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Umehara K, Nakanishi S, Kojima T, Yamamoto M, Shindo R, Obata S, Miyagi E, Aoki S. Impact of changes in recommendation of optimal gestational weight gain in Japan: A retrospective study in a single tertiary center. J Obstet Gynaecol Res 2024. [PMID: 39104004 DOI: 10.1111/jog.16040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/16/2024] [Indexed: 08/07/2024]
Abstract
AIM In March 2021, the Japanese Ministry of Health, Labour and Welfare revised the optimal gestational weight gain standards. In this study, we examined whether this revision affected gestational weight gain and low birth weight rates. METHODS We analyzed the records of singleton pregnant women who underwent checkups from their 1st trimester and delivered at our institute after 37 weeks between 2020 and 2021 (before the revision) and between 2022 and 2023 (after the revision). Pregnancy outcomes were assessed in the following four groups stratified by pre-pregnancy body mass index (BMI): underweight (BMI: <18.5 kg/m2), normal-weight (BMI: 18.5-24.9 kg/m2), overweight (BMI: 25-29.9 kg/m2), and obese (BMI: ≥30 kg/m2). Leaflets on the optimal gestational weight gain standards for each group were distributed to all pregnant women at the first prenatal checkup. RESULTS In each group, gestational weight gain did not change before and after the revision, with the corresponding values of 10.8 kg and 11.1 kg in the underweight (p = 0.94), 10.7 kg and 10.4 kg in the normal weight (p = 0.14), 9.7 kg and 9.2 kg in the overweight (p = 0.32), and 7.4 kg and 6.7 kg in the obese (p = 0.44) groups. Furthermore, the prevalence of low birth weight did not decrease in all groups. CONCLUSIONS No significant differences in gestational weight gain or low birth weight were observed after the revision of the 2021 gestational weight gain recommendations. Merely distributing leaflets to pregnant women may not be sufficient to improve gestational weight gain or reduce low birth weight rates.
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Affiliation(s)
- Kotono Umehara
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Sayuri Nakanishi
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Tomoyuki Kojima
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Masafumi Yamamoto
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryosuke Shindo
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Soichiro Obata
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shigeru Aoki
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
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Wang L, Zou L, Yi H, Li T, Zhou R, Yang J, Wang J, Zhang C, Guo H. The implementation of online and offline hybrid weight management approach for pregnant women based on the Fogg behavior model in Hainan, China: a pilot randomized controlled trial. BMC Pregnancy Childbirth 2024; 24:516. [PMID: 39080659 PMCID: PMC11289958 DOI: 10.1186/s12884-024-06699-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 07/15/2024] [Indexed: 08/02/2024] Open
Abstract
OBJECTIVE This study aimed at evaluating the effects of online and offline hybrid weight management approach based on the Fogg behavior model on total gestational weight gain and perinatal outcomes. METHODS Pregnant women in Hainan, the southernmost province of China, were recruited into a randomized controlled trial, which was designed to develop a WeChat platform for pregnancy weight management, and implement individualized and continuous pregnancy weight management services for pregnant women under the guidance of the Fogg behavior model. All pregnant women participating in the study were included in the full analysis set (FAS) for analysis. The pregnant women who completed the intervention and provided all outcome indicators were included in the per protocol set (PPS) for outcome evaluation. RESULTS Fifty-eight pregnant women were included in FAS analysis, and 52 pregnant women were finally included in PPS analysis. There was no statistically significant difference (P > 0.05) between the two groups at baseline. The gestational weight gain of the intervention group was significantly lower than that of the control group (P < 0.05). In the control group, the rate of appropriate weight gain during pregnancy was 48.26%, the rate of appropriate weight gain during pregnancy was 93.30% in the intervention group, with a statistically significant difference (P < 0.05). In the delivery outcomes, the cesarean section rate in the intervention group was significantly lower than that in the control group, and the differences were statistically significant (P < 0.05). The incidence of gestational diabetes mellitus and gestational hypertension in the intervention group was lower than those in the control group, and the differences were statistically significant (P < 0.05). The neonatal weight and incidence of macrosomia of the intervention group were lower than that of the control group, and the difference was statistically significant (P < 0.05). CONCLUSIONS This study combined the individualized and continuous pregnancy weight management of the online WeChat platform and offline consultation based on the Fogg behavior model, showing great potential in improving maternal and infant outcomes. TRIAL REGISTRATION The study was registered with www.chictr.org.cn/index.aspx , Chinese Clinical Trial Registry (ChiCTR2200066707, 2022-12-14, retrospectively registered).
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Affiliation(s)
- Linjie Wang
- International Nursing School, Hainan Medical University, Longhua District, No.3 Xueyuan Road, Haikou, 571199, Hainan Province, China
| | - Lanli Zou
- International Nursing School, Hainan Medical University, Longhua District, No.3 Xueyuan Road, Haikou, 571199, Hainan Province, China
| | - Huanying Yi
- International Nursing School, Hainan Medical University, Longhua District, No.3 Xueyuan Road, Haikou, 571199, Hainan Province, China
| | - Tong Li
- International Nursing School, Hainan Medical University, Longhua District, No.3 Xueyuan Road, Haikou, 571199, Hainan Province, China
| | - Rong Zhou
- International Nursing School, Hainan Medical University, Longhua District, No.3 Xueyuan Road, Haikou, 571199, Hainan Province, China
| | - Jing Yang
- International Nursing School, Hainan Medical University, Longhua District, No.3 Xueyuan Road, Haikou, 571199, Hainan Province, China
| | - Jia Wang
- International Nursing School, Hainan Medical University, Longhua District, No.3 Xueyuan Road, Haikou, 571199, Hainan Province, China
| | - Caihong Zhang
- International Nursing School, Hainan Medical University, Longhua District, No.3 Xueyuan Road, Haikou, 571199, Hainan Province, China.
| | - Honghua Guo
- International Nursing School, Hainan Medical University, Longhua District, No.3 Xueyuan Road, Haikou, 571199, Hainan Province, China.
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Peña A, Miller AM, Campbell AG, Holden RJ, Scifres CM. Mapping Lifestyle Interventions for Gestational Diabetes Prevention: A Scoping Review. Curr Diab Rep 2024; 24:74-83. [PMID: 38367172 DOI: 10.1007/s11892-024-01535-5] [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] [Accepted: 02/01/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE OF REVIEW The purpose of this study was to conduct a scoping review to map intervention, sample, and physiologic measurement characteristics of lifestyle interventions for gestational diabetes mellitus (GDM) prevention. RECENT FINDINGS A total of 19 studies met selection criteria from 405 articles screened (PubMed, Web of Science). No studies were US-based (47% multi-site), and all were delivered in clinical settings. The most targeted nutrition components were low carbohydrate intake (sugar rich foods/added sugars, low glycemic index), low fat intake (mainly low-fat meat, dairy, and saturated fat), and increased fruits and vegetables. Many studies promoted 150 min/week moderate-intensity physical activity. Only two studies provided supervised physical activity sessions. Dietitians and nurses were the most common implementers. Samples were characterized as adults with obesity (mean age 31 yr, BMI 31 kg/m2). Asian populations were predominantly studied. Four studies used theoretical frameworks (75% of which used Social Cognitive Theory). GDM diagnostic criteria set forth by the American Diabetes Association were the most widely used. Insulin sensitivity was commonly assessed via fasting indices. There was a lack of multi-disciplinary, multi-level, and theory-based lifestyle interventions for reducing GDM risk. Addressing these gaps and prioritizing high-risk populations in the US with measurement of traditional and novel biomarkers will advance the field.
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Affiliation(s)
- Armando Peña
- Department of Health & Wellness Design, School of Public Health in Bloomington, Indiana University, Bloomington, IN, USA.
| | - Alison M Miller
- Department of Health & Wellness Design, School of Public Health in Bloomington, Indiana University, Bloomington, IN, USA
| | - Angela G Campbell
- Applied Health Sciences, School of Public Health in Bloomington, Indiana University, Bloomington, IN, USA
| | - Richard J Holden
- Department of Health & Wellness Design, School of Public Health in Bloomington, Indiana University, Bloomington, IN, USA
| | - Christina M Scifres
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, IN, USA
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Fong M, Kenny RPW, Thomson K, Jesurasa A, Lavans A, Patterson M, Sermin-Reed L, Nguyen G, Aquino MRJ, Cullen E, O'Keefe H, Moffat M, Heslehurst N. Effectiveness and implementation of lower-intensity weight management interventions delivered by the non-specialist workforce in postnatal women: a mixed-methods systematic review. Front Public Health 2024; 12:1359680. [PMID: 38605879 PMCID: PMC11008719 DOI: 10.3389/fpubh.2024.1359680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/14/2024] [Indexed: 04/13/2024] Open
Abstract
Lower-intensity interventions delivered in primary and community care contacts could provide more equitable and scalable weight management support for postnatal women. This mixed-methods systematic review aimed to explore the effectiveness, implementation, and experiences of lower-intensity weight management support delivered by the non-specialist workforce. We included quantitative and qualitative studies of any design that evaluated a lower-intensity weight management intervention delivered by non-specialist workforce in women up to 5 years post-natal, and where intervention effectiveness (weight-related and/or behavioural outcomes), implementation and/or acceptability were reported. PRISMA guidelines were followed, and the review was prospectively registered on PROSPERO (CRD42022371828). Nine electronic databases were searched to identify literature published between database inception to January 2023. This was supplemented with grey literature searches and citation chaining for all included studies and related reviews (completed June 2023). Screening, data extraction and risk of bias assessments were performed in duplicate. Risk of bias was assessed using the Joanna Briggs Institute appraisal tools. Narrative methods were used to synthesise outcomes. Seven unique studies described in 11 reports were included from the Netherlands (n = 2), and the United Kingdom, Germany, Taiwan, Finland, and the United States (n = 1 each). All studies reported weight-related outcomes; four reported diet; four reported physical activity; four reported intervention implementation and process outcomes; and two reported intervention acceptability and experiences. The longest follow-up was 13-months postnatal. Interventions had mixed effects on weight-related outcomes: three studies reported greater weight reduction and/or lower postnatal weight retention in the intervention group, whereas four found no difference or mixed effects. Most studies reporting physical activity or diet outcomes showed no intervention effect, or mixed effects. Interventions were generally perceived as acceptable by women and care providers, although providers had concerns about translation into routine practice. The main limitations of the review were the limited volume of evidence available, and significant heterogeneity in interventions and outcome reporting which limited meaningful comparisons across studies. There is a need for more intervention studies, including process evaluations, with longer follow-up in the postnatal period to understand the role of primary and community care in supporting women's weight management. Public Health Wales was the primary funder of this review.
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Affiliation(s)
- Mackenzie Fong
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Applied Research Collaboration (ARC) North East and North Cumbria, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
| | - Ryan Patrick William Kenny
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Innovation Observatory, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Evidence Synthesis Group, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Katie Thomson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Applied Research Collaboration (ARC) North East and North Cumbria, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
- NIHR Innovation Observatory, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Evidence Synthesis Group, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Amrita Jesurasa
- Primary Care Division, Public Health Wales, Cardiff, United Kingdom
| | - Amber Lavans
- Primary Care Division, Public Health Wales, Cardiff, United Kingdom
| | - Maddey Patterson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Applied Research Collaboration (ARC) North East and North Cumbria, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
| | - Letitia Sermin-Reed
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Applied Research Collaboration (ARC) North East and North Cumbria, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
| | - Giang Nguyen
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
| | - Maria Raisa Jessica Aquino
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
| | - Emer Cullen
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Hannah O'Keefe
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Innovation Observatory, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Evidence Synthesis Group, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Malcolm Moffat
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
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Mavroeidi I, Manta A, Asimakopoulou A, Syrigos A, Paschou SA, Vlachaki E, Nastos C, Kalantaridou S, Peppa M. The Role of the Glycemic Index and Glycemic Load in the Dietary Approach of Gestational Diabetes Mellitus. Nutrients 2024; 16:399. [PMID: 38337683 PMCID: PMC10857473 DOI: 10.3390/nu16030399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
Gestational diabetes mellitus (GDM) is a common metabolic disorder that often develops during pregnancy, characterized by glucose intolerance and insulin resistance (IR). To ensure the well-being of both the mother and the fetus, the body undergoes multiple metabolic and immunological changes that result in peripheral IR and, under certain hereditary or acquired abnormalities, GDM in predisposed women. The adverse short- and long-term effects of GDM impact both the mother and the fetus. Nutrition seems to play an important role to prevent GDM or improve its evolution. An emphasis has been given to the proportion of carbohydrates (CHO) relative to protein and lipids, as well as dietary patterns, in GDM. The effects of CHO on postprandial glucose concentrations are reflected in the glycemic index (GI) and glycemic load (GL). Diets rich in GI and GL may induce or exacerbate IR, whereas diets low in GI and GL appear to enhance insulin sensitivity and improve glycemic control. These positive outcomes may be attributed to direct interactions with insulin and glucose homeostasis or indirect effects through improved body composition and weight management. This comprehensive narrative review aims to explore the significance of nutrition, with a focus on the critical evaluation of GI and GL in the dietary management of women with GDM.
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Affiliation(s)
- Ioanna Mavroeidi
- Endocrine Unit, 2nd Propaedeutic Department of Internal Medicine, Research Institute and Diabetes Center, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12461 Athens, Greece
| | - Aspasia Manta
- Endocrine Unit, 2nd Propaedeutic Department of Internal Medicine, Research Institute and Diabetes Center, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12461 Athens, Greece
| | - Athina Asimakopoulou
- 3rd Department of Internal Medicine, Sotiria General Hospital, 11527 Athens, Greece
| | - Alexandros Syrigos
- 3rd Department of Internal Medicine, Sotiria General Hospital, 11527 Athens, Greece
| | - Stavroula A Paschou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Efthimia Vlachaki
- Hematological Laboratory, 2nd Department of Internal Medicine, Hippokrateion Hospital, Aristotle University, 54640 Thessaloniki, Greece
| | - Constantinos Nastos
- 3rd Department of Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12461 Athens, Greece
| | - Sophia Kalantaridou
- Department of Obstetrics and Gynecology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12461 Athens, Greece
| | - Melpomeni Peppa
- Endocrine Unit, 2nd Propaedeutic Department of Internal Medicine, Research Institute and Diabetes Center, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12461 Athens, Greece
- 3rd Department of Internal Medicine, Sotiria General Hospital, 11527 Athens, Greece
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Abdolalipour S, Mousavi S, Hadian T, Meedya S, Mohammad‐Alizadeh‐Charandabi S, Mohammadi E, Mirghafourvand M. Adolescent pregnant women's perception of health practices: A qualitative study. Nurs Open 2023; 10:6186-6196. [PMID: 37209034 PMCID: PMC10416080 DOI: 10.1002/nop2.1852] [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: 06/08/2022] [Revised: 01/14/2023] [Accepted: 05/07/2023] [Indexed: 05/21/2023] Open
Abstract
AIM To explore adolescent pregnant women's perception of health practices. DESIGN A qualitative study. METHOD Fifteen pregnant women in Tehran (capital of Iran) were selected based on purposive sampling to participate in semi-structured, in-depth interviews. The content of interviews was recorded and transcribed and then analysed using conventional content analysis. RESULTS The first theme extracted was health practice with main categories of balanced rest/activity pattern, observance of an appropriate diet, sensitivity to personal health, observance of an appropriate pattern of social interactions, religious and spiritual orientations, recreational and leisure time activities, and stress management; second theme was perceived benefits with main categories of a sense of physical health improvement, a sense of mental health improvement, positive attitudes towards the effect of nutrition on pregnancy and childbirth health; and third theme was effective factors with main categories of facilitators of health practices and inhibitors of health practices. CONCLUSIONS Most pregnant adolescents' perception of health practices is at a satisfactory level; however, some inhibitors of health practice were explored in this study. These should be improved by adopting appropriate approaches in health policies. No Patient or Public Contribution.
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Affiliation(s)
- Somyieh Abdolalipour
- Department of Midwifery, Faculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
| | - Sanaz Mousavi
- Women Reproductive Health Research CenterTabriz University of Medical SciencesTabrizIran
| | - Tahereh Hadian
- Departement of MidwiferyIslamic Azad University, Tehran Medical BranchTehranIran
| | - Shahla Meedya
- South Asia Infant Feeding Research Network (SAIFRN), School of Nursing, Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
| | | | - Eesa Mohammadi
- Department of Nursing, School of MedicineTarbiat Modares UniversityTehranIran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Faculty of Nursing and MidwiferyTabriz University of Medical sciencesTabrizIran
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Dickert JJ, Mbang Springer DL, von Kaisenberg C, Hillemanns P, de Zwaan M, Brodowski L. Comprehensive Questionnaire in Postpartum Women to Assess Women's Knowledge of the Current Weight Gain Guidelines during Pregnancy in Lower Saxony. Obes Facts 2023; 16:576-587. [PMID: 37647859 PMCID: PMC10697741 DOI: 10.1159/000533276] [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: 11/30/2022] [Accepted: 07/21/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION Maternal body mass index and gestational weight gain (GWG) are important factors for maternal and neonatal health. The objective of this study was to assess women's knowledge and examine adherence to the Institute of Medicine (IOM) criteria for weight gain during pregnancy by evaluating the information received from obstetricians and women's knowledge about GWG. METHODS This is an analytical semi-longitudinal observational study. Weight data from a nonconsecutive convenience sample of 389 women who gave birth at the Hannover Medical School in the period from August 2020 to July 2021 were taken from their maternal records. Immediately after giving birth, the whole collective (n = 389) was asked to participate in a questionnaire study including questions that were taken from the EMat Health Survey inquiring about their knowledge and received information about GWG and about their eating behavior. Here, a subset of 202 women participated. RESULTS Sixty-five percent of the participants who answered the questionnaire reported that they had not been informed by their obstetrician about GWG recommendations. Additionally, a minority of women knew the correct IOM GWG category based on their pre-pregnancy weight. Meeting the IOM GWG guidelines did not depend on whether or not women received GWG recommendations or knew about the correct GWG category. The majority of women were not concerned about gaining too much weight during pregnancy. 20.7% of all women participating in the study were affected by obesity pre-pregnancy. According to the IOM criteria for GWG, 50.4% gained too much weight. The proportion of women exceeding IOM recommendations was highest in women with pre-pregnancy overweight and obesity (67%). DISCUSSION Weight gain outside of the IOM recommendations is widespread in our survey. Information received and knowledge about GWG recommendations were inadequate in our sample. Considering the fact that GWG outside recommended ranges can contribute to short- and long-term health complications, especially when a woman enters pregnancy already with overweight or obesity, identifying ways of achieving a healthier GWG is warranted.
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Affiliation(s)
- Jennifer Jessica Dickert
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Daliah Laura Mbang Springer
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | | | - Peter Hillemanns
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Lars Brodowski
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
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Knoke J, Raab R, Geyer K, Spies M, Haller B, Hauner H. Antibiotic Treatment During Pregnancy and the First Six Months Postpartum - a Secondary Analysis of the "Healthy Living in Pregnancy" (GeliS) Study. Geburtshilfe Frauenheilkd 2023; 83:850-861. [PMID: 37564896 PMCID: PMC10410684 DOI: 10.1055/a-2091-0620] [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] [Received: 11/12/2022] [Accepted: 05/06/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction Antibiotic therapies for the treatment of bacterial infections pose a particular challenge during pregnancy and breastfeeding. For Germany, there is hardly any information on the frequency of antibiotic use during this phase. Our analysis uses data from the "Healthy Living in Pregnancy" (GeliS) study to describe antibiotic treatments during pregnancy and in the first six months after birth (postpartum), and to compare their use with existing recommendations. Methods This is a retrospective secondary analysis of the GeliS study. In the cluster randomized lifestyle intervention study, detailed information on antibiotic therapies during pregnancy and postpartum was collected using surveys. Chi-square tests and generalized estimating equations were used for evaluation. Results Of the 1636 women included in the analysis, 21% reported antibiotic treatment at least once during pregnancy (14%) or in the first six months postpartum (7%). During pregnancy, the antibiotic therapies of women increased from 1.7% in the first trimester to 6.5% in the third trimester. Common reasons for treatment were urinary tract infections (7.3% of women), ear, nose, throat (ENT) infections (3.6%), and birth complications (2.6%). The information on the prescribed preparations corresponded to the current recommendations. A significant increase in the frequency of treatment with antibiotics was observed in the lifestyle intervention group (p < 0.001), in participants without a partner (p < 0.001), and in women who breastfed their children (p = 0.005) or gave birth by caesarean section (p = 0.003) or prematurely (p = 0.012). Other socioeconomic or lifestyle factors were not significant. Conclusion Approximately one in five women receives at least one antibiotic treatment during pregnancy and breastfeeding that meets current treatment recommendations. Treatment with antibiotics is more common in premature births, caesarean sections, and breastfeeding women.
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Affiliation(s)
- Johanna Knoke
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München,
Germany
| | - Roxana Raab
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München,
Germany
| | - Kristina Geyer
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München,
Germany
| | - Monika Spies
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München,
Germany
| | - Bernhard Haller
- Institut für KI und Informatik in der Medizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Hans Hauner
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München,
Germany
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9
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Mohammed AK. Impact of Pre-pregnancy Body Mass Index and Gestational Weight Gain with Mode of Delivery on Health Behavior of Primigravida Women. Am J Health Behav 2023; 47:579-587. [PMID: 37596743 DOI: 10.5993/ajhb.47.3.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
Objective: This research was conducted to analyze the relationship between maternal body mass index (BMI) before pregnancy and weight gain in childbirth. This research is also an approach to understand women health behavior for BMI. Methods: In this descriptive analysis of 588 singleton pregnancies, their pre-pregnancy BMI was measured and gestational weight growth in the third trimester, all reserved pregnant women were tracked, and the method of delivery was recorded in Maternity Teaching Hospital from February to December 2020. The data collected throughout the investigation were analyzed using the SPSS 25 package application. Results: According to the study's findings, the average age of women was 24.4 years old, with a standard deviation of 5.04. About 66% of women had standard BMI, 17.56% were underweight, 10.13% were overweight, and 6.08% were obese. Conclusion: A statistically significant association was discovered between maternal weight during pregnancy and mode of delivery in this study. The study highlighted that women health behavior is significant factor to improve their BMI during pregnancy and delivery.
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Affiliation(s)
- Atiya Kareem Mohammed
- Department of Maternal Neonatal Nursing, College of Nursing, University of Sulaimani, Sulaimaniyah, Republic of Iraq
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Harrison CL, Bahri Khomami M, Enticott J, Thangaratinam S, Rogozińska E, Teede HJ. Key Components of Antenatal Lifestyle Interventions to Optimize Gestational Weight Gain: Secondary Analysis of a Systematic Review. JAMA Netw Open 2023; 6:e2318031. [PMID: 37326994 PMCID: PMC10276313 DOI: 10.1001/jamanetworkopen.2023.18031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/27/2023] [Indexed: 06/17/2023] Open
Abstract
Importance Randomized clinical trials have found that antenatal lifestyle interventions optimize gestational weight gain (GWG) and pregnancy outcomes. However, key components of successful interventions for implementation have not been systematically identified. Objective To evaluate intervention components using the Template for Intervention Description and Replication (TIDieR) framework to inform implementation of antenatal lifestyle interventions in routine antenatal care. Data Sources Included studies were drawn from a recently published systematic review on the efficacy of antenatal lifestyle interventions for optimizing GWG. The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, MEDLINE, and Embase were searched from January 1990 to May 2020. Study Selection Randomized clinical trials examining efficacy of antenatal lifestyle interventions in optimizing GWG were included. Data Extraction and Synthesis Random effects meta-analyses were used to evaluate the association of intervention characteristics with efficacy of antenatal lifestyle interventions in optimizing GWG. The results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Data extraction was performed by 2 independent reviewers. Main Outcomes and Measures The main outcome was mean GWG. Measures included characteristics of antenatal lifestyle interventions comprising domains related to theoretical framework, material, procedure, facilitator (allied health staff, medical staff, or researcher), delivery format (individual or group), mode, location, gestational age at commencement (<20 wk or ≥20 wk), number of sessions (low [1-5 sessions], moderate [6-20 sessions], and high [≥21 sessions]), duration (low [1-12 wk], moderate [13-20 wk], and high [≥21 wk]), tailoring, attrition, and adherence. For all mean differences (MDs), the reference group was the control group (ie, usual care). Results Overall, 99 studies with 34 546 pregnant individuals were included with differential effective intervention components found according to intervention type. Broadly, interventions delivered by an allied health professional were associated with a greater decrease in GWG compared with those delivered by other facilitators (MD, -1.36 kg; 95% CI, -1.71 to -1.02 kg; P < .001). Compared with corresponding subgroups, dietary interventions with an individual delivery format (MD, -3.91 kg; 95% CI -5.82 to -2.01 kg; P = .002) and moderate number of sessions (MD, -4.35 kg; 95% CI -5.80 to -2.89 kg; P < .001) were associated with the greatest decrease in GWG. Physical activity and mixed behavioral interventions had attenuated associations with GWG. These interventions may benefit from an earlier commencement and a longer duration for more effective optimization of GWG. Conclusions and Relevance These findings suggest that pragmatic research may be needed to test and evaluate effective intervention components to inform implementation of interventions in routine antenatal care for broad public health benefit.
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Affiliation(s)
- Cheryce L. Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Diabetes and Endocrine Unit, Monash Health, Melbourne, Victoria, Australia
| | - Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shakila Thangaratinam
- World Health Organization Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- Birmingham Women’s and Children’s National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Ewelina Rogozińska
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, London, United Kingdom
| | - Helena J. Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Diabetes and Endocrine Unit, Monash Health, Melbourne, Victoria, Australia
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Geyer K, Raab R, Hoffmann J, Hauner H. Development and validation of a screening questionnaire for early identification of pregnant women at risk for excessive gestational weight gain. BMC Pregnancy Childbirth 2023; 23:249. [PMID: 37055730 PMCID: PMC10100402 DOI: 10.1186/s12884-023-05569-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/01/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Excessive weight gain during pregnancy is associated with adverse health outcomes for mother and child. Intervention strategies to prevent excessive gestational weight gain (GWG) should consider women's individual risk profile, however, no tool exists for identifying women at risk at an early stage. The aim of the present study was to develop and validate a screening questionnaire based on early risk factors for excessive GWG. METHODS The cohort from the German "Gesund leben in der Schwangerschaft"/ "healthy living in pregnancy" (GeliS) trial was used to derive a risk score predicting excessive GWG. Sociodemographics, anthropometrics, smoking behaviour and mental health status were collected before week 12th of gestation. GWG was calculated using the last and the first weight measured during routine antenatal care. The data were randomly split into development and validation datasets with an 80:20 ratio. Using the development dataset, a multivariate logistic regression model with stepwise backward elimination was performed to identify salient risk factors associated with excessive GWG. The β coefficients of the variables were translated into a score. The risk score was validated by an internal cross-validation and externally with data from the FeLIPO study (GeliS pilot study). The area under the receiver operating characteristic curve (AUC ROC) was used to estimate the predictive power of the score. RESULTS 1790 women were included in the analysis, of whom 45.6% showed excessive GWG. High pre-pregnancy body mass index, intermediate educational level, being born in a foreign country, primiparity, smoking, and signs of depressive disorder were associated with the risk of excessive GWG and included in the screening questionnaire. The developed score varied from 0-15 and divided the women´s risk for excessive GWG into low (0-5), moderate (6-10) and high (11-15). The cross-validation and the external validation yielded a moderate predictive power with an AUC of 0.709 and 0.738, respectively. CONCLUSIONS Our screening questionnaire is a simple and valid tool to identify pregnant women at risk for excessive GWG at an early stage. It could be used in routine care to provide targeted primary prevention measures to women at particular risk to gain excessive gestational weight. TRIAL REGISTRATION NCT01958307, ClinicalTrials.gov, retrospectively registered 9 October 2013.
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Affiliation(s)
- Kristina Geyer
- Institute of Nutritional Medicine, Else Kröner-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany
| | - Roxana Raab
- Institute of Nutritional Medicine, Else Kröner-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany
| | - Julia Hoffmann
- Institute of Nutritional Medicine, Else Kröner-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany
- European Foundation for the Care of Newborn Infants, Hofmannstrasse 7a, 81379, Munich, Germany
| | - Hans Hauner
- Institute of Nutritional Medicine, Else Kröner-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany.
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12
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Gestational Weight Gain in Pregnant People with Obesity. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2023. [DOI: 10.1007/s13669-023-00346-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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13
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Channon S, Coulman E, Cannings-John R, Henley J, Lau M, Lugg-Widger F, Strange H, Davies F, Sanders J, Scherf C, Couzens Z, Morantz L. Acceptability and feasibility of a planned preconception weight loss intervention in women with long-acting reversible contraception: the Plan-it mixed-methods study. Health Technol Assess 2023; 27:1-224. [PMID: 36688498 PMCID: PMC9885302 DOI: 10.3310/nkix8285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Women with overweight (a body mass index of ≥ 25 kg/m2) or obesity (a body mass index of ≥ 30 kg/m2) are at greater risk of experiencing complications during pregnancy and labour than women with a healthy weight. Women who remove their long-acting reversible contraception (i.e. coils or implants) are one of the few groups of people who contact services as part of their preparation for conception, creating an opportunity to offer a weight loss intervention. OBJECTIVES The objectives were to understand if routine NHS data captured the pathway from long-acting reversible contraception removal to pregnancy and included body mass index; to identify the suitable components of a preconception weight loss intervention; and to engage with key stakeholders to determine the acceptability and feasibility of asking women with overweight/obesity to delay the removal of their long-acting reversible contraception in order to take part in a preconception weight loss intervention. DESIGN This was a preparatory mixed-methods study, assessing the acceptability and feasibility of a potential intervention, using routine NHS data and purposefully collected qualitative data. PARTICIPANTS The NHS routine data included all women with a long-acting reversible contraception code. There were three groups of participants in the surveys and interviews: health-care practitioners who remove long-acting reversible contraception; weight management consultants; and women of reproductive age with experience of overweight/obesity and of using long-acting reversible contraception. SETTING UK-based health-care practitioners recruited at professional meetings; and weight management consultants and contraceptive users recruited via social media. DATA SOURCES Anonymised routine data from UK sexual health clinics and the Clinical Practice Research Datalink, including the Pregnancy Register; and online surveys and qualitative interviews with stakeholders. RESULTS The records of 2,632,871 women aged 16-48 years showed that 318,040 had at least one long-acting reversible contraception event, with 62% of records including a body mass index. Given the identified limitations of the routine NHS data sets, it would not be feasible to reliably identify women with overweight/obesity who request a long-acting reversible contraception removal with an intention to become pregnant. Online surveys were completed by 100 health-care practitioners, four weight management consultants and 243 contraceptive users. Ten health-care practitioners and 20 long-acting reversible contraception users completed qualitative interviews. A realist-informed approach generated a hypothesised programme theory. The combination of weight discussions and the delay of long-acting reversible contraception removal was unacceptable as an intervention to contraceptive users for ethical and practical reasons. However, a preconception health intervention incorporating weight loss could be acceptable, and one potential programme is outlined. LIMITATIONS There was very limited engagement with weight management consultants, and the sample of participating stakeholders may not be representative. CONCLUSIONS An intervention that asks women to delay long-acting reversible contraception removal to participate in a preconception weight loss intervention would be neither feasible nor acceptable. A preconception health programme, including weight management, would be welcomed but requires risk communication training of health-care practitioners. FUTURE WORK Work to improve routine data sets, increase awareness of the importance of preconception health and overcome health-care practitioner barriers to discussing weight as part of preconception care is a priority. TRIAL REGISTRATION This trial is registered as ISRCTN14733020. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 1.
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Affiliation(s)
- Susan Channon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Elinor Coulman
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Josie Henley
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Mandy Lau
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | | | - Freya Davies
- The Welsh Centre for Primary and Emergency Care Research (PRIME), Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Julia Sanders
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Caroline Scherf
- Cardiff and Vale University Health Board, Department of Sexual Health, Cardiff Royal Infirmary, Cardiff, UK
| | - Zoë Couzens
- Public Health Wales NHS Trust, Public Health Wales, Cardiff, UK
| | - Leah Morantz
- 1Centre for Trials Research, Cardiff University, Cardiff, UK
- 2The Welsh Centre for Primary and Emergency Care Research (PRIME), Division of Population Medicine, Cardiff University, Cardiff, UK
- 3School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
- 4Cardiff and Vale University Health Board, Department of Sexual Health, Cardiff Royal Infirmary, Cardiff, UK
- 5Public Health Wales NHS Trust, Public Health Wales, Cardiff, UK
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14
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Wang X, Zhu C, Liu H, Sun L, Zhu W, Gu C. The effects of a midwife-led weight management program for pregnant women: A randomized controlled trial. Int J Nurs Stud 2023; 137:104387. [PMID: 36435003 DOI: 10.1016/j.ijnurstu.2022.104387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Inappropriate weight gain during pregnancy may present risks for maternal and newborn health. Pregnancy is considered the optimal time to intervene on women's health behaviors such as eating habits and physical activity. However, current clinical practice guidelines for weight management during pregnancy were not fully based on randomized trials, thus lacking specific "active intervention ingredients" that are proven effective in achieving appropriate gestational weight gain. Therefore it is essential to develop and implement an evidence-based weight management program for pregnant women. OBJECTIVE To examine the effects of a midwife-led weight management program on improving appropriate gestational weight gain, health literacy, experience of antenatal care, and maternal and neonatal outcomes among Chinese pregnant women. DESIGN A two-group randomized controlled trial. SETTINGS AND PARTICIPANTS A total of 426 pregnant women were recruited from a tertiary women's hospital in eastern China. METHODS Participants were randomly allocated to either intervention group (n = 213) or control group (n = 213). Women in the intervention group participated in a midwife-led weight management program during pregnancy, while women in the control group received the conventional obstetrician-led antenatal care. We assessed women at the first antenatal contact, 35-36 weeks gestation and 2-3 days postpartum. Data on gestational weight gain, health literacy, experience of antenatal care, and maternal and neonatal outcomes were compared between the two groups. Dummy variable analysis was conducted to reveal the effect of weight management program on gestational weight gain. RESULTS The overall gestational weight gain between the two groups was not statistically different (t = -1.377, P = 0.170). Compared with women in the control group, the odds of having inappropriate gestational weight gain was lower in the intervention group (OR = 0.270, 95%CI 0.169, 0.431). Further subgroup analyses showed that women in the intervention group had lower risk of inadequate gestational weight gain (OR = 0.305, 95%CI 0.180, 0.515) and excessive gestational weight gain (OR = 0.236, 95%CI 0.138, 0.404) than those in the control group. The score of experience of antenatal care was significantly higher in the midwife-led weight management group than that in the control group (193.70 ± 18.51 versus 165.70 ± 28.23, P < 0.001). Women's health literacy score was higher in the intervention group than control group [74.41 (69.57, 81.77) versus 71.88 (66.23, 77.18), P = 0.004]. CONCLUSION Compared with the conventional antenatal care, the midwife-led weight management program could facilitate appropriate gestational weight gain, enhance health literacy, and promote positive experience of antenatal care for Chinese pregnant women.
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Affiliation(s)
- Xiaojiao Wang
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Chunxiang Zhu
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Hongyan Liu
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; School of Nursing, Fudan University, Shanghai,China
| | - Liping Sun
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Wenli Zhu
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; School of Nursing, Fudan University, Shanghai,China
| | - Chunyi Gu
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
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15
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Barroso CS, Yockey A, Degon E, Poudel PG, Brown SD, Hedderson MM, Moreno-Hunt C, Ehrlich SF. Efficacious lifestyle interventions for appropriate gestational weight gain in women with overweight or obesity set in the health care system: a scoping review. J Matern Fetal Neonatal Med 2022; 35:6411-6424. [PMID: 34034608 PMCID: PMC8613304 DOI: 10.1080/14767058.2021.1914576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/27/2021] [Accepted: 04/06/2021] [Indexed: 12/22/2022]
Abstract
Purpose: Health care systems offer opportunities to scale up interventions for appropriate gestational weight gain (GWG); however, GWG interventions in the health care setting remain largely unavailable to women with overweight or obesity. To inform the translation of efficacious lifestyle interventions to health care delivery systems, this scoping review aimed to systematically identify randomized controlled trials for appropriate GWG in women with overweight or obesity that were set in a health care system.Methods: A scoping review allows for the systematic synthesis of knowledge on an exploratory research question aimed at mapping key concepts (e.g. time, location, source, and evidence) and gaps in a specific area of study. The Colquhoun et al. (2014) framework to conducting scoping reviews was used to develop the research question, identify relevant studies, select studies, extract data, and synthesize data. Specifically, two reviewers searched publication databases for English-language articles published from January 2009 to May 2020 using specific keywords/MeSH terms.Results: Eight peer-reviewed journal articles were identified; six trials were based in Europe and two in the U.S. Only four included lifestyle interventions that were efficacious in reducing GWG. Three trials with efficacious interventions were among women with obesity only and encouraged them to gain at or below the lower limit for total GWG (i.e. ≤5 kg) of the Institute of Medicine (IOM) guidelines. The fourth was among women with overweight or obesity and encouraged women to gain within the IOM guidelines with a telehealth behavioral intervention. Efficacious interventions were initiated in the first half of pregnancy and included frequent contact delivered through multiple modalities (i.e. in-person visits, telephone calls, text messages, email) by trained intervention staff (i.e. dietitian, lifestyle coach, and/or physiotherapist). Only one efficacious intervention trial briefly mentioned theoretical components for health promotion (e.g. self-monitoring); likewise, only one included cost-effectiveness analyses.Conclusions: This review systematically identified randomized controlled trials of efficacious lifestyle interventions (i.e. consisting of diet and physical activity components) for appropriate GWG in women with overweight or obesity that were set in the health care system and delivered by non-clinicians. Translation efforts could draw upon aspects of the efficacious lifestyle interventions described in this review. Future studies should examine theory-based telehealth interventions and cost-effectiveness.
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Affiliation(s)
- Cristina S. Barroso
- Department of Public Health, the University of Tennessee Knoxville, Knoxville, TN, USA
| | - Andrew Yockey
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Emoni Degon
- Department of Public Health, the University of Tennessee Knoxville, Knoxville, TN, USA
| | - Pragya Gautam Poudel
- Department of Public Health, the University of Tennessee Knoxville, Knoxville, TN, USA
| | - Susan D. Brown
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Carey Moreno-Hunt
- Maternal Fetal Medicine, Kaiser Permanente Roseville Medical Center, Roseville, CA, USA
| | - Samantha F. Ehrlich
- Department of Public Health, the University of Tennessee Knoxville, Knoxville, TN, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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16
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Herzberger V, Bäz E, Kunze M, Markfeld-Erol F, Juhasz-Böss I. Exercise During Pregnancy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:793-797. [PMID: 36045499 PMCID: PMC9902891 DOI: 10.3238/arztebl.m2022.0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Pregnancy is a good time to motivate women to implement health-promoting behaviors in their everyday lives. There is no official German-language guideline for the counseling of pregnant women by professionals involved in their care. The goal of this review is, therefore, to discuss the links between exercise and gestational diabetes mellitus (GDM), low birth weight, and prematurity. METHODS This review is based on pertinent articles retrieved by a systematic search of PubMed and the Web of Science. The articles included in the evaluation were reports of randomized controlled trials (RCTs) and meta-analyses of RCTs of exercise interventions in pregnant women that were published from 1 January 2011 to 15 November 2021. RESULTS A structured exercise program during pregnancy can lower the risk of gestational diabetes by as much as 49%. A 25% risk reduction for GDM was achieved with 140 minutes of exercise per week. The mean birth weight was not affected but the rate of excessively heavy newborns was lowered by 32-59% in the normal-weight subgroup. This effect was not seen in the overweight subgroup, possibly because of poorer compliance. Exercise did not elevate the risk of preterm delivery. CONCLUSION Regular exercise during pregnancy lessens gestationally induced weight gain and lowers the risk of excessive weight gain, as well as the risk of GDM, without elevating the risk of preterm delivery.
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Affiliation(s)
- Veerle Herzberger
- Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
| | - Elke Bäz
- Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
| | - Mirjam Kunze
- Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
| | - Filiz Markfeld-Erol
- Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
| | - Ingolf Juhasz-Böss
- Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
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Kavle JA. Strengthening maternal nutrition counselling during routine health services: a gap analysis to guide country programmes. Public Health Nutr 2022; 26:1-18. [PMID: 36210775 DOI: 10.1017/s1368980022002129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The WHO recommends counselling on healthy eating, weight gain, and physical activity during antenatal care (ANC) and postnatal care (PNC), yet advice and information are often not tailored to women's nutritional needs and contexts. The purpose of the gap analysis was to identify key elements related to the provision of maternal nutrition counselling during routine health contacts and provide programme considerations to strengthen quality service delivery. DESIGN A search of PubMed, Cochrane Library, CINAHL Plus and Scopus databases was conducted to retrieve studies from January 2010 to December 2021. Using inclusion criteria, quantitative, qualitative and mixed methods studies were included in the final gap analysis. SETTING Low-, middle- and high-income country contexts. PARTICIPANTS Following application of gap analysis criteria, thirty-seven articles from sixteen countries were included in the analysis. RESULTS Gaps in delivery of maternal nutrition counselling include provider capacity building, frequency, content and delivery platforms. Globally, counselling on appropriate weight gain during pregnancy is often not delivered with the desired content nor quality, while targeted counselling to overweight and obese women was provided in several high-income country contexts. Delivery of maternal nutrition counselling through multiple delivery platforms demonstrated improvements in maternal diet and/or weight gain during pregnancy. CONCLUSIONS Strengthening the integration of maternal nutrition counselling into pre- and in-service curricula, routine health provider training, supportive supervision and provider mentoring is needed. Future efforts may consider generating global and regional weight gain guidelines and incorporating maternal nutrition counselling indicators as part of quality-of-care ANC/PNC standards and routine health systems.
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Affiliation(s)
- Justine A Kavle
- Kavle Consulting, LLC, 200 Massachusetts Ave NW, Washington, DC20001, USA
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18
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Bahri Khomami M, Teede HJ, Enticott J, O’Reilly S, Bailey C, Harrison CL. Implementation of Antenatal Lifestyle Interventions Into Routine Care: Secondary Analysis of a Systematic Review. JAMA Netw Open 2022; 5:e2234870. [PMID: 36197663 PMCID: PMC9535535 DOI: 10.1001/jamanetworkopen.2022.34870] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Lifestyle interventions in pregnancy optimize gestational weight gain and improve pregnancy outcomes, with implementation recommended by the US Preventive Services Task Force. Yet, implementation research taking these efficacy trials into pragmatic translation remains limited. OBJECTIVE To evaluate success factors for implementing pregnancy lifestyle interventions into antenatal care settings in a meta-analysis, using the penetration, implementation, participation, and effectiveness (PIPE) impact metric. DATA SOURCES Data from a previous systematic review that searched across 9 databases, including MEDLINE, Embase, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Health Technology Assessment Database, were obtained, in 2 stages, up to May 6, 2020. STUDY SELECTION Randomized clinical trials reporting gestational weight gain in singleton pregnancies. DATA EXTRACTION AND SYNTHESIS The association of penetration, implementation, and participation with effectiveness of antenatal lifestyle interventions in optimizing gestational weight gain was estimated using random-effects meta-analyses. The Cochrane risk of bias tool, version 1.0, was used to assess risk of bias. MAIN OUTCOMES AND MEASURES Penetration (reach), implementation (fidelity), participation, and effectiveness of randomized clinical trials of lifestyle interventions in pregnancy. RESULTS Ninety-nine studies with 34 546 participants were included. Only 14 studies reported penetration of target populations. Overall, 38 studies (38.4%) had moderate fidelity, 25 (25.2%) had high fidelity, and 36 (36.4%) had unclear fidelity. Participation was reported in 84 studies (84.8%). Lifestyle interventions were associated with reducing gestational weight gain by 1.15 kg (95% CI, -1.40 to -0.91 kg). CONCLUSIONS AND RELEVANCE The findings of this systematic review and meta-analysis suggest that, despite the large body of evidence on efficacy of lifestyle interventions during pregnancy in optimizing gestational weight gain, little guidance is available to inform implementation of this evidence into practice. There is a need to better elucidate implementation outcomes in trial design alongside pragmatic implementation research to improve the health of women who are pregnant and the next generation.
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Affiliation(s)
- Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Helena J. Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Diabetes and Endocrine Unit, Monash Health, Melbourne, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sharleen O’Reilly
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin, Ireland
| | - Cate Bailey
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Cheryce L. Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Diabetes and Endocrine Unit, Monash Health, Melbourne, Australia
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Goławski K, Wojtyła C. Impact of Physical Activity of Pregnant Women on Obstetric Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912541. [PMID: 36231839 PMCID: PMC9564719 DOI: 10.3390/ijerph191912541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 05/27/2023]
Abstract
Regular and well-planned physical activity (PA) has a positive impact on pregnancy outcomes. In this study, we determine the impact of the PA of pregnant women on the occurrence of certain pregnancy outcomes, such as type of labor, duration of pregnancy, and birthweight. The study is based on the results of a Polish national survey performed between 2011 and 2017 on a group of 9170 women. The Pregnancy Physical Activity Questionnaire (PPAQ) was used to estimate the PA of pregnant women. Light intensity PA accounts for the largest proportion of women's total energy expenditure. Increase in women's total energy expenditure was associated with an increase in the birthweight of a child. A similar relationship was observed in the case of light and moderate PA. Vaginal birth was more common among women with higher total energy expenditure. Mothers of preterm children showed lower energy expenditure for each type of PA compared to term pregnancies. There was also a correlation between moderate and vigorous PA and low birthweight. Our study indicates that PA undertaken by pregnant women has a positive impact on pregnancy outcomes.
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Affiliation(s)
- Ksawery Goławski
- Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-015 Warsaw, Poland
| | - Cezary Wojtyła
- International Prevention Research Institute—Collaborating Centre, Calisia University, 16 Kaszubska St., 62-800 Kalisz, Poland
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20
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Bombana M, Wensing M, Wittenborn L, Ullrich C. Health Education about Lifestyle-Related Risk Factors in Gynecological and Obstetric Care: A Qualitative Study of Healthcare Providers' Views in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11674. [PMID: 36141943 PMCID: PMC9517227 DOI: 10.3390/ijerph191811674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/05/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Lifestyle-related risk factors (LRRFs) during pregnancy and lactation are associated with a range of health problems. However, previous studies have shown a large knowledge gap among pregnant women regarding the effects of LRRFs. This study aimed to investigate the role of health education about LRRFs during pregnancy and lactation in gynecological and obstetric care from healthcare providers' (HCPs) point of view. METHODS To explore the views of healthcare providers, a qualitative study was performed. In 2019, 22 in-depth interviews were conducted with a purposive sample of 9 gynecologists and 13 midwives. Participants came from different inpatient and outpatient care settings and from rural, urban, and socially deprived areas in southern Germany. All the interviews were tape-recorded and transcribed verbatim. A combined inductive and deductive approach was applied for data analysis. RESULTS Interviews with HCPs showed that they were aware of the possible impacts of LRRFs during pregnancy and lactation. They noted the importance of action, specifically among women with low socioeconomic status (SES), migrants, and women with a concerning medical history or other specific needs. However, the interviews showed that, at present, there is no standardized practice of educating patients on LRRFs in routine care. This was attributed to a lack of guidelines and time, unfavorable regulations, and undefined responsibilities. The priority of health education is lower in inpatient healthcare settings as compared to outpatient healthcare settings. HCPs apply a demand-driven healthcare approach, focusing on a woman's medical history, needs, and personal circumstances. HCPs voiced the importance of implementing pre-conception education across different healthcare settings, garnering support from other health organizations, and setting out clearly defined responsibilities among HCPs. CONCLUSIONS This qualitative study explored HCPs' perspectives on health education about LRRFs during pregnancy and lactation. The results from this study emphasize the need for a central strategy for health education about LRRFs during pregnancy and lactation in gynecological and obstetric care.
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Affiliation(s)
- Manuela Bombana
- Department of General Medicine and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
- Department of Prevention, AOK Baden-Württemberg, Presselstrasse 19, 70191 Stuttgart, Germany
| | - Michel Wensing
- Department of General Medicine and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Lisa Wittenborn
- Department of General Medicine and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Charlotte Ullrich
- Department of General Medicine and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
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21
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Di Renzo L, Marchetti M, Rizzo G, Gualtieri P, Monsignore D, Dominici F, Mappa I, Cavicchioni O, Aguzzoli L, De Lorenzo A. Adherence to Mediterranean Diet and Its Association with Maternal and Newborn Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148497. [PMID: 35886346 PMCID: PMC9321919 DOI: 10.3390/ijerph19148497] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 12/10/2022]
Abstract
Background: Pregnancy is a crucial stage in a woman’s life and can be affected by epigenetic and environmental factors. Diet also plays a key role in gestation. This study aimed to evaluate how a greater or lesser adherence to the Mediterranean Diet (MD) influences specific parameters of mother and newborn. Methods: After delivery, the women participating in the study answered a questionnaire: demographic information; anthropometric data (pre-pregnancy weight, height, and gestational weight gain); dietary habits information (adherence to MD before and during pregnancy, using the validated Mediterranean Diet Adherence Screener (MEDAS), quality of protein intake); pregnancy information (onset of complications, cesarean/vaginal delivery, gestational age at birth, birth weight, birth length); and clinical practitioner for personalized dietary patterns during pregnancy. Results: A total of 501 respondents have been included in the study, and 135 were excluded for complications. Women who followed the advice of clinical nutritionists showed better adherence to MD (p = 0.02), and the baby’s birth weight was higher (p = 0.02). Significant differences in gestational weight gain (p < 0.01) between groups with dissimilar diet adherence were demonstrated. Conclusion: Our data demonstrate a significant relationship between adherence to MD and birthweight.
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Affiliation(s)
- Laura Di Renzo
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (L.D.R.); (D.M.); (F.D.); (A.D.L.)
| | - Marco Marchetti
- PhD School of Applied Medical-Surgical Sciences, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy;
| | - Giuseppe Rizzo
- Division of Gynecology and Obstetrics, Department of Biomedicine and Prevention, Tor Vergata University, 00133 Rome, Italy; (G.R.); (I.M.)
- Fondazione Policlinico Tor Vergata, 00133 Rome, Italy
| | - Paola Gualtieri
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (L.D.R.); (D.M.); (F.D.); (A.D.L.)
- Correspondence:
| | - Diego Monsignore
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (L.D.R.); (D.M.); (F.D.); (A.D.L.)
| | - Francesca Dominici
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (L.D.R.); (D.M.); (F.D.); (A.D.L.)
| | - Ilenia Mappa
- Division of Gynecology and Obstetrics, Department of Biomedicine and Prevention, Tor Vergata University, 00133 Rome, Italy; (G.R.); (I.M.)
- Division of Maternal Fetal Medicine, Ospedale Cristo Re, Tor Vergata University, 00167 Rome, Italy
| | - Ottavia Cavicchioni
- Unit of Obstetrics and Gynecology, Ospedale S. Maria Nuova, 42123 Reggio Emilia, Italy; (O.C.); (L.A.)
| | - Lorenzo Aguzzoli
- Unit of Obstetrics and Gynecology, Ospedale S. Maria Nuova, 42123 Reggio Emilia, Italy; (O.C.); (L.A.)
| | - Antonino De Lorenzo
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (L.D.R.); (D.M.); (F.D.); (A.D.L.)
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22
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Geyer K, Günther J, Hoffmann J, Spies M, Raab R, Zhelyazkova A, Rose I, Hauner H. Dietary Supplementation Before, During and After Pregnancy: Results of the Cluster-Randomized GeliS Study. Geburtshilfe Frauenheilkd 2022; 82:736-746. [PMID: 35815097 PMCID: PMC9262633 DOI: 10.1055/a-1771-6368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/11/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction
The nutritional status of women before, during, and after pregnancy plays an important role in the health of mother and child. In addition to a balanced mixed diet, the
increased need for folic acid and iodine should be met and ensured with supplements. The aim of this study was to assess dietary supplementation in the context of pregnancy and to
investigate the effect of targeted counselling on supplementation behavior during and after pregnancy.
Methods
In the context of the “Gesund leben in der Schwangerschaft” (GeliS; “Healthy living in pregnancy”) trial, women in the intervention group (IG) received four structured
lifestyle counselling sessions during pregnancy as well as postpartum, during which they were informed about appropriate dietary supplementation. The women in the control group (CG) received
routine prenatal care. The intake of dietary supplements was recorded at different points using a questionnaire.
Results
In total, 2099 women were included in the analysis. Prior to conception, 31.3% of the women in the IG and 31.4% of the women in the CG took folic acid supplements.
Prenatally, about half of the women took folic acid (IG: 54.1%; CG: 52.0%) and iodine (IG: 50.2%; CG: 48.2%). Statistically significant differences between the groups with regard to
supplementation behavior could not be observed, neither prior to inclusion in the study nor during the intervention. During pregnancy, 23.0% of all women took docosahexaenoic acid (DHA)
supplements and 21.8% iron supplements. 49.4% of the women additionally took vitamin D supplements. A higher educational level (p < 0.001), advanced age (p < 0.001), primiparity
(p < 0.001), and a vegetarian diet (p = 0.037) were all associated with a higher level of dietary supplementation.
Conclusion
The GeliS lifestyle counselling did not significantly improve the supplementation behavior of women during and after pregnancy. Women should be informed about adequate
dietary supplementation early on within the scope of gynecological prenatal care.
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Affiliation(s)
- Kristina Geyer
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Julia Günther
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Julia Hoffmann
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
- European Foundation for the Care of Newborn Infants, München, Germany
| | - Monika Spies
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Roxana Raab
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Ana Zhelyazkova
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, München, Germany
| | - Inga Rose
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Hans Hauner
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
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23
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Tang Q, Zhong Y, Xu C, Li W, Wang H, Hou Y. Effectiveness of five interventions used for prevention of gestational diabetes: A network meta-analysis. Medicine (Baltimore) 2022; 101:e29126. [PMID: 35475799 PMCID: PMC9276162 DOI: 10.1097/md.0000000000029126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/03/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with short- and long-term health issues for mother and child; preventing these complications is crucially important. This study aimed to perform a systematic review and network meta-analysis of the relationships among 5 interventions used to prevent GDM. MATERIALS AND METHODS A comprehensive literature search was performed to pool evidence from inception to June 30, 2020. The type of studies was confined to randomized control trials and quasi-randomized control trials published in English investigating the interventions for preventing GDM, including physical activity, dietary intervention, probiotic intervention, mixed intervention, and inositol supplementation. The data were pooled together to report the odds ratio (OR) of GDM with a corresponding 95% credible interval (CrI) and generate a network plot, the surface under the cumulative ranking curve plot, and contribution plot. In addition, loop inconsistency was examined, and a funnel plot combined with Egger test was used to measure heterogeneity. RESULTS The network meta-analysis included 46 randomized control trials involving 16,545 patients. Compared with placebo, physical activity (OR: 0.64, 95% CrI: 0.46-0.88) and probiotic intervention (OR: 0.57, 95% CrI: 0.34-0.96) reduced the incidence of GDM significantly. However, dietary intervention, a combination of physical activity and diet intervention, and inositol supplementation did not significantly alter GDM risk. CONCLUSIONS Physical activity and probiotic intervention are more effective than placebo in reducing the risk of developing GDM. Future work should focus on the type, duration, frequency, and timing of physical activity and probiotic intervention.
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Affiliation(s)
- Qiongyao Tang
- Operating Theatre, Haikou Maternal, and Child Health Hospital, Haikou, Hainan, China
| | - Ying Zhong
- Operating Theatre, Haikou Maternal, and Child Health Hospital, Haikou, Hainan, China
| | - Chenyun Xu
- Longhua Outpatient Department, Hainan General Hospital, Haikou, Hainan, China
| | - Wangya Li
- Operating Theatre, Haikou Maternal, and Child Health Hospital, Haikou, Hainan, China
| | - Haiyan Wang
- Operating Theatre, Haikou Maternal, and Child Health Hospital, Haikou, Hainan, China
| | - Yu Hou
- Department of Critical Care Medicine, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, Hainan, China
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24
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Raab R, Hoffmann J, Spies M, Geyer K, Meyer D, Günther J, Hauner H. Are pre- and early pregnancy lifestyle factors associated with the risk of preterm birth? A secondary cohort analysis of the cluster-randomised GeliS trial. BMC Pregnancy Childbirth 2022; 22:230. [PMID: 35313852 PMCID: PMC8935257 DOI: 10.1186/s12884-022-04513-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/22/2022] [Indexed: 11/30/2022] Open
Abstract
Background Maternal lifestyle is discussed as a modifiable determinant in the prevention of preterm birth. However, previous research on associations between individual lifestyle factors and preterm birth risk is inconclusive. In this secondary analysis, we investigated the associations between several modifiable antenatal lifestyle factors and the odds of preterm birth. Methods This secondary cohort analysis used data from the cluster-randomised controlled “healthy living in pregnancy” (GeliS) trial. Data were collected from early pregnancy to birth with maternity records, validated questionnaires and birth protocols. Women with complete datasets for all covariates were eligible for analysis. Multivariate logistic regression models, adjusted for recognised risk factors, were fitted to determine whether dietary quality, assessed with a healthy eating index (HEI), physical activity (PA) levels and antenatal anxiety/distress influenced the odds of preterm birth. Moreover, the combined association between pre-pregnancy body mass index (BMI) and HEI on the odds of preterm birth was explored. The independent associations of individual dietary components and types of PA on prematurity were assessed by adjusted logistic regression models. Results Overall, 1738 women were included in the analysis. A low HEI significantly increased the odds of preterm birth (OR 1.54 (CI 1.04 – 2.30), p = 0.033), while no associations with either low PA levels or antenatal anxiety/distress were observed. BMI significantly interacted with HEI on the association with prematurity (p = 0.036). Energy % from protein and the intake of average portions of vegetables and cereals were significantly negatively associated with the odds of preterm birth. There was no significant evidence of an association between different types of PA and prematurity. Conclusions This cohort analysis revealed that low dietary quality in early pregnancy may increase the chance of giving birth prematurely, while healthier dietary choices may help to prevent preterm birth. More research on pre- and early pregnancy modifiable lifestyle factors is warranted. Trial registration This trial is registered with the Clinical Trial Registry ClinicalTrials.gov (NCT01958307). Registration date 09 October 2013, retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04513-5.
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Affiliation(s)
- Roxana Raab
- Institute of Nutritional Medicine, School of Medicine, Else Kröner-Fresenius-Centre for Nutritional Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany
| | - Julia Hoffmann
- Institute of Nutritional Medicine, School of Medicine, Else Kröner-Fresenius-Centre for Nutritional Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany.,European Foundation for the Care of Newborn Infants, Hofmannstrasse 7a, 81379, Munich, Germany
| | - Monika Spies
- Institute of Nutritional Medicine, School of Medicine, Else Kröner-Fresenius-Centre for Nutritional Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany
| | - Kristina Geyer
- Institute of Nutritional Medicine, School of Medicine, Else Kröner-Fresenius-Centre for Nutritional Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany
| | - Dorothy Meyer
- Institute of Nutritional Medicine, School of Medicine, Else Kröner-Fresenius-Centre for Nutritional Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany
| | - Julia Günther
- Institute of Nutritional Medicine, School of Medicine, Else Kröner-Fresenius-Centre for Nutritional Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany
| | - Hans Hauner
- Institute of Nutritional Medicine, School of Medicine, Else Kröner-Fresenius-Centre for Nutritional Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany.
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25
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Child Anthropometrics and Neurodevelopment at 2 and 3 Years of Age Following an Antenatal Lifestyle Intervention in Routine Care-A Secondary Analysis from the Cluster-Randomised GeliS Trial. J Clin Med 2022; 11:jcm11061688. [PMID: 35330013 PMCID: PMC9040717 DOI: 10.3390/jcm11061688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/02/2022] [Accepted: 03/15/2022] [Indexed: 12/11/2022] Open
Abstract
Maternal characteristics around pregnancy may influence obesity risk and neurodevelopment in children. To date, the effect of antenatal lifestyle interventions on long-term child development is unclear. The objective was to investigate the potential long-term effects of an antenatal lifestyle intervention programme conducted alongside routine care on child anthropometrics and neurodevelopment up to 3 years of age. Mother-child pairs from the cluster-randomised GeliS trial were followed up to 3 years of age. Data on child anthropometrics in both groups were collected from routine health examinations. Neurodevelopment was assessed via questionnaire. Of the 2286 study participants, 1644 mother-child pairs were included in the analysis. Children from the intervention group were less likely to score below the cut-off in Fine motor (p = 0.002), and more likely to have a score below the cut-off in Problem-solving (p < 0.001) compared to the control group at 3 years of age. Mean weight, height, head circumference, body mass index, and the respective z-scores and percentiles were comparable between the groups at 2 and 3 years of age. We found no evidence that the lifestyle intervention affected offspring development up to 3 years of age. Further innovative intervention approaches are required to improve child health in the long-term.
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26
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Teede HJ, Bailey C, Moran LJ, Bahri Khomami M, Enticott J, Ranasinha S, Rogozinska E, Skouteris H, Boyle JA, Thangaratinam S, Harrison CL. Association of Antenatal Diet and Physical Activity-Based Interventions With Gestational Weight Gain and Pregnancy Outcomes: A Systematic Review and Meta-analysis. JAMA Intern Med 2022; 182:106-114. [PMID: 34928300 PMCID: PMC8689430 DOI: 10.1001/jamainternmed.2021.6373] [Citation(s) in RCA: 103] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Excessive gestational weight gain (GWG) is common and associated with adverse pregnancy outcomes. Antenatal lifestyle interventions limit GWG; yet benefits of different intervention types and specific maternal and neonatal outcomes are unclear. OBJECTIVE To evaluate the association of different types of diet and physical activity-based antenatal lifestyle interventions with GWG and maternal and neonatal outcomes. DATA SOURCES A 2-stage systematic literature search of MEDLINE, Embase, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Health Technology Assessment Database was conducted from February 1, 2017, to May 31, 2020. Search results from the present study were integrated with those from a previous systematic review from 1990 to February 2017. STUDY SELECTION Randomized trials reporting GWG and maternal and neonatal outcomes. DATA EXTRACTION AND SYNTHESIS Data were extracted for random-effects meta-analyses to calculate the summary effect estimates and 95% CIs. MAIN OUTCOMES AND MEASURES Outcomes were clinically prioritized, with mean GWG as the primary outcome. Secondary outcomes included gestational diabetes, hypertensive disorders of pregnancy, cesarean section, preterm delivery, large or small for gestational age neonates, neonatal intensive care unit admission, or fetal death. RESULTS A total of 117 randomized clinical trials of antenatal lifestyle interventions (involving 34 546 women) were included. Overall lifestyle intervention was associated with reduced GWG (-1.15 kg; 95% CI, -1.40 to -0.91), risk of gestational diabetes (odds ratio [OR], 0.79; 95% CI, 0.70-0.89), and total adverse maternal outcomes (OR, 0.89; 95% CI, 0.84-0.94) vs routine care. Compared with routine care, diet was associated with less GWG (-2.63 kg; 95% CI, -3.87 to -1.40) than physical activity (-1.04 kg; 95% CI, -1.33 to -0.74) or mixed interventions (eg, unstructured lifestyle support, written information with weight monitoring, or behavioral support alone) (-0.74 kg; 95% CI, -1.06 to -0.43). Diet was associated with reduced risk of gestational diabetes (OR, 0.61; 95% CI, 0.45-0.82), preterm delivery (OR, 0.43; 95% CI, 0.22-0.84), large for gestational age neonate (OR, 0.19; 95% CI, 0.08-0.47), neonatal intensive care admission (OR, 0.68; 95% CI, 0.48-0.95), and total adverse maternal (OR, 0.75; 95% CI, 0.61-0.92) and neonatal outcomes (OR, 0.44; 95% CI, 0.26-0.72). Physical activity was associated with reduced GWG and reduced risk of gestational diabetes (OR, 0.60; 95% CI, 0.47-0.75), hypertensive disorders (OR, 0.66; 95% CI, 0.48-0.90), cesarean section (OR, 0.85; 95% CI, 0.75-0.95), and total adverse maternal outcomes (OR, 0.78; 95% CI, 0.71-0.86). Diet with physical activity was associated with reduced GWG (-1.35 kg; 95% CI, -1.95 to -0.75) and reduced risk of gestational diabetes (OR, 0.72; 95% CI, 0.54-0.96) and total adverse maternal outcomes (OR, 0.81; 95% CI, 0.69-0.95). Mixed interventions were associated with reduced GWG only. CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis found level 1 evidence that antenatal structured diet and physical activity-based lifestyle interventions were associated with reduced GWG and lower risk of adverse maternal and neonatal outcomes. The findings support the implementation of such interventions in routine antenatal care and policy around the world.
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Affiliation(s)
- Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Endocrinology and Diabetes Units, Monash Health, Melbourne, Victoria, Australia.,Warwick Business School, Warwick University, Coventry, United Kingdom
| | - Cate Bailey
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Endocrinology and Diabetes Units, Monash Health, Melbourne, Victoria, Australia
| | - Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sanjeeva Ranasinha
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ewelina Rogozinska
- Meta-Analysis Group, Institute of Clinical Trials and Methodology, Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Warwick Business School, Warwick University, Coventry, United Kingdom
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Monash Women's, Monash Health, Melbourne, Victoria, Australia
| | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.,Birmingham Women's and Children's National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Endocrinology and Diabetes Units, Monash Health, Melbourne, Victoria, Australia
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27
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Lindsay KL, Gyllenhammer LE, Entringer S, Wadhwa PD. Rate of Gestational Weight Gain and Glucose-Insulin Metabolism Among Hispanic Pregnant Women With Overweight and Obesity. J Clin Endocrinol Metab 2022; 107:e734-e744. [PMID: 34468745 PMCID: PMC8764225 DOI: 10.1210/clinem/dgab655] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Indexed: 12/12/2022]
Abstract
CONTEXT Hispanic women are at elevated risk of gestational glucose intolerance and postpartum type 2 diabetes compared with non-Hispanic White women. Identification of potentially modifiable factors contributing to this trajectory of beta-cell dysfunction is warranted. OBJECTIVE We aimed to determine the association between rate of gestational weight gain (rGWG) and glucose-insulin metabolism in Hispanic pregnant women with overweight and obesity. METHODS This cross-sectional, observational study, conducted from 2018-2020 at the clinical research center at University of California, Irvine, included 33 nondiabetic Hispanic pregnant women at 28 to 30 weeks' gestation with pre-pregnancy body mass index (BMI) 25.0 to 34.9 kg/m2. Participants consumed a standardized liquid mixed meal after an overnight fast. Serial blood samples were collected at fasting and up to 2 hours postprandial. The glucose and insulin area under the curve (AUC), insulin sensitivity index (ISI) and insulin secretion sensitivity index (ISSI)-2 were computed. RESULTS Average rGWG (0.36 ± 0.22 kg/week) was classified as excessive in 60% of women. While rGWG was not associated with the glucose or insulin AUC or ISI, it accounted for 13.4% of the variance in ISSI-2 after controlling for covariates (maternal age, parity, and pre-pregnancy BMI); for each 1 unit increase in rGWG, ISSI-2 decreased 2.1 units (P = 0.015). CONCLUSION Even in the absence of gestational diabetes, rGWG was inversely associated with beta-cell function in a high-risk population of Hispanic pregnant women with overweight and obesity. Beta-cell decline is an established risk factor for transition to type 2 diabetes, and these cross-sectional findings highlight rGWG as a potentially modifiable contributor to this process.
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Affiliation(s)
- Karen L Lindsay
- Departments of Pediatrics, UCI School of Medicine, University of California, Irvine, CA 92697, USA
- Susan Samueli Integrative Health Institute, UCI College of Health Sciences, University of California, Irvine, CA 92617, USA
- Correspondence: Karen L Lindsay, PhD, RDN, 5141 California Ave, Suite 200B, University of California, Irvine, Irvine, CA 92617, USA.
| | - Lauren E Gyllenhammer
- Departments of Pediatrics, UCI School of Medicine, University of California, Irvine, CA 92697, USA
- UCI Development health and Disease Research Program, University of California, Irvine, CA 92868, USA
| | - Sonja Entringer
- Departments of Pediatrics, UCI School of Medicine, University of California, Irvine, CA 92697, USA
- UCI Development health and Disease Research Program, University of California, Irvine, CA 92868, USA
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, 10117 Berlin, Germany
| | - Pathik D Wadhwa
- UCI Development health and Disease Research Program, University of California, Irvine, CA 92868, USA
- Departments of Psychiatry and Human Behavior, UCI School of Medicine, University of California, Irvine, CA 92697, USA
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Pinto FCS, Silva AAM, Souza SL. Repercussions of intermittent fasting on the intestinal microbiota community and body composition: a systematic review. Nutr Rev 2022; 80:613-628. [PMID: 35020929 DOI: 10.1093/nutrit/nuab108] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
CONTEXT Several therapies have been tested for combating weight gain and obesity-related metabolic diseases, and among these therapies, intermittent fasting (IF) has gained a great deal of interest. OBJECTIVE The aim of this study was to provide the reader with a current survey of IF protocols and an understanding of the outcomes found to date in terms of the profile of the intestinal microbiota (IM) in obese organisms. DATA SOURCES Data were obtained from 4 databases: PubMed, SCOPUS, LILACs, and Web of Science. DATA EXTRACTION Data from studies relating IF protocols to the microbiota and weight loss were extracted using a protocol in START program. DATA ANALYSIS Of the 82 original articles identified from the databases, 35 were eliminated due to duplication, and 32 were excluded due to not meeting the inclusion criteria. Two additional articles found in a new search were added, yielding a total of 17 studies to be included in this review. Among the protocols, alternate-day fasting (ADF) and time-restricted feeding (TRF) were the most common, and they were shown to have different mechanisms of metabolic signaling. TRF influences weight control and biochemical parameters by regulating the circadian system, and improving satiety control systems by acting on leptin secretion. On the other hand, ADF leads to a reduction of ±75% of all energy consumption regardless of dietary composition in addition to promoting hormonal adjustments that promote weight control. Furthermore, both protocols showed the ability to remodel the IM by changing the Firmicutes/Bacteroidetes ratio and increasing the abundance of strains such as Lactobacillus spp. and Akkermansia m. that have a protective effect on metabolism against the effects of weight gain. CONCLUSION In short, the ADF and TRF protocols have a positive effect on the remodeling of the IM and can possibly be used to control body adiposity, improve insulin sensitivity, and achieve other obesity-related metabolic changes.
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Affiliation(s)
- Flaydson C S Pinto
- Department of Nutrition, Federal University of Pernambuco, Recife, Brazil
| | - Amanda A M Silva
- Faculty of Medical Sciences, University of Pernambuco, Recife, Brazil
| | - Sandra L Souza
- Department of Nutrition, Federal University of Pernambuco, Recife, Brazil
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30
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Günther J, Hoffmann J, Stecher L, Spies M, Geyer K, Raab R, Meyer D, Rauh K, Hauner H. How does antenatal lifestyle affect the risk for gestational diabetes mellitus? A secondary cohort analysis from the GeliS trial. Eur J Clin Nutr 2022; 76:150-158. [PMID: 33893447 PMCID: PMC8766288 DOI: 10.1038/s41430-021-00910-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 02/27/2021] [Accepted: 03/23/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We aimed to investigate the predictive potential of early pregnancy factors such as lifestyle, gestational weight gain (GWG) and mental well-being on gestational diabetes mellitus (GDM) beyond established risk factors. METHODS GDM risk was investigated in the cohort of the German 'Gesund leben in der Schwangerschaft'/healthy living in pregnancy study. Women were recruited up to the 12th week of gestation. GDM was diagnosed with a 75 g oral glucose tolerance test between the 24th and 28th weeks of gestation. Pre-pregnancy age and weight, mental health and lifestyle were assessed via questionnaires. Maternal weight was measured throughout pregnancy. Early excessive GWG was defined based on the guidelines of the Institute of Medicine. The association between several factors and the odds of developing GDM was assessed using multiple logistic regression analyses. RESULTS Of 1694 included women, 10.8% developed GDM. The odds increased with pre-pregnancy BMI and age (women with obesity: 4.91, CI 3.35-7.19, p < 0.001; women aged 36-43 years: 2.84, CI 1.45-5.56, p = 0.002). Early excessive GWG, mental health and general lifestyle ratings were no significant risk factors. A 31% reduction in the odds of GDM was observed when <30% of energy was consumed from fat (OR 0.69, CI 0.49-0.96, p = 0.026). Vigorous physical activity tended to lower the odds without evidence of statistical significance (OR 0.59 per 10 MET-h/week, p = 0.076). CONCLUSIONS Maternal age and BMI stand out as the most important drivers of GDM. Early pregnancy factors like dietary fat content seem to be associated with GDM risk. Further evaluation is warranted before providing reliable recommendations.
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Affiliation(s)
- Julia Günther
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julia Hoffmann
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lynne Stecher
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Monika Spies
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kristina Geyer
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Roxana Raab
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dorothy Meyer
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kathrin Rauh
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Competence Centre for Nutrition (KErn), Freising, Germany
| | - Hans Hauner
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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Wu Y, Pei J, Dong L, Zhou Z, Zhou T, Zhao X, Che R, Han Z, Hua X. Association Between Maternal Weight Gain in Different Periods of Pregnancy and the Risk of Venous Thromboembolism: A Retrospective Case-Control Study. Front Endocrinol (Lausanne) 2022; 13:858868. [PMID: 35923618 PMCID: PMC9339610 DOI: 10.3389/fendo.2022.858868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) remains an important cause of maternal deaths. Little is known about the associations of specific periods of gestational weight gain (GWG) with the category of VTE, pulmonary embolism (PE), or deep venous thrombosis (DVT) with or without PE. METHODS In a retrospective case-control study conducted in Shanghai First Maternity and Infant Hospital from January 1, 2017 to September 30, 2021, cases of VTE within pregnancy or the first 6 postnatal weeks were identified. Controls without VTE were randomly selected from women giving birth on the same day as the cases, with 10 controls matched to each case. Total GWG and rates of early, mid, and late GWG values were standardized into z-scores, stratified by pre-pregnant body mass index (BMI). The adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated through multivariate logistic regression models. RESULTS There were 196 cases (14.4 per 10,000) of VTE within pregnancy or the first 6 postnatal weeks were identified. Higher total weight gain was associated with increased risks of PE (aOR, 13.22; 95% CI, 2.03-85.99) and VTE (OR, 10.49; 95% CI, 1.82-60.45) among women with underweight. In addition, higher total weight gain was associated with increased risk of PE (aOR, 2.06; 95% CI, 1.14-3.72) among women with healthy weight. Similarly, rate of higher early weight gain was associated with significantly increased risk for PE (aOR, 2.15; 95% CI, 1.05-4.42) among women with healthy BMI. The lower rate of late weight gain was associated with increased risks of PE (aOR, 7.30; 95% CI, 1.14-46.55) and VTE (OR, 7.54; 95% CI, 1.20-47.57) among women with underweight. No significant associations between maternal rate of mid GWG and increased risk for any category of VTE, PE, or DVT with or without PE were present, regardless of maternal pre-pregnant BMI. CONCLUSION The GWG associations with the category of VTE, PE, or DVT with or without PE differ at different periods of pregnancy. In order to effectively improve maternal and child outcomes, intensive weight management that continues through pregnancy may be indispensable.
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Affiliation(s)
- Yuelin Wu
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jindan Pei
- Obstetrics Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lingling Dong
- Obstetrics Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zheying Zhou
- Obstetrics Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tianfan Zhou
- Obstetrics Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaobo Zhao
- Obstetrics Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ronghua Che
- Obstetrics Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhimin Han
- Obstetrics Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaolin Hua
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- Obstetrics Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Xiaolin Hua,
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32
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Chan SY. Gestational Weight Gain in Women With Obesity and Consideration of Infant Morbidity and Mortality in Clinical Practice. JAMA Netw Open 2021; 4:e2141508. [PMID: 34967888 DOI: 10.1001/jamanetworkopen.2021.41508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Shiao-Yng Chan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, and National University Hospital, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
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33
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Chen Y, Ma G, Hu Y, Yang Q, Deavila JM, Zhu MJ, Du M. Effects of Maternal Exercise During Pregnancy on Perinatal Growth and Childhood Obesity Outcomes: A Meta-analysis and Meta-regression. Sports Med 2021; 51:2329-2347. [PMID: 34143412 DOI: 10.1007/s40279-021-01499-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Perinatal growth abnormalities program susceptibility to childhood obesity, which is further exaggerated by maternal overweight and obesity (MO) during pregnancy. Exercise is highly accessible, but reports about the benefits of maternal exercise on fetal growth and childhood obesity outcomes are inconsistent, reducing the incentives for pregnant women to participate in exercise to improve children's perinatal growth. OBJECTIVE This systematic review and meta-analysis aims to establish evidence-based efficacy of exercise in mothers with normal weight (MNW) and MO during pregnancy in reducing the risks of perinatal growth abnormalities and childhood obesity. In addition, the impacts of exercise volume are also assessed. METHODS The PubMed, ScienceDirect, Web of Science, and Cochrane Library databases were searched from inception to February 15, 2020. We included randomized controlled trials with exercise-only intervention or exercise with other confounders in pregnant MNW (body mass index, BMI 18.5-24.9 kg/m2) and MO (BMI ≥ 25 kg/m2), which were further subgrouped in the meta-analysis. Primary outcomes included birth weight, preterm birth, small for gestational age (SGA), large for gestational age (LGA), infant and childhood weight, and childhood obesity. A linear meta-regression analysis was also used to explore the effects of exercise volume on outcomes. RESULTS 99 studies were included in the meta-analysis (n = 596,876), and individual study quality ranged from fair to good according to the Newcastle-Ottawa scale assessment. Exercise only interventions in MNW reduced preterm birth by 15% (26 studies, n = 76,132; odds ratio [OR] 0.85; 95% CI 0.72, 1.01; I2 = 83.3%), SGA by 17% (33 studies, n = 92,351; OR 0.83; 95% CI 0.71, 0.98; I2 = 74.5%) and LGA by 17% (29 studies, n = 84,310; OR 0.83; 95% CI 0.74, 0.95; I2 = 60.4%). Exercise only interventions in MO reduced preterm birth by 33% (2 studies, n = 3,050; OR 0.67; 95% CI 0.70, 0.96; I2 = 0%), SGA by 27% (8 studies, n = 3,909; OR 0.73; 95% CI 0.50, 1.05; I2 = 40.4%) and LGA by 55% (9 studies, n = 81,581; OR 0.45; 95% CI 0.18, 1.11; I2 = 98.3%). Exercise only interventions in MNW reduced childhood obesity by 53% (3 studies, n = 6,920; OR 0.47; 95% CI 0.36, 0.63; I2 = 77.0%). However, no significant effect was observed in outcomes from exercise confounders in either MNW or MO. In the meta-regression, the volume of exercise-only intervention in MNW was negatively associated with birth weight, greatly driven by volumes more than 810 metabolic equivalents (MET)-min per week. Other outcomes were not associated with exercise volume. CONCLUSIONS This systematic review and meta-analysis suggests that exercise during pregnancy in both MNW and MO safely and effectively reduce the risks of preterm birth, SGA, and LGA. Furthermore, MNW exercise also reduces the risk of childhood obesity. Overall, regardless of prepregnancy BMI, maternal exercise during pregnancy provides an excellent opportunity to mitigate the high prevalence of adverse birth outcomes and childhood obesity.
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Affiliation(s)
- Yanting Chen
- Center for Reproductive Biology, School of Molecular Biosciences, Washington State University, Pullman, WA, 99164, USA.,Nutrigenoimics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA, 99164, USA
| | - Guiling Ma
- College of Animal Science and Technology, Yangzhou University, Yangzhou, 225009, People's Republic of China
| | - Yun Hu
- College of Animal Science and Technology, Yangzhou University, Yangzhou, 225009, People's Republic of China
| | - Qiyuan Yang
- Department of Molecular, Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Jeanene M Deavila
- Center for Reproductive Biology, School of Molecular Biosciences, Washington State University, Pullman, WA, 99164, USA.,Nutrigenoimics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA, 99164, USA
| | - Mei-Jun Zhu
- School of Food Science, Washington State University, Pullman, WA, 99164, USA
| | - Min Du
- Center for Reproductive Biology, School of Molecular Biosciences, Washington State University, Pullman, WA, 99164, USA. .,Nutrigenoimics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA, 99164, USA.
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34
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Walker LO, Kang S. Helping Individuals Achieve a Healthy Weight Gain During Pregnancy: A Multipronged Approach. Nurs Womens Health 2021; 25:296-303. [PMID: 34144007 DOI: 10.1016/j.nwh.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/17/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
Approximately half of pregnant individuals in the United States exceed recommendations for gestational weight gain (GWG). Excessive GWG is associated with negative outcomes for maternal and infant health. In this article, we provide guidance to nurses who counsel patients about GWG. Because of negative bias toward persons with obesity, nurses need to understand their own attitudes toward obesity to provide supportive GWG counseling. The use of words such as weight is preferred to obese, and recommended GWG goals should be consistent with established guidelines. The setting of specific, measurable, attainable, realistic, and trackable behavioral goals can help translate a goal for GWG into practical actions in daily living. Mobile phone apps, if carefully chosen, may help individuals learn about and track GWG.
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35
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Mate A, Reyes-Goya C, Santana-Garrido Á, Vázquez CM. Lifestyle, Maternal Nutrition and Healthy Pregnancy. Curr Vasc Pharmacol 2021; 19:132-140. [PMID: 32234002 DOI: 10.2174/1570161118666200401112955] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 02/07/2023]
Abstract
Healthy lifestyle habits spanning from preconception to postpartum are considered as a major safeguard for achieving successful pregnancies and for the prevention of gestational diseases. Among preconception priorities established by the World Health Organization (WHO) are healthy diet and nutrition, weight management, physical activity, planned pregnancy and physical, mental and psychosocial health. Most studies covering the topic of healthy pregnancies focus on maternal diet because obesity increases the risks for adverse perinatal outcomes, including gestational diabetes mellitus, large for gestational age newborns, or preeclampsia. Thus, foods rich in vegetables, essential and polyunsaturated fats and fibre-rich carbohydrates should be promoted especially in overweight, obese or diabetic women. An adequate intake of micronutrients (e.g. iron, calcium, folate, vitamin D and carotenoids) is also crucial to support pregnancy and breastfeeding. Moderate physical activity throughout pregnancy improves muscle tone and function, besides decreasing the risk of preeclampsia, gestational diabesity (i.e. diabetes associated with obesity) and postpartum overweight. Intervention studies claim that an average of 30 min of exercise/day contributes to long-term benefits for maternal overall health and wellbeing. Other factors such as microbiome modulation, behavioural strategies (e.g. smoking cessation, anxiety/stress reduction and sleep quality), maternal genetics and age, social class and education might also influence the maternal quality of life. These factors contribute to ensure a healthy pregnancy, or at least to reduce the risk of adverse maternal and foetal outcomes during pregnancy and later in life.
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Affiliation(s)
- Alfonso Mate
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, E-41012 Sevilla, Spain
| | - Claudia Reyes-Goya
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, E-41012 Sevilla, Spain
| | - Álvaro Santana-Garrido
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, E-41012 Sevilla, Spain
| | - Carmen M Vázquez
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, E-41012 Sevilla, Spain
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36
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Cantor AG, Jungbauer RM, McDonagh M, Blazina I, Marshall NE, Weeks C, Fu R, LeBlanc ES, Chou R. Counseling and Behavioral Interventions for Healthy Weight and Weight Gain in Pregnancy: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 325:2094-2109. [PMID: 34032824 DOI: 10.1001/jama.2021.4230] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Counseling and active behavioral interventions to limit excess gestational weight gain (GWG) during pregnancy may improve health outcomes for women and infants. The 2009 National Academy of Medicine (NAM; formerly the Institute of Medicine) recommendations for healthy GWG vary according to prepregnancy weight category. OBJECTIVE To review and synthesize the evidence on benefits and harms of behavioral interventions to promote healthy weight gain during pregnancy to inform the US Preventive Services Task Force recommendation. DATA SOURCES Ovid MEDLINE and the Cochrane Library to March 2020, with surveillance through February 2021. STUDY SELECTION Randomized clinical trials and nonrandomized controlled intervention studies focused on diet, exercise, and/or behavioral counseling interventions on GWG. DATA EXTRACTION AND SYNTHESIS Independent data abstraction and study quality rating with dual review. MAIN OUTCOMES AND MEASURES Gestational weight-related outcomes; maternal and infant morbidity and mortality; harms. RESULTS Sixty-eight studies (N = 25 789) were included. Sixty-seven studies evaluated interventions during pregnancy, and 1 evaluated an intervention prior to pregnancy. GWG interventions were associated with reductions in risk of gestational diabetes (43 trials, n = 19 752; relative risk [RR], 0.87 [95% CI, 0.79 to 0.95]; absolute risk difference [ARD], -1.6%) and emergency cesarean delivery (14 trials, n = 7520; RR, 0.85 [95% CI, 0.74 to 0.96]; ARD, -2.4%). There was no significant association between GWG interventions and risk of gestational hypertension, cesarean delivery, or preeclampsia. GWG interventions were associated with decreased risk of macrosomia (25 trials, n = 13 990; RR, 0.77 [95% CI, 0.65 to 0.92]; ARD, -1.9%) and large for gestational age (26 trials, n = 13 000; RR, 0.89 [95% CI, 0.80 to 0.99]; ARD, -1.3%) but were not associated with preterm birth. Intervention participants experienced reduced weight gain across all prepregnancy weight categories (55 trials, n = 20 090; pooled mean difference, -1.02 kg [95% CI, -1.30 to -0.75]) and demonstrated lower likelihood of GWG in excess of NAM recommendations (39 trials, n = 14 271; RR, 0.83 [95% CI, 0.77 to 0.89]; ARD, -7.6%). GWG interventions were associated with reduced postpartum weight retention at 12 months (10 trials, n = 3957; mean difference, -0.63 kg [95% CI, -1.44 to -0.01]). Data on harms were limited. CONCLUSIONS AND RELEVANCE Counseling and active behavioral interventions to limit GWG were associated with decreased risk of gestational diabetes, emergency cesarean delivery, macrosomia, and large for gestational age. GWG interventions were also associated with modest reductions in mean GWG and decreased likelihood of exceeding NAM recommendations for GWG.
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Affiliation(s)
- Amy G Cantor
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
- Department of Family Medicine, Oregon Health & Science University, Portland
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Rebecca M Jungbauer
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Marian McDonagh
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Ian Blazina
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Nicole E Marshall
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Chandler Weeks
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Rongwei Fu
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
- School of Public Health, Oregon Health & Science University-Portland State University
| | - Erin S LeBlanc
- Kaiser Permanente, Center for Health Research, Portland, Oregon
| | - Roger Chou
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
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Malta MB, Gomes CDB, Barros AJD, Baraldi LG, Takito MY, Benício MHD, Carvalhaes MADBL. Effectiveness of an intervention focusing on diet and walking during pregnancy in the primary health care service. CAD SAUDE PUBLICA 2021; 37:e00010320. [PMID: 34037070 DOI: 10.1590/0102-311x00010320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 08/17/2020] [Indexed: 11/22/2022] Open
Abstract
Interventions during prenatal care can mitigate negative outcomes of a sedentary lifestyle and unhealthy diet during pregnancy. We aimed to evaluate the effectiveness of an intervention that promoted healthy diet and leisure-time walking during antenatal care in a pragmatic, controlled, non-randomized intervention study. Physicians and nurses from all health care units of the Family Health Strategy model of health assistance participated in educational training to promote leisure-time walking and healthy diet during antenatal care visits. Pregnant women who received health care from these professionals constituted the intervention group (n = 181). The control group (n = 172) included pregnant women who received routine antenatal care, in health care units of the traditional model of health assistance. Data were collected in each trimester of pregnancy. Diet was investigated using a food frequency questionnaire adapted from Risk and Protective Factors Surveillance System for Chronic Non-Comunicable Diseases Through Telephone Interview (Vigitel). Leisure-time walking in a typical week was assessed using questions from the Physical Activity in Pregnancy Questionnaire. There were positive effects on leisure-time walking during the second trimester and the third trimester of pregnancy and on the women who achieved 150 minutes per week of walking during the third trimester. The intervention reduced the risk of pregnant women consuming soft drinks and/or commercially prepared cookies in the third trimester. This lifestyle intervention was partially effective, tripling the proportion of pregnant women who achieved the recommended walking time and reducing by half the proportion of women who had a high weekly consumption of soft drinks and industrially processed cookies.
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Affiliation(s)
- Maíra Barreto Malta
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil.,Programa de Pós-graduação em Saúde Coletiva, Universidade Católica de Santos, Santos, Brasil
| | - Caroline de Barros Gomes
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, Brasil
| | - Aluísio J D Barros
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil
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Geyer K, Spies M, Günther J, Hoffmann J, Raab R, Meyer D, Rauh K, Hauner H. Effects of a Prenatal Lifestyle Intervention in Routine Care on Maternal Health Behaviour in the First Year Postpartum-Secondary Findings of the Cluster-Randomised GeliS Trial. Nutrients 2021; 13:1310. [PMID: 33921063 PMCID: PMC8071441 DOI: 10.3390/nu13041310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/08/2021] [Accepted: 04/13/2021] [Indexed: 12/16/2022] Open
Abstract
Lifestyle interventions during pregnancy were shown to beneficially influence maternal dietary behaviour and physical activity, but their effect on health behaviour after delivery is unclear. The objective of this secondary analysis was to investigate the sustained effect of a lifestyle intervention in routine care on maternal health behaviour during the first year postpartum. The cluster-randomised controlled "Healthy living in pregnancy" (GeliS) study included 2286 pregnant women. Data on maternal health behaviour were collected at 6-8 weeks (T1pp) and one year postpartum (T2pp) using validated questionnaires. The intervention group showed a lower mean intake of fast food (T1pp: p = 0.016; T2pp: p < 0.001) and soft drinks (T1pp: p < 0.001), a higher mean intake of vegetables (T2pp: p = 0.015) and was more likely to use healthy oils for meal preparation than the control group. Dietary quality rated by a healthy eating index was higher in the intervention group (T1pp: p = 0.093; T2pp: p = 0.043). There were minor trends towards an intervention effect on physical activity behaviour. The proportion of smokers was lower in the intervention group (p < 0.001, both time points). The lifestyle intervention within routine care modestly improved maternal postpartum dietary and smoking behaviours.
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Affiliation(s)
- Kristina Geyer
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Institute of Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany; (K.G.); (M.S.); (J.G.); (J.H.); (R.R.); (D.M.); (K.R.)
| | - Monika Spies
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Institute of Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany; (K.G.); (M.S.); (J.G.); (J.H.); (R.R.); (D.M.); (K.R.)
| | - Julia Günther
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Institute of Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany; (K.G.); (M.S.); (J.G.); (J.H.); (R.R.); (D.M.); (K.R.)
| | - Julia Hoffmann
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Institute of Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany; (K.G.); (M.S.); (J.G.); (J.H.); (R.R.); (D.M.); (K.R.)
| | - Roxana Raab
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Institute of Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany; (K.G.); (M.S.); (J.G.); (J.H.); (R.R.); (D.M.); (K.R.)
| | - Dorothy Meyer
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Institute of Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany; (K.G.); (M.S.); (J.G.); (J.H.); (R.R.); (D.M.); (K.R.)
| | - Kathrin Rauh
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Institute of Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany; (K.G.); (M.S.); (J.G.); (J.H.); (R.R.); (D.M.); (K.R.)
- Competence Centre for Nutrition (KErn), Am Gereuth 4, 85354 Freising, Germany
| | - Hans Hauner
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Institute of Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany; (K.G.); (M.S.); (J.G.); (J.H.); (R.R.); (D.M.); (K.R.)
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Bodnar LM, Abrams B, Simhan HN, Scifres CM, Silver RM, Parry S, Crosland BA, Chung J, Himes KP. The impact of setting a pregnancy weight gain goal on total weight gain. Paediatr Perinat Epidemiol 2021; 35:164-173. [PMID: 33155708 PMCID: PMC7878338 DOI: 10.1111/ppe.12724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Expert groups recommend that women set a pregnancy weight gain goal with their care provider to optimise weight gain. OBJECTIVE Our aim was to describe the concordance between first-trimester personal and provider pregnancy weight gain goals with the Institute of Medicine (IOM) recommendations and to determine the association between these goals and total weight gain. METHODS We used data from 9353 women in the Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be. In the first trimester, women reported their personal pregnancy weight gain goal and their provider weight gain goal, and we categorised personal and provider weight gain goals and total weight gain according to IOM recommendations. We used log-binomial or linear regression models to relate goals to total weight gain, adjusting for confounders including race/ethnicity, maternal age, education, smoking, marital status and planned pregnancy. RESULTS Approximately 37% of women reported no weight gain goals, while 24% had personal and provider goals, 31% had only a personal goal, and 8% had only a provider goal. Personal and provider goals were outside the recommended ranges in 12%-23% of normal-weight women, 31%-41% of overweight women and 47%-63% of women with obesity. Women with both personal and provider pregnancy weight gain goals were 6%-14% more likely than their counterparts to have a goal within IOM-recommended ranges. Having any goal or a goal within the IOM-recommended ranges was unrelated to pregnancy weight gain. Excessive weight gain occurred in approximately half of normal-weight or obese women and three-quarters of overweight women, regardless of goal setting group. CONCLUSIONS These findings do not support the effectiveness of early-pregnancy personal or provider gestational weight gain goal setting alone in optimising weight gain. Multifaceted interventions that address a number of mediators of goal setting success may assist women in achieving weight gain consistent with their goals.
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Affiliation(s)
- Lisa M. Bodnar
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA,Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA,Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Barbara Abrams
- School of Public Health, University of California at Berkeley, Berkeley, CA, USA
| | - Hyagriv N. Simhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA,Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Christina M. Scifres
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, IN, USA
| | - Robert M. Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Brian A. Crosland
- Department of Obstetrics and Gynecology, University of California Irvine College of Medicine, Irvine, CA, USA
| | - Judith Chung
- Department of Obstetrics and Gynecology, University of California Irvine College of Medicine, Irvine, CA, USA
| | - Katherine P. Himes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA,Magee-Womens Research Institute, Pittsburgh, PA, USA
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Sarma S, Sockalingam S, Dash S. Obesity as a multisystem disease: Trends in obesity rates and obesity-related complications. Diabetes Obes Metab 2021; 23 Suppl 1:3-16. [PMID: 33621415 DOI: 10.1111/dom.14290] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/05/2020] [Accepted: 12/06/2020] [Indexed: 12/12/2022]
Abstract
Obesity is a chronic multisystem disease associated with increased morbidity and mortality. The increasing prevalence of obesity makes it a major healthcare challenge across both developed and developing countries. Traditional measures such as body mass index do not always identify individuals at increased risk of comorbidities, yet continue to be used in deciding who qualifies for weight loss treatment. A better understanding of how obesity is associated with comorbidities, in particular non-metabolic conditions, is needed to identify individuals at risk in order to prioritize treatment. For metabolic disorders such as type 2 diabetes (T2D), weight loss can prevent T2D in individuals with prediabetes. It can improve and reverse T2D if weight loss is achieved early in the course of the disease. However, access to effective weight loss treatments is a significant barrier to improved health for people with obesity. In the present paper, we review the rising prevalence of obesity and why it should be classed as a multisystem disease. We will discuss potential mechanisms underlying its association with various comorbidities and how these respond to treatment, with a particular focus on cardiometabolic disease, malignancy and mental health.
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Affiliation(s)
- Shohinee Sarma
- Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Satya Dash
- Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
- Banting and Best Diabetes Centre, University of Toronto, Toronto, Ontario, Canada
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Hoffmann J, Günther J, Stecher L, Spies M, Geyer K, Raab R, Meyer D, Rauh K, Hauner H. Infant growth during the first year of life following a pregnancy lifestyle intervention in routine care-Findings from the cluster-randomised GeliS trial. Pediatr Obes 2021; 16:e12705. [PMID: 32725809 DOI: 10.1111/ijpo.12705] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lifestyle interventions in pregnancy may influence postpartum development and obesity risk in offspring. The impact of lifestyle interventions as health system-based approaches is unclear. OBJECTIVE To evaluate the effect of an antenatal lifestyle intervention conducted as public health approach on infant development and feeding practices. METHODS We followed offspring born to women participating in the cluster-randomised GeliS trial who received usual care (CG) or repeated lifestyle counselling (IG). We collected data on offspring development and complementary feeding until the 12th month postpartum. RESULTS Of the 1998 mother-child pairs, 1783 completed the follow-up. Mean infant weight at 12 months was comparable between groups (IG: 9497.9 ± 1137.0 g; CG: 9433.4 ± 1055.2 g; P = .177). There was no significant evidence of differences in sex- and age-adjusted z-scores or in the odds of offspring being overweight. More infants in the IG received whole-grain products compared to the CG (95.6% vs. 90.8%; P = .003). Despite small differences in the timing of introducing solid foods, there were no further significant differences in the pattern of complementary feeding. CONCLUSIONS The antenatal lifestyle intervention embedded in routine care did not substantially influence infant anthropometrics and is thus unlikely to impact future development.
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Affiliation(s)
- Julia Hoffmann
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julia Günther
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lynne Stecher
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Monika Spies
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kristina Geyer
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Roxana Raab
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dorothy Meyer
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kathrin Rauh
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Competence Centre for Nutrition, Freising, Germany
| | - Hans Hauner
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Chen T, Liu D, Yao X. Progress of Clinical Trials for the Treatment of Gestational Diabetes Mellitus. Diabetes Metab Syndr Obes 2021; 14:315-327. [PMID: 33519220 PMCID: PMC7837562 DOI: 10.2147/dmso.s290749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/31/2020] [Indexed: 01/09/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is one of the most common and severe complications of pregnancy, which is not only associated with perinatal complications but also has a long-term adverse effect on maternal and their offsprings. At present, the treatment of GDM focuses on the control of maternal blood glucose. Although lifestyle changes, hypoglycemic drugs, blood glucose monitoring, and other medicines that can improve maternal blood glucose to a certain extent, there are still some patients affected and have adverse pregnancy outcomes. The prevention of GDM and the treatment of improving pregnancy outcomes are urgently needed. This review summarized recently published clinical trials related with the treatment of GDM, aiming to provide additional options for the treatment of GDM.
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Affiliation(s)
- Tong Chen
- Department of Endocrinology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People’s Republic of China
| | - Dan Liu
- Department of Endocrinology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People’s Republic of China
- Correspondence: Dan Liu Department of Endocrinology, First Affiliated Hospital of Dalian Medical University, Zhongshan Str. 222, Dalian116011, People’s Republic of China Email
| | - Xiaofeng Yao
- Department of Preventive Medicine, Dalian Medical University, Dalian, Liaoning, People’s Republic of China
- Xiaofeng Yao Department of Preventive Medicine, Dalian Medical University, 9 W Lushun South Road, Dalian116044, People’s Republic of China Email
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Lau CHE, Taylor-Bateman V, Vorkas PA, Graça G, Vu THT, Hou L, Chekmeneva E, Ebbels TMD, Chan Q, Van Horn L, Holmes E. Metabolic Signatures of Gestational Weight Gain and Postpartum Weight Loss in a Lifestyle Intervention Study of Overweight and Obese Women. Metabolites 2020; 10:metabo10120498. [PMID: 33291639 PMCID: PMC7761920 DOI: 10.3390/metabo10120498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Overweight and obesity amongst women of reproductive age are increasingly common in developed economies and are shown to adversely affect birth outcomes and both childhood and adulthood health risks in the offspring. Metabolic profiling in conditions of overweight and obesity in pregnancy could potentially be applied to elucidate the molecular basis of the adverse effects of gestational weight gain (GWG) and postpartum weight loss (WL) on future risks for cardiovascular disease (CVD) and other chronic diseases. Methods: Biofluid samples were collected from 114 ethnically diverse pregnant women with body mass index (BMI) between 25 and 40 kg/m2 from Chicago (US), as part of a randomized lifestyle intervention trial (Maternal Offspring Metabolics: Family Intervention Trial; NCT01631747). At 15 weeks, 35 weeks of gestation, and at 1 year postpartum, the blood plasma lipidome and metabolic profile of urine samples were analyzed by liquid chromatography mass spectrometry (LC-MS) and 1H nuclear magnetic resonance spectroscopy (1H NMR) respectively. Results: Urinary 4-deoxyerythronic acid and 4-deoxythreonic acid were found to be positively correlated to BMI. Seventeen plasma lipids were found to be associated with GWG and 16 lipids were found to be associated with WL, which included phosphatidylinositols (PI), phosphatidylcholines (PC), lysophospholipids (lyso-), sphingomyelins (SM) and ether phosphatidylcholine (PC-O). Three phospholipids found to be positively associated with GWG all contained palmitate side-chains, and amongst the 14 lipids that were negatively associated with GWG, seven were PC-O. Six of eight lipids found to be negatively associated with WL contained an 18:2 fatty acid side-chain. Conclusions: Maternal obesity was associated with characteristic urine and plasma metabolic phenotypes, and phospholipid profile was found to be associated with both GWG and postpartum WL in metabolically healthy pregnant women with overweight/obesity. Postpartum WL may be linked to the reduction in the intake of linoleic acid/conjugated linoleic acid food sources in our study population.
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Affiliation(s)
- Chung-Ho E. Lau
- Section of Nutrition, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK;
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK;
- Correspondence: (C.-H.E.L.); (E.H.)
| | - Victoria Taylor-Bateman
- Section of Nutrition, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK;
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Panagiotis A. Vorkas
- Section of Biomolecular Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK;
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, 57001 Thessaloniki, Greece
| | - Gonçalo Graça
- Section of Bioinformatics, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK; (G.G.); (T.M.D.E.)
| | - Thanh-Huyen T. Vu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (T.-H.T.V.); (L.H.); (L.V.H.)
| | - Lifang Hou
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (T.-H.T.V.); (L.H.); (L.V.H.)
| | - Elena Chekmeneva
- National Phenome Centre and Section of Bioanalytical Chemistry, Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Campus, IRDB Building, London W12 0NN, UK;
| | - Timothy M. D. Ebbels
- Section of Bioinformatics, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK; (G.G.); (T.M.D.E.)
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK;
- MRC Centre for Environment and Health, Imperial College London, London W2 1PG, UK
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (T.-H.T.V.); (L.H.); (L.V.H.)
| | - Elaine Holmes
- Section of Nutrition, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK;
- Centre for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Perth, WA 6150, Australia
- Correspondence: (C.-H.E.L.); (E.H.)
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Prenatal Counseling throughout Pregnancy: Effects on Physical Activity Level, Perceived Barriers, and Perinatal Health Outcomes: A Quasi-Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238887. [PMID: 33260471 PMCID: PMC7729670 DOI: 10.3390/ijerph17238887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 12/25/2022]
Abstract
Physical activity during pregnancy has many health benefits. However, the physical activity level is insufficient throughout pregnancy and women report perceived barriers to physical activity. This study assessed the impact of a counseling intervention offered in addition to routine pregnancy care on physical activity patterns, perceived barriers, and perinatal health outcomes. A quasi-experimental trial was conducted in the Maternity Unit of a hospital in Guadeloupe (a French department). Ninety-six pregnant women were allocated to a control or intervention group. Regular physical activity counseling was dispensed to the women in the intervention group by trained healthcare providers. The physical activity level and the perceived barriers were assessed in each trimester. Outcomes for the perinatal health of the mother and child were measured throughout pregnancy and after delivery. The perceived barriers, such as a lack of information about the health benefits and risks over the two trimesters (all p < 0.05) and insecurity related to practice throughout pregnancy (all p < 0.05), were different in favor of the intervention group. There were no significant between-group differences for the major indices of physical activity, whether measured or reported. The intervention women reported significantly more sedentary activity compared with the control group in the third trimester, 64.7 (36.4–78.7) vs. 22.7 (9.4–49.8) MET-hours/week, respectively (p < 0.001). The perinatal health outcomes for the mother and child showed no significant differences. The intervention was unable to limit the decline in physical activity or improve health outcomes. However, it was associated with an improvement in the perception of barriers. Future research should focus on interventions that have a sufficient quantitative impact on perceived barriers in order to limit physical activity decline.
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Davis DW, Crew J, Planinic P, Alexander JM, Basu A. Associations of Dietary Bioactive Compounds with Maternal Adiposity and Inflammation in Gestational Diabetes: An Update on Observational and Clinical Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7528. [PMID: 33081175 PMCID: PMC7589556 DOI: 10.3390/ijerph17207528] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 02/06/2023]
Abstract
Gestational diabetes mellitus (GDM) is a common complication of pregnancy that adversely affects maternal and offspring health. Maternal obesity, oxidative stress, and inflammation have been implicated in GDM. In non-pregnant adults, intakes of dietary bioactive compounds inversely associate with insulin resistance and inflammation. However, associations of dietary bioactive compounds with biomarkers of adiposity, antioxidant vitamin and mineral status, oxidative stress, and inflammation in GDM have not been fully elucidated. We addressed this gap by conducting a semi-quantitative review of observational studies and randomized controlled trials published between 2010 and 2020 and retrieved from Google Scholar, Medline, and PubMed. Our analysis revealed that women with GDM are more likely to consume a pro-inflammatory diet before pregnancy and tend to consume fewer antioxidant vitamins and minerals during pregnancy than healthy pregnant women. Women with GDM also have lower blood levels of vitamins A, C, and D and certain adipokines. Several dietary bioactive compounds were noted to improve antioxidant status and biomarkers of inflammation. The Dietary Approaches to Stop Hypertension (DASH) diet and soybean oligosaccharides increased antioxidant enzyme levels. Supplementing n-3 fatty acids, probiotics, synbiotics, and trace elements increased antioxidant enzymes and reduced hs-CRP and MDA. Improvements in inflammation by vitamin D may be contingent upon co-supplementation with other dietary bioactive compounds.
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Affiliation(s)
- Dustin W. Davis
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV 89154, USA; (D.W.D.); (J.C.)
| | - Jeannette Crew
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV 89154, USA; (D.W.D.); (J.C.)
| | - Petar Planinic
- Department of Obstetrics & Gynecology, School of Medicine, University of Nevada at Las Vegas, Las Vegas, NV 89154, USA; (P.P.); (J.M.A.)
| | - James M. Alexander
- Department of Obstetrics & Gynecology, School of Medicine, University of Nevada at Las Vegas, Las Vegas, NV 89154, USA; (P.P.); (J.M.A.)
| | - Arpita Basu
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV 89154, USA; (D.W.D.); (J.C.)
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Doi SAR, Furuya-Kanamori L, Toft E, Musa OAH, Mohamed AM, Clark J, Thalib L. Physical activity in pregnancy prevents gestational diabetes: A meta-analysis. Diabetes Res Clin Pract 2020; 168:108371. [PMID: 32827593 DOI: 10.1016/j.diabres.2020.108371] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/15/2020] [Accepted: 08/10/2020] [Indexed: 01/30/2023]
Abstract
AIMS The effectiveness of physical activity (PA) programs for prevention of gestational diabetes (GDM) lacks conclusive evidence. The aim of this study was to generate clear evidence regarding the effectiveness of physical activity programs in GDM prevention to guide clinical practice. METHODS PubMed/Medline, ISI Web of Science, Scopus, and EMBASE were searched to identify the randomized trials (RCTs) published until June 2019. Randomised controlled trials enrolling women at high risk before the 20th week of gestation comparing the effect of PA interventions with usual care for prevention of GDM were retrieved. Data obtained were synthesised using a bias-adjusted model of meta-analysis. RESULTS A total of 1467 adult women in 11 eligible trials were included. The risk of GDM was significantly lower with PA, but only when it was delivered in the healthcare facility (RR 0.53; 95% CI 0.38-0.74). The number needed to treat with PA in pregnancy (compared to usual care) to prevent one GDM event was 18 (95% CI 14 - 29). The overall effect of PA interventions regardless of location of the intervention was RR 0.69 (95% CI 0.51 - 0.94). CONCLUSIONS This study provides evidence that in-facility physical activity programs started before the 20th week of gestation can significantly decrease the incidence of GDM among women at high risk.
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Affiliation(s)
- Suhail A R Doi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar.
| | - Luis Furuya-Kanamori
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar; Research School of Population Health, Australian National University, Canberra, Australia
| | - Egon Toft
- Deans Office, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Omran A H Musa
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Aisha M Mohamed
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Justin Clark
- The Centre for Research into Evidence Based Practice, Bond University, Gold Coast, Australia
| | - Lukman Thalib
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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Garmendia ML, Corvalan C, Araya M, Casanello P, Kusanovic JP, Uauy R. Effectiveness of a normative nutrition intervention in Chilean pregnant women on maternal and neonatal outcomes: the CHiMINCs study. Am J Clin Nutr 2020; 112:991-1001. [PMID: 32692805 DOI: 10.1093/ajcn/nqaa185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/15/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Some nutritional interventions have shown their efficacy in reducing gestational weight gain (GWG); however, their applicability in routine care is limited. OBJECTIVE We assessed the effectiveness of a low-intensity and high-coverage nutritional intervention on maternal and offspring outcomes; the intervention enhanced existing nutritional health care standards and practices at the primary health care level in Chile. METHODS This study was a cluster-randomized controlled trial of 12 primary health care centers (PHCCs) from Santiago, Chile. PHCCs were randomly allocated to either nutritional intervention [intervention group (IG), n = 5] or routine care [control group (CG), n = 7]. A total of 4631 pregnant women were recruited (IG, n = 2565; and CG, n = 2066). Primary outcomes were adequate GWG and glycemic control in mothers and birth weight, birth length, macrosomia, and large for gestational age in neonates. The intervention consisted of 4 key actions: training of health care professionals on nutritional recommendations, counseling of pregnant women on diet and physical activity recommendations, offering a physical activity program implemented in the participating PHCCs, and adequate referral to dietitians. Women randomly assigned to the CG received routine antenatal care. RESULTS At baseline, the mean age was 26.1 y; 45% of women were primipara and 24% were obese. No differences were found in the percentage of women achieving adequate GWG (IG: 30.3%, compared with CG: 31.3%; OR: 0.94; 95% CI: 0.81, 1.09), but women in the IG had lower GWG than those in the CG (11.3 compared with 11.9 kg; mean difference: -0.63 kg; 95% CI: -1.19, -0.08). Effects of the intervention were significantly higher in women with obesity at the begining of pregnancy (mean difference: -1.24 kg; 95% CI: -2.18, -0.30; P for interaction < 0.05). No differences were found between groups regarding maternal glycemic control or neonatal outcomes. CONCLUSIONS Our findings demonstrate that a low-intensity, high-coverage intervention delivered through the Chilean public health care system under standard operating conditions reduces GWG and has the potential for successful scale-up. This trial was registered at clinicaltrials.gov as NCT01916603.
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Affiliation(s)
- Maria Luisa Garmendia
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Camila Corvalan
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Marcela Araya
- Department of Women and Newborn Health Promotion, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Paola Casanello
- Department of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Department of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Pedro Kusanovic
- Department of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF), Department of Obstetrics and Gynecology, Sótero del Río Hospital, Santiago, Chile
| | - Ricardo Uauy
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile.,Department of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Evaluation of antenatal risk factors for postpartum depression: a secondary cohort analysis of the cluster-randomised GeliS trial. BMC Med 2020; 18:227. [PMID: 32703266 PMCID: PMC7379365 DOI: 10.1186/s12916-020-01679-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/23/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Maternal weight variables are important predictors of postpartum depression (PPD). While preliminary evidence points to an association between pre-pregnancy obesity and PPD, the role of excessive gestational weight gain (GWG) on PPD is less studied. In this secondary cohort analysis of the German 'healthy living in pregnancy' (GeliS) trial, we aimed to investigate associations between weight-related variables and PPD and to assess the influence of GWG on the risk for PPD. METHODS We included women with normal weight, overweight, and obesity (BMI 18.5-40.0 kg/m2). Symptoms of PPD were assessed 6-8 weeks postpartum using the Edinburgh Postnatal Depression Scale. Pre-pregnancy BMI was self-reported. During the course of pregnancy, weight was measured at gynaecological practices within regular check-ups. GWG was defined as the difference between the last measured weight before delivery and the first measured weight at the time of recruitment (≤ 12th week of gestation). Excessive GWG was classified according to the Institute of Medicine. Multiple logistic regression analyses were used to estimate the odds of PPD in relation to pre-pregnancy BMI, GWG, and excessive GWG adjusting for important confounders. RESULTS Of the total 1583 participants, 45.6% (n = 722) showed excessive GWG and 7.9% (n = 138) experienced PPD. Pre-pregnancy BMI (per 5-unit increase; OR = 1.23, 95% CI 1.08-1.41, p = 0.002) and pre-pregnancy overweight or obesity were significantly positively associated with the odds of developing PPD, particularly among women with an antenatal history of anxiety or depressive symptoms (overweight: OR = 1.93, 95% CI = 1.15-3.22, p = 0.01; obesity: OR = 2.11, 95% CI = 1.13-3.96, p = 0.02). Sociodemographic or lifestyle factors did not additively influence the odds of having PPD. In fully adjusted models, there was no significant evidence that GWG or the occurrence of excessive GWG increased the odds of experiencing PPD (excessive vs. non-excessive: OR = 3.48, 95% CI 0.35-34.94; GWG per 1 kg increase: OR = 1.16, 95% CI 0.94-1.44). CONCLUSION Pre-pregnancy overweight or obesity is associated with PPD independent of concurrent risk factors. History of anxiety or depressive symptoms suggests a stress-induced link between pre-pregnancy weight and PPD. TRIAL REGISTRATION NCT01958307 , ClinicalTrials.gov, retrospectively registered on 9 October 2013.
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Alayli A, Krebs F, Lorenz L, Nawabi F, Bau AM, Lück I, Moreira A, Kuchenbecker J, Tschiltschke E, John M, Klose S, Häusler B, Giertz C, Korsten-Reck U, Stock S. Evaluation of a computer-assisted multi-professional intervention to address lifestyle-related risk factors for overweight and obesity in expecting mothers and their infants: protocol for an effectiveness-implementation hybrid study. BMC Public Health 2020; 20:482. [PMID: 32293391 PMCID: PMC7158079 DOI: 10.1186/s12889-020-8200-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The first 1000 days after conception are a critical period to encourage lifestyle changes to reduce the risk of childhood obesity and early programming of chronic diseases. A healthy lifestyle during pregnancy is also crucial to avoid high post-partum weight retention. Currently, lifestyle changes are not consistently discussed during routine health services in Germany. The objective of this study is to evaluate a novel computer-assisted lifestyle intervention embedded in prenatal visits and infant check-ups. The intervention seeks to reduce lifestyle-related risk factors for overweight and obesity among expecting mothers and their infants. METHODS The study is designed as a hybrid effectiveness-implementation trial to simultaneously collect data on the effectiveness and implementation of the lifestyle intervention. The trial will take place in eight regions of the German state Baden-Wuerttemberg. Region were matched using propensity score matching. Expecting mothers (n = 1860) will be recruited before 12 weeks of gestation through gynecological practices and followed for 18 months. During 11 routine prenatal visits and infant check-ups gynecologists, midwives and pediatricians provide lifestyle counseling using Motivational Interviewing techniques. The primary outcome measure is the proportion of expecting mothers with gestational weight gain within the recommended range. To understand the process of implementation (focus group) interviews will be conducted with providers and participants of the lifestyle intervention. Additionally, an analysis of administrative data and documents will be carried out. An economic analysis will provide insights into cost and consequences compared to routine health services. DISCUSSION Findings of this study will add to the evidence on lifestyle interventions to reduce risk for overweight and obesity commenced during pregnancy. Insights gained will contribute to the prevention of early programming of chronic disease. Study results regarding implementation fidelity, adoption, reach and cost-effectiveness of the lifestyle intervention will inform decisions about scale up and public funding. TRIAL REGISTRATION German Clinical Trials Register (DRKS00013173). Registered 3rd of January 2019, https://www.drks.de.
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Affiliation(s)
- Adrienne Alayli
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne (IGKE), Cologne, Germany.
- Federal Centre for Health Education (BZgA), Cologne, Germany.
| | - Franziska Krebs
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne (IGKE), Cologne, Germany
| | - Laura Lorenz
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne (IGKE), Cologne, Germany
| | - Farah Nawabi
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne (IGKE), Cologne, Germany
| | | | - Isabel Lück
- Platform Nutrition and Physical Activity (peb), Berlin, Germany
| | - Andrea Moreira
- Platform Nutrition and Physical Activity (peb), Berlin, Germany
| | | | | | - Michael John
- Fraunhofer Institute for Open Communication Systems (FOKUS), Berlin, Germany
| | - Stefan Klose
- Fraunhofer Institute for Open Communication Systems (FOKUS), Berlin, Germany
| | - Benny Häusler
- Fraunhofer Institute for Open Communication Systems (FOKUS), Berlin, Germany
| | - Christian Giertz
- Fraunhofer Institute for Open Communication Systems (FOKUS), Berlin, Germany
| | | | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne (IGKE), Cologne, Germany
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Abstract
PURPOSE OF REVIEW Gestational weight gain is a modifiable risk factor for adverse perinatal outcomes. After the Institute of Medicine (IOM) released updated recommendations for gestational weight gain in 2009, a multitude of studies were released examining the recommendations, particularly for women with obesity. As the obesity epidemic continues, many physicians are interested in minimizing gestational weight gain for all women. Our aim was to review the evidence for the association of gestational weight gain and perinatal outcomes, particularly for weight gain outside the IOM guidelines. RECENT FINDINGS Gestational weight gain is associated with several adverse perinatal outcomes including fetal growth, preterm delivery, cesarean delivery, gestational diabetes, hypertensive disorders of pregnancy, and infant mortality as well as with long-term offspring metabolic health outcomes. Multiple randomized controlled trials have been conducted evaluating the efficacy of lifestyle intervention on gestational weight gain, and while lifestyle interventions may alter gestational weight gain, they have not been associated with improvement in perinatal outcomes. Weight loss during pregnancy is associated with decreased risks of macrosomia and cesarean delivery; however, given an association with low birth weight, it is not currently recommended. Excessive gestational weight gain is known to be associated with multiple adverse fetal and maternal outcomes. Lifestyle interventions during pregnancy may be helpful in decreasing excessive weight gain, but have not shown to be beneficial for most adverse pregnancy outcomes. More research is needed before making recommendations for weight loss in women with obesity during pregnancy.
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Affiliation(s)
- Macie L Champion
- Division of Maternal Fetal Medicine. Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, 1700 6th Ave S, Birmingham, AL, 35233, USA.
| | - Lorie M Harper
- Division of Maternal Fetal Medicine. Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, 1700 6th Ave S, Birmingham, AL, 35233, USA
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