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

Psychosocial Determinants of Adequacy of Gestational Weight Gain

Pregnancy is a critical time window for evaluating weight gain on subsequent risk for obesity among women of childbearing age. The purpose of this investigation was to determine if symptoms of depression, anxiety, stress, self-esteem and fetal health locus of control beliefs were significant risk factors for adequacy of gestational weight gain (GWG) when maternal sociodemographic characteristics and health behaviors were considered

The Effect of Remuneration Schedule on Data Completion and Retention in the Pregnancy Eating Attributes Study (PEAS)

Maximizing data completion and study retention is essential in population research. This study examined the effect of remuneration schedule and data collection modality on data completion and retention in the Pregnancy Eating Attributes Study cohort. Participants (n = 458) completed online surveys and attended six in-person study visits. Initially, remuneration was a prespecified amount per visit, then was changed mid-study to be prorated based on the number of forms completed. Additionally, survey data collection modality was changed to in-person at the sixth study visit. In this secondary data analysis, there was no effect of remuneration schedule on withdrawal rates or time-to-withdrawal. Survey completion was significantly lower under prorated remuneration at the first visit but did not significantly differ at subsequent visits. The lump sum group had significantly greater odds of completely the first and second trimester dietary record (OR = 4.1, OR = 2.6, respectively) then the prorated group but were almost half as likely to complete the dietary record at the 6-month postpartum visit (OR = 0.5). Survey completion at sixth visit was significantly higher for in-person versus online completion (68.6% vs. 93.1%). Findings suggest that remuneration schedule and data collection modality can impact completion of self- reported assessments

Pregravid body mass index is negatively associated with diet quality during pregnancy

OBJECTIVE: To investigate the association between pregravid weight status and diet quality. DESIGN: Institute of Medicine body mass index (BMI) cut-off points of 26.0-29.0 kg m- 2 for overweight and >29 kg m- 2 for obese were used to categorise women's weight status. Dietary information was obtained by self-report at 26-28 weeks' gestation using a modified Block food-frequency questionnaire. The Diet Quality Index for Pregnancy (DQI-P) included: servings of grains, vegetables and fruits, folate, iron and calcium intake, percentage calories from fat, and meal pattern score. Multinomial logistic regression models were used to estimate the association between weight status and tertiles of DQI-P controlling for potential individual confounders. SETTING: A clinical-based population recruited through four prenatal clinics in central North Carolina. SUBJECTS: A total of 2394 women from the Pregnancy, Infection and Nutrition study were included in this analysis. RESULTS: Evidence of a dose-response relationship was found between BMI and inadequate servings of grains and vegetables, and iron and folate intake. Pregravid obesity was associated with 76% increased odds of falling into the lowest diet quality tertile compared with underweight women after controlling for potential confounders. CONCLUSION: A modest association was found between pregravid weight status and diet quality. If corroborated, these findings suggest that overweight pregnant women should be targeted for nutrition counselling interventions aimed to improve diet quality

Pregravid BMI is associated with dietary restraint and psychosocial factors during pregnancy

The objective was to investigate the association of pregravid weight status, dietary restraint and psychosocial factors during pregnancy. We used data from the Pregnancy, Infection and Nutrition study, that recruited 2,006 women at prenatal clinics before 20 weeks’ gestation who were >16 years and English speaking. Institute of Medicine BMI cutpoints of underweight (26.0–29.0), obese (>29.0–34.9) and an additional category morbidly obese (≥ 35.0), were used to categorize weight status. Eight psychosocial measures and dietary restraint were assessed with regard to BMI; perceived stress, trait anxiety, depression symptoms, and internal locus of control (LOC), chance LOC, powerful others LOC, self-esteem and mastery. Linear regression was used to estimate associations, controlling for potential confounders. A significant test for trend was found between increasing pregravid weight categories and perceived stress, trait anxiety, depression symptoms, powerful others LOC, self-esteem, mastery and dietary restraint. In adjusted models, pregravid obesity was independently associated with perceived stress, trait anxiety and depression. Morbidly obese status was independently associated with all measures except internal LOC. A strong linear association was found between increasing weight categories and dietary restraint. A consistent association was found between pregravid weight status, psychosocial factors and dietary restraint. If corroborated, these findings suggest that with increasing pregravid weight, pregnant women are at greater risk for experiencing negative psychological states, are less likely to experience positive personal dispositions, and may need additional support to prevent adverse maternal complications and pregnancy outcomes

Predictors of pregnancy and postpartum haemoglobin concentrations in low-income women

OBJECTIVE: Pregnancy and postpartum iron status is of great public health importance, yet few studies have examined predictors of haemoglobin (Hb) concentration during this time. We identified predictors of Hb from 24 weeks' gestation until delivery and from 4 to 25 weeks postpartum. DESIGN: Blood was drawn as many as four times during care: at the initial visit, at 24-29 weeks' gestation, at delivery and postpartum. A longitudinal, multivariable linear regression model was used to predict Hb concentration. SETTING: A public health clinic in Raleigh, North Carolina. SUBJECTS: n=520 women who participated in the Iron Supplementation Study. RESULTS: Hb concentration at the previous blood draw, short stature, non-Hispanic white ethnicity/race, >12 years of education and smoking were positive predictors of pregnancy and postpartum Hb concentrations. Iron supplement use was a positive predictor, while inadequate weight gain and severe nausea/vomiting were negative predictors of gestational Hb. A high infant birth weight and postpartum haemorrhage were negative predictors of postpartum Hb. Pre-pregnancy body mass index had a slight positive relationship with gestational Hb, but had a strong negative relationship with postpartum Hb. The longitudinal model also confirmed the typical pattern of gestational Hb concentration. As the number of weeks between the initial visit and the 24- to 29-week visit increased, Hb at 24-29 weeks' gestation decreased. As gestational age increased from 24 weeks until delivery, Hb concentration increased as well. CONCLUSIONS: The predictors identified here could be used in clinical settings to target high-risk women for intervention

Childbearing is not associated with young women’s long-term obesity risk

Contemporary childbearing is associated with greater gestational weight gain and post-partum weight retention than in previous decades, potentially leading to a more pronounced effect of childbearing on women’s long-term obesity risk. Previous work on the association of childbearing with women’s long-term obesity risk mostly examined births in the 1970s and 1980s and produced mixed results.OBJECTIVEWe estimated the association of childbearing and obesity incidence in a diverse, contemporary sample of 2,731 U.S. women.DESIGN AND METHODSPropensity-score (PS) matching was used for confounding control when estimating the effect of incident parity (1996 to 2001) on 7-year incident obesity (BMI≥30 kg/m2) (2001 to 2008).RESULTSIn the sample, 19.3% of parous women became obese while 16.1% of unmatched nulliparous women did. After PS matching without and with replacement, the differences in obesity incidence were, respectively, 0.0 percentage points (ppts) (95% CI: −4.7 to 4.7) and 0.9 ppts (95% CI: −4.9 to 6.7). Results were similar in analyses of prevalent parity and obesity in 2008 (n=6601) conducted to explore possible selection bias.CONCLUSIONSThese results imply that, in contemporary U.S. parous women in their late 20s and early 30s, childbearing may not increase obesity incidence

The impact of exposure misclassification on associations between prepregnancy body mass index and adverse pregnancy outcomes

Prepregnancy body mass index (BMI) is a widely used marker of maternal nutritional status that relies on maternal self-report of prepregnancy weight and height. Pregravid BMI has been associated with adverse health outcomes for the mother and infant, but the impact of BMI misclassification on measures of effect has not been quantified. The authors applied published probabilistic bias analysis methods to quantify the impact of exposure misclassification bias on well-established associations between self-reported prepregnancy BMI category and five pregnancy outcomes (small- and large-for gestational age birth (SGA; LGA), spontaneous preterm birth (sPTB), gestational diabetes (GDM), and preeclampsia) derived from a hospital-based delivery database in Pittsburgh, PA (2003-2005; n=18 362). The bias analysis method recreates the data that would have been observed had BMI been correctly classified, assuming given classification parameters. The point estimates derived from the bias analysis account for random error as well as systematic error caused by exposure misclassification bias and additional uncertainty contributed by classification errors. In conventional multivariable logistic regression models, underweight women were at increased risk of SGA and sPTB, and reduced risk of LGA, while overweight, obese, and severely obese women had elevated risks of LGA, GDM, and preeclampsia compared with normal-weight women. After applying the probabilistic bias analysis method, adjusted point estimates were attenuated, indicating the conventional estimates were biased away from the null. However, the majority of relations remained readily apparent. This analysis suggests that in this population, associations between self-reported prepregnancy BMI and pregnancy outcomes are slightly overestimated

A Diet Quality Index for Pregnancy detects variation in diet and differences by sociodemographic factors

Methods currently used to assess nutritional status during pregnancy have limitations if one wishes to examine the overall quality of the diet. A Diet Quality Index for Pregnancy (DQI-P) was developed to reflect current nutritional recommendations for pregnancy and national dietary guidelines. Dietary intake was assessed during the second trimester using a food-frequency questionnaire. The DQI-P includes eight components: % recommended servings of grains, vegetables and fruits, % recommendations for folate, iron and calcium, % energy from fat, and meal/snack patterning score. Scores can range from 0 to 80; each component contributed 10 points. Two public prenatal clinics in central North Carolina. N = 2063 pregnant women who participated in the Pregnancy, Infection, and Nutrition (PIN) Study. The DQI-P quantitatively differentiated diets. The mean score for the population was 56.0 (standard deviation 12.0). Women who wer

Maternal Dietary Patterns are Associated with Lower Levels of Cardiometabolic Markers during Pregnancy

Elevated levels of cardiometabolic markers are characteristic of normal pregnancy; however, insulin resistance and increased glucose, triglyceride, and cholesterol levels can adversely influence maternal and child health. Diet is a modifiable behavior that could have significant impact on maternal cardiometabolic levels during pregnancy. We investigated the association between dietary patterns and cardiometabolic markers (glucose, insulin, insulin resistance (HOMA-IR), triglycerides, and cholesterol) during pregnancy