Excessive Weight Gain In Pregnancy Research Articles

Maternal overconsumption of calories during pregnancy programs offspring for increased adiposity through induction of adipogenic genes

Obesity during pregnancy predisposes offspring to metabolic diseases such as obesity and diabetes. Few studies have explored the molecular underpinnings of the increased obesity risk in the offspring. To determine the effects of excessive maternal energy intake on adiposity in the offspring, pregnant Duroc x Landrace gilts were fed either a normal energy (mNE) or high energy diet (mHE) to induce excessive pregnancy weight gain. Offspring were sacrificed at 48h after birth and at weaning (day 21). Expression of adipogenic genes was measured using RT‐PCR. Expression of genes such as PPARγ and CEBPα was not different between mNE and mHE offspring at 48h after birth, but they were induced (P < 0.05) in mHE offspring at weaning. Additionally, SFRP4, SFRP5 and PAI‐1 were induced in mHE offspring at weaning. However, SRC1 expression was higher in mNE offspring at 48h, but not different at weaning (P < 0.05). The expression of PPARγ corepressors, SIRT1 and NCoR1, was elevated (P < 0.05) in mHE offspring at weaning. Therefore, excessive maternal energy intake during gestation programs offspring for increased adiposity through induction of adipogenic transcription factors and suppression of wnt signaling.Grant Funding Source: Showalter Research Trust

The obese woman with gestational diabetes: effects of body mass index and weight gain in pregnancy on obstetric and glycaemic outcomes.

Obese women with gestational diabetes mellitus (GDM) represent a high-risk group in pregnancy, although the effects of increasing degrees of obesity and weight gain in pregnancy in this group is poorly defined. We performed a retrospective analysis of 375 singleton pregnancies complicated by maternal obesity and GDM. Women with a body mass index (BMI) of 30-35 kg/m(2) were compared with those with a BMI of ≥ 35 kg/m(2). Additionally, women were categorized according to weight gain in pregnancy: Group A (<0.18 kg/week), Group B (0.18-0.27 kg/week), Group C (>0.27 kg/week). Obstetric outcomes did not differ between the groups; however, postpartum dysglycaemia was more likely in women with a BMI ≥ 35 kg/m(2) (odds ratio [OR] 3.2, 95% confidence interval [CI]: 1.2-8.9). Group B and Group C had higher odds of LGA (OR 3.8, 95% CI: 1.3-11.3; OR 5.0, 95% CI: 2.0-12.1, respectively) compared with Group A. Group C also had a lower risk of SGA (OR 0.4, 95% CI: 0.2-1.0) and a higher risk of postpartum dysglycaemia (OR 6.8, 95% CI: 1.7-26.9) compared with Group A. Greater degrees of obesity are associated with higher risk of abnormal metabolic outcomes after pregnancy. Excessive weight gain in pregnancy in obese women increases adverse obstetric and glycaemic outcomes. Our findings suggest that targets for weight gain in pregnancy for obese women should be reduced from current recommendations.

The consequences of obesity and excess weight gain in pregnancy – CORRIGENDUM

The consequences of obesity and excess weight gain in pregnancy – CORRIGENDUM

The consequences of obesity and excess weight gain in pregnancy

The prevalence of obesity in pregnancy is rising exponentially; about 15-20% of pregnant women now enter pregnancy with a BMI which would define them as obese. This paper provides a review of the strong links between obesity and adverse pregnancy outcome which operate across a range of pregnancy complications. For example, obesity is associated with an increased risk of maternal mortality, gestational diabetes mellitus, thromboembolism, pre-eclampsia and postpartum haemorrhage. Obesity also complicates operative delivery; it makes operative delivery more difficult, increases complications and paradoxically increases the need for operative delivery. The risk of the majority of these complications is amplified by excess weight gain in pregnancy and increases in proportion to the degree of obesity, for example, women with extreme obesity have OR of 7·89 for gestational diabetes and 3·84 for postpartum haemorrhage compared to their lean counterparts. The consequences of maternal obesity do not stop once the baby is born. Maternal obesity programmes a variety of long-term adverse outcomes, including obesity in the offspring at adulthood. Such an effect is mediated at least in part via high birthweight; a recent study has suggested that the odds of adult obesity are two-fold greater in babies weighing more than 4 kg at birth. The mechanism by which obesity causes adverse pregnancy outcome is uncertain. This paper reviews the emerging evidence that hyperglycaemia and insulin resistance may both play a role: the links between hyperglycaemia in pregnancy and both increased birthweight and insulin resistance have been demonstrated in two large studies. Lastly, we discuss the nature and rationale for possible intervention strategies in obese pregnant women.

Behavioural interventions for weight management in pregnancy: A systematic review of quantitative and qualitative data

BackgroundThere is a rising prevalence of excessive weight gain in pregnancy and an increasing number of pregnant women who are overweight or obese at the start of the pregnancy. Excessive weight gain during pregnancy is associated with adverse maternal and neonatal consequences and increases the risk of long-term obesity. Pregnancy therefore may be a key time to prevent excessive weight gain and improve the health of women and their unborn child. This systematic review sought to assess the effectiveness of behavioural interventions to prevent excessive weight gain in pregnancy and explore the factors that influence intervention effectiveness.MethodsWe undertook a systematic review of quantitative and qualitative evidence. This included a meta-analysis of controlled trials of diet and physical activity interventions to prevent excessive weight gain during pregnancy and a thematic synthesis of qualitative studies that investigated the views of women on weight management during pregnancy. A thorough search of eleven electronic bibliographic databases, reference lists of included studies, relevant review articles and experts in the field were contacted to identify potentially relevant studies.Two independent reviewers extracted data. RevMan software was used to perform the meta-analyses. Qualitative data was subject to thematic analysis. Both quantitative and qualitative data were aligned using a matrix framework.ResultsFive controlled trials and eight qualitative studies were included. The overall pooled effect size found no significant difference in gestational weight gain amongst participants in the intervention group compared with the control group (mean difference -0.28 95% CI -0.64 to 0.09). The study designs, participants and interventions all varied markedly and there was significant heterogeneity within this comparison in the meta-analysis (I2 67%). Subgroup and sensitivity analysis did not identify contextual elements that influenced the effectiveness of the intervention.In a thematic analysis of the qualitative studies, three major themes emerged relating to women's views of weight management in pregnancy: pregnancy as a time of transition and change, conflicting and contradictory messages and a perceived lack of control. When the results of both quantitative and qualitative data were aligned it was clear that some of the barriers that women described in achieving healthy weight gain in pregnancy were not addressed by the interventions evaluated. This may have contributed to the limited effectiveness of the interventions.ConclusionsDespite intense and often tailored interventions there was no statistically significant effect on weight gain during pregnancy. Inadequate and often contradictory information regarding healthy weight management was reported by women in qualitative studies and this was addressed in the interventions but this in itself was insufficient to lead to reduced weight gain. Multiple types of interventions, including community based strategies are needed to address this complex health problem.

Effect of regular exercise on prevention of excessive weight gain in pregnancy: A randomised controlled trial

Objectives To assess whether a 12-week supervised exercise-programme with an additional 30 min of moderate self-imposed physical activity on the non-supervised weekdays prevents excessive weight gain in pregnancy, as well as postpartum weight retention.Methods One hundred and five sedentary, nulliparous pregnant women with a mean age of 30.7 ± 4.0 years and a pre-pregnancy body mass index of 23.8 ± 4.3 kg/m2 were randomised to either an exercise group (EG, n = 52) or a control group (CG, n = 53). The exercise programme consisted of 60 min supervised aerobic dance and strength training for 60 min, at least twice per week for a minimum of 12 weeks.Results Drop-out rates were 19% and 21% in the EG and CG, respectively. Fewer women in the EG than in the CG exceeded the Institute of Medicine recommendations; however, only EG participants who attended 24 exercise sessions (n = 14) differed significantly from controls (p = 0.006) with regard to weight gain during pregnancy (11.0 ± 2.3 vs. 13.8 ± 3.8 kg, p < 0.01) and postpartum weight retention (0.8 ± 1.7 vs. 3.3 ± 4.1 kg, p < 0.01).Conclusions Regular participation in aerobic dance exercise can contribute to significantly reduce weight gain during pregnancy.

Evaluation of Sexual Function in Brazilian Pregnant Women

The objective of the present study was to evaluate the sexual function of pregnant women and to identify the potential variables associated with it. The study was conducted on 137 low-risk, sexually active pregnant women who filled out the Female Sexual Function Index (FSFI) questionnaire. Although 61% of the women assessed presented an FSFI score ≤26.5, they declared that they were satisfied with the emotional proximity to their partner, with their relationship, and with their sex life. A positive association was detected between sexual dysfunction and gestational age and a report of urinary incontinence and excessive weight gain in the current pregnancy.

Gestational weight gain and subsequent postpartum weight loss among young, low-income, ethnic minority women

Document weight change trajectories that lead to gestational weight gain or postpartum weight loss outside clinical recommendations established by the Institute of Medicine. Women aged 14-25 receiving prenatal care and delivering singleton infants at term (n = 427). Medical record review and 4 structured interviews conducted: second and third trimester, 6- and 12-months postpartum. Longitudinal mixed modeling to evaluate weight change trajectories. Only 22% of participants gained gestational weight within Institute of Medicine guidelines. There were 62% that exceeded maximum recommendations-more common among those overweight/obese (body mass index ≥25.0; P < .0001). 52% retained ≥10 lb 1-year postpartum. Increased weight gain and retention documented among smokers and women with pregnancy-induced hypertension; breastfeeding promoted postpartum weight loss (all P < .02). Body mass index by race interaction suggested healthier outcomes for Latinas (P = .02). Excessive pregnancy weight gain and inadequate postpartum weight loss are highly prevalent among young low-income ethnic minority women. Pregnancy and postpartum are critical junctures for weight management interventions.

Systematic review of diet and physical activity intervention aimed at reducing excess weight gain in pregnancy: Outcomes and implications for public health policy and practice

Systematic review of diet and physical activity intervention aimed at reducing excess weight gain in pregnancy: Outcomes and implications for public health policy and practice

Associations Between Mothers' and Their Children's Weights at 4 Years of Age

OBJECTIVES: To examine the importance of maternal weight characteristics as predictors of overweight (BMI ≥85th percentile and <95th percentile) and obesity (BMI ≥ 95th percentile) in offspring at age 4 years. METHODS: Chi-square and logistic regression analyses were conducted on a sample of 321 mother/child pairs from an earlier observational cohort study on mothers' postpartum weight retention. RESULTS: Maternal early pregnancy BMI and infant birth weight were each positively and significantly (p <0.05) associated with increased risk of obesity in offspring at age 4 years. A significant interaction was found between these two variables in predicting children's risk of obesity. It was driven by the high proportion of obese children among obese women who had infants weighing < 3 kg at birth. Net gestational weight gain was not associated with obesity risk in children, but was positively associated with infant birth weight among normal weight and overweight women. CONCLUSIONS: Reducing maternal BMI in the preconception period among overweight and obese women and preventing excessive weight gain in pregnancy for all women appear to be appropriate strategies to address the childhood obesity epidemic.

Does Breastfeeding Protect Against Overweight and Obesity in Children? A Review

Obesity has become a national problem. It has a serious impact on health. Precursors of childhood obesity have been studied for decades but often do not start until school age. When the investigation begins during the perinatal period, it is clear that excessive weight gain in pregnancy is a significant contributor. Infant studies dramatically demonstrate the protective constituents of human milk as well as the importance of the process of suckling of the breast in obesity protection. It is concluded that obesity prevention begins with breastfeeding.

Socioeconomic, demographic and nutritional factors associated with maternal weight gain in general practices in Southern Brazil

In order to describe adequacy of weight gain during pregnancy and its association with pre-pregnancy nutritional status and other factors, a cohort study of pregnant women enrolled at 16-36 weeks of gestation and followed up until delivery was carried out in prenatal care in primary care services in Rio Grande do Sul State, Brazil. Maternal weight was recorded at each prenatal care visit. Weight gain was classified as "adequate," "insufficient" or "excessive" (Institute of Medicine). Poisson regression was used to measure the associations. The sample was comprised of 667 women, and insufficient and excessive weight gain incidences were 25.8% and 44.8%, respectively. Overweight and obese before pregnancy had a significant increased risk of excessive weight gain in pregnancy (RR: 1.75; 95%CI: 1.48-2.07, RR: 1.55; 95%CI: 1.23-1.96, respectively). Women with fewer than six prenatal visits had a 52% increased risk for weight gain below recommended values. Although insufficient weight gain may still be a public health problem, excessive gain is becoming a concern that needs immediate attention in prenatal care.

Preventing Excessive Weight Gain in Pregnancy: How Do Prenatal Care Providers Approach Counseling?

Excessive weight gain during pregnancy is becoming more common and is associated with many adverse maternal and infant outcomes. There is a paucity of data on how weight gain counseling is actually provided in prenatal care settings. Our objective was to study prenatal care providers and their knowledge, attitudes, and practices regarding prevention of excessive weight gain during pregnancy and, secondarily, their approach to nutrition and physical activity counseling during pregnancy. We conducted seven focus groups of general obstetrician/gynecologists, midwives, and nurse practitioners. We analyzed data using qualitative methods. Providers agreed to participate because they were unsure of the effectiveness of their counseling efforts and wanted to learn new techniques for counseling patients about weight gain, nutrition, and physical activity. We identified several barriers to weight gain counseling, including insufficient training, concern about the sensitivity of the topic, and the perception that counseling is ineffective. Providers all agreed that weight gain was an important topic with short-term and long-term health consequences, but they described widely disparate counseling styles and approaches. Prenatal care providers are deeply concerned about excessive weight gain and its sequelae in their patients but encounter barriers to effective counseling. Providers want new tools to help them address weight gain counseling during pregnancy.

Preconception Predictors of Weight Gain During Pregnancy: Prospective Findings from the Central Pennsylvania Women's Health Study

We examined preconception (prepregnancy) predictors of pregnancy weight gain and weight gain that exceeds the 2009 Institute of Medicine (IOM) recommendations based on pre-pregnancy body mass index (BMI), in a prospective study. Data are from a population-based cohort study of 1,420 women who were interviewed at baseline and 2 years later. The analytic sample includes 103 women who were not pregnant at baseline and gave birth to full-term singletons during the follow-up period. Preconception maternal weight category as well as health behaviors, psychosocial stress, parity, and age were examined as predictors of pregnancy weight gain and of weight gain in excess of the IOM recommendations using multiple linear and logistic regression analysis. Pregnancy weight gain averaged 33.01 pounds, with 51% of women gaining weight in excess of the 2009 IOM recommendations for their preconception weight category. Preconception overweight (BMI = 25-29.9) increased the odds of excessive pregnancy weight gain nearly threefold, whereas preconception physical activity levels meeting activity guidelines reduced the odds of excessive weight gain but was marginally statistically significant. Although future research examining the role of physical activity in relation to pregnancy weight gain is needed, preconception overweight and physical activity levels are prime targets for interventions to avoid excessive pregnancy weight gain.

Nutrition and exercise prevent excess weight gain in overweight pregnant women.

To determine the effect of a Nutrition and Exercise Lifestyle Intervention Program (NELIP) for overweight (OW) and obese (OB) pregnant women on pregnancy weight gain, birth weight, and maternal weight retention at 2 months postpartum. This is a single-arm intervention matched by prepregnant body mass index, age, and parity to a historical cohort (4:1). Women with a prepregnancy body mass index of > or = 25.0 kg x m(-2) (N = 65) participated in a NELIP starting at 16-20 wk of pregnancy, continuing until delivery. NELIP consisted of an individualized nutrition plan with total energy intake of approximately 2000 kcal x d(-1) (8360 kJ x d(-1)) and 40%-55% of total energy intake from carbohydrate. Exercise consisted of a walking program (30% HR reserve), three to four times per week, using a pedometer to count steps. Matched historical cohort (MC; N = 260) was from a large local perinatal database. Weight gained by women on the NELIP was 6.8 +/- 4.1 kg (0.38 +/- 0.2 kg x wk(-1)), with a total pregnancy weight gain of 12.0 +/- 5.7 kg. Excessive weight gain occurred before NELIP began at 16 wk of gestation. Eighty percent of the women did not exceed recommended pregnancy weight gain on NELIP. Weight retention at 2 months postpartum was 2.2 +/- 5.6 kg with no difference between the OW and the OB women on NELIP. Mean birth weight was not different between NELIP (3.59 +/- 0.5 kg) and MC (3.56 +/- 0.6 kg, P > 0.05). NELIP reduces the risk of excessive pregnancy weight gain with minimal weight retention at 2 months postpartum in OW and OB women. This intervention may assist OW and OB women in successful weight control after childbirth.

A Review of Inadequate and Excessive Weight Gain in Pregnancy

Women with a normal prepregnancy body mass index (BMI) and those who meet the recommended weight gains are healthiest and have healthier children. Adequate gestational weight gain contributes to better perinatal short- and long-term health outcomes in both mothers and infants. However, many key aspects of the health of women of childbearing age have changed, including a high prepregnancy BMI and advanced age, along with a high proportion of women from diverse ethnicities. Overweight and obesity have become major problems in the world. High prepregnancy BMI, overweight and obesity, are risk factors for adverse pregnancy outcomes, such as gestational diabetes, preeclampsia, cesarean delivery, and having a macrosomic infant. On the other hand, underweight is associated with a higher incidence of miscarriage, and the delivery of small for gestational age (SGA) and low birth weight (LBW) infant. Prepregnancy BMI and gestational weight gain show strong association with pregnancy outcomes. Their combined effects on maternal and neonatal outcomes, including short- and long-term health risks, are strong. Therefore, it is important that health providers help women implement lifestyle changes to achieve normal BMI levels preconception, avoid excess weight gain during pregnancy and eliminate postpartum weight retention.

O372 Effect of supervised aerobic dance exercise in prevention of excessive weight gain in pregnancy: A single blind randomized controlled trial

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S198-S198 Free communication (oral) presentations O372 Effect of supervised aerobic dance exercise in prevention of excessive weight gain in pregnancy: A single blind randomized controlled trial L. Haakstad, L. HaakstadSearch for more papers by this authorK. Bo, K. BoSearch for more papers by this author L. Haakstad, L. HaakstadSearch for more papers by this authorK. Bo, K. BoSearch for more papers by this author First published: 06 October 2011 https://doi.org/10.1016/S0020-7292(09)60744-XCitations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S198-S198 RelatedInformation

Reducing excessive weight gain in pregnancy: a randomised controlled trial

To determine if regular weight measurement throughout pregnancy can reduce excessive gestational weight gain. A randomised controlled trial. A tertiary obstetric hospital in Melbourne, between July 2007 and May 2008. 236 pregnant women recruited at < or = 14 weeks' gestation. Women allocated to the intervention group were given a personalised weight measurement card, advised of their optimal gestational weight gain (based on their body mass index at the time of recruitment and the United States Institute of Medicine guidelines), and instructed to record their weight at 16, 20, 24, 28, 30, 32 and 34 weeks' gestation. The control group were weighed at recruitment, but were not given instructions about regular weight measurement. All participants were blinded to the purpose of the study. Weight gain from recruitment to follow-up at 36 weeks' gestation. In the study population, there was a trend to less weight gain in the intervention group. The women in the intervention group experienced a mean (SD) per-week weight gain of 0.44 (0.173) kg compared with those in the control group, who gained 0.46 (0.156) kg/week (mean difference, 0.02 kg/week; 95% CI, - 0.02 to 0.07 kg/week). The intervention significantly reduced gestational weight gain in the group of women who were overweight but not obese at recruitment: those in the intervention group (20 women) gained a mean (SD) of 0.42 (0.153) kg/week and the control group (18 women) gained 0.54 (0.123) kg/week (mean difference, 0.12 kg/week; 95% CI, 0.03 to 0.22 kg/week; P = 0.01). Regular weight measurement in pregnancy was not found to be effective in reducing weight gain, except among women who were overweight but not obese before pregnancy. Australian Clinical Trials Registry ACTRN12607000272493.

The Effect of Excess Weight Gain in Teenage Pregnancies

Excess weight gain in pregnancy, as defined by the Institute of Medicine (IOM), has been linked to adverse obstetrical outcomes. However, this relationship has not been examined in the younger maternal population. Our aim was to study excess weight gain in our inner-city teenage population. In this retrospective cohort study, we reviewed all nulliparous teenage deliveries between 2000 and 2004. The groups were divided by IOM criteria into "underweight" (body mass index [BMI] <20 kg/m(2); n = 58), "normal" (BMI, 20 to 26.0 kg/m(2); n = 255), "overweight" (BMI, 26.1 to 29.0 kg/m(2); n = 54), and "obese" (BMI > 29.0 kg/m(2); n = 89). The groups were then compared according to normal (control, n = 257) and excess weight gain (n = 199). Frequencies and odds ratios (ORs) for adverse outcomes were calculated. Excess weight gain was associated with an increased risk for cesarean delivery (OR 1.96, 95% confidence interval [CI], 1.28 to 3.01) and postpartum fever (OR, 2.46; 95% CI, 1.13 to 5.35). Significant neonatal findings included higher birthweight (3199 g versus 2864 g; p < 0.0001) and increased risk of macrosomia (OR, 8.18; 95% CI, 2.02 to 32.99) in the excess weight gain group. We concluded that excess weight gain places teen mothers at increased risk for cesarean delivery, postpartum febrile morbidity, and macrosomia. Interventions aimed at optimal weight gain in teen pregnancies are warranted.

Effect of smoking among Indigenous and non‐Indigenous mothers on preterm birth and full‐term low birthweight

TO THE EDITOR: Wills and Coory emphasise maternal smoking as a risk factor for preterm birth and low birthweight, with exaggerated effects apparent in Indigenous women. They suggest that governments have a responsibility to ensure that interventions are offered to help women quit. Unfortunately, there are adverse effects of smoking cessation that mitigate the gains of cessation and introduce a caveat to that otherwise laudable motive. It has been shown that young women who cease smoking almost always gain significant weight. The fall in smoking rates in women over the past 20 years appears to have been in inverse proportion to the rise in rates of obesity in pregnancy, suggesting a possible relationship. The adverse maternal and fetal effects of overweight and obesity in pregnancy have been confirmed in numerous studies, and equal or exceed those of smoking. Typical odds ratios (ORs) from the literature are shown below. Maternal overweight (body mass index [BMI], 25–30kg/m) and obesity (BMI, > 30kg/m) are associated with significant increases in pre-eclampsia (OR for overweight, 1.8; OR for obese, 3.0), gestational diabetes (1.8; 3.2), macrosomia (1.6; 2.4), shoulder dystocia (2.9 for obese), obstructed labour, caesarean delivery (1.5; 2.0), postpartum haemorrhage (1.2; 1.5), wound infection (1.3; 2.2), venous thromboembolism (1.3; 2.8) and maternal death. Further, overweight and obesity are also associated with increased rates of infertility, fetal abnormality (OR, 1.3–3.5), miscarriage (1.2–3.0), stillbirth (1.5; 2.0), admission to neonatal intensive care (1.2; 1.4) and neonatal death (1.6–2.7 for obese). In addition, the adverse effects of excessive weight gain during pregnancy are very similar to those detailed above. The long-term effects on the offspring of women who were obese in pregnancy (increased rates of obesity, diabetes and components of the metabolic syndrome) are well documented, and at least equal in severity to the consequences for the children of smokers. What then should we do? Should we condone smoking during pregnancy? No one would agree. Ideally, women should never start smoking, or they should give up without gaining weight, but these are elusive aims. At the very least, the conscientious practitioner must provide weight-control counselling, referral to a dietitian and an exercise program lest the gains of smoking cessation be overwhelmed by the losses accompanying excess maternal weight gain, overweight and obesity in pregnancy.