Odds Of Excessive Weight Gain Research Articles

Anti-inflammatory diets reduce the risk of excessive gestational weight gain in urban South Africans from the Soweto First 1000-Day Study (S1000).

PurposeTo (i): examine whether maternal dietary inflammation assessed using the dietary inflammatory index (DII) is associated with gestational weight gain (GWG) and delivery outcomes in urban South African women from the Soweto First 1000-Day Study (S1000); and (ii): explore whether serum high-sensitivity c-reactive protein (hs-CRP) levels mediate these associations.MethodsEnergy-adjusted-DII (E-DII™) scores were calculated for 478 pregnant women using a quantitative food frequency questionnaire. GWG (kg/week) was assessed via anthropometry and hs-CRP concentrations were assessed in a sub-sample at < 14 (n = 263) and at 24–28 (n = 270) weeks gestational age. Multivariable linear and logistic regression models were used to examine associations between maternal E-DII scores, GWG, hs-CRP concentrations, and delivery outcomes.ResultsPositive vs. negative E-DII scores were associated with an increased odds of excessive weight gain (OR (95% CI): 2.23 (1.20; 4.14); P = 0.01) during pregnancy. Higher hs-CRP concentrations in the first trimester were associated with lower weight-for-length z-score (β (95% CI): −0.06 (−0.11; −0.01) per 1 mg/l hs-CRP; P = 0.02) and a reduction in odds of a large-for-gestational age delivery (OR (95% CI): 0.66 (0.47; 0.94); P = 0.02). Higher hs-CRP concentrations in the second trimester were associated with an increased odds of delivering preterm (OR (95% CI): 1.16 (1.01; 1.32); P = 0.03).ConclusionsConsumption of an anti-inflammatory diet during pregnancy reduced the risk of excessive GWG in a rapidly urbanising setting (Soweto, South Africa), where obesity prevalence rates are high. Further research is needed to better understand how maternal diet may ameliorate the effects of maternal adiposity on inflammatory milieu and fetal programming.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00394-022-02931-x.

Abstract P194: Psychosocial Stressors And Cardiovascular Disease Risk Factors In Young African American Women: A Systematic Review

Background: Emerging evidence suggests that psychosocial factors are related to morbidity and mortality due to cardiovascular disease (CVD). African American women experience a unique multitude of psychosocial stressors, including racism, discrimination, poverty, neighborhood stress, anxiety, and depression. The impact of these stressors on CVD risk in African American women during early adulthood (age 19-24 years) is limited. Objective: In this systematic review, we synthesized and evaluated the existing evidence on the relationship between psychosocial stress and CVD risk in young adult African American women. Methods: We conducted a comprehensive search of the literature in PubMed, APA PsycINFO, and CINAHL for studies published between January 1975 and May 2020 that examined psychosocial stress and CVD risk factors in young adult African American women. Eligible studies measured at least one psychosocial stress exposure, a CVD risk factor, or subclinical CVD outcome (e.g., body mass index, blood pressure, carotid intima-media thickness), and included African American women age 19-24 years or reported sex-stratified analyses. We excluded reviews, editorials, case studies, and gray literature. Two reviewers independently screened studies for eligibility and appraised the quality of the included studies using the Newcastle-Ottawa Scale. Results: The literature search yielded 1,100 potentially relevant articles for review. Of these, we identified nine studies that met our inclusion criteria: six cross-sectional and three prospective cohort studies. The mean age of participants ranged from 19 to 22 years. Of the nine studies, eight found that stress (i.e., perceived stress, racial discrimination, internalized racism, depression) was related to higher body mass index and blood pressure. In one longitudinal study, a greater frequency of everyday discrimination was associated with a nearly 2-fold higher odds of excessive weight gain (&gt;40 pounds) during pregnancy. Overall, the majority of studies (n=6) were rated as excellent ; the remainder were good and fair. The lowest risk of bias was the selection and outcome measurement. Conclusion: This systematic review found sufficient evidence to support a relationship between psychosocial stress and CVD risk factors in young adult African American women. However, future studies that follow women from childhood to early adulthood are needed to gain a better understanding of the impact of psychosocial stress on the progression of CVD risk. Further investigation on specific stressors relevant to early adulthood, including self-identity and social role stress, are needed to understand the full extent to which psychosocial stress impacts CVD risk in young African American women.

EXCESSIVE WEIGHT GAIN IN PEDIATRIC INFLAMMATORY BOWEL DISEASE PATIENTS ON ANTI-TNF THERAPY

Abstract Background Limited studies in patients with inflammatory bowel disease (IBD) suggest that anti-TNF therapy may be associated with excessive weight gain. The objective of this study was to compare the change in BMI z-score in children with Crohn Disease (CD) on anti-TNF therapy (CD exposed) to those not on anti-TNF therapy (CD unexposed) over time. We also sought to determine if anti-TNF exposure is a risk factor for excessive weight gain and obesity. Methods This was a retrospective cohort study utilizing the RISK database, a longitudinal inception cohort of pediatric patients with CD. Multivariable logistic, linear random mixed effects, and multilevel mixed effects generalized linear regression models were used to evaluate the association of anti-TNF therapy with excessive weight gain, change in BMI z-score, and obesity, respectively. Excessive weight gain was defined as patients with a normal baseline BMI z-score who became overweight/obese or had a delta BMI z-score &amp;gt;1 at the end of follow-up, underweight patients who became overweight/obese, and overweight patients who became obese or had a delta BMI z-score &amp;gt;0.5 at the end of follow-up. Results 625 (61%) exposed and 404 (39%) unexposed patients were included. There was no difference in age at diagnosis or sex between groups, however the CD exposed group had lower BMI z-score [-0.9 (IQR -1.8, 0.0) vs -0.5 (IQR -1.4, 0.3)] as well as higher disease activity index [52.5 (IQR 35.0, 72.5) vs 40.0 (IQR 25, 57.5)] and C-reactive protein (CRP) [4.5 (IQR 1.4, 13.0) vs 2.7 (IQR 0.7, 9.0)] at baseline. 28% of the group exposed to anti-TNF therapy met criteria for excessive weight gain. Exposed patients were at 1.43 (CI 1.06, 1.93) greater odds of excessive weight gain as compared to the unexposed group, controlling for baseline BMI z-score and sex. BMI z-score increased with anti-TNF exposure, particularly in the first year of follow-up and in children who were underweight at baseline, controlling for baseline BMI z-score, sex, CRP, and steroid exposure (Table 1). Male sex was associated with higher BMI z-score, while CRP and steroid exposure were inversely related to BMI z-score. Exposed patients had increased adjusted odds of obesity and morbid obesity: OR 1.72 (CI 1.34, 2.20) and OR 5.72 (CI 2.77, 11.33), respectively (Table 2). Male sex and baseline BMI z-score also increased the odds of obesity and morbid obesity. Conclusion CD patients with anti-TNF exposure have a significant increase in BMI z-score over time as compared to patients unexposed to anti-TNF therapy. While for most patients this increase in BMI z-score is restorative, a subset of patients gain excessive weight or become obese. Anti-TNF therapy may be a risk-factor for this phenomenon. BMI z-score at diagnosis and male sex may also be risk factors. Future studies evaluating changes in adiposity and energy expenditure should be pursued. Note: Interaction term between anti-TNF and baseline BMI z-score. Interaction term between anti-TNF and time. Interaction term between anti-TNF and quadratic time. Note: Table for risk factors for morbid obesity in CD patients not included due to text constraints but with similar findings.

Elite Athletes and Pregnancy Outcomes: A Systematic Review and Meta-analysis.

The purpose of this systematic review was to evaluate fetal and maternal pregnancy outcomes of elite athletes who had participated in competitive sport immediately before conception. Online databases were searched up to March 24, 2020. Studies of any design and language were eligible if they contained information on the relevant population (pregnant women), exposure (engaged in elite sport immediately before pregnancy), and outcomes (birth weight, low birth weight, macrosomia, preterm birth, fetal heart rate and pulse index, cesarean sections, instrumental deliveries, episiotomies, duration of labor, perineal tears, pregnancy-induced low back pain, pelvic girdle pain, urinary incontinence, miscarriages, prenatal weight gain, inadequate/excess prenatal weight gain, maternal depression or anxiety). Eleven unique studies (n = 2256 women) were included. We identified "low" certainty evidence demonstrating lower rates of low back pain in elite athletes compared with active/sedentary controls (n = 248; odds ratio, 0.38; 95% confidence interval, 0.20-0.73; I2 = 0%) and "very low" certainty evidence indicating an increased odds of excessive prenatal weight gain in elite athletes versus active/sedentary controls (n = 1763; odds ratio, 2.47; 95% confidence interval, 1.26-4.85; I2 = 0%). Low certainty evidence from two studies (n = 7) indicated three episodes of fetal bradycardia after high-intensity exercise that resolved within 10 min of cessation of activity. No studies reported inadequate gestational weight gain or maternal depression or anxiety. There were no differences between elite athletes and controls for all other outcomes. There is "low" certainty of evidence that elite athletes have reduced odds of experiencing pregnancy-related low back pain and "very low"certainty of evidence that elite athletes have increased the odds of excessive weight gain compared with active/sedentary controls. More research is needed to provide strong evidence of how elite competitive sport before pregnancy affects maternal and fetal outcomes.PROSPERO Registration: CRD42020167382.

Association Between Obstetric Provider's Advice and Gestational Weight Gain.

Objective This study examined associations between pregnant women's report of obstetric provider GWG advice, self-reported adherence to such advice, and GWG. Methods Healthy pregnant women (N = 91) who started obstetric care prior to 17 weeks of gestation completed assessments between 30 and 34 weeks of gestation. These included survey (questions on receipt of and adherence to provider GWG advice, and demographics) and anthropometric measures. GWG data were abstracted from electronic health records. Analyses included Chi square and Mann-Whitney tests, and binary and multivariate logistic regressions. Results The cohort's median age was 28 years, 68% of women were White, 78% had a college education, 50.5% were overweight or obese before the pregnancy, and 62.6% had GWGs above the Institute of Medicine-recommended ranges. Sixty-seven percent of women reported having received GWG advice from their obstetric providers and, of those, 54.1% reported that they followed their provider's advice. Controlling for race, education and pre-pregnancy BMI, receipt of GWG advice was marginally associated with increased odds of excessive weight gain (OR 2.52, CI 0.89-7.16). However, women that reported following the advice had lower odds of excessive GWG (OR 0.18, CI 0.03-0.91) and, on average, gained 11.3 pounds less than those who reported following the advice somewhat or not at all. Conclusions Frequency of GWG advice from obstetric providers is less than optimal. When given and followed, provider advice may reduce the risk of excessive GWG. Research to understand factors that facilitate providers GWG advice giving and women's adherence to providers' advice, and to develop interventions to optimize both, is needed.

The Influence of Maternal Dietary Patterns on Body Mass Index and Gestational Weight Gain in Urban Black South African Women

Maternal pre-pregnancy body mass index (BMI) and subsequent gestational weight gain (GWG) are strong predictors of maternal and infant outcomes; however the influence of dietary patterns on BMI-specific GWG is unclear. This study identifies patterns of habitual dietary intake in urban South African women and explores their associations with first trimester BMI and GWG. Habitual dietary intake of 538 pregnant women was assessed using a quantitative food-frequency questionnaire and dietary patterns were depicted via principle component analysis. Associations between dietary patterns and BMI-specific GWG were analyzed using linear and logistic regression. Three dietary patterns were identified: Western, Traditional and Mixed. Western and Mixed diet patterns were associated with 35 g/week (p = 0.021) and 24 g/week (p = 0.041) higher GWG in normal weight and obese women respectively. Additionally, high intakes of a Traditional diet pattern were associated with a reduced odds of excessive weight gain in the total sample (OR: 0.81; p = 0.006) and in normal weight women (OR: 0.68; p = 0.003). Increased intake of a traditional diet pattern—high in whole grains, legumes, vegetables and traditional meats—and decreased intake of refined, high sugar and fat driven diets may reduce GWG (including risk of excessive weight gain) in urban South African women.

Discrimination and excessive weight gain during pregnancy among Black and Latina young women

RationaleExcessive weight gain during pregnancy is a major determinant of later life obesity among both Black and Latina women and their offspring. However, psychosocial determinants of this risk, including everyday discrimination, and potential moderators of such effects remain unexplored. ObjectiveWe examined the influence of discrimination, a culturally relevant stressor, on odds of gaining weight beyond Institute of Medicine recommendations during pregnancy. Whether the effect was moderated by race/ethnicity, age, or depressive symptoms was also examined. MethodParticipants were 413 Black and Latina pregnant young women, ages 14–21 years. Experience with discrimination and all moderators were assessed in the second trimester. Last weight recorded in the third trimester was abstracted from medical records and used to determine excessive weight gain. ResultsEver experiencing discrimination was associated with a 71% increase in the odds of excessive weight gain. The effect of discrimination was primarily present among women who attributed this treatment to membership in a historically oppressed group (e.g., ethnic minority, female) or to membership in other stigmatized groups (e.g., overweight). The effect of ever experiencing discrimination was not moderated by race/ethnicity or age but was moderated by depressive symptoms. Supporting the perspective of the environmental affordances model, discrimination strongly predicted excessive weight gain when women were low in depressive symptoms but had no effect when women were high in depressive symptoms. The moderating role of depressive symptoms was equivalent for Black and Latina women. ConclusionResults highlight the role of discrimination in perpetuating weight-related health disparities and suggest opportunities for improving health outcomes among young pregnant women.

Association Between Obstetric Provider's Advice and Gestational Weight Gain in a Diverse Sample of Women

BackgroundOptimal gestational weight gain (GWG) reduces the risk of adverse pregnancy outcomes. Thus, the Institute of Medicine provides recommendations for GWG. However, the frequency in which obstetric providers deliver GWG advice to their patients is unclear. Moreover, little is known about the degree to which women follow such advice.ObjectiveTo examine the frequency of subjects' self‐reported GWG advice received from providers and self‐reported adherence to such advice.Methods: Healthy pregnant women (N=94) enrolled in care &lt;17 weeks gestation completed assessments that included survey (demographics, questions on receipt of, agreement with and adherence to provider GWG advice) and anthropometric measures. GWG data were abstracted from medical records. Analyses included chi‐square and t‐tests, and binary and multivariate logistic regressions.Results: The cohort age was 28 (+5.1) years; 67% White, 28% Hispanic, 51% overweight pre‐pregnancy, and 64% with above‐guideline GWG. 71% reported receiving GWG advice from their obstetric providers. Controlling for gestational age and pre‐pregnancy BMI, receiving GWG advice was associated with increased risk of excessive weight gain (OR=3.216, CI: 1.098, 9.419). However, those that reported following the advice, gained on average 13.4 pounds less than those that did not and had lower odds of excessive weight gain (OR=0.144, CI: 0.033, 0.624).ConclusionRecollection of provider GWG advice is less than optimal. Advice was associated with greater GWG. Findings show favorable outcomes among women who reported following their providers' advice. Strategies that promote obstetric providers' delivery of GWG advice and pregnant women's adherence to the GWG advice received are needed.

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

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

Neighborhood Factors Associated with Physical Activity and Adequacy of Weight Gain During Pregnancy

Healthy diet, physical activity, smoking, and adequate weight gain are all associated with maternal health and fetal growth during pregnancy. Neighborhood characteristics have been associated with poor maternal and child health outcomes, yet conceptualization of potential mechanisms are still needed. Unique information captured by neighborhood inventories, mostly conducted in northern US and Canadian urban areas, has been shown to reveal important aspects of the community environment that are not captured by the demographic quantities in census data. This study used data from the Pregnancy, Nutrition, and Infection (PIN) prospective cohort study to estimate the influences of individual-level and neighborhood-level characteristics on health behaviors and adequacy of weight gain during pregnancy. Women who participated in the PIN study and who resided in Raleigh, North Carolina and its surrounding suburbs were included (n = 703). Results from a neighborhood data collection inventory identified three social constructs, physical incivilities, territoriality, and social spaces, which were hypothesized to influence maternal health behaviors. The physical incivility scale was associated with decreased odds (adjusted OR = 0.74, 95%CI = 0.57, 0.98) in participating in vigorous leisure activity before pregnancy after controlling for several individual confounders, and a crude association for decreased odds of excessive weight gain (OR = 0.79, 95%CI = 0.64, 0.98). The social spaces scale was associated with decreased odds for inadequate (adjusted OR = 0.74, 95%CI = 0.56, 0.98) and excessive (adjusted OR = 0.69, 95%CI = 0.54, 0.98) gestational weight gain. The social spaces scale was also associated with decreased odds of living greater than 3 miles from a supermarket (adjusted OR = 0.03, 95%CI = 0.00, 0.27). Territoriality was not associated with any pregnancy-related health behavior. None of the neighborhood constructs were associated with smoking or diet quality. Physical incivilities and social spaces neighborhood characteristics may be important to measure to improve our understanding of the potential mechanisms through which neighborhood environments influence health.