Pregnancy Overweight Research Articles

Associations Between Overweight in Early Pregnancy and Newborn Conditions: A Focus on the SDGs, With Emphasis on SDG 3 for Ensuring Healthy Lives and Well-Being for All Ages

Aim: The aim of this study was to investigate the links between overweight in women giving birth in early pregnancy and the condition of their newborns at the Souissi maternity hospital in Rabat, two factors closely linked to the achievement of the 3rd Sustainable Development Goal, which is based on ensuring healthy lives and promote well-being for all at all ages. Materials and Methods: This was a prospective descriptive study conducted over a 9-month period from March to November 2022, at the Souissi maternity hospital in Rabat. Including mothers of newborns who followed their pregnancy, were either normal weight or overweight at the beginning of pregnancy, and had an uncomplicated pregnancy. Results: A total of 1,145 newborns were recruited. With a response rate of 81.65% and using a mixed questionnaire, the number of newborns surveyed was 935, subdivided into two groups. A group of mothers of normal-bodied newborns (637 cases) and a group of mothers of overweight newborns (298 cases). This study showed the existence of associations between overweight at the start of pregnancy, recorded in the mothers of the newborns surveyed, and the term of delivery (P=0.033), the course of delivery (P=0.031), the mode of delivery (P=0.005), the Apgar score at 5min below 7 (P=0.004) and neonatal complications (P=0.002). Discussion: This study, found that 68.13% of surveyed mothers had a normal BMI, while 31.87% were overweight at the beginning of pregnancy. They were more likely to have overdue deliveries (70.80% vs. 25.27% for normal-weight mothers) and dystocic deliveries (25.50% vs. 4.24%). Overweight status also correlated with higher rates of vaginal delivery (27.18% vs. 0.78% for normal-weight mothers) and poorer Apgar scores (36.58% vs. 12.56%).

Effects of an antenatal dietary intervention in women with obesity or overweight on child outcomes at 8–10 years of age: LIMIT randomised trial follow-up

BackgroundThe LIMIT randomised controlled trial looked at the effect of a dietary and lifestyle intervention compared with routine antenatal care for pregnant women with overweight and obesity on pregnancy outcomes. While women in the intervention group improved diet and physical activity with a reduction of high birth weight, other outcomes were similar. We have followed the children born to women in this study at birth, 6 and 18 months and 3–5 years of age and now report follow-up of children at 8–10 years of age.MethodsChildren at 8–10 years of age who were born to women who participated in the LIMIT randomised trial, and whose mother provided consent to ongoing follow-up were eligible for inclusion. The primary study endpoint was the incidence of child BMI z-score > 85th centile for child sex and age. Secondary study outcomes included a range of anthropometric measures, neurodevelopment, child dietary intake, and physical activity. Analyses used intention to treat principles according to the treatment group allocated in pregnancy. Outcome assessors were blinded to the allocated treatment group.ResultsWe assessed 1,015 (Lifestyle Advice n = 510; Standard Care n = 505) (48%) of the 2,121 eligible children. BMI z-score > 85th percentile was similar for children of women in the dietary Lifestyle Advice Group compared with children of women in the Standard Care Group (Lifestyle Advice 479 (45%) versus Standard Care 507 (48%); adjusted RR (aRR) 0.93; 95% CI 0.82 to 1.06; p = 0.302) as were secondary outcomes. We observed that more than 45% of all the children had a BMI z-score > 85th percentile, consistent with findings from follow-up at earlier time-points, indicating an ongoing risk of overweight and obesity.ConclusionsDietary and lifestyle advice for women with overweight and obesity in pregnancy has not reduced the risk of childhood obesity, with children remaining at risk of adolescent and adult obesity. Other strategies are needed to address the risk of overweight and obesity in children including investigation of preconception interventions to assess whether this can modify the effects of maternal pre-pregnancy BMI. The LIMIT randomised controlled trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12607000161426).

Lung function in young adulthood in relation to moderate-to-late preterm birth.

Moderate-to-late preterm birth (32 to <37 weeks of gestation) has been associated with impaired lung function in adolescence, but data in adulthood and physiological phenotyping beyond spirometry are scarce. We aimed to investigate lung function development from adolescence into young adulthood and to provide physiological phenotyping in individuals born moderate-to-late preterm. Lung function data from individuals born moderate-to-late preterm (n=110) and term (37 to <42 weeks of gestation, n=1895) in the Swedish birth cohort BAMSE were used for analysis and included dynamic spirometry, fractional exhaled nitric oxide and multiple breath nitrogen wash-out. Data from 16- and 24-year follow-ups were analysed using regression models stratified on sex and adjusted for smoking. Data-driven latent class analysis was used to phenotype moderate-to-late preterm individuals at 24 years, and groups were related to background factors. Males born moderate-to-late preterm had lower forced expiratory volume in 1 s (FEV1) at 24 years of age (-0.28 z-score, p=0.045), compared to males born term. In females, no difference was seen at 24 years, partly explained by a significant catch up in FEV1 between 16 and 24 years (0.18 z-score, p=0.01). Lung function phenotypes described as "asthma-like", "dysanapsis-like" and "preterm reference" were identified within the preterm group. Maternal overweight in early pregnancy was associated with "asthma-like" group membership (OR 3.59, p=0.02). Our results show impaired FEV1 at peak lung function in males born moderate-to-late preterm, while females born moderate-to-late preterm had significant catch up between the ages of 16 and 24 years. Several phenotypes of lung function impairment exist in individuals born moderate-to-late preterm.

Aberrations in the early pregnancy serum metabolic profile in women with prediabetes at two years postpartum

IntroductionAberrations in circulating metabolites have been associated with diabetes and cardiovascular risk.ObjectivesTo investigate if early and late pregnancy serum metabolomic profiles differ in women who develop prediabetes by two years postpartum compared to those who remain normoglycemic.MethodsAn NMR metabolomics platform was used to measure 228 serum metabolite variables from women with pre-pregnancy overweight in early and late pregnancy. Co-abundant groups of metabolites were compared between the women who were (n = 40) or were not (n = 138) prediabetic at two years postpartum. Random Forests classifiers, based on the metabolic profiles, were used to predict the prediabetes status, and correlations of the metabolites to glycemic traits (fasting glucose and insulin, HOMA2-IR and HbA1c) and hsCRP at postpartum were evaluated.ResultsWomen with prediabetes had higher concentrations of small HDL particles, total lipids in small HDL, phospholipids in small HDL and free cholesterol in small HDL in early pregnancy (p = 0.029; adj with pre-pregnancy BMI p = 0.094). The small HDL related metabolites also correlated positively with markers of insulin resistance at postpartum. Similar associations were not detected for metabolites in late pregnancy. A Random Forests classifier based on serum metabolites and clinical variables in early pregnancy displayed an acceptable predictive power for the prediabetes status at postpartum (AUROC 0.668).ConclusionElevated serum concentrations of small HDL particles in early pregnancy associate with prediabetes and insulin resistance at two years postpartum. The serum metabolic profile during pregnancy might be used to identify women at increased risk for type 2 diabetes.

Racial and ethnic disparities in postpartum weight retention: A narrative review mapping the literature to the National Institute on Minority Health and Health Disparities Research Framework.

A Review of the Literature Using the National Institutes of Health, National Institute on Minority Health and Health Disparities (NIMHD) Research Framework to Create a Roadmap of the Studies Investigating Racial and Ethnic Disparities in Excess Weight Retained After Pregnancy. Three out of four people who give birth retain excess weight at 1-year post-pregnancy. This is concerning, as weight that is retained following pregnancy is associated with increased risk for the development of disease. People from racial and ethnic minority groups experience weight retention more frequently post-pregnancy. Black and Hispanic/Latina/o/x birthing people are more likely to begin pregnancy overweight or obese. They are also more likely to retain excess weight following pregnancy. Investigating these risks in people from racially/ethnically diverse backgrounds may be an important way to address disparities in excess weight retained post-pregnancy. This review of the literature used a tool called the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework to map the literature to date on racial and ethnic disparities in excess weight retained post-pregnancy. We used the NIMHD Research Framework as a visual guide of the existing research about excess weight retained following pregnancy. Results illustrate the levels and domains at which research has been investigated. These results reveal that efforts have been focused at the individual level, with most attention given to diet and activity. Mapping the literature to the NIMHD Research Framework sheds light on gaps in the research. Mapping the literature has revealed a need for investigations that make connections between the levels and domains of the Framework, so that we may understand underlying factors that contribute to health disparities.

The Impact of Overweight and Obesity in Early Pregnancy on Maternal and Fetal Outcome

The recent increase in prevalence of overweight and obesity in pregnancy has become a major public health problem as it is associated with increased risk of obstetric and neonatal complications. A hospital based observational comparative study was done on women attending obstetrics and gynecology outpatient department of a tertiary care hospital in Kathmandu from September 2021 to January 2022 after taking ethical clearance from Institutional Review Committee. A total of 113 overweight/obese women in first trimester of singleton pregnancies and similar number of women with normal BMI were recruited for the study and followed throughout pregnancy for the development of maternal complications like gestational hypertension, gestational diabetes mellites, antepartum hemorrhage, preterm labor and postpartum hemorrhage. The neonatal outcome compared were birth weight, low Apgar score at birth and NICU admission. Maternal overweight/obesity as compared to normal BMI was associated with increased risk of gestational diabetes mellites (RR 2.06, 95% CI: 1.2 to 3.52; P value = 0.006), gestational hypertension (RR 2.2, 95% CI: 1.09 to 4.43; P value = 0.02) and caesarean delivery (RR 1.81, 95% CI: 1.28 to 2.55; P value = 0.004). The risk of primary postpartum hemorrhage was also increased in overweight/ obese women than in normal weight women (RR 2.8, 95% CI: 1.04 to 7.51; P value=0.03). In neonatal outcomes, the mean birth weight (3.18 + 0.54 kg vs 2.9 + 0.33kg, P value &lt; 0.001) and admission to NICU (28.3% vs 10.61%, P value = 0.008) were significantly higher in overweight/ obese women. Maternal overweight/obesity in early pregnancy is associated with higher risk of adverse pregnancy and neonatal outcome.

Association between maternal shift work during pregnancy child overweight and metabolic outcomes in early childhood.

BackgroundPrevious studies found that maternal shift work during pregnancy was associated with many reproductive hazards, including small for gestational age, preterm birth, stillbirth, and neurodevelopmental impairment. Some studies also showed that these children are more likely to become overweight in early childhood. However, the association with metabolic factors, such as insulin resistance and dyslipidemia, was less studied. Hence, we aimed to understand better the relationship between maternal shift work during pregnancy and the risk of childhood overweight and metabolic outcomes. Confounding factors were also discussed, including diet, exercise, and demographical factors.MethodsWe enrolled pregnant women before delivery in the Taiwan Birth Panel Study (TBPS) II conducted between 2010 and 2012, and followed the children of these participants in 2018. The objective of this study is to investigate the influence of prenatal and postnatal factors on infant and early childhood health. During the follow-up in 2018, we checked children's demographic data, obtained blood specimens, and checked their blood sugar, blood insulin, and lipid profiles. Structured questionnaires were used to evaluate demographic data. Multiple linear and logistic regressions were used to examine the associations between maternal shift work during pregnancy and child overweight, metabolic disorders, such as HOMA-IR, and lipid profiles.ResultsIn this study, we included 407 mother-children pairs with different work shifts (350 day workers and 57 shift workers), and a sub-population without underweight children was also created (290 day workers and 47 shift workers). Shift work during pregnancy was associated with a higher Homeostasis Model Assessment-Insulin Resistance index (HOMA-IR) and a higher odds ratio for overweight in children born from mothers doing shift work during pregnancy after adjustment. The findings were attenuated when we investigated the effect of shift work before pregnancy.ConclusionOur study suggested that maternal shift work during pregnancy was associated with child overweight and insulin resistance in early childhood.

Programming by maternal obesity: a pathway to poor cardiometabolic health in the offspring.

There is an ever increasing prevalence of maternal obesity worldwide such that in many populations over half of women enter pregnancy either overweight or obese. This review aims to summarise the impact of maternal obesity on offspring cardiometabolic outcomes. Maternal obesity is associated with increased risk of adverse maternal and pregnancy outcomes. However, beyond this exposure to maternal obesity during development also increases the risk of her offspring developing long-term adverse cardiometabolic outcomes throughout their adult life. Both human studies and those in experimental animal models have shown that maternal obesity can programme increased risk of offspring developing obesity and adipose tissue dysfunction; type 2 diabetes with peripheral insulin resistance and β-cell dysfunction; CVD with impaired cardiac structure and function and hypertension via impaired vascular and kidney function. As female offspring themselves are therefore likely to enter pregnancy with poor cardiometabolic health this can lead to an inter-generational cycle perpetuating the transmission of poor cardiometabolic health across generations. Maternal exercise interventions have the potential to mitigate some of the adverse effects of maternal obesity on offspring health, although further studies into long-term outcomes and how these translate to a clinical context are still required.

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.

A prospective cohort study of adverse fetomaternal outcomes among overweight, obese, and normal weight pregnant women with term singleton pregnancy in a tertiary care hospital

Background: Globally, overweight and obesity are the common risk factors with increasing frequency for adverse fetomaternal outcomes. In resource-poor countries, it is emerging as a threat for favorable pregnancy outcome even with the prevalence of high hunger index. Aims and Objectives: This study aims to determine the impact of obesity and overweight in pregnancy on fetomaternal outcomes in comparison to normal weight mothers. Materials and Methods: A prospective cohort study was conducted in a tertiary care center for 1½ years with singleton term pregnancies and 64 mothers with body mass index (BMI) ≥25 kg/m2 (cases) were compared with 64 normal weight mothers with BMI 18.5–24.9 kg/m2 (controls). Maternal and perinatal outcome was analyzed during antenatal, intranatal periods and after delivery along with the follow-up of newborns up to early neonatal period. Results: After optimizing the two groups in different sociodemographic status, the result shows significantly higher weight gain (P&lt;0.001), incidence of gestational diabetes mellitus (P&lt;0.001), hypertensive disorders of pregnancy (P&lt;0.001), and macrosomia (P&lt;0.001) in overweight and obese pregnant women than their normal weight counterparts. Increased cesarean section rate (P&lt;0.001), postpartum hemorrhage (P&lt;0.005), neonatal low Apgar score at 5 min (P&lt;0.05), neonatal intensive care unit admission (P&lt;0.05), and higher rate of early neonatal death were also observed in cases group than controls group. Conclusion: Pre-pregnancy intervention for optimization of maternal weight with proper surveillance of every pregnant mother of this subset and vigilant neonatal care may improve the obstetric and perinatal outcome.

Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review.

The global prevalence of overweight and obesity in pregnancy is rising and this represents a significant challenge for the management of pregnancy and delivery. Women who have a pre‐pregnancy body mass index greater than 25 kg m–2 are more likely than those with a body mass index in the ideal range (20–24.99 kg m–2) to have problems conceiving a child and are at greater risk of miscarriage and stillbirth. All pregnancy complications are more likely with overweight, obesity and excessive gestational weight gain, including those that pose a significant threat to the lives of mothers and babies. Labour complications arise more often when pregnancies are complicated by overweight and obesity. Pregnancy is a stage of life when women have greater openness to messages about their lifestyle and health. It is also a time when they come into greater contact with health professionals. Currently management of pregnancy weight gain and the impact of overweight tends to be poor, although a number of research studies have demonstrated that appropriate interventions based around dietary change can be effective in controlling weight gain and reducing the risk of pregnancy complications. The development of individualised and flexible plans for avoiding adverse outcomes of obesity in pregnancy will require investment in training of health professionals and better integration into normal antenatal care.

Developmental programming by maternal obesity: Lessons from animal models.

The obesity epidemic has led to more women entering pregnancy overweight or obese. In addition to adverse short-term outcomes, maternal obesity and/or gestational diabetes predispose offspring to developing obesity, type 2 diabetes and cardiovascular disease in adulthood through developmental programming. Human epidemiological studies, although vital in identifying associations, are often unable to address causality and mechanistic studies can be limited by the lack of accessibility of key metabolic tissues. Furthermore, multi-generational studies take many years to complete. Integration of findings from human studies with those from animal models has therefore been critical in moving forward this field that has been termed the 'Developmental Origins of Health and Disease'. This review summarises the evidence from animal models and highlights how animal models provide valuable insight into the maternal factors responsible for developmental programming, potential critical developmental windows, sexual dimorphism, molecular mechanisms and age-related offspring outcomes throughout life. Moreover, we describe how animal models are vital to explore clinically relevant interventions to prevent adverse offspring outcomes in obese or glucose intolerant pregnancy, such as antioxidant supplementation, exercise and maternal metformin treatment.

Efficacy of Metformin on Pregnancy Outcome in Healthy Overweight Pregnant Women; A Double-Blinded Parallel Randomized Clinical Trial

Background Maternal obesity increases the risk of pregnancy complications such as preeclampsia, postpartum hemorrhage, weight gain and the need for cesarean section. We compared the role of metformin on pregnancy outcome in overweight mothers. Materials and Methods: This double-blinded parallel randomized clinical trial was carried out on 360 pregnant women at 12-16 gestational weeks who referred to the gynecology clinic of Motahari hospital, Urmia, Iran, during 2019 to 2020. The intervention group received 1000 mg of metformin orally every day up to the end of pregnancy. Demographic and clinical characteristics of patients such as age, gravidity, parity, preterm infant weight, live birth, abortion, previous delivery method, maternal weight, body mass index, birth weight, delivery method, blood sugar at birth, gestational age at birth, neonatal hypoglycemia, infant mortality and anomalies were also recorded. Finally, the pregnancy outcomes (gravidity, parity, abortion and weight) were compared between the two groups. Results: Of 180 patients, 169 patients remained in the intervention group and 171 patients remained in the control group based on the eligibility criteria. In the control group, 13 patients (7.6%), and in the intervention group, five patients (2.9%) had preeclampsia and high blood pressure during pregnancy (P= 0.053). In the control group, the mean maternal weight gain during pregnancy was 10.22 ± 3.3 kg and in the intervention group was 7.6 ± 2.3 kg (P 0.05). Conclusion The administration of 1000 mg metformin daily has been shown to be effective in preventing overweight in pregnancy, but has not affected the birth weight. Metformin did not have any side effects on pregnancy outcomes.

Maternal pre-pregnancy overweight and infertility in sons and daughters: A cohort study.

Overweight and obesity in pregnancy is increasing worldwide and may harm the developing fetus, including its future reproductive health. We therefore studied the association between in utero exposure to maternal overweight and obesity and infertility in adulthood. No studies have previously assessed this association. We performed a cohort study with 9232 adult sons and daughters whose mothers were enrolled in the Danish Healthy Habits for Two cohort during pregnancy in 1984-87. Participants were sons and daughters followed in the Danish In-Vitro-Fertilization-Register and Danish National Patient Register until February 2018 for diagnoses of infertility. In total, 1203 (13%) sons and daughters were born to mothers with a body mass index (BMI) >25kg/m2 ; 871 (9.4%) of the participants were identified as being infertile during follow-up. Sons of overweight mothers had slightly increased odds of infertility compared with sons of mothers with normal body weight (BMI 18.5-24.9kg/m2 , adjusted odds ratio 1.4, 95% confidence interval [CI] 1.0-1.9). Cubic spline analyses with continuous BMI levels showed increasing odds with higher levels of BMI; however, for BMI>29kg/m2 the confidence intervals were too wide to draw conclusions. No association between maternal overweight and infertility was found among daughters (adjusted odds ratio 0.9, 95% CI 0.7-1.2)). Sons born to overweight mothers had higher odds of infertility compared with sons of normal weight mothers. No association between maternal overweight and infertility was observed in daughters. Prevention of overweight during pregnancy may be an important tool to preserve fecundity in future generations.

Temporal trend of early pregnancy high body mass index in Australian women: risk factors and outcomes

Background There is a shift toward the increasing weight gain among women of reproductive age. Aim To assess changes in the prevalence of high body mass index (BMI) (including both overweight and obese) in early pregnancy in Australian women, and its risk factors and association with selected birth outcomes from 2011–2017. Methods Records of pregnant women who received antenatal care and gave birth at an Australian tertiary hospital during 2011–2017 were evaluated and trends of high BMI were investigated. Results The risk of high BMI at early pregnancy increased by 3% annually and rose from 37% in 2011 to 44% in 2017. The risk of high BMI was greater in women who were more than 35 years old, multiparous, were smoking during pregnancy, and who had neurological disorders. High maternal BMI was associated with greater risks of having assisted conception, caesarean section and larger neonate. Conclusion The rate of high BMI in early pregnancy increased between 2011–2017.

Early pregnancy body mass index, gestational weight gain and perinatal outcome in an obstetric population in Lagos, Nigeria.

Introductionthe burden of overweight and obesity is rapidly increasing worldwide with significant health and social consequences. We determined the prevalence of overweight and obesity, pattern of gestational weight gain (GWG) and the associations of these with perinatal outcome among pregnant women in Lagos, Nigeria.Methodsthis was a retrospective review of case records of all deliveries in Lagos State University Teaching Hospital (LASUTH) over a period of two years. Case records of women with singleton pregnancies who registered for antenatal care at or below 20 weeks gestation were retrieved and reviewed to extract information on demography, anthropometrics, composites of pregnancy and perinatal outcomes. World Health Organization classification of BMI and the United States Institute of Medicine categorization of GWG were used to stratify subjects.Resultsout of 4,512 deliveries, 365 (8.1%) met our criteria. The prevalence of overweight and obesity in early pregnancy was 34.6% and 25.6% respectively while 2.9% were underweight. Thirty-seven (11.1%) pregnant women gained more than the recommended weight while 77.8% of underweight pregnant women gained less than the recommended weight. Following multiple logistic regression analysis, obesity in early pregnancy was significantly related to hypertensive pregnancy disorder (AOR 2.2; 95% CI, 1.08-4.32, p = 0.030), gestational diabetes mellitus (AOR 14.4; 95% CI, 4.85-42.6, p = < 0.001), caesarean section (AOR 2.7; 95% CI, 1.51-4.87, p = 0.001) and infections (AOR 4.9; 95% CI, 1.93-12.62, p = 0.001) while excessive GWG was significantly associated with gestational diabetes mellitus (AOR 4.8; 95% CI, 1.63-14.12, p = 0.004).Conclusionprevalence of early pregnancy overweight, obesity and excessive GWG were high among pregnant women in Nigeria and were associated with significant adverse consequences.

Early pregnancy overweight/obesity and length of residence among immigrants in Sweden: a pooled analysis of Swedish population registers between 1992 and 2012.

To examine whether the association between women's origin and early pregnancy overweight and obesity (OW/OB) varies by length of residence in Sweden. This cross-sectional observational study used pooled Swedish population register data from 1992 to 2012. Logistic regression models were run to estimate odds ratios (OR) of early pregnancy OW/OB and 95 % confidence intervals (95 % CI), comparing Swedish-born and immigrants by length-of-residence categories while adjusting for covariates. Sweden. In total, 1 771 821 pregnant women, 315 992 of whom were immigrants. With longer residence in Sweden, more immigrant women from various origins exhibited higher odds of experiencing early OW/OB compared with Swedish-born women. Findings specifically showed increased odds of early pregnancy OW/OB with increasing length of residence for women born in Latin America, Europe-27 and Southeast Asia. For example, immigrant women from Latin America residing in Sweden for < 6 years showed similar odds as Swedish-born (OR≤ 5 years 0·92, 95 % CI 0·87, 0·98), while their longer residing counterparts showed higher odds than Swedish-born women (OR6-15 years1·21, 95 % CI 1·14, 1·28 and OR≥ 16 years 1·68, 95 % CI 1·59, 1·78). Mixed results were found for other origins. The current study suggests that host country conditions might play an important role in explaining OW/OB among some groups of immigrant women. Although further studies are needed to disentangle the mechanisms that generate these health inequalities, policy efforts should focus on immigrant reception and early integration to prevent pregnancy-related OW/OB.

Metabolic Signatures of Gestational Weight Gain and Postpartum Weight Loss in a Lifestyle Intervention Study of Overweight and Obese Women.

Background: Overweight and obesity amongst women of reproductive age are increasingly common in developed economies and are shown to adversely affect birth outcomes and both childhood and adulthood health risks in the offspring. Metabolic profiling in conditions of overweight and obesity in pregnancy could potentially be applied to elucidate the molecular basis of the adverse effects of gestational weight gain (GWG) and postpartum weight loss (WL) on future risks for cardiovascular disease (CVD) and other chronic diseases. Methods: Biofluid samples were collected from 114 ethnically diverse pregnant women with body mass index (BMI) between 25 and 40 kg/m2 from Chicago (US), as part of a randomized lifestyle intervention trial (Maternal Offspring Metabolics: Family Intervention Trial; NCT01631747). At 15 weeks, 35 weeks of gestation, and at 1 year postpartum, the blood plasma lipidome and metabolic profile of urine samples were analyzed by liquid chromatography mass spectrometry (LC-MS) and 1H nuclear magnetic resonance spectroscopy (1H NMR) respectively. Results: Urinary 4-deoxyerythronic acid and 4-deoxythreonic acid were found to be positively correlated to BMI. Seventeen plasma lipids were found to be associated with GWG and 16 lipids were found to be associated with WL, which included phosphatidylinositols (PI), phosphatidylcholines (PC), lysophospholipids (lyso-), sphingomyelins (SM) and ether phosphatidylcholine (PC-O). Three phospholipids found to be positively associated with GWG all contained palmitate side-chains, and amongst the 14 lipids that were negatively associated with GWG, seven were PC-O. Six of eight lipids found to be negatively associated with WL contained an 18:2 fatty acid side-chain. Conclusions: Maternal obesity was associated with characteristic urine and plasma metabolic phenotypes, and phospholipid profile was found to be associated with both GWG and postpartum WL in metabolically healthy pregnant women with overweight/obesity. Postpartum WL may be linked to the reduction in the intake of linoleic acid/conjugated linoleic acid food sources in our study population.

Abstract 15564: What Pre-pregnancy, Pregnancy, and Inter-pregnancy Cardiometabolic Factors Contribute to Increased Risk of Recurrent Preeclampsia?: A Longitudinal Analysis in the Boston Birth Cohort

Introduction: Women with recurrent preeclampsia represent a group at uniquely high risk for maternal and perinatal morbidity, as well as future cardiovascular complications. The aim of this study is to examine the association of cardiometabolic risk factors with recurrent preeclampsia in the subsequent pregnancy. Methods: The Boston Birth Cohort is a racially/ethnically diverse birth cohort with over 8500 women. We identified 618 women with repeat pregnancies. Of those, 78 women had preeclampsia in the index pregnancy, and of those, 33 had recurrent preeclampsia in the subsequent pregnancy. We used log-binomial regression to examine the association between pre-pregnancy, pregnancy, and inter-pregnancy cardiometabolic risk factors (e.g., obesity, hypertension, diabetes mellitus, preterm birth, low birth weight, and gestational diabetes mellitus) and recurrent risk of preeclampsia. Results: Among the 78 women who had preeclampsia in their index pregnancy, the recurrence rate of preeclampsia was 42.3%. Several maternal risk factors were associated with this recurrent risk. Compared to women with pre-(index) pregnancy normal weight, the risk of recurrent preeclampsia was 3 times higher for women with pre-(index) pregnancy overweight (RR 3.0 [95% CI: 1.4 to 6.6]) or obesity (RR 3.1 [95% CI: 1.5 to 6.7). Compared to women without new inter-pregnancy chronic hypertension, women with new inter-pregnancy chronic hypertension had a 2-fold higher risk of recurrent preeclampsia (RR 2.4 [95% CI: 1.5 to 3.9]). Conclusions: Pre-(index) pregnancy obesity and new inter-pregnancy chronic hypertension was highly associated with recurrent preeclampsia in the subsequent pregnancy. Clinical and public health programs focused on reducing preconception obesity and reducing risk of hypertension in both the pre-pregnancy and inter-pregnancy periods may help reduce recurrent preeclampsia, which, in turn may help prevent or reduce subsequent cardiovascular disease.

Barriers to and facilitators for addressing overweight and obesity before conception: A qualitative study

BackgroundObesity is a significant global health issue, especially for reproductive-aged women. Women who enter pregnancy overweight or obese are at increased risk of a range of adverse reproductive, maternal, and child health outcomes. The preconception period has been recognised as a critical time to intervene to improve health outcomes for women and their children. Despite this recognition, adequate information is significantly lacking in relation to women’s health experiences, behaviours, and information preferences to inform the development of high-quality preconception intervention strategies. AimThis study aimed to examine women’s perspectives of barriers, enablers, and strategies for addressing overweight and obesity before conception. MethodUsing a qualitative research design, twelve multiparous women, aged between 32 and 43 years, who considered themselves to be overweight or obese were interviewed. Data were analysed using thematic analysis. FindingsThree themes were identified in relation to barriers: lack of information and knowledge, time constraints, and affordability. The following four themes emerged with respect to enablers and strategies: knowledge provision, accountability and motivation, regular contact, and habit formation. ConclusionKey factors to incorporate in women-centred interventions for preconception weight loss include multi-faceted knowledge provision and practical affordable methods for supporting healthy behaviours. Interventions should integrate techniques for ensuring regular contact with support networks, to enhance accountability, motivation, and facilitate habit formation. Further research is now being conducted by our team to co-design interventions and strategies informed by these findings.