Gestational weight gain below recommendations and adverse maternal and child health outcomes for pregnancies with overweight or obesity: a United States cohort study.

The current Institute of Medicine (IOM) pregnancy weight gain guidelines were developed using the best available evidence but were limited by substantial knowledge gaps. Some have raised concern that the guidelines for individuals affected by overweight or obesity are too high and contribute to short- and long-term complications for the mother and child. To determine the association between pregnancy weight gain below the lower limit of the current IOM recommendations and risk of 10 adverse maternal and child health outcomes among individuals with overweight and obesity. We used data from a prospective cohort study of United States nulliparae with prepregnancy overweight (n = 955) or obesity (n = 897) followed from the first trimester to 2-7 y postpartum. We used multivariable Poisson regression to relate pregnancy weight gain z-scores with a severity-weighted composite outcome consisting of ≥1 of 10 adverse outcomes (gestational diabetes, preeclampsia, unplanned cesarean delivery, maternal postpartum weight increase >10 kg, maternal postpartum metabolic syndrome, infant death, stillbirth, preterm birth, small-for-gestational age birth, and childhood obesity). Pregnancy weight gain z-scores below, within, and above the IOM-recommended ranges occurred in 5%, 13%, and 80% of pregnancies with overweight and 17%, 13%, and 70% of pregnancies with obesity. There was a positive association between pregnancy weight gain z-scores and all adverse maternal outcomes, childhood obesity, and the composite outcome. Pregnancy weight gain z-scores below the lower limit of the recommended ranges (<6.8 kg for overweight, <5 kg for obesity) were not associated with the severity-weighted composite outcome. For example, compared with the lower limit, adjusted rate ratios (95% confidence interval) for z-scores of -2 standard deviations in pregnancies with overweight (equivalent to 3.6 kg at 40 wk) and obesity (-2.8 kg at 40 wk) were 0.99 (95% confidence interval [CI]: 0.91, 1.06) and 0.97 (95% CI: 0.87, 1.07). These findings support arguments to decrease the lower limit of recommended weight gain ranges in these prepregnancy body mass index groups.

Bodnar LM ，Johansson K ，Himes KP ，Khodyakov D ，Abrams B ，Parisi SM ，Hutcheon JA ... -  《-》

Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes.

LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group ，Voerman E ，Santos S ，Inskip H ，Amiano P ，Barros H ，Charles MA ，Chatzi L ，Chrousos GP ，Corpeleijn E ，Crozier S ，Doyon M ，Eggesbø M ，Fantini MP ，Farchi S ，Forastiere F ，Georgiu V ，Gori D ，Hanke W ，Hertz-Picciotto I ，Heude B ，Hivert MF ，Hryhorczuk D ，Iñiguez C ，Karvonen AM ，Küpers LK ，Lagström H ，Lawlor DA ，Lehmann I ，Magnus P ，Majewska R ，Mäkelä J ，Manios Y ，Mommers M ，Morgen CS ，Moschonis G ，Nohr EA ，Nybo Andersen AM ，Oken E ，Pac A ，Papadopoulou E ，Pekkanen J ，Pizzi C ，Polanska K ，Porta D ，Richiardi L ，Rifas-Shiman SL ，Roeleveld N ，Ronfani L ，Santos AC ，Standl M ，Stigum H ，Stoltenberg C ，Thiering E ，Thijs C ，Torrent M ，Trnovec T ，van Gelder MMHJ ，van Rossem L ，von Berg A ，Vrijheid M ，Wijga A ，Zvinchuk O ，Sørensen TIA ，Godfrey K ，Jaddoe VWV ，Gaillard R ... -  《-》

Do current pregnancy weight gain guidelines balance risks of adverse maternal and child health in a United States cohort?

Bodnar LM ，Johansson K ，Himes KP ，Khodyakov D ，Abrams B ，Parisi SM ，Hutcheon JA ... -  《-》

Weight loss prior to pregnancy and subsequent gestational weight gain: Prepare, a randomized clinical trial.

Women with elevated body mass index are encouraged to lose weight before pregnancy, but no trials have tested the effects of prepregnancy weight loss on health outcomes. This study aimed to determine whether prepregnancy weight loss reduces gestational weight gain and improves pregnancy outcomes. Pragmatic randomized clinical trial was conducted between May 2015 and October 2019 at Kaiser Permanente Northwest, an integrated health system. Data collection was blind to condition assignment. Eligible participants were women aged 18 to 40 years with a body mass index of ≥27 kg/m2 who were planning pregnancy within 2 years. Recruitment contacts were sent to 27,665 health system members who met age and body mass index criteria; 329 women attended screening visits, and 326 were randomized. They were randomized to either a behavioral weight loss intervention or usual care control. The intervention consisted of health coaching phone sessions weekly for 6 months and then monthly for 18 months or until end of pregnancy. We used logistic regression to examine the a priori primary hypothesis that participants in the intervention would be less likely to exceed National Academy of Medicine guidelines for gestational weight gain during each trimester and overall. Secondary and exploratory outcomes included absolute weight gain before and during pregnancy and perinatal and newborn outcomes. Of the 326 participants, 169 had singleton pregnancies lasting ≥14 weeks (analytical cohort: intervention, 89; control, 80). At baseline, mean age was 31.3±3.5 years, and body mass index was 34.8±5.8 kg/m2. Participants in the intervention group lost more weight before pregnancy than those in the control group (-0.25±0.51 vs -0.03±0.21 kg/wk; P<.001). However, participants in the intervention group gained more weight than those in the control group in the second trimester (0.42±0.26 vs 0.33±0.28 kg/wk; P=.04) and third trimester (0.56±0.37 vs 0.43±0.33 kg/wk; P=.02) and overall (13.2±8.20 vs 10.3±7.41 kg; P=.03). Nevertheless, arms did not differ in rates of exceeding gestational weight gain guidelines at any time point. Spontaneous pregnancy loss was less common in the intervention arm than in the control arm (8 [4.9%] vs 19 [11.8%]; odds ratio, 0.39 [0.16-0.92]), but we found no other differences in the secondary or exploratory outcomes. Participation in the prepregnancy weight loss intervention had no effect on women's likelihood of exceeding gestational weight gain guidelines. Although the intervention group successfully lost weight before conception, the intervention group was associated with greater weight gain in late pregnancy. To effectively reduce weight throughout pregnancy and improve maternal and child outcomes, prepregnancy weight loss interventions may need to be combined with intensive weight management that continues throughout delivery.

LeBlanc ES ，Smith NX ，Vesco KK ，Paul IM ，Stevens VJ ... -  《-》

Defining the optimum strategy for identifying adults and children with coeliac disease: systematic review and economic modelling.

Elwenspoek MM ，Thom H ，Sheppard AL ，Keeney E ，O'Donnell R ，Jackson J ，Roadevin C ，Dawson S ，Lane D ，Stubbs J ，Everitt H ，Watson JC ，Hay AD ，Gillett P ，Robins G ，Jones HE ，Mallett S ，Whiting PF ... -  《-》