Abstract
BackgroundThe rising prevalence of maternal overweight/obesity and excessive gestational weight gain poses a serious public health concern due to the contribution of these factors to increased risk of negative health outcomes for both mother and child. Scant intervention research has indicated moderate short-term improvement in maternal diet and gestational weight gain, with little evidence of long-term behavior change, in parallel with findings from interventions outside of pregnancy. Recent laboratory-based findings from neuroscience implicate aberrant reward processing of food at the brain level (“food reward sensitivity,” the between-individual variation in the response to food stimuli) as a contributor to eating beyond energy needs. However, scant research has examined the influence of these processes on weight change in population-based settings, and the relevance of these processes to pregnancy-related weight change has not been explored. The purpose of the Pregnancy Eating Attributes Study (PEAS) is to examine the role of food reward sensitivity in maternal diet and weight change during pregnancy and postpartum. The study examines the interplay of food reward sensitivity with behavioral control, home food environment, and related aspects of eating behavior in the context of weight-related biomedical, psychosocial, genetic and behavioral factors including physical activity, stress, sleep and depression.MethodsWomen of varying baseline weight status (n = 450) are enrolled early in pregnancy and followed, along with their infants, until 1 year postpartum. Assessments occur during each trimester of pregnancy, and postpartum at approximately 2 months, 6 months, 9 months and 12 months. Maternal food reward, self-control, home food environment, eating behaviors, dietary intake, health behaviors, and anthropometrics are assessed along with maternal and infant clinical and biological data, infant anthropometrics, and feeding practices. Primary exposures of interest include food reward sensitivity, behavioral control, and home food environment. Primary outcomes include gestational weight gain, postpartum weight retention and maternal diet quality.DiscussionWith increasing evidence suggesting the relevance of food reward sensitivity for understanding eating behavior, PEAS aims to advance understanding of the determinants of eating behavior during pregnancy, informing future interventions for improving maternal diet and weight change, and leading to improved maternal and child health and weight trajectories.Trial registrationClinicaltrials.gov, NCT02217462. Date of registration: August 13, 2014
Highlights
The rising prevalence of maternal overweight/obesity and excessive gestational weight gain poses a serious public health concern due to the contribution of these factors to increased risk of negative health outcomes for both mother and child
Approximately two-thirds of women of reproductive age are overweight or obese [1], and across the range of body mass index (BMI), gestational weight gain (GWG) in excess of guidelines is more common than GWG within or below guidelines, contributing to maternal obesity risk, pregnancy complications, and unsuccessful breastfeeding [1]
Antecedents of obesity may develop in utero [16, 17], and data suggest that altering maternal prenatal diet impacts offspring body composition [18,19,20,21,22,23] as well as a range of adverse child outcomes including birth defects [24], cancer [25,26,27,28], type 1 diabetes [29], and asthma symptoms [30]
Summary
The rising prevalence of maternal overweight/obesity and excessive gestational weight gain poses a serious public health concern due to the contribution of these factors to increased risk of negative health outcomes for both mother and child. Adverse infant outcomes associated with maternal obesity and excessive GWG include birth defects, macrosomia, shoulder dystocia, perinatal mortality, hyperinsulinemia, developmental delays, childhood obesity and cardiovascular disease [2,3,4,5,6,7,8,9,10,11,12,13,14,15]. The problem of obesity and weight gain in pregnancy is linked to the larger epidemic of obesity in the US which, along with poor diet quality, contributes to numerous adverse health outcomes, including reduced fecundity and fertility and chronic diseases such as cardiovascular disease, sleep disorders, and many cancers [32]. Mirroring findings regarding weight management in pregnancy, weight management interventions in the general population have been only marginally successful, with less than optimal initial weight loss and poor longterm maintenance [38,39,40,41]
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