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Diamond-Smith N, Baer RJ, Jelliffe-Pawlowski L. Impact of being underweight before pregnancy on preterm birth by race/ethnicity and insurance status in California: an analysis of birth records. J Matern Fetal Neonatal Med 2024; 37:2321486. [PMID: 38433400 DOI: 10.1080/14767058.2024.2321486] [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: 11/21/2023] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The US still has a high burden of preterm birth (PTB), with important disparities by race/ethnicity and poverty status. There is a large body of literature looking at the impact of pre-pregnancy obesity on PTB, but fewer studies have explored the association between underweight status on PTB, especially with a lens toward health disparities. Furthermore, little is known about how weight, specifically pre-pregnancy underweight status, and socio-economic-demographic factors such as race/ethnicity and insurance status, interact with each other to contribute to risks of PTB. OBJECTIVES The objective of this study was to measure the association between pre-pregnancy underweight and PTB and small for gestational age (SGA) among a large sample of births in the US. Our secondary objective was to see if underweight status and two markers of health disparities - race/ethnicity and insurance status (public vs. other) - on PTB. STUDY DESIGN We used data from all births in California from 2011 to 2017, which resulted in 3,070,241 singleton births with linked hospital discharge records. We ran regression models to estimate the relative risk of PTB by underweight status, by race/ethnicity, and by poverty (Medi-cal status). We then looked at the interaction between underweight status and race/ethnicity and underweight and poverty on PTB. RESULTS Black and Asian women were more likely to be underweight (aRR = 1.0, 95% CI: 1.01, 1.1 and aRR = 1.4, 95% CI: 1.4, 1.5, respectively), and Latina women were less likely to be underweight (aRR = 0.7, 95% CI: 0.7, 0.7). Being underweight was associated with increased odds of PTB (aRR = 1.3, 95% CI 1.3-1.3) and, after controlling for underweight, all nonwhite race/ethnic groups had increased odds of PTB compared to white women. In interaction models, the combined effect of being both underweight and Black, Indigenous and People of Color (BIPOC) statistically significantly reduced the relative risk of PTB (aRR = 0.9, 95% CI: 0.8, 0.9) and SGA (aRR = 1.0, 95% CI: 0.9, 1.0). The combined effect of being both underweight and on public insurance increased the relative risk of PTB (aRR = 1.1, 95% CI: 1.1, 1.2) but there was no additional effect of being both underweight and on public insurance on SGA (aRR = 1.0, 95% CI: 1.0, 1.0). CONCLUSIONS We confirm and build upon previous findings that being underweight preconception is associated with increased risk of PTB and SGA - a fact often overlooked in the focus on overweight and adverse birth outcomes. Additionally, our findings suggest that the effect of being underweight on PTB and SGA differs by race/ethnicity and by insurance status, emphasizing that other factors related to inequities in access to health care and poverty are contributing to disparities in PTB.
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Affiliation(s)
- Nadia Diamond-Smith
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
| | - Rebecca J Baer
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
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Sanders SA, Wallace ML, Burke LE, Tapia AL, Rathbun SL, Casas AD, Gary-Webb TL, Davis EM, Méndez DD. Examining demographic and psychosocial factors related to self-weighing behavior during pregnancy and postpartum periods. Prev Med Rep 2023; 35:102320. [PMID: 37554350 PMCID: PMC10404542 DOI: 10.1016/j.pmedr.2023.102320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023] Open
Abstract
Black childbearing individuals in the US experience a higher risk of postpartum weight retention (PPWR) compared to their White counterparts. Given that PPWR is related to adverse health outcomes, it is important to investigate predictors of weight-related health behaviors, such as self-weighing (i.e., using a scale at home). Regular self-weighing is an evidence-based weight management strategy, but there is minimal insight into sociodemographic factors related to frequency. The Postpartum Mothers Mobile Study (PMOMS) facilitated longitudinal ambulatory weight assessments to investigate racial inequities in PPWR. Our objective for the present study was to describe self-weighing behavior during and after pregnancy in the PMOMS cohort, as well as related demographic and psychosocial factors. Applying tree modeling and multiple regression, we examined self-weighing during and after pregnancy. Participants (N = 236) were 30.2 years old on average (SD = 4.7), with the majority being college-educated (53.8%, n = 127), earning at least $30,000 annually (61.4%, n = 145), and self-identifying as non-Hispanic White (NHW; 68.2%, n = 161). Adherence to regular self-weighing (at least once weekly) was highest among participants during pregnancy, with a considerable decline after giving birth. Low-income Black participants (earning < $30,000) were significantly less likely to reach a completion rate of ≥ 80% during pregnancy (AOR = 0.10) or the postpartum period (AOR = 0.16), compared to NHW participants earning at least $30,000 annually. Increases in perceived stress were associated with decreased odds of sustained self-weighing after delivery (AOR = 0.79). Future research should consider behavioral differences across demographic intersections, such as race and socioeconomic status, and the impact on efficacy of self-weighing.
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Affiliation(s)
- Sarah Annalise Sanders
- Department of Behavioral & Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Meredith L. Wallace
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lora E. Burke
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Amanda L. Tapia
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Stephen L. Rathbun
- Department of Epidemiology & Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Andrea D. Casas
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Tiffany L. Gary-Webb
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Esa M. Davis
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Dara D. Méndez
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
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Collin DF, Pulvera R, Hamad R. The effect of the 2009 revised U.S. guidelines for gestational weight gain on maternal and infant health: a quasi-experimental study. BMC Pregnancy Childbirth 2023; 23:118. [PMID: 36803304 PMCID: PMC9936770 DOI: 10.1186/s12884-023-05425-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/03/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Excess gestational weight gain (GWG) has adverse short- and long-term effects on the health of mothers and infants. In 2009, the US Institute of Medicine revised its guidelines for GWG and reduced the recommended GWG for women who are obese. There is limited evidence on whether these revised guidelines affected GWG and downstream maternal and infant outcomes. METHODS We used data from the 2004-2019 waves of the Pregnancy Risk Assessment Monitoring System, a serial cross-sectional national dataset including over 20 states. We conducted a quasi-experimental difference-in-differences analysis to assess pre/post changes in maternal and infant outcomes among women who were obese, while "differencing out" the pre/post changes among a control group of women who were overweight. Maternal outcomes included GWG and gestational diabetes; infant outcomes included preterm birth (PTB), low birthweight (LBW), and very low birthweight (VLBW). Analysis began in March 2021. RESULTS There was no association between the revised guidelines and GWG or gestational diabetes. The revised guidelines were associated with reduced PTB (- 1.19% points, 95%CI: - 1.86, - 0.52), LBW (- 1.38% points 95%CI: - 2.07, - 0.70), and VLBW (- 1.30% points, 95%CI: - 1.68, - 0.92). Results were robust to several sensitivity analyses. CONCLUSION The revised 2009 GWG guidelines were not associated with changes in GWG or gestational diabetes but were associated with improvements in infant birth outcomes. These findings will help inform further programs and policies aimed at improving maternal and infant health by addressing weight gain in pregnancy.
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Affiliation(s)
- Daniel F. Collin
- grid.266102.10000 0001 2297 6811Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 995 Potrero Avenue, Building 80, Ward 83, San Francisco, CA 94110 USA
| | - Richard Pulvera
- grid.47840.3f0000 0001 2181 7878School of Public Health, University of California Berkeley, Berkeley, CA USA
| | - Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 995 Potrero Avenue, Building 80, Ward 83, San Francisco, CA, 94110, USA. .,Department of Family & Community Medicine, University of California San Francisco, 995 Potrero Avenue, Building 80, Ward 83, San Francisco, CA, 94110, USA.
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Chandler-Laney P, Biggio JR, Tipre M, Carson TL, Bae S, Everett AB, Baskin ML. Relationship Between Race and Gestational Weight Gain in Pregnancy and Early Life in the South Birth-Cohort Study. Matern Child Health J 2023; 27:356-366. [PMID: 36662382 PMCID: PMC11092968 DOI: 10.1007/s10995-022-03584-2] [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: 09/29/2021] [Revised: 10/18/2022] [Accepted: 12/23/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The goal of this study was to evaluate whether differences in gestational weight gain (GWG) and adverse perinatal outcomes exist for Black and White women who are overweight or have obesity (OW/OB) at entry to prenatal care. METHODS We enrolled 183 pregnant women with BMI 25-45 kg/m2 (71% black, 29% white) prior to 14 weeks gestation. Data were collected on demographic, medical history, diet and physical activity during pregnancy. Relationships between race and maternal outcomes and infant outcomes were assessed using multivariable logistic regression models. RESULTS The average age of pregnant women were 26 years (±4.8), with a mean BMI of 32.1 (±5.1) kg/m2 at the time of enrollment. At delivery, 60 women (33%) had GWG within Institute of Medicine recommendations and 69% had at least one comorbidity. No significant differences by race were found in GWG (in lbs) (11±7.5 vs. 11.4±7.3, p=0.2006) as well as other perinatal outcomes including maternal morbidity, LBW and PTB. Race differences were noted for gestational diabetes, total energy expenditure and average daily calorie intake, but these differences did not result in significant differences in GWG or maternal morbidity. CONCLUSION The lack of racial differences in GWG and perinatal outcomes demonstrated in this study differs from prior literature and could potentially be attributed to small sample size. Findings suggest that race differences in GWG and perinatal outcomes may diminish for women with a BMI in the overweight or obese range at conception.
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Affiliation(s)
- Paula Chandler-Laney
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Joseph R Biggio
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Meghan Tipre
- Division of Preventive Medicine, University of Alabama at Birmingham (UAB), 1717 11th Ave S, MT 618, 35294-4410, Birmingham, AL, USA
| | - Tiffany L Carson
- Department of Health Outcomes and Behavior, H. Lee Moffit Cancer Center & Research Institute, Tampa, FL, USA
| | - Sejong Bae
- Division of Preventive Medicine, University of Alabama at Birmingham (UAB), 1717 11th Ave S, MT 618, 35294-4410, Birmingham, AL, USA
| | - Alysha B Everett
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Monica L Baskin
- Division of Preventive Medicine, University of Alabama at Birmingham (UAB), 1717 11th Ave S, MT 618, 35294-4410, Birmingham, AL, USA.
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Dong X, Zhou A. Associations of maternal pre-pregnancy body mass index and gestational weight gain with risk of offspring neurodevelopment at 2 years: A Chinese birth cohort study. Front Pediatr 2023; 11:1165743. [PMID: 37144148 PMCID: PMC10151668 DOI: 10.3389/fped.2023.1165743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/21/2023] [Indexed: 05/06/2023] Open
Abstract
Introduction In recent decades, there has been a surge in both obesity and developmental impairments. Only a few research have looked at the relationship between gestational weight growth and pre-pregnancy BMI in mothers and the neurobehavioral development of their infants. The current research investigates the associations among maternal pre-pregnancy BMI, GWG, and the risk of child neural development at 2 years of age depending on a Chinese birth prospective study. Methods The study population was 3,115 mother-infant pairs were registered in the Wuhan Health Baby cohort between September 2013 and October 2018, and data from this cohort was used in this investigation. The Chinese classification was used to group maternal BMI before conception. Based on the 2019 Life Cycle Project-Maternal Obesity and Childhood Outcomes Study Group, categories for GWG were created. The outcome was an assessment of child neural development at age 2 which was measured by employing a Chinese translation of the Bayley scales (BSID-CR). The multivariate regression models were used to calculate the beta (β) coefficients and 95% confidence intervals (CIs) for estimating the associations between continuous Bayley scores and maternal pre-pregnancy BMI categories, as same as in GWG categories. Results Infants of overweight and obese moms exhibited lower MDI scores than those of mothers with normal pre-pregnancy BMI (β = -2.510, 95%CI = -4.821 to -0.200) in the entire sample. Meanwhile, we find among the normal pre-pregnancy BMI mothers, infants of inadequate GWG mothers had lower MDI scores (β = -3.952, 95%CI = -7.809 to -0.094) compared with the referenced adequate GWG mothers, as well as the infants of excessive GWG mothers among the underweight pre-pregnancy BMI mothers (β = -5.173, 95%CI = -9.803 to -0.543). The PDI scores of the infants were not affected by the maternal pre-pregnancy BMI or GWG. Conclusion For Chinese babies aged 2 in this nationally representative sample, aberrant pre-pregnancy BMI and GWG can impair infants' mental development, but not psychomotor development. Such results are significant given the incidence of overweight and obesity as well as the long-term effects of early brain development. In this study we found optimal GWG recommendations proposed by 2019 Life Cycle Project-Maternal Obesity and Childhood Outcomes Study Group were more suitable for Chinese women than 2009 Institute of Medicine(IOM) guidelines. Additionally, women should be given general advice on how to achieve their ideal pre-pregnancy BMI and GWG.
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Affiliation(s)
- Xiaohan Dong
- Department of Obstetrics and Gynecology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Aifen Zhou
- Department of Obstetrics and Gynecology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
- Institute of Maternal and Child Health, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
- Correspondence: Aifen Zhou
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Robertson OC, Marceau K, Moding KJ, Knopik VS. Developmental pathways linking obesity risk and early puberty: The thrifty phenotype and fetal overnutrition hypotheses. DEVELOPMENTAL REVIEW 2022. [DOI: 10.1016/j.dr.2022.101048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pulvera R, Collin DF, Hamad R. The effect of the 2009 WIC revision on maternal and child health: A quasi-experimental study. Paediatr Perinat Epidemiol 2022; 36:851-860. [PMID: 35871753 PMCID: PMC9588600 DOI: 10.1111/ppe.12898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is the largest U.S. nutrition program for low-income pregnant women. It was revised in 2009, with the goal of improving nutritional content of food packages, enhancing nutrition education, and strengthening breast feeding support. Few studies have assessed the effects of this revision on perinatal health. OBJECTIVES To investigate the impact of the revised WIC program on maternal and child health in a large, multi-state data set. METHODS We conducted a quasi-experimental difference-in-differences analysis, comparing the pre/post changes among WIC recipients to changes among non-recipients. We adjusted for key sociodemographic covariates in multivariable linear models. We used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) for 18 states from 2004 to 2017. RESULTS The main analysis included 331,946 mother-infant dyads. WIC recipients were more likely to be younger, Black or Hispanic/Latina, unmarried, and of greater parity. The revised WIC program was associated with reduced likelihood of more-than-recommended GWG (-1.29% points, 95% confidence interval [CI] -2.03, -0.56) and increased likelihood of ever breast fed (1.18% points, 95% CI 0.28, 2.08). We also identified heterogeneous effects on GWG, with more pronounced associations among women 35 and older. There were no associations with foetal growth. CONCLUSIONS The revised WIC program was associated with improvements in women's gestational weight gain and infant breast feeding.
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Affiliation(s)
- Richard Pulvera
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Daniel F. Collin
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
- Department of Family & Community Medicine, University of California San Francisco, San Francisco, California, USA
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Widen EM, Burns N, Daniels M, Backlund G, Rickman R, Foster S, Nichols AR, Hoepner LA, Kinsey EW, Ramirez-Carvey J, Hassoun A, Perera FP, Bukowski R, Rundle AG. Gestational weight change and childhood body composition trajectories from pregnancy to early adolescence. Obesity (Silver Spring) 2022; 30:707-717. [PMID: 35137558 PMCID: PMC8957403 DOI: 10.1002/oby.23367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE A mother-child dyad trajectory model of weight and body composition spanning from conception to adolescence was developed to understand how early life exposures shape childhood body composition. METHODS African American (49.3%) and Dominican (50.7%) pregnant mothers (n = 337) were enrolled during pregnancy, and their children (47.5% female) were followed from ages 5 to 14. Gestational weight gain (GWG) was abstracted from medical records. Child weight, height, percentage body fat, and waist circumference were measured. GWG and child body composition trajectories were jointly modeled with a flexible latent class model with a class membership component that included prepregnancy BMI. RESULTS Four prenatal and child body composition trajectory patterns were identified, and sex-specific patterns were observed for the joint GWG-postnatal body composition trajectories with more distinct patterns among girls but not boys. Girls of mothers with high GWG across gestation had the highest BMI z score, waist circumference, and percentage body fat trajectories from ages 5 to 14; however, boys in this high GWG group did not show similar growth patterns. CONCLUSIONS Jointly modeled prenatal weight and child body composition trajectories showed sex-specific patterns. Growth patterns from childhood though early adolescence appeared to be more profoundly affected by higher GWG patterns in females, suggesting sex differences in developmental programming.
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Affiliation(s)
- Elizabeth M Widen
- Department of Nutritional Sciences, School of Human Ecology, College of Natural Sciences, University of Texas at Austin, Austin, Texas, USA
- Department of Women's Health, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
- Dell Pediatric Research Institute, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York, USA
| | - Natalie Burns
- Department of Statistics, University of Florida, Gainesville, Florida, USA
| | - Michael Daniels
- Department of Statistics, University of Florida, Gainesville, Florida, USA
| | - Grant Backlund
- Department of Statistics, University of Florida, Gainesville, Florida, USA
| | - Rachel Rickman
- Department of Nutritional Sciences, School of Human Ecology, College of Natural Sciences, University of Texas at Austin, Austin, Texas, USA
- Dell Pediatric Research Institute, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Saralyn Foster
- Department of Nutritional Sciences, School of Human Ecology, College of Natural Sciences, University of Texas at Austin, Austin, Texas, USA
- Dell Pediatric Research Institute, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Amy R Nichols
- Department of Nutritional Sciences, School of Human Ecology, College of Natural Sciences, University of Texas at Austin, Austin, Texas, USA
| | - Lori A Hoepner
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York, USA
- Department of Environmental and Occupational Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Eliza W Kinsey
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Judyth Ramirez-Carvey
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York, USA
| | - Abeer Hassoun
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York, USA
| | - Frederica P Perera
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York, USA
| | - Radek Bukowski
- Department of Women's Health, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Andrew G Rundle
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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Lindsay AC, Le Q, Nogueira DL, Tavares Machado MM, Greaney ML. Healthcare Providers' Advice About Gestational Weight Gain, Diet, and Exercise: a Cross-Sectional Study with Brazilian Immigrant Women in the USA. J Racial Ethn Health Disparities 2022; 9:23-31. [PMID: 33206356 DOI: 10.1007/s40615-020-00926-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023]
Abstract
This study sought to quantify healthcare providers' advice about gestational weight gain (GWG), diet, and exercise among first-time pregnant Brazilian women living in the USA. This is a cross-sectional study of first-time pregnant Brazilian women living in selected cities in Massachusetts. The study sample included 86 women, nearly all (97%; n = 83) immigrants. Participants' mean age was 28.3 years and mean gestation was 27.5 weeks. Approximately 25.6% (n = 22) reported being overweight, and 1.2% (n = 1) being underweight. Only about 62% (n = 53) reported receiving advice from their healthcare provider on recommended GWG. In addition, about 83% (n = 71) and 81% (n = 70) reported receiving healthcare providers' advice on exercise and diet, respectively. Women who self-reported being overweight pre-pregnancy (OR 0.15; 95% confidence interval [CI] 0.03-0.73; p = 0.02) and women who were classified low acculturation levels (OR 0.12; 95% CI 0.02-0.08; p = 0.03) were less likely to report receiving healthcare providers' advice on GWG compared to women who self-reported being normal weight pre-pregnancy and those classified having high acculturation level, respectively. Furthermore, women who self-reported being overweight pre-pregnancy were less likely to report receiving diet-related advice (OR 0.32; 95% CI 0.10-1.02; p = 0.05) than women who self-reported being normal weight pre-pregnancy. Findings indicate the need for increased communication and counseling between healthcare providers and Brazilian immigrant women about GWG, in particular for women with low acculturation levels and language barriers suggesting the need for linguistic and culturally relevant interventions designed to improve Brazilian immigrant women's access to evidence-based information about GWG, diet, and exercise.
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Affiliation(s)
- Ana Cristina Lindsay
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts-Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA.
| | - Qun Le
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, The State University of New Jersey, New Brunswick, NJ, USA
| | - Denise Lima Nogueira
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Márcia M Tavares Machado
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Mary L Greaney
- Department of Health Studies, University of Rhode Island, Kingston, RI, USA
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A Review of the Clinician's Role in Women's Weight Management and Implications for Women's Health and Pregnancy Outcomes. Obstet Gynecol Surv 2021; 76:493-503. [PMID: 34449852 DOI: 10.1097/ogx.0000000000000908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance Ten years have passed since the Institute of Medicine (IOM) released its recommendations for gestational weight gain (GWG), based on a woman's prepregnancy body mass index. Despite this, the majority of women do not gain the appropriate gestational weight; most women gain too much weight, and a small but substantial number gain too little. Objective We review the literature concerning GWG, the opinions and practices of clinicians in managing their patients' weight, and how these practices are perceived by patients. We also review several randomized control trials that investigate the efficacy of clinical intervention in managing GWG. Evidence Acquisition A literature review search was conducted with no limitations on the number of years searched. Results The number of clinicians who are aware of and use the IOM recommendations has increased, but the prevalence of inappropriate GWG has not decreased. Clinicians report feeling less than confident in their ability to have an impact on their patients' weight gain, and there are discrepancies between what clinicians and patients report regarding counseling. Many randomized control trials demonstrate a beneficial impact of clinical intervention, highlighting the importance of collaboration and technology to provide educational information and support throughout a pregnancy. Conclusions Pregnancy provides an opportunity for clinicians to have open and direct conversations with their patients about their weight. Providing clinicians with the tools, skillset, and confidence to assist in the management of GWG is essential to the health of women and their children, and warrants further investigation.
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Poncet L, Panjo H, Schmitz T, Luton D, Mandelbrot L, Estellat C, Andro A, Ringa V, Azria E. Gestational weight gain in a migration context: are migrant women more at risk of inadequate or excessive weight gain during pregnancy? J Epidemiol Community Health 2021; 76:230-238. [PMID: 34389663 DOI: 10.1136/jech-2021-216619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/20/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Inadequate or excessive gestational weight gain (GWG) is associated with adverse maternal and neonatal outcomes. Little is known on adequacy of GWG in migrant women. This study investigates whether migrant women in France are at higher risk of inadequate or excessive GWG, and what characteristics are associated with GWG in migrant and non-migrant groups. METHODS We used data from the PreCARE multicentric prospective cohort (N=10 419). The study includes 5403 women with singleton deliveries, with non-migrant (n=2656) and migrant (n=2747) status. We used multinomial logistic regression, adjusting for maternal age and parity, to investigate the association of migrant status, socioeconomic status-related variables and GWG. In stratified analyses, we identified factors associated with GWG in both groups. RESULTS Compared with non-migrant women, migrant women had increased risk of inadequate GWG (adjusted odds ratio (aOR) 1.18; 95% CI 1.03 to 1.34). Non-migrant women with foreign origins had increased risk of excessive GWG (aOR 1.58; 95% CI 1.30 to 1.92). Women born in Sub-Saharan Africa had increased risk of both inadequate and excessive GWG. Regardless of migration status, women with lower education and women who did not start pregnancy with a normal weight were less likely to gain adequately. Inadequate prenatal care was associated with inadequate GWG only among non-migrant women. CONCLUSION Migrant women are at higher risk of inadequate GWG.
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Affiliation(s)
- Lorraine Poncet
- CESP Primary Care and Prevention Team, Université Paris-Saclay, UVSQ, Université Paris-Sud, INSERM, Villejuif, France .,French Collaborative Institute on Migrations, France, Paris, France
| | - Henri Panjo
- CESP Primary Care and Prevention Team, Université Paris-Saclay, UVSQ, Université Paris-Sud, INSERM, Villejuif, France
| | - Thomas Schmitz
- Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University, 53 Avenue de l'Observatoire, INSERM U1153, Paris, France.,Department of Obstetrics and Gynecology, Hopital Universitaire Mere-enfant Robert-Debre, Paris, France
| | - Dominique Luton
- Department of Obstetrics and Gynecology, DHU Risks in Pregnancy, Hopital Bichat - Claude-Bernard, Paris, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynecology, DHU Risks in Pregnancy, Hopital Louis-Mourier, Colombes, France
| | - Candice Estellat
- Department of Biostatistics, Public Health and Medical Information, Clinical research unit, Pharmacoepidemiology center, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Armelle Andro
- French Collaborative Institute on Migrations, France, Paris, France.,Institute of demography research center, Université Paris 1 Panthéon-Sorbonne, Paris, France
| | - Virginie Ringa
- CESP Primary Care and Prevention Team, Université Paris-Saclay, UVSQ, Université Paris-Sud, INSERM, Villejuif, France
| | - Elie Azria
- Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University, 53 Avenue de l'Observatoire, INSERM U1153, Paris, France.,Department of Obstetrics, Groupe hospitalier Paris Saint-Joseph, Paris, France
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Obata S, Shimura M, Misumi T, Nakanishi S, Shindo R, Miyagi E, Aoki S. Weight gain during twin pregnancy with favorable pregnancy outcomes in Japan: A retrospective investigation for new criteria based on perinatal registry data. PLoS One 2021; 16:e0253596. [PMID: 34214100 PMCID: PMC8253415 DOI: 10.1371/journal.pone.0253596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/08/2021] [Indexed: 12/17/2022] Open
Abstract
In 2009, the United States Institute of Medicine (IOM) reported the optimal gestational weight gain (GWG) during twin pregnancy based on the pre-pregnancy body mass index (BMI). However, there are ethnic variations in the relationship between GWG and pregnancy outcomes. We aimed to establish the criteria for optimal GWG during twin pregnancy in Japan. The study included cases of dichorionic diamniotic twin pregnancy registered in the Japan Society of Obstetrics and Gynecology Successive Pregnancy Birth Registry System between 2013 and 2017. We analyzed data for cases wherein both babies were appropriate for gestational age and delivered at term. Cases were classified into four groups based on the pre-pregnancy BMI: underweight (BMI <18.5 kg/m2), normal weight (18.5 kg/m2 ≤BMI< 25.0 kg/m2), overweight (25.0 kg/m2 ≤BMI< 30.0 kg/m2), and obese (BMI ≥30.0 kg/m2) and we calculated the 25th-75th percentile range for GWG for the cases. The 3,936 cases were included. The GWG ranges were 11.5-16.5 kg, 10.3-16.0 kg, 6.9-14.7 kg, and 2.2-11.7 kg in the underweight, normal weight, overweight, and obese groups, respectively. Thus, in the current study, the optimal GWG during twin pregnancy was lower than that specified by the IOM criteria. Factoring this in maternal management may improve the outcomes of twin pregnancies in Japan.
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Affiliation(s)
- Soichiro Obata
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
- * E-mail:
| | - Mai Shimura
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Toshihiro Misumi
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Sayuri Nakanishi
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryosuke Shindo
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, Yokohama, Japan
| | - Shigeru Aoki
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
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Sources of information about gestational weight gain, diet and exercise among Brazilian immigrant women living in the USA: a cross-sectional study. Public Health Nutr 2021; 24:5720-5729. [PMID: 33904387 DOI: 10.1017/s1368980021001798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to assess sources of information about gestational weight gain (GWG), diet and exercise among first-time pregnant Brazilian women in the USA. DESIGN Cross-sectional survey. SETTING Massachusetts, USA. PARTICIPANTS First-time pregnant Brazilian women. RESULTS Eighty-six women, the majority of whom were immigrants (96·5 %) classified as having low acculturation levels (68 %), participated in the study. Approximately two-thirds of respondents had sought information about GWG (72·1 %), diet (79·1 %) and exercise (74·4 %) via the internet. Women classified as having low acculturation levels were more likely to seek information about GWG via the internet (OR = 7·55; 95 % CI 1·41, 40·26) than those with high acculturation levels after adjusting for age and receiving information about GWG from healthcare provider (doctor or midwife). Moreover, many respondents reported seeking information about GWG (67 %), diet (71 %) and exercise (52 %) from family and friends. Women who self-identified as being overweight pre-pregnancy were less likely to seek information about diet (OR = 0·32; 95 % CI 0·11, 0·93) and exercise (OR = 0·33; 95 % CI 0·11, 0·96) from family and friends than those who self-identified being normal-weight pre-pregnancy. CONCLUSIONS This is the first study to assess sources of information about GWG, diet and exercise among pregnant Brazilian immigrants in the USA. Findings have implications for the design of interventions and suggest the potential of mHealth intervention as low-cost, easy access option for delivering culturally and linguistically tailored evidence-based information about GWG incorporating behavioural change practices to this growing immigrant group.
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Dongarwar D, Tahseen D, Wang L, Aliyu MH, Salihu HM. Temporal trends in preterm birth phenotypes by plurality: Black-White disparity over half a century. J Perinatol 2021; 41:204-211. [PMID: 33452419 PMCID: PMC7886650 DOI: 10.1038/s41372-020-00912-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine trends in rates of preterm birth by race and plurality; to evaluate the association between race, plurality, and phenotypes of preterm birth. STUDY DESIGN Temporal trends analyses for preterm birth by race and plurality were performed for the years 1971-2018. Adjusted logistic regression models were utilized to evaluate the association between race, plurality, and phenotypes of preterm birth. RESULTS We observed that 1105,266 (0.7%), 1901,604 (1.2%), and 14,769,746 (9.3%) births belonged to extreme preterm, very preterm, and moderate-to-late preterm categories, respectively. We also observed that the risk of extreme preterm (RR: 2.69, 95% CI: 2.642-2.75) was highest for Black mothers as compared to White mothers. CONCLUSION Over the study period, preterm births disproportionately impacted Black mothers as well as pregnancies of higher plurality. With the persistence of racial disparities and growing trend of delayed childbearing and multiple pregnancies, targeted intervention is necessitated toward these vulnerable subgroups.
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Affiliation(s)
- Deepa Dongarwar
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA.
| | - Danyal Tahseen
- grid.267308.80000 0000 9206 2401McGovern Medical School, University of Texas Health Science Center, Houston, TX USA
| | - Liye Wang
- grid.266436.30000 0004 1569 9707Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, TX USA
| | - Muktar H. Aliyu
- grid.412807.80000 0004 1936 9916Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN USA
| | - Hamisu M. Salihu
- grid.39382.330000 0001 2160 926XCenter of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX USA ,grid.39382.330000 0001 2160 926XDepartment of Family Medicine, Baylor College of Medicine, Houston, TX USA
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Green TL, Simuzingili M, Bodas M, Xue H. Pregnancy-related weight among immigrant and US-born mothers: The role of nativity, maternal duration of residence, and age at arrival. WOMEN'S HEALTH (LONDON, ENGLAND) 2021; 17:17455065211003692. [PMID: 33787409 PMCID: PMC8020768 DOI: 10.1177/17455065211003692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The goals of this study were to examine the associations between nativity and pregnancy-related weight and to assess the associations between maternal duration of residence and age at arrival in the United States on pregnancy-related weight among immigrants. METHODS Using logistic regression and data from the Early Childhood Longitudinal Study-Birth Cohort, we assessed differences in preconception weight and gestational weight gain between US-born and immigrant women (N = 7000). We then analyzed differences in both outcomes by duration of residence among immigrants (n = 1850) and examined whether the identified relationships varied by age at arrival in the United States. RESULTS Compared to US-born mothers, immigrants were less likely to be classified as obese prior to pregnancy (odds ratio 0.435, 95% confidence interval, 0.321-0.590) or experience excessive gestational weight gain (odds ratio 0.757, 95% confidence interval, 0.614-0.978). Among the immigrant sub-sample, living in the United States for 10-15 years (odds ratio 2.737, 95% confidence interval, 1.459-5.134) or 16+ years was positively associated with both preconception obesity (odds ratio 2.918, 95% confidence interval, 1.322-6.439) and excessive gestational weight gain (odds ratio 1.683, 95% confidence interval, 1.012-2.797, 16+ years only). There was some evidence that the duration of residence was positively associated with preconception obesity, but only among women who had moved to the United States at age 18 years and older. CONCLUSION In sum, while immigrants are less likely than US-born mothers to experience preconception obesity or excessive gestational weight gain, these outcomes vary among the former group by duration of US residence.
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Affiliation(s)
- Tiffany L Green
- Department of Population Health Sciences, University of Wisconsin–Madison, Madison, WI, USA
| | - Muloongo Simuzingili
- Department of Health Behavior and Policy, VCU School of Medicine, Richmond, VA, USA
| | - Mandar Bodas
- Department of Health Behavior and Policy, VCU School of Medicine, Richmond, VA, USA
| | - Hong Xue
- Department of Health Administration and Policy, College of Health and Human Sciences, George Mason University, Fairfax, VA, USA
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Green TL, Son YK, Simuzingili M, Mezuk B, Bodas M, Hagiwara N. Pregnancy-Related Weight and Postpartum Depressive Symptoms: Do the Relationships Differ by Race/Ethnicity? J Womens Health (Larchmt) 2020; 30:816-828. [PMID: 33085545 PMCID: PMC10163440 DOI: 10.1089/jwh.2019.8175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: There are significant racial/ethnic disparities in the prevalence of postpartum depression. Prior research in the general population suggests that weight status is related to depression and that this relationship varies by race/ethnicity. However, few studies have investigated whether race/ethnicity moderates the relationship between pregnancy-related weight and postpartum depressive symptoms (PPDS). The objective of this study is to examine the relationship between pregnancy-related weight and maternal PPDS overall and by race/ethnicity. Materials and Methods: This study used data from the Early Childhood Longitudinal Study-Birth Cohort (n ≈ 6950). Ordinary least-squares and logistic regression was used to examine whether pregnancy-related weight, including preconception weight status and gestational weight gain (GWG), was associated with PPDS measured using the Center for Epidemiologic Studies-Depression Scale (CES-D). Stratified analyses were used to assess whether these relationships varied by race/ethnicity. Results: Preconception obesity (body mass index [BMI] ≥30 kg/m2) was associated with higher levels of PPDS (β = 0.601, 95% confidence interval [CI], 0.149-1.053). GWG adequacy was not associated with PPDS. Among non-Hispanic (NH) whites, preconception obesity was positively associated with PPDS (β = 1.016, 95% CI, 0.448-1.584). In contrast, among Hispanics, preconception overweight (25 kg/m2 ≤ BMI <30 kg/m2) was associated with lower levels of PPDS (β = -0.887, 95% CI, -1.580 to -0.195). There were no statistically significant relationships between pregnancy-related weight and PPDS among NH black or Asian women, but both groups were significantly more likely than NH whites to report PPDS. Conclusion: Whether and how pregnancy-related weight is associated with PPDS varies by race/ethnicity. Addressing preconception weight could help reduce overall levels of PPDS among NH whites but would likely fail to mitigate racial/ethnic disparities in postpartum mental health.
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Affiliation(s)
- Tiffany L Green
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Yena K Son
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Muloongo Simuzingili
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Briana Mezuk
- Department of Epidemiology, Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Mandar Bodas
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nao Hagiwara
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
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Shimura M, Obata S, Misumi T, Miyagi E, Aoki S. Are the Institute of Medicine guidelines for optimal gestational weight gain in twin pregnancies applicable to Japanese women? J Obstet Gynaecol Res 2020; 47:337-342. [PMID: 33051925 DOI: 10.1111/jog.14529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/17/2020] [Accepted: 09/30/2020] [Indexed: 11/27/2022]
Abstract
AIMS To investigate whether the Institute of Medicine (IOM) guidelines for optimal gestational weight gain (GWG) in twin pregnancies are applicable to Japanese women. METHODS This was a retrospective study involving women who delivered full-term twins at our tertiary center diagnosed with a normal prepregnancy body mass index. The women were divided into two groups, according to the optimal GWG recommended by the IOM (16.8-24.5 kg): the adequate GWG (AGWG) group with GWG meeting the guidelines and the low GWG (LGWG) group with GWG below the guidelines. Next, the women were divided into two groups according to birthweight: a group with both twins born appropriate for gestational age (AGA group) and a group with one or both twins born small for gestational age (SGA group). Their GWG as well as their pregnancy outcomes were compared. RESULTS A total of 265 women were included. The AGWG group had a significantly higher proportion of hypertensive disorders of pregnancy than the LGWG group. There was no significant difference in the proportion of women with both twins born AGA or the rate of admission to the neonatal intensive care unit. Meanwhile, the median GWG in the AGA group was 13.6 kg, which was significantly higher than 12.0 kg in the SGA group. And even the median GWG in the AGA group was below the lower limit of the IOM guidelines. CONCLUSION The optimal GWG for Japanese women with twin pregnancies may be below the IOM guidelines.
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Affiliation(s)
- Mai Shimura
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Soichiro Obata
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Toshihiro Misumi
- Department of Biostatistics, Yokohama City University school of Medicine, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, Yokohama, Japan
| | - Shigeru Aoki
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
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Richardson DM, Andrea SB, Ziring A, Robinson C, Messer LC. Pregnancy Outcomes and Documentation Status Among Latina Women: A Systematic Review. Health Equity 2020; 4:158-182. [PMID: 32440614 PMCID: PMC7241052 DOI: 10.1089/heq.2019.0126] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The impression that Latinas experience paradoxically good pregnancy outcomes in the United States persists, despite evidence showing that these outcomes are not enjoyed by all Latina subgroups. We conducted this systematic literature review to examine the relationship between documentation status and pregnancy outcomes among Latinas. Methods: This review synthesizes empirical evidence on this relationship; examines how these studies define and operationalize documentation status; and makes recommendations of how a more comprehensive methodological approach can guide public health research on the impact of documentation status on Latina immigrants to the United States. We searched the literature within PubMed, Web of Science, Academic Search Premier, and Google Scholar in 2017 for relevant studies. Results: Based on stringent inclusion criteria, we retained nine studies for analysis. Conclusion: We found that evidence for the impact of documentation status on pregnancy outcomes among Latinas is not conclusive. We believe the divergence in our findings is, in part, due to variation in: conceptualization of how documentation status impacts pregnancy outcomes, sample populations, definitions of exposures and outcomes, and contextual factors included in models. Specific analytic challenges around sampling, measurement, and data analysis are identified. Suggestions for future research are offered regarding measurement of documentation status. Findings highlight the need for increased attention to documentation as an influence on Latina pregnancy outcomes.
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Affiliation(s)
- Dawn M Richardson
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Sarah B Andrea
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Amber Ziring
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Cassandra Robinson
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Lynne C Messer
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
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Guo Y, Miao Q, Huang T, Fell DB, Muldoon K, Wen SW, Walker MC, Gaudet LM. Racial differences in contribution of prepregnancy obesity and excessive gestational weight gain to large-for-gestational-age neonates. Int J Obes (Lond) 2020; 44:1521-1530. [PMID: 32076106 DOI: 10.1038/s41366-020-0543-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 01/09/2020] [Accepted: 02/03/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To examine the racial differences in the population attributable fraction (PAF) of prepregnancy obesity and excessive gestational weight gain to large-for-gestational-age (LGA) neonates. METHODS We conducted a population-based retrospective cohort study among all women who had prenatal screening and had a singleton live birth in a hospital (1 April 2016-31 March 2017) using data from Ontario birth registry in Canada. We used multivariable log-binomial regression models to estimate the PAF and 95% confidence interval (CI) of LGA neonates due to prepregnancy obesity and excessive gestational weight gain. All models were stratified by race (White, Asian, and Black). RESULTS Of the 74,402 eligible women, the prevalence of prepregnancy obesity, excessive gestational weight gain, and LGA neonate was 21.1%, 60.0%, and 11.3%, respectively, for Whites; 9.3%, 45.9%, and 5.4%, respectively, for Asians; and 28.6%, 52.4%, and 7.9%, respectively, for Blacks. The association of prepregnancy obesity was greater than that of excessive gestational weight gain on LGA for all racial groups. Excessive gestational weight gain contributed more than prepregnancy obesity in Whites (PAF 32.9%, 95% CI [30.3-35.5%] and 16.6%, 95% CI [15.3-17.9%], respectively, for excessive gestational weight gain and prepregnancy obesity) and in Asians (PAF 32.1%, 95% CI [27.2-36.7%] and 11.8%, 95% CI [9.5-14.1%], respectively, for excessive gestational weight gain and prepregnancy obesity). Prepregnancy obesity (PAF 22.8%, 95% CI [17.1-28.1%]) and excessive gestational weight gain (PAF 20.1%, 95% CI [4.7-33.0%]) contributed to LGA neonates almost the same in Blacks. CONCLUSIONS Excessive gestational weight gain contributed more to LGA neonates than prepregnancy obesity in Whites and Asians, while there was no difference between excessive gestational weight gain and prepregnancy obesity in their contributions to the LGA neonates in Blacks. The differences are mostly driven by the differential prevalence of the two risk factors across racial groups.
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Affiliation(s)
- Yanfang Guo
- Better Outcomes Registry & Network Ontario, Ottawa, ON, Canada. .,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada. .,OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
| | - Qun Miao
- Better Outcomes Registry & Network Ontario, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Tianhua Huang
- Better Outcomes Registry & Network Ontario, Ottawa, ON, Canada.,Genetics Program, North York General Hospital, Toronto, ON, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
| | - Deshayne B Fell
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Katherine Muldoon
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Shi-Wu Wen
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Department of Obstetrics, Gynecology, and Newborn Care, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mark C Walker
- Better Outcomes Registry & Network Ontario, Ottawa, ON, Canada.,OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Department of Obstetrics, Gynecology, and Newborn Care, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Laura M Gaudet
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. .,Department of Obstetrics and Gynecology, Queen's University, Kingston, ON, Canada. .,Department of Obstetrics and Gynecology, Kingston Health Sciences Center, Kingston, ON, Canada.
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Khanolkar AR, Hanley GE, Koupil I, Janssen PA. 2009 IOM guidelines for gestational weight gain: how well do they predict outcomes across ethnic groups? ETHNICITY & HEALTH 2020; 25:110-125. [PMID: 29132221 DOI: 10.1080/13557858.2017.1398312] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/10/2017] [Indexed: 06/07/2023]
Abstract
Objective: To determine whether the Institute Of Medicine's (IOM) 2009 guidelines for weight-gain during pregnancy are predictive of maternal and infant outcomes in ethnic minority populations.Methods: We designed a population-based study using administrative data on 181,948 women who delivered live singleton births in Washington State between 2006-2008. We examined risks of gestational hypertension, preeclampsia/eclampsia, cesarean delivery, and extended hospital stay in White, Black, Native-American, East-Asian, Hispanic, South-Asian and Hawaiian/Pacific islander women according to whether they gained more or less weight during pregnancy than recommended by IOM guidelines. We also examined risks of neonatal outcomes including Apgar score <7 at 5 min, admission to NICU, requirement for ventilation, and a diagnosis of small or large for gestational age at birth.Results: Gaining too much weight was associated with increased odds for gestational hypertension (adjusted OR (aOR) ranged between 1.53-2.22), preeclampsia/eclampsia (aOR 1.44-1.81), cesarean delivery (aOR 1.07-1.38) and extended hospital stay (aOR 1.06-1.28) in all ethnic groups. Gaining too little weight was associated with decreased odds for gestational hypertension and delivery by cesarean section in Whites, Blacks and Hispanics. Gaining less weight or more weight than recommended was associated with increased odds for small for gestational age and large for gestational age infants respectively, in all ethnic groups.Conclusions: Adherence to the 2009 IOM guidelines for weight gain during pregnancy reduces risk for various adverse maternal outcomes in all ethnic groups studied. However, the guidelines were less predictive of infant outcomes with the exception of small and large for gestational age.Abbreviations: GWG: Gestational weight gain; IOM/NRC; Institute of Medicine and National Research Council; NICU: Neonatal intensive care need for ventilation; SGA: Small for gestational age; LGA: Large for gestational age; BERD: Birth Events Records Database; CHARS: Comprehensive Hospital Discharge Abstract Reporting System; ICD: International Classification of Disease; LMP: Last menstrual period; OR: Odds ratio.
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Affiliation(s)
- Amal R Khanolkar
- Centre for Health Equity Studies (CHESS), Stockholm University, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- GOS Institute of Child Health, University College London, London, UK
| | - Gillian E Hanley
- School of Population and Public Health and the Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Ilona Koupil
- Centre for Health Equity Studies (CHESS), Stockholm University, Stockholm, Sweden
| | - Patricia A Janssen
- School of Population and Public Health and the Child and Family Research Institute, University of British Columbia, Vancouver, Canada
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Associations Between Parity, Breastfeeding, and Risk of Maternal Type 2 Diabetes Among Postmenopausal Women. Obstet Gynecol 2019; 134:591-599. [DOI: 10.1097/aog.0000000000003407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guo Y, Miao Q, Huang T, Fell DB, Harvey ALJ, Wen SW, Walker M, Gaudet L. Racial/ethnic variations in gestational weight gain: a population-based study in Ontario. Canadian Journal of Public Health 2019; 110:657-667. [PMID: 31452112 PMCID: PMC6825031 DOI: 10.17269/s41997-019-00250-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/11/2019] [Indexed: 02/07/2023]
Abstract
Objective To explore inadequate and excessive gestational weight gain (GWG) among pregnant women of different racial/ethnic backgrounds in Ontario, Canada. Methods A population-based retrospective cohort study was conducted among women who had prenatal screening and had a singleton birth in an Ontario hospital between April 2016 and March 2017. We estimated adjusted risk ratios (aRR) of racial/ethnic differences for inadequate or excessive GWG using multinomial logistic regression models. Interaction effects were examined to determine whether racial/ethnic difference in GWG varied by pre-pregnancy body mass index (BMI). Results Among 74,424 women, the prevalence of inadequate GWG in White, Asian, and Black women was 15.7%, 25.8%, and 25.0%, and excessive GWG was 62.8%, 45.5%, and 54.7%, respectively. There were significant interaction effects between race/ethnicity and pre-pregnancy BMI for inadequate GWG (Wald p < 0.01) and excessive GWG (Wald p < 0.01). Compared with White women, Asian women had higher risk of inadequate GWG and lower risk of excessive GWG in all weight classes, and Black women had higher risk of inadequate GWG and lower risk of excessive GWG if their BMI was normal, overweight, or obese. Conclusion Variations in unhealthy GWG by pre-pregnancy weight classes among Ontario White, Asian and Black women were observed. Individualized counseling regarding appropriate GWG is universally recommended. Additional consideration of racial/ethnic variations by maternal weight classes may help to promote healthy GWG in Canada. Electronic supplementary material The online version of this article (10.17269/s41997-019-00250-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yanfang Guo
- Better Outcomes Registry & Network Ontario, CHEO Research Institute - Centre for Practice-Changing Research Building, Ottawa, Ontario, Canada. .,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
| | - Qun Miao
- Better Outcomes Registry & Network Ontario, CHEO Research Institute - Centre for Practice-Changing Research Building, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Tianhua Huang
- Better Outcomes Registry & Network Ontario, CHEO Research Institute - Centre for Practice-Changing Research Building, Ottawa, Ontario, Canada.,Genetics Program, North York General Hospital, Toronto, Ontario, Canada
| | - Deshayne B Fell
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Alysha L J Harvey
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, Ottawa, ON, Canada
| | - Shi Wu Wen
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, Ottawa, ON, Canada
| | - Mark Walker
- Better Outcomes Registry & Network Ontario, CHEO Research Institute - Centre for Practice-Changing Research Building, Ottawa, Ontario, Canada.,Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Laura Gaudet
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, Ottawa, ON, Canada. .,Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada.
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Nagourney EM, Goodman D, Lam Y, Hurley KM, Henderson J, Surkan PJ. Obese women's perceptions of weight gain during pregnancy: a theory-based analysis. Public Health Nutr 2019; 22:2228-2236. [PMID: 31134872 PMCID: PMC10260617 DOI: 10.1017/s1368980019000703] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/27/2018] [Accepted: 02/06/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Excess gestational weight gain (GWG) in obese women is linked to adverse maternal outcomes and is particularly pervasive among African Americans, who have the highest obesity rates in the USA. A better understanding of culturally relevant attitudes and perceptions of GWG is needed to develop targeted interventions to prevent excess GWG among this group. DESIGN Using the constructs of Social Cognitive Theory, we explored attitudes and perceptions surrounding diet and exercise among low-income obese African-American pregnant women in Baltimore. We conducted twenty-one semi-structured in-depth interviews with pregnant adult women. SETTING Participants were recruited from a referral clinic for obese pregnant women at a large urban hospital in Baltimore, MD, USA. PARTICIPANTS Twenty-one low-income African-American adult females in the first two trimesters of pregnancy with BMI > 30·0 kg/m2. RESULTS Lack of knowledge was not the main obstacle to healthy behaviours during pregnancy. Rather, food cravings and fatigue, an unhealthy physical food environment, limited self-efficacy for controlling excessive GWG, and a lack of adequate emotional and informational support impacted women's agency. While digital technology was discussed as a vehicle to promote maintenance of a healthy weight in pregnancy, further research is needed to test how it can be used to empower women to engage in healthy behaviours during pregnancy. CONCLUSION Interventions to prevent excess GWG among African-American pregnant women should harness support from partners and family and must go beyond sharing of clinical knowledge to also include strategies that improve the food environment, diet quality and self-efficacy.
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Affiliation(s)
- Emily M Nagourney
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Dina Goodman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Yukyan Lam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Kristen M Hurley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Janice Henderson
- Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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Mascarenhas M, Kulkarni M, Balen A. Can the ethnic differences in IVF cycle outcome be influenced by the impact of BMI? HUM FERTIL 2019; 23:275-281. [DOI: 10.1080/14647273.2018.1563915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - Mugdha Kulkarni
- Leeds Fertility, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Adam Balen
- Leeds Fertility, Leeds Teaching Hospital NHS Trust, Leeds, UK
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25
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Schumacher TL, Weatherall L, Keogh L, Sutherland K, Collins CE, Pringle KG, Rae KM. Reprint of characterizing gestational weight gain in a cohort of indigenous Australian women. Midwifery 2018; 74:148-156. [PMID: 30558960 DOI: 10.1016/j.midw.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE to determine the adequacy of gestational weight gain for a cohort of Indigenous Australian women and investigate whether it is associated with pre-pregnancy body mass index. DESIGN analysis of observational data collected from a longitudinal cohort study that follows Indigenous Australian women through pregnancy. SETTING women recruited through antenatal clinics in regional and remote towns in NSW, Australia to the Gomeroi gaaynggal program. PARTICIPANTS 110 pregnant women who either identified as being an Indigenous Australian or as carrying an Indigenous child. MEASUREMENTS AND FINDINGS measurements included weight and height, self-reported pre-pregnancy weight and smoking status, parity and health conditions that may contribute to gestational weight gain, such as hypertensive or diabetic disorders. Compared to the 2009 Institute of Medicine recommendations for gestational weight gain and based on pre-pregnancy body mass index, the rate of adequate gestational weight gain in this cohort was low (26%). 33% of women had inadequate weight gain and 41% had excessive weight gain. The highest rate of excessive gestational weight gain was found in overweight women (65%), with rates of 39% and 31% found in healthy and obese (all classes) categories, respectively. Parity (coefficient 4.2, p < 0.01) and hypertension (coefficient 4.3, p = 0.049) were found to be significantly associated with gestational weight gain in mixed model linear regression. CONCLUSIONS few women gained adequate gestational weight gain in this study. Culturally acceptable ways of addressing this issue are needed for this group of women, as inadequate and excessive rates of gestational weight gain have health implications for women and their offspring. IMPLICATIONS FOR PRACTICE a systematic approach to addressing gestational weight gain within antenatal care is required, including asking about diet and exercise, for all women identifying as Indigenous Australian.
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Affiliation(s)
- Tracy L Schumacher
- Gomeroi gaayngal Centre, Faculty of Health and Medicine, University of Newcastle, 2/1 Hinkler Rd, Tamworth, NSW 2340, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Ring Rd, Callaghan, NSW 2308, Australia
| | - Loretta Weatherall
- Gomeroi gaayngal Centre, Faculty of Health and Medicine, University of Newcastle, 2/1 Hinkler Rd, Tamworth, NSW 2340, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Lyniece Keogh
- Gomeroi gaayngal Centre, Faculty of Health and Medicine, University of Newcastle, 2/1 Hinkler Rd, Tamworth, NSW 2340, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Kathryn Sutherland
- Gomeroi gaayngal Centre, Faculty of Health and Medicine, University of Newcastle, 2/1 Hinkler Rd, Tamworth, NSW 2340, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Clare E Collins
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Ring Rd, Callaghan, NSW 2308, Australia; School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Kirsty G Pringle
- School of Biomedical Sciences and Pharmacy, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre of Reproductive Sciences, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Kym M Rae
- Gomeroi gaayngal Centre, Faculty of Health and Medicine, University of Newcastle, 2/1 Hinkler Rd, Tamworth, NSW 2340, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre of Reproductive Sciences, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre of Generational Health and Ageing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Department of Rural Health, University of Newcastle, Tamworth, NSW 2340, Australia.
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Denize KM, Acharya N, Prince SA, da Silva DF, Harvey AL, Ferraro ZM, Adamo KB. Addressing cultural, racial and ethnic discrepancies in guideline discordant gestational weight gain: a systematic review and meta-analysis. PeerJ 2018; 6:e5407. [PMID: 30186674 PMCID: PMC6118200 DOI: 10.7717/peerj.5407] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 07/18/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To systematically review the literature and describe the discrepancies in achieving the 2009 Institute of Medicine (IOM) gestational weight gain (GWG) guidelines across cultures. METHODS Ten databases were searched from inception to April 2018. Observational cohort studies were included that examined adult women; reported on a measure of culture; compared cultural groups, and reported on GWG. Articles were broken down into papers that used the current 2009 IOM GWG guidelines and those that used others. A meta-analysis was conducted for studies using the 2009 guidelines examining the prevalence of discordant GWG across cultural groups. RESULTS The review included 86 studies. Overall, 69% of women experienced discordant GWG irrespective of culture. White women experienced excessive GWG most often, and significantly more than Asian and Hispanic women; Black women had a higher prevalence of excessive GWG than Hispanic and Asian women; however, this difference was not significant. CONCLUSIONS The majority of women experience excessive GWG, with White women experiencing this most often. Culturally diverse GWG guidelines are needed to individualize antenatal care and promote optimal maternal-fetal health outcomes across cultural groups.
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Affiliation(s)
- Kathryn M. Denize
- School of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, Canada
| | - Nina Acharya
- School of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, Canada
| | - Stephanie A. Prince
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Danilo Fernandes da Silva
- Department of Physical Education, State University of Midwest/Parana (UNICENTRO), Guarapuava, Paraná, Brazil
| | - Alysha L.J. Harvey
- School of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, Canada
| | | | - Kristi B. Adamo
- School of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, Canada
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Garmendia ML, Matus O, Mondschein S, Kusanovic JP. Gestational weight gain recommendations for Chilean women: a mathematical optimization approach. Public Health 2018; 163:80-86. [PMID: 30103088 DOI: 10.1016/j.puhe.2018.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/03/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES We examined if the guidelines for gestational weight gain (GWG) proposed by the Institute of Medicine (IOM) are the most suitable for Chilean women. STUDY DESIGN Secondary analysis of records of single full-term births at the Dr. Sótero del Río Hospital, Santiago, Chile, during 2003-2012 (n = 62,579). METHODS From clinical records, we obtained data regarding maternal age, height, prepregnancy and at delivery weights, pathologies during pregnancy such as gestational diabetes (GDM) and pre-eclampsia, gestational age at delivery, and number of infants born small for gestational age (SGA) and large for gestational age (LGA). We formulated a mathematical model (MM) to determine the GWG range that maximizes the likelihood of a healthy pregnancy (HP) if the recommendation is followed. We defined an HP as one where the mother has no complications such as pre-eclampsia, GDM, SGA, or LGA. RESULTS Forty-six percent of women had prepregnancy overweight or obesity. The prevalence of GDM, pre-eclampsia, SGA, and LGA were 3%, 1.2%, 9%, and 12%, respectively. An HP was present in 76% of pregnancies, 79% in the underweight group, 79% in normal weight group, 74% in the overweight group, and 67% in obese women. The GWG recommendations given by the MM (14-20 kg for underweight, 6-20 kg for normal weight, 9-11 kg for overweight, and 6-7 kg for obese) led to higher probabilities of achieving an HP than the ones obtained with the IOM recommendations. CONCLUSION The adoption of GWG recommendations based on characteristics of the Chilean population might lead to better short- and long-term health results for pregnant women.
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Affiliation(s)
- M L Garmendia
- Institute of Nutrition and Food Technology, University of Chile, Avda. El Libano 5524, Macul, Santiago, Chile
| | - O Matus
- School of Engineering, Universidad Adolfo Ibáñez, Avda. Diagonal Las Torres 2460, Building C, Peñalolen, Santiago, Chile
| | - S Mondschein
- School of Engineering, Universidad Adolfo Ibáñez, Avda. Diagonal Las Torres 2460, Building C, Peñalolen, Santiago, Chile.
| | - J P Kusanovic
- Centro de Investigación e Innovación en Medicina Materno-Fetal (CIMAF), Unidad de Alto Riesgo Obstétrico, Hospital Dr. Sótero Del Río, Santiago, Chile; División de Obstetricia y Ginecología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Abstract
PURPOSE OF REVIEW Obesity rates in the USA have reached pandemic levels with one third of the population with obesity in 2015-2016 (39.8% of adults and 18.5% of youth). It is a major public health concern, and it is prudent to understand the factors which contribute. Racial and ethnic disparities are pronounced in both the prevalence and treatment of obesity and must be addressed in the efforts to combat obesity. RECENT FINDINGS Disparities in prevalence of obesity in racial/ethnic minorities are apparent as early as the preschool years and factors including genetics, diet, physical activity, psychological factors, stress, income, and discrimination, among others, must be taken into consideration. A multidisciplinary team optimizes lifestyle and behavioral interventions, pharmacologic therapy, and access to bariatric surgery to develop the most beneficial and equitable treatment plans. The reviewed studies outline disparities that exist and the impact that race/ethnicity have on disease prevalence and treatment response. Higher prevalence and reduced treatment response to lifestyle, behavior, pharmacotherapy, and surgery, are observed in racial and ethnic minorities. Increased research, diagnosis, and access to treatment in the pediatric and adult populations of racial and ethnic minorities are proposed to combat the burgeoning obesity epidemic and to prevent increasing disparity.
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Affiliation(s)
- Angel S Byrd
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander T Toth
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Fatima Cody Stanford
- Harvard Medical School, Boston, MA, USA.
- MGH Weight Center, Gastrointestinal Unit-Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 430, Boston, MA, 02114, USA.
- Department of Pediatrics-Endocrinology, Massachusetts General Hospital, Boston, MA, USA.
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Comparison of Self-reported and Measured Pre-pregnancy Weight: Implications for Gestational Weight Gain Counseling. Matern Child Health J 2018; 21:1469-1478. [PMID: 28155023 DOI: 10.1007/s10995-017-2266-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives To examine clinical and demographic characteristics associated with availability of self-reported and measured pre-pregnancy weight, differences in these parameters, and characteristics associated with self-report accuracy. Methods Retrospective cohort of 7483 women who delivered at a large academic medical center between 2011 and 2014. Measured pre-pregnancy weights recorded within a year of conception and self-reported pre-pregnancy weights reported anytime during pregnancy were abstracted from electronic medical records. Difference in weights was calculated as self-reported minus measured pre-pregnancy weight. Logistic and linear regression models estimated associations between demographic and clinical characteristics, and presence of self-reported and measured weights, and weight differences. Results 42.2% of women had both self-reported and measured pre-pregnancy weight, 49.7% had only self-reported, and 2.8% had only measured. Compared to white women, black women and women of other races/ethnicities were less likely to have self-reported weight, and black, Asian, and Hispanic women, and women of other races/ethnicities were less likely to have measured weights. For 85%, pre-pregnancy BMI categorized by self-reported and measured weights were concordant. Primiparas and multiparas were more likely to underreport their weight compared to nulliparas (b = -1.32 lbs, 95% CI -2.24 to -0.41 lbs and b = -2.74 lbs, 95% CI -3.82 to -1.67 lbs, respectively). Discussion Utilization of self-reported or measured pre-pregnancy weight for pre-pregnancy BMI classification results in identical categorization for the majority of women. Providers may wish to account for underreporting for patients with a BMI close to category cutoff by recommending a range of gestational weight gain that falls within recommendations for both categories where feasible.
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Akgun N, Keskin HL, Ustuner I, Pekcan G, Avsar AF. Factors affecting pregnancy weight gain and relationships with maternal/fetal outcomes in Turkey. Saudi Med J 2018; 38:503-508. [PMID: 28439600 PMCID: PMC5447211 DOI: 10.15537/smj.2017.5.19378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives: To determine the effects of pre-pregnancy body mass index (BMI) and gestational weight gain on maternal and fetal complications, and to examine whether Turkish women achieve the recommended gestational weight gain. We also investigated the relationship between pregnancy weight gain and mode of delivery, with an examination of maternal anthropometry. Methods: A retrospective cross-sectional study was conducted on a population of 986 pregnant women between November 2011 and November 2015 at Atatürk Education and Research Hospital, Ankara, Turkey. Maternal age, BMI, monthly weight gain during pregnancy, infant birth weight, gender, and maternal and fetal adverse outcomes were evaluated. Results: The frequency of maternal complications was positively associated with elevated pre-pregnancy BMI (p<0.05), and weight gain during pregnancy was associated with parity and increased infant birth weight (p<0.05). However, no correlations were observed between mean pregnancy weight gain and maternal complications (p>0.05). The percentage of women who gained the Institute of Medicine (IOM)-recommended amount of weight was the highest in the underweight BMI group (54.1%) and the lowest in the obese BMI group (24.3%). Pregnancy weight gain exceeded IOM recommendations in the overweight (56.3%) and obese (52.5%) groups. Conclusions: While maternal weight gain during pregnancy affects neonatal body weight, higher pre-pregnancy BMI has an adverse effect on recommended weight gain during pregnancy, with increased maternal complications.
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Affiliation(s)
- Nilufer Akgun
- Department of Gynecology and Obstetrics, Atatürk Education and Research Hospital, Ankara, Turkey. E-mail.
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Schumacher TL, Weatherall L, Keogh L, Sutherland K, Collins CE, Pringle KG, Rae KM. Characterizing gestational weight gain in a cohort of Indigenous Australian women. Midwifery 2018; 60:13-19. [PMID: 29471174 DOI: 10.1016/j.midw.2018.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 01/26/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE to determine the adequacy of gestational weight gain for a cohort of Indigenous Australian women and investigate whether it is associated with pre-pregnancy body mass index. DESIGN analysis of observational data collected from a longitudinal cohort study that follows Indigenous Australian women through pregnancy. SETTING women recruited through antenatal clinics in regional and remote towns in NSW, Australia to the Gomeroi gaaynggal program. PARTICIPANTS 110 pregnant women who either identified as being an Indigenous Australian or as carrying an Indigenous child. MEASUREMENTS AND FINDINGS measurements included weight and height, self-reported pre-pregnancy weight and smoking status, parity and health conditions that may contribute to gestational weight gain, such as hypertensive or diabetic disorders. Compared to the 2009 Institute of Medicine recommendations for gestational weight gain and based on prepregnancy body mass index, the rate of adequate gestational weight gain in this cohort was very low (15%). 32% of women had inadequate weight gain and 54% had excessive weight gain. The highest rate of excessive gestational weight gain was found in overweight women (74%), with rates of 48% and 50% found in healthy and obese (all classes) categories, respectively. Parity (coefficient 4.5, p<0.01) and hypertension (coefficient 4.8, p = 0.04) were found to be significantly associated with gestational weight gain in mixed model linear regression. CONCLUSIONS few women gained adequate gestational weight gain in this study. Culturally acceptable ways of addressing this issue are needed for this group of women, as inadequate and excessive rates of gestational weight gain have health implications for women and their offspring. IMPLICATIONS FOR PRACTICE a systematic approach to addressing gestational weight gain within antenatal care is required, including asking about diet and exercise, for all women identifying as Indigenous Australian.
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Affiliation(s)
- Tracy L Schumacher
- Gomeroi gaayngal Centre, Faculty of Health and Medicine, University of Newcastle, 2/1 Hinkler Rd, Tamworth, NSW 2340, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Ring Rd, Callaghan, NSW 2308, Australia.
| | - Loretta Weatherall
- Gomeroi gaayngal Centre, Faculty of Health and Medicine, University of Newcastle, 2/1 Hinkler Rd, Tamworth, NSW 2340, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Lyniece Keogh
- Gomeroi gaayngal Centre, Faculty of Health and Medicine, University of Newcastle, 2/1 Hinkler Rd, Tamworth, NSW 2340, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Kathryn Sutherland
- Gomeroi gaayngal Centre, Faculty of Health and Medicine, University of Newcastle, 2/1 Hinkler Rd, Tamworth, NSW 2340, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Clare E Collins
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Ring Rd, Callaghan, NSW 2308, Australia; School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Kirsty G Pringle
- School of Biomedical Sciences and Pharmacy, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre of Reproductive Sciences, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Kym M Rae
- Gomeroi gaayngal Centre, Faculty of Health and Medicine, University of Newcastle, 2/1 Hinkler Rd, Tamworth, NSW 2340, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre of Reproductive Sciences, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre of Generational Health and Ageing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Department of Rural Health, University of Newcastle, Tamworth, NSW 2340, Australia.
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32
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Shen Y, Dong H, Lu X, Lian N, Xun G, Shi L, Xiao L, Zhao J, Ou J. Associations among maternal pre-pregnancy body mass index, gestational weight gain and risk of autism in the Han Chinese population. BMC Psychiatry 2018; 18:11. [PMID: 29343227 PMCID: PMC5773027 DOI: 10.1186/s12888-018-1593-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 01/07/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Autism is a neurodevelopmental disorder with an unclear etiology. Pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) have been suggested to play a role in the etiology of autism. The current study explores the associations among maternal pre-pregnancy BMI, GWG and the risk of autism in the Han Chinese population. METHODS Demographic information, a basic medical history and information regarding maternal pre-pregnancy and pregnancy conditions were collected from the parents of 705 Han Chinese children with autism and 2236 unrelated typically developing children. Binary logistic regressions were conducted to calculate the odds ratio (OR) for the relationship among pre-pregnancy BMI, GWG and the occurrence of autism. The interaction between pre-pregnancy BMI and GWG was analyzed by performing stratification analyses using a logistic model. RESULTS After adjusting for the children's gender, parental age and family annual income, excessive GWG was associated with autism risk in the entire sample (OR = 1.327, 95% CI: 1.021-1.725), whereas the relationship between maternal pre-pregnancy BMI and autism was not significant. According to the stratification analyses, excessive GWG increased the risk of autism in overweight/obese mothers (OR = 2.468, 95% CI: 1.102-5.526) but not in underweight or normal weight mothers. CONCLUSIONS The maternal pre-pregnancy BMI might not be independently associated with autism risk. However, excessive GWG might increase the autism risk of offspring of overweight and obese mothers.
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Affiliation(s)
- Yidong Shen
- Institute of Mental Health, The Second Xiangya Hospital, Central South University; National Clinical Research Center on Mental Disorders, The National Technology Institute on Mental disorders; Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Huixi Dong
- Institute of Mental Health, The Second Xiangya Hospital, Central South University; National Clinical Research Center on Mental Disorders, The National Technology Institute on Mental disorders; Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Xiaozi Lu
- grid.452792.fQingdao Mental Health Center, Qingdao, China
| | - Nan Lian
- grid.412633.1The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guanglei Xun
- Mental Health Center of Shandong Province, Jinan, China
| | - Lijuan Shi
- 0000000119573309grid.9227.eNeuropsychology and Applied Cognitive Neuroscience Research Group, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Lu Xiao
- Institute of Mental Health, The Second Xiangya Hospital, Central South University; National Clinical Research Center on Mental Disorders, The National Technology Institute on Mental disorders; Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Jingping Zhao
- Institute of Mental Health, The Second Xiangya Hospital, Central South University; National Clinical Research Center on Mental Disorders, The National Technology Institute on Mental disorders; Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China.
| | - Jianjun Ou
- Institute of Mental Health, The Second Xiangya Hospital, Central South University; National Clinical Research Center on Mental Disorders, The National Technology Institute on Mental disorders; Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China.
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33
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Zanardo V, Cavallin F, Guerrini P, Bertin M, Straface G. Prepregnancy Body Mass Index Shift Across Gestation: An Association with Breastfeeding Practices? Breastfeed Med 2017; 12:615-620. [PMID: 28872892 DOI: 10.1089/bfm.2017.0037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Research has shown that mother's obesity and underweight are major risk factors for reduced initiation, duration, and exclusivity of breastfeeding. OBJECTIVE We compared breastfeeding practices from discharge until the third postnatal month in women, accounting to prepregnancy body mass index (BMI) and its shift across gestation. STUDY DESIGN Data on maternal shifts in BMI category from prepregnancy to gestational BMI by gestational weight gain (GWG) were defined according to 2009 Institute of Medicine (IOM) guidelines. Logistic regression models were estimated to assess the effect of prepregnancy and gestational BMI on breastfeeding, adjusting for clinically relevant factors. RESULTS The analysis included 658 women. According to prepregnancy BMI, 84 (12.8%) mothers were underweight, 444 (67.4%) were normal weight, 94 (14.3%) were overweight, and 36 (5.5%) were obese. Although in the range defined by IOM 2009, GWG shifted across the BMI categories in 445 (67.6%). Thus, while underweight women shifted in higher BMI categories, normal weight women category halved (230, 35%), and both overweight women (301, 45.7%) and obese women (127, 19.3%) tripled. Breastfeeding patterns at discharge, at first month, and at third month were comparable among prepregnancy and gestational BMI groups, except for prepregnancy BMI groups at third month (p 0.03). At multivariable analysis, neither prepregnancy BMI nor gestational BMI was associated with reduced exclusive breastfeeding within 3 months after discharge. CONCLUSIONS Prepregnancy BMI and gestational BMI, in women with adequate GWG, do not affect exclusive breastfeeding initiation, duration, and exclusivity until the third month postpartum. Women need information and support to gain adequate weight during pregnancy.
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Affiliation(s)
- Vincenzo Zanardo
- 1 Division of Perinatal Medicine, Policlinico Abano Terme , Abano Terme, Italy
| | | | - Pietro Guerrini
- 1 Division of Perinatal Medicine, Policlinico Abano Terme , Abano Terme, Italy
| | - Martina Bertin
- 1 Division of Perinatal Medicine, Policlinico Abano Terme , Abano Terme, Italy
| | - Gianluca Straface
- 1 Division of Perinatal Medicine, Policlinico Abano Terme , Abano Terme, Italy
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Teefey CP, Durnwald CP. Strategies to reduce disparities in maternal morbidity and mortality: The role of obesity and metabolic disease. Semin Perinatol 2017; 41:287-292. [PMID: 28709520 DOI: 10.1053/j.semperi.2017.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Maternal obesity, excessive gestational weight gain, and preexisting diabetes are known risk factors for increased maternal and neonatal morbidity. These conditions are more prevalent in certain racial and ethnic minorities. Identification and acknowledgement of racial and ethnic inequalities related to maternal metabolic disease is crucial for clinicians to provide the most comprehensive care in pregnancy. Research and clinical efforts should focus on implementation of healthy lifestyle interventions preconceptually and risk reduction efforts in disease complications during pregnancy. In addition, obstetrical providers can provide the framework and ongoing support for sustainable lifestyle modifications, thereby, improving a woman's long-term metabolic health.
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Affiliation(s)
- Christina Paidas Teefey
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, 2 Silverstein Building, 3400 Spruce St, Philadelphia, PA 19104.
| | - Celeste P Durnwald
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, 2 Silverstein Building, 3400 Spruce St, Philadelphia, PA 19104
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35
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Gay CL, Richoux SE, Beebe KR, Lee KA. Sleep disruption and duration in late pregnancy is associated with excess gestational weight gain among overweight and obese women. Birth 2017; 44:173-180. [PMID: 28198036 DOI: 10.1111/birt.12277] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Poor sleep during pregnancy has been associated with poorer birth outcomes. High body mass index (BMI) is often associated with poor sleep, but little is known about the relationship between gestational weight gain and sleep in late pregnancy. The purpose of this study was to evaluate the relationships of both gestational weight gain and pre-pregnancy BMI to objective and subjective measures of sleep during late pregnancy. METHODS Pregnant women (n=128) were recruited from prenatal clinics and childbirth classes primarily serving low-income women. Their sleep (disruption and duration) was objectively assessed in their last month of pregnancy with 72 hours of wrist actigraphy monitoring. Their perceived sleep quality was assessed with the Pittsburgh Sleep Quality Index. Pre-pregnancy and late pregnancy height and weight were assessed by self-report and used to calculate BMI and gestational weight gain, which were then grouped into standardized categories. RESULTS Mean Pittsburgh Sleep Quality Index score was 6.8 ± 3.1 (range 2-16). Sixty percent had excess gestational weight gain and it was associated with poorer perceived sleep quality, but was unrelated to objective measures of sleep duration and disruption. Pre-pregnancy BMI was unrelated to all sleep parameters. However, analyses of the interaction of pre-pregnancy BMI and gestational weight gain indicated that excess weight gain was associated with shorter sleep duration and more sleep disruption, but only among women who were overweight before pregnancy. CONCLUSION Pregnancy is an opportunity to promote long-term women's health with a better understanding of the relationship between weight management and healthy sleep habits.
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Affiliation(s)
- Caryl L Gay
- Department of Family Health Care Nursing, University of California, San Francisco, CA, USA.,Lovisenberg Diakonale Hospital, Oslo, Norway
| | - Sarah E Richoux
- Department of Family Health Care Nursing, University of California, San Francisco, CA, USA
| | - Kathleen R Beebe
- Department of Nursing, Dominican University of California, San Rafael, CA, USA
| | - Kathryn A Lee
- Department of Family Health Care Nursing, University of California, San Francisco, CA, USA
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36
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Leonard SA, Petito LC, Stephansson O, Hutcheon JA, Bodnar LM, Mujahid MS, Cheng Y, Abrams B. Weight gain during pregnancy and the black-white disparity in preterm birth. Ann Epidemiol 2017; 27:323-328.e1. [PMID: 28595737 PMCID: PMC5567690 DOI: 10.1016/j.annepidem.2017.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 03/10/2017] [Accepted: 05/01/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE To quantify the relationship between pregnancy weight gain with early and late preterm birth and evaluate whether associations differed between non-Hispanic (NH) black and NH white women. METHODS We analyzed a retrospective cohort of all live births to NH black and NH white women in the United States 2011-2015 (n = 10,714,983). We used weight gain z-scores in multiple logistic regression models stratified by prepregnancy body mass index (BMI) and race to calculate population attributable risk (PAR) percentages for the contribution of high and low pregnancy weight gain to early and late preterm birth. RESULTS Pregnancy weight gain was related to early and late preterm birth, but associations varied by BMI and race. For early preterm birth, the PAR percentage for high pregnancy weight gain ranged from 8 to 10% in NH black women and from 6 to 8% in NH white women. There was little evidence of racial differences in late preterm birth: PAR percentages ranged from 2 to 7% in NH black women and from 3 to 7% in NH white women. CONCLUSIONS Moderate gestational weight gain is associated with lower rate of preterm birth, with greatest reductions for early preterm birth in NH black women.
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Affiliation(s)
- Stephanie A Leonard
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Lucia C Petito
- Division of Biostatistics, School of Public Health, University of California, Berkeley
| | - Olof Stephansson
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Lisa M Bodnar
- Department of Epidemiology, Graduate School of Public Health, and the Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Yvonne Cheng
- Department of Surgery, University of California, Davis, Sacramento; Department of Obstetrics and Gynecology, California Pacific Medical Center, San Francisco, CA
| | - Barbara Abrams
- Division of Epidemiology, School of Public Health, University of California, Berkeley.
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37
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Galin J, Abrams B, Leonard SA, Matthay EC, Goin DE, Ahern J. Living in Violent Neighbourhoods is Associated with Gestational Weight Gain Outside the Recommended Range. Paediatr Perinat Epidemiol 2017; 31:37-46. [PMID: 27921300 PMCID: PMC5195875 DOI: 10.1111/ppe.12331] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND During pregnancy, most women do not meet gestational weight gain (GWG) guidelines, potentially resulting in adverse maternal and infant health consequences. Social environment determinants of GWG have been identified, but evidence on the relationship between neighbourhood violence and GWG is scant. Our study aims to examine the relationship between neighbourhood violence and GWG outside the recommended range. METHODS We used statewide vital statistics and health care utilization data from California for 2006-12 (n = 2 364 793) to examine the relationship of neighbourhood violence (quarters of zip-code rates of homicide and assault) in the first 37 weeks of pregnancy with GWG (categorized using the Institute of Medicine's pregnancy weight gain guidelines). We estimated risk ratios (RR) and marginal risk differences, and analyses were stratified by maternal race/ethnicity and prepregnancy body mass index. RESULTS Residence in neighbourhoods with the highest quartile of violence was associated with more excessive GWG (adjusted RR 1.04, 95% confidence interval CI 1.03, 1.05), compared to the lowest quartile of violence; violence was not associated with inadequate GWG. On the difference scale, this association translates to 2.3% more women gaining weight excessively rather than adequately if all women were exposed to high violence compared to if all women were exposed to low violence. Additionally, associations between neighbourhood violence and excessive GWG were larger in non-white women than in white women. CONCLUSIONS These findings support the hypothesis that violence can affect weight gain during pregnancy, emphasizing the importance of neighbourhood violence as a public health issue.
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Affiliation(s)
- Jessica Galin
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Barbara Abrams
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Stephanie A. Leonard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Ellicott C. Matthay
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Dana E. Goin
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Jennifer Ahern
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
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Kawada T. Maternal obesity, gestational weight gain and childhood cardiac outcome at age 6 years. Int J Obes (Lond) 2016; 41:95. [PMID: 27748743 DOI: 10.1038/ijo.2016.181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- T Kawada
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
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39
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Zanardo V, Mazza A, Parotto M, Scambia G, Straface G. Gestational weight gain and fetal growth in underweight women. Ital J Pediatr 2016; 42:74. [PMID: 27495115 PMCID: PMC4974686 DOI: 10.1186/s13052-016-0284-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 07/29/2016] [Indexed: 11/10/2022] Open
Abstract
Background Despite the current obesity epidemic, maternal underweight remains a common occurrence with potential adverse perinatal outcomes. Methods We aimed to investigate the relationship between weight gain during pregnancy, and fetal growth in underweight women with low and late fertility. Women body mass index (BMI), defined according to the World Health Organization’s definition, gestational weight gain (GWG), defined by the Institute of Medicine and National Research Council and neonatal birth weight were prospectively collected at maternity ward of Policlinico Abano Terme (Italy) in 793 consecutive at term, uncomplicated deliveries. Results Among those, 96 (12.1 %) were categorized as underweight (BMI < 18.5 kg/m2), 551 (69.5 %) as normal weight, 107 (13.4 %) as overweight, and 39 (4.9 %) as obese, respectively. In all mother groups, GWG was within the range recommended by IOM 2009 guidelines. However, underweight women gained more weight in pregnancy (12.8 ± 3.9 kg) in comparison to normal weight (12.3 ± 6.7 kg) and overweight (11.0 ± 4.7 kg) women and their GWG was significantly higher (p < 0.001) with respect to obese women 5.8 ± 6.1 kg). In addition, offspring of underweight women were comparable in size at birth to offspring of normal weight women, whereas they were significantly lighter to offspring of both overweight and obese women. Conclusions Pre-pregnancy underweight does not impact birth weight of healthy, term neonates in presence of normal GWG. Presumably, medical or personal efforts to reach ‘optimal’ GWG could be a leading choice for many women living in industrialized and in low-income countries.
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Affiliation(s)
- Vincenzo Zanardo
- Division of Perinatal Medicine, Policlinico Abano Terme, Piazza Colombo 1, 35031, Abano Terme, Italy.
| | - Alessandro Mazza
- Division of Perinatal Medicine, Policlinico Abano Terme, Piazza Colombo 1, 35031, Abano Terme, Italy
| | - Matteo Parotto
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, Catholic University of sacred Heart, Rome, Italy
| | - Gianluca Straface
- Division of Perinatal Medicine, Policlinico Abano Terme, Piazza Colombo 1, 35031, Abano Terme, Italy
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40
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Brumley J, Cain MA, Stern M, Louis JM. Gestational Weight Gain and Breastfeeding Outcomes in Group Prenatal Care. J Midwifery Womens Health 2016; 61:557-562. [DOI: 10.1111/jmwh.12484] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 03/01/2016] [Accepted: 03/02/2016] [Indexed: 12/18/2022]
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41
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Manyanga T, da Silva DF, Ferraro ZM, Harvey ALJ, Wilson S, Ockenden HN, Adamo KB. The effects of culture on guideline discordant gestational weight gain: a systematic review protocol. Syst Rev 2015; 4:145. [PMID: 26527534 PMCID: PMC4630828 DOI: 10.1186/s13643-015-0132-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/12/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND A significant proportion of women exceeds or does not meet the Institute of Medicine's gestational weight gain (GWG) guidelines. Inadequate, excessive GWG or weight loss during pregnancy is associated with an increased risk of negative maternal and fetal outcomes. Among the many determinants of GWG identified in the 2009 Institute of Medicine guidelines, culture was named as one of the few whose influence has not been fully explored. Some cultural beliefs may erroneously promote overeating as "eating for two" and discourage physical activity during pregnancy, but there is lack of empirical evidence on how culture affects GWG. The purpose of this systematic review is to examine the effects of culture on GWG. METHODS/DESIGN Ten electronic databases will be searched to identify studies reporting on the effects of culture on GWG. Grey literature, published conference abstracts, websites of relevant organizations and reference lists of included studies will also be searched. Studies that report on effects of culture, acculturation, ethnicity, race, nationality, ancestry and identity on GWG in adult women will be included. Quality of evidence will be evaluated using the grading of recommendations, assessment, development and evaluations (GRADE) approach to rating evidence. Study selection, data extraction and risk of bias assessment will be conducted by two independent reviewers, with disagreements being resolved by consensus or third party adjudication as needed. Formal meta-analyses will be conducted among included studies that are sufficiently statistically and clinically homogeneous. DISCUSSION This review will provide a comprehensive assessment and synthesis of current evidence and will draw attention to potential gaps where future research on the effects of culture on guideline discordant gestational weight gain remains to be conducted. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015023399.
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Affiliation(s)
- Taru Manyanga
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. .,School of Human Kinetics, University of Ottawa, Faculty of Health Sciences, Ottawa, ON, K1H 8L6, Canada.
| | - Danilo F da Silva
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. .,Department of Physical Education, State University of Maringa, Maringa, PR, 87020-900, Brazil.
| | - Zachary M Ferraro
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. .,Division of Maternal-Fetal Medicine, The Ottawa Hospital, General Campus, Ottawa, ON, K1H 8L6, Canada. .,Faculty of Medicine, University of Ottawa, Ottawa, ON, K1H 8L6, Canada.
| | - Alysha L J Harvey
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. .,School of Human Kinetics, University of Ottawa, Faculty of Health Sciences, Ottawa, ON, K1H 8L6, Canada.
| | - Shanna Wilson
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada.
| | - Holly N Ockenden
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. .,School of Human Kinetics, University of Ottawa, Faculty of Health Sciences, Ottawa, ON, K1H 8L6, Canada.
| | - Kristi B Adamo
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. .,School of Human Kinetics, University of Ottawa, Faculty of Health Sciences, Ottawa, ON, K1H 8L6, Canada. .,Department of Pediatrics, University of Ottawa, Faculty of Medicine, Ottawa, ON, K1H 8L6, Canada.
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