The Maternal Obesity Management (MOM) Trial Protocol: A lifestyle intervention during pregnancy to minimize downstream obesity

Adamo, Kristi B.; Ferraro, Zachary M.; Goldfield, Gary S.; Keely, Erin; Stacey, Dawn; Hadjiyannakis, Stasia; Jean-Philippe, Sonia; Walker, Mark; Barrowman, Nicholas

doi:10.1016/j.cct.2013.02.010

Cited by 48 publications

(42 citation statements)

References 99 publications

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“…Aliyu et al 15 apresentaram em seu estudo a associação entre obesidade materna e ocorrência de parto instrumental. Adamo et al 16 também verificaram um número maior de cesarianas em pacientes com IMC superiores aos valores normais. Esses resultados convergem com os encontrados neste estudo, no qual…”

Section: Discussionunclassified

“…O IMC (kg/m²) pré-gestacional foi classificado a partir dos critérios da OMS como de baixo peso (<18,5), normal (18,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)9) Referências a chance de parto normal foi reduzida em cinco vezes nas mulheres obesas. A ocorrência de diabetes gestacional e DHEG tem sido associada diretamente ao excesso de peso da gestante 10,13,17,18 .…”

Section: Métodosunclassified

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Obesidade durante a gravidez: resultados adversos da gestação e do parto

Silva

Amaral

Ferreira

et al. 2014

Rev. Bras. Ginecol. Obstet.

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ResumoOBJETIVO: Avaliar a influência do excesso de peso materno na gestação, no parto e nos desfechos neonatais. MÉTODOS: Estudo transversal e retrospectivo que incluiu 298 puérperas. As informações foram obtidas por meio de entrevistas e acesso aos prontuários das pacientes. As puérperas foram divididas em três grupos, conforme o índice de massa corpórea pré-gestacional: normal (18,5-24,9 kg/m²); sobrepeso (25,0-29,9 kg/m²) e obesidade (≥30,0 kg/m²). Foram construídos modelos de regressão logística multinominal para ajustar o efeito das variáveis de confusão. Estabeleceram-se intervalos de confiança de 95% (IC95%). RESULTADOS: Comparadas às gestantes com peso normal, pacientes com sobrepeso apresentaram chances maiores de cesariana, sendo a odds ratio (OR) de 2,2 e IC95% 1,3-3,9, e as obesas tiveram ainda maiores (OR=4,2; IC95% 2,1-8,1). As chances de desenvolvimento de diabetes gestacional aumentaram nos grupos Sobrepeso (OR=2,5; IC95% 1,1-5,6) e Obesidade (OR=11,1; IC95% 5,0-24,6). A síndrome hipertensiva na gravidez também se mostrou mais provável nas gestantes com sobrepeso (OR=3,2; IC95% 1,2-8,1) e obesas (OR=7,5; IC95% 2,9-19,1). A hemorragia de grande porte no momento do parto somente apresentou maiores valores no grupo de obesas (OR=4,1; IC95% 1,1-15,8). Quanto aos recém-nascidos, a probabilidade de Apgar baixo no primeiro minuto foi superior entre as obesas (OR=5,5; IC95% 1,2-23,7), e a ocorrência de macrossomia aumentou nas mulheres com sobrepeso (OR=2,9; IC95% 1,3-6,3). Os resultados quanto à hipoglicemia neonatal não foram conclusivos. CONCLUSÃO: As chances de intercorrências maternas (diabetes gestacional, síndrome hipertensiva, hemorragia pós-parto) e neonatais (cesariana, macrossomia e escore Apgar baixo) foram maiores nos grupos com excesso de peso (sobrepeso e obesidade). Abstract PURPOSE:To evaluate the influence of maternal obesity on pregnancy, childbirth, and neonatal outcomes. METHODS: A cross-sectional study with 298 postpartum women. Information was obtained through interviews and access to patients' medical records. The patients were divided into three groups according to their pre-gestational body mass index: normal weight (18.5-24.9 kg/m²), overweight (25.0-29.9 kg/m²), and obese (≥30.0 kg/m²). Data are reported as adjusted odds ratios with 95% confidence interval (95%CI) following multinomial logistic regression analysis to account for confounding variables. RESULTS: Compared to pregnant women with normal body mass index, overweight women had greater chances of having cesarean delivery, odds ratio (OR) of 2.2 and 95%CI 1.3-3.9, and obese women even more (OR=4.2; 95%CI 2.1-8.1). The chances of gestational diabetes increased in the Overweight (OR=2.5; 95%CI 1.1-5.6) and Obese groups (OR=11.1; 95%CI 5.0-24.6). The occurrence of hypertensive syndrome was also higher in overweight (OR=3.2; 95%CI 1.2-8.1) and obese pregnant women (OR=7.5; 95%CI 2.9-19.1). Major postpartum hemorrhage only showed greater values in the obese women group (OR=4.1; 95%CI 1.1-15.8).Regarding the newborns, the pro...

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Section: Métodosunclassified

Obesidade durante a gravidez: resultados adversos da gestação e do parto

Silva

Amaral

Ferreira

et al. 2014

Rev. Bras. Ginecol. Obstet.

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“…21 Hence, with respect to each variable analyzed, these correlations make it possible for the reader to identify the events caused by maternal overweight and to deem dyslipidemic alternations as indicators of complications, such as predisposition to high systemic arterial blood pressure, cardiometabolic events and the outcomes of a premature delivery. 18,22,23 Dyslipidemic complications in preterm birth Even though changes in pregnancy are evident, the likelihood of a clinical and physiological imbalance during the gestational period is indisputable. It is therefore essential that pregnant women be followed up and have their weight controlled to ensure both maternal and fetal health.…”

Section: Metabolic Changes and Gestational Dyslipidemiamentioning

confidence: 99%

Dyslipidemia and maternal obesity: Prematurity and neonatal prognosis

Nascimento

Souza

Silva

et al. 2018

Rev. Assoc. Med. Bras.

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NascimeNto iB et al. 264Rev assoc med Objective: To identify the changes caused by dyslipidemia and obesity in pregnancy suggesting causes for premature birth, and the prognosis for the newborn. Method: Systematic review based on the Medline, Lilacs, Embase and Cochrane library databases between 1996 and 2016. The search for studies included the following keywords: "dyslipidemia, pregnancy, obesity, preterm birth." A protocol was programmed and a protocol for inclusion/exclusion of studies was implemented. Results: Of the 5,789 articles initially selected between March 1996 and July 2016, only 32 were in accordance with the established criteria. Of these, 28.12% discussed risk factors of prematurity; 37.50%, metabolic alterations and gestational dyslipidemia; 21.87%, dyslipidemic complications in preterm birth; and 12,50%, lipid metabolism, glycemic and placental transfer. Conclusion:There is a reduced adaptation of obese pregnant women to the metabolic changes of gestation. This favors dyslipidemic intercurrences in the mother, which, directly or indirectly, suggests the occurrence of premature births and high lipid transfer to the fetus. Therefore, preterm newborns, whose mothers were dyslipidemic during pregnancy, have greater risk of epicardial fat, both in early (first year of life) and in later (adult) phases of life.

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“…Regular moderate intensity PA during pregnancy has consistently been shown to reduce the incidence of GDM [21][22][23][24] and pre-eclampsia [23,[25][26][27][28][29], two pregnancy-related complications implicated in poor neonatal outcomes and downstream child health. Systematic reviews and meta-analyses looking exclusively at PA interventions during pregnancy have shown success in restricting GWG (-0.36 kg, 95% CI: -0.64 to -0.09 kg [30]; -0.61 kg, 95% CI: -1.17, -0.06 [31]; -0.91kg , 95% CI: -1.76, -0.06 [32]) but few studies have been designed to examine the effects on longer-term child growth or body composition [33][34][35]. Data that are available from population-level surveillance, randomized controlled trials, and prospective birth cohorts suggest that regular, moderate amounts of PA can protect against birth weight extremes (i.e.…”

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confidence: 99%

“…Data that are available from population-level surveillance, randomized controlled trials, and prospective birth cohorts suggest that regular, moderate amounts of PA can protect against birth weight extremes (i.e. small-and large-for-gestational age), and increase the likelihood of delivering an infant whose birth weight is appropriate for their gestational age [28][29][30][31][32][33][34][35][36]. Research demonstrating a reduction in fetal growth without an increased incidence of small-forgestational-age infants suggests that sensible prenatal exercise may help normalize nutrient supply to the fetus, thus helping regulate fetal growth [37].…”

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confidence: 99%

Optimizing Pregnancy for Intergenerational Health Benefits

Ferraro

2017

UOJM

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A mong the many factors that contribute to childhood obesity (i.e. maternal smoking, nutrition/sugar intake, air pollution, endocrine disruptors, sleep disturbance, lack of breastfeeding), there are two powerful maternal determinants: high maternal body mass index (BMI) and exceeding the Institute of Medicine (IOM) gestational weight gain (GWG) guidelines [1]. Furthermore, pregnancy weight-related issues increase the likelihood of adverse cardiovascular risk factors in offspring [2,3]. Excessive GWG is directly linked to giving birth to a large-for-gestational-age (LGA) neonate [4], which is predictive of downstream obesity and chronic conditions, including Type 2 diabetes and cardiovascular disease [reviewed in 5,6]. Recently, high birth weight and parental overweight/obesity were associated with lower levels of both physical activity (PA) and cardiorespiratory fitness in adolescence [7], further supporting the need for prenatal strategies that optimize fetal growth for long-term health. To the surprise of many, excessive GWG in normal-weight women is associated with higher neonatal fat mass and less favorable body composition (i.e. greater percentage of body fat, less muscle mass) [8]. This dysregulation in body composition suggests that an energy surplus in utero acts independent of parental genetics with respect to predisposition for excess weight. In fact, according to recent systematic reviews and meta-analyses, excessive GWG increases the risk of childhood overweight/obesity by 30-40% [9,10], thereby propagating the intergenerational cycle of obesity and the proliferation of chronic disease [5]. This may be due to a host of sociopolitical and physiological factors that promote maternal resource storage, decrements in PA, a loss of metabolic control, and a partitioning of excess energy reserves to the fetus [5,11].Physical activity remains one of nature's best medicines for prevention and management of chronic disease [12]. However, it is seldom recommended in pregnancy [13]. Furthermore, population PA levels are at an all-time low [14] and reach a nadir during the prenatal period. The reasons for these observations are not well-established, but likely involve a patient-provider knowledge translation discrepancy [15]. Despite the historical dogma and the ensuing clinical recommendations, a pregnant Keywords: Pregnancy; Physical activity; Pediatrics; Obstetrics; Exercise Pregnancy is a critical period of body weight regulation for both mother and baby. Vital energy-sensing processes are established in utero that aid in nutrient storage and metabolic control later in life. Excessive weight gain during pregnancy and a surplus of maternal resources leads to preferential shuttling of nutrients and growth-promoting peptides across the placenta, resulting in fetal overgrowth -a well-established predictor of childhood obesity. Physical activity during pregnancy offers a safe and accessible way in which one can modify these intricate cellular networks across the maternal-placental-fetal interface to prevent dysregu...

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The Maternal Obesity Management (MOM) Trial Protocol: A lifestyle intervention during pregnancy to minimize downstream obesity

Cited by 48 publications

References 99 publications

Obesidade durante a gravidez: resultados adversos da gestação e do parto

Obesidade durante a gravidez: resultados adversos da gestação e do parto

Dyslipidemia and maternal obesity: Prematurity and neonatal prognosis

Optimizing Pregnancy for Intergenerational Health Benefits

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