Weight gain in healthy pregnant women in relation to pre-pregnancy BMI, diet and physical activity

Influence of gestational weight gain on the nutritional status of offspring at birth and at 5 years of age

OBJECTIVE

To determine the influence of pre-pregnancy maternal BMI and increases in maternal weight during pregnancy on perinatal and child outcomes at birth and at 5 years.

RESEARCH DESIGN/SETTING

A prospective cohort study was conducted between November 2016 and December 2021. The participants were a total of 115 women-child dyads, selected from among pregnant women receiving routine prenatal care in different health centres belonging to 2 health districts. Follow-ups were conducted with the women during pregnancy and with their children during the 10 days after birth and at 5 years.

FINDINGS

The total weight gain during pregnancy is influenced by an inadequate pre-pregnancy BMI (0.03; 95 % CI, 0.004 - 0.25; P=.001) and a greater increase in maternal BMI during the first and second term of pregnancy. A greater increase in BMI during pregnancy was associated with higher breastfeeding rates both in the short term (1.21; 95 % CI, 1.01-1.44; P = 0.04) and the long term (12 months: 1.30; 95 % CI, 1.02 - 1.67; P = 0.04; 24 months: 1.30; 95 % CI, 1.02 - 1.69; P = 0.04). No links were found between gains in maternal weight and the weight of the newborn, nor between maternal weight and/or pre-pregnancy BMI with the nutritional status of the child.

KEY CONCLUSIONS

After studying these results, it was concluded that promoting and implementing health and education policies focused on enhancing maternal nutritional status is essential to improve the nutritional status of children.

IMPLICATIONS FOR PRACTICE

Healthy gestational weight gain (GWG) is an important issue to be addressed by the midwife in primary care, both in the preconception period and throughout pregnancy. As a result, it is important that the midwife is trained and has the appropriate resources and tools to work with pregnant women individually and collectively. In addition to paying attention to overweight and obese pregnant women, the midwife should also pay attention to women with a normal BMI, as they seem to have greater difficulty in maintaining a healthy weight gain. Another line of intervention to be addressed is breastfeeding (BF), where the midwife should be the main point of reference from the beginning of this process, taking into account the relationship between BMI and BF.

Dietitian-led cluster randomised controlled trial on the effectiveness of mHealth education on health outcomes among pregnant women: a protocol paper

INTRODUCTION

Nutrition education is the cornerstone to maintain optimal pregnancy outcomes including gestational weight gain (GWG). Nevertheless, default for appointments is common and often lead to suboptimal achievement of GWG, accompanied with unfavourable maternal and child health outcomes. While mobile health (mHealth) usage is increasing and helps minimising barriers to clinic appointments among pregnant mothers, its effectiveness on health outcomes has been inconclusive. Therefore, this study aimed to address the gap between current knowledge and clinical care, by exploring the effectiveness of mHealth on GWG as the primary outcome, hoping to serve as a fundamental work to achieve optimal health outcomes with the improvement of secondary outcomes such as physical activity, psychosocial well-being, dietary intake, quality of life and sleep quality among pregnant mothers.

METHODS AND ANALYSIS

A total of 294 eligible participants will be recruited and allocated into 3 groups comprising of mHealth intervention alone, mHealth intervention integrated with personal medical nutrition therapy and a control group. Pretested structured questionnaires are used to obtain the respondents' personal information, anthropometry data, prenatal knowledge, physical activity, psychosocial well-being, dietary intake, quality of life, sleep quality and GWG. There will be at least three time points of data collection, with all participants recruited during their first or second trimester will be followed up prospectively (after 3 months or/and after 6 months) until delivery. Generalised linear mixed models will be used to compare the mean changes of outcome measures over the entire study period between the three groups.

ETHICS AND DISSEMINATION

Ethical approvals were obtained from the ethics committee of human subjects research of Universiti Putra Malaysia (JKEUPM-2022-072) and medical research & ethics committee, Ministry of Health Malaysia: NMRR ID-22-00622-EPU(IIR). The results will be disseminated through journals and conferences targeting stakeholders involved in nutrition research.

TRIAL REGISTRATION NUMBER

Clinicaltrial.gov ID: NCT05377151.

The association between multidimensional sleep health and gestational weight gain

BACKGROUND

Although poor sleep health is associated with weight gain and obesity in the non-pregnant population, research on the impact of sleep health on weight change among pregnant people using a multidimensional sleep health framework is needed.

OBJECTIVES

This secondary data analysis of the Nulliparous Pregnancy Outcome Study: Monitoring Mothers-to-be Sleep Duration and Continuity Study (n = 745) examined associations between mid-pregnancy sleep health indicators, multidimensional sleep health and gestational weight gain (GWG).

METHODS

Sleep domains (i.e. regularity, nap duration, timing, efficiency and duration) were assessed via actigraphy between 16 and 21 weeks of gestation. We defined 'healthy' sleep in each domain with empirical thresholds. Multidimensional sleep health was based on sleep profiles derived from latent class analysis and composite score defined as the sum of healthy sleep domains. Total GWG, the difference between self-reported pre-pregnancy weight and the last measured weight before delivery, was converted to z-scores using gestational age- and BMI-specific charts. GWG was defined as low (<-1 SD), moderate (-1 or +1 SD) and high (>+1 SD).

RESULTS

Nearly 50% of the participants had a healthy sleep profile (i.e. healthy sleep in most domains), whereas others had a sleep profile defined as having varying degrees of unhealthy sleep in each domain. The individual sleep domains were associated with a 20%-30% lower risk of low or high GWG. Each additional healthy sleep indicator was associated with a 10% lower risk of low (vs. moderate), but not high, GWG. Participants with late timing, long duration and low efficiency (vs. healthy) profiles had the strongest risk of low GWG (relative risk 1.5, 95% confidence interval 0.9, 2.4). Probabilistic bias analysis suggested that most associations between individual sleep health indicators, sleep health profiles and GWG were biased towards the null.

CONCLUSIONS

Future research should determine whether sleep health is an intervention target for healthy GWG.

An Evaluation of Food and Nutrient Intake among Pregnant Women in The Netherlands: A Systematic Review

Nutritional deficiencies during pregnancy can have serious consequences for the health of the (unborn) child. This systematic review provides an updated overview of the available food and nutrient intake data for pregnant women in The Netherlands and an evaluation based on the current recommendations. Embase, MEDLINE, and national institute databases were used. Articles were selected if they had been published since 2008 and contained data on food consumption, nutrient intake, or the status of healthy pregnant women. A qualitative comparison was made with the 2021 Dutch Health Council recommendations and reference values. A total of 218 reports were included, representing 54 individual studies. Dietary assessments were primarily performed via food frequency questionnaires. Protein, vitamin A, thiamin, riboflavin, vitamin B₆, folate, vitamin B₁₂, vitamin C, iron, calcium, and magnesium intakes seemed to be adequate. For folate and vitamin D, supplements were needed to reach the recommended intake. The reasons for concern are the low intakes of fruits, vegetables, and (fatty) fish, and the intakes of alcohol, sugary drinks, and salt. For several foods and nutrients, no or limited intake data were found. High-quality, representative, and recent data are needed to evaluate the nutrient intake of pregnant women in order to make accurate assessments and evaluations, supporting scientific-based advice and national nutritional policies.

Risk factors for inadequate and excessive gestational weight gain in 25 low- and middle-income countries: An individual-level participant meta-analysis

BACKGROUND

Many women experience suboptimal gestational weight gain (GWG) in low- and middle-income countries (LMICs), but our understanding of risk factors associated with GWG in these settings is limited. We investigated the relationships between demographic, anthropometric, lifestyle, and clinical factors and GWG in prospectively collected data from LMICs.

METHODS AND FINDINGS

We conducted an individual participant-level meta-analysis of risk factors for GWG outcomes among 138,286 pregnant women with singleton pregnancies in 55 studies (27 randomized controlled trials and 28 prospective cohorts from 25 LMICs). Data sources were identified through PubMed, Embase, and Web of Science searches for articles published from January 2000 to March 2019. Titles and abstracts of articles identified in all databases were independently screened by 2 team members according to the following eligibility criteria: following inclusion criteria: (1) GWG data collection took place in an LMIC; (2) the study was a prospective cohort or randomized trial; (3) study participants were pregnant; and (4) the study was not conducted exclusively among human immunodeficiency virus (HIV)-infected women or women with other health conditions that could limit the generalizability of the results. The Institute of Medicine (IOM) body mass index (BMI)-specific guidelines were used to determine the adequacy of GWG, which we calculated as the ratio of the total observed weight gain over the mean recommended weight gain. Study outcomes included severely inadequate GWG (percent adequacy of GWG <70), inadequate GWG (percent adequacy of GWG <90, inclusive of severely inadequate), and excessive GWG (percent adequacy of GWG >125). Multivariable estimates from each study were pooled using fixed-effects meta-analysis. Study-specific regression models for each risk factor included all other demographic risk factors measured in a particular study as potential confounders, as well as BMI, maternal height, pre-pregnancy smoking, and chronic hypertension. Risk factors occurring during pregnancy were further adjusted for receipt of study intervention (if any) and 3-month calendar period. The INTERGROWTH-21st standard was used to define high and low GWG among normal weight women in a sensitivity analysis. The prevalence of inadequate GWG was 54%, while the prevalence of excessive weight gain was 22%. In multivariable models, factors that were associated with a higher risk of inadequate GWG included short maternal stature (<145 cm), tobacco smoking, and HIV infection. A mid-upper arm circumference (MUAC) of ≥28.1 cm was associated with the largest increase in risk for excessive GWG (risk ratio (RR) 3.02, 95% confidence interval (CI) [2.86, 3.19]). The estimated pooled difference in absolute risk between those with MUAC of ≥28.1 cm compared to those with a MUAC of 24 to 28.09 cm was 5.8% (95% CI 3.1% to 8.4%). Higher levels of education and age <20 years were also associated with an increased risk of excessive GWG. Results using the INTERGROWTH-21st standard among normal weight women were similar but attenuated compared to the results using the IOM guidelines among normal weight women. Limitations of the study's methodology include differences in the availability of risk factors and potential confounders measured in each individual dataset; not all risk factors or potential confounders of interest were available across datasets and data on potential confounders collected across studies.

CONCLUSIONS

Inadequate GWG is a significant public health concern in LMICs. We identified diverse nutritional, behavioral, and clinical risk factors for inadequate GWG, highlighting the need for integrated approaches to optimizing GWG in LMICs. The prevalence of excessive GWG suggests that attention to the emerging burden of excessive GWG in LMICs is also warranted.

Systematic review of the associations between prenatal sleep behaviours and components of energy balance for regulating weight gain

This systematic review aimed to examine the magnitude and direction of the associations between prenatal sleep behaviours (i.e. nighttime sleep duration, sleep quality, night awakenings and daytime nap duration) and eating behaviours, physical activity and gestational weight gain. A systematic search was conducted using Medline/PubMed, PsychINFO, CINAHL Complete, ProQuest Dissertations and Thesis A&I, and Web of Science to identify studies with at least one sleep measure, and either eating behaviours, physical activity and/or gestational weight gain. In summary, 11 studies met the review criteria and generated 11 total effect size across 10,900 participants. The majority of the studies were conducted after 2010, which highlights the infancy of this research. Overall, the strengths of the effect size were small: sleep-gestational weight gain (effect size = 0.29), sleep-eating behaviours (effect size = 0.13) and sleep-physical activity (effect size = 0.13). The only effect size that emerged as significant was for the pooled sleep behaviours-physical activity association; good sleep behaviours were positively associated with higher levels of physical activity. These findings summarize and provide insight on how sleep behaviours are related to prenatal gestational weight gain, eating behaviours and physical activity by identifying the strength and direction of the associations that have been previously unknown. Results support the rationale for future longitudinal and randomized control trials to examine the effects of sleep behaviours on gestational weight gain, eating behaviours and physical activity over the course of pregnancy.

The association between multidimensional sleep health and gestational weight gain: nuMoM2b Sleep Duration and Continuity Study

Background

Although poor sleep health is associated with weight gain and obesity in the non-pregnant population, research on the impact of sleep health on weight change among pregnant people using a multidimensional sleep-health framework is needed. This study examined associations among mid-pregnancy sleep health indicators, multidimensional sleep health, and gestational weight gain (GWG).

Methods

We conducted a secondary data analysis of the Nulliparous Pregnancy Outcome Study: Monitoring Mothers-to-be Sleep Duration and Continuity Study (n=745). Indicators of individual sleep domains (i.e., regularity, nap duration, timing, efficiency, and duration) were assessed via actigraphy between 16 and 21 weeks of gestation. We defined "healthy" sleep in each domain based on empirical thresholds. Multidimensional sleep health was based on sleep profiles derived from latent class analysis. Total GWG, the difference between self-reported pre-pregnancy weight and the last measured weight before delivery, was converted to z-scores using gestational age- and BMI-specific charts. GWG was defined as low (<-1 SD), moderate (-1 or +1 SD), and high (>+1 SD).

Results

Nearly 50% of the participants had a healthy sleep profile (i.e., healthy sleep in most domains), whereas others had a sleep profile defined as having varying degrees of poor health in each domain. While indicators of individual sleep domains were not associated with GWG, multidimensional sleep health was related to low and high GWG. Participants with a sleep profile characterized as having low efficiency, late timing, and long sleep duration (vs. healthy sleep profile) had a higher risk (RR 1.7; 95% CI 1.0, 3.1) of low GWG a lower risk of high GWG (RR 0.5 95% CI 0.2, 1.1) (vs. moderate GWG).

Conclusions

Multidimensional sleep health was more strongly associated with GWG than individual sleep domains. Future research should determine whether sleep health is a valuable intervention target for optimizing GWG.

Synopsis

Study question: What is the association between mid-pregnancy multidimensional sleep health and gestational weight gain?What's already known?: Sleep is associated with weight and weight gain outside of pregnancyWhat does this study add?: We identified patterns of sleep behaviors associated with an increased risk of low gestational weight gain.

Effects of 8-Week Online, Supervised High-Intensity Interval Training on the Parameters Related to the Anaerobic Threshold, Body Weight, and Body Composition during Pregnancy: A Randomized Controlled Trial

We aimed to assess the effects of an 8-week, online high-intensity interval training (HIIT) program on the parameters related to the anaerobic threshold (AT), body weight, and body composition in pregnant women. A total of 69 Caucasian women with an uncomplicated singleton pregnancy (age: 31 ± 4 years; gestational age: 22 ± 5 weeks; mean ± standard deviation) were randomly allocated to either an 8-week HIIT program (HIIT group) or to a comparative 8-week educational program (EDU group). Our most important finding was that even with the 8-week progression of pregnancy and physiological weight gain, the HIIT group maintained the same level of parameters related to AT: volume of oxygen at the AT (VO2/AT), percentage of maximal oxygen uptake at the AT (%VO2max/AT), and heart rate at the AT (HR/AT). In contrast, in the EDU group we observed a substantial deterioration of parameters related to the AT. The HIIT intervention substantially reduced the fat mass percentage (median: 30 to 28%; p < 0.01) and improved the total fat-free mass percentage (median: 70% to 72%; p < 0.01). In the EDU group, the body composition did not change significantly. An online, supervised HIIT program may be used to prevent the pregnancy-related risk of excessive weight gain and reduction in exercise capacity without yielding adverse obstetric or neonatal outcomes.

Association between 1st trimester diet quality & gestational weight gain rate among pregnant women in Dhulikhel, Nepal

BACKGROUND

Despite promising data from high-income countries, the impact of diet quality on gestational weight gain (GWG) has not been investigated in the context of many low-income countries including Nepal.

METHODS

We prospectively examined the association between 1st trimester diet quality and GWG rate among a cohort of singleton pregnant women (n = 101; age 25.9 ± 4.1 years) from a community-based periurban hospital in Dhulikhel, Nepal. Diet quality was assessed from the adapted Nepali version of the 21-item PrimeScreen questionnaire in the 1st trimester. The diet quality score is based on consumption frequency of 21 food group components (score ranging 0-42), categorized as healthy (12 groups) versus unhealthy (9 groups), with higher scores indicative of better overall diet quality. The GWG rate was calculated as the measured weight at early-to-mid 3rd trimester (28-35 wks) minus the weight at 2nd trimester (13-25 wks), divided by the number of weeks in between. Linear regression estimated the association between diet quality and GWG rate, adjusting for a priori covariates (i.e. age, education, ethnicity, pre-pregnancy BMI, and nausea/vomiting.) RESULTS: The mean GWG rate in mid-to-late pregnancy was 0.46 ± 0.2 kg/wk and the mean diet quality score was 23.6 ± 2.5. Based on pre-pregnancy BMI, 49.4% of women had excessive GWG rate, while nearly equal numbers had either adequate GWG or inadequate GWG rate. There was no significant association between diet quality and GWG rate [adjusted β (95% CI) = -0.02 (-0.05, 0.01); p = 0.14]. The mean GWG rate was marginally higher (0.57 vs. 0.44 kg/wk; p = 0.06) among those with high versus low (2 + servings vs. 0-1 serving/wk) intake of red meat; similar findings were seen when comparing red meat intake between women with excessive versus adequate GWG (Cramer's V = 0.2; p = 0.06).

CONCLUSIONS

While 1st trimester diet quality is not related to GWG among Nepali women, a high intake of red meat may be a potential risk factor for excessive GWG in this population.

Physical activity and gestational weight gain: a systematic review of observational studies

BACKGROUND

Now that excessive weight gain during pregnancy is recognized as leading to complications during pregnancy that affect foetal growth, limiting weight gain during pregnancy has become a public health concern. Our aim was to perform a systematic review to assess whether observational studies reported associations between Physical Activity (PA) and Gestational Weight Gain (GWG). We were particularly interested in whether insufficient PA might be associated with high GWG.

METHODS

Using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we searched the MEDLINE ® databases for articles published up to February 2020 concerning case-control, cohort, and ecological studies assessing the association between PA during pregnancy and the risk of excessive and/or inadequate GWG.

RESULTS

21 observational studies on the PA of pregnant women were screened. 11 of these focused on excessive GWG, and of these a majority tend to show a significant association between various aspects of PA and excessive GWG. However, the results were more mitigated when it came to rate of GWG: three studies found that neither meeting PA recommendations nor high levels of total PA nor time spent in moderate vigorous physical activity (MVPA) or engaged in sedentary behaviour were associated with weekly GWG, while two others suggested that pregnant women not meeting PA guidelines in late pregnancy did have a higher rate of GWG. Of the seven studies investigating total GWG, only one found no association with PA. All studies suggested an inverse association between PA and total GWG - yet not all studies are statistically significant.

CONCLUSION

Despite the small number of observational studies selected for our research, our findings support the main international findings, suggesting that active pregnant women gained less weight than inactive women; a lack of PA may therefore contribute to excessive GWG. The limitations of this body of evidence impede the formulation of firm conclusions. Further studies focusing clearly on the general PA assessment classification scheme are called for, to address limitations capable of affecting the strength of association.

Physical inactivity in early pregnancy and the determinants in an urban city setting of Kuala Lumpur, Malaysia

BACKGROUND

Physical inactivity in pregnancy has been associated with excessive gestational weight gain, hypertensive disorders, gestational diabetes mellitus and postpartum depression. Despite these risks, physical inactivity level remains high especially in higher income countries. The prevalence of physical inactivity among women in Malaysia aged ≥16 years was 28.2% in 2019 exceeding men by 6.1%. However, little is known regarding the subpopulation of pregnant women especially in Kuala Lumpur which is the most urbanized and highly populated city in Malaysia. Therefore, the aim of this study is to measure the physical inactivity prevalence among first trimester pregnant women in Kuala Lumpur and to identify its determining factors.

METHODS

This was a cross-sectional study in which 339 first trimester pregnant women were sampled from 13 maternal and child health clinics located in all four parliament districts of Kuala Lumpur. Self-administered questionnaires which contained the Malay version of the pregnancy physical activity questionnaire (PPAQ) were used. Descriptive analysis was conducted to determine the physical inactivity prevalence followed by simple and multiple logistic regression to identify the determinants of physical inactivity with significant level of 5%.

RESULTS

The prevalence of physical inactivity was 38.3%. The highest activity was seen in the household activity domain, despite only 24.8% of the respondents were housewives/unemployed. There was little to no participation observed in the vigorous intensity category. The determinants of physical inactivity were primigravida (aOR 3.54 95% CI 1.40, 8.97), education level (aOR 3.77 95% CI 1.35, 10.52) and body mass index (aOR 0.88 95% CI 0.80, 0.97) which explained 22.6% variation of physical inactivity in the final adjusted model.

CONCLUSION

The prevalence of physical inactivity among first trimester pregnant mothers in this study was 38.3%, and the highest activity was seen in the household category. Health education on physical activity in pregnancy should be focused on those who are primigravida and have no tertiary education. The educational content should be updated and tailored to current pandemic situation where self-isolation is the new norm, by advocating for home-based, moderate to vigorous intensity physical activities.

The Relationship of Diet and Physical Activity with Weight Gain and Weight Gain Prevention in Women of Reproductive Age

Reproductive-age women often see increased weight gain, which carries an increased risk of long-term overweight and obesity and adverse maternal and child health outcomes. Supporting women to achieve optimal weight through lifestyle modification (diet and physical activity) is of critical importance to reduce weight gain across key reproductive life-stages (preconception, pregnancy and postpartum). This review comprehensively summarizes the current state of knowledge on the contribution of diet and physical activity to weight gain and weight gain prevention in reproductive-aged women. Suboptimal diets including a higher proportion of discretionary choices or energy intake from fats, added sugars, sweets or processed foods are associated with higher weight gain, whereas increased consumption of core foods including fruits, vegetables and whole grains and engaging in regular physical activity are associated with reduced weight gain in reproductive age women. Diet and physical activity contributing to excessive gestational weight gain are well documented. However, there is limited research assessing diet and physical activity components associated with weight gain during the preconception and postpartum period. This review highlights the need for further research to identify key dietary and physical activity components targeting the critical windows of reproductive life-stages in women to best guide interventions to prevent weight gain.

Short Nighttime Sleep Duration and High Number of Nighttime Awakenings Explain Increases in Gestational Weight Gain and Decreases in Physical Activity but Not Energy Intake among Pregnant Women with Overweight/Obesity

Pregnant women are at a high risk for experiencing sleep disturbances, excess energy intake, low physical activity, and excessive gestational weight gain (GWG). Scant research has examined how sleep behaviors influence energy intake, physical activity, and GWG over the course of pregnancy. This study conducted secondary analyses from the Healthy Mom Zone Study to examine between- and within-person effects of weekly sleep behaviors on energy intake, physical activity, and GWG in pregnant women with overweight/obesity (PW-OW/OB) participating in an adaptive intervention to manage GWG. The overall sample of N = 24 (M age = 30.6 years, SD = 3.2) had an average nighttime sleep duration of 7.2 h/night. In the total sample, there was a significant between-person effect of nighttime awakenings on physical activity; women with >1 weekly nighttime awakening expended 167.56 less physical activity kcals than women with <1 nighttime awakening. A significant within-person effect was also found for GWG such that for every increase in one weekly nighttime awakening there was a 0.76 pound increase in GWG. There was also a significant within-person effect for study group assignment; study group appeared to moderate the effect of nighttime awakenings on GWG such that for every one increase in weekly nighttime awakening, the control group gained 0.20 pounds more than the intervention group. There were no significant between- or within-person effects of sleep behaviors on energy intake. These findings illustrate an important need to consider the influence of sleep behaviors on prenatal physical activity and GWG in PW-OW/OB. Future studies may consider intervention strategies to reduce prenatal nighttime awakenings.

A Prospective Study of the Relationship of Sleep Quality and Duration with Gestational Weight Gain and Fat Gain

Objective/Background: Fewer than one-third of U.S. women meet the Institute of Medicine guidelines for healthy gestational weight gain (GWG). While poor sleep quality and short sleep duration have been associated with weight gain and obesity in the general population, the relationship of sleep with pregnancy weight and body composition changes is unclear. This study aimed to examine associations of sleep duration and quality with pregnancy-related changes in body weight and fat. Participants: Pregnant women obtaining obstetric care through the University of North Carolina at Chapel Hill Healthcare System (UNC) (n = 339 who reported any sleep data) participating in the Pregnancy Eating Attributes Study. Materials and Methods: Participants were recruited at ≤12 weeks gestation and followed through delivery. The Pittsburgh Sleep Quality Index measured sleep duration and quality in early and late pregnancy. Weight was measured at each pregnancy medical visit and skinfolds were measured each trimester. t-tests examined sleep changes from early to late pregnancy and regression analyses estimated associations of sleep quality and duration with GWG and gestational fat gain (GFG). Results: Sleep quality and duration declined across pregnancy. A greater proportion of women with high early pregnancy body mass index (>25) reported low sleep quality and short sleep duration. Sleep quality was not associated with GWG adequacy, whereas longer late pregnancy sleep duration was associated with greater odds of inadequate GWG. Shorter sleep duration and lower sleep quality in late, but not early, pregnancy were associated with greater GFG. Conclusions: Lower sleep quality and shorter sleep duration in late pregnancy were associated with greater GFG. Experimental studies are needed to test the direction of causality between GFG and sleep attributes. ClinicalTrials.gov ID: NCT02217462.

Methodological quality of clinical practice guidelines for nutrition and weight gain during pregnancy: a systematic review

CONTEXT

Ensuring a healthy pregnancy and achieving optimal gestational weight gain (GWG) are important for maternal and child health. Nevertheless, the nutritional advice provided during pregnancy is often conflicting, suggesting limited adherence to clinical practice guidelines (CPGs).

OBJECTIVE

The aim of this review was to identify all CPGs on maternal nutrition and GWG and to critically appraise their methodological quality.

DATA SOURCES

The MEDLINE/PubMed, Cochrane, Guidelines International Network, and BMJ Best Practice databases, along with gray literature, were searched from inception until February 2019 for CPGs and consensus, position, and practice papers.

STUDY SELECTION

Clinical practice guidelines published in English and containing advice on maternal nutrition or GWG were eligible.

DATA EXTRACTION

Two authors independently extracted data on items pertaining to maternal nutrition or GWG, and CPGs were appraised using the AGREE II instrument.

RESULTS

Twenty-two CPGs were included. All scored adequately in the "scope" domain, but most were considered inadequate with regard to stakeholder involvement, rigor of development, applicability, and editorial independence. Many CPGs lacked patient or dietician involvement, and more than half did not disclose funding sources or conflicts of interest. Guidance on GWG was based mostly on Institute of Medicine thresholds, while nutrition recommendations appeared scattered and heterogeneous.

CONCLUSION

Despite the importance of maternal nutrition and the plethora of advising bodies publishing relevant guidance, there is room for substantial improvement in terms of development standards and content of nutritional recommendations.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42019120898.

Predictive factors for nutritional behavior among pregnant women attending antenatal care clinic in 6th of October City

Background

Good maternal nutrition during pregnancy is important to ensure health for both the mother and the foetus. This study aimed to assess nutritional knowledge and behavior among a group of Egyptian pregnant women in addition to identify the factors influencing both their nutritional knowledge and behavior.

Methods

This comparative cross sectional study included 300 pregnant women attending the antenatal care clinics in 6^th of October University private hospital and El-Hussary primary health care (PHC) unit. The data was collected through a modified nutritional survey that was translated from Spanish to Arabic and revised by language experts for clarity.

Results

Almost all of the women attending the private hospital were university educated while about half of the women attending the PHC unit were graduated from technical education. In general, the level of knowledge about food requirements of both groups was satisfactory good; however, neither of them fulfilled the WHO recommendations of food intake during pregnancy or the optimum number of meals per day. The mean of random blood glucose was higher among the women attending the PHC unit; the BMI, mid arm circumference and subcutaneous fat were higher among the same group as well. In regard to fulfilling the WHO recommended servings per day, only starch and fat items were fulfilled by both groups, whereas the other three items (vegetables, fruits and dairy products) were merely included in the diets of both groups.

Conclusions

Healthy behavior among pregnant women in both group were influenced by their educational level, occupation as well as their pre-gestational BMI. Those were the only three significant predictive factors, where women with higher education showed an active lifestyle. In addition, women starting with normal BMI before pregnancy had better healthy behaviours including the choice of healthy diets.

A Pilot Study Evaluating the Effectiveness of the 5As of Healthy Pregnancy Weight Gain

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.

The influence of socioeconomic status on gestational weight gain: a systematic review

Background

Despite a large number of publications regarding the association between socioeconomic status (SES) and gestational weight gain (GWG), the literature is inconsistent. We conducted a systematic review of current evidence relating to the association between SES and GWG, according to the Institute of Medicine (IOM) 2009 guidelines.

Methods

Six electronic databases were searched, with the final search run on first July 2016. The PRISMA Statement guidelines were followed and a modified version of the RTI Item Bank was used to assess risk of bias within studies. The primary outcome was inadequate, adequate or excessive GWG, as per the IOM guidelines.

Results

Sixteen studies were included. There was a positive skew in the number of studies that indicated that those who are less well educated are most at risk of gaining weight outside of the recommendations. Other measures of SES were not significantly associated with GWG.

Conclusions

Low educational attainment is likely to be associated with women gaining outside the IOM recommendations for GWG. Healthcare providers should provide additional support to pregnant women who are most at risk of gaining outside the recommendations, thus reducing the gap in health inequalities between those of high and low SES.

Intra- and inter-rater reliability in a comparative study of cross-sectional and spiral computed tomography pelvimetry methods

Background

Different low-dose computed tomography (CT) pelvimetry methods can be used to evaluate the size of birth canal before delivery. CT pelvimetry might generate an acceptable low fetal radiation dose but its measurement accuracy is unknown.

Purpose

To investigate intra- and inter-rater measurement reliability of cross-sectional and two spiral CT pelvimetry methods: standard spiral and short spiral.

Material and Methods

Ten individuals (age ≥60 years, body mass index ≥30 kg/m²) having a CT scan of the abdomen also had CT pelvimetry scans. Three radiologists made independent measurements of each pelvimetry method on two occasions and also in consensus for a reference pelvimetry computed from the standard-dose CT scan of the abdomen. Inter- and intra-rater reliability was analyzed by intraclass correlation coefficient.

Results

Measurements in the short spiral pelvimetry demonstrated excellent intra- and inter-rater reliability, intraclass correlation coefficient ≥0.93, and good to excellent 95% confidence interval 0.87–0.99. Corresponding results of the standard spiral and cross-sectional pelvimetry showed good to excellent intraclass correlation coefficient ≥0.85 and ≥0.76, and 95% confidence interval was least good and moderate 0.73–0.98 and 0.59–0.97, respectively. Intraclass correlation coefficient between reference pelvimetry and other CT methods showed analogous results.

Conclusion

The short spiral pelvimetry demonstrated high and best reliability in comparison to other methods. Standard spiral method showed also good measurement reliability but the short spiral pelvimetry generates lower fetal radiation dose. This method might be suitable for measurements at narrow pelvis. Patient acceptance and attitude to CT pelvimetry should be investigated.

Food Consumption, Nutrient Intake and Status during the First 1000 days of Life in the Netherlands: a Systematic Review

Adequate nutrition is essential for growth and development in early life. Nutritional data serves as a basis for national nutritional guidelines and policies. Currently, there is no insight into the availability of such data during the first 1000 days of life. Therefore, a systematic review was performed, following the PRISMA reporting guideline, to identify studies on food consumption, nutrient intake or status in the Netherlands. Potential gaps were identified, and the quality of the studies is discussed. The databases Embase and Medline were used, as well as databases from national institutes. Articles published in 2008-2018 were screened by two independent reviewers. In total 601 articles were identified, of which 173 were included. For pregnant women, 32 studies were available with nutritional data, for young children 40 studies were identified. No studies were available for breastfeeding women. A large variety of foods and nutrients were assessed, however certain nutrients were lacking (e.g., vitamin K). Overall, the studies had methodological limitations, making the data unsuitable to assess nutrient inadequacies. There is a need for recent, high quality nutritional research to strengthen the understanding of the nutritional needs and deficiencies during early life, and is fundamental for national guidelines and policies.

Gestational weight gain counselling gaps as perceived by pregnant women and new mothers: Findings from the electronic maternal health survey

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.

Inconsistent Weight Communication Among Prenatal Healthcare Providers and Patients: A Narrative Review

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.

Relationship Between Psychosocial Factors, Dietary Intake and Gestational Weight Gain: A Narrative Review

Inadequate gestational weight gain (GWG), which has reached almost two-thirds of Canadian pregnant women, is associated with several adverse effects both in the mother and her child. The aim of this review was to establish how psychosocial factors, diet and GWG are interrelated during pregnancy. More specifically, it aimed to evaluate how psychosocial factors can impact on diet and, thus, influence GWG. Studies published through May 2017 that examined factors related to GWG were included. Of 3268 non-duplicate titles and abstract, 77 articles underwent full-text review. Regarding dietary intakes, the majority of the included studies demonstrated that a higher caloric intake was associated with an elevated GWG. Also, a negative body image and attitude toward weight gain as well as a poor knowledge of GWG recommendations and inadequate prenatal care is associated with an increased GWG. Only few studies examined altogether the factors included and conclusions about how psychosocial factors can impact on diet and, thus, influence GWG cannot be drawn at this point. In the few studies that evaluated the interrelationships between psychosocial factors, diet and GWG, energy intake was not identified as a mediator of the association between psychosocial factors and GWG. This review highlights the scarcity of findings regarding psychosocial and dietary factors in relation to GWG and the need for high quality prospective cohort studies that will include all these factors to provide a better understanding of how they are interrelated to influence short- and long-term health.

Dietary Patterns Prior to Pregnancy and Associations with Pregnancy Complications

Few studies have explored pre-pregnancy diet and its relationship with pregnancy outcomes. The objectives of this study were to: (1) derive pre-pregnancy dietary patterns for women enrolled in a prospective cohort in the province of Alberta, Canada; (2) describe associations between dietary patterns and socio-demographic characteristics; and (3) describe associations between dietary patterns and pregnancy complications. Upon enrolment into the Alberta Pregnancy Outcomes and Nutrition (APrON) study (median age of gestation, 17 weeks), women (n = 1545) completed a validated 142-item food frequency questionnaire recording food and beverages consumed “in the 12 months prior to pregnancy”. Other assessments included pre-pregnancy body mass index (BMI), gestational weight gain, gestational hypertension, gestational diabetes, and socio-demographic characteristics. Dietary patterns were derived using principal components analysis. Scores were calculated to represent adherence with each dietary pattern retained. Four dietary patterns were retained, accounting for 22.9% of the variation in the overall diet. Dietary patterns were named the “healthy”, “meat and refined carbohydrate”, “beans, cheese and salad” or “tea and coffee” patterns. Higher “healthy” pattern scores prior to pregnancy were associated with lower odds of developing gestational hypertension during pregnancy (adjusted Odds Ratio (OR): 0.6, 95% Confidence Intervals (CI): 0.4, 0.9). Diet prior to pregnancy is an important target for interventions and may reduce the likelihood of developing complications such as gestational hypertension during pregnancy.

Health behaviour information provided to clients during midwife-led prenatal booking visits: Findings from video analyses

OBJECTIVE

to quantify to what extent evidence-based health behaviour topics relevant for pregnancy are discussed with clients during midwife-led prenatal booking visits and to assess the association of client characteristics with the extent of information provided.

DESIGN

quantitative video analyses.

SETTING AND PARTICIPANTS

173 video recordings of prenatal booking visits with primary care midwives and clients in the Netherlands taking place between August 2010 and April 2011.

MEASUREMENTS

thirteen topics regarding toxic substances, nutrition, maternal weight, supplements, and health promoting activities were categorized as either 'never mentioned', 'briefly mentioned', 'basically explained' or 'extensively explained'. Rates on the extent of information provided were calculated for each topic and relationships between client characteristics and dichotomous outcomes of the extent of information provided were assessed using Generalized Linear Mixed Modelling.

FINDINGS

our findings showed that women who did not take folic acid supplementation, who smoked, or had a partner who smoked, were usually provided basic and occasionally extensive explanations about these topics. The majority of clients were provided with no information on recommended weight gain (91.9%), fish promotion (90.8%), caffeine limitation (89.6%), vitamin D supplementation (87.3%), physical activity promotion (81.5%) and antenatal class attendance (75.7%) and only brief mention of alcohol (91.3%), smoking (81.5%), folic acid (58.4) and weight at the start of pregnancy (52.0%). The importance of a nutritious diet was generally either never mentioned (38.2%) or briefly mentioned (45.1%). Nulliparous women were typically given more information on most topics than multiparous women.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

although additional information was generally provided about folic acid and smoking, when relevant for their clients, the majority of women were provided with little or no information about the other health behaviours examined in this study. Midwives may be able to improve prenatal health promotion by providing more extensive health behaviour information to their clients during booking visits.

Come On! Using intervention mapping to help healthy pregnant women achieve healthy weight gain

OBJECTIVE

Gaining too much or too little weight in pregnancy (according to Institute of Medicine (IOM) guidelines) negatively affects both mother and child, but many women find it difficult to manage their gestational weight gain (GWG). Here we describe the use of the intervention mapping protocol to design 'Come On!', an intervention to promote adequate GWG among healthy pregnant women.

DESIGN

We used the six steps of intervention mapping: (i) needs assessment; (ii) formulation of change objectives; (iii) selection of theory-based methods and practical strategies; (iv) development of the intervention programme; (v) development of an adoption and implementation plan; and (vi) development of an evaluation plan. A consortium of users and related professionals guided the process of development.

RESULTS

As a result of the needs assessment, two goals for the intervention were formulated: (i) helping healthy pregnant women to stay within the IOM guidelines for GWG; and (ii) getting midwives to adequately support the efforts of healthy pregnant women to gain weight within the IOM guidelines. To reach these goals, change objectives and determinants influencing the change objectives were formulated. Theories used were the Transtheoretical Model, Social Cognitive Theory and the Elaboration Likelihood Model. Practical strategies to use the theories were the foundation for the development of 'Come On!', a comprehensive programme that included a tailored Internet programme for pregnant women, training for midwives, an information card for midwives, and a scheduled discussion between the midwife and the pregnant woman during pregnancy. The programme was pre-tested and evaluated in an effect study.

Gestational weight gain, cesarean delivery, and cesarean delivery on maternal request: a cohort analysis of Chinese nulliparous women

PURPOSE

To examine the association between gestational weight gain (GWG) and cesarean delivery including cesarean delivery on maternal request (CDMR) among low-risk women.

METHODS

A total of 1,009,987 Chinese nulliparous women who delivered live term singletons during 1993-2010 were included. GWG, according to maternal pre-pregnancy body mass index-specified z-scores, was categorized into five groups: less than -1.2, -1.2 to less than -0.6, -0.6 to 0.6 (reference), more than 0.6 to 1.2, and more than 1.2. Multivariate log-binomial regression models were used to estimate the adjusted risk ratios and 95% confidence intervals (95% CIs).

RESULTS

GWG was positively associated with overall cesarean and CDMR after adjusting for various confounders. Adjusted risk ratios for cesarean were 0.75 (95% CI, 0.73-0.77), 0.84 (95% CI, 0.82-0.85), 1.00, 1.16 (95% CI, 1.14-1.19), and 1.32 (95% CI, 1.29-1.35) in five ascending GWG categories, and 0.70 (95% CI, 0.67-0.73), 0.80 (95% CI, 0.78-0.82), 1.00, 1.20 (95% CI, 1.18-1.23), and 1.43 (95% CI, 1.40-1.45) for CDMR. The graded positive associations were consistent across levels of maternal pre-pregnancy body mass index, and in strata defined by southern and/or northern provinces, urban and/or rural residence, maternal age at delivery, year of delivery, and level of delivering hospital.

CONCLUSIONS

Even among low-risk women, higher GWG was monotonically associated with an increased risk of cesarean delivery, indicating that limiting GWG could benefit to curb the rate of both medically necessary and unnecessary cesareans.

The early infant gut microbiome varies in association with a maternal high-fat diet

BACKGROUND

Emerging evidence suggests that the in utero environment is not sterile as once presumed. Work in the mouse demonstrated transmission of commensal bacteria from mother to fetus during gestation, though it is unclear what modulates this process. We have previously shown in the nonhuman primate that, independent of obesity, a maternal high-fat diet during gestation and lactation persistently shapes the juvenile gut microbiome. We therefore sought to interrogate in a population-based human longitudinal cohort whether a maternal high-fat diet similarly alters the neonatal and infant gut microbiome in early life.

METHODS

A representative cohort was prospectively enrolled either in the early third trimester or intrapartum (n = 163), with a subset consented to longitudinal sampling through the postpartum interval (n = 81). Multiple body site samples, including stool and meconium, were collected from neonates at delivery and by 6 weeks of age. A rapid dietary questionnaire was administered to estimate intake of fat, added sugars, and fiber over the past month (National Health and Examination Survey). DNA was extracted from each infant meconium/stool sample (MoBio) and subjected to 16S rRNA gene sequencing and analysis.

RESULTS

On average, the maternal dietary intake of fat ranged from 14.0 to 55.2 %, with an average intake of 33.1 % (σ = 6.1 %). Mothers whose diets significantly differed from the mean (±1 standard deviation) were separated into two distinct groups, a control group (n = 13, μ = 24.4 %) and a high-fat group (n = 13, μ = 43.1 %). Principal coordinate analysis revealed that the microbiome of the neonatal stool at birth (meconium) clustered differently by virtue of maternal gestational diet (PERMANOVA p = 0.001). LEfSe feature selection identified several taxa that discriminated the groups, with a notable relative depletion of Bacteroides in the neonates exposed to a maternal high-fat gestational diet (Student's t-test, p < 0.05) that persisted to 6 weeks of age.

CONCLUSIONS

Similar to the primate, independent of maternal body mass index, a maternal high-fat diet is associated with distinct changes in the neonatal gut microbiome at birth which persist through 4-6 weeks of age. Our findings underscore the importance of counseling pregnant mothers on macronutrient consumption during pregnancy and lactation.

Association between Maternal Fish Consumption and Gestational Weight Gain: Influence of Molecular Genetic Predisposition to Obesity

Background

Studies suggest that fish consumption can restrict weight gain. However, little is known about how fish consumption affects gestational weight gain (GWG), and whether this relationship depends on genetic makeup.

Objective

To examine the association between fish consumption and GWG, and whether this relationship is dependent on molecular genetic predisposition to obesity.

Design

A nested case-cohort study based on the Danish National Birth Cohort (DNBC) sampling the most obese women (n = 990) and a random sample of the remaining participants (n = 1,128). Replication of statistically significant findings was attempted in the Avon Longitudinal Study of Parents and Children (ALSPAC) (n = 4,841). We included 32 body mass index (BMI) associated single nucleotide polymorphisms (SNPs) and 5 SNPs found associated with GWG. BMI associated SNPs were combined in a genetic risk score (GRS). Associations between consumption of fish, GRS or individual variants and GWG were analysed, and interactions between fish and the GRS or individual variants were examined.

Results

In the DNBC, each portion/week (150 g) of fatty fish was associated with a higher GWG of 0.58 kg (95% CI: 0.16, 0.99, P<0.01). For total fish and lean fish, similar patterns were observed, but these associations were not statistically significant. We found no association between GRS and GWG, and no interactions between GRS and dietary fish on GWG. However, we found an interaction between the PPARG Pro12Ala variant and dietary fish. Each additional Pro12Ala G-allele was associated with a GWG of -0.83 kg (95% CI: -1.29, -0.37, P<0.01) per portion/week of dietary fish, with the same pattern for both lean and fatty fish. In ALSPAC, we were unable to replicate these findings.

Conclusion

We found no consistent evidence of association between fish consumption and GWG, and our results indicate that the association between dietary fish and GWG has little or no dependency on GRS or individual SNPs.