Promoting Health Weights in Pregnancy and Beyond

Question 1

Developmental origins of health and disease

Answer 1

poor nutrition during pregnancy: too much or too little
* may lead to adverse consequences in mom and baby with short and long term effects
* may see emergence of NCD later in life

Question 2

Single best predictor of infant health is…

Answer 2

birth weight

Question 3

What is tightly associated with infant birth weight?

Answer 3

Maternal pre-pregnancy weight and her weight gain in pregnancy are strongly associated with infant birth weight and health.

Question 4

Weight reccomendations in pregnancy

Answer 4

Range of weights recommended for total gestational weight gain
* Gain weight at a recommended rate
* Guided by current BMI classifications of pre- pregnancy BMI

Question 5

Risks associated with low gestational weight gain?

Answer 5

• Small for gestational age (SGA)
• preterm birth
• low birth weight

Question 6

Risks associated with high gestational weight gain for infant

Answer 6

• SGA
• Large for gestational age (LGA)
• preterm birth

Question 7

Risks associated with high gestational weight gain for mom

Answer 7

• Pregnancy: preclampsia, GDM
• Delivery: impaired fetal development, labour induction, secondary/emergency c-section,
• Postpartum: postpartum weight retention, childhood overweight

Question 8

interpretation

Answer 8

Categorized according to pre-pregnancy BMI then looked at the risks or outcomes associated for gaining weight. As maternal weight increases over the course of pregnancy can see how risks for things change, so tried to find where the lowest risk for all the factors are.
* For each group it is a bit different

Question 9

Gestational weight gain guidelines

Answer 9

dependant on starting BMI and get both rate of gain and total amount of weight gained

Question 10

Goal of APrON study

Answer 10

Looking at Alberta pregnancy outcomes and nutrition
* APrON started in 2009 with a cohort who were pregnant at the time from Edmonton and Calgary. Children are about 12 now and are still being followed. About 2200 women participated and many are still being followed

Question 11

Results of APrON study

Answer 11

Even under best conditions with normal BMI still see a lot of variety in gestational weight gain
* ~50% of women in APrON gained in excess of gestational weight gain guidelines.
* ~ 20% of women gained less weight than is recommended.

Question 12

When does most excess gestational weight gain occur

Answer 12

Evident Early in Pregnancy
* 3/4 evident by 18 – 33 weeks gestation
* Earlier for women who start pregnancy with higher BMI

Question 13

Inter-pregnancy weight gain

Answer 13

Over a 1/4 heavier by next pregnancy
* Median weight change = +1.4 kg (-0.6-+4.6kg)

Question 14

Common postpartum weight patterns

Answer 14

many women retain weight after pregnancy: 20% women experience a 10% increase in body weight with each pregnancy
* higher starting weight associated with higher risk of weight retention
* women starting with a BMI 25.0-30.9 retain the most weight
* pregnancy is considered a risk factor for obesity

Question 15

What are some resources to promote healthy weights in pregnancy?

Answer 15

• AHS - digital ad campaign
• AHS - Health Parents Healthy Children
• Learning modules for healthcare providers

Question 16

Purpose of learning modules for healthcare providers

Answer 16

• Help discuss pregnancy-related weight changes in respectful ways with all women
• Measure and discuss weight starting early in pregnancy, and into postpartum

Question 17

When are the best times to promote healthy weight gains in infants?

Answer 17

probably 1st trimester
* Interventions starting after the 1st trimester of pregnancy alone may be too late to significantly alter pregnancy- related outcomes in women entering pregnancy with a BMI >25 kg/m2
* As found in LIMIT trial

Question 18

What is key to improving health weight gains during pregnancy?

Answer 18

continuum of care is needed
* before and through pregnancy, childbirth, postnatal period, infancy, childhood, adolescence and adulthood

Question 19

Promoting healthy weight gain from SEM

Answer 19

effected at multiple levels