Contribution of greenness, air pollution, and residential food environment to excess gestational weight gain: A cross-sectional study in Wuhan, China.

OBJECTIVES: Our goal was to explore how greenness, air pollution, and residential food environment were linked to excessive gestational weight gain (EGWG), and to estimate their combined effects on this condition. METHOD: This cross-sectional analysis included 51,507 pregnant women from the Wuhan Maternal and Child Health Management Information System between 2016 and 2019. Generalized linear mixed regression models were employed to explore the relationships between greenness, air pollution, residential food environmental exposure, and EGWG; and the combined effects were further estimated by cluster analysis and principal components analysis. RESULT: We only found a significant association between convenience store density within the 250 m buffer zone (OR = 1.03 and 95% CI: 1.01,1.05) and EGWG. In terms of air pollution, sulfur dioxide(SO2), particulate matter with a diameter of 10 µm or less(PM10), and particulate matter with a diameter of 2.5 µm or less(PM2.5) were substantially correlated with a higher prevalence of EGWG and higher GWG, with (OR = 1.16 and 95% CI: 1.12,1.21; OR = 1.12 and 95% CI: 1.08,1.16; OR = 1.17 and 95% CI: 1.14,1.21, respectively) per interquartile range(IQR) increase. Cluster analysis revealed the presence of three clusters representing urban exposures. In contrast to urban environment clusters characterized by favourable conditions, those exhibiting elevated air pollution levels, high-density residential food environment and low levels of greenness were found to have increased odds of EGWG (OR = 1.10, 95% CI: 1.03, 1.19). CONCLUSION: This study emphasizes that exposure to elevated air pollution, high-density residential neighbourhood food environments, and low levels of greenness is a neighbourhood obesogenic environment for pregnant women.

The Effect of Prenatal Docosahexaenoic Acid Supplementation on Offspring Fat Mass and Distribution at 24 Months Old.

Background: Excessive gestational weight gain (GWG) is related to increased offspring fat accrual, and increased fat mass (FM) is related to obesity development. Prenatal DHA supplementation has been linked to lower levels of offspring FM; however, conflicting data exist. Objectives: This study aimed to determine if there is a protective effect of prenatal DHA supplementation on offspring fat accrual and adipose tissue deposition at 24 mo in offspring born to females who gain excessive weight compared with nonexcessive weight during pregnancy. We also explored if the effect of DHA dose on FM differed by offspring sex. Methods: Infants born to females who participated in the Assessment of DHA on Reducing Early Preterm Birth randomized controlled trial (ADORE) were recruited. In ADORE, females were randomly assigned to either a high or low prenatal DHA supplement. Offspring body composition and adipose tissue distribution were measured using dual-energy x-ray absorptiometry (DXA). GWG was categorized as excessive or not excessive based on clinical guidelines. Results: For total FM, there was a significant main effect for the DHA dose (P = 0.03); however, the dose by GWG status was nonsignificant (P = 0.44). Therefore, a higher prenatal DHA dose was related to greater offspring FM (622.9 g greater) and unrelated to GWG status. When investigating a DHA dose by sex effect, a significant main effect for DHA dose (P = 0.01) was detected for central FM. However, no interaction was detected (P = 0.98), meaning that both boys and girls had greater central FM if their mother was assigned to the higher DHA dose. Conclusions: Greater prenatal DHA supplementation was associated with greater offspring FM and adipose tissue distribution at 24 mo. It will be important to understand if these effects persist into childhood.This trial was registered at clinicaltrials.gov as NCT03310983.

Pre-Gestational Obesity and Gestational Weight Gain as Predictors of Childhood Obesity.

OBJECTIVE: To evaluate the associations of pre-gestational body mass index (BMI) and gestational weight gain (GWG) with the risks of overweight, obesity, and adiposity in the first seven years of life in the offspring of a cohort of pregnant women. METHODS: Analysis of 751 mothers and their children participating in the PROGRESS cohort. These women were recruited in Mexico City between 2007 and 2010. Pre-gestational BMI was classified as normal, overweight, and obesity according to the WHO. GWG was calculated as the difference between the last reported pre-pregnancy weight and the pre-gestational weight and categorized as inadequate, adequate, or excessive, according to US IOM recommendations. Children's anthropometry was evaluated at 4-5 and 6-7 years of age. Adiposity was classified into three groups: normal (BMI z-score and waist circumference), overweight (BMI z-score>1), and overweight plus abdominal obesity (OW+AO). A generalized structural equation model (GSEM) was constructed to account for the temporal relationship between variables and to assess direct and indirect effects. RESULTS: A total of 49.3% of the women had excessive (13.8 ± 4.2 kg) and 19.8% inadequate (3.15 ± 3.4 kg) GWG. Women with pre-gestational overweight or obesity were more likely to have excessive GWG (OR 1.9 [95% CI: 1.32, 2.74] and 3.50 [95% CI: 1.83, 6.69], respectively). In the GSEM, excessive GWG was directly associated with OW+AO at 4-5 years. At 6-7 years, pre-gestational obesity was associated with OW+AO. CONCLUSION: Pre-gestational obesity and excessive GWG were independent predictors of childhood obesity.

Recent Insights and Recommendations for Preventing Excessive Gestational Weight Gain.

Recommendations for weight gain during pregnancy are based on pre-pregnancy body mass index (BMI). Pregnancy is a risk factor for excessive weight gain and many endocrine problems, making it difficult to return to pre-pregnancy weight and increasing the risk of postpartum obesity and, consequently, type 2 diabetes and metabolic syndrome. Both excessive gestational weight gain (EGWG) and obesity are associated with an increased risk of gestational hypertension, pre-eclampsia, gestational diabetes, cesarean section, shoulder dystocia, and neonatal macrosomia. In the long term, EGWG is associated with increased morbidity and mortality, particularly from diabetes, cardiovascular disorders, and some cancers. This study aims to present recommendations from various societies regarding weight gain during pregnancy, dietary guidance, and physical activity. In addition, we discuss the pathophysiology of this complication and the differential diagnosis in pregnant women with EGWG. According to our research, inadequate nutrition might contribute more significantly to the development of EGWG than insufficient physical activity levels in pregnant women. Telehealth systems seem to be a promising direction for future EGWG prevention by motivating women to exercise. Although the importance of adequate pre-pregnancy weight and weight gain during pregnancy is well known, an increasing number of women gain excessive weight during pregnancy.

Substance P Concentration in Gestational Diabetes and Excessive Gestational Weight Gain and Its Impact on Neonatal Anthropometry.

Fetal programming is a process initiated by intrauterine conditions, leaving a lasting impact on the offspring's health, whether they manifest immediately or later in life. It is believed that children born to mothers with gestational diabetes mellitus (GDM) and excessive gestational weight gain (EGWG) may be at an increased risk of developing type 2 diabetes mellitus (T2DM) and obesity later in their adult lives. Substance P is a neurotransmitter associated with obesity development and impairment of insulin signaling. Dysregulation of substance P could lead to several pregnancy pathologies, such as preeclampsia and preterm birth. Our study aimed to compare substance P concentrations in serum and umbilical cord blood in patients with GDM, EGWG, and healthy women with a family history of gestational weight gain. Substance P levels in umbilical cord blood were significantly higher in the GDM group compared to the EGWG and control groups. Substance P levels in serum and umbilical cord blood were positively correlated in all groups and the GDM group. A very interesting direction for future research is the relationship between the concentration of substance P in newborns of diabetic mothers and the occurrence of respiratory distress syndrome as a complication of impaired surfactant synthesis. To our knowledge, it is the first study assessing substance P concentration in GDM and EGWG patients.

Interactive effects and relative contribution of prepregnancy overweight and obesity, excessive gestational weight gain and gestational diabetes mellitus to macrosomia: A retrospective cohort in Fujian, China.

AIM: To conduct a retrospective cohort study to investigate the association between prepregnancy overweight and obesity, excessive gestational weight gain (GWG), gestational diabetes mellitus (GDM) and macrosomia, both individually and in combination. METHODS: Binary logistic regression was used to analyse the effects of overweight and obesity, excessive GWG and GDM on macrosomia, both separately and in combination. The interaction effects between prepregnancy overweight and obesity, excessive GWG and GDM were tested. The population attributable fraction (PAF) was calculated separately when interaction terms were significant. RESULTS: When analysed separately, prepregnancy overweight and obesity, excessive GWG and GDM increased the risk of macrosomia significantly. The pairwise interactions of each pair of risk factors or all three risk factors on macrosomia appear to be greater than any of them individually. Prepregnancy overweight and obesity contributed the least (5.69%) to macrosomia, while GDM contributed the most (8.5%). The PAF values for prepregnancy overweight and obesity/GDM, excessive GWG/GDM, and prepregnancy overweight and obesity/excessive GWG were 13.6%, 16.25% and 14.45%, respectively, and the total PAF for all three risk factors was 22.63%. CONCLUSIONS: Prepregnancy overweight and obesity, excessive GWG and GDM were associated with newborn macrosomia.

The Impact of Higher Than Recommended Gestational Weight Gain on Fetal Growth and Perinatal Risk Factors-The IOM Criteria Reconsidered.

A too-high gestational weight gain, in combination with steadily increasing obesity rates among women of reproductive age, represents an enormous obstetrical problem, as obesity and high gestational weight gain are associated with enhanced fetal growth, low vital parameters, and increased cesarean section rates. This medical record-based study investigates the association patterns between too-low as well as too-high gestational weight gain, according to the 2009 Institute of Medicine (IOM) guidelines, and fetal growth, as well as birth mode and pregnancy outcome. The data of 11,755 singleton births that had taken place between 2010 and 2020 at the Public Clinic Donaustadt in Vienna, Austria, were analyzed. Birth weight, birth length, head circumference, APGAR scores, and pH values of the arterial umbilical cord blood described fetal growth as well as the vital parameters after birth. Gestational weight gain was classified as too low, recommended, or too high according to the different weight status categories of the IOM guidelines. Birth weight, birth length, and head circumference of the newborn were significantly increased (p < 0.001) among underweight, normal-weight, and overweight women who gained more weight than recommended. Among obese women, only birthweight was significantly (p < 0.001) higher among women who gained more weight than recommended. Furthermore, a too-high gestational weight gain was significantly associated with an increased risk of macrosomia and emergency cesarean sections among underweight, normal-weight, and overweight women, but not among obese ones. Obese and morbidly obese women experiencing excessive gestational weight gain showed no significantly increased risk of macrosomia or emergency cesarean section. However, among obese mothers, a too-low gestational weight gain reduced the risk of emergency cesarean sections significantly (p = 0.010). Consequently, the IOM recommendations for gestational weight gain fit only partly for pregnant women in Austria. In the case of obese and morbidly obese women, new guidelines for optimal pregnancy weight gain should be considered.

Association of DPP-4 Concentrations with the Occurrence of Gestational Diabetes Mellitus and Excessive Gestational Weight Gain.

Gestational diabetes mellitus (GDM) is considered one of the most common diseases that occur during pregnancy. In addition to increasing the risk of numerous complications throughout gestation, it is also believed to have a long-term potential to impact the risk of developing type 2 diabetes mellitus (T2DM) and cardiovascular disease for the mother and her offspring. While there are clear guidelines for healthy weight gain in pregnancy depending on pre-pregnancy BMI, as well as dietary and training recommendations to achieve this, an increasing number of women are experiencing excessive gestational weight gain (EGWG). Such patients have a higher risk of developing GDM and gestational hypertension, as well as requiring caesarian delivery. Dipeptidyl peptidase-4 (DPP-4) is a glycoprotein that seems to play an important role in glucose metabolism, and inhibition of its activity positively affects glucose regulation. The aim of our study was to compare DPP-4 concentrations in patients with GDM and EGWG with healthy women. DPP-4 levels were assessed in serum and urine samples collected on the day of delivery. The bioelectrical impedance analysis (BIA) method was also used to analyze the body composition of patients on the second day of the postpartum period. DPP-4 serum concentrations were significantly higher in patients in the GDM and EGWG groups compared to healthy women. Urinary DPP-4 concentrations were significantly higher in the control and GDM groups than in the EGWG group. Serum DPP-4 levels were positively correlated with BMI measured before pregnancy, on the delivery day, and in the early postpartum period, among other factors. According to our knowledge, this is the first study to determine DPP-4 levels in EGWG patients. DPP-4 may be related to the occurrence of GDM and EGWG; however, this requires further research.

Development and validation of a screening questionnaire for early identification of pregnant women at risk for excessive gestational weight gain.

BACKGROUND: Excessive weight gain during pregnancy is associated with adverse health outcomes for mother and child. Intervention strategies to prevent excessive gestational weight gain (GWG) should consider women's individual risk profile, however, no tool exists for identifying women at risk at an early stage. The aim of the present study was to develop and validate a screening questionnaire based on early risk factors for excessive GWG. METHODS: The cohort from the German "Gesund leben in der Schwangerschaft"/ "healthy living in pregnancy" (GeliS) trial was used to derive a risk score predicting excessive GWG. Sociodemographics, anthropometrics, smoking behaviour and mental health status were collected before week 12th of gestation. GWG was calculated using the last and the first weight measured during routine antenatal care. The data were randomly split into development and validation datasets with an 80:20 ratio. Using the development dataset, a multivariate logistic regression model with stepwise backward elimination was performed to identify salient risk factors associated with excessive GWG. The ß coefficients of the variables were translated into a score. The risk score was validated by an internal cross-validation and externally with data from the FeLIPO study (GeliS pilot study). The area under the receiver operating characteristic curve (AUC ROC) was used to estimate the predictive power of the score. RESULTS: 1790 women were included in the analysis, of whom 45.6% showed excessive GWG. High pre-pregnancy body mass index, intermediate educational level, being born in a foreign country, primiparity, smoking, and signs of depressive disorder were associated with the risk of excessive GWG and included in the screening questionnaire. The developed score varied from 0-15 and divided the women´s risk for excessive GWG into low (0-5), moderate (6-10) and high (11-15). The cross-validation and the external validation yielded a moderate predictive power with an AUC of 0.709 and 0.738, respectively. CONCLUSIONS: Our screening questionnaire is a simple and valid tool to identify pregnant women at risk for excessive GWG at an early stage. It could be used in routine care to provide targeted primary prevention measures to women at particular risk to gain excessive gestational weight. TRIAL REGISTRATION: NCT01958307, ClinicalTrials.gov, retrospectively registered 9 October 2013.

Leptin/SFRP5 ratio as a potential predictor of postpartum weight retention. A prospective pilot study.

Excessive gestational weight gain (EGWG) and failure to lose weight within 6 months from delivery are important and identifiable predictors of the long-term obesity. The aim of the study was to verify clinical usefulness of several substances that had been proved to play a significant role in metabolism and body mass regulation, i.e., leptin, ghrelin, fatty acid binding protein 4 (FABP4), secreted frizzled-related protein 5 (SFRP5), and vaspin, in relation to certain laboratory results, body composition and hydration status of females in the early postpartum period. The main goal was to determine a potential marker, which assessed as early as 48 hours after delivery, could predict serious difficulties in achieving pre pregnancy body mass of women with EGWG six months afterwards. The same inclusion criteria applied to the study group (women with EGWG) as well as the control group (women with appropriate body mass gain in pregnancy). These included normal pre-pregnancy BMI, absence of any diseases prior, during pregnancy and after delivery, 6-month long breastfeeding. Postpartum weight retention (PPWR) depended positively on gestational weight gain as well as the leptin/SFRP5 ratio assessed 48 hours after delivery. Both obstetricians and midwives should pay special attention to proper nutrition of pregnant women. The assessment of biophysical and biochemical parameters in the early postpartum period, when the mothers are usually hospitalized, seems to allow to predict the risk of greater body weight retention. Future research will help to determine to what extent the circulating concentrations of leptin and SFRP5 in the early puerperium are important for prediction of maternal PPWR and obesity.

Residential greenness and air pollution concerning excessive gestational weight gain during pregnancy: A cross-sectional study in Wuhan, China.

BACKGROUND: Previous studies have indicated that exposure to residential greenness may benefit the health status of pregnant women, and air pollution may exert a mediating effect. Gestational weight gain (GWG) is an important indicator of pregnant women and fetuses' health and nutrition status. However, evidence concerning the impact of residential greenness on excessive gestational weight gain (EGWG) is scarce, and to what extent air pollution in urban settings mediates this relationship remains unclear. OBJECTIVE: This study aims to explore the association of residential greenness with EGWG, consider the mediating effect of air pollution, and estimate the combined impact of residential greenness and air pollution exposures on EGWG. METHOD: This population-based cross-sectional study involved 51,507 pregnant women with individual-level data on residential addresses in the Wuhan Maternal and Child Health Management Information System. Two spectral indexes, the normalized difference vegetation index (NDVI) and soil-adjusted vegetation index (SAVI), were used to proxy residential greenness. The air pollution data included six indicators (PM2.5, PM10, SO2, CO, NO2, O3) and used the Ordinary Kriging interpolation method to estimate overall pregnancy exposure to air pollutants. Generalized linear mixed regression models were utilized to explore the relationship between residential greenness and EGWG. Restricted cubic spline (RCS) models were developed to examine the dose-response relationships. Mediation analyses explored the potential mediating role of air pollution in the residential greenness-EGWG associations. Finally, the weighted-quantile-sum (WQS) regression model was used to investigate the association between residential greenness-air pollutants co-exposure and EGWG. RESULT: Among all participants, 26,442 had EGWG. In the adjusted model, the negative association was found significant for NDVI100-m, NDVI200-m, and NDVI500-m with EGWG. For example, each IQR increase in NDVI100-m was associated with 2.8% (95% CI: 0.6-5.0) lower odds for EGWG. The result of WQS regression showed that, when considering the six air pollutants and NDVI-100m together, both positive and negative WQS indices were significantly associated with EGWG, PM10, PM2.5, with SO2 having significant weights in the positive effect direction and CO, O3, NO2, and NDVI100-m having a negative effect. Our results also suggested that SO2, NO2, PM10, PM2.5, and CO significantly mediated the association between NDVI-100m and EGWG, and our estimates were generally robust in the sensitivity analysis. CONCLUSION: Exposure to a higher level of residential greenness is associated with a reduced risk of EGWG, in which air pollution may exert a mediating effect. Pregnant women might benefit more in gaining healthy gestational weight when greenness levels increase from low to medium than from medium to high. Given the current cross-sectional study design, large-sale prospective cohort studies are needed to confirm our findings further.

Effects of excessive weight gain during pregnancy on offspring health: a review / 预防医学

@#Excessive gestational weight gain has already become a global clinical and public health problem that seriously affects maternal health. Excessive gestational weight gain not only increases the cesarean section rate and induces adverse pregnant outcomes, but also affects offspring development and health. This article reviews the effects of excessive weight gain during pregnancy on offspring health and its underlying mechanisms. Excessive gestational weight gain may increase the risk of obesity, cardiovascular diseases, infectious diseases of the respiratory tract, diabetes, polycystic ovary syndrome, mental or psychological illness among offspring, and the pathophysiological mechanisms include inflammatory response, intestinal flora dysbiosis and epigenetics theory. However, further studies are required to validate these hypotheses and to evaluate the effect of excessive weight gain at different gestational stages on offspring health, so as to provide insights into reasonable management of weight gain during pregnancy and improvements of offspring health.

Effect of the e-health supported INTER-ACT lifestyle intervention on postpartum weight retention and body composition, and associations with lifestyle behavior: A randomized controlled trial.

We investigated whether a postpartum lifestyle intervention reduced postpartum weight retention (PPWR) and improved body composition, and whether improved lifestyle was associated with less PPWR and improved body composition. A total of 1075 women with excessive gestational weight gain were randomized into the intervention (N = 551) or control (N = 524) group. A completion rate of 76% was reached. Anthropometrics and lifestyle data were collected at 6 weeks and 6 months postpartum. The e-health supported intervention consisted of 4 face-to-face coaching's, focusing on nutrition, exercise and mental wellbeing and using motivational interviewing and behavior change techniques. In the intervention group we observed; larger decrease in weight in women who reduced their energy intake (mean ± SD: 3.1 ± 4.2 kg vs. 2.2 ± 3.8 kg, P = 0.05) and decreased uncontrolled eating (3.5 ± 4.2 kg vs. 1.9 ± 3.7 kg, P ≤0.001) by the end of the intervention; larger decrease in fat percentage in women who reduced energy intake (2.3% ± 2.9 vs. 1.4% ± 2.7, P = 0.01), enhanced restrained eating (2.2% ± 3 vs. 1.4% ± 2.6, P = 0.02) and decreased uncontrolled eating (2.3% ± 2.9 vs. 1.5% ± 2.7, P = 0.01) and larger decrease in waist circumference in women who reduced energy intake (4.6 cm ± 4.8 vs. 3.3 cm ± 4.7, P = 0.01), enhanced restrained eating (4.5 cm ± 4.8 vs. 3.4 cm ± 4.8, P = 0.05) and decreased uncontrolled eating (4.7 cm ± 4.8 vs. 3.3 cm ± 4.8, P = 0.006), compared to those who did not. Improved energy intake, restrained eating and uncontrolled eating behavior were associated with more favorable outcomes in weight and body composition. ClinicalTrials.gov identifier:NCT02989142.

Interactive Affection of Pre-Pregnancy Overweight or Obesity, Excessive Gestational Weight Gain and Glucose Tolerance Test Characteristics on Adverse Pregnancy Outcomes Among Women With Gestational Diabetes Mellitus.

Purpose: To examine the combined effect of pre-pregnancy overweight or obesity, excessive gestational weight gain, and glucose tolerance status on the incidence of adverse pregnancy outcomes among women with gestational diabetes mellitus. Methods: A observational study including 5529 gestational diabetes mellitus patients was performed. Logistic regression were used to assess the independent and multiplicative interactions of overweight or obese, excessive gestational weight gain, abnormal items of oral glucose tolerance test and adverse pregnancy outcomes. Additive interactions were calculated using an Excel sheet developed by Anderson to calculate relative excess risk. Results: Overall 1076(19.46%) study subject were overweight or obese and 1858(33.60%) women gained weight above recommended. Based on IADPSG criteria, more than one-third women with two, or three abnormal glucose values. Preconception overweight or obesity, above recommended gestational weight gain, and two or more abnormal items of oral glucose tolerance test parameters significantly increased the risk of adverse pregnancy outcomes, separately. After accounting for confounders, each two of overweight or obesity, excessive gestational weight gain, two or more abnormal items of OGTT parameters, the pairwise interactions on adverse pregnancy outcomes appear to be multiplicative. Coexistence of preconception overweight or obesity, above recommended gestational weight gain and two or more abnormal items of oral glucose tolerance test parameters increased the highest risk for adverse pregnancy outcomes. No additive interaction was found. Conclusions: Pre-pregnancy overweight or obesity, excessive gestational weight gain, two or more abnormal items of OGTT parameters contribute to adverse pregnancy outcomes independently among women with gestational diabetes mellitus. Additionally, the combined effect between these three factors and adverse pregnancy outcomes appear to be multiplicative. Interventions focus on maternal overweight or obesity and gestational weight gain should be offered to improve pregnancy outcomes.

Determinants of excessive gestational weight gain: a systematic review and meta-analysis.

BACKGROUND: The prevalence of excessive gestational weight gain (EGWG) during pregnancy is increasing, and it is extremely harmful to pregnant women and newborns. Previous studies have suggested that EGWG is associated with various factors. We conducted a systematic review and meta-analysis to identify, quantify and analyze determinants of EGWG and evaluate the effect of these determinants on EGWG. METHODS: We searched for articles, from January 2009 to November 2020, related to the determinants of EGWG during pregnancy using four Chinese and four English databases. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement was utilized to guide the systematic review and meta-analysis process. RESULTS: Seventy studies, which identified EGWG factors in pregnant women (58 factors, 3 themes: individual [7 aspects, 37 factors]; family [4 aspects, 8 factors]; and social [4 aspects, 13 factors]), were included and analyzed in the systematic review. A meta-analysis was conducted for 13 factors (including 10 individual factors, 2 family factors, and 1 social factor) and revealed that pre-pregnancy overweight (including obesity), younger age (≤ 30 years old), unemployed, primiparity, smoking, and being unmarried (including divorced) were risk factors for EGWG, while prepregnancy underweight and inadequate antenatal care were protective factors for EGWG. There was no significant correlation between EGWG and education level, alcohol consumption, planning pregnancy, food security, and whether access to nutrition guidance during pregnancy. CONCLUSIONS: EGWG was prevalent in pregnant women, and its prevalence seemed to be high and similar in many countries. Based on observational studies with medium-level and high-level evidence, some individual, family, and social factors were found to be associated with EGWG using qualitative and quantitative methods. In the future, exposure of pregnant women to risk factors for EGWG should be avoided, and interventions should be developed around the identified factors.

Effect of individualized weight management intervention on excessive gestational weight gain and perinatal outcomes: a randomized controlled trial.

It is unclear whether weight management is still effective for pregnant women with excessive weight gain in the second or third trimester in China. This study adopted individualized weight management intervention for pregnant women with abnormal weight gain in the second or third trimester, to analyze the effect of intervention by observing the gestational weight gain and perinatal outcomes. This randomized controlled trial was performed at Aerospace Center Hospital. The obstetrician determined whether the pregnant women gained too much weight in the second or third trimester according to the Institute of Medicine guidelines, and randomly divided the pregnant women who gained too much weight in the second or third trimester into the intervention group or the control group according to the inclusion and exclusion criteria. The pregnant women in the intervention group and in the control group all received routine prenatal examination and diet nutrition education by the doctors in the Department of Obstetrics and Gynecology. The intervention group underwent individualized weight management, including individualized diet, exercise, psychological assessment, cognitive intervention and continuous communication, the whole process is tracked and managed by professional nutritionists. The obstetrician collected the prenatal examination data and pregnancy outcome data of all enrolled pregnant women. The primary outcome measure was weight gain during pregnancy. A generalized linear model and a logistic regression model were used to compare the outcomes between the two groups. In total, 348 pregnant women participated in this study with 203 in the intervention group and 145 in the control group. The whole gestational weight gain in the intervention group (15.8 ± 5.4 Kg) was lower than that in the control group (17.5 ± 3.6 Kg; adjusted ß =  - 1.644; 95% CI [-2.660--0.627]; P = 0.002). The percent of pregnant women with excessive weight gainbefore delivery was 54.2% (110/203) in the intervention group, which was lower than 69.7% (101/145) in the control group (adjusted RR = 0.468; 95% CI [0.284-0.769] P = 0.003). The pregnant women given the individualized weight management intervention from the second to the third trimester experienced less weight gain than that from the third trimester (15.5 ± 5.6 Kg vs. 16.2 ± 5.2 Kg), but without significant difference (P = 0.338). Lower rates of GDM, preeclampsia and gestational hypertension, higher rates of fetal distress and puerperal infection were observed in the intervention group than in the control group (all P < 0.05). Individualized weight management during the second or third trimesters is still beneficial for pregnant women who gain excessive weight and can decrease the associated adverse outcomes.

Behaviour model integrated by protection motivation theory and information-motivation-behavioural skills model applying in pregnancy weight management (PrInMAMa): a study protocol for a randomised controlled trial in China.

INTRODUCTION: Excessive gestational weight gain poses a significant threat to maternal and child health. The healthy behaviour theory has been increasingly applied to weight management during pregnancy, but research is still insufficient. The successful application of the protection motivation theory (PMT) and the information-motivation-behavioural skills (IMB) model in the field of healthy behaviour laid the foundation for this intervention study. The overall aim of this study is to test the effectiveness of interventions based on the behaviour model integrated with the PMT and IMB model (PMT-IMB model) on weight management and provide feasible methods for weight management during pregnancy. METHODS AND ANALYSIS: This prospective, single-centre, randomised controlled trial involves two steps. First, based on the PMT-IMB model, evaluation tools and intervention materials will be developed. Second, more than 800 women in the first trimester of pregnancy will be randomly assigned to two groups and will be followed until 1 week after delivery. The control group will receive standardised antenatal care (ANC), whereas the experimental group will receive both standardised ANC and interventions based on the PMT-IMB model. After three surveys (at enrolment, at 28 weeks of gestation, and on the day of hospitalisation for delivery), primary outcomes (scores of the subscales of the PMT-IMB model, scores of the pregnancy weight management strategy scale, and gestational weight gain) and secondary outcomes (pregnancy outcomes and pregnancy complications) will be obtained. Differences in outcomes between the two groups will be analysed to evaluate the effectiveness of the intervention. ETHICS AND DISSEMINATION: The study protocol has been approved by the ethics committee of Nanjing Medical University. All participants will sign an informed consent form prior to enrolment. The findings of the study will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER: ChiCTR2100043231.

The impact of excessive gestational weight gain on fetal hepatic lipid metabolism and the regulatory mechanism / 中华实用儿科临床杂志

Objective:A rat model of excessive gestational weight gain (EGWG) was constructed to investigate the impact of EGWG on fetal hepatic lipid metabolism and the relevant regulatory mechanism.Methods:Healthy Sprague-Dawley rats were caged together and tested for pregnancy.Rats with the sperm observed under microscope were considered pregnant for 0.5 days.Pregnant rats were divided into the normal diet (ND) group and high-fat diet (HFD) group by the random number table method, with 8 rats in each group.The body weight during pregnancy of the pregnant rats was recorded.Cesarean section was performed at day 21.5 of gestation and the birth weight of the fetal rats was recorded.Hepatic lipid deposition of the pregnant and fetal rats was examined by hematoxylin-eosin (HE) staining and oil red O staining.Triglyceride (TG) and cholesterol (TC) levels in livers and serum of the pregnant and fetal rats were detected by glycerol phosphate oxidase-peroxidase(GPO-PAP) method.The mRNA and protein expression levels of key genes FASN and SREBP1c in hepatic lipid metabolism of fetal rats were measured by real-time polyme-rase chain reaction (RT-PCR) and Western blot.Differences between the two groups were compared by independent sample t test. Results:There was no difference in pre-pregnancy body weight between the HFD group and the ND group, but the differences in the weight and the weight gain during pregnancy gradually enlarged between the two groups.At day 21.5 of gestation, the weight of the pregnant rats[(467.75±22.05) g vs.(430.88±18.80) g, t=-3.600, P=0.003], the weight gain of the pregnant rats during pregnancy[(181.50±9.68) g vs.(148.50±10.86) g, t=-6.415, P<0.001] and the birth weight of the fetal rats[(5.51±0.17) g vs.(4.85±0.35) g, t=-4.779, P<0.001] of the HFD group were significantly higher than those of the ND group.Both HE staining and oil red O staining presented increased hepatic lipid deposition in the pregnant and fetal rats of the HFD group.The hepatic and serum TG and TC levels of the pregnant and fetal rats of the HFD group were significantly higher than those of the ND group (all P<0.05). RT-PCR and Western blot showed that the mRNA and protein levels of key genes FASN and SREBP1c in hepatic lipid metabolism of fetal rats of the HFD group were significantly higher than those of the ND group (all P<0.05). Conclusions:An EGWG model can be successfully constructed by a 21-day HFD during pregnancy.EGWG can lead to hepatic lipid deposition in the fetal rats.The mechanism may be related to the expression changes of key genes FASN and SREBP1c in hepatic lipid metabolism of fetal rats.

Fetal and Placental Weight in Pre-Gestational Maternal Obesity (PGMO) vs. Excessive Gestational Weight Gain (EGWG)-A Preliminary Approach to the Perinatal Outcomes in Diet-Controlled Gestational Diabetes Mellitus.

Both pre-gestational maternal obesity (PGMO) and excessive gestational weight gain (EGWG) increase the risk of gestational diabetes mellitus (GDM). Here, we conducted a retrospective study to comparatively examine the relation between fetal birth weight (FW) and placental weight (PW) in PGMO (n = 100) compared to EGWG (n = 100) with respect to perinatal outcomes in diet-controlled GDM. The control group was made up of 100 healthy pregnancies. The mean FW and the mean PW in EGWG were correlated with lowered fetal weight/placental weight ratio (FW/PW ratio). The percentage of births completed by cesarean section accounted for 47%, 32%, and 18% of all deliveries (EGWG, PGMO, and controls, respectively), with the predominance of FW-related indications for cesarean section. Extended postpartum hospital stays due to neonate were more frequent in EGWG, especially due to neonatal jaundice (p < 0.05). The results indicate the higher perinatal risk in mothers with EGWG compared to PGMO during GDM-complicated pregnancy. Further in-depth comparative studies involving larger patient pools are needed to validate these findings, the intent of which is to formulate guidelines for GDM patients in respect to management of PGMO and EGWG.

Gestational Weight Gain: Achieving a Healthier Weight Between Pregnancies.

Rates of obesity continue to be a cause of morbidity and mortality, requiring intervention. Excessive gestational weight gain is related to postpartum weight retention and subsequent development of obesity, which translates into higher risk of adverse maternal and neonatal outcomes in future pregnancies and long-term excess cardiovascular disease and cancer for the mothers. Limiting gestational weight gain to within recommended limits prevents postpartum weight retention. This article provides an overview of methods and practices aimed at helping women achieve a healthy weight between pregnancies by improving gestational weight gain. These interventions include lifestyle behavioral changes, diet and exercise, and motivational interviewing.