Maternal obesity: can pregnancy weight gain modify risk of selected adverse pregnancy outcomes?

The role of miRNA molecules in the miscarriage process

The etiology and pathogenesis of miscarriage, which is the most common pregnancy complication, have not been fully elucidated. There is a constant search for new screening biomarkers that would allow for the early diagnosis of disorders associated with pregnancy pathology. The profiling of microRNA expression is a promising research area, which can help establish the predictive factors for pregnancy diseases. Molecules of microRNAs are involved in several processes crucial for the development and functioning of the body. These processes include cell division and differentiation, programmed cell death, blood vessel formation or tumorigenesis, and the response to oxidative stress. The microRNAs affect the number of individual proteins in the body due to their ability to regulate gene expression at the post-transcriptional level, ensuring the normal course of many cellular processes. Based on the scientific facts available, this paper presents a compendium on the role of microRNA molecules in the miscarriage process. The expression of potential microRNA molecules as early minimally invasive diagnostic biomarkers may be evaluated as early as the first weeks of pregnancy and may constitute a monitoring factor in the individual clinical care of women in early pregnancy, especially after the first miscarriage. To summarize, the described scientific data set a new direction of research in the development of preventive care and prognostic monitoring of the course of pregnancy.

Effect of a Low-Glycemic Load Diet Intervention on Maternal and Pregnancy Outcomes in Obese Pregnant Women

The increased prevalence of obese, pregnant women who have a higher risk of glucose intolerance warrants the need for nutritional interventions to improve maternal glucose homeostasis. In this study, the effect of a low-glycemic load (GL) (n = 28) was compared to a high-GL (n = 34) dietary intervention during the second half of pregnancy in obese women (body mass index (BMI) > 30 or a body fat >35%). Anthropometric and metabolic parameters were assessed at baseline (20 week) and at 28 and 34 weeks gestation. For the primary outcome 3h-glucose-iAUC (3h-incremental area under the curve), mean between-group differences were non-significant at every study timepoint (p = 0.6, 0.3, and 0.8 at 20, 28, and 34 weeks, respectively) and also assessing the mean change over the study period (p = 0.6). Furthermore, there was no statistically significant difference between the two intervention groups for any of the other examined outcomes (p ≥ 0.07). In the pooled cohort, there was no significant effect of dietary GL on any metabolic or anthropometric outcome (p ≥ 0.2). A post hoc analysis comparing the study women to a cohort of overweight or obese pregnant women who received only routine care showed that the non-study women were more likely to gain excess weight (p = 0.046) and to deliver large-for-gestational-age (LGA) (p = 0.01) or macrosomic (p = 0.006) infants. Thus, a low-GL diet consumed during the last half of pregnancy did not improve pregnancy outcomes in obese women, but in comparison to non-study women, dietary counseling reduced the risk of adverse outcomes.

Maternal Body Mass Index and Breastfeeding Non-Initiation and Cessation: A Quantitative Review of the Literature

This study aims to investigate which maternal body mass index (BMI) categories are associated with the non-initiation or cessation of breastfeeding (BF) based on a quantitative review of the literature. We searched Ovid MEDLINE and EBSCO CINAHL for peer-reviewed articles published between 1946 (MEDLINE) or 1981 (CINAHL), and 2019. Selected studies were either cross-sectional or cohort studies, of healthy mothers and infants, that reported nutrition method (exclusive/full or any) and period (initiation/duration/cessation) of breastfeeding according to maternal BMI levels. Pairwise meta-analyses of 57 studies demonstrated that the pooled odds risks (OR) of not initiating BF among overweight and obese mothers compared to normal weight mothers were significant across 29 (OR 1.33, 95% confidence interval (CI), 1.15–1.54, I² = 98%) and 26 studies (OR 1.61, 95% CI, 1.33–1.95, I² = 99%), respectively; the pooled risks for BF cessation were inconsistent in overweight and obese mothers with substantial heterogeneity. However, we found that overweight mothers (n = 10, hazard ratio (HR) 1.16, 95% CI, 1.07–1.25; I² = 23%) and obese mothers (n = 7, HR 1.45, 95% CI: 1.27–1.65; I² = 44%) were both associated with an increased risk of not continuing any BF and exclusive BF, respectively. Overweight and obese mothers may be at increased risk of not initiating or the cessation of breastfeeding.

Maternal pre-pregnancy body mass index, gestational weight gain and breastfeeding outcomes: a cross-sectional analysis

BACKGROUND

It is well established that mothers with above-normal pre-pregnancy BMI are at increased risk of breastfeeding cessation; however, the impact of pregnancy weight-gain (PWG) is less well-defined. Excess PWG may alter the hormonal preparation of breast tissue for lactation, increase the risk of complications that negatively impact breastfeeding (e.g. Cesarean-section, gestational diabetes), and may make effective latch more difficult to achieve.

METHODS

Our objective was to determine the impact of PWG and pre-pregnancy BMI on the risk of breastfeeding cessation utilizing the Institute of Medicine's 2009 recommendations. Cox proportional hazards models were utilized to estimate the risk of cessation of exclusive breastfeeding, and cessation of any breastfeeding among women who initiated exclusive and any breastfeeding, respectively, in a cross sectional sample of survey respondents from a New York county (N = 1207). PWG category was interacted with pre-pregnancy BMI (3 levels of pre-pregnancy BMI, 3 levels of PWG). Confounders of the relationship of interest were evaluated using directed acyclic graphs and bivariate analyses; variables not on the proposed causal pathway and associated with the exposure and outcome were included in multivariate models.

RESULTS

After adjustment, women of normal and obese pre-pregnancy BMI with greater-than-recommended PWG had 1.39 (1.03-1.86) and 1.48 (1.06-2.07) times the risk of any breastfeeding cessation within the first 3 months postpartum compared to women with normal pre-pregnancy BMI who gained within PWG recommendations. Overweight women with greater-than-recommended PWG were at increased risk of cessation, although not significantly (aHR [95% CI]: 1.29 [0.95-1.75]). No significant relationship was observed for exclusive breastfeeding cessation.

CONCLUSIONS

Pre-pregnancy BMI and PWG may be modifiable risk factors for early breastfeeding cessation. Understanding the mechanism behind this risk should be ascertained by additional studies aimed at understanding the physiological, social, logistical (positioning) and other issues that may lead to early breastfeeding cessation.

Within-subject effects of environmental and social stressors on pre- and post-partum obesity-related biobehavioral responses in low-income Hispanic women: protocol of an intensive longitudinal study

BACKGROUND

Disproportionately high rates of maternal overweight and obesity among the Hispanic population before, during, and after pregnancy pose serious health concerns for both mothers (e.g., preeclampsia, gestational diabetes, weight retention) and children (e.g., elevated lifelong obesity risk). A growing body of evidence implicates environmental exposures (e.g., air pollution, metals) and social stressors (e.g., poverty, violence) in contributing to obesity-related biobehavioral processes, such as physical activity, dietary intake, perceived stress, and cortisol regulation. However, current understanding of the role of environmental exposures and social stressors on obesity-related biobehavioral processes is limited by infrequent, inter-individual measurement, and lack of personal exposure monitoring.

METHODS

The "Maternal and Developmental Risks from Environmental and Social Stressors" (MADRES) real-time and personal sampling study examines the within-subject day-level effects of environmental and social stressors on maternal pre- and post-partum obesity-related biobehavioral responses. Among a cohort of 65 low-income, Hispanic women in urban Los Angeles, this study uses innovative personal, real-time data capture strategies (e.g., ecological momentary assessment [EMA], personal exposure monitoring, geolocation monitoring, accelerometry) to repeatedly assess obesity-related processes during the 1st and 3rd trimester, and at 4-6 months postpartum. Day-level effects of environmental exposures and social stressors on women's physical activity, diet, perceived stress and salivary cortisol measured across repeated days will be tested using multilevel modeling.

DISCUSSION

Hispanic women of childbearing age bear a disproportionately high burden of obesity, and this population is also unduly exposed to numerous obesogenic settings. By using innovative real-time data capture strategies, the current study will uncover the daily impacts of environmental and social stressor exposures on women's obesity-related biobehavioral responses, which over time can lead to excessive gestational weight gain, postpartum weight retention and can pose serious consequences for both mother and child. Findings from the real-time and personal sampling study will identify key mechanistic targets for policy, clinical, and programmatic interventions, with the potential for broad-reaching public health impacts.

The mindful moms training: development of a mindfulness-based intervention to reduce stress and overeating during pregnancy

Background

Pregnancy is a time of high risk for excessive weight gain, leading to health-related consequences for mothers and offspring. Theory-based obesity interventions that target proposed mechanisms of biobehavioral change are needed, in addition to simply providing nutritional and weight gain directives. Mindfulness training is hypothesized to reduce stress and non-homeostatic eating behaviors – or eating for reasons other than hunger or caloric need. We developed a mindfulness-based intervention for high-risk, low-income overweight pregnant women over a series of iterative waves using the Obesity-Related Behavioral Intervention Trials (ORBIT) model of intervention development, and tested its effects on stress and eating behaviors.

Methods

Overweight pregnant women (n = 110) in their second trimester were enrolled in an 8-week group intervention. Feasibility, acceptability, and facilitator fidelity were assessed, as well as stress, depression and eating behaviors before and after the intervention. We also examined whether pre-to-post intervention changes in outcomes of well-being and eating behaviors were associated with changes in proposed mechanisms of mindfulness, acceptance, and emotion regulation.

Results

Participants attended a mean of 5.7 sessions (median = 7) out of 8 sessions total, and facilitator fidelity was very good. Of the women who completed class evaluations, at least half reported that each of the three class components (mindful breathing, mindful eating, and mindful movement) were “very useful,” and that they used them on most days at least once a day or more. Women improved in reported levels of mindfulness, acceptance, and emotion regulation, and these increases were correlated with reductions in stress, depression, and overeating.

Conclusions

These findings suggest that in pregnant women at high risk for excessive weight gain, it is both feasible and effective to use mindfulness strategies taught in a group format. Further, increases in certain mindfulness skills may help with better management of stress and overeating during pregnancy.

Trial registration

ClinicalTrials.gov NCT01307683, March 8, 2011.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-1757-6) contains supplementary material, which is available to authorized users.

Optimal Gestational Weight Gain for Women with Gestational Diabetes and Morbid Obesity

OBJECTIVES

Our aim was to investigate the greatest gestational weight gain (GWG) without adverse pregnancy complications in women with gestational diabetes mellitus (GDM) and morbid obesity.

METHODS

An observational retrospective study including 3284 patients with single pregnancies and GDM was completed. Of the patients, 131 (4.0%) were classified as having pre-pregnancy morbid obesity (BMI ≥ 35 kg/m²). Perinatal complications were compared among BMI groups. In the group with morbid obesity, GWG threshold values to predict outcomes were examined based on sensitivity and specificity values under the receiver operating characteristic curve.

RESULTS

GWG was higher in mothers with morbid obesity and macrosomic neonates: 11.3 (4.4-15.7) versus 4.8 (1.5-8.2) kg (p = 0.033). The GWG and neonatal ponderal index were positively correlated (r = 0.305, p = 0.001). The GWG was 7.0 (2.9-11.6) kg in women with hypertensive disorder versus 4.5 (1.0-7.5) kg in normotensive women (p = 0.017). A GWG above 5 kg was a risk factor for macrosomia (87.8% sensitivity, 54.7% specificity) and hypertensive disorder (70.0% sensitivity, 48.4% specificity). GWG associations were maintained after controlling for glycemic control, maternal and gestational age, parity, smoking and neonatal sex.

CONCLUSIONS FOR PRACTICE

A GWG below 5 kg is recommended for women with GDM and morbid obesity. In these women, adequate GWG may prevent macrosomia, fetal overgrowth and hypertensive disorder.

Feasibility and Initial Efficacy Evaluation of a Community-Based Cognitive-Behavioral Lifestyle Intervention to Prevent Excessive Weight Gain During Pregnancy in Latina Women

About 48 % of US women gain more weight during pregnancy than recommended by the Institute of Medicine (IOM). Excessive gestational weight gain is a major risk factor for obesity in both women and offspring over their lifetimes, and should be avoided. This study was designed to test the feasibility and initial efficacy of a prenatal behavioral intervention in a sample of low-income, predominantly Latina women. The intervention was delivered in groups of 8–10 women in a community recreation center, and structured to reduce the proportion of women who gained weight in excess of IOM guidelines. Recruitment targets were met in 3 months: 135 pregnant women (>10 and <28 weeks) were randomly assigned to receive a 12-week intervention (n = 68) or usual care (n = 67). Retention rate was 81 %. On average, women attended 4 of 12 group sessions, and each session had 4 of the 8–10 assigned participants in attendance. Initial efficacy analyses were based on 87 women. Compared to usual care, fewer normal-weight women in the intervention exceeded IOM recommendations (47.1 % usual care vs. 6.7 % intervention; absolute difference 40.4 %; p = .036). Recommendations for recruitment, retention, and delivery are discussed. A community-based cognitive-behavioral lifestyle intervention during pregnancy was feasible in a hard-to-reach, high-risk population of low-income Latina women, and showed efficacy in preventing excessive gestational weight gain. Due to frequently changing work schedules, strategies are needed to either increase attendance at group sessions (e.g., within a group prenatal care format) or to build core skills necessary for behavior change through other modalities.

Reduced breastfeeding rates among obese mothers: a review of contributing factors, clinical considerations and future directions

Maternal obesity is associated with significantly lower rates of breastfeeding initiation, duration and exclusivity. Increasing rates of obesity among reproductive-age women has prompted the need to carefully examine factors contributing to lower breastfeeding rates in this population. Recent research has demonstrated a significant impact of breastfeeding to reduce the risk of obesity in both mothers and their children. This article presents a review of research literature from three databases covering the years 1995 to 2014 using the search terms of breastfeeding and maternal obesity. We reviewed the existing research on contributing factors to lower breastfeeding rates among obese women, and our findings can guide the development of promising avenues to increase breastfeeding among a vulnerable population. The key findings concerned factors impacting initiation and early breastfeeding, factors impacting later breastfeeding and exclusivity, interventions to increase breastfeeding in obese women, and clinical considerations. The factors impacting early breastfeeding include mechanical factors and delayed onset of lactogenesis II and we have critically analyzed the potential contributors to these factors. The factors impacting later breastfeeding and exclusivity include hormonal imbalances, psychosocial factors, and mammary hypoplasia. Several recent interventions have sought to increase breastfeeding duration in obese women with varying levels of success and we have presented the strengths and weaknesses of these clinical trials. Clinical considerations include specific techniques that have been found to improve breastfeeding incidence and duration in obese women. Many obese women do not obtain the health benefits of exclusive breastfeeding and their children are more likely to also be overweight or obese if they are not breastfed. Further research is needed into the physiological basis for decreased breastfeeding among obese women along with effective interventions supported by rigorous clinical research to advance the care of obese reproductive age women and their children.

Counseling About Weight Gain Guidelines and Subsequent Gestational Weight Gain

BACKGROUND

The purpose of this study was to investigate what percentage of postpartum women were informed about how much weight to gain during pregnancy, the accuracy of the weight gain recommendations based on the 2009 Institute of Medicine (IOM) gestational weight gain (GWG) recommendations and whether being informed was associated with greater likelihood of meeting the recommendations.

METHODS

This was a cross-sectional study of postpartum women interviewed in maternity recovery rooms at two large urban hospitals. Body mass index was obtained from medical records, and adherence to gestational weight gain guidelines was determined based on the 2009 IOM recommendations.

RESULTS

One hundred thirty four women with a mean pregravid body mass index of 28.0 kg/m(2) were studied. Sixty-seven percent of participants reported receiving weight gain recommendations. A greater percentage of healthy weight women (78.6%) reported being informed of a GWG recommendation than overweight (53.8%) or obese women (64.9%), (chi-squared=6.6, p=0.04). Of the women given information about gestational weight gain, 40 (54.8%) received GWG recommendations consistent with the IOM and 33 (45.2%) received discrepant information. The accuracy of the GWG recommendation varied based on weight status. Women of healthy weight were much more likely to be given information in accordance with the IOM recommendations (86.8%) than women who were overweight (12.5%) or obese (26.3%) (chi-squared=33.5, p<0.001). Meeting the IOM recommendations did not differ depending on whether women were told how much weight to gain during pregnancy.

CONCLUSIONS

Women who are overweight or obese are less likely to be informed about weight gain recommendations than healthy weight women, and nearly half of women receive information inconsistent with the IOM recommendations. There may be a need for further practitioner education on GWG recommendations and increased patient counseling to help promote healthy weight gain during pregnancy.

Comparative effectiveness of group and individual prenatal care on gestational weight gain

This study examined differences in gestational weight gain for women in CenteringPregnancy (CP) group prenatal care versus individually delivered prenatal care. We conducted a retrospective chart review and used propensity scores to form a matched sample of 393 women (76 % African-American, 13 % Latina, 11 % White; average age 22 years) receiving prenatal care at a community health center in the South. Women were matched on a wide range of demographic and medical background characteristics. Compared to the matched group of women receiving standard individual prenatal care, CP participants were less likely to have excessive gestational weight gain, regardless of their pre-pregnancy weight (b = -.99, 95 % CI [-1.92, -.06], RRR = .37). CP reduced the risk of excessive weight gain during pregnancy to 54 % of what it would have been in the standard model of prenatal care (NNT = 5). The beneficial effect of CP was largest for women who were overweight or obese prior to their pregnancy. Effects did not vary by gestational age at delivery. Post-hoc analyses provided no evidence of adverse effects on newborn birth weight outcomes. Group prenatal care had statistically and clinically significant beneficial effects on reducing excessive gestational weight gain relative to traditional individual prenatal care.

Maternal obesity and occurrence of fetal macrosomia: a systematic review and meta-analysis

OBJECTIVE

To determine a precise estimate for the contribution of maternal obesity to macrosomia.

DATA SOURCES

The search strategy included database searches in 2011 of PubMed, Medline (In-Process & Other Non-Indexed Citations and Ovid Medline, 1950-2011), and EMBASE Classic + EMBASE. Appropriate search terms were used for each database. Reference lists of retrieved articles and review articles were cross-referenced.

METHODS OF STUDY SELECTION

All studies that examined the relationship between maternal obesity (BMI ≥30 kg/m(2)) (pregravid or at 1st prenatal visit) and fetal macrosomia (birth weight ≥4000 g, ≥4500 g, or ≥90th percentile) were considered for inclusion.

TABULATION, INTEGRATION, AND RESULTS

Data regarding the outcomes of interest and study quality were independently extracted by two reviewers. Results from the meta-analysis showed that maternal obesity is associated with fetal overgrowth, defined as birth weight ≥ 4000 g (OR 2.17, 95% CI 1.92, 2.45), birth weight ≥4500 g (OR 2.77,95% CI 2.22, 3.45), and birth weight ≥90% ile for gestational age (OR 2.42, 95% CI 2.16, 2.72).

CONCLUSION

Maternal obesity appears to play a significant role in the development of fetal overgrowth. There is a critical need for effective personal and public health initiatives designed to decrease prepregnancy weight and optimize gestational weight gain.

Perception of weight status and its impact on gestational weight gain in an urban population

To examine the association between actual and perceived overweight/obese status and excess gestational weight gain (GWG). As part of an infant feeding trial, multi-ethnic lower and moderate income women-completed a checklist of current health conditions, including "overweight/obesity," "asthma," and "hypertension" while pregnant. Odds of excessive GWG per the Institute of Medicine guidelines in 'accurate' versus 'inaccurate' reporters, by overweight status were analyzed with multivariate logistic regression for women with pre-or early pregnancy BMIs of ≥18.5. 775 women met study criteria. Just 21 % (n = 107) of overweight/obese women accurately identified their weight status, compared to >90 % accurate report of documented hypertension or asthma. Compared to normal-weight accurate reporters, the adjusted odds of excessive GWG in overweight/obese women was 2.3 (95 % CI 1.4, 3.7) in accurate reporters, and 2.5 (95 % CI 1.7, 3.4) in inaccurate reporters. Overweight/obesity is associated with excessive GWG, but this risk is not modified by inaccurate reporting/perception of weight-status.

Relationship between gestational weight gain and birthweight among clients enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Hawaii, 2003-2005

To investigate the relationship between gestational weight gain (GWG) and birthweight outcomes among a low-income population in Hawaii using GWG recommendations from the 2009 Institute of Medicine (IOM) guidelines. Data were analyzed for 19,130 mother-infant pairs who participated in Hawaii's Special Supplemental Nutrition Program for Women, Infants, and Children from 2003 through 2005. GWG was categorized as inadequate, adequate, or excessive on the basis of GWG charts in the guidelines. Generalized logit models assessed the relationship between mothers' GWG and their child's birthweight category (low birthweight [LBW: < 2,500 g], normal birthweight [2,500 g ≤ BW < 4,000 g], or high birthweight [HBW: ≥ 4,000 g]). Final models were stratified by prepregnancy body mass index (underweight, normal weight, overweight, or obese) and adjusted for maternal age, education, race/ethnicity, smoking status, parity, and marital status. Overall, 62% of the sample had excessive weight gain and 15% had inadequate weight gain. Women with excessive weight gain were more likely to deliver a HBW infant; this relationship was observed for women in all prepregnancy weight categories. Among women with underweight or normal weight prior to pregnancy, those with inadequate weight gain during pregnancy were more likely to deliver a LBW infant. Among the low-income population of Hawaii, women with GWG within the range recommended in the 2009 IOM guidelines had better birthweight outcomes than those with GWG outside the recommended range. Further study is needed to identify optimal GWG goals for women with an obese BMI prior to pregnancy.

Weight loss after diagnosis with gestational diabetes and birth weight among overweight and obese women

To determine if, among overweight or obese women with gestational diabetes (GDM), weight loss after GDM diagnosis is associated with lower infant birth weight within levels of overweight or obesity class. Overweight and obese women with singleton pregnancies managed for GDM at a large diabetes and pregnancy program located in Charlotte, NC between November 2000 and April 2010, were eligible for this retrospective cohort study. All were managed using a rigorous standardized clinical protocol. Clinical information including maternal pre-pregnancy body mass index, gestational weight gain, treatment, and medical and obstetric history was abstracted from medical records. The association of weight loss after GDM diagnosis and birth weight was analyzed using linear regression stratified by maternal pre-pregnancy overweight or obesity class (I, II/III). Of the 322 women in this study 19 % lost weight between diagnosis of GDM and delivery. After adjustment for maternal age, parity, race/ethnicity, gestational week at first hemoglobin A1c (A1C), A1C at diagnosis, weight gain prior to GDM, treatment with insulin or oral hypoglycemic agents, gestational age at delivery, and infant sex, weight loss was associated with 238.3 g lower mean infant birth weight among overweight women (95 % CI -393.72, -82.95 g), but was not associated with lower mean infant birth weight among obese class II/III women (95 % CI -275.61, 315.38 g). Weight loss, after diagnosis of GDM, is associated with lower infant birth weight among overweight women, but not among obese class II/III women.

Central adiposity and other anthropometric factors in relation to risk of macrosomia in an African American population

OBJECTIVE

Previous studies have consistently identified maternal obesity and gestational weight gain (GWG) as risk factors for macrosomia, but little is known about the effects of central adiposity and body fat distribution. Using self-reported data from the Black Women's Health Study (BWHS), a large follow-up study of US black women, we examined the risk of macrosomia in relation to prepregnancy waist circumference, prepregnancy waist-to-hip ratio (WHR), prepregnancy BMI, and GWG.

DESIGN AND METHODS

During 1995-2003, BWHS participants ages 21-44 years delivered 6,687 full-term singleton births (gestational age >37 weeks). We compared mothers of 691 infants weighing ≥ 4,000 g with mothers of 5,996 infants weighing <4,000 g. Generalized estimating equation models (GEE) that accounted for more than one birth per mother were used to estimate multivariable odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

Independent of prepregnancy BMI, prepregnancy waist circumference was positively associated with risk of macrosomia (OR = 1.58, 95% CI: 1.07-2.32, for ≥ 35.0 vs. <27.0 inches (≥ 88.9 vs. <68.6 cm); P trend = 0.04). As expected, prepregnancy BMI was also positively associated with macrosomia (OR = 1.74, 95% CI: 1.25-2.41 for BMI ≥ 35.0 vs. 18.5-24.9 kg m(-2)). GWG above the amount recommended by the 2009 Institute of Medicine report was associated with an increased risk of macrosomia and the association was present in each category of prepregnancy BMI (18.5-24.9, 25.0-29.9, and ≥ 30.0 kg m(-2); P trend <0.001).

CONCLUSIONS

Our data suggest that overall obesity, high GWG, and high waist circumference are independent risk factors for macrosomia among US black women.

How pregnant African American women view pregnancy weight gain

OBJECTIVE

To gain insight into how low-income, pregnant African American women viewed their weight gain while pregnant and how they managed their weight during pregnancy.

DESIGN

Descriptive study using three focus groups.

SETTING

Women were recruited from urban prenatal care sites and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) services in a medium-sized urban northeastern city.

PARTICIPANTS

Twenty-six adult, low-income, pregnant African American women, age 18 to 39; the majority were within the first 20 weeks of pregnancy.

METHODS

Three focus groups were conducted utilizing open-ended questions related to pregnancy weight gain. Content analysis was used to analyze the verbatim transcripts. Analysis focused on meaning, intention, and context. Groups were compared and contrasted at the within and between group levels to identify themes.

RESULTS

Four themes were identified that provided insight into how women viewed their pregnancy weight gain and managed weight gain during pregnancy: (a) pregnancy weight gain: no matter how much means a healthy baby; (b) weight retention: it happens; (c) there is a limit: weight gain impact on appearance; and (d) watching and waiting: plans for controlling weight.

CONCLUSION

Low-income African American women, though cognizant of the likelihood of retention of weight following pregnancy, are not focused on limiting their gestational weight gain. The cultural acceptance of a larger body size along with the belief that gaining more weight is indicative of a healthy infant present challenges for interventions to limit excessive gestational weight gain.

Patterns of gestational weight gain in healthy, low-risk pregnant women without co-morbidities

BACKGROUND

little is known of the impact of gestational weight gain (GWG) in relation to Body Mass Index (BMI) classification on perinatal outcomes in healthy pregnant women without co-morbidities. As a first step, the prevalence of obesity and the distribution of GWG in relation to the Institute of Medicine (IOM) 2009 guidelines for GWG were examined.

METHODS

data from a prospective cohort study of - a priori - low risk, pregnant women from five midwife-led practices (n=1449) were analysed. Weight was measured at 12, 24 and 36 weeks.

FINDINGS

at 12 weeks, 1.4% of the women were underweight, 53.8% had a normal weight, 29.6% were overweight, and 15.1% were obese according to the WHO classification of BMI. In our study population, 60% of the women did not meet the IOM recommendations: 33.4% had insufficient GWG and 26.7% gained too much weight. Although BMI was negatively correlated to total GWG (p<.001), overweight and obese women class I had a significant higher risk of exceeding the IOM guidelines. Normal weight women had a significantly higher risk of gaining less weight than recommended. Obese women classes II and III were at risk in both over- and undergaining.

CONCLUSIONS

our data showed that the majority of women were unable to stay within recommended GWG ranges without additional interventions. The effects on pregnancy and health outcomes of falling out the IOM guidelines remain unclear for - a priori - low risk women. Since interventions to control GWG would have considerable impact on women and caregivers, harms and benefits should be well-considered before implementation.

Maternal dietary glycaemic load during pregnancy and gestational weight gain, birth weight and postpartum weight retention: a study within the Danish National Birth Cohort

Dietary glycaemic index and glycaemic load (GL) have been related to obesity and other health outcomes. The objective of the present study was to examine the associations between maternal dietary GL and gestational weight gain, birth weight, the risk of giving birth to a child large-for-gestational age (LGA) or small-for-gestational age and postpartum weight retention (PPWR). Data were derived from the Danish National Birth Cohort (1996-2002), including data on gestational and lifestyle factors in pregnancy and 18 months postpartum. Dietary data were collected using a validated FFQ. Information on birth outcome was obtained through registers. A total of 47,003 women were included. The associations between the GL and birth outcome, gestational weight gain, assessed between weeks 12 and 30 of gestation, and PPWR were analysed by linear and logistic regression. Birth weight increased by 36 g from the lowest to highest GL quintile (95% CI 19, 53 g), and an increased risk of LGA of 14% was detected in the highest GL quintile compared with the lowest GL quintile. Among normal-weight and overweight women, higher gestational weight gain rates were detected in the highest GL quintile (26 g/week (95% CI 19, 34) and 30 g/week (95% CI 13, 46), respectively). The association between the GL and PPWR was most pronounced among pre-pregnant obese women, with an increase in weight retention of 1·3 (95% CI 0·2, 2·8) kg from the lowest to highest GL quintile. The GL may play a role for excessive gestational weight gain and PPWR, which may be more pronounced among overweight and obese women.

Addressing obesity in pregnancy: what do obstetric providers recommend?

OBJECTIVE

Maternal obesity is associated with adverse pregnancy outcomes. To improve outcomes, obstetric providers must effectively evaluate and manage their obese pregnant patients. We sought to determine the knowledge, attitudes, and practice patterns of obstetric providers regarding obesity in pregnancy.

METHODS

In 2007-2008, we surveyed 58 practicing obstetricians, nurse practitioners, and certified nurse-midwives at a multispecialty practice in Massachusetts. We administered a 26-item questionnaire that included provider self-reported weight, sociodemographic characteristics, knowledge, attitudes, and management practices. We created an 8-point score for adherence to 8 practices recommended by the American College of Obstetricians and Gynecologists (ACOG) for the management of obese pregnant women.

RESULTS

Among the respondents, 37% did not correctly report the minimum body mass index (BMI) for diagnosing obesity, and most reported advising gestational weight gains that were discordant with 1990 Institute of Medicine (IOM) guidelines, especially for obese women (71%). The majority of respondents almost always recommended a range of weight gain (74%), advised regular physical activity (74%), or discussed diet (64%) with obese mothers, but few routinely ordered glucose tolerance testing during the first trimester (26%), planned anesthesia referrals (3%), or referred patients to a nutritionist (14%). Mean guideline adherence score was 3.4 (SD 1.9, range 0-8). Provider confidence (beta = 1.0, p = 0.05) and body satisfaction (beta = 1.5, p = 0.02) were independent predictors of higher guideline adherence scores.

CONCLUSIONS

Few obstetric providers were fully compliant with clinical practice recommendations, defined obesity correctly, or recommended weight gains concordant with IOM guidelines. Provider personal factors were the strongest correlates of self-reported management practices. Our findings suggest a need for more education around BMI definitions and weight gain guidelines, along with strategies to address provider personal factors, such as confidence and body satisfaction, that may be important predictors of adherence to recommendations for managing obese pregnant women.

Gestational weight gain and predicted changes in offspring anthropometrics between early infancy and 3 years

OBJECTIVE

To determine how gestational weight gain (GWG), categorized using the 2009 Institute of Medicine recommendations, relates to changes in offspring weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length z-scores (WLZ) between early infancy and 3 years.

METHODS

Women with singleton infants were recruited from the third cohort of the Pregnancy, Infection, and Nutrition Study (2001-2005). Term infants with at least one weight or length measurement during the study period were included (n = 476). Multivariable linear mixed effects regression models estimated longitudinal changes in WAZ, LAZ and WLZ associated with GWG.

RESULTS

In early infancy, compared with infants of women with adequate weight gain, those of women with excessive weight gains had higher WAZ, LAZ and WLZ. Excessive GWG ≥ 200% of the recommended amount was associated with faster rates of change in WAZ and LAZ and noticeably higher predicted mean WAZ and WLZ that persisted across the study period.

CONCLUSIONS

GWG is associated with significant differences in offspring anthropometrics in early infancy that persisted to 3 years of age. More longitudinal studies that utilize maternal and paediatric body composition measures are necessary to understand the nature of this association.

Prepregnancy obesity and the risk of gestational diabetes mellitus

Background

Prepregnancy obesity is associated with increased risk for adverse pregnancy outcome such as gestational diabetes mellitus (GDM), gestational hypertension, preeclampsia, fetal macrosomia and the need for cesarean delivery. The objectives of this study assessed whether Thai women classified as obese according to WHO's recommended body mass index (BMI) for Asians were at risk for developing gestational diabetes mellitus (GDM) and other complications such as preeclampsia, gestational hypertension and fetal macrosomia.

Methods

Two hundred and forty women participated in this study and followed prospectively until delivery. Half of the women (n = 120) were obese (BMI ≥ 27.5 kg/m²) and the other half (n = 120) had normal weight (BMI > 18.5-23 kg/m²). Maternal demographic data, obstetric and neonatal outcomes from both groups were compared to each other. Relative risk and 95% confidence interval (CI) were calculated.

Results

Compared to normal weight women, obese Thai women were not at increased risk for gestational diabetes mellitus (RR = 0.9 [95% CI 0.6-1.4]). Relative risk of preeclampsia and fetal macrosomia in obese women were 0.7 [95% CI 0.2-3.3] and 1.4 [95% CI 0.5-4.3], respectively. Relative risk of gestational hypertension in obese women was 12 [95% CI 1.6-90.8].

Conclusion

When WHO's classification of obesity was used for Asian populations, prepregnancy obesity without metabolic problems did not increase the risk for GDM, preeclampsia and fetal macrosomia in Thai women. But, prepregnancy obesity continued to increase the risk for developing gestational hypertension.

Improving diet and exercise in pregnancy with Video Doctor counseling: a randomized trial

OBJECTIVE

To determine if an interactive, computerized Video Doctor counseling tool improves self-reported diet and exercise in pregnant women.

METHODS

A randomized trial comparing a Video Doctor intervention to usual care in ethnically diverse, low-income, English-speaking pregnant women was conducted. Brief messages about diet, exercise, and weight gain were delivered by an actor-portrayed Video Doctor twice during pregnancy.

RESULTS

In the Video Doctor group (n=158), there were statistically significant increases from baseline in exercise (+28 min), intake of fruits and vegetables, whole grains, fish, avocado and nuts, and significant decreases in intake of sugary foods, refined grains, high fat meats, fried foods, solid fats, and fast food. In contrast, there were no changes from baseline for any of these outcomes in the usual care group (n=163). Nutrition knowledge improved significantly over time in both groups but more so in the Video Doctor group. Clinician-patient discussions about these topics occurred significantly more frequently in the Video Doctor group. There was no difference in weight gain between groups.

CONCLUSION

A brief Video Doctor intervention can improve exercise and dietary behaviors in pregnant women.

PRACTICE IMPLICATIONS

The Video Doctor can be integrated into prenatal care to assist clinicians with effective diet and exercise counseling.

Gestational high fat diet programs hepatic phosphoenolpyruvate carboxykinase gene expression and histone modification in neonatal offspring rats

In insulin resistance and type II diabetes, there is an elevation of hepatic gluconeogenesis, which contributes to hyperglycaemia. Studies in experimental animals have provided evidence that consumption of high fat (HF) diets by female rats programs the progeny for glucose intolerance in adulthood, but the mechanisms behind the in utero programming remain poorly understood. The present study analysed the effect of a maternal HF diet on fetal gluconeogenic gene expression and potential regulation mechanism related to histone modifications. Dams were fed either a Control (C, 16% kcal fat) or a high-fat (HF, 45% kcal fat) diet throughout gestation. Livers of the offspring were collected on gestational day 21 and analysed to determine the consequences of a maternal HF diet on molecular markers of fetal liver gluconeogenesis. We demonstrated that offspring of HF-fed dams were significantly heavier and had significantly higher blood glucose levels at the time of delivery than offspring of dams fed the C diet. While maternal gluconeogenesis and plasma glucose were not affected by the HF diet, offspring of HF-fed dams had significantly higher mRNA contents of gluconeogenic genes in addition to the elevated plasma glucose. In addition to increased transcription rate, a gestational HF diet resulted in modifications of the Pck1 histone code in livers of offspring. Our results demonstrate that in utero exposure to HF diet has the potential to program the gluconeogenic capacity of offspring through epigenetic modifications, which could potentially lead to excessive glucose production and altered insulin sensitivity in adulthood.

Gut microbiota composition is associated with body weight, weight gain and biochemical parameters in pregnant women

Obesity is associated with complications during pregnancy and increased health risks in the newborn. The objective of the present study was to establish possible relationships between gut microbiota, body weight, weight gain and biochemical parameters in pregnant women. Fifty pregnant women were classified according to their BMI in normal-weight (n 34) and overweight (n 16) groups. Gut microbiota composition was analysed by quantitative real-time PCR in faeces and biochemical parameters in plasma at 24 weeks of pregnancy. Reduced numbers of Bifidobacterium and Bacteroides and increased numbers of Staphylococcus, Enterobacteriaceae and Escherichia coli were detected in overweight compared with normal-weight pregnant women. E. coli numbers were higher in women with excessive weight gain than in women with normal weight gain during pregnancy, while Bifidobacterium and Akkermansia muciniphila showed an opposite trend. In the whole population, increased total bacteria and Staphylococcus numbers were related to increased plasma cholesterol levels. Increased Bacteroides numbers were related to increased HDL-cholesterol and folic acid levels, and reduced TAG levels. Increased Bifidobacterium numbers were related to increased folic acid levels. Increased Enterobacteriaceae and E. coli numbers were related to increased ferritin and reduced transferrin, while Bifidobacterium levels showed the opposite trend. Therefore, gut microbiota composition is related to body weight, weight gain and metabolic biomarkers during pregnancy, which might be of relevance to the management of the health of women and infants.

Risks and management of obesity in pregnancy: current controversies

PURPOSE OF REVIEW

To explore recent developments in obesity-related topics of interest and importance to obstetricians. Specifically addressed are the impact of gestational weight gain on perinatal risk, the increased risk of congenital anomalies in offspring, developmental origins of health and disease in offspring, and reproductive issues following bariatric surgery.

RECENT FINDINGS

Limiting maternal weight gain in obese women to less than 15 lb may favorably attenuate perinatal risk (macrosomia, cesarean delivery, preeclampsia) but increase risk for small-for-gestational-age newborns. Obese women are at significantly increased risk for offspring to develop open neural tube defects and congenital heart disease as well as other anomalies. Impaired sonographic visualization in this population may impede prenatal diagnosis of these serious birth defects. Intrauterine nutritional overabundance may cue adaptive fetal responses predisposing to childhood and adult obesity as well as the metabolic syndrome. Bariatric surgery, the only effective treatment for morbid obesity, causes lifelong physiologic and anatomic changes associated with significant reproductive implications. Procedures can predispose to caloric and micronutrient deficiencies, improved fertility and fecundity, and late surgical complications. Pregnancy outcomes are typically similar to those of women without previous bariatric surgery and better than those of untreated morbidly obese women.

SUMMARY

Obesity and its surgical treatment are associated with lifelong health implications for the mother as well as her offspring. An appreciation of these obesity-related reproductive issues is critical for optimal care of this growing segment of the female population.

Prenatal nutrition: a critical window of opportunity for mother and child

The prenatal period encompasses a critical window for future health and functioning of mother and child. Attention previously focused on undernutrition risk (i.e., in developing countries and famine conditions) shifted to mismatch between prenatal 'programming' by undernutrition and postnatal overconsumption (i.e., low birthweight vs rapid postnatal growth), now to overconsumption/overweight throughout the reproductive cycle and short- and long-term health risks, including obesity, diabetes, dyslipidemia and cardiovascular disease. Moreover, overconsumption/overweight do not guarantee adequacy of critical nutrients (i.e., against birth defects or for brain development). Multinutrient supplementation - including zinc, iodine, choline and long-chain polyunsaturated fatty acids, especially n-3 - may have advantages over single-nutrient supplements, for example, iron or folate. Future nutritional care for healthy in utero programming may necessitate individual assessment and follow-up, including preconception nutritional preparation, appropriate weight gain, metabolic balance and food-based regimens enhanced by key nutrient fortification and/or supplementation, warranting further research into nutritional optimization of pregnancy outcomes.

Misperceived pre-pregnancy body weight status predicts excessive gestational weight gain: findings from a US cohort study

BACKGROUND

Excessive gestational weight gain promotes poor maternal and child health outcomes. Weight misperception is associated with weight gain in non-pregnant women, but no data exist during pregnancy. The purpose of this study was to examine the association of misperceived pre-pregnancy body weight status with excessive gestational weight gain.

METHODS

At study enrollment, participants in Project Viva reported weight, height, and perceived body weight status by questionnaire. Our study sample comprised 1537 women who had either normal or overweight/obese pre-pregnancy BMI. We created 2 categories of pre-pregnancy body weight status misperception: normal weight women who identified themselves as overweight ('overassessors') and overweight/obese women who identified themselves as average or underweight ('underassessors'). Women who correctly perceived their body weight status were classified as either normal weight or overweight/obese accurate assessors. We performed multivariable logistic regression to determine the odds of excessive gestational weight gain according to 1990 Institute of Medicine guidelines.

RESULTS

Of the 1029 women with normal pre-pregnancy BMI, 898 (87%) accurately perceived and 131 (13%) overassessed their weight status. 508 women were overweight/obese, of whom 438 (86%) accurately perceived and 70 (14%) underassessed their pre-pregnancy weight status. By the end of pregnancy, 823 women (54%) gained excessively. Compared with normal weight accurate assessors, the adjusted odds of excessive gestational weight gain was 2.0 (95% confidence interval [CI]: 1.3, 3.0) in normal weight overassessors, 2.9 (95% CI: 2.2, 3.9) in overweight/obese accurate assessors, and 7.6 (95% CI: 3.4, 17.0) in overweight/obese underassessors.

CONCLUSION

Misperceived pre-pregnancy body weight status was associated with excessive gestational weight gain among both normal weight and overweight/obese women, with the greatest likelihood of excessive gain among overweight/obese underassessors. Future interventions should test the potential benefits of correcting misperception to reduce the likelihood of excessive gestational weight gain.

Distinct composition of gut microbiota during pregnancy in overweight and normal-weight women

BACKGROUND

Results of experimental studies suggest that deviations in gut microbiota composition predispose to excessive energy storage and obesity. The mother influences the original inoculum and the development of infant microbiota, which in turn is associated with later weight gain.

OBJECTIVE

We characterized the gut microbiota in women according to their body mass index (BMI) and the effect of weight gain over pregnancy on the composition of microbiota before delivery.

DESIGN

Overweight women (n = 18) were selected according to their prepregnancy BMI from a prospective follow-up study. Normal-weight women (n = 36) were selected as controls in consecutive order of recruitment. Excessive weight gain during pregnancy was defined as >16.0 kg for normal-weight and >11.5 kg for overweight states according to Institute of Medicine recommendations. The composition of gut microbiota was analyzed by fluorescent in situ hybridization coupled with flow cytometry (FCM-FISH) and by quantitative real-time polymerase chain reaction (qPCR).

RESULTS

Bacteroides and Staphylococcus were significantly higher in the overweight state than in normal-weight women as assessed by FCM-FISH and qPCR. Mother's weight and BMI before pregnancy correlated with higher concentrations of Bacteroides, Clostridium, and Staphylococcus. Microbial counts increased from the first to third trimester of pregnancy. High Bacteroides concentrations were associated with excessive weight gain over pregnancy (P = 0.014).

CONCLUSIONS

Gut microbiota composition and weight are linked, and mother's weight gain is affected by microbiota. Microbiota modification before and during pregnancy may offer new directions for preventive and therapeutic applications in reducing the risk of overweight and obesity.

Obesity, diabetes, and links to congenital defects: a review of the evidence and recommendations for intervention

OBJECTIVE

To review evidence on the link between obesity and diabetes in pregnant women and the incidence of birth defects. In addition, the article offers recommendations for facilitating the broader scale implementation of evidence-based approaches to preventing obesity, particularly among pregnant women.

METHODS

A review of the evidence, primarily from epidemiologic studies, linking obesity and obesity-related metabolic disturbances in pregnant women to a range of birth defects. It also reviews potential mechanisms by which obesity and diabetes during pregnancy lead to damage in the developing embryo and highlights some evidence-based approaches to prevention. Finally it reviews policy options for positively impacting obesity and diabetes in this population.

RESULTS

Obesity and diabetes are a growing problem in the US population. This problem is particularly acute among women of childbearing age because the combination of obesity and diabetes is toxic to the developing fetus, which each contributing independently to embryopathy.

CONCLUSIONS

There is an urgent need for a national strategy for combating the growing and related problems of obesity and diabetes in the population. This strategy needs to encompass a spectrum of tax breaks, economic incentives, legislation, and educational approaches in order to be effective.

Gestational weight and dietary intake during pregnancy: perspectives of African American women

OBJECTIVES

This investigation explored the participants' perspective on weight, nutrition, and dietary habits during pregnancy. The data of interest were culled from a larger ethnographic research study designed to gather information and ideas about the socio-cultural, psychological, and behavioral influences on maternal health during pregnancy (N=63).

METHODS

My study focused on the six participants (including three teenagers) who delivered low birth weight and/or preterm babies and 13 participants aged<or=18 years (teenagers) who delivered normal weight babies. Data were analyzed utilizing qualitative methodology.

RESULTS

Four of the participants who delivered low birth/weight preterm infants reported weight related concerns during pregnancy. These included: weight loss, lack of weight gain, and exceeding their expected weight gain. Frequently, the nutrition knowledge was based on miseducation, misconceptions, and/or 'a grain of truth' i.e. folk beliefs. Support group members had an influential role on participants' dietary habits during pregnancy.

CONCLUSION

The next step appears to be more qualitative work, with health care providers, the Women Infants and Children Program (WIC) nutrition counselors, clinical dietetic professionals, and women who already have children, to explore strategies for improving diet quality as well as address the issue of inadequate and excessive weight gain during pregnancy.