Pregestational Weight Research Articles

Nutrición en el embarazo y lactancia

El peso materno pregestacional, el índice de masa corporal y la ganancia de peso durante la gestación son factores que influyen en el peso del recién nacido y su peso y salud a largo plazo. Por ello el simposio sobre Nutrición en la gestante y lactante que se desarrolla en las páginas siguientes, cuyos artículos puedan orientar al profesional de la salud a educar sobre nutrición a la gestante y su entorno.

Estado nutricional y ganancia de peso en gestantes peruanas, 2009-2010

Pregestational maternal nutritional status and weight gain during pregnancy affect maternal and perinatal conditions and increases the risk of low birth weig...

A gene variant in the transcription factor 7-like 2 (TCF7L2) is associated with an increased risk of gestational diabetes mellitus

ObjectiveAdipokines play an important role in the pathogenesis of insulin resistance during pregnancy. We studied the association of genetic variants linked with type 2 diabetes in gestational diabetes mellitus (GDM) subjects and its influence on maternal adipokines. Study designWe recruited 25 healthy pregnant women (Controls) and 45 women with GDM at 24–28 weeks of gestation. Maternal blood samples were collected at recruitment and delivery. Adipokines were determined at both sampling times. Genomic DNA was extracted from recruitment samples and FTO rs9939609, TCF7L2 rs4506565, rs7901695, rs12243326, rs12255372 and rs7903146, INSIG2 rs7566605, SREBF1 rs114001633, rs45535737 and rs12941356 and FATP4 rs2003560 genotyped. ResultsSerum adiponectin was significantly lower in GDM than Controls at recruitment and showed a similar trend at delivery (p=0.060). In contrast, resistin tended to higher levels in GDM only at recruitment. TCF7L2 rs4506565 (OR=2.31, 95% CI: 1.97–5.01; p=0.031) and FTO rs9939609 (OR=2.17, 95% CI: 1.07–4.41; p=0.039) were associated with GDM risk. Women carrying the T allele of TCF7L2 rs4506565 had increases in plasma resistin of 9.38μg/L (95% CI 1.39–17.37; p=0.022) per allele; this association remained significant after adjusting for pre-gestational body weight. ConclusionTCF7L2 rs4506565 variant (T/T) is associated with increased risk of GDM and plasma resistin concentrations in women with GDM.

Factors associated with prospective leptin concentrations throughout pregnancy in pregestational normal weight, overweight and obese women.

Leptin concentrations increase throughout pregnancy but little is known about factors that influence this physiological change and whether they differ according to pregestational body mass index (BMI). To assess whether longitudinal trends of leptin in pregnancy are influenced by biochemical, anthropometric and lifestyle factors in women with normal weight (NW), overweight (OW) or obese (OB) pregestational BMI. Prospective cohort of 232 pregnant women followed at 5-13th, 20-26th and 30-36th gestational weeks. The effect of selected variables on longitudinal behaviour of plasma leptin concentrations, stratifying for NW (18·5-24·9 kg/m(2) ), OW (25-29·9 kg/m(2) ) and OB (≥30·0 kg/m(2) ) pregestational BMI was assessed through longitudinal linear mixed-effects models. The multiple regression model for women with NW revealed associations of maternal body weight (β = 0·714, CI = 0·491 to 0·937), serum HDL-cholesterol (β = 0·239, CI =0·089 to 0·388) and C-reactive protein (CRP) (β = -0·138, CI = -0·272 to -0·004) with plasma leptin concentrations. Maternal body weight (β = -0·871, CI = 0·475 to 1·267) and serum HDL-cholesterol concentrations (β = 0·315, CI = -0·022 to 0·651) were also associated with leptin in OW women. In OB women, serum HDL-cholesterol (β = 0·722, CI = 0·219 to 1·226), maternal body weight (β = 0·666, CI = 0·187 to 1·145), triglycerides concentrations (β = -0·130, CI = -0·241 to -0·020) and dietary carbohydrate (β = 0·075, CI = 0·023 to 0·126) were significantly associated with plasma leptin. Maternal body weight and serum concentrations of HDL-cholesterol were associated with leptin changes independent of pregestational BMI. Serum CRP concentrations were associated with leptin only in NW women and serum triglycerides concentrations and dietary carbohydrate only in OB. These results indicate that factors that influence leptin concentrations differ according to pregestational BMI.

ASSOCIAÇÃO DA INTERRUPÇÃO DO ALEITAMENTO MATERNO EXCLUSIVO COM A RETENÇÃO DE PESO E A PERDA DE PESO NO PÓS-PARTO

Approximately 43.1% of Brazilian women in their fertile age present weight excess. However, theinterruption of exclusive breastfeeding (IAME), due to the significant nutritional demands imposed uponmothers, has the potential influence on post-partum weight loss and weight retention in women. To investigatethe association between the interruption of exclusive breastfeeding and weight retention and weight loss inthe second month post-partum. Sectional study inserted in a prospective cohort, with the source populationof women (n=298) that attended one of four Primary Health Care Units of the Municipality of Rio de Janeiro.To evaluate the breastfeeding practices, a 24-hour dietary recall of the newborns’ feeding was applied, thesame instrument used in the national vaccination campaigns. Newborns were considered IAME when theydid not receive only breast milk in the 24 hours that preceded the three interviews during the babies firsttwo months. The data analysis was based on multinomial logistic regression models which were adjustedaccording to the covariates that presented associations with p-value ≤0.20 in raw analysis. Regarding theanalysis of the interruption of breastfeeding and weight retention at post-partum, it was observed that tonot offer breast milk during the first two months after childbirth did not demonstrate association to weightretention. And the results of the final multinomial logistic regression model showed that the mothers thatinterrupted exclusive breastfeeding (AME) during the first two months post-partum have two and a halfmore chances of not losing weight when compared to women that within some moment of that period offeredAME to their children, independent of the gestational weight gain and pre-gestational weight (p<0.05).Considering the presented discoveries, we point out the evidences to support the implementation of healthpolicies to avoid the retention of post-partum weight and obesity. DOI 10.12957/demetra.2014.10828

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Curvas de crecimiento personalizadas para optimizar el diagnóstico de restricción de crecimiento Intrauterino

Introducción: Los fetos con restricción de crecimiento intrauterino (RCIU) tienen riesgo alto de morbimortalidad perinatal y existe mucha dificultad para diferenciarlos de los pequeños para la edad gestacional (PEG), debido a que incluso la ecografía Doppler tiene limitaciones al respecto. Se ha planteado que las curvas de crecimiento personalizadas podrían esclarecer esta disyuntiva. Objetivos: Diseñar un software con curvas de crecimiento personalizadas para optimizar el diagnóstico de RCIU en EsSalud. Diseño: Estudio comparativo, observacional y descriptivo. Institución: Hospital Edgardo Rebagliati Martins (HNERM), EsSalud, Lima, Perú. Participantes: Gestantes y sus fetos y recién nacidos. Metodología: Se construyó una curva de crecimiento con mediciones ultrasónicas de fetos de gestantes del HNERM cuyo peso se conoció al nacimiento y, en base a esta, se diseñó un software con curvas personalizadas. Se usó t de student, ANOVA y pruebas no paramétricas para el estudio estadístico y se consideró p&lt;0,05 para la significancia. Principales medidas de resultados: Curva de crecimiento fetal personalizada. Resultados: Se seleccionó 29 239 recién nacidos, atendidos entre 2003 y 2010. El peso neonatal estuvo influido por la talla materna, el peso pregestacional, la edad materna (ANOVA: F=3,8; F= 214,7 y F=11,2, respectivamente; p&lt;0,05), el sexo fetal masculino y la multiparidad (t de student; p&lt;0,001). Se diseñó un software, basado en estos parámetros, para la predicción del peso fetal para cada semana gestacional. Conclusiones: Se diseñó un software con curvas de crecimiento intrauterino personalizadas para optimizar el diagnóstico de fetos con RCIU, en EsSalud.

Ganho de peso excessivo na gestação é fator de risco para o excesso de peso em mulheres

To evaluate weight retention 12 months postpartum and factors associated among women who had received prenatal care at Health Care Centers in Porto Alegre, southern Brazil. Pregnant women in the last trimester were identified at 20 Health Care Centers. Socioeconomic, demographic and anthropometrics data were obtained. Six and 12 months after delivery, the women received home visits for anthropometric measures. The gestational weight gain was defined by pre-pregnancy Body Mass Index (BMI). Weight retention was defined as the difference between pre-gestational weight and weight at postpartum. Data were analyzed using McNemar's Test, ANOVA with Bonferroni correction and multiple linear regression. Of the 715 pregnant women recruited, 545 were assessed 12 months after delivery. Women were more likely to be overweight 12 months postpartum compared to the pre-pregnancy period (52.9 versus 36.7%) and weight retention during the 12 months postpartum was more than 10 kg in 30.7% of the women. Weight retention in the postpartum period was higher among women who were overweight (9.9 ± 7.7 kg) compared to those who were of normal weight during the pre-pregnancy period (7.6 ± 6.2 kg). Pre-pregnancy BMI, gestational weight gain, and maternal age were associated with gestational weight retention 12 months postpartum (p<0.001). Adequate prenatal care is necessary to minimize the adverse effects of excessive weight gain during pregnancy on women's health.

Conformity of pre-gestational weight measurement and agreement of anthropometric data reported by pregnant women and those recorded in prenatal cards, City of Rio de Janeiro, 2007-2008.

To assess the conformity of the weight measurement process in the pre-gestational care offered in the city of Rio de Janeiro by primary units and hospitals of the National Health System, as well as to verify the agreement between the anthropometric data reported by pregnant women and those recorded in prenatal cards. A cross-sectional study was conducted in 2007 - 2008 with two cluster samples: one to obtain a sample of pregnant women to be interviewed and another one for the weight measurement procedures to be observed. The conformity of the weight measurement process was evaluated according to the Ministry of Health standards, and the agreement between the two sources of anthropometric data was evaluated using mean differences, Bland-Altman method, intraclass correlation coefficient (ICC) and weighted Kappa. Out of the twelve criteria for weight measurement evaluation (n = 159 observations), three weren't in conformity (< 50% of conformity), two of them only need to be assessed when the scale is mechanical. For the interviewed pregnant women (n = 2,148), who had the two sources of anthropometric data, there was a tendency of self-reported height overestimation and pre-gestational and current weight and Body Mass Index underestimation. Accordance between the two sources of anthropometric information, according to ICC and weighted Kappa, were high (> 0.80). Studies may use weight and height information reported by pregnant women, in the absence of prenatal cards records, when it is an important economy to their execution, although the improvement of these two sources of information by means of better anthropometric process is necessary.

Effects of Breastfeeding on Weight Loss and Recovery of Pregestational Weight in Adolescent and Adult Mothers

Exclusive breastfeeding (EBF) in adolescent mothers has been associated with greater postpartum maternal weight loss. To assess the associations between EBF and weight loss in adolescent and adult mothers and between EBF and weight and length gain of their children. A cohort of 68 adolescent mothers (15 to 19 years), 64 adult mothers (20 to 29 years), and their infants were studied. Anthropometric measurements were performed at 15, 90, 180, and 365 days postpartum in the mothers and children. EBF was defined as consumption of human milk without supplementation of any type (water, juice, nonhuman milk, or food) for 4 months. Sixty-five percent of mothers sustained EBF for 4 months. There were no significant differences in the weight or length of the infants of adolescent and adult mothers at 365 days postpartum. Among infants of adult mothers, there was a significant difference between the weight gain of those were exclusively breastfed and those who were not exclusively breastfed (6,498 +/- 1,060 vs 6,096 +/- 1,035 g, p < .050) at 365 days postpartum, according to the parameters for weight gain and length established by the World Health Organization (WHO). Among both adult and adolescent mothers, those who practiced EBF lost more weight than those who did not practice EBF (-2.9 kg, 95% interquartile range, -5.7 to 0.8 kg, vs -1.8 kg 95% interquartile range -2.8 to 2.2 kg; p = .004). Gestational weight gain, duration of EBF, and recovery menstruation explained 21% of the variance (F = 28.184, p = .001) in change in postpartum maternal weight (in kilograms) from 0 to 365 days postpartum in all mothers. Pregestational weight, duration of EBF, and maternal age were factors that explained 14% (F = 22.759, p = .001) of the change in the weight and length of the infants from 0 to 365 days of life. EBF in adolescent and adult mothers influences postpartum weight loss and provides adequate infant growth in accordance with the WHO 2006 standards.

Obesidad pregestacional como factor de riesgo asociado a preeclampsia

Objetivo: Evaluar la obesidad como factor de riesgo de preeclampsia. Diseño: Estudio caso control realizado en el Hospital Dos de Mayo, Lima, Perú. Material y métodos: Después de excluir 35 pacientes, se comparó 107 mujeres preeclámpticas con 107 gestantes normotensas, pareadas para edad gestacional (±1 semana). Se correlacionó peso pregestacional con la presencia de preeclampsia usando chi-cuadrado; se empleó t de student para comparar promedios y se controló variables confusoras usando la regresión logística. Resultados: La preeclampsia estuvo asociada con una edad de 35 años o más (OR 3,0; IC 95% 1,2 a 7,9), historia de preeclampsia en el embarazo previo (OR 5,4; IC 95% 1,6 a 17,9) y obesidad (OR 6,5; 6,2 a 2,8), considerada como el tercil más alto de los parámetros índice de masa corporal (IMC), pliegue tricipital y circunferencia braquial media en el grupo control. Existió significativa tendencia linear de riesgo de preeclampsia con estos parámetros (p&amp;lt; 0,001). Conclusiones: Las mujeres obesas deben ser cuidadosamente controladas, para reducir la incidencia de preeclampsia y sus complicaciones.

OP33.01: Which affect more birth weight—maternal pregestational BMI or weight gain? Prospective observational study

OP33.01: Which affect more birth weight—maternal pregestational BMI or weight gain? Prospective observational study

No changes in weight and body fat in lactating adolescent and adult women from Mexico

To evaluate changes in weight and body fat of Mexican adolescent compared to those of adult lactating women from the Northwest (NM) and Central (CM) regions of Mexico in the first trimester postpartum. A prospective design was used to evaluate 41 exclusively breastfeeding women (21 adolescents and 20 adults) recruited 1-2 days after delivering a healthy singleton at the Hospital Infantil del Estado de Sonora (Northwest Mexico) and Instituto Nacional de Perinatología, in Mexico City. Socioeconomic status, height, body weight and composition, dietary intake, physical activity, and milk volume (quantified by deuterium dilution method) were measured at the 1st and 3rd month postpartum. Women did not lose weight throughout the first trimester postpartum. Mean postpartum weight retention at the end of the study was 3.8 kg. No differences in weight and body mass index (BMI) were found between adolescent and adult women in both periods. Energy and macronutrient intakes, physical activity and milk volume were similar between the two groups of women. In both periods, adolescents from the CM region had lower weight, BMI, and body fat than adolescents from the NM region (P<0.05). At the 3rd month, pregestational weight (P < 0.0001) was a predictor of BMI, and region (P < 0.05) and milk volume (P < 0.01) were associated with percentage of body fat. Exclusively breastfeeding for 3 months did not reduce weight or body fat in the Mexican population of this study. Efforts to avoid weight retention in the lactation period may contribute to prevent overweight and obesity in women.

Risk Factors for Gestational Diabetes Mellitus in a Large Population of Women Living in Spain: Implications for Preventative Strategies

The aim of this study is to establish a risk appraisal model for GDM by identifying modifiable factors that can help predict the risk of GDM in a large population of 2194 women living in Spain. They were recruited between 2009-2010 when screening for GDM was performed. Participants completed a questionnaire on socio-demographic, anthropomorphic and behavioral characteristics, and reproductive and medical history. A total of 213 (9.7%) women were diagnosed as having GDM. Age, pregestational body weight (BW) and body mass index (BMI), and number of events of medical, obstetric and family history were significantly associated with GDM. After logistic regression model, biscuits and pastries intake <4 times/week, red and processed meats intake <6 servings/week, sugared drinks <4 servings/week, light walking >30 minutes/day, and 30 minutes/day of sports at least 2 days/week, compared with opposite consumption, was associated with less GDM risk. Our study identified several pregestational modifiable lifestyle risk factors associated with an increase in the risk of developing GDM. This may represent a promising approach for the prevention of GDM and subsequent complications. Further intervention studies are needed to evaluate if this appraisal model of risk calculation can be useful for prevention and treatment of GDM.

Changes in Plasma’s Oxidative Stress and Antioxidant Activity, Measured with Melatonin Levels, and its Relationship to Newborns from Obese and Diabetic Pregnancies

Researchers have reported that an overproduction of reactive oxygen species, together with lacking of antioxidant defense, promote oxidative damage involved in the etiology of various degenerative diseases. Women with normal pregnancies experience a physiological increase of oxidative stress without major cytotoxicity due to an effective antioxidant response. This delicate balance maybe disturbed with the presence of pro inflammatory diseases together with unhealthy lifestyles; such as excessive pregestational weight and high fatty and sugar diets (gluco- and lipotoxicity). We believe that disruption of prooxidant-antioxidant homeostasis may have a role on pregnancy adverse outcomes and unfavorable consequences for offspring in the short and long term. Especially for newborns from diabetic and obese mothers who may be exposed to metabolic programming changes with higher risk of developing degenerative diseases in their adult life. This minireview focuses on investigations that have found a relationship between increased oxidative damage during pregnancy and adverse fetal outcomes classified in normal, presence of hyperglycemia, and obese pregnancies; as well as recommendations for approaching these conditions including the novel potential findings of melatonin.

Estado Nutricional Pré-Gestacional e Gestacional: uma Análise de Gestantes Internas em um Hospital Público

Objective: To evaluate the pre-gestational and current nutritional status of pregnant women and its intercurrences that influence on the maternal health. Material and Methods: This cross-sectional study had a convenience sample composed by 36 pregnant women. The data collection instrument was a questionnaire containing open questions and dichotomous and multiple-choice closed questions. Information referring to age, nutritional status, pre-gestational and gestational weight, existing pathologies and obstetric outcome was collected. Data were analyzed using the SPSS software and presented by descriptive statistics. Results: The age of the pregnant women ranged from 14 to 39 years and it was observed that 11.1% of the women presented malnutrition in the pre-gestational period and this percentage increased to 27.7% during pregnancy. Overweight increased from 22.2% in the pre-gestational period to 33.3% during pregnancy. The mean pre-gestational weight was 58.8 kg (±6.77 kg) while the mean gestational weight was 68.0 kg (±12.2 kg). The mean weight gain in the patients who had vaginal delivery was 9.2 kg, while in those who had cesarean section delivery the mean weight gain was 12.2 kg. Conclusion: It was observed an increase in malnutrition and overweight during pregnancy, demonstrating the importance of having a healthy diet and a maintaining an adequate weight gain during pregnancy in order to preserve mother-child health. DESCRIPTORS: Pregnant Women. Nutritional Status. Weight Gain. Obesity.

Anthropometric nutritional evaluation of the pregnant women and its relation with the product of the gestation

The objective of the present study was to evaluate the association between the anthropometric nutritional state of the pregnant women during his third trimester of pregnancy with the anthropometric state nutritional of the product of the gestation, who carried out their prenatal control in the University Hospital of Caracas and the Hospital of Caracas Clinics. The evaluated variables were: pregestational weight, gestational weight, chart, average circumference of the arm and fold of triceps; the anthropometric indicators were constructed: index of corporal mass (IMC) pregestational and gestational and of corporal composition such as greasy and muscular area of the arm. In new born, one evaluated the weight and the stature and so the ponderal index was constructed (IP), as well as the clinical evaluation of the nutritional state of the newborn one (ECEN). Statistical Package SPSS 13,0 for Windows, calculating statistical descriptive basic and coefficient of correlation of Pearson was used (p 0.05). The results indicate that when considering the associations between the maternal variables and anthropometric indicators with the neonatal ones is to a great extent positive correlation, of this form, cases as the average circumference of arm (CMB) maternal were statistically significant with the ponderal index and puntaje ECEN, indicating that the maternal CMB is constituted like an indicative variable of the nutritional state of the newborn one. The early incorporation in the routine monitoring of the prenatal control, the anthropometric valuation with effective simple variables of low cost is recommended and, being able to detect nutritional alterations in which it is found opportunely to prevent adverse results in the newborn one.

Exactitud diagnóstica de cinco referencias gestacionales para predecir el peso insuficiente al nacer

The maternal anthropometry is a potentially valuable tool in the evaluation of pregnancy status and prediction of birth weight.Diagnostic accuracy of birth weight was compared for five gestational anthropometric references.Longitudinal study was designed for 245 pregnant Colombian participants. Variables consisted of birth weight, gestational age, maternal height and weight. The references were as follows: gestational weight gain of Fescina (Uruguayan samples), % weight/height and body mass index of Rosso-Mardones (Chilean sample), pregestational weight of the Institute of Medicine (United States sample), and the body mass index of Atalah and colleagues (Chilean sample). The insufficient birth weight (<3,000 g) was defined as the critical threshold value. The following indices, with correspondent confidence intervals (CI 95%) were obtained: diagnostic accuracy, sensitivity, specificity, positive and negative predictive values, and agreement (Kappa index).The ability to predict the weight <3,000 g was higher in the first trimester measurement with the Chilean references, and in the second trimester with the USA and the Uruguayan references. The best concordance was presented between the Chilean references and the least with the Uruguayan. After the second trimester, the Chilean reference of Atalah and colleagues provided the best diagnostic accuracy, specificity and positive predictive value.The gestational anthropometric references that provided the most heterogeneous results were the US Institute of Medicine and the Fescina. Overall, the Atalah reference was the most accurate diagnostic predictor of insufficient weight at birth.

Pregestational body mass index, weight gain during pregnancy and maternal hyperglycemia

Objective. To evaluate the associations between pregestational BMI and weight gain during pregnancy and the risk for maternal hyperglycemia.Methods. The charts of all patients who delivered at our hospital between June 2001 and June 2006 were reviewed. Maternal hyperglycemia categories were defined as GDM (by the Carpenter and Coustan criteria); Impaired glucose tolerance (IGT – only one abnormal value in the 100 g OGTT); Abnormal GCT (≥140 mg/dL) but no high values on the OGTT. Women with GCT < 140 were defined as normal glucose tolerance (NGT).Results. Pregravid BMI and glucose tolerance data were available for 9269 women. We also had data on weight gain during pregnancy for 7766 of these women. There was strong graded association between increasing BMI category and all levels of maternal hyperglycemia. There was significant negative correlation between BMI and weight gain during pregnancy (R = −0.251, P value < 0.0001). However, in the multivariate logistic regression model, only pregestational BMI was significantly associated with maternal hyperglycemia, whereas weight gain during pregnancy was no longer significant.Conclusions. Obesity is a strong predictor for gestational maternal hyperglycemia. Weight gain during pregnancy has less effect. Every effort should be made for pregestational weight reduction in overweight women.

Gestational nutrition improves outcomes of vaginal deliveries in Jordan: an epidemiologic screening

Adequate and balanced nutrition during gestation is essential for achieving healthy pregnancy outcomes. This retrospective survey tested the hypothesis that maternal nutrition (macronutrients intake, micronutrients intake, and weight gain) during gestation will impact gestational outcomes (gestational age, birth weight, and labor spontaneity). The objectives of this study were to test the impact of macronutrients and micronutrients consumed during gestation, pregestational weight and weight gain during gestation on gestational age, birth weight, and labor spontaneity among Jordanian women. Study participants (n = 700) were recruited from a women's hospital in northern Jordan. Data were collected using structured interviews. Dietary determinants examined in the study included daily intake of macronutrients (energy, carbohydrate, protein, fat, and n-3 and n-6 fatty acids) and micronutrients (zinc, calcium, folate, vitamin C, vitamin A, and vitamin B6), pregestational body mass index, total weight gain, and weight gain pattern during pregnancy. Dietary data were obtained from a semiquantitative food frequency questionnaire. Mean (SEM) daily intakes of energy, carbohydrate, and protein were 10894 (138) Kj, 320 (3.8) g, and 90 (0.95) g, respectively; with fat contributing 36% of total energy. Average daily energy and carbohydrate intake during pregnancy were related negatively to gestational age (P < .05). Pregestational body mass index was associated positively with gestational age and birth weight (P < .05). Intakes of vitamin A and calcium had significant relationships with birth weight. Daily intakes of zinc, calcium, vitamin B6, and n-3 and n-6 fatty acids were associated with labor spontaneity. Dietary factors consumed during pregnancy are associated with pregnancy outcomes.