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Martínez-Hortelano JA, González PB, Rodríguez-Rojo IC, Garrido-Miguel M, Arenas-Arroyo SND, Sequí-Domínguez I, Martínez-Vizcaíno V, Berlanga-Macías C. Interpregnancy weight change and neonatal and infant outcomes: A systematic review and meta-analysis. Ann Epidemiol 2024; 97:1-10. [PMID: 39002666 DOI: 10.1016/j.annepidem.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE To synthesize evidence regarding the association between interpregnancy weight change (IPWC) in consecutive pregnancies and neonatal or infant outcomes in the subsequent pregnancy. METHODS Search strategy was implemented in MEDLINE, EMBASE, Web of Science, Scopus and Cochrane Library from their inception to 13 November 2023. The most adjusted odds ratio (OR) or risk ratio estimates provided by original studies were used to calculate pooled risk ratios and their corresponding 95 % confidence intervals (CI) with the DerSimonian and Laird random effects method. Publication bias was assessed by funnel plots and Egger's method, and risk of bias was assessed with The NewcastleOttawa Quality Assessment Scale. RESULTS Thirty-seven observational studies were included. Interpregnancy weight loss or gain were associated with large for gestational age (OR: 0.89; 95 % CI: 0.84-0.94; I2 = 83.6 % and OR: 1.33; 95 % CI:1.26-1.40; I2 = 98.9 %), and stillbirth risk (OR: 1.10; 95 % CI: 1.01-1.18; I2 = 0.0 % and OR: 1.21; 95 % CI: 1.09-1.33; I2 = 60.2 %,). CONCLUSIONS Findings highlight the importance of managing weight between interpregnancy periods, although these findings should be interpreted cautiously because of the possible influence of social determinants of health and other factors.
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Affiliation(s)
- José Alberto Martínez-Hortelano
- Universidad de Alcalá, Facultad de Enfermería y Fisioterapia, Departamento de Enfermería y Fisioterapia, Enfermería, Cuidado comunitario y Determinantes Sociales de la Salud, Madrid, Spain; University of Castilla-La Mancha, Health Care and Social Research Center, Cuenca, Spain
| | - Patricia Blázquez González
- Universidad de Alcalá, Facultad de Enfermería y Fisioterapia, Departamento de Enfermería y Fisioterapia, Enfermería, Cuidado comunitario y Determinantes Sociales de la Salud, Madrid, Spain; Department of Nursing, Red Cross University, Madrid, Spain
| | - Inmaculada Concepción Rodríguez-Rojo
- Universidad de Alcalá, Facultad de Enfermería y Fisioterapia, Departamento de Enfermería y Fisioterapia, Enfermería, Cuidado comunitario y Determinantes Sociales de la Salud, Madrid, Spain; Center for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, Madrid, Spain.
| | - Miriam Garrido-Miguel
- University of Castilla-La Mancha, Health Care and Social Research Center, Cuenca, Spain; Universidad de Castilla-La Mancha, Facultad de Enfermería de Albacete, Albacete, Spain
| | - Sergio Núñez de Arenas-Arroyo
- University of Castilla-La Mancha, Health Care and Social Research Center, Cuenca, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Cuenca, Spain
| | - Irene Sequí-Domínguez
- University of Castilla-La Mancha, Health Care and Social Research Center, Cuenca, Spain; Universidad de Castilla-La Mancha, Facultad de Enfermería de Albacete, Albacete, Spain
| | - Vicente Martínez-Vizcaíno
- University of Castilla-La Mancha, Health Care and Social Research Center, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Carlos Berlanga-Macías
- University of Castilla-La Mancha, Health Care and Social Research Center, Cuenca, Spain; Universidad de Castilla-La Mancha, Facultad de Enfermería de Albacete, Albacete, Spain
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2
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Yu Y, Ma Q, Groth SW. Prepregnancy dieting and obstetrical and neonatal outcomes: Findings from a national surveillance project in the United States. Midwifery 2024; 132:103972. [PMID: 38493519 DOI: 10.1016/j.midw.2024.103972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024]
Abstract
PROBLEM AND BACKGROUND Women with overweight or obesity are recommended to lose weight before pregnancy. Dieting is one of the most used weight control strategies. However, the health implications of dieting before pregnancy remain unclear. AIM To evaluate the associations of dieting during the year before pregnancy with obstetrical and neonatal outcomes, including gestational weight gain (GWG), gestational diabetes, low birthweight, macrosomia, small-for-gestational-age infants (SGA), large-for-gestational-age infants (LGA), and preterm birth. METHODS This study analyzed data from the Pregnancy Risk Assessment Monitoring System (PRAMS), which is a surveillance project in the United States that collects data on maternal health before, during, and after pregnancy. Women who participated in PRAMS phase 7 with a prepregnancy body mass index ≥25 kg/m2 and a singleton birth were eligible. Statistical analyses included logistic regressions and post-hoc mediation analysis (Sobel Test). FINDINGS A total number of 51,399 women were included in the analysis. Women who self-reported prepregnancy dieting (42.8 %) had lower odds of SGA (adjusted odds ratio [aOR]: 0.87; 95 % CI: 0.79-0.97), and higher odds of excessive GWG vs adequate GWG (aOR: 1.42; 95 % CI: 1.32-1.52), gestational diabetes (aOR: 1.12; 95 % CI: 1.02-1.22), and LGA (aOR: 1.18; 95 % CI: 1.08-1.28). Furthermore, the association between prepregnancy dieting and LGA was mediated by excessive GWG (Sobel Test z-value = 5.72, p < 0.01). DISCUSSION AND CONCLUSION This analysis revealed that prepregnancy dieting was associated with several adverse consequences, including excessive GWG, gestational diabetes, and LGA infants. Findings contribute to an improved understanding of the perinatal implications of prepregnancy dieting.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Qianheng Ma
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd, Stanford, CA, 94305, USA
| | - Susan W Groth
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA
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Shinohara S, Horiuchi S, Shinohara R, Otawa S, Kushima M, Miyake K, Yui H, Kojima R, Ooka T, Akiyama Y, Yokomichi H, Yamagata Z. Interpregnancy weight change as a potential risk factor for large-for-gestational-age infants: the Japan Environment and Children's Study. J Matern Fetal Neonatal Med 2023; 36:2209251. [PMID: 37150595 DOI: 10.1080/14767058.2023.2209251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVE This study aimed to estimate the impact of interpregnancy weight change from the first to the second pregnancy on the risk of infants being large for gestational age (LGA). METHODS This nationwide prospective birth cohort analysis included 3245 women who delivered their first two live singletons between 2011 and 2014. Interpregnancy weight change was calculated as the difference between the prepregnancy body mass index (BMI) of the first and second pregnancies. LGA infants were compared among three interpregnancy weight change groups: weight loss (a BMI loss >1 unit), weight gain (a BMI gain >1 unit), and stable weight (BMI maintained within - 1 to <1 unit). Interpregnancy weight change was assessed in mothers with a BMI <25 and ≥25 kg/m2, and adjusted odds ratios (ORs) were calculated for LGA infants by multiple logistic regression. RESULTS The incidence of LGA infants was 8.6% (279 out of 3245). Compared with the stable weight group, interpregnancy weight gain was associated with an increased risk of infants being LGA (adjusted OR: 1.69, 95% confidence interval: 1.21-2.36) in the normal BMI (<25 kg/m2) group. In contrast, in the overweight/obese BMI (≥25 kg/m2) group, interpregnancy BMI was not a significant risk factor for LGA infants. CONCLUSIONS Accurate risk stratification using interpregnancy BMI could assist the clinical management of women with a normal BMI who are at risk of delivering LGA infants.
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Affiliation(s)
- Satoshi Shinohara
- Department of Obstetrics and Gynaecology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Sayaka Horiuchi
- Department of Health Sciences, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Ryoji Shinohara
- Centre for Birth Cohort Studies, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Sanae Otawa
- Centre for Birth Cohort Studies, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Megumi Kushima
- Centre for Birth Cohort Studies, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Kunio Miyake
- Department of Health Sciences, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hideki Yui
- Centre for Birth Cohort Studies, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Reiji Kojima
- Department of Health Sciences, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Tadao Ooka
- Department of Health Sciences, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Yuka Akiyama
- Department of Health Sciences, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hiroshi Yokomichi
- Department of Health Sciences, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Zentaro Yamagata
- Department of Health Sciences, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
- Centre for Birth Cohort Studies, University of Yamanashi, Chuo, Yamanashi, Japan
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Chang MW, Tan A, Wegener DT, Lee RE. A Pilot Goal-Oriented Episodic Future Thinking Weight Loss Intervention for Low-Income Overweight or Obese Young Mothers. Nutrients 2023; 15:3023. [PMID: 37447349 DOI: 10.3390/nu15133023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/23/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Episodic future thinking (EFT) has shown efficacy in laboratory settings. We conducted a pilot goal-oriented EFT (GoEFT) intervention in a real-world setting to help low-income overweight or obese mothers lose weight. This paper presents intervention acceptability and efficacy. METHODS The study used a single-group, before-after design. During the 3-week intervention, participants (N = 15) completed weekly web-based lessons and online health coaching sessions to manage stress and emotion, eat healthier, and be more physically active. Participants completed online surveys at baseline and immediately after the intervention. They also completed an interview to evaluate intervention acceptability. We applied paired t-tests to evaluate efficacy and used content analysis to discover interview themes. RESULTS Participants consistently identified the intervention as acceptable, noting the usefulness of pre-written goals, GoEFT strategies, and goal progress evaluations. The intervention effectively promoted weight loss (d = -0.69), fruit and vegetable intake (d = 0.45-0.49), and emotion control (d = 0.71). It also reduced fat (d = -0.51) and added sugar intake (d = -0.48) and alleviated stress (d = -0.52). Moreover, the intervention increased autonomous motivation (d = 0.75-0.88) and self-efficacy (d = 0.46-0.61). CONCLUSION The GoEFT intervention was acceptable to participants, showing strong preliminary efficacy.
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Affiliation(s)
- Mei-Wei Chang
- College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, USA
| | - Alai Tan
- College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, USA
| | - Duane T Wegener
- Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH 43210, USA
| | - Rebecca E Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 N. 3rd St., Phoenix, AZ 85004, USA
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5
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Dude AM, Smid MC, Branch DW, West J, Meeks H, Yu Z, Fraser A, Smith K, Reddy D. Interpregnancy Body Mass Index Change and Offspring Mortality Risk following the Second Pregnancy. Am J Perinatol 2023; 40:387-393. [PMID: 33878768 PMCID: PMC10552797 DOI: 10.1055/s-0041-1727230] [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] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of the study is to examine the impact of maternal interpregnancy body mass index (BMI) change on subsequent offspring mortality risk. STUDY DESIGN This is a retrospective cohort study of women who had two consecutive live singleton deliveries of at least 20 weeks' gestation from the Utah Population Database. Our exposure was defined as interpregnancy BMI change from the date of first delivery to the conception date of subsequent pregnancy. We categorized BMI change as: < - 1, -1 to 0, 0 to <1 (reference), 1 to 2, 2 to 4, ≥4 kg/m2. Our primary outcome was all-cause age-specific mortality during four time periods: neonatal (≤28 days), infant (29 days to <1 year old), childhood ((≥1 to <5 years old), and late childhood (5 to <18 years old). We also examined mortality specifically attributed to congenital anomalies. Analyses used Cox proportional hazard models stratified by full term (≥37 weeks) and preterm (<37 weeks) deliveries. All models were adjusted for relevant confounders. RESULTS Of 266,752 women, among full-term deliveries, women with a BMI increase of 4 kg/m2 or more had an increased risk of neonatal mortality in their subsequent pregnancy (hazard ratio or HR = 1.72, 95% confidence interval or CI: 1.23-2.41) Women who lost 1 kg/m2 or more between deliveries also had increased neonatal mortality (HR = 1.46, 95% CI: 1.04-2.05). There were no differences in infant, early, or late childhood mortality by interpregnancy BMI change. Maternal interpregnancy interval weight loss of 1 kg/m2 or more and weight gain of ≥4 kg/m2 also had increased risk of mortality associated with congenital anomalies or conditions arising during the neonatal period following their subsequent delivery. CONCLUSION Women with significant interpregnancy weight gain and modest weight loss have a significant increased risk of neonatal mortality following their subsequent pregnancy. KEY POINTS · Significant weight gain between deliveries increases the risk of neonatal death.. · Modest weight loss between deliveries increases the risk of neonatal death.. · This risk may be partially explained by increased risk of congenital malformations..
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Affiliation(s)
- Annie M. Dude
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Marcela C. Smid
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Division of Maternal Fetal Medicine, Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
| | - D. Ware Branch
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Division of Maternal Fetal Medicine, Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
| | - Jennifer West
- Department of Population Science, Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Huong Meeks
- Department of Population Science, Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Zhe Yu
- Department of Population Science, Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Alison Fraser
- Department of Population Science, Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Ken Smith
- Department of Population Science, Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, Utah
| | - Deepika Reddy
- Department of Medicine, University Diabetes and Endocrinology Center, University of Utah, Salt Lake City, Utah
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6
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Lecorguillé M, Camier A, Kadawathagedara M. Weight Changes, Nutritional Intake, Food Contaminants, and Supplements in Women of Childbearing Age, including Pregnant Women: Guidelines for Interventions during the Perinatal Period from the French National College of Midwives. J Midwifery Womens Health 2022; 67 Suppl 1:S135-S148. [PMID: 36480662 DOI: 10.1111/jmwh.13423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/10/2022] [Indexed: 12/13/2022]
Abstract
Adequate maternal nutrition is crucial for a healthy pregnancy and optimal fetal growth. Many women in France of childbearing age start their pregnancy in an unfavorable nutritional status. Recent studies highlight the value of paying attention to weight issues from the preconceptional period. It is important to call attention to the need for folate supplementation and to promote a varied and balanced diet throughout pregnancy to cover essential nutritional needs.
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Affiliation(s)
| | - Aurore Camier
- Université de Paris, CRESS, INSERM, INRAE, Paris, F-75004, France
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7
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Fayed A, Wahabi HA, Esmaeil S, Elkouny R, Elmorshedy H, Bakhsh H. Independent effect of gestational weight gain and prepregnancy obesity on pregnancy outcomes among Saudi women: A sub-cohort analysis from Riyadh mother and baby cohort study (RAHMA). PLoS One 2022; 17:e0262437. [PMID: 35015784 PMCID: PMC8751991 DOI: 10.1371/journal.pone.0262437] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 12/22/2021] [Indexed: 12/02/2022] Open
Abstract
Background Gestational weight gain (GWG) and prepregnancy obesity are garnering more attention as determining factors of pregnancy outcomes when it comes to the wellbeing of both the mother and her baby. This study was conducted to describe the pattern of GWG among participants of Riyadh Mother and Baby Multicenter Cohort Study (RAHMA) and to investigate the detrimental effects of excessive GWG and prepregnancy obesity on pregnancy outcomes. Methods RAHMA is a multicentre cohort study conducted in three hospitals in Riyadh, Saudi Arabia. Participants were categorized according to the Institute of Medicine into inadequate, adequate, and excessive GWG, and stratified by body mass index (BMI) into under/normal weight, overweight, and obese. To examine the independent effect of maternal prepregnancy obesity and GWG, a multivariate regression model was used and adjusted odds ratio (AOR) and 95% Confidence Interval (CI) for each outcome were calculated. Results A total of 7029 participants were included in this study; 31.8% had adequate GWG, 25.9% had excessive GWG and 42.3% had inadequate GWG, while 29.7% had normal BMI, 33.3% were overweight, 34.8% were obese, and 2.2% were underweight. Excessive GWG was independently associated with increased risk of hypertensive events, (AOR = 1.77, 95% CI 1.20–2.63). Obesity was associated with higher risk of gestational diabetes (AOR 2.11, 95% CI 1.76–2.53), hypertensive events (AOR 2.06, 95% CI 1.48–3.01), and delivery by emergency caesarean section (AOR = 1.63, 95% CI 1.35–1.97). Infants of obese women had increased odds of macrosomia (AOR 3.11, 95% CI 1.94–4.99) and lower odds of low birth weight (AOR = 0.68, 95% CI 0.53–0.88). Conclusion In comparison to excessive GWG, which increases the risk of hypertensive events during pregnancy, prepregnancy obesity is associated with more adverse outcomes including GDM, hypertensive events in pregnancy and emergency CS.
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Affiliation(s)
- Amel Fayed
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hayfaa A. Wahabi
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University Medical City and College of Medicine, Riyadh, Saudi Arabia
- * E-mail:
| | - Samia Esmaeil
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
| | - Roaa Elkouny
- College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
| | - Hala Elmorshedy
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hanadi Bakhsh
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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8
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Nagpal TS, Souza SCS, Moffat M, Hayes L, Nuyts T, Liu RH, Bogaerts A, Dervis S, Piccinini-Vallis H, Adamo KB, Heslehurst N. Does prepregnancy weight change have an effect on subsequent pregnancy health outcomes? A systematic review and meta-analysis. Obes Rev 2022; 23:e13324. [PMID: 34694053 DOI: 10.1111/obr.13324] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/25/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022]
Abstract
International guidelines recommend women with an overweight or obese body mass index (BMI) aim to reduce their body weight prior to conception to minimize the risk of adverse perinatal outcomes. Recent systematic reviews have demonstrated that interpregnancy weight gain increases women's risk of developing adverse pregnancy outcomes in their subsequent pregnancy. Interpregnancy weight change studies exclude nulliparous women. This systematic review and meta-analysis was conducted following MOOSE guidelines and summarizes the evidence of the impact of preconception and interpregnancy weight change on perinatal outcomes for women regardless of parity. Sixty one studies met the inclusion criteria for this review and reported 34 different outcomes. We identified a significantly increased risk of gestational diabetes (OR 1.88, 95% CI 1.66, 2.14, I2 = 87.8%), hypertensive disorders (OR 1.46 95% CI 1.12, 1.91, I2 = 94.9%), preeclampsia (OR 1.92 95% CI 1.55, 2.37, I2 = 93.6%), and large-for-gestational-age (OR 1.36, 95% CI 1.25, 1.49, I2 = 92.2%) with preconception and interpregnancy weight gain. Interpregnancy weight loss only was significantly associated with increased risk for small-for-gestational-age (OR 1.29 95% CI 1.11, 1.50, I2 = 89.9%) and preterm birth (OR 1.06 95% CI 1.00, 1.13, I2 = 22.4%). Our findings illustrate the need for effective preconception and interpregnancy weight management support to improve pregnancy outcomes in subsequent pregnancies.
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Affiliation(s)
- Taniya S Nagpal
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Sara C S Souza
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Malcolm Moffat
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Louise Hayes
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Tinne Nuyts
- Department of Development and Regeneration, Research Unit Woman and Child, KU Leuven, Leuven, Belgium
| | - Rebecca H Liu
- Institute for Health System Solutions & Virtual Care, Women's College Hospital, Toronto, Canada
| | - Annick Bogaerts
- Department of Development and Regeneration, Research Unit Woman and Child, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium.,Faculty of Health, University of Plymouth, Plymouth, UK
| | - Sheila Dervis
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Helena Piccinini-Vallis
- Faculty of Medicine, Departments of Family Medicine and Obstetrics and Gynecology, Dalhousie University, Halifax, Canada
| | - Kristi B Adamo
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
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9
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Simmons LA, Phipps JE, Overstreet C, Smith PM, Bechard E, Liu S, Walker C, Noonan D. Goals for reaching optimal wellness (GROWell): A clinical trial protocol of a digital dietary intervention for pregnant and postpartum people with prenatal overweight or obesity. Contemp Clin Trials 2021; 113:106627. [PMID: 34813963 PMCID: PMC9044978 DOI: 10.1016/j.cct.2021.106627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 11/15/2022]
Abstract
Background: Excess gestational weight gain (EGWG) is associated with multiple
pregnancy complications and health risks for birthing people and their
infants. Likewise, postpartum weight retention (PPWR), or not losing all
pregnancy weight, has long-term health consequences. EGWG among people who
enter pregnancy with overweight or obesity have worse obstetric outcomes and
increased PPWR compared to women who gain within Institute of Medicine
guidelines. Methods: This study protocol describes the details of a blinded, randomized
clinical trial of GROWell: Goals for Reaching Optimal
Wellness, a mHealth tool designed to improve diet quality among people who
enter pregnancy with overweight or obese BMIs to help them achieve
appropriate GWG and safe postpartum pregnancy weight loss. Individuals with
overweight and obesity will be randomly assigned to an attention control or
intervention arm. The intervention group will receive personalized,
goal-oriented text messages regarding dietary choices, while the attention
control group will receive text messages about healthy pregnancy, labor,
delivery, and early infancy. Both groups will complete online surveys at
baseline, follow up, 3 and 6 months postpartum. Results and discussion: Currently, 162 subjects have been enrolled. Outcomes associated with
GWG and pregnancy are expected in late 2023, while outcomes on postpartum
weight retention GROWell adherence are expected in late
2024. The results of this trial will support the use of an evidence-based
mHealth tool to be integrated into clinical practice to reduce EGWG and PPWR
among pregnant people with overweight and obese BMIs, a resource that is
currently lacking. Trial registration: ClinicalTrials.gov identifier: NCT04449432. Registered on June 26, 2020.
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Affiliation(s)
- Leigh Ann Simmons
- University of California Davis, Department of Human Ecology, Davis, CA 95616, United States of America.
| | - Jennifer E Phipps
- University of California Davis, Department of Human Ecology, Davis, CA 95616, United States of America
| | - Courtney Overstreet
- University of California Davis Health, Obstetrics and Gynecology Department, Sacramento, CA 95817, United States of America
| | - Paige M Smith
- University of California Davis, Department of Human Ecology, Davis, CA 95616, United States of America
| | - Elizabeth Bechard
- Duke Integrative Medicine, Durham, NC 27705, United States of America
| | - Siwei Liu
- University of California Davis, Department of Human Ecology, Davis, CA 95616, United States of America
| | - Cheryl Walker
- University of California Davis Health, Obstetrics and Gynecology Department, Sacramento, CA 95817, United States of America
| | - Devon Noonan
- Duke University School of Nursing, Durham, NC 27710, United States of America
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10
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Tabet M, Banna S, Luong L, Kirby R, Chang JJ. Pregnancy Outcomes after Preeclampsia: The Effects of Interpregnancy Weight Change. Am J Perinatol 2021; 38:1393-1402. [PMID: 32521560 DOI: 10.1055/s-0040-1713000] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to examine the effects of interpregnancy weight change on pregnancy outcomes, including recurrent preeclampsia, preterm birth, small-for-gestational age (SGA), large-for-gestational age (LGA), and cesarean delivery, among women with a history of preeclampsia. We also evaluated whether these associations were modified by prepregnancy body mass index (BMI) category in the first pregnancy (BMI < 25 vs. ≥25 kg/m2) and if associations were present among women who maintained a healthy BMI category in both pregnancies. STUDY DESIGN We conducted a population-based retrospective cohort study including 15,108 women who delivered their first two nonanomalous singleton live births in Missouri (1989-2005) and experienced preeclampsia in the first pregnancy. We performed Poisson regression with robust error variance to estimate relative risks and 95% confidence intervals for outcomes of interest after controlling for potential confounders. RESULTS Interpregnancy weight gain was associated with increased risk of recurrent preeclampsia, LGA, and cesarean delivery. These risks increased in a "dose-response" manner with increasing magnitude of interpregnancy weight gain and were generally more pronounced among women who were underweight or normal weight in the first pregnancy. Interpregnancy weight loss exceeding 1 BMI unit was associated with increased risk of SGA among underweight and normal weight women, while interpregnancy weight loss exceeding 2 BMI units was associated with reduced risk of recurrent preeclampsia among overweight and obese women. CONCLUSION Even small changes in interpregnancy weight may significantly affect pregnancy outcomes among formerly preeclamptic women. Appropriate weight management between pregnancies has the potential to attenuate such risks. KEY POINTS · Interpregnancy weight change among formerly preeclamptic women significantly affects pregnancy outcomes.. · Interpregnancy weight gain is associated with increased risk of recurrent preeclampsia, large-for-gestational-age and cesarean delivery.. · Interpregnancy weight loss is associated with increased risk of small-for-gestational age and recurrent preeclampsia..
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Affiliation(s)
- Maya Tabet
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri
| | - Soumya Banna
- School of Medicine, Saint Louis University, Saint Louis, Missouri
| | - Lan Luong
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri
| | - Russell Kirby
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida
| | - Jen Jen Chang
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri
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11
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Abstract
Obstetrician-gynecologists are the leading experts in the health care of women, and obesity is the most common medical condition in women of reproductive age. Obesity in women is such a common condition that the implications relative to pregnancy often are unrecognized, overlooked, or ignored because of the lack of specific evidence-based treatment options. The management of obesity requires long-term approaches ranging from population-based public health and economic initiatives to individual nutritional, behavioral, or surgical interventions. Therefore, an understanding of the management of obesity during pregnancy is essential, and management should begin before pregnancy and continue through the postpartum period. Although the care of the obese woman during pregnancy requires the involvement of the obstetrician or other obstetric care professional, additional health care professionals, such as nutritionists, can offer specific expertise related to management depending on the comfort level of the obstetric care professional. The purpose of this Practice Bulletin is to offer an integrated approach to the management of obesity in women of reproductive age who are planning a pregnancy.
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12
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Kawakita T, Franco S, Ghofranian A, Thomas A, Landy HJ. Interpregnancy Body Mass Index Change and Risk of Intrapartum Cesarean Delivery. Am J Perinatol 2021; 38:759-765. [PMID: 33368071 DOI: 10.1055/s-0040-1721698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study aimed to examine the association between interpregnancy body mass index (BMI, kg/m2) change and intrapartum cesarean delivery in multiparous women without a history of cesarean delivery. STUDY DESIGN We conducted a retrospective cohort study of all women who had more than one singleton pregnancy at 23 weeks' gestation or greater at MedStar Washington Hospital Center from January 2009 to June 2018. We excluded women who had a history of cesarean delivery, prelabor cesarean delivery, and contraindications for vaginal delivery. Interpregnancy BMI change was calculated by the change of early pregnancy BMI measured in the office. Women were categorized according to the interpregnancy BMI change (BMI loss more than 2 kg/m2, BMI change ± 2 kg/m2, and BMI gain more than 2 kg/m2). The primary outcome was an intrapartum cesarean delivery. Multivariable logistic regression was performed to calculate adjusted odds ratio (aOR) with 95% confidence interval (CI) after adjusting for predefined covariates. RESULTS Of 2,168 women who were analyzed, 258 (12%), 1,192 (55%), and 718 (33%) had interpregnancy BMI loss more than 2 kg/m2, BMI change ± 2 kg/m2, and BMI gain more than 2 kg/m2, respectively. Women with BMI gain more than 2 kg/m2 compared with those with BMI change ± 2 kg/m2 had increased odds of intrapartum cesarean delivery (7.4 vs. 4.5%; aOR: 1.78; 95% CI: 1.10-2.86) and cesarean delivery for arrest disorders (3.1 vs. 1.1%; aOR: 3.06; 95% CI: 1.30-7.15). Women with BMI loss more than 2 kg/m2 compared with those with BMI change ± 2 kg/m2 had similar rates of cesarean delivery. CONCLUSION Compared with interpregnancy BMI change ± 2 kg/m2, interpregnancy BMI gain 2 kg/m2 was associated with increased odds of intrapartum cesarean delivery. KEY POINTS · BMI gain between pregnancies was associated with intrapartum cesarean delivery.. · BMI loss between pregnancies was not associated with intrapartum cesarean delivery.. · Our study suggests that at least maintaining weight between pregnancies is beneficial..
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Affiliation(s)
- Tetsuya Kawakita
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia.,Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Stephanie Franco
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Atoosa Ghofranian
- Department of Obstetrics and Gynecology, Northwell Health, Manhattan, New York
| | - Alexandra Thomas
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Helain J Landy
- Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, District of Columbia
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13
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Dalrymple KV, Uwhubetine O, Flynn AC, Pasupathy D, Briley AL, Relph SA, Seed PT, O’Keeffe M, Poston L. Modifiable Determinants of Postpartum Weight Loss in Women with Obesity: A Secondary Analysis of the UPBEAT Trial. Nutrients 2021; 13:nu13061979. [PMID: 34207523 PMCID: PMC8227672 DOI: 10.3390/nu13061979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/25/2021] [Accepted: 06/02/2021] [Indexed: 11/17/2022] Open
Abstract
Pregnancy can alter a woman's weight gain trajectory across the life course and contribute to the development of obesity through retention of weight gained during pregnancy. This study aimed to identify modifiable determinants associated with postpartum weight retention (PPWR; calculated by the difference in pre-pregnancy and 6 month postpartum weight) in 667 women with obesity from the UPBEAT study. We examined the relationship between PPWR and reported glycaemic load, energy intake, and smoking status in pregnancy, excessive gestational weight gain (GWG), mode of delivery, self-reported postpartum physical activity (low, moderate, and high), and mode of infant feeding (breast, formula, and mixed). At the 6 month visit, 48% (n = 320) of women were at or above pre-pregnancy weight. Overall, PPWR was negative (-0.06 kg (-42.0, 40.4)). Breastfeeding for ≥4 months, moderate or high levels of physical activity, and GWG ≤9 kg were associated with negative PPWR. These three determinants were combined to provide a modifiable factor score (range 0-3); for each added variable, a further reduction in PPWR of 3.0 kg (95% confidence interval 3.76, 2.25) occurred compared to women with no modifiable factors. This study identified three additive determinants of PPWR loss. These provide modifiable targets during pregnancy and the postnatal period to enable women with obesity to return to their pre-pregnancy weight.
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Affiliation(s)
- Kathryn V. Dalrymple
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE1 7EH, UK; (O.U.); (A.C.F.); (D.P.); (A.L.B.); (S.A.R.); (P.T.S.); (L.P.)
- Correspondence:
| | - Onome Uwhubetine
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE1 7EH, UK; (O.U.); (A.C.F.); (D.P.); (A.L.B.); (S.A.R.); (P.T.S.); (L.P.)
| | - Angela C. Flynn
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE1 7EH, UK; (O.U.); (A.C.F.); (D.P.); (A.L.B.); (S.A.R.); (P.T.S.); (L.P.)
- Department of Nutritional Sciences, School of Life Course Sciences, King’s College London, London SE1 9NH, UK;
| | - Dharmintra Pasupathy
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE1 7EH, UK; (O.U.); (A.C.F.); (D.P.); (A.L.B.); (S.A.R.); (P.T.S.); (L.P.)
- Westmead Reproduction and Perinatal Medicine Centre, Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia
| | - Annette L. Briley
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE1 7EH, UK; (O.U.); (A.C.F.); (D.P.); (A.L.B.); (S.A.R.); (P.T.S.); (L.P.)
- College of Nursing & Health Sciences, Flinders University, Adelaide 5042, Australia
| | - Sophie A. Relph
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE1 7EH, UK; (O.U.); (A.C.F.); (D.P.); (A.L.B.); (S.A.R.); (P.T.S.); (L.P.)
| | - Paul T. Seed
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE1 7EH, UK; (O.U.); (A.C.F.); (D.P.); (A.L.B.); (S.A.R.); (P.T.S.); (L.P.)
| | - Majella O’Keeffe
- Department of Nutritional Sciences, School of Life Course Sciences, King’s College London, London SE1 9NH, UK;
- School of Food and Nutritional Sciences, University College Cork, T12 K8AF Cork, Ireland
| | - Lucilla Poston
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE1 7EH, UK; (O.U.); (A.C.F.); (D.P.); (A.L.B.); (S.A.R.); (P.T.S.); (L.P.)
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14
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Poblete JA, Olmos P. Obesity and Gestational Diabetes in Pregnant Care and Clinical Practice. Curr Vasc Pharmacol 2021; 19:154-164. [PMID: 32598260 DOI: 10.2174/1570161118666200628142353] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/17/2020] [Accepted: 05/11/2020] [Indexed: 02/07/2023]
Abstract
Obesity and Gestational Diabetes Mellitus (GDM) are the most frequent pathologies affecting mothers and offspring during pregnancy. Both conditions have shown a sustained increase in their prevalence in recent years, and they worsen the outcome of pregnancy and the long-term health of mothers. Obesity increases the risk of GDM and pre-eclampsia during pregnancy and elevates the risk of developing metabolic syndrome in later life. Offspring of obese mothers have an increased risk of obstetric morbidity and mortality and, consistent with the developmental origins of health and disease, a long term risk of childhood obesity and metabolic dysfunction. On the other hand, GDM also increases the risk of pre-eclampsia, caesarean section, and up to 50% of women will develop type 2 diabetes later in life. From a fetal point of view, it increases the risk of macrosomia, large-for-gestational-age fetuses, shoulder dystocia and birth trauma. The insulin resistance and inflammatory mediators released by a hypoxic trophoblast are mainly responsible for the poor pregnancy outcome in obese or GDM patients. The adequate management of both pathologies includes modifications in the diet and physical activity. Drug therapy should be considered when medical nutrition therapy and moderate physical activity fail to achieve treatment goals. The antenatal prediction of macrosomia is a challenge for physicians. The timing and the route of delivery should consider adequate metabolic control, gestational age, and optimal conditions for a vaginal birth. The best management of these pathologies includes pre-conception planning to reduce the risks during pregnancy and improve the quality of life of these patients.
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Affiliation(s)
- José Andrés Poblete
- Division of Obstetrics and Gynaecology, School of Medicine, Pontificia Universidad Catolica de Santiago, Región Metropolitana, Chile
| | - Pablo Olmos
- Department of Nutrition, School of Medicine, Pontificia Universidad Catolica de Santiago, Región Metropolitana, Chile
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15
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Bourke M, Patel D, Rocca A, Maric T, Savvidou M. Effect of postbariatric maternal weight loss and surgery to conception interval on perinatal outcomes of nulliparous women. Surg Obes Relat Dis 2021; 17:1473-1479. [PMID: 34031009 DOI: 10.1016/j.soard.2021.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/02/2021] [Accepted: 04/21/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Bariatric surgery is associated with an increased risk of delivering a small neonate. The role of maternal weight loss and surgery to conception interval is unclear. OBJECTIVES To investigate the effect of maternal weight loss, as a result of bariatric surgery, and surgery to conception interval on fetal growth and birthweight (BW). SETTING Inner London Teaching Hospital METHODS: We studied prospectively nulliparous women with previous bariatric surgery. Information on type, time, and presurgery weight was obtained. Surgery-to-conception interval was calculated as the time between surgery and conception, defined as the fourteenth day of the pregnancy dated by first trimester ultrasound scan. In the first trimester, maternal weight was measured. Assessment of maternal weight change between presurgery and first trimester of pregnancy was defined as total weight loss (TWL) (%). Fetal ultrasound scans were performed twice; 30-32 and 35-37 weeks' gestation and estimated fetal weight (EFW) was calculated. Fetal growth rate was calculated as the ratio of EFW increase (in grams) between 30-32 and 35-37 weeks divided by the time interval (in days) between the 2 examinations. BW was recorded. RESULTS The study included 54 pregnant women, 26 with a restrictive procedure (gastric band or vertical sleeve gastrectomy) and 28 with a gastric bypass. Surgery to conception interval was not a significant predictor of the offspring's growth. Maternal TWL was a significant predictor of fetal growth rate (P = .04) and predictor of BW (P = .005), even after adjustment for confounders. CONCLUSIONS Maternal weight loss, as a result of bariatric surgery, has an inverse correlation with fetal growth rate and BW.
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Affiliation(s)
- Miriam Bourke
- Department of Research & Development, Chelsea & Westminster Hospital, London, United Kingdom
| | - Deesha Patel
- Academic Department of Obstetrics and Gynaecology, Department of Metabolism, Digestion and Reproduction, Imperial College London, Chelsea & Westminster Hospital, London, United Kingdom
| | - Alessandra Rocca
- Department of Research & Development, Chelsea & Westminster Hospital, London, United Kingdom
| | - Tanya Maric
- Fetal Medicine Unit, Chelsea & Westminster Hospital, London, United Kingdom
| | - Makrina Savvidou
- Academic Department of Obstetrics and Gynaecology, Department of Metabolism, Digestion and Reproduction, Imperial College London, Chelsea & Westminster Hospital, London, United Kingdom; Fetal Medicine Unit, Chelsea & Westminster Hospital, London, United Kingdom.
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16
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Kawakita T, Downs SK, Franco S, Ghofranian A, Thomas A. Interpregnancy body mass index change and risk of hypertensive disorders in pregnancy. J Matern Fetal Neonatal Med 2020; 35:3223-3228. [PMID: 32928011 DOI: 10.1080/14767058.2020.1817371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hypertensive disorders are a common cause of maternal mortality. Whether interpregnancy BMI (body mass index kg/m2) gain is associated with hypertensive disorders in a subsequent pregnancy is not unclear. OBJECTIVES To examine the association between interpregnancy BMI and hypertensive disorders in women without a history of hypertensive disorders in pregnancy. STUDY DESIGN This was a retrospective cohort study of all women who had more than one singleton pregnancy at 23 weeks' gestation or greater at a single academic institution. Only the second pregnancy in the dataset was analyzed. We excluded women who had any hypertensive disorder in the index pregnancy. Interpregnancy BMI change was calculated by the change of early pregnancy BMI (within 14 weeks' gestation) measured in the office between the index pregnancy compared to that of the subsequent pregnancy. Women were categorized according to interpregnancy BMI change (BMI loss greater than 2 kg/m2, BMI change ±2 kg/m2, and BMI gain greater than 2 kg/m2). The primary outcome was any hypertensive disorder (chronic hypertension and pregnancy-associated hypertension). Multivariable logistic regression was performed to calculate adjusted odds ratios (aOR) with 95% confidence interval (95%CI) after adjusting for predefined covariates. RESULTS Of 3068 women who were analyzed, 342 (11%), 1698 (55%), and 1028 (34%) had interpregnancy BMI loss greater than 2 kg/m2, interpregnancy BMI change ±2 kg/m2, and interpregnancy BMI gain greater than 2 kg/m2, respectively. Interpregnancy BMI gain greater than 2 kg/m2 compared to interpregnancy BMI loss more than 2 kg/m2 was associated with increased odds of hypertensive disorders (8.3% vs. 4.0%; adjusted odds ratio 2.20 [95% confidence interval 1.55-3.13]) and pregnancy-associated hypertension (adjusted odds ratio 2.25 [95% confidence interval 1.54-3.27]). Interpregnancy BMI loss greater than 2 kg/m2 compared to interpregnancy BMI change ±2 kg/m2 was not associated with increased odds of any hypertensive disorders (5.3% vs. 4.0%; adjusted odds ratio 0.58 [95% confidence interval 0.32-1.05]). CONCLUSIONS Compared to interpregnancy BMI change ±2 kg/m2, interpregnancy BMI gain greater than 2 kg/m2 was associated with increased odds of any hypertensive disorder. Weight control after pregnancy could be a potentially modifiable factor that may reduce the risk of hypertensive disorders.
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Affiliation(s)
- Tetsuya Kawakita
- Obstetrics and Gynecology Department, Eastern Virginia Medical School, Norfolk, VA, USA.,Obstetrics and Gynecology Department, MedStar Washington Hospital Center, Washington, DC, USA
| | - Sarah K Downs
- Obstetrics and Gynecology Department, MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Atoosa Ghofranian
- Obstetrics and Gynecology Department, Northwell Health, Manhattan, NY, USA
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17
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Maxwell C, Gaudet L, Cassir G, Nowik C, McLeod NL, Jacob CÉ, Walker M. Guideline No. 392-Pregnancy and Maternal Obesity Part 2: Team Planning for Delivery and Postpartum Care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 41:1660-1675. [PMID: 31640866 DOI: 10.1016/j.jogc.2019.03.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This guideline will review key aspects in the pregnancy care of women with obesity. Part I will focus on Preconception and Pregnancy Care. Part II will focus on Team Planning for Delivery and Postpartum Care. INTENDED USERS All health care providers (obstetricians, family doctors, midwives, nurses, anaesthesiologists) who provide pregnancy-related care to women with obesity. TARGET POPULATION Women with obesity who are pregnant or planning pregnancies. EVIDENCE Literature was retrieved through searches of Statistics Canada, Medline, and The Cochrane Library on the impact of obesity in pregnancy on antepartum and intrapartum care, maternal morbidity and mortality, obstetric anaesthesia, and perinatal morbidity and mortality. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to September 2018. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALIDATION METHODS The content and recommendations were drafted and agreed upon by the authors. Then the Maternal-Fetal Medicine Committees peer reviewed the content and submitted comments for consideration, and the Board of the Society of Obstetricians and Gynaecologists of Canada (SOGC) approved the final draft for publication. Areas of disagreement were discussed during meetings at which time consensus was reached. The level of evidence and quality of the recommendation made were described using the Evaluation of Evidence criteria of the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS Implementation of the recommendations in these guidelines may increase obstetrical provider recognition of the issues affecting pregnant individuals with obesity, including clinical prevention strategies, communication between the health care team, the patient and family as well as equipment and human resource planning. It is hoped that regional, provincial and federal agencies will assist in the education and support of coordinated care for pregnant individuals with obesity. GUIDELINE UPDATE SOGC guideline will be automatically reviewed 5 years after publication. However, authors can propose another review date if they feel that 5 years is too short/long based on their expert knowledge of the subject matter. SPONSORS This guideline was developed with resources funded by the SOGC. SUMMARY STATEMENTS RECOMMENDATIONS.
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18
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Maternal weight change between successive pregnancies: an opportunity for lifecourse obesity prevention. Proc Nutr Soc 2020; 79:272-282. [PMID: 32624015 DOI: 10.1017/s0029665120007065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Maternal obesity is a major risk factor for adverse health outcomes for both the mother and the child, including the serious public health problem of childhood obesity which is globally on the rise. Given the relatively intensive contact with health/care professionals following birth, the interpregnancy period provides a golden opportunity to focus on preconception and family health, and to introduce interventions that support mothers to achieve or maintain a healthy weight in preparation for their next pregnancy. In this review, we summarise the evidence on the association between interpregnancy weight gain with birth and obesity outcomes in the offspring. Gaining weight between pregnancies is associated with an increased risk of large-for-gestational age (LGA) birth, a predictor of childhood obesity, and weight loss between pregnancies in women with overweight or obesity seems protective against recurrent LGA. Interpregnancy weight loss seems to be negatively associated with birthweight. There is some suggestion that interpregnancy weight change may be associated with preterm birth, but the mechanisms are unclear and the direction depends if it is spontaneous or indicated. There is limited evidence on the direct positive link between maternal interpregnancy weight gain with gestational diabetes, pre-eclampsia, gestational hypertension and obesity or overweight in childhood, with no studies using adult offspring adiposity outcomes. Improving preconception health and optimising weight before pregnancy could contribute to tackling the rise in childhood obesity. Research testing the feasibility, acceptability and effectiveness of interventions to optimise maternal weight and health during this period is needed, particularly in high-risk and disadvantaged groups.
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19
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Erickson ML, Mey JT, Axelrod CL, Paul D, Gordesky L, Russell K, Barkoukis H, O'Tierney-Ginn P, Fielding RA, Kirwan JP, Catalano PM. Rationale and study design for lifestyle intervention in preparation for pregnancy (LIPP): A randomized controlled trial. Contemp Clin Trials 2020; 94:106024. [PMID: 32389808 DOI: 10.1016/j.cct.2020.106024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Maternal obesity increases neonatal risk for obesity and metabolic syndrome later in life. Prior attempts to break this intergenerational obesity cycle by limiting excessive gestational weight gain have failed to reduce neonatal adiposity. Alternatively, pre-conception lifestyle interventions may improve the in utero metabolic milieu during early pregnancy leading to improved fetal outcomes. This randomized controlled trial (RCT) is evaluating whether a lifestyle intervention to reduce weight and improve maternal metabolism in preparation for pregnancy (LIPP) attenuates neonatal adiposity, compared to standard medical advice. MATERIAL AND METHODS Overweight/class 1 obese women after a previous pregnancy, ~12 weeks postpartum, preparing for a subsequent pregnancy, will be block randomized (1:1) to either LIPP or standard of care in a parallel design. Randomization is stratified by lactation status and overweight vs. class 1 obesity. The LIPP program consists of intensive short-term weight loss followed by weight maintenance until conception using supervised exercise and a low glycemic Mediterranean diet. PRIMARY OUTCOMES Group differences in neonatal adiposity at birth assessed by PEA POD and placental mitochondrial lipid metabolism. SECONDARY OUTCOMES Group differences in maternal pregravid and gestational body composition, insulin sensitivity, β-cell function, fasting metabolic and inflammatory biomarkers, and overall quality of life. Exploratory outcomes include umbilical cord blood insulin resistance, lipid profile and inflammation. DISCUSSION This RCT will determine the efficacy of maternal weight loss prior to pregnancy on reducing neonatal adiposity. Findings may change standard obstetrical care by providing Level 1 evidence on lifestyle interventions improving neonatal outcomes for women planning for pregnancy. CLINICAL TRIAL REGISTRATION NCT03146156.
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Affiliation(s)
- M L Erickson
- Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States of America
| | - J T Mey
- Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States of America
| | - C L Axelrod
- Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States of America; Department of Translational Services, Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America
| | - D Paul
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States of America
| | - L Gordesky
- Department of Reproductive Biology, Center for Reproductive Health, MetroHealth Medical, 2500 MetroHealth Dr, Cleveland, OH 44109, United States of America
| | - K Russell
- Mother Infant Research Institute, Tufts Medical Center, 800 Washington St, Boston, MA 02111, United States of America
| | - H Barkoukis
- Department of Nutrition, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, United States of America
| | - P O'Tierney-Ginn
- Department of Reproductive Biology, Center for Reproductive Health, MetroHealth Medical, 2500 MetroHealth Dr, Cleveland, OH 44109, United States of America; Mother Infant Research Institute, Tufts Medical Center, 800 Washington St, Boston, MA 02111, United States of America
| | - R A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, 711 Washington St, Boston, MA 02111, United States of America
| | - J P Kirwan
- Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States of America.
| | - P M Catalano
- Department of Reproductive Biology, Center for Reproductive Health, MetroHealth Medical, 2500 MetroHealth Dr, Cleveland, OH 44109, United States of America; Mother Infant Research Institute, Tufts Medical Center, 800 Washington St, Boston, MA 02111, United States of America.
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20
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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: 6] [Impact Index Per Article: 1.5] [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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McGirr C, Rooney C, Gallagher D, Dombrowski SU, Anderson AS, Cardwell CR, Free C, Hoddinott P, Holmes VA, McIntosh E, Somers C, Woodside JV, Young IS, Kee F, McKinley MC. Text messaging to help women with overweight or obesity lose weight after childbirth: the intervention adaptation and SMS feasibility RCT. PUBLIC HEALTH RESEARCH 2020. [DOI: 10.3310/phr08040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background
There is a need to develop weight management interventions that fit seamlessly into the busy lives of women during the postpartum period.
Objective
The objective was to develop and pilot-test an evidence- and theory-based intervention, delivered by short message service, which supported weight loss and weight loss maintenance in the postpartum period.
Design
Stage 1 involved the development of a library of short message service messages to support weight loss and weight loss maintenance, with personal and public involvement, focusing on diet and physical activity with embedded behaviour change techniques, and the programming of a short message service platform to allow fully automated intervention delivery. Stage 2 comprised a 12-month, single-centre, two-arm, pilot, randomised controlled trial with an active control.
Setting
This study was set in Northern Ireland; women were recruited via community-based approaches.
Participants
A total of 100 women with overweight or obesity who had given birth in the previous 24 months were recruited.
Interventions
The intervention group received an automated short message service intervention about weight loss and weight loss maintenance for 12 months. The active control group received automated short message service messages about child health and development for 12 months.
Main outcome measures
The main outcomes measured were the feasibility of recruitment and retention, acceptability of the intervention and trial procedures, and evidence of positive indicative effects on weight. Weight, waist circumference and blood pressure were measured by the researchers; participants completed a questionnaire booklet and wore a sealed pedometer for 7 days at baseline, 3, 6, 9 and 12 months. Outcome assessments were collected during home visits and women received a voucher on completion of each of the assessments. Qualitative interviews were conducted with women at 3 and 12 months, to gather feedback on the intervention and active control and the study procedures. Quantitative and qualitative data were used to inform the process evaluation and to assess fidelity, acceptability, dose, reach, recruitment, retention, contamination and context.
Results
The recruitment target of 100 participants was achieved (intervention, n = 51; control, n = 49); the mean age was 32.5 years (standard deviation 4.3 years); 28 (28%) participants had a household income of < £29,999 per annum. Fifteen women became pregnant during the follow-up (intervention, n = 9; control, n = 6) and withdrew from the study for this reason. At the end of the 12-month study, the majority of women remained in the study [85.7% (36/42) in the intervention group and 90.7% (39/43) in the active control group]. The research procedures were well accepted by women. Both groups indicated a high level of satisfaction with the short message service intervention that they were receiving. There was evidence to suggest that the intervention may have a positive effect on weight loss and prevention of weight gain during the postpartum period.
Limitations
The interviews at 3 and 12 months were conducted by the same researchers who collected other outcome data.
Conclusions
An evidence- and theory-based intervention delivered by short message service was successfully developed in conjunction with postpartum women with overweight and obesity. The intervention was acceptable to women and was feasible to implement in the 12-month pilot randomised controlled trial. The progression criteria for a full randomised controlled trial to examine effectiveness and cost-effectiveness were met.
Future work
Some minor refinements need to be made to the intervention and trial procedures based on the findings of the pilot trial in preparation for conducting a full randomised controlled trial.
Trial registration
Current Controlled Trial ISRCTN90393571.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 4. See the NIHR Journals Library website for further project information. The intervention costs were provided by the Public Health Agency, Northern Ireland.
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Affiliation(s)
- Caroline McGirr
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Ciara Rooney
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Dunla Gallagher
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | | | - Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, Cancer Division, Medical Research Institute, Ninewells Medical School, Dundee, UK
| | - Christopher R Cardwell
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Caroline Free
- Clinical Trials Unit, Department for Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Valerie A Holmes
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Camilla Somers
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jayne V Woodside
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Ian S Young
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Frank Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Michelle C McKinley
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
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Timmermans YEG, van de Kant KDG, Oosterman EO, Spaanderman MEA, Villamor-Martinez E, Kleijnen J, Vreugdenhil ACE. The impact of interpregnancy weight change on perinatal outcomes in women and their children: A systematic review and meta-analysis. Obes Rev 2020; 21:e12974. [PMID: 31751496 PMCID: PMC7050512 DOI: 10.1111/obr.12974] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 10/03/2019] [Accepted: 10/12/2019] [Indexed: 12/12/2022]
Abstract
Prepregnancy overweight and obesity are associated with higher risk of perinatal complications. However, the effect of weight change prior to pregnancy on perinatal outcome is largely unknown. Therefore, it is aimed to examine the impact on perinatal outcomes of interpregnancy BMI change in women of different BMI categories. The MEDLINE, EMBASE, LILACS, and CINAHL databases were searched (1990-August 2019). Observational studies on interpregnancy BMI change were selected. Outcomes evaluated were gestational diabetes mellitus (GDM), preeclampsia, gestational hypertension (GH), cesarean section, preterm birth, and newborns being large (LGA) or small (SGA) for gestational age. Meta-analyses and meta-regression analyses were executed. Thirty studies were included (n > 1 million). Interpregnancy BMI gain was associated with a higher risk of GDM (for BMI gain ≥3 kg/m2 : OR 2.21; [95%CI 1.53-3.19]), preeclampsia (1.77 [1.53-2.04]), GH (1.78 [1.61-1.97]), cesarean section (1.32 [1.24-1.39]), and LGA (1.54 [1.28-1.86]). The effects of BMI gain were most pronounced in women with BMI <25 kg/m2 before the first pregnancy regarding GDM, GH, and cesarean section. Except for LGA, interpregnancy BMI loss did not result in a decreased risk of perinatal complications. In this study, women of normal weight who gain weight before pregnancy were identified as a high-risk population for perinatal complications. This emphasizes that weight management is important for women of all BMI categories and a pregnancy wish.
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Affiliation(s)
- Yvon E G Timmermans
- Department of Pediatrics, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
| | - Kim D G van de Kant
- Department of Pediatrics, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School for Public Health and Primary Health Care (CAPHRI), Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Elise O Oosterman
- Department of Pediatrics, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Marc E A Spaanderman
- School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands.,Department of Gynecology and Obstetrics, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Eduardo Villamor-Martinez
- Department of Pediatrics, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
| | - Jos Kleijnen
- School for Public Health and Primary Health Care (CAPHRI), Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Anita C E Vreugdenhil
- Department of Pediatrics, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
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Maxwell C, Gaudet L, Cassir G, Nowik C, McLeod NL, Jacob CÉ, Walker M. Directive clinique N o 392 - Grossesse et obésité maternelle Partie 2 : Planification en équipe de l'accouchement et soins post-partum. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1676-1693. [PMID: 31640867 DOI: 10.1016/j.jogc.2019.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIF La présente directive clinique aborde les aspects essentiels des soins prénataux chez les femmes atteintes d'obésité. La partie 1 porte sur la préconception et les soins prénataux. La partie 2 porte sur la planification en équipe de l'accouchement et les soins post-partum. UTILISATEURS CONCERNéS: Tous les fournisseurs de soins de santé (obstétriciens, médecins de famille, sages-femmes, infirmières, anesthésiologistes) qui prodiguent des soins relatifs à la grossesse auprès de femmes atteintes d'obésité. POPULATION CIBLE Femmes atteintes d'obésité qui sont enceintes ou prévoient le devenir. DONNéES PROBANTES: Des recherches ont été menées en consultant les ressources de Statistique Canada, de Medline et de Cochrane Library en vue d'en tirer la littérature relativement aux effets de l'obésité durant la grossesse sur les soins prénataux et intrapartum, la morbidité et la mortalité maternelles, l'anesthésie obstétricale ainsi que sur la morbidité et la mortalité périnatales. Seuls les résultats de revues systématiques, d'essais cliniques randomisés ou comparatifs et d'études observationnelles ont été retenus. Aucune restriction de date ou de langue n'a été employée. Les recherches ont été mises à jour régulièrement, et les résultats ont été incorporés à la directive clinique jusqu'en septembre 2018. Nous avons également tenu compte de la littérature grise (non publiée) obtenue sur les sites Web d'organismes d'évaluation des technologies de la santé et d'autres organismes pertinents, dans des collections de directives cliniques et des registres d'essais cliniques, et auprès d'associations nationales et internationales de médecins spécialistes. MéTHODES DE VALIDATION: Le contenu et les recommandations ont été rédigés et acceptés par les auteurs. Les membres du comité de médecine fœto-maternelle ont ensuite passé en revue le contenu et formulé des commentaires aux fins d'examen. Enfin, le conseil d'administration de la Société des obstétriciens et gynécologues du Canada (SOGC) a approuvé la publication de la version définitive de la directive. Les points de désaccord ont été abordés lors de réunions pour enfin arriver à un consensus. La qualité des données et des recommandations a été déterminée à l'aide des critères d'évaluation décrits par le Groupe d'étude canadien sur les soins de santé préventifs. AVANTAGES, PRéJUDICE ET COûTS: La mise en place des recommandations des présentes directives peut améliorer la reconnaissance des fournisseurs de soins obstétricaux relativement aux problèmes qui touchent les personnes enceintes atteintes d'obésité, notamment au moyen de stratégies de prévention clinique; de la communication entre l'équipe de soins de santé, la patiente et la famille; et de la planification de l'équipement et des ressources humaines. Il est à espérer que les organismes régionaux, provinciaux et fédéraux participeront à la formation et au soutien en matière de soins coordonnés pour les personnes enceintes atteintes d'obésité. MISE à JOUR DE LA DIRECTIVE CLINIQUE: Les directives de la SOGC sont automatiquement passées en revue 5 ans après leur publication. Les auteurs peuvent toutefois proposer une autre date de réévaluation s'ils croient qu'une période de 5 ans est trop courte ou trop longue en fonction de leurs connaissances du sujet à titre d'experts en la matière. PROMOTEURS La présente directive a été élaborée à l'aide de ressources financées par la SOGC. DéCLARATIONS SOMMAIRES: RECOMMANDATIONS.
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Teulings NEWD, Masconi KL, Ozanne SE, Aiken CE, Wood AM. Effect of interpregnancy weight change on perinatal outcomes: systematic review and meta-analysis. BMC Pregnancy Childbirth 2019; 19:386. [PMID: 31660893 PMCID: PMC6819632 DOI: 10.1186/s12884-019-2566-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/22/2019] [Indexed: 02/07/2023] Open
Abstract
Background Although obesity is a well-known risk factor for adverse pregnancy outcomes, evidence is sparse about the effects of interpregnancy weight change on the risk of adverse perinatal complications in a subsequent pregnancy. The current study aims to assess the effect of interpregnancy weight change on the risk of developing gestational diabetes, pre-eclampsia, pregnancy induced hypertension, preterm birth, or delivering a large- or small-for-gestational age neonate. Methods Pubmed, Ovid Embase, ClinicalTrial.gov and the Cochrane library were systematically searched up until July 24th, 2019. Interpregnancy weight change was defined as the difference between pre-pregnancy weight of an index pregnancy and a consecutive pregnancy. Inclusion criteria included full text original articles reporting quantitative data about interpregnancy weight change in multiparous women with any time interval between consecutive births and the risk of any perinatal complication of interest. Studies reporting adjusted odds ratios and a reference group of − 1 to + 1 BMI unit change between pregnancies were harmonised by meta-analysis. Results Twenty-three cohort studies identified a total of 671,906 women with two or more consecutive pregnancies. Seven of these studies were included in the meta-analysis (280,672 women). Interpregnancy weight gain was consistently associated with a higher risk of gestational diabetes, pre-eclampsia, pregnancy induced hypertension and large-for-gestational age births. In contrast, interpregnancy weight loss was associated with a lower risk of delivering a large-for-gestational age neonate. The effect magnitude (relative risk) of interpregnancy weight gain on pregnancy induced hypertension or delivering a large-for-gestational age neonate was greater among women with a normal BMI in the index pregnancy compared to women with a starting BMI ≥25 kg/m2. Conclusion These findings confirm that interpregnancy weight change impacts the risk of developing perinatal complications in a subsequent pregnancy. This provides evidence in support of guidelines encouraging women to achieve post-partum weight loss, as their risk of perinatal complications might be minimised if they return to their pre-pregnancy weight before conceiving again. Prospectively registered with PROSPERO (CRD42017067326).
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Affiliation(s)
- Noor E W D Teulings
- Department of Public Health and Primary Care, University of Cambridge, 2 Worth's Causeway Cambridge, Cambridge, CB1 8RN, UK. .,University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
| | - Katya L Masconi
- Department of Public Health and Primary Care, University of Cambridge, 2 Worth's Causeway Cambridge, Cambridge, CB1 8RN, UK
| | - Susan E Ozanne
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Catherine E Aiken
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.,Department of Obstetrics and Gynaecology, University of Cambridge, Box 223, The Rosie Hospital and NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK
| | - Angela M Wood
- Department of Public Health and Primary Care, University of Cambridge, 2 Worth's Causeway Cambridge, Cambridge, CB1 8RN, UK
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Delivery-to-Delivery Weight Gain and Risk of Hypertensive Disorders in a Subsequent Pregnancy. Obstet Gynecol 2019; 132:868-874. [PMID: 30204702 DOI: 10.1097/aog.0000000000002874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate whether weight gain between deliveries is associated with an increased risk of hypertensive disorders in a subsequent pregnancy. METHODS This is a case-control study of women who had two live singleton births of at least 24 weeks of gestation at a single maternity hospital from January 1, 2005, to December 31, 2015, with no hypertensive disorder documented in the index pregnancy. Maternal weight gain between deliveries was measured as the change in body mass index (BMI) at delivery. Women who were diagnosed with any hypertensive disorder in the subsequent pregnancy were compared with those who experienced no hypertensive disorder in the subsequent pregnancy using χ statistics for categorical variables and t tests for continuous variables. Logistic regression was used to determine whether weight gain remained independently associated with hypertensive disorders after adjusting for potential confounders. RESULTS Of 1,033 women, 188 (18.2%) were diagnosed with a hypertensive disorder in the subsequent pregnancy. Of these, 166 (88.3%) had a hypertensive disorder specific to pregnancy (gestational hypertension; preeclampsia; superimposed preeclampsia; or hemolysis, elevated liver enzymes, and low platelet count syndrome), and 22 (11.7%) had chronic hypertension only. Greater weight gain between deliveries was significantly associated with a higher frequency of hypertensive disorders, which remained significant for a BMI increase of at least 2 kg/m in multivariable analyses (adjusted odds ratio [OR] 1.76, 95% CI 1.14-2.74 for 2 to less than 4 kg/m, adjusted OR 3.19, 95% CI 1.86-5.47 for 4 kg/m or more). Conversely, weight loss of 2 kg/m or more was associated with a decreased risk of a hypertensive disorder (adjusted OR 0.41, 95% CI 0.21-0.81). CONCLUSION Among women with no hypertensive disorder noted in an index pregnancy, an increase in BMI of at least 2 kg/m between deliveries was independently associated with an increased risk of a hypertensive disorder in a subsequent pregnancy.
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Abstract
OBJECTIVE We determined whether time between deliveries is associated with developing diabetes at the time of a subsequent delivery. STUDY DESIGN This is a case-control study of women who had two consecutive singleton births at the same institution with no pregestational diabetes in the baseline pregnancy. Cases were defined as women who were diagnosed with any type of diabetes at the time of the subsequent delivery. Controls were defined as women who had no diagnosis of diabetes at the time of the subsequent delivery. Interdelivery interval (IDI) was categorized as < 18, 18 to 60, or > 60 months. RESULTS Of 12,263 women, 4.1% (N = 501) were diagnosed with diabetes at the subsequent delivery. Women with diabetes were more likely to have an IDI of >60 months than women without diabetes (9.0 vs. 4.2%, p < 0.001). After controlling for confounding factors, an IDI > 60 months remained associated with development of pregestational or gestational diabetes by the conclusion of the subsequent pregnancy (adjusted odds ratio = 2.13 compared with an IDI of 18-60 months, 95% confidence interval 1.44-3.15). CONCLUSION A longer IDI is an independent risk factor for the development of diabetes at the time of a subsequent delivery.
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Affiliation(s)
- Annie M. Dude
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Chicago, Illinois
| | - Ashley Battarbee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Chicago, Illinois
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Lecorguillé M, Jacota M, de Lauzon-Guillain B, Forhan A, Cheminat M, Charles MA, Heude B. An association between maternal weight change in the year before pregnancy and infant birth weight: ELFE, a French national birth cohort study. PLoS Med 2019; 16:e1002871. [PMID: 31430274 PMCID: PMC6701747 DOI: 10.1371/journal.pmed.1002871] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/17/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Weight-control interventions in pregnant women with overweight or obesity have limited effectiveness for fetal growth and birth outcomes. Interventions or prevention programs aiming at the pre-pregnancy period should be considered. However, how the woman's weight change before pregnancy affects fetal growth is not known. We investigated the association between weight change over the year before pregnancy and birth weight. METHODS AND FINDINGS We used the inclusion data of 16,395 women from the ELFE French national birth cohort, a nationally representative cohort in which infants were enrolled at birth with their families in 2011. Maternal weight change was self-reported and classified into 3 groups: moderate weight variation or stable weight, weight loss > 5 kg, and weight gain > 5 kg or both weight loss and gain > 5 kg. Multiple linear regression models were used to investigate the association between pre-pregnancy weight change and a birth weight z-score calculated according to the French Audipog reference, adjusted for a large set of maternal characteristics. The analyses were stratified by maternal body mass index (BMI) at conception (<25 versus ≥25 kg/m2) and adjusted for BMI within these categories. We used the MacKinnon method to test the mediating effect of gestational weight gain (GWG) on these associations. Mother's mean age was 30.5 years, 87% were born in France, and 26% had overweight or obesity. For women in either BMI category at conception, GWG was more than 2 kg higher, on average, for women with weight loss before pregnancy than for women with stable weight or moderate weight variation. For women with BMI < 25 kg/m2 at conception, birth weight was significantly higher with weight loss than stable weight before pregnancy (β = 0.08 [95% CI 0.02; 0.14], p = 0.01), and this total effect was explained by a significant mediating effect through GWG. For women with BMI ≥ 25 kg/m2 at conception, birth weight was not associated with pre-pregnancy weight loss during the year before pregnancy. Mediation analysis revealed that in these women, the direct effect of pre-pregnancy weight loss that would have resulted in a smaller birth weight z-score (β = -0.11 [95% CI -0.19; -0.03], p = 0.01) was cancelled out by the GWG. The mediating effect of GWG was even higher when weight loss resulted from a restrictive diet in the year before pregnancy. Weight gain before pregnancy was not associated with birth weight. Although we included a large number of women and had extensive data, the only potential cause of pre-pregnancy weight loss that was investigated was dieting for intentional weight loss. We have no information on other potential causes but did however exclude women with a history of pre-pregnancy chronic disease. Another limitation is declaration bias due to self-reported data. CONCLUSIONS Health professionals should be aware that GWG may offset the expected effect of weight loss before conception on fetal growth in overweight and obese women. Further studies are required to understand the underlying mechanisms in order to develop weight-control interventions and improve maternal periconceptional health and developmental conditions for the fetus.
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Affiliation(s)
- Marion Lecorguillé
- Université de Paris, Centre of Research in Epidemiology and Statistics, INSERM, Institut national de la recherche agronomique, Paris, France
| | - Madalina Jacota
- APHP, Unité de Recherche Clinique, Hôpitaux Universitaires Paris île-de-France Ouest, Paris, France
| | - Blandine de Lauzon-Guillain
- Université de Paris, Centre of Research in Epidemiology and Statistics, INSERM, Institut national de la recherche agronomique, Paris, France
| | - Anne Forhan
- Université de Paris, Centre of Research in Epidemiology and Statistics, INSERM, Institut national de la recherche agronomique, Paris, France
| | - Marie Cheminat
- Institut national d'études démographiques, INSERM, Établissement français du sang, Joint Unit Elfe, Paris, France
| | - Marie-Aline Charles
- Université de Paris, Centre of Research in Epidemiology and Statistics, INSERM, Institut national de la recherche agronomique, Paris, France
- Institut national d'études démographiques, INSERM, Établissement français du sang, Joint Unit Elfe, Paris, France
| | - Barbara Heude
- Université de Paris, Centre of Research in Epidemiology and Statistics, INSERM, Institut national de la recherche agronomique, Paris, France
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Ziauddeen N, Wilding S, Roderick PJ, Macklon NS, Alwan NA. Is maternal weight gain between pregnancies associated with risk of large-for-gestational age birth? Analysis of a UK population-based cohort. BMJ Open 2019; 9:e026220. [PMID: 31289065 PMCID: PMC6615839 DOI: 10.1136/bmjopen-2018-026220] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Maternal overweight and obesity during pregnancy increases the risk of large-for-gestational age (LGA) birth and childhood obesity. We aimed to investigate the association between maternal weight change between subsequent pregnancies and risk of having a LGA birth. DESIGN Population-based cohort. SETTING Routinely collected antenatal healthcare data between January 2003 and September 2017 at University Hospital Southampton, England. PARTICIPANTS Health records of women with their first two consecutive singleton live-birth pregnancies were analysed (n=15 940). PRIMARY OUTCOME MEASURE Risk of LGA, recurrent LGA and new LGA births in the second pregnancy. RESULTS Of the 15 940 women, 16.0% lost and 47.7% gained weight (≥1 kg/m2) between pregnancies. A lower proportion of babies born to women who lost ≥1 kg/m2 (12.4%) and remained weight stable between -1 and 1 kg/m2 (11.9%) between pregnancies were LGA compared with 13.5% and 15.9% in women who gained 1-3 and ≥3 kg/m2, respectively. The highest proportion was in obese women who gained ≥3 kg/m2 (21.2%). Overweight women had a reduced risk of recurrent LGA in the second pregnancy if they lost ≥1 kg/m2 (adjusted relative risk (aRR) 0.69, 95% CI 0.48 to 0.97) whereas overweight women who gained ≥3 kg/m2 were at increased risk of new LGA after having a non-LGA birth in their first pregnancy (aRR 1.35, 95% CI 1.05 to 1.75). Normal-weight women who gained weight were also at increased risk of new LGA in the second pregnancy (aRR 1.26, 95% CI 1.06 to 1.50 with gain of 1-3 kg/m2 and aRR 1.34, 95% CI 1.09 to 1.65 with gain of ≥3 kg/m2). CONCLUSIONS Losing weight after an LGA birth was associated with a reduced LGA risk in the next pregnancy in overweight women, while interpregnancy weight gain was associated with an increased new LGA risk. Preventing weight gain between pregnancies is an important measure to achieve better maternal and offspring outcomes.
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Affiliation(s)
- Nida Ziauddeen
- School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sam Wilding
- School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul J Roderick
- School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nicholas S Macklon
- Department of Obstetrics and Gynaecology, University of Copenhagen, Zealand University Hospital, Roskilde, Denmark
- London Women's Clinic, London, UK
| | - Nisreen A Alwan
- School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Martínez-Hortelano JA, Berlanga-Macías C, Pozuelo-Carrascosa DP, Sanabria-Martínez G, Poyatos-León R, Martínez-Vizcaíno V. Interpregnancy weight change and perinatal outcomes: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e15470. [PMID: 31096442 PMCID: PMC6531238 DOI: 10.1097/md.0000000000015470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/08/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Growing evidence suggests that interpregnancy weight change (IPWC) is a risk factor for perinatal outcomes, since it may increase the probability of gestational complications including gestational diabetes or cesarean delivery. Additionally, IPWC may affect neonatal outcomes increasing the prevalence of newborns small for gestational age or preterm birth. However, the association between IPWC and perinatal outcomes has not systematically synthesized thus far. This study protocol aims to provide a clear, transparent and standardized procedure for systematically reviewing the association between IPWC and perinatal outcomes. METHODS AND ANALYSIS This systematic review and meta-analyses protocol is based on the preferred reporting items for systematic review and meta-analysis protocols and the Cochrane Collaboration Handbook. MEDLINE, EMBASE, the Cochrane Library, and Web of Science will be systematically searched from their inception. No limits will be defined by study design, as such different tools to assess risk of bias will be used:Odd ratios and their corresponding 95% confidence intervals will be reported to evaluate associations between IPWC and perinatal outcomes. RESULTS The results of this study will be published in a peer-reviewed journal. CONCLUSION This systematic review and meta-analysis will systematically synthesize the evidence regarding the association between IPWC and perinatal outcomes. Data will be extracted from published articles and findings will be published in peer-reviewed journals. Ethical approval and informed consent will not be required due to the nature of the study. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018100449.
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Affiliation(s)
| | | | | | | | | | - Vicente Martínez-Vizcaíno
- Universidad de Castilla- La Mancha, Health and Social Care Research Center
- Universidad Autónoma de Chile, Faculty of Health Sciences. Talca, Chile
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Panchenko PE, Lacroix MC, Jouin M, Voisin S, Badonnel K, Lemaire M, Meunier N, Safi-Stibler S, Persuy MA, Jouneau L, Durieux D, Lecoutre S, Jammes H, Rousseau-Ralliard D, Breton C, Junien C, Baly C, Gabory A. Effect of Maternal Obesity and Preconceptional Weight Loss on Male and Female Offspring Metabolism and Olfactory Performance in Mice. Nutrients 2019; 11:nu11050948. [PMID: 31035463 PMCID: PMC6566604 DOI: 10.3390/nu11050948] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/19/2019] [Accepted: 04/24/2019] [Indexed: 01/12/2023] Open
Abstract
According to the “developmental origins of health and disease” (DOHaD) concept, maternal obesity predisposes the offspring to non-communicable diseases in adulthood. While a preconceptional weight loss (WL) is recommended for obese women, its benefits on the offspring have been poorly addressed. We evaluated whether preconceptional WL was able to reverse the adverse effects of maternal obesity in a mouse model, exhibiting a modification of foetal growth and of the expression of genes encoding epigenetic modifiers in liver and placenta. We tracked metabolic and olfactory behavioural trajectories of offspring born to control, obese or WL mothers. After weaning, the offspring were either put on a control diet (CD) or a high-fat (HFD). After only few weeks of HFD, the offspring developed obesity, metabolic alterations and olfactory impairments, independently of maternal context. However, male offspring born to obese mother gained even more weight under HFD than their counterparts born to lean mothers. Preconceptional WL normalized the offspring metabolic phenotypes but had unexpected effects on olfactory performance: a reduction in olfactory sensitivity, along with a lack of fasting-induced, olfactory-based motivation. Our results confirm the benefits of maternal preconceptional WL for male offspring metabolic health but highlight some possible adverse outcomes on olfactory-based behaviours.
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Affiliation(s)
- Polina E Panchenko
- UMR BDR, INRA, ENVA, Université Paris-Saclay, 78350 Jouy-en-Josas, France.
| | | | - Mélanie Jouin
- UMR BDR, INRA, ENVA, Université Paris-Saclay, 78350 Jouy-en-Josas, France.
| | - Sarah Voisin
- UMR BDR, INRA, ENVA, Université Paris-Saclay, 78350 Jouy-en-Josas, France.
| | - Karine Badonnel
- NBO, INRA, Université Paris-Saclay, 78350 Jouy-en-Josas, France.
| | - Marion Lemaire
- UMR BDR, INRA, ENVA, Université Paris-Saclay, 78350 Jouy-en-Josas, France.
| | - Nicolas Meunier
- NBO, INRA, Université Paris-Saclay, 78350 Jouy-en-Josas, France.
| | | | | | - Luc Jouneau
- UMR BDR, INRA, ENVA, Université Paris-Saclay, 78350 Jouy-en-Josas, France.
| | - Didier Durieux
- NBO, INRA, Université Paris-Saclay, 78350 Jouy-en-Josas, France.
| | - Simon Lecoutre
- Équipe Malnutrition Maternelle et Programmation des Maladies Métaboliques, EA4489, Université de Lille, 59000 Lille, France.
| | - Hélène Jammes
- UMR BDR, INRA, ENVA, Université Paris-Saclay, 78350 Jouy-en-Josas, France.
| | | | - Christophe Breton
- Équipe Malnutrition Maternelle et Programmation des Maladies Métaboliques, EA4489, Université de Lille, 59000 Lille, France.
| | - Claudine Junien
- UMR BDR, INRA, ENVA, Université Paris-Saclay, 78350 Jouy-en-Josas, France.
| | - Christine Baly
- NBO, INRA, Université Paris-Saclay, 78350 Jouy-en-Josas, France.
| | - Anne Gabory
- UMR BDR, INRA, ENVA, Université Paris-Saclay, 78350 Jouy-en-Josas, France.
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Benjamin RH, Littlejohn S, Canfield MA, Ethen MK, Hua F, Mitchell LE. Interpregnancy change in body mass index and infant outcomes in Texas: a population-based study. BMC Pregnancy Childbirth 2019; 19:119. [PMID: 30953457 PMCID: PMC6451298 DOI: 10.1186/s12884-019-2265-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/26/2019] [Indexed: 02/04/2023] Open
Abstract
Background Maternal prepregnancy body mass index (BMI) is associated with several infant outcomes, but it is unclear whether these associations reflect causal relationships. We conducted a study of interpregnancy change in BMI (IPC-BMI) to improve understanding of the associations between BMI and large for gestational age (LGA), small for gestational age (SGA), and preterm birth (PTB). Methods Birth certificate data from 2481 linked sibling pairs (Texas, 2005–2012) were used to estimate IPC-BMI and evaluate its association with LGA, SGA, and PTB in the younger sibling of the pair. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) using data from the full sample and within strata defined by prepregnancy BMI for the older sibling. Results On average, women gained 1.1 BMI units between pregnancies. In the full sample, interpregnancy BMI decreases were associated with reduced odds of LGA and increased odds of SGA and PTB (IPC-BMI < -1 versus 0 to < 1: LGA aOR 0.7, 95% CI 0.4, 1.1; SGA aOR 1.6, 95% CI 1.0, 2.7; PTB aOR 1.9, 95% CI 1.3, 2.8). In stratified analyses, similar associations were observed in some, but not all, strata. Findings for interpregnancy BMI increases were less consistent, with little evidence for associations between these outcomes and the most extreme IPC-BMI increases. Conclusions There is growing evidence that interpregnancy BMI decreases are associated with LGA, SGA, and PTB. However, taken as a whole, the literature provides insufficient evidence to establish causal links between maternal BMI and these outcomes.
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Affiliation(s)
- Renata H Benjamin
- UTHealth School of Public Health, Department of Epidemiology, Human Genetics and Environmental Sciences, 1200 Pressler Street, Houston, TX, 77030, USA
| | - Sarah Littlejohn
- UTHealth School of Public Health, Department of Epidemiology, Human Genetics and Environmental Sciences, 1200 Pressler Street, Houston, TX, 77030, USA
| | - Mark A Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX, USA
| | - Mary K Ethen
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX, USA
| | - Fei Hua
- Center for Health Statistics, Texas Department of State Health Services, Austin, TX, USA
| | - Laura E Mitchell
- UTHealth School of Public Health, Department of Epidemiology, Human Genetics and Environmental Sciences, 1200 Pressler Street, Houston, TX, 77030, USA.
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Åmark H, Westgren M, Persson M. Prediction of large-for-gestational-age infants in pregnancies complicated by obesity: A population-based cohort study. Acta Obstet Gynecol Scand 2019; 98:769-776. [PMID: 30687927 DOI: 10.1111/aogs.13546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/22/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Infants born large for gestational age (LGA) have increased risks of adverse perinatal outcomes. Maternal obesity, defined as body mass index (BMI) ≥30 kg/m2 , is one of the most prevalent risk factors for LGA and the proportion of pregnancies complicated by obesity is increasing. Early identification of women with BMI ≥30 kg/m2 at increased risk of giving birth to an LGA infant may open possibilities for prevention, aiming at decreasing the incidence of LGA. MATERIAL AND METHODS A population-based cohort study using information from the first-trimester screening database, which was cross-linked with the Swedish Medical Birth Register. The database included 139 277 full-term singletons without fetal anomalies born between 2006 and 2015 to mothers without prepregnancy diabetes. Of these, 9.1% (n = 12 704) were infants of mothers with BMI ≥30 kg/m2 . For all women with BMI ≥30 kg/m2 , a prediction model for LGA to be used in early pregnancy was constructed based on information on biochemical markers and maternal characteristics. A similar model, as well as a prepregnancy prediction model, were constructed for parous women with BMI ≥30 kg/m2 . In parous women, data from the previous pregnancy were also used. Receiver operating characteristic curve and area under curve (AUC) were calculated. RESULTS The predictive models for LGA in parous women with BMI ≥30 kg/m2 prepregnancy and in early pregnancy had AUCs of 0.80 (95% CI 0.78-0.82) and 0.81 (95% CI 0.79-0.82), respectively. For all women with BMI ≥30 kg/m2 , the prediction of LGA in early pregnancy had an AUC of 0.66 (95% CI 0.64-0.67). CONCLUSIONS Performance of the prepregnancy and early pregnancy prediction models for LGA in parous women with BMI ≥30 kg/m2 was good. The predictive capacity was largely driven by previous child's birthweight. First-trimester measurements of fetal size did not improve the predictive capacity in parous women. Predictions of LGA in all women with BMI ≥30 kg/m2 in early pregnancy, without taking previous child's birthweight into account, remain difficult.
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Affiliation(s)
- Hanna Åmark
- Department of Clinical Science and Education, Unit of Obstetrics and Gynecology, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
| | - Magnus Westgren
- Department of Clinical Sciences, Intervention & Technology, Karolinska Institutet, Stockholm, Sweden
| | - Martina Persson
- Department of Clinical Science and Education, Unit of Obstetrics and Gynecology, Karolinska Institute, Södersjukhuset, Stockholm, Sweden.,Department of Medicine, Clinical Epidemiology Unit, Karolinska University Hospital, Stockholm, Sweden
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Sijpkens MK, van den Hazel CZ, Delbaere I, Tydén T, Mogilevkina I, Steegers EAP, Shawe J, Rosman AN. Results of a Dutch national and subsequent international expert meeting on interconception care. J Matern Fetal Neonatal Med 2019; 33:2232-2240. [PMID: 30606078 DOI: 10.1080/14767058.2018.1547375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: The potential value of preconception care and interconception care is increasingly acknowledged, but delivery is generally uncommon. Reaching women for interconception care is potentially easier than for preconception care, however the concept is still unfamiliar. Expert consensus could facilitate guidelines, policies and subsequent implementation. A national and subsequent international expert meeting were organized to discuss the term, definition, content, relevant target groups, and ways to reach target groups for interconception care.Methods: We performed a literature study to develop propositions for discussion in a national expert meeting in the Netherlands in October 2015. The outcomes of this meeting were discussed during an international congress on preconception care in Sweden in February 2016. Both meetings were recorded, transcribed and subsequently reviewed by participants.Results: The experts argued that the term, definition, and content for interconception care should be in line with preconception care. They discussed that the target group for interconception care should be "all women who have been pregnant and could be pregnant in the future and their (possible) partners". In addition, they opted that any healthcare provider having contact with the target group should reach out and make every encounter a potential opportunity to promote interconception care.Discussion: Expert discussions led to a description of the term, definition, content, and relevant target groups for interconception care. Opportunities to reach the target group were identified, but should be further developed and evaluated in policies and guidelines to determine the optimal way to deliver interconception care.
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Affiliation(s)
- Meertien K Sijpkens
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Céline Z van den Hazel
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ilse Delbaere
- Department of Health Care, VIVES University College, Kortrijk, Belgium
| | - Tanja Tydén
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Iryna Mogilevkina
- Educational and Research Center of Continuous Medical Education, Bogomolets National Medical University, Kiev, Ukraine
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jill Shawe
- Institute of Health & Community, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| | - Ageeth N Rosman
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Health Care Studies, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
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Catalano PM. Reassessing strategies to improve pregnancy outcomes in overweight and obese women. Lancet Diabetes Endocrinol 2019; 7:2-3. [PMID: 30528219 DOI: 10.1016/s2213-8587(18)30337-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Patrick M Catalano
- Mother Infant Research Institute (MIRI), Tufts Medical Center, Tufts University School of Medicine, Boston MA 02111, USA.
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Dalrymple KV, Flynn AC, Relph SA, O'Keeffe M, Poston L. Lifestyle Interventions in Overweight and Obese Pregnant or Postpartum Women for Postpartum Weight Management: A Systematic Review of the Literature. Nutrients 2018; 10:nu10111704. [PMID: 30405088 PMCID: PMC6265993 DOI: 10.3390/nu10111704] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 10/29/2018] [Accepted: 11/03/2018] [Indexed: 11/16/2022] Open
Abstract
Excessive gestational weight gain (GWG) and postpartum weight retention (PPWR) may predispose women to the development of obesity. The objective of this systematic review was to evaluate the effectiveness of lifestyle interventions in overweight or obese pregnant and/or postpartum women for managing postpartum weight up to 2 years after giving birth. Eighteen randomised controlled trials were included (2559 participants) and divided into three categories according to the timing of the intervention: pregnancy only (n = 3), postpartum only (n = 12) and pregnancy and postpartum (n = 3). The intervention duration varied from 10 weeks to 10 months and included diet only (n = 5) or diet and physical activity (n = 13). Seven postpartum only interventions reported significant improvements in postpartum weight when compared to the control group. Most of these interventions were short and intensive, lasting 10–16 weeks. One pregnancy only and one pregnancy and postpartum intervention reported reduced PPWR at 6 months. Nine trials did not report an effect of the intervention on postpartum weight. However, of these, four reported associations between GWG and PPWR. This review suggests that successful postpartum weight management is achievable with intensive lifestyle interventions starting in the postpartum period; however, there is insufficient evidence to conclude whether interventions starting in pregnancy are effective. Larger trials utilising comparative methodologies in the pregnancy and postpartum periods are required to inform the development of targeted strategies preventing PPWR or reducing postpartum weight.
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Affiliation(s)
- Kathryn V Dalrymple
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
| | - Angela C Flynn
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
| | - Sophie A Relph
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
| | - Majella O'Keeffe
- Department of Nutritional Sciences, School of Life Course Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH, UK.
| | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
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Abstract
It is important to pay attention to weight management before and between pregnancies, as women have an increased risk of weight gain during the reproductive years. Having a baby is a life-changing event for women and the challenge of weight management amidst this period of major physiological, psychological and social change should not be underestimated. However, the postpartum period offers an opportune time for lifestyle interventions, as women may have heightened awareness of their own and their wider families' health. Systematic reviews indicate that interventions including both diet and physical activity along with individualised support and self-monitoring are more likely to be successful in promoting postpartum weight loss. However, high levels of attrition and poor engagement have been an issue in previous trials in this area. Since postpartum women are difficult to reach and retain, future research must consider how to make weight-management interventions an attractive and attainable proposition for women who are juggling multiple, competing demands on their time. Ideally, intervention approaches need to be flexible and allow sustained contact with women, to facilitate a focus on maintenance of weight loss, as well as opportunities for re-engagement after life events that may disrupt weight-management progress. Using technology to deliver or support interventions holds promise but trials are needed to generate a range of appealing, effective and scalable options for postpartum women. What works at other life stages may not necessarily work here owing to specific barriers to weight management encountered in the postpartum period.
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Oteng-Ntim E, Mononen S, Sawicki O, Seed PT, Bick D, Poston L. Interpregnancy weight change and adverse pregnancy outcomes: a systematic review and meta-analysis. BMJ Open 2018; 8:e018778. [PMID: 29866719 PMCID: PMC5988168 DOI: 10.1136/bmjopen-2017-018778] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 04/10/2018] [Accepted: 04/16/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To evaluate the effect of interpregnancy body mass index (BMI) change on pregnancy outcomes, including large-for-gestational-age babies (LGA), small-for-gestational-age babies (SGA), macrosomia, gestational diabetes mellitus (GDM) and caesarean section (CS). DESIGN Systematic review and meta-analysis of observational cohort studies. DATA SOURCES Literature searches were performed across Cochrane, MEDLINE, EMBASE, CINAHL, Global Health and MIDIRS databases. STUDY SELECTION Observational cohort studies with participants parity from 0 to 1. MAIN OUTCOME MEASURES Adjusted ORs (aORs) with 95% CIs were used to evaluate the association between interpregnancy BMI change on five outcomes. RESULTS 925 065 women with singleton births from parity 0 to 1 were included in the meta-analysis of 11 studies selected from 924 identified studies. A substantial increase in interpregnancy BMI (>3 BMI units) was associated with an increased risk of LGA (aOR 1.85, 95% CI 1.71 to 2.00, p<0.001), GDM (aOR 2.28, 95% CI 1.97 to 2.63, p<0.001), macrosomia (aOR 1.54, 95% CI 0.939 to 2.505) and CS (aOR 1.72, 95% CI 1.32 to 2.24, p<0.001) compared with the reference category, and a decreased risk of SGA (aOR 0.83, 95% CI 0.70 to 0.99, p=0.044). An interpregnancy BMI decrease was associated with a decreased risk of LGA births (aOR 0.70, 95% CI 0.55 to 0.90, p<0.001) and GDM (aOR 0.80, 95% CI 0.62 to 1.03), and an increased risk of SGA (aOR 1.31, 95% CI 1.06 to 1.63, p=0.014). Women with a normal BMI (<25kg/m2) at first pregnancy who have a substantial increase in BMI between pregnancies had a higher risk of LGA (aOR 2.10, 95% CI 1.93 to 2.29) and GDM (aOR 3.10, 95% CI 2.74 to 3.50) when compared with a reference than women with a BMI ≥25 kg/m2 at first pregnancy. CONCLUSIONS Gaining weight between pregnancies increases risk of developing GDM, CS and LGA, and reduces risk of SGA in the subsequent pregnancy. Losing weight between pregnancies reduces risk of GDM and LGA and increases risk of SGA. Weight stability between first and second pregnancy is advised in order to reduce risk of adverse outcomes. TRIAL REGISTRATION NUMBER CRD42016041299.
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Affiliation(s)
| | - Sofia Mononen
- Department of Women and Children’s Health, King’s College, London, UK
| | - Olga Sawicki
- London School of Hygiene and Tropical Medicine, London, UK
| | - Paul T Seed
- Department of Women and Children’s Health, King’s College, London, UK
| | - Debra Bick
- Department of Women and Children’s Health, King’s College, London, UK
| | - Lucilla Poston
- Department of Women and Children’s Health, King’s College, London, UK
- Women’s and children, King’s College London, London, England, United Kingdom
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Association between periconceptional weight loss and maternal and neonatal outcomes in obese infertile women. PLoS One 2018; 13:e0192670. [PMID: 29590118 PMCID: PMC5873932 DOI: 10.1371/journal.pone.0192670] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 01/23/2018] [Indexed: 11/25/2022] Open
Abstract
Background Obesity in women of reproductive age has deleterious effects on reproductive and offspring health. In this study, we aimed to evaluate the association between the magnitude of periconceptional body-mass index (BMI) change and maternal and neonatal outcomes in obese infertile women who participated in the LIFEstyle study. The LIFEstyle study was a randomized controlled trial, evaluating if a six-month lifestyle intervention program prior to infertility treatment in obese infertile women improved birth rates, compared to prompt infertility treatment. Methods and findings This is an exploratory post hoc analysis of the LIFEstyle study. We recorded periconceptional BMI change in women with an ongoing pregnancy, pooling data of all women, regardless of randomization arm. Periconceptional BMI change was calculated using weight at randomization and the periconceptional weight (measured in kilograms 12 weeks before or after conception and expressed as BMI change in units BMI (kg/m2)). Subsequently, women were categorized into quartiles according to the magnitude of their periconceptional change in BMI. The odds of maternal and neonatal outcomes were calculated using logistic regression analysis, comparing women in each of the first three weight change quartiles separately, and combined, to women in the fourth quartile. The fourth quartile was chosen as reference group, since these women had the least weight loss. We adjusted for periconceptional BMI, nulliparity and smoking status. In addition, we performed a subgroup analysis for singleton pregnancies. In the LIFEstyle study, 321 obese infertile women achieved an ongoing pregnancy which was conceived within 24 months after randomization. Periconceptional BMI change was available in 244 of these women (76%). Median BMI at randomization was 35.9 kg/m2. Women in the first quartile (Q1) had a periconceptional BMI change of <-2.1 kg/m2, women in the second quartile (Q2) -2.1 to -0.9 kg/m2, women in the third quartile (Q3) -0.9 to 0.1 kg/m2 and women in the fourth quartile (Q4) gained ≥0.1 kg/m2. There were no significant differences between women in the quartiles regarding rates of excessive gestational weight gain (in term pregnancies), gestational diabetes, preterm birth, induction of labor, spontaneous vaginal birth and Caesarean section. Compared to women in Q4, the adjusted odds ratios, aOR, and 95% confidence interval for a hypertensive complication were; 0.55 (0.22–1.42) for women in Q1, 0.30 (0.12–0.78) for women in Q2, 0.39 (0.16–0.96) for women in Q3 and 0.39 (0.19–0.82) for women in Q1 to Q3 combined. In the subgroup analysis, investigating singleton pregnancies only, the statistically significant decreased rate of a hypertensive complication remained in women in Q2 (aOR 0.27, 95% CI 0.10–0.72) and Q3 (aOR 0.39, 95%CI 0.16–0.98) and when comparing women in Q1 to Q3 together to women in Q4 (aOR 0.38, 95%CI 0.18–0.80). Furthermore, there was a significantly decreased aOR (95%CI) of preterm birth in women in Q2 (0.24, 0.06–0.98) and when combining women in Q1 to Q3 (0.37, 0.14–0.97) compared to women in Q4. Conclusions These results suggest that a periconceptional decrease in BMI in obese infertile women could lead to a decrease of the rates of hypertensive pregnancy complications and preterm birth. The results are limited by the exploratory nature of the analyses and further evidence is necessary to provide more definitive conclusions.
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Iversen DS, Kesmodel US, Ovesen PG. Associations between parity and maternal BMI in a population-based cohort study. Acta Obstet Gynecol Scand 2018; 97:694-700. [PMID: 29415327 DOI: 10.1111/aogs.13321] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 01/29/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION We aimed to investigate the change in prevalence of overweight and obesity in pregnant Danish women from 2004 to 2012, and investigate whether increasing parity was associated with a change in body mass index (BMI) prevalence. MATERIAL AND METHODS We obtained a population-based cohort from the Danish Medical Birth Registry consisting of all Danish women giving birth in 2004-2012 (n = 572 321). This registry contains information on 99.8% of all births in Denmark. We calculated the overall change in prepregnancy BMI status among pregnant women in Denmark, and a multiple linear regression model with adjustment for several potential confounders was used to examine the change in prepregnancy BMI with increasing parity. RESULTS In 2004, the prevalence of prepregnancy overweight and obesity (BMI ≥ 25) and obesity alone (BMI ≥ 30) was 31.9 and 11%, respectively. In 2012, the prevalence had reached 34.2 and 12.8%. The mean BMI increased for every additional parity from 23.80 (95% CI 23.77-23.82) in parity group 1 to 26.70 (26.52-26.90) in parity group 5+. A multiple linear regression adjusted for potential confounders showed that women on average gained 0.62 (0.58-0.65) BMI units after every additional birth. CONCLUSIONS This study showed a 7.2% increase in overweight and obesity (BMI ≥ 25) and a 16.4% increase in obesity alone (BMI ≥ 30) for pregnant women in Denmark from 2004 to 2012. In addition, an increase in interpregnancy BMI was seen at every additional delivery, suggesting that obesity is an increasing challenge in obstetrics.
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Affiliation(s)
- Ditte S Iversen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ulrik S Kesmodel
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Herlev University Hospital, Herlev, Denmark
| | - Per G Ovesen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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Dutton HP, Borengasser SJ, Gaudet LM, Barbour LA, Keely EJ. Obesity in Pregnancy: Optimizing Outcomes for Mom and Baby. Med Clin North Am 2018; 102:87-106. [PMID: 29156189 PMCID: PMC6016082 DOI: 10.1016/j.mcna.2017.08.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Obesity is common in women of childbearing age, and management of this population around the time of pregnancy involves specific challenges. Weight and medical comorbidities should be optimized both before and during pregnancy. During pregnancy, gestational weight gain should be limited, comorbidities should be appropriately screened for and managed, and fetal health should be monitored. Consideration should be given to the optimal timing of delivery and to reducing surgical and anesthetic complications. In the postpartum period, breastfeeding and weight loss should be promoted. Maternal obesity is associated with adverse metabolic effects in offspring, promoting an intergenerational cycle of obesity.
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Affiliation(s)
- Heidi Pauline Dutton
- University of Ottawa, 1967 Riverside Dr., Ottawa On Canada, K1h7W9, , 613 738 8400 ext 81946
| | - Sarah Jean Borengasser
- University of Colorado – Anschutz, 12631 E. 17 Ave. Mailstop F561, Aurora, CO 80045, USA, , 303 724 9550
| | - Laura Marie Gaudet
- University of Ottawa, 1053 Carling Ave, Ottawa On Canada, K1Y 4E9, , 613 737 8899 ext 73056
| | - Linda A Barbour
- Professor of Endocrinology and Maternal-Fetal Medicine, University of Colorado School of Medicine, 12801 E 17 Ave RC1 South Room 7103, Aurora, CO 80405, , 303 724 3921
| | - Erin Joanne Keely
- University of Ottawa, 1967 Riverside Dr., Ottawa On Canada, K1h7W9, , 613 738 8400 ext 81941
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Dude AM, Lane-Cordova AD, Grobman WA. Interdelivery weight gain and risk of cesarean delivery following a prior vaginal delivery. Am J Obstet Gynecol 2017; 217:373.e1-373.e6. [PMID: 28526451 PMCID: PMC5581260 DOI: 10.1016/j.ajog.2017.05.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/20/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Approximately one third of all deliveries in the United States are via cesarean. Previous research indicates weight gain during pregnancy is associated with an increased risk of cesarean delivery. It remains unclear, however, whether and to what degree weight gain between deliveries (ie, interdelivery weight gain) is associated with cesarean delivery in a subsequent pregnancy following a vaginal delivery. OBJECTIVES The objective of the study was to determine whether interdelivery weight gain is associated with an increased risk of intrapartum cesarean delivery following a vaginal delivery. STUDY DESIGN This was a case-control study of women who had 2 consecutive singleton births of at least 36 weeks' gestation between 2005 and 2016, with a vaginal delivery in the index pregnancy. Women were excluded if they had a contraindication to a trial of labor (eg, fetal malpresentation or placenta previa) in the subsequent pregnancy. Maternal characteristics and delivery outcomes for both pregnancies were abstracted from the medical record. Maternal weight gain between deliveries was measured as the change in body mass index at delivery. Women who underwent a subsequent cesarean delivery were compared with those who had a repeat vaginal delivery using χ2 statistics for categorical variables and Student t tests or analysis of variance for continuous variables. Multivariable logistic regression was used to determine whether interdelivery weight gain remained independently associated with intrapartum cesarean delivery after adjusting for potential confounders. RESULTS Of 10,396 women who met eligibility criteria and had complete data, 218 (2.1%) had a cesarean delivery in the subsequent pregnancy. Interdelivery weight gain was significantly associated with cesarean delivery and remained significant in multivariable analysis for women with a body mass index increase of at least 2 kg/m2 (adjusted odds ratio, 1.53, 95% confidence interval, 1.03-2.27 for a body mass index increase of 2 kg/m2 to <4 kg/m2; adjusted odds ratio, 1.99, 95% confidence interval, 1.19-3.34 for body mass index increase of 4 kg/m2 or more). Furthermore, women who gained 2 kg/m2 or more were significantly more likely to undergo cesarean delivery specifically for the indications of arrest of dilation or arrest of descent (adjusted odds ratio, 2.01, 95% confidence interval, 1.21-3.33 for body mass index increase of 2 to <4 kg/m2; adjusted odds ratio, 2.34, 95% confidence interval, 1.15-4.76 for body mass index increase of ≥4 kg/m2). Contrarily, women who lost ≥2 kg/m2 were less likely to undergo any cesarean delivery (adjusted odds ratio, 0.41, 95% confidence interval, 0.21-0.78) as well as less likely to undergo cesarean delivery for an arrest disorder (adjusted odds ratio, 0.29, 95% confidence interval, 0.10-0.82). Weight gain or loss was not significantly associated with a cesarean delivery for fetal indications. CONCLUSION Among women with a prior vaginal delivery, interdelivery weight gain was independently associated with an increased risk of intrapartum cesarean delivery in a subsequent pregnancy.
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Affiliation(s)
- Annie M Dude
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Abbi D Lane-Cordova
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Wallace JM, Bhattacharya S, Horgan GW. Weight change across the start of three consecutive pregnancies and the risk of maternal morbidity and SGA birth at the second and third pregnancy. PLoS One 2017. [PMID: 28628636 PMCID: PMC5476268 DOI: 10.1371/journal.pone.0179589] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Weight-change across parities and/or current BMI may influence maternal and fetal morbidity and requires to be differentiated to better inform weight-management guidance. METHODS Direction, pattern and magnitude of weight-change across three consecutive parities and thereby two inter-pregnancy periods was described in 5079 women. The association between inter-pregnancy weight-change versus current BMI and adverse maternal events, SGA-birth and preterm delivery at second and third pregnancy were investigated by logistic regression. RESULTS More women gained weight across the defined childbearing period than lost it, with ~35% of normal and overweight women gaining sufficient weight to move up a BMI-category. Nine patterns of weight-change were defined across two inter-pregnancy periods and 50% of women remained weight-stable throughout (within 2BMI units/period). Women who were overweight/obese at first pregnancy had higher risk of substantial weight-gain and loss (>10kg) during each of two inter-pregnancy periods. Inter-pregnancy weight-gain (> 2BMI units) between first and second pregnancy increased the risk of maternal morbidity (1or more event of hypertensive disease, caesarean-section, thromboembolism) at second pregnancy, while weight-loss (>2BMI units) increased the risk of SGA-birth. Similarly, increased risk of maternal morbidity at the third pregnancy was influenced by weight-gain during both inter-pregnancy periods but not by current BMI-category. Both weight-gain between first and second pregnancy, and being overweight/obese by third pregnancy protected the fetus against SGA-birth whereas weight-loss between second and third pregnancy doubled the SGA risk. CONCLUSION Half the women studied exhibited significant weight-fluctuations. This influenced their risk of maternal morbidity and SGA-birth at second and third pregnancy.
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Affiliation(s)
- Jacqueline M. Wallace
- Rowett Institute, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- * E-mail:
| | - Sohinee Bhattacharya
- Dugald Baird Centre for Research on Women’s Health, Aberdeen Maternity Hospital, Aberdeen, Scotland, United Kingdom
| | - Graham W. Horgan
- Biomathematics & Statistics Scotland, Rowett Institute, University of Aberdeen, Aberdeen, Scotland, United Kingdom
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Crosby DA, Walsh JM, Segurado R, McAuliffe FM. Interpregnancy weight changes and impact on pregnancy outcome in a cohort of women with a macrosomic first delivery: a prospective longitudinal study. BMJ Open 2017; 7:e016193. [PMID: 28588113 PMCID: PMC5726057 DOI: 10.1136/bmjopen-2017-016193] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 03/10/2017] [Accepted: 03/16/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To determine the median interpregnancy maternal weight change between first and second pregnancies, and second and third pregnancies and to assess the impact of this weight change on pregnancy outcome in a cohort of women with a macrosomic first delivery. STUDY DESIGN Prospective longitudinal study conducted over three pregnancies from 2007 to 2015. SETTING Tertiary referral maternity hospital, Dublin, Ireland. PARTICIPANTS Women were recruited if their first baby weighed >4.0 kg. METHODS The pregnancy outcomes in the second and third pregnancies were analysed separately. Data were also analysed for both interpregnancy intervals comparing outcomes for those who gained any weight, or more weight than the median, with those who did not. MAIN OUTCOME MEASURES Recurrent fetal macrosomia ≥4.0 kg and gestational diabetes mellitus. RESULTS There were 280 women who delivered a third baby between 2011 and 2015. There were no differences in pregnancy outcomes for the second pregnancy in women who gained interpregnancy weight compared with those who did not and those who gained more interpregnancy weight than the median compared with those who did not. There was a statistically significant increase in birth weight ≥4.0 kg (54.0% vs 39.6% p=0.03) in those women who gained any weight between the second and third pregnancies. In those women who gained more interpregnancy weight than the median (1.70 kg) between a second and third pregnancy, there was a significant increase in the rate of gestational diabetes (6.5% vs 1.4%, p=0.03). CONCLUSIONS This longitudinal study demonstrates that within this cohort maternal interpregnancy weight change between a second and third pregnancy is associated with an increase in birth weight ≥4.0 kg. Additionally, a gain of more weight than the median (1.70 kg) is associated with a higher rate of gestational diabetes.
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Affiliation(s)
- David A Crosby
- Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
| | - Jennifer M Walsh
- Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
| | - Ricardo Segurado
- CSTAR, School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Fionnuala M McAuliffe
- Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
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Catalano PM, Shankar K. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ 2017; 356:j1. [PMID: 28179267 PMCID: PMC6888512 DOI: 10.1136/bmj.j1] [Citation(s) in RCA: 652] [Impact Index Per Article: 93.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Obesity is the most common medical condition in women of reproductive age. Obesity during pregnancy has short term and long term adverse consequences for both mother and child. Obesity causes problems with infertility, and in early gestation it causes spontaneous pregnancy loss and congenital anomalies. Metabolically, obese women have increased insulin resistance in early pregnancy, which becomes manifest clinically in late gestation as glucose intolerance and fetal overgrowth. At term, the risk of cesarean delivery and wound complications is increased. Postpartum, obese women have an increased risk of venous thromboembolism, depression, and difficulty with breast feeding. Because 50-60% of overweight or obese women gain more than recommended by Institute of Medicine gestational weight guidelines, postpartum weight retention increases future cardiometabolic risks and prepregnancy obesity in subsequent pregnancies. Neonates of obese women have increased body fat at birth, which increases the risk of childhood obesity. Although there is no unifying mechanism responsible for the adverse perinatal outcomes associated with maternal obesity, on the basis of the available data, increased prepregnancy maternal insulin resistance and accompanying hyperinsulinemia, inflammation, and oxidative stress seem to contribute to early placental and fetal dysfunction. We will review the pathophysiology underlying these data and try to shed light on the specific underlying mechanisms.
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Affiliation(s)
- Patrick M Catalano
- Department of Obstetrics and Gynecology, Center for Reproductive Health/MetroHealth Medical Center, Cleveland, Ohio, USA
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Kartik Shankar
- Arkansas Children's Nutrition Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Poston L, Caleyachetty R, Cnattingius S, Corvalán C, Uauy R, Herring S, Gillman MW. Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endocrinol 2016; 4:1025-1036. [PMID: 27743975 DOI: 10.1016/s2213-8587(16)30217-0] [Citation(s) in RCA: 655] [Impact Index Per Article: 81.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/25/2016] [Accepted: 07/28/2016] [Indexed: 12/16/2022]
Abstract
Obesity in women of reproductive age is increasing in prevelance worldwide. Obesity reduces fertility and increases time taken to conceive, and obesity-related comorbidities (such as type 2 diabetes and chronic hypertension) heighten the risk of adverse outcomes for mother and child if the woman becomes pregnant. Pregnant women who are obese are more likely to have early pregnancy loss, and have increased risk of congenital fetal malformations, delivery of large for gestational age infants, shoulder dystocia, spontaneous and medically indicated premature birth, and stillbirth. Late pregnancy complications include gestational diabetes and pre-eclampsia, both of which are associated with long-term morbidities post partum. Women with obesity can also experience difficulties during labour and delivery, and are more at risk of post-partum haemorrhage. Long-term health risks are associated with weight retention after delivery, and inherent complications for the next pregnancy. The wellbeing of the next generation is also compromised. All these health issues could be avoided by prevention of obesity among women of reproductive age, which should be viewed as a global public health priority. For women who are already obese, renewed efforts should be made towards improved management during pregnancy, especially of blood glucose, and increased attention to post-partum weight management. Effective interventions, tailored to ethnicity and culture, are needed at each of these stages to improve the health of women and their children in the context of the global obesity epidemic.
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Affiliation(s)
- Lucilla Poston
- Division of Women's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | - Rishi Caleyachetty
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sven Cnattingius
- Department of Medicine Solna, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Camila Corvalán
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Ricardo Uauy
- Division of Pediatrics, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile; Center for Obesity Research and Education, Departments of Medicine and Public Health, Temple University, Philadelphia, PA, USA
| | - Sharron Herring
- Center for Obesity Research and Education, Departments of Medicine and Public Health, Temple University, Philadelphia, PA, USA
| | - Matthew W Gillman
- Office of the Director, Environmental Influences on Child Health Outcomes (ECHO), National Institutes of Health, Rockville, MD, USA
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Wallace JM, Bhattacharya S, Campbell DM, Horgan GW. Inter-Pregnancy Weight Change and the Risk of Recurrent Pregnancy Complications. PLoS One 2016; 11:e0154812. [PMID: 27145132 PMCID: PMC4856284 DOI: 10.1371/journal.pone.0154812] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/19/2016] [Indexed: 11/30/2022] Open
Abstract
Women with specific adverse pregnancy outcomes in their first pregnancy may be receptive to inter-pregnancy weight management guidance aimed at preventing these complications reoccurring in subsequent pregnancies. Thus the association between inter-pregnancy weight change and the risk of recurrent pregnancy complications at the second pregnancy was investigated in a retrospective cohort study of 24,520 women with their first-ever and second consecutive deliveries in Aberdeen using logistic regression. Compared with women who were weight stable, weight loss (>2BMI units) between pregnancies was associated with an increased risk of recurrent small for gestational age (SGA) birth and elective Cesarean-section, and was protective against recurrent pre-eclampsia, placental oversize and large for gestational age (LGA) birth. Conversely weight gain (>2BMI units) between pregnancies increased the risk of recurrent gestational hypertension, placental oversize and LGA birth and was protective against recurrent low placental weight and SGA birth. The relationships between weight gain, and placental and birth weight extremes were evident only in women with a healthy weight at first pregnancy (BMI<25units), while that between weight gain and the increased risk of recurrent gestational hypertension was largely independent of first pregnancy BMI. No relationship was detected between inter-pregnancy weight change and the risk of recurrent spontaneous preterm delivery, labour induction, instrumental delivery, emergency Cesarean-section or postpartum hemorrhage. Therefor inter-pregnancy weight change impacts the risk of recurrent hypertensive disorders, SGA and LGA birth and women with a prior history of these specific conditions may benefit from targeted nutritional advice to either lose or gain weight after their first pregnancy.
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Affiliation(s)
- Jacqueline M. Wallace
- Lifelong Health Division, Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- * E-mail:
| | - Sohinee Bhattacharya
- Dugald Baird Centre for Research on Women’s Health, Aberdeen Maternity Hospital, Aberdeen, Scotland, United Kingdom
| | - Doris M. Campbell
- Dugald Baird Centre for Research on Women’s Health, Aberdeen Maternity Hospital, Aberdeen, Scotland, United Kingdom
| | - Graham W. Horgan
- Biomathematics & Statistics Scotland, Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, Scotland, United Kingdom
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Tabet M, Flick LH, Tuuli MG, Macones GA, Chang JJ. Prepregnancy body mass index in a first uncomplicated pregnancy and outcomes of a second pregnancy. Am J Obstet Gynecol 2015; 213:548.e1-7. [PMID: 26103529 DOI: 10.1016/j.ajog.2015.06.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/09/2015] [Accepted: 06/12/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study examined the effect of body mass index (BMI) before a first uncomplicated pregnancy on maternal and fetal outcomes in a subsequent pregnancy, including preterm births, preeclampsia, cesarean delivery, small for gestational age, large for gestational age, and neonatal deaths. STUDY DESIGN We conducted a population-based cohort study (n = 121,092) using the Missouri maternally linked birth registry (1989 through 2005). Multivariable binary logistic regression models were fit to estimate odds ratios and 95% confidence intervals for the parameters of interest after controlling for sociodemographic and pregnancy-related confounders in the second pregnancy. RESULTS Compared to women with a normal BMI in their first pregnancy, those who were underweight prepregnancy had increased odds for preterm birth by 20% and small for gestational age by 40% in their second pregnancy, while those with prepregnancy obesity had increased odds for large for gestational age, preeclampsia, cesarean delivery, and neonatal deaths in their second pregnancy by 54%, 156%, 85%, and 37%, respectively. CONCLUSION Women starting a first pregnancy with suboptimal BMI may be at risk of adverse maternal and fetal outcomes in a subsequent pregnancy, even if their first pregnancy was uncomplicated or if they reached a normal weight by their second pregnancy. The long-term consequences of suboptimal BMI carry considerable public health implications.
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Affiliation(s)
- Maya Tabet
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO.
| | - Louise H Flick
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO
| | - Methodius G Tuuli
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - George A Macones
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Jen Jen Chang
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO
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Abstract
Maternal obesity is recognized as one of the largest contributors to compromised health during pregnancy. Lifestyle interventions in obese pregnant women may be able to reduce gestational weight gain (GWG) but have shown limited success in improving pregnancy and neonatal outcomes. Lack of statistical power, poor compliance and inconsistency in inclusion BMI and setting across studies may be some of the reasons. Since pregestational BMI is the single most important predictor of obesity-related complications, the metabolic profile in the first trimester of pregnancy may play a very important role. Observational studies have shown that interpregnancy weight loss reduces the risk of macrosomia in a subsequent pregnancy. Future lifestyle randomized controlled trials should target the prepregnant state and examine the effect on maternal and neonatal outcomes.
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Affiliation(s)
| | - Ellen Nøhr
- a Department of Gynecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
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Abstract
The aim of interconception care is to provide women who have had a prior adverse pregnancy outcome with optimal care in order to reduce risks that may affect the woman׳s health and any future birth she may choose to have. National recommendations call for action, and evidence supports specific clinical interventions. The need for interconception care is documented in national and state survey and surveillance data. Chronic diseases and behavioral risks affect the health of millions of U.S. women of childbearing age. Interconception care demonstration projects have used a "disease management" approach that includes medical care and case management. The increasing use of postpartum visits, as a gateway to interconception interventions, is essential. The Affordable Care Act emphasis on preventive services and expanded health coverage for women offers new opportunities to finance interconception care. Improved and enhanced clinical practices, along with the engagement of women, in interconception care have the potential to improve birth outcomes and reduce disparities.
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Affiliation(s)
- Kay A Johnson
- Department of Pediatrics, Geisel Medical School at Dartmouth, Lebanon, NH
| | - Rebekah E Gee
- Departments of Health Policy and Management, Schools of Public Health and Medicine, Louisiana State University, 2020 Gravier St, New Orleans, LA; Departments of Obstetrics and Gynecology, Schools of Public Health and Medicine, Louisiana State University, New Orleans, LA.
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