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Johansson K, Bodnar LM, Stephansson O, Abrams B, Hutcheon JA. Safety of low weight gain or weight loss in pregnancies with class 1, 2, and 3 obesity: a population-based cohort study. Lancet 2024; 403:1472-1481. [PMID: 38555927 PMCID: PMC11097195 DOI: 10.1016/s0140-6736(24)00255-1] [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: 11/01/2023] [Revised: 01/24/2024] [Accepted: 02/07/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND There are concerns that current gestational weight gain recommendations for women with obesity are too high and that guidelines should differ on the basis of severity of obesity. In this study we investigated the safety of gestational weight gain below current recommendations or weight loss in pregnancies with obesity, and evaluated whether separate guidelines are needed for different obesity classes. METHODS In this population-based cohort study, we used electronic medical records from the Stockholm-Gotland Perinatal Cohort study to identify pregnancies with obesity (early pregnancy BMI before 14 weeks' gestation ≥30 kg/m2) among singleton pregnancies that delivered between Jan 1, 2008, and Dec 31, 2015. The pregnancy records were linked with Swedish national health-care register data up to Dec 31, 2019. Gestational weight gain was calculated as the last measured weight before or at delivery minus early pregnancy weight (at <14 weeks' gestation), and standardised for gestational age into z-scores. We used Poisson regression to assess the association of gestational weight gain z-score with a composite outcome of: stillbirth, infant death, large for gestational age and small for gestational age at birth, preterm birth, unplanned caesarean delivery, gestational diabetes, pre-eclampsia, excess postpartum weight retention, and new-onset longer-term maternal cardiometabolic disease after pregnancy, weighted to account for event severity. We calculated rate ratios (RRs) for our composite adverse outcome along the weight gain z-score continuum, compared with a reference of the current lower limit for gestational weight gain recommended by the US Institute of Medicine (IOM; 5 kg at term). RRs were adjusted for confounding factors (maternal age, height, parity, early pregnancy BMI, early pregnancy smoking status, prepregnancy cardiovascular disease or diabetes, education, cohabitation status, and Nordic country of birth). FINDINGS Our cohort comprised 15 760 pregnancies with obesity, followed up for a median of 7·9 years (IQR 5·8-9·4). 11 667 (74·0%) pregnancies had class 1 obesity, 3160 (20·1%) had class 2 obesity, and 933 (5·9%) had class 3 obesity. Among these pregnancies, 1623 (13·9%), 786 (24·9%), and 310 (33·2%), respectively, had weight gain during pregnancy below the lower limit of the IOM recommendation (5 kg). In pregnancies with class 1 or 2 obesity, gestational weight gain values below the lower limit of the IOM recommendation or weight loss did not increase risk of the adverse composite outcome (eg, at weight gain z-score -2·4, corresponding to 0 kg at 40 weeks: adjusted RR 0·97 [95% CI 0·89-1·06] in obesity class 1 and 0·96 [0·86-1·08] in obesity class 2). In pregnancies with class 3 obesity, weight gain values below the IOM limit or weight loss were associated with reduced risk of the adverse composite outcome (eg, adjusted RR 0·81 [0·71-0·89] at weight gain z-score -2·4, or 0 kg). INTERPRETATION Our findings support calls to lower or remove the lower limit of current IOM recommendations for pregnant women with obesity, and suggest that separate guidelines for class 3 obesity might be warranted. FUNDING Karolinska Institutet and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
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Affiliation(s)
- Kari Johansson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden.
| | - Lisa M Bodnar
- Department of Epidemiology, School of Public Health and Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Barbara Abrams
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
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Hutcheon JA, Platt RW. Invited Commentary: Aligning Methodological Research on Pregnancy Weight Gain With the Questions That Matter Most for Public Health Guidelines. Am J Epidemiol 2023; 192:1054-1056. [PMID: 36899293 PMCID: PMC10893856 DOI: 10.1093/aje/kwad047] [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: 11/01/2022] [Revised: 02/09/2023] [Accepted: 02/23/2023] [Indexed: 03/12/2023] Open
Abstract
The inherent correlation between the total amount of weight gained in pregnancy and the duration of pregnancy creates major methodological challenges in the study of pregnancy weight gain. In this issue (Am J Epidemiol. 2022;191(10):1687-1699), Richards et al. examine the extent to which different measures of pregnancy weight gain (including covariate adjustment for gestational age and standardizing weight gain for gestational duration using a pregnancy weight gain chart) are able to disentangle the effects of low weight gain on perinatal health from the role of younger gestational age at delivery for 3 outcomes: small-for-gestational-age birth, cesarean delivery, and low birth weight. While methodological research to understand how to best disentangle the effects of gestational weight gain from pregnancy duration is valuable, we argue that the practical utility of this type of research would be increased by aligning the specific research questions more closely with health outcomes on which evidence is most needed-those not considered in current weight gain guidelines due to lack of high-quality evidence (such as pre-eclampsia and stillbirth). Further, evaluations of weight gain charts should separate out the potential for bias introduced by the use of a normative chart per se from the use of a chart unsuitable for the study population.
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Affiliation(s)
- Jennifer A Hutcheon
- Correspondence to Dr. Jennifer Hutcheon, BC Children’s and Women’s Hospital, Shaughnessy Building C408A, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada (e-mail: )
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Hoch M, Meloncelli N, de Jersey S. Examining Enhanced Implementation of Routine Antenatal Care Practices to Support Healthy Pregnancy Weight Gain. J Midwifery Womens Health 2023; 68:449-457. [PMID: 36789484 DOI: 10.1111/jmwh.13477] [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: 06/19/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Current antenatal guidelines advocate for regular weighing of women during their pregnancy, with supportive conversations to assist healthy gestational weight gain (GWG). To facilitate overcoming weight monitoring barriers, a pregnancy weight gain chart (PWGC), coupled with brief intervention advice, was implemented in 2016 to guide provider and woman-led routine weight monitoring. This study aimed to examine the extent to which the use of PWGCs and routine advice provision were normalized into routine antenatal care following enhanced implementation strategies and whether this led to a change in GWG. METHODS This pre-post study included data from 2010 (preimplementation), 2016, and 2019 (postimplementation). A retrospective audit of health records and PWGCs was undertaken to assess adherence to chart use and evaluate GWG outcomes. A survey was sent to women in 2010 and repeated in 2019 to understand the advice women received from health care professionals. RESULTS Compared with the preimplementation cohort (2010), more women achieved a healthy GWG in 2019 (42% vs 31%, P = .04). In 2019, having 3 or more weights recorded was associated with a reduction in excess GWG (P = .028). More women reported receiving helpful advice about healthy GWG in 2019 compared with 2010, although minimal changes to advice received about nutrition and physical activity were observed. DISCUSSION Enhanced implementation strategies and ongoing efforts to optimize supportive antenatal care practices are required to effect positive change in GWG. Further evaluation of the perspectives of pregnant women and counseling practices of health professionals is needed.
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Affiliation(s)
- Mikeeley Hoch
- School of Exercise and Nutrition Science, Queensland University of Technology, Brisbane, Australia
| | - Nina Meloncelli
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - Susan de Jersey
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
- Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Gondin MS, Aguiar HP, Patriota ÉSO, Paula WO, Pizato N, Franceschini SCC, Gonçalves VSS. Home-Prepared Meal Consumption Is Associated with Healthy Food Choices in Pregnant Women Followed Up by Primary Health Care. Int J Environ Res Public Health 2022; 19:16557. [PMID: 36554440 PMCID: PMC9779241 DOI: 10.3390/ijerph192416557] [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] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
The act of preparing food, especially at home, may be related to improvement in healthy eating patterns. This study analyzed the association between home-prepared meals consumption and the food markers consumption, and weight gain in pregnant women followed up in Primary Health Care in the Federal District (DF), Brazil. This is a cross-sectional study, conducted with pregnant women of all gestational ages. The characteristics of meals preparation and intake, as well as the consumption of food markers, were evaluated through structured questionnaires. Gestational weight gain was evaluated based on data recorded in the pregnant woman's booklet. Variables related to pregnancy, health, lifestyle, and socioeconomic status were analyzed as covariates. A total of 233 pregnant women were included in this study, with a mean age of 28.50 (SD = 6.32) years. Inadequate gestational weight gain was found in 46% of pregnant women. Consumption of soft drinks was 49% lower in pregnant women who prepared all meals at home. Eating home-prepared meals was inversely associated with a high score for unhealthy foods. Home-prepared meals consumption could be an effective health promotion strategy in Primary Health Care, helping to increase the chances of vegetable consumption, and decrease the consumption of soft drinks.
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Affiliation(s)
- Mariana S. Gondin
- Department of Nutrition, University of Brasilia, Campus Universitário Darcy Ribeiro S/N, Asa Norte, Brasilia 70910-900, DF, Brazil
| | - Henrique P. Aguiar
- Department of Nutrition, University of Brasilia, Campus Universitário Darcy Ribeiro S/N, Asa Norte, Brasilia 70910-900, DF, Brazil
| | - Érika S. O. Patriota
- Graduate Program in Public Health, Faculty of Health Sciences, University of Brasilia, Campus Universitário Darcy Ribeiro S/N, Asa Norte, Brasilia 70910-900, DF, Brazil
| | - Walkyria O. Paula
- Graduate Program in Human Nutrition, Faculty of Health Sciences, University of Brasilia, Campus Universitário Darcy Ribeiro S/N, Asa Norte, Brasilia 70910-900, DF, Brazil
| | - Nathalia Pizato
- Graduate Program in Human Nutrition, Faculty of Health Sciences, University of Brasilia, Campus Universitário Darcy Ribeiro S/N, Asa Norte, Brasilia 70910-900, DF, Brazil
| | - Sylvia C. C. Franceschini
- Graduate Program in Nutrition Sciences, Federal University of Viçosa—UFV, Edifício Centro de Ciências Biológicas II, Campus Universitário, S/N, Viçosa 36570-900, MG, Brazil
| | - Vivian S. S. Gonçalves
- Graduate Program in Public Health, Faculty of Health Sciences, University of Brasilia, Campus Universitário Darcy Ribeiro S/N, Asa Norte, Brasilia 70910-900, DF, Brazil
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Amyx M, Korb D, Zeitlin J, Schmitz T, Le Ray C. Gestational weight gain adequacy among twin pregnancies in France. Matern Child Nutr 2022; 19:e13436. [PMID: 36222213 PMCID: PMC9749591 DOI: 10.1111/mcn.13436] [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] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/11/2022] [Accepted: 09/07/2022] [Indexed: 11/07/2022]
Abstract
The objective of this paper is to describe gestational weight gain (GWG), to assess the applicability of the 2009 Institute of Medicine (IOM) guidelines, and to derive a GWG adequacy classification within a French cohort. We included twins from the national, prospective, population-based JUmeaux MODe d'Accouchement (JUMODA) cohort study (2014-2015). Following the IOM approach, we selected a 'standard' population of term pregnancies with 'optimal' birthweight (≥2500 g; n = 2562). GWG adequacy (insufficient; adequate; excessive) was defined using IOM recommendations (normal body mass index [BMI]: 16.8-24.5 kg [also utilized for underweight BMI]; overweight: 14.1-22.7 kg; obese: 11.4-19.1 kg). Additionally, using the IOM approach, we determined the 25th and 75th percentiles of GWG in our standard population to create a JUMODA-derived GWG adequacy classification. GWG and GWG adequacy were described, overall and by BMI and parity. In the JUMODA standard population of term twin livebirths with optimal birthweight, mean GWG was 16.1 kg (standard deviation 6.3). Using IOM recommendations, almost half (46.5%) of the women had insufficient and few (10.0%) had excessive GWG, with similar results regardless of BMI or parity. The 25th and 75th percentiles of GWG in the JUMODA standard population (underweight: 13-21 kg; normal weight: 13-20 kg; overweight: 11-19 kg; obese: 7-16 kg) were lower than the IOM recommendations. The IOM recommendations classified a relatively high percentage of French women as having insufficient and a low percentage as having excessive GWG. Additional research to evaluate recommendations in relation to adverse perinatal outcomes is needed to determine whether the IOM recommendations or the JUMODA-derived classification is more appropriate for French twin gestations.
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Affiliation(s)
- Melissa Amyx
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, INRAUniversité de Paris CitéParisFrance
| | - Diane Korb
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, INRAUniversité de Paris CitéParisFrance,Service de Gynécologie Obstétrique, Hôpital Robert Debré, Assistance Publique‐Hôpitaux de ParisUniversité de Paris CitéParisFrance
| | - Jennifer Zeitlin
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, INRAUniversité de Paris CitéParisFrance
| | - Thomas Schmitz
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, INRAUniversité de Paris CitéParisFrance,Service de Gynécologie Obstétrique, Hôpital Robert Debré, Assistance Publique‐Hôpitaux de ParisUniversité de Paris CitéParisFrance
| | - Camille Le Ray
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, INRAUniversité de Paris CitéParisFrance,Maternité Port Royal, Hôpital Cochin Port Royal, Assistance Publique‐Hôpitaux de ParisUniversité de Paris CitéParisFrance
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Bodnar LM, Khodyakov D, Parisi SM, Himes KP, Burke JG, Hutcheon JA. Rating the seriousness of maternal and child health outcomes linked with pregnancy weight gain. Paediatr Perinat Epidemiol 2021; 35:459-468. [PMID: 33216402 PMCID: PMC8134513 DOI: 10.1111/ppe.12741] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/18/2020] [Accepted: 10/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current pregnancy weight gain guidelines were developed based on implicit assumptions of a small group of experts about the relative seriousness of adverse health outcomes. Therefore, they will not necessarily reflect the values of women. OBJECTIVE To estimate the seriousness of 11 maternal and child health outcomes that have been consistently associated with pregnancy weight gain by engaging patients and health professionals. METHODS We collected data using an online panel approach with a modified Delphi structure. We selected a purposeful sample of maternal and child health professionals (n = 84) and women who were pregnant or recently postpartum (patients) (n = 82) in the United States as panellists. We conducted three concurrent panels: professionals only, patients only, and patients and professionals. During a 3-round online modified Delphi process, participants rated the seriousness of health outcomes (Round 1), reviewed and discussed the initial results (Round 2), and revised their original ratings (Round 3). Panellists assigned seriousness ratings (0, [not serious] to 100 [most serious]) for infant death, stillbirth, preterm birth, gestational diabetes, preeclampsia, small-for-gestational-age (SGA) birth, large-for-gestational-age (LGA) birth, unplanned caesarean delivery, maternal obesity, childhood obesity, and maternal metabolic syndrome. RESULTS Each panel individually came to a consensus on all seriousness ratings. The final median seriousness ratings combined across all panels were highest for infant death (100), stillbirth (95), preterm birth (80), and preeclampsia (80). Obesity in children, metabolic syndrome in women, obesity in women, and gestational diabetes had median seriousness ratings ranging from 55 to 65. The lowest seriousness ratings were for SGA birth, LGA birth, and unplanned caesarean delivery (30-40). CONCLUSION Professionals and women rate some adverse outcomes as being more serious than others. These ratings can be used to establish the range of pregnancy weight gain associated with the lowest risk of a broad range of maternal and child health outcomes.
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Affiliation(s)
- Lisa M. Bodnar
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States,Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Sara M. Parisi
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Katherine P. Himes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jessica G. Burke
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jennifer A. Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
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Paljk I, Verdenik I, Blickstein I, Tul N. Maternal BMI and weight gain in singleton pregnancies: has something changed in the last decade? J Matern Fetal Neonatal Med 2019; 34:7-11. [PMID: 30704327 DOI: 10.1080/14767058.2019.1570111] [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: 10/27/2022]
Abstract
Aim: To assess the trend of the pregravid body mass index (BMI), pregnancy weight gain, and BMI gain in singleton pregnancies delivered at ≥38 completed weeks during the last decade.Materials and methods: We used data from a population-based dataset for the period of 2006-2015. Linear regression was used to assess the relationship between BMI, pregnancy weight gain, and BMI change over time.Results: A total of 70,866 women were included and stratified as primiparous and multiparous. The average BMI in the primiparous women increased 0.52 kg/m2 in the past decade, increasing for 0.05 kg/m2 every year. The average pregnancy weight gain in this group decreased in this period by 0.7 kg, consequently lowering for 0.07 kg per year, the average BMI change during pregnancy decreased overall by 0.26 kg/m2 (0.026 kg/m2/year). However, in multiparous women, the average pregravid BMI did not change over time, but the average pregnancy weight gain decreased by 0.21 kg (0.021 kg/year), and the average BMI change decreased for 0.10 kg/m2.Conclusions: Our study showed that the pregravid BMI is increasing in the pregnant primiparous women, but the BMI gain, as well as the pregnancy weight gain, decreased irrespective of parity. Given that the range of differences is not clinically significant, we conclude that pregravid BMI, pregnancy weight gain, and BMI change during pregnancy did not change in the last decade.
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Affiliation(s)
- Ivana Paljk
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Isaac Blickstein
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel and Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem, Israel
| | - Nataša Tul
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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de Jersey S, Guthrie T, Tyler J, Ling WY, Powlesland H, Byrne C, New K. A mixed method study evaluating the integration of pregnancy weight gain charts into antenatal care. Matern Child Nutr 2018; 15:e12750. [PMID: 30423601 DOI: 10.1111/mcn.12750] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/16/2018] [Accepted: 11/06/2018] [Indexed: 11/29/2022]
Abstract
Monitoring pregnancy weight can reduce excess gestational weight gain (GWG), and is recommended in clinical practice guidelines as part of routine care. This study aimed to evaluate the implementation of routine weight monitoring using a pregnancy weight gain chart (PWGC), and assess health care professionals (HCPs) and pregnant women's attitudes and practices around its use. A semiquantitative survey was conducted with a consecutive sample of antenatal women at 16 and 36 weeks gestation. Women were weighed, and a PWGC audit done at 36 weeks gestation to assess adherence to chart use and GWG. A cross-sectional survey of antenatal HCPs at the Australian facility assessed staff attitudes and practices relating to weight monitoring and PWGC use. Of the 291 women surveyed, 68% reported being given a PWGC. Of the audited PWGCs (n = 258), 54% had less than three weights recorded, 36% had errors, and 3% were unused. All HCPs surveyed (n = 42) were aware of the PWGC, 63% reported using it to track GWG regularly and 26% believed it to be only the woman's responsibility (i.e., not the midwife's role) to complete it. Seventy-six percent reported they needed more training in counselling pregnant women, and insufficient time was a main barrier to weighing and conversing with women. It is feasible to implement a PWGC into routine antenatal care. Clarity over women's and HCPs responsibility for monitoring GWG and completion of the PWGC is needed. Training on correct PWGC use and counselling and workforce engagement are required to overcome barriers and support healthy GWG.
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Affiliation(s)
- Susan de Jersey
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Exercise and Nutrition Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Taylor Guthrie
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jeanette Tyler
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Wan Yin Ling
- School of Exercise and Nutrition Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Hilary Powlesland
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Clare Byrne
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Karen New
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
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Johansson K, Hutcheon JA, Bodnar LM, Cnattingius S, Stephansson O. Pregnancy weight gain by gestational age and stillbirth: a population-based cohort study. BJOG 2017; 125:973-981. [PMID: 29160923 PMCID: PMC6032856 DOI: 10.1111/1471-0528.15034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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] [Accepted: 11/13/2017] [Indexed: 11/30/2022]
Abstract
Objective To study the association between total and early pregnancy (<22 completed weeks) weight gain and risk of stillbirth, stratified by early‐pregnancy body mass index (BMI). Design Population‐based cohort study. Setting Stockholm‐Gotland Region, Sweden. Population Pregnant women with singleton births (n = 160 560). Methods Pregnancy weight gain was standardised into gestational age‐specific z‐scores. For analyses of total pregnancy weight gain, a matched design with an incidence density sampling approach was used. Findings were also contrasted with current Institute of Medicine (IOM) weight gain recommendations. Main outcome measures Stillbirth defined as fetal death at ≥22 completed weeks of gestation. Results For all BMI categories, there was no statistical association between total or early pregnancy weight gain and stillbirth within the range of a weight gain z‐score of −2.0 SD to +2.0 SD. Among normal‐weight women, the adjusted odds ratio of stillbirth for lower (−2.0 to −1.0 SD) and higher (+1.0 to +1.9 SD) total weight gain was 0.85 (95% CI; 0.48–1.49) and 1.03 (0.60–1.77), respectively, as compared with the reference category. Further, there were no associations between total or early pregnancy weight gain and stillbirth within the range of weight gain currently recommended by the IOM. For the majority of the BMI categories, the point estimates at the extremes of weight gain values (<−2.0SD and ≥2.0 SD) suggested protective effects of low weight gain and increased risks of high weight gain, but estimates were imprecise and not statistically significant. Conclusion We found no associations between total or early pregnancy weight gain and stillbirth across the range of weight gain experienced by most women. Tweetable abstract There was no association between weight gain during pregnancy and stillbirth among most women. Tweetable abstract There was no association between weight gain during pregnancy and stillbirth among most women.
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Affiliation(s)
- K Johansson
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - J A Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - L M Bodnar
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - S Cnattingius
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - O Stephansson
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.,Division of Obstetrics and Gynaecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Shieh C, Yang Z, Haas DM, Carpenter JS. Feasibility and Potential Benefits of a Self-Monitoring Enhanced Lifestyle Intervention to Prevent Excessive Gestational Weight Gain in Women Who Are Overweight or Obese. J Obstet Gynecol Neonatal Nurs 2017; 46:182-196. [PMID: 28063804 DOI: 10.1016/j.jogn.2016.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility and potential benefits of a self-monitoring enhanced lifestyle intervention to prevent excessive gestational weight gain in women who are overweight and obese. DESIGN A one-group, prospective design involving 8 weeks of healthy eating and physical activity and self-monitoring of weight, nutrition, and walking. SETTING Recruitment and enrollment in prenatal clinics and self-monitoring at home. PARTICIPANTS Women (N = 22) at 14 to 24 gestational weeks, with body mass indexes of 25 to 40 kg/m2, without medical and psychiatric diseases that affected cognition or walking. METHODS Participants self-monitored weight and nutrition intake for the first 4 weeks and weight, nutrition intake, and walking in the second 4 weeks. Feasibility data were collected weekly (attrition, self-monitoring adherence, program safety, participant feedback) or at the end of Week 8 (satisfaction ratings). Potential benefits included weight, nutrition, and physical activity, measured at baseline (T1), the end of Week 4 (T2), or the end of Week 8 (T3). RESULTS Attrition rates were 27.3% by T2 and 40.9% by T3. Adherence to log return was 100%. No adverse effects were noted, but food craving was persistent, and stress levels were high. Program satisfaction was high. Trends for improved activity and reduced trans fat consumption were seen. CONCLUSION Our findings indicate that the intervention is worthy of further development and testing with a randomized controlled trial.
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Maslin K. Commentary on a Cochrane Review of Diet and Exercise Interventions to Prevent Excessive Gestational Weight Gain. Nurs Womens Health 2016; 20:447-449. [PMID: 27719774 DOI: 10.1016/j.nwh.2016.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Indexed: 10/20/2022]
Abstract
Excessive weight gain during pregnancy is associated with poor maternal and neonatal health outcomes. A Cochrane Review found that healthful diet and/or exercise interventions reduced the risk of excessive gestational weight gain on average by 20%. The largest reduction occurred with combined diet and supervised exercise interventions.
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Thomas DM, Bredlau C, Islam S, Armah KA, Kunnipparampil J, Patel K, Redman LM, Misra D, Salafia C. Relationships between misreported energy intake and pregnancy in the pregnancy, infection and nutrition study: new insights from a dynamic energy balance model. Obes Sci Pract 2016; 2:174-179. [PMID: 29071098 PMCID: PMC5523690 DOI: 10.1002/osp4.29] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 07/29/2015] [Revised: 11/11/2015] [Accepted: 01/01/2016] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Providing effective dietary counselling so that pregnancy weight gain remains within the 2009 Institute of Medicine (IOM) guidelines requires accurate maternal energy intake measures. Current practice is based on self-reported intake that has been demonstrated unreliable. This study applies an objective calculation of energy intake from a validated mathematical model to identify characteristics of individuals more likely to misreport during pregnancy. METHODS A validated maternal energy balance equation was used to calculate energy intake from gestational weight gain in 1,368 subjects. The difference between self-reported and model-predicted energy intake was tested for demographics, economic status, education level and maternal health status. RESULTS A weight gain of 15.2 kg resulted in model-predicted intake during pregnancy of 2,882.97 ± 135.71 kcal day-1, which differed from self-reported intake of 2,180.5 ± 856.0 kcal day-1. The achieved weight gain exceeded the IOM guidelines; however, the model predicted weight gain from self-reported energy intake was below IOM guidelines. Higher income (p = 0.004), education (p = 0.003), birth weight (p = 0.017), gestational diabetes (p = 0.008) and pre-existing diabetes (p < 0.001) were associated with under-reported energy intake. More children living at home (p = 0.001) were associated with more accurate self-reported intake. CONCLUSIONS When assessing self-reported energy intake in pregnancy studies, birth weight, gestational diabetes status, pre-existing diabetes, higher income and education predict higher under-reporting. Clinicians providing dietary treatment recommendations during pregnancy should be aware that individuals with pre-existing diabetes and gestational diabetes mellitus are more likely to misreport their intake. Additionally, the systems model approach can be applied early in intervention to objectively monitor dietary compliance to treatment recommendations.
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Affiliation(s)
- D M Thomas
- Center for Quantitative Obesity Research Montclair State University Montclair NJ USA
| | - C Bredlau
- Center for Quantitative Obesity Research Montclair State University Montclair NJ USA
| | - S Islam
- Center for Quantitative Obesity Research Montclair State University Montclair NJ USA
| | - K A Armah
- Center for Quantitative Obesity Research Montclair State University Montclair NJ USA
| | - J Kunnipparampil
- Center for Quantitative Obesity Research Montclair State University Montclair NJ USA
| | - K Patel
- Center for Quantitative Obesity Research Montclair State University Montclair NJ USA
| | - L M Redman
- Pennington Biomedical Research Center Louisiana State University System Baton Rouge LA USA
| | - D Misra
- Department of Family Medicine and Public Health Sciences, School of Medicine Wayne State University Detroit MI USA
| | - C Salafia
- Placental Analytics Larchmont NY USA
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13
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Stuart C, Merrill E, Cherry B. Certified Nurse-Midwives' Experiences with Gestational Weight Management. Nurs Womens Health 2016; 20:38-50. [PMID: 26902439 DOI: 10.1016/j.nwh.2015.12.007] [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: 04/28/2015] [Revised: 07/09/2015] [Indexed: 06/05/2023]
Abstract
Excessive gestational weight gain is associated with fetal metabolic reprogramming and subsequent childhood obesity, as well as maternal recalcitrant obesity and its successive morbidities. We conducted a review of the literature and an explorative, descriptive study of the techniques and strategies used by a subset of certified nurse-midwives to help women achieve optimal gestational weight gain. We also identified barriers to this outcome. With more effective management approaches to gestational weight gain, adverse maternal and neonatal health outcomes could potentially be prevented. http://dx.doi.org/10.1016/j.nwh.2015.12.007.
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Affiliation(s)
| | - Emily Merrill
- Texas Tech University Health Sciences Center Lubbock TX
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14
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Clifton RG, Evans M, Cahill AG, Franks PW, Gallagher D, Phelan S, Pomeroy J, Redman LM, Van Horn L. Design of lifestyle intervention trials to prevent excessive gestational weight gain in women with overweight or obesity. Obesity (Silver Spring) 2016; 24:305-13. [PMID: 26708836 PMCID: PMC4731277 DOI: 10.1002/oby.21330] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [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: 03/25/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The Lifestyle Interventions for Expectant Moms (LIFE-Moms) Consortium is designed to determine, in pregnant women with overweight or obesity, whether various behavioral and lifestyle interventions reduce excessive gestational weight gain (GWG) and subsequent adverse maternal and neonatal outcomes and obesity in offspring. The design and planning process of the LIFE-Moms Consortium is described. METHODS The LIFE-Moms Consortium is a collaboration among seven clinical centers, a Research Coordinating Unit, and the NIH designed to support each clinical center's conduct of a separate trial of a unique intervention. Specific common measures, procedures, and eligibility criteria are consistent across the seven trials allowing data to be combined in exploratory analyses and/or compared readily. RESULTS Numerous committees and working groups were created to define common measures and outcomes during pregnancy and through 1 year postpartum, develop Consortium policies, and oversee progress of the trials. The primary outcome for the Consortium is excessive GWG. Secondary outcomes include maternal, neonatal, and infant anthropometric measures, physical activity, sleep, and complications of pregnancy and delivery. CONCLUSIONS A multi-center consortium of independent, lifestyle interventions with common measures and outcomes may enhance the ability to identify promising interventions for improving outcomes in pregnant women and their offspring.
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Affiliation(s)
- Rebecca G Clifton
- The George Washington University Biostatistics Center, Washington, DC, USA
| | - Mary Evans
- The National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Alison G Cahill
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Paul W Franks
- Genetic and Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University, Skåne University Hospital Malmö, Malmö, Sweden
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Dympna Gallagher
- Department of Medicine, St. Luke's-Roosevelt Hospital and Columbia University, New York, New York, USA
| | - Suzanne Phelan
- Department of Kinesiology, California Polytechnic State University, San Luis Obispo, California, USA
| | - Jeremy Pomeroy
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA
| | - Leanne M Redman
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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15
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Elhassan ME, Miller AL, Vazquez DM, Lumeng JC. Associations of Prenatal and Perinatal Factors with Cortisol Diurnal Pattern and Reactivity to Stress at Preschool Age Among Children Living in Poverty. J Clin Res Pediatr Endocrinol 2015; 7:114-20. [PMID: 26316433 PMCID: PMC4563182 DOI: 10.4274/jcrpe.1685] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To examine the association of pre- and perinatal factors with diurnal cortisol pattern and reactivity to a stressor at preschool age among children living in poverty. METHODS Preschool aged children (n=275) provided saliva samples 3 times per day for 3 days to assess circadian rhythmicity (intercept and slope reflected diurnal pattern) and during a behavioral stress elicitation protocol to measure reactivity (5 samples before, during and after the stressor). Pre- and perinatal predictors were pregnancy weight gain, pre-pregnancy body mass index (BMI), infant birth weight z-score and gestational age. We ran 7 linear regression models predicting each of the cortisol outcomes including all pre- and perinatal predictors and covariates simultaneously. RESULTS Greater pregnancy weight gain predicted higher morning cortisol [b=0.020 (SE 0.007), p=0.003]. Greater pregnancy weight gain also predicted higher cortisol at recovery from the stressor in girls only [β=0.002 (SE 0.001), p=0.036]. There was no association of pre-pregnancy BMI with any cortisol outcome. Higher birth weight z-score predicted higher morning cortisol in the total sample [β=0.134 (SE 0.066, p=0.043]. Greater gestational age predicted lower cortisol during peak stress in the sample who underwent cortisol reactivity testing [β=-0.015 (SE 0.007), p=0.032] and in boys [β=-0.032 (SE 0.014), p=0.027]. CONCLUSION Pre- and perinatal factors are associated with cortisol patterning in offspring at preschool age. The implications for child health require additional studies.
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Affiliation(s)
- Maha E. Elhassan
- Michigan University Faculty of Medicine, Department of Pediatrics, Division of Endocrinology, Michigan, USA
| | - Alison L. Miller
- Michigan University Faculty of Medicine, School of Public Health, Department of Health Behavior and Health Education, Michigan, USA
,
Michigan University Center for Human Growth and Development, Michigan, USA
| | - Delia M. Vazquez
- Michigan University Faculty of Medicine, Department of Pediatrics, Division of Endocrinology, Michigan, USA
,
Michigan University Center for Human Growth and Development, Michigan, USA
,
Michigan University Faculty of Medicine, Department of Psychiatry, Michigan, USA
| | - Julie C. Lumeng
- Michigan University Center for Human Growth and Development, Michigan, USA
,
Michigan University Faculty of Medicine, Department of Pediatrics, Division of Child Behavioral Health, Michigan, USA
,
Michigan University, School of Public Health, Department of Environmental Health Sciences, Michigan, USA
,* Address for Correspondence: Michigan University Faculty of Medicine, Center for Human Growth and Development, Michigan, USA Phone: +1 7346471102 E-mail:
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16
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Hui AL, Back L, Ludwig S, Gardiner P, Sevenhuysen G, Dean HJ, Sellers E, McGavock J, Morris M, Jiang D, Shen GX. Effects of lifestyle intervention on dietary intake, physical activity level, and gestational weight gain in pregnant women with different pre-pregnancy Body Mass Index in a randomized control trial. BMC Pregnancy Childbirth 2014; 14:331. [PMID: 25248797 PMCID: PMC4287470 DOI: 10.1186/1471-2393-14-331] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [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: 03/05/2014] [Accepted: 09/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objectives of this study were to assess the efficacy of lifestyle intervention on gestational weight gain in pregnant women with normal and above normal body mass index (BMI) in a randomized controlled trial. METHODS A total of 116 pregnant women (<20 weeks of pregnancy) without diabetes were enrolled and 113 pregnant women completed the program. Participants were randomized into intervention and control groups. Women in the intervention group received weekly trainer-led group exercise sessions, instructed home exercise for 3-5-times/week during 20-36 weeks of gestation, and dietary counseling twice during pregnancy. Participants in the control group did not receive the intervention. All participants completed a physical activity questionnaire and a 3-day food record at enrolment and 2 months after enrolment. RESULTS The participants in the intervention group with normal pre-pregnancy BMI (≤24.9 kg/M2, n = 30) had lower gestational weight gain (GWG), offspring birth weight and excessive gestational weight gain (EGWG) on pregnancy weight gain compared to the control group (n = 27, p < 0.05). Those weight related-changes were not detected between the intervention (n = 27) and control group (n = 29) in the above normal pre-pregnancy BMI participants. Intervention reduced total calorie, total fat, saturated fat and cholesterol intake were detected in women with normal or above normal pre-pregnancy BMI compared to the control group (p < 0.05 or 0.01). Increased physical activity and reduced carbohydrate intake were detected in women with normal (p < 0.05), but not above normal, pre-pregnancy BMI at 2 months after the onset of the intervention compared to the control group. CONCLUSION The results of the present study demonstrated that the lifestyle intervention program decreased EGWG, GWG, offspring birth weight in pregnant women with normal, but not above normal, pre-pregnancy BMI, which was associated with increased physical activity and decreased carbohydrate intake. TRIAL REGISTRATION NCT00486629.
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Affiliation(s)
- Amy Leung Hui
- />Departments of Internal Medicine, University of Manitoba, Room 801D, 715 McDermot Ave, Winnipeg, MB R3E 3P4 Canada
| | - Lisa Back
- />Departments of Internal Medicine, University of Manitoba, Room 801D, 715 McDermot Ave, Winnipeg, MB R3E 3P4 Canada
| | - Sora Ludwig
- />Departments of Internal Medicine, University of Manitoba, Room 801D, 715 McDermot Ave, Winnipeg, MB R3E 3P4 Canada
| | | | | | - Heather J Dean
- />Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB Canada
| | - Elisabeth Sellers
- />Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB Canada
| | - Jonathan McGavock
- />Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB Canada
| | - Margaret Morris
- />Obstetrics and Gynecology, University of Manitoba, Winnipeg, MB Canada
| | - Depeng Jiang
- />Departments of Internal Medicine, University of Manitoba, Room 801D, 715 McDermot Ave, Winnipeg, MB R3E 3P4 Canada
| | - Garry X Shen
- />Departments of Internal Medicine, University of Manitoba, Room 801D, 715 McDermot Ave, Winnipeg, MB R3E 3P4 Canada
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17
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Yang NY, Wroth S, Parham C, Strait M, Simmons LA. Personalized health planning with integrative health coaching to reduce obesity risk among women gaining excess weight during pregnancy. Glob Adv Health Med 2013; 2:72-7. [PMID: 24278848 PMCID: PMC3833555 DOI: 10.7453/gahmj.2013.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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] [Indexed: 11/25/2022] Open
Abstract
Health coaching is an emerging behavioral intervention to improve outcomes in chronic disease management and prevention; however, no studies have investigated its utility in postpartum women who have gained excess weight during pregnancy. A 32-year-old primigravida woman who was overweight at conception and gained 23 lbs more than Institute of Medicine recommendations for her pre-pregnancy body mass index participated in a 6-month personalized health planning with integrative health coaching (PHPIHC) intervention. The intervention included a baseline health risk assessment review with a healthcare provider and eight biweekly, 30-minute telephonic health coaching sessions. The participant demonstrated improvement in physical activity, energy expenditure, knowledge, and confidence to engage in healthpromoting behaviors. Although the participant did not reach the target weight by completion of the health coaching sessions, follow up 8 months later indicated she achieved the target goal (within 5% of prepregnancy weight). This case report suggests that PHP-IHC can support postpartum women in returning to pre-pregnancy weight after gaining excess gestational weight. Future research and clinical trials are needed to determine the best timing, length, and medium (online, in-person, telephonic) of PHP-IHC for postpartum women.
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Affiliation(s)
- Nancy Y Yang
- Duke University School of Nursing, Durham, North Carolina
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18
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Montgomery KS, Best M, Aniello TB, Phillips JD, Hatmaker-Flanigan E. Postpartum weight loss: weight struggles, eating, exercise, and breast-feeding. J Holist Nurs 2012; 31:129-38. [PMID: 23175169 DOI: 10.1177/0898010112464120] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Twenty-four women with children 5 years old or younger were interviewed regarding their experiences in losing weight during the postpartum period. Phenomenological interviews were conducted according to Husserl's perspective. Women who participated in the study revealed the issues related to postpartum weight loss: weight struggles, exercise, breast-feeding, eating, and pregnancy contributions to weight gain. The overall theme that resulted from these in-depth interviews was that women struggle to balance their successes and setbacks in losing weight during the postpartum period.
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Abstract
The perinatal period, from early in the first trimester to 1 year postpartum, provides opportunities for novel public health interventions to reduce obesity disparities. We present a unifying socio-biological framework to suggest opportunities for multidisciplinary research and public health approaches to elucidate and target the mechanisms for the development of maternal obesity and related disparities. The framework illustrates the interplay of the social, cultural and physical environment; stress appraisal and response; and coping behaviors on short-term outcomes (e.g. allostatic load and gestational weight gain), the intermediate outcomes of persistent insulin resistance and post-partum weight retention, and longer term outcomes of obesity and its disease consequences. Testing the proposed relationships may provide insights into how childbearing risk factors such as gestational weight gain, postpartum weight retention and parity contribute to obesity, which are needed to inform public health policies and clinical care guidelines aimed at reducing obesity and improving the health of women.
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Affiliation(s)
- Esa M Davis
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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20
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Abstract
We investigated body mass index (BMI) and weight gain among pregnant women (ages 14 to 25) and assessed the relationship of BMI and weight gain on birth outcomes. We performed a secondary analysis of 841 women enrolled in a randomized controlled trial receiving prenatal care in two university-affiliated clinics. Almost half the patients were overweight or obese. An average of 32.3 +/- 23.6 pounds was gained in pregnancy with only 25.3% gaining the recommended weight and over half overgaining. Weight gain had a significant relationship to birth weight. Multivariate analysis showed that prepregnancy BMI but not weight gain was a significant predictor of cesarean delivery (odds ratio [OR] 1.91, confidence interval [CI] 1.24 to 2.69, P < 0.0001). When large-for-gestational-age infants were removed from the analysis, there was still a significant effect of BMI on cesarean delivery (OR 1.76, CI 1.17 to 2.66, P = 0.007) but not of weight gain (OR 1.45, CI 0.94 to 2.17, P = 0.093). Prepregnancy BMI is a more significant predictor of cesarean delivery than pregnancy weight gain in young women.
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Affiliation(s)
- Urania Magriples
- Yale University School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, New Haven, Connecticut 06520-8034, USA.
| | | | | | - Claire Westdahl
- Emory University School of Medicine, Department of Obstetrics and Gynecology, Atlanta, Georgia
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Kabali C, Werler MM. Pre-pregnant body mass index, weight gain and the risk of delivering large babies among non-diabetic mothers. Int J Gynaecol Obstet 2007; 97:100-4. [PMID: 17376448 PMCID: PMC1964793 DOI: 10.1016/j.ijgo.2007.02.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [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: 12/13/2006] [Revised: 01/30/2007] [Accepted: 02/02/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Pre-pregnancy overweight and excess weight gain during pregnancy have each been associated with an increased risk of delivering large babies. However, previous studies have focused on the separate effects of these two indices of weight in diabetic women. METHOD This study analyzed both separate and combined effects of pre-pregnant body mass index and weight gain in relation to macrosomia (> or =4000 g) in offspring among 815 non-diabetic women, using data collected from a retrospective study. RESULT Compared to mothers with normal pre-pregnancy BMI and pregnancy weight gain, risk of macrosomia in offspring was significantly elevated only in overweight women with excess weight gain (adjusted OR=2.6, 95% CI [1.2,5.4]) but not among normal weight mothers with excess gain (adjusted OR=1.1, 95% CI [0.5,2.4]) or overweight mothers with normal or low gain (adjusted OR=1.1, 95% CI [0.4,3.1]). CONCLUSION Given the complications that are associated with delivering large babies, overweight women may benefit from not gaining excess weight in pregnancy.
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Affiliation(s)
- Conrad Kabali
- Boston University School of Public Health, Boston, Massachusetts
- National Institute of Medical Research, Dar es Salaam,Tanzania
| | - Martha M. Werler
- Slone Epidemiology Center, Boston University School of Public Health, Boston, Massachusetts
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Ahrari M, Houser RF, Yassin S, Mogheez M, Hussaini Y, Crump P, Darmstadt GL, Marsh D, Levinson FJ. A positive deviance-based antenatal nutrition project improves birth-weight in Upper Egypt. J Health Popul Nutr 2006; 24:498-507. [PMID: 17591347 PMCID: PMC3001154] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The positive deviance approach identifies and promotes existing uncommon healthy behaviours. A positive deviance-informed antenatal project was pilot-tested in Al-Minia Governorate, Upper Egypt, during 2003-2004, after a positive deviance study in 2000 found that successful pregnancies had increased consumption of meat and vegetables, daytime rest, and antenatal care; less second-hand smoke exposure; and symptoms of no urinary tract infection. Accordingly, health facilities were upgraded in target and comparison areas to provide quality antenatal care, including treatment of urinary tract infection. Additionally, in the target villages, women at-risk of delivering low-birth-weight infants were enrolled in weekly 'IMPRESS' (improved pregnancy through education and supplementation) sessions with counselling and supplemental food. In total, 519 women (344 target, 175 comparison) were enrolled in the third or fourth month of pregnancy and were followed through delivery. Birth-weights of the target mothers increased 2.2 times more than birth-weights of the comparison mothers over baseline (mean increase: 0.58 vs 0.26 g respectively, p<0.01). Similarly, the decrease in prevalence of low birth-weight from baseline was greater in the target villages than in the comparison mothers (% of decrease: 26.9 vs 11.9 respectively, p<0.01). The target at-risk women were far more likely than their counterparts to report eating more food (54.9% vs 10.6%), more meat (57.1% vs 4.2%), more vegetables (66.9% vs 5.3%), increasing daytime rest (64.1% vs 11.7%), and avoiding second-hand smoke (91.3% vs 51.6%) during pregnancy. The cost per 100 g of improvement in birth-weight was US$ 3.98. The Government of Egypt and partners are scaling up the elements of the project.
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Affiliation(s)
- Mahshid Ahrari
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
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