Gestational Diabetes Diagnostic Methods (GD2M) Pilot Randomized Trial Postpartum Weight Retention is Associated with Elevated Ratio of Oxidized LDL Lipids to HDL-Cholesterol Safety and efficacy of a lifestyle intervention for pregnant women to prevent excessive maternal weight gain: a cluster-randomized controlled trial Medical record review to recover missing data in a Portuguese birth cohort: agreement with self-reported data collected by questionnaire and inter-rater variability. Association between Gestational Weight Gain and Postpartum Diabetes: Evidence from a Community Based Large Cohort Study The impact of exposure misclassification on associations between prepregnancy BMI and adverse pregnancy outcomes. The correlation between self-reported and measured height, weight, and BMI in reproductive age women. Pregnancy: a "teachable moment" for weight control and obesity prevention. The effects of measurement errors on relative risk regressions. Risk factors and outcomes of maternal obesity and excessive weight gain during pregnancy. The quality of the new birth certificate data: a validation study in North Carolina. Parental anthropometrics, early growth and the risk of overweight in pre-school children: the Generation R Study. Association of maternal gestational weight gain with short- and long-term maternal and child health outcomes. Missing clinical information during primary care visits. Ethnic Differences in Effects of Maternal Pre-Pregnancy and Pregnancy Adiposity on Offspring Size and Adiposity. How do pregnancy-related weight changes and breastfeeding relate to maternal weight and BMI-adjusted waist circumference 7 y after delivery? Results from a path analysis
To test the feasibility of conducting a pragmatic r and omized controlled trial ( RCT ) comparing the International Association of Diabetes in Pregnancy Study Groups ( IADPSG ) versus Carpenter – Coustan diagnostic criteria for gestational diabetes ( GDM ) , and to examine patient and provider views on GDM screening . A single-blinded pragmatic pilot RCT . Participants with a singleton pregnancy between 24 and 28 weeks gestation received a 50 g oral glucose challenge test and if the value was < 200 mg/dL were r and omized to either the 2 h 75 g OGTT using the IADPSG criteria or the 3 h 100 g OGTT using the Carpenter – Coustan criteria . Primary outcome was the feasibility of r and omization and screening . Secondary outcomes included patient and provider views ( or preferences ) on GDM testing .  Sixty-eight women were recruited , 48 ( 71 % ) enrolled and 47 ( 69 % ) were r and omized . Participants in both study arms identified the main challenges to GDM testing to be : drinking the glucola , fasting prior to testing , waiting to have blood drawn , and multiple venipuntures . Women in both study arms would prefer the 2 h 75 g OGTT or whichever test is recommended by their doctor in a future pregnancy . Physicians and nurse midwives endorsed screening and were comfortable with being blinded to the GDM testing strategy and results values . Both pregnant women and providers value GDM screening , and pregnant women can be recruited to a blinded , r and omized GDM screening trial with minimal attrition and missing data Oxidized LDL lipids ( ox-LDL ) are associated with lifestyle diseases such as cardiovascular diseases , metabolic syndrome and type 2 diabetes . The present study investigated how postpartum weight retention effects on ox-LDL and serum lipids . The study is a nested comparative research of a cluster-r and omized controlled trial , NELLI ( lifestyle and counselling during pregnancy ) . During early pregnancy ( 8–12 weeks ) and 1 year postpartum , 141 women participated in measurements for determining of plasma lipids : total cholesterol ( T-C ) , LDL-cholesterol ( LDL-C ) , HDL-cholesterol ( HDL-C ) , triacylglycerols ( TAG ) and ox-LDL . Subjects were stratified into tertiles ( weight loss , unaltered weight and weight gain groups ) based on their weight change from baseline to follow-up . Ox-LDL was determined by baseline level of conjugated dienes in LDL lipids . Among the group of weight gainers , concentration of TAG reduced less ( −0.14 vs. −0.33 , p = 0.002 ) , HDL-C reduced more ( −0.31 vs. −0.16 , p = 0.003 ) and ox-LDL/HDL-C ratio increased ( 3.0 vs. −0.2 , p = 0.003 ) when compared to group of weight loss . Both T-C and LDL-C elevated more ( 0.14 vs. −0.21 , p = 0.008 ; 0.31 vs. 0.07 , p = 0.015 ) and TAG and ox-LDL reduced less ( −0.33 vs. 0.20 , p = 0.033 ; −3.33 vs. −0.68 , p = 0.026 ) in unaltered weight group compared to weight loss group . The women who gained weight developed higher TAG and ox-LDL/HDL-C ratio as compared to those who lost weight . Postpartum weight retention of 3.4 kg or more is associated with atherogenic lipid profile Background Excessive gestational weight gain ( GWG ) is associated with short- and long-term health problems among mothers and their offspring . There is a strong need for effective intervention strategies targeting excessive GWG to prevent adverse outcomes . Methods We performed a cluster-r and omized controlled intervention trial in eight gynecological practice s evaluating the feasibility and effectiveness of a lifestyle intervention presented to all pregnant women ; 250 healthy , pregnant women were recruited for the study . The intervention program consisted of two individually delivered counseling sessions focusing on diet , physical activity , and weight monitoring . The primary outcome was the proportion of pregnant women exceeding weight gain recommendations of the Institute of Medicine ( IOM ) . Secondary outcome variables were maternal weight retention and short-term obstetric and neonatal outcomes . Results The intervention result ed in a lower proportion of women exceeding IOM guidelines among women in the intervention group ( 38 % ) compared with the control group ( 60 % ) ( odds ratio ( OR ) : 0.5 ; 95 % confidence interval ( CI ) : 0.3 to 0.9 ) without prompting an increase in the proportion of pregnancies with suboptimal weight gain ( 19 % vs. 21 % ) . Participants in the intervention group gained significantly less weight than those in the control group . Only 17 % of the women in the intervention group showed substantial weight retention of more than 5 kg compared with 31 % of those in the control group at month four postpartum ( pp ) ( OR : 0.5 ; 95 % CI : 0.2 to 0.9 ) . There were no significant differences in obstetric and neonatal outcomes . Conclusions Lifestyle counseling given to pregnant women reduced the proportion of pregnancies with excessive GWG without increasing suboptimal weight gain , and may exert favorable effects on pp weight retention . Trial registration German Clinical Trials Register DRKS00003801 OBJECTIVES To assess the yield of medical record review to recover missing data originally collected by question naire , to analyze the agreement between these two data sources and to determine interobserver variability in clinical record review . METHODS We analyzed data from a birth cohort of 8,127 women who were consecutively recruited after giving birth from 2005 - 2006 . Recruitment was conducted at all public maternity units of Porto , Portugal . We review ed the medical records of 3,657 women with missing data in the baseline question naire  and assessed agreement between these two sources by using information from participants with data from both sources . Interobserver variability was assessed by using 400 r and omly selected clinical records . RESULTS Data on pregnancy complications and maternal anthropometric parameters were successfully recovered . Agreement between the question naire and records in family history data was fair , particularly for cardiovascular disease [ k=0.27 ; 95 % confidence interval ( 95%CI ) : 0.23 - 0.32 ] . The highest agreement was observed for personal history of diabetes ( k=0.82 ; 95%CI 0.70 - 0.93 ) , while agreement for hypertension was moderate ( k=0.60 ; 95%CI 0.50 - 0.69 ) . Discrepancies in prepregnancy body mass index classes were observed in 10.3 % women . Data were highly consistent between the two review ers , with the highest agreement found for gestational diabetes ( k=1.00 ) and birth weight ( 99.5 % concordance ) . CONCLUSION Data from the medical records and question naire were concordant with regard to pregnancy and well-known risk factors . The low interobserver variability did not threaten the precision of our data We have investigated the prospect i ve association between excess gestational weight gain ( GWG ) and development of diabetes by 21 years post-partum using a community-based large prospect i ve cohort study in Brisbane , Australia . There were 3386 mothers for whom complete data were available on GWG , pre-pregnancy BMI and self-reported diabetes 21 years post-partum . We used The Institute of Medicine ( IOM ) definition to categorize GWG as inadequate , adequate and excessive . We found 839 ( 25.78 % ) mothers gained inadequate weight , 1,353 ( 39.96 % ) had adequate weight gain and 1,194 ( 35.26 % ) had gained excessive weight during pregnancy . At 21 years post-partum , 8.40 % of mothers self-reported a diagnosis of diabetes made by their doctor . In the age adjusted model , we found mothers who gained excess weight during pregnancy  were 1.47(1.11,1.94 ) times more likely to experience diabetes at 21 years post-partum compared to the mothers who gained adequate weight . This association was not explained by the potential confounders including maternal age , parity , education , race , smoking , TV watching and exercise . However , this association was mediated by the current BMI . There was no association for the women who had normal BMI before pregnancy and gained excess weight during pregnancy . The findings of this study suggest that women who gain excess weight during pregnancy are at greater risk of being diagnosed with diabetes in later life . This relationship is likely mediated through the pathway of post-partum weight-retention and obesity . This study adds evidence to the argument that excessive GWG during pregnancy for overweight mothers has long term maternal health implication Prepregnancy BMI is a widely used marker of maternal nutritional status that relies on maternal self-report of prepregnancy weight and height . Pregravid BMI has been associated with adverse health outcomes for the mother and infant , but the impact of BMI misclassification on measures of effect has not been quantified . The authors applied published probabilistic bias analysis methods to quantify the impact of exposure misclassification bias on well-established associations between self-reported prepregnancy BMI category and five pregnancy outcomes ( small for gestational age ( SGA ) and large for gestational age ( LGA ) birth , spontaneous preterm birth ( sPTB ) , gestational diabetes mellitus ( GDM ) , and preeclampsia ) derived from a hospital-based delivery data base in Pittsburgh , PA ( 2003 - 2005 ; n = 18,362 ) . The bias analysis method recreates the data that would have been observed had BMI been correctly classified , assuming given classification parameters . The point estimates derived from the bias analysis account for r and om error as well as systematic error caused by exposure misclassification bias and additional uncertainty contributed by classification errors . In conventional multivariable logistic regression models , underweight women were at increased risk of SGA and sPTB , and reduced risk of LGA , whereas overweight , obese , and severely obese women had elevated risks of LGA , GDM , and preeclampsia compared with normal-weight women . After applying the probabilistic bias analysis method , adjusted point estimates were attenuated , indicating the conventional estimates were biased away from the null . However , the majority of relations remained readily apparent . This analysis suggests that in this population , associations between self-reported prepregnancy BMI and pregnancy outcomes are slightly overestimated This prospect i ve , cross-sectional study of 60 women compares self-reported height , weight , and BMI with measured values . Self-reported BMI ( 29.0±8.37 kg/m(2 ) ) was slightly lower than measured BMI ( 29.1±8.38 kg/m(2 ) ) ( p=0.4 ) . Eighty percent of participants reported a BMI in the same category in which their BMI was measured . Pearson 's correlation coefficient for height ( 0.96 , p<0.001 ) , weight ( 0.99 , p<0.001 ) , and BMI ( 0.99 , p<0.001 ) were high . Reproductive age women accurately reported their height and weight Excessive gestational weight gain has been shown to relate to high-postpartum weight retention and the development of overweight and obesity later in life . Because many women are concerned about the health of their babies during pregnancy and are in frequent contact with their healthcare providers , pregnancy may be an especially powerful " teachable moment " for the promotion of healthy eating and physical activity behaviors among women . Initial research suggests that helping women gain the recommended amount during pregnancy through healthy eating and physical activity could make a major contribution to the prevention of postpartum weight retention . However , more r and omized controlled trials with larger sample sizes are needed to identify the most effective and disseminable intervention . Providers have the potential to prevent high postpartum weight retention and future obesity by monitoring weight gain during pregnancy and giving appropriate advice about recommended amounts of gestational weight gain This paper concerns the effects of r and om error in  numerical measurements of risk factors ( covariates ) in relative risk regressions . When not dependent on outcome ( nondifferential ) , such error usually attenuates relative risk estimates ( shifts them toward one ) and leads to spuriously narrow confidence intervals . The presence of measurement error also reduces precision of estimates and power of significance tests . However , significance levels obtained by using the approximate measurements are usually valid and as powerful as possible given the measurement error . The attenuation in risk estimate depends not only on the size ( variance ) of the measurement error , but also on its distributional form , on whether it is dependent on the true level of the risk factor ( whether it is of " Berkson " type ) , on the variance and distributional form of true levels of the risk factor , on the functional form of the regression ( exponential or linear ) , and on the confounding variables included in the model . Error in measuring confounding variables leads to loss of control of confounding , leaving residual bias . Uncomplicated techniques of correcting the effects of measurement error in simple models in which distributions are assumed normal are available in the statistical literature . For these corrections , information on measurement error variance is required . Some approaches appropriate for more general models have been proposed , but these appear to be insufficiently developed for routine application OBJECTIVE The prevalence of overweight and obesity among women of reproductive age is increasing . We aim ed to determine risk factors and maternal , fetal and childhood consequences of maternal obesity and excessive gestational weight gain . DESIGN AND METHODS The study was embedded in a  population -based prospect i ve cohort study among 6959 mothers and their children . The study was based in Rotterdam , The Netherl and s ( 2001 - 2005 ) . RESULTS Maternal lower educational level , lower household income , multiparity , and FTO risk allel were associated with an increased risk of maternal obesity , whereas maternal European ethnicity , nulliparity , higher total energy intake , and smoking during pregnancy were associated with an increased risk of excessive gestational weight gain ( all p-values < 0.05 ) . As compared to normal weight , maternal obesity was associated with increased risks of gestational hypertension ( OR 6.31 ( 95 % CI 4.30 , 9.26 ) ) , preeclampsia ( OR ( 3.61 , ( 95 % CI 2.04 , 6.39 ) ) , gestational diabetes ( OR 6.28 ( 95%CI 3.01 , 13.06 ) ) , caesarean delivery ( OR 1.91 ( 95 % CI 1.46 , 2.50 ) ) , delivering large size for gestational age infants ( OR 2.97 ( 95 % CI 2.16 , 4.08 ) ) , and childhood obesity ( OR 5.02 ( 95 % CI:2.97 , 8.45 ) ) . Weaker associations of excessive gestational weight gain with maternal , fetal and childhood outcomes were observed , with the strongest effects for first trimester weight gain . CONCLUSIONS Our study shows that maternal obesity and excessive weight gain during pregnancy are associated with socio-demographic , lifestyle , and genetic factors and with increased risks of adverse maternal , fetal and childhood outcomes . As compared to prepregnancy overweight and obesity , excessive gestational weight gain has a limited influence on adverse pregnancy outcomes A r and om sample of 395 December 1989 North Carolina birth certificates and the corresponding maternal hospital medical records  were examined to vali date selected items . Reporting was very accurate for birth-weight , Apgar score , and method of delivery ; fair to good for tobacco use , prenatal care , weight gain during pregnancy , obstetrical procedures , and events of labor and delivery ; and poor for medical history and alcohol use . This study suggests that many of the new birth certificate items will support valid aggregate analyses for maternal and child health research and evaluation BACKGROUND There are limited data regarding the associations of both maternal and paternal anthropometrics with longitudinally measured post-natal growth measures in early childhood . OBJECTIVE To assess the associations of maternal and paternal anthropometrics with growth characteristics and the risk of overweight in pre-school children . STUDY DESIGN Population -based prospect i ve cohort study from early foetal life onwards in the Netherl and s. METHODS Maternal pre-pregnancy anthropometrics and gestational weight gain  , and paternal anthropometrics were related to foetal and post-natal growth measures and the risk of overweight until the age of 4 years . Analyses were based on 5674 mothers , fathers and their children . RESULTS Both pre-pregnancy maternal and paternal height , weight and body mass index were associated with corresponding foetal and post-natal anthropometric measures . Maternal body mass index had a significantly stronger effect on childhood body mass index than paternal body mass index . As compared to children from parents with normal body mass index , children from two obese parents had an increased risk of overweight at the age of 4 years ( odds ratio 6.52 ( 95 % confidence interval 3.44 , 12.38 ) . Maternal gestational weight gain was only among mothers with normal body mass index associated with body mass index and the risk of overweight in the children . CONCLUSION Maternal and paternal anthropometrics affect early growth in pre-school children differently . Gestational weight gain in mothers without overweight and obesity is related to the risk of overweight in early childhood OBJECTIVE The purpose of this study was to investigate the associations between  gestational weight gain ( GWG ) and small- and large-for-gestational-age ( SGA , LGA ) , cesarean delivery , child overweight , and maternal postpartum weight retention  in a diverse sample of women in the Unites States . STUDY DESIGN We estimated associations between GWG ( continuous and within categories defined by the Institute of Medicine ) , maternal prepregnancy body mass index , and each outcome in 4496 births in the National Longitudinal Survey of Youth 1979 , which was a prospect i ve cohort . RESULTS GWG ( kilograms ) was associated with decreased risk of SGA and increased risk of LGA , cesarean delivery , postpartum weight retention , and child overweight independent of maternal demographic and pregnancy characteristics . Gain above the Institute of Medicine guidelines was associated with decreased risk of SGA and increased risk of all other outcomes . CONCLUSION Excessive gain may have long-term consequences for maternal and child body size , but the benefits of lower gain must be balanced against risk of SGA CONTEXT The coordinating function of primary care is information-intensive and may be impeded by missing clinical information . However , missing clinical information has not been explicitly investigated in the primary care setting . OBJECTIVE To describe primary care clinicians ' reports of missing clinical information . DESIGN , SETTING , AND PARTICIPANTS Cross-sectional survey conducted in 32 primary care clinics within State Networks of Colorado Ambulatory Practice s and Partners ( SNOCAP ) , a consortium of practice -based research networks participating in the Applied Strategies for Improving Patient Safety medical error reporting study . Two hundred fifty-three clinicians were surveyed about 1614 patient visits between May and December 2003 . For every visit during 1 half-day session , each clinician completed a question naire about patient and visit characteristics and stated whether important clinical information had been missing . Clinician characteristics were also recorded . MAIN OUTCOME MEASURES Reports of missing clinical information frequency , type , and presumed location ; perceived likelihood of adverse effects , delays in care , and additional services ; and time spent looking for missing information . Multivariate analysis was conducted to assess the relationship of missing information to patient , visit , or clinician characteristics , adjusting for potential confounders and effects of clustering . RESULTS Clinicians reported missing clinical information in 13.6 % of visits ; missing information included laboratory results ( 6.1 % of all visits ) , letters/dictation ( 5.4 % ) , radiology results ( 3.8 % ) , history and physical examination ( 3.7 % ) , and medications ( 3.2 % ) . Missing clinical information was frequently reported to be located outside their clinical system but within the United States ( 52.3 % ) , to be at least somewhat likely to adversely affect patients ( 44 % ) , and to potentially result in delayed care or additional services ( 59.5 % ) . Significant time was reportedly spent unsuccessfully search ing for missing clinical information ( 5 - 10 minutes , 25.6 % ; > 10 minutes , 10.4 % ) . After adjustment , reported missing clinical information was more likely when patients were recent immigrants ( odds ratio [ OR ] , 1.78 ; 95 % confidence interval [ CI ] , 1.06 - 2.99 ) , new patients ( OR , 2.39 ; 95 % CI , 1.70 - 3.35 ) , or had multiple medical problems compared with no problems ( 1 problem : OR , 1.09 ; 95 % CI , 0.69 - 1.73 ; 2 - 5 problems : OR , 1.87 ; 95 % CI , 1.21 - 2.89 ; > 5 problems : OR , 2.78 ; 95 % CI , 1.61 - 4.80 ) . Missing clinical information was less likely in rural practice s ( OR , 0.52 ; 95 % CI , 0.29 - 0.92 ) and when individual clinicians reported having full electronic records ( OR , 0.40 ; 95 % CI , 0.17 - 0.94 ) . CONCLUSIONS Primary care clinicians report that missing clinical information is common , multifaceted , likely to consume time and other re sources , and may adversely affect patients . Additional research on missing information is needed to focus on validating clinicians ' perceptions and on conducting prospect i ve studies of its causes and sequelae CONTEXT Maternal adiposity and overnutrition , both before and during pregnancy , plays a key role in the subsequent development of obesity and metabolic outcomes in offspring . OBJECTIVE We explored the hypothesis that maternal adiposity  ( pre-pregnancy and at 26 - 28 weeks ' gestation ) and mid-pregnancy gestational weight gain ( GWG ) are independently associated with offspring size and adiposity in early childhood , and determined whether these effects are ethnicity dependent . DESIGN In a prospect i ve mother-offspring cohort study ( N = 976 , 56 % Chinese , 26 % Malay , and 18 % Indian ) , we assessed the associations of  offspring size ( weight , length ) and adiposity ( subscapular and triceps skinfolds ) , measured at birth and age 6 , 12 , 18 , and 24 mo , with  maternal pre-pregnancy body mass index  ( pp BMI ) , mid-pregnancy GWG , and mid-pregnancy four-site skinfold thicknesses ( triceps , biceps , subscapular , suprailiac ) . RESULTS pp BMI and mid-pregnancy GWG were independently associated with postnatal weight up to 2 y and skinfold thickness at birth . Weight and subscapular and triceps skinfolds at birth increased by 2.56 % ( 95 % confidence interval , 1.68 - 3.45 % ) , 3.85 % ( 2.16 - 5.57 % ) , and 2.14 % ( 0.54 - 3.75 % ) , respectively for every SD increase in pp BMI . Similarly , a one-SD increase in GWG increased weight and subscapular and triceps skinfolds at birth by 2.44 % ( 1.66 - 3.23 % ) , 3.28 % ( 1.75 - 4.84 % ) , and 3.23 % ( 1.65 - 4.84 % ) , respectively . pp BMI and mid-pregnancy suprailiac skinfold independently predicted postnatal skinfold adiposity up to 2 years of age , whereas only GWG predicted postnatal length . The associations of GWG with postnatal weight and length were present only among Chinese and Indians , but not Malays ( P < .05 for interaction ) . CONCLUSIONS pp BMI and GWG are independent modifiable factors for child size and adiposity up to 2 years of age . The associations are ethnic-dependent , and underscore the importance of ethnic specific studies before generalizing the applicability of risk factors reported in other population ABSTRACT Background : Reproduction has been related to long-term maternal weight gain , and changes in fat mass , with gestational weight gain , have been identified as an important contributor . However , the influence of weight changes during the whole reproductive cycle and the modifying effect of breastfeeding are unknown . Objective : The objective was to examine how prepregnancy weight , gestational weight gain , postpartum weight changes , and breastfeeding influence maternal weight and body mass index – adjusted waist circumference ( WC BMI ) 7 y after delivery . Design : This was a prospect i ve cohort study of 23,701 women participating in the Danish National Birth Cohort with singleton births and no births during follow-up . Path analysis was used to assess the total , direct , and indirect effects ; the latter was mediated through weight changes on the pathways . Results : Postpartum weight retention at 6 mo and weight gain from 6 to 18 mo postpartum were highly positively associated with both outcomes . A 1-kg increase in weight retention at 6 mo postpartum corresponded to an average increase of 0.5 kg at 7 y. Gestational weight gain was not associated with WC BMI but was positively associated with weight at 7 y ; 87 % of this effect was mediated through later weight changes . For both outcomes , a small inverse association was observed for breastfeeding duration . This was strongest for WC BMI , for which 97 % of the effect was direct , ie , not mediated through postpartum weight . Conclusions : These findings show that postpartum weight retention at 6 mo and weight gain from 6 to 18 mo postpartum contribute equally to adverse maternal anthropometric measures 7 y after delivery . Breastfeeding duration may have a beneficial effect
Self-reported maternal weight is error-prone , and the context of pregnancy may impact error distributions .
This systematic review summarizes error in self-reported weight across pregnancy and assesses implication s for bias in associations between pregnancy-related weight and birth outcomes .