Pregestational excess weight and adverse maternal outcomes: a systematic review of previous studies in Brazil

Environmental and individual factors associated with gestational weight gain

BACKGROUND

Environmental factors have an impact on inappropriate food choices and sedentary lifestyle, and both individually and in combination these factors favour improper gestational weight gain (GWG) and consequent maternal and neonatal health problems. The objective of this study was to analyze the environmental and individual factors associated with GWG.

METHODS

Data were from "Born in Belo Horizonte: Survey on childbirth and birth", a hospital-based retrospective cohort of 506 pregnant women with deliveries in public and private maternity hospitals in Belo Horizonte, Minas Gerais. Data were collected via face-to-face interviews from November 2011 to March 2013. The outcome variable of this study was the GWG categorized based on the Institute of Medicine Guidelines. Explanatory environmental variables included the availability and access to food environment and places available for physical activity in the neighborhood. Explanatory individual variables included socioeconomic and demographic, obstetric and childbirth variables. Generalized estimating equations examined the association of environmental and individual factors with insufficient or excessive GWG.

RESULTS

The final sample consisted of 506 mothers. There was 36.4% pregnant women showing excessive GWG and 22.7% showing GWG below the recommended interval. Regarding excessive GWG, there was a positive association with the number of mixed food purchasing establishments close to the place of residence, pre-pregnancy body mass index in the categories of overweight and obesity, arterial hypertension and the private sector as the predominant place for prenatal consultations.

CONCLUSION

GWG outside of the recommended interval was associated with individual and environmental factors, and most pregnant women had insufficient or excessive gestational weight gain. Such results can complement previously published evidence, important for creating more effective strategies for the prevention of excessive and inadequate GWG and the consequent problems related to it during pregnancy.

Association of leptin receptor expression in placenta and peripheral blood mononuclear cell with maternal weight in birth outcomes

INTRODUCTION

The pregnancy period represents the most intense period of growth and development. Pre-pregnancy weight influences weight gain during pregnancy. Leptin is a hormone mainly derived from white adipose tissue, during pregnancy leptin is also produced by the placenta. It has been suggested that the effects of placental leptin on the mother may contribute to endocrine-mediated alterations in energy balance; a dysregulation in leptin levels or its receptors may lead to poor birth outcomes. Therefore, the main goal of the present study was to analyze the differences in birth outcomes by maternal weight with the expression level of leptin receptor in maternal peripheral blood mononuclear cell (PBMC) and placental tissue.

METHODS

Women with full-term gestation and its offspring were enrolled. Total RNA from maternal PBMC and placenta was obtained to perform the analysis of expression of the leptin receptor (LEPR) gene trough real-time PCR technique. Data were analyzed using one-way ANOVA or Mann-Whitney u test when applicable. Pearson correlation coefficient was used to determine the relationship between continuous variables (Stata v.13); p ≤ 0.05 was considered statistically significant.

RESULTS

No statistically significant differences were found between LEPR expression level and the BMI studied groups in maternal PBMC and placental tissue. Interaction between gestational weight gain (GWG) and LEPR in maternal PBMC explain in a 32% the variability of the newborn weight.

CONCLUSIONS

LEPR expression level in maternal PBMC correlates with newborn measurements independent from sex. GWG can affect fetal development by increasing fetal birth weight.