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Lin L, Huang Y, Chen L, Zheng L, Feng Y, Lin J, Yan J. Gestational weight trajectory and risk of adverse pregnancy outcomes among women with gestational diabetes mellitus: A retrospective cohort study. MATERNAL & CHILD NUTRITION 2024; 20:e13645. [PMID: 38517119 PMCID: PMC11168372 DOI: 10.1111/mcn.13645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
The aim of this study was to explore gestational weight gain (GWG) trajectories and their associations with adverse pregnancy outcomes. A retrospective cohort study including 11,064 women with gestational diabetes mellitus (GDM) was conducted between 2015 and 2019 in China. The latent class trajectory model was used to identify GWG trajectories, and logistic regression was performed to examine odds ratio (OR) of pregnancy outcomes. Three trajectories of GWG were identified in these 11,604 women with GDM. Trajectory 1: 64.02% of women had sustained moderate GWG throughout pregnancy; Trajectory 2: 17.75% of women showed a high initial GWG but followed by a low GWG from the third trimester until delivery; Trajectory 3: 18.23% had low initial GWG but followed by drastic GWG from the second trimester until delivery. Compared with pregnant women with Trajectory 1, women with Trajectory 2 had a higher risk of large for gestational age (adjusted odds ratio [AOR]: 1.29, 95% confidence interval [CI]: 1.12-1.48) but at a lower risk of having hypertensive disorders of pregnancy (AOR: 0.76, 95% CI: 0.57-0.96). Women in Trajectory 3 were more likely to develop small for gestational age (AOR: 2.12, 95% CI: 1.62-2.78), low birthweight (AOR: 1.49, 95% CI: 1.07-2.08), preterm birth (AOR: 1.28, 95% CI: 1.05-1.63), caesarean section (AOR: 1.26, 95% CI: 1.112-1.42) and hypertensive disorders of pregnancy (AOR: 2.24, 95% CI: 1.82-2.76). The association of GWG trajectory with adverse pregnancy outcomes differs across prepregnancy body mass index and GWG categories. Women with a slow initial GWG but followed by drastic GWG had higher risks of adverse pregnancy outcomes. Early clinical recognition of poor GWG trajectory will contribute to early intervention in high-risk groups to minimise adverse outcomes.
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Affiliation(s)
- Lihua Lin
- Department of Healthcare, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Yanhong Huang
- Department of Healthcare, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Lijuan Chen
- Department of Child Healthcare Center, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Lianghui Zheng
- Department of Obstetric, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Yebin Feng
- Department of Research Office, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Juan Lin
- Department of Obstetric, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Jianying Yan
- Department of Obstetric, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
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Wang J, Li J, Yang Z, Duan Y, Li F, Zhou P, Lai J. Trajectory of gestational weight gain is related to birthweight: The TAWS cohort study in China. MATERNAL & CHILD NUTRITION 2024; 20:e13578. [PMID: 38576191 PMCID: PMC11168369 DOI: 10.1111/mcn.13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/20/2023] [Accepted: 09/29/2023] [Indexed: 04/06/2024]
Abstract
Few studies have reported the timing and amount of gestational weight gain (GWG) to prevent large-for-gestational-age (LGA) or small-for-gestational-age (SGA). This study aimed to evaluate the association of GWG velocity in each trimester with LGA or SGA based on data from the Taicang and Wuqiang cohort study (TAWS, n = 2008). We used a linear mixed model to evaluate the association of trimester-specific GWG velocity with birthweight categories and stratified by prepregnancy body mass index category and parity. For normal-weight pregnant women, mothers with LGA births had higher GWG velocities than mothers with appropriate-for-gestational-age (AGA) births in the first trimester (0.108 vs. 0.031 kg/week, p < 0.01), second trimester (0.755 vs. 0.631 kg/week, p < 0.01) and third trimester (0.664 vs. 0.594 kg/week, p < 0.01); in contrast, mothers with SGA births had lower GWG velocities than mothers with AGA births in the second trimester (0.528 vs. 0.631 kg/week, p < 0.01) and third trimester (0.541 vs. 0.594 kg/week, p < 0.01). For normal-weight pregnant women with AGA births, multiparous women had lower GWG velocities than primiparous women in the second (0.602 vs. 0.643 kg/week, p < 0.01) and third trimesters (0.553 vs. 0.606 kg/week, p < 0.01). Therefore, for normal-weight women, LGA prevention would begin in early pregnancy and continue until delivery and the second and third trimesters may be critical periods for preventing SGA; in addition, among normal-weight pregnant women with AGA births, multiparous women tend to have lower weight gain velocities than primiparous women.
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Affiliation(s)
- Jie Wang
- National Institute for Nutrition and HealthChinese Center for Disease Control and PreventionBeijingChina
- Key Laboratory of Human Milk ScienceChinese Center for Disease Control and PreventionBeijingChina
- Key Laboratory of Trace Element NutritionNational Health Commission of ChinaBeijingChina
| | - Jun Li
- Taicang Service Center for Mother and Child Health and Family Planning, TaicangSuzhouChina
| | - Zhenyu Yang
- National Institute for Nutrition and HealthChinese Center for Disease Control and PreventionBeijingChina
- Key Laboratory of Human Milk ScienceChinese Center for Disease Control and PreventionBeijingChina
- Key Laboratory of Trace Element NutritionNational Health Commission of ChinaBeijingChina
| | - Yifan Duan
- National Institute for Nutrition and HealthChinese Center for Disease Control and PreventionBeijingChina
- Key Laboratory of Human Milk ScienceChinese Center for Disease Control and PreventionBeijingChina
- Key Laboratory of Trace Element NutritionNational Health Commission of ChinaBeijingChina
| | - Fang Li
- Taicang Service Center for Mother and Child Health and Family Planning, TaicangSuzhouChina
| | - Pinjiao Zhou
- Taicang Service Center for Mother and Child Health and Family Planning, TaicangSuzhouChina
| | - Jianqiang Lai
- National Institute for Nutrition and HealthChinese Center for Disease Control and PreventionBeijingChina
- Key Laboratory of Human Milk ScienceChinese Center for Disease Control and PreventionBeijingChina
- Key Laboratory of Trace Element NutritionNational Health Commission of ChinaBeijingChina
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Siega-Riz AM, Faith M, Nicholson W, Stuebe A, Lipsky L, Nansel T. Anthropometric Changes During Pregnancy and Their Association with Adequacy of Gestational Weight Gain. Curr Dev Nutr 2024; 8:102051. [PMID: 38187988 PMCID: PMC10767142 DOI: 10.1016/j.cdnut.2023.102051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/16/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Abstract
Background Gestational weight gain (GWG) is an expected component of a healthy pregnancy. Gaining weight within the recommended range helps support the mother's health by providing energy reserves and nutrients to meet the increased metabolic demands during pregnancy. Too much or too little GWG has been associated with adverse health outcomes for the mother and child. Objective The objective of the study was to examine how changes in anthropometric indicators during pregnancy, including fat gain, vary, compare changes among body mass index (BMI) (kg/m2) groups, and examine how the changes were associated with adequacy of GWG defined using the 2009 Institute of Medicine guidelines. Methods Data came from a cohort of 360 pregnant women with measured anthropometric indicators (weight, midupper arm circumference, and skin folds of the triceps, thigh, and upper iliac) at <12-, 16 to 22-, and 28 to 32-wks of gestation. Fat gain was calculated using a formula. Analysis of variance was used to test for differences in anthropometric changes by BMI and adequacy of GWG in the third trimester. Multiple logistic regression was used to examine associations between changes in anthropometric indicators and GWG recommendations. Results Women with normal weight had greater increases in all anthropometric indicators, which differed from women with obesity, who had negative changes and gained less weight. Women who gained inadequately (21%) had negative changes that were all less, compared with women who gained adequately (46%) (except in upper iliac) or excessively (34%). Women with BMI of >25 who gained adequately also had negative changes. Logistic regression results indicated that changes in midupper arm circumference, triceps, and thigh skin folds, and fat gain were all inversely associated with inadequate GWG, whereas all indicators were positively associated with excessive GWG. Conclusions Anthropometric changes during pregnancy differ by BMI and are associated with adequacy of GWG. Women who gained adequately had minimal fat gain, lending support for current GWG guidelines.
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Affiliation(s)
- Anna Maria Siega-Riz
- Departments of Epidemiology and Nutrition, Gillings School of Global Public Health, the University of North Carolina at Chapel Hill, NC, United States
| | - Myles Faith
- Department of Counseling, School, and Educational Psychology, Graduate School of Education, University at Buffalo – The State University of New York, Buffalo, NY, United States
| | - Wanda Nicholson
- Department of Obstetrics and Gynecology, School of Medicine, the University of North Carolina at Chapel Hill, NC, United States
| | - Alison Stuebe
- Department of Obstetrics and Gynecology, School of Medicine and Department of Maternal and Child Health, the University of North Carolina at Chapel Hill, NC, United States
| | - Leah Lipsky
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Tonja Nansel
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
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Widen EM, Burns N, Kahn LG, Grewal J, Backlund G, Nichols AR, Rickman R, Foster S, Nhan-Chang CL, Zhang C, Wapner R, Wing DA, Owen J, Skupski DW, Ranzini AC, Newman R, Grobman W, Daniels MJ. Prenatal weight and regional body composition trajectories and neonatal body composition: The NICHD Foetal Growth Studies. Pediatr Obes 2023; 18:e12994. [PMID: 36605025 PMCID: PMC9924063 DOI: 10.1111/ijpo.12994] [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: 07/19/2022] [Accepted: 11/30/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Gestational weight gain (GWG) and anthropometric trajectories may affect foetal programming and are potentially modifiable. OBJECTIVES To assess concomitant patterns of change in weight, circumferences and adiposity across gestation as an integrated prenatal exposure, and determine how they relate to neonatal body composition. METHODS Data are from a prospective cohort of singleton pregnancies (n = 2182) enrolled in United States perinatal centres, 2009-2013. Overall and by prepregnancy BMI group (overweight/obesity and healthy weight), joint latent trajectory models were fit with prenatal weight, mid-upper arm circumference (MUAC), triceps (TSF) and subscapular (SSF) skinfolds. Differences in neonatal body composition by trajectory class were assessed via weighted least squares. RESULTS Six trajectory patterns reflecting co-occurring changes in weight and MUAC, SSF and TSF across pregnancy were identified overall and by body mass index (BMI) group. Among people with a healthy weight BMI, some differences were observed for neonatal subcutaneous adipose tissue, and among individuals with overweight/obesity some differences in neonatal lean mass were found. Neonatal adiposity measures were higher among infants born to individuals with prepregnancy overweight/obesity. CONCLUSIONS Six integrated trajectory patterns of prenatal weight, subcutaneous adipose tissue and circumferences were observed that were minimally associated with neonatal body composition, suggesting a stronger influence of prepregnancy BMI.
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Affiliation(s)
- Elizabeth M Widen
- Department of Nutritional Sciences, University of Texas at Austin, Austin, Texas, USA
- Department of Women's Health & Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Natalie Burns
- Department of Statistics, University of Florida, Gainesville, Florida, USA
| | - Linda G Kahn
- Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Jagteshwar Grewal
- Division of Population Health Research, Division of Intramural Research, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Grant Backlund
- Department of Statistics, University of Florida, Gainesville, Florida, USA
| | - Amy R Nichols
- Department of Nutritional Sciences, University of Texas at Austin, Austin, Texas, USA
| | - Rachel Rickman
- Department of Nutritional Sciences, University of Texas at Austin, Austin, Texas, USA
| | - Saralyn Foster
- Department of Nutritional Sciences, University of Texas at Austin, Austin, Texas, USA
| | - Chia-Ling Nhan-Chang
- Department of Obstetrics and Gynecology, Columbia University Medical Center, Columbia, South Carolina, USA
| | - Cuilin Zhang
- Division of Population Health Research, Division of Intramural Research, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Ronald Wapner
- Department of Obstetrics and Gynecology, Columbia University Medical Center, Columbia, South Carolina, USA
| | - Deborah A Wing
- Division of Maternal-Fetal Medicine, Department of Obstetrics-Gynecology, University of California, Irvine, School of Medicine, Irvine, and Fountain Valley Regional Hospital and Medical Center, Fountain Valley, California, USA
| | - John Owen
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Daniel W Skupski
- Department of Obstetrics and Gynecology, New York-Presbyterian Queens Hospital, Queens, New York, USA
| | - Angela C Ranzini
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, St Peter's University Hospital, New Brunswick, New Jersey, USA
| | - Roger Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Columbia, South Carolina, USA
| | - William Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University (WAG), New Rochelle, New York, USA
| | - Michael J Daniels
- Department of Statistics, University of Florida, Gainesville, Florida, USA
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Versele V, Stas L, Aerenhouts D, Deliens T, Clarys P, Gucciardo L, Bogaerts A, Devlieger R. Changes in maternal and paternal body composition during the transition to parenthood (TRANSPARENTS). Obesity (Silver Spring) 2023; 31:225-233. [PMID: 36471905 DOI: 10.1002/oby.23586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/27/2022] [Accepted: 08/10/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The transition to parenthood might negatively influence health-related behavior and can result in increased adiposity. The aim of this study was to investigate how body composition in mother-father dyads changes from pregnancy up to 6 months post partum. METHODS Anthropometrics were collected from 144 nulliparous couples at 12 weeks of gestation (PG12) and 6 weeks (PP6WK) and 6 months (PP6M) post partum. A longitudinal dyadic confirmatory factor analysis model was used to analyze changes in body composition. Body composition was treated as a latent variable using BMI, body fat percentage, and waist circumference as indicators. RESULTS For women, latent means increased at 6 weeks post partum (PP6WK - PG12: +1.115, SE: 0.117, p < 0.001), decreased again at 6 months post partum (PP6M - PP6WK: -0.368, SE: 0.107, p < 0.001), but remained above baseline levels (PP6M - PG12: +0.747; SE: 0.115, p < 0.001). For men, the latent means at follow-up were higher than at baseline (PP6WK-PG12: +0.370, SE: 0.075; PP6M-PG12: +0.366, SE: 0.084, both p < 0.001). CONCLUSIONS Increases in latent means correspond to unfavorable changes in BMI, body fat percentage, and waist circumference. These changes were observed from the beginning of pregnancy up to 6 months post partum. Weight management for both women and men during pregnancy and the early postpartum period is recommended and fathers should be included in pre- and postnatal standard care.
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Affiliation(s)
- Vickà Versele
- Faculty of Physical Education and Physiotherapy, Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Faculty of Medicine, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Lara Stas
- Support for Quantitative and Qualitative Research (SQUARE), Core Facility, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Biostatistics and Medical Informatics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Dirk Aerenhouts
- Faculty of Physical Education and Physiotherapy, Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Tom Deliens
- Faculty of Physical Education and Physiotherapy, Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Peter Clarys
- Faculty of Physical Education and Physiotherapy, Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Leonardo Gucciardo
- Faculty of Medicine, Department of Obstetrics and Prenatal Medicine, Vrije Universiteit Brussel, Brussels, Belgium
- Obstetrics and Prenatal Medicine, University Hospital Brussel, Brussels, Belgium
| | - Annick Bogaerts
- Faculty of Medicine, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerpen, Belgium
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Roland Devlieger
- Faculty of Medicine, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Obstetrics and Gynaecology, University Hospital KU Leuven, Leuven, Belgium
- Department of Obstetrics, Gynaecology and Fertility, GZA Campus Wilrijk, Antwerp, Belgium
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Ćwiek D, Lubkowska A, Zimny M, Szymoniak K, Sipak-Szmigiel O. Weight Gain during and after Pregnancy in Women with Gestational Diabetes Mellitus-A Preliminary Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11959. [PMID: 36231261 PMCID: PMC9564576 DOI: 10.3390/ijerph191911959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
UNLABELLED Appropriate gestational weight gain (GWG) favors fewer complications related to pregnancy, delivery, puerperium, and the condition of the fetus and newborn baby. The aim of this study was to evaluate weight gain in women during and after pregnancy, including both women with and without gestational diabetes mellitus (GDM). MATERIALS AND METHODS The study involved 42 singleton pregnant women diagnosed with GDM between the 24th and 28th week of pregnancy. The control group consisted of 28 nondiabetic women with a singleton pregnancy. The pre-pregnancy BMI, intra-pregnancy weight gain, and postpartum body weight were assessed in the participants. RESULTS There were no statistically significant differences in the values of intra-pregnancy weight gain. Only diabetic women who were also overweight or obese had a significantly higher percentage of weight gain during pregnancy. The analysis of the percentage of weight gain during the entire pregnancy showed differences only in the group of women with pre-pregnancy BMI over 30. CONCLUSIONS There were no significant differences in total pregnancy or mid-pregnancy weight gain between women with and without GDM. Most of the women had too high or too low total-pregnancy and mid-pregnancy weight gain. Therefore it is necessary to control GWG and educate pregnant women about it.
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Affiliation(s)
- Dorota Ćwiek
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland
| | - Anna Lubkowska
- Department of Functional Diagnostics and Physical Medicine, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland
| | - Małgorzata Zimny
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland
| | - Katarzyna Szymoniak
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland
| | - Olimpia Sipak-Szmigiel
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland
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Gains in body mass and body water in pregnancy and relationships to birth weight of offspring in rural and urban Pune, India. J Nutr Sci 2022; 11:e75. [PMID: 36304819 PMCID: PMC9554425 DOI: 10.1017/jns.2022.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 12/14/2022] Open
Abstract
Maternal size, weight gain in pregnancy, fetal gender, environment and gestational age are known determinants of birth weight. It is not clear which component of maternal weight or gained weight during pregnancy influences birth weight. We evaluated the association of maternal total body water measured by the deuterium dilution technique (TBW-D2O) at 17 and 34 weeks of gestation with birth weight. A secondary aim was to examine the utility of bioimpedance spectroscopy (BIS) to determine total body water (TBW-BIS) in pregnancy. At 17 and 34 weeks of pregnancy, ninety-nine women (fifty-one rural and forty-eight urban) from Pune, India had measurements of body weight, TBW-D2O, TBW-BIS and offspring birth weight. At 17 weeks of gestation, average weights for rural and urban women were 45⋅5 ± 4⋅8 (sd) and 50⋅7 ± 7⋅8 kg (P < 0⋅0001), respectively. Maternal weight gains over the subsequent 17 weeks for rural and urban women were 6⋅0 ± 2⋅2 and 7⋅5 ± 2⋅8 kg (P = 0⋅003) and water gains were 4⋅0 ± 2⋅4 and 4⋅8 ± 2⋅8 kg (P = 0⋅092), respectively. In both rural and urban women, birth weight was positively, and independently, associated with gestation and parity. Only for rural women, between 17 and 34 weeks, was an increase in dry mass (weight minus TBW-D2O) or a decrease in TBW-D2O as a percentage of total weight associated with a higher birth weight. At both 17 and 34 weeks, TBW-BIS increasingly underestimated TBW-D2O as the water space increased. Differences in body composition during pregnancy between rural and urban environments and possible impacts of nutrition transition on maternal body composition and fetal growth were demonstrated.
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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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Rosinger AY, Bethancourt HJ, Pauley AM, Latona C, John J, Kelyman A, Leonard KS, Hohman EE, McNitt K, Gernand AD, Downs DS, Savage JS. Variation in urine osmolality throughout pregnancy: a longitudinal, randomized-control trial among women with overweight and obesity. Eur J Nutr 2022; 61:127-140. [PMID: 34218315 PMCID: PMC8720908 DOI: 10.1007/s00394-021-02616-x] [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: 01/27/2021] [Accepted: 06/09/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Water needs increase during pregnancy, and proper hydration is critical for maternal and fetal health. This study characterized weekly hydration status changes throughout pregnancy and examined change in response to a randomized, behavioral intervention. An exploratory analysis tested how underhydration during pregnancy was associated with birth outcomes. METHODS The Healthy Mom Zone Study is a longitudinal, randomized-control trial intervention aiming to regulate gestational weight gain (GWG) in pregnant women with overweight/obesity (n = 27). Fourteen women received standard of care; 13 women additionally received weekly guidance on nutrition, physical activity, water intake, and health-promoting behaviors. Hydration status was measured weekly via overnight urine osmolality (Uosm) from ~ 8-36 weeks gestation; underhydration was dichotomized (Uosm ≥ 500 mOsm/kg). Gestational age- and sex-standardized birth weight and length z scores and percentiles were calculated. We used mixed-effect and linear regression models to test covariate-adjusted relationships. RESULTS No differences existed in Uosm or other characteristics between control and intervention women at baseline. Significant interactions (p = 0.01) between intervention and week of pregnancy on Uosm indicated intervention women maintained lower Uosm, whereas control women had a significant quadratic (inverse-U) relationship and greater Uosm in the second and early third trimesters. Results were consistent across robustness and sensitivity checks. Exploratory analyses suggest underhydration was associated with birth weight, but not length, in opposite ways in the second vs. third trimester. CONCLUSION A multi-component behavioral intervention helped women with overweight/obesity maintain better hydration throughout pregnancy. Future studies should confirm birth outcome results as they have important implications for early life nutrition. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03945266; registered May 10, 2019 retrospectively.
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Affiliation(s)
- Asher Y Rosinger
- Department of Biobehavioral Health, Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA, 16802, USA.
- Department of Anthropology, Pennsylvania State University, University Park, PA, USA.
| | - Hilary J Bethancourt
- Department of Biobehavioral Health, Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA, 16802, USA
| | - Abigail M Pauley
- Exercise Psychology Laboratory, Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
| | - Celine Latona
- Department of Biobehavioral Health, Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA, 16802, USA
| | - Jason John
- Department of Biobehavioral Health, Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA, 16802, USA
| | - Alysha Kelyman
- Department of Biobehavioral Health, Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA, 16802, USA
| | - Krista S Leonard
- Exercise Psychology Laboratory, Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
| | - Emily E Hohman
- Center for Childhood Obesity Research, Pennsylvania State University, University Park, PA, USA
| | - Katherine McNitt
- Center for Childhood Obesity Research, Pennsylvania State University, University Park, PA, USA
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA
| | - Alison D Gernand
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA
| | - Danielle Symons Downs
- Exercise Psychology Laboratory, Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, USA
| | - Jennifer S Savage
- Center for Childhood Obesity Research, Pennsylvania State University, University Park, PA, USA
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA
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10
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Razaghi M, Gharibeh N, Vanstone CA, Sotunde OF, Wei SQ, McNally D, Rauch F, Jones G, Weiler HA. Maternal excess adiposity and serum 25-hydroxyvitamin D < 50 nmol/L are associated with elevated whole body fat mass in healthy breastfed neonates. BMC Pregnancy Childbirth 2022; 22:83. [PMID: 35093026 PMCID: PMC8801116 DOI: 10.1186/s12884-022-04403-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/11/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Vitamin D status of pregnant women is associated with body composition of the offspring. The objective of this study was to assess whether the association between maternal vitamin D status and neonatal adiposity is modified by maternal adiposity preconception. METHODS Healthy mothers and their term appropriate weight for gestational age (AGA) infants (n = 142; 59% male, Greater Montreal, March 2016-2019) were studied at birth and 1 month postpartum (2-6 weeks). Newborn (24-36 h) serum was collected to measure total 25-hydroxyvitamin D [25(OH)D] (immunoassay); maternal pre-pregnancy BMI was obtained from the medical record. Anthropometry, body composition (dual-energy X-ray absorptiometry) and serum 25(OH)D were measured at 2-6 weeks postpartum in mothers and infants. Mothers were grouped into 4 categories based on their vitamin D status (sufficient 25(OH)D ≥ 50 nmol/L vs. at risk of being insufficient < 50 nmol/L) and pre-pregnancy BMI (< 25 vs. ≥25 kg/m2): insufficient-recommended weight (I-RW, n = 24); insufficient-overweight/obese (I-OW/O, n = 21); sufficient-recommended weight (S-RW, n = 69); and sufficient-overweight/obese (S-OW/O, n = 28). Partial correlation and linear fixed effects model were used while adjusting for covariates. RESULTS At birth, infant serum 25(OH)D mean concentrations were below 50 nmol/L, the cut-point for sufficiency, for both maternal pre-pregnancy BMI categories; 47.8 [95%CI: 43.8, 51.9] nmol/L if BMI < 25 kg/m2 and 38.1 [95%CI: 33.5, 42.7] nmol/L if BMI ≥25 kg/m2. Infant serum 25(OH)D concentrations at birth (r = 0.77; P < 0.0001) and 1 month (r = 0.59, P < 0.0001) were positively correlated with maternal postpartum serum 25(OH)D concentrations. Maternal serum 25(OH)D concentration was weakly correlated with maternal percent whole body fat mass (r = - 0.26, P = 0.002). Infants of mothers in I-OW/O had higher fat mass versus those of mothers in S-OW/O (914.0 [95%CI: 766.4, 1061.6] vs. 780.7 [95%CI: 659.3, 902.0] g; effect size [Hedges' g: 0.42]; P = 0.04 adjusting for covariates) with magnitude of difference of 220.4 g or ~ 28% difference. CONCLUSIONS Maternal and neonatal vitamin D status are positively correlated. In this study, maternal adiposity and serum 25(OH)D < 50 nmol/L are dual exposures for neonatal adiposity. These findings reinforce the importance of vitamin D supplementation early in infancy irrespective of vitamin D stores acquired in utero and maternal weight status.
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Affiliation(s)
- Maryam Razaghi
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Québec, Canada
| | - Nathalie Gharibeh
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Québec, Canada
| | - Catherine A Vanstone
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Québec, Canada
| | - Olusola F Sotunde
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Québec, Canada
| | - Shu Qin Wei
- Institut national de santé publique du Québec, Montréal, Québec, Canada
| | - Dayre McNally
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Frank Rauch
- Shriners Hospital for Children, Montréal, Québec, Canada
| | - Glenville Jones
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Hope A Weiler
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Québec, Canada.
- Nutrition Research Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, 251 Sir Frederick Banting Driveway, Room E338, Ottawa, Ontario, K1A 0K9, Canada.
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11
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Wang D, Wang M, Darling AM, Perumal N, Liu E, Danaei G, Fawzi WW. Gestational weight gain in low-income and middle-income countries: a modelling analysis using nationally representative data. BMJ Glob Health 2021; 5:bmjgh-2020-003423. [PMID: 33177038 PMCID: PMC7661366 DOI: 10.1136/bmjgh-2020-003423] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/29/2020] [Accepted: 10/16/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Gestational weight gain (GWG) has important implications for maternal and child health and is an ideal modifiable factor for preconceptional and antenatal care. However, the average levels of GWG across all low-income and middle-income countries of the world have not been characterised using nationally representative data. METHODS GWG estimates across time were computed using data from the Demographic and Health Surveys Program. A hierarchical model was developed to estimate the mean total GWG in the year 2015 for all countries to facilitate cross-country comparison. Year and country-level covariates were used as predictors, and variable selection was guided by the model fit. The final model included year (restricted cubic splines), geographical super-region (as defined by the Global Burden of Disease Study), mean adult female body mass index, gross domestic product per capita and total fertility rate. Uncertainty ranges (URs) were generated using non-parametric bootstrapping and a multiple imputation approach. Estimates were also computed for each super-region and region. RESULTS Latin America and Caribbean (11.80 kg (95% UR: 6.18, 17.41)) and Central Europe, Eastern Europe and Central Asia (11.19 kg (95% UR: 6.16, 16.21)) were the super-regions with the highest GWG estimates in 2015. Sub-Saharan Africa (6.64 kg (95% UR: 3.39, 9.88)) and North Africa and Middle East (6.80 kg (95% UR: 3.17, 10.43)) were the super-regions with the lowest estimates in 2015. With the exception of Latin America and Caribbean, all super-regions were below the minimum GWG recommendation for normal-weight women, with Sub-Saharan Africa and North Africa and Middle East estimated to meet less than 60% of the minimum recommendation. CONCLUSION The levels of GWG are inadequate in most low-income and middle-income countries and regions. Longitudinal monitoring systems and population-based interventions are crucial to combat inadequate GWG in low-income and middle-income countries.
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Affiliation(s)
- Dongqing Wang
- Department of Global Health and Population, Harvard University TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Molin Wang
- Department of Epidemiology, Department of Biostatistics, Harvard University TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Anne Marie Darling
- Department of Global Health and Population, Harvard University TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Nandita Perumal
- Department of Global Health and Population, Harvard University TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Goodarz Danaei
- Department of Global Health and Population, Department of Epidemiology, Harvard University TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Department of Epidemiology, Department of Nutrition, Harvard University TH Chan School of Public Health, Boston, Massachusetts, USA
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12
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Abstract
PURPOSE OF THE REVIEW The purpose of this review was to compare physiological and metabolic changes in singleton and twin gestations and to review pregnancy outcomes with respect to current weight gain guidelines. RECENT FINDINGS Reviews in singleton gestations show that weight gain below the recommended guidelines has been associated with small for gestational age infants (less than the 10th percentile) which place these infants at increased risk for neonatal morbidities. Observational studies have shown that adequate and excessive gestational weight gain in twin gestations has been associated with longer gestations and less preterm birth along with increased birth weight at delivery. Weight gain in pregnancy has been identified as a factor that affects both maternal and infant health outcomes in singleton and twin gestations. There is a larger body of research examining these effects in singleton gestations than twin gestations; however, in both groups, the data remain mostly observational and retrospective. Thus far, the research supports the Institute of Medicine recommended weight gain guidelines in singleton and twin gestations for women with normal BMI, but future research should be directed toward underweight and overweight women and the long-term outcomes in all mothers and their offspring.
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Affiliation(s)
- Manisha Gandhi
- Baylor College of Medicine, 6651 Main St, Suite 1096, Houston, TX, 77030, USA.
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13
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Stevens DR, Grobman W, Kumar R, Lipsky LM, Hinkle SN, Chen Z, Williams A, Rohn MCH, Kanner J, Sherman S, Mendola P. Gestational and Postpartum Weight Trajectories Among Women With and Without Asthma. Am J Epidemiol 2021; 190:744-754. [PMID: 33169142 DOI: 10.1093/aje/kwaa248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/06/2020] [Accepted: 11/04/2020] [Indexed: 11/14/2022] Open
Abstract
Asthma leads to increased weight gain in nonpregnant populations, but studies have not examined this association within the context of pregnancy. The association between asthma and perinatal weight trajectories was examined in the Breathe-Wellbeing, Environment, Lifestyle, and Lung Function Study (2015-2019). Multilevel linear spline models were adjusted for age, race/ethnicity, income, marital status, education, cigarette smoking, parity, study site, and prepregnancy body mass index were used to examine differences in perinatal weight trajectories between women with (n = 299) and without (n = 101) asthma. Secondary analyses were conducted to assess whether associations differed by asthma phenotypes. At 40 weeks' gestation, women with asthma gained 16.2 kg (95% confidence interval (CI): 14.6, 17.7) and women without asthma gained 13.1 kg (95% CI: 10.9, 15.4). At 3 months postpartum, women with asthma retained 10.4 kg (95% CI: 8.9, 11.9) and women without asthma retained 8.0 kg (95% CI: 5.9, 10.2). Among women with asthma, exercise-induced asthma and step 3 asthma medications were associated with excess gestational weight gain. These study findings suggest women with asthma gain and retain more weight during pregnancy and postpartum than do women without asthma.
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14
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The relationship between gestational weight gain, maternal upper-body subcutaneous fat changes and infant birth size: A pilot observational study amongst women with obesity. Early Hum Dev 2021; 154:105307. [PMID: 33453458 DOI: 10.1016/j.earlhumdev.2021.105307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND It is widely acknowledged that maternal obesity and excessive gestational weight gain (GWG) are associated with increased risk of fetal macrosomia and recent studies have suggested a role for the timing and composition of GWG. AIMS To examine the effect of the rate of change in GWG and maternal upper-body subcutaneous fat on neonatal anthropometric outcomes in a pilot observational study amongst women with obesity. STUDY DESIGN Expectant women with a body mass index (BMI) > 30 kg/m2 at first antenatal appointment were recruited at 12 weeks gestation. Maternal height, weight and skinfold thickness (SFT) measurements were collected at baseline and repeated at 28 and 36 weeks gestation. Following delivery, World Health Organisation (WHO)-UK infant birthweight z-scores were calculated, and infant anthropometric measurements were obtained. RESULTS The sum of upper body SFT measurements increased in mid-pregnancy (0.08 ± 0.71 mm/week) and decreased in late pregnancy (-0.04 ± 1.17 mm/week). After adjustment for maternal age, BMI and parity, mid- but not late- pregnancy GWG was positively associated with infant birthweight z-score (p<0.05), while mid- but not late-pregnancy changes in the sum of SFT were inversely associated with infant birthweight z-score (p<0.01). CONCLUSIONS The present study suggests that mid- rather than late-pregnancy changes in weight and upper-body subcutaneous fat are associated with infant birthweight. Further research is required in larger, more diverse populations to explore whether pregnancy interventions aiming to improve maternal and offspring health can be personalised beyond BMI and GWG.
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15
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Edi M, Chin YS, Woon FC, Appannah G, Lim PY. Inadequate Gestational Weight Gain and Exposure to Second-Hand Smoke during Pregnancy Increase the Risk of Low Birth Weight: A Cross-Sectional Study among Full-Term Infants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1068. [PMID: 33530307 PMCID: PMC7907990 DOI: 10.3390/ijerph18031068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/25/2020] [Accepted: 12/03/2020] [Indexed: 11/25/2022]
Abstract
Despite the advancement of the healthcare system, low birth weight (LBW) remains as one of the leading causes of under-five mortality. This cross-sectional study aimed to determine the prevalence of LBW and its associated factors among 483 third trimester pregnant women recruited from six selected public health clinics in the Federal Territory of Kuala Lumpur and the state of Selangor, Malaysia. Pregnant women were interviewed for information on socio-demographic characteristics, smoking behaviour, and second-hand smoke (SHS) exposure at home and in the workplace. Information on the obstetrical history and prenatal care visits history were retrieved from the maternal medical records, while infant's birth outcomes were retrieved from infant medical records. The prevalence of LBW (<2.5 kg) in infants was 10.4%, with a mean birth weight of 3.0 [standard deviation (SD) 0.4] kg. Results from the multivariable logistic regression model showed that inadequate weight gained during pregnancy [odds ratio (OR) = 2.41, 95% confidence interval (CI) = 1.18-4.90] and exposure to SHS at home (OR = 1.92, 95% CI = 1.03-3.55) were significantly associated with LBW. In conclusion, pregnant women should monitor their rate of weight gain throughout pregnancy and avoid SHS exposure at home to reduce the risk of delivering LBW infants.
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Affiliation(s)
- Muliana Edi
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor 43400, Malaysia; (M.E.); (F.C.W.); (G.A.)
| | - Yit Siew Chin
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor 43400, Malaysia; (M.E.); (F.C.W.); (G.A.)
- Research Centre of Excellence, Nutrition and Non-Communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor 43400, Malaysia
| | - Fui Chee Woon
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor 43400, Malaysia; (M.E.); (F.C.W.); (G.A.)
- Faculty of Engineering and Information Sciences, School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Geeta Appannah
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor 43400, Malaysia; (M.E.); (F.C.W.); (G.A.)
| | - Poh Ying Lim
- Department of Community Health, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Selangor 43400, Malaysia;
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Álvarez D, Muñoz Y, Ortiz M, Maliqueo M, Chouinard-Watkins R, Valenzuela R. Impact of Maternal Obesity on the Metabolism and Bioavailability of Polyunsaturated Fatty Acids during Pregnancy and Breastfeeding. Nutrients 2020; 13:nu13010019. [PMID: 33374585 PMCID: PMC7822469 DOI: 10.3390/nu13010019] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022] Open
Abstract
Prenatal and postnatal development are closely related to healthy maternal conditions that allow for the provision of all nutritional requirements to the offspring. In this regard, an appropriate supply of fatty acids (FA), mainly n-3 and n-6 long-chain polyunsaturated fatty acids (LCPUFA), is crucial to ensure a normal development, because they are an integral part of cell membranes and participate in the synthesis of bioactive molecules that regulate multiple signaling pathways. On the other hand, maternal obesity and excessive gestational weight gain affect FA supply to the fetus and neonate, altering placental nutrient transfer, as well as the production and composition of breast milk during lactation. In this regard, maternal obesity modifies FA profile, resulting in low n-3 and elevated n-6 PUFA levels in maternal and fetal circulation during pregnancy, as well as in breast milk during lactation. These modifications are associated with a pro-inflammatory state and oxidative stress with short and long-term consequences in different organs of the fetus and neonate, including in the liver, brain, skeletal muscle, and adipose tissue. Altogether, these changes confer to the offspring a higher risk of developing obesity and its complications, as well as neuropsychiatric disorders, asthma, and cancer. Considering the consequences of an abnormal FA supply to offspring induced by maternal obesity, we aimed to review the effects of obesity on the metabolism and bioavailability of FA during pregnancy and breastfeeding, with an emphasis on LCPUFA homeostasis.
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Affiliation(s)
- Daniela Álvarez
- Endocrinology and Metabolism Laboratory, West Division, Faculty of Medicine, University of Chile, Santiago 8380000, Chile; (D.Á.); (Y.M.); (M.O.); (M.M.)
| | - Yasna Muñoz
- Endocrinology and Metabolism Laboratory, West Division, Faculty of Medicine, University of Chile, Santiago 8380000, Chile; (D.Á.); (Y.M.); (M.O.); (M.M.)
| | - Macarena Ortiz
- Endocrinology and Metabolism Laboratory, West Division, Faculty of Medicine, University of Chile, Santiago 8380000, Chile; (D.Á.); (Y.M.); (M.O.); (M.M.)
| | - Manuel Maliqueo
- Endocrinology and Metabolism Laboratory, West Division, Faculty of Medicine, University of Chile, Santiago 8380000, Chile; (D.Á.); (Y.M.); (M.O.); (M.M.)
| | - Raphaël Chouinard-Watkins
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S1A8, Canada;
| | - Rodrigo Valenzuela
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S1A8, Canada;
- Nutrition Department, Faculty of Medicine, University of Chile, Santiago 8380000, Chile
- Correspondence: or ; Tel.: +56-2-9786746
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17
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Martínez-Hortelano JA, Cavero-Redondo I, Álvarez-Bueno C, Garrido-Miguel M, Soriano-Cano A, Martínez-Vizcaíno V. Monitoring gestational weight gain and prepregnancy BMI using the 2009 IOM guidelines in the global population: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2020; 20:649. [PMID: 33109112 PMCID: PMC7590483 DOI: 10.1186/s12884-020-03335-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 10/14/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Previous studies have reported a high prevalence of excessive gestational weight gain (GWG) in women with prepregnancy BMI classified as overweight and obese. However, the joint evidence regarding GWG and prepregnancy BMI in the worldwide population has not been synthesized. Thus, this systematic review and meta-analysis aimed to estimate global and regional mean GWG and the prevalence of GWG above, within and below 2009 Institute of Medicine (IOM) guidelines. Second, we aimed to estimate global and regional prepregnancy BMI and the prevalence of BMI categories according to World Health Organization (WHO) classification. METHODS We searched Medline, Embase, the Cochrane Library and Web of Science to identify observational studies until 9 May 2018. We included studies published from 2009 that used 2009 IOM guidelines, reporting data from women in general population with singleton pregnancies. The 2009 IOM categories for GWG and the WHO categories for prepregnancy BMI were used. DerSimonian and Laird random effects methods were used to estimate the pooled and their respective 95% confidence intervals (95% CIs) of the mean and by category rates of GWG and prepregnancy BMI, calculated by global and regions. RESULTS Sixty-three published studies from 29 countries with a total sample size of 1,416,915 women were included. The global prevalence of GWG above and below the 2009 IOM guidelines, was 27.8% (95% CI; 26.5, 29.1) and 39.4% (95% CI; 37.1, 41.7), respectively. Furthermore, meta-regression analyses showed that the mean GWG and the prevalence of GWG above guidelines have increased. The global prevalence of overweight and obesity, was 23.0% (95% CI; 22.3, 23.7) and 16.3% (95% CI; 15.4, 17.4), respectively. The highest mean GWG and prepregnancy BMI were in North America and the lowest were in Asia. CONCLUSIONS Considering the high prevalence of GWG above the 2009 IOM guidelines and women with overweight/obesity and their continuously increasing trend in most regions, clinicians should recommend lifestyle interventions to improve women's weight during reproductive age. Due to regional variability, these interventions should be adapted to each cultural context. TRIAL REGISTRATION Prospectively registered with PROSPERO ( CRD42018093562 ).
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Affiliation(s)
| | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Social and Health Care Research Center, Santa Teresa Jornet s/n, 16071, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Social and Health Care Research Center, Santa Teresa Jornet s/n, 16071, Cuenca, Spain.
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay.
| | - Miriam Garrido-Miguel
- Universidad de Castilla-La Mancha, Social and Health Care Research Center, Santa Teresa Jornet s/n, 16071, Cuenca, Spain
| | - Alba Soriano-Cano
- Universidad de Castilla-La Mancha, Social and Health Care Research Center, Santa Teresa Jornet s/n, 16071, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Social and Health Care Research Center, Santa Teresa Jornet s/n, 16071, Cuenca, Spain
- Faculty of Health Sciences, Universidad Autónoma de Chile, Talca, Chile
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Abstract
BACKGROUND Most existing research on gestational weight gain and pregnancy outcomes has not accounted for timing of weight gain. The area under the weight gain curve (AUC) provides a single measure that incorporates both timing of weight gain and total amount gained. This study evaluated predictors and outcomes associated with second- and third-trimester weight gain AUC from the second and third trimester using time-to-event analysis to account for the correlation between gestational weight gain and gestational duration. METHODS Our prospective cohort study used data from the LifeCodes study at Brigham and Women's Hospital. Maternal weights were available from all prenatal and study visits. We used log-Poisson models with empirical variance estimation to identify predictors of total AUC from 14 weeks to delivery and Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between AUC quintile and adverse pregnancy outcomes. RESULTS Compared to the middle quintile, the highest quintile of accumulated pound-days was associated with a decreased hazard of spontaneous preterm birth among multigravid women (HR = 0.44; 95% CI = 0.23, 0.84), a decreased hazard of small-for-gestational-age births (HR = 0.65; 95% CI = 0.45, 0.92) overall and an increased hazard of large-for-gestational-age births among normal and underweight women (HR = 3.21; 95% CI = 1.50, 6.89) CONCLUSIONS:: In our study, a pattern of gestational weight gain characterized by more rapid gains earlier in pregnancy was associated with improved pregnancy outcomes in some subgroups of pregnant women.
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Dude AM, Kominiarek MA, Haas DM, Iams J, Mercer BM, Parry S, Reddy UM, Saade G, Silver RM, Simhan H, Wapner R, Wing D, Grobman W. Weight gain in early, mid, and late pregnancy and hypertensive disorders of pregnancy. Pregnancy Hypertens 2020; 20:50-55. [PMID: 32172170 DOI: 10.1016/j.preghy.2020.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/24/2020] [Accepted: 03/01/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the relationship of weight change during early, mid, and late pregnancy with the development of a hypertensive disorder of pregnancy (HDP). STUDY DESIGN These data are from a prospective cohort study of nulliparous women with live singleton pregnancies. "Early" weight change was defined as the difference between self-reported pre-pregnancy weight and weight at the first visit (between 6 and 13 weeks' gestation); "mid" weight change was defined as the weight change between the first and second visits (between 16 and 21 weeks' gestation); "late" weight change was defined as the weight change between the second and third visits (between 22 and 29 weeks' gestation). Weight change in each time period was further characterized as inadequate, adequate, or excessive based on the Institute of Medicine's (IOM's) trimester-specific weekly weight gain goals based on pre-pregnancy body mass index. Multivariable Poisson regression was performed to adjust for potential confounders. MAIN OUTCOME MEASURE Development of any hypertensive disorder of pregnancy. RESULTS Of 8296 women, 1564 (18.9%) developed a HDP. Weight gain in excess of the IOM recommendations during the latter two time periods was significantly associated with HDP. Specifically, trimester-specific excessive weight gain in the mid period (aIRR 1.16, 95% CI 1.01-1.35) as well as in the late period (aIRR = 1.19, 95% CI = 1.02-1.40) was associated with increased risk of developing HDP. The weight gain preceded the onset of clinically apparent disease. CONCLUSIONS Excessive weight gain as early as the early second trimester was associated with increased risks of development of HDP.
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Affiliation(s)
- Annie M Dude
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, United States.
| | - Michelle A Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, United States
| | - David M Haas
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jay Iams
- Department of Obstetrics & Gynecology, The Ohio State University, Columbus, OH, United States
| | - Brian M Mercer
- Department of Obstetrics & Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Samuel Parry
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Uma M Reddy
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Yale University, New Haven, CT, United States
| | - George Saade
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Texas Medical Branch - Galveston, Galveston, TX, United States
| | - Robert M Silver
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, UT, United States
| | - Hyagriv Simhan
- Division Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women's Hospital, University of Pittsburgh, United States
| | - Ronald Wapner
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Columbia University, New York, NY, United States
| | - Deborah Wing
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of California-Irvine, Irvine, CA, United States
| | - William Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, United States
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Deierlein AL, Messito MJ, Katzow M, Berube LT, Dolin CD, Gross RS. Total and trimester-specific gestational weight gain and infant anthropometric outcomes at birth and 6 months in low-income Hispanic families. Pediatr Obes 2020; 15:e12589. [PMID: 31696650 PMCID: PMC7012708 DOI: 10.1111/ijpo.12589] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/18/2019] [Accepted: 09/28/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe total and trimester-specific gestational weight gain (GWG) among low-income Hispanic women and determine whether these GWG exposures are associated with infant anthropometric outcomes at birth and 6 months. STUDY DESIGN Data were from 448 mother-infant pairs enrolled in the Starting Early child obesity prevention trial. Prenatal weights were used to calculate total GWG and 2nd and 3rd trimester GWG rates (kg/week) and categorized as inadequate, adequate, and excessive according to the 2009 Institute of Medicine recommendations. Multivariable linear and modified Poisson regressions estimated associations of infant anthropometric outcomes (birthweight, small-for-gestational age [SGA], large-for-gestational age [LGA], rapid weight gain, and weight-for-age, length-for-age, and weight-for-length z-scores at 6 months) with GWG categories. RESULTS For total GWG, 39% and 27% of women had inadequate and excessive GWG, respectively. 57% and 46% had excessive GWG rates in the 2nd and 3rd trimesters, respectively, with 29% having excessive rates in both trimesters. Inadequate total GWG was associated with lower infant weight and length outcomes (ß range for z-scores = -0.21 to -0.46, p < 0.05) and lower risk of LGA (adjusted Relative Risk, aRR = 0.38; 95% confidence intervals, CI: 0.16, 0.95) and rapid weight gain (aRR = 0.72; 95%CI: 0.51, 1.00). GWG rates above recommendations in the 2nd trimester or 2nd /3rd trimesters were associated with greater weight outcomes at birth and 6 months (ß range for z-scores = 0.24 to 0.35, p < 0.05). CONCLUSIONS Counseling women about health behaviors and closely monitoring GWG beginning in early pregnancy is necessary, particularly among populations at high-risk of obesity.
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Affiliation(s)
- Andrea L. Deierlein
- Department of Epidemiology, New York University College of Global Public Health, New York
| | - Mary Jo Messito
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, New York
| | - Michelle Katzow
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, New York
| | - Lauren Thomas Berube
- Department of Nutrition and Food Studies, New York University Steinhardt, New York
| | - Cara D. Dolin
- Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania
| | - Rachel S. Gross
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, New York
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de Castro MBT, Cunha DB, Araujo MC, Bezerra IN, Adegboye ARA, Kac G, Sichieri R. High protein diet promotes body weight loss among Brazilian postpartum women. MATERNAL AND CHILD NUTRITION 2018; 15:e12746. [PMID: 30381901 DOI: 10.1111/mcn.12746] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 01/07/2023]
Abstract
There is evidence in the general population that adhering to a high protein and low carbohydrate diet may help in losing weight. However, there is little evidence among postpartum women. The aim of this study is to evaluate the effect of a high protein diet on weight loss among postpartum women. A parallel-randomized controlled trial with 94 postpartum women was conducted in a maternity ward in Mesquita county (recruitment from February 2009 to December 2010) and in a polyclinic in Rio de Janeiro city (recruitment from December 2010 to December 2011). Women were randomized to the intervention group (IG) or control group (CG), and both groups received an isocaloric diet (1,800 kcal). Additionally, the IG received approximately 25 g of protein obtained from 125 g per week of sardine to increase daily dietary protein content and was advised to restrict carbohydrate intake. The CG received nutritional counselling to follow the national nutrition guidelines (15% protein, 60% carbohydrates, and 25% lipids). A linear mixed-effects model was used to test the effect of high protein intake and macronutrient intake on weight loss during the postpartum period. Body weight decreased in the IG compared with the CG (ß = -0.325; p = 0.049) among overweight and obese postpartum women. The percentage of energy intake from lipid (ß = -0.023; p = 0.050) was negatively associated with body weight, and carbohydrate intake (ß = 0.020; p = 0.026) was positively associated with body weight over time among all women. Protein intake and lower carbohydrate intake may be used as a dietary strategy to improve body weight loss during the postpartum period.
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Affiliation(s)
- Maria Beatriz Trindade de Castro
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josue de Castro (INJC), Federal University of Rio de Janeiro, Graduate Program of Nutrition/INJC, Rio de Janeiro, Brazil
| | - Diana Barbosa Cunha
- Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marina Campos Araujo
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation/Ministry of Health, Rio de Janeiro, Brazil
| | | | | | - Gilberto Kac
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josue de Castro (INJC), Federal University of Rio de Janeiro, Graduate Program of Nutrition/INJC, Rio de Janeiro, Brazil
| | - Rosely Sichieri
- Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Pellonperä O, Koivuniemi E, Vahlberg T, Mokkala K, Tertti K, Rönnemaa T, Laitinen K. Dietary quality influences body composition in overweight and obese pregnant women. Clin Nutr 2018; 38:1613-1619. [PMID: 30224302 DOI: 10.1016/j.clnu.2018.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 06/26/2018] [Accepted: 08/25/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS Excessive adiposity and gestational weight gain (GWG) have been linked with maternal and offspring morbidity. We investigated the relation of maternal diet, physical activity and GWG on body composition in overweight and obese pregnant women. METHODS Fat mass (FM) and fat free mass (FFM) of 110 overweight and obese pregnant women were measured by air displacement plethysmography in early and late pregnancy (mean 13.5 and 35.3 gestational weeks). At the same time points, the quality of overall diet was assessed by validated index of diet quality (IDQ) questionnaire (score < 10/15 denotes poor dietary quality and score ≥ 10/15 denotes good dietary quality), nutrient intakes by 3-day food diaries, and physical activity by questionnaire. Weight gain between early and late pregnancy was compared to the gestational weight gain guidelines issued by Institute of Medicine. RESULTS Of the women, 77% gained more weight than recommended; this was related to greater dietary fat consumption (80 ± 21 g/day vs. 67 ± 11 g/day, p = 0.010) and greater increase in FM (2.7 ± 3.0 kg vs. -1.0 ± 2.4 kg, p < 0.001) compared to women with ideal GWG. Dietary protein intake (g) correlated positively with FFM at both time points (early pregnancy: r = 0.31, p < 0.002, late pregnancy: r = 0.39, p < 0.001). Women with higher dietary quality index score had more FFM, compared to women with lower dietary quality (early pregnancy FFM: 48.8 ± 5.8 kg vs. 45.8 ± 4.7 kg, p = 0.004, late pregnancy FFM: 56.1 ± 6.4 kg vs. 53.4 ± 5.6 kg, p = 0.025). No correlations were detected between total energy intake or physical activity and FM or FFM at early or late pregnancy. CONCLUSIONS Body composition changes from early to late pregnancy were related to the amount of weight gained and overall dietary quality during pregnancy. Higher dietary quality and protein intake were associated with greater FFM, while dietary fat intake was related to excess weight gain. Identification of these dietary determinants of body composition and weight offers new targets for dietary counseling of pregnant women and thus potential for ensuing health benefits through reduced adiposity.
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Affiliation(s)
- Outi Pellonperä
- University of Turku and Turku University Hospital, Department of Obstetrics and Gynecology, Finland.
| | | | - Tero Vahlberg
- University of Turku and Turku University Hospital, Department of Clinical Medicine, Biostatistics, Finland
| | - Kati Mokkala
- University of Turku, Institute of Biomedicine, Finland
| | - Kristiina Tertti
- University of Turku and Turku University Hospital, Department of Obstetrics and Gynecology, Finland
| | - Tapani Rönnemaa
- University of Turku and Turku University Hospital, Department of Medicine, Finland
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Widen EM. Weight Gain for Gestational-Age Charts in Dichorionic Twins: Tool for Establishing Optimal Weight Gain in Twin Pregnancies. Paediatr Perinat Epidemiol 2018; 32:181-183. [PMID: 29508907 PMCID: PMC5902643 DOI: 10.1111/ppe.12460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Elizabeth M. Widen
- Department of Nutritional Sciences, University of Texas at Austin,
Austin, TX
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Inadequate Gestational Weight Gain, the Hidden Link Between Maternal IBD and Adverse Pregnancy Outcomes: Results from the Norwegian Mother and Child Cohort Study. Inflamm Bowel Dis 2017; 23:1225-1233. [PMID: 28452861 DOI: 10.1097/mib.0000000000001123] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) are in general prone to weight loss. We explored the risk of inadequate gestational weight gain (GWG), and the impact of GWG on adverse pregnancy outcomes, among mothers with IBD in the Norwegian Mother and Child Cohort Study (MoBa). METHODS The MoBa with 95,200 mothers enrolled from 1999 to 2008, comprised 217 mothers with ulcerative colitis and 166 with Crohn's disease. Demographics were ascertained through a basic questionnaire before the first ultrasound visit and an IBD history and disease activity during pregnancy through a questionnaire mailed out in 2013. Inadequate GWG was based on the US Institute of Medicine recommendations. The associations between IBD and inadequate GWG or adverse pregnancy outcomes were explored, adjusted for diabetes, hypertension, smoking, maternal age, education, and disease activity. RESULTS Mothers with Crohn's disease (34.3%) and ulcerative colitis (26.7%) were more frequently exposed to inadequate GWG compared with non-IBD mothers (19.4%) (adjusted odds ratio [aOR] = 2.02, 95% confidence interval [CI], 1.42-2.86 and aOR = 1.46, 95% CI, 1.04-2.05, respectively). Mothers with IBD with inadequate GWG (exposed) had a 2-fold risk of small for gestational age infants compared with exposed non-IBD mothers (aOR = 1.93, 95% CI, 1.13-3.29). Exposed mothers with Crohn's disease and ulcerative colitis had a several-fold increased risk of small for gestational age compared with nonexposed IBD mothers (aOR = 4.5, 95% CI, 1.3-16.2, aOR = 5.5, 95% CI, 1.6-18.5). Disease activity was associated with reduced GWG (<13 kg compared with >17.5 kg) (aOR = 3.34, 95% CI, 1.33-8.38). CONCLUSIONS Inadequate GWG should be considered as a risk factor for adverse pregnancy outcomes or as a marker of disease activity.
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Doherty A, EL-Khuffash A, Monteith C, McSweeney L, Breatnach C, Kent E, Tully E, Malone F, Thornton P. Comparison of bioreactance and echocardiographic non-invasive cardiac output monitoring and myocardial function assessment in primagravida women. Br J Anaesth 2017; 118:527-532. [DOI: 10.1093/bja/aex045] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2017] [Indexed: 12/13/2022] Open
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Gillespie SL, Christian LM. Body Mass Index as a Measure of Obesity: Racial Differences in Predictive Value for Health Parameters During Pregnancy. J Womens Health (Larchmt) 2016; 25:1210-1218. [PMID: 27487272 DOI: 10.1089/jwh.2016.5761] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND As a measure of obesity, body mass index (BMI; kg/m2) is an imperfect predictor of health outcomes, particularly among African Americans. However, BMI is used to guide prenatal care. We examined racial differences in the predictive value of maternal BMI for physiologic correlates of obesity, serum interleukin (IL)-6 and C-reactive protein (CRP), as well as cesarean section and infant birth weight. METHODS One hundred five pregnant women (40 European American, 65 African American) were assessed during the second trimester. BMI was defined as per prepregnancy weight. Electrochemiluminescence and enzyme-linked immunosorbent assays were used to quantify IL-6 and CRP, respectively. Birth outcomes were determined by medical record review. RESULTS Women of both races classified as obese had higher serum IL-6 and CRP than their normal-weight counterparts (ps ≤ 0.01). However, among women with overweight, elevations in IL-6 (p < 0.01) and CRP (p = 0.06) were observed among European Americans, but not African Americans (ps ≥ 0.61). Maternal obesity was a significantly better predictor of cesarean section among European Americans versus African Americans (p = 0.03) and BMI was associated with infant birth weight among European Americans (p < 0.01), but not African Americans (p = 0.94). Effects remained after controlling for gestational age at delivery, gestational diabetes, and gestational weight gain as appropriate. CONCLUSIONS BMI may be a less valid predictor of correlates of overweight/obesity among African Americans versus European Americans during pregnancy. This should be considered in epidemiological studies of maternal-child health. In addition, studies examining the comparative validity of alternative/complementary measures to define obesity in pregnancy are warranted to inform clinical care.
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Affiliation(s)
| | - Lisa M Christian
- 2 Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center , Columbus, Ohio.,3 Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center , Columbus, Ohio.,4 The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center , Columbus, Ohio.,5 Department of Psychology, The Ohio State University , Columbus, Ohio
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Jarman M, Yuan Y, Pakseresht M, Shi Q, Robson PJ, Bell RC. Patterns and trajectories of gestational weight gain: a prospective cohort study. CMAJ Open 2016; 4:E338-45. [PMID: 27525254 PMCID: PMC4966992 DOI: 10.9778/cmajo.20150132] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Gestational weight gain in excess of or below Health Canada's guidelines is known to increase the risk of adverse outcomes for both the woman and her baby. This study describes patterns and trajectories of total and rate of gestational weight gain in a large prospective cohort of pregnant women and adolescents in the Alberta Pregnancy Outcomes and Nutrition study. METHODS We collected weight and height data for 1541 pregnant adolescents and women (mean age 31 years, < 27 weeks' gestation) recruited through advertisements and physicians' offices in Calgary and Edmonton between May 2009 and November 2012. Data were collected once during each trimester following enrolment and once at about 3 months post partum. The participants were categorized according to their prepregnancy body mass index (BMI) as underweight, of normal weight, overweight or obese. We calculated distributions of total and weekly rates of weight gain and determined trajectories of weight gain for each prepregnancy BMI category. RESULTS Of the 1541 participants, 761 (49.4%) exceeded Health Canada's guidelines for total gestational weight gain, and 272 (17.6%) gained less weight than recommended. A total of 63 (19.2%) and 38 (23.6%) participants categorized as overweight or obese, respectively, exceeded the recommended upper limit by 5 to less than 10 kg, and 53 (16.2%) and 27 (16.8%), respectively, exceeded the upper limit by at least 10 kg. Ninety-five participants (30.3%) in the overweight group and 59 (39.6%) of those in the obese group gained weight at more than double the recommended rate between the second and third trimesters. The median weight gain for participants in the normal, overweight and obese categories had exceeded recommended upper limits by about 30, 20 and 18 weeks' gestation, respectively. INTERPRETATION Adherence to Health Canada's guidelines for gestational weight gain was low. Excess gestational weight gain was most marked among those with a prepregnancy BMI in the overweight or obese category. The findings suggest that weight management in pregnancy is challenging and complex. Messages and supports that are tailored for women in different prepregnancy BMI categories may help to improve guideline-concordant gestational weight gain.
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Affiliation(s)
- Megan Jarman
- Department of Agricultural, Food and Nutritional Science (Jarman, Pakseresht, Robson, Bell) and School of Public Health (Yuan, Shi), University of Alberta; Cancer Measurement, Outcomes, Research and Evaluation (C-MORE) (Robson), Cancer Control Alberta, Alberta Health Services, Edmonton, Alta
| | - Yan Yuan
- Department of Agricultural, Food and Nutritional Science (Jarman, Pakseresht, Robson, Bell) and School of Public Health (Yuan, Shi), University of Alberta; Cancer Measurement, Outcomes, Research and Evaluation (C-MORE) (Robson), Cancer Control Alberta, Alberta Health Services, Edmonton, Alta
| | - Mohammadreza Pakseresht
- Department of Agricultural, Food and Nutritional Science (Jarman, Pakseresht, Robson, Bell) and School of Public Health (Yuan, Shi), University of Alberta; Cancer Measurement, Outcomes, Research and Evaluation (C-MORE) (Robson), Cancer Control Alberta, Alberta Health Services, Edmonton, Alta
| | - Qian Shi
- Department of Agricultural, Food and Nutritional Science (Jarman, Pakseresht, Robson, Bell) and School of Public Health (Yuan, Shi), University of Alberta; Cancer Measurement, Outcomes, Research and Evaluation (C-MORE) (Robson), Cancer Control Alberta, Alberta Health Services, Edmonton, Alta
| | - Paula J Robson
- Department of Agricultural, Food and Nutritional Science (Jarman, Pakseresht, Robson, Bell) and School of Public Health (Yuan, Shi), University of Alberta; Cancer Measurement, Outcomes, Research and Evaluation (C-MORE) (Robson), Cancer Control Alberta, Alberta Health Services, Edmonton, Alta
| | - Rhonda C Bell
- Department of Agricultural, Food and Nutritional Science (Jarman, Pakseresht, Robson, Bell) and School of Public Health (Yuan, Shi), University of Alberta; Cancer Measurement, Outcomes, Research and Evaluation (C-MORE) (Robson), Cancer Control Alberta, Alberta Health Services, Edmonton, Alta
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Branco M, Santos-Rocha R, Vieira F, Silva MR, Aguiar L, Veloso AP. Influence of Body Composition on Gait Kinetics throughout Pregnancy and Postpartum Period. SCIENTIFICA 2016; 2016:3921536. [PMID: 27073713 PMCID: PMC4814704 DOI: 10.1155/2016/3921536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/24/2016] [Indexed: 06/05/2023]
Abstract
Pregnancy leads to several changes in body composition and morphology of women. It is not clear whether the biomechanical changes occurring in this period are due exclusively to body composition and size or to other physiological factors. The purpose was to quantify the morphology and body composition of women throughout pregnancy and in the postpartum period and identify the contribution of these parameters on the lower limb joints kinetic during gait. Eleven women were assessed longitudinally, regarding anthropometric, body composition, and kinetic parameters of gait. Body composition and body dimensions showed a significant increase during pregnancy and a decrease in the postpartum period. In the postpartum period, body composition was similar to the 1st trimester, except for triceps skinfold, total calf area, and body mass index, with higher results than at the beginning of pregnancy. Regression models were developed to predict women's internal loading through anthropometric variables. Four models include variables associated with the amount of fat; four models include variables related to overall body weight; three models include fat-free mass; one model includes the shape of the trunk as a predictor variable. Changes in maternal body composition and morphology largely determine kinetic dynamics of the joints in pregnant women.
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Affiliation(s)
- Marco Branco
- Neuromechanics of Human Movement Research Group, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics, Estrada da Costa, 1499-002 Cruz Quebrada-Dafundo, Portugal
- Polytechnic Institute of Santarém-Sport Sciences School of Rio Maior (IPS-ESDRM), Avenida Dr. Mário Soares 110, 2040-413 Rio Maior, Portugal
| | - Rita Santos-Rocha
- Neuromechanics of Human Movement Research Group, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics, Estrada da Costa, 1499-002 Cruz Quebrada-Dafundo, Portugal
- Polytechnic Institute of Santarém-Sport Sciences School of Rio Maior (IPS-ESDRM), Avenida Dr. Mário Soares 110, 2040-413 Rio Maior, Portugal
| | - Filomena Vieira
- Neuromechanics of Human Movement Research Group, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics, Estrada da Costa, 1499-002 Cruz Quebrada-Dafundo, Portugal
- Faculty of Human Kinetics, University of Lisbon (UL-FMH), Estrada da Costa, 1499-002 Cruz Quebrada-Dafundo, Portugal
| | - Maria-Raquel Silva
- Faculty of Health Sciences, University Fernando Pessoa, Rua Carlos da Maia 296, 4200-150 Porto, Portugal
- Research Centre for Anthropology and Health, University of Coimbra, Calçada Martim de Freitas, 3000-456 Coimbra, Portugal
- Institute of Environmental Health, University of Lisbon (UL-FML), Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Liliana Aguiar
- Neuromechanics of Human Movement Research Group, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics, Estrada da Costa, 1499-002 Cruz Quebrada-Dafundo, Portugal
- Faculty of Human Kinetics, University of Lisbon (UL-FMH), Estrada da Costa, 1499-002 Cruz Quebrada-Dafundo, Portugal
| | - António P. Veloso
- Neuromechanics of Human Movement Research Group, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics, Estrada da Costa, 1499-002 Cruz Quebrada-Dafundo, Portugal
- Faculty of Human Kinetics, University of Lisbon (UL-FMH), Estrada da Costa, 1499-002 Cruz Quebrada-Dafundo, Portugal
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