Prenatal Diet Quality, Intake of Ultra-Processed Foods, and Gestational Weight Gain

The Institute of Medicine (IOM) and National Research Council (NRC) established guidelines for weight gain during pregnancy to maximize positive health outcomes for mothers and their offspring. However, in the US, about half of all pregnant women exceed these recommendations. Excessive weight gain during pregnancy is associated with various negative outcome for mothers and their children. Research in recent years has begun to explore the relationship between both diet quality and ultra-processed food (UPF) intake during pregnancy with gestational weight gain (GWG). However, research is scarce, especially pertaining to UPF intake and GWG. Additionally, there is no research which explores these relationships among Latina women living within the US. The purpose of this study is to explore the relationships between prenatal diet quality, measured with the Healthy Eating Index-2020 (HEI), and intake of UPF, based on the Nova classification system, with the adequacy of GWG among a predominantly Latina sample of adult pregnant women living within the US. Additionally, the association between social determinants of health with diet quality and with UPF intake were also explored. The study is a secondary-data analysis of data from a longitudinal study. The sample analyzed includes 118 pregnant women between the ages of 18-45 years old (mean = 29.9, SD = 6.1). Mean pre-pregnancy body mass index (pBMI) for the total sample was 25.8 kg/m2 (overweight). 67% of the sample identified as Hispanic/Latina. Overall, 22% of the sample were classified with inadequate GWG; 17% with adequate GWG; and 61% with excessive GWG. The mean total HEI score for the sample was 54.1 out of 100, where higher scores reflect higher diet quality and adherence to the Dietary Guidelines for Americans. There was a statistically significant difference across GWG groups (inadequate/adequate/excessive) in mean total HEI scores (p < .05). The adequate GWG group had the highest total HEI scores and the excessive GWG group had the lowest total HEI scores. Variables that were found to be univariately associated with excessive gestational weight gain included: average total HEI score, pBMI, ethnicity; education; and income (p < .05). A 1-point increase in mean total HEI scores was associated with a 5% lower chance of excessive GWG (p = .02). However, after adjustment for covariates (maternal age; pBMI; income; education; race and ethnicity), the association between average total HEI score and excessive gestational weight gain was attenuated and no longer statistically significant. There was a statistically significant difference across GWG groups (inadequate, adequate, or excessive) in their scores of two HEI components: Greens and Beans (p < .01); and Seafood and Plant Proteins (p < .01). The adequate GWG group had the highest scores and the excessive GWG group had the lowest scores in these HEI components. In simple logistic regressions of excessive GWG versus adequate GWG on HEI components, the Greens and Beans scores and the Seafood and Plant Protein scores were significantly associated with excessive GWG. After adjustment, the Greens and Beans scores and Seafood and Plant Proteins scores indicated strong estimated negative associations with excessive GWG, OR = 0.61, 〖 χ〗_1^2= 8.07, p < 0.01 and OR = 0.60, 〖 χ〗_1^2= 7.84, p < 0.01, respectively. A higher score on these components was associated with a lower risk of excessive GWG. The mean percentage of energy intake from ultra-processed foods (PEI-UPF) was 51.2%. There was no statistically significant difference in the PEI-UPF across GWG groups (inadequate, adequate, or excessive) and the PEI-UPF was not associated with odds of excessive GWG. However, the adequate GWG group had the lowest intake of PEI-UPF (49.2%) and the excessive GWG group had the highest intake of PEI-UPF (52.1%). Social determinants of health were not associated with the mean PEI-UPF, but results suggested a positive relationship between social support and total HEI scores (p = .08). Deeper analysis of the social support measure revealed a statistically significant relationship between the appraisal subscale of social support and HEI scores, Β = 0.13, F(1, 102) = 7.11 (p = 0.009). Overall, dietary intake during pregnancy may influence the adequacy of gestational weight gain. Achieving recommended intake of greens and beans, as well as seafood and plant proteins, may play a particularly important role in reducing the risk for excessive gestational weight gain. In addition, greater levels of social support, particularly access to another person who can offer advice and guidance with personal problems, may enhance diet quality during pregnancy

Blossom Project 2: Longitudinal assessment of physical activity, sedentary behavior, diet quality, and weight gain during pregnancy

The benefits of physical activity (PA) during pregnancy have been well documented, but little is known about the contribution of activity sub-components including sleep, sedentary, light, moderate, and vigorous activity on gestational weight gain (GWG). Additionally, the relationship between diet quality and GWG has yet to be determined. A prospective, longitudinal study was conducted during 2nd and 3rd trimester to objectively quantify and identify modifiable aspects of total PA including sleep, sedentary, light, moderate, and vigorous activity, and dietary intake. Participants (n=46) wore a SenseWear Armband and an activPALTM activity monitor for seven consecutive days during which a weighed 3-day diet record was also completed. Paired t-tests were used to compare data across pregnancy and multiple regression was used to identify predictors of GWG. Time spent in nighttime sleep, naps, sedentary behavior (SB), and moderate PA did not change across pregnancy while light and vigorous PA significantly decreased. During both the 2nd and 3rd trimester women spent an average of 75% of time awake in sedentary behavior even though 65% (week 18) and 61% (week 35) met the prenatal PA recommendations. Additionally, prediction equations showed positive correlations between protein intake (P = 0.071) and MET-minutes (P = 0.038) with GWG at week 18 (R2 = 0.29, rMSEP = 2.18); and between carbohydrate intake (P = 0.098) and MET-minutes (P = 0.038) with GWG at week 35 (R2 = 0.19, rMSEP = 3.99). Due to the large portion of the day spent in SB regardless of whether or not prenatal PA recommendations were met, and the observed relationship between total activity (MET-minutes) and weight gain across pregnancy, an overall increase in activity during pregnancy should be promoted. Furthermore, dietary quality of CHO should be investigated with respect to GWG

From data to action : CDC's public health surveillance for women, infants, and children (second edition)

The initial edition of Data to Action: CDC\u2019s Public Health Surveillance for Women, Infants and Children, published in 1994, was the first comprehensive description of the Centers for Disease Control\u2019s many surveillance and data system activities related to the health of women and children. It covered critical public health concerns, spanning the life cycle from infancy to reproductive-age women, with each chapter structured similarly so that differences and connections could be more easily discerned.Public health professionals have always been concerned with measuring health events across the life span. Maternal and child health surveillance captures data on reproductive health, pregnancy, birth, infancy, childhood, adolescence. Public health planners need to know the data that are available and how to use that information. In turn, public health data systems need to respond to the needs of stakeholders by providing and interpreting data that can be translated into appropriate action. The demand for such information is rapidly increasing in the public health community and will become even more critical in the face of emerging public health crises and emergency preparedness and response.This monograph is a step toward making the surveillance systems of the Centers for Disease Control and Prevention (CDC) more accessible to persons concerned with the health of women, infants, and children. It aims to note achievements from previous decades as well as identify new and ongoing challenges. Data needs evolve over time, and surveillance systems can adapt and respond to these challenges. This monograph offers health practitioners and planners at national, state, local and tribal levels a better appreciation of the uses and limitations of these surveillance systems, and enables us to think more critically about improvements in measuring the health of these populations.Data-To-Action_508.pdf2020897

An exploration of a weight management programme for pregnant women living with obesity

Introduction: Pregnancy is a time of both transformation and adaptation within the human body. Entering pregnancy with a body mass index (BMI) above the healthy range of 18.5-24.9kg/m2 increases a range of health risks for both the mother and baby and so is a targeted area for weight management. This thesis aims to evaluate a weight management programme (Bumps and Beyond) developed for pregnant women with a high BMI and delivered in two geographic areas in the UK. Methods: Service evaluation was based on audit sheets completed by staff at the two locations. Data from anonymised records were statistically analysed to see if the intervention reduced gestational weight gain, and complications in pregnancy and labour. Intervention fidelity was reviewed via transcripts of staff delivering the intervention in Lincolnshire. Hermeneutic phenomenological analysis (HPA) was undertaken on transcripts of staff delivering the sessions within the intervention at one site. The HPA used the novel approach of utilising the Roles of ‘Sarah the Mother’, ‘Sarah the Dietitian’, and ‘Sarah the Researcher’ to find the essence within the texts of the transcripts. Results: Intervention fidelity was good, and staff were responsive to participants' needs. Full attendance at Lincolnshire Bumps and Beyond showed a positive impact on gestational weight gain, total pregnancy complications, pre-eclampsia, preterm birth, low birth weight and breastfeeding initiation. Full attendance at Nottinghamshire Bumps and Beyond did not show the same benefits and was associated with greater risk of instrumental delivery and lower breastfeeding initiation. HPA of transcripts brought out several essences for each role that indicated possible pathways for development of the programme in the future. Discussion: The contrasting efficacy of Bumps and Beyond at the two locations gives a clear indication that just transferring a programme from one setting to another is not enough to ensure it will be successful. Despite being geographically close, the two locations had different populations which may in part explain the lack of success in Nottinghamshire. In addition to this, the type of staff may have had some effect in how the programme was delivered in each location. Use of the HPA output allowed insight into possible areas that could be further developed or adapted for the population the intervention is to serve. The Bumps and Beyond programme is similar to other small-scale midwife-led interventions that report positive outcomes in one local area. Larger trials have been less successful overall. Conclusion: Small local interventions to control gestational weight gain in women living with obesity can be effective when adapted to suit the needs of the population

An exploration of a weight management programme for pregnant women living with obesity

Introduction: Pregnancy is a time of both transformation and adaptation within the human body. Entering pregnancy with a body mass index (BMI) above the healthy range of 18.5-24.9kg/m2 increases a range of health risks for both the mother and baby and so is a targeted area for weight management. This thesis aims to evaluate a weight management programme (Bumps and Beyond) developed for pregnant women with a high BMI and delivered in two geographic areas in the UK. Methods: Service evaluation was based on audit sheets completed by staff at the two locations. Data from anonymised records were statistically analysed to see if the intervention reduced gestational weight gain, and complications in pregnancy and labour. Intervention fidelity was reviewed via transcripts of staff delivering the intervention in Lincolnshire. Hermeneutic phenomenological analysis (HPA) was undertaken on transcripts of staff delivering the sessions within the intervention at one site. The HPA used the novel approach of utilising the Roles of ‘Sarah the Mother’, ‘Sarah the Dietitian’, and ‘Sarah the Researcher’ to find the essence within the texts of the transcripts. Results: Intervention fidelity was good, and staff were responsive to participants' needs. Full attendance at Lincolnshire Bumps and Beyond showed a positive impact on gestational weight gain, total pregnancy complications, pre-eclampsia, preterm birth, low birth weight and breastfeeding initiation. Full attendance at Nottinghamshire Bumps and Beyond did not show the same benefits and was associated with greater risk of instrumental delivery and lower breastfeeding initiation. HPA of transcripts brought out several essences for each role that indicated possible pathways for development of the programme in the future. Discussion: The contrasting efficacy of Bumps and Beyond at the two locations gives a clear indication that just transferring a programme from one setting to another is not enough to ensure it will be successful. Despite being geographically close, the two locations had different populations which may in part explain the lack of success in Nottinghamshire. In addition to this, the type of staff may have had some effect in how the programme was delivered in each location. Use of the HPA output allowed insight into possible areas that could be further developed or adapted for the population the intervention is to serve. The Bumps and Beyond programme is similar to other small-scale midwife-led interventions that report positive outcomes in one local area. Larger trials have been less successful overall. Conclusion: Small local interventions to control gestational weight gain in women living with obesity can be effective when adapted to suit the needs of the population

Guidelines for the identification and management of lead exposure in pregnant and lactating women

"Lead exposure during pregnancy and breastfeeding can result in lasting adverse health effects independent of lead exposure during other life stages. However, to date there has been limited guidance available for clinicians and the public health community regarding the screening and management of pregnant and lactating women exposed to high levels of lead. Recognizing the need for national recommendations, the Centers for Disease Control and Prevention and the Advisory Committee on Childhood Lead Poisoning Prevention convened a workgroup of recognized experts to review the existing evidence for adverse effects of past and current maternal lead exposure on maternal health and fertility and on the developing fetus, infant, and child in prenatal and postnatal states and to propose evidence-based strategies for intervention. These Guidelines for the Identification and Management of Lead Exposure in Pregnant and Lactating Women are based on scientific data and practical considerations regarding preventing lead exposure during pregnancy, assessment and blood lead testing during pregnancy, medical and environmental management to reduce fetal exposure, breastfeeding, and follow up of infants and children exposed to lead in utero. The guidelines also outline a research agenda that will provide crucial information for future efforts to prevent and treat lead exposure during pregnancy and lactation. Further research is needed for a better understanding of lead's effect on pregnancy outcomes and infant development; lead kinetics across the placenta and in breast milk and their relationship to long-term health effects; genetic susceptibility to damage from lead; as well as the pharmacokinetics, effectiveness, and safety of chelating agents in the pregnant woman. Research is also needed to address important clinical and public health needs including validation of risk questionnaires for pregnant women, optimal timing of blood lead testing, and effective strategies for identification and treatment of pica in pregnant women." - p.