Pregnancy Overweight Research Articles

Maternal thyroid disease and adiposity in mother and child.

Thyroid hormones are crucial developmental factors, and thyroid disease in pregnant women is a concern. Overweight and obesity are also important health concerns, and we hypothesized that in utero exposure to maternal thyroid disease could programme the foetus to development of adiposity. Cohort and case-cohort studies. Pregnant women from the Danish National Birth Cohort and their 7-year-old children. Maternal thyroid disease (hyperthyroidism and hypothyroidism) was assessed from registrations of diagnoses and treatment (n=71706) or from the measurement of thyroid-stimulating hormone (TSH) in a stored blood sample from the early pregnancy (n=7624). Maternal prepregnancy body mass index (BMI) and child BMI at 7years of age were used to define overweight and obesity, and associations were evaluated using regression models adjusting for potential confounders. No association was found between maternal thyroid disease in pregnancy and child overweight (hyperthyroidism: adjusted risk ratio (aRR): 1.02 (95% confidence interval (CI): 0.58-1.82); hypothyroidism: 1.31 (0.86-1.97)) or obesity (hyperthyroidism: 0.96 (0.53-1.75); hypothyroidism: 1.25 (0.76-2.05)). On the other hand, pregnant women with hypothyroidism in early pregnancy had a higher risk of being overweight (aRR: 1.20 (95% CI: 1.03; 1.41)) and obese (1.45 (1.07; 1.96)), whereas women with hyperthyroidism had a lower risk of being overweight (0.79 (0.64; 0.98)). Results provide no evidence that maternal thyroid disease in pregnancy programmes adiposity in the child, but corroborate an association between maternal thyroid disease and adiposity in the mother.

Association between maternal smoking during pregnancy and offspring overweight in U.S.-born children.

The criticism of the literature on smoking during pregnancy and offspring overweight was the confounding from postnatal factors. Interaction between gestational age and prenatal maternal smoking has not yet assessed. We used the Third National Health and Nutrition Examination Survey (1988-1994), linked with natality files of US-born singletons aged 2 to 6 years. A body mass index in the 85th percentile or higher were considered overweight, including obesity. Gestational age was dichotomized as preterm (<37 weeks, n = 240) or full-term (n = 2125). Smoking status during pregnancy was ascertained by a questionnaire-based interview during National Health and Nutrition Examination Survey. The prevalence of offspring overweight and obesity combined was 17.3% (SE = 1.3%). And 24.0% (1.3%) of mothers smoked while pregnant. A significant interaction was observed between maternal smoking and gestational age. In preterm children, a higher prevalence of overweight (34.3% [6.7%]) was found among the offspring of smoking mothers compared to non-smoking mothers (15.8% [3.6%]). After adjustment for socio-demographics, prenatal and postnatal factors, in preterm born offspring, the odds ratio of being born to smoking mothers was 2.46 (95% confidence intervals: 1.13-5.37) among children with overweight/obesity compared to children with healthy weight born to non-smoking mothers. In full-term children, the OR of being born to smoking mothers was 0.72 (0.50-1.03) among offspring with overweight/obesity relative to offspring with healthy weight born to non-smoking mothers. Maternal smoking during pregnancy was strongly associated with offspring overweight and obesity in preterm births after control for postnatal factors. Preterm children of smoking mothers should be prioritized for obesity prevention.

Early pregnancy serum IGFBP-1 relates to lipid profile in overweight and obese women

Lower level of insulin-like growth factor-binding protein (IGFBP-1) has been observed in insulin resistance, while higher level of matrix metalloproteinase-8 (MMP-8) has been linked to obesity. The aim here was to study in overweight and obese women, typically manifesting with insulin resistance, whether IGFBP-1 and MMP-8 are related to and reflect systemic low-grade inflammation, metabolism and diet. Fasting serum from overweight and obese pregnant women (n = 100) in early pregnancy were analysed for IGFBP-1, phosphorylated IGFBP-1 (phIGFBP-1) and MMP-8. High-sensitivity CRP and GlycA were used as markers for low grade inflammation. GlycA and lipids were quantified using NMR. IGFBP-1 associated negatively with GlycA, evidenced by higher concentrations in the lowest quartile (median 1.53 (IQR 1.45–1.72)) compared to the highest (1.46 (1.39–1.55)) (P = 0.03). Several lipid metabolites, particularly HDL-cholesterol, correlated inversely with phIGFBP-1 (FDR<0.1). Nutritional status and diet contributed to the levels of IGFBP-1, demonstrated as an inverse correlation with maternal weight (Spearman r = -0.205, P = 0.04) and dietary intake of vitamin A (r = -0.253, P = 0.014) and a direct correlation with dietary intake of polyunsaturated fatty acids (Spearman r = 0.222, P = 0.03). MMP-8 correlated inversely with pyridoxine (r = -0.321, P = 0.002) and potassium (r = -0.220, P = 0.033). Maternal serum IGFBP-1 may contribute to maternal lipid metabolism in overweight and obese women during early pregnancy. These findings may be of importance in identification of metabolic disturbances preceding the adverse metabolic outcomes in pregnancy.

Change In Physical Activity In The Health In Pregnancy And Postpartum (HIPP) Randomized Controlled Trial (RCT)

Despite the known benefits of physical activity (PA) in pregnancy, PA is consistently shown to decrease from early to late pregnancy. Very few antenatal interventions have targeted PA and included sensor-measured outcomes in overweight and obese pregnant women. PURPOSE: To examine whether a lifestyle intervention increased moderate- to vigorous-intensity PA (MVPA), light PA, and steps or reduced their decline from early to late pregnancy compared to a standard care condition. METHODS: HIPP is a RCT comparing the effects of a lifestyle intervention vs standard care on gestational weight gain (primary outcome) and health behaviors including PA (secondary outcomes) among women entering pregnancy overweight or obese. The lifestyle intervention was grounded in social cognitive theory and, during pregnancy, included an introductory behavioral counseling session followed by telephone counseling calls, behavioral podcasts, and a private Facebook group. Usual care participants received usual care from their obstetrician and received mailings and podcasts focused on a healthy pregnancy. Participants wore a SenseWear armband ≥ 21 hrs/d for ≥ 5 d at baseline (early pregnancy, n=205) and 32-wk gestation (n=167). We tested Randomization x Time interaction effects (SAS PROC MIXED) for min/d of MVPA, min/d of light PA, and steps/d. RESULTS: Participant demographics were: 30±5 years, 44% African American, 56% white, 60% college graduate, 61% employed full-time, 67% married, 42% nulliparous, and 13±2 wk gestation at baseline. While the time main effects indicated that MVPA (p=.007), light PA (p=.04), and steps (p<.0001) decreased significantly, intervention effects (Randomization x Time) were not significant for these PA variables (see Table). Table. Changes in MVPA, Light PA, and Steps Over Time, by Randomization Group, Least Square Means (SEs) CONCLUSION: A behaviorally based lifestyle intervention did not significantly lessen the decline in PA typically seen from early to late pregnancy. Assessments will be repeated at 6- and 12-mo postpartum. Funded by NIH/NICHD.

GDM Acts as a Moderator Between Pregnancy BMI and Metabolic Syndrome Severity Score

Abstract Objectives Overweight or obesity is a risk factor for Metabolic Syndrome (MetS), as is a history of gestational diabetes (GDM). Many women with GDM are overweight in pregnancy, and so it is difficult to disentangle the effects of pregnancy BMI (pregBMI) from GDM. The purpose of this study was to examine whether GDM moderates the association between pregBMI and MetS severity Z-scores 4–10 years following pregnancy. We hypothesized that the positive association between pregBMI and MetS Z-scores would be stronger in women with GDM compared to women without GDM. Methods Data for this analysis were drawn from N = 179 women enrolled in a cross-sectional study examining obesity and cardiometabolic disease risk in mother-child dyads. Women with GDM were oversampled relative to the prevalence in the general population. Women were eligible for inclusion if they delivered a healthy term infant 4–10 years prior to enrolling in this study, and were aged 20–36 years at delivery. PregBMI was calculated using measured body weight recorded in the medical record from their first prenatal visit. GDM status was retrieved from medical records. Waist circumference and blood pressure were measured using standard clinical procedures, and a fasting blood draw was obtained to measure glucose, triglycerides, and HDL-cholesterol. MetS Z-scores were measured using the method of Gurka and DeBoer (Metabolism, 63(2), 218–225; Clinical and Translational Science – Informatics and Technology group). Results The association between pregBMI and MetS was significantly modified by GDM status (P &amp;lt; 0.001) such that pregBMI was more strongly associated with MetS in women with GDM. Among women with a pregBMI of 30.9 (the sample mean), the mean difference in MetS Z-scores between conditions (those with or without GDM) is 0.65 SD units, a difference that grows larger at higher levels of pregBMI. Conclusions These results suggest greater MetS severity in women with GDM and a high pregBMI compared to women with a high pregBMI but without GDM. Future research should prospectively examine whether MetS is present in early pregnancy for women who develop GDM, and whether there are other modifiable factors that could reduce the risk for MetS among women with overweight or obesity in pregnancy. Funding Sources American Heart Association, NHLBI T32 training grant.

Effects of Maternal Obesity On Placental Phenotype.

The incidence of obesity is rising rapidly worldwide with the consequence that more women are entering pregnancy overweight or obese. This leads to an increased incidence of clinical complications during pregnancy and of poor obstetric outcomes. The offspring of obese pregnancies are often macrosomic at birth although there is also a subset of the progeny that are growth-restricted at term. Maternal obesity during pregnancy is also associated with cardiovascular, metabolic and endocrine dysfunction in the offspring later in life. As the interface between the mother and fetus, the placenta has a central role in programming intrauterine development and is known to adapt its phenotype in response to environmental conditions such as maternal undernutrition and hypoxia. However, less is known about placental function in the abnormal metabolic and endocrine environment associated with maternal obesity during pregnancy. This review discusses the placental consequences of maternal obesity induced either naturally or experimentally by increasing maternal nutritional intake and/or changing the dietary composition. It takes a comparative, multi-species approach and focusses on placental size, morphology, nutrient transport, metabolism and endocrine function during the later stages of obese pregnancy. It also examines the interventions that have been made during pregnancy in an attempt to alleviate the more adverse impacts of maternal obesity on placental phenotype. The review highlights the potential role of adaptations in placental phenotype as a contributory factor to the pregnancy complications and changes in fetal growth and development that are associated with maternal obesity.

SAT-LB132 3-Generation Study of Metabolic Disruption by Pregnancy Serum PFASs: Associations With Abdominal and Whole-Body Obesity in Granddaughters in a 60-Year Follow-Up of the Child Health and Development Studies Cohort

Introduction. We previously found a 3.6-fold increased risk of breast cancer in daughters associated with high maternal (F0) early postpartum serum EtFOSAA combined with high F0 cholesterol (https://doi.org/10.1016/j.reprotox.2019.06.012). Here we test the hypothesis that F0 early postpartum EtFOSAA, in combination with F0 serum cholesterol predicts abdominal obesity (waist circumference > 88cm) and/or whole-body overweight or obesity (body mass index > 25 kg/m2) in daughters (F1) at age 30 and granddaughters (F2) at age 20. Methods. We measured F1 and F2 weight, height, waist circumference and blood pressure when F1 were an average age of 50 years and adult F2 were an average age of 20 years (N=213 triads). F1 also reported their weight at age 30, near the mean age of their pregnancies with their daughters (F2) to allow control for obesity during F2 gestation. EtFOSAA, PFOS, and cholesterol were assayed in archived early postpartum F0 serum samples collected within 3 days of delivery. Results. F0 cholesterol significantly (p<0.05) modified the association of F0 EtFOSAA with self-reported obesity at age 30 in F1 and measured abdominal and whole-body obesity, and blood pressure at age 20 in F2. Association patterns were similar for all outcomes: F0 EtFOSAA was associated with high metabolic risk when F0 serum cholesterol was low (Quartile 1): e.g. 20-year-old F2 had an estimated 2.3 fold increase in the joint risk of abdominal and whole-body obesity over the inter-quartile range of F0 ETFOSAA, 95% Confidence Interval= 1.1, 4.8. F0 EtFOSAA associations with F2 metabolic risk were independent of F0 race, early pregnancy overweight (BMI >25 kg/m2), and serum PFOS. F1 obesity at age 30 did not mediate F0 EtFOSAA associations with F2 outcomes, but additionally predicted high metabolic F2 risk. Conclusions. Findings support the hypothesis that in utero exposure to EtFOSAA impacts metabolic risk factors in female F2 exposed as germline and also independently via promotion of overweight in F1 (their mothers) during F2 gestation.

Environmental Risk/Protective Factors and Biomarkers for Attention-Deficit/Hyperactivity Disorder: An Umbrella Review of the Evidence

Background: Numerous potential environmental risk/protective factors and biomarkers for attention deficit/hyperactivity disorder (ADHD) have been investigated, but their consistency and magnitude are unclear. Methods: We conducted an umbrella review (registered in PROSPERO, registration: CRD42019145032) to systematically appraise the evidence of association between risk/protective factors or biomarkers and ADHD. We searched PubMed/MEDLINE, Embase, and Cochrane Database of Systematic Reviews from inception to Oct 31 st , 2019 and screened the references of relevant articles. We calculated the summary effect estimates (e.g. odds ratio [OR], relative risk [RR], and weighted mean difference [WMD]), 95% confidence interval, heterogeneity I 2 statistic, 95% prediction interval, small study effects and excess significance biases. Analyses under credibility ceilings were conducted. We assessed the quality of the meta-analyses with AMSTAR 2. Findings: The 37 eligible articles yielded 67 meta-analyses encompassing 43 environmental risk/protective factors (ADHD cases= 728 899, population=37 898 120) and 24 biomarkers (cases=13 784, population=37 629). Evidence of association was convincing (class I) for maternal pre-pregnancy obesity (OR=1·63, 1·49-1·77), childhood eczema (OR=1·31, 1·20-1‧44), preeclampsia (OR=1·31, 1·23-1‧40), hypertensive disorders during pregnancy (OR=1·29, 1·22-1·36), and maternal acetaminophen exposure during pregnancy (RR=1·25, 95% CI=1·17-1·34), and highly suggestive (class II) for maternal smoking during pregnancy (OR=1·56, 1·41-1·73), childhood asthma (OR=1·51, 1·4-1·63), childhood unhealthy dietary pattern (OR=1·41, 1·25-1·58), maternal pre-pregnancy overweight (OR=1·28, 1·21-1·35), and low serum vitamin D (WMD=−6·93, −9·34-−4·51). Interpretation: Pre-pregnancy obesity, overweight, and acetaminophen in pregnancy are strongly associated with ADHD. However, these associations are not necessarily causative and further high-quality studies to confirm these findings would be required. Funding Statement: None. Declaration of Interests: The authors declare no competing interests in relation to the current manuscript. Ethics Approval Statement: PROSPERO: CRD42019145032

The joint effect of maternal smoking during pregnancy and maternal pre-pregnancy overweight on infants\u2019 term birth weight

BackgroundIt is well known that maternal smoking during pregnancy and maternal pre-pregnancy overweight have opposite effects on the infants’ birth weight. We report on the association of the combination between both risk factors and the infants’ birth weight.MethodsWe studied 3241 infants born at term in the PIAMA birth cohort. Maternal smoking during pregnancy and pre-pregnancy height and weight were self-reported. Multivariable regression analysis was performed to assess the associations between infants of mothers who only smoked during pregnancy, who only had pre-pregnancy overweight and who had both risk factors simultaneously, on term birth weight and the risk of being SGA or LGA.ResultsOf 3241 infants, 421 infants (13%) were born to smoking, non-overweight mothers, 514 (15.8%) to non-smoking, overweight mothers, 129 (4%) to smoking and overweight mothers and 2177 (67%) to non-smoking, non-overweight mothers (reference group). Infants of mothers who smoked and also had pre-pregnancy overweight had similar term birth weight (− 26.6 g, 95%CI: − 113.0, 59.8), SGA risk (OR = 1.06, 95%CI: 0.56, 2.04), and LGA risk (OR = 1.09, 95%CI: 0.61, 1.96) as the reference group.ConclusionsOur findings suggested that the effects of maternal smoking during pregnancy and maternal pre-pregnancy overweight on infants’ birth weight cancel each other out. Therefore, birth weight may not be a good indicator of an infant’s health status in perinatal practice because it may mask potential health risks due to these maternal risk factors when both present together.

Influence of overweight in pregnancy on the intestinal flora as well as maternal and infant outcome

Influence of overweight in pregnancy on the intestinal flora as well as maternal and infant outcome

Relation between maternal obesity and fetal congenital malformations

Background: There is evidence suggests that there is an association between maternal obesity and some congenital abnormalities. Objective: Since there is no local study has been examined the relation between maternal pregnancy obesity and overweight and fetal congenital malformations, we explored this relation in Babylon women and compared our findings with previous studies. Materials and Methods: This prospective study was carried on patients admitted to Babil Obestetric and Pediatric Teaching Hospital in Babylon city, Iraq, from April 2016 to April 2017. Data were collected by history, clinical examination, and investigations and body mass index was measured for all patients. All neonates examined by pediatrician and surgeon to detect any congenital malformations. All the mothers of case infants or control infants of age more than 35 years or

High level of hemoglobin during the first trimester of pregnancy associated with the risk of gestational diabetes mellitus

Objective: To explore the relationship between hemoglobin (Hb) level during the first trimester of pregnancy and gestational diabetes mellitus (GDM). Methods: A total of 1 276 participants, who underwent scheduled prenatal examination and normal singleton delivery at the Fifth People's Hospital of Shanghai and Hospital of Intergrated Chinese and Western Medicine in Minhang District, from January 2016 to May 2018 were included. There were 99 cases of GDM (GDM group) and 1 177 cases of normal (control group) pregnant women.Based on the serum Hb level during the first trimester of pregnancy, participants were divided into three groups, 236 cases of low Hb level group (Hb<110 g/L), 868 cases of normal Hb level group (110 g/L≤Hb<130 g/L), and 172 cases of high Hb level group (Hb≥130 g/L). Maternal clinical data were collected, including Hb level during the first trimester of pregnancy, three-point blood glucose (BG) of oral glucose tolerance test (OGTT) and fasting insulin during the second trimester of pregnancy. Homeostasis model assessment of insulin resistance index (HOMA-IR) and homeostasis model assessment of pancreatic β cell function index (HOMA-β) were used to evaluate insulin resistance and pancreatic β cell function. Results: (1) Hb level during the first trimester of pregnancy in GDM group was significantly higher than that in control group [(123±10),(119±11) g/L, P<0.05]. There were no significant difference in gravidity, parity, index of liver and renal function (all P>0.05). (2) Pre-pregnancy body mass index (BMI), 1-hour BG and 2-hour BG of OGTT were significantly increased in the high Hb level group during the first trimester of pregnancy, which were (23±4) kg/m(2), (7.3±2.0) mmol/L, and (6.5±1.4) mmol/L (P<0.05), respectively. The pre-pregnancy BMI, 1-hour BG and 2-hour BG of the normal or low Hb level group were (22±3) kg/m(2), (6.7±1.6) mmol/L, (6.1±1.2) mmol/L; (22±3) kg/m(2), (6.5±1.5) mmol/L, (5.9±1.1) mmol/L, respectively. There were no statistically significant difference in levels of fasting blood glucose, fasting insulin, HOMA-IR and HOMA-β within 3 groups (all P>0.05). (3) In the high Hb level group, prevalence of pregnancy overweight or obesity and GDM were the highest, which were 37.2%(64/172) and 15.1%(26/172), respectively; the differences were statistically significant (all P<0.05). (4) The serum Hb level in the first trimester was positively related with pre-pregnancy BMI (r=0.130, P<0.05), 1-hour BG (r=0.129, P<0.05), 2-hour BG (r=0.134, P<0.05), fasting insulin (r=0.096, P<0.05), and HOMA-IR (r=0.101, P<0.05).Logistic regression indicated that Hb≥130 g/L during the first trimester of pregnancy was an independent risk factor for GDM (OR=2.799, 95%CI: 1.186-6.604; P<0.05). Conclusion: The high level of Hb (Hb≥130 g/L) during the first trimester of pregnancy is associated with GDM.

Antibiotic use during pregnancy and childhood overweight: A population-based nationwide cohort study

Studies in mice suggest that early life represents a critical time window, where antibiotics may exert profound and lasting effects on the gut microbiota and metabolism. We aimed to test the hypothesis that prenatal antibiotic exposure is associated with increased risk of childhood overweight in a population-based cohort study. We linked 43,365 mother-child dyads from a nationwide cohort of pregnant women and their offspring to the Danish National Prescription Registry. Linear and logistic regression models were used to examine associations between prenatal exposure to antibiotics and BMI z-score and overweight (including obesity) at age seven and 11 years. Prenatal antibiotic exposure and childhood overweight were both associated with high pre-pregnancy BMI, maternal diabetes, multi-parity, smoking, low socioeconomic status, high paternal BMI, and short duration of breastfeeding. After adjustment for confounders, no associations were observed between prenatal antibiotic exposure and odds of overweight at age seven and 11 years. Whereas no association was observed between broad-spectrum antibiotics and overweight at age 11 years, exposure to broad-spectrum antibiotics was associated with higher odds of overweight at age seven years with an odds ratio of 1.27 (95% CI, 1.05–1.53) for ampicillin and an odds ratio of 1.56 (95% CI, 1.23–1.97) for amoxicillin. As we did not account for underlying infections, the observed associations with early childhood overweight could be explained by confounding by indication. In conclusion, our population-based study suggests that prenatal exposure to narrow-spectrum antibiotics is not associated with overweight in offspring. Exposure to some broad-spectrum antibiotics may increase the odds of overweight in early childhood, but the association does not persist in later childhood.

ASSESSMENT OF THE EFFECT OF MATERNAL PRE-PREGNANCY BODY MASS INDEX ON PREGNANCY OUTCOMES

Obesity is a significant health problem which can lead to serious health complications. It does not exclude pregnant population. It is well known that maternal pre pregnancy obesity and overweight is a common health problem which can lead to adverse neonatal and maternal outcomes such as gestational diabetes, pre eclapmsia, post partum haemorrhage, caesarean delivery, neonatal intensive care unit admission, small/ large for gestational age, stillbirth, etc. The aim of the present study is to assess the effect of maternal pre- pregnancy BMI on maternal and fetal outcomes. It was a prospective hospital based cohort study that was carried out for a period of 6 months at St. Philomena’s Hospital, Bangalore. The subjects were included after obtaining informed consent. Women with multiple pregnancies and pregnant women whose gestational period was&lt;20 weeks and those who were not willing to participate in the study were excluded. All the relevant data of both maternal and fetal demographic details, type of delivery and neonatal outcomes were collected. Chi square test was used to assess associations between maternal BMI and period of gestation, fetal position, type of delivery, fetal weight, newborn complications and Apgar score. A total of 432 pregnant women were included in the study comprising 49.5% normal weight, 29.3% overweight and 21.2% obese women. We observed higher incidence of LSCS and neonatal complications including pneumonia, hydronephrosis, hypoglycaemia, respiratory distress syndrome, transient tachypnea of newborn in obese and overweight mothers compared to normal weight mothers. We could not find any significant relation between pre pregnancy BMI and neonatal birth weight, period of gestation, Apgar score and fetal position at time of delivery. Maternal and neonatal complications are associated with pre pregnancy obesity.

Sensor-measured Physical Activity In Overweight And Obese Women In Early Pregnancy

Overweight and obese pregnant women may benefit from physical activity (PA) in pregnancy, yet few studies have examined sensor-measured PA in pregnancy. PURPOSE: To evaluate sensor-measured PA in overweight and obese pregnant women and its sociodemographic and psychological correlates. METHODS: We analyzed baseline data from an ongoing behavioral lifestyle intervention trial in Columbia, SC (n=202). PA was measured with the SenseWear Armband; compliance was set at wearing for 20+ hrs/d, 5+ days (including 1+ weekend day). PA measures were daily duration of light PA (LPA), moderate to vigorous PA (MVPA), daily steps, and meeting MVPA guidelines (≥150 min/wk of MVPA in ≥10 min bouts). PA was presented as median (interquartile range). Subgroup differences in medians were examined with quantile regression models. Correlations of PA measures with perceived stress, depressive symptoms, PA social support, PA self-efficacy, and PA self-regulation were studied. A logistic regression model was used to examine correlates of meeting MVPA guidelines. RESULTS: Participants (mean of 12.4 weeks gestation) had a median of 203 (154, 258) min/d LPA, 34 (20, 49) min/d MVPA, and 4,870 (3768, 6590) steps/d. LPA, MVPA, and steps were lower in African American and obese women (p<.05). LPA was lower in nulliparous women (p<.05). Participants with less than college education had lower MVPA and steps (p<0.05). Further, LPA, MVPA, and steps were positively associated with PA self-efficacy (r’s ranging from 0.13 to 0.16, p≤.05) and PA goal setting (r’s ranging from 0.16 to 0.21, p<.05). MVPA was positively associated with PA planning (r=0.16, p<.05). Only 10.4% of participants met MVPA guidelines, which was more prevalent in white (17.1%) vs African American (2.2%) women and in overweight (17.9%) vs obese women (3.7%) (p<0.05). After adjusting for age, parity, and marital status, white women and overweight women had higher odds of meeting MVPA recommendation than their counterparts: white: 5.8 (1.2-28.6); overweight: 5.2 (1.6, 16.9). CONCLUSION: Sensor-measured PA was low in overweight and obese pregnant women in early pregnancy with significant differences by race, education, parity, and pre-pregnancy weight status. Programs targeting PA are needed for this population. Funded by NIH/NICHD.

An investigation of Australian midwifery curricula for obesity management and health behaviour change training.

Fifty percent of Australian women enter pregnancy overweight or obese. Unfortunately, few women receive weight management advice from health professionals during pregnancy. The aim of this study was to investigate current midwifery curricula from Australian universities to identify strengths and deficits in the teaching of preconception and antenatal weight management. Midwifery courses from 20 universities were identified. Of the 568 units taught at these universities, 252 course outlines were obtained. Data were coded using the qualitative analysis technique of Framework Analysis for the following main themes: 1) the effect of weight, diet and physical activity on health outcomes for women who are pregnant or planning a pregnancy; 2) weight management advice in any population; and 3) health behaviour change techniques in any context. Analysis revealed a variety of teaching methods and skills training that emphasised the importance of clinical judgement and autonomous clinical practice, in conjunction with critical enquiry and sourcing reputable evidence. There was little evidence, however, that weight management advice was taught explicitly to midwifery students in the curricula. A greater emphasis on skilling midwifery students to address weight gain during pregnancy, and behavioural techniques to achieve this, is required.

Weight Gain in Pregnancy and Weight Retention after Birth

AIM:Our study aims to determine the weight gain of pregnant women and their body weight one year after delivery. We compared these changes in body weight with education and place of residence (urban/rural).METHODS:Secundigravidae women (N = 113) filled out the structured checklist regarding anthropological characteristics, such as body weight (the current and before and after the first pregnancy). Some sociodemographic characteristics were also obtained.RESULTS:Average weight gain in pregnancy was 16.9 kg (Sd 6.1, median 16 kg; range 6-40 kg). Women with high school education only gained 2 kg more than women with college/university degree (F (1, 108) 4.11, p ≤ 0.05). There was no significant difference in weight gain when the place of residence was compared (F (1, 111) 2.86, p ≥ 0.05). The average weight difference one year after delivery was 3.3 kg (Sd 4.3, median 2 kg; spread -5 to 20 kg). There was no significant difference in weight difference one year after delivery in different educational groups. Women from rural area retained 2.5 kg more than women in an urban area (F (1, 109) 7.50, p ≤ 0.01).CONCLUSION:Our research has shown that women with higher education level gain less weight than women with lower degrees. They had more possibility to get access to information about health risks. The overall impression is that women do care about weight gain in pregnancy and actively work on getting back to desirable weight after delivery. This is even more important if we know that body weight before pregnancy, weight gain in pregnancy, pregnancy overweight and pregnancy obesity impact later life of mother and child. Therefore, the need for weight control in pregnancy and between pregnancies should be properly addressed.

Maternal early pregnancy body mass index and diurnal salivary cortisol in young adult offspring

Background Maternal early pregnancy overweight (body mass index [BMI] 25.0–29.9 kg/m2) and obesity (BMI ≥ 30 kg/m2) are associated with mental and physical health adversities in the offspring. Prenatal programming of the hypothalamic-pituitary-adrenal (HPA) axis has been put forward as one of the mechanisms that may play pathophysiological role. However, evidence linking maternal overweight and obesity with offspring HPA-axis activity is scarce. We studied if maternal early pregnancy BMI is associated with diurnal salivary cortisol, a marker of HPA-axis activity, in young adult offspring.Methods At a mean age of 25.3 (standard deviation [SD) = 0.6) years, 653 Arvo Ylppö Longitudinal Study participants collected saliva samples for cortisol analyses, at awakening, 15 and 30 min thereafter, 10:30AM, 12:00PM, 5:30PM and at bedtime. Maternal BMI was calculated from weight and height verified by a measurement in the first antenatal clinic visit before 12 weeks of gestation derived from healthcare records.Results Per each one kg/m2 higher maternal early pregnancy BMI offspring diurnal average salivary cortisol was -1.4% (95% CI:-2.6, -0.2, pFDR = 0.033) lower, at awakening it was -2.4% (95% CI:-4.0, -0.7, pFDR = 0.025) lower and the morning average salivary cortisol was -2.0% (95% CI:-3.4, -0.5, pFDR=0.017) lower. These associations were independent of the offspring’s own young adulthood BMI, and other important covariates.Conclusion Our findings show that young adult offspring born to mothers with higher early pregnancy BMI show lower average levels of diurnal cortisol, especially in the morning. Whether these findings reflect prenatal programming of the offspring HPA-axis activity warrants further investigation.

Maternal smoking during pregnancy and offspring body mass index and overweight: a systematic review and meta-analysis.

The present study aimed to conduct a systematic review and meta-analysis to evaluate the evidence on the association of maternal smoking during pregnancy with offspring body composition in childhood, adolescence and adulthood. MEDLINE, Web of Science and LILACS databases were searched. Reference lists were also screened. We included original studies, conducted in humans, that assessed the association of maternal smoking during pregnancy with offspring body mass index (BMI) and overweight in childhood, adolescence and adulthood, published through May 1st, 2018. A meta-analysis was used to estimate pooled effect sizes. The systematic review included 64 studies, of which 37 evaluated the association of maternal smoking during pregnancy with overweight, 13 with BMI, and 14 evaluated both outcomes. Of these 64 studies, 95 measures of effect were extracted and included in the meta-analysis. We verified that the quality of evidence across studies regarding maternal smoking in pregnancy and overweight and BMI of offspring to be moderate and low, respectively. Most studies (44 studies) were classified as moderate risk bias. Heterogeneity among studies included was high and, in the random-effects pooled analysis, maternal smoking during pregnancy increased the odds of offspring overweight (OR: 1.43, 95%CI: 1.35; 1.52) and mean difference of BMI (β: 0.31, 95%CI: 0.23; 0.39). In conclusion, offspring of mothers who smoked during pregnancy have higher odds of overweight and mean difference of BMI, and these associations persisted into adulthood.

Comparing barriers to breastfeeding success in the first month for non-overweight and overweight women

BackgroundWomen who enter pregnancy overweight or obese tend to have poorer breastfeeding outcomes compared to non-overweight women. Women’s experiences of specific breastfeeding-related problems and reasons for use of formula have not been systematically investigated according to pre-pregnancy BMI. The aim of this study was to compare self-reported breastfeeding problems in non-overweight and overweight women and identify the main reasons for use of infant formula during the first month postpartum.MethodsThe present study involved a cross-sectional secondary analysis of data collected as part of a hospital-based longitudinal study of women that commenced in pregnancy (~ 16 weeks). At ~ 4 months postpartum Australian women (N = 477) self-reported breastfeeding problems and reasons for use of infant formula during the first month postpartum. Pre-pregnancy BMI was calculated based on self-reported pre-pregnancy weight and measured height. Binary logistic regression analyses were used to compare pre-pregnancy weight status groups (“non-overweight” [BMI < 25 km/m2] and “overweight” [BMI ≥25 km/m2]) on self-reported breastfeeding problems and reasons for use of infant formula. Analyses were adjusted for covariates that differed between groups (P < .1).ResultsFrequency of self-reported breastfeeding problems was similar across weight status groups. “Not enough milk” was the predominant reason for giving infant formula. Overweight women were more likely than non-overweight women to agree that infant formula was as good as breastmilk.ConclusionsOverall it does not appear that overweight women are more likely to experience a range of specific breastfeeding problems in the first months compared to non-overweight women. However, the severity and duration of the problems needs to be examined. Breastfeeding interventions need to addresses concerns around milk supply as these are common and are likely to be of universal benefit however overweight women in particular may benefit from guidance regarding the benefits of breastfeeding for both themselves and their infants.