Gestational Weight Gain In Obese Women Research Articles

Association between Gestational Weight Gain and Pregnancy Outcomes in Various Body Mass Index Groups: A Retrospective Observational Study

Abstract Introduction: Body mass index (BMI) has been known to be an important determinant of pregnancy morbidities. However, multiple studies show that the effects are equally dependent on the gestational weight gain (GWG). There is a lack of data in the Indian population, especially using the Asia–Pacific guidelines of BMI. This study is meant to identify the degree of association between the GWG in different BMIs and the development of pregnancy morbidities. Materials and Methods: This was a retrospective study, in which case records of women who delivered in our hospitals during 1 year were analyzed. Pregnancy outcomes, such as growth restriction, preterm deliveries, development of hypertensive disorders, gestational diabetes, inductions, and cesareans, were analyzed in three classes of GWG inadequate, adequate, and excess GWG (as per institue of medicine guidelines). The Chi-square test was done to see the difference in the pregnancy outcomes. Results: Of the 1396 women enrolled, women with inadequate GWG had higher preterm deliveries (13.8% vs. 4.4%, P < 0.001) and fetal growth restriction (8.8% vs. 3.9%, P = 0.003) with higher odds in underweight women with inadequate GWG (odds ratio [OR] of 2.6 and 1.75, respectively). Excess GWG had a significantly higher induction (34.9% vs. 29%, P > 0.05) and cesarean delivery rate (34.3% vs. 21.6%, P = 0.003) with higher odds seen in obese women with excess GWG (OR of 2.6 and 1.75, respectively). Conclusion: All women having out-of-range BMI should be identified during the first antenatal contact. Inadequate GWG in underweight women and excess GWG in obese women should be strictly monitored and targeted to prevent a wide spectrum of maternal morbidities.

Benefit of insufficient gestational weight gain in obese women with gestational diabetes mellitus: A multicenter study in Portugal

BackgroundBoth obesity and gestational diabetes mellitus (GDM) are independent risk factors for adverse maternal and fetal outcomes. The Institute of Medicine (IOM) recommends different targets for an adequate gestational weight gain (GWG), depending on the prepregnancy body mass index, but they have been questioned. We aim to compare obese pregnant women with GDM according to GWG stratification (insufficient, adequate and excessive) with regard to maternal and neonatal outcomes and to clarify whether insufficient GWG can be associated with better outcomes. MethodsA multicenter observational study with prospectively collected data of obese singleton pregnant women with GDM was conducted. GWG was expressed according to the 2009 IOM’s recommendations. ResultsOf 4563 obese women with GDM, 34.5%, 30.4% and 35.2% registered insufficient, adequate and excessive GWG, respectively. Multiple logistic regression analysis revealed that women with insufficient GWG had lower odds of gestational hypertension, preeclampsia, caesarean section, large for gestational age (LGA) neonates and prediabetes in postpartum. Despite the higher incidence of small for gestational age (SGA) neonates, they were not associated with adverse outcomes. Women with excessive GWG had higher odds of caesarean section, macrosomic and LGA neonates. ConclusionsInsufficient GWG in obese women with GDM was beneficial due to better maternal and neonatal outcomes. In clinical practice, we should be strict with regard to weight gain in obese pregnant women with GDM and encourage a reduced GWG, provided an adequate fetal growth is guaranteed.

Supporting the individual needs of obese pregnant women: Effects of risk-management processes

Obesity is the UK's most prevalent antenatal comorbidity, and reducing rates of maternal obesity and risk management of complications in pregnancy and labour is a priority for the NHS. The emphasis on managing maternal obesity-related risks, rather than dealing with the causes of long-term obesity, is short-sighted and fails to consider the needs of the individual woman. This process of risk management is fuelled by the maternity services' costly litigation insurance that presents measures to manage obesity-related risks, leading to bureaucratic shaping of maternity services. This limits the choices for this group of women by standardising care rather than facilitating their individual needs. This article explores an alternative long-term strategy called Pregnancy Plus that facilitates the management of risk alongside supporting the needs of individual obese pregnant women, offering choice and equal access to maternity services while maintaining the safety of the women and their babies. Pregnancy Plus is an award-winning multi-intervention health education and weight maintenance programme that has presented promising outcomes to date. It utilises a salutogenic approach to health education and care-planning for obese pregnant women and adopts the principles of the US Institute of Medicine guidelines for the maintenance of gestational weight-gain in obese women.

Interventions to reduce and prevent obesity in pre-conceptual and pregnant women: a systematic review and meta-analysis.

BackgroundThe increasing prevalence of obesity in pregnant women is associated with adverse maternal and neonatal outcomes, and increased costs to healthcare, the economy and broader society.ObjectivesTo assess the efficacy of behavioural interventions for managing gestational weight gain (GWG) in the pre-conceptual and pregnancy period in overweight, obese and morbidly obese women.Search MethodsA search was performed for published studies in the English language, from date? 2000–31 December 2012 in five electronic databases; PubMed, Scopus, Cochrane Library, CINAHL and PsycINFO.Selection criteriaStudies were included if they compared the efficacy or effectiveness of a particular behavioural intervention in pregnant or pre-conceptual women with standard maternity care. Studies that included women with co-morbid conditions such as diabetes mellitus and polycystic ovarian syndrome were excluded to help isolate the effect of the intervention.ResultsFifteen studies involving 3,426 participants were included. One study (n = 692) focused on the pre-conceptual period and the remaining 14 (n = 2,734) in the pregnancy period. Pooled mean difference for GWG indicated a lower GWG in the intervention groups when compared to standard maternity care groups (n = 1771, mean difference (MD) −1.66 kg, 95% CI −3.12 to −0.21 kg). With respect to the types of participants, considerable heterogeneity between studies was shown in the obese subgroup [Tau2 = 15.61; Chi2 = 40.80, df = 3 (P<0.00001); I2 = 93%].ConclusionsBehavioural interventions in pregnancy may be effective in reducing GWG in obese women without comorbid conditions, but not overweight or morbidly obese women. Behavioural interventions had no effect on postpartum weight loss or retention, gestation week of delivery and infant birth weight in overweight, obese and morbidly obese women.

O021 INTERVENTIONS TO REDUCE AND PREVENT OBESITY IN PRE-CONCEPTUAL AND PREGNANT WOMEN: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background: The increasing prevalence of obesity in pregnant women is associated with adverse maternal and neonatal outcomes, and increased costs to healthcare, the economy and broader society. Objectives: To assess the efficacy of behavioural interventions for managing gestational weight gain (GWG) in the preconceptual and pregnancy period in overweight, obese and morbidly obese women. Search Methods: A search was performed for published studies in the English language, from date? 2000–31 December 2012 in five electronic databases; PubMed, Scopus, Cochrane Library, CINAHL and PsycINFO. Selection criteria: Studies were included if they compared the efficacy or effectiveness of a particular behavioural intervention in pregnant or pre-conceptual women with standard maternity care. Studies that included women with comorbid conditions such as diabetes mellitus and polycystic ovarian syndrome were excluded to help isolate the effect of the intervention. Results: Fifteen studies involving 3,426 participants were included. One study (n = 692) focused on the pre-conceptual period and the remaining 14 (n = 2,734) in the pregnancy period. Pooled mean difference for GWG indicated a lower GWG in the intervention groups when compared to standard maternity care groups (n = 1771, mean difference (MD) 21.66 kg, 95% CI 23.12 to 20.21 kg). With respect to the types of participants, considerable heterogeneity between studies was shown in the obese subgroup [Tau = 15.61; Chi = 40.80, df = 3 (P,0.00001); I = 93%]. Conclusions: Behavioural interventions in pregnancy may be effective in reducing GWG in obese women without comorbid conditions, but not overweight or morbidly obese women. Behavioural interventions had no effect on postpartum weight loss or retention, gestation week of delivery and infant birth weight in overweight, obese and morbidly obese women. Citation: Agha M, Agha RA, Sandell J (2014) Interventions to Reduce and Prevent Obesity in Pre-Conceptual and Pregnant Women: A Systematic Review and Meta-Analysis. PLoS ONE 9(5): e95132. doi:10.1371/journal.pone.0095132 Editor: Cheryl S. Rosenfeld, University of Missouri, United States of America Received June 20, 2013; Accepted March 24, 2014; Published May 14, 2014 Copyright: 2014 Agha et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: These authors have no support or funding to report. Competing Interests: The authors have declared that no competing interests exist. * E-mail: mail@riazagha.com