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Yu Y, Ma Q, Groth SW. Prepregnancy dieting and obstetrical and neonatal outcomes: Findings from a national surveillance project in the United States. Midwifery 2024; 132:103972. [PMID: 38493519 DOI: 10.1016/j.midw.2024.103972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024]
Abstract
PROBLEM AND BACKGROUND Women with overweight or obesity are recommended to lose weight before pregnancy. Dieting is one of the most used weight control strategies. However, the health implications of dieting before pregnancy remain unclear. AIM To evaluate the associations of dieting during the year before pregnancy with obstetrical and neonatal outcomes, including gestational weight gain (GWG), gestational diabetes, low birthweight, macrosomia, small-for-gestational-age infants (SGA), large-for-gestational-age infants (LGA), and preterm birth. METHODS This study analyzed data from the Pregnancy Risk Assessment Monitoring System (PRAMS), which is a surveillance project in the United States that collects data on maternal health before, during, and after pregnancy. Women who participated in PRAMS phase 7 with a prepregnancy body mass index ≥25 kg/m2 and a singleton birth were eligible. Statistical analyses included logistic regressions and post-hoc mediation analysis (Sobel Test). FINDINGS A total number of 51,399 women were included in the analysis. Women who self-reported prepregnancy dieting (42.8 %) had lower odds of SGA (adjusted odds ratio [aOR]: 0.87; 95 % CI: 0.79-0.97), and higher odds of excessive GWG vs adequate GWG (aOR: 1.42; 95 % CI: 1.32-1.52), gestational diabetes (aOR: 1.12; 95 % CI: 1.02-1.22), and LGA (aOR: 1.18; 95 % CI: 1.08-1.28). Furthermore, the association between prepregnancy dieting and LGA was mediated by excessive GWG (Sobel Test z-value = 5.72, p < 0.01). DISCUSSION AND CONCLUSION This analysis revealed that prepregnancy dieting was associated with several adverse consequences, including excessive GWG, gestational diabetes, and LGA infants. Findings contribute to an improved understanding of the perinatal implications of prepregnancy dieting.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Qianheng Ma
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd, Stanford, CA, 94305, USA
| | - Susan W Groth
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA
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Yu Y, Lyo V, Groth SW. The impact of maternal bariatric surgery on long-term health of offspring: a scoping review. Pediatr Res 2023; 94:1619-1630. [PMID: 37340100 DOI: 10.1038/s41390-023-02698-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/22/2023]
Abstract
While pregnancy post-bariatric surgery has become increasingly common, little is known about whether and how maternal bariatric surgery affects the next generation. This scoping review aimed to collate available evidence about the long-term health of offspring following maternal bariatric surgery. A literature search was conducted using three databases (PubMed, PsycINFO, EMBASE) to obtain relevant human and animal studies. A total of 26 studies were included: 17 were ancillary reports from five "primary" studies (three human, two animal studies) and the remaining nine were "independent" studies (eight human, one animal studies). The human studies adopted sibling-comparison, case-control, and single-group descriptive designs. Despite limited data and inconsistent results across studies, findings suggested that maternal bariatric surgery appeared to (1) modify epigenetics (especially genes involved in immune, glucose, and obesity regulation); (2) alter weight status (unclear direction of alteration); (3) impair cardiometabolic, immune, inflammatory, and appetite regulation markers (primarily based on animal studies); and (4) not affect the neurodevelopment in offspring. In conclusion, this review supports that maternal bariatric surgery has an effect on the health of offspring. However, the scarcity of studies and heterogenous findings highlight that more research is required to determine the scope and degree of such effects. IMPACT: There is evidence that bariatric surgery modifies epigenetics in offspring, especially genes involved in immune, glucose, and obesity regulation. Bariatric surgery appears to alter weight status in offspring, although the direction of alteration is unclear. There is preliminary evidence that bariatric surgery impairs offspring's cardiometabolic, immune, inflammatory, and appetite regulation markers. Therefore, extra care may be needed to ensure optimal growth in children born to mothers with previous bariatric surgery.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Victoria Lyo
- Department of Surgery, University of California Davis, Sacramento, CA, 95817, USA
- Center for Alimentary and Metabolic Science, University of California Davis, Sacramento, CA, 95817, USA
| | - Susan W Groth
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA
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Meng Y, Thornburg LL, Hoeger KM, Núñez ZR, Kautz A, Evans AT, Wang C, Miller RK, Groth SW, O’Connor TG, Barrett ES. Association between sex steroid hormones and subsequent hyperglycemia during pregnancy. Front Endocrinol (Lausanne) 2023; 14:1213402. [PMID: 37766683 PMCID: PMC10520461 DOI: 10.3389/fendo.2023.1213402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/08/2023] [Indexed: 09/29/2023] Open
Abstract
Objective Sex steroid hormones may play a role in insulin resistance and glucose dysregulation. However, evidence regarding associations between early-pregnancy sex steroid hormones and hyperglycemia during pregnancy is limited. The primary objective of this study was to assess the relationships between first trimester sex steroid hormones and the subsequent development of hyperglycemia during pregnancy; with secondary evaluation of sex steroid hormones levels in mid-late pregnancy, concurrent with and subsequent to diagnosis of gestational diabetes. Methods Retrospective analysis of a prospective pregnancy cohort study was conducted. Medically low-risk participants with no known major endocrine disorders were recruited in the first trimester of pregnancy (n=319). Sex steroid hormones in each trimester, including total testosterone, free testosterone, estrone, estradiol, and estriol, were assessed using high-performance liquid chromatography and tandem mass spectrometry. Glucose levels of the 1-hour oral glucose tolerance test and gestational diabetes diagnosis were abstracted from medical records. Multivariable linear regression models were fitted to assess the associations of individual first trimester sex steroids and glucose levels. Results In adjusted models, first trimester total testosterone (β=5.24, 95% CI: 0.01, 10.46, p=0.05) and free testosterone (β=5.98, 95% CI: 0.97, 10.98, p=0.02) were positively associated with subsequent glucose concentrations and gestational diabetes diagnosis (total testosterone: OR=3.63, 95% CI: 1.50, 8.78; free testosterone: OR=3.69; 95% CI: 1.56, 8.73). First trimester estrone was also positively associated with gestational diabetes (OR=3.66, 95% CI: 1.56, 8.55). In mid-late pregnancy, pregnant people with gestational diabetes had lower total testosterone levels (β=-0.19, 95% CI: -0.36, -0.02) after adjustment for first trimester total testosterone. Conclusion Early-pregnancy sex steroid hormones, including total testosterone, free testosterone, and estrone, were positively associated with glucose levels and gestational diabetes in mid-late pregnancy. These hormones may serve as early predictors of gestational diabetes in combination with other risk factors.
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Affiliation(s)
- Ying Meng
- School of Nursing, University of Rochester, Rochester, NY, United States
| | - Loralei L. Thornburg
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Kathleen M. Hoeger
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Zorimar Rivera- Núñez
- Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, United States
| | - Amber Kautz
- Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Adam T. Evans
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Christina Wang
- Division of Endocrinology, Department of Medicine and Clinical and Translational Science Institue, The Lundquist Institute at Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, United States
| | - Richard K. Miller
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Susan W. Groth
- School of Nursing, University of Rochester, Rochester, NY, United States
| | - Thomas G. O’Connor
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
- Department of Psychiatry, University of Rochester, Rochester, NY, United States
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, United States
- Wynne Center for Family Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Emily S. Barrett
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
- Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, United States
- Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
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Yu Y, Groth SW. Use of Continuous Glucose Monitoring in Patients Following Bariatric Surgery: A Scoping Review. Obes Surg 2023; 33:2573-2582. [PMID: 37410260 DOI: 10.1007/s11695-023-06704-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/19/2023] [Accepted: 06/23/2023] [Indexed: 07/07/2023]
Abstract
The objective of this scoping review was to summarize the emerging literature on the use of continuous glucose monitoring (CGM) in post-bariatric surgery patients, with a focus on its features (e.g., device, mode, and accuracy), as well as purposes and outcomes of utilization. Three databases (PubMed, EMBASE, and Web of Science) were searched to obtain relevant studies. Results suggested that most studies used CGM for 3-7 days under blinded mode. Accuracy data were available in only one study, which reported a mean absolute relative difference of 21.7% for Freestyle Libre. The primary applications of CGM were for elucidating glucose patterns and assessing glycemic treatment outcomes. No study has tested the effect of CGM as an intervention strategy to enhance glucose control.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Susan W Groth
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA
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Yu Y, Groth SW. Risk factors of lower birth weight, small-for-gestational-age infants, and preterm birth in pregnancies following bariatric surgery: a scoping review. Arch Gynecol Obstet 2023; 307:343-378. [PMID: 35332360 DOI: 10.1007/s00404-022-06480-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/17/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Bariatric surgery increases the risk of lower birth weight, small-for-gestational-age (SGA) infants, and preterm birth in a subsequent pregnancy. However, the factors that contribute to these adverse birth outcomes are unclear. This review aimed to collate available information about risk factors of lower birth weight, SGA, and preterm birth following bariatric surgery. METHODS A literature search was conducted using five databases (PubMed, PsycINFO, EMBASE, Web of Science, and Cochrane Library) to obtain relevant studies. RESULTS A total number of 85 studies were included. Studies generally excluded surgery-to-conception interval, pregnancy complications, cigarette use, and maternal age as influencing factors of birth weight, SGA, or preterm birth. In contrast, most studies found that malabsorptive procedures, lower gestational weight gain, lower glucose levels, abdominal pain, and insufficient prenatal care were associated with an elevated risk of adverse birth outcomes. Findings were mixed regarding the effects of surgery-to-conception weight loss, pre-pregnancy body mass index, micronutrient deficiency, and lipid levels on birth outcomes. The examination of maternal microbiome profiles, placental function, alcohol use, and exercise was limited to one study; therefore, no conclusions could be made. CONCLUSION This review identified factors that appear to be associated (e.g., surgery type) or not associated (e.g., surgery-to-conception interval) with birth outcomes following bariatric surgery. The mixed findings and the limited number of studies on several variables (e.g., micronutrients, exercise) highlight the need for further investigation. Additionally, future studies may benefit from exploring interactions among risk factors and expanding to assess additional exposures such as maternal mental health.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Susan W Groth
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA
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Yu Y, Ma Q, Groth SW. Risk factors for preterm birth in pregnancies following bariatric surgery: an analysis of the Longitudinal Assessment of Bariatric Surgery-2. Surg Obes Relat Dis 2022; 18:1304-1312. [PMID: 35995663 PMCID: PMC9617754 DOI: 10.1016/j.soard.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/15/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bariatric surgery has been shown to increase the risk for preterm birth in a subsequent pregnancy. Determining factors that contribute to this heightened risk will inform the development of targeted interventions to improve birth outcomes postbariatric surgery. OBJECTIVES This study aimed to identify risk factors of preterm birth in pregnancies following bariatric surgery. Factors being considered were preoperative medical conditions and behaviors (e.g., obesity-associated co-morbidities, gastrointestinal symptoms, substance use), antenatal factors (e.g., prepregnancy body mass index, gestational weight gain), and surgery-specific factors (e.g., surgery type, surgery-to-conception interval). SETTING Bariatric surgery centers in the United States. METHODS This is a retrospective analysis of the Longitudinal Assessment of Bariatric Surgery-2. Participants were women who reported at least 1 singleton live birth during the 7-year postoperative period. Logistic regressions were used to identify risk factors of preterm birth, adjusting for covariates such as maternal age, race, and ethnicity. RESULTS Participants (n = 97) were mostly White (84.5%) and non-Hispanic (88.7%). At the time of surgery, the mean age was 29.4 ± 4.6 years, and the mean body mass index was 47.6 ± 6.3 kg/m2. The prevalence of preterm birth was 13.4%. Preoperative gastrointestinal symptoms significantly increased (odds ratio: 1.12; 95% confidence interval: 1.00-1.26), while unexpectedly, excessive versus adequate gestational weight gain (odds ratio: .12; 95% confidence interval: .02-1.00) decreased the odds of preterm birth following bariatric surgery. CONCLUSIONS This analysis identified potential risk and protective factors of preterm birth among pregnancies postbariatric surgery. However, given the small sample size, findings should be regarded as hypothesis-generating and merit further study.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, Rochester, New York.
| | - Qianheng Ma
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Susan W Groth
- School of Nursing, University of Rochester, Rochester, New York
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Yu Y, Ma Q, Groth SW. Association between maternal psychological factors and offspring executive function: analysis of African-American mother-child dyads. Pediatr Res 2022; 92:1051-1058. [PMID: 35505078 DOI: 10.1038/s41390-022-02084-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 03/30/2022] [Accepted: 04/07/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND Executive function (EF) develops throughout childhood and adolescence; however, little is known about whether and how early life factors are associated with EF during these two stages. This secondary analysis examined the associations between maternal psychological characteristics at 2 years after childbirth and offspring EF at 6 and 18 years. METHODS Data were from the 18-year New Mothers' Study in Memphis, TN. Women who self-identified as African-American were included (mother-child dyads: N = 414). Maternal psychological characteristics (e.g., depressive symptoms, self-esteem) were assessed using standardized questionnaires; offspring EF at 6 (i.e., working memory, response inhibition) and 18 years (e.g., working memory, sustained attention) were assessed using age-appropriate cognitive tasks. Statistical analyses included principal component analysis (PCA) and regression models. RESULTS PCA reduced the correlated psychological characteristics to two factors: emotionality (depressive symptoms, emotional instability) and psychological resources (self-esteem, mastery, active coping). After controlling for maternal IQ, maternal emotionality was associated with worse working memory and response inhibition (marginally significant) at 6 years. Maternal psychological resources were marginally associated with better working memory at 6 years. CONCLUSIONS Maternal psychological characteristics may be associated with later EF in offspring. Future studies are needed to replicate these findings and to explore potential mediators. IMPACT African-American mothers' depressive symptoms and emotional instability at 2 years after childbirth were associated with offspring executive function at 6 and 18 years. African-American mothers' psychological resources at 2 years after childbirth were marginally associated with offspring working memory at 6 years. Maternal IQ attenuated all of the associations observed between maternal psychological status and offspring executive function.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Qianheng Ma
- School of Public Health Sciences, The University of Chicago, 5841S Maryland Avenue, Chicago, IL, 60637, USA
| | - Susan W Groth
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA
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Murphy HR, Gu Y, Wu Q, Brunner J, Panisch LS, Best M, Arnold MS, Duberstein ZT, Putzig J, Carnahan J, Groth SW, Barrett ES, Qiu X, O'Connor TG. Prenatal diurnal cortisol: Normative patterns and associations with affective symptoms and stress. Psychoneuroendocrinology 2022; 143:105856. [PMID: 35797838 DOI: 10.1016/j.psyneuen.2022.105856] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
Abstract
The hypothalamic-pituitary-adrenal (HPA) axis in pregnancy has attracted considerable research attention, in part, because it may be a mechanism by which diverse prenatal exposures alter perinatal and child health outcomes. Symptoms of affective disturbance and stress are among the most-studied prenatal factors associated with HPA axis alterations, but there remains uncertainty about the nature of the association because of the limitations to, and variability in, data collection and analytic approaches. The current study capitalized on a prospective, longitudinal pregnancy cohort that examined salivary diurnal cortisol, collected at 5 time points across the day, at each trimester in a diverse sample of women. Detailed data on affective symptoms and major life events were collected at each trimester, as were data on health behaviors, medication, and socio-demographics. Results indicated modest stability of individual differences in diurnal cortisol across pregnancy, which was evident for diurnal slope (ICC = .20) and measures of total output (area under the curve, ICC = .25); substantial gestation-related increases in total cortisol output across pregnancy was also observed (p < .001). Adjusting for health behaviors, medication, and socio-demographic covariates, elevated levels of depressive symptoms and major life events were significantly (p < .05) associated with a higher morning awakening value and flatter diurnal slope, which was evident across all trimesters. In addition to the normative gestation-related changes in cortisol production, our results demonstrate selective but robust associations between psychological symptoms, stressors, and the HPA axis across gestation, and suggest both methodological and mechanistic strategies for future study.
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Affiliation(s)
- Hannah R Murphy
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA; Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA
| | - Yu Gu
- Biostatistics and Computational Biology, University of Rochester, 265 Crittenden Blvd., Box 630, Rochester, NY 14642, USA
| | - Qiuyi Wu
- Biostatistics and Computational Biology, University of Rochester, 265 Crittenden Blvd., Box 630, Rochester, NY 14642, USA
| | - Jessica Brunner
- Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA
| | - Lisa S Panisch
- Wayne State University School of Social Work, 5447 Woodward Ave., Detroit, MI 48202, USA
| | - Meghan Best
- Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA
| | - Molly S Arnold
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA; Psychology, University of Rochester, Meliora Hall, P.O. Box 270266, Rochester, NY 14627, USA
| | - Zoe T Duberstein
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA; Psychology, University of Rochester, Meliora Hall, P.O. Box 270266, Rochester, NY 14627, USA
| | - Jenelle Putzig
- Pediatrics Infectious Diseases, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA
| | - Jennifer Carnahan
- Pediatrics Infectious Diseases, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA
| | - Susan W Groth
- School of Nursing, University of Rochester, 255 Crittenden Blvd., Rochester, NY, USA
| | - Emily S Barrett
- Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA; Environmental and Occupational Health Sciences Institute, Rutgers University, 170 Frelinghuysen Rd., Piscataway, NJ 08854, USA
| | - Xing Qiu
- Biostatistics and Computational Biology, University of Rochester, 265 Crittenden Blvd., Box 630, Rochester, NY 14642, USA
| | - Thomas G O'Connor
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA; Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA; Psychology, University of Rochester, Meliora Hall, P.O. Box 270266, Rochester, NY 14627, USA; Neuroscience, University of Rochester, 601 Elmwood Avenue, Box 603, KMRB G.9602, Rochester, NY 14642, USA; Psychiatry, University of Rochester, 300 Crittenden Blvd., Rochester, NY 14642, USA.
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Yu Y, Ma Q, Groth SW. Desire to lose weight was associated with the adoption of weight control strategies but not healthier lifestyle behaviours among post-bariatric surgery patients: NHANES 2013-2018. Clin Obes 2022; 12:e12511. [PMID: 35170233 DOI: 10.1111/cob.12511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 01/07/2022] [Accepted: 01/30/2022] [Indexed: 12/01/2022]
Abstract
The desire to lose weight is presumably high among patients with severe obesity who have undergone bariatric surgery. The purpose of this study is to examine the associations of desire to lose weight with weight control strategies, depressive symptoms and lifestyle behaviours among post-bariatric surgery patients. Participants were adults who participated in the National Health and Nutrition Examination Survey (2013-2018) and self-identified a history of bariatric surgery. The desire to lose weight, weight control strategies, depressive symptoms, physical activity and sitting time were measured by self-report questionnaires. Dietary information was derived from 24-h dietary recalls. The correlates of the desire to lose weight were examined by logistic or linear regressions with appropriate weighting and variance estimation techniques, adjusting for covariates such as length of time post-surgery. Results showed that at a mean of 7.8 (standard deviation [SD] = 0.5) years post-surgery (N = 142), 88.6% of participants wanted to weigh less. The average total energy intake was 1747 (SD = 72) kcal/day with 36.2% (SD = 0.7%) of the energy from total fat; the median total moderate-intensity physical activity was 88.5 min/week; and the mean sitting time was 796.0 (SD = 47.0) min/day. The desire to lose weight was positively associated with the adoption of healthy weight control strategies (odds ratio 17.4, 95% confidence interval 3.5-87.0, p < .01). No other significant associations were observed. Findings highlight the need for studies to improve patients' lifestyle behaviours post-surgery (e.g., reduce fat intake, increase physical activity) and examine the correlates of desire to lose weight in larger samples.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, Rochester, New York, USA
| | - Qianheng Ma
- School of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | - Susan W Groth
- School of Nursing, University of Rochester, Rochester, New York, USA
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Yu Y, Kalarchian MA, Ma Q, Groth SW. Corrigendum to Eating Patterns and Unhealthy Weight Control Behaviors are Associated with Loss of Control Eating following Bariatric Surgery. Surg Obes Relat Dis 2022; 18:999. [DOI: 10.1016/j.soard.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
OBJECTIVE Binge eating, a core diagnostic symptom in binge eating disorder and bulimia nervosa, increases the risk of multiple physiological and psychiatric disorders. The neurotransmitter dopamine is involved in food craving, decision making, executive functioning, and impulsivity personality trait; all of which contribute to the development and maintenance of binge eating. The objective of this paper is to review the associations of dopamine levels/activities, dopamine regulator (e.g., dopamine transporter, degrading enzymes) levels/activities, and dopamine receptor availability/affinity with binge eating. METHODS A literature search was conducted in PubMed and PsycINFO to obtain human and animal studies published since 2010. RESULTS A total of 31 studies (25 human, six animal) were included. Among the human studies, there were 12 case-control studies, eight randomized controlled trials, and five cross-sectional studies. Studies used neuroimaging (e.g., positron emission tomography), genetic, and pharmacological (e.g., dopamine transporter inhibitor) techniques to describe or compare dopamine levels/activities, dopamine transporter levels/activities, dopamine degrading enzyme (e.g., catechol-O-methyltransferase) levels/activities, and dopamine receptor (e.g., D1, D2) availability/affinity among participants with and without binge eating. Most human and animal studies supported an altered dopaminergic state in binge eating (26/31, 83.9%); however, results were divergent regarding whether the altered state was hyperdopaminergic (9/26, 34.6%) or hypodopaminergic (17/26, 65.4%). The mixed findings may be partially explained by the variability in sample characteristics, study design, diagnosis criteria, and neuroimaging/genetic/pharmacological techniques used. However, it is possible that instead of being mutually exclusive, the hyperdopaminergic and hypodopaminergic state may co-exist, but in different stages of binge eating or in different individual genotypes. CONCLUSIONS For future studies to clarify the inconsistent findings, a homogenous sample that controls for confounders that may influence dopamine levels (e.g., psychiatric diseases) is preferable. Longitudinal studies are needed to evaluate whether the hyper- and hypo-dopaminergic states co-exist in different stages of binge eating or co-exist in individual phenotypes. Binge eating is characterized by eating a large amount of food in a short time and a feeling of difficulty to stop while eating. Binge eating is the defining symptom of binge eating disorder and bulimia nervosa, both of which are associated with serious health consequences. Studies have identified several psychological risk factors of binge eating, including a strong desire for food, impaired cognitive skills, and distinct personality traits (e.g., quick action without careful thinking). However, the physiological markers of binge eating remain unclear. Dopamine is a neurotransmitter that is heavily involved in feeding behavior, human motivation, cognitive ability, and personality. Therefore, dopamine is believed to play a critical role in binge eating. This review synthesized study findings related to the levels and activities of dopamine, dopamine regulators, and dopamine receptors in the context of binge eating. The primary finding is that most studies that used neuroimaging, genetic, or drug techniques found an altered dopaminergic state related to binge eating. However, the literature is inconsistent concerning the direction of the alteration. Considering the mixed findings and the limitations in study design, future studies, especially those that include repeated measurements, are needed to clarify the role of dopamine in binge eating.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Renee Miller
- Brain and Cognitive Sciences, University of Rochester, 303F Meliora Hall, Rochester, NY, 14627, USA
| | - Susan W Groth
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA
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Yu Y, Ma Q, Johnson JA, O'Malley WE, Sabbota A, Groth SW. Predictors of 30-day follow-up visit completion after primary bariatric surgery: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. Surg Obes Relat Dis 2021; 18:384-393. [PMID: 34974998 DOI: 10.1016/j.soard.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/01/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adherence to follow-up visits is often unsatisfactory after bariatric surgery. OBJECTIVES To identify predictors, including surgery type and preoperative demographics, body mass index (BMI), medical conditions, and smoking status, of 30-day follow-up visit completion. SETTING Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participating centers (2015-2018). METHODS Patients who underwent primary Roux-en-Y gastric bypass or sleeve gastrectomy were included in this analysis. Data were analyzed using weighted logistic regression. Subanalyses included stratification of the sample by sex and age (<45, 45-60, and >60 years). RESULTS Patients (n = 566,774) were predominantly female (79.6%), White (72.4%), non-Hispanic (77.9%), and middle-aged (44.5 ± 11.9 years), with a mean BMI of 45.3 ± 7.8 kg/m2. More than 95% of patients completed the 30-day visits. In the whole-sample analysis, older age (odds ratio [OR], 1.02) and the presence of non-insulin-dependent diabetes (OR, 1.04), hypertension (OR, 1.03), hyperlipidemia (OR, 1.10), obstructive sleep apnea (OR, 1.15), and gastroesophageal reflux disease (OR, 1.16) were positive predictors of the 30-day visit completion (Ps < .01). Conversely, sleeve gastrectomy procedure (OR, .86), Black race (OR, .87), Hispanic ethnicity (OR, .94), and the presence of insulin-dependent diabetes (OR, .96) and smoking (OR, .83) were negative predictors (Ps < .01). Several differences emerged in subanalyses. For example, in sex stratification, Hispanic ethnicity lost its significance in men. In age stratification, BMI and male sex emerged as positive predictors in the age groups of <45 and 45-60 years, respectively. CONCLUSION Although challenged by small effect sizes, this analysis identified subgroups at a higher risk of being lost to follow-up after bariatric surgery.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, Rochester, New York.
| | - Qianheng Ma
- School of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Joseph A Johnson
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - William E O'Malley
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Aaron Sabbota
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Susan W Groth
- School of Nursing, University of Rochester, Rochester, New York
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Groth SW, Meng Y, Yeh KL, Fernandez ID. Influence of Appetite and Perceived Ability to Control Cravings on Excessive Gestational Weight Gain. J Obstet Gynecol Neonatal Nurs 2021; 50:669-678. [PMID: 34474006 PMCID: PMC8594632 DOI: 10.1016/j.jogn.2021.08.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To explore whether appetite is associated with gestational weight gain (GWG) and to assess the effect of perceived ability to control cravings on excessive GWG. DESIGN Secondary data analysis. SETTING Rochester, New York, United States. PARTICIPANTS Women who were pregnant (N = 1,005) and participated in a randomized controlled trial to test the effect of electronically mediated interventions to prevent excessive GWG and postpartum weight retention. METHODS We used two questions to assess appetite and perceived ability to control cravings before 28 weeks gestation: "How would you describe your appetite now compared to times when you are not pregnant?" and "How sure are you that you will be able to avoid overeating when you have cravings?" We conducted logistic regression to assess the relationships between appetite, perceived ability to control cravings, and excessive GWG. RESULTS More than 47% of participants gained excessive weight during pregnancy. Approximately 62% of participants reported being hungrier, and more than 42% indicated that they were unsure they could avoid overeating with cravings. Participants who reported similar/less appetite than before pregnancy were less likely to gain excessive weight (p < .05). Participants who were sure they could control cravings were less likely to gain excessive weight (p = .02). CONCLUSION Our results show that appetite and perceived ability to control cravings may affect GWG. Additional research is needed to assess if interventions targeting appetite and craving control could limit GWG.
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Yu Y, Fernandez ID, Meng Y, Zhao W, Groth SW. Gut hormones, adipokines, and pro- and anti-inflammatory cytokines/markers in loss of control eating: A scoping review. Appetite 2021; 166:105442. [PMID: 34111480 PMCID: PMC10683926 DOI: 10.1016/j.appet.2021.105442] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 12/31/2022]
Abstract
Loss of control (LOC) eating is the defining feature of binge-eating disorder, and it has particular relevance for bariatric patients. The biomarkers of LOC eating are unclear; however, gut hormones (i.e., ghrelin, cholecystokinin [CCK], peptide YY [PYY], glucagon-like peptide 1 [GLP-1], and pancreatic polypeptide [PP]), adipokines (i.e., leptin, adiponectin), and pro- and anti-inflammatory cytokines/markers (e.g., high-sensitivity C-reactive protein [hsCRP]) are candidates due to their involvement in the psychophysiological mechanisms of LOC eating. This review aimed to synthesize research that has investigated these biomarkers with LOC eating. Because LOC eating is commonly examined within the context of binge-eating disorder, is sometimes used interchangeably with subclinical binge-eating, and is the latent construct underlying disinhibition, uncontrolled eating, and food addiction, these eating behaviors were included in the search. Only studies among individuals with overweight or obesity were included. Among the identified 31 studies, 2 studies directly examined LOC eating and 4 studies were conducted among bariatric patients. Most studies were case-control in design (n = 16) and comprised female-dominant (n = 13) or female-only (n = 13) samples. Studies generally excluded fasting total ghrelin, fasting CCK, fasting PYY, and fasting PP as correlates of the examined eating behaviors. However, there was evidence that the examined eating behaviors were associated with lower levels of fasting acyl ghrelin (the active form of ghrelin) and adiponectin, higher levels of leptin and hsCRP, and altered responses of postprandial ghrelin, CCK, and PYY. The use of GLP-1 analog was able to decrease binge-eating. In conclusion, this review identified potential biomarkers of LOC eating. Future studies would benefit from a direct focus on LOC eating (especially in the bariatric population), using longitudinal designs, exploring potential mediators and moderators, and increased inclusion of the male population.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - I Diana Fernandez
- School of Public Health, University of Rochester, 265 Crittenden Blvd, Rochester, NY, 14642, USA.
| | - Ying Meng
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Wenjuan Zhao
- Department of Oncology, Shanghai Medical College, Fudan University, 138 Yixueyuan Rd, Xuhui District, Shanghai, 200032, China.
| | - Susan W Groth
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
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Barrett ES, Groth SW, Preston EV, Kinkade C, James-Todd T. Endocrine-Disrupting Chemical Exposures in Pregnancy: a Sensitive Window for Later-Life Cardiometabolic Health in Women. CURR EPIDEMIOL REP 2021; 8:130-142. [PMID: 35291208 PMCID: PMC8920413 DOI: 10.1007/s40471-021-00272-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Purpose of Review
Pregnancy can be seen as a “stress test” with complications predicting later-life cardiovascular disease risk. Here, we review the growing epidemiological literature evaluating environmental endocrine-disrupting chemical (EDC) exposure in pregnancy in relation to two important cardiovascular disease risk factors, hypertensive disorders of pregnancy and maternal obesity.
Recent Findings
Overall, evidence of EDC-maternal cardiometabolic associations was mixed. The most consistent associations were observed for phenols and maternal obesity, as well as for perfluoroalkyl substances (PFASs) with hypertensive disorders. Research on polybrominated flame retardants and maternal cardiometabolic outcomes is limited, but suggestive.
Summary
Although numerous studies evaluated pregnancy outcomes, few evaluated the postpartum period or assessed chemical mixtures. Overall, there is a need to better understand whether pregnancy exposure to these chemicals could contribute to adverse cardiometabolic health outcomes in women, particularly given that cardiovascular disease is the leading cause of death in women.
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Affiliation(s)
- Emily S. Barrett
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 08854, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - Susan W. Groth
- University of Rochester School of Nursing, Rochester, NY 14642, USA
| | - Emma V. Preston
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, 665 Huntington Ave., Bldg. 1, 14th Floor, Boston, MA 02120, USA
| | - Carolyn Kinkade
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 08854, USA
| | - Tamarra James-Todd
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, 665 Huntington Ave., Bldg. 1, 14th Floor, Boston, MA 02120, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
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16
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Meng Y, Groth SW, Hodgkinson CA, Mariani TJ. Serotonin system genes contribute to the susceptibility to obesity in Black adolescents. Obes Sci Pract 2021; 7:441-449. [PMID: 34401202 PMCID: PMC8346375 DOI: 10.1002/osp4.511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The importance of the central and peripheral serotonin systems in regulating energy balance and obesity development has been highlighted in animal models. Yet, the role of both serotonin systems has not been systematically assessed in humans. The purpose of this study was to investigate the association of genes within both serotonin systems with obesity outcomes in black adolescents. METHODS African-American adolescents (n = 1052) whose mothers participated the Memphis New Mother's Study were assessed. In total, 110 polymorphisms mapped to 10 serotonin genes were examined for their associations with standardized body mass index (BMI-z) scores and waist circumferences using generalized estimating equation models. RESULTS Over 39% of adolescents were overweight or had obesity. Three single nucleotide polymorphisms (SNPs) within TPH2, HTR3B, and SLC6A4, were significantly associated with BMI-z scores (p < 1.7 × 10-3). Two SNPs in TPH2 were nominally associated with waist circumferences. One SNP in HTR2C was associated with BMI-z scores (p = 0.001) and waist circumferences (p = 0.005) only in girls. Tissue-specific expression indicates that three identified genes are predominantly expressed in the brain. CONCLUSION The central serotonin system may play a key role in obesity development in black adolescents. Future studies are warranted to explore additional serotonin system genes and their potential obesogenic mechanisms in humans.
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Affiliation(s)
- Ying Meng
- School of NursingUniversity of RochesterRochesterNew YorkUSA
| | - Susan W. Groth
- School of NursingUniversity of RochesterRochesterNew YorkUSA
| | - Colin A. Hodgkinson
- Lab of NeurogeneticsDivision of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and AlcoholismRockvilleMarylandUSA
| | - Thomas J. Mariani
- Department of PediatricsUniversity of Rochester Medical CenterRochesterNew YorkUSA
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Groth SW, Fernandez ID, Block RC, Thurston SW, Wong E, Brunner J, Mayo N, Kapula N, Yu Y, Meng Y, Yeh KL, Kinkade CW, Thornburg LL, O’Connor TG, Barrett ES. Biological changes in the pregnancy-postpartum period and subsequent cardiometabolic risk-UPSIDE MOMS: A research protocol. Res Nurs Health 2021; 44:608-619. [PMID: 33993510 PMCID: PMC8378197 DOI: 10.1002/nur.22141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/05/2021] [Accepted: 05/02/2021] [Indexed: 01/21/2023]
Abstract
Multiple physiological changes occur in pregnancy as a woman's body adapts to support the growing fetus. These pregnancy-induced changes are essential for fetal growth, but the extent to which they reverse after pregnancy remains in question. For some women, physiological changes persist after pregnancy and may increase long-term cardiometabolic disease risk. The National Institutes of Health-funded study described in this protocol addresses a scientific gap by characterizing weight and biological changes during pregnancy and an extended postpartum period in relation to cardiometabolic risk. We use a longitudinal repeated measures design to prospectively examine maternal health from early pregnancy until 3 years postpartum. The aims are: (1) identify maternal weight profiles in the pregnancy-postpartum period that predict adverse cardiometabolic risk profiles three years postpartum; (2) describe immune, endocrine, and metabolic biomarker profiles in the pregnancy-postpartum period, and determine their associations with cardiometabolic risk; and (3) determine how modifiable postpartum health behaviors (diet, physical activity, breastfeeding, sleep, stress) (a) predict weight and cardiometabolic risk in the postpartum period; and (b) moderate associations between postpartum weight retention and downstream cardiometabolic risk. The proposed sample is 250 women. This study of mothers is conducted in conjunction with the Understanding Pregnancy Signals and Infant Development study, which examines child health outcomes. Biological and behavioral data are collected in each trimester and at 6, 12, 24, and 36 months postpartum. Findings will inform targeted health strategies that promote health and reduce cardiometabolic risk in childbearing women.
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Affiliation(s)
- Susan W Groth
- University of Rochester, School of Nursing, Rochester NY
| | - I Diana Fernandez
- University of Rochester School of Medicine and Dentistry, Department of Public Health Sciences
| | - Robert C Block
- University of Rochester, Departments of Public Health Sciences, Cardiology, and Medicine
| | - Sally W Thurston
- University of Rochester, Department of Biostatistics and Computational Biology
| | - Eunyoung Wong
- University of Rochester, School of Nursing, Rochester NY
| | - Jessica Brunner
- University of Rochester Medical Center, Department of Obstetrics and Gynecology
| | - Nicole Mayo
- University of Rochester School of Medicine and Dentistry, Department of Public Health Sciences
| | - Ntemena Kapula
- University of Rochester Medical Center, Department of Obstetrics and Gynecology
| | - Yang Yu
- University of Rochester, School of Nursing, Rochester NY
| | - Ying Meng
- University of Rochester, School of Nursing, Rochester NY
| | - Kuan-Lin Yeh
- University of Rochester, School of Nursing, Rochester NY
| | - Carolyn W Kinkade
- Rutgers University, Exposure Science and Epidemiology, Environmental and Occupational Health Sciences Institute
| | - Loralei L Thornburg
- University of Rochester Medical Center, Department of Obstetrics and Gynecology
| | - Thomas G O’Connor
- University of Rochester, Departments of Psychiatry, Psychology, Neuroscience, Obstetrics and Gynecology, and Wynne Center for Family Research
| | - Emily S Barrett
- University of Rochester Medical Center, Department of Obstetrics and Gynecology
- Rutgers University, Exposure Science and Epidemiology, Environmental and Occupational Health Sciences Institute
- Rutgers School of Public Health, Biostatistics and Epidemiology
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18
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Kautz A, Meng Y, Barrett ES, Brunner J, Miller R, Groth SW, O'Connor TG. Associations of Tryptophan, Docosahexaenoic Acid (DHA), and Vitamin D With Sleep Quality and Depression During Pregnancy. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab046_063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
During pregnancy women are at increased risk of poor sleep quality and depression. Serotonin and melatonin are compounds that are involved in regulation of sleep and mood. Several nutrients are involved in the synthesis of these compounds, including tryptophan, docosahexaenoic acid (DHA), and vitamin D. Studies exploring associations between these nutrients and sleep, as well as mood, have been largely limited to the general population, showing mixed results. The aim of this study was to assess the associations of dietary intake of these nutrients with sleep quality and depression in pregnant women.
Methods
Participants enrolled in the Understanding Pregnancy Signals and Infant Development (UPSIDE) Study (n = 253) were included in this analysis if they completed dietary, sleep and depression assessments during the 2nd trimester. Dietary and supplement intake were measured using 24-hour dietary recalls. The NCI method was used to estimate usual intake. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI). Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale (EPDS). Multivariable linear regression was conducted to estimate the associations between nutrients and sleep/depression, adjusting for age, race/ethnicity, parity, education, early pregnancy body mass index, smoking status, energy and macronutrient intake.
Results
The NCI adjusted mean intakes of tryptophan, DHA, and vitamin D were 1.02 ± 0.11 g/day, 0.13 ± 0.11g/day, and 19.74 ± 21.80 mcg/day, respectively. Mean PSQI score was 6.15 ± 3.39, where higher scores indicated worse sleep quality, and mean EPDS score was 5.84 ± 4.77, where higher scores indicated increased severity of depressive symptoms. Tryptophan intake was inversely associated with EPDS scores (b = −15.23, 95%CI: −26.75, −3.72). The associations between DHA, vitamin D, and depression were not significant. The selected nutrients were not associated with PSQI scores.
Conclusions
In this study, higher tryptophan intake was associated with lower depressive symptoms among pregnant women during the second trimester. Additional research on the relationship between tryptophan intake and maternal mental health during pregnancy is warranted.
Funding Sources
NIH, Mae Stone Goode Foundation, Wynne Family Foundation.
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Affiliation(s)
- Amber Kautz
- University of Rochester School of Medicine and Dentistry
| | - Ying Meng
- University of Rochester School of Nursing
| | | | | | - Richard Miller
- University of Rochester School of Medicine and Dentistry
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19
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Yu Y, Ma Q, Fernandez ID, Groth SW. Mental Health, Behavior Change Skills, and Eating Behaviors in Postpartum Women. West J Nurs Res 2021; 44:932-945. [PMID: 34088249 DOI: 10.1177/01939459211021625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Excessive postpartum weight retention conveys risks for future metabolic diseases. Eating behaviors influence postpartum weight retention; however, the modifiable predictors of eating behaviors remain unclear. Using data from a three-arm, randomized controlled trial, the purpose of this study was to examine the longitudinal associations of mental health (e.g., depressive symptoms) and behavior change skills (e.g., self-efficacy) with eating behaviors (i.e., compensatory restraint, routine restraint, emotional eating, and external eating) among women (N = 424) over 18-months postpartum. Results revealed that depressive symptoms, perceived stress, healthy eating self-efficacy, overeating self-efficacy, self-weighing, and problem-solving confidence were associated with one or more of the examined eating behaviors. Furthermore, depressive symptoms moderated the association between healthy eating self-efficacy and routine restraint. Perceived stress moderated the associations between healthy eating/overeating self-efficacy and emotional eating. The findings suggest that mental health and behavior change skills may serve as targets for interventions designed to improve postpartum women's eating behaviors.Clinical trials registry:ClinicalTrials.gov #NCT01331564.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Qianheng Ma
- School of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | | | - Susan W Groth
- School of Nursing, University of Rochester, Rochester, NY, USA
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20
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Yu Y, Kalarchian MA, Ma Q, Groth SW. Eating patterns and unhealthy weight control behaviors are associated with loss-of-control eating following bariatric surgery. Surg Obes Relat Dis 2021; 17:976-985. [PMID: 33619009 DOI: 10.1016/j.soard.2021.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/27/2020] [Accepted: 01/11/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Loss-of-control (LOC) eating is associated with poor weight-loss outcomes following bariatric surgery. It is not clear whether eating patterns (e.g., total number of daily meals/snacks, eating after suppertime, eating when not hungry) and unhealthy weight control behaviors (e.g., smoking, using laxatives) are associated with or predictive of LOC eating. OBJECTIVES To examine whether eating patterns and unhealthy weight-control behaviors are associated with LOC eating and, if so, whether they predict LOC eating in bariatric patients. SETTING Multicenter study, United States. METHODS This is a secondary analysis of the Longitudinal Assessment of Bariatric Surgery-2 study. Assessments were conducted before surgery and at 12, 24, 36, 48, 60, and 84 months after surgery. Logistic mixed models were used to examine the longitudinal associations between eating patterns, unhealthy weight-control behaviors, and LOC eating. Time-lag techniques were applied to examine whether the associated patterns and behaviors predict LOC eating. RESULTS The participants (n = 1477) were mostly women (80%), white (86.9%), and married (62.5%). At the time of surgery, the mean age was 45.4 ± 11.0 years and the mean body mass index was 47.8 ± 7.5 kg/m2. The total number of daily meals/snacks, food intake after suppertime, eating when not hungry, eating when feeling full, and use of any unhealthy weight-control behaviors were positively associated with LOC eating (P < .05). Food intake after suppertime, eating when not hungry, and eating when feeling full predicted LOC eating (P < .05). CONCLUSION Meal patterns and unhealthy weight control behaviors may be important intervention targets for addressing LOC eating after bariatric surgery.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, Rochester, New York.
| | | | - Qianheng Ma
- School of Public Health Sciences, The University of Chicago, Chicago, Illinois
| | - Susan W Groth
- School of Nursing, University of Rochester, Rochester, New York
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21
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Affiliation(s)
- Susan W. Groth
- University of Rochester School of Nursing, Rochester, New York
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22
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Rhee H, Love T, Groth SW, Grape A, Tumiel-Berhalter L, Harrington D. Associations between overweight and obesity and asthma outcomes in urban adolescents. J Asthma 2019; 57:1053-1062. [PMID: 31204534 DOI: 10.1080/02770903.2019.1633663] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective: To examine the prevalence of overweight and obesity in urban adolescents with asthma and to investigate the relationships between anthropometric measures and asthma outcomes including quality of life, asthma control and lung function.Methods: Adolescents with an asthma diagnosis, 12-20 years-old, were recruited from three urban communities in the United States. Spirometry and anthropometric data including height, weight and waist circumferences were collected along with questionnaire data measuring quality of life, asthma control, and medication adherence. Body mass index (BMI) and waist-height ratio (WHtR) were computed.Results: The sample (N = 294) included 48% female and 80% African American. About 50% of the sample were either overweight or obese, and 41% had central obesity. No significant gender interactions with either BMI or WHtR on asthma outcomes were found. Neither BMI nor WHtR predicted quality of life, asthma control or medication adherence, while females had poorer quality of life and asthma control regardless of weight status (p < 0.001). Higher BMI or WHtR predicted higher spirometry values. Regardless of weight status, females had greater percent predicted spirometry values, while raw values (L) were significantly greater in males.Conclusions: High BMI is a common comorbidity among poor, primarily African American, urban adolescents with asthma. The negative impact of being overweight or obese on quality of life or asthma control is yet to be manifested in adolescents. The findings underscore adolescence as an ideal period to safely intervene to reduce excessive body weight, which can prevent the potentially harmful effects of obesity on future asthma outcomes.
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Affiliation(s)
- Hyekyun Rhee
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Tanzy Love
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Susan W Groth
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Annette Grape
- School of Social Work, The College at Brockport, Brockport, NY, USA
| | - Laurene Tumiel-Berhalter
- Department of Family Medicine, School of Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - Donald Harrington
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
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Steinl GK, Whisner CM, Pressman EK, Cooper EM, Groth SW, O'Brien KO. Patterns and Correlates of Self-Reported Physical Activity in a Cohort of Racially Diverse Pregnant Adolescents. J Pediatr Adolesc Gynecol 2019; 32:51-56. [PMID: 30223025 DOI: 10.1016/j.jpag.2018.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/08/2018] [Accepted: 09/08/2018] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE Regular physical activity (PA) during pregnancy decreases the risk of gestational hypertension and preeclampsia. Currently, little is known about the PA of pregnant adolescents. Our intent was to characterize the PA behaviors of a group of racially diverse, low-income pregnant teens and to identify potential determinants of PA. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS A cohort of 157 racially diverse pregnant adolescents (13-18 years of age) completed up to 3 previous day PA recalls as part of a larger prospective longitudinal study on determinants of maternal and fetal bone health. Subjects self-reported activities from 7 AM to 11:30 PM, choosing from a list of 37 activities including a category for "other." Subjects recorded activities in 30-minute intervals. MAIN OUTCOME MEASURES Estimated metabolic equivalent task (MET) values were assigned to each activity and summed for a measure of total daily PA in MET min/d. Determinants of PA were evaluated using a stepwise linear mixed effect model. RESULTS The average calculated MET min/d was 1478 ± 130. Significant determinants of MET min/d included race (P = .007), maternal age at conception (P = .042), gestational age (P = .002), and attending school (P < .001). Black teens were less physically active than white teens, and older teens were more active than younger teens; activity decreased throughout gestation, and teens currently attending school were more active. CONCLUSION PA is low across gestation and pregnant teens spent more than half of their monitored time in sedentary activities. Targeted interventions are needed to achieve current PA goals in this pediatric obstetric population.
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Affiliation(s)
| | - Corrie M Whisner
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona
| | - Eva K Pressman
- School of Medicine, University of Rochester, Rochester, New York
| | | | - Susan W Groth
- School of Medicine, University of Rochester, Rochester, New York
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Abstract
OBJECTIVE To examine low birthweight and preterm birth of second children born to home-visited first-time mothers. SUBJECTS Women were previously recruited for a randomized controlled trial of the home visiting model disseminated as Nurse-Family Partnership. 512 of these women had second children within 18 years of the first child's birth, and were included in our sample. RESULTS The intervention was associated with a lower likelihood of low birthweight for second children (odds ratio: 0.51, 95% CI: 0.27, 0.97), an effect apparent only if the first-born had low birthweight and mediated by close birth spacing. These moderation and mediation patterns were similar in the preterm birth outcome. CONCLUSION A home visiting program provided for first-born children reduced low birthweight for second-born children, if the first-born had low birthweight. This finding implies a broader impact than previously documented, because few studies have included these second children.
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Affiliation(s)
- Margaret L. Holland
- Yale School of Nursing, 400 West Campus Drive, Orange, CT 06518, USA, 203-737-4929,
| | - Susan W. Groth
- University of Rochester, School of Nursing, 255 Crittenden Ave, Rochester, NY 14642, USA, 585-275-8895,
| | - Joyce A. Smith
- University of Rochester, School of Nursing, 255 Crittenden Ave, Rochester, NY 14642, USA, 585-275-3405,
| | - Ying Meng
- University of Rochester, School of Nursing, 255 Crittenden Ave, Rochester, NY 14642, USA,
| | - Harriet Kitzman
- University of Rochester, School of Nursing, 255 Crittenden Ave, Rochester, NY 14642, USA, 585-275-8874,
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Olson CM, Groth SW, Graham ML, Reschke JE, Strawderman MS, Fernandez ID. The effectiveness of an online intervention in preventing excessive gestational weight gain: the e-moms roc randomized controlled trial. BMC Pregnancy Childbirth 2018; 18:148. [PMID: 29743026 PMCID: PMC5944067 DOI: 10.1186/s12884-018-1767-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 04/24/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Excessive gestational weight gain (GWG) is common and contributes to the development of obesity in women and their offspring. Electronic or e-health interventions have the potential to reach large groups of women and prevent excessive GWG, but their effectiveness has not been demonstrated. The purpose of this study was to evaluate, in a real-world setting, the effectiveness of a self-directed, integrated online and mobile phone behavioral intervention in preventing excessive GWG. METHODS This effectiveness trial was a double-blind, three-arm trial with a parallel group design. Two arms received the same e-health intervention during pregnancy with the third arm serving as the placebo control. The intervention was based on a previously efficacious non-digital intervention that was adapted to electronic format. It included three behavior change tools: a weight gain tracker, and separate diet and physical activity goal-setting and self-monitoring tools. Both treatment conditions received access to informational tools, event reminders, and a blogging feature. Healthy pregnant women age 18-35 years with body mass indexes (BMI) ≥18.5 and < 35, at ≤20 weeks gestation, and an e-mail address were eligible. The proportion of women with excessive total GWG, as defined by the Institute of Medicine (IOM), was the primary outcome. 1689 randomized women were analyzed in the intent-to-treat (ITT) analysis. The study was designed to have 87% power to detect a 10 percentage point reduction from a control rate of 55% with a sample of 1641 (p = 0.0167, two-sided). RESULTS In the ITT sample, 48.1% (SD = 2.0%) gained excessively in the intervention group as did 46.2% (SD = 2.4%) in the placebo control group. These proportions were not significantly different (RR 1.09; 95% CI 0.98, 1.20, p = 0.12). The results were not altered in several sensitivity analyses. CONCLUSION The addition of three behavior change tools to an informational placebo control did not result in a difference in the proportion of women with excessive total GWG compared to the placebo control in this effectiveness trial of an online, self-directed intervention. The similarity of intervention and control treatments and low usage of the behavior change tools in the intervention group are possible explanations. TRIAL REGISTRATION NCT01331564 , ClinicalTrials.gov.
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Affiliation(s)
- Christine M Olson
- Division of Nutritional Sciences, 406 Savage Hall, Cornell University, Ithaca, NY, 14853, USA.
| | - Susan W Groth
- School of Nursing, University of Rochester, Box SON, 601 Elmwood Ave., Rochester, NY, 14642, USA
| | - Meredith L Graham
- Division of Nutritional Sciences, 352 MVR Hall, Cornell University, Ithaca, NY, 14853, USA
| | - Jennifer E Reschke
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd, CU420644, Rochester, NY, 14642, USA
| | - Myla S Strawderman
- Division of Nutritional Sciences, 352 MVR Hall, Cornell University, Ithaca, NY, 14853, USA
| | - Isabel Diana Fernandez
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd, CU420644, Rochester, NY, 14642, USA
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McKee KS, Seplaki C, Fisher S, Groth SW, Fernandez ID. Cumulative Physiologic Dysfunction and Pregnancy: Characterization and Association with Birth Outcomes. Matern Child Health J 2018; 21:147-155. [PMID: 27439420 DOI: 10.1007/s10995-016-2103-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective To characterize cumulative physiologic dysfunction (CPD) in pregnancy as a measure of the biological effects of chronic stress and to examine its associations with gestational age and birth weight. Methods Women ≤28 weeks gestation were enrolled from obstetric clinics in Rochester, NY and followed through their delivery. CPD parameters included total cholesterol, Interleukin 6 (IL-6), high sensitivity-C-reactive protein (hs-CRP), systolic and diastolic blood pressure, body mass index at <14 weeks gestation, glucose tolerance, and urinary albumin collected in the third trimester. Linear regression was used to estimate the association between physiologic dysfunction and birth weight and gestational age, respectively (N = 111). Results CPD scores ranged from 0 to 6, out of a total of 8 parameters (Mean 2.09; SD = 1.42). Three-fourths of the participants had a CPD score of 3.0 or lower. The mean birth weight was 3397 g (SD = 522.89), and the mean gestational age was 39.64 weeks (SD = 1.08). CPD was not significantly associated with either birth weight or gestational age (p = 0.42 and p = 0.44, respectively). Conclusion CPD measured at >28 weeks was not associated with birth weight or gestational age. Refinement of a CPD score for pregnancy is needed, taking into consideration both the component parameters and clinical and pre-clinical cut-points for risk scoring.
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Affiliation(s)
- Kimberly Schmitt McKee
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA. .,Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, USA.
| | - Christopher Seplaki
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA
| | - Susan Fisher
- Temple Clinical Research Institute, Department of Clinical Sciences, Temple University School of Medicine, Kresge Science Hall, Second Floor, 3440 N. Broad Street, Philadelphia, PA, 19140, USA.,Population Research, Fox Chase Cancer Center, Kresge Science Hall, Second Floor, 3440 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Susan W Groth
- School of Nursing, University of Rochester Medical Center, 255 Crittenden Blvd. Box SON, Rochester, NY, 14642, USA
| | - I Diana Fernandez
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA
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Abstract
Objective To determine the contribution of paternal factors to the risk of adverse birth outcomes. Methods This is a retrospective cross-sectional analysis using birth certificate data from 2004 to 2015 retrieved from the Finger Lakes Regional Perinatal Data System. Primiparous women with singleton pregnancies were analyzed in the study. Two multivariate logistic regression models were conducted to assess potential paternal risk factors including age, race/ethnicity, and education on four birth outcomes, including preterm birth (PTB), low birthweight (LBW), high birthweight (HBW), and small for gestational age (SGA). Results A total of 36,731 singleton births were included in the analysis. Less paternal education was significantly related to an elevated risk of PTB, LBW, and SGA, even after adjustment for maternal demographic, medical, and lifestyle factors (P < 0.05). Paternal race/ethnicity was also significantly associated with all four birth outcomes (P < 0.05) while controlling for maternal factors. Older paternal age was associated with increased odds (OR 1.012, 95% CI 1.003-1.022) of LBW. Maternal race/ethnicity partially mediated the association of paternal race/ethnicity with HBW and SGA. Maternal education partially mediated the relationship between paternal education and SGA. Conclusion Paternal factors were important predictors of adverse birth outcomes. Our results support the inclusion of fathers in future studies and clinical programs aimed at reducing adverse birth outcomes.
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Affiliation(s)
- Ying Meng
- Clinical and Translational Science Institute, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Susan W Groth
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA
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Groth SW, LaLonde A, Wu T, Fernandez ID. Obesity candidate genes, gestational weight gain, and body weight changes in pregnant women. Nutrition 2017; 48:61-66. [PMID: 29469022 DOI: 10.1016/j.nut.2017.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 10/17/2017] [Accepted: 11/01/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the associations of two obesity-associated genes, FTO (rs9939609) and GNB3 (rs5443) single nucleotide polymorphisms (SNPs), with early pregnancy body mass index, gestational weight gain, and postpartum weight retention. METHODS Secondary data analysis of self-identified white (n = 580) and black (n = 194) women who participated in a randomized controlled trial (2009-2014) and provided a saliva sample of DNA. Bivariate relationships were assessed using analysis of variance. Multiple regression models assessed the relationship between outcomes and gene SNPs, controlling for income, parity, and smoking status. RESULTS FTO and GNB3 gene associations with pregnancy weight were different by racial group and early pregnancy body mass index. Obese black women homozygote for the FTO risk allele (AA) had a higher gestational weight gain compared with non-risk homozygotes (TT) (P = 0.006). GNB3 non-risk CC homozygotes tended to have a lower gestational weight gain compared with heterozygotes (P = 0.05). White GNB3 C carriers tended to be heavier in early pregnancy (P <0.1) and GNB3 homozygote (TT) overweight women tended to have lower postpartum weight retention than C carriers. CONCLUSIONS The FTO gene and possibly the GNB3 gene are associated with high gestational weight gain in obese black women. Obese carriers of the FTO risk allele gained 4.1 kg (AT) and 7.6 kg (TT) more than those without risk alleles. Overweight GNB3 heterozygotes (CT) gained 6.6 kg less than homozygotes (CC). Overweight or obese black women who have either risk variant are at risk for high gestational weight gain.
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Affiliation(s)
- Susan W Groth
- University of Rochester School of Nursing, Rochester, NY, USA; Department of Public Health Sciences, University of Rochester, Rochester, NY, USA.
| | - Amy LaLonde
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Tongtong Wu
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - I Diana Fernandez
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
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Meng Y, Groth SW, Stewart P, Smith JA. An Exploration of the Determinants of Gestational Weight Gain in African American Women: Genetic Factors and Energy Expenditure. Biol Res Nurs 2017; 20:118-125. [PMID: 29161908 DOI: 10.1177/1099800417743326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Excessive gestational weight gain (GWG) has a long-term impact on women's body weight and contributes to the development of obesity in the mother and her child. Many risk factors for GWG have been identified, but to date, only 6-33.8% of the variance in GWG has been explained. The purpose of this study was to evaluate the overall variance of GWG that can be explained by including weight-adjusted resting metabolic rate (aRMR) and a genetic risk score constructed on obesity-related genes in addition to sociodemographic and lifestyle factors. METHODS In this observational study involving 55 African American women, data collected/measured during pregnancy included sociodemographic factors, medical information, lifestyle factors, aRMR, and seven obesity-related genes. Multivariable linear regression was performed to evaluate the variance in GWG explained by the potential risk factors listed above. RESULTS The mean GWG was 15 kg (±7.5 kg), and 63.6% of women gained more than the Institute of Medicine's GWG recommendations. The final regression model explained 53.3% of the variance in GWG. Higher genetic risk score, lower aRMR, and higher dietary intake of total energy and percentage of fat were significantly associated with increased GWG ( p < .05). These factors explained 18% additional variance in GWG over that explained by significant sociodemographic and lifestyle factors in the analysis (i.e., maternal age, prepregnancy body mass index, parity, illegal drug use, and education). CONCLUSION Overall, our results indicate that the genetic risk score, aRMR, and dietary intake have a substantial impact on GWG in African American women.
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Affiliation(s)
- Ying Meng
- 1 Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA.,2 School of Nursing, University of Rochester, Rochester, NY, USA
| | - Susan W Groth
- 2 School of Nursing, University of Rochester, Rochester, NY, USA
| | - Patricia Stewart
- 3 Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Joyce A Smith
- 2 School of Nursing, University of Rochester, Rochester, NY, USA
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Groth SW, Holland ML, Smith JA, Meng Y, Kitzman H. Effect of Gestational Weight Gain and Prepregnancy Body Mass Index in Adolescent Mothers on Weight and Body Mass Index of Adolescent Offspring. J Adolesc Health 2017; 61:626-633. [PMID: 28711316 PMCID: PMC5654683 DOI: 10.1016/j.jadohealth.2017.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 04/26/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of the study was to examine the association of the gestational weight gain and prepregnancy body mass index (BMI) of low-income adolescent mothers with the risk of their children being overweight and/or obese in late adolescence. METHODS Study subjects were low-income, primiparous adolescents (n = 360) who self-identified as black and participated in the New Mothers Study in Memphis, Tennessee, and their children. Gestational weight gain was examined as a continuous variable and also categorized into overgain, recommended gain, and undergain following the 2009 Institute of Medicine guidelines. The effects of maternal prepregnancy BMI percentiles and calculated BMI were also considered. Multivariable logistic and linear regression models were used. The main outcome measures were offspring overweight, obesity, and BMI. RESULTS Thirty-nine percent of offspring were overweight or obese. Higher maternal gestational weight gain increased the risk for offspring overweight and obesity. There was an interaction between gestational weight gain and prepregnancy BMI: offspring of mothers with a BMI percentile ≤76 were at greater risk of obesity with higher maternal weight gain. If mothers with a BMI percentile between the 29th and 83rd percentiles overgained, offspring were at greater risk for overweight. Using calculated BMIs, if a mother's BMI was ≤26 kg/m2, offspring risk for obesity was greater with higher gestational weight gain. CONCLUSIONS High gestational weight gain had a larger effect on offspring overweight and obesity if maternal prepregnancy BMI percentile was ≤76. The gestational weight gain of primiparous adolescents who self-identified as black had an effect on offspring weight.
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Affiliation(s)
- Susan W Groth
- School of Nursing, University of Rochester, Rochester, New York.
| | - Margaret L Holland
- School of Nursing, Yale University, P. O. Box 27399, West Haven, CT 06516-7399, USA
| | - Joyce A Smith
- University of Rochester, School of Nursing 601 Elmwood Ave., Box SON, Rochester, NY 14642, USA
| | - Ying Meng
- University of Rochester, School of Nursing 601 Elmwood Ave., Box SON, Rochester, NY 14642, USA
| | - Harriet Kitzman
- University of Rochester, School of Nursing 601 Elmwood Ave., Box SON, Rochester, NY 14642, USA
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Groth SW, Stewart PA, Ossip DJ, Block RC, Wixom N, Fernandez ID. Micronutrient Intake Is Inadequate for a Sample of Pregnant African-American Women. J Acad Nutr Diet 2017; 117:589-598. [PMID: 28065633 DOI: 10.1016/j.jand.2016.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 11/16/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Micronutrient intake is critical for fetal development and positive pregnancy outcomes. Little is known about the adequacy of micronutrient intake in pregnant African-American women. OBJECTIVE To describe nutrient sufficiency and top food groups contributing to dietary intake of select micronutrients in low-income pregnant African-American women and determine whether micronutrient intake varies with early pregnancy body mass index (BMI) and/or gestational weight gain. DESIGN Secondary analysis of data collected in a cohort study of pregnant African-American women. PARTICIPANTS/SETTING A total of 93 women aged 18 to 36 years, <20 weeks pregnant, with early pregnancy BMIs ≥18.5 and <40.0. The study was conducted during 2008 to 2012 with participants from university-affiliated obstetrics clinics in an urban setting in the northeastern United States. MAIN OUTCOME MEASURES Proportion of women with dietary intakes below Estimated Average Requirement (EAR) or Adequate Intake (AI) for vitamin D, folate, iron, calcium, and choline throughout pregnancy. Top food groups from which women derived these micronutrients was also determined. STATISTICAL ANALYSES PERFORMED Descriptive statistics included means, standard deviations, and percentages. Percent of women reaching EAR or AI was calculated. The χ2 test was used to assess micronutrient intake differences based on early pregnancy BMI and gestational weight gain. RESULTS A large percentage of pregnant women did not achieve the EAR or AI from dietary sources alone; EAR for folate (66%), vitamin D (100%), iron (89%), and AI for choline (100%). Mean micronutrient intake varied throughout pregnancy. Top food sources included reduced-fat milk, eggs, and mixed egg dishes, pasta dishes, and ready-to-eat cereal. CONCLUSIONS The majority of study participants had dietary micronutrient intake levels below EAR/AI throughout pregnancy. Findings suggest that practitioners should evaluate dietary adequacy in women to avoid deficits in micronutrient intake during pregnancy. Top food sources of these micronutrients can be considered when assisting women in improving dietary intake.
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Groth SW, Dozier A, Demment M, Li D, Fernandez ID, Chang J, Dye T. Participation in Genetic Research: Amazon's Mechanical Turk Workforce in the United States and India. Public Health Genomics 2016; 19:325-335. [PMID: 27811475 DOI: 10.1159/000452094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 09/28/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Genomic research has innumerable benefits. However, if people are unwilling to participate in genomic research, application of knowledge will be limited. This study examined the likelihood of respondents from a high- and a low- to middle-income country to participate in genetic research. METHODS Cross-sectional data were collected using Amazon's Mechanical Turk workforce to ascertain attitudes toward participation in genetic research. Registered country of residence was either the US (n = 505) or India (n = 505). Multiple logistic regression models were used to assess adjusted effects of demographic characteristics, health, social status, beliefs and concerns on 4 genetic research outcomes. RESULTS Participants from India who believed chance and powerful others influenced their health were more likely to participate in genetic research (OR = 1.0, 95% CI 1.0-1.1) and to agree with sharing of DNA data (OR = 1.1, 95% CI 1.1-1.2). US participants were more likely to be concerned about protection of family history, which they indicated would affect participation (OR = 3.6, 95% CI 2.1-6.0). Commonalities for the likelihood of participation were beliefs that genetic research could help find new treatments (India OR = 2.3, 95% CI 1.0-5.4; US OR = 4.7, 95% CI 2.0-11.2) and descendants would benefit (India OR = 2.6, 95% CI 1.2-5.5; US OR = 3.0, 95% CI 1.3-7.1). CONCLUSIONS Concurrence of beliefs on benefits and concerns about genetic research suggest they may be common across countries. Consideration of commonalities may be important to increase global participation in genetic research.
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Groth SW, Simpson AH, Fernandez ID. The Dietary Choices of Women Who Are Low-Income, Pregnant, and African American. J Midwifery Womens Health 2016; 61:606-612. [PMID: 27448099 DOI: 10.1111/jmwh.12463] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 01/24/2016] [Accepted: 01/28/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Multiple factors influence the dietary choices of pregnant women that may increase the risk of excessive gestational weight gain. Several of these factors converge for African American women who are low income and reside in an urban setting. The objective of this study was to gain an understanding of how factors previously identified affect dietary decision making and determine the barriers that impede adoption of a healthy diet for this population. METHODS Twenty-five in-depth semistructured interviews were conducted with African American women who were low income, pregnant, and residing in an urban setting. The participants were recruited from a university obstetric clinic in a medium-sized urban northeastern city. Interviews were digitally recorded and transcribed. Analysis was a recursive process such that data analysis was done continually during data collection. Individual interviews were conducted until informational redundancy was reached. A directed content analysis approach was used, building from prior research and themes that emerged from focus groups with a similar population. Data were coded and grouped into meaningful clusters. RESULTS The participants indicated that food cravings, taste, and appetite influenced their food choices. Limited knowledge about healthy foods, cravings for unhealthy foods, time, and finances were barriers to making healthy dietary choices. Women indicated that if healthy food tasted better, they got more rest, and their schedules were regular, it would help them make the best possible food choices. DISCUSSION Women who are low income, African American, and pregnant could benefit from interventions targeting food cravings, taste, and appetite, and information about what constitutes a healthy diet. Cravings for calorie-dense, nutrient-poor foods were a driver of dietary choice and potentially increased the risk of excessive gestational weight gain. The complexities of cravings, taste, and appetite that converge with limited funds, tight schedules, and a knowledge deficit of important dietary information are critical to consider when providing care to pregnant women from this population.
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Tantillo M, McGraw JS, Hauenstein EJ, Groth SW. Partnering with patients and families to develop an innovative multifamily therapy group treatment for adults with anorexia nervosa. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/21662630.2015.1048478] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fernandez ID, Groth SW, Reschke JE, Graham ML, Strawderman M, Olson CM. eMoms: Electronically-mediated weight interventions for pregnant and postpartum women. Study design and baseline characteristics. Contemp Clin Trials 2015; 43:63-74. [PMID: 25957183 DOI: 10.1016/j.cct.2015.04.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 04/22/2015] [Accepted: 04/26/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The influence of childbearing in the development of obesity is situated within two different but related contexts: pregnancy-related weight gain and weight gain prevention and control in young adult women. Pregnancy related weight gain contributes to long-term weight retention in childbearing women. OBJECTIVE To present the study design, data collection procedures, recruitment challenges, and the baseline characteristics for the eMoms of Rochester study, a randomized clinical trial testing the effect of electronically-mediated behavioral interventions to prevent excessive gestational weight gain (GWG) and postpartum weight retention among women aged 18-35 years of diverse income and racial/ethnic backgrounds in an urban setting. DESIGN Randomized double blind clinical trial. A total of 1722 women at or below 20 weeks of gestation were recruited primarily from obstetric practices and randomized to 3 treatment groups: control arm; intervention arm with access to intervention during pregnancy and control at postpartum (e-intervention 1); and intervention arm with access to intervention during pregnancy and postpartum (e-intervention 2). Enrollment and consent were completed via study staff or online. Data were collected via online surveys, medical charts, and measurement of postpartum weights. The primary endpoints are gaining more weight than recommended by the Institution of Medicine guidelines and weight retained at 12 months postpartum. CONCLUSION This study will provide evidence on the efficacy of behavioral interventions in the prevention of excessive GWG and postpartum weight retention with potential dissemination to obstetric practices and/or health insurances. ClinicalTrials.gov #NCT01331564.
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Affiliation(s)
- Isabel Diana Fernandez
- Department of Public Health Sciences, Division of Epidemiology, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd., CU 420644, Rochester, NY 14642-0644, United States.
| | - Susan W Groth
- School of Nursing, University of Rochester, United States
| | - Jennifer E Reschke
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, United States
| | | | - Myla Strawderman
- Division of Nutritional Sciences, Cornell University, United States
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Abstract
BACKGROUND Gestational weight gain (GWG) is a modifiable risk factor for obesity in women. Black women have the greatest prevalence of high body mass, which predisposes them to excessive GWG. Increased understanding of genetic influences on GWG has implications for the health of women. The purpose of this study was to explore the associations of GNB3 and FTO risk alleles in pregnant women with prepregnancy body mass index (BMI), GWG, and postpartum and infant birth weights. RESEARCH DESIGN AND METHODS This was an observational, prospective candidate gene association study. Pregnant, low-income Black women (N = 97) were enrolled in early pregnancy and followed until 6 months postpartum. RESULTS GWG differed depending on number of FTO risk alleles. The mean 6-month postpartum BMI differed, although not significantly, by 4 kg/m(2) between homozygous women. There was an interaction between the FTO risk allele and prepregnancy BMI (p = .022), with obese homozygote AA women having significantly higher mean GWG than obese TT women. When controlling for age and smoking, the FTO gene and physical activity predicted GWG (p = .032). Although not statistically significant, women who carried the GNB3 T risk allele gained 6 pounds more than noncarriers, and mean 6-month postpartum BMI differed by 2.2 kg/m(2) between homozygous women. Neither the GNB3 nor FTO gene predicted prepregnancy BMI, infant birth weight, or postpartum weight. CONCLUSION Obese women homozygous for the FTO risk allele were at greater risk of excessive GWG compared to nonrisk allele homozygous obese women or nonobese women. This study provides evidence of the FTO gene's effect on GWG in Black women.
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Blackmore ER, Groth SW, Chen DGD, Gilchrist MA, O'Connor TG, Moynihan JA. Depressive symptoms and proinflammatory cytokines across the perinatal period in African American women. J Psychosom Obstet Gynaecol 2014; 35:8-15. [PMID: 24350831 DOI: 10.3109/0167482x.2013.868879] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Comparatively few studies have examined the biological mechanisms that may underlie the reported racial disparities in antenatal and postpartum depression. OBJECTIVE To examine the associations among race, depressive symptoms and the proinflammatory cytokines interleukin (IL)-6 and tumor necrosis factor (TNF)-α across the perinatal period in a diverse sample of healthy pregnant women at elevated psychosocial risk. METHODS 171 subjects were enrolled. Women were interviewed and blood samples drawn at 18 and 32 weeks gestation and 6 weeks and 6 months postpartum. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale. Serum levels of IL-6 and TNF-α were assayed using high sensitivity enzyme-linked immunosorbent assay kits. RESULTS Compared with non-African American (AA) women, AA women had significantly higher levels of IL-6 (est. diff = 0.521, p = 0.02, confidence interval (CI): 0.088-0.954) but not TNF-α across all time points (est. diff = -0.060, p = 0.80, CI: -0.517 to 0.397). IL-6 was not associated with depressive symptoms but differences in IL-6 were accounted for by greater Body Mass Index in AA women. CONCLUSIONS Compared with non-AA women, AA women entered pregnancy with elevated inflammatory cytokine levels that persisted across the perinatal period. This group difference in inflammation did not suggest increased risk for depression, but suggests other implications for long-term health.
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Groth SW, Holland ML, Kitzman H, Meng Y. Gestational weight gain of pregnant African American adolescents affects body mass index 18 years later. J Obstet Gynecol Neonatal Nurs 2013; 42:541-50. [PMID: 24003870 DOI: 10.1111/1552-6909.12230] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine if gestational weight gain (GWG) in adolescents is associated with long-term weight increases 12 years and 18 years after delivery of a first child and the differential effects of weight gain during pregnancy that is inadequate, the appropriate amount, and excessive based on the 2009 Institute of Medicine (IOM) recommendations. DESIGN Secondary data analysis of data from a randomized controlled trial. SETTING Memphis, Tennessee. PARTICIPANTS Two hundred ninety-eight (298) primiparous low-income Black women who were adolescents at the time of their first pregnancies. METHOD Linear regression was used to examine the relationship between body mass index (BMI) at 12 and 18 years postdelivery and GWG, parity, prepregnancy BMI, and smoking. RESULTS The total sample experienced a significant BMI increase from prepregnancy to 12 years and 18 years postdelivery. More than 50% of the women had a BMI increase greater than 10 kg/m(2) . By 18 years postdelivery, 85% were overweight or obese. Prepregnancy BMI and GWG had a positive significant effect on BMI 12 and 18 years later, whereas smoking had a negative effect. Those who gained excessive weight based on the IOM recommendations had a significantly higher BMI compared with those who gained appropriately. CONCLUSION Gestational weight gain had long-term effects on BMI in a minority adolescent population. Excessive pregnancy weight gain is likely to contribute to long-term weight retention, especially if adolescents are overweight or obese when they become pregnant with their first children. Intervention during pregnancy to limit GWG has the potential of limiting long-term negative health consequences that result from overweight and obesity in minority women.
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Groth SW, Holland ML. Eighteen Years After Pregnancy Adolescent Gestational Weight Gain Still Affects Body Mass Index. J Obstet Gynecol Neonatal Nurs 2013. [DOI: 10.1111/1552-6909.12168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
INTRODUCTION This research was conducted to gain insight into how low-income, pregnant, African American women viewed physical activity and approached nutrition during pregnancy. METHODS Three focus groups with a total of 26 women were conducted utilizing open-ended questions related to physical activity and diet during pregnancy. Content analysis was used to analyze the verbatim transcripts. Groups were compared and contrasted at the within-group and between-group levels to identify themes. RESULTS Two themes that related to physical activity during pregnancy were identified: 1) fatigue and low energy dictate activity and 2) motivation to exercise is not there. Three themes were identified that related to diet: 1) despite best intentions, appetite, taste, and cravings drive eating behavior; 2) I'll decide for myself what to eat; and 3) eating out is a way of life. DISCUSSION Women reported that being physically active and improving their diets was not easy. Women indicated that their levels of physical activity had decreased since becoming pregnant. Attempts at improving their diets were undermined by frequenting fast food restaurants and cravings for highly dense, palatable foods. Women ceded to the physical aspects of pregnancy, often choosing to ignore the advice of others. A combination of low levels of physical activity and calorie-dense diets increased the risk of excessive gestational weight gain in this sample of women, consequently increasing the risk for weight retention after pregnancy. Health care providers can promote healthy eating and physical activity by building on women's being "in tune with and listening to" their bodies. They can query women about their beliefs regarding physical activity and diet and offer information to ensure understanding of what contributes to healthy pregnancy outcomes. Intervention can focus on factors such as cravings and what tastes good, suggesting ways to manage pregnancy effects within a healthy diet.
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Affiliation(s)
- Susan W Groth
- University of Rochester School of Nursing, 601 Elmwood Ave, Box SON,Rochester, NY 14642, USA. Susan
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Abstract
OBJECTIVE To gain insight into how low-income, pregnant African American women viewed their weight gain while pregnant and how they managed their weight during pregnancy. DESIGN Descriptive study using three focus groups. SETTING Women were recruited from urban prenatal care sites and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) services in a medium-sized urban northeastern city. PARTICIPANTS Twenty-six adult, low-income, pregnant African American women, age 18 to 39; the majority were within the first 20 weeks of pregnancy. METHODS Three focus groups were conducted utilizing open-ended questions related to pregnancy weight gain. Content analysis was used to analyze the verbatim transcripts. Analysis focused on meaning, intention, and context. Groups were compared and contrasted at the within and between group levels to identify themes. RESULTS Four themes were identified that provided insight into how women viewed their pregnancy weight gain and managed weight gain during pregnancy: (a) pregnancy weight gain: no matter how much means a healthy baby; (b) weight retention: it happens; (c) there is a limit: weight gain impact on appearance; and (d) watching and waiting: plans for controlling weight. CONCLUSION Low-income African American women, though cognizant of the likelihood of retention of weight following pregnancy, are not focused on limiting their gestational weight gain. The cultural acceptance of a larger body size along with the belief that gaining more weight is indicative of a healthy infant present challenges for interventions to limit excessive gestational weight gain.
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Affiliation(s)
- Susan W Groth
- School of Nursing, University of Rochester, Rochester, NY 14642, USA.
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Abstract
This study examined the associations among smoking tobacco and/or cannabis with alcohol use, depression, disordered eating and healthy behaviors among adolescent girls enrolled in an HIV prevention intervention randomized trial. Baseline self-reported behaviors from 744 sexually active, low-income, urban participants were collected using an audio computer assisted self interview. Girls ranged in age from 15 to 19 years old with a mean age of 16.5. Over 16% of girls reported smoking cigarettes, 41% smoked cannabis and 12% used both substances. Girls who smoked either substance had higher scores for depression symptoms, alcohol use and disordered eating when compared to nonsmokers. Girls who used both substances were at a higher risk for alcohol use, depression symptoms and disordered eating. The association of cannabis and tobacco with the other health related issues differed depending on age, indicating that assessment and targeting of health behavior interventions may differ depending on a girl's age. Disordered eating, depressive symptoms and cannabis use were higher among these adolescent girls than previously documented in the literature, suggesting that to improve the health of this population multi-focused interventions must target girls before they have engaged in smoking.
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Affiliation(s)
- Susan W Groth
- University of Rochester School of Nursing, 601 Elmwood Ave, Box SON, Rochester, NY 14642, USA.
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Groth SW, Morrison-Beedy D. Obesity risk in urban adolescent girls: nutritional intentions and health behavior correlates. J N Y State Nurses Assoc 2011; 42:15-28. [PMID: 22187861 PMCID: PMC3640335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Obesity is an expanding epidemic and minority adolescent girls are at high risk. One way to tailor interventions for obesity prevention is to target intention to engage in particular behaviors. Data collected from adolescent girls' intentions and behaviors regarding nutrition, physical activity, and sleep patterns were used to examine nutritional intentions in relation to healthy behaviors. Adolescent girls reported behaviors that increased their risks for obesity. Nutritional intentions were significantly associated with physical activity and sleep. These results suggest that healthy behaviors tend to occur in clusters, possibly extending the theory of planned behavior beyond individual behaviors to groups of related behaviors. Nurses can intervene with high-risk adolescent girls by promoting healthy diets, recommended levels of physical activity, and adequate sleep.
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Affiliation(s)
- Susan W Groth
- University of Rochester School of Nursing in Rochester, NY, USA
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Abstract
INTRODUCTION Polycystic ovary syndrome (PCOS) has a prevalence of 5-8% in women of reproductive age. Women with PCOS have an increased risk of metabolic syndrome and associated comorbidities. Adiponectin is a circulating protein produced by adipocytes. Circulating levels of adiponectin are inversely related to adipocyte mass. Low levels occur with insulin resistance, type 2 diabetes, metabolic syndrome, and obesity-related cardiovascular disease. This article reviews the literature on the link between adiponectin and PCOS and the potential use of adiponectin as a biomarker for PCOS. METHOD Data-based studies on adiponectin and PCOS and adiponectin measurement were identified through the Medline (1950-2009) and ISI Web of Knowledge (1973-2009) databases. RESULTS Fifteen studies related to adiponectin and PCOS met inclusion criteria and were included in this review. These studies present evidence that adiponectin is linked to insulin resistance, insulin sensitivity, body mass index (BMI), and adiposity. In women with PCOS, lower levels, as opposed to higher levels, of adiponectin occur in the absence of adiposity. CONCLUSION The relationships between adiponectin and insulin resistance and sensitivity, metabolic syndrome, and BMI in women with PCOS suggest that adiponectin potentially could serve as a marker for disease risk and provide opportunity for earlier intervention if knowledge is successfully translated from laboratory to clinical practice. However, further study of the relationship between adiponectin and PCOS is required before there can be direct application to clinical practice.
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Groth SW, Kearney MH. Diverse women's beliefs about weight gain in pregnancy. J Midwifery Womens Health 2010; 54:452-7. [PMID: 19879517 DOI: 10.1016/j.jmwh.2009.03.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Revised: 03/04/2009] [Accepted: 03/04/2009] [Indexed: 11/30/2022]
Abstract
This research was conducted to describe ethnically diverse new mothers' perceptions of gestational weight gain. Forty-nine low-income women of diverse racial and ethnic origins who birthed an infant within the past year completed a semistructured interview in a pediatric clinic waiting room. The interviews were designed to elicit views on gestational weight gain, including expectations and perceived consequences. Data were analyzed using content analysis techniques. Women believed that others like themselves were concerned about pregnancy weight gain. Many focused on the effects of insufficient pregnancy weight gain on the infant but were not aware of the infant risks of excessive gain. Several had inaccurate knowledge of appropriate gestational weight gain, and many suggested an amount below the current recommendations. One-third of the women believed women will weigh more following pregnancy, yet others assumed that even with excessive weight gain there would be a return to prepregnant weight following pregnancy. Pregnancy-related weight gain is disturbing to women. Health care providers have the opportunity to intervene by acknowledging these concerns and providing information and support to help women make positive choices and achieve appropriate weight gain.
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Affiliation(s)
- Susan W Groth
- University of Rochester School of Nursing, 601 Elmwood Ave., Box SON, Rochester, NY 14642, USA.
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Groth SW. Honorarium or coercion: use of incentives for participants in clinical research. J N Y State Nurses Assoc 2010; 41:11-22. [PMID: 20882821 PMCID: PMC3646546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Nurses are frequently involved in the recruitment of subjects for clinical research studies when their patients are potential study participants. As professionals, it is nurses' responsibility to make sure that patients are treated with beneficence when they are included in clinical research. Financial incentives are frequently used to encourage participation, and the concern has been raised that this practice could be coercive, especially for people who have limited financial resources.
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Affiliation(s)
- Susan W Groth
- University of Rochester School of Nursing, Rochester, NY, USA
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