Anthropometric and biochemical changes during pregnancy in Asian and European mothers having well grown babies

Effects of maternal anthropometrics on pregnancy outcomes in South Asian women: a systematic review

AIM

This systematic review investigates associations between maternal pre-pregnancy/early-pregnancy anthropometrics (e.g. weight and body fat), anthropometric change and pregnancy outcomes in South Asian and White women.

METHODS

Twelve electronic literature databases, reference lists and citations of all included studies were searched. Observational studies published in the English language were included. Descriptive synthesis was used to summarize the evidence base.

RESULTS

Twenty-two studies met the inclusion criteria (403,609 births [351,856 White and 51,753 South Asian]). Nine were prospective cohort studies, nine were retrospective cohort studies and two were cross-sectional studies. Results suggested that in South Asian women, maternal pre-pregnancy/early-pregnancy anthropometrics were associated with anthropometric change, birthweight, mode of delivery and gestational diabetes mellitus (GDM). Gestational anthropometric change was found to be associated with GDM. There was limited evidence to suggest that there may be associations between maternal pre-anthropometrics/early anthropometrics and hypertensive disorders, stillbirth, congenital anomalies, post-natal weight retention and post-natal impaired glucose tolerance. The evidence suggested a combined effect of pre-pregnancy/early-pregnancy anthropometrics and gestational anthropometric change on both GDM and post-natal weight retention.

CONCLUSION

The increased risk of adverse pregnancy outcomes in South Asian women should be considered in guidelines for weight management before and during pregnancy.

Nutrition for Multiples

In 2012 there were 135,943 infants of multiple pregnancies born in the United States, nearly a 2-fold increase since 1980, with twins accounting for 96% of all multiple births. To date, most perinatal morbidities associated with multiple births have proven resistant to technological or pharmaceutical interventions. Maternal nutrition can have a profound effect on the course and outcome of multiple pregnancy, with the goal of achieving optimal intrauterine growth and birthweights, and minimizing prenatal and perinatal complications for the mother and her children.

Nutrition in multiple gestations

Multiple pregnancies represent a state of magnified nutritional requirements, resulting in a greater nutrient drain on maternal resources and an accelerated depletion of nutritional reserves. Maternal weight gain to 20 weeks and between 20 and 28 weeks has the greatest effect on birthweight in twin and triplet pregnancies, particularly among underweight women. Parity, which most likely represents a higher proportion of body fat, has a positive effect on pregnancy outcome, with an average 7 to 10 days longer gestation for multiparous versus nulliparous women. In addition to being the nutrients most often lacking in a woman's diet, calcium, magnesium, and zinc have been identified as having the most potential for reducing pregnancy complications and improving outcomes.

Pattern and predictors of weight gain during pregnancy among HIV-1-infected women from Tanzania

Progression of HIV disease is often accompanied by weight loss and wasting. Gestational weight gain is a strong determinant of maternal and neonatal outcomes; however, the pattern and predictors of weight gain during pregnancy among HIV-positive women are unknown. We obtained monthly anthropometric measurements in a cohort of 957 pregnant women from Tanzania who were HIV infected. We estimated the weekly rate of weight gain at various points during the second and third trimesters of pregnancy and computed rate differences between levels of sociodemographic, nutritional, immunologic, and parasitic variables at the first prenatal visit. The change in mid-upper arm circumference (MUAC) from baseline to delivery was also examined. The rate of weight gain decreased progressively during pregnancy. There was an average decline of 1 cm in MUAC between weeks 12 and 38. Lower level of education and helminthic infections at first visit were associated with decreased adjusted rates of weight gain during the third trimester. High baseline MUAC, not contributing to household income, lower serum retinol and selenium concentrations, advanced clinical stage of HIV disease, and malaria infection were related to decreased rates of weight gain during the second trimester. Low baseline CD4 T-cell counts were related to a poorer pattern of weight gain throughout pregnancy. Prevention and treatment of parasitic infections and improvement of nutritional status are likely to enhance the pattern of gestational weight gain among HIV-infected women.

Birth weight: nature or nurture?

OBJECTIVE

To investigate the relative role of environmental and genetic factors in the determination of birth weight following ovum donation.

METHODS

Data from 62 cases of ovum donation were used to examine the relative influence of donor and recipient on birth weight.

RESULTS

The only discernible factors that significantly influenced birth weight were gestational age and recipient's weight. Donor weight, her own birth weight, and the birth weight of the donor's own children were not significantly correlated with the birth weight of the child following ovum donation.

CONCLUSIONS

It is concluded that the environment provided by the human mother is more important than her genetic contribution to birth weight.

Prenatal weight gain and the birthweight of triplets

The objective of this study was to evaluate the association between maternal factors, including rates of gestational weight gain before and after 24 weeks' gestation, and adequacy of intrauterine growth for gestational age at birth of triplets, as a mean Z-score of the triplet set. The study design was a retrospective, anonymous, pilot telephone survey of mothers of triplets and an historical cohort analysis of their prenatal weight gain records. The statistical analyses performed included multiple regression analysis to formulate a model for mean triplet Z-score (a measure of birthweight-for-gestational age) and analysis of variance to confirm and simplify the components of this model. Factors significant in the final model and their beta coefficients included weeks' gestation (-0.124, p < 0.0001), rate of gain before 24 weeks' gestation (0.606, p = 0.005), and induced conception (-0.404, p = 0.01). Rate of gain > or = 1.5 lbs/week before 24 weeks was significant in the analysis of variance (p = 0.009). Better intrauterine growth for gestational age is achieved in triplet gestations with maternal weight gains of > or = 1.5 lbs/week before 24 weeks' gestation.

The ideal twin pregnancy: patterns of weight gain, discordancy, and length of gestation

OBJECTIVE

Our purpose was to evaluate factors associated with the best intrauterine growth and lowest morbidity among twins ("ideal twin pregnancy").

STUDY DESIGN

A historic prospective study of 163 twin births was performed. Ten models were formulated with multiple regression and multivariate logistic regression.

RESULTS

In the models of birth weight, gestations of 28 to 36 and 39 to 41 weeks, black race, > or = 15% discordancy, and smoking were all significant negative factors. The pattern of early low weight gain (< 0.85 pounds per week before 24 weeks) and late low weight gain (< 1.0 pound per week after 24 weeks) was negatively associated with all eight models of intrauterine growth.

CONCLUSIONS

The best intrauterine growth and lowest morbidity is achieved earlier for twins than for singletons. Using length of stay and growth retardation criteria, nearly 70% of "ideal" twin pregnancies were between 35 and 38 weeks. In addition, poor weight gain and poor patterns of weight gain were associated with all measures of intrauterine growth and adverse pregnancy outcomes.

Sorrento studies of birthweight. Case for international reference data

There is little doubt that the mother's state of protein-energy nutrition affects birthweight and intra-uterine growth generally. The state of nutritional balance (i.e. intake minus expenditure) during the second trimester is probably more important than dietary intake alone. Not all mothers producing poorly grown babies are undernourished, however, so that preventative and therapeutic measures should be aimed only at those who require them. As with many other aspects of medical practice, unnecessary treatment can have adverse effects. The effect of maternal nutrition on intra-uterine growth is one more reason against adopting a plethora of local intra-uterine growth standards. Just as for postnatal growth, international reference data of weight (and other measurements) for gestational age should be established and accepted, against which the growth of all babies irrespective of geographical, ethnic or economic background, may be compared. These international reference data should allow for sex of the baby, parity and maternal height. They should not allow for smoking, weight, diet, physical activity. "FIGOFeGS" (Fédération Internationale de Gynécologie et d'Obstétrique Fetal Growth Standard) is proposed.

Amniotic fluid alkaline ribonuclease activity: an indicator of foetal growth retardation and anencephaly

Amniotic fluid alkaline ribonuclease (RNase) activity was measured in 55 normal and 29 neural tube defect pregnancies. The pregnancies which resulted in neural tube defects gave a mean value of 2,500 U/l with a SD of 600 compared with a mean activity of 1,600 U/l (SD 350) from the control normal pregnancies. The mean amniotic fluid RNase activity of 15 anencephalic pregnancies was 2,600 U/l (SD 600), compared with 1,600 U/l (SD 350), for 28 gestational age-matched controls. Highest RNase activities appear to be related to anencephaly.

Anthropometric and biochemical changes during pregnancy in Asian and European mothers having light for gestational age babies

An assessment of nutritional status using anthropometric and biochemical measurements was made during pregnancy in 8 European and 15 Asian women who produced babies which were light for gestational age. These results were compared with similar measurements in women of both races with normal or pathological pregnancies (hypertension or bleeding) who produced babies of normal size. European mothers of light for gestational age babies with one exception had pregnancies complicated by pathology. They were heavy and fat but apart from urinary peptide hydroxyproline (which was reduced), no other biochemical measurement was specifically associated with poor intrauterine growth. Asian mothers of light for gestational age babies mostly had pregnancies not complicated by obstetric pathology. They gained less weight and fat during the second trimester and during the third trimester, they had biochemical evidence of a poorer nutritional status. Some of the biochemical changes were also noted in pathological pregnancies even though the mothers gained weight and fat normally and had well grown babies.