Article

Excessive Early Gestational Weight Gain and Risk of Gestational Diabetes Mellitus in Nulliparous Women

Drexel University, Filadelfia, Pennsylvania, United States
Obstetrics and Gynecology (Impact Factor: 5.18). 06/2012; 119(6):1227-33. DOI: 10.1097/AOG.0b013e318256cf1a
Source: PubMed

ABSTRACT

To estimate whether there is an association between excessive early gestational weight gain and the development of gestational diabetes mellitus (GDM) and excessive fetal growth.
This is a secondary analysis of a randomized controlled trial of vitamins C and E in nulliparous low-risk women. Maternal weight gain from prepregnancy (self-reported) to 15-18 weeks of gestation was measured, and expected gestational weight gain was determined using the Institute of Medicine 2009 guidelines for each prepregnancy body mass index category. Excessive early gestational weight gain was defined as gestational weight gain greater than the upper range of the Institute of Medicine guidelines. Rates of GDM, birth weight greater than 4,000 g, and large for gestational age (LGA, birth weight 90 percentile or higher) were calculated and compared between women with excessive early gestational weight gain and early nonexcessive gestational weight gain (within or below Institute of Medicine guidelines).
A total of 7,985 women were studied. Excessive early gestational weight gain occurred in 47.5% of women. Ninety-three percent of women with excessive early gestational weight gain had total gestational weight gain greater than Institute of Medicine guidelines. In contrast, only 55% of women with nonexcessive early gestational weight gain had total gestational weight gain greater than Institute of Medicine guidelines (P<.001). Rates of GDM, LGA, and birth weight greater than 4,000 g were higher in women with excessive early gestational weight gain.
In our population, excessive early gestational weight gain occurred in 93% of women who had total gestational weight gain greater than the Institute of Medicine guidelines. In low-risk nulliparous women, excessive early gestational weight gain is associated with the development of GDM and excessive fetal growth.
II.

Download full-text

Full-text

Available from: James M Roberts, Mar 14, 2014
  • Source
    • "It is well established that sleep quality declines with advancing gestation [43] and early GWG is a risk factor for GDM and neonatal macrosomia [44], both risk factors for downstream child obesity in the offspring [7]. The high prevalence of pregnancy-related sleep complaints and the limited number of efficacious pharmacological treatments indicate that behavioural management of sleep hygiene is essential in early gestation when sleep quality is optimal. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The quality of the intrauterine environment influences maternal-fetal health and also offspring predisposition to obesity and cardiometabolic disease later in life. Several determinants, including but not limited to pregravid obesity and excessive gestational weight gain, alter the developmental milieu, fetal growth, and child obesity risk. However, the role of sleep and its relationship to healthy pregnancy is not fully established. Given the host of psychosocial and physiological complications associated with childhood obesity, targeting the gestational period is purported to be an opportune time for preventive intervention. Many longitudinal studies suggest that short sleep duration is a risk factor for the development of impaired glycemia and obesity. However, there is a dearth of information concerning the role of sleep hygiene and its role in a healthy pregnancy. Reports note disrupted and poorer quality of sleep during gestation and highlight an association between reduced sleep and risk of gestational diabetes mellitus. Given the lack of well-designed human trials assessing the value of sleep and healthy pregnancy outcomes, this review summarizes current evidence which suggests that incorporating sleep recommendations and utilizing time management strategies that encourage a healthful night 's sleep may improve the health of the mom and the baby.
    Full-text · Article · Feb 2014
    • "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). "
    [Show abstract] [Hide abstract]
    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.
    No preview · Article · Oct 2013 · British Journal of Health Psychology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Obesity and being overweight affect almost half of all women of childbearing age, with postpartum weight retention (PWR) being a key contributing factor. Retention of postpartum weight has a number of negative health implications for mothers and offspring, including longer-term higher body mass index (BMI). There is increasing evidence that psychological factors are associated with PWR, including depressive symptoms, anxiety, stress, and body dissatisfaction. However, what is less known is how these psychological factors might interact with maternal physiological and physical weight factors, sociocontextual influences, pregnancy-related medical factors, and maternal behaviours to lead to PWR. We have incorporated identified psychological influences within an empirically supported, multifactorial, conceptual model of hypothesised predictors of PWR, and argue that a systematic and rigorous evaluation of this conceptual model will inform the development of appropriate prevention strategies.
    No preview · Article · Jul 2012 · Journal of Reproductive and Infant Psychology
Show more