Maternal Weight Gain Research Articles

Growth and adiposity in newborns study (GAINS): The influence of prenatal DHA supplementation protocol

BackgroundObesity and central fat mass (FM) accrual drive disease development and are related to greater morbidity and mortality. Excessive gestational weight gain (GWG) increases fetal fat accretion resulting in greater offspring FM across the lifespan. Studies associate greater maternal docosahexaenoic acid (DHA) levels with lower offspring FM and lower visceral adipose tissue during childhood, however, most U.S. pregnant women do not consume an adequate amount of DHA. We will determine if prenatal DHA supplementation is protective for body composition changes during infancy and toddlerhood in offspring exposed to excessive GWG. Methods and designInfants born to women who participated in the Assessment of DHA on Reducing Early Preterm Birth randomized controlled trial (ADORE; NCT 02626299) will be invited to participate. Women were randomized to either a high 1000 mg or low 200 mg daily prenatal DHA supplement starting in the first trimester of pregnancy. Offspring body composition and adipose tissue distribution will be measured at 2 weeks, 6 months, 12 months, and 24 months using dual energy x-ray absorptiometry. Maternal GWG will be categorized as excessive or not excessive based on clinical guidelines. DiscussionEffective strategies to prevent obesity development are lacking. Exposures during the prenatal period are important in the establishment of the offspring phenotype. However, it is largely unknown which exposures can be successfully targeted to have a meaningful impact. This study will determine if prenatal DHA supplementation modifies the relationship between maternal weight gain and offspring FM and FM distribution at 24 months of age. Ethics and disseminationThe University of Kansas Medical Center Institutional Review Board (IRB) approved the study protocol (STUDY00140895). The results of the trial will be disseminated at conferences and in peer reviewed publications.Trial registration: ClinicalTrials.gov ID: NCT03310983

Study of Metformin as first line therapy for control of gestational diabetes in Independent University Hospital.

Objective: To assess the control of gestational diabetes with metformin and to study maternal and fetal outcome in patients using metformin. Study Design: Cross Sectional study. Setting: Department of Obs & Gynae, Independent University Hospital. Period: September 2019 to July 2021. Material & Methods: Eighty six patient diagnosed as having gestational diabetes mellitus by oral glucose tolerance test included in study and Metformin used as first line therapy along with diet for control of blood sugar levels. While patients with insulin dependent diabetes and type 2 DM were excluded from study. Results: It was observed in study, that with metformin use glycemic control was excellent in 70 (81.3%) of patients. Maternal outcome like risk of maternal weight gain>10kg, preeclampsia, and premature births were low in patient usung metformin in pregnancy and as well as neonatal risk of macrosomia, prematurity, neonatal hypoglycemia and need for hospital admission were low with the use of metformin in patients suffering from gestational diabetes. Conclusion: GDM associated adverse outcome for mother like maternal weight gain, pregnancy induced hypertension operative delivery and neonate like macrosomia, birth trauma, neonatal hypoglycemia are well controlled by the use of life style modification and metformin use in almost >80 % of cases only in few cases there is additional need of insulin therapy. Maternal and fetal outcome found to be satisfactory with the use of metformin. Further studies are required to build a more confidence.

P18-057-23 In Couples With Obesity, Poor Paternal Tendency To Eat in Response to Food Cues and Limit Food Intake Is Associated With Higher Total and Rate of Maternal Gestational Weight Gain

P18-057-23 In Couples With Obesity, Poor Paternal Tendency To Eat in Response to Food Cues and Limit Food Intake Is Associated With Higher Total and Rate of Maternal Gestational Weight Gain

Maternal weight and its association with risk of overweight in offspring: a trajectory analysis from a birth cohort in China.

Most studies on the association of maternal pregnancy weight with offspring weight trajectory have a short follow-up time. This study aimed to explore the associations of maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) with childhood weight trajectories in a 7-year birth cohort. A total of 946 mother-child pairs (467 boys and 479 girls) from a longitudinal birth cohort in TianjinCity, China, were included in this study, ranging from pregnancy to offspring at 7years. The outcome variable was defined as overweight or not overweight in offspring at the last round. A group-based trajectory model was applied to identify childhood BMI trajectory groups. Five discrete BMI trajectory groups were identified and characterized as constant underweight (25.2%), constant normal weight (42.8%), and high or increasing trajectory [at risk of overweight (16.9%), progressive overweight (11.0%) and progressive obesity (4.1%)]. Maternal prepregnancy overweight was associated with 1.72 (95% CI 1.14-2.60, P = 0.01) to 4.02 (95% CI 1.94-8.36, P < 0.001) times the risk of all high or increasing trajectory groups, and excessive GWG was related to groups at risk of overweight [relative risk ratio (RRR) 2.09, 95% CI 1.27-3.46, P = 0.004] and progressive obesity (RRR 3.33, 95% CI 1.13-9.79, P = 0.029). Children in all high or increasing trajectory groups were associated with greater overweight risk at the last round [risk ratios (RRs) ranged from 3.54 (95% CI 2.53-4.95, P < 0.001) to 6.18 (95% CI 4.05-9.42, P < 0.001)]. Maternal prepregnancy overweight and excessive gestational weight gain were associated with increasing or high-level childhood body mass index trajectories as well as a greater risk of overweight at 7 years.

The distribution of dietary choline intake and serum choline levels in Australian women during pregnancy and associated early life factors

BackgroundMaternal dietary choline has a central role in foetal brain development and may be associated with later cognitive function. However, many countries are reporting lower than recommended intake of choline during pregnancy.MethodsDietary choline was estimated using food frequency questionnaires in pregnant women participating in population-derived birth cohort, the Barwon Infant Study (BIS). Dietary choline is reported as the sum of all choline-containing moieties. Serum total choline-containing compounds (choline-c), phosphatidylcholine and sphingomyelin were measured using nuclear magnetic resonance metabolomics in the third trimester. The main form of analysis was multivariable linear regression.ResultsThe mean daily dietary choline during pregnancy was 372 (standard deviation (SD) 104) mg/day. A total of 236 women (23%) had adequate choline intake (440 mg/day) based on the Australian and New Zealand guidelines, and 27 women (2.6%) took supplemental choline (ge 50 mg/dose) daily during pregnancy. The mean serum choline-c in pregnant women was 3.27 (SD 0.44) mmol/l. Ingested choline and serum choline-c were not correlated (R2) = − 0.005, p = 0.880. Maternal age, maternal weight gain in pregnancy, and a pregnancy with more than one infant were associated with higher serum choline-c, whereas gestational diabetes and environmental tobacco smoke during preconception and pregnancy were associated with lower serum choline-c. Nutrients or dietary patterns were not associated with variation in serum choline-c.ConclusionIn this cohort, approximately one-quarter of women met daily choline recommendations during pregnancy. Future studies are needed to understand the potential impact of low dietary choline intake during pregnancy on infant cognition and metabolic intermediaries.

The Nutritional Needs of Mothers and Babies: A Review

The aim is to assess the importance of measuring healthy habits by pregnant women, that enhance different factors of mother and fetus health. We evaluate the change and variations in dietary recommendations. A female went through a lot of physical and mental changes in different stages of pregnancy and there are some common symptoms such as vomiting, fatigue, nausea, frequent urination, dizziness, etc. Certain hormonal changes are there to balance the body’s fatigue, tiredness, and hormones, few dietary recommendations are mentioned and it has been concluded that diet plays an important role during pregnancy, and meeting all the nutrition needs is an essential factor in planning the diet. Many diseases/deficiencies are there such as goiter, iodine deficiency, folate deficiency, gestational diabetes mellitus, gestational weight gain, Neural tube defects, and much more. A detailed view is mentioned below in the following paper: On average, pregnancy lasts 40 to 42 weeks (Nine months). On average, weight gain for a pregnant woman is 12 to 14 kg, thus weight gain can lower the risk of complications during labor and also lower the risk of LBW (low birth weight). Low GWG increases the risk of having an LBW infant. The average weight of the baby should be 2.5–3 kg. A baby having this much body weight should be considered a healthy infant. We provide up-to-date advice for achieving optimal nutrition before conception, throughout breastfeeding, in the first two years of life, and for preschoolers, with an eye on long-term health benefits. These guidelines are intended to aid in the primary prevention of obesity and the non-communicable diseases it is linked to among economically privileged groups, such as European women and children. Medical professionals should be incentivized and educated to promote and advise patients on preconception nutrition, which includes enhancing adolescent nutrition and health. Women who are physically active, eat healthily, don’t smoke, don’t drink excessively, and have a good body mass index (BMI) have a higher chance of having a safe pregnancy. Women of childbearing age should have their consumption and status of specific micronutrients closely monitored, especially folate. Women at risk for insufficient dietary intake of certain micronutrients may benefit from taking dietary supplements containing iron, vitamin D, vitamin B12, iodine, and maybe others. Smoke and alcohol should be strictly eliminated from the diet. Yes, diet plays an important role during pregnancy but staying physically active is equally important for the mother and the baby to promote general health and well-being. Exercise and stretching can reduce the risk of excessive maternal weight gain or gestational weight gain(Obesity). A long walk can greatly help a pregnant woman after lunch or in the morning.

Focus on Metformin: Its Role and Safety in Pregnancy and Beyond.

Metformin is used worldwide in the treatment of type 2 diabetes and has been used in the treatment of diabetes in pregnancy since the 1970s. It is highly acceptable to patients due to its ease of administration, cost and adverse effect profile. It is effective in reducing macrosomia, large-for-gestational-age infants and reduces maternal weight gain. Despite its many advantages, metformin has been associated with reductions in foetal size and has been associated with an increase in infants born small-for-gestational-age in certain cohorts. In this article, we review its efficacy, adverse effects and long-term follow-up before, during and after pregnancy for both mother and infant. We also evaluate the other forms of treatment for gestational diabetes, including oral therapies, insulin therapy and emerging treatments.

1385-P: Maternal Gestational Weight Gain and Children’s Genetic Susceptibility on Childhood Adiposity—A Longitudinal Cohort Study

Few studies have assessed the association of early-life environmental and genetic factors with the risk of childhood adiposity. The aim of the present study was to investigate the interaction between maternal gestational weight gain (GWG) and children’s genetic susceptibility on childhood adiposity. The present study included 1038 mother-child pairs. Body mass index (BMI) for age Z-score (BMI-Z) and childhood overweight were evaluated according to the World Health Organization (WHO) growth reference. Genetic risk score (GRS) was established by aggregating alleles of 10 BMI susceptibility single-nucleotide polymorphisms identified from a recent study. Children born to mothers with excessive GWG had higher BMI-Z (P&amp;lt;0.001), percentage of body fat (P&amp;lt;0.001), and prevalence of overweight (28.4% vs 15.9%, P&amp;lt;0.001) than those born to mothers with adequate GWG. Children’s BMI GRS was significantly and positively associated with BMI-Z, percentage of body fat and overweight risk (all P&amp;lt;0.05). Stratified analyses showed the positive association of children’s BMI GRS with adiposity risk was especially concentrated among mothers with pre-pregnancy normal weight but excessive GWG. The present study identified an interactive effect between maternal GWG and children’s genetic susceptibility on childhood adiposity risk. The findings provided new insight into the etiology of childhood obesity and highlighted the importance of GWG management. Disclosure H.Liu: None. W.Li: None. L.Wang: None. S.Zhang: None. W.Li: None. X.Yang: None. J.Leng: None. G.Hu: None. S.Wang: None. Funding European Foundation for the Study of Diabetes/Chinese Diabetes Society/Lilly Programme for Collaborative Research between China and Europe; National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100790, R01DK132011); National Institute of General Medical Sciences (U54GM104940)

1305-P: The Effect of Limited Pregnancy Weight Gain on Fetal Growth during Dietary Therapy in Gestational Diabetes Mellitus–Affected Women

Aims: We aimed to evaluate how diet-related maternal weight gain (GWG) affected foetal growth in gestational diabetes (GDM)-complicated pregnancies. Methods: This study involved 182 women who were sequentially diagnosed with GDM before 34 weeks of pregnancy and gave birth to live singletons at our hospital. To gauge compliance with an energy-limited “diabetic diet,” the women were divided into three groups based on their restricted (53%), appropriate (16%), and excessive (31%) weekly GWG. If necessary, insulin therapy was started in accordance with regional clinical recommendations. Results: At the time of the diagnosis of GDM at 276 ± 51 weeks, the three groups' glucose tolerance, HbA1c, weekly GWG before dietary treatment, and SD score for foetal abdominal circumference were comparable. The women were monitored for 100 ± 51 weeks, during which time 54% of them got further insulin medication, and the average GWG during dietary therapy varied amongst the three groups, weighing 0 kg, 3 kg, and 5 kg. Increased HbA1c between the time of GDM diagnosis and late pregnancy was associated with excessive weekly GWG during dietary treatment, reflecting poor dietary adherence, and newborns had a birthweight-SD score of 0.59 ± 1.6. Conclusions: In women with GDM, restricted GWG during nutritional therapy was linked to improved foetal growth. Clinical determinants of infant birthweight-SD score that are possibly modifiable include GWG during nutritional therapy and late-pregnancy HbA1c. Disclosure N.Kumar: None. S.C.Jha: None.

Body Mass Index Categories Among Pregnant Women Attending Primary Health Care Centers / Baghdad 2022

Background: Recommended weight gain to support a healthy pregnancy vary by prepregnant body mass index. Insufficient weight gain especially associated with prepregnant underweight is associated with increased risk of spontaneous preterm delivery, small for gestational age. Extensive weight gain often results in large for gestational age babies also may increase risk during delivery. Good nutrition and a healthy diet during pregnancy are critical for a mother’s health, as well as that of her child. A healthy diet contains adequate energy, protein, vitamins and mineral obtained from a variety of foods including green and orange vegetables, meat, fish, beans, nuts, whole grains, and fruit. Many studies have suggested that weight gain during pregnancy is affected by prepregnancy BMI. This study is conducted to determine maternal weight gain, pattern and associated of some selected socio-demographic factors. Method: A cross-sectional analytic study wholly done from July 4th to December 20th; the sample size was 114 pregnant antenatal care files archived selected from primary health care centers. It searched for the full previous pregnancy files and with frequent visits from the beginning of pregnancy to birth. The data and information were collected from antenatal care files from six primary health care centers of As-Salam, AL-A’dil, AL-Mansour, AL-A’dhamiya 3rd, AL-Baladiyaat, AL-Mustansiriya. The exclusion criteria exclude all incomplete files, pregnant women less than 18 years, and pregnant with chronic disease multiple pregnancy. Frequencies and percentage were calculated; Chi square test were used; and the statistical probability were consider significant if P value &lt; 0.05. Results: The current study was conducted through 114 pregnant care files or antenatal care in 6 primary health care centers. 73% of them gained excessive weight during pregnancy; 11% of them gained insufficient weight gain during pregnancy; and 17% of pregnant women had adequate weight gain during pregnancy. There was a statistically significant association between weight gain during pregnancy and primary health care centers, as representing social factor, and also significant association between pre pregnancy BMI and gestational weight gain. Conclusion: Gestational weight gain was significantly affected by pre pregnancy body mass index. Prevalence of excessive weight gain increases with the increase of the pre-pregnancy body mass index and with the increase of age in pregnant women. Weight gain during pregnancy should be monitored and intervention should be developed.

Associations of maternal pre-pregnancy BMI and gestational weight gain with the risks of adverse pregnancy outcomes in Chinese women with gestational diabetes mellitus

BackgroundGive the high background risk of adverse pregnancy outcomes (APOs), it is important to understand the associations of maternal pre-pregnancy body mass index (ppBMI), gestational weight gain (GWG) with APOs in women with gestational diabetes mellitus (GDM). We addressed the independent and joint associations of maternal ppBMI and GWG with APOs in Chinese women with GDM.Methods764 GDM women with singleton delivery were studied and they were stratified into three weight groups by ppBMI (underweight, normal weight and overweight/obesity) following classification standards for Chinese adults and three GWG groups (inadequate, adequate, excessive GWG) by the 2009 Institute of Medicine guidelines, respectively. Univariate and multivariate logistic regression analyses were performed to estimate the odds ratios of APOs.ResultsMaternal overweight/obesity was associated with increased odds of pregnancy-induced hypertension [PIH, adjusted odds ratio (aOR): 2.828, 95% confidence interval (CI) 1.382–5.787], cesarean delivery (CS) (aOR 2.466, 95%CI 1.694–3.590), preterm delivery (aOR 2.466, 95%CI 1.233–4.854), LGA (aOR 1.664, 95%CI 1.120–2.472), macrosomia (aOR 2.682, 95%CI 1.511–4.760) and any pregnancy complication (aOR 2.766, 95%CI 1.840–4.158) compared with healthy weight. Inadequate GWG was less likely to develop PIH (aOR 0.215, 95%CI 0.055–0.835), CS (aOR 0.612, 95%CI 0.421–0.889) and any pregnancy complication (aOR 0.628, 95%CI 0.435–0.907), but had higher risk of preterm birth (aOR 2.261, 95%CI 1.089–4.692), while excessive GWG was more vulnerable to LGA (aOR 1.929, 95%CI 1.272–2.923), macrosomia (aOR 2.753, 95%CI 1.519–4.989) and any pregnancy complication (aOR 1.548, 95%CI 1.006–2.382) as compared to adequate GWG. Furthermore, compared to normal weight mothers with adequate GWG, obese mothers with excessive GWG had the highest risk of any pregnancy complication (aOR 3.064, 95%CI 1.636–5.739).ConclusionsMaternal overweight/obesity and GWG were associated with APOs in the already high-risk settings of GDM. Obese mothers with excessive GWG may confer the greatest risk of adverse outcomes. It was very helpful to reduce the burden of APOs and benefit GDM women by promoting a healthy pre-pregnancy BMI and GWG.

Maternal weight latent trajectories and associations with adverse pregnancy outcomes using a smoothing mixture model

Class membership is a critical issue in health data sciences. Different types of statistical models have been widely applied to identify participants within a population with heterogeneous longitudinal trajectories. This study aims to identify latent longitudinal trajectories of maternal weight associated with adverse pregnancy outcomes using smoothing mixture model (SMM). Data were collected from the Khuzestan Vitamin D Deficiency Screening Program in Pregnancy. We applied the data of 877 pregnant women living in Shooshtar city, whose weights during the nine months of pregnancy were available. In the first step, maternal weight was classified and participants were assigned to only one group for which the estimated trajectory is the most similar to the observed one using SMM; then, we examined the associations of identified trajectories with risk of adverse pregnancy endpoints by applying logistic regression. Three latent trajectories for maternal weight during pregnancy were identified and named as low, medium and high weight trajectories. Crude estimated odds ratio (OR) for icterus, preterm delivery, NICU admission and composite neonatal events shows significantly higher risks in trajectory 1 (low weight) compared to trajectory 2 (medium weight) by 69% (OR = 1.69, 95%CI 1.20, 2.39), 82% (OR = 1.82, 95%CI 1.14, 2.87), 77% (OR = 1.77, 95%CI 1.17, 2.43), and 85% (OR = 1.85, 95%CI 1.38, 2.76), respectively. Latent class trajectories of maternal weights can be accurately estimated using SMM. It is a powerful means for researchers to appropriately assign individuals to their class. The U-shaped curve of association between maternal weight gain and risk of maternal complications reveals that the optimum place for pregnant women could be in the middle of the growth curve to minimize the risks. Low maternal weight trajectory compared to high had even a significantly higher hazard for some neonatal adverse events. Therefore, appropriate weight gain is critical for pregnant women.Trial registration International Standard Randomized Controlled Trial Number (ISRCTN): 2014102519660N1; http://www.irct.ir/searchresult.php?keyword=&id=19660&number=1&prt=7805&total=10&m=1 (Archived by WebCite at http://www.webcitation.org/6p3lkqFdV).

Dose additive maternal and offspring effects of oral maternal exposure to a mixture of three PFAS (HFPO-DA, NBP2, PFOS) during pregnancy in the Sprague-Dawley rat

Simultaneous exposure to multiple per- and polyfluoroalkyl substances (PFAS) is common in humans across the globe. Individual PFAS are associated with adverse health effects, yet the nature of mixture effects after exposure to two or more PFAS remains unclear. Previously we reported that oral administration of hexafluoropropylene oxide-dimer acid (HFPO-DA, or GenX), Nafion byproduct 2 (NBP2), or perfluorooctane sulfonate (PFOS) individually during pregnancy produced maternal and F1 effects. Here, we hypothesized that responses to the combined exposure to these three PFAS would be dose additive. Pregnant Sprague-Dawley rats were exposed to a fixed-ratio equipotent mixture where the top dose contained each PFAS at their ED50 for neonatal mortality (100 % dose = PFOS 3 mg/kg; NBP2 10 mg/kg; HFPO-DA 110 mg/kg), followed by a dilution series (33.3, 10, 3.3, and 1 %) and vehicle controls (0 % dose). Consistent with the single chemical studies, dams were exposed from gestation day (GD)14–18 or from GD8-postnatal day (PND2). Fetal and maternal livers on GD18 displayed multiple significantly upregulated genes associated with lipid and carbohydrate metabolism at all dose levels, while dams displayed significantly increased liver weight (≥3.3 % dose) and reduced serum thyroid hormones (≥33.3 % dose). Maternal exposure from GD8-PND2 significantly reduced pup bodyweights at birth (≥33.3 % dose) and PND2 (all doses), increased neonatal liver weights (≥3.3 % dose), increased pup mortality (≥3.3 % dose), and reduced maternal bodyweights and weight gain at the top dose. Echocardiography of adult F1 males and females identified significantly increased left ventricular anterior wall thickness (~10 % increase), whereas other cardiac morphological, functional, and transcriptomic measures were unaffected. Mixture effects in maternal and neonatal animals conformed to dose addition using a relative potency factor (RPF) analysis. Results support dose addition-based cumulative assessment approaches for estimating combined effects of PFAS co-exposure.

The role of m6A methylation in prenatal maternal psychological distress and birth outcome

BackgroundPrenatal maternal psychological distress (PMPD) is a known risk factor for adverse birth outcomes. N6-methyladenosine RNA (m6A) methylation is crucial in moderating RNA biology. This study aimed to evaluate the relationships between PMPD, birth outcomes, and placental m6A methylation. MethodsThis was a prospective cohort study. PMPD exposure was assessed by questionnaires about prenatal stress, depression, and anxiety. Placental m6A methylation was measured using a colorimetric assay. The relationships between PMPD, m6A methylation, gestational age (GA), and birth weight (BW) were analyzed using structural equation models (SEMs). Maternal weight gain during pregnancy and infant sex were included as covariables. ResultsThe study included 209 mother-infant dyads. In an adjusted SEM, PMPD was associated with BW (B = −26.034; 95 % CI: −47.123, −4.868) and GA (B = −0.603; 95 % CI: −1.102, −0.154). M6A methylation was associated with PMPD (B = 0.055; 95 % CI: 0.040,0.073) and BW (B = −305.799; 95 % CI: −520.164, −86.460) but not GA. The effect of PMPD on BW was partially mediated by m6A methylation (B = −16.817; 95 % CI: −31.348, −4.638) and GA (B = −12.280; 95 % CI: −23.612, −3.079). Maternal weight gain was associated with BW (B = 5.113; 95 % CI: 0.229,10.438). LimitationsThe study sample size was small, and the specific mechanism of m6A methylation on birth outcomes needs to be further explored. ConclusionsIn this study, PMPD exposure negatively affected BW and GA. Placental m6A methylation was associated with PMPD and BW and partially mediated the effect of PMPD on BW. Our findings highlight the importance of perinatal psychological evaluation and intervention.

Psychological factors of pregnant women associated with inadequate maternal weight gain in Japan

Objectives Inadequate gestational weight gain (GWG) has been associated with low birth weight (LBW). However, factors associated with inadequate GWG in Japan remain unclear. Here, we aimed to determine the factors associated with inadequate GWG and the characteristics of inadequate GWG based on the pre-pregnancy body mass index (BMI) among pregnant women in Japan. Methods This observational study included pregnant women at ≥16 weeks of gestation. The study was conducted at two general hospitals in Tokyo, Japan. The participants were requested to complete a questionnaire during the antenatal checkup visit and a mail survey after childbirth. Data were also collected from medical records. The GWG level and associated factors were assessed using the chi-square test or t-test. Results In total, 252 pregnant women were recruited and completed the questionnaires. Data from 128 pregnant women were analyzed. Overall, 23 (18.0%) women were classified as having inadequate GWG. The factors associated with inadequate GWG were as follows: pre-pregnancy underweight, hospital admission owing to hyperemesis, low body esteem, high Edinburgh Postnatal Depression Scale score, low target GWG, more significant weight loss during pregnancy when compared with that pre-pregnancy, high maximum weight loss during pregnancy, delay in return to pre-pregnancy weight, lower birth weight, and inadequate GWG perception. Pregnant women with inadequate weight gain did not receive any medical advice to avoid being overweight but were rather advised to gain additional weight. Conclusion Target GWG and low body esteem were associated with inadequate GWG and other factors that could be modified. Medical staff should focus on achieving the target GWG and improving the body appreciation level among pregnant women.

THE RELATIONSHIP BETWEEN FAMILY INCOME AND THE NUTRITIONAL STATUS OF PREGNANT MOTHERS AT AMPEL 1 PRIMARY HEALTH CARE CENTER IN BOYOLALI REGENCY

Pregnancy represents a significant phase in the lives of women, particularly for those who are married. Thus, pregnancy necessitates specialized attention, especially concerning the fulfillment of energy and nutritional requirements. The quality of maternal dietary intake before and during pregnancy has the potential to influence the health of both the mother and her baby. Malnutrition during pregnancy can lead to various complications, affecting both the mother and the fetus, including issues like anemia, bleeding, and inadequate maternal weight gain. Maternal nutritional intake is influenced by a multitude of internal and external factors within the pregnant mother and her family, encompassing factors such as low levels of knowledge, social dynamics, and household income. This study aims to explore the correlation between the nutritional status of pregnant women and the family income level at the Ampel Health Center in Boyolali Regency. The research employs a quantitative approach utilizing an analytical survey method with a cross-sectional design. The study involved a sample size of 30 pregnant women. The results reveal that the majority of participants are aged between 20-35 years, predominantly in the second trimester of pregnancy, with 10 respondents (33.3%) in trimester II and 20 respondents (66.6%) in trimester III. The Spearman's rank correlation test yielded a p-value of 0.353, which is above the significance level of 0.05 (0.353 &gt; 0.05). Nonetheless, there is no significant correlation between the nutritional status of pregnant women and the family income level at the Ampel Health Center in Boyolali Regency.

Maternal preconception BMI and gestational weight gain are associated with weight retention and maternal and child body fat at 6-7 years postpartum in the PRECONCEPT cohort.

There is limited evidence from prospective cohorts in low-resource settings on the long-term impact of pre-pregnancy body mass index (PPBMI) and gestational weight gain (GWG) on postpartum weight retention (PPWR) and maternal and child body composition. We examined the associations between PPBMI and timing of GWG on PPWR at 1, 2, and 6-7 years and maternal and child percent body fat at 6-7 years. We used data from the PRECONCEPT study (NCT01665378) that included prospectively collected data on 864 mother-child pairs from preconception through 6-7 years postpartum. The key outcomes were PPWR at 1, 2, and 6-7 years, and maternal and child percent body fat at 6-7 years that was measured using bioelectric impedance. Maternal conditional GWG (CGWG) was defined as window-specific weight gains (< 20wk, 21-29wk, and ≥ 30wk), uncorrelated with PPBMI and all prior body weights. PPBMI and CGWG were calculated as standardized z-scores to allow for relative comparisons of a 1 standard deviation (SD) increase in weight gain for each window. We used multivariable linear regressions to examine the associations, adjusting for baseline demographic characteristics, intervention, breastfeeding practices, diet and physical activity. Mean (SD) PPBMI and GWG were 19.7 (2.1) kg/m2 and 10.2 (4.0) kg, respectively. Average PPWR at 1, 2, and 6-7 years was 1.1, 1.5 and 4.3 kg, respectively. A one SD increase in PPBMI was associated with a decrease in PPWR at 1 year (β [95% CI]: -0.21 [-0.37, -0.04]) and 2 years (-0.20 [-0.39, -0.01]); while a one SD in total CGWG was associated with an increase in PPWR at 1 year (1.01 [0.85,1.18]), 2 years (0.95 [0.76, 1.15]) and 6-7 years (1.05 [0.76, 1.34]). Early CGWG (< 20 weeks) had the greatest association with PPWR at each time point as well as with maternal (0.67 [0.07, 0.87]) and child (0.42 [0.15, 0.69]) percent body fat at 6-7 years. Maternal nutrition before and during pregnancy may have long-term implications for PPWR and body composition. Interventions should consider targeting women preconception and early in pregnancy to optimize maternal and child health outcomes.

A new care pathway to optimize gestational weight gain in twin pregnancies

Maternal gestational weight gain (GWG) is an important determinant of pregnancy outcomes and may have an even greater role in twin pregnancies due to the higher rate of pregnancy complications and greater nutritional demands. However, data on the optimal week-specific GWG in twin pregnancies and interventions that should be taken in cases of inadequate GWG are limited. To determine whether a new care pathway that involves monitoring GWG using a week-specific chart along with a standardized protocol for managing cases with inadequate GWG can optimize maternal GWG in twin pregnancies. In this study, patients with twin pregnancies followed in a single tertiary center between Feb-2021 and May-2022 were exposed to the new care pathway (post-intervention group). GWG and clinical outcomes were compared with a previously described cohort of patients with twins followed in our clinic before the implementation of the new care pathway (pre-intervention group). The new care pathway targeted patients and care providers and included educational material, a newly developed BMI-group-specific GWG chart, and a stepwise management algorithm in cases of inadequate GWG. The BMI-group-specific GWG charts were divided into three zones: (1) green zone (optimal GWG, at 25th-75th centiles); (2) yellow zone (suboptimal GWG, at 5th-24th or 76th-95th centiles); and (3) gray zone (abnormal GWG, at <5th or >95th centile). The primary outcome was the overall proportion of patients achieving optimal GWG at birth. A total of 123 patients were exposed to the new care pathway and were compared with 1079 patients from the pre-intervention period. Patients in the post-intervention group were more likely to achieve optimal GWG at birth (60.2% vs. 47.7%; adjusted odds ratio [aOR] 1.91, 95%-confidence interval [CI] 1.28.2.86) and were less likely to achieve low suboptimal GWG (7.3% vs. 14.7%; aOR 0.41, 95%-CI 0.20-0.85) or any suboptimal GWG (26.8% vs. 34.8%; aOR 0.60, 95%-CI 0.39-0.93) at birth. In addition, patients in the post-intervention group were less likely to experience low-abnormal GWG anytime during gestation (18.9% vs. 29.1%, p=0.017) and were more likely to experience normal GWG throughout pregnancy (21.3% vs. 14.0%, p=0.031) or high-abnormal GWG anytime during gestation (18.0% vs. 11.1%, p=0.025), suggesting that the care pathway is more effective than the standard care in preventing patients from moving into the low-abnormal zone than the high-abnormal zone. Furthermore, the new care pathway was more effective than the standard care in correcting high-suboptimal GWG and high-abnormal GWG. Our findings suggest that the new care pathway may be effective in optimizing maternal GWG in twin gestations, which may, in turn, contribute to better clinical outcomes. This is a simple, low-cost intervention that can be easily disseminated among providers caring for patients with twin pregnancies.

Effect of Adherence to the Mediterranean Diet on Maternal Iron Related Biochemical Parameters during Pregnancy and Gestational Weight Gain.

Gestation is a crucial life stage for both women and offspring, and outcomes are affected by many environmental factors, including diet. The Mediterranean dietary pattern (MD) is considered a healthy eating pattern that can provide the nutritional requirements of pregnancy. Meanwhile, iron deficiency anemia is one of the most frequent complications related to pregnancy. This study aimed to evaluate how the level of adherence to the MD influences maternal gestational weight gain and specific iron-related maternal biochemical parameters during the pregnancy. Accordingly, an observational, population-based study using data from pregnant women conducted over the entire course of their pregnancy was carried out. Adherence to the MD was assessed once using the MEDAS score questionnaire. Of the 506 women studied, 116 (22.9%) were classified as demonstrating a high adherence, 277 (54.7%) a medium adherence, and 113 (22.3%) a low adherence to the MD. No differences were observed in gestational weight gain among the MD adherence groups but the adequacy of weight gain did vary among the groups, with the proportions of inadequate (insufficient or excessive) weight gain presenting the most notable differences. Total anemia prevalence was 5.3%, 15.6%, and 12.3%, respectively, during the first, second, and third trimesters. For iron-related biochemical parameters, no differences are observed among the adherence groups during pregnancy. With high adherence to the MD as the reference group, the crude odds of iron deficiency diagnosis are significant in the first trimester for both the medium [OR = 2.99 (1.55-5.75)] and low [OR = 4.39 (2.15-8.96)] adherence groups, with deficient adherence to the Mediterranean dietary pattern being responsible for 66.5% (35.5-82.6) and 77.2% (53.5-88.8) of the risk of iron deficiency diagnosis for medium and low adherence, respectively. However, adjusted odds ratios were not significant, possibly due to the small sample size. Our data suggest that MD adherence could be related to gestational weight gain adequacy and that optimal adherence could reduce iron deficiency and/or anemia during pregnancy in the studied population.

Investigating the Shape and Strength of the Relationship Between Maternal Weight Gain and Gestational Age at Delivery in Twin and Singleton Pregnancies.

Both inadequate and excessive maternal weight gain are correlated with preterm delivery in singleton pregnancies, yet this relationship has not been adequately studied in twins. We investigated the relationship between time-varying maternal weight gain and gestational age at delivery in twin pregnancies and compared it with that in singletons delivered in the same study population. We used serial weight measurements abstracted from charts for twin and singleton pregnancies delivered during 1998-2013 in Pittsburgh, Pennsylvania. Our exposure was time-varying weight gain z score, calculated using gestational age-standardized and prepregnancy body mass index-stratified twin- and singleton-specific charts, and our outcome was gestational age at delivery. Our analyses used a flexible extension of the Cox proportional hazards model that allowed for nonlinear and time-dependent effects. We found a U-shaped relationship between weight gain z score and gestational age at delivery among twin pregnancies (lowest hazard of delivery observed at z score= 1.2), which we attributed to increased hazard of early preterm spontaneous delivery among pregnancies with low weight gain and increased hazard of late preterm delivery without labor among pregnancies with high weight gain. Our findings may be useful for updating provisional guidelines for maternal weight gain in twin pregnancies.