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Yu Y, Ma Q, Groth S. Prepregnancy weight loss and maternal metabolic and inflammatory biomarkers during pregnancy: An analysis of National Health and Nutrition Examination Survey. J Obstet Gynaecol Res 2024; 50:809-820. [PMID: 38369640 DOI: 10.1111/jog.15904] [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: 07/29/2023] [Accepted: 01/31/2024] [Indexed: 02/20/2024]
Abstract
AIM Women with overweight or obesity are recommended to lose weight before conception to optimize pregnancy outcomes. However, the obstetrical implications of prepregnancy weight loss have been minimally examined. The objective of this study was to investigate the association between prepregnancy weight loss and maternal metabolic and inflammatory profiles during a subsequent pregnancy. METHODS This study was a retrospective analysis of National Health and Nutrition Examination Survey data (2003-2018). Participants were women who were pregnant at the time of assessment. Prepregnancy weight loss was described as percent weight change based on self-reported baseline (1 year before pregnancy) and prepregnancy weight. Metabolic (e.g., blood pressure [BP]) and inflammatory biomarkers (i.e., high-sensitivity C-reactive protein [hs-CRP]) were determined by standard medical tests. Statistical analyses included linear regressions with appropriate imputation, weighting, and variance estimation techniques. RESULTS Participants (N = 236) reported a mean percent weight loss of 4.6% (standard error [SE] = 0.3%) during the year before pregnancy. Regression models showed that prepregnancy weight loss was inversely associated with levels of total cholesterol (β = -1.24, p = 0.01), low-density lipoprotein-cholesterol (β = -0.79, p < 0.01), and high-density lipoprotein-cholesterol (β = -0.18, p < 0.01). The effect of prepregnancy weight loss on BP, insulin sensitivity, and hs-CRP was not significant, although there was a trend toward higher levels of diastolic BP (β = 0.24, p = 0.07) and hs-CRP (β = 0.10, p = 0.08). CONCLUSIONS This study found favorable changes in lipid profiles following prepregnancy weight loss. Due to limitations such as a relatively small sample size, self-reported weight measures, and missing data on several outcome variables, future studies are needed to confirm study findings.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, Rochester, New York, USA
| | - Qianheng Ma
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Susan Groth
- School of Nursing, University of Rochester, Rochester, New York, USA
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Parker J, O’Brien CL, Yeoh C, Gersh FL, Brennecke S. Reducing the Risk of Pre-Eclampsia in Women with Polycystic Ovary Syndrome Using a Combination of Pregnancy Screening, Lifestyle, and Medical Management Strategies. J Clin Med 2024; 13:1774. [PMID: 38541997 PMCID: PMC10971491 DOI: 10.3390/jcm13061774] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/12/2024] [Accepted: 03/17/2024] [Indexed: 05/04/2024] Open
Abstract
Polycystic ovary syndrome (PCOS) is a multisystem disorder that presents with a variety of phenotypes involving metabolic, endocrine, reproductive, and psychological symptoms and signs. Women with PCOS are at increased risk of pregnancy complications including implantation failure, miscarriage, gestational diabetes, fetal growth restriction, preterm labor, and pre-eclampsia (PE). This may be attributed to the presence of specific susceptibility features associated with PCOS before and during pregnancy, such as chronic systemic inflammation, insulin resistance (IR), and hyperandrogenism, all of which have been associated with an increased risk of pregnancy complications. Many of the features of PCOS are reversible following lifestyle interventions such as diet and exercise, and pregnant women following a healthy lifestyle have been found to have a lower risk of complications, including PE. This narrative synthesis summarizes the evidence investigating the risk of PE and the role of nutritional factors in women with PCOS. The findings suggest that the beneficial aspects of lifestyle management of PCOS, as recommended in the evidence-based international guidelines, extend to improved pregnancy outcomes. Identifying high-risk women with PCOS will allow targeted interventions, early-pregnancy screening, and increased surveillance for PE. Women with PCOS should be included in risk assessment algorithms for PE.
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Affiliation(s)
- Jim Parker
- School of Medicine, University of Wollongong, Wollongong 2522, Australia
| | - Claire Louise O’Brien
- Faculty of Science and Technology, University of Canberra, Canberra 2617, Australia;
| | - Christabelle Yeoh
- Next Practice Genbiome, 2/2 New McLean Street, Edgecliff 2027, Australia;
| | - Felice L. Gersh
- College of Medicine, University of Arizona, Tucson, AZ 85004, USA;
| | - Shaun Brennecke
- Department of Maternal-Fetal Medicine, Pregnancy Research Centre, The Royal Women’s Hospital, Melbourne 3052, Australia;
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne 3052, Australia
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Behnam S, Timmesfeld N, Arabin B. Lifestyle Interventions to Improve Pregnancy Outcomes: a Systematic Review and Specified Meta-Analyses. Geburtshilfe Frauenheilkd 2022; 82:1249-1264. [PMID: 36339633 PMCID: PMC9634950 DOI: 10.1055/a-1926-6636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/16/2022] [Indexed: 11/09/2022] Open
Abstract
To compare the impact of lifestyle interventions for overweight and obese pregnant women a systematic review and meta-analysis was conducted using pre-registration and audit of the interventions as selection criteria. PubMed, Web of Science and CENTRAL were searched for randomized controlled trials examining diet, exercise, combined interventions or associated behavioral therapy. Trials were selected if they reported one of the primary outcomes (gestational diabetes, hypertensive disorders, perinatal mortality, admission to neonatal intensive care unit). Results were established from the total group and separately from pre-registered or clinically audited studies. Out of 1304 titles, 28 randomized controlled trials were included. Among the primary outcomes only hypertensive disorders were significantly reduced by exercise in the total group: odds ratio 0.52 (95% confidence interval 0.28 to 0.96, four trials, 1324 participants). When behavioral therapy supported combined interventions, maternal weight gain, (Standardized Mean Difference -0.16 kilogram; 95% confidence interval -0.28 to -0.04, four trials, 2132 participants) and neonatal birthweight, (Standardized Mean Difference -0.4 gram; 95% confidence interval -0.62 to -0.18, five trials, 1058 participants), were significantly reduced within the total group and both specified meta-analyses. Higher frequencies of physical activity improved the results. Risk of bias, assessed with the Cochrane Tool, was low to moderate. Elements of behavioral therapy might better prevent adverse effects of maternal obesity when combined with lifestyle interventions. Unfortunately, high heterogeneity due to different intervention and population characteristics was a limiting factor. Future studies should also focus on increased intensities of physical activity.
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Affiliation(s)
- Susann Behnam
- Clara Angela Foundation, Berlin, Germany,38696Department of Obstetrics, HELIOS Horst Schmidt Klinikum,
Wiesbaden, Germany,Phillips-University Marburg, Marburg, Germany,Korrespondenzadresse Susann Behnam, MD Clara Angela FoundationKoenigsallee 3614193 BerlinGermany
| | - Nina Timmesfeld
- Department for Medical Informatics, Biometry and Epidemiology, Ruhr-University,
Bochum, Germany
| | - Birgit Arabin
- Clara Angela Foundation, Berlin, Germany,Department of Obstetrics, Charité University Medicine, Berlin,
Germany
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Sandborg J, Henriksson P, Söderström E, Migueles JH, Bendtsen M, Blomberg M, Löf M. The effects of a lifestyle intervention (the HealthyMoms app) during pregnancy on infant body composition: Secondary outcome analysis from a randomized controlled trial. Pediatr Obes 2022; 17:e12894. [PMID: 35106942 PMCID: PMC9285397 DOI: 10.1111/ijpo.12894] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/11/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pregnancy has been identified as a window for childhood obesity prevention. Although lifestyle interventions in pregnancy can prevent excessive gestational weight gain (GWG), little is known whether such interventions also affect infant growth and body composition. OBJECTIVES To investigate (i) the effects of a 6-month lifestyle intervention (the HealthyMoms app) on infant body composition 1-2 weeks postpartum, and (ii) whether a potential intervention effect on infant body composition is mediated through maternal GWG. METHODS This is a secondary outcome analysis of the HealthyMoms randomized controlled trial. Air-displacement plethysmography was used to measure body composition in 305 healthy full-term infants. RESULTS We observed no statistically significant effect on infant weight (β = -0.004, p = 0.94), length (β = -0.19, p = 0.46), body fat percentage (β = 0.17, p = 0.72), or any of the other body composition variables in the multiple regression models (all p ≥ 0.27). Moreover, we observed no mediation effect through GWG on infant body composition. CONCLUSIONS Our findings support that HealthyMoms may be implemented in healthcare to promote a healthy lifestyle in pregnant women without compromising offspring growth. Further research is required to elucidate whether lifestyle interventions in pregnancy also may result in beneficial effects on infant body composition and impact future obesity risk.
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Affiliation(s)
- Johanna Sandborg
- Department of Biosciences and NutritionKarolinska InstitutetStockholmSweden,Department of Health, Medicine and Caring SciencesLinköping UniversityLinköping
| | - Pontus Henriksson
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköping
| | - Emmie Söderström
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköping
| | - Jairo H. Migueles
- Department of Biosciences and NutritionKarolinska InstitutetStockholmSweden,Department of Health, Medicine and Caring SciencesLinköping UniversityLinköping,PROFITH (PROmoting FITness and Health Through Physical Activity) Research Group, Department of Physical Education and Sports, Faculty of Sport SciencesResearch Institute of Sport and Health, University of GranadaGranadaSpain
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköping
| | - Marie Blomberg
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Marie Löf
- Department of Biosciences and NutritionKarolinska InstitutetStockholmSweden,Department of Health, Medicine and Caring SciencesLinköping UniversityLinköping
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Wen X, Mi B, Wang Y, Taveras EM, Bartashevskyy M. Potentially modifiable mediators for socioeconomic disparities in childhood obesity in the United States. Obesity (Silver Spring) 2022; 30:718-732. [PMID: 35195362 PMCID: PMC8934591 DOI: 10.1002/oby.23379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/07/2021] [Accepted: 12/22/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to examine modifiable mediators for socioeconomic disparities in childhood obesity in the United States. METHODS This study used the data of 1,211 mother-child dyads from a US national birth cohort from pregnancy to 6 years post partum. Socioeconomic status was indicated by maternal education (college graduate vs. less) and family income (>185% vs. ≤185% of the poverty line). Single- and multiple-factor mediation analyses were conducted for socioeconomic disparities in childhood obesity at 6 years, adjusting for demographics. RESULTS The confounder-adjusted relative risk of childhood obesity was 1.79 for low maternal education and 1.42 for low family income. Low-maternal-education-related obesity was individually mediated by maternal preconception BMI (percentage of indirect effect, 8.8%), smoking during pregnancy (7.0%), infant weight gain (14.4%), child sleep duration (11.4%), and TV viewing during weekdays at 6 years (4.9%). Low-family-income-related obesity was mediated by maternal preconception BMI (18.5%), smoking during pregnancy (6.3%), child sleep duration (12.8%), and the home learning environment at 6 years (26.2%). In multiple-mediator analysis, significant mediators together mediated 54.0% of maternal-education-related or 39.4% of family-income-related disparities. CONCLUSIONS Maternal preconception BMI, smoking during pregnancy, infant weight gain, child sleep, TV viewing, and the home learning environment substantially mediated socioeconomic disparities in childhood obesity in the United States.
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Affiliation(s)
- Xiaozhong Wen
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Baibing Mi
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Youfa Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Elsie M Taveras
- Department of Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, Boston, Massachusetts, USA
| | - Maksym Bartashevskyy
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
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Tarui T, Rasool A, O'Tierney-Ginn P. How the placenta-brain lipid axis impacts the nutritional origin of child neurodevelopmental disorders: Focus on attention deficit hyperactivity disorder and autism spectrum disorder. Exp Neurol 2021; 347:113910. [PMID: 34742689 DOI: 10.1016/j.expneurol.2021.113910] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/19/2021] [Accepted: 10/31/2021] [Indexed: 12/01/2022]
Abstract
Dietary fish is a rich source of omega-3 (n-3) fatty acids, and as such, is believed to have played an important role in the evolution of the human brain and its advanced cognitive function. The long chain polyunsaturated fatty acids, particularly the n-3 docosahexanoic acid (DHA), are critical for proper neurological development and function. Both low plasma DHA and obesity in pregnancy are associated with neurodevelopmental disorders such as attention deficit and hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in childhood, and n-3 supplementation has been shown to improve symptoms, as reviewed herein. The mechanisms underlying the connection between maternal obesity, n-3 fatty acid levels and offspring's neurological outcomes are poorly understood, but we review the evidence for a mediating role of the placenta in this relationship. Despite promising data that n-3 fatty acid supplementation mitigates the effect of maternal obesity on placental lipid metabolism, few clinical trials or animal studies have considered the neurological outcomes of offspring of mothers with obesity supplemented with n-3 FA in pregnancy.
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Affiliation(s)
- Tomo Tarui
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA, United States of America
| | - Aisha Rasool
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA, United States of America
| | - Perrie O'Tierney-Ginn
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA, United States of America.
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Moholdt T, Hayman M, Shorakae S, Brown WJ, Harrison CL. The Role of Lifestyle Intervention in the Prevention and Treatment of Gestational Diabetes. Semin Reprod Med 2021; 38:398-406. [PMID: 33472245 DOI: 10.1055/s-0040-1722208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Obesity during pregnancy is associated with the development of adverse outcomes, including gestational diabetes mellitus (GDM). GDM is highly associated with obesity and independently increases the risk of both complications during pregnancy and future impaired glycemic control and risk factors for cardiovascular disease for both the mother and child. Despite extensive research evaluating the effectiveness of lifestyle interventions incorporating diet and/or exercise, there remains a lack of definitive consensus on their overall efficacy alone or in combination for both the prevention and treatment of GDM. Combination of diet and physical activity/exercise interventions for GDM prevention demonstrates limited success, whereas exercise-only interventions report of risk reductions ranging from 3 to 49%. Similarly, combination therapy of diet and exercise is the first-line treatment of GDM, with positive effects on maternal weight gain and the prevalence of infants born large-for-gestational age. Yet, there is inconclusive evidence on the effects of diet or exercise as standalone therapies for GDM treatment. In clinical care, women with GDM should be treated with a multidisciplinary approach, starting with lifestyle modification and escalating to pharmacotherapy if needed. Several key knowledge gaps remain, including how lifestyle interventions can be optimized during pregnancy, and whether intervention during preconception is effective for preventing the rising prevalence of GDM.
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Affiliation(s)
- Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Women's Clinic, St. Olav's Hospital, Trondheim, Norway
| | - Melanie Hayman
- School of Health, Medical and Applied Sciences, Physical Activity Research Group, Appleton Institute, CQ University, Rockhampton, Australia
| | - Soulmaz Shorakae
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia
| | - Wendy J Brown
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia
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