Abstract
Excess maternal weight gain during pregnancy elevates infants’ risk for macrosomia and early-onset obesity. Eating behavior is also related to weight gain, but the relationship to fetal growth is unclear. We examined whether Healthy Mom Zone, an individually tailored, adaptive gestational weight gain intervention, and maternal eating behaviors affected fetal growth in pregnant women (n = 27) with a BMI > 24. At study enrollment (6–13 weeks gestation) and monthly thereafter, the Three-Factor Eating Questionnaire was completed. Ultrasounds were obtained monthly from 14–34 weeks gestation. Data were analyzed using multilevel modeling. Higher baseline levels of uncontrolled eating predicted faster rates of fetal growth in late gestation. Cognitive restraint was not associated with fetal growth, but moderated the effect of uncontrolled eating on fetal growth. Emotional eating was not associated with fetal growth. Among women with higher baseline levels of uncontrolled eating, fetuses of women in the control group grew faster and were larger in later gestation than those in the intervention group (study group × baseline uncontrolled eating × gestational week interaction, p = 0.03). This is one of the first intervention studies to use an individually tailored, adaptive design to manage weight gain in pregnancy to demonstrate potential effects on fetal growth. Results also suggest that it may be important to develop intervention content and strategies specific to pregnant women with high vs. low levels of disinhibited eating.
Highlights
Over 50% of women in the United States enter pregnancy already having overweight or obesity; the majority of these women (60%) gain more weight in pregnancy than is recommended by the InstituteNutrients 2019, 11, 899; doi:10.3390/nu11040899 www.mdpi.com/journal/nutrientsNutrients 2019, 11, 899 of Medicine (IOM) [1]
Data for this analysis were collected as part of an ancillary study to measure fetal growth in women participating in Healthy Mom Zone, an optimization trial within the multiphase optimization strategy (MOST) framework [46], of an adaptive intervention to manage gestational weight gain among pregnant women with overweight or obesity [18]
Healthy Mom Zone, an individually tailored, adaptive intervention designed to effectively gestational weight gain among women with overweight or obesity tended to result in a slower rate of manage gestational weight gain among women with overweight or obesity tended to result in a fetal growth compared to fetuses of control women, with significant effects emerging in models that slower rate of fetal growth compared to fetuses of control women, with significant effects emerging accounted for uncontrolled eating
Summary
Over 50% of women in the United States enter pregnancy already having overweight or obesity; the majority of these women (60%) gain more weight in pregnancy than is recommended by the InstituteNutrients 2019, 11, 899; doi:10.3390/nu11040899 www.mdpi.com/journal/nutrientsNutrients 2019, 11, 899 of Medicine (IOM) [1]. The prenatal period may be an opportune time to intervene and break the intergenerational cycle of obesity by reducing fetal exposure to an “obesogenic” intrauterine environment [5,6] through promoting maternal energy balance (EB) (i.e., a nutrient-rich, low-energy dense diet and physical activity) [7]. Maternal weight gain during pregnancy is necessary for healthy fetal development, but high gestational weight gain elevates infant risk for macrosomia and early onset obesity [1]. Infant birth weight is a positive, independent predictor of obesity during later childhood [9,10,11], and high birth weight is associated with increased risk for adult-onset obesity and diabetes [12]
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