Excessive Gestational Weight Gain and Subsequent Maternal Obesity at Age 40: A Hypothetical Intervention
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To model the hypothetical impact of preventing excessive gestational weight gain on midlife obesity and compare the estimated reduction with the US Healthy People 2020 goal of a 10% reduction of obesity prevalence in adults.Novel antipsychotic drugs (APDs) have enhanced therapeutic actions compared to ‘typical’ APDs. However,clinical studies indicate that some induce marked weight gain. We attempted to model this effect in female Wistar rats given olanzapine chronically at 4 mg/kg b.i.d (4.5 h between injections). Such rats showed marked weight gain, which was statistically significant after only a single day of treatment, although weight gain increased up to a plateau after 10 days of treatment. Cessation of treatment led to rapid weight loss, which was significant after a single day of withdrawal. The weight gain observed was characterized by marked individual differences. As some clinical reports suggest that novel APD-induced weight gain is most pronounced in patients with the lowest body weight, we examined the relationship between weight gain and baseline body weight. However, we observed no significant relationship between baseline body weight and weight gain. The observation that olanzapine can induce weight gain rapidly in rats, in conjunction with the observation of marked individual differences in weight gain, suggests that patients at risk of developing weight gain might be detectable early in treatment. Furthermore, the finding that weight gain is rapidly reversible suggests that patients at risk of weight gain could be switched to APDs with less pronounced tendencies to induce weight gain. The study of APD-induced weight gain in rodents may provide insights into the nature, causes, and treatments for, novel APD-induced weight gain in the clinic. However, it remains to be determined how closely rodent models mimic the clinical situation and whether the mechanism(s) involved in the weight gain we have observed are the same as those involved in the clinical use of these drugs.
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(1) To evaluate the proportion who correctly classify- or misclassify maternal weight gain; (2) to investigate weight gain attitudes, and (3) to compare weight gain attitudes with weight gain recommendations by the Institute of Medicine (IOM), as well as background and lifestyle factors.This is secondary analysis of cohort data collected as part of a prospective study of determinants of macrosomic infants in Norway (the STORK project). The participants (n = 467) answered a self-administered questionnaire, including report on maternal weight gain and attitudes towards weight gain, in mean gestation week 36.4 (SD = 1.7). The women were also weighted (kg) at the hospital using a digital beam scale.A significant discrepancy was found between self-reported and measured maternal weight gain. About 76% reported to be satisfied with maternal weight gain while 24% were dissatisfied. Women reporting to be dissatisfied were significantly more likely to be sedentary, sick-listed, reporting poor eating habits and to be multiparous.Most women reported to be satisfied with their maternal weight gain, but had gained excessively according to recommended weight gain ranges issued by IOM. Pregnant women may need targeted advice on their specific weight gain and impact of increased weight gain on health variables for mother and child.
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Optimal birth weight and outcome are influenced by maternal weight gain. Low gestational weight gain is associated with poor fetal growth and risk of preterm delivery. Excessive weight gain affects infant growth, body fatness in childhood, and the potential for postpartum weight retention and future obesity. Guidelines from the Institute of Medicine recommend that a woman with a normal body mass index (BMI) of 19.8 to 26 should gain 11.5–16kg (25 to 351b). Women with a lower-than-normal BMI should gain slightly more, and those with a BMI greater than 26 should gain 5.9–11.5 kg (13 to 251b). Ideally, weight gain recommendations should be individualized to promote the best outcomes while reducing risk for excessive postpartum weight retention and reducing the risk of later chronic disease for the child and adult.
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First, to evaluate and compare the performance of routine ultrasonographic estimated fetal weight (EFW) and fetal abdominal circumference (AC) at 31 + 0 to 33 + 6 and 35 + 0 to 36 + 6 weeks' gestation in the prediction of a large-for-gestational-age (LGA) neonate born at ≥ 37 weeks' gestation. Second, to assess the additive value of fetal growth velocity between 32 and 36 weeks' gestation to the performance of EFW at 35 + 0 to 36 + 6 weeks' gestation for prediction of a LGA neonate. Third, to define the predictive performance for a LGA neonate of different EFW cut-offs on routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation. Fourth, to propose a two-stage strategy for identifying pregnancies with a LGA fetus that may benefit from iatrogenic delivery during the 38th gestational week.This was a retrospective study. First, data from 21 989 singleton pregnancies that had undergone routine ultrasound examination at 31 + 0 to 33 + 6 weeks' gestation and 45 847 that had undergone routine ultrasound examination at 35 + 0 to 36 + 6 weeks were used to compare the predictive performance of EFW and AC for a LGA neonate with birth weight > 90th and > 97th percentiles born at ≥ 37 weeks' gestation. Second, data from 14 497 singleton pregnancies that had undergone routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation and had a previous scan at 30 + 0 to 34 + 6 weeks were used to determine, through multivariable logistic regression analysis, whether addition of growth velocity, defined as the difference in EFW Z-score or AC Z-score between the early and late third-trimester scans divided by the time interval between the scans, improved the performance of EFW at 35 + 0 to 36 + 6 weeks in the prediction of delivery of a LGA neonate at ≥ 37 weeks' gestation. Third, in the database of the 45 847 pregnancies that had undergone routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation, the screen-positive and detection rates for a LGA neonate born at ≥ 37 weeks' gestation and ≤ 10 days after the initial scan were calculated for different EFW percentile cut-offs between the 50th and 90th percentiles.First, the areas under the receiver-operating characteristics curves (AUC) of screening for a LGA neonate were significantly higher using EFW Z-score than AC Z-score and at 35 + 0 to 36 + 6 than at 31 + 0 to 33 + 6 weeks' gestation (P < 0.001 for all). Second, the performance of screening for a LGA neonate achieved by EFW Z-score at 35 + 0 to 36 + 6 weeks was not significantly improved by addition of EFW growth velocity or AC growth velocity. Third, in screening by EFW > 90th percentile at 35 + 0 to 36 + 6 weeks' gestation, the predictive performance for a LGA neonate born at ≥ 37 weeks' gestation was modest (65% and 46% for neonates with birth weight > 97th and > 90th percentiles, respectively, at a screen-positive rate of 10%), but the performance was better for prediction of a LGA neonate born ≤ 10 days after the scan (84% and 71% for neonates with birth weight > 97th and > 90th percentiles, respectively, at a screen-positive rate of 11%). Fourth, screening by EFW > 70th percentile at 35 + 0 to 36 + 6 weeks' gestation predicted 91% and 82% of LGA neonates with birth weight > 97th and > 90th percentiles, respectively, born at ≥ 37 weeks' gestation, at a screen-positive rate of 32%, and the respective values of screening by EFW > 85th percentile for prediction of a LGA neonate born ≤ 10 days after the scan were 88%, 81% and 15%. On the basis of these results, it was proposed that routine fetal biometry at 36 weeks' gestation is a screening rather than diagnostic test for fetal macrosomia and that EFW > 70th percentile should be used to identify pregnancies in need of another scan at 38 weeks, at which those with EFW > 85th percentile should be considered for iatrogenic delivery during the 38th week.First, the predictive performance for a LGA neonate by routine ultrasonographic examination during the third trimester is higher if the scan is carried out at 36 than at 32 weeks, the method of screening is EFW than fetal AC, the outcome measure is birth weight > 97th than > 90th percentile and if delivery occurs within 10 days than at any stage after assessment. Second, prediction of a LGA neonate by EFW > 90th percentile is modest and this study presents a two-stage strategy for maximizing the prenatal prediction of a LGA neonate. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Objective To explore the relationship of weight gain during pregnancy and dietary nutrition and the knowledge of weight gain, to provide guidance for managing gestational weight and nutrition. Methods 100 pregnant women were investigated with self-designed questionnaire focusing on gestational dietary and weight gain.These pregnant women were divided into three groups according to weight gain during pregnancy-low, normal and high weight gain group. ANOVA was used to explore the difference of dietary nutrition and knowledge of weight gain among the groups. Results Of the 100 pregnant women surveyed, 60% had high weight gain, 25% had normal weight gain and 15% had low weight gain. The dietary scores of the normal and low weight gain group were significantly higher than the high weigh gain group ( P ＜ 0.01 ), but the scores of weight gain knowledge had no statistically difference among the groups (P ＞ 0.05). Conclusions It is important to strengthen nutritional guidance and take effective supervision measures on weight gain during pregnancy.
Key words:
Pregnant women; Gestational weight gain; Gestational nutrition
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The relationship between blood pressure and cardiovascular mortality according to body mass index has been analyzed in two French prospective studies: the Paris Prospective Study, composed of 7,704 men aged 40–53 years examined in 1967–1972, and the Investigations Pré-Cliniques Study, made up of 19,618 men aged 40–69 years who underwent a checkup in 1970–1980. In the Paris Prospective Study, during a mean follow-up of 11.2 years, 241 cardiovascular deaths occurred, while in the Investigations Pré-Cliniques Study, with a mean follow-up of 7.6 years, 262 cardiovascular deaths occurred. A Cox survival analysis was performed on the data of each study to test the interaction of blood pressure and body mass index in the prediction of cardiovascular risk. Both analyses demonstrate a significant negative interaction, suggesting that a decreasing trend of the relative risk of cardiovascular death with increasing body mass index is better supported by the data than a constant relative risk. These results might have some bearing on the problem of the management of hypertension in overweight subjects.
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This chapter contains sections titled: Recommended weight gain - the Institute of Medicine Guidelines Optimal weight gain in class 2 and 3 obesity Gestational weight gain among obese women Ongoing controversy over optimal weight gain range for obese women: studies supporting restricted weight gain (less than IOM guidelines) for obese women Possible risks associated with restricted weight gain among obese women The role of prenatal counseling Studies of interventions to prevent excessive gestational weight gain among obese women Nutrition for obese pregnant women (Table 9.2) Postpartum weight concerns in obese women References Other useful online resources
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