Differences In Gestational Weight Gain Research Articles

Investigating discrepancies in findings between rigorous randomized trials and meta-analyses evaluating pregnancy interventions to limit gestational weight gain.

Robust randomized trials consistently demonstrate little impact from diet and physical activity interventions on gestational weight gain (GWG) and clinical outcomes, although meta-analyses report some benefit. Our aim was to evaluate the effect of trial quality on treatment effect estimates and review conclusions. We conducted a systematic review of dietary and/or physical activity interventions for pregnant women with a body mass index ≥18.5kg/m2. We assessed studies for risk of bias and methodological features impacting reliability. Outcomes included GWG; gestational diabetes mellitus (GDM); pre-eclampsia; caesarean birth; and birth weight measures. For each outcome, a sequence of meta-analyses was performed based on intervention group and level of potential bias in the effect estimate. We identified 128 eligible studies. The most robust estimate from a combined diet and physical activity behavioral intervention, with only studies at negligible risk of bias, was a difference in GWG of 1.10kg (95% CI -1.62 to -0.58; 17,755 women). There was no evidence of an effect on any clinical outcomes. Our findings highlight discrepancies produced by the indiscriminate inclusion of studies with methodological flaws in previous systematic reviews. Regular weighing of pregnant women is futile in the absence of clinical benefit.

Impact of changes in recommendation of optimal gestational weight gain in Japan: A retrospective study in a single tertiary center.

In March 2021, the Japanese Ministry of Health, Labour and Welfare revised the optimal gestational weight gain standards. In this study, we examined whether this revision affected gestational weight gain and low birth weight rates. We analyzed the records of singleton pregnant women who underwent checkups from their 1st trimester and delivered at our institute after 37 weeks between 2020 and 2021 (before the revision) and between 2022 and 2023 (after the revision). Pregnancy outcomes were assessed in the following four groups stratified by pre-pregnancy body mass index (BMI): underweight (BMI: <18.5 kg/m2), normal-weight (BMI: 18.5-24.9 kg/m2), overweight (BMI: 25-29.9 kg/m2), and obese (BMI: ≥30 kg/m2). Leaflets on the optimal gestational weight gain standards for each group were distributed to all pregnant women at the first prenatal checkup. In each group, gestational weight gain did not change before and after the revision, with the corresponding values of 10.8 kg and 11.1 kg in the underweight (p = 0.94), 10.7 kg and 10.4 kg in the normal weight (p = 0.14), 9.7 kg and 9.2 kg in the overweight (p = 0.32), and 7.4 kg and 6.7 kg in the obese (p = 0.44) groups. Furthermore, the prevalence of low birth weight did not decrease in all groups. No significant differences in gestational weight gain or low birth weight were observed after the revision of the 2021 gestational weight gain recommendations. Merely distributing leaflets to pregnant women may not be sufficient to improve gestational weight gain or reduce low birth weight rates.

Gestational Diabetes Risk and Low Birth Weight After Metabolic Bariatric Surgery: a Complex Interplay to be Balanced

IntroductionMetabolic bariatric surgery (MBS) is known to improve the obstetric outcomes of women with obesity and to prevent gestational diabetes (GD). To what extent does MBS decreases GD, without incurring at additional risks is a matter of concern.MethodsA retrospective case–control study to compare the pregnancy outcomes of women previously submitted to MBS to those of age and preconception body mass index (PC BMI) matched non-operated controls.ResultsPregnancies of women after MBS (n = 79) and matched controls (n = 79) were included. GD was significantly less frequent after MBS (7.6% vs. 19%; p = 0.03). Fasting blood glucose (76.90 ± 0.77 vs 80.37 ± 1.15 mg/dl, p < 0.05; 70.08 ± 1.34 vs. 76.35 ± 0.95 mg/dl; p < 0.05, first and second trimesters respectively) and birth weight (2953.67 ± 489.51 g vs. 3229.11 ± 476.21 g; p < 0.01) were significantly lower after MBS when compared to controls. The occurrence of small-for-gestational-age (SGA) was more frequent after MBS (22.8% vs. 6.3%; p < 0.01), but no longer significant after controlling for smoking habits (15.5% vs. 6%, p = 0.14). There were no significant differences in gestational weight gain, prematurity rate nor mode of delivery between groups.ConclusionMBS was associated with a lower prevalence of GD than observed in non-operated women with the same age and BMI. After controlling for smoking, this occurred at the expense of a lower birth weight. Our data reinforces the hypothesis that MBS has body weight independent effects on glucose kinetics during pregnancy with distinctive impacts for mother and offspring, which need to be balanced.Graphical

P-447 Gestational weight gain in relation to time-to-pregnancy and conception by assisted reproductive technology

Abstract Study question Does the gestational weight gain trajectory differ across levels of time-to-pregnancy (TTP) for spontaneously conceived pregnancies and pregnancies conceived by assisted reproductive technology (ART)? Summary answer Women with ART pregnancies had lower weekly weight gain during the third trimester compared with women with spontaneous conceptions with TTP ≤3. What is known already Studies suggest that both prolonged TTP and conception by ART may increase the risk of pregnancy complications and affect perinatal outcomes such as birthweight. Suboptimal gestational weight gain might further increase the risk of adverse pregnancy outcomes. However, it remains unclear whether there may be differences in gestational weight gain according to TTP and ART, which contribute to the subsequent risk of adverse pregnancy outcomes. Study design, size, duration We studied 69,121 singleton planned pregnancies contributed by 60,847 women participating in the Norwegian Mother, Father and Child Cohort Study. Participants completed questionnaires at 15 weeks’ gestation (study entry), 30 weeks’ gestation, and six months postpartum on sociodemographic, reproductive, and behavioral factors. Participants reported their TTP, and up to four weight measurements and corresponding gestational age from preconception through delivery. We identified use of ART in the Medical Birth Registry of Norway. Participants/materials, setting, methods We fitted gestational weight gain trajectories using mixed-effects linear regression models and included an interaction term between time (gestational weeks) and the exposure groups, TTP ≤3 (reference); TTP 4-6; TTP 7-11, TTP ≥12 months, and ART, to assess differences across levels of TTP and conception by ART. The analyses were adjusted for maternal age at start of pregnancy, pre-pregnancy height, educational attainment, pre-pregnancy smoking, parity, and gestational age at birth. Main results and the role of chance The adjusted average weekly weight gain was -15g (95% CI: −19; −12) during the first trimester, 620g (95% CI: 615; 624) during the second trimester, and 491g (95% CI: 489; 494) during the third trimester. When we compared differences in average weekly weight change during the first trimester, we observed little difference between the exposure groups. During the second trimester, compared with TTP≤3 months women with TTP 4-6 months, TTP 7-11 months or TTP ≥12 months gained on average 7g (95% CI: −18; 3), 19g (95% CI: −33; −5) and 15g (95% CI: −29; −1) less per week, respectively, whereas women with ART pregnancies gained 11g more per week (95% CI: −13; 34). However, the results for TTP 4-6 and ART pregnancies were imprecise. During the third trimester, average weekly weight gain did not differ according to TTP for spontaneous conceptions, while women who conceived after ART gained 35g (95% CI: −49; −22) less than women with TTP≤3 each week. Limitations, reasons for caution Because TTP and gestational weight gain were self-reported, non-differential misclassification may have influenced our results. Wider implications of the findings Decelerated weight gain during the third trimester in ART pregnancies compared with women who conceived spontaneously within 3 months might be associated with adverse pregnancy outcomes. Although our findings are imprecise and need to be replicated, monitoring gestational weight gain trajectories might support identification of pregnancies at increased risk. Trial registration number Not applicable

Gestational Weight Gain During the COVID-19 Pandemic.

Healthy gestational weight gain (GWG) is associated with improved pregnancy and delivery outcomes. The COVID-19 pandemic changed eating behaviours and physical activity, and thus may have impacted GWG. This study examines the impact of the COVID-19 pandemic on GWG. Participants (N = 371, 86% of the larger study) were part of a study focused on GWG among TRICARE beneficiaries (i.e., active-duty military personnel and other beneficiaries). Participants were randomized to two treatment groups (GWG intervention (n = 149 pre-COVID and n = 98 during COVID), and usual care condition (n = 76 pre-COVID and n = 48 during COVID). GWG was calculated as the difference between screening weight and at 36 weeks gestation. Participants who delivered prior to the COVID-19 pandemic (March 1, 2020, N = 225) were compared to participants whose pregnancies occurred during the pandemic (N = 146). We found no significant difference in GWG between those who delivered prior to the pandemic (11.2 ± 4.3kg) and those whose pregnancies occurred during COVID-19 (10.6 ± 5.4kg), with no effect of intervention arm. While excessive GWG was higher pre-COVID (62.8%) than during the pandemic (53.7%), this difference was not significant overall or by intervention arm. In addition, we found lower attrition during the pandemic (8.9%) than in the pre-COVID period (18.7%). In contrast to prior research that indicated challenges with engaging in health behaviors during the COVID-19 pandemic, we found that women did not have increased GWG or higher odds of excessive GWG. This research contributes to our understanding of how the pandemic impacted pregnancy weight gain and engagement in research.

Using flash glucose monitoring in pregnancies in routine care of patients with gestational diabetes mellitus: a pilot study

AimFlash glucose monitoring (FGM) has been approved for the care of pregnant women with preexisting diabetes since 2017. However, its use in gestational diabetes (GDM) has been critically discussed. Inaccuracy and missing recommendations for target values are the main arguments against the use of FGM in GDM. To date, there is a lack of data to justify routine use of FGM in GDM pregnancies. Consequently, this new technology has been withheld from GDM-patients. Aim of our pilot study was to analyze the impact of FGM use on pregnancy outcomes, patient’s satisfaction and to confirm the safe use in GDM pregnancies.MethodsCohort study of 37 FGM-managed GDM pregnancies compared with 74 matched women using self-monitoring of blood glucose (SMBG). Group comparison using nonparametric testing concerning patients characteristic and perinatal outcome focusing on adverse outcomes (preeclampsia, preterm delivery, large for gestational age, C-sections, neonatal intensive care unit admission, hyperbilirubinemia and hypoglycemia). Evaluation of patient’s treatment satisfaction using the “Diabetes Treatment Satisfaction Questionnaire change” (DTSQc) and patient interviews.ResultsNo significant differences in patient’s characteristics despite gestational age at diagnosis (FGM with 20 vs. SMBG with 25 weeks). No difference in gestational weight gain, HbA1c progression and perinatal outcome. Treatment satisfaction obtained by the DTSQc revealed a high level of satisfaction with FGM use.ConclusionFGM use was well accepted and did not affect perinatal outcome. Use of FGM during pregnancy is safe and non-inferior to the management with SBGM. FGM should be considered as an option in the management of GDM patients.

Relationship Between Race and Gestational Weight Gain in Pregnancy and Early Life in the South Birth-Cohort Study.

The goal of this study was to evaluate whether differences in gestational weight gain (GWG) and adverse perinatal outcomes exist for Black and White women who are overweight or have obesity (OW/OB) at entry to prenatal care. We enrolled 183 pregnant women with BMI 25-45kg/m2 (71% black, 29% white) prior to 14 weeks gestation. Data were collected on demographic, medical history, diet and physical activity during pregnancy. Relationships between race and maternal outcomes and infant outcomes were assessed using multivariable logistic regression models. The average age of pregnant women were 26 years (±4.8), with a mean BMI of 32.1 (±5.1) kg/m2 at the time of enrollment. At delivery, 60 women (33%) had GWG within Institute of Medicine recommendations and 69% had at least one comorbidity. No significant differences by race were found in GWG (in lbs) (11±7.5 vs. 11.4±7.3, p=0.2006) as well as other perinatal outcomes including maternal morbidity, LBW and PTB. Race differences were noted for gestational diabetes, total energy expenditure and average daily calorie intake, but these differences did not result in significant differences in GWG or maternal morbidity. The lack of racial differences in GWG and perinatal outcomes demonstrated in this study differs from prior literature and could potentially be attributed to small sample size. Findings suggest that race differences in GWG and perinatal outcomes may diminish for women with a BMI in the overweight or obese range at conception.

A Pilot Lifestyle Behavior Intervention for Overweight or Obese Pregnant Women: Results and Process Evaluation.

This paper presents a pilot lifestyle behavior intervention effect on gestational weight gain and maternal and neonatal outcomes and intervention acceptability. Overweight or obese pregnant participants (N = 70) were randomized to the intervention or usual care group. The 20-week intervention integrated Hope theory and goal-oriented episodic future thinking (GoEFT) to prevent excessive gestational weight gain through stress and emotion management, healthy eating, and physical activity. Intervention participants completed a weekly web intervention module with 2 parts (I and II) and joined individual health coaching sessions (10 sessions). The primary outcome was gestational weight gain (GWG). Secondary outcomes included maternal and neonatal outcomes. Data were collected at 3 time points: baseline (< 17 weeks gestation, T1), 24-27 weeks gestation (T2), and 35-37 weeks gestation (T3). Intervention participants completed a semi-structured interview to evaluate the intervention. We compared GWG at T2 and T3 with T1 for intervention and usual care groups using t-tests and conducted content analysis to identify common themes for intervention acceptability. There were no significant group differences in GWG at T2 and T3. Maternal and neonatal outcomes were similar between groups. Common themes for intervention acceptability were disked web Part I intervention presented in text, the need for choosing a weekly intervention topic, raising awareness through GoEFT and self-evaluation, increased motivation through GoEFT, and usefulness of pre-written goals and goal progress evaluation. Results of process evaluation are helpful for researchers to design a lifestyle intervention to prevent excessive gestational weight gain.

Effectiveness of different behavioral interventions on gestational weight gain, post-partum weight retention and anthropometric measures in pregnancy: A randomized controlled trial.

Background: The antenatal and postnatal periods are critical stages in a woman's reproductive life. Many physical changes occur during pregnancy, such as water retention and excessive weight gain. The aim of the present study is to find out the effectiveness of various behavioral interventions during pregnancy to prevent excessive gestational weight gain (GWG) and postpartum weight retention (PPWR). Methods: In this parallel-group randomized controlled trial, 150 pregnant women with singleton pregnancy, aged 20-30 years, body mass index (BMI)≥18.5 kg/m2 and gestational age of less than 16 weeks were randomly allocated into five groups (N=30 in each group): Group A: Control; Group B: Supervised exercise; Group C: Pedometer; Group D: Text message; and Group E: Pedometer plus text message group. Group B received four supervised exercise sessions per month up to delivery; Groups C and E were urged to increase their levels of physical activity, focusing on pedometer-measured step counts of at least 5000-7500 steps per day on seven consecutive days each month. Group E along with group D also received standard SMS messages about physical activity, diet, motivation, and educational-specific topics. Results: The between-group comparisons revealed a statistically significant reduction in PPWR but insignificant difference in GWG. The greatest reduction in PPWR was found in the supervised exercise group (MD=3.25 kg, 95% CI: [1.75, 4.75], P=0.0001 with effect size (η2 )=0.155). Conclusion: The study found that the supervised exercise can be seen as an effective way of improving the physical activity level and reducing excessive PPWR in pregnant women.

Effectiveness of a nurse-led mHealth app to prevent excessive gestational weight gain among overweight and obese women: A randomized controlled trial.

To explore the effectiveness of a nurse-led mobile health (mHealth) intervention to prevent excessive gestational weight gain (GWG) in overweight and obese women. A randomized controlled trial with an experimental study design. Ninety-two pregnant women with body mass index (BMI) ≥25 kg/m2 at less than 17 weeks gestation were recruited from two prenatal clinics in northern Taiwan from January to June 2020. The experimental group used the MyHealthyWeight (MHW) app and a wearable activity tracker (WAT), and the controls received standard antenatal treatments with no mHealth-based elements. Two hospital follow-up visits were scheduled at 24-26 weeks in the second trimester and 34-36 weeks in the third trimester. A generalized estimating equation (GEE) was used to examine the trajectories and the effectiveness of mHealth on GWG. No difference in GWG was found between the intervention and control groups at baseline (p > 0.05). The GWG trajectory in the entire cohort of women with obesity exhibited a quadratic pattern (ß=1.8, 95% confidence interval [CI]=1.27-2.32), and intervention participants' weekly GWG was gained significantly lower than their controls in the second trimester (p < 0.05). Throughout the pregnancy, the mHealth intervention group had a significantly lower proportion of individuals who exceeded their GWG in both total (21.6% vs. 32.6%) and weekly weight gain (first trimester=58.7% vs. 65.2%; second trimester=45% vs. 67.4%; third trimester=48.6% vs. 55.1%). In particular, among obese women in the third trimester, those in the intervention group gained less gestational weight than their controls. The adjusted body weight difference was 5.44 kg (p=0.023), signifying the total GWG difference (3.30 vs. 8.74 kg) between the means of the two groups. The GEE model indicated that obese women who were aged 35 years, had prepregnancy exercise habits, perceived self-efficacy of diet, and more physical activity tended to have low GWG (p < 0.05). The nurse-led mHealth-based intervention shows promising results in significantly preventing excessive GWG among high-BMI women. More effectiveness was found among the obese subgroup. The mHealth-based intervention would be successfully implemented by nurses to help high-BMI women maintain their optimal body weight and promote healthy behavioral changes, particularly in diet and physical activity during pregnancy.

Adherence to Mediterranean Diet and Its Association with Maternal and Newborn Outcomes.

Background: Pregnancy is a crucial stage in a woman’s life and can be affected by epigenetic and environmental factors. Diet also plays a key role in gestation. This study aimed to evaluate how a greater or lesser adherence to the Mediterranean Diet (MD) influences specific parameters of mother and newborn. Methods: After delivery, the women participating in the study answered a questionnaire: demographic information; anthropometric data (pre-pregnancy weight, height, and gestational weight gain); dietary habits information (adherence to MD before and during pregnancy, using the validated Mediterranean Diet Adherence Screener (MEDAS), quality of protein intake); pregnancy information (onset of complications, cesarean/vaginal delivery, gestational age at birth, birth weight, birth length); and clinical practitioner for personalized dietary patterns during pregnancy. Results: A total of 501 respondents have been included in the study, and 135 were excluded for complications. Women who followed the advice of clinical nutritionists showed better adherence to MD (p = 0.02), and the baby’s birth weight was higher (p = 0.02). Significant differences in gestational weight gain (p < 0.01) between groups with dissimilar diet adherence were demonstrated. Conclusion: Our data demonstrate a significant relationship between adherence to MD and birthweight.

Smoking status and maternal weight trajectories during pregnancy and postpartum: Preliminary results from a pilot study

ObjectiveTo preliminarily examine throughout pregnancy and 12 months postpartum: 1) the critical timings of abnormal gestational weight gain (GWG) among quitters and non-quitters; 2) the consequences of abnormal GWG on weight retention during postpartum; 3) the potential difference in GWG by timing of quitting (early vs. late). MethodsWe included 59 pregnant smokers (49 quitters and 10 non-quitters) from two clinical pilot studies. Smoking status and weight were repeatedly measured throughout pregnancy and postpartum. Weight trajectories were analyzed using mixed models with smoking cessation status, pregnancy week or postpartum month, their interaction term, and potential confounders. ResultsAt enrollment, mothers had a mean BMI of 28.7 (SD, 7.2) and mean age of 30.1 years (SD, 5.8). Both groups had a linear increase in GWG, but quitters had a much higher rate of GWG (0.87 vs. 0.22 pounds/week) than non-quitters throughout pregnancy. Before delivery, 63.3% of quitters and 20.0% of non-quitters had excessive total GWG, while 12.2% of quitters and 60.0% of non-quitters had inadequate total GWG (p-value=0.004). Early quitters (<21 weeks) had a higher risk of excessive GWG (85.0%) than late quitters (≥21 weeks, 36.4%) (p-value=0.026). After delivery, quitters’ weight remained stable following a rapid weight loss, whereas non-quitters’ weight increased continuously. ConclusionsNon-quitters have a high risk of inadequate GWG, while quitters, especially early quitters, have a high risk of excessive GWG. The group difference in weight trajectories lasted from conception to postpartum.

Differences in gestational weight gain in accordance with Japanese and Institute of Medicine guidelines between Japanese and non-Japanese Asian pregnant women at a perinatal medical center in Japan

Differences in gestational weight gain in accordance with Japanese and Institute of Medicine guidelines between Japanese and non-Japanese Asian pregnant women at a perinatal medical center in Japan

The association between weight gain at different stages of pregnancy and risk of gestational diabetes mellitus.

Aims/IntroductionWomen with excessive gestational weight gain (GWG) are at a higher risk for complications during pregnancy, such as preeclampsia. However, the association between excessive GWG and gestational diabetes mellitus (GDM) remains unclear.Materials and MethodsWe retrospectively reviewed 8,352 women from our obstetric database with singleton pregnancies who gave birth after 28 completed weeks of gestation between January 1, 2012, and December 31, 2016, excluding pregnancies complicated by fetal anomalies, fetal death, and overt diabetes. Diagnosis of GDM was based on the criteria recommended by the International Association of Diabetes and Pregnancy Study Groups. We used two classification methods to define excessive GWG: a weight gain above the 90th percentile of the population, or exceeding the upper range recommended by the Institute of Medicine, stratified by pre‐pregnancy body mass index. Statistical analysis was performed using multiple logistic regression to determine the association between excessive GWG and the risk of GDM.ResultsOverall, 1,129 women (13.5%) were diagnosed with GDM. There was no difference in GWG between women with and without GDM in the first trimester and before GDM screening. Women with GDM had significantly less GWG in the second trimester, after GDM screening, and throughout the whole gestation than women without GDM. No correlation was found between excessive GWG in the first and second trimesters, before GDM screening, and the later development of GDM.ConclusionsOur results indicate that excessive GWG prior to GDM screening is not associated with an increased risk of GDM.

Encouraging appropriate gestational weight gain in high-risk gravida: A randomized controlled trial.

Trial DesignExcessive gestational weight gain (GWG) can increase pregnancy morbidity and is particularly problematic for women with pregestational obesity. A lifestyle modification intervention was introduced to gravida with obesity to decrease excessive GWG as compared to usual care (UC).MethodsA randomized controlled trial was conducted to improve healthy lifestyle behaviors to manage appropriate GWG. Consenting participants with prepregnancy obesity and singletons ≤17 weeks were randomized to (1) Usual Care (UC): usual written educational materials and counseling by obstetric provider or (2) Enhanced Care (EC): UC plus (a) personalized letter from physician detailing appropriate GWG; (b) access to individualized GWG chart; (c) ongoing counseling with registered dietitian/nutritionist (RDN). The primary outcome was proportion with GWG ≤9.1 kg, as this is upper limit recommended by Institute of Medicine (IOM). Total GWG and GWG as less than/within/greater than IOM recommendations (in aggregate and stratified by obesity class), and pregnancy/neonatal outcomes were evaluated as secondary outcomes.ResultsAnalyses included 105 participants in EC and 109 in UC arms. The groups had similar demographics: 46% with class I obesity, 26% class II, and 28% class III. There were no group differences for any GWG, pregnancy, or neonatal outcomes when analyzed in aggregate. As compared to those randomized to the EC arm, participants in UC arm with class I obesity gained 1.4 kg less and those with class II obesity were significantly more likely to gain within IOM guidelines (14.8% vs. 40.0%, adjusted p = 0.04). Participants with class III obesity randomized to EC arm were more likely to gain within IOM guidelines as compared to participants randomized to UC arm (29.0% vs. 6.7%, adjusted p = 0.02).ConclusionThere were no differences in GWG observed between groups when analyzing participants in aggregate. However, a physician's letter detailing appropriate GWG, patient portal access to a personalized GWG chart, and RDN consultation were helpful for encouraging GWG within IOM guidelines for women with prepregnancy class III obesity. Women with class I or II obesity had better GWG outcomes without these additional interventions.

343 Evaluating compliance with a remote self-monitoring weight program in low risk women and perinatal outcomes

To compare gestational weight gain (GWG), postpartum weight retention (PPWR) and other perinatal outcomes according to compliance with a remote self-monitoring weight program in low-risk women. Women were recruited in the first trimester for the Babyscripts program, which provided a mobile application, educational resources and an internet-connected digital scale during 2016-2018 from a single hospital-based clinic. Women with pre-gravid BMI ≤ 38, single gestation and without pre-existing diabetes or hypertension were invited to participate. Participants were instructed to weigh themselves weekly from initiation of the program to delivery. Demographics, GWG, PPWR and other outcomes were abstracted from the electronic medical records. Compliance was defined as weights recorded for ≥ 50% of weeks during participation. GWG and PPWR were analyzed as weight differences from first prenatal visit to delivery and 4-12 weeks postpartum, respectively. GWG goals were calculated using the Institute of Medicine (IOM) guidelines for GWG per pre-gravid body mass index (BMI). Of the 442 women who participated, 298 (69%) were compliant (median of 22.5 weeks of weight measurements) and 135 (31%) were noncompliant (median of 7 weeks of weight measurements). There were significantly more nulliparas in the compliant group (68% vs. 54%, p=0.005) and more normal weight, less overweight, and less obese women in the compliant group (p=0.03). Mean GWG (13.4 kg ± 8.6 vs. 13.3 kg ± 5.3, p=0.91) and mean PPWR (3.0 kg ± 3.7 vs. 3.5 kg ± 4.6, p=0.46) were similar in compliant compared to noncompliant groups. There were no differences in GWG goals of inadequate (28% vs. 19%), adequate (40% vs. 44%), or excessive (33% vs. 36%), p=0.18. There were no differences in gestational age at delivery, mode of delivery or birthweight between the groups, p>0.05 for all comparisons. Compliance with a remote self-monitoring program of perinatal weight was higher among nulliparous, normal weight low-risk women, but there were no differences in GWG, PPWR, or other perinatal outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

202 Effect of mild chronic restraint stress on gestational weight gain in murine model

To assess the effect of restraint stress on gestational weight gain in a murine model. Nulliparous female mice, divided among C57BL/6 (n=14), DBA/2 (n=11), and B6D2F1/J (n=9) strains were bred at 8-10 weeks of age with B6D2F1/J males. Detection of a copulation plug was used to determine embryonic day (E) 0.5. Dams were then randomly assigned to either stress or control groups. The mice assigned to stress underwent daily 2-hour periods of restraint in a ventilated clear 50-mL conical centrifuge tube from E1.5-E15.5. The primary outcome was the difference between weight on day E15.5 compared to day E0.5. Pregnancy was confirmed by either preterm delivery from E15.5-E17.5 or by inspection of the uterus after sacrifice on E17.5. Mean weight gain for each strain was compared between the control and stress groups using independent sample t-tests. Values of p < .05 were considered statistically significant. Mean gestational weight gain is presented in Figure 1. DBA/2 and B6D2F1/J mice exposed to restraint stress demonstrated significantly lower gestational weight gain than their respective controls (p=.001 and p=.005, respectively). There was not a significant difference in gestational weight gain in stressed C57BL/6 mice compared to controls (p=.70). Mild chronic restraint stress results in decreased gestational weight gain in DBA/2 and B6D2F1/J mice but not in C57BL/6 mice.

Maternal Gestational Weight Gain in Relation to Antidepressant Continuation in Pregnancy.

Both excessive and inadequate gestational weight gain (GWG) are associated with adverse health outcomes for the woman and her child. Antidepressant use in pregnancy could affect GWG, based on evidence in nonpregnant women that some antidepressants may cause weight gain and others weight loss. Previous studies of antidepressant use and GWG were small with limited ability to account for confounding, including by maternal mental health status and severity. We assessed the association of antidepressant continuation in pregnancy with GWG among women using antidepressants before pregnancy. Our retrospective cohort study included singleton livebirths from 2001 to 2014 within Kaiser Permanente Washington, an integrated health care system. Data were obtained from electronic health records and linked Washington State birth records. Among women with ≥1 antidepressant fill within 6 months before pregnancy, women who filled an antidepressant during pregnancy were considered "continuers;" women without a fill were "discontinuers." We calculated mean differences in GWG and relative risks (RR) of inadequate and excessive weight gain based on Institute of Medicine guidelines. Using inverse probability of treatment weighting with generalized estimating equations, we addressed differences in maternal characteristics, including mental health conditions. Among the 2,887 births, 1,689 (59%) were to women who continued antidepressants in pregnancy and 1,198 (42%) were to discontinuers. After accounting for confounding, continuers had similar weight gain to those who discontinued (mean difference: 1.3 lbs, 95% confidence interval [CI]: -0.1 to 2.8 lbs) and similar risks of inadequate and excessive GWG (RR: 0.95, 95% CI: 0.80-1.14 and RR: 1.06, 95% CI: 0.98-1.14, respectively). Findings were comparable for specific antidepressants and trimesters of exposure. We did not find evidence that continuation of antidepressants in pregnancy led to differences in GWG. · Antidepressant use is associated with weight change in nonpregnant populations.. · Prior evidence on whether antidepressant use in pregnancy affects gestational weight gain is sparse.. · We accounted for confounding by characteristics such as mental health conditions and their severity.. · We found no association between pregnancy antidepressant continuation and gestational weight gain..

Effect of Educational Short Message Service (SMS) on Excessive Gestational Weight Gain (GWG)

Abstract Objectives The objective of this trial was to investigate the effect of educational short message service (SMS), or text messages, on gestational weight gain (GWG) in a low-income population. It was expected that the intervention group, which received text messages on nutrition and physical activity during pregnancy, would experience less GWG when compared to the control group. Methods Participants (n = 83) were recruited at WIC clinics on the island of O‘ahu, Hawai‘i at 15–20 weeks gestational age. Eligibility criteria were: body mass index (BMI) of 25–45 kg/m2 in the first trimester, 18 years of age or older at the time of recruitment, and possession of a cellular phone with the ability to receive text messages. After recruitment, participants were randomized into intervention (n = 42) and control (n = 41) groups. The intervention group received SMS on nutrition and physical activity during pregnancy per the Institute of Medicine and American College of Obstetricians and Gynecologists guidelines, respectively. The control group received SMS about general health topics during pregnancy. Both groups received one text message per week for eighteen weeks. GWG was defined as the difference between the last weight taken before delivery and participants’ self-reported weight before pregnancy. GWG in intervention and control groups was compared using a linear regression model. Results Women were age 27.7 ± 5.3y on average, 65.5% were Native Hawaiian, Pacific Islander or American Indian, 54.8% had some college or more and 37.8% were employed. The average weight before pregnancy was higher in the intervention group (80.6 + 17.7 kg) than that in the control group (76.2 + 15.9 kg), but this difference was not significant (P = 0.24). GWG was lower in the control group (14.1 + 11.4 kg) compared to the intervention group (15.5 + 11.6 kg), but this result was not significant (P = 0.58). Conclusions There was no significant difference in gestational weight gain between the intervention and control groups. Trials that begin earlier in pregnancy or before pregnancy with longer interventions and more frequent messages are needed. Funding Sources Mountain West Clinical Translational Research Infrastructure Network under a grant from the National Institute of General Medicine Sciences of the National Institutes of Health.

Multistrain Probiotic Increases the Gut Microbiota Diversity in Obese Pregnant Women: Results from a Randomized, Double-Blind Placebo-Controlled Study.

BackgroundMaternal obesity is associated with adverse pregnancy outcomes. Probiotic supplementation during pregnancy may have positive effects on blood glucose, gestational weight gain (GWG), and the risk of gestational diabetes mellitus [GDM and glycated hemoglobin (HbA1c)].ObjectivesThis feasibility study involved a daily probiotic intervention in obese pregnant women from the early second trimester until delivery. The primary aim was to investigate the effect on GWG and maternal glucose homeostasis (GDM and HbA1c). Secondary aims were the effect on infant birth weight, maternal gut microbiota, and other pregnancy outcomes.MethodsWe carried out a randomized double-blinded placebo-controlled study in 50 obese pregnant women. Participants were randomly allocated (1:1) to multistrain probiotic (4 capsules of Vivomixx®; total of 450 billion CFU/d) or placebo at 14–20 weeks of gestation until delivery. Participants were followed with 2 predelivery visits at gestational week 27–30 and 36–37 and with 1 postdelivery visit. All visits included blood and fecal sampling. An oral-glucose-tolerance test was performed at inclusion and gestational week 27–30.ResultsForty-nine participants completed the study. Thirty-eight participants took >80% of the capsules (n = 21), placebo (n = 17). There was no significant difference in GWG, GDM, HbA1c concentrations, and infant birth weight between groups. Fecal microbiota analyses showed an overall increase in α-diversity over time in the probiotic group only (P = 0.016).ConclusionsAdministration of probiotics during pregnancy is feasible in obese women and the women were willing to participate in additional study visits and collection of fecal samples during pregnancy. Multistrain probiotic can modulate the gut microbiota in obese women during pregnancy. A larger study population is needed to uncover pregnancy effects after probiotic supplementation. This trial was registered at clincaltrials.gov as NCT02508844.