The Implications of Maternal Overweight and Obesity on the Course of Pregnancy and Birth Outcomes

The increasing prevalence of overweight and obesity among women of childbearing age is a growing public health concern in the United States. The average body mass index (BMI) is increasing among all age categories and women enter pregnancy at higher weights. Women are also more likely to retain gestational weight with each pregnancy. Women who are overweight (BMI 25–30) and obese (BMI ≥30) are at greater risk of adverse reproductive health outcomes compared to women of normal weight status (BMI 19.8–25). This article provides an overview of the complications associated with maternal overweight and obesity including diabetes, pre-eclampsia, c-sections, and birth defects. We present updated information on the weight trends among women. Finally, we present an overview of the prevention studies aimed at adolescents and women prior to pregnancy

Exercise During Pregnancy and Cesarean Delivery: North Carolina PRAMS, 2004-2005

Background—The current rate of cesarean delivery in the United States is 31 percent. Previous studies have suggested that exercise during pregnancy may be associated with a lower risk of cesarean delivery, but sample sizes were small and methods often inadequate. This study examined whether or not an association exists between prenatal exercise and delivery mode using data from the 2004 and 2005 North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Methods—PRAMS postpartum questionnaire responses about frequency of exercise during the last 3 months of pregnancy for 1,955 women without a prior cesarean delivery were linked to birth certificates. Results—Among 1,342 women delivering at term, exercise was not associated with delivery mode in this data set: compared with women exercising less than once a week, neither women exercising 1 to 4 times per week nor those exercising 5 times or more per week had an altered risk of cesarean [RR (95% CL) 0.89 (0.69, 1.15), 1.04 (0.66, 1.64), respectively, adjusted for parity, gestational age, hypertension]. Among 613 women delivering preterm, the results were also not statistically significant, but a compelling trend toward a protective effect could be seen [RR (95% CL) 0.65 (0.38, 1.13), 0.62 (0.29, 1.33)]. Conclusions—Maternal self-reported frequency of exercise during pregnancy was not associated with a reduced risk of cesarean delivery. Larger studies with better exposure ascertainment may provide a more definitive answer

Prepregnancy Obesity: Determinants, Consequences, and Solutions

Obesity among women of childbearing age is of paramount importance because of its association with multiple adverse health outcomes for the mother and fetus once a woman becomes pregnant. Obesity is more prevalent among women of lower socioeconomic status and of color who often times lack health insurance. This health disparity that exists within a framework of repeating cycle of risk emphasizes the urgency for accelerating the discovery of solutions for the obesity problem among women of childbearing age

Gestational weight gain recommendations in the context of the obesity epidemic

The impact of the obesity epidemic on women of childbearing age has been of particular concern in recent years as a result of studies linking maternal weight status to long-term adverse outcomes for obese mothers and their offspring. The US Institute of Medicine developed new gestational weight gain guidelines based on this literature that attempts to strike a balance between the known risks and benefits of weight gain during pregnancy. More studies that include large numbers of obese women, examine outcomes beyond the perinatal period, and identify safe and effective pregnancy weight gain interventions are needed before lower weight gain recommendations can be made for obese women

Provider Advice About Pregnancy Weight Gain and Adequacy of Weight Gain

To explore the association between health care provider advice about weight gain and gestational weight gain. Using data from a prospective cohort study, we explored the association between provider advice about weight gain in pregnancy with weight gain adequacy among 1,454 pregnant women. Provider advice was measured by maternal self-report at 27–30 weeks’ gestation. Linear and Poisson regression were used to explore associations. Seventy-eight percent of the women gained outside current recommendations. Fifty-one percent reported receiving weight gain advice from a health care provider. Adjusted Generalized Linear Model (GLM) estimates showed weak effect of provider advice on inadequate or excessive gain (Relative Risk (RR) 0.96, 95% CI 0.74, 1.26 for inadequate gain and RR 1.01, 95% CI 0.97, 1.06 for excessive gain). There is a need for more women to hear about their targeted weight gains during pregnancy and the present advice that exists does little to influence actual gains. Further studies are warranted to find better strategies for providers to motivate their patients to gain weight within the appropriate ranges

Food insecurity with past experience of restrained eating is a recipe for increased gestational weight gain

Food insecurity is linked to higher weight gain in pregnancy, as is dietary restraint. We hypothesized that pregnant women exposed to marginal food insecurity, and who reported dietary restraint before pregnancy, will paradoxically show the greatest weight gain. Weight outcomes were defined as total kilograms, observed-to-recommended weight gain ratio, and categorized as adequate, inadequate or excessive weight gain based on 2009 Institute of Medicine guidelines. A likelihood ratio test assessed the interaction between marginal food insecurity and dietary restraint and found significant. Adjusted multivariate regression and multinomial logistic models were used to estimate weight gain outcomes. In adjusted models stratified by dietary restraint, marginal insecurity and low restraint was significantly associated with lower weight gain and weight gain ratio compared to food secure and low restraint. Conversely, marginal insecurity and high restraint was significantly associated with higher weight gain and weight gain ratio compared to food secure and high restraint. Marginal insecurity with high restraint was significantly associated with excessive weight gain. Models were consistent when restricted to low-income women and full-term deliveries. In the presence of marginal food insecurity, women who struggle with weight and dieting issues may be at risk for excessive weight gain

Trends in energy intake in U.S. between 1977 and 1996: Similar shifts seen across age groups

Objective: To determine the trends in locations and food sources of Americans stratified by age group for both total energy and the meal and snack subcomponents. Research Methods and Procedures: Nationally representative data was taken from the 1977 to 1978 Nationwide Food Consumption Survey and the 1989 to 1991 and 1994 to 1996 (and 1998 for children age 2 through 9) Continuing Surveys of Food Intake by Individuals. The sample consisted of 63,380 individuals, age 2 and up. For each survey year, the percentage of total energy intake from meals and snacks was calculated separately for 2‐ to 18‐year‐olds, 19‐ to 39‐year‐olds, 40‐ to 59‐year‐olds, and those 60 years and older. The percentage of energy intake by location (at‐home consumption or preparation, vending, store eaten out, restaurant/fast‐food, and school) and by specific food group was computed for all age groups separately. Results: The trends in location and food sources were almost identical for all age groups. Key dietary behavior shifts included greater away‐from‐home consumption; large increases in total energy from salty snacks, soft drinks, and pizza; and large decreases in energy from low‐ and medium‐fat milk and medium‐ and high‐fat beef and pork. Discussion: Total energy intake has increased over the past 20 years, with shifts away from meals to snacks and from at‐home to away‐from‐home consumption. The similarity of changes across all age groups furthers the assertion that broad‐based environmental changes are needed to improve the diets of Americans

Dietary energy density but not glycemic load is associated with gestational weight gain

The majority of pregnant women are gaining outside of the recommended weight gain ranges. Excessive weight gains have been linked to pregnancy complications and long term maternal and child health outcomes

Household Food Insecurity Is Associated with Self-Reported Pregravid Weight Status, Gestational Weight Gain, and Pregnancy Complications

Household food insecurity is positively associated with weight among women. The association between household food insecurity and pregnancy related weight gain and complications is not well understood

Physical Activity During Pregnancy and Risk of Hyperglycemia

To determine the association between moderate and vigorous physical activities (MVPA) during midpregnancy and the risk of hyperglycemia