Understanding multifactorial influences on the continuum of maternal weight trajectories in pregnancy and early postpartum: study protocol, and participant baseline characteristics.

Tiffany A Moore Simas,Bruce Barton,Katherine Leung,Barbara Olendzki,Milagros C Rosal,Ningning Zhang,Mary M Lee,Silvia Corvera

doi:10.1186/s12884-015-0490-7

Abstract

BackgroundMaternal and offspring immediate and long-term health are affected by pregnancy weight gain and maternal weight. This study was designed to determine feasibility of: 1) recruiting a socio-economically and racially/ethnically diverse sample of pregnant women into a longitudinal observational study, including consenting the women for serial biologic specimen evaluations; 2) implementing comprehensive assessments (including biologic, anthropometric, behavioral, cognitive/psychosocial and socio-demographic, and cultural measures) at multiple time points over the study period, including collecting biologic specimens at planned and unplanned pregnancy delivery times; and 3) retaining the sample for one year into the postpartum period. Additionally, the study will provide preliminary data of associations among hypothesized predictors, mediators and moderators of pregnancy and post-partum maternal and infant weight trajectories. The study was conceptualized under a Biopsychosocial Model using a lifespan approach. Study protocol and baseline characteristics are described.Methods/DesignWe sought to recruit a sample of 100 healthy women age 18–45 years, between 28–34 weeks gestation, with singleton pregnancies, enrolled in care prior to 17 weeks gestation. Women provide written consent for face-to-face (medical history, anthropometrics, biologic specimens), and paper-and-pencil assessments, at five time points: baseline (third trimester), delivery-associated, and 6-weeks, 3-months and 6-months postpartum. Additional telephone-based assessments (diet, physical activity and breastfeeding) administered baseline and three-months postpartum. Infant weights are collected until 1-year of life. We seek to retain 80% of participants at six-months postpartum and 80% of offspring at 12-months.110 women were recruited. Sample characteristics include: mean age 28.3 years, BMI 25.7 kg/m2, and gestational age at baseline visit of 32.5 weeks. One-third of cohort was non-white, over a quarter were Latina, and almost a quarter were non-US born. The cohort majority was multigravida, had graduated high school and/or had higher levels of education, and worked outside the home.DiscussionDocumentation of study feasibility and preliminary data for theory-driven hypothesis of maternal and child factors associated with weight trajectories will support future large scale longitudinal studies of risk and protective factors for maternal and child health. This research will also inform intervention targets facilitating healthy maternal and child weight.

Highlights

Maternal and offspring immediate and long-term health are affected by pregnancy weight gain and maternal weight
Documentation of study feasibility and preliminary data for theory-driven hypothesis of maternal and child factors associated with weight trajectories will support future large scale longitudinal studies of risk and protective factors for maternal and child health
Excessive gestational weight gain contributes to subsequent postpartum weight retention [7], and failure to lose pregnancy weight by six months postpartum predicts long-term obesity [9,10] with women retaining an average of 3 kg per pregnancy at 10 years [11]

Summary

Introduction

Maternal and offspring immediate and long-term health are affected by pregnancy weight gain and maternal weight. Given well-established associations between obesity and an array of chronic maternal health conditions, including cardiometabolic diseases [12,13,14,15] and some cancers [16], achieving a healthy weight gain during pregnancy, and preventing postpartum weight retention, are critical to the long-term health of many women [9,10]. Excessive maternal weight gain in pregnancy is associated with childhood obesity [18] which is subsequently associated with longterm offspring consequences including cardiometabolic and neuro-developmental disorders. The growing body of evidence in support of the Developmental Origins of Health and Disease Hypothesis (DOHaD, the Barker hypothesis) [19] suggests that optimizing maternal health before and during pregnancy is critical for improved outcomes not just for women and for their children

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