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Grandfils S, Durand P, Hoge A, Seidel L, Emonts P, Paquot N, Philips JC. Gestational weight gain: Toward best practices in managing gestational weight gain in patients with obesity: Comparison of recommendations. Eur J Obstet Gynecol Reprod Biol 2024; 298:197-203. [PMID: 38795431 DOI: 10.1016/j.ejogrb.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 05/02/2024] [Accepted: 05/11/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND AND AIMS In 2009, the Institute of Medicine (IOM) issued recommendations for gestational weight gain (GWG) based on body mass index (BMI). Several studies have challenged those recommendations for women with obesity, considering them too liberal and advising more limited weight gain - or even weight loss - during pregnancy to improve maternal and neonatal outcomes. Our aim was to study how gestational weight gain in women with obesity impacted maternal and fetal complications in the Belgian population. We did this by comparing the results from two groups of patients with obesity: those who met the 2009 IOM standards and those who satisfied the stricter recommendations suggested by other authors. MATERIALS AND METHODS This is a retrospective cohort study using data collected at the Centre d'Epidémiologie Périnatale (CEpiP) from obese (BMI ≥ 30 kg/m2) pregnant women with live singleton deliveries between 2010 and 2019 in Wallonia-Brussels Federation (n = 65,314). RESULTS Compared to obese patients whose GWG satisfied the IOM standards, those with GWG meeting the stricter recommendations had lower rates of gestational hypertension (7.1 % vs. 10.1 %; p = 0.0059), cesarean section (22.1 % vs. 26.3 %; p = 0.0074), and macrosomia (12.0 % vs. 17.7 %; p < 0.0001). There was no significant difference in the rate of preterm delivery (6.9 % vs 5.8 %; p = 0.12) or small-for-gestational-age births (7.2 % vs. 6.2 %; p = 0.16). CONCLUSION Gestational weight gain below that currently recommended by the IOM appears beneficial to the health of mothers with obesity and their children. These data, from our population, further challenge the standards proposed since 2009.
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Affiliation(s)
- Sebastien Grandfils
- Department of Gynecology and Obstetrics, University Hospital of Liège, Belgium.
| | - Pauline Durand
- Department of Public Health, University of Liège, Belgium
| | - Axelle Hoge
- Department of Public Health, University of Liège, Belgium
| | - Laurence Seidel
- Biostatistics and Research Method Center (B-STAT), University Hospital of Liège, Belgium
| | - Patrick Emonts
- Department of Gynecology and Obstetrics, University Hospital of Liège, Belgium
| | - Nicolas Paquot
- Department of Diabetology, Nutrition and Metabolic Diseases, University Hospital of Liège, Belgium
| | - Jean Christophe Philips
- Department of Diabetology, Nutrition and Metabolic Diseases, University Hospital of Liège, Belgium
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Nichols AR, Burns N, Xu F, Foster SF, Rickman R, Hedderson MM, Widen EM. Novel approaches to examining weight changes in pregnancies affected by obesity. Am J Clin Nutr 2023; 117:1026-1034. [PMID: 36878431 PMCID: PMC10273092 DOI: 10.1016/j.ajcnut.2023.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 02/16/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Current gestational weight change (GWC) recommendations for obese individuals were established with limited evidence of the pattern and timing of weight change across pregnancy. Similarly, the recommendation of 5-9 kg does not differentiate by the severity of obesity. OBJECTIVES We sought to describe GWC trajectory classes by obesity grade and associated infant outcomes among a large, diverse cohort. METHODS The study population included 22,355 individuals with singleton pregnancies, obesity (BMI ≥30.0 kg/m2), and normal glucose tolerance who delivered at Kaiser Permanente Northern California between 2008 and 2013. Obesity grade-specific GWC trajectories were modeled at 38 wk using flexible latent class mixed modeling (package lcmm) in R. Multivariable Poisson or linear regression models estimated the associations between the GWC trajectory class and infant outcomes (size-for-gestational age and preterm birth) by obesity grade. RESULTS Five GWC trajectory classes were identified for each obesity grade, each with a distinct pattern of weight change before 15 wk (including loss, stability, and gain) followed by weight gain thereafter (low, moderate, and high). Two classes with high overall gain were associated with an increased risk for large for gestational age (LGA) in obesity grade 1 (IRR = 1.27; 95% CI: 1.10, 1.46; IRR = 1.47; 95% CI: 1.24, 1.74). Both high (IRR = 2.02; 95% CI: 1.61, 2.52; IRR = 1.98; 95% CI: 1.52, 2.58) and 2 moderate-gain classes (IRR = 1.40; 95% CI 1.14, 1.71; IRR = 1.51; 95% CI: 1.20, 1.90) were associated with LGA in grade 2, and only early loss/late moderate-gain class 3 (IRR = 1.30; 95% CI: 1.04, 1.62) was associated in grade 3. This class was also associated with preterm birth in grade 2. No associations were detected between GWC and small for gestational age (SGA). CONCLUSIONS Among the pregnancies affected by obesity, GWC was not linear or uniform. Different patterns of high gain were associated with an increased risk for LGA with the greatest magnitude in obesity grade 2, whereas GWC patterns were not associated with SGA.
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Affiliation(s)
- Amy R Nichols
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, United States
| | - Natalie Burns
- Department of Statistics, University of Florida, Gainesville, FL, United States
| | - Fei Xu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Saralyn F Foster
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, United States
| | - Rachel Rickman
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, United States
| | - Monique M Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States.
| | - Elizabeth M Widen
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, United States.
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Zhou X, Rao L, Yang D, Wang T, Li H, Liu Z. Effects of maternal pre-pregnancy body mass index and gestational weight gain on antenatal mental disorders in China: a prospective study. BMC Pregnancy Childbirth 2023; 23:188. [PMID: 36934260 PMCID: PMC10024407 DOI: 10.1186/s12884-023-05502-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/06/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Maternal obesity is the most common medical condition among women of reproductive age worldwide. The pre-pregnancy body mass index and gestational weight gain have been suggested to be associated with maternal mental disorders. This study aimed to investigate the effects of the pre-pregnancy body mass index and gestational weight gain on antenatal depression, stress, and anxiety. METHODS In total, 4,890 pregnant women were enrolled in the present study, which is based on an ongoing prospective cohort study. We used self-reported pre-pregnancy weights and the last weights measured prior to delivery (using professional instruments) to calculate the pre-pregnancy body mass index and gestational weight gain. The questionnaires used included the Center for Epidemiologic Studies Depression Scale (CES-D), Self-Rating Anxiety Scale (SAS), and 10-item version of the Perceived Stress Scale (PSS-10). We used Pearson product-moment correlation and multivariable logistic regression models to examine the impact of the pre-pregnancy body mass index and gestational weight gain on different maternal mental disorders. RESULTS After adjusting for conception, annual household income, occupation, education, smoking status, and drinking status, excessive gestational weight gain during pregnancy was associated with a greater chance of anxiety symptoms in the entire sample (adjusted model: odds ratio = 1.479, 95% confidence interval = 1.128, 1.938) and especially in women with a normal body mass index (adjusted model: odds ratio = 1.668, 95% confidence interval = 1.209, 2.302). However, the relationship between the maternal pre-pregnancy body mass index and mental health was not significant. CONCLUSION Pregnant women with a normal pre-pregnancy body mass index had a greater chance of experiencing anxiety symptoms before delivery if gestational weight gain was excessive; however, its effects on depression or stress symptoms were not observed. The maternal pre-pregnancy body mass index may not be independently associated with maternal mental disorders.
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Affiliation(s)
- Xuan Zhou
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910 Hengshan Road, Xuhui District, 200030, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, 200030, Shanghai, China
- Institute of Birth Defects and Rare Diseases, School of Medicine, Shanghai Jiao Tong University, 200030, Shanghai, China
| | - Lin Rao
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910 Hengshan Road, Xuhui District, 200030, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, 200030, Shanghai, China
- Institute of Birth Defects and Rare Diseases, School of Medicine, Shanghai Jiao Tong University, 200030, Shanghai, China
| | - Dongjian Yang
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910 Hengshan Road, Xuhui District, 200030, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, 200030, Shanghai, China
- Institute of Birth Defects and Rare Diseases, School of Medicine, Shanghai Jiao Tong University, 200030, Shanghai, China
| | - Tong Wang
- Shanghai Jiao Tong University School of Medicine, 200030, Shanghai, China
| | - Hong Li
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910 Hengshan Road, Xuhui District, 200030, Shanghai, China.
- Shanghai Key Laboratory of Embryo Original Diseases, 200030, Shanghai, China.
- Institute of Birth Defects and Rare Diseases, School of Medicine, Shanghai Jiao Tong University, 200030, Shanghai, China.
| | - Zhiwei Liu
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910 Hengshan Road, Xuhui District, 200030, Shanghai, China.
- Shanghai Key Laboratory of Embryo Original Diseases, 200030, Shanghai, China.
- Institute of Birth Defects and Rare Diseases, School of Medicine, Shanghai Jiao Tong University, 200030, Shanghai, China.
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Chen W, Li B, Gan K, Liu J, Yang Y, Lv X, Ma H. Gestational Weight Gain and Small for Gestational Age in Obese Women: A Systematic Review and Meta-Analysis. Int J Endocrinol 2023; 2023:3048171. [PMID: 36686320 PMCID: PMC9848811 DOI: 10.1155/2023/3048171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE This systematic review and meta-analysis evaluates the relationship between gestational weight gain and the risk of small for gestational age in obese pregnant women. METHODS Studies were identified by searching the Web of Science, Embase, and PubMed databases up to June 30th, 2022. The meta-analysis was carried out to determine the risk of small for gestational age with gestational weight gain (GWG) below the 2009 Institute of Medicine (IOM) guidelines compared with within the guidelines in obese women. The Newcastle-Ottawa Scale was used to assess the methodological quality. The chi-squared test, Q test, and I2 test were used to evaluate statistical heterogeneity. Subgroup analyses were conducted, and publication bias was assessed by funnel plots and Egger's test. Sensitivity analyses were performed for three groups of obese people (I: BMI 30-34.9 kg/m2, II: BMI 35-39.9 kg/m2, and III: BMI ≥ 40 kg/m2) to examine the association of obesity and SGA. RESULTS A total of 788 references were screened, and 29 studies (n = 1242420 obese women) were included in the systematic review. Obese women who gained weight below the IOM guideline had a higher risk of SGA than those who gained weight within the guideline (OR = 1.27, 95% CI = 1.16-1.38, Z = 5.36). Both weight loss (<0 kg) and inadequate weight (0-4.9 kg) during pregnancy in obese women are associated with an increased risk of SGA (OR = 1.50, 95% CI = 1.37-1.64, Z = 8.82) (OR = 1.18, 95% CI = 1.14-1.23, Z = 8.06). The same conclusions were also confirmed for the three obesity classes (I: OR = 1.38, 95% CI = 1.29-1.47; II: OR = 1.39, 95% CI = 1.30-1.49; and III: OR = 1.26, 95% CI = 1.16-1.37). Subgroup analysis by country showed that GWG below guidelines in obese women of the USA and Europe was associated with risk for SGA (USA (OR = 1.30, 95% CI = 1.15-1.46), Europe (OR = 1.24, 95% CI = 1.11-1.40)) and not in Asia (OR = 1.17, 95% CI = 0.91-1.50). CONCLUSION Our findings indicated that obese pregnant women who had weight loss or inadequate weight (0-4.9 kg) according to the IOM guideline had increased risks for SGA. Moreover, we also evaluated that gestational weight loss (<0 kg) in these pregnancies was associated with an increased risk for SGA compared with inadequate weight (0-4.9 kg) in these pregnancies. Therefore, the clinical focus should assist obese women to achieve GWG within the IOM guidelines to decrease the risk for SGA.
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Affiliation(s)
- Wen Chen
- Department of Anus and Intestine Surgery, Shijiazhuang People Hospital, Shijiazhuang 050000, Hebei, China
| | - Beiyi Li
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang 050017, Hebei, China
| | - Kexin Gan
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang 050017, Hebei, China
| | - Jing Liu
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang 050017, Hebei, China
| | - Yajing Yang
- Graduate School of North China University of Science and Technology, Tangshan 063000, Hebei, China
| | - Xiuqin Lv
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang 050017, Hebei, China
| | - Huijuan Ma
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang 050017, Hebei, China
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Mitchell AJ, Dunn GA, Sullivan EL. The Influence of Maternal Metabolic State and Nutrition on Offspring Neurobehavioral Development: A Focus on Preclinical Models. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:450-460. [PMID: 34915175 PMCID: PMC9086110 DOI: 10.1016/j.bpsc.2021.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/19/2021] [Accepted: 11/29/2021] [Indexed: 12/22/2022]
Abstract
The prevalence of both obesity and neurodevelopmental disorders has increased substantially over the last several decades. Early environmental factors, including maternal nutrition and metabolic state during gestation, influence offspring neurodevelopment. Both human and preclinical models demonstrate a link between poor maternal nutrition, altered metabolic state, and risk of behavioral abnormalities in offspring. This review aims to highlight evidence from the current literature connecting maternal nutrition and the associated metabolic changes with neural and behavioral outcomes in the offspring, as well as identify possible mechanisms underlying these neurodevelopmental outcomes. Owing to the highly correlated nature of poor nutrition and obesity in humans, preclinical animal models are important in distinguishing the unique effects of maternal nutrition and metabolic state on offspring brain development. We use a translational lens to highlight results from preclinical animal models of maternal obesogenic diet related to alterations in behavioral and neurodevelopmental outcomes in offspring. Specifically, we aim to highlight results that resemble behavioral phenotypes described in the diagnostic criteria of neurodevelopmental conditions in humans. Finally, we examine the proinflammatory nature of maternal obesity and consumption of a high-fat diet as a mechanism for neurodevelopmental alterations that may alter offspring behavior later in life. It is important that future studies examine potential therapeutic interventions and prevention strategies to interrupt the transgenerational transmission of the disease. Given the tremendous risk to the next generation, changes need to be made to ensure that all pregnant people have access to nutritious food and are informed about the optimal diet for their developing child.
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Affiliation(s)
- A J Mitchell
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon; Department of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon
| | - Geoffrey A Dunn
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Elinor L Sullivan
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon; Department of Psychiatry, Oregon Health & Science University, Portland, Oregon; Department of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon; Department of Human Physiology, University of Oregon, Eugene, Oregon.
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6
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Sellner AA, Garbarino AH, Miao D, Hollier LM, Ratan BM. Effects of Gestational Weight Gain on Delivery Outcomes in an Obese, Low-Income Population. South Med J 2021; 114:686-691. [PMID: 34729611 DOI: 10.14423/smj.0000000000001320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine the effects of weight gain/loss on delivery outcomes stratified by class of obesity in an obese, low-income, predominantly minority population. METHODS A retrospective review of a cohort of 1428 women receiving care at a large Medicaid clinic from 2013 to 2016 with pregravid body mass index ≥30 was conducted. Multinomial logistic regression analysis was used to compare differences in gestational weight change to the primary outcomes of birth-weight percentile and delivery type and secondary outcomes of preterm delivery, preterm labor, gestational diabetes mellitus, and gestational hypertension. RESULTS Obesity class 1 patients who lost weight were more likely to have a small-for-gestational-age (SGA) infant compared with those who had recommended weight gain. Obesity classes 2 and 3 patients had no statistically significant increase in SGA infants with weight loss or weight gain below current recommendations. Obesity classes 1 and 2 patients with weight loss had a statistically significant increase in both preterm delivery and preterm labor; however, class 3 patients did not. Obesity class 3 patients who lost weight were significantly more likely to have gestational diabetes mellitus. CONCLUSIONS Obesity class 3 women may benefit from less weight gain than current recommendations without increasing their risk of SGA infants or preterm birth, especially if gestational diabetes mellitus is present.
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Affiliation(s)
- Allison Archer Sellner
- From the Department of Obstetrics and Gynecology, Baylor College of Medicine, and Texas Children's Health Plan, Houston, Texas
| | - Abigail Hook Garbarino
- From the Department of Obstetrics and Gynecology, Baylor College of Medicine, and Texas Children's Health Plan, Houston, Texas
| | - Di Miao
- From the Department of Obstetrics and Gynecology, Baylor College of Medicine, and Texas Children's Health Plan, Houston, Texas
| | - Lisa Marie Hollier
- From the Department of Obstetrics and Gynecology, Baylor College of Medicine, and Texas Children's Health Plan, Houston, Texas
| | - Bani Maheshwari Ratan
- From the Department of Obstetrics and Gynecology, Baylor College of Medicine, and Texas Children's Health Plan, Houston, Texas
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Naghizadeh M, Karajibani M, Fanaei H, Montazerifar F, Dashipour A. Effect of synbiotic supplementation on asprosin level in high fat diet-induced metabolic disorder in pregnant rats. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2021. [DOI: 10.3233/mnm-210595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Synbiotic supplementation can improve metabolic disorders. The aim of this study was to assess the impact of synbiotic supplementation on the levels of asprosin, lipid profile, glucose, and insulin resistance in pregnant rats fed a high-fat diet (HFD). Rats were divided into three groups: control group (fed base chow), HFD group, and HFD + synbiotic group. Levels of blood glucose, total cholesterol, triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), insulin, and asprosin levels were measured. Birth weight of offspring in the HFD + synbiotic group was significantly lower than in the HFD group. Similarly, serum asprosin, insulin, insulin resistance, TG and total cholesterol levels in the HFD + symbiotic group were significantly lower than in the HFD group. Asprosin levels had a significant and positive correlation between food intake in the first ten days of the experiment and gestation period, fasting blood sugar (FBS), TG, and homeostatic model assessment (HOMA) index. Moreover, asprosin levels had a significant and negative correlation with HDL and insulin levels. Results showed, synbiotic supplementation has beneficial effects on obese animals and improves weight gain during pregnancy, pup birth weight, FBS, insulin resistance and lipid profile. These advantages of synbiotic supplementation could be mediated by reducing serum asprosin levels.
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Affiliation(s)
- Mehrdad Naghizadeh
- Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mansour Karajibani
- Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Health Promotion Research Center, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hamed Fanaei
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Physiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Farzaneh Montazerifar
- Health Promotion Research Center, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Alireza Dashipour
- Department of Food Science, School of medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Cellular and Molecular Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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Whitaker KM, Ryan R, Becker C, Healy H. Gestational Weight Gain in Twin Pregnancies and Maternal and Child Health: An Updated Systematic Review. J Womens Health (Larchmt) 2021; 31:362-381. [PMID: 33926213 DOI: 10.1089/jwh.2021.0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: The Institute of Medicine (IOM) has provisional gestational weight gain (GWG) guidelines for women pregnant with twins due to limited data in this population. To better inform guidelines, the objective of this systematic review was to build on prior work and examine recent data on the associations of GWG with maternal and child health in twin pregnancies. Materials and Methods: In February 2021, Ovid MEDLINE, Embase, CINAHL, and Cochrane Library were searched. Observational studies were eligible if published from January 1, 2013 through February 23, 2021, and examined associations of GWG with maternal or child health outcomes after accounting for gestational age at delivery and pre-pregnancy body mass index. Heterogeneity across studies precluded the use of meta-analytic methods. Results: A total of 29 studies were included. For maternal outcomes, excessive GWG was associated with an increased risk of hypertensive disorders of pregnancy; whereas studies examining gestational diabetes and delivery method reported mixed findings. For child outcomes, inadequate GWG was associated with lower birthweight, small for gestational age, and preterm birth. Adequate or excessive GWG was associated with later gestational age at delivery. Conclusions: This study advances an earlier review by including a more diverse array of maternal and child outcomes. Many of the limitations noted in the original review persist; for example, no studies examined the associations of GWG and outcomes beyond birth. Although it appears that GWG within the IOM guidelines is associated with more optimal outcomes, additional methodologically rigorous studies are needed to better inform evidence-based guidelines.
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Affiliation(s)
- Kara M Whitaker
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, USA.,Department of Epidemiology, University of Iowa, Iowa City, Iowa, USA
| | - Rachel Ryan
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, USA
| | - Courtney Becker
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, USA
| | - Heather Healy
- Hardin Library for the Health Sciences, University of Iowa Libraries, Iowa City, Iowa, USA
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9
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Ferrey AE, Astbury NM, Kenworthy Y, Mackillop L, Frie K, Jebb SA. Exploring women's thoughts on self-weighing during pregnancy: results of the Self-Weighing in Pregnancy: Experiences (SWIPE) study. BMC Pregnancy Childbirth 2021; 21:154. [PMID: 33610166 PMCID: PMC7897370 DOI: 10.1186/s12884-021-03636-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/10/2021] [Indexed: 11/22/2022] Open
Abstract
Background Excess gestational weight gain is common and an important risk factor for adverse pregnancy outcomes. Regular weighing can be used to assess and manage weight gain, but NICE guidelines do not recommend routine weighing during antenatal care. Trials that have tested the effectiveness of self-weighing to manage GWG have been unsuccesful in engaging women in regular self-weighing, although the reasons for lack of engagement are not fully understood. This study aimed to understand why this lack of engagement occurred by exploring the naturally occurring thoughts and feelings of pregnant women (9 to 15 weeks gestational age) who were asked to weigh themselves at home. Methods Twenty-five women were recruited to take part. Participants completed short questionnaires at their first-trimester and 20-week scans. After recruitment, participants were asked to weigh themselves at roughly the same time each week for 8 weeks. Whilst they weighed themselves they were asked to audio-record their current weight and describe any thoughts or feelings that occurred as they weighed themselves. These audio recordings were then sent to researchers using a secure messaging service. Results Most of the recruited women (56%) were unaware of guidelines for gestational weight gain, and only 40% could identify the ideal rate of GWG for their BMI group. Thematic analysis of the think-aloud recordings resulted in three main themes: “understanding weight gain in pregnancy”, “taking action to prevent weight gain” and “reactions to self-weighing”. Overall, there was a relatively positive response to self-weighing and some participants used self-weighing to reflect on the reasons for weight gain and plan actions they could take to avoid excess gain. Negative emotional responses tended to be related to a lack of guidance about what level of weight gain or loss was “healthy”, or to other worries about the pregnancy. Of the women recruited who submitted at least one think aloud recording (n 10), 80% found self-weighing to be useful, and said they would likely continue to self-weigh at home. Conclusions Women had complex emotions about self-weighing during pregnancy but overall found it useful, suggesting it could be encouraged as part of self-regulatory interventions to control GWG. Clear guidelines about appropriate gestational weight gain could help to reduce anxiety. Trial registration The study was prospectively registered with ISRCTN ISRCTN10035244. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03636-5.
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Affiliation(s)
- Anne E Ferrey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK. .,NIHR Oxford Biomedical Research Centre, Oxford, UK.
| | - Nerys M Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Yvonne Kenworthy
- NIHR Oxford Biomedical Research Centre, Oxford, UK.,Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Lucy Mackillop
- NIHR Oxford Biomedical Research Centre, Oxford, UK.,Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kerstin Frie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
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10
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Garay SM, Sumption LA, Pearson RM, John RM. Risk factors for excessive gestational weight gain in a UK population: a biopsychosocial model approach. BMC Pregnancy Childbirth 2021; 21:43. [PMID: 33423656 PMCID: PMC7798251 DOI: 10.1186/s12884-020-03519-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 12/22/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Gestational weight gain (GWG) can have implications for the health of both mother and child. However, the contributing factors remain unclear. Despite the advantages of using a biopsychosocial approach, this approach has not been applied to study GWG in the UK. This study aimed to investigate the risk factors of excessive GWG in a UK population, employing a biopsychosocial model. METHODS This study utilised data from the longitudinal Grown in Wales (GiW) cohort, which recruited women in late pregnancy in South Wales. Specifically, data was collected from midwife recorded notes and an extensive questionnaire completed prior to an elective caesarean section (ELCS) delivery. GWG was categorised according to Institute of Medicine (IOM) guidelines. The analysis was undertaken for 275 participants. RESULTS In this population 56.0% of women had excessive GWG. Increased prenatal depression symptoms (Exp(B)=1.10, p=.019) and an overweight (Exp(B)=4.16, p<.001) or obese (Exp(B)=4.20, p=.010) pre-pregnancy BMI, consuming alcohol in pregnancy (Exp(B)=.37, p=.005) and an income of less than £18,000 (Exp(B)=.24, p=.043) and £25-43,000 (Exp(B)=.25, p=.002) were associated with excessive GWG. CONCLUSION GWG is complex and influenced by a range of biopsychosocial factors, with the high prevalence of excessive weight gain in this population a cause for concern. Women in the UK may benefit from a revised approach toward GWG within the National Health Service (NHS), such as tracking weight gain throughout pregnancy. Additionally, this research provides evidence for potential targets for future interventions, and potentially at-risk populations to target, to improve GWG outcomes.
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Affiliation(s)
- S. M. Garay
- grid.5600.30000 0001 0807 5670Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX UK
| | - L. A. Sumption
- grid.5600.30000 0001 0807 5670Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX UK
| | - R. M. Pearson
- grid.5337.20000 0004 1936 7603Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Bristol, BS8 2BN UK
| | - R. M. John
- grid.5600.30000 0001 0807 5670Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX UK
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11
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Chen J, Xiao H, Yang Y, Tang Y, Yang X, Zhang Z, Lu W, Yao J, Huang L, Liu X, Zhou W. Demographic and Clinical Features of Small-for-Gestational-Age Infants Born to Mothers With Gestational Diabetes Mellitus. Front Pediatr 2021; 9:741793. [PMID: 34660493 PMCID: PMC8517473 DOI: 10.3389/fped.2021.741793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022] Open
Abstract
We studied the demographic and clinical characteristic, risk factors, outcomes of full-term small-for-gestational-age (SGA) infants born to mothers with gestational diabetes mellitus (GDM) in China. A retrospective case-control study that included 1981 SGA infants was conducted; the demographic and clinical data between SGA infants born to mothers with and without GDM were compared. Of 383 SGA infants born to mothers with GDM, 221 (57.7%) were female, and the incidence of these infants was 1 in 155 live births. The risk of SGA siblings (RR, 1.88; 95% CI, [1.23-2.86]), low 1- and 5-min Apgar scores (RR,2.04 and 4.21; 95%CI [1.05-4.00] and [1.05-16.89], respectively), early thrombocytopenia (RR, 3.39; 95%CI, [1.33-8.64]), hypoglycemia(RR, 2.49; 95%CI, [1.55-3.98]), and hypoxic-ischemic encephalopathy (RR,5.61; 95%CI, [1.25-25.18]) were increased in SGA infants born to mothers with GDM compared to SGA infants born to mothers without GDM. SGA girls born to mothers with GDM had a significantly higher ratio of catch-up growth (CUG) (RR, 1.73; 95%CI, [1.18-2.54]) in the first year of life. These results show that genetic factors may be one of the etiologies of SGA infants born to mothers with GDM; and these infants have more adverse perinatal outcomes compared to SGA infants born to mothers without GDM. SGA girls born to mothers with GDM had accelerated CUG in the first year of life.
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Affiliation(s)
- Juncao Chen
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huimin Xiao
- Department of Neonatology, Dongguan Houjie Hospital, Guangdong Medical University, Dongguan, China
| | - Yong Yang
- Department of Neonatology, Dongguan City Maternal and Child Health Hospital, Southern Medical University, Dongguan, China
| | - Yaping Tang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China
| | - Xiaoqi Yang
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhe Zhang
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Weineng Lu
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jie Yao
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Longguang Huang
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaoping Liu
- Department of Hematology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wei Zhou
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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12
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Casas R, Castro Barquero S, Estruch R. Impact of Sugary Food Consumption on Pregnancy: A Review. Nutrients 2020; 12:nu12113574. [PMID: 33266375 PMCID: PMC7700555 DOI: 10.3390/nu12113574] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 12/16/2022] Open
Abstract
Obesity in pregnancy has been directly associated with an increased risk of almost all pregnancy complications such as gestational hypertension, preeclampsia, gestational diabetes mellitus (GDM), and premature delivery. Thereby, according to current evidence available, life-style interventions to prevent pre-pregnancy overweight and obesity in women of fertile age are necessary to reduce the negative impact of obesity on mother and child health. Unhealthy dietary patterns, together with the increased consumption of processed foods rich in simple sugar and sweeteners are some of the responsible, among others, for the increase in obesity rates during the last years. Nevertheless, how its consumption can affect pregnancy outcomes and long-term children’s health is still uncertain. This review aims to collate the available evidence about the consequences of unhealthy dietary patterns and sugary products consumption, including sweeteners, during pregnancy for obesity in childhood and mid-childhood. High simple sugar intake during gestation may contribute to an excessive gestational weight gain (GWG) as well as to develop other pregnancy complications such as GDM, preeclampsia and preterm birth. The heterogeneity of study populations, sample size, different approaches to measure GWG, GMD, preeclampsia, and birth weight, among other conditions, might explain the divergences observed among studies. Therefore, large, well-designed intervention-controlled trials with biological biomarkers to ensure dietary adherence are necessary to evaluate the effectiveness of lifestyle interventions in order to provide effective nutritional advice.
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Affiliation(s)
- Rosa Casas
- Department of Internal Medicine, Hospital Clinic, Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel, 170, 08036 Barcelona, Spain; (S.C.B.); (R.E.)
- CIBER 06/03: Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-93-2275745; Fax: +34-93-2275758
| | - Sara Castro Barquero
- Department of Internal Medicine, Hospital Clinic, Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel, 170, 08036 Barcelona, Spain; (S.C.B.); (R.E.)
- CIBER 06/03: Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ramon Estruch
- Department of Internal Medicine, Hospital Clinic, Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel, 170, 08036 Barcelona, Spain; (S.C.B.); (R.E.)
- CIBER 06/03: Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain
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13
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Mitchell CJ, Adkins L, Tucker A, Brown H, Siegel A, Dotter-Katz S. Impact of Excess Weight Gain on Risk of Postpartum Infection in Class III Obesity. AJP Rep 2020; 10:e213-e216. [PMID: 33094007 PMCID: PMC7571565 DOI: 10.1055/s-0040-1715165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 03/07/2020] [Indexed: 12/20/2022] Open
Abstract
Objective To assess the impact of gestational weight gain >20 pounds (more than Institute of Medicine [IOM] recommendations) on postpartum infectious morbidity in women with class III obesity. Methods This is a retrospective cohort of term, nonanomalous singleton pregnancies with body mass index ≥40 at a single institution from 2013 to 2017. Pregnancies with multiple gestation, late entry to care, and missing weight gain data are excluded. Primary outcome is a composite of postpartum infection (endometritis, urinary tract, respiratory, and wound infection). Secondary outcomes include components of composite, wound complication, readmission, and blood transfusion. Bivariate statistics compared demographics, pregnancy complications, and delivery characteristics of women exceeding IOM guidelines (GT20) with those who did not (LT20). Regression models were used to estimate adjusted odds of outcomes. Results Of 374 women, 144 (39%) gained GT20 and 230 (62%) gained LT20. Primiparous, nonsmokers more likely gained GT20 ( p < 0.05). No significant difference in other demographics. Among women who gained GT20, 10.4% had postpartum infectious morbidity compared with 3.0% in LT20 ( p < 0.01). Wound infection is more common in the GT20 group (7.6 vs. 2%, p = 0.02). After adjustment, women who gained GT20 had threefold higher odds of postpartum infectious morbidity (adjusted odds ratio: 3.17, 95% confidence interval: 1.17, 8.60). Conclusion Women with class III obesity who gain more than the IOM recommends are at increased risk for postpartum infectious morbidity.
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Affiliation(s)
- Courtney J Mitchell
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - LaMani Adkins
- Duke University School of Medicine, Durham, North Carolina
| | - Ann Tucker
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Haywood Brown
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida
| | - Anne Siegel
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Sarah Dotter-Katz
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
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14
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Njagu R, Adkins L, Tucker A, Gatta L, Brown HL, Reiff E, Dotters-Katz S. Maternal weight gain and neonatal outcomes in women with class III obesity. J Matern Fetal Neonatal Med 2020; 35:546-550. [PMID: 32089032 DOI: 10.1080/14767058.2020.1729116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: Obesity in the USA continues to be a prominent medical and public health concern. Due to increasing rates of maternal obesity, the current Institute of Medicine (IOM) guidelines recommend 11-20 pounds of total weight gain during pregnancy in women with a BMI ≥30 kg/m2. The impact of maternal obesity on adverse perinatal outcomes has been well documented however, there is minimal data on the effect of gestational weight gain on neonatal outcomes. In this study, we assessed the association between gestational weight gain (GWG) and neonatal outcomes at term in women with class III obesity.Study design: A retrospective cohort of women delivering at a tertiary care institution between July 2013 and December 2017 with a first-trimester baseline BMI ≥40 kg/m2 was studied. Pregnancies complicated by multiple gestations, preterm delivery, fetal anomalies, intrauterine fetal demise or with missing data were excluded. The primary outcome was a composite of adverse neonatal outcomes including 5 min Apgar <7, neonatal intubation, grade 3 or 4 intraventricular hemorrhage (IVH), confirmed neonatal sepsis or Neonatal Intensive Care Unit (NICU) admission. Secondary outcomes included individual components of composite and NICU admission for >7 days. Demographic, pregnancy complications & delivery characteristics of women who gained more than IOM guidelines (>20 lbs.) were compared to women who gained at or less than IOM guidelines (≤20 lbs.) using bivariate statistics. Stepwise backward regression was used to estimate the odds of outcomes as appropriate.Results: Of 374 women included, 144 (39.5%) gained more than guidelines. Women who gained above IOM recommendations were less likely to be multiparous and use tobacco. Additional demographic, obstetric and delivery characteristics, including BMI at the entry to care, did not differ. The neonatal composite occurred in 30 (8.0%) of all neonates; corresponding to 11.1% of women who gained more than IOM recommendations and 6.1% of those who gained at or below recommendations (p = .12, OR = 1.71, 95%CI 0.74-3.96). Additionally, neonates born to women gaining more than IOM recommendations were more likely to be admitted to the NICU (10.4 vs. 4.3%, p = .03) and have a NICU length of stay >7 days (6.9 vs. 2.2%, p = .03). When adjusted for mode of delivery, delivery BMI, tobacco use, and chorioamnionitis, women who gained more were not more likely to have an adverse neonatal outcome (1.54, 95%CI 0.62-3.80), they were 3.6 times more likely to have a neonate admitted to the NICU for more than 7 days (95%CI 1.00-13.42).Conclusions: In women with class III obesity, excess gestational weight gain was associated with increased odds of NICU stay >7 days, with trends toward increased NICU admission risk, further emphasizing the importance of appropriate weight gain counseling in this population at risk.
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Affiliation(s)
- Ravyn Njagu
- School of Medicine, Duke University, Durham, NC, USA
| | - LaMani Adkins
- School of Medicine, Duke University, Durham, NC, USA
| | - Ann Tucker
- University of Mississippi, Jackson, MS, USA
| | - Luke Gatta
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | | | - Emily Reiff
- Brigham and Women's Hospital, Boston, MA, USA
| | - Sarah Dotters-Katz
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
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15
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Maternal obesity leads to long-term altered levels of plasma ceramides in the offspring as revealed by a longitudinal lipidomic study in children. Int J Obes (Lond) 2018; 43:1231-1243. [PMID: 30568270 DOI: 10.1038/s41366-018-0291-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 11/21/2018] [Accepted: 11/30/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND/OBJECTIVES Maternal obesity is associated with increased risk of obesity and other symptoms of the metabolic syndrome in the offspring. Nevertheless, the molecular mechanisms and cellular factors underlying this enhanced disease susceptibility remain to be determined. Here, we aimed at identifying changes in plasma lipids in offspring of obese mothers that might underpin, and serve as early biomarkers of, their enhanced metabolic disease risk. SUBJECTS/METHODS We performed a longitudinal lipidomic profiling in plasma samples from normal weight, overweight, and obese pregnant women and their children that participated in the Prenatal Omega-3 Fatty Acid Supplementation, Growth, and Development trial conducted in Mexico. At recruitment women were aged between 18 and 35 years and in week 18-22 of pregnancy. Blood samples were collected at term delivery by venipuncture from mothers and from the umbilical cord of their newborns and from the same infants at 4 years old under non-fasting conditions. Lipidomic profiling was done using ultra-performance liquid chromatography high-resolution mass spectrometry. RESULTS Analysis of the lipidomic data showed that overweight and obese mothers exhibited a significant reduction in the total abundance of ceramides (Cer) in plasma, mainly of Cer (d18:1/20:0), Cer (d18:1/22:0), Cer (d18:1/23:0), and Cer (d18:1/24:0), compared with mothers of normal body weight. This reduction was confirmed by the direct quantification of these and other ceramide species. Similar quantitative differences in the plasma concentration of Cer (d18:1/22:0), Cer (d18:1/23:0), and Cer (d18:1/24:0), were also found between 4-year-old children of overweight and obese mothers compared with children of mothers of normal body weight. Noteworthy, children exhibited equal daily amounts of energy and food intake independently of the BMI of their mothers. CONCLUSIONS Maternal obesity results in long-lasting changes in plasma ceramides in the offspring suggesting that these lipids might be used as early predictors of metabolic disease risk due to maternal obesity.
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16
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Liao J, Yu H, Xia W, Zhang B, Lu B, Cao Z, Liang S, Hu K, Xu S, Li Y. Exposure to ambient fine particulate matter during pregnancy and gestational weight gain. ENVIRONMENT INTERNATIONAL 2018; 119:407-412. [PMID: 30007191 DOI: 10.1016/j.envint.2018.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/27/2018] [Accepted: 07/06/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Gestational weight gain (GWG) is increasingly reported to be associated with adverse birth outcomes. However, the effect of PM2.5 exposure during pregnancy on GWG is unknown. OBJECTIVES We investigated the associations between the exposure to PM2.5 and GWGs during three pregnancy trimesters based on a prospective birth cohort. METHODS Data were obtained from 2029 pregnant women who participated in a birth cohort between January 2013 and October 2014 in Wuhan, China. A spatial-temporal land use regression model was used to estimate the trimester and overall pregnancy exposures of PM2.5 of each pregnant woman. The relationships between PM2.5 exposure and GWG were estimated using linear mixed models. RESULTS The median value of GWG was 2.0 kg (interquartile range (IQR): 4.0) in the first trimester, 6.5 kg (IQR: 3.5) in the second trimester, and 7.0 kg (IQR: 3.5) in the third trimester, respectively. The exposure to PM2.5 was peaked in the first trimester (median concentration: 117.3 μg/m3 (IQR: 71.9)). After adjustment for potential confounders, each 10 μg/m3 increase in PM2.5 was consistently associated with increases in GWG in overall pregnancy (0.14 kg, 95% confidence interval (CI): 0.12, 0.17), the first (0.15 kg, 95%CI: 0.12, 0.18), second (0.15 kg, 95%CI: 0.10, 0.19) and third trimester (0.13 kg, 95%CI: 0.09, 0.17). Further stratified analysis indicated that pregnant women who delivered in spring or summer gained more body weight associated with PM2.5 exposure. CONCLUSIONS This study provides evidence on the effect of exposure to PM2.5 on GWG and it is the first report on the importance of reducing the ambient PM2.5 in controlling of GWG in pregnant women.
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Affiliation(s)
- Jiaqiang Liao
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Huifang Yu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Wei Xia
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Bin Zhang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical Collegec, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Bin Lu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Zhongqiang Cao
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical Collegec, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Shengwen Liang
- Wuhan Environmental Monitoring Center, Wuhan, Hubei Province 430000, People's Republic of China
| | - Ke Hu
- Wuhan Environmental Monitoring Center, Wuhan, Hubei Province 430000, People's Republic of China
| | - Shunqing Xu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yuanyuan Li
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
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17
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Most J, Vallo PM, Gilmore LA, St Amant M, Hsia DS, Altazan AD, Beyl RA, Ravussin E, Redman LM. Energy Expenditure in Pregnant Women with Obesity Does Not Support Energy Intake Recommendations. Obesity (Silver Spring) 2018; 26:992-999. [PMID: 29797559 PMCID: PMC5978753 DOI: 10.1002/oby.22194] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/26/2018] [Accepted: 03/27/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE This study aimed to identify factors that may predispose women to excess gestational weight gain (GWG). METHODS Seventy-two healthy women with obesity (30 class I, 24 class II, 18 class III) expecting a singleton pregnancy were studied at 13 to 16 weeks gestation. Energy expenditure (EE) was measured during sleep (SleepEE, average EE from 0200-0500 hours) in a whole-room calorimeter, and total daily EE (TDEE) over 7 days using doubly labeled water. Glucose, insulin, thyroid hormones, and catecholamines were measured. RESULTS Body composition explained 70% variability in SleepEE, and SleepEE accounted for 67% to 73% of TDEE. Though there was no evidence of consistent low metabolism, there was considerable variability. Low SleepEE was associated with insulin resistance and low triiodothyronine concentrations (both P = 0.01). Physical activity level was 1.47 ± 0.02. For women with SleepEE within 100 kcal/d of their predicted EE, TDEE was significantly less than the estimate (2,530 ± 91 vs. 2,939 kcal/d; P < 0.001) provided from the most recent gestational energy requirement model. CONCLUSIONS Pregnant women with obesity are inactive, possibly predisposing them to excess GWG. Current energy requirement models overestimate activity and may promote excess GWG in women with obesity. Furthermore, the observed large interindividual variability in basal metabolism may be important to consider when assessing the risk for excess GWG.
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Affiliation(s)
- Jasper Most
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Porsha M Vallo
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - L Anne Gilmore
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Marshall St Amant
- LSU Health Sciences Center, Louisiana State University, New Orleans, Louisiana, USA
- Woman's Hospital, Baton Rouge, Louisiana, USA
| | - Daniel S Hsia
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Abby D Altazan
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Robbie A Beyl
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Eric Ravussin
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Leanne M Redman
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
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18
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Mastella LS, Weinert LS, Gnielka V, Hirakata VN, Oppermann MLR, Silveiro SP, Reichelt AJ. Influence of maternal weight gain on birth weight: a gestational diabetes cohort. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:55-63. [PMID: 29694632 PMCID: PMC10118693 DOI: 10.20945/2359-3997000000009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 06/12/2017] [Indexed: 11/23/2022]
Abstract
Objective Our objective was to evaluate gestational weight gain (GWG) patterns and their relation to birth weight. Subjects and methods We prospectively enrolled 474 women with gestational diabetes mellitus (GDM) at a university hospital (Porto Alegre, Brazil, November 2009-May 2015). GWG was categorized according to the 2009 Institute of Medicine guidelines; birth weight was classified as large (LGA) or small (SGA) for gestational age. Adjusted relative risks (aRRs) and 95% confidence intervals (95% CIs) were determined. Results Adequate GWG occurred in 121 women [25.5%, 95% CI: 22, 30%]; excessive, in 180 [38.0%, 95% CI: 34, 43%]; and insufficient, in 173 [36.5%, 95% CI: 32, 41%]. In women with normal body mass index (BMI), the prevalence of SGA was higher in those with insufficient compared to adequate GWG (30% vs. 0%, p < 0.001). In women with BMI ≥ 25 kg/m2, excessive GWG increased the prevalence of LGA [aRR 2.58, 95% CI: 1.06, 6.29] and protected from SGA [aRR 0.25, 95% CI: 0.10, 0.64]. Insufficient vs. adequate GWG did not influence the prevalence of SGA [aRR 0.61, 95% CI: 0.31, 1.22]; insufficient vs. excessive GWG protected from LGA [aRR 0.46, 95% CI: 0.23, 0.91]. Conclusions One quarter of this cohort achieved adequate GWG, indicating that specific ranges have to be tailored for GDM. To prevent inadequate birth weight, excessive GWG in women with higher BMI and less than recommended GWG in normal BMI women should be avoided; less than recommended GWG may be suitable for overweight and obese women.
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Affiliation(s)
- Livia S Mastella
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | | | - Vanessa Gnielka
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Vânia N Hirakata
- Unidade de Bioestatística, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Maria Lúcia R Oppermann
- Serviço de Obstetrícia e Ginecologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | | | - Angela J Reichelt
- Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
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19
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Barquiel B, Herranz L, Meneses D, Moreno Ó, Hillman N, Burgos MÁ, Bartha JL. Optimal Gestational Weight Gain for Women with Gestational Diabetes and Morbid Obesity. Matern Child Health J 2018; 22:1297-1305. [PMID: 29497985 DOI: 10.1007/s10995-018-2510-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Our aim was to investigate the greatest gestational weight gain (GWG) without adverse pregnancy complications in women with gestational diabetes mellitus (GDM) and morbid obesity. METHODS An observational retrospective study including 3284 patients with single pregnancies and GDM was completed. Of the patients, 131 (4.0%) were classified as having pre-pregnancy morbid obesity (BMI ≥ 35 kg/m2). Perinatal complications were compared among BMI groups. In the group with morbid obesity, GWG threshold values to predict outcomes were examined based on sensitivity and specificity values under the receiver operating characteristic curve. RESULTS GWG was higher in mothers with morbid obesity and macrosomic neonates: 11.3 (4.4-15.7) versus 4.8 (1.5-8.2) kg (p = 0.033). The GWG and neonatal ponderal index were positively correlated (r = 0.305, p = 0.001). The GWG was 7.0 (2.9-11.6) kg in women with hypertensive disorder versus 4.5 (1.0-7.5) kg in normotensive women (p = 0.017). A GWG above 5 kg was a risk factor for macrosomia (87.8% sensitivity, 54.7% specificity) and hypertensive disorder (70.0% sensitivity, 48.4% specificity). GWG associations were maintained after controlling for glycemic control, maternal and gestational age, parity, smoking and neonatal sex. CONCLUSIONS FOR PRACTICE A GWG below 5 kg is recommended for women with GDM and morbid obesity. In these women, adequate GWG may prevent macrosomia, fetal overgrowth and hypertensive disorder.
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Affiliation(s)
- Beatriz Barquiel
- Diabetes and Pregnancy Unit, Division of Diabetes, La Paz University Hospital, Paseo de la Castellana 261, CP 28046, Madrid, Spain.
| | - Lucrecia Herranz
- Diabetes and Pregnancy Unit, Division of Diabetes, La Paz University Hospital, Paseo de la Castellana 261, CP 28046, Madrid, Spain
| | - Diego Meneses
- Diabetes and Pregnancy Unit, Division of Diabetes, La Paz University Hospital, Paseo de la Castellana 261, CP 28046, Madrid, Spain
| | - Óscar Moreno
- Diabetes and Pregnancy Unit, Division of Diabetes, La Paz University Hospital, Paseo de la Castellana 261, CP 28046, Madrid, Spain
| | - Natalia Hillman
- Diabetes and Pregnancy Unit, Division of Diabetes, La Paz University Hospital, Paseo de la Castellana 261, CP 28046, Madrid, Spain
| | - Mª Ángeles Burgos
- Diabetes and Pregnancy Unit, Department of Obstetrics, La Paz University Hospital, Madrid, Spain
| | - José Luis Bartha
- Diabetes and Pregnancy Unit, Department of Obstetrics, La Paz University Hospital, Madrid, Spain
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Goldstein RF, Abell SK, Ranasinha S, Misso M, Boyle JA, Black MH, Li N, Hu G, Corrado F, Rode L, Kim YJ, Haugen M, Song WO, Kim MH, Bogaerts A, Devlieger R, Chung JH, Teede HJ. Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis. JAMA 2017; 317:2207-2225. [PMID: 28586887 PMCID: PMC5815056 DOI: 10.1001/jama.2017.3635] [Citation(s) in RCA: 973] [Impact Index Per Article: 139.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Body mass index (BMI) and gestational weight gain are increasing globally. In 2009, the Institute of Medicine (IOM) provided specific recommendations regarding the ideal gestational weight gain. However, the association between gestational weight gain consistent with theIOM guidelines and pregnancy outcomes is unclear. OBJECTIVE To perform a systematic review, meta-analysis, and metaregression to evaluate associations between gestational weight gain above or below the IOM guidelines (gain of 12.5-18 kg for underweight women [BMI <18.5]; 11.5-16 kg for normal-weight women [BMI 18.5-24.9]; 7-11 kg for overweight women [BMI 25-29.9]; and 5-9 kg for obese women [BMI ≥30]) and maternal and infant outcomes. DATA SOURCES AND STUDY SELECTION Search of EMBASE, Evidence-Based Medicine Reviews, MEDLINE, and MEDLINE In-Process between January 1, 1999, and February 7, 2017, for observational studies stratified by prepregnancy BMI category and total gestational weight gain. DATA EXTRACTION AND SYNTHESIS Data were extracted by 2 independent reviewers. Odds ratios (ORs) and absolute risk differences (ARDs) per live birth were calculated using a random-effects model based on a subset of studies with available data. MAIN OUTCOMES AND MEASURES Primary outcomes were small for gestational age (SGA), preterm birth, and large for gestational age (LGA). Secondary outcomes were macrosomia, cesarean delivery, and gestational diabetes mellitus. RESULTS Of 5354 identified studies, 23 (n = 1 309 136 women) met inclusion criteria. Gestational weight gain was below or above guidelines in 23% and 47% of pregnancies, respectively. Gestational weight gain below the recommendations was associated with higher risk of SGA (OR, 1.53 [95% CI, 1.44-1.64]; ARD, 5% [95% CI, 4%-6%]) and preterm birth (OR, 1.70 [1.32-2.20]; ARD, 5% [3%-8%]) and lower risk of LGA (OR, 0.59 [0.55-0.64]; ARD, -2% [-10% to -6%]) and macrosomia (OR, 0.60 [0.52-0.68]; ARD, -2% [-3% to -1%]); cesarean delivery showed no significant difference (OR, 0.98 [0.96-1.02]; ARD, 0% [-2% to 1%]). Gestational weight gain above the recommendations was associated with lower risk of SGA (OR, 0.66 [0.63-0.69]; ARD, -3%; [-4% to -2%]) and preterm birth (OR, 0.77 [0.69-0.86]; ARD, -2% [-2% to -1%]) and higher risk of LGA (OR, 1.85 [1.76-1.95]; ARD, 4% [2%-5%]), macrosomia (OR, 1.95 [1.79-2.11]; ARD, 6% [4%-9%]), and cesarean delivery (OR, 1.30 [1.25-1.35]; ARD, 4% [3%-6%]). Gestational diabetes mellitus could not be evaluated because of the nature of available data. CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis of more than 1 million pregnant women, 47% had gestational weight gain greater than IOM recommendations and 23% had gestational weight gain less than IOM recommendations. Gestational weight gain greater than or less than guideline recommendations, compared with weight gain within recommended levels, was associated with higher risk of adverse maternal and infant outcomes.
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Affiliation(s)
- Rebecca F. Goldstein
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
- Monash Diabetes and Endocrine Units, Monash Health, Victoria, Australia
| | - Sally K. Abell
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
- Monash Diabetes and Endocrine Units, Monash Health, Victoria, Australia
| | - Sanjeeva Ranasinha
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
| | - Marie Misso
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
| | - Jacqueline A. Boyle
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
| | - Mary Helen Black
- Kaiser Permanente, Southern California, Los Angeles
- Ambry Genetics, Aliso Viejo, California
| | - Nan Li
- Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | | | - Line Rode
- Department of Biochemistry, Copenhagen University Hospital, Righospitalet, Copenhagen, Denmark
| | - Young Ju Kim
- Department of Obstetrics and Gynecology, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | | | | | - Min Hyoung Kim
- Dankook University College of Medicine, Seoul, Republic of Korea
| | - Annick Bogaerts
- Department of Development and Regeneration KU Leuven, University of Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium
- Faculty of Health and Social Work, Research Unit Healthy Living, UC Leuven-Limburg, Leuven, Belgium
| | - Roland Devlieger
- Department of Obstetrics and Gynaecology, University Hospitals KU Leuven, Leuven, Belgium
- Department of Obstetrics, Gynaecology and Fertility, GZA Campus Sint-Augustinus, Wilrijk, Belgium
| | | | - Helena J. Teede
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
- Monash Diabetes and Endocrine Units, Monash Health, Victoria, Australia
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Shmueli A, Borovich A, Bergel R, Ovadia T, Hiersch L, Ashwal E, Yogev Y, Aviram A. Gestational weight gain among nutritionally treated GDM patients. J Matern Fetal Neonatal Med 2017; 31:1177-1181. [PMID: 28335654 DOI: 10.1080/14767058.2017.1311316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We aimed to evaluate pregnancy outcome in diet-treated gestational diabetes mellitus (GDM) patients according to the 2009 Institute of Medicine (IOM) guidelines concerning gestational weight gain (GWG). DESIGN AND PATIENTS This was a retrospective cohort study, limited to women with singleton pregnancies and diet-treated GDM. Women with preexisting diabetes or women with pharmaceutical treatment were excluded. We compared patients with adequate GWG with patients with excess GWG according to the 2009 IOM guidelines. RESULTS Overall, 142 women were evaluated, of which 99 (69.7%) had adequate GWG and 43 (30.3%) had excess GWG. All demonstrated good glycemic control. Patients in the excess GWG group had higher mean pre-pregnancy weight and body mass index (BMI). No other obstetrical or perinatal statistically significant differences were demonstrated, although there was a trend for higher birth weight percentile and higher rate of respiratory distress among the excess GWG group. CONCLUSIONS Higher pre-pregnancy BMI is a risk factor for failing to comply with the 2009 IOM GWG guidelines. However, it seems that in pregnancies complicated by diet-treated GDM, GWG is not a reliable marker for adverse pregnancy outcome if glycemic control is adequate.
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Affiliation(s)
- Anat Shmueli
- a Helen Schneider Hospital for Women, Rabin Medical Center, Petah-Tikva, Israel (Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel )
| | - Adi Borovich
- a Helen Schneider Hospital for Women, Rabin Medical Center, Petah-Tikva, Israel (Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel )
| | - Riki Bergel
- a Helen Schneider Hospital for Women, Rabin Medical Center, Petah-Tikva, Israel (Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel )
| | - Tamar Ovadia
- a Helen Schneider Hospital for Women, Rabin Medical Center, Petah-Tikva, Israel (Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel )
| | - Liran Hiersch
- a Helen Schneider Hospital for Women, Rabin Medical Center, Petah-Tikva, Israel (Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel )
| | - Eran Ashwal
- b Lis Maternity and Women's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel (Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel )
| | - Yariv Yogev
- b Lis Maternity and Women's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel (Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel )
| | - Amir Aviram
- b Lis Maternity and Women's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel (Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel )
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Thompson JR, Valleau JC, Barling AN, Franco JG, DeCapo M, Bagley JL, Sullivan EL. Exposure to a High-Fat Diet during Early Development Programs Behavior and Impairs the Central Serotonergic System in Juvenile Non-Human Primates. Front Endocrinol (Lausanne) 2017; 8:164. [PMID: 28785241 PMCID: PMC5519527 DOI: 10.3389/fendo.2017.00164] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 06/27/2017] [Indexed: 12/29/2022] Open
Abstract
Perinatal exposure to maternal obesity and high-fat diet (HFD) consumption not only poses metabolic risks to offspring but also impacts brain development and mental health. Using a non-human primate model, we observed a persistent increase in anxiety in juvenile offspring exposed to a maternal HFD. Postweaning HFD consumption also increased anxiety and independently increased stereotypic behaviors. These behavioral changes were associated with modified cortisol stress response and impairments in the development of the central serotonin synthesis, with altered tryptophan hydroxylase-2 mRNA expression in the dorsal and median raphe. Postweaning HFD consumption decreased serotonergic immunoreactivity in area 10 of the prefrontal cortex. These results suggest that perinatal exposure to HFD consumption programs development of the brain and endocrine system, leading to behavioral impairments associated with mental health and neurodevelopmental disorders. Also, an early nutritional intervention (consumption of the control diet at weaning) was not sufficient to ameliorate many of the behavioral changes, such as increased anxiety, that were induced by maternal HFD consumption. Given the level of dietary fat consumption and maternal obesity in developed nations these findings have important implications for the mental health of future generations.
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Affiliation(s)
- Jacqueline R. Thompson
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, United States
- Division of Cardiometabolic Health, Oregon National Primate Research Center, Beaverton, OR, United States
| | - Jeanette C. Valleau
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, United States
- Division of Cardiometabolic Health, Oregon National Primate Research Center, Beaverton, OR, United States
| | - Ashley N. Barling
- Department of Biology, University of Portland, Portland, OR, United States
| | - Juliana G. Franco
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, United States
- Division of Cardiometabolic Health, Oregon National Primate Research Center, Beaverton, OR, United States
| | - Madison DeCapo
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, United States
- Division of Cardiometabolic Health, Oregon National Primate Research Center, Beaverton, OR, United States
| | - Jennifer L. Bagley
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, United States
- Division of Cardiometabolic Health, Oregon National Primate Research Center, Beaverton, OR, United States
| | - Elinor L. Sullivan
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, United States
- Division of Cardiometabolic Health, Oregon National Primate Research Center, Beaverton, OR, United States
- Department of Biology, University of Portland, Portland, OR, United States
- *Correspondence: Elinor L. Sullivan,
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Bodnar LM, Pugh SJ, Lash TL, Hutcheon JA, Himes KP, Parisi SM, Abrams B. Low Gestational Weight Gain and Risk of Adverse Perinatal Outcomes in Obese and Severely Obese Women. Epidemiology 2016; 27:894-902. [PMID: 27682365 PMCID: PMC5117438 DOI: 10.1097/ede.0000000000000535] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Our objective was to estimate associations between gestational weight gain z scores and preterm birth, neonatal intensive care unit admission, large- and small-for-gestational age birth, and cesarean delivery among grades 1, 2, and 3 obese women. METHODS We included singleton infants born in Pennsylvania (2003-2011) to grade 1 (body mass index 30-34.9 kg/m, n = 148,335), grade 2 (35-39.9 kg/m, n = 72,032), or grade 3 (≥40 kg/m, n = 47,494) obese mothers. Total pregnancy weight gain (kg) was converted to gestational age-standardized z scores. Multivariable Poisson regression models stratified by obesity grade were used to estimate associations between z scores and outcomes. A probabilistic bias analysis, informed by an internal validation study, evaluated the impact of body mass index and weight gain misclassification. RESULTS Risks of adverse outcomes did not substantially vary within the range of z scores equivalent to 40-week weight gains of -4.3 to 9 kg for grade 1 obese, -8.2 to 5.6 kg for grade 2 obese, and -12 to -2.3 kg for grade 3 obese women. As gestational weight gain increased beyond these z score ranges, there were slight declines in risk of small-for-gestational age birth but rapid rises in cesarean delivery and large-for-gestational age birth. Risks of preterm birth and neonatal intensive care unit admission were weakly associated with weight gain. The bias analysis supported the validity of the conventional analysis. CONCLUSIONS Gestational weight gain below national recommendations for obese mothers (5-9 kg) may not be adversely associated with fetal growth, gestational age at delivery, or mode of delivery.
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Affiliation(s)
- Lisa M. Bodnar
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA
- Magee-Womens Research Institute, Pittsburgh, PA
| | - Sarah J. Pugh
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Timothy L. Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jennifer A. Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine P. Himes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA
- Magee-Womens Research Institute, Pittsburgh, PA
| | - Sara M. Parisi
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Barbara Abrams
- Division of Epidemiology, University of California at Berkeley School of Public Health, Berkeley, CA
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Kim SY, Sharma AJ, Sappenfield W, Salihu HM. Preventing large birth size in women with preexisting diabetes mellitus: The benefit of appropriate gestational weight gain. Prev Med 2016; 91:164-168. [PMID: 27539071 PMCID: PMC5050147 DOI: 10.1016/j.ypmed.2016.08.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/12/2016] [Accepted: 08/14/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To estimate the percentage of infants with large birth size attributable to excess gestational weight gain (GWG), independent of prepregnancy body mass index, among mothers with preexisting diabetes mellitus (PDM). STUDY DESIGN We analyzed 2004-2008 Florida linked birth certificate and maternal hospital discharge data of live, term (37-41weeks) singleton deliveries (N=641,857). We calculated prevalence of large-for-gestational age (LGA) (birth weight-for-gestational age≥90th percentile) and macrosomia (birth weight>4500g) by GWG categories (inadequate, appropriate, or excess). We used multivariable logistic regression to estimate the relative risk (RR) of large birth size associated with excess compared to appropriate GWG among mothers with PDM. We then estimated the population attributable fraction (PAF) of large birth size due to excess GWG among mothers with PDM (n=4427). RESULTS Regardless of diabetes status, half of mothers (51.2%) gained weight in excess of recommendations. Large birth size was higher in infants of mothers with PDM than in infants of mothers without diabetes (28.8% versus 9.4% for LGA, 5.8% versus 0.9% for macrosomia). Among women with PDM, the adjusted RR of having an LGA infant was 1.7 (95% CI 1.5, 1.9) for women with excess GWG compared to those with appropriate gain; the PAF was 27.7% (95% CI 22.0, 33.3). For macrosomia, the adjusted RR associated with excess GWG was 2.1 (95% CI 1.5, 2.9) and the PAF was 38.6% (95% CI 24.9, 52.4). CONCLUSION Preventing excess GWG may avert over one-third of macrosomic term infants of mothers with PDM. Effective strategies to prevent excess GWG are needed.
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Affiliation(s)
- Shin Y Kim
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Andrea J Sharma
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; US Public Health Service Commissioned Corps, Atlanta, GA, USA
| | | | - Hamisu M Salihu
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
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Xu Z, Wen Z, Zhou Y, Li D, Luo Z. Inadequate weight gain in obese women and the risk of small for gestational age (SGA): a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2016; 30:357-367. [PMID: 27033234 DOI: 10.3109/14767058.2016.1173029] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To examine the association between small for gestational age (SGA) and inadequate gestational weight gain (GWG) in obese women (compared with Institute of Medicine [IOM] guidelines) stratified by obesity classes. METHODS We conducted a meta-analysis of original researches with sufficient information about inadequate GWG in obese women stratified by obesity classes. SGA as the chief outcome was extracted and assessed in our analysis. MEDLINE and EMBASE were searched through Ovid from 28 May 2009 to 1 December 2015. Quality was assessed using a modified Newcastle-Ottawa scale. RESULTS 480 citations were screened and 13 studies (437 512 obese women) were included. Obese women who gained weight below the guidelines had higher risks of SGA than those who gained weight within the guidelines (OR 1.28; 95% CI 1.14-1.43). The same conclusions were also confirmed in Class I, Class II and Class III of obese women: Class I (OR 1.37; 95% CI 1.22-1.54); Class II (OR 1.38; 95% CI 1.24-1.54); Class III (OR 1.25; 95% CI 1.14-1.36). CONCLUSIONS From our analysis, the guidelines of IOM can be applied to all the classes of obesity. More accurate boundaries for each obesity class should be established to evaluate the maternal and fetal risks. Diverse populations are thus necessary for more studies in the future.
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Affiliation(s)
- Zhou Xu
- a The College of Clinical Medicine, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Zhenxing Wen
- a The College of Clinical Medicine, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Yuhan Zhou
- b The College of Clinical Pediatrics, Chongqing Medical University , Chongqing , China
| | - Duanhua Li
- c Sichuan Industrial Institute of Antibiotics, Chengdu University , Chengdu , China
| | - Zhongli Luo
- d Molecular Medicine and Cancer Research Center, Chongqing Medical University , Chongqing , China , and.,e The College of Basic Medical Sciences, Chongqing Medical University , Chongqing , China
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Emotional Experiences of Obese Women with Adequate Gestational Weight Variation: A Qualitative Study. PLoS One 2015; 10:e0141879. [PMID: 26529600 PMCID: PMC4631528 DOI: 10.1371/journal.pone.0141879] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 10/14/2015] [Indexed: 11/25/2022] Open
Abstract
Background As a result of the growth of the obese population, the number of obese women of fertile age has increased in the last few years. Obesity in pregnancy is related to greater levels of anxiety, depression and physical harm. However, pregnancy is an opportune moment for the intervention of health care professionals to address obesity. The objective of this study was to describe how obese pregnant women emotionally experience success in adequate weight control. Methods and Findings Using a qualitative design that seeks to understand content in the field of health, the sample of subjects was deliberated, with thirteen obese pregnant women selected to participate in an individual interview. Data was analysed by inductive content analysis and includes complete transcription of the interviews, re-readings using suspended attention, categorization in discussion topics and the qualitative and inductive analysis of the content. The analysis revealed four categories, three of which show the trajectory of body care that obese women experience during pregnancy: 1) The obese pregnant woman starts to think about her body;2) The challenge of the diet for the obese pregnant woman; 3) The relation of the obese pregnant woman with the team of antenatal professionals. The fourth category reveals the origin of the motivation for the change: 4) The potentializing factors for change: the motivation of the obese woman while pregnant. Conclusions During pregnancy, obese women are more in touch with themselves and with their emotional conflicts. Through the transformations of their bodies, women can start a more refined self-care process and experience of the body-mind unit. The fear for their own and their baby's life, due to the risks posed by obesity, appears to be a great potentializing factor for change. The relationship with the professionals of the health care team plays an important role in the motivational support of the obese pregnant woman.
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Sullivan EL, Riper KM, Lockard R, Valleau JC. Maternal high-fat diet programming of the neuroendocrine system and behavior. Horm Behav 2015; 76:153-61. [PMID: 25913366 PMCID: PMC4619177 DOI: 10.1016/j.yhbeh.2015.04.008] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/20/2015] [Accepted: 04/06/2015] [Indexed: 01/05/2023]
Abstract
This article is part of a Special Issue "SBN 2014". Maternal obesity, metabolic state, and diet during gestation have profound effects on offspring development. The prevalence of neurodevelopmental and mental health disorders has risen rapidly in the last several decades in parallel with the rise in obesity rates. Evidence from epidemiological studies indicates that maternal obesity and metabolic complications increase the risk of offspring developing behavioral disorders such as attention deficit hyperactivity disorder (ADHD), autism spectrum disorders (ASD), and schizophrenia. Animal models show that a maternal diet high in fat similarly disrupts behavioral programming of offspring, with animals showing social impairments, increased anxiety and depressive behaviors, reduced cognitive development, and hyperactivity. Maternal obesity, metabolic conditions, and high fat diet consumption increase maternal leptin, insulin, glucose, triglycerides, and inflammatory cytokines. This leads to increased risk of placental dysfunction, and altered fetal neuroendocrine development. Changes in brain development that likely contribute to the increased risk of behavioral and mental health disorders include increased inflammation in the brain, as well as alterations in the serotonergic system, dopaminergic system and hypothalamic-pituitary-adrenal (HPA) axis.
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Affiliation(s)
- Elinor L Sullivan
- Department of Biology, University of Portland, Portland, OR, USA; Division of Diabetes, Obesity and Metabolism, Oregon National Primate Research Center, Beaverton, OR, USA.
| | - Kellie M Riper
- Department of Biology, University of Portland, Portland, OR, USA
| | - Rachel Lockard
- Department of Biology, University of Portland, Portland, OR, USA
| | - Jeanette C Valleau
- Division of Diabetes, Obesity and Metabolism, Oregon National Primate Research Center, Beaverton, OR, USA
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Faucher MA, Barger MK. Gestational weight gain in obese women by class of obesity and select maternal/newborn outcomes: A systematic review. Women Birth 2015; 28:e70-9. [DOI: 10.1016/j.wombi.2015.03.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 03/25/2015] [Accepted: 03/27/2015] [Indexed: 11/16/2022]
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Rivera HM, Christiansen KJ, Sullivan EL. The role of maternal obesity in the risk of neuropsychiatric disorders. Front Neurosci 2015; 9:194. [PMID: 26150767 PMCID: PMC4471351 DOI: 10.3389/fnins.2015.00194] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 05/16/2015] [Indexed: 12/22/2022] Open
Abstract
Recent evidence indicates that perinatal exposure to maternal obesity, metabolic disease, including diabetes and hypertension, and unhealthy maternal diet has a long-term impact on offspring behavior and physiology. During the past three decades, the prevalence of both obesity and neuropsychiatric disorders has rapidly increased. Epidemiologic studies provide evidence that maternal obesity and metabolic complications increase the risk of attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, anxiety, depression, schizophrenia, eating disorders (food addiction, anorexia nervosa, and bulimia nervosa), and impairments in cognition in offspring. Animal models of maternal high-fat diet (HFD) induced obesity also document persistent changes in offspring behavior and impairments in critical neural circuitry. Animals exposed to maternal obesity and HFD consumption display hyperactivity, impairments in social behavior, increased anxiety-like and depressive-like behaviors, substance addiction, food addiction, and diminished cognition. During development, these offspring are exposed to elevated levels of nutrients (fatty acids, glucose), hormones (leptin, insulin), and inflammatory factors (C-reactive protein, interleukin, and tumor necrosis factor). Such factors appear to permanently change neuroendocrine regulation and brain development in offspring. In addition, inflammation of the offspring brain during gestation impairs the development of neural pathways critical in the regulation of behavior, such as serotoninergic, dopaminergic, and melanocortinergic systems. Dysregulation of these circuits increases the risk of mental health disorders. Given the high rates of obesity in most developed nations, it is critical that the mechanisms by which maternal obesity programs offspring behavior are thoroughly characterized. Such knowledge will be critical in the development of preventative strategies and therapeutic interventions.
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Affiliation(s)
- Heidi M Rivera
- Division of Diabetes, Obesity, and Metabolism, Oregon National Primate Research Center Beaverton, OR, USA
| | | | - Elinor L Sullivan
- Division of Diabetes, Obesity, and Metabolism, Oregon National Primate Research Center Beaverton, OR, USA ; Department of Biology, University of Portland Portland, OR, USA
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