Energy and Weight Gain in Pregnancy 2012. Energy Requirements in Pregnancy Increased energy costs in pregnancy: –increased maternal metabolic rate –fetal

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  • Slide 1
  • Energy and Weight Gain in Pregnancy 2012
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  • Energy Requirements in Pregnancy Increased energy costs in pregnancy: increased maternal metabolic rate fetal tissues increase in maternal tissues
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  • DRI for Energy in Pregnancy - 2002
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  • Estimated Energy Requirement Average dietary energy intake that is predicted to maintain energy balance in a healthy adult of a defined age, gender, weight, height, level of physical activity consistent with good health. In children, pregnant and lactating women the EER is taken to include the needs associated with deposition of tissues or secretion of milk
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  • BEE: Basal Energy Expenditure BEE = energy consumed while at rest and fasting In pregnancy BEE increases due to metabolic contribution of uterus and fetus and increased work of heart and lungs. Variable for individuals
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  • Growth of Maternal and Fetal Tissues Calculations Based on: Hytten IOM weight gain recommendations
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  • T1 and T2 ~ 180 kcal per day
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  • Longitudinal Data from DLW Database Median TEE (total energy expenditure) change from non-pregnant was 8 kcal/gestational week. TEE changes little in first trimester.
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  • Variations in Energy Requirements Body size - especially lbm Activity: most women decrease activity in last months of pregnancy if they can increased energy cost of moving heavier body BMR rises in well nourished women (27%) rises less or not at all in women who are not well nourished -Diet Induced Thermogenesis?
  • Slide 16
  • Evidence of energy sparing in Gambian women during pregnancy: a longitudinal study using whole-body calorimetry (AJCN, 1993) N=58, initially recruited, ages 18-40 25 became pregnant 21 participated in study protocols 9 completed BMR and 24 hour energy expenditure 12 completed BMR Adjusted for seasonality, weight loss expected during wet season
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  • Poppitt et al., cont. Mean maternal prepregnancy weight was 52 kg Mean prepregnancy BMI was 21.2 + 2 Mean birthweight was 3.0 + 0.1 Mean gestational length was 39.4 Mean weight gain was 6.8 kg Mean fat gain was 2.0 kg at 36 weeks
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  • Poppitt et al., cont. BMR fell in early pregnancy Values per kg lbm remained below baseline for duration of pregnancy Individual variation was high
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  • Poppitt et al., cont. Energy sparing mechanisms may act via a suppression of metabolism in women on habitually low intakes. This maintains positive balance in the mother and protects the fetus from growth retardation
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  • Prentice and Goldberg. Energy Adaptations in human pregnancy: limits and long-term consequences. Am J Clin Nutr. 2000;71(supple):1226S-32S.
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  • Longitudinal assessment of energy balance in well-nourished, pregnant women (Koop-Hoolihan et al, AJCN, 1999) N=16, SF area 10 became pregnant BMI range was 19-26 Mean weight gain at 36 weeks was 11.6 + 4 kg Mean birth weight was 3.6 kg
  • Slide 24
  • Koop-Hoolihan, cont Protocol: 5 times before pregnancy, 3 times during, once 4-6 weeks postpartum RMR (resting metabolic rate/metabolic cart) DIT (diet induced thermogenesis/metabolic cart) TEE (total energy expenditure/doubly labeled water) AEE (activity energy expenditure/difference between TEE and RMR) EI (energy intake/3 day food records) Body composition - densitometry, tbw, bmc with absorptiometry
  • Slide 25
  • Koop-Hoolihan, cont Women with the largest cumulative increase in RMR deposited the least fat mass (this was the only prepregnant factor that predicted fat mass gain) In all indices there was large individual variation Average total energy cost of pregnancy was similar to work of Hytten and Leitch (1971) Food intake records indicated 9% increase in kcals with pregnancy, but highly variable
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  • Weight Gain in Pregnancy Components & patterns IOM recommendations 1990 2009
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  • Components of Weight Gain
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  • Patterns of Maternal Fat Accretion
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  • Maternal Weight Gain Year Number Included in Analysis < Ideal % > Ideal % 2009917,03221.248.2 2007920,89321.448.6 2005661,12822.248.9 2003594,31121.749.6 2001555,53722.448.6 1999505,06524.846.5 1997410,95930.940.8 1995363,95927.642.6 1993209,07428.640.3 1991110,40429.341.0 1990118,30130.640.6 1989104,11932.136.9 198817,68133.037.4 National Pregnancy Nutrition Surveillance http://www.cdc.gov/pe dnss/pnss_tables/htm l/pnss_national_table 16.htm
  • Slide 30
  • Percent of Women Gaining
  • Characteristics of Women Associated with Inadequate Weight Gain Lower education levels Unmarried Aged > 30 years Smoking Multiple parity Unintended pregnancy Psychosocial characteristics such as attitude toward weight gain, social support, depression, stress, anxiety, and self-efficacy. Hicky, CA. Am J Clin Nutr. 2000;71(supple):1364S-70S.
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  • 1990 IOM Recommendations Institute of Medicine. Nutrition during pregnancy, weight gain and nutrient supplements. Report of the Subcommittee on Nutritional Status and Weight Gain during Pregnancy, Subcommittee on Dietary Intake and Nutrient Supplements during Pregnancy, Committee on Nutritional Status during Pregnancy and Lactation, Food and Nutrition Board. Washington, DC: National Academy Press, 1990
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  • Cogswell M, Serdula M, Hungerford D, Yip R. Gestational weight gain among average-weight and overweight womenwhat is excessive? Am J Obstet Gynecol 1995;172:70512
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  • 1990: Recommended total weight gain in pregnant women by prepregnancy BMI (in kg/m 2 ) Weight-for-height categoryRecommended total gain (kg) Low (BMI 26.029.0) 2 711.5 Adolescents and black women should strive for gains at the upper end of the recommended range. Short women ( 29.0) is 6.0.
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  • Incidence of adverse outcomes for 6690 pregnancies in San Francisco Parker J, Abrams B. Prenatal weight gain advice: an examination of the recent prenatal weight gain recommendations of the Institute of Medicine. Obstet Gynecol 1992;79:6649
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  • Percentage of US women with normal prepregnancy weights who retained >9 kg 1024 mo postpartum relative to prepregnancy weight (Parker J, Abrams B. Differences in postpartum weight retention between black and white mothers. Obstet Gynecol 1993;81:76874)
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  • Percentage of US Women Who Gained >40 pounds during pregnancy (MMWR, February 2008) (source = birth certificates; singleton delivery only)
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  • * Obesity is defined as prepregnancy weight > 200 lbs Morbid obesity is defined as prepregnancy weight > 275 lbs Prepregnancy Obesity* Washington State,1992-2005
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  • Obesity by Parity and Race/Ethnicity Washington State, 2003-2005
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  • Weight Gain During Pregnancy: Reexamining the Guidelines (IOM, 2009) New Guidelines Conceptual Framework Composition and Components of Weight Gain Determinants of Weight Gain Maternal Consequences of Weight Gain Child Consequences of Weight Gain Determining Optimal Weight Gain Achieving Recommendations
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  • 2009 Guidelines for Specific Populations Women of Short Stature unable to identify evidence sufficient to continue to support a modification of GWG guidelines Pregnant Adolescents unable to identify evidence sufficient to continue to support a modification of GWG guidelines Racial or Ethnic Groups Recommendations should be generally applicable to the various racial or ethnic subgroups Women with Multiple Fetuses Provisional Guidelines for Twins (at term): Underweight: insufficient evidence Normal Weight: 17-25 kg Overweight : 14-23 kg Obese: 11-19 kg Obesity Classes II and III Insufficient evidence to develop more specific recommendations.
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  • Determinants of Gestational Weight Gain
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  • Determinants: Social & Policy Findings Health Services Evidence for influence is weak; advice missing, inconsistent, erroneous Communityneighborhood environments can influence GWG by providing access to healthy foods and opportunities for PA FamilyMarried women more likely to gain within guidelines; association between partner violence and insufficient GWG; family support associated with good GWG SESInteractive and confounding effects; food insecurity in obese women associated with high GWG
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  • Determinants: Genetics Maternal: insufficient evidence Fetal: GWG associated with birthweight; preliminary conclusions about fetal genotype and birthweight: (a) there is a fetal genotype effect on weight at birth (about 30 percent of the adjusted variance) (b) both parents genes influence birth weight with a stronger effect for maternal genes (c) specific allelic variant

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