scholarly journals How Can Maternal Lifestyle Interventions Modify the Effects of Gestational Diabetes in the Neonate and the Offspring? A Systematic Review of Meta-Analyses

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 353 ◽  
Author(s):  
Delphine Mitanchez ◽  
Cécile Ciangura ◽  
Sophie Jacqueminet
Keyword(s):  
Systematic Review ◽  
Gestational Diabetes ◽  
Maternal Obesity ◽  
Adverse Outcomes ◽  
Lifestyle Interventions ◽  
Obese Women ◽  
Gestational Weight ◽  
Excessive Gestational Weight Gain ◽  
Adverse Neonatal Outcomes ◽  
Meta Analyses

Gestational diabetes (GDM) has deleterious effects on the offspring. Maternal obesity and excessive gestational weight gain (GWG), often associated with diabetes, also contribute to these adverse outcomes. Objectives: To assess the benefit for the offspring of maternal lifestyle interventions, including diets and physical activity, to prevent or to improve GDM and to limit excessive GWG. Method: Systematic review of meta-analyses published in English between December 2014 and November 2019. Results: Lifestyle interventions to reduce the risk of GDM reported a decreased risk of 15% to 40%, with a greater effect of exercise compared to diet. Combined lifestyle interventions specifically designed to limit GWG reduced GWG by 1.6 kg in overweight and obese women, and on average by 0.7 to 1 kg in all pregnant women. In these trials, adverse neonatal outcomes were poorly studied. Combined lifestyle interventions in women with GDM significantly reduced fetal growth. Altogether, lifestyle interventions reduced the risk of preterm birth and shoulder dystocia, but individually, diets or exercise alone had no effect on neonatal adverse outcomes. Conclusion: Specific maternal, neonatal and offspring benefits of lifestyle interventions during pregnancy to prevent or improve GDM control or to limit GWG still require clarification.

scholarly journals Influence of Maternal Prepregnancy Obesity and Excessive Gestational Weight Gain on Maternal and Child Gastrointestinal Microbiome Composition: A Systematic Review

2019 ◽  
Vol 22 (1) ◽  
pp. 114-125 ◽  
Author(s):  
Caitlin Dreisbach ◽  
Stephanie Prescott ◽  
Jeanne Alhusen
Keyword(s):  
Systematic Review ◽  
Weight Gain ◽  
Gestational Weight Gain ◽  
Maternal Obesity ◽  
Adverse Outcomes ◽  
Metagenomic Sequencing ◽  
Gastrointestinal Microbiome ◽  
Microbiome Composition ◽  
Gestational Weight ◽  
Excessive Gestational Weight Gain

Background: Maternal obesity is a well-known risk factor for significant obstetric and neonatal complications. The influence of the gastrointestinal microbiome in the setting of maternal obesity during pregnancy is less understood. The purpose of this systematic review is to synthesize the literature on the relationships between maternal obesity and excessive gestational weight gain (EGWG) and the composition of maternal and child gastrointestinal microbiomes. Method: We searched CINHAL, OVID Medline, Web of Science, and PubMed for relevant literature using medical subject heading terms related to obesity, pregnancy, and the gastrointestinal microbiome. We assessed 249 articles for potential inclusion using the preferred reporting items for systematic review and meta-analyses framework and deemed 11 articles as relevant for this review. Results: Maternal obesity was associated with significant microbial changes in both maternal and infant fecal microbiome biospecimens including increases in Bacteroidetes, Firmicutes, and the Actinobacteria phyla and decreases in Bifidobacteria. However, inconsistencies in uniform taxonomic results across all studies mean that evidence of specific microbial associations with obesity and EGWG is inconclusive. Conclusion: Our findings suggest that both maternal and child gastrointestinal microbiome composition is altered in the setting of maternal obesity and EGWG during pregnancy. Future microbiome studies should concentrate on the investigation of metagenomic sequencing to elucidate microbial function rather than solely taxonomic composition. More diverse populations of mothers should be sampled to address health disparities and adverse outcomes of underrepresented populations. Finally, analytic pipelines should be standardized across studies to aid in reproducibility.

scholarly journals Fetal and Placental Weight in Pre-Gestational Maternal Obesity (PGMO) vs. Excessive Gestational Weight Gain (EGWG)—A Preliminary Approach to the Perinatal Outcomes in Diet-Controlled Gestational Diabetes Mellitus

2020 ◽  
Vol 9 (11) ◽  
pp. 3530
Author(s):  
Mariusz Gujski ◽  
Dariusz Szukiewicz ◽  
Marta Chołuj ◽  
Włodzimierz Sawicki ◽  
Iwona Bojar
Keyword(s):  
Diabetes Mellitus ◽  
Weight Gain ◽  
Gestational Diabetes ◽  
Cesarean Section ◽  
Maternal Obesity ◽  
Perinatal Outcomes ◽  
Placental Weight ◽  
Gestational Weight ◽  
Excessive Gestational Weight Gain ◽  
The Mean

Both pre-gestational maternal obesity (PGMO) and excessive gestational weight gain (EGWG) increase the risk of gestational diabetes mellitus (GDM). Here, we conducted a retrospective study to comparatively examine the relation between fetal birth weight (FW) and placental weight (PW) in PGMO (n = 100) compared to EGWG (n = 100) with respect to perinatal outcomes in diet-controlled GDM. The control group was made up of 100 healthy pregnancies. The mean FW and the mean PW in EGWG were correlated with lowered fetal weight/placental weight ratio (FW/PW ratio). The percentage of births completed by cesarean section accounted for 47%, 32%, and 18% of all deliveries (EGWG, PGMO, and controls, respectively), with the predominance of FW-related indications for cesarean section. Extended postpartum hospital stays due to neonate were more frequent in EGWG, especially due to neonatal jaundice (p < 0.05). The results indicate the higher perinatal risk in mothers with EGWG compared to PGMO during GDM-complicated pregnancy. Further in-depth comparative studies involving larger patient pools are needed to validate these findings, the intent of which is to formulate guidelines for GDM patients in respect to management of PGMO and EGWG.

Identification of Problems and Needs When Designing an mHealth App for Overweight and Obese Pregnant Women to Prevent Excessive Gestational Weight Gain: A Focus Group Study (Preprint)

2020 ◽  
Author(s):  
Ching-Fang Lee ◽  
Li-Kang Chi ◽  
Jian-Pei Huang ◽  
Chen-Ju Lin
Keyword(s):  
Weight Gain ◽  
Focus Group ◽  
Pregnant Women ◽  
Gestational Weight Gain ◽  
Healthcare Providers ◽  
Adverse Outcomes ◽  
Obese Women ◽  
Focus Group Study ◽  
Gestational Weight ◽  
Excessive Gestational Weight Gain

BACKGROUND Overweight and obese women tend to gain excessive weight and have adverse outcomes during pregnancy. Despite the increasing number of health-related apps, there is still a lack of a user-based app to help prevent excessive gestational weight gain (GWG) and extend the longevity of the changes in behavior needed to maintain a woman’s optimal weight during pregnancy. OBJECTIVE The aim of this study was to identify the problems and needs for designing an mHealth app for obese and overweight pregnant women that they can continue to use to control their GWG. METHODS We used a qualitative interpretive approach and analytical induction to present the findings of three focus group sessions involving 13 overweight and obese pregnant women in Taipei, Taiwan. This study was conducted from July to October 2019. RESULTS Five problems and 10 needs were identified related to the use of an app to control overweight and obese women’s GWG. These problems were 1) an information gap, 2) a lack of support, 3) perceived complications of using the app(s), 4) easily forgetting the app(s), and 5) low motivation. The 10 main needs were 1) prenatal examination, 2) credible information, 3) short and easily understandable information, 4) a network community of peer support, 5) feedback from and interaction with healthcare providers, 6) a convenient and user-friendly interface, 7) goal-setting, 8) evaluation and tracking, 9) reminders, and 10) incentives for systematic celebrations and rewarding success. CONCLUSIONS The results of this study will help in the development of a user-based app that serves as a guide based on evidenced and informative practices. CLINICALTRIAL No

scholarly journals An Analysis of Behaviour Change Techniques Used in a Sample of Gestational Weight Management Trials

2016 ◽  
Vol 2016 ◽  
pp. 1-15 ◽  
Author(s):  
H. Soltani ◽  
M. A. Arden ◽  
A. M. S. Duxbury ◽  
F. J. Fair
Keyword(s):  
Weight Gain ◽  
Weight Management ◽  
Gestational Weight Gain ◽  
Behaviour Change ◽  
Maternal Obesity ◽  
Adverse Outcomes ◽  
Behaviour Change Techniques ◽  
Lifestyle Interventions ◽  
Maternal Weight ◽  
Gestational Weight

Introduction. Maternal obesity and excessive gestational weight gain are associated with multiple adverse outcomes. There is a lack of clarity on the specific components of effective interventions to support pregnant women with gestational weight management.Method. All 44 studies within a preexisting review of lifestyle interventions, with a potential to impact on maternal weight outcomes, were considered for content analysis. Interventions were classified using Behaviour Change Technique (BCT) taxonomy clusters to explore which categories of BCT were used in interventions and their effectiveness in managing gestational weight gain.Results. The most commonly used BCTs were within the categories of “feedback and monitoring,” “shaping knowledge,” “goals and planning,” “repetition and substitution,” “antecedents,” and “comparison of behaviours.” For diet and mixed interventions “feedback and monitoring,” “shaping knowledge,” and “goals and planning” appeared the most successful BCT categories.Conclusions. Poor reporting within studies in defining the BCTs used, in clarifying the differences in processes between intervention and control groups, and in differentiating between the intervention and research processes made BCT classification difficult. Future studies should elaborate more clearly on the behaviour change techniques used and report them accurately to allow a better understanding of the effective ingredients for lifestyle interventions during pregnancy.

scholarly journals Maternal Diabetes in Pregnancy: Early and Long-Term Outcomes on the Offspring and the Concept of “Metabolic Memory”

2011 ◽  
Vol 2011 ◽  
pp. 1-12 ◽  
Author(s):  
Akadiri Yessoufou ◽  
Kabirou Moutairou
Keyword(s):  
Gestational Diabetes ◽  
Maternal Obesity ◽  
Maternal Diabetes ◽  
Adverse Outcomes ◽  
Metabolic Memory ◽  
Obese Women ◽  
Diabetes In Pregnancy ◽  
Obesity And Diabetes ◽  
In Pregnancy

The adverse outcomes on the offspring from maternal diabetes in pregnancy are substantially documented. In this paper, we report main knowledge on impacts of maternal diabetes on early and long-term health of the offspring, with specific comments on maternal obesity. The main adverse outcome on progenies from pregnancy complicated with maternal diabetes appears to be macrosomia, as it is commonly known that intrauterine exposure to hyperglycemia increases the risk and programs the offspring to develop diabetes and/or obesity at adulthood. This “fetal programming”, due to intrauterine diabetic milieu, is termed as “metabolic memory”. In gestational diabetes as well as in macrosomia, the complications include metabolic abnormalities, degraded antioxidant status, disrupted immune system and potential metabolic syndrome in adult offspring. Furthermore, there is evidence that maternal obesity may also increase the risk of obesity and diabetes in offspring. However, women with GDM possibly exhibit greater macrosomia than obese women. Obesity and diabetes in pregnancy have independent and additive effects on obstetric complications, and both require proper management. Management of gestational diabetes mellitus and maternal obesity is essential for maternal and offspring's good health. Increasing physical activity, preventing gestational weight gain, and having some qualitative nutritional habits may be beneficial during both the pregnancy and offspring's future life.

scholarly journals Efficacy and safety of instantaneous wave-free ratio in patients undergoing coronary revascularisation: protocol for a systematic review

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e017868
Author(s):  
Joey S.W. Kwong ◽  
Sheyu Li ◽  
Wan-Jie Gu ◽  
Hao Chen ◽  
Chao Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Adverse Outcomes ◽  
Coronary Revascularisation ◽  
Eligibility Criteria ◽  
Registration Number ◽  
Collection Form ◽  
Randomised Controlled ◽  
Meta Analyses

IntroductionEffective selection of coronary lesions for revascularisation is pivotal in the management of symptoms and adverse outcomes in patients with coronary artery disease. Recently, instantaneous ‘wave-free’ ratio (iFR) has been proposed as a new diagnostic index for assessing the severity of coronary stenoses without the need of pharmacological vasodilation. Evidence of the effectiveness of iFR-guided revascularisation is emerging and a systematic review is warranted.Methods and analysisThis is a protocol for a systematic review of randomised controlled trials and controlled observational studies. Electronic sources including MEDLINE via Ovid, Embase, Cochrane databases and ClinicalTrials.gov will be searched for potentially eligible studies investigating the effects of iFR-guided strategy in patients undergoing coronary revascularisation. Studies will be selected against transparent eligibility criteria and data will be extracted using a prestandardised data collection form by two independent authors. Risk of bias in included studies and overall quality of evidence will be assessed using validated methodological tools. Meta-analysis will be performed using the Review Manager software. Our systematic review will be performed according to the guidance from the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.Ethics and disseminationEthics approval is not required. Results of the systematic review will be disseminated as conference proceedings and peer-reviewed journal publication.Trial registration numberThis protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42017065460.

scholarly journals Association between Gestational Weight Gain, Gestational Diabetes Risk, and Obstetric Outcomes: A Randomized Controlled Trial Post Hoc Analysis

Nutrients ◽  
2018 ◽  
Vol 10 (11) ◽  
pp. 1568 ◽  
Author(s):  
David Simmons ◽  
Roland Devlieger ◽  
Andre van Assche ◽  
Sander Galjaard ◽  
Rosa Corcoy ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Weight Gain ◽  
Gestational Diabetes ◽  
Gestational Weight Gain ◽  
First Trimester ◽  
Obstetric Outcomes ◽  
Lifestyle Interventions ◽  
Gestational Weight ◽  
Randomized Controlled ◽  
Post Hoc

Excess gestational weight gain (GWG) is associated with the development of gestational diabetes mellitus (GDM). Lifestyle trials have not achieved much GWG limitation, and have largely failed to prevent GDM. We compared the effect of substantial GWG limitation on maternal GDM risk. Pregnant women with a body mass index (BMI) ≥29 kg/m2 <20 weeks gestation without GDM (n = 436) were randomized, in a multicenter trial, to usual care (UC), healthy eating (HE), physical activity (PA), or HE and PA lifestyle interventions. GWG over the median was associated with higher homeostasis model assessment insulin resistance (HOMA-IR) and insulin secretion (Stumvoll phases 1 and 2), a higher fasting plasma glucose (FPG) at 24–28 weeks (4.66 ± 0.43 vs. 4.61 ± 0.40 mmol/L, p < 0.01), and a higher rate of caesarean section (38% vs. 27% p < 0.05). The GWG over the median at 35–37 weeks was associated with a higher rate of macrosomia (25% vs. 16%, p < 0.05). A post hoc comparison among women from the five sites with a GWG difference >3 kg showed no significance difference in glycaemia or insulin resistance between HE and PA, and UC. We conclude that preventing even substantial increases in GWG after the first trimester has little effect on maternal glycaemia. We recommend randomized controlled trials of effective lifestyle interventions, starting in or before the first trimester.

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