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Raju S, Cowdell F, Dyson J. Barriers and facilitators to healthy gestational weight gain amongst pregnant women from ethnic minority groups: A systematic search and narrative synthesis. Midwifery 2024; 135:104051. [PMID: 38870776 DOI: 10.1016/j.midw.2024.104051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 04/02/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Excessive weight gain can be detrimental to the health and wellbeing of both mother and child. There is evidence that women from ethnic minority groups are more likely to gain excessive weight during pregnancy. For the purpose of this review, ethnic minority women are defined as those with different national or cultural traditions from the main population. AIM Our aim was to identify barriers and facilitators to healthy gestational weight gain in pregnant women in ethnic minority groups. METHODS Databases searched were MEDLINE, CINAHL, PsycInfo and PsycArticles between 2011 and 2022. Inclusion criteria were empirical studies of any method considering gestational weight gain in ethnic minority women published in English. Data were extracted according to aim, participants, methods, and findings in relation to barriers and facilitators. Included papers were assessed for quality according to relevant Joanna Briggs Institute checklists. FINDINGS Twenty-six studies were identified. Five themes were revealed: (1) knowledge and beliefs, (2) cultural and social influences, (3) confidence, (4) physical experiences, and (5) personal and environmental factors. DISCUSSION Some barriers and facilitators were relevant to all groups and others were more specific to ethnic minority groups. The latter included social and cultural influences, which were reported extensively. Our search was comprehensive, although it is possible we may not have captured all relevant papers. CONCLUSION We recommend that the barriers and facilitators identified here are considered in designing future, or adjusting current, health care practitioner mediated interventions to support healthy gestational weight gain in ethnic minority women.
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Affiliation(s)
- Sereena Raju
- Birmingham City University, Faculty of Health, Education and Life Sciences, Westbourne Road, Birmingham B15 3TN, England, UK.
| | - Fiona Cowdell
- Birmingham City University, Faculty of Health, Education and Life Sciences, Westbourne Road, Birmingham B15 3TN, England, UK
| | - Judith Dyson
- Birmingham City University, Faculty of Health, Education and Life Sciences, Westbourne Road, Birmingham B15 3TN, England, UK
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Dias Duarte de Carvalho Souza M, Bueno Ferreira L, Dos Santos LC. The Dietary Inflammatory Index is associated with diet quality and nutrient intake during the gestational period. Nutr Res 2024; 125:27-35. [PMID: 38460227 DOI: 10.1016/j.nutres.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/11/2024]
Abstract
In pregnant women, the Energy-adjusted Dietary Inflammatory Index (E-DII) is adopted to measure the inflammatory potential of the diet, but it does not predict the quality of the diet. Our hypothesis is that a more pro-inflammatory diet during pregnancy is also a poorer quality diet. Thus, the objective of this study is to verify the association of the E-DII with the Diet Quality Index Adapted for Pregnancy (DQI-P) and the nutrient intake from the diet in terms of the second and third gestational trimesters. This is a cross-sectional study that took place in Brazil (2018-2019), with eligible adult women up to 72 hours' postpartum and in good health. Socioeconomic, gestational, anthropometric, and food consumption data were collected, enabling the calculation of E-DII, DQI-P, and nutrient intake. The sample (n = 260) had a median E-DII of 0.04 (-1.30 to 1.90) and DQI-P of 68.82 (18.82-98.22). There was no relevant difference between E-DII tertiles by sociodemographic, gestational, and anthropometric characteristics. The E-DII and the DQI-P showed agreement (55.7%) and inverse correlation (r = -0.53; P < .001). Each 1-unit increase in DQI-P, iron, iodine, magnesium, pyridoxine, and vitamin E decreased the E-DII score (P < .05). An increase of 1 unit in protein, saturated fatty acids, and vitamin C increased the E-DII score (P < .05). Thus, the results suggest that the E-DII can predict diet quality during pregnancy, with the added benefit of measuring the inflammatory potential of the diet.
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Affiliation(s)
- Mariane Dias Duarte de Carvalho Souza
- Nutrition Department, Nursing school, Federal University of Minas Gerais, Professor Alfredo Balena Avenue, 190 - Santa Efigênia, Belo Horizonte MG, Brazil.
| | - Larissa Bueno Ferreira
- Nutrition Department, Faculty of Health Sciences, University of Brasilia, Darcy Ribeiro University Campus, Asa Norte, Brasília DF, Brazil
| | - Luana Caroline Dos Santos
- Nutrition Department, Nursing school, Federal University of Minas Gerais, Professor Alfredo Balena Avenue, 190 - Santa Efigênia, Belo Horizonte MG, Brazil
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Raju S, Cowdell PF, Dyson PJ. Midwives' experiences of supporting healthy gestational weight management: A mixed methods systematic literature review. Midwifery 2023; 124:103750. [PMID: 37285752 DOI: 10.1016/j.midw.2023.103750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 05/10/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Excessive levels of gestational weight gain (GWG) are linked with poorer health outcomes for mother and baby, including an increased risk of pregnancy-related hypertension, labour induction, caesarean delivery and increased birth weight. OBJECTIVE To explore literature relating to midwives' experiences and challenges and identify interventions relating to GWG. DESIGN This review was conducted in accordance with the Joanna Briggs Institute methodology for mixed methods systematic reviews. CINAHL complete, APA PsycArticles, APA PsycInfo, the Cochrane Library and MEDLINE were systematically searched in May 2022. Search terms related to midwives, advice, weight management and experiences were used. A PRISMA approach was taken to identify data, and thematic analysis combined with descriptive statistics allowed synthesis and integration. FINDINGS Fifty-seven papers were included and three overarching themes were generated; i) emotion and weight, ii) ability to influence and iii) practical challenges and strategies for success. Weight was consistently described as a sensitive topic. Challenges included level of expertise and comfort, perceptions of ability to influence and an awareness of incongruence of midwives' own weight and the advice they are delivering. Interventions evaluated well with some self-reports of improved knowledge and confidence. There was no evidence of impact on practice or GWG. KEY CONCLUSIONS Although addressing maternal weight gain is an international priority due to the significant risks incurred, in this review we have identified multiple challenges for midwives to support women in healthy weight management. Identified interventions targeting midwives do not directly address the challenges identified and are therefore likely to be insufficient to improve existing practice. IMPLICATIONS FOR PRACTICE Partnership working and co-creation with women and midwives is essential to ensure knowledge about maternal weight gain is effectively shared across communities to catalyse change.
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Affiliation(s)
- Sereena Raju
- Birmingham City University, Faculty of Health, Education and Life Sciences, Westbourne Road, Birmingham, B15 3TN, England.
| | - Professor Fiona Cowdell
- Birmingham City University, Faculty of Health, Education and Life Sciences, Westbourne Road, Birmingham, B15 3TN, England.
| | - Professor Judith Dyson
- Birmingham City University, Faculty of Health, Education and Life Sciences, Westbourne Road, Birmingham, B15 3TN, England.
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Raju S, Cowdell F, Dyson J. A Systematic Review of Women's Experiences of Interventions to Prevent Excessive Gestational Weight Gain. Nurs Womens Health 2023; 27:211-219. [PMID: 37080250 DOI: 10.1016/j.nwh.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/14/2022] [Accepted: 03/08/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE To synthesize research on women's experiences of interventions to prevent excessive gestational weight gain. DATA SOURCES A systematic search of the following databases was conducted: CINAHL Complete, Maternity and Infant Care Database, American Psychological Association PsycArticles, American Psychological Association PsycInfo, and MEDLINE. STUDY SELECTION Studies were included if they involved primary research regarding the experiences of women who were pregnant or up to 1 year postpartum when reflecting on their involvement in interventions to prevent excessive weight gain during pregnancy. Nonempirical studies and those that examined experiences of women who were not pregnant or who were beyond 1 year postpartum were excluded. DATA EXTRACTION Information was extracted and captured in a summary table that included the study aim, participants, study design, intervention, findings, and summary score, with exceptions to quality. DATA SYNTHESIS Data were synthesized thematically into three themes: (a) Intervention Qualities Valued by Women, (b) Challenges Faced by Women, and (c) Perceived Benefits and Recommendations for Modifications. CONCLUSION Interventions intended to help women prevent excessive gestational weight gain should be tailored to individuals' unique needs to ensure that the interventions are acceptable and effective.
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Santos SFMD, Costa ACCD, Araújo RGPDS, Silva LAT, Gama SGND, Fonseca VDM. Factors associated with the adequacy of gestational weight gain among Brazilian teenagers. CIENCIA & SAUDE COLETIVA 2022; 27:2629-2642. [PMID: 35730834 DOI: 10.1590/1413-81232022277.17812021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 12/03/2021] [Indexed: 11/21/2022] Open
Abstract
The scope of this article is to evaluate the adequacy of total gestational weight gain (GWG) according to maternal characteristics of Brazilian adolescents. It involved a cross-sectional, hospital-based study. A total of 3,904 teenagers with a single fetus gestation and gestational age (GA) at birth ≥ 37 weeks were included. A hierarchical model was built to analyze the dependent and independent variables adequacy of GWG: sociodemographic, care, obstetric and behavioral characteristics. The chances of insufficient GWG were higher for adolescents from the North (OR = 1.50, 95%CI: 1.07-2.10) and Northeast (OR = 1.68, 95%CI: 1.27-2.21). Paid work increased the chances of insufficient (95%CI: 1.15-2.39) and excessive (95%CI: 1.01-1.86) GWG. The pre-pregnancy body mass index of overweight or obese adolescents was associated with excessive GWG (OR = 1.86, 95%CI: 1.19-2.92 and OR = 3.06, 95%CI: 2.10-4.45, respectively), as well as GA ≥ 42 weeks (OR = 2.23, 95%CI: 1.03-4.81). Living in the North and Northeast regions increases the chances of adolescents having insufficient GWG. Having paid work was associated with a greater chance of excessive and insufficient GWG. Furthermore, pre-pregnancy excess weight or obesity and GA ≥ 42 weeks increased the chances of excessive GWG.
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Affiliation(s)
- Samira Fernandes Morais Dos Santos
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
| | - Ana Carolina Carioca da Costa
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
| | | | - Laís Araújo Tavares Silva
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
| | | | - Vania de Matos Fonseca
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
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Zhou M, Peng X, Yi H, Tang S, You H. Determinants of excessive gestational weight gain: a systematic review and meta-analysis. Arch Public Health 2022; 80:129. [PMID: 35505415 PMCID: PMC9066815 DOI: 10.1186/s13690-022-00864-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 03/23/2022] [Indexed: 11/20/2022] Open
Abstract
Background The prevalence of excessive gestational weight gain (EGWG) during pregnancy is increasing, and it is extremely harmful to pregnant women and newborns. Previous studies have suggested that EGWG is associated with various factors. We conducted a systematic review and meta-analysis to identify, quantify and analyze determinants of EGWG and evaluate the effect of these determinants on EGWG. Methods We searched for articles, from January 2009 to November 2020, related to the determinants of EGWG during pregnancy using four Chinese and four English databases. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement was utilized to guide the systematic review and meta-analysis process. Results Seventy studies, which identified EGWG factors in pregnant women (58 factors, 3 themes: individual [7 aspects, 37 factors]; family [4 aspects, 8 factors]; and social [4 aspects, 13 factors]), were included and analyzed in the systematic review. A meta-analysis was conducted for 13 factors (including 10 individual factors, 2 family factors, and 1 social factor) and revealed that pre-pregnancy overweight (including obesity), younger age (≤ 30 years old), unemployed, primiparity, smoking, and being unmarried (including divorced) were risk factors for EGWG, while prepregnancy underweight and inadequate antenatal care were protective factors for EGWG. There was no significant correlation between EGWG and education level, alcohol consumption, planning pregnancy, food security, and whether access to nutrition guidance during pregnancy. Conclusions EGWG was prevalent in pregnant women, and its prevalence seemed to be high and similar in many countries. Based on observational studies with medium-level and high-level evidence, some individual, family, and social factors were found to be associated with EGWG using qualitative and quantitative methods. In the future, exposure of pregnant women to risk factors for EGWG should be avoided, and interventions should be developed around the identified factors. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00864-9.
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Affiliation(s)
- Meng Zhou
- Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xueqing Peng
- Nanjing Medical University, Nanjing, Jiangsu, China
| | - Honggang Yi
- Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shaowen Tang
- Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Hua You
- Nanjing Medical University, Nanjing, Jiangsu, China.
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Liu Z, Szpiro AA, Workalemahu T, Young MT, Kaufman JD, Enquobahrie DA. Associations of perinatal exposure to PM 2.5 with gestational weight gain and offspring birth weight. ENVIRONMENTAL RESEARCH 2022; 204:112087. [PMID: 34562475 PMCID: PMC8678308 DOI: 10.1016/j.envres.2021.112087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND PM2.5 have been associated with weight change in animal models and non-pregnant populations. Evidence of associations between PM2.5 and gestational weight gain (GWG), an important determinant of course and outcomes of pregnancy, and subsequent birth outcomes is limited. METHODS The study was conducted among a subset of participants from the Omega Study, a prospective pregnancy cohort. Exposure to PM2.5 (μg/m3) was ascertained for participants (N = 855) based on their residential address using a validated national spatiotemporal model. Adjusted multivariable linear regression models were used to estimate associations of trimester-specific and pregnancy-month PM2.5 exposures with early (<20 weeks gestation), late (≥20 weeks gestation), and total GWG and infant birth weight. Stratified models and product terms were used to examine whether pre-pregnancy BMI (ppBMI) and infant sex modified the associations. RESULTS Average monthly PM2.5 exposure during the first, second, and third trimesters were 7.3 μg/m3, 7.9 μg/m3, and 7.7 μg/m3, respectively. Higher third trimester PM2.5 exposure was associated with higher late (0.40 kg per 5 μg/m (McDowell et al., 2018); 95%CI: 0.12, 0.67) and total (0.35 kg; 95%CI: 0.01, 0.70) GWG among participants with normal ppBMI. Higher second month PM2.5 exposure was associated with lower early (-0.70 kg; 95%CI: 1.22, -0.18), late (-0.84 kg; 95% CI: 1.54, -0.14), and total (-1.70 kg; 95%CI: 2.57, -0.82) GWG among participants with overweight/obese ppBMI. Product terms between PM2.5 and ppBMI were significant for second month PM2.5 exposure and early (p-value = 0.01) and total GWG (p-value<0.01). Higher third trimester PM2.5 exposure was associated with higher birth weight, though higher fourth month PM2.5 exposure was associated with lower birth weight, particularly among those with normal ppBMI and male infants. CONCLUSIONS Associations of PM2.5 with GWG vary by exposure window and ppBMI, while associations of PM2.5 with birth weight potentially vary by exposure window, ppBMI and infant sex. Further exploration of associations between PM2.5 and maternal/child health outcomes are needed.
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Affiliation(s)
- Zengjing Liu
- Department of Epidemiology, University of Washington, Seattle, WA, 98195, USA.
| | - Adam A Szpiro
- Department of Biostatistics, University of Washington, Seattle, WA, 98195, USA
| | | | - Michael T Young
- Department of Epidemiology, University of Washington, Seattle, WA, 98195, USA; Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, 98195, USA
| | - Joel D Kaufman
- Department of Epidemiology, University of Washington, Seattle, WA, 98195, USA; Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, 98195, USA
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Santos SFMD, Costa ACCD, Araújo RGPDS, Silva LAT, Gama SGND, Fonseca VDM. Factors associated with the adequacy of gestational weight gain among Brazilian teenagers. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022277.17812021en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract The scope of this article is to evaluate the adequacy of total gestational weight gain (GWG) according to maternal characteristics of Brazilian adolescents. It involved a cross-sectional, hospital-based study. A total of 3,904 teenagers with a single fetus gestation and gestational age (GA) at birth ≥ 37 weeks were included. A hierarchical model was built to analyze the dependent and independent variables adequacy of GWG: sociodemographic, care, obstetric and behavioral characteristics. The chances of insufficient GWG were higher for adolescents from the North (OR = 1.50, 95%CI: 1.07-2.10) and Northeast (OR = 1.68, 95%CI: 1.27-2.21). Paid work increased the chances of insufficient (95%CI: 1.15-2.39) and excessive (95%CI: 1.01-1.86) GWG. The pre-pregnancy body mass index of overweight or obese adolescents was associated with excessive GWG (OR = 1.86, 95%CI: 1.19-2.92 and OR = 3.06, 95%CI: 2.10-4.45, respectively), as well as GA ≥ 42 weeks (OR = 2.23, 95%CI: 1.03-4.81). Living in the North and Northeast regions increases the chances of adolescents having insufficient GWG. Having paid work was associated with a greater chance of excessive and insufficient GWG. Furthermore, pre-pregnancy excess weight or obesity and GA ≥ 42 weeks increased the chances of excessive GWG.
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