Early Gestational Weight Gain Research Articles

PSVII-13 Influence of early maternal gestational body weight gain on liver gene expression across generations in offspring

Abstract Maternal nutrition in the periconceptional period influences gene regulation in the fetal liver across generations, affecting long-term metabolism. This study aimed to examine the effects of the rate of body weight (BW) gain of the dam (F0) during early gestation on the differential gene expression of the liver of first (F1) and second-generation (F2) offspring. Crossbred Angus heifers (F0) were assigned into two groups based on their targeted rate of BW gain during the first 84 d of gestation: low gain (LG; 0.28 kg/d; n = 8) or moderate gain (MG; 0.79 kg/d; n = 8). Following this period, all heifers (F0) were kept on a forage-based diet until the F1 offspring were weaned at 8 mo. The F1 heifers underwent estrus synchronization and were artificially inseminated at 15 mo of age. Liver samples were obtained from the F1 heifers at birth and later when harvested at 84 d of gestation, along with liver samples from their F2 fetuses, for a comprehensive multigenerational RNA-Seq analysis. Differentially expressed genes (DEGs) were identified using the DESeq2 R-package, focusing on significant genes determined by a P-value ≤ 0.05 and a log2 fold change |0.5|. Metabolic pathways and biological processes were analyzed using the WebGestalt tool to understand the implications of the observed gene expression changes. At birth, F1 heifers from MG dams exhibited 281 DEGs, comprising 152 downregulated and 129 upregulated genes compared with the offspring of LG dams. These genes were over-represented in lipid metabolism, cellular homeostasis, and signaling pathways, such as MAPK and chemokine signaling. At harvest, 159 DEGs were identified in F1 heifers, with 67 genes downregulated and 92 genes upregulated in the MG group. These genes were related to cellular morphogenesis and biogenesis processes, with a notable downregulation of metabolic pathways. For the F2 fetuses, 192 DEGs were identified, where 71 genes were downregulated, and 121 genes were upregulated. These genes were involved in biological functions such as peptide secretion to cell proliferation and signaling pathways, including PI3K-Akt and Hippo signaling. The analysis of DEGs shared between F1 heifers and F2 fetuses highlighted the influence of the moderate BW weight gain of the F0 dams. At birth and harvest, F1 heifers shared three genes (NAV2, FAM131C, SH3D21). F1 heifers at birth and F2 fetuses shared five genes (CD3E, H1-12, SLC7A11, PIP4P2, ENSBTAG00000051730). From the harvest at d 84 in F1 heifers and F2 fetuses, five genes were shared (DCDC2, RIN1, ENSBTAG00000008911, ENSBTAG00000040518, ENSBTAG00000048049). No DEGs were shared across all comparisons. These findings emphasize the multigenerational impact of early gestational BW gain of the dam on liver gene expression, influencing metabolic pathways and signaling across generations.

Early-pregnancy BMI, maternal gestational weight gain, and asthma and allergic diseases in children.

Association of early pregnancy body mass index (BMI) and maternal gestational weight gain (GWG), and asthma and allergic disease in children is unclear. We analyzed data from 3176 mother-child pairs in a prospective birth cohort study. Maternal anthropometric measurements in the first and last antenatal clinic visits were obtained through post-delivery questionnaires to calculate early pregnancy BMI and maternal GWG. Asthma and allergic diseases in children by the age of 5 years was assessed using a validated questionnaire. Furthermore, serum samples were analyzed for IgE antibodies to eight allergens. We applied Cox proportional hazards and logistic regression analyses to estimate the association of early pregnancy BMI and maternal GWG (as continuous variables and categorized into quarters), and asthma, atopic eczema, atopic sensitization, and allergic rhinitis in children. Neither early pregnancy BMI nor maternal GWG was associated with asthma and allergic disease in children when analyzed as continuous variables. However, compared to the first quarter of GWG (a rate <0.32 kg/week), mothers in the third quarter (rate 0.42-0.52 kg/week) had children with significantly higher odds of developing atopic eczema (adjusted OR 1.49, 95% CI [1.13-1.96]) by 5 years of age. Association of early pregnancy BMI and maternal GWG, and asthma and allergic disease in children, is inconsistent. High maternal GWG may be associated with increased odds of atopic eczema.

Association of maternal body mass index and gestational weight gain rate with cardiometabolic traits in childhood: A prospective cohort study

Background and aimsEvidence on the association of maternal obesity with offspring cardiometabolic health is limited, particularly for the Asian population. We aimed to examine the associations of maternal body mass index (BMI) in early pregnancy and gestational weight gain (GWG) rate in mid- and late-pregnancy with childhood cardiometabolic traits. Methods and resultsWe used data of 1452 mother-child pairs from a population-based prospective cohort study in China. Maternal BMI in early pregnancy and GWG rate in mid- and late-pregnancy were calculated. Childhood cardiometabolic traits were assessed at aged 4–7 years, including BMI, BMI-z, systolic blood pressure (SBP), diastolic blood pressure, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, total cholesterol, triglycerides, fasting glucose, and C-reactive protein. Each 1 kg/m2 increase in maternal BMI in early pregnancy was associated with 0.46% (95% confidence interval, 0.19%–0.72%) higher children BMI, 0.05 (0.02–0.08) higher BMI-z, 0.41% (0.22%–0.59%) higher waist circumference, and 0.24% (0.03%–0.46%) higher SBP. Each 1 kg/week higher GWG rate in mid- and late-pregnancy was associated with higher children SBP (4.58% [1.46%–7.71%]), triglycerides (18.28% [3.13%–33.44%]), and fasting glucose (5.83% [2.64%–9.02%]) and lower BMI-z (−0.45 [−0.82 to −0.08]). Additional adjustment for offspring BMI attenuated the associations for maternal BMI but not for GWG rate. ConclusionsThe increase in maternal BMI and GWG are associated with adverse cardiometabolic profiles in childhood. The association between maternal BMI and childhood cardiometabolic traits is likely mediated using the offspring BMI.

PSV-3 Effects of maternal early gestational weight gain on multigenerational skeletal muscle gene regulation in offspring

Abstract Maternal nutrition during the periconceptional period may have multigenerational effects on the gene regulation of fetal skeletal muscle. This study aimed to investigate the impact of maternal rate of body weight gain (F0) during early gestation on the differential gene expression in the skeletal muscle of newborn (F1) and second-generation fetuses (F2) female offspring. To this end, crossbred Angus heifers (F0) were assigned to either a low gain (LG; 0.28 kg/d; n = 8) or moderate gain (MG; 0.79 kg/d; n = 8) group during the first 84 d of gestation. Subsequently, heifers (F0) were managed as a single group on a forage-based diet until the weaning of the F1 offspring (8 mo). The F1 heifers were estrus synchronized and bred via AI at 15 mo, and F2 fetuses were harvested on d 84 of gestation. Longissimus dorsi muscle was collected at birth (F1) and the 84-d harvest in F1 heifers and their F2 fetuses for multigenerational RNA-Seq analysis. Differentially expressed genes (DEGs) were identified using the DESeq2 R-package. Significant genes were retrieved based on P - value ≤ 0.05 and log2 fold change|0.5|. We previously reported that F1 heifers from MG dams at birth were ~2 kg heavier (P &amp;lt; 0.03), and herein we report the impact on the gene regulation of skeletal muscle in the F1 and F2 generations. At birth, F1 heifers from MG cows exhibited 275 DEGs, of which 98 were downregulated, and 177 genes were upregulated, related to the immune system (TNFAIP3, TLR5), cellular signaling and transduction (RASGRP2, NFE2), and extracellular matrix (TGM3, MMP17). Changes in gene expression persisted in F1 heifers through development, breeding, and until the evaluation at d 84 of gestation. At this time point, we identified 75 upregulated genes out of 177 DEGs. These genes were underlying cellular functions (USP43, PASK), hematopoiesis (THPO), metabolism, and enzymatic activity (SMOX, OAT) as possible metabolic adaptations. Similarly, 102 genes were downregulated, mainly associated with immune and inflammatory response (CHI3L1, LDAF1). Regarding the F2 fetuses, 151 DEGs were differentially expressed. Among them, 63 were upregulated in the MG group and involved with biological functions such as ion channels and transport (KCNAB1, SLC9A3), transcriptional regulation, and signaling (ZNF75D, TMEM106B, DPP6), enzymatic activity, and metabolism (B3GNT4, FAM20A, ALDH5A1, and PRSS23). Likewise, 88 downregulated genes were associated with the cell cycle and proliferation (APOOL, CIR1, and STIL). In conclusion, periconceptional maternal nutrition aimed at moderate weight gains can have multigenerational effects on the gene regulation of fetal muscle tissue.

The association between gestational weight trajectories in women with gestational diabetes and their offspring's weight from birth to 40 months

AimsTo identify the gestational weight gain (GWG) patterns in women with gestational diabetes mellitus (GDM) and evaluate their association with offspring weight status from birth to 40 months.Materials and methodsThis study included 2,723 GDM-mother–child pairs from the Beijing Birth Cohort Study. The association between GWG trajectories identified by the latent class model and offspring weight outcomes from birth to 40 months were evaluated, after adjustment for maternal age, parity, pre-pregnancy body mass index, maternal height, and blood glucose levels.ResultsThree GWG rate groups, including the non-excessive GWG group (1,994/2,732), excessive GWG group (598 /2,732), and excessive early GWG group (140/2,732), were identified in women with GDM, respectively. Compared to the non-excessive GWG group, the adjusted OR (aOR) and 95% CI were 1.83 (1.35–2.47) and 1.79 (1.06–3.01) for macrosomia, 1.33 (1.07–1.66) and 1.48 (1.01–2.17) for large for gestational age (LGA) in the excessive GWG group and excessive early GWG group. Excessive GWG was also associated with an increased risk of BMI-for-age at 40 months (aOR = 1.66, 95% CI 1.14–2.42).ConclusionsBoth excessive GWG and excessive early GWG increased the risk of macrosomia and LGA in women with GDM, but only the excessive GWG was associated with childhood overweight/obesity. The results suggest the long-term impact of GWG on offspring weight status in women with GDM and the potential benefits of GWG restriction after GDM diagnosis.

First Trimester Maternal Body Mass Index and Ges-tational Weight Gain and Their Association with Feto-Maternal Outcomes

Introduction: Women of reproductive age have also been impacted by the significant rise in the prevalence of obesity. A significant predictor of poor outcomes for the health of the mother and the newborn is excessive gestational weight increase. The study was conducted with an objective to study first trimester maternal Body Mass Index and gestational weight gain and their association with maternal and perinatal outcomes.&#x0D; Methodology: This was a prospective observational clinical study conducted in 196 primigravida patients presenting in a tertiary care hospital in central India. BMI of women were recorded during the first trimester and followed up to assesses gestational weight gain. Early pregnancy BMI and gestational weight gain were compared with various feto maternal outcome.&#x0D; Results: The mean of First trimester BMI was 21.3 kg/m2. In Overweight category, 65.2% had high weight gain (WG) while in obese, 26.1% had High WG. Type of delivery and NICU admission rate significantly differ in BMI categories (p &lt;0.05). LSCS rate were higher in overweight and obese category. Preterm babies and post-partum hemorrhage were higher in higher WG categories; however, the difference was non-significant (p&gt;0.05).&#x0D; Conclusion: This study conclude that First trimester underweights and overweight/obesity is associated with higher antenatal, intra-natal and postnatal complications as well as neonatal complications. Caesarian rate and instrumental deliver are also common in First trimester overweight and obese women. Preeclampsia is associated with extreme of First trimester BMI.

Body mass index and weight gain in pregnancy and cardiovascular health in middle age: A cohort study.

To examine associations between body mass index (BMI) in early pregnancy and gestational weight gain (GWG) with cardiovascular health in middle age using the 'Life's Essential 8' (LE8) concept of the American Heart Association (AHA). Population-based cohort study. Swedish CardioPulmonary bioImage Study (SCAPIS). A total of 8871 women from SCAPIS were included. Information on cardiovascular health in middle age was collected from SCAPIS and linked to pregnancy weight data obtained from the Swedish Medical Birth Register, with an average follow-up time of 24.5 years. An LE8 score between 0 and 100 was determined, where a score under 60 points was defined as poor cardiovascular health. Binary logistic regression and restricted cubic splines were used. Cardiovascular health according to LE8 in middle age. The odds of having poor cardiovascular health in middle age were significantly higher in women who had overweight (adjusted odds ratio, aOR 3.30, 95% CI 2.82-3.88) or obesity (aOR 7.63, 95% CI 5.86-9.94), compared with women classified as being of normal weight in pregnancy. Higher odds were also found for excessive GWG (aOR 1.31, 95% CI 1.09-1.57), compared with women who gained weight within the recommendations. A high BMI in early pregnancy and excessive GWG were associated with greater odds of poor cardiovascular health in middle age. Although further studies are needed, our results highlight pregnancy as an important period to support long-term cardiovascular health.

Effect of Early Gestational Body Mass Index and Gestational Weight Gain on Pregnancy Outcome

Effect of Early Gestational Body Mass Index and Gestational Weight Gain on Pregnancy Outcome

Prediction of pre-diabetes and type 2 diabetes nine years postpartum using serum metabolome in pregnant women with gestational diabetes requiring pharmacological treatment

AimsWe examined the association between serum metabolome in women with pharmacologically treated gestational diabetes (GDM) and measures of glucose metabolism 9 years postpartum. MethodsSerum targeted metabolome, adiponectin, inflammatory markers, and insulin-like growth factor-binding protein-1 phosphoisoforms were analyzed at the time of diagnosing GDM. Glucose metabolism and insulin resistance were assessed at 9 years postpartum. Data from 119 subjects were available for analyses. Associations between baseline measures and future measures of glycemia were examined with univariate regressions and multivariate prediction models. This is a secondary analysis of a previous prospective trial (NCT02417090). ResultsBaseline serum markers were most strongly related to measures of insulin resistance at 9-years follow-up. In multivariate analyses combination of IDL cholesterol, early gestational weight gain and in oral glucose tolerance test fasting and 2-h glucose predicted development of disorders of glucose metabolism (pre-diabetes and/or type 2 diabetes) better than clinical predictors alone (ROC-AUC 0.75 vs. 0.65, p = 0.020). ConclusionsSerum metabolome in pregnancy in women with GDM is related to future glucose metabolism and insulin resistance. Compared to clinical variables alone metabolome might result in better prediction of future disorders of glucose metabolism and could facilitate personalized risk stratification for postpartum interventions and follow-up.

Early Gestational Weight Gain and the Risk of Preeclampsia in Dichorionic Twin Pregnancies.

The purpose of our study was to evaluate the body mass index (BMI)-specific association between early gestational weight gain (GWG) in dichorionic twin pregnancies and the risk of preeclampsia. We conducted a retrospective cohort study of all dichorionic twin pregnancies from 1998 to 2013. Data were obtained from a perinatal database and chart abstraction. Prepregnancy BMI was categorized as normal (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (≥30 kg/m2). Early GWG was defined as the last measured weight from 160/7 to 196/7weeks' gestation minus prepregnancy weight. GWG was standardized for gestational duration using BMI-specific z-score charts for dichorionic pregnancies. Preeclampsia was diagnosed using American College of Obstetricians and Gynecologists criteria and identified with International Classification of Diseases-9 coding. Early GWG z-score was modeled as a three-level categorical variable (≤ - 1 standard deviation [SD], 0, 3 +1 SD), where -1 to +1 was the referent group. We estimated risk differences and 95% confidence intervals (CIs) via marginal standardization. We included 1,693 dichorionic twin pregnancies in the cohort. In adjusted analysis, the incidence of preeclampsia increased with increasing early GWG among women with normal BMI. Women with normal BMI and a GWG z-score < - 1 (equivalent to 2.6 kg by 20 weeks) had 2.5 fewer cases of preeclampsia per 100 births (95% CI: -4.7 to - 0.3) compared with the referent; those with GWG z-score > +1 (equivalent to gaining 9.8 kg by 20 weeks) had 2.8 more cases of preeclampsia per 100 (95 % CI: 0.1-5.5) compared with the referent. In adjusted analyses, early GWG had minimal impact on the risk of preeclampsia in women with overweight or obesity. GWG of 2.6 kg or less by 20 weeks was associated with a decreased risk of preeclampsia among women pregnant with dichorionic twins and normal prepregnancy BMI. Current GWG guidelines focus on optimizing fetal weight and gestational length. Our findings demonstrate the importance of considering other outcomes when making GWG recommendations for twin pregnancy. · Early GWG decreased with increasing BMI category.. · Among women with normal weight, as early GWG increased so did the risk of preeclampsia.. · There was no association between early GWG and preeclampsia among women with overweight or obesity..

Risk of gestational diabetes mellitus in relation to early pregnancy and gestational weight gain before diagnosis: Apopulation-based cohort study.

Gestational diabetes mellitus (GDM) is a common pregnancy complication associated with adverse consequences for the mother and offspring in both short and long term. The aim of this study was to investigate associations between risk of GDM and gestational weight gain in early pregnancy and before diagnosis. Our population-based cohort study included 131 164 singleton pregnancies in the Stockholm-Gotland region in Sweden from 2008 through 2013. The exposures were weight gain in early pregnancy (<22 weeks) and weight gain before diagnosis, standardized into gestational age-specific z scores. The outcome was GDM. We used logistic regression models with a generalized estimating equations method to estimate odds ratios with 95% confidence intervals for GDM, stratified by early-pregnancy body mass index (BMI) category. Above average weight gain before diagnosis (z score >0) was associated with increased risk of GDM among all BMI groups except for obese III. Early gestational weight gain above average was associated with increased risk for GDM in overweight women. Below average weight gain before diagnosis (z score <0) was only associated with decreased risk of GDM in obese III. Early gestational weight gain below average was associated with reduced risks of GDM in obese class I, II, and III women. The risk of GDM increased with higher weight gain before diagnosis in all BMI groups except obese class III, whereas the risk was reduced with lower weight gain before diagnosis in obese III women only. The risk of GDM increased with higher early gestational weight gain in overweight women, while the risk was reduced with lower early gestational weight gain among obese women. Obese women may benefit from lower weight gain, especially in early pregnancy.

Early pregnancy body mass index and gestational weight gain: A mediating or moderating factor for short stature and risk of gestational diabetes mellitus?

This study examined the association between height and the risk of Gestational Diabetes Mellitus (GDM), and whether this association was mediated or moderated by early pregnancy body mass index (BMI) and gestational weight gain (GWG) that are known independent risk factors for GDM. Data of a retrospective cohort of pregnant women (N = 1,945) were extracted from antenatal clinic cards. The cut-off values of height in relation to risk of GDM were identified using receiver operating characteristic analysis and four categories of height were derived: < 150 cm, 150–155 cm, 156–160 cm, and > 160cm. Mediation analysis was performed using the Preacher and Hayes bootstrapping method while the moderation effect was tested with multiple regression analysis with interaction terms. Although there was no mediation effect of BMI and GWG on the association between height and risk of GDM, both factors moderated this association with a significant association between shorter height and risk of GDM was observed in overweight / obese women (height < 150 cm: AOR = 1.41, 95% CI = 1.03–2.44; height 156–160 cm: AOR = 1.48, 95% CI = 1.03–2.14). Overweight / obese women with height < 150 cm and excessive GWG at the end of the second trimester (AOR = 2.25, 95% CI = 1.45–4.17) had significantly higher risk of GDM than those without these factors. Short stature (< 150 cm) was significantly associated with GDM risk among OW/OB women with excessive gestational weight gain at the end of second trimester. This finding underscores the importance of maintaining a healthy BMI during reproductive age and gaining weight in recommended range during pregnancy.

Association Between Early Pregnancy Body Mass Index and Gestational Weight Gain in Relation to Neonatal Birth Weight.

Introduction: Maternal early pregnancy body mass index (BMI) and gestational weight gain (GWG) strongly correlate with pregnancy outcomes. Gestational hypertension and diabetes have been associated with overweight and obesity in pregnancy. A low pre-pregnancy BMI has been associated with low birth weight and preterm birth.Method: This observational study was carried out from November 2018 to July 2020 in a tertiary care hospital in South India with a sample size of 100. Pregnant women with uncomplicated singleton pregnancies booked for regular antenatal care by 10 weeks of gestation were included in the study. During the participants' antenatal check-ups, detailed history and examinations were made. The weight of the participants was recorded at every antenatal check-up. Information about the gestational age at delivery and the birth weight of the neonates were collected following delivery.Results: The mean age of women was 25.83 + 2.74 years. Of women who delivered low birth weight neonates (<2.5 kg), 86% had GWG below the Institute of Medicine (IOM) recommendation. A total of 57% of women with normal early pregnancy BMI and 67% of obese women had GWG within the IOM recommendation. Early pregnancy BMI had a positive correlation with neonatal birth weight (r (98) = 0.779, p = 0.001). Of the underweight pregnant women, 72% gave birth to small for gestational age (SGA) babies, and 97% percent of normal early pregnancy BMI women delivered neonates with normal weight for gestational age. A total of 33% of overweight and 50% of obese women had large for gestational age (LGA) babies.Conclusion: Results from this study suggest that maternal early pregnancy BMI is more strongly associated with neonatal birth weight than GWG. Therefore, early pregnancy BMI may be an important focus for counseling during pregnancy.

Cause-Specific Stillbirth and Neonatal Death According to Prepregnancy Obesity and Early Gestational Weight Gain: A Study in the Danish National Birth Cohort.

Maternal obesity is associated with impaired fetal and neonatal survival, but underlying mechanisms are poorly understood. We examined how prepregnancy BMI and early gestational weight gain (GWG) were associated with cause-specific stillbirth and neonatal death. In 85,822 pregnancies in the Danish National Birth Cohort (1996–2002), we identified causes of death from medical records for 272 late stillbirths and 228 neonatal deaths. Prepregnancy BMI and early GWG derived from an early pregnancy interview and Cox regression were used to estimate associations with stillbirth or neonatal death as a combined outcome and nine specific cause-of-death categories. Compared to women with normal weight, risk of stillbirth or neonatal death was increased by 66% with overweight and 78% with obesity. Especially deaths due to placental dysfunction, umbilical cord complications, intrapartum events, and infections were increased in women with obesity. More stillbirths and neonatal deaths were observed in women with BMI < 25 and low GWG. Additionally, unexplained intrauterine death was increased with low GWG, while more early stillbirths were seen with both low and high GWG. In conclusion, causes of death that relate to vascular and metabolic disturbances were increased in women with obesity. Low early GWG in women of normal weight deserves more clinical attention.

Early Predictors of Gestational Diabetes Mellitus in IVF-Conceived Pregnancies

ObjectiveGestational diabetes mellitus (GDM) is associated with adverse maternal and fetal outcomes. This study aimed to identify early and reliable GDM predictors that would enable implementation of preventive and management measures. MethodsThe participants were a 28-week prospective cohort of in vitro fertilization (IVF)-conceived pregnant women (≤39 years, body mass index [BMI] 18.5-38 kg/m2) without a known history of diabetes mellitus. Fasting blood samples were analyzed at baseline (pre-IVF) and 12 weeks’ gestation for reproductive hormones, glucose, serum insulin, lipids, thyroid function, adiponectin, and lipopolysaccharide-binding protein. At 28 weeks, a 75-g oral glucose tolerance test was used to screen for GDM. ResultsFor the overall group at baseline, 22% had BMI ≥30 kg/m2, 45% had polycystic ovary syndrome, 16% had hemoglobin A1C of 5.7% to 6.1%, and 14% had a past history of GDM. At 28 weeks of gestation (n = 158), 34 women had developed GDM and 124 had not. Significant baseline predictors of GDM onset included greater BMI (29.0 vs 25.8 kg/m2), older age (34 vs 32 years), higher levels of follicle-stimulating hormone/luteinizing hormone ratio (1.2 vs 1.0), hemoglobin A1C (5.5 vs 5.2%), insulin (10.6 vs 7.1 μIU/mL), homeostatic model assessment of insulin resistance (2.2 vs 1.7), total cholesterol (199 vs 171 mg/dL), and low-density lipoprotein cholesterol (123 vs 105 mg/dL), and lower triglyceride levels (74 vs 76 mg/dL). Significant 12-week GDM predictors included greater maternal weight gain (delta: 3.4 vs 1.5 kg) and higher levels of insulin (11.3 vs 7.6 μIU/mL), triglycerides (178 vs 120 mg/dL), and homeostatic model assessment of insulin resistance (2.3 vs 1.5). Twelve-week BMI is a predictor of GDM following adjustment for polycystic ovary syndrome status and maternal age. ConclusionWhile preconception maternal BMI, age, and follicle-stimulating hormone/luteinizing hormone ratio are predictors of subsequent development of GDM, early IVF-conceived gestational weight gain is the best predictor of GDM onset.

Does Excess First- or Second-Trimester Weight Gain Predict Excess Total Gestational Weight Gain? A Multicentre Prospective Cohort Study.

Early excess gestational weight gain (GWG) has been examined as a predictor of total excess GWG in a few international studies; however, Canadian data are lacking. We sought to determine whether early (first- and second-trimester) excess GWG predicted total excess GWG. We conducted an a priori planned secondary analysis of a multicentre prospective study of English-speaking Ontario women with a singleton pregnancy between 80 and 206 weeks gestation. Our primary outcome was prediction of total excess GWG. We calculated the sensitivity, specificity, predictive values, and likelihood ratios, by body mass index (BMI), for excess first- and second-trimester GWG. Of the 970 women who met the inclusion criteria, 387 and 754, had first- and second-trimester weights recorded in their antenatal record, respectively. For normal, overweight, and obese women, the sensitivity of excess first-trimester GWG for total excess gain was 66%, 68%, and 65%, respectively; and the specificity was 48%, 43%, and 36%, respectively. The sensitivity of excess second-trimester GWG for total excess gain for normal weight, overweight, and obese women was higher, at 92%, 96%, and 95%, respectively; while the specificity was low at 31%, 16%, and 29%, respectively. In the first known Canadian study of early excess weight gain as the predictor of total GWG, we found that excess first-trimester GWG did not predict total excess GWG, but that the sensitivity of excess second-trimester GWG for excess total GWG was high across BMI categories.

Factors associated with early gestational weight gain among women with pre-pregnancy overweight or obesity

The present study aimed to document the prevalence of and identify factors associated with excessive gestational weight gain (GWG) in early pregnancy among women with pre-pregnancy overweight or obesity. Women with pre-pregnancy overweight or obesity (n = 247) were recruited between 12 and 20 weeks of gestation and completed questionnaires and were weighed to estimate early GWG. Nearly one-third of women met (17%, n = 42) or exceeded (13%, n = 33) guidelines for total GWG in early pregnancy. Univariate analyses showed race, income, and pre-pregnancy weight status to be significantly related to GWG category in early pregnancy (p < .009). Only race and pre-pregnancy weight status remained significant in a multivariate model, with Black women and women with pre-pregnancy obesity having higher odds of having met or exceeded guidelines for total GWG in early pregnancy compared with White women and women with pre-pregnancy overweight (p < .04). These findings highlight the need for early intervention to reduce weight-related complications among pregnant women. Impact statement What is already known on this subject? Women with pre-pregnancy overweight or obesity who gain excessive gestational weight early in pregnancy are at unique risk for pregnancy complications and adverse birth outcomes. What do the results of this study add? The present study adds to a growing body of literature documenting that a notable amount of women are gaining excessive gestational weight early in pregnancy. The present study further documents that Black women and women with pre-pregnancy obesity are at particular risk of gaining excessive gestational weight early in pregnancy. What are the implications of these findings for clinical practice and/or further research? Additional work examining modifiable risk factors, particularly among Black women and women with pre-pregnancy obesity, that contribute to excessive gestational weight gain (GWG) in the first half of pregnancy is warranted and will be necessary to inform interventions aimed at promoting weight loss during the preconception and interconception periods or encouraging appropriate GWG across the entire course of pregnancy.

The impact of excessive gestational weight gain timing on neonatal outcomes in women with class III obesity

Objective This study evaluated the influence of early gestational weight gain (GWG) on neonatal outcomes among women with class III obesity. Study Design Retrospective cohort of women with class III obesity who gained more than the Institute of Medicine (IOM) guidelines (>20lbs). Women gaining ≥75% of total gestational weight prior to 28 weeks (EWG) were compared to women gaining <75% of their total weight prior to 28 weeks (SWG). The primary outcome was a neonatal composite morbidity and mortality. Secondary outcomes included individual components of composite and LGA. Results Of 144 women identified, 42 (29.2%) had EWG and 102 (70.8%) had SWG. Though 11% of the total population had composite neonatal morbidity, this did not differ between groups (p = .4). LGA was nearly twice as common in the SWG group (41% vs 26%, p = .13). EWG was associated with decreased risk of LGA (AOR 0.25 95% CI 0.08, 0.78) and lower median birth weight (AOR −312 g 95% CI −534.7, −90.2). Conclusion Though adverse neonatal outcomes were common in this population, timing of gestational weight gain was not correlated. Increased rates of LGA and higher median birth weight in the SWG group suggests excessive GWG continuing in the third trimester of pregnancy may be of import for neonatal size.

1215: The impact of early pregnancy weight gain on ultrasound growth parameters and birth weight category

To evaluate whether insufficient and excessive early gestational weight gain is associated with ultrasound estimates of fetal growth, and either small for gestational age (SGA) or large for gestational age (LGA) birth weight. Among women enrolled in the nuMoM2b Study, maternal weight gain in early pregnancy (1st and 2nd trimesters) was categorized as appropriate, inadequate, or excessive using the IOM guidelines based on their pre-pregnancy BMI. Outcomes included abnormal growth on the 22-29 week ultrasound (estimated fetal weight [EFW] or abdominal circumference [AC] >90th or < 10th percentile) and either SGA or LGA birth weight. Multivariable logistic regression was used to assess the relationship between early weight gain and outcomes. We also evaluated whether insufficient or excess weight gain in the third trimester affected the relationship between early pregnancy weight gain and birth weight category. Of the 8641 women, 1439 (16.7%) had adequate, 1053 (12.2%) had inadequate, and 6149 (71.2%) had excessive weight gain. Women with inadequate early weight gain were more likely to have an AC or EFW < 10th percentile, and those with excessive early weight gain were more likely to have an AC and EFW >90th percentile. Inadequate early weight gain was associated with more SGA infants, while excessive early weight gain was associated with fewer SGA infants and more LGA infants (Table). Third trimester weight gain was not associated with birth weight category in women with inadequate early weight gain, but higher 3rd trimester weight gain was associated with reduced odds for SGA birth weight (aOR 0.68, 95% CI 0.53-0.87) and increased odds for LGA birth weight (aOR 1.36, 95% CI 1.01-1.82) among women with early excessive weight gain. Early weight gain is associated with ultrasound findings at 22-29 weeks’ gestation and abnormal birth weight. Further studies are needed to evaluate whether interventions designed to modify third trimester weight gain in women with early excessive weight gain can improve perinatal outcomes.

Effects of laparoscopic sleeve gastrectomy on obstetric outcomes within 12 months after surgery.

To determine the obstetric and neonatal outcomes of pregnant patients having undergone laparoscopic sleeve gastrectomy (LSG) in the previous 12 months. This retrospective and observational study included 144 pregnant women: 48 had pregnancies within 12 months after LSG (Group A), 42 became pregnant more than 1 year after surgery (Group B) and 54 obese pregnant women who had a body mass index (BMI) >30 kg/m2 , were categorized as the control group because they did not undergo surgery (Group C). The participants' early gestational BMI, predelivery BMI and gestational weight gain were determined and the obstetric and neonatal outcomes of the groups were compared. The time interval from surgery to conception was 7.8 ± 3.4 months and 25.8 ± 13.4 months for Groups A and B, respectively (P < 0.01). There were no significant differences in the rates of gestational hypertension, pre-eclampsia, preterm delivery and cesarean section between the groups. The number of patients with gestational diabetes mellitus was significantly higher in Group C than in Groups A and B (P = 0.004). The number of large-for-gestational-age infants was higher in Group C than in Groups A and B (P = 0.046). The number of small-for-gestational-age infants was significantly higher in Group A than in Groups B and C (P = 0.025). Pregnancy within one year after LSG is related to an increased risk of small-for-gestational-age infants. LSG decreases the risk of gestational diabetes mellitus independent of the time interval between surgery and conception.