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Lavelle F, McKernan C, Shrewsbury V, Wolfson JA, Taylor RM, Duncanson K, Martins CA, Elliott C, Collins CE. An online qualitative study exploring wants and needs for a cooking programme during pregnancy in the UK and Ireland. J Hum Nutr Diet 2024; 37:927-942. [PMID: 38606553 DOI: 10.1111/jhn.13307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 03/19/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Optimal maternal nutrition is associated with better pregnancy and infant outcomes. Culinary nutrition programmes have potential to improve diet quality during pregnancy. Therefore, this research aimed to understand the experiences of cooking and the wants and needs of pregnant women regarding a cooking and food skills programme in the United Kingdom (UK) and Republic of Ireland (ROI). METHODS Online focus group discussions with pregnant women and those who had experienced a pregnancy in the UK or ROI were conducted between February and April 2022. Two researchers conducted a thematic analysis. Seven focus groups with ROI participants (n = 24) and six with UK participants (n = 28) were completed. RESULTS Five themes were generated. These were (1) cooking during pregnancy: barriers, motivators and solutions; (2) food safety, stress and guilt; (3) need for cooking and food skills programmes and desired content; (4) programme structure; (5) barriers and facilitators to programme participation. Overall, there was support for a programme focusing on broad food skills, including planning, food storage, using leftovers and to manage pregnancy-specific physiological symptoms such as food aversions. Participants emphasised the importance of inclusivity for a diverse range of people and lifestyles for programme design and content. CONCLUSIONS Current findings support the use of digital technologies for culinary nutrition interventions, potentially combined with in-person sessions using a hybrid structure to enable the development of a support network.
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Affiliation(s)
- Fiona Lavelle
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, UK
- Department of Nutritional Sciences, School of Life Course & Population Sciences, King's College London, London, UK
| | - Claire McKernan
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - Vanessa Shrewsbury
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Julia A Wolfson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Rachael M Taylor
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Kerith Duncanson
- School of Medicine and Public Health, College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Carla A Martins
- Center for Epidemiological Research in Nutrition and Health, University of Sao Paulo, Sao Paulo, Brazil
- Institute of Food and Nutrition, Federal University of Rio de Janeiro, Macaé, Brazil
| | - Christopher Elliott
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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Fossee E, Zamora AN, Peterson KE, Cantoral A, Perng W, Téllez-Rojo MM, Torres-Olascoaga LA, Jansen EC. Prenatal dietary patterns in relation to adolescent offspring adiposity and adipokines in a Mexico City cohort. J Dev Orig Health Dis 2023; 14:371-380. [PMID: 36655507 PMCID: PMC10202837 DOI: 10.1017/s2040174422000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Maternal diet during pregnancy has been associated with obesity among offspring. The extent to which trimester-specific dietary patterns are associated with markers of adiposity during adolescence remains unclear. We examined associations between prenatal diet patterns with adolescent offspring measures of adiposity and adipokines in 384 mother-adolescent dyads from the Mexico City ELEMENT cohort. Trimester-specific diet patterns were derived from principal component analysis of food frequency questionnaire data. Adolescent anthropometry and serum leptin and adiponectin were measured at 10-17 years. Three maternal diet patterns were identified: Prudent Diet (PD), high in fish and vegetables, the High Meat and Fat Diet (HMFD), high in pork and processed meats, and the Transitioning Mexican Diet (TMD), high in corn tortillas and sugar-sweetened beverages. Multiple linear regression was used to estimate sex-stratified associations among quartiles of diet patterns with adiposity and adipokines, adjusting for maternal marital status, education, and parity. First trimester TMD was associated with greater anthropometric measures and higher leptin in females, while third trimester HMFD was associated higher body fat percentage, triceps thickness, waist circumference, and leptin, but lower adiponectin among males. Contrary to expectation, there were positive associations between the trimester 1 PD pattern and anthropometric measurements in females, and for trimester 2 HMFD and TMD patterns with adipokines among males. Findings suggest maternal diet patterns may influence offspring adiposity markers during adolescence in a sex-specific manner.
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Affiliation(s)
- Erica Fossee
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Astrid N. Zamora
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Karen E. Peterson
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Wei Perng
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Martha M. Téllez-Rojo
- Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Libni A. Torres-Olascoaga
- Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Erica C. Jansen
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Teo SM, Murrin CM, Mehegan J, Douglas A, Hébert JR, Segurado R, Kelleher CC, Phillips CM. Associations between maternal dietary scores during early pregnancy with placental outcomes. Front Nutr 2023; 10:1060709. [PMID: 36845057 PMCID: PMC9945217 DOI: 10.3389/fnut.2023.1060709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/12/2023] [Indexed: 02/11/2023] Open
Abstract
Background and aims Individual macronutrient and micronutrient effects on placental growth have been widely investigated. However, the influence of overall maternal diet is relatively unknown. Therefore, the aim of this study is to examine associations between a range of maternal dietary scores during early pregnancy with placental outcomes, and to investigate whether there is evidence of sexual dimorphism. Methods This analysis of the Lifeways Cross-Generational Cohort includes 276 mother-child pairs. A validated 148-item semi-quantitative food frequency questionnaire assessed maternal diet in early pregnancy. Dietary scores reflecting dietary quality [Healthy Eating Index (HEI-2015), Dietary Approaches to Stop Hypertension (DASH)], dietary inflammatory potential [Dietary Inflammatory Index (DII) and the energy adjusted DII (E-DII)], dietary antioxidant status [Dietary Antioxidant Quality (DAQ)], and glycemic and insulinemic loads/indices (GL/GI, IL/II) were calculated. Linear regression analyses assessed maternal dietary score relationships with untrimmed placental weight (PW) and birth weight:placental weight (BW:PW) ratio. Results In fully adjusted models, maternal E-DII and GI were positively associated, and HEI-2015 and DAQ were negatively associated with PW (B: 12.31, 95% CI: 0.41, 24.20, p = 0.04, B: 4.13, 95% CI: 0.10, 8.17, p = 0.04, B: -2.70, 95% CI: -5.03, -0.35, p = 0.02 and B: -15.03, 95% CI: -28.08, -1.98, p = 0.02, for E-DII, GI, HEI-2015 and DAQ respectively). Maternal DAQ associations with BW:PW ratio were attenuated. When stratified by sex, maternal GI and pregnancy-specific DAQ were associated with PW in female offspring (B: 5.61, 95% CI: 0.27, 10.96, p = 0.04 and B: -15.31, 95% CI: -30.35, -0.27, p = 0.046). Maternal E-DII and HEI-2015 were associated with PW in males (B: 24.31, 95% CI: 5.66, 42.96, p = 0.01 and B: -3.85, 95% CI: -7.47, -0.35, p = 0.03 respectively). Conclusion The results of this novel investigation suggest that maternal diet may influence placental development. Female fetuses may be more sensitive to increased glucose levels whereas male fetuses may be more susceptible to in-utero stresses that are regulated by inflammatory pathways and overall diet quality. Hence, early pregnancy offers an opportune time for a mother to prioritize dietary changes that focus on reducing inflammatory and glycemic responses.
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Affiliation(s)
- Shevaun M. Teo
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Celine M. Murrin
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - John Mehegan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Alexander Douglas
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - James R. Hébert
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Ricardo Segurado
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Cecily C. Kelleher
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Catherine M. Phillips
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland,*Correspondence: Catherine M. Phillips,
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Callanan S, Yelverton CA, Geraghty AA, O'Brien EC, Donnelly JM, Larkin E, Horan MK, Mehegan J, McAuliffe FM. The association of a low glycaemic index diet in pregnancy with child body composition at 5 years of age: A secondary analysis of the ROLO study. Pediatr Obes 2021; 16:e12820. [PMID: 34080318 DOI: 10.1111/ijpo.12820] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/15/2021] [Accepted: 04/26/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Childhood obesity remains a significant global health concern. Early intervention through maternal diet during pregnancy represents a possible mode of improving childhood adiposity. AIM To examine the impact of a low glycaemic index diet during pregnancy on offspring anthropometry at 5 years of age. METHODS This is a secondary analysis of 387 children from the ROLO pregnancy study 5 years' post-intervention. At the follow-up, BMI, circumferences and skinfold thickness were obtained. A subgroup of 103 children had a DXA scan completed. Statistical analyses included Independent sample t tests, Mann Whitney-U tests and chi-square tests to compare the intervention and control groups. Adjusted analysis using linear regression controlled for significant confounders between participants who returned at follow-up and those that did not. RESULTS There were no significant differences in BMI (16.05 kg/m2 vs 16.16 kg/m2 , P = 0.403), general adiposity (36.60 mm vs 36.00 mm, P = 0.920), central adiposity (0.61 mm vs 0.60 mm, P = 0.540), total fat mass (4.91 kg vs 4.71 kg, P = 0.377) or total lean mass (14.29 kg vs 14.56 kg, P = 0.386) between the intervention and control groups, respectively. No associations were observed in 5-year outcomes in adjusted analyses when controlling for maternal age at delivery, maternal early pregnancy BMI, maternal education and gestational age. CONCLUSION Our study found no evidence that a low glycaemic index diet in pregnancy impacts offspring anthropometry 5 years' post-intervention. Therefore, modulating maternal carbohydrate quality in pregnancy may not be an appropriate approach to improving weight status in childhood. Future research should investigate the impact of other dietary practices in pregnancy on child health.
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Affiliation(s)
- Sophie Callanan
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Cara A Yelverton
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Aisling A Geraghty
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Eileen C O'Brien
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Jean M Donnelly
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Elizabeth Larkin
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Mary K Horan
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - John Mehegan
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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Wiertsema CJ, Wahab RJ, Mulders AGMGJ, Gaillard R. Associations of dietary glycemic index and load during pregnancy with blood pressure, placental hemodynamic parameters and the risk of gestational hypertensive disorders. Eur J Nutr 2021; 61:703-716. [PMID: 34524507 PMCID: PMC8854313 DOI: 10.1007/s00394-021-02670-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 08/31/2021] [Indexed: 11/10/2022]
Abstract
Purpose The aim of this study was to examine the associations of dietary glycemic index and load with gestational blood pressure, placental hemodynamic parameters and the risk of gestational hypertensive disorders. Methods In a population-based cohort among 3378 pregnant Dutch women, dietary glycemic index and load were assessed from food frequency questionnaires at median 13.4 (95% range 9.9–22.9) weeks gestation. Blood pressure was measured in early-, mid- and late-pregnancy. Placental hemodynamic parameters were measured in mid- and late-pregnancy by ultrasound. Data on gestational hypertensive disorders was acquired from medical records. Results Mean dietary glycemic index (SD) was 58 (3) and mean dietary glycemic load (SD) was 155 (47). Dietary glycemic index was not associated with blood pressure, placental hemodynamic parameters and the risk of gestational hypertensive disorders. Higher dietary glycemic load SDS was associated with a higher diastolic blood pressure in early-pregnancy, remaining after adjustment for socio-demographic and lifestyle factors ((0.98 (95% CI 0.35–1.61) mmHg per SDS increase in glycemic load). No other associations of glycemic load with blood pressure or placental hemodynamic parameters and the risk of gestational hypertensive disorders were present. No significant associations of dietary glycemic index and load quartiles with longitudinal blood pressure patterns from early to late-pregnancy were present. Conclusion Within this low-risk pregnant population, we did not find consistent associations of dietary glycemic index and load with blood pressure, placental hemodynamic parameters and the risk of gestational hypertensive disorders. Further studies need to assess whether the effects on gestational hemodynamic adaptations are more pronounced among high-risk women with an impaired glucose metabolism. Supplementary Information The online version contains supplementary material available at 10.1007/s00394-021-02670-5.
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Affiliation(s)
- Clarissa J Wiertsema
- The Generation R Study Group, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Rama J Wahab
- The Generation R Study Group, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Annemarie G M G J Mulders
- Departments of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Romy Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Alick CL, Maguire RL, Murphy SK, Fuemmeler BF, Hoyo C, House JS. Periconceptional Maternal Diet Characterized by High Glycemic Loading Is Associated with Offspring Behavior in NEST. Nutrients 2021; 13:nu13093180. [PMID: 34579057 PMCID: PMC8469715 DOI: 10.3390/nu13093180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 01/08/2023] Open
Abstract
Maternal periconceptional diets have known associations with proper offspring neurodevelopment. Mechanisms for such associations include improper energy/nutrient balances between mother and fetus, as well as altered offspring epigenetics during development due to maternal nutrient and inflammatory status. Using a comprehensive food frequency questionnaire and assessing offspring temperament with the Infant-Toddler Social and Emotional Assessment (n = 325, mean age = 13.9 months), we sought to test whether a maternal periconceptional diet characterized by high glycemic loading (MGL) would affect offspring temperament using adjusted ordinal regression. After limiting false discovery to 10%, offspring born to mothers in tertile 3 of glycemic loading (referent = tertile 1) were more likely to be in the next tertile of anxiety [OR (95% CI) = 4.51 (1.88-11.07)] and inhibition-related behaviors [OR (95% CI) = 3.42 (1.49-7.96)]. Male offspring were more likely to exhibit impulsive [OR (95% CI) = 5.55 (1.76-18.33)], anxiety [OR (95% CI) = 4.41 (1.33-15.30)], sleep dysregulation [OR (95% CI) = 4.14 (1.34-13.16)], empathy [6.68 (1.95-24.40)], and maladaptive behaviors [OR (95% CI) = 9.86 (2.81-37.18)], while females were more likely to exhibit increased anxiety-related behaviors [OR (95% CI) = 15.02 (3.14-84.27)]. These associations persisted when concurrently modeled with the maternal-Mediterranean dietary pattern. In a subset (n = 142), we also found MGL associated with increased mean methylation of the imprint control region of SGCE/PEG10. In conclusion, these findings highlight the importance of maternal dietary patterns on offspring neurodevelopment, offering avenues for prevention options for mothers.
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Affiliation(s)
- Candice L. Alick
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA;
| | - Rachel L. Maguire
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC 27695, USA; (R.L.M.); (C.H.)
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27695, USA
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27701, USA;
| | - Susan K. Murphy
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27701, USA;
| | - Bernard F. Fuemmeler
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA 23219, USA;
| | - Cathrine Hoyo
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC 27695, USA; (R.L.M.); (C.H.)
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27695, USA
| | - John S. House
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC 27695, USA; (R.L.M.); (C.H.)
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, Durham, NC 27709, USA
- Correspondence:
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Maternal Dietary Quality and Dietary Inflammation Associations with Offspring Growth, Placental Development, and DNA Methylation. Nutrients 2021; 13:nu13093130. [PMID: 34579008 PMCID: PMC8468062 DOI: 10.3390/nu13093130] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/31/2021] [Accepted: 09/04/2021] [Indexed: 12/14/2022] Open
Abstract
The ‘Developmental Origins of Health and Diseases’ hypothesis posits that prenatal maternal diet influences offspring growth and later life health outcomes. Dietary assessment has focused on selected nutrients. However, this approach does not consider the complex interactions between foods and nutrients. To provide a more comprehensive approach to public health, dietary indices have been developed to assess dietary quality, dietary inflammation and risk factors for non-communicable diseases. Thus far, their use in the context of placental development is limited and associations with offspring outcomes have been inconsistent. Although epidemiological studies have focused on the role of maternal diet on foetal programming, the underlying mechanisms are still poorly understood. Some evidence suggests these associations may be driven by placental and epigenetic changes. In this narrative review, we examine the current literature regarding relationships between key validated diet quality scores (Dietary Inflammatory Index [DII], Mediterranean diet [MD], Healthy Eating Index [HEI], Alternative Healthy Eating Index [AHEI], Dietary Approaches to Stop Hypertension [DASH], Glycaemic Index [GI] and Glycaemic Load [GL]) in pregnancy and birth and long-term offspring outcomes. We summarise findings, discuss potential underlying placental and epigenetic mechanisms, in particular DNA methylation, and highlight the need for further research and public health strategies that incorporate diet quality and epigenetics.
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Pre-Pregnancy Diet Quality Is Associated with Lowering the Risk of Offspring Obesity and Underweight: Finding from a Prospective Cohort Study. Nutrients 2021; 13:nu13041044. [PMID: 33804865 PMCID: PMC8063840 DOI: 10.3390/nu13041044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/11/2021] [Accepted: 03/20/2021] [Indexed: 12/16/2022] Open
Abstract
Maternal diet plays a critical role in epigenetic changes and the establishment of the gut microbiome in the fetus, which has been associated with weight outcomes in offspring. This study examined the association between maternal diet quality before pregnancy and childhood body mass index (BMI) in offspring. There were 1936 mothers with 3391 children included from the Australian Longitudinal Study on Women’s Health (ALSWH) and the Mothers and their Children’s Health (MatCH) study. Maternal dietary intakes were assessed using a semi-quantitative and validated 101-item food-frequency questionnaire (FFQ). The healthy eating index (HEI-2015) score was used to explore preconception diet quality. Childhood BMI was categorized as underweight, normal, overweight, and obese based on sex and age-specific BMI classifications for children. Multinomial logistic regression with cluster-robust standard errors was used for analyses. Greater adherence to maternal diet quality before pregnancy was associated with a lower risk of offspring being underweight after adjustment for potential confounders, highest vs. lowest quartile (relative risk ratio (RRR) = 0.68, 95% confidence interval (CI): 0.49, 0.96). Higher adherence to preconception diet quality was also inversely linked with the risk of childhood obesity (RRR = 0.49, 95% CI: 0.24, 0.98). This association was, however, no longer significant after adjusting for pre-pregnancy BMI. Sodium intake was significantly associated with decreased risk of childhood overweight and obesity (RRR = 0.18, 95% CI: 0.14, 0.23) and (RRR = 0.21, 95% CI: 0.17, 0.26), respectively. No significant association was detected between preconception diet quality and offspring being overweight. This study suggests that better adherence to maternal diet quality before pregnancy is associated with a reduced risk of childhood underweight and obesity.
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9
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Wahab RJ, Jaddoe VWV, Gaillard R. Associations of maternal early-pregnancy dietary glycemic index with childhood general, abdominal and ectopic fat accumulation. Clin Nutr 2021; 40:1628-1636. [PMID: 33752151 PMCID: PMC7613756 DOI: 10.1016/j.clnu.2021.02.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/08/2021] [Accepted: 02/28/2021] [Indexed: 11/19/2022]
Abstract
Background & aims Maternal hyperglycemia during pregnancy is an important risk factor for childhood adiposity. Maternal dietary glycemic index during pregnancy directly influences maternal and fetal glucose concentrations. We examined the associations of maternal early-pregnancy dietary glycemic index with offspring general, abdominal and ectopic fat accumulation among normal weight and overweight or obese pregnant women and their offspring. Methods In a population-based cohort study among 2488 Dutch pregnant women and their children, we assessed maternal dietary glycemic index by food frequency questionnaire at median 13.4 (95% range 10.7; 21.1) weeks gestation. Dietary glycemic index was used continuously and categorized into low (≤55), normal (56–69) and high (≥70) glycemic index diet. We measured offspring BMI, total fat mass and android/gynoid fat mass ratio by DXA, and visceral fat mass and liver fat fraction by MRI at 10 years. Results No associations of maternal early-pregnancy dietary glycemic index with offspring adiposity were present among normal weight women and their children. Among overweight and obese women and their children, 1-Standard Deviation Score (SDS) increase in maternal early-pregnancy dietary glycemic index was associated with higher childhood BMI (0.10 SDS, 95% Confidence Interval (CI) 0.01; 0.19), total fat mass index (0.13 SDS, 95% CI 0.05; 0.22), visceral fat mass index (0.19 SDS, 95% CI 0.07; 0.32) and tended to be associated with a higher android/gynoid fat mass ratio (0.09 SDS, 95% CI −0.01; 0.19) and higher risk of childhood overweight (Odds Ratio (OR) 1.20, 95% CI 0.97; 1.48). Overweight and obese women consuming an early-pregnancy low-glycemic index diet, as compared to an early-pregnancy normal-glycemic index diet, had children with lower BMI, total fat mass index, visceral fat mass index and android/gynoid fat mass ratio at 10 years (p-values<0.05). No women consumed a high-glycemic index diet. No associations were explained by maternal socio-economic, lifestyle and dietary characteristics, birth or childhood characteristics. No associations with liver fat fraction were present. Conclusions In overweight or obese women and their children, a higher maternal early-pregnancy dietary glycemic index is associated with childhood general, abdominal and visceral fat accumulation, but not with liver fat. Intervention studies among overweight and obese pregnant women may need to target the dietary glycemic index to prevent childhood adiposity.
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Affiliation(s)
- Rama J Wahab
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Romy Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Trumpff C, Sturm G, Picard M, Foss S, Lee S, Feng T, Cardenas A, McCormack C, Champagne FA, Monk C. Added sugar intake during pregnancy: Fetal behavior, birth outcomes, and placental DNA methylation. Dev Psychobiol 2021; 63:878-889. [PMID: 33415750 DOI: 10.1002/dev.22088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 11/23/2020] [Accepted: 12/20/2020] [Indexed: 12/11/2022]
Abstract
Pregnancy is a critical time for the effects of environmental factors on children's development. The effect of added sugar intake on fetal development and pregnancy outcomes remains understudied despite increasing dietary intake in the United States. This study investigated the effect of added sugar on fetal programming by examining the association between maternal added sugar consumption, fetal movement, birth outcomes, and placental DNA methylation. Further, primary human fibroblasts were cultured under normal or high glucose conditions to assess the effect of high glucose exposure on cells' DNA methylation. We found that higher added sugar intake across pregnancy was associated with reduced 3rd-trimester fetal movement (p < .05) and shorter gestation (p < .01). Our sample size was not powered to detect the alteration of individual placental CpG with genome-wide significance. However, a secondary analysis suggested that added sugar consumption was associated with differential methylation of functionally related gene families across pregnancy. Consistent with this, high glucose exposure in primary cultured human fibroblasts altered the methylation of 17% of all CpGs, providing converging evidence for an effect of sugar on DNA methylation. Our results suggest that diets high in added sugar during pregnancy may have implications for offspring health via prenatal programming effects measurable before birth.
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Affiliation(s)
- Caroline Trumpff
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, NY, USA
| | - Gabriel Sturm
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, NY, USA
| | - Martin Picard
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, NY, USA.,Department of Neurology, Columbia Translational Neuroscience Initiative, Columbia University Medical Center, New York, NY, USA
| | - Sophie Foss
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, NY, USA
| | - Seonjoo Lee
- Division of Mental Health Data Science, New York State Psychiatric Institute, New York, NY, USA.,Research Foundation for Mental Hygiene Inc, New York, NY, USA.,Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Tianshu Feng
- Research Foundation for Mental Hygiene Inc, New York, NY, USA.,Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Andrès Cardenas
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Clare McCormack
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, NY, USA
| | - Frances A Champagne
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Catherine Monk
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, NY, USA.,Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA.,New York State Psychiatric Institute, New York, NY, USA
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11
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Roskjær AB, Ásbjörnsdóttir B, Tetens I, Larnkjær A, Mølgaard C, Mathiesen ER. Dietary intake of carbohydrates in pregnant women with type 1 diabetes-A narrative review. Food Sci Nutr 2021; 9:17-24. [PMID: 33473266 PMCID: PMC7802534 DOI: 10.1002/fsn3.1982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/21/2020] [Accepted: 09/26/2020] [Indexed: 12/02/2022] Open
Abstract
In pregnant women with type 1 diabetes, a low but sufficient, intake of carbohydrates is important to aim for near normal glycemic control. However, knowledge about the carbohydrate intake in this group is limited. To assess the average quantity and quality of carbohydrate intake in pregnant women with type 1diabetes compared to healthy pregnant women and current dietary reference intakes. A narrative literature search was performed in PubMed, Embase, and Cochrane Library and by using a snow-ball search technique to identify papers published on studies conducted in industrialized countries within the last 20 years. Intakes of carbohydrate were assessed qualitatively in relation to the Dietary Reference Intakes recommended by the American Diabetes Association and quantitatively as mean intake of dietary fiber. Five observational studies including 810 pregnant women with type 1 diabetes and 15 observational studies with a total of 118,246 healthy pregnant women were identified. The mean total carbohydrate intake was within the Acceptable Macronutrient Distribution Range (45%-64% of energy intake) in both groups. In pregnant women with type 1 diabetes, the average total intake was 218 ± 19 g/day, which was 20% (53 g/day) lower than in healthy pregnant women. Mean intake of dietary fiber in women with diabetes was lower than the recommended adequate intake for healthy women. With the limitations of pronounced heterogeneity across the included studies, pregnant women with type 1 diabetes reported a mean total carbohydrate intake, which was lower than in healthy pregnant women but still within the recommended range.
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Affiliation(s)
- Ann B. Roskjær
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenDenmark
| | - Björg Ásbjörnsdóttir
- Center for Pregnant Women with DiabetesCopenhagenDenmark
- Department of EndocrinologyRigshospitaletCopenhagenDenmark
- Institute of Clinical MedicineFaculty of Health SciencesUniversity of CopenhagenDenmark
| | - Inge Tetens
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenDenmark
| | - Anni Larnkjær
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenDenmark
| | - Christian Mølgaard
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenDenmark
- Pediatric Nutrition UnitRigshospitaletCopenhagenDenmark
| | - Elisabeth R. Mathiesen
- Center for Pregnant Women with DiabetesCopenhagenDenmark
- Department of EndocrinologyRigshospitaletCopenhagenDenmark
- Institute of Clinical MedicineFaculty of Health SciencesUniversity of CopenhagenDenmark
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12
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Kasuga Y, Kawai T, Miyakoshi K, Saisho Y, Tamagawa M, Hasegawa K, Ikenoue S, Ochiai D, Hida M, Tanaka M, Hata K. Epigenetic Changes in Neonates Born to Mothers With Gestational Diabetes Mellitus May Be Associated With Neonatal Hypoglycaemia. Front Endocrinol (Lausanne) 2021; 12:690648. [PMID: 34267729 PMCID: PMC8276691 DOI: 10.3389/fendo.2021.690648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 06/01/2021] [Indexed: 12/28/2022] Open
Abstract
The detection of epigenetic changes associated with neonatal hypoglycaemia may reveal the pathophysiology and predict the onset of future diseases in offspring. We hypothesized that neonatal hypoglycaemia reflects the in utero environment associated with maternal gestational diabetes mellitus. The aim of this study was to identify epigenetic changes associated with neonatal hypoglycaemia. The association between DNA methylation using Infinium HumanMethylation EPIC BeadChip and neonatal plasma glucose (PG) level at 1 h after birth in 128 offspring born at term to mothers with well-controlled gestational diabetes mellitus was investigated by robust linear regression analysis. Cord blood DNA methylation at 12 CpG sites was significantly associated with PG at 1 h after birth after adding infant sex, delivery method, gestational day, and blood cell compositions as covariates to the regression model. DNA methylation at two CpG sites near an alternative transcription start site of ZNF696 was significantly associated with the PG level at 1 h following birth (false discovery rate-adjusted P < 0.05). Methylation levels at these sites increased as neonatal PG levels at 1 h after birth decreased. In conclusion, gestational diabetes mellitus is associated with DNA methylation changes at the alternative transcription start site of ZNF696 in cord blood cells. This is the first report of DNA methylation changes associated with neonatal PG at 1 h after birth.
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Affiliation(s)
- Yoshifumi Kasuga
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Tomoko Kawai
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, Japan
- *Correspondence: Kenichiro Hata, ; Tomoko Kawai,
| | - Kei Miyakoshi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshifumi Saisho
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Masumi Tamagawa
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Keita Hasegawa
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Satoru Ikenoue
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Daigo Ochiai
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Mariko Hida
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Mamoru Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kenichiro Hata
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, Japan
- *Correspondence: Kenichiro Hata, ; Tomoko Kawai,
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13
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Wahab RJ, Scholing JM, Gaillard R. Maternal early pregnancy dietary glycemic index and load, fetal growth, and the risk of adverse birth outcomes. Eur J Nutr 2020; 60:1301-1311. [PMID: 32666314 PMCID: PMC7987612 DOI: 10.1007/s00394-020-02327-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/02/2020] [Indexed: 01/19/2023]
Abstract
Purpose Maternal hyperglycemia is associated with adverse birth outcomes. Maternal dietary glycemic index and load influence postprandial glucose concentrations. We examined the associations of maternal early pregnancy dietary glycemic index and load with fetal growth and risks of adverse birth outcomes. Methods In a population-based cohort study of 3471 pregnant Dutch women, we assessed dietary glycemic index and load using a food frequency questionnaire at median 13.4 (95% range 10.6; 21.2) weeks gestation. We measured fetal growth in mid- and late-pregnancy by ultrasound and obtained birth outcomes from medical records. Results Mean maternal early pregnancy dietary glycemic index and load were 57.7 (SD 3.3, 95% range 52.8; 63.5) and 155 (SD 47, 95% range 87; 243), respectively. Maternal early pregnancy dietary glycemic index was not associated with fetal growth parameters. A higher maternal early pregnancy dietary glycemic load was associated with a higher fetal abdominal circumference and estimated fetal weight in late-pregnancy (p values < 0.05), but not with mid-pregnancy or birth growth characteristics. A higher maternal early pregnancy dietary glycemic index was associated with a lower risk of a large-for-gestational-age infant (p value < 0.05). Maternal early pregnancy glycemic index and load were not associated with other adverse birth outcomes. Conclusion Among pregnant women without an impaired glucose metabolism, a higher early pregnancy dietary glycemic load was associated with higher late-pregnancy fetal abdominal circumference and estimated fetal weight. No consistent associations of maternal dietary glycemic index and load with growth parameters in mid-pregnancy and at birth were present. A higher glycemic index was associated with a lower risk of a large-for-gestational-age infant. Electronic supplementary material The online version of this article (10.1007/s00394-020-02327-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rama J Wahab
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Judith M Scholing
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Romy Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. .,Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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14
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Maternal healthful dietary patterns during peripregnancy and long-term overweight risk in their offspring. Eur J Epidemiol 2020; 35:283-293. [PMID: 32185575 PMCID: PMC7154013 DOI: 10.1007/s10654-020-00621-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 03/09/2020] [Indexed: 12/13/2022]
Abstract
Adherence to healthful dietary patterns is associated with lower body mass index (BMI) in adults; however, whether maternal diet quality during peripregnancy is related to a lower overweight risk in the offspring remains to be elucidated. We investigated the associations between the Alternate Healthy Eating Index (AHEI), Alternate Mediterranean Diet (aMED) and Dietary Approach to Stop Hypertension (DASH) during peripregnancy and offspring weight outcomes in a study including 2729 mother–child pairs from the Nurses’ Health Study II and offspring cohort Growing Up Today Study II. Children, 12–14 years at baseline were 21–23 years at the last follow-up. Overweight or obesity was defined according to International Obesity Task Force (< 18 years) and World-Health-Organization guidelines (18 + years). Maternal dietary patterns were calculated from food frequency questionnaires. Log-binomial models were used to estimate relative risks (RR) and 95% confidence intervals. In models adjusted for sex, gestational age at delivery and maternal total energy intake, greater maternal adherence to aMED and DASH, but not AHEI, was associated with lower overweight risk in the offspring (RRQ5 vs Q1 = 0.82 [0.70–0.97] for aMED and 0.86 [0.72–1.04] for DASH, P for trend < 0.05 for both). After additional adjustment for maternal pre-pregnancy lifestyle factors and socio-demographic characteristic, none of the diet quality scores were significantly associated with offspring overweight risk. Maternal pre-pregnancy BMI did not modify any of these associations. In this population of generally well-nourished women, maternal healthful dietary patterns during the period surrounding pregnancy were not independently associated with offspring overweight risk at ages 12–23 years.
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15
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Litvak J, Parekh N, Deierlein A. Prenatal dietary exposures and offspring body size from 6 months to 18 years: A systematic review. Paediatr Perinat Epidemiol 2020; 34:171-189. [PMID: 32011754 DOI: 10.1111/ppe.12629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 10/28/2019] [Accepted: 11/03/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND In utero dietary exposures may influence childhood obesity. OBJECTIVES To evaluate the relationship between prenatal dietary exposures and offspring body size from 6 months to 18 years. DATA SOURCES Articles were identified in PubMed and Web of Science (January 2010-March 2018) using the PRISMA guidelines. Additional studies were identified through a reference review of articles that met the inclusion criteria and related reviews. STUDY SELECTION Prospective cohort studies that assessed dietary patterns, foods, macronutrients, or beverages during healthy pregnancy and offspring body size. The extraction of articles was done using predefined data fields. SYNTHESIS One author extracted all information and evaluated bias with the NHLBI's Quality Assessment Tool. RESULTS A total of 851 research articles were evaluated. Twenty-one studies assessing dietary patterns, macronutrients, foods, and beverages met inclusion criteria. Consumption of a Mediterranean dietary pattern during pregnancy was associated with reduced body size, while refined carbohydrates were associated with offspring obesity. No association was observed between data-driven dietary patterns and offspring body size, as well as a pro-inflammatory diet pattern and offspring body size. Mixed and null findings were observed for the relationship between total carbohydrates, n-3 polyunsaturated fatty acids, protein, sugar-sweetened beverages, and artificially sweetened beverages and offspring body size. CONCLUSIONS Adhering to a Mediterranean diet and limiting refined carbohydrates during pregnancy may influence offspring body size between 6 months and 18 years. The diverging results that exist between studies highlight the complexity of this topic.
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Affiliation(s)
- Jacqueline Litvak
- Department of Epidemiology, College of Global Public Health, New York University, New York, NY, USA
| | - Niyati Parekh
- Department of Epidemiology, College of Global Public Health, New York University, New York, NY, USA.,Department of Population Health Sciences, School of Medicine, New York University, New York, NY, USA
| | - Andrea Deierlein
- Department of Epidemiology, College of Global Public Health, New York University, New York, NY, USA.,Department of Population Health Sciences, School of Medicine, New York University, New York, NY, USA
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16
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Goran MI, Plows JF, Ventura EE. Effects of consuming sugars and alternative sweeteners during pregnancy on maternal and child health: evidence for a secondhand sugar effect. Proc Nutr Soc 2019; 78:262-271. [PMID: 30501650 PMCID: PMC7441786 DOI: 10.1017/s002966511800263x] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Consumption of sugar and alternative low- or no-energy sweeteners has increased in recent decades. However, it is still uncertain how consumption of sugar and alternative sweeteners during pregnancy affects pregnancy outcomes and long-term offspring health. This review aims to collate the available evidence surrounding the consequences of sugar and alternative sweetener consumption during pregnancy, a so-called secondhand sugar effect. We found evidence that sugar consumption during pregnancy may contribute to increased gestational weight gain and the development of pregnancy complications, including gestational diabetes, preeclampsia and preterm birth. Further, we found a growing body of the animal and human evidence that maternal sugar intake during pregnancy may impact neonatal and childhood metabolism, taste perception and obesity risk. Emerging evidence also suggests that both maternal and paternal preconception sugar intakes are linked to offspring metabolic outcomes, perhaps via epigenetic alterations to the germline. While there have been fewer studies of the impacts of alternative sweetener consumption before and during pregnancy, there is some evidence to suggest effects on infant outcomes including preterm birth risk, increased infant body composition and offspring preference for sweet foods, although mechanisms are unclear. We conclude that preconception and gestational sugar and alternative sweetener consumption may negatively impact pregnancy outcomes and offspring health and that there is a need for further observational, mechanistic and intervention research in this area.
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Affiliation(s)
- M. I. Goran
- Department of Preventive Medicine, University of Southern California Health Sciences Campus, 2250 Alcazar Street, Los Angeles, CA 90033, USA
| | - J. F. Plows
- Department of Preventive Medicine, University of Southern California Health Sciences Campus, 2250 Alcazar Street, Los Angeles, CA 90033, USA
| | - E. E. Ventura
- Department of Preventive Medicine, University of Southern California Health Sciences Campus, 2250 Alcazar Street, Los Angeles, CA 90033, USA
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17
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Ásbjörnsdóttir B, Ronneby H, Vestgaard M, Ringholm L, Nichum VL, Jensen DM, Raben A, Damm P, Mathiesen ER. Lower daily carbohydrate consumption than recommended by the Institute of Medicine is common among women with type 2 diabetes in early pregnancy in Denmark. Diabetes Res Clin Pract 2019; 152:88-95. [PMID: 31121274 DOI: 10.1016/j.diabres.2019.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 01/08/2023]
Abstract
AIMS To secure adequate carbohydrate supply in pregnancy, the Institute of Medicine (IOM) recommends a minimum amount of carbohydrates of 175 g daily. Currently a low carbohydrate diet is a popular health trend in the general population and this might also be common among overweight and obese pregnant women with type 2 diabetes (T2D). Thus, we explored carbohydrate consumption among pregnant women with T2D including women with type 1 diabetes (T1D) for comparison. METHODS A retrospective cohort study of consecutive women with T2D (N = 96) and T1D (N = 108), where dietary records were collected at the first antenatal visit. RESULTS Among women with T2D and T1D, bodyweight at the first visit was 90.8 ± 22 (mean ± SD) and 75.5 ± 15 kg (P < 0.001) while HbA1c was 6.6 ± 1.2% (49 ± 13 mmol/mol) and 6.6 ± 0.8% (48 ± 8 mmol/mol), P = 0.8, respectively. The average daily carbohydrate consumption from the major carbohydrate sources was similar in the two groups (159 ± 56 and 167 ± 48 g, P = 0.3), as was the level of total daily physical activity (median (interquartile range)): 215 (174-289) and 210 (178-267) metabolic equivalent of task-hour/week (P = 0.9). A high proportion of women with T2D and T1D (52% and 40%, P = 0.08) consumed fewer carbohydrates than recommended by the IOM. The prevalence of ketonuria (≥4 mmol/L) was 1% in both groups. CONCLUSIONS In early pregnancy, a lower daily carbohydrate consumption than recommended by the IOM was common among women with T2D. The results were quite similar to women with T1D, despite a markedly higher bodyweight in women with T2D. Reassuringly, ketonuria was rare in both groups.
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Affiliation(s)
- Björg Ásbjörnsdóttir
- Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9 - 4001, 2100 Copenhagen Ø, Denmark; Department of Endocrinology, Rigshospitalet, Ole Måløes Vej 24 - 7551, 2100 Copenhagen Ø, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen N, Denmark.
| | - Helle Ronneby
- Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9 - 4001, 2100 Copenhagen Ø, Denmark; The Nutrition Unit, Rigshospitalet, Henrik Harpestrengs Vej 4 - 5711, 2100 Copenhagen Ø, Denmark.
| | - Marianne Vestgaard
- Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9 - 4001, 2100 Copenhagen Ø, Denmark; Department of Endocrinology, Rigshospitalet, Ole Måløes Vej 24 - 7551, 2100 Copenhagen Ø, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen N, Denmark.
| | - Lene Ringholm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9 - 4001, 2100 Copenhagen Ø, Denmark; Department of Endocrinology, Rigshospitalet, Ole Måløes Vej 24 - 7551, 2100 Copenhagen Ø, Denmark; Steno Diabetes Center Copenhagen, Niels Steensens Vej 2, 2820 Gentofte, Denmark.
| | - Vibeke L Nichum
- Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9 - 4001, 2100 Copenhagen Ø, Denmark; Department of Obstetrics, Rigshospitalet, Blegdamsvej 9 - 4031, 2100 Copenhagen Ø, Denmark.
| | - Dorte M Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Kløvervænget 10, 5000 Odense C, Denmark; Department of Gynaecology and Obstetrics, Odense University Hospital, Kløvervænget 23, 5000 Odense C, Denmark.
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg C, Denmark.
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9 - 4001, 2100 Copenhagen Ø, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen N, Denmark; Department of Obstetrics, Rigshospitalet, Blegdamsvej 9 - 4031, 2100 Copenhagen Ø, Denmark.
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9 - 4001, 2100 Copenhagen Ø, Denmark; Department of Endocrinology, Rigshospitalet, Ole Måløes Vej 24 - 7551, 2100 Copenhagen Ø, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen N, Denmark.
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18
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Chen LW, Navarro P, Murrin CM, Mehegan J, Kelleher CC, Phillips CM. Maternal Dietary Glycemic and Insulinemic Indexes Are Not Associated with Birth Outcomes or Childhood Adiposity at 5 Years of Age in an Irish Cohort Study. J Nutr 2019; 149:1037-1046. [PMID: 31049568 DOI: 10.1093/jn/nxz025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/26/2018] [Accepted: 01/31/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND High maternal dietary glycemic index (GI) and glycemic load (GL) may be associated with adverse offspring birth and postnatal adiposity outcomes through metabolic programming, but the evidence thus far, mainly from studies conducted in high-risk pregnant populations, has been inconclusive. No study has examined the influence of maternal insulin demand [measured by food insulinemic index (II) and insulinemic load (IL)] on offspring outcomes. OBJECTIVES We investigated associations between maternal GI, GL, II, and IL and offspring birth outcomes and postnatal adiposity in a general pregnant population. METHODS The study was based on data from 842 mother-child pairs from the Lifeways prospective cohort study in Ireland. Through the use of standard methodology, maternal GI, GL, II, and IL were derived from dietary information obtained via a validated food-frequency questionnaire in early pregnancy (12-16 wk). Birth outcomes were abstracted from hospital records. At 5-y follow-up, children's body mass index (BMI) and waist circumference were measured. Associations were assessed through the use of multivariable-adjusted regression analysis. RESULTS Mothers had a mean ± SD age of 30.3 ± 5.7 y and a mean BMI (kg/m2) of 23.9 ± 4.2. The mean ± SD for dietary glycemic and insulinemic indexes were: GI = 58.9 ± 4.4; GL = 152 ± 49; II = 57.4 ± 14.5; IL = 673 ± 267. After adjustment for confounders, no consistent associations were observed between maternal GI, GL, II, and IL and birth outcomes including birth weight, macrosomia, gestational age, and postterm births. Similarly, no association was observed with BMI and waist circumference z scores and childhood obesity (general and central) at 5-y follow-up. There was no evidence of a nonlinear relation between the studied indexes and outcomes. CONCLUSIONS We observed no clear relation between maternal GI, GL, II, and IL and offspring birth outcomes and childhood obesity in a general pregnant population.
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Affiliation(s)
- Ling-Wei Chen
- HRB Centre for Diet and Health Research, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Belfield, Dublin, Republic of Ireland
| | - Pilar Navarro
- HRB Centre for Diet and Health Research, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Belfield, Dublin, Republic of Ireland
| | - Celine M Murrin
- HRB Centre for Diet and Health Research, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Belfield, Dublin, Republic of Ireland
| | - John Mehegan
- HRB Centre for Diet and Health Research, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Belfield, Dublin, Republic of Ireland
| | - Cecily C Kelleher
- HRB Centre for Diet and Health Research, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Belfield, Dublin, Republic of Ireland
| | - Catherine M Phillips
- HRB Centre for Diet and Health Research, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Belfield, Dublin, Republic of Ireland
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19
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Koletzko B, Godfrey KM, Poston L, Szajewska H, van Goudoever JB, de Waard M, Brands B, Grivell RM, Deussen AR, Dodd JM, Patro-Golab B, Zalewski BM. Nutrition During Pregnancy, Lactation and Early Childhood and its Implications for Maternal and Long-Term Child Health: The Early Nutrition Project Recommendations. ANNALS OF NUTRITION & METABOLISM 2019; 74:93-106. [PMID: 30673669 PMCID: PMC6397768 DOI: 10.1159/000496471] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 12/28/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND A considerable body of evidence accumulated especially during the last decade, demonstrating that early nutrition and lifestyle have long-term effects on later health and disease ("developmental or metabolic programming"). METHODS Researchers involved in the European Union funded international EarlyNutrition research project consolidated the scientific evidence base and existing recommendations to formulate consensus recommendations on nutrition and lifestyle before and during pregnancy, during infancy and early childhood that take long-term health impact into account. Systematic reviews were performed on published dietary guidelines, standards and recommendations, with special attention to long-term health consequences. In addition, systematic reviews of published systematic reviews on nutritional interventions or exposures in pregnancy and in infants and young children aged up to 3 years that describe effects on subsequent overweight, obesity and body composition were performed. Experts developed consensus recommendations incorporating the wide-ranging expertise from additional 33 stakeholders. FINDINGS Most current recommendations for pregnant women, particularly obese women, and for young children do not take long-term health consequences of early nutrition into account, although the available evidence for relevant consequences of lifestyle, diet and growth patterns in early life on later health and disease risk is strong. INTERPRETATION We present updated recommendations for optimized nutrition before and during pregnancy, during lactation, infancy and toddlerhood, with special reference to later health outcomes. These recommendations are developed for affluent populations, such as women and children in Europe, and should contribute to the primary prevention of obesity and associated non-communicable diseases.
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Affiliation(s)
- Berthold Koletzko
- LMU, Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, Medical Centre of LMU Munich, München, Germany,
| | - K M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Lucilla Poston
- Division of Women's Health, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Hania Szajewska
- Medical University of Warsaw, Department of Paediatrics, Warsaw, Poland
| | | | - Marita de Waard
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - Brigitte Brands
- LMU, Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, Medical Centre of LMU Munich, München, Germany
| | - Rosalie M Grivell
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Andrea R Deussen
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jodie M Dodd
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
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Maternal glycemic index and glycemic load in pregnancy and offspring metabolic health in childhood and adolescence-a cohort study of 68,471 mother-offspring dyads from the Danish National Birth Cohort. Eur J Clin Nutr 2018; 73:1049-1062. [PMID: 30250133 DOI: 10.1038/s41430-018-0316-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 07/27/2018] [Accepted: 08/17/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND High glycemic index (GI) and glycemic load (GL) as indicators of carbohydrate quality and quantity have been found to increase risk of metabolic outcomes in adults. Whether carbohydrate quality may influence metabolic programming already in early life is unknown. We examined the association of maternal GI and GL with offspring body mass index (BMI) in the first 7 years of life among 68,471 mother-offspring dyads from the Danish National Birth Cohort (DNBC). In a sub-cohort of offspring with clinical data (n = 1234) that included 608 dyads exposed to gestational diabetes mellitus (GDM), we also examined the relation to metabolic health at 9-16 years. METHODS Maternal GI and GL were quantified using a mid-pregnancy food frequency questionnaire. We used birth weight and length to calculate offspring's ponderal index. Age- and sex-specific BMI z scores at 5 mo, 12 mo, and 7 y were standardized against WHO reference data. In the clinical cohort, we quantified body composition, HOMA-IR, and HOMA-B. We used multivariable mixed linear and Poisson regression to model the associations. RESULTS Median (IQR) of GI and GL were 83 (63-111) and 241 (180-333) g/day, respectively. We found that GI (Q4 vs. Q1:1.09, 95%CI: 1.03, 1.15) and GL (Q4 vs. Q1:1.10, 95%CI: 1.05, 1.16) modestly increased the relative risk of large-for gestational age (LGA). In the clinical sub-cohort, we observed a potential increase in offspring HOMA-IR, adiposity, and metabolic syndrome z score with higher maternal GI and GI. These associations were stronger among the GDM-exposed offspring, but the CI included the null value. CONCLUSION We found associations of GI and GL in pregnancy with offspring LGA. Potential long-term benefits to offspring exposed to GDM need to be confirmed in larger, well-powered studies.
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21
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Patti AM, Giglio RV, Pafili K, Rizzo M, Papanas N. Pharmacotherapy for gestational diabetes. Expert Opin Pharmacother 2018; 19:1407-1414. [PMID: 30136869 DOI: 10.1080/14656566.2018.1509955] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) represents impaired carbohydrate metabolism during pregnancy and is characterized by progressive insulin resistance and compensatory hyperinsulinaemia. If inadequately treated, it may lead to fetal macrosomia and other adverse outcomes. AREAS COVERED In this review, the authors summarize the current evidence from studies on the use of insulin and other agents for the treatment of women with GDM. EXPERT OPINION Lifestyle management is of paramount importance for the treatment of GDM. In pharmacotherapy, insulin remains the long-established mainstay of treatment. NPH (Neutral Protamine Hagedorn) and soluble human insulin have long been established for use, but favorable experience has now also accumulated with the newer insulins (aspart, lispro, detemir). Alternatively, metformin and glyburide have been used in GDM, but they have never gained wide acceptance. Nutritional supplements based on micronutrients and bioactives (probiotics and myoinositol) have shown promising results as well. Further experience with incretin agents (DPP-4 inhibitors and GLP-1 receptor agonists) is awaited.
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Affiliation(s)
- Angelo Maria Patti
- a Department of Internal Medicine and Medical Specialties , University of Palermo , Palermo , Italy
| | - Rosaria Vincenza Giglio
- a Department of Internal Medicine and Medical Specialties , University of Palermo , Palermo , Italy
| | - Kalliopi Pafili
- b Diabetes Centre, Second Department of Internal Medicine , Democritus University of Thrace, University Hospital of Alexandroupolis , Alexandroupolis , Greece
| | - Manfredi Rizzo
- a Department of Internal Medicine and Medical Specialties , University of Palermo , Palermo , Italy
| | - Nikolaos Papanas
- b Diabetes Centre, Second Department of Internal Medicine , Democritus University of Thrace, University Hospital of Alexandroupolis , Alexandroupolis , Greece
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22
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Micali N, Al Essimii H, Field AE, Treasure J. Pregnancy loss of control over eating: a longitudinal study of maternal and child outcomes. Am J Clin Nutr 2018; 108:101-107. [PMID: 29873682 DOI: 10.1093/ajcn/nqy040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background To our knowledge, no previous studies have investigated longitudinal outcomes of maternal loss of control over eating (LOC) in pregnancy in a general population sample. Objective We aimed to determine whether pregnancy LOC is associated with dietary, gestational weight gain, and offspring birth-weight outcomes in a large population-based prospective study of pregnant women and their children. We also explored the association with offspring weight at age 15.5 y. Design Women (n = 11,132) from the Avon Longitudinal Study of Parents and Children (ALSPAC) were included. Crude and adjusted logistic and multinomial regression models were used. LOC in pregnancy and diet at 32 wk of gestation were assessed by self-report. Pregnancy weight gain and birth weight were obtained from obstetric records. Child weight and height were objectively measured at age 15.5 y. Results LOC in pregnancy was common (36.3%). Women with pregnancy LOC reported higher total energy intake, consumed more snacks, and had lower vitamin B-6, A, and C intake compared with women without LOC. Women with frequent LOC had lower vitamin B-1 and folate intake [respectively: b = -0.05 (95% CI: -0.07, -0.02) and b = -7.1 (95% CI: -11.8, -2.3) in adjusted analyses], and gained on average 3.74 kg (95% CI: 3.33, 4.13 kg) more than women without LOC. Frequent and occasional LOC were associated with higher birth weight [respectively: b = 0.07 (95% CI: 0.03, 0.1), b = 0.04 (95% CI: 0.02, 0.06)]. Offspring of mothers with frequent pregnancy LOC had 2-fold increased odds of being overweight/obese at 15.5 y [OR = 2.02 (95% CI: 1.37, 3.01)]. Conclusions Pregnancy LOC eating is common and has an adverse short- and long-term impact on mother and offspring, but has received very limited attention. Our findings further the understanding of risk factors for obesity and highlight a need for improved identification of maternal pregnancy loss of control eating. This trial was registered at clinicaltrials.gov as NCT03269253.
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Affiliation(s)
- Nadia Micali
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Great Ormond Street Institute of Child Health, Child and Adolescent Mental Health, Palliative Care and Pediatrics Section, University College London, London, United Kingdom.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY.,Service de Psychiatrie de l'enfant et de l'adolescent, Department of Children and Adolescents (DEA), University Hospital of Geneva (HUG), Geneva, Switzerland
| | - Haya Al Essimii
- Department of Clinical Nutrition, College of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia.,Metabolic Medicine Research Unit, Division of Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Alison E Field
- Department of Epidemiology, Brown University School of Public Health, Providence, RI.,Department of Pediatrics, Warren Alpert School of Medicine of Brown University, Providence, RI
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom
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23
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Curtis EM, Suderman M, Phillips CM, Relton C, Harvey NC. Early-life dietary and epigenetic influences on childhood musculoskeletal health: Update on the UK component of the ALPHABET project. NUTR BULL 2018. [DOI: 10.1111/nbu.12322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- E. M. Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton; Southampton UK
| | - M. Suderman
- MRC Integrative Epidemiology Unit, University of Bristol; Bristol UK
| | - C. M. Phillips
- HRB Centre for Diet and Health Research, University College Dublin; Dublin Ireland
| | - C. Relton
- MRC Integrative Epidemiology Unit, University of Bristol; Bristol UK
| | - N. C. Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton; Southampton UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust; Southampton UK
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24
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Schaefer-Graf U, Napoli A, Nolan CJ. Diabetes in pregnancy: a new decade of challenges ahead. Diabetologia 2018; 61:1012-1021. [PMID: 29356835 PMCID: PMC6448995 DOI: 10.1007/s00125-018-4545-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/21/2017] [Indexed: 01/13/2023]
Abstract
Every 10 years, the Diabetic Pregnancy Study Group, a study group of the EASD, conducts an audit meeting to review the achievements of the preceding decade and to set the directions for research and clinical practice improvements for the next decade. The most recent meeting focused on the following areas: improving pregnancy outcomes for women with pregestational type 1 diabetes and type 2 diabetes; the influence of obesity and gestational diabetes on pregnancy outcomes; the determinants and assessment of fetal growth and development; and public health issues, including consideration of transgenerational consequences and economic burden. The audit meeting also considered the likely impact of 'omics' on research within the field and the potential of these technologies to enable precision-medicine approaches to management. Through sharing of the findings and ideas of audit meeting participants, the DPSG hopes to promote networking, research and advances in clinical care, to improve outcomes for all women and their offspring affected by diabetes and obesity in pregnancy.
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Affiliation(s)
- Ute Schaefer-Graf
- Berlin Center for Diabetes in Pregnancy, Department of Obstetrics and Gynecology, St Joseph's Hospital, Wüsthoffstraße 15, 12101, Berlin, Germany.
- Department of Obstetrics, Charité, Humboldt University, Berlin, Germany.
| | - Angela Napoli
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Christopher J Nolan
- Department of Endocrinology, The Canberra Hospital, Garran, ACT, Australia
- Australian National University Medical School and John Curtin School of Medical Research, Australian National University, Acton, ACT, Australia
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25
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The Maternal Nutritional Milieu and Neonatal Outcomes: Connecting the Dots. J Pediatr 2018; 195:9-11. [PMID: 29398061 DOI: 10.1016/j.jpeds.2017.12.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022]
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26
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Hanson M, Gluckman P. Commentary: Developing the future: life course epidemiology, DOHaD and evolutionary medicine. Int J Epidemiol 2018; 45:993-996. [PMID: 27880687 DOI: 10.1093/ije/dyw105] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mark Hanson
- Institute of Developmental Sciences, .,NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK and
| | - Peter Gluckman
- Liggins Institute, University of Auckland, Auckland, New Zealand
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27
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Gillman MW, Rifas-Shiman SL, Fernandez-Barres S, Kleinman K, Taveras EM, Oken E. Beverage Intake During Pregnancy and Childhood Adiposity. Pediatrics 2017; 140:peds.2017-0031. [PMID: 28689188 PMCID: PMC5527670 DOI: 10.1542/peds.2017-0031] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To examine associations of sugar sweetened beverages (SSBs) and other beverage intake during pregnancy with adiposity in midchildhood (median age of 7.7 years). METHODS We studied 1078 mother-child pairs in Project Viva, a prospective prebirth cohort study. Exposures were sugary and nonsugary beverage intake assessed in the first and second trimesters of pregnancy by using a food frequency questionnaire. Main outcome measures were offspring overall adiposity (BMI z score, fat mass index [FMI, kg/m2] from dual-energy radiograph absorptiometry, and sum of subscapular [SS] and triceps [TR] skinfold thicknesses) and central adiposity (SS:TR ratio and waist circumference). RESULTS In the second trimester, mean (SD) SSB intake was 0.6 (0.9) servings per day. Thirty-two percent of mothers were multiracial or people of color, 68% were college graduates, and 10% smoked during pregnancy. In midchildhood, mean (SD) BMI z score was 0.38 (1.00), and the FMI was 4.4 (1.9) kg/m2. In multivariable models adjusted for multiple maternal and child covariates, each additional serving per day of SSB was associated with higher BMI z scores (0.07 U; 95% confidence interval [CI]: -0.01 to 0.15), FMI (0.15 kg/m2; 95% CI: -0.01 to 0.30), SS + TR (0.85 mm; 95% CI: 0.06 to 1.64), and waist circumference (0.65 cm; 95% CI: 0.01 to 1.28). Stratified models suggested that the associations were due primarily to maternal, not child, SSB intake and to sugary soda rather than fruit drinks or juice. We did not find differences between boys and girls, nor did we observe the effects of sugar-free soda or of first-trimester beverage intake. CONCLUSIONS Higher SSB intake during the second trimester of pregnancy was associated with greater adiposity in midchildhood.
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Affiliation(s)
- Matthew W. Gillman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Sheryl L. Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Silvia Fernandez-Barres
- Nutrition and Mental Health Research Group, Universitat Rovira I Virgili, Reus, Spain;,ISGlobal, Center for Research in Environmental Epidemiology, Barcelona, Spain
| | - Ken Kleinman
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts; and
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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28
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Patel N, Godfrey KM, Pasupathy D, Levin J, Flynn AC, Hayes L, Briley AL, Bell R, Lawlor DA, Oteng-Ntim E, Nelson SM, Robson SC, Sattar N, Singh C, Wardle J, White S, Seed PT, Poston L. Infant adiposity following a randomised controlled trial of a behavioural intervention in obese pregnancy. Int J Obes (Lond) 2017; 41:1018-1026. [PMID: 28216644 PMCID: PMC5482395 DOI: 10.1038/ijo.2017.44] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/09/2016] [Accepted: 01/31/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Randomised controlled trials are required to address causality in the reported associations between maternal influences and offspring adiposity. The aim of this study was to determine whether an antenatal lifestyle intervention, associated with improvements in maternal diet and reduced gestational weight gain (GWG) in obese pregnant women leads to a reduction in infant adiposity and sustained improvements in maternal lifestyle behaviours at 6 months postpartum. SUBJECTS AND METHODS We conducted a planned postnatal follow-up of a randomised controlled trial (UK Pregnancies Better Eating and Activity Trial (UPBEAT)) of a complex behavioural intervention targeting maternal diet (glycaemic load (GL) and saturated fat intake) and physical activity in 1555 obese pregnant women. The main outcome measure was infant adiposity, assessed by subscapular and triceps skinfold thicknesses. Maternal diet and physical activity, indices of the familial lifestyle environment, were assessed by questionnaire. RESULTS A total of 698 (45.9%) infants (342 intervention and 356 standard antenatal care) were followed up at a mean age of 5.92 months. There was no difference in triceps skinfold thickness z-scores between the intervention vs standard care arms (difference -0.14 s.d., 95% confidence interval -0.38 to 0.10, P=0.246), but subscapular skinfold thickness z-score was 0.26 s.d. (-0.49 to -0.02; P=0.03) lower in the intervention arm. Maternal dietary GL (-35.34; -48.0 to -22.67; P<0.001) and saturated fat intake (-1.93% energy; -2.64 to -1.22; P<0.001) were reduced in the intervention arm at 6 months postpartum. Causal mediation analysis suggested that lower infant subscapular skinfold thickness was partially mediated by changes in antenatal maternal diet and GWG rather than postnatal diet. CONCLUSIONS This study provides evidence from follow-up of a randomised controlled trial that a maternal behavioural intervention in obese pregnant women has the potential to reduce infant adiposity and to produce a sustained improvement in maternal diet at 6 months postpartum.
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Affiliation(s)
- Nashita Patel
- Division of Women’s Health, Women’s Health Academic Centre, Faculty of Life Sciences and Medicine, King’s College London, St Thomas’ Hospital, London, UK
| | - Keith M. Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Dharmintra Pasupathy
- Division of Women’s Health, Women’s Health Academic Centre, Faculty of Life Sciences and Medicine, King’s College London, St Thomas’ Hospital, London, UK
| | - Julia Levin
- London School of Hygiene and Tropical Medicine, London, UK
| | - Angela C Flynn
- Division of Women’s Health, Women’s Health Academic Centre, Faculty of Life Sciences and Medicine, King’s College London, St Thomas’ Hospital, London, UK
- Division of Diabetes and Nutritional Sciences, King’s College London, London, UK
| | - Louise Hayes
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Annette L Briley
- Division of Women’s Health, Women’s Health Academic Centre, Faculty of Life Sciences and Medicine, King’s College London, St Thomas’ Hospital, London, UK
| | - Ruth Bell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol & School of Social and Community Medicine, Bristol, England, UK
| | | | | | - Stephen C. Robson
- Institute of Cellular Medicine Uterine Cell Signalling Group Newcastle University, Newcastle, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Claire Singh
- Guys and St Thomas’ NHS Foundation Trust, London, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Institute of Epidemiology and Health, University College London, London, UK
| | - Sara White
- Division of Women’s Health, Women’s Health Academic Centre, Faculty of Life Sciences and Medicine, King’s College London, St Thomas’ Hospital, London, UK
| | - Paul T Seed
- Division of Women’s Health, Women’s Health Academic Centre, Faculty of Life Sciences and Medicine, King’s College London, St Thomas’ Hospital, London, UK
| | - Lucilla Poston
- Division of Women’s Health, Women’s Health Academic Centre, Faculty of Life Sciences and Medicine, King’s College London, St Thomas’ Hospital, London, UK
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29
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Hollis JL, Crozier SR, Inskip HM, Cooper C, Godfrey KM, Harvey NC, Collins CE, Robinson SM. Modifiable risk factors of maternal postpartum weight retention: an analysis of their combined impact and potential opportunities for prevention. Int J Obes (Lond) 2017; 41:1091-1098. [PMID: 28337028 PMCID: PMC5500180 DOI: 10.1038/ijo.2017.78] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/12/2017] [Accepted: 03/14/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES Pregnancy triggers a physiological change in weight status. Postpartum weight retention in the childbearing years can substantially alter a woman's weight gain trajectory, with several potential contributing factors identified. Most research has relied on women's recall of pre-pregnancy weight during pregnancy or later, and not considered risk factors in combination. Using measured pre-pregnancy weight, this study aimed to examine the associations of maternal postpartum weight retention with parity, pre-pregnancy BMI, excessive gestational weight gain (GWG), maternal serum vitamin D concentration and dietary Glycaemic Index in early and late pregnancy, and breastfeeding duration, including analysis of the combined impact of potentially modifiable risk factors. SUBJECTS/METHODS Prospective cohort study of 12 583 non-pregnant women aged 20-34 years in Southampton (UK) who were assessed prior to pregnancy, with those who subsequently became pregnant followed up in early and late gestation, and after delivery (n=2559 in the final sample). Linear regression models examined potential predictors of weight retention in adjusted individual and multivariate analyses, and as a risk factor score. RESULTS Compared with pre-pregnancy weight, 73% of women retained some weight at 6 months postpartum (mean (s.d.): 3.5 (6.2) kg). In the adjusted multivariate model, women who were primiparous, had a lower pre-pregnancy BMI, excessive GWG, a lower early pregnancy vitamin D concentration and breastfed for <6 months had greater weight retention 6 months postpartum (P<0.05 for all variables). For each additional modifiable risk factor (excessive GWG, low vitamin D concentration in early pregnancy and short breastfeeding duration; scale 0-3), women retained an additional 2.49 kg (95% CI: 2.16, 2.82; P<0.001). CONCLUSIONS Having a greater number of modifiable risk factors was associated with greater weight retention 6 months postpartum. Initiatives supporting women to target these risk factors in the years prior to, during and after pregnancy could impact on their weight gain trajectory and later risk of adverse weight-related outcomes.
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Affiliation(s)
- J L Hollis
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S R Crozier
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - H M Inskip
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - K M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - N C Harvey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C E Collins
- Priority Research Centre in Physical Activity and Nutrition, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - S M Robinson
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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30
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Skreden M, Bere E, Sagedal LR, Vistad I, Øverby NC. Changes in fruit and vegetable consumption habits from pre-pregnancy to early pregnancy among Norwegian women. BMC Pregnancy Childbirth 2017; 17:107. [PMID: 28376732 PMCID: PMC5381088 DOI: 10.1186/s12884-017-1291-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 03/24/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND A healthy diet is important for pregnancy outcome and the current and future health of woman and child. The aims of the study were to explore the changes from pre-pregnancy to early pregnancy in consumption of fruits and vegetables (FV), and to describe associations with maternal educational level, body mass index (BMI) and age. METHODS Healthy nulliparous women were included in the Norwegian Fit for Delivery (NFFD) trial from September 2009 to February 2013, recruited from eight antenatal clinics in southern Norway. At inclusion, in median gestational week 15 (range 9-20), 575 participants answered a food frequency questionnaire (FFQ) where they reported consumption of FV, both current intake and recollection of pre-pregnancy intake. Data were analysed using a linear mixed model. RESULTS The percentage of women consuming FV daily or more frequently in the following categories increased from pre-pregnancy to early pregnancy: vegetables on sandwiches (13 vs. 17%, p <0.01), other vegetables (11 vs. 14%, p = 0.01), fruits (apples, pears, oranges or bananas) (24 vs. 41%, p < 0.01), other fruits and berries (8 vs. 15%, p < 0.01) and fruits and vegetables as snacks (14 vs. 28%, p < 0.01). The percentage of women who reported at least daily consumption of vegetables with dinner (22% at both time points) was stable. A higher proportion of older women increased their consumption of vegetables and fruits as snacks from pre-pregnancy to early pregnancy compared to younger women (p=0.04). CONCLUSIONS We found an increase in the proportion of women consuming FV daily or more frequently from pre-pregnancy to early pregnancy. TRIAL REGISTRATION ClinicalTrials.gov database, NCT01001689 . https://clinicaltrials.gov/ct2/show/NCT01001689?term=NCT01001689&rank=1 .
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Affiliation(s)
- Marianne Skreden
- Department of Public Health, Sports and Nutrition, University of Agder, PO Box 422, 4604, Kristiansand, Norway.
| | - Elling Bere
- Department of Public Health, Sports and Nutrition, University of Agder, PO Box 422, 4604, Kristiansand, Norway
| | - Linda R Sagedal
- Department of Obstetrics and Gynaecology, Sørlandet Hospital HF, PO Box 416, 4604, Kristiansand, Norway.,Department of Research, Sørlandet Hospital HF, PO Box 416, 4604, Kristiansand, Norway
| | - Ingvild Vistad
- Department of Obstetrics and Gynaecology, Sørlandet Hospital HF, PO Box 416, 4604, Kristiansand, Norway.,Department of Research, Sørlandet Hospital HF, PO Box 416, 4604, Kristiansand, Norway
| | - Nina C Øverby
- Department of Public Health, Sports and Nutrition, University of Agder, PO Box 422, 4604, Kristiansand, Norway
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31
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Poston L, Bell R, Briley AL, Godfrey KM, Nelson SM, Oteng-Ntim E, Sandall J, Sanders TAB, Sattar N, Seed PT, Robson SC, Trépel D, Wardle J. Improving pregnancy outcome in obese women: the UK Pregnancies Better Eating and Activity randomised controlled Trial. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BackgroundObesity in pregnancy is associated with insulin resistance, which underpins many common complications including gestational diabetes mellitus (GDM) and fetal macrosomia.ObjectivesTo assess the effect of a complex behavioural intervention based on diet and physical activity (PA) on the risk of GDM and delivery of a large-for-gestational age (LGA) infant.DesignThree phases: (1) the development phase, (2) the pilot study and (3) a multicentre randomised controlled trial (RCT) comparing a behavioural intervention to improve glycaemic control with standard antenatal care in obese pregnant women. A cost–utility analysis was undertaken to estimate the cost-effectiveness of the health training (intervention) over and above standard care (control).SettingPilot study: antenatal clinics in four inner-city UK hospitals. RCT: eight antenatal clinics in eight UK inner-city hospitals.ParticipantsWomen were eligible for inclusion if they had a body mass index of ≥ 30 kg/m2, were pregnant with a single fetus and at 15+0to 18+6weeks’ gestation, were able to give written informed consent and were without predefined disorders.InterventionThe intervention comprised an initial session with a health trainer, followed by eight weekly sessions. Dietary advice recommended foods with a low dietary glycaemic index, avoidance of sugar-sweetened beverages and reduced saturated fats. Women were encouraged to increase daily PA.Main outcome measuresDevelopment phase: intervention development, acceptability and optimal approach for delivery. Pilot study: change in dietary and PA behaviours at 28 weeks’ gestation. RCT: the primary outcome of the RCT was, for the mother, GDM [as measured by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG)’s diagnostic criteria] and, for the infant, LGA delivery (i.e. customised birthweight ≥ 90th centile for gestational age).ResultsDevelopment phase: following a literature meta-analysis, a study of dietary intention questionnaires and semistructured interviews, an intervention based on behavioural science was developed that incorporated optimal and acceptable methods for delivery. Pilot study: the pilot study demonstrated improvement in dietary behaviours in the intervention compared with the standard care arm but no increase in objectively measured PA. Process evaluation demonstrated feasibility and general acceptability. RCT: the RCT showed no effect of the intervention on GDM in obese pregnant women or the number of deliveries of LGA infants. There was a reduction in dietary glycaemic load (GL) and reduced saturated fat intake, an increase in PA and a modest reduction in gestational weight gain, all secondary outcomes. Lower than expected was the number of LGA infant deliveries in all women, which suggested that universal screening for GDM with IADPSG’s diagnostic criteria, and subsequent treatment, may reduce the number of deliveries of LGA infants. According to the cost–utility analysis, the estimated probability that the UK Pregnancies Better Eating and Activity Trial (UPBEAT) behavioural intervention is cost-effective at the £30,000/quality-adjusted life-year willingness-to-pay threshold was 1%.LimitationsIncluded the high refusal rate for participation and self-reported assessment of diet and PA.ConclusionsThe UPBEAT intervention, an intense theoretically based intervention in obese pregnant women, did not reduce the risk of GDM in women or the number of LGA infant deliveries, despite successfully reducing the dietary GL. Based on total cost to the NHS provider and health gains, the UPBEAT intervention provided no supporting evidence to suggest that the intervention represents value for money based on the National Institute for Health and Care Excellence benchmarks for cost-effectiveness.Future workAlternative strategies for reducing the risk of GDM in obese pregnant women and the number of LGA infant deliveries should be considered, including development of clinically effective interventions to prevent obesity in women of reproductive age, of clinically effective interventions to reduce weight retention following pregnancy and of risk stratification tools in early pregnancy.Trial registrationCurrent Controlled Trials ISRCTN89971375 and UK Clinical Research Network Portfolio 5035.FundingThis project was funded by the NIHR Programme Grant for Applied Research programme and will be published in full inProgramme Grants for Applied Research, Vol. 5, No. 10. See the NIHR journals library website for further project information. Contributions to funding were also provided by the Chief Scientist Office CZB/4/680, Scottish Government Health Directorates, Edinburgh; Guys and St Thomas’ Charity, Tommy’s Charity (Lucilla Poston, Annette L Briley, Paul T Seed) and the NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, UK and the Academy of Finland, Finland. Keith M Godfrey was supported by the National Institute for Health Research through the NIHR Southampton Biomedical Research Centre. Lucilla Poston and Keith M Godfrey were supported by the European Union’s Seventh Framework Programme (FP7/2007-2013), project EarlyNutrition under grant agreement number 289346.
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Affiliation(s)
- Lucilla Poston
- Division of Women’s Health, King’s College London, King’s Health Partners, London, UK
| | - Ruth Bell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Annette L Briley
- Division of Women’s Health, King’s College London, King’s Health Partners, London, UK
| | - Keith M Godfrey
- Lifecourse Epidemiology Unit and NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Jane Sandall
- Division of Women’s Health, King’s College London, King’s Health Partners, London, UK
| | - Thomas AB Sanders
- Division of Diabetes and Nutritional Sciences, King’s College London, London, UK
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Paul T Seed
- Division of Women’s Health, King’s College London, King’s Health Partners, London, UK
| | - Stephen C Robson
- Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Dominic Trépel
- Department of Health Sciences, University of York, York, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Institute of Epidemiology and Health, University College London, London, UK
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Chen LW, Aris IM, Bernard JY, Tint MT, Colega M, Gluckman PD, Tan KH, Shek LPC, Chong YS, Yap F, Godfrey KM, van Dam RM, Chong MFF, Lee YS. Associations of maternal macronutrient intake during pregnancy with infant BMI peak characteristics and childhood BMI. Am J Clin Nutr 2017; 105:705-713. [PMID: 28179222 DOI: 10.3945/ajcn.116.148270] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/04/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Infant body mass index (BMI) peak characteristics and early childhood BMI are emerging markers of future obesity and cardiometabolic disease risk, but little is known about their maternal nutritional determinants.Objective: We investigated the associations of maternal macronutrient intake with infant BMI peak characteristics and childhood BMI in the Growing Up in Singapore Towards healthy Outcomes study.Design: With the use of infant BMI data from birth to age 18 mo, infant BMI peak characteristics [age (in months) and magnitude (BMIpeak; in kg/m2) at peak and prepeak velocities] were derived from subject-specific BMI curves that were fitted with the use of mixed-effects model with a natural cubic spline function. Associations of maternal macronutrient intake (assessed by using a 24-h recall during late gestation) with infant BMI peak characteristics (n = 910) and BMI z scores at ages 2, 3, and 4 y were examined with the use of multivariable linear regression.Results: Mean absolute maternal macronutrient intakes (percentages of energy) were 72 g protein (15.6%), 69 g fat (32.6%), and 238 g carbohydrate (51.8%). A 25-g (∼100-kcal) increase in maternal carbohydrate intake was associated with a 0.01/mo (95% CI: 0.0003, 0.01/mo) higher prepeak velocity and a 0.04 (95% CI: 0.01, 0.08) higher BMIpeak These associations were mainly driven by sugar intake, whereby a 25-g increment of maternal sugar intake was associated with a 0.02/mo (95% CI: 0.01, 0.03/mo) higher infant prepeak velocity and a 0.07 (95% CI: 0.01, 0.13) higher BMIpeak Higher maternal carbohydrate and sugar intakes were associated with a higher offspring BMI z score at ages 2-4 y. Maternal protein and fat intakes were not consistently associated with the studied outcomes.Conclusion: Higher maternal carbohydrate and sugar intakes are associated with unfavorable infancy BMI peak characteristics and higher early childhood BMI. This trial was registered at clinicaltrials.gov as NCT01174875.
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Affiliation(s)
| | - Izzuddin M Aris
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, and
| | - Jonathan Y Bernard
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, and
| | | | - Marjorelee Colega
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, and
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, and.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Kok Hian Tan
- Departments of Maternal Fetal Medicine and.,Duke-National University of Singapore Graduate Medical School, Singapore
| | | | - Yap-Seng Chong
- Obstetrics and Gynecology, and.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, and
| | - Fabian Yap
- Pediatric Endocrinology, KK Women's and Children's Hospital, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit and National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Rob M van Dam
- Medicine, Yong Loo Lin School of Medicine, and.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Department of Nutrition, Harvard School of Public Health, Boston, MA; and
| | - Mary Foong-Fong Chong
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore; .,Liggins Institute, University of Auckland, Auckland, New Zealand.,Departments of Maternal Fetal Medicine and
| | - Yung Seng Lee
- Departments of Pediatrics, .,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, and.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
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33
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Flynn AC, Seed PT, Patel N, Barr S, Bell R, Briley AL, Godfrey KM, Nelson SM, Oteng-Ntim E, Robinson SM, Sanders TA, Sattar N, Wardle J, Poston L, Goff LM. Dietary patterns in obese pregnant women; influence of a behavioral intervention of diet and physical activity in the UPBEAT randomized controlled trial. Int J Behav Nutr Phys Act 2016; 13:124. [PMID: 27894316 PMCID: PMC5126873 DOI: 10.1186/s12966-016-0450-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/21/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Understanding dietary patterns in obese pregnant women will inform future intervention strategies to improve pregnancy outcomes and the health of the child. The aim of this study was to investigate the effect of a behavioral intervention of diet and physical activity advice on dietary patterns in obese pregnant woman participating in the UPBEAT study, and to explore associations of dietary patterns with pregnancy outcomes. METHODS In the UPBEAT randomized controlled trial, pregnant obese women from eight UK multi-ethnic, inner-city populations were randomly assigned to receive a diet/physical activity intervention or standard antenatal care. The dietary intervention aimed to reduce glycemic load and saturated fat intake. Diet was assessed using a food frequency questionnaire (FFQ) at baseline (15+0-18+6 weeks' gestation), post intervention (27+0-28+6 weeks) and in late pregnancy (34+0-36+0 weeks). Dietary patterns were characterized using factor analysis of the baseline FFQ data, and changes compared in the control and intervention arms. Patterns were related to pregnancy outcomes in the combined control/intervention cohort (n = 1023). RESULTS Four distinct baseline dietary patterns were defined; Fruit and vegetables, African/Caribbean, Processed, and Snacks, which were differently associated with social and demographic factors. The UPBEAT intervention significantly reduced the Processed (-0.14; 95% CI -0.19, -0.08, P <0.0001) and Snacks (-0.24; 95% CI -0.31, -0.17, P <0.0001) pattern scores. In the adjusted model, baseline scores for the African/Caribbean (quartile 4 compared with quartile 1: OR = 2.46; 95% CI 1.41, 4.30) and Processed (quartile 4 compared with quartile 1: OR = 2.05; 95% CI 1.23, 3.41) patterns in the entire cohort were associated with increased risk of gestational diabetes. CONCLUSIONS In a diverse cohort of obese pregnant women an intensive dietary intervention improved Processed and Snack dietary pattern scores. African/Caribbean and Processed patterns were associated with an increased risk of gestational diabetes, and provide potential targets for future interventions. TRIAL REGISTRATION Current controlled trials; ISRCTN89971375.
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Affiliation(s)
- Angela C Flynn
- Division of Women's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, UK.,Division of Diabetes and Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, UK
| | - Paul T Seed
- Division of Women's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, UK
| | - Nashita Patel
- Division of Women's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, UK
| | - Suzanne Barr
- Department of Cardiovascular Medicine, Imperial College London, London, UK
| | - Ruth Bell
- Institute of Health & Society Newcastle University, UK Baddiley-Clark Building Richardson Road, Newcastle upon Tyne, UK
| | - Annette L Briley
- Division of Women's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, UK
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Mailpoint 95, Southampton, UK
| | - Scott M Nelson
- School of Medicine, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, UK
| | - Eugene Oteng-Ntim
- Guys and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, UK
| | - Sian M Robinson
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Mailpoint 95, Southampton, UK
| | - Thomas A Sanders
- Division of Diabetes and Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, RC214 Level C2, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Institute of Epidemiology and Health, University College London, 1-19 Torrington Place, London, UK
| | - Lucilla Poston
- Division of Women's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, UK
| | - Louise M Goff
- Division of Diabetes and Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, UK.
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34
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Flynn AC, Dalrymple K, Barr S, Poston L, Goff LM, Rogozińska E, van Poppel MNM, Rayanagoudar G, Yeo S, Barakat Carballo R, Perales M, Bogaerts A, Cecatti JG, Dodd J, Owens J, Devlieger R, Teede H, Haakstad L, Motahari-Tabari N, Tonstad S, Luoto R, Guelfi K, Petrella E, Phelan S, Scudeller TT, Hauner H, Renault K, Sagedal LR, Stafne SN, Vinter C, Astrup A, Geiker NRW, McAuliffe FM, Mol BW, Thangaratinam S. Dietary interventions in overweight and obese pregnant women: a systematic review of the content, delivery, and outcomes of randomized controlled trials. Nutr Rev 2016; 74:312-28. [PMID: 27083868 DOI: 10.1093/nutrit/nuw005] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
CONTEXT Interventions targeting maternal obesity are a healthcare and public health priority. OBJECTIVE The objective of this review was to evaluate the adequacy and effectiveness of the methodological designs implemented in dietary intervention trials for obesity in pregnancy. DATA SOURCES A systematic review of the literature, consistent with PRISMA guidelines, was performed as part of the International Weight Management in Pregnancy collaboration. STUDY SELECTION Thirteen randomized controlled trials, which aimed to modify diet and physical activity in overweight and obese pregnant women, were identified. DATA SYNTHESIS There was significant variability in the content, delivery, and dietary assessment methods of the dietary interventions examined. A number of studies demonstrated improved dietary behavior in response to diet and/or lifestyle interventions. Nine studies reduced gestational weight gain. CONCLUSION This review reveals large methodological variability in dietary interventions to control gestational weight gain and improve clinical outcomes in overweight and obese pregnant women. This lack of consensus limits the ability to develop clinical guidelines and apply the evidence in clinical practice.
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Affiliation(s)
- Angela C Flynn
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Kathryn Dalrymple
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Suzanne Barr
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Lucilla Poston
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Louise M Goff
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Ewelina Rogozińska
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Mireille N M van Poppel
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Girish Rayanagoudar
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - SeonAe Yeo
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Ruben Barakat Carballo
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Maria Perales
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Annick Bogaerts
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Jose G Cecatti
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Jodie Dodd
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Julie Owens
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Roland Devlieger
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Helena Teede
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Lene Haakstad
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Narges Motahari-Tabari
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Serena Tonstad
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Riitta Luoto
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Kym Guelfi
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Elisabetta Petrella
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Suzanne Phelan
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Tânia T Scudeller
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Hans Hauner
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Kristina Renault
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Linda Reme Sagedal
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Signe N Stafne
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Christina Vinter
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Arne Astrup
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Nina R W Geiker
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Fionnuala M McAuliffe
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Ben W Mol
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
| | - Shakila Thangaratinam
- A.C. Flynn is with the Diabetes and Nutritional Sciences Division, School of Medicine, and the Division of Women's Health, Women's Health Academic Centre King's College London, London, United Kingdom. K. Dalrymple is with Nutricia, Early Life Nutrition, Trowbridge, United Kingdom. S. Barr is with the Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom. L. Poston is with the Division of Women's Health, Women's Health Academic Centre, King's College London, London, United Kingdom. L.M. Goff is with the Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom. E. Rogozinska is with the Women's Health Research Unit and the Multidisciplinary Evidence Synthesis Hub (mEsh), Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. M.N.M. van Poppel is with the Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. G. Rayanagoudar is with the Women's Health Research Unit, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. S. Yeo is with the School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R. Barakat Carballo is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. M. Perales is with the Facultad de Ciencias de la Actividad Fı'sica y del Deporte-INEF, Universidad Polite'cnica de Madrid, Madrid, Spain. A. Bogaerts is with the Division of Mother and Child, Department of Obstetrics and Gynaecology, University Colleges Leuven-Limburg and Antwerp University, Faculty of Medicine and Health Sciences, Antwerp, Belgium. J.G. Cecatti is with the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. J. Dod
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Zhang R, Han S, Chen GC, Li ZN, Silva-Zolezzi I, Parés GV, Wang Y, Qin LQ. Effects of low-glycemic-index diets in pregnancy on maternal and newborn outcomes in pregnant women: a meta-analysis of randomized controlled trials. Eur J Nutr 2016; 57:167-177. [PMID: 27612876 DOI: 10.1007/s00394-016-1306-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/27/2016] [Indexed: 01/09/2023]
Abstract
PURPOSE Maternal diet with a high glycemic index (GI) is associated with fetal overgrowth and higher infant body adiposity. Effects of low-GI diet on maternal and newborn outcomes have been assessed in both healthy pregnancy and gestational diabetes mellitus, but the results remain inconclusive. This meta-analysis aimed to examine the effects of low-GI diets on maternal and newborn outcomes. METHODS PubMed, Clinical Trials, and Cochrane Library databases were searched for relevant randomized trials up to January 2016. Random- or fixed-effects models were used to calculate combined treatment effects. RESULTS A total of 11 trials involving 1985 women were eligible for analysis. This meta-analysis assessed 7 maternal and 11 newborn outcomes. Of these, gestational weight gain (GWG), fasting blood glucose (FBG), newborn birth weight, ponderal index (PI), proportion of macrosomia, and large for gestational age (LGA) were investigated in more than 8 trials. Compared with control diets, low-GI diets significantly reduced FBG (weight mean differences (WMD) = -0.18 mmol/L, 95 % CI: -0.33, -0.02), 2-h postprandial glucose level (WMD = -0.33 mmol/L, 95 % CI: -0.54, -0.12), and the proportion of LGA (RR = 0.52, 95 % CI: 0.31, 0.89). A lower GWG (WMD = -0.69 kg, 95 % CI: -1.74, 0.36) and birth weight (WMD = -0.10 kg, 95 % CI: -0.23, 0.03) were also observed without significant differences. Heterogeneity was observed in the GWG, FBG, and birth weight analyses. Low-GI diets did not affect other maternal and newborn outcomes. In subgroup and sensitivity analyses, the intervention effects of low GI on GWG and FBG varied. CONCLUSIONS Low-GI diets may have beneficial effects on maternal outcomes for those at risk of developing high glucose levels, without causing adverse effects on newborn outcomes. However, results should be interpreted with caution because of the evidence of heterogeneity and limited number of studies.
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Affiliation(s)
- Ru Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, 199 Renai Road, Dushu Lake Higher Education Town, Suzhou, 215123, China
| | - Shufen Han
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, 199 Renai Road, Dushu Lake Higher Education Town, Suzhou, 215123, China
| | - Guo-Chong Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, 199 Renai Road, Dushu Lake Higher Education Town, Suzhou, 215123, China
| | - Zeng-Ning Li
- Department of Nutrition, First Hospital of Hebei Medical University, Shijiazhuang, 050031, China
| | - Irma Silva-Zolezzi
- Nutrition and Health Research, Nestlé Research Center, Lausanne, Switzerland
| | | | - Yi Wang
- Nestlé Research Center, Beijing, 100095, China.
| | - Li-Qiang Qin
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, 199 Renai Road, Dushu Lake Higher Education Town, Suzhou, 215123, China.
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Sharma D, Shastri S, Sharma P. Intrauterine Growth Restriction: Antenatal and Postnatal Aspects. Clin Med Insights Pediatr 2016; 10:67-83. [PMID: 27441006 PMCID: PMC4946587 DOI: 10.4137/cmped.s40070] [Citation(s) in RCA: 437] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/07/2016] [Accepted: 06/13/2016] [Indexed: 12/14/2022] Open
Abstract
Intrauterine growth restriction (IUGR), a condition that occurs due to various reasons, is an important cause of fetal and neonatal morbidity and mortality. It has been defined as a rate of fetal growth that is less than normal in light of the growth potential of that specific infant. Usually, IUGR and small for gestational age (SGA) are used interchangeably in literature, even though there exist minute differences between them. SGA has been defined as having birth weight less than two standard deviations below the mean or less than the 10th percentile of a population-specific birth weight for specific gestational age. These infants have many acute neonatal problems that include perinatal asphyxia, hypothermia, hypoglycemia, and polycythemia. The likely long-term complications that are prone to develop when IUGR infants grow up includes growth retardation, major and subtle neurodevelopmental handicaps, and developmental origin of health and disease. In this review, we have covered various antenatal and postnatal aspects of IUGR.
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Affiliation(s)
- Deepak Sharma
- Department of Neonatology, NEOCLINIC, TN Mishra Marg, Everest Vihar, Nirman Nagar, Jaipur, Rajasthan, India
| | - Sweta Shastri
- Department of Pathology, N.K.P Salve Medical College, Nagpur, Maharashtra, India
| | - Pradeep Sharma
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Jaipur, Rajasthan, India
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Horan MK, Donnelly JM, McGowan CA, Gibney ER, McAuliffe FM. The association between maternal nutrition and lifestyle during pregnancy and 2-year-old offspring adiposity: analysis from the ROLO study. JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2016; 24:427-436. [PMID: 27695668 PMCID: PMC5025498 DOI: 10.1007/s10389-016-0740-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/25/2016] [Indexed: 11/26/2022]
Abstract
Aim To examine the association between maternal nutrition and lifestyle factors and offspring adiposity, using baseline and 2-year postpartum follow-up data from a randomised control trial of low glycaemic index diet. Subject and methods Food diaries and lifestyle questionnaires were completed during pregnancy and infant feeding and maternal lifestyle questionnaires 2 years postpartum for 281 mother and infant pairs from the ROLO study. Maternal anthropometry was measured throughout pregnancy and infant and maternal anthropometry was measured 2 years postpartum. Results Maternal 2 year postpartum body mass index (BMI) was positively associated with offspring BMI-for-age z-score (B = 0.105, p = 0.015). Trimester 2 saturated fat intake was positively associated with offspring subscapular:triceps skinfold ratio (B = 0.018, p = 0.001). Trimester 1 glycaemic index was also positively associated with offspring sum of subscapular and triceps skinfolds (B = 0.009, p = 0.029). Conclusions Maternal BMI 2 years postpartum was positively associated with offspring BMI. Pregnancy saturated fat intake was positively and polyunsaturated fat negatively associated with offspring adiposity. While further research is necessary, pregnancy and the postpartum period may be early opportunities to combat childhood obesity. Electronic supplementary material The online version of this article (doi:10.1007/s10389-016-0740-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mary K. Horan
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Jean M. Donnelly
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Ciara A. McGowan
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Eileen R. Gibney
- Science Centre – South, University College Dublin School Of Agriculture & Food Science, Belfield, Dublin 4 Ireland
| | - Fionnuala M. McAuliffe
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
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Ahmad NN, Butsch WS, Aidarous S. Clinical Management of Obesity in Women: Addressing a Lifecycle of Risk. Obstet Gynecol Clin North Am 2016; 43:201-30. [PMID: 27212089 DOI: 10.1016/j.ogc.2016.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The World Health Organization estimates that nearly 2 billion people worldwide are overweight, 600 million of whom are obese. The increasing prevalence of this condition in women is of particular concern given its impact on reproductive health and mortality. Burgeoning data implicating maternal obesity in fetal programming and the metabolic health of future generations further suggest that obesity in women is one of the most pressing public health concerns of the twenty-first century. However, health care professionals are infrequently engaged in obesity management. This article provides a conceptual understanding of obesity and a rational approach to treatment.
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Affiliation(s)
- Nadia N Ahmad
- Obesity Medicine Institute, Armada Towers, P2, Floor 19, Jumeirah Lake Towers, Dubai, United Arab Emirates; Armada Medical Center, Internal Medicine, Armada Towers, P2, Floor 19, Jumeirah Lake Towers, Dubai, United Arab Emirates.
| | - Winfield Scott Butsch
- MGH Weight Center, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, USA
| | - Sabina Aidarous
- Obesity Medicine Institute, Armada Towers, P2, Floor 19, Jumeirah Lake Towers, Dubai, United Arab Emirates
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Maternal Nutrition and Glycaemic Index during Pregnancy Impacts on Offspring Adiposity at 6 Months of Age--Analysis from the ROLO Randomised Controlled Trial. Nutrients 2016; 8:nu8010007. [PMID: 26742066 PMCID: PMC4728621 DOI: 10.3390/nu8010007] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/04/2015] [Accepted: 12/09/2015] [Indexed: 01/15/2023] Open
Abstract
Childhood obesity is associated with increased risk of adult obesity and metabolic disease. Diet and lifestyle in pregnancy influence fetal programming; however the influence of specific dietary components, including low glycaemic index (GI), remains complex. We examined the effect of a maternal low GI dietary intervention on offspring adiposity at 6 months and explored the association between diet and lifestyle factors in pregnancy and infant body composition at 6 months. 280 6-month old infant and mother pairs from the control (n = 142) and intervention group (n = 138), who received low GI dietary advice in pregnancy, in the ROLO study were analysed. Questionnaires (food diaries and lifestyle) were completed during pregnancy, followed by maternal lifestyle and infant feeding questionnaires at 6 months postpartum. Maternal anthropometry was measured throughout pregnancy and at 6 months post-delivery, along with infant anthropometry. No difference was found in 6 months infant adiposity between control and intervention groups. Maternal trimester three GI, trimester two saturated fats and trimester one and three sodium intake were positively associated with offspring adiposity, while trimester two and three vitamin C intake was negatively associated. In conclusion associations were observed between maternal dietary intake and GI during pregnancy and offspring adiposity at 6 months of age.
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40
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Markovic TP, Muirhead R, Overs S, Ross GP, Louie JCY, Kizirian N, Denyer G, Petocz P, Hyett J, Brand-Miller JC. Randomized Controlled Trial Investigating the Effects of a Low-Glycemic Index Diet on Pregnancy Outcomes in Women at High Risk of Gestational Diabetes Mellitus: The GI Baby 3 Study. Diabetes Care 2016; 39:31-8. [PMID: 26185283 DOI: 10.2337/dc15-0572] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/22/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Dietary interventions can improve pregnancy outcomes in women with gestational diabetes mellitus (GDM). We compared the effect of a low-glycemic index (GI) versus a conventional high-fiber (HF) diet on pregnancy outcomes, birth weight z score, and maternal metabolic profile in women at high risk of GDM. RESEARCH DESIGN AND METHODS One hundred thirty-nine women [mean (SD) age 34.7 (0.4) years and prepregnancy BMI 25.2 (0.5) kg/m(2)] were randomly assigned to a low-GI (LGI) diet (n = 72; target GI ∼50) or a high-fiber, moderate-GI (HF) diet (n = 67; target GI ∼60) at 14-20 weeks' gestation. Diet was assessed by 3-day food records and infant body composition by air-displacement plethysmography, and pregnancy outcomes were assessed from medical records. RESULTS The LGI group achieved a lower GI than the HF group [mean (SD) 50 (5) vs. 58 (5); P < 0.001]. There were no differences in glycosylated hemoglobin, fructosamine, or lipids at 36 weeks or differences in birth weight [LGI 3.4 (0.4) kg vs. HF 3.4 (0.5) kg; P = 0.514], birth weight z score [LGI 0.31 (0.90) vs. HF 0.24 (1.07); P = 0.697], ponderal index [LGI 2.71 (0.22) vs. HF 2.69 (0.23) kg/m(3); P = 0.672], birth weight centile [LGI 46.2 (25.4) vs. HF 41.8 (25.6); P = 0.330], % fat mass [LGI 10 (4) vs. HF 10 (4); P = 0.789], or incidence of GDM. CONCLUSIONS In intensively monitored women at risk for GDM, a low-GI diet and a healthy diet produce similar pregnancy outcomes.
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Affiliation(s)
- Tania P Markovic
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Ros Muirhead
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia School of Molecular Bioscience, The University of Sydney, Sydney, NSW, Australia
| | - Shannon Overs
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia School of Molecular Bioscience, The University of Sydney, Sydney, NSW, Australia
| | - Glynis P Ross
- Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Jimmy Chun Yu Louie
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia School of Molecular Bioscience, The University of Sydney, Sydney, NSW, Australia
| | - Nathalie Kizirian
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia School of Molecular Bioscience, The University of Sydney, Sydney, NSW, Australia
| | - Gareth Denyer
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia School of Molecular Bioscience, The University of Sydney, Sydney, NSW, Australia
| | - Peter Petocz
- Department of Statistics, Macquarie University, Sydney, NSW, Australia
| | - Jon Hyett
- RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Jennie C Brand-Miller
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia School of Molecular Bioscience, The University of Sydney, Sydney, NSW, Australia
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Barton SJ, Mosquera M, Cleal JK, Fuller AS, Crozier SR, Cooper C, Inskip HM, Holloway JW, Lewis RM, Godfrey KM. Relation of FTO gene variants to fetal growth trajectories: Findings from the Southampton Women's survey. Placenta 2015; 38:100-6. [PMID: 26907388 PMCID: PMC4776702 DOI: 10.1016/j.placenta.2015.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/17/2015] [Accepted: 12/21/2015] [Indexed: 12/24/2022]
Abstract
Introduction Placental function is an important determinant of fetal growth, and fetal growth influences obesity risk in childhood and adult life. Here we investigated how FTO and MC4R gene variants linked with obesity relate to patterns of fetal growth and to placental FTO expression. Methods Southampton Women's Survey children (n = 1990) with measurements of fetal growth from 11 to 34 weeks gestation were genotyped for common gene variants in FTO (rs9939609, rs1421085) and MC4R (rs17782313). Linear mixed-effect models were used to analyse relations of gene variants with fetal growth. Results Fetuses with the rs9939609 A:A FTO genotype had faster biparietal diameter and head circumference growth velocities between 11 and 34 weeks gestation (by 0.012 (95% CI 0.005 to 0.019) and 0.008 (0.002–0.015) standard deviations per week, respectively) compared to fetuses with the T:T FTO genotype; abdominal circumference growth velocity did not differ between genotypes. FTO genotype was not associated with placental FTO expression, but higher placental FTO expression was independently associated with larger fetal size and higher placental ASCT2, EAAT2 and y + LAT2 amino acid transporter expression. Findings were similar for FTO rs1421085, and the MC4R gene variant was associated with the fetal growth velocity of head circumference. Discussion FTO gene variants are known to associate with obesity but this is the first time that the risk alleles and placental FTO expression have been linked with fetal growth trajectories. The lack of an association between FTO genotype and placental FTO expression adds to emerging evidence of complex biology underlying the association between FTO genotype and obesity. Variants in the FTO gene are previously known to be associated with obesity. discovered novel associations between FTO variants and growth trajectory of fetal head measures. also found novel associations between placental FTO expression and fetal size.
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Affiliation(s)
- S J Barton
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
| | - M Mosquera
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; Department of Physiological Sciences, Faculty of Health, University of Valle, Cali, Colombia
| | - J K Cleal
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - A S Fuller
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - S R Crozier
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, OX1 2JD, UK
| | - H M Inskip
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - J W Holloway
- Human Genetics and Genomic Medicine, Human Development & Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - R M Lewis
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - K M Godfrey
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
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Patel N, Pasupathy D, Poston L. Determining the consequences of maternal obesity for offspring health. Exp Physiol 2015; 100:1421-8. [PMID: 26464224 DOI: 10.1113/ep085132] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/05/2015] [Indexed: 12/20/2022]
Abstract
NEW FINDINGS What is the topic of this review? Observational studies have highlighted the association of increasing maternal body mass index with offspring adiposity and the subsequent risk of cardiometabolic disorders in adulthood. The in utero environment has become a target for intervention in order to reduce the burden of obesity, despite the mechanistic pathways of this association remaining unclear. What advances does it highlight? This short review provides a critical appraisal of the recent literature, including biological pathways and strategies to address causal relationships. The global obesity epidemic has been causally linked to changes in diet and lifestyle. Observational data and animal studies have now highlighted associations between in utero environmental exposures and increased susceptibility to obesity and related cardiometabolic disorders in later life. Maternal body mass index has been reported to show an independent association with offspring adiposity from an early age and to play an important role in the predisposition to obesity and metabolic disease in later life. Thus, the in utero environment has been the focus of recent targeted interventions to improve public health. In this review, we summarize recent progress in this field, including the use of animal models to investigate mechanistic links between maternal obesity and offspring metabolic risk. We then assess the level of evidence and challenges in establishing causal inferences from present birth cohorts.
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Affiliation(s)
- Nashita Patel
- Division of Women's Health, Women's Health Academic Centre, Faculty of Life Sciences and Medicine, King's College London, St Thomas' Hospital, London, UK
| | - Dharmintra Pasupathy
- Division of Women's Health, Women's Health Academic Centre, Faculty of Life Sciences and Medicine, King's College London, St Thomas' Hospital, London, UK
| | - Lucilla Poston
- Division of Women's Health, Women's Health Academic Centre, Faculty of Life Sciences and Medicine, King's College London, St Thomas' Hospital, London, UK
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Poston L, Bell R, Croker H, Flynn AC, Godfrey KM, Goff L, Hayes L, Khazaezadeh N, Nelson SM, Oteng-Ntim E, Pasupathy D, Patel N, Robson SC, Sandall J, Sanders TAB, Sattar N, Seed PT, Wardle J, Whitworth MK, Briley AL. Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. Lancet Diabetes Endocrinol 2015; 3:767-77. [PMID: 26165396 DOI: 10.1016/s2213-8587(15)00227-2] [Citation(s) in RCA: 451] [Impact Index Per Article: 50.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Behavioural interventions might improve clinical outcomes in pregnant women who are obese. We aimed to investigate whether a complex intervention addressing diet and physical activity could reduce the incidence of gestational diabetes and large-for-gestational-age infants. METHODS The UK Pregnancies Better Eating and Activity Trial (UPBEAT) is a randomised controlled trial done at antenatal clinics in eight hospitals in multi-ethnic, inner-city locations in the UK. We recruited pregnant women (15-18 weeks plus 6 days of gestation) older than 16 years who were obese (BMI ≥30 kg/m(2)). We randomly assigned participants to either a behavioural intervention or standard antenatal care with an internet-based, computer-generated, randomisation procedure, minimising by age, ethnic origin, centre, BMI, and parity. The intervention was delivered once a week through eight health trainer-led sessions. Primary outcomes were gestational diabetes (diagnosed with an oral glucose tolerance test and by criteria from the International Association of Diabetes in Pregnancy Study Groups) and large-for-gestational-age infants (≥90th customised birthweight centile). Analysis was by intention to treat. This trial is registered with Current Controlled Trials, ISCRTN89971375. Recruitment and pregnancy outcomes are complete but childhood follow-up is ongoing. FINDINGS Between March 31, 2009, and June 2, 2014, we assessed 8820 women for eligibility and recruited 1555, with a mean BMI of 36·3 kg/m(2) (SD 4·8). 772 were randomly assigned to standard antenatal care and 783 were allocated the behavioural intervention, of which 651 and 629 women, respectively, completed an oral glucose tolerance test. Gestational diabetes was reported in 172 (26%) women in the standard care group compared with 160 (25%) in the intervention group (risk ratio 0·96, 95% CI 0·79-1·16; p=0·68). 61 (8%) of 751 babies in the standard care group were large for gestational age compared with 71 (9%) of 761 in the intervention group (1·15, 0·83-1·59; p=0·40). Thus, the primary outcomes did not differ between groups, despite improvements in some maternal secondary outcomes in the intervention group, including reduced dietary glycaemic load, gestational weight gain, and maternal sum-of-skinfold thicknesses, and increased physical activity. Adverse events included neonatal death (two in the standard care group and three in the intervention group) and fetal death in utero (ten in the standard care group and six in the intervention group). No maternal deaths were reported. Incidence of miscarriage (2% in the standard care group vs 2% in the intervention group), major obstetric haemorrhage (1% vs 3%), and small-for-gestational-age infants (≤5th customised birthweight centile; 6% vs 5%) did not differ between groups. INTERPRETATION A behavioural intervention addressing diet and physical activity in women with obesity during pregnancy is not adequate to prevent gestational diabetes, or to reduce the incidence of large-for-gestational-age infants. FUNDING National Institute for Health Research, Guys and St Thomas' Charity, Chief Scientist Office Scotland, Tommy's Charity.
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Affiliation(s)
- Lucilla Poston
- Division of Women's Health, King's College London, St Thomas' Hospital, London, UK.
| | - Ruth Bell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Helen Croker
- Health Behaviour Research Centre, Institute of Epidemiology and Health, University College London, London, UK
| | - Angela C Flynn
- Division of Diabetes and Nutritional Sciences, King's College London, London, UK
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Louise Goff
- Division of Diabetes and Nutritional Sciences, King's College London, London, UK
| | - Louise Hayes
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Dharmintra Pasupathy
- Division of Women's Health, King's College London, St Thomas' Hospital, London, UK
| | - Nashita Patel
- Division of Women's Health, King's College London, St Thomas' Hospital, London, UK
| | - Stephen C Robson
- Institute of Cellular Medicine, Uterine Cell Signalling Group, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Jane Sandall
- Division of Women's Health, King's College London, St Thomas' Hospital, London, UK
| | - Thomas A B Sanders
- Division of Diabetes and Nutritional Sciences, King's College London, London, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Paul T Seed
- Division of Women's Health, King's College London, St Thomas' Hospital, London, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Institute of Epidemiology and Health, University College London, London, UK
| | - Melissa K Whitworth
- Maternity Services, Central Manchester University Hospitals NHS Foundation Trust, St Mary's Hospital, Manchester, UK
| | - Annette L Briley
- Division of Women's Health, King's College London, St Thomas' Hospital, London, UK
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Maternal obesity during pregnancy and cardiovascular development and disease in the offspring. Eur J Epidemiol 2015; 30:1141-52. [PMID: 26377700 PMCID: PMC4684830 DOI: 10.1007/s10654-015-0085-7] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/08/2015] [Indexed: 01/15/2023]
Abstract
Maternal obesity during pregnancy is an important public health problem in Western countries. Currently, obesity prevalence rates in pregnant women are estimated to be as high as 30 %. In addition, approximately 40 % of women gain an excessive amount of weight during pregnancy in Western countries. An accumulating body of evidence suggests a long-term impact of maternal obesity and excessive weight gain during pregnancy on adiposity, cardiovascular and metabolic related health outcomes in the offspring in fetal life, childhood and adulthood. In this review, we discuss results from recent studies, potential underlying mechanisms and challenges for future epidemiological studies.
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Isolauri E, Rautava S, Collado MC, Salminen S. Role of probiotics in reducing the risk of gestational diabetes. Diabetes Obes Metab 2015; 17:713-9. [PMID: 25885278 DOI: 10.1111/dom.12475] [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: 12/23/2014] [Revised: 04/12/2015] [Accepted: 04/13/2015] [Indexed: 12/11/2022]
Abstract
Overweight and obesity currently constitute a major threat to human well-being. Almost half of the female population are currently overweight. Pregnant overweight women are at risk of gestational diabetes affecting the health of the mother and the child, in both the short and long term. Notwithstanding the extensive scientific interest centred on the problem, research efforts have thus far been unable to devise preventive strategies. Recent scientific advances point to a gut microbiota dysbiosis, with ensuing low-grade inflammation as a contributing element, in obesity and its comorbidities. Such findings would suggest a role for specific probiotics in the search for preventive and therapeutic adjunct applications in gestational diabetes. The aim of the present paper was to critically review recent demonstrations of the role of intestinal microbes in immune and metabolic regulation, which could be exploited in nutritional management of pregnant women by probiotic bacteria. By modulating specific target functions, probiotic dietary intervention may exert clinical effects beyond the nutritional impact of food. As this approach in pregnancy is new, an overview of the role of gut microbiota in shaping host metabolism, together with the definition of probiotics are presented, and finally, specific targets and potential mechanisms for probiotics in pregnancy are discussed. Pregnancy appears to be the most critical stage for interventions aiming to reduce the risk of non-communicable disease in future generations, beyond the immediate dangers attributable to the health of the mother, labour and the neonate. Specific probiotic interventions during pregnancy provide an opportunity, therefore, to promote the health not only of the mother but also of the child.
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Affiliation(s)
- E Isolauri
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Department of Clinical Sciences, Faculty of Medicine, University of Turku, Turku, Finland
| | - S Rautava
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Department of Clinical Sciences, Faculty of Medicine, University of Turku, Turku, Finland
| | - M C Collado
- Instituto de Agroquímica y Tecnología de Alimentos (IATA-CSIC), Burjassot, Valencia, Spain
| | - S Salminen
- Functional Foods Forum, Faculty of Medicine, University of Turku, Turku, Finland
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