Predictors of excessive and inadequate gestational weight gain in Hispanic women

Factors influencing gestational weight gain are incompletely understood, particularly among Hispanic women. We assessed medical, sociodemographic, behavioral, and psychosocial predictors of overall gestational weight gain, as well as gains below, within, or above the range recommended by the Institute of Medicine (IOM) within a prospective study of 770 Hispanic (predominantly Puerto Rican) prenatal care patients at a large tertiary care facility in Western Massachusetts. One third of women gained within the recommended range, 22% gained below, and 45% gained above the range. In multivariate analysis, women in the highest category of BMI (P(trend)<0.001) and parity (P(trend)<0.001) gained on average 9 lbs less than those in the lowest category. Increasing time in residence in the continental United States (P(trend)<0.01) as well as a number of prenatal care visits (P(trend)=0.03) were positively associated with weight gain. Overweight women (odds ratio (OR)=2.2, 95% confidence interval (CI) 1.3, 3.8) and those over age 30 years (OR=2.5, 95% CI 1.2, 5.0) were more likely to gain above the IOM range as compared to normal-weight women and those aged 20-24, respectively. Women with <10 years of residence in the United States were 50% less likely to gain above the IOM range as compared to third-generation women (95% CI 0.3, 0.9). Findings identify determinants of gestational weight gain which can form the basis of targeted interventions in this rapidly growing ethnic group.     

Predictors of poor perinatal outcome following maternal perception of reduced fetal movements--a prospective cohort study

Background

Maternal perception of reduced fetal movement (RFM) is associated with increased risk of stillbirth and fetal growth restriction (FGR). RFM is thought to represent fetal compensation to conserve energy due to insufficient oxygen and nutrient transfer resulting from placental insufficiency.

Objective

To identify predictors of poor perinatal outcome after maternal perception of reduced fetal movements (RFM).

Design

Prospective cohort study.

Methods

305 women presenting with RFM after 28 weeks of gestation were recruited. Demographic factors and clinical history were recorded and ultrasound performed to assess fetal biometry, liquor volume and umbilical artery Doppler. A maternal serum sample was obtained for measurement of placentally-derived or modified proteins including: alpha fetoprotein (AFP), human chorionic gonadotrophin (hCG), human placental lactogen (hPL), ischaemia-modified albumin (IMA), pregnancy associated plasma protein A (PAPP-A) and progesterone. Factors related to poor perinatal outcome were determined by logistic regression.

Results

22.1% of pregnancies ended in a poor perinatal outcome after RFM. The most common complication was small-for-gestational age infants. Pregnancy outcome after maternal perception of RFM was related to amount of fetal activity while being monitored, abnormal fetal heart rate trace, diastolic blood pressure, estimated fetal weight, liquor volume, serum hCG and hPL. Following multiple logistic regression abnormal fetal heart rate trace (Odds ratio 7.08, 95% Confidence Interval 1.31–38.18), (OR) diastolic blood pressure (OR 1.04 (95% CI 1.01–1.09), estimated fetal weight centile (OR 0.95, 95% CI 0.94–0.97) and log maternal serum hPL (OR 0.13, 95% CI 0.02–0.99) were independently related to pregnancy outcome. hPL was related to placental mass.

Conclusion

Poor perinatal outcome after maternal perception of RFM is closely related to factors which are connected to placental dysfunction. Novel tests of placental function and associated fetal response may provide improved means to detect fetuses at greatest risk of poor perinatal outcome after RFM.     

Relative contributions of maternal social and biological characteristics to birth weight and gestation among mothers of different childhood socioeconomic status

There has been no reported systematic attempt to quantify the relative unique contribution of multiple social and biologic maternal characteristics to birthweight and gestational time among mothers of differing childhood socioeconomic backgrounds. This issue was examined in 3 nativity cohorts from a population of 766 black prenatal clinic patients in New York City using a series of stepwise hierarchical multiple regression analyses. Different variable sets contributed to birthweight variance in each group, although total variance explained was similar for the 3. Since the foreign-born cohort represented a different higher childhood socioeconomic background, but was similar to the other groups in current socioeconomic status, the differing observed associations of variable sets to birthweight may be related to childhood socioeconomic status. In all groups, social factors show more effect on gestation among those births more than 2500 grams than for smaller babies and thus account for more total explained birthweight variance for births over 2500 grams. Future research is necessary to replicate these results in the general population since this is the 1st study using multivariate techniques to look at social and biological factors associated with birthweight in groups with different childhood social backgrounds.     

Relative contributions of maternal social and biological characteristics to birth weight and gestation among mothers of different childhood socioeconomic status

Abstract

There has been no reported systematic attempt to quantify the relative unique contribution of multiple social and biologic maternal characteristics to birth weight and gestational time among mothers of differing childhood socioeconomic backgrounds. We examined this issue in three nativity cohorts from a population of 766 black prenatal clinic patients in New York City using a series of stepwise hierarchical multiple regression analyses. Different variable sets contributed to birth weight variance in each group, although total variance explained was similar for the three. Since the foreign‐born cohort represented a different higher childhood socioeconomic background, but was similar to the other groups in current SES, the differing observed associations of variable sets to birth weight may be related to childhood socioeconomic status. In all groups, social factors show more effect on gestation among births more than 2,500 grams than for smaller babies and thus account for more total explained birth weight variance for births over 2,500 grams.     

Effect of orlistat on eating behavior among participants in a 3-year weight maintenance trial

Objective: To examine the effect of orlistat on dietary restraint, disinhibition, hunger, and binge eating and to understand the relation between changes in eating behavior and weight maintenance. Methods and Procedures: Subjects were 306 women and men (age: 19–45 years; BMI: 37.5 ± 4.1 kg/m²) included in the Scandinavian Multicenter study of Obese subjects with the Metabolic Syndrome, a 3‐year clinical trial of orlistat or placebo following an 8‐week very low energy diet (VLED). Outcomes were changes in weight and in the Three Factor Eating Questionnaire (TFEQ) and Binge Eating Scale (BES) between screening and 17 and 33 months after randomization. As reported previously, weight gain following VLED was lower in subjects treated with orlistat than with placebo. Results: Compared to screening results, dietary restraint was increased and disinhibition, hunger, and binge eating were decreased in both groups. These changes were similar in both groups with the exception of the hunger score at month 33 that was reduced more in the placebo than in the orlistat group (difference between groups ?1.1 (95% CI (?2.0, ?0.2)) P = 0.014). In multivariate analyses, scores for restraint, disinhibition and binge eating were associated with weight loss after adjustment for BMI, gender, age, and treatment (all P ≤ 0.002, model R ² = 0.12–0.17). Discussion: Orlistat did not affect eating behavior differently in any substantial way than the placebo did in this long‐term weight maintenance trial. The results indicate that increased restraint and decreased disinhibition and binge eating are important for sustained weight maintenance in obese subjects with the metabolic syndrome.     

Over, under, or about right: misperceptions of body weight among food stamp participants

The purpose of this research was to investigate the associations between misperception of body weight and sociodemographic factors such as food stamp participation status, income, education, and race/ethnicity. National Health and Nutrition Examination Survey (NHANES) data from 1999-2004 and multivariate logistic regression are used to estimate how sociodemographic factors are associated with (i) the probability that overweight adults misperceive themselves as healthy weight; (ii) the probability that healthy-weight adults misperceive themselves as underweight; and (iii) the probability that healthy-weight adults misperceive themselves as overweight. NHANES data are representative of the US civilian noninstitutionalized population. The analysis included 4,362 men and 4,057 women. BMI derived from measured weight and height was used to classify individuals as healthy weight or overweight. These classifications were compared with self-reported categorical weight status. We find that differences across sociodemographic characteristics in the propensity to underestimate or overestimate weight status were more pronounced for women than for men. Overweight female food stamp participants were more likely to underestimate weight status than income-eligible nonparticipants. Among healthy-weight and overweight women, non-Hispanic black and Mexican-American women, and women with less education were more likely to underestimate actual weight status. We found few differences across sociodemographic characteristics for men. Misperceptions of weight are common among both overweight and healthy-weight individuals and vary across socioeconomic and demographic groups. The nutrition education component of the Food Stamp Program could increase awareness of healthy body weight among participants.     

Effect of maternal weight, adipokines, glucose intolerance and lipids on infant birth weight among women without gestational diabetes mellitus

Background:

The delivery of excess maternal nutrients to the fetus is known to increase the risk of macrosomia, even among infants of women without gestational diabetes mellitus. With the current obesity epidemic, maternal adiposity and its associated effects on circulating adipokines and inflammatory proteins may now have a greater impact on fetal growth. We sought to evaluate the independent effects of maternal glycemia, lipids, obesity, adipokines and inflammation on infant birth weight.

Methods:

We included 472 women who underwent an oral glucose tolerance test in late pregnancy and were found not to have gestational diabetes; 104 (22.0%) had gestational impaired glucose tolerance. We also measured fasting levels of insulin, low-and high-density lipoprotein cholesterol, triglycerides, leptin, adiponectin and C-reactive protein. Obstetric outcomes were assessed at delivery.

Results:

The mean birth weight was 3481 g (standard deviation 493 g); 68 of the infants were large for gestational age. On multiple linear regression analysis, positive determinants of birth weight were length of gestation, male infant, weight gain during pregnancy up to the time of the oral glucose tolerance test, body mass index (BMI) before pregnancy and impaired glucose tolerance in pregnancy. Leptin, adiponectin and C-reactive protein levels were each negatively associated with birth weight. On logistic regression analysis, the significant metabolic predictors of having a large-for-gestational-age infant were BMI before pregnancy (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.05–1.27, per 1 kg/m² increase), weight gain during pregnancy up to the time of the oral glucose tolerance test (OR 1.12, 95% CI 1.05–1.19, per 1 kg increase) and leptin level (OR 0.50, 95% CI 0.30–0.82, per 1 standard deviation change).

Interpretation:

Among women without gestational diabetes, maternal adiposity and leptin levels were the strongest metabolic determinants of having a large-for-gestational-age infant rather than glucose intolerance and lipid levels.In 1952, Jørgen Pedersen proposed that delivery of excess maternal glucose to the fetus may be responsible for the increased risk of macrosomia among infants of women with diabetes during pregnancy.¹ He postulated that maternal hyperglycemia leads to fetal hyperglycemia, which in turn stimulates insulin secretion in the fetus, the anabolic effects of which result in excessive fetal growth. Since its introduction, the Pedersen hypothesis has been further extended by other investigators and accepted as the pathophysiologic basis for increased risk of macrosomia among infants of women with diabetes during pregnancy.^2,3 Accordingly, for pregnant women with either pre-existing diabetes or gestational diabetes, modern clinical practice focuses on normalizing blood glucose levels to reduce the risk of fetal hyperglycemia and hence the risk of fetal macrosomia and its associated adverse clinical outcomes (e.g., shoulder dystocia, birth injury, need for cesarean delivery).It is now recognized that the association between maternal nutrients and fetal growth is not restricted solely to women with diabetes. Several studies have shown associations linking maternal blood glucose and triglyceride levels with infant birth weight among women without gestational diabetes.^4–7 This awareness has led to recent recommendations to lower the diagnostic thresholds for gestational diabetes on glucose tolerance testing in pregnancy, to optimize the detection of women who may be at risk of having a large-for-gestational-age infant.⁸Another important factor relevant to the risk of macrosomia is maternal adiposity.⁹ Indeed, the past decade has seen a marked increase in the prevalence of pre-existing obesity among pregnant women.¹⁰ In the context of the current obesity epidemic, we hypothesized that, in women without gestational diabetes, maternal adiposity and its associated effects on circulating levels of adipokines (e.g., adiponectin and leptin) and inflammatory proteins (C-reactive protein) may now have a greater impact than glucose and lipid levels on fetal growth. We conducted this study to evaluate the independent effects of maternal glycemia, lipid levels, obesity, adipokine levels and inflammation on the infant birth weight in a cohort of women without gestational diabetes.     

Use of "entertainment" chimpanzees in commercials distorts public perception regarding their conservation status

Chimpanzees (Pan troglodytes) are often used in movies, commercials and print advertisements with the intention of eliciting a humorous response from audiences. The portrayal of chimpanzees in unnatural, human-like situations may have a negative effect on the public's understanding of their endangered status in the wild while making them appear as suitable pets. Alternatively, media content that elicits a positive emotional response toward chimpanzees may increase the public's commitment to chimpanzee conservation. To test these competing hypotheses, participants (n?=?165) watched a series of commercials in an experiment framed as a marketing study. Imbedded within the same series of commercials was one of three chimpanzee videos. Participants either watched 1) a chimpanzee conservation commercial, 2) commercials containing "entertainment" chimpanzees or 3) control footage of the natural behavior of wild chimpanzees. Results from a post-viewing questionnaire reveal that participants who watched the conservation message understood that chimpanzees were endangered and unsuitable as pets at higher levels than those viewing the control footage. Meanwhile participants watching commercials with entertainment chimpanzees showed a decrease in understanding relative to those watching the control footage. In addition, when participants were given the opportunity to donate part of their earnings from the experiment to a conservation charity, donations were least frequent in the group watching commercials with entertainment chimpanzees. Control questions show that participants did not detect the purpose of the study. These results firmly support the hypothesis that use of entertainment chimpanzees in the popular media negatively distorts the public's perception and hinders chimpanzee conservation efforts.     

Effect of number of rooms and sibs on nutritional status among rural Bengalee preschool children from eastern India

In developing countries including rural India, undernutrition among preschool children is one of the main barriers of the national development. However, there exists scanty information on the prevalence of underweight and stunting and their socio-demographic predictors among preschool children in India and West Bengal. The aim of the present study was to investigate the prevalence of underweight and stunting and the impact of two socio-demographic indicators, namely number of living rooms (NLR) and number of sibs (NS), on them among 1-5 year old Bengalee rural preschool children of Integrated Child Development Services (ICDS) Centres. This cross sectional study was undertaken at 30 randomly selected ICDS centre of Chapra Block, Nadia District, West Bengal, India. A total of 673 children, aged 1-5 years were studied. The overall (age and sex combined) rates of underweight and stunting were 54.40% and 39.20%, respectively. NLR was significantly associated with the prevalence of underweight (chi2 = 4.34, df = 1, p < 0.05) and stunting (chi2 = 8.98, df = 1, p < 0.01) among girls. Similarly, NS had a significant association with prevalence of underweight (chi2 = 10.29, df = 1, p < 0.001) and stunting (chi2 = 5.42, df = 1, p < 0.05) among girls. Girls with < 2 NLR had significant higher risk of being underweight (OR = 1.64, C.I = 1.30-2.62) or stunted (OR=2.23, C.I = 1.31-3.80) than those with > or = 2 NLR. Moreover, girls with > or = 3 NS had significant higher rate of underweight (OR = 2.03, CI = 1.32-3.146) or stunting (OR = 1.69, C.I = 1.09-2.63) than those with < 3 sibs. Logistic regression analyses also revealed that both NLR as well as NS were strong predictors of underweight (NLR: Wald = 4.30, p < 0.05; NS: Wald = 8.74, p < 0.001) and stunting (NLR: Wald = 10.17, p < 0.001; NS: Wald = 5.38, p < 0.05) among girls. Gender discrimination could be a likely cause for this sex difference in the impact of NRL and NS. Moreover, logistic regression were also undertaken with underweight and stunting status (yes/ no) as dependent variables and NLR and NS (combined) as independent variables to identify their effects, when considered together, on undernutrition. Results showed that NS had significant impact on underweight (Wald = 8.28, p < 0.001) rather than NLR among girls. Results also demonstrated that NLR had significant impact on stunting (Wald = 6.874, p < 0.01) rather than NS.     

Effects of weight status and barriers on physical activity adoption among previously inactive women

This study examined self‐reported physical activity (PA) barriers, and their effects on PA behavior change at 3 and 12 months among 280 previously inactive women enrolled in a PA promotion trial. Effect modification of baseline barriers by baseline weight status on PA behavior change was also examined. At baseline and month 12, obese women reported significantly greater PA barriers compared with normal and overweight women (P < 0.05). Individual barriers that were more likely to be elevated for obese vs. normal and overweight participants at baseline were feeling too overweight, feeling self‐conscious, reporting minor aches and pains, and lack of self‐discipline. Also, weight status moderated the effect of PA barriers on PA behavior change from baseline to month 3 (P < 0.05), but not to month 12 (P = 0.637), with obese participants reporting high barriers achieving 70 min/week fewer than those with low barriers (P < 0.05). Finally, the interaction between barriers (high vs. low) and weight status (obese vs. normal), shows PA barriers had a detrimental PA effect among obese participants that was 122.5 min/week (95% confidence interval (CI) = 15.7, 229.4; P < 0.05) lower than their effect on normal‐weight participants. These results suggest that for obese women, PA barriers have quantifiable effects on PA behavior change. This study has implications for the design of future weight loss and PA interventions, suggesting that a comprehensive assessment of PA barriers is a prerequisite for appropriate tailoring of behavioral PA interventions.     

An observational study of associations among maternal fluids during parturition, neonatal output, and breastfed newborn weight loss

Background

Counselling human immunodeficiency virus (HIV) positive mothers on safer infant and young child feeding (IYCF) options is an important component of programmes to prevent mother to child transmission of HIV, but the quality of counselling is often inadequate. The aim of this study was to determine the effect the World Health Organization HIV and infant feeding cards on the quality of counselling provided to HIV positive mothers by health workers about safer infant feeding options.

Method

This was a un-blinded cluster-randomized controlled field trial in which 36 primary health facilities in Kafue and Lusaka districts in Zambia were randomized to intervention (IYCF counselling with counselling cards) or non- intervention arm (IYCF counselling without counselling cards). Counselling sessions with 10 HIV positive women attending each facility were observed and exit interviews were conducted by research assistants.

Results

Totals of 180 women in the intervention group and 180 women in the control group were attended to by health care providers and interviewed upon exiting the health facility. The health care providers in the intervention facilities more often discussed the advantages of disclosing their HIV status to a household member (RR = 1.46, 95% CI [1.11, 1.92]); used visual aids in explaining the risk of HIV transmission through breast milk (RR = 4.65, 95% CI [2.28, 9.46]); and discussed the advantages and disadvantages of infant feeding options for HIV positive mothers (all p values < 0.05). The differences also included exploration of the home situation (p < 0.05); involving the partner in the process of choosing a feeding option (RR = 1.38, 95% CI [1.09, 1.75]); and exploring how the mother will manage to feed the baby when she is at work (RR = 2.82, 95% CI [1.70, 4.67]). The clients in the intervention group felt that the provider was more caring and understanding (RR = 1.81, 95% CI [1.19, 2.75]).

Conclusion

The addition of counselling cards to the IYCF counselling session for HIV positive mothers were a valuable aid to counselling and significantly improved the quality of the counselling session.     

Nanopore Cas9-targeted sequencing enables accurate and simultaneous identification of transgene integration sites,their structure and epigenetic status in recombinant Chinese hamster ovary cells

The integration of a transgene expression construct into the host genome is the initial step for the generation of recombinant cell lines used for biopharmaceutical production. The stability and level of recombinant gene expression in Chinese hamster ovary (CHO) can be correlated to the copy number, its integration site as well as the epigenetic context of the transgene vector. Also, undesired integration events, such as concatemers, truncated, and inverted vector repeats, are impacting the stability of recombinant cell lines. Thus, to characterize cell clones and to isolate the most promising candidates, it is crucial to obtain information on the site of integration, the structure of integrated sequence and the epigenetic status. Current sequencing techniques allow to gather this information separately but do not offer a comprehensive and simultaneous resolution. In this study, we present a fast and robust nanopore Cas9-targeted sequencing (nCats) pipeline to identify integration sites, the composition of the integrated sequence as well as its DNA methylation status in CHO cells that can be obtained simultaneously from the same sequencing run. A Cas9-enrichment step during library preparation enables targeted and directional nanopore sequencing with up to 724× median on-target coverage and up to 153 kb long reads. The data generated by nCats provides sensitive, detailed, and correct information on the transgene integration sites and the expression vector structure, which could only be partly produced by traditional Targeted Locus Amplification-seq data. Moreover, with nCats the DNA methylation status can be analyzed from the same raw data without prior DNA amplification.     

Differences in need for antihypertensive drugs among those aware and unaware of their hypertensive status: a cross sectional survey

Peripheral arterial disease (PAD) is a common, progressive manifestation of atherothrombotic vascular disease, which should be managed no different to cardiac disease. Indeed, there is growing evidence that PAD patients are a high risk group, although still relatively under-detected and under treated. This is despite the fact that PAD patients are an increased mortality rate comparable to those with pre-existing or established cardiovascular disease [myocardial infarction, stroke]. With a holistic approach to atherothrombotic vascular disease, our management of PAD can only get better.     

Pattern of evolutionarily distinct species among four classes of animals and their conservation status: a comparison using evolutionary distinctiveness scores

The percentage of species with high evolutionary distinctiveness (ED) scores in four different classes was related to conservation concern. We considered the number of species belonging to the upper level of the distribution of ED scores, and the overall distribution of ED scores in each category of concern assigned by IUCN. Generalized linear and mixed models were used to explore the relationship between variables, separately for each animal class. Overall values of ED score were higher for Squamates, Rhynchocephalia and amphibians than mammals and birds. However, the frequency distribution of ED scores was similar among classes, with a leptokurtotic distribution. Amphibians, reptiles, birds and mammals showed a markedly right skewed distribution, with a similar proportion of species in each equal category of the distribution. In all classes, the number of species with the highest ED score (positioned in the upper 20% of the frequency distribution of the variable) was very small ranging between 0.01 and 0.05%. ED score was slightly but negatively correlated with IUCN conservation status in amphibians, but unrelated in the other three classes. The bird population trend was unrelated to ED score of bird species in both USA and Europe. Also, the population’s trend for selected mammal species was unrelated to the ED score of those species. Our results provide more evidence that distribution shape of ED of animal forms is uniform among classes, with only very few species characterized by highest ED scores in each group. Surprisingly, ED score and IUCN conservation status were unrelated in the four classes examined. Finally, our study underlines that declining animals are not necessarily the most evolutionarily distinct species.     

The influence of maternal lineages on social affiliations among humpback whales (Megaptera novaeangliae) on their feeding grounds in the southern gulf of Maine

Humpback whales on their feeding grounds in the Gulf of Maine typically form fluid fission/fusion groups of two to three individuals characterized by noncompetitive and, at times, cooperative behavior. Here we test the hypothesis that, despite the apparent absence of close kinship bonds, the fluid associations between feeding whales are influenced by "maternal lineages" as represented by mtDNA haplotypes. Using skin samples collected with a biopsy dart, variation in the hypervariable segment of the mtDNA control region identified 17 unique haplotypes among 159 individually identified whales from the southern Gulf of Maine. The haplotypes of a further 143 individuals were inferred from known direct maternal (cow-calf) relationships. The frequencies of associations among these 302 individuals were calculated from 21,617 sighting records collected from 1980 to 1995, excluding associations between a cow and her dependent calf. For groups of two where the haplotypes of both individuals were known (n = 3,151), individuals with the same haplotype were together significantly more often (26%) than expected by random association (20%). To account for different group sizes and associations with individuals of unknown haplotype and sex, we used Monte Carlo simulations to test for nonrandom associations in the full data set, as well as known female-only (n = 1,512), male-only (n = 730), and mixed-sex (n = 2,745) groups. Within-haplotype associations were significantly more frequent than expected at random for all groups (P = .002) and female-only groups (P = .011) but not male-only groups, while mixed-sex groups approached significance (P = .062). A Mantel test of individual pairwise association indices and haplotype identity confirmed that within-haplotype associations were more frequent than expected for all sex combinations except male-male associations, with females forming within-haplotype associations 1.7 times more often than expected by random assortment. Partial matrix correlations and permutation analyses indicated that the skew toward within-haplotype associations could not be accounted for by short-term temporal co-occurrence or fine-scale spatial distributions of individuals with shared haplotypes. While the mechanism by which individuals with a common mtDNA haplotype assort remains unknown, our results strongly suggest an influence of maternal lineages on the social organization of humpback whales within a regional feeding ground.