Differences In Gestational Weight Gain Research Articles

Predictors of Gestational Weight Gain in a Low-Income Hispanic Population: Sociodemographic Characteristics, Health Behaviors, and Psychosocial Stressors.

Hispanic women have a higher prevalence of weight associated complications in pregnancy. This ethnic disparity is likely related to behavior patterns, social circumstances, environmental exposures, and access to healthcare, rather than biologic differences. The objective was to determine associations between sociodemographic characteristics, health behaviors, and psychosocial stressors and gestational weight gain (GWG) in low-income Hispanic women. During pregnancy, information on sociodemographic characteristics, health behaviors, and psychosocial stressors were collected. Linear regression estimated mean differences in GWG by selected predictors. Multinomial logistic regression estimated odds of inadequate and excessive GWG by selected predictors. Five-hundred and eight women were included, 38% had inadequate and 28% had excessive GWG; 57% with a normal pre-pregnancy BMI had inadequate GWG. Compared to women with normal BMI, women with overweight or obesity were more likely to have excessive GWG (aRRR = 1.88, 95% CI: 1.04, 3.40 and aRRR = 1.98, 95% CI: 1.08, 3.62, respectively). Mean total GWG was higher among women who were nulliparous (ß = 1.34 kg, 95% CI: 0.38, 2.29) and those who engaged in ≥3 h of screen time daily (ß = 0.98 kg, 95% CI: 0.02, 1.94), and lower among women who were physically active during pregnancy (ß = −1.00 kg, 95% CI: −1.99, −0.03). Eating breakfast daily was associated with lower risk of inadequate GWG (aRRR = 0.47, 95% CI: 0.26, 0.83). Depressive symptoms and poor adherence to dietary recommendations were prevalent, but none of the psychosocial or dietary variables were associated with GWG. In this cohort of primarily immigrant, low-income, Hispanic women, there were high rates of poor adherence to diet and physical activity recommendations, and a majority of women did not meet GWG guidelines. Modifiable health behaviors were associated with GWG, and their promotion should be included in prenatal care.

Stratified analysis of the correlation between gestational weight gain and birth weight for gestational age: a retrospective single-center cohort study in Japan

BackgroundJapan has an exceptionally high proportion of low-weight births and underweight women. It has been suggested that an appropriate increase in gestational weight gain (GWG) for underweight women will help to prevent low birth weight. The current strategy aims to raise the desired value of GWG equally for all pregnant women within the underweight category. However, it remains elusive whether or not the relationship between GWG and birth weight for gestational age (BW/GA) are uniformly equivalent for all the women.MethodsWe performed a retrospective cohort analysis of women who delivered their newborns at Tokyo Medical and Dental University Hospital from 2013 to 2017. First, in order to examine the direct effect of an increase or decrease in GWG on BW/GA, we analyzed the correlation between inter-pregnancy differences in GWG and BW/GA using a sub-cohort of women who experienced two deliveries during the study period (n = 75). Second, we dichotomized the main cohort (n = 1114) according to BW/GA to verify our hypothesis that the correlation between GWG and BW/GA differs depending on the size of the newborn.ResultsThe inter-pregnancy difference in BW/GA was not correlated with that of GWG. However, the correlation between BW/GA of siblings was high (r = 0.63, p = 1.9 × 10− 9). The correlation between GWG and BW/GA in women who delivered larger-sized newborns was higher (r = 0.17, p = 4.1 × 10− 5) than that in women who delivered smaller-sized newborns (r = 0.099, p = 1.9 × 10− 2). This disparity did not change after adjustment for pre-pregnancy BMI. The mean birth weight in the dichotomized groups corresponded to percentile 52.0 and 13.4 of the international newborn size assessed by INTERGROWTH-21st standards.ConclusionsIn our study, GWG was positively correlated with BW/GA for heavier neonates whose birth weights were similar to the average neonatal weight according to world standards. However, caution might be required for low-birth-weight neonates because increased GWG does not always result in increased birth weight.

Racial/ethnic variations in gestational weight gain: a population-based study in Ontario

ObjectiveTo explore inadequate and excessive gestational weight gain (GWG) among pregnant women of different racial/ethnic backgrounds in Ontario, Canada.MethodsA population-based retrospective cohort study was conducted among women who had prenatal screening and had a singleton birth in an Ontario hospital between April 2016 and March 2017. We estimated adjusted risk ratios (aRR) of racial/ethnic differences for inadequate or excessive GWG using multinomial logistic regression models. Interaction effects were examined to determine whether racial/ethnic difference in GWG varied by pre-pregnancy body mass index (BMI).ResultsAmong 74,424 women, the prevalence of inadequate GWG in White, Asian, and Black women was 15.7%, 25.8%, and 25.0%, and excessive GWG was 62.8%, 45.5%, and 54.7%, respectively. There were significant interaction effects between race/ethnicity and pre-pregnancy BMI for inadequate GWG (Wald p < 0.01) and excessive GWG (Wald p < 0.01). Compared with White women, Asian women had higher risk of inadequate GWG and lower risk of excessive GWG in all weight classes, and Black women had higher risk of inadequate GWG and lower risk of excessive GWG if their BMI was normal, overweight, or obese.ConclusionVariations in unhealthy GWG by pre-pregnancy weight classes among Ontario White, Asian and Black women were observed. Individualized counseling regarding appropriate GWG is universally recommended. Additional consideration of racial/ethnic variations by maternal weight classes may help to promote healthy GWG in Canada.

Feasibility of conducting an early pregnancy diet and lifestyle e-health intervention: the Pregnancy Lifestyle Activity Nutrition (PLAN) project.

Childhood obesity is a global issue. Excessive weight gain in early pregnancy is independently associated with obesity in the next generation. Given the uptake of e-health, our primary aim was to pilot the feasibility of an e-health intervention, starting in the first trimester, to promote healthy lifestyle and prevent excess weight gain in early pregnancy. Methods: Women were recruited between 8 and 11 weeks gestation and randomised to the intervention or routine antenatal care. The intervention involved an e-health program providing diet, physical activity and well-being advice over 12 weeks. Women (n = 57, 43.9% overweight/obese) were recruited at 9.38 ± 1.12 (control) and 9.06 ± 1.29 (intervention) weeks' gestation, mainly from obstetric private practices (81.2%). Retention was 73.7% for the 12-week intervention, 64.9% at birth and 55.8% at 3 months after birth.No difference in gestational weight gain or birth size was detected. Overall treatment effect showed a mean increase in score ranking the perceived confidence of dietary change (1.2 ± 0.46, p = 0.009) and score ranking readiness to exercise (1.21 ± 0.51, p = 0.016) over the intervention. At 3 months, infants weighed less in the intervention group (5405 versus 6193 g, p = 0.008) and had a lower ponderal index (25.5 ± 3.0 versus 28.8 ± 4.0 kg/m3) compared with the control group. A lifestyle intervention starting in the first-trimester pregnancy utilising e-health mode of delivery is feasible. Future studies need strategies to target recruitment of participants of lower socio-economic status and ensure maximal blinding. Larger trials (using technology and focused on early pregnancy) are needed to confirm if decreased infant adiposity is maintained.

Mighty Mums \u2013 a lifestyle intervention at primary care level reduces gestational weight gain in women with obesity

BackgroundObesity (BMI ≥30) during pregnancy is becoming an increasing public health issue and is associated with adverse maternal and perinatal outcomes. Excessive gestational weight gain (GWG) further increases the risks of adverse outcomes. However, lifestyle intervention can help pregnant women with obesity to limit their GWG. This study evaluated whether an antenatal lifestyle intervention programme for pregnant women with obesity, with emphasis on nutrition and physical activity, could influence GWG and maternal and perinatal outcomes.MethodsThe intervention was performed in a city in Sweden 2011–2013. The study population was women with BMI ≥30 in early pregnancy who received standard antenatal care and were followed until postpartum check-up. The intervention group (n = 459) was provided with additional support for a healthier lifestyle, including motivational talks with the midwife, food advice, prescriptions of physical activity, walking poles, pedometers, and dietician consultation. The control group was recruited from the same (n = 105) and from a nearby antenatal organisation (n = 790).ResultsIn the per-protocol population, the intervention group had significantly lower GWG compared with the control group (8.9 ± 6.0 kg vs 11.2 ± 6.9 kg; p = 0.031). The women managed to achieve GWG < 7 kg to a greater extent (37.1% vs. 23.0%; p = 0.036) and also had a significantly lower weight retention at the postpartum check-up (− 0.3 ± 6.0 kg vs. 1.6 ± 6.5 kg; p = 0.019) compared to the first visit. The most commonly used components of the intervention, apart from the extra midwife time, were support from the dietician and retrieval of pedometers. Overall compliance with study procedures, actual numbers of visits with logbook activity, and dietician contact correlated significantly with GWG. There was no statistically significant difference in GWG (10.3 ± 6.1 kg vs. 11.2 ± 6.9 kg) between the intervention and control groups in the intention-to-treat population.ConclusionPregnant women with obesity who follow a lifestyle intervention programme in primary health care can limit their weight gain during pregnancy and show less weight retention after pregnancy. This modest intervention can easily be implemented in a primary care setting.Trial registrationThe study has been registered at ClinicalTrials.gov, Identifier: NCT03147079. May 10 2017, retrospectively registered.

Nutrient deficiency and obstetrical outcomes in pregnant women following Roux-en-Y gastric bypass: A retrospective Danish cohort study with a matched comparison group

ObjectiveRoux-en-Y gastric bypass surgery and small-for-gestational-age births are known to be associated although the etiology is not fully understood. This study aimed to investigate pregnancy outcomes and maternal nutritional status among pregnant women with a history of Roux-en-Y gastric bypass using maternal anemia and gestational weight gain as indicators of micronutrient and macronutrient deficiency in pregnancy. Study designThe study was designed as a retrospective matched cohort study. All Roux-en-Y-gastric-bypass-operated pregnant women (n=151) who were followed in the outpatient obstetric clinic at Aalborg University Hospital in Denmark and gave birth between 1 January 2010 and 31 December 2013 were included. Each Roux-en-Y-gastric-bypass-operated woman was closely matched with a non-Roux-en-Y-gastric-bypass-operated woman. Primary outcomes were small-for-gestational-age birth, maternal anemia and gestational weight gain. The two groups (matched 1:1) were compared by paired tests on all measures, conditional logistic regression for paired binary data and the paired t-test or Wilcoxon signed-rank test for paired continuous data. ResultsThe risk of small-for-gestational-age birth (odds ratio (OR)=2.67, 95% confidence interval (CI); 1.04–6.82) and maternal anemia (OR=3.0, 95% CI; 1.09–8.25) were significantly increased for the Roux-en-Y gastric bypass group compared to the non-Roux-en-Y gastric bypass group. No significant difference was found in gestational weight gain (p=0.169) between women with a history of Roux-en-Y gastric bypass (11.51kg±8.97 standard deviation (SD)) and non- Roux-en-Y-gastric-bypass-operated women (12.18kg±6.28 SD). ConclusionA history of Roux-en-Y gastric bypass surgery increases the risk of small-for-gestational-age birth and anemia, while a finding of differences in gestational weight gain is uncorroborated. Our findings suggest a role of micronutrient deficiency rather than reduced gestational weight gain in the etiology of small-for-gestational-age birth among women with a history of Roux-en-Y gastric bypass surgery.

Effect of Probiotics on Metabolic Outcomes in Pregnant Women with Gestational Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The metabolic effects of probiotic administration in women with gestational diabetes mellitus (GDM) is unknown. The objective of this review was to investigate the effect of probiotics on fasting plasma glucose (FPG), insulin resistance (HOMA-IR) and LDL-cholesterol levels in pregnant women diagnosed with GDM. Seven electronic databases were searched for RCTs published in English between 2001 and 2017 investigating the metabolic effects of a 6–8 week dietary probiotic intervention in pregnant women following diagnosis with GDM. Eligible studies were assessed for risk of bias and subjected to qualitative and quantitative synthesis using a random effects model meta-analyses. Four high quality RCTs involving 288 participants were included in the review. Probiotic supplementation was not effective in decreasing FBG (Mean Difference = −0.13; 95% CI −0.32, 0.06, p = 0.18) or LDL-cholesterol (−0.16; 95% CI −0.45, 0.13, p = 0.67) in women with GDM. However, a significant reduction in HOMA-IR was observed following probiotic supplementation (−0.69; 95% CI −1.24, −0.14, p = 0.01). There were no significant differences in gestational weight gain, delivery method or neonatal outcomes between experimental and control groups, and no adverse effects of the probiotics were reported. Probiotic supplementation for 6–8 weeks resulted in a significant reduction in insulin resistance in pregnant women diagnosed with GDM. The use of probiotic supplementation is promising as a potential therapy to assist in the metabolic management of GDM. Further high quality studies of longer duration are required to determine the safety, optimal dose and ideal bacterial composition of probiotics before their routine use can be recommended in this patient group.

Association of Group Prenatal Care With Gestational Weight Gain.

To compare gestational weight gain among women in group prenatal care with that of women in individual prenatal care. In this retrospective cohort study, women who participated in group prenatal care from 2009 to 2015 and whose body mass indexes (BMIs) and gestational weight gain were recorded were matched with the next two women who had the same payer type, were within 2-kg/m prepregnancy BMI and 2-week gestational age at delivery, and had received individual prenatal care. Bivariate comparisons of demographics and antenatal complications were performed for women in group and individual prenatal care, and weight gain was categorized as "below," "met," or "exceeded" goals according to the 2009 Institute of Medicine guidelines. Logistic regression analysis estimated the association between excessive weight gain and model of care, with adjustment for confounders, stratified by BMI. Women in group prenatal care (n=2,117) were younger and more commonly non-Hispanic black, nulliparous, and without gestational diabetes (P≤.005 for all). Women in group prenatal care more commonly exceeded the weight gain goals (55% compared with 48%, P<.001). The differences in gestational weight gain were concentrated among normal-weight (mean 34.2 compared with 32.1 pounds, P<.001; 47% compared with 41% exceeded, P=.008) and overweight women (mean 31.5 compared with 27.1 pounds, P<.001; 69% compared with 54% exceeded, P<.001). When adjusted for age, race-ethnicity, parity, education, and tobacco use, the increased odds for excessive gestational weight gain persisted among normal-weight (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.09-1.51) and overweight (OR 1.84, 95% CI 1.50-2.27) women. Nulliparity was associated with increased excessive gestational weight gain (OR 1.49, 95% CI 1.33-1.68), whereas Hispanic ethnicity was associated with decreased excessive gestational weight gain (OR 0.68, 95% CI 0.59-0.78). Among normal-weight or overweight women, group prenatal care, compared with individual prenatal care, is associated with excessive gestational weight gain.

Sense of Weight Control Prior to Pregnancy Could Help Predict Women at Risk for Excessive Gestational Weight Gain

IntroductionGaining weight in excess of the Institute of Medicine gestational weight gain (GWG) guidelines is associated with adverse health outcomes for mother and child. It is estimated that 49% of women in Alberta gain excess gestational weight. Weight gain in pregnancy is multifactorial and there is a need to better support women during pregnancy to gain weight within the guidelines. A study in Edmonton, AB, aimed to understand if differing amounts of lifestyle support provided by a Registered Dietitian (RD) throughout pregnancy could help women achieve appropriate GWG. The purpose of these analyses is to understand if there was any difference in GWG between the three groups and to explore the gestational weight related perspectives of the women within the study.MethodsSeventy low‐risk pregnant women, &lt;20 weeks gestation, were randomized to an active control (AC) or intervention (INT) group where they saw a RD for two visits in pregnancy. The two visits occurred at &lt; 24 weeks and 30 weeks gestation. Women completed lifestyle questionnaires throughout pregnancy and a postpartum questionnaire that asked about their prenatal experiences. A passive control group (PC) of women ≤12 months postpartum (n=55) was recruited to only complete the postpartum questionnaire. This group models standard prenatal care in Alberta (no RD visits in pregnancy). GWG information was collected from obstetrical charts and adherence to GWG recommendations was defined in accordance with IOM guidelines. Data were analyzed using chi‐square, t‐test, or one‐way ANOVA.ResultsPre‐pregnancy BMI, ethnicity, education, marital status, household income and parity did not differ between INT (n=33), AC (n=37), and PC (n=55) groups. However, maternal age was different between the groups with the mean age in the PC group as 32.1 compared to 34.4 years for both the INT and AC groups (p=0.022). When asked about GWG perspectives, 78% (n=81) of women stated the amount of weight they gained was important to them with the top 3 reasons being: “To have a healthy pregnancy”, “To deliver a healthy baby” and “For my health”. Intentional changes were made by 68% of the women to help manage their weight in pregnancy, with ~45% changing the type of foods they ate (n=57) and 28% increasing their physical activity (n=35). Total GWG, rate of weight gain and adherence to GWG guidelines did not differ between the three groups. Overall, 50%, 42% and 8% of the participants exceeded, met and fell below the guidelines, respectively. Guideline concordance differed by pre‐pregnancy BMI category (p=0.024), with 78% of the overweight and 67% of the obese women exceeding the guidelines compared with 34% of women within a normal BMI. Women who agreed to feeling in control of their weight prior to pregnancy were more likely to gain weight within the guidelines during pregnancy (p=0.008).ConclusionMost women understand why weight gain in pregnancy is important, yet half exceed the guidelines. Understanding a woman's sense of weight control prior to pregnancy may help aid healthcare providers understand which women who may be at increased risk for excess GWG.Support or Funding InformationThe Danone Institute of Canada, Alberta Innovates Health Solutions

Exercise Training In Pregnancy For Women With Bmi ≥ 28. A Randomized Controlled Trial.

PURPOSE: Maternal obesity is a risk factor for adverse pregnancy outcomes, and excessive gestational weight gain (GWG) is further increasing the risk. Previous lifestyles interventions during pregnancy have shown conflicting results, and have often combined effects of physical activity with dietary guidance. Our aim was to assess the effects of regular exercise training during pregnancy on gestational weight gain (GWG) and incidence of gestational diabetes mellitus (GDM) in women with pre-pregnancy body mass index (BMI) of 28 kg/m2 or more. METHODS: This was a randomized controlled trial, which included women with a pre-pregnancy BMI (kg/m2) ≥ 28. Baseline testing and randomization to exercise or control were done in gestational week 12-18. We measured weight at baseline and at birth, GDM at baseline and gestational week 36 (late pregnancy). GDM was defined by a fasting oral 75 g glucose tolerance test ≥ 6,9 mmol/L and/or 2 hours ≥ 7,8 mmol/L. The exercise was supervised, 3 times per week; 35 minutes of moderate treadmill walking/running and 25 minutes of resistance training for large muscle groups. The control group received standard maternity care. Statistical analyses were done on basis of «intention to treat», with use of linear mixed model and mixed-effect logistic regression. RESULTS: 91 participants were randomized; 46 to exercise and 45 to control. 18 women were lost to follow up (8 exercise, 10 control). 47,7 % in the exercise group performed the training per protocol. At baseline mean weight in the exercise group was 95,5 ± 12,3 kg (BMI 33,9 ± 3,8 kg/m2), in the control group 98,3 ± 14,2 kg (BMI 35,2 ± 4,4 kg/m2). There was no difference in GWG between the exercise and control group (98,3 10,2 ± 5,2 kg and 9,36 ± 7,5 kg, respectively, p = 0.84). At baseline, 3 women in each group had GDM, whereas 2 women in exercise and 8 women in the control group had GDM in late pregnancy (p = 0.086). 2 of the women with GDM at baseline did not fulfill the criteria for GDM at late pregnancy. CONCLUSIONS: Regular exercise during the pregnancy among overweight/obese women did not reduce GWG, compared to a non-exercising control group. The women in the training group had a tendency of lower incidence of GDM in late pregnancy.

Ethnic Differences in Gestational Weight Gain: A Population-Based Cohort Study in Norway.

Objectives To explore ethnic differences in gestational weight gain (GWG). Methods This was a population-based cohort study conducted in primary care child health clinics in Groruddalen, Oslo, Norway. Participants were healthy pregnant women (n=632) categorised to six ethnic groups (43% were Western European women, the reference group). Body weight was measured at 15 and 28weeks' gestation on average. Data on pre-pregnancy weight and total GWG until delivery were self-reported. The main method of analysis was linear regression adjusting for age, weeks' gestation, pre-pregnancy body mass index, education and severe nausea. Results No ethnic differences were observed in GWG by 15weeks' gestation. By 28weeks' gestation, Eastern European women had gained 2.71kg (95% confidence interval, CI 1.10-4.33) and Middle Eastern women 1.32kg (95% CI 0.14-2.50) more weight on average than the Western European women in the fully adjusted model. Among Eastern European women, the total adjusted GWG was 3.47kg (95% CI 1.33-5.61) above the reference group. Other ethnic groups (South Asian, East Asian and African) did not differ from the reference group. When including non-smokers (n=522) only, observed between-group differences increased and Middle Eastern women gained more weight than the reference group by all time points. Conclusions Eastern European and Middle Eastern women had higher GWG on average than Western European women, especially among the non-smokers. Although prevention of excessive GWG is important for all pregnant women, these ethnic groups might need special attention during pregnancy.

Predictors of Gestational Weight Gain among White and Latina Women and Associations with Birth Weight.

This study examined racial/ethnic differences in gestational weight gain (GWG) predictors and association of first-trimester GWG to overall GWG among 271 White women and 300 Latina women. Rates of within-guideline GWG were higher among Latinas than among Whites (28.7% versus 24.4%, p < 0.016). Adjusted odds of above-guideline GWG were higher among prepregnancy overweight (OR = 3.4, CI = 1.8–6.5) and obese (OR = 4.5, CI = 2.3–9.0) women than among healthy weight women and among women with above-guideline first-trimester GWG than among those with within-guideline first-trimester GWG (OR = 4.9, CI = 2.8–8.8). GWG was positively associated with neonate birth size (p < 0.001). Interventions targeting prepregnancy overweight or obese women and those with excessive first-trimester GWG are needed.

Routine weighing to reduce excessive antenatal weight gain: a randomised controlled trial.

To assess whether routinely weighing women at each antenatal visit leads to a difference in gestational weight gain and weight gain within the Institute of Medicine (IOM) recommendation. A randomised controlled trial. Antenatal clinics in a tertiary obstetric hospital in Melbourne, Australia. Healthy women were enrolled during their antenatal booking visit if they were between 18 and 45 years of age, were <21 weeks' gestation with a singleton pregnancy. The intervention was weighing at each antenatal clinic appointment followed by counselling by their treating clinician according to IOM gestational weight gain guidelines. The control group had standard antenatal care comprising recording weight at booking and then at 36 weeks. Primary analysis was by intention-to-treat. The primary outcome was difference in mean weight gain between groups. An important secondary outcome was gestational weight gain within IOM recommendations. Secondary outcomes also included maternal or neonatal morbidity. Seven hundred and eighty two women consented to take part and 386 were randomised to the intervention group and 396 to the control group. There was no significant difference in weight gain between the intervention group (0.54 kg/week) compared with the control group (0.53 kg/week) (P = 0.63). A similar proportion of women gained more weight than the IOM recommended range: 75% in the intervention group and 71% in the control group (P = 0.21). There were no significant differences in secondary outcomes between the two groups. We found no evidence that regular weighing in antenatal clinics changed weight gain or was effective at reducing excessive gestational weight gain.

Gestational weight gain and preterm birth in obese women: a systematic review and meta-analysis.

Prepregnant obesity is a global concern and gestational weight gain has been found to influence the risks of preterm birth. To assess the relationship between gestational weight gain and risk for preterm birth in obese women. Four electronic databases were searched from 18 February through to 28 April 2015. Primary research reporting preterm birth as an outcome in obese women and gestational weight gain as a variable that could be compared to the 2009 Institute of Medicine's recommendations. Two reviewers independently assessed trials for inclusion. The Newcastle Ottawa Scale was used to assess study bias. Our search identified six studies meeting the inclusion criteria; five were conducted in the USA and one in Peru. Four studies with a total of 10 171 obese women were meta-analysed. Significant heterogeneity was found between studies in the pooled analysis. Results for indicated preterm birth in obese women with gestational weight gain above the Institute of Medicine's recommendations showed increased risk (adjusted odds ratio 1.54; 95% CI 1.09-2.16). Available science on this topic is limited to special populations of obese pregnant women. Generalisable research is needed to assess the variation in risk for preterm birth in obese women by differences in gestational weight gain and class of obesity controlling for significant variables in the pathway to preterm birth. This research has the potential to illuminate new science impacting preterm birth and interventions for prevention.

Web-Based Behavioral Intervention Increases Maternal Exercise but Does Not Prevent Excessive Gestational Weight Gain in Previously Sedentary Women.

Innovative methods are warranted to optimize prenatal outcomes. This study's objective was to determine if a web-based behavioral intervention (BI) can prevent excessive gestational weight gain (GWG) by increasing physical activity (PA). Participants were randomized to usual care (UC; n = 21) or BI (n = 24) between 10 to 14 weeks gestation. GWG, PA, and diet were assessed at baseline, mid-, and late pregnancy. No differences in GWG or adherence to GWG recommendations presented between groups. Total UC MET-minutes significantly decreased from baseline to late-pregnancy (1,234 ± 372 MET-minutes, P = .013). Mid-pregnancy sustained PA was greater for BI than UC (20-minute PA bouts: 122 ± 106 vs. 46 ± 48 minutes/week, P = .005; 30-minute PA bouts: 74 ± 70 vs. 14 ± 24 minutes/week, P < .001), and greater for BI at mid-pregnancy compared with baseline (20-minute PA bouts: 61.3 ± 21.9; 30-minute PA bouts: 39.6 ± 14.8, both P < .05). BI energy intake at mid-pregnancy significantly increased from baseline (336 ± 127 kcals, P = .04) and was significantly greater than UC (2,503 ± 703 vs. 1,894 ± 594, P = .005). Sedentary pregnant women should increase PA but may need additional dietary counseling to prevent excessive GWG.

Ethnic disparities in maternal obesity and weight gain during pregnancy. The Generation R Study

ObjectiveTo examine ethnic disparities in maternal prepregnancy obesity and gestational weight gain, and to examine to which extent these differences can be explained by socio-demographic, lifestyle and pregnancy related characteristics. MethodsIn a multi-ethnic population-based prospective cohort study among 6444 pregnant women in Rotterdam, the Netherlands, maternal anthropometrics were repeatedly measured throughout pregnancy. Ethnicity, socio-demographic, lifestyle and pregnancy related characteristics were assessed by physical examinations and questionnaires. ResultsThe prevalence of prepregnancy overweight and obesity was 23.1% among Dutch-origin women. Statistically higher prevalences were observed among Dutch Antillean-origin (40.8%), Moroccan-origin (49.9%), Surinamese-Creole-origin (38.6%) and Turkish-origin (41.1%) women (all p-values <0.05). Only Dutch Antillean-origin, Moroccan-origin, Surinamese-Creole-origin and Turkish-origin women had higher risks of maternal prepregnancy overweight and obesity as compared to Dutch-origin women (p-values <0.05). Socio-demographic and lifestyle related characteristics explained up to 45% of the ethnic differences in body mass index. Compared to Dutch-origin women, total gestational weight gain was lower in all ethnic minority groups, except for Cape Verdean-origin and Surinamese-Creole-origin women (p-values <0.05). Lifestyle and pregnancy related characteristics explained up to 33% and 40% of these associations, respectively. The largest ethnic differences in gestational weight gain were observed in late pregnancy. ConclusionWe observed moderate ethnic differences in maternal prepregnancy overweight, obesity and gestational weight gain. Socio-demographic, lifestyle and pregnancy related characteristics partly explained these differences. Whether these differences also lead to ethnic differences in maternal and childhood outcomes should be further studied.

Gestational Weight Gain and Maternal Diet Composition [272

INTRODUCTION: Obesity (body mass index [BMI, calculated as weight (kg)/[height (m)]2] greater than 30) affects 32% of women of reproductive age. Excessive gestational weight gain and obesity are each linked to poor maternal and fetal outcomes including macrosomia and increased incidence of obesity and diabetes among offspring. Our study looks at the relationships between maternal diet and gestational weight gain. METHODS: Forty-one women with term (greater than 37 weeks of gestation) uncomplicated singleton gestations were enrolled who met prepregnancy BMI criteria for normal (n=11), overweight (n=15), and obese (n=15) status. Each completed three 24-hour food frequency questionnaires, which were evaluated using the Healthy Eating Index. Gestational weight gain was measured using self-reported prepregnancy weight or weight at the first prenatal visit and weight at time of delivery and was assessed by Institute of Medicine 2009 gestational weight gain recommendations. Statistical analysis included linear regression and one-way analysis of variance. RESULTS: The average gestational weight gain was 10.5 kg (−13.5 to 30.7 kg). Seven of 41 women had excessive gestational weight gain. There was a statistically significant difference in gestational weight gain by BMI group (P=.015) with overweight women having the highest gestational weight gain (mean 13.7 kg) and obese women the lowest (mean 6.8 kg). Increased total carbohydrate consumption (g) and percent intake of carbohydrates was associated with increased gestational weight gain (P<.005, r2=0.19, and P=.015, r2=0.14, respectively) regardless of BMI category. There was no association between total fat, total protein, total calorie intake, or Healthy Eating Index score and gestational weight gain. CONCLUSION: These results suggest that pregnant women with excessive carbohydrate intake are at increased risk of excess gestational weight gain and poor outcomes. Dietary intake is a potential target for education and intervention.

Exercise in pregnancy does not alter gestational weight gain, MCP-1 or leptin in obese women.

Increasing physical activity in pregnancy may improve pregnancy outcomes for obese women. Exercise could reduce gestational weight gain, improve the maternal circulating lipid profile as well as alter leptin, Interleukin-8 (IL-8) and Monocyte Chemoattractant Protein-1 (MCP-1) levels. The aim of this study was to investigate the effects of exercise on gestational weight gain, maternal circulating lipids, IL-8, MCP-1 and leptin levels in obese pregnant women. The analysis was performed in the 35 obese women enrolled in the pilot BAMBINO randomised controlled trial who provided blood samples at 12- and 28-weeks gestation. Women in the exercise intervention arm received an individualised exercise plan. Blood samples, exercise diary and pedometer data were obtained at 12-, 20-, 28- and 36-weeks' gestation. Cord blood was obtained at delivery. Women in the exercise arm exercised more than those in the control arm (P=0.038). There was no difference in gestational weight gain, excess gestational weight gain, MCP-1 and leptin levels between women in the exercise intervention (n=19) or the control arm (n=16). IL-8 was not detectable. Exercise did not alter the maternal lipid profile. The low level of physical activity achieved in obese women in the exercise intervention arm was insufficient to alter gestational weight gain, MCP-1, leptin or circulating lipid levels.

Heterogeneous effect of gestational weight gain on birth weight: quantile regression analysis from a population-based screening

PurposeClassical regression models might give an incomplete picture of the associations between predictors and outcomes. We investigated associations between gestational weight gain (GWG) and birth weight along the entire birth weight distribution with quantile regression and estimated effects of hypothetical prevention strategies. MethodsThe GWG–birth weight association was analyzed using quantile and classical regression models on data from a population-based gestational diabetes screening (n = 4760) at the Szent Imre Teaching Hospital in Budapest, Hungary (2002–2005). Birth weight distributions were modeled based on hypothetical GWG changes. ResultsAt a body mass index of 20 kg/m2, a 1-kg difference in GWG was associated with a 14.2 g (95% confidence interval, 10.0–20.9) higher birth weight at the fifth percentile of the birth weight distribution and a 29.0 g (21.3–35.6) higher birth weight at the 95th percentile. The coefficient from linear regression was 20.7 (17.5–24.0). Estimates differed modestly between the two regressions at a body mass index of 30 kg/m2. A population-wide 2-kg decrease in GWG would rather affect the risk of macrosomia (−1.8%) than that of low birth weight (+0.4%). In contrast, a 3-kg decrease in GWG among overweight and obese women would lower macrosomia more modestly (−0.8%). ConclusionsA population-wide lowering of GWG would lead to greater improvements in the right tail of the birth weight distribution.

Maternal genetic variation accounts in part for the associations of maternal size during pregnancy with offspring cardiometabolic risk in adulthood.

BackgroundMaternal pre-pregnancy body-mass index (ppBMI) and gestational weight gain (GWG) are associated with cardiometabolic risk (CMR) traits in the offspring. The extent to which maternal genetic variation accounts for these associations is unknown.Methods/ResultsIn 1249 mother-offspring pairs recruited from the Jerusalem Perinatal Study, we used archival data to characterize ppBMI and GWG and follow-up data from offspring to assess CMR, including body mass index (BMI), waist circumference, glucose, insulin, blood pressure, and lipid levels, at an average age of 32. Maternal genetic risk scores (GRS) were created using a subset of SNPs most predictive of ppBMI, GWG, and each CMR trait, selected among 1384 single-nucleotide polymorphisms (SNPs) characterizing variation in 170 candidate genes potentially related to fetal development and/or metabolic risk. We fit linear regression models to examine the associations of ppBMI and GWG with CMR traits with and without adjustment for GRS. Compared to unadjusted models, the coefficient for the association of a one-standard-deviation (SD) difference in GWG and offspring BMI decreased by 41% (95%CI −81%, −11%) from 0.847 to 0.503 and the coefficient for a 1SD difference in GWG and WC decreased by 63% (95%CI −318%, −11%) from 1.196 to 0.443. For other traits, there were no statistically significant changes in the coefficients for GWG with adjustment for GRS. None of the associations of ppBMI with CMR traits were significantly altered by adjustment for GRS.ConclusionsMaternal genetic variation may account in part for associations of GWG with offspring BMI and WC in young adults.