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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Public Health".

Deadline for manuscript submissions: closed (15 April 2021) | Viewed by 52984

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Special Issue Editors

Prof. Dr. Judith Rankin

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Guest Editor

Faculty of Medical Sciences, Newcastle University, Newcastle, UK
Interests: pregnancy; maternal health; foetal health; obesity

Dr. Nicola Heslehurst

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Guest Editor

Faculty of Medical Sciences, Newcastle University, Newcastle, UK
Interests: obesity; pregnancy; nutrition; inequalities

Dr. Laura Gaudet

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Guest Editor

Faculty of Medicine, Department of Obstetrics and Gynecology, Queen’s University, Kingston, Ontario, Canada
Interests: pregnancy outcomes; obesity; weight bias; clinical trial design

Special Issue Information

Dear Colleagues,

You are invited to submit proposals for manuscripts that fit the objectives and topics of this Special Issue on “Maternal Obesity and Nutrients”. Maternal obesity is increasing globally, impacting the health of women and their children. There are significant implications for the mother’s health and well-being, fertility, pregnancy outcomes, fetal development, and long-term health implications including intergenerational obesity development. However, the periods around pregnancy (including preconception, pregnancy, postnatal, and interpregnancy) present an opportunity to improve maternal nutrition and long-term health for women and children at increased obesity-related risk. Such opportunities include improving macro- and micronutrient intake and dietary behaviours; promoting weight loss before and after pregnancy; and preventing excessive weight gain during pregnancy, adverse pregnancy outcomes, and the inter-generational cycle of obesity.

The objective of this proposed Special Issue on “Maternal Obesity and Nutrients” is to publish selected papers detailing aspects of nutrition that are important around the pregnancy period, specifically for women living with obesity. In particular, papers (reviews, public health, clinical or experimental studies) will be included that report maternal obesity and the role of specific nutrients on maternal, foetal, and longer-term health; clinical research targeting high-risk populations for nutritional deficiencies such as women living with multi-morbidity or who have had bariatric surgery; and public health research that specifically addresses well-established obesity and nutrition inequalities such as food insecurity in high income countries and low, middle income countries, or explores the role of health professionals and policy makers.

Prof. Dr. Judith Rankin
Dr. Nicola Heslehurst
Dr. Laura Gaudet
Guest Editors

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Keywords

maternal diet
macronutrients
micronutrients
obesity
pregnancy
preconception
postnatal
interpregnancy
foetal development

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Published Papers (11 papers)

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Research

Jump to: Review

20 pages, 331 KiB

Open AccessArticle

Diet, Physical Activity and Gestational Weight Gain Patterns among Pregnant Women Living with Obesity in the North East of England: The GLOWING Pilot Trial

by Nicola Heslehurst, Angela C. Flynn, Lem Ngongalah, Catherine McParlin, Kathryn V. Dalrymple, Kate E. Best, Judith Rankin and Elaine McColl

Nutrients 2021, 13(6), 1981; https://doi.org/10.3390/nu13061981 - 9 Jun 2021

Cited by 9 | Viewed by 4077

Abstract

Maternal diet, physical activity (PA) behaviours, and gestational weight gain (GWG) are important for optimum health of women and their babies. This secondary analysis of the GLOWING pilot cluster trial explored these among women living with obesity in high deprivation. Pregnant women completed food frequency, PA and psychosocial questionnaires. Weights were retrieved from medical records and measured during routine appointments with midwives. Descriptive and regression analyses were stratified by obesity class. A total of 163 women were recruited; 54.0% had class 1 obesity, 25.8% class 2, 20.2% class 3, and 76.1% lived in the two most deprived quintiles. Women had suboptimal dietary intake, particularly for oily fish, fruit and vegetables. PA was predominantly light intensity, from household, care and occupational activities. Most women gained weight outside of Institute of Medicine (IOM) guideline recommendations (87.8%); women in class 3 obesity were most likely to have inadequate GWG below IOM recommendations (58.3%, p < 0.01) and reduced odds of excessive GWG compared with class 1 (AOR 0.13, 95% 0.04–0.45). Deprived women with obesity have a double inequality as both increase pregnancy risks. This population requires support to meet guideline recommendations for diet, PA and GWG. Further research exploring obesity classes would inform policies and care to achieve the best pregnancy outcomes. Full article

(This article belongs to the Special Issue Maternal Obesity and Nutrients)

11 pages, 700 KiB

Open AccessArticle

Modifiable Determinants of Postpartum Weight Loss in Women with Obesity: A Secondary Analysis of the UPBEAT Trial

by Kathryn V. Dalrymple, Onome Uwhubetine, Angela C. Flynn, Dharmintra Pasupathy, Annette L. Briley, Sophie A. Relph, Paul T. Seed, Majella O’Keeffe and Lucilla Poston

Nutrients 2021, 13(6), 1979; https://doi.org/10.3390/nu13061979 - 9 Jun 2021

Cited by 9 | Viewed by 5018

Abstract

Pregnancy can alter a woman’s weight gain trajectory across the life course and contribute to the development of obesity through retention of weight gained during pregnancy. This study aimed to identify modifiable determinants associated with postpartum weight retention (PPWR; calculated by the difference in pre-pregnancy and 6 month postpartum weight) in 667 women with obesity from the UPBEAT study. We examined the relationship between PPWR and reported glycaemic load, energy intake, and smoking status in pregnancy, excessive gestational weight gain (GWG), mode of delivery, self-reported postpartum physical activity (low, moderate, and high), and mode of infant feeding (breast, formula, and mixed). At the 6 month visit, 48% (n = 320) of women were at or above pre-pregnancy weight. Overall, PPWR was negative (−0.06 kg (−42.0, 40.4)). Breastfeeding for ≥4 months, moderate or high levels of physical activity, and GWG ≤9 kg were associated with negative PPWR. These three determinants were combined to provide a modifiable factor score (range 0–3); for each added variable, a further reduction in PPWR of 3.0 kg (95% confidence interval 3.76, 2.25) occurred compared to women with no modifiable factors. This study identified three additive determinants of PPWR loss. These provide modifiable targets during pregnancy and the postnatal period to enable women with obesity to return to their pre-pregnancy weight. Full article

(This article belongs to the Special Issue Maternal Obesity and Nutrients)

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14 pages, 1352 KiB

Open AccessArticle

Pregnancy after Bariatric Surgery: A Nested Case-Control Study of Risk Factors for Small for Gestational Age Babies in AURORA

by Zainab Akhter, Nicola Heslehurst, Dries Ceulemans, Judith Rankin, Roger Ackroyd and Roland Devlieger

Nutrients 2021, 13(5), 1699; https://doi.org/10.3390/nu13051699 - 17 May 2021

Cited by 17 | Viewed by 3057

Abstract

Bariatric surgery prior to pregnancy is a significant risk factor for small for gestational age (SGA) babies. This case-control study investigated differences between mothers delivering an SGA baby following bariatric surgery, compared to those delivering an appropriate for gestational age (AGA) baby. Out of 129 babies born to mothers in the AURORA cohort study, 25 were SGA (<10th percentile) and 97 were AGA (10th–90th percentile). Higher gestational weight gain (GWG) was significantly associated with decreased odds of SGA (aOR per kg 0.92, 95% CI 0.85–0.99). According to the Institute of Medicine GWG guidelines, 44% of SGA mothers had ‘inadequate’ GWG compared to 17% of AGA mothers. Nearly half of the mothers had ‘excessive’ GWG yet still gave birth to an SGA or AGA baby. Mothers of SGA babies lost more weight following bariatric surgery (45.6 ± 14.4 kg vs. 39.0 ± 17.9 kg). Women who reported receiving nutritional advice following bariatric surgery were significantly less likely to have an SGA baby (aOR 0.15, 95% CI 0.0.4–0.55). Women with a history of bariatric surgery should be provided with specialized support before and during pregnancy to encourage adequate nutritional intake and weight gain to support healthy fetal growth. Full article

(This article belongs to the Special Issue Maternal Obesity and Nutrients)

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17 pages, 831 KiB

Open AccessArticle

Cause-Specific Stillbirth and Neonatal Death According to Prepregnancy Obesity and Early Gestational Weight Gain: A Study in the Danish National Birth Cohort

by Ellen Aagaard Nohr, Sanne Wolff, Helene Kirkegaard, Chunsen Wu, Anne-Marie Nybo Andersen, Jørn Olsen and Bodil Hammer Bech

Nutrients 2021, 13(5), 1676; https://doi.org/10.3390/nu13051676 - 15 May 2021

Cited by 8 | Viewed by 3536

Abstract

Maternal obesity is associated with impaired fetal and neonatal survival, but underlying mechanisms are poorly understood. We examined how prepregnancy BMI and early gestational weight gain (GWG) were associated with cause-specific stillbirth and neonatal death. In 85,822 pregnancies in the Danish National Birth Cohort (1996–2002), we identified causes of death from medical records for 272 late stillbirths and 228 neonatal deaths. Prepregnancy BMI and early GWG derived from an early pregnancy interview and Cox regression were used to estimate associations with stillbirth or neonatal death as a combined outcome and nine specific cause-of-death categories. Compared to women with normal weight, risk of stillbirth or neonatal death was increased by 66% with overweight and 78% with obesity. Especially deaths due to placental dysfunction, umbilical cord complications, intrapartum events, and infections were increased in women with obesity. More stillbirths and neonatal deaths were observed in women with BMI < 25 and low GWG. Additionally, unexplained intrauterine death was increased with low GWG, while more early stillbirths were seen with both low and high GWG. In conclusion, causes of death that relate to vascular and metabolic disturbances were increased in women with obesity. Low early GWG in women of normal weight deserves more clinical attention. Full article

(This article belongs to the Special Issue Maternal Obesity and Nutrients)

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19 pages, 4313 KiB

Open AccessArticle

Pre- and Post-Migration Influences on Weight Management Behaviours before and during Pregnancy: Perceptions of African Migrant Women in England

by Lem Ngongalah, Judith Rankin, Nicola Heslehurst and Tim Rapley

Nutrients 2021, 13(5), 1667; https://doi.org/10.3390/nu13051667 - 14 May 2021

Cited by 3 | Viewed by 2696

Abstract

The prevalence of overweight/obesity is high among Black women in England, who also face high risks of pregnancy and childbirth complications. This study explored African migrant women’s perceptions of pre- and post-migration influences on their weight-related behaviours and weight management support during pregnancy. Interviews were conducted with women of child-bearing age from Ghana, Nigeria, and Cameroon (n = 23). Data were analysed using thematic analysis. Four themes were identified: changing dietary behaviours after migration, changing physical activity (PA) behaviours after migration, increased discourse on obesity, and weight management advice and support received. Navigating a new food environment, interactions with other populations in England, and the need to socialise influenced changes in dietary behaviours. Participants considered that living in England ‘makes you lazy’ due to its obesogenic environment, while increased discourses on obesity heightened weight awareness. Women struggled to relate to dietary advice from midwives but found PA advice useful. Relatives provided valuable support but could influence unhealthy weight-related practices. There is a need for interventions addressing gaps in weight management support for these women, especially considering their migrant backgrounds and multicultural identities. Further research is needed to understand their unique challenges, and collaborations with relatives could inform the development of effective weight management interventions. Full article

(This article belongs to the Special Issue Maternal Obesity and Nutrients)

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17 pages, 541 KiB

Open AccessArticle

Pregnant Women Living with Obesity: A Cross-Sectional Observational Study of Dietary Quality and Pregnancy Outcomes

by Margaret Charnley, Lisa Newson, Andrew Weeks and Julie Abayomi

Nutrients 2021, 13(5), 1652; https://doi.org/10.3390/nu13051652 - 13 May 2021

Cited by 11 | Viewed by 5026

Abstract

Good maternal nutrition is key to optimal maternal and foetal health. A poor-quality diet is often associated with obesity, and the prevalence and severity of maternal obesity has increased significantly in recent years. This study observed dietary intakes in pregnant women living with obesity and assessed the quality of their diet. In total, 140 women with a singleton pregnancy, aged > 18 years and BMI ≥ 35 kg/m², were recruited from antenatal clinics, weighed and completed food diaries at 16-, 28- and 36-weeks’ gestation. Clinical data were recorded directly from the women’s medical records. Nutrient intake was determined using ‘Microdiet^TM’, then compared to Dietary Reference Values (DRVs). Energy intakes were comparable with DRVs, but intakes of sugar and saturated fatty acids were significantly higher. Intake of fibre and several key micronutrients (Iron, Iodine, Folate and Vitamin D) were significantly low. Several adverse obstetric outcomes were higher than the general obstetric population. Women with obesity, often considered ‘over nourished’, may have diets deficient in essential micronutrients, often associated with poor obstetric outcomes. To address the intergenerational transmission of poor health via poor diets warrants a multi-disciplinary approach focusing away from ‘dieting’ onto positive messages, emphasising key nutrients required for good maternal and foetal health. Full article

(This article belongs to the Special Issue Maternal Obesity and Nutrients)

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17 pages, 1359 KiB

Open AccessArticle

Effects of a Prenatal Lifestyle Intervention in Routine Care on Maternal Health Behaviour in the First Year Postpartum—Secondary Findings of the Cluster-Randomised GeliS Trial

by Kristina Geyer, Monika Spies, Julia Günther, Julia Hoffmann, Roxana Raab, Dorothy Meyer, Kathrin Rauh and Hans Hauner

Nutrients 2021, 13(4), 1310; https://doi.org/10.3390/nu13041310 - 15 Apr 2021

Cited by 6 | Viewed by 3273

Abstract

Lifestyle interventions during pregnancy were shown to beneficially influence maternal dietary behaviour and physical activity, but their effect on health behaviour after delivery is unclear. The objective of this secondary analysis was to investigate the sustained effect of a lifestyle intervention in routine care on maternal health behaviour during the first year postpartum. The cluster-randomised controlled “Healthy living in pregnancy” (GeliS) study included 2286 pregnant women. Data on maternal health behaviour were collected at 6–8 weeks (T1pp) and one year postpartum (T2pp) using validated questionnaires. The intervention group showed a lower mean intake of fast food (T1pp: p = 0.016; T2pp: p < 0.001) and soft drinks (T1pp: p < 0.001), a higher mean intake of vegetables (T2pp: p = 0.015) and was more likely to use healthy oils for meal preparation than the control group. Dietary quality rated by a healthy eating index was higher in the intervention group (T1pp: p = 0.093; T2pp: p = 0.043). There were minor trends towards an intervention effect on physical activity behaviour. The proportion of smokers was lower in the intervention group (p < 0.001, both time points). The lifestyle intervention within routine care modestly improved maternal postpartum dietary and smoking behaviours. Full article

(This article belongs to the Special Issue Maternal Obesity and Nutrients)

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14 pages, 450 KiB

Open AccessArticle

The INTER-ACT E-Health Supported Lifestyle Intervention Improves Postpartum Food Intake and Eating Behavior, but Not Physical Activity and Sedentary Behavior—A Randomized Controlled Trial

by Margriet Bijlholt, Lieveke Ameye, Hanne Van Uytsel, Roland Devlieger and Annick Bogaerts

Nutrients 2021, 13(4), 1287; https://doi.org/10.3390/nu13041287 - 14 Apr 2021

Cited by 13 | Viewed by 3972

Abstract

Unhealthy postpartum lifestyle is related to long-term adverse psychological, metabolic and cardiovascular health outcomes as well as to complications in the next pregnancy. Especially women with preceding excessive gestational weight gain are at risk. This paper aims to evaluate the effect of the postpartum phase of the INTER-ACT randomized controlled trial (RCT) on food intake, eating behavior, physical activity and sedentary time at the end of the intervention (six months postpartum) and at six-months follow-up (12 months postpartum). The study population comprised women with excessive gestational weight gain in the preceding pregnancy. The lifestyle intervention combined a smartphone application with four face-to-face coaching sessions between six weeks and six months postpartum. After the intervention, restrained eating score was 1 point higher (95% CI 0.5, 1.5; p < 0.001), uncontrolled eating score was 1 point lower (95% CI −1.9, −0.2; p = 0.02) and energy intake was 69 kcal lower (95% CI −123, −15; p = 0.01) in the intervention group compared to the control group. The differences were no longer statistically significant at follow-up. No significant effects on emotional eating, physical activity and sedentary behavior were found. In conclusion, the postpartum phase of the INTER-ACT RCT was effective in improving nutrition-related outcomes, however, these improvements could not be sustained at follow-up. ClinicalTrials.gov identifier: NCT02989142. Full article

(This article belongs to the Special Issue Maternal Obesity and Nutrients)

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Review

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10 pages, 631 KiB

Open AccessReview

Periconceptional Folate Supplementation in Women after Bariatric Surgery—A Narrative Review

by An-Katrien Vynckier, Dries Ceulemans, Greet Vanheule, Paulien De Mulder, Mieke Van Den Driessche and Roland Devlieger

Nutrients 2021, 13(5), 1557; https://doi.org/10.3390/nu13051557 - 5 May 2021

Cited by 5 | Viewed by 2858

Abstract

The prevalence of obesity is increasing globally, and along with it, there is a growing number of patients opting to undergo bariatric surgery to treat this condition. Whilst it has many advantages, bariatric surgery is known to induce micronutrient deficiency, with possible deleterious effects on overall health. This topic becomes even more relevant during pregnancy, where deficiencies can also affect the developing fetus, possibly being the cause of an increase in congenital anomalies. Most notably amongst these micronutrients is folate, or vitamin B9, which plays an essential role in development, gene expression and genomic stability. As insufficient levels of folate are associated with neural tube defects in the fetus, preventing and treating folate deficiencies during pregnancies after bariatric surgery is a relevant issue. Unfortunately, folate supplementation recommendations for bariatric patients who wish to become pregnant are not clear. In this narrative review, we discuss whether the recommendations for the general population are still valid for bariatric patients. Furthermore, we discuss the role of folate in the human body, folate status in both non-bariatric and bariatric patients, the various types of folate that are available for substitution and the risk associated with over-supplementation. Full article

(This article belongs to the Special Issue Maternal Obesity and Nutrients)

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31 pages, 7707 KiB

Open AccessReview

The Effectiveness of Smoking Cessation, Alcohol Reduction, Diet and Physical Activity Interventions in Improving Maternal and Infant Health Outcomes: A Systematic Review of Meta-Analyses

by Louise Hayes, Catherine McParlin, Liane B Azevedo, Dan Jones, James Newham, Joan Olajide, Louise McCleman and Nicola Heslehurst

Nutrients 2021, 13(3), 1036; https://doi.org/10.3390/nu13031036 - 23 Mar 2021

Cited by 28 | Viewed by 8927

Abstract

Diet, physical activity, smoking and alcohol behaviour-change interventions delivered in pregnancy aim to prevent adverse pregnancy outcomes. This review reports a synthesis of evidence from meta-analyses on the effectiveness of interventions at reducing risk of adverse health outcomes. Sixty-five systematic reviews (63 diet and physical activity; 2 smoking) reporting 602 meta-analyses, published since 2011, were identified; no data were identified for alcohol interventions. A wide range of outcomes were reported, including gestational weight gain, hypertensive disorders, gestational diabetes (GDM) and fetal growth. There was consistent evidence from diet and physical activity interventions for a significantly reduced mean gestational weight gain (ranging from −0.21 kg (95% confidence interval −0.34, −0.08) to −5.77 kg (95% CI −9.34, −2.21). There was evidence from larger diet and physical activity meta-analyses for a significant reduction in postnatal weight retention, caesarean delivery, preeclampsia, hypertension, GDM and preterm delivery, and for smoking interventions to significantly increase birth weight. There was no statistically significant evidence of interventions having an effect on low or high birthweight, neonatal intensive care unit admission, Apgar score or mortality outcomes. Priority areas for future research to capitalise on pregnancy as an opportunity to improve the lifelong wellbeing of women and their children are highlighted. Full article

(This article belongs to the Special Issue Maternal Obesity and Nutrients)

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23 pages, 1371 KiB

Open AccessReview

Impact of Maternal Obesity on the Metabolism and Bioavailability of Polyunsaturated Fatty Acids during Pregnancy and Breastfeeding

by Daniela Álvarez, Yasna Muñoz, Macarena Ortiz, Manuel Maliqueo, Raphaël Chouinard-Watkins and Rodrigo Valenzuela

Nutrients 2021, 13(1), 19; https://doi.org/10.3390/nu13010019 - 23 Dec 2020

Cited by 35 | Viewed by 8916

Abstract

Prenatal and postnatal development are closely related to healthy maternal conditions that allow for the provision of all nutritional requirements to the offspring. In this regard, an appropriate supply of fatty acids (FA), mainly n-3 and n-6 long-chain polyunsaturated fatty acids (LCPUFA), is crucial to ensure a normal development, because they are an integral part of cell membranes and participate in the synthesis of bioactive molecules that regulate multiple signaling pathways. On the other hand, maternal obesity and excessive gestational weight gain affect FA supply to the fetus and neonate, altering placental nutrient transfer, as well as the production and composition of breast milk during lactation. In this regard, maternal obesity modifies FA profile, resulting in low n-3 and elevated n-6 PUFA levels in maternal and fetal circulation during pregnancy, as well as in breast milk during lactation. These modifications are associated with a pro-inflammatory state and oxidative stress with short and long-term consequences in different organs of the fetus and neonate, including in the liver, brain, skeletal muscle, and adipose tissue. Altogether, these changes confer to the offspring a higher risk of developing obesity and its complications, as well as neuropsychiatric disorders, asthma, and cancer. Considering the consequences of an abnormal FA supply to offspring induced by maternal obesity, we aimed to review the effects of obesity on the metabolism and bioavailability of FA during pregnancy and breastfeeding, with an emphasis on LCPUFA homeostasis. Full article

(This article belongs to the Special Issue Maternal Obesity and Nutrients)

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