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Hong M, Liang F, Zheng Z, Chen H, Li X, Guo Y, Liu X, Li K, Xia H. Interaction and joint association of gestational diabetes mellitus and subsequent weight gain rate on macrosomia. Clin Nutr ESPEN 2023; 58:368-374. [PMID: 38057029 DOI: 10.1016/j.clnesp.2023.11.001] [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: 04/09/2023] [Revised: 10/13/2023] [Accepted: 11/06/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND & AIMS Gestational diabetes mellitus (GDM) and gestational weight gain are two crucial modifiable nutritional factors during pregnancy in preventing macrosomia, warranting appropriate management of both glycemic levels and weight gain to prevent macrosomia, particularly in individuals with GDM. Unfortunately, current general weight targets appear not to apply to individuals with GDM, suggesting that weight gain, specifically following an oral glucose tolerance test (OGTT), may affect risk of macrosomia dependent on GDM status. Therefore, this study aims to evaluate the interaction and joint association of GDM and post-OGTT weight gain rate (PWGR) in relation to macrosomia. METHODS This was a population-based cohort study of 59,421singleton pregnant women in South China during 2017-2020. Among them, 9856 were diagnosed with GDM while 49,565 did not have the condition. All participants underwent an OGTT between 20 and 28 weeks of pregnancy, typically occurring between 24 and 28 weeks. PWGR was defined as the average rate of change in maternal weight with gestational weeks following OGTT, which was estimated using a repeated linear mixed effects model including a random intercept and slope for each individual. The relative risk (RR) of macrosomia associated with GDM and PWGR was estimated using a multivariate generalized linear model. RESULTS There was a significant interaction between GDM and PWGR in increasing the risk of macrosomia. The combination of GDM and a 1-SD increase in PWGR was associated with a 2.26-fold higher risk of macrosomia (95% CI 1.92 to 2.65), with the interaction of these two factors contributing to 58.0% (95% CI 31.4%-84.7%) of this association. Moreover, we observed a significant heterogeneity in susceptibility to macrosomia due to increased PWGR between GDM and non-GDM populations, with the highest PWGR quartile having respective RRs of 2.27 (95% CI 1.62 to 3.18) and 1.41 (95% CI 1.18 to 1.69) compared to the lowest quartile category, which was corresponded to 55.9% (95% CI 38.3%-68.6%) and 29.1% (95% CI 15.3%-40.8%) preventable proportions of macrosomia cases in these populations. CONCLUSIONS GDM and PWGR had a synergistic effect in increasing the risk of macrosomia. Furthermore, individuals with GDM exhibited a heightened susceptibility to macrosomia due to elevated PWGR. These findings emphasize the importance of appropriate weight interventions during late pregnancy and suggest the need for different weight targets between these two populations, with a stricter PWGR potentially being more effective for the GDM population.
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Affiliation(s)
- Miao Hong
- Clinical Research & Data Center, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China
| | - Feng Liang
- Clinical Research & Data Center, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China
| | - Zheng Zheng
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China
| | - Huimin Chen
- Department of Clinical Nutrition, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China
| | - Xiaojun Li
- Clinical Research & Data Center, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China
| | - Yi Guo
- Clinical Research & Data Center, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China
| | - Xihong Liu
- Department of Clinical Nutrition, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China
| | - Kuanrong Li
- Clinical Research & Data Center, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China
| | - Huimin Xia
- Clinical Research & Data Center, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China; Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China.
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Bastain T, Naya C, Yang T, Vigil M, Chen C, Chavez T, Toledo-Corral C, Farzan S, Habre R, Lerner D, Lurvey N, Grubbs B, Dunton G, Breton C, Eckel S. Poor Sleep Quality Increases Gestational Weight Gain Rate in Pregnant People: Findings from the MADRES Study. RESEARCH SQUARE 2023:rs.3.rs-2944456. [PMID: 37841879 PMCID: PMC10571604 DOI: 10.21203/rs.3.rs-2944456/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background Poor sleep quality is associated with weight gain in non-pregnant populations, but evidence in pregnant people is lacking. Our study examined the association between early-to-mid pregnancy sleep quality and weekly gestational weight gain (GWG) rate during mid-to-late pregnancy by pre-pregnancy body mass index (BMI). Method Participants were 316 pregnant participants from the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) study. During early-to-mid pregnancy, participants reported their sleep quality which was used to construct four categories: very poor, poor, good, and very good. Linear growth curve models examined the association between early-to-mid pregnancy sleep quality and weekly rate of GWG (kg/week) during mid-to-late pregnancy (> 20 weeks gestation), with a three-way cross-level interaction between gestational age, sleep quality, and pre-pregnancy BMI category. Models adjusted for ethnicity by birthplace, hypertensive disorders, perceived stress score, and physical activity level. Results Overall, poorer early-to-mid pregnancy sleep quality was associated with increased weekly weight gain during mid-to-late pregnancy. For example, amongst normal weight participants, mid-to-late pregnancy weight gain was, on average, 0.39 kg (95% CI: 0.29, 0.48) per week for those with very good sleep quality, 0.53 kg (95% CI: 0.44, 0.61) per week for those with poor sleep quality, and 0.54 kg (95% CI: 0.46, 0.62) per week for those with very poor sleep quality during early-to-mid pregnancy. This difference in GWG rate was statistically significantly comparing very good to poor sleep (0.14 kg/week, 95% CI: 0.01, 0.26) and very good to very poor sleep (0.15kg/week, 85% CI: 0.02, 0.27). This association between sleep quality and GWG rate did not statistically differ by pre-pregnancy BMI. Conclusion Our study found very poor early-to-mid pregnancy sleep quality was associated with higher mid-to-late pregnancy GWG rate. Incorporating pregnancy-specific sleep recommendations into routine obstetric care may be a critical next step in promoting healthy GWG.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Carrie Breton
- Keck School of Medicine, University of Southern California
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Faraji Azad S, Biglarian A, Rostami M, Bidhendi-Yarandi R. Maternal weight latent trajectories and associations with adverse pregnancy outcomes using a smoothing mixture model. Sci Rep 2023; 13:9011. [PMID: 37268823 DOI: 10.1038/s41598-023-36312-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 05/31/2023] [Indexed: 06/04/2023] Open
Abstract
Class membership is a critical issue in health data sciences. Different types of statistical models have been widely applied to identify participants within a population with heterogeneous longitudinal trajectories. This study aims to identify latent longitudinal trajectories of maternal weight associated with adverse pregnancy outcomes using smoothing mixture model (SMM). Data were collected from the Khuzestan Vitamin D Deficiency Screening Program in Pregnancy. We applied the data of 877 pregnant women living in Shooshtar city, whose weights during the nine months of pregnancy were available. In the first step, maternal weight was classified and participants were assigned to only one group for which the estimated trajectory is the most similar to the observed one using SMM; then, we examined the associations of identified trajectories with risk of adverse pregnancy endpoints by applying logistic regression. Three latent trajectories for maternal weight during pregnancy were identified and named as low, medium and high weight trajectories. Crude estimated odds ratio (OR) for icterus, preterm delivery, NICU admission and composite neonatal events shows significantly higher risks in trajectory 1 (low weight) compared to trajectory 2 (medium weight) by 69% (OR = 1.69, 95%CI 1.20, 2.39), 82% (OR = 1.82, 95%CI 1.14, 2.87), 77% (OR = 1.77, 95%CI 1.17, 2.43), and 85% (OR = 1.85, 95%CI 1.38, 2.76), respectively. Latent class trajectories of maternal weights can be accurately estimated using SMM. It is a powerful means for researchers to appropriately assign individuals to their class. The U-shaped curve of association between maternal weight gain and risk of maternal complications reveals that the optimum place for pregnant women could be in the middle of the growth curve to minimize the risks. Low maternal weight trajectory compared to high had even a significantly higher hazard for some neonatal adverse events. Therefore, appropriate weight gain is critical for pregnant women.Trial registration International Standard Randomized Controlled Trial Number (ISRCTN): 2014102519660N1; http://www.irct.ir/searchresult.php?keyword=&id=19660&number=1&prt=7805&total=10&m=1 (Archived by WebCite at http://www.webcitation.org/6p3lkqFdV ).
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Affiliation(s)
- Shirin Faraji Azad
- Department of Biostatistics and Epidemiology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Akbar Biglarian
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Maryam Rostami
- Department of Community Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics and Epidemiology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
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Lee CS, Zhu S, Wu Q, Hu Y, Chen Y, Chen D, Liang Z. Independent and Joint Associations of Age, Pre-pregnancy BMI, and Gestational Weight Gain with Adverse Pregnancy Outcomes in Gestational Diabetes Mellitus. Diabetes Ther 2023; 14:363-375. [PMID: 36562982 PMCID: PMC9944684 DOI: 10.1007/s13300-022-01352-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION To explore the independent and combined effects of maternal age, pre-pregnancy body mass index (BMI), and gestational weight gain (GWG) on pregnancy outcomes in gestational diabetes mellitus (GDM). METHODS A total of 2171 pregnant women with GDM attending the Women's Hospital of Zhejiang University were retrospectively included. We compared pregnancy outcomes in different age, BMI, and GWG groups after adjusting for confounding variables. RESULTS Results showed that (1) advanced maternal age increased the risk of primary Cesarean section and hypertensive disorders of pregnancy (HDP) in normal weight; (2) independent of age and GWG, high BMI significantly increased the risk of HDP, primary Cesarean section, and macrosomia; (3) Women with excessive GWG had a higher risk of primary Cesarean section and HDP, even they were ≤ 29 years old or normal weight, respectively; (4) Pregnant women with inadequate GWG had a higher risk of preterm birth and a lower risk of macrosomia in both the 30-34 age group and the normal weight group; (5) BMI was a better predictor of HDP than GWG among women younger than 30. CONCLUSIONS Among the GDM population, women over the age of 35, overweight and obese, or with an excessive GWG were more prone to adverse pregnancy outcomes, especially primary Cesarean delivery and HDP.
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Affiliation(s)
- Chee S Lee
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, China
| | - Shuqi Zhu
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, China
| | - Qi Wu
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, China
| | - Ying Hu
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, China
| | - Yunyan Chen
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, China
- Huzhou Women and Children's Hospital, Zhejiang, China
| | - Danqing Chen
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, China.
| | - Zhaoxia Liang
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, China.
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
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Msollo SS, Martin HD, Mwanri AW, Petrucka P. Simple method for identification of women at risk of gestational diabetes mellitus in Arusha urban, Tanzania. BMC Pregnancy Childbirth 2022; 22:545. [PMID: 35794524 PMCID: PMC9258134 DOI: 10.1186/s12884-022-04838-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Screening for gestational diabetes mellitus in Tanzania is challenged by limited resources. Therefore, this study aimed to develop a simple method for identification of women at risk of gestational diabetes mellitus in Arusha urban, Tanzania. METHODS This study used data from a cross sectional study, that was conducted between March and December 2018 in Arusha District involving 468 pregnant women who were not known to have diabetes before pregnancy. Urine glucose was tested using urine multistics and blood glucose levels by Gluco-Plus™ and diagnosed in accordance with the World Health Organization's criteria. Anthropometrics were measured using standard procedures and maternal characteristics were collected through face-to-face interviews using a questionnaire with structured questions. Univariate analysis assessed individual variables association with gestational diabetes mellitus where variables with p-value of < 0.05 were included in multivariable analysis and predictors with p-value < 0.1 remained in the final model. Each variable was scored based on its estimated coefficients and risk scores were calculated by multiplying the corresponding coefficients by ten to get integers. The model's performance was assessed using c-statistic. Data were analyzed using Statistical Package for Social Science™. RESULTS The risk score included body fat ≥ 38%, delivery to macrosomic babies, mid-upper arm circumference ≥ 28 cm, and family history of type 2 diabetes mellitus. The score correctly identified 98% of women with gestational diabetes with an area under the receiver operating characteristic curve of 0.97 (95% CI 0.96-0.99, p < 0.001), sensitivity of 0.98, and specificity of 0.46. CONCLUSION The developed screening tool is highly sensitive and correctly differentiates women with and without gestational diabetes mellitus in a Tanzanian sub-population.
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Affiliation(s)
- Safiness Simon Msollo
- Depertment of Food Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Haikael David Martin
- School of Life Sciences, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Akwilina Wendelin Mwanri
- Depertment of Food Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
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Sibiak R, Ozegowska K, Wender-Ozegowska E, Gutaj P, Mozdziak P, Kempisty B. Fetomaternal Expression of Glucose Transporters (GLUTs)-Biochemical, Cellular and Clinical Aspects. Nutrients 2022; 14:2025. [PMID: 35631166 PMCID: PMC9146575 DOI: 10.3390/nu14102025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/28/2022] [Accepted: 05/11/2022] [Indexed: 12/10/2022] Open
Abstract
Several types of specialized glucose transporters (GLUTs) provide constant glucose transport from the maternal circulation to the developing fetus through the placental barrier from the early stages of pregnancy. GLUT1 is a prominent protein isoform that regulates placental glucose transfer via glucose-facilitated diffusion. The GLUT1 membrane protein density and permeability of the syncytial basal membrane (BM) are the main factors limiting the rate of glucose diffusion in the fetomaternal compartment in physiological conditions. Besides GLUT1, the GLUT3 and GLUT4 isoforms are widely expressed across the human placenta. Numerous medical conditions and molecules, such as hormones, adipokines, and xenobiotics, alter the GLUT's mRNA and protein expression. Diabetes upregulates the BM GLUT's density and promotes fetomaternal glucose transport, leading to excessive fetal growth. However, most studies have found no between-group differences in GLUTs' placental expression in macrosomic and normal control pregnancies. The fetomaternal GLUTs expression may also be influenced by several other conditions, such as chronic hypoxia, preeclampsia, and intrahepatic cholestasis of pregnancy.
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Affiliation(s)
- Rafal Sibiak
- Department of Histology and Embryology, Poznan University of Medical Sciences, 60-701 Poznan, Poland;
- Doctoral School, Poznan University of Medical Sciences, 60-701 Poznan, Poland
| | - Katarzyna Ozegowska
- Department of Infertility and Reproductive Endocrinology, Poznan University of Medical Sciences, 61-701 Poznan, Poland;
| | - Ewa Wender-Ozegowska
- Department of Reproduction, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (E.W.-O.); (P.G.)
| | - Pawel Gutaj
- Department of Reproduction, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (E.W.-O.); (P.G.)
| | - Paul Mozdziak
- Prestage Department of Poultry Science, North Carolina State University, Raleigh, NC 27695, USA;
| | - Bartosz Kempisty
- Department of Histology and Embryology, Poznan University of Medical Sciences, 60-701 Poznan, Poland;
- Prestage Department of Poultry Science, North Carolina State University, Raleigh, NC 27695, USA;
- Department of Anatomy, Poznan University of Medical Sciences, 60-701 Poznan, Poland
- Department of Veterinary Surgery, Institute of Veterinary Medicine, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland
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Naya CH, Toledo-Corral CM, Chavez T, Lerner D, Lurvey N, Eckel SP, Peterson AK, Grubbs BH, Dunton GF, Breton CV, Bastain TM. Third trimester cortisol is positively associated with gestational weight gain in pregnant women with class one obesity. Int J Obes (Lond) 2022; 46:366-373. [PMID: 34718334 PMCID: PMC9012147 DOI: 10.1038/s41366-021-01009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/27/2021] [Accepted: 10/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND/OBJECTIVE Prevalence of pre-pregnancy obesity and excessive gestational weight gain (GWG) are higher among women of color with low SES. Dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis and its end-product, cortisol, during pregnancy is hypothesized to be associated with excessive GWG. However, past studies have produced inconsistent findings and often did not include health disparities populations. This study examined the association between pre-pregnancy body mass index (BMI), third trimester diurnal cortisol, and GWG in low-income, predominantly Hispanic women. SUBJECTS/METHODS The MADRES study is an ongoing prospective cohort study of primarily Hispanic, low-income pregnant women and their children in Los Angeles, California. Data from 176 participants were included in this study. Total cortisol secretion (area under the curve, AUC) was quantified using four salivary cortisol samples (awakening, 30 min after awakening, afternoon, and bedtime) that were collected at home on one day during the third trimester of pregnancy. Moderation of the association between total cortisol and GWG by pre-pregnancy BMI was tested using multiple linear regression with a multiplicative interaction term. RESULTS There was no association between total cortisol secretion and GWG overall (p = 0.82), but the association between total cortisol and GWG was stronger for women with class 1 pre-pregnancy obesity compared to women with normal pre-pregnancy BMI (interaction term p = 0.04). CONCLUSIONS Results suggest that obesity status before pregnancy may be exacerbating the physiological impact of cortisol on GWG.
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Affiliation(s)
- Christine H Naya
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Claudia M Toledo-Corral
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Health Sciences, California State University Northridge, Northridge, CA, USA
| | - Thomas Chavez
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | | | - Sandrah P Eckel
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alicia K Peterson
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brendan H Grubbs
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Genevieve F Dunton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Carrie V Breton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Theresa M Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Nørgård BM, Catalini L, Jølving LR, Larsen MD, Friedman S, Fedder J. The Efficacy of Assisted Reproduction in Women with a Wide Spectrum of Chronic Diseases - A Review. Clin Epidemiol 2021; 13:477-500. [PMID: 34194244 PMCID: PMC8236837 DOI: 10.2147/clep.s310795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/07/2021] [Indexed: 01/11/2023] Open
Abstract
Assisted reproductive technology (ART) treatments in women with underlying chronic diseases have become increasingly frequent. The objective of this review is to provide an overview of the literature examining the chance of having a live born child after ART in women with chronic diseases, compared to other women receiving ART. We focused on some of the most prevalent chronic diseases in women during their reproductive years, ie ulcerative colitis, Crohn's disease, rheumatoid arthritis, multiple sclerosis, epilepsy, hyperthyroidism, hypothyroidism, and diabetes mellitus. Secondly, we studied the chance of successful implantation. The literature search was performed in the database Pubmed.gov. including all studies published before October 2020. Title and abstracts of 58 papers were reviewed, 37 papers were excluded and other 8 studies were excluded after full-text evaluation. Only 13 papers were eligible for review. Results indicate that women with ulcerative colitis, Crohn's disease, rheumatoid arthritis, hyperthyroidism, and diabetes mellitus type 2 might have problems with low implantation rate or early embryo development during ART. On the contrary, the few studies on women with hypothyroidism, diabetes mellitus type 1, and epilepsy suggest an equivalent chance of a live birth compared to other women undergoing ART. A possible explanation behind these differences could reside in the disease-specific dysregulation of the innate or adaptive immune system. To our knowledge, this is the first review on ART in women with chronic diseases, and it has disclosed that the evidence in this area is indeed sparse. We encourage others to examine live birth after ART in women with chronic diseases.
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Affiliation(s)
- Bente Mertz Nørgård
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Laura Catalini
- Centre of Andrology and Fertility Clinic, Odense University Hospital, Odense, Denmark
- Research Unit of Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Line Riis Jølving
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Michael Due Larsen
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sonia Friedman
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Center for Crohn’s and Colitis, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jens Fedder
- Centre of Andrology and Fertility Clinic, Odense University Hospital, Odense, Denmark
- Research Unit of Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Loh HH, Taipin H, Said A. Maternal obesity and risk of adverse obstetric outcomes in Malaysia. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:285-288. [PMID: 33855332 DOI: 10.47102/annals-acadmedsg.202054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Huai Heng Loh
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Malaysia
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10
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Xu H, Arkema EV, Cnattingius S, Stephansson O, Johansson K. Gestational weight gain and delivery outcomes: A population-based cohort study. Paediatr Perinat Epidemiol 2021; 35:47-56. [PMID: 32725913 DOI: 10.1111/ppe.12709] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 06/05/2020] [Accepted: 06/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gestational weight gain is a modifiable factor that could impact maternal and infant health. However, its effect on delivery outcomes is not well established. OBJECTIVES To investigate the associations between gestational weight gain and delivery outcomes stratified by early-pregnancy body mass index (BMI). METHODS The study population included singleton livebirths in the Stockholm-Gotland obstetric cohort (January 2008 to October 2014; n = 174 953). The exposure was total gestational weight gain standardised into gestational-age-specific z-scores by using previously defined Swedish pregnancy weight gain-for-gestational age charts. The outcomes included caesarean delivery (overall, elective, and emergency), instrumental vaginal delivery, induction of labour, and postpartum haemorrhage. Confounders included maternal age, maternal height, parity, smoking status, cohabitation status, chronic hypertension, and pre-pregnancy diabetes. Logistic regression models with marginal standardisation were used to estimate risk ratios (RR) with 95% confidence intervals (CI) for each delivery outcome stratified by early-pregnancy BMI. RESULTS Above average weight gain (z-score ≥ 0.50 SD) increased risks of caesarean delivery (from RR 1.08, 95% CI 1.00, 1.15 to RR 1.45, 95% CI 1.35, 1.55 across BMI groups), induction of labour (from RR 1.14, 95% CI 1.04, 1.23 to RR 1.38, 95% CI 1.25, 1.51 across BMI groups except underweight), and postpartum haemorrhage (from RR 1.13, 95% CI 1.07, 1.19 to RR 1.25, 95% CI 1.09, 1.41 among normal and overweight). Below average weight gain (z-score <-0.50 SD) decreased caesarean delivery risk (from RR 0.77, 95% CI 0.61, 0.93 to RR 0.89, 95% CI 0.84, 0.95 across BMI groups except underweight). CONCLUSIONS In normal and overweight women, the risks of caesarean delivery, induction of labour, and postpartum haemorrhage increased with gestational weight gain. In obese women, higher gestational weight gain increased risks of caesarean delivery and induction of labour. Low gestational weight gain reduced risk of caesarean delivery in all BMI groups except underweight.
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Affiliation(s)
- Huiling Xu
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Elizabeth V Arkema
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sven Cnattingius
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Division of Obstetrics and Gynaecology, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Kari Johansson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Division of Obstetrics and Gynaecology, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden
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11
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Larsen MD, Jensen DM, Fedder J, Jølving LR, Nørgård BM. Live-born children after assisted reproduction in women with type 1 diabetes and type 2 diabetes: a nationwide cohort study. Diabetologia 2020; 63:1736-1744. [PMID: 32548699 PMCID: PMC7406522 DOI: 10.1007/s00125-020-05193-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/23/2020] [Indexed: 01/10/2023]
Abstract
AIMS/HYPOTHESIS Type 1 and type 2 diabetes are among the most prevalent chronic diseases in women in the fertile years and women with diabetes may experience several reproductive issues. We aimed to examine the chance of biochemical pregnancy, clinical pregnancy and live birth after assisted reproductive technology (ART) treatment in women with type 1 and type 2 diabetes and whether obesity per se influenced the results. METHODS This nationwide register-based cohort study is based on the Danish ART Registry comprising 594 women with either type 1 diabetes or type 2 diabetes from 2006 to 2017. RESULTS Relative to women without diabetes, the adjusted OR (95% CI) of a live birth per embryo transfer was 0.50 (0.36, 0.71) in women with type 2 diabetes and 1.10 (0.86, 1.41) in women with type 1 diabetes. CONCLUSIONS/INTERPRETATION Our data on the efficacy of ART treatment in women with type 1 and type 2 diabetes is the first in this field. When compared with women without diabetes, women with type 1 diabetes had an equivalent chance of a live birth per embryo transfer whereas women with type 2 diabetes had a reduced chance. The findings in women with type 2 diabetes did not seem to be driven by obesity per se as the same pattern was seen in both normal-weight and obese women. Graphical abstract.
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Affiliation(s)
- Michael Due Larsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Erling Skjalgssons gt. 1, Laboratoriesenteret, 5. etasje, 7491, Trondheim, Norway.
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark.
| | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Jens Fedder
- Department D, Centre of Andrology and Fertility Clinic, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Line Riis Jølving
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bente Mertz Nørgård
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Willcox JC, Chai D, Beilin LJ, Prescott SL, Silva D, Neppe C, Huang RC. Evaluating Engagement in a Digital and Dietetic Intervention Promoting Healthy Weight Gain in Pregnancy: Mixed Methods Study. J Med Internet Res 2020; 22:e17845. [PMID: 32442153 PMCID: PMC7380982 DOI: 10.2196/17845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/16/2020] [Accepted: 03/21/2020] [Indexed: 01/16/2023] Open
Abstract
Background Early excess and inadequate gestational weight gain (GWG) have been associated with negative outcomes for mother and child. The use of digital media to deliver pregnancy lifestyle interventions is increasing, but there is little data on participant engagement. The Pregnancy Lifestyle Activity and Nutrition (PLAN) intervention pilot study was an electronic health and dietetic-delivered intervention program promoting healthy GWG in early pregnancy. Objective This study aims to explore the interactions of participants with the program and to assess its acceptability. Methods This study uses both quantitative and qualitative methods using data from parent randomized controlled trial (ACTRN12617000725369). Quantitative data from 22 participants in the intervention arm who completed the study provided measures of the interactions participants had with the digital components of the program and with dietetic consultations. A descriptive qualitative analysis employed semistructured interviews with 9 participants to elicit views on the acceptability of the intervention and its components. Results The electronic delivery of information and recording of weight from 8 to 20 weeks of gestation were universally accepted. Component (face-to-face dietitian, weight tracker, website information delivery, and SMS goal prompting) acceptability and engagement differed between individuals. A total of 4 key themes emerged from the qualitative analysis: supporting lifestyle change, component acceptability and value, delivery platforms, and engagement barriers. Conclusions The PLAN intervention and its delivery via a blend of personal dietetic consultations and digital program delivery was found to be acceptable and valuable to pregnant women. Individuals responded differently to various components, emphasizing the importance of including women in the development of lifestyle interventions and allowing participants to choose and tailor programs. Larger randomized controlled trials using these insights in a broader section of the community are needed to inform the iterative development of practical, time-efficient, and cost-effective ways of supporting optimal GWG with the potential to optimize outcomes for pregnant women and their child.
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Affiliation(s)
| | | | | | | | - Desiree Silva
- Joondalup Health Campus, Shenton Avenue, Perth, Australia
| | - Cliff Neppe
- Joondalup Health Campus, Shenton Avenue, Perth, Australia
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Javadi M, Rafiei S, Zahedifar F, Barikani A. Relationships between maternal characteristics and infant birth weight. Int J Health Care Qual Assur 2019; 32:688-697. [PMID: 31111782 DOI: 10.1108/ijhcqa-05-2017-0081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Nowadays, the importance of infant birth weight (IBW) as a key factor in determining the future of physical and mental development of children is a growing concern. The purpose of this paper is to investigate the relationship between maternal characteristics and IBW among pregnant women who were referred to health centers in Qazvin city in the year 2016. DESIGN/METHODOLOGY/APPROACH A descriptive-analytical study was conducted among pregnant women in 28-36 weeks of gestation who referred to healthcare centers and facilities affiliated by the Qazvin University of Medical Sciences in April-June 2016. The associations between maternal physical activity, mothers' socioeconomic status and birth weight were examined by SPSS Software Package version 16 through linear and logistic regression tests. FINDINGS Linear regression modeling suggested that maternal weight (p=0.001), income (p=0.04), gestational age of delivery (p=0.00) and pre-pregnancy BMI (p=0.02) were positively associated with birth weight, while occupational and heavy physical activity (p=0.003 and 0.008, respectively) were negatively associated with IBW. In this study, low birth weight infants are compared to those with normal weight belonged to mothers who have spent more time in doing heavy physical activities (OR=1.11, 95% CI 1.01-1.23). Also infants with low birth weight compared to others in the normal weight category were born from mothers with lower pre-pregnancy BMI (OR=0.65, 95% CI 0.62-0.78), gestational age of delivery (OR=0.82, 95% CI 0.79-0.86), maternal weight (OR=0.86, 95% CI 0.84-0.88) and income (OR=0.79, 95% CI 0.69-0.83). PRACTICAL IMPLICATIONS The study findings revealed that certain maternal characteristics could play a significant role in IBW. Despite the importance, in most of developing countries (particularly Iran), future mothers are not advised about an appropriate weight gain during pregnancy or the optimal level of physical activity in such a period of time. Therefore, counseling pregnant women and giving them proper information on appropriate perinatal care would be helpful in order to have pregnancies with optimal outcomes. ORIGINALITY/VALUE The authors applied several statistical methods to analyze IBW among mothers with different maternal characteristics and predict birth weight based on contributing factors.
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Affiliation(s)
- Maryam Javadi
- Department of Nutrition, Children Growth Research Center, Qazvin University of Medical Sciences , Qazvin, Islamic Republic of Iran
| | - Sima Rafiei
- Department of Healthcare Management, School of Health, Qazvin University of Medical Sciences , Qazvin, Islamic Republic of Iran
| | - Fariba Zahedifar
- Department of Health Education, School of Health, Qazvin University of Medical Sciences , Qazvin, Islamic Republic of Iran
| | - Ameneh Barikani
- Department of Social Medicine, Children Growth Research Center, Qazvin University of Medical Sciences , Qazvin, Islamic Republic of Iran
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14
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Msollo SS, Martin HD, Mwanri AW, Petrucka P. Prevalence of hyperglycemia in pregnancy and influence of body fat on development of hyperglycemia in pregnancy among pregnant women in urban areas of Arusha region, Tanzania. BMC Pregnancy Childbirth 2019; 19:315. [PMID: 31455272 PMCID: PMC6712730 DOI: 10.1186/s12884-019-2463-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/19/2019] [Indexed: 12/16/2022] Open
Abstract
Background Hyperglycemia in pregnancy is a medical condition resulting from either pre-existing diabetes or insulin resistance developed during pregnancy. This study aimed to determine the prevalence of hyperglycemia in pregnancy and influence of body fat percentage and other determinants on developing hyperglycemia in pregnancy among women in Arusha District, Tanzania. Methods A cross–sectional study was conducted between March and December 2018 at selected health facilities in Arusha District involving 468 pregnant women who were not known to have diabetes before pregnancy. Blood glucose was tested by Gluco-Plus™ using the World Health Organization criteria at fasting and 2 h after consuming 75 g of glucose dissolved in 300 ml of water. Body fat was measured using a bioelectric impedance analyzer, mid-upper arm circumference using a regulated tape, weight using SECA™, blood pressure using a GT-868UF Geratherm™ machine, and height using a stadiometer. Demographic and maternal characteristics were collected through face to face interviews using a structured questionnaire. Results The participants’ mean age was 28 years (SD ± 6), mid-upper arm circumference 27 cm (SD ± 3.7), body fat 33.72% (SD ± 7.2) and pre-pregnancy body mass index 25.6 kg/m2 (SD ± 5.5). One-third of participants had mid-upper arm circumferences ≥28 cm with 25% being overweight and 22.7% obese before pregnancy. Prevalence of hyperglycemia in pregnancy was 16.2% (n = 76) of which 13% had gestational diabetes and 3.2% diabetes in pregnancy. Hyperglycemia in pregnancy was significantly associated with body fat percentage (AOR 1.33; 95% CI: 1.22–1.44), family history of Type 2 diabetes mellitus (AOR 6.95, 95% CI: 3.11–15.55), previous delivery of babies ≥4 kg (AOR 2.3, 95% CI: 1.00–5.28), mid-upper arm circumference ≥ 28 cm (AOR 1.2, 95% CI: 1.09–1.32), and Type 2 diabetes mellitus symptoms (AOR 2.83, 95% CI: 1.53–6.92). Conclusion The prevalence of hyperglycemia in pregnancy was high, particularly among women with history of delivering ≥4-kg babies, increased body fat, mid-upper arm circumference, symptoms and/or family history of Type 2 diabetes mellitus. These findings identify opportunities to further explore the utility of body fat percentage and other determinants for rapid screening and management of hyperglycemia in pregnancy.
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Affiliation(s)
- Safiness Simon Msollo
- Department of Food Biotechnology and Nutritional Sciences in School of Life Sciences, Nelson Mandela African Institution of Science and Technology, P. O. Box 477, Arusha, Tanzania. .,Department of Food Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Tanzania.
| | - Haikael David Martin
- Department of Food Biotechnology and Nutritional Sciences in School of Life Sciences, Nelson Mandela African Institution of Science and Technology, P. O. Box 477, Arusha, Tanzania
| | - Akwilina Wendelin Mwanri
- Department of Food Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
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15
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O’Connor SG, Habre R, Bastain TM, Toledo-Corral CM, Gilliland FD, Eckel SP, Cabison J, Naya CH, Farzan SF, Chu D, Chavez TA, Breton CV, Dunton GF. Within-subject effects of environmental and social stressors on pre- and post-partum obesity-related biobehavioral responses in low-income Hispanic women: protocol of an intensive longitudinal study. BMC Public Health 2019; 19:253. [PMID: 30819155 PMCID: PMC6396454 DOI: 10.1186/s12889-019-6583-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/22/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Disproportionately high rates of maternal overweight and obesity among the Hispanic population before, during, and after pregnancy pose serious health concerns for both mothers (e.g., preeclampsia, gestational diabetes, weight retention) and children (e.g., elevated lifelong obesity risk). A growing body of evidence implicates environmental exposures (e.g., air pollution, metals) and social stressors (e.g., poverty, violence) in contributing to obesity-related biobehavioral processes, such as physical activity, dietary intake, perceived stress, and cortisol regulation. However, current understanding of the role of environmental exposures and social stressors on obesity-related biobehavioral processes is limited by infrequent, inter-individual measurement, and lack of personal exposure monitoring. METHODS The "Maternal and Developmental Risks from Environmental and Social Stressors" (MADRES) real-time and personal sampling study examines the within-subject day-level effects of environmental and social stressors on maternal pre- and post-partum obesity-related biobehavioral responses. Among a cohort of 65 low-income, Hispanic women in urban Los Angeles, this study uses innovative personal, real-time data capture strategies (e.g., ecological momentary assessment [EMA], personal exposure monitoring, geolocation monitoring, accelerometry) to repeatedly assess obesity-related processes during the 1st and 3rd trimester, and at 4-6 months postpartum. Day-level effects of environmental exposures and social stressors on women's physical activity, diet, perceived stress and salivary cortisol measured across repeated days will be tested using multilevel modeling. DISCUSSION Hispanic women of childbearing age bear a disproportionately high burden of obesity, and this population is also unduly exposed to numerous obesogenic settings. By using innovative real-time data capture strategies, the current study will uncover the daily impacts of environmental and social stressor exposures on women's obesity-related biobehavioral responses, which over time can lead to excessive gestational weight gain, postpartum weight retention and can pose serious consequences for both mother and child. Findings from the real-time and personal sampling study will identify key mechanistic targets for policy, clinical, and programmatic interventions, with the potential for broad-reaching public health impacts.
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Affiliation(s)
- Sydney G. O’Connor
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032 USA
| | - Rima Habre
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032 USA
| | - Theresa M. Bastain
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032 USA
| | - Claudia M. Toledo-Corral
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032 USA
- Department of Health Sciences, California State University, Northridge, 18111 Nordhoff Street, Northridge, CA 91330 USA
| | - Frank D. Gilliland
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032 USA
| | - Sandrah P. Eckel
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032 USA
| | - Jane Cabison
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032 USA
| | - Christine H. Naya
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032 USA
| | - Shohreh F. Farzan
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032 USA
| | - Daniel Chu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032 USA
| | - Thomas A. Chavez
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032 USA
| | - Carrie V. Breton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032 USA
| | - Genevieve F. Dunton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032 USA
- Department of Psychology, University of Southern California, 3620 South McClintock Ave, Los Angeles, CA 90089 USA
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16
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Mediators of Lifestyle Behaviour Changes in Obese Pregnant Women. Secondary Analyses from the DALI Lifestyle Randomised Controlled Trial. Nutrients 2019; 11:nu11020311. [PMID: 30717227 PMCID: PMC6412227 DOI: 10.3390/nu11020311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 11/17/2022] Open
Abstract
A better understanding of what drives behaviour change in obese pregnant overweight women is needed to improve the effectiveness of lifestyle interventions in this group at risk for gestational diabetes (GDM). Therefore, we assessed which factors mediated behaviour change in the Vitamin D and Lifestyle Intervention for GDM Prevention (DALI) Lifestyle Study. A total of 436 women, with pre-pregnancy body mass index ≥29 kg/m², ≤19 + 6 weeks of gestation and without GDM, were randomised for counselling based on motivational interviewing (MI) on healthy eating and physical activity, healthy eating alone, physical activity alone, or to a usual care group. Lifestyle was measured at baseline, and at 24⁻28 and 35⁻37 weeks of gestation. Outcome expectancy, risk perception, task self-efficacy and social support were measured at those same time points and considered as possible mediators of intervention effects on lifestyle. All three interventions resulted in increased positive outcome expectancy for GDM reduction, perceived risk to the baby and increased task self-efficacy. The latter mediated intervention effects on physical activity and reduced sugared drink consumption. In conclusion, our MI intervention was successful in increasing task self-efficacy, which was related to improved health behaviours.
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Egan AM, Simmons D. Lessons learned from lifestyle prevention trials in gestational diabetes mellitus. Diabet Med 2019; 36:142-150. [PMID: 29939439 DOI: 10.1111/dme.13772] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2018] [Indexed: 01/01/2023]
Abstract
Gestational diabetes mellitus (GDM) is associated with an increased risk of adverse outcomes for mother and infant both at birth and later in life. A large body of evidence is now available relating to antenatal prevention of GDM. Overall, despite some individual trials of a variety of lifestyle interventions revealing benefit, many more have shown no effect from the second trimester onwards, even with significant gestational weight gain limitation. At-risk women often seem reluctant to engage in lifestyle changes and frequently cannot adhere to recommended interventions even within a clinical trial setting. Many trials have not considered the heterogeneity of diabetes first discovered in pregnancy, something of importance into the future. Future work should focus on designing interventions acceptable to the population at risk, whether those taking place before or during the first trimester of pregnancy are effective, and whether greater individualization can identify those women most likely to benefit.
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Affiliation(s)
- A M Egan
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - D Simmons
- Macarthur Clinical School, Western Sydney University, Sydney, Australia
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18
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Association Between Obstetric Provider’s Advice and Gestational Weight Gain. Matern Child Health J 2018; 22:1127-1134. [DOI: 10.1007/s10995-018-2497-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tebbani F, Oulamara H, Agli A. Effects of gestational weight gain on pregnancy complications. NUTR CLIN METAB 2018. [DOI: 10.1016/j.nupar.2017.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Relationship Between Gestational Weight Gain and Pregnancy Complications or Delivery Outcome. Sci Rep 2017; 7:12531. [PMID: 28970543 PMCID: PMC5624932 DOI: 10.1038/s41598-017-12921-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/11/2017] [Indexed: 12/05/2022] Open
Abstract
The purpose of this study is to analyse the association between gestational weight gain and delivery outcome or the morbidity of pregnancy complications. A total of 1,102 pregnant women who delivered at Peking University People’s Hospital in China between January 2011 and December 2012 were included in this study. We divided them into 4 groups according to the baseline BMI quartiles and weight gain quartiles in different trimesters of pregnancy to analyse the status of delivery outcome and morbidity of pregnancy complications. Baseline BMI was significantly positive correlated with the morbidity of gestational hypertension and gestational diabetes. Weight gain in the second trimester of pregnancy was significantly positively correlated with the morbidity of macrosomia. Weight gain in the third trimester of pregnancy showed significantly positive correlation with the morbidity of macrosomia, and significantly negative correlation with the morbidity of neonatal death, preterm birth, gestational diabetes, and low birth-weight infant. Gestational weight gain showed significantly positive correlation with the morbidity of macrosomia and significantly negative correlation with neonatal death, stillbirth, gestational diabetes, preterm birth and low birth-weight infant. There is a correlation between baseline BMI, pregnancy weight gain and gestational complications, adverse pregnancy outcomes, and status of neonate in varying degrees.
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de Castro MBT, Farias DR, Lepsch J, Mendes RH, Ferreira AA, Kac G. High cholesterol dietary intake during pregnancy is associated with large for gestational age in a sample of low-income women of Rio de Janeiro, Brazil. MATERNAL & CHILD NUTRITION 2017; 13:e12361. [PMID: 27696759 PMCID: PMC6866211 DOI: 10.1111/mcn.12361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/07/2016] [Accepted: 07/08/2016] [Indexed: 01/12/2023]
Abstract
The association between the quality of maternal dietary fat intake during pregnancy and the infant's birthweight (BW) remains controversial. Our goal was to investigate the association between maternal dietary fat intake during pregnancy and the rate of large for gestational age (LGA) newborns. This study employed a cross-sectional analysis of 297 pairs of mothers/children attending a public maternity at Rio de Janeiro, Brazil. BW for gestational age according to the Intergrowth 21st was defined as follows: adequate for gestational age (AGA ≤ 90th percentile) and LGA (>90th percentile). The statistical analysis was a Poisson regression with robust estimations of the standard errors. Maternal dietary fat intake variables comprised lipids (% total energy); saturated (mg/1000 kcal), monounsaturated (mg/1000 kcal) and polyunsaturated (mg/1000 kcal) fats; and cholesterol (mg/1000 kcal), all of which were obtained with a Food Frequency Questionnaire. The mean BW was 3338 g (SD = 446.9), and the rate of LGA newborns was 13.1%. The mean maternal total energy intake was 2880 kcal (SD = 1074), cholesterol was 154.3 mg/1000 kcal (SD = 68.1) and monounsaturated fat was 6.9 mg/1000 kcal (SD = 2). Mothers of LGA newborns reported higher cholesterol dietary intake (195.8 vs. 148 mg/1000 kcal; P < 0.001), pre-pregnancy body mass index (25.1 vs. 23.5 kg/m2 ; P = 0.026) when compared with mothers of AGA newborns. Women with cholesterol intake within the fourth quartile were 2.48 (95% confidence interval: 1.31-4.66) times more likely to have an LGA infant compared with those in the 1-3 quartiles. Dietary intake of cholesterol during pregnancy influences LGA even after adjusting for other confounders.
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Affiliation(s)
- Maria Beatriz Trindade de Castro
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de CastroFederal University of Rio de JaneiroRio de JaneiroBrazil
| | - Dayana Rodrigues Farias
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de CastroFederal University of Rio de JaneiroRio de JaneiroBrazil
| | - Jaqueline Lepsch
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de CastroFederal University of Rio de JaneiroRio de JaneiroBrazil
| | - Roberta Hack Mendes
- BRAIN Laboratory (Basic Research and Advanced Investigations in Neurosciences)Hospital de Clínicas de Porto AlegresPorto AlegreBrazil
| | - Aline Alves Ferreira
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de CastroFederal University of Rio de JaneiroRio de JaneiroBrazil
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de CastroFederal University of Rio de JaneiroRio de JaneiroBrazil
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Siegel AM, Tita AT, Machemehl H, Biggio JR, Harper LM. Evaluation of Institute of Medicine Guidelines for Gestational Weight Gain in Women with Chronic Hypertension. AJP Rep 2017; 7:e145-e150. [PMID: 28706753 PMCID: PMC5507687 DOI: 10.1055/s-0037-1604076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/25/2017] [Indexed: 12/11/2022] Open
Abstract
Objective To assess the impact of gestational weight gain (GWG) outside the Institute of Medicine (IOM) recommendations on perinatal outcomes in pregnancies complicated by chronic hypertension (HTN). Methods The study consisted of a retrospective cohort of all singletons with HTN from 2000 to 2014. Maternal outcomes examined were superimposed preeclampsia and cesarean delivery. Neonatal outcomes were small for gestational age (SGA), large for gestational age (LGA), and preterm birth (PTB). Groups were compared using analysis of variance and chi-squared test for trend. Backward stepwise logistic regression was adjusted for confounding factors. Results Of 702 subjects, 106 (15.1%) gained within, 176 (25.0%) gained less, and 420 (59.8%) gained more weight than the IOM recommendations. After adjusting for confounders, GWG above IOM recommendations remained associated with LGA (adjusted odds ratio [AOR]: 2.53, confidence interval [CI] 95%:1.29-4.95). Weight gain less than recommended was associated with a decreased risk of superimposed preeclampsia (AOR: 0.49, CI 95%: 0.26-0.93) without increasing the risk of SGA (AOR: 1.03, CI 95%: 0.57-1.86). Conclusion Women with pregnancies complicated by chronic HTN should be counseled regarding the association of LGA with excessive GWG. Additionally, they should be counseled that weight gain below recommendations may be associated with a decreased risk of superimposed preeclampsia; however, this association deserves further investigation.
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Affiliation(s)
- Anne M. Siegel
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
| | - Alan T. Tita
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
| | - Hannah Machemehl
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
| | - Joseph R. Biggio
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
| | - 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, Birmingham, Alabama
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Hao M, Lin L. Fasting plasma glucose and body mass index during the first trimester of pregnancy as predictors of gestational diabetes mellitus in a Chinese population. Endocr J 2017; 64:561-569. [PMID: 28420856 DOI: 10.1507/endocrj.ej16-0359] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This retrospective study assessed fasting plasma glucose (FPG) and body mass index (BMI) during the first trimester of pregnancy as potential screening indicators of later gestational diabetes mellitus (GDM). The study population included 820 pregnant women who delivered in our hospital between 17 September 2013 and 3 March 2014. Demographics and baseline characteristics were collected at the first antenatal visit; FPG levels were measured at 8 or 9 weeks. All participants underwent a 75-g oral glucose tolerance test at 24-28 weeks gestation. Multivariate logistic regression and receiver operating characteristic curve analysis were performed to determine the diagnostic power of risk factors. GDM was diagnosed in 20.3% of the women. There was an increased prevalence of GDM with advancing age, parity, high FPG, and obesity, but not in women with family predisposition. FPG (OR: 3.984; 95% CI: 2.397-6.62) and BMI (OR: 1.144; 95% CI: 1.083-1.208) were independent risk factors for later development of GDM (p<0.01). FPG level ≥4.6 mmol/L was the best threshold for predicting GDM with a sensitivity of 53.89 and specificity of 70.90%. BMI ≥23.5 kg/m2 yielded a sensitivity of 48.5% and a specificity of 73.1% for predicting GDM. FPG and BMI combined markedly enhanced the predictive capability for GDM (OR, 3.861; 95% CI: 2.701-5.520). High FPG or BMI in the first trimester, especially in combination, may predict later GDM with limited accuracy and specificity in Chinese women.
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Affiliation(s)
- Min Hao
- Department of Obstetrics and Gynecology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Li Lin
- Department of Obstetrics and Gynecology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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24
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Simmons D, Devlieger R, van Assche A, Jans G, Galjaard S, Corcoy R, Adelantado JM, Dunne F, Desoye G, Harreiter J, Kautzky-Willer A, Damm P, Mathiesen ER, Jensen DM, Andersen L, Lapolla A, Dalfrà MG, Bertolotto A, Wender-Ozegowska E, Zawiejska A, Hill D, Snoek FJ, Jelsma JGM, van Poppel MNM. Effect of Physical Activity and/or Healthy Eating on GDM Risk: The DALI Lifestyle Study. J Clin Endocrinol Metab 2017; 102:903-913. [PMID: 27935767 PMCID: PMC5460688 DOI: 10.1210/jc.2016-3455] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/01/2016] [Indexed: 12/16/2022]
Abstract
CONTEXT Lifestyle approaches for preventing gestational diabetes mellitus (GDM) have produced mixed results. OBJECTIVE The aim of the present study was to compare the effectiveness of 3 lifestyle interventions [healthy eating (HE), physical activity (PA), and both HE and PA (HE+PA)] with usual care (UC) in reducing GDM risk. DESIGN The present study was a multicenter randomized controlled trial conducted from 2012 to 2014 [the DALI (vitamin D and lifestyle intervention for GDM prevention) lifestyle study]. SETTING The study occurred at antenatal clinics across 11 centers in 9 European countries. PATIENTS Consecutive pregnant women at <20 weeks of gestation with a body mass index (BMI) of ≥29 kg/m2 and without GDM using the International Association of Diabetes and Pregnancy Study Group criteria (n = 436). For the intervention, women were randomized, stratified by site, to UC, HE, PA, or HE+PA. The women received 5 face-to-face and ≤4 telephone coaching sessions using the principles of motivational interviewing. A gestational weight gain (GWG) <5 kg was targeted. The coaches received standardized training and an intervention toolkit tailored to their culture and language. MAIN OUTCOME MEASURES The endpoints were the GWG at 35 to 37 weeks and the fasting glucose and insulin sensitivity [homeostasis model assessment insulin resistance (HOMA-IR)] at 24 to 28 weeks. RESULTS We randomized 108 women to HE+PA, 113 to HE, 110 to PA, and 105 to UC. In the HE+PA group, but not HE or PA alone, women achieved substantially less GWG than did the controls (UC) by 35 to 37 weeks (-2.02; 95% confidence interval, -3.58 to -0.46 kg). Despite this reduction, no improvements were seen in fasting or postload glucose levels, insulin concentrations, or HOMA-IR. The birthweights and large and small for gestational age rates were similar. CONCLUSIONS The combined HE+PA intervention was able to limit GWG but did not reduce fasting glycemia. Thus, lifestyle changes alone are unlikely to prevent GDM among women with a BMI of ≥29 kg/m2.
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Affiliation(s)
- David Simmons
- Western Sydney University, Campbelltown, New South Wales 2560, Australia;
- Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, CB2 0QQ England;
| | - Roland Devlieger
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium;
| | - André van Assche
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium;
| | - Goele Jans
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium;
| | - Sander Galjaard
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium;
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands;
| | - Rosa Corcoy
- Institut de Recerca de l´Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;
| | - Juan M Adelantado
- Institut de Recerca de l´Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;
- CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Zaragoza, Spain;
| | - Fidelma Dunne
- Galway Diabetes Research Centre and College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland;
| | - Gernot Desoye
- Department of Obstetrics and Gynecology, Medizinische Universitaet Graz, Graz, Austria;
| | - Jürgen Harreiter
- Gender Medicine Unit, Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria;
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria;
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;
| | - Dorte M. Jensen
- Department of Endocrinology and Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark;
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark;
| | - Liselotte Andersen
- Department of Endocrinology and Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark;
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark;
| | | | | | | | | | | | - David Hill
- Recherche en Santé Lawson SA, Bronschhofen, Switzerland
| | - Frank J. Snoek
- Department of Medical Psychology, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands;
- Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands;
| | - Judith G. M. Jelsma
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands; and
| | - Mireille N. M. van Poppel
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands; and
- Institute of Sport Science, University of Graz, Graz, Austria
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Mathiesen ER. Pregnancy Outcomes in Women With Diabetes-Lessons Learned From Clinical Research: The 2015 Norbert Freinkel Award Lecture. Diabetes Care 2016; 39:2111-2117. [PMID: 27879355 DOI: 10.2337/dc16-1647] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Among women with diabetes, the worst pregnancy outcome is seen in the subgroup of women with diabetic nephropathy. Development of severe preeclampsia that leads to early preterm delivery is frequent. Predictors and pathophysiological mechanisms for the development of preeclampsia among women with diabetes and observational studies that support antihypertension treatment for pregnant women with microalbuminuria or diabetic nephropathy preventing preeclampsia and early preterm delivery are presented here. Obtaining and maintaining strict glycemic control before and during pregnancy is paramount to prevent preterm delivery. The cornerstones of diabetes management are appropriate diet and insulin, although the risk of severe hypoglycemia always needs to be taken into account when tailoring a diabetes treatment plan. Pathophysiological mechanisms of the increased risk of hypoglycemia during pregnancy are explored, and studies evaluating the use of insulin analogs, insulin pumps, and continuous glucose monitoring to improve pregnancy outcomes and to reduce the risk of severe hypoglycemia in pregnant women with type 1 diabetes are reported. In addition to strict glycemic control, other factors involved in fetal overgrowth are explored, and restricting maternal gestational weight gain is a promising treatment area. The optimal carbohydrate content of the diet is discussed. In summary, the lessons learned from this clinical research are that glycemic control, gestational weight gain, and antihypertension treatment all are of importance for improving pregnancy outcomes in pregnant women with preexisting diabetes. An example of how to use app technology to share the recent evidence-based clinical recommendations for women with diabetes who are pregnant or planning pregnancy is given.
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Affiliation(s)
- Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes and Faculty of Health and Medical Sciences, Department of Endocrinology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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26
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Berntorp K, Anderberg E, Claesson R, Ignell C, Källén K. The relative importance of maternal body mass index and glucose levels for prediction of large-for-gestational-age births. BMC Pregnancy Childbirth 2015; 15:280. [PMID: 26514116 PMCID: PMC4627395 DOI: 10.1186/s12884-015-0722-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/21/2015] [Indexed: 01/06/2023] Open
Abstract
Background The risk of gestational diabetes mellitus (GDM) increases substantially with increasing maternal body mass index (BMI). The aim of the present study was to evaluate the relative importance of maternal BMI and glucose levels in prediction of large-for-gestational-age (LGA) births. Method This observational cohort study was based on women giving birth in southern Sweden during the years 2003–2005. Information on 10 974 pregnancies was retrieved from a population-based perinatal register. A 75-g oral glucose tolerance test (OGTT) was performed in the 28 week of pregnancy for determination of the 2-h plasma glucose concentration. BMI was obtained during the first trimester. The dataset was divided into a development set and a validation set. Using the development set, multiple logistic regression analysis was used to identify maternal characteristics associated with LGA. The prediction of LGA was assessed by receiver-operating characteristic (ROC) curves, with LGA defined as birth weight > +2 standard deviations of the mean. Results In the final multivariable model including BMI, 2-h glucose level and maternal demographics, the factor most strongly associated with LGA was BMI (odds ratio 1.1, 95 % confidence interval [CI] 1.08–1.30). Based on the total dataset, the area under the ROC curve (AUC) of 2-h glucose level to predict LGA was 0.54 (95 % CI 0.48–0.60), indicating poor performance. Using the validation database, the AUC for the final multiple model was 0.69 (95 % CI 0.66–0.72), which was identical to the AUC retrieved from a model not including 2-h glucose (0.69, 95 % CI 0.66–0.72), and larger than from a model including 2-h glucose but not BMI (0.63, 95 % CI 0.60–0.67). Conclusions Both the 2-h glucose level of the OGTT and maternal BMI had a significant effect on the risk of LGA births, but the relative contribution was higher for BMI. The findings highlight the importance of concentrating on healthy body weight in pregnant women and closer monitoring of weight during pregnancy as a strategy for reducing the risk of excessive fetal growth.
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Affiliation(s)
- Kerstin Berntorp
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - Eva Anderberg
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Rickard Claesson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden. .,Department of Obstetrics and Gynecology, Office for Healthcare "Kryh", Ystad, SE-27182, Sweden.
| | - Claes Ignell
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Obstetrics and Gynecology, Office for Healthcare "Sund", Helsingborg, Sweden
| | - Karin Källén
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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27
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Simmons D. Safety considerations with pharmacological treatment of gestational diabetes mellitus. Drug Saf 2015; 38:65-78. [PMID: 25542297 DOI: 10.1007/s40264-014-0253-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The number of women with gestational diabetes mellitus (GDM: diabetes first diagnosed in pregnancy) continues to grow, as do the associated risks of antenatal and postnatal complications and the chance of future diabetes and obesity in both mother and offspring. Recent randomised controlled trials have demonstrated clear benefits for intensive management of GDM using lifestyle modification, self blood glucose monitoring, close clinical supervision and, where glycaemia remains inadequately controlled, insulin therapy. More recently, metformin and glibenclamide have been shown to adequately reduce hyperglycaemia as part of a stepped approach to GDM management, with a switch to insulin therapy where necessary. Other oral medications have not been shown to be safe in pregnancy. Human insulin therapy is safe within the limits of hypoglycaemia and weight gain. Most insulin analogues are also now considered safe for use in pregnancy (insulin lispro, aspart and detemir). Metformin therapy is oral, and therefore preferred to insulin, but is associated with more gastrointestinal adverse effects, although not hypoglycaemia or weight gain. Conversely, glibenclamide is also an oral therapy but is associated with hypoglycaemia and weight gain. However, metformin crosses the placenta and it remains unclear whether glibenclamide crosses the placenta or not: long-term risks have not been shown, and are thought to be minimal, but further studies are needed. Metformin is seen by some as the treatment of choice where weight gain is an issue, providing that the unanswered questions over the long-term safety of oral agents have been discussed.
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Affiliation(s)
- David Simmons
- Wolfson Diabetes and Endocrinology Clinic, Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital, Cambridge, CB2 2QQ, UK,
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28
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Simmons D. Prevention of gestational diabetes mellitus: Where are we now? Diabetes Obes Metab 2015; 17:824-34. [PMID: 25974384 DOI: 10.1111/dom.12495] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/12/2015] [Accepted: 05/12/2015] [Indexed: 12/12/2022]
Abstract
Gestational diabetes mellitus (GDM) is increasing at a rapid rate, driven by the increasing proportion of the population that is overweight/obese from a young age. More than 25 randomized controlled trials testing whether GDM can be prevented have now reported their findings, but only four different interventions have shown a reduction in the proportion of women with GDM (healthy eating alone, healthy eating with physical activity, myoinositol supplementation and probiotic treatment), and these results have not been replicated. The interventions tested to date include different diets and different forms of physical activity, in combination or alone, vitamin D, myoinositol, probiotics and metformin. Studies could be improved by using the International Association of Diabetes and Pregnancy Study Group criteria for GDM (which are probably more sensitive to change because of their multiple time points), targeting and tailoring interventions to subgroups most likely to benefit, and separating those with GDM early in pregnancy from those developing GDM de novo. The greatest societal benefit is likely to arise from population-based lifestyle approaches which include those women yet to become pregnant and those who are already pregnant and their families; an approach that is yet to be fully tested.
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Affiliation(s)
- D Simmons
- Macarthur Clinical School, University of Western Sydney, Campbelltown, New South Wales, Australia
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29
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Simmons D, Jelsma JGM, Galjaard S, Devlieger R, van Assche A, Jans G, Corcoy R, Adelantado JM, Dunne F, Desoye G, Harreiter J, Kautzky-Willer A, Damm P, Mathiesen ER, Jensen DM, Andersen LL, Lapolla A, Dalfra M, Bertolotto A, Wender-Ozegowska E, Zawiejska A, Hill D, Rebollo P, Snoek FJ, van Poppel MNM. Results From a European Multicenter Randomized Trial of Physical Activity and/or Healthy Eating to Reduce the Risk of Gestational Diabetes Mellitus: The DALI Lifestyle Pilot. Diabetes Care 2015; 38:1650-6. [PMID: 26112044 DOI: 10.2337/dc15-0360] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 05/12/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Ways to prevent gestational diabetes mellitus (GDM) remain unproven. We compared the impact of three lifestyle interventions (healthy eating [HE], physical activity [PA], and both HE and PA [HE+PA]) on GDM risk in a pilot multicenter randomized trial. RESEARCH DESIGN AND METHODS Pregnant women at risk for GDM (BMI ≥29 kg/m2) from nine European countries were invited to undertake a 75-g oral glucose tolerance test before 20 weeks' gestation. Those without GDM were randomized to HE, PA, or HE+PA. Women received five face-to-face and four optional telephone coaching sessions, based on the principles of motivational interviewing. A gestational weight gain (GWG) <5 kg was targeted. Coaches received standardized training and an intervention toolkit. Primary outcome measures were GWG, fasting glucose, and insulin sensitivity (HOMA) at 35-37 weeks. RESULTS Among the 150 trial participants, 32% developed GDM by 35-37 weeks and 20% achieved GWG <5 kg. HE women had less GWG (-2.6 kg [95% CI -4.9, -0.2]; P = 0.03) and lower fasting glucose (-0.3 mmol/L [-0.4, -0.1]; P = 0.01) than those in the PA group at 24-28 weeks. HOMA was comparable. No significant differences between HE+PA and the other groups were observed. CONCLUSIONS An antenatal HE intervention is associated with less GWG and lower fasting glucose compared with PA alone. These findings require a larger trial for confirmation but support the use of early HE interventions in obese pregnant women.
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Affiliation(s)
- David Simmons
- Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, U.K. University of Western Sydney, Campbelltown, NSW, Australia
| | - Judith G M Jelsma
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Sander Galjaard
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Roland Devlieger
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Andre van Assche
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Goele Jans
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Rosa Corcoy
- Institut de Recerca de l´Hospital de la Santa Creu i Sant Pau, Barcelona, Spain CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan M Adelantado
- Institut de Recerca de l´Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Gernot Desoye
- Department of Obstetrics and Gynecology, Medizinische Universitaet Graz, Graz, Austria
| | - Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | - Ewa Wender-Ozegowska
- Department of Obstetrics and Women's Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Agnieszka Zawiejska
- Department of Obstetrics and Women's Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - David Hill
- Recherche en Santé Lawson SA, Bronschhofen, Switzerland
| | | | - Frank J Snoek
- Department of Medical Psychology, VU University Medical Center and Academic Medical Center, Amsterdam, the Netherlands
| | - Mireille N M van Poppel
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
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Willcox JC, Campbell KJ, McCarthy EA, Lappas M, Ball K, Crawford D, Shub A, Wilkinson SA. Gestational weight gain information: seeking and sources among pregnant women. BMC Pregnancy Childbirth 2015; 15:164. [PMID: 26249832 PMCID: PMC4528714 DOI: 10.1186/s12884-015-0600-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 07/24/2015] [Indexed: 11/22/2022] Open
Abstract
Background Promoting healthy gestational weight gain (GWG) is important for preventing obstetric and perinatal morbidity, along with obesity in both mother and child. Provision of GWG guidelines by health professionals predicts women meeting GWG guidelines. Research concerning women’s GWG information sources is limited. This study assessed pregnant women’s sources of GWG information and how, where and which women seek GWG information. Methods Consecutive women (n = 1032) received a mailed questionnaire after their first antenatal visit to a public maternity hospital in Melbourne, Australia. Recalled provision of GWG guidelines by doctors and midwives, recalled provided GWG goals, and the obtaining of GWG information and information sources were assessed. Results Participants (n = 368; 35.7 % response) averaged 32.5 years of age and 20.8 weeks gestation, with 33.7 % speaking a language other than English. One in ten women recalled receiving GWG guidelines from doctors or midwives, of which half were consistent with Institute of Medicine guidelines. More than half the women (55.4 %) had actively sought GWG information. Nulliparous (OR 7.07, 95 % CI = 3.91–12.81) and obese (OR 1.96, 95 % CI = 1.05–3.65) women were more likely to seek information. Underweight (OR 0.29, 95 % CI = 0.09–0.97) women and those working part time (OR 0.52, 95 % CI = 0.28–0.97) were less likely to seek information. Most frequently reported GWG sources included the internet (82.7 %), books (55.4 %) and friends (51.5 %). The single most important sources were identified as the internet (32.8 %), general practitioners (16.9 %) and books (14.9 %). Conclusion More than half of women were seeking GWG guidance and were more likely to consult non-clinician sources. The small numbers given GWG targets, and the dominance of non-clinical information sources, reinforces that an important opportunity to provide evidence based advice and guidance in the antenatal care setting is currently being missed. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0600-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jane C Willcox
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
| | - Karen J Campbell
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
| | - Elizabeth A McCarthy
- Department of Obstetrics and Gynaecology, University of Melbourne/Mercy Hospital for Women, Melbourne, Australia.
| | - Martha Lappas
- Department of Obstetrics and Gynaecology, University of Melbourne/Mercy Hospital for Women, Melbourne, Australia.
| | - Kylie Ball
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
| | - David Crawford
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
| | - Alexis Shub
- Department of Obstetrics and Gynaecology, University of Melbourne/Mercy Hospital for Women, Melbourne, Australia.
| | - Shelley A Wilkinson
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia. .,Department of Nutrition & Dietetics, Mater Mothers Hospital, South Brisbane, Queensland, Australia.
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Associations of prepregnancy body mass index and gestational weight gain with pregnancy outcomes in nulliparous women delivering single live babies. Sci Rep 2015; 5:12863. [PMID: 26242798 PMCID: PMC4525357 DOI: 10.1038/srep12863] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 07/13/2015] [Indexed: 11/09/2022] Open
Abstract
The study was to assess the associations of prepregnancy body mass index (BMI) and gestational weight gain (GWG) with pregnancy outcomes. This was a retrospective analysis of 2973 nulliparous women who delivered single live babies. Prepregnancy BMI was categorized as underweight (<18.5 kg/m2), normal weight (18.5–24.9 kg/m2) or overweight/obese (≥25.0 kg/m2). GWG was categorized as inadequate, adequate or excessive. 567 (19.1%) women were overweight/obese, and 1600 (53.8%) exhibited excessive GWG. Compared with women of normal weight, overweight/obese women had a higher incidence of cesarean section (odds ratio, 95% confidence interval: 2.02, 1.59–2.56), postpartum hemorrhage (1.50, 1.05–2.14), preterm delivery (2.51, 1.83–3.45), preterm premature rupture of membranes (2.11, 1.32–3.38), gestational diabetes mellitus (2.04, 1.65–2.53), gestational hypertension (7.68, 4.21–14.00), preeclampsia (1.98, 1.18–3.33) and small for gestational age (2.81, 1.21–6.54). Compared with adequate GWG, excessive GWG increased the incidence of cesarean section (2.02, 1.59–2.56), preterm delivery (1.48, 1.05–2.71), preeclampsia (1.78, 1.34–4.27) and macrosomia (2.61, 1.61–4.25), and reduced the incidence of gestational diabetes mellitus (0.75, 0.62–0.92). High prepregnancy BMI and excessive GWG in nulliparous Chinese women are associated with adverse pregnancy outcomes. Weight control before and during pregnancy could reduce the complications of pregnancy.
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HALSE RHIANNONE, WALLMAN KARENE, DIMMOCK JAMESA, NEWNHAM JOHNP, GUELFI KYMJ. Home-Based Exercise Improves Fitness and Exercise Attitude and Intention in Women with GDM. Med Sci Sports Exerc 2015; 47:1698-704. [DOI: 10.1249/mss.0000000000000587] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Renault KM, Carlsen EM, Nørgaard K, Nilas L, Pryds O, Secher NJ, Olsen SF, Halldorsson TI. Intake of Sweets, Snacks and Soft Drinks Predicts Weight Gain in Obese Pregnant Women: Detailed Analysis of the Results of a Randomised Controlled Trial. PLoS One 2015; 10:e0133041. [PMID: 26192183 PMCID: PMC4507874 DOI: 10.1371/journal.pone.0133041] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/18/2015] [Indexed: 11/17/2022] Open
Abstract
Background Lifestyle interventions targeting obese pregnant women often result in modest reduction in gestational weight gain, pregnancy complications and related risk factors. Examining adherence to the intervention can, however, provide valuable information on the importance of the different factors targeted. Objective To evaluate improvements and relevance of different dietary factors targeted with respect to gestational weight gain in a 3-arm Randomised Controlled Trial (n=342) among obese pregnant women with BMI≥30 kg/m2. Methods Randomisation 1:1:1 to either hypocaloric Mediterranean type of diet and physical activity intervention (D+PA); physical activity intervention alone (PA); or control (C). Diet was assessed at baseline (weeks 11–14) and endpoint (weeks 36–37) using a validated food frequency questionnaire. Results During the intervention women in the D+PA group significantly lowered their intakes of added sugars and saturated fat and increased their protein intake by ~1% of total energy compared to controls. Of these dietary variables only intakes of added sugar appeared to be related to GWG, while no association was observed for saturated fat or protein. Further analyses revealed that foods that contributed to intake of added sugars, including sweets, snacks, cakes, and soft drinks were strongly associated with weight gain, with women consuming sweets ≥2/day having 5.4 kg (95% CI 2.1-8.7) greater weight gain than those with a low (<1wk) intake. The results for soft drinks were more conflicting, as women with high weight gain tended to favour artificially sweetened soft drinks. Conclusion In our sample of obese pregnant women, craving for sweets, snacks, and soft drinks strongly predicts GWG. Emphasis on reducing intakes of these foods may be more relevant for limiting gestational weight gain than encouraging strict compliance to more specific diets. Trial Registration ClinicalTrials.gov NCT01345149
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Affiliation(s)
- Kristina M Renault
- Department of Obstetrics and Gynaecology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Obstetrics and Gynaecology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Emma M Carlsen
- Department of Paediatrics, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten Nørgaard
- Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lisbeth Nilas
- Department of Obstetrics and Gynaecology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ole Pryds
- Department of Paediatrics, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Niels J Secher
- The Research Unit Women's and Children's Health, the Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sjurdur F Olsen
- Centre for Foetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Thorhallur I Halldorsson
- Centre for Foetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
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Wrotniak BH, Dentice S, Mariano K, Salaam EM, Cowley AE, Mauro EM. Counseling About Weight Gain Guidelines and Subsequent Gestational Weight Gain. J Womens Health (Larchmt) 2015; 24:819-24. [PMID: 26125311 DOI: 10.1089/jwh.2014.4984] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate what percentage of postpartum women were informed about how much weight to gain during pregnancy, the accuracy of the weight gain recommendations based on the 2009 Institute of Medicine (IOM) gestational weight gain (GWG) recommendations and whether being informed was associated with greater likelihood of meeting the recommendations. METHODS This was a cross-sectional study of postpartum women interviewed in maternity recovery rooms at two large urban hospitals. Body mass index was obtained from medical records, and adherence to gestational weight gain guidelines was determined based on the 2009 IOM recommendations. RESULTS One hundred thirty four women with a mean pregravid body mass index of 28.0 kg/m(2) were studied. Sixty-seven percent of participants reported receiving weight gain recommendations. A greater percentage of healthy weight women (78.6%) reported being informed of a GWG recommendation than overweight (53.8%) or obese women (64.9%), (chi-squared=6.6, p=0.04). Of the women given information about gestational weight gain, 40 (54.8%) received GWG recommendations consistent with the IOM and 33 (45.2%) received discrepant information. The accuracy of the GWG recommendation varied based on weight status. Women of healthy weight were much more likely to be given information in accordance with the IOM recommendations (86.8%) than women who were overweight (12.5%) or obese (26.3%) (chi-squared=33.5, p<0.001). Meeting the IOM recommendations did not differ depending on whether women were told how much weight to gain during pregnancy. CONCLUSIONS Women who are overweight or obese are less likely to be informed about weight gain recommendations than healthy weight women, and nearly half of women receive information inconsistent with the IOM recommendations. There may be a need for further practitioner education on GWG recommendations and increased patient counseling to help promote healthy weight gain during pregnancy.
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Affiliation(s)
- Brian H Wrotniak
- 1 Center for Health Behavior Research, D'Youville College , Buffalo, New York.,2 Women & Children's Hospital of Buffalo , Buffalo, New York
| | - Shoshone Dentice
- 1 Center for Health Behavior Research, D'Youville College , Buffalo, New York
| | | | - Erin M Salaam
- 1 Center for Health Behavior Research, D'Youville College , Buffalo, New York
| | - Ashley E Cowley
- 1 Center for Health Behavior Research, D'Youville College , Buffalo, New York
| | - Erin M Mauro
- 1 Center for Health Behavior Research, D'Youville College , Buffalo, New York
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Willcox JC, Campbell KJ, McCarthy EA, Wilkinson SA, Lappas M, Ball K, Fjeldsoe B, Griffiths A, Whittaker R, Maddison R, Shub A, Pidd D, Fraser E, Moshonas N, Crawford DA. Testing the feasibility of a mobile technology intervention promoting healthy gestational weight gain in pregnant women (txt4two) - study protocol for a randomised controlled trial. Trials 2015; 16:209. [PMID: 25947578 PMCID: PMC4426547 DOI: 10.1186/s13063-015-0730-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 04/23/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Overweight, obesity and excess gestational weight gain (GWG) are associated with negative health outcomes for mother and child in pregnancy and across the life course. Interventions promoting GWG within guidelines report mixed results. Most are time and cost intensive, which limits scalability. Mobile technologies (mHealth) offer low cost, ready access and individually-tailored support. We aim to test the feasibility of an mHealth intervention promoting healthy nutrition, physical activity and GWG in women who begin pregnancy overweight or obese. METHODS/DESIGN txt4two is a parallel randomised control trial pilot recruiting women with a singleton, live gestation between 10(+0) and 17(+6) weeks at the first hospital antenatal clinic visit. Inclusion criteria are pre-pregnancy BMI > 25 kg/m(2) and mobile phone ownership. One hundred consenting women will be randomised to intervention or control groups at a 1:1 ratio. All participants will receive standard antenatal care. In addition, the txt4two intervention will be delivered from baseline to 36 weeks gestation and consists of a tailored suite of theoretically-grounded, evidence-based intervention strategies focusing on healthy nutrition, physical activity and GWG. This includes: mobile phone interactive text messages promoting positive health behaviours, goal setting and self-monitoring; video messages; an information website; and a private moderated Facebook® chat forum. The primary outcome is the feasibility of the intervention. Secondary outcomes include GWG and participants' knowledge and behaviour regarding diet and physical activity during pregnancy. DISCUSSION Findings will inform the development of larger-scale mHealth programmes to improve the delivery of healthy pregnancy nutrition, physical activity and GWG, that could be widely translated and disseminated. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRNU111111544397 . Date of registration: 19 March 2014.
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Affiliation(s)
- Jane Catherine Willcox
- Centre for Physical Activity and Nutrition Research, Deakin University, Geelong, Victoria, Australia.
| | - Karen Jane Campbell
- Centre for Physical Activity and Nutrition Research, Deakin University, Geelong, Victoria, Australia.
| | - Elizabeth Anne McCarthy
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.
- Mercy Hospital for Women, University of Melbourne, Melbourne, Victoria, Australia.
| | | | - Martha Lappas
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.
- Mercy Hospital for Women, University of Melbourne, Melbourne, Victoria, Australia.
| | - Kylie Ball
- Centre for Physical Activity and Nutrition Research, Deakin University, Geelong, Victoria, Australia.
| | - Brianna Fjeldsoe
- Cancer Prevention Research Centre, School of Population Health, University of Queensland, Queensland, Australia.
| | - Anne Griffiths
- Centre for Physical Activity and Nutrition Research, Deakin University, Geelong, Victoria, Australia.
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
| | - Ralph Maddison
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
| | - Alexis Shub
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.
- Mercy Hospital for Women, University of Melbourne, Melbourne, Victoria, Australia.
| | - Deborah Pidd
- Mercy Hospital for Women, University of Melbourne, Melbourne, Victoria, Australia.
| | - Elise Fraser
- Mercy Hospital for Women, University of Melbourne, Melbourne, Victoria, Australia.
| | - Nelly Moshonas
- Mercy Hospital for Women, University of Melbourne, Melbourne, Victoria, Australia.
| | - David Andrew Crawford
- Centre for Physical Activity and Nutrition Research, Deakin University, Geelong, Victoria, Australia.
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Pregnancy outcome according to pre-pregnancy body mass index and gestational weight gain. Int J Gynaecol Obstet 2015; 129:240-3. [PMID: 25794819 DOI: 10.1016/j.ijgo.2014.12.013] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/02/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess birth weight in relation to gestational weight gain (GWG) among women who were and were not obese before pregnancy. METHODS For a retrospective cohort study, data were obtained for women with a pre-pregnancy body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) of at least 30 who had a singleton delivery at a center in Denmark in 2010-2011. Data were also obtained for 455 non-obese women (BMI 20.0-24.9). GWG was expressed in absolute terms and relative to published recommendations (11-16kg in non-obese women; 5-9kg in obese women). RESULTS A total of 231 obese women were included in analyses. In non-obese and obese women, fetal weight was highest when GWG was above the recommended amount. Among women who had a GWG in line with the recommendations, mean birth weight was higher among those with a pre-pregnancy BMI of 35.0-39.9 (3758±410g) or at least 40 (3671±374g) than among non-obese women (3394±453g; P=0.0058). CONCLUSION Birth weight is related to both maternal BMI and GWG. In obese women, adherence to GWG recommendations does not seem to prevent increased birth weights.
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Visser GH, de Valk HW. Management of diabetes in pregnancy: Antenatal follow-up and decisions concerning timing and mode of delivery. Best Pract Res Clin Obstet Gynaecol 2015; 29:237-43. [DOI: 10.1016/j.bpobgyn.2014.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 08/12/2014] [Indexed: 10/24/2022]
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Gaudet L, Ferraro ZM, Wen SW, Walker M. Maternal obesity and occurrence of fetal macrosomia: a systematic review and meta-analysis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:640291. [PMID: 25544943 PMCID: PMC4273542 DOI: 10.1155/2014/640291] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 11/09/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine a precise estimate for the contribution of maternal obesity to macrosomia. DATA SOURCES The search strategy included database searches in 2011 of PubMed, Medline (In-Process & Other Non-Indexed Citations and Ovid Medline, 1950-2011), and EMBASE Classic + EMBASE. Appropriate search terms were used for each database. Reference lists of retrieved articles and review articles were cross-referenced. METHODS OF STUDY SELECTION All studies that examined the relationship between maternal obesity (BMI ≥30 kg/m(2)) (pregravid or at 1st prenatal visit) and fetal macrosomia (birth weight ≥4000 g, ≥4500 g, or ≥90th percentile) were considered for inclusion. TABULATION, INTEGRATION, AND RESULTS Data regarding the outcomes of interest and study quality were independently extracted by two reviewers. Results from the meta-analysis showed that maternal obesity is associated with fetal overgrowth, defined as birth weight ≥ 4000 g (OR 2.17, 95% CI 1.92, 2.45), birth weight ≥4500 g (OR 2.77,95% CI 2.22, 3.45), and birth weight ≥90% ile for gestational age (OR 2.42, 95% CI 2.16, 2.72). CONCLUSION Maternal obesity appears to play a significant role in the development of fetal overgrowth. There is a critical need for effective personal and public health initiatives designed to decrease prepregnancy weight and optimize gestational weight gain.
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Affiliation(s)
- Laura Gaudet
- University of Ottawa, Faculty of Medicine, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6
- Ottawa Hospital Research Institute, Ottawa, ON, Canada K1H 8L6
| | - Zachary M. Ferraro
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6
- Healthy Active Living and Obesity (HALO) Research Group, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada K1H 8L1
| | - Shi Wu Wen
- Ottawa Hospital Research Institute, Ottawa, ON, Canada K1H 8L6
| | - Mark Walker
- University of Ottawa, Faculty of Medicine, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6
- Ottawa Hospital Research Institute, Ottawa, ON, Canada K1H 8L6
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Huynh M, Borrell LN, Chambers EC. Maternal education and excessive gestational weight gain in New York city, 1999-2001: the effect of race/ethnicity and neighborhood socioeconomic status. Matern Child Health J 2014; 18:138-145. [PMID: 23456346 DOI: 10.1007/s10995-013-1246-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To examine the association between maternal education and excessive gestational weight gain (EGWG) and whether this association differs by maternal race/ethnicity and neighborhood socio-economic status (SES). A sample of 56,911 New York City births between 1999 and 2001 was used. Self-reported EGWG was defined as gaining >40 pounds. Maternal education and race/ethnicity were obtained from birth record data. Neighborhood SES was determined from 2000 US Census data. Women with a high school [prevalence ratio (PR) = 1.21; 95 % CI 1.10-1.32] and some college (PR = 1.33; 95 % CI 1.21-1.47) education were more likely to gain excessive weight during pregnancy than their counterparts with less than a high school education. Having a college or more education was associated with a decreased EGWG for non-Hispanic white women (PR = 0.81; 95 % CI 0.67-0.96) but an increased EGWG for Hispanic women (PR = 1.25; 95 % CI 1.12-1.44). EGWG increased for women with a college or more education in medium and low SES neighborhoods (1.26; 95 % CI 1.04-1.53 and 1.20; 95 % CI 1.10-1.30, respectively); whereas a college or more education was not significant in the high SES neighborhoods. Our findings suggest that maternal education is associated with EGWG. However, this association depends on race/ethnicity and SES of the neighborhood of residence.
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Affiliation(s)
- Mary Huynh
- Department of Health Sciences, Lehman College, City University of New York, Gillet Hall 413, 250 Bedford Park Boulevard, Bronx, NY, 10468, USA.
| | - Luisa N Borrell
- Department of Health Sciences, Lehman College, City University of New York, Gillet Hall 413, 250 Bedford Park Boulevard, Bronx, NY, 10468, USA
| | - Earle C Chambers
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, 10461, USA
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Secher AL, Parellada CB, Ringholm L, Asbjörnsdóttir B, Damm P, Mathiesen ER. Higher gestational weight gain is associated with increasing offspring birth weight independent of maternal glycemic control in women with type 1 diabetes. Diabetes Care 2014; 37:2677-84. [PMID: 25249669 DOI: 10.2337/dc14-0896] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We evaluate the association between gestational weight gain and offspring birth weight in singleton term pregnancies of women with type 1 diabetes. RESEARCH DESIGN AND METHODS One hundred fifteen consecutive women referred at <14 weeks were retrospectively classified as underweight (prepregnancy BMI <18.5 kg/m(2); n = 1), normal weight (18.5-24.9; n = 65), overweight (25.0-29.9; n = 39), or obese (≥30.0; n = 10). Gestational weight gain was categorized as excessive, appropriate, or insufficient according to the Institute of Medicine recommendations for each BMI class. Women with nephropathy, preeclampsia, and/or preterm delivery were excluded because of restrictive impact on fetal growth and limited time for total weight gain. RESULTS HbA1c was comparable at ∼6.6% (49 mmol/mol) at 8 weeks and ∼6.0% (42 mmol/mol) at 36 weeks between women with excessive (n = 62), appropriate (n = 37), and insufficient (n = 16) gestational weight gain. Diabetes duration was comparable, and median prepregnancy BMI was 25.3 (range 18-41) vs. 23.5 (18-31) vs. 22.7 (20-30) kg/m(2) (P = 0.05) in the three weight gain groups. Offspring birth weight and birth weight SD score decreased across the groups (3,681 [2,374-4,500] vs. 3,395 [2,910-4,322] vs. 3,295 [2,766-4,340] g [P = 0.02] and 1.08 [-1.90 to 3.25] vs. 0.45 [-0.83 to 3.18] vs. -0.02 [-1.51 to 2.96] [P = 0.009], respectively). In a multiple linear regression analysis, gestational weight gain (kg) was positively associated with offspring birth weight (g) (β = 19; P = 0.02) and birth weight SD score (β = 0.06; P = 0.008) when adjusted for prepregnancy BMI, HbA1c at 36 weeks, smoking, parity, and ethnicity. CONCLUSIONS Higher gestational weight gain in women with type 1 diabetes was associated with increasing offspring birth weight independent of glycemic control and prepregnancy BMI.
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Affiliation(s)
- Anna L Secher
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Clara B Parellada
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Lene Ringholm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Björg Asbjörnsdóttir
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Aubuchon-Endsley NL, Bublitz MH, Stroud LR. Pre-pregnancy obesity and maternal circadian cortisol regulation: Moderation by gestational weight gain. Biol Psychol 2014; 102:38-43. [PMID: 25038305 DOI: 10.1016/j.biopsycho.2014.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 05/23/2014] [Accepted: 07/03/2014] [Indexed: 01/20/2023]
Abstract
We investigated main and interactive effects of maternal pre-pregnancy obesity and gestational weight gain on circadian cortisol from the second to third trimester. A diverse sample of 215 pregnant women was enrolled. Maternal height and most recent pre-pregnancy weight were collected at study initiation (22% obese). Weight and circadian salivary cortisol samples were measured during second (24±4) and third (35±1 weeks) trimesters. During the third trimester, women who were obese prior to conception showed elevated evening cortisol versus normal weight women. This pattern was moderated by weight gain in excess of Institute of Medicine guidelines, such that women who were obese prior to conception and gained greater than 7.94kg by the 35±1 week visit displayed greatest elevations in evening cortisol. Given links between excessive prenatal glucocorticoid exposure and both poor maternal and offspring health outcomes, elevated maternal cortisol may be one mechanism underlying links between maternal obesity and adverse perinatal outcomes.
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Affiliation(s)
- Nicki L Aubuchon-Endsley
- Department of Psychology, Idaho State University, 921 S 8th Avenue, Stop 8112, Pocatello, ID 83209, USA.
| | - Margaret H Bublitz
- Centers for Behavioral and Preventive Medicine, 164 Summit Avenue, Providence, RI 02906, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA.
| | - Laura R Stroud
- Centers for Behavioral and Preventive Medicine, 164 Summit Avenue, Providence, RI 02906, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA.
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Liu J, Gallagher AE, Carta CM, Torres ME, Moran R, Wilcox S. Racial differences in gestational weight gain and pregnancy-related hypertension. Ann Epidemiol 2014; 24:441-7. [PMID: 24685832 PMCID: PMC4029921 DOI: 10.1016/j.annepidem.2014.02.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 02/17/2014] [Accepted: 02/19/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of the study was to examine racial differences in gestational weight gain (GWG) and pregnancy-related hypertension. METHODS Logistic regression models tested racial differences in adequacy of GWG and pregnancy-induced hypertension in all singleton live births from the South Carolina 2004-2006 birth certificates. RESULTS Compared with white women, black and Hispanic women had 16%-46% lower odds of gaining weight above the recommendations. However, the odds of inadequate GWG was ∼50% higher in black and Hispanic women with a pregnancy body mass index (BMI) less than 25 kg/m(2). Furthermore, compared with women with adequate GWG, women with excessive GWG had higher odds of pregnancy-related hypertension (underweight: 2.35, 95% confidence interval [CI; 1.66, 3.32]; normal: 2.05, 95% CI [1.84, 2.27]; overweight: 1.93, 95% CI [1.64, 2.27]; obese: 1.46, 95% CI [1.30, 1.63]). Among women with a BMI less than 25 kg/m(2), black women had higher odds of pregnancy-related hypertension than white women (underweight: 1.64, 95% CI [1.14, 2.36]; normal weight: 1.28, 95% CI [1.15, 1.42]), whereas among women with a BMI less than 25 kg/m(2), Hispanic women had 40% lower odds. CONCLUSIONS Programs are needed to curb excessive GWG in all racial groups and to help some sub-groups ensure adequate GWG. Maternal obesity and GWG are two factors that should be used in combination to reduce racial differences in pregnancy-related hypertension.
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Affiliation(s)
- Jihong Liu
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia.
| | - Alexa E Gallagher
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | - Courtney M Carta
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | - Myriam E Torres
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | - Robert Moran
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | - Sara Wilcox
- Department of Exercise Science, University of South Carolina, Columbia
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Robič T, Benedik E, Fidler Mis N, Bratanič B, Rogelj I, Golja P. Challenges in determining body fat in pregnant women. ANNALS OF NUTRITION AND METABOLISM 2014; 63:341-9. [PMID: 24603563 DOI: 10.1159/000358339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 12/19/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Determining body composition in pregnant women is challenging as not all of the existing applicable methodologies can be used during pregnancy and not all of the methods have been properly standardized. The aim of this study was to compare the existing anthropometric methods for the evaluation of body composition, especially in pregnant women. METHODS One hundred forty-seven pregnant volunteers aged [average (SD)] 31 years (± 4) in gestational week 32 (± 3) provided information on their age and prepregnancy body mass. Their height, current mass, skinfold thicknesses, and limb circumferences were measured. The body density and fat percentage were calculated according to 17 different anthropometric equations obtained from the literature. Data were analyzed with ANOVA. RESULTS For the same sample of pregnant women, the body fat percentages obtained using the existing anthropometric methods varied greatly (p < 0.0001) and ranged from 16% (± 5) to 38% (± 4); methods developed specifically for pregnant women yielded disturbingly large differences, with body fat values ranging from 16% (± 5) to 36% (± 6). CONCLUSIONS This study revealed large discrepancies among anthropometric methods for body composition assessment in pregnant women. As the results from the same sample obtained with different existing equations are wide ranging, the existing methodologies should be examined and improved before they can serve as sources of information regarding the health status of pregnant women.
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Affiliation(s)
- Tatjana Robič
- Department of Biology, Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
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Renault KM, Nørgaard K, Nilas L, Carlsen EM, Cortes D, Pryds O, Secher NJ. The Treatment of Obese Pregnant Women (TOP) study: a randomized controlled trial of the effect of physical activity intervention assessed by pedometer with or without dietary intervention in obese pregnant women. Am J Obstet Gynecol 2014; 210:134.e1-9. [PMID: 24060449 DOI: 10.1016/j.ajog.2013.09.029] [Citation(s) in RCA: 157] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 08/12/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective of the study was to assess physical activity intervention assessed by a pedometer with or without dietary intervention on gestational weight gain (GWG) in obese pregnant women by comparing with a control group. STUDY DESIGN This study was a randomized controlled trial of 425 obese pregnant women comparing 3 groups: (1) PA plus D, physical activity and dietary intervention (n = 142); (2) PA, physical activity intervention (n = 142); and (3) C, a control group receiving standard care (n = 141). All participants routinely in gestational weeks 11-14 had an initial dietary counseling session and were advised to limit GWG to less than 5 kg. Physical activity intervention included encouragement to increase physical activity, aiming at a daily step count of 11,000, monitored by pedometer assessment on 7 consecutive days every 4 weeks. Dietary intervention included follow-up on a hypocaloric Mediterranean-style diet. Instruction was given by a dietician every 2 weeks. The primary outcome measure was GWG, and the secondary outcome measures were complications of pregnancy and delivery and neonatal outcome. RESULTS The study was completed by 389 patients (92%). Median values of GWG (ranges) were lower in each of the intervention groups (PA plus D, 8.6 [-9.6 to 34.1] kg, and group PA, 9.4 [-3.4 to 28.2] kg) compared with the control group (10.9 [-4.4 to 28.7] kg [PA+D vs C]; P = .01; PA vs C; P = .042). No significant difference was found between the 2 intervention groups. In a multivariate analysis, physical activity intervention decreased GWG by a mean of 1.38 kg (P = .040). The Institute of Medicine's recommendations for GWG were more frequently followed in the intervention groups. CONCLUSION Physical activity intervention assessed by pedometer with or without dietary follow-up reduced GWG compared with controls in obese pregnant women.
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Alberico S, Montico M, Barresi V, Monasta L, Businelli C, Soini V, Erenbourg A, Ronfani L, Maso G. The role of gestational diabetes, pre-pregnancy body mass index and gestational weight gain on the risk of newborn macrosomia: results from a prospective multicentre study. BMC Pregnancy Childbirth 2014; 14:23. [PMID: 24428895 PMCID: PMC3898774 DOI: 10.1186/1471-2393-14-23] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 01/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is crucial to identify in large population samples the most important determinants of excessive fetal growth. The aim of the study was to evaluate the independent role of pre-pregnancy body mass index (BMI), gestational weight gain and gestational diabetes on the risk of macrosomia. METHODS A prospective study collected data on mode of delivery and maternal/neonatal outcomes in eleven Hospitals in Italy. Multiple pregnancies and preterm deliveries were excluded. The sample included 14109 women with complete records. Associations between exposure variables and newborn macrosomia were analyzed using Pearson's chi squared test. Multiple logistic regression models were built to assess the independent association between potential predictors and macrosomia. RESULTS Maternal obesity (adjusted OR 1.7, 95% CI 1.4-2.2), excessive gestational weight gain (adjusted OR 1.9, 95% CI 1.6-2.2) and diabetes (adjusted OR 2.1, 95% CI 1.5-3.0 for gestational; adjusted OR 3.0, 95% CI 1.2-7.6 for pre-gestational) resulted to be independent predictors of macrosomia, when adjusted for other recognized risk factors. Since no significant interaction was found between pre-gestational BMI and gestational weight gain, excessive weight gain should be considered an independent risk factor for macrosomia. In the sub-group of women affected by gestational or pre-gestational diabetes, pre-gestational BMI was not significantly associated to macrosomia, while excessive pregnancy weight gain, maternal height and gestational age at delivery were significantly associated. In this sub-population, pregnancy weight gain less than recommended was not significantly associated to a reduction in macrosomia. CONCLUSIONS Our findings indicate that maternal obesity, gestational weight gain excess and diabetes should be considered as independent risk factors for newborn macrosomia. To adequately evaluate the clinical evolution of pregnancy all three variables need to be carefully assessed and monitored.
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Affiliation(s)
| | | | | | | | | | | | | | - Luca Ronfani
- Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", via dell'Istria 65/1, 34137 Trieste Italy.
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Barnes RA, Edghill N, Mackenzie J, Holters G, Ross GP, Jalaludin BB, Flack JR. Predictors of large and small for gestational age birthweight in offspring of women with gestational diabetes mellitus. Diabet Med 2013; 30:1040-6. [PMID: 23551273 DOI: 10.1111/dme.12207] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 12/20/2012] [Accepted: 03/22/2013] [Indexed: 12/17/2022]
Abstract
AIM To identify predictors of large and small for gestational age in women with gestational diabetes mellitus. METHODS A retrospective audit of clinical data analysed for singleton births in women diagnosed with gestational diabetes by Australasian Diabetes in Pregnancy Society guidelines from 1994 to 2009. Exclusions were: incomplete data, delivered at < 36 weeks gestation and/or last recorded weight > 4 weeks pre-delivery. We assessed: pre-pregnancy BMI, ethnicity, total maternal weight gain, weight gain before and after treatment initiation for gestational diabetes, HbA(1c) at gestational diabetes presentation and treatment modality (diet or insulin) and smoking. Birthweight was assessed using customized percentile charts (large for gestational age > 90th; small for gestational age < 10th percentile). Multiple regression analyses were undertaken; statistical significance was p < 0.05. RESULTS There were 1695 women first seen at (mean ± sd) 28.1 ± 5.3 weeks gestation (range 6-39). Ethnic mix was South-East Asian 36.7%, Middle Eastern 27.6%, European 22.4%, Indian/Pakistani 8.6%, Samoan 1.9%, African 1.5% and Maori 1.1%. Therapy was diet 69.1% and insulin 30.9%. Mean total weight gain was 12.3 ± 6.1 kg, the majority (10.6 ± 6.0 kg), gained before dietary intervention. There were 7.9% small for gestational age and 15.2% large for gestational age births. Significant independent large for gestational age predictors were: weight gain before intervention, pre-pregnancy BMI, weight gain after intervention and treatment type, but not HbA1c or smoking. Significant small for gestational age predictors were: weight gain before intervention, weight gain after intervention, but not pre-pregnancy BMI, HbA(1c) or smoking. CONCLUSION Conventional treatment for gestational diabetes mellitus concentrates on management of blood glucose levels. The trends identified here emphasize the need to also address pregnancy weight gain stratified by pre-pregnancy BMI.
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Affiliation(s)
- R A Barnes
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, NSW, Australia.
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Asbjörnsdóttir B, Rasmussen SS, Kelstrup L, Damm P, Mathiesen ER. Impact of restricted maternal weight gain on fetal growth and perinatal morbidity in obese women with type 2 diabetes. Diabetes Care 2013; 36:1102-6. [PMID: 23248191 PMCID: PMC3631818 DOI: 10.2337/dc12-1232] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Since January 2008, obese women with type 2 diabetes were advised to gain 0-5 kg during pregnancy. The aim with this study was to evaluate fetal growth and perinatal morbidity in relation to gestational weight gain in these women. RESEARCH DESIGN AND METHODS A retrospective cohort comprised the records of 58 singleton pregnancies in obese women (BMI ≥30 kg/m(2)) with type 2 diabetes giving birth between 2008 and 2011. Birth weight was evaluated by SD z score to adjust for gestational age and sex. RESULTS Seventeen women (29%) gained ≤5 kg, and the remaining 41 gained >5 kg. The median (range) gestational weight gains were 3.7 kg (-4.7 to 5 kg) and 12.1 kg (5.5-25.5 kg), respectively. Prepregnancy BMI was 33.5 kg/m(2) (30-53 kg/m(2)) vs. 36.8 kg/m(2) (30-48 kg/m(2)), P = 0.037, and median HbA1c was 6.7% at first visit in both groups and decreased to 5.7 and 6.0%, P = 0.620, in late pregnancy, respectively. Gestational weight gain ≤5 kg was associated with lower birth weight z score (P = 0.008), lower rates of large-for-gestational-age (LGA) infants (12 vs. 39%, P = 0.041), delivery closer to term (268 vs. 262 days, P = 0.039), and less perinatal morbidity (35 vs. 71%, P = 0.024) compared with pregnancies with maternal weight gain >5 kg. CONCLUSIONS In this pilot study in obese women with type 2 diabetes, maternal gestational weight gain ≤5 kg was associated with a more proportionate birth weight and less perinatal morbidity.
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Jefferys AE, Siassakos D, Draycott T, Akande VA, Fox R. Deflation of gastric band balloon in pregnancy for improving outcomes. Cochrane Database Syst Rev 2013:CD010048. [PMID: 23633380 DOI: 10.1002/14651858.cd010048.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In line with the rise in the prevalence of obesity, an increasing number of women of childbearing age are undergoing laparoscopic adjustable gastric banding (LAGB), resulting in an increasing number of pregnancies with a band in place. Currently, there is no consensus on optimal band management in pregnancy. Some clinicians advocate leaving the band balloon inflated to reduce gestational weight gain and associated adverse perinatal outcomes. However, there are concerns that maintaining balloon inflation during pregnancy might increase the risk of band complications and adversely affect fetal development and/or growth as a result of reduced nutritional intake. OBJECTIVES To compare maternal and perinatal outcomes for elective gastric band balloon deflation versus intention to maintain balloon inflation during pregnancy. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2012) and the Web of Science database (1940 to September 2012). SELECTION CRITERIA Randomised-controlled trials comparing elective deflation of the gastric band balloon with intention to maintain balloon inflation in pregnant women who have undergone LAGB. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion. MAIN RESULTS No studies met the criteria for inclusion in the review. AUTHORS' CONCLUSIONS To date no randomised controlled trials exist that compare elective deflation of the gastric band balloon in pregnancy versus intention to maintain balloon inflation. Further research is needed to define the optimum management of the gastric band balloon in pregnancy.
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Stewart ZA, Wallace EM, Allan CA. Patterns of weight gain in pregnant women with and without gestational diabetes mellitus: An observational study. Aust N Z J Obstet Gynaecol 2012; 52:433-9. [DOI: 10.1111/ajo.12001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Zoe A. Stewart
- Department of Obstetrics and Gynaecology; Monash University; Clayton; Victoria; Australia
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Willcox JC, Campbell KJ, van der Pligt P, Hoban E, Pidd D, Wilkinson S. Excess gestational weight gain: an exploration of midwives' views and practice. BMC Pregnancy Childbirth 2012; 12:102. [PMID: 23013446 PMCID: PMC3531303 DOI: 10.1186/1471-2393-12-102] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 09/06/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Excess gestational weight gain (GWG) can affect the immediate and long term health outcomes of mother and infant. Understanding health providers' views, attitudes and practices around GWG is crucial to assist in the development of practical, time efficient and cost effective ways of supporting health providers to promote healthy GWGs. This study aimed to explore midwives' views, attitudes and approaches to the assessment, management and promotion of healthy GWG and to investigate their views on optimal interventions. METHODS Midwives working in antenatal care were recruited from one rural and one urban Australian maternity hospital employing purposive sampling strategies to assess a range of practice areas. Face-to-face interviews were conducted with 15 experienced midwives using an interview guide and all interviews were digitally recorded, transcribed verbatim and analysed thematically. RESULTS Midwives interviewed exhibited a range of views, attitudes and practices related to GWG. Three dominant themes emerged. Overall GWG was given low priority for midwives working in the antenatal care service in both hospitals. In addition, the midwives were deeply concerned for the physical and psychological health of pregnant women and worried about perceived negative impacts of discussion about weight and related interventions with women. Finally, the midwives saw themselves as central in providing lifestyle behaviour education to pregnant women and identified opportunities for support to promote healthy GWG. CONCLUSIONS The findings indicate that planning and implementation of healthy GWG interventions are likely to be challenging because the factors impacting on midwives' engagement in the GWG arena are varied and complex. This study provides insights for guideline and intervention development for the promotion of healthy GWG.
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Affiliation(s)
- Jane C Willcox
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia
| | - Karen J Campbell
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia
| | - Paige van der Pligt
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia
| | - Elizabeth Hoban
- School of Health and Social Development, Deakin University, Melbourne, Australia
| | | | - Shelley Wilkinson
- Mater Mothers’ Hospital, Brisbane, Australia
- Mater Medical Research Institute, Brisbane, Australia
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