Human milk oligosaccharide (HMO) composition varies throughout lactation and can be influenced by maternal characteristics. This study describes HMO variation up to three months postpartum and explores the influences of maternal sociodemographic and anthropometric characteristics in a Brazilian prospective cohort. We followed 101 subjects from 28–35 gestational weeks (baseline) and throughout lactation at 2–8 (visit 1), 28–50 (visit 2) and 88–119 days postpartum (visit 3). Milk samples were collected at visits 1, 2 and 3, and 19 HMOs were quantified usinghigh-performance liquid chromatography with fluorescence detection (HPLC-FL). Friedman post-hoc test, Spearman rank correlation for maternal characteristics and HMOs and non-negative matrix factorization (NMF) were used to define the HMO profile. Most women were secretors (89.1%) and presented high proportion of 2′-fucosyllactose (2′FL) at all three sample times, while lacto-N-tetraose (LNT, 2–8 days) and lacto-N-fucopentaose II (LNFPII, 28–50 and 88–119 days) were the most abundant HMOs in non-secretor women. Over the course of lactation, total HMO weight concentrations (g/L) decreased, but total HMO molar concentrations (mmol/L) increased, highlighting differential changes in HMO composition over time. In addition, maternal pre-pregnancy body mass index (BMI) and parity influence the HMO composition in healthy women in this Brazilian cohort.

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Objectives To evaluate the association between gestational weight gain (GWG) classified according to three international charts and adverse child outcomes in the Brazilian population. Methods Data from 12 cohorts conducted in Brazil (1990-2018) were combined in a pooled dataset of 15,066 women. Weight and gestational age were measured. Adult (18-48 years) women with singleton pregnancies and free of hypertension and diabetes were included. Selected centiles of three international charts were used [Life-cycle project – L charts, Intergrowth-21st - I chart and Hutcheon – H charts]. Total GWG was calculated as: difference between the weight measured up to 14 days before delivery and the weight measured in the 1st trimester (I chart) or the pre-pregnancy self-reported weight (L and H charts). The outcomes were small and large for gestational age infants (SGA/LGA, < 10th/ > 90th - Intergrowth centile), low birth weight (LBW, < 2500g) and macrosomia (> 4000g). Multinomial logistic regressions were fitted for selected centiles (lowest: 3rd, 5th, 10th, 25th; highest: 75th, 90th, 95th, 97th) to evaluate the charts’ performance in the prediction of the outcomes. Results A total of 7,456 women were included in the analysis. Total GWG was 12.1 kg (SD = 5.9) and GWG from the 1st trimester to delivery 10.9 kg (SD = 4.8). The prevalence of SGA was 6.6%, LGA, 14.9%, LBW, 6.5% and macrosomia, 4.7%. For all charts, women who gained weight in the lowest centiles presented higher prevalences of SGA and LBW in comparison to those on the highest centiles, while women with gains in the highest centiles, presented higher prevalences of LGA and macrosomia. L charts presented a better performance to predict outcomes, i.e., women with gains in the highest centiles were associated with increased odds of LGA and macrosomia and those in the lowest centiles with increased odds for SGA and LBW. Analysis based on H charts provided similar results. The poorest performance was observed for I charts, in which only women with gains on the higher centiles were associated with the occurrence of LGA (Figure). Conclusions L charts seem to better predict the occurrence of child outcomes. Further investigation is needed to decide the most appropriate chart and cutoffs for GWG recommendations for the Brazilian population, considering maternal and child adverse outcomes. Funding Sources The Brazilian National Council for Scientific and Technological Development and Bill and Melinda Gates Foundation. Supporting Tables, Images and/or Graphs

Objectives To compare gestational weight gain (GWG) trajectories of Brazilian women with three international charts used to monitor GWG, and to test whether there are differences in the classification of total GWG centiles between these charts. Methods This is a multiple combined cohort dataset with data from 10 Brazilian studies with repeated measures (mean of 6.9 measures) of GWG. Total GWG was obtained by the difference between the weight measured up to 14 days before delivery and the weight measured in the 1st trimester [Intergrowth-21st, I-chart] or the pre-pregnancy self-reported weight [Life-cycle project, L-charts; and Hutcheon, H-charts]. A total of 3,423 (23,340 observations) adult women with singleton pregnancies and free of hypertension and diabetes were included. We compared graphically the mean linear prediction (linear mixed-effect models) of Brazilian women GWG with the 50th centile of three international charts. The agreement of total GWG classification in < 10th, 10th–90th and > 90th centiles was tested using Cohen's kappa coefficient according to Landis & Koch classification. Results Women had a mean total GWG of 12.2 kg (SD: 5.8) and were, on average, 27.4 (SD: 5.8) years old. Pre-pregnancy normal weight women had a different pattern of GWG compared to I-chart, and the mean GWG of this group was slightly higher than the 50th centile of the L-chart. Underweight and obese women presented a different slope of GWG compared with the 50th centiles of H and L-charts. Pre-pregnancy overweight women presented a linear prediction that overlaps the 50th centile of the L-chart in the second half of pregnancy (Figure). It was observed a moderate agreement (kappa = 0.56) comparing the 10th, 10th–90th and 90th centiles classification between L and I-charts for normal weight women. L and H-charts presented a substantial agreement for underweight (kappa = 0.71), and moderate for overweight (kappa = 0.52) and obese women (kappa = 0.59). Conclusions L-charts are the ones that most closely resemble the Brazilian GWG distribution, especially for overweight women. We observed moderate agreement in the GWG classification of women in the 10th and 90th centiles between charts, which may lead to different diagnosis of GWG depending on which chart is used. This is a first step to create new Brazilian GWG recommendations. Funding Sources The Brazilian National Council for Scientific and Technological Development and Bill and Melinda Gates Foundation (Grand Challenges Exploration). Supporting Tables, Images and/or Graphs