Pregnancy as a window to future health: Excessive gestational weight gain and obesity

Genomic Insights into Gestational Weight Gain: Uncovering Tissue-Specific Mechanisms and Pathways

Increasing gestational weight gain (GWG) is linked to adverse outcomes in pregnant persons and their children. The Early Growth Genetics (EGG) Consortium identified previously genetic variants that could contribute to early, late, and total GWG from fetal and maternal genomes. However, the biologic mechanisms and tissue-Specificity of these variants in GWG is unknown. We evaluated the association between genetically predicted gene expression in five relevant maternal (subcutaneous and visceral adipose, breast, uterus, and whole blood) from GTEx (v7) and fetal (placenta) tissues and early, late, and total GWG using S-PrediXcan. We tested enrichment of pre-defined biological pathways for nominally (P < 0.05) significant associations using the GENE2FUNC module from Functional Mapping and Annotation of Genome-Wide Association Studies. After multiple testing correction, we did not find significant associations between maternal and fetal gene expression and early, late, or total GWG. There was significant enrichment of several biological pathways, including metabolic processes, secretion, and intracellular transport, among nominally significant genes from the maternal analyses (false discovery rate p-values: 0.016 to 9.37×10). Enriched biological pathways varied across pregnancy. Though additional research is necessary, these results indicate that diverse biological pathways are likely to impact GWG, with their influence varying by tissue and weeks of gestation.

Cohort profile: the Environmental Reproductive and Glucose Outcomes (ERGO) Study (Boston, Massachusetts, USA) - a prospective pregnancy cohort study of the impacts of environmental exposures on parental cardiometabolic health

PURPOSE

Pregnancy and the postpartum period are increasingly recognised as sensitive windows for cardiometabolic disease risk. Growing evidence suggests environmental exposures, including endocrine-disrupting chemicals (EDCs), are associated with an increased risk of pregnancy complications that are associated with long-term cardiometabolic risk. However, the impact of perinatal EDC exposure on subsequent cardiometabolic risk post-pregnancy is less understood. The Environmental Reproductive and Glucose Outcomes (ERGO) Study was established to investigate the associations of environmental exposures during the perinatal period with post-pregnancy parental cardiometabolic health.

PARTICIPANTS

Pregnant individuals aged ≥18 years without pre-existing diabetes were recruited at <15 weeks of gestation from Boston, Massachusetts area hospitals. Participants completed ≤4 prenatal study visits (median: 12, 19, 26, 36 weeks of gestation) and 1 postpartum visit (median: 9 weeks), during which we collected biospecimens, health histories, demographic and behavioural data, and vitals and anthropometric measurements. Participants completed a postpartum fasting 2-hour 75 g oral glucose tolerance test. Clinical data were abstracted from electronic medical records. Ongoing (as of 2024) extended post-pregnancy follow-up visits occur annually following similar data collection protocols.

FINDINGS TO DATE

We enrolled 653 unique pregnancies and retained 633 through delivery. Participants had a mean age of 33 years, 10% (n=61) developed gestational diabetes and 8% (n=50) developed pre-eclampsia. Participant pregnancy and postpartum urinary phthalate metabolite concentrations and postpartum glycaemic biomarkers were quantified. To date, studies within ERGO found higher exposure to phthalates and phthalate mixtures, and separately, higher exposure to radioactive ambient particulate matter, were associated with adverse gestational glycaemic outcomes. Additionally, certain personal care products used in pregnancy, notably hair oils, were associated with higher urinary phthalate metabolite concentrations, earlier gestational age at delivery and lower birth weight.

FUTURE PLANS

Future work will leverage the longitudinal data collected on pregnancy and cardiometabolic outcomes, environmental exposures, questionnaires, banked biospecimens and paediatric data within the ERGO Study.

Pre-gestational counselling for women living with CKD: starting from the bright side

Pregnancy in women living with chronic kidney disease (CKD) was often discouraged due to the risk of adverse maternal-fetal outcomes and the progression of kidney disease. This negative attitude has changed in recent years, with greater emphasis on patient empowerment than on the imperative 'non nocere'. Although risks persist, pregnancy outcomes even in advanced CKD have significantly improved, for both the mother and the newborn. Adequate counselling can help to minimize risks and support a more conscious and informed approach to those risks that are unavoidable. Pre-conception counselling enables a woman to plan the most appropriate moment for her to try to become pregnant. Counselling is context sensitive and needs to be discussed also within an ethical framework. Classically, counselling is more focused on risks than on the probability of a successful outcome. 'Positive counselling', highlighting also the chances of a favourable outcome, can help to strengthen the patient-physician relationship, which is a powerful means of optimizing adherence and compliance. Since, due to the heterogeneity of CKD, giving exact figures in single cases is difficult and may even be impossible, a scenario-based approach may help understanding and facing favourable outcomes and adverse events. Pregnancy outcomes modulate the future life of the mother and of her baby; hence the concept of 'post partum' counselling is also introduced, discussing how pregnancy results may modulate the long-term prognosis of the mother and the child and the future pregnancies.

Number of Pregnancies and Risk of Atherosclerotic Cardiovascular Disease in Postmenopausal Women: A Cross-Sectional Study of NHANES from 1999 to 2018

Background: Atherosclerotic cardiovascular disease (ASCVD) remains the most common cause of death in women. Pregnancy is an exposure unique to women leading to significant changes in maternal cardiovascular function. However, studies of the relationship between the number of pregnancies and ASCVD are rare. We aimed to clarify the association between the number of pregnancies and ASCVD. Methods: In this cross-sectional study, we used publicly available data from the National Health and Nutrition Examination Survey from 1999 to 2018. The number of pregnancies was divided into 0 (reference), 1, 2-3, 4-5, or ≥6, to create more stable estimates. A multiple logistic regression approach was used to examine the correlation between pregnancy and ASCVD in women aged 45 years or older who reported no menstruation in the past 12 months due to menopause, as well as in those aged 55 years or older, encompassing various age groups. We also separately estimated the association between the exposure of pregnancy and individual components of ASCVD. Results: In this study, age-adjusted data showed that women with six or more pregnancies had a doubled risk (odds ratio [OR]: 2.07) of ASCVD. The risk remained elevated at 1.69 times in women with four to five pregnancies and further increased to 1.90 times in women with six or more pregnancies, after adjusting for social factors. Similar patterns were observed when considering reproductive health and cardiovascular risk factors. Across the full population, every model that accounted for these variables consistently indicated that with an increasing number of pregnancies, we observed higher ORs for ASCVD risk (all p values <0.05). Conclusions: A higher number of pregnancies was associated with a higher risk of ASCVD after menopause, especially among women aged 45-64 years. Moreover, this association is particularly significant in the risk of stroke, cardiovascular heart disease, and heart attack.

Recent Insights and Recommendations for Preventing Excessive Gestational Weight Gain

Recommendations for weight gain during pregnancy are based on pre-pregnancy body mass index (BMI). Pregnancy is a risk factor for excessive weight gain and many endocrine problems, making it difficult to return to pre-pregnancy weight and increasing the risk of postpartum obesity and, consequently, type 2 diabetes and metabolic syndrome. Both excessive gestational weight gain (EGWG) and obesity are associated with an increased risk of gestational hypertension, pre-eclampsia, gestational diabetes, cesarean section, shoulder dystocia, and neonatal macrosomia. In the long term, EGWG is associated with increased morbidity and mortality, particularly from diabetes, cardiovascular disorders, and some cancers. This study aims to present recommendations from various societies regarding weight gain during pregnancy, dietary guidance, and physical activity. In addition, we discuss the pathophysiology of this complication and the differential diagnosis in pregnant women with EGWG. According to our research, inadequate nutrition might contribute more significantly to the development of EGWG than insufficient physical activity levels in pregnant women. Telehealth systems seem to be a promising direction for future EGWG prevention by motivating women to exercise. Although the importance of adequate pre-pregnancy weight and weight gain during pregnancy is well known, an increasing number of women gain excessive weight during pregnancy.

A cost-effectiveness evaluation of a dietitian-delivered telephone coaching program during pregnancy for preventing gestational diabetes mellitus

BACKGROUND

This study aimed to evaluate the cost-effectiveness of a telehealth coaching intervention to prevent gestational diabetes mellitus (GDM) and to calculate the breakeven point of preventing GDM.

METHODS

Data to inform the economic evaluation model was sourced directly from the large quaternary hospital in Brisbane, where the Living Well during Pregnancy (LWdP) program was implemented, and further supplemented with literature-based estimates where data had not been directly collected in the trial. A cost-effectiveness model was developed using a decision tree framework to estimate the potential for cost savings and quality of life improvement. A total of 1,315 pregnant women (49% with a BMI 25-29.9, and 51% with a BMI ≥ 30) were included in the analyses.

RESULTS

The costs of providing routine care and routine care plus LWdP coaching intervention to pregnant women were calculated to be AUD 20,933 and AUD 20,828, respectively. The effectiveness of the LWdP coaching program (0.894 utility) was slightly higher compared to routine care (0.893). Therefore, the value of the incremental cost-effectiveness ratio (ICER) was negative, and it indicates that the LWdP coaching program is a dominant strategy to prevent GDM in pregnant women. We also performed a probabilistic sensitivity analysis using Monte Carlo simulation through 1,000 simulations. The ICE scatter plot showed that the LWdP coaching intervention was dominant over routine care in 93.60% of the trials using a willingness to pay threshold of AUD 50,000.

CONCLUSION

Findings support consideration by healthcare policy and decision makers of telehealth and broad-reach delivery of structured lifestyle interventions during pregnancy to lower short-term costs associated with GDM to the health system.

Weight Categories, Trajectories, Eating Behavior, and Metabolic Consequences during Pregnancy and Postpartum in Women with GDM

Pre-pregnancy overweight and obesity are associated with increased risk for adverse outcomes, such as gestational diabetes mellitus (GDM). This study investigated weight trajectories, eating behaviors, and metabolic consequences in women with GDM during pregnancy and postpartum according to pre-pregnancy BMI. We prospectively included 464 women with GDM. Intuitive eating (Intuitive Eating Scale-2 questionnaire), gestational weight gain (GWG), postpartum weight retention (PPWR) at 6-8 weeks and 1-year postpartum, and glucose intolerance (prediabetes and diabetes) at 1-year were assessed. Women with obesity (WOB) had lower GWG but gained more weight in the postpartum (p < 0.0001). PPWR at 1-year did not differ across BMI categories (p = 0.63), whereas postpartum weight loss was most pronounced in women with normal weight (p < 0.0001), and within this category, in their lowest tertile (p < 0.05). Intuitive eating was not linked to perinatal weight changes but differed among BMI categories. PPWR predicted a 2.5-fold increased risk of glucose intolerance at 1-year independent of pre-pregnancy BMI (p < 0.001), and the adverse metabolic impact of PPWR was most pronounced in WOB with odds of increased risk of glucose intolerance 8.9 times higher (95% CI 2.956;26.968). These findings suggest an adaptive capacity to relatively rapid weight changes in the perinatal period that is less present with higher BMI.

The impact of a lifestyle intervention on postpartum weight retention among US Hispanic women with overweight and obesity

Introduction

To evaluate the effect of a culturally-modified, motivationally-targeted, individually-tailored lifestyle intervention on postpartum weight retention among Hispanic women with overweight/obesity.

Materials and methods

Proyecto Mamá was a randomized controlled trial conducted in western Massachusetts (2014-2020). Hispanic women with overweight/obese pre-pregnancy BMI (n = 148) were randomized in early pregnancy to a Lifestyle Intervention (LI) or a Health & Wellness (HW) comparison arm. The LI was based upon theoretical concepts, used a low-cost, high-reach strategy, and focused on healthy exercise and diet with follow-up through 12-months postpartum. The primary outcome of change in weight was calculated as the difference between pre-pregnancy weight and 6-week, 6-month, and 12-month postpartum weight. The secondary outcome was achievement of 5 % weight reduction from pre-pregnancy weight. Retention was 68.2 % in the overall postpartum period and 31.0 % at 12-months.

Results

In intent-to-treat analyses, compared to the HW arm, there was no difference in postpartum weight retention at 6-weeks (0.0 kg, 95 % CI: -3.4, 3.5), 6-months (-1.8 kg, 95 % CI: -5.6, 2.0), or 12-months (-2.0 kg, 95 % CI: -7.0, 3.1). In a secondary complete case analysis, compared to the HW arm, the LI arm had 5.5 times higher odds of meeting the postpartum weight reduction goal (aOR = 5.5, 95 % CI: 1.7, 17.9) adjusting for pre-pregnancy weight.

Conclusions

A lifestyle intervention among at-risk Hispanic women with overweight/obesity had no overall impact on postpartum weight, but a beneficial impact among those who completed the trial. Future studies should focus on increasing the feasibility and acceptability of the intervention in this at-risk population.

Mapping the Postpartum Experience Through Obstetric Patient Navigation for Low-Income Individuals

Background: Although the postpartum period is an opportunity to address long-term health, fragmented care systems, inadequate attention to social needs, and a lack of structured transition to primary care threaten patient wellbeing, particularly for low-income individuals. Postpartum patient navigation is an emerging innovation to address these disparities. Methods: This mixed-methods analysis uses data from the first year of an ongoing randomized controlled trial to understand the needs of low-income postpartum individuals through 1 year of patient navigation. We designed standardized logs for navigators to record their services, tracking mode, content, intensity, and target of interactions. Navigators also completed semistructured interviews every 3 months regarding relationships with patients and care teams, care system gaps, and navigation process. Log data were categorized, quantified, and mapped temporally through 1 year postpartum. Qualitative data were analyzed using the constant comparative method. Results: Log data from 50 participants who received navigation revealed the most frequent needs related to health care access (45.4%), health and wellness (18.2%), patient-navigator relationship building (14.8%), parenting (13.6%), and social determinants of health (8.0%). Navigation activities included supporting physical and mental recovery, accomplishing health goals, connecting patients to primary and specialty care, preparing for health system utilization beyond navigation, and referring individuals to community resources. Participant needs fluctuated, yielding a dynamic timeline of the first postpartum year. Conclusion: Postpartum needs evolved throughout the year, requiring support from various teams. Navigation beyond the typical postpartum care window may be useful in mitigating health system barriers, and tracking patient needs may be useful in optimizing postpartum care. Clinical Trial Registration: Registered April 19, 2019, enrollment beginning January 21, 2020, NCT03922334, https://clinicaltrials.gov/ct2/show/NCT03922334.

Teaching by texting to promote positive health behaviours in pregnancy: a protocol for a randomised controlled trial of SmartMom

INTRODUCTION

Prenatal education is associated with positive health behaviours, including optimal weight gain, attendance at prenatal care, acceptance of routine screening tests, smoking cessation, decreased alcohol consumption and breast feeding. Adoption of these behaviours has been associated with reduced rates of caesarean birth, preterm birth and low birth weight. Barriers to prenatal class attendance faced by parents in Canada include geography, socioeconomic status, age, education, and, among Indigenous peoples and other equity-deserving groups, stigma. To address the need for easily accessible and reliable information, we created 'SmartMom', Canada's first prenatal education programme delivered by short message service text messaging. SmartMom provides evidence-based information timed to be relevant to each week of pregnancy. The overall goal of SmartMom is to motivate the adoption of positive prenatal health behaviours with the ultimate goal of improving health outcomes among women and their newborns.

METHODS AND ANALYSIS

We will conduct a two-arm single-blinded randomised controlled trial. Blinding of participants to trial intervention will not be possible as they will be aware of receiving the intervention, but data analysts will be blinded. Our primary research questions are to determine if women experiencing uncomplicated pregnancies randomly assigned to receive SmartMom messages versus messages addressing general topics related to pregnancy but without direction for behaviour change, have higher rates of: (1) weight gain within ranges recommended for prepregnancy body mass index and (2) adherence to Canadian guidelines regarding attendance at prenatal care appointments.

ETHICS AND DISSEMINATION

The study has been granted a Certificate of Approval, number H22-00603, by the University of British Columbia Research Ethics Board. To disseminate our findings, we are undertaking both integrated and end-of-grant knowledge translation, which will proactively involve potential end-users and stakeholders at every phase of our project.

TRIAL REGISTRATION NUMBER

NCT05793944.

Nutritional Knowledge about Maternal and Newborn Health among Physiotherapists during the COVID-19 Pandemic in Minas Gerais, Brazil

Adequate nutrition before and during pregnancy, as well as postpartum, is among the major contributors to maternal and newborn health. Physiotherapists' knowledge of this area is still scarce, although their clinical practice has been linked to newborns' neuropsychomotor development, which, in turn, is influenced by maternal health and nutritional status. Therefore, this study aimed to evaluate the nutritional knowledge of physiotherapists regarding maternal and newborn health. A total of 70 Brazilian physiotherapists (32.2 ± 6.0 years; 72.9% females) were evaluated between November 2019 and February 2020 for their sociodemographic characteristics, professional experience, and nutritional knowledge about maternal and newborn health through a validated questionnaire personally administered by the same trained researcher. Most of the physiotherapists had graduated but had no specialization in maternal and child physiotherapy (96.1% of the females and all the males). The nutritional knowledge about maternal and newborn health was significantly different between the female and male health professionals, as well as between the less and more experienced participants, i.e., female physiotherapists and the more experienced ones had more correct answers on the nutritional questionnaire than the male and less experienced physiotherapists, respectively (p < 0.05). Our results open an interesting window for the future education and training of Brazilian physiotherapists in nutrition.

Anthropometric Changes During Pregnancy and Their Association with Adequacy of Gestational Weight Gain

Background

Gestational weight gain (GWG) is an expected component of a healthy pregnancy. Gaining weight within the recommended range helps support the mother's health by providing energy reserves and nutrients to meet the increased metabolic demands during pregnancy. Too much or too little GWG has been associated with adverse health outcomes for the mother and child.

Objective

The objective of the study was to examine how changes in anthropometric indicators during pregnancy, including fat gain, vary, compare changes among body mass index (BMI) (kg/m2) groups, and examine how the changes were associated with adequacy of GWG defined using the 2009 Institute of Medicine guidelines.

Methods

Data came from a cohort of 360 pregnant women with measured anthropometric indicators (weight, midupper arm circumference, and skin folds of the triceps, thigh, and upper iliac) at <12-, 16 to 22-, and 28 to 32-wks of gestation. Fat gain was calculated using a formula. Analysis of variance was used to test for differences in anthropometric changes by BMI and adequacy of GWG in the third trimester. Multiple logistic regression was used to examine associations between changes in anthropometric indicators and GWG recommendations.

Results

Women with normal weight had greater increases in all anthropometric indicators, which differed from women with obesity, who had negative changes and gained less weight. Women who gained inadequately (21%) had negative changes that were all less, compared with women who gained adequately (46%) (except in upper iliac) or excessively (34%). Women with BMI of >25 who gained adequately also had negative changes. Logistic regression results indicated that changes in midupper arm circumference, triceps, and thigh skin folds, and fat gain were all inversely associated with inadequate GWG, whereas all indicators were positively associated with excessive GWG.

Conclusions

Anthropometric changes during pregnancy differ by BMI and are associated with adequacy of GWG. Women who gained adequately had minimal fat gain, lending support for current GWG guidelines.

Maternal diet quality and associations with plasma lipid profiles and pregnancy-related cardiometabolic health

PURPOSE

To assess the relationship of early pregnancy maternal diet quality (DQ) with maternal plasma lipids and indicators of cardiometabolic health, including blood pressure (BP), gestational diabetes mellitus (GDM) and gestational weight gain (GWG).

METHODS

Women (n = 215) aged 18-40 years with singleton pregnancies were recruited at 10-20 weeks gestation. Diet quality was assessed by the Dietary Guideline Index, calculated at early ([mean ± SD]) (15 ± 3 weeks) and late (35 ± 2 weeks) pregnancy. Lipidomic analysis was performed, and 698 species across 37 lipid classes were measured from plasma blood samples collected at early (15 ± 3 weeks) and mid (27 ± 3 weeks)-pregnancy. Clinical measures (BP, GDM diagnosis, weight) and blood samples were collected across pregnancy. Multiple linear and logistic regression models assessed associations of early pregnancy DQ with plasma lipids at early and mid-pregnancy, BP at three antenatal visits, GDM diagnosis and total GWG.

RESULTS

Maternal DQ scores ([mean ± SD]) decreased significantly from early (70.7 ± 11.4) to late pregnancy (66.5 ± 12.6) (p < 0.0005). At a false discovery rate of 0.2, early pregnancy DQ was significantly associated with 13 plasma lipids at mid-pregnancy, including negative associations with six triglycerides (TGs); TG(54:0)[NL-18:0] (neutral loss), TG(50:1)[NL-14:0], TG(48:0)[NL-18:0], TG(52:1)[NL-18:0], TG(54:1)[NL-18:1], TG(50:0)[NL-18:0]. No statistically significant associations were found between early pregnancy DQ and BP, GDM or GWG.

CONCLUSION

Maternal diet did not adhere to Australian Dietary Guidelines. Diet quality was inversely associated with multiple plasma TGs. This study provides novel insights into the relationship between DQ, lipid biomarkers and cardiometabolic health during pregnancy.

Trends in Maternal Weight Disparities: Statewide Differences in Rural and Urban Minnesota Residents From 2012 to 2019

INTRODUCTION

Despite research showing substantial weight disparities along the rural-urban continuum, little work has attempted to identify differences in prepregnancy weight status or gestational weight gain (GWG) outcomes between rural and urban birthing people. As such, the goals of this research were to 1) document the prevalence of prepregnancy overweight and obesity and excessive GWG in rural and urban birthing people and 2) examine changes in rural and urban prepregnancy overweight or obesity and excessive GWG over time.

METHODS

Birth certificate data provided sociodemographic variables, prepregnancy body mass index, GWG, and rurality status on 465,709 respondents who gave birth in Minnesota from 2012 to 2019. A series of regression models estimated risk differences in 1) prepregnancy weight status and 2) excessive GWG between rural and urban respondents over time, controlling for relevant covariates.

RESULTS

Rural individuals had a 4.9 percentage-point (95% confidence interval, 4.5-5.3) higher risk of having prepregnancy overweight or obesity compared with urban individuals, and a 2.6 percentage-point (95% confidence interval, 1.9-3.3) higher risk of gaining excessive gestational weight. The disparities in prepregnancy overweight or obesity and excessive gestational weight between rural and urban individuals widened over time.

CONCLUSIONS

These findings contribute to accumulating evidence documenting notable health disparities between rural and urban individuals during the perinatal period and support the need to develop prevention and treatment efforts focused on improving the weight-related health of individuals living in rural communities.

Maternal hepatic adaptations during obese pregnancy encompass lobe-specific mitochondrial alterations and oxidative stress

Maternal obesity (MO) is rising worldwide, affecting half of all gestations, constituting a possible risk-factor for some pregnancy-associated liver diseases (PALD) and hepatic diseases. PALD occur in approximately 3% of pregnancies and are characterized by maternal hepatic oxidative stress (OS) and mitochondrial dysfunction. Maternal hepatic disease increases maternal and fetal morbidity and mortality. Understanding the role of MO on liver function and pathophysiology could be crucial for better understanding the altered pathways leading to PALD and liver disease, possibly paving the way to prevention and adequate management of disease. We investigated specific hepatic metabolic alterations in mitochondria and oxidative stress during MO at late-gestation. Maternal hepatic tissue was collected at 90% gestation in Control and MO ewes (fed 150% of recommended nutrition starting 60 days before conception). Maternal hepatic redox state, mitochondrial respiratory chain (MRC), and OS markers were investigated. MO decreased MRC complex-II activity and its subunits SDHA and SDHB protein expression, increased complex-I and complex-IV activities despite reduced complex-IV subunit mtCO1 protein expression, and increased ATP synthase ATP5A subunit. Hepatic MO-metabolic remodeling was characterized by decreased adenine nucleotide translocator 1 and 2 (ANT-1/2) and voltage-dependent anion channel (VDAC) protein expression and protein kinase A (PKA) activity (P<0.01), and augmented NAD+/NADH ratio due to reduced NADH levels (P<0.01). MO showed an altered redox state with increased OS, increased lipid peroxidation (P<0.01), decreased GSH/GSSG ratio (P=0.005), increased superoxide dismutase (P=0.03) and decreased catalase (P=0.03) antioxidant enzymatic activities, lower catalase, glutathione peroxidase (GPX)-4 and glutathione reductase protein expression (P<0.05), and increased GPX-1 abundance (P=0.03). MO-related hepatic changes were more evident in the right lobe, corroborated by the integrative data analysis. Hepatic tissue from obese pregnant ewes showed alterations in the redox state, consistent with OS and MRC and metabolism remodeling. These are hallmarks of PALD and hepatic disease, supporting MO as a risk-factor and highlighting OS and mitochondrial dysfunction as mechanisms responsible for liver disease predisposition.

Per- and polyfluoroalkyl substances, gestational weight gain, postpartum weight retention and body composition in the UPSIDE cohort

BACKGROUND

Per- and polyfluoroalkyl substances (PFAS) are synthetic chemicals found in drinking water and consumer products, resulting in ubiquitous human exposure. PFAS have been linked to endocrine disruption and altered weight gain across the lifespan. A limited and inconsistent body of research suggests PFAS may impact gestational weight gain (GWG) and postpartum body mass index (BMI), which are important predictors of overall infant and maternal health, respectively.

METHODS

In the Understanding Pregnancy Signals and Infant Development (UPSIDE/UPSIDE-MOMs) study (n = 243; Rochester, NY), we examined second trimester serum PFAS (PFOS: perfluorooctanesulfonic acid, PFOA: perfluorooctanoic acid, PFNA: perfluorononanoic acid, PFHxS: perfluorohexanesulfonic acid, PFDA: perfluorodecanoic acid) in relation to GWG (kg, and weekly rate of gain) and in the postpartum, weight retention (PPWR (kg) and total body fat percentage (measured by bioelectrical impedance)). We fit multivariable linear regression models examining these outcomes in relation to log-transformed PFAS in the whole cohort as well as stratified by maternal pre-pregnancy BMI (< 25 vs. =  > 25 kg/m2), adjusting for demographics and lifestyle factors. We used weighted quantile sum regression to find the combined influence of the 5 PFAS on GWG, PPWR, and body fat percentage.

RESULTS

PFOA and PFHxS were inversely associated with total GWG (PFOA: ß = -1.54 kg, 95%CI: -2.79, -0.30; rate ß = -0.05 kg/week, 95%CI: -0.09, -0.01; PFHxS: ß = -1.59 kg, 95%CI: -3.39, 0.21; rate ß = -0.05 kg/week, 95%CI: -0.11, 0.01) and PPWR at 6 and 12 months (PFOA 6 months: ß = -2.39 kg, 95%CI: -4.17, -0.61; 12 months: ß = -4.02 kg, 95%CI: -6.58, -1.46; PFHxS 6 months: ß = -2.94 kg, 95%CI: -5.52, -0.35; 12 months: ß = -5.13 kg, 95%CI: -8.34, -1.93). PFOA was additionally associated with lower body fat percentage at 6 and 12 months (ß = -1.75, 95%CI: -3.17, -0.32; ß = -1.64, 95%CI: -3.43, 0.16, respectively) with stronger associations observed in participants with higher pre-pregnancy BMI. The PFAS mixture was inversely associated with weight retention at 12 months (ß = -2.030, 95%CI: -3.486, -0.573) amongst all participants.

CONCLUSION

PFAS, in particular PFOA and PFHxS, in pregnancy are associated with altered patterns of GWG and postpartum adiposity with potential implications for fetal development and long-term maternal cardiometabolic health.

Effectiveness of a structured exercise intervention in gestational weight gain in pregnant women with overweight and obesity: A systematic review with meta-analysis

OBJECTIVES

To assess the effectiveness of exercise interventions during pregnancy in managing gestational weight gain (GWG), excessive GWG, gestational diabetes (GD), hypertensive disorders, 2-h post-oral glucose tolerance test (OGTT), and birth weight in pregnant women with overweight/obesity (OW/OB).

METHODS

The search strategy was conducted in five electronic databases, restricting to articles published within the past 10 years. Randomized controlled trials comparing exercise intervention with usual prenatal care in pregnant women with OW/OB were considered. Two reviewers extracted data and assessed the risk of bias using version 2 of the Cochrane risk-of-bias tool for randomized trials and the quality of studies using Grading of Recommendations Assessment, Development and Evaluation classification. Continuous data were calculated as mean differences (MDs) and dichotomous data as risk ratios (RRs).

RESULTS

Seven trials comprising 1648 pregnant women were included. Exercise interventions were associated with lower GWG (MD, -1.19 kg [95% confidence interval, CI, -1.79 to -0.60]) and lower incidence of GD (RR, 0.56 [95% CI, 0.40-0.78]). When analyzing excessive GWG, 2-h post-OGTT, birth weight, and hypertensive disorders, there was no statistically significant difference between the exercise and usual care groups. The strength of evidence was considered moderate.

CONCLUSION

Exercise interventions during pregnancy in women with OW/OB were shown to influence GWG and the incidence of GD.

Using the Person-Based Approach to Develop a Digital Intervention Targeting Diet and Physical Activity in Pregnancy: Development Study

BACKGROUND

In pregnancy, eating well, keeping active, and avoiding excessive weight gain are associated with better maternal and fetal health outcomes. Dietary and physical activity (PA) interventions can be effective in changing behaviors and managing weight gain. The comparatively lower cost and greater accessibility of digital interventions make them an attractive alternative to in-person interventions. Baby Buddy is a free pregnancy and parenting app from the charity Best Beginnings. Designed to support parents, improve health outcomes, and reduce inequalities, the app is actively used within the UK National Health Service. It offers an ideal platform for delivering and evaluating a new prenatal dietary and PA intervention.

OBJECTIVE

The aim of this study was to create a theory-based intervention within Baby Buddy to empower, encourage, and support expectant parents to develop healthier dietary and PA habits for pregnancy and parenthood.

METHODS

The intervention's development process was guided by the Behavior Change Wheel, with the person-based approach used to create and test its design. Three stages of qualitative research with pregnant and recently pregnant parents guided the intervention design. Study 1 (n=30), comprising 4 web-based focus groups and 12 telephone interviews, gauged response to the rudimentary concept and generated ideas for its development. Results were analyzed thematically. At this stage, the guiding principles for the intervention development were established, and regular team meetings ensured that the intervention design remained aligned with Best Beginnings' objectives, evidence-based approach, and feasibility criteria. Study 2 (n=29), comprising web-based individual and couple interviews, explored design ideas using wireframes and scripts and generated iterative feedback on the intervention content, branding, and tone. A table of changes analysis tracked design amendments. Study 3 (n=19) tested an app prototype using think-aloud interviews with current Baby Buddy users. A patient and public involvement and engagement activity (n=18) and other expert contributors (n=14) provided ad hoc input into the research process and design development.

RESULTS

Study 1 confirmed the appeal and relevance of the intervention concept and its novel approach of including partners. The identified themes underpinned the development of the intervention design. Iterative feedback from study 2, in conjunction with patient and public involvement and engagement and expert contributor input, helped refine the intervention design and ensure its relevance and appeal to a diverse target user group. Study 3 highlighted functionality, content, and design issues with the app prototype and identified ways of improving the user experience.

CONCLUSIONS

This study illustrates the value of combining a theoretical method for intervention development with the person-based approach to create a theory-based intervention that is also user-friendly, appealing, and engaging for its target audience. Further research is needed to evaluate the effectiveness of the intervention in improving diet, PA, and weight management in pregnancy.

Number of children and disability pension due to mental and musculoskeletal disorders: A longitudinal register-based study in Norway

Earlier research has documented a relationship between parity and all-cause mortality, as well as parity and cause-specific mortality (e.g. cancer and cardiovascular disease mortality). Less is known about the relationship between parity and two very common (but less deadly) types of disorder: mental and musculoskeletal. We examine the association between parity and risk of disability pensioning from all causes and due to mental or musculoskeletal disorders, using Norwegian register data. In addition to controlling for adult socio-demographic characteristics, we control for unobserved confounding from family background by estimating sibling fixed-effects models. We find a higher risk of disability pensioning among the childless and those with one child than for parents with two children, both for all causes combined and for mental disorders. Childless men and fathers with one child also experience excess risk of being pensioned due to musculoskeletal disorders. For mental disorders, we find a positive association with high parity, particularly for men.

The effect of motivational interviewing and/or cognitive behaviour therapy techniques on gestational weight gain - a systematic review and meta-analysis

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).

Implementation of postpartum navigation for low-income individuals at an urban academic medical center

BACKGROUND

Patient navigation, a patient-centered intervention to promote comprehensive health care, is an emerging innovation in obstetrics to optimize postpartum care. We aimed to evaluate the implementation of a novel postpartum patient navigation program at an urban academic medical center.

METHODS

This mixed-methods study analyzed the implementation of a postpartum patient navigation program within an ongoing randomized control trial. This study analyzed three navigators' logs of interactions with 50 patients, care team members, and community organizations throughout patients' first year postpartum. We categorized and quantified interactions by topic addressed, care team member interacted with, and communication mode used. We also conducted semi-structured interviews with each navigator every three months (5 interviews per navigator), emphasizing navigation experiences, relationships with patients and care teams, integration in the care team, and healthcare system gaps. Interview data were analyzed using the constant comparative method to identify themes using the constructs of the Consolidated Framework for Implementation Research (CFIR).

RESULTS

Analysis of navigator logs revealed a high patient need level, especially in the first 3 months postpartum. CFIR-guided analysis of intervention characteristics revealed positive perceptions of navigation's utility due to its adaptability. Navigation's complexity, however, posed an early obstacle to implementation that diminished over time. Outer setting analysis indicated navigators addressed patient needs through interactions with multiple systems. Despite clinicians' initial unfamiliarity with navigation, inner setting analysis suggested ongoing communication and electronic medical record use facilitated integration into the care team. Regarding individual and process characteristics, findings emphasized how navigator self-efficacy and confidence increased with experience (individual) and was facilitated by comprehensive training and reflection (process). Overall, barriers to implementation included unfamiliarity, varied patient engagement, and innovation complexity. Facilitators included high patient need, communication with outside organizations, medical record usage, navigator characteristics (self-efficacy, communication skills, and personal growth), a comprehensive training period, consistent reflection, high relative advantage, and high adaptability to patient need.

CONCLUSION

Patient navigation is a promising innovation to improve postpartum care coordination and support care team efforts. The successful implementation of navigation in this study indicates that, if shown to improve patient outcomes, obstetric navigation could be a component of patient-centered postpartum care.

Associations of maternal insulin sensitivity during pregnancy with childhood central adiposity in the Genetics of Glucose regulation in Gestation and Growth (Gen3G) cohort

BACKGROUND

Childhood obesity has been associated with prenatal exposure to maternal hyperglycaemia, but we lack understanding about maternal insulin physiologic components that contribute to this association.

OBJECTIVES

Evaluate the association between maternal insulin sensitivity during pregnancy and adiposity measures in childhood.

METHODS

In 422 mother-child pairs, we tested associations between maternal insulin sensitivity measures at ~26 weeks of pregnancy and child adiposity measures, including dual-energy X-ray absorptiometry body composition and anthropometry (body mass index and waist circumference) at ~5 years. We used linear regression analyses to adjust for maternal age, ethnicity, gravidity, first-trimester body mass index, and child sex and age at mid-childhood.

RESULTS

In early pregnancy, maternal mean age was 28.6 ± 4.3 years and median body mass index was 24.1 kg/m2 . Lower maternal insulin sensitivity indices were correlated with greater child adiposity based on anthropometry measures and on dual-energy X-ray absorptiometry total and trunk % fat in univariate associations (r = -0.122 to -0.159). Lower maternal insulin sensitivity was specifically associated with higher dual-energy X-ray absorptiometry trunk % fat (n = 359 for Matsuda; β = -0.034 ± 0.013; p = 0.01) after adjustment for covariates, including maternal body mass index.

CONCLUSIONS

Maternal insulin sensitivity during pregnancy may contribute to increased risk for higher offspring central adiposity in middle childhood.

The effect of vitamin D supplementation on body composition in nursing mothers with overweight or obesity: a randomized double-blind placebo-controlled clinical trial

BACKGROUND

This study aimed to evaluate the effect of vitamin D3 supplementation on body composition and anthropometric measures of nursing mothers.

METHODS

In a double-blind, randomized clinical trial, 90 nursing mothers with overweight or obesity were randomized into three groups for 12 weeks: two groups of vitamin D3 supplementation (2000 IU/d (VD1), n = 32 and 4000 IU/d (VD2), n = 29) and placebo (PL) group (n = 29). The information on body composition was obtained using the body impedance analysis (BIA) method. Serum 25-Hydroxy vitamin D (25(OH) D), Intact Parathyroid Hormone (iPTH), calcium, and phosphorus were measured before and after the intervention. Data were analyzed based on the intention-to-treat (ITT) method. Two-way repeated measure ANOVA (mixed ANOVA) was applied to assess whether the mean changes in the results from baseline to 12 weeks differ in the three groups.

RESULTS

There was a significant increase in the serum 25(OH) D concentration in the VD2 group compared to VD1 and PL groups (mean change (MC), 12.3 ng/ml; 95% CI, 9.4/15.0, p-value < 0.001). In addition, fat mass (MC, - 4.3 kg; 95% CI, - 7.0/- 1.1, p-value < 0.007), fat mass index (MC, - 1.6; 95% CI, - 2.6/- 0.5, p-value < 0.006) and body fat percentage (MC, - 8.1; 95% CI, - 12.0/- 4.2, p-value < 0.007) reduced in VD2 group as compared with VD1 and PL groups.

CONCLUSION

The intake of 4000 IU/d vitamins D3 supplementation would elevate circulating 25(OH) D concentrations in nursing mothers with overweight or obesity and improve some indices of body composition.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials ( http://www.irct.ir : IRCT20140413017254N6) registered on 11-04-2018. The graphical abstract of this clinical trial, is a figure that explains the final results of the manuscript in a clear and attractive way.

Assessing the Content and Quality of Digital Tools for Managing Gestational Weight Gain: Systematic Search and Evaluation

BACKGROUND

Digital health resources have the potential to assist women in optimizing gestational weight gain (GWG) during pregnancy to improve maternal health outcomes.

OBJECTIVE

In this study, we aimed to evaluate the quality and behavior change potential of publicly available digital tools (websites and apps) that facilitate GWG tracking.

METHODS

Digital tools were identified using key search terms across website search engines and app stores and evaluated using the Mobile App Rating Scale, the App Behavior Change Scale, as well as criteria to evaluate the rigor and safety of GWG information.

RESULTS

Overall, 1085 tools were screened for inclusion (162 websites and 923 apps), and 19 were deemed eligible. The mean Mobile App Rating Scale quality score was 3.31 (SD 0.53) out of 5, ranging from 2.26 to 4.39, and the mean App Behavior Change Scale score was 6 (SD 3.4) out of 21, ranging from 19 to 0. Of the 19 items used to evaluate rigor of GWG advice, most tools (n=11, 57.9%) contained ≤3 items.

CONCLUSIONS

This review emphasizes the substantial limitations in current digital resources promoting the monitoring and optimization of GWG. Most tools were of low quality, had minimal behavior change potential, and were potentially unsafe, with minimal linkage to evidence-based information or partnership with health care.

Remote multimodality monitoring of maternal physiology from the first trimester to postpartum period: study results

OBJECTIVES

Current antenatal care largely relies on widely spaced appointments, hence only a fraction of the pregnancy period is subject to monitoring. Continuous monitoring of physiological parameters could represent a paradigm shift in obstetric care. Here, we analyse the data from daily home monitoring in pregnancy and consider the implications of this approach for tracking pregnancy health.

METHODS

Prospective feasibility study of continuous home monitoring of blood pressure, weight, heart rate, sleep and activity patterns from the first trimester to 6 weeks postpartum.

RESULTS

Fourteen out of 24 women completed the study (58%). Compared to early pregnancy [week 13, median heart rate (HR) 72/min, interquartile range (IQR) 12.8], heart rate increased by week 35 (HR 78/min, IQR 16.6; P  = 0.041) and fell postpartum (HR 66/min, IQR 11.5, P  = 0.021). Both systolic and diastolic blood pressure were lower at mid-gestation (week 20: SBP 103 mmHg, IQR 6.6; DPB 63 mmHg, IQR 5.3 P  = 0.005 and P  = 0.045, respectively) compared to early pregnancy (week 13, SBP 107 mmHg, IQR 12.4; DPB 67 mmHg, IQR 7.1). Weight increased during pregnancy between each time period analyzed, starting from week 15. Smartwatch recordings indicated that activity increased in the prepartum period, while deep sleep declined as pregnancy progressed.

CONCLUSION

Home monitoring tracks individual physiological responses to pregnancy in high resolution that routine clinic visits cannot. Changes in the study protocol suggested by the study participants may improve compliance for future studies, which was particularly low in the postpartum period. Future work will investigate whether distinct adaptative patterns predate obstetric complications, or can predict long-term maternal cardiovascular health.

A Comparison of Bioimpedance Analysis vs. Dual X-ray Absorptiometry for Body Composition Assessment in Postpartum Women and Non-Postpartum Controls

Postpartum fat mass (FM) and fat-free mass (FFM) may be informative predictors of future disease risk among women; hence, there is growing use of bioelectrical impedance analysis (BIA) to quantify FFM and FM among postpartum women due to the quick, non-invasive, and inexpensive nature of BIA. Despite this, very few studies have examined BIA's performance, and it remains unclear as to whether specific BIA equations are needed for postpartum women. To explore these questions, we measured total body FFM and FM with a multi-frequency, segmental BIA, and dual-X-ray absorptiometry (DXA) in (1) women at one and four months postpartum (n = 21); and (2) height- and weight-matched non-postpartum women (controls, n = 21). BIA was compared to DXA using Deming regression models, paired t-tests, and Bland-Altman plots. Between-group comparisons were performed using an analysis of variance models. The mean difference between DXA and BIA was 1.2 ± 1.7 kg FFM (p < 0.01) and -1.0 ± 1.7 kg FM (p < 0.05) in postpartum women at both time points. The measurements of longitudinal changes in FFM and FM were not significantly different between BIA and DXA. Furthermore, there was no significant difference in BIA's performance in postpartum vs. non-postpartum women (p = 0.29), which suggests that population-specific equations are not needed for postpartum women. The results of this study suggest that BIA is a suitable method to assess postpartum body composition among women at one and four months postpartum, using existing age-, race-, and sex-adjusted equations.

Prenatal programming of developmental trajectories for obesity risk and early pubertal timing

The thrifty phenotype and fetal overnutrition hypotheses are two developmental hypotheses that originated from the developmental origins of health and disease (DOHaD) perspective. The DOHaD posits that exposures experienced prenatally and early in life may influence health outcomes through altering form and function of internal organs related to metabolic processes. Obesity risk and early pubertal timing might be influenced by similar mechanisms. The thrifty phenotype hypothesis is primarily characterized by experiencing a deprivation of nutrients during gestation paired with an energy rich postnatal environment. The fetal overnutrition hypothesis says that obesity experienced prenatally will be associated with increased lifetime risk of obesity in the offspring. Both hypotheses were tested by examining developmental pathways from genetic and prenatal risk through early growth trajectories (birth to 7 years) to pubertal timing at age 11 years. Participants included 361 children adopted at birth (57% male; 57% non-Hispanic White, 11% Black, 9% Hispanic; adoptive family income Mdn = $70,000-$100,000, birth family income Mdn = < $15,000). Associations between boys' childhood body mass index (BMI) and pubertal timing were confounded by genetics, prenatal risk, and early growth. The thrifty phenotype hypothesis was partially supported for boys' childhood BMI (at ages 4 to 7 years). Both hypotheses were partially supported for girls' childhood BMI but not pubertal timing. A novel Gene × Prenatal Risk interaction showed that genetic risk predicted girls' childhood BMI most strongly at adequate compared with at excessive levels of gestational weight gain. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Fourth Trimester: a Time for Enhancing Transitions in Cardiovascular Care

Purpose of Review

The "fourth trimester" concept, defined as the first 12 weeks after delivery (and beyond), is a critical window of time for clinicians to intervene to optimize women's cardiovascular health after pregnancy. A timely and comprehensive postpartum cardiovascular assessment should be performed in all women following delivery in order to (1) follow up medical conditions present prior to conception, (2) evaluate symptoms and signs of common postpartum complications, and (3) identify risk factors and prevent future adverse cardiovascular outcomes. In this review, we aim to discuss major maternal cardiovascular risk factors such as hypertensive disorders of pregnancy, gestational diabetes mellitus, postpartum weight retention, and postpartum depression, as well as lactation as a potential protective risk modifying factor. Additionally, we will review effectiveness of outpatient interventions to enhance transitions in cardiovascular care during the fourth trimester.

Recent Findings

A seamless hand-off from obstetric to primary care, and potentially cardiology, is needed for early detection and management of hypertension, weight, glycemic control, stress and mood, and long-term cardiovascular risk. Additionally, the use of telemedicine, blood pressure self-monitoring, remote activity monitoring, and behavioral health coaches are potentially feasible modalities to augment clinic-based care for cardiovascular risk factors and weight management, but additional studies are needed to study their long-term effectiveness.

Summary

Development of a comprehensive postpartum care plan with careful consideration of each patient's risk profile and access to resources is critical to improve maternal morbidity and mortality, reduce health disparities, and achieve long-term cardiovascular health for women. Supporting postpartum well-being of women during this transition period requires a multidisciplinary approach, especially primary care engagement, and planning should start before delivery.

A theory driven, pragmatic trial implementing changes to routine antenatal care that supports recommended pregnancy weight gain

Background

Prevention of weight gain outside recommendations is a challenge for health services, with several barriers to best practice care identified. The aim of this pragmatic implementation study with a historical control was to examine the impact of implementing a service wide education program, and antenatal care pregnancy weight gain chart combined with brief advice on women’s knowledge of recommended gestational weight gain (GWG), the advice received and actual GWG.

Methods

The PRECEDE PROCEED Model of Health Program planning guided intervention and evaluation targets and an implementation science approach facilitated service changes. Pregnant women < 22 weeks’ gestation attending the antenatal clinic at a metropolitan birthing hospital in Australia were recruited pre (2010, n = 715) and post (2016, n = 478) implementation of service changes. Weight measurements and questionnaires were completed at recruitment and 36 weeks’ gestation. Questionnaires assessed advice received from health professionals related to healthy eating, physical activity, GWG, and at recruitment only, pre-pregnancy weight and knowledge of GWG recommendations.

Results

Women who correctly reported their recommended GWG increased from 34% (pre) to 53% (post) (p < 0.001). Between pre and post implementation, the advice women received from midwives on recommended GWG was significantly improved at both recruitment- and 36-weeks’ gestation. For normal weight women there was a reduction in GWG (14.2 ± 5.3 vs 13.3 ± 4.7 kg, p = 0.04) and clinically important reduction in excess GWG between pre and post implementation (31% vs 24%, p = 0.035) which remained significant after adjustment (AOR 0.53 [95%CI 0.29–0.96]) (p = 0.005).

Conclusions

Service wide changes to routine antenatal care that address identified barriers to supporting recommended GWG are likely to improve the care and advice women receive and prevent excess GWG for normal weight women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04750-8.

Role of Perinatal Biological Factors in Delayed Lactogenesis II Among Women With Pre-pregnancy Overweight and Obesity

BACKGROUND

Pre-pregnancy overweight and obesity are negatively associated with delayed onset of lactogenesis II (OL), but the mechanisms by which these conditions affect OL are still unclear.

OBJECTIVES

To identify biological factors related to pre-pregnancy overweight/obesity and determine whether these biological factors were associated with delayed OL in this population.

METHODS

In this prospective observational study, we assigned 72 primipara to a pre-pregnancy overweight/obese group (n = 36) and a normal-weight group (n = 36). Blood samples were collected at 37 w of gestation and 48 h postpartum and assayed for levels of the following hormones: leptin, insulin, estradiol, prolactin (PRL), progesterone, and oxytocin. The primary outcome was timing of OL, estimated by maternal perception of breast fullness. We used linear-regression analysis to determine associations between hormones and delayed OL.

RESULTS

Sixty-three participants (87.5%) had complete data. OL occurred later in overweight/obese than in normal-weight women (p < .001). Compared with the normal-weight group, the overweight/obese group showed higher leptin levels at both times of observation and exhibited a slower drop in estrogen concentrations from 37 w of gestation to 48 h postpartum (all p < .05). After adjusting for confounding factors, leptin concentrations in late pregnancy and the magnitudes of decline in estrogen concentrations at 48 h postpartum were correlated with OL.

CONCLUSION

Women who were overweight/obese before pregnancy had elevated leptin levels in late pregnancy and a delayed decline in estrogen concentrations at 48 h postpartum. Both of these phenomena were related to delayed OL in this population.

Correlation between parity and metabolic syndrome in Chinese women aged 40 years and older: the Reaction study

AIMS

The purpose of the present study was to investigate the correlation between the number of live-birth pregnancies and metabolic syndrome (MetS) in Chinese women according to menstruation history.

METHODS

Registry data for all pregnancies in a cohort of 6157 Chinese women aged 40 years or older were obtained and the number of live-birth pregnancies were enumerated. We defined MetS using five criteria: impaired insulin metabolism and glucose tolerance, obesity in the abdominal area, dyslipidemia, and hypertension. Multivariate logistic regression analysis was conducted to assess potential risk factors for MetS. Postmenopausal women with three or more of live-birth pregnancies had the highest prevalence of MetS (P < 0.05).

RESULTS

Among the 6157 females aged 40 years or older in Luzhou city, 2143 (34.8%) participants had incident MetS. The number of live-birth pregnancies was significantly correlated with age and fasting blood glucose (FBG) level (P < 0.05). The prevalence of MetS increased with the number of live-birth pregnancies (P < 0.01), and the frequency in postmenopausal women was significantly higher than that in premenopausal women (P < 0.001). In the binary logistic regression model, menopausal status [OR = 0.343 (0.153-0.769), P < 0.001] were significantly associated with an increased risk of MetS.

CONCLUSIONS

The number of live-birth pregnancies is correlated with an increased risk of MetS in Chinese women aged 40 years and over, especially in postmenopausal women. Greater attention should be paid to postmenopausal women who have had multiple live-birth pregnancies with a view to intervening early to prevent related diseases.

Maternal Gestational Weight Gain in Relation to Antidepressant Continuation in Pregnancy

OBJECTIVE

Both excessive and inadequate gestational weight gain (GWG) are associated with adverse health outcomes for the woman and her child. Antidepressant use in pregnancy could affect GWG, based on evidence in nonpregnant women that some antidepressants may cause weight gain and others weight loss. Previous studies of antidepressant use and GWG were small with limited ability to account for confounding, including by maternal mental health status and severity. We assessed the association of antidepressant continuation in pregnancy with GWG among women using antidepressants before pregnancy.

STUDY DESIGN

Our retrospective cohort study included singleton livebirths from 2001 to 2014 within Kaiser Permanente Washington, an integrated health care system. Data were obtained from electronic health records and linked Washington State birth records. Among women with ≥1 antidepressant fill within 6 months before pregnancy, women who filled an antidepressant during pregnancy were considered "continuers;" women without a fill were "discontinuers." We calculated mean differences in GWG and relative risks (RR) of inadequate and excessive weight gain based on Institute of Medicine guidelines. Using inverse probability of treatment weighting with generalized estimating equations, we addressed differences in maternal characteristics, including mental health conditions.

RESULTS

Among the 2,887 births, 1,689 (59%) were to women who continued antidepressants in pregnancy and 1,198 (42%) were to discontinuers. After accounting for confounding, continuers had similar weight gain to those who discontinued (mean difference: 1.3 lbs, 95% confidence interval [CI]: -0.1 to 2.8 lbs) and similar risks of inadequate and excessive GWG (RR: 0.95, 95% CI: 0.80-1.14 and RR: 1.06, 95% CI: 0.98-1.14, respectively). Findings were comparable for specific antidepressants and trimesters of exposure.

CONCLUSION

We did not find evidence that continuation of antidepressants in pregnancy led to differences in GWG.

KEY POINTS

· Antidepressant use is associated with weight change in nonpregnant populations.. · Prior evidence on whether antidepressant use in pregnancy affects gestational weight gain is sparse.. · We accounted for confounding by characteristics such as mental health conditions and their severity.. · We found no association between pregnancy antidepressant continuation and gestational weight gain..

The Association between Weight-related Variables and Postpartum Depressive Symptoms

Objectives: Postpartum depressive symptoms (PPDS) are common, and weight-related variables may be risk factors. In this study, we examined associations between weight-related variables and PPDS in postpartum women. Methods: Participants who gave birth within the past 12 months completed an online survey assessing various weight-related variables and PPDS. We examined associations between weight-related variables and PPDS using regression models. Results: Participants (N=315) were 30.1±3.9 years of age and 5.6±3.7 months postpartum. A majority were white (96.2%), married (87.9%), and had a bachelor's degree or higher (70.5%). Having a higher pre-pregnancy body mass index (BMI) and current BMI, lower weight loss at 6 months postpartum, and substantial postpartum weight retention were associated with higher PPDS. There was no relationship between total gestational weight gain, IOM weight gain category, excess weight gain, postpartum weight retention, and pre-pregnancy-to-postpartum change in BMI, and postpartum depressive symptoms. Conclusions: Understanding factors associated with postpartum depressive symptoms can help to develop and implement appropriate screenings/follow-ups and interventions among those at greatest risk. Given the potential connection to PPDS, there is a need for interventions aimed at promoting healthy pre-conception weight and helping women to lose excess pregnancy weight during the postpartum period.

Interconception Care for Primary Care Providers: Consensus Recommendations on Preconception and Postpartum Management of Reproductive-Age Patients With Medical Comorbidities

Severe maternal morbidity and mortality continue to increase in the United States, largely owing to chronic and newly diagnosed medical comorbidities. Interconception care, or care and management of medical conditions between pregnancies, can improve chronic disease control before, during, and after pregnancy. It is a crucial and time-sensitive intervention that can decrease maternal morbidity and mortality and improve overall health. Despite these potential benefits, interconception care has not been well implemented by the primary care community. Furthermore, there is a lack of guidelines for optimizing preconception chronic disease, risk stratifying postpartum chronic diseases, and recommending general collaborative management principles for reproductive-age patients in the period between pregnancies. As a result, many primary care providers, especially those without obstetric training, are unclear about their specific role in interconception care and may be unsure of effective methods for collaborating with obstetric care providers. In particular, internal medicine physicians, the largest group of primary care physicians, may lack sufficient clinical exposure to medical conditions in the obstetric population during their residency training and may feel uncomfortable in caring for these patients in their subsequent practice.

The objective of this article is to review concepts around interconception care, focusing specifically on preconception care for patients with chronic medical conditions (eg, chronic hypertension, chronic diabetes mellitus, chronic kidney disease, venous thromboembolism, and obesity) and postpartum care for those with medically complicated pregnancies (eg, hypertensive disorders of pregnancy, gestational diabetes mellitus, excessive gestational weight gain, peripartum cardiomyopathy, and peripartum mood disorders). We also provide a pragmatic checklist for preconception and postpartum management.

Weight gain and body composition during pregnancy: a randomised pilot trial with probiotics and/or fish oil

We evaluated the effects of fish oil and/or probiotic supplementation in a randomised placebo-controlled intervention pilot trial on gestational weight gain (GWG) and body composition. Additionally, the influence of gestational diabetes (GDM) on GWG and body composition was assessed. We randomised 439 overweight women into intervention groups: fish oil + placebo, probiotics + placebo, fish oil + probiotics and placebo + placebo (fish oil: 1·9 g DHA and 0·22 g EPA and probiotics: Lactobacillus rhamnosus HN001 and Bifidobacterium animalis ssp. lactis 420, 1010 colony-forming units each). GDM was diagnosed with oral glucose tolerance test. Body composition was measured with air displacement plethysmography at randomisation (mean 13·9) and in late pregnancy (mean 35·2 gestational weeks). Intervention did not influence mean GWG or change in body fat mass/percentage (P > 0·17). Body composition in early pregnancy did not differ between the women who did or did not develop GDM (adjusted P > 0·23). Compared with the normoglycaemic women (n 278), women diagnosed with GDM (n 119) gained less weight (7·7 (sd 0·4) v. 9·3 (sd 0·4) kg, adjusted mean difference -1·66 (95 % CI -2·52, -0·80) and fat mass (0·4 (sd 0·4) v. 1·8 (sd 0·3) kg, adjusted mean difference -1·43 (95 % CI -2·19, -0·67) during the follow-up. In conclusion, adiposity of pregnant overweight women was not affected by supplementation with fish oil and/or probiotics, nor did it predict the development of GDM. However, adiposity was reduced in women with GDM compared with normoglycaemic women irrespective of the dietary intervention.

The association between weight gain at different stages of pregnancy and risk of gestational diabetes mellitus

AIMS/INTRODUCTION

Women with excessive gestational weight gain (GWG) are at a higher risk for complications during pregnancy, such as preeclampsia. However, the association between excessive GWG and gestational diabetes mellitus (GDM) remains unclear.

MATERIALS AND METHODS

We retrospectively reviewed 8,352 women from our obstetric database with singleton pregnancies who gave birth after 28 completed weeks of gestation between January 1, 2012, and December 31, 2016, excluding pregnancies complicated by fetal anomalies, fetal death, and overt diabetes. Diagnosis of GDM was based on the criteria recommended by the International Association of Diabetes and Pregnancy Study Groups. We used two classification methods to define excessive GWG: a weight gain above the 90th percentile of the population, or exceeding the upper range recommended by the Institute of Medicine, stratified by pre-pregnancy body mass index. Statistical analysis was performed using multiple logistic regression to determine the association between excessive GWG and the risk of GDM.

RESULTS

Overall, 1,129 women (13.5%) were diagnosed with GDM. There was no difference in GWG between women with and without GDM in the first trimester and before GDM screening. Women with GDM had significantly less GWG in the second trimester, after GDM screening, and throughout the whole gestation than women without GDM. No correlation was found between excessive GWG in the first and second trimesters, before GDM screening, and the later development of GDM.

CONCLUSIONS

Our results indicate that excessive GWG prior to GDM screening is not associated with an increased risk of GDM.

Cardiovascular Risk Reduction in Women Following Hypertensive Disorders of Pregnancy - a Prospective, Randomised, Controlled Interventional Study

Background Women have a markedly increased lifetime risk for cardiovascular morbidity and mortality following hypertensive disorders of pregnancy. Arterial stiffness is regarded as a target parameter for reducing cardiovascular risk and can be modified by lifestyle changes.

Methods In a prospective, randomised, controlled interventional study, starting 6 weeks postpartum, the effect of nutritional intervention combined with an intensive 6-month cardiovascular exercise programme on arterial stiffness was investigated by means of pulse wave velocity (PWV) in 38 women with severe hypertensive disorder of pregnancy (preeclampsia with or without pre-existing hypertension and/or HELLP syndrome). A reference group was formed with postpartum women without pregnancy complications or known cardiovascular risk and the arterial stiffness was studied by means of PWV at the time of delivery. The PWV was measured in the intervention and control groups within a week after delivery and after 32 weeks (6 weeks + 6 months). A feasibility analysis was performed in addition.

Results 29 of 38 women with severe hypertensive disorder of pregnancy and 38 postpartum women in the reference group were included in the analysis (intervention group n = 14; control group n = 15; reference group n = 38). Adherence to a) the nutritional counselling and b) the intensive cardiovascular exercise programme was 73% and 79% respectively. A clinically significant difference (d = 0.65) in pulse wave velocity between the intervention and control groups was found after 6 months (6.36 ± 0.76 vs. 7.33 ± 2.25 m/s; group × time: p = 0.632). The PWV of the intervention group corresponded to that of the reference group at the end of the study (6.36 ± 0.76 m/s vs. 6.5 ± 0.70; d = 0.19), while the results in the control group differed markedly from this (7.33 ± 2.25 m/s; d = 0.56).

Conclusion The study documents the feasibility of lifestyle intervention with physical exercise after delivery (starting 6 weeks postpartum). The intervention showed a significant clinical effect by reducing arterial stiffness to the level of the reference group. Before this intervention can be included in the standard of care and prevention, follow-up studies must confirm these results and the medium-term effects on cardiovascular risk.

Endocrine-Disrupting Chemical Exposures in Pregnancy: a Sensitive Window for Later-Life Cardiometabolic Health in Women

Purpose of Review

Pregnancy can be seen as a “stress test” with complications predicting later-life cardiovascular disease risk. Here, we review the growing epidemiological literature evaluating environmental endocrine-disrupting chemical (EDC) exposure in pregnancy in relation to two important cardiovascular disease risk factors, hypertensive disorders of pregnancy and maternal obesity.

Recent Findings

Overall, evidence of EDC-maternal cardiometabolic associations was mixed. The most consistent associations were observed for phenols and maternal obesity, as well as for perfluoroalkyl substances (PFASs) with hypertensive disorders. Research on polybrominated flame retardants and maternal cardiometabolic outcomes is limited, but suggestive.

Summary

Although numerous studies evaluated pregnancy outcomes, few evaluated the postpartum period or assessed chemical mixtures. Overall, there is a need to better understand whether pregnancy exposure to these chemicals could contribute to adverse cardiometabolic health outcomes in women, particularly given that cardiovascular disease is the leading cause of death in women.

Biological changes in the pregnancy-postpartum period and subsequent cardiometabolic risk-UPSIDE MOMS: A research protocol

Multiple physiological changes occur in pregnancy as a woman's body adapts to support the growing fetus. These pregnancy-induced changes are essential for fetal growth, but the extent to which they reverse after pregnancy remains in question. For some women, physiological changes persist after pregnancy and may increase long-term cardiometabolic disease risk. The National Institutes of Health-funded study described in this protocol addresses a scientific gap by characterizing weight and biological changes during pregnancy and an extended postpartum period in relation to cardiometabolic risk. We use a longitudinal repeated measures design to prospectively examine maternal health from early pregnancy until 3 years postpartum. The aims are: (1) identify maternal weight profiles in the pregnancy-postpartum period that predict adverse cardiometabolic risk profiles three years postpartum; (2) describe immune, endocrine, and metabolic biomarker profiles in the pregnancy-postpartum period, and determine their associations with cardiometabolic risk; and (3) determine how modifiable postpartum health behaviors (diet, physical activity, breastfeeding, sleep, stress) (a) predict weight and cardiometabolic risk in the postpartum period; and (b) moderate associations between postpartum weight retention and downstream cardiometabolic risk. The proposed sample is 250 women. This study of mothers is conducted in conjunction with the Understanding Pregnancy Signals and Infant Development study, which examines child health outcomes. Biological and behavioral data are collected in each trimester and at 6, 12, 24, and 36 months postpartum. Findings will inform targeted health strategies that promote health and reduce cardiometabolic risk in childbearing women.

Association of weight status and carbohydrate intake with gestational weight gain

Test the hypothesis that women with obesity have greater gestation weight gain (GWG) with a moderately higher, vs lower, carbohydrate (CHO) diet, independent of energy intake, whereas GWG for women of normal weight would not differ by CHO group. This was a secondary analysis of data collected from glucose tolerant women with normal weight (NW) or obesity in pregnancy. Women completed a three-day food diary 16 to 20 weeks. A median split for percent kilocalories from CHO (median = 49.6%) categorized women into moderately highCHO vs lowCHO groups (n = 13-15/group). GWG was calculated between consent and the last prenatal care visit. A two-way ANOVA was used to examine whether there was an interaction between weight status and CHO group on GWG, independent of energy intake, time between consent and last prenatal visit, and age. Women in both highCHO groups consumed more sugars and starches compared to women in the lowCHO groups (P < .05). A significant interaction between weight status and CHO content of the diet was found (P < .05), such that, for women with obesity, those consuming a lowCHO diet had less GWG than those consuming a highCHO diet, whereas the pattern was opposite for women with NW. Results suggest that intake of a moderately lower CHO diet may help limit GWG among glucose tolerant women with obesity. Given that women in this study were eligible only if they had normal fasting glucose concentrations in early pregnancy, it is not clear if these results would generalize to all women with obesity during pregnancy.

Adipose tissue function in healthy pregnancy, gestational diabetes mellitus and pre-eclampsia

Gestational diabetes mellitus (GDM) is a common disorder of pregnancy with short- and long-term consequences for mother and baby. Pre-eclampsia is of major concern to obstetricians due to its sudden onset and increased morbidity and mortality for mother and baby. The incidence of these conditions continues to increase due to widespread maternal obesity. Maternal obesity is a risk factor for GDM and pre-eclampsia, yet our understanding of the role of adipose tissue and adipocyte biology in their aetiology is very limited. In this article, available data on adipose tissue and adipocyte function in healthy and obese pregnancy and how these are altered in GDM and pre-eclampsia are reviewed. Using our understanding of adipose tissue and adipocyte biology in non-pregnant populations, a role for underlying adipocyte dysfunction in the pathological pathways of these conditions is discussed.

Determining optimal gestational weight gain (GWG) in a northwest Chinese population: A CONSORT

ABSTRACT

To determine optimal gestational weight gain (GWG) for the Chinese population.Live singleton deliveries at the largest maternal & childcare hospital in northwest China from 2010 to 2012 were analyzed retrospectively. Multivariable logistic regression analysis was conducted to determine the lowest aggregated risk of interested perinatal outcomes based on Chinese adult body mass index (BMI) categories.Eight thousand eight hundred seventy enrolled parturients were divided into 4 groups according to their prepregnancy BMI: underweight (21.31%, BMI < 18.5 kg/m2), normal weight (67.81%, 18.5 kg/m2 ≤ BMI < 24 kg/m2), overweight (8.99%, 24 kg/m2 ≤ BMI < 28 kg/m2 and obese (1.89%, BMI ≥ 28 kg/m2). The optimal GWG values for the above 4 groups were 16.7 kg (GWG range, 12.0-21.5), 14.5 kg (9.5-19.5), 11.5 kg (7.0-16.5), and 8.0 kg (5.0-13.0). The rates of inadequate, optimal and excessive GWG in present study were 6.14% (545), 62.34% (5529), and 31.52% (2796) respectively, which were significantly different from those of the 2009 Institute of Medicine recommendation (χ2 = 1416.05, Pinteraction < 0.0001).Wider optimal GWG ranges than those recommended by Institute of Medicine were found in our study, and our proposed criteria seems to be practical to the Chinese population.

A meta-review of systematic reviews of lifestyle interventions for reducing gestational weight gain in women with overweight or obesity

Women with overweight or obesity are twice as likely to gain excessive gestational weight than women of normal weight. Identifying effective interventions to support this group achieve healthy gestational weight gain is important. An overview of systematic reviews regarding the effectiveness of lifestyle interventions on gestational weight gain in women with overweight or obesity was undertaken, including searching eight electronic databases. Quality of included reviews was assessed by two independent researchers. A narrative data synthesis was undertaken, with subgroup and sensitivity analyses by type of intervention and quality of the included reviews. A total of 15 systematic reviews were included within this meta-review. A small reduction in gestational weight gain of between 0.3 and 2.4 kg was noted with lifestyle interventions compared with standard care. There was some evidence that dietary only or physical activity only interventions may reduce the odds of gestational diabetes. No differences were noted in the odds of other maternal or infant health outcomes. Although lifestyle interventions appeared to decrease gestational weight gain, current evidence does not show a clear benefit on maternal and infant outcomes from the small nature of the reduction in gestational weight gain produced by lifestyle interventions in women with overweight or obesity.

Obesity and the Risk of Infertility, Gestational Diabetes, and Type 2 Diabetes in Polycystic Ovary Syndrome

This review describes the relationship between obesity and the most common reproductive (infertility) and metabolic (gestational diabetes mellitus [GDM] and type 2 diabetes mellitus [T2DM]) consequences in polycystic ovary syndrome (PCOS). It also describes the vital role of lifestyle management for PCOS. PCOS is a heterogeneous endocrine disorder common in reproductive-age women. Consensus on the exact etiological mechanisms of PCOS is unreached. Overweight or obesity is present in at least 60% of the PCOS population, but the condition occurs irrespective of BMI, with excess BMI increasing both the prevalence and severity of clinical features. Use of lifestyle therapies (nutrition, physical activity, and/or behavioral) for the prevention and management of excess weight gain, infertility, GDM, and T2DM is a vital component of best-practice PCOS care. Lifestyle management is recommended for all women with PCOS as the first-line treatment with or without medications. Due to a lack of high-quality trials demonstrating the efficacy of specific lifestyle approaches, PCOS lifestyle recommendations are as those for the general population. This review summarizes current knowledge relating to obesity and its impact on fertility, GDM, and T2DM. It also summarizes the lifestyle recommendations to best manage these conditions in women with PCOS and obesity.

Maternal weight change from prepregnancy to 18 months postpartum and subsequent risk of hypertension and cardiovascular disease in Danish women: A cohort study

BACKGROUND

One-fourth of women experience substantially higher weight years after childbirth. We examined weight change from prepregnancy to 18 months postpartum according to subsequent maternal risk of hypertension and cardiovascular disease (CVD).

METHODS AND FINDINGS

We conducted a cohort study of 47,966 women with a live-born singleton within the Danish National Birth Cohort (DNBC; 1997-2002). Interviews during pregnancy and 6 and 18 months postpartum provided information on height, gestational weight gain (GWG), postpartum weights, and maternal characteristics. Information on pregnancy complications, incident hypertension, and CVD was obtained from the National Patient Register. Using Cox regression, we estimated adjusted hazard ratios (HRs; 95% confidence interval [CI]) for hypertension and CVD through 16 years of follow-up. During this period, 2,011 women were diagnosed at the hospital with hypertension and 1,321 with CVD. The women were on average 32.3 years old (range 18.0-49.2) at start of follow-up, 73% had a prepregnancy BMI <25, and 27% a prepregnancy BMI ≥25. Compared with a stable weight (±1 BMI unit), weight gains from prepregnancy to 18 months postpartum of >1-2 and >2 BMI units were associated with 25% (10%-42%), P = 0.001 and 31% (14%-52%), P < 0.001 higher risks of hypertension, respectively. These risks were similar whether weight gain presented postpartum weight retention or a new gain from 6 months to 18 months postpartum and whether GWG was below, within, or above the recommendations. For CVD, findings differed according to prepregnancy BMI. In women with normal-/underweight, weight gain >2 BMI units and weight loss >1 BMI unit were associated with 48% (17%-87%), P = 0.001 and 28% (6%-55%), P = 0.01 higher risks of CVD, respectively. Further, weight loss >1 BMI unit combined with a GWG below recommended was associated with a 70% (24%-135%), P = 0.001 higher risk of CVD. No such increased risks were observed among women with overweight/obesity (interaction by prepregnancy BMI, P = 0.01, 0.03, and 0.03, respectively). The limitations of this observational study include potential confounding by prepregnancy metabolic health and self-reported maternal weights, which may lead to some misclassification.

CONCLUSIONS

Postpartum weight retention/new gain in all mothers and postpartum weight loss in mothers with normal-/underweight may be associated with later adverse cardiovascular health.

Long-Term IoT-Based Maternal Monitoring: System Design and Evaluation

Pregnancy is a unique time when many mothers gain awareness of their lifestyle and its impacts on the fetus. High-quality care during pregnancy is needed to identify possible complications early and ensure the mother’s and her unborn baby’s health and well-being. Different studies have thus far proposed maternal health monitoring systems. However, they are designed for a specific health problem or are limited to questionnaires and short-term data collection methods. Moreover, the requirements and challenges have not been evaluated in long-term studies. Maternal health necessitates a comprehensive framework enabling continuous monitoring of pregnant women. In this paper, we present an Internet-of-Things (IoT)-based system to provide ubiquitous maternal health monitoring during pregnancy and postpartum. The system consists of various data collectors to track the mother’s condition, including stress, sleep, and physical activity. We carried out the full system implementation and conducted a real human subject study on pregnant women in Southwestern Finland. We then evaluated the system’s feasibility, energy efficiency, and data reliability. Our results show that the implemented system is feasible in terms of system usage during nine months. We also indicate the smartwatch, used in our study, has acceptable energy efficiency in long-term monitoring and is able to collect reliable photoplethysmography data. Finally, we discuss the integration of the presented system with the current healthcare system.

The relationship between gestational weight gain, maternal upper-body subcutaneous fat changes and infant birth size: A pilot observational study amongst women with obesity

BACKGROUND

It is widely acknowledged that maternal obesity and excessive gestational weight gain (GWG) are associated with increased risk of fetal macrosomia and recent studies have suggested a role for the timing and composition of GWG.

AIMS

To examine the effect of the rate of change in GWG and maternal upper-body subcutaneous fat on neonatal anthropometric outcomes in a pilot observational study amongst women with obesity.

STUDY DESIGN

Expectant women with a body mass index (BMI) > 30 kg/m² at first antenatal appointment were recruited at 12 weeks gestation. Maternal height, weight and skinfold thickness (SFT) measurements were collected at baseline and repeated at 28 and 36 weeks gestation. Following delivery, World Health Organisation (WHO)-UK infant birthweight z-scores were calculated, and infant anthropometric measurements were obtained.

RESULTS

The sum of upper body SFT measurements increased in mid-pregnancy (0.08 ± 0.71 mm/week) and decreased in late pregnancy (-0.04 ± 1.17 mm/week). After adjustment for maternal age, BMI and parity, mid- but not late- pregnancy GWG was positively associated with infant birthweight z-score (p<0.05), while mid- but not late-pregnancy changes in the sum of SFT were inversely associated with infant birthweight z-score (p<0.01).

CONCLUSIONS

The present study suggests that mid- rather than late-pregnancy changes in weight and upper-body subcutaneous fat are associated with infant birthweight. Further research is required in larger, more diverse populations to explore whether pregnancy interventions aiming to improve maternal and offspring health can be personalised beyond BMI and GWG.