Gestational Weight Gain During the COVID-19 Pandemic.

INTRODUCTION: Healthy gestational weight gain (GWG) is associated with improved pregnancy and delivery outcomes. The COVID-19 pandemic changed eating behaviours and physical activity, and thus may have impacted GWG. This study examines the impact of the COVID-19 pandemic on GWG. METHODS: Participants (N = 371, 86% of the larger study) were part of a study focused on GWG among TRICARE beneficiaries (i.e., active-duty military personnel and other beneficiaries). Participants were randomized to two treatment groups (GWG intervention (n = 149 pre-COVID and n = 98 during COVID), and usual care condition (n = 76 pre-COVID and n = 48 during COVID). GWG was calculated as the difference between screening weight and at 36 weeks gestation. Participants who delivered prior to the COVID-19 pandemic (March 1, 2020, N = 225) were compared to participants whose pregnancies occurred during the pandemic (N = 146). RESULTS: We found no significant difference in GWG between those who delivered prior to the pandemic (11.2 ± 4.3 kg) and those whose pregnancies occurred during COVID-19 (10.6 ± 5.4 kg), with no effect of intervention arm. While excessive GWG was higher pre-COVID (62.8%) than during the pandemic (53.7%), this difference was not significant overall or by intervention arm. In addition, we found lower attrition during the pandemic (8.9%) than in the pre-COVID period (18.7%). DISCUSSION: In contrast to prior research that indicated challenges with engaging in health behaviors during the COVID-19 pandemic, we found that women did not have increased GWG or higher odds of excessive GWG. This research contributes to our understanding of how the pandemic impacted pregnancy weight gain and engagement in research.

Indirect effects of the COVID-19 pandemic on risk of gestational diabetes and factors contributing to increased risk in a multiethnic population: a retrospective cohort study.

BACKGROUND: The COVID-19 pandemic has had indirect effects on pregnancy outcomes. There is limited data on the impact on gestational diabetes (GDM) in diverse populations and the possible underlying mediators. This study aimed to assess the risk of GDM pre-COVID-19 and in two distinct pandemic exposure periods, and to determine the potential factors contributing to increased risk in a multiethnic population. METHODS: A multicentre, retrospective cohort study was performed of women with singleton pregnancy receiving antenatal care at three hospitals two years pre-COVID-19 (January 2018 - January 2020), first year of COVID-19 with limited pandemic-mitigating restrictions (February 2020 - January 2021) and second year of COVID-19 with stringent restrictions (February 2021 - January 2022). Baseline maternal characteristics and gestational weight gain (GWG) were compared between cohorts. The primary outcome was GDM, assessed using univariate and multivariate generalised estimating equations models. RESULTS: 28,207 pregnancies met the inclusion criteria, 14,663 pregnancies two years pre-COVID-19, 6,890 in COVID-19 Year 1 and 6,654 in COVID-19 Year 2. Maternal age increased across exposure periods (30.7 ± 5.0 years pre-COVID-19 vs 31.0 ± 5.0 years COVID-19 Year 1 vs 31.3 ± 5 years COVID-19 Year 2; p < 0.001). There were increases in pre-pregnancy body mass index (BMI) (25.5 ± 5.7 kg/m2 vs 25.7 ± 5.6 kg/m2 vs 26.1 ± 5.7 kg/m2; p < 0.001), proportion who were obese (17.5% vs 18.1% vs 20.7%; p < 0.001) and proportion with other traditional risk factors for GDM including South Asian ethnicity and prior history of GDM. Rate of GWG and proportion exceeding recommended GWG increased with pandemic exposure (64.3% vs 66.0% vs 66.6%; p = 0.009). GDM diagnosis increased across exposure periods (21.2% vs 22.9% vs 24.8%; p < 0.001). Both pandemic exposure periods were associated with increased risk of GDM on univariate analysis, only COVID-19 Year 2 remaining significantly associated after adjusting for maternal baseline characteristics and GWG (OR 1.17 [1.06, 1.28], p = 0.01). CONCLUSIONS: Diagnosis of GDM increased with pandemic exposure. Progressive sociodemographic changes and greater GWG may have contributed to increased risk. However, exposure to the second year of COVID-19 remained independently associated with GDM after adjusting for shifts in maternal characteristics and GWG.

IDF2022-1278 Pilot trial to optimize gestational weight gain and step counts in women with gestational diabetes: ACTIVE PATIENT GDM

Background Physical activity and dietary habit optimization in women with gestational diabetes mellitus (GDM) or such a history can improve both short-term [1,2] and long-term outcomes [3]. This requires strategies that are accessible, usable, and perceived as beneficial. Aim To examine uptake and engagement for the following interventions: (1) step and weight tracking through an online platform using a pedometer and weight scale, with delivery of weekly goals;(2) weekly telephone-based health coaching;and (3) a combination of these. We are assessing recruitment, completion of health coaching sessions and/or step count and weight data upload, and participant perspectives. Method Five-city pilot randomized controlled trial (Montreal, Halifax, Calgary, Winnipeg, Toronto;Canada). Women with GDM are recruited at 20-32 weeks' gestation. Data collection is through web-based questionnaire, electronic tracking of data upload, coaching session logs, chart review (gestational weight gain;blood pressure;A1C;glucose levels;offspring sex, weight, and gestational age), in-depth telephone interview (perspectives, breastfeeding status), and mailed in pedometers with concealed windows worn for 7 days (baseline and 37 weeks). Participants are randomized to one of the 3 interventions described or a control arm (resource website only). Results The trial started in August 2019 with COVID-related interruptions. By June 30, 2022, 192/225 mothers were recruited (recruitment ongoing): 27/192 (14%) withdrew, 13 are currently undergoing interventions, and 152 completed final questionnaires. An interim process analysis of the first 52 indicates that those randomized to step and weight tracking employ the pedometer and scale a mean 81.6% (SD 29.6%) and 69.0% (SD 32.0%) of the time, respectively. High proportions report step tracking (92.3%, n = 24/26) and health coach conversations (87.5% n = 21/24) as useful, with weight tracking endorsed by over half (61.5%, n = 16/26). Conclusion The findings will inform a larger scale clinical trial in terms of impacts on gestational weight gain and appropriate for size offspring status.Copyright © 2023 Elsevier B.V.

Weight gain in pregnancy and infant birthweight after the onset of the COVID-19 pandemic: an interrupted time series analysis.

BACKGROUND: Increased weight gain and decreased physical activity have been reported in some populations since the coronavirus disease 2019 (COVID-19) pandemic, but this has not been well characterized in pregnant populations. OBJECTIVES: Our objective was to characterize the impact of the COVID-19 pandemic and associated countermeasures on pregnancy weight gain and infant birthweight in a US cohort. METHODS: Washington State pregnancies and births (1 January, 2016 to 28 December, 2020) from a multihospital quality improvement organization were examined for pregnancy weight gain, pregnancy weight gain z-score adjusted for pregestational BMI and gestational age, and infant birthweight z-score, using an interrupted time series design that controls for underlying time trends. We used mixed-effect linear regression models, controlled for seasonality and clustered at the hospital level, to model the weekly time trends and changes on 23 March, 2020, the onset of local COVID-19 countermeasures. RESULTS: Our analysis included 77,411 pregnant people and 104,936 infants with complete outcome data. The mean pregnancy weight gain was 12.1 kg (z-score: -0.14) during the prepandemic time period (March to December 2019) and increased to 12.4 kg (z-score: -0.09) after the onset of the pandemic (March to December 2020). Our time series analysis found that after the pandemic onset, the mean weight gain increased by 0.49 kg (95% CI: 0.25, 0.73 kg) and weight gain z-score increased by 0.080 (95% CI: 0.03, 0.13), with no changes in the baseline yearly trend. Infant birthweight z-scores were unchanged (-0.004; 95% CI: -0.04, 0.03). Overall, the results were unchanged in analyses stratified by pregestational BMI categories. CONCLUSIONS: We observed a modest increase in weight gain after the onset of the pandemic among pregnant people but no changes in infant birthweights. This weight change could be more important in high BMI subgroups.

Retrospective cohort study on weight gain among pregnant women of the Italian Province of Trento during the 2020 lockdown due to COVID-19

Objective. The lockdown due to COVID-19 has been associated with a reduction of physical activity and a change in eating behaviors, with consequent weight gain, in general and specific populations. The objective of this study was to assess whether women whose pregnancies encompassed the lockdown due to COVID-19 in 2020 had an excess gestational weight gain as compared with those who were pregnant in the same periods of previous years. Materials and Methods. This was a retrospective cohort study based on anony-mous data from the Birth Attendance Certificate (CedAP) information flow which is mandatorily collected in all Italian Regions. In the Autonomous Province of Trento, North-Eastern Italy, more information than those required as a minimum data set are collected, including maternal weight at the first gestational obstetric visit, initial body mass index (BMI), and maternal weight at delivery. We calculat-ed mean gestational weight gain for women whose pregnancy encompassed the 2-month lockdown in 2020 and for those who were pregnant in corresponding periods of the years 2016-2019. Linear and logistic regression models were built to assess the association between lockdown and weight gain or excess weight gain, respectively, adjusting for the potential confounding effect of gestational month at the beginning of lockdown or corresponding period and pre-pregnancy body mass index. Results. In 2020, mean gestational weight gain was not significantly different from the previous years, nor was the likelihood of gaining excess weight. Conclusions. Unlike other populations that increased weight during the COVID-19 lockdown, the Italian population of pregnant women described in this study has a gestational weight gain comparable with that of the previous years. Public health and environmental interventions, as well as dedicated programs taking care of women from conception to post-partum may have a role in the health of future mothers and should be promoted.

Comparison of the Prevalence of Gestational Diabetes Pre-COVID-19 Pandemic Versus During COVID-19

INTRODUCTION: Recent studies suggest that the rate of gestational diabetes (GDM) diagnosis has increased following the onset of the COVID-19 pandemic. This study investigated the prevalence of GDM among patients delivering at a single academic institution, prior to and after the onset of the COVID-19 pandemic. METHODS: This was a retrospective study of patients with a singleton, full-term birth who delivered pre-COVID-19 (January 2019-May 2020) and during the COVID-19 pandemic (June 2020- July 2021). Institutional review board approval was obtained. Data collected included diagnosis of GDM, maternal age, prepregnancy BMI, and gestational weight gain (GWG). Chi-square tests assessed the relationship between GDM diagnosis (yes, no) and time (pre-COVID- 19, during COVID-19). Binary regression further evaluated this relationship, controlling for confounding factors. RESULTS: Among the 7,653 patients included in analysis, 58.6% delivered pre-COVID-19 and 41.1% delivered during COVID-19. During COVID-19, 12.5% of patients were diagnosed with GDM, compared to 9.0% pre-COVID-19 (P<.001). When stratified by prepregnancy weight status, the significantly increased prevalence of GDM during COVID-19 remained among those with a lean, overweight, and obese prepregnancy BMI (underweight, 6.2% versus 3.8%, P=.40;lean, 7.4% versus 5.0%, P<.01;overweight, 10.9% versus 7.4%, P<.01;obese, 21.1% versus 17.2%, P=.02). When controlling for maternal age, prepregnancy BMI, and GWG, time (related to COVID- 19) remained a significant predictor of GDM diagnosis (P<.001). CONCLUSION: This study demonstrates a 38.9% increase in the prevalence of GDM delivering at a single academic institution during the COVID-19 pandemic, compared to pre-COVID-19. Future research is needed to determine the underlying mechanisms potentially contributing to hyperglycemia in pregnancy.

EFFECT OF THE LOW PREVALENCE FIRST YEAR OF COVID-19 ON WEIGHT CHANGES DURING PREGNANCY IN A MULTIETHNIC AUSTRALIAN POPULATION

Background: Obesity and excessive gestational weight gain are associated with adverse pregnancy outcomes. The impact of the COVID-19 pandemic on weight and weight gain during pregnancy are unknown. Methods: Retrospective cohort study of all singleton pregnancies before (January 2018-January 2020) and during the low prevalence first year of COVID-19 (February 2020-January 2021). Demographic data, booking BMI and rate of weight gain were compared between time periods. Results: 14908 patients (9544 before and 5364 during the COVID-19 first year) met the inclusion criteria. There was a trend towards higher booking BMI (25.5 ± 0.1 kg/m2 during vs 25.3 ± 0.1 kg/m2 before COVID-19, p = 0.08) and higher rate of obesity (17.0% vs 16.5%, p = 0.08) during the COVID-19 first year. Rate of weight gain in pregnancy was greater during COVID-19 (0.539 ± 0.006 kg/week vs 0.505 ± 0.004 kg/week, p < 0.001), driven by the greater difference in rate of 2nd trimester weight gain (0.664 ± 0.010 kg/week during vs 0.571 ± 0.007 kg/week before COVID-19, p < 0.001). After adjusting for maternal age, ethnicity, socioeconomic status and booking BMI, the COVID-19 first year was associated with significantly greater rate of weight gain (β = 0.02, p = 0.001). Rate of weight gain recommended for BMI was achieved in fewer pregnancies during COVID-19 (14.4% vs 16.3%, p = 0.007). Conclusions: The first year of COVID-19 was associated with a greater rate of gestational weight gain and a lower proportion of patients achieving recommended weight gain. This likely reflects the impact of COVID-19 restrictions in the community of Western Sydney and may have contributed to adverse pregnancy outcomes during the low prevalence first year of the COVID-19 pandemic.

TELEMEDICINE IN WOMEN WITH GESTATIONAL DIABETES DURING THE COVID-19 EPIDEMIC

Background and Aims: Telemedicine allowed continued care during the COVID-19 epidemic. However, less is known about the role of telemedicine in women with gestational diabetes (GDM). Therefore, we aimed to evaluate whether telemedicine, compared to standard care, provides equivalent clinical outcomes. Methods: Telemedicine group was treated from home by using videoconference and glucose measurements sent daily to the telemedicine centre. The first and the last medical appointments were performed at the outpatient clinic, with medical consultation and laboratory examination. Primary outcomes were HbA1c at the first and the last medical check-up and gestational weight gain, while secondary outcome was infant's birth weight, adjusted for sex and gestational age when compared to the standard care group. Results: The telemedicine (n = 39) and the standard care group (n = 39) were equalized by age (31.6±4.1 vs. 33.0±5.3) and prepregnancy body mass index (26.4±5.3 vs. 26.0±4.7). No significant difference was found between groups in gestational weight gain (10.2±4.2 vs. 11.4±5.4). Both groups did not differ significantly in HbA1c at baseline (4.9±0.3 vs. 4.9±0.2), neither was the difference significant at the last visit (5.2±0.3 vs. 5.1±0.3). Furthermore, no difference was found between groups in the birth weight expressed in percentiles (48.0±25.7 vs. 52.6±26.7). Conclusions: Telemedicine has been shown to be a safe alternative to standard care in women with GDM, giving comparable glycemic outcomes. However, comprehensive studies on a larger sample, with a broader set of perinatal outcomes are needed.

Gestational diabetes increase associated with covid-19 pandemic in an inner-city multi-ethnic cohort

Background and Aims: During the covid-19 pandemic revisions were recommended to the gestational diabetes diagnostic criteria. Given the characteristics of our inner city multi-ethnic cohort, we continued with the NICE 2015 criteria. We aimed to determine the incidence of gestational diabetes during the first wave of the covid-19 pandemic. Methods: Women diagnosed with gestational diabetes in March-July 2020 were retrospectively reviewed and compared to two separate historical time-matched cohorts (03-07/ 2018 and 03-07/ 2017). Maternal demographics, gestational diabetes incidence and fetal outcomes were compared. Results: 953 pregnancies were registered in 2020, 963 in 2018 and 1162 in 2017. The highest gestational diabetes incidence was observed in the covid-19 cohort (12.6% (n = 120), 7.3% (n = 70) and 4.4% (n = 52) respectively, p < 0.001). On average, women were diagnosed with GDM later in 2020 (mean gestational age (GA) 28.6 weeks, 27.0 and 27.0 weeks, p < 0.001). Mean ( ± SD) age, height, and early pregnancy weight/ body mass index were similar. Proportional differences in women with gestational diabetes of non-white ethnicity were exhibited, with the lowest proportion in 2020 (77.0%, 86.4% and 82.9% respectively, p < 0.001). Mean ( ± SD) fetal birth weight varied across the groups (3237.5 ( ± 473)g, 3117 ( ± 647)g and 2981 ( ± 845)g, p < 0.001). There were no differences in adjusted fetal birth weight centiles. Mean (SD) GA at birth was higher in 2020 (38.8 ( ± 1.26), 38.4 ( ± 2.38), 37.60 ( ± 5.1) weeks, p = 0.03). Conclusions: A significant increase in the diagnosis of gestational diabetes during the covid-19 epidemic was observed. The implementation of national lockdowns may have resulted in reduced physical activity and excess gestational weight gain, which could explain this.

Hydration status count for weight gain on pregnancy period

Purpose>In Indonesia, 29.3% of Indonesian women were obese. Dehydrated women have 1.6 times higher risk of becoming obese than normal ones. This study was aimed to further explore the association between gestational weight gain (GWG) and maternal hydration status.Design/methodology/approach>This longitudinal study involved 50 pregnant women aged 18–35 years. Subject identity, age, parity and household expenses were collected using questionnaire. Urine specific gravity (USG) was used as an indicator for hydration status. Venous blood was collected to measured haemoglobin (Hb) by anemometer method. Anthropometric data such as pre-pregnancy weight, maternal body weight, GWG, body mass index (BMI) and mid-upper arm circumference (MUAC) was collected using standardized tools. Dietary and total water intake (TWI) were measured through three consecutive days of a 24-h food recall. Pearson’s correlation, independent t-test and analysis of covariance were used to appraise the hypothesis.Findings>The subject’s mean age was 29.3 ± 5.6 years;BMI was 23.5 ± 4.1 kg/m2. MUAC (28.2 ± 4.0 cm) and Hb (11.5 ± 1.0 g/dl) were still in the normal range. Most subjects were well hydrated, with an average USG of 1.016 g/mL. GWG and TWI are significantly correlated (p < 0.01). Based on the hydration status, after corrected with TWI, GWG was not significantly different.Originality/value>It calls to mind that nutrition and water intake, alongside weight gain monitoring during pregnancy, are part of an effort to prevent pregnancy risks.

Effectiveness of a Step Counter Smartband and Midwife Counseling Intervention on Gestational Weight Gain and Physical Activity in Pregnant Women With Obesity (Pas and Pes Study): Randomized Controlled Trial.

BACKGROUND: Women who are pregnant and have obesity and excessive gestational weight gain (GWG) present a higher risk of maternal and perinatal complications. The use of mobile apps and a wristband during pregnancy may contribute to promoting healthy lifestyles and, thus, improving maternal and neonatal health. OBJECTIVE: This study aims to evaluate the effectiveness of a complex digital health intervention, using a smartband and app with midwife counseling, on GWG and physical activity (PA) in women who are pregnant and have obesity and analyze its impact on maternal and perinatal outcomes. In addition, we aim to study the frequency of use, usability, and satisfaction with the mobile apps used by the women in the intervention group. METHODS: A parallel, 2-arm, randomized controlled trial was conducted. A total of 150 women who were pregnant and had obesity were included. The intervention group received a complex combined digital intervention. The intervention was delivered with a smartband (Mi Band 2) linked to the app Mi Fit to measure PA and the Hangouts app with the midwife to provide personal health information. The control group received usual care. The validated Spanish versions of the International Physical Activity Questionnaire-Short Form and the System Usability Scale were used. Satisfaction was measured on a 1- to 5-point Likert scale. RESULTS: We analyzed 120 women, of whom 30 (25%) were withdrawn because of the COVID-19 pandemic. The median GWG in the intervention group was 7.0 (IQR 4-11) kg versus 9.3 (IQR 5.9-13.3) kg in the control group (P=.04). The adjusted mean GWG per week was 0.5 (95% CI 0.4-0.6) kg per week in the control group and 0.3 (95% CI 0.3-0.4) kg per week in the intervention group (df=0.1, 95% CI -0.2 to 0.03; P=.008). During the 35 and 37 gestational weeks, women in the intervention group had higher mean PA than women in the control group (1980 metabolic equivalents of tasks-minutes per week vs 1386 metabolic equivalents of tasks-minutes per week, respectively; P=.01). No differences were observed between the study groups in the incidence of maternal and perinatal outcomes. In the intervention group, 61% (36/59) of the women who were pregnant used the smartband daily, and 75% (44/59) evaluated the usability of the Mi Fit app as excellent. All women in the intervention group used the Hangouts app at least once a week. The mean of the satisfaction scale with the health counseling app and midwife support was 4.8/5 (SD 0.6) points. CONCLUSIONS: The use of a complex mobile health intervention was associated with adequate GWG, which was lower in the intervention group than in the control group. In addition, we observed that the intervention group had increases in PA. No differences were observed in maternal perinatal complications. TRIAL REGISTRATION: ClinicalTrials.gov NCT03706872; https://www.clinicaltrials.gov/ct2/show/NCT03706872.

Feasibility of acceptance-based health coaching targeting food cravings in pregnancy

Excess gestational weight gain (GWG) is the leading high-risk condition in pregnancy in the United States and associated with a variety of poor delivery and health outcomes for the mother and infant. The majority of interventions addressing diet and physical activity in pregnancy have at best small effects on weight gain and pregnancy health outcomes. Past studies on weight loss in non-pregnant samples have demonstrated the utility of addressing psychological factors to modify eating behaviors. Currently, there is a lack of research to evaluate the efficacy of targeting psychological factors to improve cognitive and affective coping skills when attempting to facilitate health behavioral change specifically in pregnancy. Food cravings, an affective-laden cognitive experience, have been shown to account for over 30% of the variance in excess GWG and could therefore serve as useful targets for weight management among women in the perinatal period. The current studies sought to determine the acceptability and feasibility of an acceptance-based health coaching workshop targeting food cravings in pregnancy via community-based recruitment. Feasibility was addressed through examining the recruitment process, resources, retention rates, and measurement burden. Acceptability was evaluated through measures of credibility and expectancy and perceptions of appropriateness and utility of the intervention. Study 1 examined concurrent and retrospective acceptability for pregnant women while study 2 addressed prospective acceptability, with pregnant women and perinatal providers as identified stakeholders. Pregnant women in study 1 (n =4) were recruited through various sites in the community and provided detailed feedback on the proposed intervention. Recruitment for study 2 was conducted online in response to restrictions placed by the COVID-19 pandemic (n = 47) and sought to address limitations that arose in study 1. Pregnant women in study 1 conducted a pre- and post-intervention assessment battery including measures of food cravings, eating patterns, thought suppression, acceptance and willingness, and obsessive- compulsive aspects of eating. Pregnant women and perinatal providers in study 2 completed a series of questions developed by study coordinators to assess acceptability and perceived need of the proposed intervention. Results from study 1 showed that the proposed intervention was generally feasible and acceptable. Measures of feasibility showed treatment retention as adequate, and measurements were generally appropriate and minimally burdensome. Participants deemed the intervention credible for coping with food cravings and expected the skills learned to be helpful in the future. Recruitment for the intervention was a major barrier, with attempts to connect with sites in the community proving to be difficult. Study 2 provided some understanding related to issues with recruitment in study 1. Specifically, pregnant women preferred to participate in this intervention at their Ob/Gyn's office and overwhelmingly stated that having the time to participate would be a major barrier. Lack of sufficient responses prevented us from reaching saturation in the sample of perinatal providers, but preliminary evidence suggests that they appeared willing to refer their patients to this workshop. Overall, the proposed acceptance- based health coaching study targeting food cravings in pregnancy appeared feasible, and future research should examine the efficacy of the proposed intervention in preventing excess GWG and associated adverse health outcomes on a larger scale. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The associated factors of cesarean section during COVID-19 pandemic: a cross-sectional study in nine cities of China.

BACKGROUND: Improving and maintaining the health of mothers and newborns is indisputably a global priority, especially during a pandemic. This study intends to examine the factors associated with cesarean section (CS) during lockdown time. METHODS: A total of 678 women who just gave birth within 7 days were enrolled from maternal and children hospitals in nine cities of China from April to May 2020. The delivery modes and potential influencing factors were investigated. The subgroup analysis and sensitivity analysis were used to examine the association of CS and risk factors among populations with different characteristics and to control for possible confounding, respectively. RESULTS: The overall rate of cesarean delivery was 37.3%. In multi-variant model, maternal age > 30 years (OR, 95% CI = 1.71, 1.21-2.41), higher pre-gestational BMI (OR, 95% CI = 1.16, 1.10-1.23), living in regions with confirmed COVID-19 cases > 500 (OR, 95% CI = 2.45, 1.74-3.45), and excess gestational weight gain (OR, 95% CI = 1.73, 1.17-2.55) were associated with cesarean delivery. These trends of associations were not changes in sensitivity analysis and subgroup analysis. Cesarean delivery occurred more in women who got more nutrition instruction during the pandemic period in the univariant model; however, this association showed insignificance in the multiple-variant analysis. CONCLUSION: A high cesarean delivery rate was found in uninfected women who experienced lockdown in their third trimester. During the COVID-19 pandemic, more medical support should be provided in severely affected regions to ensure and promote health in pregnancy.

Emotional Eating in Pregnant Women during the COVID-19 Pandemic and Its Association with Dietary Intake and Gestational Weight Gain.

Reproductive health is a significant public health issue during pandemics; however, the impacts of the novel 2019 coronavirus disease (COVID-19) on noninfected pregnant women are still unknown. This study intends (1) to examine whether emotional eating (EE) occurred during the pandemic triggered by disease concerns and (2) to explore the associations among EE, dietary changes, and gestational weight gain (GWG). Based on an online survey, 640 new mothers who experienced the lockdown in their third trimester were recruited from seven provinces in China. EE was evaluated with the Chinese version of the Dutch Eating Behavior Questionnaire, EE domain. A self-designed e-questionnaire was used to collect the data of participants on the sociodemographic characteristics, concerns about the COVID-19 pandemic, maternity information, physical activities, and dietary changes during lockdown. The results show that the average EE score was 26.5 ± 8.3, and women living in a severely affected area, who are very worried about the pandemic and who had less physical activity had a higher tendency of EE. Although there is a dietary pattern changed during pandemic, the average GWG in the studied group was in the normal range. However, a higher EE score was associated with a significant excess of GWG in women not from Wuhan (EE score 33-65 vs. 13-22: adjusted Odd Ratio (OR), 95% Confidence Interval (CI) = 1.90, 1.08-3.32). The sensitivity analysis that additionally adjusted for the pregestational body mass index and gestational metabolic disease was consistent with this result. The mediation model was also examined and showed that, after adjusting for living area and exercise, EE was associated with significantly increased consumption of cereals (EE score 33-65 vs. 13-22: adjusted OR, 95% CI = 2.22, 1.29-3.82) and oil (EE score 33-65 vs. 13-22: adjusted OR, 95% CI = 3.03, 1.06-8.69) but decreased consumption of fish and seafood (EE score 33-65 vs. 13-22: adjusted OR, 95% CI = 1.88, 1.14-3.11; 23-32 vs. 13-22: adjusted OR, 95% CI = 1.79, 1.20-2.66). In conclusion, this study indicated that EE occurred in a proportional number of pregnant women during the COVID-19 pandemic and is associated with excess GWG mediated by increased intake of certain foods. The findings suggest the need for psychosocial and nutritional education and interventions during pregnancy checkups. Further studies are needed to determine modifiable psychosocial predictors and potential nutritional concerns in pregnant women during disease outbreaks.