Maternal glucose concentration influences fetal growth, gestation, and pregnancy complications.

Using 1990-1995 data, the authors examined the influence of post-challenge maternal glucose concentration on pregnancy outcome in 1,157 nondiabetic US gravidas. After control for potential confounding variables and comparing gravidas with lower glucose concentrations (<99 mg/dl) with the others, they found that mean birth weight increased by 50 g and 200 g with glucose concentrations of 99-130 mg/dl and >130 mg/dl, respectively. Increased maternal glucose concentration also was associated with an increased risk of large-for-gestation fetuses (p for trend < 0.001) and a decreased risk of fetal growth restriction (p for trend < 0.05). The association between glucose and gestation was inverse and significantly shortened when glucose concentrations were higher. Maternal complications increased twofold or more with high glucose concentrations and included cesarean section and clinical chorioamnionitis. Chorioamnionitis in combination with high maternal glucose concentration increased the risk of very preterm delivery almost 12-fold. These observations extend Pedersen's hypothesis-that high concentrations of maternal glucose give rise to increased nutrient transfer to the fetus and increase fetal growth, beyond the model of maternal diabetes (Acta Endocrinol 1954;16:330-42). They raise the question of whether higher, but seemingly normal maternal glucose concentration predisposes to or is a marker for placental inflammation and infection.

Oxidant damage to DNA and pregnancy outcome.

OBJECTIVE: DNA is susceptible to oxidation and is constantly being damaged and repaired in living cells. The most abundant of the nucleoside oxidation products is 8-oxo-7,8 dihydro-2 deoxyguanosine (8 OH-dG). Our objective was to determine whether oxidative damage to DNA, as measured by 8 OH-dG, is increased with poor pregnancy outcome. METHOD: We utilized a case-control design to study oxidative damage to DNA during an ongoing prospective study. Cases (n = 18) included all women giving birth to a low-birth-weight (< 2500 g) or growth-restricted (< 10th centile) or preterm infant (< 37 completed weeks). Controls (n = 34) were selected at random from women with normal pregnancies. Urine samples were obtained early in the third trimester (28 +/- 2 weeks) and normalized to creatinine. Diet was assessed at three points during pregnancy. RESULTS: Cases had significant (p < 0.05) increases in maternal urinary 8 OH-dG excretion at week 28, when all cases were considered and when cases were defined as those who delivered a low-birth-weight infant. 8OH-dG excretion, in turn, correlated positively with saturated fat in the maternal diet. CONCLUSION: This study suggests that gravidas with poor pregnancy outcome have increased oxidative damage to their DNA early in the third trimester of pregnancy.

Leptin and maternal growth during adolescent pregnancy.

BACKGROUND: Maternal growth on the basis of knee height occurs in nearly 50% of pregnant teenagers and is associated with greater gestational weight gain and accrual of subcutaneous fat in the mother but lower fetal growth compared with nongrowing teenagers and mature pregnant women. OBJECTIVE: The objective of this study was to determine whether leptin is a biomarker for continued maternal growth. DESIGN: Leptin concentrations were measured in 162 growing and nongrowing teenage gravidas (aged 5-fold, fetal growth restriction increased >6-fold, and infant birth weight decreased by approximately 200 g. Gravidas who developed pregnancy-induced hypertension showed a different pattern-higher leptin concentrations at entry and week 28, no difference in the leptin surge, and no postpartum difference in leptin concentration. CONCLUSION: A leptin surge by week 28 appears to mark reduced mobilization of maternal fat stores that is associated with maternal growth on the basis of knee height during adolescent pregnancy.

Adequacy of prenatal care and pregnancy outcome.

The objective of this study was to determine whether a relationship exists between adequacy of prenatal care and preterm delivery, low-birth-weight, and small-for-gestational-age infants. Data from 1771 patients enrolled in an ongoing study of maternal growth in young gravidas were studied. The indices of both Kessner and colleagues (the Kessner index) and Kotelchuck (the Kotelchuck index) were used to determine adequacy of prenatal care. Patients receiving adequate care were compared with those receiving intermediate or inadequate care and the incidence of preterm birth, low-birth-weight, and small-for-gestational-age infants was determined in each group. The study controlled for potential confounding variables, that is, black ethnicity, maternal age, pregravid body mass index, parity, adequate prenatal weight gain, smoking, and previous delivery of low-birth-weight or preterm infant. The data were analyzed by logistic regression. When classified according to the Kessner index, 290 (16.4%) of the women received inadequate care, 961 (54.3%) received intermediate care, and 520 (29.4%) received adequate care. By the Kotelchuck index, 651 (36.8%) of the women received inadequate care, 201 (11.3%) received intermediate care, 604 (34.1%) received adequate care, and 315 (17.8%) received adequate-plus care. By use of the Kessner index and by estimating gestation from the last menstrual period, it was determined that women who received inadequate care had a 2.8 times greater risk (95% confidence interval [CI], 2.07-3.78), and by use of the Kotelchuck index, a 2.1 times greater risk (95% CI, 1.58-2.81) of having a preterm delivery. When the obstetric estimate of gestation was used, risk was 2.01 times greater (95% CI, 1.44-2.80) with the Kessner index and 1.4 times greater (95% CI, 1.0-1.94) with the Kotelchuck index. There was little effect of prenatal care on incidence of small-for-gestational-age infants. The results of this study confirmed that inadequate prenatal care is associated with an increased risk of preterm delivery.

Nutrition in adolescent pregnancy.

Prevention of unintended adolescent pregnancy is a primary goal of the American Academy of Pediatrics and of many health providers. Nevertheless, many adolescents become pregnant every year in America. Pediatricians therefore should be aware of nutritional recommendations for pregnant adolescents to provide optimal care. The importance of nutrition during pregnancy is here reviewed from a pediatric perspective. Pregnancy, particularly during adolescence, is a time of extreme nutritional risk. The adolescents most likely to become pregnant are often those with inadequate nutritional status and unfavorable socio-economic background. There is increasing evidence of competition for nutrients between the growing pregnant adolescent and her fetus. Also, the prenatal environment has been implicated in the development of obesity, cardiovascular disease, and diabetes in both the mother and her offspring. Many adolescents have poor diet quality and poor knowledge of appropriate nutrition; these habits may not change during pregnancy. Current knowledge and recommendations regarding the intake of energy, calcium, and folate are discussed in detail.

Folic acid: influence on the outcome of pregnancy.

The periconceptional use of folic acid-containing supplements reduces the first occurrence, as well as the recurrence, of neural tube defects. Women of populations in which adverse pregnancy outcomes are prevalent often consume diets that contain a low density of vitamins and minerals, including folate. Folate intake may need to be sustained after complete closure of the neural tube to decrease the risk of other poor pregnancy outcomes. A central feature of embryonic and fetal development is widespread cell division; folate is central because of its role in nucleic acid synthesis. During gestation, marginal folate nutriture can impair cellular growth and replication in the fetus or placenta. Folate deficiency can occur because dietary folate intake is low or because the metabolic requirement for folate is increased by a particular genetic defect or defects. During pregnancy, low concentrations of dietary and circulating folate are associated with increased risks of preterm delivery, infant low birth weight, and fetal growth retardation. A metabolic effect of folate deficiency is an elevation of blood homocysteine. Likewise, the presence of maternal homocysteine concentrations have been associated both with increased habitual spontaneous abortion and pregnancy complications (eg, placental abruption and preeclampsia), which increase the risk of poor pregnancy outcome and of decreased birth weight and gestation duration.

Anemia, iron and pregnancy outcome.

When maternal anemia is diagnosed before midpregnancy, it has been associated with an increased risk of preterm delivery. Maternal anemia detected during the later stages of pregnancy, especially the third trimester, often reflects the expected (and necessary) expansion of maternal plasma volume. Third-trimester anemia usually is not associated with increased risk of preterm delivery. High hemoglobin concentration, elevated hematocrit and increased levels of serum ferritin late in pregnancy, however, all have been associated with increased preterm delivery. This increased risk may reflect in part the failure to expand maternal plasma volume adequately, thus diminishing appropriate placental perfusion. Although controlled trials of iron supplementation during pregnancy have consistently demonstrated positive effects on maternal iron status at delivery, they have not demonstrated reductions in factors that are associated with maternal anemia, i.e., increased risk of preterm delivery and infant low birth weight. One reason for discordant findings may be the exclusion of many gravidas with iron deficiency from these trials or the data concerning gravidas with pregnancy outcomes such as preterm delivery from the analysis. Finally, recent concerns have been voiced about harmful effects of iron supplementation during pregnancy. No adverse effects of iron supplementation on pregnancy outcome have been demonstrated to date. Questions about the efficacy of iron supplementation during pregnancy for reducing adverse outcomes such as preterm delivery and side effects from iron supplementation, including the potential for oxidation of lipids and DNA, require further research in iron-deficient women.

Plasma leptin influences gestational weight gain and postpartum weight retention.

BACKGROUND: Leptin, a product of the obese (ob) gene, is released from adipocytes. At the same body mass index, women have higher concentrations than men. Thus, during pregnancy, leptin may influence gestational weight gain and retention of a portion of that gain postpartum. OBJECTIVE: We examined the relation between plasma leptin at entry to prenatal care and subsequent changes in weight from entry to prenatal care (at 17 wk gestation, baseline) until 6 mo postpartum. DESIGN: This was an observational study of leptin, gestational weight gain, and postpartum weight retention (at 6 wk and 6 mo postpartum) in 103 low-income pregnant women from Camden, NJ, with a pregravid body mass index (in kg/m2) in the normal range (19.8-26). RESULTS: After potential confounding variables were controlled for, leptin at entry significantly (P < 0.05) predicted weight gain in pregnancy, including measured rate of weight gain (x +/- SEE: 0.25 +/- 0.13 kg x unit log leptin(-1) x wk(-1)), measured rate of third-trimester weight gain (0.37 +/- 0.15 kg x unit log leptin(-1) x wk(-1)), rate of weight gain from recalled pregravid weight (0.23 +/- 0.09 kg x unit log leptin(-1) x wk(-1)), and net rate of gestational weight gain (0.22 +/- 0.09 kg x unit log leptin(-1) x wk(-1)). The leptin concentration at entry also significantly predicted retained weight in the postpartum period (at 6 mo: 7.29 +/- 3.33 kg/unit log leptin at entry) and marginally predicted changes in the sum of skinfold thicknesses (at 6 mo: 14.7 +/- 7.5 mm/unit log leptin at entry). CONCLUSION: These results suggest that a high leptin concentration at entry to prenatal care may predict an increased risk of overweight and obesity in vulnerable women.

High third-trimester ferritin concentration: associations with very preterm delivery, infection, and maternal nutritional status.

OBJECTIVE: To determine whether a high concentration of serum ferritin during the third trimester is a marker of subclinical maternal infection and very preterm delivery and is associated with maternal nutritional status. METHODS: A total of 1162 gravidas was followed prospectively from entry to prenatal care (15.0 +/- 4.9 completed weeks' gestation) in Camden, New Jersey, between 1985 and 1995. Multiple logistic regression and analysis of covariance were used to examine the influence of serum ferritin on the outcomes of interest. RESULTS: High concentrations of serum ferritin (at or above the 90th percentile) at week 28, but not at entry to prenatal care, increased risk of preterm and very preterm delivery, but the risk changed if the concentration of ferritin declined from entry. If the concentration declined as expected, high ferritin concentration had no influence on outcome. If the concentration increased, then high ferritin concentration at week 28 was associated with very preterm delivery (adjusted odds ratio [AOR] 8.77; 95% confidence interval [CI] 3.90, 19.72), preterm delivery (AOR 3.81; 95% CI 1.93, 7.52), low birth weight (AOR 5.15; 95% CI 2.47, 10.72), clinical chorioamnionitis (AOR 2.56; 95% CI 1.01, 6.52), and symptoms of "flu" as an index of unmeasured infection (AOR 6.02; 95% CI 1.16, 31.17). Factors associated with failure of the ferritin concentration to decline included iron deficiency anemia earlier in pregnancy (AOR 3.98; 95% CI 1.17, 8.98) and lower levels of serum and red cell folate. CONCLUSION: High serum ferritin concentration in the third trimester, resulting from a failure of ferritin to decline, is associated with very preterm delivery and markers of maternal infection. Iron deficiency anemia and other indicators reflecting poor maternal nutritional status earlier in pregnancy underlie this relationship.

Social factors predicting postpartum choice of Norplant among African-American and non-Hispanic white adolescents.

PURPOSE: This study was designed to determine the factors associated with Norplant choice for postpartum teens. METHODS: A total of 151 teenagers, ages 12-20 years, who delivered at the Medical Center of Delaware from July to December 1992, were offered insertion of Norplant within 48 h postpartum. A structured interview was conducted in the postpartum period after nondirective counseling sessions including a physical demonstration using anatomical models of various contraceptive methods. Student's t-tests, chi-square, and multivariate analyses were used. RESULTS: Eighty-six teenagers were African-American (mean age = 17.3 +/- 1.9 years) and 65 non-Hispanic white (NHW) (mean age = 18.3 +/- 1.5 years). The NHW teenagers were older (p < 0.001); the African-American teenagers were more likely to have Medicaid (49% vs. 14%; p < 0.001) and to have one or more friends who use Norplant (62% vs. 34%; p < 0.001). In multivariate analyses, NHW teenagers were more likely to choose Norplant if they had discussed their choice with a parent or guardian [adjusted odds ratio (AOR) = 14.6, 95% confidence interval (CI), 2.12-100.57]; had Medicaid funding (AOR = 12.1; 95% (CI), 10.6-91.34); and had any friends who used Norplant (AOR = 6.3; 95% (CI), 1.38-28.40). However, for African-American teenagers, the strongest predictor for choice of Norplant was number of prior children delivered. After two deliveries, there was a better than four-fold likelihood (AOR = 4.8; 95% (CI), 1.47-15.94) that African-American teenagers would choose Norplant. For the African-American teenagers, parental discussion, Medicaid status, and friends' use of Norplant were not as important as family size, but far greater percentages of the African-American teenagers had access to Medicaid funding and peers who used Norplant. CONCLUSIONS: NHW and African-American teenagers choose Norplant for different reasons. Lack of funding may have been a barrier to choosing Norplant. Discussions with parents and friends have a positive influence on choosing Norplant for NHW teenagers. African-American teenagers were more likely than NHW to have Medicaid coverage, and more frequently choose Norplant if the current birth was their third child.

PIP: 151 youths, aged 12-20 years, who delivered at the Medical Center of Delaware from July to December 1992, were offered insertion of Norplant within 48 hours postpartum. These young women were subsequently interviewed to determine which factors are associated with choosing to accept or not accept Norplant. 86 Black teenagers of mean age 17.3 years and 65 non-Hispanic Whites of mean age 18.3 years participated. The White teenagers were significantly older, 49% of Blacks and 14% of Whites had Medicaid, and 62% of Blacks and 34% of Whites had one or more friends who use Norplant. In multivariate analyses, the White teens were more likely to choose Norplant if they had discussed their choice with a parent or guardian, if they received Medicaid funding, and if they had any friends who used Norplant. The strongest predictor for choice of Norplant among Black teens was the number of prior children delivered. After 2 deliveries, there was an almost 5-fold likelihood that Black teenagers would choose Norplant. For the Black teens, parental discussion, Medicaid status, and friends' use of Norplant were not as important as family size, but larger proportions of the Black teens had access to Medicaid funding and peers who used Norplant.

Young maternal age and preterm labor.

PURPOSE: The relationship among young age, biologic immaturity (as indexed by low gynecologic age), and the causes of preterm delivery (idiopathic preterm labor [PTL], premature rupture of the membranes [PROM], and medical indications) were investigated among 605 primigravidas from the Camden Study. METHODS: The sample consisted of 366 young adolescents < 16 years at the time of their last menstrual period (LMP) and 239 older women, 18-29 years at LMP (controls). The young adolescents were significantly shorter, thinner, had younger ages at menarche, and over a third (36.3%) were of low gynecologic age, i.e., their chronologic age was 2 or fewer years more than their age at menarche. RESULTS: Adjusting for ethnicity, cigarettes smoked/day, weight gain rate, height, fetal sex, gestational diabetes mellitus, and pregnancy-induced hypertension, young adolescents overall had a nearly 75% increased risk of PTL (adjusted odds ratio [AOR] = 1.74, 95% confidence interval [95% CI]: 1.07-2.84), and preterm delivery with PTL (AOR = 2.08, 95% CI: 1.08-4.00). There was a modest decreased risk of preterm delivery among young gravidas attributable to other causes, such as PROM or medical indications (AOR = 0.70, 95% CI: 0.28-1.75). This increased risk of PTL and preterm delivery with PTL was principally attributable to biologic immaturity. Young age with low gynecologic age was associated with a twofold risk of PTL (AOR = 2.15, 95% CI: 1.19-3.89) and preterm delivery with PTL (AOR = 2.64, 95% CI: 1.23-5.65), while the risk associated with young age and higher gynecologic age was only increased moderately. CONCLUSIONS: Young adolescents, and especially those of low gynecologic age, appear prone to PTL and are at increased risk for preterm delivery through this pathway.

PIP: The relationship between young maternal age and preterm delivery was investigated in a subsample of 605 primigravidas enrolled in the Camden (New Jersey, US) Study. Included were 366 adolescents under 16 years of age (cases) and 239 women 18-29 years of age (controls). 36.3% of young mothers had a low gynecological age (i.e., their chronological age was 2 or fewer years more than their age at menarche). After adjustment for ethnicity, cigarette smoking, weight gain rate, height, fetal sex, gestational diabetes mellitus, and pregnancy-induced hypertension, the odds ratio (OR) of preterm labor among young adolescents was 1.74 (95% confidence interval (CI), 1.07-2.84) and that of preterm delivery was 2.08 (95% CI, 1.08-4.00). There was a modest decreased risk of preterm delivery attributable to other causes (e.g., premature rupture of the membranes) among the youngest women (OR, 0.70; 95% CI, 0.28-1.75). Young age with low gynecological age was associated with a 2.15 OR (95% CI, 1.19-3.89) of preterm labor and a 2.64 OR (95% CI, 1.23-5.65) of preterm delivery with preterm labor. The risk associated with young age and higher gynecological age was increased only moderately. These findings suggest that it is the biological immaturity often associated with young age, rather than young maternal age per se, that increases the risks of adolescent pregnancy. The association between low gynecological age and preterm labor is presumed to reflect an irritability of the adolescent uterus, a sensitivity to dehydration, and/or an altered hormonal milieu that promotes maternal development at the expense of fetal well-being.

Use of multivitamin/mineral prenatal supplements: influence on the outcome of pregnancy.

The objective of this study was to examine the association of prenatal multivitamin/mineral supplement use during the first and second trimesters of pregnancy by low income, urban women in the Camden Study (1985-1995, n = 1,430) and preterm delivery (< 37 completed weeks) and infant low birth weight (< 2,500 g). Prenatal supplement use was corroborated by assay of circulating micronutrients at entry to care (no differences) and week 28 gestation (increased concentrations of folate and ferritin for supplement users). Compared with women who entered care during the first or second trimester but did not use prenatal supplements, supplement use starting in the first or second trimester was associated with approximately a twofold reduction in risk of preterm delivery. After controlling for potential confounding variables, risk of very preterm delivery (< 33 weeks' gestation) was reduced more than fourfold for first trimester users and approximately twofold when use dated from the second trimester. Infant low birth weight and very low birth weight (< 1,500 g) risks were also reduced. Risk of low birth weight was reduced approximately twofold with supplement use during the first and second trimester. Diminution in risk was greater for very low birth weight infants, amounting to a sevenfold reduction in risk of very low birth weight with first trimester supplementation and a greater than sixfold reduction when supplement use started in the second trimester. Thus, in low income, urban women, use of prenatal multivitamin/mineral supplements may have the potential to diminish infant morbidity and mortality.

Gestational age and infant size at birth are associated with dietary sugar intake among pregnant adolescents.

The objective of this study was explore the relationship between pregnancy outcomes and dietary sugar intake by pregnant adolescents. From two urban, prenatal clinics in the City of Camden, NJ, a cohort of 594 nondiabetic, pregnant adolescents, aged 13-19 y, who delivered live, singleton newborns between 1985 and 1990, was recruited and followed through pregnancy. Registered dietitians collected up to three 24-h recalls during pregnancy. The adolescents were categorized according to total sugar in their diets, with those in the top 10th percentile defined as high sugar consumers (> or = 206 g, n = 60) and the remainder as reference consumers (< 206 g). Primary outcome measures were birth of small-for-gestational-age infants and gestational age. The cohort was 61% black, 30% Hispanic (Puerto Rican) and 9% white. The adjusted odds ratio was 2.01 (95% confidence interval 1.05-7.53) for the delivery of a small-for-gestational-age infant for adolescents consuming high sugar diets, regardless of their ethnicity. In addition, gestational age at delivery was -1.69 +/- 0.62 wk (beta +/- SE) shorter among Puerto Rican adolescents consuming high sugar diets (P = 0.007) compared with all reference sugar consumers and white adolescents consuming high sugar diets. Black adolescents consuming high sugar diets did not exhibit a shortening of gestation. Thus, adolescents consuming high sugar diets are at increased risk for delivering small-for-gestational-age infants, and for delivering infants earlier if they are of Puerto Rican ethnicity.

Implications of the Camden Study of adolescent pregnancy: interactions among maternal growth, nutritional status, and body composition.

One of the principal goals of the Camden Study over the past decade has been to document the extent to which pregnancy during adolescence is affected by continued maternal growth. Findings from the Camden Study relating to the other main goal, the effects of maternal growth during pregnancy on the outcome of pregnancy (maternal-fetal competition), are reviewed elsewhere. Contrary to widely held beliefs, we have found that there is considerable growth in late adolescence for girls, and, in particular, continued development of weight (> 1 kg/year) and increases in subcutaneous fatness at central sites. Thus, when pregnancy occurs during this final phase of adolescent growth, the normal growth processes may be exacerbated. That is, the adolescent potential for weight gain (as fat) may be exploited. Along with others, we have documented that adolescent pregnancy is associated with larger gestational weight gains. Using methods sufficiently sensitive to detect maternal growth prospectively, we also found that the larger-than-average total weight gains among adolescents appear attributable primarily to the growing adolescent gravidas and reflect their continued accrual of subcutaneous fat and increased risk for weight retention. Excessive gestational weight gain, as is more common among growing adolescent gravidas, appears to exacerbate the accumulation of fat at central sites. Aside from the consequences to the outcome of pregnancy, adolescents who begin their childbearing early while still growing themselves, such as those we have followed in the Camden Study over the past decade, may be at particularly increased risk for overweight and obesity. Further, the excessive deposition of subcutaneous fat at central body sites, as we have documented for adolescent pregnancy, will often in later life presage the development of cardiovascular disease, noninsulin-dependent diabetes mellitus (NIDDM), and hypertension. Thus, far from being benign, pregnancy during adolescence, particularly when the adolescent is herself still growing, may contribute to long-term risk for obesity-related diseases and diminish the quality of life.

Pregnancy in early adolescence: are there obstetric risks?

The purpose of this study was to determine if early adolescence imparts a significant obstetric risk in young primiparas relative to adult primiparas. The records of 239 young primiparas (< 16 years) and 148 older primiparas (18-29 years) were reviewed for demographic information, antepartum complications, mode of delivery, length of labor, episiotomy, lacerations, birthweight, and length of gestation. The young adolescents were shorter, had an earlier age at menarche, a lower pregravid body mass index, and a higher gestational weight gain. The young teens were less likely to smoke cigarettes but were more likely to be Medicaid recipients. The incidence of most antenatal complications (chronic hypertension, pregnancy-induced hypertension, placental abruption, placenta previa, premature rupture of the membranes, urinary tract infections, and anemia) were similar between the two groups. Preterm labor and contracted pelvis were more common among the young adolescent, while gestational diabetes was less common. The young primiparas were significantly (P < .05) less likely to have a Cesarean delivery and to lacerate with vaginal delivery. The length of labor and its stages were similar, as were overall birthweight and length of gestation. Thus, obstetric concerns regarding pregnancy in early adolescence may be unfounded. With the exception of an increased risk for preterm labor, it appears that pregnancy, labor, and delivery do not pose inordinate obstetric and medical risk to the very young adolescent primipara.

Point of diminishing returns: when does gestational weight gain cease benefiting birthweight and begin adding to maternal obesity?

This study is a reanalysis of the first scientific paper published by one of the authors, originally coauthored with Dr. Roy H. Petrie. In honor of Dr. Petrie, these data have been reanalyzed to re-evaluate the data using more sophisticated techniques and to expand on the original findings. This reanalysis examines the contribution of maternal weight gain to infant birthweight and retained maternal weight in the immediate postpartum period, and the effect of weight gains below, at, and above the Institute of Medicine (IOM) guidelines on both infant birthweight and retained maternal weight in the postpartum period. The study population included 487 term, uncomplicated, singleton pregnancies. Body mass index (BMI) was calculated for each woman, and categorized as underweight, normal weight, or overweight. Maternal retained weight was calculated as postpartum weight 2 days after delivery minus pregravid weight. Every kilogram of gestational weight gain increased birthweight by 44.9 g for underweight women, 22.9 g for normal weight women, and 11.9 g for overweight women. For every kilogram of retained weight, birthweight was increased by 35.6 g for underweight women, 15.9 g for normal-weight women, and 5.1 g for overweight women. Increasing weight gains from below to equal to IOM guidelines increased birthweight and maternal retained weight by 317 g (11%) (P < 0.01) and 5 kg (P < 0.01), respectively, for underweight women; 141 g (4.4%) (P < 0.02) and 6.2 kg (P < 0.01), respectively, for normal-weight women; and 200 g (6.4%) (NS) and 6.4 kg (P < 0.01), respectively, for overweight women. Increasing weight gains from equal to above the IOM guidelines increased birthweight and maternal retained weight by an additional 299 g (9.4%) (P < 0.02) and 7.3 kg (P < 0.01), respectively, for underweight women; an additional 196 g (5.9%) (P < 0.01) and 5.9 kg (P < 0.01), respectively, for normal weight women; and an additional 9 g (0.3%) (NS) and 8.3 kg (P < 0.01), respectively, for overweight women. These findings suggest that, beyond a certain level of weight gain, there is a point of diminishing returns (increase in birthweight) at the expense of increasing maternal postpartum obesity for the woman who has gained excessively.

Dietary and serum folate: their influence on the outcome of pregnancy.

We examined the influence of folate intake from diet and supplements b y 28 wk of gestation and third trimester circulating concentrations of serum folate on the outcome of pregnancy in women from Camden, NJ. Mean daily folate intake by week 28 included both dietary and supplemental folate obtained prospectively in 832 women. Circulating concentrations of serum folate as well as serum vitamin B-12 were assayed at 28 wk of gestation (+/- 2 wk) by radioimmunoassay. The outcomes of interest included preterm delivery (<37 wk) and infants with low birth weight (<2500 g). Mean folate intake was significantly correlated with circulating concentrations of serum folate (r=0.17, P<0.001). Women with a low mean daily folate intake (

Gestational weight gain, pregnancy outcome, and postpartum weight retention.

OBJECTIVE: To determine whether the risk of maternal overweight associated with an excessive rate of gestational gain needs to be balanced against the risks of impaired fetal growth associated with a low rate of gain. METHODS: Rate of gestational weight gain was measured prospectively in a sample of 274 young, low-income, and primarily minority women (12-29 years old) with pregravid body mass indices (BMI) in the normal range (19.8-26.0). We defined an excessive rate of gain between 20-36 weeks' gestation as one greater than 0.68 kg/week, and a low rate of gain as one less than 0.34 kg/week. Women were followed-up at 4-6 weeks and 6 months postpartum. RESULTS: Rate of measured gestational gain between 20-36 weeks' gestation was associated with total weight gain based on pregravid weight, with infant birth weight and gestation duration, and with maternal overweight (BMI greater than 26) and weight retention postpartum. Infant birth weight and gestation duration were significantly reduced for women with low rates of gain, and there was no significant difference between women with excessive and moderate gains. Despite little difference in pregravid BMI, women with excessive rates of gain retained more weight overall, attained a greater postpartum BMI, and had higher levels of subcutaneous fat and overweight. Maternal anthropometric status showed little change between 4-6 weeks and 6 months postpartum. CONCLUSION: Weight gained at an excessive rate by women with a pregravid BMI in the normal range does not greatly enhance fetal growth and gestation duration, contributing instead to postpartum maternal overweight.