Association of maternal weight gain in early pregnancy with congenital heart disease in offspring: a China birth cohort study.

OBJECTIVES: Little study has reported the association of maternal weight gain in early pregnancy with fetal congenital heart disease (CHD). We aimed to explore the potential relationship based on a China birth cohort while adjusting by multiple factors. DESIGN: Cohort study. SETTING: China birth cohort study conducted from 2017 to 2021. PARTICIPANTS: The study finally included 114 672 singleton pregnancies in the 6-14 weeks of gestation, without missing data or outliers, loss to follow-up or abnormal conditions other than CHD. The proportion of CHD was 0.65% (749 cases). PRIMARY AND SECONDARY OUTCOME MEASURES: Association between maternal pre-pregnancy weight gain and CHD in the offspring were analysed by multivariate logistic regression, with the unadjusted, minimally adjusted and maximally adjusted methods, respectively. RESULTS: The first-trimester weight gain showed similar discrimination of fetal CHD to that period of maternal body mass index (BMI) change (DeLong tests: p=0.091). Compared with weight gain in the lowest quartile (the weight gain less than 0.0 kg), the highest quartile (over 2.0 kg) was associated with a higher risk of fetal CHD in unadjusted (OR 1.36, 95% CI: 1.08 to 1.72), minimally adjusted (adjusted OR (aOR) 1.29, 95% CI: 1.02 to 1.62) and maximally adjusted (aOR 1.29, 95% CI: 1.02 to 1.63) models. The association remains robust in pregnant women with morning sickness, normal pre-pregnancy BMI, moderate physical activity, college/university level, natural conception or with folic acid (FA) and/or multivitamin supplementation. CONCLUSIONS AND RELEVANCE: Although the association of maternal pre-pregnancy weight gain on fetal CHD is weak, the excessive weight gain may be a potential predictor of CHD in the offspring, especially in those with morning sickness and other conditions that are routine in the cohort, such as normal pre-pregnancy BMI, moderate physical activity, college/university level, natural conception or with FA and/or multivitamin supplementation.

Is postpartum depression related to total weight gain during pregnancy and maternal anemia?

OBJECTIVE: This study aimed to investigate the effects of weight gain and maternal anemia on postpartum depression. METHODS: This is a prospective, single-center, case-control study. We recorded the demographic characteristics, blood ferritin level, and weight gain during the pregnancy. This study was planned between April 2023 and June 2023 in the Obstetrics and Gynecology Clinic of Ankara Etlik City Hospital. A total of 109 patients were enrolled in the study. Patients were assessed with the Edinburgh Postpartum Depression Scale. Weight gain, nutritional education, educational level, mode of delivery, and pregnancy history were asked in person. Ferritin levels at the onset of labor were determined to detect anemia. Twin births, births due to fetal anomalies or intrauterine stillbirths, patients with systemic infections, and patients diagnosed with a psychiatric disorder in the past 6 months whose records were not accessible were excluded from the study. RESULTS: Pregnancy weight gain and percentage of pregnancy weight gain were higher. Serum ferritin levels and nutritional education during pregnancy were lower in the postpartum depression group (p<0.001). These parameters with statistical significance were identified as risk factors in the regression analysis for postpartum depression (p<0.05). In receiver operating characteristics analysis, >15 kg for weight gain, >28.8 for percentage of weight gain in pregnancy, and <19 ng/dL for serum ferritin level were identified as cutoff values (p<0.001). CONCLUSION: Nutritional education and vitamin supplementation should be recommended to pregnant women during routine examinations.

[Effect of gestational weight gain in a cohort of pregnancy women with obesity operated and not operated for bariatric surgery]. / Efecto de la ganancia ponderal gestacional en una cohorte de gestantes con obesidad operadas y no operadas de cirugía bariátrica.

Introduction: Objective: to determine the effect of gestational weight gain and perinatal outcomes in obese women who underwent and did not undergo bariatric surgery. Material and methods: a retrospective observational cohort study was conducted. The gestational weight gain was classified as insufficient, adequate or excessive according to the guidelines of the United States Institute of Medicine: 4.99-9.07 kg for body mass index (BMI) > 30 kg/m2. Weight gain was calculated as the difference between the weight at the first visit of the 1st trimester and the weight at the visit of the 3rd trimester. Outcomes examined included antepartum variables (gestational diabetes, gestational hypertension, preeclampsia, premature rupture of membranes, placenta previa, placental abruption, intrauterine growth retardation, chorioammionitis, spontaneous abortion), intrapartum variables (induced delivery, vaginal delivery, vacuum, forceps delivery, cesarean section, shoulder dystocia), postpartum variables (postpartum hemorrhage, need for postpartum transfusion, postpartum anemia, need for emergency care, maternal death, postpartum tear, postpartum thrombosis) and neonatal variables (preterm delivery, weight percentile > 90, weight percentile < 10, Apgar score < 7, malformations). Using the statistical package SPSS 22.0, a statistical analysis of the data was performed. Results: two hundred and fifty-six women were recruited; 38 (14.58 %) were pregnant after bariatric surgery and 218 (85.15 %) were pregnant women with obesity who had not been operated on. Of the pregnant women with obesity who had not been operated on, 119 (46.68 %) had grade 1 obesity (BMI 30-34.9), and 99 (38.67 %) had grade 2 and 3 obesity (BMI > 35). A global and subgroup analysis was performed. In the overall analysis, 78 (30.46 %) had insufficient gain, 117 (45.70 %) had adequate gain, and 61 (23.82 %) excessive gain. Overall, insufficient weight gain was associated with a lower probability of gestational hypertension (p < 0.015) and forceps delivery (p < 0.000) and large for gestational age newborn (p < 0.000). On the other hand, insufficient weight gain was associated with a higher probability of intrauterine growth retardation (p 0.044), peripartum infection (0.022), preterm delivery (0.006), and delivery < 35 weeks (p 0.016). Excessive weight gain was associated with a higher probability of gestational hypertension (p 0.025), induced labor (p 0.009), forceps delivery (p 0.011) and large for gestational age newborn (p 0.006). Pregnancies after bariatric surgery had fewer overall complications compared to the other groups. Conclusions: insufficient and excessive weight gain worsens perinatal outcomes. Adequate weight gain does not increase complications and produces some benefits.

Introducción: Objetivo: determinar el efecto de la ganancia de peso gestacional y los resultados perinatales en mujeres con obesidad operadas y no operadas de cirugía bariátrica. Material y métodos: se realizó un estudio retrospectivo observacional de cohortes. La ganancia ponderal gestacional fue clasificada como insuficiente, adecuada o excesiva según las guías del Instituto de Medicina de Estados Unidos: 4,99-9,07 kg para índice de masa corporal (IMC) > 30 kg/m2. La ganancia ponderal se calculó con la diferencia entre el peso de la primera visita del primer trimestre y el peso en la visita del tercer trimestre. Los resultados examinados incluyeron variables anteparto (diabetes gestacional, hipertensión gestacional, preeclampsia, ruptura prematura de membranas, placenta previa, desprendimiento prematuro de placenta, retraso de crecimiento intrauterino, corioamnionitis, aborto espontáneo), intraparto (parto inducido, parto vaginal, ventosa, fórceps, cesárea, distocia de hombros), posparto (hemorragia posparto, necesidad de trasfusión posparto, anemia posparto, necesidad de asistencia a Urgencias, muerte materna, desgarro posparto, trombosis posparto) y neonatales (parto pretérmino, percentil peso > 90, percentil peso < 10, puntuación Apgar < 7, malformaciones). Mediante el paquete estadístico SPSS 22.0 se realizó un análisis estadístico de los datos. Resultados: se reclutaron 256 mujeres; 38 (14,58 %) eran gestantes poscirugía bariátrica y las 218 (85,15 %) restantes eran gestantes con obesidad no operadas. De las gestantes con obesidad no operadas, 119 (46,68 %) tenían obesidad grado 1 (IMC 30-34,9) y 99 (38,67 %) tenían obesidad grados 2 y 3 (IMC > 35). Se realizó un análisis global y por subgrupos. En el análisis global tuvieron ganancia insuficiente 78 (30,46 %), ganancia adecuada 117 (45,70 %) y excesiva 61 (23,82 %). En conjunto, la ganancia ponderal insuficiente se asoció con menor probabilidad de hipertensión arterial (HTA) gestacional (p 0,015) y parto con fórceps (p 0,000) y grande para edad gestacional (p 0,000). Por otro lado, la ganancia ponderal insuficiente se asoció a mayor probabilidad de retraso de crecimiento intrauterino (p 0,044), infección periparto (0,022), parto pretérmino (0,006) y parto < 35 semanas (p 0,016). La ganancia ponderal excesiva se asoció a mayor probabilidad de HTA gestacional (p 0,025), parto inducido (p 0,009), parto por fórceps (p 0,011) y grande para edad gestacional (p 0,006). Las gestaciones poscirugía bariátrica tuvieron menos complicaciones globales respecto al resto de grupos. Conclusiones: la ganancia ponderal insuficiente y excesiva empeora los resultados perinatales. La ganancia ponderal adecuada no aumenta las complicaciones y produce algunos beneficios.

The Effect of Yoga on Maternal Anxiety in Women with Excessive Gestational Weight Gain: A Randomized Controlled Trial.

BACKGROUND: Excessive gestational weight gain (EGWG) and anxiety are comorbid conditions that increase the risk of adverse maternal and neonatal outcomes. This study was conducted to investigate the effect of yoga on the anxiety of women with EGWG. MATERIALS AND METHODS: This randomized controlled trial was performed on EGWG pregnant women referring to comprehensive health centers in Qom city, Iran, between October 2021 and August 2022. Eighty-eight participants were assigned to the intervention (N = 44) and control (N = 44) groups. The experimental group participated in six sessions of 90-min yoga classes, and the control group only received routine care. Two questionnaires including a demographic information questionnaire and the State-Trait Anxiety Inventory (STAI) questionnaire were used for data collection. Data were analyzed using SPSS software version 22. RESULTS: The results of this study showed a statistically significant difference between the two groups in terms of trait anxiety (25.84 ± 3.45 vs. 57.38 ± 8.07; p < 0.05) and state anxiety (27.93 ± 3.72 vs. 60.13 ± 8.13; p < 0.05) after intervention. On the other hand, the trait and state anxiety rates were stable in the experimental group before and after intervention, while they increased to the severe form of anxiety in the control group (effect size = -21.84 ± 10.66 vs. -19.43 ± 8.44). CONCLUSION: The result of this study showed that yoga has a positive effect on the anxiety of pregnant women with EGWG and can be used as a preventive or complementary solution to control the anxiety of these mothers.Exzessive Gewichtszunahme in der Schwangerschaft (EGWG) und Angst sind Komorbiditäten, die das Risiko für einen ungünstigen Verlauf für Mutter und Kind erhöhen. Diese Studie wurde durchgeführt, um die Auswirkung von Yoga auf Angst bei Frauen mit exzessiver Gewichtszunahme in der Schwangerschaft zu untersuchen.Diese randomisierte, kontrollierte Studie wurde bei Schwangeren mit EGWG durchgeführt, die sich zwischen Oktober 2021 und August 2022 an Zentren für ganzheitliche Gesundheit in der Stadt Ghom im Iran vorstellten. 88 Teilnehmerinnen wurden einer Interventions- (N = 44) und einer Kontrollgruppe (N = 44) zugeteilt. Die experimentelle Gruppe nahm an einem Yogakurs von sechsmal 90 minuten Dauer teil, die Kontrollgruppe erhielt lediglich die Standardversorgung. Die Datenerhebung erfolgte mit zwei Fragebögen: einem Fragebogen zu demografischen Angaben und dem State-Trait-Angstinventar (STAI). Die Auswertung der Daten erfolgte mit SPSS-Software, Version 22.Die Ergebnisse dieser Studie zeigten einen statistisch signifikanten Unterschied zwischen beiden Gruppen im Hinblick auf Eigenschaftsangst (25.84 ± 3.45 vs. 57.38 ± 8.07; p < 0.05) und Zustandsangst (27.93 ± 3.72 vs. 60.13 ± 8.13; p < 0.05) nach der Intervention. Auf der anderen Seite waren die Raten von Eigenschafts- und Zustandsangst in der experimentellen Gruppe vor und nach der Intervention stabil, während sie in der Kontrollgruppe zur schweren Form von Angst anstiegen (Effektstärke = −21.84 ± 10.66 vs. −19.43 ± 8.44).Die Ergebnisse dieser Studie zeigen, dass Yoga sich bei Schwangeren mit EGWG positive auf Angst auswirkt und als präventive oder komplementäre Lösung zur Beherrschung von Angst bei diesen Müttern eingesetzt werden kann.

Growth and adiposity in newborns study (GAINS): The influence of prenatal DHA supplementation protocol.

BACKGROUND: Obesity and central fat mass (FM) accrual drive disease development and are related to greater morbidity and mortality. Excessive gestational weight gain (GWG) increases fetal fat accretion resulting in greater offspring FM across the lifespan. Studies associate greater maternal docosahexaenoic acid (DHA) levels with lower offspring FM and lower visceral adipose tissue during childhood, however, most U.S. pregnant women do not consume an adequate amount of DHA. We will determine if prenatal DHA supplementation is protective for body composition changes during infancy and toddlerhood in offspring exposed to excessive GWG. METHODS AND DESIGN: Infants born to women who participated in the Assessment of DHA on Reducing Early Preterm Birth randomized controlled trial (ADORE; NCT02626299) will be invited to participate. Women were randomized to either a high 1000 mg or low 200 mg daily prenatal DHA supplement starting in the first trimester of pregnancy. Offspring body composition and adipose tissue distribution will be measured at 2 weeks, 6 months, 12 months, and 24 months using dual energy x-ray absorptiometry. Maternal GWG will be categorized as excessive or not excessive based on clinical guidelines. DISCUSSION: Effective strategies to prevent obesity development are lacking. Exposures during the prenatal period are important in the establishment of the offspring phenotype. However, it is largely unknown which exposures can be successfully targeted to have a meaningful impact. This study will determine if prenatal DHA supplementation modifies the relationship between maternal weight gain and offspring FM and FM distribution at 24 months of age. ETHICS AND DISSEMINATION: The University of Kansas Medical Center Institutional Review Board (IRB) approved the study protocol (STUDY00140895). The results of the trial will be disseminated at conferences and in peer reviewed publications. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03310983.

Midwives' experiences of supporting healthy gestational weight management: A mixed methods systematic literature review.

BACKGROUND: Excessive levels of gestational weight gain (GWG) are linked with poorer health outcomes for mother and baby, including an increased risk of pregnancy-related hypertension, labour induction, caesarean delivery and increased birth weight. OBJECTIVE: To explore literature relating to midwives' experiences and challenges and identify interventions relating to GWG. DESIGN: This review was conducted in accordance with the Joanna Briggs Institute methodology for mixed methods systematic reviews. CINAHL complete, APA PsycArticles, APA PsycInfo, the Cochrane Library and MEDLINE were systematically searched in May 2022. Search terms related to midwives, advice, weight management and experiences were used. A PRISMA approach was taken to identify data, and thematic analysis combined with descriptive statistics allowed synthesis and integration. FINDINGS: Fifty-seven papers were included and three overarching themes were generated; i) emotion and weight, ii) ability to influence and iii) practical challenges and strategies for success. Weight was consistently described as a sensitive topic. Challenges included level of expertise and comfort, perceptions of ability to influence and an awareness of incongruence of midwives' own weight and the advice they are delivering. Interventions evaluated well with some self-reports of improved knowledge and confidence. There was no evidence of impact on practice or GWG. KEY CONCLUSIONS: Although addressing maternal weight gain is an international priority due to the significant risks incurred, in this review we have identified multiple challenges for midwives to support women in healthy weight management. Identified interventions targeting midwives do not directly address the challenges identified and are therefore likely to be insufficient to improve existing practice. IMPLICATIONS FOR PRACTICE: Partnership working and co-creation with women and midwives is essential to ensure knowledge about maternal weight gain is effectively shared across communities to catalyse change.

Effect of maternal dietary habits and gestational weight gain on birth weight: an analytical cross-sectional study among pregnant women in the Tamale Metropolis.

Introduction: dietary intake and optimal gestational weight gain are important factors leading to a positive outcome for both mothers and their infants. Women who consume inadequate diet and gain inadequate weight during pregnancy are at risk of bearing a baby with low birth weight, whereas those who gain excessive weight are at increased risk of preeclampsia, having macrosomal babies, and gestational diabetes. The study aimed to assess the effect of maternal dietary intake, gestational weight on birth weight among pregnant women in Tamale Metropolis. Methods: the study was a health-facility-based analytical cross-sectional study that involved 316 postnatal mothers. A semi-structured questionnaire was used to collect the data. Data collected were analyzed using STATA version 12. Multiple logistic regression model was estimated to determine the predictors of birth weight. Statistical significance was set at p<0.05. Results: the study showed 17.8%, 55.9%, and 26.4% prevalence of inadequate, adequate, and excessive gestational weight gain, respectively. Although, all respondents consume supper every day, only 40.0% consumes snacks daily, 97.5% and 98.7% consumes breakfast and lunch daily respectively. Majority of the respondents (92.4%) had acceptable minimum dietary diversity. About 11.0% and 4.0% of the babies were low birth weight and macrosomic, respectively. Furthermore, the prevalence of inadequate and adequate dietary intake was, respectively, 7.6% and 92.4%. The results showed that underweight before pregnancy (BMI<18Kg/m2) (AOR=8.3, 95% CI: 6.7-15.0) and inadequate weight gain during pregnancy (AOR=4.5, 95% CI: 3.9-6.5) were significant determinant of low birthweight baby. Conclusion: on the whole, maternal body mass index and weight gain during pregnancy were strong predictors of low birth weight. Low birth weight is a major public health concern and the causes multifaceted in natures. Therefore, to deal with low birth weight, a more holistic and multi-sectoral approaches such as behaviour change communication and comprehensive preconception care are required.

Prevalence and pregnant women's knowledge of maternal obesity and excessive gestational weight gain among women attending antenatal care in Fako Division, Cameroon.

Introduction: obesity poses significant public health concerns, being a risk factor for most non-communicable diseases and future cardiovascular diseases. Maternal obesity could be associated with adverse maternal-foetal outcomes, and there is a scarcity of data regarding obesity in pregnancy in our setting. Our objective was to determine the prevalence and knowledge of obesity and excessive Gestational Weight Gain (GWG) among pregnant women attending ANC in the Fako Division. Methods: we conducted a hospital-based cross-sectional study from January 28 to May 29, 2020, in the Limbe District Hospital (LDH) and Buea Road Integrated Health Centre (BRIHC). We collected data on socio-demographic prevalence, including knowledge of obesity and excessive GWG among pregnant women. Data was analysed using IBM SPSS version 26. Results: out of the 317 participants included, 58.9% (n=185) were aged 20-29 years, 36% (n=116) unemployed. The mean gestational age was 28.82 ± 7.75 weeks and 33.1% (n=105) were nulliparous. The prevalence of obesity in pregnancy and excessive GWG were 42.3% (n=134) and 41.6% (n=132) respectively. Respondents who consumed alcohol were more likely to be obese (aOR: 2.11, 95% CI 1.19-3.71; p; = 0.01). Those aged <20 (aOR: 0.064, 95% CI 0.007-0.57; p= 0.014) and 20-29 years (aOR: 0.297, 95% CI 0.16-0.56; p<0.001) were less likely to be obese than those 30-39 years. 46.1% (n=147) had poor knowledge of the complications of obesity in pregnancy, while 77.3% (n=245) had moderate knowledge of the safe and effective weight management methods during pregnancy. Late ANC booking was associated with excessive GWG (P=0.002). Conclusion: maternal obesity and excessive GWG is highly prevalent among ANC clients in the Fako Division, with excessive GWG being associated with late ANC booking. Hence, there is a need to design community-based interventions that could increase rates of early booking visits and consequently increase its benefits.

The effects of a midwife-led weight management program for pregnant women: A randomized controlled trial.

BACKGROUND: Inappropriate weight gain during pregnancy may present risks for maternal and newborn health. Pregnancy is considered the optimal time to intervene on women's health behaviors such as eating habits and physical activity. However, current clinical practice guidelines for weight management during pregnancy were not fully based on randomized trials, thus lacking specific "active intervention ingredients" that are proven effective in achieving appropriate gestational weight gain. Therefore it is essential to develop and implement an evidence-based weight management program for pregnant women. OBJECTIVE: To examine the effects of a midwife-led weight management program on improving appropriate gestational weight gain, health literacy, experience of antenatal care, and maternal and neonatal outcomes among Chinese pregnant women. DESIGN: A two-group randomized controlled trial. SETTINGS AND PARTICIPANTS: A total of 426 pregnant women were recruited from a tertiary women's hospital in eastern China. METHODS: Participants were randomly allocated to either intervention group (n = 213) or control group (n = 213). Women in the intervention group participated in a midwife-led weight management program during pregnancy, while women in the control group received the conventional obstetrician-led antenatal care. We assessed women at the first antenatal contact, 35-36 weeks gestation and 2-3 days postpartum. Data on gestational weight gain, health literacy, experience of antenatal care, and maternal and neonatal outcomes were compared between the two groups. Dummy variable analysis was conducted to reveal the effect of weight management program on gestational weight gain. RESULTS: The overall gestational weight gain between the two groups was not statistically different (t = -1.377, P = 0.170). Compared with women in the control group, the odds of having inappropriate gestational weight gain was lower in the intervention group (OR = 0.270, 95%CI 0.169, 0.431). Further subgroup analyses showed that women in the intervention group had lower risk of inadequate gestational weight gain (OR = 0.305, 95%CI 0.180, 0.515) and excessive gestational weight gain (OR = 0.236, 95%CI 0.138, 0.404) than those in the control group. The score of experience of antenatal care was significantly higher in the midwife-led weight management group than that in the control group (193.70 ±â€¯18.51 versus 165.70 ±â€¯28.23, P < 0.001). Women's health literacy score was higher in the intervention group than control group [74.41 (69.57, 81.77) versus 71.88 (66.23, 77.18), P = 0.004]. CONCLUSION: Compared with the conventional antenatal care, the midwife-led weight management program could facilitate appropriate gestational weight gain, enhance health literacy, and promote positive experience of antenatal care for Chinese pregnant women.

Dietary Advice to Support Glycaemic Control and Weight Management in Women with Type 1 Diabetes during Pregnancy and Breastfeeding.

In women with type 1 diabetes, the risk of adverse pregnancy outcomes, including congenital anomalies, preeclampsia, preterm delivery, foetal overgrowth and perinatal death is 2-4-fold increased compared to the background population. This review provides the present evidence supporting recommendations for the diet during pregnancy and breastfeeding in women with type 1 diabetes. The amount of carbohydrate consumed in a meal is the main dietary factor affecting the postprandial glucose response. Excessive gestational weight gain is emerging as another important risk factor for foetal overgrowth. Dietary advice to promote optimized glycaemic control and appropriate gestational weight gain is therefore important for normal foetal growth and pregnancy outcome. Dietary management should include advice to secure sufficient intake of micro- and macronutrients with a focus on limiting postprandial glucose excursions, preventing hypoglycaemia and promoting appropriate gestational weight gain and weight loss after delivery. Irrespective of pre-pregnancy BMI, a total daily intake of a minimum of 175 g of carbohydrate, mainly from low-glycaemic-index sources such as bread, whole grain, fruits, rice, potatoes, dairy products and pasta, is recommended during pregnancy. These food items are often available at a lower cost than ultra-processed foods, so this dietary advice is likely to be feasible also in women with low socioeconomic status. Individual counselling aiming at consistent timing of three main meals and 2-4 snacks daily, with focus on carbohydrate amount with pragmatic carbohydrate counting, is probably of value to prevent both hypoglycaemia and hyperglycaemia. The recommended gestational weight gain is dependent on maternal pre-pregnancy BMI and is lower when BMI is above 25 kg/m2. Daily folic acid supplementation should be initiated before conception and taken during the first 12 gestational weeks to minimize the risk of foetal malformations. Women with type 1 diabetes are encouraged to breastfeed. A total daily intake of a minimum of 210 g of carbohydrate is recommended in the breastfeeding period for all women irrespective of pre-pregnancy BMI to maintain acceptable glycaemic control while avoiding ketoacidosis and hypoglycaemia. During breastfeeding insulin requirements are reported approximately 20% lower than before pregnancy. Women should be encouraged to avoid weight retention after pregnancy in order to reduce the risk of overweight and obesity later in life. In conclusion, pregnant women with type 1 diabetes are recommended to follow the general dietary recommendations for pregnant and breastfeeding women with special emphasis on using carbohydrate counting to secure sufficient intake of carbohydrates and to avoid excessive gestational weight gain and weight retention after pregnancy.

Predictors of Human Milk Fatty Acids and Associations with Infant Growth in a Norwegian Birth Cohort.

Triglyceride-bound fatty acids constitute the majority of lipids in human milk and may affect infant growth. We describe the composition of fatty acids in human milk, identify predictors, and investigate associations between fatty acids and infant growth using data from the Norwegian Human Milk Study birth cohort. In a subset of participants (n = 789, 30% of cohort), oversampled for overweight and obesity, we analyzed milk concentrations of detectable fatty acids. We modelled percent composition of fatty acids in relation to maternal body mass index, pregnancy weight gain, parity, smoking, delivery mode, gestational age, fish intake, and cod liver oil intake. We assessed the relation between fatty acids and infant growth from 0 to 6 months. Of the factors tested, excess pregnancy weight gain was positively associated with monounsaturated fatty acids and inversely associated with stearic acid. Multiparity was negatively associated with monounsaturated fatty acids and n-3 fatty acids while positively associated with stearic acid. Gestational age was inversely associated with myristic acid. Medium-chain saturated fatty acids were inversely associated with infant growth, and mono-unsaturated fatty acids, particularly oleic acid, were associated with an increased odds of rapid growth. Notably, excessive maternal weight gain was associated with cis-vaccenic acid, which was further associated with a threefold increased risk of rapid infant growth (OR = 2.9, 95% CI 1.2-6.6), suggesting that monounsaturated fatty acids in milk may play a role in the intergenerational transmission of obesity.

Effects of prenatal nutritional supplements on gestational weight gain in low- and middle-income countries: a meta-analysis of individual participant data.

BACKGROUND: Gestational weight gain (GWG) below or above the Institute of Medicine (IOM) recommendations has been associated with adverse perinatal outcomes. Few studies have examined the effect of prenatal nutrient supplementations on GWG in low- and middle-income countries (LMICs). OBJECTIVES: We aimed to investigate the effects of multiple micronutrient supplements (MMSs) and small-quantity lipid-based nutrient supplements (LNSs) on GWG in LMICs. METHODS: A 2-stage meta-analysis of individual participant data was conducted to examine the effects of MMSs (45,507 women from 14 trials) and small-quantity LNSs (6237 women from 4 trials) on GWG compared with iron and folic acid supplements only. Percentage adequacy of GWG and total weight gain at delivery were calculated according to the IOM 2009 guidelines. Binary outcomes included severely inadequate (percentage adequacy <70%), inadequate (<90%), and excessive (>125%) GWG. Results from individual trials were pooled using fixed-effects inverse-variance models. Heterogeneity was examined using I2, stratified analysis, and meta-regression. RESULTS: MMSs resulted in a greater percentage adequacy of GWG [weighted mean difference (WMD): 0.86%; 95% CI: 0.28%, 1.44%; P < 0.01] and higher GWG at delivery (WMD: 209 g; 95% CI: 139, 280 g; P < 0.01) than among those in the control arm. Women who received MMSs had a 2.9% reduced risk of severely inadequate GWG (RR: 0.971; 95% CI: 0.956, 0.987; P < 0.01). No association was found between small-quantity LNSs and GWG percentage adequacy (WMD: 1.51%; 95% CI: -0.38%, 3.40%; P = 0.21). Neither MMSs nor small-quantity LNSs were associated with excessive GWG. CONCLUSIONS: Maternal MMSs were associated with greater GWG percentage adequacy and total GWG at delivery than was iron and folic acid only. This finding is consistent with previous results on birth outcomes and will inform policy development and local recommendations of switching routine prenatal iron and folic acid supplements to MMSs.

Fortified Balanced Energy-Protein Supplementation, Maternal Anemia, and Gestational Weight Gain: A Randomized Controlled Efficacy Trial among Pregnant Women in Rural Burkina Faso.

BACKGROUND: Anemia and suboptimal gestational weight gain (GWG) are associated with adverse maternal and birth outcomes. Limited research indicates that balanced energy-protein (BEP) supplements reduce the incidence of inadequate GWG. OBJECTIVES: We assessed the efficacy of a micronutrient-fortified BEP supplement on the secondary outcomes of anemia, GWG, GWG rate, and GWG in relation to the Institute of Medicine (IOM)'s recommendations, as compared with an iron-folic acid (IFA) tablet. METHODS: We conducted a randomized controlled trial in Burkina Faso, among pregnant women (15-40 y old) enrolled at <21 weeks of gestation. Women received either BEP and IFA (intervention) or IFA (control). Hemoglobin (g/dL) concentrations were measured at baseline and the third antenatal care visit (ANC), whereas maternal weight was measured at baseline and all subsequent ∼7-weekly ANCs. GWG (kg) was calculated as a woman's last weight measurement (at ∼36 weeks of gestation) minus weight at enrollment, whereas GWG rate (kg/wk) was GWG divided by the time between the first and last weight measurements. GWG adequacy (%) was computed as GWG divided by the IOM's recommendation. Binary outcomes included severely inadequate, inadequate, and excessive GWG. Statistical analyses followed the intention-to-treat principle. Linear regression and probability models were fitted for the continuous and binary outcomes, respectively, adjusting for baseline measurements. RESULTS: Women in the BEP group tended to have higher, but nonsignificantly different, GWG (0.28 kg; 95% CI: -0.05, 0.58 kg; P = 0.099). Furthermore, there were no significant differences in prenatal anemia prevalence, GWG rate, GWG adequacy, or incidence of inadequate or excessive GWG. Findings were robust to model adjustments and complete case and per protocol analyses. CONCLUSIONS: This trial does not provide evidence that fortified BEP supplementation reduces maternal anemia or increases GWG, as compared with IFA. In conjunction with the small, but positive, effects of maternal BEP supplementation on birth outcomes, our findings warrant the investigation of additional biochemical and postnatal outcomes.This trial was registered at clinicaltrials.gov as NCT03533712.

Gestational weight gain during the second and third trimesters and adverse pregnancy outcomes, results from a prospective pregnancy cohort in urban Tanzania.

BACKGROUND: Appropriate gestational weight gain (GWG) is important for optimal pregnancy outcomes. This study prospectively evaluated the associations between GWG during the second and third trimesters of pregnancy and adverse pregnancy outcomes in an urban Tanzanian pregnancy cohort. METHODS: We used data from a randomized clinical trial conducted among pregnant women recruited by 27 weeks of gestation in Dar es Salaam, Tanzania (N = 1230). Women's gestational weight was measured at baseline and at monthly antenatal visits. Weekly GWG rate during the second and third trimesters was calculated and characterized as inadequate, adequate, or excessive, in conjunction with measured or imputed early-pregnancy BMI status according to the 2009 Institute of Medicine (IOM) GWG guidelines. We used multivariable Poisson regression with a sandwich variance estimator to calculate risk ratios (RR) for associations of GWG with low birth weight, preterm birth, small for gestational age (SGA), and large for gestational age (LGA). Degree of appropriate GWG defined using additional metrics (i.e., percentage of adequacy, z-score) and potential effect modification by maternal BMI were additionally evaluated. RESULTS: According to the IOM guidelines, 517 (42.0%), 270 (22.0%), and 443 (36.0%) women were characterized as having inadequate, adequate, and excessive GWG, respectively. Overall, compared to women with adequate GWG, women with inadequate GWG had a lower risk of LGA births (RR = 0.54, 95% CI: 0.36-0.80) and a higher risk of SGA births (RR = 1.32, 95% CI: 0.95-1.81). Women with inadequate GWG as defined by percentage of GWG adequacy had a higher risk of LBW (OR = 1.93, 95% CI: 1.03-3.63). In stratified analyses by early-pregnancy BMI, excessive GWG among women with normal BMI was associated with a higher risk of preterm birth (RR = 1.59, 95% CI: 1.03-2.44). CONCLUSIONS: A comparatively high percentage of excessive GWG was observed among healthy pregnant women in Tanzania. Both inadequate and excessive GWGs were associated with elevated risks of poor pregnancy outcomes. Future studies among diverse SSA populations are warranted to confirm our findings, and clinical recommendations on optimal GWG should be developed to promote healthy GWG in SSA settings. TRIAL REGISTRATION: This trial was registered as "Prenatal Iron Supplements: Safety and Efficacy in Tanzania" (NCT01119612; http://clinicaltrials.gov/show/NCT01119612 ).

Pregnancy is a critical lifetime event for both mother and the offspring, with implications in short-term and long-term health consequences. Gestational weight gain (GWG) is an important modifiable factor for pregnancy outcomes related to infant body size and weight and prematurity. Countries in sub-Saharan Africa (SSA) have long had poor rates of insufficient GWG and pregnancy complications associated with insufficient GWG. Nevertheless, some SSA countries are experiencing economic transitions accompanied with changes in lifestyle and nutrition, which might impact pregnancy experiences, including GWG and pregnancy outcomes. This study aimed to characterize recent GWG patterns and the associations of both inadequate and excessive GWG with adverse pregnancy outcomes, using an urban pregnancy cohort in Tanzania. This study found that 42.0%. 22.0%, and 36.0% of women had insufficient, adequate, and excessive GWG, respectively. Insufficient GWG was associated with higher risks of small infant size and low infant body weight, and excessive GWG was associated with higher risk of preterm birth, particularly among women with body mass index 18.5­25.0 kg/m². Results from the present study highlight that both insufficient and excessive GWG are of potential public health concerns in urban centers of SSA, concerning upward trends in obesity and possibly obesity-related pregnancy consequences. Local public health practitioners should continue to advocate longitudinal GWG monitoring and care among African pregnant women, and optimal GWG with feasible and effective clinical guidelines should be developed to prevent both over- and under-gaining of maternal weight during pregnancy.

Longitudinal Nutritional Intakes in Italian Pregnant Women in Comparison with National Nutritional Guidelines.

BACKGROUND: Nutritional quality during pregnancy is crucial for mother and child health and their short/long-term outcomes. The aim of this study is to evaluate the adherence to nutritional recommendations in Italy during the three pregnancy trimesters in Normal Weight (NW) and Over Weight (OW) women. METHODS: Data from a multicenter randomized controlled trial included 176 women (NW = 133; OW = 43) with healthy singleton pregnancies enrolled within 13 + 6 weeks of gestation. Dietary intake was assessed every trimester by a Food Frequency Questionnaire. RESULTS: OW and NW had similar gestational weight gain. However, as Institute of Medicine (IOM) recommend lower gestational weight gain (GWG) for OW, they exceeded the suggested range. In both groups, caloric intake during the three trimesters never met recommendations. Protein intake in first and second trimester was higher than recommendations, as was sugars percentage. Dietary fiber intake was lower in OW. Polyunsaturated fatty acids, calcium, iron and folic acid requirements were never satisfied, while sodium intake exceeded recommendations. CONCLUSIONS: NW and OW women in Italy do not adhere to nutritional recommendations during pregnancy, with lower caloric intake, protein and sugars excess and inadequacies in micronutrients intake. Pregnant women in Italy should be provided with an adequate counseling and educational intervention as well as supplementation when indicated.

FADS1 and FADS2 Gene Polymorphisms Modulate the Relationship of Omega-3 and Omega-6 Fatty Acid Plasma Concentrations in Gestational Weight Gain: A NISAMI Cohort Study.

The polymorphisms of fatty acid desaturase genes FADS1 and FADS2 have been associated with an increase in weight gain. We investigated FADS1 and FADS2 gene polymorphisms and the relation between ω-3 and ω-6 fatty acid plasma concentrations and gestational weight gain. A prospective cohort study of 199 pregnant women was followed in Santo Antônio de Jesus, Brazil. Plasma levels of polyunsaturated fatty acids (PUFAs) were measured at baseline and gestational weight gain during the first, second, and third trimesters. Fatty acid recognition was carried out with the aid of gas chromatography. Single nucleotide polymorphisms (SNPs) were genotyped using real-time PCR. Statistical analyses included Structural Equation Modelling. A direct effect of FADS1 and FADS2 gene polymorphisms on gestational weight was observed; however, only the SNP rs174575 (FADS2) showed a significant positive direct effect on weight over the course of the pregnancy (0.106; p = 0.016). In terms of the influence of SNPs on plasma levels of PUFAs, it was found that SNP rs174561 (FADS1) and SNP rs174575 (FADS2) showed direct adverse effects on plasma concentrations of ω-3 (eicosapentaenoic acid and alpha-linoleic acid), and only SNP rs174575 had positive direct effects on plasma levels of ARA and the ARA/LA (arachidonic acid/linoleic acid) ratio, ω-6 products, while the SNP rs3834458 (FADS2) had an adverse effect on plasma concentrations of EPA, leading to its increase. Pregnant women who were heterozygous and homozygous for the minor allele of the SNP rs3834458 (FADS2), on the other hand, showed larger concentrations of series ω-3 substrates, which indicates a protective factor for women's health.

Effectiveness of a Step Counter Smartband and Midwife Counseling Intervention on Gestational Weight Gain and Physical Activity in Pregnant Women With Obesity (Pas and Pes Study): Randomized Controlled Trial.

BACKGROUND: Women who are pregnant and have obesity and excessive gestational weight gain (GWG) present a higher risk of maternal and perinatal complications. The use of mobile apps and a wristband during pregnancy may contribute to promoting healthy lifestyles and, thus, improving maternal and neonatal health. OBJECTIVE: This study aims to evaluate the effectiveness of a complex digital health intervention, using a smartband and app with midwife counseling, on GWG and physical activity (PA) in women who are pregnant and have obesity and analyze its impact on maternal and perinatal outcomes. In addition, we aim to study the frequency of use, usability, and satisfaction with the mobile apps used by the women in the intervention group. METHODS: A parallel, 2-arm, randomized controlled trial was conducted. A total of 150 women who were pregnant and had obesity were included. The intervention group received a complex combined digital intervention. The intervention was delivered with a smartband (Mi Band 2) linked to the app Mi Fit to measure PA and the Hangouts app with the midwife to provide personal health information. The control group received usual care. The validated Spanish versions of the International Physical Activity Questionnaire-Short Form and the System Usability Scale were used. Satisfaction was measured on a 1- to 5-point Likert scale. RESULTS: We analyzed 120 women, of whom 30 (25%) were withdrawn because of the COVID-19 pandemic. The median GWG in the intervention group was 7.0 (IQR 4-11) kg versus 9.3 (IQR 5.9-13.3) kg in the control group (P=.04). The adjusted mean GWG per week was 0.5 (95% CI 0.4-0.6) kg per week in the control group and 0.3 (95% CI 0.3-0.4) kg per week in the intervention group (df=0.1, 95% CI -0.2 to 0.03; P=.008). During the 35 and 37 gestational weeks, women in the intervention group had higher mean PA than women in the control group (1980 metabolic equivalents of tasks-minutes per week vs 1386 metabolic equivalents of tasks-minutes per week, respectively; P=.01). No differences were observed between the study groups in the incidence of maternal and perinatal outcomes. In the intervention group, 61% (36/59) of the women who were pregnant used the smartband daily, and 75% (44/59) evaluated the usability of the Mi Fit app as excellent. All women in the intervention group used the Hangouts app at least once a week. The mean of the satisfaction scale with the health counseling app and midwife support was 4.8/5 (SD 0.6) points. CONCLUSIONS: The use of a complex mobile health intervention was associated with adequate GWG, which was lower in the intervention group than in the control group. In addition, we observed that the intervention group had increases in PA. No differences were observed in maternal perinatal complications. TRIAL REGISTRATION: ClinicalTrials.gov NCT03706872; https://www.clinicaltrials.gov/ct2/show/NCT03706872.

Prenatal yoga and excessive gestational weight gain: A review of evidence and potential mechanisms.

PURPOSE: To review the evidence of the potential mechanisms (behavioral, psychological/emotional, and physical factors) of prenatal yoga for preventing excessive gestational weight gain (GWG) in pregnant women to guide future research. MAIN BODY: Prenatal yoga is a common form of physical activity during pregnancy and includes a combination of physical postures, breath control and meditation. This review theorizes how combining physical activity (i.e., prenatal yoga postures) with the add-ons brought by prenatal yoga (e.g., breath control, meditation), might provide a more comprehensive and effective strategy to prevent excessive GWG than physical activity alone. This article a) summarizes the literature on potential mechanisms of prenatal yoga to prevent excessive GWG specifically focusing on behavioral (diet, physical activity, and sleep), psychological/emotional (self-awareness, emotion regulation, stress, mood, mindfulness) and physical factors (pregnancy discomforts), b) highlights limitations of current studies, and c) provides suggestions for future research. The findings demonstrate there is insufficient evidence that prenatal yoga improves behavioral, psychological/emotional and physical factors in pregnant women and more research is needed. Though these factors have been more strongly linked to improved weight outcomes in non-pregnant populations, further testing in pregnant women is necessary to draw definitive conclusions for the efficacy of prenatal yoga to prevent excessive GWG. CONCLUSION: Effective strategies are needed to prevent excessive GWG to encourage optimal maternal and child health outcomes. More research is warranted to evaluate the impact of prenatal yoga on weight outcomes during pregnancy and design studies to test the proposed mechanisms discussed in this review.

Associations between Gestational Weight Gain Adequacy and Neonatal Outcomes in Tanzania.

INTRODUCTION: Gestational weight gain (GWG) is associated with fetal and newborn health; however, data from sub-Saharan Africa are limited. METHODS: We used data from a prenatal micronutrient supplementation trial among a cohort of human immunodeficiency virus-negative pregnant women in Dar es Salaam, Tanzania to estimate the relationships between GWG and neonatal outcomes. GWG adequacy was defined as the ratio of the total observed weight gain over the recommended weight gain based on the Institute of Medicine body mass index-specific guidelines. Neonatal outcomes assessed were stillbirth, perinatal death, preterm birth, low birthweight, macrosomia, small-for-gestational age (SGA), large-for-gestational age (LGA), stunting at birth, and microcephaly. Modified Poisson regressions with robust standard error were used to estimate the relative risk of newborn outcomes as a function of GWG adequacy. RESULTS: Of 7,561 women included in this study, 51% had severely inadequate (<70%) or inadequate GWG (70 to <90%), 31% had adequate GWG (90 to <125%), and 18% had excessive GWG (≥125%). Compared to adequate GWG, severely inadequate GWG was associated with a higher risk of low birthweight, SGA, stunting at birth, and microcephaly, whereas excessive GWG was associated with a higher risk of LGA and macrosomia. CONCLUSION: Interventions to support optimal GWG are needed and may contribute to preventing adverse neonatal outcomes.

Modeling the Predictive Value of Evidence-Based Referral Criteria to Support Healthy Gestational Weight Gain among an Australian Pregnancy Cohort.

Globally, there has been a renewed focus on addressing gestational weight gain (GWG). In Australia, the Department of Health pregnancy care guidelines recommend women be offered routine weighing and receive brief nutritional and physical activity support during antenatal care visits. Women gaining weight outside the Institute of Medicine (IOM)'s weight gain reference values are further recommended to be referred to a dietitian. However, professional and organizational barriers, including an absence of weight gain referral pathways and limited workforce resources, exist with the translation and scaling of these recommendations into practice. This study aimed to explore patterns of GWG among a cohort of Australian pregnant women and to determine if pregnancy weight gains of above or below 2 kg or 5 kg in the second and third trimester can be used to predict total GWG outside recommendations. Sensitivity, specificity, negative, and positive likelihood ratios were calculated. The most predictive time point was 24 weeks' gestation using the minimum weight change parameter of +/-2 kg, demonstrating reasonable sensitivity (0.81, 95% CI 0.61-0.83) and specificity (0.72, 95% CI 0.61-0.83), resulting in 55% (n = 72/131) of the cohort qualifying for dietetic referral. Given the current health service constraints, a review of dietetic services within maternity care is warranted.