Institute Of Medicine Recommendations Research Articles

Pattern of weight gain during pregnancy among pregnant women attending antenatal clinics

Background Excessive and inadequate weight gain during pregnancy is associated with adverse maternal and neonatal outcomes. The aim of this study was to assess the pattern of weight gain among pregnant women attending antenatal clinics. Design A descriptive research design was adopted to describe how weight pattern changes during pregnancy. Sample A convenience sample of 400 pregnant women was included in the study. Setting The study was conducted at the antenatal outpatient clinic of El-Kasr El Aini University Hospital, Cairo University, Egypt. Tools Two tools were used: (a) maternal structured interviewing and (b) assessment and follow-up. Results Approximately 36% had normal weight, 34.3% were overweight, 26% were obese, and only 3.8% were underweight at recruitment. Appropriate weight gain was observed in 81.0% of underweight pregnant women and 75.5% of normal weight women. However, 61.5% of overweight women and 72% of obese women gained weight above the recommendation range by the Institute of Medicine. The mean total weight gain at the time of delivery among underweight women was 13.5 kg, normal weight women was 12.43 kg, overweight women was 12.05 kg, and obese women was 10.43 kg. Conclusion Overweight and obese women had excessive weight gain during pregnancy, whereas underweight and normal weight women gained weight within the Institute of Medicine recommendations. Recommendation Counseling during early pregnancy toward adequate gestational weight gain management should be required for pregnant women at the outpatient clinic.

Inappropriate gestational weight gain impact on maternofetal outcomes in gestational diabetes

Objective To evaluate the association between the dimension of deviation from appropriate gestational weight gain (GWG) and adverse maternofetal outcomes in women with gestational diabetes mellitus (GDM). Methods We performed a multicentric retrospective study based on the Portuguese GDM Database. Women were classified as within GWG, insufficient (IGWG) or excessive (EGWG) than the Institute of Medicine recommendations. EGWG and IGWG were calculated for each prepregnancy BMI category. Large-for-gestational-age (LGA) and macrosomia were defined as a birthweight more than the 90th percentile for the gestational age and newborn weight greater than 4000 g, respectively. Logistic regression models (adjusted odds ratio [aOR] plus 95% confidence interval [95%CI]) were derived to evaluate the association between EGWG or IGWG and adverse maternofetal outcomes. Results A total of 18961 pregnant women were included: 39.7% with IGWG and 27.8% with EGWG. An EGWG over 3 kg was associated with a higher risk of LGA infants (aOR 1.95, 95%CI 1.17–3.26) and macrosomia (aOR 2.01, 95%CI 1.23–3.27) in prepregnancy normal weight women. An EGWG greater than 4 kg was associated with a higher risk of LGA infants (aOR 1.67, 95%CI 1.23–2.23) and macrosomia (aOR 1.90, 95%CI 1.38–2.61) in obese women. In overweight women, an EGWG above 3.5 kg was associated with a higher risk of LGA infants (aOR 1.65, 95%CI 1.16–2.34), macrosomia (aOR 1.85, 95%CI 1.30–2.64), preeclampsia (aOR 2.40, 95%CI 1.45–3.98) and pregnancy-induced hypertension (aOR 2.21, 95%CI 1.52–3.21). An IGWG below −3.1 kg or −3kg was associated with a higher risk of small-for-gestational-age [SGA] infants in women with normal (OR 1.40, 95%CI 1.03–1.90) and underweight (OR 2.29, 95%CI 1.09–4.80), respectively. Conclusions Inappropriate gestational weight gain seems to be associated with an increased risk for adverse maternofetal outcomes, regardless of prepregnancy BMI. Beyond glycemic control, weight management in women with GDM must be a focus of special attention to prevent adverse pregnancy outcomes. KEY MESSAGES The dimension of deviation from appropriate gestational weight gain was associated with an increased risk for adverse maternofetal outcomes among women with gestational diabetes. Weight management must be a focus of special attention in women with gestational diabetes to prevent adverse pregnancy outcomes.

Reducing the risk of gestational diabetes mellitus in chronic hepatitis B virus carriers via more strict control of gestational weight gain.

To explore the association between gestational weight gain (GWG) and gestational diabetes mellitus (GDM) in hepatitis B surface antigen (HBsAg) -positive women using a retrospective cohort study to provide advice on the management of GWG. Our study included 39 539 pregnant women who gave birth at the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. Patients were divided into two groups: the HBsAg-negative and HBsAg-positive groups, comprising 36 500 and 3039 participants, respectively. We used univariate and multivariable logistic regression analyses to explore the association between GWG and GDM in maternal hepatitis B virus (HBV) carrier women. Being HBsAg positive and excessive GWG were independent risk factors for GDM. Excessive GWG was associated with a higher risk of GDM in HBsAg-positive women. Among pre-pregnancy women of normal weight, HBsAg-positive women with adequate GWG had a higher risk of GDM than HBsAg-negative women, whereas HBsAg-positive women with inadequate GWG had a lower risk of GDM. The optimal GWG ranges for pre-pregnancy normal-weight HBsAg-positive pregnancies might be lower than the US Institute of Medicine recommendations. HBsAg-positive women should strictly control GWG to reduce the risk of GDM.

ODP413 Impact of Gestational Weight Gain according to 2009 IOM Recommendations on Neonatal Anthropometrics in Asians: A Pilot Study from Malaysia

Abstract Introduction Gestational Weight Gain (GWG) modulates pregnancy outcomes and long-term offspring metabolic health [1,2]. Thus far, the widely used 2009 Institute of Medicine (IOM) recommendations on GWG have largely been evaluated in Caucasian populations and some monoethnic East Asian cohorts. We designed this study to determine if IOM GWG thresholds are applicable in a multi-ethnic Asian cohort of Malaysian mothers. Methods In this prospective observational study, 875 mothers were recruited from a Malaysian tertiary urban center during screening for gestational diabetes. Amongst data collected were Total GWG (maternal weight at delivery – self-reported pre-gravid weight) and neonatal anthropometrics. BMI was stratified by Caucasian (overweight ≥25kg/m 2, obese ≥30 kg/m 2) and Asian (overweight ≥23kg/m 2, obese ≥27.5kg/m 2) thresholds, and patients categorized by 2009 IOM GWG recommendations. Results This study included 67% Malay, 23% Chinese and 10% Indian mothers. There was a high prevalence of overweight/obesity regardless of cut-offs used (Asian 56.9% vs Caucasian 44%). When Asian BMI cut-offs were used, excessive GWG prevalence increased (34.1% → 40.6%) whilst inadequate GWG declined (30% → 24.9%). Prevalence of LGA, macrosomia, Birth Weight(BW)/Neonatal Fat Mass(NFM)/Sum of Skinfold Thickness(SSFT) >90th centile was highest (p<0. 05) in those with excess GWG whether stratified by Caucasian or Asian BMI cut-offs. Upon multivariate analysis adjusting for age, parity, race, GDM, Ln HOMA2%S and baby gender, excessive GWG (by Asian BMI categories) was associated only with increased risk of SSFT >90th centile (aOR 5.7, 95% CI 2.33–14. 03). Excessive GWG (by Caucasian BMI categories) was associated with increased risk of macrosomia (aOR 8.65, 95% CI 1. 07–70. 01), NFM >90th centile (aOR 2.14, 95% CI 1. 02–4.45) and SSFT >90th centile (aOR 3.88, 95% CI 1.77–8.51). SGA status was associated with insufficient GWG by both Caucasian (aOR 4.26, 95% CI 2.46–7.38) and Asian BMI cut-offs (aOR 3.55, 95% CI 2. 07–6.10). Conclusion The 2009 IOM recommendations, using either Caucasian or regional Asian BMI thresholds, are applicable in our multi-ethnic Asian cohort in terms of predicting increased neonatal adiposity and SGA status.

Gestational weight gain adequacy among twin pregnancies in France.

The objective of this paper is to describe gestational weight gain (GWG), to assess the applicability of the 2009 Institute of Medicine (IOM) guidelines, and to derive a GWG adequacy classification within a French cohort. We included twins from the national, prospective, population-based JUmeaux MODe d'Accouchement(JUMODA) cohort study (2014-2015). Following the IOM approach, we selected a 'standard'population of term pregnancies with 'optimal' birthweight (≥2500 g; n = 2562). GWG adequacy (insufficient; adequate; excessive) was defined using IOM recommendations (normal body mass index[BMI]: 16.8-24.5 kg [also utilized for underweight BMI]; overweight: 14.1-22.7 kg; obese: 11.4-19.1 kg). Additionally, using the IOM approach, we determined the 25th and 75th percentiles of GWG in our standard population to create a JUMODA-derived GWG adequacy classification. GWG and GWG adequacy were described, overall and by BMI and parity. In the JUMODA standard population of term twin livebirths with optimal birthweight, mean GWG was 16.1 kg (standard deviation 6.3). Using IOM recommendations, almost half (46.5%) of the women had insufficient and few (10.0%) had excessive GWG, with similar results regardless of BMI or parity. The 25th and 75th percentiles of GWG in the JUMODA standard population (underweight: 13-21 kg; normal weight: 13-20 kg; overweight: 11-19 kg; obese: 7-16 kg) were lower than the IOM recommendations. The IOM recommendations classified a relatively high percentage of French women as having insufficient and a low percentage as having excessive GWG. Additional research to evaluate recommendations in relation to adverse perinatal outcomes is needed to determine whether the IOM recommendations or the JUMODA-derived classification is more appropriate for French twin gestations.

Fortified Balanced Energy-Protein Supplementation, Maternal Anemia, and Gestational Weight Gain: A Randomized Controlled Efficacy Trial among Pregnant Women in Rural Burkina Faso

ABSTRACTBackgroundAnemia and suboptimal gestational weight gain (GWG) are associated with adverse maternal and birth outcomes. Limited research indicates that balanced energy-protein (BEP) supplements reduce the incidence of inadequate GWG.ObjectivesWe assessed the efficacy of a micronutrient-fortified BEP supplement on the secondary outcomes of anemia, GWG, GWG rate, and GWG in relation to the Institute of Medicine (IOM)’s recommendations, as compared with an iron–folic acid (IFA) tablet.MethodsWe conducted a randomized controlled trial in Burkina Faso, among pregnant women (15–40 y old) enrolled at <21 weeks of gestation. Women received either BEP and IFA (intervention) or IFA (control). Hemoglobin (g/dL) concentrations were measured at baseline and the third antenatal care visit (ANC), whereas maternal weight was measured at baseline and all subsequent ∼7-weekly ANCs. GWG (kg) was calculated as a woman's last weight measurement (at ∼36 weeks of gestation) minus weight at enrollment, whereas GWG rate (kg/wk) was GWG divided by the time between the first and last weight measurements. GWG adequacy (%) was computed as GWG divided by the IOM's recommendation. Binary outcomes included severely inadequate, inadequate, and excessive GWG. Statistical analyses followed the intention-to-treat principle. Linear regression and probability models were fitted for the continuous and binary outcomes, respectively, adjusting for baseline measurements.ResultsWomen in the BEP group tended to have higher, but nonsignificantly different, GWG (0.28 kg; 95% CI: −0.05, 0.58 kg; P = 0.099). Furthermore, there were no significant differences in prenatal anemia prevalence, GWG rate, GWG adequacy, or incidence of inadequate or excessive GWG. Findings were robust to model adjustments and complete case and per protocol analyses.ConclusionsThis trial does not provide evidence that fortified BEP supplementation reduces maternal anemia or increases GWG, as compared with IFA. In conjunction with the small, but positive, effects of maternal BEP supplementation on birth outcomes, our findings warrant the investigation of additional biochemical and postnatal outcomes.This trial was registered at clinicaltrials.gov as NCT03533712.

Knowledge, attitude, and practice of the 2009 Institute of Medicine (IOM) recommendations on the nutritional management of diabetes in pregnancy: an online national survey

AimsAs recommended by the Institute of Medicine (IOM), health practitioners should encourage a healthy nutrition and adequate weight gain during pregnancy in order to ensure favorable pregnancy and fetal outcomes, and to prevent diseases later in life for both mother and child. The purpose of this online survey was to determine the knowledge, attitude, and practice of the 2009 IOM recommendations among healthcare professionals managing nutritional therapy in pregnancies complicated by diabetes in Italy.MethodsA cross-sectional survey was conducted by using an online self-administered questionnaire undertaken between October and December 2021.ResultsOf the 220 participants 89% were diabetologists/endocrinologists/internal medicine specialists and 11% dietitians/nutritionists. The survey found that the 53% of respondents provide a personalized diet to pregnant women with diabetes, while 32% a standard diet plan and only 15% healthy dietary advice. The 69% of the participants investigated for appropriate gestational weight gain, mainly based on pre-pregnancy BMI (96%), gestational weight gain (GWG) at first prenatal visit (80%) and presence of twin pregnancy (58%). Maternal weight gain was evaluated at each regularly scheduled prenatal visit and compared with IOM recommendations for the 87% of healthcare professionals. Diet plan was periodically re-evaluated and/or modified (90% of participants), based on inadequate maternal weight gain and/or fetal growth abnormalities (78%), trimester transition (53%), changes in physical activity and/or a “feel hungry” (50%).ConclusionsThis survey reported the knowledge and attitude of IOM guidelines and the nutritional knowledge and practice of Italian professionals on the nutritional management of diabetes in pregnancy. The application of these recommendations seemed more feasible in clinics/team dedicated to "Diabetes in Pregnancy".

What is the “cost” of reducing adverse pregnancy outcomes in patients with gestational diabetes mellitus - risk factors for perinatal complications in a retrospective cohort of pregnant women with GDM

BackgroundGestational diabetes mellitus (GDM) is a frequent pregnancy complication, affecting the maternal and neonatal health. The new diagnostic strategy for GDM, proposed by the International Association of Diabetes and Pregnancy Study Groups in 2010 and World Health Organization in 2013, raised hope to reduce perinatal complications. The purpose of the study was to compare risk factors influencing maternal and foetal outcomes in a group of pregnant women diagnosed with GDM, and in a group of pregnant women without GDM, regardless of the adopted diagnostic criteria. Also, the aim of the study was to evaluate the impact of risk factors on perinatal results and the “cost” of reducing adverse pregnancy outcomes in patients with GDM.MethodsIt was a retrospective study based on the analysis of births given after 37 weeks of pregnancy at the 2nd Department of Obstetrics and Gynaecology, Warsaw Medical University during the years 2013 to 2015. All pregnant women had a 75 g OGTT between the 24th and 28th weeks of pregnancy. The study compared risk factors for perinatal complications in 285 GDM patients and in 202 randomly selected women without GDM. The impact of selected risk factors on perinatal outcomes was analysed.ResultsBoth the diagnosis of GDM and maternal BMI prior to pregnancy, significantly modified the risk of excessive and insufficient weight gain during pregnancy. The parameters significantly influencing the risk of the composite adverse maternal outcome were the maternal abdominal circumference [OR: 1.08 (1.04; 1.11)] and multiparity, which reduced the risk by almost half [OR: 0.47 (0.30; 0.75)]. The maternal abdominal circumference before the delivery was a strong factor correlating with the occurrence of perinatal complications in both the mother and the foetus in the entire cohort. A circumference over 100 cm increased the risk of at least one maternal complication (increased blood loss, soft tissue injury, pre-eclampsia) by almost 40% (OR 1.38, p < 0.001).ConclusionsNo differences were found in maternal and foetal outcomes in GDM and non-GDM women except gestational weight gain below Institute of Medicine recommendations. The only “cost” of reducing adverse pregnancy outcomes in GDM patients seems to be lowering gestational weight gain, the future impact of which on GDM pregnant population should be assessed. The maternal abdominal circumference measured before delivery not the severity of carbohydrate intolerance, remained the main predictor for significant perinatal complications.

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.

The impact of IOM recommendations on gestational weight gain among US women: An analysis of birth records during 2011-2019.

The prevailing guidelines of the Institute of Medicine (IOM) of United States on gestational weight gain (GWG) are based on women's prepregnancy body mass index (BMI) categories. Previous research has shown that the guidelines issued in 1990 and revised in 2009 had no effect. We investigate the effectiveness of new guidelines issued in 2009 analyzing the records of all singleton births in the U.S. during 2011-2019 (34.0 million observations). We use the discontinuity in recommended guidelines at the threshold values of BMI categories in a regression discontinuity (RD) research design to investigate the effect of IOM guidelines on GWG. We also use an RD analysis in a difference in difference (DID) framework where we compare the effect on women who had any prenatal care to others who did not receive prenatal care. The naïve RD estimator predicts an effect in the expected direction at the threshold BMI values of 18.5 and 25.0 but not at 30.0. After the DID based correction, the RD analyses show that the GWG, measured in kg, drop at the BMI values of 18.5, 25.0 and 30.0 by 0.189 [CI: 0.341, 0.037], 0.085 [CI: 0.179, -0.009] and 0.200 [CI: 0.328, 0.072] respectively when the midpoint of the recommended range in kg drops by 1.5, 4.5 and 2.25. This implies a responsiveness of 12.6%, 1.9% and 8.9% respectively to changes in guidelines at these BMI values. The findings show that the national guidelines have induced some behavioral changes among US women during their pregnancy resulting in a change in GWG in the expected direction. However, the magnitude of the change has not been large compared to the expectations, implying that the existing mechanisms to implement these guidelines have not been sufficiently strong.

Impact of pre-pregnancy obesity on cesarean delivery rates in nulliparous pregnant people undergoing induction of labor

Objective To evaluate the impact of pre-pregnancy obesity on the cesarean delivery rate in nulliparous pregnant people undergoing induction of labor. Study design This is a retrospective cohort study of nulliparous pregnant people with a normal weight and obesity who underwent induction of labor between 37 and 41 weeks gestation at a single institution from 2012 to 2018. Weight category was based on pre-pregnancy body mass index. The primary outcome was rate of cesarean delivery. Additional demographic and clinical characteristics were analyzed. A chi square test was used to compare the cesarean delivery rates. Multivariate logistic regression was used to generate adjusted odds ratios (aOR) and 95% confidence intervals (CI) controlling for potential cofounders. Results Of the 557 pregnancies identified, 88/285 (31%) of pregnant people with a normal weight had a cesarean delivery while 165/263 (63%) of pregnant people with obesity had a cesarean delivery (cOR 3.8, 95% CI 2.6–5.4). After adjustment, pregnant people with obesity remained more likely to have a cesarean delivery compared to pregnant people with a normal weight (aOR 2.7, 95% CI 1.8–4.0). Further, cesarean delivery was more likely in those with an unfavorable modified Bishop score (aOR 3.4, 95% CI 1.8–6.5) and gestational weight gain above the Institute of Medicine recommendation (aOR 2.6, 95% CI 1.8–3.9). The rate of cesarean delivery was not different by class of obesity (p = .32). Conclusion Pre-pregnancy obesity is associated with higher cesarean delivery rates in nulliparous pregnant people undergoing induction of labor compared with normal pre-pregnancy body mass index. Gestational weight gain above the Institute of Medicine recommendations and having an unfavorable modified Bishop score at the time of induction are associated with increased cesarean delivery rates.

Outcomes from a hybrid implementation-effectiveness study of the living well during pregnancy Tele-coaching program for women at high risk of excessive gestational weight gain

BackgroundExcess gestational weight gain (GWG) is associated with short-term perinatal complications and longer term cardiometabolic risks for mothers and their babies. Dietitian counselling and weight gain monitoring for women at risk of high pregnancy weight gain is recommended by clinical practice guidelines. However, face-to-face appointments, during a time with high appointment burden, can introduce barriers to engaging with care. Telephone counselling may offer a solution. The Living Well during Pregnancy (LWdP) program is a dietitian-delivered telephone coaching program implemented within routine antenatal care for women at risk of excess GWG. This program evaluation used a hybrid implementation-effectiveness design guided by the RE-AIM framework to report on the primary outcomes (reach, adoption, implementation, maintenance) and secondary outcomes (effectiveness) of the LWdP intervention.MethodsThe LWdP program evaluation compared data from women participating in the LWdP program with a historical comparison group (pregnant women receiving dietetic counselling for GWG in the 12 months prior to the study). The primary outcomes were described for the LWdP program. Between group comparisons were used to determine effectiveness of achieving appropriate GWG and pre and post intervention comparisons of LWdP participants was used to determine changes to dietary intake and physical activity.ResultsThe LWdP intervention group (n = 142) were compared with women in the historical comparison group (n = 49). Women in the LWdP intervention group attended 3.4 (95% CI 2.9–3.8) appointments compared with 1.9 (95% CI, 1.6–2.2) in the historical comparison group. GWG was similar between the two groups, including the proportion of women gaining weight above the Institute of Medicine recommendations (70% vs 73%, p = 0.69). Within group comparison showed that total diet quality, intake of fruit and vegetables and weekly physical activity were all significantly improved from baseline to follow-up for the women in LWdP, while consumption of discretionary food and time spent being sedentary decreased (all p < 0.05).ConclusionThe LWdP program resulted in more women accessing care and positive improvements in diet quality, intuitive eating behaviours and physical activity. It was as effective as face-to-face appointments for GWG, though more research is required to identify how to engage women earlier in pregnancy and reduce appointment burden.

Professional Development Strategies: Organization Experience in addressing the call to action, the Future of Nursing, Leading Change, Advancing Health

Introduction and Background: Professional development is vital to achieving excellence in clinical practice, education, administration, health policies, research, and management. In 2010, the Institute of Medicine (IOM) made recommendations for an action-oriented blueprint for the future of nursing. Some of the recommendations include ensuring nurses are well-prepared, nursing organizations to institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. To respond to these recommendations, the National Association of Nigerian Nurses in North America [NANNNA] a not-for-profit organization, implemented various strategies to support its members in achieving the IOM recommendations. Purpose: The purpose of this study was to evaluate the various strategies used by NANNNA to achieve the IOM recommendations for professional development among its members. Method: NANNNA Research subcommittee conducted an online survey of its members. The academic data obtained from 259 members was analyzed descriptively using SPSS and excel. A total of 323 degrees were attained during the 10 years from the 259 participants. Results: Based on the significant value of 0.029 (i.e., p = .029), which is below 0.05, there is a statistically significant difference in the mean of NANNNA members’ degree attainment. The result shows that the strategies implemented, mentorship, preceptorship, leadership, networking, and inter-professional collaboration, were vital to professional development among its members. This finding has important implications for the future of nursing, leading change and provides new insights into not-for-profit organizational influence on nurses’ personal and professional development.

Multivitamin Supplementation Is Associated with Greater Adequacy of Gestational Weight Gain among Pregnant Women in Tanzania

Gestational weight gain (GWG) is a modifiable risk factor associated with adverse birth outcomes. Studies have shown that the provision of multiple micronutrient supplements to pregnant women reduces the risk of low birth weight. However, the effect of multiple micronutrient supplements on GWG has been understudied. We examined the effect of daily supplementation of pregnant women with multivitamins on GWG in relation to the GWG recommendation by the Institute of Medicine (IOM). Pregnant women with gestational age between 12 and 27 wk were randomly assigned to receive daily multivitamins or placebo until delivery. Weight was measured at enrollment and every follow-up visit. Percentage adequacy of GWG was calculated as actual GWG divided by the recommended GWG according to the IOM recommendation. Binary outcomes included severely inadequate (<70%), inadequate (<90%), and excessive GWG (≥125%). The analysis included 7573 women with singleton pregnancies. Multiple linear regression models were used to examine the association between multivitamin supplementation and percentage adequacy of GWG, and log-binomial models were used for binary outcomes. The mean percentage adequacy of GWG was 96.7% in the multivitamin arm and 94.4% in the placebo arm, with a mean difference of 2.3% (95% CI: 0.3%, 4.2%; P=0.022). Compared with women in the placebo arm, those who received multivitamins had a lower risk of severely inadequate GWG (RR: 0.90; 95% CI: 0.83, 0.97; P=0.008) and inadequate GWG (RR: 0.95; 95% CI: 0.91, 0.99; P=0.018). No significant difference was found in excessive GWG. Multivitamin supplementation increased GWG and reduced the risk of severely inadequate and inadequate GWG among pregnant women in Tanzania. Together with previously reported beneficial effects of the supplements on birth outcomes in low- and middle-income countries, our findings support scaling up the use of prenatal supplements that include multivitamins in addition to iron and folic acid.This trial was registered at clinicaltrials.gov as NCT00197548.

Gestational weight gain and postpartum weight retention in Tasmanian women: The Baby-bod Study.

Many factors can negatively impact perinatal outcomes, including inappropriate gestational weight gain (GWG). Despite having the greatest potential to influence maternal and infant health, there is a lack of consensus regarding the GWG consistent with a healthy pregnancy. To date, GWG in Northern Tasmania remains understudied. We investigated how maternal pre-pregnancy body mass index (BMI) is related to weight gain during pregnancy and weight retention post-partum, and how maternal pre-pregnancy BMI is related to the mode of delivery. Approximately 300 Tasmanian mothers (n = 291 for mode of delivery and n = 282 for GWG) were included in this study. Analysis of variance and chi square tests were conducted to assess differences in BW of mothers across BMI categories and differences between categorical variables; respectively. Based on pre-pregnancy BMI, mothers were assigned to one of three groups, with healthy weight (<25 kg m-2), with overweight (25–29.9 kg m-2), or with obesity (>30 kg m-2). Pre-pregnancy BMI and body weight (BW) were significantly associated (p<0.001) with post-partum BW at 3 and 6 months. Only 25% of mothers with a normal weight BMI, 34% with overweight and 13% with obesity, achieved the Institute of Medicine (IOM) recommendation for GWG. Interestingly, a number of women in our cohort lost weight during gestation (1.5, 9 and 37% in <25, 25–29.9 and >30 kg m-2 groups, respectively). Further, women with obesity showed the lowest level of BW fluctuation and retained less weight post-partum. The highest number of caesarean sections were observed in mothers who exceeded GWG recommendations. Most mothers either exceeded or failed to achieve IOM recommendations for GWG. To improve the generalisability of these findings, this study should be replicated in a larger representative sample of the Tasmanian maternal population.

Association between gestational weight gain and pregnancy outcomes in a Singaporean population: A prospective cohort study

ObjectivesInadequate or excessive gestational weight gain (GWG) is associated with adverse pregnancy outcomes. We aimed to study GWG in a Singaporean population and its association with pregnancy outcomes, including small for gestational age (SGA), macrosomia, and caesarean section secondary to failure to progress (FTP) or cephalopelvic disproportion (CPD). Study Design926 women with low-risk singleton pregnancy were enrolled in a prospective cohort study from 2010 to 2014 in a Singapore tertiary maternity hospital. 704 patients without pre-existing diabetes or hypertension and had maternal weight information till term pregnancy were included in analyses. Participants were categorized according to their first antenatal visit body mass index (BMI) as underweight, normal weight, overweight and obese. Total GWG for each BMI group was calculated and compared to Institute of Medicine (IOM) 2009 GWG guidelines. Logistic regression analyses were performed to assess the association of GWG below or above IOM guidelines with pregnancy outcomes. ResultsGWG below IOM guidelines was associated with an increased risk of SGA (adjusted OR: 2.97 [1.71, 5.15]; p < 0.0001). GWG above IOM guidelines significantly increased the risk of caesarean section due to FTP or CPD (adjusted OR: 2.10 [1.09, 4.01]; p = 0.0275). GWG above IOM guidelines was associated with an increased risk of macrosomia (adjusted odds ratio: 2.27 [1.43, 3.63]; p = 0.0006), while GWG below IOM guidelines was associated with a reduced risk of macrosomia (adjusted odds ratio: 0.18 [0.08, 0.39]; p < 0.0001). ConclusionsGWG not achieving the IOM recommendations has been found to be associated with adverse pregnancy outcomes in Singaporean women. Inadequate GWG is associated with an increased risk of SGA whereas excessive GWG is associated with increased risks of macrosomia and caesarean section due to failure to progress or CPD. Results of the current study add to our understanding on the association of GWG with pregnancy outcomes in the South-East Asia and suggest that appropriate weight management during pregnancy is important.

Be Healthy in Pregnancy (BHIP): A Randomized Controlled Trial of Nutrition and Exercise Intervention from Early Pregnancy to Achieve Recommended Gestational Weight Gain.

A randomized two-arm prospective superiority trial tested the efficacy of a novel structured and monitored nutrition (bi-weekly counselling for individualized energy and high dairy protein diet) and exercise program (walking goal of 10,000 steps/day) (intervention) compared to usual care (control) in pregnant women to achieve gestational weight gain (GWG) within current recommendations. Women recruited in communities in southern Ontario, Canada were randomized at 12–17 weeks gestation with stratification by site and pre-pregnancy BMI to intervention (n = 119) or control (n = 122). The primary outcome was the proportion of women who achieved GWG within the Institute of Medicine recommendations. Although the intervention compared to control group was more likely to achieve GWG within recommendations (OR = 1.51; 95% CI (0.81, 2.80)) and total GWG was lower by 1.45 kg (95% CI: (−11.9, 8.88)) neither reached statistical significance. The intervention group achieved significantly higher protein intake at 26–28 week (mean difference (MD); 15.0 g/day; 95% CI (8.1, 21.9)) and 36–38 week gestation (MD = 15.2 g/day; 95% CI (9.4, 21.1)) and higher healthy diet scores (22.5 ± 6.9 vs. 18.7 ± 8.5, p < 0.005) but step counts were similar averaging 6335 steps/day. Pregnancy and infant birth outcomes were similar between groups. While the structured and monitored nutrition with counselling improved diet quality and protein intake and may have benefited GWG, the exercise goal of 10,000 steps/day was unachievable. The results can inform future recommendations for diet and physical activity in pregnancy.

Prepregnancy weight change associated with high gestational weight gain.

Gestational weight gain (GWG) above recommendations is a risk factor for adverse maternal, perinatal, and long-term outcomes. This study hypothesized that prepregnancy weight gain may portend excess GWG. Among 1,126 women (51% of whom were of Black race) in the Coronary Artery Risk Development in Young Adults (CARDIA) study with post-baseline births, the prepregnancy annual rate of BMI change per woman was estimated (slope; 5 years before pregnancy) and was related to the risk of GWG above Institute of Medicine recommendations using mixed-effects models (binary) and GWG z score (continuous), adjusting for confounders, and stratified by prepregnancy overweight/obesity status. A total of 626 women (56%) had excess GWG. Each standard deviation increase in prepregnancy BMI (0.16 kg/m2 per year) was associated with an 18% increased risk of excess GWG (95% CI: 1.13-1.23), adjusted for covariates. Stratified results showed an association for women without overweight or obesity (adjusted relative risk = 1.71 [95% CI: 1.38-2.13]) but not among those with overweight or obesity (adjusted relative risk = 0.98 [95% CI: 0.91-1.05]). When evaluated as a z score, prepregnancy weight gain was associated with higher GWG among women with and without overweight or obesity (mean = 0.24 [0.10] and 0.28 [0.12] z score, respectively). Weight gain before pregnancy is associated with higher GWG during pregnancy. Assessment of prepregnancy weight changes may identify those at risk for high GWG.

Influence of gestational weight gain on the organochlorine pollution content of breast milk

BackgroundTransplacental transfer and breastfeeding are the main transport routes of organic pollutants into children at the beginning of life. Although pollutant transmission through these mechanisms primarily depends on the maternal pollution burden, its impact may be modulated by physiological effects. ObjectivesWe have examined whether gestational weight gain (GWG) exerts an influence on the content of lipophilic low volatile pollutants in breast milk. ResultsColostrum from mothers from the INMA cohorts of Sabadell and Gipuzkoa (n = 256 and 119, respectively) with low GWG as defined by the Institute of Medicine (IOM) from the US National Academies of Sciences, Engineering and Medicine had significantly higher concentrations of polychlorobiphenyls (PCBs) and 4,4′-DDE than colostrum in mothers who gained weight within IOM recommendations or in those who exceeded this threshold. Statistically significant differences were also found in the colostrum:maternal serum ratios of these compounds. Women with low GWG retained higher pollutant amounts in colostrum. These observations are consistent with previously described higher concentrations of these pollutants in infant cord blood from mothers with low GWG by IOM standards. They indicate that mobilization of lipophilic organic pollutants by metabolic pregnant changes not only leads to higher fetal transfer but to higher accumulation into the mammary system upon low GWG. Conclusions: The present results show that insufficient GWG, besides increasing in utero exposure, also enhances pollutant transfer to infants during breastfeeding which considerably extends the significance of this physiological change for the pollutant children intake in early life.

The Effect of Antiretroviral Therapy for the Treatment of Human Immunodeficiency Virus (HIV)-1 in Pregnancy on Gestational Weight Gain.

Gestational weight gain above Institute of Medicine recommendations is associated with increased risk of pregnancy complications. The goal was to analyze the association between newer HIV antiretroviral regimens (ART) on gestational weight gain. A retrospective cohort study of pregnant women with HIV-1 on ART. The primary outcome was incidence of excess gestational weight gain. Treatment effects were estimated by ART regimen type using log-linear models for relative risk (RR), adjusting for prepregnancy BMI and presence of detectable viral load at baseline. Three hundred three pregnant women were included in the analysis. Baseline characteristics, including prepregnancy BMI, viral load at prenatal care entry, and gestational age at delivery were similar by ART, including 53% of the entire cohort had initiated ART before pregnancy (P = nonsignificant). Excess gestational weight gain occurred in 29% of the cohort. Compared with non-integrase strand transfer inhibitor (-INSTI) or tenofovir alafenamide fumarate (TAF)-exposed persons, receipt of INSTI+TAF showed a 1.7-fold increased RR of excess gestational weight gain (95% CI: 1.18-2.68; P < .01), while women who received tenofovir disoproxil fumarate had a 0.64-fold decreased RR (95% CI: .41-.99; P = .047) of excess gestational weight gain. INSTI alone was not significantly associated with excess weight gain in this population. The effect of TAF without INSTI could not be inferred from our data. There was no difference in neonatal, obstetric, or maternal outcomes between the groups. Pregnant women receiving ART with a combined regimen of INSTI and TAF have increased risk of excess gestational weight gain.