9,345 research outputs found

    Unhealthy gestational weight gain: are we neglecting inadequate gestational weight gain?

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    Objective: To evaluate the prevalence of unhealthy gestational weight gain and analyze the role of women ́s knowledge about the recommendations, expectations, beliefs, counseling, and information pro- vided by midwives as potential factors contributing to failure to meet recommendations. Research design/setting: A retrospective cross-sectional study was performed in a tertiary Hospital in Seville (Spain) between March and September 2019. A sample of 500 singleton pregnant women at or over 37 weeks of gestation completed a self-administered questionnaire during a prenatal visit. Gestational weight gain was categorized as healthy/excessive/inadequate, according to the Institute of Medicine, for 409 women. Descriptive, bivariate, and multivariate analysis was performed. Findings: Inadequate and excessive gestational weight gain were 33.4% and 33.9%, respectively. A multi- variate model for excessive gestational weight gain showed pre-gestational body mass index was a risk factor, while exercise and believing the weight gain was healthy were protective factors. The model for inadequate gestational weight gain showed knowledge of recommendations was a protective factor while believing gestational weight was healthy was a risk factor. Key conclusions: Unhealthy gestational weight gain is common. Inadequate gain from women with healthy pre-pregnancy body mass index who believed their gain was healthy, was almost as common as excessive gestational weight gain. As shown by our predictive model beliefs regarding healthy gestational weight gain may act either as a protective factor, in the excessive gain model, or as a risk factor, in the inadequate gain model, depending on women ́s pre-pregnancy body mass index and despite knowledge of the recommendations. Implications for practice: Inadequate weight gain, and not only excessive gain, should be properly ad- dressed during pregnancy. Healthy gestational weight gain should be approached by midwives with a combination of one-to-one and group antenatal care, where believes regarding healthy gestational weight gain should be addressed. Midwives should remain alert as we may be facing a new trend: increasing numbers of women presenting with inadequate gestational weight gain; with negative health implica- tions for a healthy population. We recommend that midwives pay attention to women with a healthy pre-pregnancy Body Mass Index and who believe that their weight gain is correct because this profile frequently had an inadequate gestational weight gain

    Appropriate Gestational Weight Gain

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    Abstract Over the past 30 years, excessive weight gain during pregnancy among American women has been a significant concern, resulting in serious health consequences to mothers and their newborns. During 2011, 48% of U.S. women gained more than the ideal amount of weight during pregnancy. Several international studies have also documented that excessive weight gain during pregnancy is associated with adverse maternal and neonatal outcomes. As a result, one in ten babies were born prematurely in the United States in 2014. Based on the Institute of Medicine\u27s (IOM) guidelines (2009), the purpose of this project was to implement the Healthy Women Healthy Children (HWHC) program at a southern California community clinic to reduce excessive prenatal weight gain. Process: The HWHC curriculum was a 12-week weight management intervention. Participants attended weekly nutrition or exercise-focused classes and were weighed at every other encounter. The number of times they met the weekly IOM weight gain guidelines over the 12-week program was recorded. Outcomes: Eleven participants were followed over a 12-week period. The frequency with which the participants met the IOM weekly weight gain guidelines averaged 68%; the range was 20%-100%; and the median rate was 67%. Discussion: The Healthy Women Healthy Children curriculum assisted pregnant women to make lifestyle changes in order to prevent excessive gestational weight gain. Conclusion: Advanced practice registered nurses can lead initiatives in the prevention of excessive gestational weight to make a positive impact on maternal and fetal outcomes

    Gestational Weight Gain Patterns

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    Background: Managing gestational weight gain (GWG) remains a global health priority as obesity among women of childbearing age and their children have been linked to excessive GWG. Excessive GWG has been linked to increased rates of cesarean sections, preterm births, hypertensive disorders, gestational diabetes, large for gestational age newborns, postpartum weight retention, long-term obesity for the woman and her children. Conversely, adverse outcomes resulting from weight gain below recommendation could potentially include preterm births, increased rates of neonatal intensive care admission, and newborn morbidity and mortality. Previous studies indicate the need for healthcare providers to help women gain within the recommended guidelines to decrease incidence of adverse outcomes. Purpose: This study explores the concept of gestational weight, describes maternal characteristics of women who adhere to the recommended guidelines, examines correlates of socio-demographic, maternal and newborn characteristics, and gestational weight gain patterns, and identifies women staying within the Institute of Medicine\u27s (IOM) 2009 recommended guidelines for GWG. To adequately address GWG patterns, study aims were achieved through concept analysis and retrospective data collection to: (1) identify GWG patterns among the sample by describing the characteristics of women who gained above, within, or below the IOM\u27s recommended guidelines and (2) examine correlates of GWG patterns. Methods: A descriptive, correlational, cross-sectional design using retrospective data abstracted from medical records was used. A purposive sample of all women (N = 4500) who gave birth between January 1, 2011 and December 31, 2012 at a large multi-community hospital healthcare system in San Diego County provided data for this study. Inclusion criteria: singleton live birth, data on pre pregnancy BMI & GWG, ≥ 4 prenatal visits, and delivered at ≥ 37 weeks gestation. Two hundred ninety women met inclusion criteria. Descriptive and inferential statistics were used to assess characteristics of the sample and examine relationships between the variables. Results: Manuscript #1 titled Understanding the Concept of Gestational Weight analyzes the concept of gestational weight and its contributing factors, clarifies its meaning, and addresses implications for practice and the need for future studies. Manuscript #2 titled Mothers\u27 Characteristics and Gestational Weight Gain Patterns identifies adherence to GWG recommendations and examines the characteristics of women who gain within, below or above the 2009 IOM GWG guidelines. Manuscript #3 titled Correlates of Gestational Weight Gain within the 2009 IOM Recommended Guidelines examines the relationships between women\u27s socio-demographic, maternal and newborn characteristics, and gestational weight gain patterns. Implications: The results of this study show there is an increased need for healthcare providers to provide appropriate guidance and support to women of childbearing age. Providers should offer preconception counseling and surveillance to help women achieve normal pre-pregnancy BMI then continue to work with women during pregnancy to gain weight within the recommended range to decrease incidence of adverse pregnancy outcomes for both women and their children

    Prevention and management of excessive gestational weight gain: a survey of overweight and obese pregnant women

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    Background - Excessive gestational weight gain is associated with adverse infant, childhood and maternal outcomes and research to develop interventions to address this issue is ongoing. The views of women on gestational weight gain and the resources they would consider helpful in addressing this are however largely unknown. This survey aimed to determine the views of newly pregnant women, living in areas of social disadvantage, on 1) their current body weight and potential gestational weight gain and 2) the resources or interventions they would consider helpful in preventing excessive gestational weight gain. Methods - A convenience sample of overweight and obese pregnant women living in Fife, UK, were invited to complete a short anonymised questionnaire at their 12 week booking visit. Results - 428 women, BMI>25 kg/m2, completed the questionnaire. Fifty-four per cent of respondents were obese (231) and 62% were living in areas of mild to moderate deprivation. Over three-quarters of participants felt dissatisfied with their current weight (81%). The majority of women (60%) expressed some concern about potential weight gain. Thirty-nine percent were unconcerned about weight gain during their pregnancy, including 34 women (19%) who reported having retained weight gained in earlier pregnancies. Amongst those concerned about weight gain advice on physical activity (41%) and access to sports/leisure facilities were favoured resources (36%). Fewer women (12%) felt that group sessions on healthy eating or attending a clinic for individualised advice (14%) would be helpful. "Getting time off work" was the most frequently cited barrier (48%) to uptake of resources other than leaflets. Conclusions- These data suggest a lack of awareness amongst overweight and obese women regarding excessive gestational weight gain. Monitoring of gestational weight gain, and approaches for its management, should be formally integrated into routine antenatal care. Barriers to the uptake of resources to address weight gain are numerous and must be considered in the design of future interventions and services

    The impact of maternal BMI, gestational weight gain, and breastfeeding on early childhood weight: Analysis of a statewide WIC dataset

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    Early childhood obesity is a persistent health concern with more frequent and significant impact on low-income families. Maternal weight factors impact offspring weight status, but evidence on whether breastfeeding protects against this impact is mixed. This analysis examined a model to predict early childhood obesity risk, simultaneously accounting for maternal pre-pregnancy body mass index (BMI), gestational weight gain, and breastfeeding. The team analyzed 27,016 unique maternal-child dyadic records collected via the Supplemental Nutrition Program for Wisconsin Women, Infants, and Children (WIC) between 2009 and 2011. Generalized Linear Modeling, specifically logistic regression, was used to predict a child\u27s risk of obesity given the mother\u27s pre-pregnancy BMI, gestational weight gain, and duration of breastfeeding. For each 1 kg/m2 increase in pre-pregnancy BMI, there was a 4.5% increase in risk of obesity compared to children with mothers of normal BMI. Children whose mothers had excessive gestational weight gain were 50% more likely to have obesity compared to those whose mothers had ideal weight gain. For each week of additional breastfeeding, there was a 1.9% increased risk of obesity. The risk models did not differ by race. In this model, accounting for pre-pregnancy weight, gestational weight gain, and breastfeeding among a diverse, low-income sample, women with pre-pregnancy overweight and obesity or who had excessive gestational weight gain had the highest risk of early childhood obesity. While breastfeeding is healthy for many reasons, providers should focus on maternal weight-related behaviors when counseling mothers about how to avoid risk of early childhood obesity

    Intervention strategies for preventing excessive gestational weight gain: systematic review and meta‐analysis

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    Background Interventions relevant to energy intake to prevent excessive gestational weight gain in pregnant overweight and obese women are important but scarce. This review synthesized healthy eating and physical activity strategies and their effects on excessive gestational weight gain prevention. Methods Twenty‐three randomized controlled trials that included healthy eating and/or physical activity as an intervention in healthy pregnant overweight or obese adult women and gestational weight gain as a primary or secondary outcome were reviewed. Findings Heathy eating and/or physical activity (21 studies, n = 6,920 subjects) demonstrated 1.81 kg (95% CI: −3.47, −0.16) of gestational weight gain reduction favouring intervention. Healthy eating (−5.77 kg, 95% CI: −9.34, −2.21, p = 0.02) had a larger effect size than combined healthy eating/physical activity (−0.82 kg, 95% CI: −1.28, −0.36, p = 0.0005) in limiting gestational weight gain. Physical activity did not show a significant pooled effect. Healthy eating with prescribed daily calorie and macronutrient goals significantly limited gestational weight gain by 4.28 kg and 4.23 kg, respectively. Conclusion Healthy eating and/or physical activity are effective in gestational weight gain control. Healthy eating with calorie and macronutrient goals are especially effective in limiting excessive gestational weight gain among pregnant overweight and obese women

    A systematic review and meta-analysis of gestational weight gain recommendations and related outcomes in Brazil

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    Worldwide, different guidelines are used to assess the adequacy of gestational weight gain. This study identified the recommendations for gestational weight gain in Brazilian women. We also determined the proportion of women with adequate weight gain in accordance with these recommendations and the associated perinatal outcomes. A systematic review was performed. A computerized search was conducted utilizing the following databases: PubMed, MEDLINE, Web of Science, Embase, SciELO and Google Scholar. Observational studies of healthy, Brazilian, pregnant women were included. Studies were excluded if they did not provide pregestational weight and gestational weight gain or if they studied women with comorbid conditions. A meta-analysis was performed to evaluate the odds ratio of inadequate (insufficient or excessive) gestational weight gain. Seventeen studies were included in the systematic review and four studies were included in the meta-analysis. The most widely used recommendations were from the Institute of Medicine. Excessive gestational weight gain was associated with fetal macrosomia and high rates of cesarean delivery. Overweight women had a higher risk of excessive gestational weight gain than eutrophic women (OR=2.80, 95%CI=2.22-3.53). There are no standardized recommendations concerning gestational weight gain based on Brazilian population-based data. Many Brazilian women are overweight or obese at the beginning of pregnancy. Overweight pregnant women have a higher risk of excessive gestational weight gain. Excessive gestational weight gain was associated with cesarean delivery and fetal macrosomia

    Impact of maternal body mass index and gestational weight gain on pregnancy complications : an individual participant data meta-analysis of European, North American and Australian cohorts

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    Objective To assess the separate and combined associations of maternal pre-pregnancy body mass index (BMI) and gestational weight gain with the risks of pregnancy complications and their population impact. Design Individual participant data meta-analysis of 39 cohorts. Setting Europe, North America, and Oceania. Population 265 270 births. Methods Information on maternal pre-pregnancy BMI, gestational weight gain, and pregnancy complications was obtained. Multilevel binary logistic regression models were used. Main outcome measures Gestational hypertension, pre-eclampsia, gestational diabetes, preterm birth, small and large for gestational age at birth. Results Higher maternal pre-pregnancy BMI and gestational weight gain were, across their full ranges, associated with higher risks of gestational hypertensive disorders, gestational diabetes, and large for gestational age at birth. Preterm birth risk was higher at lower and higher BMI and weight gain. Compared with normal weight mothers with medium gestational weight gain, obese mothers with high gestational weight gain had the highest risk of any pregnancy complication (odds ratio 2.51, 95% CI 2.31- 2.74). We estimated that 23.9% of any pregnancy complication was attributable to maternal overweight/obesity and 31.6% of large for gestational age infants was attributable to excessive gestational weight gain. Conclusions Maternal pre-pregnancy BMI and gestational weight gain are, across their full ranges, associated with risks of pregnancy complications. Obese mothers with high gestational weight gain are at the highest risk of pregnancy complications. Promoting a healthy pre-pregnancy BMI and gestational weight gain may reduce the burden of pregnancy complications and ultimately the risk of maternal and neonatal morbidity.Peer reviewe

    Pre-conception and prenatal factors influencing gestational weight gain:a prospective study in Tigray region, northern Ethiopia

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    Abstract Background In low-income countries, the high prevalence of pre-pregnancy undernutrition remains a challenge for the future health of women and their offspring. On top of good nutrition, adequate gestational weight gain has been recognized as an essential prerequisite for optimal maternal and child health outcomes. However, good-quality data on factors influencing gestational weight gain is lacking. Therefore, this study was aimed to prospectively identify pre-conception and prenatal factors influencing gestational weight gain in Ethiopia. Methods A population based prospective study was undertaken between February 2018 and January 2019 in the Tigray region, northern Ethiopia. Firstly, the weight of non-pregnant women of reproductive age living in the study area was measured between August and October 2017. Subsequently, eligible pregnant women identified during the study period were included consecutively and followed until birth. Data were collected through an interviewer-administered questionnaire and anthropometric measurements complemented with secondary data. Gestational weight gain, i.e., the difference between 32 to 36 weeks of gestation and pre-pregnancy weights, was classified as per the Institute of Medicine (IOM) guideline. Linear, spline, and logistic regression models were used to estimate the influence of pre-conception and prenatal factors on gestational weight gain. Results The mean gestational weight gain (standard deviation[SD]) was 10.6 (2.3) kg. Overall, 64.0% (95% CI 60.9, 67.1) of the women did not achieve adequate weight gain. Factors associated with higher gestational weight gain were higher women empowerment (B 0.60, 95% CI 0.06, 1.14), dietary diversity (B 0.39, 95% CI 0.03, 0.76), pre-pregnancy body mass index (B 0.13, 95% CI 0.05, 0.22), and haemoglobin (B 0.54, 95% CI 0.45, 0.64). Additionally, adequate prenatal care (B 0.58, 95% CI 0.28, 0.88) was associated with higher gestational weight gain. Conclusions Adequate gestational weight gain was not achieved by most women in the study area, primarily not by those who were underweight before pregnancy. Interventions that advance women’s empowerment, dietary quality, pre-pregnancy nutritional status, and prenatal care utilization may improve gestational weight gain and contribute to optimizing maternal and child health outcomes
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