Association Between Maternal Weight Gain in Different Periods of Pregnancy and the Risk of Venous Thromboembolism: A Retrospective Matched Case-Control Study

Background Although the rate of maternal mortality has declined over the past few decades, pulmonary embolus (PE) remains an important cause of maternal deaths. Little is known about the associations of specific periods of gestational weight gain with detailed PE and deep venous thrombosis (DVT). We explored the incidence of pregnancy-related venous thromboembolism (VTE) in China and assessed the associations of maternal weight gain in different periods of pregnancy with VTE.Methods In a retrospective case-control study conducted in in Shanghai First Maternity and Infant Hospital from January 1st, 2017 to July 31th, 2021, 151 cases (11.7 per 10000) of venous thromboembolism (VTE) within pregnancy or the first 6 postnatal weeks were identified. 302 controls without VTE who gave birth at the same time as the cases were selected. Maternal pre-pregnancy weight, weight in early, mid and late pregnancy and other maternal pregnancy and newborn characteristics were obtained. GWG was standardized into gestational age-specific z-scores stratified by body mass index (BMI) and categorized as low (z score <-1), normal (-1 to 1), and high (>1). The adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated through log-binomial regression models. Interaction effects between gestational weight gain (GWG) and some other adjustment factors were tested, further stratified analyses were performed separately where interaction terms were significant. Results There were 65.6% (99 of 151) of pulmonary embolus (PE) alone and 34.4% (52 of 151) of deep venous thrombosis (DVT) alone or combined with PE. For all pre-pregnancy BMI categories (underweight, normal weight, overweight and obese), there was no statistical association between maternal weight gain of all gestational intervals and DVT or all VTE in this study. However, for PE, there was observed protective effects of low weight gain (aOR 0.79; 95% CI 0.37–1.68) and significantly increased risks of high weight gain (aOR=1.47; 95% CI: 1.03-2.09) among normal-weight women in early pregnancy. Similarly, a tendency towards decreased risk at lower weight gain throughout pregnancy (aOR 0.79; 95% CI 0.37–1.68) and significantly increased risk at higher values (aOR=1.52; 95% CI: 1.01-2.31) for PE was observed in normal-weight women. As for underweight and overweight women, results from the categorical model for early, late or total pregnancy weight gain indicated an increased risk in PE at both low and high weight gain, but confidence intervals were wide.Conclusion Chinese women have a higher risk of PE than the foreigner counterparts. Maternal weight gain in total or early pregnancy is an important risk factor for PE. In order to effectively improve maternal and child outcomes, intensive weight management that continues through pregnancy may be indispensable.

Correlation Between Maternal Weight Gain in Each Trimester and Fetal Growth According to Pre-pregnancy Maternal Body Mass Index in Twin Pregnancies

Background: This study aimed to determine the correlation between maternal weight gain in each trimester and fetal growth according to pre-pregnancy maternal body mass index in twin pregnancies.Methods: We conducted a retrospective review of the medical records of 500 twin pregnancies delivered at 28 weeks’ gestation or greater at a single tertiary center between January 2011 and December 2020. We measured the height, pre-pregnant body weight, and maternal body weight of women with twin pregnancies and evaluated the relationship between the maternal weight gain at each trimester and fetal growth restriction according to pre-pregnancy body mass index.Results: The overweight pregnant women were older than the normal or underweight pregnant women, and the risk of gestational diabetes was high. The underweight pregnant women were younger, and the incidences of preterm labor and short cervical length during pregnancy was high. Especially in normal weight pregnant women, the heavier the weight of the newborn babies as the second trimester of pregnancy weight gain, the less significant the weight gain in the first trimester of pregnancy and fetal growth. The most predictive single factor for the prediction of small neonates was weight gain during 24-28 weeks and 15-18 weeks, and the cutoff value was 6.2 kg. (area under the curve 0.592, p < 0.001).Conclusions: In twin pregnancy, regardless of the pre-pregnant body mass index, maternal weight gain affected fetal growth. Furthermore, weight gain in the second trimester of pregnancy is considered a powerful indicator of fetal growth, especially in normal weight pregnancies.

Insufficient maternal gestational weight gain and infant neurodevelopment at 12 months of age: the Japan Environment and Children’s Study

Abnormal maternal gestational weight gain (GWG) increases the risk of obstetric-related complications. This investigation examined the impact of GWG on infant neurodevelopmental abnormalities at 12 months of age using the data of a nationwide Japanese cohort study. Questionnaire data were obtained from the ongoing Japan Environment and Children’s Study cohort study. Maternal GWG was subdivided as below, within, or above the reference values of the Institution of Medicine pregnancy weight guidelines. The Ages and Stages Questionnaire, third edition (ASQ-3) is a parent-reported developmental screening instrument for children across five domains: communication, gross motor, fine motor, problem-solving, and personal–social. Multiple logistic regression analysis was employed to identify correlations between GWG and developmental delay defined as ASQ-3 scores of less than two standard deviations below the mean. A total of 30,694 mothers with singleton live births and partners who completed the questionnaire were analyzed. The prevalence of mothers below, within, and above the GWG guidelines was 60.4% (18,527), 32.1% (9850), and 7.5% (2317), respectively. We recorded 10,943 infants (35.7%) who were outliers in at least one ASQ-3 domain. After controlling for covariates, GWG below established guidelines was associated with a significantly higher risk of developmental delay for the communication (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.09–1.34), gross motor (OR 1.14, 95% CI 1.05–1.24), fine motor (OR 1.13, 95% CI 1.04–1.24), problem-solving (OR 1.09, 95% CI 1.01–1.18), and personal–social (OR 1.15, 95% CI 1.07–1.24) domains.Conclusion: This large survey revealed a possible deleterious effect of insufficient maternal GWG on infant neurodevelopment.Trial registration: The Japan Environment and Children’s Study (JECS) was registered in the UMIN Clinical Trials Registry on January 15, 2018 (number UMIN000030786). What is Known:• Inappropriate maternal gestational weight gain may cause obstetric complications and adverse birth outcomes.• Excess maternal weight gain may result in gestational diabetes, hypertension, eclampsia, caesarean delivery, and macrosomia, while insufficient maternal weight gain has been associated with pre-term birth and small for gestational age. What is New:• This study provides important information on a possible adverse effect of insufficient maternal gestational weight gain on offspring neurodevelopment at 12 months of age.• Our findings indicate a need to reconsider the optimal body mass index and gestational weight gain for women desiring pregnancy.

The Relationship Between Maternal Weight Gain and Newborn Weight With the Frequency of Stunting in South Central Timor District (TTS)

During pregnancy, mothers are prone to experiencing nutritional problems. This problem can be fatal and exceptionally perilous for both the fetus and the mother. Malnutrition in pregnant women encompasses a huge enough affect on the growth process of the fetus and the child to be born, one of which is stunting. Toddlers' stunting in NTT is ranked 34th in Indonesia with a short presentation of 22.30% and very short 18.00%, while the incidence of stunting in TTS district reaches 57.3%. The point of the study was to analyze the relationship between maternal weight gain and newborn weight with the frequency of stunting. This type of research used case control with retrospective approach. The population of all children under five with incidence of stunting and non-stunting, the subjects of the study were 200 samples in 8 Public Helath Center in TTS district. Data collection using a questionnaire and with univariate and bivariate analysis and tested using the Chi-square test. The results showed that maternal weight gain during pregnancy in stunting infants had a weight gain that was not according to the recommendation, which was 55%, experiencing weight gain as recommended during pregnancy was 45%, while the weight of newborns who were stunted had an abnormal weight gain 60 % and the normal weight gain is 40%. After doing the Chi-Square test, the Asymp was obtained. Sig. is 0.000 <α (0.05). Therefore, it can be concluded that there’s a critical relationship between maternal weight gain during pregnancy and birth weight on the incidence of stunting.

Maternal Vitamin and Mineral Supplementation and Rate of Maternal Weight Gain Affects Placental Expression of Energy Metabolism and Transport-Related Genes

Maternal nutrients are essential for proper fetal and placental development and function. However, the effects of vitamin and mineral supplementation under two rates of maternal weight gain on placental genome-wide gene expression have not been investigated so far. Furthermore, biological processes and pathways in the placenta that act in response to early maternal nutrition are yet to be elucidated. Herein, we examined the impact of maternal vitamin and mineral supplementation (from pre-breeding to day 83 post-breeding) and two rates of gain during the first 83 days of pregnancy on the gene expression of placental caruncles (CAR; maternal placenta) and cotyledons (COT; fetal placenta) of crossbred Angus beef heifers. We identified 267 unique differentially expressed genes (DEG). Among the DEGs from CAR, we identified ACAT2, SREBF2, and HMGCCS1 that underlie the cholesterol biosynthesis pathway. Furthermore, the transcription factors PAX2 and PAX8 were over-represented in biological processes related to kidney organogenesis. The DEGs from COT included SLC2A1, SLC2A3, SLC27A4, and INSIG1. Our over-representation analysis retrieved biological processes related to nutrient transport and ion homeostasis, whereas the pathways included insulin secretion, PPAR signaling, and biosynthesis of amino acids. Vitamin and mineral supplementation and rate of gain were associated with changes in gene expression, biological processes, and KEGG pathways in beef cattle placental tissues.