Maternal body composition at term gestation and birth weight: is there a link?

Associations between Maternal Dietary Patterns and Perinatal Outcomes: A Systematic Review and Meta-Analysis of Cohort Studies

The aim was to systematically review and meta-analyze prospective cohort studies investigating the relation between maternal dietary patterns during pregnancy with pregnancy and birth outcomes. PubMed, Scopus, and ISI Web of Science were searched from inception until October 2019 for eligible studies. Studies reporting relative risk, ORs, or incidences (for binary data) or means ± SDs or B-coefficients (for continuous outcomes) comparing the highest and lowest adherence with maternal dietary patterns were included. Dietary patterns were categorized as "healthy," "unhealthy," or "mixed." No language restrictions were applied. Study-specific effect sizes with SEs for outcomes of interest were pooled using a random-effects model. Quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Sixty-six relevant publications were included. A higher maternal adherence to a healthy diet was associated with a reduced risk of gestational hypertension (14%, P < 0.001), maternal depression (40%, P = 0.004), low birth weight (28%, P = 0.001), preterm birth (56%, P < 0.001), higher gestational weight gain (Hedges' g: 0.15; P = 0.01), and birth weight (Hedges' g: 0.19; P = 0.007). Higher maternal adherence to an unhealthy or a mixed diet was associated with higher odds of gestational hypertension (23%, P < 0.001 for unhealthy, and 8%, P = 0.01 for mixed diet). In stratified analyses, a higher healthy eating index was associated with reduced odds of being large based on gestational age (31%, P = 0.02) and a higher head circumference at birth (0.23 cm, P = 0.02). The Mediterranean and "prudent" dietary patterns were related to lower odds of being small based on gestational age (46%, P = 0.04) and preterm birth (52%, P = 0.03), respectively. The overall GRADE quality of the evidence for most associations was low or very low, indicating that future high-quality research is warranted. This study was registered at http://www.crd.york.ac.uk/PROSPERO as CRD42018089756.

Effects of Breastfeeding on Maternal Body Composition in Moroccan Lactating Women during Twelve Months after Birth Using Stable Isotopic Dilution Technique

BACKGROUND

Exclusive breastfeeding during the first six months of an infant's life is an important factor for their optimal growth and health. Breastfeeding also has maternal benefits and can assist with postpartum weight loss. As shown by previous studies, postpartum weight retention can contribute to obesity.

OBJECTIVE

To quantify the human milk and evaluate the effect of breastfeeding on maternal weight loss during the 12 months postpartum.

METHOD

This study included 70-mother-baby pairs. Infants' intake of human milk and water from other sources, as well as the body composition of the mothers, were measured at the 1st, 3rd, 6th, 9th and 12th month postpartum by using the deuterium oxide dose-to-mother technique.

RESULTS

There was a significant change in the mothers' body composition between the first and twelfth months in exclusive breastfeeding women compared to not-exclusive ones. Similarly, the difference between the quantities of human milk intake was highly significant in exclusive breastfeeding women compared to women who were not exclusively breastfeeding.

CONCLUSION

Our results showed that exclusive breastfeeding for twelve months has a significant effect on postpartum weight loss among Moroccan women and that it is an effective way to control overweight and obesity among lactating women.

Maternal cardiometabolic markers are associated with fetal growth: a secondary exploratory analysis of the LIMIT randomised trial

BACKGROUND

To determine the association between maternal cardiometabolic and inflammatory markers with measures of fetal biometry and adiposity.

METHODS

Women included in this exploratory analysis were randomised to the 'Standard Care' group (N = 911) from the LIMIT randomised trial involving a total of 2212 pregnant women who were overweight or obese (ACTRN12607000161426, Date of registration 9/03/2007, prospectively registered). Fetal biometry including abdominal circumference (AC), estimated fetal weight (EFW), and adiposity measurements (mid-thigh fat mass, subscapular fat mass, abdominal fat mass) were obtained from ultrasound assessments at 28 and 36 weeks' gestation. Maternal markers included C reactive protein (CRP), leptin and adiponectin concentrations, measured at 28 and 36 weeks' gestation and fasting triglycerides and glucose concentrations measured at 28 weeks' gestation.

RESULTS

There were negative associations identified between maternal serum adiponectin and fetal ultrasound markers of biometry and adiposity. After adjusting for confounders, a 1-unit increase in log Adiponectin was associated with a reduction in the mean AC z score [- 0.21 (- 0.35, - 0.07), P = 0.004] and EFW [- 0.23 (- 0.37, - 0.10), P < 0.001] at 28 weeks gestation. Similarly, a 1-unit increase in log Adiponectin was association with a reduction in the mean AC z score [- 0.30 (- 0.46, - 0.13), P < 0.001] and EFW [- 0.24 (- 0.38, - 0.10), P < 0.001] at 36 weeks gestation. There were no consistent associations between maternal cardiometabolic and inflammatory markers with measurements of fetal adiposity.

CONCLUSION

Adiponectin concentrations are associated with measures of fetal growth. Our findings contribute to further understanding of fetal growth in the setting of women who are overweight or obesity.

Life history trade-offs and the partitioning of maternal investment: Implications for health of mothers and offspring

Lay Summary: This review sets out the hypothesis that life history trade-offs in the maternal generation favour the emergence of similar trade-offs in the offspring generation, mediated by the partitioning of maternal investment between pregnancy and lactation, and that these trade-offs help explain widely reported associations between growth trajectories and NCD risk. Growth patterns in early life predict the risk of non-communicable diseases (NCDs), but adaptive explanations remain controversial. It is widely assumed that NCDs occur either because of physiological adjustments to early constraints, or because early ecological cues fail to predict adult environmental conditions (mismatch). I present an inter-generational perspective on developmental plasticity, based on the over-arching hypothesis that a key axis of variability in maternal metabolism derives from life history trade-offs, which influence how individual mothers partition nutritional investment in their offspring between pregnancy and lactation. I review evidence for three resulting predictions: (i) Allocating relatively more energy to growth during development promotes the capacity to invest in offspring during pregnancy. Relevant mechanisms include greater fat-free mass and metabolic turnover, and a larger physical space for fetal growth. (ii) Allocating less energy to growth during development constrains fetal growth of the offspring, but mothers may compensate by a tendency to attain higher adiposity around puberty, ecological conditions permitting, which promotes nutritional investment during lactation. (iii) Since the partitioning of maternal investment between pregnancy and lactation impacts the allocation of energy to 'maintenance' as well as growth, it is expected to shape offspring NCD risk as well as adult size and body composition. Overall, this framework predicts that life history trade-offs in the maternal generation favour the emergence of similar trade-offs in the offspring generation, mediated by the partitioning of maternal investment between pregnancy and lactation, and that these trade-offs help explain widely reported associations between growth trajectories and NCD risk.

Relationships between Breastfeeding Patterns and Maternal and Infant Body Composition over the First 12 Months of Lactation

Breastfeeding has been implicated in the establishment of infant appetite regulation, feeding patterns and body composition (BC). A holistic approach is required to elucidate relationships between infant and maternal BC and contributing factors, such as breastfeeding parameters. Associations between maternal and breastfed term infant BC (n = 20) and feeding parameters during first 12 months of lactation were investigated. BC was measured at 2, 5, 9 and/or 12 months postpartum with ultrasound skinfolds (US; infants only) and bioimpedance spectroscopy (infants and mothers). 24-h milk intake (MI) and feeding frequency (FFQ) were measured. Higher FFQ was associated with larger 24-h MI (p ≤ 0.003). Higher 24-h MI was associated with larger infant fat mass (FM) (US: p ≤ 0.002), greater percentage FM (US: p ≤ 0.008), greater FM index (FMI) (US: p ≤ 0.001) and lower fat-free mass index (FFMI) (US: p = 0.015). Lower FFQ was associated with both larger FFM (US: p ≤ 0.001) and FFMI (US: p < 0.001). Greater maternal adiposity was associated with smaller infant FFM measured with US (BMI: p < 0.010; %FM: p = 0.004; FMI: p < 0.011). Maternal BC was not associated with FFQ or 24-h MI. These results reinforce that early life is a critical window for infant programming and that breastfeeding may influence risk of later disease via modulation of BC.

Maternal fat free mass during pregnancy is associated with birth weight

Background

The relationship between maternal body compositions and birth weight was not definite. Fat Mass (FM) and Fat Free Mass (FFM) can accurately reflect the maternal body fat compositions and have been considered as better predictors of birth weight. Despite its potential role, no studies have been described the maternal compositions during pregnancy in East Asian women previously. We investigated the correlation between birth weight and Maternal body composition including fat mass (FM) and fat free mass (FFM). To determine whether birth weight is associated with maternal body fat FM and FFM during pregnancy and, if so, which trimester and parameter is more critical in determining birth weight.

Methods

A longitudinal prospective observational study performed, 348, 481 and 321 non-diabetics Han Chinese women with a singleton live birth attending a routine visit in their first, second and third trimesters were recruited. Maternal body composition was measured using segmental multi-frequency bioelectrical impedance analysis. Data of the pre-pregnancy body mass index (BMI), maternal BMI, the gestational weight gain (GWG), and placental and birth weight were collected.

Results

A significant correlation exists between maternal FFM in the process of pregnancy, placental weight, GWG at delivery, and birth weight (P < 0.05). On stepwise multiple linear regression analysis, material’s FFM was the most important factor associated with the birth weight. After adjustment, there was significantly associated with 2.47-fold increase in risk for birth weight more than 4 kg when FFM ≥ 40.76 kg (Upper quartile of participants). The increased maternal age became a protective factor (OR = 0.69) while the increased pre-pregnancy BMI (OR = 1.50) remained predictors to birth weight more than 4 kg.

Conclusions

The change of maternal FFM during pregnancy is independently affected the birth weight.

The role of TGF-β1 869 T > C and PPAR γ2 34 C > G polymorphisms, fat mass, and anthropometric characteristics in predicting childhood obesity at birth: A cross-sectional study according the parental characteristics and newborn's risk for child obesity (the newborns obesity's risk) NOR study

This study proposed to establish a correlation between the risk score for child obesity and anthropometric, genetic, and bioimpedance characteristics in mothers and newborns, and to assess the discriminant ability for anthropometric parameters to classify over-fatness (defined by bioimpedance body fatness %) in pregnant women.We performed a cross-sectional study on 388 couples (mother and father) and their newborns admitted in a Tertiary Hospital from Romania. The measured parameters for mothers and their newborns were risk percentage for child obesity, anthropometric characteristics (mid-upper arm circumference [MUAC], tricipital skinfold thickness [TST] of mother and newborn), genetic polymorphisms (human peroxisome proliferator-activated receptor γ [PPARγ2] 34 C > G and transforming growth factor-beta 1 [TGF-β1] 869 T > C gene polymorphisms in both mothers and newborns), and mother's bioimpedance characteristics (fat mass [FM] %).The obesity risk score according to standard predictable Northern Finland Birth Cohort equation was in our study 4.07%. We found a monotone positive significant correlation between the newborn's risk of childhood obesity and the mother's TST (P = 0.01), as well as a tendency toward statistical significance concerning correlation with mother's MUAC (P = 0.053), without any correlations with the mothers' bioimpedance parameters and also a positive correlation between the newborn's risk of childhood obesity and the newborn's anthropometrical characteristics like body mass index (BMI), MUAC, and TST (P < 0.001). We observed that the calculated newborn's risk percentage for child obesity was greater for the variant allele of the TGF-β1 869 T > C polymorphism and also for the wild-type C allele of the PPARγ2 34 C > G gene polymorphism. Our study indicated that the best predictors for over-fatness are BMI and MUAC (P = 0.01 < 0.02 and P = 0.019 < 0.02, respectively).

Impact of demographic, genetic, and bioimpedance factors on gestational weight gain and birth weight in a Romanian population: A cross-sectional study in mothers and their newborns: the Monebo study (STROBE-compliant article)

The present study had 2 objectives, first, to investigate possible relationships between increased gestational weight gain and demographic, clinical, paraclinical, genetic, and bioimpedance (BIA) characteristics of Romanian mothers, and second, to identify the influence of predictors (maternal and newborns characteristics) on our outcome birth weight (BW).We performed a cross-sectional study on 309 mothers and 309 newborns from Romania, divided into 2 groups: Group I-141 mothers with high gestational weight gain (GWG) and Group II-168 mothers with normal GWG, that is, control group.The groups were evaluated regarding demographic, anthropometric (body mass index [BMI], middle upper arm circumference, tricipital skinfold thickness, weight, height [H]), clinical, paraclinical, genetic (interleukin 6 [IL-6]: IL-6 -174G>C and IL-6 -572C>G gene polymorphisms), and BIA parameters.We noticed that fat mass (FM), muscle mass (MM), bone mass (BM), total body water (TBW), basal metabolism rate (BMR) and metabolic age (P < 0.001), anthropometric parameters (middle upper arm circumference, tricipital skinfold thickness; P < 0.001/P = 0.001) and hypertension (odds ratio = 4.65, 95% confidence interval: 1.27-17.03) were higher in mothers with high GWG. BW was positively correlated with mothers' FM (P < 0.001), TBW (P = 0.001), BMR (P = 0.02), while smoking was negatively correlated with BW (P = 0.04). Variant genotype (GG+GC) of the IL-6 -572C>G polymorphism was higher in the control group (P = 0.042).We observed that high GWG may be an important predictor factor for the afterward BW, being positively correlated with FM, TBW, BMR, metabolic age of the mothers, and negatively with the mother's smoking status. Variant genotype (GG+GC) of the IL-6 -572C>G gene polymorphism is a protector factor against obesity in mothers. All the variables considered explained 14.50% of the outcome variance.

Maternal fat mass at mid-pregnancy and birth weight in Brazilian women

BACKGROUND

The relationship between maternal body composition and foetal development is unclear.

AIM

To determine the relationship between maternal body composition [fat mass (FM) and fat-free mass (FFM)] and foetal growth and birth weight, independent of potential confounding factors.

SUBJECTS AND METHODS

This study consisted of 92 women, normal and overweight/obese, recruited from the Instituto Fernandes Figueira in Rio de Janeiro, Brazil. Body composition (FM and FFM) was estimated using bioelectrical impedance. Foetal growth was assessed using serial ultrasound measurements at the second and third trimester and infant's weight and length were measured at birth. Multiple linear regression analyses were used to determine the association between maternal FM and FFM and birth weight adjusted for gestational age (BWt) and change in estimated foetal weight (ΔEFW), controlling for infant gender, maternal serum glucose, energy intake, parity, height and income.

RESULTS

Maternal FM, but not FFM, was positively associated with BWt (p = 0.02) and borderline with ΔEFW (p = 0.05). FM expressed as a percentage of body weight (%FM) showed a significant positive association with BWt (p < 0.001) and ΔEFW (p < 0.01). Using backward linear regression analysis, FM was a significant predictor of BWt (p < 0.001) and ΔEFW (p = 0.03), but not change in femur length.

CONCLUSION

In this small sample of normal and overweight/obese women, maternal FM at mid-pregnancy is associated with neonatal BW and foetal growth.

Maternal weight and body composition during pregnancy are associated with placental and birth weight in rural Bangladesh

Placental growth is a strong predictor of fetal growth, but little is known about maternal predictors of placental growth in malnourished populations. Our objective was to investigate in a prospective study the associations of maternal weight and body composition [total body water (TBW) estimated by bioelectrical impedance and fat and fat-free mass derived from upper arm fat and muscle areas (UAFA, UAMA)] and changes in these with placental and birth weights. Within a cluster-randomized trial of maternal micronutrient supplementation, a subsample of 350 women was measured 3 times across gestation. Longitudinal analysis was used to examine independent associations of ∼10-wk measurements and ∼10-20 wk and ∼20-32 wk changes with birth outcomes. Weight, TBW, and UAMA, but not UAFA, at ∼10 wk were each positively and independently associated with placental weight and birth weight (P < 0.05). Of the maternal ∼10-20 wk changes in measurements, only TBW change and placental weight, and maternal weight and birth weight were positively associated (P < 0.05). Gains in weight, TBW, and UAMA from 20 to 32 wk were positively and UAFA gain was negatively associated with placental weight (P ≤ 0.01). Gains in weight and UAMA from 20 to 32 wk were positively associated with birth weight (P ≤ 0.01). Overall, higher maternal weight and measures of fat-free mass at ∼10 wk gestation and gains from 20 to 32 wk are independently associated with higher placental and birth weight.

Maternal nutritional status in early pregnancy is associated with body water and plasma volume changes in a pregnancy cohort in rural Bangladesh

Plasma volume expansion has been associated with fetal growth. Our objective was to examine the associations between maternal nutritional status in early pregnancy and extracellular water (ECW), total body water (TBW), and percentage plasma volume change across pregnancy. In a subsample of 377 pregnant women participating in a cluster-randomized trial of micronutrient supplementation, hemoglobin, hematocrit, and multi-frequency bioelectrical impedance were measured at ~10, 20, and 32 wk of gestation. In early pregnancy, women were short (mean ± SD, 148.9 ± 5.3 cm) and thin (19.5 ± 2.5 kg/m(2)). In mixed-effects multiple regression models, a 1-unit higher BMI at ~10 wk was associated with higher ECW and TBW (0.27 and 0.66 kg per kg/m(2), respectively; P < 0.01) at ~10, ~20, and ~32 wk. Height was also positively associated with ECW and TBW at each time point. Early pregnancy BMI was negatively associated with gains in ECW and TBW (-0.06 and -0.14 kg per kg/m(2), respectively; P < 0.01) from 10 to 20 wk, but not with 20- to 32-wk gains after accounting for weight gain. BMI was positively associated with percentage changes in plasma volume from 20 to 32 wk (0.57% per kg/m(2); P < 0.05). Height was not associated with changes in body water or plasma volume. Women with low BMI and height in early pregnancy have lower ECW and TBW in early, mid, and late pregnancy and lower late pregnancy plasma volume expansion, potentially increasing risk of fetal growth restriction.

Postpartum changes in body composition

Parity is associated with weight retention and has long-lasting and detrimental effects on the health of women. Previous studies have shown that increasing parity was independently associated with an increased prevalence of metabolic syndrome. Postpartum weight is made up of several components including uterine and mammary tissues, body water (intracellular (ICW) and extracellular water (ECW)), and fat. These components change in variable amounts postpartum, thereby distinctly affecting the interpretation of individual weight retention; however, it is unclear which components contribute to weight retention. The aims of this longitudinal study were to evaluate changes in body composition during the postpartum period and to investigate their effects on weight retention. This prospective study examined 41 healthy, pregnant women who gave birth at Korea University Guro Hospital. We measured body composition at 2 days, 2 weeks, and 6 weeks postpartum using bioelectrical impedance analysis. Weight decreased during this postpartum period (P < 0.001); the postpartum weight retention from prepregnancy to 6 weeks postpartum was 4.43 ± 4.0 kg. Among various body composition components, ECW, ICW, total body water, and fat-free mass (FFM) decreased postpartum. However, fat mass (FM) and visceral fat area, the components that experienced the greatest changes, increased postpartum. Our results demonstrate that the postpartum period is associated with a preferential accumulation of adipose tissue in the visceral compartment, even though overall body weight is decreased. Further studies are needed to evaluate the changes in body composition over longer time periods and their long-term effects on health.

Pregnancy complicated by diabetes: what is the best level of HbA1c for conception?

To reduce the congenital malformations that occur in pregnancies complicated by diabetes, it is essential to achieve and maintain a good metabolic control before conception. In this context, measuring HbA1c is considered as the gold standard for monitoring metabolic control in diabetes and various different HbA1c levels have been recommended as optimal in the preconception period for diabetic women planning a pregnancy. An analysis of key studies published on this issue until now clearly shows that HbA1c levels correlate closely with the occurrence of congenital malformations and other neonatal complications characteristic of pregnant diabetic women. HbA1c is therefore one of the key markers to use in monitoring metabolic control, and the most reasonable approach would seem to be to use a standardized measurement method and aim for HbA1c levels resembling normal values as closely as possible, with a view to preventing episodes of hypoglycemia.