The impact of gestational weight gain on fetal and neonatal outcomes: the Araraquara Cohort Study.

BACKGROUND: Gestational weight gain (GWG) is an important indicator for monitoring maternal and fetal health. OBJECTIVE: To evaluate the effect of GWG outside the recommendations of the Institute of Medicine (IOM) on fetal and neonatal outcomes. STUDY DESIGN: A prospective cohort study with 1642 pregnant women selected from 2017 to 2023, with gestational age ≤ 18 weeks and followed until delivery in the city of Araraquara, Southeast Brazil. The relationship between IOM-recommended GWG and fetal outcomes (abdominal subcutaneous tissue thickness, arm and thigh subcutaneous tissue area and intrauterine growth restriction) and neonatal outcomes (percentage of fat mass, fat-free mass, birth weight and length, ponderal index, weight adequateness for gestational age by the Intergrowth curve, prematurity, and Apgar score) were investigated. Generalized Estimating Equations were used. RESULTS: GWG below the IOM recommendations was associated with increased risks of intrauterine growth restriction (IUGR) (aOR 1.61; 95% CI: 1.14-2.27), low birth weight (aOR 2.44; 95% CI: 1.85-3.21), and prematurity (aOR 2.35; 95% CI: 1.81-3.05), and lower chance of being Large for Gestational Age (LGA) (aOR 0.38; 95% CI: 0.28-0.54), with smaller arm subcutaneous tissue area (AST) (-7.99 g; 95% CI: -8.97 to -7.02), birth length (-0.76 cm; 95% CI: -1.03 to -0.49), and neonatal fat mass percentage (-0.85%; 95% CI: -1.12 to -0.58). Conversely, exceeding GWG guidelines increased the likelihood of LGA (aOR 1.53; 95% CI: 1.20-1.96), with lower 5th-minute Apgar score (aOR 0.42; 95% CI: 0.20-0.87), and increased birth weight (90.14 g; 95% CI: 53.30 to 126.99). CONCLUSION: Adherence to GWG recommendations is crucial, with deviations negatively impacting fetal health. Effective weight control strategies are imperative.

Prevalence of overweight and obesity among adolescents living with HIV after dolutegravir - based antiretroviral therapy start in Kampala, Uganda.

BACKGROUND: Dolutegravir (DTG)-based antiretroviral therapy (ART) is currently the preferred first-line treatment for persons living with HIV (PLHIV) including children and adolescents in many low- and middle-income countries including Uganda. However, there are concerns about excessive weight gain associated with DTG especially in adults. There remains paucity of current information on weight-related outcomes among adolescents on DTG. We determined the prevalence of excessive weight gain and associated factors among adolescents living with HIV (ALHIV) receiving DTG-based ART in Kampala, Uganda. METHODS: Cross-sectional study involving ALHIV aged 10-19 years on DTG-based ART for at least one year were recruited from public health facilities in Kampala between February and May 2022. Excessive weight gain was defined as becoming overweight or obese per body mass index (BMI) norms while on DTG-based ART for at least one year. Demographic, clinical and laboratory data were collected using interviewer-administered questionnaires and data extracted from medical records. At enrolment, blood pressure and anthropometry were measured and blood was drawn for blood glucose and lipid profile. Data was summarised using descriptive statistics and logistic regression was performed to determine the associated factors. RESULTS: We enrolled 165 ALHIV with a median age of 14 years (IQR 12-16). Eighty (48.5%) were female. The median duration on ART and DTG was 8 years (IQR 7-11) and 2 years (IQR 1-3) respectively. At DTG initiation, the majority of participants (152/165, 92.1%) were ART-experienced, and had normal BMI (160/165, 97%). Overall, 12/165 (7.3%) adolescents (95% CI: 4.2-12.4) had excessive weight gain. No factors were significantly associated with excessive weight gain after DTG start in ALHIV. However, all ALHIV with excessive weight gain were females. CONCLUSION: Our study found a prevalence of 7.3% of overweight and obesity in ALHIV after initiating DTG. We did not find any factor significantly associated with excessive weight gain in ALHIV on DTG. Nonetheless, we recommend ongoing routine monitoring of anthropometry and metabolic markers in ALHIV as DTG use increases globally, to determine the exact magnitude of excessive weight gain and to identify those at risk of becoming overweight or obese while taking the medication.

The Prevalence of Weight Gain After Obtaining Employment: A Cross-Sectional Survey of Employees at the Ministry of National Guard Health Affairs, Eastern Region, Saudi Arabia.

Background and objective Even though obesity is a major global health concern, few studies in the literature have discussed obesity in the workplace. In light of this, we aimed to explore obesity in the workplace and its contributing factors. Methodology An online survey was distributed via official work emails. The survey assessed demographic variables and work environment-related factors, such as physical and mental well-being, lack of time, and social and personal habits. The total sample included 380 full-time employees, of which 16.67% were excluded for not meeting the inclusion criteria. Data were analyzed by using descriptive and inferential statistics. Results Of note, 79.87% of the participants reported an increase in weight after getting employed. The average weight gain was 10.4 kg for 8.2 years of experience. The physical and mental items and time-related items had the highest average scores of 3.24 and 3.44, respectively. The multivariable logistic regression showed a significant association between work experience (p = 0.0259) and time (p = 0.0363), as well as physical and mental domains (p = 0.0007). Conclusions Based on our findings, greater work experience, a lack of time, and negative mental and physical well-being are risk factors for weight gain among employees.

The influence of maternal prepregnancy weight and gestational weight gain on the umbilical cord blood metabolome: a case-control study.

BACKGROUND: Maternal overweight/obesity and excessive gestational weight gain (GWG) are frequently reported to be risk factors for obesity and other metabolic disorders in offspring. Cord blood metabolites provide information on fetal nutritional and metabolic health and could provide an early window of detection of potential health issues among newborns. The aim of the study was to explore the impact of maternal prepregnancy overweight/obesity and excessive GWG on cord blood metabolic profiles. METHODS: A case control study including 33 pairs of mothers with prepregnancy overweight/obesity and their neonates, 30 pairs of mothers with excessive GWG and their neonates, and 32 control mother-neonate pairs. Untargeted metabolomic profiling of umbilical cord blood samples were performed using UHPLC‒MS/MS. RESULTS: Forty-six metabolites exhibited a significant increase and 60 metabolites exhibited a significant reduction in umbilical cord blood from overweight and obese mothers compared with mothers with normal body weight. Steroid hormone biosynthesis and neuroactive ligand‒receptor interactions were the two top-ranking pathways enriched with these metabolites (P = 0.01 and 0.03, respectively). Compared with mothers with normal GWG, in mothers with excessive GWG, the levels of 63 metabolites were increased and those of 46 metabolites were decreased in umbilical cord blood. Biosynthesis of unsaturated fatty acids was the most altered pathway enriched with these metabolites (P < 0.01). CONCLUSIONS: Prepregnancy overweight and obesity affected the fetal steroid hormone biosynthesis pathway, while excessive GWG affected fetal fatty acid metabolism. This emphasizes the importance of preconception weight loss and maintaining an appropriate GWG, which are beneficial for the long-term metabolic health of offspring.

Inhibitory effect of stinging nettle (Urtica dioica L.) extract on body weight gain in rats on a high-fat diet.

Introduction: The leaves and seeds of Urtica dioica (UD) are used in folk treatments for many diseases. Anticarcinogenic, anti-inflammatory, antioxidant, and antiallergenic properties of UD have been reported. Aim: To uncover the effects of nettle seed (Urtica dioica; UD) extract on body weight gain in rats on a high-fat diet (HFD). Material and methods: Male Wistar albino rats (n = 32) were divided into 4 groups, comprising a control group, a group that received a HFD (HFD group), a group that received UD extracts (UD group), and a group that received a HFD as well as UD extracts (HFD + UD group). UD extracts were given a daily dose of 300 mg/kg of body weight orally for 75 days. Results: The HFD led to weight gain that was partially moderated by the UD extract. Histopathological findings in the HFD + UD group were uniformly significantly lower than those in the HFD group. Serum alanine transaminase, alanine aminotransferase, triglyceride, and low-density lipoprotein levels were significantly higher in the HFD group than in the HFD + UD group, and the HDL levels were lower in the HFD group than in the control group and the HFD + UD group. Conclusions: The cholesterol levels were discovered to be highest in the HFD + UD group. Therefore, it was concluded that the UD extract did not completely protect the rats against body weight gain.

Nutritional parameters and productive performance of grazing sheep using castor bean cake as supplement or fertilizer.

The objective was to evaluate the effect of detoxified castor bean replacing soybean meal in the concentrate diet or as nitrogen organic fertilizer replacing urea on intake and nutrient digestibility, blood parameters and productive performance of sheep finished on irrigated Tamani grass pasture under continuous stocking and variable stocking rate. The treatments were two concentrate diets: standard (ground corn and soybean meal) and alternative diet (ground corn and detoxified castor bean cake), and two nitrogen fertilizers: chemical (urea) and organic (fresh castor bean cake). The randomized complete block design was used in a 2 × 2 factorial arrangement with four replications (500 m² paddocks). Four sheep (2 castrated males and 2 females) were distributed in each experimental unit, totaling 64 animals with an average initial weight of 19.42 ± 3.6 kg. No effects (P > 0.05) were observed on the variables inherent to the evaluation of the pasture. The average stocking rate (SR) among treatments was 85.50 sheep/ha, equivalent to 9.87 Animal Units (AU)/ha. The alternative diet presented lower dry matter digestibility (62.71%), with no negative effects on nutrient intake and kidney parameters. Animals fed the standard and alternative diet showed average daily gain of 103.75 and 86.76 g/day, respectively. A finishing period of up to 100 days is recommended for sheep selected for production systems in semi-arid regions managed intensively on pasture. Detoxified castor bean cake did not alter nutrient intake, liver and kidney parameters of the sheep and can be used in pasture-based sheep farming.

Association of Growth During Infancy With Neurodevelopment and Obesity in Children Born Very Preterm: The Environmental influences on Child Health Outcomes Cohort.

OBJECTIVE: To evaluate associations between change in weight z-score after neonatal intensive care unit (NICU) discharge and neurodevelopmental outcomes and obesity at 12-48 months of age among individuals born very preterm. STUDY DESIGN: This secondary analysis used data from infants born very preterm participating in the Environmental influences on Child Health Outcomes cohort (n=1400). Growth during infancy was calculated as change in weight z-score between NICU discharge and follow-up at a mean of 27 months of age. Very low weight gain was defined as a change in weight z-score <-1.67; very high weight gain was a change in weight z-score >1.67. Neurodevelopmental outcomes included the Bayley Scales of Infant and Toddler Development, Child Behavior Checklist 1.5-5 years, and Modified Checklist for Autism in Toddlers. Multivariable linear regression was used to estimate associations between increase in weight z-score and neurodevelopmental outcomes. RESULTS: Very low weight gain between NICU discharge and follow-up (experienced by 6.4% of participants) was associated with lower scores on cognitive (adjusted mean difference: -4.26; 95% confidence interval: -8.55, -0.04) and language (adjusted mean difference: -4.80; 95% confidence interval: -9.70, -0.11) assessments. Very high weight gain (experienced by 13.6% of participants) was associated with an increased obesity risk (adjusted relative risk: 6.20; 95% confidence interval: 3.99, 9.66) but not with neurodevelopmental outcomes. CONCLUSIONS: Very high weight gain in the first 12-48 months after NICU discharge was associated with a higher risk of obesity at follow-up; very low weight gain was associated with lower scores on cognitive and language assessments.

Exploring the optimal indicator of short-term peridiagnosis weight dynamics to predict cancer survival: A multicentre cohort study.

BACKGROUND: Body weight and its changes have been associated with cancer outcomes. However, the associations of short-term peridiagnosis weight dynamics in standardized, clinically operational time frames with cancer survival remain largely unknown. This study aimed to screen for and evaluate the optimal indicator of short-term peridiagnosis weight dynamics to predict overall survival (OS) in patients with cancer. METHODS: This multicentre cohort study prospectively collected data from 7460 patients pathologically diagnosed with cancer between 2013 and 2019. Body weight data were recorded 1 month before, at the time of and 1 month following diagnosis. By permuting different types (point value in kg, point height-adjusted value in kg/m2, absolute change in kg or relative change in percentage) and time frames (prediagnosis, postdiagnosis or peridiagnosis), we generated 12 different weight-related indicators and compared their prognostic performance using Harrell's C-index, integrated discrimination improvement, continuous net reclassification improvement and time-dependent C-index. We analysed associations of peridiagnosis relative weight change (RWC) with OS using restricted cubic spine (RCS), Kaplan-Meier analysis and multivariable-adjusted Cox regression models. RESULTS: The study enrolled 5012 males and 2448 females, with a median age of 59 years. During a median follow-up of 37 months, 1026 deaths occurred. Peridiagnosis (1 month before diagnosis to 1 month following diagnosis) RWC showed higher prognostic performance (Harrell's C-index = 0.601, 95% confidence interval [CI] = [0.583, 0.619]) than other types of indicators including body mass index (BMI), absolute weight change, absolute BMI change, prediagnosis RWC and postdiagnosis RWC in the study population (all P < 0.05). Time-dependent C-index analysis also indicated that peridiagnosis RWC was optimal for predicting OS. The multivariable-adjusted RCS analysis revealed an N-shaped non-linear association between peridiagnosis RWC and OS (PRWC < 0.001, Pnon-linear < 0.001). Univariate survival analysis showed that the peridiagnosis RWC groups could represent distinct mortality risk stratifications (P < 0.001). Multivariable survival analysis showed that, compared with the maintenance group (weight change < 5%), the significant (gain >10%, hazard ratio [HR] = 0.530, 95% CI = [0.413, 0.680]) and moderate (gain 5-10%, HR = 0.588, 95% CI = [0.422, 0.819]) weight gain groups were both associated with improved OS. In contrast, the moderate (loss 5-10%, HR = 1.219, 95% CI = [1.029, 1.443]) and significant (loss >10%, HR = 1.280, 95% CI = [1.095, 1.497]) weight loss groups were both associated with poorer OS. CONCLUSIONS: The prognostic performance of peridiagnosis RWC is superior to other weight-related indicators in patients with cancer. The findings underscore the importance of expanding the surveillance of body weight from at diagnosis to both past and future, and conducting it within clinically operational time frames, in order to identify and intervene with patients who are at risk of weight change-related premature deaths.

A case of secondary pseudohypoaldosteronism that presented as poor weight gain.

Key clinical message: Pseudohypoaldosteronism (PHA) carries a good prognosis if treated early and appropriately, but some cases can have life-threatening events. We underscored the need to consider secondary PHA as one of the differential diagnoses of hyponatremia and hyperkalemia in infancy. Abstract: Pseudohypoaldosteronism (PHA) type 1 has two classifications; the primary type, caused by genetic abnormalities that develop during neonatal and infancy periods, and the secondary type, caused by urinary tract malformation and urinary tract infection. Secondary PHA, if treated early and appropriately, has a good prognosis; however, some cases can present life-threatening events. Therefore, early diagnosis is crucial. We present a case of early infancy secondary PHA presented with marked hyponatremia and poor weight gain. The patient's growth and development improved with secondary PHA treatment. Here, were demonstrated the value of prompt action against infection and electrolyte imbalance and the importance of imaging for diagnosis, and underscore the need to consider secondary PHA as a differential diagnoses of hyponatremia and hyperkalemia in infancy. However further studies, including basic research, to elucidate the diseases pathology is warranted.

Associations of gestational weight gain with the long-term postpartum weight gain, body mass index, waist circumference and abdominal obesity: A 27-year prospective cohort study.

BACKGROUND: This prospective cohort study aimed to investigate the associations between gestational weight gain (GWG) and long-term postpartum maternal weight gain, body mass index (BMI), waist circumference (WC), and the risk of general and abdominal obesity, beyond motherhood (some 27 y after childbirth). METHODS: Participants were 1953 women enrolled in the Mater-University of Queensland Study of Pregnancy cohort study that started in the early 1980 s, with the most recent follow-up at 27 y postpartum. We examined the prospective associations of GWG in pregnancy with weight, BMI, and WC and the risk of adiposity 27 y after the index pregnancy. We used linear and multinomial logistic regressions to examine the independent effect of GWG on each outcome, adjusting for potential confounders and mediators. RESULTS: The average GWG during pregnancy was 14.88 kg (SD 5.24). One in four women (25.50%) gained below the Institute of Medicine (IOM) recommendations and one in three (34.00%) gained excess weight during pregnancy. Every 100 g/week increment of GWG was associated with 2.0 (95% CI: 1.5, 2.6) kg, 0.7 (0.5, 0.9) kg/m2, 1.3 (0.8, 1.8) cm greater body weight, BMI, and WC, respectively 27 y postpartum. Women who gained inadequate weight in pregnancy had significantly lower odds of general obesity (OR; 0.70, 95% CI:0.53,0.94) or abdominal obesity (0.73; 0.56,0.96), whereas those who gained excess gestational weight had much higher odds of general obesity (4.49; 3.36,6.00) and abdominal obesity (3.09; 2.29,4.16). These associations were independent of potential confounders. CONCLUSION: Maternal GWG in pregnancy independently and strongly predicted beyond motherhood weight gain trajectory. GWG within IOM recommendation may prevent long-term development of both general and central obesity.

Trajectory of gestational weight gain is related to birthweight: The TAWS cohort study in China.

Few studies have reported the timing and amount of gestational weight gain (GWG) to prevent large-for-gestational-age (LGA) or small-for-gestational-age (SGA). This study aimed to evaluate the association of GWG velocity in each trimester with LGA or SGA based on data from the Taicang and Wuqiang cohort study (TAWS, n = 2008). We used a linear mixed model to evaluate the association of trimester-specific GWG velocity with birthweight categories and stratified by prepregnancy body mass index category and parity. For normal-weight pregnant women, mothers with LGA births had higher GWG velocities than mothers with appropriate-for-gestational-age (AGA) births in the first trimester (0.108 vs. 0.031 kg/week, p < 0.01), second trimester (0.755 vs. 0.631 kg/week, p < 0.01) and third trimester (0.664 vs. 0.594 kg/week, p < 0.01); in contrast, mothers with SGA births had lower GWG velocities than mothers with AGA births in the second trimester (0.528 vs. 0.631 kg/week, p < 0.01) and third trimester (0.541 vs. 0.594 kg/week, p < 0.01). For normal-weight pregnant women with AGA births, multiparous women had lower GWG velocities than primiparous women in the second (0.602 vs. 0.643 kg/week, p < 0.01) and third trimesters (0.553 vs. 0.606 kg/week, p < 0.01). Therefore, for normal-weight women, LGA prevention would begin in early pregnancy and continue until delivery and the second and third trimesters may be critical periods for preventing SGA; in addition, among normal-weight pregnant women with AGA births, multiparous women tend to have lower weight gain velocities than primiparous women.

The effect of an injectable toltrazuril - gleptoferron (Forceris®) on Cystoisospora suis oocyst excretion and growth of neonatal piglets pre- and post-weaning.

In this study the efficacy of an intramuscular formulation of toltrazuril combined with gleptoferron for the control of porcine cystoisosporosis caused by Cystoisospora suis was investigated. The study was carried out on three Belgian farms with a confirmed history of C. suis infections. As none of the farms implemented a standardized toltrazuril treatment regimen for their piglets, the presence of resistant C. suis strains seems improbable. In total 90 litters, representing 1249 piglets, were included in the study and randomly allocated to either the treatment or control group. Piglets in the treatment group received a single intramuscular injection, containing 45 mg toltrazuril and 200 mg gleptoferron, between 1 and 3 days of age. Piglets in the control group received a single injection with only 200 mg gleptoferron. The effect of treatment on oocyst excretion, expressed in oocysts per gram of feces (OPG), average daily weight gain (ADG) and mortality was determined both pre- and post-weaning. A significant decrease in OPG as well as a decrease in the number of litters (pre-weaning) and pens (post-weaning) that tested positive for cystoisosporosis, was observed in the treated animals compared to the controls. Furthermore, treatment resulted in an increased ADG during the period from day 1 to day 21 (p-value: 0.03881). There was no significant difference in mortality observed between the treatment group to the control group (p-value: 0.2167). To our knowledge, this is the first report on the effect of toltrazuril on oocyst excretion after weaning. This finding highlights the potential long-term benefits of the treatment beyond the initial administration.

Risk Factors for Incident Polycystic Ovary Syndrome Diagnosis.

Objective: While highly prevalent, risk factors for incident polycystic ovary syndrome (PCOS) are poorly delineated. Using a population-based cohort, we sought to identify predictors of incident PCOS diagnosis. Materials and Methods: A matched case-control analysis was completed utilizing patients enrolled in Kaiser Permanente Washington from 2006 to 2019. Inclusion criteria included female sex, age 16-40 years, and ≥3 years of prior enrollment with ≥1 health care encounter. PCOS cases were identified using International Classification of Diseases codes. For each incident case (n = 2,491), 5 patients without PCOS (n = 12,455) were matched based on birth year and enrollment status. Potential risk factors preceding diagnosis included family history of PCOS, premature menarche, parity, race, weight gain, obesity, valproate use, metabolic syndrome, epilepsy, prediabetes, and types 1 and 2 diabetes. Potential risk factors for incident PCOS diagnosis were assessed with univariate and multivariable conditional logistic regressions. Results: Mean age of PCOS cases was 26.9 years (SD 6.8). PCOS cases, compared with non-PCOS, were more frequently nulliparous (70.9% versus 62.4%) and in the 3 years prior to index date were more likely to have obesity (53.8% versus 20.7%), metabolic syndrome (14.5% versus 4.3%), prediabetes (7.4% versus 1.6%), and type 2 diabetes (4.1% versus 1.7%) (p < 0.001 for all comparisons). In multivariable models, factors associated with higher risk for incident PCOS included the following: obesity (compared with nonobese) Class I-II (body-mass index [BMI], 30-40 kg/m2; odds ratio [OR], 3.8; 95% confidence interval [CI], 3.4-4.2), Class III (BMI > 40 kg/m2; OR, 7.5, 95% CI, 6.5-8.7), weight gain (compared with weight loss or maintenance) of 1-10% (OR, 1.7, 95% CI, 1.3-2.1), 10-20% (OR, 1.9; 95% CI, 1.5-2.4), and >20% (OR, 2.6; 95% CI, 1.9-3.6), prediabetes (OR, 2.7; 95% CI, 2.1-3.4), and metabolic syndrome (OR, 1.8: 95% CI, 1.5-2.1). Conclusion: Excess weight gain, obesity, and metabolic dysfunction may play a key role in the ensuing phenotypic expression of PCOS. Treatment and prevention strategies targeted at preventing weight gain in early reproductive years may help reduce the risk of this syndrome.

Mitochondrial Haplogroups and Weight Gain After Initiating ART in Patients with HIV.

We studied the association of mitochondrial DNA (mtDNA) haplogroups with weight and body mass index (BMI) gain at 96 weeks in 1,019 treatment-naïve persons with HIV (PWH) who initiated first-line antiretroviral therapy (ART) since 2014. The mean increase in weight and BMI over the study period was 2.90 Kg and 0.98 Kg/m2, respectively. We found a significant adjusted association between the major UK mtDNA haplogroup and lower weight and BMI increase at 96 weeks after ART initiation. Our findings reveal a potential role for mitochondrial genetics in the complex phenomenon of weight gain after initial ART in PWH.

Who is at risk for weight gain after weight-gain associated treatment with antipsychotics, antidepressants, and mood stabilizers: A machine learning approach.

BACKGROUND: Weight gain is a common side effect in psychopharmacology; however, targeted therapeutic interventions and prevention strategies are currently absent in day-to-day clinical practice. To promote the development of such strategies, the identification of factors indicative of patients at risk is essential. METHODS: In this study, we developed a transdiagnostic model using and comparing decision tree classifiers, logistic regression, XGboost, and a support vector machine to predict weight gain of ≥5% of body weight during the first 4 weeks of treatment with psychotropic drugs associated with weight gain in 103 psychiatric inpatients. We included established variables from the literature as well as an extended set with additional clinical variables and questionnaires. RESULTS: Baseline BMI, premorbid BMI, and age are known risk factors and were confirmed by our models. Additionally, waist circumference has emerged as a new and significant risk factor. Eating behavior next to blood glucose were found as additional potential predictor that may underlie therapeutic interventions and could be used for preventive strategies in a cohort at risk for psychotropics induced weight gain (PIWG). CONCLUSION: Our models validate existing findings and further uncover previously unknown modifiable factors, such as eating behavior and blood glucose, which can be used as targets for preventive strategies. These findings underscore the imperative for continued research in this domain to establish effective preventive measures for individuals undergoing psychotropic drug treatments.

Should gestational weight gain charts exclude individuals with excess postpartum weight retention?

BACKGROUND: High gestational weight gain is associated with excess postpartum weight retention, yet excess postpartum weight retention is not an exclusion criterion for current gestational weight gain charts. We aimed to assess the impact of excluding individuals with high interpregnancy weight change (a proxy for excess postpartum weight retention) on gestational weight gain distributions. METHODS: We included individuals with an index birth from 2008 to 2014 and a subsequent birth before 2019, in the population-based Stockholm-Gotland Perinatal Cohort. We estimated gestational weight gain (kg) at 25 and 37 weeks, using weight at first prenatal visit (<14 weeks) as the reference. We calculated high interpregnancy weight change (≥10 kg and ≥5 kg) using the difference between weight at the start of an index and subsequent pregnancy. We compared gestational weight gain distributions and percentiles (stratified by early-pregnancy body mass index) before and after excluding participants with high interpregnancy weight change. RESULTS: Among 55,723 participants, 17% had ≥10 kg and 34% had ≥5 kg interpregnancy weight change. The third, tenth, 50th, 90th and 97th percentiles of gestational weight gain were similar (largely within 1 kg) before versus after excluding participants with high interpregnancy weight change, at both 25 and 37 weeks. For example, among normal weight participants at 37 weeks, the 50th and 97th percentiles were 14 kg and 23 kg including versus 13 kg and 23 kg excluding participants with ≥5 kg interpregnancy weight change. CONCLUSIONS: Excluding individuals with excess postpartum weight retention from normative gestational weight gain charts may not meaningfully impact the charts' percentiles.

The impact of self-monitoring physical and mental health via an mHealth application on postpartum weight retention: Data from the INTER-ACT RCT.

Background: Postpartum weight retention (PPWR) has many health risks. Digital self-monitoring of weight can potentially make postpartum weight management easier. We aim to test to what extent the self-monitoring of weight, steps and mental health through an mHealth application increases postpartum weight loss and reduces the odds of substantial PPWR (≥5 kg). Methods: Participants were mothers in the intervention arm of the INTER-ACT multicenter randomized controlled trial (RCT), an inter-pregnancy lifestyle intervention among mothers with excessive gestational weight gain. Participants (n=288) had access to an mHealth application to log their weight, steps and mental health between 6 weeks and 6 months postpartum. A linear multiple regression model and a logistic regression model were run to test to what extent self-monitoring via the app increases postpartum weight loss and reduces the risk of substantial PPWR. Results: Women who logged their weight more often lost more weight (B=0.03, ß=0.26, CIB =[0.01,0.05], P<0.01), and had reduced odds of substantive PPWR (OR=0.99, CIOR =[0.98, 0.999], P<.05). Mental health logging reduced the odds of substantive PPWR (OR=0.98, CIOR =[0.97, 1.00], P<0.05), but was unrelated to the amount of weight loss. Steps logging was unrelated to either weight loss or substantive PPWR. Conclusion: Mothers with excessive gestational weight gain can benefit from app-based lifestyle interventions to reduce PPWR by self-monitoring their weight. More attention to mental health in PPWR interventions is needed.

Comparison of Paladai Cup Against Nifty Cup Feeding in Preterm Low-Birth-Weight Infants: An Open-Labeled Randomized Controlled Trial.

Background: Neonatal Intuitive Feeding Technology (NIFTY) cup feeding has been found to be feasible in preterm low-birth-weight babies. However, literature on direct comparison of the same with paladai feeding is lacking. Methods: In this open-labeled, randomized controlled trial, preterm infants (<34 weeks/<1800 g) on full oral gastric tube feeding for at least 3 consecutive days, eligible to be given a trial of suck and swallow cup feeding, prior to initiation of direct breastfeeding, were randomized to the two feeding intervention groups: paladai cup and Nifty cup. The primary outcome was the time taken from initiation of oral cup feeds to reaching complete gavage-free cup feeds for at least 24 hours. Secondary outcomes were the ease of use of both instruments, the adverse effects during and within 10 minutes after feeding, and anthropometric parameters (head circumference and weight gain). Results: The median (IQR) time taken from initiation to complete transition to full cup feeding for at least 24 hours was not significantly different [4(3,7) days in Nifty cup group versus 3(2,6) days in paladai cup group, p = 0.25]. Mean ± SD weight gain from intervention to discharge was also similar in both the groups (16 ± 6 g/kg/day in Nifty cup group versus 17 ± 5 g/kg/day in paladai cup group, p = 0.18). Adverse events did not differ (32.9% in group A versus 27.1% in group B, p = 0.580). Nurses did not find any difference in ease of teaching caregivers [median (IQR) Nifty cup group 4(4,5) versus paladai cup group 4(4,5), p = 0.13]. Conclusion: The efficacy and adverse event rates were similar between Nifty cup feeding and paladai cup feeding in preterm infants. Both feeding modalities can be used prior to transition to direct breastfeeding in preterm low-birth-weight infants.

Substance P Concentration in Gestational Diabetes and Excessive Gestational Weight Gain and Its Impact on Neonatal Anthropometry.

Fetal programming is a process initiated by intrauterine conditions, leaving a lasting impact on the offspring's health, whether they manifest immediately or later in life. It is believed that children born to mothers with gestational diabetes mellitus (GDM) and excessive gestational weight gain (EGWG) may be at an increased risk of developing type 2 diabetes mellitus (T2DM) and obesity later in their adult lives. Substance P is a neurotransmitter associated with obesity development and impairment of insulin signaling. Dysregulation of substance P could lead to several pregnancy pathologies, such as preeclampsia and preterm birth. Our study aimed to compare substance P concentrations in serum and umbilical cord blood in patients with GDM, EGWG, and healthy women with a family history of gestational weight gain. Substance P levels in umbilical cord blood were significantly higher in the GDM group compared to the EGWG and control groups. Substance P levels in serum and umbilical cord blood were positively correlated in all groups and the GDM group. A very interesting direction for future research is the relationship between the concentration of substance P in newborns of diabetic mothers and the occurrence of respiratory distress syndrome as a complication of impaired surfactant synthesis. To our knowledge, it is the first study assessing substance P concentration in GDM and EGWG patients.