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      Reaching women with obesity to support weight loss before pregnancy: feasibility and qualitative assessment

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          Abstract

          Background:

          We sought to assess attitudes toward weight and barriers to recruitment of women with obesity for a potential preconception weight-loss/lifestyle modification intervention.

          Methods:

          We performed a qualitative study involving women of reproductive age (18–45) with obesity (body mass index ⩾30 kg/m 2) who were considering a pregnancy in the next 2 years. We evaluated four methods of recruitment. We used previously validated survey questions to evaluate risk perceptions. In a subset, we used semistructured interviews for topics that required more in-depth information: domains included attitudes toward weight-related issues, intentions, and barriers to engagement in a structured weight-loss program. We performed qualitative analyses of interview transcripts using immersion crystallization.

          Results:

          We recruited the majority (80/82, 98%) of women using e-recruitment strategies. Eighty-one women filled out the survey and 39 completed an interview. Three-quarters of the women surveyed (60 of 81) reported attempts to lose weight in the past year and 77% (68/81) of survey respondents cited jobs and work schedules as a barrier to adopting healthy habits. More than 87% (34 of 39) of women interviewed reported willingness to participate in a structured weight-loss program prior to getting pregnant. Of these, 74% (25 of 34) stated they would consider delaying their attempts at a future pregnancy in order to participate in such a program.

          Conclusions:

          E-recruitment is a promising strategy for recruitment for preconception weight-loss and lifestyle modification program. Most women state a willingness to delay pregnancy attempts to participate in a weight-loss program.

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          Most cited references26

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          Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis.

          The objective of this study is to assess and quantify the risk for gestational diabetes mellitus (GDM) according to prepregnancy maternal body mass index (BMI). The design is a systematic review of observational studies published in the last 30 years. Four electronic databases were searched for publications (1977-2007). BMI was elected as the only measure of obesity, and all diagnostic criteria for GDM were accepted. Studies with selective screening for GDM were excluded. There were no language restrictions. The methodological quality of primary studies was assessed. Some 1745 citations were screened, and 70 studies (two unpublished) involving 671 945 women were included (59 cohorts and 11 case-controls). Most studies were of high or medium quality. Compared with women with a normal BMI, the unadjusted pooled odds ratio (OR) of an underweight woman developing GDM was 0.75 (95% confidence interval [CI] 0.69 to 0.82). The OR for overweight, moderately obese and morbidly obese women were 1.97 (95% CI 1.77 to 2.19), 3.01 (95% CI 2.34 to 3.87) and 5.55 (95% CI 4.27 to 7.21) respectively. For every 1 kg m(-2) increase in BMI, the prevalence of GDM increased by 0.92% (95% CI 0.73 to 1.10). The risk of GDM is positively associated with prepregnancy BMI. This information is important when counselling women planning a pregnancy.
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            Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis.

            Evidence suggests that maternal obesity increases the risk of fetal death, stillbirth, and infant death; however, the optimal body mass index (BMI) for prevention is not known. To conduct a systematic review and meta-analysis of cohort studies of maternal BMI and risk of fetal death, stillbirth, and infant death. The PubMed and Embase databases were searched from inception to January 23, 2014. Cohort studies reporting adjusted relative risk (RR) estimates for fetal death, stillbirth, or infant death by at least 3 categories of maternal BMI were included. Data were extracted by 1 reviewer and checked by the remaining reviewers for accuracy. Summary RRs were estimated using a random-effects model. Fetal death, stillbirth, and neonatal, perinatal, and infant death. Thirty eight studies (44 publications) with more than 10,147 fetal deaths, more than 16,274 stillbirths, more than 4311 perinatal deaths, 11,294 neonatal deaths, and 4983 infant deaths were included. The summary RR per 5-unit increase in maternal BMI for fetal death was 1.21 (95% CI, 1.09-1.35; I2 = 77.6%; n = 7 studies); for stillbirth, 1.24 (95% CI, 1.18-1.30; I2 = 80%; n = 18 studies); for perinatal death, 1.16 (95% CI, 1.00-1.35; I2 = 93.7%; n = 11 studies); for neonatal death, 1.15 (95% CI, 1.07-1.23; I2 = 78.5%; n = 12 studies); and for infant death, 1.18 (95% CI, 1.09-1.28; I2 = 79%; n = 4 studies). The test for nonlinearity was significant in all analyses but was most pronounced for fetal death. For women with a BMI of 20 (reference standard for all outcomes), 25, and 30, absolute risks per 10,000 pregnancies for fetal death were 76, 82 (95% CI, 76-88), and 102 (95% CI, 93-112); for stillbirth, 40, 48 (95% CI, 46-51), and 59 (95% CI, 55-63); for perinatal death, 66, 73 (95% CI, 67-81), and 86 (95% CI, 76-98); for neonatal death, 20, 21 (95% CI, 19-23), and 24 (95% CI, 22-27); and for infant death, 33, 37 (95% CI, 34-39), and 43 (95% CI, 40-47), respectively. Even modest increases in maternal BMI were associated with increased risk of fetal death, stillbirth, and neonatal, perinatal, and infant death. Weight management guidelines for women who plan pregnancies should take these findings into consideration to reduce the burden of fetal death, stillbirth, and infant death.
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              Maternal body mass index and the risk of preeclampsia: a systematic overview.

              Maternal obesity, both in itself and as part of the insulin resistance syndrome, is an important risk factor for the development of preeclampsia. Accurately quantifying the relation between prepregnancy maternal body mass index and the risk of preeclampsia may better identify those at highest risk. We performed a systematic overview of the literature to determine the association between prepregnancy body mass index and the risk of preeclampsia. Two reviewers independently retrieved all relevant English language cohort studies through a systematic search of Medline and Embase between 1980 and June 2002. Study data were abstracted in a similar fashion. For each study, the risk ratio of preeclampsia was calculated by comparing the risk of preeclampsia among women with the highest body mass index with those with the lowest. We identified thirteen cohort studies, comprising nearly 1.4 million women. The risk of preeclampsia typically doubled with each 5-7 kg/m2 increase in prepregnancy body mass index. This relation persisted in studies that excluded women with chronic hypertension, diabetes mellitus or multiple gestations, or after adjustment for other confounders. Most observational studies demonstrate a consistently strong positive association between maternal prepregnancy body mass index and the risk of preeclampsia. Increasing obesity in developed countries is likely to increase the occurrence of preeclampsia. Consideration should be given to the potential benefits of prepregnancy weight reduction programs.
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                Author and article information

                Contributors
                Journal
                Ther Adv Reprod Health
                Ther Adv Reprod Health
                REH
                spreh
                Therapeutic Advances in Reproductive Health
                SAGE Publications (Sage UK: London, England )
                2633-4941
                13 May 2020
                Jan-Dec 2020
                : 14
                : 2633494120909106
                Affiliations
                [1-2633494120909106]Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, USA
                [2-2633494120909106]Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, USA
                [3-2633494120909106]Division of Maternal-Fetal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
                [4-2633494120909106]Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, USA
                [5-2633494120909106]Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
                [6-2633494120909106]Department of Population Medicine, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA 02215, USA
                [7-2633494120909106]Diabetes Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02214, USA
                Author notes
                Author information
                https://orcid.org/0000-0002-4248-1952
                Article
                10.1177_2633494120909106
                10.1177/2633494120909106
                7254592
                9e3c220c-ffa3-4c91-98ac-2107eb64438e
                © The Author(s) 2020

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 21 January 2020
                : 27 January 2020
                Categories
                Original Research
                Custom metadata
                January-December 2020
                ts1

                preconception care,obesity,weight loss,recruitment,feasibility

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