The Institute of Medicine's gestational weight gain guidelines are intended to reduce pregnancy complications, poor birth outcomes and excessive postpartum weight retention. The specific weight gain guidelines vary by prepregnancy weight status. We evaluated the validity of prepregnancy weight status (underweight, normal weight, overweight and obesity) classified from self-reported prepregnancy height and weight in reference to those from measured data during the first trimester of pregnancy and imputed data for both pregnant and age-matched non-pregnant women included in the National Health and Nutrition Examination Survey 2003-2006. Self-reported prepregnancy weight status was validated by two ideal references: imputed data with the number of imputations as 10 (n = 5,040) using the data of age-matched non-pregnant women who had both self-reported and measured data, and weight status based on height and weight measured during the first trimester (n = 95). Mean differences, Pearson's correlations (r), and Kappa statistics (κ) were used to examine the strength of agreement between self-reported data and the two reference measures. Mean (standard error of the mean) differences between self-reported versus imputed prepregnancy weight was -1.7 (0.1) kg with an r = 0.98 (p < 0.001), and κ = 0.78 which indicate substantial agreement for the 504 pregnant women. Mean (SEM) differences between self-reported prepregnancy weight versus measured weight in the first trimester was -2.3 (0.7) kg with r = 0.98 (p < 0.001), and κ = 0.76, which also showed substantial agreements in 95 pregnant women. Prepregnancy weight status classified based on self-reported prepregnancy height and weight was valid.

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The gestational weight gain (GWG) guidelines of the Institute of Medicine (IOM) aim to optimize birth outcomes and reduce pregnancy complications. The GWG guidelines are set based on the prepregnancy weight status and optimal weight gain at different trimesters of pregnancy. Dietary references intakes (DRIs) of the IOM are set for each trimester of pregnancy for energy intake and other essential nutrients by age groups (≤ 18, 19-30, 31-51 years). The DRIs, however, do not take into account the differing energy and nutrient requirements of women with different prepregnancy weights. In this cross-sectional study, we tested the hypothesis that diet quality during pregnancy is associated with adequate GWG at different stages of pregnancy. Diet quality during pregnancy was assessed from a 24-h recall measured by the healthy eating index of 2005 (HEI-2005). Both GWG and diet quality data were from 490 pregnant women aged 16-43 years included in National Health and Nutrition Examination Survey 2003-2006, a program of studies designed to assess the health and nutritional status of adults and children in the US, during which pregnant women were oversampled. Logistic regression models adjusted for age, trimester of gestation, race/ethnicity, education level, marital status, family poverty income ratio, daily supplement use, physical activity, and prepregnancy BMI were used to investigate if HEI-2005 is a determinant of GWG status at different trimesters of pregnancy. We found that HEI-2005 scores were not determinants of adequate GWG, although inadequate intake of total vegetables (OR 3.8, CI 1.1-13.2, p = 0.03) and oils were associated with excessive GWG (OR 2.8, CI 1.2-6.4, p = 0.02) when covariates were controlled. Although adequate GWG was not associated with diet quality as measured by HEI-2005 during pregnancy in this study, comprehensive prenatal counseling is still important to reduce adverse birth outcomes.

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Objective: We tested the relative importance of a low-glycemic response versus a high glycemic response breakfast meal on postprandial serum glucose, insulin and free fatty acid (FFA) responses after consumption of a standardized mid-day meal in adult individuals with Type 2 diabetes mellitus (DM). Design: Following an overnight fast of 8-10 h, a randomized crossover intervention using control and test meals was conducted over a 3-week-period. A fasting baseline measurement and postprandial measurements at various time intervals after the breakfast and mid-day meal were taken. Subjects: Forty-five Type 2 DM subjects completed the requirements and were included in the study results. Interventions: Two different breakfast meals were administered during the intervention: (A) a high glycemic load breakfast meal consisting of farina (kJ 1833; carbohydrate (CHO) 78 g and psylium soluble fiber 0 g), (B) a low-glycemic load breakfast meal consisting of a fiber-loop cereal (kJ 1515; CHO 62 g and psyllium soluble fiber 6.6 g). A standardized lunch was provided approximately 4 h after breakfast. Blood plasma concentrations and area under the curve (AUC) values for glucose, insulin and FFA were measured in response to the breakfast and mid-day lunch. Statistical analyses were performed using SAS software (8.02). Comparisons between diets were based on adjusted Bonferroni t-tests. Results: In post-breakfast analyses, Breakfast B had significantly lower area under the curve (AUC) values for plasma glucose and insulin compared to Breakfast A (Po0.05) (95% confidence level). The AUC values for FFA were higher for Breakfast B than for Breakfast A (Po0.05) (95% confidence level). Post-lunch analyses indicated similar glucose responses for the two breakfast types. Insulin AUC values for Breakfasts B were significantly lower than Breakfast A (Po0.05) (95% confidence level). The AUC values for FFA were unaffected by breakfast type. Conclusions: These data indicate that ingesting a low-glycemic load meal containing psyllium soluble fiber at breakfast significantly improves the breakfast postprandial glycemic, insulinemic and FFA responses in adults with Type 2 DM. These data revealed no residual postprandial effect of the psyllium soluble fiber breakfast meal beyond the second meal consumed. Thus, there was no evidence of an improvement postprandially in the glycemic, insulinemic and FFA responses after the consumption of the lunch meal. Sponsorship: This study was supported with an unrestricted grant from Kellogg Company, Battle Creek, Michigan.