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Bohlen SM, Eckmann-Scholz C, Rath W, Maass N, Pecks U. [Does Apolipoprotein B Level in Early Pregnancy Predict Excessive Gestational Weight Gain and Adverse Pregnancy Outcome?]. Z Geburtshilfe Neonatol 2020; 224:348-354. [PMID: 32162284 DOI: 10.1055/a-1118-4084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Excessive maternal gestational weight gain (GWG) is a risk factor for maternal and fetal complications. The lipid profile changes physiologically during pregnancy. Weight gain can affect lipid metabolism. The hypothesis of the study was that apoB levels early in pregnancy are associated with excessive GWG and predictive for adverse outcomes. METHODS Out of 547 patients there were 95 women with inadequate GWG, 171 with adequate GWG, and 281 with excessive GWG. Out of 581 patients there were 14 patients with pregnancy-induced hypertonus/pre-eclampsia, 67 with small-for-gestational-age (SGA) infants, and 7 with fetal growth restriction (FGR). ApoB levels were measured by ELISA. RESULTS There was no significant difference in apoB levels between the different GWG groups. We found significantly higher levels of apoB in overweight and obese patients compared to those with normal BMI. Smoking was correlated with higher apoB levels. There were no differences either between women with PIH/PE and normotensive women or between SGA/IUGR and pregnancies without. Women with pre-existing hypertension showed significantly higher apoB levels than the control group. CONCLUSIONS ApoB cannot be used as a marker for identifying the risk of excessive GWG or adverse pregnancy outcomes early in pregnancy. However, it may be involved in the pathophysiology of adverse pregnancy outcomes in high-risk patients.
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Affiliation(s)
- Sophia-Marie Bohlen
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel
| | - Christel Eckmann-Scholz
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel
| | - Werner Rath
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel
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Morisset AS, Dubois L, Colapinto CK, Luo ZC, Fraser WD. Prepregnancy Body Mass Index as a Significant Predictor of Total Gestational Weight Gain and Birth Weight. CAN J DIET PRACT RES 2017; 78:66-73. [DOI: 10.3148/cjdpr-2016-035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: We aimed to describe adherence to gestational weight gain (GWG) recommendations and identify determinants of excessive GWG in a sample of women from Quebec, Canada. Methods: Data were collected from the multi-centre 3D (Design, Develop, Discover) pregnancy cohort study, which included women who delivered between May 2010 and August 2012 at 9 obstetrical hospitals in Quebec, Canada. GWG was calculated for 1145 women and compared to the 2009 Institute of Medicine (IOM) recommendations. Results: Overall, 51% of participants exceeded the recommendations. Approximately 68% of women with obesity gained weight in excess of the IOM recommendations. The corresponding numbers were 75%, 44%, and 27% in overweight, normal weight, and underweight women, respectively. A prepregnancy BMI of 25 kg/m2 or more was the only significant predictor of exceeding GWG recommendations (OR 3.35, 95% CI 2.44–4.64) in a multivariate model. Birth weight was positively associated with GWG. GWG and prepregnancy BMI could explain 3.13% and 2.46% of the variance in birth weight, respectively. Conclusion: About half of women exceeded GWG recommendations, and this was correlated with infant birth weight. This reinforces the need to develop and evaluate strategies, including nutritional interventions, for pregnant women to achieve optimal GWG.
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Affiliation(s)
- Anne-Sophie Morisset
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC
- Sainte Justine University Hospital Research Center, University of Montreal, Montreal, QC
| | - Lise Dubois
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON
| | - Cynthia K. Colapinto
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC
| | - Zong-Chen Luo
- Sainte Justine University Hospital Research Center, University of Montreal, Montreal, QC
- Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, Huangpu
| | - William D. Fraser
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC
- Sainte Justine University Hospital Research Center, University of Montreal, Montreal, QC
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Childhood maltreatment and pre-pregnancy obesity: a comparison of obese, overweight, and normal weight pregnant women. Arch Womens Ment Health 2016; 19:355-65. [PMID: 26386682 DOI: 10.1007/s00737-015-0573-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 09/13/2015] [Indexed: 10/25/2022]
Abstract
Pre-pregnancy overweight and obesity is associated with poor health outcomes for the mother and the child. General population studies suggest that childhood maltreatment is associated with obesity in adulthood. The aim of our study was to examine the association between pre-pregnancy overweight and obesity and a history of childhood abuse or neglect including different stages of severity of abuse and neglect. Three hundred twenty-six normal weight, overweight, or obese pregnant women reported demographic data, height and weight, and general psychological distress at 18-22 weeks of gestation. Childhood maltreatment was assessed using the Childhood Trauma Questionnaire. Associations were examined using logistic regression analyses and a reference group of normal weight women. Fifty percent reported a history of abuse or neglect. After adjusting for age, education, income, marital status, and the number of previous children, pre-pregnancy overweight and obesity were strongly associated with severe physical abuse (overweight: OR = 8.33, 95% CI 1.48-47.03; obesity: OR = 6.31, 95% CI 1.06-37.60). Women with severe physical neglect (OR = 4.25, 95% CI 1.23-14.74) were at increased risk of pregnancy overweight. We found a dose-response relationship between physical abuse and pre-pregnancy overweight and obesity. Whereas other studies report an association between childhood maltreatment and pre-pregnancy obesity, this is the first study that found an association between childhood maltreatment and pre-pregnancy overweight. Considering the severe health risks of pre-pregnancy overweight and obesity and the long-term consequences of childhood maltreatment, affected women constitute a subgroup with special needs in prenatal care. Further research is needed to improve the understanding of the underlying mechanisms.
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Manyanga T, da Silva DF, Ferraro ZM, Harvey ALJ, Wilson S, Ockenden HN, Adamo KB. The effects of culture on guideline discordant gestational weight gain: a systematic review protocol. Syst Rev 2015; 4:145. [PMID: 26527534 PMCID: PMC4630828 DOI: 10.1186/s13643-015-0132-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/12/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND A significant proportion of women exceeds or does not meet the Institute of Medicine's gestational weight gain (GWG) guidelines. Inadequate, excessive GWG or weight loss during pregnancy is associated with an increased risk of negative maternal and fetal outcomes. Among the many determinants of GWG identified in the 2009 Institute of Medicine guidelines, culture was named as one of the few whose influence has not been fully explored. Some cultural beliefs may erroneously promote overeating as "eating for two" and discourage physical activity during pregnancy, but there is lack of empirical evidence on how culture affects GWG. The purpose of this systematic review is to examine the effects of culture on GWG. METHODS/DESIGN Ten electronic databases will be searched to identify studies reporting on the effects of culture on GWG. Grey literature, published conference abstracts, websites of relevant organizations and reference lists of included studies will also be searched. Studies that report on effects of culture, acculturation, ethnicity, race, nationality, ancestry and identity on GWG in adult women will be included. Quality of evidence will be evaluated using the grading of recommendations, assessment, development and evaluations (GRADE) approach to rating evidence. Study selection, data extraction and risk of bias assessment will be conducted by two independent reviewers, with disagreements being resolved by consensus or third party adjudication as needed. Formal meta-analyses will be conducted among included studies that are sufficiently statistically and clinically homogeneous. DISCUSSION This review will provide a comprehensive assessment and synthesis of current evidence and will draw attention to potential gaps where future research on the effects of culture on guideline discordant gestational weight gain remains to be conducted. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015023399.
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Affiliation(s)
- Taru Manyanga
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. .,School of Human Kinetics, University of Ottawa, Faculty of Health Sciences, Ottawa, ON, K1H 8L6, Canada.
| | - Danilo F da Silva
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. .,Department of Physical Education, State University of Maringa, Maringa, PR, 87020-900, Brazil.
| | - Zachary M Ferraro
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. .,Division of Maternal-Fetal Medicine, The Ottawa Hospital, General Campus, Ottawa, ON, K1H 8L6, Canada. .,Faculty of Medicine, University of Ottawa, Ottawa, ON, K1H 8L6, Canada.
| | - Alysha L J Harvey
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. .,School of Human Kinetics, University of Ottawa, Faculty of Health Sciences, Ottawa, ON, K1H 8L6, Canada.
| | - Shanna Wilson
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada.
| | - Holly N Ockenden
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. .,School of Human Kinetics, University of Ottawa, Faculty of Health Sciences, Ottawa, ON, K1H 8L6, Canada.
| | - Kristi B Adamo
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. .,School of Human Kinetics, University of Ottawa, Faculty of Health Sciences, Ottawa, ON, K1H 8L6, Canada. .,Department of Pediatrics, University of Ottawa, Faculty of Medicine, Ottawa, ON, K1H 8L6, Canada.
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Willcox JC, Campbell KJ, McCarthy EA, Lappas M, Ball K, Crawford D, Shub A, Wilkinson SA. Gestational weight gain information: seeking and sources among pregnant women. BMC Pregnancy Childbirth 2015; 15:164. [PMID: 26249832 PMCID: PMC4528714 DOI: 10.1186/s12884-015-0600-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 07/24/2015] [Indexed: 11/22/2022] Open
Abstract
Background Promoting healthy gestational weight gain (GWG) is important for preventing obstetric and perinatal morbidity, along with obesity in both mother and child. Provision of GWG guidelines by health professionals predicts women meeting GWG guidelines. Research concerning women’s GWG information sources is limited. This study assessed pregnant women’s sources of GWG information and how, where and which women seek GWG information. Methods Consecutive women (n = 1032) received a mailed questionnaire after their first antenatal visit to a public maternity hospital in Melbourne, Australia. Recalled provision of GWG guidelines by doctors and midwives, recalled provided GWG goals, and the obtaining of GWG information and information sources were assessed. Results Participants (n = 368; 35.7 % response) averaged 32.5 years of age and 20.8 weeks gestation, with 33.7 % speaking a language other than English. One in ten women recalled receiving GWG guidelines from doctors or midwives, of which half were consistent with Institute of Medicine guidelines. More than half the women (55.4 %) had actively sought GWG information. Nulliparous (OR 7.07, 95 % CI = 3.91–12.81) and obese (OR 1.96, 95 % CI = 1.05–3.65) women were more likely to seek information. Underweight (OR 0.29, 95 % CI = 0.09–0.97) women and those working part time (OR 0.52, 95 % CI = 0.28–0.97) were less likely to seek information. Most frequently reported GWG sources included the internet (82.7 %), books (55.4 %) and friends (51.5 %). The single most important sources were identified as the internet (32.8 %), general practitioners (16.9 %) and books (14.9 %). Conclusion More than half of women were seeking GWG guidance and were more likely to consult non-clinician sources. The small numbers given GWG targets, and the dominance of non-clinical information sources, reinforces that an important opportunity to provide evidence based advice and guidance in the antenatal care setting is currently being missed. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0600-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jane C Willcox
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
| | - Karen J Campbell
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
| | - Elizabeth A McCarthy
- Department of Obstetrics and Gynaecology, University of Melbourne/Mercy Hospital for Women, Melbourne, Australia.
| | - Martha Lappas
- Department of Obstetrics and Gynaecology, University of Melbourne/Mercy Hospital for Women, Melbourne, Australia.
| | - Kylie Ball
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
| | - David Crawford
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
| | - Alexis Shub
- Department of Obstetrics and Gynaecology, University of Melbourne/Mercy Hospital for Women, Melbourne, Australia.
| | - Shelley A Wilkinson
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia. .,Department of Nutrition & Dietetics, Mater Mothers Hospital, South Brisbane, Queensland, Australia.
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Gilmore LA, Klempel-Donchenko M, Redman LM. Pregnancy as a window to future health: Excessive gestational weight gain and obesity. Semin Perinatol 2015; 39:296-303. [PMID: 26096078 PMCID: PMC4516569 DOI: 10.1053/j.semperi.2015.05.009] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Metabolic and behavioral changes that occur during pregnancy have well-known effects on maternal and fetal health during the immediate pregnancy and now are thought to be a catalyst for future health throughout later life. Recommendations for appropriate gestational weight gain (GWG) and lifestyle modifications during pregnancy have changed throughout history as more is known about this crucial time. Herein we discuss the current GWG recommendations and the impact of pregnancy and excess GWG gain on the current and future health of women and children including risk of obesity, gestational diabetes, type 2 diabetes, cardiovascular disease, and metabolic syndrome.
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Affiliation(s)
| | | | - Leanne M. Redman
- Corresponding author. Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808,
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Adamo KB, Shen GX, Mottola M, Nascimento S, Jean-Philippe S, Ferraro ZM, Nerenberg K, Smith G, Ohari R, Gaudet L, Piccinini-Vallis H, McDonald S, Atkinson S, Godbout A, Robitaille J, Davidge ST, Gruslin A, Prud'homme D, Stacey D, Rossiter M, Goldfield GS, Dodd J. Obesity Prevention from Conception: A Workshop to Guide the Development of a Pan-Canadian Trial Targeting the Gestational Period. Nutr Metab Insights 2014. [PMCID: PMC3999948 DOI: 10.4137/nmi.s14146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This report summarizes a meeting, Obesity Prevention from Conception, held in Ottawa in 2012. This planning workshop was funded by the Canadian Institutes of Health Research (CIHR) to bring together researchers with expertise in the area of maternal obesity (OB) and weight gain in pregnancy and pregnancy-related disease to attend a one-day workshop and symposium to discuss the development of a cross-Canada lifestyle intervention trial for targeting pregnant women. This future intervention will aim to reduce downstream OB in children through encouraging appropriate weight gain during the mother’s pregnancy. The workshop served to (i) inform the development of a lifestyle intervention for women with a high pre-pregnancy body mass index (BMI), (ii) identify site investigators across Canada, and (iii) guide the development of a grant proposal focusing on the health of mom and baby. A brief summary of the presentations as well as the focus groups is presented for use in planning future research.
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Affiliation(s)
- Kristi B. Adamo
- Healthy Active Living Obesity, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Garry X. Shen
- Diabetes Research Group, Section of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michelle Mottola
- R. Samuel McLaughlin Foundation–-Exercise and Pregnancy Lab, The University of Western Ontario, London, Ontario, Canada
| | - Simony Nascimento
- Obstetric Unit, Department of Obstetrics and Gynecology, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Sonia Jean-Philippe
- Healthy Active Living Obesity, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Zachary M. Ferraro
- Healthy Active Living Obesity, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Kara Nerenberg
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Graeme Smith
- Queen's Perinatal Research Unit, Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada
| | - Radha Ohari
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Laura Gaudet
- Department of Obstetrics & Gynecology, Moncton Hospital, Moncton, New Brunswick, Canada
| | | | - Sarah McDonald
- Department of Obstetrics & Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Atkinson
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ariane Godbout
- Endocrinology Division, Department of Medicine, Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Julie Robitaille
- Département des sciences des aliments et de nutrition, Institut sur la nutrition et les aliments fonctionnels, Université Laval, Québec, Québec, Canada
| | - Sandra T. Davidge
- Women and Children's Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Obstetrics and Gynaecology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Andrée Gruslin
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynaecology and Newborn Care, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Denis Prud'homme
- Institut de Recherche de l'Hôpital Montfort, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
| | - Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
| | - Melissa Rossiter
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Gary S. Goldfield
- Healthy Active Living Obesity, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jodie Dodd
- Discipline of Obstetrics & Gynaecology, School of Paediatrics & Reproductive Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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An evolving scientific basis for the prevention and treatment of pediatric obesity. Int J Obes (Lond) 2014; 38:887-905. [PMID: 24662696 DOI: 10.1038/ijo.2014.49] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 03/10/2014] [Indexed: 12/11/2022]
Abstract
The 2013 Pennington Biomedical Research Center's Scientific Symposium focused on the treatment and management of pediatric obesity and was designed to (i) review recent scientific advances in the prevention, clinical treatment and management of pediatric obesity, (ii) integrate the latest published and unpublished findings and (iii) explore how these advances can be integrated into clinical and public health approaches. The symposium provided an overview of important new advances in the field, which led to several recommendations for incorporating the scientific evidence into practice. The science presented covered a range of topics related to pediatric obesity, including the role of genetic differences, epigenetic events influenced by in utero development, pre-pregnancy maternal obesity status, maternal nutrition and maternal weight gain on developmental programming of adiposity in offspring. Finally, the relative merits of a range of various behavioral approaches targeted at pediatric obesity were covered, together with the specific roles of pharmacotherapy and bariatric surgery in pediatric populations. In summary, pediatric obesity is a very challenging problem that is unprecedented in evolutionary terms; one which has the capacity to negate many of the health benefits that have contributed to the increased longevity observed in the developed world.
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Adamo KB, Ferraro ZM, Goldfield G, Keely E, Stacey D, Hadjiyannakis S, Jean-Philippe S, Walker M, Barrowman NJ. The Maternal Obesity Management (MOM) Trial Protocol: a lifestyle intervention during pregnancy to minimize downstream obesity. Contemp Clin Trials 2013; 35:87-96. [PMID: 23459089 DOI: 10.1016/j.cct.2013.02.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 01/24/2013] [Accepted: 02/17/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Maternal obesity and/or high gestational weight gain (GWG) are associated with downstream child obesity. Pregnancy represents a critical period for prevention as women are highly motivated and more receptive to behavior change. OBJECTIVE This pilot study was developed to test the feasibility of intervening with the mother, specifically keeping her GWG within the Institute of Medicine (IOM) limits, with the intended target of preventing obesity in her child downstream. We are testing the practicality of delivering a structured physical activity and nutrition intervention to pregnant women during gestation and then following mom and baby to 24 months of age. STUDY DESIGN This study is a two-arm, parallel group, randomized controlled trial being conducted in Ottawa. Pregnant women, with pregravid BMI >18.5, between 12 and 20 weeks gestation are randomized to one of two groups: intervention (n=30) who receive the MOM trial Handbook (guide to healthy gestation) plus a structured physical activity and nutrition program, or a standard clinical care control group (n=30). The intervention lasts 25-28 weeks (6 months) depending on anticipated delivery date, with follow-up assessment on mother and child at 3, 6, 12 and 24 months post-delivery. SIGNIFICANCE Pregnancy, a critical time of growth, development and physiological change, provides an opportunity for early lifestyle intervention. The goal of identifying an effective lifestyle program for the gestational period that leads to healthy fetal development and subsequently normal weight offspring, less likely to develop obesity and its co-morbidities, is unique and could possibly attenuate the inter-generational cycle of obesity.
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Affiliation(s)
- Kristi B Adamo
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, Canada.
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Willcox JC, Campbell KJ, van der Pligt P, Hoban E, Pidd D, Wilkinson S. Excess gestational weight gain: an exploration of midwives' views and practice. BMC Pregnancy Childbirth 2012; 12:102. [PMID: 23013446 PMCID: PMC3531303 DOI: 10.1186/1471-2393-12-102] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 09/06/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Excess gestational weight gain (GWG) can affect the immediate and long term health outcomes of mother and infant. Understanding health providers' views, attitudes and practices around GWG is crucial to assist in the development of practical, time efficient and cost effective ways of supporting health providers to promote healthy GWGs. This study aimed to explore midwives' views, attitudes and approaches to the assessment, management and promotion of healthy GWG and to investigate their views on optimal interventions. METHODS Midwives working in antenatal care were recruited from one rural and one urban Australian maternity hospital employing purposive sampling strategies to assess a range of practice areas. Face-to-face interviews were conducted with 15 experienced midwives using an interview guide and all interviews were digitally recorded, transcribed verbatim and analysed thematically. RESULTS Midwives interviewed exhibited a range of views, attitudes and practices related to GWG. Three dominant themes emerged. Overall GWG was given low priority for midwives working in the antenatal care service in both hospitals. In addition, the midwives were deeply concerned for the physical and psychological health of pregnant women and worried about perceived negative impacts of discussion about weight and related interventions with women. Finally, the midwives saw themselves as central in providing lifestyle behaviour education to pregnant women and identified opportunities for support to promote healthy GWG. CONCLUSIONS The findings indicate that planning and implementation of healthy GWG interventions are likely to be challenging because the factors impacting on midwives' engagement in the GWG arena are varied and complex. This study provides insights for guideline and intervention development for the promotion of healthy GWG.
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Affiliation(s)
- Jane C Willcox
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia
| | - Karen J Campbell
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia
| | - Paige van der Pligt
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia
| | - Elizabeth Hoban
- School of Health and Social Development, Deakin University, Melbourne, Australia
| | | | - Shelley Wilkinson
- Mater Mothers’ Hospital, Brisbane, Australia
- Mater Medical Research Institute, Brisbane, Australia
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Diouf I, Botton J, Charles MA, Morel O, Forhan A, Kaminski M, Heude B. Specific role of maternal weight change in the first trimester of pregnancy on birth size. MATERNAL AND CHILD NUTRITION 2012; 10:315-26. [PMID: 22783998 DOI: 10.1111/j.1740-8709.2012.00423.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The specific role of weight change in the first weeks of gestation in fetal growth has not been fully explored in humans. Our aims were to investigate: (1) the specific association between weight change in the first trimester of pregnancy (WCT1) and size at birth in term pregnancies; and (2) the role of placental weight in this relationship. From 2002 women included in the French EDEN study, 1744 mother-child pairs reached term, had pre-pregnancy weight available and at least five measures of weight in pregnancy. We extrapolated women's weight at each week of gestation with a three-degree polynomial model and estimated weight change during each trimester of gestation. We used a multivariate linear model to investigate the associations between WCT1 and birth size after taking into account potential confounders (age, parity, BMI, tobacco use, educational level, length of gestation, newborn gender, weight change after the first trimester and centre of study). Then, we performed path analysis to investigate whether the relation between WCT1 and birth size could be mediated by placental weight. After taking into account weight gain in later gestation, WCT1 was positively associated with birthweight. Results of path analysis showed that there was no direct association between WCT1 and birth size, but that this association was mediated by placental weight. Weight change during the first weeks of pregnancy may impact on fetal growth independently of weight change later in pregnancy through its effects on placental growth and function.
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Affiliation(s)
- Ibrahima Diouf
- INSERM, CESP Centre for Research in Epidemiology and Populations Health, U1018 Team 10 'Lifelong Epidemiology of Obesity, Diabetes and Chronic Renal Disease', Villejuif, France Univ Paris-Sud 11, UMRS 1018, Villejuif, France Regional Maternity, University of Nancy, Nancy, France INSERM, UMRS 953, Epidemiological Research on Perinatal Health and Women's and Children's Health, Villejuif, France UPMC Univ Paris 06, F-75005, Paris, France
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Kabir Z, Clancy L. Smoking Ban and Pregnancy Complications: New Evidence. J Womens Health (Larchmt) 2012; 21:616-8. [DOI: 10.1089/jwh.2012.3695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Luke Clancy
- TobaccoFree Research Institute, Dublin, Ireland
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Adamo KB, Ferraro ZM, Brett KE. Pregnancy is a Critical Period for Prevention of Obesity and Cardiometabolic Risk. Can J Diabetes 2012. [DOI: 10.1016/j.jcjd.2012.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Adamo KB, Ferraro ZM, Brett KE. Can we modify the intrauterine environment to halt the intergenerational cycle of obesity? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:1263-307. [PMID: 22690193 PMCID: PMC3366611 DOI: 10.3390/ijerph9041263] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 02/24/2012] [Accepted: 02/27/2012] [Indexed: 02/07/2023]
Abstract
Child obesity is a global epidemic whose development is rooted in complex and multi-factorial interactions. Once established, obesity is difficult to reverse and epidemiological, animal model, and experimental studies have provided strong evidence implicating the intrauterine environment in downstream obesity. This review focuses on the interplay between maternal obesity, gestational weight gain and lifestyle behaviours, which may act independently or in combination, to perpetuate the intergenerational cycle of obesity. The gestational period, is a crucial time of growth, development and physiological change in mother and child. This provides a window of opportunity for intervention via maternal nutrition and/or physical activity that may induce beneficial physiological alternations in the fetus that are mediated through favourable adaptations to in utero environmental stimuli. Evidence in the emerging field of epigenetics suggests that chronic, sub-clinical perturbations during pregnancy may affect fetal phenotype and long-term human data from ongoing randomized controlled trials will further aid in establishing the science behind ones predisposition to positive energy balance.
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Affiliation(s)
- Kristi B. Adamo
- Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; (Z.M.F.); (K.E.B.)
- Faculty of Medicine, Pediatrics, University of Ottawa, Ottawa, ON K1H 8L1, Canada
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Zachary M. Ferraro
- Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; (Z.M.F.); (K.E.B.)
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Kendra E. Brett
- Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; (Z.M.F.); (K.E.B.)
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON K1H 8L1, Canada
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15
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Rooney BL, Mathiason MA, Schauberger CW. Predictors of obesity in childhood, adolescence, and adulthood in a birth cohort. Matern Child Health J 2012; 15:1166-75. [PMID: 20927643 DOI: 10.1007/s10995-010-0689-1] [Citation(s) in RCA: 171] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
To determine how characteristics of pregnancy, birth, and early infancy are related to offspring obesity at three critical developmental periods. Mothers were followed through pregnancy and 10-15 years after. Offspring data were obtained through medical record review. Maternal and offspring characteristics were examined to predict obesity in childhood (ages 4-5 years), adolescence (ages 9-14 years), and early adulthood (ages 19-20 years). The original cohort included 802 children born to 795 women. Children who were twins, who had died, or whose mothers had died were excluded (n=25). Medical records of 68.5% of the remaining 777 children documented a height and weight at childhood, adolescence, or early adulthood. Relative risks (RRs) to predict obesity at early adulthood were 12.3 for childhood and 45.1 at adolescence. RRs were also significant to predict obesity at early adulthood between the mother's obesity at prepregnancy (RR=6.4), 4-5 years postpregnancy (RR=6.3), and 10-15 years postpregnancy (RR=6.2). Excluding these variables from the multivariate models and adjusting by gender, birth insurance, and mother's marital status at delivery, the best model to predict obesity at childhood included birth weight, weight gain in infancy, and delivery type. At adolescence, it included maternal pregnancy smoking status, gestational weight gain, and weight gain in infancy, and in early adulthood, included maternal pregnancy smoking status, gestational weight gain, and birth weight. Maternal pregnancy smoking status, gestational weight gain, and weight gain in infancy have long-term effects on offspring. Maternal obesity is the strongest predictor of obesity at all times studied.
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Affiliation(s)
- Brenda L Rooney
- Gundersen Lutheran Health System, 1900 South Avenue (NCA1-04), La Crosse, WI 54601, USA.
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van der Pligt P, Campbell K, Willcox J, Opie J, Denney-Wilson E. Opportunities for primary and secondary prevention of excess gestational weight gain: General Practitioners' perspectives. BMC FAMILY PRACTICE 2011; 12:124. [PMID: 22050899 PMCID: PMC3258202 DOI: 10.1186/1471-2296-12-124] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 11/04/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND The impact of excess gestational weight gain (GWG) on maternal and child health outcomes is well documented. Understanding how health care providers view and manage GWG may assist with influencing healthy gestational weight outcomes. This study aimed to assess General Practitioner's (GPs) perspectives regarding the management and assessment of GWG and to understand how GPs can be best supported to provide healthy GWG advice to pregnant women. METHODS Descriptive qualitative research methods utilising semi - structured interview questions to assess GPs perspectives and management of GWG. GPs participating in shared antenatal care in Geelong, Victoria and Sydney, New South Wales were invited to participate in semi - structured, individual interviews via telephone or in person. Interviews were digitally recorded and transcribed verbatim. Data was analysed utilising thematic analysis for common emerging themes. RESULTS Twenty eight GPs participated, 14 from each state. Common themes emerged relating to awareness of the implications of excess GWG, advice regarding weight gain, regularity of gestational weighing by GPs, options for GPs to seek support to provide healthy lifestyle behaviour advice and barriers to engaging pregnant women about their weight. GPs perspectives concerning excess GWG were varied. They frequently acknowledged maternal and child health complications resulting from excess GWG yet weighing practices and GWG advice appeared to be inconsistent. The preferred support option to promote healthy weight was referral to allied health practitioners yet GPs noted that cost and limited access were barriers to achieving this. CONCLUSIONS GPs were aware of the importance of healthy GWG yet routine weighing was not standard practice for diverse reasons. Management of GWG and perspectives of the issue varied widely. Time efficient and cost effective interventions may assist GPs in ensuring women are supported in achieving healthy GWG to provide optimal maternal and infant health outcomes.
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Affiliation(s)
- Paige van der Pligt
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, Australia
| | - Karen Campbell
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, Australia
| | - Jane Willcox
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, Australia
| | - Jane Opie
- General Practitioners Association of Geelong, Geelong, Australia
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Diouf I, Charles MA, Blondel B, Heude B, Kaminski M. Discordant time trends in maternal body size and offspring birthweight of term deliveries in France between 1972 and 2003: data from the French National Perinatal Surveys. Paediatr Perinat Epidemiol 2011; 25:210-7. [PMID: 21470260 DOI: 10.1111/j.1365-3016.2010.01188.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We investigated time trends in maternal weight before and during pregnancy and in infant birthweight in France, from 1972 to 2003, using data on singleton live term births from the representative National Perinatal Surveys of 1972, 1981, 1995, 1998 and 2003 (n=8,664, 4,494, 11,445, 12,006, 12,692, respectively). Mothers were interviewed a few days after delivery and data on delivery and the newborn were extracted from hospital records. Maternal prepregnancy weight, height, body mass index and pregnancy weight gain all increased from 1972 to 2003; however, birthweight did not show a parallel trend. After taking gestational age, maternal age, parity, country of origin, newborn gender and maternal smoking during pregnancy into account, mean birthweight increased between 1972 and 1995 but decreased thereafter and, consistently, there was an increase in small-for-gestational age (SGA) and a decrease in large-for-gestational age newborns. Further adjustment for induced delivery, an indicator of obstetric practice, did not change the results. A similar variation has been observed very recently in the US and in Germany. Further research is needed to identify the factors responsible for these discordant changes and especially the factors responsible for the recent increase in SGA since this has been shown to be associated with poorer health in later life.
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Affiliation(s)
- Ibrahima Diouf
- INSERM, Unit 1018, Center for Epidemiology and Populations Health (CESP) Villejuif, France.
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Korpi-Hyövälti EAL, Laaksonen DE, Schwab US, Vanhapiha TH, Vihla KR, Heinonen ST, Niskanen LK. Feasibility of a lifestyle intervention in early pregnancy to prevent deterioration of glucose tolerance. BMC Public Health 2011; 11:179. [PMID: 21429234 PMCID: PMC3078095 DOI: 10.1186/1471-2458-11-179] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 03/24/2011] [Indexed: 12/16/2022] Open
Abstract
Background In conjunction with the growing prevalence of obesity and the older age of pregnant women gestational diabetes (GDM) is a major health problem. The aim of the study was to evaluate if a lifestyle intervention since early pregnancy is feasible in improving the glucose tolerance of women at a high-risk for GDM in Finland. Methods A 75-g oral glucose tolerance test (OGTT) was performed in early pregnancy (n = 102). Women at high risk for GDM (n = 54) were randomized at weeks 8-12 from Apr 2005 to May 2006 to a lifestyle intervention group (n = 27) or to a close follow-up group (n = 27). An OGTT was performed again at weeks 26-28 for the lifestyle intervention and close follow-up groups. Results The values of the OGTT during the second trimester did not differ between the lifestyle intervention and close follow-up groups. In the lifestyle intervention group three women had GDM in the second trimester and respectively one woman in the close follow up group. Insulin therapy was not required in both groups. The intervention resulted in somewhat lower weight gain 11.4 ± 6.0 kg vs. 13.9 ± 5.1 kg, p = 0.062, adjusted by the prepregnancy weight. Conclusions Early intervention with an OGTT and simple lifestyle advice is feasible. A more intensive lifestyle intervention did not offer additional benefits with respect to glucose tolerance, although it tended to ameliorate the weight gain. Trial Registration ClinicalTrials.gov: NCT01130012
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Streuling I, Beyerlein A, Rosenfeld E, Hofmann H, Schulz T, von Kries R. Physical activity and gestational weight gain: a meta-analysis of intervention trials. BJOG 2010; 118:278-84. [PMID: 21134106 DOI: 10.1111/j.1471-0528.2010.02801.x] [Citation(s) in RCA: 134] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND high gestational weight gain (GWG) has been found to be associated with a number of adverse perinatal and long-term outcomes. OBJECTIVES we aimed to perform a systematic review and meta-analysis to find out whether physical activity in pregnancy might help avoid high GWG. SEARCH STRATEGY a literature search in relevant databases and an additional search by hand through bibliographies of various publications were performed. SELECTION CRITERIA we included randomised controlled trials on healthy women, with increased physical activity as the only intervention. GWG had to be documented for the intervention and control group separately. DATA COLLECTION AND ANALYSIS two reviewers independently extracted data and performed quality assessment. Data from the included trials were combined using a random-effects model. The effect size was expressed as mean difference (MD). MAIN RESULTS of 1380 studies identified, 12 trials met the inclusion criteria. In seven trials, GWG was lower in the exercise group compared with the control group, whereas five trials showed a lower GWG in the control groups. The meta-analysis resulted in an MD of GWG of -0.61 (95% CI: -1.17, -0.06), suggesting less GWG in the intervention groups compared with the control groups. We found no indication for publication bias or dose effects. AUTHOR'S CONCLUSIONS in summary, our analyses suggest that physical activity during pregnancy might be successful in restricting GWG.
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Affiliation(s)
- I Streuling
- Division of Epidemiology, Institute of Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians University of Munich, Munich, Germany.
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Beyerlein A, Schiessl B, Lack N, von Kries R. Optimal gestational weight gain ranges for the avoidance of adverse birth weight outcomes: a novel approach. Am J Clin Nutr 2009; 90:1552-8. [PMID: 19812177 DOI: 10.3945/ajcn.2009.28026] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Gestational weight gain (GWG) has been shown to be directly associated with birth weight. OBJECTIVE We aimed to define ranges for optimal GWG with respect to the risk of either small- or large-for-gestational-age offspring by using a new statistical approach. DESIGN For the purpose of an observational study, data on n = 177,079 mature singleton deliveries in Bavaria between 2004 and 2006 were extracted from a standard data set that is regularly collected for national benchmarking of obstetric units in terms of clinical performance. Joint predicted risks of either small- or large-for-gestational-age births in relation to GWG (continuous measurement) were estimated by logistic regression models with adjustment for potential confounders. RESULTS The estimated optimal GWG ranges as defined by a joint predicted risk of <or=20% were substantially wider than those recommended by the Institute of Medicine for underweight (8-25 compared with 12.5-18.0 kg) and normal-weight (2-18 compared with 11.5-16.0 kg) women. Overweight and obese women's optimal GWG ranged from -7 to 12 and -15 to 2 kg, respectively (Institute of Medicine recommendations: 7.0-11.5 and 5.0-9.0 kg, respectively). We observed considerable effect modifications by parity and smoking in pregnancy. In normal-weight primiparae, for example, the optimal GWG range was 10-26 kg for nonsmokers compared with 23-27 kg for smokers. CONCLUSIONS Considerably wider optimal GWG ranges than recommended by the Institute of Medicine might be tolerated with respect to avoidance of adverse birth weight outcome. Stratification by maternal body mass index category alone might not be sufficient.
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Affiliation(s)
- Andreas Beyerlein
- Division of Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany.
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Schiessl B, Beyerlein A, Lack N, von Kries R. Temporal trends in pregnancy weight gain and birth weight in Bavaria 2000-2007: slightly decreasing birth weight with increasing weight gain in pregnancy. J Perinat Med 2009; 37:374-9. [PMID: 19309253 DOI: 10.1515/jpm.2009.068] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To assess temporal trends in birth weight and pregnancy weight gain in Bavaria from 2000 to 2007. METHODS Data on 695,707 mother and infant pairs (singleton term births) were available from a compulsory reporting system for quality assurance, including information on birth weight, maternal weight at delivery and at booking, maternal smoking, age, and further anthropometric and lifestyle factors. Pregnancy weight gain was defined as: weight prior to delivery minus weight at first booking minus weight of the newborn. RESULTS Although mean weight gain during pregnancy increased considerably from 10.10 to 10.73 kg in seven years, the mean birth weight in mature singletons decreased slightly from 3433 to 3414 g. These trends could not be explained by concurrent changes in the rates of primiparity, smoking and gestational diabetes. CONCLUSIONS These German data confirm an increased weight gain during pregnancy with adjustment for potential confounders.
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Affiliation(s)
- Barbara Schiessl
- Department of Obstetrics and Gynecology, Ludwig-Maximilians-University, Munich, Germany.
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Unhealthy dietary patterns are associated with weight gain during pregnancy among Finnish women. Public Health Nutr 2009; 12:2392-9. [PMID: 19323867 DOI: 10.1017/s136898000900528x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To study whether the dietary patterns of Finnish pregnant women are associated with their weight gain rate during pregnancy. DESIGN A validated 181-item FFQ was applied retrospectively to assess the diet during the eighth month of pregnancy, and maternal height and maternal weight at first and last antenatal visits were recalled. Information on sociodemographic characteristics, parity and smoking of the pregnant women was obtained by a structured questionnaire and from the Finnish Birth Registry. Principal components analysis was used to identify dietary patterns that described the diet of pregnant women based on their food consumption profile. SETTING Finland. SUBJECTS Subjects consisted of 3360 women who had newly delivered in 1997-2002 and whose baby carried human leucocyte antigen-conferred susceptibility to type 1 diabetes in two university hospital regions, Oulu and Tampere, in Finland. RESULTS Out of seven dietary patterns identified, the 'fast food' pattern was positively associated (beta = 0.010, se = 0.003, P = 0.004) and the 'alcohol and butter' pattern was inversely associated (beta = -0.010, se = 0.003, P < 0.0001) with weight gain rate (kg/week) during pregnancy after adjusting for potential dietary, perinatal and sociodemographic confounding factors. Both of the dietary pattern associations demonstrated dose dependency. CONCLUSIONS Pregnant women should be guided to have a well-planned, balanced, healthy diet during pregnancy in order to avoid rapid gestational weight gain. The association between diet, health and maternal weight gain of the women who consumed alcohol during pregnancy should be studied further.
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França AP, Aldrighi JM, Marucci MDFN. Fatores associados à obesidade global e à obesidade abdominal em mulheres na pós-menopausa. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2008. [DOI: 10.1590/s1519-38292008000100008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVOS: avaliar a prevalência de obesidade global e obesidade abdominal, em mulheres pós-menopausa, segundo o grau de instrução, nível de atividade física, uso de terapia hormonal na menopausa (THM) e paridade. MÉTODOS: foram entrevistadas 157 mulheres na pós-menopausa, atendidas em dois ambulatórios públicos da cidade de São Paulo, São Paulo, Brasil. A obesidade foi determinada segundo o índice de massa corporal (IMC > 30,0) e segundo o percentual de gordura corporal (%GC > 37%). A obesidade abdominal foi determinada pela relação cintura-quadril (RCQ > 0,85). RESULTADOS: a prevalência de obesidade global foi 34,4% (segundo o IMC) e de 40,1% (segundo o %GC). A prevalência de obesidade abdominal foi de 73,8%. Grande parte das entrevistadas referiu até sete anos de instrução formal (47,8%), foi considerada sedentária ou insuficientemente ativa (52,3%) e nunca tinha utilizado THM oral ou tinha utilizado por menos de 12 meses (72,0%). Foi constatada maior prevalência de obesidade global no grupo de mulheres sedentárias ou insuficientemente ativas e no grupo de não usuárias de THM (p<0,05). Quanto à obesidade abdominal, fator de risco para doenças cardiovasculares (DCV), apenas o grau de instrução mostrou-se associado à RCQ (p<0,05). CONCLUSÕES: mulheres após a menopausa, fisicamente ativas e usuárias de THM exibiram menor prevalência de obesidade global, porém a prevalência de obesidade abdominal foi alta e ainda maior nas mulheres com menor grau de instrução.
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Kinnunen TI, Pasanen M, Aittasalo M, Fogelholm M, Hilakivi-Clarke L, Weiderpass E, Luoto R. Preventing excessive weight gain during pregnancy - a controlled trial in primary health care. Eur J Clin Nutr 2007; 61:884-91. [PMID: 17228348 DOI: 10.1038/sj.ejcn.1602602] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate whether individual counselling on diet and physical activity during pregnancy can have positive effects on diet and leisure time physical activity (LTPA) and prevent excessive gestational weight gain. DESIGN A controlled trial. SETTING Six maternity clinics in primary health care in Finland. The clinics were selected into three intervention and three control clinics. SUBJECTS Of the 132 pregnant primiparas, recruited by 15 public health nurses (PHN), 105 completed the study. INTERVENTIONS The intervention included individual counselling on diet and LTPA during five routine visits to a PHN until 37 weeks' gestation; the controls received the standard maternity care. RESULTS The counselling did not affect the proportion of primiparas exceeding the weight gain recommendations or total LTPA when adjusted for confounders. The adjusted proportion of high-fibre bread of the total weekly amount of bread decreased more in the control group than in the intervention group (difference 11.8%-units, 95% confidence interval (CI) 0.6-23.1, P=0.04). The adjusted intake of vegetables, fruit and berries increased by 0.8 portions/day (95% CI 0.3-1.4, P=0.004) and dietary fibre by 3.6 g/day (95% CI 1.0-6.1, P=0.007) more in the intervention group than in the control group. There were no high birth weight babies (>or=4000 g) in the intervention group, but eight (15%) of them in the control group (P=0.006). CONCLUSIONS The counselling helped pregnant women to maintain the proportion of high-fibre bread and to increase vegetable, fruit and fibre intakes, but was unable to prevent excessive gestational weight gain.
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Affiliation(s)
- T I Kinnunen
- UKK Institute for Health Promotion Research, Tampere, Finland.
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Rooney BL, Schauberger CW, Mathiason MA. Impact of perinatal weight change on long-term obesity and obesity-related illnesses. Obstet Gynecol 2006; 106:1349-56. [PMID: 16319262 DOI: 10.1097/01.aog.0000185480.09068.4a] [Citation(s) in RCA: 253] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To estimate the impact of perinatal weight change on obesity, weight gain, and development of obesity-related illnesses 15 years after pregnancy. METHODS Pregnancy-related factors and weights of 795 women were recorded at first prenatal visit and 6 months postpartum and were available through medical record review at 4, 10, and 15 years. Obesity-related illnesses were recorded 15 years later. RESULTS A total of 484 (61%) original cohort members were available for follow-up. Weight gain during pregnancy, weight loss by 6 months postpartum, and baseline body mass index (BMI) were all related to current BMI and weight gain at follow-up. Women who breastfed beyond 12 weeks and participated in postpartum aerobic exercise had lower BMI and weight gain 15 years later. By follow-up, 13% had developed diabetes or prediabetes. Thirty percent had developed heart disease, hypertension, or dyslipidemia. Baseline BMI and weight change over 15 years were significant predictors of both diseases. Smoking status at last follow-up was also a significant predictor of heart disease or pre-heart disease. CONCLUSION Excess pregnancy weight gain and failure to lose weight in an appreciable time are indicators of obesity in midlife. Excess weight gain and obesity status are predictors of diabetes and heart disease, although pregnancy-related weight changes alone are not directly related.
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Affiliation(s)
- Brenda L Rooney
- Gundersen Lutheran Medical Center, La Crosse, Wisconsin 54601, USA.
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