Pregravid BMI Research Articles

The effect of gestational diabetes, pre-gravid maternal obesity, and their combination (‘diabesity’) on outcomes of singleton gestations

Objective: To assess the effect of the combination of gestational diabetes mellitus (GDM) and pre-gravid obesity (‘diabesity’) in singleton gestations.Methods: We compared perinatal outcomes of singleton gestations in mothers with GDM and pre-gravid obesity, with GDM but with normal pre-gravid BMI, and obese mothers without GDM.Results: We compared diabesity mothers (n = 1525, 24.4% of mothers with GDM, 9.9% of all obese women) to mothers with GDM but with normal BMI (n = 4704, 75.6% of mothers with GDM) and to obese mothers without GDM (n = 13,937, 90.1% of all obese mothers). Obesity, with and without GDM, increased the odds of having chronic hypertension whereas preeclampsia appears to be influenced by obesity only, as were the risk of births at <33 weeks’ gestation, of birth weight >4000 g, low 5-min Apgar scores and NICU admissions.Conclusion: Obesity (without diabetes) is more frequently associated with adverse perinatal outcomes than diabesity or GDM in non-obese mothers. A campaign to decrease pre-gravid obesity should have at least the same priority as any campaign to control GDM.

Associations of Maternal Leptin with Neonatal Adiposity Differ according to Pregravid Weight

Background: During pregnancy, maternal circulating leptin is released by maternal adipose tissue and the placenta, and may have a role in fetal development. Objectives: We investigated maternal leptinemia and glycemia associations with neonatal adiposity, taking into account pregravid weight status. Methods: We included 235 pregnant women from the Genetics of Glucose Regulation in Gestation and Growth prospective cohort with data: blood samples collected during the 2nd trimester, an oral glucose tolerance test (OGTT), and the measured leptin and glucose levels. As an integrated measure of maternal leptin exposure, we calculated the area under the curve for maternal leptin at the OGTT (AUC_leptin). Within 72 h of delivery, we measured the triceps, biceps, subscapular, and suprailiac skinfold thicknesses (SFTs); the sum of these SFTs represented neonatal adiposity. We conducted a regression analysis to assess the maternal metabolic determinants of neonatal adiposity, adjusting for parity, smoking status, maternal triglyceride levels, gestational weight gain, placental weight, delivery mode, neonate sex, and gestational age at delivery. Results: The pregravid BMI of the participating women was 23.3 (21.2-27.0). In the 2nd trimester, maternal AUC_leptin was 1,292.0 (767.0-2,222.5) (ng × min)/mL, and fasting glucose levels were 4.2 ± 0.4 mmol/L. At delivery, the neonatal sum of 4 SFTs was 17.9 ± 3.3 mm. Higher maternal leptinemia was associated with higher neonatal adiposity (β = 4.23 mm [SE = 1.77] per log-AUC_leptin; p = 0.02) in mothers with a BMI ≥25, independently of confounders and maternal glycemia, but not in mothers with a BMI <25. Higher maternal fasting glucose was associated with higher neonatal adiposity (β = 0.88 mm [SE = 0.30] per SD glucose; p = 0.005) in mothers with a BMI <25, independently of confounders and maternal leptinemia. Conclusion: Maternal leptinemia may be associated with neonatal adiposity in offspring from overweight/obese mothers, independently of maternal glycemia.

Causal relationship between obesity-related traits and TLR4-driven responses at the maternal-fetal interface.

Obesity triggers complex inflammatory networks within the innate immune system. During pregnancy, the placenta amplifies the low-grade inflammation through activation of Toll-like receptor 4 (TLR4) signalling pathways. The purpose of this study was to investigate the impact of obesity on placental TLR4 expression and inflammatory signals. The secondary aim was to analyse the placental cell type responsible for TLR4 activation. Thirty-nine women recruited at term-scheduled Caesarean section were grouped according to their pre-gravid BMI (<25kg/m(2) and >30kg/m(2)). Placenta, venous maternal and cord blood were obtained at delivery for analysis. Data were analysed with linear regression and Spearman's rank correlation coefficient analysis. TLR4, IL6 and IL8 expression was increased three- to ninefold (p < 0.001) in the placenta of obese vs lean women. There was a positive correlation between placental TLR4 and maternal systemic and placental IL6 and IL8 concentrations. Placental TLR4 expression was correlated with maternal pre-gravid BMI, insulin resistance index, plasma insulin and C-reactive protein (r = 0.57, 0.31, 0.35, 0.53, respectively; p < 0.001) but not with plasma glucose, maternal age, gestational age and gestational weight gain (r < 0.2; p > 0.1). TLR4 was located in both trophoblast and macrovascular endothelial cells lining fetal vasculature. Lipopolysaccharide-induced TLR4 activation was more robust in trophoblasts than in endothelial vascular cells (100-fold vs tenfold; p < 0.001). Trophoblastic TLR4 is strongly implicated in the propagation of placental inflammation. Placental inflammation is related to maternal metabolic conditions such as pre-gravid BMI, whilst gestational weight gain or gestational age are not. These results implicate the pre-gravid condition as a significant contributor to metabolic inflammation in late pregnancy.

Associations Between Maternal Pregravid Obesity and Gestational Diabetes and the Timing of Pubarche in Daughters.

We investigated whether in utero exposure to maternal pregravid obesity and/or gestational diabetes mellitus (GDM) was associated with early puberty in girls. We used data from a longitudinal study of 421 mother-daughter pairs enrolled in an integrated health services organization, Kaiser Permanente Northern California (2005-2012). Girls aged 6-8 years were followed annually through ages 12-14 years. Onset of puberty was assessed using study clinic-based Tanner staging. We examined associations of self-reported pregravid obesity and maternal GDM with timing of the daughter's transition to pubertal maturation stage 2 or above for development of breasts and pubic hair, using accelerated failure time regression models with interval censoring to estimate time ratios and hazard ratios and corresponding 95% confidence intervals. Maternal obesity (pregravid body mass index (BMI; weight (kg)/height (m)(2)) ≥30) was associated with a daughter's earlier transition to breast and pubic hair stage 2+ in comparison with girls whose mothers had pregravid BMI <25. These associations were attenuated and not statistically significant after adjustment for covariates. Girls whose mothers had both pregravid BMI ≥25 and GDM were at higher risk of an earlier transition to pubic hair stage 2+ than those whose mothers had neither condition (adjusted time ratio = 0.89, 95% confidence interval: 0.83, 0.96; hazard ratio = 2.97, 95% confidence interval: 1.52, 5.83). These findings suggest that exposure to maternal obesity and hyperglycemia places girls at higher risk of earlier pubarche.

Early pregnancy fasting plasma glucose and lipid concentrations in pregnancy and association to offspring size: a retrospective cohort study.

BackgroundHyperlipidemia and high fasting plasma glucose levels at the first prenatal visit (First Visit FPG) are both related to gestational diabetes mellitus, maternal obesity/overweight and fetal overgrowth. The purpose of the present study is to investigate the correlation between First Visit FPG and lipid concentrations, and their potential association with offspring size at delivery.Materials and methodsPregnant women that received regular prenatal care and delivered in our center in 2013 were recruited for the study. Fasting plasma glucose levels were tested at the first prenatal visit (First Visit FPG) and prior to delivery (Before Delivery FPG). HbA1c and lipid profiles were examined at the time of OGTT test. Maternal and neonatal clinical data were collected for analysis. Data was analyzed by independent sample t test, Pearson correlation, and Chi-square test, followed by partial correlation and multiple linear regression analyses to confirm association. Statistical significance level was α =0.05.ResultsAnalyses were based on 1546 mother-baby pairs. First Visit FPG was not correlated with any lipid parameters after adjusting for maternal pregravid BMI, maternal age and gestational age at First Visit FPG. HbA1c was positively correlated with triglyceride and Apolipoprotein B in the whole cohort and in the NGT group after adjusting for maternal age and maternal BMI at OGTT test. Multiple linear regression analyses showed neonatal birth weight, head circumference and shoulder circumference were all associated with First Visit FPG and triglyceride levels.ConclusionFasting plasma glucose at first prenatal visit is not associated with lipid concentrations in mid-pregnancy, but may influence fetal growth together with triglyceride concentration.

Maternal Obesity and Excessive Gestational Weight Gain Are Associated with Components of Child Cognition1–3

Background: Maternal overweight and obesity affect two-thirds of women of childbearing age and may increase the risk of impaired child cognition.Objective: Our objective was to test the hypothesis that high/low gestational weight gain (GWG) and high/low prepregnancy BMI were associated with offspring intelligence quotient (IQ) and executive function at age 10.Methods: Mother–infant dyads (n = 763) enrolled in a birth cohort study were followed from early pregnancy to 10 y postpartum. IQ was assessed by trained examiners with the use of the Stanford Binet Intelligence Scale–4th edition. Executive function was assessed by the number of perseverative errors on the Wisconsin Card Sorting Test and time to complete Part B on the Trail Making Test. Self-reported total GWG was converted to gestational-age–standardized GWG z score. Multivariable linear regression and negative binomial regression were used to estimate independent and joint effects of GWG and BMI on outcomes while adjusting for covariates.Results: At enrollment, the majority of women in the Maternal Health Practices and Child Development cohort were unmarried and unemployed, and more than one-half reported their race as black. The mean ± SD GWG z score was −0.5 ± 1.8, and 27% of women had a pregravid BMI ≥25. The median (IQR) number of perseverative errors was 23 (17, 29), the mean ± SD time on Part B was 103 ± 42.6 s, and 44% of children had a low average IQ (≤89). Maternal obesity was associated with 3.2 lower IQ points (95% CI: −5.6, −0.8) and a slower time to complete the executive function scale Part B (adjusted β: 12.7 s; 95% CI: 2.8, 23 s) compared with offspring of normal-weight mothers. Offspring of mothers whose GWG was >+1 SD, compared with −1 to +1 SD, performed 15 s slower on the executive function task (95% CI: 1.8, 28 s). There was no association between GWG z score and offspring composite IQ score (adjusted β: −0.32; 95% CI: −0.72, 0.10). Prepregnancy BMI did not modify these associationsConclusions: Although GWG may be important for executive function, maternal BMI has a stronger relation than GWG to both offspring intelligence and executive function. Our findings contribute to evidence linking maternal obesity to long-term child outcomes.

Psychosocial factors and excessive gestational weight gain: The effect of parity in an Australian cohort

Objectivespsychosocial variables can be protective or risk factors for excessive gestational weight gain (GWG). Parity has also been associated with GWG; however, its effect on psychosocial risk factors for GWG is yet to be determined. The aim of this study was to investigate if, and how, psychosocial factors vary in their impact on the GWG of primiparous and multiparous women. Design/Participantspregnant women were recruited in 2011 via study advertisements placed in hospitals, online, in parenting magazines, and at baby and children’s markets, resulting in a sample of 256 women (113 primiparous, 143 multiparous). Participants completed questionnaires at 16–18 weeks’ gestation and their pregravid BMI was recorded. Final weight before delivery was measured and used to calculate GWG. Findingsthe findings revealed that primiparous women had significantly higher feelings of attractiveness (a facet of body attitude; p=0.01) than multiparous women. Hierarchical regressions revealed that in the overall sample, increased GWG was associated significantly with lower pre-pregnancy BMI (standardised coefficient β=−0.39, p<0.001), higher anxiety symptoms (β=0.25, p=0.004), and reduced self-efficacy to eat a healthy diet (β=−0.20, p=0.02). Although higher GWG was predicted significantly by decreased feelings of strength and fitness for primiparous women (β=−0.25, p=0.04) and higher anxiety was related significantly to greater GWG for multiparous women (β=0.43, p<0.001), statistical comparison of the model across the two groups suggested the magnitude of these effects did not differ across groups (p>0.05). Conclusions/Implications for practicethe findings suggest that psychosocial screening and interventions by healthcare professionals may help to identify women who are at risk of excessive GWG, and there may be specific psychosocial factors that are more relevant for each parity group.

Do tall women beget larger babies?

Objective: To evaluate the possible relationship between maternal height and fetal size.Patients and methods: We used a population-based cohort of apparently healthy mothers of singletons to evaluate quartiles of the maternal height distribution for parity, being overweight or obese, and for gestational age and birth weight parameters. We also generated birth weight by gestational age curves for each quartile.Results: We analyzed data of 198 745 mothers. Mother from the four quartiles had similar parity, pre-gravid BMI, and gestational age at birth. Short mothers had a significantly higher rate of VLBW and LBW and 2501–4000 g infants, for an OR = 1.38 (95% CI: 1.17–1.62), OR = 2.2 (95% CI: 2.05–2.37) and OR = 1.82 (95% CI: 1.73–1.87) between the shortest and tallest mothers, respectively. By contrast, the opposite trend was noticed for birth weights >4000 g, for an OR = 2.77 (95% CI: 2.65–2.89) between the tallest and shortest mothers. A very similar “growth curve” was apparent until 33 weeks, when a slower growth velocity was observed for shorter compared with taller women.Conclusions: Maternal stature does not appear to be associated with gestational age but significantly influences birth weight. Height-related differences between mothers appears to begin after 33 weeks’ gestation.

Blood volume determination in obese and normal-weight gravidas: the hydroxyethyl starch method

The impact of obesity on maternal blood volume in pregnancy has not been reported. We compared the blood volumes of obese and normal-weight gravidas using a validated hydroxyethyl starch (HES) dilution technique for blood volume estimation. Blood volumes were estimated in 30 normal-weight (pregravid body mass index [BMI] <25 kg/m(2)) and 30 obese (pregravid BMI >35 kg/m(2)) gravidas >34 weeks' gestation using a modified HES dilution technique. Blood samples obtained before and 10 minutes after HES injection were analyzed for plasma glucose concentrations after acid hydrolysis of HES. Blood volume was calculated from the difference between glucose concentrations measured in hydrolyzed plasma. Obese gravidas had higher pregravid and visit BMI (mean [SD]): pregravid (41 [4] vs 22 [2] kg/m(2), P = .001); visit (42 [4] vs 27 [2] kg/m(2), P = .001), but lower weight gain (5 [7] vs 12 [4] kg, P = .001) than normal-weight women. Obese gravidas had similar estimated total blood volume to normal-weight women (8103 ± 2452 vs 6944 ± 2830 mL, P = .1), but lower blood volume per kilogram weight (73 ± 22 vs 95 ± 30 mL/kg, P = .007). Obese gravidas have similar circulating blood volume, but lower blood volume per kilogram body weight, than normal-weight gravidas near term.

The Comparative Effectiveness of Diabetes Prevention Strategies to Reduce Postpartum Weight Retention in Women With Gestational Diabetes Mellitus: The Gestational Diabetes' Effects on Moms (GEM) Cluster Randomized Controlled Trial.

To compare the effectiveness of diabetes prevention strategies addressing postpartum weight retention for women with gestational diabetes mellitus (GDM) delivered at the health system level: mailed recommendations (usual care) versus usual care plus a Diabetes Prevention Program (DPP)-derived lifestyle intervention. This study was a cluster randomized controlled trial of 44 medical facilities (including 2,280 women with GDM) randomized to intervention or usual care. The intervention included mailed gestational weight gain recommendations plus 13 telephone sessions between 6 weeks and 6 months postpartum. Primary outcomes included the following: proportion meeting the postpartum goals of 1) reaching pregravid weight if pregravid BMI <25.0 kg/m(2) or 2) losing 5% of pregravid weight if BMI ≥25.0 kg/m(2); and pregravid to postpartum weight change. On average, over the 12-month postpartum period, women in the intervention had significantly higher odds of meeting weight goals than women in usual care (odds ratio [OR] 1.28 [95% CI 1.10, 1.47]). The proportion meeting weight goals was significantly higher in the intervention than usual care at 6 weeks (25.5 vs. 22.4%; OR 1.17 [1.01, 1.36]) and 6 months (30.6 vs. 23.9%; OR 1.45 [1.14, 1.83]). Condition differences were reduced at 12 months (33.0 vs. 28.0%; OR 1.25 [0.96, 1.62]). At 6 months, women in the intervention retained significantly less weight than women in usual care (mean 0.39 kg [SD 5.5] vs. 0.95 kg [5.5]; mean condition difference -0.64 kg [95% CI -1.13, -0.14]) and had greater increases in vigorous-intensity physical activity (mean condition difference 15.4 min/week [4.9, 25.8]). A DPP-derived lifestyle intervention modestly reduced postpartum weight retention and increased vigorous-intensity physical activity.

Pregnancy Body Weight and Neonate Gut Microbiota

BackgroundBabies born to overweight/obese (OWOB) moms have elevated obesity risk. A study using culture‐based methods suggested this may be due to neonates' acquisition of obese bacteria from their moms.AimsWe used high‐throughput sequencing to examine if maternal pregravid BMI and pregnancy weight gain are associated with neonate gut microbiota.MethodsWe obtained the 1st (meconium) and 2nd stool from 62 elective C‐section (CS; n=26 OWOB) and 21 vaginally delivered (VD; n=5 OWOB) babies. We consented mothers at a hospital in Porto Alegre, Brazil. Bacterial V4 16S rRNA region was sequenced with the Illumina platform. We performed metagenomic analyses using QIIME and used the linear discriminant analysis (LDA) effect size method, which integrates statistical significance and biologic relevance, to compare microbiota of neonates from moms with pregravid OWOB vs normal BMI, and excess vs normal pregnancy weight gain, by delivery mode.ResultsIn the meconium of CS and VD babies, microbial composition did not vary by pregravid BMI or pregnancy weight gain. The 2nd stool of VD babies from OWOB moms, however, had greater abundance of 11 phylotypes, including the Bacteroides genus, and lower abundance of 23 phylotypes compared to the 2nd stool of VD babies from normal BMI moms. imageIn contrast, only 3 phylotypes differed in the 2nd stool of CS babies from OWOB vs normal BMI moms. Results were similar for pregnancy weight gain and neonate gut microbiota according to delivery mode.ConclusionsPregnancy weight is associated with microbiota from the 2nd (but not 1st) stool of VD (but not CS) neonates, indicating maternal‐offspring transfer of obese bacteria may occur at birth.

Fetal growth is associated with maternal fasting plasma glucose at first prenatal visit.

AimsFasting plasma glucose (FPG) concentration measured at the first prenatal visit is a predictor of gestational diabetes mellitus (GDM); however, whether this test is indicative of fetal growth has not been clarified. Thus, the purpose of this study was to determine whether birth weight and birth length were related to FPG levels at the first prenatal visit.Materials and MethodsResearch samples were collected from pregnant women who took an FPG test at their first prenatal visit (10–24 gestational weeks), received regular prenatal care, and delivered in our center. FPG value, maternal pre-gravid BMI, weight gain before FPG test, before and after Oral Glucose Tolerance Test (OGTT), neonatal birthweight, birth length, Ponderal Index and birthing method were recorded for analysis. Data were analyzed by independent sample t test, Pearson correlation, and Chi-square test, followed by partial correlation or logistic regression to confirm differences. Statistical significance level was α = 0.05.Results2284 pregnant women, including 462 GDM and 1822 with normal glucose tolerance (NGT) were recruited for the present study. FPG concentration at the first prenatal visit was associated with neonatal birth weight (partial correlation coefficient r′ = 0.089, P<0.001) and birth length (partial correlation coefficient r′ = 0.061, P = 0.005), but not with Ponderal Index or birthing method. Maternal pre-gravid BMI was associated with FPG value (partial correlation coefficient r′ = 0.113, P<0.001). FPG concentration at the first prenatal visit (OR = 2.945, P<0.001), weight gain before OGTT test (OR = 1.039, P = 0.010), and age (OR = 1.107, P<0.001) were independent related factors of GDM.ConclusionFasting plasma glucose concentration at the first prenatal visit is associated with fetal growth. Maternal pre-gravid BMI and weight gain are related to glucose metabolism.

Maternal hyperglycemia during pregnancy predicts adiposity of the offspring.

To investigate associations between maternal pregnancy hyperglycemia, gestational diabetes mellitus (GDM), and offspring adiposity. We evaluated these associations in a longitudinal study of 421 mother-daughter pairs at Kaiser Permanente Northern California. Maternal pregnancy glucose values were obtained from maternal medical records. Outcomes included three measures of girls' adiposity, measured annually: (1) ≥85th age-specific percentile for BMI; (2) percent body fat (%BF); and (3) waist-to-height ratio (WHR). Adjusting for maternal age at delivery, race/ethnicity, pregravid BMI, girl's age, and girl's age at onset of puberty, having a mother with GDM increased a girl's risk of having a BMI ≥85th percentile or having %BF or WHR in the highest quartile (Q4), compared with those in the lowest quintile of blood glucose (odds ratio [OR] 3.56 [95% CI 1.28-9.92]; OR 3.13 [95% CI 1.08-9.09]; and OR 2.80 [95% CI 1.00-7.84], respectively). There was a significant interaction between the presence of GDM and pregravid BMI; girls whose mothers had both risk factors had the highest odds of having a BMI ≥85th percentile (OR 5.56 [95%CI 1.70-18.2]; Q4 %BF, OR 6.04 [95% CI 1.76-20.7]; and Q4 WHR, OR 3.60 [95% CI 1.35-9.58]). Similar, although weaker, associations were found in the association between hyperglycemia and offspring adiposity. Girls who were exposed to maternal GDM or hyperglycemia in utero are at higher risk of childhood adiposity; risk increases if the mother is overweight or obese. Screening and intervention for this high-risk group is warranted to slow the intergenerational transmission of obesity and its sequelae.

Lipid Changes and Effect of Diet Therapy only in Gestational Diabetes Mellitus and Normal Pregnancy in Developing Area Southern China

Objective: To explore the changes in the feature of serum lipid in different trimester of normal pregnancy and GDM, analysis of the effect of diet therapy on blood lipid level on GDM and the relationship between serum and lipid. Methods: 92 normal pregnant women and 85 GDM women were inclusive in this study. The maternal serum lipid levels, diet intake and newborn weight of both groups were recorded. After diet therapy, GDM group was further divided into two subgroups, one with blood glucose under control and one with poor glycemic control according to the blood glucose monitoring. Results: LDL-C and apoB were significantly increased in GDM group compared to normal group in the first trimester(P < 0.05); GDM patients consume more energy having higher weight gain/ pregravid BMI compared to normal group till gestational diabetes was confirmed (P <0.05). Compared to early trimester, TC,TG, LDL-C, LDL-C,apoA1 and apoB were increased in the normal group in late trimester(P <0.05); Compared to the control group in late phase, there was higher apoB, but lower TG in glucose control group. There were higher TC, TG and neonatal weight in the poor glycemic group compared to the control group in late phase (P < 0.05); There was a positive correlation between TC, TG and newbornweight (P < 0.05). Conclusion: With increasing gestational age, there is increasing level of blood lipid profile during pregnancy. Excessive nutrient intake and incidence of GDM may be related. Diet therapy can improve blood lipid status which may help control neonatal weight.

Exposure analysis methods impact associations between maternal physical activity and cesarean delivery.

Previous studies report conflicting results regarding a possible association between maternal physical activity (PA) and cesarean delivery. Seven-day PA recalls were collected by telephone from pregnant women (n = 1205) from North Carolina, without prior cesarean, during 2 time windows: 17 to 22 weeks and 27 to 30 weeks completed gestation. PA was treated as a continuous, nonlinear variable in binomial regressions (log-link function); models controlled for primiparity, maternal contraindications to exercise, preeclampsia, pregravid BMI, and percent poverty. We examined both total PA and moderate-to-vigorous PA (MVPA) at each time. Outcomes data came from medical records. The dose-response curves between PA or MVPA and cesarean risk at 17 to 22 weeks followed an inverse J-shape, but at 27 to 30 weeks the curves reversed and were J-shaped. However, only (total) PA at 27 to 30 weeks was strongly associated with cesarean risk; this association was attenuated when women reporting large volumes of PA (> 97.5 percentile) were excluded. We did not find evidence of an association between physical activity and cesarean birth. We did, however, find evidence that associations between PA and risk of cesarean may be nonlinear and dependent on gestational age at time of exposure, limiting the accuracy of analyses that collapse maternal PA into categories.

Perinatal factors relating to changes in maternal body fat in late gestation

To examine changes in skinfolds in late gestation in healthy women. Skinfold measures were performed in 39 women at 30.8 (mean) and 37.7 weeks gestation. Fat mass (kg) and sum of three skinfolds were calculated. A decrease in skinfold thickness was observed in 21 women (-3.1±2.1 mm) in late gestation, whereas 18 women had an increase (4.3±3.2 mm), P<0.001. The group of women who lost body fat (decrease in skinfold thickness) had a trend toward greater pregravid body mass index (BMI, 25 vs 22 kg/m(2), P=0.06), and gained less weight in late gestation (3.0 vs 4.3 kg, P=0.042). On multiple regression, maternal age and gestational weight gain were positively correlated with fat mass accrual, whereas pregravid BMI and dietary fiber were negative determinants of late gestational fat mass. Increases in maternal fat mass in late gestation were related to maternal age and gestational weight gain, whereas decreases were related to increased pregravid BMI and dietary fiber.

Maternal pre‐gravid body mass index and adiposity influence umbilical cord gene expression at term in AGA infants

While maternal obesity is associated with unfavorable maternal and fetal outcomes, the influence of maternal obesity on fetal gene expression is less clear. Umbilical cords (UC) from 12 lean (pre‐gravid BMI &lt; 25) and 10 overweight/obese (OB, pre‐gravid BMI ≥25) women without gestational diabetes were collected at term and utilized for gene expression analysis using Human Primeview microarrays (Affymetrix). Although offspring birth weight and infant adiposity (at 2‐wk) did not differ between groups, expression of 232 transcripts was affected in UC from OB compared to lean mothers. GSEA analysis revealed an up‐regulation of genes related to metabolism, stimulus and defense response and inhibitory to insulin signaling in the OB group. We confirmed that Egr‐1, periostin, FosB, and NEDD9 mRNA expression was induced in UCs from OB moms, while endothelin receptor B, Klf10, Peg3 and Egln3 expression was decreased. mRNA expression of Egr‐1, FosB, MEST and SOCS1 was positively associated (p&lt;0.05) with mother's 1st trimester body fat mass (%). Metabolic and hormonal assessments were also assayed in mother's serum at 30 weeks of gestation and in UC plasma. Our data indicate that maternal obesity per se causes changes in UC gene expression favoring inflammation and insulin resistance, possibly predisposing infants of overweight moms to become overweight later on in life. Funding USDA ARS‐CRIS 6251–51000‐007–04S.

Peripheral adiposity in relation to offspring birth size in women with and without gestational diabetes: Preliminary data

To document the relationship between maternal body composition parameters and offspring anthropometric measurements. A prospective sample of 48 pregnant women with either gestational diabetes (GDM, n=21) or normal glucose tolerance (NGT, n=27) was studied. Maternal weight, hip circumference and skinfold thicknesses were obtained at 32 weeks of gestation. Offspring length and weight, as well as cranial and thoracic perimeters were obtained at birth. Reported maternal pregravid BMI correlated with offspring thoracic perimeter (ρ=0.52, P<0.05) and tended to correlate with birth weight (ρ=0.41, P=0.07). There were significant correlations between hip circumference and pregravid BMI, and with biceps, triceps, subscapular, thigh and total sum of skinfold thicknesses (ρ=0.53-0.75, all P<0.01). Hip circumference also correlated with offspring length (ρ=0.61), weight (ρ=0.75) and thoracic perimeter (ρ=0.60, all P<0.05). Maternal hip circumference was an independent and significant predictor of offspring weight, explaining 14.1% of the observed variance (P<0.05). In a sample of women with and without GDM, maternal hip circumference was strongly related to other body composition estimates and was also predictive of offspring size measurements at birth.

A multifactorial relationship exists between total circulating cell‐free DNA levels and maternal BMI

A multifactorial relationship exists between total circulating cell‐free DNA levels and maternal BMI

Impact of maternal prenatal metabolic abnormalities on metabolic hormones in human milk

Metabolic hormones are present in human milk, but no studies have investigated the impact of maternal metabolic status during pregnancy on milk insulin and adiponectin concentrations. We aimed to investigate the association of prenatal metabolic status with milk insulin and adiponectin. Participants (n=170) underwent a 3‐h oral glucose tolerance test at 30 (95% CI 25, 33) weeks gestation and donated milk in the first week (early milk) and at 3 months postpartum (mature milk). Prenatal metabolic abnormalities including higher pregravid BMI (beta±SE 0.053±0.014, p=0.0003), in addition to gravid hyperglycemia (0.218±0.087, p=0.01), insulin resistance (0.255±0.047, p&lt;0.0001), lower insulin sensitivity (−0.521±0.108, p&lt;0.0001), and higher serum adiponectin (0.116±0.029, p&lt;0.0001) were associated with higher insulin in mature milk with multiple adjustment. Prenatal metabolic measures were not associated with milk adiponectin, but obstetrical measures including nulliparity (0.171±0.058, p=0.004), longer duration of gestation (0.546±0.146, p=0.0002), and unscheduled C‐section (0.387±0.162, p=0.02) were associated with higher adiponectin in early milk with multiple adjustment. In conclusion, maternal prenatal metabolic abnormalities were associated with high insulin concentrations in mature milk, while only obstetrical parameters were associated adiponectin concentrations in early milk.Grant Funding Source: CDA, CFDR, CIHR