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

The impact of a high versus a low glycaemic index breakfast cereal meal on verbal episodic memory in healthy adolescents

In this study, healthy adolescents consumed a) a low glycaemic index (G.I.) breakfast cereal meal, or b) a high G.I. breakfast cereal meal, before completing a test of verbal episodic memory in which the memory materials were encoded under conditions of divided attention. Analysis of remembering/forgetting indices revealed that the High G.I. breakfast group remembered significantly more items relative to the Low G.I. breakfast group after a long delay. The superior performance observed in the High G.I. group, relative to the Low G.I. group, may be due to the additional glucose availability provided by the high G.I. meal at the time of memory encoding. This increased glucose availability may be necessary for effective encoding under dual task conditions

Diet, physical activity and mental health status are associated with dysglycaemia in pregnancy: the Healthy Start Study

Prenatal dysglycaemia is associated with adverse maternal and offspring outcomes. This study examined the association between dysglycaemia and multiple modifiable factors measured during pregnancy

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

A comparison of dietary trends among racial and socioeconomic groups in the United States

Background: There may be dietary differences among racial and socioeconomic groups in the United States. Methods: Using data from a representative sample of adults, we compared dietary trends among blacks and whites of varying socioeconomic status. We developed comparable measures of diet and of the consumption of macronutrients and food groups for 6061 participants in the 1965 Nationwide Food Consumption Surveys, 16,425 in the 1977-1978 Nationwide Food Consumption Surveys, and 9920 in the 1989-1991 Continuing Survey of Food Intake by Individuals (all conducted by the U.S. Department of Agriculture). The primary outcome was the score (range, 0 to 16) on the Diet Quality Index, a composite of eight food-and-nutrient-based recommendations from the National Academy of Sciences. A score of 4 or less was considered to indicate a relatively more healthful diet, and a value of 10 or more a relatively less healthful diet. Results: Overall dietary quality improved in all groups, from a mean Diet Quality Index score of 7.4 in 1965 to 6.4 in 1989-1991. In 1965, blacks of low socioeconomic status and, to a lesser extent, whites of low socioeconomic status had better diets than whites of high socioeconomic status. By the 1989-1991 survey, the differences among racial and socioeconomic groups had narrowed. In 1965, 9.3 percent of whites of low socioeconomic status, 16.4 percent of blacks of low socioeconomic status, and 4.7 percent of whites of high socioeconomic status had mean scores of 4 or less. In the 1989-1991 survey, the respective percentages were 19.9, 23.5, and 20.0. Fat consumption decreased in all groups. The consumption of fruits and vegetables varied little over time, except for an increase among blacks of medium and high socioeconomic status. The consumption of grains and legumes increased over time among whites of medium and high socioeconomic status and declined among blacks of low socioeconomic status. Conclusions: In 1965, there were large differences among groups in dietary quality, with whites of high socioeconomic status eating the least healthful diet, as measured by the index, and blacks of low socioeconomic status the most healthful. By the 1989-1991 survey, the diets of all groups had improved and were relatively similar

Maternal diet quality in pregnancy and neonatal adiposity: the Healthy Start Study

Poor maternal diet in pregnancy can influence fetal growth and development. We tested the hypothesis that poor maternal diet quality during pregnancy would increase neonatal adiposity (percent fat mass, %FM) at birth by increasing the fat mass (FM) component of neonatal body composition

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