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Poprzeczny AJ, Louise J, Deussen AR, Dodd JM. Fetal Growth and Adiposity of Infants Born Large for Gestational Age in Three Harmonized Randomized Trials. Am J Perinatol 2024. [PMID: 38134941 DOI: 10.1055/a-2234-7980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
OBJECTIVE Infants born large for gestational age (LGA) are at an increased risk of short- and longer-term adverse outcomes. Understanding fetal growth and adiposity and their trajectories may help inform interventions to prevent birth of LGA infants. We aimed to compare fetal growth and adiposity measures of infants born LGA with those born not LGA, to determine whether the discrepancy at birth was primarily due to larger size throughout gestation, or instead to different trajectories of fetal growth. STUDY DESIGN This was a secondary analysis of secondary outcomes of fetal growth and adiposity from three harmonized randomized trials-the LIMIT, GRoW, and Optimise randomized trials. These trials recruited women in early pregnancy, and a singleton gestation, from three major public metropolitan Adelaide maternity hospitals. Maternal body mass index (BMI) ranged from 18.5 to ≥40.0 kg/m2. Data were obtained from enrolled women who underwent research ultrasounds at 28 and 36 weeks' gestation. Outcome measures were ultrasound measures of fetal biometry and adiposity. RESULTS Infants born LGA had larger fetal biometry measures, and higher growth trajectories, from 20 weeks' gestation. Fetal adiposity measures were consistently larger among infants born LGA and these differences increased over time. We did not find evidence that the differences in biometry and adiposity measurements varied according to maternal BMI. CONCLUSION Infants born LGA had larger fetal biometry measures at all time points from 20 weeks' gestation, compared with infants born not LGA suggesting any interventions to prevent LGA likely need to commence earlier in pregnancy or prior to conception. KEY POINTS · Infants born LGA had larger fetal biometry measures from 20 weeks' gestation.. · Infants born LGA had larger fetal adiposity measures.. · Interventions to prevent LGA need to start earlier in pregnancy or prior to conception..
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Affiliation(s)
- Amanda J Poprzeczny
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
- Department of Perinatal Medicine, The Women's and Children's Hospital, Women's and Babies Division, Adelaide, South Australia, Australia
| | - Jennie Louise
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
- The University of Adelaide, School of Public Health; Adelaide, South Australia, Australia
| | - Andrea R Deussen
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
| | - Jodie M Dodd
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
- Department of Perinatal Medicine, The Women's and Children's Hospital, Women's and Babies Division, Adelaide, South Australia, Australia
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Cornish RP, Magnus MC, Urhoj SK, Santorelli G, Smithers LG, Odd D, Fraser A, Håberg SE, Nybo Andersen AM, Birnie K, Lynch JW, Tilling K, Lawlor DA. Maternal pre-pregnancy body mass index and risk of preterm birth: a collaboration using large routine health datasets. BMC Med 2024; 22:10. [PMID: 38178112 PMCID: PMC10768428 DOI: 10.1186/s12916-023-03230-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 12/13/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Preterm birth (PTB) is a leading cause of child morbidity and mortality. Evidence suggests an increased risk with both maternal underweight and obesity, with some studies suggesting underweight might be a greater factor in spontaneous PTB (SPTB) and that the relationship might vary by parity. Previous studies have largely explored established body mass index (BMI) categories. Our aim was to compare associations of maternal pre-pregnancy BMI with any PTB, SPTB and medically indicated PTB (MPTB) among nulliparous and parous women across populations with differing characteristics, and to identify the optimal BMI with lowest risk for these outcomes. METHODS We used three UK datasets, two USA datasets and one each from South Australia, Norway and Denmark, together including just under 29 million pregnancies resulting in a live birth or stillbirth after 24 completed weeks gestation. Fractional polynomial multivariable logistic regression was used to examine the relationship of maternal BMI with any PTB, SPTB and MPTB, among nulliparous and parous women separately. The results were combined using a random effects meta-analysis. The estimated BMI at which risk was lowest was calculated via differentiation and a 95% confidence interval (CI) obtained using bootstrapping. RESULTS We found non-linear associations between BMI and all three outcomes, across all datasets. The adjusted risk of any PTB and MPTB was elevated at both low and high BMIs, whereas the risk of SPTB was increased at lower levels of BMI but remained low or increased only slightly with higher BMI. In the meta-analysed data, the lowest risk of any PTB was at a BMI of 22.5 kg/m2 (95% CI 21.5, 23.5) among nulliparous women and 25.9 kg/m2 (95% CI 24.1, 31.7) among multiparous women, with values of 20.4 kg/m2 (20.0, 21.1) and 22.2 kg/m2 (21.1, 24.3), respectively, for MPTB; for SPTB, the risk remained roughly largely constant above a BMI of around 25-30 kg/m2 regardless of parity. CONCLUSIONS Consistency of findings across different populations, despite differences between them in terms of the time period covered, the BMI distribution, missing data and control for key confounders, suggests that severe under- and overweight may play a role in PTB risk.
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Affiliation(s)
- R P Cornish
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Road, Bristol, BS8 2BN, UK.
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
| | - M C Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - S K Urhoj
- Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - G Santorelli
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - L G Smithers
- School of Public Health, University of Adelaide, Adelaide, Australia
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - D Odd
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - A Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Road, Bristol, BS8 2BN, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - S E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - A M Nybo Andersen
- Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - K Birnie
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Road, Bristol, BS8 2BN, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - J W Lynch
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Road, Bristol, BS8 2BN, UK
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - K Tilling
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Road, Bristol, BS8 2BN, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - D A Lawlor
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Road, Bristol, BS8 2BN, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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Sari NP, Tsompanidis A, Wahab RJ, Gaillard R, Aydin E, Holt R, Allison C, Baron-Cohen S, van IJzendoorn MH, Jansen PW. Is the association between mothers' autistic traits and childhood autistic traits moderated by maternal pre-pregnancy body mass index? Mol Autism 2023; 14:46. [PMID: 38066561 PMCID: PMC10709910 DOI: 10.1186/s13229-023-00578-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Previous studies showed that there is a positive association between mothers' and children's autistic traits. We also tested if this association is more pronounced in mothers with a higher pre-pregnancy body mass index (BMI). METHOD The study was embedded in two cohorts with information available for 4,659 participants from the Generation R and for 179 participants from the Cambridge Ultrasound Siblings and Parents Project (CUSP) cohort. In both cohorts, maternal autistic traits were assessed using the short form of the Autism Spectrum Quotient, and information about maternal height and weight before pregnancy was obtained by questionnaire. Child autistic traits were assessed with the short form of Social Responsiveness Scale in Generation R (M = 13.5 years) and with the Quantitative Checklist for Autism in Toddlers (Q-CHAT) in the CUSP cohort (M = 1.6 years). RESULT Higher maternal autistic traits were associated with higher autistic traits in toddlerhood (CUSP cohort; βadjusted = 0.20, p < 0.01), in early childhood (Generation R; βadjusted = 0.19, p < 0.01), and in early adolescence (Generation R; βadjusted = 0.16, p < 0.01). Furthermore, a higher maternal pre-pregnancy BMI was associated with higher child autistic traits, but only in Generation R (βadjusted = 0.03, p < 0.01). There was no significant moderating effect of maternal pre-pregnancy BMI on the association between autistic traits of mothers and children, neither in Generation R nor in CUSP. In addition, child autistic traits scores were significantly higher in mothers who were underweight and in mothers who were overweight compared to mothers with a healthy weight. CONCLUSION We confirm the association between maternal and child autistic traits in toddlerhood, early childhood, and early adolescence. Potential interacting neurobiological processes remain to be confirmed.
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Affiliation(s)
- Novika Purnama Sari
- Department Psychology, Education & Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Department of Child & Adolescent Psychiatry/Psychology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
- Generation R Study Group, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands.
- Department Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands.
| | - Alexandros Tsompanidis
- Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, UK.
| | - Rama J Wahab
- Generation R Study Group, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Romy Gaillard
- Department of Child & Adolescent Psychiatry/Psychology, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Generation R Study Group, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ezra Aydin
- Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Rosemary Holt
- Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, UK
| | - Carrie Allison
- Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, UK
| | - Simon Baron-Cohen
- Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, UK
| | - Marinus H van IJzendoorn
- Department Psychology, Education & Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Pauline W Jansen
- Department Psychology, Education & Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Department of Child & Adolescent Psychiatry/Psychology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Yun I, Park EC, Nam JY. Association between Delivery during Off-Hours and the Risk of Severe Maternal Morbidity: A Nationwide Population-Based Cohort Study. J Clin Med 2023; 12:6818. [PMID: 37959282 PMCID: PMC10648246 DOI: 10.3390/jcm12216818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/12/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
This study evaluated the association between off-hour deliveries and the risk of severe maternal morbidity (SMM). Data regarding Korean deliveries between 2005 and 2019 obtained from the National Health Insurance Service were used. SMM was evaluated using an algorithm developed by the United States Centers for Disease Control and Prevention. Modified Poisson regression analyses were conducted to investigate the association between off-hour deliveries and SMM, with stratification by hospital region and the number of beds. Approximately 32.7% of the 3,076,448 nulliparous women in this study delivered during off-hours, including 2.6% who experienced SMM. Patients who delivered at night had the highest risk of SMM (weekday nights, adjusted risk ratio (aRR): 1.41, 95% confidence interval (CI): 1.38-1.44; weekend nights, OR: 1.40, 95% CI: 1.34-1.46). The SMM of night deliveries was higher at hospitals located in small cities and those with 100-499 beds (weekend night: small cities, aRR: 1.49, 95% CI: 1.40-1.59; 100-499 beds, aRR: 1.83, 95% CI: 1.67-2.01; weekday night: small cities, aRR: 1.46, 95% CI: 1.42-1.51; 100-499 beds, aRR: 1.70, 95% CI: 1.62-1.79). Therefore, nighttime deliveries are associated with a higher risk of SMM, especially at hospitals located in small cities and those with 100-499 beds.
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Affiliation(s)
- Il Yun
- Department of Public Health, Graduate School, Yonsei University, Seoul 03722, Republic of Korea;
- Institute of Health Services Research, Yonsei University, Seoul 03722, Republic of Korea;
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul 03722, Republic of Korea;
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jin Young Nam
- Department of Healthcare Management, Eulji University, Seongnam 13135, Republic of Korea
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Bernardo DS, Carvalho CB, Conde M, Mota JA, Santos PC. Effectiveness of a structured exercise intervention in gestational weight gain in pregnant women with overweight and obesity: A systematic review with meta-analysis. Int J Gynaecol Obstet 2023; 162:811-822. [PMID: 36825992 DOI: 10.1002/ijgo.14741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 02/10/2023] [Accepted: 02/22/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES To assess the effectiveness of exercise interventions during pregnancy in managing gestational weight gain (GWG), excessive GWG, gestational diabetes (GD), hypertensive disorders, 2-h post-oral glucose tolerance test (OGTT), and birth weight in pregnant women with overweight/obesity (OW/OB). METHODS The search strategy was conducted in five electronic databases, restricting to articles published within the past 10 years. Randomized controlled trials comparing exercise intervention with usual prenatal care in pregnant women with OW/OB were considered. Two reviewers extracted data and assessed the risk of bias using version 2 of the Cochrane risk-of-bias tool for randomized trials and the quality of studies using Grading of Recommendations Assessment, Development and Evaluation classification. Continuous data were calculated as mean differences (MDs) and dichotomous data as risk ratios (RRs). RESULTS Seven trials comprising 1648 pregnant women were included. Exercise interventions were associated with lower GWG (MD, -1.19 kg [95% confidence interval, CI, -1.79 to -0.60]) and lower incidence of GD (RR, 0.56 [95% CI, 0.40-0.78]). When analyzing excessive GWG, 2-h post-OGTT, birth weight, and hypertensive disorders, there was no statistically significant difference between the exercise and usual care groups. The strength of evidence was considered moderate. CONCLUSION Exercise interventions during pregnancy in women with OW/OB were shown to influence GWG and the incidence of GD.
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Affiliation(s)
- Diana Salvador Bernardo
- KinesioLab Research Unit in Human Movement, Department of Physiotherapy, School of Health, Piaget Institute, Vila Nova de Gaia, Portugal
- Faculty of Sport, Research Centre in Physical Activity, Health and Leisure (CIAFEL), University of Porto (FADEUP), Porto, Portugal
| | | | - Monserrat Conde
- Nuffield Department of Primary Care Health Sciences, Center for Evidence Based Medicine, University of Oxford, Oxford, UK
| | - Jorge Augusto Mota
- Faculty of Sport, Research Centre in Physical Activity, Health and Leisure (CIAFEL), University of Porto (FADEUP), Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), FADEUP-Faculty of Sport, University of Porto, Porto, Portugal
| | - Paula Clara Santos
- Faculty of Sport, Research Centre in Physical Activity, Health and Leisure (CIAFEL), University of Porto (FADEUP), Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), FADEUP-Faculty of Sport, University of Porto, Porto, Portugal
- Department of Physiotherapy, Health School, Polytechnic of Porto (ESS), Porto, Portugal
- Center for Rehabilitation Research (CIR), School of Health, Polytechnic of Porto, Porto, Portugal
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Barrera C, Castillo V, Valenzuela R, Valenzuela CA, Garcia-Diaz DF, Llanos M. Effects on Fetal Metabolic Programming and Endocannabinoid System of a Normocaloric Diet during Pregnancy and Lactation of Female Mice with Pregestational Obesity. Nutrients 2023; 15:3531. [PMID: 37630722 PMCID: PMC10458167 DOI: 10.3390/nu15163531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Fetal programming provides explanatory mechanisms for the currently high prevalence of gestational obesity. The endocannabinoid system (ECS) participates in the regulation of energy balance, and with a high-fat diet (HFD), it is overactivated. The aim of this study was to determine the effects of a nutritional intervention during pregnancy and lactation on obese female progenitors, on metabolic alterations of the offspring and on the involvement of ECS. Female mice (C57/BL/6-F0), 45 days old, and their offspring (males) were separated according to type of diet before and during gestation and lactation: CON-F1: control diet; HFD-F1 group: HFD (fat: 60% Kcal); INT-F1 group: HFD until mating and control diet (fat: 10% Kcal) afterward. Glucose tolerance and insulin sensitivity (IS) were tested at 2 and 4 months. At 120 days, mice were sacrificed, plasma was extracted for the determination of hormones, and livers for gene expression and the protein level determination of ECS components. INT-F1 group presented a lower IS compared to CON-F1, and normal levels of adiponectin and corticosterone in relation to the HFD-F1 group. The intervention increased hepatic gene expression for fatty-acid amide hydrolase and monoacylglycerol lipase enzymes; however, these differences were not observed at the protein expression level. Our results suggest that this intervention model normalized some hormonal parameters and hepatic mRNA levels of ECS components that were altered in the offspring of progenitors with pre-pregnancy obesity.
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Affiliation(s)
- Cynthia Barrera
- Department of Nutrition, Faculty of Medicine, University of Chile, Santiago 8380000, Chile; (C.B.); (R.V.); (D.F.G.-D.)
| | - Valeska Castillo
- Laboratory of Nutrition and Metabolic Regulation, Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago 8380453, Chile;
| | - Rodrigo Valenzuela
- Department of Nutrition, Faculty of Medicine, University of Chile, Santiago 8380000, Chile; (C.B.); (R.V.); (D.F.G.-D.)
| | - Carina A. Valenzuela
- Eating Behavior Research Center, School of Nutrition and Dietetics, Faculty of Pharmacy, Universidad de Valparaíso Playa Ancha, Valparaíso 2360102, Chile;
| | - Diego F. Garcia-Diaz
- Department of Nutrition, Faculty of Medicine, University of Chile, Santiago 8380000, Chile; (C.B.); (R.V.); (D.F.G.-D.)
| | - Miguel Llanos
- Laboratory of Nutrition and Metabolic Regulation, Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago 8380453, Chile;
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Sperling MM, Leonard SA, Blumenfeld YJ, Carmichael SL, Chueh J. Prepregnancy body mass index and gestational diabetes mellitus across Asian and Pacific Islander subgroups in California. AJOG Glob Rep 2023; 3:100148. [PMID: 36632428 PMCID: PMC9826825 DOI: 10.1016/j.xagr.2022.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The American College of Obstetricians and Gynecologists recommends early screening for gestational diabetes mellitus among pregnant Asian people with a prepregnancy body mass index ≥23.0 kg/m2, in contrast with the recommended screening at a body mass index ≥25 kg/m2 for other races and ethnicities. However, there is significant heterogeneity within Asian and Pacific Islander populations, and gestational diabetes mellitus and its association with body mass index among Asian and Pacific Islander subgroups may not be uniform across all groups. OBJECTIVE This study aimed to analyze the association between body mass index and gestational diabetes mellitus among Asian and Pacific Islander subgroups in California, specifically gestational diabetes mellitus rates among those with a body mass index above vs below 23 kg/m2, which is the cutoff point for the designation of being overweight among Asians populations. STUDY DESIGN Using a linked delivery hospitalization discharge and vital records database, we identified patients who gave birth in California between 2007 and 2017 and who self-reported to be 1 of 13 Asian and Pacific Islander subgroups, which was collected from birth and fetal death certificates. In each subgroup, we evaluated the association between body mass index and gestational diabetes mellitus using multivariable logistic regression models adjusted for age, education, parity, payment method, the trimester in which prenatal care was initiated, and nativity. We fit body mass index nonlinearly with splines and categorized body mass index as being above or below 23 kg/m2. Predicted probabilities of gestational diabetes mellitus with 95% confidence intervals were calculated across body mass index values using the nonlinear regression models. RESULTS The overall prevalence of gestational diabetes mellitus was 14.3% (83,400/584,032), ranging between 8.4% and 17.1% across subgroups. The highest prevalence was among Indian (17.1%), Filipino (16.7%), and Vietnamese (15.5%) subgroups. In these subgroups, gestational diabetes mellitus was diagnosed in 10% to 13% of those with a body mass index <23.0 kg/m2 and in 22% of those with a body mass index ≥23 kg/m2. Gestational diabetes mellitus was least common among Korean (8.4%), Japanese (9.0%), and Samoan (9.8%) subgroups with a gestational diabetes mellitus rate of 5% to 7% among those with a body mass index <23.0 kg/m2 and in 10% to 15% among those with a body mass index ≥23 kg/m2. Although Samoan patients had the highest rate of obesity, defined as body mass index ≥30 kg/m2 (57.4%), they had the third lowest prevalence of gestational diabetes mellitus. Conversely, Vietnamese patients had the second lowest rate of obesity (2.4%) but the highest rate of gestational diabetes mellitus at a body mass index of ≥23 kg/m2 (22.3%). CONCLUSION Gestational diabetes mellitus and its association with body mass index varied among Asian subgroups but increased as body mass index increased. Subgroups with the lowest prevalence of obesity trended toward a higher prevalence of gestational diabetes mellitus and those with a higher prevalence of obesity trended toward a lower prevalence of gestational diabetes mellitus.
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Affiliation(s)
- Meryl M. Sperling
- Departments of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Sperling, Leonard, Blumenfeld, Carmichael, and Chueh)
| | - Stephanie A. Leonard
- Departments of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Sperling, Leonard, Blumenfeld, Carmichael, and Chueh)
| | - Yair J. Blumenfeld
- Departments of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Sperling, Leonard, Blumenfeld, Carmichael, and Chueh)
| | - Suzan L. Carmichael
- Departments of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Sperling, Leonard, Blumenfeld, Carmichael, and Chueh)
- Pediatrics (Dr Carmichael), Stanford University School of Medicine, Stanford, CA
| | - Jane Chueh
- Departments of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Sperling, Leonard, Blumenfeld, Carmichael, and Chueh)
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McNamara JA, Mena NZ, Wright A, Barr ML. "There's a Lot of Like, Contradicting Stuff"-Views on Healthy Living during Pregnancy and Postpartum. Int J Environ Res Public Health 2022; 19:5849. [PMID: 35627385 DOI: 10.3390/ijerph19105849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022]
Abstract
The transition from pregnancy through early postpartum can be a particularly vulnerable time for women as they adjust to the changes of motherhood. This study aimed to provide a detailed account of additional health challenges that mothers are facing throughout motherhood during the pandemic. Data obtained can be utilized to create tailored interventions to aid women during their reproductive years. A sequential approach was utilized, collecting health-related information via survey and subsequent focus groups or interviews to further examine health experiences during pregnancy or postpartum. Fifty-seven participants completed the online survey, 73.5% were postpartum. The healthy eating index of the cohort was low, 50.5 ± 10.3%. Prior to pregnancy, 54.5% were classified as overweight/obese. Following pregnancy, 71.1% were classified as overweight or obese. Emergent qualitative themes from focus groups (n = 3) and interviews (n = 6) included (1) value and desire for healthy eating, (2) desire to make well-informed health-based decisions, and (3) role of social networks during pregnancy and postpartum. Pregnant/postpartum women desire to lead a healthy lifestyle but experience barriers to accomplishing intended goals. Upstream resources and policies that promote healthy living for pregnant/postpartum women can reduce chronic disease throughout the lifespan following childbirth.
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Johnsson IW, Lindberger E, Ahlsson F, Gustafsson J, Lundgren ME. Relation of maternal birthweight with early pregnancy obesity, gestational diabetes, and offspring macrosomia. J Dev Orig Health Dis 2022;:1-6. [PMID: 35000649 DOI: 10.1017/S2040174421000751] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study aimed to investigate how maternal birthweight is related to early pregnancy obesity, gestational diabetes mellitus (GDM), and offspring birthweight. Females born term and singleton in Sweden between 1973 and 1995 (N = 305,893) were studied at their first pregnancy. Information regarding their birthweight, early pregnancy body mass index, and pregnancy complications was retrieved from the Swedish Medical Birth Register, as were data on their mothers and offspring. High maternal birthweights (2-3 standard deviation scores (SDS) and >3 SDS) were associated with greater odds of early pregnancy obesity, odds ratio (OR) 1.52 (95% confidence interval (CI) 1.42-1.63) and OR 2.06 (CI 1.71-2.49), respectively. A low maternal birthweight (<2 SDS) was associated with greater odds of GDM (OR 2.49, CI 2.00-3.12). No association was found between high maternal birthweight and GDM. A maternal birthweight 2-3 SDS was associated with offspring birthweight 2-3 SDS (OR 3.83, CI 3.44-4.26), and >3 SDS (OR 3.55, CI 2.54-4.97). Corresponding ORs for a maternal birthweight >3 SDS were 5.38 (CI 4.12-7.01) and 6.98 (CI 3.57-13.65), respectively. In conclusion, a high maternal birthweight was positively associated with early pregnancy obesity and offspring macrosomia. A low, but not a high maternal birthweight, was associated with GDM.
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Hieronimus B, Ensenauer R. Influence of maternal and paternal pre-conception overweight/obesity on offspring outcomes and strategies for prevention. Eur J Clin Nutr 2021; 75:1735-1744. [PMID: 34131301 PMCID: PMC8636250 DOI: 10.1038/s41430-021-00920-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 02/07/2023]
Abstract
Overweight, obesity, and their comorbidities remain global health challenges. When established early in life, overweight is often sustained into adulthood and contributes to the early onset of non-communicable diseases. Parental pre-conception overweight and obesity is a risk factor for overweight and obesity in childhood and beyond. This increased risk likely is based on an interplay of genetic alterations and environmental exposures already at the beginning of life, although mechanisms are still poorly defined. In this narrative review, potential routes of transmission of pre-conceptional overweight/obesity from mothers and fathers to their offspring as well as prevention strategies are discussed. Observational evidence suggests that metabolic changes due to parental overweight/obesity affect epigenetic markers in oocytes and sperms alike and may influence epigenetic programming and reprogramming processes during embryogenesis. While weight reduction in overweight/obese men and women, who plan to become pregnant, seems advisable to improve undesirable outcomes in offspring, caution might be warranted. Limited evidence suggests that weight loss in men and women in close proximity to conception might increase undesirable offspring outcomes at birth due to nutritional deficits and/or metabolic disturbances in the parent also affecting gamete quality. A change in the dietary pattern might be more advisable. The data reviewed here suggest that pre-conception intervention strategies should shift from women to couples, and future studies should address possible interactions between maternal and paternal contribution to longitudinal childhood outcomes. Randomized controlled trials focusing on effects of pre-conceptional diet quality on long-term offspring health are warranted.
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Affiliation(s)
- Bettina Hieronimus
- Institute of Physiology and Biochemistry of Nutrition, Max Rubner-Institut, Federal Research Institute of Nutrition and Food, Karlsruhe, Germany
- Institute of Child Nutrition, Max Rubner-Institut, Federal Research Institute of Nutrition and Food, Karlsruhe, Germany
| | - Regina Ensenauer
- Institute of Child Nutrition, Max Rubner-Institut, Federal Research Institute of Nutrition and Food, Karlsruhe, Germany.
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Zou J, Yang Y, Wei Q, Zhang Y, Shi H. Longitudinal Association of Maternal Pre-Pregnancy BMI and Third-Trimester Glycemia with Early Life Growth of Offspring: A Prospective Study among GDM-Negative Pregnant Women. Nutrients 2021; 13:3971. [PMID: 34836226 DOI: 10.3390/nu13113971] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 01/22/2023] Open
Abstract
Intrauterine modifiable maternal metabolic factors are essential to the early growth of offspring. The study sought to evaluate the associations of pre-pregnancy BMI and third-trimester fasting plasma glucose (FPG) with offspring growth outcomes within 24 months among GDM-negative pregnant women. Four hundred eighty-three mother –offspring dyads were included from the Shanghai Maternal-Child Pairs Cohort. The pregnant women were categorized into four mutually exclusive groups according to pre-pregnancy BMI as normal or overweight/obesity and third-trimester FPG as controlled or not controlled. Offspring growth in early life was indicated by the BAZ (BMI Z-score), catch-up growth, and overweight/obesity. Among those with controlled third-trimester FPG, pre-pregnancy overweight/obesity significantly increased offspring birth weight, BAZ, and risks of overweight/obesity (RR 1.83, 95% CI 1.23 to 2.73) within 24 months. Those who had uncontrolled third-trimester FPG had a reduced risk of offspring overweight/obesity within 24 months by 47%. The combination of pre-pregnancy overweight/obesity and maternal uncontrolled third-trimester FPG increased 5.24-fold risk of offspring catch-up growth within 24 months (p < 0.05). Maternal pre-pregnancy overweight/obesity and uncontrolled third-trimester glycemia among GDM-negative women both have adverse effects on offspring growth within 24 months. With the combination of increasing pre-pregnancy BMI and maternal third-trimester FPG, the possibility of offspring catch-up growth increases.
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12
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Bahri Khomami M, Walker R, Kilpatrick M, de Jersey S, Skouteris H, Moran LJ. The role of midwives and obstetrical nurses in the promotion of healthy lifestyle during pregnancy. Ther Adv Reprod Health 2021; 15:26334941211031866. [PMID: 34396131 PMCID: PMC8361518 DOI: 10.1177/26334941211031866] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 06/24/2021] [Indexed: 11/17/2022] Open
Abstract
Women with maternal obesity, an unhealthy lifestyle before and during pregnancy
and excess gestational weight gain have an increased risk of adverse pregnancy
and birth outcomes that can also increase the risk of long-term poor health for
them and their children. Pregnant women have frequent medical appointments and
are highly receptive to health advice. Healthcare professionals who interact
with women during pregnancy are in a privileged position to support women to
make lasting healthy lifestyle changes that can improve gestational weight gain
and pregnancy outcomes and halt the intergenerational nature of obesity.
Midwives and obstetrical nurses are key healthcare professionals responsible for
providing antenatal care in most countries. Therefore, it is crucial for them to
build and enhance their ability to promote healthy lifestyles in pregnant women.
Undergraduate midwifery curricula usually lack sufficient lifestyle content to
provide emerging midwives and obstetrical nurses with the knowledge, skills, and
confidence to effectively assess and support healthy lifestyle behaviours in
pregnant women. Consequently, registered midwives and obstetrical nurses may not
recognise their role in healthy lifestyle promotion specific to healthy eating
and physical activity in practice. In addition, practising midwives and
obstetrical nurses do not consistently have access to healthy lifestyle
promotion training in the workplace. Therefore, many midwives and obstetrical
nurses may not have the confidence and/or skills to support pregnant women to
improve their lifestyles. This narrative review summarises the role of midwives
and obstetrical nurses in the promotion of healthy lifestyles relating to
healthy eating and physical activity and optimising weight in pregnancy, the
barriers that they face to deliver optimal care and an overview of what we know
works when supporting midwives and obstetrical nurses in their role to support
women in achieving a healthy lifestyle.
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Affiliation(s)
- Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation (MCHRI), Level 1, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia
| | - Ruth Walker
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michelle Kilpatrick
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Susan de Jersey
- Perinatal Research Centre, Centre for Clinical Research and Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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13
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Wawer AA, Hodyl NA, Fairweather-Tait S, Froessler B. Are Pregnant Women Who Are Living with Overweight or Obesity at Greater Risk of Developing Iron Deficiency/Anaemia? Nutrients 2021; 13:1572. [PMID: 34067098 PMCID: PMC8151407 DOI: 10.3390/nu13051572] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/14/2022] Open
Abstract
Low-grade inflammation is often present in people living with obesity. Inflammation can impact iron uptake and metabolism through elevation of hepcidin levels. Obesity is a major public health issue globally, with pregnant women often affected by the condition. Maternal obesity is associated with increased pregnancy risks including iron deficiency (ID) and iron-deficiency anaemia (IDA)-conditions already highly prevalent in pregnant women and their newborns. This comprehensive review assesses whether the inflammatory state induced by obesity could contribute to an increased incidence of ID/IDA in pregnant women and their children. We discuss the challenges in accurate measurement of iron status in the presence of inflammation, and available iron repletion strategies and their effectiveness in pregnant women living with obesity. We suggest that pre-pregnancy obesity and overweight/obese pregnancies carry a greater risk of ID/IDA for the mother during pregnancy and postpartum period, as well as for the baby. We propose iron status and weight gain during pregnancy should be monitored more closely in women who are living with overweight or obesity.
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Affiliation(s)
- Anna A. Wawer
- Department of Anaesthesia, Lyell McEwin Hospital, Elizabeth Vale, SA 5112, Australia;
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Nicolette A. Hodyl
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Susan Fairweather-Tait
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK;
| | - Bernd Froessler
- Department of Anaesthesia, Lyell McEwin Hospital, Elizabeth Vale, SA 5112, Australia;
- Discipline of Acute Care Medicine, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
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14
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Mehraban SS, Pessolano JC, Ponterio JM, Williamson K, Holubyeva A, Moretti M, Lakhi N. The vertical dimension of obesity: adverse pregnancy outcomes in the short obese versus tall obese parturient. J OBSTET GYNAECOL 2021; 42:43-48. [PMID: 33892618 DOI: 10.1080/01443615.2021.1871887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objective of this study was to examine the effect of maternal height on adverse perinatal outcomes in obese parturients. This retrospective study was conducted from January 2015 to December 2015. Patients with BMI ≥ 35.0 kg/m2 before delivery were included and divided into 2 groups based on height. Patients ≤63 inches were in the short stature group and those > 63 inches were in the tall stature group. One hundred and twenty-five patients were in the short stature cohort and 124 in the tall stature cohort. Patients in short cohort had a significantly higher risk of preterm delivery <37 weeks (RR = 4.21 [1.24, 12.88]), spontaneous rupture of membranes (RR 1.47 [1.01-2.16]), and second stage caesarean delivery (CD) (RR 2.64 [1.1-6.39]). After multiple regression analysis, Hispanic race and short stature were independent predictors of preterm birth for obese patients.IMPACT STATEMENTWhat is already known on this subject? Compared to normal weight individuals, those who are obese have at a higher risk of adverse obstetric and perinatal outcomes including gestational diabetes, hypertension, pre-eclampsia, thromboembolism, macrosomia, higher incidence of caesarean deliveries and perinatal mortality.What do the results of this study add? Our findings show that short stature is an independent predictor for adverse perinatal outcomes in obese women. Specifically, short obese patients had significantly higher risk of preterm delivery before 37 weeks and second stage CD.What are the implications of the findings for clinical practice and/or further research? Our findings highlight the need for formulating a tailored plan for preconception health including pregnancy weight goals in short obese women. Additionally, maternal fat distribution and its effect on pro-inflammatory cytokine profiles is a potential area for future research, as maternal body composition may be a better predictor of perinatal outcome than BMI.
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Affiliation(s)
- Shadan S Mehraban
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY, USA
| | - Joanna C Pessolano
- Department of Obstetrics and Gynecology, New York Medical College, New York, NY, USA
| | - Jane M Ponterio
- Department of Obstetrics and Gynecology, New York Medical College, New York, NY, USA
| | - Katherine Williamson
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY, USA
| | | | - Michael Moretti
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY, USA
| | - Nisha Lakhi
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY, USA.,Department of Obstetrics and Gynecology, New York Medical College, New York, NY, USA
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15
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Bizuayehu HM, Harris ML, Chojenta C, Forder PM, Loxton D. Low birth weight and its associated biopsychosocial factors over a 19-year period: findings from a national cohort study. Eur J Public Health 2021; 31:776-783. [PMID: 33755156 DOI: 10.1093/eurpub/ckab033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In Australia, 6.7% of babies (5.2% for singletons) are born low birth weight (LBW), and over the past decade, this figure has increased by 8%. Evidence regarding LBW has largely come from hospital-based cross-sectional studies, which are not representative, lack temporality and do not examine the potential predictors of LBW using a comprehensive theoretical framework. This study, therefore, examined predictors of LBW within a biopsychosocial framework, using a community-based representative prospective cohort with 19 years of data. METHODS The study included 11 854 singleton babies born to 5622 women from the 1973 to 1978 cohort of the Australian Longitudinal Study on Women's Health. RESULTS Among 5622 first births, 310 (5.5%) were reported as LBW. Maternal risk factors included pre-pregnancy underweight (aOR = 2.27, 95% CI: 1.43-3.62), chronic diabetes (aOR = 2.38, 95% CI: 1.14-4.95), gestational diabetes (aOR = 1.93, 95% CI: 1.27-2.94), chronic hypertension (aOR = 2.23, 95% CI: 1.50-3.33) and gestational hypertension (aOR = 2.44, 95% CI: 1.78-3.36). Among all births (N = 11 854), the overall LBW rate was 3.8% with a recurrence rate of 4.8%. Identified risk factors included menarche before 12 years (aOR = 1.57; 95% CI: 1.17-2.11), pre-pregnancy underweight (aOR = 2.25, 95% CI: 1.46-3.45), gestational diabetes (aOR = 1.74, 95% CI: 1.16-2.59), chronic hypertension (aOR = 2.01, 95% CI: 1.40-2.90) and gestational hypertension (aOR = 2.81, 95% CI: 2.05-3.84). LBW was less likely for second births (aOR = 0.39, 95% CI: 0.31-0.50) and third/above births (aOR = 0.49, 95% CI: 0.35-0.67) compared with the first births. CONCLUSION Increased nutrition counselling/supplementation for underweight women and interventions aimed at chronic disease prevention and management by using a multi-sectoral approach may be the key to the prevention of LBW.
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Affiliation(s)
- Habtamu Mellie Bizuayehu
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia.,Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Melissa L Harris
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Catherine Chojenta
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Peta M Forder
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
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16
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Redfern KM, Hollands HJ, Hosking J, Welch CR, Pinkney JH, Rees GA. The relationship between gestational weight gain, maternal upper-body subcutaneous fat changes and infant birth size: A pilot observational study amongst women with obesity. Early Hum Dev 2021; 154:105307. [PMID: 33453458 DOI: 10.1016/j.earlhumdev.2021.105307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND It is widely acknowledged that maternal obesity and excessive gestational weight gain (GWG) are associated with increased risk of fetal macrosomia and recent studies have suggested a role for the timing and composition of GWG. AIMS To examine the effect of the rate of change in GWG and maternal upper-body subcutaneous fat on neonatal anthropometric outcomes in a pilot observational study amongst women with obesity. STUDY DESIGN Expectant women with a body mass index (BMI) > 30 kg/m2 at first antenatal appointment were recruited at 12 weeks gestation. Maternal height, weight and skinfold thickness (SFT) measurements were collected at baseline and repeated at 28 and 36 weeks gestation. Following delivery, World Health Organisation (WHO)-UK infant birthweight z-scores were calculated, and infant anthropometric measurements were obtained. RESULTS The sum of upper body SFT measurements increased in mid-pregnancy (0.08 ± 0.71 mm/week) and decreased in late pregnancy (-0.04 ± 1.17 mm/week). After adjustment for maternal age, BMI and parity, mid- but not late- pregnancy GWG was positively associated with infant birthweight z-score (p<0.05), while mid- but not late-pregnancy changes in the sum of SFT were inversely associated with infant birthweight z-score (p<0.01). CONCLUSIONS The present study suggests that mid- rather than late-pregnancy changes in weight and upper-body subcutaneous fat are associated with infant birthweight. Further research is required in larger, more diverse populations to explore whether pregnancy interventions aiming to improve maternal and offspring health can be personalised beyond BMI and GWG.
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17
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Ingvorsen C, Lelliott CJ, Brix S, Hellgren LI. Effects of maternal high-fat/high sucrose diet on hepatic lipid metabolism in rat offspring. Clin Exp Pharmacol Physiol 2021; 48:86-95. [PMID: 32772427 PMCID: PMC7818417 DOI: 10.1111/1440-1681.13396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/15/2020] [Accepted: 08/05/2020] [Indexed: 01/22/2023]
Abstract
Maternal obesity and/or high-fat diet during pregnancy predispose the offspring to metabolic disease. It is however unclear how pre-natal and post-natal exposure respectively affect the risk of hepatic steatosis and the trajectory towards non-alcoholic steatohepatitis in the offspring. We investigate hepatic lipid metabolism and how these factors are related to metabolic outcome in new born and young rats. Rat dams were exposed to a high-fat/high sucrose (HFHS) diet for 17 weeks prior to mating and during pregnancy. After birth, female offspring were killed and male offspring were cross-fostered, creating four groups; Control-born pups lactated by control (CC) or HFHS dams (CH) and HFHS-born pups lactated by control (HC) or HFHS dams (HH). At 4 weeks of age, pups were killed and metabolic markers in plasma were assayed, together with hepatic lipid composition and expression of relevant genes. Female HFHS neonates had smaller livers at birth (P < .05), a reduced hepatic lipid content (P < .05) and altered lipid composition. The post-natal environment dominated the metabolic profile in the male offspring at 4 weeks of age. Offspring exposed to a HFHS environment post-natally had increased adiposity (P < .0001), increased hepatic triacylglycrol accumulation (P < .0001), and an altered lipid profile with elevated n-6 polyunsaturated fatty acid (PUFA) levels (P < .0001) and a reduction in ceramide (P < .001) and monounsaturated fatty acid (MUFA) (P < .0001). In summary, maternal HFHS diet during gestation affects the hepatic lipid profile in neonates. The pre-natal exposure becomes less pronounced in young male offspring at 4 weeks of age, where the post-natal diet has the largest impact.
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Affiliation(s)
- Camilla Ingvorsen
- Department of Systems BiologyTechnical University of DenmarkKgs. LyngbyDenmark
- Centre for Fetal ProgrammingCopenhagenDenmark
- Present address:
Novo Nordisk A/SMaaloevDenmark
| | | | - Susanne Brix
- Department of Systems BiologyTechnical University of DenmarkKgs. LyngbyDenmark
- Present address:
Department of Biotechnology and BiomedicineTechnical University of DenmarkKgs. LyngbyDenmark
| | - Lars I. Hellgren
- Department of Systems BiologyTechnical University of DenmarkKgs. LyngbyDenmark
- Centre for Fetal ProgrammingCopenhagenDenmark
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Salmon C, Thibon P, Prime L, Renouf S, Dreyfus M, Dolley P. Impact of maternal underweight on obstetric and neonatal prognosis: A retrospective study. Eur J Obstet Gynecol Reprod Biol 2020; 260:6-9. [PMID: 33706226 DOI: 10.1016/j.ejogrb.2020.12.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Maternal underweight (BMI < 18.5) is an uncommon situation with potentially serious obstetric consequences, though data in the literature are scarce. OBJECTIVE To compare the obstetrical prognosis of patients with normal BMI and BMI < 18.5. STUDY DESIGN We performed a retrospective study in France (Normandy). RESULTS We included 14,246 patients between January 2011 and November 2017, among whom 12,648 (88.8 %) had normal BMI, 1269 were considered mild underweight (17 ≤ BMI < 18.5 kg/m²) and 329 (2.3 %) were considered severe to moderate underweight (BMI < 17 kg/m²). The risk of preterm birth was all the greater as the thinness was severe (ORa: 1.34 [1.12-1.60] and ORa 1.77 [1.31-2.34]) and the risk of intrauterine growth retardation also increased with severe thinness (ORa: 1.63 [1.35-1.96] and ORa 2.28 [1.69-3.07]). The risk of a caesarean section or scheduled labour was no different. Neonatal parameters were comparable between the groups. CONCLUSION Our study confirms an increased risk of preterm delivery and intrauterine growth retardation with increased thinness after adjusting for confounding factors. This link had only been shown previously in 2 studies Neither the type of prematurity (induced or spontaneous) nor the severity of prematurity is influenced by the severity of thinness; however, the low prevalence of thinness limits the power of these data. It would be interesting to study the medico-economic relevance of a policy of close maternal-foetal surveillance in this target population.
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Affiliation(s)
- Capucine Salmon
- Service de Gynécologie-Obstétrique, CHU de Caen Normandie, Normandie Univ, UNICAEN, 14000 Caen, France.
| | - Pascal Thibon
- Réseau Périnatal, Centre Hospitalo-Universitaire, Caen F-14033, France
| | - Ludovic Prime
- Réseau Périnatal, Centre Hospitalo-Universitaire, Caen F-14033, France
| | - Solène Renouf
- Service de Gynécologie-Obstétrique, Centre Hospitalo-Universitaire, Caen F-14033, France
| | - Michel Dreyfus
- Service de Gynécologie-Obstétrique, Centre Hospitalo-Universitaire, Caen F-14033, France
| | - Patricia Dolley
- Service de Gynécologie-Obstétrique, Centre Hospitalo-Universitaire, Caen F-14033, France.
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Dalbye R, Gunnes N, Blix E, Zhang J, Eggebø T, Nistov Tokheim L, Øian P, Bernitz S. Maternal body mass index and risk of obstetric, maternal and neonatal outcomes: A cohort study of nulliparous women with spontaneous onset of labor. Acta Obstet Gynecol Scand 2020; 100:521-530. [PMID: 33031566 DOI: 10.1111/aogs.14017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/21/2020] [Accepted: 09/30/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION This study investigates associations between maternal body mass index (BMI) early in pregnancy and obstetric interventions, maternal and neonatal outcomes. MATERIAL AND METHODS This is a cohort study of nulliparous women originally included in a cluster randomized controlled trial carried out at 14 Norwegian obstetric units between 2014 and 2017. The sample included 7189 nulliparous women with a singleton fetus, cephalic presentation and spontaneous onset of labor at term, denoted as group 1 in the Ten-Group Classification System. The women were grouped according to the World Health Organization BMI classifications: underweight (BMI <18.5), normal weight (BMI 18.5-24.9), pre-obesity (BMI 25.0-29.9), obesity class I (BMI 30.0-34.9), and obesity classes II and III (BMI ≥35.0). We used binary logistic regression to estimate crude and adjusted odds ratios (ORs) of the interventions and outcomes, with associated 95% confidence intervals (CIs), comparing women in different BMI groups with women of normal weight. RESULTS We found an increased risk of intrapartum cesarean section in women of obesity class I and obesity classes II and III, with adjusted OR of 1.70 (95% CI 1.21-2.38) and 2.31 (95% CI 1.41-3.77), respectively. Women in obesity groups had a gradient of risk of epidural analgesia and use of continuous CTG (including STAN), with adjusted OR of 2.39 (95% CI 1.69-3.38) and 3.28 (95% CI 1.97-5.48), respectively. Women in obesity classes II and III had higher risk of amniotomy (adjusted OR = 1.42, 95% CI 1.02-1.96), oxytocin augmentation (adjusted OR = 1.54, 95% CI 1.11-2.15), obstetric anal sphincter injuries (adjusted OR = 2.21, 95% CI 1.01-4.85) and postpartum hemorrhage ≥1000 mL (adjusted OR = 2.20, 95% CI 1.29-3.78). We found a reduced likelihood of spontaneous vaginal delivery for pre-obese women (adjusted OR = 0.85, 95% CI 0.74-0.97) and no associations between maternal BMI and neonatal outcomes. CONCLUSIONS Obese women in Ten-Group Classification System group 1 had increased risks of obstetric interventions and maternal complications. There was a gradient of risk for intrapartum cesarean section, with the highest risk for women in obesity classes II and III. No associations between maternal BMI and neonatal outcomes were observed.
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Affiliation(s)
- Rebecka Dalbye
- Department of Obstetrics and Gynecology, Østfold Hospital Trust, Grålum, Norway
| | - Nina Gunnes
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway
| | - Ellen Blix
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Jun Zhang
- Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Torbjørn Eggebø
- National Center for Fetal Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - Linn Nistov Tokheim
- Department of Obstetrics and Gynecology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Pål Øian
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Norway, Tromsø, Norway
| | - Stine Bernitz
- Department of Obstetrics and Gynecology, Østfold Hospital Trust, Grålum, Norway.,Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
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Benton MR, Tape N, Deussen AR, Turnbull D, Dodd JM. Barriers to and facilitators for addressing overweight and obesity before conception: A qualitative study. Women Birth 2020; 34:e493-e497. [PMID: 33077404 DOI: 10.1016/j.wombi.2020.09.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Obesity is a significant global health issue, especially for reproductive-aged women. Women who enter pregnancy overweight or obese are at increased risk of a range of adverse reproductive, maternal, and child health outcomes. The preconception period has been recognised as a critical time to intervene to improve health outcomes for women and their children. Despite this recognition, adequate information is significantly lacking in relation to women's health experiences, behaviours, and information preferences to inform the development of high-quality preconception intervention strategies. AIM This study aimed to examine women's perspectives of barriers, enablers, and strategies for addressing overweight and obesity before conception. METHOD Using a qualitative research design, twelve multiparous women, aged between 32 and 43 years, who considered themselves to be overweight or obese were interviewed. Data were analysed using thematic analysis. FINDINGS Three themes were identified in relation to barriers: lack of information and knowledge, time constraints, and affordability. The following four themes emerged with respect to enablers and strategies: knowledge provision, accountability and motivation, regular contact, and habit formation. CONCLUSION Key factors to incorporate in women-centred interventions for preconception weight loss include multi-faceted knowledge provision and practical affordable methods for supporting healthy behaviours. Interventions should integrate techniques for ensuring regular contact with support networks, to enhance accountability, motivation, and facilitate habit formation. Further research is now being conducted by our team to co-design interventions and strategies informed by these findings.
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Affiliation(s)
- Madeleine R Benton
- School of Psychology, The University of Adelaide, South Australia, Australia.
| | - Nicole Tape
- School of Psychology, The University of Adelaide, South Australia, Australia
| | - Andrea R Deussen
- The University of Adelaide, Discipline of Obstetrics and Gynaecology and Robinson Research Institute, South Australia, Australia
| | - Deborah Turnbull
- School of Psychology, The University of Adelaide, South Australia, Australia
| | - Jodie M Dodd
- The University of Adelaide, Discipline of Obstetrics and Gynaecology and Robinson Research Institute, South Australia, Australia; The Women's and Children's Hospital, Women's and Babies Division, Department of Perinatal Medicine, South Australia, Australia
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21
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Silva DT, Hagemann E, Davis JA, Gibson LY, Srinivasjois R, Palmer DJ, Colvin L, Tan J, Prescott SL. Introducing the ORIGINS project: a community-based interventional birth cohort. Rev Environ Health 2020; 35:281-293. [PMID: 32853171 DOI: 10.1515/reveh-2020-0057] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/12/2020] [Indexed: 06/11/2023]
Abstract
Objectives Non-communicable diseases (NCDs) pose the greatest threat to human health globally. The dramatic rise in early onset NCDs - such as childhood obesity, the allergy epidemic and an increasing burden of mental ill health in children and youth - reflect the profound early impact of modern environments on developing systems. The ORIGINS Project is a research platform enabling world class investigation of early antecedent pathways to NCDs, and how to curtail these. As well as facilitating strategic long-term research capacity, ORIGINS is a pipeline for short-term productivity through a series of clinical trials, early interventions, mechanistic studies, and targeted research questions to improve maternal and paternal health and the early environment. Methods ORIGINS is a decade-long collaborative initiative between the Joondalup Health Campus (JHC) and the Telethon Kids Institute (TKI) to establish a Western Australian (WA) birth cohort of 10,000 families, enrolled during pregnancy. It is currently funded to follow up participating children and their families to five years of age. Comprehensive data and biological samples are collected from participants at up to 15 different timepoints, from the first antenatal clinic visit. In the process, ORIGINS is creating a major research platform, consisting of an extensive, world class biobank and databank. Of key strength and novelty, ORIGINS includes a series of harmonised nested sub-projects integrated with clinical and diagnostic services and providing real-time feedback to improve the health of individuals and the community. Conclusions At its core, ORIGINS aims to improve the health and quality of life of the next generation through improved pathways to optimise the early environment and reduce adversity by promoting primary prevention, early detection and early intervention. This dynamic, interactive, community-based project not only provides novel research capacity, productivity, collaboration and translational impact on future generations - it is also anticipated to have flow on benefits for community engagement, cohesion and purpose. This will provide a sentinel example for tailored replication in other communities around the world as part of interconnected grass root strategies to improve planetary health.
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Affiliation(s)
- Desiree T Silva
- Telethon Kids Institute, Perth, WA, Australia
- The University of Western Australia, Perth, WA, Australia
- Joondalup Health Campus, Perth, WA, Australia
- Edith Cowan University, Perth, WA, Australia
- Curtin University, Perth, WA, Australia
| | - Erika Hagemann
- Telethon Kids Institute, Perth, WA, Australia
- Edith Cowan University, Perth, WA, Australia
| | - Jacqueline A Davis
- Telethon Kids Institute, Perth, WA, Australia
- The University of Western Australia, Perth, WA, Australia
- Curtin University, Perth, WA, Australia
| | - Lisa Y Gibson
- Telethon Kids Institute, Perth, WA, Australia
- The University of Western Australia, Perth, WA, Australia
- Edith Cowan University, Perth, WA, Australia
| | - Ravisha Srinivasjois
- Joondalup Health Campus, Perth, WA, Australia
- Edith Cowan University, Perth, WA, Australia
- Curtin University, Perth, WA, Australia
| | - Debra J Palmer
- Telethon Kids Institute, Perth, WA, Australia
- The University of Western Australia, Perth, WA, Australia
| | - Lyn Colvin
- Telethon Kids Institute, Perth, WA, Australia
- The University of Western Australia, Perth, WA, Australia
| | - Jamie Tan
- Telethon Kids Institute, Perth, WA, Australia
- Joondalup Health Campus, Perth, WA, Australia
| | - Susan L Prescott
- Telethon Kids Institute, Perth, WA, Australia
- The University of Western Australia, Perth, WA, Australia
- Joondalup Health Campus, Perth, WA, Australia
- Edith Cowan University, Perth, WA, Australia
- in VIVO Planetary Health , Worldwide Universities Network (WUN), West New York, NJ, USA
- Perth Children's Hospital, Nedlands, WA, Australia
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Poprzeczny AJ, Louise J, Deussen AR, Dodd JM. Effect of metformin in addition to an antenatal diet and lifestyle intervention on fetal growth and adiposity: the GRoW randomised trial. BMC Endocr Disord 2020; 20:139. [PMID: 32928167 PMCID: PMC7488668 DOI: 10.1186/s12902-020-00618-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 08/31/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The infants born to women who are overweight or obese in pregnancy are at an increased risk of being born macrosomic or large for gestational age. Antenatal dietary and lifestyle interventions have been shown to be ineffective at reducing this risk. Our aim was to examine the effects of metformin in addition to a diet and lifestyle intervention on fetal growth and adiposity among women with a BMI above the healthy range. METHODS Women who had a body mass index ≥25 kg/m2 in early pregnancy, and a singleton gestation, were enrolled in the GRoW trial from three public maternity hospitals in metropolitan Adelaide. Women were invited to have a research ultrasounds at 28 and 36 weeks' gestation at which ultrasound measures of fetal biometry and adiposity were obtained. Fetal biometry z-scores and trajectories were calculated. Measurements and calculations were compared between treatment groups. This secondary analysis was pre-specified. RESULTS Ultrasound data from 511 women were included in this analysis. The difference in femur length at 36 weeks' gestation was (0.07 cm, 95% CI 0.01-0.14 cm, p = 0.019) and this was was statistically significant, however the magnitude of effect was small. Differences between treatment groups for all other fetal biometry measures, z-scores, estimated fetal weight, and adiposity measures at 28 and 36 weeks' gestation were similar. CONCLUSIONS The addition of metformin to dietary and lifestyle advice in pregnancy for overweight and obese women has no clinically relevant effect on ultrasound measures of fetal biometry or adiposity. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ( ACTRN12612001277831 ).
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Affiliation(s)
- Amanda J Poprzeczny
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia.
- Department of Perinatal Medicine, The Women's and Children's Hospital, Women's and Babies Division, Adelaide, South Australia, Australia.
- The University of Adelaide, Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia, 5006, Australia.
| | - Jennie Louise
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
- The University of Adelaide, School of Public Health, Adelaide, South Australia, Australia
| | - Andrea R Deussen
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
| | - Jodie M Dodd
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
- Department of Perinatal Medicine, The Women's and Children's Hospital, Women's and Babies Division, Adelaide, South Australia, Australia
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Louise J, Deussen AR, Dodd JM. Gestational Weight Gain-Re-Examining the Current Paradigm. Nutrients 2020; 12:E2314. [PMID: 32752149 DOI: 10.3390/nu12082314] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 11/17/2022] Open
Abstract
Our aim was to investigate the underlying assumptions of the current gestational weight gain (GWG) paradigm, specifically that—(1) GWG is modifiable through diet and physical activity; (2) optimal GWG and risk of excess GWG, vary by pre-pregnancy body mass index (BMI) category and (3) the association between GWG and adverse pregnancy outcomes is causal. Using data from three large, harmonized randomized controlled trials (RCTs) of interventions to limit GWG and improve pregnancy outcomes and with appropriate regression models, we investigated the link between diet and physical activity and GWG; the relationships between pre-pregnancy BMI, GWG and birth weight z-score; and the evidence for a causal relationship between GWG and pregnancy outcomes. We found little evidence that diet and physical activity in pregnancy affected GWG and that the observed relationships between GWG and adverse pregnancy outcomes are causal in nature. Further, while there is evidence that optimal GWG may be lower for women with higher BMI, target ranges defined by BMI categories do not accurately reflect risk of adverse outcomes. Our findings cast doubt upon current advice regarding GWG, particularly for overweight and obese women and suggest that a change in focus is warranted.
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Coppell KJ, Paterson H, Norton J, Jeffs E, Hay-Smith EJC. Using a citizens' jury approach to determine a good nutrition resource for pregnant women. Public Health Nutr 2020; 23:1916-23. [PMID: 32482178 DOI: 10.1017/S1368980020000452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The development of user-friendly nutrition resources for pregnant women seldom involves end-users. This qualitative study used a citizens' jury approach to determine if our modification of a longstanding, frequently used dietitian-informed diet and diabetes booklet was deemed to be a good healthy eating resource for pregnant women. DESIGN Midwives recruited thirteen first-time pregnant women not requiring specialist obstetric care or specialist dietetic advice for any reason. Participants were sent a copy of the modified healthy eating in pregnancy booklet prior to 'jury day'. Five women were unable to attend the citizens' jury citing reasons such as early labour. At the jury, five experts presented evidence. Participants adjourned, with an independent facilitator, to 'deliberate' as to whether the resource was suitable or not. The verdict was presented, and subsequent discussion was audio-recorded, transcribed and inductively content analysed. SETTING Southland, New Zealand. PARTICIPANTS Pregnant women aged 19-35 years (n 8), of whom half had a household income <$NZ30 000. RESULTS The verdict was 'Yes'; the resource was good. Three themes were derived: communication of health information, resource content and harm reduction in pregnancy. Based on these data, ways to enhance the quality and usability of the booklet were evident. CONCLUSIONS Citizens' juries can be used to obtain an independent assessment by end-users of health resources. Our modified diet and diabetes booklet was considered suitable for providing healthy eating advice to pregnant women. Inclusion of end-users' perspectives is critical for end-user relevant content, comprehension and resource credibility.
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Harper LM, Jauk V, Longo S, Biggio JR, Szychowski JM, Tita AT. Early gestational diabetes screening in obese women: a randomized controlled trial. Am J Obstet Gynecol 2020; 222:495.e1-495.e8. [PMID: 31926951 PMCID: PMC7196002 DOI: 10.1016/j.ajog.2019.12.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although in 2013 the American College of Obstetricians and Gynecologists recommended early screening for gestational diabetes in obese women, no studies demonstrate an improvement in perinatal outcomes with this strategy. OBJECTIVE We sought to determine whether early screening for gestational diabetes improves perinatal outcomes in obese women. MATERIALS AND METHODS Randomized controlled trial comparing early gestational diabetes screening (14-20 weeks) to routine screening (24-28 weeks) in obese women (body mass index ≥30 kg/m2) at 2 tertiary care centers in the United States. Screening was performed using a 50-g, 1-hour glucose challenge test followed by a 100-g, 3-hour glucose tolerance test if the initial screen was ≥135 mg/dL. Gestational diabetes was diagnosed using Carpenter-Coustan criteria. Women not diagnosed at 14 to 20 weeks were rescreened at 24 to 28 weeks. Exclusion criteria were pre-existing diabetes, major medical illness, bariatric surgery, and prior cesarean delivery. The primary outcome was a composite of macrosomia (>4000 g), primary cesarean delivery, hypertensive disease of pregnancy, shoulder dystocia, neonatal hyperbilirubinemia, and neonatal hypoglycemia (assessed within 48 hours of birth). RESULTS A total of 962 women were randomized, and outcomes were available for 922. Of these 922 women, 459 (49.8%) were assigned to early screen and 463 (50.2%) to routine screen. Baseline characteristics were balanced between groups. In the early screening group, 69 (15.0%; 95% confidence interval, 11.9-18.6%) were diagnosed with gestational diabetes: 29 (6.3%; 95% confidence interval, 4.3-8.9%) at <20 weeks and 40 (8.7%; 95% confidence interval, 6.3-11.7%) at >24 weeks. Of those randomized to routine screening, 56 (12.1%; 95% confidence interval, 9.3-15.4%) had gestational diabetes. Early screening did not reduce the incidence of the primary outcome (56.9% in the early screen versus 50.8% in the routine screen, P = .07; relative risk, 1.12; 95% confidence interval, 0.99-1.26). CONCLUSION Early screening for gestational diabetes in obese women did not reduce the composite perinatal outcome.
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Affiliation(s)
- Lorie M Harper
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL.
| | - Victoria Jauk
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL
| | - Sherri Longo
- Women's Services Center of Excellence, Ochsner Health System, New Orleans, LA
| | - Joseph R Biggio
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL; Women's Services Center of Excellence, Ochsner Health System, New Orleans, LA
| | - Jeff M Szychowski
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL
| | - Alan T Tita
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL
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Cremona A, Saunders J, Cotter A, Hamilton J, Donnelly AE, O'Gorman CS. Maternal obesity and degree of glucose intolerance on neonatal hypoglycaemia and birth weight: a retrospective observational cohort study in women with gestational diabetes mellitus. Eur J Pediatr 2020; 179:653-660. [PMID: 31873801 DOI: 10.1007/s00431-019-03554-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022]
Abstract
Gestational diabetes mellitus (GDM) is an increasing problem worldwide. Postnatal hypoglycaemia and excess foetal growth are known important metabolic complications of neonates born to women with diabetes. This retrospective cohort study aims to determine the influence of obesity and glucose intolerance on neonatal hypoglycaemia and birth weight over the 90th percentile (LGA). Data were abstracted from 303 patient medical records from singleton pregnancies diagnosed with GDM. Data were recorded during routine hospital visits. Demographic data were acquired by facilitated questionnaires and anthropometrics measured at the first antenatal appointment. Blood biochemical indices were recorded. Plasma glucose area under the curve (PG-AUC) was calculated from OGTT results as an index of glucose intolerance. OGTT results of 303 pregnant women aged between 33.6 years (29.8-37.7) diagnosed with GDM were described. Neonates of mothers with a BMI of over 30 kg/m2 were more likely to experience neonatal hypoglycaemia (24 (9.2%) vs. 23 (8.8%), p = 0.016) with odds ratio for neonatal hypoglycaemia significantly higher at 2.105, 95% CI (1.108, 4.00), p = 0.023. ROC analysis showed poor strength of association (0.587 (95% CI, .487 to .687). Neonatal LGA was neither associated with or predicted by PG-AUC nor obesity; however, multiparous women were 2.8 (95% CI (1.14, 6.78), p = 0.024) times more likely to have a baby born LGA.Conclusion: Maternal obesity but not degree of glucose intolerance increased occurrence of neonatal hypoglycaemia. Multiparous women had greater risk of neonates born LGA.What is Known:•Excess foetal growth in utero has long-term metabolic implications which track into adulthood.•Neonatal hypoglycaemia is detrimental to newborns in the acute phase with potential long-term implications on the central nervous system.What is New:•Maternal obesity but not degree of glucose intolerance in a GDM cohort increased occurrence of neonatal hypoglycaemia.•Multiparous women diagnosed had greater risk of neonates born LGA.
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Affiliation(s)
- Alexandra Cremona
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland. .,School of Allied Health, University of Limerick, Limerick, Ireland. .,Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland. .,Institute of Nutrition & Dietetics (INDI), Dublin, Ireland. .,Physical Education and Sports Science (PESS), University of Limerick, Limerick, Ireland.
| | - Jean Saunders
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland.,Statistics Consulting Unit (SCU/CSTAR @ UL), University of Limerick, Limerick, Ireland
| | - Amanda Cotter
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland.,Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland.,University Maternity Hospital Limerick (UMHL), Limerick, Ireland
| | - Jill Hamilton
- The Division of Endocrinology, Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Alan E Donnelly
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland.,Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland.,Physical Education and Sports Science (PESS), University of Limerick, Limerick, Ireland
| | - Clodagh S O'Gorman
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland.,Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland.,Department of Paediatrics, University Hospital Limerick, Limerick, Ireland
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Leghi GE, Netting MJ, Middleton PF, Wlodek ME, Geddes DT, Muhlhausler BS. The impact of maternal obesity on human milk macronutrient composition: A systematic review and meta-analysis. Nutrients 2020; 12:nu12040934. [PMID: 32230952 PMCID: PMC7231188 DOI: 10.3390/nu12040934] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/25/2020] [Indexed: 12/11/2022] Open
Abstract
Maternal obesity has been associated with changes in the macronutrient concentration of human milk (HM), which have the potential to promote weight gain and increase the long-term risk of obesity in the infant. This article aimed to provide a synthesis of studies evaluating the effects of maternal overweight and obesity on the concentrations of macronutrients in HM. EMBASE, MEDLINE/PubMed, Cochrane Library, Scopus, Web of Science, and ProQuest databases were searched for relevant articles. Two authors conducted screening, data extraction, and quality assessment independently. A total of 31 studies (5078 lactating women) were included in the qualitative synthesis and nine studies (872 lactating women) in the quantitative synthesis. Overall, maternal body mass index (BMI) and adiposity measurements were associated with higher HM fat and lactose concentrations at different stages of lactation, whereas protein concentration in HM did not appear to differ between overweight and/or obese and normal weight women. However, given the considerable variability in the results between studies and low quality of many of the included studies, further research is needed to establish the impact of maternal overweight and obesity on HM composition. This is particularly relevant considering potential implications of higher HM fat concentration on both growth and fat deposition during the first few months of infancy and long-term risk of obesity.
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Affiliation(s)
- Gabriela E. Leghi
- School of Agriculture, Food and Wine, The University of Adelaide, Adelaide, SA 5064, Australia;
| | - Merryn J. Netting
- Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia; (M.J.N.); (P.F.M.)
- Discipline of Paediatrics, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Philippa F. Middleton
- Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia; (M.J.N.); (P.F.M.)
| | - Mary E. Wlodek
- Department of Physiology, The University of Melbourne, Melbourne, VIC 3010, Australia;
| | - Donna T. Geddes
- School of Molecular Sciences, The University of Western Australia, Perth, WA 6009, Australia;
| | - Beverly S. Muhlhausler
- School of Agriculture, Food and Wine, The University of Adelaide, Adelaide, SA 5064, Australia;
- Commonwealth Scientific and Industrial Research Organisation (CSIRO), Adelaide, SA 5000, Australia
- Correspondence: ; Tel.: +61-8-8305-0697
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Fernández-Buhigas I, Brik M, Martin-Arias A, Vargas-Terrones M, Varillas D, Barakat R, Santacruz B. Maternal physiological changes at rest induced by exercise during pregnancy: A randomized controlled trial. Physiol Behav 2020; 220:112863. [PMID: 32160968 DOI: 10.1016/j.physbeh.2020.112863] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE to analyse maternal physiological changes in several areas (cardiovascular, metabolic, renal and hepatic) related to the regular practice of a supervised exercise program. METHODS This is an unplanned secondary analysis from a randomized controlled trial carried out in a single maternity unit in Madrid, Spain (NCT 02,756,143). From November 2014 to June 2015, 92 women were randomly assigned to perform a mild-moderate supervised exercise program during pregnancy (Intervention group, IG) or to continue with their routine pregnancy care (control group, CG). For the purpose of this study we collected clinical and analytical data (heart blood pressure, weight, blood glucose, AST, ALT, blood Creatinine and blood Uric acid) available from all obstetric visits and examined the differences between groups. RESULTS We did not find any differences in: pregnancy weight (IG: 11.4 ± 4.4 Kg vs. CG: 10.1 ± 5.3 Kg; p = 0.173); fasting glucose at 10+0-12+6 weeks (IG: 78.48±8.34 vs. CG: 76±13.26, p = 0.305) or at 34+0-36+4 weeks (IG: 73.25±10.27 vs CG: 73.45± 8.29,p = 0.920), and 50 gs glucose tolerance at 24+4-26+6weeks (IG: 116.23±35.07 vs CG: 116.36±25.98, p = 0.984); Aspartate-amino-transferase at 10+0-12+6 weeks (IG: 15.38±4.17 vs CG: 17.33±7.05, p = 0.124) and at 34+0-36+4 weeks (IG: 21.65±5.25 vs CG: 19.53±8.32, p = 0.165) or Alanine-amino- transferase at 10+0-12+6 weeks (IG: 27.50±10.63 vs CG: 28.27±11.77, p = 0.746) or at 34+0-36+4 weeks (IG: 22.93±9.23 vs CG: 20.84±13.49, p = 0.407); blood Creatinine concentrations at 34+0-36+4 weeks (IG: 0.595±0.401 vs CG: 0.575±0.100, p = 0.757) and blood uric acid concentrations at 34+0-36+4 weeks (IG: 3.526 ± 0.787 vs CG: 3.262±0.672, p = 0.218). Heart blood pressure was similar between groups except at 27+0-28+6 weeks, where systolic blood pressure was significantly lower in the CG in comparison to the IG (116.31±10.8 mmHg vs. 120.22 ± 10.3 mmHg, p = 0.010). CONCLUSION Regular supervised exercise during pregnancy does not alter normal maternal physiology.
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Affiliation(s)
- Irene Fernández-Buhigas
- Obstetrics Department, Hospital Universitario de Torrejon, Madrid, Spain; Faculty of Medicine, Pozuelo de Alarcón, Universidad Francisco de Vitoria, Madrid, Spain.
| | - Maia Brik
- Obstetrics Department, Hospital Universitario de Torrejon, Madrid, Spain; Faculty of Medicine, Pozuelo de Alarcón, Universidad Francisco de Vitoria, Madrid, Spain; Maternal Fetal Medicine Department. Hospital Universitari Vall d'Hebron. Universitat Autonoma de Barcelona. Barcelona, Spain.
| | - Aranzazu Martin-Arias
- Obstetrics Department, Hospital Universitario de Torrejon, Madrid, Spain; Faculty of Medicine, Pozuelo de Alarcón, Universidad Francisco de Vitoria, Madrid, Spain
| | - Marina Vargas-Terrones
- AFIPE Research Group, Faculty of Sciences for Physical Activity and Sport, INEF, Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - David Varillas
- Faculty of Medicine, Pozuelo de Alarcón, Universidad Francisco de Vitoria, Madrid, Spain.
| | - Rubén Barakat
- AFIPE Research Group, Faculty of Sciences for Physical Activity and Sport, INEF, Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - Belén Santacruz
- Obstetrics Department, Hospital Universitario de Torrejon, Madrid, Spain; Faculty of Medicine, Pozuelo de Alarcón, Universidad Francisco de Vitoria, Madrid, Spain.
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Vince K, Brkić M, Poljičanin T, Matijević R. Prevalence and impact of pre-pregnancy body mass index on pregnancy outcome: a cross-sectional study in Croatia. J OBSTET GYNAECOL 2020; 41:55-59. [DOI: 10.1080/01443615.2019.1706157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Marko Brkić
- Croatian Institute of Public Health, Zagreb, Croatia
| | | | - Ratko Matijević
- University Hospital Merkur, Zagreb, Croatia
- Department of Obstetrics and Gynaecology, School of Medicine, University of Zagreb, Zagreb, Croatia
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Machado C, Monteiro S, Oliveira MJ. Impact of overweight and obesity on pregnancy outcomes in women with gestational diabetes - results from a retrospective multicenter study. Arch Endocrinol Metab 2020; 64:45-51. [PMID: 31576966 PMCID: PMC10522280 DOI: 10.20945/2359-3997000000178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 08/04/2019] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to evaluate the impact of pre-pregnancy body mass index (BMI) on pregnancy outcomes in women with gestational diabetes (GD). Subjects and methods Retrospective multicenter study using data from the Portuguese National Register. We included women with GD with a singleton pregnancy. GD diagnosis was according to the International Association of the Diabetes and Pregnancy Study Group criteria. Women were divided into groups according to their pre-pregnancy BMI: < 18.5 kg/m2 (underweight), ≥ 18.5 and < 25.0 kg/m2 (normal weight), ≥ 25 and < 30 kg/m2 (overweight) and ≥ 30 kg/m2 (obese). Results We included 3,103 pregnant women with GD, 29.6% (n = 918) were overweight and 27.3% (n = 846) were obese. Compared to normal weight, the overweight and obese groups had a higher percentage of gestational hypertension (4.0% and 8.5% vs. 2.1%), cesarean delivery (32.8% and 41.3% vs. 27.9%), macrosomia (3.9% and 6.7% vs. 2.4%), and large for gestational age (LGA) newborns (8.3% and 13.5% vs. 6.0%). Obesity increased the risk of gestational hypertension (OR 4.5, p < 0.001), preeclampsia (OR 1.9, p = 0.034), cesarean delivery (OR 2.0, p < 0.001), macrosomia (OR 3.1, p < 0.001) and LGA (OR 2.3, p < 0.001). Conclusion In pregnant women with GD, pregnancy complications increase with pre-pregnancy BMI. In obese women, appropriate diet and counseling prior to gestation and more aggressive medical intervention during pregnancy are needed in order to prevent macrosomic and LGA newborns and to reduce maternal complications.
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Affiliation(s)
- Catarina Machado
- Departamento de Endocrinologia, Centro Hospitalar de Vila Nova de Gaia, Espinho, Porto, Portugal
| | - Sara Monteiro
- Departamento de Endocrinologia, Centro Hospitalar de Vila Nova de Gaia, Espinho, Porto, Portugal
| | - Maria João Oliveira
- Departamento de Endocrinologia, Centro Hospitalar de Vila Nova de Gaia, Espinho, Porto, Portugal
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Leghi GE, Netting M, Muhlhausler BS. The short-term impact of dietary fat and sugar intake on breast milk composition: A clinical trial protocol. Nutr Health 2020; 26:65-72. [PMID: 31948337 DOI: 10.1177/0260106019895367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Breast milk is uniquely designed for the infant and contains the key nutrients and bioactive factors required to support optimal infant health and development. While previous studies have reported that maternal obesity can influence milk composition, whether this relationship is driven by maternal or dietary factors remains unclear. AIM The aim of this study is to assess the impact of test meals varying in fat and sugar content on post-prandial concentrations of macronutrients and metabolic hormones in the breast milk. METHODS This open label crossover study will include 25 lactating women. On the three days of the intervention, women will be randomized to receive a breakfast meal with a fat and sugar content consistent with the Australian Guide to Healthy Eating (9 g fat, 25 g of sugar) or a breakfast meal containing higher levels of fat (28 g fat, 18 g of sugar) or sugar (5 g fat, 56 g of sugar). All breakfast meals will be similar in composition (cereal, milk, yogurt, toast and spread) and matched for total energy content. This study will measure breast milk concentrations of metabolic hormones (leptin, insulin, adiponectin, ghrelin and glucagon-like peptide-1) and macronutrients in the following 12 hours. RESULTS AND CONCLUSION The results of this study will provide novel direct evidence of the impact of variations in dietary fat and sugar content to alter the macronutrient and/or metabolic hormone concentrations in breast milk. Data on the effect of maternal diet on milk composition is critical given the established importance of nutritional exposures in early infancy for an individual's life-long health outcomes.
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Affiliation(s)
- Gabriela E Leghi
- Department of Food and Wine Sciences, The University of Adelaide, Australia.,Healthy Mothers, Babies and Children Theme, South Australian Health and Medical Research Institute (SAHMRI), Australia
| | - Merryn Netting
- Healthy Mothers, Babies and Children Theme, South Australian Health and Medical Research Institute (SAHMRI), Australia.,Discipline of Paediatrics, School of Medicine, The University of Adelaide, Australia
| | - Beverly S Muhlhausler
- Department of Food and Wine Sciences, The University of Adelaide, Australia.,CSIRO, Australia
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Cremona A, Hayes K, O’Gorman CS, Laighin CN, Ismail KI, Donnelly AE, Hamilton J, Cotter A. Inter and intra-reliability of ultrasonography for the measurement of abdominal subcutaneous & visceral adipose tissue thickness at 12 weeks gestation. BMC Med Imaging 2019; 19:95. [PMID: 31847832 PMCID: PMC6916062 DOI: 10.1186/s12880-019-0393-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/08/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Excess abdominal adiposity cause metabolic disturbances, particularly in pregnancy. Methods of accurate measurement are limited in pregnancy due to risks associated with these procedures. This study outlines a non-invasive methodology for the measurement of adipose tissue in pregnancy and determines the intra- and inter-observer reliability of ultrasound (US) measurements of the two components of adipose tissue (subcutaneous (SAT) and visceral adipose tissue (VAT)) within a pregnant population. METHODS Thirty pregnant women were recruited at the end of their first trimester, from routine antenatal clinic at the University Maternity Hospital Limerick, Ireland. Measurements of adipose tissue thickness were obtained using a GE Voluson E8 employing a 1-5 MHz curvilinear array transducer. Two observers, employing methodological rigour in US technique, measured thickness of adipose tissue three times, and segmented the US image systematically in order to define measurements of SAT and VAT using specifically pre-defined anatomical landmarks. RESULTS Intra-observer and inter-observer precision was assessed using Coefficient of Variation (CV). Measurements of SAT and total adipose for both observers were < 5% CV and < 10% CV for VAT in measures by both observers. Inter-observer reliability was assessed by Limits of Agreement (LoA). LoA were determined to be - 0.45 to 0.46 cm for SAT and - 0.34 to 0.53 cm for VAT values. Systematic bias of SAT measurement was 0.01 cm and 0.10 cm for VAT. Inter-observer precision was also assessed by coefficient of variation (CV: SAT, 3.1%; VAT, 7.2%; Total adipose, 3.0%). CONCLUSION Intra-observer precision was found to be acceptable for measures of SAT, VAT and total adipose according to anthropometric criterion, with higher precision reported in SAT values than in VAT. Inter-observer reliability assessed by Limits-Of-Agreement (LoA) confirm anthropometrically reliable to 0.5 cm. Systematic bias was minimal for both measures, falling within 95% confidence intervals. These results suggest that US can produce reliable, repeatable and accurate measures of SAT and VAT during pregnancy.
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Affiliation(s)
- Alexandra Cremona
- Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland
- School of Allied Health (SAH), University of Limerick, Limerick, Ireland
- Institute of Nutrition & Dietetics (INDI), Dublin, Ireland
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland
- Physical Education and Sport Sciences (PESS), University of Limerick, Limerick, Ireland
| | - Kevin Hayes
- Department of Statistics, University College Cork (UCC), Cork, Ireland
| | - Clodagh S. O’Gorman
- Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland
| | - Ciara Ní Laighin
- Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland
- University Maternity Hospital Limerick (UMHL), Limerick, Ireland
| | - Khadijah I. Ismail
- Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland
- University Maternity Hospital Limerick (UMHL), Limerick, Ireland
| | - Alan E. Donnelly
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland
- Physical Education and Sport Sciences (PESS), University of Limerick, Limerick, Ireland
| | | | - Amanda Cotter
- Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland
- University Maternity Hospital Limerick (UMHL), Limerick, Ireland
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Dodd JM, Deussen AR, Louise J. A Randomised Trial to Optimise Gestational Weight Gain and Improve Maternal and Infant Health Outcomes through Antenatal Dietary, Lifestyle and Exercise Advice: The OPTIMISE Randomised Trial. Nutrients 2019; 11:nu11122911. [PMID: 31810217 PMCID: PMC6949931 DOI: 10.3390/nu11122911] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 01/06/2023] Open
Abstract
There are well-recognised associations between excessive gestational weight gain (GWG) and adverse pregnancy outcomes, including an increased risk of pre-eclampsia, gestational diabetes and caesarean birth. The aim of the OPTIMISE randomised trial was to evaluate the effect of dietary and exercise advice among pregnant women of normal body mass index (BMI), on pregnancy and birth outcomes. The trial was conducted in Adelaide, South Australia. Pregnant women with a body mass index in the healthy weight range (18.5–24.9 kg/m2) were enrolled in a randomised controlled trial of a dietary and lifestyle intervention versus standard antenatal care. The dietitian-led dietary and lifestyle intervention over the course of pregnancy was based on the Australian Guide to Healthy Eating. Baseline characteristics of women in the two treatment groups were similar. There was no statistically significant difference in the proportion of infants with birth weight above 4.0 kg between the Lifestyle Advice and Standard Care groups (24/316 (7.59%) Lifestyle Advice versus 26/313 (8.31%) Standard Care; adjusted risk ratio (aRR) 0.91; 95% confidence interval (CI) 0.54 to 1.55; p = 0.732). Despite improvements in maternal diet quality, no significant differences between the treatment groups were observed for total GWG, or other pregnancy and birth outcomes.
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Affiliation(s)
- Jodie M. Dodd
- Discipline of Obstetrics & Gynaecology, and Robinson Research Institute, The University of Adelaide, Adelaide, SA 5006, Australia; (A.R.D.); (J.L.)
- Department of Perinatal Medicine Women’s and Children’s Hospital, North Adelaide, Adelaide, SA 5006, Australia
- Correspondence:
| | - Andrea R. Deussen
- Discipline of Obstetrics & Gynaecology, and Robinson Research Institute, The University of Adelaide, Adelaide, SA 5006, Australia; (A.R.D.); (J.L.)
| | - Jennie Louise
- Discipline of Obstetrics & Gynaecology, and Robinson Research Institute, The University of Adelaide, Adelaide, SA 5006, Australia; (A.R.D.); (J.L.)
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Pratt A, Howat P, Hui L. Maternal and perinatal outcomes for women with body mass index ≥50 kg/m
2
in a non‐tertiary hospital setting. Aust N Z J Obstet Gynaecol 2019; 60:361-368. [DOI: 10.1111/ajo.13064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/12/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Anita Pratt
- Department of Obstetrics and Gynaecology The Northern Hospital Melbourne Victoria Australia
| | - Paul Howat
- Department of Obstetrics and Gynaecology The Northern Hospital Melbourne Victoria Australia
| | - Lisa Hui
- Department of Obstetrics and Gynaecology The Northern Hospital Melbourne Victoria Australia
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D'Ambrosio V, Brunelli R, Vena F, Di Mascio D, Marchetti C, Boccherini C, Piccioni MG, Benedetti Panici P, Giancotti A. Metformin reduces maternal weight gain in obese pregnant women: A systematic review and meta-analysis of two randomized controlled trials. Diabetes Metab Res Rev 2019; 35:e3164. [PMID: 30945418 DOI: 10.1002/dmrr.3164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 02/20/2019] [Accepted: 03/19/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Valentina D'Ambrosio
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Roberto Brunelli
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Flaminia Vena
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Daniele Di Mascio
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Claudia Marchetti
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Chiara Boccherini
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Maria Grazia Piccioni
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Antonella Giancotti
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
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Ward MC, Agarwal A, Bish M, James R, Faulks F, Pitson J, Yuen N, Mnatzaganian G. Trends in obesity and impact on obstetric outcomes in a regional hospital in Victoria, Australia. Aust N Z J Obstet Gynaecol 2019; 60:204-211. [PMID: 31353441 DOI: 10.1111/ajo.13035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/06/2019] [Indexed: 12/28/2022]
Abstract
AIMS Obesity-related complications have been identified across the entire childbearing journey. This study investigated changes in obesity prevalence and their impact on obstetric outcomes in a regional hospital in Victoria, Australia. METHODS All women delivering during 1 January 2010 and 31 December 2016 were eligible to participate. Trends over time and outcomes were assessed on body mass indices (BMI). Incidences of complications were compared by BMI categories. The effect of obesity on hospital length of stay (LoS) was further assessed using the Generalised Estimating Equations approach. RESULTS During the study period a total of 6661 women of whom 27.5% were overweight, and 16.1, 7.7, and 5.5% were respectively obese class I, class II, and class III, contributed to 8838 births. An increased trend over time in the prevalence of obesity (BMI > 35.0) (P = 0.041) and a decreased trend for vaginal deliveries for the whole sample (P = 0.003) were found. Multiple adverse outcomes were associated with increasing maternal BMI including increased risk of gestational diabetes, gestational hypertension, preeclampsia, emergency caesarean section, shoulder dystocia, macrosomia, and admission to special care. The multivariable analysis showed no associations between LoS and BMI. CONCLUSIONS Over a short period of seven years, this study provides evidence of a significant trend toward more obesity and fewer vaginal births in a non-urban childbearing population, with increasing trends of poorer health outcomes. Assessing needs and risk factors tailored to this population is crucial to ensuring a model of care that safeguards a sustainable and effective regional maternity health service.
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Affiliation(s)
- Madeleine C Ward
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia
| | - Anju Agarwal
- Department of Women's & Children's Services, Bendigo Health, Bendigo, Victoria, Australia
| | - Melanie Bish
- Department of Rural Nursing and Midwifery, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Rachel James
- Department of Women's & Children's Services, Bendigo Health, Bendigo, Victoria, Australia
| | - Fiona Faulks
- Department of Women's & Children's Services, Bendigo Health, Bendigo, Victoria, Australia.,Department of Rural Nursing and Midwifery, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Jennifer Pitson
- Department of Women's & Children's Services, Bendigo Health, Bendigo, Victoria, Australia
| | - Nicola Yuen
- Department of Women's & Children's Services, Bendigo Health, Bendigo, Victoria, Australia
| | - George Mnatzaganian
- Department of Community and Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
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McPhie S, Skouteris H, Millar L, Olsson C, Campbell K, van der Pligt P, Dodd J, Hill B. Preconception weight management: an untapped area of women's health. Aust J Prim Health 2019; 23:61-65. [PMID: 27491461 DOI: 10.1071/py16004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 06/28/2016] [Indexed: 11/23/2022]
Abstract
The aim of this study was to identify barriers to providing preconception weight management. Twenty health professionals participated in a semistructured phone interview regarding their beliefs on perceived barriers to providing preconception weight management. The interviews were recorded, transcribed verbatim and examined using thematic analysis to extract the key themes. Two themes were identified from the interviews: (1) barriers hindering women from accessing preconception weight management interventions (i.e. women's lack of awareness regarding the importance of preconception weight, and not being provided with weight management information or interventions by health professionals); and (2) barriers preventing health professionals from providing preconception weight management (i.e. an absence of implementation resources for preconception weight management, limited access to women of childbearing age who plan to conceive, and a high percentage of pregnancies being unplanned). There are significant client- and heath professional-based barriers to implementing preconception weight management. To begin to address these barriers, developing policy and preconception weight management programs based on evidence collected via a needs assessment, quantitative or mixed-method designs may be of benefit. Furthermore, these barriers are likely contributing to the paucity in research into preconception weight management services.
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Affiliation(s)
- Skye McPhie
- School of Psychology, Deakin University, Locked Bag 20000, Geelong, Vic. 3220, Australia
| | - Helen Skouteris
- School of Psychology, Deakin University, Locked Bag 20000, Geelong, Vic. 3220, Australia
| | - Lynne Millar
- School of Health and Social Development, Deakin University, Locked Bag 20000, Geelong, Vic. 3220, Australia
| | - Craig Olsson
- School of Psychology, Deakin University, Locked Bag 20000, Geelong, Vic. 3220, Australia
| | - Karen Campbell
- School of Exercise and Nutrition Sciences, Deakin University, Locked Bag 20000, Geelong, Vic. 3220, Australia
| | - Paige van der Pligt
- School of Exercise and Nutrition Sciences, Deakin University, Locked Bag 20000, Geelong, Vic. 3220, Australia
| | - Jodie Dodd
- Obstetrics and Gynaecology, The University of Adelaide, Women's & Children's Hospital, 72 King William Road, North Adelaide, SA 5006, Australia
| | - Briony Hill
- School of Psychology, Deakin University, Locked Bag 20000, Geelong, Vic. 3220, Australia
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Dodd JM, Louise J, Deussen AR, Grivell RM, Dekker G, McPhee AJ, Hague W. Effect of metformin in addition to dietary and lifestyle advice for pregnant women who are overweight or obese: the GRoW randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol 2019; 7:15-24. [PMID: 30528218 DOI: 10.1016/s2213-8587(18)30310-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/18/2018] [Accepted: 10/18/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Maternal overweight and obesity are associated with well recognised pregnancy complications. Antenatal dietary and lifestyle interventions have a modest effect on gestational weight gain without affecting pregnancy outcomes. We aimed to assess the effects on maternal and infant outcomes of antenatal metformin given in addition to dietary and lifestyle advice among overweight and obese pregnant women. METHODS GRoW was a multicentre, randomised, double-blind, placebo-controlled trial in which pregnant women at 10-20 weeks' gestation with a BMI of 25 kg/m2 or higher were recruited from three public maternity units in Adelaide, SA, Australia. Women were randomly assigned (1:1) via a computer-generated schedule to receive either metformin (to a maximum dose of 2000 mg per day) or matching placebo. Participants, their antenatal care providers, and research staff (including outcome assessors) were masked to treatment allocation. All women received an antenatal dietary and lifestyle intervention. The primary outcome was the proportion of infants with birthweight greater than 4000 g. Secondary outcomes included measures of maternal weight gain, maternal diet and physical activity, maternal pregnancy and birth outcomes, maternal quality of life and emotional wellbeing, and infant birth outcomes. Outcomes were analysed on an intention-to-treat basis (including all randomly assigned women who did not withdraw consent to use their data, and who did not have a miscarriage or termination of pregnancy before 20 weeks' gestation, or a stillbirth). The trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12612001277831. FINDINGS Of 524 women who were randomly assigned between May, 28 2013 and April 26, 2016, 514 were included in outcome analyses (256 in the metformin group and 258 in the placebo group). Median gestational age at trial entry was 16·29 weeks (IQR 14·43-18·00) and median BMI was 32·32 kg/m2 (28·90-37·10); 167 (32%) participants were overweight and 347 (68%) were obese. There was no significant difference in the proportion of infants with birthweight greater than 4000 g (40 [16%] with metformin vs 37 [14%] with placebo; adjusted risk ratio [aRR] 0·97, 95% CI 0·65 to 1·47; p=0·899). Women receiving metformin had lower average weekly gestational weight gain (adjusted mean difference -0·08 kg, 95% CI -0·14 to -0·02; p=0·007) and were more likely to have gestational weight gain below recommendations (aRR 1·46, 95% CI 1·10 to 1·94; p=0·008). Total gestational weight gain, pregnancy and birth outcomes, maternal diet and physical activity, and maternal quality of life and emotional wellbeing did not differ significantly between groups. Similar numbers of women in both treatment groups (76% [159/208] in the metformin group and 73% [144/196] in the placebo group) reported side-effects including nausea, diarrhoea, and vomiting. Two stillbirths (placebo group) and one neonatal death (metformin group) occurred; none of the perinatal deaths were determined to be attributable to participation in the trial. INTERPRETATION For pregnant women who are overweight or obese, metformin given in addition to dietary and lifestyle advice initiated at 10-20 weeks' gestation does not improve pregnancy and birth outcomes. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Jodie M Dodd
- Discipline of Obstetrics & Gynaecology and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia; Department of Perinatal Medicine, Women's and Children's Hospital, North Adelaide, SA, Australia.
| | - Jennie Louise
- Discipline of Obstetrics & Gynaecology and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia; School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Andrea R Deussen
- Discipline of Obstetrics & Gynaecology and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Rosalie M Grivell
- Department of Obstetrics and Gynaecology, Flinders University, Bedford Park, SA, Australia
| | - Gustaaf Dekker
- Discipline of Obstetrics & Gynaecology and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia; Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Andrew J McPhee
- Department of Neonatal Medicine, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - William Hague
- Discipline of Obstetrics & Gynaecology and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia; Department of Perinatal Medicine, Women's and Children's Hospital, North Adelaide, SA, Australia
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O'Brien CM, Louise J, Deussen A, Grivell R, Dodd JM. The effect of maternal obesity on fetal biometry, body composition, and growth velocity. J Matern Fetal Neonatal Med 2018; 33:2216-2226. [PMID: 30394153 DOI: 10.1080/14767058.2018.1543658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: The aim of this secondary analysis was to investigate the relationship between maternal body mass index (BMI) and fetal biometry, body composition, and velocity measurements at 28 and 36 weeks gestation.Materials and methods: The current analysis involves 911 overweight or obese women who were randomized to the Standard Care group of the LIMIT randomized trial.Results: The fetus of women with Class 3 obesity (BMI ≥ 40.0) showed the greatest increase in all biometry z-scores, abdominal area (AA), and abdominal fat mass (AFM) compared with women classified as overweight (BMI 25.0-29.9). In women with Class 3 obesity, AA velocity was increased by 0.035 cm2 (0.004, 0.066, p = .029) and the z-score velocity was increased by 0.238 (0.022, 0.453, p = .03). Estimated fetal weight (EFW) velocity for women with Class 3 obesity was higher than that of overweight women by 2.028 g per day (0.861, 3.196, p<.001) and the z-score velocity was also higher by 0.441 per day (0.196, 0.687, p < .001).Conclusions: Maternal obesity is associated with an increase in fetal abdominal circumference, AFM and area along with EFW velocity over time. Women with Class 3 obesity (BMI ≥ 40.0) may represent a higher risk group for perpetuating the intergenerational transmission of obesity to their offspring.
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Affiliation(s)
- Cecelia M O'Brien
- Discipline of Obstetrics and Gynaecology, Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Jennie Louise
- Discipline of Obstetrics and Gynaecology, Robinson Research Institute, University of Adelaide, Adelaide, Australia.,Adelaide Health Technology Assessment, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Andrea Deussen
- Discipline of Obstetrics and Gynaecology, Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Rosalie Grivell
- Discipline of Obstetrics and Gynaecology, Robinson Research Institute, University of Adelaide, Adelaide, Australia.,Discipline of Obstetrics, Gynaecology and Reproductive Medicine Flinders Medical Centre, Adelaide, Australia
| | - Jodie M Dodd
- Discipline of Obstetrics and Gynaecology, Robinson Research Institute, University of Adelaide, Adelaide, Australia.,Department of Perinatal Medicine, Women's and Babies Division, Women's and Children's Hospital, Adelaide, Australia
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Abstract
Rates of obesity among women of reproductive age have risen dramatically in recent decades. Obesity impacts on health of women across their reproductive lifespan with adverse effects on not only fertility and short-term complications of pregnancy, but also on longer term health outcomes for both women and their children. This places considerable burden and cost on health services. Here, we review the evidence linking maternal obesity to adverse fertility, pregnancy and longer term health outcomes for women and their children. We discuss the outcomes of recent lifestyle, pharmacological and surgical intervention studies. As many of these studies have not shown a significant improvement in clinical outcomes, we discuss the need for better study design in future trials.
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Affiliation(s)
- Rebecca M Reynolds
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Adrienne Gordon
- Charles Perkins Centre, University of Sydney, Sydney, Australia
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Lee A, Muggli E, Halliday J, Lewis S, Gasparini E, Forster D. What do pregnant women eat, and are they meeting the recommended dietary requirements for pregnancy? Midwifery 2018; 67:70-76. [PMID: 30267936 DOI: 10.1016/j.midw.2018.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 08/30/2018] [Accepted: 09/08/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To compare the dietary intake of pregnant women to the 2013 Australian Dietary Guidelines and explore factors associated with inadequate intake. DESIGN Dietary intake data were collected between July 2011 and July 2012 (n = 1570) using a 74-item food frequency questionnaire. SETTING Metropolitan public health hospitals in Melbourne, Australia. PARTICIPANTS Pregnant women, at least 16 years of age, with a singleton pregnancy, and literate in English. MEASUREMENTS AND FINDINGS The highest proportion of women met the recommended daily servings for fruit (65.7%), followed by dairy products (55.2%), meat/meat alternatives (31.1%), vegetables (10.3%), and then grain foods (1.8%). A majority of women (83.8%) regularly consumed up to 2.5 serves of discretionary foods per day. Only one woman met the minimum recommended daily servings for all five food groups. Women who were obese were more likely to consume an inadequate diet (Adj. OR 2.13, 95% CI 1.53, 2.95); and having a university degree was associated with a lower odds of consuming an inadequate diet (Adj. OR 0.63, 95% CI 0.50, 0.78). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Pregnancy care providers need to be aware of women's low compliance with the national dietary guidelines, particularly regarding the poor intake of vegetables and grain foods; targeted as well as population-based approaches may be required.
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Affiliation(s)
- Amelia Lee
- Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia.
| | - Evelyne Muggli
- Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia; University of Melbourne, Parkville, Victoria 3052, Australia.
| | - Jane Halliday
- Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia; University of Melbourne, Parkville, Victoria 3052, Australia.
| | - Sharon Lewis
- Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia; University of Melbourne, Parkville, Victoria 3052, Australia.
| | - Elisabeth Gasparini
- Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia.
| | - Della Forster
- Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia; Latrobe University, Bundoora, Victoria 3086, Australia.
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Dodd JM, Deussen AR, O’Brien CM, Schoenaker DAJM, Poprzeczny A, Gordon A, Phelan S. Targeting the postpartum period to promote weight loss: a systematic review and meta-analysis. Nutr Rev 2018; 76:639-654. [PMID: 29889259 PMCID: PMC6280945 DOI: 10.1093/nutrit/nuy024] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Context Many international clinical guidelines recommend that overweight and obese women lose weight prior to pregnancy to reduce the risk of adverse pregnancy outcomes. Women who have recently given birth and plan future pregnancies are an important target population for preconception weight-loss interventions. Objective A systematic review to evaluate postpartum dietary and/or physical activity interventions to promote weight loss and improve health in a subsequent pregnancy was conducted. Data Sources Five databases-the Cochrane Central Register of Controlled Trials, MEDLINE (through PubMed), Embase, the Australian New Zealand Clinical Trials Registry, and the International Clinical Trials Registry-were searched using the following terms: preconception, pregnancy, postpartum, pregnancy outcomes, body mass index, weight gain, weight loss, weight change, postpartum weight retention, dietary or lifestyle intervention, and randomiz(s)ed controlled trial. The date of last search was November 2017. Data Extraction Data were extracted from each identified study using a standard form. The primary outcomes were weight loss at the completion of the intervention and at follow-up assessments. Secondary endpoints included maternal and infant outcomes in a subsequent pregnancy. Data Analysis Mean differences (MDs) were calculated for continuous data and risk ratios for dichotomous data, both with 95%CIs. Results A total of 235 abstracts (193 after duplicates were excluded) were identified, from which 37 manuscripts were selected for full-text review. In total, 27 trials were identified for inclusion. Outcome data were available for approximately 75% of participants (n = 3485). A combined dietary and physical activity intervention provided post partum produced greater postpartum weight loss (MD, -2.49 kg; 95%CI, -3.34 to -1.63 kg [random-effects model]; 12 studies, 1156 women), which was maintained at 12 months post partum (MD, -2.41 kg; 95%CI, -3.89 to -0.93 kg [random-effects model]; 4 studies, 405 women), compared with no intervention. No studies reported maternal or infant health outcomes in a subsequent pregnancy. Conclusions Providing a postpartum intervention is associated with weight loss after birth, but effects on maternal and infant health in a subsequent pregnancy are uncertain.
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Affiliation(s)
- Jodie M Dodd
- Discipline of Obstetrics and Gynaecology and the Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
- Department of Perinatal Medicine, Women’s and Babies Division, Women’s and Children’s Hospital, Adelaide, South Australia, Australia
| | - Andrea R Deussen
- Discipline of Obstetrics and Gynaecology and the Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Cecelia M O’Brien
- Discipline of Obstetrics and Gynaecology and the Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Danielle A J M Schoenaker
- Discipline of Obstetrics and Gynaecology and the Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Amanda Poprzeczny
- Discipline of Obstetrics and Gynaecology and the Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
- Department of Obstetrics and Gynaecology, Lyell McEwin Hospital, Elizabeth, South Australia, Australia
| | - Adrienne Gordon
- Department of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Suzanne Phelan
- Department of Kinesiology, California Polytechnic State University, San Luis Obispo, California, USA
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Koning SH, van Zanden JJ, Hoogenberg K, Lutgers HL, Klomp AW, Korteweg FJ, van Loon AJ, Wolffenbuttel BHR, van den Berg PP. Insights uncovered from experiencing a rise in the incidence of gestational diabetes at a Melbourne hospital. Reply to Ng E, Neff M, Sztal-Mazer S [letter]. Diabetologia 2018; 61:1884-1885. [PMID: 29931413 DOI: 10.1007/s00125-018-4667-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/25/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Sarah H Koning
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Jelmer J van Zanden
- Laboratory of Clinical Chemistry, Certe, Medical Laboratory North, Groningen, the Netherlands
| | - Klaas Hoogenberg
- Department of Internal Medicine, Martini Hospital, Groningen, the Netherlands
| | - Helen L Lutgers
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Alberdina W Klomp
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Fleurisca J Korteweg
- Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, the Netherlands
| | - Aren J van Loon
- Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, the Netherlands
| | - Bruce H R Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
| | - Paul P van den Berg
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Abstract
BACKGROUND There has been considerable interest in providing antenatal dietary and lifestyle advice for women with obesity or who are overweight during pregnancy, as a strategy to limit gestational weight gain and improve maternal and infant health. However, such antenatal interventions appear to have a modest effect on gestational weight gain and other clinical pregnancy and birth outcomes and additional strategies are required.Metformin is an oral insulin-sensitising medication that acts to decrease blood glucose concentrations. Metformin is commonly used in the treatment of type 2 diabetes mellitus and polycystic ovarian syndrome, and is being used increasingly in the treatment of gestational diabetes, having been shown to result in decreased rates of caesarean birth and neonatal hypoglycaemia. Metformin may be an adjuvant therapy to current antenatal strategies in pregnant women with obesity or who are overweight, acting to reduce glucose production in the liver and improve glucose uptake in smooth muscle cells, and therefore improve the overall metabolic health of women in pregnancy and reduce the risk of known adverse pregnancy outcomes. OBJECTIVES To evaluate the role of metformin in pregnant women with obesity or who are overweight, on maternal and infant outcomes, including adverse effects of treatment and costs. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (11 October 2017), and reference lists of retrieved studies. SELECTION CRITERIA All published and unpublished randomised controlled trials evaluating metformin use (compared with placebo or no metformin) in women with obesity or who are overweight in pregnancy for improving outcomes, alone or in combination with other interventions were eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We used the GRADE approach to assess the quality of the evidence. MAIN RESULTS We included three studies which randomised women (1099) with a body mass index (BMI) of 30 kg/m2 (1 study) and 35 kg/m2 (2 studies), with outcomes available for 1034 participants. None of the studies assessed women with a BMI between 25 kg/m2and 29.9 kg/m2, therefore we could not assess the use of metformin in women considered overweight. We did not identify studies of metformin in combination with another treatment. Two other studies are ongoing.All three included studies were randomised controlled trials and compared metformin with placebo, commencing early in the second trimester. Doses ranged from 500 mg twice daily to 3.0 g per day. All three studies (two in the UK, one in Egypt) included women attending hospitals for antenatal care.Two studies were generally at a low risk of bias across the majority of domains. We assessed the third study as being at an unclear risk of selection bias, performance and detection bias due to insufficient information in the report. We assessed the trial as being at a low risk of attrition bias and other bias; we felt it was at a high risk of reporting bias.The primary outcome for this review was infant birthweight large-for-gestational-age (> 90th centile for gestational age and infant sex). Women who received metformin or placebo had a similar risk of their baby being born large for his or her gestational age (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.70 to 1.30; 2 studies, 831 infants; high-quality evidence).Women who received metformin may have a slightly lower gestational weight gain (mean difference (MD) -2.60 kg, 95% CI -5.29 to 0.10; 3 studies, 899 women; low-quality evidence).Metformin may make little or no difference in the risk of women developing gestational hypertension (average RR 1.02, 95% CI 0.54 to 1.94; 3 studies, 1040 women; low-quality evidence) or pre-eclampsia (RR 0.74, 95% CI 0.09 to 6.28; 2 studies, 840 women; low-quality evidence). Metformin probably makes little or no difference in the risk of women developing gestational diabetes (RR 0.85, 95% CI 0.61 to 1.19; 3 studies, 892 women; moderate-quality evidence).One study of 400 women reported women receiving metformin were more likely to experience any adverse effect compared with women receiving placebo (RR 1.63, 95% CI 1.27 to 2.08; 1 study, 400 women). Adverse effects included abdominal pain, diarrhoea, or headache. When considering individual side effects, women receiving metformin were more likely to experience diarrhoea than women receiving placebo (RR 2.34, 95% CI 1.74 to 3.14; 797 women; 2 studies, 797 women; high-quality evidence). No other important differences were identified between Metformin and placebo for other maternal secondary outcomes, including: caesarean birth, birth before 37 weeks of pregnancy, shoulder dystocia, perineal tear, or postpartum haemorrhage.In terms of other infant outcomes, there was little or no difference in the infant birthweight (MD 6.39 g, 95% CI -81.15 to 93.92; 2 studies, 834 infants; high-quality evidence). There were no other important differences identified for other infant secondary outcomes in this review: hypoglycaemia (low blood sugar); hyperbilirubinaemia (jaundice); Apgar score less than 7 at five minutes; or stillbirth and neonatal death. Only one study reported admission to the neonatal intensive care unit (NICU), indicating similar rates of admission between women receiving metformin or placebo; no other admission data were reported to assess differences in costs. AUTHORS' CONCLUSIONS There is insufficient evidence to support the use of metformin for women with obesity in pregnancy for improving maternal and infant outcomes. Metformin was, however, associated with increased risk of adverse effects, particularly diarrhoea. The quality of the evidence in this review varied from high to low, with downgrading decisions based on study limitations and inconsistency.There were only a small number of studies included in this review. Furthermore, none of the included studies included women categorised as 'overweight' and no trials looked at metformin in combination with another treatment.Future research is required in order to further evaluate the role of metformin therapy in pregnant women with obesity or who are overweight, as a strategy to improve maternal and infant health, alone or as an adjuvant to dietary and lifestyle advice.
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Affiliation(s)
- Jodie M Dodd
- The University of Adelaide, Women's and Children's HospitalSchool of Paediatrics and Reproductive Health, Discipline of Obstetrics and Gynaecology72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Rosalie M Grivell
- Flinders University and Flinders Medical CentreDepartment of Obstetrics and GynaecologyBedford ParkSouth AustraliaAustraliaSA 5042
| | - Andrea R Deussen
- The University of Adelaide, Women's and Children's HospitalSchool of Paediatrics and Reproductive Health, Discipline of Obstetrics and Gynaecology72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - William M Hague
- Women's and Children's HospitalKing William RoadAdelaideSouth AustraliaAustraliaSA 5006
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Yang Z, Phung H, Freebairn L, Sexton R, Raulli A, Kelly P. Contribution of maternal overweight and obesity to the occurrence of adverse pregnancy outcomes. Aust N Z J Obstet Gynaecol 2018; 59:367-374. [PMID: 30024043 DOI: 10.1111/ajo.12866] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 06/19/2018] [Indexed: 12/24/2022]
Abstract
AIMS Maternal overweight and obesity in pregnancy are known to increase the risk of a range of complications and adverse pregnancy outcomes. This study estimates the population-level contribution of maternal overweight and obesity to adverse pregnancy outcomes. METHODS Data derived from the Australian Capital Territory (ACT) Maternal and Perinatal Data Collection were analysed. A total of 24 161 women who had a singleton birth in 2009-2015, with maternal weight and height information available, were included. In this study, the association between risk factors and outcomes was investigated using multilevel regression modelling. Based on model predictions under various hypothetical maternal weight scenarios, the number and proportion of adverse perinatal outcomes that could be potentially prevented were estimated. RESULTS Maternal overweight and obesity were associated with increased risks of gestational diabetes mellitus (GDM), pre-eclampsia, caesarean delivery, preterm birth (PTB), large for gestational age (LGA) and admission to the special care nursery or neonatal intensive care unit (SCN/NICU). The estimated proportions of adverse pregnancy outcomes attributable to overweight and obesity in pregnancy are 29.3% for GDM, 36.2% for pre-eclampsia, 15.5% for caesarean delivery, 21.6% for longer antenatal stay in hospital (≥2 days), 16.3% for extreme PTB, 25.2% for LGA and 6.5% for SCN/NICU admission. CONCLUSIONS Maternal overweight and obesity contribute to a large proportion of obstetric complications and adverse outcomes in the ACT. Effective intervention strategies to reduce the prevalence of overweight and obesity in pregnant women could have significant beneficial effects on pregnancy outcomes.
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Affiliation(s)
- Zongjian Yang
- Population Health Protection and Prevention, ACT Health Directorate, Canberra, Australia
| | - Hai Phung
- Population Health Protection and Prevention, ACT Health Directorate, Canberra, Australia
| | - Louise Freebairn
- Population Health Protection and Prevention, ACT Health Directorate, Canberra, Australia
| | - Rosalind Sexton
- Population Health Protection and Prevention, ACT Health Directorate, Canberra, Australia
| | - Alexandra Raulli
- Population Health Protection and Prevention, ACT Health Directorate, Canberra, Australia
| | - Paul Kelly
- Population Health Protection and Prevention, ACT Health Directorate, Canberra, Australia.,Medical School, Australian National University, Canberra, Australia
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Poprzeczny AJ, Louise J, Deussen AR, Dodd JM. The mediating effects of gestational diabetes on fetal growth and adiposity in women who are overweight and obese: secondary analysis of the LIMIT randomised trial. BJOG 2018; 125:1558-1566. [PMID: 29782075 DOI: 10.1111/1471-0528.15288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the mediating effect of maternal gestational diabetes on fetal biometry and adiposity measures among overweight or obese pregnant women. DESIGN Secondary analysis of the LIMIT randomised trial. SETTING Public hospitals, metropolitan Adelaide, South Australia. POPULATION Pregnant women with body mass index (BMI) ≥25 kg/m2 and singleton gestation. METHODS Fetal ultrasound measures at 36 weeks of gestation and baseline BMI from women randomised to the LIMIT trial Standard Care group (n = 912 women) were used to conduct causal mediation analyses using regression-based methods. MAIN OUTCOMES MEASURES Ultrasound measures of fetal biometry and adiposity at 36 weeks of gestation. RESULTS Increased maternal BMI was associated with increased measures of fetal head circumference [direct (unmediated) effect 0.18 (95% CI: 0.05-0.31), P = 0.005; total effect 0.17 (95% CI: 0.02-0.31), P = 0.018], abdominal circumference [direct effect 0.26 (95% CI: 0.11-0.41), P = 0.001; total effect 0.26 (95% CI: 0.11-0.42), P = 0.001] and estimated fetal weight [direct effect 0.22 (95% CI: 0.08-0.35), P = 0.002; total effect 0.22 (95% CI: 0.08-0.35), P = 0.002], with no evidence of mediation by treated gestational diabetes. There was no apparent association between maternal BMI and fetal adiposity measures, or mediation by treated gestational diabetes. CONCLUSIONS We show an important association between increased maternal BMI and fetal growth, not mediated by treated gestational diabetes. There was no association between increased maternal BMI and fetal adiposity measures, or mediation by treated gestational diabetes. Whether these findings represent 'saturation' in the effect of maternal BMI on fetal growth or the effect of treatment of GDM is unclear. FUNDING This project was funded by a 4-year project grant from the National Health and Medical Research Council (NHMRC), Australia (ID 519240); The Channel 7 Children's Research Foundation, South Australia; and the US National Institutes of Health (R01 HL094235-01). TWEETABLE ABSTRACT Increased fetal growth associated with maternal obesity is not mediated by gestational diabetes.
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Affiliation(s)
- A J Poprzeczny
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.,Department of Obstetrics and Gynaecology, Lyell McEwin Hospital, Elizabeth, SA, Australia
| | - J Louise
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.,School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - A R Deussen
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - J M Dodd
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.,Department of Perinatal Medicine, Women's and Babies Division, The Women's and Children's Hospital, Adelaide, SA, Australia
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Moran LJ, McNaughton SA, Sui Z, Cramp C, Deussen AR, Grivell RM, Dodd JM. The characterisation of overweight and obese women who are under reporting energy intake during pregnancy. BMC Pregnancy Childbirth 2018; 18:204. [PMID: 29859056 PMCID: PMC5984749 DOI: 10.1186/s12884-018-1826-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 05/15/2018] [Indexed: 11/16/2022] Open
Abstract
Background Misreporting of energy intake is common and can contribute to biased estimates of the relationship between diet and disease. Energy intake misreporting is poorly understood in pregnancy and there is limited research assessing characteristics of women who misreport energy intake or changes in misreporting of energy intake across pregnancy. Methods An observational study in n = 945 overweight or obese pregnant women receiving standard antenatal care who participated in the LIMIT randomised trial. Diet, physical activity, psychological factors, body image satisfaction and dieting behaviour were assessed at trial entry (10–20 weeks gestation) and 36 weeks gestation. Energy misreporting status was assessed through the ratio of daily energy intake over basal metabolic rate. Logistic regression analyses were conducted with the dependent variable of under reporting of energy intake at study entry or 36 weeks in separate analysis. Results At study entry and 36 weeks, women were classified as under reporters (38 vs 49.4%), adequate reporters (59.7 vs 49.8%) or over reporters of energy intake (2.3 vs 0.8%) respectively. The prevalence of under reporting energy intake at 36 weeks was higher than at study entry (early pregnancy). Body mass index (BMI) at study entry and 36 weeks and socioeconomic status, dieting behaviour and risk of depression at 36 weeks were independent predictors of under reporting of energy intake. Conclusions Under reporting of energy intake was present in over a third of overweight and obese pregnant women and was higher in late compared to early pregnancy. Characteristics such as BMI, socioeconomic status, past dieting behaviour and risk of depression may aid in identifying women who either require support in accurate recording of food intake or attention for improving diet quality. Results were unable to distinguish whether under reporting reflects misreporting or a true restriction of dietary intake. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12607000161426, registered 9/3/2007. Electronic supplementary material The online version of this article (10.1186/s12884-018-1826-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L J Moran
- The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, VIC, 3168, Australia. .,Monash Centre for Health Research Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia.
| | - S A McNaughton
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Z Sui
- The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, VIC, 3168, Australia
| | - C Cramp
- The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, VIC, 3168, Australia
| | - A R Deussen
- The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, VIC, 3168, Australia
| | - R M Grivell
- The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, VIC, 3168, Australia.,Department of Perinatal Medicine, Women's & Babies Division, Women's and Children's Hospital, North Adelaide, Adelaide, Australia
| | - J M Dodd
- The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, VIC, 3168, Australia.,Department of Perinatal Medicine, Women's & Babies Division, Women's and Children's Hospital, North Adelaide, Adelaide, Australia
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48
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Davis D, Davey R, Williams LT, Foureur M, Nohr E, Knight-Agarwal C, Lawlis T, Oats J, Skouteris H, Fuller-Tyszkiewicz M. Optimizing Gestational Weight Gain With the Eating4Two Smartphone App: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e146. [PMID: 29848468 PMCID: PMC6000478 DOI: 10.2196/resprot.9920] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/26/2018] [Accepted: 03/26/2018] [Indexed: 11/19/2022] Open
Abstract
Background Approximately 50% of women gain excessive weight in pregnancy. Optimizing gestational weight gain is important for the short- and long-term health of the childbearing woman and her baby. Despite this, there is no recommendation for routine weighing in pregnancy, and weight is a topic that many maternity care providers avoid. Resource-intensive interventions have mainly targeted overweight and obese women with variable results. Few studies have examined the way that socioeconomic status might influence the effectiveness or acceptability of an intervention to participants. Given the scale of the problem of maternal weight gain, maternity services will be unlikely to sustain resource intensive interventions; therefore, innovative strategies are required to assist women to manage weight gain in pregnancy. Objective The primary aim of the trial was to examine the effectiveness of the Eating4Two smartphone app in assisting women of all body mass index categories to optimize gestational weight gain. Secondary aims include comparing childbirth outcomes and satisfaction with antenatal care and examining the way that relative advantage and disadvantage might influence engagement with and acceptability of the intervention. Methods This randomized controlled trial will randomize 1330 women to control or intervention groups in 3 regions of different socioeconomic status. Women will be recruited from clinical and social media sites. The intervention group will be provided with access to the Eating4Two mobile phone app which provides nutrition and dietary information specifically tailored for pregnancy, advice on food serving sizes, and a graph that illustrates women’s weight change in relation to the range recommended by the Institute of Medicine. Women will be encouraged to use the app to prompt conversations with their maternity care providers about weight gain in pregnancy. The control group will receive routine antenatal care. Results Recruitment has commenced though the recruitment rate is slower than expected. Additional funds are required to employ research assistants and promote the study in an advertising campaign. Conclusion Feasibility testing highlighted the inadequacy of the original recruitment strategy and the need to provide the app in both major platforms (Android and iOS). Smartphone technologies may offer an effective alternative to resource intensive strategies for assisting women to optimize weight gain in pregnancy. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12617000169347; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371470 (Archived by WebCite at http://www.webcitation.org /6zDvgw5bo) Registered Report Identifier RR1-10.2196/9920
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Affiliation(s)
- Deborah Davis
- University of Canberra, Canberra, Australia.,ACT Government Health Directorate, Canberra, Australia
| | - Rachel Davey
- Centre for Research & Action in Public Health, Health Research Institute, University of Canberra, Canberra, Australia
| | - Lauren T Williams
- Menzies Health Institute of Queensland, Griffith University, Southport, Australia
| | - Maralyn Foureur
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, Australia
| | - Ellen Nohr
- Institute of Clinical Research, University of Southern Denmark, Odense, Australia
| | | | - Tanya Lawlis
- Faculty of Health, University of Canberra, Sydney, Australia
| | - Jeremy Oats
- Melbourne School Population & Global Health, The University of Melbourne, Melbourne, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
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Kennedy N, Quinton A, Peek MJ, Lanzarone V, Benzie R, Nanan R. Anthropometric and ultrasound measures of maternal adiposity in the first trimester of pregnancy. Australas J Ultrasound Med 2018; 21:147-155. [PMID: 34760515 DOI: 10.1002/ajum.12092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Aim Estimations of central adiposity in pregnancy is a difficult undertaking due to physiological changes that occur in the body. Therefore, the value of some anthropometric measures particularly in pregnancy, such as body mass index (BMI), waist and hip measures are in doubt. The aim was to compare ultrasound (US) measured abdominal subcutaneous fat (USSFT) with other simple anthropometric methods for obesity assessment, evaluating these measures in pregnancy. Method Recruited from a larger study, anthropometric measurements were performed between 11-14 weeks' gestation on 575 women. Measuring height, weight, hip, waist circumference, skin-folds of the triceps, thigh and supra-iliac and USSFT. Percentage maternal fat mass was calculated using skin-fold measures. Correlations of these measures were performed to gauge relationships. Results The anthropometric measures demonstrated good correlation (0.54-0.93) between individual adipose measures skin-folds, waist, hip, waist to height ratio (WSR) and USSFT with BMI, percentage fat mass and weight. USSFT correlated well with all anthropometric measures (0.54-0.73) correlating best with waist, WSR, BMI and weight. Waist/hip ratio demonstrated a poor correlation with USSFT, BMI, percentage fat mass and weight (0.3-0.41). Mean anthropometric measures were stratified across BMI categories describing adiposity distribution. Conclusion USSFT correlates well with most anthropometric measures in early pregnancy. Limitations of the gravid uterus on waist measurements, hydration and compressibility of skin-fold measures and pregnancy influences on weight and BMI assessments could be overcome using US measures. There is a potential for post hoc evaluation using US for pregnancy complications. Maternal research could benefit from a more accurate measure of adiposity.
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Affiliation(s)
- Narelle Kennedy
- Discipline of Obstetrics, Gynaecology and Neonatology Sydney Medical School Nepean University of Sydney Nepean Hospital Penrith New South Wales 2750 Australia.,Christopher Kohlenberg Department of Perinatal Ultrasound Nepean Hospital Penrith New South Wales 2750 Australia
| | - Ann Quinton
- Discipline of Obstetrics, Gynaecology and Neonatology Sydney Medical School Nepean University of Sydney Nepean Hospital Penrith New South Wales 2750 Australia.,Medical Sonography School of Health, Medical and Applied Science Central Queensland University Sydney New South Wales 2000 Australia
| | - Michael John Peek
- ANU Medical School College of Health and Medicine The Australian National University Centenary Hospital for Women and Children Garran Australian Capital Territory 2605 Australia
| | - Valeria Lanzarone
- Discipline of Obstetrics, Gynaecology and Neonatology Sydney Medical School Nepean University of Sydney Nepean Hospital Penrith New South Wales 2750 Australia.,Ultrasound for Women Penrith Nepean Hospital Penrith New South Wales Australia
| | - Ron Benzie
- Discipline of Obstetrics, Gynaecology and Neonatology Sydney Medical School Nepean University of Sydney Nepean Hospital Penrith New South Wales 2750 Australia.,Christopher Kohlenberg Department of Perinatal Ultrasound Nepean Hospital Penrith New South Wales 2750 Australia
| | - Ralph Nanan
- Discipline of Obstetrics, Gynaecology and Neonatology Sydney Medical School Nepean University of Sydney Nepean Hospital Penrith New South Wales 2750 Australia.,Charles Perkins Centre, Nepean Sydney New South Wales Australia
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Dodd JM, Deussen AR, Louise J. Optimising gestational weight gain and improving maternal and infant health outcomes through antenatal dietary, lifestyle and physical activity advice: the OPTIMISE randomised controlled trial protocol. BMJ Open 2018; 8:e019583. [PMID: 29463591 PMCID: PMC5855335 DOI: 10.1136/bmjopen-2017-019583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Obesity represents a significant health burden, and WHO recognises the importance of preventing weight gain and subsequent development of obesity among adults who are within the healthy weight range. Women of reproductive age have demonstrated high rates of weight gain during pregnancy placing them at risk of becoming overweight or obese. We will evaluate the effects of dietary and physical activity advice on maternal, fetal and infant health outcomes, among pregnant women of normal body mass index (BMI). METHODS AND ANALYSIS We will conduct a randomised controlled trial, consenting and randomising women with a live singleton pregnancy between 10+0 and 20+0 weeks and BMI 18.5-24.9 kg/m2 at first antenatal visit, from a tertiary maternity hospital. Women randomised to the Lifestyle Advice Group will receive three face-to-face sessions (two with a research dietitian and one with a trained research assistant) and three telephone calls over pregnancy, in which they will be provided with dietary and lifestyle advice and encouraged to make change using a SMART goals approach. Women randomised to the Standard Care Group will receive routine antenatal care. The primary outcome is infant birth weight >4 kg. Secondary outcomes will include adverse infant and maternal outcomes, maternal weight change, maternal diet and physical activity changes, maternal quality of life and emotional well-being, fetal growth and costs of healthcare. We will recruit 624 women to detect a reduction from 8.72% to 3.87% (alpha 0.05 (two-tailed); power 70%) in infants with birth weight >4 kg. Analyses will be intention to treat with estimates reported as relative risks and 95% CIs. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Women's and Children's Hospital ethics committee. Findings will be disseminated widely via journal publication and conference presentation(s), and participants informed of results. TRIAL REGISTRATION NUMBER ACTRN12614000583640.
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Affiliation(s)
- Jodie M Dodd
- Discipline of Obstetrics and Gynaecology, Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Perinatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Andrea R Deussen
- Discipline of Obstetrics and Gynaecology, Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jennie Louise
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
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