Maternal diet, C-reactive protein, and the outcome of pregnancy.

OBJECTIVE: To examine the association of high-sensitivity C-reactive protein (hsCRP), a systemic biomarker for the inflammatory process at entry to care, with pregnancy-induced hypertension/preeclampsia, adverse outcomes of pregnancy, and the maternal diet. DESIGN: Random sample (N = 520) with normal glucose tolerance from a large prospective cohort study of urban, low income, minority gravidae. RESULTS: During pregnancy, the highest tertile of hsCRP (range, 7.06-137.41 mg/L) was associated with significantly increased risks for early preterm delivery (<34 weeks). However, after stratification by maternal pregravid body mass index (BMI), risk for early preterm delivery <34 weeks (adjusted odds ratios [AOR] = 3.58, 95% confidence interval [CI] = 1.05-12.27), and pregnancy-induced hypertension (AOR = 2.66, 95% CI = 1.03-6.86) including preeclampsia (AOR = 2.72, 95% CI = 1.08-6.85) was shown to be specific to lean women (BMI <25) with high hsCRP. Increased hsCRP was unrelated to risk among overweight and obese gravidae. We found high hsCRP to be associated with diet. After stratification by BMI, dietary differences (higher intakes of protein and cholesterol with a lower intake of carbohydrate and a higher entry dietary glycemic index) were associated with increased hsCRP only among lean gravidae and not among those who were overweight or obese. CONCLUSIONS: High hsCRP is a diet-related biomarker for serious complications and poor outcome in lean women with normal glucose tolerance.

Individual free fatty acids have unique associations with inflammatory biomarkers, insulin resistance and insulin secretion in healthy and gestational diabetic pregnant women.

Objective: We investigated the relationships of maternal circulating individual free fatty acids (FFA) with insulin resistance, insulin secretion and inflammatory biomarkers during mid-pregnancy. Research design and methods: The data were drawn from a prospective cohort of generally healthy pregnant women (n=1368, African-American 36%, Hispanic 48%, Caucasian 16%) in Camden, NJ. We quantitatively determined 11 FFAs, seven cytokine/adipokine, homeostatic model assessment of insulin resistance (HOMA-IR) and C-peptide levels from the fasting blood samples that were collected at 16 weeks of gestation. Multivariate analyses were performed along with separate analyses for each individual FFA. Results: High HOMA-IR (p<0.001) and C-peptide (p<0.0001) levels were positively associated with a twofold to fourfold increased risk for developing gestational diabetes mellitus (GDM). Negative relationships were found with specific FFAs (molecular percentage, palmitoleic, oleic, linolenic, myristic acids) and HOMA-IR and C-peptide levels (p<0.01 to p<0.0001). In contrast, palmitic, stearic, arachidonic, dihomo-γ-linolenic (DGLA) and docosahexaenoic acids were positively associated with HOMA-IR and C-peptide (p<0.01 to p<0.0001). The individual FFAs also predicted cytokine/adipokine levels. For example, women who had elevated DGLA (highest quartile) were twice as (adjusted OR 2.06, 95% CI 1.42 to 2.98) likely to have higher interleukin (IL)-8 (p<0.0001) levels. Conversely, women with high palmitoleic, oleic, and linolenic acid levels had reduced odds (≥2-fold, p<0.01 to p<0.001) for having higher IL-8, IL-6 or tumor necrosis factor-alpha levels. Conclusion: Our results suggest that maternal individual FFAs uniquely affect insulin resistance and secretion. The effects are either direct or indirect via modulation of the inflammatory response. Modifying the composition of FFAs may help in reducing the risk of GDM.

Does Partial Meal Replacement During Pregnancy Reduce 12-Month Postpartum Weight Retention?

OBJECTIVE: This randomized trial tested whether a behavioral intervention with meal replacements in pregnancy could increase the proportion of women who returned to prepregnancy weight and reduce postpartum weight retention by 12 months after delivery. METHODS: Women (N = 264; 13.7 weeks' gestation) with overweight or obesity were randomly assigned to usual care or intervention. The intervention reduced excess gestational weight gain and was discontinued at delivery. At follow-up, 83.7% completed the 12-month assessment. RESULTS: Compared with usual care, prenatal intervention had no significant effect on odds of achieving prepregnancy weight (38/128 [29.7%] vs. 41/129 [31.8%]; P = 0.98) or in reducing the magnitude of weight retained (3.3 vs. 3.1 kg; P = 0.82) at 12 months. After delivery, significant (P < 0.0001) declines in meal replacements, practice of weight control behaviors, and dietary restraint were observed in the intervention group. Independent of group, lower gestational weight gain was the strongest predictor of achieving prepregnancy weight at 12 months (P = 0.0008). CONCLUSIONS: A prenatal behavioral intervention with meal replacements that reduced pregnancy weight gain had no significant effect on 12-month postpartum weight retention.

Association of elevated free fatty acids during late pregnancy with preterm delivery.

OBJECTIVE: To examine the association between moderately elevated maternal plasma free fatty acids (FFAs) during late pregnancy and preterm delivery. METHODS: In a prospective observational cohort with 523 healthy pregnant women, fasting plasma FFAs were measured during the third trimester. Socioeconomic, demographic, and anthropometric measures were collected at entry to prenatal care, and pregnancy outcomes were abstracted from medical record at delivery. RESULTS: After control for confounders including prepregnant body mass index (multiple logistic regression analysis), women who had moderately elevated plasma FFAs (in the highest tertile), showed a greater than threefold increased risk of preterm delivery (adjusted odds ratio (AOR) 3.49, 95% (CI) 1.73-7.03, P<.001). The associations persisted in women who had spontaneous preterm delivery (AOR 2.35, 95% CI 1.05-5.28, P<.05) and after excluding women with gestational diabetes mellitus and preeclampsia (AOR 3.30, 95% CI 1.38-7.87, P<.01). Additional stratified analyses showed that the association of high maternal FFAs and increased risk of preterm delivery was independent of prepregnant obesity. CONCLUSION: Elevated fasting plasma FFA levels at 30 weeks of gestation were associated with an increased risk of preterm delivery. This effect was independent of prepregnant obesity and several other known risk factors for preterm delivery, including cigarette smoking, ethnicity, and prior preterm delivery. These data may have important clinical significance because they provide a possible link between preterm delivery and high lipid levels, a known risk factor for cardiovascular disease.

Randomized controlled clinical trial of behavioral lifestyle intervention with partial meal replacement to reduce excessive gestational weight gain.

Background: Behavioral lifestyle interventions during pregnancy can prevent excessive gestational weight gain (GWG) in women with normal weight; however, effective interventions to reduce GWG in ethnically diverse women with obesity are lacking. Objective: A randomized controlled trial was conducted to test whether a behavioral lifestyle intervention with partial meal replacement reduces GWG rate in Hispanic and non-Hispanic women with overweight or obesity relative to enhanced usual care. Design: Participants (n = 257) were recruited in San Luis Obispo, California, and Providence, Rhode Island, between November 2012 and May 2016. Participants were pregnant (mean ± SD: 13.6 ± 1.8 wk of gestation) with overweight or obesity and had a mean age of 30.3 y; 41.6% of participants were Hispanic. Women were randomly assigned within site and by ethnicity to enhanced usual care (n = 128) or to a behavioral lifestyle intervention with partial meal replacement (n = 129). The primary outcome was GWG per week of observation. Secondary outcomes were proportions exceeding Institute of Medicine (IOM) guidelines for total GWG, changes in weight-control behaviors and cardiovascular disease risk factors, and incidence of pregnancy complications. Study retention was 99.6% (256 of 257). Results: The intervention compared with usual care resulted in less mean ± SD weekly GWG (0.33 ± 0.25 compared with 0.39 ± 0.23 kg/wk; P = 0.02) and total GWG (9.4 ± 6.9 compared with 11.2 ± 7.0 kg; P = 0.03) and reduced the proportion of women who exceeded IOM guidelines for total GWG (41.1% compared with 53.9%; P = 0.03). No significant group × time × demographic subgroup (ethnicity, BMI, age, parity, and income) interactions were observed. Among intervention participants, greater meal replacement intake was related to reduced GWG rate (ß = -0.07; 95% CI:-0.12, -0.03; P = 0.002). The intervention compared with usual care increased weight-control strategies (P < 0.0001) and cognitive restraint (P < 0.0001) and reduced triglycerides (P = 0.03). Conclusion: Prenatal behavioral intervention with partial meal replacement significantly reduced GWG in Hispanic and non-Hispanic women with overweight or obesity. This trial was registered at www.clinicaltrials.gov as NCT01545934.

Association of elevated serum ferritin levels and the risk of gestational diabetes mellitus in pregnant women: The Camden study.

OBJECTIVE- We examined the influence of a moderately elevated serum ferritin level at entry to care on the risk of gestational diabetes mellitus (GDM) and a possible mechanism (increased iron stores versus inflammation). RESEARCH DESIGN AND METHODS- In a prospective observational study with 1,456 healthy pregnant women in Camden, New Jersey, serum ferritin and anthropometric measurements were determined. Serum C-reactive protein (CRP) concentration was measured in a nested case-control study of 172 subjects. RESULTS- Women who developed GDM had a higher concentration of serum ferritin than women who did not develop GDM (P < 0.001). Elevated serum ferritin level (highest quintile) was significantly and positively correlated with prepregnant BMI and skinfold measurements. Women in the highest quintile of serum ferritin had a twofold increased risk of developing GDM adjusted for several known risk factors (adjusted odds ratio, 2.02 [95% CI 1.04-3.92], P < 0.05). Similar results were obtained with a nested case-control study, in which women in the highest tertile of serum ferritin (2.35 [1.06-5.22], P < 0.05) or CRP (2.67 [1.16-6.17], P < 0.001) had a greater than twofold increased risk of GDM. However, these effects were modified and became nonstatistically significant after additional adjustment for prepregnant BMI. CONCLUSIONS- Elevated serum ferritin concentrations early in gestation are associated with an increased risk of GDM. The association, at least in part, is mediated by the maternal fat mass and obesity. These data suggest a possible link between elevated serum ferritin and low-grade inflammation.

Maternal Circulating Lipid Profile during Early Pregnancy: Racial/Ethnic Differences and Association with Spontaneous Preterm Delivery.

Prior reports on the association between altered maternal serum lipid levels with preterm delivery are inconsistent. Ethnic differences in serum lipids during pregnancy and their relation to preterm delivery have not been studied. We examined the relationships of six maternal lipids during early pregnancy with the risk of spontaneous preterm delivery (SPTD). The design represents a case-control study nested within a large prospective, multiethnic cohort of young, generally healthy pregnant women. SPTD cases (n = 183) and controls who delivered at term (n = 376) were included. SPTD is defined as delivery at <37 completed weeks of gestation without indicated conditions. We found that African-American women had significantly increased levels of high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A1 (apoA1), and lower triglyceride (TG) and apolipoprotein B (apoB) levels compared to Hispanic and non-Hispanic Caucasians combined. Elevated HDL-C and apoA1 concentrations were significantly associated with an increased odds of SPTD after controlling for potential confounding factors. The adjusted odds ratio (AOR) was 1.91 (95% confidence interval (CI) 1.15, 3.20) for the highest quartile of HDL-C relative to the lowest quartile, and for apoA1 the AOR was 1.94 (95% CI 1.16, 3.24). When controlling for ethnicity, the results remained comparable. These data suggest that pregnant African-American women had a more favorable lipid profile suggestive of a reduction in cardiovascular risk. Despite this, increased HDL-C and apoA1 were both found to be associated with SPTD.

Vitamin E: maternal concentrations are associated with fetal growth.

BACKGROUND: Few data exist on the effects of the 2 most abundant isomers of vitamin E (alpha- and gamma-tocopherols) on fetal growth. OBJECTIVE: We measured maternal plasma concentrations of alpha- and gamma-tocopherols and examined their relation with measures of fetal growth. We also examined the relation, controlled for associated maternal factors, of diet and supplement use to tocopherol concentrations at week 28 of gestation. DESIGN: A cohort of 1231 gravid women from Camden, NJ, was studied from entry to care (16.0 +/- 0.15 wk gestation); plasma tocopherol concentrations were measured at entry and at week 28. RESULTS: Plasma concentrations of alpha-tocopherol at entry and at week 28 were positively related to increased fetal growth (birth weight for gestation), a decreased risk of small-for-gestational-age births, and an increased risk of large-for-gestational-age births. Concentration of alpha-tocopherol at week 28 was positively related to use of prenatal multivitamins and dietary intake of vitamin E; concentration of gamma-tocopherol was related positively to dietary fat intake and negatively to multivitamin use. CONCLUSION: Early and late circulating concentrations of alpha-tocopherol are positively associated with fetal growth.

Spontaneous Preterm Delivery, Particularly with Reduced Fetal Growth, is Associated with DNA Hypomethylation of Tumor Related Genes.

BACKGROUND: Preterm delivery and sub-optimal fetal growth are associated with each other and affect both mother and infant. Our aim was to determine (i) whether there are detectable differences in DNA methylation between early and late gestation and (ii) whether changes in DNA methylation from entry are associated with spontaneous preterm delivery with and without reduced fetal growth. METHODS: We conducted a case-control study nested within a large prospective cohort. Gene specific methylation was measured by Methyl-Profiler PCR Array in a Human Breast Cancer Signature Panel of 24 genes from maternal peripheral leukocytes genomic DNA at entry and 3rd trimester (sampled at 16 and 30 weeks of gestation, respectively). Clonal bisulfite DNA sequencing was performed to confirm the changes in selected genes (CYP1B1, GADD45A and CXCL12). Multivariable analysis was used for data analysis. RESULTS: There was significantly decrease in DNA methylation in 15 of 24 genes during the 3rd trimester in cases of spontaneous preterm delivery (n=23) as compared to the controls (n=19) (p<0.05-p<0.01 for each gene). Similar results were observed by bisulfite sequencing for 3 genes. The change in DNA methylation between late and early gestation was significantly different in cases (overall decrease in methylation was -4.0 ± 1.5%) compared to the controls (overall increase in methylation was 12.6 ± 2.19%, p<0.0001). A graded pattern of DNA methylation was observed in 15 genes. Cases who delivered preterm with reduced fetal growth had the lowest level of methylation, cases delivering preterm without reduced fetal growth were next and term controls were highest in methylation (p for trend <0.05 to p<0.01 for each gene). Cases of preterm delivery also had significantly lower dietary choline intake. CONCLUSIONS: These data suggest that epigenetic modification is associated with an increased risk of spontaneous preterm delivery, spontaneous preterm delivery with reduced fetal growth in particular.

Iron status during pregnancy: setting the stage for mother and infant.

Supplementation with iron is generally recommended during pregnancy to meet the iron needs of both mother and fetus. When detected early in pregnancy, iron deficiency anemia (IDA) is associated with a > 2-fold increase in the risk of preterm delivery. Maternal anemia when diagnosed before midpregnancy is also associated with an increased risk of preterm birth. Results of recent randomized clinical trials in the United States and in Nepal that involved early supplementation with iron showed some reduction in risk of low birth weight or preterm low birth weight, but not preterm delivery. During the 3rd trimester, maternal anemia usually is not associated with increased risk of adverse pregnancy outcomes and may be an indicator of an expanded maternal plasma volume. High levels of hemoglobin, hematocrit, and ferritin are associated with an increased risk of fetal growth restriction, preterm delivery, and preeclampsia. While iron supplementation increases maternal iron status and stores, factors that underlie adverse pregnancy outcome are considered to result in this association, not iron supplements. On the other hand, iron supplements and increased iron stores have recently been linked to maternal complications (eg, gestational diabetes) and increased oxidative stress during pregnancy. Consequently, while iron supplementation may improve pregnancy outcome when the mother is iron deficient it is also possible that prophylactic supplementation may increase risk when the mother does not have iron deficiency or IDA. Anemia and IDA are not synonymous, even among low-income minority women in their reproductive years.

Oxidative stress, diet, and the etiology of preeclampsia.

BACKGROUND: A current theory holds that oxidative stress, ie, an imbalance between maternal prooxidants and antioxidants, is a component of preeclampsia. It is uncertain whether such an imbalance occurs before clinical recognition of the syndrome or whether it is related to diet. OBJECTIVE: We measured urinary excretion of the isoprostane 8-iso-prostaglandin F(2alpha), which is an indicator of oxidative damage to lipids, and the total antioxidant power, which is a global measure of antioxidant status, at the entry to prenatal care. We also examined the relation of these indexes to diet during pregnancy. DESIGN: A cohort of 307 gravidae from Camden, NJ, was studied from entry to prenatal care (at 15.0 +/- 0.49 wk gestation). Measures of the maternal diet were obtained by 24-h recall. RESULTS: Risk of preeclampsia was increased 5-fold with higher urinary isoprostane excretion and decreased 3-fold with higher total antioxidant power. Over the course of pregnancy, there were significant trends for an association of higher isoprostane excretion with increased consumption of energy-adjusted fat, polyunsaturated fat, and polyunsaturated fatty acids (n-3, n-6, and linoleic and linolenic fatty acids), whereas total antioxidant power was not related to diet. CONCLUSIONS: Increased urinary excretion of isoprostane and decreased antioxidant production is an imbalance that is consistent with oxidative stress, and it precedes clinical recognition of preeclampsia. The maternal diet is an underlying factor that provides an environment for free radical generation.

Common dihydrofolate reductase 19-base pair deletion allele: a novel risk factor for preterm delivery.

BACKGROUND: Folate is critical for cell division, a major feature of in utero development. Dihydrofolate reductase (DHFR) is required to convert the folic acid used in supplements and for food fortification and the dihydrofolate produced by thymidylate synthase during DNA synthesis to the reduced folate forms used by the cell. OBJECTIVE: We aimed to determine whether a common, recently discovered deletion polymorphism in the DHFR gene is a risk factor for preterm delivery or low birth weight. DESIGN: We studied 324 pregnant women from Camden, NJ. Folate intake was computed from folate supplement intake plus the mean of two 24-h recalls completed during the course of pregnancy. Genomic DNA was extracted from the women's leukocytes and genotyped. RESULTS: Women with a deletion allele had a significantly greater risk of preterm delivery [adjusted odds ratio (AOR): 3.0; 95% CI: 1.0, 8.8; P < 0.05] than did those without a deletion allele. Women with both a DHFR deletion allele and low folate intake (<400 microg/d from diet plus supplements) had a significantly greater risk of preterm delivery (AOR: 5.5; 95% CI: 1.5, 20.4; P = 0.01) and a significantly greater risk of having an infant with a low birth weight (AOR: 8.3; 95% CI: 1.8, 38.6; P = 0.01) than did women without a deletion allele and with a folate intake >/=400 microg/d. CONCLUSIONS: The DHFR 19-base pair deletion allele may be a risk factor for preterm delivery. In the presence of low dietary folate, the allele may also be a risk factor for low birth weight. This may be a gene-environment interaction.

The thyroid and pregnancy: a novel risk factor for very preterm delivery.

The major cause of neonatal mortality and morbidity is preterm delivery in general (< 37 completed weeks), and especially very preterm delivery (< 32 completed weeks). The objective of this study is to determine if either thyroid hormonal dysfunction and/or the presence of thyroid autoantibodies in the mother are associated with an increased risk of preterm and/or very preterm delivery. Data were collected prospectively and analyzed as a nested-case control study. There were 953 delivered gravidas enrolled between 1996 and 2002. Samples were collected at entry to care and stored at -70 degrees C. Cases included all women with preterm delivery (n = 124). Controls (n = 124) were randomly selected from among the 829 women who delivered at term (> 37 completed weeks). All samples were assessed for thyroid stimulating hormone, thyroperoxidase antibody, and thyroglobulin antibody. Gravidas with high thyrotropin (TSH) levels had a greater than threefold increase in risk of very preterm delivery. In some analyses, gravidas who tested positive for thyroglobulin antibody at entry to prenatal care also had a better than twofold increased risk of very preterm delivery. There were no significant associations between TSH level or thyroglobulin antibody positivity and the risk of moderately preterm delivery.

Ethnic Differences in Maternal Adipokines during Normal Pregnancy.

Two adipokines (adiponectin and resistin) have opposite relations with insulin resistance and inflammation. Our major focus was to determine whether there were detectable ethnic differences in maternal adipokines during pregnancy. We also explored the correlation of the adipokines with maternal glucose homeostasis, blood pressure and anthropometric parameters. Pregnant women (n = 1634) were from a large prospective cohort study in Camden NJ (African-American 36.8%; Hispanic 47.6%; Caucasian 15.6%). Serum adiponectin and resistin were measured at entry (week 16.8) and the 3rd trimester (week 30.7) using the Luminex xMapTechnology. Significant differences were observed among ethnic groups, controlling for confounding variables. African American women were exceptional in that they had decreased adiponectin and increased resistin throughout the course of pregnancy (p < 0.05 to p < 0.0001) and a greater than two fold risk of simultaneously exhibiting low adiponectin (lowest tertile) and high resistin (highest tertile) compared to Caucasians and/or Hispanics. The cohort as a whole and each ethnic group showed similar negative correlations between adiponectin, and glucose homeostasis, blood pressure and anthropometric parameters but there was lesser correspondence with resistin. Our data underscore the need for further research on ethnic variation in adipokines and other physiologic biomarkers during complicated and uncomplicated pregnancy.

Ethnic differences in C-peptide/insulin/glucose dynamics in young pregnant women.

There are ethnic differences in insulin secretion and resistance in healthy nondiabetic adults, children, and adolescents. It is not known whether these ethnic differences are also detectable during normal pregnancy. The objective of this study was to examine whether ethnic differences in glucose homeostasis (C-peptide/insulin/glucose dynamics) are present in nondiabetic pregnant women. Fasting serum C-peptide, insulin, and plasma glucose were measured in the second and third trimesters in 773 pregnant women (343 African-Americans, 312 Hispanics, and 118 Caucasians), and a 50-g oral glucose challenge test was performed in the third trimester. Significantly reduced C-peptide levels and C-peptide to insulin ratio and elevated fasting insulin to glucose ratios were observed in African-American women compared with Caucasians and/or Hispanics. Similar results were found after a 50-g glucose load. In addition, African-Americans had greater insulin and lower glucose levels at glucose challenge test. There were ethnic differences in insulin production and resistance in both fasting and glucose-stimulated conditions in normal young nondiabetic pregnant women.

Association of glutathione peroxidase activity with insulin resistance and dietary fat intake during normal pregnancy.

Glutathione peroxidase (GPx) is one of the most important antioxidant enzymes in humans. We studied the relationship between erythrocyte GPx activity and fasting serum insulin, plasma glucose, and C-peptide, estimates of insulin resistance from the homeostasis model of assessment as well as dietary fat intake in 408 normotensive nondiabetic pregnant women from Camden, NJ. GPx activity and the metabolic parameters were determined at entry to care (16 wk of pregnancy) and during the third trimester. GPx activity and the levels of insulin resistance increased significantly between entry and the third trimester. Statistically significant associations, all positive, were observed between GPx activity and fasting insulin (beta = 0.009, P < 0.001), glucose (beta = 0.975, P < 0.05), C-peptide (beta = 1.537, P < 0.01), and insulin resistance from the homeostasis model of assessment (beta = 0.209, P < 0.01). Dietary intakes of fat and polyunsaturated fatty acids were positively correlated with GPx activity as well. African Americans had significantly higher GPx activity, dietary fat, and polyunsaturated fatty acid intake than Hispanics and Caucasians. In conclusion, we demonstrated that normal pregnancy is associated with increased GPx activity and insulin resistance. There are ethnic differences in antioxidant response and dietary fat intake. Our findings suggest a potential link among antioxidant defenses, insulin resistance, and dietary fat intake.

Early weight gain in pregnant adolescents and fetal outcome.

While the contribution of total maternal gain to birthweight is well described, less is known about whether there are specific effects of early weight gain. Early weight gain adequacy may be a particular problem among teenage gravidas who are more likely to have low prepregnant weight and in developing countries where chronic undernutrition is endemic. We studied the effects of early weight gain adequacy on infant birthweight in a geographical cohort of 1,790 adolescents from Camden County, New Jersey. Weight gain was calculated for prepregnant weight to 24 weeks' gestation and 24 weeks to delivery. Inadequate early weight gain was defined as gains less than 4.3 kg and inadequate late gains as averaging less than 400 gm/week from 24 weeks' gestation to delivery. In regressions predicting birthweight outcome, we found significant independent effects of timing of weight gain inadequacy. Early inadequate gains were associated with a -186.6 ± 31.6 gm decrement in birthweight that was not diminished even when later weight gains were compensatory. Late inadequate (-154.4 ± 29.3 gm) and inadequate gains both early and later (-298.6 ± 49.1 gm) were also associated with birthweight decrements. However, overweight (body mass index >24.5) appeared to buffer some of the effects of inadequate weight gains, reducing the decrement to about -100 gm. Protocols that seek to improve infant outcomes should focus on early weight gain during pregnancy. Affecting weight gain only late in pregnancy may not be able to substantially reduce the risk of fetal growth retardation.

Excessive gestational weight gain and chronic disease risk.

Excessive deposition of central body and abdominal (centripetal) fat early in life often will presage the later development of cardiovascular and metabolic diseases. Data from urban, low-income women from Camden, New Jersey, were used to examine the influence of gestational weight gain on patterns of weight change and fat deposition in 118 young women followed over two consecutive pregnancies. Adjusting for confounding factors, there was a significant (P < 0.05) dose-response relationship between the amount of gestational gain (in the subsequent pregnancy) and increases in postpartum weight compared with the postpartum in the prior pregnancy: +1.5 kg with a low gain, +2.9 kg with recommended amounts of gain, and +7.9 kg with excessive gain. Excessive gain (18+ kg) was common (18%) in the sample. The incidence of "new" obesity (body mass index [BMI] >29.0 in the subsequent postpartum but not the index postpartum) increased significantly with gestational gain: 4.7% with low gain, 7.0% with recommended gains, and 25.0% with excessive gain. There were similar dose-response increases related to gestational weight gain in all skinfolds (suprailiac, subscapular, and triceps) and the sum of the skinfolds. However, in women with excessive gains, fat was increased disproportionately at upper (+52%) and lower (+48%) central body sites, compared with the periphery (+27%), and compared with increases in women with lesser gestational gains. Thus, excessive gestational weight gain, which is common among low-income women, may be a factor which promotes obesity and a centripetal fat pattern during the reproductive years, thereby increasing the risk for cardiovascular and metabolic diseases in later life. © 1996 Wiley-Liss, Inc.

Influence of prepregnant body mass and weight gain for gestation on spontaneous preterm delivery and duration of gestation during adolescent pregnancy.

We examined the influence of two measures of maternal nutritional status: prepregnant body mass (kilograms/meter2 ) and Weight gain during pregnancy (adjusted for duration of gestation) on spontaneous preterm delivery (<37 completed Weeks' gestation) and duration of gestation, as well as on low birthweight (<2,500 grams) and small-for-gestational-age (SGA) in pregnant adolescents. Inadequate Weight gain for gestation increased the risk of spontaneous preterm delivery when prematurity was reckoned by the obstetric estimate (Adjusted Odds Ratio, AOR = 1.75 95% CI 1.22-2.50) or from the mother's LMP (AOR = 1.49 95% CI 1.10-2.02). In linear models, gestation duration was significantly reduced, by more than half a week, when reckoned from eiter estimate of gestation. However, the association between preterm birth or gestation duration and prepregnancy body mass was not consistent and depended on the method of estimating gestation. Low birthweight and SGA were each significantly associated with inadequate weight gain during pregnancy as well as with prepregnant body mass. These results suggest that current maternal nutritional status, as measured by weight gain during pregnancy, may influence preterm delivery and gestation duration. The inconsistent results obtained with prepregnancy body mass may reflect a size bias inherent in the obstetric estimate of gestation, rather than effects of prepregnant maternal nutritional status on gestation.

Growth of postmenarcheal girls from three ethnic groups.

Documentation of normal growth in late adolescence has been limited to a few studies using largely white participants. Annual growth rates of 668 high school girls who had already achieved menarche were determined for stature, sitting height, and knee height measured using the Knee Height Measuring Device (KHMD), an instrument with superior reliability. The sample was 61.4% white, 16.8% Puerto Rican, 15.7% African American, and 6.1% girls of other ethnic backgrounds. Median growth rate was 1.5 cm/year for stature, 1.1 cm/year for sitting height, and 2.7 mm/year for knee height in the first full year after menarche, and >80% of all girls grew in at least one dimension. Growth in stature (≥1 cm) continued for 64% of girls 1 full year after menarche and for 31% of girls 2 years after menarche, and growth in knee height (≥1 mm) continued in >45% of girls up to 5 completed years past menarche. Whites, African Americans, and Puerto Ricans showed small but significant differences in amounts of postmenarcheal growth in the dimensions measured. African-American girls grew less in stature and sitting height than other groups, whereas Puerto Rican girls grew significantly more in sitting height and significantly less in knee height than other ethnic groups. These findings demonstrate that, as documented in other studies of postmenarcheal growth, there is substantial growth after menarche in most girls. The most sensitive measures indicate that small amounts of growth persist >5 years after menarche. Appreciation of this phenomenon needs to be communicated to clinicians who generally assume that growth ceases at/or just after menarche. © 1996 Wiley-Liss, Inc.