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Dodd JM, Louise J, Deussen AR, Mitchell M, Poston L. Rethinking causal assumptions about maternal BMI, gestational weight gain, and adverse pregnancy outcomes. BMC Med 2024; 22:197. [PMID: 38750522 PMCID: PMC11094971 DOI: 10.1186/s12916-024-03410-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 04/29/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The aim of this study was to evaluate commonly assumed causal relationships between body mass index (BMI), gestational weight gain (GWG), and adverse pregnancy outcomes, which have formed the basis of guidelines and interventions aimed at limiting GWG in women with overweight or obesity. We explored relationships between maternal BMI, total GWG (as a continuous variable and as 'excessive' GWG), and pregnancy outcomes (including infant birthweight measures and caesarean birth). METHODS Analysis of individual participant data (IPD) from the i-WIP (International Weight Management in Pregnancy) Collaboration, from randomised trials of diet and/or physical activity interventions during pregnancy reporting GWG and maternal and neonatal outcomes. Women randomised to the control arm of 20 eligible randomised trials (4370 of 8908 participants) from the i-WIP dataset of 36 randomised trials (total 12,240 women). The main research questions were to characterise the relationship between maternal BMI and (a) total GWG, (b) the risk of 'excessive' GWG (using the Institute of Medicine's guidelines), and (c) adverse pregnancy outcomes as mediated via GWG versus other pathways to determine the extent to which the observed effect of maternal BMI on pregnancy outcomes is mediated via GWG. We utilised generalised linear models and regression-based mediation analyses within an IPD meta-analysis framework. RESULTS Mean GWG decreased linearly as maternal BMI increased; however, the risk of 'excessive' GWG increased markedly at BMI category thresholds (i.e. between the normal and overweight BMI category threshold and between the overweight and obese BMI category threshold). Increasing maternal BMI was associated with increased risk of all pregnancy outcomes assessed; however, there was no evidence that this effect was mediated via effects on GWG. CONCLUSIONS There is evidence of a meaningful relationship between maternal BMI and GWG and between maternal BMI and adverse pregnancy outcomes. There is no evidence that the effect of maternal BMI on outcomes is via an effect on GWG. Our analyses also cast doubt on the existence of a relationship between 'excessive' GWG and adverse pregnancy outcomes. Our findings challenge the practice of actively managing GWG throughout pregnancy.
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Affiliation(s)
- Jodie M Dodd
- Department of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
- Department of Obstetrics and Gynaecology, Women's and Babies Division, The Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia, 5006, Australia.
| | - Jennie Louise
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Women's and Children's Research Centre, Women's and Children's Hospital Research Network, Adelaide, South Australia, Australia
| | - Andrea R Deussen
- Department of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Megan Mitchell
- Department of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lucilla Poston
- Women and Children's Health and School of Life Course Sciences, King's College London, London, UK
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Skytte HN, Roland MCP, Christensen JJ, Holven KB, Lekva T, Gunnes N, Michelsen TM. Maternal metabolic profiling across body mass index groups: An exploratory longitudinal study. Acta Obstet Gynecol Scand 2024; 103:540-550. [PMID: 38083835 PMCID: PMC10867396 DOI: 10.1111/aogs.14750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Increased BMI has been identified as a risk factor for most pregnancy complications, but the underlying metabolic factors mediating the detrimental effects of BMI are largely unknown. We aimed to compare metabolic profiles in overweight/obese women (body mass index [BMI] ≥ 25 kg/m2 ) and normal weight/underweight women (BMI < 25 kg/m2 ) across gestation. We also explored how gestational weight gain (GWG) affected maternal metabolic profiles. MATERIAL AND METHODS Exploratory nested case-control study based on a prospective longitudinal cohort of women who were healthy prior to pregnancy and gave birth at Oslo University Hospital from 2002 to 2008. The sample consisted of 48 women who were overweight/obese and 59 normal-weight/underweight women. Plasma samples from four time points in pregnancy (weeks 14-16, 22-24, 30-32 and 36-38) were analyzed by nuclear magnetic resonance spectroscopy and 91 metabolites were measured. Linear regression models were fitted for each of the metabolites at each time point. RESULTS Overweight or obese women had higher levels of lipids in very-low-density lipoprotein (VLDL), total triglycerides, triglycerides in VLDL, total fatty acids, monounsaturated fatty acids, saturated fatty acids, leucine, valine, and total branched-chain amino acids in pregnancy weeks 14-16 compared to underweight and normal-weight women. Docosahexaenoic acid and degree of unsaturation were significantly lower in overweight/obese women in pregnancy weeks 36-38. In addition, overweight or obese women had higher particle concentration of XXL-VLDL and glycoprotein acetyls (GlycA) at weeks 14-16 and 30-32. GWG did not seem to affect the metabolic profile, regardless of BMI group when BMI was treated as a dichotomous variable, ≥25 kg/m2 (yes/no). CONCLUSIONS Overweight or obese women had smaller pregnancy-related metabolic alterations than normal-weight/underweight women. There was a trend toward higher triglyceride and VLDL particle concentration in overweight/obese women. As this was a hypothesis-generating study, the similarities with late-onset pre-eclampsia warrant further investigation. The unfavorable development of fatty acid composition in overweight/obese women, with possible implication for the offspring, should also be studied further in the future.
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Affiliation(s)
- Hege Nyhus Skytte
- Norwegian Research Center for Women's HealthOslo University HospitalOsloNorway
- Faculty of MedicineUniversity of OsloOsloNorway
| | | | | | - Kirsten Bjørklund Holven
- Department of NutritionUniversity of OsloOsloNorway
- Norwegian National Advisory Unit on Familial HypercholesterolemiaOslo University HospitalOsloNorway
| | - Tove Lekva
- Research Institute of Internal MedicineOslo University HospitalOsloNorway
| | - Nina Gunnes
- Norwegian Research Center for Women's HealthOslo University HospitalOsloNorway
| | - Trond Melbye Michelsen
- Faculty of MedicineUniversity of OsloOsloNorway
- Division of Obstetrics and GynecologyOslo University HospitalOsloNorway
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He Y, Huang C, He Q, Liao S, Luo B. Effects of mHealth-Based Lifestyle Interventions on Gestational Diabetes Mellitus in Pregnant Women With Overweight and Obesity: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2024; 12:e49373. [PMID: 38231555 PMCID: PMC10831670 DOI: 10.2196/49373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The increasing incidence of gestational diabetes mellitus (GDM) is a global health problem that is more likely to occur in pregnant women with overweight or obesity. Adhering to a healthy lifestyle is associated with a reduced risk of GDM. With the development of IT, mobile health (mHealth) interventions have become widely available in health care. However, there are no definitive conclusions on the effectiveness of mHealth-based lifestyle interventions in preventing GDM. OBJECTIVE This study aims to evaluate the impact of mHealth-based lifestyle interventions on GDM and other pregnancy outcomes in pregnant women with overweight or obesity. METHODS A systematic literature search was conducted in 5 English databases (MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL) and 4 Chinese databases (CBM, CNKI, Vip, and Wanfang) to identify randomized controlled trials (RCTs) on the effectiveness of mHealth-based interventions for GDM from inception to January 10, 2023. In total, 2 authors independently screened the studies and extracted the data. The quality of the included studies was examined using the Cochrane risk-of-bias tool. Data synthesis was conducted using Review Manager (version 5.4; The Cochrane Collaboration). RESULTS A total of 16 RCTs with 7351 participants were included in this study. The included studies were published between 2014 and 2021 and were conducted in China, the United States, Australia, New Zealand, the United Kingdom, Ireland, and Norway. The sample sizes of the studies ranged from 75 to 2202, and the duration of the mHealth-based lifestyle interventions ranged from 4 to 28 weeks. Compared with usual care, mHealth-based lifestyle interventions significantly reduced the incidence of GDM (odds ratio [OR] 0.74, 95% CI 0.56-0.96; P=.03; I2=65%), preterm birth (OR 0.65, 95% CI 0.48-0.87; P=.004; I2=25%), macrosomia (OR 0.59, 95% CI 0.40-0.87; P=.008; I2=59%), and gestational weight gain (mean difference=-1.12 kg, 95% CI -1.44 to -0.80; P<.001; I2=43%). The subgroup analysis showed that interventions delivered via apps (OR 0.55, 95% CI 0.37-0.83; P=.004; I2=44%), provided by obstetricians (OR 0.69, 95% CI 0.51-0.93; P=.02; I2=60%), and targeted at Asian populations (OR 0.44, 95% CI 0.34-0.58; P<.001; I2=0%) and that used the International Association of Diabetes and Pregnancy Study Groups diagnostic criteria (OR 0.58, 95% CI 0.39-0.86; P=.007; I2=69%) showed a statistically significant reduction in the risk of GDM. CONCLUSIONS mHealth-based lifestyle interventions had a favorable impact on the prevention of GDM in pregnant women with overweight and obesity. Future studies need to further explore the potential of mHealth-based interventions for GDM through better design and more rigorous large-scale RCTs. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021286995; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=286995.
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Affiliation(s)
- Yirong He
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Chuanya Huang
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Qiuyang He
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
- Department of Obstetric Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shujuan Liao
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Biru Luo
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
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Barakat R, Silva-Jose C, Zhang D, Sánchez-Polán M, Refoyo I, Montejo R. Influence of Physical Activity during Pregnancy on Maternal Hypertensive Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Pers Med 2023; 14:10. [PMID: 38276226 PMCID: PMC10817323 DOI: 10.3390/jpm14010010] [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: 11/18/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Gestational hypertension is a notable concern with ramifications for maternal and fetal health. Preemptive measures, including physical activity (PA), are crucial. There is a pressing need for comprehensive investigations into the impact of various forms of PA on hypertensive disorders. A systematic review and meta-analysis (CRD42022372468) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Our review exclusively considered randomized clinical trials (RCTs) between 2010 and 2023, using the following databases: EBSCO, including Academic Search Premier, Education Resources Information Center, PubMed/MEDLINE, SPORTDiscus, and OpenDissertations; Clinicaltrials.gov; Web of Science; Scopus; the Cochrane Database of Systematic Reviews; and the Physiotherapy Evidence Database (PEDro). The primary outcome was hypertensive disorders occurring during pregnancy (14 studies). Diagnosed preeclampsia (15 studies) and blood pressure levels were also examined (17 studies). PA during pregnancy was significantly associated with a reduced risk of hypertensive disorders (RR = 0.44, 95% CI = 0.30, 0.66). The data also indicate a positive correlation between PA during pregnancy and both systolic (MD = -2.64, 95% CI = -4.79, -0.49) and diastolic (MD = -1.99, 95% CI = -3.68, -0.29) blood pressure levels. The relationship between PA and the incidence of diagnosed preeclampsia did not demonstrate a statistically significant association (RR = 0.81, 95% CI = 0.59, 1.11; p = 0.20). Random effects were used for all analyses. PA during pregnancy promises to improve maternal health by reducing the risk of gestational hypertension and positively affecting systolic and diastolic blood pressure.
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Affiliation(s)
- Rubén Barakat
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (D.Z.); (M.S.-P.)
| | - Cristina Silva-Jose
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (D.Z.); (M.S.-P.)
| | - Dingfeng Zhang
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (D.Z.); (M.S.-P.)
| | - Miguel Sánchez-Polán
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (D.Z.); (M.S.-P.)
| | - Ignacio Refoyo
- Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain;
| | - Rocío Montejo
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41346 Gothenburg, Sweden;
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, 41346 Gothenburg, Sweden
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Silva-Jose C, May L, Sánchez-Polán M, Zhang D, Barrera-Garcimartín A, Refoyo I, Barakat R. Influence of Physical Activity during Pregnancy on Neonatal Complications: Systematic Review and Meta-Analysis. J Pers Med 2023; 14:6. [PMID: 38276221 PMCID: PMC10820764 DOI: 10.3390/jpm14010006] [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: 11/18/2023] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024] Open
Abstract
Newborn hospitalisations after delivery are indicators of poor neonatal health with potential risks of future diseases for children. Interventions to promote a healthy environment have been used during pregnancy, with physical activity as a principal element. A systematic review and meta-analyses were performed to evaluate the effect of physical activity during pregnancy on neonatal intensive care unit (NICU) admissions and Apgar 1 and 5 scores (Registration No.: CRD42022372493). Fifty studies (11,492 pregnant women) were included. There were significantly different rates of NICU admissions between groups (RR = 0.76, 95% CI = 0.62, 0.93; Z = 2.65, p = 0.008; I2 = 0%, and Pheterogeneity = 0.78), and significant differences in Apgar 1 (Z = 2.04; p = 0.04) (MD = 0.08, 95% CI = 0.00, 0.17, I2 = 65%, Pheterogeneity = 0.00001) and Apgar 5 (Z = 3.15; p = 0.002) (MD = 0.09, 95% CI = 0.04, 0.15, I2 = 80%, and Pheterogeneity = 0.00001), favouring intervention groups. Physical activity during pregnancy could help to reduce the risk of NICU admissions that are related to neonatal complications.
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Affiliation(s)
- Cristina Silva-Jose
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (M.S.-P.); (D.Z.); (A.B.-G.)
| | - Linda May
- Department of Kinesiology, East Carolina University, Greenville, NC 27834, USA;
| | - Miguel Sánchez-Polán
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (M.S.-P.); (D.Z.); (A.B.-G.)
| | - Dingfeng Zhang
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (M.S.-P.); (D.Z.); (A.B.-G.)
| | - Alejandro Barrera-Garcimartín
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (M.S.-P.); (D.Z.); (A.B.-G.)
| | - Ignacio Refoyo
- Sports Department, Faculty of Physical Activity and Sports Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain;
| | - Rubén Barakat
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (M.S.-P.); (D.Z.); (A.B.-G.)
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Rai AS, Sletner L, Jenum AK, Øverby NC, Stafne SN, Qvigstad E, Pripp AH, Sagedal LR. Employing fasting plasma glucose to safely limit the use of oral glucose tolerance tests in pregnancy: a pooled analysis of four Norwegian studies. Front Endocrinol (Lausanne) 2023; 14:1278523. [PMID: 38098869 PMCID: PMC10720624 DOI: 10.3389/fendo.2023.1278523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/10/2023] [Indexed: 12/17/2023] Open
Abstract
Background/objective There is no international consensus about the optimal approach to screening and diagnosis of gestational diabetes mellitus (GDM). Fasting plasma glucose (FPG) has been proposed as an alternative universal screening test to simplify the diagnosis of GDM. We investigate the ability of the FPG to predict a 2-hour glucose value below the cut-off for GDM, thereby "ruling out" the necessity of a full OGTT and assess the proportion of GDM-related complications associated with the identified FPG level. Materials and methods This study included secondary data from four Norwegian pregnancy cohorts (2002-2013), encompassing 2960 women universally screened with late mid-pregnancy 75g OGTT measuring FPG and 2-hour glucose. For a range of FPG thresholds, we calculated sensitivity to predict elevated 2-hour glucose, number of OGTTs needed and percentage of GDM cases missed, applying modified World Health Organization (WHO) 2013 criteria (2013WHO) and 2017 Norwegian criteria (2017Norwegian). We analyzed pregnancy outcomes for women above and below our selected threshold. Results The prevalence of GDM was 16.6% (2013WHO) and 10.1% (2017Norwegian). A FPG threshold of 4.7 mmol/L had a sensitivity of 76% (2013WHO) and 80% (2017Norwegian) for detecting elevated 2-hour glucose, with few missed GDM cases (2.0% of those ruled out and 7.5% of all GDM cases for 2013WHO, and 1.1% of those ruled out and 7% of all GDM cases for 2017Norwegian). When excluding women with FPG <4.7mmol/l and those with GDM based on FPG, only 24% (2013WHO) and 29% (2017Norwegian) would require OGTT. Women with FPG <4.7mmol/l, including missed GDM cases, had low risk of large-for-gestational-age newborns, cesarean section and operative vaginal delivery. Conclusion A FPG threshold of 4.7mmol/l as a first step when screening for GDM could potentially eliminate the need for OGTT in 70-77% of pregnancies. Women with FPG below this threshold appear to carry low risk of GDM-associated adverse pregnancy outcomes.
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Affiliation(s)
- Anam Shakil Rai
- Department of Research, Sorlandet Hospital, Kristiansand, Norway
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Line Sletner
- Department of Pediatric and Adolescents Medicine, Akershus University Hospital, Akershus, Norway
| | - Anne Karen Jenum
- General Practice Research Unit (AFE), Department of General Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Nina Cecilie Øverby
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Signe Nilssen Stafne
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Clinical Services, St.Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Elisabeth Qvigstad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Linda Reme Sagedal
- Department of Research, Sorlandet Hospital, Kristiansand, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Obstetrics and Gynaecology, Sorlandet Hospital, Kristiansand, Norway
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Kadam I, Dalloul M, Hausser J, Huntley M, Hoepner L, Fordjour L, Hittelman J, Saxena A, Liu J, Futterman ID, Minkoff H, Jiang X. Associations between nutrients in one-carbon metabolism and fetal DNA methylation in pregnancies with or without gestational diabetes mellitus. Clin Epigenetics 2023; 15:137. [PMID: 37633918 PMCID: PMC10464204 DOI: 10.1186/s13148-023-01554-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/14/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM), characterized by hyperglycemia that develops during pregnancy, increases the risk of fetal macrosomia, childhood obesity and cardiometabolic disorders later in life. This process has been attributed partly to DNA methylation modifications in growth and stress-related pathways. Nutrients involved with one-carbon metabolism (OCM), such as folate, choline, betaine, and vitamin B12, provide methyl groups for DNA methylation of these pathways. Therefore, this study aimed to determine whether maternal OCM nutrient intakes and levels modified fetal DNA methylation and in turn altered fetal growth patterns in pregnancies with and without GDM. RESULTS In this prospective study at a single academic institution from September 2016 to June 2019, we recruited 76 pregnant women with and without GDM at 25-33 weeks gestational age and assessed their OCM nutrient intake by diet recalls and measured maternal blood OCM nutrient levels. We also collected placenta and cord blood samples at delivery to examine fetal tissue DNA methylation of the genes that modify fetal growth and stress response such as insulin-like growth factor 2 (IGF2) and corticotropin-releasing hormone (CRH). We analyzed the association between maternal OCM nutrients and fetal DNA methylation using a generalized linear mixed model. Our results demonstrated that maternal choline intake was positively correlated with cord blood CRH methylation levels in both GDM and non-GDM pregnancies (r = 0.13, p = 0.007). Further, the downstream stress hormone cortisol regulated by CRH was inversely associated with maternal choline intake (r = - 0.36, p = 0.021). Higher maternal betaine intake and serum folate levels were associated with lower cord blood and placental IGF2 DNA methylation (r = - 0.13, p = 0.049 and r = - 0.065, p = 0.034, respectively) in both GDM and non-GDM pregnancies. Further, there was an inverse association between maternal betaine intake and birthweight of infants (r = - 0.28, p = 0.015). CONCLUSIONS In conclusion, we observed a complex interrelationship between maternal OCM nutrients and fetal DNA methylation levels regardless of GDM status, which may, epigenetically, program molecular pathways related to fetal growth and stress response.
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Affiliation(s)
- Isma'il Kadam
- Departments of Health and Nutrition Sciences, Brooklyn College of City University of New York, 2900 Bedford Ave, Brooklyn, NY, 11210, USA
| | - Mudar Dalloul
- Department of Obstetrics and Gynecology, State University of New York Downstate Health Sciences University, Brooklyn, NY, 11203, USA
| | - Jeanette Hausser
- Departments of Health and Nutrition Sciences, Brooklyn College of City University of New York, 2900 Bedford Ave, Brooklyn, NY, 11210, USA
| | - Monique Huntley
- Departments of Health and Nutrition Sciences, Brooklyn College of City University of New York, 2900 Bedford Ave, Brooklyn, NY, 11210, USA
| | - Lori Hoepner
- Department of Environmental and Occupational Health Sciences, State University of New York Downstate Health Sciences University, Brooklyn, NY, 11203, USA
| | - Lawrence Fordjour
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, NY, 11203, USA
| | - Joan Hittelman
- Department of Psychology, State University of New York Downstate Health Sciences University, Brooklyn, NY, 11203, USA
| | - Anjana Saxena
- Departments of Biology, Brooklyn College of City University of New York, Brooklyn, USA
| | - Jia Liu
- Neuroscience Initiative, Advanced Science Research Center at the Graduate Center of the CUNY, New York, NY, 10031, USA
| | - Itamar D Futterman
- Division of Maternal Fetal Medicine, Departments of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, USA
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, State University of New York Downstate Health Sciences University, Brooklyn, NY, 11203, USA
- Division of Maternal Fetal Medicine, Departments of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, USA
| | - Xinyin Jiang
- Departments of Health and Nutrition Sciences, Brooklyn College of City University of New York, 2900 Bedford Ave, Brooklyn, NY, 11210, USA.
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Zhang D, Nagpal TS, Silva-José C, Sánchez-Polán M, Gil-Ares J, Barakat R. Influence of Physical Activity during Pregnancy on Birth Weight: Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2023; 12:5421. [PMID: 37629463 PMCID: PMC10455907 DOI: 10.3390/jcm12165421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Birth weight is a marker that is often referred to determine newborn health, potential growth trajectories and risk of future disease. Accordingly, interventions to promote appropriate and healthy birth weight have been extensively studied and implemented in pregnancy. In particular, physical activity in pregnancy is recommended to promote appropriate fetal development and newborn birth weight. This systematic review and meta-analyses aimed to summarize the effect of physical activity during pregnancy specifically from randomized controlled trials on the following outcomes: birth weight, macrosomia, low birth weight, being large for the gestational age, and being small for the gestational age (Registration No.: CRD42022370729). 63 studies (16,524 pregnant women) were included. There was a significant negative relationship between physical activity during pregnancy and macrosomia (z = 2.16; p = 0.03; RR = 0.79, 95% CI = 0.63, 0.98, I2 = 29%, Pheterogeneity = 0.09). No other significant relationships were found. Promoting physical activity during pregnancy may be an opportune time to reduce the risk of future chronic disease, such as obesity, through the prevention of macrosomia and the promotion of appropriate birth weights.
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Affiliation(s)
- Dingfeng Zhang
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (D.Z.); (C.S.-J.); (M.S.-P.); (R.B.)
| | - Taniya S. Nagpal
- Faculty of Kinesiology Sport and Recreation, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Cristina Silva-José
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (D.Z.); (C.S.-J.); (M.S.-P.); (R.B.)
| | - Miguel Sánchez-Polán
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (D.Z.); (C.S.-J.); (M.S.-P.); (R.B.)
| | - Javier Gil-Ares
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (D.Z.); (C.S.-J.); (M.S.-P.); (R.B.)
| | - Rubén Barakat
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (D.Z.); (C.S.-J.); (M.S.-P.); (R.B.)
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9
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Barakat R, Zhang D, Silva-José C, Sánchez-Polán M, Franco E, Mottola MF. The Influence of Physical Activity during Pregnancy on Miscarriage-Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5393. [PMID: 37629435 PMCID: PMC10455409 DOI: 10.3390/jcm12165393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Miscarriage is an inability to complete the normal process of pregnancy and childbirth and represents a major concern for pregnant women that can be an emotionally devastating event. While it has been suggested that engaging in strenuous physical activity might be associated with an elevated risk of miscarriage, there is a recent systematic review that suggested that prenatal exercise is not associated with fetal mortality. The aim of this systematic review and meta-analysis (SR + MA) was to assess the effects of physical activity during pregnancy on the likelihood of experiencing a miscarriage (Registration No.: CRD42022370629). Thirteen randomized clinical trials (3728 pregnant women) were included. Meta-analyses were conducted with the dependent variable being the miscarriage ratio in each study. The total risk ratio (RR) sum was calculated using a random effects model. The I2 statistic was utilized to quantify the heterogeneity observed in the results. No significant association between exercise during pregnancy and the occurrence of miscarriage was found (RR = 0.83 95% CI = 0.83 (0.49-1.41); z = 0.69, p = 0.49; I2 = 0.00%, Heterogeneity p = 0.91). Results of the present SR + MA showed no increase in miscarriage risk in those who engaged in low- to moderate-intensity exercise compared to those who did not.
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Affiliation(s)
- Rubén Barakat
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (R.B.); (D.Z.); (C.S.-J.); (M.S.-P.)
| | - Dingfeng Zhang
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (R.B.); (D.Z.); (C.S.-J.); (M.S.-P.)
| | - Cristina Silva-José
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (R.B.); (D.Z.); (C.S.-J.); (M.S.-P.)
| | - Miguel Sánchez-Polán
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (R.B.); (D.Z.); (C.S.-J.); (M.S.-P.)
| | - Evelia Franco
- Department of Education, Research and Evaluation Methods, Faculty of Social and Human Sciences, Universidad Pontificia de Comillas, 28049 Madrid, Spain
| | - Michelle F. Mottola
- R. Samuel McLaughlin Foundation-Exercise and Pregnancy Lab, 2245, 3-M Centre, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Children’s Health Research Institute, The University of Wester Ontario, London, ON N6A 3K7, Canada;
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Barakat R, Zhang D, Sánchez-Polán M, Silva-José C, Gil-Ares J, Franco E. Is Exercise during Pregnancy a Risk for Gestational Age and Preterm Delivery? Systematic Review and Meta-Analysis. J Clin Med 2023; 12:4915. [PMID: 37568315 PMCID: PMC10419377 DOI: 10.3390/jcm12154915] [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: 06/28/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
Traditionally, one of the primary concerns regarding exercise during pregnancy has been the potential of reducing gestational age and increasing the likelihood of preterm delivery. The aim of this study was to perform a systematic review about the effects of physical activity (PA) during pregnancy on gestational age and preterm delivery. A systematic review and two meta-analyses were performed (Registration No. CRD42022370770). Data sources from online databases were searched up to November 2022. The review exclusively included studies involving pregnant populations and interventions consisting of PA implemented during pregnancy. The primary outcomes analysed were gestational age, measured in weeks, and the occurrence of preterm deliveries. A total of 57 studies were analysed through two independent meta-analyses for the first one, no association was found between moderate exercise during pregnancy and gestational age (Z = 0.45, p = 0.65, ES = 0.08, 95% CI = -0.06-0.04, I2 = 42%, P heterogeneity = 0.001), showing the exercise group had a higher gestational age. In addition, no differences were found between groups in terms of number of preterm deliveries (RR = 0.96, (95% CI = 0.77-1.21, Z = 0.33, p = 0.74; ES = 0.07; I2 = 31%, P heterogeneity = 0.05)). The findings of this study indicate that there is no association between exercise during pregnancy and reduced gestational age or increased risk of preterm delivery in healthy pregnancies.
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Affiliation(s)
- Rubén Barakat
- AFIPE Research Group, Faculty of PA and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (R.B.); (D.Z.); (M.S.-P.); (C.S.-J.)
| | - Dingfeng Zhang
- AFIPE Research Group, Faculty of PA and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (R.B.); (D.Z.); (M.S.-P.); (C.S.-J.)
| | - Miguel Sánchez-Polán
- AFIPE Research Group, Faculty of PA and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (R.B.); (D.Z.); (M.S.-P.); (C.S.-J.)
| | - Cristina Silva-José
- AFIPE Research Group, Faculty of PA and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (R.B.); (D.Z.); (M.S.-P.); (C.S.-J.)
| | - Javier Gil-Ares
- AFIPE Research Group, Faculty of PA and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (R.B.); (D.Z.); (M.S.-P.); (C.S.-J.)
| | - Evelia Franco
- Department of Education, Research and Evaluation Methods, Faculty of Social and Human Sciences, Universidad Pontificia de Comillas, 28049 Madrid, Spain;
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11
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Paulsen CP, Bandak E, Edemann-Callesen H, Juhl CB, Händel MN. The Effects of Exercise during Pregnancy on Gestational Diabetes Mellitus, Preeclampsia, and Spontaneous Abortion among Healthy Women-A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6069. [PMID: 37372656 DOI: 10.3390/ijerph20126069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
The aim was to compare the effects of different exercise modalities (aerobic, resistance, aerobic and resistance combined, or mind-body exercise) on gestational diabetes mellitus (GDM), preeclampsia, spontaneous abortion, withdrawal from the study, and adverse events in healthy pregnant women. A systematic search was conducted in February 2022 using MEDLINE, EMBASE, Cochrane library, and SPORT Discus to identify eligible randomized trials. The meta-analysis of 18 studies that examined exercise compared to no exercise showed a reduced risk of GDM (RR: 0.66 (95% CI: 0.50 to 0.86)). No subgroup differences were found regarding modality, intensity, or supervision. Exercise did not reduce the risk of preeclampsia (nine studies, RR: 0.65 (95% CI: 0.42 to 1.03)); however, in subgroup analyses, mind-body exercise and low-intensity exercise seemed to be effective in reduction of preeclampsia. There was no effect of exercise on withdrawal or adverse events found. No studies reported on spontaneous abortion, therefore, exercise during pregnancy is beneficial and safe. In the prevention of GDM, any modality and intensity seem equally effective. Subgroup analyses support an association between mind-body exercise and physical activity with low intensity and reduced risk of preeclampsia, but more high-quality randomized studies are needed. PROSPERO: CRD42022307053.
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Affiliation(s)
- Camilla Paludan Paulsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark
| | - Elisabeth Bandak
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark
- Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | | | - Carsten Bogh Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark
- Department Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, 2100 Copenhagen, Denmark
| | - Mina Nicole Händel
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
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12
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Harrison CL, Bahri Khomami M, Enticott J, Thangaratinam S, Rogozińska E, Teede HJ. Key Components of Antenatal Lifestyle Interventions to Optimize Gestational Weight Gain: Secondary Analysis of a Systematic Review. JAMA Netw Open 2023; 6:e2318031. [PMID: 37326994 PMCID: PMC10276313 DOI: 10.1001/jamanetworkopen.2023.18031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/27/2023] [Indexed: 06/17/2023] Open
Abstract
Importance Randomized clinical trials have found that antenatal lifestyle interventions optimize gestational weight gain (GWG) and pregnancy outcomes. However, key components of successful interventions for implementation have not been systematically identified. Objective To evaluate intervention components using the Template for Intervention Description and Replication (TIDieR) framework to inform implementation of antenatal lifestyle interventions in routine antenatal care. Data Sources Included studies were drawn from a recently published systematic review on the efficacy of antenatal lifestyle interventions for optimizing GWG. The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, MEDLINE, and Embase were searched from January 1990 to May 2020. Study Selection Randomized clinical trials examining efficacy of antenatal lifestyle interventions in optimizing GWG were included. Data Extraction and Synthesis Random effects meta-analyses were used to evaluate the association of intervention characteristics with efficacy of antenatal lifestyle interventions in optimizing GWG. The results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Data extraction was performed by 2 independent reviewers. Main Outcomes and Measures The main outcome was mean GWG. Measures included characteristics of antenatal lifestyle interventions comprising domains related to theoretical framework, material, procedure, facilitator (allied health staff, medical staff, or researcher), delivery format (individual or group), mode, location, gestational age at commencement (<20 wk or ≥20 wk), number of sessions (low [1-5 sessions], moderate [6-20 sessions], and high [≥21 sessions]), duration (low [1-12 wk], moderate [13-20 wk], and high [≥21 wk]), tailoring, attrition, and adherence. For all mean differences (MDs), the reference group was the control group (ie, usual care). Results Overall, 99 studies with 34 546 pregnant individuals were included with differential effective intervention components found according to intervention type. Broadly, interventions delivered by an allied health professional were associated with a greater decrease in GWG compared with those delivered by other facilitators (MD, -1.36 kg; 95% CI, -1.71 to -1.02 kg; P < .001). Compared with corresponding subgroups, dietary interventions with an individual delivery format (MD, -3.91 kg; 95% CI -5.82 to -2.01 kg; P = .002) and moderate number of sessions (MD, -4.35 kg; 95% CI -5.80 to -2.89 kg; P < .001) were associated with the greatest decrease in GWG. Physical activity and mixed behavioral interventions had attenuated associations with GWG. These interventions may benefit from an earlier commencement and a longer duration for more effective optimization of GWG. Conclusions and Relevance These findings suggest that pragmatic research may be needed to test and evaluate effective intervention components to inform implementation of interventions in routine antenatal care for broad public health benefit.
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Affiliation(s)
- Cheryce L. Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Diabetes and Endocrine Unit, Monash Health, Melbourne, Victoria, Australia
| | - Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shakila Thangaratinam
- World Health Organization Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- Birmingham Women’s and Children’s National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Ewelina Rogozińska
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, London, United Kingdom
| | - Helena J. Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Diabetes and Endocrine Unit, Monash Health, Melbourne, Victoria, Australia
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13
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Stalheim AM, Iversen MM, Jenum AK, Sletner L, Stafne SN, Qvigstad E, Sagedal L, Nilsen RM, Aasheim V, Strandberg RB. Seasonal variation in gestational diabetes mellitus among women in Norway: a national population-based study. BMJ Open 2023; 13:e063725. [PMID: 36918247 PMCID: PMC10016255 DOI: 10.1136/bmjopen-2022-063725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
OBJECTIVES Previous research on seasonal variation in the incidence of gestational diabetes mellitus (GDM) has shown inconclusive results. Furthermore, little is known about whether a seasonal variation in GDM might be associated with the maternal country of birth. We examined whether there was seasonal variation in GDM incidence by the maternal country background. DESIGN National population-based registry study. SETTING AND PARTICIPANTS We used national population-based data from the Medical Birth Registry of Norway (MBRN), n=1 443 857 (1990-2016) and data from four merged community-based studies (4GDM) with universal screening for GDM, n=2 978 (2002-2013). OUTCOME MEASURES The association between season of pregnancy onset with incidence of GDM was examined separately in both datasets using logistic regression analyses, stratified by the mother's country background using two broad geographical categories (MBRN: Norwegian and immigrant; 4GDM: European and African/Asian ethnicity). Winter season was used as reference category. RESULTS The incidence of GDM in MBRN was highest when the pregnancy started during the winter (Norwegian-born: 1.21%; immigrants: 3.32%) and lowest when pregnancy started during the summer for both Norwegian and immigrant women (Norwegian-born: 1.03% (OR 0.85, 95% CI 0.81 to 0.98); immigrants: 2.99% (OR 0.90, 95% CI 0.84 to 0.96)). The 4GDM data showed that women with European ancestry had the highest incidence of GDM when pregnancy started during autumn (10.7%, OR 1.01, 95% CI 0.69 to 1.46) and winter (10.6%), while ethnic African and Asian women had the highest incidence when pregnancy onset was during the summer (15.3%, OR 1.17, 95% CI 0.54 to 2.53). CONCLUSIONS Based on national population-based data, this study suggests that GDM incidence varies by season in both Norwegian-born and immigrant women. The 4GDM dataset did not show a clear seasonal variation in GDM incidence, possibly due to the relatively small sample. Causes for the seasonal variation in GDM should be explored further.
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Affiliation(s)
- Astrid Melteig Stalheim
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | | | - Anne Karen Jenum
- Department of General Practice, General Practice Unit (AFE), Insitute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Line Sletner
- Department for Paediatric and Adolescent Medicine, Akershus University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Signe N Stafne
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinical services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Elisabeth Qvigstad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Linda Sagedal
- Department of Obstetrics and Gynecology, Sørlandet Hospital, Kristiansand, Norway
| | - Roy Miodini Nilsen
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Vigdis Aasheim
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ragnhild B Strandberg
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Malmström N, Lydell M, Carlsson IM. “Womanhood,” a shared experience of participating in a lifestyle intervention with a focus on integration and physical activity to promote health among pregnant women: perspectives from pregnant women, midwives, and cultural interpreter doulas. Int J Qual Stud Health Well-being 2022; 17:2043527. [PMID: 35212612 PMCID: PMC8925914 DOI: 10.1080/17482631.2022.2043527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose Migrating women, have an overall increased risk of adverse outcomes and poorer health during pregnancy and childbirth. In addition, they do not participate in planned antenatal care to the same extent as natives. These disparities among migrants and native pregnant women point to the need for interventions to improve equal health and care during pregnancy and childbirth. This study aimed to explore the experiences of participating in a lifestyle intervention, named “Dancing for birth,” focusing on integration and physical activity, from the perspectives of the participating pregnant women, midwives, and cultural interpreter doulas. Method Qualitative interviews were conducted from March 2019 to December 2020, with ten women who participated in a lifestyle intervention in Sweden: four pregnant women, three midwives, and three cultural interpreter doulas. Thematic analysis was used to analyse the data. Results The lifestyle intervention ”Dancing for birth” provided positive shared Health-promoting experiences among the participants with social inclusivness and a commitment to supporting each other. This seemed to encourage the sense of strength as a woman- a strengthboth for the individual woman and as a kind of women´s power. Conclusions Interventions targeting physical activity, social inclusiveness, and health literacy are of utmost importance in promoting positive pregnancy experiences and equal healthcare during pregnancy. Further research is needed on how to implement antenatal education that includes all women in society.
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Affiliation(s)
- Nina Malmström
- Department of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Marie Lydell
- Department of Health and Welfare, Halmstad University, Halmstad, Sweden
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15
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Herzberger V, Bäz E, Kunze M, Markfeld-Erol F, Juhasz-Böss I. Exercise During Pregnancy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:793-797. [PMID: 36045499 PMCID: PMC9902891 DOI: 10.3238/arztebl.m2022.0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Pregnancy is a good time to motivate women to implement health-promoting behaviors in their everyday lives. There is no official German-language guideline for the counseling of pregnant women by professionals involved in their care. The goal of this review is, therefore, to discuss the links between exercise and gestational diabetes mellitus (GDM), low birth weight, and prematurity. METHODS This review is based on pertinent articles retrieved by a systematic search of PubMed and the Web of Science. The articles included in the evaluation were reports of randomized controlled trials (RCTs) and meta-analyses of RCTs of exercise interventions in pregnant women that were published from 1 January 2011 to 15 November 2021. RESULTS A structured exercise program during pregnancy can lower the risk of gestational diabetes by as much as 49%. A 25% risk reduction for GDM was achieved with 140 minutes of exercise per week. The mean birth weight was not affected but the rate of excessively heavy newborns was lowered by 32-59% in the normal-weight subgroup. This effect was not seen in the overweight subgroup, possibly because of poorer compliance. Exercise did not elevate the risk of preterm delivery. CONCLUSION Regular exercise during pregnancy lessens gestationally induced weight gain and lowers the risk of excessive weight gain, as well as the risk of GDM, without elevating the risk of preterm delivery.
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Affiliation(s)
- Veerle Herzberger
- Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
| | - Elke Bäz
- Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
| | - Mirjam Kunze
- Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
| | - Filiz Markfeld-Erol
- Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
| | - Ingolf Juhasz-Böss
- Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
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Bahri Khomami M, Teede HJ, Enticott J, O’Reilly S, Bailey C, Harrison CL. Implementation of Antenatal Lifestyle Interventions Into Routine Care: Secondary Analysis of a Systematic Review. JAMA Netw Open 2022; 5:e2234870. [PMID: 36197663 PMCID: PMC9535535 DOI: 10.1001/jamanetworkopen.2022.34870] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Lifestyle interventions in pregnancy optimize gestational weight gain and improve pregnancy outcomes, with implementation recommended by the US Preventive Services Task Force. Yet, implementation research taking these efficacy trials into pragmatic translation remains limited. OBJECTIVE To evaluate success factors for implementing pregnancy lifestyle interventions into antenatal care settings in a meta-analysis, using the penetration, implementation, participation, and effectiveness (PIPE) impact metric. DATA SOURCES Data from a previous systematic review that searched across 9 databases, including MEDLINE, Embase, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Health Technology Assessment Database, were obtained, in 2 stages, up to May 6, 2020. STUDY SELECTION Randomized clinical trials reporting gestational weight gain in singleton pregnancies. DATA EXTRACTION AND SYNTHESIS The association of penetration, implementation, and participation with effectiveness of antenatal lifestyle interventions in optimizing gestational weight gain was estimated using random-effects meta-analyses. The Cochrane risk of bias tool, version 1.0, was used to assess risk of bias. MAIN OUTCOMES AND MEASURES Penetration (reach), implementation (fidelity), participation, and effectiveness of randomized clinical trials of lifestyle interventions in pregnancy. RESULTS Ninety-nine studies with 34 546 participants were included. Only 14 studies reported penetration of target populations. Overall, 38 studies (38.4%) had moderate fidelity, 25 (25.2%) had high fidelity, and 36 (36.4%) had unclear fidelity. Participation was reported in 84 studies (84.8%). Lifestyle interventions were associated with reducing gestational weight gain by 1.15 kg (95% CI, -1.40 to -0.91 kg). CONCLUSIONS AND RELEVANCE The findings of this systematic review and meta-analysis suggest that, despite the large body of evidence on efficacy of lifestyle interventions during pregnancy in optimizing gestational weight gain, little guidance is available to inform implementation of this evidence into practice. There is a need to better elucidate implementation outcomes in trial design alongside pragmatic implementation research to improve the health of women who are pregnant and the next generation.
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Affiliation(s)
- Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Helena J. Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Diabetes and Endocrine Unit, Monash Health, Melbourne, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sharleen O’Reilly
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin, Ireland
| | - Cate Bailey
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Cheryce L. Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Diabetes and Endocrine Unit, Monash Health, Melbourne, Australia
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17
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de Castro R, Antunes R, Mendes D, Szumilewicz A, Santos-Rocha R. Can Group Exercise Programs Improve Health Outcomes in Pregnant Women? An Updated Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4875. [PMID: 35457743 PMCID: PMC9024782 DOI: 10.3390/ijerph19084875] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/09/2022] [Accepted: 04/15/2022] [Indexed: 02/06/2023]
Abstract
Current scientific evidence supports the recommendation to initiate or continue physical exercise in healthy pregnant women. Group exercise programs have positive effects on improving health, well-being, and social support. In 2015, a systematic review was provided to evaluate the evidence on the effectiveness of group exercise programs in improving pregnant women's and newborns' health outcomes and to assess the content of the programs. This review aims to update this knowledge between 2015 and 2020. The exercise program designs were analyzed with the Consensus of Exercise Reporting Template (CERT) model, the compliance with the current guidelines, and effectiveness in the maternal health and fitness parameters. Three databases were used to conduct literature searches. Thirty-one randomized control trials were selected for analysis. All studies followed a supervised group exercise program including aerobic, resistance, pelvic floor training, stretching, and relaxation sections. Group interventions during pregnancy improved health and fitness outcomes for the women and newborns, although some gaps were identified in the interventions. Multidisciplinary teams of exercise and health professionals should advise pregnant women that group exercise improves a wide range of health outcomes for them and their newborns.
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Affiliation(s)
- Rebeca de Castro
- ESECS—Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; (R.d.C.); (D.M.)
| | - Raul Antunes
- ESECS—Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; (R.d.C.); (D.M.)
- Life Quality Research Centre (CIEQV), 2040-413 Leiria, Portugal
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2410-541 Leiria, Portugal
| | - Diogo Mendes
- ESECS—Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; (R.d.C.); (D.M.)
- Life Quality Research Centre (CIEQV), 2040-413 Leiria, Portugal
| | - Anna Szumilewicz
- Department of Fitness, Faculty of Physical Culture, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland;
| | - Rita Santos-Rocha
- ESDRM Sport Sciences School of Rio Maior—Polytechnic Institute of Santarém, 2040-413 Rio Maior, Portugal;
- CIPER Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics (FMH), University of Lisbon, 1499-002 Cruz Quebrada, Portugal
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18
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Ranasinha S, Hill B, Teede HJ, Enticott J, Wang R, Harrison CL. Efficacy of behavioral interventions in managing gestational weight gain (GWG): A component network meta-analysis. Obes Rev 2022; 23:e13406. [PMID: 34927351 DOI: 10.1111/obr.13406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/04/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify the most effective behavioral components within lifestyle interventions to optimize gestational weight gain (GWG) to inform guidelines, policy and translation into healthcare. METHODS Behavioral components were identified from study level data of randomized antenatal lifestyle interventions using a behavioral taxonomy framework and analyzed using component network meta-analysis (NMA). The NMA ranked behavioral combinations hierarchically by efficacy of optimizing GWG. Direct and estimated indirect comparisons between study arms (i.e., control and intervention) and between different component combinations were estimated to evaluate component combinations associated with greater efficacy. RESULTS Overall, 32 studies with 11,066 participants were included. Each intervention contained between 3 and 7 behavioral components with 26 different behavioral combinations identified. The majority (n = 24) of combinations were associated with optimizing GWG, with standard mean differences (SMD) ranging from -1.01 kg (95% CI -1.64 to -0.37) and -0.07 kg (-0.38 to 0.24), compared with controls. The behavioral cluster identified as most effective, included components of goals, feedback and monitoring, natural consequences, comparison of outcomes, and shaping knowledge (SMD -1.01 kg [95% CI -1.64 to -0.37]). CONCLUSION Findings support the application of goal setting, feedback and monitoring, natural consequences, comparison of outcomes, and shaping knowledge as essential, core components within lifestyle interventions to optimize gestational weight gain.
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Affiliation(s)
- Sanjeeva Ranasinha
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Briony Hill
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rui Wang
- Department of Obstetrics and Gynaecology, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia
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19
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Liney T, Shah NM, Singh N. Recurrent gestational diabetes : Breaking the transgenerational cycle with lifestyle modification. Wien Klin Wochenschr 2022; 134:788-798. [PMID: 35147773 DOI: 10.1007/s00508-022-02004-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE This literature review is aimed at examining the benefits of lifestyle modifications in preventing recurrent gestational diabetes (GDM). Worldwide GDM affects approximately 16.2% of all pregnancies with significant maternal, fetal and neonatal complications. Almost two thirds of pregnant women with GDM will develop type 2 diabetes mellitus (T2DM) in the years following pregnancy. The proportion of women affected by GDM is on the rise and reflects increasing trends in T2DM as well as adult and childhood obesity. METHODS Using predefined subject headings, we searched for relevant articles from the PubMed, Scopus, and Cochrane databases. RESULTS For high-risk women lifestyle modifications, such as dietary and exercise changes, are the mainstay of treatment to reduce negative outcomes for both women and their pregnancies. This includes reducing the incidence of recurrent GDM and future T2DM by intervening during pregnancy and in the postnatal period. CONCLUSION This review provides an overview of the literature to date, discusses different targeted approaches and how these interventions can optimise their benefits, and where further research is required.
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Affiliation(s)
- Thomas Liney
- The Hillingdon Hospitals NHS Foundation Trust, Pield Heath Road, UB8 3NN, Uxbridge, UK
| | - Nishel M Shah
- Imperial College London, Academic Department of Obstetrics & Gynaecology, Level 3, Chelsea and Westminster Hospital, 369 Fulham Road, SW10 9NH, London, UK
| | - Natasha Singh
- Imperial College London, Academic Department of Obstetrics & Gynaecology, Level 3, Chelsea and Westminster Hospital, 369 Fulham Road, SW10 9NH, London, UK.
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20
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Jensen SD, Andreassen P, Knorr S, Rasmussen L, Ovesen P, Kampmann U, Bruun JM. Ambivalence and moral dilemmas in women's lived experiences of obesity and pregnancy: Qualitative insights for maternal lifestyle interventions. Scand J Caring Sci 2021; 36:416-425. [PMID: 34877704 DOI: 10.1111/scs.13052] [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: 07/01/2021] [Revised: 11/12/2021] [Accepted: 11/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Maternal obesity is a global health concern that is associated with significant effects on both short- and long-term health of both mother and child. However, maternal lifestyle interventions tend to focus solely on diet and physical activity in ways that disembody and disengage the social context in which women live their lives. AIMS The aim of this study was to explore the lived experiences of maternal obesity and delve into how experiences of the body and motherhood affect women's motivation for participating in a postpartum lifestyle intervention. METHOD A qualitative study using in-depth semi-structured interviews based on participant-generated photographs was used to allow the women to openly express their lived experiences of maternal obesity. The study emanated from a gynaecological department of a major Danish hospital, and five pregnant or postpartum women living with obesity participated. Interviews were audio recorded, transcribed and analysed using an Interpretive Phenomenological Approach. RESULTS The analysis identified an overall theme of ambivalence and four subthemes among the participating women. The themes reflected contrasting feelings where the obese body was simultaneously an arena for aesthetic failure, functional success and moral dilemmas. Experiences of weight stigma and moral accusations in healthcare settings further increased the women's sense of ambivalence and challenged their strong desire to lose weight. CONCLUSION This study highlights an ambivalent and vulnerable situation of maternal obesity which makes moral sensitivity towards weight and body concerns crucial to consider in future maternal health interventions. Our data suggest that an emphasis on functionality and capability rather than aesthetics and measured ideals would be useful in providing care and support in postpartum lifestyle interventions for women living with obesity.
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Affiliation(s)
- Sissel D Jensen
- Danish National Centre for Obesity, Aarhus, Denmark.,Steno Diabetes Centre Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sine Knorr
- Steno Diabetes Centre Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Louise Rasmussen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Per Ovesen
- Steno Diabetes Centre Aarhus, Aarhus University Hospital, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Ulla Kampmann
- Steno Diabetes Centre Aarhus, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Jens M Bruun
- Danish National Centre for Obesity, Aarhus, Denmark.,Steno Diabetes Centre Aarhus, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
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21
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Øverby NC, Medin AC, Valen EL, Salvesen L, Wills AK, Engeset D, Vik FN, Hillesund ER. Effectiveness of a digital dietary intervention program targeting young adults before parenthood: protocol for the PREPARED randomised controlled trial. BMJ Open 2021; 11:e055116. [PMID: 34853111 PMCID: PMC8638463 DOI: 10.1136/bmjopen-2021-055116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION The importance of preconception health for lifelong physical and mental health in the next generation has gained increasing recognition in recent years. Preconception paternal and maternal risk factors such as obesity and inadequate diet affect the metabolic and cardiovascular health of their offspring later in life. This highlights the importance of diet and dietary behaviour in the years before parenthood. In our project, PREPARED, we will evaluate the effectiveness of a digital intervention targeting young adults. Our primary aim is to improve participants' preconception diet, and our secondary aim is to improve preconception quality of life and maternal and child perinatal outcomes. METHODS AND ANALYSIS We plan to recruit 7000 men and women individually, aged 20-35 years without children, to be randomised to an intervention or a control group. The intervention group will receive access to a digital resource for 6 months promoting a healthy diet for their health now, later in life and for the next generation. Follow-up is up to 20 years or until they have their first child. To evaluate intervention effects, we will collect dietary data (2×24-hour dietary recalls and a screener). For those participants for which birth ensues, we will link study data with data from the Medical Birth Registry of Norway on maternal and child perinatal outcomes. ETHICS AND DISSEMINATION The study is approved by the Regional Ethics Committee, the Norwegian Data Protection Service and our Faculty Ethical Committee (REC: 78104, NSD: 907212, FEC 20/10119). Participation is voluntary and all participants will provide informed consent. Participants can withdraw their consent without giving any reason. Findings will be communicated to the public through a project website and social media, and to professionals through conferences and peer-reviewed papers. TRIAL REGISTRATION NUMBER ISRCTN44294662.
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Affiliation(s)
- Nina Cecilie Øverby
- Department of Nutrition and Public Health, Universitetet i Agder, Kristiansand, Vest-Agder, Norway
| | - Anine C Medin
- Department of Nutrition and Public Health, Universitetet i Agder, Kristiansand, Vest-Agder, Norway
| | - Erlend Larsen Valen
- Department of Nutrition and Public Health, Universitetet i Agder, Kristiansand, Vest-Agder, Norway
| | - Lorentz Salvesen
- Department of Nutrition and Public Health, Universitetet i Agder, Kristiansand, Vest-Agder, Norway
| | - Andrew Keith Wills
- Department of Nutrition and Public Health, Universitetet i Agder, Kristiansand, Vest-Agder, Norway
| | - Dagrun Engeset
- Department of Nutrition and Public Health, Universitetet i Agder, Kristiansand, Vest-Agder, Norway
| | - Frøydis N Vik
- Department of Nutrition and Public Health, Universitetet i Agder, Kristiansand, Vest-Agder, Norway
| | - Elisabet R Hillesund
- Department of Nutrition and Public Health, Universitetet i Agder, Kristiansand, Vest-Agder, Norway
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22
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Okafor UB, Goon DT. Development and Validation of Prenatal Physical Activity Intervention Strategy for Women in Buffalo City Municipality, South Africa. Healthcare (Basel) 2021; 9:healthcare9111445. [PMID: 34828491 PMCID: PMC8622375 DOI: 10.3390/healthcare9111445] [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: 08/24/2021] [Revised: 10/12/2021] [Accepted: 10/23/2021] [Indexed: 11/24/2022] Open
Abstract
Women rarely participate in physical activity during pregnancy, despite scientific evidence emphasising its importance. This study sought to develop an intervention strategy to promote prenatal physical activity in Buffalo City Municipality, Eastern Cape Province, South Africa. A multi-stage approach was utilised. The Strength, Weakness, Opportunity and Threat (SWOT) approach was applied to the interfaced empirical findings on prenatal physical activity in the setting. Subsequently, the Build, Overcome, Explore and Minimise model was then used to develop strategies based on the SWOT findings. A checklist was administered to key stakeholders to validate the developed strategies. Key strategies to promote prenatal physical activity include the application of the Mom-Connect (a technological device already in use in South Africa to promote maternal health-related information for pregnant women) in collaboration with cellphone and network companies; the South African government to integrate prenatal physical activity and exercise training in the medical and health curricula to empower the healthcare providers with relevant knowledge and skills to support pregnant women in prenatal physical activity counselling; provision of increased workforce and the infrastructure necessary in antenatal sessions and antenatal physical exercise classes and counselling; the government, in partnership with various stakeholders, to provide periodical prenatal physical activity campaigns based in local, community town halls and clinics to address the lack of awareness, misrepresentations and concerns regarding the safety and benefits of physical activity during pregnancy. The effective implementation of this developed prenatal physical activity by policymakers and health professionals may help in the promotion of physical activity practices in the context of women in the setting.
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Affiliation(s)
- Uchenna Benedine Okafor
- Department of Nursing Science, University of Fort Hare, East London 5201, South Africa
- Correspondence:
| | - Daniel Ter Goon
- Department of Public Health, University of Fort Hare, East London 5201, South Africa;
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23
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Kristiansen O, Zucknick M, Reine TM, Kolset SO, Jansson T, Powell TL, Haugen G, Henriksen T, Michelsen TM. Mediators Linking Maternal Weight to Birthweight and Neonatal Fat Mass in Healthy Pregnancies. J Clin Endocrinol Metab 2021; 106:1977-1993. [PMID: 33713406 PMCID: PMC8692236 DOI: 10.1210/clinem/dgab166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Indexed: 12/16/2022]
Abstract
CONTEXT Lifestyle interventions have not efficaciously reduced complications caused by maternal weight on fetal growth, requiring insight into explanatory mediators. OBJECTIVE We hypothesized that maternal mediators, including adiponectin, leptin, insulin, and glucose, mediate effects of pregestational BMI (pBMI) and gestational weight gain (GWG) on birthweight and neonatal fat mass percentage (FM%) through placental weight and fetal mediators, including insulin levels (Ifv) and venous-arterial glucose difference (ΔGfva). Hypothesized confounders were maternal age, gestational age, and parity. METHODS A cross-sectional study of healthy mother-offspring-pairs (n = 165) applying the 4-vessel in vivo sampling method at Oslo University Hospital, Norway. We obtained pBMI, GWG, birthweight, and placental weight. FM% was available and calculated for a subcohort (n = 84). We measured circulating levels of adiponectin, leptin, glucose, and insulin and performed path analysis and traditional mediation analyses based on linear regression models. RESULTS The total effect of pBMI and GWG on newborn size was estimated to be 30 g (range, 16-45 g) birthweight and 0.17 FM% (range, 0.04-0.29 FM%) per kg∙m-2 pBMI and 31 g (range, 18-44 g) and 0.24 FM% (range, 0.10-0.37 FM%) per kg GWG. The placental weight was the main mediator, mediating 25-g birthweight and 0.11 FM% per kg∙m-2 pBMI and 25-g birthweight and 0.13 FM% per kg GWG. The maternal mediators mediated a smaller part of the effect of pBMI (3.8-g birthweight and 0.023 FM% per kg∙m-2 pBMI) but not GWG. CONCLUSION Placental weight was the main mediator linking pBMI and GWG to birthweight and FM%. The effect of pBMI, but not GWG, on birthweight and FM%, was also mediated via the maternal and fetal mediators.
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Affiliation(s)
- Oddrun Kristiansen
- Department of Obstetrics, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, 0424Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, 0372Norway
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, 0372Norway
- Correspondence: Oddrun Kristiansen, PhD, Department of Obstetrics, Division of Obstetrics and Gynecology, Oslo University Hospital, Postboks 4956 Nydalen, Oslo, 0424 Norway. ;
| | - Manuela Zucknick
- Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, 0372Norway
| | - Trine M Reine
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, 0372Norway
- Institute of Cancer Genetics and Informatics, Oslo University Hospital, Oslo, 0379Norway
| | - Svein O Kolset
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, 0372Norway
| | - Thomas Jansson
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Colorado 80045, USA
| | - Theresa L Powell
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Colorado 80045, USA
- Section of Neonatology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Colorado 80045, USA
| | - Guttorm Haugen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, 0372Norway
- Department of Fetal Medicine, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, 0424Norway
| | - Tore Henriksen
- Department of Obstetrics, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, 0424Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, 0372Norway
| | - Trond M Michelsen
- Department of Obstetrics, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, 0424Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, 0372Norway
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24
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Almalki SA, Ibraheem EF, Alotibi T. Level of exercise and physical activity among pregnant women in Saudi Arabia: A systematic review. J Family Med Prim Care 2021; 10:2140-2147. [PMID: 34322404 PMCID: PMC8284203 DOI: 10.4103/jfmpc.jfmpc_2408_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/16/2021] [Accepted: 02/28/2021] [Indexed: 11/10/2022] Open
Abstract
The current study aimed to clarify the health benefits of physical activity on the mother and fetus in the Saudi women population. Besides, it is intended to provide recommendation based on the literature and results of studies from Saudi Arabia for exercise in pregnancy to improve the general health of women in Saudi Arabia. Prenatal physical exercise enhances physical and mental health of pregnant women. It can also reduce the risk of multiple pregnancy-related complications such as; lower back pain, fluid retention and risk of gestational diabetes. All these factors can affect fetal development and life later. Multiple studies showed that prenatal exercise could reduce the risk of fetal macrosomia with no effect on other perinatal or postnatal complications. The study followed the systematic literature review approach where it included multiple medical search Databases using PICOS eligibility criteria up to January 2019. The review was based on the following keywords: pregnancy, gestational, or prenatal) and (physical exercise, exercise, or physical activity. There are only two studies that dealt with physical exercises among Saudi women. The results indicated a relation between prenatal physical exercise on improving or decreasing risks on the mother and child during pregnancy.
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Affiliation(s)
- Salwa A. Almalki
- Department of Family Medicine, King Fahad Medical City, Academy for Postgraduate Studies in Family Medicine, Riyadh, KSA
| | - Eman F. Ibraheem
- Department of Family Medicine, King Fahad Medical City, Academy for Postgraduate Studies in Family Medicine, Riyadh, KSA
| | - Turkiah Alotibi
- Department of Family Medicine, King Fahad Medical City, Academy for Postgraduate Studies in Family Medicine, Riyadh, KSA
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25
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Cantor AG, Jungbauer RM, McDonagh M, Blazina I, Marshall NE, Weeks C, Fu R, LeBlanc ES, Chou R. Counseling and Behavioral Interventions for Healthy Weight and Weight Gain in Pregnancy: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 325:2094-2109. [PMID: 34032824 DOI: 10.1001/jama.2021.4230] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Counseling and active behavioral interventions to limit excess gestational weight gain (GWG) during pregnancy may improve health outcomes for women and infants. The 2009 National Academy of Medicine (NAM; formerly the Institute of Medicine) recommendations for healthy GWG vary according to prepregnancy weight category. OBJECTIVE To review and synthesize the evidence on benefits and harms of behavioral interventions to promote healthy weight gain during pregnancy to inform the US Preventive Services Task Force recommendation. DATA SOURCES Ovid MEDLINE and the Cochrane Library to March 2020, with surveillance through February 2021. STUDY SELECTION Randomized clinical trials and nonrandomized controlled intervention studies focused on diet, exercise, and/or behavioral counseling interventions on GWG. DATA EXTRACTION AND SYNTHESIS Independent data abstraction and study quality rating with dual review. MAIN OUTCOMES AND MEASURES Gestational weight-related outcomes; maternal and infant morbidity and mortality; harms. RESULTS Sixty-eight studies (N = 25 789) were included. Sixty-seven studies evaluated interventions during pregnancy, and 1 evaluated an intervention prior to pregnancy. GWG interventions were associated with reductions in risk of gestational diabetes (43 trials, n = 19 752; relative risk [RR], 0.87 [95% CI, 0.79 to 0.95]; absolute risk difference [ARD], -1.6%) and emergency cesarean delivery (14 trials, n = 7520; RR, 0.85 [95% CI, 0.74 to 0.96]; ARD, -2.4%). There was no significant association between GWG interventions and risk of gestational hypertension, cesarean delivery, or preeclampsia. GWG interventions were associated with decreased risk of macrosomia (25 trials, n = 13 990; RR, 0.77 [95% CI, 0.65 to 0.92]; ARD, -1.9%) and large for gestational age (26 trials, n = 13 000; RR, 0.89 [95% CI, 0.80 to 0.99]; ARD, -1.3%) but were not associated with preterm birth. Intervention participants experienced reduced weight gain across all prepregnancy weight categories (55 trials, n = 20 090; pooled mean difference, -1.02 kg [95% CI, -1.30 to -0.75]) and demonstrated lower likelihood of GWG in excess of NAM recommendations (39 trials, n = 14 271; RR, 0.83 [95% CI, 0.77 to 0.89]; ARD, -7.6%). GWG interventions were associated with reduced postpartum weight retention at 12 months (10 trials, n = 3957; mean difference, -0.63 kg [95% CI, -1.44 to -0.01]). Data on harms were limited. CONCLUSIONS AND RELEVANCE Counseling and active behavioral interventions to limit GWG were associated with decreased risk of gestational diabetes, emergency cesarean delivery, macrosomia, and large for gestational age. GWG interventions were also associated with modest reductions in mean GWG and decreased likelihood of exceeding NAM recommendations for GWG.
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Affiliation(s)
- Amy G Cantor
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
- Department of Family Medicine, Oregon Health & Science University, Portland
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Rebecca M Jungbauer
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Marian McDonagh
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Ian Blazina
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Nicole E Marshall
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Chandler Weeks
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Rongwei Fu
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
- School of Public Health, Oregon Health & Science University-Portland State University
| | - Erin S LeBlanc
- Kaiser Permanente, Center for Health Research, Portland, Oregon
| | - Roger Chou
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
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26
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Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Krist AH, Kubik M, Li L, Ogedegbe G, Pbert L, Silverstein M, Simon M, Stevermer J, Tseng CW, Wong JB. Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy: US Preventive Services Task Force Recommendation Statement. JAMA 2021; 325:2087-2093. [PMID: 34032823 DOI: 10.1001/jama.2021.6949] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE The prevalence of overweight and obesity is increasing among persons of childbearing age and pregnant persons. In 2015, almost half of all persons began pregnancy with overweight (24%) or obesity (24%). Reported rates of overweight and obesity are higher among Black, Alaska Native/American Indian, and Hispanic women and lower among White and Asian women. Excess weight at the beginning of pregnancy and excess gestational weight gain have been associated with adverse maternal and infant health outcomes such as a large for gestational age infant, cesarean delivery, or preterm birth. OBJECTIVE The USPSTF commissioned a systematic review to evaluate the benefits and harms of behavioral counseling interventions to prevent adverse health outcomes associated with obesity during pregnancy and to evaluate intermediate outcomes, including excess gestational weight gain. This is a new recommendation. POPULATION Pregnant adolescents and adults in primary care settings. EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy have a moderate net benefit for pregnant persons. RECOMMENDATION The USPSTF recommends that clinicians offer pregnant persons effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy. (B recommendation).
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Affiliation(s)
| | - Karina W Davidson
- Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York
| | | | | | | | | | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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27
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Letter to the editor on: "Second-trimester and third-trimester maternal lipid profiles significantly correlated to LGA and macrosomia". Arch Gynecol Obstet 2021; 304:1109. [PMID: 33963891 DOI: 10.1007/s00404-021-06084-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
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28
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Hillesund ER, Sagedal LR, Bere E, Øverby NC. Family meal participation is associated with dietary intake among 12-month-olds in Southern Norway. BMC Pediatr 2021; 21:128. [PMID: 33722218 PMCID: PMC7958408 DOI: 10.1186/s12887-021-02591-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family meal participation is associated with healthier eating among children and adolescents. Less is known about family meal participation among infants and toddlers. The objective of the present study was to explore whether family meal participation at 12 months of age is associated with dietary intake and whether a potential relationship differs according to maternal education or child sex. METHODS Follow-up data from children born to mothers participating in the Norwegian Fit for Delivery (NFFD) trial during pregnancy were used to assess the frequency of intake of 11 dietary items according to frequency of participating in the respective family meals. Dietary differences according to seldom (0-3 times/week) or often (4-7 times/week) participating in each respective meal category were assessed in linear regression models. Potential dose-response associations with frequency of participation in all family meal categories combined were also estimated. Models were adjusted for maternal randomization status, education, and child sex. RESULTS The sample comprised 408 children. A total of 74, 53 and 74% had breakfast, lunch, and dinner with family ≥4 times/week, respectively, while 39% had supper and 27% between-meal snacks with family ≥4 times/week. Having family dinner ≥4 times/week was associated with more frequent intake of vegetables, homemade infant cereal, milk, and water, and less frequent intake of commercial infant foods while the other family meal categories were associated with fewer dietary outcomes. For each additional meal category eaten with family ≥4 times/week, frequency of vegetable intake (β = 0.45), water (β = 0.17), and milk (β = 0.09) per day increased, while commercial infant cereal was eaten less frequently (β = - 0.18). The inverse association between family meals and commercial infant cereal was only evident in children born to mothers in the intervention group. Several associations with diet were stronger and only significant among boys. CONCLUSIONS Being fed in the context of family meals at 12 months of age was associated with a more favorable diet. Including the infant in family meals has potential in the promotion of early nutritional health.
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Affiliation(s)
- Elisabet R Hillesund
- Department of Nutrition and Public Health, University of Agder, Serviceboks 422, 4604, Kristiansand, Norway.
| | - Linda R Sagedal
- Department of Obstetrics and Gynecology, Sørlandet Hospital HF, Serviceboks 416, 4604, Kristiansand, Norway.,Department of Research, Sørlandet Hospital HF, Serviceboks 416, 4604, Kristiansand, Norway
| | - Elling Bere
- Department of Sport Science and Physical Education, Serviceboks 422, 4604, Kristiansand, Norway.,Department of Health and Inequalities & Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Nina C Øverby
- Department of Nutrition and Public Health, University of Agder, Serviceboks 422, 4604, Kristiansand, Norway
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The relationship between gestational weight gain, maternal upper-body subcutaneous fat changes and infant birth size: A pilot observational study amongst women with obesity. Early Hum Dev 2021; 154:105307. [PMID: 33453458 DOI: 10.1016/j.earlhumdev.2021.105307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND It is widely acknowledged that maternal obesity and excessive gestational weight gain (GWG) are associated with increased risk of fetal macrosomia and recent studies have suggested a role for the timing and composition of GWG. AIMS To examine the effect of the rate of change in GWG and maternal upper-body subcutaneous fat on neonatal anthropometric outcomes in a pilot observational study amongst women with obesity. STUDY DESIGN Expectant women with a body mass index (BMI) > 30 kg/m2 at first antenatal appointment were recruited at 12 weeks gestation. Maternal height, weight and skinfold thickness (SFT) measurements were collected at baseline and repeated at 28 and 36 weeks gestation. Following delivery, World Health Organisation (WHO)-UK infant birthweight z-scores were calculated, and infant anthropometric measurements were obtained. RESULTS The sum of upper body SFT measurements increased in mid-pregnancy (0.08 ± 0.71 mm/week) and decreased in late pregnancy (-0.04 ± 1.17 mm/week). After adjustment for maternal age, BMI and parity, mid- but not late- pregnancy GWG was positively associated with infant birthweight z-score (p<0.05), while mid- but not late-pregnancy changes in the sum of SFT were inversely associated with infant birthweight z-score (p<0.01). CONCLUSIONS The present study suggests that mid- rather than late-pregnancy changes in weight and upper-body subcutaneous fat are associated with infant birthweight. Further research is required in larger, more diverse populations to explore whether pregnancy interventions aiming to improve maternal and offspring health can be personalised beyond BMI and GWG.
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Okafor UB, Goon DT. Physical activity and exercise during pregnancy in Africa: a review of the literature. BMC Pregnancy Childbirth 2020; 20:732. [PMID: 33238920 PMCID: PMC7691114 DOI: 10.1186/s12884-020-03439-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnancy is an important phase in a woman's life, with health status at this stage affecting both the woman and her child's life. Global evidence suggests that many women engage in low levels of physical activity (PA) and exercise during pregnancy despite its beneficial effects. This is particularly the case in Africa. METHODS This article reviews the literature on levels of PA and exercise among pregnant women in Africa, highlighting the level of PA or exercise participation during pregnancy in Africa, including types of PA, factors affecting PA, beliefs about and benefits of prenatal activity, advice or counselling on PA during pregnancy in Africa, and PA interventions proposed to promote the uptake of prenatal PA. Electronic search databases used were Google Scholar, Science Direct, Scopus, EMBASE, ERIC, Medline, Web of Science, EBSCOhost, PubMed, BIOMED Central, and African Journal Online. The basic search terms were: 'Physical activity', 'Exercise', 'Pregnancy', 'Pregnant women' and 'Africa'. A total of 40 references were found. On the basis of an analysis of titles, abstracts and the language of publication (other than English), 11 articles were rejected, and 29 articles were fully read, although two had to be rejected due to a lack of access to the full version. Finally, 27 references were included in the review. RESULTS Few studies exist on PA during pregnancy in Africa. The limited data available suggests that, compared to the Western world, pregnant women in Africa do not adhere to the recommendations for PA during pregnancy. Levels of participation in PA during pregnancy are low and decline as the pregnancy progresses. The majority of the studies used direct, objective measures to assess PA during pregnancy. Personal and environmental factors such as lack of time, lack of knowledge, inadequate information from healthcare providers, feelings of tiredness and an absence of social support constituted the main barriers to PA during pregnancy. The types of PA participation among pregnant women varied across studies and geographical settings. CONCLUSIONS While published data is limited, it seems clear that the participation of pregnant women in PA during pregnancy in Africa is low and declines with advancing pregnancy. There is a need for more studies to examine the dynamics of PA during pregnancy in Africa to guide contextual interventions to improve and promote maternal health on the continent.
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Affiliation(s)
- Uchenna Benedine Okafor
- Department of Nursing Science, University of Fort Hare, 50 Church Street, 5201, East London, South Africa.
| | - Daniel Ter Goon
- Department of Public Health, University of Fort Hare, 05 Oxford Street, East London, South Africa
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Flannery C, Mtshede MN, McHugh S, Anaba AE, Clifford E, O'Riordan M, Kenny LC, McAuliffe FM, Kearney PM, Matvienko‐Sikar K. Dietary behaviours and weight management: A thematic analysis of pregnant women's perceptions. MATERNAL & CHILD NUTRITION 2020; 16:e13011. [PMID: 32350987 PMCID: PMC7507482 DOI: 10.1111/mcn.13011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 03/18/2020] [Accepted: 03/28/2020] [Indexed: 12/26/2022]
Abstract
Maternal obesity is associated with increased risk of gestational diabetes and other complications. Although antenatal interventions to help prevent these complications are ongoing, an understanding of overweight and obese pregnant women's opinions and attitudes is lacking. Therefore, this study aims to explore these women's experiences and perceptions of dietary behaviours and weight management during pregnancy. Secondary analysis of qualitative data originally collected to examine lifestyle behaviours in pregnant women was conducted. The data were from a purposive sample of overweight and obese pregnant women attending a public antenatal clinic in Cork, Ireland. The data were explored using thematic analysis. Interviews with 30 overweight and obese pregnant women were analysed. Three themes were developed relating to overweight and obese women's dietary behaviours and weight management perceptions including 'pregnancy's influence on dietary behaviours', 'external influences on dietary behaviours' and 'perception of and preferences for weight related advice and resources'. Together these themes reveal women's experiences of diet and how pregnancy factors (physiological changes) and external factors (family and friends) can influence dietary behaviours. Furthermore, perceptions of weight management advice and lack thereof were highlighted with women drawing attention to potential resources for future use during pregnancy. This study provides important insights into overweight and obese pregnant women's dietary behaviours and perceptions of weight management. According to these findings, there is a need for clear and unambiguous information about weight management, acceptable weight gain, food safety and how to achieve a balanced diet.
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Affiliation(s)
- Caragh Flannery
- Health Behaviour Change Research GroupNational University of IrelandGalwayIreland
- School of Public HealthUniversity College CorkCorkIreland
| | | | - Sheena McHugh
- School of Public HealthUniversity College CorkCorkIreland
| | | | - Emma Clifford
- Department of Nutrition and DieteticsSIVUHCorkIreland
| | - Mairead O'Riordan
- Department of Obstetrics and GynaecologyUniversity College CorkCorkIreland
| | - Louise C. Kenny
- Department of Women's and Children's Health, Faculty of Health and Life SciencesUniversity of LiverpoolLiverpoolUK
| | - Fionnuala M. McAuliffe
- UCD Perinatal Research Centre, School of Medicine, National Maternity HospitalUniversity College DublinDublinIreland
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Stamm R, Coppell K, Paterson H. Minimization of bias in measures of gestational weight gain. Obes Rev 2020; 21:e13056. [PMID: 32627331 DOI: 10.1111/obr.13056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/13/2020] [Accepted: 05/11/2020] [Indexed: 12/25/2022]
Abstract
Gestational weight gain (GWG) is an important predictor of adverse pregnancy outcomes including gestational diabetes, preterm birth, delivery by caesarean and post-partum weight retention. The Institute of Medicine guidelines on GWG are widely adopted, and GWG is widely researched as an outcome of interest in lifestyle interventions during pregnancy. However, estimation of prepregnancy weight and measurement of weight prior to delivery introduce bias into measures of GWG. This review discusses the sources of bias in measures of GWG and the potential effect of bias on the relationship between adverse pregnancy outcomes associated with GWG. Bias in measures of GWG can be minimized by using measured weight at the first antenatal appointment in early pregnancy rather than self-reported prepregnancy weight and by adjusting for gestational age when the last weight is collected earlier than the delivery date. Bias owing to gestational age is an important potential confounder in the relationship between GWG and adverse pregnancy outcomes.
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Affiliation(s)
- Rosemary Stamm
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Kirsten Coppell
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Helen Paterson
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
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Jack-Roberts C, Maples P, Kalkan B, Edwards K, Gilboa E, Djuraev I, Zou S, Hoepner L, Fordjour L, Lee WC, Kral J, Dalloul M, Jiang X. Gestational diabetes status and dietary intake modify maternal and cord blood allostatic load markers. BMJ Open Diabetes Res Care 2020; 8:8/1/e001468. [PMID: 33093129 PMCID: PMC7583070 DOI: 10.1136/bmjdrc-2020-001468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/23/2020] [Accepted: 09/26/2020] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Allostatic load (AL) defines cardiometabolic, inflammatory, and neuroendocrine changes in the body in response to internal and external stressors. It is largely unknown whether gestational diabetes mellitus (GDM) alters maternal and fetal AL, which in turn affects GDM outcomes. Whether dietary intakes and quality can modify AL and thus influence GDM progression is also unknown. RESEARCH DESIGN AND METHODS In this study, we recruited 35 GDM and 30 non-GDM women in gestational week 25-33. Fasting blood samples were collected at enrollment, and cord venous blood samples were collected at delivery for the measurement of a series of AL biomarkers to calculate the composite AL index. Three-day dietary recalls were conducted at enrollment. RESULTS Results suggest that GDM women had 60% higher composite AL index scores (p value=0.01). Maternal AL index was associated with shorter duration of gestation (β=-0.33, p value=0.047) and higher fetal AL index (β=0.47, p value=0.006) after adjusting for GDM status. Dietary intake of monounsaturated fatty acids was negatively associated with maternal AL index (β=-0.20, p value=0.006). GDM women had lower total caloric intake and dietary glycemic load, yet their linolenic acid, vitamin C and E intakes were also decreased (all p value<0.05). These dietary differences were not related to birth outcomes measured. CONCLUSIONS In this study, GDM status and dietary intakes modify AL in this population. AL may serve as an indicator of GDM control. Future research on dietary interventions that can improve maternal AL markers during GDM is warranted.
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Affiliation(s)
| | - Patricia Maples
- Department of Health and Nutrition Sciences, Brooklyn College, Brooklyn, New York, USA
| | - Betul Kalkan
- Department of Health and Nutrition Sciences, Brooklyn College, Brooklyn, New York, USA
| | - Kaydine Edwards
- Department of Health and Nutrition Sciences, Brooklyn College, Brooklyn, New York, USA
| | - Ella Gilboa
- Department of Health and Nutrition Sciences, Brooklyn College, Brooklyn, New York, USA
| | - Ikhtiyor Djuraev
- Department of Health and Nutrition Sciences, Brooklyn College, Brooklyn, New York, USA
| | - Shuli Zou
- Department of Obstetrics and Gynecology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Lori Hoepner
- Department of Environmental and Occupational Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Lawrence Fordjour
- Department of Pediatrics, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Wen-Ching Lee
- Department of Obstetrics and Gynecology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - John Kral
- Department of Surgery, Medicine, and Cell Biology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Mudar Dalloul
- Department of Obstetrics and Gynecology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Xinyin Jiang
- Department of Health and Nutrition Sciences, Brooklyn College, Brooklyn, New York, USA
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Effect of Behavioural Interventions for Obesity Prevention in Pregnancy on the Adequacy of Gestational Weight Gain and Retention: Metabolic Health of Indian Women. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2020. [DOI: 10.2478/sjecr-2018-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The aim of this study was to measure the adequacy of gestational weight gain (GWG) in Indian women using various behavioural interventions during pregnancy, which primarily aim to observe the effects on obesity markers and weight retention.
In this experimental study, one hundred and forty pregnant women underwent interventions in 5 groups, control (C), diet (D), home exercise (HE), supervised exercise (SE) and supervised exercise with diet (SED), from pregnancy through delivery with 2 months follow-up post-delivery. The outcome measures were GWG and baby birth weight.
A one-way ANOVA indicated no differences in the mean GWG between groups (12.39±4.71 kg, p=0.947). The control group had the most (50%) and both the supervised exercise groups had the fewest (32%) women who gained above the recommended GWG, followed by the diet group (33.3%). The D and HE groups had the most women who gained within the GWG range, while both the SE and SED groups had the most women who gained below the GWG range. However, these results did not affect the birth weight between the groups (mean 2.96 kg±0.40, p=0.203). In women with normal BMIs, (18.5-22.9 kg/m2), the diet group had the most effective maintenance of adequate GWG, with 15%, 55%, and 30% of the women gaining above, within, and below the recommended GWG, respectively. The SE and SED groups had the least postpartum weight retention (PPWR) at 2 months, followed by the HM, D and C groups; i.e., the results showed a trend in the desired direction clinically, although they were not statistically significant (p=0.12).
Supervised exercise can be effectively used as a pregnancy intervention to prevent excess GWG in Indian women. Diet counselling was found to be the next best intervention in combination with exercise, as well as for women with normal BMI.
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Erickson ML, Mey JT, Axelrod CL, Paul D, Gordesky L, Russell K, Barkoukis H, O'Tierney-Ginn P, Fielding RA, Kirwan JP, Catalano PM. Rationale and study design for lifestyle intervention in preparation for pregnancy (LIPP): A randomized controlled trial. Contemp Clin Trials 2020; 94:106024. [PMID: 32389808 DOI: 10.1016/j.cct.2020.106024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Maternal obesity increases neonatal risk for obesity and metabolic syndrome later in life. Prior attempts to break this intergenerational obesity cycle by limiting excessive gestational weight gain have failed to reduce neonatal adiposity. Alternatively, pre-conception lifestyle interventions may improve the in utero metabolic milieu during early pregnancy leading to improved fetal outcomes. This randomized controlled trial (RCT) is evaluating whether a lifestyle intervention to reduce weight and improve maternal metabolism in preparation for pregnancy (LIPP) attenuates neonatal adiposity, compared to standard medical advice. MATERIAL AND METHODS Overweight/class 1 obese women after a previous pregnancy, ~12 weeks postpartum, preparing for a subsequent pregnancy, will be block randomized (1:1) to either LIPP or standard of care in a parallel design. Randomization is stratified by lactation status and overweight vs. class 1 obesity. The LIPP program consists of intensive short-term weight loss followed by weight maintenance until conception using supervised exercise and a low glycemic Mediterranean diet. PRIMARY OUTCOMES Group differences in neonatal adiposity at birth assessed by PEA POD and placental mitochondrial lipid metabolism. SECONDARY OUTCOMES Group differences in maternal pregravid and gestational body composition, insulin sensitivity, β-cell function, fasting metabolic and inflammatory biomarkers, and overall quality of life. Exploratory outcomes include umbilical cord blood insulin resistance, lipid profile and inflammation. DISCUSSION This RCT will determine the efficacy of maternal weight loss prior to pregnancy on reducing neonatal adiposity. Findings may change standard obstetrical care by providing Level 1 evidence on lifestyle interventions improving neonatal outcomes for women planning for pregnancy. CLINICAL TRIAL REGISTRATION NCT03146156.
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Affiliation(s)
- M L Erickson
- Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States of America
| | - J T Mey
- Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States of America
| | - C L Axelrod
- Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States of America; Department of Translational Services, Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America
| | - D Paul
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States of America
| | - L Gordesky
- Department of Reproductive Biology, Center for Reproductive Health, MetroHealth Medical, 2500 MetroHealth Dr, Cleveland, OH 44109, United States of America
| | - K Russell
- Mother Infant Research Institute, Tufts Medical Center, 800 Washington St, Boston, MA 02111, United States of America
| | - H Barkoukis
- Department of Nutrition, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, United States of America
| | - P O'Tierney-Ginn
- Department of Reproductive Biology, Center for Reproductive Health, MetroHealth Medical, 2500 MetroHealth Dr, Cleveland, OH 44109, United States of America; Mother Infant Research Institute, Tufts Medical Center, 800 Washington St, Boston, MA 02111, United States of America
| | - R A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, 711 Washington St, Boston, MA 02111, United States of America
| | - J P Kirwan
- Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States of America.
| | - P M Catalano
- Department of Reproductive Biology, Center for Reproductive Health, MetroHealth Medical, 2500 MetroHealth Dr, Cleveland, OH 44109, United States of America; Mother Infant Research Institute, Tufts Medical Center, 800 Washington St, Boston, MA 02111, United States of America.
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Koech WA, Lilly CL. Association of county perinatal resources and gestational weight gain in West Virginia, United States. BMC Pregnancy Childbirth 2019; 19:497. [PMID: 31842827 PMCID: PMC6915988 DOI: 10.1186/s12884-019-2650-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 11/29/2019] [Indexed: 11/15/2022] Open
Abstract
Background Inappropriate (inadequate or excessive) gestational weight gain (GWG) is of great concern to maternal, fetal and infant health. Different maternal and fetal risk factors are associated with GWG, but little is known about a more distal risk factor: inadequate county-level perinatal resources. Therefore, the study aim was to investigate GWG in women living in counties with below average perinatal resources in comparison with their counterparts living in counties with above average perinatal resources. Methods Retrospective study of 406,792,010–2011 West Virginia births in 55 counties. The outcome was GWG and the main predictor was county perinatal resources. Hierarchical linear mixed model was used to investigate the association of county perinatal resources and GWG. Results County perinatal resources was associated with GWG (p = 0.009), controlling for important covariates. Below average county perinatal resources was not significantly associated with a decrease in mean GWG (M: − 5.29 lbs., 95% CI: − 13.94, 3.35, p = 0.2086), in comparison with counties with above average county perinatal resources. There was significant difference between average, and above average county perinatal resources (M: − 17.20 lbs., 95% CI: − 22.94, − 11.47, p < 0.0001), controlling for smoking during pregnancy and other covariates. Conclusions Average county perinatal resources was associated with reduced mean GWG relative to above average county perinatal resources, but not below average county perinatal resources. However, this could be due to the small number of counties with above average resources as the effect was in the hypothesized direction. This highlights one of the challenges in county perinatal resource studies.
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Affiliation(s)
- Wilson A Koech
- Department of Epidemiology, School of Public Health, WV University Health Sciences Center, Morgantown, WV, USA.
| | - Christa L Lilly
- Department of Biostatistics, School of Public Health, WV University Health Sciences Center, Morgantown, WV, USA
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Stubert J, Reister F, Hartmann S, Janni W. The Risks Associated With Obesity in Pregnancy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:276-283. [PMID: 29739495 DOI: 10.3238/arztebl.2018.0276] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 06/20/2017] [Accepted: 02/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Approximately one-third of all women of childbearing age are overweight or obese. For these women, pregnancy is associated with increased risks for both mother and child. METHODS This review is based on pertinent publications retrieved by a selective search of PubMed, with special attention to current population-based cohort studies, systematic reviews, meta-analyses, and controlled trials. RESULTS Obesity in pregnancy is associated with unfavorable clinical outcomes for both mother and child. Many of the risks have been found to depend linearly on the body-mass index (BMI). The probability of conception declines linearly, starting from a BMI of 29 kg/m2, by 4% for each additional 1 kg/m2 of BMI (hazard ratio 0.96, 95% confidence interval: [0.91; 0.99]). A 10% increase of pregravid BMI increases the relative risk of gestational diabetes and that of preeclampsia by approximately 10% each. A 5 kg/m2 increase of BMI elevates the relative risk of intrauterine death to 1.24 [1.18; 1.30]. An estimated 11% of all neonatal deaths can be attributed to the consequences of maternal overweight and obesity. Nonetheless, in most randomized controlled trials, nutritional and lifestyle interventions did not bring about any clinically relevant reduction in the incidence of gestational diabetes and fetal macrosomia. CONCLUSION The risks associated with obesity in pregnancy cannot necessarily be influenced by intervention. Preventive measures aimed at normalizing body weight before a woman becomes pregnant are, therefore, all the more important.
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Affiliation(s)
- Johannes Stubert
- Department of Gynecology and Obstetrics, Rostock University Medical Center, Rostock, Germany; Department of Gynecology and Obstetrics, Ulm University Medical Center, Ulm, Germany
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O'Brien EC, Segurado R, Geraghty AA, Alberdi G, Rogozinska E, Astrup A, Barakat Carballo R, Bogaerts A, Cecatti JG, Coomarasamy A, de Groot CJM, Devlieger R, Dodd JM, El Beltagy N, Facchinetti F, Geiker N, Guelfi K, Haakstad L, Harrison C, Hauner H, Jensen DM, Khan K, Kinnunen TI, Luoto R, Willem Mol B, Mørkved S, Motahari-Tabari N, Owens JA, Perales M, Petrella E, Phelan S, Poston L, Rauh K, Rayanagoudar G, Renault KM, Ruifrok AE, Sagedal L, Salvesen KÅ, Scudeller TT, Shen G, Shub A, Stafne SN, Surita FG, Thangaratinam S, Tonstad S, van Poppel MNM, Vinter C, Vistad I, Yeo S, McAuliffe FM. Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: individual participant data meta-analysis. BMJ Open 2019; 9:e025620. [PMID: 31375602 PMCID: PMC6688690 DOI: 10.1136/bmjopen-2018-025620] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To identify if maternal educational attainment is a prognostic factor for gestational weight gain (GWG), and to determine the differential effects of lifestyle interventions (diet based, physical activity based or mixed approach) on GWG, stratified by educational attainment. DESIGN Individual participant data meta-analysis using the previously established International Weight Management in Pregnancy (i-WIP) Collaborative Group database (https://iwipgroup.wixsite.com/collaboration). Preferred Reporting Items for Systematic reviews and Meta-Analysis of Individual Participant Data Statement guidelines were followed. DATA SOURCES Major electronic databases, from inception to February 2017. ELIGIBILITY CRITERIA Randomised controlled trials on diet and physical activity-based interventions in pregnancy. Maternal educational attainment was required for inclusion and was categorised as higher education (≥tertiary) or lower education (≤secondary). RISK OF BIAS Cochrane risk of bias tool was used. DATA SYNTHESIS Principle measures of effect were OR and regression coefficient. RESULTS Of the 36 randomised controlled trials in the i-WIP database, 21 trials and 5183 pregnant women were included. Women with lower educational attainment had an increased risk of excessive (OR 1.182; 95% CI 1.008 to 1.385, p =0.039) and inadequate weight gain (OR 1.284; 95% CI 1.045 to 1.577, p =0.017). Among women with lower education, diet basedinterventions reduced risk of excessive weight gain (OR 0.515; 95% CI 0.339 to 0.785, p = 0.002) and inadequate weight gain (OR 0.504; 95% CI 0.288 to 0.884, p=0.017), and reduced kg/week gain (B -0.055; 95% CI -0.098 to -0.012, p=0.012). Mixed interventions reduced risk of excessive weight gain for women with lower education (OR 0.735; 95% CI 0.561 to 0.963, p=0.026). Among women with high education, diet based interventions reduced risk of excessive weight gain (OR 0.609; 95% CI 0.437 to 0.849, p=0.003), and mixed interventions reduced kg/week gain (B -0.053; 95% CI -0.069 to -0.037,p<0.001). Physical activity based interventions did not impact GWG when stratified by education. CONCLUSIONS Pregnant women with lower education are at an increased risk of excessive and inadequate GWG. Diet based interventions seem the most appropriate choice for these women, and additional support through mixed interventions may also be beneficial.
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Affiliation(s)
- Eileen C O'Brien
- UCD Perinatal Research Centre, Obstetrics and Gynaecology, UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - Ricardo Segurado
- Centre for Support and Training in Analysis and Research (CSTAR), School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Aisling A Geraghty
- UCD Perinatal Research Centre, Obstetrics and Gynaecology, UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - Goiuri Alberdi
- UCD Perinatal Research Centre, Obstetrics and Gynaecology, UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - Ewelina Rogozinska
- Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Multidisciplinary Evidence Synthesis Hub (mEsh), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Arne Astrup
- Department of Nutrition, Exercise and Sports, Univesity of Copenhagen, Copenhagen, Denmark
| | - Rubenomar Barakat Carballo
- Facultad de Ciencias de la Actividad Fısica y del Deporte (INEF), Universidad Politecnica de Madrid, Madrid, Spain
| | - Annick Bogaerts
- Department of Development and Regeneration KU Leuven, University of Leuven, Leuven, Belgium
- Faculty of Health and Social Work, UC Leuven-Limburg, Leuven, Belgium
- Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Belgium
| | - Jose Guilherme Cecatti
- Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Arri Coomarasamy
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Christianne J M de Groot
- Obstetrics and Gynaecology, Faculty of Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Roland Devlieger
- Department of Development and Regeneration KU Leuven, University of Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Jodie M Dodd
- Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, The Unversity of Adelaide, Adelaide, Australia
| | - Nermeen El Beltagy
- Department of Obstetrics and Gynecology, Alexandria University, Alexandria, Egypt
| | - Fabio Facchinetti
- Mother-Infant Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Nina Geiker
- Clinical Nutrition Research, Copenhagen University Hospital Herlev-Gentofte, Gentofte, Denmark
| | - Kym Guelfi
- School of Human Sciences, The University of Western Australia, Perth, Australia
| | - Lene Haakstad
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Cheryce Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Hans Hauner
- Else Kroener-Fresenius-Center for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Dorte M Jensen
- Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Khalid Khan
- Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Multidisciplinary Evidence Synthesis Hub (mEsh), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Tarja Inkeri Kinnunen
- Health Sciences, Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Riitta Luoto
- Health Sciences, Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Ben Willem Mol
- Robinson Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia
| | - Siv Mørkved
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Narges Motahari-Tabari
- Midwifery Department, Faculty of Nursing and Midwifery, Mazandaran University of Medical Science, Sari, Iran
| | - Julie A Owens
- Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, The Unversity of Adelaide, Adelaide, Australia
| | - Maria Perales
- Facultad de Ciencias de la Actividad Fısica y del Deporte (INEF), Universidad Politecnica de Madrid, Madrid, Spain
| | - Elisabetta Petrella
- Mother-Infant Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Suzanne Phelan
- Kinesiology Department, College of Science and Mathematics, California Polytechnic State University, San Luis Obispo, California, USA
| | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Kathrin Rauh
- Nutrition Information and Knowledge Transfer, Competence Centre for Nutrition (KErn), Freising, Germany
| | - Girish Rayanagoudar
- Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kristina M Renault
- Department of Obstetrics and Gynecology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
- Obstetric Clinic, Juliane Marie Centret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anneloes E Ruifrok
- Department of Obstetrics and Gynaecology, Academisch Medisch Centrum Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - Linda Sagedal
- Department of Obstetrics and Gynecology, Sorlandet Hospital, Kristiansand, Norway
| | - Kjell Å Salvesen
- Department of Obstetrics and Gynaecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Laboratory Medicine Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tania T Scudeller
- Department of Management and Health Care, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Gary Shen
- Department of Internal Medicine, University of Manitoba College of Medicine, Winnipeg, Canada
| | - Alexis Shub
- Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - Signe N Stafne
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Fernanda G Surita
- Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Shakila Thangaratinam
- Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Multidisciplinary Evidence Synthesis Hub (mEsh), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Serena Tonstad
- Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
| | - Mireille N M van Poppel
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
| | - Christina Vinter
- Department of Obstetrics and Gynecology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Ingvild Vistad
- Department of Obstetrics and Gynecology, Sorlandet Hospital, Kristiansand, Norway
| | - SeonAe Yeo
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, Obstetrics and Gynaecology, UCD School of Medicine, University College Dublin, Dublin, Ireland
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Günther J, Hoffmann J, Kunath J, Spies M, Meyer D, Stecher L, Rosenfeld E, Kick L, Rauh K, Hauner H. Effects of a Lifestyle Intervention in Routine Care on Prenatal Dietary Behavior-Findings from the Cluster-Randomized GeliS Trial. J Clin Med 2019; 8:jcm8070960. [PMID: 31269753 PMCID: PMC6678299 DOI: 10.3390/jcm8070960] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 11/16/2022] Open
Abstract
The antenatal lifestyle and excessive gestational weight gain (GWG) modify the risk of obstetric complications, maternal weight retention, and the risk of obesity for the next generation. The cluster-randomized controlled "Healthy living in pregnancy" (GeliS) study, recruiting 2286 women, was designed to examine whether a lifestyle intervention reduced the proportion of women with excessive GWG. Trained healthcare providers gave four counseling sessions covering a healthy diet, regular physical activity, and self-monitoring of GWG in the intervention group. In this secondary analysis, the effect on maternal dietary behavior was analyzed. Dietary behavior was assessed by means of a 58-item food frequency questionnaire in early and late pregnancy. The intervention resulted in a significant reduction in soft drink intake (p < 0.001) and an increase in the consumption of fish (p = 0.002) and vegetables (p = 0.023). With the exception of higher percentage energy from protein (p = 0.018), no effects of the intervention on energy and macronutrient intake were observed. There was no evidence for an overall effect on dietary quality measured with a healthy eating index. Some dietary variables were shown to be associated with GWG. In a routine prenatal care setting in Germany, lifestyle advice modified single aspects of dietary behavior, but not energy intake or overall dietary quality.
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Affiliation(s)
- Julia Günther
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, Munich 80992, Bavaria, Germany
| | - Julia Hoffmann
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, Munich 80992, Bavaria, Germany
| | - Julia Kunath
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, Munich 80992, Bavaria, Germany
| | - Monika Spies
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, Munich 80992, Bavaria, Germany
| | - Dorothy Meyer
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, Munich 80992, Bavaria, Germany
| | - Lynne Stecher
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, Munich 80992, Bavaria, Germany
| | - Eva Rosenfeld
- Competence Centre for Nutrition (KErn), Am Gereuth 4, Freising 85354, Bavaria, Germany
| | - Luzia Kick
- Competence Centre for Nutrition (KErn), Am Gereuth 4, Freising 85354, Bavaria, Germany
| | - Kathrin Rauh
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, Munich 80992, Bavaria, Germany
- Competence Centre for Nutrition (KErn), Am Gereuth 4, Freising 85354, Bavaria, Germany
| | - Hans Hauner
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, Munich 80992, Bavaria, Germany.
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Chan CWH, Au Yeung E, Law BMH. Effectiveness of Physical Activity Interventions on Pregnancy-Related Outcomes among Pregnant Women: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101840. [PMID: 31126153 PMCID: PMC6571580 DOI: 10.3390/ijerph16101840] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/08/2019] [Accepted: 05/21/2019] [Indexed: 12/16/2022]
Abstract
Regular physical activity has been demonstrated to contribute to physical and psychological health. Nevertheless, pregnant women generally exhibit low levels of physical activity. Implementation of interventions that enhance the self-efficacy of pregnant women on increasing physical activity is required. This paper provides an in-depth review of studies reporting the effect of various physical activity interventions dedicated for pregnant women on pregnancy-related issues, including gestational weight gain, pain and depression, physical activity level, and quality of life among these individuals. Five databases were used in searching the literature. Findings of the included studies were presented narratively, and appraisal of their methodological quality was conducted using the quality assessment tool developed by Effective Public Health Practice Project. Review findings demonstrated that physical activity interventions are effective in enhancing physical activity levels of pregnant women. Further, they are potentially useful in alleviating pregnancy-related pain and psychological symptoms, reducing gestational weight gain, and increasing self-efficacy in enhancing physical activity levels among these individuals. Nevertheless, inconsistencies in findings between studies hamper the drawing of firm conclusions on these latter outcomes. Overall, studies demonstrated a positive effect of physical activity interventions on the well-being and physical and psychological health of pregnant women.
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Affiliation(s)
- Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.
| | - Elce Au Yeung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.
| | - Bernard M H Law
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.
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Barakat R, Refoyo I, Coteron J, Franco E. Exercise during pregnancy has a preventative effect on excessive maternal weight gain and gestational diabetes. A randomized controlled trial. Braz J Phys Ther 2019; 23:148-155. [PMID: 30470666 PMCID: PMC6428908 DOI: 10.1016/j.bjpt.2018.11.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 10/29/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Excessive gestational weight gain is associated with several adverse events and pathologies during pregnancy. OBJECTIVE The purpose of this study was to examine the effects of an exercise program throughout pregnancy on maternal weight gain and prevalence of gestational diabetes. METHOD A randomized controlled trial was designed that included an exercise intervention group (EG) and standard care control group (CG). The exercise intervention included moderate aerobic exercise performed three days per week (50-55minutes per session) for 8-10 weeks to 38-39 weeks gestation. RESULTS 594 pregnant women were assessed for eligibility and 456 were included (EG n=234; CG n=222). The results showed a higher percentage of pregnant women gained excessive weight in the CG than in the EG (30.2% vs 20.5% respectively; odds ratio, 0.597; 95% confidence interval, 0.389-0.916; p=0.018). Similarly, the prevalence of gestational diabetes was significantly higher in the CG than the EG (6.8% vs 2.6% respectively; odds ratio, 0.363; 95% confidence interval, 0.138-0.953; p=0.033). CONCLUSION The results of this trial indicate that exercise throughout pregnancy can reduce the risk of excessive maternal weight gain and gestational diabetes.
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Affiliation(s)
- Ruben Barakat
- AFIPE Research Group, Technical University of Madrid, Madrid, Spain.
| | - Ignacio Refoyo
- AFIPE Research Group, Technical University of Madrid, Madrid, Spain
| | - Javier Coteron
- AFIPE Research Group, Technical University of Madrid, Madrid, Spain
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42
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Craemer KA, Sampene E, Safdar N, Antony KM, Wautlet CK. Nutrition and Exercise Strategies to Prevent Excessive Pregnancy Weight Gain: A Meta-analysis. AJP Rep 2019; 9:e92-e120. [PMID: 31041118 PMCID: PMC6424817 DOI: 10.1055/s-0039-1683377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 12/11/2018] [Indexed: 02/06/2023] Open
Abstract
Objective To evaluate nutrition-only, exercise-only, and nutrition-plus-exercise interventions for optimizing gestational weight gain (GWG) based on the 2009 Institute of Medicine (IOM) guidelines. Study PubMed, Google Scholar, and 2015 Cochrane Review were searched. Analysis of variance was used to determine if significant GWG differences exist between strategies, with additional subanalyses on overweight (OV) or obese women based on 2009 IOM guidelines. Results Of 66 identified studies, 31 contributed data ( n = 8,558). Compared with routine prenatal care, nutrition-only interventions were significantly associated with reduced GWG and are most likely to produce weight gain within IOM recommendations ( p = 0.013). Exercise-only ( p = 0.069) and nutrition-plus-exercise ( p = 0.056) interventions trended toward GWG within IOM guidelines, but did not reach statistical significance. Supervised ( p = 0.61) and unsupervised ( p = 0.494) exercise programs had similar effectiveness. Subanalyses on OV or obese women produced similar results to studies that did not differentiate results based on body mass index: nutrition only ( p = 0.011), exercise only ( p = 0.308), and nutrition plus exercise ( p = 0.129). Conclusion Preventing excessive GWG is crucial, especially for OV or obese women. In the current study, nutrition-based intervention is the health system strategy that showed significant impact on preventing excessive GWG compared with routine prenatal care. Among women who are OV or have obesity, nutrition-only interventions hold the most promise compared with routine prenatal care.
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Affiliation(s)
- Katherine A Craemer
- Department of Integrated Biology, University of Wisconsin - Madison, Madison, Wisconsin.,Department of Obstetrics and Gynecology, University of Wisconsin - Madison, Madison, Wisconsin
| | - Emmanuel Sampene
- Department of Biostatistics and Medical Informatics, University of Wisconsin - Madison, Madison, Wisconsin
| | - Nasia Safdar
- Division of Infectious Disease, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.,Department of Medicine, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Kathleen M Antony
- Department of Obstetrics and Gynecology, University of Wisconsin - Madison, Madison, Wisconsin
| | - Cynthia K Wautlet
- Department of Obstetrics and Gynecology, University of Wisconsin - Madison, Madison, Wisconsin
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43
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Kiani Asiabar A, Amin Shokravi F, Hajifaraji M, Zayeri F. The effect of an educational intervention in early pregnancy with spouse's participation on optimal gestational weight gain in pregnancy: a randomized controlled trial. HEALTH EDUCATION RESEARCH 2018; 33:535-547. [PMID: 30496409 DOI: 10.1093/her/cyy040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/10/2018] [Indexed: 06/09/2023]
Abstract
Gaining weight above the Institute of Medicine recommended range contributes to the development of obesity, which increases risk for diseases. We evaluated the effectiveness of an educational program with the spouse's participation on the optimal gestational weight gain (GWG) in pregnancy. We conducted a randomized controlled trial on 128 nulliparous women attending Najmieh Hospital-Antenatal Clinic based in Tehran-Iran. Participants randomly allocated into two groups of interventions and one control group. In group A, the women received education with their spouse's participation. In group B, the women received education without the participation of the spouses. In the control group, women received only routine prenatal care. Data were analysed by the ANOVA and Chi-square coefficient. The mean of the total GWG in the groups A and B was significantly lower than the control group (13.50 ± 3.85, 13.55 ± 3.20 and 15.53 ± 4.20 kg, respectively, P > 0.05). The rate of optimal GWG in groups A and B was 1.97 and 1.77 times of the control group, respectively (P < 0.05). The percentage of non-optimal GWG significantly decreased (P < 0.05). Groups A and B were not significantly different indicating no effect of spousal presence.
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Affiliation(s)
- Azita Kiani Asiabar
- Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
- Department of Midwifery, Faculty of Nursing and Midwifery, Shahed University, Tehran, Iran
| | - Farkhondeh Amin Shokravi
- Department of Health Educations and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Majid Hajifaraji
- National Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Zayeri
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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44
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Farzandipour M, Nabovati E, Anvari S, Vahedpoor Z, Sharif R. Phone-based interventions to control gestational weight gain: a systematic review on features and effects. Inform Health Soc Care 2018; 45:15-30. [DOI: 10.1080/17538157.2018.1540421] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Mehrdad Farzandipour
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | - Ehsan Nabovati
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | - Shima Anvari
- Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra Vahedpoor
- Department of Gynecology and Obstetrics, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Reihane Sharif
- Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
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45
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Ming WK, Ding W, Zhang CJP, Zhong L, Long Y, Li Z, Sun C, Wu Y, Chen H, Chen H, Wang Z. The effect of exercise during pregnancy on gestational diabetes mellitus in normal-weight women: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2018; 18:440. [PMID: 30419848 PMCID: PMC6233372 DOI: 10.1186/s12884-018-2068-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 10/19/2018] [Indexed: 02/06/2023] Open
Abstract
Background Gestational diabetes mellitus (GDM) is one of the most common complications during pregnancy, and it has both short- and long-term adverse effects on the health of mothers and fetuses. To investigate the effect of exercise during pregnancy on the occurrence of GDM among normal-weight pregnant women. Methods We searched for studies published between January 1994 and June 2017 that appeared in the Web of Science, Scopus, ClinicalTrials.gov or Cochrane library databases. Randomized controlled trials that investigated the preventive effect of exercise on GDM in normal-weight women were included. Interventions including any confounding factors (e.g., dietary) were excluded. We extracted maternal characteristics, the diagnostic criteria of GDM, and basic information for intervention and obstetric outcomes. The primary outcome was the occurrence of GDM, and the secondary outcomes included gestational weight gain, gestational age at birth, birth weight, and the odds of cesarean section. A meta-analysis was conducted based on calculations of pooled estimates using the random-effects model. Results Eight studies were included in this systematic review and meta-analysis. Exercise during pregnancy was shown to decrease the occurrence of GDM [RR = 0.58, 95% CI (0.37, 0.90), P = 0.01 and RR = 0.60, 95% CI (0.36, 0.98), P = 0.04 based on different diagnosis criteria, respectively] in normal-weight women. Regarding secondary outcomes, exercise during pregnancy can decrease gestational weight gain [MD = − 1.61, 95% CI (− 1.99, − 1.22), P<0.01], and had no significant effects on gestational age at birth [MD = − 0.55, 95% CI (− 1.57, 0.47), P = 0.29], birth weight [MD = − 18.70, 95% CI (− 52.49, 15.08), P = 0.28], and the odds of caesarean section [RR = 0.88, 95% CI (0.72, 1.08), P = 0.21], respectively. Conclusions Exercise during pregnancy can ostensibly decrease the occurrence of GDM without reducing gestational age at delivery and increasing the odds of cesarean section in normal-weight women. Electronic supplementary material The online version of this article (10.1186/s12884-018-2068-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wai-Kit Ming
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Harvard Medical School, Harvard University, Boston, MA, USA.,Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA
| | - Wenjing Ding
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Casper J P Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Lieqiang Zhong
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuhang Long
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhuyu Li
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Cong Sun
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanxin Wu
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hanqing Chen
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haitian Chen
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zilian Wang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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46
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Attenuation of maternal weight gain impacts infant birthweight: systematic review and meta-analysis. J Dev Orig Health Dis 2018; 10:387-405. [PMID: 30411697 DOI: 10.1017/s2040174418000879] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Despite many interventions aiming to reduce excessive gestational weight gain (GWG), it is currently unclear the impact on infant anthropometric outcomes. The aim of this review was to evaluate offspring anthropometric outcomes in studies designed to reduce GWG. A systematic search of seven international databases, one clinical trial registry and three Chinese databases was conducted without date limits. Studies were categorised by intervention type: diet, physical activity (PA), lifestyle (diet + PA), other, gestational diabetes mellitus (GDM) (diet, PA, lifestyle, metformin and other). Meta-analyses were reported as weighted mean difference (WMD) for birthweight and birth length, and risk ratio (RR) for small for gestational age (SGA), large for gestational age (LGA), macrosomia and low birth weight (LBW). Collectively, interventions reduced birthweight, risk of macrosomia and LGA by 71 g (WMD: -70.67, 95% CI -101.90 to -39.43, P<0.001), 16% (RR: 0.84, 95% CI 0.73-0.98, P=0.026) and 19% (RR: 0.81, 95% CI 0.69-0.96, P=0.015), respectively. Diet interventions decreased birthweight and LGA by 99 g (WMD -98.80, 95% CI -178.85 to -18.76, P=0.016) and 65% (RR: 0.35, 95% CI 0.17-0.72, P=0.004). PA interventions reduced the risk of macrosomia by 51% (RR: 0.49, 95% CI 0.26-0.92, P=0.036). In women with GDM, diet and lifestyle interventions reduced birthweight by 211 and 296 g, respectively (WMD: -210.93, 95% CI -374.77 to -46.71, P=0.012 and WMD:-295.93, 95% CI -501.76 to -90.10, P=0.005, respectively). Interventions designed to reduce excessive GWG lead to a small reduction in infant birthweight and risk of macrosomia and LGA, without influencing the risk of adverse outcomes including LBW and SGA.
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47
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Guo XY, Shu J, Fu XH, Chen XP, Zhang L, Ji MX, Liu XM, Yu TT, Sheng JZ, Huang HF. Improving the effectiveness of lifestyle interventions for gestational diabetes prevention: a meta-analysis and meta-regression. BJOG 2018; 126:311-320. [PMID: 30216635 DOI: 10.1111/1471-0528.15467] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Diet and exercise during pregnancy have been used to prevent gestational diabetes mellitus (GDM) with some success. OBJECTIVE To examine the effectiveness of lifestyle intervention on GDM prevention and to identify key effectiveness moderators to improve the prevention strategy. SEARCH STRATEGY Pubmed, Scopus, Cochrane, and cross-references were searched. SELECTION CRITERIA Randomised controlled trials (RCTs) evaluating lifestyle interventions during pregnancy for GDM prevention. DATA COLLECTION AND ANALYSIS Two independent reviewers extracted data. A random-effects model was used to analyse the relative risk (RR) and 95% confidence interval (95% CI). Meta-regressions and subgroup analyses were used to investigate important moderators of effectiveness. MAIN RESULTS Forty-seven RCTs involving 15 745 participants showed that diet and exercise during pregnancy were preventive of GDM (RR 0.77, 95% CI 0.69-0.87). Four key aspects were identified to improve the preventive effect: targeting the high-risk population; an early initiation of the intervention; the correct intensity and frequency of exercise; and gestational weight gain management. Although 24 RCTs targeted women who were overweight or obese, body mass index (BMI) failed to predict the effectiveness of an intervention. Instead, interventions are most effective in high-incidence populations rather than simply in women who are overweight or obese. Furthermore, exercise of moderate intensity for 50-60 minutes twice a week could lead to an approximately 24% reduction in GDM. CONCLUSION The best strategy to prevent GDM is to target the high-risk population predicted by risk evaluation models and to control the gestational weight gain of women through intensified diet and exercise modifications early in their pregnancy. TWEETABLE ABSTRACT Four key effectiveness moderators of lifestyle interventions for GDM prevention.
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Affiliation(s)
- X-Y Guo
- Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - J Shu
- Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - X-H Fu
- Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - X-P Chen
- Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - L Zhang
- Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - M-X Ji
- Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - X-M Liu
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Embryo-Fetal Original Adult Disease, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - T-T Yu
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Embryo-Fetal Original Adult Disease, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - J-Z Sheng
- Department of Pathophysiology, School of Medicine, Zhejiang University, Hangzhou, China
| | - H-F Huang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Embryo-Fetal Original Adult Disease, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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48
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Davenport MH, Ruchat SM, Sobierajski F, Poitras VJ, Gray CE, Yoo C, Skow RJ, Jaramillo Garcia A, Barrowman N, Meah VL, Nagpal TS, Riske L, James M, Nuspl M, Weeks A, Marchand AA, Slater LG, Adamo KB, Davies GA, Barakat R, Mottola MF. Impact of prenatal exercise on maternal harms, labour and delivery outcomes: a systematic review and meta-analysis. Br J Sports Med 2018; 53:99-107. [PMID: 30337349 DOI: 10.1136/bjsports-2018-099821] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To perform a systematic review of the relationships between prenatal exercise and maternal harms including labour/delivery outcomes. DESIGN Systematic review with random effects meta-analysis and meta-regression. DATASOURCES Online databases were searched up to 6 January 2017. STUDY ELIGIBILITY CRITERIA Studies of all designs were included (except case studies) if they were published in English, Spanish or French and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise, alone ["exercise-only"] or in combination with other intervention components [e.g., dietary; "exercise + co-intervention"]) and outcome (preterm/prelabour rupture of membranes, caesarean section, instrumental delivery, induction of labour, length of labour, vaginal tears, fatigue, injury, musculoskeletal trauma, maternal harms (author defined) and diastasis recti). RESULTS 113 studies (n=52 858 women) were included. 'Moderate' quality evidence from exercise-only randomised controlled trials (RCTs) indicated a 24% reduction in the odds of instrumental delivery in women who exercised compared with women who did not (20 RCTs, n=3819; OR 0.76, 95% CI 0.63 to 0.92, I 2= 0 %). The remaining outcomes were not associated with exercise. Results from meta-regression did not identify a dose-response relationship between frequency, intensity, duration or volume of exercise and labour and delivery outcomes. SUMMARY/CONCLUSIONS Prenatal exercise reduced the odds of instrumental delivery in the general obstetrical population. There was no relationship between prenatal exercise and preterm/prelabour rupture of membranes, caesarean section, induction of labour, length of labour, vaginal tears, fatigue, injury, musculoskeletal trauma, maternal harms and diastasis recti.
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Affiliation(s)
- Margie H Davenport
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Frances Sobierajski
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | | | - Casey E Gray
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Courtney Yoo
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Rachel J Skow
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | | | - Nick Barrowman
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Victoria L Meah
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Taniya S Nagpal
- R. Samuel McLaughlin Foundation - Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Children's Health Research Institute , The University of Western Ontario, London, Ontario, Canada
| | - Laurel Riske
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Marina James
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Megan Nuspl
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ashley Weeks
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Andree-Anne Marchand
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Linda G Slater
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Gregory A Davies
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Ruben Barakat
- Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | - Michelle F Mottola
- R. Samuel McLaughlin Foundation - Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Children's Health Research Institute , The University of Western Ontario, London, Ontario, Canada
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49
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Davenport MH, Meah VL, Ruchat SM, Davies GA, Skow RJ, Barrowman N, Adamo KB, Poitras VJ, Gray CE, Jaramillo Garcia A, Sobierajski F, Riske L, James M, Kathol AJ, Nuspl M, Marchand AA, Nagpal TS, Slater LG, Weeks A, Barakat R, Mottola MF. Impact of prenatal exercise on neonatal and childhood outcomes: a systematic review and meta-analysis. Br J Sports Med 2018; 52:1386-1396. [DOI: 10.1136/bjsports-2018-099836] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2018] [Indexed: 12/12/2022]
Abstract
ObjectiveWe aimed to identify the relationship between maternal prenatal exercise and birth complications, and neonatal and childhood morphometric, metabolic and developmental outcomes.DesignSystematic review with random-effects meta-analysis and meta-regression.Data sourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were eligible (except case studies and reviews) if published in English, Spanish or French, and contained information on the relevant population (pregnant women without contraindication to exercise), intervention (subjective/objective measures of frequency, intensity, duration, volume or type of exercise, alone (‘exercise-only’) or in combination with other intervention components (eg, dietary; ‘exercise+cointervention’)), comparator (no exercise or different frequency, intensity, duration, volume, type or trimester of exercise) and outcomes (preterm birth, gestational age at delivery, birth weight, low birth weight (<2500 g), high birth weight (>4000 g), small for gestational age, large for gestational age, intrauterine growth restriction, neonatal hypoglycaemia, metabolic acidosis (cord blood pH, base excess), hyperbilirubinaemia, Apgar scores, neonatal intensive care unit admittance, shoulder dystocia, brachial plexus injury, neonatal body composition (per cent body fat, body weight, body mass index (BMI), ponderal index), childhood obesity (per cent body fat, body weight, BMI) and developmental milestones (including cognitive, psychosocial, motor skills)).ResultsA total of 135 studies (n=166 094) were included. There was ‘high’ quality evidence from exercise-only randomised controlled trials (RCTs) showing a 39% reduction in the odds of having a baby >4000 g (macrosomia: 15 RCTs, n=3670; OR 0.61, 95% CI 0.41 to 0.92) in women who exercised compared with women who did not exercise, without affecting the odds of growth-restricted, preterm or low birth weight babies. Prenatal exercise was not associated with the other neonatal or infant outcomes that were examined.ConclusionsPrenatal exercise is safe and beneficial for the fetus. Maternal exercise was associated with reduced odds of macrosomia (abnormally large babies) and was not associated with neonatal complications or adverse childhood outcomes.
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50
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Davenport MH, Ruchat SM, Poitras VJ, Jaramillo Garcia A, Gray CE, Barrowman N, Skow RJ, Meah VL, Riske L, Sobierajski F, James M, Kathol AJ, Nuspl M, Marchand AA, Nagpal TS, Slater LG, Weeks A, Adamo KB, Davies GA, Barakat R, Mottola MF. Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis. Br J Sports Med 2018; 52:1367-1375. [DOI: 10.1136/bjsports-2018-099355] [Citation(s) in RCA: 195] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2018] [Indexed: 12/11/2022]
Abstract
ObjectiveGestational diabetes mellitus (GDM), gestational hypertension (GH) and pre-eclampsia (PE) are associated with short and long-term health issues for mother and child; prevention of these complications is critically important. This study aimed to perform a systematic review and meta-analysis of the relationships between prenatal exercise and GDM, GH and PE.DesignSystematic review with random effects meta-analysis and meta-regression.Data sourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were included (except case studies) if published in English, Spanish or French, and contained information on the Population (pregnant women without contraindication to exercise), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone [“exercise-only”] or in combination with other intervention components [e.g., dietary; “exercise + co-intervention”]), Comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and Outcomes (GDM, GH, PE).ResultsA total of 106 studies (n=273 182) were included. ‘Moderate’ to ‘high’-quality evidence from randomised controlled trials revealed that exercise-only interventions, but not exercise+cointerventions, reduced odds of GDM (n=6934; OR 0.62, 95% CI 0.52 to 0.75), GH (n=5316; OR 0.61, 95% CI 0.43 to 0.85) and PE (n=3322; OR 0.59, 95% CI 0.37 to 0.9) compared with no exercise. To achieve at least a 25% reduction in the odds of developing GDM, PE and GH, pregnant women need to accumulate at least 600 MET-min/week of moderate-intensity exercise (eg, 140 min of brisk walking, water aerobics, stationary cycling or resistance training).Summary/conclusionsIn conclusion, exercise-only interventions were effective at lowering the odds of developing GDM, GH and PE.
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