Social inequality in pre-pregnancy BMI and gestational weight gain in the first and second pregnancy among women in Sweden

Holowko, Natalie; Chaparro, M. Pia; Nilsson, Karina; Ivarsson, Anneli; Mishra, Gita D.; Koupil, Ilona; Goodman, Anna

doi:10.1136/jech-2015-205598

Cited by 21 publications

(22 citation statements)

References 37 publications

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“…This indicates that overweight and obese women are at higher risk of excessive GWG, which may increase the risk of complications during pregnancy and delivery. This is in line with previous findings of excessive GWG in different BMI categories according to IOMs guidelines (Holowko et al 2015 ).…”

Section: Discussionsupporting

confidence: 93%

Food intake and gestational weight gain in Swedish women

et al. 2016

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BackgroundThe objective of this study was to investigate if food intake (dairy, snacks, caloric beverages, bread, cheese, margarine/butter, potato/rice/pasta/grains, red meat, fish and fruit/berries/vegetables) is associated with gestational weight gain (GWG) in Swedish women.MethodsFour day food records from 95 pregnant Swedish women were collected in the last trimester. GWG was calculated as weighed body weight in the last trimester (median gestational week 36) minus self-reported pre-pregnancy body weight. Excessive GWG was defined according to the guidelines by the Institute of Medicine. Food groups tested for association with GWG were dairy (milk, yoghurt and sour milk), snacks (sweets, crisps, popcorn, ice cream and cookies, but not nuts and seeds), caloric beverages (soft drinks, juice, lemonade and non-alcoholic beer), bread, cheese, margarine/butter, potato/rice/pasta/grains, red meat, fish and fruit/berries/vegetables.ResultsMedian (lower–upper quartiles) GWG was 12.1 kg (10.0–15.3). In total, 28 % had an excessive GWG. Excessive GWG was most common among pre-pregnancy overweight and obese women, where 69 % had an excessive GWG. Median daily intake of fruits and vegetables was 352 g (212–453), caloric beverages was 238 g (100–420) and snacks was 111 g (69–115). Multivariable linear regression analysis showed that intake of caloric beverages, snacks, fish, bread and dairy in the last trimester of pregnancy were positively related to GWG (R2 = 0.32). Multivariable logistic regression analysis showed that intake of caloric beverages, snacks, fish, and bread was associated with higher odds ratios for excessive GWG.ConclusionIntake of caloric beverages, snacks, fish and bread were positively related to excessive GWG. Thus, these results indicate that maternal dietary intake should be given higher attention in the antenatal care.

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Section: Discussionsupporting

confidence: 93%

Food intake and gestational weight gain in Swedish women

et al. 2016

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“…The prevalence was higher in pregnant women with elementary education (vs. high school or university) and women born in foreign countries [ 2 ]. Women with lower education also had the largest BMI increase between pregnancies [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Mighty Mums – a lifestyle intervention at primary care level reduces gestational weight gain in women with obesity

et al. 2018

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BackgroundObesity (BMI ≥30) during pregnancy is becoming an increasing public health issue and is associated with adverse maternal and perinatal outcomes. Excessive gestational weight gain (GWG) further increases the risks of adverse outcomes. However, lifestyle intervention can help pregnant women with obesity to limit their GWG. This study evaluated whether an antenatal lifestyle intervention programme for pregnant women with obesity, with emphasis on nutrition and physical activity, could influence GWG and maternal and perinatal outcomes.MethodsThe intervention was performed in a city in Sweden 2011–2013. The study population was women with BMI ≥30 in early pregnancy who received standard antenatal care and were followed until postpartum check-up. The intervention group (n = 459) was provided with additional support for a healthier lifestyle, including motivational talks with the midwife, food advice, prescriptions of physical activity, walking poles, pedometers, and dietician consultation. The control group was recruited from the same (n = 105) and from a nearby antenatal organisation (n = 790).ResultsIn the per-protocol population, the intervention group had significantly lower GWG compared with the control group (8.9 ± 6.0 kg vs 11.2 ± 6.9 kg; p = 0.031). The women managed to achieve GWG < 7 kg to a greater extent (37.1% vs. 23.0%; p = 0.036) and also had a significantly lower weight retention at the postpartum check-up (− 0.3 ± 6.0 kg vs. 1.6 ± 6.5 kg; p = 0.019) compared to the first visit. The most commonly used components of the intervention, apart from the extra midwife time, were support from the dietician and retrieval of pedometers. Overall compliance with study procedures, actual numbers of visits with logbook activity, and dietician contact correlated significantly with GWG. There was no statistically significant difference in GWG (10.3 ± 6.1 kg vs. 11.2 ± 6.9 kg) between the intervention and control groups in the intention-to-treat population.ConclusionPregnant women with obesity who follow a lifestyle intervention programme in primary health care can limit their weight gain during pregnancy and show less weight retention after pregnancy. This modest intervention can easily be implemented in a primary care setting.Trial registrationThe study has been registered at ClinicalTrials.gov, Identifier: NCT03147079. May 10 2017, retrospectively registered.

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“…One found that education was inversely associated with excessive GWG among healthy women having either their first or second singleton birth (Holowko et al, 2015). Another found that among women with a healthy pre-pregnancy BMI, those with an elementary or secondary education had greater odds of excessive GWG than women with higher education (Holowko, Mishra, & Koupil, 2014).…”

Section: Introductionmentioning

confidence: 99%

Educational Attainment and Gestational Weight Gain among U.S. Mothers

Cohen

Kazi

Headen

et al. 2016

Women's Health Issues

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Background Education is an important social determinant of many health outcomes, but the relationship between educational attainment and the amount of weight gained over the course of a woman's pregnancy (gestational weight gain (GWG)) has not been clearly established. Methods We used data from 1979-2010 for women in the National Longitudinal Survey of Youth 1979 cohort (n= 6344 pregnancies from 2769 women). We used generalized estimating equations to estimate the association between educational attainment and GWG adequacy (as defined by 2009 Institute of Medicine guidelines), controlling for diverse social factors from across the life course (e.g., income, wealth, educational aspirations and expectations) and considering effect measure modification by race/ethnicity and pre-pregnancy overweight status. Results In most cases, women with more education had increased odds of gaining a recommended amount of gestational weight, independent of educational aspirations and educational expectations and relatively robust to sensitivity analyses. This trend manifested itself in a few different ways. Those with less education had higher odds of inadequate GWG than those with more education. Among those who were not overweight pre-pregnancy, those with less education had higher odds of excessive GWG than college graduates. Among women who were white, those with less than a high school degree had higher odds of excessive GWG than those with more education. Conclusion The relationship between educational attainment and GWG is nuanced and nonlinear.

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Social inequality in pre-pregnancy BMI and gestational weight gain in the first and second pregnancy among women in Sweden

Cited by 21 publications

References 37 publications

Food intake and gestational weight gain in Swedish women

Food intake and gestational weight gain in Swedish women

Mighty Mums – a lifestyle intervention at primary care level reduces gestational weight gain in women with obesity

Educational Attainment and Gestational Weight Gain among U.S. Mothers

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