Gestational weight gain and postpartum behaviors associated with weight change from early pregnancy to 1 y postpartum Determinants of excessive gestational weight gain in urban, low-income women. The effect of pre-pregnancy body mass index and gestational weight gain on pregnancy outcomes in urban care settings in Urmia-Iran Risk factors and outcomes of maternal obesity and excessive weight gain during pregnancy. Common mental disorders during pregnancy and adverse obstetric outcomes Pre-pregnancy body mass index among pregnant adolescents: gestational weight gain and long-term post partum weight retention. Household food insecurity is associated with self-reported pregravid weight status, gestational weight gain, and pregnancy complications. Use of mouth rinse during pregnancy to improve birth and neonatal outcomes: a randomized controlled trial Gestational Weight Gain: Results from the Delta Healthy Sprouts Comparative Impact Trial Prediction of gestational weight gain - a biopsychosocial model. Feasibility and Initial Efficacy Evaluation of a Community-Based Cognitive-Behavioral Lifestyle Intervention to Prevent Excessive Weight Gain During Pregnancy in Latina Women Smoking Cessation and Changes in Body Mass Index: Findings From the First Randomized Cessation Trial in a Low-Income Country Setting Zinc status and dietary intake of pregnant women, Alexandria, Egypt. Gestational Weight Gain, Pregnancy Outcome, and Postpartum Weight Retention The role of gestational diabetes, pre-pregnancy body mass index and gestational weight gain on the risk of newborn macrosomia: results from a prospective multicentre study Gestational weight gain in overweight and obese women enrolled in a healthy lifestyle and eating habits program Dietary protein-to-carbohydrate ratio and added sugar as determinants of excessive gestational weight gain: a prospective cohort study Continuity of midwifery care and gestational weight gain in obese women: a randomised controlled trial The Association Between Physical Activity and Maternal and Neonatal Outcomes: A Prospective Cohort Role of nutrition in pregnancy with phenylketonuria and birth defects. A combined community- and facility-based approach to improve pregnancy outcomes in low-resource settings: a Global Network cluster randomized trial Pre-pregnancy Body Mass Index, Gestational Weight Gain, and Other Maternal Characteristics in Relation to Infant Birth Weight Neonatal death in low- to middle-income countries: a global network study. Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies Weight Gain in Women of Normal Weight Before Pregnancy: Complications in Pregnancy or Delivery and Birth Outcome Vitamin D intake during pregnancy: association with maternal characteristics and infant birth weight. Effect of intensive counselling on the quality of dietary fats in pregnant women at high risk of gestational diabetes mellitus.
OBJECTIVES : ( 1 ) To describe the relative importance of gestational weight gain , postpartum exercise , food intake and breastfeeding to weight change from early pregnancy to 1 y postpartum ; and ( 2 ) to identify subgroups of women at greatest risk for major weight gain surrounding childbearing . DESIGN : A prospect i ve cohort study of women who registered for obstetrical care in a hospital and primary care clinic system serving a 10 county area of upstate New York . SUBJECTS : A total of 540 healthy adult women who gave birth to full-term singleton infants . MEASUREMENTS : Sociodemographic characteristics , exercise , food-related behaviors and breastfeeding were assessed using the medical record and a mailed question naire .  Body weight was measured at prenatal visits and 1 y postpartum . Weight retained and major weight gain ( 4.55 kg ) at 1 y postpartum were the main outcomes . ANALYSIS : Linear and logistic regression analyses were conducted . RESULTS : Women were on average 1.51±5.95 kg heavier at 1 y postpartum than they were in early pregnancy . Nearly 25 % of women experienced a major weight gain of 4.55 kg or more at 1 y postpartum . Gestational weight gain , exercise frequency , change in food intake and breastfeeding were each significantly related to postpartum weight retention . With the exception of breastfeeding , all of these factors were also associated with major weight gain .  Women under 20 y or over 40 y at delivery , and single women retained significantly more weight .  Lower income women with gestational weight gains above the Institute of Medicine ( IOM ) range retained 3.73 kg more than lower income women who gained within the range . They were also 4.7 times more likely to experience major weight gain with childbearing . The impact of exceeding the IOM gestational weight gain guidelines was three times greater in lower income women than it was in higher income women . CONCLUSION : Gestational weight gain , postpartum exercise frequency , and food intake are significantly associated with weight change from early pregnancy to 1 y postpartum and major weight gain with childbearing . Lower income women who gain more weight in pregnancy than the IOM recommends are at high risk for major weight gain with childbearing BACKGROUND Factors influencing excessive weight gain in pregnancy have not been well-studied among urban , low-income women . METHODS This prospect i ve cohort study of 94 prenatal care patients at a large university hospital in Philadelphia examined associations of modifiable midpregnancy behaviors and nonmodifiable or early pregnancy factors with  excessive gestational weight gain . Data were collected through question naires and medical record abstract ion from 2009 to 2011 . FINDINGS The majority of women were African American ( 83 % ) and all ( 100 % ) received Medicaid . Nearly two thirds ( 60 % ) were overweight or obese in early pregnancy and 41 % experienced excessive gain . In multivariable logistic regression analyses , significant predictors of excessive gestational weight gain included high early pregnancy body mass index ( odds ratio [ OR ] , 4.20 ; 95 % confidence interval [ CI ] , 1.43 - 12.34 for overweight/obese vs. normal weight ) , nulliparity ( OR , 3.35 ; 95 % CI , 1.17 - 9.62 for nulliparity vs. multiparity ) , and clinician advice discordant with Institute of Medicine guidelines ( OR , 5.88 ; 95 % CI , 1.04 - 33.32 for discordant vs. concordant advice ) . Watching under 2 hours of television daily ( OR , 0.18 ; 95 % CI , 0.03 - 1.03 ) , and engaging in regular physical activity during pregnancy ( OR , 0.35 ; 95 % CI , 0.11 - 1.09 ) were suggestive of a reduced risk of excessive gain . CONCLUSIONS In this sample of urban , low-income women , high early pregnancy body mass index , nulliparity , and discordant clinician advice were directly associated with excessive gestational weight gain , with a trend toward decreased risk for viewing fewer hours of television and engaging in regular physical activity . Intervening on these targets may optimize gestational weight gain and promote long-term maternal health Background Nutritional status of women has been considered an important prognostic indicator of pregnancy outcomes . Few studies have evaluated patterns of weight gain and pre-pregnancy body mass index in developing regions where malnutrition and poor weight gain as well as maternal obesity have significant influences on the pregnancy outcome . This study aims to show effect of pregnancy body mass index and the corresponding gestational weight gain on the outcome of pregnancy . Methods On a prospect i ve cross sectional study , two hundred and seventy women from urban areas of Northwest Iran were recruited for participation during their first eight weeks of pregnancy .  Body mass index ( BMI ) was categorized and gestational weight gain was divided into two groups of normal and abnormal based on recommendations of Institute of Medicine ( IOM ) published in 1990 . Chi square and one way ANOVA were used in the univariate analysis of the association between weight gain and corresponding adverse outcomes including cesarean , preterm labor and low neonatal birth weight . Adjusted odds ratios for adverse outcomes were determined by multiple logistic regression models , while controlling for the following factors : maternal age , parity , and education . Results Both pre-pregnancy BMI < 19 and abnormal weight gain during pregnancy were found to be associated with low neonatal birth weight defined as < 2500 g. Abnormal weight gain , during pregnancy was not related to an increased risk of preterm labor or cesarean delivery but it was highly associated with low birth weight (LBW)(P < 0.05 ) . Conclusion Low pre-pregnancy BMI is an established risk factor for LBW . Abnormal gestational weight gain may further complicate the pregnancy as an additional risk factor for neonatal LBW . All women , regardless of their pre-pregnancy BMI may be at risk for abnormal weight gain and hence low birth weight . Pre-pregnancy and gestation nutritional assessment s remain significant part of all prenatal visits 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 Objective . To estimate the association between common mental disorders ( CMD ) during pregnancy and risk of low birth weight ( LBW ) or preterm birth ( PTB ) . Methods . A prospect i ve cohort study was conducted with 831 pregnant women from antenatal clinics in primary healthcare in São Paulo , Brazil . The clinical interview schedule-revised and demographic question naires were administered between the 20th and 30th weeks of gestation . Information on infant weight and gestational age at birth were obtained from hospital records . Univariate analyses were used to examine the association between the main exposure and main outcomes . Statistical associations were examined with χ2 tests . Adjusted odds ratios ( OR ) and 95 % confidence intervals ( CI ) for the main outcomes were obtained using a multivariable logistic regression model . Results . The prevalence of CMD during gestation was 33.6 ( 95 % CI : 30.4–36.9 ) . The follow-up rate was 99.5 % . Sixty three ( 7.6 % ) newborns were classified as LBW and 56 ( 6.9 % ) were classified as PTB . CMD during pregnancy was not associated with risk of PTB ( adjusted OR:1.03 , 95 % CI : 0.57–1.88 ) or LBW ( adjusted OR:1.09 , 95 % CI : 0.62–1.91 ) . Conclusions . CMD prevalence is high among low-income and low-risk pregnant women attended by public health services in a middle-income country , but not confer an increased risk for adverse obstetric outcome STUDY OBJECTIVE To determine the relationship between adolescents ' pre-pregnancy body mass index ( BMI ) , and gestational weight gain and postpartum weight retention . DESIGN We review the medical records of adolescents participating in a prospect i ve cohort study on comprehensive health care and parenting education  to determine pre-pregnancy BMI , gestational weight gain , and postpartum weight retention at one year . SETTING Urban academic hospital clinic . PARTICIPANTS 102 pregnant adolescents aged 15 - 21 years . MAIN OUTCOMES Gestational weight gain and weight retention at one year postpartum . RESULTS AND CONCLUSIONS Fifty-two ( 51 % ) adolescent women had normal pre-pregnancy BMI according to the Institute of Medicine classification . Adolescent women with normal ( 36.5 % ) and high pre-pregnancy BMI ( 66.5 % ) were more likely than women with low pre-pregnancy BMI ( 26.5 % ) to exceed recommended gestational weight gain . Adolescent women who exceeded recommended weight gain retained significantly more weight at 1 year postpartum than women with weight gain within or below the recommendation . In a linear regression model that controlled for age , smoking , pregnancy complication , and post partum contraceptive use , pre-pregnancy BMI and gestational weight gain were the strongest predictors of postpartum weight retention at 1 year . A normal to high pre-pregnancy BMI and excessive gestational weight gain are important predictors of postpartum weight retention in adolescents . These two predictors must be monitored systematic ally with the aim of preventing postpartum obesity and its associated diseases among this population BACKGROUND Household food insecurity is positively associated with weight among women . The association between household food insecurity and pregnancy-related  weight gain and complications is not well understood . OBJECTIVE To identify whether an independent association exists between household food insecurity and pregnancy-related complications . DESIGN Data from the Pregnancy , Infection , and Nutrition prospect i ve cohort study were used to assess household food insecurity retrospectively using the US Department of Agriculture 18-item Core Food Security Module among 810 pregnant women with incomes < or = 400 % of the income/poverty ratio , recruited between January 2001 and June 2005 and followed through pregnancy . MAIN OUTCOME MEASURES Self-reported pregravid body mass index , gestational weight gain , second trimester anemia , pregnancy-induced hypertension , and gestational diabetes mellitus . STATISTICAL ANALYSES PERFORMED Multivariate linear , multinomial logistic , and logistic regression analyses . RESULTS Among 810 pregnant women , 76 % were from fully food secure , 14 % were from marginally food secure , and 10 % were from food insecure households . In adjusted models , living in a food insecure household was significantly associated with severe pregravid obesity ( adjusted odds ratio 2.97 , 95 % confidence intervals [ CIs ] 1.44 to 6.14 ) , higher gestational weight gain ( adjusted beta coefficient 1.87 , 95 % CI 0.13 to 3.62 ) , and with a higher adequacy of weight gain ratio ( adjusted beta .27 , 95 % CI 0.07 to 0.50 ) . Marginal food security was significantly associated with gestational diabetes mellitus ( adjusted odds ratio 2.76 , 95 % CI 1.00 to 7.66 ) . CONCLUSIONS This study highlights the possibility that living in a food insecure household during pregnancy may increase risk of greater weight gain and pregnancy complications Background Poor oral health , such as periodontal ( gum ) disease , has been found to be associated with an increased risk of adverse pregnancy outcomes including preterm birth , low birth weight , and neonatal and infant mortality , especially in low- and middle-income countries . However , there is little or no access to preventive dental care in most low- and middle-income countries . We propose to develop and test a “ Mouth Rinse Intervention ” among pregnant women to prevent the progression of periodontal disease during pregnancy and reduce adverse birth and neonatal outcomes in a rural county of China . Methods / Design This is a r and omized controlled clinical trial . A sample of 468 ( 234 in each arm of the study ) women in early pregnancy with periodontal disease will be recruited for the study . Periodontal disease will be diagnosed through the methods of Periodontal Screening and Recording . All women diagnosed with periodontal disease will be r and omly allocated into the intervention or control group . Women assigned in the intervention group will be provided with non-alcohol antimicrobial mouth rinse containing cetylpyridinium chloride throughout the pregnancy and oral health education . Women in the control group will receive a package of tooth brush and paste , plus oral hygiene education . Women will be followed-up to childbirth until the 42nd day postpartum . The main outcomes include mean birthweight ( gram ) and mean gestational age ( week ) . Discussion Compared with conventional mechanical ‘ scaling and root planning ’ periodontal treatment during pregnancy , our proposed mouth rinse intervention could be a simple , cost-effective , and sustainable solution to improve both mother ’s oral health and neonate outcomes . If the mouth rinse is confirmed to be effective , it would demonstrate great potential for the application in other low- or middle-income countries to prevent adverse birth outcomes such as preterm birth and low birth weight and to reduce neonatal and infant mortality . Trial registration This trial was registered with Chinese Clinical Trial Registry ( ChiCTR ) : ( # ChiCTR-TRC-13003768 ) on November 06 , 2013 Introduction . Delta Healthy Sprouts trial was design ed to test the comparative impact of two home visiting programs on weight status , dietary intake , and health behaviors of Southern African American women and their infants . Results pertaining to the primary outcome , gestational weight gain , are reported . Methods . Participants ( n = 82 ) , enrolled early in their second trimester of pregnancy , were r and omly assigned to one of two treatment arms . Gestational weight gain , measured at six monthly home visits , was calculated by subtracting measured weight at each visit from self-reported prepregnancy weight . Weight gain was classified as under , within , or exceeding the Institute of Medicine recommendations based on prepregnancy body mass index . Chi-square tests and generalized linear mixed models were used to test for significant differences in percentages of participants within recommended weight gain ranges . Results . Differences in percentages of participants within the gestational weight gain guidelines were not significant between treatment arms across all visits . Conclusions . Enhancing the gestational nutrition and physical activity components of an existing home visiting program is feasible in a high risk population of primarily low income African American women . The impact of these enhancements on appropriate gestational weight gain is question able given the more basic living needs of such women . This trial is registered with Clinical Trials.gov NCT01746394 , registered 4 December 2012 OBJECTIVE To examine the influence of health behaviours and psychological well-being on  gestational weight gain  using a biopsychosocial model . DESIGN A prospect i ve cohort study of pregnant women consecutively recruited at their first antenatal care visit . A self-administered question naire was used to collect data on health behaviours and psychological well-being in early pregnancy . Linear regression and logistic regression were used to identify predictors of total weight gain in kilograms and weight gain outside the current Institute of Medicine recommendations , respectively . SETTING A maternity hospital in the Republic of Irel and . SUBJECTS Data on 799 women were analysed . RESULTS Pre-pregnant BMI ≥30·0 kg/m2 , short stature , parity > 0 , decreased food intake and absence of health insurance predicted lower absolute gestational weight gain , while foreign nationality , consumption of takeaway meals more than once weekly and increased food intake predicted higher absolute gestational weight gain . Overweight and obesity , foreign nationality , increased food intake and height > 170 cm were risk factors for excessive weight gain , while antenatal depression was protective against excessive weight gain . Notably , physical activity measures were not related to the gestational weight gain outcomes . Pre-pregnancy overweight and increased food intake were the strongest predictors of excessive gestational weight gain . CONCLUSIONS None of the psychological well-being measures examined , with the exception of antenatal depression , was associated with any of the weight gain outcomes . The behavioural predictors of gestational weight gain were increased food intake and takeaway consumption . Public health promotions should target pre-pregnancy BMI and pregnancy-associated change in food intake About 48 % of US women gain more weight during pregnancy than recommended by the Institute of Medicine ( IOM ) . Excessive gestational weight gain is a major risk factor for obesity in both women and offspring over their lifetimes , and should be avoided . This study was design ed to test the feasibility and initial efficacy of a prenatal behavioral intervention in a sample of low-income , predominantly Latina women . The intervention was delivered in groups of 8–10 women in a community recreation center , and structured to reduce the proportion of women who gained weight in excess of IOM guidelines . Recruitment targets were met in 3 months : 135 pregnant women ( > 10 and < 28 weeks ) were r and omly assigned to receive a 12-week intervention ( n = 68 ) or usual care ( n = 67 ) . Retention rate was 81 % . On average , women attended 4 of 12 group sessions , and each session had 4 of the 8–10 assigned participants in attendance . Initial efficacy analyses were based on 87 women . Compared to usual care , fewer normal-weight women in the intervention exceeded IOM recommendations ( 47.1 % usual care vs. 6.7 % intervention ; absolute difference 40.4 % ; p = .036 ) . Recommendations for recruitment , retention , and delivery are discussed . A community-based cognitive-behavioral lifestyle intervention during pregnancy was feasible in a hard-to-reach , high-risk population of low-income Latina women , and showed efficacy in preventing excessive gestational weight gain . Due to frequently changing work schedules , strategies are needed to either increase attendance at group sessions ( e.g. , within a group prenatal care format ) or to build core skills necessary for behavior change through other modalities Background In high-income countries , quitting cigarette smoking is associated with weight gain , which can reduce motivation to abstain . Whether smoking cessation is associated with weight gain in a low-income country context has never been investigated . We aim ed to determine the post-cessation changes in body mass index ( BMI ) and its predictors among smokers who received a smoking cessation intervention in a low-income country setting . Methods We performed post hoc analyses of data from 269 smokers who participated in a two-group , parallel-arm , double-blind , placebo-controlled r and omized trial of combined nicotine replacement therapy ( NRT ) and behavioral counseling in primary care clinics in Aleppo , Syria . We used generalized estimating equation modeling to identify predictors of changes in BMI at 6 weeks and 6- and 12-month follow-ups after quit date . Results The mean pre-cessation BMI of the sample was 27.9kg/m2 ( SD = 5.2 ) . Over 12 months of follow-up , BMI of smoking abstainers averaged 1.8 BMI units ( approximately 4.8 kg ) greater than non-abstainers ( p = .012 ) . Throughout the study , greater BMI was associated with being female ( p = .048 ) , reporting smoking to control weight ( p < .001 ) and having previously failed to quit due to weight gain ( p = .036 ) . Conclusion Similar to findings from high-income countries , smoking cessation in Syria is associated with weight gain , particularly among women and those who have weight concerns prior to quitting . This group of smokers may benefit from tailored cessation interventions with integrated body weight management elements that take into consideration the prevailing local and cultural influences on diet and levels of physical activity . Implication s This study provides the first evidence regarding post-cessation changes in BMI among smokers who attempt to quit in a low-income country setting . Our findings advance knowledge regarding post-cessation weight gain and offers insight for research ers and clinicians to identify smokers at higher risk of post-cessation weight gain . This information will help in delivering interventions that take into account the prevailing cultural influence on diet and physical activity and will ultimately help in design ing future tailored cessation programs in Syria and other low-income countries with similar cultural background and level of development BACKGROUND AND OBJECTIVES Deficiencies of protein , energy , and micronutrients are highly prevalent in developing countries and have major effects on pregnancy outcome . Low dietary intake is the most common reason for zinc deficiency . The present research is part of a larger double-blind r and omized-controlled trial to evaluate the effect of zinc supplementation on the pregnancy outcome . The aim of the present study was to assess the  zinc status and dietary intake of zinc and other macronutrients and micronutrients among pregnant women in Alex and ria , Egypt . PARTICIPANTS AND METHODS Participants were pregnant women attending two antenatal care centers that serve low-income and middle-income pregnant population s. A total of 1055 healthy pregnant women aged 20 - 45 years were assessed for eligibility . Of these , only 675 had serum zinc level below the median for the gestational age . They were assigned r and omly to one of three parallel groups . Zinc supplements were provided from 16 weeks until delivery . A sub sample of 100 women was assessed for their dietary intake . A question naire interview was used to collect basic socioeconomic and data on current pregnancy and labor . Dietary data were collected using the 24-h recall method and a food frequency question naire . The nutritive value of the daily diet was computed using the Egyptian food composition tables . The blood hemoglobin level , serum zinc level , and fasting blood sugar were determined . RESULTS Zinc deficiency was detected among 53.5 % of the sample . Dietary intake of zinc was low , representing 59.4 , 59.4 , and 62 % of the recommended dietary allowance ( RDA ) for the zinc group , zinc plus multivitamins , and the placebo group , respectively . The iron intake was below 50 % of the RDA . Protein intake was less than 70 % of the RDA . The mean intakes of fat were 191.97 , 211.8 , and 196.3 g/day for the three groups . The mean energy intake represented 51.1 , 53.5 , and 49.8 % of the RDA . CONCLUSION AND RECOMMENDATIONS Except for carbohydrate intake , the dietary intake of all macronutrients and micronutrients was low . The lowest intake was of iron ( below 50 % of the RDA ) . Zinc and protein intake represented less than 70 % of the RDA . The overall energy intake was around 50 % of the RDA . Nutritional health education should be used as a preventive approach to allow the large sector of the low-income population to maximize the use of the limited re sources in the best way . In women at high risk of zinc deficiency , zinc supplementation should be added to the routine supplements Objective To determine whether the risk of maternal overweight associated with an excessive rate of gestational gain needs to be balanced against the risks of impaired fetal growth associated with a low rate of gain . Methods  Rate of gestational weight gain  was measured prospect ively in a sample of 274 young , low-income , and primarily minority women ( 12–29 years old ) with pregravid body mass indices ( BMI ) in the normal range ( 19.8–26.0 ) . We defined an excessive rate of gain between 20–36 weeks ' gestation as one greater than 0.68 kg/week , and a low rate of gain as one less than 0.34 kg/week . Women were followed-up at 4–6 weeks and 6 months postpartum . Results Rate of measured gestational gain between 20–36 weeks ' gestation was associated with total weight gain based on pregravid weight , with infant birth weight and gestation duration , and with maternal overweight ( BMI greater than 26 ) and weight retention postpartum . Infant birth weight and gestation duration were significantly reduced for women with low rates of gain , and there was no significant difference between women with excessive and moderate gains . Despite little difference in pregravid BMI , women with excessive rates of gain retained more weight overall , attained a greater postpartum BMI , and had higher levels of subcutaneous fat and overweight . Maternal anthropometric status showed little change between 4–6 weeks and 6 months postpartum . Conclusion Weight gained at an excessive rate by women with a pregravid BMI in the normal range does not greatly enhance fetal growth and gestation duration , contributing instead to postpartum maternal overweight Background It is crucial to identify in large population sample s the most important determinants of excessive fetal growth . The aim of the study was to evaluate the independent role of pre-pregnancy body mass index ( BMI ) , gestational weight gain and gestational diabetes on the risk of macrosomia . Methods A prospect i ve study collected data on mode of delivery and maternal/neonatal outcomes in eleven Hospitals in Italy . Multiple pregnancies and preterm deliveries were excluded . The sample included 14109 women with complete records . Associations between exposure variables and newborn macrosomia were analyzed using Pearson ’s chi squared test . Multiple logistic regression models were built to assess the independent association between potential predictors and macrosomia . Results Maternal obesity ( adjusted OR 1.7 , 95 % CI 1.4 - 2.2 ) , excessive gestational weight gain ( adjusted OR 1.9 , 95 % CI 1.6 - 2.2 ) and diabetes ( adjusted OR 2.1 , 95 % CI 1.5 - 3.0 for gestational ; adjusted OR 3.0 , 95 % CI 1.2 - 7.6 for pre-gestational ) result ed to be independent predictors of macrosomia , when adjusted for other recognized risk factors . Since no significant interaction was found between pre-gestational BMI and gestational weight gain , excessive weight gain should be considered an independent risk factor for macrosomia . In the sub-group of women affected by gestational or pre-gestational diabetes , pre-gestational BMI was not significantly associated to macrosomia , while excessive pregnancy weight gain , maternal height and gestational age at delivery were significantly associated . In this sub- population , pregnancy weight gain less than recommended was not significantly associated to a reduction in macrosomia . Conclusions Our findings indicate that maternal obesity , gestational weight gain excess and diabetes should be considered as independent risk factors for newborn macrosomia . To adequately evaluate the clinical evolution of pregnancy all three variables need to be carefully assessed and monitored Abstract Objectives : To determine whether changes in lifestyle in women with BMI > 25 could decrease gestational weight gain and unfavorable pregnancy outcomes . Methods : Women with BMI > 25 were r and omized at 1st trimester to no intervention or a Therapeutic Lifestyle Changes ( TLC ) Program including diet  ( overweight : 1700 kcal/day , obese : 1800 kcal/day ) and mild physical activity ( 30 min/day , 3 times/week ) . At baseline and at the 36th week women filled-in a Food Frequency Question naire . Outcomes : gestational weight gain , gestational diabetes mellitus , gestational hypertension , preterm delivery . Data stratified by BMI categories . Results : Socio-demographic features were similar between groups ( TLC : 33 cases , Controls : 28 cases ) . At term , gestational weight gain in obese women r and omized to TLC group was lower ( 6.7 ± 4.3 kg ) versus controls ( 10.1 ± 5.6 kg , p = 0.047 ) . Gestational diabetes mellitus , gestational hypertension and preterm delivery were also significantly lower . TLC was an independent factor in preventing gestational weight gain , gestational diabetes mellitus , gestational hypertension . Significant changes in eating habits occurred in the TLC group , which increased the number of snacks , the intake of fruits – vegetables and decreased the consumption of sugar . Conclusions : A caloric restriction associated to changes in eating behavior and constant physical activity , is able to reduce gestational weight gain and related pregnancy complications in obese women Objective To examine the relation between the protein : carbohydrate ( P/C ) ratio and added sugar intake in pregnancy and gestational weight gain ( GWG ) . Design A prebirth cohort including 103 119 pregnancies enrolled between 1996 and 2003 . Setting All women in Denmark were eligible to participate if they spoke Danish and were planning to carry to term . The pregnant women were recruited and enrolled during their first antenatal visit ( 6–10 weeks of gestation ) . Participants Participants included women with live-born singletons and complete data on dietary intake and GWG , leaving 46 262 women for the analysis . Exposure Macronutrient intake was quantified using a vali date d food frequency question naire administered in the 25th week of gestation . The P/C ratio and added sugar intake were examined in quintiles . Primary outcome measures GWG was based on self-reported weight in gestational weeks 12 and 30 and defined as gain in g/week . We used multivariable linear regression , including adjusting for pre-pregnancy body mass index , to calculate relative change in GWG and 95 % CI . Results Average GWG was 471(224 ) g/week . The adjusted weight gain was 16 g/week lower ( 95 % CI 9 to 22 , p for trend < 0.001 ) in the highest ( Q5 ) versus lowest ( Q1 ) quintile of the P/C ratio ( ∼3 % average reduction across the entire pregnancy ) . Weight gain for those with > 20%E vs < 12%E from protein was 36 g/week lower ( 95 % CI 20 to 53 , p for trend < 0.0001 ; ∼8 % average reduction ) . A high P/C ratio was inversely related to intake of added sugars . Added sugar consumption was strongly associated with GWG ( Q5 vs Q1 : 34 , 95 % CI 28 to 40 g/week , p for trend < 0.0001 ) . Conclusions A high P/C ratio was associated with reduced GWG . This association appeared to be partly driven by a decrease in intake of added sugar . These results are consistent with r and omised trials in non-pregnant participants . A dietary intervention targeting an increased P/C ratio with emphasis on reducing added sugar can contribute to reducing excessive GWG Background The increased prevalence of obesity in pregnant women in Australia and other developed countries is a significant public health concern . Obese women are at increased risk of serious perinatal complications and guidelines recommend weight gain restriction and additional care . There is limited evidence to support the effectiveness of dietary and physical activity lifestyle interventions in preventing adverse perinatal outcomes and new strategies need to be evaluated . The primary aim of this project is to evaluate the effect of continuity of midwifery care on restricting gestational weight gain in obese women to the recommended range . The secondary aims of the study are to assess the impact of continuity of midwifery care on : women 's experience of pregnancy care ; women 's satisfaction with care and a range of psychological factors . Methods / Design A two arm r and omised controlled trial ( RCT ) will be conducted with primigravid women recruited from maternity services in Victoria , Australia . Participants will be primigravid women , with a BMI ≥30 who are less than 17 weeks gestation . Women allocated to the intervention arm will be cared for in a midwifery continuity of care model and receive an informational leaflet on managing weight gain in pregnancy . Women allocated to the control group will receive routine care in addition to the same informational leaflet  . Weight gain during pregnancy , st and ards of care , medical and obstetric information will be extracted from medical records . Data collected at recruitment ( self administered survey ) and at 36 weeks by postal survey will include socio-demographic information and the use of vali date d scales to measure secondary outcomes . Discussion Continuity of midwifery care models are well aligned with current Victorian , Australian and many international government policies on maternity care . Increasingly , midwifery continuity models of care are being introduced in low risk maternity care , and information on their application in high risk population s is required . There is an identified need to trial alternative antenatal interventions to reduce perinatal risk factors for women who are obese and the findings from this project may have application in other maternity services . In addition this study will inform a larger trial that will focus on birth and postnatal outcomes .Trial Registration Australian New Zeal and Clinical Trials RegistryACTRN12610001078044 Some evidence , but not enough to be conclusive , suggests that physical activity in pregnancy reduces the risk of perinatal complications . Our objective was to examine if physical activity in the year before pregnancy and in the first half of pregnancy is associated with maternal and neonatal outcomes . Associations between physical activity and maternal and neonatal outcomes were examined in a prospect i ve cohort ( n = 1,749 ) in Halifax , Canada . The Kaiser Physical Activity Survey , completed at approximately 20 weeks ’ gestation , requested information regarding physical activity during the year before the pregnancy and the first 20 weeks of pregnancy . Outcomes were assessed by medical chart review . Multiple logistic regression was used to estimate odds ratios ( OR ) with 95 % confidence intervals ( CI ) . Women with prepregnancy physical activity levels in the middle and highest tertiles were more likely to have high gestational weight gain relative to women in the lowest tertile [ OR ( CI ) : 1.40 ( 1.06–1.85 ) and 1.57 ( 1.18–2.09 ) , respectively ] . Higher physical activity  in the first half of pregnancy decreased the odds of delivering a macrosomic infant ( p trend = 0.005 ) . Associations were not observed between  total physical activity and gestational diabetes , gestational hypertension , pre-eclampsia , preterm birth , and low birth weight .  Physical activity before , but not in the first half of pregnancy , is associated with high gestational weight gain . Physical activity in the first half of pregnancy may reduce the occurrence of macrosomia without affecting preterm birth or low birth weight OBJECTIVE The maternal phenylketonuria ( PKU ) syndrome is caused by high blood phenylalanine ( Phe ) levels during pregnancy , leading to a host of birth defects , especially microcephaly and congenital heart disease ( CHD ) . For finding whether the maternal PKU syndrome could be prevented , an international collaborative study was organized to evaluate treatment with a Phe-restricted diet .  Blood Phe levels , maternal weight gain , and nutrient intakes during pregnancy were evaluated as to their effect on the rate of microcephaly and CHD in the offspring . METHODS The study was a prospect i ve , longitudinal effort aim ed at lowering blood Phe during pregnancy . Women were enrolled at time of referral for pregnancy .  Nutrient intake analysis , which serves as the basis for this report , was available from 251 pregnancies . Subjects were stratified by blood Phe control of < or = 600 micromol/L by 8 weeks gestation or > 600 micromol/L by 8 weeks gestation . Outcome of these pregnancies was correlated to blood Phe levels , weight gain , and nutrient intake . RESULTS The study goal was to attain blood Phe levels of 120 to 360 micromol/L 3 months preconception ; however , this goal was achieved by only a limited number of patients . Therefore , the data presented were based on blood Phe control < or = 600 micromol/L or > 600 micromol/L by 8 weeks of gestation . Blood Phe control of < or = 600 micromol/L by 8 weeks of gestation was attained by 86 ( 34.3 % ) of the 251 women in this study , whereas the other 165 women had blood Phe control > 600 micromol/L by 8 weeks of gestation . Of the 251 offspring , 166 were born with normal head circumference and 85 were born with microcephaly ( < 2 st and ard deviations below normal ) . Women with blood Phe > 600 micromol/L at 8 weeks of gestation included 78 ( 92 % ) of the 85 infants with microcephaly compared with 8 % in the group of women who had blood Phe levels < or = 600 micromol/L. Weight gain during pregnancy was related to the rate of microcephaly . The highest occurrence of microcephaly ( 58 % ) was found in the pregnant women who gained < 70 % of recommended weight gain . Stepwise logistic regression analysis was used to determine factors associated with microcephaly . Significant factors included higher blood Phe levels when off diet , higher average Phe exposure during the pregnancy , low prepregnancy weight , poor weight gain during the pregnancy , and lower intake of protein and higher iron intake during the pregnancy . Infants with CHD were found only in the group of women who had blood Phe levels > 600 micromol/L by 8 weeks of gestation . There was a higher rate of CHD in the offspring who were born to women who consumed < 50 % of the recommended intake of protein in the first trimester . The main source of protein for women with PKU is the medical food ; therefore , when protein intake was low , vitamin and mineral intakes were also inadequate . CONCLUSIONS The data indicate that blood Phe control and how soon it is attained during pregnancy with PKU is important . Normal pregnancy weight gain should be encouraged to reduce microcephaly . Adequate protein and vitamin intakes early in pregnancy may have a protective effect for the prevention of CHD , even if blood Phe is elevated . The rate of microcephaly and CHD may be reduced if nutrient intake is optimal while attempting to control blood Phe levels Background Fetal and neonatal mortality rates in low-income countries are at least 10-fold greater than in high-income countries . These differences have been related to poor access to and poor quality of obstetric and neonatal care . Methods This trial tested the hypothesis that teams of health care providers , administrators and local residents can address the problem of limited access to quality obstetric and neonatal care and lead to a reduction in perinatal mortality in intervention compared to control locations . In seven geographic areas in five low-income and one middle-income country , most with high perinatal mortality rates and substantial numbers of home deliveries , we performed a cluster r and omized non-masked trial of a package of interventions that included community mobilization focusing on birth planning and hospital transport , community birth attendant training in problem recognition , and facility staff training in the management of obstetric and neonatal emergencies . The primary outcome was perinatal mortality at ≥28 weeks gestation or birth weight ≥1000 g. Results Despite extensive effort in all sites in each of the three intervention areas , no differences emerged in the primary or any secondary outcome between the intervention and control clusters . In both groups , the mean perinatal mortality was 40.1/1,000 births ( P = 0.9996 ) . Neither were there differences between the two groups in outcomes in the last six months of the project , in the year following intervention cessation , nor in the clusters that best implemented the intervention . Conclusions This cluster r and omized comprehensive , large-scale , multi-sector intervention did not result in detectable impact on the proposed outcomes . While this does not negate the importance of these interventions , we expect that achieving improvement in pregnancy outcomes in these setting s will require substantially more obstetric and neonatal care infrastructure than was available at the sites during this trial , and without them provider training and community mobilization will not be sufficient . Our results highlight the critical importance of evaluating outcomes in r and omized trials , as interventions that should be effective may not be . Trial registration Clinical Trials.gov Objectives Infant birth weight is influenced by modifiable maternal pre-pregnancy behaviors and characteristics . We evaluated the relationship among pre-pregnancy body mass  index ( BMI ) , gestational weight gain , and infant birth weight , in a prospect i ve cohort study . Methods Women were enrolled at ≤20 weeks gestation , completed in-person interviews and had their medical records review ed after delivery .  Infant birth weight was first analyzed as a continuous variable , and then grouped into Low birth weight ( LBW ) ( < 2,500 g ) , normal birth weight ( 2,500–3,999 g ) , and macrosomia ( ≥4,000 g ) in categorical analysis . Pre-pregnancy BMI and gestational weight gain were categorized based on Institute of Medicine BMI groups and gestational weight gain guidelines . Associations among infant birth weight and pre-pregnancy BMI , gestational weight gain , and other factors were evaluated using multivariate regression . Risk ratios were estimated using generalized linear modeling procedures . Results Pre-pregnancy BMI was independently and positively associated with infant birth weight ( β = 44.7 , P = 0.001 ) after adjusting for confounders , in a quadratic model . Gestational weight gain was positively associated with infant birth weight ( β = 19.5 , P < 0.001 ) . Lower infant birth weight was associated with preterm birth ( β = −965.4 , P < 0.001 ) , nulliparity ( β = −48.6 , P = 0.015 ) , and female babies ( β = −168.7 , P < 0.001 ) . Less than median gestational weight gain was associated with twice the risk of LBW ( RR = 2.04 , 95 % CI 1.34–3.11 ) . Risk of macrosomia increased with increasing pre-pregnancy BMI and gestational weight gain ( P for linear trend < 0.001 ) . Conclusions These findings support the need to balance pre-pregnancy weight and gestational weight gain against the risk of LBW and macrosomia among lean and obese women , respectively OBJECTIVE To determine population -based neonatal mortality rates in low- and middle-income countries and to examine gestational age , birth weight , and timing of death to assess the potentially preventable neonatal deaths . METHODS A prospect i ve observational study was conducted in communities in five low-income countries ( Kenya , Zambia , Guatemala , India , and Pakistan ) and one middle-income country ( Argentina ) . Over a 2-year period , all pregnant women in the study communities were enrolled by trained study staff and their infants followed to 28 days of age . RESULTS Between October 2009 and March 2011 , 153,728 babies were delivered and followed through day 28 . Neonatal death rates ranged from 41 per 1000 births in Pakistan to 8 per 1000 in Argentina ; 54 % of the neonatal deaths were > 37 weeks and 46 % weighed 2500 g or more . Half the deaths occurred within 24 hours of delivery . CONCLUSION In our population -based low- and middle-income country registries , the majority of neonatal deaths occurred in babies > 37 weeks ' gestation and almost half weighed at least 2500 g. Most deaths occurred shortly after birth . With access to better medical care and hospitalization , especially in the intrapartum and early neonatal period , many of these neonatal deaths might be prevented Summary Background Fast weight gain and linear growth in children in low-income and middle-income countries are associated with enhanced survival and improved cognitive development , but might increase risk of obesity and related adult cardiometabolic diseases . We investigated how linear growth and relative weight gain during infancy and childhood are related to health and human capital outcomes in young adults . Methods We used data from five prospect i ve birth cohort studies from Brazil , Guatemala , India , the Philippines , and South Africa . We investigated  body-mass index , systolic and diastolic blood pressure , plasma glucose concentration , height , years of attained schooling , and related categorical indicators of adverse outcomes in young adults . With linear and logistic regression models , we assessed how these outcomes relate to birthweight and to statistically independent measures representing linear growth and weight gain independent of linear growth ( relative weight gain ) in three age periods : 0–2 years , 2 years to mid-childhood , and mid-childhood to adulthood . Findings We obtained data for 8362 participants who had at least one adult outcome of interest . A higher birthweight was consistently associated with an adult body-mass index of greater than 25 kg/m2 ( odds ratio 1·28 , 95 % CI 1·21–1·35 ) and a reduced likelihood of short adult stature ( 0·49 , 0·44–0·54 ) and of not completing secondary school ( 0·82 , 0·78–0·87 ) . Faster linear growth was strongly associated with a reduced risk of short adult stature ( age 2 years : 0·23 , 0·20–0·52 ; mid-childhood : 0·39 , 0·36–0·43 ) and of not completing secondary school ( age 2 years : 0·74 , 0·67–0·78 ; mid-childhood : 0·87 , 0·83–0·92 ) , but did raise the likelihood of overweight ( age 2 years : 1·24 , 1·17–1·31 ; mid-childhood : 1·12 , 1·06–1·18 ) and elevated blood pressure ( age 2 years : 1·12 , 1·06–1·19 ; mid-childhood : 1·07 , 1·01–1·13 ) . Faster relative weight gain was associated with an increased risk of adult overweight ( age 2 years : 1·51 , 1·43–1·60 ; mid-childhood : 1·76 , 1·69–1·91 ) and elevated blood pressure ( age 2 years : 1·07 , 1·01–1·13 ; mid-childhood : 1·22 , 1·15–1·30 ) . Linear growth and relative weight gain were not associated with dysglycaemia , but a higher birthweight was associated with decreased risk of the disorder ( 0·89 , 0·81–0·98 ) . Interpretation Interventions in countries of low and middle income to increase birthweight and linear growth during the first 2 years of life are likely to result in substantial gains in height and schooling and give some protection from adult chronic disease risk factors , with few adverse trade-offs . Funding Wellcome Trust and Bill & Melinda Gates Foundation OBJECTIVE To investigate the relation between gestational weight gain in women of normal prepregnant weight and complications during pregnancy and delivery in a population with high gestational weight gain and birth weight . METHODS Healthy women ( n = 615 ) of normal weight before pregnancy ( body mass index 19.5–25.5 kg/m2 ) were r and omly selected . Maternity records gave information on age , height , prepregnant weight , gestational weight gain , parity , smoking , gestational hypertension and diabetes , preeclampsia , delivery complications , and infants ' birth size and health . RESULTS The mean weight gain in pregnancy was 16.8 ± 4.9 kg ( mean ± st and ard deviation ) . A total of 26.4 % of the women had complications , either in pregnancy ( 9.1 % ) or delivery ( 17.3 % ) . Women gaining weight according to the recommendation of the Institute of Medicine ( 11.5–16.0 kg ) had lower frequency of pregnancy‐delivery complications than women gaining more than 20.0 kg ( P = .017 ) , but did not differ significantly from those gaining 16–20 kg ( P > .05 ) . When dividing weight gain in pregnancy into quintiles , a relative risk of 2.69 ( 95 % confidence interval 1.01 , 7.18 , P = .048 ) was found for complications in pregnancy in the fourth quintile ( 17.9–20.8 kg ) , using the second quintile as reference ( 12.5–15.5 kg ) . The mean birth weight was 3778 ± 496 g. A low weight gain in pregnancy ( less than 11.5 kg ) was associated with an increased frequency of infants weighing less than 3500 g at birth ( P < .01 ) . CONCLUSION A gestational weight gain of 11.5–16.0 kg ( Institute of Medicine recommendation ) for women of normal prepregnant weight is related to the lowest risk for pregnancy‐delivery complications . In the population studied , the upper limit might be higher ( up to 18 kg ) , and low weight gain should be avoided to optimize birth outcome BACKGROUND Vitamin D insufficiency is beginning to be recognized as a public health problem . It is plausible that some portion of the lower Vitamin D levels which characterize minority population s is related to diet . AIMS We examined and described total Vitamin D intake during pregnancy from the mean of three 24-hour recalls plus use of dietary supplements . STUDY DESIGN Prospect i ve cohort . SUBJECTS 2251 low income , minority gravidae from Camden , New Jersey , USA . OUTCOME MEASURES Differences in total Vitamin D intake by maternal ethnicity . BMI and other factors ( age , parity ) and associations of total Vitamin D intake with gestation duration and birth weight adjusted for gestation . RESULTS AND CONCLUSIONS Total Vitamin D intake was significantly lower for minority gravidae ( African American , and Hispanic , mainly Puerto Rican ) , for parous women , and for women with pregravid BMI s consistent with obesity or being overweight . After control for energy , other nutrients , and other potential confounding variables , total intake of Vitamin D was associated with increased infant birth weight ; gravidae below the current adequate intake ( < 5 microg/day or 200 IU ) had infants with significantly lower birth weights ( p<0.05 ) . Additional intake of Vitamin D may be of importance since higher intake is associated with increased birth weight in a population at risk of adverse pregnancy outcomes As part of a feasibility study to prevent gestational diabetes mellitus ( GDM ) , we evaluated the effect of an intensive dietary therapy on quality of diet , weight gain and birth weight in women at high risk of GDM . Women with risk factors for GDM ( n 54 ) were r and omly assigned from April 2005 to May 2006 to a  lifestyle intervention group ( n 27 ) including dietary advice six times during pregnancy or to a close follow-up group ( n 27 ) in a community-based setting in Finl and . Dietary intake was recorded three times during pregnancy using 4 d food records . The main outcome was the incidence of GDM . The secondary outcomes were the changes in nutrient intake , weight gain and birth weight . Overall , seventeen ( 65 % ) women in the intervention group and eighteen ( 69 % ) women in the close follow-up group returned all three food records . PUFA intake increased ( P = 0·008 ) during pregnancy in the intervention as compared to the close follow-up group . There were no clear differences in the changes of saturated fat or fibre intake between the groups . Intensive dietary education result ed in a somewhat lower weight gain during pregnancy ( P = 0·062 ) and higher birth weights of the infants ( P = 0·047 ) without an effect on macrosomia as compared to the close follow-up group . Individualised counselling by a clinical nutritionist as part of a lifestyle intervention improved the quality of dietary fat intake in pregnant women at high risk of GDM
Maternal fat intake ( n = 25 ) might be associated with gestational weight gain as suggested by observational studies , although the direction of this association might depend on specific types of fat ( e.g. , saturated fat ) .
Macronutrient intake was not consistently associated with the prevalence of inadequate or excessive gestational weight gain .
CONCLUSIONS The current literature provides evidence that energy intake is associated with gestational weight gain , but the roles of individual macronutrients are inconsistent .
BACKGROUND  Abnormal gestational weight gain is associated with unfavorable pregnancy outcomes .
Several risk factors have been identified , but the effect of macronutrient intake during pregnancy on gestational weight gain has not been systematic ally evaluated in both high-income countries and low- and middle-income countries .