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Gestational weight gain is defined as the amount of weight gain a woman experiences between conception and birth of an infant. [1]
The Institute of Medicine (IOM) recommendations for gestational weight gain are based on body mass index (BMI) of women prior to pregnancy. However, early first trimester BMI appears to be a valid proxy for pre-conception BMI. [2] BMI is split up into four categories: underweight (<18.5 kg/m^2), normal weight (18.5-24.9 kg/m^2), overweight (25-29.9 kg/m^2), and obese (≥30.0 kg/m^2). [3] The IOM has recommended the ranges of weight gain to be 12.5–18 kg, 11.5–16 kg, 7-11.5 kg, and 5–9 kg respectively. That is, the smaller the BMI pre pregnancy, the more weight a woman is expected to gain during her pregnancy. [3]
Excessive GWG (eGWG) has been shown to adversely affect maternal and baby health postpartum. [4] Only a little over a quarter of women have adequate GWG, meaning that their weight gain during pregnancy falls within the IOM recommended range. A little less than a quarter of women have inadequate GWG. However, excessive GWG is the most prevalent occurring in around half of pregnant women. [4] [5] [6] [7]
Having a higher BMI pre-pregnancy may leave one at a greater risk for excessive gestational weight gain and ultimately for cardio-metabolic diseases prenatally and postpartum. [7] [8] [9]
Food security is defined as consistent access, geographically or financially, to sufficient, nutritious, and affordable food and has been theorized to be a cause of excess gestational weight gain. [7] Women that only have access to fast food, for example, would be considered to be "lower food security", and these women might be more likely to suffer from excess gestational weight gain because the food available is cheap, but high in calories. [7] [4] [10] Having access to affordable and nutritious food has been linked to a lesser risk of impaired glucose tolerance. [10] which is related to excess gestational weight gain. [11]
It is not uncommon for there to be a correlation between socioeconomic status and food security; that is, women of low socioeconomic status have been reported to have low food security, particularly in terms of the affordability of nutritious food. [7] Some women of low socioeconomic status claim that they feel pressure to eat more during pregnancy out of the fear that they are not providing their babies with enough food. [7] [12] With low food security, these women would consume high calorie food in significant quantities, potentially leading to excess gestational weight gain. [7] There seems to be a negative correlation between food security and excess gestational weight gain that is sometimes related to socioeconomic status.[ citation needed ]
Overweight and obese women are significantly more likely to expect excessive gestational weight gain compared with normal-weight women, and women who report expecting to gain excessively are three times more likely to actually gain excessively than those who expect to gain within the guidelines. [13]
Regardless of a relation to food security, having a low income might also predispose women to excess gestational weight gain, yet the reasoning is unclear. [10] One possibility is related to stress. Financial stress has been shown to be positively correlated with levels of CRP postpartum, a stress hormone associated with weight gain most likely because people eat increasingly unhealthy when stressed. [14] Women with a higher monthly budget for food may have a healthier gestational weight gain, while those with less money allocated for food may be more likely to experience excessive gestational weight gain. [15] However, the opposite may also be true: wealthier women may be more likely to suffer from excess gestational weight gain. [4] [10] Women in wealthy communities have been reported to have higher postpartum weight retention than those in more poverty, [10] and since women who have excessive gestational weight gain are more likely to retain weight postpartum [16] [17] women in less poverty might be more likely to have excess gestational weight gain. [4] [10] This suggests that a greater household income does not necessarily provide protection against excess gestational weight gain.[ citation needed ]
Race/ethnicity is an important variable to take into account when discussing gestational weight gain because women of racial/ethnic minorities demonstrate disproportionately higher obesity levels than non-Hispanic white women. [8] [18] The IOM guidelines were created from data mostly consisting of white women, and thus may not be an appropriate measure for women of other races/ethnicities. [8]
African American women in general may have higher postpartum cardio-metabolic risk and more excess gestational weight gain than Latina women, who in turn have more than white women. [9] However, this is not always the case. One study reported that although African American women are more likely to be overweight or obese pre-pregnancy, they were less likely to have excessive weight gain than white women in one study. [8]
Even though in many areas in the United States, there has been a decline in inequality on the basis of race/ethnicity, there still exists disproportionate social stratification. [4] Racial/ethnic minorities, such as blacks and Latinos, are more likely to be found in neighborhoods high in poverty. [4] [9] African American women in poverty have been seen to have significantly higher postpartum cardio-metabolic risk than wealthier African American women, [9] which could be partially related to these impoverished women having excess gestational weight gain. [19] White women in poverty, on the other hand, had excess gestational weight gain and higher postpartum cardio-metabolic risk than the white women with higher incomes. [4] [9] This was also true for Latina women in poverty compared to those wealthier. [9] The information regarding how race/ethnicity affects experience of excess gestational weight gain can be related to poverty levels, and the data available is limited and variable.[ citation needed ]
Abdominal obesity, also known as central obesity and truncal obesity, is the human condition of an excessive concentration of visceral fat around the stomach and abdomen to such an extent that it is likely to harm its bearer's health. Abdominal obesity has been strongly linked to cardiovascular disease, Alzheimer's disease, and other metabolic and vascular diseases.
Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classified as obese when their body mass index (BMI)—a person's weight divided by the square of the person's height—is over 30 kg/m2; the range 25–30 kg/m2 is defined as overweight. Some East Asian countries use lower values to calculate obesity. Obesity is a major cause of disability and is correlated with various diseases and conditions, particularly cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis.
Gestational diabetes is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy. Gestational diabetes generally results in few symptoms; however, it increases the risk of pre-eclampsia, depression, and of needing a Caesarean section. Babies born to individuals with poorly treated gestational diabetes are at increased risk of macrosomia, of having hypoglycemia after birth, and of jaundice. If untreated, diabetes can also result in stillbirth. Long term, children are at higher risk of being overweight and of developing type 2 diabetes.
Weight gain is an increase in body weight. This can involve an increase in muscle mass, fat deposits, excess fluids such as water or other factors. Weight gain can be a symptom of a serious medical condition.
Large for gestational age (LGA) is a term used to describe infants that are born with an abnormally high weight, specifically in the 90th percentile or above, compared to other babies of the same developmental age. Macrosomia is a similar term that describes excessive birth weight, but refers to an absolute measurement, regardless of gestational age. Typically the threshold for diagnosing macrosomia is a body weight between 4,000 and 4,500 grams, or more, measured at birth, but there are difficulties reaching a universal agreement of this definition.
Birth weight is the body weight of a baby at their birth. The average birth weight in babies of European and African descent is 3.5 kilograms (7.7 lb), with the normative range between 2.5 and 4.0 kilograms. On average, babies of Asian descent weigh about 3.25 kilograms (7.2 lb). The prevalence of low birth weight has changed over time. Trends show a slight decrease from 7.9% (1970) to 6.8% (1980), then a slight increase to 8.3% (2006), to the current levels of 8.2% (2016). The prevalence of low birth weights has trended slightly upward from 2012 to the present.
Complications of pregnancy are health problems that are related to, or arise during pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal disorders. While some complications improve or are fully resolved after pregnancy, some may lead to lasting effects, morbidity, or in the most severe cases, maternal or fetal mortality.
An underweight person is a person whose body weight is considered too low to be healthy. A person who is underweight is malnourished.
Childhood obesity is a condition where excess body fat negatively affects a child's health or well-being. As methods to determine body fat directly are difficult, the diagnosis of obesity is often based on BMI. Due to the rising prevalence of obesity in children and its many adverse health effects it is being recognized as a serious public health concern. The term overweight rather than obese is often used when discussing childhood obesity, as it is less stigmatizing, although the term overweight can also refer to a different BMI category. The prevalence of childhood obesity is known to differ by sex and gender.
Maternal health is the health of women during pregnancy, childbirth, and the postpartum period. In most cases, maternal health encompasses the health care dimensions of family planning, preconception, prenatal, and postnatal care in order to ensure a positive and fulfilling experience. In other cases, maternal health can reduce maternal morbidity and mortality. Maternal health revolves around the health and wellness of pregnant women, particularly when they are pregnant, at the time they give birth, and during child-raising. WHO has indicated that even though motherhood has been considered as a fulfilling natural experience that is emotional to the mother, a high percentage of women develop health problems and sometimes even die. Because of this, there is a need to invest in the health of women. The investment can be achieved in different ways, among the main ones being subsidizing the healthcare cost, education on maternal health, encouraging effective family planning, and ensuring progressive check up on the health of women with children. Maternal morbidity and mortality particularly affects women of color and women living in low and lower-middle income countries.
Bariatric surgery is a surgical procedure used to manage obesity and obesity-related conditions. Long term weight loss with bariatric surgery may be achieved through alteration of gut hormones, physical reduction of stomach size, reduction of nutrient absorption, or a combination of these. Standard of care procedures include Roux en-Y bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch, from which weight loss is largely achieved by altering gut hormone levels responsible for hunger and satiety, leading to a new hormonal weight set point.
Metabolic imprinting refers to the long-term physiological and metabolic effects that an offspring's prenatal and postnatal environments have on them. Perinatal nutrition has been identified as a significant factor in determining an offspring's likelihood of it being predisposed to developing cardiovascular disease, obesity, and type 2 diabetes amongst other conditions.
Being overweight is having more body fat than is optimally healthy. Being overweight is especially common where food supplies are plentiful and lifestyles are sedentary.
Obesity is a risk factor for many chronic physical and mental illnesses.
Maternal obesity refers to obesity of a woman during pregnancy. Parental obesity refers to obesity of either parent during pregnancy.
Weight management refers to behaviors, techniques, and physiological processes that contribute to a person's ability to attain and maintain a healthy weight. Most weight management techniques encompass long-term lifestyle strategies that promote healthy eating and daily physical activity. Moreover, weight management involves developing meaningful ways to track weight over time and to identify the ideal body weights for different individuals.
Prenatal nutrition addresses nutrient recommendations before and during pregnancy. Nutrition and weight management before and during pregnancy has a profound effect on the development of infants. This is a rather critical time for healthy development since infants rely heavily on maternal stores and nutrient for optimal growth and health outcome later in life.
Obesity is defined as an abnormal accumulation of body fat, usually 20% or more over an individual's ideal body weight. This is often described as a body mass index (BMI) over 30. However, BMI does not account for whether the excess weight is fat or muscle, and is not a measure of body composition. For most people, however, BMI is an indication used worldwide to estimate nutritional status. Obesity is usually the result of consuming more calories than the body needs and not expending that energy by doing exercise. There are genetic causes and hormonal disorders that cause people to gain significant amounts of weight but this is rare. People in the obese category are much more likely to suffer from fertility problems than people of normal healthy weight.
Fetal programming, also known as prenatal programming, is the theory that environmental cues experienced during fetal development play a seminal role in determining health trajectories across the lifespan.
Maternal health outcomes differ significantly between racial groups within the United States. The American College of Obstetricians and Gynecologists describes these disparities in obstetric outcomes as "prevalent and persistent." Black, indigenous, and people of color are disproportionately affected by many of the maternal health outcomes listed as national objectives in the U.S. Department of Health and Human Services's national health objectives program, Healthy People 2030. The American Public Health Association considers maternal mortality to be a human rights issue, also noting the disparate rates of Black maternal death. Race affects maternal health throughout the pregnancy continuum, beginning prior to conception and continuing through pregnancy (antepartum), during labor and childbirth (intrapartum), and after birth (postpartum).