Maternal Pre-Pregnancy BMI, Breastfeeding, and Child BMI

Weight management during pregnancy, what is new?

PURPOSE OF REVIEW

The prevalence of women entering pregnancy with overweight or obesity is increasing which raises concerns for adverse outcomes for mothers and their infants. Evidence suggests that appropriate gestational weight gain is important, irrespective of maternal BMI. The aim of this present article is to review the evidence on weight management during pregnancy and evaluate the evidence on current interventions.

RECENT FINDINGS

There is currently no standardized definition of 'excessive' gestational weight gain or a unified approach to manage gestational weight, despite the rising prevalence of maternal overweight and obesity globally. Recently, the Dietary Intervention in Gestational Diabetes (DiGest) trial showed promising results for energy restriction as a potential strategy to reduce gestational weight gain and improve maternal and infant outcomes. Pharmacological treatments, including GLP-1 receptor agonists, also show promise, but safety concerns remain requiring further research. More studies are needed to assess the effectiveness of both lifestyle and pharmacological interventions to guide future clinical recommendations.

SUMMARY

There is a need for individualized guidelines that consider maternal characteristics including ethnicity, preexisting conditions and emerging health risks, to tackle weight management during pregnancy and improve pregnancy outcomes. Further research is needed on optimal weight management strategies during pregnancy.

Impact of Laser-Assisted Hatching on Cognitive and Metabolic Development of Singletons Conceived Through Frozen-Thawed Embryo Transfer: A Matched Cohort Study

OBJECTIVE

This study aimed to examine the impact of laser-assisted hatching (LAH) on the physical, metabolic, cognitive and behavioural profiles of singletons conceived through frozen-thawed embryo transfer (FET) at the preschool age.

DESIGN

A matched cohort study.

SETTING

The reproductive centre of Women's Hospital, Zhejiang University School of Medicine.

POPULATION

Singletons born to couples with infertility who underwent FET cycles with or without LAH treatment from 2016 to 2019 and were followed up till age 4-6 years in 2023.

METHODS

Cognitive and behavioural development was evaluated at the preschool age using the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) and the Adaptive Behavior Assessment System, Second Edition (ABAS-II). Statistical analysis was performed using moderated multiple linear regression.

MAIN OUTCOME MEASURES

The full-scale intelligence quotient (FSIQ) and general adaptive composite (GAI).

RESULTS

In total, 120 pairs of mother and child were included in the analysis. No significant differences in age, sex, height, weight, body mass index, blood pressure, thyroid function and metabolic indicators were observed between the two groups. After adjusting for demographics and socioeconomic status, LAH singletons showed FSIQ and GAI scores similar to those of non-LAH singletons.

CONCLUSIONS

At 4-6 years of age, the cognitive, metabolic and physical developmental outcomes of preschool children born after LAH treatment were comparable with those of the non-LAH group, indicating that LAH may be considered a safe assisted reproductive technology method. However, further longer and regular follow-ups are needed to validate the findings of this study.

Implementation of a Language-Concordant, Culturally Tailored Inpatient Lactation Program

Importance

Benefits of breastfeeding are extensive, but racial and ethnic disparities persist. Mama Sana (Spanish for healthy mother) is a bilingual, culturally tailored program that aims to reduce breastfeeding inequities.

Objective

To examine differences in lactation support and breastfeeding outcomes among Spanish-speaking Hispanic birthing parents who participated in Mama Sana compared with a historical control (pre-Mama Sana) group.

Design, Setting, and Participants

In this cohort study, patients who participated in the Mama Sana program during their delivery hospitalization from January 2022 to September 2023 were compared with a historical control group who delivered prior to the implementation of the program (July 2019 to December 2021). The study took place at an academic medical center in Boston with a high-risk obstetric service. Data were analyzed from January to September 2024.

Exposure

Beginning in January 2022, a bilingual native Spanish-speaker licensed as a registered dietitian and certified lactation counselor provided lactation support to participants during their delivery hospitalization with follow-up phone calls after discharge (until 6 months post partum).

Main Outcomes and Measures

The primary outcome was exclusive breastfeeding at discharge. Secondary outcomes included any breastfeeding at discharge, any breastfeeding and exclusive breastfeeding at 6 weeks post partum, and change in maternal body mass index (BMI). Process measures included inpatient lactation consult placement and receipt of any and language-concordant lactation support. The χ2 test was used to analyze outcomes, process measures, and balancing measures.

Results

In this study, 417 patients were included (Mama Sana group, 175 patients; mean [SD] age, 28.9 [6.1] years; pre-Mama Sana group: 242 patients; mean [SD] age, 29.8 [6.1] years). Sociodemographic characteristics including age and BMI were similar between groups. Mama Sana participants were less likely to be multiparous or to have diabetes compared with the pre-Mama Sana group. At hospital discharge, 36 of 175 Mama Sana participants (20.6%) were exclusively breastfeeding compared with 39 of 242 pre-Mama Sana (16.1%) (adjusted risk difference [aRD], 2.5%; 95% CI, -1.2 to 6.4). Significantly more Mama Sana participants engaged in any breastfeeding prior to hospital discharge (172 of 175 [98.3%] vs 222 of 242 [91.7%]; aRD, 7.1%; 95% CI, 2.8% to 11.5%) and at the 6 week postpartum visit (81 of 102 [79.4%] vs 109 of 170 [64.1%]; aRD, 15.6%; 95% CI, 4.8% to 26.4%) compared with the pre-Mama Sana group. More Mama Sana participants had a lactation consult placed (109 of 175 [62.3%] vs 108 of 242 [44.6%]; P < .001) and received lactation support in Spanish (175 of 175 [100%] vs 49 of 242 [20.3%]; P < .001) than those in the pre-Mama Sana group.

Conclusions and Relevance

In this cohort study, Mama Sana's language-concordant, culturally tailored lactation program was associated with higher rates of lactation support and some breastfeeding outcomes, which suggests the program may be a useful approach to perinatal care equity.

The intergenerational metabolic-cardiovascular life course: maternal body mass index (BMI), offspring BMI, and blood pressure of adolescents born extremely preterm

BACKGROUND

The aim of this study was to evaluate associations between pre-pregnancy maternal obesity and adolescent blood pressures (BPs) among children born extremely preterm.

METHODS

This longitudinal observational cohort study included participants in the multicenter Extremely Low Gestational Age Newborn (ELGAN) study, born before 28 weeks of gestation, recruited at birth between 2002 and 2004, and followed prospectively through late adolescence. Between 2015 and 2022, three oscillometric BPs were obtained from participants (mean age 17.8 years). We used linear regression modeling to evaluate the association between maternal self-reported pre-pregnancy body mass index (BMI) and offspring adolescent systolic BP (SBP). In secondary analyses, we evaluated the association between maternal pre-pregnancy and offspring preadolescent (10-year-old) BMI and between offspring preadolescent BMI and adolescent SBP.

RESULTS

The 100 (24%) participants born to a mother with a history of pre-pregnancy obesity (BMI ≥ 30) had a greater mean SBP of 120.5 (± 14.3) mmHg compared to the 324 (76%) of adolescents born to mothers without pre-pregnancy obesity (SBP 115.6 (± 12.0) mmHg). Pre-pregnancy obesity was associated with higher offspring BMI (aβ 10.8, 95% CI 2.3, 19.2), and higher offspring BMI was associated with higher adolescent SBP (aβ 0.12, 95% CI 0.09,0.16).

CONCLUSIONS

For ELGANs, higher maternal pre-pregnancy BMI was associated with higher adolescent SBP. Findings from secondary analyses suggest potential mediation through preadolescent BMI. Future research directions include multi-level interventions to reduce maternal pre-pregnancy obesity, followed by offspring obesity prevention interventions as a way of reducing intergenerational cardiovascular disease in high-risk infants born extremely preterm.

Profiles and predictors of child neurodevelopment and anthropometry: The maternal-infant research on environmental chemicals study

Background

Evaluating individual health outcomes does not capture co-morbidities children experience.

Purpose

We aimed to describe profiles of child neurodevelopment and anthropometry and identify their predictors.

Methods

Using data from 501 mother-child pairs (age 3-years) in the Maternal-Infant Research on Environmental Chemicals (MIREC) Study, a prospective cohort study, we developed phenotypic profiles by applying latent profile analysis to twelve neurodevelopmental and anthropometric traits. Using multinomial regression, we evaluated odds of phenotypic profiles based on maternal, sociodemographic, and child level characteristics.

Results

For neurodevelopmental outcomes, we identified three profiles characterized by Non-optimal (9%), Typical (49%), and Optimal neurodevelopment (42%). For anthropometric outcomes, we observed three profiles of Low (12%), Average (61%), and Excess Adiposity (27%). When examining joint profiles, few children had both Non-optimal neurodevelopment and Excess Adiposity (2%). Lower household income, lower birthweight, younger gestational age, decreased caregiving environment, greater maternal depressive symptoms, and male sex were associated with increased odds of being in the Non-optimal neurodevelopment profile. Higher pre-pregnancy body mass index was associated with increased odds of being in the Excess Adiposity profile.

Conclusions

Phenotypic profiles of child neurodevelopment and adiposity were associated with maternal, sociodemographic, and child level characteristics. Few children had both non-optimal neurodevelopment and excess adiposity.

Affective symptoms in pregnancy are associated with the vaginal microbiome

BACKGROUND

Composition of the vaginal microbiome in pregnancy is associated with adverse maternal, obstetric, and child health outcomes. Therefore, identifying sources of individual differences in the vaginal microbiome is of considerable clinical and public health interest. The current study tested the hypothesis that vaginal microbiome composition during pregnancy is associated with an individual's experience of affective symptoms and stress exposure.

METHODS

Data were based on a prospective longitudinal study of a medically healthy community sample of 275 mother-infant pairs. Affective symptoms and stress exposure and select measures of associated biomarkers (diurnal salivary cortisol, serum measures of sex hormones) were collected at each trimester; self-report, clinical, and medical records were used to collect detailed data on socio-demographic factors and health behavior, including diet and sleep. Vaginal microbiome samples were collected in the third trimester (34-40 weeks) and characterized by 16S rRNA sequencing. Identified taxa were clustered into three community clusters (CC1-3) based on dissimilarity of vaginal microbiota composition.

RESULTS

Results indicate that depressive symptoms during pregnancy were reliably associated with individual taxa and CC3 in the third trimester. Prediction of functional potential from 16S taxonomy revealed a differential abundance of metabolic pathways in CC1-3 and individual taxa, including biosynthetic pathways for serotonin and dopamine. We did not find robust evidence linking symptom- and stress-related biomarkers and CCs.

CONCLUSIONS

Our results provide further evidence of how prenatal psychological distress during pregnancy alters the maternal-fetal microbiome ecosystem that may be important for understanding maternal and child health outcomes.

Breastfeeding duration and nutritional status of infants and toddlers in Spain. LAyDI study (PAPenRed)

INTRODUCTION

Breastfeeding appears to protect the onset of obesity in infants. The aim is to know whether breastfeeding duration is associated with the risk of obesity in infants and toddlers aged 12 and 24 months.

MATERIAL AND METHODS

Prospective longitudinal study in a cohort of children born in Spain between April 2017 and March 2018 (LAyDI study) in the paediatric primary care system conducted in the framework of the PAPenRed research network. Analysis of breastfeeding duration (group 1: fewer than 6 months; group: more than 6 months) and its association with anthropometric variables.

RESULTS

A total of 1495 patients attended the 12 months preventive child health visit and 1073 patients the 24 months visit. We found a statistically significant association between breastfeeding duration and weight-for-age, BMI-for-age and weight-for-length/height at 12 and 24 months; breastfeeding duration of less than 6 months was significantly associated with overweight and obesity (based on BMI-for-age and weight-for-length/height) at ages 12 and 24 months. Maternal pre-pregnancy BMI acted as a modifier on the association between breastfeeding duration and overweight and obesity (based on BMI-for-age).

CONCLUSIONS

A breastfeeding duration of less than 6 months is associated with a higher percentage of overweight and obesity at ages 12 and 24 months, although maternal pre-pregnancy BMI modifies this relationship at 24 months.

Affective Symptoms in Pregnancy are Associated with the Vaginal Microbiome

Composition of the vaginal microbiome in pregnancy is associated with adverse maternal, obstetric, and child health outcomes. Identifying the sources of individual differences in the vaginal microbiome is therefore of considerable clinical and public health interest. The current study tested the hypothesis that vaginal microbiome composition during pregnancy is associated with an individual's experience of affective symptoms and stress exposure. Data were based on a prospective longitudinal study of a diverse and medically healthy community sample of 275 mother-infant pairs. Affective symptoms and stress exposure and select measures of associated biomarkers (diurnal salivary cortisol, serum measures of sex hormones) were collected at each trimester; self-report, clinical, and medical records were used to collect detailed data on socio-demographic factors and health behavior, including diet and sleep. Vaginal microbiome samples were collected in the third trimester (34-40 weeks) and characterized by 16S rRNA sequencing. Identified taxa were clustered into three community state types (CST1-3) based on dissimilarity of vaginal microbiota composition. Results indicate that depressive symptoms during pregnancy were reliably associated with individual taxa and CST3 in the third trimester. Prediction of functional potential from 16S taxonomy revealed a differential abundance of metabolic pathways in CST1-3 and individual taxa, including biosynthetic pathways for the neuroactive metabolites, serotonin and dopamine. With the exception of bioavailable testosterone, no significant associations were found between symptoms- and stress-related biomarkers and CSTs. Our results provide further evidence of how prenatal psychological distress during pregnancy alters the maternal-fetal microbiome ecosystem that may be important for understanding maternal and child health outcomes.