1
|
Totland TH, Øvrebø B, Brantsæter AL, Holvik K, Bere ET, Torheim LE, Abel MH. Development and evaluation of an index assessing adherence to the Norwegian food-based dietary guidelines: the Norwegian Dietary Guideline Index (NDGI). BMC Nutr 2024; 10:94. [PMID: 38956729 PMCID: PMC11218056 DOI: 10.1186/s40795-024-00900-7] [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: 01/08/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Monitoring adherence to the Norwegian food-based dietary guidelines (FBDGs) could provide valuable insight into current and future diet-related health risks. This study aimed to develop and evaluate an index measuring adherence to the Norwegian FBDGs to be used as a compact tool in nutrition surveillance suitable for inclusion in large public health surveys. METHODS The Norwegian Dietary Guideline Index (NDGI) was designed to reflect adherence to the Norwegian FBDGs on a scale from 0-100, with a higher score indicating better adherence. Dietary intakes were assessed through 19 questions, reflecting 15 dietary components covered by the Norwegian FBDGs. The NDGI was applied and evaluated using nationally representative dietary data from the cross-sectional web-based Norwegian Public Health Survey which included 8,558 adults. RESULTS: The population-weighted NDGI score followed a nearly normal distribution with a mean of 65 (SD 11) and range 21-99. Mean scores varied with background factors known to be associated with adherence to a healthy diet; women scored higher than men (67 vs. 64) and the score increased with age, with higher educational attainment (high 69 vs. low 64) and with better self-perceived household economy (good 67 vs. restricted 62). The NDGI captured a variety of dietary patterns that contributed to a healthy diet consistent with the FBDGs. CONCLUSION The NDGI serve as a compact tool to assess and monitor adherence to the Norwegian FBDGs, to identify target groups for interventions, and to inform priorities in public health policies. The tool is flexible to adjustments and may be adaptable to use in other countries or settings with similar dietary guidelines.
Collapse
Affiliation(s)
- T H Totland
- Department of Physical Health and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Sustainable Diets, Norwegian Institute of Public Health, Oslo, Norway
| | - B Øvrebø
- Centre for Sustainable Diets, Norwegian Institute of Public Health, Oslo, Norway
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - A L Brantsæter
- Centre for Sustainable Diets, Norwegian Institute of Public Health, Oslo, Norway
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - K Holvik
- Department of Physical Health and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - E T Bere
- Department of Physical Health and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - L E Torheim
- Department of Physical Health and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Sustainable Diets, Norwegian Institute of Public Health, Oslo, Norway
| | - M H Abel
- Department of Physical Health and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.
- Centre for Sustainable Diets, Norwegian Institute of Public Health, Oslo, Norway.
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway.
| |
Collapse
|
2
|
Brito SM, Santana JDM, Pereira M, Santos DB, Oliveira AM. Post-partum weight retention in Northeastern Brazilian women: a prospective NISAMI cohort study. SAO PAULO MED J 2024; 142:e2023084. [PMID: 38597530 PMCID: PMC11000731 DOI: 10.1590/1516-3180.2023.0084.r1.010623] [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] [Received: 03/12/2023] [Revised: 04/21/2023] [Accepted: 06/01/2023] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Weight retention during the post-partum period is associated with excessive weight gain. OBJECTIVES To investigate factors associated with maternal weight retention at six months post-partum (PPWR). DESIGN AND SETTING A prospective cohort study was conducted with 127 women monitored using prenatal services. METHODS The outcome variable was represented by post-partum maternal weight retention and calculated as the difference between the mother's weight at sixth month post-partum and her pregestational weight. RESULTS The mean age of the pregnant women was 26.7 ± 5.25 years old, and the post-partum maternal weight retention was 46.5%. The proximal determinants showed a direct association with PPWR after adjusting for the distal and intermediate variables: excessive gestational weight gain (odds ratio [OR]:3.34; confidence interval [CI]:1.16-9.59), greater adhesion to dietary intake pattern 2 (composed of red meats and derivatives, eggs, industrialized foods, and coffee) (OR:2.70; CI:1.16-6.32), and the absence of exclusive maternal breastfeeding in the first month (OR:3.40; CI:1.27-9.12), as well as primiparity (OR:2.36; CI:1.00-5.55), an intermediate determinant. Insufficient weight gain in pregnancy was inversely associated with the outcome (OR:0.35; CI:0.31-0.93). CONCLUSIONS Among the hierarchical determinants, proximal factors were interrelated with maternal weight retention, indicating that excessive total weight gain, an inadequate dietary intake pattern, and the absence of exclusive maternal breastfeeding in the first month of life work as dampeners of the return to pre-gestational weight. Prepartum and post-partum care interventions can contribute to reducing excess weight in women.
Collapse
Affiliation(s)
- Sheila Monteiro Brito
- MSc, PhD. Adjunct Professor, Health Sciences Center, Universidade Federal do Recôncavo da Bahia (UFRB), Santo Antônio de Jesus (BA), Brazil
| | - Jerusa da Mota Santana
- MSc, PhD. Adjunct Professor, Health Sciences Center, Universidade Federal do Recôncavo da Bahia (UFRB), Santo Antônio de Jesus (BA), Brazil
| | - Marcos Pereira
- MSc, PhD. Adjunct Professor, Instituto de Saúde Coletiva (ISC), Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Djanilson Barbosa Santos
- MSc, PhD. Adjunct Professor, Health Sciences Center, Universidade Federal do Recôncavo da Bahia (UFRB), Santo Antônio de Jesus (BA), Brazil
| | - Ana Marlucia Oliveira
- MSc, PhD. Full Professor, School of Nutrition, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| |
Collapse
|
3
|
Svensson K, Gennings C, Hagenäs L, Wolk A, Håkansson N, Wikström S, Bornehag CG. Maternal nutrition during mid-pregnancy and children's body composition at 7 years of age in the SELMA study. Br J Nutr 2023; 130:1982-1992. [PMID: 37232113 PMCID: PMC10632724 DOI: 10.1017/s0007114523000983] [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: 11/22/2022] [Revised: 03/24/2023] [Accepted: 04/12/2023] [Indexed: 05/27/2023]
Abstract
Optimal nutrition during pregnancy is vital for both maternal and child health. Our objective was to explore if prenatal diet is associated with children's height and body fat. Nutrient intake was assessed through a FFQ from 808 pregnant women and summarised to a nutrition index, 'My Nutrition Index' (MNI). The association with children's height and body fat (bioimpedance) was assessed with linear regression models. Secondary analysis was performed with BMI, trunk fat and skinfolds. Overall, higher MNI score was associated with greater height (β = 0·47; (95 % CI 0·00, 0·94), among both sexes. Among boys, higher MNI was associated with 0·15 higher BMI z-scores, 0·12 body fat z-scores, 0·11 trunk fat z-scores, and larger triceps, and triceps + subscapular skinfolds (β = 0·05 and β = 0·06; on the log2 scale) (P-value < 0·05). Among girls, the opposite associations were found with 0·12 lower trunk fat z-scores, and smaller subscapular and suprailiac skinfolds (β = -0·07 and β = -0·10; on the log2 scale) (P-value < 0·05). For skinfold measures, this would represent a ± 1·0 millimetres difference. Unexpectedly, a prenatal diet in line with recommended nutrient intake was associated with higher measures of body fat for boys and opposite to girls at a pre-pubertal stage of development.
Collapse
Affiliation(s)
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Lars Hagenäs
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Alicja Wolk
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niclas Håkansson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sverre Wikström
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
- Centre for Clinical Research and Education, County Council of Värmland, Värmland County, Sweden
| | - Carl-Gustaf Bornehag
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| |
Collapse
|
4
|
Brown SD, Kiernan M, Ehrlich SF, Zhu Y, Hedderson MM, Daredia S, Feng J, Millman A, Quesenberry CP, Ferrara A. Intrinsic motivation for physical activity, healthy eating, and self-weighing in association with corresponding behaviors in early pregnancy. Prev Med Rep 2023; 36:102456. [PMID: 37854666 PMCID: PMC10580041 DOI: 10.1016/j.pmedr.2023.102456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/18/2023] [Accepted: 10/01/2023] [Indexed: 10/20/2023] Open
Abstract
Healthy lifestyle behaviors influence maternal cardiovascular health, but motivation for them in pregnancy is poorly understood. We examined whether intrinsic motivation (assessed on 5-point scales for each behavior) is associated with three lifestyle behaviors in early pregnancy: physical activity, by intensity level; healthy eating, quantified with the Alternate Healthy Eating Index for Pregnancy (AHEI-P); and weight self-monitoring, a standard weight management technique. Participants in the Northern California Pregnancy, Lifestyle and Environment Study (PETALS) population-based cohort completed validated surveys in early pregnancy (2017-18; N = 472; 22 % Asian, 6 % Black, 30 % Hispanic, 13 % multiracial, 30 % White). Cross-sectional data were analyzed in 2021-22. Overall, 40.7 % (n = 192) met United States national physical activity guidelines; the average AHEI-P score was 62.3 out of 130 (SD 11.4); and 36.9 % reported regular self-weighing (≥once/week; n = 174). In models adjusted for participant characteristics, 1-unit increases in intrinsic motivation were associated with increased likelihood of meeting physical activity guidelines (risk ratio [95 % CI]: 1.66 [1.48, 1.86], p < 0.0001); meeting sample-specific 75th percentiles for vigorous physical activity (1.70 [1.44, 1.99], p < 0.0001) and AHEI-P (1.75 [1.33, 2.31], p < 0.0001); and regular self-weighing (2.13 [1.92, 2.37], p < 0.0001). A 1-unit increase in intrinsic motivation lowered the risk of meeting the 75th percentile for sedentary behavior (0.79 [0.67, 0.92], p < 0.003). Intrinsic motivation was not associated with reaching 75th percentiles for total, light, or moderate activity. Intrinsic motivation is associated with physical activity, healthy eating, and self-weighing among diverse individuals in early pregnancy. Results can inform intervention design to promote maternal health via increased enjoyment of lifestyle behaviors.
Collapse
Affiliation(s)
- Susan D. Brown
- Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
- Center for Upstream Prevention of Adiposity and Diabetes Mellitus (UPSTREAM), Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Michaela Kiernan
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Monique M. Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
- Center for Upstream Prevention of Adiposity and Diabetes Mellitus (UPSTREAM), Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Saher Daredia
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Juanran Feng
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Andrea Millman
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Center for Upstream Prevention of Adiposity and Diabetes Mellitus (UPSTREAM), Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| |
Collapse
|
5
|
Food security and diet quality in a racially diverse cohort of postpartum women in the USA. Br J Nutr 2023; 129:503-512. [PMID: 35510523 PMCID: PMC9876811 DOI: 10.1017/s0007114522001143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Food insecurity has been associated with poor diet, but few studies focused on the postpartum period - an important time for women's health. We examined associations between food security and diet quality in postpartum women and assessed whether participation in federal food assistance programmes modified this potential relation. Using longitudinal data, we analysed the association between food security at 3 months postpartum and a modified Alternate Healthy Eating Index-2010 (AHEI) at 6 months postpartum (excluding alcohol). We conducted multivariable linear regressions examining associations between food security and AHEI. We assessed two food assistance programmes as potential effect modifiers. The sample included 363 postpartum women from the Nurture study, located in the Southeastern USA (2013-2017). Among women, 64·4 % were Black and 45·7 % had a high school diploma or less. We found no evidence of an interaction between food security and two federal food assistance programmes. In adjusted models, marginal, low and very low food security were not associated with AHEI. However, low (β: -0·64; 95 % CI -1·15, -0·13; P = 0·01) and very low (β: -0·57; 95 % CI -1·02, -0·13; P = 0·01) food security were associated with greater trans fat intake. Food security status was not associated with overall diet quality but was associated with higher trans fat (low and very low) and more moderate alcohol (marginal) intake. Future studies should assess the consistency and generalisability of these findings.
Collapse
|
6
|
Brantsæter AL, Garthus-Niegel S, Brandlistuen RE, Caspersen IH, Meltzer HM, Abel MH. Mild-to-moderate iodine deficiency and symptoms of emotional distress and depression in pregnancy and six months postpartum - Results from a large pregnancy cohort. J Affect Disord 2022; 318:347-356. [PMID: 36096375 DOI: 10.1016/j.jad.2022.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The relationship between iodine intake and depression is unknown. The aim of the present study was to investigate whether iodine intake was associated with symptoms of perinatal emotional distress and depression in a mild- to moderately iodine deficient population. METHODS The study population comprised 67,812 women with 77,927 pregnancies participating in the Norwegian Mother, Father and Child Cohort Study. Self-reported emotional distress and depressive symptoms were reported in pregnancy and at six months postpartum. Iodine intake was assessed by a food frequency questionnaire in mid-pregnancy. Urinary iodine concentration (UIC) was available for 2792 pregnancies. RESULTS The median iodine intake from food was 121 μg/day and the median UIC was 68 μg/L. The prevalence of high scores for emotional distress was 6.6 % in pregnancy and 5.8 % six months postpartum, and for high scores on postpartum depression it was 10.3 %. In non-users of iodine supplements (63 %), a low maternal iodine intake from food (lower than ~100-150 μg/day) was associated with increased risk of high scores of emotional distress and depression both in pregnancy and six months postpartum (p < 0.001). Iodine supplement use was associated with increased risk of high scores of emotional distress in pregnancy compared to no supplement use or use of supplements without iodine. LIMITATIONS Observational design, self-report information, and short scales to assess symptoms of emotional distress and depression. CONCLUSION A low habitual iodine intake was associated with increased prevalence of perinatal emotional distress and depression. The potential non-beneficial effect of iodine supplements may have biological explanations. More studies are needed.
Collapse
Affiliation(s)
- Anne Lise Brantsæter
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Susan Garthus-Niegel
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway; Institute for Systems Medicine (ISM) and Faculty of Medicine, Medical School Hamburg, Hamburg, Germany; Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | | | | | - Helle Margrete Meltzer
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Marianne Hope Abel
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
7
|
Ferreira LB, Lobo CV, Miranda AEDS, Carvalho BDC, Santos LCD. Dietary Patterns during Pregnancy and Gestational Weight Gain: A Systematic Review. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:540-547. [PMID: 35483873 PMCID: PMC9948295 DOI: 10.1055/s-0042-1744290] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The present systematic review (PROSPERO: CRD42020148630) hypothesizes the association of excessive weight gain during pregnancy with dietary patterns composed of ultraprocessed foods. Thus, the objective was to investigate the association between dietary patterns after analysis and weight gain during pregnancy. The search for articles was performed in nine databases. Two reviewers selected the articles in the databases and extracted from them the data used in the review. Two scales were used to evaluate the quality of the selected studies: New Castle-Ottawa Quality Assessment for cohort-based studies and Appraisal tool for Cross-Sectional Studies (AXIS) for cross-sectional-based studies. In total, 11 studies were identified with sample size variation (n = 173-5,733). Women presenting more adherence to healthy and traditional patterns (fruits, vegetables, salads, nuts, and dairy) recorded less excessive gestational weight gain (GWG). Higher intake of mixed patterns and western patterns rich in ultraprocessed foods were associated with a higher prevalence of excessive GWG (24.48-55.20%). Gestational dietary patterns a posteriori-derived that have presented ultraprocessed components rich in fat and sugars presented association with high GWG; healthy and traditional dietary patterns were related to better mother-child health conditions, such as adequate GWG.
Collapse
Affiliation(s)
- Larissa Bueno Ferreira
- Child and Adolescent Health, Federal University of Minas Gerais, Faculdade de Medicina/UFMG, Belo Horizonte, MG, Brazil
| | - Cecília Viana Lobo
- Nutrition Departament, Federal University of Minas Gerais, Escola de Enfermagem/UFMG, Belo Horizonte, MG, Brazil
| | | | - Brenda da Cunha Carvalho
- Nutrition Departament, Federal University of Minas Gerais, Escola de Enfermagem/UFMG, Belo Horizonte, MG, Brazil
| | - Luana Caroline Dos Santos
- Nutrition Departament, Federal University of Minas Gerais, Escola de Enfermagem/UFMG, Belo Horizonte, MG, Brazil
| |
Collapse
|
8
|
Dietary Patterns During Pregnancy and Their Association with Gestational Weight Gain and Anthropometric Measurements at Birth. Matern Child Health J 2022; 26:1464-1472. [PMID: 35195821 DOI: 10.1007/s10995-022-03392-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Dietary patterns can influence maternal and child health outcomes. The study aims to characterize dietary patterns during pregnancy as well as to identify their associations with gestational weight gain (GWG) and anthropometric measurements at birth. METHODS A minimum sample size of 95 nursing mothers was estimated for this work. Socioeconomic, anthropometric, physical activity, obstetric and food consumption (food frequency questionnaire) data was collected from mothers and their newborns in immediate postpartum (n = 260) at the maternity hospital. Maternal pregestational weight and GWG were self-reported and the neonatal data was obtained from their records. The patterns were derived posteriori by Principal Component Analysis (PCA). Multinomial Logistic Regression and Poisson Regression with Robust Variance were applied. FINDINGS Four dietary patterns were derived: "pattern 1", characterized by the consumption of meat and eggs, processed meat, vegetables and olive oil; "pattern 2", consisting of sweets, snacks and cookies; "pattern 3", which includes cereals and breads, coffee and tea, and processed fats; and "pattern 4", characterized by soft drinks, tubers and instant noodles. Together, the dietary patterns account for 49.16% of the total variance for food intake. Higher adherence to "pattern 3" was associated with inadequate birth weight (low and excessive birth weight); while greater adherence to "pattern 2" was associated with lower chances of inadequate GWG. CONCLUSION The dietary patterns presented mixed composition and predominance of ultra-processed foods. They were associated with the investigated outcomes, denoting the importance of strategies to promote healthy eating habits during pregnancy in order to avoid possible complications.
Collapse
|
9
|
Simmons K, Meloncelli N, Kearney L, Maher J. Low vegetable intake in pregnancy and associated maternal factors: A scoping review. Nutr Res 2022; 99:78-97. [DOI: 10.1016/j.nutres.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 12/16/2022]
|
10
|
Diet quality of Norwegian children at 3 and 7 years: changes, predictors and longitudinal association with weight. Int J Obes (Lond) 2022; 46:10-20. [PMID: 34462565 DOI: 10.1038/s41366-021-00951-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Poor diet quality in early life can have long-term health effects, but the evidence is largely from cross-sectional studies. Our objective was to examine diet quality of Norwegian children by applying a-priori diet quality indices, identify early life determinants and examine prospective associations with overweight. SUBJECTS/METHODS We included 34,074 preschoolers (3-year-olds) and 18,350 school-aged children (7-years-olds) from the prospective, population-based Norwegian Mother, Father and Child Cohort Study. Diet quality was assessed as (i) adherence to a Mediterranean diet, estimated by the food frequency-based Mediterranean Diet Score (fMDS, score range: 0-6) and (ii) by the diet quality index (DQI, score range: -33% to 100%), reflecting compliance to food-based dietary guidelines. In multivariate analyses we explored perinatal and childhood characteristics as potential determinants of diet quality. We used logistic regression to examine the associations between diet quality at 3 years and BMI status at 8 years, adjusting for relevant confounders and diet quality at 7 years. RESULTS One in three children had high MD adherence at 3 and 8 years, and DQI (mean 60%) at 3 and 7 years was strongly correlated (r = 0.48, p < 0.001). Short breastfeeding duration, physical activity and sleep duration and long screentime at 18 months were associated with 2-3% lower DQI at 3 years. At both ages, maternal diet quality was the strongest prospective predictor of DQI (beta = 5%, 95% CI = 4.7, 5.2 and beta = 3.1%, 95% CI = 2.8, 3.4), and screentime was the strongest cross-sectional predictor (beta = -5.2%, 95% CI = -5.9, -4.5 and beta = -4.1%, 95% CI = -5.0, -3.2). High DQI score at 3 years, but not MD adherence, was associated with a lower risk for overweight (including obesity) at 8 years, compared to low DQI (lower tertile) (adjusted OR = 0.77, 95% CI = 0.62, 0.96). CONCLUSIONS Our study provides evidences that high diet quality in early childhood may reduce the risk for overweight in later childhood, independent of the current dietary behaviors.
Collapse
|
11
|
Mazloomy Mahmoodabad SS, Molavi S, Nadjarzadeh A, Mardanian F, Riahi R, Ardian N, Salehi K, Goodarzi-Khoigani M. Prevention of Postpartum Weight Retention during One Year after Childbirth by Prenatal Nutrition Education: A Randomized Controlled Trial. Int J Prev Med 2021; 12:117. [PMID: 34760128 PMCID: PMC8551776 DOI: 10.4103/ijpvm.ijpvm_37_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 10/27/2020] [Indexed: 11/09/2022] Open
Abstract
Background: It seems that 14–25% of the women retain at least 5 kg weight from 6 to 12 months after delivery and gestational weight gain is the most important reason of weight retention. Thus, we assessed the effect of prenatal nutrition education program on the retained weights at 8, 26, and 52 weeks after delivery in primiparous women. Methods: This randomized controlled trial was implemented among 192 primiparous pregnant women in five hospitals, fifteen community health centers, and fifteen private offices. Self-developed questionnaire was used to collect the participants’ characteristics. A 72-hr dietary recall was applied to evaluate the food intakes before and after intervention. The pregnancy physical activity questionnaire determined the physical activity score. The participants’ weights at 8, 26, and 52 weeks after delivery were measured by a digital beam. Results: The means of postpartum weight decreased in both groups, but nutrition education was significantly effective on reducing postpartum weight in intervention group (β = -3.112, SE =. 7384, P < 0.001). Also, the women in intervention group had less retained weight compared to control during the follow-up (β = -3.35, SE = 0.75, p < 0.001). The proportion of pregnant women in intervention group who reached to their pre-gravid weight was more than control during the follow-up (OR = 2.86, 95% CI: 1.62, 5.07). Conclusions: Nutrition education considering an individualized calorie-appropriate diet for each pregnant woman and based on the national guideline is effective on postpartum weight retention and reaching to pre-gravid weight.
Collapse
Affiliation(s)
- Seyed Saeed Mazloomy Mahmoodabad
- Department of Health Education and Promotion, Social Determinants of Health Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sajedeh Molavi
- Msc in Counselling Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azadeh Nadjarzadeh
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Farahnaz Mardanian
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Riahi
- Ph.D, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nahid Ardian
- Social Determinants of Health Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Kobra Salehi
- Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Science, Isfahan, Iran
| | - Masoomeh Goodarzi-Khoigani
- Ph.D, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
12
|
Borge TC, Biele G, Papadopoulou E, Andersen LF, Jacka F, Eggesbø M, Caspersen IH, Aase H, Meltzer HM, Brantsæter AL. The associations between maternal and child diet quality and child ADHD - findings from a large Norwegian pregnancy cohort study. BMC Psychiatry 2021; 21:139. [PMID: 33685413 PMCID: PMC7941947 DOI: 10.1186/s12888-021-03130-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder. Effective long-term treatment options are limited, which warrants increased focus on potential modifiable risk factors. The aim of this study was to investigate associations between maternal diet quality during pregnancy and child diet quality and child ADHD symptoms and ADHD diagnosis. METHODS This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa). We assessed maternal diet quality with the Prenatal Diet Quality Index (PDQI) and Ultra-Processed Food Index (UPFI) around mid-gestation, and child diet quality using the Diet Quality Index (CDQI) at 3 years. ADHD symptoms were assessed at child age 8 years using the Parent Rating Scale for Disruptive Behaviour Disorders. ADHD diagnoses were retrieved from the Norwegian Patient Registry. RESULTS In total, 77,768 mother-child pairs were eligible for studying ADHD diagnoses and 37,787 for ADHD symptoms. Means (SD) for the PDQI, UPFI and CDQI were 83.1 (9.3), 31.8 (9.7) and 60.3 (10.6), respectively. Mean (SD) ADHD symptom score was 8.4 (7.1) and ADHD diagnosis prevalence was 2.9% (male to female ratio 2.6:1). For one SD increase in maternal diet index scores, we saw a change in mean (percent) ADHD symptom score of - 0.28 (- 3.3%) (CI: - 0.41, - 0.14 (- 4.8, - 1.6%)) for PDQI scores and 0.25 (+ 3.0%) (CI: 0.13, 0.38 (1.5, 4.5%)) for UPFI scores. A one SD increase in PDQI score was associated with a relative risk of ADHD diagnosis of 0.87 (CI: 0.79, 0.97). We found no reliable associations with either outcomes for the CDQI, and no reliable change in risk of ADHD diagnosis for the UPFI. CONCLUSIONS We provide evidence that overall maternal diet quality during pregnancy is associated with a small decrease in ADHD symptom score at 8 years and lower risk for ADHD diagnosis, with more robust findings for the latter outcome. Consumption of ultra-processed foods was only associated with increased ADHD symptom score of similar magnitude as for overall maternal diet quality, and we found no associations between child diet quality and either outcome. No causal inferences should be made based on these results, due to potential unmeasured confounding.
Collapse
Affiliation(s)
- Tiril Cecilie Borge
- Department of Child Health and Development, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213, Oslo, Norway.
| | - Guido Biele
- Department of Child Health and Development, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213, Oslo, Norway
| | - Eleni Papadopoulou
- Department of Environmental Health, Section of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213, Oslo, Norway
| | - Lene Frost Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O. Box 1046, Blindern, 0317, Oslo, Norway
| | - Felice Jacka
- Food & Mood Centre, IMPACT, Deakin University, Geelong, VIC, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Black Dog Institute, Randwick, NSW, Australia
- James Cook University, Townsville, Qld, Australia
| | - Merete Eggesbø
- Department of Environmental Health, Section of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213, Oslo, Norway
| | - Ida Henriette Caspersen
- Department of Environmental Health, Section of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213, Oslo, Norway
| | - Heidi Aase
- Department of Child Health and Development, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213, Oslo, Norway
| | - Helle Margrete Meltzer
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213, Oslo, Norway
| | - Anne Lise Brantsæter
- Department of Environmental Health, Section of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213, Oslo, Norway
| |
Collapse
|
13
|
Maternal Diet Influences Fetal Growth but Not Fetal Kidney Volume in an Australian Indigenous Pregnancy Cohort. Nutrients 2021; 13:nu13020569. [PMID: 33572217 PMCID: PMC7914647 DOI: 10.3390/nu13020569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/15/2022] Open
Abstract
Suboptimal nutrition during pregnancy is recognised as a significant modifiable determinant in the development of chronic disease in offspring in later life. The current study aimed: (i) to assess the dietary intakes of pregnant Indigenous Australian women against national recommendations and (ii) to investigate the associations between maternal nutrition during pregnancy and the growth of the offspring, including kidney development in late gestation in the Gomeroi gaaynggal cohort (n = 103). Maternal dietary intake in the third trimester was assessed using the Australian Eating Survey Food Frequency Questionnaire. Estimated fetal weight (EFW) and kidney size were obtained by ultrasound. Birth weight was retrieved from hospital birth records. Of the five key nutrients for optimal reproductive health (folate, iron, calcium, zinc and fibre), the nutrients with the highest percentage of pregnant women achieving the nutrient reference values (NRVs) were zinc (75.7%) and folate (57.3%), whereas iron was the lowest. Only four people achieved all NRVs (folate, iron, calcium, zinc and fibre) important in pregnancy. Sodium and saturated fat intake exceeded recommended levels and diet quality was low, with a median score of 28 out of 73 points. After adjusting for smoking and pre-pregnancy body mass index, only maternal intake of retinol equivalents and the proportion of energy from nutrient-dense or energy-dense, nutrient-poor (EDNP) foods were associated with fetal growth. EFW decreased by 0.13 g and birth weight decreased by 0.24 g for every µg increase in maternal dietary retinol intake. Interestingly, EFW, but not actual birth weight, was positively associated with percentage energy from nutrient dense foods and negatively associated with percentage energy from EDNP foods. Dietary supplement usage was associated with increased birthweight, most significantly iron and folate supplementation. Current dietary intakes of pregnant Australian women from this cohort do not align with national guidelines. Furthermore, current findings show that maternal retinol intake and diet composition during pregnancy can influence fetal growth, but not fetal kidney growth in late gestation. Strategies that aim to support and optimise nutrient intakes of Indigenous pregnant women are urgently needed. Future studies with long-term follow-up of the children in the current cohort to assess renal damage and blood pressure are imperative.
Collapse
|
14
|
Kadawathagedara M, Ahluwalia N, Dufourg MN, Forhan A, Charles MA, Lioret S, de Lauzon-Guillain B. Diet during pregnancy: Influence of social characteristics and migration in the ELFE cohort. MATERNAL AND CHILD NUTRITION 2021; 17:e13140. [PMID: 33528115 PMCID: PMC8189248 DOI: 10.1111/mcn.13140] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/15/2020] [Accepted: 01/04/2021] [Indexed: 11/26/2022]
Abstract
Better adherence to dietary guidelines during pregnancy is supposed to result in healthier perinatal outcomes. We aim to characterize the diets of pregnant women by hypothesis‐driven and exploratory approaches and describe potential social determinants. Analyses included 12 048 mothers from the French nationwide ELFE birth cohort. Dietary intake over the last three months of the pregnancy was assessed by a food frequency questionnaire. Two hypothesis‐driven scores (the Diet Quality score, based on benchmarks derived from the National Health and Nutrition Program Guidelines, and the PANDiet score, based on nutrient intake) were calculated. Exploratory dietary patterns were also identified by principal component analysis. Multiple linear regressions were used to assess associations of maternal social characteristics with dietary patterns, accounting for the possible effect modification by their migration status. Five dietary patterns were identified: the Western, Balanced, Bread and toppings, Processed products, and Milk and breakfast cereals. Younger maternal age, single motherhood, unemployment and the presence of older children in the household were related to a suboptimal diet during pregnancy. The less acculturated the women were, the healthier and less processed their diets were, independent of their socio‐economic position. Several social determinants of the quality of women's diets were however moderated by their migration status. These findings shed light on the relations between indicators of social vulnerability, such as single motherhood and unemployment, and poorer diet quality. Given the reduced diet quality that accompanies the acculturation process, it is of paramount importance to identify the specific factors or obstacles that affect migrant women in maintaining their diet quality advantage over the majority population.
Collapse
Affiliation(s)
| | | | | | - Anne Forhan
- Université de Paris, CRESS, INSERM, INRAE, Paris, France
| | - Marie Aline Charles
- Université de Paris, CRESS, INSERM, INRAE, Paris, France.,INED, INSERM, Joint Unit Elfe, Paris, France
| | | | | |
Collapse
|
15
|
Boutté AK, Turner-McGrievy GM, Eberth JM, Wilcox S, Liu J, Kaczynski AT. Healthy Food Density is Not Associated With Diet Quality Among Pregnant Women With Overweight/Obesity in South Carolina. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:120-129. [PMID: 33573765 PMCID: PMC7888703 DOI: 10.1016/j.jneb.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/17/2020] [Accepted: 11/22/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Examine the association and moderating effect of residential location (urban/rural) on the relationship between neighborhood healthy food density and diet quality. DESIGN Cross-sectional analysis of baseline data from the Health in Pregnancy and Postpartum study, a randomized trial designed to prevent excessive gestational weight gain. PARTICIPANTS Pregnant women in South Carolina with prepregnancy overweight/obesity (n = 228). MAIN OUTCOME MEASURES Healthy Eating Index-2015 (HEI) was used to measure diet quality from 2 24-hour dietary recalls. The HEI total scores and 11 binary HEI components (those that met the standard for maximum component score vs those that did not) were calculated as dependent variables. ANALYSIS Multiple linear and logistic regression models were used to examine the association between healthy food density and HEI total scores and meeting the standards for maximum component scores. Healthy food density × residential location tested for moderation. P < 0.05 indicated significance. RESULTS Participants' diet quality was suboptimal (mean, 52.0; SD, 11.7; range, 27-85). Healthy food density was not significantly related to HEI total scores or components, and residential location was not a moderator. CONCLUSIONS AND IMPLICATIONS Diet quality was suboptimal, and there was no relationship between healthy food density and diet quality among Health in Pregnancy and Postpartum study participants. These data support examining behavioral factors that could influence diet quality.
Collapse
Affiliation(s)
- Alycia K Boutté
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC; Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC.
| | - Gabrielle M Turner-McGrievy
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC; South Carolina Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Sara Wilcox
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC; Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Andrew T Kaczynski
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC; Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC
| |
Collapse
|
16
|
Abdollahi S, Soltani S, de Souza RJ, Forbes SC, Toupchian O, Salehi-Abargouei A. Associations between Maternal Dietary Patterns and Perinatal Outcomes: A Systematic Review and Meta-Analysis of Cohort Studies. Adv Nutr 2021; 12:1332-1352. [PMID: 33508080 PMCID: PMC8321866 DOI: 10.1093/advances/nmaa156] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/10/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023] Open
Abstract
The aim was to systematically review and meta-analyze prospective cohort studies investigating the relation between maternal dietary patterns during pregnancy with pregnancy and birth outcomes. PubMed, Scopus, and ISI Web of Science were searched from inception until October 2019 for eligible studies. Studies reporting relative risk, ORs, or incidences (for binary data) or means ± SDs or B-coefficients (for continuous outcomes) comparing the highest and lowest adherence with maternal dietary patterns were included. Dietary patterns were categorized as "healthy," "unhealthy," or "mixed." No language restrictions were applied. Study-specific effect sizes with SEs for outcomes of interest were pooled using a random-effects model. Quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Sixty-six relevant publications were included. A higher maternal adherence to a healthy diet was associated with a reduced risk of gestational hypertension (14%, P < 0.001), maternal depression (40%, P = 0.004), low birth weight (28%, P = 0.001), preterm birth (56%, P < 0.001), higher gestational weight gain (Hedges' g: 0.15; P = 0.01), and birth weight (Hedges' g: 0.19; P = 0.007). Higher maternal adherence to an unhealthy or a mixed diet was associated with higher odds of gestational hypertension (23%, P < 0.001 for unhealthy, and 8%, P = 0.01 for mixed diet). In stratified analyses, a higher healthy eating index was associated with reduced odds of being large based on gestational age (31%, P = 0.02) and a higher head circumference at birth (0.23 cm, P = 0.02). The Mediterranean and "prudent" dietary patterns were related to lower odds of being small based on gestational age (46%, P = 0.04) and preterm birth (52%, P = 0.03), respectively. The overall GRADE quality of the evidence for most associations was low or very low, indicating that future high-quality research is warranted. This study was registered at http://www.crd.york.ac.uk/PROSPERO as CRD42018089756.
Collapse
Affiliation(s)
- Shima Abdollahi
- School of Public Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Sepideh Soltani
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Scott C Forbes
- Department of Physical Education, Faculty of Education, Brandon University, Brandon, Manitoba, Canada
| | - Omid Toupchian
- School of Public Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | | |
Collapse
|
17
|
Mwanukuzi C, Nyamhanga T. "It is painful and unpleasant": experiences of sexual violence among married adolescent girls in Shinyanga, Tanzania. Reprod Health 2021; 18:1. [PMID: 33388066 PMCID: PMC7777290 DOI: 10.1186/s12978-020-01058-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/15/2020] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND While the situation of married adolescent girls in Tanzania is increasingly documented, empirical evidence concerning the ways in which child marriage impacts girls' and young women's sexual lives is limited. Specifically, little is known about lived experiences on sexual violence among married adolescent girls in Tanzania. METHODS This article reports on a qualitative study using a phenomenological approach to describe married girls' experiences of sexual violence in the Shinyanga Region, an area with the highest prevalence (59%) of child marriage in Tanzania. Data were collected from 20 married girls aged 12-17 years. RESULTS The study identified four analytical themes regarding the experience of sexual violence, namely: forced sex; rape; struggling against unpleasant and painful sex; and inculcation of the culture of tolerance of sexual violence. CONCLUSION The study highlights the voices of married adolescents on an important but a neglected topic of relevance to Tanzania's public health. Findings from this study suggest that married adolescent girls suffer sexual coercion in silence. Child marriage is a major public health problem in sub-Saharan Africa in general and in Tanzania in particular. However, there is limited research on the ways in which it impacts sexual lives of married adolescent girls. In response to the inadequacy of information, married adolescent girls in Shinyanga Region of Tanzania were requested to voice out their experiences of sexual violence. Three themes were identified from the responses, namely: forced sex; rape, struggling against unpleasant and painful sex; and the inculcation of the culture of tolerance of sexual violence. In conclusion, this study has echoed voices of married adolescent girls on the sexual troubles they experience. Their main concern is that they suffer sexual coercion in silence, which increases their risk of acquiring sexually transmitted infections and/or unwanted pregnancies. Recommendations for sexual violence prevention strategies are discussed.
Collapse
Affiliation(s)
| | - Tumaini Nyamhanga
- Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| |
Collapse
|
18
|
Associations of maternal diet quality with weight gain during pregnancy and obesity at three-year postpartum in Jakarta. PLoS One 2020; 15:e0244449. [PMID: 33382776 PMCID: PMC7775051 DOI: 10.1371/journal.pone.0244449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 12/10/2020] [Indexed: 11/24/2022] Open
Abstract
Dietary changes during pregnancy (DP) and post-partum are essential for women’s nutrition status and the health of their offspring. We compared the diet quality DP and at 3-year post-partum (3YPP) and assessed the relationship between maternal diet quality and nutritional status using a prospective cohort design among women in East Jakarta. In total, 107 women were recruited from the study in 2014 and followed up at 3YPP in 2018. The mid-upper arm circumference (MUAC), weight, and height were evaluated. Food consumption data were collected from repeated 24-h recalls. The validated US Diet Quality Index-Pregnancy (DQI-P) scores with eight components were calculated using the food consumption data and compared between DP and 3YPP. Associations of the DQI-P score with the MUAC and weight gain DP and body mass index (BMI) at 3YPP were analyzed using multivariable linear and logistic regression. The median of the DQI-P score DP was significantly higher than at 3YPP [35 (27; 42) versus 27 (19; 30); p-value <0.001, respectively]. The higher DQI-P score was associated with increased weight gain DP of 3.3 kg (adjusted β = 3.30, 95% confidence interval = 1.06–5.54) after adjusting for the mother's age and household income. The DQI-P score was not associated with an increased risk of chronic energy deficiency DP and overweight–obesity at 3YPP. Thus, the diet adequacy was associated with weight gain DP but did not affect the MUAC DP and BMI at 3YPP. The DQI-P score DP was slightly better than the diet at 3YPP; however, the overall diet quality was inadequate. In conclusion, a higher DQI-P score was associated with increased weight gain DP of 3.3 kg but was not associated with other nutritional status indices in DP and 3YPP. Innovative dietary quality improvement programs are required to reduce malnutrition risk in pregnant and reproductive-age women.
Collapse
|
19
|
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.
Collapse
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
| | | | | |
Collapse
|
20
|
Grammatikopoulou MG, Theodoridis X, Gkiouras K, Lampropoulou M, Petalidou A, Patelida M, Tsirou E, Papoutsakis C, Goulis DG. Methodological quality of clinical practice guidelines for nutrition and weight gain during pregnancy: a systematic review. Nutr Rev 2020; 78:546-562. [PMID: 31755916 DOI: 10.1093/nutrit/nuz065] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
CONTEXT Ensuring a healthy pregnancy and achieving optimal gestational weight gain (GWG) are important for maternal and child health. Nevertheless, the nutritional advice provided during pregnancy is often conflicting, suggesting limited adherence to clinical practice guidelines (CPGs). OBJECTIVE The aim of this review was to identify all CPGs on maternal nutrition and GWG and to critically appraise their methodological quality. DATA SOURCES The MEDLINE/PubMed, Cochrane, Guidelines International Network, and BMJ Best Practice databases, along with gray literature, were searched from inception until February 2019 for CPGs and consensus, position, and practice papers. STUDY SELECTION Clinical practice guidelines published in English and containing advice on maternal nutrition or GWG were eligible. DATA EXTRACTION Two authors independently extracted data on items pertaining to maternal nutrition or GWG, and CPGs were appraised using the AGREE II instrument. RESULTS Twenty-two CPGs were included. All scored adequately in the "scope" domain, but most were considered inadequate with regard to stakeholder involvement, rigor of development, applicability, and editorial independence. Many CPGs lacked patient or dietician involvement, and more than half did not disclose funding sources or conflicts of interest. Guidance on GWG was based mostly on Institute of Medicine thresholds, while nutrition recommendations appeared scattered and heterogeneous. CONCLUSION Despite the importance of maternal nutrition and the plethora of advising bodies publishing relevant guidance, there is room for substantial improvement in terms of development standards and content of nutritional recommendations. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42019120898.
Collapse
Affiliation(s)
- Maria G Grammatikopoulou
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, Thessaloniki, Greece.,Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Xenophon Theodoridis
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Medical School, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Konstantinos Gkiouras
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Medical School, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Maria Lampropoulou
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, Thessaloniki, Greece.,Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Fourth Department of Pediatrics, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Arianna Petalidou
- Medical School, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Maria Patelida
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, Thessaloniki, Greece
| | - Efrosini Tsirou
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
21
|
Quality of periconceptional dietary intake and maternal and neonatal outcomes. Am J Obstet Gynecol 2020; 223:121.e1-121.e8. [PMID: 31981510 DOI: 10.1016/j.ajog.2020.01.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Periconceptional diet quality is commonly suboptimal and sociodemographic disparities in diet quality exist. However, it is unknown whether individual periconceptional diet quality is associated with obstetric outcomes. OBJECTIVE Our objective was to assess differences in maternal and neonatal outcomes according to maternal periconceptional diet quality. STUDY DESIGN This is a secondary analysis of a large, multicenter prospective cohort study of 10,038 nulliparous women receiving obstetrical care at 8 United States centers. Women underwent 3 antenatal study visits and had detailed maternal and neonatal data abstracted by trained research personnel. In the first trimester (between 6 and 13 weeks), women completed the modified Block 2005 Food Frequency Questionnaire, a semiquantitative assessment of usual dietary intake for the 3 months around conception. Responses were scored using the Healthy Eating Index-2010, which assesses adherence to the 2010 Dietary Guidelines for Americans. Higher scores on the Healthy Eating Index represent better adherence. Healthy Eating Index scores were analyzed by quartile; quartile 4 represents the highest dietary quality. Bivariable and multivariable analyses were performed to assess associations between diet quality and outcomes. A sensitivity analysis in which markers of socioeconomic status were included in the multivariable Poisson regression models was performed. RESULTS In the cohort of 8259 women with Healthy Eating Index data, the mean Healthy Eating Index score was 63 (±13) of 100. Women with the lowest quartile Healthy Eating Index scores were more likely to be younger, non-Hispanic black and Hispanic, publicly insured, low income, and tobacco users. They were more likely to have comorbidities (obesity, chronic hypertension, pregestational diabetes, mental health disorders), a higher prepregnancy body mass index, and less education. Women with lowest quartile scores experienced less frequent major perineal lacerations and more frequent postpartum hemorrhage requiring transfusion and hypertensive disorders of pregnancy, which persisted on multivariable analyses (controlling for age, body mass index, tobacco use, chronic hypertension, pregestational diabetes mellitus, and mental health disorders) comparing women in each quartile with quartile 4. Additionally, women in quartiles 1 and 2 experienced greater adjusted relative risk of cesarean delivery compared with women in quartile 4. Neonatal outcomes also differed by dietary quartile, with women in the lowest Healthy Eating Index quartile experiencing greater adjusted relative risk of preterm birth, neonatal intensive care unit admission, small for gestational age infant, and low birthweight, and lower risk of macrosomia; all neonatal findings also persisted in multivariable analyses. The sensitivity analysis with inclusion of markers of socioeconomic status (race/ethnicity, insurance status, marital status) in the multivariable models supported these findings. CONCLUSION Periconceptional diet quality among women in the United States is poor. Poorer periconceptional dietary quality is associated with adverse maternal and neonatal outcomes, even after controlling for potential comorbidities and body mass index, suggesting periconceptional diet may be an important social or biological determinant of health underlying existing health disparities.
Collapse
|
22
|
Bick D, Taylor C, Bhavnani V, Healey A, Seed P, Roberts S, Zasada M, Avery A, Craig V, Khazaezadah N, McMullen S, O’Connor S, Oki B, Oteng-Ntim E, Poston L, Ussher M. Lifestyle information and access to a commercial weight management group to promote maternal postnatal weight management and positive lifestyle behaviour: the SWAN feasibility RCT. PUBLIC HEALTH RESEARCH 2020. [DOI: 10.3310/phr08090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Increasing numbers of UK women have overweight or obese body mass index scores when they become pregnant, or gain excessive weight in pregnancy, increasing their risk of adverse outcomes. Failure to manage postnatal weight is linked to smoking, non-healthy dietary choices, lack of regular exercise and poorer longer-term health. Women living in areas of higher social deprivation are more likely to experience weight management problems postnatally.
Objectives
The objectives were to assess the feasibility of conducting a definitive randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of lifestyle information and access to a commercial weight management group focusing on self-monitoring, goal-setting and motivation to achieve dietary change commencing 8–16 weeks postnatally to achieve and maintain weight management and positive lifestyle behaviour.
Design
The design was a randomised two-arm feasibility trial with a nested mixed-methods process evaluation.
Setting
The setting was a single centre in an inner city setting in the south of England.
Participants
Participants were women with body mass index scores of > 25 kg/m2 at antenatal ‘booking’ and women with normal body mass index scores (18.0–24.9 kg/m2) at antenatal booking who developed excessive gestational weight gain as assessed at 36 weeks’ gestation.
Main outcome measures
Recruitment, retention, acceptability of trial processes and identification of relevant economic data were the feasibility objectives. The proposed primary outcome was difference between groups in weight at 12 months postnatally, expressed as percentage weight change and weight loss from antenatal booking. Other proposed outcomes included assessment of diet, physical activity, smoking, alcohol consumption, body image, maternal esteem, mental health, infant feeding and NHS costs.
Results
Most objectives were achieved. A total of 193 women were recruited, 98 allocated to the intervention arm and 95 to the control arm. High follow-up rates (> 80%) were achieved to 12 months. There was an 8.8% difference in weight loss at 12 months between women allocated to the intervention arm and women allocated to the control arm (13.0% vs. 4.2%, respectively; p = 0.062); 47% of women in the intervention arm attended at least one weight management session, with low risk of contamination between arms. The greatest benefit was among women who attended ≥ 10 sessions. Barriers to attending sessions included capability, opportunity and motivation issues. Data collection tools were appropriate to support economic evaluation in a definitive trial, and economic modelling is feasible to quantify resource impacts and outcomes not directly measurable within a trial.
Limitations
The trial recruited from only one site. It was not possible to recruit women with normal body mass index scores who developed excessive pregnancy weight gain.
Conclusions
It was feasible to recruit and retain women with overweight or obese body mass index scores at antenatal booking to a trial comparing postnatal weight management plus standard care with standard care only and collect relevant data to assess outcomes. Approaches to recruit women with normal body mass index scores who gain excessive gestational weight need to be considered. Commercial weight management groups could support women’s weight management as assessed at 12 months postnatally, with probable greater benefit from attending ≥ 10 sessions. Process evaluation findings highlighted the importance of providing more information about the intervention on trial allocation, extended duration of time to commence sessions following birth and extended number of sessions offered to enhance uptake and retention. Results support the conduct of a future randomised controlled trial.
Trial registration
Current Controlled Trials ISRCTN39186148.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 9. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
| | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, UK
| | | | - Andy Healey
- King’s Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Paul Seed
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
| | - Sarah Roberts
- King’s Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Amanda Avery
- Faculty of Science, University of Nottingham, Nottingham, UK
| | | | | | | | | | - Bimpe Oki
- Public Health, London Borough of Lambeth, London, UK
| | | | - Lucilla Poston
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
| | - Michael Ussher
- Population Health Research Institute, St George’s, University of London, London, UK
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| |
Collapse
|
23
|
Garnweidner‐Holme L, Torheim LE, Henriksen L, Borgen I, Holmelid S, Lukasse M. Adherence to the Norwegian dietary recommendations in a multi-ethnic pregnant population prior to being diagnosed with gestational diabetes mellitus. Food Sci Nutr 2020; 8:3031-3040. [PMID: 32724567 PMCID: PMC7382101 DOI: 10.1002/fsn3.1248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/16/2019] [Accepted: 09/21/2019] [Indexed: 12/14/2022] Open
Abstract
Maternal diet is a modifiable risk factor for the development of gestational diabetes mellitus (GDM). Even though pregnant women are considered to be motivated to eat healthy, previous research found unhealthy eating patterns among some ethnic and lower socio-economic status groups. This cross-sectional study assessed adherence to national dietary recommendations prior to GDM diagnosis in a multi-ethnic population comprising 237 pregnant women. Participants were diagnosed with GDM after performing a two-hour oral glucose tolerance test ≥ 9 mmol/L. Participants answered a 41-item Food Frequency Questionnaire about dietary habits prior to being diagnosed with GDM from October 2015 to March 2018. Their scores were based on adherence to the recommended intake in each food group and summed into a Healthy Diet Score (HDS). Results showed low adherence to national dietary recommendations. A significantly higher proportion of non-native Norwegian-speaking women had a high HDS compared with native Norwegian-speaking women. Participants with a normal prepregnancy weight were more likely to have a high HDS compared with overweight or obese participants. Participants showed low adherence to the recommendations for whole grains, vegetables, and fruits and berries, and a relatively low proportion adhered to the recommendations for intakes of fish, red/processed meat, and ready-made meals. However, the food group intakes varied by country of birth. Given the increase in women with GDM and the emerging evidence that maternal diet is a modifiable risk factor for GDM, effective nutrition communication strategies in antenatal care are urgently needed.
Collapse
Affiliation(s)
- Lisa Garnweidner‐Holme
- Faculty of Health SciencesInstitute of Nursing and Health PromotionOsloMet – Oslo Metropolitan UniversityOsloNorway
| | - Liv Elin Torheim
- Faculty of Health SciencesInstitute of Nursing and Health PromotionOsloMet – Oslo Metropolitan UniversityOsloNorway
| | - Lena Henriksen
- Faculty of Health SciencesInstitute of Nursing and Health PromotionOsloMet – Oslo Metropolitan UniversityOsloNorway
| | - Iren Borgen
- Faculty of Health SciencesInstitute of Nursing and Health PromotionOsloMet – Oslo Metropolitan UniversityOsloNorway
| | - Sigrid Holmelid
- Faculty of Health SciencesInstitute of Nursing and Health PromotionOsloMet – Oslo Metropolitan UniversityOsloNorway
| | - Mirjam Lukasse
- Faculty of Health SciencesInstitute of Nursing and Health PromotionOsloMet – Oslo Metropolitan UniversityOsloNorway
| |
Collapse
|
24
|
Vincze L, Rollo M, Hutchesson M, Hauck Y, MacDonald-Wicks L, Wood L, Callister R, Collins C. Interventions including a nutrition component aimed at managing gestational weight gain or postpartum weight retention: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2020; 17:297-364. [PMID: 30870329 DOI: 10.11124/jbisrir-2017-003593] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The objective of this systematic review was to evaluate the effectiveness of interventions that include a nutrition component aimed at improving gestational weight gain and/or postpartum weight retention. INTRODUCTION Excessive gestational weight gain and postpartum weight retention increase the risk of adverse maternal and neonatal outcomes. Current evidence comprises many interventions targeting gestational weight gain and postpartum weight retention that incorporate a nutrition component. To date, no review has synthesized evidence from pregnancy through the postpartum period or described the intervention approaches in detail. INCLUSION CRITERIA The review included women (≥18 years) during pregnancy and/or up to 12 months postpartum. Studies were included if they involved a weight management intervention with a nutrition component and had the primary objective of determining the impact of gestational weight gain and/or postpartum weight change. Interventions were compared to usual care (i.e. control conditions with no intervention or wait-list control or standard pregnancy or postpartum care) or "other" (alternative intervention). The review considered randomized controlled trials published between 1980 and January 21, 2016. Studies that included a weight related primary outcome measured during pregnancy and/or postpartum were included. METHODS Seven databases were searched and the reference lists of included studies were searched for additional studies not previously identified. Two independent reviewers assessed the methodological quality of studies using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI SUMARI). The JBI SUMARI standardized data extraction tool was used to extract data. A narrative synthesis was undertaken to qualitatively synthesize included studies, with meta-analyses used to pool weight outcome data from studies conducted separately for pregnancy and postpartum. Effect sizes for meta-analyses have been expressed as weighted mean differences (95% confidence intervals). RESULTS The search yielded 4063 articles of which 48 articles from 39 studies were included. Eleven of 20 studies during pregnancy reported significant reductions in gestational weight gain with the intervention when compared to control groups. One of five studies where the intervention was conducted during both pregnancy and postpartum reported statistically significant reductions in gestational weight gain, and postpartum weight retention between intervention and control groups. Nine of 14 studies conducted after childbirth reported statistically significant intervention effects, indicating lesser postpartum weight retention. Random effects meta-analyses indicated that despite considerable heterogeneity, interventions conducted during pregnancy (-1.25 kg; 95% CI: -2.10 kg, -0.40 kg; p = 0.004), and postpartum (-3.25 kg; 95% CI: -4.69 kg, -1.82 kg; p < 0.001) were significantly more effective at improving weight outcomes compared to usual care or other interventions. Most studies were of moderate quality due to lack of clarity in describing study details required for appraising methodological quality. Few interventions were conducted from pregnancy through the postpartum period (n = 5). Limited interventions adopted online modalities in intervention delivery (n = 4). Intention-to-treat analysis was used in only 12 studies. CONCLUSIONS The pregnancy and postpartum period presents a unique opportunity to engage women in interventions to help optimize lifestyle behaviors for weight management, however the optimal approach is unclear. Improving consistency in intervention implementation and reporting will improve future evidence synthesis.
Collapse
Affiliation(s)
- Lisa Vincze
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Megan Rollo
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Australia.,School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Australia
| | - Melinda Hutchesson
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Australia.,School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Australia
| | - Yvonne Hauck
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia.,Department Nursing Midwifery Education and Research, King Edward Memorial Hospital, Perth, Australia
| | - Lesley MacDonald-Wicks
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Australia.,School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Australia
| | - Lisa Wood
- School of Biomedical Sciences, Faculty of Health and Medicine, University of Newcastle, Australia.,Priority Research Centre Grow Up Well and Priority Research Centre Healthy Lungs, University of Newcastle, Australia
| | - Robin Callister
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Australia.,School of Biomedical Sciences, Faculty of Health and Medicine, University of Newcastle, Australia
| | - Clare Collins
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Australia.,School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Australia.,The University of Newcastle Centre for Evidence Based Healthcare Informing Research (CEBHIR): a Joanna Briggs Institute Centre of Excellence
| |
Collapse
|
25
|
Relationship between gestational acrylamide exposure and offspring's growth: a systematic review and meta-analysis of cohort studies. Public Health Nutr 2020; 23:1791-1799. [PMID: 32349855 DOI: 10.1017/s1368980019005123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To estimate the current evidence regarding the association between gestational acrylamide (AA) exposure and offspring's growth. DESIGN Systematic review and meta-analysis. SETTING A systematic literature search for relevant publications was conducted using PubMed, Medline, Embase, Web of Science databases from inception to 26 April 2019. The standardised mean difference (SMD) or OR with 95 % CI was selected as the effect sizes and was calculated using a random effects model. RESULTS Five cohort studies including 54 728 participants were identified. Offspring's birth weight was significantly lower in high AA exposure group than in low AA exposure group (SMD -0·05, 95 % CI -0·09, -0·02, P = 0·005). There was also an association between maternal AA exposure and small for gestational age (OR 1·14, 95 % CI 1·06, 1·23, P < 0·001). In addition, pooled ORs suggested that children had a high risk of developing overweight/obesity in the future in maternal high AA exposure group (OR 1·14, 95 % CI 1·08, 1·21, P < 0·001 at age 3; OR 1·13, 95 % CI 1·07, 1·19, P < 0·001 at age 5; OR 1·09, 95 % CI 1·02, 1·16, P = 0·020 at age 8). CONCLUSIONS These findings have important implications for conducting health education, providing guidance on maternal diet and developing an appropriate dietary strategy for pregnant women to reduce dietary AA exposure.
Collapse
|
26
|
Maternal use of folic acid and multivitamin supplements and infant risk of birth defects in Norway, 1999-2013. Br J Nutr 2020; 124:316-329. [PMID: 32238218 DOI: 10.1017/s0007114520001178] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The association between folic acid supplementation and birth defects other than neural tube defects (NTD) remains unclear. We used a log-binomial regression model to investigate if periconceptional folic acid and/or multivitamin use was associated with birth defects in Norway with prospectively collected data from the Medical Birth Registry of Norway (MBRN) during 1999-2013. We used the European Surveillance of Congenital Anomalies (EUROCAT) classification system to define eleven organ-specific major birth defect groups (nervous system, eye, ear-face-neck, cardiovascular system, respiratory system, oral clefts, digestive system, abdominal wall, urinary system, genital organs and limb), with additional subgroups. Fetuses or infants whose mothers used folic acid and/or multivitamin supplements before and during pregnancy were classified as exposed. During the years 1999-2013, 888 294 (99·0 %) live-born infants, 6633 (0·7 %) stillborn infants and 2135 (0·2 %) fetuses from terminated pregnancies due to fetal anomalies were registered in the MBRN. Among the live- and stillborn infants of women who used vitamin supplements compared with infants of non-users, the adjusted relative risk (aRR) was 0·94 (95 % CI 0·91, 0·98) for total birth defects (n 18 382). Supplement use was associated with reduced risk of abdominal wall defects (aRR 0·58; 95 % CI 0·42, 0·80, n 377), genital organ defects (aRR 0·81; 95 % CI 0·72, 0·91, n 2299) and limb defects (aRR 0·81; 95 % CI 0·74, 0·90, n 3409). Protective associations were also suggested for NTD, respiratory system defects and digestive system defects although CI included the null value of 1. During the full study period, statistically significant associations between supplement use and defects in the eye, ear-face-neck, heart or oral clefts were not observed.
Collapse
|
27
|
Avalos LA, Caan B, Nance N, Zhu Y, Li DK, Quesenberry C, Hyde RJ, Hedderson MM. Prenatal Depression and Diet Quality During Pregnancy. J Acad Nutr Diet 2020; 120:972-984. [PMID: 32063456 DOI: 10.1016/j.jand.2019.12.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Maternal nutrition during pregnancy has a significant effect on the health of the offspring and mother, highlighting the need for identifying factors that may affect diet during pregnancy. Research in nonpregnant and pregnant populations suggest depression may play a role. OBJECTIVE To investigate the relationship between prenatal depression and diet quality during pregnancy overall and by race/ethnicity and to explore the relationships between prenatal depression and the 12 Healthy Eating Index 2010 dietary components. DESIGN A cross-sectional secondary analysis of a cohort study of Kaiser Permanente Northern California women entering prenatal care between October 2011 and April 2013. PARTICIPANTS/SETTING Participants included 1,160 adult pregnant women. MAIN OUTCOME MEASURES Poor diet quality was defined as a Healthy Eating Index 2010 score in the lowest quartile. STATISTICAL ANALYSES PERFORMED Logistic regression was used to assess the relationship between prenatal depression (defined as a depression diagnosis, Patient Health Questionnaire score of 10 or greater or antidepressant medication dispensing between the last menstrual period and completion of the food frequency questionnaire) and poor diet quality overall and by race/ethnicity. Relationships between prenatal depression and each of the 12 Healthy Eating Index 2010 dietary components were assessed using t-tests and linear regression analyses. RESULTS One hundred fifty-nine (14%) participants had prenatal depression. Women with prenatal depression had nearly two times the odds of poor diet quality (odds ratio 1.80, 95% CI 1.23 to 2.60) compared with women without prenatal depression, after adjusting for potential confounders. Differences emerged by race/ethnicity; after adjusting for potential confounders the adjusted odds of poor diet quality were significant only among Hispanic women. Hispanic women with prenatal depression had an increased odds of poor diet quality compared with Hispanic women without prenatal depression (odds ratio 2.66, 95% CI 1.15 to 6.06). Women with prenatal depression had a higher consumption of empty calories (from solid fats, alcohol, and added sugars; threshold for counting alcohol >13 g/1,000 kcal) (P=0.01) and lower consumption of greens and beans (P<0.05), total fruit (P<0.01), and whole fruit (P<0.01), compared with women without prenatal depression. Except for empty calories, these findings remained after adjusting for potential confounders. CONCLUSIONS Study findings suggest that women with prenatal depression are at a higher risk of poor diet quality compared with women without prenatal depression, and the relationship is stronger among Hispanic women. Nutrition counseling interventions for women with depression should consider the use of culturally sensitive materials and target limiting empty calories from solid fats, alcohol, and added sugars and encourage eating more greens, beans, and fruit.
Collapse
|
28
|
Saunders CM, Rehbinder EM, Carlsen KCL, Gudbrandsgard M, Carlsen KH, Haugen G, Hedlin G, Jonassen CM, Sjøborg KD, Landrø L, Nordlund B, Rudi K, O Skjerven H, Söderhäll C, Staff AC, Vettukattil R, Carlsen MH. Food and nutrient intake and adherence to dietary recommendations during pregnancy: a Nordic mother-child population-based cohort. Food Nutr Res 2019; 63:3676. [PMID: 31920469 PMCID: PMC6939665 DOI: 10.29219/fnr.v63.3676] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 12/21/2022] Open
Abstract
Background A woman's food intake during pregnancy has important implications not only for herself but also for the future health and well-being of her child. Suboptimal dietary quality has been consistently reported in many high-income countries, reflecting poor adherence to dietary guidelines. Objective This study aimed to explore the intake of food and nutrients in a cohort of pregnant women in Norway and their adherence to Nordic Nutrition Recommendations (NNR) and Norwegian food-based guidelines (NFG). Design We investigated the dietary intake in 1,674 pregnant women from the mother-child birth cohort, PreventADALL, recruited at approximately 18-week gestational age. Dietary intake was assessed by an electronic validated food frequency questionnaire (PrevFFQ) in the first half of pregnancy. Results Total fat intake was within the recommended intake (RI) range in most women; however, the contribution of saturated fatty acids to the total energy intake was above RI in the majority (85.2%) of women. Carbohydrate intake was below RI in 43.9% of the women, and 69.5% exceeded the RI of salt. Intakes of fiber, vegetables, and fish were high in a large part of the population. Many women had a high probability of inadequate intakes of the following key micronutrients during pregnancy: folate (54.4%), iron (49.6%), calcium (36.2%), vitamin D (28.7%), iodine (24.4%), and selenium (41.3%). A total of 22.8% women reported an alcohol intake of >1 g/day, and 4.4% reported an alcohol intake of >10 g/day. Women with higher educational levels showed a tendency towards healthier eating habits, except for higher intakes of alcohol and coffee, compared to women with lower educational level. Discussion Excessive saturated fat intake and limited intake of many important micronutrients during pregnancy were common, potentially increasing the risk for adverse pregnancy and birth outcomes. Conclusions This study highlights the need for improved nutritional guidance to pregnant women across all educational levels.
Collapse
Affiliation(s)
- Carina Madelen Saunders
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eva Maria Rehbinder
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - Karin C Lødrup Carlsen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Malén Gudbrandsgard
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Kai-Håkon Carlsen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Guttorm Haugen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Christine Monceyron Jonassen
- Genetic Unit, Centre for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway.,Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
| | | | - Linn Landrø
- Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - Björn Nordlund
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Knut Rudi
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
| | - Håvard O Skjerven
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Cilla Söderhäll
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Anne Cathrine Staff
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Riyas Vettukattil
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Monica Hauger Carlsen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| |
Collapse
|
29
|
Loy SL, Cheung YB, Colega MT, Chia A, Han CY, Godfrey KM, Chong YS, Shek LPC, Tan KH, Lek N, Chan JKY, Chong MFF, Yap F. Associations of Circadian Eating Pattern and Diet Quality with Substantial Postpartum Weight Retention. Nutrients 2019; 11:nu11112686. [PMID: 31698715 PMCID: PMC6893719 DOI: 10.3390/nu11112686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/29/2019] [Accepted: 11/04/2019] [Indexed: 12/12/2022] Open
Abstract
Besides food quantity and quality, food timing and frequency may contribute to weight regulation. It is unclear if these factors during pregnancy can influence maternal weight retention after childbirth. We thus aimed to examine the associations of maternal circadian eating pattern and diet quality in pregnancy with substantial postpartum weight retention (PPWR) at 18 months in an Asian cohort. We assessed circadian eating pattern and diet quality of 687 women using 24-h dietary recalls at 26–28 weeks’ gestation. We calculated PPWR by subtracting maternal weight in the first trimester from weight at 18-month postpartum and defined substantial PPWR as ≥5 kg weight retention. Multivariable binary logistic regression was performed. Overall, 16% of women had substantial PPWR. After the confounders adjustment, night eating, defined by greater night-time caloric intake (odds ratio 1.95; 95% confidence interval 1.05, 3.62), and lower diet quality, classified by median score of the Healthy Eating Index (1.91; 1.17, 3.10), were independently associated with higher odds of substantial PPWR. No associations with substantial PPWR were observed for night fasting duration and number of eating episodes. In conclusion, alignment of eating time with day–night cycles and diet quality during pregnancy may play a role in PPWR, with possible implications for long-term obesity risk.
Collapse
Affiliation(s)
- See Ling Loy
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore;
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore; (K.H.T.); (N.L.)
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore 117609, Singapore; (M.T.C.); (Y.-S.C.); (L.P.-C.S.); (M.F.-F.C.)
- Correspondence: (S.L.L.); (F.Y.)
| | - Yin Bun Cheung
- Programme in Health Services & Systems Research and Center for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore;
- Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Arvo Ylpönkatu 34 (ARVO B235), 33014 Tampere, Finland
| | - Marjorelee T. Colega
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore 117609, Singapore; (M.T.C.); (Y.-S.C.); (L.P.-C.S.); (M.F.-F.C.)
| | - Airu Chia
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, Singapore 119228, Singapore;
| | - Chad Yixian Han
- Department of Nutrition and Dietetics, College of Nursing and Health Science, Flinders University, Sturt Rd, Bedford Park, SA 5042, Australia;
- Department of Dietetics, National University Hospital, National University Health System, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Keith M. Godfrey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK;
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton SO16 6YD, UK
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore 117609, Singapore; (M.T.C.); (Y.-S.C.); (L.P.-C.S.); (M.F.-F.C.)
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, Singapore 119228, Singapore;
| | - Lynette Pei-Chi Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore 117609, Singapore; (M.T.C.); (Y.-S.C.); (L.P.-C.S.); (M.F.-F.C.)
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore 119228, Singapore
- Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
| | - Kok Hian Tan
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore; (K.H.T.); (N.L.)
- Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - Ngee Lek
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore; (K.H.T.); (N.L.)
- Department of Paediatrics, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - Jerry Kok Yen Chan
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore;
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore; (K.H.T.); (N.L.)
| | - Mary Foong-Fong Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore 117609, Singapore; (M.T.C.); (Y.-S.C.); (L.P.-C.S.); (M.F.-F.C.)
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore
| | - Fabian Yap
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore; (K.H.T.); (N.L.)
- Department of Paediatrics, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232, Singapore
- Correspondence: (S.L.L.); (F.Y.)
| |
Collapse
|
30
|
Borge TC, Brantsæter AL, Caspersen IH, Meltzer HM, Brandlistuen RE, Aase H, Biele G. Estimating the Strength of Associations Between Prenatal Diet Quality and Child Developmental Outcomes: Results From a Large Prospective Pregnancy Cohort Study. Am J Epidemiol 2019; 188:1902-1912. [PMID: 31375821 PMCID: PMC6825833 DOI: 10.1093/aje/kwz166] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 12/15/2022] Open
Abstract
Our aim in this study was to estimate the strength of associations between prenatal diet quality and child behavioral, language, and motor functions in the Norwegian Mother and Child Cohort Study (1999-2008). We created a prenatal diet quality index (PDQI) based on adherence to Norwegian dietary guidelines. Child outcomes were defined as sum scores on the Child Behavior Checklist, the Ages and Stages Questionnaire, and the Child Development Index at ages 18, 36, and 60 months. Using a longitudinal cohort study design and Bayesian hierarchical modeling, we estimated association strengths using inverse probability weighting to account for selection bias. In total, 27,529 mother-child pairs were eligible for inclusion. A 1-standard-deviation increase in PDQI score was associated with an absolute reduction in outcome sum scores of 0.02-0.21 and a 3%-7% relative decrease, with larger decreases seen for language and motor functions than for behavioral functions. PDQI scores were inversely associated with all child functions, but the estimated strength of each association was low. The results indicate that the observed variations in PDQI scores in an industrialized Western society may not profoundly influence the child functions studied.
Collapse
Affiliation(s)
- Tiril Cecilie Borge
- Correspondence to Tiril Cecilie Borge, Department of Child Health and Development, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway (e-mail: )
| | | | | | | | | | | | | |
Collapse
|
31
|
Chen L, Wu B, Han Q, Yan J. Clinical analysis of emergency exploratory laparotomy in patients with intractable postpartum hemorrhage. J Int Med Res 2019; 48:300060519879294. [PMID: 31662015 PMCID: PMC7607188 DOI: 10.1177/0300060519879294] [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] [Indexed: 11/22/2022] Open
Abstract
Objective This study was performed to explore the causes and clinical characteristics
of emergency exploratory laparotomy in patients with intractable postpartum
hemorrhage. Methods This retrospective study was performed from January 2004 to December 2017.
Patients with intractable postpartum hemorrhage were grouped according to
the initial pathogenesis as determined by exploratory laparotomy: uterine
atony, placental factors, coagulation dysfunction, or uterine rupture. Results This study involved 72 patients who underwent emergency exploratory
laparotomy, accounting for 0.04% of total deliveries. Uterine preservation
surgery and hysterectomy were performed in 31 and 41 patients, respectively.
Abnormal events upon returning to the ward were primarily vaginal hemorrhage
and pelvic hematoma. The frequency of uterine artery ligation was lower in
the hysterectomy group than uterine preservation group. The prothrombin
activity level, fibrinogen level, and platelet count before surgery were
lower in the hysterectomy group than uterine preservation group. The
international normalized ratio and activated partial thromboplastin time
were higher in the hysterectomy group than uterine preservation group. In
total, 44 patients developed complications. Conclusion Placental implantation is a primary cause of hysterectomy after emergency
laparotomy. However, the possibility of postpartum hemorrhage caused by
coagulation disorders should not be ignored.
Collapse
Affiliation(s)
- Lichun Chen
- Obstetrics Department, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Baohua Wu
- Obstetrics Department, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Qing Han
- Obstetrics Department, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Jianying Yan
- Obstetrics Department, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| |
Collapse
|
32
|
Berube LT, Messito MJ, Woolf K, Deierlein A, Gross R. Correlates of Prenatal Diet Quality in Low-Income Hispanic Women. J Acad Nutr Diet 2019; 119:1284-1295. [PMID: 30956126 PMCID: PMC6663603 DOI: 10.1016/j.jand.2019.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/18/2019] [Accepted: 02/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Low-income Hispanic women are at-risk of poor prenatal diet quality. Correlates associated with prenatal diet quality in this group of women are understudied. OBJECTIVE The objective of this study was to examine the associations between financial, cultural, psychosocial, and lifestyle correlates and prenatal diet quality in low-income Hispanic women. DESIGN This cross-sectional analysis used data from pregnant women enrolled in the Starting Early Trial, a randomized-controlled trial of a primary-care based child obesity prevention program beginning in pregnancy. The trial enrolled women from clinics affiliated with a large urban medical center in New York City from 2012 to 2014. Financial, cultural, psychosocial, and lifestyle variables were collected using a comprehensive baseline questionnaire. Usual dietary intakes over the past year were assessed using the Block Food Frequency Questionnaire 2005 bilingual version. PARTICIPANTS The study enrolled low-income Hispanic women between 28 and 32 gestational weeks (N=519). MAIN OUTCOME MEASURES Prenatal diet quality was measured by the Healthy Eating Index 2015. STATISTICAL ANALYSES PERFORMED Unadjusted and adjusted multivariable linear regression analyses were performed to determine independent associations between financial, cultural, psychosocial, and lifestyle correlates and Healthy Eating Index 2015 total score. RESULTS Overall prenatal diet quality was poor (mean Healthy Eating Index 2015 total score=69.0±9.4). Most women did not meet the maximum score for total vegetables (65.3%), whole grains (97.1%), dairy (74.8%), fatty acids (84.4%), refined grains (79.8%), sodium (97.5%), saturated fats (92.9%), and added sugars (66.5%). Women who reported screen time ≤2 hours/day, physical activity before and/or during pregnancy, and being born outside the United States had higher mean Healthy Eating Index 2015 total score than women with screen time >2 hours/day, no physical activity, and those born in the United States. CONCLUSIONS Prenatal diet quality of low-income pregnant Hispanic women was suboptimal. This cross-sectional study revealed associations between cultural and lifestyle factors and prenatal diet quality in low-income Hispanic women. Longitudinal studies are needed to determine long-term influences and specific behaviors to target for effective intervention studies.
Collapse
Affiliation(s)
- Lauren Thomas Berube
- New York University Steinhardt, Department of Nutrition and Food Studies, 411 Lafayette St, 5 Floor, New York, NY 10003, 212-998-5580,
| | - Mary Jo Messito
- New York University School of Medicine, Department of Pediatrics, 462 First Avenue, New York, NY 10016, 212-263-6424,
| | - Kathleen Woolf
- New York University Steinhardt, Department of Nutrition and Food Studies, 411 Lafayette Street, 5 Floor, New York, NY 10003, 212-992-7898,
| | - Andrea Deierlein
- New York University College of Global Public Health, Department of Public Health Nutrition, 715-719 Broadway, 12 Floor, New York, NY 10003,
| | - Rachel Gross
- New York University School of Medicine, Department of Pediatrics, 462 First Avenue, New York, NY 10016, 212-263-8974,
| |
Collapse
|
33
|
Adherence to the New Nordic Diet during pregnancy and subsequent maternal weight development: a study conducted in the Norwegian Mother and Child Cohort Study (MoBa). Br J Nutr 2019; 119:1286-1294. [PMID: 29770760 DOI: 10.1017/s0007114518000776] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The rising prevalence of overweight and obesity is a worldwide public health challenge. Pregnancy and beyond is a potentially important window for future weight gain in women. We investigated associations between maternal adherence to the New Nordic diet (NND) during pregnancy and maternal BMI trajectories from delivery to 8 years post delivery. Data are from the Norwegian Mother and Child Cohort. Pregnant women from all of Norway were recruited between 1999 and 2008, and 55 056 are included in the present analysis. A previously constructed diet score, NND, was used to assess adherence to the diet. The score favours intake of Nordic fruits, root vegetables, cabbages, potatoes, oatmeal porridge, whole grains, wild fish, game, berries, milk and water. Linear spline multi-level models were used to estimate the association. We found that women with higher adherence to the NND pattern during pregnancy had on average lower post-partum BMI trajectories and slightly less weight gain up to 8 years post delivery compared with the lower NND adherers. These associations remained after adjustment for physical activity, education, maternal age, smoking and parity (mean diff at delivery (high v. low adherers): -0·3 kg/m2; 95 % CI -0·4, -0·2; mean diff at 8 years: -0·5 kg/m2; 95 % CI -0·6, -0·4), and were not explained by differences in energy intake or by exclusive breast-feeding duration. Similar patterns of associations were seen with trajectories of overweight/obesity as the outcome. In conclusion, our findings suggest that the NND may have beneficial properties to long-term weight regulation among women post-partum.
Collapse
|
34
|
Elvebakk T, Mostad IL, Mørkved S, Salvesen KÅ, Stafne SN. Dietary Intakes and Dietary Quality during Pregnancy in Women with and without Gestational Diabetes Mellitus-A Norwegian Longitudinal Study. Nutrients 2018; 10:nu10111811. [PMID: 30463394 PMCID: PMC6266178 DOI: 10.3390/nu10111811] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/01/2018] [Accepted: 11/16/2018] [Indexed: 12/13/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is associated with maternal diet, however, findings are inconsistent. The aims of the present study were to assess whether intakes of foods and beverages during pregnancy differed between women who developed GDM and non-GDM women, and to compare dietary intakes with dietary recommendations of pregnancy. This is a longitudinal study using participants of a randomized controlled trial. Women with complete measurements of a 75 g oral glucose tolerance test (OGTT) at 18–22 and 32–36 weeks gestation were included in the cohort (n = 702). Women were diagnosed for GDM according to the simplified International Association of Diabetes and Pregnancy Study Group criteria at 32–36 weeks (GDM women: n = 40; non-GDM women: n = 662). Dietary data (food frequency questionnaire) was collected at both time points and compared between GDM and non-GDM women. Variability in OGTT values was assessed in a general linear model. Marginal differences between GDM and non-GDM women in intakes of food groups were found. No associations were found between dietary variables and OGTT values. Not all dietary recommendations were followed in the cohort, with frequently reported alcohol consumption giving largest cause for concern. This study did not find dietary differences that could help explain why 40 women developed GDM.
Collapse
Affiliation(s)
- Trude Elvebakk
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7089 Trondheim, Norway.
- Children's Clinic, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway.
| | - Ingrid L Mostad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7089 Trondheim, Norway.
- Department of Clinical Nutrition and Speech-Language Therapy, Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway.
| | - Siv Mørkved
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7089 Trondheim, Norway.
- Research Department, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway.
| | - Kjell Å Salvesen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7089 Trondheim, Norway.
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway.
| | - Signe N Stafne
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7089 Trondheim, Norway.
- Department of Physiotherapy, Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway.
| |
Collapse
|
35
|
Fadzil F, Shamsuddin K, Wan Puteh SE, Mohd Tamil A, Ahmad S, Abdul Hayi NS, Abdul Samad A, Ismail R, Ahmad Shauki NI. Predictors of postpartum weight retention among urban Malaysian mothers: A prospective cohort study. Obes Res Clin Pract 2018; 12:493-499. [PMID: 29960869 DOI: 10.1016/j.orcp.2018.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 05/28/2018] [Accepted: 06/05/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Women of childbearing age are predisposed to becoming overweight or obese. This study determines the mean, prevalence and factors associated with 6 months postpartum weight retention among urban Malaysian mothers. METHODS A prospective cohort study was conducted at baseline (after delivery), 2, 4 and 6 months postpartum. From 638 eligible mothers initially recruited, 420 completed until 6 months. Dependent variable was weight retention, defined as difference between weight at 6 months postpartum and pre-pregnancy weight, and weight retention ≥5kg was considered excessive. Independent variables included socio-demographic, history of pregnancy and delivery, lifestyle, practices and traditional postpartum practices. RESULTS Average age was 29.61±4.71years, majority (83.3%) were Malays, 58.8% (low education), 70.0% (employed), 65.2% (middle income family), 33.8% (primiparous) and 66.7% (normal/instrumental delivery). Average gestational weight gain was 12.90±5.18kg. Mean postpartum weight retention was 3.12±4.76kg, 33.8% retaining ≥5kg. Bivariable analysis showed low income, primiparity, gestational weight gain ≥12kg, less active physically, higher energy, protein, carbohydrate and fat intake in diet, never using hot stone compression and not continuing breastfeeding were significantly associated with higher 6 months postpartum weight retention. From multivariable linear regression analysis, less active physically, higher energy intake in diet, gestational weight gain ≥12kg, not continuing breastfeeding 6 months postpartum and never using hot stone compression could explain 55.1% variation in 6 months postpartum weight retention. CONCLUSION Women need to control gestational weight gain, remain physically active, reduce energy intake, breastfeed for at least 6 months and use hot stone compression to prevent high postpartum weight retention.
Collapse
Affiliation(s)
- Fariza Fadzil
- Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia.
| | - Khadijah Shamsuddin
- Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Sharifa Ezat Wan Puteh
- Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Azmi Mohd Tamil
- Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Shuhaila Ahmad
- Department of Obstetrics & Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | | | - Azah Abdul Samad
- Wilayah Persekutuan Kuala Lumpur & Putrajaya Health Department, Kuala Lumpur, Malaysia
| | | | | |
Collapse
|
36
|
Kadawathagedara M, Botton J, de Lauzon-Guillain B, Meltzer HM, Alexander J, Brantsaeter AL, Haugen M, Papadopoulou E. Dietary acrylamide intake during pregnancy and postnatal growth and obesity: Results from the Norwegian Mother and Child Cohort Study (MoBa). ENVIRONMENT INTERNATIONAL 2018; 113:325-334. [PMID: 29398013 DOI: 10.1016/j.envint.2018.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 01/10/2018] [Accepted: 01/10/2018] [Indexed: 06/07/2023]
Abstract
BACKGROUND Prenatal acrylamide exposure has been negatively associated with fetal growth but the association with child growth is unknown. OBJECTIVES We studied the association between prenatal acrylamide exposure and child postnatal growth up to 8 years in the Norwegian Mother and Child Cohort Study (MoBa). METHODS In 51,952 mother-child pairs from MoBa, acrylamide intake during pregnancy was estimated by combining maternal food intake with food concentrations of acrylamide. Mothers reported their child's weight and length/height up to 11 times between 6 weeks and 8 years. Weight and height growth trajectories were modelled using Jenss-Bayley's growth model. Logistic regression models were used to study the association with overweight/obese status at 3, 5 and 8 years, as identified using the International Obesity Task Force cut-offs. Linear mixed-effect models were used to explore associations with overall growth. RESULTS At 3 years, the adjusted odds ratios (95% Confidence Intervals (CI)) of being overweight/obese were 1.10 (1.02, 1.20), 1.12 (1.04, 1.22) and 1.21 (1.11, 1.31) by increasing prenatal acrylamide exposure quartile. Similar dose-response associations were found at 5 and 8 years. Acrylamide intake during pregnancy was associated with higher weight growth velocity in childhood. Children exposed at the highest level had 22 g (95% CI: 8, 37), 57 g (95% CI: 32, 81), and 194 g (95% CI: 110, 278) higher weight at 0.5, 2, and 8 years, respectively, compared to their low exposed peers. CONCLUSIONS Children prenatally exposed to acrylamide in the highest quartile experienced a moderate increase in weight growth velocity during early childhood that resulted in a moderately increased prevalence of overweight/obesity compared to peers in the lowest quartile. Our study is the first to link prenatal acrylamide exposure and postnatal growth.
Collapse
Affiliation(s)
- Manik Kadawathagedara
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Early determinants of the child's health and development Team (ORCHAD), Paris F-75014, France; Paris Descartes University, Paris, France.
| | - Jérémie Botton
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Early determinants of the child's health and development Team (ORCHAD), Paris F-75014, France; Univ. Paris-Sud, Université Paris-Saclay, F-92296 Châtenay-Malabry, France
| | - Blandine de Lauzon-Guillain
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Early determinants of the child's health and development Team (ORCHAD), Paris F-75014, France; Paris Descartes University, Paris, France
| | | | | | - Anne Lise Brantsaeter
- Department of Environmental Exposure and Epidemiology, Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Margaretha Haugen
- Department of Environmental Exposure and Epidemiology, Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Eleni Papadopoulou
- Department of Environmental Exposure and Epidemiology, Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
37
|
Lee YQ, Collins CE, Schumacher TL, Weatherall LJ, Keogh L, Sutherland K, Gordon A, Rae KM, Pringle KG. Disparities exist between the dietary intake of Indigenous Australian women during pregnancy and the Australian dietary guidelines: the
Gomeroi gaaynggal
study. J Hum Nutr Diet 2018; 31:473-485. [DOI: 10.1111/jhn.12550] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Y. Q. Lee
- Priority Research Centre for Reproductive Sciences University of Newcastle Newcastle NSW Australia
- School of Biomedical Sciences and Pharmacy Faculty of Health and Medicine University of Newcastle Newcastle NSW Australia
| | - C. E. Collins
- Priority Research Centre for Physical Activity and Nutrition University of Newcastle Newcastle NSW Australia
- School of Health Sciences Faculty of Health and Medicine University of Newcastle Newcastle NSW Australia
| | - T. L. Schumacher
- Priority Research Centre for Physical Activity and Nutrition University of Newcastle Newcastle NSW Australia
- Gomeroi gaaynggal Centre Faculty of Health and Medicine University of Newcastle Tamworth NSW Australia
- School of Medicine and Public Health Faculty of Health and Medicine University of Newcastle Newcastle NSW Australia
- Department of Rural Health University of Newcastle Tamworth NSW Australia
| | - L. J. Weatherall
- Gomeroi gaaynggal Centre Faculty of Health and Medicine University of Newcastle Tamworth NSW Australia
| | - L. Keogh
- Gomeroi gaaynggal Centre Faculty of Health and Medicine University of Newcastle Tamworth NSW Australia
| | - K. Sutherland
- Gomeroi gaaynggal Centre Faculty of Health and Medicine University of Newcastle Tamworth NSW Australia
| | - A. Gordon
- Charles Perkins Centre University of Sydney Australia
| | - K. M. Rae
- Priority Research Centre for Reproductive Sciences University of Newcastle Newcastle NSW Australia
- Gomeroi gaaynggal Centre Faculty of Health and Medicine University of Newcastle Tamworth NSW Australia
- School of Medicine and Public Health Faculty of Health and Medicine University of Newcastle Newcastle NSW Australia
- Department of Rural Health University of Newcastle Tamworth NSW Australia
- Priority Research Centre for Generational Health and Ageing University of Newcastle Newcastle NSW Australia
| | - K. G. Pringle
- Priority Research Centre for Reproductive Sciences University of Newcastle Newcastle NSW Australia
- School of Biomedical Sciences and Pharmacy Faculty of Health and Medicine University of Newcastle Newcastle NSW Australia
- Gomeroi gaaynggal Centre Faculty of Health and Medicine University of Newcastle Tamworth NSW Australia
| |
Collapse
|
38
|
Antenatal diet and postpartum depressive symptoms: A prospective study. Midwifery 2018; 62:69-76. [PMID: 29655007 DOI: 10.1016/j.midw.2018.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/15/2018] [Accepted: 03/17/2018] [Indexed: 01/25/2023]
Abstract
Postnatal depression is a critical public health concern, and gaining a better understanding of possible causes is paramount. Recently, diet quality during pregnancy has emerged as a possible preventative measure in ameliorating postnatal depression, however the evidence-base exploring this association is immature. The aim of this study was to examine the association between consumption of food groups characteristic of a quality diet during pregnancy (that is fruit, vegetable and fish intake) and postnatal depressive symptoms at 12 months postpartum. Pregnant women were recruited at 10-18 weeks gestation via advertising on online pregnancy forums, pregnancy and parenting magazines, and two Australian maternity clinics. Participants (n = 253) completed self-report questionnaires assessing fruit, vegetable and fish intake as well as depressive symptoms at early- to mid- pregnancy. Path analyses were conducted to examine whether fruit, vegetable and fish intake during pregnancy were associated with depressive symptom scores at 12 months postpartum. There were no associations between fruit, vegetable or fish intake in pregnancy and postnatal depressive symptoms. Antenatal diet quality as measured by intake of food groups associated with a healthy diet was not associated with postpartum depressive symptoms at 12 months postpartum. Future research should consider the exploration of dietary quality as a measure of overall adherence to evidence-based dietary guidelines.
Collapse
|
39
|
Is dietary macronutrient composition during pregnancy associated with offspring birth weight? An observational study. Br J Nutr 2018; 119:330-339. [DOI: 10.1017/s0007114517003609] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AbstractThere is lack of evidence on the differential impact of maternal macronutrient consumption: carbohydrates (CHO), fats and protein on birth weight. We investigated the association between maternal dietary macronutrient intakes and their sub-components such as saccharides and fatty acids and birth weight. This analyses included 1,196 women with singleton pregnancies who were part of the CAffeine and REproductive health study in Leeds, UK between 2003 and 2006. Women were interviewed in each trimester. Dietary information was collected twice using a 24-h dietary recall about 8–12 weeks and 13–27 weeks of gestation. Multiple linear regression models adjusted for alcohol and smoking in trimester 1, showed that each additional 10 g/d CHO consumption was associated with an increase of 4 g (95 % CI 1, 7;P=0·003) in birth weight. Conversely, an additional 10 g/d fat intake was associated with a lower birth weight of 8 g (95 % CI 0, 16;P=0·04) when we accounted for energy contributing macronutrients in each model, and maternal height, weight, parity, ethnicity, gestational age at delivery and sex of the baby. There was no evidence of an association between protein intake and birth weight. Maternal diet in trimester 2 suggested that higher intakes of glucose (10 g/d) and lactose (1 g/d) were both associated with higher birth weight of 52 g (95 % CI 4, 100;P=0·03) and 5 g (95 % CI 2, 7;P<0·001) respectively. These results show that dietary macronutrient composition during pregnancy is associated with birth weight outcomes. An appropriately balanced intake of dietary CHO and fat during pregnancy could support optimum birth weight.
Collapse
|
40
|
Lee A, Belski R, Radcliffe J, Newton M. What do Pregnant Women Know About the Healthy Eating Guidelines for Pregnancy? A Web-Based Questionnaire. Matern Child Health J 2017; 20:2179-88. [PMID: 27395383 DOI: 10.1007/s10995-016-2071-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives This study explored nutrition knowledge of pregnant women, and how it correlated with participant characteristics, their main sources of information and changes to their diet since becoming pregnant. Methods Pregnant women residing in Australia accessing pregnancy forums on the internet were invited to complete a web-based questionnaire on general nutrition and pregnancy-specific nutrition guidelines. Results Of the 165 eligible questionnaire responses, 114 were complete and included in the analysis. Pregnancy nutrition knowledge was associated with education (r s = 0.21, p < 0.05) and income (r s = 0.21, p < 0.05). Only 2 % of pregnant women achieved nutrition knowledge scores over 80 %. Few women received nutrition advice during their pregnancy, of which most were advised by their doctor. Dietary changes adopted since becoming pregnant included consuming more fruit, vegetables, dairy and high fibre foods. Conclusions for Practice Pregnant women in this study had limited knowledge of the dietary guidelines for healthy eating during pregnancy. Furthermore, nutrition counselling in maternity care appears to be infrequent. One approach to optimising maternal diets and subsequently preventing adverse health outcomes is to enhance their knowledge of the pregnancy nutrition guidelines through the provision of nutritional counselling. Furthermore, research exploring the access and use of nutrition resources, and nutrition advice provided to pregnant women is recommended to understand how knowledge impacts on dietary behaviour.
Collapse
Affiliation(s)
- Amelia Lee
- School of Allied Health, La Trobe University, Bundoora, VIC, 3086, Australia.
- Nutrition Department, Royal Women's Hospital, Parkville, VIC, 3052, Australia.
| | - Regina Belski
- School of Allied Health, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Jessica Radcliffe
- School of Allied Health, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Michelle Newton
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, 3086, Australia
| |
Collapse
|
41
|
Moran LJ, Flynn AC, Louise J, Deussen AR, Dodd JM. The effect of a lifestyle intervention on pregnancy and postpartum dietary patterns determined by factor analysis. Obesity (Silver Spring) 2017; 25:1022-1032. [PMID: 28452404 DOI: 10.1002/oby.21848] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 03/13/2017] [Accepted: 03/17/2017] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Optimizing maternal diet during pregnancy improves maternal and infant health. This study assessed the effect of an antenatal lifestyle intervention for women with overweight or obesity on dietary patterns during pregnancy and post partum. METHODS This study is a secondary analysis of a randomized controlled trial in which pregnant women (BMI ≥ 25 kg/m2 ) received lifestyle advice (n = 943) or standard care (n = 924). Dietary pattern analysis was undertaken using factor analysis with comparisons between trial entry and 28 weeks, 36 weeks, and 4 months post partum. RESULTS The dietary pattern analysis revealed two distinct patterns: "prudent" and "Western." There was a significant difference between groups in the change over time for both patterns (P < 0.001). For the prudent score, the lifestyle group had higher scores at all times after trial entry compared with standard care, while for the Western score, the lifestyle group had a lower score at 28 weeks. The intervention effect differed based on trial entry BMI (P = 0.043) and smoking (P = 0.019), with higher prudent scores for women with obesity compared with overweight and smokers compared with nonsmokers. CONCLUSIONS The provision of an antenatal lifestyle intervention for women with overweight and obesity was associated with an improvement in dietary patterns that persisted post partum. This has important implications for the future consideration of optimal dietary intervention components to include in antenatal lifestyle interventions.
Collapse
Affiliation(s)
- Lisa J Moran
- The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Monash Centre for Health Research Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Angela C Flynn
- Division of Women's Health, King's College London, London, UK
- Division of Diabetes and Nutritional Sciences, King's College London, London, UK
| | - Jennie Louise
- The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- The University of Adelaide, School of Public Health, Adelaide, South Australia, Australia
| | - Andrea R Deussen
- The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jodie M Dodd
- The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Women's and Babies Division, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| |
Collapse
|
42
|
Malek L, Umberger WJ, Makrides M, ShaoJia Z. Predicting healthy eating intention and adherence to dietary recommendations during pregnancy in Australia using the Theory of Planned Behaviour. Appetite 2017; 116:431-441. [PMID: 28536056 DOI: 10.1016/j.appet.2017.05.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 05/16/2017] [Accepted: 05/16/2017] [Indexed: 11/29/2022]
Abstract
This study aims to aid in the development of more effective healthy eating intervention strategies for pregnant women by understanding the relationship between healthy eating intention and actual eating behaviour. Specifically, the study explored whether Theory of Planned Behaviour (TPB) constructs [attitude, subjective-norm, perceived-behavioural-control (PBC)] and additional psychosocial variables (perceived stress, health value and self-identity as a healthy eater) are useful in explaining variance in women's 1) intentions to consume a healthy diet during pregnancy and 2) food consumption behaviour (e.g. adherence to food group recommendations) during pregnancy. A cross-sectional sample of 455 Australian pregnant women completed a TPB questionnaire as part of a larger comprehensive web-based nutrition questionnaire. Women's perceived stress, health value and self-identity as a healthy eater were also measured. Dietary intake was assessed using six-items based on the 2013 Australian Dietary Guidelines. Hierarchical multiple linear regression models were estimated (significance level <0.05), which explained 70% of the variance in healthy eating intention scores and 12% of the variance in adherence to food group recommendations. TPB constructs explained 66% of the total variance in healthy eating intention. Significant predictors of stronger healthy eating intention were greater PBC and subjective norm, followed by positive attitude and stronger self-identity as a healthy eater. Conversely, TPB constructs collectively explained only 3.4% of total variance in adherence to food group recommendations. These findings reveal that the TPB framework explains considerable variance in healthy eating intention during pregnancy, but explains little variance in actual food consumption behaviour. Further research is required to understand this weak relationship between healthy eating intention and behaviour during pregnancy. Alternative behavioural frameworks, particularly those that account for the automatic nature of most dietary choices, should also be considered.
Collapse
Affiliation(s)
- Lenka Malek
- Centre for Global Food and Resources, Faculty of the Professions, The University of Adelaide, Level 6 NEXUS 10 Tower, 10 Pulteney Street, SA 5005, Australia.
| | - Wendy J Umberger
- Centre for Global Food and Resources, Faculty of the Professions, The University of Adelaide, Level 6 NEXUS 10 Tower, 10 Pulteney Street, SA 5005, Australia.
| | - Maria Makrides
- The Discipline of Paediatrics, The University of Adelaide, Women's and Children's Hospital, 72 King William Road, North Adelaide, SA 5006, Australia; Healthy Mothers, Babies and Children, South Australian Health Medical Research Institute, Women's and Children's Hospital, 72 King William Road, North Adelaide, SA 5006, Australia.
| | - Zhou ShaoJia
- The Discipline of Paediatrics, The University of Adelaide, Women's and Children's Hospital, 72 King William Road, North Adelaide, SA 5006, Australia; School of Agriculture, Food and Wine, The University of Adelaide, Waite Campus, PMB 1, Glen Osmond, SA 5064, Australia.
| |
Collapse
|
43
|
Skreden M, Bere E, Sagedal LR, Vistad I, Øverby NC. Changes in fruit and vegetable consumption habits from pre-pregnancy to early pregnancy among Norwegian women. BMC Pregnancy Childbirth 2017; 17:107. [PMID: 28376732 PMCID: PMC5381088 DOI: 10.1186/s12884-017-1291-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 03/24/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND A healthy diet is important for pregnancy outcome and the current and future health of woman and child. The aims of the study were to explore the changes from pre-pregnancy to early pregnancy in consumption of fruits and vegetables (FV), and to describe associations with maternal educational level, body mass index (BMI) and age. METHODS Healthy nulliparous women were included in the Norwegian Fit for Delivery (NFFD) trial from September 2009 to February 2013, recruited from eight antenatal clinics in southern Norway. At inclusion, in median gestational week 15 (range 9-20), 575 participants answered a food frequency questionnaire (FFQ) where they reported consumption of FV, both current intake and recollection of pre-pregnancy intake. Data were analysed using a linear mixed model. RESULTS The percentage of women consuming FV daily or more frequently in the following categories increased from pre-pregnancy to early pregnancy: vegetables on sandwiches (13 vs. 17%, p <0.01), other vegetables (11 vs. 14%, p = 0.01), fruits (apples, pears, oranges or bananas) (24 vs. 41%, p < 0.01), other fruits and berries (8 vs. 15%, p < 0.01) and fruits and vegetables as snacks (14 vs. 28%, p < 0.01). The percentage of women who reported at least daily consumption of vegetables with dinner (22% at both time points) was stable. A higher proportion of older women increased their consumption of vegetables and fruits as snacks from pre-pregnancy to early pregnancy compared to younger women (p=0.04). CONCLUSIONS We found an increase in the proportion of women consuming FV daily or more frequently from pre-pregnancy to early pregnancy. TRIAL REGISTRATION ClinicalTrials.gov database, NCT01001689 . https://clinicaltrials.gov/ct2/show/NCT01001689?term=NCT01001689&rank=1 .
Collapse
Affiliation(s)
- Marianne Skreden
- Department of Public Health, Sports and Nutrition, University of Agder, PO Box 422, 4604, Kristiansand, Norway.
| | - Elling Bere
- Department of Public Health, Sports and Nutrition, University of Agder, PO Box 422, 4604, Kristiansand, Norway
| | - Linda R Sagedal
- Department of Obstetrics and Gynaecology, Sørlandet Hospital HF, PO Box 416, 4604, Kristiansand, Norway.,Department of Research, Sørlandet Hospital HF, PO Box 416, 4604, Kristiansand, Norway
| | - Ingvild Vistad
- Department of Obstetrics and Gynaecology, Sørlandet Hospital HF, PO Box 416, 4604, Kristiansand, Norway.,Department of Research, Sørlandet Hospital HF, PO Box 416, 4604, Kristiansand, Norway
| | - Nina C Øverby
- Department of Public Health, Sports and Nutrition, University of Agder, PO Box 422, 4604, Kristiansand, Norway
| |
Collapse
|
44
|
Kadawathagedara M, Kersuzan C, Wagner S, Tichit C, Gojard S, Charles MA, Lioret S, de Lauzon-Guillain B. Adéquation des consommations alimentaires des femmes enceintes de l’étude ELFE aux recommandations du Programme national nutrition santé. CAHIERS DE NUTRITION ET DE DIETETIQUE 2017. [DOI: 10.1016/j.cnd.2016.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
45
|
Bodnar LM, Simhan HN, Parker CB, Meier H, Mercer BM, Grobman WA, Haas DM, Wing DA, Hoffman MK, Parry S, Silver RM, Saade GR, Wapner R, Iams JD, Wadhwa PD, Elovitz M, Peaceman AM, Esplin S, Barnes S, Reddy UM. Racial or Ethnic and Socioeconomic Inequalities in Adherence to National Dietary Guidance in a Large Cohort of US Pregnant Women. J Acad Nutr Diet 2017; 117:867-877.e3. [PMID: 28320597 DOI: 10.1016/j.jand.2017.01.016] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 01/19/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The significance of periconceptional nutrition for optimizing offspring and maternal health and reducing social inequalities warrants greater understanding of diet quality among US women. OBJECTIVE Our objective was to evaluate racial or ethnic and education inequalities in periconceptional diet quality and sources of energy and micronutrients. DESIGN Cross-sectional analysis of data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort. PARTICIPANTS AND SETTING Nulliparous women (N=7,511) were enrolled across eight US medical centers from 2010 to 2013. MAIN OUTCOME MEASURES A semiquantitative food frequency questionnaire assessing usual dietary intake during the 3 months around conception was self-administered during the first trimester. Diet quality, measured using the Healthy Eating Index-2010 (HEI-2010), and sources of energy and micronutrients were the outcomes. STATISTICAL ANALYSES Differences in diet quality were tested across maternal racial or ethnic and education groups using F tests associated with analysis of variance and χ2 tests. RESULTS HEI-2010 score increased with higher education, but the increase among non-Hispanic black women was smaller than among non-Hispanic whites and Hispanics (interaction P value <0.0001). For all groups, average scores for HEI-2010 components were below recommendations. Top sources of energy were sugar-sweetened beverages, pasta dishes, and grain desserts, but sources varied by race or ethnicity and education. Approximately 34% of energy consumed was from empty calories (the sum of energy from added sugars, solid fats, and alcohol beyond moderate levels). The primary sources of iron, folate, and vitamin C were juices and enriched breads. CONCLUSIONS Diet quality is suboptimal around conception, particularly among women who are non-Hispanic black, Hispanic, or who had less than a college degree. Diet quality could be improved by substituting intakes of refined grains and foods empty in calories with vegetables, peas and beans (legumes), seafood, and whole grains.
Collapse
|
46
|
Flynn AC, Seed PT, Patel N, Barr S, Bell R, Briley AL, Godfrey KM, Nelson SM, Oteng-Ntim E, Robinson SM, Sanders TA, Sattar N, Wardle J, Poston L, Goff LM. Dietary patterns in obese pregnant women; influence of a behavioral intervention of diet and physical activity in the UPBEAT randomized controlled trial. Int J Behav Nutr Phys Act 2016; 13:124. [PMID: 27894316 PMCID: PMC5126873 DOI: 10.1186/s12966-016-0450-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/21/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Understanding dietary patterns in obese pregnant women will inform future intervention strategies to improve pregnancy outcomes and the health of the child. The aim of this study was to investigate the effect of a behavioral intervention of diet and physical activity advice on dietary patterns in obese pregnant woman participating in the UPBEAT study, and to explore associations of dietary patterns with pregnancy outcomes. METHODS In the UPBEAT randomized controlled trial, pregnant obese women from eight UK multi-ethnic, inner-city populations were randomly assigned to receive a diet/physical activity intervention or standard antenatal care. The dietary intervention aimed to reduce glycemic load and saturated fat intake. Diet was assessed using a food frequency questionnaire (FFQ) at baseline (15+0-18+6 weeks' gestation), post intervention (27+0-28+6 weeks) and in late pregnancy (34+0-36+0 weeks). Dietary patterns were characterized using factor analysis of the baseline FFQ data, and changes compared in the control and intervention arms. Patterns were related to pregnancy outcomes in the combined control/intervention cohort (n = 1023). RESULTS Four distinct baseline dietary patterns were defined; Fruit and vegetables, African/Caribbean, Processed, and Snacks, which were differently associated with social and demographic factors. The UPBEAT intervention significantly reduced the Processed (-0.14; 95% CI -0.19, -0.08, P <0.0001) and Snacks (-0.24; 95% CI -0.31, -0.17, P <0.0001) pattern scores. In the adjusted model, baseline scores for the African/Caribbean (quartile 4 compared with quartile 1: OR = 2.46; 95% CI 1.41, 4.30) and Processed (quartile 4 compared with quartile 1: OR = 2.05; 95% CI 1.23, 3.41) patterns in the entire cohort were associated with increased risk of gestational diabetes. CONCLUSIONS In a diverse cohort of obese pregnant women an intensive dietary intervention improved Processed and Snack dietary pattern scores. African/Caribbean and Processed patterns were associated with an increased risk of gestational diabetes, and provide potential targets for future interventions. TRIAL REGISTRATION Current controlled trials; ISRCTN89971375.
Collapse
Affiliation(s)
- Angela C Flynn
- Division of Women's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, UK.,Division of Diabetes and Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, UK
| | - Paul T Seed
- Division of Women's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, UK
| | - Nashita Patel
- Division of Women's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, UK
| | - Suzanne Barr
- Department of Cardiovascular Medicine, Imperial College London, London, UK
| | - Ruth Bell
- Institute of Health & Society Newcastle University, UK Baddiley-Clark Building Richardson Road, Newcastle upon Tyne, UK
| | - Annette L Briley
- Division of Women's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, UK
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Mailpoint 95, Southampton, UK
| | - Scott M Nelson
- School of Medicine, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, UK
| | - Eugene Oteng-Ntim
- Guys and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, UK
| | - Sian M Robinson
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Mailpoint 95, Southampton, UK
| | - Thomas A Sanders
- Division of Diabetes and Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, RC214 Level C2, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Institute of Epidemiology and Health, University College London, 1-19 Torrington Place, London, UK
| | - Lucilla Poston
- Division of Women's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, UK
| | - Louise M Goff
- Division of Diabetes and Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, UK.
| | | |
Collapse
|
47
|
Flynn AC, Dalrymple K, Barr S, Poston L, Goff LM, Rogozińska E, van Poppel MNM, Rayanagoudar G, Yeo S, Barakat Carballo R, Perales M, Bogaerts A, Cecatti JG, Dodd J, Owens J, Devlieger R, Teede H, Haakstad L, Motahari-Tabari N, Tonstad S, Luoto R, Guelfi K, Petrella E, Phelan S, Scudeller TT, Hauner H, Renault K, Sagedal LR, Stafne SN, Vinter C, Astrup A, Geiker NRW, McAuliffe FM, Mol BW, Thangaratinam S. Dietary interventions in overweight and obese pregnant women: a systematic review of the content, delivery, and outcomes of randomized controlled trials. Nutr Rev 2016; 74:312-28. [PMID: 27083868 DOI: 10.1093/nutrit/nuw005] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
CONTEXT Interventions targeting maternal obesity are a healthcare and public health priority. OBJECTIVE The objective of this review was to evaluate the adequacy and effectiveness of the methodological designs implemented in dietary intervention trials for obesity in pregnancy. DATA SOURCES A systematic review of the literature, consistent with PRISMA guidelines, was performed as part of the International Weight Management in Pregnancy collaboration. STUDY SELECTION Thirteen randomized controlled trials, which aimed to modify diet and physical activity in overweight and obese pregnant women, were identified. DATA SYNTHESIS There was significant variability in the content, delivery, and dietary assessment methods of the dietary interventions examined. A number of studies demonstrated improved dietary behavior in response to diet and/or lifestyle interventions. Nine studies reduced gestational weight gain. CONCLUSION This review reveals large methodological variability in dietary interventions to control gestational weight gain and improve clinical outcomes in overweight and obese pregnant women. This lack of consensus limits the ability to develop clinical guidelines and apply the evidence in clinical practice.
Collapse
Affiliation(s)
- Angela C Flynn
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Kathryn Dalrymple
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Suzanne Barr
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Lucilla Poston
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Louise M Goff
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Ewelina Rogozińska
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Mireille N M van Poppel
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Girish Rayanagoudar
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - SeonAe Yeo
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Ruben Barakat Carballo
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Maria Perales
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Annick Bogaerts
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Jose G Cecatti
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Jodie Dodd
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Julie Owens
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Roland Devlieger
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Helena Teede
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Lene Haakstad
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Narges Motahari-Tabari
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Serena Tonstad
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Riitta Luoto
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Kym Guelfi
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Elisabetta Petrella
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Suzanne Phelan
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Tânia T Scudeller
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Hans Hauner
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Kristina Renault
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Linda Reme Sagedal
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Signe N Stafne
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Christina Vinter
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Arne Astrup
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Nina R W Geiker
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Fionnuala M McAuliffe
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Ben W Mol
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Shakila Thangaratinam
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | | |
Collapse
|
48
|
Effect of a diet intervention during pregnancy on dietary behavior in the randomized controlled Norwegian Fit for Delivery study. J Dev Orig Health Dis 2016; 7:538-547. [PMID: 27307037 DOI: 10.1017/s2040174416000258] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A mother's diet during pregnancy has the potential to influence both her own and her child's short- and long-term health. This paper reports the effects of a randomized controlled diet intervention during pregnancy on dietary behavior post-intervention as reported in late pregnancy. The diet intervention was part of a lifestyle intervention targeting both diet and physical activity behaviors among nulliparous women participating in the randomized controlled Norwegian Fit for Delivery study (NFFD). Eligible women were enrolled in early pregnancy from eight healthcare clinics in southern Norway between 2009 and 2013. The diet intervention was based on 10 dietary recommendations that were conveyed during two counseling sessions by phone and in a pamphlet describing the recommendations and their simplified rationale. A diet score was constructed from a 43-item food frequency questionnaire (FFQ) and used to assess intervention effect on dietary behavior (score range 0-10). Between-group dietary differences post-intervention were estimated with analysis of covariance, with adjustment for baseline diet. A total of 508 women completed the FFQ both at baseline and post-intervention. There were no between-group differences in diet score and subscales at baseline. Post-intervention, the intervention group had higher overall diet score (control: 4.61, intervention: 5.04, P=0.013) and favorable dietary behavior in seven of the 10 dietary domains: 'consumption of water relative to total beverage consumption' (P=0.002), 'having vegetables with dinner' (P=0.027), 'choosing fruits and vegetables for between-meal snacks' (P=0.023), 'buying small portion sizes of unhealthy foods' (P=0.010), 'limiting sugar intake' (P=0.005), 'avoiding eating beyond satiety' (P=0.009) and 'reading food labels' (P=0.011). The NFFD diet intervention improved dietary behavior. Potential long-term clinical influence in mother and child will be investigated in further studies.
Collapse
|
49
|
Nyström HF, Brantsæter AL, Erlund I, Gunnarsdottir I, Hulthén L, Laurberg P, Mattisson I, Rasmussen LB, Virtanen S, Meltzer HM. Iodine status in the Nordic countries - past and present. Food Nutr Res 2016; 60:31969. [PMID: 27283870 PMCID: PMC4901513 DOI: 10.3402/fnr.v60.31969] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/08/2016] [Accepted: 05/09/2016] [Indexed: 11/19/2022] Open
Abstract
Background Adequate iodine nutrition is dependent on ground water content, seafood, and, as many countries use iodized cow fodder, dairy products. In most countries, salt fortification programs are needed to assure adequate iodine intake. Objectives The objectives are threefold: 1) to describe the past and present iodine situation in the Nordic countries, 2) to identify important gaps of knowledge, and 3) to highlight differences among the Nordic countries’ iodine biomonitoring and fortification policies. Design Historical data are compared with the current situation. The Nordic countries’ strategies to achieve recommended intake and urine iodine levels and their respective success rates are evaluated. Results In the past, the iodine situation ranged from excellent in Iceland to widespread goiter and cretinism in large areas of Sweden. The situation was less severe in Norway and Finland. According to a 1960 World Health Organization (WHO) report, there were then no observations of iodine deficiency in Denmark. In Sweden and Finland, the fortification of table salt was introduced 50–75 years ago, and in Norway and Finland, the fortification of cow fodder starting in the 1950s helped improve the population's iodine status due to the high intake of milk. In Denmark, iodine has been added to household salt and salt in bread for the past 15 years. The Nordic countries differ with regard to regulations and degree of governmental involvement. There are indications that pregnant and lactating women, the two most vulnerable groups, are mildly deficient in iodine in several of the Nordic countries. Conclusion The Nordic countries employ different strategies to attain adequate iodine nutrition. The situation is not optimal and is in need of re-evaluation. Iodine researchers, Nordic national food administrations, and Nordic governmental institutions would benefit from collaboration to attain a broader approach and guarantee good iodine health for all.
Collapse
Affiliation(s)
- Helena Filipsson Nyström
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden;
| | | | - Iris Erlund
- National Institute for Health and Welfare, Helsinki, Finland
| | - Ingibjörg Gunnarsdottir
- Unit for Nutrition Research, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland
| | - Lena Hulthén
- Department of Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Laurberg
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Lone Banke Rasmussen
- Department of Endocrinology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Suvi Virtanen
- National Institute for Health and Welfare, Helsinki, Finland.,School of Health Sciences, University of Tampere, Finland
| | | |
Collapse
|
50
|
Stang J, Huffman LG. Position of the Academy of Nutrition and Dietetics: Obesity, Reproduction, and Pregnancy Outcomes. J Acad Nutr Diet 2016; 116:677-91. [DOI: 10.1016/j.jand.2016.01.008] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Indexed: 10/22/2022]
|