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Objectives Prepregnancy body mass index (BMI) and gestational weight gain (GWG) are known determinants of maternal and child health; calculating both requires an accurate measure of prepregnancy weight. We compared self-reported prepregnancy weight to measured weights to assess reporting bias by maternal and clinical characteristics. Methods We conducted a retrospective cohort study among pregnant women using electronic health records (EHR) data from Kaiser Permanente Northwest, a non-profit integrated health care system in Oregon and southwest Washington State. We identified women age [greater than or equal to] 18 years who were pregnant between 2000 and 2010 with self-reported prepregnancy weight, [greater than or equal to] 2 measured weights between [less than or equal to] 365-days-prior-to and [less than or equal to] 42-days-after conception, and measured height in their EHR. We compared absolute and relative difference between self-reported weight and two 'gold-standards': (1) weight measured closest to conception, and (2) usual weight (mean of weights measured 6-months-prior-to and [less than or equal to] 42-days-after conception). Generalized-estimating equations were used to assess predictors of misreport controlling for covariates, which were obtained from the EHR or linkage to birth certificate. Results Among the 16,227 included pregnancies, close agreement (± 1 kg or [less than or equal to] 2%) between self-reported and closest-measured weight was 44% and 59%, respectively. Overall, self-reported weight averaged 1.3 kg (SD 3.8) less than measured weight. Underreporting was higher among women with elevated BMI category, late prenatal care entry, and pregnancy outcome other than live/stillbirth (p < .05). Using self-reported weight, BMI was correctly classified for 91% of pregnancies, but ranged from 70 to 98% among those with underweight or obesity, respectively. Results were similar using usual weight as gold standard. Conclusions for Practice Accurate measure of prepregnancy weight is essential for clinical guidance and surveillance efforts that monitor maternal health and evaluate public-health programs. Identification of characteristics associated with misreport of self-reported weight can inform understanding of bias when assessing the influence of prepregnancy BMI or GWG on health outcomes., Author(s): Andrea J. Sharma [sup.1] [sup.3] , Joanna E. Bulkley [sup.2] , Ashley B. Stoneburner [sup.2] , Padmavati Dandamudi [sup.2] , Michael Leo [sup.2] , Williams M. Callaghan [sup.1] , [...]

Objective: The objective of this study was to estimate the effects of trimester‐specific gestational weight gain (GWG) on small and large (compared with appropriate) for gestational age (i.e., SGA, LGA, and AGA) by prepregnancy BMI classifications. Methods: We conducted a cohort study of pregnancies in a national network of community health care organizations, stratifying by prepregnancy BMI (n = 20,676 with normal weight; 19,156 with overweight; 11,647 with obesity class I; 5124 with obesity class II; and 3197 with obesity class III). SGA and LGA (vs. AGA) were modeled as a function of trimester 1, 2, or 3 GWG rate, previous trimester(s) GWG rate, and maternal characteristics using modified Poisson regression. Results: GWG rates ranged from weight loss to substantial gains. GWG‐LGA associations were strongest in trimester 1 (risk ratio [RR] range for 10th vs. 50th percentile GWG, across BMI categories: 0.60–0.73). GWG‐SGA associations were strongest in lower BMI categories and in trimester 2; RRs were 1.62, 1.40, and 1.17 for prepregnancy normal weight, obesity class I, and obesity class III, respectively, with curvilinear associations for class II and III. Conclusions: Among people with prepregnancy obesity class II or III, GWG rate is associated with higher LGA risk in a dose‐dependent manner, including understudied ranges of weight loss, but with weak associations with SGA. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding information stored within electronic health records (EHR) has recently been used for pharmacoepidemiological research, however the data are primarily collected for clinical care. Objectives: To characterise breastfeeding information recorded in structured fields in EHR during infant and postpartum health care visits, and to assess the validity of lactation status based on EHR data versus maternal report at research study visits. Methods: We assessed breastfeeding information recorded in structured fields in EHR from one health system for a subset of 211 patients who were also enrolled in a study on breast milk composition between 2014 and 2017 that required participants to exclusively breastfeed their infants until at least 1 month of age. We assessed the frequency of breastfeeding information in EHR during the first 12 months of age and compared lactation status based on EHR with maternal report at 1 and 6‐month study visits (reference standard). Results: The median number of breastfeeding records in the EHR per infant was six (interquartile range 3) with most observations clustering in the first few weeks of life and around well‐infant visits. At the 6‐month study visit, 93.8% of participants were breastfeeding and 80.1% were exclusively breastfeeding according to maternal report. Sensitivity of EHR data for identifying ever breastfeeding was at or near 100%, and sensitivity for identifying ever exclusive breastfeeding was 98.0% (95% CI: 95.0%, 99.2%). Sensitivities were 97.3% (95% CI: 93.9%, 98.9%) for identifying any breastfeeding and 94.4% (95% CI: 89.7%, 97.0%) for exclusive breastfeeding, and positive predictive values were 99.5% (95% CI: 97.0%, 99.9%) for any breastfeeding and 95.0% (95% CI: 90.4%, 97.4%) for exclusive breastfeeding. Conclusions: Breastfeeding information in structured EHR fields have the potential to accurately classify lactation status. The validity of these data should be assessed in populations with a lower breastfeeding prevalence. [ABSTRACT FROM AUTHOR]

ObjectiveThis analysis was focused on 1-year maternal and infant follow-up of a randomized trial that tested a weight management intervention conducted during pregnancy.MethodsOne hundred fourteen women with obesity (mean BMI 36.7 kg/m(2) ) were randomly assigned at a mean of 15 weeks gestation to a weight management intervention or usual care control condition. The intervention ended at delivery and resulted in less gestational weight gain and a lower proportion of large-for-gestational-age newborns among intervention compared with control participants. The primary outcome at 12 months postpartum was maternal weight. Secondary outcomes included infant weight-for-age and weight-for-length z-scores.ResultsAt 1 year, mothers in the intervention group weighed 96.3 ± 18.6 kg and those in the control group 99.7 ± 19.2 kg. There was no significant difference between groups in change in weight from randomization to 1 year postpartum (b = -0.47, 95% CI: -4.03 to 3.08). There was a significant main effect of group for infant weight-for-age z-scores (b = -0.40, 95% CI: -0.75 to -0.05) but not infant weight-for-length z-scores (b = -0.20, 95% CI: -0.59 to 0.20).ConclusionsA gestational weight management intervention did not influence maternal weight or infant weight-for-length at 1 year postpartum. Future studies may be warranted to determine whether extending prenatal interventions into the postpartum period would be beneficial for maternal and infant outcomes.

Objective To estimate the maternity-related cost of health care services in women with and without severe maternal morbidity (SMM). Methods Women with a live inpatient birth in the calendar year 2013 were identified in the MarketScan.sup.® Commercial and Medicaid health insurance claims databases. Costs were defined as the amounts paid by insurers plus out-of-pocket and third-party payments. Costs were calculated as total maternity-related costs and categorized as prenatal, delivery, and postpartum costs. SMM was identified using the CDC algorithm of 25 ICD-9 diagnostic and procedural codes. Variables associated with higher delivery costs were determined by multivariable linear regression analysis. Results A total of 750 women met the criteria for SMM in the Commercial population. The total, per-patient mean costs of care for women without and with SMM were $14,840 and $20,380, respectively. Delivery hospitalization costs were 76-77% of total mean costs for women without and with SMM. A total of 99 women met the criteria for SMM in the Medicaid population. The total, per-patient mean costs of care for women without and with SMM were $6894 and $10,134, respectively. Delivery costs were 71-72% of total costs. Variables independently predictive of increased delivery costs in both Commercial and Medicaid populations were delivery by cesarean section, multifetal gestation, gestational hypertension/preeclampsia, and obstetric infection. Conclusions The occurrence of SMM was associated with an increase in maternity-related costs of 37% in the Commercial and 47% in the Medicaid population. Some of the factors associated with increased delivery hospitalization costs may be prevented., Author(s): Kimberly K. Vesco [sup.1] , Shannon Ferrante [sup.2] [sup.3] , Yong Chen [sup.2] [sup.3] , Thomas Rhodes [sup.2] , Christopher M. Black [sup.2] , Felicia Allen-Ramey [sup.2] Author Affiliations: [...]

ObjectiveObservational studies suggest that minimal gestational weight gain (GWG) may optimize pregnancy outcomes for obese women. This trial tested the efficacy of a group-based weight management intervention for limiting GWG among obese women.MethodsOne hundred and fourteen obese women (BMI [mean ± SD] 36.7 ± 4.9 kg/m(2) ) were randomized between 7 and 21 weeks' (14.9 ± 2.6) gestation to intervention (n = 56) or usual care control conditions (n = 58). The intervention included individualized calorie goals, advice to maintain weight within 3% of randomization and follow the Dietary Approaches to Stop Hypertension dietary pattern without sodium restriction, and attendance at weekly group meetings until delivery. Control participants received one-time dietary advice. Our three main outcomes were maternal weight change from randomization to 2 weeks postpartum and from randomization to 34 weeks gestation, and newborn large-for-gestational age (birth weight >90th percentile, LGA).ResultsIntervention participants gained less weight from randomization to 34 weeks gestation (5.0 vs. 8.4 kg, mean difference = -3.4 kg, 95% CI [-5.1-1.8]), and from randomization to 2 weeks postpartum (-2.6 vs. +1.2 kg, mean difference = -3.8 kg, 95% CI [-5.9-1.7]). They also had a lower proportion of LGA babies (9 vs. 26%, odds ratio = 0.28, 95% CI [0.09-0.84]).ConclusionsThe intervention resulted in lower GWG and lower prevalence of LGA newborns.

Objectives Low gestational weight gain (GWG) in the second and third trimesters has been associated with increased risk of preterm delivery (PTD) among women with a body mass index (BMI) < 25 mg/m.sup.2. However, few studies have examined whether this association differs by the assumptions made for first trimester gain or by the reason for PTD. Methods We examined singleton pregnancies during 2000-2008 among women with a BMI < 25 kg/m.sup.2 who delivered a live-birth [greater than or equal to]28 weeks gestation (n = 12,526). Women received care within one integrated health care delivery system and began prenatal care [less than or equal to]13 weeks. Using antenatal weights measured during clinic visits, we interpolated GWG at 13 weeks gestation then estimated rate of GWG (GWG.sub.rate) during the second and third trimesters of pregnancy. We also estimated GWG.sub.rate using the common assumption of a 2-kg gain for all women by 13 weeks. We examined the covariate-adjusted association between quartiles of GWG.sub.rate and PTD (28-36 weeks gestation) using logistic regression. We also examined associations by reason for PTD [premature rupture of membranes (PROM), spontaneous labor, or medically indicated]. Results Mean GWG.sub.rate did not differ among term and preterm pregnancies regardless of interpolated or assumed GWG at 13 weeks. However, only with GWG.sub.rate estimated from interpolated GWG at 13 weeks, we observed a U-shaped relationship where odds of PTD increased with GWG.sub.rate in the lowest (OR 1.36, 95 % CI 1.10, 1.69) or highest quartile (OR 1.49, 95 % CI 1.20, 1.85) compared to GWG.sub.rate within the second quartile. Further stratifying by reason, GWG.sub.rate in the lowest quartile was positively associated with spontaneous PTD while GWG.sub.rate in the highest quartile was positively associated with PROM and medically indicated PTD. Conclusions Accurate estimates of first trimester GWG are needed. Common assumptions applied to all pregnancies may obscure the association between GWG.sub.rate and PTD. Further research is needed to fully understand whether these associations are causal or related to common antecedents., Author(s): Andrea J. Sharma[sup.1] [sup.3] , Kimberly K. Vesco[sup.2] , Joanna Bulkley[sup.2] , William M. Callaghan[sup.1] , F. Carol Bruce[sup.1] , Jenny Staab[sup.2] , Mark C. Hornbrook[sup.2] , Cynthia J. [...]

Objective To determine, among children with normal birth weight, if maternal hyperglycemia and weight gain independently increase childhood obesity risk in a very large diverse population. Methods Study population was 24,141 individuals (mothers and their normal birth weight offspring, born 1995-2003) among a diverse population with universal GDM screening [50-g glucose-challenge test (GCT); 3 h. 100 g oral glucose tolerance test (OGTT) if GCT+]. Among the 13,037 full-term offspring with normal birth weight (2500-4000 g), annual measured height/weight was ascertained between ages 2 and 10 years to calculate gender-specific BMI-for-age percentiles using USA norms (1960-1995 standard). Results Among children who began life with normal birth weight, we found a significant trend for developing both childhood overweight (>85 %ile) and obesity (>95 %ile) during the first decade of life with both maternal hyperglycemia (normal GCT, GCT+ but no GDM, GDM) and excessive gestational weight gain [>40 pounds (18.1 kg)]; p < 0.0001 for both trends. These maternal glucose and/or weight gain effects to imprint for childhood obesity in the first decade remained after adjustment for potential confounders including maternal age, parity, as well as pre-pregnancy BMI. The attributable risk (%) for childhood obesity was 28.5 % (95 % CI 15.9-41.1) for GDM and 16.4 % (95 % CI 9.4-23.2) for excessive gestational weight gain. Conclusions for Practice Both maternal hyperglycemia and excessive weight gain have independent effects to increase childhood obesity risk. Future research should focus on prevention efforts during pregnancy as a potential window of opportunity to reduce childhood obesity., Author(s): Teresa A. Hillier[sup.1] [sup.2] , Kathryn L. Pedula[sup.1] , Kimberly K. Vesco[sup.1] , Caryn E.S. Oshiro[sup.2] , Keith K. Ogasawara[sup.3] Author Affiliations: (1) Center for Health Research, Kaiser Permanente [...]

Studies report increased risk of preterm birth (PTB) among underweight and normal weight women with low gestational weight gain (GWG). However, most studies examined GWG over gestational periods that differ by term and preterm which may have biased associations because GWG rate changes over the course of pregnancy. Furthermore, few studies have specifically examined the amount and pattern of GWG early in pregnancy as a predictor of PTB. Within one integrated health care delivery system, we examined 12,526 singleton pregnancies between 2000 and 2008 among women with a body mass index 28 weeks gestation. Using self-reported pregravid weight and serial measured antenatal weights, we estimated GWG and the area under the GWG curve (AUC; an index of pattern of GWG) during the first and second trimesters of pregnancy (≤28 weeks). Using logistic regression adjusted for covariates, we examined associations between each GWG measure, categorized into quartiles, and PTB (, Author(s): Andrea J. Sharma[sup.1] [sup.3] , Kimberly K. Vesco[sup.2] , Joanna Bulkley[sup.2] , William M. Callaghan[sup.1] , F. Carol Bruce[sup.1] , Jenny Staab[sup.2] , Mark C. Hornbrook[sup.2] , Cynthia J. [...]

The objective of the study was to assess if small- and large-for gestational age term infants have greater health care utilization during the first year of life. The sample included 28,215 singleton term infants (37-42 weeks) without major birth defects delivered from 1998 through 2007 and continuously enrolled at Kaiser Permanente Northwest for 12 months after delivery. Birth weight for gestational age was categorized into 3 levels: < 10th percentile (SGA), 10-90th percentile (AGA), > 90th percentile (LGA). Length of delivery hospitalization, re-hospitalizations and sick/emergency room visits were obtained from electronic records. Logistic regression models estimated associations between birth weight category and re-hospitalization. Generalized linear models estimated adjusted mean number of sick/emergency visits. Among term infants, 6.2% were SGA and 13.9% were LGA. Of infants born by cesarean section, SGA infants had 2.7 higher odds [95% 1.9, 3.8] than AGA infants of staying [greater than or equal to] 5 nights during the delivery hospitalization; of those born vaginally, SGA infants had 1.5 higher adjusted odds [95% 1.1, 2.1] of staying [greater than or equal to] 4 nights. LGA compared to AGA infants had higher odds of re-hospitalization within 2 weeks of delivery [OR 1.25, 95% CI 0.99, 1.58] and of a length of stay [greater than or equal to] 4 days during that hospitalization [OR 2.6, 95% CI 1.3, 5.0]. The adjusted mean number of sick/ emergency room visits was slightly higher in SGA (7.8) than AGA (7.5) infants (P < .05). Term infants born SGA or LGA had greater health care utilization than their counterparts, although the increase in utilization beyond the initial delivery hospitalization was small. Keywords Low birth weight * Fetal growth restriction * Large for gestational age * Macrosomia * Health care utilization, Introduction Infants born small--(SGA) and large--for-gestational age (LGA) experience greater health complications shortly after birth compared to infants born appropriate for gestational age (AGA). SGA infants experience greater risk of [...]