Trimester Gestational Weight Gain Research Articles

Trimester-specific rate of gestational weight loss or gain and birth size: differences by prepregnancy BMI.

The objective of this study was to estimate the effects of trimester-specific gestational weight gain (GWG) on small and large (compared with appropriate) for gestational age (i.e., SGA, LGA, and AGA) by prepregnancy BMI classifications. We conducted a cohort study of pregnancies in a national network of community health care organizations, stratifying by prepregnancy BMI (n = 20,676 with normal weight; 19,156 with overweight; 11,647 with obesity class I; 5124 with obesity class II; and 3197 with obesity class III). SGA and LGA (vs. AGA) were modeled as a function of trimester 1, 2, or 3 GWG rate, previous trimester(s) GWG rate, and maternal characteristics using modified Poisson regression. GWG rates ranged from weight loss to substantial gains. GWG-LGA associations were strongest in trimester 1 (risk ratio [RR] range for 10th vs. 50th percentile GWG, across BMI categories: 0.60-0.73). GWG-SGA associations were strongest in lower BMI categories and in trimester 2; RRs were 1.62, 1.40, and 1.17 for prepregnancy normal weight, obesity class I, and obesity class III, respectively, with curvilinear associations for class II and III. Among people with prepregnancy obesity class II or III, GWG rate is associated with higher LGA risk in a dose-dependent manner, including understudied ranges of weight loss, but with weak associations with SGA.

Association between 1st trimester diet quality & gestational weight gain rate among pregnant women in Dhulikhel, Nepal

BackgroundDespite promising data from high-income countries, the impact of diet quality on gestational weight gain (GWG) has not been investigated in the context of many low-income countries including Nepal.MethodsWe prospectively examined the association between 1st trimester diet quality and GWG rate among a cohort of singleton pregnant women (n = 101; age 25.9 ± 4.1 years) from a community-based periurban hospital in Dhulikhel, Nepal. Diet quality was assessed from the adapted Nepali version of the 21-item PrimeScreen questionnaire in the 1st trimester. The diet quality score is based on consumption frequency of 21 food group components (score ranging 0–42), categorized as healthy (12 groups) versus unhealthy (9 groups), with higher scores indicative of better overall diet quality. The GWG rate was calculated as the measured weight at early-to-mid 3rd trimester (28–35 wks) minus the weight at 2nd trimester (13–25 wks), divided by the number of weeks in between. Linear regression estimated the association between diet quality and GWG rate, adjusting for a priori covariates (i.e. age, education, ethnicity, pre-pregnancy BMI, and nausea/vomiting.)ResultsThe mean GWG rate in mid-to-late pregnancy was 0.46 ± 0.2 kg/wk and the mean diet quality score was 23.6 ± 2.5. Based on pre-pregnancy BMI, 49.4% of women had excessive GWG rate, while nearly equal numbers had either adequate GWG or inadequate GWG rate. There was no significant association between diet quality and GWG rate [adjusted β (95% CI) = -0.02 (-0.05, 0.01); p = 0.14]. The mean GWG rate was marginally higher (0.57 vs. 0.44 kg/wk; p = 0.06) among those with high versus low (2 + servings vs. 0–1 serving/wk) intake of red meat; similar findings were seen when comparing red meat intake between women with excessive versus adequate GWG (Cramer's V = 0.2; p = 0.06).ConclusionsWhile 1st trimester diet quality is not related to GWG among Nepali women, a high intake of red meat may be a potential risk factor for excessive GWG in this population.

Insufficient weight management in pregnant women with gestational diabetes mellitus.

ObjectivesThis study investigated whether weight was managed appropriately in pregnant women with gestational diabetes mellitus (GDM) and examined the association between insufficient gestational weight gain (GWG) and adverse pregnancy outcomes.Methods The study included 235 pregnant women with GDM from the Korean Pregnancy Outcome Study. GWG from the second to the third trimester (kg/wk ) and total GWG (kg) were classified as insufficient, appropriate, or excessive according to the 2009 Institute of Medicine guidelines. Adverse pregnancy outcomes included maternal (hypertensive disorders of pregnancy, preterm birth, cesarean delivery, and delivery complications) and infant (low birth weight, high birth weight, neonatal intensive care unit admission, and congenital anomalies) outcomes.Results The proportion of pregnant women with GDM who had insufficient GWG from the second to the third trimester was 52.3%, and that of participants with total insufficient GWG was 48.1%. There were no significant associations between insufficient GWG from the second to the third trimester and adverse pregnancy outcomes. Participants with total insufficient GWG had a significantly lower risk of preterm birth (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.05–0.60) and high birth weight (OR, 0.23; 95% CI, 0.07–0.80).Conclusion Our findings suggest the importance of appropriate weight management and the need for GWG guidelines for pregnant women with GDM.

Impact of maternal gestational weight gain in twin pregnancies on early childhood obesity risk: A longitudinal birth cohort study.

ObjectivesTo investigate the impact of gestational weight gain (GWG) on the body mass index-for-age z score (BAZ) and obesity risk among twin offspring.MethodsThis study included 263 women who were pregnant with twins and their offspring. Maternal GWG was measured in each trimester, and infant weight and length were measured at 6, 12, and 24 months.ResultsTotal GWG was positively correlated with offspring birthweight and BAZ at 6, 12 and 24 months [adjusted β 0.013 (95% CI: 0.008–0.019), 0.028 (95% CI: 0.005–0.050), 0.033 (95% CI: 0.010–0.056) and 0.025 (95% CI: 0.004–0.047), respectively]. Excessive total GWG was related to an increased relative risk (RR) of large for gestational age (LGA) and overweight at 6 and 12 months. Only the second trimester gestational weight gain rate (GWGR) was positively correlated with birthweight (adjusted β 0.380, 95% CI: 0.256–0.504), and RRs of 6.818 (95% CI: 1.568–29.642) and 2.852 (95% CI: 1.466–5.548) were found for LGA and overweight at 12 months, respectively.ConclusionsTotal GWG and the second trimester GWGR were correlated with BAZ and overweight/obesity risk in twin offspring; the impact was obvious in the first year of life and gradually disappeared over time.Clinical trial registrationChiCTR-OOC-16008203, Registered on 1 April 2016 at the Chinese Clinical Trial Registry.

Low prenatal resting energy expenditure and high energy intake predict high gestational weight gain in pregnant women with overweight/obesity

IntroductionRecent evidence suggests that low resting energy expenditure (REE) is associated with gestational weight gain (GWG). However, little research has examined whether REE explains GWG beyond the contributions of energy intake (EI) and physical activity (PA). This study examined the extent to which EI, PA, and REE were associated with and explained second trimester GWG in pregnant women with overweight/obesity. MethodsPregnant women with overweight/obesity (N = 26) participating in the Healthy Mom Zone study, a theoretically-based behavioral intervention that adapted the intervention dosage over time to regulate GWG completed weekly point estimates of EI (back-calculation), PA (wrist-worn activity monitor), and REE (mobile metabolism device) from 14- to 28-weeks gestation. Second trimester GWG was calculated as the weekly point estimate of weight from a Wi-Fi weight scale at gestational week 28 minus the weekly point estimate of weight at gestational week 14. ResultsPartial correlations revealed second trimester EI and PA were not significantly associated with second trimester GWG, but low second trimester REE was significantly associated with high second trimester GWG. Hierarchical regression analyses showed the model of fat-free mass, EI, PA, and REE explained 56% of the variance in second trimester GWG. Low REE was the strongest determinant followed by high EI; fat-free mass and PA were not significant predictors. ConclusionsWhile EI and PA remain important determinants of GWG, future researchers should explore the role of REE to inform individualized EI and PA goals to better regulate GWG.

Maternal body composition and gestational weight gain in relation to asthma control during pregnancy.

Poor asthma control is common during pregnancy and contributes to adverse pregnancy outcomes. Identification of risk factors for poor gestational asthma control is crucial. Examine associations of body composition and gestational weight gain with asthma control in a prospective pregnancy cohort (n = 299). Exposures included pre-pregnancy body mass index (BMI), first trimester skinfolds, and trimester-specific gestational weight gain. Outcomes included percent predicted forced expiratory volumes (FEV1, FEV6), forced vital capacity (FVC), peak expiratory flow (PEF), FEV1/FVC, symptoms (activity limitation, nighttime symptoms, inhaler use, and respiratory symptoms), and exacerbations (asthma attacks, medical encounters). Linear and Poisson models examined associations with lung function (β (95% confidence interval (CI)), asthma symptom burden (relative rate ratio (RR (95%CI)), and exacerbations (RR (95%CI)). Women with a BMI ≥ 30 had lower percent predicted FVC across pregnancy (βThirdTrimester: -5.20 (-8.61, -1.78)) and more frequent night symptoms in the first trimester (RR: 1.66 (1.08, 2.56)). Higher first trimester skinfolds were associated with lower FEV1, FEV6, and FVC, and more frequent night symptoms and inhaler use across pregnancy. Excessive first trimester gestational weight gain was associated with more frequent activity limitation in the first trimester (RR: 3.36 (1.15, 9.80)) and inhaler use across pregnancy (RRThirdTrimester: 3.49 (1.21, 10.02)). Higher adiposity and first trimester excessive gestational weight gain were associated with restrictive changes in lung function and symptomology during pregnancy.

Associations between maternal and environmental exposures on atopic disease in the offspring of mothers with asthma.

Background and ObjectiveAvailable data on the impact of perinatal and environmental factors on atopic diseases in the offspring are sparse and conflicting. We, therefore, investigated the impact of these factors on the risk of atopic diseases in the offspring of women with asthma.MethodsPregnant women referred to give birth at Copenhagen University Hospital‐Hvidovre, Denmark, have since 2007 been invited to participate in the Management of Asthma during Pregnancy program. Women with diagnosed asthma, currently prescribed asthma medication, first visit to the respiratory out‐patient clinic within the first 18 weeks of pregnancy that completed an online questionnaire about atopic diseases in their child were included in the current study.ResultsFive hundred and seventy‐one pregnancies were included. Among the off‐spring, 113 children (21%) had doctor‐diagnosed asthma, 178 (31%) atopic dermatitis (AD), and 55 (32%) both AD and doctor‐diagnosed asthma. AD in the offspring was associated with having a dog at home (odds ratio [OR], 2.56; 95% confidence interval [CI], [1.40–4.67], p = .002), whereas having a cat at home was associated with a higher risk of asthma in the offspring (OR, 2.16; 95% CI, [1.14–4.11], p = .02). The associations remained significant after adjusting for maternal age, smoking status, allergy, treatment with inhaled corticosteroids, forced expiratory volume in 1 s less than 80% predicted, uncontrolled asthma, and history of pre‐pregnancy asthma exacerbations. No association was found between gestational weight gain (GWG) in first trimester and total GWG and atopic disease in the offspring.ConclusionHaving pets at home is associated with AD and asthma in the offspring of mothers with asthma.

Low Resting Energy Expenditure Is Associated with High Gestational Weight Gain Only When Resting Energy Expenditure Fluctuates.

Resting energy expenditure (REE) may be useful for individualizing energy intake (EI) and physical activity (PA) goals, and in turn, regulating gestational weight gain (GWG). Limited research, however, has examined the association between REE and GWG. This study examined (1) change in REE from 14 to 28 gestation, (2) time-varying associations between REE and GWG, and (3) EI and PA patterns during the weeks when REE and GWG were significantly associated. Pregnant women with overweight/obesity (N = 27) participating in the Healthy Mom Zone study completed weekly point estimates of EI (back-calculation), PA (wrist-worn activity monitor), REE (mobile metabolism device), and weight (Wi-Fi scale) from 14 to 28 weeks gestation. Analyses included descriptives and time-varying effect modeling. REE fluctuated, increasing on average from 14 to 28 weeks gestation, but decreased at gestational weeks 17, 20, 21, 23, 26, and 28. Most women increased in REE; however there was large between-person variability in the amount of change. Associations between REE and GWG were small but time-varying; low REE was associated with high GWG between gestational weeks 25 to 28 when there was observably larger fluctuation in REE. Moreover, over half of the women were categorized as having excessive EI and most as low active during this time. EI needs may be overestimated and PA needs may be underestimated when REE is fluctuating, which may increase the risk for high second trimester GWG. Researchers should consider the role of REE to inform EI and PA goals to regulate GWG.

Positive attitudes toward weight gain in late pregnancy are associated with healthy eating behaviours.

This cross-sectional study examined the associations between 3rd trimester attitudes toward weight gain and (1) pre-pregnancy BMI, (2) gestational weight gain (GWG) and (3) eating behaviours assessed in the 3rd trimester. Seventy-nine (79) pregnant women completed the French version of the Pregnancy Weight Gain Attitude Scale (PWGAS), the Three-Factor Eating Questionnaire (TFEQ) and the Intuitive Eating Scale-2 (IES-2) in their 3rd trimester. Total GWG was calculated as the difference between the weight recorded before delivery and self-reported pre-pregnancy weight. Most (55.6%) women gained weight above the Institute of Medicine's (IOM) recommendations, but there was no association between PWGAS scores and total or 3rd trimester GWG. Women with obesity had lower PWGAS total scores compared to women with overweight (3.48 ± 0.6 vs. 3.99 ± 0.3, p = 0.005), indicating more negative attitudes in women with obesity vs. overweight. Higher total PWGAS scores were positively correlated with intuitive eating scores (r = 0.28, p < 0.05), and inversely associated with unfavourable eating behaviours such as dietary restraint (r = - 0.42, p < 0.01). Women with positive attitudes toward weight gain reported healthier eating behaviours in late pregnancy, which remains to be confirmed in prospective studies. Interventions addressing body image issues during pregnancy may positively influence pregnant women's health, including eating behaviours. Level III, case-control analytic study.

Association between urinary paraben concentrations and gestational weight gain during pregnancy.

Parabens, a group of endocrine-disrupting chemicals, have been associated with obesity in previous studies. However, there is a paucity of literature regarding the effects of paraben exposures on gestational weight gain (GWG), a considerable predictor of obesity risk in both mothers and offspring later in life. The aim of the present study was to evaluate the associations between urinary paraben concentrations and GWG during the three trimesters of pregnancy. We collected urine samples from 613 pregnant women during the first, second, and third trimesters of their pregnancies between 2014 and 2015 in Wuhan, China. The urine concentrations of five parabens, including methylparaben (MeP), ethylparaben (EtP), propylparaben (PrP), butylparaben, and benzylparaben, were measured. Gestational weight in each trimester and prepregnancy weight were used to calculate trimester GWG. Linear mixed models were used to evaluate the trimester-specific and overall associations between paraben exposures and GWG rate (trimester GWG divided by the gestational week of the weight measurement, kg/week). We performed stratified analysis to further explore the potential effect modification by prepregnancy BMI. In the trimester-specific association analyses, the first-trimester concentrations MeP, EtP, PrP, and ∑parabens (sum of all five parabens's molar concentrations) were associated with an increased first-trimester GWG rate, and these associations were stronger than those of the second or third trimesters. The overall association analysis showed that increased trimester GWG rates were associated with the combined effects of exposure to MeP, PrP, or ∑parabens during all three trimesters. Stratified analysis showed that higher paraben exposures were associated with higher trimester GWG rates among overweight/obese women that among normal-weight or underweight women. Our results showed that paraben exposures were positively associated with trimester GWG rate during pregnancy, especially during the first trimester. Replicated research in populations exposed to higher paraben levels is needed in the future.

Total and trimester-specific gestational weight gain and infant anthropometric outcomes at birth and 6months in low-income Hispanic families.

To describe total and trimester-specific gestational weight gain (GWG) among low-income Hispanic women and determine whether these GWG exposures are associated with infant anthropometric outcomes at birth and 6months. Data were from 448 mother-infant pairs enrolled in the Starting Early child obesity prevention trial. Prenatal weights were used to calculate total GWG and 2nd and 3rd trimester GWG rates (kg/week) and categorized as inadequate, adequate, and excessive according to the 2009 Institute of Medicine recommendations. Multivariable linear and modified Poisson regressions estimated associations of infant anthropometric outcomes (birthweight, small-for-gestational age [SGA], large-for-gestational age [LGA], rapid weight gain, and weight-for-age, length-for-age, and weight-for-length z-scores at 6months) with GWG categories. For total GWG, 39% and 27% of women had inadequate and excessive GWG, respectively. 57% and 46% had excessive GWG rates in the 2nd and 3rd trimesters, respectively, with 29% having excessive rates in both trimesters. Inadequate total GWG was associated with lower infant weight and length outcomes (ß range for z-scores=-0.21 to -0.46, p<0.05) and lower risk of LGA (adjusted Relative Risk, aRR=0.38; 95% confidence intervals, CI: 0.16, 0.95) and rapid weight gain (aRR=0.72; 95%CI: 0.51, 1.00). GWG rates above recommendations in the 2nd trimester or 2nd /3rd trimesters were associated with greater weight outcomes at birth and 6months (ß range for z-scores=0.24 to 0.35, p<0.05). Counseling women about health behaviors and closely monitoring GWG beginning in early pregnancy is necessary, particularly among populations at high-risk of obesity.

Maternal BMI-Increasing Genetic Risk Score and Fetal Weights among Diverse US Ethnic Groups.

Associations between maternal genetic risk for obesity and fetal weight were examined at the end of the first (13 weeks 6 days), second (27 weeks 6 days), and third (40 weeks 0 days) trimesters of pregnancy among four race/ethnic groups in the US. For 603 white, 591 black, 535 Hispanic, and 216 Asian women, maternal genetic risk score (GRS) was calculated as the sum of 189 BMI-increasing alleles and was categorized into high or low GRS. Associations between GRS (continuous and categorical) and estimated fetal weight were tested overall and stratified by prepregnancy BMI, gestational weight gain (GWG), and fetal sex. High GRS compared with low GRS was associated with increased fetal weight at the end of the second (β: 22.7 g; 95% CI: 2.4-43.1; P = 0.03) and third trimesters (β: 88.3 g; 95% CI: 9.0-167.6; P = 0.03) among Hispanic women. The effect of GRS was stronger among Hispanic women with normal prepregnancy weight, adequate first trimester GWG, or inadequate second trimester GWG (P < 0.05). Among Asian women, high GRS was associated with increased weight among male fetuses but decreased weight among female fetuses (P < 0.05). Maternal obesity genetic risk was associated with fetal weight with potential effect modifications by maternal prepregnancy BMI, GWG, and fetal sex.

Gestational biomarkers of daughter’s breast cancer in the Child Health and Development Studies

We examined the link between gestational biomarkers and breast cancer in 9169 daughters born into the Child Health and Development Studies from 1959 to 1967. We identified 137 breast cancer cases diagnosed by age 52 as of 2012. Markers of increased risk included higher placental volume and rapid 2nd trimester gestational weight gain. Protective markers were placental hemorrhage and fibrin deposition, indicators of resistance to placental trophoblast invasion. Paradoxically, higher ponderal index at birth was protective suggesting that fetal and placental pathways to breast cancer are multiple and distinct. Results link placental and fetal phenotypes to breast cancer, characterizing some as restrictive and others as permissive markers of tumor development. We found new biomarkers of breast cancer risk that can be mined to discover ‘omic correlates in the pregnancy exposome using archived and contemporary pregnancy samples. This line of investigation may discover new pathways to risk and new opportunities for prevention.

Association between trimester-specific gestational weight gain and childhood obesity at 5\u2009years of age: results from Shanghai obesity cohort

BackgroundIt is still unclear if and at which trimester gestational weight gain is related to childhood adiposity. Thus we aimed to evaluate the association between trimester-specific gestational weight gain and body-fat compositions in Chinese children.MethodsMaternal gestational weight were measured by trained nurses every 2 to 4 weeks from the first prenatal care, and body-fat compositions of 407 children from the Shanghai Obesity Cohort at 5 years of age were measured by nutritionist through bioelectrical impedance analysis. Overweight/obesity of children was defined according to the criteria of International Obesity Task Force. Logistic and linear regression models adjusted for potential confounders were conducted to evaluate the associations of gestational weight gains with childhood obesity and body-fat compositions. Two-sided P-value < 0.05 was considered statistically significant.ResultsGreater gestational weight gain in the 1st-trimester was significantly associated with a higher risk of childhood overweight/obesity [OR: 1.40 (95% CI: 1.06, 1.86)], fat mass index [β: 0.25 (95% CI: 0.12, 0.38)], body fat percentage [β: 1.04 (95% CI: 0.43, 1.65)], and waist-to-height ratio [β: 0.005 (95% CI: 0.002, 0.008)]. A positive but nonsignificant association was found between greater 3rd-trimester gestational weight gain and a higher risk of offspring overweight/obesity, and we speculated that the association between 2nd-trimester gestational weight gain and offspring overweight/obesity is the “U” type.ConclusionsWeight gain in the first trimester gestation is positively correlated with the risk of childhood overweight/obesity and with body adiposity distributions of children at 5 years of age. Weight gain should be well controlled and monitored from early pregnancy.

Correlation between second trimester weight gain and perinatal outcomes in dichorionic twin pregnancies: The LoTiS cohort study

PurposeTo investigate how second trimester gestational weight gain relates to perinatal outcomes in twin pregnancies of the LoTiS cohort in Chongqing, China. MethodsA cohort study was conducted among women with dichorionic twin pregnancies; pregnancies that culminated in delivery at ≥20 gestational weeks were included in the analysis (n = 177). Data were collected through the Longitudinal Twin Study (LoTiS). The second trimester was divided into two periods: 12–20 and 21–28 gestational weeks. Correlations between maternal weight gain and perinatal outcomes were estimated using linear or logistic regression models; the crude OR and adjusted OR were calculated. ResultsThe average total gestational weight gain for the whole pregnancy was 17.71 ± 4.98 kg and average gestational weight gains during 12–20 gestational weeks and 20–28 gestational weeks were 5.11 ± 1.81 kg and 5.84 ± 2.05 kg, respectively. Insufficient gestational weight gain was associated with higher risk of preterm birth (OR = 0.92, 95% CI 0.86-0.99) and spontaneous preterm birth (OR = 0.89, 95% CI 0.82–0.97). Reduced gestational weight gain during 12–20 gestational weeks was associated with higher risk of small for gestational age. Additionally, the mean birth weight of a twin pair increased by 45.78 g or 13.03 g when gestational weight gain during 12–20 weeks or total gestational weight gain increased by 1 kg. ConclusionMaternal weight gain in the early second trimester was correlated with birth weight in dichorionic twins.

Impact of changes in maternal body composition on birth weight and neonatal fat mass in dichorionic twin pregnancies

Although the impact of gestational weight gain (GWG) on birth weight in twin pregnancies has been demonstrated, the specific components of GWG have not been delineated for twin gestations. Fetal body composition has been shown to be modifiable in singleton gestations based on nutritional intervention strategies and may prove to have similar modifications in twin gestations. We aimed to determine the relation of maternal body composition changes to birth weight, birth length, and neonatal fat mass (FM) in dichorionic-diamniotic twin pregnancies. This is a prospective study of 20 women with twin gestations. Comparisons were made between body composition variables during each trimester and for the entire pregnancy and compared with the outcomes of birth weight, neonatal fat percentage, and birth length. GWG within or above compared with below the IOM recommendations was associated with higher birth weights (P=0.03, P=0.04, respectively), but also with higher postpartum weight retention (P=0.001). Total maternal protein gain over the pregnancy was positively associated with birth weight (P=0.03). Changes in maternal fat-free mass (FFM), total body water (TBW), and FM from the first to the third trimester were not associated with either birth weight or neonatal FM percentage. However, maternal FM change from the second to the third trimester was significantly correlated to neonatal FM percentage (P=0.02). Third trimester GWG and total protein gain were positively correlated with neonatal birth length (P=0.02 and 0.03, respectively). Maternal FFM over all 3 trimesters showed a positive relation with neonatal birth length (P=0.01). Significant increases in maternal protein are associated with greater birth weight and neonatal birth length. Protein accretion, in contrast to TBW and FM gains, may be the most critical component of maternal GWG in dichorionic twin gestations.

Prepregnancy Body Mass Index, Gestational Weight Gain, and Odds of Cesarean Delivery in Hispanic Women

ObjectiveTo evaluate the association between prepregnancy body mass index (BMI), gestational weight gain (GWG), and cesarean delivery in Hispanics.MethodsWe examined these associations among 1,215 participants in Proyecto Buena Salud, a prospective cohort conducted from 2006–2011 among Hispanic women. Prepregnancy BMI, GWG, and mode of delivery were abstracted from medical records.ResultsA quarter of participants entered pregnancy with obesity, 23% delivered via cesarean, and 52% exceeded Institute of Medicine guidelines for GWG. After adjusting for age, women who were obese had 2.03 times the odds of cesarean delivery compared to women with normal BMI (95% confidence interval [CI] 1.46–2.82); findings remained significant after adjusting for GWG. Women with excessive total GWG had 1.49 times the odds of cesarean delivery (95% CI 1.06–2.10) compared to women who gained within guidelines. Excessive rate of 3rd trimester GWG (standard deviation [SD] change in GWG/week) increased odds of cesarean delivery (OR=1.66, 95% CI 1.05–2.62), while excessive rate of 1st and 2nd trimester GWG were not associated with increased odds.ConclusionsObesity prior to pregnancy was associated with an increased odds of cesarean delivery among Hispanics. Excessive GWG across pregnancy and excessive rate of 3rd trimester GWG were also associated with increased odds.

Influence of gestational weight gain on low birth weight in short-statured South Indian pregnant women.

India contributes to one-third of the global burden of low birth weight (LBW) neonates, which is associated with increased risk of mortality and adverse consequences on long-term health. Factors leading to LBW are multidimensional and maternal short stature is an important component with an inter-generational effect. On the contrary gestational weight gain (GWG) shows an independent positive influence on birth weight. The aim of the present study therefore was to determine the influence of GWG on birth weight in short pregnant women. A prospective observational cohort of 1254 pregnant women was studied. Total, second and third trimester GWG per week were computed. Women were divided into two groups, "short" and "not-short", using a cut off of 152 cm that corresponded to the 25th percentile for height in the cohort. Association of tertiles of GWG with LBW was examined using log binomial regression analysis. "Short" women in highest tertile of total GWG had a significantly reduced adjusted relative risk (ARR 0.37, 95% confidence interval 0.16-0.83, P = 0.016) for LBW, compared to the lowest tertile. However, there was no significant increase in risk for cesarean section (CS) with increasing tertiles of total GWG. In women with height <152 cm a significant reduced risk for LBW was observed with the greatest total GWG, without a significant increase in the risk for CS. This suggests that improving GWG in short women may be beneficial for the birth weight of the offspring.

The Influence of Maternal Dietary Patterns on Body Mass Index and Gestational Weight Gain in Urban Black South African Women

Maternal pre-pregnancy body mass index (BMI) and subsequent gestational weight gain (GWG) are strong predictors of maternal and infant outcomes; however the influence of dietary patterns on BMI-specific GWG is unclear. This study identifies patterns of habitual dietary intake in urban South African women and explores their associations with first trimester BMI and GWG. Habitual dietary intake of 538 pregnant women was assessed using a quantitative food-frequency questionnaire and dietary patterns were depicted via principle component analysis. Associations between dietary patterns and BMI-specific GWG were analyzed using linear and logistic regression. Three dietary patterns were identified: Western, Traditional and Mixed. Western and Mixed diet patterns were associated with 35 g/week (p = 0.021) and 24 g/week (p = 0.041) higher GWG in normal weight and obese women respectively. Additionally, high intakes of a Traditional diet pattern were associated with a reduced odds of excessive weight gain in the total sample (OR: 0.81; p = 0.006) and in normal weight women (OR: 0.68; p = 0.003). Increased intake of a traditional diet pattern—high in whole grains, legumes, vegetables and traditional meats—and decreased intake of refined, high sugar and fat driven diets may reduce GWG (including risk of excessive weight gain) in urban South African women.

First and second trimester gestational weight gains are most strongly associated with cord blood levels of hormones at delivery important for glycemic control and somatic growth

BackgroundExcessive gestational weight gain (GWG) during pregnancy is associated with adverse outcomes for mothers and offspring. Early, mid, and late pregnancy GWGs have different associations with fetal growth and later life adiposity, but associations with cord blood hormones, which might predict later health, are not well studied. MethodsIn 978 pregnant women from the pre-birth Project Viva cohort, we calculated trimester-specific GWG using clinically recorded prenatal weights. Outcomes were levels of umbilical cord blood hormones related to fetal and postnatal growth. We used linear regression models adjusted for maternal race/ethnicity, pre-pregnancy BMI, parity, education, pregnancy smoking status and child sex; 2nd and 3rd trimester models were additionally adjusted for GWG in prior trimesters. ResultsMean±SD pre-pregnancy BMI was 24.9±5.5kg/m2, 30% were non-white, and 63% were college graduates. Mean±SD cord blood hormone levels were insulin-like growth factor [IGF]-1 (56.4±24.3ng/mL), IGF-2 (408.5±92.7ng/mL), IGFBP-3 (1084±318ng/mL), insulin (6.5±7.2 uU/mL), C-peptide (1.0±0.6ng/mL), leptin (9.0±6.6ng/mL) and adiponectin (28.7±6.8μg/mL). Mean±SD 1st, 2nd and 3rd trimester GWG rates were 0.22±0.22, 0.49±0.19 and 0.46±0.22kg/wk. Greater 1st trimester GWG (per 0.2kg/wk) was associated with higher insulin (0.5 uU/mL; 95% CI 0.1, 0.9) and C-peptide (0.06ng/mL; 95% CI 0.02, 0.09) and lower adiponectin (−0.4μg/mL; 95% CI −0.9, 0.0). Greater 2nd trimester GWG (per 0.2kg/wk) was associated with higher IGF-1 (2.3ng/mL; 95% CI 0.6, 4.0), IGF-2 (7.9ng/mL; 95% CI 1.2, 14.6), IGFBP-3 (41.6ng/mL; 95% CI 19.4, 63.7) and leptin (0.9ng/mL; 0.4, 1.4). 3rd trimester GWG was not associated with cord blood hormones. Conclusion1st trimester weight gain appears to matter more for cord blood hormones related to offspring glucose/insulin regulation, whereas 2nd trimester gain matters more for hormones related to growth and adiposity.