Service-wide management of healthy gestational weight gain following an implementation science approach

BACKGROUND Excessive gestational weight gain (GWG) has public health implications including preterm birth, preeclampsia, gestational diabetes, and cesarean delivery. In an effort to mitigate adverse consequences of excessive GWG, this study tests a health intervention that includes enhancements to improve knowledge and awareness of appropriate GWG, and patient-centered nutritional counseling to promote appropriate GWG. OBJECTIVE The primary objective of the study was to increase the proportion of women who are managing their GWG as recommended by the IOM.4,5 METHODS This randomized controlled trial was conducted at Geisinger in Pennsylvania where excessive GWG is common among women with pre-conception obesity. Eligible, consenting participants with pre-pregnancy body mass index >30.0 kg/m2 were randomized (1:1) to: 1) Usual Care: usual written educational materials and counseling by an obstetric care provider or 2) Enhanced Care: Usual Care plus a) a personalized letter from a physician detailing appropriate GWG, b) exposure to individualized GWG chart in the electronic health record via the patient portal, and c) a consult with a Registered Dietitian Nutritionist and follow-up via tele-health counseling (10-20 mins/1-2 weeks) for the duration of the pregnancy. RESULTS The primary outcome was the proportion of women that gain less than 20 pounds over the course of the pregnancy. Secondary outcomes include knowledge, expectations, and attitude about pregnancy weight gain; increased self-efficacy for ability to eat healthy and being physically active to manage weight; and eating behavior. Potential moderators that will be explored include sleep, perceived stress, perceived involvement in care, and household food security. Data collection has been completed as of November 2019. CONCLUSIONS As GWG care was initiated for mothers with pre-pregnancy BMI >30 kg/m2 within the first and second trimesters, the intervention may have the additional benefit of reducing other adverse pregnancy outcomes including the incidence of gestational diabetes due to healthier rates of GWG. In addition to assessing appropriate GWG, this project will assess eating habits, physical activity, GWG attitudes, sleep quality, and psychological measures, all of which are associated with GWG. Exploratory mediators including perceived stress and food insecurity will also be evaluated. CLINICALTRIAL ClinicalTrials.gov NCT02963428

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The Role of Health-related Behaviors in Gestational Weight Gain among Women with Overweight and Obesity: A Cross-sectional Analysis

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0040-1712132 ◽

2020 ◽

Vol 42 (06) ◽

pp. 316-324

Author(s):

Daiane Sofia Morais Paulino ◽

Maira Pinho-Pompeu ◽

Fernanda Raikov ◽

Juliana Vasconcellos Freitas-Jesus ◽

Helymar Costa Machado ◽

...

Keyword(s):

Weight Gain ◽

Sleep Duration ◽

Gestational Weight Gain ◽

Overweight And Obesity ◽

The Body ◽

Stepwise Logistic Regression ◽

Cross Sectional ◽

Gestational Weight ◽

Health Related Behaviors ◽

Health Related

Abstract Objective To evaluate the influence of health-related behaviors including food intake, physical activity, sleep time, smoking habits, stress, depression, and optimism on excessive gestational weight gain (GWG) among women with overweight and obesity. Methods A cross-sectional study was conducted at the Women's Hospital of the Universidade de Campinas, Campinas, state of São Paulo, Brazil, with 386 mediate postpartum women that fit the inclusion criteria of ≥ 19 years old, first prenatal care visit at or before 14 weeks, and single live baby. Dietary habits, physical exercise practice, sleep duration, smoking and alcohol habits were self-reported. Psychosocial history was evaluated using the Edinburgh Postpartum Depression Scale (EPDS), Perceived Stress Scale (PSS), and Life Orientation Test-Revised (LOT-R). Sociodemographic, obstetric, anthropometric, and neonatal data were retrieved from medical records. Descriptive statistics and stepwise logistic regression were performed. Results The prevalence of overweight and obesity was 29.27% and 24.61%, respectively, according to the body mass index (BMI). Excessive GWG was observed in 47.79% of women with overweight and in 45.26% of women with obesity. Excessive GWG among overweight and obese women was associated with inadequate vegetable and bean consumption (odds ratio [OR] = 2.95, 95% confidence interval [CI]: 1.35–6.46 and OR = 1.91; 95%CI: 1.01–3.63, respectively) and stress (OR = 1.63; 95%CI 1.01–2.64). After adjustment by maternal age, multiparity, sleep duration, smoking, and alcohol intake, we found that stress (PSS ≥ 20) was associated with excessive GWG in women with overweight or obesity (OR: 1.75; 95%CI: 1.03–2.96). Conclusion Among women with overweight and obesity, stress is the main variable associated with excessive GWG. Inadequate vegetables and beans consumption also showed association with excessive GWG.

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Association between gestational weight gain and risk of obesity in preadolescence: a longitudinal study (1997-2007) of 5125 children in Greece

Journal of Human Nutrition and Dietetics ◽

10.1111/jhn.12398 ◽

2016 ◽

Vol 30 (1) ◽

pp. 51-58 ◽

Cited By ~ 9

Author(s):

S. P. Mourtakos ◽

K. D. Tambalis ◽

D. B. Panagiotakos ◽

G. Antonogeorgos ◽

C. D. Alexi ◽

...

Keyword(s):

Weight Gain ◽

Longitudinal Study ◽

Gestational Weight Gain ◽

Gestational Weight

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Association between perinatal factors, genetic susceptibility to obesity and age at adiposity rebound in children of the EDEN mother–child cohort

International Journal of Obesity ◽

10.1038/s41366-021-00847-w ◽

2021 ◽

Author(s):

Aminata Hallimat Cissé ◽

Sandrine Lioret ◽

Blandine de Lauzon-Guillain ◽

Anne Forhan ◽

Ken K. Ong ◽

...

Keyword(s):

Weight Gain ◽

Genetic Susceptibility ◽

Gestational Weight Gain ◽

Gestational Age ◽

Obesity Risk ◽

Perinatal Factors ◽

Gestational Weight ◽

Adiposity Rebound ◽

Kinetics Of

Abstract Background Early adiposity rebound (AR) has been associated with increased risk of overweight or obesity in adulthood. However, little is known about early predictors of age at AR. We aimed to study the role of perinatal factors and genetic susceptibility to obesity in the kinetics of AR. Methods Body mass index (BMI) curves were modelled by using mixed-effects cubic models, and age at AR was estimated for 1415 children of the EDEN mother–child cohort study. A combined obesity risk-allele score was calculated from genotypes for 27 variants identified by genome-wide association studies of adult BMI. Perinatal factors of interest were maternal age at delivery, parental education, parental BMI, gestational weight gain, maternal smoking during pregnancy, and newborn characteristics (sex, prematurity, and birth weight). We used a hierarchical level approach with multivariable linear regression model to investigate the association between these factors, obesity risk-allele score, and age at AR. Results A higher genetic susceptibility to obesity score was associated with an earlier age at AR. At the most distal level of the hierarchical model, maternal and paternal educational levels were positively associated with age at AR. Children born to parents with higher BMI were more likely to exhibit earlier age at AR. In addition, higher gestational weight gain was related to earlier age at AR. For children born small for gestational age, the average age at AR was 88 [±39] days lower than for children born appropriate for gestational age and 91 [±56] days lower than for children born large for gestational age. Conclusion The timing of AR seems to be an early childhood manifestation of the genetic susceptibility to adult obesity. We further identified low birth weight and gestational weight gain as novel predictors of early AR, highlighting the role of the intrauterine environment in the kinetics of adiposity.

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Maternal and Cord Blood Metabolite Associations with Gestational Weight Gain and Pregnancy Health Outcomes

Journal of Proteome Research ◽

10.1021/acs.jproteome.0c00854 ◽

2021 ◽

Author(s):

Jane Shearer ◽

Matthias S. Klein ◽

Hans J. Vogel ◽

Shuhiba Mohammad ◽

Shannon Bainbridge ◽

...

Keyword(s):

Weight Gain ◽

Health Outcomes ◽

Cord Blood ◽

Gestational Weight Gain ◽

Gestational Weight ◽

Blood Metabolite

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Low Resting Energy Expenditure Is Associated with High Gestational Weight Gain Only When Resting Energy Expenditure Fluctuates

Reproductive Sciences ◽

10.1007/s43032-021-00544-z ◽

2021 ◽

Author(s):

Krista S. Leonard ◽

Zita Oravecz ◽

Danielle Symons Downs

Keyword(s):

Weight Gain ◽

Energy Expenditure ◽

Gestational Weight Gain ◽

Resting Energy Expenditure ◽

Gestational Weight ◽

Resting Energy

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