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Ingram K, Ngalame Eko E, Nunziato J, Ahrens M, Howell B. Impact of obesity on the perinatal vaginal environment and bacterial microbiome: effects on birth outcomes. J Med Microbiol 2024; 73. [PMID: 39171766 DOI: 10.1099/jmm.0.001874] [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] [Indexed: 08/23/2024] Open
Abstract
Introduction. Lactobacillus species predominate the human vagina and are associated with positive vaginal health, including an acidic pH (<4.5). The prevalence of vaginal Lactobacilli increases with increased oestrogen due to increased glycogen production within the vagina. Lactobacilli produce lactic acid, thereby lowering vaginal pH, preventing growth of other bacteria, and lowering microbial diversity. Lower placental oestrogen levels in obese pregnant women could dampen the mechanism to initiate this process, which may be associated with vaginal dysbiosis and unfavourable pregnancy outcomes.Hypothesis. We hypothesize that oestrogen and glycogen levels will be lower, vaginal pH will be higher, and vaginal microbiome diversity will be greater during pregnancy in obese and overweight women compared to healthy weight women.Aim. Pregnancy complications (e.g. preterm birth) are more common in overweight and obese women. If vaginal dysbiosis plays a role, and quantifiable predictors of this increased risk can be determined, these measures could be used to prospectively identify women at risk for pregnancy complications early in pregnancy.Methodology. Vaginal samples were collected at 10-14, 18-24, 26-30, and 34-37 weeks gestation and at delivery from 67 pregnant participants (23 healthy weight, 22 overweight, 22 obese). A blood sample to quantify serum oestrogen was collected at 10-14 weeks. Vaginal samples were collected to test vaginal pH using pH paper, glycogen abundance using fluorometry, and the vaginal microbiome using 16S rRNA amplicon sequencing.Results. Vaginal pH was higher in obese participants compared to healthy weight participants (P=<0.001). Vaginal glycogen levels increased over time in obese participants (P=0.033). The vaginal bacterial alpha diversity was higher in obese participants compared to healthy weight participants (P=0.033). The relative abundances of Peptoniphilus and Anaerococcus were increased in overweight and obese participants, as well as in complicated pregnancies, at 10-14 weeks gestation.Conclusion. The relative abundance of specific vaginal bacteria, like Peptoniphilus and Anaerococcus, in early pregnancy could predict pregnancy outcomes. Our goal is to use the information gathered in this pilot study to further determine the feasibility of assessing the vaginal environment during pregnancy to identify women at risk for negative pregnancy and birth outcomes in the context of a larger study.
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Affiliation(s)
- Kelly Ingram
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | | | - Jaclyn Nunziato
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
- Carilion Clinic, Roanoke, Virginia, USA
| | - Monica Ahrens
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
- Department of Statistics, Virginia Tech, Blacksburg, Virginia, USA
- Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Brittany Howell
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
- Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
- Department of Human Development and Family Science, Virginia Tech, Blacksburg, Virginia, USA
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Kwok J, Speyer LG, Soursou G, Murray AL, Fanti KA, Auyeung B. Maternal metabolic syndrome in pregnancy and child development at age 5: exploring mediating mechanisms using cord blood markers. BMC Med 2023; 21:124. [PMID: 37013575 PMCID: PMC10071709 DOI: 10.1186/s12916-023-02835-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 03/15/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND There is limited evidence on how the classification of maternal metabolic syndrome during pregnancy affects children's developmental outcomes and the possible mediators of this association. This study uses a cohort sample of 12,644 to 13,832 mother-child pairs from the UK Born in Bradford Study to examine the associations between maternal metabolic syndrome classification (MetS) and child development outcomes at age 5, using cord blood markers as candidate mediators. METHODS Maternal cardiometabolic markers included diabetes, obesity, triglycerides, high-density lipoprotein cholesterol, blood pressure, hypertension, and fasting glucose during pregnancy. Cord blood markers of high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, leptin, and adiponectin were used as child mediators. Child outcomes included two starting school variables: British Picture Vocabulary Scale (BPVS) and the Letter Identification Assessment (LID), and five developmental milestone domains from a national UK framework: (1) communication and language (COM); (2) personal, social, and emotional (PSE); (3) physical development (PHY); (4) literacy (LIT); and (5) mathematics (MAT). Mediation models were used to examine the associations between the classification of maternal metabolic syndrome and child developmental milestones. Models were adjusted for potential maternal, socioeconomic, and child confounders such as maternal education, deprivation, and gestational age. RESULTS In mediation models, significant total effects were found for MetS associations with children's development in the LIT domain at age 5. MetS predicted individual cord blood mediators of lower HDL and increased leptin levels in both adjusted and unadjusted models. Total indirect effects (effects of all mediators combined) for MetS on a child's COM and PSE domain were significant, through all child cord blood mediators of LDL, HDL, triglycerides, adiponectin, and leptin for adjusted models. CONCLUSIONS The results support the hypothesis that maternal metabolic syndrome classification during pregnancy is associated with some child developmental outcomes at age 5. After adjusting for maternal, child, and environmental covariates, maternal metabolic syndrome classification during pregnancy was associated with children's LIT domain through direct effects of maternal metabolic health and indirect effects of cord blood markers (total effects), and COM and PSE domains via changes only in a child's cord blood markers (total indirect effects).
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Affiliation(s)
- Janell Kwok
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK.
| | - Lydia Gabriela Speyer
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Georgia Soursou
- Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
- Department of Psychology, University of Cyprus, Nicosia, Cyprus
| | - Aja Louise Murray
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
| | - Kostas A Fanti
- Department of Psychology, University of Cyprus, Nicosia, Cyprus
| | - Bonnie Auyeung
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
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Adamo KB, Semeniuk K, da Silva DF, Souza SCS, Baillargeon JP, Redman LM, Piccinini-Vallis H, Shen GX, Nerenberg K. SmartMoms Canada: An evaluation of a mobile app intervention to support a healthy pregnancy. Contemp Clin Trials 2023; 126:107066. [PMID: 36572241 DOI: 10.1016/j.cct.2022.107066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND There is a lack of cost-effective and readily available access to evidence-based information to manage healthy behaviours for pregnant individuals. Mobile health (mHealth) tools offer a cost-effective, interactive, personalized option that can be delivered anywhere at a time most convenient for the user. This study protocol was primarily developed to, i) assess the feasibility of the SmartMoms Canada intervention in supporting participants to achieve gestational weight gain (GWG) guidelines. The secondary objectives are to, ii) assess user experience with the app, measured by adherence to the program via app software metrics and frequency of use, iii) determine the impact of SmartMoms Canada app usage on the adoption of healthful behaviours related to nutrition, physical activity and sleep habits, improvements in health-related quality of life, pregnancy-related complications, and symptoms of depression, and iv) investigate the potential extended effects of the app on postpartum health-related outcomes. METHODS This is a feasibility trial. Pregnant individuals aged 18-40 years with pre-gravid body mass index between 18.5 and 39.9 kg/m2, carrying a singleton fetus, having Wi-Fi access, and at ≤20 weeks' gestation will be recruited. Eligible people will be followed from recruitment until 12 months postpartum. DISCUSSION SmartMoms Canada is the first bilingual Canadian-centric app designed for pregnant people. This mHealth intervention, with its ability to supply frequent interactions, provides pregnancy- related health knowledge to users, potentially leading to an improvement in pregnancy-related outcomes and behaviours, and, ultimately a reduction in the present economic burden related to in-person interventions. TRIAL REGISTRATION ISRCTN, ISRCTN16254958. Registered 20 December 2019, http://www.isrctn.com/ ISRCTN16254958.
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Affiliation(s)
- Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
| | - Kevin Semeniuk
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
| | - Danilo F da Silva
- Sports Studies Department, Faculty of Arts and Science, Bishop's University, Sherbrooke, QC, Canada.
| | - Sara C S Souza
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
| | | | - Leanne M Redman
- Pennington Biomedical Research Center, Baton Rouge, LA, United States.
| | - Helena Piccinini-Vallis
- Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Garry X Shen
- Department of Internal Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Kara Nerenberg
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Assessing the Mediterranean diet adherence during pregnancy: Practical considerations based on the associations with cardiometabolic risk. Pregnancy Hypertens 2023; 31:17-24. [PMID: 36446188 DOI: 10.1016/j.preghy.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/05/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of the present study was to provide practical considerations for assessing MD adherence during pregnancy based on the association with cardiometabolic risk. STUDY DESIGN Longitudinal study. MAIN OUTCOME MEASURES A food frequency questionnaire was fulfilled by 152 pregnant women at the 16th gestational week (g.w.). We calculated the Mediterranean Food Pattern (MFP), the MD Scale (MDScale), the Short MD questionnaire (SMDQ), the MD Score (MedDietScore), and the MD scale for pregnant women (MDS-P). The cardiometabolic risk score consisted of pre-pregnancy body mass index, blood pressure, glucose, triglycerides, and high-density lipoprotein-cholesterol (at 16th and 34th g.w.). RESULTS Multiple linear regression models showed that the MFP, the MedDietScore, and the SMDQ were associated with lower cardiometabolic risk at the 16th and 34th g.w. (β's: -0.193 to -0.415, all p < 0.05); and the MDS-P at the 34th g.w. (β = -0.349, p < 0.01). A comparison of these models with the J test showed that the MFP and the MedDietScore outperformed the SMDQ at the 16th g.w. (p's < 0.05); while the MedDietScore outperformed the SMDQ, MFP, and MDS-P (p's < 0.05) at the 34th g.w. Receiver-Operating-Characteristic-derived thresholds for the MFP, MedDietScore and MDS-P indices were 21, 30, and 6 points, respectively, to identify women with high cardiometabolic risk. CONCLUSION The MFP and MedDietScore are recommended to assess MD adherence during pregnancy, as these showed the strongest associations with cardiometabolic risk. Our validated thresholds might assist in the detection of poor dietary patterns during pregnancy.
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The short-term effect of a mHealth intervention on gestational weight gain and health behaviors: The SmartMoms Canada pilot study. Physiol Behav 2022; 257:113977. [PMID: 36181787 DOI: 10.1016/j.physbeh.2022.113977] [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: 03/31/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 11/24/2022]
Abstract
Gestational weight gain (GWG) has been shown to impact several maternal-infant outcomes. Since healthcare provider guidance on weight gain and healthy behaviors alone has failed to help women to meet guidelines during pregnancy, a practical adjunctive approach is to deliver evidence-based behavior change programs through mobile interventions. The present study aimed to assess the short-term effect of the SmartMoms Canada app to promote adequate GWG and healthy behaviors. Twenty-nine pregnant women were recruited in this app-based intervention trial to test whether a higher app usage (≥ 3.8 min·week-1) between 12-20 gestational weeks and 24-28 gestational weeks improved GWG, diet, physical activity, and sleep, compared to women with a lower app usage (< 3.8 min·week-1). Two-way mixed ANOVA for repeated measures was used to estimate the effect of the app usage and time, as well as their interaction on GWG and healthy behaviors. The likelihood ratio was used to examine the association between app usage categorization and GWG classification. Cramer's V statistic was used to estimate the effect size for interpretation of the association. Pregnant women using the SmartMoms Canada app more frequently had a higher moderate-to-vigorous physical activity (MVPA) daily average when compared with women with a lower usage (mean difference: 17.84 min/day, 95% CI: 2.44; 33.25). A moderate effect size (28.6% vs. 15.4%; Cramer's V = 0.212) was found for the association between app categorization and rate of GWG, representing a greater adherence to the GWG guidelines in women in the higher app usage group vs. the lower app usage group. Considering other physical activity, diet, and sleep variables, no app categorization effect was observed. A short-term higher usage of SmartMoms Canada app has a positive effect on objectively-measured MVPA.
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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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Raab R, Michel S, Günther J, Hoffmann J, Stecher L, Hauner H. Associations between lifestyle interventions during pregnancy and childhood weight and growth: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2021; 18:8. [PMID: 33413486 PMCID: PMC7792105 DOI: 10.1186/s12966-020-01075-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Maternal health and lifestyle during pregnancy may be critical for the onset and progression of childhood obesity. Prenatal lifestyle interventions have been shown to positively affect maternal behaviors, gestational weight gain, and anthropometric outcomes in infants at birth. The influence of such interventions on child weight or growth beyond birth is unknown. We therefore examined the association between lifestyle interventions during pregnancy and anthropometric outcomes during childhood. METHODS A systematic literature search was conducted in three electronic databases, two clinical trial registers and further sources, without language or publication status restrictions. Additionally, 110 study authors were contacted to obtain unpublished data. Randomized controlled trials comparing any antenatal lifestyle or behavioral intervention to standard prenatal care, in women of any body mass index (BMI), with offspring anthropometric data at 1 month of age or older, were considered. Two reviewers independently extracted data and assessed the risk of bias using the Cochrane Collaboration's updated tool. Data on weight, length, and BMI, and corresponding z-scores, were stratified into six age ranges and weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated in univariate and multivariate random-effects meta-analytical models. RESULTS Twenty trials comprising 11,385 women were included in this systematic review, of which 19 were combined in meta-analyses. Overall, lifestyle interventions during pregnancy were not associated with differences in weight, length, BMI, or corresponding z-scores, in children aged 1 month to 7 years (e.g. weight in 5 to 6 month old children, WMD: 0.02 kg; 95% CI: - 0.05 to 0.10 kg, I2 = 38%; 13 studies, 6667 participants). Findings remained consistent when studies were stratified by maternal baseline BMI or other risk factors, and intervention content and duration. Based on the GRADE criteria, the strength of the body of evidence was considered moderate. CONCLUSION Prenatal lifestyle interventions were not shown to influence childhood weight or growth. Nevertheless, women should be encouraged to pursue a healthy lifestyle during pregnancy. Further efforts to establish early prevention strategies for childhood obesity are urgently needed. Thus, large, high-quality studies with pre-planned, long-term follow-ups are warranted. TRIAL REGISTRATION PROSPERO CRD42018118678 .
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Affiliation(s)
- Roxana Raab
- Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany
| | - Sophie Michel
- Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany
| | - Julia Günther
- Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany
| | - Julia Hoffmann
- Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany
| | - Lynne Stecher
- Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany
| | - Hans Hauner
- Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany
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Maternal physical activity significantly alters the placental transcriptome. Placenta 2020; 100:111-121. [PMID: 32891005 DOI: 10.1016/j.placenta.2020.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Maternal lifestyle, in particular physical activity (PA), influences many of the physiological adaptations during pregnancy associated with feto-placental development and growth. There is limited to no information on the link between PA during pregnancy and the molecular mechanisms governing placental function. The aim of this study was to investigate the molecular mechanisms through which maternal PA may influence placental function. METHODS The level of PA was measured by accelerometry and gene expression was measured in term placenta with custom polymerase chain reaction (PCR) arrays and microarray analysis followed by a pathway analyses on significantly differentially expressed genes (DEGs). RESULTS Microarray analysis showed 43 significantly DEGs between active and non-active participants. RT-qPCR validation of a sub-sample of DEGs revealed significant changes in the level of expression between active and non-active moms (student's t-test, p < 0.05, n = 11). Genes involved in transport of water (p = 0.00236) and uptake of glycerol (p = 0.00219) were enriched in active moms. PA was also associated with the alteration of alternative splicing patters. The most consistent splicing changes were observed for AQP9 where active moms lacked exon 2. DISCUSSION Variations in maternal PA influences placental gene. We show significant expression changes of genes that are involved in transport and localization between active and non-active women. Most notably, the expression of the aquaporin family of genes (e.g. AQP1 and AQP9) were found to be significantly higher in the placentas of active women suggesting an adaptive response for the transport of water and glycerol in this population.
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Weeks A, Halili L, Ferraro ZM, Harvey AL, Deonandan R, Adamo KB. A Pilot Study Evaluating the Effectiveness of the 5As of Healthy Pregnancy Weight Gain. J Midwifery Womens Health 2020; 65:546-554. [PMID: 32270589 DOI: 10.1111/jmwh.13081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 12/02/2019] [Accepted: 12/08/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Gestational weight gain (GWG) outside of the 2009 Institute of Medicine guidelines may be harmful to women and their fetuses. Prenatal health care providers (HCPs) are important sources of health information, but not all discuss GWG with their patients. The Canadian Obesity Network's 5As (ask, assess, advise, agree, and assist) of Healthy Pregnancy Weight Gain (5As) is a tool developed to help HCPs counsel their patients on GWG. The main objective of this study was to evaluate the impact of the 5As tool on patient perceptions of GWG discussions with their HCP and to identify suggestions to improve the tool. METHODS A quasiexperimental study design was conducted whereby HCPs were trained in using the 5As tool (intervention). Patients were then queried at baseline and postintervention using an electronic questionnaire measuring patient-perceived 5As counseling. Inclusion criteria for pregnant women were (1) currently attending their first appointment with participating HCPs, (2) English-speaking, and (3) over 18 years of age. RESULTS One hundred pregnant women (50 baseline, 50 postintervention) and 15 HCPs (11 midwives, 4 obstetricians) participated. Participants receiving care from 5As-trained HCPs reported scores twice as high (P = .047) in being asked about and were approximately 3 times more likely to be advised an exact amount of target weight gain (P = .03). HCPs suggested improving patient handouts and HCP education on GWG guidelines as well as reducing the content presented in the 5As tool. DISCUSSION The 5As Tool is effective at initiating HCP-mediated GWG counseling; further research is needed to examine the usefulness of the 5As in clinical practice throughout the length of a full pregnancy. Whether the uptake of the 5As tool contributes to prenatal behavior change remains to be established. Future steps include modifying the tool based on HCP feedback, the development of novel knowledge translation tools, and improved HCP and patient education.
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Affiliation(s)
- Ashley Weeks
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Lyra Halili
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | | | - Alysha Lj Harvey
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Raywat Deonandan
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
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Kennedy RAK, Mullaney L, O'Higgins AC, Doolan A, McCartney DM, Turner MJ. The relationship between early pregnancy dietary intakes and subsequent birthweight and neonatal adiposity. J Public Health (Oxf) 2019; 40:747-755. [PMID: 30590769 DOI: 10.1093/pubmed/fdx131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 09/13/2017] [Indexed: 01/24/2023] Open
Abstract
Background Maternal nutrition intakes may influence neonatal birthweight and adiposity; however, inconsistencies within the literature exist. The relationships between maternal dietary intakes in early pregnancy and both birthweight and neonatal adiposity requires elucidation. This study examined the relationship between early pregnancy dietary intakes and subsequent birthweight and neonatal adiposity. Methods Women were recruited at their convenience after sonographic confirmation of a singleton pregnancy. Women completed a Willet food frequency questionnaire evaluating habitual food and nutrient intakes at their first antenatal visit. Neonatal body composition was measured using air-displacement plethysmography. Results Of the 385 mother-neonate dyads, mean maternal age was 30.8 ± 5.3 years, mean Body Mass Index (BMI) was 24.5 ± 4.8 kg/m2 and 41.8% (n = 161) were nulliparous. There were no relationships between maternal food intakes and birthweight (P > 0.05) (n = 385). On multivariable analysis there was a positive relationship between polyunsaturated fat and neonatal fat mass index (FMI) (beta = 0.015, 95% CI = 0.002-0.028, P = 0.04) (n = 80). Conclusion Dietary intakes of polyunsaturated fat in early pregnancy are positively associated with neonatal FMI at birth on multivariable analysis. Further longitudinal studies need to explore this association and the long-term implications for the neonate.
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Affiliation(s)
- R A K Kennedy
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Cork Street, Dublin, Ireland.,School of Biological Sciences, Dublin Institute of Technology, Kevin Street, Dublin, Ireland
| | - L Mullaney
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Cork Street, Dublin, Ireland.,School of Biological Sciences, Dublin Institute of Technology, Kevin Street, Dublin, Ireland
| | - A C O'Higgins
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Cork Street, Dublin, Ireland
| | - A Doolan
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Cork Street, Dublin, Ireland
| | - D M McCartney
- School of Biological Sciences, Dublin Institute of Technology, Kevin Street, Dublin, Ireland
| | - M J Turner
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Cork Street, Dublin, Ireland
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Gestational weight gain counselling gaps as perceived by pregnant women and new mothers: Findings from the electronic maternal health survey. Women Birth 2019; 33:e88-e94. [PMID: 30852187 DOI: 10.1016/j.wombi.2019.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 02/06/2023]
Abstract
PROBLEM Too much or too little gestational weight gain (GWG) can negatively impact maternal and fetal health, according to Institute of Medicine Guidelines. BACKGROUND Health care providers are key players in providing reliable evidence-informed prenatal advice related to appropriate GWG. However, there appears to be inconsistent GWG communication among healthcare providers during prenatal care. AIM To determine pregnant women and new mothers' perceptions of healthcare provider GWG and dietary counselling during the pregnancy period. METHODS A reliable and validated cross-sectional electronic survey was administered to currently pregnant women and women who had recently given birth. The web-based questionnaire was self-administered and took 10-25min. FINDINGS A total of 1507 eligible women participated in the survey. More than half (57%) reported that their healthcare provider talked to them about personal weight gain limits. Of these participants, about a third (34%) of participants were counselled regularly at each or most visits. Among the women that were not counselled on personal GWG limits, over half (56%) reported that healthcare provider guidance would have been helpful to achieve their target weight. Less than half (45%) of participants reported that their healthcare providers discussed dietary requirements or changes in pregnancy. DISCUSSION These findings highlight areas for improvement in prenatal dialogue, which can support better outcomes for both mother and baby. CONCLUSION A better understanding of pregnant and mothers' perceptions about weight and diet counselling is needed to understand what may need greater attention and clarification and to improve such dialogue.
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Inconsistent Weight Communication Among Prenatal Healthcare Providers and Patients: A Narrative Review. Obstet Gynecol Surv 2018; 73:423-432. [PMID: 30169887 DOI: 10.1097/ogx.0000000000000588] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Importance Gestational weight gain (GWG) is an independent and modifiable factor for a healthy pregnancy. Gestational weight gain above or below the Institute of Medicine Guidelines has been shown to impact both maternal and fetal health (eg, gestational diabetes, hypertension, downstream obesity). Healthcare providers (HCPs) have the potential to be reliable sources of evidence-based weight information and advice during pregnancy. Objective The aim of this study was to summarize the literature assessing GWG discussions between patients and their HCPs in a clinical setting to better understand the knowledge that is currently being exchanged. Evidence Acquisition A literature review was conducted by searching Ovid Medline, CINAHL, and Embase databases. All relevant primary research articles in English that assessed GWG discussions were included, whereas intervention studies were excluded. Results A total of 54 articles were included in this review. Although the overall prevalence and content of GWG counseling varied between studies, counseling was often infrequent and inaccurate. Healthcare providers tended to focus more on women experiencing obesity and excessive GWG, as opposed to the other body mass index categories or inadequate GWG. Women of higher socioeconomic status, older age, nulliparous, history of dieting, low physical activity, and those categorized as overweight/obese were more likely to receive GWG advice. Patients also reported receiving conflicting facts between different HCP disciplines. Conclusions The evidence regarding GWG counseling in prenatal care remains variable, with discrepancies between geographic regions, patient populations, and HCP disciplines. Relevance Healthcare providers should counsel their pregnant patients on GWG with advice that is concordant with the Institute of Medicine Guidelines.
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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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Sherifali D, Nerenberg KA, Wilson S, Semeniuk K, Ali MU, Redman LM, Adamo KB. The Effectiveness of eHealth Technologies on Weight Management in Pregnant and Postpartum Women: Systematic Review and Meta-Analysis. J Med Internet Res 2017; 19:e337. [PMID: 29030327 PMCID: PMC5660296 DOI: 10.2196/jmir.8006] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/12/2017] [Accepted: 07/12/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The emergence and utilization of electronic health (eHealth) technologies has increased in a variety of health interventions. Exploiting the real-time advantages offered by mobile technologies during and after pregnancy has the potential to empower women and encourage behaviors that may improve maternal and child health. OBJECTIVE The objective of this study was to assess the effectiveness of eHealth technologies for weight management during pregnancy and the postpartum period and to review the efficacy of eHealth technologies on health behaviors, specifically nutrition and physical activity. METHODS A systematic search was conducted of the following databases: MEDLINE, EMBASE, Cochrane database of systematic reviews (CDSR), Cochrane central register of controlled trials (CENTRAL), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO. The search included studies published from 1990 to July 5, 2016. All relevant primary studies that involved randomized controlled trials (RCTs), non-RCTs, before-and-after studies, historically controlled studies, and pilot studies were included. The study population was adult women of childbearing age either during pregnancy or the postpartum period. eHealth weight management intervention studies targeting physical activity, nutrition, or both, over a minimum 3-month period were included. Titles and abstracts, as well as full-text screening were conducted. Study quality was assessed using Cochrane's risk of bias tool. Data extraction was completed by a single reviewer, which was then verified by a second independent reviewer. Results were meta-analyzed to calculate pooled estimates of the effect, wherever possible. RESULTS Overall, 1787 and 176 citations were reviewed at the abstract and full-text screening stages, respectively. A total of 10 studies met the inclusion criteria ranging from high to low risk of bias. Pooled estimates from studies of the effect for postpartum women resulted in a significant reduction in weight (-2.55 kg, 95% CI -3.81 to -1.28) after 3 to 12 months and six studies found a nonsignificant reduction in weight gain for pregnant women (-1.62 kg, 95% CI -3.57 to 0.33) at approximately 40 weeks. CONCLUSIONS This review found evidence for benefits of eHealth technologies on weight management in postpartum women only. Further research is still needed regarding the use of these technologies during and after pregnancy.
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Affiliation(s)
- Diana Sherifali
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Clinical Nurse Specialist, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Kara A Nerenberg
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Shanna Wilson
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Kevin Semeniuk
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Muhammad Usman Ali
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Leanne M Redman
- Reproductive Endocrinology and Women's Health Lab, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Ockenden H, Gunnell K, Giles A, Nerenberg K, Goldfield G, Manyanga T, Adamo K. Development and Preliminary Validation of a Comprehensive Questionnaire to Assess Women's Knowledge and Perception of the Current Weight Gain Guidelines during Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13121187. [PMID: 27916921 PMCID: PMC5201328 DOI: 10.3390/ijerph13121187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/09/2016] [Accepted: 11/22/2016] [Indexed: 12/20/2022]
Abstract
The aim of this study was to develop and validate an electronic questionnaire, the Electronic Maternal Health Survey (EMat Health Survey), related to women's knowledge and perceptions of the current gestational weight gain guidelines (GWG), as well as pregnancy-related health behaviours. Constructs addressed within the questionnaire include self-efficacy, locus of control, perceived barriers, and facilitators of physical activity and diet, outcome expectations, social environment and health practices. Content validity was examined using an expert panel (n = 7) and pilot testing items in a small sample (n = 5) of pregnant women and recent mothers (target population). Test re-test reliability was assessed among a sample (n = 71) of the target population. Reliability scores were calculated for all constructs (r and intra-class correlation coefficients (ICC)), those with a score of >0.5 were considered acceptable. The content validity of the questionnaire reflects the degree to which all relevant components of excessive GWG risk in women are included. Strong test-retest reliability was found in the current study, indicating that responses to the questionnaire were reliable in this population. The EMat Health Survey adds to the growing body of literature on maternal health and gestational weight gain by providing the first comprehensive questionnaire that can be self-administered and remotely accessed. The questionnaire can be completed in 15-25 min and collects useful data on various social determinants of health and GWG as well as associated health behaviours. This online tool may assist researchers by providing them with a platform to collect useful information in developing and tailoring interventions to better support women in achieving recommended weight gain targets in pregnancy.
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Affiliation(s)
- Holly Ockenden
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
- Heathy Active Living and Obesity Research Group (HALO), Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON K1H 8L1, Canada.
| | - Katie Gunnell
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
- Heathy Active Living and Obesity Research Group (HALO), Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON K1H 8L1, Canada.
| | - Audrey Giles
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | - Kara Nerenberg
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada.
| | - Gary Goldfield
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
- Heathy Active Living and Obesity Research Group (HALO), Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON K1H 8L1, Canada.
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
- Department of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | - Taru Manyanga
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
- Heathy Active Living and Obesity Research Group (HALO), Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON K1H 8L1, Canada.
| | - Kristi Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
- Heathy Active Living and Obesity Research Group (HALO), Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON K1H 8L1, Canada.
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
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Early parenthood as a link between childhood disadvantage and adult heart problems: A gender-based approach. Soc Sci Med 2016; 171:58-66. [PMID: 27823815 DOI: 10.1016/j.socscimed.2016.10.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 10/12/2016] [Accepted: 10/24/2016] [Indexed: 11/21/2022]
Abstract
Drawing on conceptual models of critical periods, major life transitions, and life pathways, we proposed that the life-course features of parenthood are important, but understudied, mechanisms for explaining possibly gendered heart-health outcomes. Using three waves from the Midlife in the U.S. Study (MIDUS), we investigated (a) gender differences in the timing of the transition to parenthood as a pathway linking childhood SES disadvantage to onset of heart problems and (b) life-course factors (which vary by gender) that link the timing of the transition to parenthood to adult heart problems. We found that individuals who were disadvantaged in childhood were more likely to have their first child as teenagers or in early young adulthood. For women only, an early transition to parenthood partially explained the association between childhood disadvantage and onset of heart problems. Furthermore, women who had their first child at younger ages, particularly in their teens, had lower rates of college graduation, more financial difficulties, higher levels of depressive symptoms, and greater risk of smoking and obesity in midlife. These factors partially accounted for the association between early parenthood and onset of heart problems in later life. Our findings underscore the significance of the timing of the transition to parenthood in specifying the associations between childhood disadvantage and adult heart problems. Various factors are involved, including low adult SES, psychological distress, and unhealthy lifestyles.
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Vernini JM, Moreli JB, Magalhães CG, Costa RAA, Rudge MVC, Calderon IMP. Maternal and fetal outcomes in pregnancies complicated by overweight and obesity. Reprod Health 2016; 13:100. [PMID: 27567898 PMCID: PMC5002321 DOI: 10.1186/s12978-016-0206-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/29/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Overweight and obesity are associated with pregnancy complications and adverse perinatal outcomes, posing short and long-term risks for maternal and child health. This study evaluated maternal, delivery and neonatal outcomes in pregnancies complicated by overweight and obesity. METHODS This prospective cross-sectional study included 258 pregnant women. According to prepregnancy body mass index (BMI), participants were classified as normal weight, overweight, or obese. Data were analyzed using the chi-square test and analysis of variance followed by the Tukey test. Logistic regression was performed to calculate odds ratios and 95 % confidence intervals (p < 0.05). RESULTS Most women ≥ 35 years old were overweight (22.7 %) and obese (27.6 %). Prepregnancy diabetes was significantly associated with obesity (15.7 %, p < 0.000). Obese women showed the lowest weight gain (9.6 ± 7.5Kg). Overweight and obese women practiced physical exercise more frequently (p = 0.010) than normal weight women. A greater proportion of obese mothers (13.4 %) had large for gestational age babies (p = 0.021), with higher thoracic circumference (33.6 ± 2.0 cm) and abdominal circumference (31.6 ± 2.3 cm). Obesity increased the risk of developing hypertension (OR = 7.0; 3.1-15.9), hyperglycemic disturbances (OR = 5.5; 2.9-10.6) and HbA1c ≥ 6.5 % (OR = 3.7; 1.2-11.1). The infants born to obese mothers had longer hospital stay (3.9 ± 3.9 days) (p = 0.005). CONCLUSION Our results confirm that obesity in pregnancy can lead to adverse outcomes, and underscore the importance of identifying and treating inadequate weight status during pregnancy.
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Affiliation(s)
- Joice Monaliza Vernini
- Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School, São Paulo State University - Unesp, São Paulo, Brazil
| | - Jusciele Brogin Moreli
- Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School, São Paulo State University - Unesp, São Paulo, Brazil
| | - Claudia Garcia Magalhães
- Department of Obstetrics and Gynecology, Botucatu Medical School, São Paulo State University - Unesp, São Paulo, Brazil
| | - Roberto Antônio Araújo Costa
- Department of Obstetrics and Gynecology, Botucatu Medical School, São Paulo State University - Unesp, São Paulo, Brazil
| | - Marilza Vieira Cunha Rudge
- Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School, São Paulo State University - Unesp, São Paulo, Brazil.,Department of Obstetrics and Gynecology, Botucatu Medical School, São Paulo State University - Unesp, São Paulo, Brazil
| | - Iracema Mattos Paranhos Calderon
- Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School, São Paulo State University - Unesp, São Paulo, Brazil. .,Department of Obstetrics and Gynecology, Botucatu Medical School, São Paulo State University - Unesp, São Paulo, Brazil.
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18
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Ng SK, Cameron CM, Hills AP, McClure RJ, Scuffham PA. Socioeconomic disparities in prepregnancy BMI and impact on maternal and neonatal outcomes and postpartum weight retention: the EFHL longitudinal birth cohort study. BMC Pregnancy Childbirth 2014; 14:314. [PMID: 25201481 PMCID: PMC4165994 DOI: 10.1186/1471-2393-14-314] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 08/11/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Long-term obesity after pregnancy is associated with obesity prior to pregnancy and retention of weight postpartum. This study aims to identify socioeconomic differences in prepregnancy body mass index, quantify the impact of prepregnancy obesity on birth outcomes, and identify determinants of postpartum weight retention. METHODS A total of 2231 pregnant women, recruited from three public hospitals in Southeast Queensland in Australia during antenatal clinic visits, completed a questionnaire to elicit information on demographics, socioeconomic and behavioural characteristics. Perinatal information was extracted from hospital records. A follow-up questionnaire was completed by each participant at 12 months after the birth to obtain the mother's postpartum weight, breastfeeding pattern, dietary and physical activity characteristics, and the child's health and development information. Multivariate logistic regression method was used to model the association between prepregnancy obesity and outcomes. RESULTS Being overweight or obese prepregnancy was strongly associated with socioeconomic status and adverse behavioural factors. Obese women (18% of the cohort) were more likely to experience gestational diabetes, preeclampsia, cesarean delivery, and their children were more likely to experience intensive- or special-care nursery admission, fetal distress, resuscitation, and macrosomia. Women were more likely to retain weight postpartum if they consumed three or fewer serves of fruit/vegetables per day, did not engage in recreational activity with their baby, spent less than once a week on walking for 30 minutes or more or spent time with friends less than once per week. Mothers who breastfed for more than 3 months had reduced likelihood of high postpartum weight retention. CONCLUSIONS Findings provide additional specificity to the increasing evidence of the predisposition of obesity prepregnancy on adverse maternal and perinatal outcomes. They may be used to target effective behavioural change interventions to address obesity in women.
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Affiliation(s)
- Shu-Kay Ng
- />School of Medicine, Griffith Health Institute, Griffith University, Brisbane, QLD 4131 Australia
| | - Cate M Cameron
- />Centre of National Research on Disability and Rehabilitation, School of Human Services and Social Work, Griffith Health Institute, Griffith University, Brisbane, QLD 4131 Australia
| | - Andrew P Hills
- />Mater Mothers’ Hospital, Mater Research Institute – University of Queensland and Centre for Musculoskeletal Research, Griffith University, Brisbane, QLD Australia
| | - Roderick J McClure
- />Injury Research Institute, Monash University, Monash, VIC 3800 Australia
| | - Paul A Scuffham
- />School of Medicine, Griffith Health Institute, Griffith University, Brisbane, QLD 4131 Australia
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Abstract
So much has changed in the field of diabetes diagnosis and management in the United States. Unhealthy lifestyle choices have hastened an epidemic of childhood obesity, causing a paradigm shift in how childhood diabetes is conceptualized. Once thought a consequence of obesity, sedentary lifestyle, and genetics, diabetes with onset in adults has been found to have a variant with autoimmunity. As the lines among adult-onset, child-onset, and type 1 and type 2 diabetes mellitus become more blurred, best practices in management and prevention become more complicated. This article highlights key points regarding 2 variants, juvenile-onset type 2 diabetes mellitus and latent autoimmune diabetes of adults.
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