Lower Mean Gestational Weight Gain Research Articles

The impact of a vegan diet on pregnancy outcomes.

To determine the effect of a maternal vegan diet on pregnancy outcome. This is a prospective observational study. Women with a singleton pregnancy who maintained the same diet prior to, and throughout current pregnancy were enrolled. Stratification was performed according to diet type: vegans, lacto-ovo-vegetarians, fish-eaters, and omnivores. Overall, 273 women were enrolled, of them, 112 omnivores, 37 fish-eaters, 64 lacto-ovo-vegetarians, and 60 vegans. The vegan diet was significantly associated with an increased risk of small-for-gestational-age newborns compared only to an omnivore diet (RR = 5.9, 95% CI, 1.2-21.8). The incidence of preterm birth was similar in all groups. Vegans had lower birthweight compared to lacto-ovo-vegetarians (3015 ± 420 g vs. 3285 ± 482 g, P = 0.004), and to omnivores (3328 ± 495 g, P < 0.001), but not to fish-eaters. Vegans also had a lower mean gestational weight gain compared only to omnivores (11.6 ± 4.2 kg vs. 14.3 ± 4.6 kg, P = 0.001). The vegan diet is associated with an increased risk for small-for-gestational-age newborns and lower birthweight.

Association between time interval from bariatric surgery to pregnancy and maternal weight outcomes

Background The majority of patients having bariatric surgery are reproductive-age women who are advised to delay pregnancy for at least 12 months after surgery. Many women become pregnant sooner and the association between gestational weight gain (GWG) and maternal long-term weight is unknown. Objectives The primary objective of this study was to compare weight outcomes in pregnancies occurring < 12 months versus ≥ 12 months after bariatric surgery. The secondary objectives were to determine the association between time interval from bariatric surgery to pregnancy and maternal nutritional status and maternal and neonatal outcomes. Study design This is a retrospective cohort study of women with singleton livebirths after bariatric surgery who received care at a single tertiary care center between 2009 and 2017. GWG was the difference in weight between the first prenatal visit and delivery. GWG adequacy was determined by the IOM 2009 guidelines according to prepregnancy BMI (inadequate, adequate, excessive). Postpartum weight retention was calculated as the difference between weight at first prenatal visit and measured postpartum weight. Weight outcomes along with maternal nutritional status and maternal and neonatal outcomes were compared between < 12 months versus ≥ 12 months after bariatric surgery with t-tests, Mann-Whitney U and chi-square tests, as appropriate. Results Of the 76 pregnancies that met inclusion criteria, 36.8% occurred < 12 months (median 7.2 months) and 63.2% occurred ≥ 12 months after surgery (median 26.9 months). Of those with pregnancies < 12 months from surgery, 34% had a restrictive procedure (adjustable gastric band or sleeve gastrectomy) while 66% had a combined restrictive-malabsorptive procedure (Roux-en-Y gastric bypass). In the ≥ 12 months group, 42.3% had a restrictive procedure while 57.7% had a combined restrictive-malabsorptive procedure. There were no significant differences in maternal age, ethnicity or nulliparity between groups, but there were more women with obesity in the < 12 months group (75 vs. 52%, p = .03). The mean prepregnancy BMI in the < 12 months group was 34.3 vs. 31.2 kg/m2 in the ≥ 12 months group. The < 12 months group had lower mean GWG (4.9 vs. 10.9 kg, p = .01) and higher frequency of weight loss during pregnancy (28.6 vs. 4.2%, p < .01) compared to the ≥ 12 months group. The < 12 months group had significantly less postpartum weight retention at 6 months compared to the ≥ 12 months group (−1.3 vs. 8.3 kg, p = .02). The < 12 months group had a higher prevalence of vitamin B12 deficiency (23.1 versus 4.9%, p = .05). There were no differences in hyperemesis, hypertensive disorders, gestational diabetes or delivery mode between groups (p > .05). There were no differences in gestational age at delivery, birth weight and small for gestational age infants between groups (p > .05). Conclusion Pregnancy < 12 months after bariatric surgery is associated with significantly lower mean GWG and a higher frequency of weight loss during pregnancy as well as less postpartum weight retention at 6 months. Although there were no differences birthweight, weight loss during pregnancy and its accompanying metabolic changes are concerning for a developing fetus. Further study is needed to determine the optimal timing of pregnancy after bariatric surgery with respect to both maternal and infant short and long-term outcomes.

The Effect of an Exercise Intervention on Gestational Weight Gain: The Behaviors Affecting Baby and You (B.A.B.Y.) Study: A Randomized Controlled Trial.

To examine the effect of a prenatal exercise intervention on gestational weight gain (GWG) and to update meta-analyses. Randomized controlled trial and meta-analysis. Obstetrical practices in a Western Massachusetts hospital. We analyzed 241 ethnically diverse pregnant participants at high risk for gestational diabetes in the Behaviors Affecting Baby and You (B.A.B.Y.) study. A total of 118 participants were randomized to an exercise intervention group and 123 to a comparison health and wellness intervention group. A 12-week individually tailored, motivationally matched program designed to increase the compliance with guidelines for exercise during pregnancy (30 min/day). The GWG and compliance with 2009 Institute of Medicine (IOM) guidelines for GWG abstracted from medical records. Unadjusted logistic regression, intent-to-treat. Results were added to the existing meta-analyses using a random effects model. Women randomized to the exercise group had a lower mean GWG than the comparison group (-0.97 kg, P value = .39) and were less likely to exceed IOM guidelines (odds ratio = 0.69, 95% confidence interval [CI] 0.34-1.40), but results were not statistically significant. Meta-analyses yielded a -0.63 kg (95% CI -1.17 to -0.08, P = .02) reduction in GWG and a 20% reduction in odds of exceeding IOM guidelines (95% CI 0.73 to 0.89) for the exercise intervention. Findings from this randomized trial among ethnically diverse women contribute to the results of meta-analyses supporting exercise as a means of attenuating GWG.

Maternal Obesity Management Using Mobile Technology: A Feasibility Study to Evaluate a Text Messaging Based Complex Intervention during Pregnancy.

Background. Maternal obesity and excessive gestational weight gain (GWG) are on the rise with negative impact on pregnancy and birth outcomes. Research into managing GWG using accessible technology is limited. The maternal obesity management using mobile technology (MOMTech) study aimed at evaluating the feasibility of text messaging based complex intervention designed to support obese women (BMI ≥ 30) with healthier lifestyles and limit GWG. Methods. Participants received two daily text messages, supported by four appointments with healthy lifestyle midwife, diet and activity goal setting, and self-monitoring diaries. The comparison group were obese mothers who declined to participate but consented for their routinely collected data to be used for comparison. Postnatal interviews and focus groups with participants and the comparison group explored the intervention's acceptability and suggested improvements. Results. Fourteen women completed the study which did not allow statistical analyses. However, participants had lower mean GWG than the comparison group (6.65 kg versus 9.74 kg) and few (28% versus 50%) exceeded the Institute of Medicine's upper limit of 9 kg GWG for obese women. Conclusions. MOMTech was feasible within clinical setting and acceptable intervention to support women to limit GWG. Before further trials, slight modifications are planned to recruitment, text messages, and the logistics of consultation visits.

Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child.

Some breastfed infants with atopic eczema benefit from elimination of cow milk, egg, or other antigens from their mother's diet. Maternal dietary antigens are also known to cross the placenta. To assess the effects of prescribing an antigen avoidance diet during pregnancy or lactation, or both, on maternal and infant nutrition and on the prevention or treatment of atopic disease in the child. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 July 2012). All randomized or quasi-randomized comparisons of maternal dietary antigen avoidance prescribed to pregnant or lactating women. We excluded trials of multimodal interventions that included manipulation of the infant's diet other than breast milk or of non-dietary aspects of the infant's environment. We extracted data from published reports, supplemented by additional information received from the trialists we contacted. The evidence from five trials, involving 952 participants, does not suggest a protective effect of maternal dietary antigen avoidance during pregnancy on the incidence of atopic eczema during the first 18 months of life. Data on allergic rhinitis or conjunctivitis, or both, and urticaria are limited to a single trial each and are insufficient to draw meaningful inferences. Longer-term atopic outcomes have not been reported. The restricted diet during pregnancy was associated with a slightly but statistically significantly lower mean gestational weight gain, a non-significantly higher risk of preterm birth, and a non-significant reduction in mean birthweight. The evidence from two trials, involving 523 participants, did not observe a significant protective effect of maternal antigen avoidance during lactation on the incidence of atopic eczema during the first 18 months or on positive skin-prick tests to cow milk, egg, or peanut antigen at one, two, or seven years. One crossover trial involving 17 lactating mothers of infants with established atopic eczema found that maternal dietary antigen avoidance was associated with a non-significant reduction in eczema severity. Prescription of an antigen avoidance diet to a high-risk woman during pregnancy is unlikely to reduce substantially her child's risk of atopic diseases, and such a diet may adversely affect maternal or fetal nutrition, or both. Prescription of an antigen avoidance diet to a high-risk woman during lactation may reduce her child's risk of developing atopic eczema, but better trials are needed. Dietary antigen avoidance by lactating mothers of infants with atopic eczema may reduce the severity of the eczema, but larger trials are needed.

Preventing excessive gestational weight gain—a secondary analysis of a cluster-randomised controlled trial

Healthy diet, physical activity and modest weight gain during pregnancy may prevent developing gestational diabetes mellitus (GDM). We examined whether a lifestyle intervention designed to prevent GDM was effective in reducing excessive gestational weight gain (GWG). A cluster-randomised controlled trial (n=399) was conducted in maternity clinics in 14 municipalities in Southern Finland. Pregnant women with at least one risk factor for GDM (for example, overweight) but no pre-existing diabetes were recruited at 8-12 weeks' gestation. The intervention included counselling on GWG, physical activity and healthy eating at five routine visits. Usual counselling practices were continued in the usual care municipalities. Statistical analyses were performed using multilevel linear and logistic regression models adjusted for weeks' gestation at last weight measurement, pre-pregnancy body mass index and smoking status. The intervention group had a lower mean GWG by weeks' gestation than the usual care group (adjusted coefficient for the between-group difference -0.016 kg per day, P=0.041). There was no difference in mean (± s.d.) GWG between the intervention and the usual care groups (13.7 ± 5.8 vs 14.3 ± 5.0 kg, P=0.64). In total, 46.8% of the intervention group and 54.4% of the usual care group exceeded the GWG recommendations. The adjusted odds ratio for excessive GWG was 0.82 (95% CI 0.53-1.26, P=0.36) in the intervention group as compared with the usual care group. The intervention had minor effects on GWG among women who were at increased risk for GDM. In order to prevent excessive GWG, additional focus on restriction of energy intake may be needed.

Gestational weight gain in Irish women

Gestational weight gain (GWG) in pregnancy has become an important issue in modern obstetrics. Concerns about rising obesity levels and the effect of excessive GWG are so great that the...

Maternal dietary antigen avoidance during pregnancy and/or lactation for preventing or treating atopic disease in the child.

Some breastfed infants with atopic eczema benefit from elimination of cow milk, egg, or other antigens from their mother's diet. Maternal dietary antigens are also known to cross the placenta. To assess the effects of prescribing an antigen avoidance diet during pregnancy and/or lactation on maternal and infant nutrition and on the prevention or treatment of atopic disease in the child. We searched the Cochrane Pregnancy and Childbirth Group trials register (October 2002) and contacted researchers in the field. All randomized or quasi-randomized comparisons of maternal dietary antigen avoidance prescribed to pregnant or lactating women. We excluded trials of multimodal interventions that included manipulation of the infant's diet other than breast milk or of nondietary aspects of the infant's environment. We extracted data from published reports, supplemented by additional information received from the trialists we contacted. The evidence from 4 trials involving approximately 451 participants does not suggest a protective effect of maternal dietary antigen avoidance during pregnancy on the incidence of atopic eczema during the first 12 to 18 months of life. Data on allergic rhinitis/conjunctivitis and urticaria are limited to a single trial each and are insufficient to draw meaningful inferences. Longer-term atopic outcomes have not been reported. The restricted diet during pregnancy was associated with a slightly but statistically significantly lower mean gestational weight gain, a nonsignificantly higher risk of preterm birth, and a nonsignificant reduction in mean birthweight.The evidence from 3 trials involving approximately 210 participants suggests a protective effect of maternal antigen avoidance during lactation on the incidence and severity of atopic eczema during the first 12 to 18 months, but methodologic shortcomings argue for caution in interpretation.One crossover trial involving 17 lactating mothers of infants with established atopic eczema found that maternal dietary antigen avoidance was associated with a nonsignificant reduction in eczema severity. Prescription of an antigen avoidance diet to a high-risk woman during pregnancy is unlikely to reduce substantially her child's risk of atopic diseases, and such a diet may adversely affect maternal and/or fetal nutrition. Prescription of an antigen avoidance diet to a high-risk woman during lactation may reduce her child's risk of developing atopic eczema, but better trials are needed. Dietary antigen avoidance by lactating mothers of infants with atopic eczema may reduce the severity of the eczema, but larger trials are needed.