risk factor for an unfavorable outcome of pregnancy in women with asthma.

OBJECTIVE

We sought to identify pregnancy-related risk factors for acute exacerbations of asthma during pregnancy.

METHODS

Since 2007, all pregnant women referred to give birth at Hvidovre Hospital, Denmark, have been offered participation in the prospective Management of Asthma during Pregnancy (MAP) program. Women were included in the present analysis if they fulfilled the following criteria: (1) diagnosed with asthma, (2) prescribed at least rescue bronchodilator, and (3) had the first visit to the respiratory outpatient clinic within the first 18 weeks of pregnancy. Data were analyzed using multiple logistic regression models with backward stepwise elimination (Proc Logistic procedure in SAS).

RESULTS

Over an 8-year study period, a total of 1283 pregnancies in 1208 women fulfilled the criteria for inclusion in the MAP cohort. Women with asthma exacerbation(s) had larger gestational weight gain (GWG) in the first trimester of pregnancy (P < .001) and increased total GWG (P < .001) compared with women without exacerbation. More than 5 kg first-trimester weight gain was associated with an increased risk of asthma exacerbation (odds ratio, 9.35; 95% CI, 6.39-13.68; P < .001), and the risk increased in a dose-dependent manner with additional weight gain in excess of 5 kg.

CONCLUSIONS

Excessive GWG in the first trimester is a risk factor for asthma exacerbation during pregnancy and the risk increases in a dose-dependent manner with increasing GWG.

Where Do Women Get Advice About Weight, Eating, and Physical Activity During Pregnancy?

BACKGROUND

Most women report not receiving information about gestational weight gain (GWG) from prenatal providers, but less is known about other sources of information and their potential impacts on GWG. The purpose of this study was to investigate sources of information about diet, physical activity, and weight control during pregnancy, and the impact of information sources on maternal GWG.

MATERIALS AND METHODS

Participants were 183 women with normal weight and 172 women with overweight/obesity who had enrolled in a prenatal lifestyle intervention trial. At 6 weeks postpartum, women were asked whether they had received information about "diet, physical activity, or weight control" from 12 sources uninvolved in the trial (e.g., physician, Internet, and friend) and, if received, the extent to which they followed the advice. Information sources were examined in relation to odds of exceeding Institute of Medicine (IOM) GWG guidelines based on measured weights.

RESULTS

Most women reported receiving information from a book (60.6%) or the Internet (58.3%). Advice from physicians, dietitians, or nurses was reported in 55.6%, 48.2%, and 33.9% of women, respectively. Reported receipt of information from physicians was associated with reduced Odds Ratio ([95% Confidence Interval] = 0.55 [0.35-0.88]; p = 0.01) of exceeding IOM GWG guidelines. Reported receipt of information from other sources was not related to GWG.

CONCLUSIONS

Books and the Internet were the most prevalent information sources reported for prenatal diet, physical activity, and weight control. However, of all sources, only physician provision of information was associated with reduced odds of excessive GWG.

Predictors of Gestational Weight Gain among White and Latina Women and Associations with Birth Weight

This study examined racial/ethnic differences in gestational weight gain (GWG) predictors and association of first-trimester GWG to overall GWG among 271 White women and 300 Latina women. Rates of within-guideline GWG were higher among Latinas than among Whites (28.7% versus 24.4%, p < 0.016). Adjusted odds of above-guideline GWG were higher among prepregnancy overweight (OR = 3.4, CI = 1.8-6.5) and obese (OR = 4.5, CI = 2.3-9.0) women than among healthy weight women and among women with above-guideline first-trimester GWG than among those with within-guideline first-trimester GWG (OR = 4.9, CI = 2.8-8.8). GWG was positively associated with neonate birth size (p < 0.001). Interventions targeting prepregnancy overweight or obese women and those with excessive first-trimester GWG are needed.

Thin mother, obese child? A review of early risk factors for obesity in offspring

PURPOSE OF REVIEW

The huge percentages of persons with obesity in many countries constitute a public health crisis. The severe consequences of obesity for physical health and emotional wellbeing already emerge in childhood. Therefore, the acknowledgment of early risk factors is essential to provide recommendations for prevention strategies. This review outlines the current state of research concerning early risk factors for obesity, that is, factors that even contribute to later obesity of the offspring during gestation. In this regard, this review specifically addresses the link between restricted eating behavior of the mother and obesity in her offspring. We systematically searched for articles in PsychINFO, PsychINDEX, MEDLINE, PubMed, MEDPILOT, and Web of Science, and we identified additional studies in bibliographies.

RECENT FINDINGS

Although some risk factors (e.g., short period of breastfeeding, gestational diabetes, and high maternal BMI) have a vast evidence base, others (e.g., restricted eating behavior and second-hand smoking) are insufficiently studied.

SUMMARY

Physical activity and diet programs in pregnancy can reduce not only the occurrence of gestational diabetes, but also the risk of inappropriate weight gain. As smoking during pregnancy and inappropriate eating behavior are associated with lower education, psychoeducation, for instance in sex education classes, could be easily conceivable.

Does pre-pregnancy BMI determine blood pressure during pregnancy? A prospective cohort study

OBJECTIVES

To evaluate if pre-pregnancy body mass index (BMI) determines blood pressure throughout pregnancy and to explore the role of gestational weight gain in this association. In addition, the effects of pre-pregnancy BMI and gestational weight gain on the occurrence of gestational hypertension and pre-eclampsia were investigated.

DESIGN

Prospective cohort study.

SETTING

Maternal and child health primary care referral centre, Jakarta, Indonesia.

POPULATION AND MEASUREMENTS

2252 pregnant women visiting Budi Kemuliaan Hospital and its branch for regular antenatal care visits from July 2012 to April 2015. Pre-pregnancy BMI (kg/m(2)) was based on self-reported pre-pregnancy weight and measured height at first visit. Gestational weight gain was calculated as weight at the day of delivery minus the pre-pregnancy weight. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured during pregnancy at every visit. Linear mixed models were used to analyse this relation with repeated blood pressure measures as the outcome and pre-pregnancy BMI as the predictor. When looking at gestational hypertension and pre-eclampsia as outcomes, (multiple) logistic regression was used in the analysis.

RESULTS

Independent of pre-pregnancy BMI, SBP and DBP increased by 0.99 mm Hg/month and 0.46 mm Hg/month, respectively. Higher pre-pregnancy BMI was associated with higher pregnancy SBP (0.25 mm Hg/kg/m(2); 95% CI 0.17 to 0.34; p<0.01) and DBP (0.18 mm Hg/kg/m(2); 0.13 to 0.24; p<0.01) in adjusted analysis. Every 1 kg/m(2) higher pre-pregnancy BMI was associated with 6% and 9% higher odds for gestational hypertension (adjusted OR (aOR) 1.06; 95% CI 1.03 to 1.09; p<0.01) and pre-eclampsia (aOR 1.09; 1.04 to 1.14; p<0.01). Accounting for gestational weight gain did not attenuate these associations.

CONCLUSIONS

Pre-pregnancy BMI determines the level, but not the change, of blood pressure in pregnancy and is linked to higher odds for gestational hypertension and pre-eclampsia, independent of gestational weight gain.

Diet, Pre-pregnancy BMI, and Gestational Weight Gain in Puerto Rican Women

OBJECTIVES

To describe the dietary patterns in pregnant woman and determine the association between diet factors, pre-pregnancy Body Mass Index (BMI) and socio-demographic characteristics with gestational weight gain (GWG).

METHODS

This is a secondary analysis of a longitudinal cohort study of pregnant women exploring the risk factors for preterm birth, the Puerto Rico Testsite for Exploring Contamination Threats program. Recruitment was conducted during 2011-2014. Data was collected from multiple sources. GWG was calculated using maternal weight recorded in the medical records at the first and last prenatal visits and classified according to the Institute of Medicine guidelines. Sociodemographic characteristics were obtained at baseline using an interviewed-based questionnaire. Participants completed a self-administered food frequency questionnaire at 20-28 weeks to assess dietary patterns. Analysis of associations between variables was conducted using Chi Square tests.

RESULTS

A total of 160 women with term pregnancies were included in this analysis. Mean pre-pregnancy BMI was 25.4 ± 5.48 kg/m(2), with 44.4 % classified as overweight/obese. Excessive GWG was observed in 24.4 % of the participants. Socio-demographic characteristics were not associated with GWG. Being overweight/obese at the start of pregnancy was significantly associated with excessive GWG (p < 0.05). In addition, women consuming one or more fruit drinks per day were more likely to have an excessive GWG while those consuming less than one fruit drink per day were more likely to have an adequate GWG (p < 0.05).

CONCLUSIONS FOR PRACTICE

Being obese before pregnancy and frequently consuming fruit drinks were important determinants of excessive GWG in this group.

Body Mass Index, Weight Gain, and Hypertensive Disorders in Pregnancy

BACKGROUND

This study examines the interrelationship between gestational weight gain, pre-pregnancy body mass index (BMI), race/ethnicity, and their association with hypertensive disorders during pregnancy (HDP).

METHODS

Data from the 2004-2011 national Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed. Women with singleton live births were included in the analysis (N = 270,131). Gestational weight gain was categorized reflecting the Institute of Medicine (IOM) weight gain recommendation (no gain/weight loss; ≤11, 12-14; 15-25; 26-35; ≥36 pounds). Pre-pregnancy BMI (underweight; normal; overweight; obese) and race/ethnicity (non-Hispanic (NH) White, NH-Black, Hispanic, and NH-other) were examined. Hypertensive disorders during pregnancy were dichotomized (HDP; no HDP). Data were stratified by BMI and race/ethnicity, and multiple logistic regression analysis was conducted to generate odds ratios and 95% confidence intervals (CIs).

RESULTS

Compared to normal and overweight women who gained the IOM recommended weight, higher odds of HDP was observed in those who gained ≥36 pounds regardless of their race/ethnicity. Among obese NH-White (odds ratio (OR) = 1.29, 95% CI = 1.11, 1.50) and Hispanic women (OR = 1.64, 95% CI = 1.05, 2.54), the odds of HDP was higher among those who gained 25-35 pounds and those who gained ≥36 pounds (OR = 1.59, 95% CI = 1.37, 1.85) and (OR = 2.20, 95% CI = 1.41, 3.44), respectively. However, for NH-Black obese women, higher odds of HDP was observed among those who gained ≥36 pounds (OR = 1.34, 95% CI = 1.04, 1.73).

CONCLUSIONS

Although there are some ethnic/racial variations, pregnant women who exceeded gestational weight gain recommendations are at increased risk of HDP. Health care providers should consider the interrelationship between pre-pregnancy gestational weight gain (GWG) and BMI when counseling patients regarding HDP.

Pre-pregnancy body mass index, height and physical activity are associated with rate of gestational weight gain among Malaysian mothers

AIM

Both inadequate and excessive weight gain during pregnancy can have immediate and long-term health risks for women and infants. This study investigated rate of gestational weight gain (GWG) and its associated factors in Malaysian pregnant women.

METHODS

This cross-sectional study was conducted at maternal and child health clinics in Selangor and Negeri Sembilan between November 2010 and April 2012. A pre-tested questionnaire was used to obtain sociodemographic, obstetric, dietary intake and physical activity information. Current weight and height were measured using standard procedures. GWG rate was calculated as the average weekly weight gain in that particular trimester of pregnancy and further categorized according to the Institute of Medicine (IOM) recommendations.

RESULTS

Mean GWG rate for all pre-pregnancy BMI categories in the second and third trimesters was higher than the IOM recommendations. Overweight women (adjusted OR, 4.26; 95%CI: 1.92-9.44) and women <153 cm tall (adjusted OR, 1.96; 95%CI: 1.21-3.18) tend to have inadequate GWG rate. Women with high pre-pregnancy body mass index (BMI; ≥25.0 kg/m(2) ; overweight: adjusted OR, 3.88; 95%CI: 2.12-7.09; obese: adjusted OR, 2.34; 95%CI: 1.28-4.29) and low physical activity (adjusted OR, 1.74; 95%CI: 0.77-3.97) were two-threefold more likely to have excessive GWG.

CONCLUSION

Both inadequate and excessive GWG can have detrimental effects on the health of mothers and infants. Pre-pregnancy BMI, height and physical activity should be emphasized in prenatal care to ensure that women have adequate GWG rate.

Higher maternal leptin levels at second trimester are associated with subsequent greater gestational weight gain in late pregnancy

BACKGROUND

Excessive gestational weight gain (GWG) is associated with adverse pregnancy outcomes. In non-pregnant populations, low leptin levels stimulate positive energy balance. In pregnancy, both the placenta and adipose tissue contribute to circulating leptin levels. We tested whether maternal leptin levels are associated with subsequent GWG and whether this association varies depending on stage of pregnancy and on maternal body mass index (BMI).

METHODS

This prospective cohort study included 675 pregnant women followed from 1(st) trimester until delivery. We collected anthropometric measurements, blood samples at 1(st) and 2(nd) trimester, and clinical data until delivery. Maternal leptin was measured by ELISA (Luminex technology). We classified women by BMI measured at 1(st) trimester: BMI < 25 kg/m(2) = normal weight; 25 ≤ BMI < 30 kg/m(2) = overweight; and BMI ≥ 30 kg/m(2) = obese.

RESULTS

Women gained a mean of 6.7 ± 3.0 kg between 1(st) and 2(nd) trimester (mid pregnancy GWG) and 5.6 ± 2.5 kg between 2(nd) and the end of 3(rd) trimester (late pregnancy GWG). Higher 1(st) trimester leptin levels were associated with lower mid pregnancy GWG, but the association was no longer significant after adjusting for % body fat (%BF; β = 0.38 kg per log-leptin; SE = 0.52; P = 0.46). Higher 2(nd) trimester leptin levels were associated with greater late pregnancy GWG and this association remained significant after adjustment for BMI (β = 2.35; SE = 0.41; P < 0.0001) or %BF (β = 2.01; SE = 0.42; P < 0.0001). In BMI stratified analyses, higher 2(nd) trimester leptin levels were associated with greater late pregnancy GWG in normal weight women (β = 1.33; SE = 0.42; P =0.002), and this association was stronger in overweight women (β = 2.85; SE = 0.94; P = 0.003--P for interaction = 0.05).

CONCLUSIONS

Our results suggest that leptin may regulate weight gain differentially at 1(st) versus 2(nd) trimester of pregnancy: at 2(nd) trimester, higher leptin levels were associated with greater subsequent weight gain--the opposite of its physiologic regulation in non-pregnancy--and this association was stronger in overweight women. We suspect the existence of a feed-forward signal from leptin in second half of pregnancy, stimulating a positive energy balance and leading to greater weight gain.

Discrimination and excessive weight gain during pregnancy among Black and Latina young women

RATIONALE

Excessive weight gain during pregnancy is a major determinant of later life obesity among both Black and Latina women and their offspring. However, psychosocial determinants of this risk, including everyday discrimination, and potential moderators of such effects remain unexplored.

OBJECTIVE

We examined the influence of discrimination, a culturally relevant stressor, on odds of gaining weight beyond Institute of Medicine recommendations during pregnancy. Whether the effect was moderated by race/ethnicity, age, or depressive symptoms was also examined.

METHOD

Participants were 413 Black and Latina pregnant young women, ages 14-21 years. Experience with discrimination and all moderators were assessed in the second trimester. Last weight recorded in the third trimester was abstracted from medical records and used to determine excessive weight gain.

RESULTS

Ever experiencing discrimination was associated with a 71% increase in the odds of excessive weight gain. The effect of discrimination was primarily present among women who attributed this treatment to membership in a historically oppressed group (e.g., ethnic minority, female) or to membership in other stigmatized groups (e.g., overweight). The effect of ever experiencing discrimination was not moderated by race/ethnicity or age but was moderated by depressive symptoms. Supporting the perspective of the environmental affordances model, discrimination strongly predicted excessive weight gain when women were low in depressive symptoms but had no effect when women were high in depressive symptoms. The moderating role of depressive symptoms was equivalent for Black and Latina women.

CONCLUSION

Results highlight the role of discrimination in perpetuating weight-related health disparities and suggest opportunities for improving health outcomes among young pregnant women.

Stress, sleep, depression and dietary intakes among low-income overweight and obese pregnant women

This study investigated the mediating roles of sleep and depression on the relationships between stress, fat intake, and fruit and vegetable intake among low-income overweight and obese pregnant women by trimesters. Participants (N = 213) completed a self-administered survey including stress (exogenous variable), depression, sleep (mediators), fat intake, and fruit and vegetable intake (endogenous variables). Path analysis was performed to compare mediation effects among pregnant women in each trimester. Consistently across three trimesters, stress was related to depression but not sleep duration, night time sleep disturbance, sleep quality, sleep latency or fat intake. Sleep duration was not associated with depression. Depending on trimester, night time sleep disturbance, sleep quality, and sleep latency were related to depression; night time sleep disturbance and depression affected fat intake; stress influenced fruit and vegetable intake. Sleep duration, sleep disturbance, sleep quality, sleep latency and depression did not mediate the relationships between stress, fat intake, and fruit and vegetable intake in the second and third trimesters. However, depression mediated the relationship between stress and fat intake in the first trimester. Stress management interventions may help low-income overweight and obese pregnant women decrease depressive symptoms and therefore contribute to overall nutritional health.

A Review of the Relationship Between Socioeconomic Position and the Early-Life Predictors of Obesity

A range of important early-life predictors of later obesity have been identified. Children of lower socioeconomic position (SEP) have a steeper weight gain trajectory from birth with a strong socioeconomic gradient in child and adult obesity prevalence. An assessment of the association between SEP and the early-life predictors of obesity has been lacking. The review involved a two-stage process: Part 1, using previously published systematic reviews, we developed a list of the potentially modifiable determinants of obesity observable in the pre-natal, peri-natal or post-natal (pre-school) periods; and part 2, conducting a literature review of evidence for socioeconomic patterning in the determinants identified in part 1. Strong evidence was found for an inverse relationship between SEP and (1) pre-natal risk factors (pre-pregnancy maternal body mass index (BMI), diabetes and pre-pregnancy diet), (2) antenatal/peri natal risk factors (smoking during pregnancy and low birth weight) and (3) early-life nutrition (including breastfeeding initiation and duration, early introduction of solids, maternal and infant diet quality, and some aspects of the home food environment), and television viewing in young children. Less strong evidence (because of a lack of studies for some factors) was found for paternal BMI, maternal weight gain during pregnancy, child sleep duration, high birth weight and lack of physical activity in young children. A strong socioeconomic gradient exists for the majority of the early-life predictors of obesity suggesting that the die is cast very early in life (even pre-conception). Lifestyle interventions targeting disadvantaged women at or before child-bearing age may therefore be particularly important in reducing inequality. Given the likely challenges of reaching this target population, it may be that during pregnancy and their child's early years are more feasible windows for engagement.

Counseling About Weight Gain Guidelines and Subsequent Gestational Weight Gain

BACKGROUND

The purpose of this study was to investigate what percentage of postpartum women were informed about how much weight to gain during pregnancy, the accuracy of the weight gain recommendations based on the 2009 Institute of Medicine (IOM) gestational weight gain (GWG) recommendations and whether being informed was associated with greater likelihood of meeting the recommendations.

METHODS

This was a cross-sectional study of postpartum women interviewed in maternity recovery rooms at two large urban hospitals. Body mass index was obtained from medical records, and adherence to gestational weight gain guidelines was determined based on the 2009 IOM recommendations.

RESULTS

One hundred thirty four women with a mean pregravid body mass index of 28.0 kg/m(2) were studied. Sixty-seven percent of participants reported receiving weight gain recommendations. A greater percentage of healthy weight women (78.6%) reported being informed of a GWG recommendation than overweight (53.8%) or obese women (64.9%), (chi-squared=6.6, p=0.04). Of the women given information about gestational weight gain, 40 (54.8%) received GWG recommendations consistent with the IOM and 33 (45.2%) received discrepant information. The accuracy of the GWG recommendation varied based on weight status. Women of healthy weight were much more likely to be given information in accordance with the IOM recommendations (86.8%) than women who were overweight (12.5%) or obese (26.3%) (chi-squared=33.5, p<0.001). Meeting the IOM recommendations did not differ depending on whether women were told how much weight to gain during pregnancy.

CONCLUSIONS

Women who are overweight or obese are less likely to be informed about weight gain recommendations than healthy weight women, and nearly half of women receive information inconsistent with the IOM recommendations. There may be a need for further practitioner education on GWG recommendations and increased patient counseling to help promote healthy weight gain during pregnancy.

Psychosocial risk factors for excessive gestational weight gain: A systematic review

BACKGROUND

Excessive weight gain during pregnancy can have adverse health outcomes for mother and infant throughout pregnancy. However, few studies have identified the psychosocial factors that contribute to women gaining excessive weight during pregnancy.

AIM

To review the existing literature that explores the impact of psychosocial risk factors (psychological distress, body image dissatisfaction, social support, self-efficacy and self-esteem) on excessive gestational weight gain.

METHODS

A systematic review of peer-reviewed English articles using Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature, MEDLINE Complete, PsycINFO, Informit, Web of Science, and Scopus was conducted. Quantitative studies that investigated psychosocial factors of excessive GWG, published between 2000 and 2014 were included. Studies investigating mothers with a low risk of mental health issues and normally-developing foetuses were eligible for inclusion. From the total of 474 articles located, 12 articles were identified as relevant and were subsequently reviewed in full.

FINDINGS

Significant associations were found between depression, body image dissatisfaction, and social support with excessive gestational weight gain. No significant relationships were reported between anxiety, stress, self-efficacy, or self-esteem and excessive gestational weight gain.

CONCLUSION

The relationship between psychosocial factors and weight gain in pregnancy is complex; however depression, body dissatisfaction and social support appear to have a direct relationship with excessive gestational weight gain. Further research is needed to identify how screening for, and responding to, psychosocial risk factors for excessive gestational weight gain can be successfully incorporated into current antenatal care.

Psychological antecedents of excess gestational weight gain: a systematic review

BACKGROUND

Excess gestational weight gain (GWG), which has reached epidemic proportions, is associated with adverse outcomes during pregnancy and postpartum obesity in women and children. Psychological variables represent potentially modifiable factors. Moreover, previous systematic reviews on GWG interventions have called for the need for a clearer understanding of psychological factors affecting GWG. Hence, a systematic review was conducted to summarize the relation between psychological factors and GWG.

METHODS

Eight databases were searched, and the guidelines on Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Methodological quality of the included studies was assessed using a modified Newcastle-Ottawa scale. Two assessors independently reviewed titles, abstracts and full articles, extracted data and assessed quality.

RESULTS

A total of 6198 titles and abstracts were reviewed of which 90 full text articles were retrieved. Thirty-five studies (25 cohort, eight cross-sectional and two case-control) met the inclusion criteria, assessing 26 different psychological constructs in affect, cognitions and personality. Negative affective states such as depression, anxiety and stress were not related to excess GWG. Among weight-related and dietary-related cognitions, risk factors for excess GWG included concern about weight gain, negative body image and attitude towards weight gain, inaccurate perceptions regarding weight, higher than recommended target weight gain, less knowledge about weight gain, higher levels of cognitive dietary restraint, and perceived barriers to healthy eating. Protective factors included an internal locus of control for weight gain, lower than recommended target weight gain and higher self-efficacy for healthy eating. Only one study examined the relation between personality and excess GWG.

CONCLUSION

In this systematic review, a number of cognitive factors were identified that were associated with excess GWG. To address excess GWG, more high quality, adequately powered studies are required examining cognitions, motivation and personality factors.

Prevalence and characteristics associated with gestational weight gain adequacy

OBJECTIVE

To estimate the prevalence of gestational weight gain adequacy according to the 2009 Institute of Medicine recommendations and examine demographic, behavioral, psychosocial, and medical characteristics associated with inadequate and excessive gain stratified by prepregnancy body mass index (BMI) category.

METHODS

We used cross-sectional, population-based data on women delivering full-term (37 weeks of gestation or greater), singleton neonates in 28 states who participated in the 2010 or 2011 Pregnancy Risk Assessment Monitoring System. We estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for inadequate and excessive compared with adequate gain, stratified by prepregnancy BMI.

RESULTS

Overall, 20.9%, 32.0%, and 47.2% of women gained inadequate, adequate, and excessive gestational weight, respectively. Prepregnancy BMI was strongly associated with weight gain outside recommendations. Compared with normal-weight women (prevalence 51.8%), underweight women (4.2%) had decreased odds of excessive gain (adjusted OR 0.50, CI 0.40-0.61), whereas overweight and obese class I, II, and III (23.6%, 11.7%, 5.4%, and 3.5%, respectively) women had increased odds of excessive gain (adjusted OR range 2.07, CI 1.63-2.62 to adjusted OR 2.99, CI 2.63-3.40). Underweight and obese class II and III women had increased odds of inadequate gain (adjusted OR 1.25, CI 1.01-1.55 to 1.86, CI 1.45-2.36). Most characteristics associated with weight gain adequacy were demographic such as racial or ethnic minority status and education and varied by prepregnancy BMI. Notably, one behavioral characteristic-smoking cessation-was associated with excessive gain among normal-weight and obese women.

CONCLUSION

Most women gained weight outside recommendations. Understanding characteristics associated with inadequate or excessive weight gain may identify potentially at-risk women and inform much-needed interventions.

How much weight are women gaining during pregnancy? An Italian cohort study

INTRODUCTION

The 2009 Institute of Medicine (IOM) guidelines define adequate gestational weight gain (GWG) in the attempt to prevent maternal and neonatal adverse outcomes. The aim of this study was to assess whether the IOM guidelines are met in pregnant women with different pre-gestational body mass index (BMI).

METHODS

The study included 230 pregnant women recruited at the University Hospital of Pisa (Italy) at their screening visit (24-28 weeks of gestation) for gestational diabetes (GDM). GWG was determined at screening time and before delivery to be compared with GWG recommended by IOM for each pre-pregnancy BMI category.

RESULTS

A total of 48% of women had a GWG exceeding IOM recommendations. The prevalence of GWG excess was higher in over-weight (OW, 63.2%) and obese (OB, 63.8%) women as compared to normal-weight (NW, 27.7%; p < 0.0001) women. The upper limit of the recommended IOM weight gain range was already exceeded at screening time in 15.5% of women. The percentage increased 27% and 18% in OW and OB, respectively, compared with 1.5% in NW (p < 0.001).

CONCLUSION

About half of pregnant women had a GWG greater than the IOM recommended. GWG excess is particularly evident in OW and OB women.

Maternal weight gain in pregnancy and risk of obesity among offspring: a systematic review

OBJECTIVES

To systematically review the evidence from prospective and retrospective cohort studies on the association between gestational weight gain (GWG) and offspring's body weight.

METHODS

Electronic databases PubMed, Web of Science, CINAHL, and Academic Search Premiere were searched from inception through March 18, 2013. Included studies (n = 23) were English articles that examined the independent associations of GWG with body mass index (BMI) and/or overweight status in the offspring aged 2 to 18.9 years. Two authors independently extracted the data and assessed methodological quality of the included studies.

RESULTS

Evidence from cohort studies supports that total GWG and exceeding the Institute of Medicine maternal weight gain recommendation were associated with higher BMI z-score and elevated risk of overweight or obesity in offspring. The evidence of high rate of GWG during early- and mid-pregnancy is suggestive. Additionally, the evidence on inadequate GWG and net GWG in relation to body weight outcomes in offspring is insufficient to draw conclusions.

CONCLUSIONS

These findings suggest that GWG is a potential risk factor for childhood obesity. However, findings should be interpreted with caution due to measurement issues of GWG and potential confounding effects of shared familial characteristics (i.e., genetics and maternal and child's lifestyle factors).

Prediction of gestational weight gain - a biopsychosocial model

OBJECTIVE

To examine the influence of health behaviours and psychological well-being on gestational weight gain using a biopsychosocial model.

DESIGN

A prospective cohort study of pregnant women consecutively recruited at their first antenatal care visit. A self-administered questionnaire was used to collect data on health behaviours and psychological well-being in early pregnancy. Linear regression and logistic regression were used to identify predictors of total weight gain in kilograms and weight gain outside the current Institute of Medicine recommendations, respectively.

SETTING

A maternity hospital in the Republic of Ireland.

SUBJECTS

Data on 799 women were analysed.

RESULTS

Pre-pregnant BMI ≥30·0 kg/m2, short stature, parity >0, decreased food intake and absence of health insurance predicted lower absolute gestational weight gain, while foreign nationality, consumption of takeaway meals more than once weekly and increased food intake predicted higher absolute gestational weight gain. Overweight and obesity, foreign nationality, increased food intake and height >170 cm were risk factors for excessive weight gain, while antenatal depression was protective against excessive weight gain. Notably, physical activity measures were not related to the gestational weight gain outcomes. Pre-pregnancy overweight and increased food intake were the strongest predictors of excessive gestational weight gain.

CONCLUSIONS

None of the psychological well-being measures examined, with the exception of antenatal depression, was associated with any of the weight gain outcomes. The behavioural predictors of gestational weight gain were increased food intake and takeaway consumption. Public health promotions should target pre-pregnancy BMI and pregnancy-associated change in food intake.

Birth outcomes of Hispanic women and risks or strengths associated with ethnicity and Texas border residence

OBJECTIVE

To assess Hispanic ethnicity, border residence, or their interaction for association with risk of high gestational weight gain (GWG) and related outcomes.

DESIGN

Retrospective analysis of 2009 birth data.

SETTING

Texas.

PARTICIPANTS

Participants included 146,458 Hispanic and 104,399 non-Hispanic (NH) White women.

METHODS

We used adjusted odds ratios (AOR) in logistic regression analyses to test the association of Hispanic ethnicity, border residence, and their interaction with high GWG, cesarean birth, macrosomia, and breastfeeding status at discharge.

RESULTS

After adjusting for covariates, risk of inadequate or excessive GWG was not associated with being a border resident, but Hispanic women compared to NH White women had an increased risk of inadequate GWG (AOR = 1.21, 99% confidence interval [CI] [1.17, 1.26]) and decreased risk of excessive GWG (AOR = 0.77, 99% CI [0.74, 0.79]). Risk of cesarean birth was increased for border residents (AOR = 1.22, 99% CI [1.05, 1.42]), and this risk was increased further among border residents who were Hispanic (AOR = 1.52, 99% CI [1.30, 1.77]).

CONCLUSION

We found strengths and vulnerabilities among Hispanic and border-residing women. Hispanic women were at lower risk of excessive GWG than NH White women. Border-residing Hispanic women were at greater risk of cesarean birth than other women.

What psychological, physical, lifestyle, and knowledge factors are associated with excess or inadequate weight gain during pregnancy? A cross-sectional survey

OBJECTIVE

Excess weight gain during pregnancy is associated with increased risks of overweight and obesity in both women and their children. Conversely, inadequate weight gain can predispose to growth restriction, which is also associated with childhood obesity. Because most pregnant women now gain more weight than is recommended in guidelines and a substantial portion gain less than the recommended amounts, we sought to determine factors associated with inappropriate weight gain, including physical, lifestyle, knowledge, and particularly psychological factors.

METHODS

We conducted a self-administered cross-sectional survey of English-speaking women with a live, singleton gestation. Biologically relevant variables significant at P < 0.10 were included in multiple logistic regression.

RESULTS

Three hundred thirty women completed the survey, a response rate of 90.7%. Gaining weight above the amount recommended in guidelines was associated with planning to do so (adjusted OR [aOR] 11.18; 95% CI 4.45 to 28.06), bedtime television (aOR 2.38; 95% CI 1.08 to 5.23), and higher emotional instability scores (aOR 1.26; 95% CI 1.10 to 1.44). Inadequate weight gain was associated with less satisfaction with body weight (aOR 4.84; 95% CI 1.56 to 15.02) and bedtime television (aOR 3.92; 95% CI 1.50 to 10.30), while self-efficacy towards healthy weight was protective (aOR 0.91; 95% CI 0.83 to 0.99).

CONCLUSION

Planned weight gain was most strongly associated with excess gestational weight gain, followed by bedtime television watching and emotional instability, while inadequate gain was associated with less satisfaction with body weight and bedtime television watching. Better characterization of psychological and other factors that predict inappropriate gain will be critical for providing a basis for interventions.

Trends and predictors of excessive gestational weight gain among hispanic WIC participants in Southern California

The objectives of this study were to describe gestational weight gain (GWG) trends and identify predictors of GWG among WIC participants in Southern California, 84 % of whom are Hispanic. Using descriptive statistics and multiple logistic regression, we examined WIC data on 23,840 Hispanic women with full term pregnancies who enrolled in WIC at first trimester and had their last prenatal WIC visit within 1 month or less of their delivery date. Overall, 23.9 % of women exceeded IOM recommendations. Among Hispanic English speakers (HES), 30 % exceeded IOM recommendations compared to 18.7 % of Hispanic Spanish speakers (HSS). Among Hispanic mothers who are less than 20 years of age, 28.9 % exceeded IOM guidelines compared to 19.8 % of Hispanic mothers 35 or older. Among those who started pregnancy overweight or obese, 30.5 % exceeded IOM recommendations versus 12.1 % of those with normal BMI. Multiple logistic regression showed that the odds of exceeding the IOM recommendations were 42 % lower for HSS versus HES, decreased by 2 % for every 1 year increase in age, and increased by 5 % for every one unit increase in BMI at first trimester. Poverty level and health care coverage were also significant predictors of GWG. Given the wide reach and high quality of height/weight measurements taken by the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Program, WIC administrative data have significant potential to help fill the existing gaps in GWG surveillance, a much needed step for forming policy and designing effective interventions.

The association between early menarche and offspring's obesity risk in early childhood was modified by gestational weight gain

OBJECTIVES

Study effect of maternal gestational weight gain (GWG) on the relationship between maternal menarcheal age (MMA) and child growth and overweight risk and examine socio-demographics characteristics of excessive GWG.

DESIGN AND METHODS

The relationships between GWG and MMA in 54,184 women and their children's growth trajectories during first 5 years of life (2000-2005) in south China were tested using longitudinal data analysis with mixed models and logistic regression.

RESULTS

Average MMA was 14.8 (1.3) years; 36.3% of the women had excessive GWG. Excessive GWG interacted with adverse effects of early MMA (if ≤ 13 years), leading to the most rapid growth in offspring and highest risk of overweight at age 4-5 (OR = 5.2 [2.0-13.5]) than others. Women with early menarche, high-education, urban residence, and a routine job were more likely to have excessive GWG than the others.

CONCLUSIONS

GWG modify the association between early MMA and offspring's growth and overweight. Controlling for GWG may reduce the adverse influence of early MMA and its own adverse influence on childhood health.

Risk factors for excessive gestational weight gain in a healthy, nulliparous cohort

OBJECTIVE

Excessive gestational weight gain (GWG) is associated with adverse maternal and child outcomes and contributes to obesity in women. Our aim was to identify early pregnancy factors associated with excessive GWG, in a contemporary nulliparous cohort.

METHODS

Participants in the SCOPE study were classified into GWG categories ("not excessive" versus "excessive") based on pregravid body mass index (BMI) using 2009 Institute of Medicine (IOM) guidelines. Maternal characteristics and pregnancy risk factors at 14-16 weeks were compared between categories and multivariable analysis controlled for confounding factors.

RESULTS

Of 1950 women, 17% gained weight within the recommended range, 74% had excessive and 9% inadequate GWG. Women with excessive GWG were more likely to be overweight (adjOR 2.9 (95% CI 2.2-3.8)) or obese (adjOR 2.5 (95% CI 1.8-3.5)) before pregnancy compared to women with a normal BMI. Other factors independently associated with excessive GWG included recruitment in Ireland, younger maternal age, increasing maternal birthweight, cessation of smoking by 14-16 weeks, increased nightly sleep duration, high seafood diet, recent immigrant, limiting behaviour, and decreasing exercise by 14-16 weeks. Fertility treatment was protective.

CONCLUSIONS

Identification of potentially modifiable risk factors for excessive GWG provides opportunities for intervention studies to improve pregnancy outcome and prevent maternal obesity.

Short-lived success: assessment of an intervention to improve pregnancy weight gain in Colorado

Inadequate weight gain in pregnancy is a major contributor to low birth weight in Colorado, where the low birth weight rate is among the highest in the nation. In 2004, the Colorado Department of Public Health and Environment implemented a population-based intervention in 9 counties, including provider training and a public media campaign, to encourage pregnant women to gain an adequate amount of weight in pregnancy as defined by the 1990 Institute of Medicine guidelines. Pregnancy Risk Assessment Monitoring System survey data were used to track weight gain in pregnancy in 1997 through 2004 (baseline), 2005 (post-intervention), and 2006 and 2007 (after the intervention had concluded). During the period immediately after the implementation of the intervention, the percentage of women delivering in the 9 study counties who gained an inadequate amount of weight during pregnancy dropped from 18.4 at baseline to 12.8 in 2005. However, this progress was reversed in 2006, when the percentage of women with inadequate weight gain rose to 19.7. Training providers to educate women about the importance of adequate weight gain in pregnancy, in conjunction with a social marketing campaign, appears to be a promising approach to addressing a major contributor to low birth weight. However, a time-limited intervention is likely to have temporary results.

Social inequality in excessive gestational weight gain

OBJECTIVE

Optimal gestational weight gain (GWG) leads to better outcomes for both the mother and child, whereas excessive gains can act as a key stage for obesity development. Little is known about social inequalities in GWG. This study investigates the influence of education level on pre-pregnancy body mass index (BMI) and GWG.

DESIGN

Register-based population study.

SETTING

Sweden

PARTICIPANTS

Four thousand and eighty women born in Sweden who were a part of the third generation Uppsala Birth Cohort Study. Register data linkages were used to obtain information on social characteristics, BMI and GWG of women with singleton first births from 1982 to 2008.

MAIN OUTCOME MEASURE

Pre-pregnancy BMI and the Institute of Medicine's (IOM) categories of GWG for a given pre-pregnancy BMI. RESULTS were adjusted for calendar period, maternal age, living arrangements, smoking, history of chronic disease and pre-pregnancy BMI when appropriate.

RESULTS

Although most women (67%) were of healthy pre-pregnancy BMI, 20% were overweight and 8% were obese. Approximately half of all women in the sample had excessive GWG, with higher pre-pregnancy BMI associated with higher risk of excessive GWG, regardless of education level; this occurred for 76% of overweight and 75% of obese women. Lower educated women with a healthy pre-pregnancy BMI were at greater risk of excessive GWG-odds ratio 1.76 (95% confidence interval 1.28-2.43) for elementary and odds ratio 1.32 (1.06-1.64) for secondary compared with tertiary educated, adjusted for age and birth year period. Nearly half of women with an elementary or secondary education (48%) gained weight excessively.

CONCLUSION

Education did not provide a protective effect in avoiding excessive GWG among overweight and obese women, of whom ∼75% gained weight excessively. Lower educated women with a BMI within the healthy range, however, are at greater risk of excessive GWG. Health professionals need to tailor their pre-natal advice to different groups of women in order to achieve optimal pregnancy outcomes and avoid pregnancy acting as a stage in the development of obesity.

Overweight, obesity and related non-communicable diseases in Asian Indian girls and women

The prevalence of obesity is rising globally and in India. Overweight, obesity and related diseases need to be delineated in Asian Indian women. A literature search was done using key words like 'obesity', 'Asian Indian women', 'body fat distribution', 'type 2 diabetes', 'fertility', 'polycystic ovarian disease', metabolic syndrome', 'cardiovascular disease', 'non-alcoholic fatty liver disease', 'gender', 'sex' and 'prevalence' up to September 2012 in Pubmed and Google Scholar search engines. This review highlights the Asian Indian body composition with regards to obesity and provides a collated perspective of gender-specific prevalence of the co-morbidities. Recent data show that women (range of prevalence of overweight and obesity from different studies 15-61%) have higher prevalence of overweight and obesity as compared with men (range of prevalence of overweight and obesity from different studies 12-54%) in India and that obesity is increasing in the youth. The prevalence of overweight and obesity in both men and women steeply rose in a Punjabi community from Jaipur. Importantly, prevalence of abdominal obesity has been consistently higher in women than in men. The lowest prevalence (6.0%) of type 2 diabetes mellitus in women is reported from South India (rural Andhra Pradesh; 2006) and the highest (14.0%) by the National Urban Diabetes Survey (2001). Although the clustering of cardiovascular disease risk factors was generally high, it increased further in post-menopausal women. There are a number of factors that predispose Indian women to obesity; sedentary behaviour, imbalanced diets, sequential and additive postpartum weight gain and further decrease in physical activity during this period and cultural issues. In view of these data, preventive measures should be specifically targeted to Indian women.

The web of risk factors for excessive gestational weight gain in low income women

The objective of this study is to gain an in-depth understanding of issues related to gestational weight gain (GWG) including general health, diet, and physical activity among high and low income women and to elucidate socio-ecological and psychosocial risk factors that increase risk for excessive GWG. We conducted 9 focus groups with high (n = 4 groups) and low (n = 5 groups) income pregnant women aged 18-35 years to discuss health, GWG, diet and physical activity following a discussion guide. The constant comparative method was used to code focus group notes and to identify emergent themes. Themes were categorized within the integrative model of behavioral prediction. Low income women, in contrast to high income women, had higher BMIs, had more children, and were African American. Diet and physical activity behaviors reported by low income women were more likely to promote positive energy balance than were those of high income women. The underlying behavioral, efficacy, and normative beliefs described by both groups of women explained most of these behaviors. Experiencing multiple risk factors may lead to (1) engaging in several behavior changes during pregnancy unrelated to weight and (2) holding more weight gain-promoting beliefs than weight maintaining beliefs. These factors could inhibit diet and physical activity behaviors and/or behavior changes that promote energy balance and in combination, result in excessive GWG. Low income women experience multiple risk factors for excessive GWG and successful interventions to prevent excessive GWG and pregnancy related weight gain will need to recognize the complex web of influences.

Socio-demographic and obstetrical correlates of pre-pregnancy body mass index and gestational weight gain

Both pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) are important determinants of a healthy pregnancy outcome and may show important variation. To study the influence of socio-demographic and obstetrical correlates on pre-pregnancy BMI and GWG, data of 54 022 singleton term pregnancies were analysed using adjusted regression models. In 2009, in the Northern region of Belgium, one-third of women were overweight (21.6%) or obese (10.1%) and GWG as recommended by the Institute of Medicine occurred in only 28% of obese women. A high pre-pregnancy BMI was significantly associated with low maternal education, high maternal age and multiparity, belonging to ethnic minority groups and a lower professional state. Compared to adequate GWG, excessive GWG was more common in younger (<20 years) women, with higher pre-pregnancy BMI and pregnancy-induced hypertension. Moreover, younger (20-24 years), single women, belonging to ethnic minority groups showed higher odds for excessive as well as insufficient GWG, while those with high/highest educational level had lower odds for excessive (odds ratio [OR] 0.76; confidence interval [CI] 0.72-0.80) and insufficient (OR 0.93; CI 0.89-0.98) GWG. The results of this study highlight the scale of the problem of maternal obesity and excessive GWG for this region and offer opportunities to target educational campaigns and intervention programmes in the clinical setting.

Determinants of excessive gestational weight gain in urban, low-income women

BACKGROUND

Factors influencing excessive weight gain in pregnancy have not been well-studied among urban, low-income women.

METHODS

This prospective cohort study of 94 prenatal care patients at a large university hospital in Philadelphia examined associations of modifiable midpregnancy behaviors and nonmodifiable or early pregnancy factors with excessive gestational weight gain. Data were collected through questionnaires and medical record abstraction from 2009 to 2011.

FINDINGS

The majority of women were African American (83%) and all (100%) received Medicaid. Nearly two thirds (60%) were overweight or obese in early pregnancy and 41% experienced excessive gain. In multivariable logistic regression analyses, significant predictors of excessive gestational weight gain included high early pregnancy body mass index (odds ratio [OR], 4.20; 95% confidence interval [CI], 1.43-12.34 for overweight/obese vs. normal weight), nulliparity (OR, 3.35; 95% CI, 1.17-9.62 for nulliparity vs. multiparity), and clinician advice discordant with Institute of Medicine guidelines (OR, 5.88; 95% CI, 1.04-33.32 for discordant vs. concordant advice). Watching under 2 hours of television daily (OR, 0.18; 95% CI, 0.03-1.03), and engaging in regular physical activity during pregnancy (OR, 0.35; 95% CI, 0.11-1.09) were suggestive of a reduced risk of excessive gain.

CONCLUSIONS

In this sample of urban, low-income women, high early pregnancy body mass index, nulliparity, and discordant clinician advice were directly associated with excessive gestational weight gain, with a trend toward decreased risk for viewing fewer hours of television and engaging in regular physical activity. Intervening on these targets may optimize gestational weight gain and promote long-term maternal health.

Maternal obesity and gestational weight gain in rural versus urban dwelling women in South Carolina

PURPOSE

An unhealthy prepregnancy weight and/or gaining an inappropriate amount of weight during pregnancy increase the risk for poor pregnancy and birth outcomes. To our knowledge, no studies to date have examined differences in prepregnancy body mass index (BMI) and gestational weight gain (GWG) patterns by rurality.

METHODS

The 2004-2006 South Carolina birth certificate data (n = 132,795) were used. Rurality of residence was determined using Rural-Urban Commuting Area (RUCA) codes. Mothers were categorized as underweight (<18.5 kg/m(2)), normal weight (18.5-24.9), overweight (25.0-29.9), and obese (≥30.0) using their prepregnancy BMI and as having inadequate, adequate, or excessive GWG according to the Institute of Medicine's 2009 GWG guidelines. Chi-square tests and adjusted multinomial logistic regression were used in analysis.

FINDINGS

Rural women had higher odds of being overweight and obese compared to urban women. This relationship was found to be partially explained by the higher proportion of minorities living in rural areas. The relationship between GWG and residence type varied by BMI category. Specifically, among normal weight women, rural women had increased odds of inadequate GWG. Among overweight women, rural women had decreased odds of excessive GWG. In obese women, rural women had decreased odds of both inadequate and excessive GWG.

CONCLUSIONS

Rural women were more likely to have an unhealthy prepregnancy weight than urban women. However, rural residence was found to be protective against unhealthy GWG in overweight and obese women. Future research exploring reasons for these findings and confirmation of these results in other populations is necessary.

Rate of gestational weight gain, pre-pregnancy body mass index and preterm birth subtypes: a retrospective cohort study from Peru

OBJECTIVE

To examine the shape (functional form) of the association between the rate of gestational weight gain, pre-pregnancy body mass index (BMI), and preterm birth and its subtypes.

DESIGN

  Retrospective cohort study.

SETTING

  National reference obstetric centre in Lima, Peru.

POPULATION

  Pregnant women who delivered singleton babies during the period 2006-2009, resident in Lima, and beginning prenatal care at ≤ 12 weeks of gestation (n=8964).

METHODS

  Data were collected from the centre database. The main analyses consisted of logistic regression with fractional polynomial modelling.

MAIN OUTCOME MEASURES

  Preterm birth and its subtypes.

RESULTS

  Preterm birth occurred in 12.2% of women, being mostly idiopathic (85.7%). The rate of gestational weight gain was independently associated with preterm birth, and the shape of this association varied by pre-pregnancy BMI. In women who were underweight, the association was linear (per 0.1 kg/week increase) and protective (OR 0.88; 95% CI 0.82-1.00). In women of normal weight or who were overweight, the association was U-shaped: the odds of delivering preterm increased exponentially with rates <0.10 or >0.66 kg/week, and <0.04 or >0.50 kg/week, respectively. In women who were obese, the association was linear, but non-significant (OR 1.01; 95% CI 0.95-1.06). The association described for preterm birth closely resembled that of idiopathic preterm birth, although the latter was stronger. The rate of gestational weight gain was not associated with indicated preterm birth or preterm prelabour rupture of membranes.

CONCLUSIONS

  In Peruvian pregnant women starting prenatal care at ≤ 12 weeks of gestation, the rate of gestational weight gain is independently associated with preterm birth, mainly because of its association with idiopathic preterm birth, and the shape of both associations varies by pre-pregnancy BMI.

Return to military weight standards after pregnancy in active duty working women: comparison of marine corps vs. navy

OBJECTIVE

To compare the likelihood of being within weight standards before and after pregnancy between United States Marine Corps (USMC) and Navy (USN) active duty women (ADW).

METHODS

ADW with singleton gestations who delivered at a USMC base were followed for 6 months to determine likelihood of returning to military weight standards. Odds ratio (OR), adjusted odds ratio (AOR) and 95% confidence intervals were calculated; p < 0.05 was considered significant.

RESULTS

Similar proportions of USN and USMC ADW were within body weight standards one year prior to pregnancy (79%, 97%) and at first prenatal visit (69%, 96%), respectively. However, USMC ADW were significantly more likely to be within body weight standards at 3 months (AOR 4.30,1.28-14.43) and 6 months after delivery (AOR 9.94, 1.53-64.52) than USN ADW. Weight gained during pregnancy did not differ significantly for the two groups (40.4 lbs vs 44.2 lbs, p = 0.163). The likelihood of spontaneous vaginal delivery was significantly higher (OR 2.52, 1.20-5.27) and the mean birth weight was significantly lower (p = 0.0036) among USMC ADW as compared to USN ADW.

CONCLUSIONS

Being within weight standards differs significantly for USMC and USN ADW after pregnancy.

Can we modify the intrauterine environment to halt the intergenerational cycle of obesity?

Child obesity is a global epidemic whose development is rooted in complex and multi-factorial interactions. Once established, obesity is difficult to reverse and epidemiological, animal model, and experimental studies have provided strong evidence implicating the intrauterine environment in downstream obesity. This review focuses on the interplay between maternal obesity, gestational weight gain and lifestyle behaviours, which may act independently or in combination, to perpetuate the intergenerational cycle of obesity. The gestational period, is a crucial time of growth, development and physiological change in mother and child. This provides a window of opportunity for intervention via maternal nutrition and/or physical activity that may induce beneficial physiological alternations in the fetus that are mediated through favourable adaptations to in utero environmental stimuli. Evidence in the emerging field of epigenetics suggests that chronic, sub-clinical perturbations during pregnancy may affect fetal phenotype and long-term human data from ongoing randomized controlled trials will further aid in establishing the science behind ones predisposition to positive energy balance.

Optimizing weight gain in pregnancy to prevent obesity in women and children

Pregnancy is now considered to be an important risk factor for new or persistent obesity among women during the childbearing years. High gestational weight gain is the strongest predictor of maternal overweight or obesity following pregnancy. A growing body of evidence also suggests that both high and low gestational weight gains are independently associated with an increased risk of childhood obesity, suggesting that influences occurring very early in life are contributing to obesity onset. In response to these data, the US Institute of Medicine (IOM) revised gestational weight gain guidelines in 2009 for the first time in nearly two decades. However, less than one third of pregnant women achieve guideline-recommended gains, with the majority gaining above IOM recommended levels. To date, interventions to optimize pregnancy weight gains have had mixed success. In this paper, we summarize the evidence from human and animal studies linking over-nutrition and under-nutrition in pregnancy to maternal and child obesity. In addition, we discuss published trials and ongoing interventions to achieve appropriate gestational weight gain as a strategy for obesity prevention in women and their children.

Changes in resting and walking energy expenditure and walking speed during pregnancy in obese women

BACKGROUND

Energy-conserving processes reported in undernourished women during pregnancy are a recognized strategy for providing the energy required to support fetal development. Women who are obese before conceiving arguably have sufficient fat stores to support the energy demands of pregnancy without the need to provoke energy-conserving mechanisms.

OBJECTIVE

We tested the hypothesis that obese women would show behavioral adaptation [ie, a decrease in self-selected walking (SSW) speed] but not metabolic compensation [ie, a decrease in resting metabolic rate (RMR) or the metabolic cost of walking] during gestation.

DESIGN

RMR, SSW speed, metabolic cost of walking, and anthropometric variables were measured in 23 women aged 31 ± 4 y with a BMI (in kg/m(2)) of 33.6 ± 2.5 (mean ± SD) at ≈15 and 30 wk of gestation. RMR was also measured in 2 cohorts of nonpregnant control subjects matched for the age, weight, and height of the pregnant cohort at 15 (n = 23) and 30 (n = 23) wk.

RESULTS

Gestational weight gain varied widely (11.3 ± 5.4 kg), and 52% of the women gained more weight than is recommended. RMR increased significantly by an average of 177 ± 176 kcal/d (11 ± 12%; P < 0.0001); however, the within-group variability was large. Both the metabolic cost of walking and SSW speed decreased significantly (P < 0.01). Whereas RMR increased in >80% of the cohort, the net oxygen cost of walking decreased in the same proportion of women.

CONCLUSION

Although the increase in RMR was greater than that explained by weight gain, evidence of both behavioral and biological compensation in the metabolic cost of walking was observed in obese women during gestation. The trial is registered with the Australian Clinical Trials Registry as ACTRN012606000271505.