Pregravid Body Mass Index Research Articles

952-P: Deranged Liver Enzyme Levels and Indices of Hepatic Steatosis and Fibrosis on the Development of Gestational Diabetes

Objective: Nonalcoholic fatty liver disease has been associated with the development of gestational diabetes (GDM). We sought to determine whether abnormal liver enzyme levels and indices of hepatic steatosis and fibrosis in an entire pregnant population are associated with GDM development. Methods: A retrospective cohort study was conducted on adult women (≥18 years) who delivered at 2 teaching hospitals in Sydney Australia from January 2016 to December 2017. Liver enzymes (aspartate aminotransaminase (AST), alanine aminotransaminase (ALT), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), albumin (ALB) and bilirubin (BIL)) obtained 12 months pre-gravid, or during pregnancy but prior to GDM screening, were extracted from the hospital pathology database and linked with oral glucose tolerance test results. The Fibrosis-4 (FIB-4) and Hepatic Steatosis Index (HSI) were calculated. Univariate analysis was undertaken to determine the association between deranged liver enzymes, FIB-4, HSI and GDM. Multiple logistic regression, with adjustment for age, ethnicity, pre-gravid body mass index (BMI), parity, prior GDM and family history of diabetes, was conducted to determine if any of these were independent predictors of GDM. Results: Over 2 years, 1429 women had liver enzymes collected. As per IADPSG (2010) criteria, 255 had diagnosed GDM, of which 82 (32.2%) were obese (BMI >30kg/m2), 243 (82.4%) were multiparous, and 223 (87.5%) had prior GDM. Elevated GGT (>35IU/L, p=0.006) and HSI (p=0.005) were associated with development of GDM, whilst low ALB (<35g/L) and elevated ALP (>110IU/L), ALT (>35IU/L), AST (>35IU/L), BIL (>19umol/L) and FIB-4 were not. On adjustment for confounders, elevated GGT (AOR 1.1, 95% CI 0.32-3.8, p=0.88) and HSI (AOR 0.6, 95% CI 0.26-1.3, p=0.21) were not independent predictors of GDM. Conclusions: Our results indicate deranged liver enzymes or clinical indices of hepatic steatosis and fibrosis were not associated with GDM. Disclosure T. Y. L. Chai: None. D. Pasupathy: None. J. George: None. N. Cheung: None.

Assessing the relationship between pregravid body mass index and risk of adverse maternal pregnancy and neonatal outcomes: prospective data in Southwest China

The relevance of pregestational body mass index (BMI) on adverse pregnancy outcomes remained unclear in Southwest China. This study aimed to investigate the overall and age-category specific association between pre-gestational BMI and gestational diabetes mellitus (GDM), preeclampsia, cesarean delivery, preterm delivery, stillbirth, macrosomia, and small-for-gestational age (SGA) or large-for-gestational age (LGA) neonates in Southwest China. Furthermore, it explores the relative importance of influence of pregravid BMI and maternal age on pregnancy outcomes. 51,125 Chinese singleton pregnant women were recruited as study subjects. Multiple logistic regression models were used to examine the influence of pre-pregnancy BMI on adverse pregnancy outcomes. Gradient boosting machine was used to evaluate the relative importance of influence of pregravid BMI and maternal age on pregnancy outcomes. It is found that women who were overweight or obese before pregnancy are at higher risk of adverse pregnancy outcomes except for SGA neonates, while pre-pregnancy underweight is a protective factor for GDM, preeclampsia, cesarean delivery, macrosomia and LGA, but not SGA. Younger mothers are more susceptible to GDM and macrosomia neonates, while older mothers are more prone to preeclampsia. Pre-pregnancy BMI has more influence on various pregnancy outcomes than maternal age. To improve pregnancy outcomes, normal BMI weight as well as relatively young maternal ages are recommended for women in child-bearing age.

Utility of modified mid-pregnancy body mass index in predicting obstetric outcomes in Middle Eastern population

Objective: To test the value of mid-pregnancy maternal body mass index (BMI) and weight gain in the second half of pregnancy in predicting pregnancy outcomes among Middle Eastern population where pre-gravid BMI was not available. Methods: Retrospective analysis of the obstetric outcomes of 290 women with singleton pregnancies who were categorized into underweight (UW), normal weight (NW), overweight (OW) and obese (OB) according to the BMI at 24-28 weeks of gestation and compared with recommended pre-gravid values by Institute of Medicine (2009). Results: The results showed that the gestational diabetes rate was significantly lower among the UW (2.4%) compared with the NW (8.8%, p<0.05), the OW (14.3%, p=0.006), and OB (20.5%, 0.001). The risk of having macrosomia was eight times higher among OW compared with NW women. The C-section rate was lowest among the UW group but there was no significant difference in terms C-section and low birth weight between groups. The obstetric outcomes among women whose weight gain was above the 90th and below the tenth centiles were not different. Conclusion: The prediction of obstetric outcomes by mid-pregnancy BMI is comparable to pre-gravid BMI. The results are encouraging, and further larger studies are needed to confirm the applicability

343 Evaluating compliance with a remote self-monitoring weight program in low risk women and perinatal outcomes

To compare gestational weight gain (GWG), postpartum weight retention (PPWR) and other perinatal outcomes according to compliance with a remote self-monitoring weight program in low-risk women. Women were recruited in the first trimester for the Babyscripts program, which provided a mobile application, educational resources and an internet-connected digital scale during 2016-2018 from a single hospital-based clinic. Women with pre-gravid BMI ≤ 38, single gestation and without pre-existing diabetes or hypertension were invited to participate. Participants were instructed to weigh themselves weekly from initiation of the program to delivery. Demographics, GWG, PPWR and other outcomes were abstracted from the electronic medical records. Compliance was defined as weights recorded for ≥ 50% of weeks during participation. GWG and PPWR were analyzed as weight differences from first prenatal visit to delivery and 4-12 weeks postpartum, respectively. GWG goals were calculated using the Institute of Medicine (IOM) guidelines for GWG per pre-gravid body mass index (BMI). Of the 442 women who participated, 298 (69%) were compliant (median of 22.5 weeks of weight measurements) and 135 (31%) were noncompliant (median of 7 weeks of weight measurements). There were significantly more nulliparas in the compliant group (68% vs. 54%, p=0.005) and more normal weight, less overweight, and less obese women in the compliant group (p=0.03). Mean GWG (13.4 kg ± 8.6 vs. 13.3 kg ± 5.3, p=0.91) and mean PPWR (3.0 kg ± 3.7 vs. 3.5 kg ± 4.6, p=0.46) were similar in compliant compared to noncompliant groups. There were no differences in GWG goals of inadequate (28% vs. 19%), adequate (40% vs. 44%), or excessive (33% vs. 36%), p=0.18. There were no differences in gestational age at delivery, mode of delivery or birthweight between the groups, p>0.05 for all comparisons. Compliance with a remote self-monitoring program of perinatal weight was higher among nulliparous, normal weight low-risk women, but there were no differences in GWG, PPWR, or other perinatal outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

737 Risk factors for acute care utilization in the 90 days following childbirth

One third of maternal deaths in the United States occur more than 7 days after delivery; improving the continuum of maternal care is therefore essential. As part of our institution's Postnatal Patient Safety Learning Lab, we sought to identify characteristics of birthing parents who utilized acute care, defined as emergency department, obstetric triage or readmission to inpatient care, following maternity discharge. We conducted a retrospective cohort study among individuals who gave birth at a gestational age > 23 weeks between January 1, 2018 and June 30, 2019 at a southeastern quaternary care hospital. We retrieved health utilization data from our institution’s electronic health record system through 90 days postpartum. Comorbidities were identified using billed diagnosis codes. We used chi-square tests and multivariable logistic regression to identify characteristics associated with acute care utilization (ACU). P values <0.05 were considered statistically significant. During the study period, there were 5845 eligible birthing parents and 983 ACU encounters, half of which occurred in the first 14 days after birth. A total of 696 (11.9%) women had at least one ACU event: 340 (5.8%) were seen in the emergency department but not admitted, 168 (2.9%) were readmitted, and 290 (5.0%) were seen in OB triage. Maternal factors associated with ACU in bivariate analyses included younger age, public insurance, race/ethnicity, pregravid body mass index > 30 kg/m2, cesarean birth, preterm birth, and pre-gestational diabetes or hypertension. In multivariable logistic regression, associations were similar (Table). Mothers classified as Asian, Hispanic and other Race/Ethnicity had lower odds of ACU compared with non-Hispanic White or Black mothers. Postpartum ACU is concentrated in the first 14 days after birth and clinical characteristics identify those at risk. Targeted, multi-level strategies have the potential to reduce the need for acute care and promote maternal safety and wellbeing through the 4th Trimester and beyond.

Perinatal outcome of in vitro fertilization pregnancies in women with polycystic ovary syndrome by pregravid BMI.

Given the adverse effects of either polycystic ovary syndrome (PCOS) or overweight/obesity, one could speculate that patients with both would fare worse than others. We sought to evaluate the relationship between pregravid BMI and pregnancy complications in PCOS patients conceived by assisted reproductive techniques (ART). Maternal and fetal/neonatal outcomes of singleton pregnancies after assisted reproduction in women with and without PCOS were compared by pregravid body mass index (BMI, <24.9 vs.≥25kg/cm2). The study population comprised 185 with a BMI <24.9kg/cm2 including 39 (21%) with PCOS and 146 (79%) without. We also included 84 patients with BMI≥25kg/cm2, involving 34 (40.5%) with PCOS and 50 (59.5%) without. PCOS (total 73 patients) was significantly more common among overweight/obese patients, OR 2.5 (95% CI 1.4, 4.4). Neonates >4,000g were born only to the overweight/obese mothers in the PCOS group. A higher incidence of gestational diabetes, chronic hypertension, and gestational hypertension was related to pregravid overweight/obesity rather than PCOS. In this specific subgroup of patients conceived after assisted reproduction, pregravid BMI>25kg/cm2 rather than PCOS itself appears to be associated with GDM and hypertensive disorders.

Maternal visceral adipose tissue during the first half of pregnancy predicts gestational diabetes at the time of delivery – a cohort study

BackgroundGestational diabetes mellitus (GDM) is a common condition, often associated with high maternal and fetal morbidity. The use of new tools for early GDM screening can contribute to metabolic control to reduce maternal and fetal risk. This study aimed to ascertain whether maternal visceral adipose tissue (VAT) measurement by ultrasound during the first half of pregnancy can predict the occurrence of GDM during the third trimester.MethodsA prospective cohort study of 133 pregnant women with gestational age ≤20 weeks in an outpatient setting. VAT depth was measured by ultrasound at the maternal periumbilical region. GDM status was obtained through hospital charts during hospitalization to delivery. A Receiver Operator Characteristic (ROC) curve was used to determine the optimum threshold to predict GDM.ResultsAccording to the ROC curve, a 45mm threshold was identified as the best cut-off value, with 66% of accuracy to predict GDM. Crude and adjusted odds ratios (OR) for GDM were 13.4 (95%CI 2.9–61.1) and 8.9 (95%CI 1.9–42.2), respectively. A similar result was obtained among pre-gravid non-obese women, with crude and adjusted OR of 16.6 (95%CI 1.9–142.6) and 14.4 (95%CI 1.7–125.7), respectively. Among pre-gravid obese patients, a 45mm threshold did not reach statistical significance to predict GDM.ConclusionThe high and significant OR found before and after adjustments provides additional evidence of a strong association between VAT and GDM. It appears that VAT measurement during the first half of pregnancy has great potential in identifying non-obese women at high risk for GDM. This evidence can assist obstetricians in correctly allocating resources among populations of pregnant women at risk, determined not only by pre-gravid body mass index (BMI).

Effect of pregravid obesity on perinatal outcomes in singleton pregnancies following in vitro fertilization and the weight-loss goals to reduce the risks of poor pregnancy outcomes: A retrospective cohort study.

ObjectiveIn the present study, we aimed to determine whether pregravid obesity independently predicts increased risks of perinatal complications following in vitro fertilization (IVF) and the weight loss goals to reduce the risk of poor pregnancy outcomes.DesignRetrospective cohort study.PopulationAll pregnancies after first the fresh IVF cycle from January 2014 to December 2016 in the Reproductive Center affiliated to Shandong University were reviewed. A total of 3,962 eligible singleton births were stratified into cohorts based on the body mass index (BMI) definitions of the Working Group on Obesity in China (WGOC).Main outcome measuresAdverse perinatal outcomes.ResultsPregravid overweight and obesity were associated with increased risks of gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), including gestational hypertension (GH) and pre-eclampsia (PE), polyhydramnios, preterm premature rupture of the membranes (PPROM), placental abruption, preterm birth (PTB) <37 weeks, caesarean section (CS), fetal macrosomia, large for gestational age (LGA) >90th percentile, neonatal respiratory distress syndrome (NRDS), neonatal intensive care unit (NICU) admission and congenital anomalies as compared with the normal-weight group after adjustment of differences in age, parity, polycystic ovary syndrome (PCOS) and type of controlled ovarian hyperstimulation (COH). The increased risks of PPROM, NRDS and congenital anomalies were eliminated after adjustment of GDM development, whereas the increased risk of NRDS disappeared after adjustment of HDP. Placenta previa was not significantly different between the obese group and reference group (REF). Moreover, the rates of postpartum hemorrhage (PPH), PTB<32 weeks, small for gestational age (SGA) >90th percentile and perinatal mortality were also not significantly different between above-mentioned two groups. For obese women, a 10%-15% reduction in prepregnancy BMI was associated with significantly decreased risks of GH, CS and fetal macrosomia. For overweight women, just a 5% reduction in BMI could significantly reduce the risks of GDM, CS and fetal macrosomia.ConclusionsPregravid obesity could independently predict a higher risk of adverse pregnancy outcomes after adjustment of differences in maternal age, parity, PCOS, and type of COH in IVF pregnancies. The potential mechanism that obesity potentiated the risks of some poor perinantal outcomes might occur through the development of GDM and HDP. A 10%-15% reduction in pregravid BMI for obese women and a 5% reduction for overweight women were associated with a significant reduction of poor perinatal complications.

537: Sonographic evaluation of fetal fractional limb volume across gestation in gestational diabetes

Fractional limb volume has recently been proposed as a useful parameter of fetal growth, quantifying fetal soft tissue volume of upper arm and thigh. However, the investigation about the growth characteristics of fractional limb volume in mothers with gestational diabetes is limited. The aim of this study was to investigate the difference in growth trajectory of fractional arm volume and thigh volume between fetuses of gestational diabetes (GDM) and normal glucose tolerance (NGT) mothers. Fetal fractional limb volume was prospectively assessed in 158 singleton pregnancies (121 NGT and 37 GDM) between 20 and 37 weeks gestation. Fractional arm volume and thigh volume were measured as cylindrical limb volume based on 50% of humeral or femoral diaphysis length using a 5-slice technique. First, Student’s t-test was performed to compare fractional arm volume and thigh volume between NGT and GDM group across gestation. Multiple regression analyses were then performed to investigate the difference of fractional limb volume between NGT and GDM group, with adjustment for potential confounding factors (maternal age, parity, pregravid body mass index and fetal sex). Maternal and neonatal characteristics of each group are shown in Table 1. A total of 276 ultrasound scans were obtained, a mean of 1.7 scans (range: 1 - 4) per pregnancy. Fractional arm volume was not different between NGT and GDM group before 32 weeks gestation. However, fractional arm volume of GDM group was significantly larger than NGT group after 32 weeks gestation (Figure 1). These results remained significant even after controlling for the confounding factors. Fractional thigh volume was not statistically different between the two groups across gestation. Fetalfractional arm volume is significantly greater in women with GDM compared with NGT, particularly after 32 weeks gestation. This finding is consistent with the characteristic soft tissue accrual (including fat deposition) in the upper part of the fetal body in GDM, which possibly explains the higher occurrence of shoulder dystocia at delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

205: Effect of weight gain on delivery mode in obese women with normal estimated fetal weight

To study the effect of excessive gestational weight gain (EGWG) on the mode of delivery (MOD) and maternal outcomes in obese women with a normal estimated fetal weight (EFW) who delivered at term. A multi-center observational retrospective cohort study using electronic health record chart review of obese women who delivered at term from October 2016 to June 2019 in UPMC Pinnacle associated hospitals and had a fetal growth ultrasound within 3 weeks of delivery with an EFW within 2500 to 4500 grams. Obese women with normal EFW were compared on the basis of weight gain. EGWG was defined as weight gain of more than 20lbs during the pregnancy by the American College of Obstetrics and Gynecology. Weight gain of more than 20 pounds had no significant effect on MOD in obese women with a normal EFW. Obese women who had EGWG had a significantly lower pre-gravid body mass index (BMI) when compared to obese women with significantly higher pre-gravid BMI (p< 0.0001). Obese women who were delivered by cesarean section had a significantly higher BMI at the time of delivery when compared to the same group who had a vaginal delivery (p=0.0403). There was no significant difference on the MOD between women with class I, class II, and class III obesity. There was no significant difference in the demographics and co-morbidities between the study groups who delivered by cesarean section versus vaginal delivery. Maternal obesity and EGWG has been associated with adverse pregnancy outcomes, large for gestational age infants and cesarean delivery. To our knowledge, the relationship between EGWG in the setting of a normal EFW and MOD had not been previously reported. Our study shows that weight gain in excess of the 20lbs recommended for obese women (class I-III) had no significant effect on the MOD in the setting a normal EFW.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Maternal lipids are associated with newborn adiposity, independent of GDM status, obesity and insulin resistance: a prospective observational cohort study.

To determine the association between maternal lipaemia and neonatal anthropometrics in Malaysian mother-offspring pairs. Prospective observational cohort study. Single tertiary multidisciplinary antenatal clinic in Malaysia. A total of 507 mothers: 145 with gestational diabetes mellitus (GDM); 94 who were obese with normal glucose tolerance (NGT) (pre-gravid body mass index, BMI≥27.5kg/m2 ), and 268 who were not obese with NGT. Maternal demographic, anthropometric, and clinical data were collected during an interview/examination using a structured questionnaire. Blood was drawn for insulin, C-peptide, triglyceride (Tg), and non-esterified fatty acid (NEFA) during the 75-g 2-hour oral glucose tolerance test (OGTT) screening, and again at 36weeks of gestation. At birth, neonatal anthropometrics were assessed and data such as gestational weight gain (GWG) were extracted from the records. Macrosomia, large-for-gestational-age (LGA) status, cohort-specific birthweight (BW), neonatal fat mass (NFM), and sum of skinfold thickness (SSFT)>90th centile. Fasting Tg>95th centile (3.6mmol/L) at screening for OGTT was independently associated with LGA (adjusted odds ratio, aOR 10.82, 95%CI 1.26-93.37) after adjustment for maternal glucose, pre-gravid BMI, and insulin sensitivity. Fasting glucose was independently associated with a birthweight ratio (BWR) of >90th centile (aOR 2.06, 95%CI 1.17-3.64), but not with LGA status, in this well-treated GDM cohort with pre-delivery HbA1c of 5.27%. In all, 45% of mothers had a pre-gravid BMI of <23kg/m2 and 61% had a pre-gravid BMI of ≤25kg/m2 , yet a GWG of >10kg was associated with a 4.25-fold risk (95%CI 1.71-10.53) of BWR>90th centile. Maternal lipaemia and GWG at a low threshold (>10kg) adversely impact neonatal adiposity in Asian offspring, independent of glucose, insulin resistance and pre-gravid BMI. These may therefore be important modifiable metabolic targets in pregnancy. Maternal lipids are associated with adiposity in Asian babies independently of pre-gravid BMI, GDM status, and insulin resistance.

Gestational Weight Gain Particularly Affects the Risk of Large for Gestational Age Infants in Non-obese Mothers.

Introduction The birth of a large for gestational age (LGA) infant is a significant risk factor for birth complications and maternal morbidity and an even higher risk factor for offspring obesity, metabolic syndrome and cardiovascular disease in later life. Relevant factors affecting the risk of delivering an LGA infant are maternal pre-gravid obesity, excessive gestational weight gain exceeding the recommendations of the Institute of Medicine (IOM) and diabetes in pregnancy. We aimed to determine what matters most in terms of the risk of fetal overgrowth. Materials and Methods We performed a database analysis of 12 701 singleton term deliveries documented in our university hospital birth registry from 2003 to 2014. Multivariate logistic regression analysis was used to determine the adjusted odds ratios. Results Excessive weight gain had the strongest impact on LGA (OR: 1.249 [95% CI: 1.018 – 1.533]) compared to maternal pre-gravid body mass index (BMI) (OR: 1.083 [95% CI: 1.066 – 1.099]) and diabetes (OR: 1.315 [95% CI: 0.997 – 1.734]). Keeping gestational weight gain within the recommendations of the IOM resulted in a risk reduction for LGA of 20% (OR: 0.801 [95% CI: 0.652 – 0.982]). The risk for LGA increases by 6.9% with each kg weight gain. Normal weight women (BMI 18.5 – 24.9 kg/m 2 ) and moderately overweight women (BMI 25 – 29.9 kg/m 2 ) showed the highest increase in LGA rates per kg weight gain during pregnancy (OR: 1.078 [95% CI: 1.052 – 1.104] and OR: 1.058 [95% CI: 1.026 – 1.09], resp.). Only in underweight (< 18.5 kg/m 2 ) and normal weight women the risk of LGA birth is strongly influenced by diabetes (OR 11.818 [95% CI: 1.156–120.782] and 1.564 [95% CI: 1.013–2.415]). Conclusion Excessive weight gain is particularly important for non-obese women. These women are therefore a target cohort for intervention, as each prevented additional kilogram weight gain reduces the risk of LGA by more than 5%.

Gestational weight gain, physical activity, sleep problems, substance use, and food intake as proximal risk factors of stress and depressive symptoms during pregnancy

BackgroundBecause maternal depressive symptoms and stress during pregnancy are strongly associated with poor health of the mother and the developing child, understanding the predictors of women’s mental health problems is important to prevent complications in the perinatal period. Therefore, this study sought to examine the association between six risk factors – gestational weight gain (GWG), low physical activity, sleep problems, alcohol use, cigarette smoking and snack food intake – and mental health problems during pregnancy. We hypothesized that risk factors would predict mental health problems while adjusting for socio-demographic characteristics and pregnancy intention, both cross-sectionally and longitudinally.MethodsHierarchical linear regression analyses were conducted in a population-based sample of N = 463 pregnant women during their 2nd trimester (gestational age: 23 to 28 weeks) of whom n = 349 were reassessed during their 3rd trimester (gestational age: 33 to 38 weeks). Women had a mean age of 29.8 ± 4.2 years and a mean pregravid body mass index of 23.5 ± 4.3 kg/m2. Data were collected by the ‘Leipzig Research Center for Civilization Diseases’ via the Patient Health Questionnaire, Pittsburgh Sleep Quality Index, Food Frequency Questionnaire, self-report items on physical activity and substance use, and objectively measured anthropometrics.ResultsCross-sectionally, while a higher snack food intake and sleep problems predicted depressive symptoms and stress during the 2nd trimester, gestational weight gain predicted stress only. Longitudinally, sleep problems positively predicted depressive symptoms during the 3rd trimester. All results remained significant after controlling for age, pregravid body mass index, and pregnancy intention. GWG and significant longitudinal effects became insignificant when controlling for gestational age or baseline depressive symptoms and stress, respectively.ConclusionsThe results showed that sleep problems were associated with maternal mental health problems during pregnancy. Longitudinal studies using standardized measures, particularly diagnostic interviews and physiological or biochemical markers, are warranted to confirm patterns of risk factors, their association with depressive symptoms and stress during the course of pregnancy, and their effects on mother’s and child’s health.

Activation of AMPK in Human Placental Explants Impairs Mitochondrial Function and Cellular Metabolism

Adenosine monophosphate-activated protein kinase (AMPK) is a cellular energy sensor whose phosphorylation increases energy production. We sought to evaluate the placenta-specific effect of AMPK activation on the handling of nutrients required for fetal development. Explants were isolated from term placenta of 29 women (pregravid body mass index: 29.1 ± 9.9 kg/m2) and incubated for 24 hours with 0 to 100 µmol/L resveratrol or 0 to 1 mmol/L of 5-aminoimidazole-4-carboxyamide ribonucleoside (AICAR). Following treatment, uptake and metabolism of radiolabeled fatty acids and glucose were measured. Phosphorylation of AMPK was measured by Western blotting. Adenosine diphosphate (ATP) production was assessed using the mitochondrial ToxGlo assay kit. P < .05 was considered statistically significant. Resveratrol and AICAR increased AMPK phosphorylation in human placental explants. Exposure to resveratrol decreased the uptake of polyunsaturated fatty acids, arachidonic acid, and docosahexaenoic acid at 100 µmol/L ( P < .0001). Fatty acid oxidation was decreased by 100 µmol/L ( P < .05) resveratrol, while esterification was unchanged. Resveratrol decreased glucose uptake at the 50 and 100 µmol/L doses ( P < .05). Glycolysis was not significantly affected. AICAR had similar effects, decreasing fatty acid uptake and glycolysis ( P < .05). Production of ATP declined at doses found to decrease nutrient metabolism ( P < .05). Activation of AMPK in the human placenta leads to global downregulation of metabolism, with mitotoxicity induced at the doses of resveratrol and AICAR used to activate AMPK. Although activation of this pathway has positive metabolic effects on other tissues, in the placenta there is potential for harm, as inadequate placental delivery of critical nutrients may compromise fetal development.

Maternal BMI and weight gain in singleton pregnancies: has something changed in the last decade?

Aim: To assess the trend of the pregravid body mass index (BMI), pregnancy weight gain, and BMI gain in singleton pregnancies delivered at ≥38 completed weeks during the last decade.Materials and methods: We used data from a population-based dataset for the period of 2006–2015. Linear regression was used to assess the relationship between BMI, pregnancy weight gain, and BMI change over time.Results: A total of 70,866 women were included and stratified as primiparous and multiparous. The average BMI in the primiparous women increased 0.52 kg/m2 in the past decade, increasing for 0.05 kg/m2 every year. The average pregnancy weight gain in this group decreased in this period by 0.7 kg, consequently lowering for 0.07 kg per year, the average BMI change during pregnancy decreased overall by 0.26 kg/m2 (0.026 kg/m2/year). However, in multiparous women, the average pregravid BMI did not change over time, but the average pregnancy weight gain decreased by 0.21 kg (0.021 kg/year), and the average BMI change decreased for 0.10 kg/m2.Conclusions: Our study showed that the pregravid BMI is increasing in the pregnant primiparous women, but the BMI gain, as well as the pregnancy weight gain, decreased irrespective of parity. Given that the range of differences is not clinically significant, we conclude that pregravid BMI, pregnancy weight gain, and BMI change during pregnancy did not change in the last decade.

Gestational weight gain and pregnancy outcome in women with excessive pre-pregnancy body mass index

Aim: To evaluate the effects of gestational weight gain on perinatal outcomes in woman with excessive pre-gravid body mass index. Material and Methods: The study group consisted of 197 overweight or obese women who delivered full-term newborns at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw. Group A included 89 (45.2%) women with inadequate or adequate weight gain. Group B included 108 patients (54.8%) with excessive weight gain during pregnancy. Results: No significant differences in the occurrence of gestational diabetes, hypertension or intrahepatic cholestasis between the analyzed groups were observed. Excessive weight gain was positively correlated with the incidence of cesarean delivery (67.6% vs 32.4%, p=0.009), newborns’ birthweight (3627g±519 vs 3406g±521, p=0.009) and the risk of low for gestational age infants (26.9% vs 12.4%, p=0.01). The highest risk of low for gestational age new born was related to gestational weight gain of about 15 kg. Appropriate preconception counselling for overweight and obese women may reduce the risk of low for gestational age infants.

Comparison of maternal serum and umbilical cord blood leptin level in IUGR neonates

Background: Gestational weight gain is an impressive factor in the fetal outcome. Intrauterine growth restriction (IUGR) is one of the most important problems during fetal period that may lead to many perinatal and long-term complications and growing neonatal morbidities and mortalities. The aim of the study was to ascertain the relationship between umbilical cord blood leptin concentration and fetal growth in neonates born with intrauterine growth restriction. Methods: Maternal serum and umbilical cord blood leptin concentration were measured by immune radiometric assay at term gestation. The study was conducted on 22 women with uncomplicated singleton pregnancies as control group (group A) and 22 women with fetal growth restriction in singleton pregnancies as case group (group B). All subjects had normal pregravid body mass index (BMI). Results: The results of the study showed that maternal serum leptin concentrations were significantly higher in group B comparing to group A (44ng/ml [28.9-58.2] vs. 24.6ng/ml [18.8-33.3]; P<0.001). However, umbilical cord blood leptin levels were significantly lower in group B comparing to group A (8.6 ng/ml [range 4.5-12.7] vs. 14.6 ng/ml [11.7-16.7]; P<0.001). Moreover, umbilical cord blood leptin levels were directly correlated with maternal BMI and neonatal birth weight in both groups. Conclusion: In growth-restricted fetuses at term, umbilical cord blood leptin concentrations were significantly lower than normal fetuses, suggesting that fetal adipose tissue is a major source for leptin production. Maternal serum leptin concentrations were higher in the presence of a growth restricted fetuses. This increas may be due to early hypoxia or an intrinsic placental mechanism, by which small placenta produces more leptin as a compensatory mechanism. Human recombinant leptin may have some roles in the treatment of IUGR fetuses in future.

Breastfeeding Discontinuation Not Associated with Maternal Pregravid BMI But Associated with Native Hawaiian or Other Pacific Islander Race in Hawaii and Puerto Rico WIC Participants.

Objectives This study investigated the association between maternal pregravid body mass index (BMI) and breastfeeding discontinuation at 4-6months postpartum in Hawaii and Puerto Rico participants from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Methods A secondary data analysis was conducted from a text message-based intervention in WIC participants in Hawaii and Puerto Rico. The analysis included 87 women from the control group who initiated breastfeeding and whose breastfeeding status was known at the end of the study when infants were 4-6months old. Pregravid BMI and breastfeeding discontinuation were assessed using questionnaires. Results The association between pregravid BMI and breastfeeding discontinuation was not significant in the unadjusted model or in the adjusted model. Native Hawaiian or Other Pacific Islander (NHOPI) participants showed significantly increased odds of discontinuing breastfeeding (adjusted odds ratio [AOR] 7.12; 95% CI 1.34, 37.97; p = .02) compared to all the other racial/ethnic participants, as did older women ages 32-39years versus women who were 25-31years old (AOR 4.21; 95% CI 1.13, 15.72; p = .03). Women who took vitamins while breastfeeding had decreased odds of discontinuing breastfeeding (AOR 0.15; 95% CI 0.05, 0.46; p = .0009). Conclusions for Practice Pregravid BMI was not significantly associated with breastfeeding discontinuation at 4-6months postpartum in women from Hawaii and Puerto Rico WIC, but NHOPIs and women who were older had higher odds of discontinuing breastfeeding. The results of this study may inform strategies for breastfeeding promotion and childhood obesity prevention but should be further investigated in larger studies. ClinicalTrials.gov Identifier: NCT02903186.

Modern dietary guidelines for healthy pregnancy; maximising maternal and foetal outcomes and limiting excessive gestational weight gain

Maternal dietary habits influence maternal and foetal health, representing a pathway for intervention to maximise pregnancy outcomes. Advice on energy intake is provided on a trimester basis, with no additional calories required in the first trimester and an additional 340 kcal d−1 and 452 kcal d−1 needed for the second and third trimesters. Energy intake depends on pre-gravid body mass index (BMI); underweight women are recommended an increase of 150, 200 and 300 kcal d−1 during the first, second and third trimester, normal weight women an increase of 0, 350 and 500 kcal d−1 and obese women an increase of 0, 450 and 350 kcal day−1. The recommendations for carbohydrate and protein intake are 175 g d−1 and 0.88–1.1 g kgBM d−1, with no change to fat intake. The number of pre-gravid obese women is rising; therefore, we need to regulate weight in women of childbearing age and limit gestational weight gain to within the recommended ranges [overweight women 6.8–11.3 kg and obese women 5.0–9.1 kg]. This can be achieved using nutritional interventions, as dietary changes have been shown to help with gestational weight management. As pregnancy has been identified as a risk factor for the development of obesity, normal weight women should gain 11.5–16.0 kg during pregnancy. While some research has shown that dietary interventions help to regulate gestational weight gain and promote postpartum weight loss to some extent, future research is needed to provide safe and effective guidelines to maximise these effects, while benefitting maternal and foetal health.

Women Who Bedshare More Frequently at 14 Weeks Postpartum Subsequently Report Longer Durations of Breastfeeding.

Breastfeeding rates in the United States continue to fall short of Healthy People 2020 goals. Bedsharing has been promoted as a way of increasing breastfeeding durations. We used prospectively collected Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) and PRAMS-2 data from 2276 women to explore whether bedsharing frequency predicts age at weaning. Bedsharing was assessed at 14 weeks after birth (PRAMS), and duration of breastfeeding was assessed at 2 years after birth (PRAMS-2). Cox proportional hazards models controlled for primiparity, cesarean birth, marital status, employment status, maternal race and ethnicity, and pregravid body mass index. Women in this sample reported high rates of bedsharing: only 15.7% of PRAMS respondents said they never shared a bed with their infant. We also observed a dose-response association between bedsharing frequency and breastfeeding duration when the analysis controlled for covariables: women who reported more frequent bedsharing at 14 weeks postpartum were more likely to wean later. Hazard ratios ranged from 1.18 (95% CI, 1.02-1.35) for "often" versus "always" bedsharing to 1.92 (95% CI, 1.66-2.24) for "never" versus "always." In other words, at any given infant age, women who always bedshared were more likely to keep breastfeeding. Women who always bedshared at 14 weeks postpartum breastfed their infant for a median of 13 months (95% CI, 12-14), compared with 10 months (95% CI, 9-11) for women who never bedshared at 14 weeks. Although we cannot rule out confounding by breastfeeding intention, our results suggest that bedsharing in early infancy might lead to later weaning. Regardless of infant feeding method, given the frequency of bedsharing reported by women in this and other samples, clinicians encountering pregnant and postpartum women should teach safe bedsharing practices.