Search

The International Olympic Committee expert group on pregnancy has identified a paucity of information regarding training and performance in truly elite athletes. Thus, the purpose of this study was to quantify elite runners' training volume throughout pregnancy and postpartum competition performance outcomes.Forty-two elite (50% competed at the World Championships/Olympic) middle-/long-distance runners' training before, during, and after pregnancy (quality/quantity/type) data (retrospective questionnaire) and competition data (published online) were collected.Running volume decreased significantly ( P0.01) from the first trimester (63 ± 34 km·wk -1 ) to the third trimester (30 ± 30 km·wk -1 ). Participants returned to activity/exercise at ~6 wk postpartum and to 80% of prepregnancy training volumes by 3 months. Participants who intended to return to equivalent performance levels postpregnancy, there was no statistical decrease in performance in the 1 to 3 yr postpregnancy compared with prepregnancy, and ~56% improved performances postpregnancy.This study features the largest cohort of elite runners training and competition outcomes assessed throughout pregnancy, with training volumes being approximately two to four times greater than current guidelines. For the first time, performance was directly assessed (due to the quantifiable nature of elite running), and study participants who intended to return to high-level competition did so at a statistically similar level of performance in the 1- to 3-yr period postpregnancy. Taken together, this article provides much needed insights into current training practices and performance of elite pregnant runners, which should help to inform future training guidelines as well as sport policy and sponsor expectations around return to training timelines and performance.

Gestational weight gain (GWG) has been shown to impact several maternal-infant outcomes. Since healthcare provider guidance on weight gain and healthy behaviors alone has failed to help women to meet guidelines during pregnancy, a practical adjunctive approach is to deliver evidence-based behavior change programs through mobile interventions. The present study aimed to assess the short-term effect of the SmartMoms Canada app to promote adequate GWG and healthy behaviors. Twenty-nine pregnant women were recruited in this app-based intervention trial to test whether a higher app usage (≥ 3.8 min·weeksup-1/sup) between 12-20 gestational weeks and 24-28 gestational weeks improved GWG, diet, physical activity, and sleep, compared to women with a lower app usage (lt; 3.8 min·weeksup-1/sup). Two-way mixed ANOVA for repeated measures was used to estimate the effect of the app usage and time, as well as their interaction on GWG and healthy behaviors. The likelihood ratio was used to examine the association between app usage categorization and GWG classification. Cramer's V statistic was used to estimate the effect size for interpretation of the association. Pregnant women using the SmartMoms Canada app more frequently had a higher moderate-to-vigorous physical activity (MVPA) daily average when compared with women with a lower usage (mean difference: 17.84 min/day, 95% CI: 2.44; 33.25). A moderate effect size (28.6% vs. 15.4%; Cramer's V = 0.212) was found for the association between app categorization and rate of GWG, representing a greater adherence to the GWG guidelines in women in the higher app usage group vs. the lower app usage group. Considering other physical activity, diet, and sleep variables, no app categorization effect was observed. A short-term higher usage of SmartMoms Canada app has a positive effect on objectively-measured MVPA.

Misconceptions about pregnant women who have obesity exist in the media and scientific literature. These misconceptions might negatively influence research quality and the delivery of health care. In 2014, Chaput and colleagues[1][1] published a commentary discussing widespread misconceptions about

Les medias et la litterature scientifique propagent des mythes concernant les femmes enceintes atteintes d’obesite. Ces mythes pourraient influer negativement sur la qualite de la recherche et la prestation des soins de sante. En 2014, Chaput et ses collegues1 publiaient un commentaire

Importance Gestational weight gain (GWG) is an independent and modifiable factor for a healthy pregnancy. Gestational weight gain above or below the Institute of Medicine Guidelines has been shown to impact both maternal and fetal health (eg, gestational diabetes, hypertension, downstream obesity). Healthcare providers (HCPs) have the potential to be reliable sources of evidence-based weight information and advice during pregnancy. Objective The aim of this study was to summarize the literature assessing GWG discussions between patients and their HCPs in a clinical setting to better understand the knowledge that is currently being exchanged. Evidence Acquisition A literature review was conducted by searching Ovid Medline, CINAHL, and Embase databases. All relevant primary research articles in English that assessed GWG discussions were included, whereas intervention studies were excluded. Results A total of 54 articles were included in this review. Although the overall prevalence and content of GWG counseling varied between studies, counseling was often infrequent and inaccurate. Healthcare providers tended to focus more on women experiencing obesity and excessive GWG, as opposed to the other body mass index categories or inadequate GWG. Women of higher socioeconomic status, older age, nulliparous, history of dieting, low physical activity, and those categorized as overweight/obese were more likely to receive GWG advice. Patients also reported receiving conflicting facts between different HCP disciplines. Conclusions The evidence regarding GWG counseling in prenatal care remains variable, with discrepancies between geographic regions, patient populations, and HCP disciplines. Relevance Healthcare providers should counsel their pregnant patients on GWG with advice that is concordant with the Institute of Medicine Guidelines.

To propose a response criterion for analyzing the intervention success by verifying patient outcomes after a multidisciplinary obesity treatment program in Brazilian children and adolescents. Obese children and adolescents (n = 103) completed a 16-week multidisciplinary intervention (IG) and were compared to the control group (CG) (n = 66). A cluster of parameters (e.g. total domain of HRQoL; BMI z-score; cardiorespiratory fitness; body mass; waist circumference; fat mass; lean mass) were measured pre and post-intervention, and the sum of the median percentage variation and the percentile 25 and 75 were used from IG and CG to determine the responsiveness to the program. We are proposing four ranges in which children and adolescents may be classified after the intervention: (1) CG percentile 50 values or lower are considered non-responsive to the intervention, (2) values greater than CG percentile 50 but lower than IG percentile 50 are considered slightly responsive, (3) values greater than IG percentile 50 but lower than IG percentile 75 were considered as moderately responsive, and (4) values greater than IG percentile 75 were considered very responsive.This criterion may serve as a complementary tool that can be employed to monitor the response to this model of multidisciplinary intervention. What is Known: • The effectiveness of multidisciplinary obesity interventions is usually determined by comparing changes in selected outcomes in the intervention versus versus control group. • There is no consensus about what should be assessed before and after the intervention program, which makes difficult to compare different programs and to determine their rate of responsiveness. What is New: • This study proposes a response criteria to pediatric obesity interventions following a similar model compared to ours based on key variables that presents low cost and high applicability in different settings.

Engaging in recommended levels of physical activity during pregnancy can provide a host of physical and mental health benefits for the expecting mother and her child. However, methodological issues related to physical activity measurement have plagued many studies examining the effects of physical activity during this important life stage. Burgeoning support exists for the more widespread use of objective methods, and accelerometers specifically, for an accurate appraisal of maternal physical activity. In this commentary, we highlight discrepancies between activity estimates obtained via self-report and objective measures and describe the implications of erroneous measurement when making clinical recommendations and in conducting future physical activity and pregnancy research. Most importantly, we aim to foster academic discussion and propose a call to action requiring a paradigm shift where we acknowledge the shortcomings of self-report and move toward an empirically driven approach for physical activity measurement. Results from more high-quality research studies will help support public health messaging and facilitate trust among health care providers, clinical researchers, and expecting mothers regarding the health benefits of physical activity recommendations.

Pregnancy is a critical period of body weight regulation for both mother and baby. Vital energy-sensing processes are established in utero that aid in nutrient storage and metabolic control later in life. Excessive weight gain during pregnancy and a surplus of maternal resources leads to preferential shuttling of nutrients and growth-promoting peptides across the placenta, resulting in fetal overgrowth — a well-established predictor of childhood obesity. Physical activity during pregnancy offers a safe and accessible way in which one can modify these intricate cellular networks across the maternal-placental-fetal interface to prevent dysregulation and optimize fetal birth weight. This commentary highlights the clinical utility of physical activity during pregnancy and provides practical recommendations as a way to ensure the best health and safety of mother, baby, and future generations. RésuméLa grossesse est une période critique de la régulation du poids corporel pour la mère et le bébé. Des processus vitaux de détection d’énergie sont établis in utero qui contribuent au stockage des nutriments et au contrôle métabolique plus tard dans la vie. Une prise de poids excessive pendant la grossesse et un surplus de ressources maternelles conduit à un transfert préférentiel des nutriments et des peptides favorisant la croissance à travers le placenta, entraînant une prolifération fœtale - un prédicteur bien établi de l’obésité infantile. L’activité physique pendant la grossesse offre un moyen sûr et accessible pour modifier ces réseaux cellulaires complexes à travers l’interface materno-placentaire-fœtal afin de prévenir le dérèglement et optimiser le poids de naissance fœtal. Ce commentaire met en évidence l’utilité clinique de l’activité physique pendant la grossesse et fournit des recommandations pratiques pour assurer la meilleure santé et sécurité de la mère, du bébé et des générations futures.

This feasibility study aimed to analyze the effects of a multidisciplinary (e.g., psychological, nutritional and water-based exercise interventions) obesity treatment program on resting heart rate variability (rHRV) indices according to the degree of excess body mass (overweight vs obesity) in adolescents. Additionally, we tested the association between changes in rHRV indices with changes in body composition and cardiorespiratory fitness. Twenty-five adolescents completed the study, 11 from the overweight group (OWG) and 14 from the obese group (OBG) classified according to body mass index. Anthropometric measures, autonomic cardiac function (measured by rate-to-rate interval analyses), lean mass and body fat, and cardiorespiratory fitness were assessed prior to and after the 16-week intervention period. Both groups increased their parasympathetic indices (e.g., standard deviation 1) [OWG: Δ = 8.5 (1.7–15.3) ms; magnitude of change: “likely”; OBG: Δ = 11.4 (4.3–18.4) ms; “very likely”] and cardiorespiratory fitness [OWG: Δ = 2.0 (1.1–2.8) mL/kg/min; “likely”; OBG: Δ = 2.4 (1.5–3.3) mL/kg/min; “Almost certain”] with a slightly greater magnitude of change for the OBG. The OWG showed greater changes in body composition [e.g., body fat: Δ = −3.2 (–4.6 to −1.8) kg “Very likely”] when compared to the OBG [Δ = −2.8 (−4.4 to −1.3) kg “Possible”]. Inverse and large correlations were noted for changes in body fat markers (%) and changes in parasympathetic indices of rHRV (%) (i.e., rMSSD and SD1). These results provide evidence that a multidisciplinary program improves parasympathetic indices, body composition, and cardiorespiratory fitness independent of the degree of excess body mass.

OBJECTIVES This review explores the ethical and medical challenges faced by women of advanced maternal age who decide to have children. Assisted reproductive technologies (ARTs) make post-menopausal pregnancy physiologically plausible, however, one must consider the associated physical, psychological, and sociological factors involved. METHODS A quasi-systematic review was conducted in PubMed and Ovid using the key terms post-menopause, pregnancy + MeSH terms [donations, hormone replacement therapy, assisted reproductive technologies, embryo donation, donor artificial insemination, cryopreservation]. Overall, 28 papers encompassing two major themes (ethical and medical) were included in the review. CONCLUSION There are significant ethical considerations and medical (maternal and fetal) complications related to pregnancy in peri- and post-menopausal women. When examining the ethical and sociological perspective, the literature portrays an overall positive attitude toward pregnancy in advanced maternal age. With respect to the medical complications, the general consensus in the evaluated studies suggests that there is greater risk of complication for spontaneous pregnancy when the mother is older (eg, >35 years old). This risk can be mitigated by careful medical screening of the mother and the use of ARTs in healthy women. In these instances, a woman of advanced maternal age who is otherwise healthy can carry a pregnancy with a similar risk profile to that of her younger counterparts when using donated oocytes.

In comparison with standard two-dimensional (2D) imaging of fetal structure and biometry, we aimed to evaluate the role of three-dimensional (3D) imaging as a screening tool in the mid-trimester. Pregnant women presenting between 18and 22 weeks for routine anatomical survey and biometric measurements were recruited. Six volumes of fetal anatomic regions were obtained and archived for later reconstruction, along with three volumes of extra-fetal structures (placenta, cervix, amniotic fluid). The 2D standard fetal images were then obtained. Offline reconstruction of 3D volumes was performed for comparative analysis (2D vs 3D). Subsequently, 3D volumes were reconstructed to mirror traditional 2D and allow biometric comparison between the two techniques. Data of 98 patients were analyzed. Complete visualization of vital anatomic structures was seen ⩾85% of the time with 3D ultrasound. The 3D imaging improved the assessment of the four heart chambers (P=0.003), thoracic spine (P=0.008) and lumbar spine (P=0.012) views. The 2D imaging was superior for the fetal head, placenta and upper limbs. Conditional probabilities were used to assess the clinical value of 3D when standard 2D views were incomplete (mean 0.8830; 95% confidence interval 0.8059 to 0.9320). Overall diagnostic accuracy of 3D ultrasound is not superior for all fetal anatomic structures. Fetal biometric measurements assessed by both techniques demonstrated substantial to excellent agreement. The use of 3D imaging as a primary screening tool is limited and may be best utilized as a second-stage test. Overall, there is good correlation between fetal biometry assessed by either 2D or 3D technology.

Introduction Gestational weight gain (GWG) outside of the 2009 Institute of Medicine guidelines may be harmful to women and their fetuses. Prenatal health care providers (HCPs) are important sources of health information, but not all discuss GWG with their patients. The Canadian Obesity Network's 5As (ask, assess, advise, agree, and assist) of Healthy Pregnancy Weight Gain (5As) is a tool developed to help HCPs counsel their patients on GWG. The main objective of this study was to evaluate the impact of the 5As tool on patient perceptions of GWG discussions with their HCP and to identify suggestions to improve the tool. Methods A quasiexperimental study design was conducted whereby HCPs were trained in using the 5As tool (intervention). Patients were then queried at baseline and postintervention using an electronic questionnaire measuring patient-perceived 5As counseling. Inclusion criteria for pregnant women were (1) currently attending their first appointment with participating HCPs, (2) English-speaking, and (3) over 18 years of age. Results One hundred pregnant women (50 baseline, 50 postintervention) and 15 HCPs (11 midwives, 4 obstetricians) participated. Participants receiving care from 5As-trained HCPs reported scores twice as high (P = .047) in being asked about and were approximately 3 times more likely to be advised an exact amount of target weight gain (P = .03). HCPs suggested improving patient handouts and HCP education on GWG guidelines as well as reducing the content presented in the 5As tool. Discussion The 5As Tool is effective at initiating HCP-mediated GWG counseling; further research is needed to examine the usefulness of the 5As in clinical practice throughout the length of a full pregnancy. Whether the uptake of the 5As tool contributes to prenatal behavior change remains to be established. Future steps include modifying the tool based on HCP feedback, the development of novel knowledge translation tools, and improved HCP and patient education.

Education level can have a substantial impact on disease risk and is considered a determinant of health. Quality learning experiences, both in- and outside the classroom, may encourage trainees to pursue higher education. Consequently, this could facilitate improvements in personal development and indirectly impact their outlook, motivation, and health status. Thus, students who have positive learning experiences may be more likely to have improved mental and physical health, and be motivated to apply their learnings in a way that positively impacts the health and well-being of others. Summer studentships are an integral part of stimulating students’ interest in science and medicine, and can direct future career endeavours. Many find summer placements beneficial as they give trainees the opportunity to apply classroom knowledge to real-world settings in order to better prepare them for life after undergrad. This commentary aims to inform aspiring medical students of the pros and cons of summer studentships, provide advice on how to overcome challenges they may be faced with during their work term, and encourage trainees to pursue these opportunities to further complement their education so they can develop the necessary skills to help others in the future.

ObjectiveTo systematically review the literature and describe the discrepancies in achieving the 2009 Institute of Medicine (IOM) gestational weight gain (GWG) guidelines across cultures.MethodsTen databases were searched from inception to April 2018. Observational cohort studies were included that examined adult women; reported on a measure of culture; compared cultural groups, and reported on GWG. Articles werebroken down into papers that used the current 2009 IOM GWG guidelines and those that used others. A meta-analysis was conducted for studies using the 2009 guidelines examining the prevalence of discordant GWG across cultural groups.ResultsThe review included 86 studies. Overall, 69% of women experienced discordant GWG irrespective of culture. White women experienced excessive GWG most often, and significantly more than Asian and Hispanic women; Black women had a higher prevalence of excessive GWG than Hispanic and Asian women; however, this difference was not significant.ConclusionsThe majority of women experience excessive GWG, with White women experiencing this most often. Culturally diverse GWG guidelines are needed to individualize antenatal care and promote optimal maternal-fetal health outcomes across cultural groups.

This reply refers to the comment available online at https://doi.org/10.1007/s10995-018-02707-y

Placenta-mediated diseases (PMDs) including preeclampsia and fetal growth restriction are often characterized by shallow trophoblast invasion and incomplete spiral artery remodeling leading to impaired placental perfusion. In this context, umbilical artery (UA) Doppler can be used to detect high resistance to flow characteristic of very late-stage placental disease. We propose that evaluation of intraplacental villous artery (IPVA) resistance can provide earlier detection of increased resistance in placental flow. Seventy-five patients were recruited from the Ottawa Hospital. All had scans at 18 to 20, 28 and 34 weeks of gestation. IPVAs arising perpendicular to the chorionic plate in three regions (placental tips 4 cm away from cord insertion and within 1 cm from cord insertion) were sampled at each gestational age for resistance index (RI) and pulsatility index (PI). UA Doppler was also obtained from a free loop of cord. Pregnancy outcomes were collected from a chart review. Data were analyzed using SAS version 9.4 and standard statistic tests (mean±s.d., Student's t-test, mixed-effects modeling). A total of 53 patients completed the study. Of these, 38 had normal pregnancy outcomes (controls) and 15 (cases) developed PMD (preeclampsia, n=8 and low birth weight/intrauterine growth restriction, n=7). Mean birth weight in the study group was 2482.1±518.85 g. At 18 to 20, 28 and 34 weeks gestation, the mean IPVA resistance indices in the control group were 0.86±0.16, 0.81±0.12 and 0.71±0.12 for PI and 0.57±0.07, 0.55±0.06 and 0.49±0.06 for RI, respectively. However, in the cases developing PMDs, the PIs were 1.09±0.17, 0.95±0.21 and 0.78±0.07 and RIs 0.66±0.07, 0.60±0.07 and 0.54±0.04, respectively (P

OBJECTIVES: Physical activity (PA) research during pregnancy relies heavily on indirect/subjective measures of PA, which may be less accurate than directly measured PA. We tested whether the Pregnancy Physical Activity Questionnaire (PPAQ) could accurately estimate PA by comparing PPAQ results to directly measured PA. METHODS: In a sample of 29 women who completed the PPAQ, PA was directly measured in the second trimester of pregnancy using Actical® accelerometers (valid day = 10+ hours; 4–7 valid days). Activity variables from the PPAQ were calculated using all questions, and also by only considering the leisure time section. Women were classified as ‘active’ or ‘non-active’ using Canadian PA guidelines for adults (150 minutes moderate to vigorous PA (MVPA)/ week, bouts of 10+ minutes). Bonferroni corrections were used to adjust for multiple comparisons. Data presented as mean ± standard deviation or median (interquartile range). RESULTS: The PPAQ overestimated MVPA by 12.12 (14.34) hours/week in the combined sample, and the difference remained substantial when investigating the non-active [overestimate = 11.54 (10.10) hrs/wk] and the active women [overestimate = 16 ± 11 hrs/wk] separately. PPAQ-measured PA variables did not correlate with any of their respective Actical®-measured variables ( p > 0.008). The leisure time PPAQ questions overestimated MVPA by 1 ± 3 hrs/wk, with a positive correlation between PPAQ-leisure time MVPA and Actical®-measured MVPA ( r = 0.565, p = 0.001). CONCLUSION: The PPAQ significantly overestimates MVPA and does not provide an accurate estimate of PA in pregnancy. While PPAQ leisure time questions may help distinguish trends in PA, data from subjective questionnaires may result in misinterpretation of relationships between prenatal PA and health outcomes.

Maternal obesity and excess gestational weight gain (GWG) increase the risk of delivering large infants. This study examined the associations between maternal obesity and GWG on the expression of genes involved in fatty acid, amino acid and glucose transport, and the mechanistic target of rapamycin (mTOR) and insulin signaling axes in the placenta.Placenta samples were obtained from lean (n = 11) and obese (n = 10) women. Gene expression in the placenta was measured using polymerase chain reaction.There were no differences in placenta gene expression between the lean and obese women, with the exception of lower expression of mTOR in the women with obesity who delivered male offspring (obese n = 6; lean n = 7). GWG in excess of the upper limit of the body mass index (BMI) specific guidelines was correlated with increased expression of SNAT1 and decreased expression of FABP3, mTOR, IRS1 and IGF1R.Variations in GWG may alter the expression of genes involved in regulating placental nutrient transport. Future research on placental nutrient transport should account for the sex of the offspring and the percentage of GWG that is gained above the upper limit for the pre-pregnancy BMI.

Introduction Adequate nutrient delivery to the fetus is essential for optimal growth. Differences in prenatal physical activity level and diet quality influence maternal energy balance and these factors may alter placental nutrient transport. We investigated the associations between meeting physical activity guidelines and the quality of maternal diet on the expression of genes involved in fatty acid, amino acid and glucose transport, and mammalian target of rapamycin (mTOR) and insulin signaling in the placenta from 16 term pregnancies. Methods Physical activity was directly measured with accelerometry, diet composition was assessed with 24 h dietary recalls, and gene expression was measured with custom polymerase chain reaction (PCR) arrays. Results Women who met physical activity guidelines had lower gene expression of fatty acid transport protein 4 (FATP4), insulin-like growth factor 1 (IGF1), and the beta non-catalytic subunit of AMP-activated protein kinase (AMPK), and a higher expression of SNAT2. There was a strong positive correlation observed between total sugar intake and glucose transporter 1 (GLUT1) (r = 0.897, p = 0.000, n = 12), and inverse correlations between total sugar and mTOR and IGF1 expression. Percentage of total calories from protein was inversely related to insulin-like growth factor 1 receptor (IGF1R) (r = −0.605, p = 0.028, n = 13). Discussion Variations in maternal physical activity and diet composition altered the expression of genes involved in fatty acid, amino acid and glucose transport and mTOR signaling. Future research on placental nutrient transport should include direct measures of maternal PA and dietary habits to help eliminate confounding factors.

Preoccupation with weight status and a desire to lose weight appears common. Many individuals seek “magic bullet” approaches to weight loss and waive the risks of using these products. In this paper, we review the challenges of weight maintenance, highlight some unhealthy weight control practices, and discuss the futility and potential danger of unregulated weight control agents. Novel clinical strategies are discussed that health care providers may use to triage patients with obesity in an attempt to make ethical and personalized treatment decisions.

da Silva, DF, Ferraro, ZM, Adamo, KB, and Machado, FA. Endurance running training individually guided by HRV in untrained women. J Strength Cond Res 33(3): 736-746, 2019-The aim of this study was to analyze the effects of heart rate variability (HRV)-guided training compared with a standardized prescription on (a) time to complete 5-km running performance (t5km), (b) peak treadmill running speed (Vpeak) and its time limit (tlim at Vpeak), and (c) autonomic cardiac modulation (i.e., parasympathetic activity and recovery) in untrained women. Additionally, we correlated changes in t5km with changes in Vpeak, tlim at Vpeak and autonomic cardiac modulation. Thirty-six untrained women were divided into a HRV-guided training group (HRVG) and a control group (CG). The CG followed a predefined program, alternating moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT). The determination of MICT or HIIT was based on the pretraining HRV for HRVG. MICT was performed if HRV was

Television (TV) viewing is a risk factor for obesity in children. This is partly due to its promotion of energy intake by distracting from normal satiety signals. Children are exposed to a variety of TV programs which differ in features such as pacing. This is reason to believe that different children's TV shows distract to varying degrees, and can therefore influence energy intake to different extents. We suggest that future research should examine how different TV shows influence energy intake in children. Such research could help identify new ways to protect children from the negative effects of TV viewing on caloric intake and ultimately body weight.

Background Emerging evidence from clinical and epidemiological studies suggests that dietary polyphenols play an important role in the prevention of chronic diseases, including cancer, cardiovascular disease, diabetes and neurodegenerative disorders. Although these beneficial health claims are supported by experimental data for many subpopulation groups, some studies purport that excessive polyphenol consumption may have negative health effects in other subpopulations. The ever-growing interest and public awareness surrounding the potential benefits of natural health products and polyphenols, in addition to their widespread availability and accessibility through nutritional supplements and fortified foods, has led to increased consumption throughout gestation. Therefore, understanding the implications of polyphenol intake on obstetrical health outcomes is of utmost importance with respect to safe consumption during pregnancy. Methods Using relevant keywords, a literature search was performed to gather information regarding polyphenol pharmacology and the molecular mechanisms by which polyphenols exert their biological effects. The primary focus of this paper is to understand the relevance of these findings in the context of reproductive physiology and medicine. Results Evidence from both in vitro experiments and in vivo studies using animals and humans demonstrates that polyphenols regulate key targets related to oxidative stress, inflammation and advanced glycation end products. Although the majority of these studies have been conducted in the context of chronic diseases, such as cancer and diabetes, several of the key targets influenced by polyphenols are also related to a variety of obstetrical complications, including pre-eclampsia, intrauterine growth restriction and preterm birth. Polyphenols have also been shown to influence fertility and sexual development, fetal health and the bioavailability of nutrients. Conclusions Further research leading to a thorough understanding of the physiological roles and potential clinical value that polyphenol consumption may play in pregnancy is urgently needed to help inform patient safety.

The quality of the intrauterine environment influences maternal-fetal health and also offspring predisposition to obesity and cardiometabolic disease later in life. Several determinants, including but not limited to pregravid obesity and excessive gestational weight gain, alter the developmental milieu, fetal growth, and child obesity risk. However, the role of sleep and its relationship to healthy pregnancy is not fully established. Given the host of psychosocial and physiological complications associated with childhood obesity, targeting the gestational period is purported to be an opportune time for preventive intervention. Many longitudinal studies suggest that short sleep duration is a risk factor for the development of impaired glycemia and obesity. However, there is a dearth of information concerning the role of sleep hygiene and its role in a healthy pregnancy. Reports note disrupted and poorer quality of sleep during gestation and highlight an association between reduced sleep and risk of gestational diabetes mellitus. Given the lack of well-designed human trials assessing the value of sleep and healthy pregnancy outcomes, this review summarizes current evidence which suggests that incorporating sleep recommendations and utilizing time management strategies that encourage a healthful night ’s sleep may improve the health of the mom and the baby.

Background Maternal obesity and/or high gestational weight gain (GWG) are associated with downstream child obesity. Pregnancy represents a critical period for prevention as women are highly motivated and more receptive to behavior change. Objective This pilot study was developed to test the feasibility of intervening with the mother, specifically keeping her GWG within the Institute of Medicine (IOM) limits, with the intended target of preventing obesity in her child downstream. We are testing the practicality of delivering a structured physical activity and nutrition intervention to pregnant women during gestation and then following mom and baby to 24 months of age. Study design This study is a two-arm, parallel group, randomized controlled trial being conducted in Ottawa. Pregnant women, with pregavid BMI > 18.5, between 12 and 20 weeks gestation are randomized to one of two groups: intervention (n = 30) who receive the MOM trial Handbook (guide to healthy gestation) plus a structured physical activity and nutrition program, or a standard clinical care control group (n = 30). The intervention lasts 25–28 weeks (6 months) depending on anticipated delivery date, with follow-up assessment on mother and child at 3, 6, 12 and 24 months post-delivery. Significance Pregnancy, a critical time of growth, development and physiological change, provides an opportunity for early lifestyle intervention. The goal of identifying an effective lifestyle program for the gestational period that leads to healthy fetal development and subsequently normal weight offspring, less likely to develop obesity and its co-morbidities, is unique and could possibly attenuate the inter-generational cycle of obesity.

Maternal obesity is associated with increased risks of pregnancy complications. Excessive fat mass, common to obese women, has the potential to influence production and secretion of adipose tissue derived proteins called adipokines. The adipokine leptin is involved in the regulation of multiple aspects of maternal metabolic homeostasis. In addition, leptin has been shown to be important for placentation and maternal-fetal exchanges processes regulating growth and development. In later stages of a healthy pregnancy, central leptin resistance occurs to allow increased nutrient availability for the fetus. Disruption of the signaling capacity of leptin associated with obesity is emerging as a potential risk factor leading to pregnancy complications as a result of aberrant fuel partitioning in utero. In this review we discuss the influence of obesity on the roles of leptin and leptin resistance at the central and placental level.

Obesity is a global epidemic whose development is rooted in complex and multi-factorial interactions. Excessive weight gain throughout the lifecourse is tightly linked to, and generally precedes, the emergence of impaired glycemic control. As such, a parallel increase in the incidence of type 2 diabetes has emerged resulting in a dual epidemic. Once established, obesity is difficult to reverse and epidemiological, animal model and experimental studies have provided strong evidence implicating the intrauterine environment in downstream obesity. This review focuses on the gestational period, a crucial time of growth, development and physiological change in mother and child. It describes the interplay between maternal obesity, gestational weight gain and lifestyle behaviours, which may act independently or in combination, to perpetuate the intergenerational cycle of obesity and cardiometabolic risk. Pregnancy represents a window of opportunity for intervention via maternal nutrition and/or physical activity that may induce beneficial physiological alternations in the fetus that are mediated through favourable adaptations to in utero environmental stimuli. Many avenues of research are merging to identify the predisposing factors for positive energy balance, insulin resistance and cardiometabolic risk throughout the lifecourse and evidence in the emerging field of epigenetics suggests that chronic, sub-clinical perturbations during pregnancy may affect fetal phenotype and long-term health.

Child obesity is a global epidemic whose development is rooted in complex and multi-factorial interactions. Once established, obesity is difficult to reverse and epidemiological, animal model, and experimental studies have provided strong evidence implicating the intrauterine environment in downstream obesity. This review focuses on the interplay between maternal obesity, gestational weight gain and lifestyle behaviours, which may act independently or in combination, to perpetuate the intergenerational cycle of obesity. The gestational period, is a crucial time of growth, development and physiological change in mother and child. This provides a window of opportunity for intervention via maternal nutrition and/or physical activity that may induce beneficial physiological alternations in the fetus that are mediated through favourable adaptations to in utero environmental stimuli. Evidence in the emerging field of epigenetics suggests that chronic, sub-clinical perturbations during pregnancy may affect fetal phenotype and long-term human data from ongoing randomized controlled trials will further aid in establishing the science behind ones predisposition to positive energy balance.

Pregnancy is a critical period of body weight regulation. Maternal obesity and excessive gestational weight gain have become increasingly common and contribute to poor obstetrical outcomes for mother and baby. Regular participation in physical activity may improve risk profiles in pregnant women.Our objectives were to provide an overview of maternal-fetal exercise physiology, summarize current evidence on the effects of physical activity during pregnancy on maternal-fetal outcomes, and review the most recent clinical practice guidelines. In addition, we summarize the findings in the context of the current obesity epidemic and discuss implications for clinical practice. A literature review was completed in which we queried OVID (Medline), EMBASE, and PSYCHINFO databases with title words "exercise or physical activity" and "pregnancy or gestation" from 1950 to March 1, 2010. A total of 212 articles were selected for review.Care providers should recommend physical activity to most pregnant women (i.e., those without contraindications) and view participation as a safe and beneficial component of a healthy pregnancy.ObstetriciansGynecologists and Family Physicians.After participating in this CME activity, physicians should be better able to classify the potential impact of physical activity on maternal glycemic control and fetal growth outcomes. Assess maternal lifestyle and provide recommendations on appropriate gestational weight gain, evaluate pregnant women for contraindications to physical activity participation, make individualized recommendations for exercise participation, and educate patients on the merits of physical activity for health benefit.

Background A significant proportion of women exceeds or does not meet the Institute of Medicine’s gestational weight gain (GWG) guidelines. Inadequate, excessive GWG or weight loss during pregnancy is associated with an increased risk of negative maternal and fetal outcomes. Among the many determinants of GWG identified in the 2009 Institute of Medicine guidelines, culture was named as one of the few whose influence has not been fully explored. Some cultural beliefs may erroneously promote overeating as “eating for two” and discourage physical activity during pregnancy, but there is lack of empirical evidence on how culture affects GWG. The purpose of this systematic review is to examine the effects of culture on GWG. Methods/design Ten electronic databases will be searched to identify studies reporting on the effects of culture on GWG. Grey literature, published conference abstracts, websites of relevant organizations and reference lists of included studies will also be searched. Studies that report on effects of culture, acculturation, ethnicity, race, nationality, ancestry and identity on GWG in adult women will be included. Quality of evidence will be evaluated using the grading of recommendations, assessment, development and evaluations (GRADE) approach to rating evidence. Study selection, data extraction and risk of bias assessment will be conducted by two independent reviewers, with disagreements being resolved by consensus or third party adjudication as needed. Formal meta-analyses will be conducted among included studies that are sufficiently statistically and clinically homogeneous. Discussion This review will provide a comprehensive assessment and synthesis of current evidence and will draw attention to potential gaps where future research on the effects of culture on guideline discordant gestational weight gain remains to be conducted. Systematic review registration PROSPERO CRD42015023399

Introduction This study evaluated whether intervening with child care providers would increase physical activity (PA) and reduce adiposity in preschoolers. Methods This was a two-arm, parallel group, cluster RCT whereby six child care centers were randomly assigned in equal numbers to intervention ( n =40 children) or control ( n =43 children). Participants were aged 3–5 years and attended licensed child care centers. Child care providers received two 3-hour train-the-trainer workshops and a training manual at program initiation aimed at increasing structured and unstructured PA through active play. Control child care centers implemented their standard curriculum. PA and sedentary behavior were measured by accelerometry, and body composition was measured using bioelectrical impedance at baseline and 6 months. Data were collected in 2011–2012 and analyzed in April 2015. Results Linear mixed-effects modeling showed that at 6 months, children in the intervention group demonstrated greater increases in minutes per preschool day spent in overall PA (22.5 minutes, 95% CI=8.9, 36.1, p =0.002), and light-intensity PA (16.1 minutes, 95% CI=5.2, 26.7, p =0.004), but changes between groups in moderate to vigorous PA did not differ. The intervention group showed greater reductions in body fat percentage (−1.9%, 95% CI=−3.5, −0.3, p =0.023) and fat mass (−0.3 kg, 95% CI=−0.7, −0.1, p =0.018), but groups did not differ on fat-free mass, BMI, or z-BMI. Conclusions Provider-led intervention in child care centers increased preschoolers' PA and reduced adiposity, therefore may represent a viable approach to promoting PA and related health benefits in preschool-aged children. Trial Registration This study is registered at www.clinicaltrials.gov NCT02293278.

This narrative review discusses gestational weight gain (GWG) and medical outcomes of pregnancy, including metabolic, cardiovascular, respiratory, musculoskeletal and psychiatric systems. Taken as a whole, the available evidence shows that excessive GWG increases the risk of all medical complications of pregnancy, and negatively impacts the long-term health and weight of both mothers and their offspring. Briefly, interventions to encourage appropriate GWG are discussed and readers are directed to resources to facilitate discussion of pregnancy weight.

Objective To determine the incidence of maternal heart rate artefact (MHRA) when monitoring fetal heart rate (FHR) in labour and to determine obstetrical factors associated with MHRA. Methods In a prospective observational study, maternal and fetal heart rates were displayed simultaneously to document the superimposition of the maternal heart rate (MHR) on FHR tracings. All women in labour who were undergoing external fetal monitoring (EFM) at the Ottawa Hospital from October 2011 to March 2012 were eligible. Every episode of MHRA was documented and classified according to its clinical significance. Wilcoxon test, t tests, and chi-square tests were used to identify time-related differences and obstetrical factors (epidural analgesia, fetal presentation, multiple gestation, maternal BMI, umbilical cord arterial pH, five-minute Apgar scores) that were associated with a potential adverse outcome. Results We assessed 1313 tracings with simultaneous displays of the MHR and FHR in labour. MHRA was present at least once in 721 tracings (55%). Of these tracings, 35 were classified as having one or more episodes that might have led to an adverse outcome (either false positive or false negative), giving an incidence of 2.7% of all women in labour. In 33 tracings, the MHRA masked an abnormal FHR tracing. In two tracings, the MHRA masked a normal FHR, which might have resulted in misinterpretation of the tracing (i.e., false positive), leading to unnecessary intervention. Conclusion The incidence of MHRA is higher than currently thought, and in more than 2% of women in labour may lead to adverse outcomes. We propose routine use of simultaneous maternal and FHR monitoring for women undergoing EFM, especially during the second stage of labour.

Letter to the Editor I welcome Drs. Ferraro and Adamo's discourse and readily admit that whenever educated readers wholly fail to comprehend the main thrust of a theory, the fault frequently lies with the author (i.e., me). Given this possibility, I now seek to remove whatever opacity led to their miscomprehension. Science is the pursuit of lawful relations, not mere correlations; and the only test of a scientific theory ishow well it explains all the available evidence, not isolated findings. With these premises as a foundation, my theory links the socio-environmental changes over the past century to the lawful relations between the physiologic mechanisms driving epidemiologic trends and the subsequent evolutionary consequences. In simple terms, the human body may be conceived as an ecosystem in which tissues compete for nutrient-energy. Within this framework, obesity is not a complex phenomenon but merely the result of the competitive dominance of fat cells over other tissues in the absorption and sequestering of energy. This competitive advantage is engendered via prenatal physiologic and postnatal behavioral ‘maternal effects’ (i.e., alterations in fat, muscle, and pancreatic beta cell development and learned physical inactivity). These environmentally-induced phenotypic effects have evolutionary consequences because they are transmitted progressively to the next generation through an altered maternal phenotype, independent of changes to the genome. As stated in my title and throughout the paper, the twin epidemics of obesity and type II diabetes mellitus (T2DM) are the result of non-genetic evolution; at no point was there an “implied contribution of epigenetics...driving the intergenerational cycle of obesity.” Quite the contrary, I wrote extensively on the near-complete failure (i.e., lack of explanatory and predictive power) of the gene-centric (i.e., DNA and epigenetic) paradigm and stated explicitly that the problem of the “missing heritability...will not be found in the genome.” Furthermore, I posited that the rapid and ubiquitous phenotypic evolution evidenced over the past century was the result of “the progressive intergenerational transmission of acquired characteristics over multiple successive generations.” My empirically supported physiologic theory of inheritance and evolution (based on accumulative maternal effects) posits that a fertilized oocyte with any human genome placed in the intrauterine milieu of a woman with an obese, inactive phenotype (i.e., with an evolutionary/familial history of high maternal resources and high levels of physical inactivity/sedentary behavior) will be born with compromised metabolic functioning. This inherited phenotype assures the adipogenic nutrient partitioning that leads to obesity and T2DM and is transmissible to the next generation via maternal effects (e.g., excessive gestational weight gain). In other words, phenotype begets phenotype because the intrauterine environment overwhelms any genetic variance across generations (i.e., the environmental determinism of obesity/T2DM; please see text of figure 4 of1). The empirical support for ‘maternal effects’ is unequivocal across species,2 including humans. For example, Brooks et al.3 examined ovum donations in humans and found that the “only discernible factor” influencing infant birth weight was the surrogate mother's body mass. Given these findings, and the fact that metabolically relevant mitochondrial DNA are (asexually) inherited via the maternal germ-line,4 I find little evidence to support the dogmatic speculation that paternal genes will have significant differential effects where it appears that maternal genes do not. With respect to fetal development, genes are merely a necessary but not sufficient component of the development of obese/T2DM phenotypes, akin to atmospheric oxygen and water. They can be conceptualized as the ‘tools’ of the fertilized oocyte, and their use (i.e., expression) is strictly environment-dependent.5-9 As such, if we assume that a hammer is necessary to build a house, it should be obvious that the hammer does not cause a house to be built, nor determine its dimensions. Nevertheless, gene-centric dogma is based on the unsupported speculation that DNA (the hammer) is the cause of the obese/T2DM phenotypes (the house and its dimensions). Not surprisingly, if the only tool one has is a hammer, one will think everything is a nail; hence the myopic nature of genetic determinism, the irrelevance of genetic testing for obesity/T2DM, and failure of the gene/DNA-centric paradigm to explain recent epidemiologic trends. Conversely, the most clinically relevant and scientifically important aspect of my paper is the empirical support presented for the ‘inheritance of acquired characteristics through use and disuse’ as a significant and universal mechanism of inheritance and evolution. This theory has been presented for millennia without strong evidence (e.g., Hippocrates,10 Aristotle11, Jean-Baptiste Lamarck12 and Charles Darwin13). Thus, I posited an empirically supported “in utero training effect” for fat cell development (i.e., the ‘use’ phase of “use and disuse”) and the post-natal effects of inactivity (i.e., the ‘disuse’ of skeletal muscles leading to insulin resistance, increased adiposity, etc.) leading to the intergenerational transmission of obesity and T2DM. The clinical and research implications of my theory are obvious given that it provides an unambiguous framework to intervene on the intergenerational transmission of obesity and T2DM: significantly increase the skeletal muscle energy flux of females across their lifespan. My theory of inheritance and evolution: 1) directly challenges and potentially refutes the hyper-reductionist gene-centric Modern Synthesis,14 2) flouts the central dogma of molecular biology15 and Weismann Barrier,16 and 3) subsumes and extends the ground-breaking (and brilliant) work of both Barker17 and Pedersen.18 From a clinical standpoint, because gene expression is environmentally determined,5-9,19 genes are a merely a marker of what was and what is, not what will be.7 Therefore, gene-centric research is a costly, unnecessary tangent to clinically relevant scientific progress. As the great evolutionary geneticist Richard Lewontin wrote in 2006, it is time to dispel the “naive current prejudice that DNA has in it all the information necessary to specify the organism.”20 I could not agree more and look forward to scientific and clinical progress.

Appropriate in utero growth is essential for offspring development and is a critical contributor to long-term health. Fetal growth is largely dictated by the availability of nutrients in maternal circulation and the ability of these nutrients to be transported into fetal circulation via the placenta. Substrate flux across placental gradients is dependent on the accessibility and activity of nutrient-specific transporters. Changes in the expression and activity of these transporters is implicated in cases of restricted and excessive fetal growth, and may represent a control mechanism by which fetal growth rate attempts to match availability of nutrients in maternal circulation. This review provides an overview of placenta nutrient transport with an emphasis on macro-nutrient transporters. It highlights the changes in expression and activity of these transporters associated with common pregnancy pathologies, including intrauterine growth restriction, macrosomia, diabetes and obesity, as well as the potential impact of maternal diet. Molecular signaling pathways linking maternal nutrient availability and placenta nutrient transport are discussed. How sexual dimorphism affects fetal growth strategies and the placenta’s response to an altered intrauterine environment is considered. Further knowledge in this area may be the first step in the development of targeted interventions to help optimize fetal growth.

Background/Objectives: The aim of this study was to evaluate the reliability of a food menu to measure energy and macronutrient intake within the laboratory and under real-life conditions in adolescents. Subjects/Methods: A total of 12 boys and 8 girls (age 14.3 (s.d. 2.4) years, body mass index (BMI) 20.8 (s.d. 4.0)?kg/m2) completed two identical in-laboratory sessions (ILS) and two out-of-laboratory sessions (OLS). During the ILS, participants had ad libitum access to a variety of foods (74 items in total), which they chose from a menu every hour, for 5?h (0800–1300?h). For the OLS (1300?h until bedtime), the foods were chosen from the same menu at 1300?h and packed into containers to bring home with them. Results: Test–retest analysis of energy and macronutrient intake revealed no significant differences (ILS and OLS). Intra-class correlations ranged between 0.69 and 0.83 (ILS) and between 0.48 and 0.73 (OLS) for energy and macronutrient intake (all P

Objective. This study aimed to investigate potential differences in appetite sensations, ghrelin, peptide YY, and glucose and their relationship with energy and macronutrient intake in obese adolescents with subclinical binge eating disorder. Methods. Fifteen obese adolescents (six and nine individuals with and without subclinical binge eating disorder, resp.) qualified for this study. Visual analog scales and Three-Factor Eating Questionnaires were used to assess eating behaviours. Circulating ghrelin, peptide YY, and glucose were measured after fasting and at multiple time points postprandially following a standardized breakfast meal. Energy and macronutrient intake were measured with an ad libitum lunch buffet. Results. Emotional eating scores were significantly higher in obese adolescents with subclinical binge eating disorder. Hunger levels rose and satiety levels fell significantly over the course of the monitoring period but there was no difference between the two groups. Obese adolescents with subclinical binge eating disorder did not have significantly different levels of appetite signaling proteins or glucose. Obese adolescents with subclinical binge eating disorder had a nonsignificantly higher energy and macronutrient intake. Conclusions. A significant difference between the two groups in terms of their emotional eating scores highlights the important role that psychological factors play in relation to eating behaviours.

Background. Placenta accreta is a potentially life-threatening obstetrical condition and is responsible for many emergency Caesarean hysterectomies. Early prenatal diagnosis may help minimize maternal morbidity and mortality. This report highlights risk factors, early diagnostic findings and complications associated with placenta accreta, and the role of first trimester sonography in diagnosis.Case. A 38-year-old pregnant woman, G2P1L1 with history of one previous Caesarean section, presented with vaginal bleeding at 13 weeks’ gestation. Ultrasound examination was highly suspicious of placenta previa with accreta. During an earlier 12-week scan for nuchal translucency measurement, the placenta was suboptimally visualized. She was counselled regarding potential maternal and fetal complications as well as management options. At 33 weeks’ gestation Caesarean hysterectomy was performed due to vaginal bleeding.Conclusion. Early ultrasound screening in high-risk patients may be advantageous in order to identify placenta accreta and conduct appropriate patient counseling regarding risks and management options.

Introduction There is discord between the recall of maternity care providers and patients when it comes to discussion of gestational weight gain (GWG) and obesity management. Few women report being advised on GWG, physical activity (PA), and nutrition, yet the majority of health care providers report discussing these topics with patients. We evaluated whether various Canadian maternal health care providers can identify appropriate GWG targets for patients with obesity and determine if providers report counseling on GWG, physical activity, and nutrition. Methods A valid and reliable e-survey was created using SurveyMonkey software and distributed by the Society of Obstetricians and Gynaecologists of Canada listserve. A total of 174 health care providers finished the survey. Respondents self-identified as general practitioners, obstetricians, maternal-fetal medicine specialists, midwives, or registered nurses. Results GWG recommendations between disciplines for all body mass index categories were similar and fell within Health Canada/Institute of Medicine (IOM) guidelines. Of those who answered this question, 110/160 (68.8%) were able to correctly identify the maximum IOM GWG recommended for patients with obesity, yet midwives tended to recommend 0.5–1 kg more GWG (P = 0.05). PA counseling during pregnancy differed between disciplines (P < 0.01), as did nutrition counseling during pregnancy (P < 0.05). Conclusion In contrast to patient reports, the majority of health care providers document counseling on GWG, PA, and nutrition and appropriately identify GWG limits for obese patients. However, the content and quality of the discourse between patient and provider warrants further investigation.

We examined how obese children perceive a maximal cardiorespiratory fitness test compared with a submaximal cardiorespiratory fitness test. Twenty-one obese children (body mass index ≥95th percentile, ages 10–17 years) completed maximal and submaximal cardiorespiratory fitness tests on 2 separate occasions. Oxygen consumption (VO2) and overall perceived exertion (Borg 15-category scale) were measured in both fitness tests. At comparable workloads, perceived exertion was rated significantly higher ( P < 0.001) in the submaximal cardiorespiratory fitness test compared with the maximal cardiorespiratory fitness test. The submaximal cardiorespiratory fitness test was significantly longer than the maximal test (14:21 ± 04:04 seconds vs. 12:48 ± 03:27 seconds, P < 0.001). Our data indicate that at the same relative intensity, obese children report comparable or even higher perceived exertion during submaximal fitness testing than during maximal fitness testing. Perceived exertion in a sample of children and youth with obesity may be influenced by test duration and protocol design.

Prenatal life is recognised as a critical period where vital physiological processes may be permanently transformed leading to altered susceptibility to disease risk later in life.1 Accordingly, fetal adaptive responses to the maternal milieu, including the in utero effect of a physically active pregnancy, may influence the long-term health and well-being of the developing child. Is there potentially lifelong significance of maternal exercise on fetal health? Although the recent study published in BJSM by Salvesen et al 2 is timely with respect to the fetal response to extreme levels of maternal exertion in competitive Olympic hopefuls, it has limited applicability to the maternal population at large who are mostly inactive.3 The latter may benefit the most from a physically active, healthful pregnancy. In their study examining fetal response and utero-placental blood flow during strenuous treadmill running in the second trimester, Salvesen et al 2 note that fetal HR was within the normal range as long as maternal exertion was below 90% maternal HRmax; an exercise intensity that few women would routinely work at, nor would be encouraged in a typical maternal population. If maternal HR exceeded 90% of maximum value and uterine artery blood flow was simultaneously less than 50% the initial value, fetal bradycardia occurred. However, despite these concerns, following exercise cessation fetal HR reached baseline values, uterine artery flow volume improved to resting values in most women and all birthweights were within the lower normal range for Norwegian children, which is encouraging. Salvasen and …