Associations of Gestational Diabetes Mellitus and Excessive Gestational Weight Gain with Offspring Obesity Risk

Objective Gestational diabetes mellitus(GDM)and gestational weight gain(GWG)are important risk factors that are known to affect offspring growth,but these outcomes are inconsistent and it remains unknown if both risk factors have a synergetic effect on early childhood growth.The present study aimed to conduct offspring body mass index-for-age Z-scores(BMIZ)trajectories and to evaluate the independent and interactive effect of the status of GDM and excessive GWG on the risks of overweight/obesity from birth to 24 months of age.Methods A total of 7949 mother-child pairs were enrolled in this study.The weight and length of children were measured at birth,6,12,and 24 months of age to calculate BMIZ.Results The status of GDM was positively associated with offspring BMIZ and risk of macrosomia at birth but was not associated with offspring BMIZ or the risks of overweight/obesity at 6,12,and 24 months of age.In contrast,excessive GWG was positively linked to offspring BMIZ,the stable high BMIZ trajectory pattern,and risks of overweight/obesity in the first 24 months of age.These two risk factors also had a significant synergistic effect on macrosomia at birth,but the interactive effect was only significant in boys during the follow-up years in the sex-stratified analyses.Conclusion The maternal GWG was a more pronounced predictor than GDM with relation to BMIZ and risk of overweight/obesity in early childhood.The interactive effect between these risk factors on offspring overweight/obesity may vary by sex.

Association between pre-pregnancy body mass index and gestational weight gain and the risk of preeclampsia:A systematic review and meta-analysis

Objective:To analyze the relationship between body mass index(BMI)before pregnancy and gestational weight gain throughout pregnancy with the incidence of preeclampsia.Methods:This was a systematic review-meta analysis of literature collected from three e-databases:Scopus,PubMed,and Science Direct.Quality assessment was measured with the Effective Public Health Practice Project methods.Meta-analysis was done by calculating the fixed and random-effects of odds ratio(OR)for each BMI category and gestational weight gain as compared with the incidence of preeclampsia.Results:Overweight was associated with a significantly increased risk of preeclampsia(OR=2.152,95%CI 1.363-3.400;P=0.001).Obesity was also associated with a noticeably increased risk of preeclampsia(OR=2.856,95%CI 1.755-4.649;P<0.001).Meanwhile,underweight was associated with a significantly reduced risk of preeclampsia(OR=0.639,95%CI 0.500-0.817;P<0.001)when compared with normal BMI.Pregnant women who gained weight below the standard throughout pregnancy was a protective factor from preeclampsia(OR=0.813,95%CI 0.610-1.083;P=0.157)whereas pregnant women who gained weight above the standard had almost doubled risk of preeclampsia(OR=1.850,95%CI 1.377-2.485;P<0.001).Conclusions:The result of this study affirms the role of overweight-obesity pre-pregnancy,and gestational weight gain above the standard during pregnancy as significant risk factors for developing preeclampsia.

Excessive gestational weight gain in early pregnancy and insufficient gestational weight gain in middle pregnancy increased risk of gestational diabetes mellitus

Background:Gestational weight gain(GWG)is associated with the risk of gestational diabetes mellitus(GDM).However,the effect of weight gain in different trimesters on the risk of GDM is unclear.This study aimed to evaluate the effect of GWG on GDM during different trimesters.Methods:A birth cohort study was conducted from 2017 to 2020 in Shenzhen,China.In total,51,205 participants were included comprising two models(early pregnancy model and middle pregnancy model).Gestational weight(kg)was measured at each prenatal clinical visit using a standardized weight scale.Logistic regression analysis was used to assess the risk of GDM.Interaction analysis and mediation effect analysis were performed in the middle pregnancy model.Results:In the early pregnancy model,the risk of GDM was 0.858 times lower(95%confidence interval[CI]:0.786,0.937)with insufficient GWG(iGWG)and 1.201 times higher(95%CI:1.097,1.316)with excessive GWG after adjustment.In the middle pregnancy model,the risk of GDM associated with iGWG increased 1.595 times(95%CI:1.418,1.794)after adjustment;for excessive GWG,no significant difference was found(P=0.223).Interaction analysis showed no interaction between GWG in early pregnancy(GWG-E)and GWG in middle pregnancy(GWG-M)(F=1.268;P=0.280).The mediation effect analysis indicated that GWG-M plays a partial mediating role,with an effect proportion of 14.9%.Conclusions:eGWG-E and iGWG-M are associated with an increased risk of GDM.Strict control of weight gain in early pregnancy is needed,and sufficient nutrition should be provided in middle pregnancy.

Risks of maternal prepregnancy overweight/obesity, excessive gestational weight gain, and bottle-feeding in infancy rapid weight gain: evidence from a cohort study in China

Rapid weight gain(RWG) in infants is associated with numerous health problems, and its risk factors are still unclear. We assessed 98,097 maternal-infant pairs from a population-based cohort study and followed up with them until the infants were6 months old. We assessed the associations between maternal prepregnancy weight status;gestational weight gain;feeding pattern;and infants’ RWG at 0–1, 0–3, 1–3, and 3–6 months using multivariate unconditional logistic regression models, with controlled confounders. We found that maternal prepregnancy weight status, gestational weight gain, and feeding pattern at the1 st, 3 rd, and 6 th months had significant impacts on the infants’ RWG at each time period(P<0.05). Infants with overweight/obese mothers had a higher risk of RWG after birth, whereas those of mothers who experienced excessive gestational weight gain had higher risks of RWG from birth than the other groups(P<0.01). Infants who were formula-fed had a higher risk of RWG than breastfed infants at the same time point(P<0.01). In conclusion, maternal prepregnancy obesity, excessive gestational weight gain, and formula-feeding were risk factors for infants’ RWG during the first 6 months of life.

Associations of Prepregnancy Body Mass Index,Gestational Weight Gain,and Intelligence in Offspring:A Systematic Review and Meta-Analysis

Objective:Increasing evidences have shown that prepregnancy maternal weight and gestational weight gain(GWG)may associate with offspring’s neurodevelopment.However,the effects of prepregnancy maternal overweight,obesity,and excessive GWG on offspring’s intelligence remain controversial.This meta-analysis aimed to re-assess the association between prepregnancy body mass index(BMI),GWG,and children’s intelligence.Methods:We systematically searched multiple databases,including PubMed,EMBASE,Cochrane Library,and Ovid Medline,from their inception through February 2021.Studies assessing the association between prepregnancy BMI or GWG and children’s intelligence were further screened manually before final inclusion.Cohorts that analyzed the association between prepregnancy BMI or GWG and intelligence of offspring were included,and we used the Mantel-Haenszel fixed-effects method to compute the weighted mean difference(WMD)and 95%confidence interval(CI)of each study.Results:A total of 12 articles were included in this systematic review,while six of them in the meta-analysis.There was a significant full-scale IQ reduction in children born from overweight and obese mothers,with WMDs of-3.08(95%CI:-4.02,-2.14)and-4.91(95%CI:-6.40,-3.42),respectively.Compared with control group,the WMDs for performance and verbal intelligence quotient(IQ)were decreased in overweight and obesity groups.However,we observed no association between children’s full-scale IQ and excessive GWG with WMD of-0.14(95%CI:-0.92,0.65).Conclusions:Women’s prepregnancy overweight and obesity adversely associate with children’s intelligence but no association with excessive GWG.Our study suggests that further researches focusing on the effect of prepregnancy maternal health on offspring’s intelligence development are needed.

Association of gestational anemia with pregnancy conditions and outcomes: A nested case-control study

BACKGROUND Gestational anemia is a serious public health problem that affects pregnant women worldwide.Pregnancy conditions and outcomes might be associated with the presence of gestational anemia.This study investigated the association of pregnancy characteristics with anemia,exploring the potential etiology of the disease.AIM To assess the association of pregnancy parameters with gestational anemia.METHODS A nested case-control study was conducted based on the Chinese Pregnant Women Cohort Study-Peking Union Medical College Project(CPWCS-PUMC).A total of 3172 women were included.Patient characteristics and gestational anemia occurrence were extracted,and univariable and multivariable logistic regression models were used to analyze the association of pregnancy parameters with gestational anemia.RESULTS Among the 3172 women,14.0% were anemic,46.4% were 25-30 years of age,21.9%resided in eastern,15.7%in middle,12.4%in western 18.0% in southern and 32.0%in northern regions of China.Most women(65.0%)had a normal prepregnancy body mass index.Multivariable analysis found that the occurrence of gestational anemia was lower in the middle and western regions than that in the eastern region[odds ratio(OR)=0.406,95%confidence interval(CI):0.309-0.533,P<0.001],higher in the northern than in the southern region(OR=7.169,95% CI:5.139-10.003,P<0.001),lower in full-term than in premature births(OR=0.491,95% CI:0.316-0.763,P=0.002),and higher in cases with premature membrane rupture(OR=1.404,95% CI:1.051-1.876,P=0.02).CONCLUSION Gestational anemia continues to be a health problem in China,and geographical factors may contribute to the situation.Premature birth and premature membrane rupture may be associated with gestational anemia.Therefore,we should vigorously promote local policy reformation to adapt to the demographic characteristics of at-risk pregnant women,which would potentially reduce the occurrence of gestational anemia.

Intensive Lifestyle Counselling Intervention: Preventing Maternal Risk for Gestational Diabetes Mellitus

This study is aimed to evaluate the effectiveness of an intensive lifestyle counselling (ILC) designed to prevent gestational diabetes mellitus (GDM) among high risk mothers. A quasi-experimental trial was conducted in four selected health clinics (two clinics for intervention and two clinics for control) in Negeri Sembilan, Malaysia. Of the 320 subjects recruited, 148 respondents in the intervention group and 150 respondents in the control group had completed the study (response rate 93.1%). The intervention group was given a routine antenatal care (RC) and a package of structured ILC sessions on diet, physical activity (PA) and information on appropriate gestational weight gain (GWG) in five routine antenatal care visits until 39 weeks’ gestation. The controls received only the RC. Both groups are comparable for sociodemographic characteristics (p < 0.05). GDM incidence is higher in control group (16.7%) compared to intervention group (6.1%), p = 0.046. After controlling the covariates, the intervention group consistently showed protective for developing GDM, (aOR: 0.25, CI: 0.18 - 0.23, p = 0.003). The intervention group had significantly increased in PA (moderate intensity) mean score (660.3 ± 289.4 Met/min) compared to control group (571.36 ± 230.38 Met/min), F(1, 296) = 10.418, p < 0.001 and comply to dietary recommendation (50.7% in intervention versus 16.7% in control), p < 0.001. Total GWG significantly lesser in intervention (11.4 ± 2.5 Kg) than the control group (12.7 ± 2.9 Kg), p < 001. An ILC can reduce GDM incidence, by increasing PA, increase compliance to the dietary intake recommendation and lesser total GWG among high risk mothers.