No description available.

Few studies have measured the changes of postpartum weight retention (PWR), and none of them have assessed the effect of pregnancy on waist circumference (WC) in Taiwanese women. The primary aims of this longitudinal study were to explore the changes in body weight and WC during the first six months postpartum and to identify the explanatory factors of PWR and of WC. A theoretical framework that incorporated Bandura's social learning theory and the results of a literature review was used to guide this study. Structured questionnaires were used for data collection. Postpartum body weight and WC were measured. Data were collected from May 2011 to January 2013 and analyzed using the SPSS 19.0 and Mplus 6.12. A sample of 200 healthy postpartum women was recruited from three clinics in Tainan City, Taiwan. The mean age of the women was 31.19 years, and the majority of them were married (98.0%), primiparas (56%), had a bachelor's degree (52.5%), and planned to have this pregnancy (62.5%). The mean prepregnancy body weight was 55.84 kg, and the mean GWG was 13.76 kg. About one third of the sample gained weight exceeding the GWG recommendations of the IOM. The mean PWR decreased over time from 9.13 kg at hospitalization to 2.73 kg at 6 months postpartum. Approximately 24% of the participants still retained 5 kg or more at 6 months postpartum, and about 44% of the women had at least one kind of weight-related risk--substantial PWR, overweight, or central obesity. Age, prepregnancy BMI, parity, GWG, and place for doing the month significantly affected PWR. The final latent growth curve (LGC) model of PWR explained 91.5% and 33.9% of the variance in initial status and overall change rate in PWR. Age, prepregnancy BMI, parity, GWG, and cesarean delivery significantly affected WC, which explained 84.1% and 38.1% of the variance in initial status and change rate in WC. GWG was the most influential factor in the change rate of PWR and WC. Establishing tailored recommendations for GWG for Taiwanese women is warranted. / text

Fetal exposure to an intrauterine environment affected by maternal obesity and excessive gestational weight gain (GWG) pose several adverse short- and long-term health risks to infants. Excessive GWG and maternal obesity are of high priority to public health across many nations. Improving maternal and child health can be achieved by encouraging women to meet Institute of Medicine (IOM) weight gain recommendations, sound clinical guidance, and other forms of support. Another means of helping women adhere to weight gain guidelines is by making use of the near ubiquitous nature of mobile technology and promoting healthy pregnancies through reliable mobile health (mHealth) applications (apps). The objective of the first study of this thesis was to examine the associations between psychosocial factors and achieving IOM-recommended weight gain during pregnancy. Cross-sectional data were collected from pregnant and postpartum women who responded to a validated questionnaire, the Electronic Maternal health survey. Multiple linear logistic regression analyses were used to determine correlates associated with meeting IOM guidelines. The objective of the second study was to conduct a preliminary exploration of women’s attitudes towards an evidence-based, mHealth app, SmartMoms Canada, as a valid source of pregnancy-related information and its ability to offer physical activity, nutrition, and lifestyle support. Focus groups were organized to assess women’s attitudes towards the app and inductive thematic content analysis was utilized to interpret focus group data. It was found that self-efficacy and perceived controllability of behaviours are important factors contributing to whether women meet IOM weight gain recommendations. Further, pregnant women are quite receptive to mHealth technology and positively viewed the future prospective of SmartMoms Canada as a means of promoting overall maternal health. Combined, these findings will contribute to our understanding of how to best improve maternal-fetal health outcomes in the near future.

A healthy in utero environment is essential for achieving optimal outcomes for women and their children. Gestational weight gain (GWG) has been shown to impact current and future maternal-infant health outcomes. Suboptimal weight gain during pregnancy (defined by the Institute of Medicine GWG guidelines) has been linked to several complications and is implicated in the inter-general cycle of obesity. Understanding contributors to GWG and intervening during pregnancy with healthy behaviour strategies may have a multi-generational effect for chronic disease prevention. The objective of the first study of this thesis was to examine the association between i) eating habits during pregnancy, ii) advice from family or friends about GWG, and iii) personal effort to stay within weight gain limits, and meeting GWG recommendations. Cross-sectional data were collected from pregnant and postpartum women who responded to the validated electronic maternal (EMat) health survey. Regardless of receiving advice about GWG, women self-reporting less healthy eating habits in pregnancy than before pregnancy, receiving advice from family/friends about GWG, and lower personal effort to stay within guidelines, had an increased odds of weight gain discordant with recommendations. The objective of the second study was to assess the short-term effect of the SmartMoms Canada application (app) usage on promoting adequate GWG and healthy behaviours. SmartMoms Canada is an app-based intervention designed to help pregnant women adhere to GWG guidelines and improve healthful behaviours. Pregnant women using the SmartMoms Canada app more frequently had a higher moderate-to-vigorous physical activity daily average when compared with women with a lower usage. Together, the EMat and SmartMoms results from this thesis contribute to identifying and mitigating potential factors associated with discordant GWG and healthy behaviours.

Background: In the pregnant population, being physical active and meeting gestational weight gain (GWG) guidelines have numerous health benefits for both mother and infant. Markers of lipid metabolism are known to be influenced by these two variables in the non-pregnant population. However, the relationship between physical activity (PA) and GWG on lipid markers has yet to be assessed during pregnancy. My thesis aims to address this gap in the literature. Methods: The first objective of my thesis was to examine the relationship between maternal PA and GWG on gross measurements of fetal and placental development (n=40). Specifically, three markers of placental efficiency (Pl-E) were examined (birthweight [BW], BW-to-placenta weight ratio, and residual BW). The second objective of my thesis was to analyze maternal serum lipid and glucose markers (n=40), in mid (24-28 weeks) and late (34-38 weeks) gestation as well as from the umbilical cord (UC) as they relate to both PA and GWG. The third objective of my thesis was to explore how PA level and GWG status affect markers of lipid metabolism in term placenta (n=31). Markers of placental lipid transport (FATP1, FABP4, FAT/CD36) were assessed at the protein level, and enzymatic activity of placental lipoprotein lipase was also measured. Lastly, placental lipid storage was assessed by examining triglyceride content, paired with lipid droplet staining. Results: There was no relationship between PA independently or in combination with GWG on any Pl-E markers. A significant association was found between GWG and BW in women who gained weight excessively compared to insufficiently. Neither PA nor GWG categorization was associated with maternal lipid and glucose markers. Total cholesterol levels measured in UC serum were significantly lower in women categorized as active throughout pregnancy (p<0.0001) or whose activity dropped in late gestation (p<0.0001) compared to those who were inactive v throughout gestation. Glucose levels were lower in UC blood of women who gained weight appropriately in mid-gestation compared to those who gained insufficient (p=0.040) or excessive (p=0.021) weight. In terms of placental fatty acid transport, there was a significant interaction between PA status and GWG categorization and placental FATP1 protein expression (F=14.62, p<0.0001). Finally, while no differences were found in placental lipid droplet staining, the droplets were more likely to be clustered within the syncytiotrophoblast border. Conclusion: In conclusion, maternal PA had no association with Pl-E, while GWG was only associated with BW. My thesis work found that while maternal serum lipid markers were not associated with PA and GWG, both maternal PA and GWG status were related to changes in UC and placental lipid markers throughout pregnancy. In combination with previous research from our lab, it is suggested that women who are physically active during pregnancy, and gain weight appropriately may be transporting fewer nutrients (i.e. fatty acid, glucose, cholesterol) to the placenta than those who are inactive, yet simultaneously increasing metabolization. Future research should further investigate these findings by performing functional experiments.

Prolonged second stage of labor, excessive gestational weight gain and cesarean delivery has been associated with adverse maternal and fetal outcomes. Physical activity during pregnancy is a modifiable risk factor which has never been studied among Hispanic women. Gestational weight gain, another modifiable risk factor has only been evaluated as a risk factor for cesarean delivery in two studies among women induced for labor. To date, no study has examined the effect of duration of second stage of labor on intra-ventricular hemorrhage in very preterm births. We examined these maternal risk factors for prolonged second stage of labor, rate of cesarean delivery and fetal outcomes. The first study evaluated the association between physical activity and duration of second stage of labor. Prior studies regarding physical activity and duration of second stage of labor have been conflicting and none have examined the Hispanic population. During pregnancy, activities such as household chores, childcare, sports and women's occupation constitute a significant proportion of physical activity but have not been considered in prior studies. We examined the association between total physical activity (occupational, sport/exercise, household/care giving, and active living) during pre, early and mid-pregnancy and duration of second stage of labor in a prospective cohort of 1,231 Hispanic participants. Physical activity was quantified using the Kaiser Physical Activity Survey administered during pregnancy. Using multivariate linear regression we did not find statistically significant association between pre, early and mid-pregnancy physical activity and duration of second stage of labor. The second study focused on the effect of gestational weight gain on the cesarean delivery rate after induction of labor. The rate of induction of labor (IOL) has more than doubled from 9.5% in 1990 to 22.5% in 2006. Cesarean delivery usually follows a failed IOL and is associated with maternal and fetal morbidity. One of the two studies evaluating the effect of gestational weight gain on the rate of cesarean section in patients undergoing IOL was restricted to women with normal Body Mass Index (BMI) and the other was subjected to bias because more than half of the patients were missing BMI data. Therefore, we evaluated the effect of gestational weight gain on the rate of cesarean delivery after labor induction. In a retrospective cohort study design, using data from May 2005 to June 2008 and a multivariate logistic regression we found a 13% increase in risk of cesarean delivery with 5 kg increase in gestational weight gain. Finally, we evaluated the effect of mode of delivery and duration of second stage of labor on intra-ventricular hemorrhage (IVH) among early preterm births. IVH is a serious complication associated with preterm birth and important predictors of cerebral palsy and neurodevelopmental delays. Prior studies on this relationship in early preterm births are sparse. In a retrospective cohort study of newborns born less than 30 weeks or less than 1500 g between May 2003 and August 2008, we found an increase in risk of IVH after vaginal delivery. However, duration of second stage of labor had no significant effect on risk of IVH.

Maternal weight during pregnancy has an important impact on multiple aspects of health for both mothers and their children. This dissertation investigated whether pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) independently impact a child’s health service utilization. Methods: This dissertation included four studies. The study population for the first three studies was all women who delivered a singleton, live infant in Ontario between 2012-2014 and have information contained in the Better Outcomes Registry and Network (BORN) Ontario registry. Health service data in the first 24 months following birth were collected via health administrative databases housed at ICES. I investigated whether there was an association of pre-pregnancy BMI (Chapter 2) or GWG (Chapter 3) with pediatric health service use. I then investigated whether adverse birth outcomes, specifically small for gestational age (SGA) or preterm birth (PTB), mediated this relationship (Chapter 4). Finally, I developed a cost effectiveness evaluation framework for the implementation of a maternal weight intervention program to limit the impact on the child (Chapter 5).Findings: Children born to women with pre-pregnancy obesity relative to normal weight experienced higher rates of hospitalization (adjusted incidence rate ratio [aIRR]: 1.20, 95% CI:1.17,1.24), physician visits (aIRR: 1.05, 95% CI: 1.04,1.05) and emergency department (ED)visits (aIRR: 1.27, 95% CI: 1.25,1.29). Children born to normal weight (aIRR: 1.07, 95% CI:1.05,1.09) or overweight (aIRR: 1.04, 95% CI: 1.01,1.07) mothers with above recommended (versus recommended) GWG had increased ED visits. Children born to underweight women with below recommended GWG had increased hospitalizations (aIRR: 1.31, 95% CI: 1.14,1.51) and physician visits (aIRR: 1.14, 95% CI: 1.10,1.17). PTB (56.74%), and SGA (6.83%)iv mediated the relationship of below recommended GWG and pediatric hospitalizations only. Adetailed cost effectiveness framework is outlined to investigate an intervention plan targeting GWG to limit adverse pediatric health outcomes. Discussion: The findings of this dissertation indicate that below or above optimal maternal weight is associated with pediatric health service use. This dissertation serves as a call to action to better inform clinical practice and impact health service policy related to maternal weight via early intervention.

No description available.

Obesity is a significant health concern for women of childbearing age. More than 40% of women have a Body Mass Index (BMI) in the overweight or obese ranges at the time they conceive, posing significant health risks for both mother and child. Excessive weight gain during pregnancy is common and associated with numerous deleterious complications. The Institute of Medicine published gestational weight gain (GWG) guidelines based on prepregnancy BMI. However, more than 50% of women gain in excess of these recommendations. Further, many women report receiving minimal guidance from their healthcare providers regarding weight gain, nutrition, and physical activity during pregnancy. There is a clear need to enhance patient-provider communication to develop relevant and targeted interventions to reduce excessive GWG. The current study used a mixed-methods approach to assess perspectives of both pregnant and postpartum women, and obstetric healthcare providers (HCPs’). Interviews with pregnant and postpartum women with overweight or obesity prior to pregnancy indicated deference to providers regarding GWG. However, many women indicated suboptimal receipt of GWG information, disagreement with the GWG guidelines, and disapproval of the restrictive weight ranges for women in higher BMI categories. Additionally, parity emerged as a salient topic for women, especially as related to weight retention between pregnancies. HCPs’ survey data suggest systemic barriers to patient-provider communication (e.g. time, training) could serve as targets for future interventions. In sum, maternal overweight and obesity, excessive GWG, and patient-provider interaction are crucial topics to address to improve maternal and fetal outcomes, and decrease healthcare costs.

ABSTRACT Gestational weight gain (GWG) is a normal and expected component of a healthy pregnancy; however, gaining too much or too little weight poses significant risks to maternal and fetal health including fetal under - or overgrowth, downstream obesity, and cardio-metabolic disease. Children born to mothers who exceed the Institute of Medicine GWG recommendations are significantly more likely to have higher birth weights, classify as large for gestational age (LGA) and develop overweight/obesity in infancy, childhood, and adulthood. Furthermore, rapid increases in infant growth weight trajectory, defined by weight-for-length (WFL), as early as six months of life are also associated with obesity in childhood. Energy expenditure and energy intake are known contributors to weight management, have been identified as predictors of excess GWG (eGWG) and are mediators of metabolic dysregulation affecting maternal-fetal health, perhaps independently of eGWG. The ACOG and the Society of Obstetricians and Gynecologists of Canada/Canadian Society for Exercise Physiology (SOGC/CSEP) currently endorse exercising for 30-minute sessions four times a week during the prenatal period. However, the guidelines are currently being reviewed to update recommendations based on more recent literature. A two-arm, parallel group randomized controlled trial (RCT; the Maternal Obesity Management (MOM) trial), was established to mediate GWG and prevent downstream child obesity. Adult pregnant women mean age 32.6 ± 4.4 years, with pre-gravid BMI > 18.5 kg/m2, between 12 and 20 weeks gestation were randomized into one of two groups: lifestyle intervention (n = 41) who received a structured physical activity (PA) and nutrition program in addition to the MOM trial healthy pregnancy handbook, or a standard clinical care control group (n = 35). The intervention took place throughout pregnancy (~ 6 mos.), with postpartum follow-up assessments on mother and child. GWG and PA were objectively measured at three-time points in pregnancy (prior to intervention, second trimester 26-28 weeks, third trimester 36-40 weeks). Offspring WFL was directly measured at 3 and 6 mos postpartum. We hypothesized that women who participated in the lifestyle intervention including regular PA with a structured prenatal exercise class in combination with a nutrition intervention would be more likely to have offspring follow a healthy growth trajectory as measured by offspring WFL z-score between 3 to 6 months of age We assessed and compared PA which was directly measured at three time points throughout the study (baseline, second trimester between 26-28 weeks, and third trimester between 36-40 weeks gestation) using accelerometers and supported by PA recall for activities not captured by the accelerometer. Compliance to exercise classes was recorded by the instructor. Total GWG was calculated in kilograms, by subtracting weight measured at the first prenatal visit from the last visit as part of the study or last prenatal visit, before birth, to capture the full extent of GWG throughout pregnancy. GWG was also evaluated categorically based on being under, meeting, or exceeding the IOM GWG guidelines. Offspring neonatal birth weight was measured in grams as an absolute value and was obtained from antenatal obstetrical records. Infant birth weight was also evaluated categorically as small for gestational age (SGA), average for gestational age (AGA) or large for gestational age (LGA). Infant body length was collected using a tape measure; two measurements were taken to the nearest 0.5 cm and the mean value was taken as true. The tape measure method has been validated against a measuring board which found no statistically significant difference between the two methods. There were no significant differences in GWG between intervention group and control group (mean difference = 0.3 kg, 95% CI, -2.5 – 3.1, p = 0.838). There were also no significant differences in moderate to vigorous physical activity (MVPA) during the second trimester (Z = -0.3408, p = 0.733) and the third trimester of pregnancy (Z = -0.0121, p = 0.9904). However, an increase in light PA from the first study visit in early pregnancy to the second study visit at the end of the second trimester was significantly associated with decreased final GWG in the intervention group, but not in the control group (p = 0.014). Furthermore, a Wilcoxon Rank-Sum Test indicated that the change in weight-for-length z-score from 3 months to 6 months was significantly lower in children born to mothers in the intervention group compared to the children in the control group Ws = 481.00, z = 2.67, p = 0.007. Although GWG did not change, an improved early growth trajectory for offspring born to women engaged in the intervention was observed supporting that early exposures to PA, even light PA, may play a role in downstream child growth and development. Future research should further evaluate optimal tools and counselling techniques that help women make the best possible nutrition and PA choices throughout pregnancy in the best interest of maternal and child health.