A longitudinal study of maternal anthropometric changes in normal weight, overweight and obese women during pregnancy and postpartum

Maternal pre-pregnancy BMI influences the associations between bisphenol and phthalate exposures and maternal weight changes and fat accumulation

BACKGROUND

Bisphenols and phthalates are two classes of endocrine-disrupting chemicals (EDCs) thought to influence weight and adiposity. Limited research has investigated their influence on maternal weight changes, and no prior work has examined maternal fat mass. We examined the associations between exposure to these chemicals during pregnancy and multiple maternal weight and fat mass outcomes.

METHODS

This study included a sample of 318 women enrolled in a Canadian prospective pregnancy cohort. Second trimester urinary concentrations of 2 bisphenols and 12 phthalate metabolites were quantified. Self-reported and measured maternal weights and measured skinfold thicknesses were used to calculate gestational weight gain, 3-months and 3- to 5-years postpartum weight retention, late pregnancy fat mass gain, total postpartum fat mass loss, and late postpartum fat mass retention. Adjusted robust regressions examined associations between chemicals and outcomes in the entire study population and sub-groups stratified by pre-pregnancy body mass index (BMI). Bayesian kernel machine regression examined chemical mixture effects.

RESULTS

Among women with underweight or normal pre-pregnancy BMIs, MBzP was negatively associated with weight retention at 3- to 5-years postpartum (B = -0.04, 95%CI: -0.07, -0.01). Among women with overweight or obese pre-pregnancy BMIs, MEHP and MMP were positively associated with weight retention at 3-months and 3- to 5-years postpartum, respectively (B's = 0.12 to 0.63, 95%CIs: 0.02, 1.07). DEHP metabolites and MCNP were positively associated with late pregnancy fat mass gain and late postpartum fat mass retention (B's = 0.04 to 0.18, 95%CIs: 0.001, 0.32). Further, the mixture of EDCs was positively associated with late pregnancy fat mass gain.

CONCLUSION

In this cohort, pre-pregnancy BMI was a key determinant of the associations between second trimester exposure to bisphenols and phthalates and maternal weight changes and fat accumulation. Investigations of underlying physiological mechanisms, windows of susceptibility, and impacts on maternal and infant health are needed.

Anthropometric Changes During Pregnancy and Their Association with Adequacy of Gestational Weight Gain

Background

Gestational weight gain (GWG) is an expected component of a healthy pregnancy. Gaining weight within the recommended range helps support the mother's health by providing energy reserves and nutrients to meet the increased metabolic demands during pregnancy. Too much or too little GWG has been associated with adverse health outcomes for the mother and child.

Objective

The objective of the study was to examine how changes in anthropometric indicators during pregnancy, including fat gain, vary, compare changes among body mass index (BMI) (kg/m2) groups, and examine how the changes were associated with adequacy of GWG defined using the 2009 Institute of Medicine guidelines.

Methods

Data came from a cohort of 360 pregnant women with measured anthropometric indicators (weight, midupper arm circumference, and skin folds of the triceps, thigh, and upper iliac) at <12-, 16 to 22-, and 28 to 32-wks of gestation. Fat gain was calculated using a formula. Analysis of variance was used to test for differences in anthropometric changes by BMI and adequacy of GWG in the third trimester. Multiple logistic regression was used to examine associations between changes in anthropometric indicators and GWG recommendations.

Results

Women with normal weight had greater increases in all anthropometric indicators, which differed from women with obesity, who had negative changes and gained less weight. Women who gained inadequately (21%) had negative changes that were all less, compared with women who gained adequately (46%) (except in upper iliac) or excessively (34%). Women with BMI of >25 who gained adequately also had negative changes. Logistic regression results indicated that changes in midupper arm circumference, triceps, and thigh skin folds, and fat gain were all inversely associated with inadequate GWG, whereas all indicators were positively associated with excessive GWG.

Conclusions

Anthropometric changes during pregnancy differ by BMI and are associated with adequacy of GWG. Women who gained adequately had minimal fat gain, lending support for current GWG guidelines.

Dietary treatment postpartum in women with obesity reduces weight and prevents weight gain: a randomised controlled trial

BACKGROUND

Women with pre-pregnancy obesity have an increased risk of retaining or gaining weight postpartum and may benefit from weight loss treatment. However, evidence is lacking for weight loss strategies in women with BMIs in the higher obesity classes. A dietary treatment for postpartum weight loss resulted in a 10% weight reduction in lactating women with a mean BMI of 30 kg/m2. We aimed to examine the effects of this dietary treatment on changes in weight, markers of lipid and glucose metabolism, waist and hip circumference and postpartum weight retention (PPWR) in postpartum women with higher BMIs than tested previously.

METHODS

At baseline, approximately 8 weeks postpartum, 29 women with a mean (SD) BMI = 40.0 (5.2) kg/m2 were randomised to a 12-week dietary treatment (n 14) or to a control treatment (n 15). Measurements were made at baseline and after 3 and 12 months. Data was analysed using mixed model.

RESULTS

The mean weight change in the diet group was -2.3 (3.1) kg compared to 1.7 (3.1) kg in the control group after 3 months (P = 0.003) and -4.2 (5.6) kg compared to 4.8 (11.8) kg in the control group after 12 months (P = 0.02). The dietary treatment led to reduced waist circumference (P < 0.04) and PPWR (P < 0.01) compared to the control treatment at both time points. The treatment lowered fasting blood glucose at 12 months (P = 0.007) as the only effect on markers of lipid and glucose metabolism.

CONCLUSION

The dietary treatment postpartum reduced weight and prevented weight retention or weight gain in women with obesity.

TRIAL REGISTRATION

The trial was retrospectively registered at ClinicalTrials.gov (NCT03579667) 06/07/2018. In a randomised, controlled trial, 29 postpartum women with obesity were allocated to a dietary treatment or a control treatment. The dietary treatment reduced weight and prevented postpartum weight retention or weight gain after 12 months. Reference: Adapted from "Randomized, Placebo-Controlled, Parallel Study Design (2 Arms, Graphical)", by BioRender.com (2022). Retrieved from https://app.biorender.com/biorender-templates .

Maternal Obesity and Patterns in Postnatal Diet, Physical Activity and Weight among a Highly Deprived Population in the UK: The GLOWING Pilot Trial

Preconception obesity is associated with adverse pregnancy outcomes and deprivation. The postnatal period provides an opportunity for preconception intervention. There is a lack of published postnatal behaviour and weight data to inform intervention needs. Secondary analysis of the GLOWING study explored postnatal diet, physical activity (PA) and weight among women living with obesity in deprivation. Thirty-nine women completed food frequency and PA questionnaires and provided weight measurement(s) between 3-12 months postnatal. Women's diet and PA fell short of national guidelines, especially for fruit/vegetables (median 1.6-2.0 portions/day) and oily fish (0-4 g/day). PA was predominantly light intensity. Patterns in weight change across time points indicated postnatal weight loss compared with 1st (median -0.8 to -2.3 kg) and 3rd-trimester weights (-9.0 to -11.6 kg). Weight loss was higher among women without excessive gestational weight gain (GWG) (-2.7 to -9.7 kg) than those with excessive GWG (2.3 to -1.8 kg), resulting in postnatal weight measurements lower than their 1st trimester. These pilot data suggest preconception interventions should commence in pregnancy with a focus on GWG, and postnatal women need early support to achieve guideline-recommendations for diet and PA. Further research in a larger population could inform preconception intervention strategies to tackle inequalities in maternal obesity and subsequent pregnancy outcomes.

Impact of maternal obesity on preterm delivery in patients with cervical cerclage

BACKGROUND

Maternal obesity has risen in the United States in recent decades.

OBJECTIVE

This study aimed to evaluate the impact of maternal obesity on the risk for spontaneous preterm delivery and the risk for overall preterm delivery among patients with cervical cerclage placement.

STUDY DESIGN

This was a retrospective study in which data from the California Office of Statewide Health Planning and Development linked birth file from 2007 to 2012 were used, yielding a total of 3654 patients with and 2,804,671 patients without cervical cerclage placement. Exclusion criteria included patients with missing information on body mass index, multiple gestation, anomalous pregnancies, and gestations <20 weeks or >42 weeks. Patients in each group were identified and were further categorized based on body mass index with the nonobese group defined as having a body mass index of <30 kg/m², the obese group defined as having a body mass index of 30 to 40 kg/m², and the morbidly obese group defined as having a body mass index >40 kg/m². The risks for overall and spontaneous preterm delivery were compared between patients without obesity and those with obesity or those with morbid obesity patients. The analysis was stratified by cerclage placement.

RESULTS

Among patients who underwent cerclage placement, the risk for spontaneous preterm delivery was not significantly different in the obese and morbidly obese group when compared with the nonobese group (24.2% vs 20.6%; adjusted odds ratio, 1.18; 95% confidence interval, 0.97-1.43; and 24.5% vs 20.6%; adjusted odds ratio, 1.12; 0.78-1.62, respectively). However, among patients without cerclage placement, the obese and morbidly obese groups had a higher risk for spontaneous preterm delivery than the nonobese group (5.1% vs 4.4%; adjusted odds ratio, 1.04; 1.02-1.05; and 5.9% vs 4.4%; adjusted odds ratio, 1.03; 1.00-1.07, respectively). The risks for overall preterm delivery at <37 weeks' gestation were higher for the obese and morbidly obese groups than for the nonobese group among patients with cerclage (33.7% vs 28.2%; adjusted odds ratio, 1.23; 1.03-1.46; and 32.1% vs 28.2%; adjusted odds ratio, 1.01; 0.72-1.43, respectively). Similarly, among patients without cerclage placement, the risks for preterm delivery at <37 weeks' gestation were higher for the obese and morbidly obese groups than for the nonobese group (7.9% vs 6.8%; adjusted odds ratio, 1.05; 1.04-1.06; and 9.3% vs 6.8%; adjusted odds ratio, 1.10; 1.08-1.13, respectively).

CONCLUSION

Among patients who received a cervical cerclage for the prevention of preterm birth, obesity was not associated with an increased risk for spontaneous preterm delivery. However, it was associated with an overall increased risk for preterm delivery.

Comparison of the Modified Lumbar Pelvic Belt with the Current Belt on Low Back and Pelvic Pain in Pregnant Women

BACKGROUND

Low back pain is one of the most common problems for pregnant women during pregnancy. Most belts are designed for supporting the surface of the symphysis pubis or upper anterior iliac spine without any support in the lumbar region.

OBJECTIVE

This study aimed to compare the related effects between the new design and the current belt on the pain and function of pregnant women.

MATERIAL AND METHODS

In this randomized control trial study, 48 pregnant women with pelvic and lumbar pain participated. The participants were randomly divided into three groups: current belt, modified belt, and control. Pain intensity assessment, pelvic girdle (PG), and Oswestry disability index (ODI) questionnaires were utilized at the beginning of the study and three weeks later.

RESULTS

The pain intensity decreased more in the modified belt group than in the current belt group. ODI and PG scores decreased in two belt groups after three weeks of follow-up. However, this decrease was greater in the modified belt group, there was no statistically significant difference.

CONCLUSION

The disability decreased in both groups using the belts, and their function was improved. Accordingly, the use of a modified belt with lumbar and PG support can significantly reduce back and pelvic pain in pregnant women compared to the current pelvic belt.

Associations Between Gestational Weight Gain and Adverse Birth Outcomes: A Population-Based Retrospective Cohort Study of 9 Million Mother-Infant Pairs

Background

Gestational weight gain (GWG) reflects maternal nutrition during pregnancy. However, the associations between maternal GWG and adverse birth outcomes are inconclusive.

Objective

We aimed to examine the associations between maternal GWG and adverse birth outcomes according to maternal pre-pregnancy body mass index (BMI) categories in a large, multiethnic and diverse population in the U.S.

Study Design

We used nationwide birth certificate data from the National Vital Statistics System to examine the association of GWG (below, within and above the Institute of Medicine [IOM] guidelines) with six adverse birth outcomes (preterm birth, low birthweight, macrosomia, small for gestational age [SGA], large for gestational age [LGA], and low Apgar score) according to the pre-pregnancy BMI categories (underweight to obesity grade 3). Multivariable logistic regression analyses were performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs).

Results

A total of 9,191,842 women aged 18–49 years at delivery with live singleton births were included. Among them, 24.5% of women had GWG below IOM guidelines, 27.6% within the guidelines, and 47.9% above the guidelines. Compared with maternal GWG within guidelines, GWG below guidelines was associated with higher odds of preterm birth (OR = 1.52, 95%CI = 1.51–1.53), low birthweight (OR = 1.46, 95%CI = 1.45–1.47) and SGA (OR = 1.44, 95%CI = 1.43–1.45). In contrast, maternal GWG above guidelines was associated with higher odds of macrosomia (OR = 2.12, 95%CI = 2.11–2.14) and LGA (OR = 2.12, 95%CI = 2.11–2.14). In addition, maternal GWG below or above guidelines had slightly higher odds of low Apgar score (below guidelines: OR = 1.04, 95%CI = 1.03–1.06, above guidelines: OR = 1.17, 95%CI = 1.15–1.18). The results were largely similar among women with GWG below or above guidelines across pre-pregnancy BMI categories of underweight, overweight, and obesity grade 1 to grade 3.

Conclusion

Pregnant women with GWG below or above the IOM guidelines have increased odds of selected adverse infant birth outcomes. Monitoring maternal GWG could enable physicians to provide tailored nutrition and exercise advice as well as prenatal care to pregnant women to reduce the likelihood of adverse birth outcomes.

Gestational diabetes in women with obesity; an analysis of clinical history and simple clinical/anthropometric measures

AIM

We assessed clinical risk factors, anthropometric measures of adiposity and weight gain to determine associations with development of GDM in a cohort of pregnant women with obesity.

METHODS

This was a secondary analysis of the UPBEAT trial of a complex lifestyle intervention in pregnant women with obesity (ISRCTN89971375). Clinical risk factors, and measures of adiposity and weight were assessed in the early 2nd trimester (mean 17 +0 weeks), and adiposity and weight repeated in the early 3rd trimester (mean 27 +5 weeks').

RESULTS

Of the 1117 women (median BMI 35.0 kg/m2) with complete data, 25.8% (n = 304) developed GDM (IADPSG criteria, OGTT 24-28weeks). Using multivariable analysis, early clinical risk factors associated with later development of GDM included age (adj OR 1.06 per year; 95% CI 1.04-1.09), previous GDM (3.27; 1.34-7.93) and systolic blood pressure (per 10mmHg, 1.34; 1.18-1.53). Anthropometric measures positively associated with GDM included second trimester (mean 17+0 weeks) subscapular skinfold thickness, (per 5mm, 1.12; 1.05-1.21), and neck circumference (per cm, 1.11; 1.05-1.18). GDM was not associated with gestational weight gain, or changes in skinfolds thicknesses or circumferences between visits.

CONCLUSIONS

In this cohort of women with obesity, we confirmed clinical risk factors for GDM, (age, systolic blood pressure) previously identified in heterogeneous weight women but add to these indices of adiposity which may provide a discriminatory approach to GDM risk assessment in this group. This study also underscores the need to focus on modifiable factors pre-pregnancy as an opportunity for GDM prevention, as targeting gestational weight gain and adiposity during pregnancy is likely to be less effective.

Goals for reaching optimal wellness (GROWell): A clinical trial protocol of a digital dietary intervention for pregnant and postpartum people with prenatal overweight or obesity

Background:

Excess gestational weight gain (EGWG) is associated with multiple pregnancy complications and health risks for birthing people and their infants. Likewise, postpartum weight retention (PPWR), or not losing all pregnancy weight, has long-term health consequences. EGWG among people who enter pregnancy with overweight or obesity have worse obstetric outcomes and increased PPWR compared to women who gain within Institute of Medicine guidelines.

Methods:

This study protocol describes the details of a blinded, randomized clinical trial of GROWell: Goals for Reaching Optimal Wellness, a mHealth tool designed to improve diet quality among people who enter pregnancy with overweight or obese BMIs to help them achieve appropriate GWG and safe postpartum pregnancy weight loss. Individuals with overweight and obesity will be randomly assigned to an attention control or intervention arm. The intervention group will receive personalized, goal-oriented text messages regarding dietary choices, while the attention control group will receive text messages about healthy pregnancy, labor, delivery, and early infancy. Both groups will complete online surveys at baseline, follow up, 3 and 6 months postpartum.

Results and discussion:

Currently, 162 subjects have been enrolled. Outcomes associated with GWG and pregnancy are expected in late 2023, while outcomes on postpartum weight retention GROWell adherence are expected in late 2024. The results of this trial will support the use of an evidence-based mHealth tool to be integrated into clinical practice to reduce EGWG and PPWR among pregnant people with overweight and obese BMIs, a resource that is currently lacking.

Trial registration:

ClinicalTrials.gov identifier: NCT04449432. Registered on June 26, 2020.

Analysis and Reliability of Anthropometric Measurements during Pregnancy: A Prospective Cohort Study in 208 Pregnant Women

Anthropometric assessment during pregnancy is a widely used, low-technology procedure that has not been rigorously evaluated. Our objective is to investigate fat mass distribution during pregnancy by examining changes in anthropometrics measures, in order to evaluate the reliability of these measures. An observational, longitudinal, prospective cohort study was performed in 208 pregnant women. Anthropometric measurements were taken following the ISAK protocol during the three trimesters and a generalized linear model for repeated measures was used to evaluate differences. Variability was assessed using the coefficient of variation, and Propagated Error (PE) was used to sum of skinfold thicknesses (SFT). SFT showed a general increase in fat mass during the three trimesters of pregnancy (∑SFT7 p = 0.003), and was observed in specific anatomical locations as well: arms (∑Arm SFT, p = 0.046), trunk (∑Trunk SFT, p = 0.019), legs (∑Leg SFT, p = 0.001) and appendicular (∑Appendicular SFT, p = 0.001). Anthropometric measures for skinfold thickness were taken individually during pregnancy and were reliable and reproducible during the three trimesters, which could help to prevent adverse pregnancy outcomes.

A Keyword Analysis Study on Postpartum Obesity Using Big Data

This study selected Google and Naver, the most recognizable Internet portals in Korea, as subjects for analysis. “Postpartum obesity” and “postpartum depression” were used as keywords for data collection. This study aimed to provide basic data for solving maternal problems using big data. Keywords related to postpartum obesity were collected from the portal site Google from 1 January 2019 to 31 December 2019. The collected data were analyzed through simple frequency analysis, N-gram analysis, and keyword network. This study can be used as basic data for postpartum obesity-related programs or academic research. It is also expected to be used for research on the development of a mobile-based customized healthcare system focused on maternal health. Previous papers and data are still insufficient at solving the physical and mental problems related to postpartum obesity and depression. It is necessary to find ways to continuously integrate and collect data from mothers across the country.

Risk factors for accidental falls during pregnancy - a systematic literature review

INTRODUCTION

Falls during pregnancy occur in 25-27% of women and can cause serious harm to both the mother and the fetus. The objective of this systematic review was to identify intrinsic and extrinsic risk factors for falls during pregnancy by reviewing original studies and addressing possible forms of prevention.

METHODS

We searched PubMed, Cochrane library, and Web of Science databases for studies assessing risk factors for falling after a fall has occurred or by using posturographic assessment.

RESULTS

Fourteen studies were included in the review. The identified extrinsic risk factors include slippery floors, cluttered areas, uneven ground, inappropriate shoes, hurrying, walking on stairs, carrying additional loads, poor lighting or obstructed view, sedentary lifestyle and working in physically demanding jobs. The identified intrinsic factors include age less than 30, height more than 160 cm, advanced pregnancy, unintended pregnancy, multiparity, hyperemesis gravidarum, low back pain, gestational diabetes, increase in abdominal circumference, lower ankle stiffness and joint laxity. Physical activity, maternity support belts, and education are possible strategies for fall prevention.

CONCLUSION

Our systematic review identified 13 intrinsic and 11 extrinsic risk factors for falling during pregnancy. With the knowledge of risk factors and the optimal prevention strategy, healthcare providers could incorporate this information in the treatment of pregnant women and reduce the risk of falling.

The relationship between gestational weight gain, maternal upper-body subcutaneous fat changes and infant birth size: A pilot observational study amongst women with obesity

BACKGROUND

It is widely acknowledged that maternal obesity and excessive gestational weight gain (GWG) are associated with increased risk of fetal macrosomia and recent studies have suggested a role for the timing and composition of GWG.

AIMS

To examine the effect of the rate of change in GWG and maternal upper-body subcutaneous fat on neonatal anthropometric outcomes in a pilot observational study amongst women with obesity.

STUDY DESIGN

Expectant women with a body mass index (BMI) > 30 kg/m² at first antenatal appointment were recruited at 12 weeks gestation. Maternal height, weight and skinfold thickness (SFT) measurements were collected at baseline and repeated at 28 and 36 weeks gestation. Following delivery, World Health Organisation (WHO)-UK infant birthweight z-scores were calculated, and infant anthropometric measurements were obtained.

RESULTS

The sum of upper body SFT measurements increased in mid-pregnancy (0.08 ± 0.71 mm/week) and decreased in late pregnancy (-0.04 ± 1.17 mm/week). After adjustment for maternal age, BMI and parity, mid- but not late- pregnancy GWG was positively associated with infant birthweight z-score (p<0.05), while mid- but not late-pregnancy changes in the sum of SFT were inversely associated with infant birthweight z-score (p<0.01).

CONCLUSIONS

The present study suggests that mid- rather than late-pregnancy changes in weight and upper-body subcutaneous fat are associated with infant birthweight. Further research is required in larger, more diverse populations to explore whether pregnancy interventions aiming to improve maternal and offspring health can be personalised beyond BMI and GWG.

Changes in maternal anthropometric measurements in the first postpartum month and associated factors

OBJECTIVE

Maternal anthropometry offers a rapid, inexpensive, and non-invasive method for assessing nutritional status during pregnancy. We aimed to assess the changes in maternal anthropometric measurements in the first month after delivery and to investigate the factors associated with longitudinal changes in maternal postpartum nutritional status.

DESIGN

This prospective longitudinal study included 147 mothers who were on the 5th postpartum day applied to outpatient clinics, from January 2018 through January 2020. Each mother completed a structured questionnaire and baseline anthropometric measurements were performed at the postpartum 5th day and re-evaluated at the end of the first month after delivery.

PARTICIPANTS

Mother-infant pairs (n = 147).

RESULTS

At the end of the first postpartum month, maternal body weight (relative change -5.1%, 95% CI: -5.6%;-4.6%), muscle mass ratio (-1.6%, 95% CI: -2.4%;-0.9%) and body fluid ratio (-2.4%, 95% CI: -3.1%;-1.7%) decreased, whereas fat mass ratio increased (10.3%, 95% CI: 9.0%;11.6%).There was a significant association between infants' feeding type and maternal BMI, weight, muscle mass ratio, body fluid ratio, triceps, and biceps skinfold thickness in mothers (p < .05). We also found a significant relationship between maternal smoke exposure and BMI, maternal weight, fat-mass ratio (p < .05).

CONCLUSIONS

There are some important alterations in maternal anthropometric parameters during the postpartum period. This study will help further our understanding of the factors influencing changes in maternal body composition after delivery.

Association between maternal prepregnancy body mass index and risk of preterm birth in more than 1 million Asian American mothers

BACKGROUND

Asian Americans are among the fastest growing subpopulations in the United States. However, evidence about maternal prepregnancy body mass index (BMI) and preterm birth among Asian Americans is lacking.

METHODS

This population-based study used nationwide birth certificate data from the US National Vital Statistics System 2014 to 2018. All Asian American mothers who had a singleton live birth were included. According to Asian-specific cutoffs, maternal prepregnancy BMI was classified into underweight (BMI < 18.5 kg/m2 ), normal weight (BMI 18.5-22.9 kg/m2 ), overweight (BMI 23.0-27.4 kg/m2 ), class I obesity (BMI 27.5-32.4 kg/m2 ), class II obesity (BMI 32.5-37.4 kg/m2 ), and class III obesity (BMI ≥37.5 kg/m2 ). Preterm birth was defined as gestational age less than 37 weeks. Multivariable logistic regression models were used to estimate the odds ratio (OR) of preterm birth.

RESULTS

We included 1 081 341 Asian American mother-infant pairs. The rate of preterm birth was 6.51% (n = 70 434). The rate of maternal prepregnancy overweight and obesity was 46.80% (n = 506 042). Compared with mothers with normal weight, the adjusted OR of preterm delivery was 1.04 (95% CI, 1.01-1.07) for underweight mothers, 1.18 (95% CI, 1.16-1.20) for overweight mothers, 1.41 (95% CI, 1.37-1.44) for mothers with class I obesity, 1.69 (95% CI, 1.63-1.76) for mothers with class II obesity, and 1.78 (95% CI, 1.66-1.90) for mothers with class III obesity. Similar patterns of associations were observed in Asian American mothers across different country origins.

CONCLUSIONS

Among Asian American mothers, maternal prepregnancy overweight or obesity, defined by Asian-specific, lower BMI cutoffs, was significantly associated with an increased risk of preterm birth. The risk of preterm birth increased with increasing obesity severity. These findings highlight the importance of using Asian-specific BMI cutoffs in assessing risk of preterm birth among Asian American mothers.

Glycine, a Dispensable Amino Acid, Is Conditionally Indispensable in Late Stages of Human Pregnancy

BACKGROUND

Recently, we showed that there are higher protein, lysine, and phenylalanine requirements in late stages of pregnancy compared with early stages. Animal studies have suggested an increased dietary need for specific dispensable amino acids in pregnancy; whether such a need exists in human pregnancies is unknown.

OBJECTIVE

The objective of the current study was to examine whether healthy pregnant women at midgestation (20-29 wk) and late gestation (30-40 wk) have a dietary demand for glycine, a dispensable amino acid, using the indicator amino acid oxidation method and measurement of plasma 5-oxoproline concentrations.

METHODS

Seventeen healthy women (aged 26-36 y) randomly received different test glycine intakes (range: 5-100 mg·kg-1·d-1) during each study day in midgestation (∼26 wk, n = 17 observations in 9 women) and late gestation (∼35 wk, n = 19 observations in 8 women). Diets were isocaloric with energy at 1.7 × resting energy expenditure. Protein was given as a crystalline amino acid mixture based on egg protein composition at current estimated average requirement (EAR; 0.88 g·kg-1·d-1). Breath samples were collected at baseline and isotopic steady state to measure oxidation of L-[1-13C]phenylalanine to 13CO2 (F13CO2). Plasma was collected at the sixth hour of the study day. Linear regression crossover analysis and simple linear regression were used to assess responses in F13CO2 and plasma 5-oxoproline concentrations to different glycine intakes.

RESULTS

No statistically significant responses were observed in midgestation. However, in late gestation, lower glycine intakes resulted in higher rates of F13CO2 (suggesting low protein synthesis) with a breakpoint for phenylalanine oxidation at >37 mg glycine·kg-1·d-1 and higher plasma 5-oxoproline (suggesting low glycine availability) with a breakpoint >27 mg glycine·kg-1·d-1.

CONCLUSIONS

The findings suggest that glycine should be considered a "conditionally" indispensable amino acid during late gestation, especially when protein intakes are at 0.88 g·kg-1·d-1, the current EAR. This trial was registered at clinicaltrials.gov as NCT02149953.

A Pilot Study of a Sleep Intervention Delivered through Group Prenatal Care to Overweight and Obese Women

OBJECTIVES

We sought to investigate the feasibility of a behavioral sleep intervention for insomnia, delivered through group prenatal care and the relationship of this intervention to improvements in insomnia symptoms and sleep quality.

PARTICIPANTS

Women receiving prenatal care and reporting a pre-pregnancy BMI of ≥25 kg/m² and sleep duration of <6.5 h per night.

METHODS

Participants were randomized to group prenatal care or group prenatal care with a behavioral sleep intervention, adapted from cognitive behavioral therapy for insomnia (CBT-I) online program Go! to Sleep®. In the second trimester (T1), late third trimester (T2) and 6-8 weeks postpartum (T3) study assessments were completed including the Insomnia Severity Index, Pittsburgh Sleep Quality Index, fasting glucose and insulin and weight and height. Data were analyzed using independent samples t-tests, chi-square tests, correlations, and two-way repeated measures ANOVA where appropriate. P < .05 was set as the level of significance.

RESULTS

From May 2014 to April 2015, 311 women were evaluated for inclusion and 53 women were randomized to participate (27 intervention; 26 control), 15% were lost to follow up. The intervention group had lower third trimester and postpartum levels of moderate to severe insomnia (T2 50.0% vs 85.0% (p = .018) and T3 13.6% vs 52.4% (p-.008)) and mean insomnia severity scores (T2 (14.7 (±6.6) vs 19.3 (± 6.0) p = .02) and T3 (9.7 (±5.4) vs 15.1(±7.2) p = .01)) when compared to the control group.

CONCLUSION

A randomized controlled trial of a behavioral sleep intervention for insomnia delivered through group prenatal care led to improvements in insomnia symptoms.

Dose-Response Relationships between Breastfeeding and Postpartum Weight Retention Differ by Pre-Pregnancy Body-Mass Index in Taiwanese Women

Postpartum weight retention (PWR) is a risk factor for future obesity. The role of breastfeeding in reducing PWR is not fully understood. We examined the relationship between PWR and the duration of exclusive/partial breastfeeding in 52,367 postpartum women from 2012–2016 Taiwan national breastfeeding surveys. The women were interviewed at 7–14 months postpartum. Non-linear models were fit to examine the association between PWR and breastfeeding duration. PWR adjusted means and 95% confidence intervals were plotted and compared for the duration of exclusive/partial breastfeeding in the total sample and between pre-pregnancy body-mass index (BMI) groups (underweight, normal, overweight, and obese). Women who breastfed exclusively for >30 days showed significantly lower PWR than those who did not breastfeed and those who breastfed partially for the same duration, thereafter each additional duration of 30 days being associated with an average of 0.1–0.2 kg less PWR. Women who breastfed partially for 120 days showed lower PWR than those who did not or those who ceased to breastfeed, thereafter each additional duration of 30 days being associated with an average of 0.1 kg less PWR. Duration of breastfeeding needed to achieve significantly less PWR differed between pre-pregnancy BMI groups, but the effect of exclusive breastfeeding appeared earlier in the normal weight group. Women with obesity who breastfed exclusively for >30 or partially for >180 days, had lower PWR than non-obese groups. The observed dose–response relationship between breastfeeding duration and PWR supports the “every feeding matters” approach in breastfeeding promotion. The larger effect of exclusive and partial breastfeeding on PWR in women with obesity may draw special attention of breastfeeding promotion.

Within-subject effects of environmental and social stressors on pre- and post-partum obesity-related biobehavioral responses in low-income Hispanic women: protocol of an intensive longitudinal study

Background

Disproportionately high rates of maternal overweight and obesity among the Hispanic population before, during, and after pregnancy pose serious health concerns for both mothers (e.g., preeclampsia, gestational diabetes, weight retention) and children (e.g., elevated lifelong obesity risk). A growing body of evidence implicates environmental exposures (e.g., air pollution, metals) and social stressors (e.g., poverty, violence) in contributing to obesity-related biobehavioral processes, such as physical activity, dietary intake, perceived stress, and cortisol regulation. However, current understanding of the role of environmental exposures and social stressors on obesity-related biobehavioral processes is limited by infrequent, inter-individual measurement, and lack of personal exposure monitoring.

Methods

The “Maternal and Developmental Risks from Environmental and Social Stressors” (MADRES) real-time and personal sampling study examines the within-subject day-level effects of environmental and social stressors on maternal pre- and post-partum obesity-related biobehavioral responses. Among a cohort of 65 low-income, Hispanic women in urban Los Angeles, this study uses innovative personal, real-time data capture strategies (e.g., ecological momentary assessment [EMA], personal exposure monitoring, geolocation monitoring, accelerometry) to repeatedly assess obesity-related processes during the 1st and 3rd trimester, and at 4–6 months postpartum. Day-level effects of environmental exposures and social stressors on women’s physical activity, diet, perceived stress and salivary cortisol measured across repeated days will be tested using multilevel modeling.

Discussion

Hispanic women of childbearing age bear a disproportionately high burden of obesity, and this population is also unduly exposed to numerous obesogenic settings. By using innovative real-time data capture strategies, the current study will uncover the daily impacts of environmental and social stressor exposures on women’s obesity-related biobehavioral responses, which over time can lead to excessive gestational weight gain, postpartum weight retention and can pose serious consequences for both mother and child. Findings from the real-time and personal sampling study will identify key mechanistic targets for policy, clinical, and programmatic interventions, with the potential for broad-reaching public health impacts.

Association Between Antenatal and Postpartum Depression and Anxiety with Weight Retention 1 Year After Childbirth: A Longitudinal Study

This was an observational, longitudinal study investigated the association between anxiety and depression in trimesters of pregnancy and early postpartum with weight retention 1 year after childbirth. Sixty-two pregnant women aged 18-35 years with a BMI of 35 or higher and 245 pregnant women with normal BMI (BMI 18.5-24.9 kg/m²) were recruited at their initial prenatal visit in the health centers. The Edinburgh Postnatal Depression Scale (EPDS) and Beck Anxiety Inventory (BAI-II) were completed in five time points, the first, second, third trimester of pregnancy, 6-8 weeks and 12 months after delivery. Pre-pregnancy weight and weight retention at 1 year postpartum was measured. A significant relationship was found between first trimester (adjusted mean difference: aMD 3.416; 95% CI 1.392-5.441) and postpartum (aMD 3.042; 95% CI 0.538-5.547) depression as well as first trimester's anxiety (aMD 3.050; 95% CI 0.631-5.470) with weight retention at 1 year after childbirth.

Anthropometric and ultrasound measures of maternal adiposity in the first trimester of pregnancy

Aim

Estimations of central adiposity in pregnancy is a difficult undertaking due to physiological changes that occur in the body. Therefore, the value of some anthropometric measures particularly in pregnancy, such as body mass index (BMI), waist and hip measures are in doubt. The aim was to compare ultrasound (US) measured abdominal subcutaneous fat (USSFT) with other simple anthropometric methods for obesity assessment, evaluating these measures in pregnancy.

Method

Recruited from a larger study, anthropometric measurements were performed between 11-14 weeks' gestation on 575 women. Measuring height, weight, hip, waist circumference, skin-folds of the triceps, thigh and supra-iliac and USSFT. Percentage maternal fat mass was calculated using skin-fold measures. Correlations of these measures were performed to gauge relationships.

Results

The anthropometric measures demonstrated good correlation (0.54-0.93) between individual adipose measures skin-folds, waist, hip, waist to height ratio (WSR) and USSFT with BMI, percentage fat mass and weight. USSFT correlated well with all anthropometric measures (0.54-0.73) correlating best with waist, WSR, BMI and weight. Waist/hip ratio demonstrated a poor correlation with USSFT, BMI, percentage fat mass and weight (0.3-0.41). Mean anthropometric measures were stratified across BMI categories describing adiposity distribution.

Conclusion

USSFT correlates well with most anthropometric measures in early pregnancy. Limitations of the gravid uterus on waist measurements, hydration and compressibility of skin-fold measures and pregnancy influences on weight and BMI assessments could be overcome using US measures. There is a potential for post hoc evaluation using US for pregnancy complications. Maternal research could benefit from a more accurate measure of adiposity.

Assessing Weight Gain by the 2009 Institute of Medicine Guidelines and Perinatal Outcomes in Twin Pregnancy

Objective The objective is to estimate the impact of maternal weight gain outside the 2009 Institute of Medicine recommendations on perinatal outcomes in twin pregnancies. Study Design Twin pregnancies with two live births between January 1, 2004 and December 31, 2014 delivered after 23 weeks Finger Lakes Region Perinatal Data System (FLRPDS) and Central New York Region Perinatal Data System were included. Women were classified into three groups using pre-pregnancy body mass index (BMI). Perinatal outcomes in women with low or excessive weekly maternal weight gain were assessed using normal weekly weight gain as the referent in each BMI group. Results Low weight gain increased the risk of preterm delivery, birth weight less than the 10th percentile for one or both twins and decreased risk of macrosomia across all BMI groups. There was a decreased risk of hypertensive disorders in women with normal pre-pregnancy weight and an increased risk of gestational diabetes with low weight gain in obese women. Excessive weight gain increased the risk of hypertensive disorders and macrosomia across all BMI groups and decreased the risk of birth weight less than 10th percentile one twin in normal pre-pregnancy BMI group. Conclusion Among twin pregnancies, low weight gain is associated with low birth weight and preterm delivery in all BMI groups and increased risk of gestational diabetes in obese women. Our study did not reveal any benefit from excessive weekly weight gain with potential harm of an increase in risk of hypertensive disorders of pregnancy. Normal weight gain per 2009 IOM guidelines should be encouraged to improve pregnancy outcome in all pre-pregnancy BMI groups.

Lysine Requirements of Healthy Pregnant Women are Higher During Late Stages of Gestation Compared to Early Gestation

Background

Lysine is the first limiting amino acid in cereal proteins and is found mainly in animal-derived products. Current Dietary Reference Intake (DRI) recommendations extrapolate lysine requirements during pregnancy from nonpregnant adult data, and may underestimate true requirements.

Objective

Our objective is to define a quantitative lysine requirement in healthy pregnant women and to determine whether requirements vary between 2 phases of gestation.

Methods

Fourteen pregnant women in early (12-19 wk) and 19 women in late (33-39 wk) gestation were studied using the indicator amino acid oxidation technique. Individual lysine intakes (6-84 mg · kg-1 · d-1, deficient to excess) were tested on each study day as a crystalline amino acid mixture based on egg protein composition. Isonitrogenous diets maintained protein intake at 1.5 g · kg-1 · d-1 and calorie intake at 1.7 times resting energy expenditure during each study day. Phenylalanine and tyrosine intakes were held constant across all lysine intakes. Breath and urine samples were collected at baseline and isotopic steady state. Lysine requirements were determined by measuring the oxidation of L-[1-13C]-phenylalanine to 13CO2 (F13CO2). Biphase linear regression crossover analysis was used to determine a breakpoint (which represents the estimated average requirement, EAR) in F13CO2.

Results

The EAR for lysine during early gestation was determined to be 36.6 mg · kg-1 · d-1 (R2 = 0.484, upper 95% CI = 46.2 mg · kg-1 · d-1), similar to an earlier adult requirement of 36 mg · kg-1 · d-1. The EAR for lysine during late gestation was determined to be 50.3 mg · kg-1 · d-1 (R2 = 0.664, upper 95% CI = 60.4 mg · kg-1 · d-1), 23% higher than the current pregnancy DRI EAR recommendation of 41 mg · kg-1 · d-1.

Conclusions

Our results suggest that lysine requirements are higher during late gestation compared to early gestation, and that current dietary lysine recommendations during late stages of pregnancy may be underestimated. The results have implications for populations consuming cereal-based diets as their primary source of protein. This trial was registered at clinicaltrials.gov as NCT01776931.

[Anthropometric methods used in the evaluation of the postpartum weight retention: a systematic review]

This paper is a systematic review of scientific papers that studied postpartum weight retention. The identification of the studies was conducted in the Medline, Lilacs and Digital Library of Theses and Dissertations databases between 2000 until 2013. The main information evaluated was: author, year of publication, sample size, year of data collection, losses and analysis thereof, age, follow-up time, weight in the baseline and in the postpartum, assessment methods of weight retention and main results. Twenty studies were selected, of which 25% (n = 5) were national. Regarding the mode of analysis, in some works the result was analyzed in different ways as continuous and categorical. Of the selected papers, 45% (n = 9) analyzed the retained weight only continuously, 5% (n = 1) only categorically and 40% (n = 8) both ways. One of the studies used distribution in percentiles and the other evaluated continuously, categorical and by indicators of absolute and relative weight reduction. In conclusion, the results found reveal a lack of well-defined information about the forms of anthropometric measurements of women after delivery, indicating the need for developing national proposals, consistent with the reality of our population.

Preconceptional and maternal obesity: epidemiology and health consequences

Obesity in women of reproductive age is increasing in prevelance worldwide. Obesity reduces fertility and increases time taken to conceive, and obesity-related comorbidities (such as type 2 diabetes and chronic hypertension) heighten the risk of adverse outcomes for mother and child if the woman becomes pregnant. Pregnant women who are obese are more likely to have early pregnancy loss, and have increased risk of congenital fetal malformations, delivery of large for gestational age infants, shoulder dystocia, spontaneous and medically indicated premature birth, and stillbirth. Late pregnancy complications include gestational diabetes and pre-eclampsia, both of which are associated with long-term morbidities post partum. Women with obesity can also experience difficulties during labour and delivery, and are more at risk of post-partum haemorrhage. Long-term health risks are associated with weight retention after delivery, and inherent complications for the next pregnancy. The wellbeing of the next generation is also compromised. All these health issues could be avoided by prevention of obesity among women of reproductive age, which should be viewed as a global public health priority. For women who are already obese, renewed efforts should be made towards improved management during pregnancy, especially of blood glucose, and increased attention to post-partum weight management. Effective interventions, tailored to ethnicity and culture, are needed at each of these stages to improve the health of women and their children in the context of the global obesity epidemic.

Pre-pregnancy body mass index, height and physical activity are associated with rate of gestational weight gain among Malaysian mothers

AIM

Both inadequate and excessive weight gain during pregnancy can have immediate and long-term health risks for women and infants. This study investigated rate of gestational weight gain (GWG) and its associated factors in Malaysian pregnant women.

METHODS

This cross-sectional study was conducted at maternal and child health clinics in Selangor and Negeri Sembilan between November 2010 and April 2012. A pre-tested questionnaire was used to obtain sociodemographic, obstetric, dietary intake and physical activity information. Current weight and height were measured using standard procedures. GWG rate was calculated as the average weekly weight gain in that particular trimester of pregnancy and further categorized according to the Institute of Medicine (IOM) recommendations.

RESULTS

Mean GWG rate for all pre-pregnancy BMI categories in the second and third trimesters was higher than the IOM recommendations. Overweight women (adjusted OR, 4.26; 95%CI: 1.92-9.44) and women <153 cm tall (adjusted OR, 1.96; 95%CI: 1.21-3.18) tend to have inadequate GWG rate. Women with high pre-pregnancy body mass index (BMI; ≥25.0 kg/m(2) ; overweight: adjusted OR, 3.88; 95%CI: 2.12-7.09; obese: adjusted OR, 2.34; 95%CI: 1.28-4.29) and low physical activity (adjusted OR, 1.74; 95%CI: 0.77-3.97) were two-threefold more likely to have excessive GWG.

CONCLUSION

Both inadequate and excessive GWG can have detrimental effects on the health of mothers and infants. Pre-pregnancy BMI, height and physical activity should be emphasized in prenatal care to ensure that women have adequate GWG rate.

Comparison of multiple methods to measure maternal fat mass in late gestation

BACKGROUND

Measurements of maternal fat mass (FM) are important for studies of maternal and fetal health. Common methods of estimating FM have not been previously compared in pregnancy with measurements using more complete body composition models.

OBJECTIVES

The goal of this pilot study was to compare multiple methods that estimate FM, including 2-, 3- and 4-compartment models in pregnant women at term, and to determine how these measures compare with FM by dual-energy X-ray absorptiometry (DXA) 2 wk postpartum.

DESIGN

Forty-one healthy pregnant women with prepregnancy body mass index (in kg/m(2)) 19 to 46 underwent skinfold thickness (SFT), bioelectrical impedance analysis (BIA), body density (Db) via air displacement plethysmography (ADP), and deuterium dilution of total body water (TBW) with and without adjustments for gestational age using van Raaij (VRJ) equations at 37-38 wk of gestation and 2 wk postpartum to derive 8 estimates of maternal FM. Deming regression analysis and Bland-Altman plots were used to compare methods of FM assessment.

RESULTS

Systematic differences in FM estimates were found. Methods for FM estimates from lowest to highest were 4-compartment, DXA, TBW(VRJ), 3-compartment, Db(VRJ), BIA, air displacement plethysmography body density, and SFT ranging from a mean ± SD of 29.5 ± 13.2 kg via 4-compartment to 39.1 ± 11.7 kg via SFT. Compared with postpartum DXA values, Deming regressions revealed no substantial departures from trend lines in maternal FM in late pregnancy for any of the methods. The 4-compartment method showed substantial negative (underestimating) constant bias, and the air displacement plethysmography body density and SFT methods showed positive (overestimating) constant bias. ADP via Db(VRJ)and 3-compartment methods had the highest precision; BIA had the lowest.

CONCLUSIONS

ADP that uses gestational age-specific equations may provide a reasonable and practical measurement of maternal FM across a spectrum of body weights in late pregnancy. SFT would be acceptable for use in larger studies. This trial was registered at clinicaltrials.gov as NCT02586714.

Influence of Body Composition on Gait Kinetics throughout Pregnancy and Postpartum Period

Pregnancy leads to several changes in body composition and morphology of women. It is not clear whether the biomechanical changes occurring in this period are due exclusively to body composition and size or to other physiological factors. The purpose was to quantify the morphology and body composition of women throughout pregnancy and in the postpartum period and identify the contribution of these parameters on the lower limb joints kinetic during gait. Eleven women were assessed longitudinally, regarding anthropometric, body composition, and kinetic parameters of gait. Body composition and body dimensions showed a significant increase during pregnancy and a decrease in the postpartum period. In the postpartum period, body composition was similar to the 1st trimester, except for triceps skinfold, total calf area, and body mass index, with higher results than at the beginning of pregnancy. Regression models were developed to predict women's internal loading through anthropometric variables. Four models include variables associated with the amount of fat; four models include variables related to overall body weight; three models include fat-free mass; one model includes the shape of the trunk as a predictor variable. Changes in maternal body composition and morphology largely determine kinetic dynamics of the joints in pregnant women.

Lifestyle risk factors for cardiovascular disease and diabetic risk in a sedentary occupational group: the Galway taxi driver study

BACKGROUND

Taxi drivers are at increased risk of cardiovascular disease (CVD), something which persists after correcting for the overrepresentation of traditional risk factors for CVD in this cohort. The contribution of lifestyle risk factors to this residually elevated CVD risk remains under-evaluated.

AIMS

We aimed to determine the prevalence of lifestyle risk factors for CVD, self-reported medical risk factors for CVD, and future risk of type 2 diabetes amongst Irish taxi drivers.

METHODS

Male taxi drivers with no history of CVD and type 2 diabetes and working in Galway city in the west of Ireland were invited to participate. Physical activity levels, dietary patterns, anthropometry, smoking, hypertension, hypercholesterolaemia, and Finnish Diabetes Risk Score (FINDRISC) values were recorded in a cross-sectional manner.

RESULTS

41 taxi drivers (mean age 56.7 ± 9.8 years) participated. 37 % were insufficiently active based on self-report, although only 8 % objectively achieved 10, 000 steps per day. Mean modified Mediterranean diet score (mMDS) was 4.6 ± 2.2, and only 13 % of participants had a normal body mass index (BMI) or waist circumference (WC). Those who worked for taxi companies tended to have a higher BMI (p = .07) and WC (p = .04) by multivariable regression. 22 % were current smokers, although a quit rate of 72 % was observed amongst the 78 % of taxi drivers who had ever smoked. 25 % were at high or very high risk of future type 2 diabetes.

CONCLUSION

Lifestyle risk factors for CVD and dysglycaemia are prevalent amongst Irish taxi drivers.

Interpregnancy weight change and risk of preterm delivery

OBJECTIVE

Prepregnant weight gain increases risk of obstetric complications, but its effect on preterm delivery is unknown. This study aimed to investigate the associations between change in body mass index (BMI) from first to second pregnancies and risk of preterm delivery in the second pregnancy according to the type and severity of preterm delivery.

METHODS

A nationwide cohort study was conducted in 465,836 Swedish women with their first two consecutive singleton live births between 1992 and 2012. Rates of very (22-31 gestational weeks) and moderately (32-36 gestational weeks) preterm delivery in the second pregnancy, classified as spontaneous or medically indicated, were compared between categories of interpregnancy BMI change.

RESULTS

Among women with first pregnancy BMI < 25, BMI gain ≥ 4 kg/m(2) and BMI loss > 2 kg/m(2) were related to 24% (95% CI, 5-46%) and 18% (95% CI, 5-33%) higher rates of spontaneous moderately preterm delivery, respectively. BMI gain ≥ 4 kg/m(2) was related to increased risk of medically indicated very preterm delivery. Weight loss was associated with reduced rates of medically indicated moderately preterm delivery among women with BMI ≥ 25.

CONCLUSIONS

High weight gain or loss in normal-weight women is associated with spontaneous moderately preterm delivery. High interpregnancy weight gain is related to increased risks of medically indicated preterm delivery.

AISF position paper on liver disease and pregnancy

The relationship between liver disease and pregnancy is of great clinical impact. Severe liver disease in pregnancy is rare; however, pregnancy-related liver disease is the most frequent cause of liver dysfunction during pregnancy and represents a severe threat to foetal and maternal survival. A rapid differential diagnosis between liver disease related or unrelated to pregnancy is required in women who present with liver dysfunction during pregnancy. This report summarizes the recommendation of an expert panel established by the Italian Association for the Study of the Liver (AISF) on the management of liver disease during pregnancy. The article provides an overview of liver disease occurring in pregnancy, an update on the key mechanisms involved in its pathogenesis, and an assessment of the available treatment options. The report contains in three sections: (1) specific liver diseases of pregnancy; (2) liver disease occurring during pregnancy; and (3) pregnancy in patients with pre-existing chronic liver disease. Each topic is discussed considering the most relevant data available in literature; the final statements are formulated according to both scientific evidence and clinical expertise of the involved physicians, and the AISF expert panel recommendations are reported.

Association between maternal obesity and offspring Apgar score or cord pH: a systematic review and meta-analysis

Previous results are inconsistent regarding the association between maternal obesity and Apgar score or cord pH in humans. The aim of this study was to investigate the association between maternal pre-pregnancy and pregnancy body mass index (BMI) and infant Apgar score or cord pH. We conducted a systematic review of studies published in English before 20 August 2015 using PubMed, EMBASE, and Cochrane Library. Eleven cohort studies with a total of 2,586,265 participants finally met our inclusion criteria. Pooled results revealed the following factors associated with Apgar score <7 at 5 minutes: overweight (odds ratio [OR] 1.13; 95% confidence interval [CI], 1.08-1.20), obese (OR 1.40; 95% CI, 1.27-1.54), and very obese (OR 1.71; 95% CI, 1.55-1.89). The pooled analysis also revealed that maternal overweight or obesity increased the risk for Apgar score <7 at 1 minute. There was no association between maternal BMI and neonatal cord pH. Thus, this study suggests that maternal overweight and obesity affect baby's condition immediately after birth in general. More studies are needed to confirm these results and detect the influence of variables across studies.

Maternal stress predicts postpartum weight retention

Postpartum weight retention (PPWR) is a significant contributor to the development of overweight and obesity in women of childbearing age. Stress may be a key mechanism making it more difficult for mothers to lose weight in the year following delivery. The aim of this study was to assess whether specific aspects of parenting stress and life stress influence postpartum weight retention in new mothers. Women in late pregnancy or up to 2 months postpartum (n = 123) were enrolled in the study and followed through the first year postpartum. Linear regression models evaluated the associations of parenting stress (isolation, attachment and depressive symptoms) as well as overall life stress at 2, 6, and 12 months postpartum with PPWR at 6 and 12 months. During the first year postpartum, higher depression and life stress were significantly associated with greater PPWR. As the effect of depression diminished, the effect of life stress became significant. Contrary to hypothesized relationships, fewer problems with attachment and less social isolation were significantly associated with greater PPWR. Higher gestational weight gain and African American race were also significantly associated with greater PPWR at both 6 and 12 months. Different types of stress predict weight retention in first time mothers during the first year postpartum. Understanding the relationships between parenting stress, concurrent life stress and PPWR can enhance the development of future interventions that specifically target self-identified stressors, leading to improved weight related outcomes.

Effects of an antenatal dietary intervention on maternal anthropometric measures in pregnant women with obesity

OBJECTIVE

The effect of providing antenatal dietary and lifestyle advice on secondary measures of maternal anthropometry was evaluated and their correlation with both gestational weight gain and infant birth weight was assessed.

METHODS

In a multicenter, randomized controlled trial, pregnant women with BMI of ≥25 kg/m(2) received either Lifestyle Advice or Standard Care. Maternal anthropometric outcomes included arm circumference, biceps, triceps, and subscapular skinfold thickness measurements (SFTM), percentage body fat (BF), gestational weight gain, and infant birth weight. The intention to treat principles were utilized by the analyses.

RESULTS

The measurements were obtained from 807 (74.7%) women in the Lifestyle Advice Group and 775 (72.3%) women in the Standard Care Group. There were no statistically significant differences identified between the treatment groups with regards to arm circumference, biceps, triceps, and subscapular SFTM, or percentage BF at 36-week gestation. Maternal anthropometric measurements were not significantly correlated with either gestational weight gain or infant birth weight.

CONCLUSIONS

Among pregnant women with a BMI of ≥25 kg/m(2) , maternal SFTM were not modified by an antenatal dietary and lifestyle intervention. Furthermore, maternal SFTM correlate poorly with both gestational weight gain and infant birth weight.

Exercise in pregnancies complicated by obesity: achieving benefits and overcoming barriers

An increasing number of women are entering pregnancy in an overweight or obese state. Obese women and their offspring are at increased risk of adverse perinatal outcomes, which may be improved by regular moderate-intensity antenatal exercise. Current guidelines recommend that all pregnant women without contraindications engage in ≥30 minutes of moderate-intensity exercise on a daily basis. However, obese women are usually less physically active and tend to further reduce activity levels during pregnancy. This commentary summarizes the potential short- and long-term benefits of antenatal exercise in obese pregnant women, highlights the challenges they face, and discusses means of improving their exercise levels. In addition, we make recommendations on exercise prescription for pregnancies complicated by obesity.

Effect of Pregnancy Upon Facial Anthropometrics and Respirator Fit Testing

Workers required to wear respirators must undergo additional respirator fit testing if a significant change in body weight occurs. Approximately 10% of working women of reproductive age will be pregnant and experience a significant change in weight, yet the effect of pregnancy-associated weight gain on respirator fit is unknown. Cephalo-facial anthropometric measurements and quantitative fit testing of N95 filtering facepiece respirators (N95 FFR) of 15 pregnant women and 15 matched, non-pregnant women were undertaken for comparisons between the groups. There were no significant differences between pregnant and non-pregnant women with respect to cephalo-facial anthropometric measurements or N95 FFR quantitative fit tests. Healthy pregnant workers, who adhere to the recommended weight gain limits of pregnancy, are unlikely to experience an increase in cephalo-facial dimensions that would mandate additional N95 FFR fit testing above that which is normally required on an annual basis.

Protein requirements of healthy pregnant women during early and late gestation are higher than current recommendations

BACKGROUND

Adequate maternal dietary protein intake is necessary for healthy pregnancy. However, current protein intake recommendations for healthy pregnant women are based on factorial calculations of nitrogen balance data derived from nonpregnant adults. Thus, an estimate of protein requirements based on pregnancy-specific data is needed.

OBJECTIVE

The objective of this study was to determine protein requirements of healthy pregnant women at 11-20 (early) and 31-38 (late) wk of gestation through use of the indicator amino acid oxidation method.

METHODS

Twenty-nine healthy women (24-37 y) each randomly received a different test protein intake (range: 0.22-2.56 g · kg(-1) · d(-1)) during each study day in early (n = 35 observations in 17 women) and late (n = 43 observations in 19 women) gestation; 7 women participated in both early and late gestation studies. The diets were isocaloric and provided energy at 1.7 × resting energy expenditure. Protein was given as a crystalline amino acid mixture based on egg protein composition, except phenylalanine and tyrosine, which were maintained constant across intakes. Protein requirements were determined by measuring the oxidation rate of L-[1-(13)C]phenylalanine to (13)CO2 (F(13)CO2). Breath and urine samples were collected at baseline and isotopic steady state. Linear regression crossover analysis identified a breakpoint (requirement) at minimal F(13)CO2 in response to different protein intakes.

RESULTS

The estimated average requirement (EAR) for protein in early and late gestation was determined to be 1.22 (R(2) = 0.60; 95% CI: 0.79, 1.66 g · kg(-1) · d(-1)) and 1.52 g · kg(-1) · d(-1) (R(2) = 0.63; 95% CI: 1.28, 1.77 g · kg(-1) · d(-1)), respectively.

CONCLUSIONS

These estimates are considerably higher than the EAR of 0.88 g · kg(-1) · d(-1) currently recommended by the Dietary Reference Intakes. To our knowledge, this study is the first to directly estimate gestational stage-specific protein requirements in healthy pregnant women and suggests that current recommendations based on factorial calculations underestimate requirements. This trial was registered at clinicaltrials.gov as NCT01784198.

Maternal Obesity Management Using Mobile Technology: A Feasibility Study to Evaluate a Text Messaging Based Complex Intervention during Pregnancy

BACKGROUND

Maternal obesity and excessive gestational weight gain (GWG) are on the rise with negative impact on pregnancy and birth outcomes. Research into managing GWG using accessible technology is limited. The maternal obesity management using mobile technology (MOMTech) study aimed at evaluating the feasibility of text messaging based complex intervention designed to support obese women (BMI ≥ 30) with healthier lifestyles and limit GWG.

METHODS

Participants received two daily text messages, supported by four appointments with healthy lifestyle midwife, diet and activity goal setting, and self-monitoring diaries. The comparison group were obese mothers who declined to participate but consented for their routinely collected data to be used for comparison. Postnatal interviews and focus groups with participants and the comparison group explored the intervention's acceptability and suggested improvements.

RESULTS

Fourteen women completed the study which did not allow statistical analyses. However, participants had lower mean GWG than the comparison group (6.65 kg versus 9.74 kg) and few (28% versus 50%) exceeded the Institute of Medicine's upper limit of 9 kg GWG for obese women.

CONCLUSIONS

MOMTech was feasible within clinical setting and acceptable intervention to support women to limit GWG. Before further trials, slight modifications are planned to recruitment, text messages, and the logistics of consultation visits.

Gut estimates: Pregnant women adapt to changing possibilities for squeezing through doorways

Possibilities for action depend on the fit between the body and the environment. Perceiving what actions are possible is challenging, because the body and the environment are always changing. How do people adapt to changes in body size and compression? In Experiment 1, we tested pregnant women monthly over the course of pregnancy to determine whether they adapted to changing possibilities for squeezing through doorways. As women gained belly girth and weight, previously passable doorways were no longer passable, but women's decisions to attempt passage tracked their changing abilities. Moreover, their accuracy was equivalent to that of nonpregnant adults. In Experiment 2, nonpregnant adults wore a "pregnancy pack" that instantly increased the size of their bellies, and they judged whether doorways were passable. Accuracy in the "pregnant" participants was only marginally worse than that of actual pregnant women, suggesting that participants adapted to the prosthesis during the test session. In Experiment 3, participants wore the pregnancy pack and gauged passability before and after attempting passage. The judgments were grossly inaccurate prior to receiving feedback. These findings indicate that experience facilitates perceptual-motor recalibration for certain types of actions.

Body composition changes in pregnancy: measurement, predictors and outcomes

Prevalence of overweight and obesity has risen in the United States over the past few decades. Concurrent with this rise in obesity has been an increase in pregravid body mass index and gestational weight gain affecting maternal body composition changes in pregnancy. During pregnancy, many of the assumptions inherent in body composition estimation are violated, particularly the hydration of fat-free mass, and available methods are unable to disentangle maternal composition from fetus and supporting tissues; therefore, estimates of maternal body composition during pregnancy are prone to error. Here we review commonly used and available methods for assessing body composition changes in pregnancy, including: (1) anthropometry, (2) total body water, (3) densitometry, (4) imaging, (5) dual-energy X-ray absorptiometry, (6) bioelectrical impedance and (7) ultrasound. Several of these methods can measure regional changes in adipose tissue; however, most of these methods provide only whole-body estimates of fat and fat-free mass. Consideration is given to factors that may influence changes in maternal body composition, as well as long-term maternal and offspring outcomes. Finally, we provide recommendations for future research in this area.

Maternal overweight and obesity and risks of severe birth-asphyxia-related complications in term infants: a population-based cohort study in Sweden

BACKGROUND

Maternal overweight and obesity increase risks of pregnancy and delivery complications and neonatal mortality, but the mechanisms are unclear. The objective of the study was to investigate associations between maternal body mass index (BMI) in early pregnancy and severe asphyxia-related outcomes in infants delivered at term (≥37 weeks).

METHODS AND FINDINGS

A nation-wide Swedish cohort study based on data from the Medical Birth Register included all live singleton term births in Sweden between 1992 and 2010. Logistic regression analyses were used to obtain odds ratios (ORs) with 95% CIs for Apgar scores between 0 and 3 at 5 and 10 minutes, meconium aspiration syndrome, and neonatal seizures, adjusted for maternal height, maternal age, parity, mother's smoking habits, education, country of birth, and year of infant birth. Among 1,764,403 term births, 86% had data on early pregnancy BMI and Apgar scores. There were 1,380 infants who had Apgar score 0-3 at 5 minutes (absolute risk  = 0.8 per 1,000) and 894 had Apgar score 0-3 at 10 minutes (absolute risk  = 0.5 per 1,000). Compared with infants of mothers with normal BMI (18.5-24.9), the adjusted ORs (95% CI) for Apgar scores 0-3 at 10 minutes were as follows: BMI 25-29.9: 1.32 (1.10-1.58); BMI 30-34.9: 1.57 (1.20-2.07); BMI 35-39.9: 1.80 (1.15-2.82); and BMI ≥40: 3.41 (1.91-6.09). The ORs for Apgar scores 0-3 at 5 minutes, meconium aspiration, and neonatal seizures increased similarly with maternal BMI. A study limitation was lack of data on effects of obstetric interventions and neonatal resuscitation efforts.

CONCLUSION

Risks of severe asphyxia-related outcomes in term infants increase with maternal overweight and obesity. Given the high prevalence of the exposure and the severity of the outcomes studied, the results are of potential public health relevance and should be confirmed in other populations. Prevention of overweight and obesity in women of reproductive age is important to improve perinatal health.

Subcutaneous body fat in pregnant New Zealand women: association with wheeze in their infants at 18 months

To investigate the association of subcutaneous body fat levels in pregnant women with wheezing in their 18 month old infants. A prospective study of European and Polynesian volunteers (n = 369) recruited from northern New Zealand were visited in months 4 and 7 of pregnancy when height, weight, and triceps, biceps and costal skinfolds were measured, and questionnaires determining personal details administered; and again visited 18 months after birth when infants were measured and questions on infant feeding and wheeze administered. At 18 months 32 % of infants had wheezed in the past 12 months. Increased wheeze was associated with maternal asthma, eczema or allergy (p = 0.001); receiving family welfare payments (p = 0.010); and being Polynesian (p = 0.021); while exclusive breastfeeding to 2 months (p = 0.045) was associated with decreased wheeze. Individual month 4 and month 7 mean triceps, biceps and costal skinfolds were all greater in mothers of wheezers compared to nonwheezers, biceps and costal skinfolds significantly so (p = 0.002, p = 0.005 at month 7). The sum of these skinfolds at month 4, at month 7, and the difference between these sums, were all significantly associated with increased risk of infant wheeze at 18 months when considered alone (p = 0.037, p = 0.001 and p = 0.015) or in combination. Prevalence of infant wheeze was 22.7 % for mothers with lower quartile month 7 skinfolds, compared to 45.0 % for mothers with upper quartile. After adjusting for significant covariates the difference in skinfolds had the strongest association (p = 0.003) followed by sum at month 4 (p = 0.074 or 0.003 depending on whether Polynesian ethnicity was included in the model). The sum of skinfolds declined between month 4 and month 7 in 34 % of women. Prevalence of wheeze was 19.2 % where the difference in mothers' skinfolds between month 4 and month 7 decreased by 10 mm or more and 41.7 % where the difference increased by 10 mm or more. Mean month 4 weights, BMI and sum of skinfolds were below average in the latter group. As the sum of month 4 or month 7 maternal skinfolds increased the prevalence of infant wheeze increased. In addition as the change in skinfolds between month 4 and month 7 became more positive the prevalence of infant wheeze increased. This study suggests for the first time that changes in subcutaneous fat during pregnancy are associated with prevalence of infant wheeze.

Perinatal factors relating to changes in maternal body fat in late gestation

OBJECTIVE

To examine changes in skinfolds in late gestation in healthy women.

STUDY DESIGN

Skinfold measures were performed in 39 women at 30.8 (mean) and 37.7 weeks gestation. Fat mass (kg) and sum of three skinfolds were calculated.

RESULTS

A decrease in skinfold thickness was observed in 21 women (-3.1±2.1 mm) in late gestation, whereas 18 women had an increase (4.3±3.2 mm), P<0.001. The group of women who lost body fat (decrease in skinfold thickness) had a trend toward greater pregravid body mass index (BMI, 25 vs 22 kg/m(2), P=0.06), and gained less weight in late gestation (3.0 vs 4.3 kg, P=0.042). On multiple regression, maternal age and gestational weight gain were positively correlated with fat mass accrual, whereas pregravid BMI and dietary fiber were negative determinants of late gestational fat mass.

CONCLUSION

Increases in maternal fat mass in late gestation were related to maternal age and gestational weight gain, whereas decreases were related to increased pregravid BMI and dietary fiber.

Obesity levels in a national cohort of women 9 months after delivery

OBJECTIVE

The purpose of this study was to examine the relationship between maternal obesity that is calculated 9 months after delivery and sociodemographic variables.

STUDY DESIGN

A national cohort of mothers was sampled 9 months after delivery as part of the Growing Up in Ireland Study Infant Cohort. Sociodemographic and clinical details were recorded at the interview by trained fieldworkers who used validated questionnaires. Body mass index was calculated based on weight and height measurements at the postpartum interview. The unadjusted and adjusted odds of obesity were calculated for predictor variables with the use of logistic regression analysis.

RESULTS

Of the 10,524 mothers whose cases were studied, the mean age was 31.6 ± 5.5 years, and the mean parity was 1.0 ± 1.1. The mean body mass index after delivery was 25.7 ± 5.4 kg/m(2); 16.8% of the women (n = 1768) were obese. Postpartum maternal obesity levels were associated positively on univariable analyses with smoking, lower household income, African nationality, earlier completion of full-time education, gestational weight gain, lower breast-feeding duration, and increasing parity. On multivariable analysis, maternal obesity was associated with increasing parity in lower income households, but not in higher income households.

CONCLUSION

Public health interventions that are aimed at decreasing obesity levels after childbirth should prioritize women who are disadvantaged socioeconomically.

Developing a tool for obtaining maternal skinfold thickness measurements and assessing inter-observer variability among pregnant women who are overweight and obese

Background

It is estimated that between 34% and 50% of Australian women entering pregnancy are overweight and obese, which is associated with an increased risk in complications for both the woman and her infant. Current tools used in clinical and research practice for measuring body composition include body mass index (BMI), waist circumference and bioimpedance analysis. Not all of these measures are applicable for use during pregnancy due to a lack of differentiation between maternal and fetal contributions. While skinfold thickness measurement (SFTM) is increasingly being used in pregnancy, there is limited data and a lack of a standard tool for its use in overweight and obese pregnant women.

Methods

We developed a standard tool for evaluating SFTM among women with a BMI ≥ 25 kg/m². Forty-nine women were measured as part of a prospective cohort study nested within a multicentre randomised controlled trial (The LIMIT Randomised Controlled Trial). Two blinded observers each performed 2 skinfold measurements on the biceps, triceps and subscapular of each woman. Intraclass correlation coefficients (ICC) and standard error of measurement (SEM) were used to analyse SFTM, body fat percentage (BF%) and inter-observer variability.

Results

The ICC for inter-observer variability in measurements were considered moderate for biceps SFTM (ICC = 0.56) and triceps SFTM (ICC = 0.51); good for subscapular SFTM (ICC = 0.71) and BF% (ICC = 0.74); and excellent for arm circumference (ICC = 0.97). The standard error of measurements ranged from 0.53 cm for arm circumference to 3.58 mm for the subscapular SFTM.

Conclusion

Our findings indicate that arm circumference and biceps, triceps and subscapular SFTM can be reliably obtained from overweight and obese pregnant women to calculate BF%, using multiple observers, and can be used in a research setting.

Trial registration

Australian and New Zealand Clinical Trials Registry ACTRN12607000161426

The molecular mechanisms of offspring effects from obese pregnancy

The incidence of obesity, increased weight gain and the popularity of high-fat / high-sugar diets are seriously impacting upon the global population. Billions of individuals are affected, and although diet and lifestyle are of paramount importance to the development of adult obesity, compelling evidence is emerging which suggests that maternal obesity and related disorders may be passed on to the next generation by non-genetic means. The processes acting within the uteri of obese mothers may permanently predispose offspring to a diverse plethora of diseases ranging from obesity and diabetes to psychiatric disorders. This review aims to summarise some of the molecular mechanisms and active processes currently known about maternal obesity and its effect on foetal and neonatal physiology and metabolism. Complex and multifactorial networks of molecules are intertwined and culminate in a pathologically synergistic manner to cause disruption and disorganisation of foetal physiology. This altered phenotype may potentiate the cycle of intergenerational transmission of obesity and related disorders.

Women's and Midwives' Perspectives on the Design of a Text Messaging Support for Maternal Obesity Services: An Exploratory Study

This study was aimed to explore women's and midwives' views on the use of mobile technology in supporting obese pregnant women with healthy lifestyle choices. A purposive sample of 14 women and midwives participated in four focus groups in Doncaster, UK. A content analysis of the transcripts from the first focus group led to the emergence of three main constructs with associated subcategories including Benefits ("modernising," "motivating," "reminding," and "reducing" the sense of isolation), Risks and Limitations (possibility of "being offensive," "creating pressure or guilt," and "being influenced by mood"), and Service Delivery (making it "available to all pregnant women," giving attention to the "message tone" and development of "message content"). They also suggested the use of other modalities such as web-based services for weight management during pregnancy. Based on the above results a text messaging service was developed and presented to the 2nd focus group participants who confirmed the positive views from the first focus group on the use of the text messaging as being supportive and informative. The participants also welcomed "women's engagement and choice" in deciding the content, timing and frequency of messages. The results informed the development of a text messaging service to support maternal obesity management. The implementation and acceptability of this service requires further investigation.