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Wen J, Lv A, Aihemaitijiang S, Li H, Zhou Y, Liu J. The association of maternal gestational weight gain with cardiometabolic risk factors in offspring: a systematic review and meta-analysis. Nutr Rev 2024:nuae027. [PMID: 38607346 DOI: 10.1093/nutrit/nuae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
CONTEXT Gestational weight gain (GWG) is known to be a risk factor for offspring obesity, a precursor of cardiometabolic diseases. Accumulating studies have investigated the association of GWG with offspring cardiometabolic risk factors (CRFs), leading to inconsistent results. OBJECTIVE This study synthesized available data from cohort studies to examine the effects of GWG on offspring CRFs. DATA SOURCE Four electronic databases, including PubMed, Web of Science, Scopus, and Embase, were searched through May 2023. DATA EXTRACTION Cohort studies evaluating the association between GWG and CRFs (fat mass [FM], body fat percentage [BF%], waist circumference [WC], systolic blood pressure [SBP] and diastolic blood pressure, high-density-lipoprotein cholesterol [HDL-C] and low-density-lipoprotein cholesterol, triglyceride [TG], total cholesterol, fasting blood glucose, and fasting insulin levels) were included. Regression coefficients, means or mean differences with 95% confidence intervals [CIs], or standard deviations were extracted. DATA ANALYSIS Thirty-three cohort studies were included in the meta-analysis. Higher GWG (per increase of 1 kg) was associated with greater offspring FM (0.041 kg; 95% CI, 0.016 to 0.067), BF% (0.145%; 95% CI, 0.116 to 0.174), WC (0.154 cm; 95% CI, 0.036 to 0.272), SBP (0.040 mmHg; 95% CI, 0.010 to 0.070), and TG (0.004 mmol/L; 95% CI, 0.001 to 0.007), and with lower HDL-C (-0.002 mmol/L; 95% CI, -0.004 to 0.000). Consistently, excessive GWG was associated with higher offspring FM, BF%, WC, and insulin, and inadequate GWG was associated with lower BF%, low-density lipoprotein cholesterol, total cholesterol, and TG, compared with adequate GWG. Most associations went non-significant or attenuated with adjustment for offspring body mass index or FM. CONCLUSIONS Higher maternal GWG is associated with increased offspring adiposity, SBP, TG, and insulin and decreased HDL-C in offspring, warranting a need to control GWG and to screen for cardiometabolic abnormalities of offspring born to mothers with excessive GWG. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42023412098.
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Affiliation(s)
- Jiaxing Wen
- Institute of Reproductive and Child Health, Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
| | - Axing Lv
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Sumiya Aihemaitijiang
- Institute of Reproductive and Child Health, Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
| | - Hongtian Li
- Institute of Reproductive and Child Health, Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
| | - Yubo Zhou
- Institute of Reproductive and Child Health, Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
| | - Jianmeng Liu
- Institute of Reproductive and Child Health, Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
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Nightingale H, Mnatzaganian G, Hooker L, Barrett S, Kingsley M. The effect of motivational interviewing and/or cognitive behaviour therapy techniques on gestational weight gain - a systematic review and meta-analysis. BMC Public Health 2023; 23:626. [PMID: 37005572 PMCID: PMC10067184 DOI: 10.1186/s12889-023-15446-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/15/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Women with gestational weight gain (GWG) that is below or above recommendations are at risk of adverse perinatal outcomes. Motivational interviewing and/or cognitive behaviour therapy have demonstrated efficacy in initiating and sustaining behaviour change, including weight control. The objective of this review was to investigate the effect of antenatal interventions that include components of motivational interviewing and/or cognitive behaviour therapy on gestational weight gain. METHODS This review was designed and reported in accordance with guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Five electronic databases were systematically searched to March 2022. Randomised controlled trials evaluating interventions with identified components of motivational interviewing and/or cognitive behaviour therapies were included. Pooled proportions of appropriate GWG and GWG above or below guidelines, and standardised mean difference for total gestational weight gain, were calculated. Risk of bias in included studies was evaluated using the Risk of Bias 2 tool, and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence. RESULTS Twenty-one studies (8030 participants) were included. Overall, MI and/or CBT interventions had a small effect on the total gestational weight gain (SMD: -0.18, 95% confidence interval: -0.27 to -0.09, p < 0.001) and improved the proportion of women achieving recommended gestational weight gain (29% versus 23% in the comparison, p < 0.001). The GRADE assessment indicated that overall quality of evidence is very uncertain, however sensitivity analyses to account for high risk of bias produced similar results to original meta-analyses. The magnitude of effect was greater in women with overweight or obesity when compared to women with BMI < 25 kg/m2. CONCLUSION Motivational interviewing and/or cognitive behaviour therapy techniques may be effective for promoting healthy gestational weight gain. Nevertheless, a high proportion of women do not achieve recommended gestational weight gain. Future interventions should consider factors, including clinician and consumer perspectives, in the design and delivery of psychosocial interventions that aim to support healthy gestational weight gain. TRIAL REGISTRATION The protocol for this review was registered with the PROSPERO International register of systematic reviews (registration number CRD42020156401).
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Affiliation(s)
- Helen Nightingale
- Rural Department of Nursing & Midwifery, La Trobe Rural Health School, La Trobe University, Bendigo, Australia.
| | - George Mnatzaganian
- Rural Department of Community Health, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Leesa Hooker
- Rural Department of Nursing & Midwifery, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Australia
| | - Stephen Barrett
- Research and Innovation, Bendigo Health, Bendigo, Australia
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Michael Kingsley
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
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Bartels HC, Kennelly MA, Killeen SL, Lindsay KL, Crowley RK, McAuliffe FM. An mHealth-Supported antenatal lifestyle intervention may be associated with improved maternal sleep in pregnancy: Secondary analysis from the PEARS trial. BJOG 2022; 129:2195-2202. [PMID: 35876246 DOI: 10.1111/1471-0528.17267] [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: 03/30/2022] [Revised: 06/16/2022] [Accepted: 07/01/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To investigate the effect of an antenatal diet and exercise intervention during pregnancy on sleep duration. As a secondary objective, associations between sleep duration and gestational weight gain (GWG), maternal metabolic parameters and pregnancy outcomes were assessed. DESIGN Secondary analysis. SETTING Large tertiary Maternity Hospital in Dublin, Ireland. POPULATION 326 women with overweight or obesity who participated in the Pregnancy Exercise And Nutrition Research Study (PEARS) randomised controlled trial between March 2013 and August 2016. METHODS Secondary analysis of a randomised trial. MAIN OUTCOME MEASURES Impact of the PEARS intervention on sleep duration, and association of sleep duration and maternal metabolic parameters, and pregnancy outcomes. RESULTS Participants had a mean age of 32.5 ± 4.5 years and median (interquartile range [IQR]) body mass index of 28.3 (26.6-31.2) kg/m2 . The intervention group had a longer sleep duration in late pregnancy (mean difference 17.1 minutes (95% confidence interval [CI] 0.5-33.7) and a higher proportion achieving optimum sleep duration of 7-9 h (54.3 vs. 42.9%, relative risk [RR] 1.28 (95% CI 1.01-1.62). In late pregnancy, sleep duration of <6 h was associated with lower breastfeeding rates on discharge (RR 0.74, 95% CI 0.57-0.95) and higher triglyceride levels (mean difference 0.24, 95% CI 0.10-0.38). There were no significant associations between sleep and incidence of gestational diabetes mellitus or pre-eclampsia/toxaemia, or other metabolic parameters assessed (insulin, fasting glucose, HOMA-IR). CONCLUSION A diet and exercise intervention from early pregnancy may promote longer and optimal sleep duration, with maternal benefits such as lower triglyceride levels and higher breastfeeding rates.
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Affiliation(s)
- Helena C Bartels
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Maria A Kennelly
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Karen L Lindsay
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.,UCI Department of Pediatrics, University of California, Irvine, CA, USA
| | - Rachel K Crowley
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.,Department of Endocrinology, St Vincent's University Hospital, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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Luo X, Gao J, He Z, Ji J, Zhang W, Wu P, Guo X, Cao D, Xu Z, Li C, Mi Y. What is an appropriate gestational weight gain for women with gestational diabetes mellitus: based on the adverse pregnancy outcomes of over 12 thousand participants? Diabetol Metab Syndr 2022; 14:166. [PMID: 36369083 PMCID: PMC9652847 DOI: 10.1186/s13098-022-00940-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/23/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Evidence showed possible benefits of a less gestational weight gain (GWG) than the US Institute of Medicine (IOM) recommendation in gestational diabetes mellitus (GDM) pregnancy. Here, we aimed to explore an appropriate GWG range in GDM women according to adverse pregnancy outcomes. METHODS We enrolled all the singleton GDM pregnant women (n = 14,213) from January 2015 to December 2018 in Xi'an, Northwest China. According to the pre-pregnancy body mass index (BMI), they were classified into the Underweight (< 18.5 kg/m2), Normal weight (18.5-24.9 kg/m2), Overweight (25.0-29.9 kg/m2) and Obesity (≥ 30.0 kg/m2) group, respectively. Logistic regression analysis was used to calculate the odds ratio (OR) and 95% confidence intervals (95% CI). The appropriate ranges of GWG were determined based on a significant protective association (OR < 1). RESULTS Totally, 12,712 participants were finally recruited. There were 1180 (9.3%), 9134 (71.9%), 2097 (16.5%), and 301 (2.4%) patients in the Underweight, Normal weight, Overweight, and Obesity groups, respectively. Adverse outcomes increased with the elevation of pre-pregnancy BMI. Among them, the risk of cesarean section was the highest, followed by large for gestational age (LGA), small for gestational age (SGA), preeclampsia, and gestational hypertension. Through the analysis of the risk of adverse outcomes in continuous GWG categories in each group, an ideal GWG range obtained in this study was as follows: 10-15.9 kg, 8-11.9 kg, 6-7.9 kg, and -5-3.9 kg for the Underweight, Normal weight, Overweight and Obesity group, respectively. Furthermore, the ranges in this study were more protective for adverse outcomes than those from IOM. CONCLUSIONS Based on the adverse pregnancy outcomes of over 12 thousand participants, our findings showed a more stringent GWG range for GDM women than the IOM criteria recommendation.
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Affiliation(s)
- Xiaoqin Luo
- Department of Nutrition and Food Safety, School of Public Health, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Jiayi Gao
- Department of Nutrition and Food Safety, School of Public Health, Xi'an Jiaotong University, Xi'an, 710061, China
- Emergency Medical Center, Xi'an Public Health Center, Xi'an, 710200, China
| | - Zhangya He
- Department of Nutrition and Food Safety, School of Public Health, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Jing Ji
- Department of Obstetrics and Gynecology, Northwest Women and Children's Hospital, Xi'an, 710061, China
| | - Wanyu Zhang
- Department of Nutrition and Food Safety, School of Public Health, Xi'an Jiaotong University, Xi'an, 710061, China
- Shaanxi Health Supervision Center, Xi'an, 710077, China
| | - Pei Wu
- Department of Nutrition and Food Safety, School of Public Health, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Xiaoxiao Guo
- Department of Nutrition and Food Safety, School of Public Health, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Dan Cao
- Department of Nutrition and Food Safety, School of Public Health, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Zhangrui Xu
- Department of Nutrition and Food Safety, School of Public Health, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Chao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yang Mi
- Department of Obstetrics and Gynecology, Northwest Women and Children's Hospital, Xi'an, 710061, China.
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North SM, Crofts C, Zinn C. Hyperinsulinaemia in pregnancy and gestational outcomes: A case series. JOURNAL OF INSULIN RESISTANCE 2022. [DOI: 10.4102/jir.v5i1.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Pathological insulin resistance in pregnancy is associated with an increased risk for complications such as gestational diabetes mellitus and pre-eclampsia. Individuals with pathological insulin resistance also exhibit hyperinsulinaemia. Currently, there are no diagnostic criteria for pathological hyperinsulinaemia in pregnancy that may be used to indicate risk of adverse outcomes.Aim: This case series aimed to explore the relationship between first trimester insulin response patterns and gestational outcomes.Setting: Auckland, New Zealand.Methods: Participants included four pregnant women with prepregnancy body mass index ≥ 25 kg/m2 and aged 25–35 years. Glucose and insulin response patterns were examined following a 120 min oral glucose tolerance test (OGTT) at 12–15 weeks of gestation using a modified Kraft methodology. Outcomes assessed at 25 and 35 weeks of gestation included gestational weight gain (GWG), blood pressure, fasting capillary blood glucose and foetal growth. Lifestyle and medical information were collected at each trimester. After delivery, total GWG, infant size, delivery method and clinical outcomes were recorded.Results: Kraft pattern IIB hyperinsulinaemia was identified in two cases. Amongst them, Case #1 experienced excessive GWG, induction of labour and surgically assisted delivery. Case #4 delivered by emergency caesarean, and the neonate required intensive care admission for 17 h. No cases developed hyperglycaemia or hypertension. Infant weights were between 3.75 kg and 3.86 kg.Conclusion: Dynamic insulin assay provides a promising template to assess metabolic risk in the first trimester of pregnancy. Diagnosing hyperinsulinaemia early in pregnancy means that lifestyle-based initiatives could be introduced earlier to mitigate excess GWG and potential adverse outcomes.
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Espírito-Santo DA, Cordeiro GS, Oliveira TWS, Santos LS, Silva RT, Costa CAS, Boaventura GT, Barreto-Medeiros JM. Exposure to a high-fat diet during intrauterine life and post-birth causes cardiac histomorphometric changes in rats: A systematic review. Life Sci 2022; 303:120658. [PMID: 35662554 DOI: 10.1016/j.lfs.2022.120658] [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: 03/07/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022]
Abstract
Cardiac histomorphometric changes are conditions present as an adaptive response to increased cardiovascular demand, such as in obesity or the consumption of a high-fat diet. Epidemiologic studies show an increase in maternal obese individuals, with repercussions on offspring cardiovascular health. OBJECTIVE The goal of this study was to systematically review studies that evaluated cardiac histomorphometric changes in rodents exposed to a high-fat diet. DATA SOURCE PubMed, Embase, Science Direct, Web of Science and Lilacs. DATA EXTRACTION Animal species, percentage of dietary fat, period and time of exposure and main cardiac change results were extracted. DATA ANALYSIS A total of 1687 studies were found, and 20 met the inclusion criteria for this systematic review. A maternal high-fat diet was started 3 to 4 weeks before mating in most (70%) of the studies. Nutritional manipulation of offspring was initiated during pregnancy and maintained until the end of lactation in most (45%) of the studies. The fat percentage of high-fat diets ranged between 20% and 62%. The studies showed increases in cardiomyocytes, left ventricle size, and whole heart hypertrophy. Some studies showed increased thickness of the middle intima layer of the aorta and atherosclerosis. Studies that maintained a high-fat diet after the lactation period also showed an increase in cardiac hypertrophy. CONCLUSION Maternal exposure to a hyperlipidic diet in the fetal stages of cardiac development causes cardiac hypertrophy in offspring. The high variation in the dietary fat and the difference in the time and period of exposure of the offspring to the high - fat diet suggest the high degree of sensitivity of the cardiac structure.
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Affiliation(s)
- Djane A Espírito-Santo
- Department of Nutrition, Graduate Program of Food Nutrition and Health, Federal University of Bahia, Brazil.
| | - Gabriele S Cordeiro
- Department of Nutrition, Graduate Program of Food Nutrition and Health, Federal University of Bahia, Brazil
| | | | | | - Rafael T Silva
- Department of Nutrition, Graduate Program of Food Nutrition and Health, Federal University of Bahia, Brazil
| | - Carlos A S Costa
- Health Sciences Center, Federal University of Recôncavo Baiano, Santo Antonio de Jesus, Bahia, Brazil
| | - Gilson T Boaventura
- Department of Nutrition, Graduate Program of Food Nutrition and Health, Federal University of Bahia, Brazil
| | - Jairza M Barreto-Medeiros
- Department of Nutrition, Graduate Program of Food Nutrition and Health, Federal University of Bahia, Brazil
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Lorenz L, Krebs F, Nawabi F, Alayli A, Stock S. Preventive Counseling in Routine Prenatal Care-A Qualitative Study of Pregnant Women's Perspectives on a Lifestyle Intervention, Contrasted with the Experiences of Healthcare Providers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6122. [PMID: 35627659 PMCID: PMC9140722 DOI: 10.3390/ijerph19106122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 11/22/2022]
Abstract
Maternal lifestyle during pregnancy and excessive gestational weight gain can influence maternal and infant short and long-term health. As part of the GeMuKi intervention, gynecologists and midwives provide lifestyle counseling to pregnant women during routine check-up visits. This study aims to understand the needs and experiences of participating pregnant women and to what extent their perspectives correspond to the experiences of healthcare providers. Semi-structured interviews were conducted with 12 pregnant women and 13 multi-professional healthcare providers, and were analyzed using qualitative content analysis. All interviewees rated routine check-up visits as a good setting in which to focus on lifestyle topics. Women in their first pregnancies had a great need to talk about lifestyle topics. None of the participants were aware of the link between gestational weight gain and maternal and infant health. The healthcare providers interviewed attributed varying relevance regarding the issue of weight gain and, accordingly, provided inconsistent counseling. The pregnant women expressed dissatisfaction regarding the multi-professional collaboration. The results demonstrate a need for strategies to improve multi-professional collaboration. In addition, health care providers should be trained to use sensitive techniques to inform pregnant women about the link between gestational weight gain and maternal and infant health.
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Affiliation(s)
- Laura Lorenz
- Institute of Health Economics and Clinical Epidemiology (IGKE), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (F.K.); (F.N.); (A.A.); (S.S.)
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Eitmann S, Mátrai P, Németh D, Hegyi P, Lukács A, Bérczi B, Czumbel LM, Kiss I, Gyöngyi Z, Varga G, Balaskó M, Pétervári E. Maternal overnutrition elevates offspring's blood pressure-A systematic review and meta-analysis. Paediatr Perinat Epidemiol 2022; 36:276-287. [PMID: 35041216 PMCID: PMC9305555 DOI: 10.1111/ppe.12859] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/13/2021] [Accepted: 12/19/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Maternal overnutrition during pregnancy predisposes the offspring to cardiometabolic diseases. OBJECTIVES This systematic review and meta-analysis aimed to investigate the association between maternal overnutrition and offspring's blood pressure (BP) and the effect of offspring's obesity on this association. DATA SOURCES PubMed, EMBASE, Clinicaltrials.gov, CENTRAL. STUDY SELECTION AND DATA EXTRACTION Human studies published in English before October 2021 were identified that presented quantitative estimates of association between maternal overnutrition just before or during pregnancy and the offspring's BP. SYNTHESIS Random-effect model with the DerSimonian and Laird weighting method was used to analyse regression coefficients or mean differences. RESULTS After selection, 17 observational studies (140,517 mother-offspring pairs) were included. Prepregnancy body mass index (ppBMI) showed positive correlation with BP in offspring (regression coefficient for systolic: 0.38 mmHg per kg/m2 , 95% confidence interval (CI) 0.17, 0.58; diastolic: 0.10 mmHg per kg/m2 , 95% CI 0.05, 0.14). These indicate 1.9 mmHg increase in systolic and 0.5 mmHg increase in diastolic BP of offspring with every 5 kg/m2 gain in maternal ppBMI. Results on coefficients adjusted for offspring's BMI also showed association (systolic: 0.08 mmHg per kg/m2 , 95% CI 0.04, 0.11; diastolic: 0.03 mmHg per kg/m2 , 95% CI 0.01, 0.04). Independent from ppBMI, gestational weight gain (GWG) showed positive correlation with systolic BP (systolic BP: 0.05 mmHg per kg, 95% CI 0.01, 0.09), but not after adjustment for offspring's BMI. Mean systolic BP was higher in children of mothers with excessive GWG than in those of mothers with optimal GWG (difference: 0.65 mmHg, 95% CI 0.25, 1.05). CONCLUSIONS Independent from offspring's BMI, higher prepregnancy BMI may increase the risk for hypertension in offspring. The positive association between GWG and offspring's systolic BP is indirect via offspring's obesity. Reduction in maternal obesity and treatment of obesity in children of obese mothers are needed to prevent hypertension.
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Affiliation(s)
- Szimonetta Eitmann
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
| | - Péter Mátrai
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
| | - Dávid Németh
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
| | - Péter Hegyi
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
- Szentágothai Research CentreMedical SchoolUniversity of PécsPécsHungary
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Division of Pancreatic Diseases, Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Anita Lukács
- Department of Physiology, Anatomy and NeuroscienceFaculty of Science and InformaticsUniversity of SzegedSzegedHungary
| | - Bálint Bérczi
- Department of Public Health MedicineMedical SchoolUniversity of PécsPécsHungary
| | - László Márk Czumbel
- Department of Oral BiologyFaculty of DentistrySemmelweis UniversityBudapestHungary
| | - István Kiss
- Department of Public Health MedicineMedical SchoolUniversity of PécsPécsHungary
| | - Zoltán Gyöngyi
- Department of Public Health MedicineMedical SchoolUniversity of PécsPécsHungary
| | - Gábor Varga
- Department of Oral BiologyFaculty of DentistrySemmelweis UniversityBudapestHungary
| | - Márta Balaskó
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
| | - Erika Pétervári
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
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Unhealthy gestational weight gain: are we neglecting inadequate gestational weight gain? Midwifery 2022; 107:103277. [DOI: 10.1016/j.midw.2022.103277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 01/19/2022] [Accepted: 02/06/2022] [Indexed: 11/23/2022]
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Li Y, Zhou X, Zhang Y, Zhong C, Huang L, Chen X, Chen R, Wu J, Li Q, Sun G, Yin H, Xiong G, Hao L, Yang N, Yang X. Association of Maternal Dietary Patterns With Birth Weight and the Mediation of Gestational Weight Gain: A Prospective Birth Cohort. Front Nutr 2021; 8:782011. [PMID: 34901129 PMCID: PMC8664542 DOI: 10.3389/fnut.2021.782011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/25/2021] [Indexed: 12/26/2022] Open
Abstract
The associations among maternal diet, birth weight, and gestational weight gain are still inconclusive. This study aimed to investigate the associations between maternal dietary patterns and birth weight, and further explore whether GWG mediates these associations. A total of 3,334 pregnant women who completed a validated semi-quantitative food frequency questionnaire from the Tongji Maternal and Child Health Cohort were included. Dietary patterns were extracted by using principal component analysis. Regression models and mediation analyses were performed to explore the associations between dietary patterns and birth weight and the effects of GWG on these associations. Five dietary patterns were identified: "Beans-vegetables," "Fish-meat-eggs," "Nuts-whole grains," "Organ-poultry-seafood" and "Rice-wheat-fruits." Only women following the "Beans-vegetables" pattern had heavier newborns (β = 47.39; 95% CI: 12.25, 82.54). Women following the "Beans-vegetables" pattern had significantly lower GWG (β = -0.7; 95% CI: -1.15, -0.25) and had a 16% lower risk of excessive GWG and 11% higher odd of adequate GWG. The association between the "Beans-vegetables" pattern and birth weight was negatively mediated by GWG. A dietary pattern enriched in beans and vegetables is beneficial for effectively controlling GWG and increasing birth weight. GWG serves. Clinical Trial Registry: This trial was registered at ClinicalTrials.gov (NCT03099837).
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Affiliation(s)
- Yan Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuezhen Zhou
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Zhang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunrong Zhong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Huang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Renjuan Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiangyue Wu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoqiang Sun
- Hubei Maternal and Child Health Hospital, Wuhan, China
| | - Heng Yin
- Hubei Maternal and Child Health Hospital, Wuhan, China
| | | | - Liping Hao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nianhong Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuefeng Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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11
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Lorenz L, Krebs F, Nawabi F, Senyel D, Alayli A, Bau AM, Stock S. [Prospects for the implementation of the Innovation Fund project GeMuKi - a cross sectional study on attitudes of health care providers regarding preventive lifestyle counselling in routine prenatal visits and infant check-ups]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2021; 165:51-57. [PMID: 34420889 DOI: 10.1016/j.zefq.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Overweight and obesity are major public health concerns in Germany. As patients can easily be accessed via physicians' offices, this setting provides a high potential for prevention. However, the limited implementation of prevention and health promotion interventions in physicians' offices so far indicates that barriers to implementation exist. This study therefore addresses how obesity prevention interventions should be designed and implemented so that health care providers perceive them as appropriate and are willing to adopt them in their daily practice. The study is performed by taking the Innovation Fund project "GeMuKi" as an example. METHODS A mixed-methods study was conducted. Data collection took place within the context of the GeMuKi training session that health care providers complete in preparation for implementing the intervention. Gynecologists, pediatricians, midwives, and medical assistants completed a questionnaire. The questions covered the implementation outcomes "appropriateness" and "adoption". Text entry fields were used to obtain information on feasibility as well as anticipated facilitating and hindering factors. In addition, observation protocols were prepared for each training session by the project team. The questionnaire was analyzed descriptively. Text entry fields and protocols were evaluated using qualitative content analysis. RESULTS Four hundred and one (n=401) training participants completed the questionnaire. Almost three quarters (73 %) of the health care providers indicate that they are motivated to implement the intervention. At the same time, concerns are expressed about organizational feasibility in everyday practice. Nevertheless, 72 % expect their care to improve as a result of the project. CONCLUSION The health care providers surveyed are positive about the implementation of the project in everyday practice. By documenting concerns about the implementation, the barriers identified can be addressed during the project course.
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Affiliation(s)
- Laura Lorenz
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Institut für Gesundheitsökonomie und Klinische Epidemiologie, Köln, Deutschland.
| | - Franziska Krebs
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Institut für Gesundheitsökonomie und Klinische Epidemiologie, Köln, Deutschland
| | - Farah Nawabi
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Institut für Gesundheitsökonomie und Klinische Epidemiologie, Köln, Deutschland
| | - Deniz Senyel
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Institut für Gesundheitsökonomie und Klinische Epidemiologie, Köln, Deutschland
| | - Adrienne Alayli
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Institut für Gesundheitsökonomie und Klinische Epidemiologie, Köln, Deutschland
| | | | - Stephanie Stock
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Institut für Gesundheitsökonomie und Klinische Epidemiologie, Köln, Deutschland
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12
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Nyasordzi J, Conrad J, Goletzke J, Ludwig-Walz H, Herder C, Roden M, Wudy SA, Hua Y, Remer T, Buyken AE. Early life factors and their relevance for markers of cardiometabolic risk in early adulthood. Nutr Metab Cardiovasc Dis 2021; 31:2109-2121. [PMID: 34023180 DOI: 10.1016/j.numecd.2021.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/09/2021] [Accepted: 03/25/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Early life exposures could be pertinent risk factors of cardiometabolic diseases in adulthood. We assessed the prospective associations of early life factors with markers of cardiometabolic risk among healthy German adults. METHODS AND RESULTS We examined 348 term-born DONALD Study participants with measurement of fasting blood at the age of 18-24 years to assess metabolic indices: fatty liver index (FLI), hepatic steatosis index (HSI), pro-inflammatory score and insulin sensitivity (HOMA2-%S). Early life factors (maternal weight in early pregnancy, maternal early pregnancy BMI, gestational weight gain (GWG), maternal age, birth weight and full breastfeeding (>17 weeks)) were assessed at enrolment of the offspring into the study. Multivariable linear regression models were used to analyze associations between early life factors and markers of cardiometabolic risk in early adulthood with adjustment for potential confounders. A higher early pregnancy BMI was related to notably higher levels of offspring FLI, HSI, pro-inflammatory score and a lower HOMA2-%S (all p < 0.0001). Similarly, a higher gestational weight gain was associated with a higher FLI (p = 0.044), HSI (p = 0.016), pro-inflammatory score (p = 0.032) and a lower HOMA2-%S among females (p = 0.034). Full breastfeeding was associated with a lower adult FLI (p = 0.037). A casual mediation analysis showed that these associations were mediated by offspring adult waist circumference (WC). CONCLUSION This study suggests that early pregnancy BMI, gestational weight gain, and full breastfeeding are relevant for offspring markers of cardiometabolic risk which seems to be mediated by body composition in young adulthood.
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Affiliation(s)
- Juliana Nyasordzi
- Department of Sports and Health, Institute of Nutrition, Consumption and Health, Paderborn University, Germany; University of Health and Allied Sciences, Ho, Volta Region, Ghana.
| | - Johanna Conrad
- Institute of Nutritional and Food Sciences, Nutritional Epidemiology, University of Bonn, Bonn, Germany.
| | - Janina Goletzke
- Department of Sports and Health, Institute of Nutrition, Consumption and Health, Paderborn University, Germany.
| | - Helena Ludwig-Walz
- DONALD Study Dortmund, Department of Nutrition and Food Sciences (IEL), Nutritional Epidemiology, University of Bonn, Dortmund, Germany; Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, Germany.
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Pediatric Endocrinology and Diabetology, Laboratory for Translational Hormone Analytics, Peptide Hormone Research Unit, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Pediatric Endocrinology and Diabetology, Laboratory for Translational Hormone Analytics, Peptide Hormone Research Unit, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Stefan A Wudy
- Pediatric Endocrinology and Diabetology, Laboratory for Translational Hormone Analytics, Peptide Hormone Research Unit, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, Germany.
| | - Yifan Hua
- DONALD Study Dortmund, Department of Nutrition and Food Sciences (IEL), Nutritional Epidemiology, University of Bonn, Dortmund, Germany; Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, Germany.
| | - Thomas Remer
- DONALD Study Dortmund, Department of Nutrition and Food Sciences (IEL), Nutritional Epidemiology, University of Bonn, Dortmund, Germany; Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, Germany.
| | - Anette E Buyken
- Department of Sports and Health, Institute of Nutrition, Consumption and Health, Paderborn University, Germany.
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13
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Torres CHA, Schultz LF, Veugelers PJ, Mastroeni SSBS, Mastroeni MF. The effect of pre-pregnancy weight and gestational weight gain on blood pressure in children at 6 years of age. J Public Health (Oxf) 2021; 43:e161-e170. [PMID: 32323723 DOI: 10.1093/pubmed/fdaa044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We evaluated the effect of maternal gestational weight gain (GWG) and pre-pregnancy weight on blood pressure (BP) of children 6 years after delivery. METHODS Cross-sectional study that compared the anthropometric measurements of 181 mothers and their children's BP 6 years after delivery. The BP was measured by the auscultatory method. We used log-binomial regression to investigate the association of pre-pregnancy body mass index (BMI) and GWG categories with BP in mid-childhood. RESULTS The prevalence of elevated BP in children was 26.5%. Maternal pre-pregnancy overweight and concurrent excessive GWG were positively associated with elevated BP at 6 years of age. Mothers with pre-pregnancy overweight and excessive GWG were more likely to have children with elevated BP at 6 years of age (OR = 2.05; P = 0.018) compared to mothers who were of normal weight pre-pregnancy and experienced appropriate GWG. We also found that mothers with pre-pregnancy BMI ≥25 kg/m2 and concurrent excessive GWG were more likely to have children with elevated diastolic blood pressure (OR = 2.72; P = 0.005). CONCLUSIONS Pre-pregnancy overweight/obesity had impact on BP in mid-childhood. Interventions aimed at reducing cardiovascular diseases in children should promote weight loss in women of reproductive age rather than in pregnant women.
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Affiliation(s)
- Camila Honorato A Torres
- University Center Tiradentes, Maceió, Alagoas CEP 57.038-000, Brazil.,Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton T6G 2R3, Canada
| | - Lidiane F Schultz
- Post-graduate Program in Health and Environment, University of Joinville Region, Joinville, Santa Catarina CEP 89.219-710, Brazil
| | - Paul J Veugelers
- Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton T6G 2R3, Canada
| | - Silmara S B S Mastroeni
- Department of Health Sciences, University of Joinville Region, Joinville, Santa Catarina CEP 89.219-710, Brazil
| | - Marco F Mastroeni
- Post-graduate Program in Health and Environment, University of Joinville Region, Joinville, Santa Catarina CEP 89.219-710, Brazil.,Department of Health Sciences, University of Joinville Region, Joinville, Santa Catarina CEP 89.219-710, Brazil
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14
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Early-life nutrition and metabolic disorders in later life: a new perspective on energy metabolism. Chin Med J (Engl) 2021; 133:1961-1970. [PMID: 32826460 PMCID: PMC7462214 DOI: 10.1097/cm9.0000000000000976] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Type 2 diabetes mellitus and metabolic disorders have become an epidemic globally. However, the pathogenesis remains largely unclear and the prevention and treatment are still limited. In addition to environmental factors during adulthood, early life is the critical developmental window with high tissue plasticity, which might be modified by external environmental cues. Substantial evidence has demonstrated the vital role of early-life nutrition in programming the metabolic disorders in later life. In this review, we aim to overview the concepts of fetal programming and investigate the effects of early-life nutrition on energy metabolism in later life and the potential epigenetic mechanism. The related studies published on PubMed database up to March 2020 were included. The results showed that both maternal overnutrition and undernutrition increased the riskes of metabolic disorders in offspring and epigenetic modifications, including DNA methylation, miRNAs, and histone modification, might be the vital mediators. The beneficial effects of early-life lifestyle modifications as well as dietary and nutritional interventions on these deleterious metabolic remolding were initially observed. Overall, characterizing the early-life malnutrition that reshapes metabolic disease trajectories may yield novel targets for early prevention and intervention and provide a new point of view to the energy metabolism.
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15
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Wilkins E, Wickramasinghe K, Pullar J, Demaio AR, Roberts N, Perez-Blanco KM, Noonan K, Townsend N. Maternal nutrition and its intergenerational links to non-communicable disease metabolic risk factors: a systematic review and narrative synthesis. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2021; 40:20. [PMID: 33902746 PMCID: PMC8077952 DOI: 10.1186/s41043-021-00241-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 03/23/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Non-communicable diseases (NCDs) are the leading cause of death and disability globally, while malnutrition presents a major global burden. An increasing body of evidence suggests that poor maternal nutrition is related to the development of NCDs and their risk factors in adult offspring. However, there has been no systematic evaluation of this evidence. METHODS We searched eight electronic databases and reference lists for primary research published between 1 January 1996 and 31 May 2016 for studies presenting data on various dimensions of maternal nutritional status (including maternal exposure to famine, maternal gestational weight gain (GWG), maternal weight and/or body mass index (BMI), and maternal dietary intake) during pregnancy or lactation, and measures of at least one of three NCD metabolic risk factors (blood pressure, blood lipids and blood glucose) in the study population of offspring aged 18 years or over. Owing to high heterogeneity across exposures and outcomes, we employed a narrative approach for data synthesis (PROSPERO= CRD42016039244, CRD42016039247). RESULTS Twenty-seven studies from 10 countries with 62,607 participants in total met our inclusion criteria. The review revealed considerable heterogeneity in findings across studies. There was evidence of a link between maternal exposure to famine during pregnancy with adverse blood pressure, blood lipid, and glucose metabolism outcomes in adult offspring in some contexts, with some tentative support for an influence of adult offspring adiposity in this relationship. However, the evidence base for maternal BMI, GWG, and dietary intake of specific nutrients during pregnancy was more limited and revealed no consistent support for a link between these exposures and adult offspring NCD metabolic risk factors. CONCLUSION The links identified between maternal exposure to famine and offspring NCD risk factors in some contexts, and the tentative support for the role of adult offspring adiposity in influencing this relationship, suggest the need for increased collaboration between maternal nutrition and NCD sectors. However, in view of the current scant evidence base for other aspects of maternal nutrition, and the overall heterogeneity of findings, ongoing monitoring and evaluation using large prospective studies and linked data sets is a major priority.
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Affiliation(s)
- Elizabeth Wilkins
- Centre on Population Approaches for NCD Prevention, University of Oxford, Oxford, UK
| | | | - Jessie Pullar
- Centre on Population Approaches for NCD Prevention, University of Oxford, Oxford, UK
| | | | - Nia Roberts
- Health Library, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | - Nick Townsend
- Department for Health, University of Bath, Bath, BA2 7AY, UK.
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16
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Ferrey AE, Astbury NM, Kenworthy Y, Mackillop L, Frie K, Jebb SA. Exploring women's thoughts on self-weighing during pregnancy: results of the Self-Weighing in Pregnancy: Experiences (SWIPE) study. BMC Pregnancy Childbirth 2021; 21:154. [PMID: 33610166 PMCID: PMC7897370 DOI: 10.1186/s12884-021-03636-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/10/2021] [Indexed: 11/22/2022] Open
Abstract
Background Excess gestational weight gain is common and an important risk factor for adverse pregnancy outcomes. Regular weighing can be used to assess and manage weight gain, but NICE guidelines do not recommend routine weighing during antenatal care. Trials that have tested the effectiveness of self-weighing to manage GWG have been unsuccesful in engaging women in regular self-weighing, although the reasons for lack of engagement are not fully understood. This study aimed to understand why this lack of engagement occurred by exploring the naturally occurring thoughts and feelings of pregnant women (9 to 15 weeks gestational age) who were asked to weigh themselves at home. Methods Twenty-five women were recruited to take part. Participants completed short questionnaires at their first-trimester and 20-week scans. After recruitment, participants were asked to weigh themselves at roughly the same time each week for 8 weeks. Whilst they weighed themselves they were asked to audio-record their current weight and describe any thoughts or feelings that occurred as they weighed themselves. These audio recordings were then sent to researchers using a secure messaging service. Results Most of the recruited women (56%) were unaware of guidelines for gestational weight gain, and only 40% could identify the ideal rate of GWG for their BMI group. Thematic analysis of the think-aloud recordings resulted in three main themes: “understanding weight gain in pregnancy”, “taking action to prevent weight gain” and “reactions to self-weighing”. Overall, there was a relatively positive response to self-weighing and some participants used self-weighing to reflect on the reasons for weight gain and plan actions they could take to avoid excess gain. Negative emotional responses tended to be related to a lack of guidance about what level of weight gain or loss was “healthy”, or to other worries about the pregnancy. Of the women recruited who submitted at least one think aloud recording (n 10), 80% found self-weighing to be useful, and said they would likely continue to self-weigh at home. Conclusions Women had complex emotions about self-weighing during pregnancy but overall found it useful, suggesting it could be encouraged as part of self-regulatory interventions to control GWG. Clear guidelines about appropriate gestational weight gain could help to reduce anxiety. Trial registration The study was prospectively registered with ISRCTN ISRCTN10035244. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03636-5.
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Affiliation(s)
- Anne E Ferrey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK. .,NIHR Oxford Biomedical Research Centre, Oxford, UK.
| | - Nerys M Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Yvonne Kenworthy
- NIHR Oxford Biomedical Research Centre, Oxford, UK.,Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Lucy Mackillop
- NIHR Oxford Biomedical Research Centre, Oxford, UK.,Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kerstin Frie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
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17
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Maternal obesity: focus on offspring cardiometabolic outcomes. INTERNATIONAL JOURNAL OF OBESITY SUPPLEMENTS 2020; 10:27-34. [PMID: 32714510 DOI: 10.1038/s41367-020-0016-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Several human and animal studies have demonstrated that cardiometabolic parameters in infancy, childhood, adolescence and even adulthood are negatively influenced by many factors besides energy imbalance. Interestingly, maternal weight excess both before and during pregnancy seems to be a negative determinant of metabolic and cardiovascular outcomes in the offspring. This review includes both human and animal studies and finally highlights the link between maternal obesity and cardiometabolic disorders in offspring.
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18
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Eitmann S, Németh D, Hegyi P, Szakács Z, Garami A, Balaskó M, Solymár M, Erőss B, Kovács E, Pétervári E. Maternal overnutrition impairs offspring's insulin sensitivity: A systematic review and meta-analysis. MATERNAL AND CHILD NUTRITION 2020; 16:e13031. [PMID: 32567808 PMCID: PMC7503101 DOI: 10.1111/mcn.13031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 04/17/2020] [Accepted: 04/27/2020] [Indexed: 12/31/2022]
Abstract
This systematic review and meta‐analysis aimed to investigate the association between maternal overnutrition and offspring's insulin sensitivity—following the Preferred Reporting Items for Systematic Reviews and Meta‐analyses statement. Studies published in English before April 22, 2019, were identified through searches of four medical databases. After selection, 15 studies aiming to explore the association between prepregnancy body mass index (ppBMI) or gestational weight gain (GWG) of non‐diabetic mothers and their offspring's insulin sensitivity (fasting insulin or glucose level and Homeostatic Measurement Assessment for Insulin Resistance [HOMA‐IR]) were included in the meta‐analysis. Associations of ppBMI and GWG with offspring's insulin sensitivity were analysed by pooling regression coefficients or standardized differences in means with 95% confidence intervals (CIs). Maternal ppBMI showed significant positive correlations with the level of both fasting insulin and HOMA‐IR in offspring (standardized regression coefficient for fasting insulin: 0.107, CI [0.053, 0.160], p < 0.001 and that for HOMA‐IR: 0.063, CI [0.006, 0.121], p = 0.031). However, the result of the analysis on coefficients adjusted for offspring's actual anthropometry (BMI and adiposity) was not significant. Independent from ppBMI, GWG tended to show a positive correlation with insulin level, but not after adjustment for offspring's anthropometry. Offspring of mothers with excessive GWG showed significantly higher HOMA‐IR than those of mothers with optimal GWG (p = 0.004). Our results demonstrate that both higher ppBMI and GWG increase the risk of offspring's insulin resistance, but the effect of ppBMI on insulin sensitivity in offspring may develop as consequence of their adiposity.
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Affiliation(s)
- Szimonetta Eitmann
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Dávid Németh
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zsolt Szakács
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - András Garami
- Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Márta Balaskó
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Margit Solymár
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Enikő Kovács
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Erika Pétervári
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
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Vargas-Aguirre P, Tene CE, Del Toro-Equihua M, Bayardo-Tortolero R, Sánchez-Meza K. Comparison of leptin levels in neonates born to mothers with high or low gestational weight gain. J Pediatr Endocrinol Metab 2020; 33:517-523. [PMID: 32126014 DOI: 10.1515/jpem-2019-0356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/20/2020] [Indexed: 12/15/2022]
Abstract
Background Gestational weight gain (GWG) influences both fetal and maternal health. Leptin is a biomarker that may predict the early development of obesity and greater weight gain in childhood. Newborns with higher neonatal weight have been found to have higher leptin levels in umbilical cord blood (UCB). There are few studies that evaluate leptin levels in UCB according to GWG in women with a normal body mass index (BMI). The aim of the present study was to determine whether the levels of leptin in UCB in neonates born to mothers with a high GWG were higher, compared with levels in newborns whose mothers had a low GWG. Methods A cross-sectional analytic study was conducted on 65 primigravidas. They were under 30 years of age, had normal pregestational BMIs, no associated diseases and were classified as having high (n = 22) or low (n = 43) GWG. The neonatal UCB leptin levels were measured and both neonatal and maternal anthropometric evaluations were carried out. The quantitative variables were compared through the Mann-Whitney U test and Student's t test, as appropriate. Results UCB leptin levels were higher in the neonates whose mothers were in the high GWG group, compared with those born to mothers in the low GWG group (7.0 [1.9-11.4] vs. 2.9 [1.2-6.7] ng/mL, p = 0.020). When stratified by sex, that difference was maintained only in male neonates. Conclusions UCB leptin levels were higher in neonates born to mothers with a high GWG, compared with those in newborns whose mothers had a low GWG.
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Affiliation(s)
| | - Carlos E Tene
- Universidad de Colima, Faculty of Medicine, Colima, Col., Mexico
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20
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Philips EM, Santos S, Steegers EAP, Asimakopoulos AG, Kannan K, Trasande L, Jaddoe VWV. Maternal bisphenol and phthalate urine concentrations and weight gain during pregnancy. ENVIRONMENT INTERNATIONAL 2020; 135:105342. [PMID: 31864031 PMCID: PMC8336629 DOI: 10.1016/j.envint.2019.105342] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 05/03/2023]
Abstract
BACKGROUND Insufficient or excessive gestational weight gain are associated with increased risks of adverse birth and childhood outcomes. Increasing evidence suggests that exposure to bisphenols and phthalates may disrupt hormonal pathways and thereby influence gestational weight gain. OBJECTIVE To examine the associations of early and mid-pregnancy bisphenol and phthalate urine concentrations with gestational weight gain. METHODS In a population-based prospective cohort study among 1,213 pregnant women, we measured early and mid-pregnancy bisphenol and phthalate urine concentrations. Maternal anthropometrics before pregnancy were obtained by questionnaire and repeatedly measured at our research center during pregnancy. We used linear and logistic regressions to evaluate the associations of bisphenols and phthalates with total and period-specific gestational weight gain. RESULTS Higher maternal total bisphenols and bisphenol S were associated with a lower total gestational weight gain at nominal level. Stratification by body mass index group showed that higher total bisphenols and bisphenol S were associated with lower total gestational weight gain specifically in normal weight women (respectively -509 g [95% CI -819, -198] and -398 g [95% CI -627, -169]). Each log unit increase in early pregnancy total bisphenol and bisphenol A urine concentrations were associated with lower mid- to late pregnancy gestational weight gain in the whole group (effect estimates -218 g/log unit increase [95% CI -334, -102] and -132 g/log unit increase [95% CI -231, -34], respectively). These associations were independent of mid-pregnancy compounds. Mid-pregnancy bisphenols and phthalates concentrations were not associated with gestational weight gain. DISCUSSION Higher maternal bisphenol urine concentrations in early pregnancy may lead to reduced gestational weight in second half of pregnancy. Further research is needed to assess the effects of maternal bisphenols and phthalates urine concentrations on placental and fetal growth and development.
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Affiliation(s)
- Elise M Philips
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Susana Santos
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics & Gynaecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Alexandros G Asimakopoulos
- Wadsworth Center, New York State Department of Health, and Department of Environmental Health Sciences, School of Public Health, State University of New York at Albany, Albany NY12201, United States; Department of Chemistry, the Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - Kurunthachalam Kannan
- Wadsworth Center, New York State Department of Health, and Department of Environmental Health Sciences, School of Public Health, State University of New York at Albany, Albany NY12201, United States; Biochemistry Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Leonardo Trasande
- Department of Pediatrics, New York University School of Medicine, New York City, New York, United States; Department of Environmental Medicine, New York University School of Medicine, New York City, New York, United States; Department of Population Health, New York University School of Medicine, New York City, New York, United States; New York Wagner School of Public Service, New York City, New York, United States; New York University Global Institute of Public Health, New York City, New York, United States
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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Gestational Exercise and Maternal and Child Health: Effects until Delivery and at Post-Natal Follow-up. J Clin Med 2020; 9:jcm9020379. [PMID: 32023833 PMCID: PMC7074577 DOI: 10.3390/jcm9020379] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/10/2020] [Accepted: 01/27/2020] [Indexed: 01/27/2023] Open
Abstract
We studied the influence of pregnancy exercise on maternal/offspring cardiometabolic health until delivery and at follow-up. We pooled data from two randomized controlled trials from our group that were performed following the same methodology (one unpublished). We also collected follow-up data de novo from the participants of both trials and their offspring. In total, 1348 women with uncomplicated, singleton gestations were assigned to an intervention (n = 688, performing a supervised, moderate-intensity exercise program (three sessions/week)) or control group (n = 660). Maternal outcomes were excessive gestational weight gain (EGWG), gestational hypertension/diabetes and, at follow-up, return to pre-pregnancy weight within six months, hypertension, overweight/obesity, and other cardiometabolic conditions. Offspring outcomes were macrosomia and low-birthweight and, at follow-up, overweight/obesity, low-weight, and cardiometabolic conditions. Adherence to the intervention, which proved safe, was > 95%. Pregnancy exercise reduced the risk of EGWG, gestational hypertension, and diabetes (adjusted odds ratio (OR) and 95% confidence interval: 0.60 (0.46–0.79), 0.39 (0.23–0.67), and 0.48 (0.28–0.84)), and it was associated with a greater likelihood of returning to pre-pregnancy weight (2.37 (1.26–4.54)) and a lower risk of maternal cardiometabolic conditions (0.27 (0.08–0.95)) at the end of follow-up (median 6.1 years (interquartile range 1.8)). Pregnancy exercise also reduced the risk of macrosomia (0.36 (0.20–0.63)) and of childhood overweight/obesity during the first year (0.20 (0.06–0.63)). Our findings suggest that pregnancy exercise might protect maternal/offspring health.
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22
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Bouvier D, Forest JC, Dion-Buteau E, Bernard N, Bujold E, Pereira B, Giguère Y. Association of Maternal Weight and Gestational Weight Gain with Maternal and Neonate Outcomes: A Prospective Cohort Study. J Clin Med 2019; 8:jcm8122074. [PMID: 31783582 PMCID: PMC6947389 DOI: 10.3390/jcm8122074] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/18/2019] [Accepted: 11/25/2019] [Indexed: 12/11/2022] Open
Abstract
We investigated the association of outcomes with pre-pregnancy body mass index (ppBMI), Institute of Medicine (IOM) recommendations about gestational weight gain, and weight gain trajectories during pregnancy. A prospective cohort of 7866 pregnant women was recruited. ppBMI and weight gain at each follow up visit were collected. The outcomes were gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), caesarean delivery, macrosomia, small (SGA) and large (LGA) for gestational age, neonatal hypoglycemia. Group-based multi-trajectory modelling was used for weight kinetics during pregnancy. In the third trimester, 53.8% of women were above IOM recommendations, with an increased relative risk (RR) of HDP (1.91 (1.40-2.61)), caesarean (1.34 (1.15-1.56)), macrosomia (2.17 (1.77-2.67)), LGA (2.26 (1.83-2.80)), and hypoglycemia (1.89 (1.12-3.18)). Women with a weight gain above IOM recommendations in the second trimester who normalized their weight gain in third trimester had, compared to those who remained above IOM recommendations, fewer events of HDP (2.8% versus 5.3%, p = 0.008), caesarean delivery (16.9% versus 22%, p = 0.006), macrosomia (8.3% versus 14.2%, p < 0.001), and LGA (7% versus 13.2%, p < 0.001). Multi-trajectory modelling identified three profiles with continued variation in RR of complications, including GDM. Weight gain above IOM recommendations increased the risk of perinatal complications. A correction of excessive weight gain in the second trimester reduces these risks.
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Affiliation(s)
- Damien Bouvier
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Université Clermont-Auvergne, Faculty of Medicine, CNRS 6293, INSERM 1103, GReD, 63000 Clermont-Ferrand, France;
- Centre de Recherche du CHU de Québec-Université Laval, Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Québec City, G1V 0A6, Canada;
| | - Jean-Claude Forest
- Centre de Recherche du CHU de Québec-Université Laval, Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Québec City, G1V 0A6, Canada;
| | - Emilie Dion-Buteau
- Centre de Recherche du CHU de Québec-Université Laval, Québec City, G1L 3L5, Canada; (E.D.-B.); (N.B.)
| | - Nathalie Bernard
- Centre de Recherche du CHU de Québec-Université Laval, Québec City, G1L 3L5, Canada; (E.D.-B.); (N.B.)
| | - Emmanuel Bujold
- Department of Obstetrics, Gynecology and Reproduction, Faculty of Medicine, Université Laval, Québec City, G1V 0A6, Canada;
| | - Bruno Pereira
- Biostatistics Unit (DRCI), CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Yves Giguère
- Centre de Recherche du CHU de Québec-Université Laval, Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Québec City, G1V 0A6, Canada;
- Correspondence: ; Tel.: +1-418-525-4444
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Stevens DR, Taylor SN, Roberts JR, Neelon B, Newman RB, Vena JE, Hunt KJ. Breastfeeding Initiation as Related to the Interaction of Race/Ethnicity and Maternal Diabetes. Breastfeed Med 2019; 14:630-639. [PMID: 31364862 PMCID: PMC6857546 DOI: 10.1089/bfm.2019.0065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Introduction: The health benefits of breastfeeding for both the mother and her offspring are well established, and breastfeeding may be especially important for mitigating negative health effects of pregnancy complicated by diabetes. Objective: This study sought to examine the association between race/ethnicity, maternal diabetes, and breastfeeding initiation in South Carolina (SC). Materials and Methods: Our study population is comprised of all live, singleton, full-term births in SC delivered January 2004 to December 2016 (292,468 non-Hispanic Whites, 173,158 non-Hispanic Blacks, and 52,174 Hispanics). Generalized estimating equations and an interaction term between race/ethnicity and maternal diabetes status were used to estimate the race/ethnic-specific odds ratio (OR) and 95% confidence intervals (CIs) that a mother with diabetes versus without diabetes initiated breastfeeding. Models were adjusted for maternal and infant sociodemographics (Model 1), additionally for clinical variables and birth outcomes (Model 2), and also for maternal prepregnancy body mass index (BMI) (Model 3). Results: We found statistically significant differences in breastfeeding initiation by race/ethnicity and diabetes status in Model 1. These associations were attenuated and lost significance upon additional adjustment. Non-Hispanic Black mothers with gestational diabetes were significantly more likely to initiate breastfeeding than nondiabetic non-Hispanic Black mothers, even after adjustment for prepregnancy BMI (OR: 1.07 [95% CI 1.02-1.12]). Conclusion: This large, population-based study of all live, singleton, full-term births in SC improves our understanding of how race/ethnicity and maternal metabolic disorders impact breastfeeding initiation, and may inform future hospital-based breastfeeding interventions in populations with the most need.
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Affiliation(s)
- Danielle R. Stevens
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Sarah N. Taylor
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - James R. Roberts
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Roger B. Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
| | - John E. Vena
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Kelly J. Hunt
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
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24
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Tam CHT, Ma RCW, Yuen LY, Ozaki R, Li AM, Hou Y, Chan MHM, Ho CS, Yang X, Chan JCN, Tam WH. The impact of maternal gestational weight gain on cardiometabolic risk factors in children. Diabetologia 2018; 61:2539-2548. [PMID: 30225524 PMCID: PMC6223878 DOI: 10.1007/s00125-018-4724-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/30/2018] [Indexed: 12/24/2022]
Abstract
AIMS/HYPOTHESIS Accumulating evidence suggests an impact of gestational weight gain (GWG) on pregnancy outcomes; however, data on cardiometabolic risk factors later in life have not been comprehensively studied. This study aimed to evaluate the relationship between GWG and cardiometabolic risk in offspring aged 7 years. METHODS We included a total of 905 mother-child pairs who enrolled in the follow-up visit of the multicentre Hyperglycemia and Adverse Pregnancy Outcome study, at the Hong Kong Centre. Women were classified as having gained weight below, within or exceeding the 2009 Institute of Medicine (IOM) guidelines. A standardised GWG according to pre-pregnancy BMI categories was calculated to explore for any quadratic relationship. RESULTS Independent of pre-pregnancy BMI, gestational hyperglycaemia and other confounders, women who gained more weight than the IOM recommendations had offspring with a larger body size and increased odds of adiposity, hypertension and insulin resistance (range of p values of all the traits: 4.6 × 10-9 < p < 0.0390) than women who were within the recommended range of weight gain during pregnancy. Meanwhile, women who gained less weight than outlined in the recommendations had offspring with increased risks of hypertension and insulin resistance, compared with those who gained weight within the recommended range (7.9 × 10-3 < p < 0.0477). Quadratic relationships for diastolic blood pressure, AUC for insulin, pancreatic beta cell function and insulin sensitivity index were confirmed in the analysis of standardised GWG (1.4 × 10-3 < pquadratic < 0.0282). Further adjustment for current BMI noticeably attenuated the observed associations. CONCLUSIONS/INTERPRETATION Both excessive and inadequate GWG have independent and significant impacts on childhood adiposity, hypertension and insulin resistance. Our findings support the notion that adverse intrauterine exposures are associated with persistent cardiometabolic risk in the offspring.
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Affiliation(s)
- Claudia H T Tam
- 9/F, Lui Che Woo Clinical Science Building, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong Special Administrative Region, Hong Kong
| | - Ronald C W Ma
- 9/F, Lui Che Woo Clinical Science Building, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong Special Administrative Region, Hong Kong.
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, Hong Kong.
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, Hong Kong.
| | - Lai Yuk Yuen
- 1/F, Special Block (Block E), Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong Special Administrative Region, Hong Kong
| | - Risa Ozaki
- 9/F, Lui Che Woo Clinical Science Building, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong Special Administrative Region, Hong Kong
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, Hong Kong
| | - Albert Martin Li
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, Hong Kong
| | - Yong Hou
- 9/F, Lui Che Woo Clinical Science Building, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong Special Administrative Region, Hong Kong
| | - Michael H M Chan
- Department of Chemical Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, Hong Kong
| | - Chung Shun Ho
- Department of Chemical Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, Hong Kong
| | - Xilin Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Juliana C N Chan
- 9/F, Lui Che Woo Clinical Science Building, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong Special Administrative Region, Hong Kong
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, Hong Kong
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, Hong Kong
| | - Wing Hung Tam
- 1/F, Special Block (Block E), Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong Special Administrative Region, Hong Kong.
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25
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Zheng Z, Bennett WL, Mueller NT, Appel LJ, Wang X. Gestational Weight Gain and Pregnancy Complications in a High-Risk, Racially and Ethnically Diverse Population. J Womens Health (Larchmt) 2018; 28:375-383. [PMID: 29920144 DOI: 10.1089/jwh.2017.6574] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Evidence used to guide the current Institute of Medicine (IOM) gestational weight gain (GWG) recommendations is largely derived from studies of European descent, and as such the guidelines are the same for all races and ethnicities. The guidelines are also the same for prepregnancy obesity classes I through III. OBJECTIVE Considering these literature gaps, we aim to (1) determine the association between the IOM GWG guidelines and three common pregnancy complications: preeclampsia, gestational diabetes mellitus, and cesarean delivery in a racially and ethnically diverse population; and (2) assess whether the association between GWG and pregnancy complications differs by race/ethnicity or prepregnancy body mass index (BMI) categories, particularly obesity classes I through III. METHODS To address these aims, we analyzed data from the Boston Birth Cohort. We calculated GWG using data from electronic medical records or, when missing, from a postdelivery questionnaire. We examined GWG continuously and categorically using the IOM formula. RESULTS Of the 5,568 women included, 54.5% met the IOM criterion for excessive GWG. Compared to women who had adequate GWG, women who gained excessive weight had 1.65 (95% confidence interval [CI] 1.27-2.14) times greater odds of preeclampsia; 1.68 (95% CI 1.15-2.46) times greater odds of gestational diabetes; and no significant change in odds of cesarean delivery (odds ratio [OR] = 1.14, 95% CI 0.99-1.31). Associations did not differ by race, ethnicity, or prepregnancy BMI categories including comparisons of obesity class I versus II or III (all p-values for interaction >0.05). CONCLUSIONS In this racially and ethnically diverse population, excessive GWG was associated with higher odds of preeclampsia, gestational diabetes, and nonsignificantly, with cesarean delivery. Associations did not differ appreciably by race, ethnicity, or prepregnancy BMI categories. Our results support the relevance of the IOM GWG recommendations in racially and ethnically diverse populations, and in women in the higher prepregnancy obesity classes.
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Affiliation(s)
- Zihe Zheng
- 1 Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Wendy L Bennett
- 2 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.,3 Division of General Internal Medicine, Department of Medicine, Johns Hopkins University , Baltimore, Maryland.,4 Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease , Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Noel T Mueller
- 2 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - Lawrence J Appel
- 2 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.,3 Division of General Internal Medicine, Department of Medicine, Johns Hopkins University , Baltimore, Maryland
| | - Xiaobin Wang
- 4 Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease , Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,5 Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine , Baltimore, Maryland
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26
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De Jong KA, Barrand S, Wood-Bradley RJ, de Almeida DL, Czeczor JK, Lopaschuk GD, Armitage JA, McGee SL. Maternal high fat diet induces early cardiac hypertrophy and alters cardiac metabolism in Sprague Dawley rat offspring. Nutr Metab Cardiovasc Dis 2018; 28:600-609. [PMID: 29691147 DOI: 10.1016/j.numecd.2018.02.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/03/2018] [Accepted: 02/27/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIM Maternal high fat diets (mHFD) have been associated with an increased offspring cardiovascular risk. Recently we found that the class IIa HDAC-MEF2 pathway regulates gene programs controlling fatty acid oxidation in striated muscle. This same pathway controls hypertrophic responses in the heart. We hypothesized that mHFD is associated with activation of signal controlling class II a HDAC activity and activation of genes involved in fatty acid oxidation and cardiac hypertrophy in offspring. METHODS AND RESULTS Female Sprague Dawley rats were fed either normal fat diet (12%) or high fat diet (43%) three weeks prior to mating, remaining on diets until study completion. Hearts of postnatal day 1 (PN1) and PN10 pups were collected. Bioenergetics and respiration analyses were performed in neonatal ventricular cardiomyocytes (NVCM). In offspring exposed to mHFD, body weight was increased at PN10 accompanied by increased body fat percentage and blood glucose. Heart weight and heart weight to body weight ratio were increased at PN1 and PN10, and were associated with elevated signalling through the AMPK-class IIa HDAC-MEF2 axis. The expression of the MEF2-regulated hypertrophic markers ANP and BNP were increased as were expression of genes involved in fatty acid oxidation. However this was only accompanied by an increased protein expression of fatty acid oxidation enzymes at PN10. NVCM isolated from these pups exhibited increased glycolysis and an impaired substrate flexibility. CONCLUSION Combined, these results suggest that mHFD induces signalling and transcriptional events indicative of reprogrammed cardiac metabolism and of cardiac hypertrophy in Sprague Dawley rat offspring.
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Affiliation(s)
- K A De Jong
- Metabolic Reprogramming Laboratory, Metabolic Research Unit, School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia.
| | - S Barrand
- Faculty of Health, School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia.
| | - R J Wood-Bradley
- Faculty of Health, School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia.
| | - D L de Almeida
- Faculty of Health, School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia.
| | - J K Czeczor
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich-Heine University, c/o Auf'm Hennekamp 65, 40225, Düsseldorf, Germany; German Center of Diabetes Research, Ingolstädter Landstraße 1, 85764, München-Neuherberg, Germany.
| | - G D Lopaschuk
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada; Alberta Diabetes Institute, University of Alberta, Edmonton, Canada.
| | - J A Armitage
- Faculty of Health, School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia.
| | - S L McGee
- Metabolic Reprogramming Laboratory, Metabolic Research Unit, School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia.
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27
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Wasenius NS, Grattan KP, Harvey ALJ, Barrowman N, Goldfield GS, Adamo KB. Maternal gestational weight gain and objectively measured physical activity among offspring. PLoS One 2017; 12:e0180249. [PMID: 28662129 PMCID: PMC5491154 DOI: 10.1371/journal.pone.0180249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/12/2017] [Indexed: 12/21/2022] Open
Abstract
Objective Animal studies have suggested that maternal weight-related factors during pregnancy can program offspring physical activity in a sex-dependent manner. However, there is limited evidence in humans. The purpose of this study was to investigate the association between maternal gestational weight gain (GWG) and offspring total physical activity (TPA) level and to determine whether these associations are moderated by sex of offspring or maternal pre-pregnancy weight status. Method We studied 56 boys (mean age = 3.7 years, standard deviation (SD) 0.5) and 57 girls (mean age = 3.5±0.5 years) enrolled in licensed childcare centers. TPA was objectively measured using Actical® accelerometers. Information on pre-pregnancy body mass index (BMI), GWG, and other maternal factors were collected with a maternal health questionnaire. Associations between GWG, as a continuous variable or categorically (inadequate, adequate, and excessive), and offspring TPA were analysed using linear mixed models to take into account the intraclass correlation between the clusters (childcare centers). Models were adjusted for gestational age, accelerometer weartime, socioeconomic status, and pre-pregnancy BMI status. Results We found a significant sex interaction (P-value = 0.009). In boys, greater GWG was associated with decreased offspring TPA (β = -3.2 counts⋅1000−1/d, 95% confidence intervals (CI) = -6.4–0.02, P-value = 0.049). In girls born to mothers categorized as overweight or obese, the association between the GWG and TPA followed an inverted U-shape curve (β for GWG squared = -0.1 counts⋅1000−1/d, 95% CI = (-0.2 –-0.04), P-value = 0.005). In contrast, a U-shaped curve was found in girls born to mothers classified as lean (pre-pregnancy BMI<25 kg/m2) (β for GWG squared = 0.7 counts⋅1000−1/d, 95% CI = 0.2–1.2, P-value = 0.011). In boys, TPA in offspring was higher among women with inadequate GWG compared to adequate GWG (P-value = 0.0137), whereas no significant differences were found in girls (P-value = 0.107). Conclusion Maternal GWG can be an important biological marker of offspring TPA. These findings support the sex-dependent early developmental programming influence of GWG on TPA.
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Affiliation(s)
- Niko S. Wasenius
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada
- Folkhalsan Research Center, Helsinki, Finland
| | - Kimberly P. Grattan
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Alysha L. J. Harvey
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Nick Barrowman
- Clinical Research Unit, Children’s Hospital of Eastern Ontario Research Institute (CHEO RI), Ottawa, Canada
| | - Gary S. Goldfield
- Healthy Active Living and Obesity (HALO) Research Group, Ottawa, Canada
| | - Kristi B. Adamo
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada
- Healthy Active Living and Obesity (HALO) Research Group, Ottawa, Canada
- * E-mail:
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28
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Tabet M, Harper LM, Flick LH, Chang JJ. Gestational Weight Gain in the First Two Pregnancies and Perinatal Outcomes in the Second Pregnancy. Paediatr Perinat Epidemiol 2017; 31:304-313. [PMID: 28543169 DOI: 10.1111/ppe.12364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gestational Weight Gain (GWG) below or above the Institute of Medicine (IOM) recommendations increases the risk of adverse pregnancy outcomes. However, it remains unknown whether the risk of adverse outcomes is affected by GWG in a previous pregnancy. We examined associations between GWG in the index (second) pregnancy and pregnancy outcomes, including preterm delivery and small for gestational age (SGA), while taking into consideration GWG in the first pregnancy. METHODS In a population-based cohort study (n = 210 564), using the Missouri maternally-linked birth registry (1989-2005), we used multivariable Poisson regression with robust error variance stratified by prepregnancy body mass index (BMI) to evaluate associations between GWG in the index pregnancy and a composite indicator of GWG in the first and second pregnancies and our outcomes of interest, after controlling for sociodemographic and pregnancy-related confounders. RESULTS Associations between GWG in the index pregnancy and pregnancy outcomes were moderated by GWG in the first pregnancy. Despite having GWG within recommendations in the index pregnancy, women had increased risk of preterm delivery and SGA if they had suboptimal GWG in their first pregnancy. Also, women having suboptimal GWG in the index pregnancy had increased risk of preterm delivery only if their GWG in the first pregnancy was also suboptimal. CONCLUSIONS The observation that women who have GWG within recommendations in a current pregnancy may still have increased risk of adverse outcomes if they had suboptimal GWG in the first pregnancy has considerable clinical and public health implications.
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Affiliation(s)
- Maya Tabet
- Department of Epidemiology, Saint Louis University College for Public Health and Social Justice, Saint Louis, MO
| | - Lorie M Harper
- Department of Obstetrics and Gynecology, Washington University in Saint Louis, Saint Louis, MO
| | - Louise H Flick
- Department of Epidemiology, Saint Louis University College for Public Health and Social Justice, Saint Louis, MO
| | - Jen Jen Chang
- Department of Epidemiology, Saint Louis University College for Public Health and Social Justice, Saint Louis, MO
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Goldstein RF, Abell SK, Ranasinha S, Misso M, Boyle JA, Black MH, Li N, Hu G, Corrado F, Rode L, Kim YJ, Haugen M, Song WO, Kim MH, Bogaerts A, Devlieger R, Chung JH, Teede HJ. Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis. JAMA 2017; 317:2207-2225. [PMID: 28586887 PMCID: PMC5815056 DOI: 10.1001/jama.2017.3635] [Citation(s) in RCA: 998] [Impact Index Per Article: 142.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Body mass index (BMI) and gestational weight gain are increasing globally. In 2009, the Institute of Medicine (IOM) provided specific recommendations regarding the ideal gestational weight gain. However, the association between gestational weight gain consistent with theIOM guidelines and pregnancy outcomes is unclear. OBJECTIVE To perform a systematic review, meta-analysis, and metaregression to evaluate associations between gestational weight gain above or below the IOM guidelines (gain of 12.5-18 kg for underweight women [BMI <18.5]; 11.5-16 kg for normal-weight women [BMI 18.5-24.9]; 7-11 kg for overweight women [BMI 25-29.9]; and 5-9 kg for obese women [BMI ≥30]) and maternal and infant outcomes. DATA SOURCES AND STUDY SELECTION Search of EMBASE, Evidence-Based Medicine Reviews, MEDLINE, and MEDLINE In-Process between January 1, 1999, and February 7, 2017, for observational studies stratified by prepregnancy BMI category and total gestational weight gain. DATA EXTRACTION AND SYNTHESIS Data were extracted by 2 independent reviewers. Odds ratios (ORs) and absolute risk differences (ARDs) per live birth were calculated using a random-effects model based on a subset of studies with available data. MAIN OUTCOMES AND MEASURES Primary outcomes were small for gestational age (SGA), preterm birth, and large for gestational age (LGA). Secondary outcomes were macrosomia, cesarean delivery, and gestational diabetes mellitus. RESULTS Of 5354 identified studies, 23 (n = 1 309 136 women) met inclusion criteria. Gestational weight gain was below or above guidelines in 23% and 47% of pregnancies, respectively. Gestational weight gain below the recommendations was associated with higher risk of SGA (OR, 1.53 [95% CI, 1.44-1.64]; ARD, 5% [95% CI, 4%-6%]) and preterm birth (OR, 1.70 [1.32-2.20]; ARD, 5% [3%-8%]) and lower risk of LGA (OR, 0.59 [0.55-0.64]; ARD, -2% [-10% to -6%]) and macrosomia (OR, 0.60 [0.52-0.68]; ARD, -2% [-3% to -1%]); cesarean delivery showed no significant difference (OR, 0.98 [0.96-1.02]; ARD, 0% [-2% to 1%]). Gestational weight gain above the recommendations was associated with lower risk of SGA (OR, 0.66 [0.63-0.69]; ARD, -3%; [-4% to -2%]) and preterm birth (OR, 0.77 [0.69-0.86]; ARD, -2% [-2% to -1%]) and higher risk of LGA (OR, 1.85 [1.76-1.95]; ARD, 4% [2%-5%]), macrosomia (OR, 1.95 [1.79-2.11]; ARD, 6% [4%-9%]), and cesarean delivery (OR, 1.30 [1.25-1.35]; ARD, 4% [3%-6%]). Gestational diabetes mellitus could not be evaluated because of the nature of available data. CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis of more than 1 million pregnant women, 47% had gestational weight gain greater than IOM recommendations and 23% had gestational weight gain less than IOM recommendations. Gestational weight gain greater than or less than guideline recommendations, compared with weight gain within recommended levels, was associated with higher risk of adverse maternal and infant outcomes.
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Affiliation(s)
- Rebecca F. Goldstein
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
- Monash Diabetes and Endocrine Units, Monash Health, Victoria, Australia
| | - Sally K. Abell
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
- Monash Diabetes and Endocrine Units, Monash Health, Victoria, Australia
| | - Sanjeeva Ranasinha
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
| | - Marie Misso
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
| | - Jacqueline A. Boyle
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
| | - Mary Helen Black
- Kaiser Permanente, Southern California, Los Angeles
- Ambry Genetics, Aliso Viejo, California
| | - Nan Li
- Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | | | - Line Rode
- Department of Biochemistry, Copenhagen University Hospital, Righospitalet, Copenhagen, Denmark
| | - Young Ju Kim
- Department of Obstetrics and Gynecology, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | | | | | - Min Hyoung Kim
- Dankook University College of Medicine, Seoul, Republic of Korea
| | - Annick Bogaerts
- Department of Development and Regeneration KU Leuven, University of Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium
- Faculty of Health and Social Work, Research Unit Healthy Living, UC Leuven-Limburg, Leuven, Belgium
| | - Roland Devlieger
- Department of Obstetrics and Gynaecology, University Hospitals KU Leuven, Leuven, Belgium
- Department of Obstetrics, Gynaecology and Fertility, GZA Campus Sint-Augustinus, Wilrijk, Belgium
| | | | - Helena J. Teede
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
- Monash Diabetes and Endocrine Units, Monash Health, Victoria, Australia
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Tabet M, Nelson E, Schootman M, Chien LC, Chang JJ. Geographic variability in gestational weight gain: a multilevel population-based study of women having term births in Florida (2005-2012). Ann Epidemiol 2017. [PMID: 28623074 DOI: 10.1016/j.annepidem.2017.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE We examined the extent of geographic variability in gestational weight gain (GWG), identified areas where women have suboptimal GWG, and evaluated whether individual- and area-level factors account for such variability. METHODS We conducted a population-based cohort study including 1,385,574 women delivering term, singleton, and live births in Florida. We used a Bayesian, structured additive regression with a spatial function to analyze data from Florida's birth certificates (2005-2012) and ZIP code tabulation areas (ZCTAs; 2010 Census). RESULTS The prevalence of insufficient (7.7%-42.9%) and excessive (17.1%-82.4%) GWG varied widely within Florida. Geographic variability was not explained by risk factors under study. Clusters in Orlando, Tampa, and Miami exhibited increased likelihood of insufficient GWG, whereas clusters in the Northwest of Florida exhibited increased likelihood of excessive GWG. CONCLUSIONS We identified areas in Florida with high likelihood of suboptimal GWG that policy-makers should prioritize in the implementation of programs for optimizing GWG.
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Affiliation(s)
- Maya Tabet
- Department of Epidemiology, Saint Louis University College for Public Health and Social Justice, St. Louis, MO.
| | - Erik Nelson
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health - Bloomington, Bloomington, IN
| | - Mario Schootman
- Department of Epidemiology, Saint Louis University College for Public Health and Social Justice, St. Louis, MO
| | - Lung-Chang Chien
- Department of Environmental and Occupational Health, University of Nevada, Las Vegas, School of Community Health Sciences, Las Vegas
| | - Jen Jen Chang
- Department of Epidemiology, Saint Louis University College for Public Health and Social Justice, St. Louis, MO
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Rifas-Shiman SL, Fleisch A, Hivert MF, Mantzoros C, Gillman MW, Oken E. First and second trimester gestational weight gains are most strongly associated with cord blood levels of hormones at delivery important for glycemic control and somatic growth. Metabolism 2017; 69:112-119. [PMID: 28285640 PMCID: PMC5354298 DOI: 10.1016/j.metabol.2017.01.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Excessive gestational weight gain (GWG) during pregnancy is associated with adverse outcomes for mothers and offspring. Early, mid, and late pregnancy GWGs have different associations with fetal growth and later life adiposity, but associations with cord blood hormones, which might predict later health, are not well studied. METHODS In 978 pregnant women from the pre-birth Project Viva cohort, we calculated trimester-specific GWG using clinically recorded prenatal weights. Outcomes were levels of umbilical cord blood hormones related to fetal and postnatal growth. We used linear regression models adjusted for maternal race/ethnicity, pre-pregnancy BMI, parity, education, pregnancy smoking status and child sex; 2nd and 3rd trimester models were additionally adjusted for GWG in prior trimesters. RESULTS Mean±SD pre-pregnancy BMI was 24.9±5.5kg/m2, 30% were non-white, and 63% were college graduates. Mean±SD cord blood hormone levels were insulin-like growth factor [IGF]-1 (56.4±24.3ng/mL), IGF-2 (408.5±92.7ng/mL), IGFBP-3 (1084±318ng/mL), insulin (6.5±7.2 uU/mL), C-peptide (1.0±0.6ng/mL), leptin (9.0±6.6ng/mL) and adiponectin (28.7±6.8μg/mL). Mean±SD 1st, 2nd and 3rd trimester GWG rates were 0.22±0.22, 0.49±0.19 and 0.46±0.22kg/wk. Greater 1st trimester GWG (per 0.2kg/wk) was associated with higher insulin (0.5 uU/mL; 95% CI 0.1, 0.9) and C-peptide (0.06ng/mL; 95% CI 0.02, 0.09) and lower adiponectin (-0.4μg/mL; 95% CI -0.9, 0.0). Greater 2nd trimester GWG (per 0.2kg/wk) was associated with higher IGF-1 (2.3ng/mL; 95% CI 0.6, 4.0), IGF-2 (7.9ng/mL; 95% CI 1.2, 14.6), IGFBP-3 (41.6ng/mL; 95% CI 19.4, 63.7) and leptin (0.9ng/mL; 0.4, 1.4). 3rd trimester GWG was not associated with cord blood hormones. CONCLUSION 1st trimester weight gain appears to matter more for cord blood hormones related to offspring glucose/insulin regulation, whereas 2nd trimester gain matters more for hormones related to growth and adiposity.
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Affiliation(s)
- Sheryl L Rifas-Shiman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Abby Fleisch
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
| | - Marie-France Hivert
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | - Matthew W Gillman
- Environmental Influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health, Rockville, MD, USA
| | - Emily Oken
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Godfrey KM, Reynolds RM, Prescott SL, Nyirenda M, Jaddoe VWV, Eriksson JG, Broekman BFP. Influence of maternal obesity on the long-term health of offspring. Lancet Diabetes Endocrinol 2017; 5:53-64. [PMID: 27743978 PMCID: PMC5245733 DOI: 10.1016/s2213-8587(16)30107-3] [Citation(s) in RCA: 584] [Impact Index Per Article: 83.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/07/2016] [Accepted: 05/25/2016] [Indexed: 01/01/2023]
Abstract
In addition to immediate implications for pregnancy complications, increasing evidence implicates maternal obesity as a major determinant of offspring health during childhood and later adult life. Observational studies provide evidence for effects of maternal obesity on her offspring's risks of obesity, coronary heart disease, stroke, type 2 diabetes, and asthma. Maternal obesity could also lead to poorer cognitive performance and increased risk of neurodevelopmental disorders, including cerebral palsy. Preliminary evidence suggests potential implications for immune and infectious-disease-related outcomes. Insights from experimental studies support causal effects of maternal obesity on offspring outcomes, which are mediated at least partly through changes in epigenetic processes, such as alterations in DNA methylation, and perhaps through alterations in the gut microbiome. Although the offspring of obese women who lose weight before pregnancy have a reduced risk of obesity, few controlled intervention studies have been done in which maternal obesity is reversed and the consequences for offspring have been examined. Because the long-term effects of maternal obesity could have profound public health implications, there is an urgent need for studies on causality, underlying mechanisms, and effective interventions to reverse the epidemic of obesity in women of childbearing age and to mitigate consequences for offspring.
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Affiliation(s)
- Keith M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Rebecca M Reynolds
- Endocrinology Unit, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, Scotland, UK
| | - Susan L Prescott
- School of Paediatrics and Child Health, and Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Moffat Nyirenda
- London School of Hygiene & Tropical Medicine, London, UK; College of Medicine, University of Malawi, Blantyre, Malawi
| | - Vincent W V Jaddoe
- Departments of Epidemiology and Pediatrics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Birit F P Broekman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; National University Health System, Singapore, Singaporre
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Casanello P, Krause BJ, Castro-Rodríguez JA, Uauy R. [Epigenetics and obesity]. ACTA ACUST UNITED AC 2016; 87:335-342. [PMID: 27692574 DOI: 10.1016/j.rchipe.2016.08.009] [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: 08/24/2016] [Accepted: 08/29/2016] [Indexed: 12/29/2022]
Abstract
Current evidence supports the notion that exposure to various environmental conditions in early life may induce permanent changes in the epigenome that persist throughout the life-course. This article focuses on early changes associated with obesity in adult life. A review is presented on the factors that induce changes in whole genome (DNA) methylation in early life that are associated with adult onset obesity and related disorders. In contrast, reversal of epigenetic changes associated with weight loss in obese subjects has not been demonstrated. This contrasts with well-established associations found between obesity related DNA methylation patterns at birth and adult onset obesity and diabetes. Epigenetic markers may serve to screen indivuals at risk for obesity and assess the effects of interventions in early life that may delay or prevent obesity in early life. This might contribute to lower the obesity-related burden of death and disability at the population level. The available evidence indicates that epigenetic marks are in fact modifiable, based on modifications in the intrauterine environment and changes in food intake, physical activity and dietary patterns patterns during pregnancy and early years of adult life. This offers the opportunity to intervene before conception, during pregnancy, infancy, childhood, and also in later life. There must be documentation on the best preventive actions in terms of diet and physical activity that will modify or revert the adverse epigenetic markers, thus preventing obesity and diabetes in suceptible individuals and populations.
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Affiliation(s)
- Paola Casanello
- División de Obstetricia y Ginecología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bernardo J Krause
- División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José A Castro-Rodríguez
- División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ricardo Uauy
- División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Lipids and leukocytes in newborn umbilical vein blood, birth weight and maternal body mass index. J Dev Orig Health Dis 2016; 7:672-677. [PMID: 27572697 DOI: 10.1017/s2040174416000362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Maternal obesity during pregnancy may influence fetal development and possibly predispose offspring to cardiovascular disease. The aim of the present study was to evaluate the relationship between maternal pre-pregnancy body mass index (BMI) and weight gain during pregnancy, and newborn birth weight, with lipid profile, high-sensitivity C-reactive protein (hs-CRP) and leukocyte in newborns. We performed a cross-sectional study of 245 mothers and their children. Blood was collected from the umbilical vein and assayed for lipid profile, hs-CRP and leukocyte count. Newborns average weight was 3241 g, total cholesterol 53.9 mg/dl, high-density lipoprotein cholesterol (HDL-c) 21.9 mg/dl, low-density lipoprotein cholesterol (LDL-c) 26.2 mg/dl, triglyceride 29.5 mg/dl and leukocytes 13,777/mm3. There was a direct correlation of pre-pregnancy BMI of overweight mothers with total cholesterol (r=0.220, P=0.037) and LDL-c (r=0.268, P=0.011) of newborns. Total cholesterol, LDL-c and HDL-c were higher in pre-term newborns (66.3±19.7, 35.9±14.6 and 25.2±7.7 mg/dl, respectively) that in full-term (52.4±13.1, 25.0±8.7 and 21.5±6.0 mg/dl), with P=0.001, 0.001 and 0.003, respectively. Leukocyte counts were higher in full-term newborns (14,268±3982/mm3) compared with pre-term (9792±2836/mm3, P<0.0001). There was a direct correlation between birth weight and leukocyte counts of newborns (r=0.282, P<0.0001). These results suggest the possible interaction of maternal weight and fetal growth with lipid metabolism and leukocyte count in the newborn, which may be linked to programming of the immune system.
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Caradeux J, Serra R, Palmeiro Y, Correa PJ, Valenzuela I, Olguin J, Montenegro L, Nien JK, Osorio E, Illanes S. Correlation between Maternal Characteristics during Early Pregnancy, Fetal Growth Rate and Newborn Weight in Healthy Pregnancies. Gynecol Obstet Invest 2016; 81:202-6. [DOI: 10.1159/000441786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 10/15/2015] [Indexed: 11/19/2022]
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Gaillard R, Welten M, Oddy WH, Beilin LJ, Mori TA, Jaddoe VWV, Huang RC. Associations of maternal prepregnancy body mass index and gestational weight gain with cardio-metabolic risk factors in adolescent offspring: a prospective cohort study. BJOG 2015; 123:207-16. [DOI: 10.1111/1471-0528.13700] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2015] [Indexed: 01/06/2023]
Affiliation(s)
- R Gaillard
- Department of Epidemiology; Erasmus Medical Center; Rotterdam the Netherlands
| | - M Welten
- Department of Epidemiology; Erasmus Medical Center; Rotterdam the Netherlands
| | - WH Oddy
- Telethon Kids Institute; The University of Western Australia; Perth WA Australia
| | - LJ Beilin
- School of Medicine and Pharmacology; UWA; Perth WA Australia
| | - TA Mori
- School of Medicine and Pharmacology; UWA; Perth WA Australia
| | - VWV Jaddoe
- Department of Epidemiology; Erasmus Medical Center; Rotterdam the Netherlands
| | - R-C Huang
- Telethon Kids Institute; The University of Western Australia; Perth WA Australia
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Maternal obesity during pregnancy and cardiovascular development and disease in the offspring. Eur J Epidemiol 2015; 30:1141-52. [PMID: 26377700 PMCID: PMC4684830 DOI: 10.1007/s10654-015-0085-7] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/08/2015] [Indexed: 01/15/2023]
Abstract
Maternal obesity during pregnancy is an important public health problem in Western countries. Currently, obesity prevalence rates in pregnant women are estimated to be as high as 30 %. In addition, approximately 40 % of women gain an excessive amount of weight during pregnancy in Western countries. An accumulating body of evidence suggests a long-term impact of maternal obesity and excessive weight gain during pregnancy on adiposity, cardiovascular and metabolic related health outcomes in the offspring in fetal life, childhood and adulthood. In this review, we discuss results from recent studies, potential underlying mechanisms and challenges for future epidemiological studies.
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Human supraphysiological gestational weight gain and fetoplacental vascular dysfunction. Int J Obes (Lond) 2015; 39:1264-73. [PMID: 25869606 DOI: 10.1038/ijo.2015.57] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/11/2015] [Accepted: 03/29/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Human foetal development and growth in an environment of maternal obesity associates with high risk of cardiovascular disease and adverse neonatal outcome. We studied whether supraphysiological gestational weight gain results in human fetoplacental endothelial dysfunction and altered fetoplacental vascular reactivity. METHODS Primary cultures of human umbilical vein endothelial cells (HUVECs) and umbilical vein rings were obtained from pregnant women (112 total of patients recruited, 7 patients dropped out) exhibiting prepregnancy normal weight that ended with a physiological (pGWG (n=67), total weight gain 11.5-16 kg, rates of weight gain ≤0.42 kg per week) or supraphysiological (spGWG (n=38), total weight gain >16 kg, rates of weight gain >0.42 kg per week) gestational weight gain (reference values from US Institute of Medicine guidelines). Vascular reactivity to insulin (0.1-1000 nmol l(-1), 5 min) in KCl-preconstricted vein rings was measured using a wire myograph. Protein levels of human equilibrative nucleoside transporter 1 (hENT1), total and Ser(1177)- or Thr(495)-phosphorylated endothelial nitric oxide synthase (eNOS) were detected by western blot or immunofluorescence, and adenosine transport (0-250 μmol l(-1) adenosine, 2 μCi ml(-1) [(3)H]adenosine, 20 s, 25 °C) was measured in the presence or absence of 1 μmol l(-1) nitrobenzylthioinosine (hENT1 inhibitor) or 10 μmol l(-1) chlorpromazine (CPZ, endocytosis inhibitor) in HUVECs. RESULTS spGWG associates with reduced NOS activity-dependent dilation of vein rings (P=0.001), lower eNOS expression and higher Thr(495) (P=0.044), but unaltered Ser(1177)eNOS phosphorylation. hENT1-adenosine maximal transport activity was reduced (P=0.041), but the expression was increased (P=0.001) in HUVECs from this group. CPZ increased hENT1-adenosine transport (P=0.040) and hENT1 plasma membrane accumulation only in cells from pGWG. CONCLUSION spGWG in women with a normal prepregnancy weight causes lower fetoplacental vascular reactivity owing to the downregulation of eNOS activity and adenosine transport in HUVECs. Maternal spGWG is a detrimental condition for human fetoplacental endothelial function and reducing these alterations could result in a better neonate outcome.
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