Lifestyle and Dietary Habits of an Obese Pregnant Cohort

Relationship between prepregnancy BMI and the concentrations of iron, calcium, and magnesium in serum and hair during the first trimester of pregnancy in women

BACKGROUND

In women of childbearing age, a low dietary supply of iron, calcium, and magnesium is often observed. Minerals deficiency in pregnant women is often associated with abnormal body weight and may impact fetal development disorders. The aim of this study is to determine the relationship between prepregnancy body mass index (BMI) and the dietary intake of iron, calcium and magnesium and their concentrations in serum and hair in pregnant women.

METHOD

The study involved 97 Caucasian/white low-risk pregnant women at 12 weeks of gestation. The analysis of minerals in serum and hair samples was performed using atomic absorption spectrometry. Pre-pregnancy BMI was calculated based on self-reported weight. The study used a validated questionnaire and a 24-h recall nutrition interview, which were analyzed using Aliant software.

RESULTS

It was found that overweight and obese women exhibited higher magnesium concentration in serum, while iron content in serum and hair was markedly lower compared to women with normal body weight. The average total supply of iron was below the recommendation in pregnant women. Moreover, an inverse significant relationship was observed between BMI and iron concentration in hair and serum in the whole population.

CONCLUSION

In conclusion, being overweight or obese before pregnancy is associated with low dietary iron intake and low iron concentration in serum and hair during the first trimester of pregnancy in women.

The relationship between pre-pregnancy BMI and energy and macronutrients intakes during pregnancy in women from Yucatan, Mexico

In this observational study, our aim was to analyse the association between pre-pregnancy BMI and adequacy rates of energy and macronutrient intakes in a sample of pregnant women from Yucatan, Mexico. From September to December 2019, we collected data on socioeconomic, pregnancy, and dietary characteristics, and took anthropometric measurements of women during household visits. Pre-pregnancy BMI was calculated from measured height and self-reported body weight. Energy and macronutrient intakes (obtained from three 24-h dietary recalls) were compared with the estimated trimester-specific requirements to calculate adequacies (%). Multiple linear regression models showed that after accounting for maternal socioeconomic characteristics and perinatal variables, each unit increase in pre-pregnancy BMI was associated with decreases of 2%, 2%, and 2.6% in energy, carbohydrate, and total fat intakes, respectively. These results were significant when under- and over-reporters were excluded from the analyses. Women who enter pregnancy with higher BMI values may voluntarily or involuntarily reduce their food intake.IMPACT STATEMENTWhat is already know about this subject? Some studies have analysed the relationship between pre-pregnancy BMI categories (normal weight, overweight, and obesity) and diet quality during pregnancy, but few studies have focussed on quantitative energy and macronutrient intakes or their adequacies in relation to pre-pregnancy BMI.What do the results of this study contribute? In this sample of Mexican women belonging to a middle socioeconomic status, we found that after excluding under- and over-reporters from the analyses and accounting for maternal socioeconomic characteristics and perinatal variables, BMI was negatively associated with adequacy intake rates of energy, carbohydrates, and total fats during pregnancy.What are the implications of these findings for clinical practice and/or further research? Women who enter pregnancy with higher BMI values may voluntarily or involuntarily reduce their food intake. These results can be used to accordingly plan diet counselling during pregnancy.

Maternal overweight and obesity and its associated factors and outcomes in human immunodeficiency virus (HIV)-infected and HIV-uninfected black South African pregnant women

AIM

This study aimed to investigate various variables between maternal overweight and/or obesity versus normal-weight pregnant black South African women living with and without human immunodeficiency virus (HIV).

METHODS

A cross-sectional study design was employed. A total of 200 pregnant women were enrolled in the study, categorized according to body mass index (BMI) (kg/m² ) into two groups: (1) overweight/obese (≥25 kg/m² ) (n = 97); and (2) nonoverweight/nonobese (<25 kg/m² ) (n = 103), where 90 were HIV-infected and 110 were HIV-uninfected. The differences between the maternal BMI categories were assessed using Fisher's exact t-test and the χ² test. Simple and multiple logistic regression analyses were used to determine factors associated with maternal overweight and obesity.

RESULTS

Multiple logistic regression analysis showed that maternal age (odds ratio [OR]: 1.061; 95% confidence interval [CI] 1.008-1.117; p = 0.023) and gestational age (OR: 1.121; 95% CI 1.005-1.251; p = 0.041) were significantly associated with maternal overweight/obesity in both HIV-infected and HIV-uninfected. For maternal health outcomes, multiple logistic regression analysis showed that hypertensive disorders (OR: 0.273; 95% CI 0.124-0.601; p = 0.001) and anemia (OR: 2.420; 95% CI 1.283-4.563; p = 0.006) were significantly associated with maternal overweight/obesity in both HIV-infected and HIV-uninfected. The overweight/obese HIV-infected participants (OR: 0.233; 95% CI 0.075-0.717; p = 0.011) had increased odds for developing hypertensive disorders compared to HIV-uninfected overweight/obese participants (OR: 0.471; 95% CI 0.172-1.291; p = 0.143).

CONCLUSIONS

Maternal overweight/obesity in both HIV-infected and HIV-uninfected pregnant black South African women was significantly associated with maternal age, gestational age, HPT disorders, and anemia. Maternal overweight/obesity decreased the odds for anemia, but increased the odds for the development of HPT disorders, especially in the HIV-infected pregnant women.

Underreporting of Energy Intake Increases over Pregnancy: An Intensive Longitudinal Study of Women with Overweight and Obesity

(1) Background: Energy intake (EI) underreporting is a widespread problem of great relevance to public health, yet is poorly described among pregnant women. This study aimed to describe and predict error in self-reported EI across pregnancy among women with overweight or obesity. (2) Methods: Participants were from the Healthy Mom Zone study, an adaptive intervention to regulate gestational weight gain (GWG) tested in a feasibility RCT and followed women (n = 21) with body mass index (BMI) ≥25 from 8−12 weeks to ~36 weeks gestation. Mobile health technology was used to measure daily weight (Wi-Fi Smart Scale), physical activity (activity monitor), and self-reported EI (MyFitnessPal App). Estimated EI was back-calculated daily from measured weight and physical activity data. Associations between underreporting and gestational age, demographics, pre-pregnancy BMI, GWG, perceived stress, and eating behaviors were tested. (3) Results: On average, women were 30.7 years old and primiparous (62%); reporting error was −38% ± 26 (range: −134% (underreporting) to 97% (overreporting)), representing an ~1134 kcal daily underestimation of EI (1404 observations). Estimated (back-calculated), but not self-reported, EI increased across gestation (p < 0.0001). Higher pre-pregnancy BMI (p = 0.01) and weekly GWG (p = 0.0007) was associated with greater underreporting. Underreporting was lower when participants reported higher stress (p = 0.02) and emotional eating (p < 0.0001) compared with their own average. (4) Conclusions: These findings suggest systemic underreporting in pregnant women with elevated BMI using a popular mobile app to monitor diet. Advances in technology that allow estimation of EI from weight and physical activity data may provide more accurate dietary self-monitoring during pregnancy.

Effectiveness of an intervention focusing on diet and walking during pregnancy in the primary health care service

Interventions during prenatal care can mitigate negative outcomes of a sedentary lifestyle and unhealthy diet during pregnancy. We aimed to evaluate the effectiveness of an intervention that promoted healthy diet and leisure-time walking during antenatal care in a pragmatic, controlled, non-randomized intervention study. Physicians and nurses from all health care units of the Family Health Strategy model of health assistance participated in educational training to promote leisure-time walking and healthy diet during antenatal care visits. Pregnant women who received health care from these professionals constituted the intervention group (n = 181). The control group (n = 172) included pregnant women who received routine antenatal care, in health care units of the traditional model of health assistance. Data were collected in each trimester of pregnancy. Diet was investigated using a food frequency questionnaire adapted from Risk and Protective Factors Surveillance System for Chronic Non-Comunicable Diseases Through Telephone Interview (Vigitel). Leisure-time walking in a typical week was assessed using questions from the Physical Activity in Pregnancy Questionnaire. There were positive effects on leisure-time walking during the second trimester and the third trimester of pregnancy and on the women who achieved 150 minutes per week of walking during the third trimester. The intervention reduced the risk of pregnant women consuming soft drinks and/or commercially prepared cookies in the third trimester. This lifestyle intervention was partially effective, tripling the proportion of pregnant women who achieved the recommended walking time and reducing by half the proportion of women who had a high weekly consumption of soft drinks and industrially processed cookies.

Adaptive, behavioral intervention impact on weight gain, physical activity, energy intake, and motivational determinants: results of a feasibility trial in pregnant women with overweight/obesity

Interventions have modest impact on reducing excessive gestational weight gain (GWG) in pregnant women with overweight/obesity. This two-arm feasibility randomized control trial tested delivery of and compliance with an intervention using adapted dosages to regulate GWG, and examined pre-post change in GWG and secondary outcomes (physical activity: PA, energy intake: EI, theories of planned behavior/self-regulation constructs) compared to a usual care group. Pregnant women with overweight/obesity (N = 31) were randomized to a usual care control group or usual care + intervention group from 8 to 2 weeks gestation and completed the intervention through 36 weeks gestation. Intervention women received weekly evidence-based education/counseling (e.g., GWG, PA, EI) delivered by a registered dietitian in a 60-min face-to-face session. GWG was monitored weekly; women within weight goals continued with education while women exceeding goals received more intensive dosages (e.g., additional hands-on EI/PA sessions). All participants used mHealth tools to complete daily measures of weight (Wi-Fi scale) and PA (activity monitor), weekly evaluation of diet quality (MyFitnessPal app), and weekly/monthly online surveys of motivational determinants/self-regulation. Daily EI was estimated with a validated back-calculation method as a function of maternal weight, PA, and resting metabolic rate. Sixty-five percent of eligible women were randomized; study completion was 87%; 10% partially completed the study and drop-out was 3%. Compliance with using the mHealth tools for intensive data collection ranged from 77 to 97%; intervention women attended > 90% education/counseling sessions, and 68-93% dosage step-up sessions. The intervention group (6.9 kg) had 21% lower GWG than controls (8.8 kg) although this difference was not significant. Exploratory analyses also showed the intervention group had significantly lower EI kcals at post-intervention than controls. A theoretical, adaptive intervention with varied dosages to regulate GWG is feasible to deliver to pregnant women with overweight/obesity.

Dietary intakes of women with Type 1 diabetes before and during pregnancy: a pre-specified secondary subgroup analysis among CONCEPTT participants

AIM

To describe the dietary intakes of women with Type 1 diabetes before and during pregnancy.

METHODS

This was a pre-specified subgroup analysis of CONCEPTT involving 63 women planning pregnancy and 93 pregnant women from 14 sites in England, Scotland and Ireland. Two hundred and forty-six 3-day food diaries (104 planning pregnancy, 142 pregnant) were matched to data source and food reference codes, and analysed using dietary software. Participants were informed that food diaries would be de-identified and used only for research purposes.

RESULTS

Mean (sd) daily energy intake was 1588 (346) kcal and 1673 (384) kcal in women planning pregnancy and pregnant women respectively. Total carbohydrate intake was consistent with dietary guideline recommendations [180 (52) g planning pregnancy, 198 (54) g pregnant], but non-recommended sources (e.g. sugars, preserves, confectionery, biscuits, cakes) contributed to 46% of total daily carbohydrate intake. Fat consumption exceeded guideline recommendations [70 (21) g planning pregnancy, 72 (21) g pregnant]. Fibre [15.5 (5.3) g planning pregnancy, 15.4 (5.1) g pregnant], fruit and vegetable intakes [3.5 (2.2) and 3.1 (1.8) serves/day] were inadequate. Twelve women planning pregnancy (19%) and 24 pregnant women (26%) did not meet micronutrient requirements.

CONCLUSIONS

The diets of pregnant women from England, Scotland and Ireland are characterized by high fat, low fibre and poor-quality carbohydrate intakes. Fruit and vegetable consumption is inadequate, with one in four women at risk of micronutrient deficiencies. Further research is needed to optimize maternal nutrition for glycaemic control and for maternal and offspring health.

Dietary behaviours and weight management: A thematic analysis of pregnant women's perceptions

Maternal obesity is associated with increased risk of gestational diabetes and other complications. Although antenatal interventions to help prevent these complications are ongoing, an understanding of overweight and obese pregnant women's opinions and attitudes is lacking. Therefore, this study aims to explore these women's experiences and perceptions of dietary behaviours and weight management during pregnancy. Secondary analysis of qualitative data originally collected to examine lifestyle behaviours in pregnant women was conducted. The data were from a purposive sample of overweight and obese pregnant women attending a public antenatal clinic in Cork, Ireland. The data were explored using thematic analysis. Interviews with 30 overweight and obese pregnant women were analysed. Three themes were developed relating to overweight and obese women's dietary behaviours and weight management perceptions including 'pregnancy's influence on dietary behaviours', 'external influences on dietary behaviours' and 'perception of and preferences for weight related advice and resources'. Together these themes reveal women's experiences of diet and how pregnancy factors (physiological changes) and external factors (family and friends) can influence dietary behaviours. Furthermore, perceptions of weight management advice and lack thereof were highlighted with women drawing attention to potential resources for future use during pregnancy. This study provides important insights into overweight and obese pregnant women's dietary behaviours and perceptions of weight management. According to these findings, there is a need for clear and unambiguous information about weight management, acceptable weight gain, food safety and how to achieve a balanced diet.

Maternal obesity and its determinants: A neglected issue?

Maternal obesity is a global public health concern that affects every aspect of maternity care. It affects the short-term and long-term health of the mother and her offspring. Obese pregnant mothers are at an increased risk of developing complications during antenatal, intrapartum, and postnatal periods. Maternal complications include gestational diabetes mellitus, hypertensive disorder in pregnancy, pre-eclampsia and eclampsia, increased rate of cesarean delivery, pulmonary embolism, and maternal mortality; fetal complications include congenital malformation, stillbirth, and macrosomia. Moreover, both mother and infant are at an increased risk of developing subsequent non-communicable diseases and cardiovascular problems later in life. Several factors are associated with the likelihood of maternal obesity, including sociodemographic characteristics, obstetric characteristics, knowledge, and perception of health-promoting behavior. Gaining a sound understanding of these factors is vital to reaching the targets of Sustainable Developmental Goal 3-to reduce global maternal mortality and end preventable deaths of children under 5 years of age-by 2030. It is essential to identify pregnant women who are at risk of maternal obesity in order to plan and implement effective and timely interventions for optimal pregnancy outcomes. Importantly, maternal obesity as a significant pregnancy risk factor is largely modifiable.

The UK Pregnancies Better Eating and Activity Trial (UPBEAT); Pregnancy Outcomes and Health Behaviours by Obesity Class

The effectiveness of antenatal intervention in women with increasing obesity is unknown. This study investigated whether there was a differential effect of antenatal intervention on diet, physical activity and pregnancy outcomes in women stratified by obesity class using data from the UK Pregnancies Better Eating and Activity Trial (UPBEAT) (n = 1555). The stratification was by World Health Organization classifications: Class I, II and III (30–34.9 kg/m², 35–39.9 kg/m² and ≥40 kg/m²). Using linear and logistic regression, adjusted for confounders, outcomes were assessed post-intervention (27⁺⁰–28⁺⁶ weeks’ gestation) and in late pregnancy (34⁺⁰–36⁺⁰ weeks’ gestation). Interactions between obesity class and the intervention were explored. Compared to the standard care arm, class III intervention women had lower gestational weight gain (GWG) (−1.87 kg; 95% CI −3.29 to −0.47, p = 0.009), and the effect of the intervention was greater in class III compared to class I, by −2.01 kg (95% CI −3.45 to −0.57, p = 0.006). Class I and II intervention women reported significantly lower dietary glycaemic load and saturated fat intake across their pregnancy. This differential effect of the intervention suggests antenatal interventions for women with obesity should stratify outcomes by obesity severity. This would inform evidence-based antenatal strategies for high-risk groups, including women with a BMI ≥ 40 kg/m².

A low intensity dietary intervention for reducing excessive gestational weight gain in an overweight and obese pregnant cohort

PURPOSE

Excessive gestational weight gain is associated with detrimental outcomes to both the mother and baby. Currently, the best approach to prevent excessive gestational weight gain in overweight and obese women is undetermined. The present study aimed to evaluate the effectiveness of a group-based outpatient dietary intervention in pregnancy to reduce excessive gestational weight gain.

METHODS

In this retrospective study, overweight and obese pregnant women who attended a single 90-min group education session were compared to women who received standard care alone. Total gestational weight gain, maternal and neonatal outcomes were compared between the intervention and control groups. Data were analysed using Student t, Mann-Whitney and Chi-squared tests as appropriate. A 24-h dietary recall was analysed and compared to the Australian National Nutrition Survey.

RESULTS

A significant reduction in gestational weight gain was observed with this intervention (P = 0.010), as well as in the rate of small for gestational age births (P = 0.043). Those who attended the intervention had saturated fat and sodium intake levels that exceeded recommendations. Intake of pregnancy-specific micronutrients including folate, calcium and iron were poor from diet alone.

CONCLUSIONS

A low-intensity antenatal dietary intervention may be effective in reducing excessive gestational weight gain, although multi-disciplinary interventions yield the best success. Further research is required to identify the optimal modality and frequency to limit excessive gestational weight gain. Dietary interventions tailored to ethnicity should also be explored.

LEVEL OF EVIDENCE

Level II, controlled trial without randomization.

An antenatal wish list: A qualitative systematic review and thematic synthesis of UK dietary advice for weight management and food borne illness

OBJECTIVES

To understand UK women's experiences of antenatal dietary advice for risk of food borne illness and weight gain.

DESIGN

A systematic review and thematic synthesis of peer-reviewed qualitative studies. PubMed, MEDLINE, CINAHL and PMC databases were searched for articles published from January 2008 to June 2018. The search strategy combined terms for pregnancy with terms for body composition, weight change, food safety, nutrition, diet and qualitative terminology. Studies were eligible for inclusion if (1) they explored experiences of implementing advice received during pregnancy for nutrition, physical activity and/or weight gain, and (2) participants were women who had experienced maternity care in the UK. Study quality was appraised using the Critical Appraisal Skills Programme (CASP) qualitative research appraisal tool.

FINDINGS

Of 25,688 articles identified by the search strategy, 20 studies were identified that met the inclusion criteria. Five major themes were recognised: control, barriers to diet and exercise, motivators, relationship with weight, and information, with a further 12 subthemes. The majority of studies reported on weight gain (n = 10).

KEY CONCLUSIONS

Evidence shows that UK antenatal dietary advice is currently inconsistent, vague and overwhelming despite pregnancy being an excellent time for lifestyle change. Women are primarily driven by the health of their baby and desire support to facilitate positive changes.

IMPLICATIONS FOR PRACTICE

Findings outline a wishlist which highlights a desire for tailored information on preventing weight gain, dietary requirements, safe physical activity and a deprioritisation of food safety guidelines. This provision should be delivered by HCP. e.g. midwives, in a sensitive and supportive way to bridge the gap between women's needs and the current antenatal provision.

An observational analysis of meal patterns in overweight and obese pregnancy: exploring meal pattern behaviours and the association with maternal and fetal health measures

BACKGROUND

Nutrient intakes are known to be poorer among pregnant women with raised body mass index (BMI) than those with a healthy BMI. While meal patterns have the potential to influence obstetric, metabolic and anthropometric measures for mother and infant, limited data exists regarding meal patterns among pregnant women with raised BMI.

AIM

To identify categories of meal patterns among pregnant women with overweight and obesity and determine whether patterns change with advancing gestation. To determine if maternal meal patterns are associated with dietary intakes and pregnancy outcomes.

METHODS

Prospective, observational analysis of pregnant women (n = 143) (BMI 25-39.9 kg/m²). Meal pattern data were analysed from 3-day food diaries at 16 and 28 weeks' gestation. Outcomes include maternal blood glucose, insulin resistance, gestational diabetes, gestational weight gain and infant anthropometry.

RESULTS

Three meal pattern categories were identified: 'main meal dominant' (3 main eating occasions + 0-3 snacks), 'large meal dominant' (≤ 2 main eating occasions + < 2 snacks), and 'snack dominant' (3 main eating occasions + > 3 snacks and ≤ 2 main + ≥ 2 snacks). A main meal-dominant pattern prevailed at 16 weeks' (85.3%) and a snack-dominant pattern at 28 weeks' (68.5%). Dietary glycaemic index was lower among the main meal versus large meal-dominant pattern at 28 weeks (P = 0.018). Infant birth weight (kg) and macrosomia were highest among participants with a large meal-dominant pattern at 28 weeks (P = 0.030 and P = 0.008, respectively).

CONCLUSION

Women with raised BMI changed eating patterns as pregnancy progressed, moving from main meal-dominant to snack-dominant patterns. Large meal-dominant meal patterns in later pregnancy were associated with higher glycaemic index and greater prevalence of macrosomia.

Tracking of Dietary Intake and Diet Quality from Late Pregnancy to the Postpartum Period

The present study aimed to characterize dietary intake and diet quality from late pregnancy to six months postpartum. Participants (n = 28) completed 2-3 Web-based 24 h recalls at three distinct periods: (1) during the third trimester of pregnancy; (2) three months and (3) six months after delivery. Energy, macro-and micronutrient intakes (from foods and supplements), as well as the Canadian healthy eating index (C-HEI) were derived from the dietary recalls. No significant variation in energy and macronutrient intakes was observed between time points. The proportion of women taking at least one supplement decreased over time (p = 0.003). The total intake of several micronutrients (vitamins A, C, D, group B vitamins, iron, magnesium, zinc, calcium, phosphorus, manganese, and copper) decreased significantly over time (p < 0.05 for all micronutrients). The total C-HEI score and its components did not change, except for the total vegetables and fruit subscore, which decreased over time (8.2 ± 2.0 in the 3rd trimester, 7.1 ± 2.2 at three months postpartum, 6.9 ± 2.4 at 6 months postpartum, p = 0.04). In conclusion, we observed a general stability in diet quality, energy, and macronutrient intakes from the third trimester of pregnancy to six months postpartum. However, several micronutrient intakes decreased over time, mostly due to changes in supplement use.

Global inequities in dietary calcium intake during pregnancy: a systematic review and meta-analysis

BACKGROUND

Evidence shows that adequate calcium intake during pregnancy reduces the risk of hypertensive disorders of pregnancy. In most low- and middle-income countries (LMICs) the daily calcium intake is well below recommendations. Mapping calcium intake during pregnancy worldwide and identifying populations with low calcium intake will provide the evidence base for more targeted actions to improve calcium intake.

OBJECTIVE

To assess dietary calcium intake during pregnancy worldwide.

SEARCH STRATEGY

MEDLINE and EMBASE (from July 2004 to November 2017).

SELECTION CRITERIA

Cross-sectional, cohort, and intervention studies reporting calcium intake during pregnancy.

DATA COLLECTION AND ANALYSIS

Five reviewers working in pairs independently performed screening, extraction, and quality assessment. We reported summary measures of calcium intake and calculated the weighted arithmetic mean for high-income countries (HICs) and LMICs independently, and for geographic regions, among studies reporting country of recruitment, mean intake, and total number of participants. When available, inadequate intakes were reported.

MAIN RESULTS

From 1880 citations 105 works met the inclusion criteria, providing data for 73 958 women in 37 countries. The mean calcium intake was 948.3 mg/day (95% CI 872.1-1024.4 mg/day) for HICs and 647.6 mg/day (95% CI 568.7-726.5 mg/day) for LMICs. Calcium intakes below 800 mg/day were reported in five (29%) countries from HICs and in 14 (82%) countries from LMICs.

CONCLUSION

These results are consistent with a lack of improvement in calcium dietary intake during pregnancy and confirm the gap between HICs and LMICs, with alarmingly low intakes recorded for pregnant women in LMICs. From the public health perspective, in the absence of specific local data, calcium supplementation of pregnant women in these countries should be universal.

TWEETABLE ABSTRACT

Despite dietary recommendations, women in LMICs face pregnancy with diets low in calcium.

Adequacy of nutritional intake during pregnancy in relation to prepregnancy BMI: results from the 3D Cohort Study

Our study compares adequacy of nutritional intakes among pregnant women with different prepregnancy BMI and explores associations between nutritional intakes during pregnancy and both prepregnancy BMI and gestational weight gain (GWG). We collected dietary information from a large cohort of pregnant Canadian women (n 861) using a 3-d food record. We estimated usual dietary intakes of energy (E), macronutrients and micronutrients using the National Cancer Institute method. We also performed Pearson's correlations between nutritional intakes and both prepregnancy BMI and GWG. In all BMI categories, intakes considered suboptimal (by comparison with estimated average requirements) were noted for Fe, vitamin D, folate, vitamin B6, Mg, Zn, Ca and vitamin A. Total fat intakes were above the acceptable macronutrient distribution range (AMDR) for 36 % of the women. A higher proportion of obese women had carbohydrate intakes (as %E) below the AMDR (v. normal-weight and overweight women; 19 v. 9 %) and Na intakes above the tolerable upper intake level (v. other BMI categories; 90 v. 77-78 %). In all BMI categories, median intakes of K and fibre were below adequate intake. Intakes of several nutrients (adjusted for energy) were correlated with BMI. Correlations were detected between energy-adjusted nutrient intakes and total GWG and were, for the most part, specific to certain BMI categories. Overweight and obese pregnant women appear to be the most nutritionally vulnerable. Nutrition interventions are needed to guide pregnant women toward their optimal GWG while also meeting their nutritional requirements.

The characterisation of overweight and obese women who are under reporting energy intake during pregnancy

Background

Misreporting of energy intake is common and can contribute to biased estimates of the relationship between diet and disease. Energy intake misreporting is poorly understood in pregnancy and there is limited research assessing characteristics of women who misreport energy intake or changes in misreporting of energy intake across pregnancy.

Methods

An observational study in n = 945 overweight or obese pregnant women receiving standard antenatal care who participated in the LIMIT randomised trial. Diet, physical activity, psychological factors, body image satisfaction and dieting behaviour were assessed at trial entry (10–20 weeks gestation) and 36 weeks gestation. Energy misreporting status was assessed through the ratio of daily energy intake over basal metabolic rate. Logistic regression analyses were conducted with the dependent variable of under reporting of energy intake at study entry or 36 weeks in separate analysis.

Results

At study entry and 36 weeks, women were classified as under reporters (38 vs 49.4%), adequate reporters (59.7 vs 49.8%) or over reporters of energy intake (2.3 vs 0.8%) respectively. The prevalence of under reporting energy intake at 36 weeks was higher than at study entry (early pregnancy). Body mass index (BMI) at study entry and 36 weeks and socioeconomic status, dieting behaviour and risk of depression at 36 weeks were independent predictors of under reporting of energy intake.

Conclusions

Under reporting of energy intake was present in over a third of overweight and obese pregnant women and was higher in late compared to early pregnancy. Characteristics such as BMI, socioeconomic status, past dieting behaviour and risk of depression may aid in identifying women who either require support in accurate recording of food intake or attention for improving diet quality. Results were unable to distinguish whether under reporting reflects misreporting or a true restriction of dietary intake.

Trial registration

Australian and New Zealand Clinical Trials Registry ACTRN12607000161426, registered 9/3/2007.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-1826-x) contains supplementary material, which is available to authorized users.

Relationship of Social Cognitive Theory Concepts to Dietary Habits of Pregnant Women

Background

Nutrition during pregnancy is undoubtedly one of the most important factors affecting maternal health. In this regard, considering the cognitive-behavioral factors associated with feeding, behaviors will play an important role in the effectiveness of interventions. Therefore, this study aimed to investigate the correlation between food habits and structures of social cognitive theory in pregnant women.

Materials and Methods

In this cross-sectional study, 192 pregnant women were randomly selected. Data were collected using a questionnaire based on the social cognitive theory structures and food habits questionnaire in the questioning manner and was also analyzed using Pearson correlation and multiple linear regression with the software Statistical Package for the Social Sciences, version 19.

Results

There was a significant correlation between nutritional behavior with self-regulation (p = 0.001), self-efficacy (p = 0.001), outcome expectations (p = 0.001), social support (p = 0.002), and access (p = 0.001). A significant correlation was observed between lack of consumption of unnecessary and unhelpful food with self-regulation (p = 0.02). In the multivariable regression analysis, only self-regulation revealed significant and direct contribution in relation to nutritional behavior (p < 0.001).

Conclusions

Results of this study showed that self-regulation is one of the important factors associated with feeding behavior in pregnant women so that it is suggested to be considered in nutritional interventions in order to improve nutritional behavior.

Gestational weight gain in obese pregnancy: impact on maternal and foetal metabolic parameters and birthweight

The aim of this prospective, observational study was to investigate the impact of gestational weight gain (GWG) among euglycaemic obese pregnant women on maternal and foetal metabolic parameters and neonatal outcome. Total GWG was recorded for 101 obese, non-diabetic women with a singleton pregnancy. At 28 weeks of gestation, fasting maternal blood samples were analysed for glucose, insulin, c-peptide and lipids. Cord bloods were collected at delivery for analysis of glucose, c-peptide and lipids. GWG (mean ± SD =10.9 ± 5.5 kg) was greatest among those of younger age and lower body mass index and 58% of women exceeded the Institute of Medicine GWG recommendations of 5-9 kg for obese pregnancy. GWG was significantly positively associated with increased risk of birthweight >4 kg, cord c-peptide levels and inversely associated with cord total cholesterol. This study identified that higher GWG in obese pregnancy may increase the risk of macrosomia and neonatal hyperinsulinaemia, within a euglycaemic maternal cohort. Impact statement Excess gestational weight gain (GWG) and maternal obesity frequently co-occur with adverse consequences for maternal and neonatal health; however, little is known of the underlying biological pathways which may be affected to contribute to adverse outcomes. Greater understanding of the biological mechanisms involved may help guide future studies to develop targeted interventions for more effective clinical outcomes. This study identified that higher GWG among obese pregnant women resulted in foetal hyperinsulinaemia even in the absence of maternal hyperglycaemia, potentially representing a biological pathway for larger birthweight babies. These results may highlight the need for more intensive dietary and lifestyle interventions among obese women who would not normally receive additional counselling beyond standard antenatal care if not diagnosed with glucose intolerance in pregnancy.

The Interplay between Maternal Nutrition and Stress during Pregnancy: Issues and Considerations

BACKGROUND

Several studies about humans and animals have separately examined the effects of prenatal nutrition and stress on fetal development, pregnancy, and birth outcomes, and subsequent child health and disease risk. Although substantial evidence from non-pregnant literature supports the presence of bidirectional interactions between nutrition and stress at various psychological, behavioral, and physiological levels, such interaction effects have not yet been systematically examined in the context of pregnancy.

SUMMARY

This paper discusses the multifaceted and multilevel relationship between nutrition and stress. It then reviews the currently available observational and experimental evidence in animals and humans regarding the interplay between maternal psychosocial stress, dietary intake, and nutritional state during pregnancy, and implications for maternal and child health-related outcomes. Key Messages: During pregnancy, maternal psychosocial stress, dietary behavior, and nutritional state likely regulate and counter-regulate one another. Emerging evidence suggests that omega-3 fatty acids may attenuate maternal psychosocial stress, and that high maternal pre-pregnancy body mass index exacerbates unhealthy dietary behaviors under high-stress conditions. Longitudinal studies are warranted in order to understand the interplay between prenatal psychosocial stress, diet, and stress- and nutrition-related biomarkers to obtain further insight and inform the development and design of future, more effective intervention trials for improved maternal and child health outcomes.

Association of maternal prepregnancy BMI with metabolomic profile across gestation

BACKGROUND/OBJECTIVES

Elevated prepregnancy body mass index (pBMI) and excess gestational weight gain (GWG) constitute important prenatal exposures that may program adiposity and disease risk in offspring. The objective of this study is to investigate the influence of pBMI and GWG on the maternal metabolomic profile across pregnancy, and to identify associations with birth weight.

SUBJECTS/METHODS

This is a longitudinal prospective study of 167 nondiabetic women carrying a singleton pregnancy. Women were recruited between March 2011 and December 2013 from antenatal clinics affiliated to the University of California, Irvine, Medical Center. Seven women were excluded from analyses because of a diagnosis of diabetes during pregnancy. A total of 254 plasma metabolites known to be related to obesity in nonpregnant populations were analyzed in each trimester using targeted metabolomics. The effects of pBMI and GWG on metabolites were tested through linear regression and principle component analysis, adjusting for maternal sociodemographic factors, diet, and insulin resistance. A Bonferroni correction was applied for multiple comparison testing.

RESULTS

pBMI was significantly associated with 40 metabolites. Nonesterified fatty acids (NEFA) showed a strong positive association with pBMI, with specificity for mono-unsaturated and omega-6 NEFA. Among phospholipids, sphingomyelins with two double bonds and phosphatidylcholines containing 20:3 fatty acid chain, indicative of omega-6 NEFA, were positively associated with pBMI. Few associations between GWG, quality and quantity of the diet, insulin resistance and the maternal metabolome throughout gestation were detected. NEFA levels in the first and, to a lesser degree, in the second trimester were positively associated with birth weight percentiles.

CONCLUSIONS

Preconception obesity appears to have a stronger influence on the maternal metabolic milieu than gestational factors such as weight gain, dietary intake and insulin resistance, highlighting the critical importance of preconception health. NEFA in general, as well as monounsaturated and omega-6 fatty acid species in particular, represent key metabolites for a potential mechanism of intergenerational transfer of obesity risk.

Educational intervention regarding diet and physical activity for pregnant women: changes in knowledge and practices among health professionals

BACKGROUND

The knowledge and practices of health professionals have a recognized role in behaviors related to the health of their patients. During pregnancy, this influence can be even stronger because there is frequent contact between women and doctors/nurses at periodic antenatal visits. When trained, supported and motivated, these professionals can act as health promoters. This study aimed to evaluate the effect of a focused educational intervention on improving the knowledge and practices of health professionals concerning diet and physical activity during pregnancy.

METHODS

A controlled, non-randomized study was performed to assess the effects of an educational intervention on the knowledge and practices of nurses and doctors who provide primary care to pregnant women. The intervention group, doctors and nurses (n = 22) from the family health units in a medium-sized city of São Paulo State, Brazil, received 16 h of training comprising an introductory course and three workshops, whereas the control group, doctors and nurses (n = 20) from traditional basic health units in Botucatu, did not. The professionals' knowledge was assessed at two time points, 1 month prior to and 1 year after the beginning of the intervention, using an ad hoc self-report questionnaire. The increases in the knowledge scores for walking and healthy eating of the intervention and control groups were calculated and compared using Student's t-test. To analyze the professionals' practice, women in the second trimester of pregnancy were asked whether they received guidance on healthy eating and leisure-time walking; 140 of these women were cared for by professionals in the intervention group, and 141 were cared for by professionals in the control group. The percentage of pregnant women in each group that received guidance was compared using the chi-square test and the Prevalence Ratio (PR), and the corresponding 95 % confidence intervals (CI) were calculated.

RESULTS

The intervention improved the professionals' knowledge regarding leisure-time walking (92 % increase in the score, p < 0.001). The women who were cared for by the intervention group were more likely to receive guidance regarding leisure-time walking (PR = 2.65; 95 % CI = 1.82-3.83) and healthy eating (PR = 1.76; 95 % CI = 1.34-2.31) when compared to the control group.

CONCLUSION

It is possible to improve the knowledge and practices of health professionals through the proposed intervention aimed at primary health care teams providing antenatal care.

Pregnancy, exercise and nutrition research study with smart phone app support (Pears): Study protocol of a randomized controlled trial

OBJECTIVE

Maternal adiposity confers an increased risk of GDM in pregnancy. A low glycemic index (GI) dietary intervention has been found to improve glucose homeostasis and reduce gestational weight gain. Mobile Health (mHealth) Technology-assisted interventions are becoming commonplace as an aid to treating many chronic diseases. The aim of this study is to assess the impact of a 'healthy lifestyle package' with mHealth smart phone technology as support compared with usual care on the incidence of GDM in an overweight and obese pregnant population.

METHODS

We propose a randomized controlled trial of an mHealth assisted healthy lifestyle intervention package versus standard obstetric care in pregnant women with a BMI ≥25kg/m(2)-39.9kg/m(2). Patients are randomized to control or intervention group in a 1:1 ratio. The intervention arm healthy lifestyle package includes a motivational counseling session to encourage behavior change, involving targeted, low GI nutritional advice and daily physical activity prescription delivered before 18weeks gestation, as well as a smart phone app to provide ongoing healthy lifestyle advice and support throughout pregnancy. The primary outcome is the incidence of GDM at 29weeks' gestation and power analysis indicates that 253 women are required in each group to detect a difference.

CONCLUSION

This will be the first clinical trial to evaluate the effectiveness of a smart phone technology-assisted targeted healthy lifestyle intervention, which is grounded in behavior change theories and techniques, to support antenatal management of an overweight and obese pregnant population in preventing GDM.