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Tag: Pre-eclampsia

  • Shared eating habits of couples impact pregnancy weight gain, study suggests

    Shared eating habits of couples impact pregnancy weight gain, study suggests

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    In a recent article published in the journal Nutrients, researchers assessed how gestational weight gain (GWG) is associated with the eating behaviors of pregnant people and their non-pregnant partners through a cohort study in the United States.

    Their results indicate that poor cognitive restraint was associated with higher GWG, suggesting that restrained eating by couples could reduce GWG and, therefore, the risk of infant macrosomia, cesarean section, pre-eclampsia, and gestational diabetes mellitus (GDM).

    Study: Healthful Eating Behaviors among Couples Contribute to Lower Gestational Weight Gain. Image Credit: El Nariz / ShutterstockStudy: Healthful Eating Behaviors among Couples Contribute to Lower Gestational Weight Gain. Image Credit: El Nariz / Shutterstock

    Background

    Excess GWG is associated with increased risks of infant macrosomia, pre-eclampsia, cesarean section, and GDM. It is also associated with pre-gravid body mass index (BMI), and diet-centric interventions during pregnancy are effective in reducing GWG.

    Though pregnancy is often associated with eating and snacking more, less is known about what eating behaviors may contribute to excess GWG. The influence of the eating habits of the non-pregnant partner has also not been studied.

    About the study

    In this study, researchers theorized that the non-pregnant partner can influence household food consumption and encourage healthy eating attitudes and food habits during pregnancy.

    They hypothesized that the couple’s behaviors would be most strongly linked with GWG, followed by the pregnant person’s behaviors alone. They expected to see the weakest association between the non-pregnant person’s behaviors and GWG.

    Pregnant people included in the study had a BMI between 18.5 and 35, were over 21 years old, had only one other child, and were either planning their pregnancy or had a gestational age of under 10 weeks.

    People receiving fertility treatments, with existing medical conditions, taking medications such as insulin, which could influence fetal growth, drinking alcohol, or smoking during pregnancy were excluded.

    Demographic factors such as marital status, age, ethnicity and race, individual income, and educational attainment were included. The pregnant person’s weight and GWG were measured during the first and third trimesters, while the partner’s weight was measured once. Weight and height were used to calculate the BMI, while GWG was classified as normal, overweight, or obese.

    An eating inventory was used to assess eating behaviors and attitudes, such as perceived hunger, dietary disinhibition, and cognitive restraint. A higher score for each of these components indicated poorer eating behavior. A couple’s score was calculated as the average of the two individual scores.

    The perceived hunger component scored between 0 and 14, assesses how susceptible an individual is to feelings of hunger, while dietary disinhibition (0-18) evaluates the tendency to overeat palatable foods. The cognitive restraint component (0-21) examines an individual’s ability to restrict their food intake for weight maintenance.

    During data analysis, adjusted general linear models were used to examine statistical associations and odds ratios were calculated.

    Findings

    The study included 218 pregnant persons (average age 30.3) and 157 non-pregnant partners (average age 31.4). The average BMI for pregnant persons was 26.1, while the partners had an average BMI of 28.5. Non-pregnant partners were more likely to be obese, earn more than USD 40,000, and be at least college graduates.

    For the entire cohort, the mean GWG was 11.8 kg, and nearly half showed excess GWG. Only one in three pregnant people with normal weight experienced excess GWG compared to 63% of overweight people and 52.2% of obese people.

    Nearly 57%, 86%, and 89% of pregnant participants received low scores on the cognitive restraint, dietary disinhibition, and perceived hunger components, respectively. People with normal weight were more likely to receive low scores. Non-pregnant partners received, on average, lower scores than their partners, indicating healthier eating habits.

    Results from the unadjusted models showed that higher scores for each of the components were associated with higher GWG. The association remained significant for the cognitive restraint score after adjusting for BMI during early pregnancy and demographic factors.

    There were no significant associations between the non-pregnant partner’s scores and GWG. However, there was a significant positive association between a couple’s score for cognitive restraint and GWG. Specifically, if cognitive restraint increased by one unit, GWG increased, on average, by 0.23 kg; this finding persisted after adjusting for BMI and demographic factors.

    Conclusions

    Findings from this study indicate that cohesive partnerships can foster better eating behaviors and lead to optimal GWG. The implication is that involving both partners in dietary interventions could lead to better outcomes than if the pregnant person alone is targeted.

    One limitation of this study is that it did not assess dietary or energy intake, which could be predicted by eating behavior. Sleep and physical activity, which may both contribute to GWG, were also not accounted for in this analysis.

    Journal reference:

    • Healthful eating behaviors among couples contribute to lower gestational weight gain. Sparks, J.R., Redman, L.M., Drews, K.L., Sims, C.R., Krukowski, R.A., Andres, A. Nutrients (2024). DOI: 10.3390/nu16060822, https://www.mdpi.com/2072-6643/16/6/822

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  • Prenatal exposure to phthalates linked to higher risk of preterm birth and low birth weight

    Prenatal exposure to phthalates linked to higher risk of preterm birth and low birth weight

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    A study published in the journal The Lancet Planetary Health reveals that prenatal exposure to phthalate metabolites can increase the risk of preterm birth and low birth weight.

    Study: Prenatal phthalate exposure and adverse birth outcomes in the USA: a prospective analysis of births and estimates of attributable burden and costs. Image Credit: Sibirian sun / ShutterstockStudy: Prenatal phthalate exposure and adverse birth outcomes in the USA: a prospective analysis of births and estimates of attributable burden and costs. Image Credit: Sibirian sun / Shutterstock

    Background

    Preterm birth and low birth weight are associated with many adverse consequences, including infant and childhood mortality, psychological, behavioral, and educational adversities in young adulthood, and cardiometabolic diseases in adulthood. In the United States, about 8% and 10% of infants suffered low birthweight and preterm birth, respectively, in 2020.

    Many risk factors are associated with adverse birth outcomes, including maternal age, poor socioeconomic status, pre-eclampsia, and lack of prenatal care. Various synthetic chemicals, such as phthalates, are also known to increase the risk of birth adversities.

    Phthalate and its metabolites are used in personal care products and food packaging. These chemicals have pro-inflammatory, pro-oxidative, and endocrine-disrupting activities. The crosstalk between these pathways can potentially disrupt hormonal regulation in pregnancy and induce placental insufficiency, pre-eclampsia, and premature membrane rupture.

    In this study, scientists investigated the effects of prenatal phthalate exposure on birthweight and gestational age at birth. They also estimated phthalate-attributable adverse birth outcomes and associated costs.   

    Study design

    The scientists collected data from the National Institutes of Health Environmental influences on Child Health Outcomes (ECHO) Program, which includes 69 unique pediatric cohorts from across the USA to identify environmental and preventable factors associated with low birthweight, preterm birth, and other birth complications.

    The concentrations of 20 phthalate metabolites were measured in maternal urinary samples. The associations of these metabolites with gestational age at birth, birthweight, birth length, and birthweight for gestational age z-scores (age-independent assessment of a fetus growth) were analyzed in the study.

    Important observations

    The study was conducted on 5006 mother-child dyads identified from 13 cohorts in the ECHO program. The concentrations of phthalate metabolites in these mothers were similar to those detected in women of childbearing age in national surveys. A similar distribution of phthalates was observed across trimesters. The metabolites of di-2-ethylhexyl phthalate (DEHP) showed a strong correlation with one another. Mono-ethyl phthalate and phthalic acid showed the highest concentrations in maternal urinary samples. 

    Higher concentrations of multiple phthalate metabolites were observed in non-Hispanic Black mothers. In contrast, Hispanic mothers showed higher concentrations of low-molecular-weight metabolites and lower concentrations of high-molecular-weight metabolites, DEHP, and phthalic acid.

    An inverse association was observed between maternal age and concentrations of all metabolites. Moreover, a positive association was observed between maternal age, birth weight and length.

    Impact of phthalates on birth outcomes

    The study analysis revealed strong associations of phthalic acid, diisodecyl phthalate (DiDP), di-n-octyl phthalate (DnOP), and diisononyl phthalate (DiNP) with gestational age, birth length, and birth weight. These associations were stronger than that observed for low- and high-molecular-weight metabolites and DEHP.

    Overall, phthalate metabolites showed an association with low birth weight. The strongest associations were observed between the concentrations of phthalic acid, DiNP, DiDP, and DnOP and preterm birth and low birth weight. The magnitude of these associations was stronger in the third trimester compared to that in the first and second trimesters.   

    The findings of sensitive analysis revealed that the association between DnOP and preterm birth is stronger for female infants than male infants. Moreover, the associations of phthalic acid, DiNP, and DnOP with many birth outcomes were stronger among non-Hispanic White mothers and college-educated mothers.   

    Regarding phthalate-attributable adverse birth outcomes and associated costs, the study estimated 56,595 preterm birth cases in 2018, with associated costs of 3.84 billion USD. A sensitive analysis considering DiDP exposure revealed 57,017 to 79,947 attributable cases with associated costs of 3.86 billion USD to 5.42 billion USD. Similarly, for DiNP exposure, the analysis showed 76,838 to 120,116 attributable cases with associated costs of 5.21 billion USD to 8.14 billion USD.

    Study significance

    The study finds that prenatal exposure to phthalate metabolites can increase the risk of preterm birth and low birth weight. The pattern of associations observed in the study indicates that phthalate metabolites replacing DHEP in food packaging are responsible for the increase in preterm birth. This suggests a need to regulate chemicals with similar properties as a class.

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  • Repeat PlGF testing for pre-eclampsia not beneficial, research finds

    Repeat PlGF testing for pre-eclampsia not beneficial, research finds

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    A single test to speed up diagnosis of a serious disease in pregnant women does not need to be repeated, new research has found.

    Results from the PARROT-2 trial, published today in the Lancet by researchers from King’s College London and funded by Jon Moulton Charitable Trust, Tommy’s Charity and the National Institute for Health and Care Research, has ruled out the need for routine repeat placental growth factor-based testing (PIGF) for all women with suspected pre-eclampsia.

    PARROT-2 is a large, multi-center UK trial in 1,252 women with suspected preterm pre-eclampsia, a life-threatening condition for pregnant women, and their babies, that can lead to major complications, such as stillbirth and neonatal death, as well as longer hospital stays.

    PIGF testing is a blood test that can detect levels of placental growth factor and soluble flt-1, which are biomarkers for pre-eclampsia. An abnormal result will identify those women and babies at higher risk of adverse outcomes, who need intensive surveillance, whilst a normal result means women can be safely discharged home to continue with normal antenatal care. Use of an initial test in pregnancy was rolled out across much of England in 2021.

    The findings show that repeat testing enabled faster diagnosis of pre-eclampsia, but this did not translate into better outcomes for women or their babies.

    Dr Alice Hurrell, first author of the study from King’s College London, said: “This large trial has major implications for policy, practice, and guidelines. Universal, routine repeat testing, as recommended by some international groups, is not supported by our findings. However, the clinical benefit of a one-off placental growth factor-based test when pre-eclampsia is first suspected, remains clear.”

    Professor Lucy Chappell, NIHR Senior Investigator from King’s College London, said: “Pregnant women repeatedly tell us the value of having greater certainty on diagnosis. These trial results should further lower the barriers to widespread equitable adoption of initial placental growth factor-based testing, improving maternal health outcomes globally. With an estimated 5% of all women affected by preterm hypertension in pregnancy (around 7 million pregnancies worldwide), this is now a pivotal time to ensure that placental growth factor-based testing can reach widespread implementation across healthcare settings.”

    These are really important findings showing that once the first test has been done, there is nothing to be gained from further testing. A single test can assure women with certainty if they are likely or unlikely to get pre-eclampsia. We look forward to completion of roll-out of placental growth factor-based testing across England, with an urgent call for implementation in the devolved administrations across all four nations. These new results also provide a timely opportunity to tackle the higher burden of adverse outcomes due to pre-eclampsia in global settings.”


    Marcus Green, CEO of Action on Pre-eclampsia

    Kath Abrahams, Chief Executive of Tommy’s, said: “This important study funded by Tommy’s is a significant and positive step forwards in the drive to reduce the harm caused by pre-eclampsia.

    “Following the breakthrough made by the previous Tommy’s funded PARROT study, we hope it will pave the way for PlGF testing for all women and birthing people who are thought to be at risk of pre-eclampsia, so that those most in need can be offered vital extra monitoring and support.”

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