Sleep Patterns in Pregnant Women with Obesity Differentially Affect Energy Intake and Metabolic Health

Abstract Objectives During pregnancy, altered glucose kinetics coupled with disrupted sleep increase the risk for adverse metabolic health outcomes. The aim of this prospective, observational study in pregnant women with obesity was to 1) examine sleep patterns in early and late pregnancy; and 2) identify how changes in sleep patterns impact gestational weight gain, energy intake and metabolic health. Methods In 52 healthy pregnant women with obesity (27.4 ± 0.6 y; BMI: 36.3 ± 0.7 kg/m,2), energy intake (intake-balance method), and changes in weight, fasting glucose, insulin, lipids and habitual sleep (5 consecutive nights via wrist worn accelerometer) were assessed from early (13,0–15,6 weeks) to late (35,0–36,6) pregnancy. A change to habitual sleep parameters (increase or decrease) was defined as ± one-half of the standard deviation of the 5-day measurement in early pregnancy. Results Results In early pregnancy, time spent in bed (TIB) was 9.40 ± 0.13 h and varied 1.61 ± 0.11 h across the 5 nights. Total sleep time (TST) and sleep efficiency (SE) significantly declined from early to late pregnancy 7.05 ± 0.13 h to 6.46 ± 0.15 h (P < 0.001) and 76 ± 0.1% to 71 ± 0.2% (P < 0.001), respectively. Women who increased TIB (11 of 52) had a significant decrease in plasma glucose −11.6 ± 4.3% (P < 0.01) and a trend towards lower insulin (−57.8 ± 33.5%; P = 0.09) and HOMA-IR (−72.4 ± 37.3%; P = 0.058) across pregnancy compared to women who decreased their TIB (13 of 52). Women who increased TIB had a significantly lower daily energy intake (−540 ± 163 kcal; P < 0.01) and tended to have less gestational weight gain (−146.7 ± 87.6 g/wk; P = 0.10). There was no difference in weight gain, energy intake or plasma markers between women who increased or decreased TST or SE. Conclusions Although sleep time and sleep quality decline throughout pregnancy, TIB had the greatest impact on metabolic health in pregnant women with obesity. Women spending more TIB consumed fewer calories. Our data suggest that the relationship between glucose metabolism and sleep during pregnancy is at least in part explained by lower energy intakes, possibly due to shorter eating windows. Studies that manipulate the eating window, independent of sleep timing are needed to understand the benefits to metabolic health for women during pregnancy. Funding Sources National Institutes of Health [R01DK099175].

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Greater energy demand of exercise during pregnancy does not impact mechanical efficiency

Applied Physiology Nutrition and Metabolism ◽

10.1139/apnm-2019-0450 ◽

2020 ◽

Vol 45 (5) ◽

pp. 493-499 ◽

Cited By ~ 1

Author(s):

Kathryn M. Denize ◽

Pegah Akbari ◽

Danilo Fernandes da Silva ◽

Francois Haman ◽

Kristi B. Adamo

Keyword(s):

Physical Activity ◽

Weight Gain ◽

Pregnant Women ◽

Gestational Weight Gain ◽

Energy Demand ◽

Movement Pattern ◽

Late Pregnancy ◽

Mechanical Efficiency ◽

Moderate Intensity ◽

Gestational Weight

Pregnant women are recommended to engage in 150 min of moderate-intensity physical activity per week to reduce pregnancy complications. Many women struggle to remain physically active throughout pregnancy, and there is no consensus about whether women adopt a less efficient movement pattern as they progress through pregnancy and experience gestational weight gain. This study assessed the change in energy expenditure and mechanical efficiency in pregnant women (PREG; n = 10) when performing a walking treadmill task in early, mid, and late pregnancy and also compared with an age- and body mass index-matched, nonpregnant (CON; n = 10) group. On average, the PREG group gained within the Institute of Medicine’s gestational weight gain guidelines (11.6 ± 3.6 kg) and were all inactive (measured using accelerometry), except for 1 participant, by the third trimester, as per the 2019 Canadian physical activity guidelines for pregnant women. Energy expended to complete the walking task increased throughout pregnancy and was higher than the controls (111.5 ± 24.6 kcal) in mid and late pregnancy (139.0 ± 22.2 kcal, p = 0.02, and 147.3 ± 24.6 kcal, p = 0.005, respectively), but not early pregnancy (129.9 ± 18.9 kcal, p = 0.08). Walking mechanical efficiency was similar within pregnant women at each time point and compared to nonpregnant controls. Our findings add to the growing body of evidence demonstrating that pregnant women can safely perform physical activity by showing that walking mechanical efficiency is unchanged at low to moderate intensities. Novelty Energy demand during exercise increases proportionally to weight gain across pregnancy trimesters. However, mechanical efficiency remains unchanged during low- to moderate-intensity walking.

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Association Between Diet Quality & Rate of Gestational Weight Gain Among Pregnant Women in Dhulikhel, Nepal

Current Developments in Nutrition ◽

10.1093/cdn/nzaa054_161 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1089-1089

Author(s):

Kelly Tiderencel ◽

Joachim Sackey ◽

Diane Rigassio-Radler ◽

Emily Barrett ◽

Archana Shrestha ◽

...

Keyword(s):

Weight Gain ◽

Pregnant Women ◽

Gestational Weight Gain ◽

Diet Quality ◽

A Priori ◽

Late Pregnancy ◽

Red Meat ◽

Food Groups ◽

Gestational Weight ◽

The Mean

Abstract Objectives The National Academy of Medicine (NAM) guidelines recommend linear gestational weight gain (GWG) in the 2nd and 3rd trimester with appropriate rate defined based on pre-pregnancy BMI. Here we prospectively examined the association between diet quality and GWG rate from 2nd to 3rd trimester among women receiving prenatal care in a periurban hospital in Nepal. Methods A pilot cohort of singleton pregnant women (N = 101; age 25.9 ± 4.1 years) was recruited from a tertiary, periurban hospital in Nepal. In the 1st trimester, diet quality was assessed from the adapted Nepali version of the PrimeScreen questionnaire, which assigned diet quality scores (range 0–42; higher scores for better quality) based on consumption frequency of 12 healthy and 9 unhealthy food groups. The GWG rate was calculated as the measured weight at the early-to-mid 3rd trimester (28–35 wks) minus the weight at 2nd trimester (13–25 wks), divided by the number of weeks in between. Linear regression estimated the association between diet quality and GWG rate, adjusting for a priori covariates including age, education, ethnicity, pre-pregnancy BMI, and nausea/vomiting. The adequacy of GWG rate was also categorized as inadequate, adequate, or excessive using NAM guidelines. Results Most women were of normal (55.4%) or overweight (33.7%) BMI status pre-pregnancy. The mean GWG rate in mid-to-late pregnancy was 0.46 ± 0.2 kg/wk and the mean diet quality score was 23.6 ± 2.5. Based on pre-pregnancy BMI, 49.4% of women had excessive GWG rate, while nearly equal numbers had either adequate GWG or inadequate GWG rate. Pre-pregnancy BMI and GWG rate were inversely correlated (r = −0.21, P = 0.049). Education level was positively associated with both GWG rate (P = 0.01) and adequacy of GWG (P = 0.02). There was no significant association between diet quality and the GWG rate [adjusted β (95% CI) = −0.02 (−0.05, 0.01); P = 0.14]. The mean GWG rate was marginally lower (0.44 vs. 0.57 kg/wk; P = 0.06) among those with high versus low (2 + servings vs. 0–1 serving/wk) intake of red meat; similar findings were seen when comparing red meat intake between women with excessive versus adequate GWG (Cramer's V = 0.2; P = 0.06). Conclusions While overall diet quality is not related to GWG among Nepali women, a high intake of red meat may be a potential risk factor for excessive GWG in this population. Funding Sources Rutgers Global Health Institute.

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The Relationship of Objectively Measured Physical Activity and Sedentary Behaviour with Gestational Weight Gain and Birth Weight

Journal of Pregnancy ◽

10.1155/2014/567379 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 13

Author(s):

Anneloes E. Ruifrok ◽

Ellen Althuizen ◽

Nicolette Oostdam ◽

Willem van Mechelen ◽

Ben Willem Mol ◽

...

Keyword(s):

Physical Activity ◽

Weight Gain ◽

Birth Weight ◽

Pregnant Women ◽

Sedentary Behaviour ◽

Gestational Weight Gain ◽

Late Pregnancy ◽

Gestational Weight ◽

Relationship Of ◽

The Relationship

Objective. To evaluate the relationship of physical activity (PA) and sedentary behaviour with gestational weight gain (GWG) and birth weight.Design. Combined data from two prospective studies: (1) nulliparous pregnant women without BMI restrictions and (2) overweight and obese pregnant women at risk for gestational diabetes.Methods. Daily PA and sedentary behaviour were measured with an accelerometer around 15 and at 32–35 weeks of gestation. The association between time spent in moderate-to-vigorous PA (MVPA) and in sedentary activities with GWG and birth weight was determined. Main outcome measures were GWG between 15 and 32 weeks of gestation, average GWG per week, and birth weight.Results. We studied 111 women. Early in pregnancy, 32% of women spent ≥30 minutes/day in at least moderate PA versus 12% in late pregnancy. No significant associations were found between time spent in MVPA or sedentary behaviour with GWG or birth weight.Conclusions.We found no relation between MVPA and sedentary behaviour with GWG or birth weight. The small percentage of women meeting the recommended levels of PA indicates the need to inform and support pregnant women to maintain regular PA, as there seems to be no adverse effect on birth weight and maintaining PA increases overall health.

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Short Nighttime Sleep Duration and High Number of Nighttime Awakenings Explain Increases in Gestational Weight Gain and Decreases in Physical Activity but Not Energy Intake among Pregnant Women with Overweight/Obesity

Clocks & Sleep ◽

10.3390/clockssleep2040036 ◽

2020 ◽

Vol 2 (4) ◽

pp. 487-501

Author(s):

Abigail M. Pauley ◽

Emily E. Hohman ◽

Krista S. Leonard ◽

Penghong Guo ◽

Katherine M. McNitt ◽

...

Keyword(s):

Physical Activity ◽

Weight Gain ◽

Pregnant Women ◽

Energy Intake ◽

Sleep Duration ◽

Gestational Weight Gain ◽

Study Group ◽

Gestational Weight ◽

Sleep Behaviors ◽

Nighttime Sleep

Pregnant women are at a high risk for experiencing sleep disturbances, excess energy intake, low physical activity, and excessive gestational weight gain (GWG). Scant research has examined how sleep behaviors influence energy intake, physical activity, and GWG over the course of pregnancy. This study conducted secondary analyses from the Healthy Mom Zone Study to examine between- and within-person effects of weekly sleep behaviors on energy intake, physical activity, and GWG in pregnant women with overweight/obesity (PW-OW/OB) participating in an adaptive intervention to manage GWG. The overall sample of N = 24 (M age = 30.6 years, SD = 3.2) had an average nighttime sleep duration of 7.2 h/night. In the total sample, there was a significant between-person effect of nighttime awakenings on physical activity; women with >1 weekly nighttime awakening expended 167.56 less physical activity kcals than women with <1 nighttime awakening. A significant within-person effect was also found for GWG such that for every increase in one weekly nighttime awakening there was a 0.76 pound increase in GWG. There was also a significant within-person effect for study group assignment; study group appeared to moderate the effect of nighttime awakenings on GWG such that for every one increase in weekly nighttime awakening, the control group gained 0.20 pounds more than the intervention group. There were no significant between- or within-person effects of sleep behaviors on energy intake. These findings illustrate an important need to consider the influence of sleep behaviors on prenatal physical activity and GWG in PW-OW/OB. Future studies may consider intervention strategies to reduce prenatal nighttime awakenings.

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When and How Should Chinese Pregnant Women Exercise? A Longitudinal Study in China

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17010180 ◽

2019 ◽

Vol 17 (1) ◽

pp. 180

Author(s):

Mi Xiang ◽

Masayuki Konishi ◽

Huanhuan Hu ◽

Mio Nishimaki ◽

Hyeon-Ki Kim ◽

...

Keyword(s):

Physical Activity ◽

Weight Gain ◽

Longitudinal Study ◽

Pregnant Women ◽

Energy Intake ◽

Gestational Weight Gain ◽

Moderate Intensity ◽

Third Trimester ◽

Gestational Weight ◽

The Third

This study aimed to examine when and how physical activity (PA) influences gestational weight gain (GWG) and infant birthweight (BW) by considering the PA’s total volume, timing, intensity, and type, controlling for the influence of energy intake. A total of 1272 participants in different stages of pregnancy were recruited from hospital. The associations between PA and GWG or BW in the latter half of pregnancy were significant. Women with the highest PA volume in the third trimester had significantly lower risks of inadequate and excessive GWG by 69% (OR = 0.31, 95%CI: 0.10–0.91) and 67% (OR = 0.33, 95% CI: 0.12–0.91), respectively, compared to women in the lowest quartile. Women who achieved the recommended moderate intensity of PA during their second and third trimesters, independent of total volume of PA, had infants with significantly lower BWs compared to those who did not (β = −0.15, SE = 66.33, p = 0.04; β = −0.20, SE = 64.54, p = 0.01, respectively). Therefore, the effects of total volume and intensity of PA on GWG and BW were different. Interventions to prevent inappropriate GWG and macrosomia may need to set different priorities and timing regarding total volume or intensity of PA.

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A prospective study of dietary intakes and influential factors from pregnancy to postpartum on maternal weight retention in Taipei, Taiwan

British Journal Of Nutrition ◽

10.1017/s0007114509991243 ◽

2009 ◽

Vol 102 (12) ◽

pp. 1828-1837 ◽

Cited By ~ 20

Author(s):

Li-Ching Lyu ◽

Chaio-Chen Lo ◽

Heng-Fei Chen ◽

Chia-Yu Wang ◽

Dou-Ming Liu

Keyword(s):

Weight Gain ◽

Pregnant Women ◽

Energy Intake ◽

Gestational Weight Gain ◽

Average Weight ◽

Postpartum Weight Retention ◽

Dietary Intakes ◽

Weight Retention ◽

Gestational Weight ◽

Postpartum Weight

Excessive gestational weight gain and postpartum weight retention are risk factors for female obesity. The present study was to examine dietary intakes and weight history from a prospective follow-up study from early pregnancy to 1 year postpartum. A total of 151 pregnant women within 20 weeks of pregnancy in Taipei, Taiwan were interviewed periodically to collect dietary and lifestyle information. The participants had an average age of 30 years and the average gestational weight gain was 14 kg, with an average daily intake of 7830 kJ (1870 kcal) in the 1 year following parturition. By bivariate analyses, maternal age, pre-pregnancy BMI and breast-feeding were not related to postpartum weight retention, but gestational weight gain had significant positive correlations (r 0·54 at 6 months, r 0·44 at 1 year; P < 0·05). The generalised estimating equations showed that the average weight before pregnancy, at 6 months and 1 year postpartum was 53·35 kg, 55·75 kg (weight retention 2·36 kg; P < 0·01) and 54·75 kg (weight retention 1·48 kg; P < 0·01), respectively. After controlling for age, pre-pregnancy BMI, gestational weight gain and parity, we found at 6 months that the adjusted weight retention at postpartum was 0·79 kg (P < 0·01), but at 1 year it was − 0·08 kg (P>0·05). From multivariate analyses, dietary energy intake and energy intake per kg body weight as a long-term physical activity index could explain 24 % of the variation at 6 months and 27 % of the variation at 1 year in postpartum weight retention. These results suggest that pregnant women should be advised to control gestational weight gain, decrease energy intakes after child-bearing and maintain regular exercise in order to prevent postpartum obesity.

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A prospective study of the relationship of sleep quality and duration with gestational weight gain and fat gain

10.31232/osf.io/98dz7 ◽

2019 ◽

Author(s):

Christine Hill ◽

Leah Lipsky ◽

Grace Betts ◽

Anna Maria Siega-Riz ◽

Tonja Nansel

Keyword(s):

Weight Gain ◽

Sleep Quality ◽

Sleep Duration ◽

Gestational Weight Gain ◽

Early Pregnancy ◽

Experimental Studies ◽

Late Pregnancy ◽

Medical Visit ◽

Short Sleep Duration ◽

Gestational Weight

Objective: To examine associations of sleep duration and quality with pregnancy-related changes in body weight and fat.Methods: Pregnant women (N = 458) obtaining obstetric care through the University of North Carolina at Chapel Hill Healthcare System were recruited at ≤12 weeks gestation and followed through delivery. The Pittsburgh Sleep Quality Index measured sleep duration and quality in early and late pregnancy. Weight was measured at each pregnancy medical visit and skinfolds were measured each trimester. T-tests examined sleep changes from early to late pregnancy, and regression analyses estimated associations of sleep quality and duration with gestational weight gain (GWG) and fat gain (GFG).Results: Sleep quality and duration declined across pregnancy. A greater proportion of women with high early pregnancy BMI (>25) reported low sleep quality and short sleep duration. GWG adequacy was not associated with sleep quality or duration while greater GFG was associated with poorer sleep quality and shorter sleep duration in late pregnancy, but not early pregnancy. Conclusions: Greater GFG was associated with poorer sleep quality and shorter sleep duration in late pregnancy. Experimental studies are needed to test the direction of causality between GFG and sleep attributes.

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Gestational Weight Gain During the Second and Third Trimesters and Adverse Pregnancy Outcomes, Results From a Prospective Pregnancy Cohort in Urban Tanzania

10.21203/rs.3.rs-563740/v1 ◽

2021 ◽

Author(s):

Jiaxi Yang ◽

Molin Wang ◽

Deirdre K. Tobias ◽

Janet W. Rich-Edwards ◽

Anne Marie Darling ◽

...

Keyword(s):

Weight Gain ◽

Preterm Birth ◽

Pregnant Women ◽

Gestational Weight Gain ◽

Early Pregnancy ◽

Gestational Age ◽

Pregnancy Outcomes ◽

Gestational Weight ◽

Pregnancy Cohort ◽

Adverse Pregnancy

Abstract Background Appropriate gestational weight gain (GWG) is important for optimal pregnancy outcomes. This study prospectively evaluated the associations between GWG during the second and third trimesters of pregnancy and adverse pregnancy outcomes in an urban Tanzanian pregnancy cohort. Methods We used data from a randomized clinical trial conducted among pregnant women recruited by 27 weeks of gestation in Dar es Salaam, Tanzania (N = 1,230). Women’s gestational weight was measured at baseline and at monthly antenatal visits. Weekly GWG rate during the second and third trimesters was calculated and characterized as inadequate, adequate, or excessive, in conjunction with measured or imputed early-pregnancy BMI status according to the 2009 Institute of Medicine (IOM) GWG guidelines. We used multivariable Poisson regression with a sandwich variance estimator to calculate risk ratios (RR) for associations of GWG with low birth weight, preterm birth, small for gestational age (SGA), and large for gestational age (LGA). Degree of appropriate GWG defined using additional metrics (i.e., percentage of adequacy, z-score) and potential effect modification by maternal BMI were additionally evaluated. Results According to the IOM guidelines, 517 (42.0%), 270 (22.0%), and 443 (36.0%) women were characterized as having inadequate, adequate, and excessive GWG, respectively. Overall, compared to women with adequate GWG, women with inadequate GWG had a lower risk of LGA births (RR=0.54, 95% CI: 0.36 - 0.80) and a higher risk of SGA births (RR=1.32, 95% CI: 0.95 - 1.81). Women with inadequate GWG as defined by percentage of GWG adequacy had a higher risk of LBW (OR=1.93, 95% CI: 1.03 - 3.63). In stratified analyses by early-pregnancy BMI, excessive GWG among women with normal BMI was associated with a higher risk of preterm birth (RR=1.59, 95% CI: 1.03 - 2.44). Conclusions A comparatively high percentage of excessive GWG was observed among healthy pregnant women in Tanzania. Both inadequate and excessive GWGs were associated with elevated risks of poor pregnancy outcomes. Future studies among diverse SSA populations are warranted to confirm our findings, and clinical recommendations on optimal GWG should be developed to promote healthy GWG in SSA settings. Trial registration This trial was registered as “Prenatal Iron Supplements: Safety and Efficacy in Tanzania” (NCT01119612; http://clinicaltrials.gov/show/NCT01119612).

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