Pregnancy Weight Gain Research Articles

Effect of tenofovir alafenamide in combination with and without integrase inhibitors on weight gain, diabetes, and hypertensive disorders of pregnancy

ObjectivesWe sought to determine if tenofovir alafenamide (TAF) was associated with excessive weight gain, diabetes (DM), and hypertensive disorders of pregnancy (HDP) in persons with HIV. Study designThis is a retrospective cohort study of pregnant persons with HIV prescribed antiretroviral therapy (ART) during the period of 01/01/2009 to 12/31/2020. Main outcomes measuresχ2 tests were used to compare the proportion of persons with excessive weight gain, DM, and HDP according to ART regimens. Excess total gestational weight gain was calculated using BMI and Institute of Medicine recommendations for weight gain in pregnancy. HDP included gestational hypertension and preeclampsia. Logistic regression models were used to determine predictors of excessive weight gain, DM, and HDP. ResultsWe identified 189 pregnant persons prescribed ART with (30) and without TAF (159). The percentage of persons with excessive gestational weight gain was not significantly different in persons prescribed TAF (32 %) and other ART (17 %), p = 0.2. Persons prescribed TAF were more likely to have HDP (30 %) compared to other ART (9 %), p = 0.001. In the adjusted analysis, DM [aOR 6.2 (95 % CI 1.2–32.7)] and TAF exposure [aOR 3.2 (95 % CI 1.0–8.9)] were significantly associated with HDP. ConclusionDespite similar gestational weight gain, persons with HIV prescribed TAF were more likely to have HDP. Further understanding of the metabolic and cardiovascular impact of ART recommended for use during pregnancy is needed.

Effect of weight gain on the development of gestational diabetes

Gestational diabetes mellitus (GDM) refers to diabetes diagnosed in the second or third trimester of pregnancy. Assessing the weight gain in each pregnant women's appointment is a common task of primary care during their visit. However, the implications of this increase in weight for the development of GDM are unknown. Evaluate if the greater than expected weight gain (HEWG) in pregnancy is a risk factor for the development of GDM. Analytical, observational, longitudinal, retrolective study, which included pregnant women between 15 and 40 years of age with complete follow-up of the preg-nancy with > 2 prenatal check-ups, somatometry and complete medical history was made. During follow-up, the GPME was determined. Odds ratio (OR) and 95% confi-dence intervals (95% CI) were calculated. Variables with significance were entered into a multiple logistic regression model (MLR), where the dependent variable was DMG. The sample size calculation was for convenience. 1000 pregnant women with a median age of 28 years were included. In the MLR The pre-gestational body mass index (BMI) with overweight had an RM of 1.3 (95% CI 0.86-1.98), BMI with obesity an OR of 2.57 (95% CI 1.6-4.14), the HEWG during pregnancy had an OR 1.14 95% CI (0.71-1.81), Age> 30 years shows an RM of 2.24 (95% CI 1.55-3.25). HEWG during pregnancy is not an independent risk factor for the devel-opment of GDM. The main ones are age> 30 years and pre-gestational obesity.

"Scaling out" evidence-informed antenatal care to support healthy pregnancy weight gain: a context assessment using the Consolidated Framework for Implementation Research.

Excess gestational weight gain is a challenge within antenatal care. Low-intensity interventions that offer opportunities for individualization, such as pregnancy weight-gain charts (PWGCs) combined with brief advice, have been a promising strategy but scaling out such interventions requires planning. The aim of this study was to examine current practices and conduct a context assessment using the Consolidated Framework for Implementation Research (CFIR) to guide implementation of PWGCs and brief intervention advice to support healthy pregnancy weight gain in two hospitals that provide antenatal care. Retrospective chart audits and surveys of staff and women were used to understand current practice as well as barriers and enablers to implementing change according to the domains and constructs reported in the CFIR. Forty-eight percent (site A) and 46% (site B) of pregnant women who were audited ( n = 180, site A; n = 176, site B) gained weight above recommendations. Most women were unable to accurately report their recommended weight gain for pregnancy (93% site A, 94% site B). Although more than 50% of women reported discussions about weight gain during pregnancy, advice about physical activity and healthy eating (in the context of helping women to achieve healthy gestational weight gain) was low. Mapping barriers and enablers to the CFIR helped guide the selection of implementation strategies, including audit and feedback, informing local opinion leaders, obtaining consensus, identifying champions, and building a coalition. Scaling out of interventions can be enhanced by undertaking a detailed context assessment guided by implementation frameworks.

Weight gain rate in the first and second trimesters and risk of gestational diabetes:a prospective cohort study

To investigate the relationship between the rate of weight gain in the first and second trimesters and gestational diabetes mellitus(GDM). A total of 1189 maternal cases were included at baseline from May to September 2019 when they first came to the Maternal and Child Health Hospital in Ma'anshan for delivery and establishment of maternal health handbook(≤14 weeks+6). A total of 968 maternal cases were included in the final analysis, including 289 cases of GDM. Information on maternal socio-demographic characteristics, past history and lifestyle was collected through questionnaires. Oral glucose tolerance test was performed to screen for GDM at 24-28 weeks of pregnancy. Multi-factor logistic regression was used to analyze the relationship between the rate of weight gain in the first and second trimesters and GDM. After adjusting for pre-pregnancy BMI, age, occupation, number of births, number of pregnancies, type of residence, family history of diabetes, season of conception and mode of conception, an increased risk of GDM was found for rapid weight gain in early pregnancy compared with appropriate rate of gain(rapid group: aOR=1.92, 95%CI 1.20-3.07). No risk of GDM was found for rapid or slow weight gain in mid-pregnancy(rapid group : aOR=0.89, 95%CI 0.47-1.70)(slow group: aOR=1.57, 95%CI 0.85-2.90). Further stratified by pre-pregnancy BMI, pre-pregnancy BMI <24-overly rapid growth rate in early pregnancy was a risk factor for GDM(rapid group; aOR=1.98, 95%CI 1.16-3.38) and no significant association was observed in pregnant women with pre-pregnancy BMI ≥24(slow group: aOR=0.79, 95%CI 0.29-2.12; rapid group: aOR=1.61, 95%CI 0.60-4.30). A multiplicative model showing no interaction between pre-pregnancy BMI and early pregnancy weight gain rate for GDM. Excessive growth rate in the first pregnancy can affect the risk of GDM.

Effects of sheep breed and grass silage quality on voluntary feed intake and enteric methane emissions in adult dry ewes

Forty adult dry ewes in early pregnancy participated in a 2 × 2 factorial design study to investigate the effects of two grass silage qualities (Early vs. Average; 7.12 vs 5.74 MJ of net energy lactation per kg dry matter (DM)) and two breeds (Norwegian White Sheep, NWS; Old Norwegian Spæl, ONS) on voluntary feed intake and enteric methane (CH4) emissions. Ewes of the two breeds were equally mixed in two groups and assigned to Early and Average silage quality for first part of the experiment and switched for the second part of the experiment. Each period of the experiment lasted for three weeks; one week of adaptation and two weeks of measurements. The ewes were housed in individual pens and fed silage ad libitum. Feed intake was continuously logged using the BioControl System. Enteric CH4 was measured for 10 weekdays in Portable Accumulation Chambers in each period. Average body weight (BW) for NWS and ONS were 91 and 60 kg, respectively. ONS had significantly (p < 0.0001) lower daily DM intake (DMI), DMI/kg BW, daily NDF intake, NDF/kg BW, g CH4/day and g CH4/kg BW, compared to the NWS. The Early grass silage (p < 0.0001) resulted in higher daily DMI (kg DMI/day, kg DMI/kg BW), and higher enteric CH4 emissions/kg BW when offered to the ewes, compared to the Average grass silage. Significant interactions (p < 0.05) between breed and grass silage quality were observed for both measures of feed intake and CH4 emission. The results show that breed differences in CH4 emission is strongly linked to DMI, however breed differences were still present after correcting for DMI, which indicated breed differences not explained by BW or DMI. Persistent breed differences after correcting for DMI may be related to contrasts in rumen passage rate, NDF digestibility, rumen microbiome, fermentation rate etc. We conclude that improved grass silage quality may be a potential mitigation option. However, to avoid weight gain in early pregnancy in an ad libitum feeding regime, the practical applicability may be limited to periods with higher feed requirements, such as in late pregnancy and early lactation. The breed differences in enteric CH4 emission need to be related to productivity (e.g., fecundity, lamb growth rate). Potential breed differences not explained by body size and/or DMI need to be further investigated.

Impact of Pregnancy on Papilledema and Vision Loss in Idiopathic Intracranial Hypertension Patients: A Chart Review and Case Series of 13 Patients.

Studies suggest that weight gain is a prominent risk factor for recurrence of papilledema in idiopathic intracranial hypertension (IIH). Given this information, the significant weight gain that occurs during pregnancy, and the fact that pharmacologic therapy is many times discontinued, raises concerns for worsening edema and vision loss. To examine the impact of pregnancy weight gain on IIH, a retrospective chart review of patients with IIH and pregnancy was performed. Compared with previous studies, we 1) quantified findings with optical coherence tomography (OCT) and Humphrey visual field (HVF) data, 2) Included baseline data before pregnancy, 3) determined excess pregnancy weight gain using body mass index-adjusted weight gain goals, and 4) correlated worsening in IIH symptoms with changes in papilledema. Charts were reviewed for patients with diagnoses of IIH who had at least 2 visits with neuro-ophthalmology during pregnancy. Thirteen patients met inclusion criteria. Data were compared from baseline visits before pregnancy, pregnancy visits, and postpregnancy visits. Comparisons of HVF mean deviation (MD), OCT retinal nerve fiber layer (RNFL), and Max OCT RNFL during pregnancy were not significant compared with baseline ( P = 0.51, 0.41, and 0.25). Three patients were found to have increased papilledema during pregnancy (Max Avg OCT RNFL of 152.5, 129, and 123.5 μm) of which 2 developed new reproducible mild visual field defects (HVF ∆MD -1.78 and -4.49). All patients showed more than the 6% weight gain, typically observed in recurrent IIH. Eleven patients gained more than their weight from initial diagnosis. Eight patients had excess pregnancy weight gain. Six patients discontinued pharmacologic therapy for IIH. Weight gain seems to carry a lower risk in IIH patients when associated with pregnancy. This is suggested by the high rate of stable or even decreased disc edema in patients despite medication discontinuation and excess pregnancy weight gain. We postulate these findings may be related to changes in weight distribution or endocrine changes during pregnancy.

Kesesuaian Peningkatan Berat Badan Selama Kehamilan Berhubungan dengan Luaran Kehamilan

Globally, 53% of pregnant women experience unsuitable weight gain with WHO recommendations. This condition is associated with poor perinatal outcomes. Study investigates pregnancy weight gain's impact on outcomes. This study design was observational with a retrospective cohort approach. The sample size was obtained based on the difference formula of two proportions, namely, 142 mothers giving birth. Consecutive sampling technique according to inclusion criteria (mothers giving birth, willing to be respondents, complete medical record status) and exclusion extraction, namely having a history of comorbidities and/or complications The form record is used to collect data. Data analysis with SPSS 25 used the exact Fisher, Mann-Whitney, and chi-square tests. The results showed that 74% of pregnant women experienced weight gain not according to recommendations with 86.5% experienced inadequate weight gain. Appropriateness of weight gain during pregnancy was related to birth weight (p=0.024), birth length (p=0.009), amniotic fluid condition (p=0.000), and Apgar score (p=0.002). Pregnancy outcomes in the form of type of delivery (p=0.426), gestational age (p=0.84), and length of gestation (p=0.0583) were not related. Examination of pre-pregnancy BMI and education about recommendations for weight gain during pregnancy have been important since the first ANC contact.

Maternal saliva visfatin level in term and preterm labor: A case control study.

Visfatin, a colony-enhancing factor (pre-B-cell), is an inflammatory biomarker that is secreted from a different number of cells and appears to have some proinflammatory or immune-regulating effects. The aim of this study was to compare maternal saliva visfatin levels in women with preterm and term delivery. In This case-control study, women in labor before 37 weeks of gestation were the case group (n = 40) and women in labor after 37 weeks of gestation were in control group (n = 40). The saliva of the participants was sampled and maternal saliva visfatin level was measured by ELISA test. In this study, 80 pregnant women were studied in case and control groups. The mean age of case and control group was 29.1±6.9 and 30.55±5.3 years, respectively. The results revealed that the mean maternal saliva visfatin level in the preterm group (4.75±2.2) is significantly (p = 0.001) lower than that in term birth group (6.7±3.1). The results of adjusted logistic regression revealed that after adjusting for GDM, preeclampsia, pre pregnancy BMI and weight gain, the mean of maternal saliva visfatin level in the preterm group is significantly lower than that in the term group (p = 0.026). Considering that during the term pregnancy visfatin levels increase and visfatin may play a role in initiating labor, in our study due to the high visfatin level in case group although the level of maternal saliva visfatin was lower than the control group but high levels of visfatin in the case group can represent the role of visfatin in initiating labor and due to this issue can be use the role of this adipokine for early diagnosis of preterm delivery can be used to prevent, treat and improve the prognosis of this disease. Also, this study is the first study to compare the maternal saliva visfatin level between SGA and AGA group and there is no difference between these groups.

Angraini Model as Effort to Early Detection of Chronic Energy Deficiency in Pregnancy

The prevalence of chronic energy deficiency in pregnant women in Indonesia is still high. This condition is one of the unresolved nutritional problems such as stunting. This study aims to develop the Angraini Model, as an effort to early detection of chronic energy deficiency in pregnancy. This research is a quantitative study with a case-control design on 190 CED and non-CED pregnant women in the city of Bandar Lampung. The research took time from October 2018 to July 2021. The data used in this study are 18 indicators and 7 latent variables. Latent variables consist of socioeconomic (education, employment, income, knowledge), culture (age, parity, food taboo), BMI (prepregnancy BMI), laboratory (anemia, iron status, protein status), food intake (energy, protein, fat carbohydrates, iron), weight gain during pregnancy (pregnancy weight gain), and CED (chronic energy deficiency). Data were analyzed using a structural equation model (SEM) with Lisrel software and then built into a web-based expert system. The results of the SEM analysis stated that food intake, laboratory values, and weight gain during pregnancy directly affect the incidence of CED. socioeconomic variables (knowledge, education, employment, and income), culture (age, parity, and food taboo), and prepregnancy BMI indirectly affect the incidence of CED through food intake variables. The model obtained based on SEM analysis is then built in a web-based expert system with the address modelangraini.com. The Angraini model is a web-based expert system that can be used to detect early CED in pregnant women for health workers in primary healthcare facilities.

P07-035-23 AWeight-Gain-for-Gestational-Age Z-Score Chart for the Assessment of Gestational Weight Gain in Twin Pregnancies in China and Its Association With Preterm Birth

P07-035-23 AWeight-Gain-for-Gestational-Age Z-Score Chart for the Assessment of Gestational Weight Gain in Twin Pregnancies in China and Its Association With Preterm Birth

No strong evidence of the protein leverage hypothesis in pregnant women with obesity and their infants.

The goal of this study was to investigate the role of dietary protein on macronutrient and energy intake, maternal adiposity during pregnancy, and infant adiposity at birth. In 41 women with obesity, early-pregnancy (13-16 weeks) protein intake was assessed with food photography and expressed as a ratio of Estimated Average Requirements (EAR) in pregnancy for protein (0.88 g/kg/d), herein "protein balance." Energy intake was measured by the intake-balance method, gestational weight gain as grams per week, and fat mass by a three-compartment model. Spearman correlations and linear models were computed using R version 4.1.1 (p < 0.05 considered significant). Women had a mean (SD) age of 27.5 (4.8) years and a pregravid BMI of 34.4 (2.9), kg/m2 , and the majority were non-White (n = 23, 56.1%). Protein balance in early pregnancy was not significantly associated with energy intake across mid and mid/late pregnancy (β = 328.7, p = 0.30 and β = 286.2, p = 0.26, respectively) or gestational weight gain (β = 117.0, p = 0.41). Protein balance was inversely associated with fat mass in early, mid, and late pregnancy (β = -10.6, p = 0.01, β = -10.4, p = 0.03, β = -10.3, p = 0.03, respectively). Protein balance did not predict infant adiposity at birth (p > 0.05). Low protein intake may have been present before pregnancy, explaining early relationships with adiposity in this cohort. The protein leverage hypothesis is likely not implicated in the intergenerational transmission of obesity.

The distribution of dietary choline intake and serum choline levels in Australian women during pregnancy and associated early life factors

BackgroundMaternal dietary choline has a central role in foetal brain development and may be associated with later cognitive function. However, many countries are reporting lower than recommended intake of choline during pregnancy.MethodsDietary choline was estimated using food frequency questionnaires in pregnant women participating in population-derived birth cohort, the Barwon Infant Study (BIS). Dietary choline is reported as the sum of all choline-containing moieties. Serum total choline-containing compounds (choline-c), phosphatidylcholine and sphingomyelin were measured using nuclear magnetic resonance metabolomics in the third trimester. The main form of analysis was multivariable linear regression.ResultsThe mean daily dietary choline during pregnancy was 372 (standard deviation (SD) 104) mg/day. A total of 236 women (23%) had adequate choline intake (440 mg/day) based on the Australian and New Zealand guidelines, and 27 women (2.6%) took supplemental choline (ge 50 mg/dose) daily during pregnancy. The mean serum choline-c in pregnant women was 3.27 (SD 0.44) mmol/l. Ingested choline and serum choline-c were not correlated (R2) = − 0.005, p = 0.880. Maternal age, maternal weight gain in pregnancy, and a pregnancy with more than one infant were associated with higher serum choline-c, whereas gestational diabetes and environmental tobacco smoke during preconception and pregnancy were associated with lower serum choline-c. Nutrients or dietary patterns were not associated with variation in serum choline-c.ConclusionIn this cohort, approximately one-quarter of women met daily choline recommendations during pregnancy. Future studies are needed to understand the potential impact of low dietary choline intake during pregnancy on infant cognition and metabolic intermediaries.

1202-P: Comparison of the Clinical Characteristics, Glycemic Control, and Pregnancy Outcomes between Wave I and III of COVID-19 Pandemic in Women with Gestational Diabetes Mellitus—A Reference Center Report

Background: The medical care for gestational diabetes mellitus (GDM) during the COVID-19 pandemic was influenced by changing epidemiological conditions and governmental regulations. Aim To compare the clinical data of GDM women between wave I and III of COVID-19 pandemic. Materials and methods: We performed retrospective analysis of the medical records from the GDM clinic of the University Hospital in Krakow, and compared the periods of March-May 2020 and March-May 2021, corresponding to wave I and III, respectively. Results: GDM women during wave I (N=118) as compared to wave III (N=116) were older (33.0±4.7 vs 32.1±4.8 years; p=0.03), booked later (21.8±8.4 vs 20.3±8.5 weeks; p=0.08) and had the last visit earlier (35.5±2.0 vs. 35.7±3.2 weeks; p&amp;lt;0.01). The pregnancy weight gain were similar (8.9±5.6 vs 8.4±5.6 kg; p=NS). Telemedicine consultations were used more frequently during wave I (36% vs 18% of all visits; p&amp;lt;0.01) while insulin therapy less often (64.7% vs. 80.2%; p&amp;lt;0.01). The mean fasting self-control glucose did not differ (4.8±0.3 vs 4.8±0.3 mmol/l; p=0.25) but a worse postprandial glycemia during wave I was reported (6.6±0.9 vs. 6.3±0.6 mmol/l; p&amp;lt;0.01). Pregnancy outcome data were available from 77 and 73 pregnancies, respectively. The groups were similar for the delivery time (38.2±1.4 vs. 38.1±1.6 weeks), cesarean sections (58.4% vs. 61.3%), APGAR score (9.7±1.0 vs. 9.7±1.0 pts) and birth weight (3306.6±460.6 g vs 3243.9±500.2) (p=NS for all), slightly higher length occurred for Wave I (54.3±2.6 cm vs. 53.3±2.6; p=0.02). Conclusions: We identified differences in many areas between GDM women booking either during wave I or III of COVID-19 pandemic, however, the pregnancy outcomes were mostly similar. Disclosure M.Wilk: None. M.Kania: None. M.Malecki: Advisory Panel; Abbott Diabetes, Novo Nordisk, Lilly, Sanofi, Dexcom, Inc., Bayer Inc., Research Support; Medtronic, Speaker's Bureau; AstraZeneca, AlfaSigma, Merck &amp; Co., Inc., BIOTON S.A., Servier Laboratories, KRKA.

1305-P: The Effect of Limited Pregnancy Weight Gain on Fetal Growth during Dietary Therapy in Gestational Diabetes Mellitus–Affected Women

Aims: We aimed to evaluate how diet-related maternal weight gain (GWG) affected foetal growth in gestational diabetes (GDM)-complicated pregnancies. Methods: This study involved 182 women who were sequentially diagnosed with GDM before 34 weeks of pregnancy and gave birth to live singletons at our hospital. To gauge compliance with an energy-limited “diabetic diet,” the women were divided into three groups based on their restricted (53%), appropriate (16%), and excessive (31%) weekly GWG. If necessary, insulin therapy was started in accordance with regional clinical recommendations. Results: At the time of the diagnosis of GDM at 276 ± 51 weeks, the three groups' glucose tolerance, HbA1c, weekly GWG before dietary treatment, and SD score for foetal abdominal circumference were comparable. The women were monitored for 100 ± 51 weeks, during which time 54% of them got further insulin medication, and the average GWG during dietary therapy varied amongst the three groups, weighing 0 kg, 3 kg, and 5 kg. Increased HbA1c between the time of GDM diagnosis and late pregnancy was associated with excessive weekly GWG during dietary treatment, reflecting poor dietary adherence, and newborns had a birthweight-SD score of 0.59 ± 1.6. Conclusions: In women with GDM, restricted GWG during nutritional therapy was linked to improved foetal growth. Clinical determinants of infant birthweight-SD score that are possibly modifiable include GWG during nutritional therapy and late-pregnancy HbA1c. Disclosure N.Kumar: None. S.C.Jha: None.

Gestational Weight Gain During the COVID-19 Pandemic.

Healthy gestational weight gain (GWG) is associated with improved pregnancy and delivery outcomes. The COVID-19 pandemic changed eating behaviours and physical activity, and thus may have impacted GWG. This study examines the impact of the COVID-19 pandemic on GWG. Participants (N = 371, 86% of the larger study) were part of a study focused on GWG among TRICARE beneficiaries (i.e., active-duty military personnel and other beneficiaries). Participants were randomized to two treatment groups (GWG intervention (n = 149 pre-COVID and n = 98 during COVID), and usual care condition (n = 76 pre-COVID and n = 48 during COVID). GWG was calculated as the difference between screening weight and at 36 weeks gestation. Participants who delivered prior to the COVID-19 pandemic (March 1, 2020, N = 225) were compared to participants whose pregnancies occurred during the pandemic (N = 146). We found no significant difference in GWG between those who delivered prior to the pandemic (11.2 ± 4.3kg) and those whose pregnancies occurred during COVID-19 (10.6 ± 5.4kg), with no effect of intervention arm. While excessive GWG was higher pre-COVID (62.8%) than during the pandemic (53.7%), this difference was not significant overall or by intervention arm. In addition, we found lower attrition during the pandemic (8.9%) than in the pre-COVID period (18.7%). In contrast to prior research that indicated challenges with engaging in health behaviors during the COVID-19 pandemic, we found that women did not have increased GWG or higher odds of excessive GWG. This research contributes to our understanding of how the pandemic impacted pregnancy weight gain and engagement in research.

A new care pathway to optimize gestational weight gain in twin pregnancies

Maternal gestational weight gain (GWG) is an important determinant of pregnancy outcomes and may have an even greater role in twin pregnancies due to the higher rate of pregnancy complications and greater nutritional demands. However, data on the optimal week-specific GWG in twin pregnancies and interventions that should be taken in cases of inadequate GWG are limited. To determine whether a new care pathway that involves monitoring GWG using a week-specific chart along with a standardized protocol for managing cases with inadequate GWG can optimize maternal GWG in twin pregnancies. In this study, patients with twin pregnancies followed in a single tertiary center between Feb-2021 and May-2022 were exposed to the new care pathway (post-intervention group). GWG and clinical outcomes were compared with a previously described cohort of patients with twins followed in our clinic before the implementation of the new care pathway (pre-intervention group). The new care pathway targeted patients and care providers and included educational material, a newly developed BMI-group-specific GWG chart, and a stepwise management algorithm in cases of inadequate GWG. The BMI-group-specific GWG charts were divided into three zones: (1) green zone (optimal GWG, at 25th-75th centiles); (2) yellow zone (suboptimal GWG, at 5th-24th or 76th-95th centiles); and (3) gray zone (abnormal GWG, at <5th or >95th centile). The primary outcome was the overall proportion of patients achieving optimal GWG at birth. A total of 123 patients were exposed to the new care pathway and were compared with 1079 patients from the pre-intervention period. Patients in the post-intervention group were more likely to achieve optimal GWG at birth (60.2% vs. 47.7%; adjusted odds ratio [aOR] 1.91, 95%-confidence interval [CI] 1.28.2.86) and were less likely to achieve low suboptimal GWG (7.3% vs. 14.7%; aOR 0.41, 95%-CI 0.20-0.85) or any suboptimal GWG (26.8% vs. 34.8%; aOR 0.60, 95%-CI 0.39-0.93) at birth. In addition, patients in the post-intervention group were less likely to experience low-abnormal GWG anytime during gestation (18.9% vs. 29.1%, p=0.017) and were more likely to experience normal GWG throughout pregnancy (21.3% vs. 14.0%, p=0.031) or high-abnormal GWG anytime during gestation (18.0% vs. 11.1%, p=0.025), suggesting that the care pathway is more effective than the standard care in preventing patients from moving into the low-abnormal zone than the high-abnormal zone. Furthermore, the new care pathway was more effective than the standard care in correcting high-suboptimal GWG and high-abnormal GWG. Our findings suggest that the new care pathway may be effective in optimizing maternal GWG in twin gestations, which may, in turn, contribute to better clinical outcomes. This is a simple, low-cost intervention that can be easily disseminated among providers caring for patients with twin pregnancies.

Effect of Adherence to the Mediterranean Diet on Maternal Iron Related Biochemical Parameters during Pregnancy and Gestational Weight Gain.

Gestation is a crucial life stage for both women and offspring, and outcomes are affected by many environmental factors, including diet. The Mediterranean dietary pattern (MD) is considered a healthy eating pattern that can provide the nutritional requirements of pregnancy. Meanwhile, iron deficiency anemia is one of the most frequent complications related to pregnancy. This study aimed to evaluate how the level of adherence to the MD influences maternal gestational weight gain and specific iron-related maternal biochemical parameters during the pregnancy. Accordingly, an observational, population-based study using data from pregnant women conducted over the entire course of their pregnancy was carried out. Adherence to the MD was assessed once using the MEDAS score questionnaire. Of the 506 women studied, 116 (22.9%) were classified as demonstrating a high adherence, 277 (54.7%) a medium adherence, and 113 (22.3%) a low adherence to the MD. No differences were observed in gestational weight gain among the MD adherence groups but the adequacy of weight gain did vary among the groups, with the proportions of inadequate (insufficient or excessive) weight gain presenting the most notable differences. Total anemia prevalence was 5.3%, 15.6%, and 12.3%, respectively, during the first, second, and third trimesters. For iron-related biochemical parameters, no differences are observed among the adherence groups during pregnancy. With high adherence to the MD as the reference group, the crude odds of iron deficiency diagnosis are significant in the first trimester for both the medium [OR = 2.99 (1.55-5.75)] and low [OR = 4.39 (2.15-8.96)] adherence groups, with deficient adherence to the Mediterranean dietary pattern being responsible for 66.5% (35.5-82.6) and 77.2% (53.5-88.8) of the risk of iron deficiency diagnosis for medium and low adherence, respectively. However, adjusted odds ratios were not significant, possibly due to the small sample size. Our data suggest that MD adherence could be related to gestational weight gain adequacy and that optimal adherence could reduce iron deficiency and/or anemia during pregnancy in the studied population.

GDF15, Genetic Risk Factor for Hyperemesis Gravidarum, Inversely Associated With Pregnancy Weight Gain [ID: 1358449

INTRODUCTION: Hyperemesis gravidarum (HG), a highly heritable condition, complicates ∼3% of pregnancies and is associated with adverse outcomes related to inadequate maternal weight gain. We report the largest-ever genome-wide association study (GWAS) of HG, composed of 8,960 cases and 369,843 controls. We identified associations with genes encoding GDF15 and its receptor GFRAL, so we compared changes in circulating GDF15 to weight gain in hospitalized HG patients. METHODS: We performed a meta-analysis of six independent studies: a multiancestry whole-exome sequencing study from the United States, four GWASs of European ancestry from 23andMe, Inc., research participants, FinnGen, Estonian and UK Biobanks, and a GWAS of British Bangladeshis and Pakistanis. We also studied three hospitalized HG patients, assessing serum GDF15 and weight at admission and discharge. Institutional review board approval was obtained. RESULTS: GDF15 was the greatest significant risk factor for HG in the meta-analysis (P= 2.47E-47) and each individual GWAS. Association with GFRAL (P=8.85E-09) further implicates the GDF15/GFRAL pathway in HG etiology. The solitary HG patient with lower GDF15 at discharge was the only one who gained weight during hospitalization. CONCLUSION: Overall, this study contributes to our understanding of the biology of HG and may inform future research evaluating new treatment avenues. Of note, drugs blocking GDF15/GFRAL mitigate appetite, weight loss, and vomiting in animal models. These drugs are currently in clinical trials of cancer cachexia, a disease with similar symptoms to HG. The strong link of HG to the GDF15/GFRAL pathway suggests that these drugs, if safe, hold great promise for improving symptoms and weight gain in HG patients.

Investigating the Shape and Strength of the Relationship Between Maternal Weight Gain and Gestational Age at Delivery in Twin and Singleton Pregnancies.

Both inadequate and excessive maternal weight gain are correlated with preterm delivery in singleton pregnancies, yet this relationship has not been adequately studied in twins. We investigated the relationship between time-varying maternal weight gain and gestational age at delivery in twin pregnancies and compared it with that in singletons delivered in the same study population. We used serial weight measurements abstracted from charts for twin and singleton pregnancies delivered during 1998-2013 in Pittsburgh, Pennsylvania. Our exposure was time-varying weight gain z score, calculated using gestational age-standardized and prepregnancy body mass index-stratified twin- and singleton-specific charts, and our outcome was gestational age at delivery. Our analyses used a flexible extension of the Cox proportional hazards model that allowed for nonlinear and time-dependent effects. We found a U-shaped relationship between weight gain z score and gestational age at delivery among twin pregnancies (lowest hazard of delivery observed at z score= 1.2), which we attributed to increased hazard of early preterm spontaneous delivery among pregnancies with low weight gain and increased hazard of late preterm delivery without labor among pregnancies with high weight gain. Our findings may be useful for updating provisional guidelines for maternal weight gain in twin pregnancies.

Association of dietary glycemic load during pregnancy with gestational weight gain and fetal physical development

To investigate the situation of women&apos;s dietary glycemic load during pregnancy and explore the correlations between dietary glycemic index(GI) and gestational weight gain and fetal physical development. The study was conducted in women in the third trimester of pregnancy and their new-born babies. The gestational dietary information was collected through a 3-day 24-hour dietary review. The general demographic information, diet and physical exercise, and weight were collected in questionnaire investigations, and the glycemic load during pregnancy were calculated. Participant were dived into low-glycemic-load group, middle-glycemic-load group and high-glycemic-load group according to the glycemic load. Gestational weigh gain, birth weight and birth length were measured. Multiple linear regression were used to analyze the relationship between glycemic load during pregnancy and gestational weight gain and fetal growth. The mean gestational glycemic load was 149.21±46.33. Women in high-glycemic-load group had higher intake of grain, potato, bacteria and algae, fruit, poultry and dairy but lower intake of aquatic product(P&lt;0.05). The mean gestational weight gain was(15.03±4.35)kg. The mean fetal weight and birth length was(3229.18±375.09)g and(49.60±1.48)cm. Women in high-glycemic-load group had higher gestational weight gain(P&lt;0.05). Multiple linear regression indicated that dietary glycemic load during pregnancy was postively correlated with gestational weight gain and birth length(β_1=0.011, β=0.003, P&lt;0.05). The higher dietary glycemic load during pregnancy is, the higher gestational weight gain and birth length will be.