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Maejima M, Yonezawa K, Sasagawa E, Hikita N, Usui Y, Haruna M. Psychological factors of pregnant women associated with inadequate maternal weight gain in Japan. J Matern Fetal Neonatal Med 2023; 36:2217466. [PMID: 37263626 DOI: 10.1080/14767058.2023.2217466] [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: 06/03/2022] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Inadequate gestational weight gain (GWG) has been associated with low birth weight (LBW). However, factors associated with inadequate GWG in Japan remain unclear. Here, we aimed to determine the factors associated with inadequate GWG and the characteristics of inadequate GWG based on the pre-pregnancy body mass index (BMI) among pregnant women in Japan. METHODS This observational study included pregnant women at ≥16 weeks of gestation. The study was conducted at two general hospitals in Tokyo, Japan. The participants were requested to complete a questionnaire during the antenatal checkup visit and a mail survey after childbirth. Data were also collected from medical records. The GWG level and associated factors were assessed using the chi-square test or t-test. RESULTS In total, 252 pregnant women were recruited and completed the questionnaires. Data from 128 pregnant women were analyzed. Overall, 23 (18.0%) women were classified as having inadequate GWG. The factors associated with inadequate GWG were as follows: pre-pregnancy underweight, hospital admission owing to hyperemesis, low body esteem, high Edinburgh Postnatal Depression Scale score, low target GWG, more significant weight loss during pregnancy when compared with that pre-pregnancy, high maximum weight loss during pregnancy, delay in return to pre-pregnancy weight, lower birth weight, and inadequate GWG perception. Pregnant women with inadequate weight gain did not receive any medical advice to avoid being overweight but were rather advised to gain additional weight. CONCLUSION Target GWG and low body esteem were associated with inadequate GWG and other factors that could be modified. Medical staff should focus on achieving the target GWG and improving the body appreciation level among pregnant women.
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Affiliation(s)
- Mariko Maejima
- Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kaori Yonezawa
- Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Division of Nursing Systems, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Emi Sasagawa
- Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Division of Nursing Systems, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naoko Hikita
- Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuriko Usui
- Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Division of Nursing Systems, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Megumi Haruna
- Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Division of Nursing Systems, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Jaisamrarn U, Esteban-Habana MA, Padolina CS, Decena DCD, Dee MT, Damodaran P, Bhaskaran V, Garg V, Dorado E, Hu H. Vitamins and minerals, education, and self-care need during preconception to 1000 days of life in Southeast Asia: An expert panel opinion. SAGE Open Med 2023; 11:20503121231173377. [PMID: 37223672 PMCID: PMC10201185 DOI: 10.1177/20503121231173377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/14/2023] [Indexed: 05/25/2023] Open
Abstract
Addressing maternal malnutrition and its drivers is paramount in Southeast Asia. This article summarizes the key clinical learnings and evidence-based opinions from the experts to understand the need for vitamins and minerals supplementation, education, and self-care from preconception to the first 1000 days of life, which warranted further attention since COVID-19 pandemic. Evidence describing the importance of vitamins and minerals during preconception, pregnancy, and lactation stages was identified using literature databases. A pre-meeting survey was conducted to determine the current practices and challenges in Southeast Asia. Based on the literature review and clinical experience, experts defined the topics, and an online meeting was held on 13th July 2021. During the meeting, nine experts from Southeast Asia provided evidence-based opinion on the vitamins and minerals supplementation, education, and self-care need during preconception, pregnancy, and lactation stages. The expert opinions underpin maternal malnutrition as a prevalent issue and discuss appropriate interventions and prevention strategies for women in Southeast Asia. The recent pandemic further impacted nutrition status, pregnancy, and neonatal health outcomes. The expert panel emphasized a need to improve existing inadequacies in education, self-care, and social support, and discussed the role of policymakers in addressing the barriers to dietary changes. As inadequacies in regular vitamins and minerals supplementation, education, and self-care for women of reproductive age implicate maternal and child health outcomes, there is an urgent need for addressing malnutrition concerns in this population. Thus, a strong partnership between policymakers, healthcare professionals, and other relevant sectors is required.
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Affiliation(s)
- Unnop Jaisamrarn
- Faculty of Medicine, Chulalongkorn
University, Bangkok, Thailand
| | | | - Christia S Padolina
- University of the East Ramon Magsaysay
Memorial Medical Center, Quezon City, Philippines
| | | | - Marlyn T Dee
- UST Faculty of Medicine and Surgery,
Manila, Philippines
| | - Premitha Damodaran
- Pantai Hospital Kuala Lumpur, Wilayah
Persekutuan Kuala Lumpur, Malaysia
| | | | - Vandana Garg
- Haleon (formerly GSK Consumer
Healthcare), Singapore, Singapore
| | - Egbert Dorado
- Haleon (formerly GSK Consumer
Healthcare), Singapore, Singapore
| | - Henglong Hu
- Haleon (formerly GSK Consumer
Healthcare), Singapore, Singapore
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Wang M, Wen C, Qi H, Xu K, Wei M, Xia W, Lv L, Duan Z, Zhang J. Residential greenness and air pollution concerning excessive gestational weight gain during pregnancy: A cross-sectional study in Wuhan, China. ENVIRONMENTAL RESEARCH 2023; 217:114866. [PMID: 36427642 DOI: 10.1016/j.envres.2022.114866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/12/2022] [Accepted: 11/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Previous studies have indicated that exposure to residential greenness may benefit the health status of pregnant women, and air pollution may exert a mediating effect. Gestational weight gain (GWG) is an important indicator of pregnant women and fetuses' health and nutrition status. However, evidence concerning the impact of residential greenness on excessive gestational weight gain (EGWG) is scarce, and to what extent air pollution in urban settings mediates this relationship remains unclear. OBJECTIVE This study aims to explore the association of residential greenness with EGWG, consider the mediating effect of air pollution, and estimate the combined impact of residential greenness and air pollution exposures on EGWG. METHOD This population-based cross-sectional study involved 51,507 pregnant women with individual-level data on residential addresses in the Wuhan Maternal and Child Health Management Information System. Two spectral indexes, the normalized difference vegetation index (NDVI) and soil-adjusted vegetation index (SAVI), were used to proxy residential greenness. The air pollution data included six indicators (PM2.5, PM10, SO2, CO, NO2, O3) and used the Ordinary Kriging interpolation method to estimate overall pregnancy exposure to air pollutants. Generalized linear mixed regression models were utilized to explore the relationship between residential greenness and EGWG. Restricted cubic spline (RCS) models were developed to examine the dose-response relationships. Mediation analyses explored the potential mediating role of air pollution in the residential greenness-EGWG associations. Finally, the weighted-quantile-sum (WQS) regression model was used to investigate the association between residential greenness-air pollutants co-exposure and EGWG. RESULT Among all participants, 26,442 had EGWG. In the adjusted model, the negative association was found significant for NDVI100-m, NDVI200-m, and NDVI500-m with EGWG. For example, each IQR increase in NDVI100-m was associated with 2.8% (95% CI: 0.6-5.0) lower odds for EGWG. The result of WQS regression showed that, when considering the six air pollutants and NDVI-100m together, both positive and negative WQS indices were significantly associated with EGWG, PM10, PM2.5, with SO2 having significant weights in the positive effect direction and CO, O3, NO2, and NDVI100-m having a negative effect. Our results also suggested that SO2, NO2, PM10, PM2.5, and CO significantly mediated the association between NDVI-100m and EGWG, and our estimates were generally robust in the sensitivity analysis. CONCLUSION Exposure to a higher level of residential greenness is associated with a reduced risk of EGWG, in which air pollution may exert a mediating effect. Pregnant women might benefit more in gaining healthy gestational weight when greenness levels increase from low to medium than from medium to high. Given the current cross-sectional study design, large-sale prospective cohort studies are needed to confirm our findings further.
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Affiliation(s)
- Miyuan Wang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, China
| | - Chen Wen
- School of Architecture & Urban Planning, Huazhong University of Science and Technology, Luoyu Road, 430074, Wuhan, China; Hubei Engineering and Technology Research Center of Urbanization, PR China
| | - Haiqin Qi
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, China
| | - Ke Xu
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, China
| | - Mengna Wei
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, China
| | - Wenqi Xia
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, China
| | - Lan Lv
- Jianghan District Maternal and Child Health Care Hospital, China
| | - Zhengrong Duan
- Maternal Health Care Department, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
| | - Jianduan Zhang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, China.
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Asefa F, Cummins A, Dessie Y, Foureur M, Hayen A. Influence of gestational weight gain on baby's birth weight in Addis Ababa, Central Ethiopia: a follow-up study. BMJ Open 2022; 12:e055660. [PMID: 35701046 PMCID: PMC9198685 DOI: 10.1136/bmjopen-2021-055660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 06/01/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Gestational weight gain (GWG) is an important indicator of fetal well-being during pregnancy. Inadequate or excessive GWG could have undesirable effects on birth weight. However, information regarding the influence of GWG on birth weight is lacking from the Ethiopian setting. OBJECTIVE This study aimed to determine the influence of GWG and other maternal-related factors on birth weight in Addis Ababa, Ethiopia. DESIGN AND METHODS A cohort of pregnant women who received the first antenatal care before or at 16 weeks of gestation in health centres in Addis Ababa were followed from 10 January 2019 to 25 September 2019. Data were collected using a structured questionnaire and medical record reviews. We conducted a multivariable linear regression analysis to determine the independent effect of gestational weight on birth weight. RESULTS Of the 395 women enrolled in the study, the participants' pregnancy outcome was available for 329 (83.3%). The mean birth weight was 3130 (SD, 509) g. The proportion of low birth weight (<2500 g) was 7.5% (95% CI 4.8% to 11.0%). Babies born to underweight women were 150.9 g (95% CI 5.8 to 308.6 g, p=0.049) lighter than babies born to normal-weight women. Similarly, babies whose mothers gained inadequate weight were 248 g (95% CI 112.8 to 383.6 g, p<0.001) lighter than those who gained adequate weight. Moreover, babies whose mothers had a previous history of abortion or miscarriages or developed gestational hypertension in the current pregnancy were 147.2 g (95% CI 3.2 to 291.3 g, p=0.045) and 310.7 g (95% CI 62.7 to 552.8 g, p=0.012) lighter, respectively, compared with those whose mothers had not. CONCLUSIONS Prepregnancy weight, GWG, having had a previous history of abortion or miscarriages, and developing gestational hypertension during a current pregnancy were independently associated with birth weight. Pregnancy-related weight management should be actively promoted through intensive counseling during routine antenatal care contacts.
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Affiliation(s)
- Fekede Asefa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Oromia, Ethiopia
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Allison Cummins
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Oromia, Ethiopia
| | - Maralyn Foureur
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- Hunter New England Health, Nursing and Midwifery Research Centre, University of Newcastle, Newcastle, NSW, Australia
| | - Andrew Hayen
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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ZANLOURENSI CB, WAGNER KJP, BOING AF. Inadequacies of gestational weight gain: prevalence and association with sociodemographic characteristics and the living environment. REV NUTR 2022. [DOI: 10.1590/1678-9865202235e210156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
ABSTRACT Objective To assess the association of gestational weight gain inadequacies with sociodemographic indicators and characteristics of the living environment. Methods Cross-sectional study conducted in 2019 with a probabilistic sample of 3580 postpartum women who gave birth in maternity hospitals of the Unified Health System in the State of Santa Catarina. Prevalence was calculated and, using logistic regression models, odd ratios of inadequate and adequate gestational weight gain were estimated according to sociodemographic and health indicators (Body Mass Index, age, marital status, race/skin color and education); and characteristics of the neighborhood (violence, social cohesion, encouragement to practice physical activity and access to healthy food). Results It was observed that 29.6% of the mothers had adequate gestational weight gain, 29.3% insufficient and 41.1% excessive gestational weight gain. Lower chances of adequate weight gain were found in women with pre-pregnancy body mass index classified as overweight (43.0%) and obesity (58.0%) and who lived in an environment with social cohesion (25.0%). In contrast, the chances of adequate weight gain were 43.0% higher among women with 12 years of schooling or more when compared to those with 8 years or less. Conclusion Inadequate gestational weight gain is associated with high pre-pregnancy body mass index, with social cohesion in the living environment and with a low level of education of the pregnant woman, requiring public policies that go beyond prenatal care.
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Asefa F, Cummins A, Dessie Y, Foureur M, Hayen A. Patterns and predictors of gestational weight gain in Addis Ababa, Central Ethiopia: a prospective cohort study. Reprod Health 2021; 18:159. [PMID: 34321037 PMCID: PMC8317358 DOI: 10.1186/s12978-021-01202-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Gaining excessive or inadequate gestational weight is associated with many adverse maternal and fetal outcomes. Inadequate gestational weight gain (GWG) increases the risk of fetal growth restriction, pre-term birth, and low birth weight. It is a public health concern in sub-Saharan Africa. The aim of this study was to assess the patterns and predictors of GWG in Addis Ababa, Ethiopia. METHODS We conducted a prospective cohort study among pregnant women who attended antenatal care in health centres in Addis Ababa, from January to September 2019. Data were collected by a structured questionnaire and checklists and analysed using Stata version-14. Weight at or before 16 weeks gestation was used as a proxy for pre-pregnancy weight. Women's height and baseline weight were measured by data collectors, and we obtained weight at the end of the 24th and 36th weeks of gestation from women's medical records. GWG was categorized as inadequate, adequate and excessive based on the United States Institute of Medicine criteria. Predictors of GWG were identified using multinomial logistic regression. RESULTS A total of 395 pregnant women were enrolled in the study. GWG was assessed for 369 (93%) women. The median GWG was 8.7 kg with inter quartile ranges (25th, 75th percentiles) of 7.0 kg and 11.6 kg. More than two-third of the participants, 248 (67.2% [95% CI: 62.2, 72.0%]), gained inadequate weight; 103 (27.9% [95% CI: 23.4, 32.8%]) gained adequate weight; and 18 (4.9% [95% CI: 2.9%, 7.6%]) gained excessive weight. Three quarters (75%) of underweight women gained inadequate gestational weight, whereas 43% of overweight or obese women gained inadequate gestational weight. Being underweight (AOR = 3.30 [95% CI: 1.32, 8.24]) or normal weight (AOR = 2.68 [95% CI: 1.37, 5.24]) before pregnancy increased the odds of gaining inadequate gestational weight compared to overweight or obese women. Not having paid employment was associated with higher odds of gaining inadequate gestational weight compared to women employed outside the home (AOR = 2.17 [95% CI: 1.16, 4.07]). CONCLUSIONS Most pregnant women in Addis Ababa gain inadequate gestational weight. In particular, three quarters of underweight women gained inadequate gestational weight. Being underweight, normal weight or having no paid employment were associated with higher odds of inadequate GWG. Promoting adequate GWG in Addis Ababa among underweight and normal weight women may be an important public health initiative.
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Affiliation(s)
- Fekede Asefa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney,
Ultimo, Sydney, NSW Australia
- School of Public Health, Faculty of Health, University of Technology Sydney,
Ultimo, Sydney, NSW Australia
| | - Allison Cummins
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney,
Ultimo, Sydney, NSW Australia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Maralyn Foureur
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney,
Ultimo, Sydney, NSW Australia
- Hunter New England Health, Nursing and Midwifery Research Centre, University of Newcastle,
Newcastle
, NSW Australia
| | - Andrew Hayen
- School of Public Health, Faculty of Health, University of Technology Sydney,
Ultimo, Sydney, NSW Australia
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Moffat T, McKerracher L, Oresnik S, Atkinson SA, Barker M, McDonald SD, Murray-Davis B, Sloboda DM. Investigating the normalization and normative views of gestational weight gain: Balancing recommendations with the promotion and support of healthy pregnancy diets. Am J Hum Biol 2021; 33:e23604. [PMID: 33956376 DOI: 10.1002/ajhb.23604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/23/2021] [Accepted: 03/24/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Gestational weight gain (GWG) is increasingly monitored in the United States and Canada. While promoting healthy GWG offers benefits, there may be costs with over-surveillance. We aimed to explore these costs/benefits. METHODS Quantitative data from 350 pregnant survey respondents and qualitative focus group data from 43 pregnant/post-partum and care-provider participants were collected in the Mothers to Babies (M2B) study in Hamilton, Canada. We report descriptive statistics and discussion themes on GWG trajectories, advice, knowledge, perceptions, and pregnancy diet. Relationships between GWG monitoring/normalization and worry, knowledge, diet quality, and sociodemographics-namely low-income and racialization-were assessed using χ2 tests and a linear regression model and contextualized with focus group data. RESULTS Most survey respondents reported GWG outside recommended ranges but rejected the mid-20th century cultural norm of "eating for two"; many worried about gaining excessively. Conversely, respondents living in very low-income households were more likely to be gaining less than recommended GWG and to worry about gaining too little. A majority had received advice about GWG, yet half were unable to identify the range recommended for their prepregnancy BMI. This proportion was even lower for racialized respondents. Pregnancy diet quality was associated with household income, but not with receipt or understanding of GWG guidance. Care-providers encouraged normalized GWG, while worrying about the consequences of pathologizing "abnormal" GWG. CONCLUSIONS Translation of GWG recommendations should be done with a critical understanding of GWG biological normalcy. Supportive GWG monitoring and counseling should consider clinical, socioeconomic, and community contexts.
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Affiliation(s)
- Tina Moffat
- Department of Anthropology, McMaster University, Hamilton, Ontario, Canada
| | - Luseadra McKerracher
- Department of Anthropology, McMaster University, Hamilton, Ontario, Canada.,Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Oresnik
- Department of Anthropology, McMaster University, Hamilton, Ontario, Canada
| | | | - Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Sarah D McDonald
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, Ontario, Canada.,Departments of Radiology and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada.,Division of Maternal-Fetal Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Beth Murray-Davis
- McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Deborah M Sloboda
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Obstetrics & Gynecology, McMaster University, Hamilton, Ontario, Canada.,Farncombe Family Digestive Diseases Research Institute, McMaster University, Hamilton, Ontario, Canada
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Choi HK, Kim HO. [Effect of Lifestyle Intervention Program for Overweight and Obesity Pregnant Women]. J Korean Acad Nurs 2021; 50:459-473. [PMID: 32632078 DOI: 10.4040/jkan.19228] [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: 10/29/2019] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was conducted to identify the effects of a lifestyle intervention program on weight gain, dietary habits, fatigue and pregnancy stress, blood pressure, and neonatal birth weight, using Cox's interaction model of client health behavior for overweight and obese women. METHODS This was a quasi-experimental research with a non-equivalent control group pre-post test design. A total of 52 patients who met the selection criteria, including 25 in the experimental group and 27 in the control group, were the subjects of the study; they comprised overweight and obese pregnant women who were receiving prenatal care at A and B women's hospital in J province. The lifestyle intervention program ran for 12 weeks in total and consisted of interactions involving affective support, health information, and professional/technical competencies. The data collection period was from February 1, 2017 to August 31, 2017. RESULTS This study showed differences in the appropriate weight gain rate (χ²=6.17, p=.013), suppression of an increase in fatigue (t=-2.32, p=.012), and an increase in pregnancy stress (t=-1.87, p=.034). Yet, no differences in physical activity, dietary habits change, blood pressure, and neonatal birth weight (p>.05) were found. CONCLUSION The study findings indicate that this program could be an effective intervention for the control of appropriate weight gain, fatigue, and pregnancy stress. Therefore, a lifestyle intervention program based on Cox's interaction model of client health behavior could be an efficient strategy for a positive health outcome of overweight and obesity pregnant women.
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Affiliation(s)
- Hye Kyung Choi
- College of Nursing, Jeonbuk National University, Jeonju, Korea
| | - Hyeon Ok Kim
- College of Nursing · Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Korea.
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Asefa F, Cummins A, Dessie Y, Foureu M, Hayen A. Midwives' and obstetricians' perspectives about pregnancy related weight management in Ethiopia: A qualitative study. PLoS One 2020; 15:e0244221. [PMID: 33332406 PMCID: PMC7746277 DOI: 10.1371/journal.pone.0244221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/04/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Midwives and obstetricians are key maternity care providers; they are the most trusted source of information regarding nutrition and gestational weight gain. However, their views, practices and perceived barriers to managing pregnancy related weight gain have not been studied in Ethiopia. The aim of this study was to explore midwives' and obstetricians' observations and perspectives about gestational weight gain and postpartum weight management in Ethiopia. METHODS We conducted face-to-face interviews with 11 midwives and 10 obstetricians, from January 2019 to March 2019. All interview data were transcribed verbatim. We analysed the data using thematic analysis with an inductive approach. RESULTS We identified three themes and associated subthemes. Midwives and obstetricians had limited knowledge of the optimal gestational weight gain. Almost all participants were unaware of the presence of the Institute of Medicine recommendations for optimal weight gain in pregnancy. According to the study participants, women in Ethiopia do not want to gain weight during pregnancy, but do want to gain weight after the birth. Counselling about gestational weight gain and postpartum weight management was not routinely provided for pregnant women. This is mostly because gestational weight gain counselling was not considered to be a priority by maternity care providers in Ethiopia. CONCLUSIONS The limited knowledge of and low attention to pregnancy related weight management by midwives and obstetricians in this setting needs appropriate intervention. Adapting a guideline for pregnancy weight management and integrating it into antenatal care is essential.
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Affiliation(s)
- Fekede Asefa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Allison Cummins
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Maralyn Foureu
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- Hunter New England Health, Nursing and Midwifery Research Centre, University of Newcastle, Newcastle, NSW, Australia
| | - Andrew Hayen
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Asefa F, Cummins A, Dessie Y, Hayen A, Foureur M. Gestational weight gain and its effect on birth outcomes in sub-Saharan Africa: Systematic review and meta-analysis. PLoS One 2020; 15:e0231889. [PMID: 32324783 PMCID: PMC7179909 DOI: 10.1371/journal.pone.0231889] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/02/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION An increased metabolic demand during pregnancy is fulfilled by gaining sufficient gestational weight. Women who gain inadequate-weight are at a high-risk of premature birth or having a baby with low-birth weight. However, women who gain excessive-weight are at a high-risk of having a baby with macrosomia. The aim of this review was to determine the distribution of gestational weight gain and its association with birth-outcomes in Sub-Saharan Africa. METHODS For this systematic review and meta-analysis, we performed a literature search using PubMed, Medline, Embase, Scopus, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. We searched grey-literature from Google and Google Scholar, and region-specific journals from the African Journals Online (AJOL) database. We critically appraised the included studies using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Two independent reviewers evaluated the quality of the studies and extracted the data. We calculated pooled relative-risks (RR) with 95% confidence intervals. RESULTS Of 1450 retrieved studies, 26 met the inclusion criteria. Sixteen studies classified gestational weight gain according to the United States Institute of Medicine recommendations. The percentage adequate amount of gestational weight ranged from 3% to 62%. The percentage of inadequate weight was >50% among nine studies. Among underweight women, the percentage of women who gained inadequate gestational weight ranged from 67% to 98%. Only two studies were included in the meta-analyses to evaluate the association of gestational weight gain with pre-eclampsia and macrosomia. No difference was observed among women who gained inadequate and adequate gestational weight regarding experiencing pre-eclampsia (RR, 0.71; 95% CI: 0.22, 2.28, P = 0.57). Excessive gestational weight gain was not significantly associated with macrosomia compared to adequate weight gain (RR, 0.68; 95% CI: 0.38, 1.22, P = 0.20). CONCLUSION A substantial proportion of sub-Saharan African women gain inadequate gestational weight particularly high among underweight women. Future interventions would need to design effective pre-pregnancy weight management strategies.
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Affiliation(s)
- Fekede Asefa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Allison Cummins
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Andrew Hayen
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Maralyn Foureur
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
- Hunter New England Health, Nursing and Midwifery Research Centre, University of Newcastle, Callaghan, NSW, Australia
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11
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Deierlein AL, Messito MJ, Katzow M, Berube LT, Dolin CD, Gross RS. Total and trimester-specific gestational weight gain and infant anthropometric outcomes at birth and 6 months in low-income Hispanic families. Pediatr Obes 2020; 15:e12589. [PMID: 31696650 PMCID: PMC7012708 DOI: 10.1111/ijpo.12589] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/18/2019] [Accepted: 09/28/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe total and trimester-specific gestational weight gain (GWG) among low-income Hispanic women and determine whether these GWG exposures are associated with infant anthropometric outcomes at birth and 6 months. STUDY DESIGN Data were from 448 mother-infant pairs enrolled in the Starting Early child obesity prevention trial. Prenatal weights were used to calculate total GWG and 2nd and 3rd trimester GWG rates (kg/week) and categorized as inadequate, adequate, and excessive according to the 2009 Institute of Medicine recommendations. Multivariable linear and modified Poisson regressions estimated associations of infant anthropometric outcomes (birthweight, small-for-gestational age [SGA], large-for-gestational age [LGA], rapid weight gain, and weight-for-age, length-for-age, and weight-for-length z-scores at 6 months) with GWG categories. RESULTS For total GWG, 39% and 27% of women had inadequate and excessive GWG, respectively. 57% and 46% had excessive GWG rates in the 2nd and 3rd trimesters, respectively, with 29% having excessive rates in both trimesters. Inadequate total GWG was associated with lower infant weight and length outcomes (ß range for z-scores = -0.21 to -0.46, p < 0.05) and lower risk of LGA (adjusted Relative Risk, aRR = 0.38; 95% confidence intervals, CI: 0.16, 0.95) and rapid weight gain (aRR = 0.72; 95%CI: 0.51, 1.00). GWG rates above recommendations in the 2nd trimester or 2nd /3rd trimesters were associated with greater weight outcomes at birth and 6 months (ß range for z-scores = 0.24 to 0.35, p < 0.05). CONCLUSIONS Counseling women about health behaviors and closely monitoring GWG beginning in early pregnancy is necessary, particularly among populations at high-risk of obesity.
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Affiliation(s)
- Andrea L. Deierlein
- Department of Epidemiology, New York University College of Global Public Health, New York
| | - Mary Jo Messito
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, New York
| | - Michelle Katzow
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, New York
| | - Lauren Thomas Berube
- Department of Nutrition and Food Studies, New York University Steinhardt, New York
| | - Cara D. Dolin
- Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania
| | - Rachel S. Gross
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, New York
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12
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Vinturache A, Winn A, Mannion C, Tough S. Women's recall of health care provider counselling on gestational weight gain (GWG): a prospective, population-based study. BMC Pregnancy Childbirth 2019; 19:136. [PMID: 31023254 PMCID: PMC6485057 DOI: 10.1186/s12884-019-2283-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prenatal care has been validated to provide medical and educational counselling intended to reduce the risk of adverse pregnancy conditions and improve the maternal and fetal outcomes. Prenatal targeted information regarding nutrition, lifestyle, and weight gain is predictive of meeting Institute of Medicine (IOM) 2009 gestational weight gain (GWG) guidelines. There is limited information about women's experiences with these prenatal counselling domains, particularly in women who do not meet GWG recommendations. The objective of this study was to evaluate the impact of women's recall of prenatal counselling and its effect on meeting their GWG within guidelines in a prospective, community-based pregnancy cohort. METHODS A sample of 2909 women with singleton pregnancies was drawn from the prospective community-based pregnancy cohort All Our Families from Alberta, Canada. Women were stratified into three GWG groups, adequate, inadequate, and excessive GWG, based on pre-pregnancy BMI and the adherence to the Institute of Medicine weight gain in pregnancy guidelines. At less than 25 and 34 to 36 weeks' gestation, maternal socio-demographic information and women's recall of prenatal counselling experiences was collected through self-administered questionnaires. Multivariate logistic regression analyses tested GWG strata impact on women's recall of the prenatal counselling advice in eight domains of nutrition, lifestyle, and weight management during pregnancy. RESULTS Adequate GWG was reached by 35.9% of women, 46.5% gained excessive and 17.6% gained inadequate weight. Women who were overweight and obese prior to pregnancy were more likely to gain excessive weight than women who were normal weight (OR 3.3, 95% CI 2.6-4.1; and OR 2.9, 95% CI 2.1-3.9, respectively). Most women reported having no difficulties in finding prenatal care, felt comfortable with their health care provider and were satisfied with the answers received. There was no difference in the recall of prenatal advice received in any of the eight domains of prenatal counselling assessed among women with appropriate and non-optimal GWG. CONCLUSION Women with adequate and non-optimal GWG received comparable prenatal counselling on nutrition, weight gain, and lifestyle modifications. There remain missed opportunities in targeting prenatal counselling advice to women at risk for suboptimal or excessive GWG.
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Affiliation(s)
- Angela Vinturache
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Department of Obstetrics & Gynaecology, St. George's University Hospitals NHS Foundation Trust, London, UK.
| | - Anika Winn
- Faculty of Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia Mannion
- Faculty of Nursing, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne Tough
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community of Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Associations between cumulative neighborhood deprivation, long-term mobility trajectories, and gestational weight gain. Health Place 2018; 52:101-109. [PMID: 29883957 DOI: 10.1016/j.healthplace.2018.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 05/18/2018] [Accepted: 05/23/2018] [Indexed: 11/21/2022]
Abstract
Existing research on neighborhood environment and gestational weight gain (GWG) focuses on point-in-time measures of neighborhood context. This precludes understanding how long-term exposure to adverse neighborhood environments influences GWG. We estimated associations between average exposure to and trajectories of long-term neighborhood socioeconomic deprivation and risk of inadequate or excessive GWG. Using data from 5690 full-term, singleton pregnancies in the 1979 National Longitudinal Survey of Youth, we estimated associations between cumulative deprivation and GWG, overall and by race/ethnicity, controlling for individual and residential covariates. A one standard deviation unit (8-point) increase in neighborhood deprivation increased risk of inadequate GWG (Relative Risk (RR): 1.08; 95% Confidence Interval (CI): 1.00-1.16) for all women and excessive GWG (RR: 1.11; 95% CI 1.02-1.21) for white women. Persistent low deprivation (RR: 0.78; 95% CI: 0.64-0.94) and upward mobility (RR: 0.76; 95% CI: 0.61-0.96), compared to persistent high deprivation, reduced risk of inadequate GWG. Persistent low deprivation also reduced risk of excessive GWG (RR: 0.84; 95% CI: 0.71-0.98). Long-term neighborhood deprivation contributes to patterns of GWG over women's life course.
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CABRAL M, SICHIERI R, ROCHA CMMD, CASTRO MBTD. Protein intake and weight gain among low-income pregnant women from Mesquita County, Rio de Janeiro, Brazil. REV NUTR 2018. [DOI: 10.1590/1678-98652018000300002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
ABSTRACT Objective To evaluate the effect of protein intake on body weight gain at pregnancy. Methods A cross-sectional study was carried out with 297 women who delivered a child at the maternity ward of Municipal Hospital Leonel de Moura Brizola in Mesquita city in the state of Rio de Janeiro. Sociodemographic and anthropometric data were collected through the use of a structured questionnaire at first week after delivery. Food intake was assessed by a food frequency questionnaire. Protein intake per kilogram of body weight (g/kg per day) during pregnancy was categorized as high or low protein intake according to overall median levels. Hierarchical multiple linear regression was fitted to estimate the effect of protein intake per kg during pregnancy on weight gain. Results Women presented an average weight gain of 12.8kg (SD=6.34) and 26.8kg/m2 (SD=4.78) of Body Mass Index. Those who consumed a diet with high levels of protein content significantly presented less weight at postpartum (p<0.01) lower Early-Pregnancy Body Mass Index (p<0.01). In the hierarchical linear regression, it was found a negative association of protein intake per kg and Weight gain (b=-4.3025; IC95%=-6.0215; -2.5836; p<0.01). In the final model, all others covariates (energy, schooling, family income and gestational age) were significantly associated with the outcome (p<0.05). The additional model showed a negatively association between Early-Pregnancy Body Mass Index and weight gain (b=-0.2951; IC95%= -0.4987; -0.0915; p<0.01). Conclusion Higher levels of protein intake per kg of body weight during pregnancy were associated with lower weight gain.
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15
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Psychosocial predictors of gestational weight gain and the role of mindfulness. Midwifery 2017; 56:86-93. [PMID: 29096284 DOI: 10.1016/j.midw.2017.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 09/17/2017] [Accepted: 10/14/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To identify the psychosocial factors (i.e., stress, anxiety, depression, social support) that are associated with gestational weight gain (GWG) and the relationship of mindfulness with GWG during each trimester of pregnancy. DESIGN In this cross-sectional study, an online survey that assessed physical and mental health and wellness practices was administered to pregnant women. PARTICIPANTS Pregnant women ≥8 weeks gestation, ≥18 years old, and could read and write in English. MEASUREMENT AND FINDINGS Women who responded to the survey (N=1,073) were on average 28.7±4.6 years old. Findings from a regression analysis suggest that increased levels of depression may be predictive of increased GWG in the second trimester and decreased levels of mindfulness may be predictive of increased GWG in the first trimester. Anxiety, stress, and overall social support were not associated with GWG in any trimester. KEY CONCLUSIONS Mindfulness-based strategies (e.g., yoga) may have the potential to manage both depression and excessive GWG and may beneficial for and preferred by pregnant women. More research is warranted to determine clear relationships between psychosocial health, mindfulness, and GWG. IMPLICATIONS FOR PRACTICE Health care providers are encouraged to screen for depression in early pregnancy (i.e., first or second trimester) and provide resources to manage symptoms of depression and GWG to promote optimal birth outcomes. Health care providers may want to counsel patients on how to manage depression and/or GWG by suggesting mindfulness-based approaches.
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Abbasalizad Farhangi M. Gestational weight gain and its related social and demographic factors in health care settings of rural and urban areas in northwest Iran. Ecol Food Nutr 2016; 55:258-65. [PMID: 27002344 DOI: 10.1080/03670244.2016.1147437] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The current study was aimed to evaluate gestational weight gain and its socio-demographic determinants among pregnant women in north-west of Iran. In the current cross-sectional study, four hundred eighty one pregnant women aged 26.12 ± 7.45 years were enrolled. Data on pre-pregnancy weight, height, age, educational attainment, parity, household size, hemoglobin status and total pregnancy weight gain were extracted from routine health center records. The pregnant women were categorized based on their pre-pregnancy body mass index (BMI) as underweight, normal weight and overweight or obese according to the 2009 Institute of Medicine (IOM) recommendations. Participants were also classified according to their educational level into three 'some school', 'high school' and 'college' groups. Gestational weight gain in 27.6% of pregnant women was in normal IOM recommended range; while, weight gain in 49% and 23.2% of pregnant women was below and above recommended range respectively. Women with high educational attainment (≥12 years) have significantly higher weight gain compared with low-educated women (<12 years) (P < 0.001). Age was in negative relationship with gestational weigh gain even after adjusting for confounder effects of residency, educational attainment and household size (r = 0.2, P < 0.001). Our data showed a high prevalence of abnormal gestational weight gain in pregnant women attending to public health centers in northwest of Iran. Moreover educational level, parity and age were significant determinants of gestational weight gain in pregnancy. Special attention should be focused on prenatal nutritional status and health care programs in current health care services in Iran.
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Affiliation(s)
- Mahdieh Abbasalizad Farhangi
- a Drug Applied Research Center (DARC), Nutrition Research Center , Tabriz University of Medical Sciences , Tabriz , Iran
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17
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Blumfield ML, Schreurs M, Rollo ME, MacDonald-Wicks LK, Kokavec A, Collins CE. The association between portion size, nutrient intake and gestational weight gain: a secondary analysis in the WATCH study 2006/7. J Hum Nutr Diet 2015; 29:271-80. [PMID: 26249316 DOI: 10.1111/jhn.12330] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Excessive gestational weight gain (GWG) is associated with adverse maternal-child health outcomes. Managing energy intake and GWG versus optimising nutrient intake can be challenging. The present study aimed to examine the relationships between dietary portion size, GWG and nutrient intakes during pregnancy. It is hypothesised that, after adjustment for potential confounders, portion size would be positively associated with both GWG and nutrient intakes during pregnancy. METHODS Prospective data were obtained for 179 Australian women from the Women and Their Children's Health Study. A validated food frequency questionnaire was used at 18-24 and 36-40 weeks of gestation to quantify diet and portion size during the previous 3 months of pregnancy. Nutrient intakes were compared with Australian Nutrient Reference Values (NRVs). GWG was measured up to 36 weeks and compared with the Institute of Medicine weight gain recommendations (WtAdh). RESULTS In multivariate regression models, portion size factor (PSF) was positively associated with GWG in women with high socio-economic status (SES; β = 0.20, P = 0.04) and those with an overweight/obese pre-pregnancy body mass index (BMI) (β = 0.28, P = 0.04). PSF uniquely accounted for 8.2% and 3.7% of the variability in GWG for women with high SES and overweight/obese pre-pregnancy BMIs, respectively. Nutrient intakes and PSF were similar regardless of WtAdh. Women achieved NRVs for calcium and zinc in all PSF categories. Most of the women with large PSF still failed to achieve the NRVs for folate (95.7%), iron (89.6%) and fibre (85.5%). CONCLUSIONS All women require advice on quality food choices during pregnancy to optimise health outcomes. Targeting portion size alone is insufficient to manage GWG but may prove to be a valuable tool in pregnant women of high SES and/or those who are overweight/obese pre-pregnancy.
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Affiliation(s)
- M L Blumfield
- Department of Nutrition and Dietetics, Southern Clinical School of Medicine, Monash University, Clayton, VIC, Australia
| | - M Schreurs
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - M E Rollo
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre in Physical Activity and Nutrition, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - L K MacDonald-Wicks
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre in Physical Activity and Nutrition, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - A Kokavec
- School of Health, University of New England, Armidale, NSW, Australia
| | - C E Collins
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre in Physical Activity and Nutrition, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
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18
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Headen I, Mujahid MS, Cohen AK, Rehkopf DH, Abrams B. Racial/Ethnic Disparities in Inadequate Gestational Weight Gain Differ by Pre-pregnancy Weight. Matern Child Health J 2015; 19:1672-86. [PMID: 25652057 PMCID: PMC4503500 DOI: 10.1007/s10995-015-1682-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Pre-pregnancy body mass index (BMI) varies by race/ethnicity and modifies the association between gestational weight gain (GWG) and adverse pregnancy outcomes, which disproportionately affect racial/ethnic minorities. Yet studies investigating whether racial/ethnic disparities in GWG vary by pre-pregnancy BMI are inconsistent, and none studied nationally representative populations. Using categorical measures of GWG adequacy based on Institute of Medicine recommendations, we investigated whether associations between race/ethnicity and GWG adequacy were modified by pre-pregnancy BMI [underweight (<18.5 kg/m(2)), normal weight (18.5-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)), or obese (≥30.0 kg/m(2))] among all births to Black, Hispanic, and White mothers in the 1979 USA National Longitudinal Survey of Youth cohort (n = 6,849 pregnancies; range 1-10). We used generalized estimating equations, adjusted for marital status, parity, smoking during pregnancy, gestational age, and multiple measures of socioeconomic position. Effect measure modification between race/ethnicity and pre-pregnancy BMI was significant for inadequate GWG (Wald test p value = 0.08). Normal weight Black [risk ratio (RR) 1.34, 95 % confidence interval (CI) 1.18, 1.52] and Hispanic women (RR 1.33, 95 % CI 1.15, 1.54) and underweight Black women (RR 1.38, 95 % CI 1.07, 1.79) experienced an increased risk of inadequate GWG compared to Whites. Differences in risk of inadequate GWG between minority women, compared to White women, were not significant among overweight and obese women. Effect measure modification between race/ethnicity and pre-pregnancy BMI was not significant for excessive GWG. The magnitude of racial/ethnic disparities in inadequate GWG appears to vary by pre-pregnancy weight class, which should be considered when designing interventions to close racial/ethnic gaps in healthy GWG.
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Affiliation(s)
- Irene Headen
- University of California Berkeley, School of Public Health, Division of
Epidemiology, 101 Haviland Hall, Berkeley, CA, USA
| | - Mahasin S. Mujahid
- University of California Berkeley, School of Public Health, Division of
Epidemiology, 101 Haviland Hall, Berkeley, CA, USA
| | - Alison K. Cohen
- University of California Berkeley, School of Public Health, Division of
Epidemiology, 101 Haviland Hall, Berkeley, CA, USA
| | - David H. Rehkopf
- Stanford University, School of Medicine, Division of General Medical
Disciplines, Stanford, CA, USA
| | - Barbara Abrams
- University of California Berkeley, School of Public Health, Division of
Epidemiology, 101 Haviland Hall, Berkeley, CA, USA
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Mahanta LB, Choudhury M, Devi A, Bhattacharya A. On the Study of Pre-Pregnancy Body Mass Index (BMI) and Weight Gain as Indicators of Nutritional Status of Pregnant Women Belonging to Low Socio-Economic Category: A Study from Assam. Indian J Community Med 2015; 40:198-202. [PMID: 26170546 PMCID: PMC4478663 DOI: 10.4103/0970-0218.158870] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 01/22/2015] [Indexed: 11/04/2022] Open
Abstract
Women, particularly pregnant women, are the most vulnerable population of the society and their health status is one of the major indicators of development. There were enough studies on pre pregnancy body mass index (IPBMI) and inadequate weight gain during pregnancy (IWGP) of women in other part of the world and India, but none in Assam. In Assam a large number of population are in the category of low socio-economic group, a group most vulnerable to under nutrition. Thus this study was framed with the said indicators to throw light on the factors affecting the health status of pregnant women to accordingly address the situation. A cross sectional study using multistage sampling design with probability proportional to size was made comprising of 461 pregnant women belonging to low socio-economic status. Responses regarding their socio-economic, socio-cultural, health, diet and environmental background were collected and coded. The study revealed that although IPBMI (34.06%) was slightly lower than the reported state, national and global percentage the revealed IWGP (82%) was an astounding figure. The blood samples analyzed showed a high degree of inadequacy in almost all micronutrients (iron 63.1%, calcium 49.5% and copper 39.9%) studied in our survey.
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Affiliation(s)
- Lipi B Mahanta
- Central Computational and Numerical Studies, Life Science Division, Paschim Boragaon, Institute of Advanced Study in Science and Technology, Guwahati, Assam, India
| | - Manisha Choudhury
- National Health Mission (NHM), Assam, Office of the Mission Director, NHM, Assam, Saikia Commercial Complex, Guwahati, Assam, India
| | - Arundhuti Devi
- Resource Management and Environment Section, Life Science Division, Paschim Boragaon, Institute of Advanced Study in Science and Technology, Guwahati, Assam, India
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20
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Park CK, Timm V, Neupane B, Beyene J, Schmidt LA, McDonald SD. Factors Associated With Women's Plans to Gain Weight Categorized as Above or Below the National Guidelines During Pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:225-235. [PMID: 26001869 DOI: 10.1016/s1701-2163(15)30308-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Given that planning to gain gestational weight categorized as above the national guidelines is associated with actually gaining above the guidelines, we sought to identify physical, lifestyle, knowledge, and psychological factors associated with planned weight gain. METHODS Using a piloted, self-administered questionnaire, a cross-sectional study of women with singleton pregnancies was conducted. Women's plans for weight gain were categorized as above, within, or below the guidelines. Univariate and multivariate analyses were performed. RESULTS The response rate was 90.7% (n = 330). Compared with women whose plans to gain weight were within the guidelines, women whose plans to gain were above the guidelines were more likely to be older (adjusted odds ratio [aOR] 1.09 per year; 95% CI 1.03 to 1.16), to have a greater pre-pregnancy BMI (aOR 1.17 per unit of BMI; 95% CI 1.10 to 1.25), to drink more than one glass of soft drink or juice per day (aOR 2.73; 95% CI 1.27 to 5.87), and to report receiving a recommendation by their care provider to gain weight above the guidelines (aOR 5.46; 95% CI 1.56 to 19.05). Women whose plans to gain weight were categorized as below the guidelines were more likely to eat lunch in front of a screen (aOR 2.27; 95% CI 1.11 to 4.66) and to aspire to greater social desirability (aOR 2.51; 95% CI 1.01 to 6.22). CONCLUSION Modifiable factors associated with planned gestational weight gain categorized as above the guidelines included soft drink or juice consumption and having a recommendation from a care provider, while planned weight gain categorized as below the guidelines was associated with eating lunch in front of a screen and social desirability.
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Affiliation(s)
| | - Valerie Timm
- School of Nursing, Western University, London ON
| | - Binod Neupane
- Department of Clinical Epidemiology and Biostatistics, Hamilton ON
| | - Joseph Beyene
- Department of Clinical Epidemiology and Biostatistics, Hamilton ON
| | - Louis A Schmidt
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton ON
| | - Sarah D McDonald
- Department of Clinical Epidemiology and Biostatistics, Hamilton ON; Departments of Obstetrics and Gynecology (Division of Maternal-Fetal Medicine) and Radiology, Hamilton ON
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21
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Psychosocial risk factors for excessive gestational weight gain: A systematic review. Women Birth 2015; 28:e99-e109. [PMID: 25959883 DOI: 10.1016/j.wombi.2015.04.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 04/20/2015] [Accepted: 04/20/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Excessive weight gain during pregnancy can have adverse health outcomes for mother and infant throughout pregnancy. However, few studies have identified the psychosocial factors that contribute to women gaining excessive weight during pregnancy. AIM To review the existing literature that explores the impact of psychosocial risk factors (psychological distress, body image dissatisfaction, social support, self-efficacy and self-esteem) on excessive gestational weight gain. METHODS A systematic review of peer-reviewed English articles using Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature, MEDLINE Complete, PsycINFO, Informit, Web of Science, and Scopus was conducted. Quantitative studies that investigated psychosocial factors of excessive GWG, published between 2000 and 2014 were included. Studies investigating mothers with a low risk of mental health issues and normally-developing foetuses were eligible for inclusion. From the total of 474 articles located, 12 articles were identified as relevant and were subsequently reviewed in full. FINDINGS Significant associations were found between depression, body image dissatisfaction, and social support with excessive gestational weight gain. No significant relationships were reported between anxiety, stress, self-efficacy, or self-esteem and excessive gestational weight gain. CONCLUSION The relationship between psychosocial factors and weight gain in pregnancy is complex; however depression, body dissatisfaction and social support appear to have a direct relationship with excessive gestational weight gain. Further research is needed to identify how screening for, and responding to, psychosocial risk factors for excessive gestational weight gain can be successfully incorporated into current antenatal care.
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Fraga ACSA, Theme Filha MM. Factors associated with gestational weight gain in pregnant women in Rio de Janeiro, Brazil, 2008. CAD SAUDE PUBLICA 2014; 30:633-44. [PMID: 24714952 DOI: 10.1590/0102-311x00085313] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 08/29/2013] [Indexed: 11/22/2022] Open
Abstract
Inadequate weight gain during pregnancy is an important predictor of complications for the mother and infant. This cross-sectional study assessed factors associated with inadequate weight gain among women in the third trimester of pregnancy who received prenatal care under the Brazilian Unified National Health System (SUS) in the city of Rio de Janeiro, Brazil, from November 2007 to July 2008. A total of 1,079 pregnant women were interviewed, and adequacy of weight gain was obtained by calculating weight gain as recommended by the U.S. Institute of Medicine. Social, demographic, and obstetric factors were analyzed as independent variables. A multinomial logistic regression model was used, and pregnant women with weight gain below or above the recommended levels were compared to those with adequate weight gain. Low schooling was associated with insufficient weight gain, while excessive gain was observed in women with hypertension and pre-gestational underweight, overweight, and obesity. Nutritional assessment during prenatal care is essential, and interventions should target cases of inadequate weight gain in order to prevent complications for the mother and infant.
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Moya J, Phillips L, Sanford J, Wooton M, Gregg A, Schuda L. A review of physiological and behavioral changes during pregnancy and lactation: potential exposure factors and data gaps. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2014; 24:449-458. [PMID: 24424408 DOI: 10.1038/jes.2013.92] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 10/28/2013] [Accepted: 11/02/2013] [Indexed: 06/03/2023]
Abstract
Exposures to environmental contaminants can pose risks to pregnant women's health, their developing fetuses, children, and adults later in their lives. Assessing risks to this potentially susceptible population requires a sound understanding of the physiological and behavioral changes that occur during pregnancy and lactation. Many physiological and anatomical changes occur in a woman's organ systems during the course of pregnancy and lactation. For example, blood volume and cardiac output increase during pregnancy, and other metabolic functions are altered to provide for the demands of the fetus. During lactation, nutritional demands are greater than during pregnancy. There are also changes in behavior during both pregnancy and lactation. For example, water consumption during pregnancy and lactation increases. These behavioral and physiological changes can lead to different environmental exposures than these women might otherwise experience in the absence of pregnancy or lactation. This paper provides a summary of information from the published literature related to behavioral and physiological changes in pregnant and lactating women that may affect their exposure or susceptibility to environmental contaminants, provides potentially useful exposure factor data for this population of women, and highlights data gaps.
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Affiliation(s)
- Jacqueline Moya
- US Environmental Protection Agency, Office of Research and Development, National Center for Environmental Assessment, Mailcode 8623P, 1200 Pennsylvania Avenue Northwest, Washington, DC 20460, USA
| | - Linda Phillips
- US Environmental Protection Agency, Office of Research and Development, National Center for Environmental Assessment, Mailcode 8623P, 1200 Pennsylvania Avenue Northwest, Washington, DC 20460, USA
| | - Jessica Sanford
- Battelle Memorial Institute, 505 King Avenue, Columbus, Ohio 43201, USA
| | - Maureen Wooton
- Battelle Memorial Institute, 505 King Avenue, Columbus, Ohio 43201, USA
| | - Anne Gregg
- Battelle Memorial Institute, 505 King Avenue, Columbus, Ohio 43201, USA
| | - Laurie Schuda
- US Environmental Protection Agency, Office of Research and Development, National Center for Environmental Assessment, Mailcode 8623P, 1200 Pennsylvania Avenue Northwest, Washington, DC 20460, USA
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Abstract
OBJECTIVE To examine the influence of health behaviours and psychological well-being on gestational weight gain using a biopsychosocial model. DESIGN A prospective cohort study of pregnant women consecutively recruited at their first antenatal care visit. A self-administered questionnaire was used to collect data on health behaviours and psychological well-being in early pregnancy. Linear regression and logistic regression were used to identify predictors of total weight gain in kilograms and weight gain outside the current Institute of Medicine recommendations, respectively. SETTING A maternity hospital in the Republic of Ireland. SUBJECTS Data on 799 women were analysed. RESULTS Pre-pregnant BMI ≥30·0 kg/m2, short stature, parity >0, decreased food intake and absence of health insurance predicted lower absolute gestational weight gain, while foreign nationality, consumption of takeaway meals more than once weekly and increased food intake predicted higher absolute gestational weight gain. Overweight and obesity, foreign nationality, increased food intake and height >170 cm were risk factors for excessive weight gain, while antenatal depression was protective against excessive weight gain. Notably, physical activity measures were not related to the gestational weight gain outcomes. Pre-pregnancy overweight and increased food intake were the strongest predictors of excessive gestational weight gain. CONCLUSIONS None of the psychological well-being measures examined, with the exception of antenatal depression, was associated with any of the weight gain outcomes. The behavioural predictors of gestational weight gain were increased food intake and takeaway consumption. Public health promotions should target pre-pregnancy BMI and pregnancy-associated change in food intake.
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Galjaard S, Pexsters A, Devlieger R, Guelinckx I, Abdallah Y, Lewis C, van Calster B, Bourne T, Timmerman D, Luts J. The influence of weight gain patterns in pregnancy on fetal growth using cluster analysis in an obese and nonobese population. Obesity (Silver Spring) 2013; 21:1416-22. [PMID: 23408453 DOI: 10.1002/oby.20348] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 12/13/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Excessive weight gain during pregnancy has an important influence on fetal growth and on weight development in future generations. DESIGN AND METHODS A prospective cohort study of 325 obese and nonobese Caucasian women with naturally conceived, singleton pregnancies was performed. They were followed up until delivery for maternal weight gain and for fetal growth with ultrasound-based weight estimations and final birth weight. Using cluster analysis distinct profiles of maternal weight gain during pregnancy were obtained. Longitudinal regression analysis was performed to investigate the relationship of the maternal weight gain profile and BMI on fetal growth and final birth weight. RESULTS Cluster analysis revealed four discernable maternal weight gain profiles: 12 cases (3.7%) ended up at their starting weight or decreased in weight (cluster 1), 16 cases (4.9%) who slightly increased in weight (maximum 4 kg) as compared to their initial weight (cluster 2), 114 cases (35.1%) who gained between 4 and 12 kg in weight (cluster 3), and 183 cases (56.3%) who showed the largest weight gain: more than 12 kg (cluster 4). There were statistically significant differences in fetal growth associated with weight gain cluster, which became apparent late in the second trimester and increased toward the end of pregnancy. Maternal BMI and maternal weight gain profile were independent predictors of fetal growth and birth weight. CONCLUSIONS Therefore, the conclusion is that the cluster analysis permits to discern four gestational weight gain (GWG) patterns in obese and nonobese subjects and that both maternal BMI and maternal weight gain pattern during pregnancy positively influence fetal growth and birth weight.
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Affiliation(s)
- S Galjaard
- Department of Obstetrics and Gynecology, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium
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Perceptions of low-income African-American mothers about excessive gestational weight gain. Matern Child Health J 2013; 16:1837-43. [PMID: 22160656 DOI: 10.1007/s10995-011-0930-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A rising number of low-income African-American mothers gain more weight in pregnancy than is recommended, placing them at risk for poor maternal and fetal health outcomes. Little is known about the perceptions of mothers in this population that may influence excessive gestational weight gain. In 2010-2011, we conducted 4 focus groups with 31 low-income, pregnant African-Americans in Philadelphia. Two readers independently coded the focus group transcripts to identify recurrent themes. We identified 9 themes around perceptions that encouraged or discouraged high gestational weight gain. Mothers attributed high weight gain to eating more in pregnancy, which was the result of being hungrier and the belief that consuming more calories while pregnant was essential for babies' health. Family members, especially participants own mothers, strongly reinforced the need to "eat for two" to make a healthy baby. Mothers and their families recognized the link between poor fetal outcomes and low weight gains but not higher gains, and thus, most had a greater pre-occupation with too little food intake and weight gain rather than too much. Having physical symptoms from overeating and weight retention after previous pregnancies were factors that discouraged higher gains. Overall, low-income African-American mothers had more perceptions encouraging high gestational weight gain than discouraging it. Interventions to prevent excessive weight gain need to be sensitive to these perceptions. Messages that link guideline recommended weight gain to optimal infant outcomes and mothers' physical symptoms may be most effective for weight control.
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Paul KH, Graham ML, Olson CM. The web of risk factors for excessive gestational weight gain in low income women. Matern Child Health J 2013; 17:344-51. [PMID: 22415812 PMCID: PMC4535446 DOI: 10.1007/s10995-012-0979-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The objective of this study is to gain an in-depth understanding of issues related to gestational weight gain (GWG) including general health, diet, and physical activity among high and low income women and to elucidate socio-ecological and psychosocial risk factors that increase risk for excessive GWG. We conducted 9 focus groups with high (n = 4 groups) and low (n = 5 groups) income pregnant women aged 18-35 years to discuss health, GWG, diet and physical activity following a discussion guide. The constant comparative method was used to code focus group notes and to identify emergent themes. Themes were categorized within the integrative model of behavioral prediction. Low income women, in contrast to high income women, had higher BMIs, had more children, and were African American. Diet and physical activity behaviors reported by low income women were more likely to promote positive energy balance than were those of high income women. The underlying behavioral, efficacy, and normative beliefs described by both groups of women explained most of these behaviors. Experiencing multiple risk factors may lead to (1) engaging in several behavior changes during pregnancy unrelated to weight and (2) holding more weight gain-promoting beliefs than weight maintaining beliefs. These factors could inhibit diet and physical activity behaviors and/or behavior changes that promote energy balance and in combination, result in excessive GWG. Low income women experience multiple risk factors for excessive GWG and successful interventions to prevent excessive GWG and pregnancy related weight gain will need to recognize the complex web of influences.
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Affiliation(s)
- Keriann H. Paul
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
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O'Reilly JR, Reynolds RM. The risk of maternal obesity to the long-term health of the offspring. Clin Endocrinol (Oxf) 2013; 78:9-16. [PMID: 23009645 DOI: 10.1111/cen.12055] [Citation(s) in RCA: 185] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 09/18/2012] [Accepted: 09/19/2012] [Indexed: 01/22/2023]
Abstract
The prevalence of maternal obesity has risen dramatically in recent years, with approximately one in five pregnant women in the UK now classed as obese (body mass index ≥ 30 kg/m(2) ) at antenatal booking. Obesity during pregnancy has been hypothesized to exert long-term health effects on the developing child through 'early life programming'. While this phenomenon has been well studied in a maternal undernutrition paradigm, the processes by which the programming effects of maternal obesity are mediated are less well understood. In humans, maternal obesity has been associated with a number of long-term adverse health outcomes in the offspring, including lifelong risk of obesity and metabolic dysregulation with increased insulin resistance, hypertension and dyslipidaemia, as well as behavioural problems and risk of asthma. The complex relationships between the maternal metabolic milieu and the developing foetus, as well as the potential influence of postnatal lifestyle and environment, have complicated efforts to study the programming effects of maternal overnutrition in humans. This review will examine the emerging evidence from human studies linking maternal obesity to adverse offspring outcomes.
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Affiliation(s)
- James R O'Reilly
- Centre for Cardiovascular Sciences, Queen's Medical Research Institute, Endocrinology Unit, University of Edinburgh, Edinburgh, UK
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Bogaerts A, Van den Bergh B, Nuyts E, Martens E, Witters I, Devlieger R. Socio-demographic and obstetrical correlates of pre-pregnancy body mass index and gestational weight gain. Clin Obes 2012; 2:150-9. [PMID: 25586250 DOI: 10.1111/cob.12004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 09/03/2012] [Accepted: 09/27/2012] [Indexed: 12/24/2022]
Abstract
Both pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) are important determinants of a healthy pregnancy outcome and may show important variation. To study the influence of socio-demographic and obstetrical correlates on pre-pregnancy BMI and GWG, data of 54 022 singleton term pregnancies were analysed using adjusted regression models. In 2009, in the Northern region of Belgium, one-third of women were overweight (21.6%) or obese (10.1%) and GWG as recommended by the Institute of Medicine occurred in only 28% of obese women. A high pre-pregnancy BMI was significantly associated with low maternal education, high maternal age and multiparity, belonging to ethnic minority groups and a lower professional state. Compared to adequate GWG, excessive GWG was more common in younger (<20 years) women, with higher pre-pregnancy BMI and pregnancy-induced hypertension. Moreover, younger (20-24 years), single women, belonging to ethnic minority groups showed higher odds for excessive as well as insufficient GWG, while those with high/highest educational level had lower odds for excessive (odds ratio [OR] 0.76; confidence interval [CI] 0.72-0.80) and insufficient (OR 0.93; CI 0.89-0.98) GWG. The results of this study highlight the scale of the problem of maternal obesity and excessive GWG for this region and offer opportunities to target educational campaigns and intervention programmes in the clinical setting.
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Affiliation(s)
- A Bogaerts
- Department of Healthcare Research, KHLim, Limburg Catholic University College, PHL University College, Hasselt, Belgium
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Herring SJ, Nelson DB, Davey A, Klotz AA, Dibble LV, Oken E, Foster GD. Determinants of excessive gestational weight gain in urban, low-income women. Womens Health Issues 2012; 22:e439-46. [PMID: 22818249 DOI: 10.1016/j.whi.2012.05.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 05/21/2012] [Accepted: 05/24/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Factors influencing excessive weight gain in pregnancy have not been well-studied among urban, low-income women. METHODS This prospective cohort study of 94 prenatal care patients at a large university hospital in Philadelphia examined associations of modifiable midpregnancy behaviors and nonmodifiable or early pregnancy factors with excessive gestational weight gain. Data were collected through questionnaires and medical record abstraction from 2009 to 2011. FINDINGS The majority of women were African American (83%) and all (100%) received Medicaid. Nearly two thirds (60%) were overweight or obese in early pregnancy and 41% experienced excessive gain. In multivariable logistic regression analyses, significant predictors of excessive gestational weight gain included high early pregnancy body mass index (odds ratio [OR], 4.20; 95% confidence interval [CI], 1.43-12.34 for overweight/obese vs. normal weight), nulliparity (OR, 3.35; 95% CI, 1.17-9.62 for nulliparity vs. multiparity), and clinician advice discordant with Institute of Medicine guidelines (OR, 5.88; 95% CI, 1.04-33.32 for discordant vs. concordant advice). Watching under 2 hours of television daily (OR, 0.18; 95% CI, 0.03-1.03), and engaging in regular physical activity during pregnancy (OR, 0.35; 95% CI, 0.11-1.09) were suggestive of a reduced risk of excessive gain. CONCLUSIONS In this sample of urban, low-income women, high early pregnancy body mass index, nulliparity, and discordant clinician advice were directly associated with excessive gestational weight gain, with a trend toward decreased risk for viewing fewer hours of television and engaging in regular physical activity. Intervening on these targets may optimize gestational weight gain and promote long-term maternal health.
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Affiliation(s)
- Sharon J Herring
- Center for Obesity Research and Education, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
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Montgomery KS, Best M, Schaller S, Kirton K, Cancilla AG, Carver P, Stokes S, Horton-Hargrove T, Murry TJ, Ray J. Men’s Perceptions of Pregnancy-Related Weight Gain: A Psychosocial Firestorm (Upheaval) Intertwined With Supportive Intentions. J Perinat Educ 2012; 21:219-28. [DOI: 10.1891/1058-1243.21.4.219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In-depth interviews were conducted with 16 men who had a significant other who had given birth within the last 5 years. Men were asked about their perceptions of pregnancy-related weight gain, and content analysis was used to identify themes from the interviews. Men described nine themes related to perinatal weight gain: (a) negative perceptions, (b) eating behaviors, (c) exercise habits, (d) health impact, (e) body changes, (f) weight-loss success, (g) “it bothered her more than me,” (h) “the weight gain wasn’t a problem,” and (i) intimacy. Together, these themes offer a glimpse into men’s experiences and highlight the discord and balance between experiencing negative feelings/perceptions and being a supportive partner. This information on how men perceive pregnancy-related weight gain can be used to develop interventions to assist men to support their significant others in meeting weight loss goals following pregnancy.
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Abstract
This review examines published literature to answer 2 questions: 1) Are there racial-ethnic differences in excessive or inadequate gestational weight gain (GWG) and postpartum weight retention (PPWR)? and 2) Is there evidence that approaches to promote healthy weight during and after pregnancy should vary by race-ethnicity? We identified a limited number of articles that explicitly looked at racial-ethnic differences in either GWG or PPWR after controlling for relevant covariates. These studies suggest that black and Hispanic women are more likely to gain inadequately based on the Institute of Medicine's pregnancy weight gain guidelines compared to white women. Black women are more likely to retain considerable amounts of weight postpartum compared to both Hispanic and white mothers. Studies were inconclusive as to whether Hispanic women retained more or less weight postpartum, so more research is needed. Interventions to increase GWG were few and those designed to reduce GWG and PPWR showed mixed results. Future studies should address the methodological and conceptual limitations of prior research as well as investigate biological mechanisms and behavioral risk factors to determine the reasons for the racial-ethnic differences in pregnancy-related weight outcomes. Interventions would benefit from a mixed-methods approach that specifically identifies race-relevant barriers to weight management during and after pregnancy. Attention to the greater social context in which pregnancy-related weight exists is also needed.
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Affiliation(s)
- Irene E. Headen
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA
| | - Esa M. Davis
- Department of General Internal Medicine Center for Research on Health Care, University of Pittsburgh/University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mahasin S. Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA
| | - Barbara Abrams
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA
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Fernandez ID, Hoffmire CA, Olson CM. Gestational weight gain in adolescents: a comparison to the new Institute of Medicine recommendations. J Pediatr Adolesc Gynecol 2011; 24:368-75. [PMID: 21945627 PMCID: PMC3303193 DOI: 10.1016/j.jpag.2011.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 06/18/2011] [Accepted: 06/28/2011] [Indexed: 10/17/2022]
Abstract
STUDY OBJECTIVE To examine the gestational weight gain distributions of healthy adolescents with optimal birth outcomes and compare them to the current 2009 Institute of Medicine (IOM) recommendations. DESIGN Secondary data analysis to conduct a population-based, cross-sectional study. SETTING The Central and Finger Lakes regions of New York state (Perinatal Database System). PARTICIPANTS 6995 adolescents with healthy singleton pregnancies (1996 to 2002). MAIN OUTCOME MEASURES Percentiles of the gestational weight gain distributions were compared within body mass index (BMI) groups categorized using 2 different classification schemes: adolescent BMI percentiles and adult BMI cut-points. We compared these distributions overall and within racial and age groups. RESULTS The gestational weight gain distribution does not differ considerably when BMI is classified using adolescent or adult cutoffs. Adolescents have good birth outcomes across a wider gestational weight gain range than recommended by the Institute of Medicine regardless of how pre-pregnancy weight status is categorized. For example, overweight adolescents by adult cutoffs have a range of gestational weight gain from 5.0 kg to 30.0 kg, and overweight adolescents by percentile cutoffs have a range from 5.4 kg to 29.5 kg, whereas the IOM range is 7.5-11.5 kg. Black and young adolescents have a similar distribution to their white and older counterparts. CONCLUSION Practitioners can safely use the new IOM gestational weight gain ranges to monitor weight gain in pregnant adolescent patients using adult BMI classifications. Future research should examine the range of gestational weight gain in adolescents considering a broader scope of birth and maternal outcomes.
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Affiliation(s)
- I D Fernandez
- Division of Epidemiology, Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642-0644, USA.
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Abeysena C, Jayawardana P. Sleep deprivation, physical activity and low income are risk factors for inadequate weight gain during pregnancy: a cohort study. J Obstet Gynaecol Res 2011; 37:734-40. [PMID: 21736667 DOI: 10.1111/j.1447-0756.2010.01421.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To determine the possible risk factors for inadequate gestational weight gain. METHODS A population-based cohort study was carried out in Sri Lanka from May 2001 to April 2002. Pregnant women were recruited on or before 16 weeks' gestation and followed up until delivery; the sample size was 710. Trimester-specific exposure status and potential confounding factors were gathered on average at the 12th, 28th and 36th weeks of gestation. Maternal weight was measured at the first antenatal clinic visit and at delivery. Inadequate weight gain was defined as weight gain below the Institute of Medicine recommendations in 2009. Multiple logistic regression was applied and the results were expressed as odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS The risk factors for inadequate weight gain were low per-capita monthly income (OR 1.63, 95% CI 1.03, 2.58), multiparity (OR 1.96, 95% CI 1.34, 2.87), sleeping <8 h/day during the second, third, or both second and third trimesters (OR 1.60, 95% CI 1.05, 2.46), standing and walking ≥5 h/day during the second trimester (OR 1.50, 95% CI 1.04, 2.15), and the newborn being of the male sex (OR 1.50, 95% CI 1.04, 2.16), controlling for the effect of body mass index and gestational age. CONCLUSIONS Risk factors for inadequate gestational weight gain were low income, being multiparous, sleep deprivation, physical activity in terms of standing and walking, and the male sex of baby.
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Affiliation(s)
- Chrishantha Abeysena
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
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Gestational weight gain and subsequent postpartum weight loss among young, low-income, ethnic minority women. Am J Obstet Gynecol 2011; 204:52.e1-11. [PMID: 20974459 DOI: 10.1016/j.ajog.2010.08.028] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 07/26/2010] [Accepted: 08/18/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Document weight change trajectories that lead to gestational weight gain or postpartum weight loss outside clinical recommendations established by the Institute of Medicine. STUDY DESIGN Women aged 14-25 receiving prenatal care and delivering singleton infants at term (n = 427). Medical record review and 4 structured interviews conducted: second and third trimester, 6- and 12-months postpartum. Longitudinal mixed modeling to evaluate weight change trajectories. RESULTS Only 22% of participants gained gestational weight within Institute of Medicine guidelines. There were 62% that exceeded maximum recommendations-more common among those overweight/obese (body mass index ≥25.0; P < .0001). 52% retained ≥10 lb 1-year postpartum. Increased weight gain and retention documented among smokers and women with pregnancy-induced hypertension; breastfeeding promoted postpartum weight loss (all P < .02). Body mass index by race interaction suggested healthier outcomes for Latinas (P = .02). CONCLUSION Excessive pregnancy weight gain and inadequate postpartum weight loss are highly prevalent among young low-income ethnic minority women. Pregnancy and postpartum are critical junctures for weight management interventions.
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Misra VK, Hobel CJ, Sing CF. The effects of maternal weight gain patterns on term birth weight in African-American women. J Matern Fetal Neonatal Med 2010; 23:842-9. [PMID: 20632908 DOI: 10.3109/14767050903387037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The goals of our study were (1) to estimate the trends in maternal weight gain patterns and (2) to estimate the influence of variation in maternal weight and rate of weight gain over different time periods in gestation on variation in birth weight in African-American and non-African-American gravidas. STUDY DESIGN AND SETTING Data from a prospective cohort study in which pregnant women were monitored at multiple time points during pregnancy were analysed. Maternal weight was measured at three times during pregnancy: preconception (W(0)); 16-20 weeks gestation (W(1)); 30-36 weeks gestation (W(2)), in a cohort of 435 women with full-term singleton pregnancies. The relationship between gestational age-adjusted birth weight (aBW) and measures of maternal weight and rate of weight gain across pregnancy was estimated using a multivariable longitudinal regression analysis stratified on African-American race. RESULTS The aBW was significantly associated with maternal weight measured at any visit in both strata. For African-American women, variation in aBW was significantly associated with variation in the rate of maternal weight gain in the first half of pregnancy (W(01)) but not the rate of maternal weight gain in the second half of pregnancy (W(12)); while for non-African-American women, variation in aBW was significantly associated with W(12) but not W(01). CONCLUSION Factors influencing the relationship between aBW and maternal weight gain patterns depend on the context of the pregnancy defined by race. Clinical decisions and recommendations about maternal weight and weight gain during pregnancy may need to account for such heterogeneity.
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Affiliation(s)
- Vinod K Misra
- Department of Pediatrics & Communicable Diseases, Division of Medical Genetics, The University of Michigan, Ann Arbor, Michigan, USA
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Araujo DMR, Vilarim MM, Sabroza AR, Nardi AE. [Depression during pregnancy and low birth weight: a systematic literature review]. CAD SAUDE PUBLICA 2010; 26:219-27. [PMID: 20396838 DOI: 10.1590/s0102-311x2010000200002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 12/10/2009] [Indexed: 01/11/2023] Open
Abstract
A systematic review was conducted, focusing on the relationship between depression during pregnancy and increased risk of low birth weight. The review covered articles published in PubMed, SciELO, and ISIWEB using the key words 'depression', 'pregnancy', 'birth weight' and 'low birth weight'. Ninety-nine studies were located, but after reading the abstracts only 10 articles were selected. According to criteria proposed by Downs & Black (1998) to assess the quality of the selected studies, only one was considered excellent, since it reached the maximum score of 20. Depression during pregnancy was associated with low birth weight in seven studies. Contradictions in the findings are due to differences in the scales used to evaluate depression, sample size, and insufficient control of important limiting factors for evaluating the results. Carefully designed studies are thus needed to elucidate the association between intra-gestational depression and low birth weight.
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Castro MBTD, Kac G, Sichieri R. Determinantes nutricionais e sóciodemográficos da variação de peso no pós-parto: uma revisão da literatura. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2009. [DOI: 10.1590/s1519-38292009000200002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Trata-se de um estudo de revisão sobre os fatores nutricionais e sócio-demográficos da variação de peso no pós-parto. Foi realizada uma busca bibliográfica nas bases de dados eletrônicas Scientific Eletronic Library On-line (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Medical Literature Analysis and Retrieval System Online (MEDLINE) referente a literatura publicada na última década (1997-2008). Treze artigos, um informe técnico e dois livros considerados relevantes sobre o assunto e publicados anteriormente ao ano 1997 foram citados na revisão. A revisão priorizou estudos de ensaios clínicos randomizados e de seguimento realizados com gestantes e mulheres no pós-parto. Os resultados obtidos mostram como principais fatores associados com a variação de peso no pós-parto o ganho de peso gestacional acima das recomendações do Institute of Medicine, Índice de Massa Corporal Pré-Gestacional > 25 kg/m2, dieta, tempo e intensidade do aleitamento materno e os fatores sócio-demográficos: raça negra, primiparidade, idade materna, baixa renda e baixa escolaridade. A prática regular de atividade física é recomendada como uma estratégia para evitar o ganho de peso excessivo e melhorar a perda de peso durante o pós-parto. No Brasil não existe uma estratégia nacional para prevenir o ganho de peso excessivo e garantir a adequada perda de peso nesse período. Durante o pós-parto, a maioria das ações de saúde visa basicamente garantir o aleitamento materno.
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Abstract
Pregnancy is a critical time window for evaluating weight gain on subsequent risk for obesity among women of childbearing age. The purpose of this investigation was to determine whether symptoms of depression, anxiety, stress, self-esteem, and fetal health locus of control (FHLC) beliefs were significant risk factors for adequacy of gestational weight gain (GWG) when maternal sociodemographic characteristics and health behaviors were considered. A total of 1,605 women were prospectively followed from < or =20 weeks' gestation through delivery. Participants completed standard self-report questionnaires. Adequacy of GWG was expressed as the ratio of observed/expected weight gain based on Institute of Medicine recommendations. Multivariate ANOVA models were conducted and generalized linear models were performed to calculate risk ratios. Higher depressive symptoms reported throughout pregnancy were significantly associated with higher adequacy ratios. Stronger beliefs in chance in determining fetal health predicted inadequate relative to adequate GWG and was positively associated with larger GWG ratios overall. Several relationships were attenuated when adjusted for covariates. The relationship between psychosocial status and adequacy of GWG is significantly impacted by maternal sociodemographic factors and health practices engaged in during pregnancy. Women who tend to believe that external factors primarily determine fetal health appear to be more vulnerable to nonadherence to clinical GWG guidelines. These results have important implications for targeting prevention and intervention efforts for improving maternal and fetal outcomes secondary to GWG patterns.
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Affiliation(s)
- Jennifer B Webb
- Department of Psychology, UNC Charlotte, Charlotte, North Carolina, USA.
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Abstract
This review uses the 1990 U.S. Institute of Medicine (IOM) gestational weight gain recommendations to examine the question, what is a healthy pregnancy weight gain? The relationship of gestational weight gain to infant size at birth; pregnancy, labor, and delivery complications; neonatal, infant, and child outcomes; and maternal weight and health outcomes in U.S. and European populations are discussed. Pregnancy weight gains within the IOM recommendations are associated with better outcomes. The possible exception is very obese women, who may benefit from weight gains less than the 7 kg (15 pounds) recommended. Only about 33% to 40% of U.S. women gain within IOM recommendations. Excessive gestational weight gain is more prevalent than inadequate gain. Women's gestational weight gains tend to follow the recommendations of health care providers. Current interventions demonstrate efficacy in influencing gestational weight gain in low-income women with normal and overweight body mass index in the United States and obese women in Scandinavia.
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Affiliation(s)
- Christine M Olson
- Division of Nutritional Sciences, Cornell University, Ithaca, New York 14853, USA.
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Chasan-Taber L, Schmidt MD, Pekow P, Sternfeld B, Solomon CG, Markenson G. Predictors of excessive and inadequate gestational weight gain in Hispanic women. Obesity (Silver Spring) 2008; 16:1657-66. [PMID: 18451771 DOI: 10.1038/oby.2008.256] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Factors influencing gestational weight gain are incompletely understood, particularly among Hispanic women. We assessed medical, sociodemographic, behavioral, and psychosocial predictors of overall gestational weight gain, as well as gains below, within, or above the range recommended by the Institute of Medicine (IOM) within a prospective study of 770 Hispanic (predominantly Puerto Rican) prenatal care patients at a large tertiary care facility in Western Massachusetts. One third of women gained within the recommended range, 22% gained below, and 45% gained above the range. In multivariate analysis, women in the highest category of BMI (P(trend)<0.001) and parity (P(trend)<0.001) gained on average 9 lbs less than those in the lowest category. Increasing time in residence in the continental United States (P(trend)<0.01) as well as a number of prenatal care visits (P(trend)=0.03) were positively associated with weight gain. Overweight women (odds ratio (OR)=2.2, 95% confidence interval (CI) 1.3, 3.8) and those over age 30 years (OR=2.5, 95% CI 1.2, 5.0) were more likely to gain above the IOM range as compared to normal-weight women and those aged 20-24, respectively. Women with <10 years of residence in the United States were 50% less likely to gain above the IOM range as compared to third-generation women (95% CI 0.3, 0.9). Findings identify determinants of gestational weight gain which can form the basis of targeted interventions in this rapidly growing ethnic group.
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Affiliation(s)
- Lisa Chasan-Taber
- Division of Biostatistics and Epidemiology, Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA.
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Rodrigues PL, Lacerda EMDA, Schlüssel MM, Spyrides MHC, Kac G. Determinants of weight gain in pregnant women attending a public prenatal care facility in Rio de Janeiro, Brazil: a prospective study, 2005-2007. CAD SAUDE PUBLICA 2008; 24 Suppl 2:S272-84. [DOI: 10.1590/s0102-311x2008001400012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 04/29/2008] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to evaluate the determinants of weight gain during pregnancy. The study adopted a prospective cohort design with four follow-up waves and included a sample of 255 pregnant women that received prenatal care at a public health care facility in Rio de Janeiro, Brazil. A mixed-effects linear longitudinal regression model was used, having as the dependent variable the weight assessed in four follow-up waves, and as independent variables: demographic, socioeconomic, reproductive, behavioral, and nutritional data. Mean weight gain was 0.413kg per gestational week, consistent with recommendations by the Institute of Medicine. Per capita family income and smoking were associated with total weight gain during gestation. According to the longitudinal multiple linear regression model, age (² = 0.6315), menarche (² = -2.3861), triglycerides (² = 0.0437), blood glucose (² = 0.1544), and adequacy of energy consumption (² = -0.0642) were associated with gestational weight gain. Special attention should be given to these sub-groups, due to increased risk of excessive weight gain.
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Blake SM, Kiely M, Gard CC, El-Mohandes AAE, El-Khorazaty MN. Pregnancy intentions and happiness among pregnant black women at high risk for adverse infant health outcomes. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2007; 39:194-205. [PMID: 18093036 DOI: 10.1363/3919407] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
CONTEXT Unintended pregnancy is associated with risk behaviors and increased morbidity or mortality for mothers and infants, but a woman's feelings about pregnancy may be more predictive of risk and health outcomes than her intentions. METHODS A sample of 1,044 black women who were at increased risk were enrolled at prenatal care clinics in the District of Columbia in 2001-2003. Bivariate and multivariate analyses assessed associations between pregnancy intentions or level of happiness about being pregnant and multiple psychosocial and behavioral risk factors, and identified correlates of happiness to be pregnant. RESULTS Pregnancy intentions and happiness were strongly associated, but happiness was the better predictor of risk. Unhappy women had higher odds than happy women of smoking, being depressed, experiencing intimate partner violence, drinking and using illicit drugs (odds ratios, 1.7-2.6). The odds of being happy were reduced among women who had other children or a child younger than two, who were single or did not have a current partner, who had had more than one sexual partner in the past year and who reported that the baby's father did not want the pregnancy (0.3-0.6). In contrast, the odds of being happy were elevated among women who had better coping strategies (1.03), who had not used birth control at conception (1.6) and who had 1-2 household members, rather than five or more (2.1). CONCLUSIONS Additional psychosocial screening for happiness about being pregnant and for partner characteristics, particularly the father's desire to have this child, may help improve prenatal care services and prevent adverse health outcomes.
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Affiliation(s)
- Susan M Blake
- Department of Prevention and Community Health, George Washington University Medical Center, Washington, DC, USA.
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Konno SC, Benicio MHDA, Barros AJD. Fatores associados à evolução ponderal de gestantes: uma análise multinível. Rev Saude Publica 2007; 41:995-1002. [DOI: 10.1590/s0034-89102007000600015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Accepted: 07/13/2007] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar a influência de fatores socioeconômicos, reprodutivos e comportamentais sobre a evolução do peso durante a gestação. MÉTODOS: O peso corporal foi mensurado prospectivamente em uma coorte de 215 gestantes saudáveis atendidas por um serviço público de pré-natal do Município de São Paulo, no período de 1997 a 1998. Os critérios de inclusão foram: idade > 18 anos e início do pré-natal com idade gestacional < 16 semanas. A relação entre as variáveis independentes com a evolução do peso durante a gestação foi avaliada mediante análise multinível linear hierarquizada, analisada pelo teste de máxima verossimilhança. RESULTADOS: Na análise multinível, os fatores significantemente associados ao ganho de peso gestacional foram IMC inicial, escolaridade, situação marital e paridade. As equações obtidas permitiram identificar o efeito individualizado de cada uma das características: IMC inicial eutrófico, escolaridade >4 anos, ausência de companheiro e primiparidade proporcionam acréscimos de 3,0 kg, 1,9 kg, 2,3 kg e 2,4 kg, respectivamente, no ganho de peso total durante a gestação. CONCLUSÕES: O IMC inicial, escolaridade e paridade são características maternas que, com o estado marital, devem ser consideradas no desenvolvimento de estratégias para a promoção de um ganho de peso adequado durante a gestação.
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Assunção PLD, Melo ASDO, Gondim SSR, Benício MHD, Amorim MMR, Cardoso MAA. Ganho ponderal e desfechos gestacionais em mulheres atendidas pelo Programa de Saúde da Família em Campina Grande, PB (Brasil). REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2007. [DOI: 10.1590/s1415-790x2007000300006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Descrever o ganho ponderal e sua associação com os desfechos gestacionais em gestantes do Programa de Saúde da Família no município de Campina Grande, PB. MÉTODOS: Trata-se de um estudo longitudinal prospectivo desenvolvido de março de 2005 a março de 2006. O peso gestacional foi avaliado a cada quatro semanas a partir da 16ª semana gestacional. O cálculo do índice de massa corporal seguiu os critérios de Atalah (1997), adotados pelo Ministério da Saúde, e o ganho ponderal foi avaliado segundo recomendações do Institute of Medicine (1990). RESULTADOS: O estudo foi concluído com 118 gestantes, entre as quais a média de idade foi de 23 anos. As incidências de ganho de peso excessivo, no segundo e no terceiro trimestres, foram iguais a 44% e a 45%, respectivamente. A hipertensão arterial gestacional foi observada em 8,5% da amostra, sendo estatisticamente significante a sua associação com o estado nutricional inicial (p=0,02). Não houve casos de diabetes gestacional e 34% das gestantes tiveram partos cirúrgicos. O estado nutricional inicial de sobrepeso/obesidade, bem como o ganho de peso excessivo nos dois trimestres estudados, apresentou associação significante com o estado nutricional pós-parto (p<0,001). CONCLUSÃO: A alta incidência de ganho de peso gestacional excessivo na coorte estudada e a associação do sobrepeso/obesidade inicial com os desfechos maternos são preocupantes e merecem a atenção dos serviços locais de saúde devido às suas implicações para a saúde da mãe e do feto.
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Nielsen JN, O'Brien KO, Witter FR, Chang SC, Mancini J, Nathanson MS, Caulfield LE. High gestational weight gain does not improve birth weight in a cohort of African American adolescents. Am J Clin Nutr 2006; 84:183-9. [PMID: 16825694 DOI: 10.1093/ajcn/84.1.183] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Because pregnant African American women and teens are at risk of low birth weight, they are frequently counseled to strive for gestational weight gains at the upper limits of the Institute of Medicine's recommended ranges. OBJECTIVE The objective was to examine whether such weight gains improve birth outcomes in a cohort of disadvantaged African American adolescents of low (<19.8), average (> or =19.8 to < or =26.0), or high (>26) prepregnancy body mass index (BMI; in kg/m2). DESIGN Data were extracted from the medical charts of 1120 African American adolescents who received prenatal care at an inner-city maternity clinic between 1990 and 2000 and analyzed by using analysis of covariance and multivariate regression methods. RESULTS Data were available for 815 adolescents, 711 of whom delivered at term (> or =37 wk). Fifty-eight percent (n = 409) of all term deliveries and 74% of the high-BMI adolescents (n = 126) had gains in the upper half of or above the recommended ranges. For all BMI groups, the most significant differences in birth outcomes were found in comparisons of teens who gained below the recommended ranges with those who gained in the lower half of the recommendation range. Further gains were not clearly beneficial, particularly for infants of high-BMI mothers. CONCLUSIONS African American adolescents entering pregnancy underweight or at average weight should be counseled to gain within the recommended ranges, whereas overweight adolescents need support to avoid excessive gestational weight gain. Such advice would be prudent in light of the known associations between obesity and the increased likelihood of chronic diseases.
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Massey Z, Rising SS, Ickovics J. CenteringPregnancy group prenatal care: Promoting relationship-centered care. J Obstet Gynecol Neonatal Nurs 2006; 35:286-94. [PMID: 16620257 DOI: 10.1111/j.1552-6909.2006.00040.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
CenteringPregnancy is an innovative model of group prenatal care that has been implemented at more than 100 prenatal care sites since 1995. CenteringPregnancy provides group prenatal care that is relationship centered, nurturing and transforming relationships among women, their families, and health care professionals. Complete prenatal care is provided in a group setting. Prenatal assessment, education, and support occur in a facilitative environment. The model offers effective and efficient care that is sustainable and can enhance the health of women, their families, health care providers, and communities.
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Affiliation(s)
- Zohar Massey
- Yale School of Public Health, New Haven, CT 06510, USA.
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Wells CS, Schwalberg R, Noonan G, Gabor V. Factors Influencing Inadequate and Excessive Weight Gain in Pregnancy: Colorado, 2000–2002. Matern Child Health J 2006; 10:55-62. [PMID: 16496222 DOI: 10.1007/s10995-005-0034-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To identify the biological, psychosocial, and behavioral characteristics that are associated with inadequate and/or excessive weight gain in pregnancy. METHODS Univariate, bivariate, and multiple logistic regression analyses were conducted using data from Colorado's 2000-2002 Pregnancy Risk Assessment Monitoring System (PRAMS). Independent variables included biological risk factors (prepregnancy BMI, parity, preterm labor, maternal morbidity), psychosocial risk factors (pregnancy intention, WIC and Medicaid enrollment, area of residence, age, race/ethnicity, education, and stressors), and behavioral risk factors (smoking and drinking alcohol in the last trimester of pregnancy). RESULTS In the bivariate analysis, all the biological risk factors were significantly associated with the pregnancy weight gain distribution, as were several of the psychosocial risk factors (WIC and Medicaid enrollment, area of residence, race/ethnicity, and maternal education). Smoking and alcohol use were not significant. After controlling for other variables through logistic regression, the only characteristics associated with inadequate weight gain were parity, underweight or obesity, preterm labor, nausea, residence in a rural area, low levels of education, and smoking. The characteristics associated with excessive weight gain were overweight or obesity, high blood pressure, and having 12 years of education. CONCLUSION Having a pre-pregnancy BMI above 29 greatly increases the risk for both inadequate and excessive weight gain. Unfortunately, obesity, like the other major risk factors identified here (maternal education and parity) are not modifiable after a given pregnancy begins. To address these problems, a sustained approach to women's health, education, and well-being across the lifespan will be required, rather than a reliance upon targeted interventions during pregnancy.
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Affiliation(s)
- Chris S Wells
- Colorado Department of Public Health and Environment, Health Statistics Section, Center for Health and Environmental Information and Statistics, Denver, Colorado 80246-1530, USA.
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