Oken E, Kleinman KP, Belfort MB, Hammitt JK, Gillman MW. Associations of gestational weight gain with short- and longer-term maternal and child health outcomes

Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA.
American journal of epidemiology (Impact Factor: 4.98). 05/2009; 170(2):173-80. DOI: 10.1093/aje/kwp101
Source: PubMed

ABSTRACT The authors investigated the rate of gestational weight gain associated with the lowest combined risk of 5 short- and longer-term maternal and child health outcomes for 2,012 mother-child pairs recruited in 1999-2002 into Project Viva, a prebirth cohort study in Massachusetts. Within each maternal prepregnancy body mass index (BMI, kg/m(2)) stratum, they performed a logistic regression analysis predicting all 5 outcomes, from which they determined the rate of gain at which average predicted prevalence of the adverse outcomes was the lowest. The mean rate of total gestational weight gain was 0.39 kg/week (standard deviation, 0.14). The prevalence of small for gestational age was 6%, large for gestational age was 14%, preterm delivery was 7%, substantial postpartum weight retention was 16%, and child obesity was 10%. The lowest predicted outcome prevalence occurred with a 0.28-kg/week gain for women whose BMI was 18.5-24.9, a 0.03-kg/week loss for a BMI of 25.0-29.9, and a 0.19-kg/week loss for a BMI of >or=30.0 kg/m(2)--the lowest observed weight changes in overweight and obese women. For normal-weight and overweight women, lowest-risk gains varied modestly with adjustment for maternal characteristics and with different outcome weightings. For obese women, the lowest-risk weight change was weight loss in all models. Recommendations for gestational weight gain for obese women should be revised.

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Available from: James K Hammitt, Jul 16, 2014
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    • "10,226 (1959–1965) 7 years Weight measured at delivery minus self-reported prepregnancy weight Total GWG (kg) IOM 1990 (i) Excessive (ii) Adequate (Ref) (iii) Inadequate BMI í µí± §-score based on measured height and weight OW: BMI ≥95th PCTL (CDC) Maternal age, prepregnancy BMI, parity, race, and smoking; child age at 7-year assessment, birth weight, gestational age, and sex Oken et al. 2009, USA (pros) [40] 2,012 (1999–2002) 3 years Medical record retrieved last prenatal weight minus self-reported prepregnancy weight Rate of GWG (kg/week) BM í µí± §-score based on measured height and weight OB: BMI >95th PCTL (CDC) "
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    ABSTRACT: Objectives. To systematically review the evidence from prospective and retrospective cohort studies on the association between gestational weight gain (GWG) and offspring's body weight. Methods. Electronic databases PubMed, Web of Science, CINAHL, and Academic Search Premiere were searched from inception through March 18, 2013. Included studies (n = 23) were English articles that examined the independent associations of GWG with body mass index (BMI) and/or overweight status in the offspring aged 2 to 18.9 years. Two authors independently extracted the data and assessed methodological quality of the included studies. Results. Evidence from cohort studies supports that total GWG and exceeding the Institute of Medicine maternal weight gain recommendation were associated with higher BMI z-score and elevated risk of overweight or obesity in offspring. The evidence of high rate of GWG during early- and mid-pregnancy is suggestive. Additionally, the evidence on inadequate GWG and net GWG in relation to body weight outcomes in offspring is insufficient to draw conclusions. Conclusions. These findings suggest that GWG is a potential risk factor for childhood obesity. However, findings should be interpreted with caution due to measurement issues of GWG and potential confounding effects of shared familial characteristics (i.e., genetics and maternal and child's lifestyle factors).
    Journal of obesity 10/2014; 2014. DOI:10.1155/2014/524939
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    • "Excess weight gain during pregnancy is of great concern given the associated health implications for both mother and child, including complications with the pregnancy, postpartum weight retention, and childhood overweight and obesity (Margerison Zilko et al. 2010; Oken et al. 2009). Two modifiable lifestyle factors contributing to excess weight gain during pregnancy include (i) an increase in energy intake from food and drink consumption above that required as pregnancy progresses (Olafsdottir et al. 2006) and (ii) a reduction in physical activity and exercise (Clapp and Little 1995; Stuebe et al. 2009). "
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    ABSTRACT: The effect of exercise on appetite and appetite-related hormones during pregnancy is not known. This study found that 30 min of moderate-intensity stationary cycling transiently attenuated hunger and increased fullness in late gestational women (n = 12). Exercise did not affect perceived appetite or appetite-related hormones in response to subsequent caloric consumption. These observations suggest that appetite responses do not intrinsically compensate for the additional energy expenditure induced by exercise, at least in the short term.
    Applied Physiology Nutrition and Metabolism 11/2013; 38(11):1162-5. DOI:10.1139/apnm-2013-0060 · 2.01 Impact Factor
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    • "More research is needed to examine the effect of prenatal lifestyle interventions on the infant weight trajectory during childhood and adulthood. Moreover, although epidemiological studies have suggested that excessive GWG is associated with an increased risk for the infant of becoming overweight/obese later in life [8] [13] [16] [17], the molecular mechanisms through which the exposure to excessive GWG translates into the development of obesity among offspring is currently unknown. Epigenetics (i.e., changes in gene expression) has been suggested as a very likely mechanism. "
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    ABSTRACT: Background. The period surrounding pregnancy has been identified as a risk period for overweight/obesity in both mother and child because of excessive gestational weight gain (GWG). The promotion of a healthy GWG is therefore of paramount importance in the context of the prevention of obesity in the current and next generations. Objective. To provide a comprehensive overview of the effect of prenatal physical activity interventions, alone or in combination with nutritional counselling, on GWG and to address whether preventing excessive GWG decreases the incidence of infant high birth weight and/or postpartum weight retention. Method. A search of the PubMed database was conducted to identify all relevant studies. Nineteen studies were included in this review: 13 interventions combining physical activity, nutrition, and GWG counselling and 6 interventions including physical activity alone. Results. Prenatal lifestyle interventions promoting healthy eating and physical activity habits appear to be the most effective approach to prevent excessive GWG. Achievement of appropriate GWG may also decrease the incidence of high infant birth weight and postpartum weight retention. Conclusion. Healthy eating habits during pregnancy, combined with an active lifestyle, may be important elements in the prevention of long-term risk of obesity for two generations.
    Journal of pregnancy 12/2012; 2012:470247. DOI:10.1155/2012/470247
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