Should Protocols for Weight Change During Pregnancy Include Information About the Previous Weight History of the Woman Who Is Pregnant? (P22-015-19)

Abstract

Abstract Objectives Recent research has indicated that an increase in weight is frequently caused by prior famine or Self-Induced Weight Loss (SIWL). The purpose of the literature search was to evaluate if famine or SIWL, in a woman who is contemplating pregnancy or who is currently pregnant, could have long term effects on the child to be born. Methods Pub Med was searched using the key phrases “Pregnancy and Famine or Starvation”, and “Gestational Weight Gain”, both limited to Humans, with no limit as to dates of publication. Results The earliest famine study found was published in 1976 and indicated that men born during the Dutch Famine (1944–45) had higher obesity rates if they were exposed to famine during the first half of pregnancy and lower rates if they experienced famine in the third trimester or the first few months of life. Other publications report results of pregnancy outcomes before, during, and after the Holocaust (1940–45), the Dutch Famine and famines in China (1959–61), Biafra (1968–70), and Bangladesh (1974–75). Long-term famine related problems include increased risk of overweight, obesity, Type 2 Diabetes, coronary heart disease, hypertension, and metabolic syndrome. Additional studies extend this observation to those who live in poverty with corresponding uncertainty about food resources. The most complete studies were published after 2004. Studies less than 18 months indicate that SIWL may be effective. However, with individuals followed 6 years or more either long-term weight gain occurs, or additional SIWL. Pregnancy protocols advocate specific limits to weight gain during pregnancy based on pre-pregnancy or early pregnancy BMI and recommend total weight gain ranges using usual BMI classifications. They do not ask about the weight history of the woman or if she has ever engaged in SIWL. BMI is based on height and weight and does not take into consideration the relative contribution of bone and muscle mass differentiated from fat mass. The size of the baby at birth is not an adequate indicator of actual health status. Conclusions An individual is conceived, lives in utero, and then is born. Caloric undernutrition in utero and during childhood can produce increased body fat and result in non-communicable diseases that are commonly related to obesity. Funding Sources Pension, University of Puerto Rico. Supporting Tables, Images and/or Graphs