Self-reported Pre-pregnancy Weight Research Articles

Ethnic differences in weight retention after pregnancy: the ABCD study

Postpartum weight retention contributes to the development of overweight and obesity in women of childbearing age and is more pronounced in ethnic minority groups. This study examined ethnic differences in postpartum weight retention and the explanatory role of socio-economic status (SES), mental health and lifestyle. In the Amsterdam Born Children and their Development (ABCD) study, a large multi-ethnic cohort study conducted in The Netherlands, women filled out questionnaires in the first trimester of pregnancy and 3-5 months postpartum. A total of 4213 women provided data on weight gain, ethnicity, SES, mental health and lifestyle during and after pregnancy. Postpartum weight retention was defined as a difference of ≥5 kg between self-reported pre-pregnancy and postpartum weight. The influence of ethnicity on postpartum weight retention was assessed in logistic regression analyses. Whether the role of ethnicity was attenuated by adding SES, mental health and lifestyle factors were subsequently investigated. Marked differences in weight change during and after pregnancy were found between ethnic groups. Turkish women had significantly more weight retention than Dutch women. This difference could not be explained by other factors. In the prevention of postpartum weight retention, no single approach seems applicable to all ethnic groups. During pregnancy, health professionals should focus on Turkish women in particular, as they appear to have the highest risk of weight retention.

575: Prenatal risk-drinking screening: T-ACER3 reduces T-ACE false positives

T-ACER3 reduces T-ACE false positives Lisa Chiodo, Robert Sokol, John Hannigan, James Janisse, Grace Patterson, Virginia Delaney-Black Wayne State University School of Medicine, Pediatrics, Detroit, MI, Wayne State University School of Medicine, Obstetrics and Gynecology, Detroit, MI, Wayne State University School of Medicine, Family Medicine, Detroit, MI, Wayne State University School of Medicine, Children’s Research Center of Michigan, Detroit, MI OBJECTIVE: Preventing Fetal Alcohol Spectrum Disorders (FASD) depends on obstetricians detecting maternal risk drinking during antenatal care. ACOG and NIAAA recommend using the T-ACE, an economical/sensitive screen. We have reported that a more stringent T-ACE total score cut-point (3 vs. 2) increased specificity in identifying maternal risk drinking & alcohol-related neurobehavioral dysfunction in children (Chiodo et al, 2010). Our aim was to assess how increasing the T-ACE cut-point could increase efficiency of clinical practice. STUDY DESIGN: Self-reported peri-conceptional & in-pregnancy drinking were assessed with semi-structured interviews and alcohol screens in a prospective sub-sample of 239 African-American mothers given an in-pregnancy T-ACE. The original T-ACE risk criterion (total score of 2) and the revised T-ACER3 criterion with a total score of 3 were analyzed. ANOVA and post-hoc comparisons compared preand in-pregnancy alcohol consumption quantity and frequency measures by risk category. Categories were: 1) No Risk Group (NRG) no risk for pregnancy alcohol use based on both T-ACE and T-ACER3 criteria (n 140); 2) At Risk Group (ARG) based on both T-ACE and T-ACER3 criteria (n 28); and 3) Change Risk Group (CRG) identified as at-risk with the original T-ACE criterion but not at-risk using the revised T-ACER3 criterion (n 71). RESULTS: The 71 women (30%) in the Change Risk Group (CRG) had patterns of alcohol use similar to the no risk group (NRG). As predicted, post-hoc analysis revealed that the at-risk group (ARG) had significantly more alcohol use both prior to and during pregnancy than either the NRG or CRG groups. CONCLUSION: The results provide further evidence that adjusting the T-ACE total score cut-point to 3 in the T-ACER3 is clinically appropriate. Using the T-ACER3 criteria, only 12% of women would require intervention, compared with 41% for T-ACE. Increasing the total T-ACE score criterion from 2 to 3 results in fewer “false positives,” allowing a more intensive targeted clinical response with pregnant women correctly identified by the T-ACER3 as drinking at fetal risk levels. 576 Excess gestational weight gain leads to post-partum weight retention Shilpi Mehta-Lee, Linzhi Xu, Jennifer Lischewski Goel, Mindy Brittner, Peter Bernstein, Karen Bonuck NYU Langone Medical Center, Obstetrics & Gynecology, New York, NY, Albert Einstein College of Medicine, Department of Family and Social Medicine, Bronx, NY, UMDNJRobert Wood Johnson Medical School, Medical School, New Brunswick, NJ, Albert Einstein College of Medicine/Montefiore Medical Center, Obstetrics & Gynecology and Women’s Health, Bronx, NY OBJECTIVE: Excessive gestational weight gain (GWG) has been linked to post-partum weight retention and long-term adverse health outcomes. We sought to determine if patients at 2 Bronx health clinics with excess GWG by Institute of Medicine (IOM) guidelines were more likely to have post-partum weight retention than those who gained at or under the recommended guidelines. STUDY DESIGN: Data are from participants in 2 randomized, controlled trials of pre-natal care based breastfeeding interventions. 941 women with 12-26 week, singleton pregnancies, were enrolled from 2008-2010. Those with pre-pregnancy self-reported weight and height, and a post-partum weight available were included. 2009 IOM guidelines were used to define excess GWG by BMI category. Postpartum weight retention was calculated using a measured weight at the first post-partum visit minus self-reported pre-pregnancy weight. Multivariate analysis of covariance was employed to compare the mean post-partum weight retention by normal v. excess GWG. RESULTS: 404 women met inclusion criteria. Demographic characteristics were similar between groups. Women with excess GWG were more likely to have higher pre-pregnancy BMI (28.6[6.2] v. 27.3[6.2]; p 0.041), deliver at a later gestational age (39.2[1.8] v. 38.6[2.4] weeks; p 0.009) and enroll in WIC (54% v 37%; p 0.001). (Table) In multivariate analysis adjusted for age, parity, race, pre-pregnancy BMI, WIC use, employment, education and the number of weeks post-partum, women gaining within recommended IOM guidelines had retained a mean of 7.2 lbs. at their first post-partum visit, whereas those with excess GWG had mean weight retention of 23.7 lbs, a difference of 16.6 lbs (p 0.001). CONCLUSION: In an urban prenatal population, excess GWG was predictive of higher post-partum weight retention regardless of age, weight, BMI, race, socioeconomic indicators, or weeks post-partum. This weight retention can have long-term consequences. This increased risk of weight retention should be added to the list of poor outcomes associated with excess GWG, and interventions are needed to address this issue postpartum. PosterSessionIV Epidemiology, Infectious Disease, Intrapartum Fetal Assessment, Operative Obstetrics, Obstetric Quality & Safety, Public Health-Global Health www.AJOG.org

Women’s reported weight: is there a discrepancy?

Objective: To compare self-reported pre-pregnancy weight & delivery weight with documented pre-pregnancy & delivery weight and determine whether there are differences compared with the Institute of Medicine’s (IOM) guidelines. Methods: This is a retrospective analysis of 234 women. Inclusion criteria included documented height, self-reported pre-pregnancy weight, self-reported delivery weight, documented pre-pregnancy weight ± 12 weeks from last menstrual period, and documented delivery weight ± 2 weeks from delivery. We determined the difference between self-reported pre-pregnancy weight vs. documented pre-pregnancy weight and self-reported delivery weight vs. documented delivery weight. Using documented pre-pregnancy weight and documented delivery weight, we calculated gestational weight gain (GWG) relative to IOM criteria. Results: Self-reported pre-pregnancy weight was 2.94 kg less than documented pre-pregnancy weight (p < 0.0001). Self-reported BMI was 1.11 mg/kg2 less than documented BMI (p < 0.0001). Self-reported GWG was 3.01 kg greater than documented GWG (p < 0.0001). Ninety-eight percent of normal weight correctly classified pregravid BMI in contrast to 86% of obese (p < 0.005) and 73% of overweight (p < 0.001). Conclusions: Overweight and obese women underestimated self-reported pre-pregnancy weight & overestimated GWG, thereby mistakenly categorizing IOM guidelines.

Prepregnancy Obesity Trends Among Low-Income Women, United States, 1999–2008

There is limited data on prepregnancy obesity trends specifically among low-income women, a population at high risk for obstetric complications. Using the Pregnancy Nutrition Surveillance System, we assessed prepregnancy obesity [body mass index (BMI) ≥ 30 kg/m(2)] trends among women who participated in the Supplemental Nutrition Program for Women, Infants, and Children in 1999, 2004, and 2008. Prepregnancy BMI was calculated using measured height and self-reported prepregnancy weight. We report unadjusted contributor (state, territory or Indian tribal organization) specific trends, and both unadjusted and adjusted overall trends, to account for changes in maternal age and race-ethnic distributions, using 1999 as the referent. Of the 27 contributors in 1999, 2 had a prepregnancy obesity prevalence <20%, and 1 had a prevalence ≥ 30%. Of the 35 contributors in 2008, none had a prepregnancy obesity prevalence <20%, and 14 had a prevalence ≥ 30%. From 1999 to 2008, the overall prevalence of prepregnancy obesity increased among all racial-ethnic groups, except among American Indian/Alaskan Natives, where it remained high, but stable. Overall prepregnancy obesity increased most rapidly among Hispanics, and remained stable from 2004 to 2008 among non-Hispanic blacks. In 2008, prevalence was highest among American Indian/Alaskan Natives (36.1%) and lowest among Asians/Pacific Islanders (10.8%). The adjusted prepregnancy obesity prevalence increased from 24.8% in 1999 to 28.3% in 2008, a relative increase of 14.1%. Prepregnancy obesity among low-income women increased from 1999 to 2008 and varied by race-ethnicity. These data can be used by obesity prevention programs to better target high-risk women.

Maternal ethnicity and pre‐eclampsia in New York City, 1995–2003

Studies on ethnic differences in the risk of pre-eclampsia are limited. We linked birth records for 902,460 singleton births for the period 1995-2003 in New York City with hospital discharge data to evaluate the association between ethnicity and the risk of pre-eclampsia and compare risks between US-born and foreign-born women. Logistic regression models adjusted for maternal age, maternal education, parity, self-reported pre-pregnancy maternal weight, smoking during pregnancy and year of delivery were used to compare each ethnic group with non-Hispanic White women. The prevalence of pre-eclampsia in this study population was 3.2%. Among the major ethnic groups considered in our study, East Asian women had the lowest risk of pre-eclampsia (1.4%) and Mexican women had the highest risk (5.0%). Compared with non-Hispanic White women, there was a slightly decreased risk for East Asian women (adjusted OR = 0.8, [95% CI 0.7, 0.8]), similar risk for North African women (adjusted OR = 1.1, [95% CI 0.9, 1.3]), and increased risk for all other major ethnic groups (adjusted ORs: 1.3, 2.9), with the highest risk for Mexican women (adjusted OR = 2.9, [95% CI 2.7, 3.1]). No difference in risks was observed for US- vs. foreign-born women with the exception that foreign-born South-East Asian and Pacific Islanders had an increased risk of pre-eclampsia (adjusted OR = 1.8, [95% CI 1.0, 3.1]) relative to those born in the US. We concluded that there was ethnic heterogeneity in the development of pre-eclampsia among women in New York City and that Asian subgroups should be examined separately in future studies on ethnicity. Our results should contribute to screening for pre-eclampsia taking ethnic variation into account, and may help to suggest leads for the study of the aetiology of the condition.

Are Canadian women achieving a fit pregnancy? A pilot study.

Canadian recommendations exist for energy intake (EI), physical activity (PA) and gestational weight gain (GWG) to help pregnant women avoid excessive GWG and attain "fit pregnancies". Our objectives were: 1) to measure daily EI, PA and GWG to observe whether pregnant women were meeting recommendations, 2) to explore the impact of health care provider advice on PA and GWG, and 3) to determine behaviours associated with recommended weekly GWG. Women (n = 81) were recruited from prenatal classes. Current weight and self-reported pre-pregnancy weight were documented. Current PA levels and provider advice for PA and GWG were surveyed using questionnaires. Dietary recalls and pedometer steps were recorded for three and seven days respectively. The majority of our women were classified as having average pre-pregnancy body mass indices (BMI) of 23.3 +/- 4 kg/m2, average EI of 2237 kcal/d and energy expenditure (EE) of 2328 kcal/d, but with weekly rates of GWG in excess of current recommendations despite having received advice about GWG (74%) and PA (73%). Most were classified as sedentary (< 5000 steps/day (d)) and 36% as low active (< 7500 steps/d). Women were most likely to achieve appropriate GWG if their total PA was > 8.5 MET-hr/wk. Health care providers need to provide appropriate PA and GWG guidelines to pregnant women. Development of pregnancy step and MET-hr/wk recommendations are warranted in order to promote greater PA during pregnancy.

Are Canadian Women Achieving a Fit Pregnancy? A Pilot Study

Objectives: Canadian recommendations exist for energy intake (EI), physical activity (PA) and gestational weight gain (GWG) to help pregnant women avoid excessive GWG and attain “fit pregnancies”. Our objectives were: 1) to measure daily EI, PA and GWG to observe whether pregnant women were meeting recommendations, 2) to explore the impact of health care provider advice on PA and GWG, and 3) to determine behaviours associated with recommended weekly GWG. Methods: Women (n=81) were recruited from prenatal classes. Current weight and self-reported pre-pregnancy weight were documented. Current PA levels and provider advice for PA and GWG were surveyed using questionnaires. Dietary recalls and pedometer steps were recorded for three and seven days respectively. Results: The majority of our women were classified as having average pre-pregnancy body mass indices (BMI) of 23.3 ± 4 kg/m2 , average EI of 2237 kcal/d and energy expenditure (EE) of 2328 kcal/d, but with weekly rates of GWG in excess of current recommendations despite having received advice about GWG (74%) and PA (73%). Most were classified as sedentary ( 8.5 MET-hr/wk. Conclusion: Health care providers need to provide appropriate PA and GWG guidelines to pregnant women. Development of pregnancy step and MET-hr/wk recommendations are warranted in order to promote greater PA during pregnancy. Key words: Physical activity; pregnancy; gestational weight gain; information resources; steps

Maternal Obesity and the Risk of Infant Death in the United States

Maternal obesity (defined as prepregnancy body mass index [BMI] >or=30 kg/m) is associated with increased risk of neonatal death. Its association with infant death, postneonatal death, and cause-specific infant death is less well-characterized. We studied the association between maternal obesity and the risk of infant death by using 1988 US National Maternal and Infant Health Survey data. A case-control analysis of 4265 infant deaths and 7293 controls was conducted using SUDAAN software. Self-reported prepregnancy BMI and weight gain were used in the primary analysis, whereas weight variables in medical records were used in a subset of 4308 women. Compared with normal weight women (prepregnancy BMI = 18.5-24.9 kg/m) who gained 0.30 to 0.44 kg/wk during pregnancy, obese women had increased risk of neonatal death and overall infant death. For obese women who had weight gain during pregnancy of <0.15, 0.15 to 0.29, 0.30 to 0.44, and >or=0.45 kg/wk, the adjusted odds ratios of infant death were 1.75 (95% confidence interval = 1.28-2.39), 1.42 (1.07-1.89), 1.59 (1.00-2.51), and 2.87 (1.98-4.16), respectively. Nonobese women with very low weight gain during pregnancy also had a higher risk of infant death. The subset with weight information from medical records had similar results for recorded prepregnancy BMI and weight gain. Maternal obesity was associated with neonatal death from pregnancy complications or disorders relating to short gestation and unspecified low birth weight. Maternal obesity is associated with increased overall risk of infant death, mainly neonatal death.

Effects of Gestational Weight Gain and Physical Activity on Postpregnancy Weight Gain and Body Composition

Retaining weight gained during pregnancy is a risk factor for a woman becoming overweight, obese, and/or increasing body fatness later in life. Pregnancy weight gain has been found to be directly related to weight retention several years following delivery. However, less is known about whether physical activity may affect postpartum weight retention or maternal body composition. PURPOSE: The purpose of this study was to examine the relationship of pregnancy weight gain, postpartum and current physical activity, to maternal body weight change over the past six years, and current body fatness. METHODS: Daily leisure time physical activity was quantified in 56 women (31 were available for this follow-up study) at 20 and 32 weeks gestation and 12 weeks postpartum. Weight gain during pregnancy was calculated by subtracting women's self-reported prepregnancy weight from body weight measured in our laboratory at approximately 32 weeks gestation. Bioelectrical Impedance Analysis was used to assess current fat free mass. Percent body fat was calculated using fat free mass and measured weight. A Modifiable Activity Questionnaire was used to assess 12 week postpartum and current physical activity levels in kcal/day/kg. Stepwise regression was used to predict weight change and current % body fat using pregnancy weight gain, physical activity at 12 weeks postpartum, and current physical activity levels as predictor variables. RESULTS: On average, the women's body weights increased 2.8 (±5.1) kg in the six years following pregnancy, with current fatness levels averaging 32±9 %. Change in body weight in the past six years was related most strongly to weight gain during pregnancy (r2=0.20), with current physical activity adding to the prediction model (final r2=0.27). In contrast, current % body fat was most strongly predicted by postpartum physical activity (r2=0.20), although pregnancy weight gain accounted for 14% additional variance (final r2=0.34) in fatness. CONCLUSIONS: Although weight gained during pregnancy was found to be more influential on long term body weight change compared to exercise performed after delivery, initiating a program of regular physical activity during the postpartum period appears to have a greater effect on body composition.

Pregnancy weight gain from 1960s to 2000 in Finland

To study secular trends in average pregnancy weight gain between the 1960s and 2000 in Finland, and whether the changes were related to body mass index (BMI), age or parity. Three cross-sectional population surveys in Finland from three different periods. Women who were pregnant in Helsinki in the period 1954-1963 (N=2262), or in Tampere in the period 1985-1986 (N=1771) or in 2000-2001 (N=371). Pregnancy weight gain was determined from self-reported prepregnancy weight and measured weights during pregnancy. The mean age and prepregnancy BMI of all pregnant women increased between the 1960s and 2000 (from 26.5 to 29.6 y, from 21.9 to 23.7 kg/m(2)). The mean pregnancy weight gain, adjusted for mother's age, BMI and parity, increased from the 1960s to the mid-1980s from 13.2 to 14.3 kg. The increase was observed in all BMI categories. Compared to the 1960 cohort, the proportion of women with a pregnancy weight gain of less than 10 kg decreased and the proportion of women with a weight gain of 15 kg or more increased in the 1980 cohort. After the mid-1980s, the average pregnancy weight gain remained the same. In all cohorts, overweight women gained least weight during pregnancy, but age and parity were not associated with BMI and parity-/age-adjusted pregnancy weight gain. Higher pregnancy weight gain was associated with higher mean child's birthweight and higher proportion of high birthweight babies in all cohorts. The mean pregnancy weight gain has increased since the 1960s, which may be of importance with regard to the development of later obesity. Factors other than changes in prepregnancy BMI, age and parity must explain the increased pregnancy weight gain over time.

Maternal Obesity and Risk for Birth Defects

Several studies have shown an increased risk for neural tube defects associated with prepregnancy maternal obesity. Because few recent studies have examined the relation between maternal prepregnancy obesity and overweight and other birth defects, we explored the relation for several birth defects and compared our findings with those of previous studies. We conducted a population-based case-control study of several selected major birth defects using data from the Atlanta Birth Defects Risk Factor Surveillance Study. Mothers who delivered an infant with and without selected birth defects in a 5-county metropolitan Atlanta area between January 1993 and August 1997 were interviewed. Maternal body mass index (BMI) was calculated from self-reported maternal prepregnancy weight and height. Women with known preexisting diabetes were excluded. The risks for obese women (BMI > or =30) and overweight women (BMI 25.0-29.9) were compared with those for average-weight women (BMI 18.5-24.9). Obese women were more likely than average-weight women to have an infant with spina bifida (unadjusted odds ratio [OR]: 3.5; 95% confidence interval [CI]: 1.2-10.3), omphalocele (OR: 3.3; 95% CI: 1.0-10.3), heart defects (OR: 2.0; 95% CI: 1.2-3.4), and multiple anomalies (OR: 2.0; 95% CI: 1.0-3.8). Overweight women were more likely than average-weight women to have infants with heart defects (OR: 2.0; 95% CI: 1.2-3.1) and multiple anomalies (OR: 1.9; 95% CI: 1.1-3.4). Our study confirmed the previously established association between spina bifida and prepregnancy maternal obesity and found an association for omphalocele, heart defects, and multiple anomalies among infants of obese women. We also found an association between heart defects and multiple anomalies and being overweight before pregnancy. A higher risk for some birth defects is yet another adverse pregnancy outcome associated with maternal obesity. Obesity prevention efforts are needed to increase the number of women who are of healthy weight before pregnancy.

Pregnancy, body weight and human immunodeficiency virus infection in African women: a prospective cohort study in Kigali (Rwanda), 1992- 1994. Pregnancy and HIV Study Group (EGE)

To study the relationship between human immunodeficiency virus (HIV) infection and body weight in African women during and after pregnancy. A prospective cohort study was initiated at the Centre Hospitalier de Kigali in July 1992. Every woman seen at the antenatal clinic and with a gestational age of <28 weeks was offered HIV-1 antibody testing. Comparable numbers of HIV-infected (HIV+) and uninfected (HIV-) women were recruited. At inclusion, socio-demographic characteristics and self-reported pre-pregnancy weight were recorded; height and weight were measured. Each woman enrolled had a monthly follow-up until 9 months after delivery, with a clinical examination including weighing. Three anthropometric indices were used to answer the study objectives: weight, body mass index (BMI), and pregnancy balance. As of April 1994, 101 HIV+ and 106 HIV- women were followed until 5 months after delivery. Weight and BMI during pregnancy were lower in HIV+ women than in HIV- women. After delivery, weight and BMI gains were significantly lower in HIV+ women. Until 5 months after delivery, the mean weight variation was -2.2 kg (standard deviation [SD] = 5.9 kg) in HIV+ women and +0.2 kg (SD = 6.6 kg) in HIV- women (P = 0.007) in comparison to pre-pregnancy weight. Comparisons of the slopes of the weight curves did not show statistical differences throughout the pregnancy, but it did during the post-partum period (P = 0.02). Our study suggests that HIV infection could impair nutritional status in pregnant women, especially during the post-partum period. Family planning and maternal and child health services including HIV testing and counselling, should consider a nutritional assessment and intervention programme targeted to HIV+ pregnant women.