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BACKGROUND: The association between obesity (body mass index (BMI) ≥ 30 kg/m(2)) and pattern of medication use during pregnancy in the United States is not well-studied. Higher prepregnancy BMI may be associated with increases or decreases in medication use across pregnancy as symptoms (e.g. reflux) or comorbidities (e.g. gestational diabetes) requiring treatment that may be associated with higher BMI could also change with advancing gestation. OBJECTIVES: To determine whether prenatal medication use, by the number and types of medications, varies by pre-pregnancy obesity status. METHODS: In a secondary data analysis of a racially/ethnically diverse prospective cohort of pregnant women with low risk for fetal abnormalities enrolled in the first trimester of pregnancy and followed to delivery (singleton, 12 United States clinical sites), free text medication data were obtained at enrollment and up to five follow-up visits and abstracted from medical records at delivery. RESULTS: In 436 women with obesity and 1750 women without obesity (pre-pregnancy BMI, 19–29.9 kg/m(2)), more than 70% of pregnant women (77% of women with and 73% of women without obesity) reported taking at least one medication during pregnancy, respectively (adjusted risk ratio (aRR)=1.10, 95% confidence interval (CI)=1.01, 1.20), with 81% reporting two and 69% reporting three or more. A total of 17 classes of medications were identified. Among medication classes consumed by at least 5% of all women, the only class that differed between women with and without obesity was hormones and synthetic substitutes (including steroids, progesterone, diabetes, and thyroid medications) in which women with obesity took more medications (11 vs. 5%, aRR = 1.9, 95% CI = 1.38, 2.61) compared to women without obesity. Within this class, a higher percentage of women with obesity took diabetes medications (2.3 vs. 0.7%) and progesterone (3.4 vs. 1.3%) than their non-obese counterparts. Similar percentages of women with and without obesity reported consuming medications in the remaining medication classes including central nervous system agents (50 and 46%), gastrointestinal drugs (43 and 40%), anti-infective agents (23 and 21%), antihistamines (20 and 17%), autonomic drugs (10 and 9%), and respiratory tract agents (7 and 6%), respectively (p > 0.05 for all adjusted comparisons). There were no differences in medication use by obesity status across gestation. Since the study exclusion criteria limited the non-obese group to women without thyroid disease, in a sensitivity analysis we excluded all women who reported thyroid medication intake and still a higher proportion of women with obesity took the hormones and synthetic substitutes class compared to women without obesity. CONCLUSION: Our findings suggest that pre-pregnancy obesity in otherwise healthy women is associated with a higher use of only selected medications (such as diabetes medications and progesterone) during pregnancy, while the intake of other more common medication types such as analgesics, antibiotics, and antacids does not vary by pre-pregnancy obesity status. As medication safety information for prenatal consumption is insufficient for many medications, these findings highlight the need for a more in-depth examination of factors associated with prenatal medication use.

Objective To identify the prevalence of pre-pregnancy overweight/obesity in pregnant women and its relationship with socio-demographic factors and to describe the maternal and perinatal outcomes in a Barcelona hospital (Spain). Method A descriptive cross-association study, with retrospective data collection, was performed Barcelona Hospital. The data of 5447 pregnant women who delivered at >=23 weeks of gestation were included. Body Mass Index (BMI) data were categorised into World Health Organization classifications. p values Results The prevalence of pre-pregnancy obesity was 8.4% and 18.9% for overweight. Gestational diabetes was more frequent in pre-pregnancy overweight/obesity (OR 1.92: 95% CI 1.54–2.40 and OR 3.34: 95% CI 2.57–4.33), as were preeclampsia (OR 2.08: 95% CI 1.55–2.79 and OR 3.35: 95% CI 2.38–4.71), induction of labour (OR 1.19: 95% CI 1.02–1.38 and OR 1.94: 95% CI 1.57–2.10), caesarean section (OR 1.41: 95% CI 1.21–1.65 and OR 2.68: 95% CI 2.18–3.29), prematurity (OR 1.28: 95% CI 1–1.65 and OR 1.79: 95% CI 1.32–2.44) and macrosomia (OR 1.87: 95% CI 1.43–2.46 and OR 2.03: 95% CI 1.40–2.93). Conclusions One in four pregnant women had pre-pregnancy overweight or obesity. This study shows the relationship between pre-pregnancy overweight or obesity with adverse maternal and perinatal outcomes.

Introduction Excessive body mass index may have adverse effects on the health of women in their perinatal period. Regular physical activity contributes to body mass control. Aim To determine the association of pre-pregnancy and pregnancy BMIs with labor duration in primi- and multiparas. Also, to determine the proportions of pre-pregnancy BMI > 25 in women after cesarean sections and vaginal deliveries. Material and methods Data of 54 women on a postpartum day 3 to 5 (29 primiparas: 17 after vaginal and 12 after cesarean deliveries; 25 multiparas: 15 after vaginal and 10 after cesarean deliveries). Demographic data collected from the patient’s history included body height, pre-pregnancy and pre-labor body mass, mode of delivery, duration of labor and its second stage, number of deliveries. Pre-pregnancy and pre-labor BMIs were calculated. Results In primiparas, there was a moderate positive correlation between pre-pregnancy and pre-labor BMIs and the labor duration (r = 0.56, p = 0.02; r = 0.65, p = 0.005, respectively). Multiparas did not exhibit a significant correlation between the BMIs and the labor duration (p > 0.05). Neither of the subgroups showed a significant correlation between pre-pregnancy and prelabor BMIs and the duration of the second stage of labor (p > 0.05). Among women after vaginal deliveries, 15.6% had pre-pregnancy BMI > 25; the respective proportion was 22.7% in women after cesarean sections. Conclusions Primiparas with greater pre-pregnancy and pre-labor BMIs were more likely to have a longer labor. The proportion of pre-pregnancy BMI > 25 was higher for cesarean compared to vaginal deliveries. Physical activity should be promoted in women planning pregnancy to help control BMI. Keywords: mirror foot, resection of foot radius, deformation classification

Estimates of prenatal alcohol use among American Indian and Alaska Native (AI/AN) women are limited. This study sought to characterize pre-pregnancy and prenatal alcohol use among AI/AN women in the Pregnancy Risk Assessment Monitoring System (PRAMS) dataset, evaluate variation in alcohol use by state and rural/urban residence, and evaluate associations between potential risk factors and prenatal alcohol use among AI/AN and non-Hispanic white (NHW) women. We pooled PRAMS data from five states (Alaska, New Mexico, Oklahoma, South Dakota and Washington) from 2015 to 2017. We estimated the prevalence of pre-pregnancy and pregnancy risk factors, and alcohol use by race and examined alcohol use by state and rural/urban residence among AI/AN women. We conducted bivariate and multivariable logistic regression modelling to estimate the association between each risk factor of interest and the odds of prenatal alcohol use for AI/AN and NHW women. AI/AN women were less likely to report pre-pregnancy alcohol use compared to NHW women (56% vs. 76%, p

Objectives Women with diabetes are at increased risk of adverse pregnancy outcomes compared to women with gestational diabetes (GDM) or no diabetes. Pregnancy outcomes are improved by specialist pre-pregnancy care. We aimed to explore pharmacists’ and women with diabetes’ perceptions of the roles and barriers to pharmacist participation in a diabetes contraception and pre-pregnancy program in South-Western Sydney (SWS). Methods The Diabetes Contraception and Pre-pregnancy Program (DCAPP) aims to reduce adverse pregnancy outcomes among women with diabetes. This includes awareness raising among, and through, pharmacists. Surveys to explore pharmacists’ roles in contraception and pre-pregnancy management (CPPM) were completed by SWS pharmacists and women with diabetes from diabetes clinics aged 18–50 years. Survey themes were then discussed in interviews and focus groups with pharmacists across Australia. Thematic analysis of transcripts was undertaken. Key findings Pharmacists were seen to have a role in diabetes health promotion, information distribution and referral to pre-pregnancy clinics. Pharmacists and women recognised the need for increased knowledge and educational materials about CPPM and effective awareness and coordination of CPPM services. Some pharmacists recognised deficits in their knowledge regarding diabetes in pregnancy, including CPPM and differences to GDM. Barriers to pharmacists’ involvement in CPPM included difficulty identifying applicable women and reluctance to initiate pregnancy planning and contraception conversations, often due to language and cultural barriers. Conclusions Pharmacists and women with diabetes see an important role for pharmacists in CPPM. Co-designed diabetes training for pharmacists and increased communication about DCAPP were seen important for ongoing implementation.

Objective: To determine the various pregnancy outcomes in females with high pre pregnancy BMI. Study Design: Descriptive case series. Setting: Sheikh Zayed Hospital, Rahim Yar Khan. Duration: 30-06-2016 to 31-12-2017. Methodology; In the present study, pregnant females with age of gestation less than 12 weeks presenting with their first ante natal visit falling in the age range of 20-40 years having pre pregnancy BMI > 25 kg/m2 were included. Then these cases were followed for their whole pregnancy to look for various outcomes. Results; In the present study there were 150 subjects enrolled with high pre pregnancy BMI. Mean age of the participants was 28.41±4.67 year and mean BMI was 28.31±3.57 kg/m2. Regarding various outcome the most common one was C section which was seen in 42 (28%) of the cases, followed by PIH seen in 35 (23.34%) of the cases, while pregnancy remained uneventful in only 21 (14%) of the cases. Conclusion: High pre pregnancy BMI leads to various complication, which are seen in almost 8 out of 10 cases and the most common one is C section. Key words: BMI, C section, PIH

BACKGROUND Obesity has become a global epidemic. Maternal overweight and obesity is now a major challenge to the treating obstetricians. We intended to find the effect of pre pregnancy body mass index (BMI) and gestational weight gain during pregnancy on maternal and neonatal outcome. METHODS 300 women with singleton pregnancy and spontaneous conception, who attended antenatal outpatient department (OPD) in our tertiary hospital, were included in this study after informed consent. The rate of gestational weight gain was calculated by subtracting the pre pregnancy weight from the final weight of the mother during last antenatal visit or during delivery. They were followed up and their maternal and perinatal outcomes such as anaemia, gestational hypertension, gestational diabetes, preterm labour, past dates, and intrauterine growth restriction, low birth weight, large for gestation, caesarean delivery and neonatal intensive care admission were studied. RESULTS The mean age of the woman in this study was 24 ± 2 years. Of them, 13 % (n = 39) of women were underweight. 40 % (n = 120) of women were of normal BMI. 33 % (n = 99) of women were overweight. 14 % (n = 52) of women were obese. Maternal complications such as anaemia, preterm labour and intrauterine growth restriction were significantly common in underweight woman and inadequate gestational weight gain woman. Gestational diabetes, gestational hypertension, large for gestation baby and Caesarean deliveries were more in pre pregnancy obese woman and excess gestational weight gain woman. CONCLUSIONS An appropriate maternal pre pregnancy body mass index of 18.5 to 22.9 Kg / m2 at conception followed by an appropriate gestational weight gain (10 to 14 Kg) during pregnancy has a better maternal and neonatal outcome. KEY WORDS Body Mass Index, Gestational Weight Gain, Maternal Outcome, and Neonatal Outcome, Obese

I.A.Lapina, T.G.Chirvon, Yu.E. Dobrokhotova, V.V.Taranov Pirogov Russian National Research Medical University, Moscow, Russian Federation In recent decades, extensive growth in the number of overweight or obese individuals is reported thus making this issue important for the medical community. According to some authors, 8% of overweight women and 18% of obese women have troubles with realizing reproductive function. Glucose and lipid metabolism disorders and hypertension that are common in women with polycystic ovary syndrome (PCOS) allow for referring this condition to metabolic diseases. Metabolic syndrome is an umbrella term for a set of metabolic abnormalities arising from insulin resistance and hyperinsulinemia. PCOS may also be considered as one of its manifestations being regarded as the most common cause of infertility in overweight and obese women. The treatment should be complex to recover reproductive function and to address metabolic disorders. Adherence to lifestyle changes, diet, and regular physical activity is still poor. Therefore, the use and assessment of the efficacy of pharmaceutical s for pre-pregnancy preparation to lose weight and to improve reproductive outcomes in PCOS. Keywords: polycystic ovary syndrome, PCOS, obesity, metabolic syndrome, infertility, pre-pregnancy preparation, treatment, prevention, ovulation. For citation: Lapina I.A., Chirvon T.G., Dobrokhotova Yu.E., Taranov V.V. Pre-pregnancy preparation in women with polycystic ovary syndrome and obesity: state-of-the-art. Russian Journal of Woman and Child Health. 2021;4(2):137–143. DOI: 10.32364/2618-8430-2021-4-2-137-143.

Pre-pregnancy care is an important approach for maternal and child health. This study aimed to determine the knowledge about pre-pregnancy care and factors associated with good pre-pregnancy care knowledge among women with high risk pregnancy in Kinta, Perak. A cross-sectional study was conducted among women diagnosed as high-risk pregnancy in governmental health clinics in Kinta. Stratified random sampling was applied and interviewer-guided questionnaires were administered. A proforma and the validated Pre-pregnancy Care Knowledge and Practice Questionnaire were used, consisting of 21 items on knowledge. Good pre-pregnancy care knowledge was defined as those with the total score of more than 12. Logistic regression analysis was conducted using SPSS software. Of the 490 women, their mean age was 29.98 (SD 5.51) years. Less than half (48.6%) had good knowledge of pre-pregnancy care. Education level and attended pre-pregnancy care services were significantly associated with good pre-pregnancy care knowledge. Compared to women with secondary and below education, those with tertiary education had two times odds of having good pre-pregnancy care knowledge (Adjusted odds ratio 2.06; 95% CI: 1.41, 3.03; p

OBJECTIVE: Loss of control over eating (LOC) is common among women, particularly those with overweight and obesity (OV/OB), and predicts weight gain. Given the importance of understanding weight and eating behaviors during pregnancy, we sought to characterize LOC across pregnancy and the postpartum period among women with pre-pregnancy OV/OB. METHODS: Pregnant women (N = 257; 28.44 ± 5.48 years old) with self-reported OV/OB prior to pregnancy were interviewed using a pregnancy-adapted version of the Eating Disorder Examination (EDE-PV). Pre-pregnancy LOC was retrospectively assessed during the first trimester and then prospectively assessed monthly throughout pregnancy and postpartum over the course of seven assessments. RESULTS: Rates of LOC were significantly higher during pregnancy compared to prior to ([Formula: see text] , p < .01) and after ([Formula: see text] , p < .01) pregnancy, with 37% (n = 95) of women reporting ≥1 LOC episode during pregnancy. LOC during pregnancy was associated with higher likelihood of LOC postpartum. Higher age (OR = 1.084, p = .04) and identifying as a minority (OR = 0.344, p = .02) was associated with greater likelihood of experiencing LOC during pregnancy only. DISCUSSION: LOC during pregnancy is common among women with pre-pregnancy OV/OB, suggesting that screening and intervention for LOC during pregnancy may be warranted. Future research is necessary to examine the relationship between LOC during pregnancy and maternal and infant health outcomes.

In the United States, the number of pregnant women who are overweight or obese is increasing. While such individuals are at increased risk of pregnancy complications, data regarding costs associated with pre-pregnancy body mass index (BMI) and maternal and infant outcomes are lacking.To estimate maternal and infant costs associated with pre-pregnancy BMI in a large cohort of pregnant women.We conducted a retrospective cohort study of women with singleton, non-anomalous births in California from 2007 to 2011. Women with preexisting diabetes mellitus and chronic hypertension were excluded. Hospitalization costs were estimated separately for women and infants using hospital charges adjusted using a cost-to-charge ratio. These costs included hospitalization costs for admission for delivery only. We estimated the differences in median costs between seven categories of pre-pregnancy BMIs, including underweight (BMI18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), class I obesity (BMI 30.0-34.9), class II obesity (BMI 35.0-39.9), class III obesity (BMI 40.0-49.9) and obesity with BMI ≥50.0. We also performed stratified analyses by mode of delivery and gestational age at delivery. We examined the length of stay for women and infants and estimated the gestational age at delivery. Analyses were conducted utilizing Kruskal-Wallis equality-of-populations rank tests with a significance cutoff of 0.05.In a California cohort of 1,722,840 women, 787,790 (45.7%) had a pre-pregnancy BMI that was considered overweight or obese. The median maternal and infant costs of each pre-pregnancy BMI strata were significantly different when compared to other strata, with underweight and normal weight women having the lowest median costs ($11,581 and $11,721, respectively) and the most obese category (BMI ≥50) having the highest costs ($15,808). When stratified by mode of delivery and gestational age at delivery, this remained true. Hospitalization costs for women and infants with severe maternal morbidity were also significantly different based on maternal BMI.The hospitalization costs associated with each strata of BMI were significantly different when compared to each other and when stratified by mode of delivery and prematurity. This analysis allows for a greater understanding of the health care costs associated with different maternal pre-pregnancy BMI classes.

To examine relationships among pre-pregnancy body dissatisfaction (BD) and gestational weight gain (GWG), and related attitudes/behaviors. Pre-pregnancy BD was self-reported in early pregnancy. Weight-related attitudes/behaviors were self-reported and physical activity was objectively measured during pregnancy. Overall, 92% of the women reported BD, with 69% desiring a smaller pre-pregnancy size than their actual pre-pregnancy size. Ideal pre-pregnancy weight was 20.7

South Africa faces dual epidemics of HIV and obesity; however, little research has explored whether HIV status influences associations between pre-pregnancy body mass index (BMI) and adverse birth outcomes.To examine associations between pre-pregnancy body mass index (BMI) and adverse birth outcomes, and if they differ by HIV status.We followed HIV-uninfected and -infected pregnant women initiating antiretroviral therapy (ART) from first antenatal visit through delivery. HIV-infected women initiated ART (tenofovir-emtricitabine/lamivudine-efavirenz) in pregnancy. Estimated pre-pregnancy BMI (kg/mAmong 1116 women (53% HIV-infected), 44% of HIV-uninfected women and 36% of HIV-infected women were classified as obese; 4% of women were underweight. Overall, 12% of infants were delivered preterm (37 weeks), 10% small for gestational age (SGA,10th percentile), and 9% large for gestational age (LGA,90th percentile). Compared to HIV-uninfected women, HIV-infected women on ART had less LGA (5% vs 13%) but more SGA (12% vs 8%), and a similar proportion of preterm (13% vs 11%) infants. Pre-pregnancy BMI was not associated with preterm birth. Among HIV-uninfected women, obesity modestly increased the risk of LGA (RR 1.34, 95% confidence interval [CI] 0.82, 2.19), and underweight modestly elevated the risk of SGA (RR 1.66, 95% CI 0.79, 3.46). These associations were attenuated among HIV-infected women (RR 1.07, 95% CI 0.44, 2.64 for LGA, and RR 1.34, 95% CI 0.49, 3.64 for SGA).In this urban African setting of high HIV prevalence, pre-pregnancy obesity was common and did not vary by HIV status. In HIV-uninfected women, obesity increased the risk of LGA and being underweight the risk of SGA, compared with among HIV-uninfected women.

Objective Most pregnant women gain weight above recommended levels, and this weight gain affects mothers’ and children's health. Factors influencing gestational weight gain (GWG) are numerous and include eating behaviours. The objective of this study was to evaluate the association between eating behaviours and GWG while considering pre-pregnancy body mass index (BMI). Methods Fifty-three (n = 53) women were recruited at 9.4 ± 0.6 gestational weeks. At each trimester, they completed the Three-Factor Eating Questionnaire, which evaluates disinhibition, dietary restraint, and susceptibility to hunger. Using a weight gain curve, trimester-specific GWG was calculated with interpolated weights. Total GWG was calculated as the difference between maternal weight before delivery and self-reported pre-pregnancy weight (Canadian Task Force Classification II-2). Results Women were aged 31.5 ± 3.5, and 81.1% had a university degree. The proportion of women who gained weight within recommendations was 21%, 28%, and 26%, at each trimester, respectively, and 38% for total pregnancy. Overall, dietary restraint score was lower in the third trimester in comparison with the first (6.1 ± 4.1 vs. 7.2 ± 4.6; P = 0.049), whereas no difference was observed for disinhibition or susceptibility to hunger. Our data suggest that variations in eating behaviours throughout pregnancy were similar among women who exhibited total GWG below, within, or above recommendations (Ptrim × GWG = NS) (NS: not significant; trim: trimester). Similar observations were reported when women were compared according to their pre-pregnancy BMI (Ptrim × BMI = NS). Conclusion Maintaining high levels of restraint may be challenging considering the increase in hunger, which could explain the decrease observed in dietary restraint scores. Changes in eating behaviours were not associated with total GWG or pre-pregnancy BMI.

This study questioned whether raised pre-pregnancy two-hour (2 h) insulin levels, measured in recurrent embryonic miscarriage (RM) patients via a 75 g Oral Glucose Tolerance Test (OGTT), are associated with an increased risk of gestational diabetes mellitus (GDM) in a subsequent pregnancy. Patients had a 75 g OGTT and insulin levels evaluated (

Background. Maternal weight during pregnancy may affect both, the course of pregnancy and the anthropometric parameters of the newborn. The steadily growing problem of excessive weight in reproductive-age women is associated with the risk for gestational obesity and its negative consequences for the infant. Objectives. The aims of the study were to analyze the following: (i) maternal weight gain as compared to the pre-pregnancy BMI, and (ii) the link between maternal weight and other environmental factors versus neonatal size. Material and methods. The study was conducted among 94 women in singleton term pregnancy, who delivered at the Department of Obstetrics, Gynecology and Oncology, Medical University of Warsaw. The American Institute of Medicine criteria for the recommended weight gain were followed. Multivariate logistic regression model and multiple regression analysis were used for statistical analysis. Results. Normal weight gain was observed in only one-third of the subjects, while excess weight gain was detected in as many as 42.5% of the women. Active smokers were at a 4-fold higher risk for excess weight gain as compared to nonsmokers (OR 4.13, 95% CI 1.19 - 14.34, p = 0.026). Infants born to mothers with insufficient weight gain (24.5% of the mothers) were lighter by 302 g (p=0.0405) and shorter by 2.4 cm (p=0.0025) as compared to those born to mothers with normal weight gain. Conclusions. Maternal weight gain in most of our subjects was not compliant with the current recommendations, regardless of the pre-pregnancy BMI. Inadequate pregnancy weight gain negatively affects the anthropometric parameters of the newborn.

Objective:To explore the effect of maternal BMI class pre-pregnancy (overweight/obese v. healthy weight/underweight) on childhood diet quality and on childhood overweight/obesity risk.Design:Dietary data were collected using 3-d parental-completed food records for their children at ages 18 and 43 months. An index of diet quality was derived by classification of food items into core and non-core foods. Adjusted multiple linear regression analyses were used to explore the effect of maternal BMI class on diet quality in their children.Setting:Avon, UK.Participants:A 10% subsample of the Avon Longitudinal Study of Parents and Children. Nine-hundred and eighty children provided complete dietary data at 18 months and 769 at 43 months.Results:Children with overweight/obese mothers consumed greater amounts of energy from non-core foods than children with healthy weight/underweight mothers (0·20 MJ (48 kcal)/d more at 18 months (P < 0·001); 0·19 MJ (45 kcal)/d more at 43 months (P = 0·008)) in adjusted models. Diet quality deteriorated between 18 and 43 months (children reduced their dietary energy intake from core foods (P < 0·001) and increased intake from non-core foods (P < 0·001)). However, this change was not associated with maternal BMI class in adjusted models. Having an overweight/obese mother was associated with an increased odds of the child being overweight/obese at 43 months (OR 1·74 (1·17, 2·58)).Conclusions:Children aged 18 and 43 months with overweight/obese mothers are likely to have a poorer quality diet than those with healthy/underweight mothers. Parents should be supported in discouraging the consumption of non-core foods in children at these ages.

The metabolic profile variability of women with diabetes mellitus type 1 (DM1) during breastfeeding, leads to a reassessment in managing glycemia, mainly to prevent hypoglycemia. In this retrospective study we assessed insulin needs, vis-à-vis breastfeeding in DM1. A 10.7% reduction of daily insulin dosage, compared to pre-pregnancy insulin needs, was noted in women who breastfed exclusively versus 10.8% in those who supplemented breastfeeding (p = NS). Women who experienced hypoglycemic episodes, tended (but not significantly) to be younger (

Background The differential effect of pre-pregnancy low BMI on macrosomia has not been fully addressed. Herein, we conducted a city-wide population-based cohort study to illuminate the association between pre-pregnancy low BMI and macrosomia, stratifying by maternal age, parity, and GDM status. Methods All pregnant women who paid their first prenatal visit to the hospital in Qingdao during August 1, 2018, to June 30, 2020, were recruited to this study. The interactive effect of maternal age and pre-pregnancy low BMI on macrosomia was evaluated using logistic regression models, followed by strata-specific analyses. Results A total of 105,768 mother-child pairs were included, and the proportion of fetal macrosomia was 11.66%. The interactive effect of maternal pre-pregnancy BMI and age was statistically significant on macrosomia irrespective of parity (nullipara: Padjusted=0.0265; multipara: Padjusted=0.0356). The protective effect of low BMI on macrosomia was most prominent among nullipara aged 35 years and above (aOR=0.16, 95% CI 0.05–0.49) and multipara aged 25 years and below (aOR=0.17, 95% CI 0.05–0.55). In nullipara without GDM, the risk estimates gradually declined with increasing conception age (20-to-24 years: aOR=0.64, 95% CI 0.51–0.80; 25-to-29 years: aOR=0.43 95% CI 0.36–0.52; 30-to-34 years: aOR=0.40 95% CI 0.29–0.53; and ≥35 years: aOR=0.19, 95% CI 0.06–0.60). A similar pattern could also be observed in nullipara with GDM, where the aOR for low BMI on macrosomia decreased from 0.54 (95% CI 0.32–0.93) in pregnant women aged 25–29 years to 0.30 (95% CI 0.12–0.75) among those aged 30–34 years. However, younger multiparous mothers, especially those aged 25 years and below without GDM (aOR=0.21, 95% CI 0.06–0.68), were more benefited from a lower BMI against the development of macrosomia. Conclusions Maternal low BMI is inversely associated with macrosomia irrespective of maternal age and parity. The impact of pre-pregnancy low BMI on macrosomia varied by maternal age and parity. The protective effect of a lower maternal BMI against fetal macrosomia was more prominent in nulliparous mothers aged 35 years and above, whereas multiparous mothers younger than 25 years of age were more benefited.

David Morris looks at how to advise expectant mothers to manage type 2 diabetes

Study Objective Adolescent pregnancy contributes to accelerated trajectories of adiposity and cardiometabolic diseases. Two potentially low-cost prevention strategies include promoting physical activity (PA) and limiting television (TV) viewing. Few studies have explored these behavior patterns in perinatal adolescents. This study sought to characterize PA and TV viewing in a socioeconomically disadvantaged perinatal adolescent population. Design, Setting, Participants, and Interventions A cross-sectional, retrospective, 10-item survey was used to explore behavior patterns in 79 predominantly Black (86%) postpartum adolescents. Main Outcome Measures: Outcomes included self-reported changes in PA from pre-pregnancy through pregnancy, and 7-day recall of PA and TV viewing in postpartum. Results The majority of adolescents (66%) reported being active on ≥3 days/week in pre-pregnancy; however, many reported low PA (≤2 days/wk) in their first (59%), second (66%), and third (54%) trimesters. Adolescents who reported being active on ≥5 days/wk in pre-pregnancy (19%) experienced first trimester PA decline, which subsequently plateaued. This group remained the most active throughout pregnancy. In postpartum, over half (54%) of all adolescents reported low PA and irrespective of PA, spent considerable time watching TV (median = 1680.0 minutes, inerquartile range = 2940). Conclusion Interventions promoting PA coupled with reducing TV viewing during pregnancy and in postpartum may benefit perinatal adolescents. The findings from this study suggest that PA history is a predictor of gestational PA, and low PA and high TV viewing in postpartum underscore the need for behavioral intervention. Conducting a brief assessment of PA history in early gestation may offer important insight.

The gestational weight gain (GWG) range of Chinese women with gestational diabetes mellitus (GDM) still remains unclear. Our objective was to identify the ranges of GWG in Chinese women with GDM, and to investigate the associations between pre-pregnancy body mass index (BMI), GWG and maternal-infant adverse outcomes. GDM Women delivering singleton from 2013 to 2018 in a tertiary public hospital were collected. Logistic regression analysis was used to assess the joint effects of pre-pregnancy BMI and GWG on maternal-infant adverse outcomes. Finally, 14,578 women were collected. The ranges of GWG of Chinese women with GDM in the underweight, normal weight, overweight and obese groups were 5.95-21.95kg, 4.23-21.83kg, 0.88-21.12kg and-1.76-19.95kg, respectively. The risks of large for gestational age (LGA), macrosomia and cesarean delivery were significantly increased with the increase of pre-pregnancy BMI. Furthermore, the risks of LGA, macrosomia and cesarean delivery were significantly higher in normal weight group with GWG higher than the National Academy of Medicine’s (NAM) recommendation. Similarly, in overweight group with GWG higher than NAM recommendation, the risks of LGA were significantly higher, while, the risks of macrosomia were significantly lower. In conclusion, the ranges of GWG in GDM women were different with NAM recommendation.

OBJECTIVES: To evaluate whether pre-pregnancy intakes of omega-3 and omega-6 fatty acids prevent HDP. METHODS: We followed 11,535 women from the Nurses' Health Study-II free of chronic disease that filled out food frequency questionnaires starting in 1991 before their 16,892 singleton pregnancies. Intakes of omega-3 fatty acids (alpha-linolenic acid[ALA] + long-chain omega-3 [LCN-3]) and omega-6 (linoleic acid [LA] + arachidonic acid[ARA]). In 2009, participants reported history of preeclampsia and GHTN. The relative risk (95%CI) of HDP across quintiles of intakes of omega-3 and omega-6 were estimated by log-binomial regression model using generalized estimating equation to account for repeated pregnancies from the same woman and adjusted for age at pregnancy, year of pregnancy, and pre-pregnancy: BMI, physical activity, smoking, infertility diagnosis, marital status, race, parity, multivitamin use, concurrent gestational diabetes, and preeclampsia at baseline. RESULTS: During 18 years of follow-up, there were 495 pregnancies with preeclampsia (2.9%) and 561 pregnancies (3.3%) with GHTN. Mean (SD) age at pregnancy was 34.6 (3.9) years. Intakes of total omega-6 and total omega-3 fatty acids before pregnancy were unrelated with the risk of either HDP. From individual omega subtypes, only ARA had a marginally significant relation to higher risk of GHTN. Women in the highest quintile of ARA had 43% increased risk of GHTN (CI: 1.00–2.04) compared to women in the lowest quintile of intake. Intakes of the remaining subtypes, LA, LCN-3, and ALA were not associated to HDP risk. When we restricted the analysis to a closer window of exposure among 5,208 women with diet assessment one year before pregnancy, only intakes of LCN-3 (RR = 0.55, CI:0.33–0.91) and LA (RR = 0.54, CI: 0.29,0.99) were associated with a lower risk of preeclampsia, comparing women in the highest versus the lowest quintile of intake. CONCLUSIONS: Dietary intake of long-chain omega-3 fatty acid and linoleic acid one year before pregnancy was associated with a reduced risk of preeclampsia. The extent to which long-chain omega-3 prevents preeclampsia may be more relevant in a window of exposure closer to pregnancy. FUNDING SOURCES: National Institutes of Health grants U01-HL145386–01, UM1-CA176726, P30-DK046200, and R00ES026648.

OBJECTIVES: This study analyzed the association between pre-pregnancy body mass index (PPBMI), dietary intake status, and birth size outcomes in the VDPM cohort study in West Sumatra, Indonesia. METHODS: The VDPM study is a prospective longitudinal study including 239 healthy pregnant women of Indonesian women with singleton pregnancies. Data on maternal dietary intake including energy, carbohydrate, protein, and fat intake, and anthropometry were collected during pregnancy. New-born anthropometry for 195 new-born babies was measured immediately after delivery. Bivariate and multivariate regression analyses were constructed to determine the association between PPBMI, dietary intake status, and birth size outcomes. RESULTS: The mean birth weight was 3195 ± 463 g. Dietary intake of pregnant mothers had a significant correlation with newborn birth weight, length of birth, head circumference, and placental weight as pregnancy outcome indicators (p ≤ 0.05). This study showed that no association between pre-pregnancy BMI status and birth size outcomes (p ≥ 0.05). CONCLUSIONS: Our studies have not shown a statistically significant difference between PPBMI and birth size outcomes. However, maternal dietary intake associated with birth size outcomes, more research is warranted to confirm these findings. FUNDING SOURCES: Indonesian Danone Institute Foundation.

During the coronavirus disease 2019 pandemic, the Japanese Society of Diabetes and Pregnancy proposed the use of random plasma glucose and glycated hemoglobin measured 1 month after delivery combined with pre‐pregnancy body mass index to detect postpartum glucose intolerance instead of carrying out the oral glucose tolerance test in women with gestational diabetes. We retrospectively evaluated the clinical utility of this strategy to detect postpartum glucose intolerance evaluated by the oral glucose tolerance test after delivery. A total of 275 Japanese women with gestational diabetes were included in the present study. The specificity of 1‐month postpartum random plasma glucose and glycated hemoglobin combined with pre‐pregnancy body mass index to predict postpartum glucose intolerance was 98.0%, with a negative predictive value of 72.6%. However, sensitivity was 6.4%, with a positive predictive value of 55.6%. In conclusion, this Japanese Society of Diabetes and Pregnancy strategy showed high specificity, but low sensitivity, for detecting glucose intolerance postpartum., During the coronavirus disease 2019 pandemic, the Japanese Society of Diabetes and Pregnancy (JSDP) proposed the use of random plasma glucose and HbA1c measured 1 month after delivery combined with pre‐pregnancy body mass index to detect postpartum glucose intolerance instead of performing oral glucose tolerance test in women with gestational diabetes. This JSDP strategy showed high specificity of 98.0% but low sensitivity of 6.4% for detecting glucose intolerance postpartum.

Introduction: Poor cardiometabolic health is a major contributor to growing rates of maternal morbidity and mortality. Given known state-level variation in maternal outcomes, we sought to describe the geographic distribution of pre-pregnancy cardiometabolic health as it could inform policy changes to optimize maternal and offspring outcomes. Hypothesis: We hypothesized that pre-pregnancy cardiometabolic health has declined over time and varies by state. Methods: We conducted a nationwide, serial cross-sectional analysis using maternal birth record data from the CDC Natality Files 2016-2018, which include all live births in the US. We included all live births to women aged 20-44 years (N= 10,693,708). Pre-pregnancy cardiometabolic health was quantified by number of pre-pregnancy risk factors: overweight or obesity (body mass index > 25 kg/m 2 ), diabetes, and/or hypertension. We calculated annual age-standardized prevalence of favorable (no risk factors), suboptimal (any single risk factor), or poor ( > 2 risk factors) pre-pregnancy cardiometabolic health and quantified percentage change between 2016-2018 by state. Results: From 2016-2018, the percentage of live births to women with favorable cardiometabolic health decreased from 43.5% (43.4, 43.6) to 41.3% (41.2, 41.3), suboptimal health increased from 51.1% (51.1, 51.2) to 53.3% (53.3, 53.4), and poor health increased from 2.1% (2.1, 2.1) to 2.4% (2.4, 2.4). All states experienced declines in favorable cardiometabolic health. There was significant geographic variation with prevalence of favorable pre-pregnancy cardiometabolic health ranging from 32.7% (32.2, 33.3) in Mississippi to 48.2% (47.7, 48.6) in Utah in 2018 (FIGURE) ; poor health ranged from 1.3% (1.3, 1.4) in California to 4.6% (4.4, 4.8) in Louisiana in 2018. Conclusions: Less than half of women had favorable pre-pregnancy cardiometabolic health between 2016-2018, with significant geographic heterogeneity. Public health efforts to improve pre-conception cardiometabolic health are needed.

Introduction: Hypertensive disorders of pregnancy (HDP) and pre-pregnancy hypertension are associated with increased maternal morbidity and mortality, and information on racial/ethnic disparities is lacking. The association of HDP and pre-pregnancy hypertension with incident maternal embolism was examined within five years of delivery and for the study period (≤14 years) overall and by race/ethnicity. Methods: Women with a live, singleton birth in South Carolina (2004-2016) aged 12-49 years were included in a retrospective cohort study (n=433,625; non-Hispanic white [NHW; 58.7%], non-Hispanic black [NHB; 31.8%)] and Hispanic [9.5%]). HDP were defined by hospitalization/emergency department (ED) visit data (pre-eclampsia, eclampsia, gestational hypertension) or birth certificates (gestational hypertension). Pre-pregnancy hypertension was also defined by these data sources. Hospitalization/ED visit data and death certificates defined fatal and non-fatal incident embolism. Cox proportional hazards models were used with covariate adjustment. Results: In women with ≥1 pregnancy, 81.6% never experienced pre-pregnancy hypertension or HDP, 0.4% had pre-pregnancy hypertension without superimposed HDP, 15.7% had HDP alone, and 2.3% had pre-pregnancy hypertension with superimposed HDP. Incident embolism risk was elevated ≤14 years after delivery for women with HDP alone (HR=1.21, 95% CI: 1.12-1.30) and with pre-pregnancy hypertension with superimposed HDP (HR=1.44, 95% CI: 1.26-1.65) compared to neither condition. Pre-pregnancy hypertension alone was not associated with incident embolism risk (HR=1.23, 95% CI: 0.84-1.80). The table shows the joint impact of racial/ethnicity and the exposure categories. Discussion: Fatal and non-fatal embolism up to 14 years after delivery was increased for HDP regardless of pre-pregnancy hypertension suggesting a long-term impact. Incident embolism event rates were highest for NHB women and lowest for Hispanic women across all HDP exposure categories.

Background: Preeclampsia carries high acute and chronic maternal and fetal morbidity and mortality. It is still unclear how pre-pregnancy conditions affect preeclampsia risk, and whether diet reduces risk. We examined associations of pre-pregnancy hypertension, obesity, and diabetes with preeclampsia, and investigated if a Mediterranean-style diet associates with lower risk. Methods: We used data from the Boston Birth Cohort, which comprises racially/ethnically diverse, urban, low-income mothers. We obtained maternal demographic and dietary intake frequencies via interviewer-administered questionnaires within 24-72 hours after birth. We extracted additional pregnancy-related clinical information, including physician diagnosis of preexisting conditions and preeclampsia from medical records. We created tertiles of a Mediterranean-style diet score previously created by our group. We performed logistic regression to assess associations of pre-pregnancy conditions and Mediterranean style diet with odds of preeclampsia. Results: Of 8,507 women in the sample, 849 developed preeclampsia. 47% were black, 28% were Hispanic, and the remaining were white/other. After multivariable adjustment (see table), pre-pregnancy hypertension had the strongest association with preeclampsia (OR 7.81; 95% CI 6.25-9.76), followed by obesity (OR 1.67; 95% CI: 1.41-1.99). Pre-pregnancy diabetes was not associated with preeclampsia after adjustment for obesity and hypertension (table). A higher Mediterranean-style diet score associated with lower preeclampsia odds, but it did not attenuate associations of hypertension or obesity with preeclampsia (table). Conclusions: Pre-pregnancy hypertension and obesity are independently associated with higher preeclampsia odds. Self-report of adherence to Mediterranean-style diet was also associated with lower preeclampsia odds, but this did not mediate risk among obese and hypertensive women. Strategies to prevent preeclampsia among high-risk women are needed.

Background It is well known that maternal smoking during pregnancy and maternal pre-pregnancy overweight have opposite effects on the infants’ birth weight. We report on the association of the combination between both risk factors and the infants’ birth weight. Methods We studied 3241 infants born at term in the PIAMA birth cohort. Maternal smoking during pregnancy and pre-pregnancy height and weight were self-reported. Multivariable regression analysis was performed to assess the associations between infants of mothers who only smoked during pregnancy, who only had pre-pregnancy overweight and who had both risk factors simultaneously, on term birth weight and the risk of being SGA or LGA. Results Of 3241 infants, 421 infants (13%) were born to smoking, non-overweight mothers, 514 (15.8%) to non-smoking, overweight mothers, 129 (4%) to smoking and overweight mothers and 2177 (67%) to non-smoking, non-overweight mothers (reference group). Infants of mothers who smoked and also had pre-pregnancy overweight had similar term birth weight (− 26.6 g, 95%CI: − 113.0, 59.8), SGA risk (OR = 1.06, 95%CI: 0.56, 2.04), and LGA risk (OR = 1.09, 95%CI: 0.61, 1.96) as the reference group. Conclusions Our findings suggested that the effects of maternal smoking during pregnancy and maternal pre-pregnancy overweight on infants’ birth weight cancel each other out. Therefore, birth weight may not be a good indicator of an infant’s health status in perinatal practice because it may mask potential health risks due to these maternal risk factors when both present together.

Pre-pregnancy care is a series of interventions aimed to identify and modify behavioral and social risk factors and improve women’s health before pregnancy. The aim of this study was to investigate the factors affecting pre-pregnancy care based on the theory of planned behavior in women aged 15–49 years in Larestan city, Shiraz, in 2016. In this descriptive-analytical, cross-sectional study, all women aged 15 to 49 years, who agreed to complete a self-administered questionnaire based on the theory of planned behavior, were included. Predictors of pre-pregnancy care intention and behavior were identified using linear and logistic regression. The results showed that 46.4% of women had received pre-pregnancy care. The most important predictors of intention were attitude (P

AimTo elicit the views and experiences of women with Type 2 diabetes and healthcare professionals relating to the pregnancy and pre‐pregnancy care they have received or provided.MethodsA qualitative study using in‐depth semi‐structured interviews with women with Type 2 diabetes (n=30) and healthcare professionals (n=22) from primary and specialist care. Women were purposively sampled to include different experiences of pregnancy and pre‐pregnancy care. Data were transcribed verbatim and analysed thematically using Framework Analysis.ResultsThe median age of the women was 37 years, and most were obese (median BMI 34.9 kg/m2), of black or Asian ethnicity (n=24, 80%) and from areas of high deprivation (n=21, 70%). Participating healthcare professionals were from primary (n=14), intermediate (n=4) and secondary (n=4) care. Seven themes expressing factors that mediate reproductive behaviour and care in women with Type 2 diabetes were identified at the patient, professional and system levels. Type 2 diabetes was generally perceived negatively by the women and the healthcare professionals. There was a lack of awareness about the pre‐pregnancy care needs for this population, and communication between both groups was unhelpful in eliciting the reproductive intentions of these women. The themes also reveal a lack of systemic processes to incorporate pre‐pregnancy care into the care of women with Type 2 diabetes, and consequently, health professionals in primary care have limited capacity to provide such support.ConclusionIf the current high levels of unprepared pregnancies in women with Type 2 diabetes are to be reduced, the reproductive healthcare needs of this group need to be embedded into their mainstream diabetes management.

This cross-sectional study examined the relationship between maternal pre-pregnancy body mass index (BMI) and dietary intake on birth size in the north-east part of Iran. Maternal information including BMI and dietary intake from 453 healthy pregnant women were collected in 2013-2014. Maternal pre-pregnancy BMI were obtained from health records and dietary intakes in third trimester were collected by using a validated food frequency questionnaire (FFQ), which consisted of 160 Iranian foods. Anthropometric measurements of neonates including weight, height, and head circumference were 3.19 ± 0.49 kg, 50.24 ± 2.1 cm, and 34.61 ± 1.5 cm, respectively. A significant difference was found in neonatal birth weight (p < 0.001) and head circumference (p = 0.002) between underweight and obese mothers. Furthermore, maternal intake of fat had a direct correlation with birth size. There was a positive relationship between vitamin A and potassium intake and birth height. The article concludes that normal maternal pre-pregnancy weight and appropriate diet are likely essential for healthy babies.

Aim The present study aimed to investigate major dietary patterns and their association with risk of gestational diabetes mellitus (GDM) in Yazd city located in Iran. Methods This case-control designed study was conducted at six healthcare centres. Two hundred and seventy-eight pregnant women who referred for GDM screening participated. Dietary assessment was carried out by using a 67-item validated food frequency questionnaire to evaluate dietary history of participants during the last year. Principal component analysis was used to identify major food patterns. Multivariable logistic regression model was employed to identify the association between dietary patterns and risk of GDM. Results Two major dietary patterns were detected. The Western dietary pattern was associated with higher intakes of sugar-sweetened beverages, refined grain products, fast foods, salty snacks, sweets and biscuit, mayonnaise and saturated oils, while the prudent dietary pattern was associated with higher intakes of fruits, low-fat dairy, potato, egg, fish, poultry, nuts, organs meat and red meat. Furthermore, prudent dietary pattern was negatively associated with GDM risk (OR = 0.88, 95% CI: 0.44-0.99). However, there was no significant association between adherence of the Western dietary pattern and risk of GDM. Conclusions Pre-pregnancy adherence of the prudent dietary pattern was significantly associated with reduced risk of GDM.

We aimed to assess the caffeine intake before and during pregnancy, compliance with caffeine recommendations during pregnancy (200 mg/day) and factors associated with higher intakes before and in first trimester of pregnancy. Caffeine consumption was collected in a Spanish cohort of pregnant women through a validated food questionnaire, before and in each trimester of gestation (T1, T2 and T3). 463 pregnant women were recruited and follow-up through pregnancy. Compliance with caffeine intake recommendations during pregnancy and quintiles of mg/day of caffeine before and in T1 of pregnancy were calculated. A multivariate logistic regression, comparing extreme quintiles of consumption (Q1 vs Q5) was used. Mean caffeine intake before pregnancy was 120.05 mg/day (SD 117.85), 42.76 mg/day (SD 63.90) at 12th GW, 42.00 mg/day (SD 59.76) at 24th GW and 39.34 mg/day (SD 50.9) at 32nd GW (p 100.1 mg/day, aOR = 22.69; 95% CI 4.67- 110.26. igh diet quality, aOR = 0.30; 95% CI, 0.13- 0.68, and moderate physical activity level, aOR= 0.44; 95% CI, 0.19-1.00, were inversely associated with Q5 > 100.1 mg/day. Pregnant women are mostly adhering to current caffeine intake guidelines. Higher caffeine intake at pregnancy is associated with other unhealthy habits during pregnancy.

Maternal diet plays a critical role in epigenetic changes and the establishment of the gut microbiome in the fetus, which has been associated with weight outcomes in offspring. This study examined the association between maternal diet quality before pregnancy and childhood body mass index (BMI) in offspring. There were 1936 mothers with 3391 children included from the Australian Longitudinal Study on Women’s Health (ALSWH) and the Mothers and their Children’s Health (MatCH) study. Maternal dietary intakes were assessed using a semi-quantitative and validated 101-item food-frequency questionnaire (FFQ). The healthy eating index (HEI-2015) score was used to explore preconception diet quality. Childhood BMI was categorized as underweight, normal, overweight, and obese based on sex and age-specific BMI classifications for children. Multinomial logistic regression with cluster-robust standard errors was used for analyses. Greater adherence to maternal diet quality before pregnancy was associated with a lower risk of offspring being underweight after adjustment for potential confounders, highest vs. lowest quartile (relative risk ratio (RRR) = 0.68, 95% confidence interval (CI): 0.49, 0.96). Higher adherence to preconception diet quality was also inversely linked with the risk of childhood obesity (RRR = 0.49, 95% CI: 0.24, 0.98). This association was, however, no longer significant after adjusting for pre-pregnancy BMI. Sodium intake was significantly associated with decreased risk of childhood overweight and obesity (RRR = 0.18, 95% CI: 0.14, 0.23) and (RRR = 0.21, 95% CI: 0.17, 0.26), respectively. No significant association was detected between preconception diet quality and offspring being overweight. This study suggests that better adherence to maternal diet quality before pregnancy is associated with a reduced risk of childhood underweight and obesity.

Background Pre‐pregnancy hypertension and hypertensive disorders of pregnancy (HDP; preeclampsia, eclampsia, gestational hypertension) are major health risks for maternal morbidity and mortality. However, it is unknown if racial/ethnic differences exist. We aimed to determine the impact of HDP and pre‐pregnancy hypertension on maternal coronary heart disease, stroke, and mortality risk ≤1, 3, and 5 years post‐delivery and by race/ethnicity ≤5 years. Methods and Results This retrospective cohort study included women aged 12 to 49 years with a live, singleton birth between 2004 to 2016 (n=254 491 non‐Hispanic White; n=137 784 non‐Hispanic Black; n=41 155 Hispanic). Birth and death certificates and International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification ( ICD‐9‐CM and ICD‐10‐CM ) diagnosis codes in hospitalization/emergency department visit data defined HDP, pre‐pregnancy hypertension, incident coronary heart disease and stroke, and all‐cause mortality. During at least 1 pregnancy of the 433 430 women, 2.3% had pre‐pregnancy hypertension with superimposed HDP, 15.7% had no pre‐pregnancy hypertension with HDP, and 0.4% had pre‐pregnancy hypertension without superimposed HDP, whereas 81.6% had neither condition. Maternal deaths from coronary heart disease, stroke, and all causes totaled 2136. Within 5 years of delivery, pre‐pregnancy hypertension, and HDP were associated with all‐cause mortality (hazard ratio [HR], 2.21; 95% CI, 1.61–3.03), incident coronary heart disease (HR, 3.79; 95% CI, 3.09–4.65), and incident stroke (HR, 3.10; 95% CI, 2.09–4.60). HDP alone was related to all outcomes. Race/ethnic differences were observed for non‐Hispanic Black and non‐Hispanic White women, respectively, in the associations of pre‐pregnancy hypertension and HDP with all‐cause mortality within 5 years of delivery (HR, 2.34 [95% CI, 1.58–3.47]; HR, 2.11 [95% CI, 1.23–3.65]; P interaction=0.001). Conclusions Maternal cardiovascular outcomes including mortality were increased ≤5 years post‐delivery in HDP, pre‐pregnancy hypertension, or pre‐pregnancy hypertension with superimposed HDP. The race/ethnic interaction for all‐cause mortality ≤5 years of delivery warrants further research.

Contains fulltext : 231159.pdf (Publisher’s version ) (Open Access) The transition to parenthood is both a joyous and a challenging event in a relationship. Studies to date have found mostly negative effects of the birth of the first child on the parental relationship. We propose that partners' pre-pregnancy individual happiness may serve as a buffer against these negative effects. We predicted that parents who are happy prior to pregnancy fare better in terms of relationship commitment after childbirth than unhappy parents. To test our prediction, we used data of a 5-wave longitudinal study among 109 Dutch newlywed couples who had their first child during the study and a comparison group of 55 couples who remained childless. We found that the relationship commitment of fathers with higher pre-pregnancy happiness and fathers with a partner with higher pre-pregnancy happiness increased slightly in the years after childbirth, whereas the relationship commitment of fathers with lower pre-pregnancy happiness and fathers with a partner with lower pre-pregnancy happiness decreased. In addition, the relationship commitment of mothers with a happier partner prior to pregnancy decreased only slightly across the transition to parenthood but showed a steeper decline for mothers with a partner with average or lower pre-pregnancy happiness. In line with the idea that happiness acts as a resource when partners have to deal with relationship challenges, individual happiness predicted changes in relationship commitment for parents, but not for partners who remained childless. 10 p.

Defining the optimal gestational weight gain (optGWG) allowing to have “normal shaped” babies (10% of Small for gestational age, SGA, and10% of large LGA babies) in severe obese women (pre-pregnancy BMI ≥40 kg/m2). South-Reunion University’s maternity (Reunion Island, Indian Ocean). 20 year-observational cohort study (2001–2019). Epidemiological perinatal data base with information on obstetrical and neonatal risk factors. All consecutive term (37–42 weeks gestation) singleton pregnancies (>21 weeks) live birth pregnancies delivered in the maternity. OptGWG to obtain newborns as close as possible of the 10% SGA/LGA goal for each BMI categories, 15–19.9, 20–24.9 …, as well as severe obese ≥40 kg/m2. Of the 71,318 singleton term live births (37 weeks onward), we could define the maternal pre-pregnancy body mass index and the GWG in of 61,764 patients (86.6%). Severe obese 40 kg/m2 losing 5–9.9 kg have 12.9% of LGA and 11.9% of SGA babies. Those losing 10 kg and more 12.7% of LGA and 7.3% of SGA. Our formerly proposed linear equation (validated from 15 to 40 kg/m2) may be prolonged at 45 kg/m2. opGWG(kg)=−1.2pp BMI(Kg/m2)+42±2kg In our population, a 32 kg/m2 obese should gain 3.6 kg (instead of 5–9 kg, IOM 2009). A very obese 40 kg/m2 should lose 6 kg, and a severe obese 45 kg/m2 lose 12 kg.

Background: Pre/eclampsia and other hypertensive disorders of pregnancy contributed to 18% of the maternal mortality reported in Northern Tanzanian. There is increasing prevalence of obesity in Tanzania which is related to excessive weight gain in pregnancy. Both high BMI and excessive gestation weight gain are identified to increase risk of PE and subtypes, however this is still inconclusive and little is known about the joint effect of pre-pregnancy BMI and GWG on risk of PE and its subtypes in Africa. We evaluated the independent and joint effects of pre-pregnancy BMI and GWG on the risk of pre-eclampsia and its subtypes among women who delivered at Kilimanjaro Christian Medical Center (KCMC) from October 2018 to May 2019, Northern Tanzania.Methods: We performed a retrospective birth cohort study from October 2018 to May 2019 at KCMC, Tanzania. Pre-pregnancy BMI was categorized using WHO categories into Underweight (˂ 18.5kg/m²), Normal weight (18.5-24.9kg/m²), Overweight (25-29.9kg/m²) and Obese (≥ 30kg/m²). Gestational Weight Gain (GWG) was categorized using the 2009 Institute of Medicine (IOM) guidelines into Inadequate, Adequate and Excessive weight gain in pregnancy. Multinomial logistic regression analysis was used to adjust for confounders using relative risk, 95% confidence interval for the risk ratios (RR) that did not cross 1 and pResults: Among the 1309 women analysed, 5.3% were Underweight, 51.1% Normal weight, 26.9% Overweight and 16.7% were Obese. About 43.5% had excessive GWG. Women with PE were 9.5%. Both obesity and excessive GWG independently increased risk of PE with adjusted RR=2.42, 95%CI: 1.48-3.96 and RR=1.77, 95%CI: 1.16-2.69 when compared to normal BMI and adequate GWG respectively. Jointly, Obesity and Excessive GWG had the highest risk of PE (ARR=4.95, 95%CI: 2.21-11.10). The increased risk was similar for Mild PE (MPE), Severe PE or eclampsia (SP/E) and Late Onset PE (LOPE). No association was found for Early Onset PE (EOPE).Conclusion: Pre-pregnancy Obesity and Excessive GWG independently and jointly increases risk for PE and the risk varies by PE subtype.

Introduction: Women with recurrent preeclampsia represent a group at uniquely high risk for maternal and perinatal morbidity, as well as future cardiovascular complications. The aim of this study is to examine the association of cardiometabolic risk factors with recurrent preeclampsia in the subsequent pregnancy. Methods: The Boston Birth Cohort is a racially/ethnically diverse birth cohort with over 8500 women. We identified 618 women with repeat pregnancies. Of those, 78 women had preeclampsia in the index pregnancy, and of those, 33 had recurrent preeclampsia in the subsequent pregnancy. We used log-binomial regression to examine the association between pre-pregnancy, pregnancy, and inter-pregnancy cardiometabolic risk factors (e.g., obesity, hypertension, diabetes mellitus, preterm birth, low birth weight, and gestational diabetes mellitus) and recurrent risk of preeclampsia. Results: Among the 78 women who had preeclampsia in their index pregnancy, the recurrence rate of preeclampsia was 42.3%. Several maternal risk factors were associated with this recurrent risk. Compared to women with pre-(index) pregnancy normal weight, the risk of recurrent preeclampsia was 3 times higher for women with pre-(index) pregnancy overweight (RR 3.0 [95% CI: 1.4 to 6.6]) or obesity (RR 3.1 [95% CI: 1.5 to 6.7). Compared to women without new inter-pregnancy chronic hypertension, women with new inter-pregnancy chronic hypertension had a 2-fold higher risk of recurrent preeclampsia (RR 2.4 [95% CI: 1.5 to 3.9]). Conclusions: Pre-(index) pregnancy obesity and new inter-pregnancy chronic hypertension was highly associated with recurrent preeclampsia in the subsequent pregnancy. Clinical and public health programs focused on reducing preconception obesity and reducing risk of hypertension in both the pre-pregnancy and inter-pregnancy periods may help reduce recurrent preeclampsia, which, in turn may help prevent or reduce subsequent cardiovascular disease.

Introduction: Peripartum cardiomyopathy (PPCM) is a form of systolic heart failure that occurs during pregnancy or in the early post-partum period. Obesity is known to be associated with other forms of heart failure in young adults, however it is unclear if it is also a risk factor for the development of PPCM. Objectives: To investigate the association of body mass index (BMI) with PPCM and heart failure in the years following childbirth. Methods: We conducted a retrospective review of pregnant women in the Danish National Patient Registry between 2004 - 2017. Baseline characteristics and other risk factors were obtained at the first prenatal visit (occurring at 8-11 weeks post-conception). Women were followed until the end of the study period, emigration, or death. Logistic regression was performed, adjusting for age as well as other known risk factors for PPCM. Cox proportional hazards analysis was used to assess the long-term risk of development of heart failure. Results: There were 403,820 pregnancies evaluated in 300,892 women, with an average age of 29 years. The average BMI was 24.4 kg/m2, with 21.6% classified as overweight (BMI 25 - 30 kg/m2) and 12.8% as obese (BMI > 30 kg/m2). The rate of PPCM was 0.1 per 1,000 in normal weight and overweight groups, and 0.3 per 1,000 in the obese women. After adjustment for age, ethnicity, smoking status, gestational diabetes, and presence of preeclampsia, there was a statistically significant increased risk of the development of PPCM up to 6 months after childbirth in patients who had class I (odds ratio [OR] 2.25, 95% CI 1.08-4.68) but not class II/III obesity (OR 1.63, 95% CI 0.60-4.43). This elevated risk persisted during long term follow up, with hazard ratios of 2.43 (95% CI 1.55 - 3.80) in women with class I obesity and 3.20 (95% CI 1.93 - 5.30) in women with class II/III obesity. Conclusions: High early pregnancy BMI is associated with elevated risk of development of peripartum cardiomyopathy even after adjustment for traditional risk factors. This risk of heart failure persists for several years after childbirth.

AIM The aim was to investigate socio-economic risk factors for maternal underweight before pregnancy and then associations of underweight with neonatal outcomes. METHODS Data of 3401 mother-child dyads from the population-based birth cohort Survey of Neonates in Pomerania (SNiP) were analysed. RESULTS Bivariate analysis showed that underweighted mothers were younger, smoked more often, had a lower equivalent income and lower socio-economic status (employment status and/or educational level) compared to women with normal weight. The final prediction model revealed that only younger maternal age (OR = 0.93; 95%-CI = 0.90-0.97) and maternal smoking during pregnancy (OR = 2.52; 95%-CI = 1.74-3.66) were associated with underweight. Compared to women with normal pre-pregnancy BMI, underweight women had an increased chance of premature labour (OR = 1.73; 95% CI: 1.29-2.31) and a reduced placental weight. The offspring of underweight women had an increased risk of late preterm birth (OR = 1.82; 95% CI: 1.21-2.74) and birthweight

Previous studies have indicated maternal exposure to particles with aerodynamic diameter

The present study aimed to document the prevalence of and identify factors associated with excessive gestational weight gain (GWG) in early pregnancy among women with pre-pregnancy overweight or obesity. Women with pre-pregnancy overweight or obesity (n = 247) were recruited between 12 and 20 weeks of gestation and completed questionnaires and were weighed to estimate early GWG. Nearly one-third of women met (17%, n = 42) or exceeded (13%, n = 33) guidelines for total GWG in early pregnancy. Univariate analyses showed race, income, and pre-pregnancy weight status to be significantly related to GWG category in early pregnancy (p < .009). Only race and pre-pregnancy weight status remained significant in a multivariate model, with Black women and women with pre-pregnancy obesity having higher odds of having met or exceeded guidelines for total GWG in early pregnancy compared with White women and women with pre-pregnancy overweight (p < .04). These findings highlight the need for early intervention to reduce weight-related complications among pregnant women.

Estimation of pre-pregnancy weight is difficult because measurements taken before pregnancy are rarely available. No studies have compared various ‘proxy’ measures using recalled weight or based on early pregnancy weight with actual measurements of pre-pregnancy weight. The Southampton Women’s Survey recruited women during 1998–2002 who were not pregnant. Data on 198 women with an estimated date of conception within 3 months of recruitment were analysed. Three proxy measures were considered: (1) recalled pre-pregnancy weight obtained during early pregnancy, (2) measured weight in early pregnancy and (3) estimated pre-pregnancy weight using a published model. Mean (standard deviation) recalled weight was 1.65 (3.03) kg lighter than measured pre-pregnancy weight, while early pregnancy weight and weights from the published model were 0.88 (2.34) and 0.88 (2.33) kg heavier, respectively. The Bland–Altman limits of agreement for recalled weight were −7.59 to 4.29 kg, wider than those for the early pregnancy weight: −3.71 to 5.47 kg and the published model: −3.68 to 5.45 kg. For estimating pre-pregnancy weight, we recommend subtraction of 0.88 kg from early pregnancy weight or the published model, or addition of 1.65 kg to recalled weight. Estimates of pre-pregnancy body mass index and gestational weight gain categories were very similar when using early pregnancy and published model weights, but they differed from those using recalled weight. Our findings indicate that calculations of first trimester weight gain using recalled weight must be treated cautiously, and a measured weight in early pregnancy provides a more precise assessment of pre-pregnancy weight than recalled weight.