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Health in Preconception Pregnancy and Postpartum

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: closed (25 December 2019) | Viewed by 52298

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Special Issue Editors

Dr. Jacqueline Boyle

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Guest Editor

Associate Professor, Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
Interests: pregnancy; preconception; public health; health services; healthy lifestyle

Prof. Dr. Robert J. Norman

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Guest Editor

The Robinson Institute, University of Adelaide, Adelaide, SA 5005, Australia
Interests: polycystic ovary syndrome; ovarian physiology and reproductive endocrinology; assisted reproduction; gonadotrophin structure and function; cytokines & reproductive function
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Helena Teede

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Guest Editor

Monash Centre for Health Research and Implementation, Monash University, Melbourne, ‎VIC‎, Australia
Interests: PCOS; pregnancy; preconception; postpartum; gestational diabetes; menopause; public health; health services; healthy lifestyle; obesity prevention

Special Issue Information

Dear Colleagues,

Up to half of women globally are overweight at the start of pregnancy. Preconception, higher body mass index (BMI) independently increases complications, including gestational diabetes mellitus, preeclampsia, caesarean section, and large-for-gestational-age infants. Intergenerational epigenetic risks are considerable, with maternal weight at conception a key determinant of childhood obesity and those born to mothers with obesity, in turn, having twice the rate of obesity, higher insulin resistance and metabolic syndrome. In pregnancy, excessive gestational weight gain (GWG) above US Institute of Medicine recommendations occurs in over 50% of pregnancies in developed countries with every kilogram above IOM recommendations increasing adverse maternal and foetal outcomes by around 10%. Preventing weight gain and adequate nutrition and physical activity are key prior to pregnancy as is preventing excess GWG. This series will outline international collaborations to review evidence and guidelines, effective interventions in preconception, pregnancy and postpartum and explore frameworks for consumer engagement.

Dr. Jacqueline Boyle
Prof. Dr. Robert Norman
Prof Dr. Helena Teede
Guest Editors

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Keywords

preconception
pregnancy
postpazrtum
gestational weight gain
obesity
lifestyle
public health

Published Papers (13 papers)

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Research

14 pages, 274 KiB

Open AccessArticle

Preconception Health and Lifestyle Behaviours of Women Planning a Pregnancy: A Cross-Sectional Study

by Bonnie R. Chivers, Jacqueline A. Boyle, Adina Y. Lang, Helena J. Teede, Lisa J. Moran and Cheryce L. Harrison

J. Clin. Med. 2020, 9(6), 1701; https://doi.org/10.3390/jcm9061701 - 02 Jun 2020

Cited by 30 | Viewed by 4883

Abstract

Preconception care and lifestyle behaviours significantly influence health outcomes of women and future generations. A cross-sectional survey of Australian women in preconception, stratified by pregnancy planning stage (active planners (currently trying to conceive) vs. non-active planners (pregnancy planned within 1–5 years)), assessed health behaviours and their alignment to preconception care guidelines. Overall, 294 women with a mean (SD) age of 30.7 (4.3) years were recruited and 38.9% were overweight or obese. Approximately half of women (54.4%) reported weight gain within the previous 12 months, of which 69.5% gained ≥ 3kg. The vast majority of women (90.2%) were unaware of reproductive life plans, and 16.8% over the age of 25 had not undertaken cervical screening. Of active planners (n = 121), 47.1% had sought medical/health advice in preparation for pregnancy and 81.0% had commenced supplementation with folic acid, iodine or a preconception multivitamin. High-risk lifestyle behaviours including cigarette smoking (7.3%), consumption of alcohol (85.3%) and excessive alcohol consumption within three months (56.3%), were frequently reported in women who were actively trying to conceive. Results indicate that women who are actively planning a pregnancy require support to optimise health and lifestyle in preparation for pregnancy to improve alignment with current preconception care recommendations. Full article

(This article belongs to the Special Issue Health in Preconception Pregnancy and Postpartum)

17 pages, 2384 KiB

Open AccessArticle

Precision Diagnostics by Affinity-Mass Spectrometry: A Novel Approach for Fetal Growth Restriction Screening during Pregnancy

by Charles A. Okai, Manuela Russ, Manja Wölter, Kristin Andresen, Werner Rath, Michael O. Glocker and Ulrich Pecks

J. Clin. Med. 2020, 9(5), 1374; https://doi.org/10.3390/jcm9051374 - 07 May 2020

Cited by 5 | Viewed by 1908

Abstract

Fetal growth restriction (FGR) affects about 3% to 8% of pregnancies, leading to higher perinatal mortality and morbidity. Current strategies for detecting fetal growth impairment are based on ultrasound inspections. However, antenatal detection rates are insufficient and critical in countries with substandard care. To overcome difficulties with detection and to better discriminate between high risk FGR and low risk small for gestational age (SGA) fetuses, we investigated the suitability of risk assessment based on the analysis of a recently developed proteome profile derived from maternal serum in different study groups. Maternal serum, collected at around 31 weeks of gestation, was analyzed in 30 FGR, 15 SGA, and 30 control (CTRL) pregnant women who delivered between 31 and 40 weeks of gestation. From the 75 pregnant women of this study, 2 were excluded because of deficient raw data and 2 patients could not be grouped due to indeterminate results. Consistency between proteome profile and sonography results was obtained for 59 patients (26 true positive and 33 true negative). Of the proteome profiling 12 contrarious grouped individuals, 3 were false negative and 9 were false positive cases with respect to ultrasound data. Both true positive and false positive grouping transfer the respective patients to closer surveillance and thorough pregnancy management. Accuracy of the test is considered high with an area-under-curve value of 0.88 in receiver-operator-characteristics analysis. Proteome profiling by affinity-mass spectrometry during pregnancy provides a reliable method for risk assessment of impaired development in fetuses and consumes just minute volumes of maternal peripheral blood. In addition to clinical testing proteome profiling by affinity-mass spectrometry may improve risk assessment, referring pregnant women to specialists early, thereby improving perinatal outcomes. Full article

(This article belongs to the Special Issue Health in Preconception Pregnancy and Postpartum)

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13 pages, 507 KiB

Open AccessArticle

Health in Preconception, Pregnancy and Postpartum Global Alliance: International Network Pregnancy Priorities for the Prevention of Maternal Obesity and Related Pregnancy and Long-Term Complications

by Briony Hill, Helen Skouteris, Jacqueline A. Boyle, Cate Bailey, Ruth Walker, Shakila Thangaratinam, Hildrun Sundseth, Judith Stephenson, Eric Steegers, Leanne M. Redman, Cynthia Montanaro, Siew Lim, Laura Jorgensen, Brian Jack, Ana Luiza Vilela Borges, Heidi J. Bergmeier, Jo-Anna B. Baxter, Cheryce L. Harrison and Helena J. Teede

J. Clin. Med. 2020, 9(3), 822; https://doi.org/10.3390/jcm9030822 - 18 Mar 2020

Cited by 30 | Viewed by 5493

Abstract

In this article, we describe the process of establishing agreed international pregnancy research priorities to address the global issues of unhealthy lifestyles and rising maternal obesity. We focus specifically on the prevention of maternal obesity to improve related clinical pregnancy and long-term complications. A team of multidisciplinary, international experts in preconception and pregnancy health, including consumers, were invited to form the Health in Preconception, Pregnancy and Postpartum (HiPPP) Global Alliance. As an initial activity, a priority setting process was completed to generate pregnancy research priorities in this field. Research, practice and policy gaps were identified and enhanced through expert and consumer consultation, followed by a modified Delphi process and Nominal Group Technique, including an international workshop. Research priorities identified included optimising: (1) healthy diet and nutrition; (2) gestational weight management; (3) screening for and managing pregnancy complications and pre-existing conditions; (4) physical activity; (5) mental health; and (6) postpartum (including intrapartum) care. Given extensive past research in many of these areas, research priorities here recognised the need to advance pregnancy research towards pragmatic implementation research. This work has set the agenda for large-scale, collaborative, multidisciplinary, implementation research to address the major public health and clinical issue of maternal obesity prevention. Full article

(This article belongs to the Special Issue Health in Preconception Pregnancy and Postpartum)

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12 pages, 288 KiB

Open AccessArticle

Relationship between Maternal Body Mass Index and Obstetric and Perinatal Complications

by Ana Ballesta-Castillejos, Juan Gómez-Salgado, Julián Rodríguez-Almagro, Inmaculada Ortiz-Esquinas and Antonio Hernández-Martínez

J. Clin. Med. 2020, 9(3), 707; https://doi.org/10.3390/jcm9030707 - 05 Mar 2020

Cited by 12 | Viewed by 2652

Abstract

Over the past few decades, overweight and obesity have become a growing health problem of particular concern for women of reproductive age as obesity in pregnancy has been associated with increased risk of obstetric and neonatal complications. The objective of this study is to describe the incidence of obstetric and perinatal complications in relation to maternal body mass index (BMI) at the time prior to delivery within the Spanish Health System. For this purpose, a cross-sectional observational study was conducted aimed at women who have been mothers between 2013 and 2018 in Spain. Data were collected through an online survey of 42 items that was distributed through lactation associations and postpartum support groups. A total of 5871 women answered the survey, with a mean age of 33.9 years (SD = 4.26 years). In the data analysis, crude odds ratios (OR) and adjusted odds ratios (AOR) were calculated through a multivariate analysis. A linear relationship was observed between the highest BMI figures and the highest risk of cephalopelvic disproportion (AOR of 1.79 for obesity type III (95% CI: 1.06–3.02)), preeclampsia (AOR of 6.86 for obesity type III (3.01–15.40)), labor induction (AOR of 1.78 for obesity type III (95% CI: 1.16–2.74)), emergency C-section (AOR of 2.92 for obesity type III (95% CI: 1.68–5.08)), morbidity composite in childbirth (AOR of 3.64 for obesity type III (95% CI: 2.13–6.24)), and macrosomia (AOR of 6.06 for obesity type III (95% CI: 3.17–11.60)), as compared with women with normoweight. Women with a higher BMI are more likely to develop complications during childbirth and macrosomia. Full article

(This article belongs to the Special Issue Health in Preconception Pregnancy and Postpartum)

15 pages, 1699 KiB

Open AccessArticle

Increased Intra-Abdominal Pressure During Laparoscopic Pneumoperitoneum Enhances Albuminuria via Renal Venous Congestion, Illustrating Pathophysiological Aspects of High Output Preeclampsia

by Pauline Dreesen, Melanie K. Schoutteten, Nele Vande Velde, Iris Kaminski, Line Heylen, Bart De Moor, Manu L.N.G. Malbrain and Wilfried Gyselaers

J. Clin. Med. 2020, 9(2), 487; https://doi.org/10.3390/jcm9020487 - 11 Feb 2020

Cited by 7 | Viewed by 3157

Abstract

Intra-abdominal hypertension (IAH) causes severe organ dysfunction. Our aim is to evaluate the effect of increased intra-abdominal pressure (IAP) on renal function, hypothesizing that venous congestion may increase proteinuria and fluid retention without endothelial dysfunction. Three urine samples were collected from 32 non-pregnant women undergoing laparoscopic-assisted vaginal hysterectomy (LAVH) and from 10 controls placed in Trendelenburg position for 60 min. Urine sampling was done before (PRE), during or immediately after (PER), and two hours after (POST) the procedure. Urinary albumin, protein and creatinine concentrations were measured in each sample, and ratios were calculated and compared within and between groups. During LAVH, the albumin/creatinine ratio (ACR) increased and persisted POST-procedure, which was not observed in controls. A positive correlation existed between the LAVH duration and the relative change in both ACR and protein/creatinine ratio (PCR) PER- and POST-procedure. Iatrogenic IAH increases urinary ACR and PCR in non-pregnant women via a process of venous congestion. This mechanism might explain the presentation of one specific subtype of late-onset preeclampsia, where no drop of maternal cardiac output is observed. Full article

(This article belongs to the Special Issue Health in Preconception Pregnancy and Postpartum)

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17 pages, 307 KiB

Open AccessArticle

Postpartum Diet Quality: A Cross-Sectional Analysis from the Australian Longitudinal Study on Women’s Health

by Julie C. Martin, Anju E. Joham, Gita D. Mishra, Allison M. Hodge, Lisa J. Moran and Cheryce L. Harrison

J. Clin. Med. 2020, 9(2), 446; https://doi.org/10.3390/jcm9020446 - 06 Feb 2020

Cited by 12 | Viewed by 3497

Abstract

Reproductive-aged women are at high risk of developing obesity, and diet quality is a potential modifiable risk factor. There is limited research exploring diet quality and its association with time since childbirth. Using data from the Australian Longitudinal Study on Women’s Health (ALSWH) survey 5 (2009) of women born between 1973–1978, who reported having previously given birth, we investigated the association between time since childbirth and diet quality, and differences in energy, macronutrients, micronutrient intake, and diet quality assessed by the dietary guideline index (DGI) in women stratified by time from last childbirth, early (0–6 months; n = 558) and late (7–12 months; n = 547), and all other women with children (>12 months post childbirth n = 3434). From this cohort, 8200 participants were eligible, of which 4539 participants completed a food frequency questionnaire (FFQ) and were included in this analysis. Overall, diet quality was higher in early and late postpartum women (mean DGI score 89.8 (SD 10.5) and mean DGI score 90.0 (SD 10.2), respectively) compared to all other women with children (>12 months post childbirth), mean DGI score 85.2 (SD 11.7), p < 0.001. Factors positively associated with diet quality included higher education, physical activity, health provider support, and vitamin and/or mineral supplement use. Conversely, increasing time from childbirth (>12 months), smoking compared with non-smoking and medium income level compared with no income was negatively associated with diet quality. A lower diet quality in women greater than 12 months post childbirth may be reflective of increased pressures, balancing childrearing and return to work responsibilities. This highlights the need to support women beyond the postpartum period to improve modifiable factors associated with weight gain, including diet quality, to optimize health and reduce chronic disease risk. Full article

(This article belongs to the Special Issue Health in Preconception Pregnancy and Postpartum)

15 pages, 748 KiB

Open AccessArticle

What Are the Most Effective Behavioural Strategies in Changing Postpartum Women’s Physical Activity and Healthy Eating Behaviours? A Systematic Review and Meta-Analysis

by Siew Lim, Briony Hill, Stephanie Pirotta, Sharleen O’Reilly and Lisa Moran

J. Clin. Med. 2020, 9(1), 237; https://doi.org/10.3390/jcm9010237 - 16 Jan 2020

Cited by 33 | Viewed by 4810

Abstract

Successful implementation of postpartum lifestyle interventions first requires the identification of effective core components, such as strategies for behavioural change. This systematic review and meta-analysis aimed to describe the associations between behavioural strategies and changes in weight, diet, and physical activity in postpartum women. Databases MEDLINE, CINAHL, EMBASE, and PsycINFO were searched for randomised controlled trials of lifestyle interventions in postpartum women (within 2 years post-delivery). Strategies were categorised according to the Behaviour Change Technique Taxonomy (v1). Forty-six articles were included (n = 3905 women, age 23–36 years). Meta-analysis showed that postpartum lifestyle interventions significantly improved weight (mean difference −2.46 kg, 95%CI −3.65 to −1.27) and physical activity (standardised mean difference 0.61, 95%CI 0.20 to 1.02) but not in energy intake. No individual strategy was significantly associated with weight or physical activity outcomes. On meta-regression, strategies such as problem solving (β = −1.74, P = 0.045), goal setting of outcome (β = −1.91, P = 0.046), reviewing outcome goal (β = −3.94, P = 0.007), feedback on behaviour (β = −2.81, P = 0.002), self-monitoring of behaviour (β = −3.20, P = 0.003), behavioural substitution (β = −3.20, P = 0.003), and credible source (β = −1.72, P = 0.033) were associated with greater reduction in energy intake. Behavioural strategies relating to self-regulation are associated with greater reduction in energy intake. Full article

(This article belongs to the Special Issue Health in Preconception Pregnancy and Postpartum)

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13 pages, 686 KiB

Open AccessArticle

Iodine Status, Thyroid Function, and Birthweight: A Complex Relationship in High-Risk Pregnancies

by Inés Velasco, Mar Sánchez-Gila, Sebastián Manzanares, Peter Taylor and Eduardo García-Fuentes

J. Clin. Med. 2020, 9(1), 177; https://doi.org/10.3390/jcm9010177 - 08 Jan 2020

Cited by 8 | Viewed by 2908

Abstract

(1) Background: The consequences of iodine deficiency and/or thyroid dysfunction during pregnancy have been extensively studied, emphasizing on infant neurodevelopment. However, the available information about the relationship between iodine, thyroid hormones, and fetal growth in high-risk pregnancies is limited. We aim to investigate if iodine metabolism and/or thyroid parameters can be affected by adverse antenatal/perinatal conditions. (2) Methods: A cross-sectional study examined differences in iodine status, thyroid function, and birthweight between high-risk (HR group; n = 108)) and low-risk pregnancies (LR group; n = 233) at the time of birth. Urinary iodine concentration (UIC), iodine levels in amniotic fluid, and thyroid parameters [thyroid-stimulating hormone (TSH), free thyroxine (FT4)] were measured in mother–baby pairs. (3) Results: There were significant differences between HR and LR groups, free thyroxine (FT4) concentration in cord blood was significantly higher in the LR group compared with HR pregnancies (17.06 pmol/L vs. 15.30 pmol/L, respectively; p < 0.001), meanwhile iodine concentration in amniotic fluid was significantly lower (13.11 µg/L vs. 19.65 µg/L, respectively; p < 0.001). (4) Conclusions: Our findings support the hypothesis that an adverse intrauterine environment can compromise the availability of FT4 in cord blood as well as the iodine metabolism in the fetus. These differences are more noticeable in preterm and/or small fetuses. Full article

(This article belongs to the Special Issue Health in Preconception Pregnancy and Postpartum)

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14 pages, 610 KiB

Open AccessArticle

Health in Preconception, Pregnancy and Postpartum Global Alliance: International Network Preconception Research Priorities for the Prevention of Maternal Obesity and Related Pregnancy and Long-Term Complications

by Briony Hill, Helen Skouteris, Helena J Teede, Cate Bailey, Jo-Anna B Baxter, Heidi J Bergmeier, Ana Luiza Vilela Borges, Cheryce L Harrison, Brian Jack, Laura Jorgensen, Siew Lim, Cynthia Montanaro, Leanne Redman, Eric Steegers, Judith Stephenson, Hildrun Sundseth, Shakila Thangaratinam, Ruth Walker and Jacqueline A Boyle

J. Clin. Med. 2019, 8(12), 2119; https://doi.org/10.3390/jcm8122119 - 02 Dec 2019

Cited by 21 | Viewed by 7779

Abstract

The preconception period is a key public health and clinical opportunity for obesity prevention. This paper describes the development of international preconception priorities to guide research and translation activities for maternal obesity prevention and improve clinical pregnancy outcomes. Stakeholders of international standing in preconception and pregnancy health formed the multidisciplinary Health in Preconception, Pregnancy, and Postpartum (HiPPP) Global Alliance. The Alliance undertook a priority setting process including three rounds of priority ranking and facilitated group discussion using Modified Delphi and Nominal Group Techniques to determine key research areas. Initial priority areas were based on a systematic review of international and national clinical practice guidelines, World Health Organization recommendations on preconception and pregnancy care, and consumer and expert input from HiPPP members. Five preconception research priorities and four overarching principles were identified. The priorities were: healthy diet and nutrition; weight management; physical activity; planned pregnancy; and physical, mental and psychosocial health. The principles were: operating in the context of broader preconception/antenatal priorities; social determinants; family health; and cultural considerations. These priorities provide a road map to progress research and translation activities in preconception health with future efforts required to advance evidence-translation and implementation to impact clinical outcomes. Full article

(This article belongs to the Special Issue Health in Preconception Pregnancy and Postpartum)

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14 pages, 540 KiB

Open AccessArticle

Associations between Prenatal Physical Activity and Neonatal and Obstetric Outcomes—A Secondary Analysis of the Cluster-Randomized GeliS Trial

by Julia Hoffmann, Julia Günther, Kristina Geyer, Lynne Stecher, Julia Kunath, Dorothy Meyer, Monika Spies, Eva Rosenfeld, Luzia Kick, Kathrin Rauh and Hans Hauner

J. Clin. Med. 2019, 8(10), 1735; https://doi.org/10.3390/jcm8101735 - 19 Oct 2019

Cited by 14 | Viewed by 3562

Abstract

Prenatal physical activity (PA) was discussed to decrease the incidence of obstetric and neonatal complications. In this secondary cohort analysis of the cluster-randomized GeliS (“healthy living in pregnancy”) trial, associations between prenatal PA and such outcomes were investigated. PA behavior was assessed twice, before or during the 12th week (baseline, T0) and after the 29th week of gestation (T1), using the self-reported Pregnancy Physical Activity Questionnaire. Obstetric and neonatal data were collected in the routine care setting. Data were available for 87.2% (n = 1994/2286) of participants. Significant differences between the offspring of women who adhered to PA recommendations at T1 and offspring of inactive women were found in birth weight (p = 0.030) but not in other anthropometric parameters. Sedentary behavior was inversely associated with birth weight at T1 (p = 0.026) and, at both time points, with an increase in the odds of low birth weight (T0: p = 0.004, T1: p = 0.005). Light-intensity PA at T0 marginally increased the odds of caesarean section (p = 0.032), but neither moderate-intensity nor vigorous-intensity activity modified the risk for caesarean delivery at any time point. The present analyses demonstrated associations between prenatal PA and some neonatal and obstetric outcomes. Full article

(This article belongs to the Special Issue Health in Preconception Pregnancy and Postpartum)

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11 pages, 414 KiB

Open AccessArticle

Vaginal Birth after Cesarean Section in Taiwan: A Population-Based Study

by Yung-Hsiang Ying, George Linn and Koyin Chang

J. Clin. Med. 2019, 8(8), 1203; https://doi.org/10.3390/jcm8081203 - 12 Aug 2019

Cited by 8 | Viewed by 3283

Abstract

The rate of vaginal birth after cesarean section (VBAC) is extremely low in Taiwan probably due to the high perceived risk of trial of labor after a cesarean (TOLAC). To promote the benefits associated with vaginal birth, this study provides evidence to potentially assist relevant public authorities adopt appropriate guidelines or optimize health insurance reimbursement policies to achieve a higher VBAC rate. Employing the National Health Insurance (NHI) Claim Data, this study analyzes women’s adoptions of birth-giving methods for those who had previous cesarean section (CS) experiences. Empirical methods include logit, probit, and hierarchical regression models controlling women’s demographics, incentive indicators, as well as hospital and obstetrician characteristics. Taiwan continues to have a decreasing trend in VBAC rate even with an increase in NHI payment for vaginal birth delivery in 2005, which stimulated a surge in VBAC rate only temporarily. Factors that significantly influence women’s adoption of VBAC include institution-specific random effects, weekend admission, comorbidities during pregnancy, and income and fertility of women. Change in service payment from National Health Insurance (NHI) to healthcare providers constitutes an effective policy in directing clinical practices in the short term. Constant and systematic policy review should be undertaken to promote safe and beneficial medical practices. The results of the study suggest that women’s adoption of birth-giving method is dominated by non-medical considerations. Significant institution-specific effects imply that women might not be well-informed regarding their optimal birth-giving choice. Health education and training programs for hospital personnel should be kept up to date to better serve society. Full article

(This article belongs to the Special Issue Health in Preconception Pregnancy and Postpartum)

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15 pages, 546 KiB

Open AccessArticle

Effects of a Lifestyle Intervention in Routine Care on Prenatal Dietary Behavior—Findings from the Cluster-Randomized GeliS Trial

by Julia Günther, Julia Hoffmann, Julia Kunath, Monika Spies, Dorothy Meyer, Lynne Stecher, Eva Rosenfeld, Luzia Kick, Kathrin Rauh and Hans Hauner

J. Clin. Med. 2019, 8(7), 960; https://doi.org/10.3390/jcm8070960 - 02 Jul 2019

Cited by 18 | Viewed by 3813

Abstract

The antenatal lifestyle and excessive gestational weight gain (GWG) modify the risk of obstetric complications, maternal weight retention, and the risk of obesity for the next generation. The cluster-randomized controlled “Healthy living in pregnancy” (GeliS) study, recruiting 2286 women, was designed to examine whether a lifestyle intervention reduced the proportion of women with excessive GWG. Trained healthcare providers gave four counseling sessions covering a healthy diet, regular physical activity, and self-monitoring of GWG in the intervention group. In this secondary analysis, the effect on maternal dietary behavior was analyzed. Dietary behavior was assessed by means of a 58-item food frequency questionnaire in early and late pregnancy. The intervention resulted in a significant reduction in soft drink intake (p < 0.001) and an increase in the consumption of fish (p = 0.002) and vegetables (p = 0.023). With the exception of higher percentage energy from protein (p = 0.018), no effects of the intervention on energy and macronutrient intake were observed. There was no evidence for an overall effect on dietary quality measured with a healthy eating index. Some dietary variables were shown to be associated with GWG. In a routine prenatal care setting in Germany, lifestyle advice modified single aspects of dietary behavior, but not energy intake or overall dietary quality. Full article

(This article belongs to the Special Issue Health in Preconception Pregnancy and Postpartum)

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17 pages, 503 KiB

Open AccessArticle

Effects of a Lifestyle Intervention in Routine Care on Short- and Long-Term Maternal Weight Retention and Breastfeeding Behavior—12 Months Follow-up of the Cluster-Randomized GeliS Trial

by Julia Hoffmann, Julia Günther, Lynne Stecher, Monika Spies, Dorothy Meyer, Julia Kunath, Roxana Raab, Kathrin Rauh and Hans Hauner

J. Clin. Med. 2019, 8(6), 876; https://doi.org/10.3390/jcm8060876 - 19 Jun 2019

Cited by 18 | Viewed by 3515

Abstract

Postpartum weight retention (PPWR) is associated with an increased risk for maternal obesity and is discussed to be influenced by breastfeeding. The objective was to evaluate the effect of a lifestyle intervention delivered three times during pregnancy and once in the postpartum period on PPWR and on maternal breastfeeding behavior. In total, 1998 participants of the cluster-randomized “healthy living in pregnancy” (GeliS) trial were followed up until the 12th month postpartum (T2_pp). Data were collected using maternity records and questionnaires. Data on breastfeeding behavior were collected at T2_pp. At T2_pp, mean PPWR was lower in women receiving counseling (IV) compared to the control group (C) (−0.2 ± 4.8 kg vs. 0.6 ± 5.2 kg), but there was no significant evidence of between-group differences (adjusted p = 0.123). In the IV, women lost more weight from delivery until T2_pp compared to the C (adjusted p = 0.008) and showed a slightly higher rate of exclusive breastfeeding (IV: 87.4%; C: 84.4%; adjusted p < 0.001). In conclusion, we found evidence for slight improvements of maternal postpartum weight characteristics and the rate of exclusive breastfeeding in women receiving a lifestyle intervention embedded in routine care, although the clinical meaning of these findings is unclear. Full article

(This article belongs to the Special Issue Health in Preconception Pregnancy and Postpartum)

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