Digital Commons Network^™

Be Healthy In Pregnancy (Bhip): A Randomized Controlled Trial Of Nutrition And Exercise Intervention From Early Pregnancy To Achieve Recommended Gestational Weight Gain, Stephanie A. Atkinson, Atherai Maran, Kendra Dempsey, Maude Perreault, Thuva Vanniyasingam, Stuart M. Phillips, Eileen K. Hutton, Michelle F. Mottola

Paediatrics Publications

A randomized two-arm prospective superiority trial tested the efficacy of a novel structured and monitored nutrition (bi-weekly counselling for individualized energy and high dairy protein diet) and exercise program (walking goal of 10,000 steps/day) (intervention) compared to usual care (control) in pregnant women to achieve gestational weight gain (GWG) within current recommendations. Women recruited in communities in southern Ontario, Canada were randomized at 12–17 weeks gestation with stratification by site and pre-pregnancy BMI to intervention (n = 119) or control (n = 122). The primary outcome was the proportion of women who achieved GWG within the Institute of Medicine recommendations. …

Evaluating Evidence-Based Content, Features Of Exercise Instruction, And Expert Involvement In Physical Activity Apps For Pregnant Women: Systematic Search And Content Analysis, Melanie J. Hayman, Kristie Lee Alfrey, Kim Waters, Summer Cannon, Gregore I. Mielke, Shelley E. Keating, Gabriela P. Mena, Michelle F. Mottola, Kelly R. Plint

Paediatrics Publications

Background: Guidelines for physical activity and exercise during pregnancy recommend that all women without contraindications engage in regular physical activity to improve both their own health and the health of their baby. Many women are uncertain how to safely engage in physical activity and exercise during this life stage and are increasingly using mobile apps to access health-relatedinformation. However, the extent to which apps that provide physical activity and exercise advice align with current evidence-based pregnancy recommendations is unclear. Objective: This study aims to conduct a systematic search and content analysis of apps that promote physical activity and exercise in …

Myasthenia Gravis In Pregnancy: Systematic Review And Case Series, Harrison Banner, Kirsten M. Niles, Michelle Ryu, Mathew Sermer, Vera Bril, Kellie E. Murphy

Paediatrics Publications

Background: Myasthenia gravis is an autoimmune disease which can impact pregnancy. Methods: Six databases were systematically searched for studies with at least five subjects reporting pregnancy outcomes for women with myasthenia gravis in pregnancy. Assessment of bias was performed for all included studies. Forty-eight cases from our own centre were also included in the analysis. Results: In total, 32 publications met inclusion criteria for systematic review, for a total of 33 unique data sets including 48 cases from our institution. Outcome data was available for 824 pregnancies. Spontaneous vaginal delivery occurred in 56.3% of pregnancies. Overall risk of myasthenia gravis …

Acetone Ingestion Mimics A Fasting State To Improve Glucose Tolerance In A Mouse Model Of Gestational Hyperglycemia, Sandra Szlapinski, Brenda Strutt, Madeline Deane, Edith Arany, Jamie Bennett, David J. Hill

Paediatrics Publications

Gestational diabetes mellitus results, in part, from a sub‐optimal β‐cell mass (BCM) during pregnancy. Artemisinins were reported to increase BCM in models of diabetes by α‐ to β‐cell conversion leading to enhanced glucose tolerance. We used a mouse model of gestational glucose intolerance to compare the effects of an artemisinin (artesunate) on glycemia of pregnant mice with vehicle treatment (acetone) or no treatment. Animals were treated daily from gestational days (GD) 0.5 to 6.5. An intraperitoneal glucose tolerance test was performed prior to euthanasia at GD18.5 or post‐partum. Glucose tolerance was significantly improved in both pregnant and non‐pregnant mice with …

A Case Report Of A Severe Neonatal Systemic Vasculitis On The First Day Of Life, Stephanie Wong, Erkan Demirkaya, Roberta Berard

Paediatrics Publications

Background: Neonatal systemic vasculitis syndromes have been reported in infants born to mothers with systemic lupus erythematosus, Sjögren’s syndrome, Behҫet’s disease, cutaneous polyarteritis nodosa and anti-neutrophil cytoplasmic antibody-associated vasculitides. Here we report a novel association of a case of new-onset maternal seronegative inflammatory arthritis associated with a transient systemic vasculitis in a neonate. Case presentation: In the first 24 h of life, a preterm Caucasian baby boy was noted to have blue discoloration to all four extremities. Despite antibiotics, fresh frozen plasma and anticoagulation, the discoloration remained, particularly in the left index finger. This was associated with fever and a …

Influence Of A Virtual Exercise Program Throughout Pregnancy During The Covid-19 Pandemic On Perineal Tears And Episiotomy Rates: A Randomized Clinical Trial, Cristina Silva-Jose, Miguel Sánchez-Polán, Ángeles Díaz-Blanco, Tirso Pérez-Medina, Vanessa Carrero Martínez, Irune Alzola, Rubén Barakat, Ignacio Refoyo, Michelle F. Ferlisi, Naveen Poonai

Paediatrics Publications

The complications associated with COVID-19 confinement (impossibility of grouping, reduced mobility, distance between people, etc.) influence the lifestyle of pregnant women with important associated complications regarding pregnancy outcomes. Therefore, perineal traumas are the most common obstetric complications during childbirth. The aim of the present study was to examine the influence of a supervised virtual exercise program throughout pregnancy on perineal injury and episiotomy rates during childbirth. A randomized clinical trial design (NCT04563065) was used. Data were collected from 98 pregnant women without obstetric contraindications who attended their prenatal medical consultations. Women were randomly assigned to the intervention (IG, N = …

Roles Of Two Small Leucine-Rich Proteoglycans Decorin And Biglycan In Pregnancy And Pregnancy-Associated Diseases, Chidambra D. Halari, Michael Zheng, Peeyush K. Lala

Paediatrics Publications

Two small leucine-rich proteoglycans (SLRP), decorin and biglycan, play important roles in structural–functional integrity of the placenta and fetal membranes, and their alterations can result in several pregnancy-associated diseases. In this review, we briefly discuss normal placental structure and functions, define and classify SLRPs, and then focus on two SLRPs, decorin (DCN) and biglycan (BGN). We discuss the consequences of deletions/mutations of DCN and BGN. We then summarize DCN and BGN expression in the pregnant uterus, myometrium, decidua, pla-centa, and fetal membranes. Actions of these SLRPs as ligands are then discussed in the context of multiple binding partners in the …

Translating Developmental Origins Of Health And Disease In Practice: Health Care Providers' Perspectives., Monica L Molinaro, Marilyn Evans, Timothy Regnault, Barbra De Vrijer

Paediatrics Publications

Currently, there is limited knowledge on how health care providers perceive and understand the Developmental Origins of Health and Disease (DOHaD), which may impact how they inform patients and their families throughout the perinatal period. This qualitative descriptive study explored if and how health care providers counsel on in utero programming and future health outcomes with parents, both preconception and during pregnancy. One-on-one, semi-structured interviews were conducted with 23 health care providers from varying health disciplines including obstetrics and gynaecology, midwifery, paediatrics, endocrinology and internal medicine. Audiotaped interviews were transcribed verbatim and analysed using inductive thematic analysis. Three themes were …

Quality, Features, And Presence Of Behavior Change Techniques In Mobile Apps Designed To Improve Physical Activity In Pregnant Women: Systematic Search And Content Analysis, Melanie Hayman, Kristie Lee Alfrey, Summer Cannon, Stephanie Alley, Amanda L. Rebar, Susan Williams, Camille E. Short, Abby Altazan

Paediatrics Publications

Background: Physical activity during pregnancy is associated with several health benefits for the mother and child. However, very few women participate in regular physical activity during pregnancy. eHealth platforms (internet and mobile apps) have become an important information source for pregnant women. Although the use of pregnancy-related apps has significantly increased among pregnant women, very little is known about their theoretical underpinnings, including their utilization of behavior change techniques (BCTs). This is despite research suggesting that inclusion of BCTs in eHealth interventions are important for promoting healthy behaviors, including physical activity. Objective: The aim of this study was to conduct …

The Application Of In Utero Magnetic Resonance Imaging In The Study Of The Metabolic And Cardiovascular Consequences Of The Developmental Origins Of Health And Disease, Stephanie A. Giza, Simran Sethi, Lauren M. Smith, Mary Ellen E.T. Empey, Lindsay E. Morris, Charles A. Mckenzie

Paediatrics Publications

Observing fetal development in utero is vital to further the understanding of later-life diseases. Magnetic resonance imaging (MRI) offers a tool for obtaining a wealth of information about fetal growth, development, and programming not previously available using other methods. This review provides an overview of MRI techniques used to investigate the metabolic and cardiovascular consequences of the developmental origins of health and disease (DOHaD) hypothesis. These methods add to the understanding of the developing fetus by examining fetal growth and organ development, adipose tissue and body composition, fetal oximetry, placental microstructure, diffusion, perfusion, flow, and metabolism. MRI assessment of fetal …

Maternal And Cord Blood Hemoglobin As Determinants Of Placental Weight: A Cross-Sectional Study, Ferrante S. Gragasin, Maria B. Ospina, Jesus Serrano-Lomelin, Su Hwan Kim, Matthew Kokotilo, Andrew G. Woodman, Stephen J. Renaud, Stephane L. Bourque

Paediatrics Publications

Background: Both high and low placental weights are associated with adverse pregnancy outcomes. Maternal hemoglobin levels can influence placental weight, but the evidence is conflicting. Since maternal hemoglobin does not invariably correlate with fetal/neonatal blood hemoglobin levels, we sought to determine whether cord blood hemoglobin or maternal hemoglobin status more closely associates with placental weight in women undergoing elective cesarean section at term. Methods: This was a cross-sectional study conducted at the Royal Alexandra Hospital, Edmonton, Canada, involving 202 women with term singleton pregnancies undergoing elective cesarean section. Maternal blood and mixed cord blood hemoglobin levels were analyzed using a …

Increased Alpha And Beta Cell Mass During Mouse Pregnancy Is Not Dependent On Transdifferentiation, Sandra K. Szlapinski, Jamie Bennett, Brenda J. Strutt, David J. Hill

Paediatrics Publications

Maternal pancreatic beta-cell mass (BCM) increases during pregnancy to compensate for relative insulin resistance. If BCM expansion is suboptimal, gestational diabetes mellitus can develop. Alpha-cell mass (ACM) also changes during pregnancy, but there is a lack of information about α-cell plasticity in pregnancy and whether α- to β-cell transdifferentiation can occur. To investigate this, we used a mouse model of gestational glucose intolerance induced by feeding low-protein (LP) diet from conception until weaning and compared pregnant female offspring to control diet-fed animals. Control and LP pancreata were collected for immunohistochemical analysis and serum glucagon levels were measured. In order to …

Long-Term Cardiovascular Outcomes After Pregnancy In Women With Heart Disease, Samuel C. Siu, Douglas S. Lee, Mohammed Rashid, Jiming Fang, Peter C. Austin, Candice K. Silversides

Paediatrics Publications

BACKGROUND: Women with heart disease are at risk for pregnancy complications, but their long-term cardiovascular outcomes after pregnancy are not known. METHODS AND RESULTS: We examined long-term cardiovascular outcomes after pregnancy in 1014 consecutive women with heart disease and a matched group of 2028 women without heart disease. The primary outcome was a composite of mortality, heart failure, atrial fibrillation, stroke, myocardial infarction, or arrhythmia. Secondary outcomes included cardiac procedures and new hypertension or diabetes mellitus. We compared the rates of these outcomes between women with and without heart disease and adjusted for maternal and pregnancy characteristics. We also determined …

Drug Therapy During Pregnancy., Dongmei Sun, Janine R. Hutson, Facundo Garcia-Bournissen Md Phd

Paediatrics Publications

No abstract provided.

Developing And Implementing A Novel Mentorship Model (4+ 1) For Maternal, Newborn And Child Health In Rwanda, Anaclet Ngabonzima, Cynthia Kenyon, Celestin Hategeka, Aimee Josephine Utuza, Paulin Ruhato Banguti, Isaac Luginaah, David F Cechetto

Paediatrics Publications

BACKGROUND: There are a number of factors that may contribute to high mortality and morbidity of women and newborns in low-income countries. These include a shortage of competent health care providers (HCP) and a lack of sufficient continuous professional development (CPD) opportunities. Strengthening the skills and building the capacity of HCP involved in the provision of maternal, newborn and child health (MNCH) is essential to ensure quality care for mothers, newborns and children. To address this challenge in Rwanda, mentorship of HCPs was identified as an approach that could help build capacity, improve the provision of care and accelerate the …

Temporal Relationships Between Maternal Metabolic Parameters With Neonatal Adiposity In Women With Obesity Differ By Neonatal Sex: Secondary Analysis Of The Dali Study, Rodrigo A. Lima, Gernot Desoye, David Simmons, Roland Devlieger, Sander Galjaard, Rosa Corcoy, Juan M. Adelantado, Fidelma Dunne

Paediatrics Publications

Objectives: To investigate the importance of time in pregnancy and neonatal sex on the association between maternal metabolic parameters and neonatal sum of skinfolds. Methods: This was a longitudinal, secondary analysis of the vitamin D and lifestyle intervention for gestational diabetes mellitus study, conducted in nine European countries during 2012 to 2015. Pregnant women with a pre-pregnancy body mass index (BMI) of ≥29 kg/m2 were invited to participate. We measured 14 maternal metabolic parameters at three times during pregnancy: <20 weeks, 24 to 28 weeks, and 35 to 37 weeks of gestation. The sum of four skinfolds assessed within 2 days after birth was the measure of neonatal adiposity. Results: In total, 458 mother-infant pairs (50.2% female infants) were included. Insulin resistance (fasting insulin and HOMA-index of insulin resistance) in early pregnancy was an important predictor for boys' sum of skinfolds, in addition to fasting glucose and maternal adiposity (leptin, BMI and neck circumference) throughout pregnancy. In girls, maternal lipids (triglycerides and fatty acids) in the first half of pregnancy were important predictors of sum of skinfolds, as well as fasting glucose in the second half of pregnancy. Conclusions: Associations between maternal metabolic parameters and neonatal adiposity vary between different periods during pregnancy. This time-dependency is different between sexes, suggesting different growth strategies.

Transient Hyponatremia Of Prematurity Caused By Mild Bartter Syndrome Type Ii: A Case Report., Subhrata Verma, Rahul Chanchlani, Victoria Mok Siu, Guido Filler

Paediatrics Publications

BACKGROUND: Bartter syndrome subtypes are a group of rare renal tubular diseases characterized by impaired salt reabsorption in the tubule, specifically the thick ascending limb of Henle's loop. Clinically, they are characterized by the association of hypokalemic metabolic alkalosis, hypercalciuria, nephrocalcinosis, increased levels of plasma renin and aldosterone, low blood pressure and vascular resistance to angiotensin II. Bartter syndrome type II is caused by mutations in the renal outer medullary potassium channel (ROMK) gene (KCNJ1), can present in the newborn period and typically requires lifelong therapy.

CASE PRESENTATION: We describe a case of a prematurely born female infant presenting with …

Development Of A Core Outcome Set For Studies On Cardiac Disease In Pregnancy (Coscarp): A Study Protocol, Rohan D'Souza, Chelsea Hall, Mathew Sermer, Samuel Siu, Candice Silversides

Paediatrics Publications

Background: Clinical studies looking at interventions to optimize pregnancy and long-term outcomes for women with cardiac disease and their babies are inconsistent in their reporting of clinical outcomes, making it difficult to compare results across studies and draw meaningful conclusions. The development of a core outcome set (COS) - a standardized, minimum set of outcomes that must be collected and reported in all studies - is a practical solution to this problem. Methods/design: We will follow a five-step process in developing a COS for studies on pregnant women with cardiac disease. First, a systematic literature review will identify all reported …

A Core Outcome Set For Studies Of Gestational Diabetes Mellitus Prevention And Treatment, Aoife M Egan, Delia Bogdanet, Tomás P Griffin, Oratile Kgosidialwa, Mila Cervar-Zivkovic, Eugene Dempsey, John Allotey, Fernanda Alvarado, Cheril Clarson, Shamil D Cooray, Harold W De Valk, Sander Galjaard, Mary R Loeken, Michael J A Maresh, Angela Napoli, Paula M O'Shea, Ewa Wender-Ozegowska, Mireille N M Van Poppel, Shakila Thangaratinam, Caroline Crowther, Linda M Biesty, Declan Devane, Fidelma P Dunne

Paediatrics Publications

AIMS/HYPOTHESIS: The aim of this systematic review was to develop core outcome sets (COSs) for trials evaluating interventions for the prevention or treatment of gestational diabetes mellitus (GDM).

METHODS: We identified previously reported outcomes through a systematic review of the literature. These outcomes were presented to key stakeholders (including patient representatives, researchers and clinicians) for prioritisation using a three-round, e-Delphi study. A priori consensus criteria informed which outcomes were brought forward for discussion at a face-to-face consensus meeting where the COS was finalised.

RESULTS: Our review identified 74 GDM prevention and 116 GDM treatment outcomes, which were presented to stakeholders …

Evidence Of Increased Hypoxia Signaling In Fetal Liver From Maternal Nutrient Restriction In Mice., Bethany N Radford, Victor K M Han

Paediatrics Publications

BACKGROUND: Intrauterine growth restriction (IUGR) is a pregnancy condition where fetal growth is reduced, and offspring from IUGR pregnancies are at increased risk for type II diabetes as adults. The liver is susceptible to fetal undernutrition experienced by IUGR infants and animal models of growth restriction. This study aimed to examine hepatic expression changes in a maternal nutrient restriction (MNR) mouse model of IUGR to understand fetal adaptations that influence adult metabolism.

METHODS: Liver samples of male offspring from MNR (70% of ad libitum starting at E6.5) or control pregnancies were obtained at E18.5 and differential expression was assessed by …

Placental Micrornas In Pregnancies With Early Onset Intrauterine Growth Restriction And Preeclampsia: Potential Impact On Gene Expression And Pathophysiology., Zain Awamleh, Gregory B Gloor, Victor K M Han

Paediatrics Publications

BACKGROUND:
A normally developed placenta is integral to a successful pregnancy. Preeclampsia (PE) and intrauterine growth restriction (IUGR) are two common pregnancy related complications that maybe a result of abnormal placental development. Placental microRNAs (miRNAs) have been investigated as potential biomarkers for these complications, as they may play a role in placental development and pathophysiology by influencing gene expression. The purpose of this study is to utilize next-generation sequencing to determine miRNA and gene expression in human placental (chorionic villous) samples from three distinct patient groups with early-onset (EO) PE, IUGR, or PE + IUGR.

METHODS:
Placental tissues were collected …

Novel Roles Of Mechanistic Target Of Rapamycin Signaling In Regulating Fetal Growth, Madhulika B. Gupta, Thomas Jansson

Paediatrics Publications

Mechanistic target of rapamycin (mTOR) signaling functions as a central regulator of cellular metabolism, growth, and survival in response to hormones, growth factors, nutrients, energy, and stress signals. Mechanistic TOR is therefore critical for the growth of most fetal organs, and global mTOR deletion is embryonic lethal. This review discusses emerging evidence suggesting that mTOR signaling also has a role as a critical hub in the overall homeostatic control of fetal growth, adjusting the fetal growth trajectory according to the ability of the maternal supply line to support fetal growth. In the fetus, liver mTOR governs the secretion and phosphorylation …

Mediators Of Lifestyle Behaviour Changes In Obese Pregnant Women. Secondary Analyses From The Dali Lifestyle Randomised Controlled Trial, Mireille N.M. Van Poppel, Judith G.M. Jelsma, David Simmons, Roland Devlieger, Goele Jans, Sander Galjaard, Rosa Corcoy, Juan M. Adelantado, Fidelma Teh, Matt Firth, Takashi Ushiki, Christopher E. Andoniou, Mariapia A. Degli-Esposti, Phillip P. Sharp, Caroline E. Sanvitale, Giuseppe Infusini, Nicholas P.D. Liau, Edmond M. Linossi, Christopher J. Burns, Sebastian Carotta, Daniel H.D. Gray, Cyril Seillet, Dana S. Hutchinson, Gabrielle T. Belz, Andrew I. Webb, Warren S. Alexander

Paediatrics Publications

A better understanding of what drives behaviour change in obese pregnant overweight women is needed to improve the effectiveness of lifestyle interventions in this group at risk for gestational diabetes (GDM). Therefore, we assessed which factors mediated behaviour change in the Vitamin D and Lifestyle Intervention for GDM Prevention (DALI) Lifestyle Study. A total of 436 women, with pre-pregnancy body mass index ≥29 kg/m 2 , ≤19 + 6 weeks of gestation and without GDM, were randomised for counselling based on motivational interviewing (MI) on healthy eating and physical activity, healthy eating alone, physical activity alone, or to a usual …

Vitamin D And Gestational Diabetes Mellitus: Is There A Link?, Gianluca Rizzo, Simone Garzon, Michele Fichera, Marco Marzio Panella, Ursula Catena, Antonio Schiattarella, Pasquale De Franciscis, George Vilos, Jan Tesarik, Péter Török, Giuseppe Grosso

Paediatrics Publications

Gestational diabetes mellitus (GDM) is a very common condition among pregnant women worldwide with important metabolic implications on the mother and the offspring. Vitamin D status has been suggested to potentially play a role in GDM risk with no documented consequences for the offspring. The purpose of this article was to review currently available evidence on the relationship between vitamin D and GDM. Current evidence shows an association between vitamin D blood levels and risk of GDM, despite heterogeneity of results across studies limit the conclusions. Moreover, data from randomized controlled trials is scarce and resulting in null findings. Among …

A Mouse Model Of Gestational Glucose Intolerance Through Exposure To A Low Protein Diet During Fetal And Neonatal Development, Sandra K. Szlapinski, Renee T. King, Gabrielle Retta, Erica Yeo, Brenda J. Strutt, David J. Hill

Paediatrics Publications

Key points: Pancreatic β-cell dysfunction is hypothesized to be the significant determinant of gestational diabetes pathogenesis, however pancreatic samples from patients are scarce. This study reports a novel mouse model of gestational glucose intolerance in pregnancy, originating from previous nutrition restriction in utero, in which glucose intolerance was restricted to late gestation as is seen in human gestational diabetes. Glucose intolerance was attributed to reduced β-cell proliferation, leading to impaired gestational β-cell mass expansion in maternal endocrine pancreas, in addition to reduced glucose-stimulated insulin secretion. This model reproduces some of the features of gestational diabetes and is suitable for testing …

Guinea Pig Models For Translation Of The Developmental Origins Of Health And Disease Hypothesis Into The Clinic, Janna L. Morrison, Kimberley J. Botting, Jack R.T. Darby, Anna L. David, Rebecca M. Dyson, Kathryn L. Gatford, Clint Gray, Emilio A. Herrera, Jonathan J. Hirst, Bona Kim, Karen L. Kind, Bernardo J. Krause, Stephen G. Matthews, Hannah K. Palliser, Timothy R.H. Regnault, Bryan S. Richardson, Aya Sasaki, Loren P. Thompson, Mary J. Berry

Paediatrics Publications

Over 30 years ago Professor David Barker first proposed the theory that events in early life could explain an individual's risk of non-communicable disease in later life: the developmental origins of health and disease (DOHaD) hypothesis. During the 1990s the validity of the DOHaD hypothesis was extensively tested in a number of human populations and the mechanisms underpinning it characterised in a range of experimental animal models. Over the past decade, researchers have sought to use this mechanistic understanding of DOHaD to develop therapeutic interventions during pregnancy and early life to improve adult health. A variety of animal models have …

Improving Pregnancy Outcomes In Humans Through Studies In Sheep, Janna L. Morrison, Mary J. Berry, Kimberley J. Botting, Jack R.T. Darby, Martin G. Frasch, Kathryn L. Gatford, Dino A. Giussani, Clint L. Gray, Richard Harding, Emilio A. Herrera, Matthew W. Kemp, Mitchell C. Lock, I. Caroline Mcmillen, Timothy J. Moss, Gabrielle C. Musk, Mark H. Oliver, Timothy R.H. Regnault, Claire T. Roberts, Jia Yin Soo, Ross L. Tellam

Paediatrics Publications

Experimental studies that are relevant to human pregnancy rely on the selection of appropriate animal models as an important element in experimental design. Consideration of the strengths and weaknesses of any animal model of human disease is fundamental to effective and meaningful translation of preclinical research. Studies in sheep have made significant contributions to our understanding of the normal and abnormal development of the fetus. As a model of human pregnancy, studies in sheep have enabled scientists and clinicians to answer questions about the etiology and treatment of poor maternal, placental, and fetal health and to provide an evidence base …

Association Between Gestational Weight Gain, Gestational Diabetes Risk, And Obstetric Outcomes: A Randomized Controlled Trial Post Hoc Analysis, David Simmons, Roland Devlieger, Andre Van Assche, Sander Galjaard, Rosa Corcoy, Juan M. Adelantado, Fidelma Dunne, Gernot Desoye, Alexandra Abenhaim, Jehier Afifi, Ruben Alvaro, James Andrews, Anthony Armson, Francois Audibert, Khalid Aziz, Marilyn Ballantyne, Jon Barrett, Marc Beltempo, Anick Berard, Valerie Bertelle, Lucie Blais, Alan Bocking, Jaya Bodani, Jason Burrows, Kimberly Butt, Roderick Canning

Paediatrics Publications

Excess gestational weight gain (GWG) is associated with the development of gestational diabetes mellitus (GDM). Lifestyle trials have not achieved much GWG limitation, and have largely failed to prevent GDM. We compared the effect of substantial GWG limitation on maternal GDM risk. Pregnant women with a body mass index (BMI) ≥29 kg/m2 <20 weeks gestation without GDM (n = 436) were randomized, in a multicenter trial, to usual care (UC), healthy eating (HE), physical activity (PA), or HE and PA lifestyle interventions. GWG over the median was associated with higher homeostasis model assessment insulin resistance (HOMA-IR) and insulin secretion (Stumvoll phases 1 and 2), a higher fasting plasma glucose (FPG) at 24–28 weeks (4.66 ± 0.43 vs. 4.61 ± 0.40 mmol/L, p < 0.01), and a higher rate of caesarean section (38% vs. 27% p < 0.05). The GWG over the median at 35–37 weeks was associated with a higher rate of macrosomia (25% vs. 16%, p < 0.05). A post hoc comparison among women from the five sites with a GWG difference >3 kg showed no significance difference in glycaemia or insulin resistance between HE and PA, and UC. We conclude that preventing even substantial increases in GWG after the first trimester has little effect on maternal glycaemia. We recommend randomized controlled trials of effective lifestyle interventions, starting in or …

Correlates Of Poor Mental Health In Early Pregnancy In Obese European Women, Matteo C. Sattler, Judith G.M. Jelsma, Annick Bogaerts, David Simmons, Gernot Desoye, Rosa Corcoy, Juan M. Adelantado, Alexandra Kautzky-Willer

Paediatrics Publications

Background: Depression during pregnancy is associated with higher maternal morbidity and mortality, and subsequent possible adverse effects on the cognitive, emotional and behavioral development of the child. The aim of the study was to identify maternal characteristics associated with poor mental health, in a group of overweight/obese pregnant women in nine European countries, and thus, to contribute to better recognition and intervention for maternal depression. Methods: In this cross-sectional observational study, baseline data from early pregnancy (< 20 weeks) of the DALI (Vitamin D and Lifestyle Intervention for gestational diabetes mellitus prevention) study were analyzed. Maternal mental health was assessed with the World Health Organization Well-Being Index (WHO-5). Women were classified as having a low (WHO-5 ≤ 50) or high wellbeing. Results.: A total of 735 pregnant women were included. The prevalence of having a low wellbeing was 27.2%, 95% CI [24.0, 30.4]. Multivariate analysis showed independent associations between low wellbeing and European ethnicity, OR = .44, 95% CI [.25,.77], shift work, OR = 1.81, 95% CI [1.11, 2.93], insufficient sleep, OR = 3.30, 95% CI [1.96, 5.55], self-efficacy, OR = .95, 95% CI [.92,.98], social support, OR = .94, 95% CI [.90,.99], and pregnancy-related worries (socioeconomic: OR = 1.08, 95% CI [1.02, 1.15]; health: OR = 1.06, 95% CI [1.01, 1.11]; relationship: OR = 1.17, 95% CI [1.05, 1.31]). Conclusions: Mental health problems are common in European overweight/obese pregnant women. The identified correlates might help in early recognition and subsequent treatment of poor mental health problems during pregnancy. This is important to reduce the unfavorable effects of poor mental health on pregnancy outcomes. Trial registration:ISRCTN70595832 , 02.12.2011.

Exercise And Pregnancy In Recreational And Elite Athletes: 2016/17 Evidence Summary From The Ioc Expert Group Meeting, Lausanne. Part 3 - Exercise In The Postpartum Period, Kari Bø, Raul Artal, Ruben Barakat, Wendy J. Brown, Gregory A.L. Davies, Michael Dooley, Kelly R. Evenson, Lene A.H. Haakstad, Bengt Pusic, Don Mcconnell, Cheri Nijssen-Jordan, Norm Silver, Brett Taylor, Ian G. Stiell

Paediatrics Publications

This is Part 3 in the series of reviews from the IOC expert committee on exercise and pregnancy in recreational and elite athletes. Part 1 focused on the effects of training during pregnancy and on the management of common pregnancy-related complaints experienced by athletes1; Part 2 addressed maternal and fetal perinatal outcomes.2 In this part, we review the implications of pregnancy and childbirth on return to exercise and on common illnesses and complaints in the postpartum period. The postpartum period can be divided into hospital-based (during hospital stay), immediate postpartum (hospital discharge to 6 weeks postpartum) and later postpartum (6 …