1
|
Zhang H, Wu L, Wu X, Chen Y, Tian FY, Yin A, Hu F, Tong J, Huang X, Wan Y, Niu J. Maternal BMI changes from the prepregnancy to postpartum period are associated with postpartum cardiometabolic risk factors: a longitudinal study. Arch Gynecol Obstet 2024; 309:2591-2603. [PMID: 37526682 PMCID: PMC11147864 DOI: 10.1007/s00404-023-07154-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/09/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE This study aimed at investigating the associations between the total body mass index (BMI) change at 3 or 4 years postpartum compared to the prepregnancy and cardiometabolic risk factors. METHODS This longitudinal study included 1305 participants. Based on the total postpartum BMI changes, they were divided into < 0 units, 0-1.7 units, and > 1.7 units groups using the interquartile range. Multiple linear regression models were used to analyze the associations. RESULTS Compared to the reference group, there was a progressive increase in the βcoefficient (βcoef) of homeostasis model assessment of insulin resistance (HOMA-IR) of cardiometabolic risk in the following groups: the '0-1.7 units' group with the 'overweight traj' [βcoef 0.33; 95% confidence intervals (CI) 0.22, 0.44)] or the 'obesity traj' [0.66; (0.45, 0.88)] and the '> 1.7 units' group with the 'normal traj' [0.33; (0.22, 0.44)], the 'overweight traj' [0.54; (0.41, 0.67)] or the 'obesity traj' [0.97; (0.79, 1.15)]. The same increasing trend of βcoef was also found in DBP, FPG, LDL, WHR, BF%. However, the '< 0 units' group with the 'low traj' [0.13; (0.06, 0.21)] and the '0-1.7 units' group with the 'low traj' [0.08; (0.03, 0.13)] had higher high-density lipoprotein cholesterol (HDL-C) level than the reference group. CONCLUSION Women with a postpartum BMI gain > 1.7 units are positively associated with cardiometabolic risk factors, especially for those in the 'obesity traj' or 'traj D'. Conversely, women with a postpartum BMI loss > 0 units have negative association with cardiometabolic risk factors, especially for those in the 'low traj' or 'traj B'.
Collapse
Affiliation(s)
- Huafan Zhang
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Linlin Wu
- Department of Obstetrics and Gynecology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, China
| | - Xiaoxia Wu
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Yixuan Chen
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Fu-Ying Tian
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Aiqi Yin
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Fengqiao Hu
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Jianing Tong
- Department of Obstetrics and Gynecology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, China
| | - Xuna Huang
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Yanmei Wan
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Jianmin Niu
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China.
| |
Collapse
|
2
|
Benson J, DeVries M, McLaurin-Jiang S, Garner CD. Experiences accessing nutritious foods and perceptions of nutritional support needs among pregnant and post-partum mothers with low income in the United States. MATERNAL & CHILD NUTRITION 2024:e13660. [PMID: 38812121 DOI: 10.1111/mcn.13660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 04/05/2024] [Accepted: 04/25/2024] [Indexed: 05/31/2024]
Abstract
Access to nutritious foods, a social determinant of health, contributes to disparities in maternal and infant health outcomes such as mental health, breastfeeding intensity and cardiometabolic risk. This study explored perceived nutrition access and intake among pregnant or post-partum women eligible for Medicaid. Qualitative, semistructured interviews were conducted with 18 women who were either currently pregnant (n = 4) or up to 12 months post-partum (n = 14) in 2021-2022. Mothers spoke English (n = 11) or Spanish (n = 7) and lived in the Texas Panhandle. Interviews were audio-recorded, transcribed, translated (Spanish to English) and verified. Two or more researchers coded each interview until consensus was reached using thematic analysis with ATLAS.ti software. The study revealed five drivers for nutrition access. (1) Social factors influenced nutrition; those with less support expressed limited ability to eat healthfully. (2) The Women, Infants and Children program was perceived as a helpful resource for some, while others faced challenges obtaining it. (3) Stress was bidirectionally related to unhealthy food choices, with food sometimes used as a coping mechanism. (4) Mothers prioritized their babies and others and had limited ability and time to prepare healthy meals. (5) Most participants felt they received inadequate nutrition guidance from their healthcare providers. Participants provided positive responses to a proposed nutritious home-delivered meal intervention. Low-income women may experience nutritional challenges specific to this life stage. Interventions that reduce stress and burden of household tasks (e.g. cooking) and improve education and access to nutritious foods may improve mothers' ability to consume nutritious foods.
Collapse
Affiliation(s)
- Jessie Benson
- School of Medicine, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
| | - Matthew DeVries
- School of Medicine, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
- Phoenix Children's Pediatric Residency Program Alliance, Phoenix, Arizona, USA
| | - Skye McLaurin-Jiang
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
| | - Christine D Garner
- InfantRisk Center, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Amarillo, Texas, United States
| |
Collapse
|
3
|
Sung M, Kumar A, Mishra R, Kulkarni B, Kim R, Subramanian SV. Temporal change in prevalence of BMI categories in India: patterns across States and Union territories of India, 1999-2021. BMC Public Health 2024; 24:1322. [PMID: 38755591 PMCID: PMC11097587 DOI: 10.1186/s12889-024-18784-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The problem of overweight/obesity often coexists with the burden of undernutrition in most low- and middle-income countries. BMI change in India incorporating the most recent trends has been under-researched. METHODS This repeated cross-sectional study of 1,477,885 adults in India analyzed the prevalence of different categories of BMI among adults (age 20-54) in 4 rounds of National Family Health Surveys (1998-1999, 2005-2006, 2015-2016, and 2019-2021) for 36 states/UTs. State differences across time were harmonized for accurate analysis. The categories were Severely/Moderately Thin (BMI < 17.0), Mildly Thin (17.0-18.4), Normal (18.5-24.9), Overweight (25.0-29.9), and Obese (≥ 30.0). We also estimated change in Standardized Absolute Change (SAC), ranking of states, and headcount burden to quantify the trend of BMI distribution across time periods for all-India, urban/rural residence, and by states/UTs. RESULTS The prevalence of thinness declined from 31.7% in 1999 to 14.2% in 2021 for women, and from 23.4% in 2006 to 10.0% in 2021 for men. Obesity prevalence increased from 2.9% (1999) to 6.3% (2021) for women, and from 2.0% (2006) to 4.2% (2021) for men. In 2021, the states with the highest obesity prevalence were Puducherry, Chandigarh, and Delhi. These states also had a high prevalence of overweight. Dadra and Nagar Haveli and Diu, Gujarat, Jharkhand, and Bihar had the highest prevalence of severe/moderately thin. Prevalence of extreme categories (severely/moderately thin and obese) was larger in the case of women than men. While States/UTs with a higher prevalence of thin populations tend to have a larger absolute burden of severe or moderate thinness, the relationship between headcount burden and prevalence for overweight and obese is unclear. CONCLUSIONS We found persistent interstate inequalities of undernutrition. Tailored efforts at state levels are required to further strengthen existing policies and develop new interventions to target both forms of malnutrition.
Collapse
Affiliation(s)
- Meekang Sung
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Akhil Kumar
- Faculty of Arts and Sciences, University of Toronto, Toronto, ON, Canada
| | - Raman Mishra
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Bharati Kulkarni
- Division of Reproductive & Child Health & Nutrition, Indian Council of Medical Research, V. Ramalingaswami Bhawan, Ansari Nagar, New Delhi, India
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Division of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
- Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA, 02138, USA.
| |
Collapse
|
4
|
Cohen E, Fu L, Brown HK, Grandi SM, Boblitz A, Fang J, Austin PC, Nathwani AA, Szentkúti P, Horváth-Puhó E, Sørensen HT, Ray JG. Adverse perinatal events and maternal interpregnancy weight change: A population-based observational study. Int J Gynaecol Obstet 2024; 165:792-800. [PMID: 38100266 DOI: 10.1002/ijgo.15296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Mothers whose newborn experiences adversity may neglect their own health to care for their affected infant or following a perinatal death. Weight gain after pregnancy is one measure of maternal self-care. We measured interpregnancy weight gain among women whose child had an adverse perinatal event. METHODS This population-based observational study included 192 154 primigravid women with two consecutive singleton births in Ontario, Canada. Outcomes included net weight gain, and adjusted odds ratios (aOR) of moving to a higher body mass index (BMI) category between pregnancies, comparing women whose child did versus did not experience either a perinatal death, prematurity, severe neonatal morbidity, major congenital anomaly, or severe neurologic impairment. RESULTS Perinatal death was associated with a +3.5 kg (95% confidence interval [CI]: 2.1-4.9) net higher maternal weight gain in the subsequent pregnancy. Relative to term births, preterm birth <32 weeks (+3.2 kg, 95% CI: 1.9-4.6), 32-33 weeks (+1.8 kg, 95% CI: 0.7-2.8) and 34-36 weeks (+0.9 kg, 95% CI: 0.6-1.3) were associated with higher net weight gain. Having an infant with severe neonatal morbidity was associated with a +1.2 kg (95% CI: 0.3-2.1) weight gain. Likewise, the aOR of moving to a higher BMI category was 1.27 (95% CI, 1.14-1.42) following a perinatal death, 1.21 (95% CI: 1.04-1.41) after a preterm birth <32 weeks, and 1.11 (95% CI: 1.02-1.22) with severe neonatal morbidity. CONCLUSION Greater interpregnancy weight gain, and movement to a higher BMI category, are each more likely in a woman whose first-born was affected by certain major adverse perinatal events.
Collapse
Affiliation(s)
- Eyal Cohen
- Department of Pediatrics and Edwin S.H. Leong Center for Healthy Children, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Hilary K Brown
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Sonia M Grandi
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Peter C Austin
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Apsara Ali Nathwani
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Péter Szentkúti
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
- Clinical Excellence Research Center, Stanford University, Stanford, California, USA
| | - Joel G Ray
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- St. Michael's Hospital Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Wang M, Ji Y, Chen S, Wang M, Lin X, Yang M. Effect of mode of delivery on postpartum weight retention: A systematic review and meta-analysis. Midwifery 2024; 132:103981. [PMID: 38574440 DOI: 10.1016/j.midw.2024.103981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Retention of weight gained over pregnancy increases the risk of long-term obesity and related health concerns. While many risk factors for this postpartum weight retention have been examined, the role of mode of delivery in this relationship remains controversial. We carried out a systematic review and meta-analysis to determine the effect of mode of delivery on postpartum weight retention. METHODS Ten electronic databases including PubMed, Cochrane Library, EMBASE, Web of Science, MEDLINE, CINAHL, China National Knowledge Infrastructure (CNKI), Wan-Fang database, the VIP database and China Biology Medicine Database (CBM) were searched from inception through November 2022. Review Manager 5.4 was used to pool the study data and calculate effect sizes. For dichotomous data, the odds ratio and 95 % confidence interval were used to report the results. For continuous data, the mean difference (MD) and 95 % confidence interval were used to report the results. The outcomes were the amount of postpartum weight retention and the number or proportion of women who experienced postpartum weight retention. The Newcastle- Ottawa Scale (NOS) and GRADE Guidelines were used to assess the methodological quality of the included studies. FINDINGS A total of 16 articles were included in the systematic review and 13 articles were included in the meta-analysis. The results showed that the mode of delivery had a significant effect on postpartum weight retention, women who delivered by caesarean section were more likely to experience postpartum weight retention compared to those who delivered vaginally. Sensitivity analysis showed that the results were stable and credible. CONCLUSION Due to the limitations of this study, the findings need to be treated with caution. And, to better prevent the postpartum weight retention, future practice and research need to further focus on upstream modifiable factors.
Collapse
Affiliation(s)
- Meiyu Wang
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China
| | - Yuting Ji
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China
| | - Shanxia Chen
- Health Management & Biotechnology School, Guangdong Food and Drug Vocational College, No.321, Longdong North Road, Tianhe District, Guangzhou City, Guangdong Province, China
| | - Minyi Wang
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China
| | - Xiaoli Lin
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China
| | - Ming Yang
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China.
| |
Collapse
|
6
|
Hailu H, Skouteris H, Incollingo Rodriguez AC, Galvin E, Hill B. Drivers and facilitators of weight stigma among preconception, pregnant, and postpartum women: A systematic review. Obes Rev 2024; 25:e13710. [PMID: 38343332 DOI: 10.1111/obr.13710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 04/18/2024]
Abstract
Women in the preconception, pregnant, or postpartum period are susceptible to weight stigma, particularly due to the risk of excess weight gain during the reproductive life period and the negative effects of stigma on the health of both the mother and the child. Identifying the drivers and facilitators of weight stigma will help guide focused weight stigma prevention interventions. This systematic review aimed to identify the drivers and facilitators of weight stigma among preconception, pregnant, and postpartum women. In May 2022, Medline, Embase, PsycINFO, and the Maternity and Infant Care Database were searched for peer-reviewed articles published since 2010 using search terms weight AND stigma AND preconception, OR pregnant, OR postpartum. Of the 1724 articles identified, 34 fulfilled the inclusion criteria and were included in a narrative synthesis. Women reported facing insensitive language, misconceptions about obesity across all settings, and inappropriate media representation. The unavailability of appropriate equipment at facilities was reported by both women and health professionals. Our findings indicate that a rigorous effort by all stakeholders is necessary to promote regulatory, legal, and educational initiatives designed to reduce weight stigma and discrimination against women in the reproductive period.
Collapse
Affiliation(s)
- Haimanot Hailu
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Warwick Business School, The University of Warwick, Coventry, UK
| | - Angela C Incollingo Rodriguez
- Psychological and Cognitive Sciences, Department of Social Science and Policy Studies, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Emma Galvin
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Briony Hill
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
Tsoi KY, Chan RCM, Zhang C, Tam WH, Ma RCW. A randomized controlled trial to evaluate the effects of an early postnatal lifestyle modification program on diet, adiposity and metabolic outcome in mothers with gestational diabetes mellitus. Int J Gynaecol Obstet 2024. [PMID: 38651286 DOI: 10.1002/ijgo.15521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/01/2024] [Accepted: 03/24/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE The aim of the present study was to evaluate the effectiveness of a 12-month early postnatal lifestyle intervention program in women with gestational diabetes in a recent pregnancy. METHODS This study was a prospective randomized intervention study conducted at a diabetes center in Hong Kong. Chinese women aged 18-45 years, who developed gestational diabetes mellitus (GDM) in their most recent pregnancy, were invited. Eligible women were randomized in 1:1 ratio at baseline (6-12 weeks postpartum), to standard care or lifestyle intervention (diet and physical activity) groups for 12 months. A standardized biochemistry assessment including oral glucose tolerance test, blood lipids, complete blood count, renal and liver functions, were measured at baseline and at 12-month. Anthropometry assessment and lifestyle questionnaire were performed at various timepoints. RESULTS A total of 103 women were randomized at baseline and a total of 79 women (standard care, n = 39, intervention, n = 40) completed the assessment. After the 12-month study period, women in the intervention group had significantly lower energy intake (intervention, -497.6 ± 488.3 kcal; standard, -222.0 ± 390.0 kcal, P < 0.01) compared to the standard care group, and a trend towards greater weight reduction (intervention, -0.93 ± 4.68 kg; standard, -0.01 ± 3.12 kg, P = 0.36). CONCLUSION The lifestyle intervention implemented within 3 months postpartum appeared to promote postpartum weight loss. The early postnatal lifestyle intervention program may provide an opportunity to reduce the long-term risk of diabetes in this high-risk population.
Collapse
Affiliation(s)
- Kit Ying Tsoi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Ruth C M Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Cuilin Zhang
- Global Center for Asian Women's Health & Bia-Echo Asia Center for Reproductive Longevity and Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Obstetrics and Gynecology, National University of Singapore, Singapore
| | - Wing Hung Tam
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
8
|
Hailu H, Skouteris H, Incollingo Rodriguez AC, Hill B. SWIPE: a conceptual, multi-perspective model for understanding and informing interventions for weight stigma in preconception, pregnancy, and postpartum. Health Psychol Rev 2024:1-17. [PMID: 38560922 DOI: 10.1080/17437199.2024.2333801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
Weight stigma is salient across the preconception, pregnancy, and postpartum (PPP) periods because of prevailing prescriptive norms and expectations about weight and weight gain during the reproductive period. Weight stigma is associated with negative physical and psychological health outcomes for mother and child. A clearly defined, multi-level conceptual model for interventions, research, and policy is critical to mitigating the adverse effects of weight stigma in PPP populations. Conceptual models of weight stigma towards PPP women have advanced our understanding of this issue and guided evidence accumulation but there remains a gap in informing the translation of evidence into action. Guided by evidence-based paradigms for conceptual model development, this paper has two primary objectives. First, we review and summarise theories, frameworks, and models from the PPP population and general literature to inform our understanding of the development and perpetuation of weight stigma for PPP women. Second, we propose a novel comprehensive intervention-guiding conceptual model that draws from and synthesises across multiple disciplines - the SWIPE (Stigma of Weight In the PPP Experience) model. This conceptual model will help to plan coordinated, multi-layered, and effective strategies to reduce and ultimately eliminate weight stigma for PPP women.
Collapse
Affiliation(s)
- Haimanot Hailu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Helen Skouteris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Warwick Business School, The University of Warwick, Coventry, UK
| | - Angela C Incollingo Rodriguez
- Psychological & Cognitive Sciences, Department of Social Science & Policy Studies, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Briony Hill
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
9
|
Meyer D, Gjika E, Raab R, Michel SKF, Hauner H. How does gestational weight gain influence short- and long-term postpartum weight retention? An updated systematic review and meta-analysis. Obes Rev 2024; 25:e13679. [PMID: 38221780 DOI: 10.1111/obr.13679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 10/16/2023] [Accepted: 11/13/2023] [Indexed: 01/16/2024]
Abstract
This systematic review and meta-analysis provide an update of an earlier meta-analysis examining the impact of gestational weight gain (GWG) on postpartum weight retention (PPWR). Thirty-four observational studies were included, and results from 18 studies were combined in meta-analyses. We found that women with excessive GWG retained an additional 2.98 kg (95% CI: 0.59, 5.37 kg, I2 = 91%) at 0.5 years, 1.89 kg (95% CI: 0.90, 2.88 kg, I2 = 61%) at > 0.5-1 year and 2.89 kg (95% CI: 1.74, 4.04 kg, I 2 = 0%) at 2-4 years, compared to women who met the National Academy of Medicine GWG recommendations. Moreover, synthesis of confounder-adjusted regression coefficients showed that each 1 kg increase of GWG corresponded to 0.62 kg (95% CI: 0.22, 1.02 kg, I2 = 96%) additional PPWR at 6-9 months, 0.48 kg (95% CI: 0.14, 0.81 kg, I2 = 93%) at 1-3 years, and 0.31 kg (95% CI: -0.24, 0.86 kg, I2 = 89%) at 5-7 years postpartum. Findings suggest that higher GWG contributes to increased maternal body weight in the short- and long-term after childbirth, independent of prepregnancy body mass index. The heterogeneity of reported data and methodological differences across studies complicate the ability to synthesize data and interpret findings.
Collapse
Affiliation(s)
- Dorothy Meyer
- Institute of Nutritional Medicine, Else Kröner Fresenius Centre for Nutritional Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Ejona Gjika
- Institute of Nutritional Medicine, Else Kröner Fresenius Centre for Nutritional Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Roxana Raab
- Institute of Nutritional Medicine, Else Kröner Fresenius Centre for Nutritional Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Sophie K F Michel
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California, USA
| | - Hans Hauner
- Institute of Nutritional Medicine, Else Kröner Fresenius Centre for Nutritional Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| |
Collapse
|
10
|
Kramer CK, Ye C, Hanley AJ, Connelly PW, Sermer M, Zinman B, Retnakaran R. Postpartum weight retention and the early evolution of cardiovascular risk over the first 5 years after pregnancy. Cardiovasc Diabetol 2024; 23:101. [PMID: 38500162 PMCID: PMC10949683 DOI: 10.1186/s12933-024-02184-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/29/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The cumulative effect of postpartum weight retention from each pregnancy in a woman's life may contribute to her risk of ultimately developing type 2 diabetes and cardiovascular disease. However, there is limited direct evidence supporting this hypothesis. Thus, we sought to characterize the impact of postpartum weight retention on the trajectories of cardiovascular risk factors over the first 5-years after pregnancy. METHODS In this prospective observational cohort study, 330 women (mean age 35.7 ± 4.3 years, mean pre-pregnancy body mass index 25.2 ± 4.8 kg/m2, 50.9% primiparous) underwent serial cardiometabolic characterization (anthropometry, blood pressure, lipids, oral glucose tolerance test, insulin sensitivity/resistance (Matsuda index, HOMA-IR), C-reactive protein (CRP), adiponectin) at 1-year, 3-years, and 5-years postpartum. Based on the magnitude of weight change between pre-pregnancy and 5-years postpartum, they were stratified into the following 3 groups: weight loss (n = 100), weight gain 0-6% (n = 110), and weight gain ≥ 6% (n = 120). RESULTS At 1-year postpartum, cardiovascular risk factors did not differ between the groups. However, an adverse risk factor profile progressively emerged in the weight retention groups at 3- and 5-years. Indeed, after covariate adjustment, there was stepwise worsening (from the weight loss group to weight gain 0-6% to weight gain ≥ 6% group) of the following cardiovascular risk factors at 5-years: triglycerides (p = 0.001), HDL (p = 0.02), LDL (p = 0.01), apolipoprotein-B (p = 0.003), Matsuda index (p < 0.0001), HOMA-IR (p < 0.0001), fasting glucose (p = 0.07), and CRP (p = 0.01). Moreover, on logistic regression analyses, weight gain ≥ 6% emerged as an independent predictor of pre-diabetes/diabetes at 5-years (adjusted OR = 3.40, 95%CI: 1.63-7.09). CONCLUSION Postpartum weight retention predicts trajectories of worsening cardiovascular risk factors and glucose intolerance over the first 5-years after delivery, consistent with its postulated contribution to future vascular disease in women.
Collapse
Affiliation(s)
- Caroline K Kramer
- Leadership Sinai Centre for Diabetes, University of Toronto, Mount Sinai Hospital, 60 Murray Street, Suite L5-025, Mailbox-21, Toronto, ON, M5T 3L9, Canada
- Division of Endocrinology, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Chang Ye
- Leadership Sinai Centre for Diabetes, University of Toronto, Mount Sinai Hospital, 60 Murray Street, Suite L5-025, Mailbox-21, Toronto, ON, M5T 3L9, Canada
| | - Anthony J Hanley
- Leadership Sinai Centre for Diabetes, University of Toronto, Mount Sinai Hospital, 60 Murray Street, Suite L5-025, Mailbox-21, Toronto, ON, M5T 3L9, Canada
- Division of Endocrinology, University of Toronto, Toronto, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Philip W Connelly
- Division of Endocrinology, University of Toronto, Toronto, Canada
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Mathew Sermer
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Canada
| | - Bernard Zinman
- Leadership Sinai Centre for Diabetes, University of Toronto, Mount Sinai Hospital, 60 Murray Street, Suite L5-025, Mailbox-21, Toronto, ON, M5T 3L9, Canada
- Division of Endocrinology, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, University of Toronto, Mount Sinai Hospital, 60 Murray Street, Suite L5-025, Mailbox-21, Toronto, ON, M5T 3L9, Canada.
- Division of Endocrinology, University of Toronto, Toronto, Canada.
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada.
| |
Collapse
|
11
|
Ramisetty-Mikler S, Willis A, Tiwari C. Pre-pregnancy Weight and Racial-Ethnic Disparities in Pregnancy-Associated Conditions in the State of Georgia: A Population-Based Study. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01932-2. [PMID: 38378940 DOI: 10.1007/s40615-024-01932-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/13/2024] [Accepted: 01/31/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION We investigate racial-ethnic disparities in pre-pregnancy obesity and pregnancy weight gain, which are known to increase the risk of pregnancy-associated conditions. METHODS We used 4-year (2017-2020) combined Georgia Pregnancy Risk Assessment Monitoring System data (N = 3208) to investigate racial-ethnic disparities in the incidence of gestational hypertension (GHT), gestational diabetes mellitus (GDM), and postpartum depression (PPD) and their associated risk with pre-pregnancy overweight/obesity after controlling for demographic and other confounders using regression modeling. The geographic distributions of hypertension and PPD rates at the county level were compared to the patterns of racial-ethnic populations and hospitals. RESULTS The PPD rates were higher among Asian (17.6), Hispanic (14.4), and Black (14.3); GDM was highest among Asian (16.0) mothers; and GHT was the highest among Black (11.7) followed by White mothers (9.0). Pre-pregnancy overweight and obese conditions increased the odds of hypertension in Black (2 ½ times) and White (> 3 ½ times) mothers. Premature birth increased the odds of hypertension (2-3 times) in all mothers. Pre-pregnancy weight also increased the odds of GDM (3-7 times) in these racial groups. Premature birth increases the odds twice as likely for PPD in Hispanic and White mothers. The convergence of high PPD and hypertension rates with high proportions of racial and ethnic minorities, and lack of hospital presence, indicates areas where healthcare interventions are required. CONCLUSIONS These findings underscore the importance of promoting a healthy pre-pregnancy weight to reduce the burden of maternal morbidity and pregnancy outcomes in general. More comprehensive prenatal monitoring using technological interventions for self-care has a great promise of being effective in maintaining a healthy pregnancy.
Collapse
Affiliation(s)
- Suhasini Ramisetty-Mikler
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, USA.
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, USA.
- Urban Life Building, Room 406, 140 Decatur St, Atlanta, GA, 30303, USA.
| | - Angelique Willis
- Department of Geosciences, Georgia State University, Atlanta, USA
| | - Chetan Tiwari
- Department of Geosciences, Georgia State University, Atlanta, USA
- Center for Disaster Informatics and Computational Epidemiology, Georgia State University, Atlanta, USA
| |
Collapse
|
12
|
Madlala HP, Myer L, Geffen H, Meyer D, Mendham AE, Goedecke JH, Bengtson AM, Jao J, Dugas LR. Measurement of body composition in postpartum South African women living with and without HIV infection. Front Nutr 2024; 11:1280425. [PMID: 38385007 PMCID: PMC10879415 DOI: 10.3389/fnut.2024.1280425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
Background While several methodologies are available to measure adiposity, few have been validated in sub-Saharan African (SSA) and none in postpartum African women living with HIV (WLHIV). We compared bioelectrical impendence analysis (BIA) and air displacement plethysmography (ADP) against dual x-ray absorptiometry (DXA) in South African women and examined differences by HIV and body mass index (BMI) status. Methods Lin's concordance correlation coefficient (CCC) test was used to examine fat mass (FM), fat free mass (FFM), and total body fat percent (%BF) difference between BIA vs. DXA, and ADP vs. DXA in women living with HIV (n = 57) and without HIV (n = 25). The Bland Altman test was used to assess mean differences and the direction of bias. Results The median age was 31 years (IQR, 26-35) and months postpartum were 11 (IQR, 7-16), 44% of the women had obesity. Lin's CCC for BIA and ADP vs. DXA were both 0.80 for %BF and 0.97 for FM, and 0.86 and 0.80 for FFM, respectively. Mean differences (DXA-BIA and ADP estimates) were 0.22 ± 4.54% (p = 0.54) and 3.35 ± 3.27% (p < 0.01) for %BF, -0.82 ± 3.56 kg (p = 0.06) and 1.43 ± 2.68 kg (p = 0.01) for FM, -1.38 ± 3.61 kg (p = 0.01) and - 3.34 ± 2.37 kg (p < 0.01) for FFM, respectively. BIA overestimated %BF in WLHIV and underestimated it in women with obesity. Conclusion Body composition measurements using BIA and ADP correlated well with DXA, thereby providing alternative, safe tools for measuring postpartum FM and FFM in SSA women, including WLHIV.
Collapse
Affiliation(s)
- Hlengiwe P. Madlala
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Hayli Geffen
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Demi Meyer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Amy E. Mendham
- Riverland Academy of Clinical Excellence (RACE), Riverland Mallee Coorong Local Health Network, South Australia Health, Berri, SA, Australia
- Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, Health Through Physical Activity, Lifestyle and Sport Research Centre (HPALS), FIMS International Collaborating Centre of Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Julia H. Goedecke
- Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, Health Through Physical Activity, Lifestyle and Sport Research Centre (HPALS), FIMS International Collaborating Centre of Sports Medicine, University of Cape Town, Cape Town, South Africa
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa
| | - Angela M. Bengtson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Jennifer Jao
- Division of Infectious Diseases, Department of Paediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lara R. Dugas
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, United States
| |
Collapse
|
13
|
Kemp BJ, Creighton RM, Cupples G, Kelly B, McAuley E, Fleck O, Wallace H, Graham U, McCance DR. Mothers' experiences of a lifestyle intervention for weight reduction 12 months after gestational diabetes mellitus: Qualitative findings from the PAIGE2 study. Midwifery 2024; 129:103911. [PMID: 38141456 DOI: 10.1016/j.midw.2023.103911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/27/2023] [Accepted: 12/19/2023] [Indexed: 12/25/2023]
Abstract
The standardised pooled prevalence of gestational diabetes mellitus (GDM) globally is approximately 14 %, a reflection of increasing rates of obesity in women of childbearing age. Lifestyle interventions to reduce GDM and subsequent type 2 diabetes (T2D) have been deemed a research priority but are challenging to perform and have variable success rates. The PAIGE2 study was a pragmatic lifestyle randomised controlled trial for women with GDM and body mass index ≥25 kg/m2, which began during pregnancy and continued for one year postnatally. The primary outcome was weight loss 12 months postnatally compared with mothers receiving standard maternity care. Qualitative results are presented from end of study focus groups conducted amongst intervention mothers to gather feedback and determine acceptability of the PAIGE2 intervention. In total, 19 mothers participated in five virtual focus groups. Content analysis explored general study experience, longer term changes to lifestyle and suggested improvements of intervention components including monthly phone calls, motivational text messages, Fitbit experience, Slimming World, and study contact timings. Overall, most mothers found the individual PAIGE2 intervention components enjoyable, although opinions differed as to which were the most effective. Several mothers claimed the intervention helped them make long-term changes to their behaviours. A common suggested improvement was the establishment of a local group where mothers could share their experiences. In conclusion, most mothers deemed the intervention acceptable, and felt that with minor enhancements, it could be utilised as an effective tool to support weight loss after pregnancy and reduce future risk of obesity and T2D.
Collapse
Affiliation(s)
- Bridie J Kemp
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, UK; School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Rachel M Creighton
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Gina Cupples
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Bronagh Kelly
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Emma McAuley
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Olwen Fleck
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Helen Wallace
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Una Graham
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - David R McCance
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, UK.
| |
Collapse
|
14
|
Wagner KA, Whitcomb BW, Marcus B, Pekow P, Rosal MC, Leidy Sievert L, Tucker KL, Manson JE, Chasan-Taber L. The impact of a lifestyle intervention on postpartum weight retention among US Hispanic women with overweight and obesity. Prev Med Rep 2024; 38:102633. [PMID: 38375164 PMCID: PMC10874874 DOI: 10.1016/j.pmedr.2024.102633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/20/2023] [Accepted: 01/26/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction To evaluate the effect of a culturally-modified, motivationally-targeted, individually-tailored lifestyle intervention on postpartum weight retention among Hispanic women with overweight/obesity. Materials and methods Proyecto Mamá was a randomized controlled trial conducted in western Massachusetts (2014-2020). Hispanic women with overweight/obese pre-pregnancy BMI (n = 148) were randomized in early pregnancy to a Lifestyle Intervention (LI) or a Health & Wellness (HW) comparison arm. The LI was based upon theoretical concepts, used a low-cost, high-reach strategy, and focused on healthy exercise and diet with follow-up through 12-months postpartum. The primary outcome of change in weight was calculated as the difference between pre-pregnancy weight and 6-week, 6-month, and 12-month postpartum weight. The secondary outcome was achievement of 5 % weight reduction from pre-pregnancy weight. Retention was 68.2 % in the overall postpartum period and 31.0 % at 12-months. Results In intent-to-treat analyses, compared to the HW arm, there was no difference in postpartum weight retention at 6-weeks (0.0 kg, 95 % CI: -3.4, 3.5), 6-months (-1.8 kg, 95 % CI: -5.6, 2.0), or 12-months (-2.0 kg, 95 % CI: -7.0, 3.1). In a secondary complete case analysis, compared to the HW arm, the LI arm had 5.5 times higher odds of meeting the postpartum weight reduction goal (aOR = 5.5, 95 % CI: 1.7, 17.9) adjusting for pre-pregnancy weight. Conclusions A lifestyle intervention among at-risk Hispanic women with overweight/obesity had no overall impact on postpartum weight, but a beneficial impact among those who completed the trial. Future studies should focus on increasing the feasibility and acceptability of the intervention in this at-risk population.
Collapse
Affiliation(s)
- Kathryn A. Wagner
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Brian W. Whitcomb
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Bess Marcus
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | - Penelope Pekow
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Milagros C. Rosal
- Division of Preventive and Behavioral Medicine, Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Lynnette Leidy Sievert
- Department of Anthropology, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Katherine L. Tucker
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, United States of America
| | - JoAnn E. Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Lisa Chasan-Taber
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, United States of America
| |
Collapse
|
15
|
Ryan JT, Day H, Egger MJ, Wu J, Depner CM, Shaw JM. Night-time sleep duration and postpartum weight retention in primiparous women. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2023; 5:zpad056. [PMID: 38314118 PMCID: PMC10838128 DOI: 10.1093/sleepadvances/zpad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/27/2023] [Indexed: 02/06/2024]
Abstract
Objectives Approximately 75% of women weigh more at 1-year postpartum than pre-pregnancy. More than 47% retain >10 lbs at 1-year postpartum, which is associated with adverse health outcomes for mother and child. Disturbed sleep may contribute to risk of postpartum weight retention (PWR) as short sleep duration is associated with increased risk of obesity. Thus, we investigated whether night-time sleep duration is associated with risk for excessive PWR. We also explored night-time sleep duration and change in postpartum waist circumference. Methods This is an ancillary analysis from a prospective cohort study. Participants were healthy primiparous adults with a singleton birth. Excessive PWR at 1-year postpartum was defined as ≥7% of pre-pregnancy weight. Log-binomial and linear regression assessed associations between night-time sleep duration at 6 months postpartum and PWR at 1-year postpartum. Linear regression assessed the association between night-time sleep duration and change in postpartum waist circumference. Results Mean age of participants (N = 467) was 29.51 (SD ± 4.78) years. Night-time sleep duration by actigraphy or self-report was not associated with risk for excessive PWR (risk ratio 0.96, [95%CI 0.87-1.06]; risk ratio 0.95 [95%CI 0.83-1.07], respectively) or change in waist circumference. Conclusion Night-time sleep duration at 6 months postpartum was not associated with PWR at 1-year postpartum. Mixed findings among our results and previous research could be due to our focus on night-time sleep, and differences in sleep measurement methods and timeframes across studies. More comprehensively assessing sleep, including multiple sleep dimensions, may help advance our understanding of potential links between sleep and PWR. Trial Registration The parent study, Motherhood and Pelvic Health (MAP Study), is registered at https://clinicaltrials.gov/ct2/show/NCT02512016, NCT02512016.
Collapse
Affiliation(s)
- Jeanna T Ryan
- Department of Health and Kinesiology, University of Utah College of Health, Salt Lake City, UT, USA
| | - Heather Day
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Marlene J Egger
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jiqiang Wu
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Christopher M Depner
- Department of Health and Kinesiology, University of Utah College of Health, Salt Lake City, UT, USA
| | - Janet M Shaw
- Department of Health and Kinesiology, University of Utah College of Health, Salt Lake City, UT, USA
| |
Collapse
|
16
|
Chalifour BN, Trifonova DI, Holzhausen EA, Bailey MJ, Schmidt KA, Babaei M, Mokhtari P, Goran MI, Alderete TL. Characterizing alterations in the gut microbiota following postpartum weight change. mSystems 2023; 8:e0080823. [PMID: 37905810 PMCID: PMC10734492 DOI: 10.1128/msystems.00808-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/21/2023] [Indexed: 11/02/2023] Open
Abstract
IMPORTANCE Previous research has reported differences in the gut microbiome associated with varying body compositions. More specifically, within populations of mothers, the focus has been on the impact of gestational weight gain. This is the first study to examine postpartum weight change and its association with changes in the gut microbiome, similarly, it is the first to use a Latina cohort to do so. The results support the idea that weight gain may be an important factor in reducing gut microbiome network connectivity, diversity, and changing abundances of specific microbial taxa, all measures thought to impact host health. These results suggest that weight gain dynamically alters mothers' gut microbial communities in the first 6 months postpartum, with comparatively little change in mothers who lost weight; further research is needed to examine the health consequences of such changes.
Collapse
Affiliation(s)
- Bridget N. Chalifour
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Diana I. Trifonova
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Elizabeth A. Holzhausen
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Maximilian J. Bailey
- Stanford University School of Medicine, Leland Stanford Junior University, Stanford, California, USA
| | - Kelsey A. Schmidt
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Mahsa Babaei
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Pari Mokhtari
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Michael I. Goran
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Tanya L. Alderete
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| |
Collapse
|
17
|
Zuo R, Ge Y, Xu J, He L, Liu T, Wang B, Sun L, Wang S, Zhu Z, Wang Y. The association of female reproductive factors with risk of metabolic syndrome in women from NHANES 1999-2018. BMC Public Health 2023; 23:2306. [PMID: 37990201 PMCID: PMC10664376 DOI: 10.1186/s12889-023-17207-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Female reproductive factors such as age at first birth (AFB), age at last birth (ALB), number of pregnancies and live births play an essential role in women's health. However, few epidemiological studies have evaluated the association between female reproductive factors and metabolic syndrome (MetS). We therefore conducted a cross-sectional study to investigate the association between MetS risk and female reproductive factors. METHODS We investigated the relationship between AFB, ALB, number of pregnancies and live births and the incidence of MetS using publicly available data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. Weighted multivariable logistic regression analysis, restricted cubic spline (RCS) model, and subgroup analysis were used to evaluate the association between AFB and ALB and the risk of MetS in women. In addition, the relationship between the number of pregnancies, live births and MetS risk was also explored. RESULTS A total of 15,404 women were included in the study, and 5,983 (38.8%) had MetS. RCS models showed an N-shaped relationship between AFB and MetS risk, whereas ALB, number of pregnancies, and live births were linearly associated with MetS. Weighted multivariable logistic regression analysis showed that the number of live births was associated with MetS risk, with ORs of 1.18 (95% CI: 1.04, 1.35) for women with ≥ 5 deliveries compared to women with ≤ 2 births. CONCLUSIONS AFB was associated with the risk of MetS in an N-shaped curve in women. In addition, women with high live births have a higher incidence of MetS.
Collapse
Affiliation(s)
- Ronghua Zuo
- Department of Anesthesiology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing, 100191, China
| | - Yiting Ge
- Department of Gynecology, Kunshan Hospital of Traditional Chinese Medicine, No.388 Zuchongzhi Road, Kunshan, Jiangsu, 215300, China
| | - Jingbo Xu
- Department of Obstetrics and Gynecology, Wuxi No.2 People's Hospital, 585 Xingyuan North Road, Liangxi District, Wuxi, Jiangsu, 214000, China
| | - Lin He
- Department of Obstetrics and Gynecology, Wuxi No.2 People's Hospital, 585 Xingyuan North Road, Liangxi District, Wuxi, Jiangsu, 214000, China
| | - Tao Liu
- Department of Cardiology, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, 201500, China
| | - Bing Wang
- Department of Cardiology, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, 201500, China
| | - Lifang Sun
- Department of Cardiology, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, 201500, China
| | - Shasha Wang
- Department of Cardiology, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, 201500, China
| | - Zhijian Zhu
- Department of Cardiology, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, 201500, China
| | - Yuefei Wang
- Department of Obstetrics and Gynecology, Wuxi No.2 People's Hospital, 585 Xingyuan North Road, Liangxi District, Wuxi, Jiangsu, 214000, China.
| |
Collapse
|
18
|
Ahmadibeni A, Kashani P, Hallaj MS, Ghanbari S, Javadifar N. The relationship of pre-pregnancy body mass index with maternal anthropometric indices, weight retention and the baby's weight and nutrition in the first 6 months post-partum. BMC Pregnancy Childbirth 2023; 23:802. [PMID: 37986057 PMCID: PMC10662692 DOI: 10.1186/s12884-023-06116-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023] Open
Abstract
PURPOSE Pre-pregnancy body fat mass is one of the important indicators of the mother's and the infant's health. Therefore, the purpose of this study was to investigate relationship of pre-pregnancy body mass index (PPBMI) with maternal anthropometric indices and weight retention as well as the baby's weight and nutrition in the first 6 months post-partum. MATERIALS AND METHODS This is a prospective cohort study including 397 mothers giving birth to healthy babies and referring to health centers in Ahvaz (southwest of Iran) in 2022. The following data were extracted from the participants' electronic record: body mass index (BMI) before or at the beginning of pregnancy, gestational weight gain, and weight at the time of delivery. In addition to demographic information, the following data were also evaluated: maternal anthropometric indices including weight, hip and waist circumference, and conicity index during the first 10 days post-partum, along with the weight and nutrition pattern of the baby 2, 4 and 6 months post-partum. RESULTS The mean age of the mothers was 29.96±5.7 years. The frequency of mothers according to BMI classification (i.e., underweight, normal, overweight, and obese) was 4.3%, 38.5%, 37%, and 20.3%, respectively. In this study, PPBMI had a significant relationship with decreasive changes of weight, waist and hip circumferen and conicity index after child birth, 2, 4 and 6 months post-partum (P<0.05) but the mean reduction of these anthropoemetric indices at 6th month postpartum were not related to PPBMI (P>0.05). However, this relationship was not significant when it came to the weight of the baby (P > .05). The lowest reduction in weight, waist and hip circumference and conicity index belonged to overweight mothers but the highest frequency of mothers with excesive gestational weight gain, the lowest frequency of breastfeeding until 6 months and also the lowest values of postpartum weight retention were observed in obese mothers (P<0.05). CONCLUSION According to the findings of this study, the decrease in anthropometric indices up to 6 months after delivery in overweight mothers is less than other BMI groups, but the consequences related to weight and nutrition in infants of obese mothers need special attention. Also, the results re-emphasize the importance of focusing on provision of educational and counseling services to mothers in order to improve their nutrition and weight, especially before pregnancy.
Collapse
Affiliation(s)
- Ayda Ahmadibeni
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Parhoon Kashani
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Sadegh Hallaj
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Ghanbari
- Biostatistics Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nahid Javadifar
- Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| |
Collapse
|
19
|
Madlala HP, Bengtson AM, Hannan L, Malaba TR, Kalk E, Nyemba D, Boulle A, Myer L. Maternal weight trajectories and associations with infant growth in South African women. BMC Public Health 2023; 23:2055. [PMID: 37858163 PMCID: PMC10588171 DOI: 10.1186/s12889-023-16963-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Despite the close relationship between pre-pregnancy body mass index (BMI), gestational weight gain (GWG) and postpartum weight (PPW), these factors are often studied separately. There are no data characterising longitudinal weight trajectories among pregnant and postpartum women in urban African populations. We examined maternal weight trajectories from pregnancy through to 12 months postpartum, factors associated with higher weight trajectory class membership and associations of weight trajectories with infant growth at 12 months. METHODS Data from 989 women were examined for weight trajectories from first antenatal care visit in pregnancy to 12 months postpartum using latent-class growth models. Baseline factors associated with class membership were assessed using multinomial logistic regression. Of the enrolled women, 613 of their infants were assessed for growth at 12 months. Anthropometry measurements for mothers and infants were conducted by a trained study nurse. Associations between maternal weight trajectory class and infant weight-for-age (WAZ), length-for-age (LAZ), weight-for-length (WLZ) at 12 months of age were analysed using linear regression. RESULTS Four distinct classes of maternal weight trajectories were identified. The classes included consistent low (29%), consistent medium (37%), medium-high (24%) and consistent high (10%) trajectories. Similar to trends observed with medium-high trajectory, baseline factors positively associated with consistent high class membership included age (OR 1.05, 95% CI 1.01-1.09), pre-pregnancy BMI (OR 2.24, 95% CI 1.97-2.56), stage 1 hypertension (OR 3.28, 95% CI 1.68-6.41), haemoglobin levels (OR 1.39, 95% CI 1.11-1.74) and parity (OR 1.39, 95% CI 1.15-1.67); living with HIV (OR 0.47, 95% CI 0.30-0.74) was inversely associated. In adjusted analyses, compared to consistent medium weight trajectory, consistent low weight trajectory (mean difference -0.41, 95% CI -0.71;-0.12) was associated with decreased, and consistent high weight trajectory (mean difference 1.21, 95% CI 0.59-1.83) with increased infant WAZ at 12 months of age. CONCLUSION Identification of unique longitudinal weight trajectory groupings might inform comprehensive efforts targeted at improving healthy maternal weight and infant outcomes.
Collapse
Affiliation(s)
- Hlengiwe P Madlala
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa.
| | - Angela M Bengtson
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Luke Hannan
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Thokozile R Malaba
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Emma Kalk
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Dorothy Nyemba
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Andrew Boulle
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
- Health Impact Assessment Unit, Western Cape Department of Health, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
| |
Collapse
|
20
|
Sanders SA, Wallace ML, Burke LE, Tapia AL, Rathbun SL, Casas AD, Gary-Webb TL, Davis EM, Méndez DD. Examining demographic and psychosocial factors related to self-weighing behavior during pregnancy and postpartum periods. Prev Med Rep 2023; 35:102320. [PMID: 37554350 PMCID: PMC10404542 DOI: 10.1016/j.pmedr.2023.102320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023] Open
Abstract
Black childbearing individuals in the US experience a higher risk of postpartum weight retention (PPWR) compared to their White counterparts. Given that PPWR is related to adverse health outcomes, it is important to investigate predictors of weight-related health behaviors, such as self-weighing (i.e., using a scale at home). Regular self-weighing is an evidence-based weight management strategy, but there is minimal insight into sociodemographic factors related to frequency. The Postpartum Mothers Mobile Study (PMOMS) facilitated longitudinal ambulatory weight assessments to investigate racial inequities in PPWR. Our objective for the present study was to describe self-weighing behavior during and after pregnancy in the PMOMS cohort, as well as related demographic and psychosocial factors. Applying tree modeling and multiple regression, we examined self-weighing during and after pregnancy. Participants (N = 236) were 30.2 years old on average (SD = 4.7), with the majority being college-educated (53.8%, n = 127), earning at least $30,000 annually (61.4%, n = 145), and self-identifying as non-Hispanic White (NHW; 68.2%, n = 161). Adherence to regular self-weighing (at least once weekly) was highest among participants during pregnancy, with a considerable decline after giving birth. Low-income Black participants (earning < $30,000) were significantly less likely to reach a completion rate of ≥ 80% during pregnancy (AOR = 0.10) or the postpartum period (AOR = 0.16), compared to NHW participants earning at least $30,000 annually. Increases in perceived stress were associated with decreased odds of sustained self-weighing after delivery (AOR = 0.79). Future research should consider behavioral differences across demographic intersections, such as race and socioeconomic status, and the impact on efficacy of self-weighing.
Collapse
Affiliation(s)
- Sarah Annalise Sanders
- Department of Behavioral & Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Meredith L. Wallace
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lora E. Burke
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Amanda L. Tapia
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Stephen L. Rathbun
- Department of Epidemiology & Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Andrea D. Casas
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Tiffany L. Gary-Webb
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Esa M. Davis
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Dara D. Méndez
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| |
Collapse
|
21
|
Kinkade CW, Rivera-Núñez Z, Thurston SW, Kannan K, Miller RK, Brunner J, Wong E, Groth S, O'Connor TG, Barrett ES. Per- and polyfluoroalkyl substances, gestational weight gain, postpartum weight retention and body composition in the UPSIDE cohort. Environ Health 2023; 22:61. [PMID: 37658449 PMCID: PMC10474772 DOI: 10.1186/s12940-023-01009-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/15/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) are synthetic chemicals found in drinking water and consumer products, resulting in ubiquitous human exposure. PFAS have been linked to endocrine disruption and altered weight gain across the lifespan. A limited and inconsistent body of research suggests PFAS may impact gestational weight gain (GWG) and postpartum body mass index (BMI), which are important predictors of overall infant and maternal health, respectively. METHODS In the Understanding Pregnancy Signals and Infant Development (UPSIDE/UPSIDE-MOMs) study (n = 243; Rochester, NY), we examined second trimester serum PFAS (PFOS: perfluorooctanesulfonic acid, PFOA: perfluorooctanoic acid, PFNA: perfluorononanoic acid, PFHxS: perfluorohexanesulfonic acid, PFDA: perfluorodecanoic acid) in relation to GWG (kg, and weekly rate of gain) and in the postpartum, weight retention (PPWR (kg) and total body fat percentage (measured by bioelectrical impedance)). We fit multivariable linear regression models examining these outcomes in relation to log-transformed PFAS in the whole cohort as well as stratified by maternal pre-pregnancy BMI (< 25 vs. = > 25 kg/m2), adjusting for demographics and lifestyle factors. We used weighted quantile sum regression to find the combined influence of the 5 PFAS on GWG, PPWR, and body fat percentage. RESULTS PFOA and PFHxS were inversely associated with total GWG (PFOA: ß = -1.54 kg, 95%CI: -2.79, -0.30; rate ß = -0.05 kg/week, 95%CI: -0.09, -0.01; PFHxS: ß = -1.59 kg, 95%CI: -3.39, 0.21; rate ß = -0.05 kg/week, 95%CI: -0.11, 0.01) and PPWR at 6 and 12 months (PFOA 6 months: ß = -2.39 kg, 95%CI: -4.17, -0.61; 12 months: ß = -4.02 kg, 95%CI: -6.58, -1.46; PFHxS 6 months: ß = -2.94 kg, 95%CI: -5.52, -0.35; 12 months: ß = -5.13 kg, 95%CI: -8.34, -1.93). PFOA was additionally associated with lower body fat percentage at 6 and 12 months (ß = -1.75, 95%CI: -3.17, -0.32; ß = -1.64, 95%CI: -3.43, 0.16, respectively) with stronger associations observed in participants with higher pre-pregnancy BMI. The PFAS mixture was inversely associated with weight retention at 12 months (ß = -2.030, 95%CI: -3.486, -0.573) amongst all participants. CONCLUSION PFAS, in particular PFOA and PFHxS, in pregnancy are associated with altered patterns of GWG and postpartum adiposity with potential implications for fetal development and long-term maternal cardiometabolic health.
Collapse
Affiliation(s)
- Carolyn W Kinkade
- Environmental and Occupational Sciences Institute, Rutgers University, Piscataway, 170 Frelinghuysen Road, Piscataway, NJ, 08854, USA.
| | - Zorimar Rivera-Núñez
- Environmental and Occupational Sciences Institute, Rutgers University, Piscataway, 170 Frelinghuysen Road, Piscataway, NJ, 08854, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Sally W Thurston
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Kurunthachalam Kannan
- Department of Environmental Medicine, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Richard K Miller
- Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Jessica Brunner
- Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Psychiatry, University of Rochester, Rochester, NY, USA
| | - Eunyoung Wong
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Susan Groth
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Thomas G O'Connor
- Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Psychiatry, University of Rochester, Rochester, NY, USA
| | - Emily S Barrett
- Environmental and Occupational Sciences Institute, Rutgers University, Piscataway, 170 Frelinghuysen Road, Piscataway, NJ, 08854, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
- Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| |
Collapse
|
22
|
Rached V, Diogenes MEL, Donangelo CM, Bezerra FF. Calcium plus vitamin D supplementation during pregnancy reduces postpartum fat mass in adolescents: A randomized trial. Am J Hum Biol 2023; 35:e23911. [PMID: 37166151 DOI: 10.1002/ajhb.23911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Pregnancy during adolescence may increase the risk of overweight/obesity. There is evidence that increasing calcium intake, alone or vitamin D-combined, may favor loss of weight and/or fat mass. OBJECTIVES We hypothesized that calcium supplementation during pregnancy reduces excessive fat accumulation during postpartum period. We aimed to investigate the effect of calcium plus vitamin D supplementation during pregnancy on body composition measurements throughout 1 year postpartum in Brazilian adolescents with habitually low calcium intake (~600 mg/day). METHODS Adolescents (14-19 years) were randomly assigned to receive a daily supplement (600 mg of calcium plus 200 UI of cholecalciferol, n = 30) or a placebo (n = 26) from 26 weeks of gestation until parturition. Body composition was determined at 5, 20, and 56 weeks postpartum by dual-energy x-ray absorptiometry. The effects of intervention group, time point, as well as their interaction were assessed using repeated measures mixed-effects models. RESULTS In the adjusted analysis, those supplemented showed lower total body mass [mean difference = -3.32 kg; confidence interval (CI) 95% -6.12 to -0.52 kg], trunk (-1.25 kg; CI 95% -2.34 to -0.15 kg), android (-0.29 kg; CI 95% -0.53 to -0.04 kg) and subcutaneous (-0.23 kg; CI 95% -0.43 to -0.03 kg) fat masses. In the supplemented group, BMI and postpartum weight retention significantly decreased from 5 to 20 weeks (-0.90 kg/m2 and -1.76 kg, respectively; p < .05). At 56 weeks, BMI was still lower (-1.22 kg/m2 ; p < .05) than 5 weeks. CONCLUSIONS Our findings suggest that increasing calcium intake through supplementation in combination with vitamin D contributes to a more pronounced reduction in total body mass overtime, mostly as a consequence of fat mass reductions in central body regions. This trial was registered at clinicaltrials.gov as NCT01732328.
Collapse
Affiliation(s)
- Verônica Rached
- Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Maria Eduarda Leão Diogenes
- Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Brazilian National Cancer Institute José Alencar Gomes da Silva, Coordenação de Prevenção e Vigilância, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | | | | |
Collapse
|
23
|
Heslehurst N, Cullen E, Flynn AC, Briggs C, Smart L, Rankin J, McColl E, Sniehotta FF, McParlin C. Maternal Obesity and Patterns in Postnatal Diet, Physical Activity and Weight among a Highly Deprived Population in the UK: The GLOWING Pilot Trial. Nutrients 2023; 15:3805. [PMID: 37686838 PMCID: PMC10490453 DOI: 10.3390/nu15173805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne NE2 4AX, UK; (E.C.); (J.R.); (E.M.); (F.F.S.); (C.M.)
| | - Emer Cullen
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne NE2 4AX, UK; (E.C.); (J.R.); (E.M.); (F.F.S.); (C.M.)
| | - Angela C. Flynn
- Department of Nutritional Sciences, Faculty of Life Sciences and Medicine, King’s College London, London WC2R 2LS, UK;
| | - Chloe Briggs
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne NE2 4AX, UK; (E.C.); (J.R.); (E.M.); (F.F.S.); (C.M.)
| | - Lewis Smart
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne NE2 4AX, UK; (E.C.); (J.R.); (E.M.); (F.F.S.); (C.M.)
| | - Judith Rankin
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne NE2 4AX, UK; (E.C.); (J.R.); (E.M.); (F.F.S.); (C.M.)
| | - Elaine McColl
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne NE2 4AX, UK; (E.C.); (J.R.); (E.M.); (F.F.S.); (C.M.)
| | - Falko F. Sniehotta
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne NE2 4AX, UK; (E.C.); (J.R.); (E.M.); (F.F.S.); (C.M.)
| | - Catherine McParlin
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne NE2 4AX, UK; (E.C.); (J.R.); (E.M.); (F.F.S.); (C.M.)
| |
Collapse
|
24
|
Chang MW, Tan A, Wegener DT, Lee RE. A Pilot Goal-Oriented Episodic Future Thinking Weight Loss Intervention for Low-Income Overweight or Obese Young Mothers. Nutrients 2023; 15:3023. [PMID: 37447349 DOI: 10.3390/nu15133023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/23/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Episodic future thinking (EFT) has shown efficacy in laboratory settings. We conducted a pilot goal-oriented EFT (GoEFT) intervention in a real-world setting to help low-income overweight or obese mothers lose weight. This paper presents intervention acceptability and efficacy. METHODS The study used a single-group, before-after design. During the 3-week intervention, participants (N = 15) completed weekly web-based lessons and online health coaching sessions to manage stress and emotion, eat healthier, and be more physically active. Participants completed online surveys at baseline and immediately after the intervention. They also completed an interview to evaluate intervention acceptability. We applied paired t-tests to evaluate efficacy and used content analysis to discover interview themes. RESULTS Participants consistently identified the intervention as acceptable, noting the usefulness of pre-written goals, GoEFT strategies, and goal progress evaluations. The intervention effectively promoted weight loss (d = -0.69), fruit and vegetable intake (d = 0.45-0.49), and emotion control (d = 0.71). It also reduced fat (d = -0.51) and added sugar intake (d = -0.48) and alleviated stress (d = -0.52). Moreover, the intervention increased autonomous motivation (d = 0.75-0.88) and self-efficacy (d = 0.46-0.61). CONCLUSION The GoEFT intervention was acceptable to participants, showing strong preliminary efficacy.
Collapse
Affiliation(s)
- Mei-Wei Chang
- College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, USA
| | - Alai Tan
- College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, USA
| | - Duane T Wegener
- Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH 43210, USA
| | - Rebecca E Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 N. 3rd St., Phoenix, AZ 85004, USA
| |
Collapse
|
25
|
Heidari Dehui P, Negarandeh R, Pashaeypoor S. Weight Management Challenges in Nulliparous Women Being Overweight or Obese Due to Pregnancy: A Qualitative Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2023; 11:190-200. [PMID: 37489224 PMCID: PMC10363267 DOI: 10.30476/ijcbnm.2023.97714.2202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023]
Abstract
Background Getting overweight after pregnancy is a common phenomenon and getting back to pre-pregnancy weight in the postpartum period is a major concern for mothers. This study aimed to explain the challenges in performing post-pregnancy weight-management behaviors in nulliparous women being overweight and obese due to pregnancy. Methods The present qualitative study was conducted with the conventional qualitative content analysis method based on Granheim and Landman's approach from October to December in 2021. In this study, participants were 15 women who referred to comprehensive health service centers in Tehran, Iran; they were purposefully selected according to the inclusion criteria. Data were collected through individual, in-depth, and semi-structured face-to-face interviews and simultaneously analyzed using the MAXQ Data version 10 software. Results The mean age of the participants was 25.93±3.21 years. Data analysis resulted in three main categories: 1) failure to adhere to calorie-restricted diets, 2) inability to engage in physical activity, and 3) lack of adequate social support. Conclusion Women with obesity due to pregnancy face many challenges to improve their weight-control behaviors. As such, improving healthy behaviors not only requires relevant stakeholders' commitment, but also demands women, their families and communities' intention to engage in healthy behaviors.
Collapse
Affiliation(s)
- Pooran Heidari Dehui
- Department of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Negarandeh
- Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahzad Pashaeypoor
- Department of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
26
|
Zhao Y, Liang X, Wang J, Baima K, Nima Q, Gao Y, Yin J, Liu Q, Zhao X. Association between pregnancy termination history and metabolic syndrome in southwestern Chinese women: modification effect of physical activity. Hum Reprod 2023:dead124. [PMID: 37366630 DOI: 10.1093/humrep/dead124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/17/2023] [Indexed: 06/28/2023] Open
Abstract
STUDY QUESTION Is there a relationship between pregnancy termination history and metabolic syndrome (MetS), and if so, is the relationship moderated by physical activity (PA)? SUMMARY ANSWER Induced abortion, and both miscarriage and induced abortion, increased the risk of MetS, while leisure PA attenuated the effects of induced abortion, and both miscarriage and induced abortion, on the risk of MetS. WHAT IS KNOWN ALREADY Pregnancy termination history is a risk factor for cardiovascular disease, but studies on women's history of pregnancy termination and MetS are limited. PA is a preventive behavior for MetS, but its modification effect on any association between pregnancy termination history and MetS is unknown. STUDY DESIGN, SIZE, DURATION The cross-sectional study included 53 702 women (age range of 30-79 years old) from southwestern China who participated in the China Multi-Ethnic Cohort (CMEC) study from May 2018 to September 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants self-reported both the number and type of pregnancy termination. PA was assessed primarily by asking participants about the cumulative time they spent doing PA either as their occupation, transportation, housework, and leisure activity in the past year. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III (ATP III) criteria. MAIN RESULTS AND THE ROLE OF CHANCE After adjusting for all confounders, the risk of MetS was significantly increased in women who experienced induced abortion alone, and both miscarriage and induced abortion, with odds ratios (ORs) of 1.08 (95% CI = 1.03-1.13) and 1.20 (95% CI = 1.08-1.33), respectively. A dose-response relationship was observed between the number of induced abortions and MetS, with the risk increasing by 3.0% for every additional induced abortion (OR = 1.03, 95% CI = 1.01-1.05). Leisure PA had a significant modification effect on the relationship between pregnancy termination history and MetS, as leisure PA attenuates the negative effects of induced abortion on MetS. LIMITATIONS, REASONS FOR CAUTION Causality cannot be established in this study. Information on pregnancy termination and PA was collected by self-report, which might be subject to recall bias. WIDER IMPLICATIONS OF THE FINDINGS A history of induced abortion was associated with an increased risk of MetS, and the risk increased with the number of induced abortions. Leisure PA attenuated the negative effect of induced abortion on MetS, whereas occupational and transportation PA amplified the negative effect of induced abortion on glucose. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the National Key R&D Program of China (grant no.: 2017YFC0907300) and the National Nature Science Foundation of China (grant no.: 82273745). The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Ying Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xian Liang
- Chengdu Center for Disease Control and Prevention, Chengdu, China
| | - Junhua Wang
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Kangzhuo Baima
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
- School of Medicine, Tibet University, Lhasa, China
| | - Qucuo Nima
- Tibet Center for Disease Control and Prevention, Lhasa, China
| | - Yang Gao
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Jianzhong Yin
- Baoshan College of Traditional Chinese Medicine, Baoshan, China
- Department of Nutrition and Food Hygiene, School of Public Health, Kunming Medical University, Kunming, China
| | - Qiaolan Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
27
|
Crossley NP, Jones EJ. Relationships among Postpartum Weight Retention, Stress, and Disinhibited Eating: A Scoping Review. West J Nurs Res 2023:1939459231175197. [PMID: 37161311 DOI: 10.1177/01939459231175197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Postpartum weight retention (PPWR) is a significant contributor to maternal cardiometabolic disease risk. The transition to motherhood is a stressful time period in which women report consuming food to cope, an eating behavior that is associated with PPWR. In this scoping review, we identified original research and review articles published since 2010 that examined relationships among PPWR, maternal stress, and disinhibited eating. In total, 16 articles met the inclusion criteria. Findings were inconsistent related to PPWR and stress. PPWR and disinhibited eating were not significantly correlated; however, disinhibition scores were higher during the postpartum period compared to prenatally. Stress and disinhibited eating were directly correlated in 4 studies. Our findings suggest these concepts, particularly disinhibited eating, have not been robustly examined during the postpartum period. Additionally, instruments used to measure maternal stress vary widely and should be further studied and refined.
Collapse
Affiliation(s)
- Nicole P Crossley
- Fran and Earl Ziegler College of Nursing, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Emily J Jones
- Fran and Earl Ziegler College of Nursing, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
28
|
Chang MW, Wegener DT, Tan A, Schaffir J, Worly B, Strafford K, Soma L, Sampsell C. Pilot Lifestyle Intervention Effect on Lifestyle Behaviors, Psychosocial Factors, and Affect. JOURNAL OF PEDIATRICS, PERINATOLOGY AND CHILD HEALTH 2023; 7:74-82. [PMID: 38576861 PMCID: PMC10994102 DOI: 10.26502/jppch.74050147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Background This paper presents results of a pilot intervention effect on lifestyle behaviors, psychosocial factors, and affect among overweight or obese pregnant women. Methods 70 participants were randomized to the intervention or usual care group. During the 20-week intervention, participants completed a weekly online intervention module and joined individual online health coaching. Data were collected at baseline (<17 weeks gestation), 24-27 weeks gestation (T2), and 35-37 weeks gestation (T3). Lifestyle behaviors included dietary intake (caloric, fat, added sugar, fruit, and vegetable) and physical activity (PA). Psychosocial factors were autonomous motivation, self-efficacy, executive functions, and consideration of future consequences (CFC). Affect comprised stress and emotional control. Two-sample t-tests and Cohen's d effect sizes were used to compare between group mean differences in the change from baseline to T2 and T3. Results At T2, intervention positively influenced fruit intake (d = 0.47), autonomous motivation for healthy eating (d = 0.36), self-efficacy for healthy eating (d = 0.25) and PA (d = 0.24), executive functions (behavior regulation, d = -0.21; metacognition, d = -0.69), and emotional control (d = 0.79). At T3, the intervention improved PA (d = 0.19), autonomous motivation for healthy eating (d = 0.33), self-efficacy for healthy eating (d = 0.50) and stress management (d = 0.62), executive functions (metacognition, d = -0.46), CFC (d = 0.25), stress (d = -0.45), and emotional control (d = 0.72). Conclusion The pilot intervention has positive effects on most psychosocial variables and affect in both the short and long terms.
Collapse
Affiliation(s)
- Mei-Wei Chang
- The Ohio State University College of Nursing, 1577 Neil Avenue, Columbus, OH 43210, USA
| | - Duane T Wegener
- The Ohio State University, Dept. of Obstetrics and Gynecology, 395 West 12th Avenue, 5th floor Columbus, OH 43210, USA
| | - Alai Tan
- The Ohio State University College of Nursing, 1577 Neil Avenue, Columbus, OH 43210, USA
| | - Jonathan Schaffir
- The Ohio State University Department of Psychology, 1835 Neil Avenue, Columbus, OH 43210, USA
| | - Brett Worly
- The Ohio State University Department of Psychology, 1835 Neil Avenue, Columbus, OH 43210, USA
| | - Katherine Strafford
- The Ohio State University Department of Psychology, 1835 Neil Avenue, Columbus, OH 43210, USA
| | - Loriana Soma
- The Ohio State University Department of Psychology, 1835 Neil Avenue, Columbus, OH 43210, USA
| | - Cassandra Sampsell
- The Ohio State University Department of Psychology, 1835 Neil Avenue, Columbus, OH 43210, USA
| |
Collapse
|
29
|
Johnson VR, Anekwe CV, Washington TB, Chhabria S, Tu L, Stanford FC. A Women's health perspective on managing obesity. Prog Cardiovasc Dis 2023; 78:11-16. [PMID: 37120120 PMCID: PMC10330433 DOI: 10.1016/j.pcad.2023.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
While the prevalence of obesity in US men and women is nearly equivalent, obesity management in women requires a different approach that considers age and life stage in development including sexual maturation/reproduction, menopause and post-menopause. In this review, the diagnosis and treatment of obesity using lifestyle modification, pharmacotherapy and metabolic and bariatric surgery are discussed from a women's health perspective, with emphasis on management during pregnancy and post-partum.
Collapse
Affiliation(s)
- Veronica R Johnson
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Chika V Anekwe
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine, Division of Endocrinology, Metabolism Unit, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | | | - Shradha Chhabria
- Departments of Internal Medicine and Pediatrics, University Hospitals Cleveland Medical Center and Rainbow Babies and Children's Hospital, Cleveland, OH, United States of America; Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Lucy Tu
- Department of Sociology, Department of History of Science, Harvard University, Cambridge, MA, United States of America
| | - Fatima Cody Stanford
- Department of Medicine-Neuroendocrine Unit, Pediatric Endocrinology, MGH Weight Center, Nutrition Obesity Research Center at Harvard, MA General Hospital, Harvard Medical School, United States of America
| |
Collapse
|
30
|
Saavedra-Peña RDM, Taylor N, Flannery C, Rodeheffer MS. Estradiol cycling drives female obesogenic adipocyte hyperplasia. Cell Rep 2023; 42:112390. [PMID: 37053070 PMCID: PMC10567995 DOI: 10.1016/j.celrep.2023.112390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/21/2022] [Accepted: 03/29/2023] [Indexed: 04/14/2023] Open
Abstract
White adipose tissue (WAT) distribution is sex dependent. Adipocyte hyperplasia contributes to WAT distribution in mice driven by cues in the tissue microenvironment, with females displaying hyperplasia in subcutaneous and visceral WAT, while males and ovariectomized females have visceral WAT (VWAT)-specific hyperplasia. However, the mechanism underlying sex-specific hyperplasia remains elusive. Here, transcriptome analysis in female mice shows that high-fat diet (HFD) induces estrogen signaling in adipocyte precursor cells (APCs). Analysis of APCs throughout the estrous cycle demonstrates increased proliferation only when proestrus (high estrogen) coincides with the onset of HFD feeding. We further show that estrogen receptor α (ERα) is required for this proliferation and that estradiol treatment at the onset of HFD feeding is sufficient to drive it. This estrous influence on APC proliferation leads to increased obesity driven by adipocyte hyperplasia. These data indicate that estrogen drives ERα-dependent obesogenic adipocyte hyperplasia in females, exacerbating obesity and contributing to the differential fat distribution between the sexes.
Collapse
Affiliation(s)
- Rocío Del M Saavedra-Peña
- Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, CT 06520, USA
| | - Natalia Taylor
- Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, CT 06520, USA
| | - Clare Flannery
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, New Haven, CT 06520, USA; Section of Endocrinology and Metabolism, Yale University, New Haven, CT 06520, USA
| | - Matthew S Rodeheffer
- Department of Comparative Medicine, Yale University, New Haven, CT 06520, USA; Department of Cellular and Molecular Physiology, Yale University, New Haven, CT 06520, USA; Yale Center for Molecular and Systems Metabolism, Yale University, New Haven, CT 06520, USA; Yale Stem Cell Center, Yale University School of Medicine, New Haven, CT 06520, USA.
| |
Collapse
|
31
|
Chang MW, Schaffir J, Tan A, Wegener DT, Strafford K, Worly B, Sampsell C, Rosen M, Soma L. Dietary Intake of Micronutrients and Essential Fatty Acids among Overweight or Obese Pregnant Women during Early Pregnancy. JOURNAL OF PEDIATRICS, PERINATOLOGY AND CHILD HEALTH 2023; 7:55-62. [PMID: 38577312 PMCID: PMC10994147 DOI: 10.26502/jppch.74050145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Background Dietary intake of micronutrients and essential fatty acids in overweight or obese pregnant women during early pregnancy is unknown. We investigated the proportion of pregnant women meeting recommendations for dietary intake of micronutrients and essential fatty acids and compared stress and depressive symptoms between those meeting and below recommendations. Methods Participants (N = 70) were overweight or obese pregnant women ≤16 weeks gestation. They completed two 24-hour dietary recalls and online surveys measuring stress and depressive symptoms. Micronutrients of interest included B vitamins, choline, and trace minerals (calcium, magnesium, selenium, and zinc). Essential fatty acids were docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Results Low proportions of participants met recommendations for choline (21.4%) and folate (24.3%). Yet, the proportion of women meeting recommendations for other B vitamins and trace minerals were much better. Less than 9.0% of participants met recommendations for essential fatty acids. Compared with those below recommendations for B3 and selenium, participants meeting recommendations had significantly fewer depressive symptoms. Conclusions Low proportions of overweight or obese pregnant participants met dietary intake recommendations for micronutrients and essential fatty acids.
Collapse
Affiliation(s)
- Mei-Wei Chang
- The Ohio State University College of Nursing, 1577 Neil Avenue, Columbus, OH 43210, USA
| | - Jonathan Schaffir
- The Ohio State University, Department of Obstetrics and Gynecology, 395 West 12 Avenue Columbus, OH 43210, USA
| | - Alai Tan
- The Ohio State University College of Nursing, 1577 Neil Avenue, Columbus, OH 43210, USA
| | - Duane T Wegener
- The Ohio State University Department of Psychology, 1835 Neil Avenue, Columbus, OH 43210, USA
| | - Katherine Strafford
- The Ohio State University, Department of Obstetrics and Gynecology, 395 West 12 Avenue Columbus, OH 43210, USA
| | - Brett Worly
- The Ohio State University, Department of Obstetrics and Gynecology, 395 West 12 Avenue Columbus, OH 43210, USA
| | - Cassandra Sampsell
- The Ohio State University, Department of Obstetrics and Gynecology, 395 West 12 Avenue Columbus, OH 43210, USA
| | - Maggie Rosen
- The Ohio State University, Department of Obstetrics and Gynecology, 395 West 12 Avenue Columbus, OH 43210, USA
| | - Loriana Soma
- The Ohio State University, Department of Obstetrics and Gynecology, 395 West 12 Avenue Columbus, OH 43210, USA
| |
Collapse
|
32
|
Skajaa GØ, Kampmann U, Ovesen PG, Fuglsang J. Breastfeeding and insulin requirements in women with Type 1 diabetes mellitus in the first year postpartum. Acta Diabetol 2023; 60:899-906. [PMID: 36991223 DOI: 10.1007/s00592-023-02068-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/28/2023] [Indexed: 03/31/2023]
Abstract
AIMS To explore whether breastfeeding affects postpartum insulin requirements, HbA1c levels, and pregnancy weight retention in women with Type 1 Diabetes Mellitus (T1DM). METHODS This prospective study included 66 women with T1DM. The women were divided into two groups based on whether they were breastfeeding (BF) at 6 months postpartum (BFyes, n = 32) or not (BFno, n = 34). Mean daily insulin requirement (MDIR), HbA1c levels, and pregnancy weight retention at 5 time-points from discharge to 12 months postpartum were compared. RESULTS MDIR increased by 35% from 35.7 IU at discharge to 48.1 IU at 12 months postpartum (p < 0.001). MDIR in BFyes and BFno were comparable, however in BFyes, MDIR were continuously lower compared to BFno. Postpartum HbA1c increased rapidly from 6.8% at 1 month to 7.4% at 3 months postpartum and settled at 7.5% at 12 months postpartum. The increase in HbA1c during the first 3 months postpartum was most pronounced in BFno (p < 0.001). Although neither were statistically significant, from 3 months postpartum HbA1c levels were highest in the BFno and BFno had a higher pregnancy weight retention compared to BFyes (p = 0.31). CONCLUSION In women with T1DM, breastfeeding did not significantly affect postpartum insulin requirements, HbA1c levels or pregnancy weight retention in the first year after delivery.
Collapse
Affiliation(s)
- Gitte Øskov Skajaa
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8210, Aarhus, Denmark.
| | - Ulla Kampmann
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Per Glud Ovesen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8210, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Fuglsang
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8210, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
33
|
Ku CW, Cheng TS, Ku CO, Zhou KX, Cheung YB, Godfrey KM, Han WM, Yap F, Chan JKY, Loy SL. Distribution and association of interpregnancy weight change with subsequent pregnancy outcomes in Asian women. Sci Rep 2023; 13:4834. [PMID: 36964283 PMCID: PMC10039003 DOI: 10.1038/s41598-023-31954-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 03/20/2023] [Indexed: 03/26/2023] Open
Abstract
The extent of interpregnancy weight change and its association with subsequent pregnancy outcomes among Asians remain unclear. We examined changes in maternal body mass index (BMI) between the first two deliveries and outcomes in the second delivery. Medical records of women with their first two consecutive deliveries between 2015 and 2020 at KK Women's and Children's Hospital, Singapore were retrieved. Gestational-age-adjusted BMI was determined by standardising to 12 weeks gestation and interpregnancy BMI change was calculated as the difference between both pregnancies. Pregnancy outcomes were analysed using modified Poisson regression models. Of 6264 included women with a median interpregnancy interval of 1.44 years, 40.7% had a stable BMI change within ± 1 kg/m2, 10.3% lost > 1 kg/m2, 34.3% gained 1-3 kg/m2 and 14.8% gained ≥ 3 kg/m2. Compared to women with stable BMI change, those with > 1 kg/m2 loss had higher risk of low birthweight (adjusted risk ratio [RR] 1.36; 95% confidence interval 1.02-1.80), while those with 1-3 kg/m2 gain had higher risks of large-for-gestational-age birth (1.16; 1.03-1.31), gestational diabetes (1.25; 1.06-1.49) and emergency Caesarean delivery (1.16; 1.03-1.31); these risks were higher in those with ≥ 3 kg/m2 gain. Our study strengthens the case for interpregnancy weight management to improve subsequent pregnancy outcomes.
Collapse
Affiliation(s)
- Chee Wai Ku
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, 229899, Singapore
- Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Tuck Seng Cheng
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus Box 285, Cambridge, CB2 0QQ, UK
| | - Chee Onn Ku
- Faculty of Science, National University of Singapore, Singapore, 119077, Singapore
| | - Kathy Xinzhuo Zhou
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 636921, Singapore
| | - Yin Bun Cheung
- Program in Health Services and Systems Research and Center for Quantitative Medicine, Duke-NUS Medical School, Singapore, 169857, Singapore
- Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, 33014, Tampere, Finland
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO16 6YD, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, SO16 6YD, UK
| | - Wee Meng Han
- Department of Dietetics, KK Women's and Children's Hospital, Singapore, 229899, Singapore
| | - Fabian Yap
- Duke-NUS Medical School, Singapore, 169857, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 636921, Singapore
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, 229899, Singapore
| | - Jerry Kok Yen Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, 229899, Singapore
- Duke-NUS Medical School, Singapore, 169857, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119077, Singapore
| | - See Ling Loy
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, 229899, Singapore.
- Duke-NUS Medical School, Singapore, 169857, Singapore.
| |
Collapse
|
34
|
Factors Affecting BMI Changes in Mothers during the First Year Postpartum. Nutrients 2023; 15:nu15061364. [PMID: 36986094 PMCID: PMC10051214 DOI: 10.3390/nu15061364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
We tested the hypotheses that mothers of infants who exclusively breastfed would differ in the trajectories of postpartum BMI changes than mothers of infants who exclusively formula fed, but such benefits would differ based on the maternal BMI status prepregnancy (primary hypothesis) and that psychological eating behavior traits would have independent effects on postpartum BMI changes (secondary hypothesis). To these aims, linear mixed-effects models analyzed measured anthropometric data collected monthly from 0.5 month (baseline) to 1 year postpartum from two groups of mothers distinct in infant feeding modality (Lactating vs. Non-lactating). While infant feeding modality group and prepregnancy BMI status had independent effects on postpartum BMI changes, the benefits of lactation on BMI changes differed based on prepregnancy BMI. When compared to lactating women, initial rates of BMI loss were significantly slower in the non-lactating women who were with Prepregnancy Healthy Weight (β = 0.63 percent BMI change, 95% CI: 0.19, 1.06) and with Prepregnancy Overweight (β = 2.10 percent BMI change, 95% CI: 1.16, 3.03); the difference was only a trend for those in the Prepregnancy Obesity group (β = 0.60 percent BMI change, 95% CI: −0.03, 1.23). For those with Prepregnancy Overweight, a greater percentage of non-lactating mothers (47%) gained ≥ 3 BMI units by 1 year postpartum than did lactating mothers (9%; p < 0.04). Psychological eating behavior traits of higher dietary restraint, higher disinhibition, and lower susceptibility to hunger were associated with greater BMI loss. In conclusion, while there are myriad advantages to lactation, including greater initial rates of postpartum weight loss regardless of prepregnancy BMI, mothers who were with overweight prior to the pregnancy experienced substantially greater loss if they breastfed their infants. Individual differences in psychological eating behavior traits hold promise as modifiable targets for postpartum weight management.
Collapse
|
35
|
Hyer S, Vaughan S, Davis JW, Xie R, Misra D, Giurgescu C. The Association of Avoidance Coping with Gestational Weight Gain among Pregnant Black Women. West J Nurs Res 2023; 45:226-233. [PMID: 36196018 PMCID: PMC10165848 DOI: 10.1177/01939459221127800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Gestational weight gain (GWG) outside recommended parameters can lead to pregnancy or birth complications. Avoidance coping may influence GWG. We examined the association of avoidance coping with GWG among a sample of 112 pregnant Black women in the Midwest. Participants completed avoidance coping questionnaires at three time points throughout pregnancy. Data were abstracted from medical records for BMI and GWG. Overall, 23.2% gained inadequate weight, 30.4% adequate weight, and 46.4% excess weight. Multinomial logistic regression models indicated associations between avoidance coping and GWG adjusted for covariates. Participants with higher avoidance coping scores at 22-29 weeks' gestation were more likely to experience excess weight gain (odds ratio [OR] = 1.19, 95% CI [1.02, 1.37]). Participants with higher avoidance coping scores at 30-36 weeks' gestation were less likely to experience excess weight gain, (OR = 0.82, 95% CI [0.72, 0.93]). The impact of higher avoidance coping on excess weight gain depends on the time period in pregnancy.
Collapse
Affiliation(s)
- Suzanne Hyer
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Sarah Vaughan
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Jean W Davis
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Rui Xie
- Department of Statistics and Data Science, University of Central Florida, Orlando, FL, USA
| | - Dawn Misra
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Carmen Giurgescu
- College of Nursing, University of Central Florida, Orlando, FL, USA
| |
Collapse
|
36
|
Dude AM, Smid MC, Branch DW, West J, Meeks H, Yu Z, Fraser A, Smith K, Reddy D. Interpregnancy Body Mass Index Change and Offspring Mortality Risk following the Second Pregnancy. Am J Perinatol 2023; 40:387-393. [PMID: 33878768 PMCID: PMC10552797 DOI: 10.1055/s-0041-1727230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of the study is to examine the impact of maternal interpregnancy body mass index (BMI) change on subsequent offspring mortality risk. STUDY DESIGN This is a retrospective cohort study of women who had two consecutive live singleton deliveries of at least 20 weeks' gestation from the Utah Population Database. Our exposure was defined as interpregnancy BMI change from the date of first delivery to the conception date of subsequent pregnancy. We categorized BMI change as: < - 1, -1 to 0, 0 to <1 (reference), 1 to 2, 2 to 4, ≥4 kg/m2. Our primary outcome was all-cause age-specific mortality during four time periods: neonatal (≤28 days), infant (29 days to <1 year old), childhood ((≥1 to <5 years old), and late childhood (5 to <18 years old). We also examined mortality specifically attributed to congenital anomalies. Analyses used Cox proportional hazard models stratified by full term (≥37 weeks) and preterm (<37 weeks) deliveries. All models were adjusted for relevant confounders. RESULTS Of 266,752 women, among full-term deliveries, women with a BMI increase of 4 kg/m2 or more had an increased risk of neonatal mortality in their subsequent pregnancy (hazard ratio or HR = 1.72, 95% confidence interval or CI: 1.23-2.41) Women who lost 1 kg/m2 or more between deliveries also had increased neonatal mortality (HR = 1.46, 95% CI: 1.04-2.05). There were no differences in infant, early, or late childhood mortality by interpregnancy BMI change. Maternal interpregnancy interval weight loss of 1 kg/m2 or more and weight gain of ≥4 kg/m2 also had increased risk of mortality associated with congenital anomalies or conditions arising during the neonatal period following their subsequent delivery. CONCLUSION Women with significant interpregnancy weight gain and modest weight loss have a significant increased risk of neonatal mortality following their subsequent pregnancy. KEY POINTS · Significant weight gain between deliveries increases the risk of neonatal death.. · Modest weight loss between deliveries increases the risk of neonatal death.. · This risk may be partially explained by increased risk of congenital malformations..
Collapse
Affiliation(s)
- Annie M. Dude
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Marcela C. Smid
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Division of Maternal Fetal Medicine, Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
| | - D. Ware Branch
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Division of Maternal Fetal Medicine, Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
| | - Jennifer West
- Department of Population Science, Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Huong Meeks
- Department of Population Science, Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Zhe Yu
- Department of Population Science, Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Alison Fraser
- Department of Population Science, Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Ken Smith
- Department of Population Science, Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, Utah
| | - Deepika Reddy
- Department of Medicine, University Diabetes and Endocrinology Center, University of Utah, Salt Lake City, Utah
| |
Collapse
|
37
|
Chang MW, Tan A, Schaffir J, Wegener DT, Worly B, Strafford K, Soma L, Sampsell C, Rosen M. A Pilot Lifestyle Behavior Intervention for Overweight or Obese Pregnant Women: Results and Process Evaluation. JOURNAL OF PEDIATRICS, PERINATOLOGY AND CHILD HEALTH 2023; 7:10-20. [PMID: 38577313 PMCID: PMC10993688 DOI: 10.26502/jppch.74050139] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Introduction This paper presents a pilot lifestyle behavior intervention effect on gestational weight gain and maternal and neonatal outcomes and intervention acceptability. Materials and Methods Overweight or obese pregnant participants (N = 70) were randomized to the intervention or usual care group. The 20-week intervention integrated Hope theory and goal-oriented episodic future thinking (GoEFT) to prevent excessive gestational weight gain through stress and emotion management, healthy eating, and physical activity. Intervention participants completed a weekly web intervention module with 2 parts (I and II) and joined individual health coaching sessions (10 sessions). The primary outcome was gestational weight gain (GWG). Secondary outcomes included maternal and neonatal outcomes. Data were collected at 3 time points: baseline (< 17 weeks gestation, T1), 24-27 weeks gestation (T2), and 35-37 weeks gestation (T3). Intervention participants completed a semi-structured interview to evaluate the intervention. We compared GWG at T2 and T3 with T1 for intervention and usual care groups using t-tests and conducted content analysis to identify common themes for intervention acceptability. Results There were no significant group differences in GWG at T2 and T3. Maternal and neonatal outcomes were similar between groups. Common themes for intervention acceptability were disked web Part I intervention presented in text, the need for choosing a weekly intervention topic, raising awareness through GoEFT and self-evaluation, increased motivation through GoEFT, and usefulness of pre-written goals and goal progress evaluation. Conclusions Results of process evaluation are helpful for researchers to design a lifestyle intervention to prevent excessive gestational weight gain.
Collapse
Affiliation(s)
- Mei-Wei Chang
- The Ohio State University College of Nursing, 1577 Neil Avenue, Columbus, OH 43210, USA
| | - Alai Tan
- The Ohio State University College of Nursing, 1577 Neil Avenue, Columbus, OH 43210, USA
| | - Jonathan Schaffir
- The Ohio State University, Dept. of Obstetrics and Gynecology, 395 West 12th Avenue, 5th floor Columbus, OH 43210, USA
| | - Duane T Wegener
- The Ohio State University Department of Psychology, 1835 Neil Avenue, Columbus, OH 43210, USA
| | - Brett Worly
- The Ohio State University, Dept. of Obstetrics and Gynecology, 395 West 12th Avenue, 5th floor Columbus, OH 43210, USA
| | - Katherine Strafford
- The Ohio State University, Dept. of Obstetrics and Gynecology, 395 West 12th Avenue, 5th floor Columbus, OH 43210, USA
| | - Loriana Soma
- The Ohio State University, Dept. of Obstetrics and Gynecology, 395 West 12th Avenue, 5th floor Columbus, OH 43210, USA
| | - Cassandra Sampsell
- The Ohio State University, Dept. of Obstetrics and Gynecology, 395 West 12th Avenue, 5th floor Columbus, OH 43210, USA
| | - Maggie Rosen
- The Ohio State University, Dept. of Obstetrics and Gynecology, 395 West 12th Avenue, 5th floor Columbus, OH 43210, USA
| |
Collapse
|
38
|
Bazzazian S, Ozgoli G, Riazi H, Mahmoodi Z, Vafa M, Nasiri M. The relationship between social determinants of health and postpartum weight retention based on the World Health Organization model: path analysis. BMC Public Health 2023; 23:323. [PMID: 36788506 PMCID: PMC9926434 DOI: 10.1186/s12889-023-15207-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 02/03/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Postpartum weight retention (PPWR) causes obesity, chronic diseases, and occurring adverse maternal-fetal and neonatal outcomes. Given the social factors' effect on health and disease and considering the lack of information on social determinants of health (SDH) effects on PPWR, this study was conducted to survey the relationship between SDH and PPWR based on the World Health Organization (WHO) model. METHODS A cross-sectional study was performed on 400 women six months after delivery in 2020. Twelve health centers were randomly selected from the three universities of Medical Sciences in the city of Tehran, Iran. Participants were selected by convenience method and based on eligibility. Questionnaires used included: Lifestyle Profile Health Promoting II, Short Form Postpartum Quality of Life Questionnaire, Multidimensional Scale of Perceived Social Support, Postpartum Social Support, Depression Anxiety Stress Scales, and questionnaires designed by reviewing the literature about breastfeeding, sleep, contraceptive, child health, unhealthy behaviors, postpartum nutritional awareness/beliefs, body satisfaction, access to postpartum care, socioeconomic status, demographic, and obstetric questionnaire. Data analysis was performed in SPSS-23, and the relationship model was examined using the path analysis method in LISREL-8.8. RESULTS Path analysis indicated the direct effect of six intermediate factors on PPWR including: gestational weight gain (β = 0.42), access to postpartum care (β = 0.11), postpartum nutritional awareness/beliefs (β=-0.17), anxiety (β = 0.09), sleep duration (β=-0.09), pre-pregnancy body mass index (β = 0.09). Among the structural factors, woman's education and socioeconomic status had an indirect negative effect on PPWR. The model fit indices showed good fit (RMSE = 0/05, GFI = 0.92, CFI = 0.92, χ2/df = 2.17). CONCLUSION The results indicate the effect of structural and intermediate determinants of health on PPWR. It is recommended to use the proposed model as an appropriate framework in the research, design, and implementation of programs to prevent and control PPWR.
Collapse
Affiliation(s)
- Shahin Bazzazian
- grid.411600.2Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Giti Ozgoli
- Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Vali Asr Ave., Niayesh Cross Road, Niayesh Complex, 1985717443, Tehran, Iran.
| | - Hedyeh Riazi
- grid.411600.2Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zohreh Mahmoodi
- grid.411705.60000 0001 0166 0922Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohammadreza Vafa
- grid.411746.10000 0004 4911 7066Nutrition Department, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Malihe Nasiri
- grid.411600.2 Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
39
|
Gestational Weight Gain in Pregnant People with Obesity. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2023. [DOI: 10.1007/s13669-023-00346-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
|
40
|
Lohr AN, Hoppe KK, Mei CC, Antony KM. Does Daily Self-Weighing Contribute to Postpartum Weight Loss? A Secondary Analysis of Daily Postpartum Weights among Women with Hypertensive Disorders of Pregnancy. Am J Perinatol 2023; 40:319-325. [PMID: 33902132 PMCID: PMC11073857 DOI: 10.1055/s-0041-1727217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study was aimed to examine the impact of daily self-weighing via remote monitoring on postpartum weight loss. STUDY DESIGN This was a secondary analysis of a nonrandomized controlled trial comprised of postpartum women with diagnosed hypertensive-related disorders in pregnancy who received a tablet device linked to Bluetooth-enabled equipment including a scale and blood pressure cuff. In addition to blood pressure monitoring, participants were instructed to perform daily self-weighing. The primary outcome of this study was to determine whether postpartum women who performed daily self-weighing lost more weight than those who did not, with a 42-day endpoint based on a 6-week postpartum visit weight. RESULTS Overall, 214 women participated in this program and 214 received usual care. Median weight loss for women participating in the remote blood pressure monitoring system was 23.0 (interquartile range [IQR]: 17-30) pounds versus 23.0 (IQR: 17-29) pounds among controls. Weight loss did not vary by prepregnancy obesity (median: 20 pounds [IQR: 17-28 pounds] for nonobese and 23 [IQR: 17-30] pounds for women with obesity, p = 0.16). Women who weighed themselves more than half of follow-up days lost a median of 24 pounds (IQR: 17-30 pounds) compared with 20.5 pounds (IQR: 14-29 pounds), p = 0.06. Women who weighed themselves more than half of follow-up days lost a mean of 11.4% (standard deviation [SD] = 0.41%) of body weight compared with 9.1% (SD = 0.74%; p = 0.01). The amount of weight loss in the telehealth group was correlated with the number of daily weights performed (Pearson's correlation coefficient 0.164, p = 0.025). Postpartum weight loss for daily self-weighing participants was most notable in the first 2 weeks with ongoing weight loss up to the 42-day (6-week) endpoint of this secondary analysis. CONCLUSION Daily self-weighing alone may be insufficient to promote postpartum weight loss. However, there was a slight trend toward more weight loss with more frequent weighing. KEY POINTS · Daily self-weighing is insufficient for postpartum weight loss.. · Women who weighed themselves more lost slightly more weight.. · Weight loss was the most notable in the first 2 weeks.. · Its use as one part of a program may be worth studying..
Collapse
Affiliation(s)
- Ali N Lohr
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin Madison, Madison, Wisconsin
| | - Kara K Hoppe
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin Madison, Madison, Wisconsin
| | - Chaoqun C Mei
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | - Kathleen M Antony
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin Madison, Madison, Wisconsin
| |
Collapse
|
41
|
Kent-Marvick J, Cloyes KG, Meek P, Simonsen S. Racial and ethnic disparities in postpartum weight retention: A narrative review mapping the literature to the National Institute on Minority Health and Health Disparities Research Framework. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231166822. [PMID: 37082834 PMCID: PMC10126608 DOI: 10.1177/17455057231166822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 04/22/2023]
Abstract
PLAIN LANGUAGE SUMMARY A Review of the Literature Using the National Institutes of Health, National Institute on Minority Health and Health Disparities (NIMHD) Research Framework to Create a Roadmap of the Studies Investigating Racial and Ethnic Disparities in Excess Weight Retained After Pregnancy. WHY WAS THIS STUDY DONE? Three out of four people who give birth retain excess weight at 1-year post-pregnancy. This is concerning, as weight that is retained following pregnancy is associated with increased risk for the development of disease. People from racial and ethnic minority groups experience weight retention more frequently post-pregnancy. Black and Hispanic/Latina/o/x birthing people are more likely to begin pregnancy overweight or obese. They are also more likely to retain excess weight following pregnancy. Investigating these risks in people from racially/ethnically diverse backgrounds may be an important way to address disparities in excess weight retained post-pregnancy. WHAT DID THE RESEARCHERS DO? This review of the literature used a tool called the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework to map the literature to date on racial and ethnic disparities in excess weight retained post-pregnancy. WHAT DID THE RESEARCHERS FIND? We used the NIMHD Research Framework as a visual guide of the existing research about excess weight retained following pregnancy. Results illustrate the levels and domains at which research has been investigated. These results reveal that efforts have been focused at the individual level, with most attention given to diet and activity. Mapping the literature to the NIMHD Research Framework sheds light on gaps in the research. WHAT DO THE FINDINGS MEAN? Mapping the literature has revealed a need for investigations that make connections between the levels and domains of the Framework, so that we may understand underlying factors that contribute to health disparities.
Collapse
Affiliation(s)
| | - Kristin G Cloyes
- College of Nursing, University of Utah, Salt Lake City, UT, USA
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Paula Meek
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Sara Simonsen
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
42
|
Kaur D, Ranjan P, Anwar W, Verma A, Kumari A, Datt Upadhyay A, Malhotra A, Kushwaha K, Mani Pandey M, Kaloiya G. Postpartum weight retention and its association with socio-demographic and obstetrics correlates: A cross-sectional hospital-based preliminary survey in India. Diabetes Metab Syndr 2023; 17:102701. [PMID: 36599249 DOI: 10.1016/j.dsx.2022.102701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Postpartum weight retention can predispose women to an elevated risk of obesity and associated complications. The study aims to assess the magnitude of postpartum weight retention and its association with socio-demographic and obstetrics correlates. METHODS A cross-sectional survey was carried out in February and March 2022 via telephonic interviews. Convenience sampling technique was used for recruiting postpartum women in first three months, four to six months and beyond six months post-delivery (date of delivery January 2021 to January 2022). Chi2 test and regression analysis were employed to study the association of socio-demographic and obstetrics correlates with postpartum weight retention. RESULTS The final sample comprised 505 postpartum women with a mean age of 29 ± 4 years. The mean postpartum weight retention was 4.96 ± 3.64 kg, 5.38 ± 3.93 kg and 5.80 ± 3.95 kg in the first three months, four to six months and beyond six months post-delivery respectively. In the first three months, socio-economic status and gestational weight gain were associated with weight retention (p < 0.05). In four-six months, type of family, education qualification, and gestational weight gain were associated with weight retention (p < 0.05). Beyond six months post-delivery, gestational weight gain was associated with postpartum weight retention (p < 0.05). CONCLUSION The findings provide preliminary data on the magnitude of weight retention in Indian postpartum women. Postpartum women are at an increased risk of weight retention with the overall shift to a higher body mass index category as compared to the pre-pregnancy period. It is crucial to timely screen women at risk and implement weight management strategies.
Collapse
Affiliation(s)
- Divjyot Kaur
- Department of Home Science, University of Delhi, Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | - Wareesha Anwar
- Department of Home Science, University of Delhi, Delhi, India
| | - Aditi Verma
- Department of Home Science, University of Delhi, Delhi, India
| | - Archana Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Datt Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Malhotra
- Department of Home Science, Lakshmibai College, University of Delhi, Delhi, India
| | - Komal Kushwaha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Mayank Mani Pandey
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurishankar Kaloiya
- Department of Psychiatry & National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
43
|
Dairy Food Intakes, Postpartum Weight Retention, and Risk of Obesity. Nutrients 2022; 15:nu15010120. [PMID: 36615778 PMCID: PMC9824318 DOI: 10.3390/nu15010120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/15/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Excessive postpartum weight retention puts women at risk for health problems. This study aimed to investigate the effects of dairy foods on weight retention and risk of obesity in postpartum women in the Nurses’ Health Study II. Weight was reported every 2 years. We identified the pre-pregnancy and postpartum exams that were approximately 2 years before and after the birth year. Dairy consumption was averaged during these 4 years. Linear models were used to assess postpartum weight retention. Multivariable models were used to estimate risk of obesity. Women with higher yogurt (≥2 servings/week vs. <1 serving/month) intakes had 0.61 pounds less postpartum weight retention. Consuming ≥ 5 cheese servings/week was associated with 0.63 pounds less weight retention than the lowest intake. Among sedentary women, only yogurt intake was associated with lower risk of postpartum obesity (RR: 0.84; 95% CI: 0.71−1.00), though of borderline statistical significance. Among women with less healthy diets, yogurt consumption was also associated with lower postpartum obesity risk (RR: 0.70; 95% CI: 0.57−0.85). In sum, higher yogurt and cheese intakes were associated with less postpartum weight retention and among higher risk women (sedentary or lower diet quality) greater yogurt intake was associated with lower risks of postpartum obesity.
Collapse
|
44
|
Lim S, Harrison C, Callander E, Walker R, Teede H, Moran L. Addressing Obesity in Preconception, Pregnancy, and Postpartum: A Review of the Literature. Curr Obes Rep 2022; 11:405-414. [PMID: 36318371 PMCID: PMC9729313 DOI: 10.1007/s13679-022-00485-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Reproductive-aged women (aged 19 to 50 years) are a key population warranting focused research for the prevention of overweight and obesity. This review highlights the importance of addressing weight before, during and after pregnancy. RECENT FINDINGS Obesity decreases fertility during the preconception period; increases the risk of adverse pregnancy outcomes including gestational diabetes, pre-eclampsia and caesarean section and postpartum weight retention; and increases the long-term health risks for both the mother and offspring. Despite overwhelming efficacy evidence on solutions, there are significant implementation gaps in translating this evidence into pragmatic models of care and real-world solutions. Interventions during preconception, pregnancy and postpartum are likely to be cost-effective or cost-saving, with future investigation needed in the preconception and postpartum period. International clinical guidelines and public health policies are needed for a concerted effort to prevent unhealthy weight gain in these life stages and to reverse the significant adverse health outcomes for women and the next generation.
Collapse
Affiliation(s)
- Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Boxhill, VIC, Australia
| | - Cheryce Harrison
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Emily Callander
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Ruth Walker
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Lisa Moran
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia.
| |
Collapse
|
45
|
Zielinska AP, Mullins E, Magni E, Zamagni G, Kleprlikova H, Adams O, Stampalija T, Monasta L, Lees C. Remote multimodality monitoring of maternal physiology from the first trimester to postpartum period: study results. J Hypertens 2022; 40:2280-2291. [PMID: 35969213 PMCID: PMC9553246 DOI: 10.1097/hjh.0000000000003260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 05/31/2022] [Accepted: 06/30/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVES Current antenatal care largely relies on widely spaced appointments, hence only a fraction of the pregnancy period is subject to monitoring. Continuous monitoring of physiological parameters could represent a paradigm shift in obstetric care. Here, we analyse the data from daily home monitoring in pregnancy and consider the implications of this approach for tracking pregnancy health. METHODS Prospective feasibility study of continuous home monitoring of blood pressure, weight, heart rate, sleep and activity patterns from the first trimester to 6 weeks postpartum. RESULTS Fourteen out of 24 women completed the study (58%). Compared to early pregnancy [week 13, median heart rate (HR) 72/min, interquartile range (IQR) 12.8], heart rate increased by week 35 (HR 78/min, IQR 16.6; P = 0.041) and fell postpartum (HR 66/min, IQR 11.5, P = 0.021). Both systolic and diastolic blood pressure were lower at mid-gestation (week 20: SBP 103 mmHg, IQR 6.6; DPB 63 mmHg, IQR 5.3 P = 0.005 and P = 0.045, respectively) compared to early pregnancy (week 13, SBP 107 mmHg, IQR 12.4; DPB 67 mmHg, IQR 7.1). Weight increased during pregnancy between each time period analyzed, starting from week 15. Smartwatch recordings indicated that activity increased in the prepartum period, while deep sleep declined as pregnancy progressed. CONCLUSION Home monitoring tracks individual physiological responses to pregnancy in high resolution that routine clinic visits cannot. Changes in the study protocol suggested by the study participants may improve compliance for future studies, which was particularly low in the postpartum period. Future work will investigate whether distinct adaptative patterns predate obstetric complications, or can predict long-term maternal cardiovascular health.
Collapse
Affiliation(s)
- Agata P. Zielinska
- Department of Metabolism, Digestion and Reproduction, Imperial College London
| | - Edward Mullins
- Department of Metabolism, Digestion and Reproduction, Imperial College London
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust
- The George Institute for Global Health, London, UK
| | - Elena Magni
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Giulia Zamagni
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Hana Kleprlikova
- Department of Metabolism, Digestion and Reproduction, Imperial College London
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust
- Department of General Anthropology, Faculty of Humanities, Charles University in Prague, Czech Republic
| | - Olive Adams
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust
| | - Tamara Stampalija
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Lorenzo Monasta
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Christoph Lees
- Department of Metabolism, Digestion and Reproduction, Imperial College London
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust
| |
Collapse
|
46
|
Garr Barry V, Martin SL, Chandler-Laney P, Carter EB, Worthington CS. A Comparison of Bioimpedance Analysis vs. Dual X-ray Absorptiometry for Body Composition Assessment in Postpartum Women and Non-Postpartum Controls. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13636. [PMID: 36294216 PMCID: PMC9602548 DOI: 10.3390/ijerph192013636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Postpartum fat mass (FM) and fat-free mass (FFM) may be informative predictors of future disease risk among women; hence, there is growing use of bioelectrical impedance analysis (BIA) to quantify FFM and FM among postpartum women due to the quick, non-invasive, and inexpensive nature of BIA. Despite this, very few studies have examined BIA's performance, and it remains unclear as to whether specific BIA equations are needed for postpartum women. To explore these questions, we measured total body FFM and FM with a multi-frequency, segmental BIA, and dual-X-ray absorptiometry (DXA) in (1) women at one and four months postpartum (n = 21); and (2) height- and weight-matched non-postpartum women (controls, n = 21). BIA was compared to DXA using Deming regression models, paired t-tests, and Bland-Altman plots. Between-group comparisons were performed using an analysis of variance models. The mean difference between DXA and BIA was 1.2 ± 1.7 kg FFM (p < 0.01) and -1.0 ± 1.7 kg FM (p < 0.05) in postpartum women at both time points. The measurements of longitudinal changes in FFM and FM were not significantly different between BIA and DXA. Furthermore, there was no significant difference in BIA's performance in postpartum vs. non-postpartum women (p = 0.29), which suggests that population-specific equations are not needed for postpartum women. The results of this study suggest that BIA is a suitable method to assess postpartum body composition among women at one and four months postpartum, using existing age-, race-, and sex-adjusted equations.
Collapse
Affiliation(s)
- Valene Garr Barry
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Samantha L. Martin
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Paula Chandler-Laney
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Ebony B. Carter
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Camille S. Worthington
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| |
Collapse
|
47
|
Postpartum Women’s Preferences for Lifestyle Intervention after Childbirth: A Multi-Methods Study Using the TIDieR Checklist. Nutrients 2022; 14:nu14204229. [PMID: 36296913 PMCID: PMC9611337 DOI: 10.3390/nu14204229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/06/2022] [Accepted: 10/09/2022] [Indexed: 11/17/2022] Open
Abstract
Postpartum lifestyle interventions are known to be efficacious in reducing postpartum weight retention, but uptake and engagement are poor. This multi-method study explored the preferences of postpartum women for the delivery of lifestyle interventions based on the Template for Intervention Description and Replication (TIDieR) checklist. Semi-structured interviews were conducted with 21 women within 2 years of childbirth, recruited through convenience and snowball sampling throughout Australia (15 May 2020 to 20 July 2020). Transcripts were analysed thematically using an open coding approach. A cross-sectional online survey was conducted in November 2021 among postpartum women within 5 years of childbirth in Australia. Data were summarised using descriptive statistics. The survey was completed by 520 women. Both the survey and interviews revealed that women were interested in receiving lifestyle support postpartum and wanted a program delivered by health professionals. They preferred a flexible low-intensity program embedded within existing maternal and child health services that is delivered through both online and face-to-face sessions. Having a pragmatic approach that taught practical strategies and enlists the support of partners, family and peers was important to mothers. Consumer-informed postpartum lifestyle interventions promote optimal engagement and improve program reach and therefore, impact.
Collapse
|
48
|
Yuhas M, Moore CF, Garay J, Brown SD. Improving Maternal Cardiovascular Health in Underserved Populations: a Narrative Review of Behavioral Intervention Trials Targeting Postpartum Weight Retention. Curr Atheroscler Rep 2022; 24:689-699. [PMID: 35781777 PMCID: PMC10373576 DOI: 10.1007/s11883-022-01045-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Racial/ethnic minority and socioeconomically disadvantaged individuals experience greater postpartum weight retention, which has been linked to the development of cardiovascular disease. This article reviews recent literature on behavioral interventions targeting postpartum weight retention in these populations. RECENT FINDINGS Seven randomized controlled trials published since 2010 were selected for this review. Four were successful in reducing or preventing postpartum weight retention. Recruitment primarily occurred in low-income urban areas. All interventions reported using the Social Cognitive Theory and targeted mostly individual-level behavior change focused on diet and physical activity. Four were technology-based, and most implemented strategies to increase cultural relevance of the intervention. Opportunities for future interventions include expand target population to enroll individuals starting in pregnancy and address rural populations; incorporate empirically tested retention strategies; increase focus on psychosocial factors, particularly chronic stress; utilize multilevel approaches; continue to leverage technology; and maximize efforts to increase cultural relevancy.
Collapse
Affiliation(s)
- Maryam Yuhas
- Department of Nutrition and Food Studies, Syracuse University, 558 White Hall, Syracuse, NY, 13244, USA.
| | - Caroline Fletcher Moore
- Department of Nutrition and Food Studies, Syracuse University, 558 White Hall, Syracuse, NY, 13244, USA
| | - Jessica Garay
- Department of Nutrition and Food Studies, Syracuse University, 558 White Hall, Syracuse, NY, 13244, USA
| | - Susan D Brown
- Department of Internal Medicine, Davis School of Medicine, University of California, Sacramento, CA, USA
| |
Collapse
|
49
|
Pafili K, Paschou SA, Armeni E, Polyzos SA, Goulis DG, Lambrinoudaki I. Non-alcoholic fatty liver disease through the female lifespan: the role of sex hormones. J Endocrinol Invest 2022; 45:1609-1623. [PMID: 35303270 DOI: 10.1007/s40618-022-01766-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/09/2022] [Indexed: 12/12/2022]
Abstract
The prevalence of non-alcoholic fatty liver disease (NAFLD) differs between various stages of the female lifespan. The aim of this review is to summarize current evidence on the association of NAFLD and circulating sex hormones and to explore the pathogenesis of NAFLD within the context of (1) sex hormone changes during the reproductive, post-reproductive female life and beyond and (2) the in vitro and in vivo evidence on pharmacological modulation in women on menopausal hormone treatment (MHT) or endocrine therapy after breast cancer. The fluctuation in estrogen concentrations, the relative androgen excess, and the age-related reduction in sex hormone-binding globulin are related to increased NAFLD risk. Moreover, the peri-menopausal changes in body composition and insulin resistance might contribute to the increased NAFLD risk. Whether MHT prevents or improves NAFLD in this population remains an open question. Studies in women with breast cancer treated with tamoxifen or non-steroidal aromatase inhibitors point to their adverse effects on NAFLD development, although a more pronounced effect of tamoxifen is reported. Future studies focusing on the underlying pathogenesis should identify subgroups with the highest risk of NAFLD development and progression into more aggressive forms, as well as elucidate the role of hormone therapies, such as MHT.
Collapse
Affiliation(s)
- K Pafili
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, Munich-Neuherberg, Germany
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - S A Paschou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Menopause Unit, 2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - E Armeni
- Menopause Unit, 2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - S A Polyzos
- First Laboratory of Pharmacology, Medical School, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - D G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - I Lambrinoudaki
- Menopause Unit, 2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| |
Collapse
|
50
|
Limiting Postpartum Weight Retention in Culturally and Linguistically Diverse Women: Secondary Analysis of the HeLP-her Randomized Controlled Trial. Nutrients 2022; 14:nu14142988. [PMID: 35889944 PMCID: PMC9316445 DOI: 10.3390/nu14142988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 02/04/2023] Open
Abstract
Postpartum weight retention (PPWR) contributes to maternal obesity development and is more pronounced in culturally and linguistically diverse (CALD) women. Our antenatal healthy lifestyle intervention (HeLP-her) demonstrated efficacy in reducing PPWR in non-Australian-born CALD women compared with Australian-born women. In this secondary analysis, we aimed to examine differences in the intervention effect on behavioral and psychosocial outcomes between Australian-born and non-Australian-born women and explore factors associated with the differential intervention effect on PPWR. Pregnant women at risk of gestational diabetes (Australian-born n = 86, non-Australian-born n = 142) were randomized to intervention (four lifestyle sessions) or control (standard antenatal care). PPWR was defined as the difference in measured weight between 6 weeks postpartum and baseline (12–15 weeks gestation). Behavioral (self-weighing, physical activity (pedometer), diet (fat-related dietary habits questionnaire), self-perceived behavior changes), and psychosocial (weight control confidence, exercise self-efficacy, eating self-efficacy) outcomes were examined by country of birth. Multivariable linear regression analysis was conducted to assess factors associated with PPWR. The intervention significantly increased self-weighing, eating self-efficacy, and self-perceived changes to diet and physical activity at 6 weeks postpartum in non-Australian-born women, compared with no significant changes observed among Australian-born women. Intervention allocation and decreased intake of snack foods were predictors of lower PPWR in non-Australian-born women. Results indicate that the HeLP-her intervention improved dietary behaviors, contributing to the reduction of PPWR in CALD women. Future translations could prioritize targeting diet while developing more effective strategies to increase exercise engagement during pregnancy in this population.
Collapse
|