Environmental and individual factors associated with gestational weight gain

Association of Community Characteristics as Measured by Social Deprivation Index Score with Prenatal Care and Obstetrical Outcomes

OBJECTIVE

 We aimed to determine the relationships between socioeconomic disadvantage, as measured by the Social Deprivation Index (SDI), and prenatal care (PNC) utilization, obstetrical outcomes, and neonatal complications.

STUDY DESIGN

 All spontaneously conceived singleton deliveries of nulliparous gravida with residence zip code available (n = 4,786) were identified in a population-based database. Deliveries were assigned SDI scores based on preconception zip code. SDI scores (1-100) are a composite measure of seven community demographic characteristics of poverty, education, transportation, employment, and household composition. SDI scores were categorized into quartiles and grouped for analysis (Q1 [n = 1,342], Q2 + 3 [n = 1,752], and Q4 [n = 1,692]) with higher scores indicative of greater disadvantage. Statistical analysis was performed using a generalized linear mixed method.

RESULTS

 Among our cohort, gravida in the lowest (least-deprived) SDI quartile (Q1) were older, had lower prepregnancy body mass indices, and were more likely to receive PNC from a physician specializing in Obstetrics and Gynecology. Gravida residing in the highest (most-deprived) SDI quartile (Q4) attended fewer prenatal visits (mean [standard deviation] 11.17 [2.9]) than those living in Q1 (12.04 [2.3], p < 0.0001). Gravida in Q4 were less likely to receive sufficient PNC compared with those in Q1 (52 vs. 64.2%, p < 0.0001) and were more likely to fail to achieve appropriate gestational weight gain (GWG) (19.6 in Q4 vs. 15.9% in Q1, p < 0.01). No significant differences in composite maternal (CMM) or neonatal morbidity (CNM) were associated with SDI quartile.

CONCLUSION

 Outer quartile social deprivation was associated with higher proportions of primigravida not meeting recommendations for GWG and attending fewer prenatal visits, but it did not affect CMM or CNM. Improving care access and providing nutritional support to all gravida are likely important steps toward health equity.

KEY POINTS

· Neighborhood social deprivation was not associated with composite maternal or neonatal morbidity.. · Community-level deprivation was associated with decreased PNC utilization.. · It is important to understand the underlying disparities that lend to suboptimal patterns of PNC.. · Doing so may inform programs that promote favorable birth outcomes in at-risk communities..

Exploring Beliefs, Concerns, Prenatal Care Advice, and Sources of Information About Gestational Weight Gain Among Immigrant Central American Pregnant Women in the United States

Gestational weight gain (GWG) is critical for maternal and neonatal health, but excessive GWG can lead to complications such as gestational diabetes, hypertension, and increased obesity risk later in life. Minoritized and immigrant women often face higher risks of excessive GWG. This cross-sectional study assessed Central American women's beliefs and concerns about GWG, the receipt of advice from healthcare providers, and sources of information for healthy weight management during pregnancy. A cross-sectional survey was conducted with 93 pregnant women from El Salvador (31.2%), Guatemala (46.2%), and Honduras (22.6%). Most participants were married (91.4%), and 91.2% had household incomes below $40,000. Self-reported pre-pregnancy weight status varied significantly (p = 0.03), with more Guatemalans self-reporting as overweight (34.9%) compared to Salvadorans (10.3%) and Hondurans (19.1%). Beliefs about GWG varied significantly; 72.1% of Guatemalan women accepted "eating for two", while only 31.0% of Salvadorans did (p = 0.002). More Honduran women (90.5%) received weight gain recommendations from healthcare providers than Salvadorans (62.1%) and Guatemalans (60.5%) (p = 0.04). The Internet and family were common information sources on weight management, highlighting the need for culturally tailored health education. This study underscores critical differences in beliefs and access to prenatal care among pregnant Central American immigrant women, emphasizing the importance of culturally competent health education to support healthy pregnancy outcomes.

Gestational weight gain and its determinants among pregnant women in Gurage zone, Central Ethiopia: a cohort study

BACKGROUND

The nutritional status of the mothers before pregnancy and the weights gained during pregnancy are very crucial factors affecting the pregnancy outcomes and health of the infants. This study aimed to assess early pregnancy weight, determine the magnitude of gestational weight gain, and investigate the factors affecting gestational weight gain among pregnant women in the Gurage zone, 2022.

METHODS

A prospective cohort study was conducted among pregnant women who started antenatal care follow-up before the 16th week of gestation in the selected hospitals and health centers of the Gurage zone, Ethiopia. The gestational weight gain was obtained by subtracting the early pregnancy weight from the last pregnancy weight and categorizing based on the Institute of Medicine (IOM) recommendation.

RESULTS

The early pregnancy weight status of the women at enrollment indicates that 10% of them were underweight and 83% of them had normal weight. On average, the study participants gained 13.3 kgs of weight with [95% CI: 13.0, 13.6]. More than half (56%) of them gained adequate weight, a quarter (26%) of them gained inadequate weight, and 18% of them gained excess weight during pregnancy compared to the IOM recommendation. Maternal age, occupational status, and early pregnancy weight status were found to have a statistically significant association with the gestational weight gained.

CONCLUSION

Almost half (44%) of the pregnant women gained either inadequate or excess weight during pregnancy. Promoting gestational weight gain within recommended guidelines should be emphasized for younger, employed women and those who are either underweight or overweight.

Barriers to implementing good nutrition in pregnancy and early childhood: Creating equitable national solutions

Exposure to deleterious stressors in early life, such as poor nutrition, underlies most adult-onset chronic diseases. As rates of chronic disease continue to climb in the United States, a focus on good nutrition before and during pregnancy, lactation, and early childhood provides a potential opportunity to reverse this trend. This report provides an overview of nutrition investigations in pregnancy and early childhood and addresses racial disparities and health outcomes, current national guidelines, and barriers to achieving adequate nutrition in pregnant individuals and children. Current national policies and community interventions to improve nutrition, as well as the current state of nutrition education among healthcare professionals and students, are discussed. Major gaps in knowledge and implementation of nutrition practices during pregnancy and early childhood were identified and action goals were constructed. The action goals are intended to guide the development and implementation of critical nutritional strategies that bridge these gaps. Such goals create a national blueprint for improving the health of mothers and children by promoting long-term developmental outcomes that improve the overall health of the US population.

Association of COVID-19 pandemic societal closures with gestational weight gain among women in South Carolina, 2018-2021

PURPOSE

During the early COVID-19 pandemic, an increase in weight gain among the general population was observed; however, gestational weight gain (GWG) was not thoroughly evaluated. We evaluated changes in GWG during the pandemic closures in South Carolina.

METHODS

We used live, singleton birth records to compare GWG outcomes among three pregnancy groups occurring before (January 2018-February 2020), during (March-May 2020), and after (June 2020-December 2021) pandemic closures. GWG categories were defined by the Institute of Medicine (IOM) recommendations. We used multinomial logistic regression models to calculate prevalence ratios (PRs) of GWG categories stratified by prepregnancy body mass index (BMI) category.

RESULTS

We analyzed 177,571 birth records. Women with normal weight (n = 64,491, 36%) had a slightly lower prevalence of excessive GWG during and after the pandemic closures (PR 0.94; 95% CI: 0.91-0.98 and PR 0.95; 95% CI: 0.93-0.98, respectively). We observed no changes in GWG patterns for women with overweight and obesity.

CONCLUSIONS

We found limited changes in GWG patterns for a subset of pregnant women during and after pandemic closures, compared with prepandemic period in South Carolina, countering findings of weight changes among the general population.

Impact of the Neighborhood Food Environment on Dietary Intake and Obesity: a Review of the Recent Literature

PURPOSE OF REVIEW

The built environment impacts obesogenic behaviors and in turn body weight outcomes. This review summarizes recent research demonstrating environmental impacts on dietary intake and obesity with a specific focus on the neighborhood food environment.

RECENT FINDINGS

In the previous five years, an abundance of reviews and research studies have been undertaken to elucidate how the neighborhood food environment impacts diet and obesity. This includes studies using primary data collection and secondary data analyses in various populations across the globe. Taken together, current research presents mixed evidence on the impact of the neighborhood food environment on both dietary intake and obesity. While there is some evidence that certain features of the neighborhood food environment influence health behaviors and outcomes in particular populations, it is imperative to acknowledge the complexity of how neighborhood features interact and constantly evolve when considering place-based influences on health behaviors and outcomes.

Gestational weight gain among pregnant women in Ibadan, Nigeria: Pattern, predictors and pregnancy outcomes

BACKGROUND

Gestational weight gain (GWG) is a risk factor for adverse pregnancy outcomes, future obesity and chronic diseases among women. However, has not received much attention in many low and middle-income countries such as Nigeria. We investigated the pattern, associated factors and pregnancy outcomes of GWG in Ibadan, Nigeria, using the Ibadan Pregnancy Cohort Study (IbPCS).

METHODOLOGY

The IbPCS is a multicentre prospective cohort study conducted among 1745 pregnant women recruited from four health facilities in Ibadan, Nigeria. GWG, the primary outcome, was categorised according to the Institute of Medicine's classification into insufficient, adequate and excessive weight gain. Pregnancy outcomes were the secondary outcome variables. Logistic regression analysis (Adjusted odds ratios and 95% confidence interval CI) was used to examine associations, and Poisson regression analyses were used to investigate associations with outcomes.

RESULTS

Only 16.9% of women had optimal GWG, 56.8% had excessive GWG, and 26.9% had insufficient GWG. Excessive GWG was associated with high income '> #20,000-' (AOR: 1.64, 95% CI: 1.25-2.17), being overweight (AOR: 2.12, 95% CI: 1.52-2.95) and obese (AOR: 1.47, 95% CI: 1.02-2.13) after adjusting for confounders. In contrast, increased odds of insufficient GWG have associated women with depression (AOR: 1.70, 95% CI 1.17-2.47). There was no significant association between inappropriate GWG and pregnancy outcomes However, there was an increased odds for postpartum haemorrhage (AOR: 2.44, 95% CI 1.14-5.22) among women with obesity and excessive GWG.

CONCLUSIONS

Excessive GWG was the most typical form of GWG among our study participants and was associated with high maternal income, and being overweight or obese. GWG needs to be monitored during antenatal care, and interventions that promote appropriate GWG should be implemented among pregnant women in Nigeria.

Prevalence and related factors of inappropriate gestational weight gain among pregnant women with overweight/ obesity in Thailand

BACKGROUND

An inappropriate gestational weight gain (GWG) among pregnant women with overweight/obesity is a crucial health problem. Its prevalence remains high worldwide, particularly in urban areas. The prevalence and predicting factors in Thailand are lack of evidence. This study aimed to investigate prevalence rates, antenatal care (ANC) service arrangement, predictive factors, and impacts of inappropriate GWG among pregnant women with overweight/obesity in Bangkok and its surrounding metropolitan area.

METHODS

This cross-sectional, retrospective study used four sets of questionnaires investigating 685 pregnant women with overweight/obesity and 51 nurse-midwives (NMs) from July to December 2019 in ten tertiary hospitals. Multinomial logistic regression identified predictive factors with a 95% confidence interval (CI).

RESULT

The prevalence rates of excessive and inadequate GWG were 62.34% and 12.99%. Weight management for pregnant women with overweight/obesity are unavailable in tertiary cares. Over three-fourths of NMs have never received weight management training for this particular group. ANC service factors, i.e., GWG counseling by ANC providers, quality of general ANC service at an excellent and good level, NMs' positive attitudes toward GWG control, significantly decreased the adjusted odds ratio (AOR) of inadequate GWG by 0.03, 0.01, 0.02, 0.20, times, respectively. While maternal factors, sufficient income, and easy access to low-fat foods reduce AOR of inadequate GWG by 0.49, and 0.31 times. In contrast, adequate maternal GWG knowledge statistically increased the AOR of inadequate GWG 1.81 times. Meanwhile, easy access to low-fat foods and internal weight locus of control (WLOC) decreased the AOR of excessive GWG by 0.29 and 0.57 times. Finally, excessive GWG significantly increased the risk of primary C/S, fetal LGA, and macrosomia 1.65, 1.60, and 5.84 times, respectively, while inadequate GWG was not associated with adverse outcomes.

CONCLUSION

Prevalence rates of inappropriate GWG, especially excessive GWG remained high and affected adverse outcomes. The quality of ANC service provision and appropriate GWG counseling from ANC providers are significant health service factors. Thus, NMs should receive gestational weight counseling and management training to improve women's knowledge and practice for gestational weight (GW) control.