BACKGROUND: In women with obesity, excess gestational weight gain (≥270 g/week) occurs in two out of three pregnancies and contributes to metabolic impairments in both mother and baby. To improve obstetrical care, objectively assessed information on energy balance is urgently needed. The objective of this study was to characterize determinants of gestational weight gain in women with obesity. METHODS: This was a prospective, observational study of pregnant women with obesity. The primary outcome was energy intake calculated by the energy intake-balance method. Energy expenditure was measured by doubly-labeled water and whole-room indirect calorimetry and body composition as 3-compartment model by air displacement plethysmography and isotope dilution in early (13-16 weeks) and late pregnancy (35-37 weeks). RESULTS: In pregnant women with obesity (n=54), recommended weight gain (n=8, 15%) during the second and third trimesters was achieved when energy intake was 125±52 kcal/d less than energy expenditure. In contrast, women with excess weight gain (67%) consumed 186±29 kcal/d more than they expended (P<0.001). Energy balance affected maternal adiposity (recommended: -2.5±0.8 kg fat mass, excess: +2.2±0.5, inadequate: -4.5±0.5, P<0.001), but not fetal growth. Weight gain was not related to demographics, activity, metabolic biomarkers, or diet quality. We estimated that energy intake requirements for recommended weight gain during the second and third trimesters were not increased as compared to energy requirements early in pregnancy (34±53 kcal/d, P=0.83). CONCLUSIONS: We here provide the first evidence-based recommendations for energy intake in pregnant women with obesity. Contrary to current recommendations, energy intake should not exceed energy expenditure. FUNDING: This study was funded by the National Institutes of Health (R01DK099175; Redman, U54GM104940 and P30DK072476; Core support). TRIAL REGISTRATION: clinicaltrials.gov: NCT01954342.
BACKGROUND: In women with obesity, excess gestational weight gain (≥270 g/week) occurs in two out of three pregnancies and contributes to metabolic impairments in both mother and baby. To improve obstetrical care, objectively assessed information on energy balance is urgently needed. The objective of this study was to characterize determinants of gestational weight gain in women with obesity. METHODS: This was a prospective, observational study of pregnant women with obesity. The primary outcome was energy intake calculated by the energy intake-balance method. Energy expenditure was measured by doubly-labeled water and whole-room indirect calorimetry and body composition as 3-compartment model by air displacement plethysmography and isotope dilution in early (13-16 weeks) and late pregnancy (35-37 weeks). RESULTS: In pregnant women with obesity (n=54), recommended weight gain (n=8, 15%) during the second and third trimesters was achieved when energy intake was 125±52 kcal/d less than energy expenditure. In contrast, women with excess weight gain (67%) consumed 186±29 kcal/d more than they expended (P<0.001). Energy balance affected maternal adiposity (recommended: -2.5±0.8 kg fat mass, excess: +2.2±0.5, inadequate: -4.5±0.5, P<0.001), but not fetal growth. Weight gain was not related to demographics, activity, metabolic biomarkers, or diet quality. We estimated that energy intake requirements for recommended weight gain during the second and third trimesters were not increased as compared to energy requirements early in pregnancy (34±53 kcal/d, P=0.83). CONCLUSIONS: We here provide the first evidence-based recommendations for energy intake in pregnant women with obesity. Contrary to current recommendations, energy intake should not exceed energy expenditure. FUNDING: This study was funded by the National Institutes of Health (R01DK099175; Redman, U54GM104940 and P30DK072476; Core support). TRIAL REGISTRATION: clinicaltrials.gov: NCT01954342.
Authors: Katherine M Flegal; Deanna Kruszon-Moran; Margaret D Carroll; Cheryl D Fryar; Cynthia L Ogden Journal: JAMA Date: 2016-06-07 Impact factor: 56.272
Authors: Patrick M Catalano; Kristen Farrell; Alicia Thomas; Larraine Huston-Presley; Patricia Mencin; Sylvie Hauguel de Mouzon; Saeid B Amini Journal: Am J Clin Nutr Date: 2009-09-16 Impact factor: 7.045
Authors: Nancy F Butte; William W Wong; Margarita S Treuth; Kenneth J Ellis; E O'Brian Smith Journal: Am J Clin Nutr Date: 2004-06 Impact factor: 7.045
Authors: David Simmons; Roland Devlieger; André van Assche; Goele Jans; Sander Galjaard; Rosa Corcoy; Juan M Adelantado; Fidelma Dunne; Gernot Desoye; Jürgen Harreiter; Alexandra Kautzky-Willer; Peter Damm; Elisabeth R Mathiesen; Dorte M Jensen; Liselotte Andersen; Annunziata Lapolla; Maria G Dalfrà; Alessandra Bertolotto; Ewa Wender-Ozegowska; Agnieszka Zawiejska; David Hill; Frank J Snoek; Judith G M Jelsma; Mireille N M van Poppel Journal: J Clin Endocrinol Metab Date: 2017-03-01 Impact factor: 5.958
Authors: Lucilla Poston; Ruth Bell; Helen Croker; Angela C Flynn; Keith M Godfrey; Louise Goff; Louise Hayes; Nina Khazaezadeh; Scott M Nelson; Eugene Oteng-Ntim; Dharmintra Pasupathy; Nashita Patel; Stephen C Robson; Jane Sandall; Thomas A B Sanders; Naveed Sattar; Paul T Seed; Jane Wardle; Melissa K Whitworth; Annette L Briley Journal: Lancet Diabetes Endocrinol Date: 2015-07-09 Impact factor: 32.069
Authors: Alison G Cahill; Debra Haire-Joshu; W Todd Cade; Richard I Stein; Candice L Woolfolk; Kelle Moley; Amit Mathur; Kenneth Schechtman; Samuel Klein Journal: Obesity (Silver Spring) Date: 2018-03 Impact factor: 5.002
Authors: Jasper Most; Porsha M Vallo; L Anne Gilmore; Marshall St Amant; Daniel S Hsia; Abby D Altazan; Robbie A Beyl; Eric Ravussin; Leanne M Redman Journal: Obesity (Silver Spring) Date: 2018-06 Impact factor: 5.002
Authors: Kimberly K Vesco; Njeri Karanja; Janet C King; Matthew W Gillman; Michael C Leo; Nancy Perrin; Cindy T McEvoy; Cara L Eckhardt; K Sabina Smith; Victor J Stevens Journal: Obesity (Silver Spring) Date: 2014-09 Impact factor: 5.002
Authors: Emily W Flanagan; Jasper Most; Abby D Altazan; Kristen E Boyle; Leanne M Redman Journal: Obesity (Silver Spring) Date: 2021-11 Impact factor: 9.298
Authors: Jasper Most; Abby D Altazan; Daniel S Hsia; Robbie A Beyl; Leanne M Redman Journal: Obesity (Silver Spring) Date: 2019-12-31 Impact factor: 5.002
Authors: Emily W Flanagan; Jasper Most; Nicholas T Broskey; Abby D Altazan; Robbie A Beyl; Sarah K Keadle; Kimberly L Drews; Prachi Singh; Leanne M Redman Journal: Sleep Med Date: 2020-12-05 Impact factor: 3.492
Authors: Lucy Peacock; Paul T Seed; Kathryn V Dalrymple; Sara L White; Lucilla Poston; Angela C Flynn Journal: Int J Environ Res Public Health Date: 2020-06-30 Impact factor: 3.390