Pregnancy as a window to future health: Excessive gestational weight gain and obesity

Gilmore, L Anne; Klempel-Donchenko, Monica; Redman, Leanne M.

doi:10.1053/j.semperi.2015.05.009

Cited by 157 publications

(148 citation statements)

References 72 publications

(78 reference statements)

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“…Other proposed long-term metabolic consequences of excessive GWG for women include type 2 diabetes, cardiovascular disease, and metabolic syndrome. 24 Most importantly, the weight gain that occurs during the first pregnancy, especially if it is excessive and not lost after delivery, is likely to influence future pregnancy outcomes. In this sense, it is important to target nulliparas in our counseling about avoiding excessive GWG.…”

Section: Risks Of Inadequate and Excessive Weight Gainmentioning

confidence: 99%

Gestational weight gain

Kominiarek

Peaceman

2017

American Journal of Obstetrics and Gynecology

305

259

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Prenatal care providers are advised to evaluate maternal weight at each regularly scheduled prenatal visit, monitor progress toward meeting weight gain goals, and provide individualized counseling if significant deviations from a woman’s goals occur. Today, nearly 50% of women exceed their weight gain goals with overweight and obese women having the highest prevalence of excessive weight gain. Risks of inadequate weight gain include low birth weight and failure to initiate breastfeeding whereas the risks of excessive weight gain include cesarean deliveries and post-partum weight retention for the mother and large for gestational age infants, macrosomia, and childhood overweight or obesity for the offspring. Prenatal care providers have many resources and tools they can use to incorporate weight and other health behavior counseling into their routine prenatal practices. Because many women are motivated to improve their health behaviors, pregnancy is often considered the optimal time to intervene for issues related to eating habits and physical activity so as to prevent excessive weight gain. Gestational weight gain is a potentially modifiable risk factor for a number of adverse maternal and neonatal outcomes and meta-analyses of randomized controlled trials report that diet or exercise interventions during pregnancy can help reduce excessive weight gain. However, health behavior interventions for gestational weight gain have not significantly improved other maternal and neonatal outcomes and have limited effectiveness in overweight and obese women.

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Section: Risks Of Inadequate and Excessive Weight Gainmentioning

confidence: 99%

Gestational weight gain

Kominiarek

Peaceman

2017

American Journal of Obstetrics and Gynecology

305

259

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“…23 24 Overweight and excessive gestational weight gain have been linked to development of GDM and later cardiometabolic disorders. 23 [25][26][27] Long-term follow-up studies on development of MeS among women at increased GDM risk are lacking. Our cluster randomised controlled trial (RCT) in Finnish pregnant women at increased GDM risk showed that lifestyle counselling was effective in controlling the proportion of large-for-gestational-age new-borns and improving the women's diet, and preventing excessive gestational weight gain and decrease in physical activity.…”

Section: Introductionmentioning

confidence: 99%

Metabolic syndrome in Finnish women 7 years after a gestational diabetes prevention trial

et al. 2017

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BackgroundRisk for developing metabolic syndrome (MeS) after delivery is high among women with gestational diabetes mellitus (GDM), but little is known about development of MeS among women with risk factors for GDM during pregnancy. In the present study, we studied the prevalence of MeS 7 years postpartum among women with GDM risk factors during pregnancy, women with early GDM diagnosis and women without GDM risk factors. We also analysed the early pregnancy risk factors associated with MeS.MethodsA Finnish cluster randomised controlled GDM prevention trial was conducted in 2007–2009. The prevalence of MeS according to International Diabetes Federation criteria was determined in the follow-up study 7 years after original trial. Eligible participants (n=289) in 4 study groups (intervention (n=83) and usual care (n=87) with GDM risk factors; early GDM (n=51), and healthy control without GDM risk factors (n=68)) were evaluated for MeS. Binary logistic regression models were used to analyse risk factors associated with MeS.Results7 years postpartum, the MeS prevalence was 14% (95% CI 8% to 25%) in the intervention group; 15% (CI 8% to 25%) in the usual care group; 50% (CI 35% to 65%) in the early GDM group and 7% (CI 2% to 18%) in the healthy control group. OR for MeS in women with GDM risk factors did not differ from the healthy control group. Body mass index (BMI)-adjusted OR for MeS was 9.18 (CI 1.82 to 46.20) in the early GDM group compared with the healthy control group. Increased prepregnancy BMI was associated with MeS (OR, 1.17, CI 1.08 to 1.28, adjusted for group).ConclusionsIncreased prepregnancy BMI and early GDM diagnosis were the strongest risk factors for developing MeS 7 years postpartum. Overweight and obese women and especially those with early GDM should be monitored and counselled for cardiometabolic risk factors after delivery.

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“…Specifically, obese women have higher risk of preeclampsia (Salihu et al 2012), gestational diabetes mellitus (GDM) (Chu et al 2007), and cesarean delivery (Weiss et al 2004), as well as stillbirth and congenital anomalies (Chu et al 2007). In addition, maternal obesity can have a long-term impact on the future health of both the mother and the offspring, especially in terms of heart disease, hypertension, and diabetes (Sridhar et al 2014; Freeman 2010; Gilmore et al 2015). Together with the standard obesity measure of body mass index (BMI), another important measure for maternal obesity is gestational weight gain (GWG) (Ferraro et al 2015).…”

Section: Introductionmentioning

confidence: 99%

Urinary phthalate metabolite concentrations and maternal weight during early pregnancy

Bellavia

Hauser

Seely

et al. 2017

International Journal of Hygiene and Environmental Health

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Background Phthalates are a class of chemicals that may be associated with obesity in non-pregnant populations. Little is known about the association between pregnancy phthalate exposure and maternal obesity. Objective We evaluated the association between early-pregnancy urinary concentrations of specific phthalate metabolites and the distribution of body mass index (BMI, cross-sectional), and early gestational weight gain (GWG, prospective). Methods We measured 1st trimester urinary phthalate metabolite concentrations (median 9.9 weeks gestation) in 347 women from the LIFECODES pregnancy cohort (Boston, MA), who delivered term births. All measures were adjusted for specific-gravity and log-transformed. We used quantile regression to evaluate shifts in the entire outcome distributions, calculating multivariable-adjusted differences in the associations between these phthalate metabolites and BMI and GWG at the 25th, 50th, and 75th percentiles of these anthropometric outcomes. Results Higher concentrations of mono-ethyl phthalate (MEP) were associated with a rightward shift of 2.8 kg/m2 at the 75th percentiles of BMI (lowest vs highest quartile, 95% CI: 0.2–5.4) and 1.3 kg at the 75th percentiles of early GWG (lowest vs second quartiles, 95% CI: 0.3–2.4). A significant right-shift in the upper tail of BMI was also observed at higher concentrations of mono-benzyl (MBzP), mono-3-carboxypropyl (MCPP), and a summary measure of di-(2-ethylhexyl) phthalate metabolites (ΣDEHP). ΣDEHP was also associated with lower GWG. Conclusions Certain phthalates may be associated with shifts in maternal obesity measures, with MEP, MBzP, MCPP, and ΣDEHP being cross-sectionally associated with 1st trimester BMI and MEP and ΣDEHP being positively and inversely associated with early GWG, respectively.

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Pregnancy as a window to future health: Excessive gestational weight gain and obesity

Cited by 157 publications

References 72 publications

Gestational weight gain

Gestational weight gain

Metabolic syndrome in Finnish women 7 years after a gestational diabetes prevention trial

Urinary phthalate metabolite concentrations and maternal weight during early pregnancy

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