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      Gestational Weight Gain and Body Mass Index in Children: Results from Three German Cohort Studies

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          Abstract

          Introduction

          Previous studies suggested potential priming effects of gestational weight gain (GWG) on offspring’s body composition in later life. However, consistency of these effects in normal weight, overweight and obese mothers is less clear.

          Methods

          We combined the individual data of three German cohorts and assessed associations of total and excessive GWG (as defined by criteria of the Institute of Medicine) with offspring’s mean body mass index (BMI) standard deviation scores (SDS) and overweight at the age of 5–6 years (total: n = 6,254). Quantile regression was used to examine potentially different effects on different parts of the BMI SDS distribution. All models were adjusted for birth weight, maternal age and maternal smoking during pregnancy and stratified by maternal pre-pregnancy weight status.

          Results

          In adjusted models, positive associations of total and excessive GWG with mean BMI SDS and overweight were observed only in children of non- overweight mothers. For example, excessive GWG was associated with a mean increase of 0.08 (95% CI: 0.01, 0.15) units of BMI SDS (0.13 (0.02, 0.24) kg/m 2 of ‘real’ BMI) in children of normal-weight mothers. The effects of total and excessive GWG on BMI SDS increased for higher- BMI children of normal-weight mothers.

          Discussion

          Increased GWG is likely to be associated with overweight in offspring of non-overweight mothers.

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          Most cited references39

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          Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy.

          Although both maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) may affect birth weight, their separate and joint associations with complications of pregnancy and delivery and with postpartum weight retention are unclear. We aimed to investigate the combined associations of prepregnancy BMI and GWG with pregnancy outcomes and to evaluate the trade-offs between mother and infant for different weight gains. Data for 60892 term pregnancies in the Danish National Birth Cohort were linked to birth and hospital discharge registers. Self-reported total GWG was categorized as low ( or=20 kg). Adjusted associations of prepregnancy BMI and GWG with outcomes of interest were estimated by logistic regression analyses. High and very high GWG added to the associations of high prepregnancy BMI with cesarean delivery and were strongly associated with high postpartum weight retention. Moreover, greater weight gains and high maternal BMI decreased the risk of growth restriction and increased the risk of the infant's being born large-for-gestational-age or with a low Apgar score. Generally, low GWG was advantageous for the mother, but it increased the risk of having a small baby, particularly for underweight women. Heavier women may benefit from avoiding high and very high GWG, which brings only a slight increase in the risk of growth restriction for the infant. High weight gain in underweight women does not appear to have deleterious consequences for them or their infants, but they may want to avoid low GWG to prevent having a small baby.
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            Gestational weight gain and long-term postpartum weight retention: a meta-analysis.

            Gestational weight gain (GWG) is known to be a potential risk factor for short-term postpartum weight retention (PPWR) and thus for overweight in women. Does GWG also determine the long-term risk of overweight in women? We aimed to study the short- and long-term effects of GWG in accordance with the Institute of Medicine (IOM) recommendations on postpartum weight retention. We systematically reviewed 5 databases and bibliographies of various publications supplemented by hand search for relevant articles published in English or German and performed meta-analyses to quantify the effect estimate of PPWR by using a random-effects model. We split the data into 4 categories of follow-up: <0.5, 0.5-1, ∼3, and ≥15 y. Of 1770 search hits, 9 observational studies remained suitable for the analysis. PPWR increased after longer time spans after delivery irrespective of whether GWG had been below, within, or above the guidelines. Compared with women with GWG within the recommendations, those with a GWG above the recommendations retained an additional 3.06 kg (95% CI: 1.50, 4.63 kg) after 3 y and 4.72 kg (95% CI: 2.94, 6.50 kg) on average after ≥15 y postpartum. Inadequate GWG was associated with less PPWR (-2.99 kg; 95% CI: -3.72, -2.27 kg) <6 mo after pregnancy. This association faded over time and became nonsignificant (-1.41 kg; 95% CI: -3.03, 0.21 kg) after ≥15 y. The results remained stable in sensitivity analyses that accounted for changes in IOM criteria over time and potential effect modification by low social class. A funnel plot did not suggest publication bias. GWG in accordance with the IOM recommendations is associated with long-term effects on PPWR.
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              Nutrition during pregnancy.

              Nutritional concerns in pregnancy are gaining increasing importance as problems with obesity, poor nutrition, and improper weight gain during pregnancy have been shown to result in morbidity for mother and infant during the pregnancy. More recent studies show that the impact of poor nutrition in pregnancy extends for decades to follow for the mother and the offspring. Clearly, prevention of problems is the best approach. This article discusses aspects of, and controversies concerning, prenatal weight gain and specific nutrients, and special patient groups who may benefit from intervention by a registered dietitian.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2012
                22 March 2012
                : 7
                : 3
                : e33205
                Affiliations
                [1 ]Institute of Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians University of Munich, Munich, Germany
                [2 ]Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
                [3 ]Institute of Human Nutrition and Food Science, Christian-Albrechts University, Kiel, Germany
                [4 ]University Hospital Ulm, Ulm, Germany
                [5 ]German Cancer Research Center, Heidelberg, Germany
                [6 ]Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
                Indiana University, United States of America
                Author notes

                Conceived and designed the experiments: AB PR JH MJM SPD MW MW HB DR. Analyzed the data: AB IN. Wrote the paper: AB IN RvK.

                Article
                PONE-D-11-10958
                10.1371/journal.pone.0033205
                3310864
                22457745
                831ea195-c67b-4b10-b1e0-b5077f450943
                Beyerlein et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                : 18 June 2011
                : 11 February 2012
                Page count
                Pages: 6
                Categories
                Research Article
                Biology
                Population Biology
                Medicine
                Clinical Research Design
                Epidemiology
                Nutrition
                Obstetrics and Gynecology
                Pediatrics
                Public Health
                Women's Health

                Uncategorized
                Uncategorized

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