Outcomes of maternal weight gain

Evidence report/technology assessment 05/2008; 1(168):1-223.
Source: PubMed


The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC) systematically reviewed evidence on outcomes of gestational weight gain and their confounders and effect modifiers, outcomes of weight gain within or outside the 1990 Institute of Medicine (IOM) guidelines, risks and benefits of weight gain recommendations, and anthropometric measures of weight gain.
We searched MEDLINE Cochrane Collaboration resources, Cumulative Index to Nursing & Allied Health Literature, and Embase.
We included studies published in English from 1990 through October 2007. We excluded studies with low sample size (based on study design: case series <100 subjects and cohorts <40 subjects).
Overall, strong evidence supported an association between gestational weight gains and the following outcomes: preterm birth, total birthweight, low birthweight (<2,500 g), macrosomia, large-for-gestational-age (LGA) infants, and small-for-gestational-age (SGA) infants; moderate evidence supported an association for cesarean delivery and intermediate-term weight retention (3 months to 3 years postpartum). The studies reviewed provided strong evidence for the independent association of pregravid weight status and outcomes, moderate evidence for age and parity, and weak evidence for race. Regarding outcomes of weight gain within or outside 1990 IOM guidelines, moderate to strong evidence suggests an association between weight gain below IOM recommendations and preterm birth, low birthweight, SGA birthweights, and failure to initiate breastfeeding, and strong evidence for the association between weight gain above IOM recommendations and high birthweight, macrosomia, and LGA birthweights. Moderate evidence supports an association between weight gain above IOM guidelines and cesarean delivery and postpartum weight retention in the short, intermediate, and long term. Included research is inadequate for objective assessments of the range of harms and benefits of providing all women, irrespective of age, race or ethnicity, or pregravid body mass index (BMI), with the same recommendation for weight gain in pregnancy.
Gestational weight gain is associated with some infant and maternal outcomes. One weight gain recommendation for all women is not supported by the evidence identified in this review. To understand fully the impact of gestational weight gain on short- and long-term outcomes for women and their offspring will require that researchers use consistent definitions of weight gain during pregnancy, better address confounders in their analyses, improve study designs and statistical models, and conduct studies with longer followup.

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Available from: Andrea L Deierlein, Jun 26, 2014
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    • "In utero exposure to background POP levels has been associ­ ated with evidence of endocrine disruption (Herbstman et al. 2008; Lopez­Espinosa et al. 2010), neurodevelopmental disorders (Forns et al. 2012; Herbstman et al. 2007b; Jacobson and Jacobson 2003), and immunosuppression (Hertz­Picciotto et al. 2008). Gestational weight gain (GWG) is itself a potential influence on the growth and health of the fetus and later outcomes during childhood and adulthood (Viswanathan et al. 2008). Inadequate GWG has been associated with low birth weight and preterm birth (Han et al. 2011), whereas excessive GWG has been associated with childhood obesity (Oken et al. 2007). "
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    ABSTRACT: Exposure to persistent organic pollutants (POPs) during fetal development can increase the risk of adverse health effects during childhood. Maternal characteristics and physiological changes during gestation such as gestational weight gain (GWG) may have an influence in the overall burden of POPs in neonates. However, the associations between GWG and POP concentrations are still not well established. We examined the association of GWG with cord serum POPs concentrations after adjusting for pre-pregnancy maternal body mass index (BMI) and other potential determinants of the transfer of POPs into newborns. The GWG values were evaluated after grouping by the reference guidelines of the Institute of Medicine (IOM). We measured levels of 14 organochlorine pesticides, 7 polychlorobiphenyls (PCBs) and 14 polybromodiphenyl ethers (PBDEs) in 325 cord serum samples from a Spanish birth cohort. Multivariable models were used to estimate associations of GWG, pre-pregnancy BMI, and other maternal determinants on cord serum concentrations of POPs. Neonatal concentrations of POPs were inversely associated with GWG after adjustment for age, pre-pregnancy BMI, educational level, and fish consumption. On average, neonates of women with IOM recommended GWG have lower POP concentrations than neonates of mothers with inadequate GWG. The present findings suggest an association between neonatal exposure to POPs and inadequate GWG during pregnancy. Encouraging pregnant women to meet the recommended IOM guidelines for GWG may reduce the accumulation of POPs in newborns.
    Environmental Health Perspectives 05/2014; 122(8). DOI:10.1289/ehp.1306758 · 7.98 Impact Factor
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    • "It is imperative that women diagnosed with GDM decrease their BMI to < 25 kg/m2 after the birth of their infant, both to improve metabolic outcomes and to decrease progression to T2DM later in life [1,2]. Among reproductive aged women, excessive gestational weight gain is a consistent predictor of worsening obesity [24,25]. A total of 40% of normal weight women and 60% of overweight women exceed the Institute of Medicine (IOM) prenatal weight gain guidelines [26,27]. "
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    ABSTRACT: Women who are diagnosed with gestational diabetes mellitus (GDM) are at increased risk for developing prediabetes and type 2 diabetes mellitus (T2DM). To date, there have been few interdisciplinary interventions that target predominantly ethnic minority low-income women diagnosed with GDM. This paper describes the rationale, design and methodology of a 2-year, randomized, controlled study being conducted in North Carolina. Using a two-group, repeated measures, experimental design, we will test a 14- week intensive intervention on the benefits of breastfeeding, understanding gestational diabetes and risk of progression to prediabetes and T2DM, nutrition and exercise education, coping skills training, physical activity (Phase I), educational and motivational text messaging and 3 months of continued monthly contact (Phase II). A total of 100 African American, non-Hispanic white, and bilingual Hispanic women between 22--36 weeks of pregnancy who are diagnosed with GDM and their infants will be randomized to either the experimental group or the wait-listed control group. The first aim of the study is to determine the feasibility of the intervention. The second aim of study is to test the effects of the intervention on maternal outcomes from baseline (22--36 weeks pregnant) to 10 months postpartum. Primary maternal outcomes will include fasting blood glucose and weight (BMI) from baseline to 10 months postpartum. Secondary maternal outcomes will include clinical, adiposity, health behaviors and self-efficacy outcomes from baseline to 10 months postpartum. The third aim of the study is to quantify the effects of the intervention on infant feeding and growth. Infant outcomes will include weight status and breastfeeding from birth through 10 months of age. Data analysis will include general linear mixed-effects models. Safety endpoints include adverse event reporting. Findings from this trial may lead to an effective intervention to assist women diagnosed with GDM to improve maternal glucose homeostasis and weight as well as stabilize infant growth trajectory, reducing the burden of metabolic disease across two generations.Trial registrationNCT01809431.
    BMC Pregnancy and Childbirth 10/2013; 13(1):184. DOI:10.1186/1471-2393-13-184 · 2.19 Impact Factor
    • "It is well established that GWG is one of the most salient and consistent predictors of PWR (Huang, Wang, & Dai, 2010; Siega-Riz et al., 2010). Additional influences include higher pre-pregnancy body mass index (BMI) (Amorim, Rossner, Neovius, Lourenco, & Linne, 2007), poor sleep quality (Gunderson et al., 2008), medical complications during pregnancy (Carreno et al., 2012), and Caesarean mode of delivery (Viswanathan et al., 2008). Demographic and sociocontextual influences include low social support (Harris, Ellison, & Clement, 1999), higher maternal age (being older than 30 years or being younger than 23 years at first childbirth; Kac, Benicio, Vel asquez-Mel endez, Valente, & Struchiner, 2004), low education, black ethnicity (Siega-Riz et al., 2010), multiparity (Gunderson & Abrams, 1999), and low socioeconomic status (SES; Shrewsbury, Robb, Power, & Wardle, 2009). "
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    ABSTRACT: Objectives Post-partum weight retention (PWR) has been identified as a critical pathway for long-term overweight and obesity. In recent years, psychological factors have been demonstrated to play a key role in contributing to and maintaining PWR. DesignTherefore, the aim of this study was to explore the relationship between post-partum psychological distress and PWR at 9 months, after controlling for maternal weight factors, sleep quality, sociocontextual influences, and maternal behaviours. Method Pregnant women (N = 126) completed a series of questionnaires at multiple time points from early pregnancy until 9 months post-partum. ResultsHierarchical regression indicated that gestational weight gain, shorter duration (6 months or less) of breastfeeding, and post-partum body dissatisfaction at 3 and 6 months are associated with higher PWR at 9 months; stress, depression, and anxiety had minimal influence. Conclusion Interventions aimed at preventing excessive PWR should specifically target the prevention of body dissatisfaction and excessive weight gain during pregnancy. Statement of contributionWhat is already known on this subject?Post-partum weight retention (PWR) is a critical pathway for long-term overweight and obesity.Causes of PWR are complex and multifactorial.There is increasing evidence that psychological factors play a key role in predicting high PWR.What does this study add?Post-partum body dissatisfaction at 3 and 6 months is associated with PWR at 9 months post-birth.Post-partum depression, stress and anxiety have less influence on PWR at 9 months.Interventions aimed at preventing excessive PWR should target body dissatisfaction.
    British Journal of Health Psychology 10/2013; 19(4). DOI:10.1111/bjhp.12074 · 2.70 Impact Factor
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