APPENDIX D
Summary of Determinants of Gestational Weight Gain

Table D-1 summarizes the literature that is referenced and discussed in Chapter 4, Determinants of Gestational Weight Gain.



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appendix D Summary of Determinants of Gestational Weight Gain Table D-1 summarizes the literature that is referenced and discussed in Chapter 4, Determinants of Gestational Weight Gain. 

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TABLE D-1 Summary of Literature on Determinants of Gestational Weight Gain  Determinants Findings/Interpretations Comments References Societal/Institutional Media The committee was unable to identify Media may exert its effects on gestational Gortmaker et al., 1996 studies that examined specifically the weight gain indirectly by influencing Gortmaker et al., 1999 media’s influence on gestational weight prepregnancy BMI and other biological Robinson, 1999 gain. determinants, as well as eating habits and Kunkel, 2001 sedentary behaviors that are established Hastings et al., 2003 well before pregnancy. Epstein et al., 2008 Culture and The committee was unable to identify Cultural norms and beliefs can influence Ventura and Taffel, 1985 Acculturation studies that examined specifically the dietary behavior and physical activities, Scribner and Dwyer, 1989 effects of culture and acculturation factors thereby affecting energy balance and Cabral et al., 1990 on gestational weight gain. gestational weight gain. Acculturation is Kleinman et al., 1991 generally associated with more unhealthy Rumbaut and Weeks, 1996 behaviors, including dietary intake, and Singh and Yu, 1996 higher rates of overweight and obesity. Fuentes-Afflick and Lurie, 1997 Schaffer et al., 1998 Jones and Bond, 1999 King, 2000 Callister and Birkhead, 2002 Lizarzaburu and Palinkas, 2002 Hubert et al., 2005 Baker and Hellerstedt, 2006 Hernandez-Valero et al., 2007 Fuentes-Afflick and Hessol, 2008

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Health Services The committee found insufficient evidence Studies limited by self-selection bias, recall Rush, 1981 to evaluate the influence of prenatal weight bias, differences in time during gestation Orstead et al., 1985 gain advice on actual gestational weight when nutrition advice was given, variation Olds et al., 1986 gain. in content and frequency of advice, the Bruce and Tchabo, 1989 pairing of advice with other food or Brown et al., 1992 nonfood interventions, individual and social Morris et al., 1993 characteristics of the provider as contrasted Hickey, 2000 with those of the pregnant woman, and racial-ethnic and socioeconomic disparities in weight gain advice given to women. Policy Examples include IOM guidelines, WIC The impact of the IOM guidelines on actual Rush et al., 1988 programs, and policy recommendations gestational weight gain may be limited in Cogswell et al., 1999 to restrict food/beverage marketing to part because many health professionals ACOG, 2005 young children. IOM guidelines appear are providing no or inappropriate advice Power et al., 2006 to influence what women believe to be about weight gain during pregnancy. More Stotland et al., 2005 appropriate weight gain during pregnancy. research on implementation of gestational Joyce et al., 2008 A national evaluation of WIC programs weight gain guidelines is needed. found a reversal of low weight gain in early pregnancy and greater total weight gain during pregnancy among women who enrolled in WIC compared with controls. Enironmental Altitude Jensen and Moore (1997) did not find any The decline in birth weight associated Jensen and Moore, 1997 significant difference in gestational weight with increase in altitude appears to be gain among women residing at 3,000 to independent of gestational weight gain. 5,000 feet, 5,000 to 7,000 feet, 7,000 to 9,000 feet, and 9,000 to 11,000 feet.  continued

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TABLE D-1 Continued  Determinants Findings/Interpretations Comments References Environmental The committee was unable to identify More research is needed on the Dar et al., 1992 Toxicants studies that examined specifically the relationships among environmental Wolff et al., 2007 effects of exposures to environmental toxicants, gestational weight gain, and fetal toxicants on gestational weight gain. growth. Natural and The committee was unable to identify Disasters can affect gestational weight Weissman et al., 1989 Man-made studies that examined specifically the gain by influencing resource availability Cordero, 1993 Disasters effects of natural or man-made disasters on (including food supply), healthcare access, Glynn et al., 2001 gestational weight gain. and stress levels. Lederman et al., 2004 Eskenazi et al., 2007 Landrigan et al., 2008 Neighborhood/Community Access to The committee found no direct evidence Laraia et al. found pregnant women Laraia et al., 2004 Healthy Foods for the influence of neighborhood or who live more than four miles from a Lane et al., 2008 community factors such as access to supermarket had a two-fold greater risk of healthy foods on gestational weight gain. falling into the lowest Diet Quality Index quartile compared to women who lived ≤ 2 miles from a supermarket, but the authors also did not report on gestational weight gain. Opportunities Laraia et al. (2007) found that social Neighborhood environments can influence Laraia et al., 2007 for Physical spaces were associated with decreased odds gestational weight gain by providing access Activity for inadequate or excessive gestational to healthy foods and opportunities for weight gain. physical activities.

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Interpersonal/Family Determinants Family Violence Several studies demonstrated lower weight More research is needed. McFarlane et al., 1996 gain and greater risk of inadequate weight Siega-Riz and Hobel, 1997 gain among abused pregnant women. Boy and Salihu, 2004 Moraes et al., 2006 Marital Status Several studies found married women More research is needed. Kleinman et al., 1991 were more likely to gain within the IOM Ventura, 1994 recommended weight gain range than Olsen and Strawderman, 2003 single or separated/divorced women. Partner and The committee found insufficient evidence More research is needed. Stevens-Simon et al., 1993b Family Support at this time to establish a relationship Parker et al., 1994 between partner support and gestational Gutierrez, 1999 weight gain. Dipietro et al., 2003 Non-modifiable Maternal Factors Genetic The committee was unable to identify Several studies have examined the effects of Festa et al., 1999 Characteristics studies of familial aggregation or ADRB3 and Pro12Ala gene polymorphisms Yanagisawa et al., 1999 heritability of gestational weight gain. on gestational weight gain with mixed Alevizaki et al., 2000 Presently it is not possible to conclude results. Studies lacked adequate statistical Dishy et al., 2003 firmly on the role of specific genes and power to identify the effects of alleles or Tsai et al., 2004 alleles on gestational weight gain. genotypes with a small effect size. Fallucca et al., 2006 Tok et al., 2006 Epigenetics and The committee was unable to identify More research is needed. Fraga et al., 2005 Developmental studies that examined specifically the Programming influence of epigenetic events and developmental programming on gestational weight gain.  continued

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TABLE D-1 Continued 0 Determinants Findings/Interpretations Comments References Prepregnancy Gestational weight gain is generally An important strategy for optimizing Voigt et al., 2007 BMI inversely proportional to prepregnancy gestational weight gain is to help women Chu et al., 2009 BMI. Chu et al. (2009) found that maternal achieve a healthy weight before pregnancy. pre pregnancy obesity was the strongest factor affecting maternal weight gain in pregnancy, with obese women reporting the lowest gestational weight gain. Preexisting The committee found no direct evidence More research is needed on the influence of Fonager et al., 1998 Morbidities for pre-existing morbidities as determinants preconceptional health status of woman on of gestational weight gain. gestational weight gain. Non-modifiable Maternal Factors Sociodemographic Several studies have demonstrated higher The committee found that data generated Hediger et al., 1990 Factors: gestational weight gain among adolescents between the IOM (1990) report and the Howie et al., 2003 Adolescents than adults; the relationships of adolescent present support the recommendation that Nielsen et al., 2006 gestational weight gain to birth outcomes, “until more is known, adolescents less than Chen et al., 2007 post-partum weight retention, and two years post-menarche should be advised Groth, 2007 subsequent risk for overweight/obesity to stay within the IOM-recommended, remain unclear and requires further BMI-specific weight range without either research. restricting weight gain or encouraging weight gain at the upper end.”

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Sociodemographic Several studies reported higher The contributions of gestational weight Gross et al., 1980 Factors: prepregnancy BMI and lower gestational gain to birth outcomes, postpartum weight Endres et al., 1987 Older Women weight gain among older women. retention and subsequent overweight/ Cnattingius et al., 1992 obesity among older women remain unclear Prysak et al., 1995 and require further research. Fretts, 2005 Joseph et al., 2005 Reddy et al., 2006 Delpisheh et al., 2008 Sociodemographic The committee found that few of the Factors: studies reviewed considered the influence Race/Ethnicity of the many possible determinants of gestational weight gain among different racial/ethnic groups or alternatively, adjusted for race/ethnicity in their analyses. Sociodemographic Several studies have reported an association Food restriction or deprivation, whether Anderson, 1990 Factors: between food insecurity and overweight/ voluntary or involuntary, results in Polivy, 1996 Food Insecurity obesity. Olson and Strawderman (2008) a variety of changes including the Frongillo et al., 1997 found that women who were both obese preoccupation with food and eating. Food- Olson, 1999 and food insecure in early pregnancy insecure households also tend to purchase Townsend et al., 2001 were at greatest risk of major gestational calorie-dense foods that are often high in Adams et al., 2003 and postpartum weight gain, suggesting fats and added sugars in adaptation to their Basiotis and Lino, 2003 that food insecurity may play a role in food insecurity Crawford et al., 2004 gestational weight gain. Drewnowski and Darmon, 2005 Wilde and Peterman, 2006 Jones and Frongillo, 2007 Olson and Strawderman, 2008  continued

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TABLE D-1 Continued  Determinants Findings/Interpretations Comments References Potentially Modifiable Maternal Factors Physiological Gestational weight gain may be related Swinburn et al., 1991 Factors: to changes in insulin sensitivity during Catalano et al., 1993 Insulin, Leptin, pregnancy which depends on maternal Catalano et al., 1998 and Hormonal pregravid metabolic status. Both leptin and Highman et al., 1998 Milieu adiponectin are correlated with various Catalano et al., 1999 components of maternal metabolism such Kirwan et al., 2002 as energy expenditure and adiposity, and Cnop, 2003 may influence gestational weight gain by Okereke et al., 2004 affecting maternal insulin sensitivity. Retnarkaran et al., 2004 Williams et al., 2004 Winzer et al., 2004 Hauguel-de Mouzon et al., 2006 Pinar et al., 2008 Physiological BMR can influence total energy Wide variability in BMR change during Prentice et al., 1983 Factors: expenditure and gestational weight gain. pregnancy has been observed and makes Forsum et al., 1985 Basal Metabolic Several studies have shown increased BMR recommendations related to energy intake Lawrence et al., 1985 Rate (BMR) during pregnancy, but change in BMR difficult. Durnin, 1991 varies according to pregravid BMI. Goldberg et al., 1993 Butte et al., 2004 Medical Factors: Several studies have demonstrated Gross et al., 1989 Hyperemesis lower gestational weight gain and birth Goodwin et al., 1992 Gravidarium weight among women with hyperemesis Vilming and Nesheim, 2000 gravidarum. Furneaux et al., 2001 Goodwin, 2002 Jewell and Young, 2003

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Medical Factors: Sollid et al. (2004) found increased preterm Sollid et al., 2004 Anorexia Nervosa delivery & SGA among women with eating Kouba et al., 2005 and Bulimia disorders but did not obtain information Wisner et al., 2007 on gestational weight gain. Kouba et al. Bulik et al., 2008 (2005) found anorexic women gained less weight and had lower birth weight infants. Medical Factors: Three studies reported a decrease in Incidence of gestational diabetes and Gurewitsch et al., 1996 Bariatric Surgery gestational weight gain during a subsequent hypertensive disorders is lower in Marceau et al., 2004 pregnancy in women who had bariatric pregnancy following bariatric surgery; Skull et al., 2004 surgery. The effect of bariatric surgery on the risk Dixon et al., 2005 of fetal macrosomia and birth weight are Santry et al., 2005 inconclusive. Davis et al., 2006 Ducarme et al., 2007 Psychological The committee found that evidence Studies limited by lack of generalizability Cameron et al., 1996 Factors: in support of a relationship between and control for confounding. Difficult to Casanueva et al., 2000 Depression depressive symptoms and gestational establish cause-effect from cross-sectional Abraham et al., 2001 weight gain is inconclusive. studies. Walker and Kim, 2002 Dipietro et al., 2003 Bodnar et al., 2009 Psychological The committee found no robust association Picone et al., 1982 Factors: between stress and gestational weight gain. Orr et al., 1996 Stress Rondo et al., 2003 Brawarksy et al., 2005 Dominguez et al., 2005 Psychological The committee found inconclusive evidence Casanueva et al., 1994 Factors: for the role of social support in gestational Hickey et al., 1995 Social Support weight gain. Olson and Strawderman, 2003  continued

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TABLE D-1 Continued  Determinants Findings/Interpretations Comments References Psychological The committee found mixed evidence This relationship may vary according to Palmer et al., 1985 Factors: for the influences of maternal attitude on maternal prepregnancy BMI. Stevens-Simon et al., 1993a Attitude Toward actual gestational weight gain. Copper et al., 1995 Low Weight Gain Behaioral Several studies have demonstrated a Dietary intake of certain types of foods Campbell, 1975 Factors: relationship between energy intake and may also influence gestational weight gain, Campbell, 1983 Dietary Intake gestational weight gain. but more research is needed. Bergmann, 1997 Clapp, 2002 Lagiou et al., 2004 Olafsdottir et al., 2006 Deierlein et al., 2008 Behaioral Several studies have demonstrated an There is a need for appropriately powered Lokey et al., 1991 Factors: inverse relationship between the level of randomized clinical trials designed to Ohlin and Rossner, 1994 Physical Activity physical activity and gestational weight clarify the relationship between volume Clapp and Little, 1995 gain. and intensity of physical activity regimens Sternfeld et al., 1995 (dose) and maternal weight gain in women Stevenson, 1997 with various levels of pre-pregnancy BMI. Abrams et al., 2000 Hinton and Olson, 2001 Kramer and Kakuma, 2003 Siega-Riz et al., 2004 Morris and Johnson, 2005 Artal et al., 2007 Haakstad et al., 2007 Lof et al., 2008

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Behaioral Several studies examining associations The major effects of substance use Rush, 1974 Factors: between decreasing GWG and amount (cigarette smoking, alcohol and drug use) Hanson et al., 1978 Substance Abuse of reported smoking show inconclusive on birth outcomes (e.g., birth defects, SGA) Garn et al., 1979 results. More recently, Furuno et al. (2004) appear to be independent of gestational Haworth et al., 1980 found no significant difference in mean weight gain. Papoz et al., 1982 GWG between smoking and non-smoking Little et al., 1986 mothers but did find an increased risk Graham et al., 1992 for low GWG among smokers. Little Stevens-Simon and McAnarney, information is available about effects of 1992 alcohol consumption on GWG. Smith Wolff et al., 1993 et al. (2006) found that those who used Jacobsen et al., 1994 amphetamine in the first two trimesters Adriananse et al., 1996 but ceased use by the third trimester Bagheri et al., 1998 gained significantly more weight than Wagner et al., 1998 either women who used throughout Seckler-Walker and Vacek, 2003 pregnancy or non-exposed women (p = Furuno et al., 2004 0.019), suggesting the anorexic effects Ogunyemi and Hernandez- of methamphetamine are limited to Loera, 2004 continuous use, and there may be a Smith et al., 2006 rebound in weight gain if the mother stops Wells et al., 2006 use. Behaioral The committee found data concerning Marsiglio and Mott, 1988 Factors: the effect of unintended pregnancy on Hickey et al., 1997 Unintended gestational weight gain to be conflicting. Siega-Riz and Hobel, 1997 Pregnancy Kost et al., 1998 Wells et al., 2006  continued

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