Counseling and Behavioral Interventions for Healthy Weight and Weight Gain in Pregnancy

Cantor, Amy; Jungbauer, Rebecca; McDonagh, Marian; Blazina, Ian; Marshall, Nicole; Weeks, Chandler; Fu, Rongwei; LeBlanc, Erin S.; Chou, Roger

doi:10.1001/jama.2021.4230

Cited by 95 publications

(20 citation statements)

References 122 publications

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“…Although this analysis cannot identify what effective interventions may be (eg, health behavior counseling before and during pregnancy, pharmacotherapy prepregnancy for weight loss), this analysis demonstrates that weight optimization should be an important focus for public health strategies to improve maternal health in the short- and long-term. The US Preventive Services Task Force 57 and the American College of Obstetricians and Gynecologists recommend clinicians provide resources or refer people of reproductive age to behavioral interventions to enhance healthful behaviors before conception, which was also highlighted in a joint statement by the American College of Obstetricians and Gynecologists and American Heart Association. 58,59 However, execution of such counseling and interventions is limited by the inadequacy of the US health care system.…”

Section: Discussionmentioning

confidence: 99%

Body Mass Index, Adverse Pregnancy Outcomes, and Cardiovascular Disease Risk

Khan,

Petito,

Huang

et al. 2023

Circulation Research

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BACKGROUND: Obesity is a well-established risk factor for both adverse pregnancy outcomes (APOs) and cardiovascular disease (CVD). However, it is not known whether APOs are mediators or markers of the obesity-CVD relationship. This study examined the association between body mass index, APOs, and postpartum CVD risk factors. METHODS: The sample included adults from the nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be) Heart Health Study who were enrolled in their first trimester (6 weeks–13 weeks 6 days gestation) from 8 United States sites. Participants had a follow-up visit at 3.7 years postpartum. APOs, which included hypertensive disorders of pregnancy, preterm birth, small-for-gestational-age birth, and gestational diabetes, were centrally adjudicated. Mediation analyses estimated the association between early pregnancy body mass index and postpartum CVD risk factors (hypertension, hyperlipidemia, and diabetes) and the proportion mediated by each APO adjusted for demographics and baseline health behaviors, psychosocial stressors, and CVD risk factor levels. RESULTS: Among 4216 participants enrolled, mean±SD maternal age was 27±6 years. Early pregnancy prevalence of overweight was 25%, and obesity was 22%. Hypertensive disorders of pregnancy occurred in 15%, preterm birth in 8%, small-for-gestational-age birth in 11%, and gestational diabetes in 4%. Early pregnancy obesity, compared with normal body mass index, was associated with significantly higher incidence of postpartum hypertension (adjusted odds ratio, 1.14 [95% CI, 1.10–1.18]), hyperlipidemia (1.11 [95% CI, 1.08–1.14]), and diabetes (1.03 [95% CI, 1.01–1.04]) even after adjustment for baseline CVD risk factor levels. APOs were associated with higher incidence of postpartum hypertension (1.97 [95% CI, 1.61–2.40]) and hyperlipidemia (1.31 [95% CI, 1.03–1.67]). Hypertensive disorders of pregnancy mediated a small proportion of the association between obesity and incident hypertension (13% [11%–15%]) and did not mediate associations with incident hyperlipidemia or diabetes. There was no significant mediation by preterm birth or small-for-gestational-age birth. CONCLUSIONS: There was heterogeneity across APO subtypes in their association with postpartum CVD risk factors and mediation of the association between early pregnancy obesity and postpartum CVD risk factors. However, only a small or nonsignificant proportion of the association between obesity and CVD risk factors was mediated by any of the APOs, suggesting APOs are a marker of prepregnancy CVD risk and not a predominant cause of postpartum CVD risk.

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Section: Discussionmentioning

confidence: 99%

Body Mass Index, Adverse Pregnancy Outcomes, and Cardiovascular Disease Risk

Khan,

Petito,

Huang

et al. 2023

Circulation Research

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“…The relationship between gestational weight gain and pregnancy outcomes has been illustrated many times, across all continents 77–79 . Recent evidence reiterates the relationship between interventions to promote healthy weight gain in pregnancy and optimal maternal and child outcomes 80 . Standardisation in reporting will further enhance the quality and certainty of evidence in this area 81 …”

Section: Discussionmentioning

confidence: 99%

“…T A B L E 2 (Continued) optimal maternal and child outcomes. 80 Standardisation in reporting will further enhance the quality and certainty of evidence in this area. 81…”

Section: Discussionmentioning

confidence: 99%

Pregnancy Nutrition Core Outcome Set (PRENCOS): A core outcome set development study

Killeen

Callaghan

O’Reilly

et al. 2023

BJOG

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To develop a core outcome set for pregnancy nutrition. Design: Mixed-methods core outcome set development study. Setting: Online. Population: Healthcare professionals, researchers and women with experience of pregnancy. Methods: Candidate outcomes were identified from a systematic review of intervention and observational studies. One-to-one semi-structured interviews with women with experience of pregnancy (n = 26) were transcribed and analysed using inductive thematic analysis. Outcomes were consolidated, organised into domains and categorised using the Core Outcome Measures in Effectiveness Trials taxonomy. A two-round, modified Delphi survey (May-August 2021) was conducted. Participants voted on how critical each outcome was to include using a nine-point Likert scale. All outcomes that did not reach consensus were discussed at a consensus meeting. Main outcome measures: Critical outcomes to include in the core outcome set. Results: A total of 53 091 articles were identified. Outcomes were extracted from 427 articles. The qualitative data yielded 45 outcomes. An additional 24 outcomes came from the literature. In round one, 82 participants ranked 30 outcomes. One new outcome was included in round two, during which participants (n = 60) voted 12/31 outcomes as critical to include. The remaining 20 outcomes were discussed at the consensus meeting and two outcomes were included. Maternal outcomes included: pregnancy complications; delivery complications; maternal wellbeing; gestational weight change; maternal vitamin and mineral status; mental health; diet quality; nutritional intakes; need for treatments, interventions, medications and supplements; pregnancy loss or perinatal death; birth defects or congenital anomalies; neonatal complications; and newborn anthropometry and body composition. Conclusions: The use of the Pregnancy Nutrition Core Outcome Set (PRENCOS) will ensure researchers measure what matters most from the perspective of key stakeholders. K E Y W O R D S core outcome set, nutrition, outcomes, pregnancy F I G U R E 2 PRISMA flow chart. *Titles were not retrieved if the work was an abstract only (e.g. poster presentation) or was published in a language other than English.

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“…To curb or attenuate the deleterious consequences associated with prepregnancy obesity, many lifestyle interventions focusing on weight management during pregnancy have been carried out. Yet, although being effective in reducing gestational weight gain (GWG), those interventions demonstrated minimal benefits (if any) in improving obstetrical or neonatal outcomes 3,4 . Justifiably, the preconception period has been considered a critical window for restoring maternal physiological milieu, and there is widespread recognition that women with obesity should address weight issues prior to, not during, pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Prepregnancy weight loss and maternal metabolic and inflammatory biomarkers during pregnancy: An analysis of National Health and Nutrition Examination Survey

Yu,

Ma,

Groth

2024

J of Obstet and Gynaecol

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AimWomen with overweight or obesity are recommended to lose weight before conception to optimize pregnancy outcomes. However, the obstetrical implications of prepregnancy weight loss have been minimally examined. The objective of this study was to investigate the association between prepregnancy weight loss and maternal metabolic and inflammatory profiles during a subsequent pregnancy.MethodsThis study was a retrospective analysis of National Health and Nutrition Examination Survey data (2003–2018). Participants were women who were pregnant at the time of assessment. Prepregnancy weight loss was described as percent weight change based on self‐reported baseline (1 year before pregnancy) and prepregnancy weight. Metabolic (e.g., blood pressure [BP]) and inflammatory biomarkers (i.e., high‐sensitivity C‐reactive protein [hs‐CRP]) were determined by standard medical tests. Statistical analyses included linear regressions with appropriate imputation, weighting, and variance estimation techniques.ResultsParticipants (N = 236) reported a mean percent weight loss of 4.6% (standard error [SE] = 0.3%) during the year before pregnancy. Regression models showed that prepregnancy weight loss was inversely associated with levels of total cholesterol (β = −1.24, p = 0.01), low‐density lipoprotein‐cholesterol (β = −0.79, p < 0.01), and high‐density lipoprotein‐cholesterol (β = −0.18, p < 0.01). The effect of prepregnancy weight loss on BP, insulin sensitivity, and hs‐CRP was not significant, although there was a trend toward higher levels of diastolic BP (β = 0.24, p = 0.07) and hs‐CRP (β = 0.10, p = 0.08).ConclusionsThis study found favorable changes in lipid profiles following prepregnancy weight loss. Due to limitations such as a relatively small sample size, self‐reported weight measures, and missing data on several outcome variables, future studies are needed to confirm study findings.

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Counseling and Behavioral Interventions for Healthy Weight and Weight Gain in Pregnancy

Cited by 95 publications

References 122 publications

Body Mass Index, Adverse Pregnancy Outcomes, and Cardiovascular Disease Risk

Body Mass Index, Adverse Pregnancy Outcomes, and Cardiovascular Disease Risk

Pregnancy Nutrition Core Outcome Set (PRENCOS): A core outcome set development study

Prepregnancy weight loss and maternal metabolic and inflammatory biomarkers during pregnancy: An analysis of National Health and Nutrition Examination Survey

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