Socioeconomic and clinical factors associated with excessive gestational weight gain.

PURPOSE: Excessive gestational weight gain (EGWG) is associated with adverse maternal and offspring outcomes but efforts to identify women at high risk for EGWG have been limited. The objective of this study is to identify socioeconomic and clinical factors associated with EGWG. METHODS: This retrospective cohort included pregnant patients who delivered live, term, singleton newborns between January 2018 and February 2020 at seven hospitals within a large health system in New York. Patients were stratified by pre-pregnancy body mass index and then classified based on whether they exceeded the Institute of Medicine guidelines for gestational weight gain (GWG) and whether they gained more than 50 pounds in pregnancy. RESULTS: A total of 44,872 subjects were included for analysis: 48% had EGWG and 17% had GWG exceeding 50 pounds. Patients with EGWG were more likely to be Black race, English speakers, overweight or obese pre-pregnancy, and have a mood disorder diagnosis. Patients who were underweight, multiparous, and those with gestational diabetes were less likely to have EGWG. CONCLUSION: Sociodemographic and clinical findings associated with GWG > 50 pounds were similar but only overweight and not obese patients were at increased risk. Patients at risk for EGWG may benefit from early nutrition counseling and education on lifestyle changes.

Maternal weight trajectories and associations with infant growth in South African women.

BACKGROUND: Despite the close relationship between pre-pregnancy body mass index (BMI), gestational weight gain (GWG) and postpartum weight (PPW), these factors are often studied separately. There are no data characterising longitudinal weight trajectories among pregnant and postpartum women in urban African populations. We examined maternal weight trajectories from pregnancy through to 12 months postpartum, factors associated with higher weight trajectory class membership and associations of weight trajectories with infant growth at 12 months. METHODS: Data from 989 women were examined for weight trajectories from first antenatal care visit in pregnancy to 12 months postpartum using latent-class growth models. Baseline factors associated with class membership were assessed using multinomial logistic regression. Of the enrolled women, 613 of their infants were assessed for growth at 12 months. Anthropometry measurements for mothers and infants were conducted by a trained study nurse. Associations between maternal weight trajectory class and infant weight-for-age (WAZ), length-for-age (LAZ), weight-for-length (WLZ) at 12 months of age were analysed using linear regression. RESULTS: Four distinct classes of maternal weight trajectories were identified. The classes included consistent low (29%), consistent medium (37%), medium-high (24%) and consistent high (10%) trajectories. Similar to trends observed with medium-high trajectory, baseline factors positively associated with consistent high class membership included age (OR 1.05, 95% CI 1.01-1.09), pre-pregnancy BMI (OR 2.24, 95% CI 1.97-2.56), stage 1 hypertension (OR 3.28, 95% CI 1.68-6.41), haemoglobin levels (OR 1.39, 95% CI 1.11-1.74) and parity (OR 1.39, 95% CI 1.15-1.67); living with HIV (OR 0.47, 95% CI 0.30-0.74) was inversely associated. In adjusted analyses, compared to consistent medium weight trajectory, consistent low weight trajectory (mean difference -0.41, 95% CI -0.71;-0.12) was associated with decreased, and consistent high weight trajectory (mean difference 1.21, 95% CI 0.59-1.83) with increased infant WAZ at 12 months of age. CONCLUSION: Identification of unique longitudinal weight trajectory groupings might inform comprehensive efforts targeted at improving healthy maternal weight and infant outcomes.

Associations of maternal weight status with the risk of offspring atopic dermatitis and wheezing by 1 year of age.

BACKGROUND: Maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) have been linked to offspring allergic disorders. However, associations observed in previous studies were inconsistent and might be confounded by unmeasured familial factors. We aimed to examine the associations of maternal weight with offspring allergic disorders by using paternal BMI as a negative control exposure. METHODS: We included the data of 10,522 children from the Born in Guangzhou Cohort Study, 2012-2017. Data on maternal weight were obtained from questionnaires and obstetric records, and paternal weight was collected from questionnaires. Atopic dermatitis (AD) and wheezing at the age of 1 year were defined according to parent-reported physician diagnosis. Risk ratios (RRs) were estimated by log-binominal regression with mutual adjustment for maternal and paternal weight status. RESULTS: By the age of 1 year, 16.2% and 7.9% of children were diagnosed with AD and wheezing, respectively. While maternal pre-pregnancy BMI as a continuous variable was not associated with offspring AD, infants of pre-pregnancy overweight/obese women had a higher risk of AD than those born to normal weight women; no such associations were observed for paternal BMI. Both maternal pre-pregnancy BMI and paternal BMI were positively associated with the risk of offspring wheezing. Maternal GWG was not associated with AD or wheezing. CONCLUSIONS: Our findings suggest that maternal pre-pregnancy overweight/obesity might increase the risk of infant AD via intrauterine mechanisms, whereas the association with wheezing might be confounded by uncontrolled familial factors. These findings may be valuable in early-life prevention for offspring allergic diseases.

Associations of ultra-processed food intake with maternal weight change and cardiometabolic health and infant growth.

BACKGROUND: Excessive intake of ultra-processed foods, formulated from substances extracted from foods or derived from food constituents, may be a modifiable behavioral risk factor for adverse maternal and infant health outcomes. Prior work has predominately examined health correlates of maternal ultra-processed food intake in populations with substantially lower ultra-processed food intake compared to the US population. This longitudinal study investigated relations of ultra-processed food intake with maternal weight change and cardiometabolic health and infant growth in a US cohort. METHODS: Mothers in the Pregnancy Eating Attributes Study were enrolled at ≤12 weeks gestation and completed multiple 24-Hour Dietary Recalls within six visit windows through one-year postpartum (458 mothers enrolled, 321 retained at one-year postpartum). The NOVA (not an acronym) system categorized food and underlying ingredient codes based on processing level. Maternal anthropometrics were measured throughout pregnancy and postpartum, and infant anthropometrics were measured at birth and ages 2 months, 6 months, and 1 year. Maternal cardiometabolic markers were analyzed from blood samples obtained during the second and third trimesters. RESULTS: Holding covariates and total energy intake constant, a 1-SD greater percent energy intake from ultra-processed foods during pregnancy was associated with 31% higher odds of excessive gestational weight gain (p = .045, 95% CI [1.01, 1.70]), 0.68±0.29 mg/L higher c-reactive protein during pregnancy (p = .021, 95% CI [0.10, 1.26]), 6.7±3.4% greater gestational weight gain retained (p = .049, 95% CI [0.03, 13.30]), and 1.09±0.36 kg greater postpartum weight retention (p = .003, 95% CI [0.38, 1.80]). No other significant associations emerged. CONCLUSIONS: Ultra-processed food intake during pregnancy may be a modifiable behavioral risk factor for adverse maternal weight outcomes and inflammation. Randomized controlled trials are needed to test whether targeting ultra-processed food intake during pregnancy may support optimal maternal health. TRIAL REGISTRATION: Clinicaltrials.gov. Registration ID - NCT02217462 . Date of registration - August 13, 2014.

Disordered eating in college women: associations with the mother-daughter relationship and family weight-related conversations.

PURPOSE: Extensive work in the field has found multiple risk factors of disordered eating among women; however, there is limited research regarding the associations of maternal influence and family weight-related conversations during childhood with eating disorder psychopathology later in adulthood. Thus, the purpose of this study was to explore how the mother-daughter relationship and family weight-related conversations may influence the development of disordered eating in college-aged women. METHODS: A diverse sample of 551 college-aged women completed an online survey with instruments that assessed disordered eating risk (dependent variable) with the following independent variables: aspects of the mother-daughter relationship (maternal regard and responsibility) and family weight-related conversations (emphasis on maternal weight, appearance weight control, and parent weight talk). Mediation analysis was performed using hierarchical regression analyses to examine the influence of maternal factors in combination with family weight-related conversations with disordered eating risk. RESULTS: Using hierarchical regression analyses, aspects of the mother-daughter relationship were significantly associated with risk of disordered eating. However, this significant relationship was diminished in the presence of family weight-related conversations. Furthermore, a test of the mediation suggests that family weight-related conversations may act as a pathway for influencing perceived maternal factors in the development of disordered eating. CONCLUSIONS: Findings illustrate the important role mothers may have in shaping their daughters eating attitudes and behaviors. Future disordered eating prevention programs and interventions may consider developing strategies in educating parents on conversations regarding weight. LEVEL OF EVIDENCE: Descriptive cross-sectional study, Level V.

Associations between Longitudinal Gestational Weight Gain and Scalar Infant Birth Weight: A Bayesian Joint Modeling Approach.

Despite the importance of maternal gestational weight gain, it is not yet conclusively understood how weight gain during different stages of pregnancy influences health outcomes for either mother or child. We partially attribute this to differences in and the validity of statistical methods for the analysis of longitudinal and scalar outcome data. In this paper, we propose a Bayesian joint regression model that estimates and uses trajectory parameters as predictors of a scalar response. Our model remedies notable issues with traditional linear regression approaches found in the clinical literature. In particular, our methodology accommodates nonprospective designs by correcting for bias in self-reported prestudy measures; truly accommodates sparse longitudinal observations and short-term variation without data aggregation or precomputation; and is more robust to the choice of model changepoints. We demonstrate these advantages through a real-world application to the Alberta Pregnancy Outcomes and Nutrition (APrON) dataset and a comparison to a linear regression approach from the clinical literature. Our methods extend naturally to other maternal and infant outcomes as well as to areas of research that employ similarly structured data.

Correlation between Maternal Weight Gain in Each Trimester and Fetal Growth According to Pre-Pregnancy Maternal Body Mass Index in Twin Pregnancies.

Background andObjectives: This study aimed to determine the correlation between maternal weight gain in each trimester and fetal growth according to pre-pregnancy maternal body mass index in twin pregnancies. Materials and Methods: We conducted a retrospective review of the medical records of 500 twin pregnancies delivered at 28 weeks' gestation or greater at a single tertiary center between January 2011 and December 2020. We measured the height, pre-pregnant body weight, and maternal body weight of women with twin pregnancies and evaluated the relationship between the maternal weight gain at each trimester and fetal growth restriction according to pre-pregnancy body mass index. Results: The overweight pregnant women were older than the normal or underweight pregnant women, and the risk of gestational diabetes was higher. The underweight pregnant women were younger, and the incidence of preterm labor and short cervical length during pregnancy was higher in the younger group. In normal weight pregnant women, newborn babies' weight was heavier when their mothers gained weight, especially when they gained weight in the second trimester. Mothers' weight gain in the first trimester was not a significant factor to predict fetal growth. The most predictive single factor for the prediction of small neonates was weight gain during 24−28 and 15−18 weeks, and the cutoff value was 6.2 kg (area under the curve 0.592, p < 0.001). Conclusions: In twin pregnancy, regardless of the pre-pregnant body mass index, maternal weight gain affected fetal growth. Furthermore, weight gain in the second trimester of pregnancy is considered a powerful indicator of fetal growth, especially in normal weight pregnancies.

Off the Charts: Identifying and Visualizing Body Mass Index Trajectories of Rural, Poor Youth.

OBJECTIVES: To identify body mass index (BMI) trajectories using methods and graphing tools that maintain and visualize variability of BMIs ≥95th percentile, and to investigate individual differences in early sociodemographic risk, infant growth and feeding patterns, and maternal weight status among these trajectories. STUDY DESIGN: Participants included 1041 predominantly rural, poor families from the Family Life Project, a longitudinal birth cohort. Youth anthropometrics were measured 8 times between ages 2 months and 12 years. Mothers reported sociodemographic information, infant birth weight, and infant feeding at 2 months and reported child weight and height at 2 months and 12 years. At 6 months, mothers reported breastfeeding. At 2 years, maternal weight and height were measured. RESULTS: Three BMI trajectories were identified: "maintained non-overweight," "developed obesity," and "developed severe obesity." Compared with the non-overweight trajectory, children with heavier trajectories were breastfed for a shorter duration and had heavier mothers at all assessments. The children with the "developed obesity" trajectory were not heavier at birth than those with the non-overweight trajectory, yet they displayed a greater change in weight-for-length percentile during infancy; in addition, their mothers had the greatest change in BMI between 2 months and 12 years. Children with the "developed severe obesity" trajectory were heavier at birth and more likely to have been heavy during infancy and to have been fed solid foods early. CONCLUSIONS: Using informed analytical and graphing approaches, we described patterns of growth, and identified early predictors of obesity and severe obesity trajectories among a diverse sample of rural, poor youth. Researchers are urged to consider these approaches in future work, and to focus on identifying protective factors in youth with obesity and severe obesity.

Birth weight increases with birth order despite decreasing maternal pregnancy weight gain.

AIM: We investigated whether birth order is an influencing factor for birth weight independent from maternal factors. METHODS: Data were obtained from the longitudinal cohort study LIFE Child and included 1864 children, of which 526 were only children. The 1338 siblings were ranked into first-borns (n = 570), second-borns (n = 606) and third-or-later-borns (n = 162). Children born prematurely, suffering from chronic or syndromic diseases, were excluded. We performed intra-family comparisons to reduce bias and assessed the impact of perinatal parameters, such as birth order on birth weight, using mixed models. RESULTS: Birth weight increased with birth order. In univariate analyses, birth order had a significant effect on birth weight-SDS with second-borns having 0.29 SDS (app. 130 g) and third-borns 0.40 SDS (app. 180 g) higher values than first-borns (P < .001). Maternal pregnancy weight gain was associated with higher birth weight-SDS (P < .01) in univariate analysis, though maternal pregnancy weight gain was lower for higher birth orders. Multivariate analyses revealed that being a second or third-or-later-born child had a stronger impact on birth weight than all maternal factors. CONCLUSION: Birth order must be considered a potential risk factor for higher birth weight. Maternal pregnancy weight gain is not the driving factor for higher birth weight in siblings.

Biological changes in the pregnancy-postpartum period and subsequent cardiometabolic risk-UPSIDE MOMS: A research protocol.

Multiple physiological changes occur in pregnancy as a woman's body adapts to support the growing fetus. These pregnancy-induced changes are essential for fetal growth, but the extent to which they reverse after pregnancy remains in question. For some women, physiological changes persist after pregnancy and may increase long-term cardiometabolic disease risk. The National Institutes of Health-funded study described in this protocol addresses a scientific gap by characterizing weight and biological changes during pregnancy and an extended postpartum period in relation to cardiometabolic risk. We use a longitudinal repeated measures design to prospectively examine maternal health from early pregnancy until 3 years postpartum. The aims are: (1) identify maternal weight profiles in the pregnancy-postpartum period that predict adverse cardiometabolic risk profiles three years postpartum; (2) describe immune, endocrine, and metabolic biomarker profiles in the pregnancy-postpartum period, and determine their associations with cardiometabolic risk; and (3) determine how modifiable postpartum health behaviors (diet, physical activity, breastfeeding, sleep, stress) (a) predict weight and cardiometabolic risk in the postpartum period; and (b) moderate associations between postpartum weight retention and downstream cardiometabolic risk. The proposed sample is 250 women. This study of mothers is conducted in conjunction with the Understanding Pregnancy Signals and Infant Development study, which examines child health outcomes. Biological and behavioral data are collected in each trimester and at 6, 12, 24, and 36 months postpartum. Findings will inform targeted health strategies that promote health and reduce cardiometabolic risk in childbearing women.

Maternal characteristics and neonatal outcomes of emergency repeat caesarean deliveries due to early-term spontaneous labour onset.

BACKGROUND: The optimal timing of elective repeat caesarean delivery has yet to be determined. One of the reasons to schedule an elective repeat caesarean delivery before 39 weeks gestation is to avoid emergency caesarean delivery due to spontaneous onset of labour. AIMS: By ascertaining maternal characteristics and neonatal outcomes associated with early-term onset of spontaneous labour, we aim to determine the optimal timing for each individual repeat caesarean delivery. MATERIALS AND METHODS: We performed a retrospective analysis of women with repeat caesarean deliveries planned at 38 weeks gestation between 2005 and 2019 at a tertiary referral hospital in Japan. A multivariate logistic regression analysis was adopted to identify independent contributing factors for early-term spontaneous labour onset. We also compared the rate of neonatal adverse events between women who underwent emergency repeat caesarean deliveries due to the onset of early-term labour and the ones who underwent elective repeat caesarean deliveries at 38 weeks. RESULTS: We included 1152 women. History of vaginal deliveries (adjusted odds ratio (AOR), 2.12; 95% confidence interval (95% CI), 1.21-3.74), history of preterm deliveries (AOR, 2.28; 95% CI, 1.38-3.77), and inadequate maternal weight gain during pregnancy (AOR, 1.78; 95% CI, 1.15-2.75) significantly increased the risk of early-term spontaneous labour onset. In terms of occurrence rate of neonatal complications, we found no significant difference between the groups. CONCLUSION: These maternal factors are significant predictors for early-term labour onset of repeat caesarean deliveries. The onset of early-term labour did not increase the likelihood of neonatal complications.

Five-year follow up of a low glycaemic index dietary randomised controlled trial in pregnancy-no long-term maternal effects of a dietary intervention.

OBJECTIVE: To determine whether a dietary intervention in pregnancy had a lasting effect on maternal outcomes of diet, HbA1c and weight retention 5 years post-intervention; and to establish whether modifiable maternal behaviours were associated with these outcomes. DESIGN: Randomised control trial of low glycaemic index (GI) diet in pregnancy with longitudinal follow up to 5 years post-intervention. SETTING: Dublin, Ireland (2007-2016). POPULATION: In all, 403 women of 759 (53.1%) were followed up at 5 years. A total of 370 (intervention n = 188; control n = 182) were included in this analysis. METHODS: Fasting glucose was measured at 13 and 28 weeks' gestation and HbA1c (mmol/mol) at 5-year follow up. Weight retention (kg) from early pregnancy to 5 years post-intervention was calculated. Dietary intakes, anthropometry, and lifestyle factors were measured in pregnancy and 5 years post-intervention. Multiple linear regression models, controlling for confounders, were used for analysis. OUTCOME: Maternal diet, HbA1c, and weight retention at 5 years post-intervention. RESULTS: There was no difference between the intervention and control at 5 years post-intervention for any long-term maternal outcomes measured. HbA1c at 5 years post-intervention was associated with early-pregnancy fasting glucose (B 1.70, 95% CI 0.36-3.04) and parity ≥3 (B 1.04, 95% CI 0.09-1.99). Weight retention was associated with change in well-being from pregnancy to 5 years (B -0.06, 95% CI -0.11 to -0.02), gestational weight gain (B 0.19, 95% CI 0.00-0.38), and GI (B 0.26, 95% CI 0.06-0.46) at 5 years. CONCLUSIONS: The ROLO low-GI dietary intervention in pregnancy had no impact on maternal dietary intakes, HbA1c or body composition 5 years post-intervention. Maternal factors and lifestyle behaviours in pregnancy have long-term effects on glucose metabolism and weight retention up to 5 years later. TWEETABLE ABSTRACT: Pregnancy factors are associated with maternal glucose metabolism and weight retention 5 years later-findings from the ROLO Study.

Does exercise during pregnancy impact on maternal weight gain and fetal cardiac function? A randomized controlled trial.

OBJECTIVE: To evaluate the association between physical exercise during pregnancy and maternal gestational weight gain and fetal cardiac function. METHODS: This was a randomized controlled trial of women with a singleton pregnancy managed from the first trimester at the Hospital de Torrejón, Madrid, between November 2014 and June 2015. Women were randomized to either follow a supervised physical conditioning program, consisting of a 60-min session 3 days per week for the duration of pregnancy, or not attend any exercise program (controls). The primary outcome was maternal weight gain during pregnancy. Secondary outcomes included fetal cardiac function parameters evaluated at 20, 28 and 36 weeks' gestation, Cesarean section, preterm delivery, induction of labor and birth weight. A sample size of 45 in each group was planned to detect differences in maternal weight gain of at least 1 kg, with a power of > 80% and α of 0.05. RESULTS: During the study period, 120 women were randomized into the exercise (n = 75) and control (n = 45) groups. Following exclusions, the final cohort consisted of 42 women in the exercise group and 43 in the control group. Baseline characteristics (maternal age, prepregnancy body mass index, parity, conception by in-vitro fertilization, Caucasian ethnicity, physical exercise prior to pregnancy and smoker) were similar between the two groups. No differences were found between the groups in maternal weight at 20, 28, 36 and 38 weeks' gestation or in weight gain at 38 weeks. However, the proportion of women with weight loss ≥ 9 kg at 6 weeks postpartum was higher in the exercise compared with the control group (68.2% vs 42.8%; relative risk 1.593; P = 0.02). The ductus arteriosus pulsatility index (DA-PI) at 20 weeks (2.43 ± 0.40 vs 2.26 ± 0.33, P < 0.05) and the ejection fraction (EF) at 36 weeks (0.85 ± 0.13 vs 0.81 ± 0.11, P < 0.05) were higher in the exercise compared with the control group. All other evaluated fetal cardiac function parameters were similar between the two groups. CONCLUSIONS: Performing exercise during pregnancy is not associated with a reduction in maternal weight gain but increases weight loss at 6 weeks postpartum. Physical exercise during pregnancy is associated with increased fetal DA-PI at 20 weeks and EF at 36 weeks, which could reflect adaptive mechanisms. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Fetal fraction-based risk algorithm for non-invasive prenatal testing: screening for trisomies 13 and 18 and triploidy in women with low cell-free fetal DNA.

OBJECTIVE: To identify pregnancies at increased risk for trisomy 13, trisomy 18 or triploidy attributable to low fetal fraction (FF). METHODS: A FF-based risk (FFBR) model was built using data from more than 165 000 singleton pregnancies referred for single-nucleotide polymorphism (SNP)-based non-invasive prenatal testing (NIPT). Based on maternal weight and gestational age (GA), FF distributions for normal, trisomy 13, trisomy 18 and triploid pregnancies were constructed and used to adjust prior risks for these abnormalities. A risk cut-off of ≥ 1% was chosen to define pregnancies at high risk for trisomy 13, trisomy 18 or triploidy (high FFBR score). The model was evaluated on an independent blinded set of pregnancies for which SNP-based NIPT did not return a result, and for which pregnancy outcome information was gathered retrospectively. RESULTS: The evaluation cohort comprised 1148 cases, of which approximately half received a high FFBR score. Compared with rates expected based on maternal age (MA) and GA, cases with a high FFBR score had a significantly increased rate of trisomy 13, trisomy 18 or triploidy combined (5.7% vs 0.7%; P < 0.001) and also of unexplained pregnancy loss (14.7% vs 10.4%; P < 0.001). For cases that did not receive a high FFBR score, the incidence of a chromosomal abnormality or pregnancy loss was not significantly different from that expected based on MA and GA. In this study cohort, the sensitivity of the FFBR model for detection of trisomy 13, trisomy 18 or triploidy was 91.4% (95% CI, 76.9-98.2%) with a positive predictive value of 5.7% (32/564; 95% CI, 3.9-7.9%). CONCLUSIONS: For pregnancies with a FF too low to receive a result on standard NIPT, the FFBR algorithm identified a subset of cases at increased risk for trisomy 13, trisomy 18 or triploidy. For the remainder of cases, the risk of a fetal chromosomal abnormality was unchanged from that expected based on MA and GA. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Unexpected drug residuals in human milk in Ankara, capital of Turkey.

BACKGROUND: Breast milk is a natural and unique nutrient for optimum growth and development of the newborn. The aim of this study was to investigate the presence of unpredictable drug residues in mothers' milk and the relationship between drug residues and maternal-infant characteristics. METHODS: In a descriptive study, breastfed infants under 3 months of age and their mothers who applied for child health monitoring were enrolled for the study. Information forms were completed for maternal-infant characteristics, breastfeeding problems, crying and sleep characteristics of infants. Maternal and infant anthropometric measurements and maternal milk sample were taken. Edinburgh Postpartum Depression Scale was applied to mothers. RANDOX Infiniplex kit for milk was used for residual analysis. RESULTS: Overall, 90 volunteer mothers and their breastfed infants were taken into the study and the mean age of the mothers and their infants was 31.5 ± 4.2 years and 57.8 ± 18.1 days, respectively. Anti-inflammatory drug residues in breast milk were detected in 30.0% of mothers and all had tolfenamic acid. Overall, 94.4% had quinolone, 93.3% beta-lactam, 31.1% aminoglycoside and 13.3% polymycin residues. Drugs used during pregnancy or lactation period were not affected by the presence of residues. Edinburgh postpartum depression scores of mothers and crying and sleeping problems of infants were similar in cases with and without drug residues in breast milk. When controlling confounding factors, maternal body mass index alterations were detected to be significantly lower in mothers with anti-inflammatory drug residues in breast milk than in their counterparts (p = 0.017). CONCLUSIONS: Our study suggests that there are unpredictable drug residues in the milk of many mothers. Anti-inflammatory drug exposure might affect maternal weight change during the postpartum period. Further studies are required to evaluate the impact of drug residues on maternal and infant health.

The effects of vigorous intensity exercise in the third trimester of pregnancy: a systematic review and meta-analysis.

BACKGROUND: Fetal growth is dependent upon utero-placental vascular supply of oxygen and nutrients from the mother and has been proposed to be compromised by vigorous intensity exercise in the third trimester. The aim of this systematic review was to investigate the effects of vigorous intensity exercise performed throughout pregnancy, on infant and maternal outcomes. METHODS: Electronic searching of the PubMed, Medline, EMBASE, Cochrane Library, Web of Science and CINAHL databases was used to conduct the search up to November 2018. Study designs included in the systematic review were randomised control trials, quasi-experimental studies, cohort studies and case-control studies. The studies were required to include an intervention or report of pregnant women performing vigorous exercise during gestation, with a comparator group of either lower intensity exercise or standard care. RESULTS: Ten cohort studies (n = 32,080) and five randomized control trials (n = 623) were included in the systematic review (n = 15), with 13 studies included in the meta-analysis. No significant difference existed in birthweight for infants of mothers who engaged in vigorous physical activity and those who lacked this exposure (mean difference = 8.06 g, n = 8006). Moreover, no significant increase existed in risk of small for gestational age (risk ratio = 0.15, n = 4504), risk of low birth weight (< 2500 g) (risk ratio = 0.44, n = 2454) or maternal weight gain (mean difference = - 0.46 kg, n = 1834). Women who engaged in vigorous physical activity had a small but significant increase in length of gestational age before delivery (mean difference = 0.21 weeks, n = 4281) and a small but significantly reduced risk of prematurity (risk ratio = - 0.20, n = 3025). CONCLUSIONS: Findings from this meta-analysis indicate that vigorous intensity exercise completed into the third trimester appears to be safe for most healthy pregnancies. Further research is needed on the effects of vigorous intensity exercise in the first and second trimester, and of exercise intensity exceeding 90% of maximum heart rate. TRIAL REGISTRATION: PROSPERO trial registration CRD42018102109 .

Effects of Food Supplementation During Pregnancy on Maternal Weight Gain, Hemoglobin Levels and Pregnancy Outcomes in Iran.

Objectives In this study, the effects of food supplementation during pregnancy on maternal weight gain, hemoglobin (Hb) levels, and pregnancy outcomes were evaluated. Methods In this randomized controlled trial, we recruited 1360 pregnant women with a gestational age of 10 weeks who had BMI < 18.5 and hemoglobin < 10.5/dL from rural areas of the east Azerbaijan province in Iran. Rural areas were randomly assigned into two groups: food-supplemented and control areas. In food-supplemented areas the food supplement was provided (1500 kcal/d) from 10 weeks of pregnancy through to the end. Information on demographic data were collected and anthropometric and Hb measurements were taken using standard instruments. Results The average weight gain was 9.1 ± 1.8 kg and 7.9 ± 1.6 kg in supplemented and control groups respectively, which was significantly different (p = 0.001). Also, a significant time × treatment interaction in maternal average weight gain (p = 0.001) was observed. The mean Hb decreased from 12 mg/dl and 12.1 mg/dl in week 10 to 11.9 mg/dl and 11.7 mg/dl in week 20 in the supplemented and control groups respectively, which was significant only for the control group. Between-group comparisons revealed significant differences in the rates of low birth weight (LBW) infants (p = 0.001) and preterm births (p = 0.013). Conclusion for practice Food supplementation significantly reduced the prevalence of poor maternal weight gain, infants with low birth weight, and preterm births compared to no intervention.

Hyperemesis gravidarum and adverse pregnancy outcomes.

PURPOSE: To assess adverse pregnancy outcomes in patients complicated with mild or severe Hyperemesis Gravidarum (HG). METHODS: A retrospective cohort study of women aged 18-45 with a singleton pregnancy that were admitted to the gynecological ward at the Soroka University Medical Center due to HG between the years 2013-2016 and gave birth at the same hospital was conducted. During the study period 89 patients met the inclusion criteria and comprised the study group. Women without HG who gave birth at the same time period comprised the comparison group (n = 91). Univariate analysis was carried out using Chi square or Fisher's exact test for nominal variables, and T test for numeric variables. Significance was defined as a P value < 0.05. RESULTS: Women with HG were more likely to have experienced HG in a previous pregnancy. Rate of amniotic fluid abnormalities was significantly lower in the study group. However, rates of all other pregnancy complications were comparable between the groups. A sub-analysis of the HG group comparing mild and severe cases demonstrated no significant differences in rates of adverse pregnancy outcomes between the groups. CONCLUSIONS: In this retrospective cohort study no association was demonstrated between HG and adverse pregnancy outcomes regardless of HG severity. Women with severe nausea and vomiting during pregnancy can be reassured that HG is not associated with unfavorable maternal and neonatal outcomes.

A new customized fetal growth standard for African American women: the PRB/NICHD Detroit study.

BACKGROUND: The assessment of fetal growth disorders requires a standard. Current nomograms for the assessment of fetal growth in African American women have been derived either from neonatal (rather than fetal) biometry data or have not been customized for maternal ethnicity, weight, height, and parity and fetal sex. OBJECTIVE: We sought to (1) develop a new customized fetal growth standard for African American mothers; and (2) compare such a standard to 3 existing standards for the classification of fetuses as small (SGA) or large (LGA) for gestational age. STUDY DESIGN: A retrospective cohort study included 4183 women (4001 African American and 182 Caucasian) from the Detroit metropolitan area who underwent ultrasound examinations between 14-40 weeks of gestation (the median number of scans per pregnancy was 5, interquartile range 3-7) and for whom relevant covariate data were available. Longitudinal quantile regression was used to build models defining the "normal" estimated fetal weight (EFW) centiles for gestational age in African American women, adjusted for maternal height, weight, and parity and fetal sex, and excluding pathologic factors with a significant effect on fetal weight. The resulting Perinatology Research Branch/Eunice Kennedy Shriver National Institute of Child Health and Human Development (hereinafter, PRB/NICHD) growth standard was compared to 3 other existing standards--the customized gestation-related optimal weight (GROW) standard; the Eunice Kennedy Shriver National Institute of Child Health and Human Development (hereinafter, NICHD) African American standard; and the multinational World Health Organization (WHO) standard--utilized to screen fetuses for SGA (<10th centile) or LGA (>90th centile) based on the last available ultrasound examination for each pregnancy. RESULTS: First, the mean birthweight at 40 weeks was 133 g higher for neonates born to Caucasian than to African American mothers and 150 g higher for male than female neonates; maternal weight, height, and parity had a positive effect on birthweight. Second, analysis of longitudinal EFW revealed the following features of fetal growth: (1) all weight centiles were about 2% higher for male than for female fetuses; (2) maternal height had a positive effect on EFW, with larger fetuses being affected more (2% increase in the 95th centile of weight for each 10-cm increase in height); and (3) maternal weight and parity had a positive effect on EFW that increased with gestation and varied among the weight centiles. Third, the screen-positive rate for SGA was 7.2% for the NICHD African American standard, 12.3% for the GROW standard, 13% for the WHO standard customized by fetal sex, and 14.4% for the PRB/NICHD customized standard. For all standards, the screen-positive rate for SGA was at least 2-fold higher among fetuses delivered preterm than at term. Fourth, the screen-positive rate for LGA was 8.7% for the GROW standard, 9.2% for the PRB/NICHD customized standard, 10.8% for the WHO standard customized by fetal sex, and 12.3% for the NICHD African American standard. Finally, the highest overall agreement among standards was between the GROW and PRB/NICHD customized standards (Cohen's interrater agreement, kappa = 0.85). CONCLUSION: We developed a novel customized PRB/NICHD fetal growth standard from fetal data in an African American population without assuming proportionality of the effects of covariates, and without assuming that these effects are equal on all centiles of weight; we also provide an easy-to-use centile calculator. This standard classified more fetuses as being at risk for SGA compared to existing standards, especially among fetuses delivered preterm, but classified about the same number of LGA. The comparison among the 4 growth standards also revealed that the most important factor determining agreement among standards is whether they account for the same factors known to affect fetal growth.

Relationship Between Maternal Pre-pregnancy Weight and Offspring Weight Strengthens as Children Develop: A Population-Based Retrospective Cohort Study.

BACKGROUND: Maternal pre-pregnancy weight has been reported to be positively associated with offspring weight. The association between maternal weight and offspring weight might be explained by maternal lifestyle. We investigated the strength of the relationship between maternal body mass index (BMI) at the beginning of pregnancy and offspring BMI at several growth stages. METHODS: The source population was all eighth graders registered in all public schools in the city of Fukuroi, Japan, in 2012. Records of maternal anthropometry at the beginning of pregnancy were obtained from the Maternal and Child Health (MCH) Handbook. The height and body weight of each student were measured. A regression model was used to assess the association between maternal BMI z-score at the beginning of pregnancy and offspring BMI z-score at various ages. RESULTS: Of the source population, data from the MCH Handbook were obtained for 480 students. Among males, maternal BMI z-score was not associated with offspring BMI z-score at birth and at age 3 years but was associated with offspring BMI z-score at age 13 years (standardized regression coefficient (ß) = 0.19; P < 0.01). Among females, maternal BMI z-score was associated with offspring BMI z-score at birth (ß = 0.11; P < 0.05), at age 3 years (ß = 0.22; P < 0.01) and at age 13 years (ß = 0.51; P < 0.01). CONCLUSIONS: Our results suggest that the positive association between maternal weight at the beginning of pregnancy and offspring weight around puberty is stronger than that between maternal weight and offspring weight at birth. Maternal lifestyle may influence offspring weight in adolescence.