Identification of Changes in Sleep Across Pregnancy and the Impact on Cardiometabolic Health and Energy Intake in Women with Obesity

This prospective, observational study investigated changes in sleep and the effect on energy intake, gestational weight gain, and cardiometabolic health across pregnancy in 52 healthy pregnant women with obesity. Habitual sleep was assessed by wrist-worn actigraphy (time spent in bed; TIB, total sleep time; TST, and sleep efficiency) in early (13(0)-15(6) weeks) and late (35(0)-36(6)) pregnancy. A change to habitual sleep was defined as change of one-half of the standard deviation of TIB and TST across six consecutive nights from early pregnancy. Energy intake and changes in weight, fasting glucose, insulin, and lipids across pregnancy were compared between women who changed sleep. During early pregnancy, TIB was 9:24±0:08h and varied by 1:37±0:07h across the six nights. TST and sleep efficiency significantly declined from early to late pregnancy (7:03±0:08h to 6:28±0:09h, p<0.001) and (76±0.1% to 71±0.2%, p<0.001), respectively. For women who increased TIB (n=11), fasting glucose decreased (−11.6±4.3%, p<0.01) across pregnancy and they had a trend towards decreased insulin (−57.8±33.5%; p=0.09) and HOMA-IR (−72.4±37.3%; p=0.06) compared to women who decreased TIB (n=13). Women who increased TIB had a significantly lower daily energy intake across pregnancy (−540±163 kcal; p<0.01) and tended to have less gestational weight gain (−147±88 g/week; p=0.10). Changes in TST did not affect plasma markers, energy intake or weight gain. The positive relationship between sleep and cardiometabolic health during pregnancy is explained in part by lower energy intake. We hypothesize lower energy intake is due to a prolonged overnight fast and a decrease in the time available for eating

Quality, Features, and Presence of Behavior Change Techniques in Mobile Apps Designed to Improve Physical Activity in Pregnant Women: Systematic Search and Content Analysis

Background: Physical activity during pregnancy is associated with a variety of health benefits for the mother and her child. Despite the many health benefits of physical activity during pregnancy, few women participate in regular physical activity during pregnancy. ehealth platforms, such as the internet and mobile applications (apps), are now altering how women access information about their pregnancy and have become an important information source for pregnant women. Whilst the use of pregnancy-related apps has significantly increased among pregnant women, very little is known about their theoretical underpinnings, including their utilisation of behaviour change techniques. This is despite research suggesting the inclusion of behaviour change techniques in ehealth interventions can play an important role in improving, supporting and maintain healthy behaviours, including physical activity. Objective: To review physical activity apps designed for pregnant women with a focus on app content, quality and features, and the presence and efficacy of Behaviour Change Techniques (BCTs). Methods: A systematic search in the Australian AppStore and GooglePlay stores using search terms relating to exercise and pregnancy. App features and quality was assessed using the 19-item Mobile Application Rating Scale (MARS) and a taxonomy of BCTs was used to determine presence of BCTs (26 items). BCTs previously demonstrating efficacy in behaviour change during pregnancy were also identified from a review of the literature. Results: Nineteen exercise apps were deemed eligible for this review and accessed via GooglePlay (n=13) or AppStore (n=6). MARS Overall Quality scores showed moderate app quality (m=3.5, SD=0.52). Functionality was the highest scoring MARS domain (m=4.2, SD=0.5), followed by Aesthetics (m=3.7, SD=0.6) and Information Quality (m=3.16, SD=0.42). Engagement (m=3.01, SD=0.9), Subjective App Quality (m=2.54, SD=0.64) and Likelihood for Behavioural Impact (m=2.5, SD=0.6) were the lowest scoring MARS domains. All 19 apps were found to incorporate at least two BCTs (m=4.74, SD=2.51, range=2–10), with provide instructions (95%) and provide information on consequences (89%) being the most common BCTs. Eleven apps included BCTs that previously demonstrated efficacy for behaviour change during pregnancy, the most common of these being provide opportunities for social comparison (n=8) and prompt self-monitoring of behaviour (n=7). Conclusions: Apps to improve exercise in pregnant women were functional and aesthetically pleasing, with overall moderate quality. However, the incorporation of BCTs was low, with the prevalence of BCTs previously demonstrating efficacy in promoting and/or supporting physical activity during pregnancy scarce. Thus, it is unlikely that apps reviewed in this study will effectively promote and/or support the exercise behaviours among pregnant women. Clinical Trial: Not required.Additional co-authors: Michelle Mottola; Taniya S Nagpal; Lisa Vincze; Stephanie Schoepp

Infant Feeding Varies Across Eating Behavior and Feeding Modalities in Mothers With Low Income

OBJECTIVE: To examine if eating behaviors in mothers with low income relate to attitudes toward infant feeding and whether associations differed between breastfeeding and formula-feeding mothers. DESIGN: Cross-sectional study. PARTICIPANTS: Forty postpartum women (aged ≥ 18 years, body mass index ≥ 25 and \u3c 40 kg/m2) in the Louisiana Women, Infants, and Children program participated in a telehealth postpartum intervention for health and weight loss. MAIN OUTCOME MEASURE(S): Maternal eating behaviors and infant feeding styles, assessed 6-8 weeks after birth (baseline) using validated questionnaires. ANALYSIS: Significance was detected using independent t tests, chi-square tests for independence, or linear models (P \u3c 0.05). RESULTS: Most mothers formula-fed (n = 27, 68%). In formula-feeding mothers, maternal disinhibition and perceived hunger were positively associated with restrictive infant feeding (β = 0.41, P \u3c0.001 and β = 0.41, P = 0.001, respectively). These relationships were significantly higher (Δ = -0.85, P = 0.006 and Δ = -0.59, P = 0.003, respectively) than among breastfeeding mothers. Comparatively, pressuring/overfeeding was lower in formula-feeding mothers than among breastfeeding mothers with dietary restraint (Δ slopes: 1.06, P = 0.02). CONCLUSIONS AND IMPLICATIONS: In this cohort of mothers with low income, maternal eating behavior was associated with infant feeding styles only when feeding modality was considered. Mothers may benefit from education on how their eating behaviors can influence their infants and children

Impact of COVID-19 Stay-at-Home Orders on Health Behaviors and Anxiety in Black and White Americans

BACKGROUND: In the United States (US), the incidence and severity of COVID-19 infections, hospitalizations, and deaths are higher in Black compared to White residents. Systemic inequities and differences in health behaviors may contribute to disparities in COVID-19 health outcomes. The aim of this study was to examine the impact of COVID-19 stay-at-home orders on changes in health behaviors and anxiety in Black and White adults residing in the US. METHODS: Beginning April 2020, the Pennington Biomedical Research Center COVID-19 Health Behaviors Study collected information on changes to employment, income, diet, physical activity, anxiety, and sleep patterns through a global online survey. RESULTS: Of 4542 survey respondents in the US, 7% identified as Black and 93% as White. Prior to the COVID-19 stay-at-home orders, a greater proportion of Blacks compared to Whites reported earning \u3c US$50,000 per year (p \u3c 0.0001). A greater proportion of Blacks reported being laid off, working fewer hours, and working from home following COVID-19 stay-at-home orders (p \u3c 0.0001 for all). In the overall sample, eating behaviors improved, physical activity decreased, sleep time prolonged, and anxiety heightened following COVID-19 stay-at-home orders (p \u3c 0.01 for all), which were universal between Black and White respondents (p ≥ 0.315 for all). CONCLUSIONS: This study highlights the disproportionate changes to employment and income in Blacks, with no differential impact on health behaviors and anxiety compared to Whites due to COVID-19 stay-at-home orders. As the COVID-19 pandemic continues, disproportionate changes to employment and income status may widen among Blacks and Whites, which may influence health behaviors and anxiety

Energy Expenditure in Pregnant Women with Obesity Does Not Support Energy Intake Recommendations

OBJECTIVE: This study aimed to identify factors that may predispose women to excess gestational weight gain (GWG). METHODS: Seventy-two healthy women with obesity (30 class I, 24 class II, 18 class III) expecting a singleton pregnancy were studied at 13 to 16 weeks gestation. Energy expenditure (EE) was measured during sleep (SleepEE, average EE from 0200-0500 hours) in a whole-room calorimeter, and total daily EE (TDEE) over 7 days using doubly labeled water. Glucose, insulin, thyroid hormones, and catecholamines were measured. RESULTS: Body composition explained 70% variability in SleepEE, and SleepEE accounted for 67% to 73% of TDEE. Though there was no evidence of consistent low metabolism, there was considerable variability. Low SleepEE was associated with insulin resistance and low triiodothyronine concentrations (both P = 0.01). Physical activity level was 1.47 ± 0.02. For women with SleepEE within 100 kcal/d of their predicted EE, TDEE was significantly less than the estimate (2,530 ± 91 vs. 2,939 kcal/d; P \u3c 0.001) provided from the most recent gestational energy requirement model. CONCLUSIONS: Pregnant women with obesity are inactive, possibly predisposing them to excess GWG. Current energy requirement models overestimate activity and may promote excess GWG in women with obesity. Furthermore, the observed large interindividual variability in basal metabolism may be important to consider when assessing the risk for excess GWG

Modifications to Infant Formula Instructions Improve the Accuracy of Formula Dispensing

Readability of infant formula preparation instructions is universally poor, which may result in inaccurate infant feeding. Given that inaccurate formula dispensing can lead to altered infant growth and increased adiposity, there is an increased need for easy to follow instructions for formula preparation. We hypothesize that altering infant formula instruction labels using feedback from iterative focus groups will improve the preparation accuracy of powdered infant formula in a randomized controlled trial. Participants were recruited from the community, 18 years of age or older, willing to disclose demographic information for focus group matching, and willing to participate freely in the first (n = 21) or second (n = 150) phase of the study. In the second phase, participants were randomized to use the standard manufacturer instructions or to use the modified instructions created in the first phase. Accuracy was defined as the percent error between manufacturer-intended powder formula quantity and the amount dispensed by the participant. Participants who were assigned to the modified instructions were able to dispense the powdered formula more accurately than participants who used the standard manufacturer instructions (&minus;0.67 &plusmn; 0.76 vs. &minus;4.66 &plusmn; 0.74% error; p &lt; 0.0001). Accuracy in powdered formula dispensing was influenced by bottle size (p = 0.02) but not by body mass index (p = 0.17), education level (p = 0.75), income (p = 0.7), age (p = 0.89) or caregiver status (p = 0.18). Percent error of water measurement was not different between the groups (standard: &minus;1.4 &plusmn; 0.6 vs. modified: 0.7 &plusmn; 0.6%; p = 0.38). Thus, caloric density was more accurate in the modified instructions group compared to the standard manufacturer instructions group (&minus;0.3 &plusmn; 0.6 vs.&minus;2.9 &plusmn; 0.9%; p = 0.03). Infant formula label modifications using focus group feedback increased infant formula preparation accuracy

Mood and quality of life changes in pregnancy and postpartum and the effect of a behavioral intervention targeting excess gestational weight gain in women with overweight and obesity: a parallel-arm randomized controlled pilot trial

Abstract Background Intensive lifestyle interventions in pregnancy have shown success in limiting gestational weight gain, but the effects on mood and quality of life in pregnancy and postpartum are less known. The purpose was to quantify changes in mental and physical quality of life and depressive symptoms across pregnancy and the postpartum period, to determine the association between gestational weight gain and change in mood and quality of life, and to assess the effect of a behavioral intervention targeting excess gestational weight gain on these outcomes. Methods A three group parallel-arm randomized controlled pilot trial of 54 pregnant women who were overweight or obese was conducted to test whether the SmartMoms® intervention decreased the proportion of women with excess gestational weight gain. Individuals randomized to Usual Care (n = 17) did not receive any weight management services from interventionists. Individuals randomized to the SmartMoms® intervention (n = 37) were provided with behavioral weight management counseling by interventionists either in clinic (In-Person, n = 18) or remotely through a smartphone application (Phone, n = 19). In a subset of 43 women, mood and mental and physical quality of life were assessed with the Beck Depression Inventory-II and the Rand 12-Item short form, respectively, in early pregnancy, late pregnancy, 1–2 months postpartum, and 12 months postpartum. Results The SmartMoms® intervention and Usual Care groups had higher depressive symptoms (p < 0.03 for SmartMoms® intervention, p < 0.01 for Usual Care) and decreased physical health (p < 0.01) from early to late pregnancy. Both groups returned to early pregnancy mood and physical quality of life postpartum. Mental health did not change from early to late pregnancy (p = 0.8), from early pregnancy to 1–2 months (p = 0.5), or from early pregnancy to 12 months postpartum (p = 0.9), respectively. There were no significant intervention effects. Higher gestational weight gain was associated with worsened mood and lower physical quality of life across pregnancy. Conclusion High depressive symptoms and poor quality of life may be interrelated with the incidence of excess gestational weight gain. The behavioral gestational weight gain intervention did not significantly impact these outcomes, but mood and quality of life should be considered within future interventions and clinical practice to effectively limit excess gestational weight gain. Trial registration NCT01610752, Expecting Success, Registered 31 May 2012

Mean percent difference and test of equivalence of simulated intake of formula prepared from powder between direct weighing and RFPM.

<p>Mean percent difference and test of equivalence of simulated intake of formula prepared from powder between direct weighing and RFPM.</p

RFPM Infant Powdered Formula Standard Card.

<p>RFPM Infant Powdered Formula Standard Card.</p