Pre-pregnancy Overweight Status Research Articles

Landscape of the gut mycobiome dynamics during pregnancy and its relationship with host metabolism and pregnancy health

ObjectiveThe remodelling of gut mycobiome (ie, fungi) during pregnancy and its potential influence on host metabolism and pregnancy health remains largely unexplored. Here, we aim to examine the characteristics of...

Identification of neurodevelopmental transition patterns from infancy to early childhood and risk factors predicting descending transition

It is unclear whether neurodevelopmental progress from infancy to early childhood remains stable. Moreover, little is known about the risk factors, if any, affecting neurodevelopmental descending transition patterns and the relationship between these patterns and later childhood adaptive behaviours. We used data of 875 children from the Hamamatsu Birth Cohort Study in Japan. Children’s neurodevelopment at 18 and 32 months and adaptive behaviours at 40 months were evaluated. Perinatal factors and infant overweight status at 18 months were investigated to identify descending-transition-associated risk factors. In the latent transition analysis, ultimately, three classes were identified for each time-point, resulting in nine transition patterns; among them, 10.4% of children showed descending class shifts (normal to delayed class). Such decelerated growth was predicted by maternal pre-pregnancy overweight status (odds ratio [OR] 2.49; 95% confidence interval [CI] 1.23, 5.02), low maternal educational history (OR 1.20; 95% CI 1.04, 1.36), and infant overweight status at 18 months (OR 5.89; 95% CI 1.26, 27.45). Children with descending transition showed poor functioning in adaptive behaviours at the age of 40 months. To prevent subsequent poor adaptive functioning, it may be necessary to consider that a certain percentage of children show decelerated growth.

The Association between the Type of Delivery and Factors Associated with Exclusive Breastfeeding Practice among Polish Women-A Cross-Sectional Study.

The type of delivery influences breastfeeding, both in terms of initiation and duration. The aim of the study was to determine the association between the type of delivery and factors associated with exclusive breastfeeding (EBF) practice among Polish women. Data on sociodemographic variables, pre-pregnancy weight, height, course of pregnancy, type of delivery and duration of breastfeeding were collected using a Computer-Assisted Web Interview. Of the 1024 breastfeeding women who participated in the study, 59.9% gave birth vaginally and 40.1% gave birth by caesarean section. The chance of starting EBF [OR: 0.478; 95% Cl: 0.274, 0.832] and continuing it for four months [OR: 0.836; 95% Cl: 0.569, 0.949] was lower in the case of caesarean delivery. Starting EBF was negatively affected by pre-pregnancy overweight status and obesity in the case of caesarean delivery. EBF practice for four months was negatively affected by age [18–24 years and 25–34 years], elementary education and average income [2001–4000 PLN] in the case of caesarean delivery. A negative impact on the chance of EBF for six months was also observed for younger age [18–24 years], elementary and secondary education and average income [2001–4000 PLN] in the case of caesarean delivery. There was no association between starting EBF and age, net income, place of living, pregnancy complications or the child′s birth weight category in the case of both subgroups, as well as between education and previous pregnancies in the case of vaginal delivery. These results suggest that women who deliver by caesarean section need additional breastfeeding support.

Maternal pre-pregnancy underweight is associated with underweight and low bone mass in school-aged children

A number of studies have reported that pre-pregnancy overweight status is associated with offspring obesity, yet only a few studies have examined pre-pregnancy underweight status as it associates with offspring health. The aim of the present study was to assess the effect of pre-pregnancy underweight status in a mother on health outcomes in her offspring. To this end, the primary outcome examined in the present study was underweight status in the offspring, with a secondary outcome of offspring low bone mass. The present retrospective cohort study, conducted from 2008 to 2011, targeted a source population of all students registered as fifth-graders at three public elementary schools in Hamamatsu and Fukuroi cities. Maternal height and weight before and after pregnancy and offspring weight and height at birth were obtained from the Maternal and Child Health Handbook. Offspring weight and height at age 10years were measured using standard procedures. Offspring total body less head (TBLH) bone mineral content (BMC) was determined with a dual-energy X-ray absorptiometry scanner. Pre-pregnancy underweight status was found to be associated with an increased risk of an underweight status in female offspring (OR = 2.88, 95% CI 1.06-7.81). Offspring TBLH BMC in the underweight mother group was significantly lower than that in the non-underweight mother group. We determined that pre-pregnancy underweight status was more likely to lead to an underweight status and low TBLH BMC in school-aged offspring.

Educational Attainment and Gestational Weight Gain among U.S. Mothers

BackgroundEducation is an important social determinant of many health outcomes, but the relationship between educational attainment and the amount of weight gained over the course of a woman's pregnancy (gestational weight gain [GWG]) has not been established clearly. MethodsWe used data from 1979 through 2010 for women in the National Longitudinal Survey of Youth (1979) cohort (n = 6,344 pregnancies from 2,769 women). We used generalized estimating equations to estimate the association between educational attainment and GWG adequacy (as defined by 2009 Institute of Medicine guidelines), controlling for diverse social factors from across the life course (e.g., income, wealth, educational aspirations and expectations) and considering effect measure modification by race/ethnicity and prepregnancy overweight status. ResultsIn most cases, women with more education had increased odds of gaining a recommended amount of gestational weight, independent of educational aspirations and educational expectations and relatively robust to sensitivity analyses. This trend manifested itself in a few different ways. Those with less education had higher odds of inadequate GWG than those with more education. Among those who were not overweight before pregnancy, those with less education had higher odds of excessive GWG than college graduates. Among women who were White, those with less than a high school degree had higher odds of excessive GWG than those with more education. ConclusionThe relationship between educational attainment and GWG is nuanced and nonlinear.

Prepregnancy body mass index, gestational weight gain, and elevated depressive symptoms in a Hispanic cohort.

Our objective was to assess the associations among prepregnancy Body Mass Index (BMI), gestational weight gain (GWG), and elevated depressive symptoms across pregnancy. We evaluated these associations among 1,090 participants in Proyecto Buena Salud, a prospective cohort study of Hispanic (predominantly Puerto Rican) women in Western Massachusetts. BMI and GWG were self-reported; GWG was classified according to the 2009 Institute of Medicine guidelines. Depressive symptoms were assessed in early, mid-, and late pregnancy using the 10-item Edinburgh Postnatal Depression Scale (EPDS). We defined elevated depressive symptoms as EPDS scores ≥13 and ≥15. In multivariable, longitudinal modeling, overweight (25.0 to <30 kg/m2) women had an odds ratio of 0.53 (95% CI [0.31, 0.90]) for EPDS scores ≥13 and 0.51 (95% CI [0.28, 0.91]) for EPDS scores ≥15 compared to normal weight women. We did not observe an association between GWG or an interaction between BMI and GWG, in predicting elevated depressive symptoms. Our findings provide preliminary support for an association of prepregnancy overweight status and lower depressive symptoms across pregnancy in Hispanic women. Future research should focus on potential social and cultural differences in perceptions of weight and weight gain in the perinatal period and how these influence psychological health.

Abstract 20038: Maternal Pre-Pregnancy Overweight is Associated with Increased Cardiovascular Disease Mortality in the Framingham Heart Study

Introduction: In the U.S., obesity among women of childbearing age is highly prevalent. Maternal obesity is associated with offspring obesity and cardiovascular disease (CVD) risk factors, potentially through epigenetic and early developmental mechanisms. There is limited evidence on the association of maternal overweight with offspring CVD events and mortality. Methods: We analyzed prospectively collected data from 1971 to 2012 on 879 Framingham Heart Study Offspring cohort participants with either directly measured pre-pregnancy maternal body mass index (BMI) (n=361) or offspring-reported maternal pre-pregnancy overweight status (n=518). Our outcomes included a composite measure of any CVD event or mortality, CVD mortality and all-cause mortality. Cox proportional hazard models were conducted, initially age and sex adjusted, and then additionally adjusted for potential mediators including traditional CVD risk factors. Pharmacologic treatments for diabetes, hypertension, and/or dyslipidemia were included as time-varying covariates. Results: Maternal pre-pregnancy overweight (BMI &gt;= 85th percentile or self-report) was available for 879 Framingham Offspring Study participants (mean age [SD] at baseline 30 [5] years; 49% female; mean follow-up [SD] 32 [8] years). There were 193 CVD events, 28 CVD deaths, and 138 total deaths among the offspring. Maternal overweight was associated with an increased hazard ratio (HR) with CVD mortality (HR 10.5 [2.6-43]; p=0.001), all-cause mortality (HR 3.1 [1.5-6.4]; p=0.002), and marginally associated with the composite endpoint of CVD events and mortality (HR 1.7 [95% CI 0.99-2.8]; p=0.05). Adjustment for offspring BMI, diabetes, hypertension, and dyslipidemia attenuated the associations. In sensitivity analyses restricted to only those with directly measured maternal pre-pregnancy BMI, effect estimates remained robust (similar hazard ratios but larger confidence intervals). Conclusions: Maternal pre-pregnancy overweight is associated with offspring CVD mortality. The association is likely mediated in part through classical CVD risk factors such as offspring obesity, hypertension, diabetes, and dyslipidemia.

Maternal Birthweight Is Associated with Subsequent Risk of Vitamin D Deficiency in Early Pregnancy

Maternal low birthweight and vitamin D deficiency in pregnancy are associated with a similar spectrum of adverse pregnancy outcomes including pre-eclampsia and gestational diabetes. However, the relationship between maternal birthweight and subsequent vitamin D concentrations in early pregnancy is largely unknown. We assessed whether self-reported maternal birthweight was associated with risk of early pregnancy vitamin D deficiency (≤20 ng/mL) among a pregnancy cohort (n = 658). Serum 25-hydroxyvitamin D [25(OH)D] was measured using liquid chromatography-tandem mass spectroscopy. Adjusting for maternal characteristics and month of blood draw, a 100-g higher maternal birthweight was associated with a 5.7% decreased risk of early pregnancy 25(OH)D deficiency [odds ratio (OR) = 0.94; 95% confidence interval (CI) 0.90, 0.99]. Low-birthweight (<2500 g) women were 3.7 times as likely to have early pregnancy 25(OH)D deficiency compared with normal-birthweight women [OR = 3.69; 95% CI 1.63, 8.34]. These relationships were not modified by either pre-pregnancy overweight status [body mass index (BMI) ≥25 kg/m(2)] or adulthood weight trajectory (BMI change ≥2 kg/m(2) from age 18 to pre-pregnancy). Further research on shared developmental mechanisms that determine birthweight and vitamin D homeostasis may help identify targets and related preventative measures for adverse pregnancy and birth outcomes.

Periconceptional multivitamin use and risk of preterm or small-for-gestational-age births in the Danish National Birth Cohort

The intake of periconceptional multivitamins may decrease the risk of preterm births (PTBs) or small-for-gestational-age (SGA) births. We related the timing and frequency of periconceptional multivitamin use to SGA births and PTBs and its clinical presentations (ie, preterm labor, premature rupture of membranes, and medical induction). Women in the Danish National Birth Cohort (n = 35,897) reported the number of weeks of multivitamin use during a 12-wk periconceptional period. Cox regression was used to estimate the relation between any multivitamin use and PTBs (<37 wk) or SGA births (birth weight adjusted for gestational age >2 SDs below the mean on the basis of fetal growth curves). The timing (preconception and postconception) and frequency of use were also analyzed. Regular users (4-6 wk) and partial users (1-3 wk) in each period were compared with nonusers. The association between periconceptional multivitamin use and PTBs varied according to prepregnancy overweight status (P-interaction = 0.07). Regular preconception and postconception multivitamin use in women with a prepregnancy BMI (in kg/m(2)) <25 was associated with reduced risks of a PTB (HR: 0.84; 95% CI: 0.73, 0.95) and preterm labor (HR: 0.80; 95% CI: 0.69, 0.94). No similar associations were shown for overweight women. The adjusted risk of an SGA birth was reduced in multivitamin users regardless of their prepregnancy BMI (HR: 0.83; 95% CI: 0.73, 0.95), with the strongest association in regular users in the postconception period. Regular periconceptional multivitamin use was associated with reduced risk of SGA births and PTBs in nonoverweight women.

Pre-Pregnancy Overweight Status between Successive Pregnancies and Pregnancy Outcomes

The two objectives of this study were to (1) examine factors associated with changes in pre-pregnancy overweight to pre-pregnancy normal/underweight or obese Body Mass Index (BMI) in the subsequent pregnancy, and (2) assess select pregnancy and newborn outcomes associated with changes in pre-pregnancy BMI. Birth certificates from 1995-2004 for residents of Kansas City, Missouri, were used to identify overweight nulliparous women who had a singleton birth and subsequently a second singleton birth. Maternal factors associated with changes in BMI between pregnancies were determined. Hypertension in pregnancy, preterm birth, emergency cesarean section, small-for-gestational age, and large-for-gestational age outcomes were examined. At second pregnancy, 55% of the women remained overweight, 33% were obese, and 12% had normal/underweight BMIs. The upward shift in BMI was associated with being unmarried and having a birth interval of 18 or more months, while the downward shift was associated with gestational weight gain. Of the five outcomes variables, only emergency cesarean section was significantly associated with an upward shift in BMI. Clinical interventions for pre-pregnancy overweight women should focus on appropriate weight gain during pregnancy and motivators for loss of pregnancy-related weight during the postpartum period.

Maternal fatty acid intake and fetal growth: evidence for an association in overweight women. The 'EDEN mother-child' cohort (study of pre- and early postnatal determinants of the child's development and health).

Recent studies suggest a benefit of seafood and n-3 fatty acid intake on fetal growth and infant development. The objective was to study the association between fatty acid intake and fetal growth in pregnant French women. Pregnant women included in the EDEN mother-child cohort study completed FFQ on their usual diet: (1) in the year before pregnancy and (2) during the last 3 months of pregnancy (n 1439). Conversion into nutrient intakes was performed using data on portion size and a French food composition table. Associations between maternal fatty acid intakes and several neonatal anthropometric measurements were studied using linear regressions adjusted for centre, mother's age, smoking habits, height, parity, gestational age and newborn's sex. Due to significant interaction, analyses were stratified according to maternal pre-pregnancy overweight status. Neither total lipid nor SFA, MUFA or PUFA intake was significantly associated with newborn size. In overweight women only (n 366), a high pre-pregnancy n-3 fatty acid intake (% PUFA) was positively associated with the newborn's birth weight (P=0.01), head, arm and wrist circumferences and sum of skinfolds (P<0.04). A substitution of 1% of n-3 fatty acids per d before pregnancy by other PUFA was related to an average decrease in birth weight of 60 g (P=0.01). Relationships with n-3 fatty acid intake at the end of pregnancy were weaker and not significant. We concluded that a high pre-pregnancy n-3 fatty acid:PUFA ratio may sustain fetal growth in overweight women. Follow-up of the children may help determine whether this has beneficial consequences for the child's health and development.

Risk of preeclampsia in relation to maternal history of migraine headaches

Objective. We examined the relationship between migraines and preeclampsia risk.Study design. Cases were 244 women with preeclampsia and controls were 470 normotensive women. Women were asked if a physician had ever told them that they had migraines. Odds ratios (OR) and 95% confidence intervals (CI) were calculated.Results. A history of migraines was associated with a 1.8-fold increased risk of preeclampsia (95% CI 1.1–2.7). Women who were 30+ years old when diagnosed with migraines had the highest risk (OR 2.8, 95% CI 0.8–9.0). The migraine–preeclampsia association appeared to be modified by pre-pregnancy overweight status (p = 0.06). Overweight migrainous women, compared with lean nonmigrainous women, had a 12-fold increased preeclampsia risk (95% CI 5.9–25.7).Conclusion. Our findings are consistent with reports from six of eight previous studies on the topic. Nevertheless, prospective cohort studies are needed to further evaluate the extent to which migraines and/or its treatments are associated with preeclampsia risk.

380-S: Hepatic Lipase Gene Polymorphism, Prepregnancy Overweight Status and Risk of Preeclampsia Among Peruvian Women

380-S: Hepatic Lipase Gene Polymorphism, Prepregnancy Overweight Status and Risk of Preeclampsia Among Peruvian Women

Maternal pre-pregnancy overweight status and obesity as risk factors for cesarean delivery

Objective. To determine the extent to which, if at all, maternal pre-pregnancy adiposity and other anthropometric factors are related to risk of cesarean delivery.Methods. This hospital-based prospective cohort study included 738 nulliparous women who initiated prenatal care prior to 16 weeks gestation. Participants provided information about their pre-pregnancy weight and height and other sociodemographic and reproductive covariates. Labor and delivery characteristics were obtained from maternal and infant medical records. Risk ratios (RR) and 95% CI were estimated by fitting generalized linear models.Results. The proportion of cesarean deliveries in this population was 26%. Women who were overweight (BMI 25.00–29.99 kg/m2) were twice as likely to deliver their infants by cesarean section as lean women (BMI < 20.00 kg/m2) (RR = 2.09; 95% CI 1.27–3.42). Obese women (BMI ⩾ 30.00 kg/m2) experienced a three-fold increase in risk of cesarean delivery when compared with this referent group (RR = 3.05; 95% CI 1.80–5.18). The joint association between maternal pre-pregnancy overweight status and short stature was additive. When compared with tall (height ⩾ 1.63 m), lean women, short ( < 1.63 m), overweight (BMI ⩾ 25.00 kg/m2) women were nearly three times as likely to have a cesarean delivery (RR = 2.79; 95% CI 1.72–4.52).Conclusion. Our findings suggest that nulliparous women who are overweight or obese prior to pregnancy, and particularly those who are also short, have an increased risk of delivering their infants by cesarean section.

Hepatic lipase gene polymorphism, pre-pregnancy overweight status and risk of preeclampsia among Peruvian women

We examined the association between the hepatic lipase (LIPC) gene promoter polymorphism (−514C/T) and risk of preeclampsia among Peruvian women. We also evaluated whether this association is modified by maternal pre-pregnancy overweight status. Using a case control study design, 157 preeclampsia cases and 180 normotensive controls were enrolled in the study. Genotyping was conducted using PCR amplification, NlaIII enzyme digestion and gel electrophoresis. Logistic regression procedures were used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CI). After adjusting for confounding by maternal age, parity and pre-pregnancy body mass index (BMI), the relative risks of preeclampsia for women with LIPC −514CT and LIPC −514TT genotypes were 1.0 (95% CI 0.5–2.2) and 1.5 (95% CI 0.7–3.3) respectively, using women with LIPC −514CC genotype as a reference. Women who were both overweight and who had the LIPC −514TT genotype had a significant 3-fold increased risk of preeclampsia (Adj. OR:3.0 95% CI 1.3–6.8) as compared to those women who were not overweight and had the LIPC −514CC/CT genotype. In this study, we found that LIPC −514TT genotype and overweight status, when occurring together, were associated with a 3-fold increase in risk of preeclampsia among Peruvian women.

A prospective study of maternal serum C-reactive protein concentrations and risk of preeclampsia

Background We measured C-reactive protein (CRP), a clinical marker of systemic inflammation, in maternal serum collected at 13 weeks gestation on average, to determine whether elevations precede the clinical manifestation of preeclampsia. Methods Using a prospective, nested, case-control study design we measured CRP concentrations using a competitive immunoassay in 60 women who developed preeclampsia and in 506 women who remained normotensive throughout pregnancy. Logistic regression procedures were used to calculate odds ratio (OR) and 95% CI. Because maternal serum CRP is highly correlated with maternal prepregnancy body mass index (BMI), all analyses were repeated after stratification by maternal prepregnancy overweight status (BMI <25 v ≥25 kg/m 2). Results Overall, the risk of preeclampsia increased across successively higher tertiles of CRP (OR = 1.0, 1.6, and 3.5, with the lowest tertile as the referent group; P < .001 for trend). After adjusting for parity and first-degree family history of chronic hypertension, the OR in the highest tertile was 3.2 (95% CI = 1.5 to 6.7). Further adjustment for BMI greatly attenuated this association (OR = 1.8, 95% CI = 0.8 to 4.1). Elevated CRP concentrations (≥4.9 mg/L) were associated with a 2.5-fold increased risk of preeclampsia (95% CI = 1.1 to 5.5) in lean women. No similar association was observed among overweight women. Conclusions Elevated CRP is highly correlated with prepregnancy adiposity and appears to be an independent predictor of preeclampsia in lean women. Further work is needed to identify modifiable risk factors for systemic inflammation in early pregnancy and to explore further the extent to which CRP and prepregnancy adiposity independently and jointly contribute to preeclampsia risk.