A Behavioral Intervention to Reduce Excessive Gestational Weight Gain

Objectives Excessive gestational weight gain (GWG) is a key modifiable risk factor for negative maternal and child health. We examined the efficacy of a behavioral intervention in preventing excessive GWG. Methods 230 pregnant women (87.4 % Caucasian, mean age = 29.2 years; second parity) participated in the longitudinal Glowing study (clinicaltrial.gov #NCT01131117), which included six intervention sessions focused on GWG. To determine the efficacy of the intervention in comparison to usual care, participants were compared to a matched contemporary cohort group from the Arkansas Pregnancy Risk Assessment Monitoring Survey (PRAMS). Results Participants attended 98 % of intervention sessions. Mean GWG for the Glowing participants was 12.7 ± 2.7 kg for normal weight women, 12.4 ± 4.9 kg for overweight women, and 9.0 ± 4.2 kg for class 1 obese women. Mean GWG was significantly lower for normal weight and class 1 obese Glowing participants compared to the PRAMS respondents. Similarly, among those who gained excessively, normal weight and class 1 obese Glowing participants had a significantly smaller mean weight gain above the guidelines in comparison to PRAMS participants. There was no significant difference in the overall proportion of the Glowing participants and the proportion of matched PRAMS respondents who gained in excess of the Institute of Medicine GWG guidelines. Conclusions for Practice This behavioral intervention was well-accepted and attenuated GWG among normal weight and class 1 obese women, compared to matched participants. Nevertheless, a more intensive intervention may be necessary to help women achieve GWG within the Institute of Medicine’s guidelines.     

Comparative Effectiveness of Group and Individual Prenatal Care on Gestational Weight Gain

This study examined differences in gestational weight gain for women in CenteringPregnancy (CP) group prenatal care versus individually delivered prenatal care. We conducted a retrospective chart review and used propensity scores to form a matched sample of 393 women (76 % African-American, 13 % Latina, 11 % White; average age 22 years) receiving prenatal care at a community health center in the South. Women were matched on a wide range of demographic and medical background characteristics. Compared to the matched group of women receiving standard individual prenatal care, CP participants were less likely to have excessive gestational weight gain, regardless of their pre-pregnancy weight (b = ?.99, 95 % CI [?1.92, ?.06], RRR = .37). CP reduced the risk of excessive weight gain during pregnancy to 54 % of what it would have been in the standard model of prenatal care (NNT = 5). The beneficial effect of CP was largest for women who were overweight or obese prior to their pregnancy. Effects did not vary by gestational age at delivery. Post-hoc analyses provided no evidence of adverse effects on newborn birth weight outcomes. Group prenatal care had statistically and clinically significant beneficial effects on reducing excessive gestational weight gain relative to traditional individual prenatal care.     

Women Gain Weight 1 Year After Smoking Cessation While Dietary Intake Temporarily Increases

Objective To examine the relationship of dietary change to weight change in women who quit smoking and remained abstinent for 1 year.Methods For 1 year, 582 women participating in smoking cessation classes were studied. Weight, diet, and physical activity were measured at baseline and at 1, 6, and 12 months after smoking cessation. Multivariate regression models were used to predict 1-year weight change for the 139 women who remained abstinent.Results Women gained, on average, 9.9 lb over a 1-year period while increasing their intake of energy for 1 and 6 months but returning to baseline levels by 1 year. Sucrose, total carbohydrate, and fat intake increased significantly for the first month; fat and total carbohydrate intake remained at an increased level for 6 months. In unadjusted analyses, older women and those who smoked more cigarettes gained more weight than younger women and lighter smokers; lighter and heavier women gained more weight than women of intermediate weight. In adjusted analyses, age remained a significant factor and number of cigarettes remained of borderline significance. Change in energy intake was predictive of weight change only in women with the highest energy intake at baseline.Applications Dietitians should acknowledge that most women who quit smoking gain weight in the short term. Although many women increase their energy intake, change in energy level is only one factor in weight change. Over the long term, women with high baseline intakes appear to be able to affect their weight change by reducing their energy intake. J Am Diet Assoc. 1996; 96:1150-1155.     

The Impact of Quitting Smoking on Weight Among Women Prisoners Participating in a Smoking Cessation Intervention

Objectives. We examined the impact of smoking cessation on weight change in a population of women prisoners.Methods. Women prisoners (n = 360) enrolled in a smoking cessation intervention; 250 received a 10-week group intervention plus transdermal nicotine replacement.Results. Women who quit smoking had significant weight gain at 3- and 6-month follow-ups, with a net difference of 10 pounds between smokers and abstainers at 6 months. By the 12-month follow-up, weight gain decreased among abstainers.Conclusions. We are the first, to our knowledge, to demonstrate weight gain associated with smoking cessation among women prisoners. Smoking cessation interventions that address postcessation weight gain as a preventative measure may be beneficial in improving health and reducing the high prevalence of smoking in prisoner populations.Smoking and obesity are the 2 major causes of mortality and morbidity in the United States.^1,2 Although smoking is the leading preventable cause of death, resulting in approximately 440 000 deaths each year,³ obesity is a growing epidemic and is the second leading cause of preventable death, resulting in more than 300 000 deaths annually.^4,5 Whereas smoking rates have declined from their peak in the 1960s, obesity rates have been steadily climbing each year, and obesity is expected to soon eclipse smoking as the most preventable cause of mortality in the United States.¹The relationship between smoking and weight is complex, and the mechanisms by which smoking influences weight are not fully understood. Smoking affects weight by increasing metabolic rate and decreasing caloric absorption, which is thought to help suppress appetite.⁶ Sympathoadrenal activation by nicotine is thought to be primarily responsible for the metabolic effect of smoking.⁷ Smoking is also associated with increased energy expenditure.⁸ Smoking a single cigarette also decreases caloric consumption by 3% within 20 minutes.⁹Compared with light smokers and nonsmokers, heavy smokers tend to have greater body weight, which likely reflects a clustering of risk behaviors (i.e., little physical activity and poor diet) and increased insulin resistance and accumulation of abdominal fat.^6,10,11 Overall, smokers tend to be less physically active than nonsmokers, which may confound explanations of weight differences between smokers and nonsmokers.¹²Most studies on weight and smoking have reported postcessation weight gain. Smoking cessation has been associated with approximately 10 pounds of weight gain after 1 year of abstinence,¹³ suggesting that health benefits from smoking cessation may be mitigated to some degree by increased health risks associated with weight gain.¹⁴ To prevent or reduce weight gain, those administering cessation programs are recommended to integrate follow-up support for weight control, provide regular body weight measurement, provide recommendations for dietary change, and encourage increased physical activity.¹⁴ Despite concerns about weight, few studies have systematically investigated weight gain following smoking cessation, particularly with underserved populations such as prisoners.Correctional populations especially are vulnerable to the negative health consequences of smoking. Smoking rates are 3 to 4 times higher among correctional populations than among the general population, and smoking is normative within the correctional environment.^15–17 Smoking prevalence is 70% to 80% among male and female prisoners,^15–20 while almost half (46%) of adolescents in juvenile justice are daily smokers.²¹ This compared to about 21% of adults in the general population who are current smokers.²² However, in the research literature, the emphasis on smoking prevalence, prevention, cessation, and policies is much greater among other populations than it is among criminal justice populations—despite the human, health, and economic costs that occur in prison and in the community.^20,23In addition to the larger prevalence of smoking in prisons, there is less access to interventions for smoking cessation in correctional facilities. Lack of resources amplifies the negative health risks associated with smoking, such as heart, circulatory, and respiratory problems. Over the past 2 decades, correctional facilities in the United States have implemented tobacco-control policies ranging from restrictions on indoor smoking to complete tobacco bans.²⁴ Tobacco restrictions and bans have not succeeded in suppressing smoking, and reduced access to programs and materials that might increase long-term smoking cessation have paralleled them.^16,17,24,25We recently conducted a randomized controlled trial of smoking cessation with women prisoners and found 7-day point prevalence cessation rates comparable to those seen in community smoking cessation interventions.¹⁵ The intervention combined nicotine replacement with a 10-week group therapy intervention.²⁶ The community-tested intervention was modified for the prison environment and included a discussion of weight gain and weekly monitoring of weight during the intervention and follow-up assessments.¹⁵ Point prevalence quit rates for intervention participants were 18% at end of treatment, 17% at 3-month follow-up, 14% at 6-month follow-up, and 12% at 12-month follow-up, compared with less than 1% at these same time points for control participants.¹⁵ We examined differences in weight change over time for (1) women in the intervention condition compared with women in the control condition and (2) women in the intervention condition who quit smoking compared with those who continued to smoke. To our knowledge, ours is the first study to conduct such a trial among women prisoners.     

Gestational Weight Gain Among Hispanic Women

To describe gestational weight gain among Hispanic women and to examine psychological, social, and cultural contexts affecting weight gain. A total of 282 Hispanic women were surveyed post-partum before leaving the hospital. Women were queried about their prepregnancy weight and weight gained during pregnancy. Adequacy of gestational weight gain was based on guidelines set by the Institute of Medicine in 2009. Independent risk factors for excessive or insufficient weight gain were examined by logistic regression. Most women were unmarried (59 %), with a mean age of 28.4 ± 6.6 years and an average weight gain of 27.9 ± 13.3 lbs. Approximately 45 % of women had gained too much, 32 % too little, and only 24 % had an adequate amount of weight gain. The mean birth weight was 7.3, 7.9, and 6.8 lbs among the adequate, excessive, and insufficient weight gain groups. Among women who exercised before pregnancy, two-thirds continued to do so during pregnancy; the mean gestational weight gain of those who continued was lower than those who stopped (26.8 vs. 31.4 lbs, p = 0.04). Independent risk factors for excessive weight gain were being unmarried, U.S. born, higher prepregnancy body mass index, and having indifferent or negative views about weight gain. Independent risk factors for insufficient weight gain were low levels of support and late initiation of prenatal care. Depression, stress, and a woman’s or her partner’s happiness regarding pregnancy were unrelated to weight gain. The results of this study can be used by prenatal programs to identify Hispanic women at risk for excessive or insufficient gestational weight gain.     

The Feasibility and Efficacy of a Behavioral Intervention to Promote Appropriate Gestational Weight Gain

Maternal and Child Health Journal - Nearly half of all women gain above gestational weight gain (GWG) recommendations. This study assessed the feasibility and efficacy of a pilot behavioral...     

Control Systems Engineering for Optimizing a Prenatal Weight Gain Intervention to Regulate Infant Birth Weight

Objectives. We used dynamical systems modeling to describe how a prenatal behavioral intervention that adapts to the needs of each pregnant woman may help manage gestational weight gain and alter the obesogenic intrauterine environment to regulate infant birth weight.Methods. This approach relies on integrating mechanistic energy balance, theory of planned behavior, and self-regulation models to describe how internal processes can be impacted by intervention dosages, and reinforce positive outcomes (e.g., healthy eating and physical activity) to moderate gestational weight gain and affect birth weight.Results. A simulated hypothetical case study from MATLAB with Simulink showed how, in response to our adaptive intervention, self-regulation helps adjust perceived behavioral control. This, in turn, changes the woman’s intention and behavior with respect to healthy eating and physical activity during pregnancy, affecting gestational weight gain and infant birth weight.Conclusions. This article demonstrates the potential for real-world applications of an adaptive intervention to manage gestational weight gain and moderate infant birth weight. This model could be expanded to examine the long-term sustainable impacts of an intervention that varies according to the participant’s needs on maternal postpartum weight retention and child postnatal eating behavior.Public health agencies1,2 advocate preventive interventions among pregnant women, particularly overweight and obese pregnant women (OW/OBPW), to assist women in meeting the Institute of Medicine (IOM) gestational weight gain (GWG) guidelines in an effort to make a long-term impact on the obesity epidemic. Despite this recommendation, nearly 60% of OW/OBPW exceed GWG guidelines,2 which has been shown to independently predict the onset of obesity,2–4 type 2 diabetes,5,6 and cardiovascular diseases7 among women and their offspring. Thus, the prenatal period may be an opportune time to intervene and break the intergenerational cycle of obesity by reducing fetus exposure to an “obesogenic” intrauterine environment8,9 through promoting maternal energy balance (EB). Although the underlying mechanism for how maternal prenatal obesity “programs” fetal development, related metabolic disorders,10,11 and later obesity during childhood and adulthood12–14 remains unclear, it is common to use high birth weight as a surrogate marker for intrauterine growth and as an indicator of the conditions experienced in utero.15Despite focused prevention efforts, behavioral intervention studies show little to no evidence for preventing excessive GWG among OW/OBPW.16,17 Even more importantly, few, if any, existing GWG interventions have had an impact on rates of high infant birth weight. Thus, there is a critical need to develop effective and efficient interventions to prevent excessive maternal GWG and high infant birth weight. One potential reason for why GWG interventions have had some success among normal weight but not overweight women is that OW/OBPW may have unique barriers that require a higher intervention (i.e., more intensive) dosage to managing GWG than the single dose selected in interventions that rely on a “one size fits all” approach (i.e., fixed, time-invariant intervention). Another reason is that many factors influence GWG including behavioral (EB: energy intake [EI] and physical activity [PA]), psychological (attitude, perceived control, intention), sociodemographic (age, parity), and physical (body mass index [BMI], defined as weight in kilograms divided by the square of height in meters [kg/m²]; fat mass),2 and thus, interventions are needed that consider how changes in these factors influence changes in GWG.A time-varying (i.e., “just-in-time”), individually tailored intervention that provides each woman, especially OW/OBPW, with the support needed to manage GWG and adapts to her unique needs over time across the pregnancy may be a promising approach to manage GWG and prevent high birth weight. This approach enhances potency and conserves resources (i.e., cost savings associated with delivering only necessary dosages to participants), and thus, it has the potential to increase compliance and improve effectiveness of treatment compared with fixed interventions that may or may not work for individuals depending on their needs.18 We have developed the conceptual framework for such an intervention. Furthermore, we have used control systems engineering principles (in general) and dynamical modeling approaches (in particular) to inform our individually tailored, time-varying GWG intervention that uses decision algorithms (i.e., controllers that will assign the optimized intervention dosage) to increase intervention effectiveness and improve participant outcomes.19,20 However, little is known about how our intervention (or any existing GWG intervention) affects infant birth weight.The goal of this study was to build on our existing research to discuss how our prenatal intervention not only helps women to manage their gestational weight gain, but also might alter the obesogenic fetus environment to regulate infant birth weight. A simulated hypothetical case study will be presented illustrating the basic workings of this model and demonstrating proof of concept for how self-regulation and adaptive interventions with decision rules influence GWG during pregnancy and, in turn, has an impact on infant birth weight. Exploratory simulations of our adaptive GWG intervention21 will be generated from data based on an intergenerational fetal EB model22 and artificial parameters to examine the effects of creating a healthy maternal–fetus eating and PA environment on infant birth weight.     

Association of Prenatal Physical Activity and Gestational Weight Gain: Results from the First Baby Study

BackgroundIn response to increasing rates of excessive gestational weight gain (GWG) and evidence of postpartum weight retention and long-term overweight and obesity, the Institute of Medicine (IOM) revised their guidelines for GWG in 2009. Prenatal physical activity is recommended, although its role in preventing excessive GWG is unclear. We sought to understand the association between prenatal physical activity and GWG in a longitudinal cohort.MethodsDuring a baseline survey at 34 weeks, women (n = 3,006) reported their height, prepregnancy weight, and physical activity during pregnancy. GWG was self-reported at 1-month postpartum. Multivariable logistic regression adjusting for age, race/ethnicity, education, poverty status, marital status, gestational age at the time of delivery, and smoking was used to model the association between adequate physical activity during pregnancy and exceeding the IOM recommendations for GWG.FindingsOverweight women were most likely to exceed the IOM recommendations for GWG (78.7%), followed by obese women and normal weight women (65.0% and 42.4%, respectively). The majority of women participated in some physical activity during pregnancy, with 41.2% engaging in 60 to 149 minutes and 32.1% engaging in at least 150 minutes of physical activity per week. In adjusted analysis, meeting the physical activity guidelines was associated with a 29% (confidence interval, 0.57–0.88) lower odds of exceeding the IOM recommendations for GWG compared with inactive women.ConclusionsFindings of high rates of excessive GWG, especially among women with overweight and obesity, are concerning given the associated health burdens. The association of guideline-concordant physical activity with appropriate GWG suggests this is an important target for future interventions.     

Effectiveness of a Combined Prenatal and Postpartum Smoking Cessation Program

Women frequently quit smoking during pregnancy but then relapse postpartum. The BABY & ME—Tobacco Free program combines prenatal and postpartum smoking cessation counseling and biomarker feedback with monthly postpartum incentives. The settings included 22 sites (WIC offices and prenatal clinics) in upstate New York. A quasi-experimental design was used to evaluate this intervention, that included four face-to-face prenatal sessions with a counselor who did smoking cessation counseling, carbon monoxide testing and random saliva cotinine testing. For 1 year postpartum, mothers were biochemically tested every 3–4 weeks and, if negative, were issued a voucher for diapers. Three implementation models were studied: multi-tasking counselors at fixed sites (Models 1 and 2) versus itinerant smoking cessation specialists (Model 3). Outcomes included biochemically validated abstinence rates during pregnancy and postpartum. Logistic regression was used to identify predictors of postpartum abstinence and program dropout. Proportional hazards regression was used to compare implementation models. Of the 777 pregnant women who enrolled in the program, 588 were eligible for the postpartum program. The intention to treat pregnancy quit rate was 60%. Postpartum, Model 3 showed consistently better quit outcomes than the other models. Predictors of abstinence at 6 months postpartum are: older age (OR = 1.07, 95% C.I. 1.02–1.12), lower baseline carbon monoxide level (OR = 0.69, 95% C.I. 0.49–0.97), Model 3 (OR = 4.60, 95% C.I. 2.80–7.57) and attending more prenatal sessions (OR = 3.52; 95% C.I. 2.19–5.65). The BABY & ME—Tobacco Free program is an effective smoking cessation program for pregnant and parenting women.     

Neighborhood Socioeconomic Disadvantage and Gestational Weight Gain and Loss

We explored the relationship between neighborhood socioeconomic disadvantage (NSED) and gestational weight gain and loss and if the association differed by race. A census tract level NSED index (categorized as low, mid-low, mid-high, and high) was generated from 12 measures from the 2000 US Census data. Gestational weight gain and other individual-level characteristics were derived from vital birth records for Allegheny County, PA for 2003–2010 (n = 55,608). Crude and adjusted relative risks were estimated using modified multilevel Poisson regression models to estimate the association between NSED and excessive and inadequate gestational weight gain (GWG) and weight loss (versus adequate GWG). Black women lived in neighborhoods that were more likely to be socioeconomically disadvantaged compared to white women. Almost 55 % of women gained an excessive amount of weight during pregnancy, and 2 % lost weight during pregnancy. Black women were more likely than white women to have inadequate weight gain or weight loss. Mid-high (aRR = 1.3, 95 % CI 1.2, 1.3) and high (aRR = 1.5, 95 % CI 1.5, 1.6) NSED compared to low NSED was associated with inadequate weight gain while NSED was not associated with excessive weight gain. Among black women, high versus low NSED was associated with weight loss during pregnancy (RR = 1.6, 95 % CI 1.1, 2.5). Among white women, each level of NSED compared to low NSED was associated with weight loss during pregnancy. This study demonstrates how neighborhood socioeconomic characteristics can contribute to our understanding of inadequate weight gain and weight loss during pregnancy, having implications for future research and interventions designed to advance pregnancy outcomes.     

Pre-pregnancy Body Size Dissatisfaction and Excessive Gestational Weight Gain

Body size dissatisfaction has been documented as a risk factor for obesity, but little is known about the effect of body size dissatisfaction on excessive gestational weight gain. The objective of the study was to determine the association of pre-pregnancy body size dissatisfaction with excessive gestational weight gain in Iranian pregnant women. This case–control study compared pre-gravid body satisfaction status in 182 women with excessive gestational weight gain and 180 women who gained weight within the guidelines of the Institute of Medicine. All the participants of the study were 35–41 weeks gestational age and received prenatal care in Shahid Akbarabadi Hospital. The women were asked to think back to their pre-pregnant state and report their body size satisfaction status measured by the Body Image Assessment for Obesity (BIA-O). According to this measurement, the women were divided into three categories: dissatisfied women with a thinner body size preference, dissatisfied women with a heavier body size preference and satisfied women. Among women with excessive gestational weight gain, 56.6 % preferred a thinner body size, while 53.9 % of those with adequate gestational weight gain were satisfied with their pre-gravid body sizes. After adjusting for cofounders, those with a thinner body size preference were more likely to gain weight excessively during pregnancy when compared to satisfied women (OR: 2.17, 95 % CI: 1.17–4.02). Our result showed that thinner body size preference was associated with excessive gestational weight gain. Further studies are needed to investigate whether changes in women’s feelings about their body sizes will decrease the proportion of women with excessive gestational weight gain.     

Higher Pre-pregnancy BMI and Excessive Gestational Weight Gain are Risk Factors for Rapid Weight Gain in Infants

Objective To describe the effects of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on infant anthropometrics at birth and 3 months and infant growth rates between birth and 3 months. Methods Body weight prior to and during pregnancy and infant weight and length at birth and 3 months were collected from 600 mother–infant pairs. Adherence to GWG was based on IOM recommendations. Age and sex specific z-scores were calculated for infant weight and length at birth and 3 months. Rapid postnatal growth was defined as a difference of >0.67 in weight-for-age z-score between birth and 3 months. Relationships between maternal and infant characteristics were analysed using multilinear regression. Results Most women (65%) had a normal pre-pregnancy BMI and 57% gained above GWG recommendations. Infants were 39.3?±?1.2 weeks and 3431?±?447.9 g at birth. At 3 months postpartum 60% were exclusively breast fed while 38% received breast milk and formula. Having a pre-pregnancy BMI >25 kg/m² was associated with higher z-scores for birth weight and weight-for-age at 3 months. Gaining above recommendations was associated with higher z-scores for birth weight, weight-for-age and BMI. Infants who experienced rapid postnatal growth had higher odds of being born to women who gained above recommendations. Conclusion for Practice Excessive GWG is associated with higher birth weight and rapid weight gain in infants. Interventions that optimize GWG should explore effects on total and rates of early infant growth.     

A Qualitative Study of Gestational Weight Gain Counseling and Tracking

Excessive gestational weight gain (GWG) predicts adverse pregnancy outcomes and later obesity risk for both mother and child. Women who receive GWG advice from their obstetric clinicians are more likely to gain the recommended amount, but many clinicians do not counsel their patients on GWG, pointing to the need for new strategies. Electronic medical records (EMRs) are a useful tool for tracking weight and supporting guideline-concordant care, but their use for care related to GWG has not been evaluated. We performed in-depth interviews with 16 obstetric clinicians from a multi-site group practice in Massachusetts that uses an EMR. We recorded, transcribed, coded, and analyzed the interviews using immersion-crystallization. Many respondents believed that GWG had “a lot” of influence on pregnancy and child health outcomes but that their patients did not consider it important. Most indicated that excessive GWG was a big or moderate problem in their practice, and that inadequate GWG was rarely a problem. All used an EMR feature that calculates total GWG at each visit. Many were enthusiastic about additional EMR-based supports, such as a reference for recommended GWG for each patient based on pre-pregnancy body mass index, a “growth chart” to plot actual and recommended GWG, and an alert to identify out-of-range gains, features which many felt would remind them to counsel patients about excessive weight gain. Additional decision support tools within EMRs would be well received by many clinicians and may help improve the frequency and accuracy of GWG tracking and counseling.     

Smoking Cessation

Smoking accounts for significant morbidity and mortality and has major economic consequences for healthcare delivery throughout the world. Government policy such as increasing taxes and restricting advertising go some way to reduce smoking, but the social and economic factors that affect target populations will impact on the success of any strategy.Public health interventions can also contribute to increasing cessation rates. The most successful interventions appear to be those characterised by personalised advice and assistance, repeated in different forms over the longest feasible period of time. Pharmacological aids, which are important components of a cessation programme, include nicotine replacement therapy in the form of chewing gum, patches, nasal spray, oral inhaler or sublingual tablets; bupropion (amfebutamone) has been approved for use in some countries. As the community pharmacy is the major point of supply of such products, the pharmacist is in a key position to encourage and support clients who wish to stop smoking.A number of studies have examined the role of the community pharmacist in assisting smokers through the so-called ‘cycle of change’. These studies have utilised a model that offers individualised advice through a motivational technique to encourage a change in behaviour; nicotine replacement therapy is optional. Follow-up is an essential part of these programmes to monitor progress and to provide additional support. Evaluations of these pharmacy-based initiatives have confirmed the importance of a multifaceted approach in achieving success in smoking cessation, i.e. behaviour modification, nicotine replacement therapy and client support.     

Cohort Study of Maternal Gestational Weight Gain,Gestational Diabetes,and Childhood Asthma

Data on the association of maternal gestational weight gain (GWG) and gestational diabetes mellitus (GDM) with childhood asthma are limited and inconsistent. We aimed to investigate these associations in a U.S. pre-birth cohort. Analyses included 16,351 mother–child pairs enrolled in the Massachusetts General Hospital Maternal-Child Cohort (1998–2010). Data were obtained by linking electronic health records for prenatal visits/delivery to determine BMI, GWG, and GDM (National Diabetes Data Group criteria) and to determine asthma incidence and allergies (atopic dermatitis or allergic rhinitis) for children. The associations of prenatal exposures with asthma were evaluated using logistic regression adjusted for maternal characteristics. A total of 2306 children (14%) developed asthma by age 5 years. Overall, no association was found between GWG and asthma. GDM was positively associated with offspring asthma (OR 1.46, 95% CI 1.14–1.88). Associations between GDM and asthma were observed only among mothers with early pregnancy BMI between 20 and 24.9 kg/m² (OR 2.31, CI 1.46–3.65, p-interaction 0.02). We report novel findings on the impact of prenatal exposures on asthma, including increased risk among mothers with GDM, particularly those with a normal BMI. These findings support the strengthening of interventions targeted toward a healthier pregnancy, which may also be helpful for childhood asthma prevention.