545: The role of gestational weight gain in progression from diet controlled to medically managed gestational diabetes

BACKGROUND Excessive gestational weight gain (GWG) has public health implications including preterm birth, preeclampsia, gestational diabetes, and cesarean delivery. In an effort to mitigate adverse consequences of excessive GWG, this study tests a health intervention that includes enhancements to improve knowledge and awareness of appropriate GWG, and patient-centered nutritional counseling to promote appropriate GWG. OBJECTIVE The primary objective of the study was to increase the proportion of women who are managing their GWG as recommended by the IOM.4,5 METHODS This randomized controlled trial was conducted at Geisinger in Pennsylvania where excessive GWG is common among women with pre-conception obesity. Eligible, consenting participants with pre-pregnancy body mass index >30.0 kg/m2 were randomized (1:1) to: 1) Usual Care: usual written educational materials and counseling by an obstetric care provider or 2) Enhanced Care: Usual Care plus a) a personalized letter from a physician detailing appropriate GWG, b) exposure to individualized GWG chart in the electronic health record via the patient portal, and c) a consult with a Registered Dietitian Nutritionist and follow-up via tele-health counseling (10-20 mins/1-2 weeks) for the duration of the pregnancy. RESULTS The primary outcome was the proportion of women that gain less than 20 pounds over the course of the pregnancy. Secondary outcomes include knowledge, expectations, and attitude about pregnancy weight gain; increased self-efficacy for ability to eat healthy and being physically active to manage weight; and eating behavior. Potential moderators that will be explored include sleep, perceived stress, perceived involvement in care, and household food security. Data collection has been completed as of November 2019. CONCLUSIONS As GWG care was initiated for mothers with pre-pregnancy BMI >30 kg/m2 within the first and second trimesters, the intervention may have the additional benefit of reducing other adverse pregnancy outcomes including the incidence of gestational diabetes due to healthier rates of GWG. In addition to assessing appropriate GWG, this project will assess eating habits, physical activity, GWG attitudes, sleep quality, and psychological measures, all of which are associated with GWG. Exploratory mediators including perceived stress and food insecurity will also be evaluated. CLINICALTRIAL ClinicalTrials.gov NCT02963428

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Association between perinatal factors, genetic susceptibility to obesity and age at adiposity rebound in children of the EDEN mother–child cohort

International Journal of Obesity ◽

10.1038/s41366-021-00847-w ◽

2021 ◽

Author(s):

Aminata Hallimat Cissé ◽

Sandrine Lioret ◽

Blandine de Lauzon-Guillain ◽

Anne Forhan ◽

Ken K. Ong ◽

...

Keyword(s):

Weight Gain ◽

Genetic Susceptibility ◽

Gestational Weight Gain ◽

Gestational Age ◽

Obesity Risk ◽

Perinatal Factors ◽

Gestational Weight ◽

Adiposity Rebound ◽

Kinetics Of

Abstract Background Early adiposity rebound (AR) has been associated with increased risk of overweight or obesity in adulthood. However, little is known about early predictors of age at AR. We aimed to study the role of perinatal factors and genetic susceptibility to obesity in the kinetics of AR. Methods Body mass index (BMI) curves were modelled by using mixed-effects cubic models, and age at AR was estimated for 1415 children of the EDEN mother–child cohort study. A combined obesity risk-allele score was calculated from genotypes for 27 variants identified by genome-wide association studies of adult BMI. Perinatal factors of interest were maternal age at delivery, parental education, parental BMI, gestational weight gain, maternal smoking during pregnancy, and newborn characteristics (sex, prematurity, and birth weight). We used a hierarchical level approach with multivariable linear regression model to investigate the association between these factors, obesity risk-allele score, and age at AR. Results A higher genetic susceptibility to obesity score was associated with an earlier age at AR. At the most distal level of the hierarchical model, maternal and paternal educational levels were positively associated with age at AR. Children born to parents with higher BMI were more likely to exhibit earlier age at AR. In addition, higher gestational weight gain was related to earlier age at AR. For children born small for gestational age, the average age at AR was 88 [±39] days lower than for children born appropriate for gestational age and 91 [±56] days lower than for children born large for gestational age. Conclusion The timing of AR seems to be an early childhood manifestation of the genetic susceptibility to adult obesity. We further identified low birth weight and gestational weight gain as novel predictors of early AR, highlighting the role of the intrauterine environment in the kinetics of adiposity.

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1100 Impact of gestational weight gain in women with chronic hypertension and pre-gestational diabetes

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2020.12.1124 ◽

2021 ◽

Vol 224 (2) ◽

pp. S678

Author(s):

Grace J. Johnson ◽

Haleh Sangi-Haghpeykar ◽

Kjersti M. Aagaard ◽

Alison N. Goulding ◽

Matthew A. Shanahan ◽

...

Keyword(s):

Weight Gain ◽

Gestational Diabetes ◽

Gestational Weight Gain ◽

Chronic Hypertension ◽

Gestational Weight

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Gestational diabetes: Linking epidemiology, excessive gestational weight gain, adverse pregnancy outcomes, and future metabolic syndrome

Seminars in Perinatology ◽

10.1053/j.semperi.2015.05.002 ◽

2015 ◽

Vol 39 (4) ◽

pp. 254-258 ◽

Cited By ~ 34

Author(s):

Celeste Durnwald

Keyword(s):

Metabolic Syndrome ◽

Weight Gain ◽

Gestational Diabetes ◽

Gestational Weight Gain ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcomes ◽

Gestational Weight ◽

Excessive Gestational Weight Gain ◽

Adverse Pregnancy

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Associations between maternal triclosan concentrations in early pregnancy and gestational diabetes mellitus, impaired glucose tolerance, gestational weight gain and fetal markers of metabolic function

Environmental Research ◽

10.1016/j.envres.2017.12.001 ◽

2018 ◽

Vol 161 ◽

pp. 554-561 ◽

Cited By ~ 7

Author(s):

Gabriel D. Shapiro ◽

Tye E. Arbuckle ◽

Jillian Ashley-Martin ◽

William D. Fraser ◽

Mandy Fisher ◽

...

Keyword(s):

Diabetes Mellitus ◽

Weight Gain ◽

Gestational Diabetes ◽

Glucose Tolerance ◽

Gestational Diabetes Mellitus ◽

Impaired Glucose Tolerance ◽

Gestational Weight Gain ◽

Early Pregnancy ◽

Metabolic Function ◽

Gestational Weight

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Gestational weight gain targets during the second and third trimesters of pregnancy for women with gestational diabetes mellitus in China

European Journal of Clinical Nutrition ◽

10.1038/s41430-018-0358-9 ◽

2018 ◽

Vol 73 (8) ◽

pp. 1155-1163 ◽

Cited By ~ 3

Author(s):

Jiang-Nan Wu ◽

Wei-Rong Gu ◽

Xi-Rong Xiao ◽

Yi Zhang ◽

Xiao-Tian Li ◽

...

Keyword(s):

Diabetes Mellitus ◽

Weight Gain ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Gestational Weight Gain ◽

Gestational Weight

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Association between Gestational Weight Gain, Gestational Diabetes Risk, and Obstetric Outcomes: A Randomized Controlled Trial Post Hoc Analysis

Nutrients ◽

10.3390/nu10111568 ◽

2018 ◽

Vol 10 (11) ◽

pp. 1568 ◽

Cited By ~ 9

Author(s):

David Simmons ◽

Roland Devlieger ◽

Andre van Assche ◽

Sander Galjaard ◽

Rosa Corcoy ◽

...

Keyword(s):

Insulin Resistance ◽

Weight Gain ◽

Gestational Diabetes ◽

Gestational Weight Gain ◽

First Trimester ◽

Obstetric Outcomes ◽

Lifestyle Interventions ◽

Gestational Weight ◽

Randomized Controlled ◽

Post Hoc

Excess gestational weight gain (GWG) is associated with the development of gestational diabetes mellitus (GDM). Lifestyle trials have not achieved much GWG limitation, and have largely failed to prevent GDM. We compared the effect of substantial GWG limitation on maternal GDM risk. Pregnant women with a body mass index (BMI) ≥29 kg/m2 <20 weeks gestation without GDM (n = 436) were randomized, in a multicenter trial, to usual care (UC), healthy eating (HE), physical activity (PA), or HE and PA lifestyle interventions. GWG over the median was associated with higher homeostasis model assessment insulin resistance (HOMA-IR) and insulin secretion (Stumvoll phases 1 and 2), a higher fasting plasma glucose (FPG) at 24–28 weeks (4.66 ± 0.43 vs. 4.61 ± 0.40 mmol/L, p < 0.01), and a higher rate of caesarean section (38% vs. 27% p < 0.05). The GWG over the median at 35–37 weeks was associated with a higher rate of macrosomia (25% vs. 16%, p < 0.05). A post hoc comparison among women from the five sites with a GWG difference >3 kg showed no significance difference in glycaemia or insulin resistance between HE and PA, and UC. We conclude that preventing even substantial increases in GWG after the first trimester has little effect on maternal glycaemia. We recommend randomized controlled trials of effective lifestyle interventions, starting in or before the first trimester.

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