Now showing 1 - 10 of 10
  • Publication
    Is birth weight the major confounding factor in the study of gestational weight gain?: an observational cohort study
    Background: Much interest has been focussed on both maternal obesity and gestational weight gain (GWG), particularly on their role in influencing birth weight (BW). Several large reviews have reported that excessive GWG is associated with an increase in BW. However recent large, well-designed, randomized controlled trials studying interventions aimed at reducing GWG have all consistently failed to show a reduction in BW despite achieving a reduction in GWG. The aim of this longitudinal prospective study was to examine the relationship between GWG and birth weight in women where GWG and Body Mass Index (BMI) were measured accurately in a strictly standardized way. Methods: Women were enrolled at their convenience before 18weeks gestation. Height and weight were measured accurately at the first antenatal visit and BMI calculated. Maternal weight was measured again after 37weeks gestation. The weight of the baby was measured at birth. Relationships were tested using linear regression analysis, chi-squared tests and t-tests as appropriate. Results: Of the 522 women studied, the mean BMI was 25.3kg/m2and 15.7% were obese. The mean BW at term was 3576g (2160-5120) and 2.7% (n=14) weighed ≥4500g. The mean GWG overall was 12.3kg (4.6 to 28.4) and GWG decreased as BMI increased. The mean GWG was less in obese women, at 8.7kg (-4.6 to 23.4), compared to non-obese,13.0kg (0.6-28.4) (p<0.001). Mean BW in obese women was 3630g vs 3565g in non-obese (p=0.27). The total GWG correlated positively with BW (p<0.001). When BW was subtracted from total GWG, GWG no longer correlated with BW (p=0.12). Conclusions: The positive correlation between GWG in pregnancy and BW can be accounted for by the contribution of fetal weight to GWG antenatally without a contribution from increased maternal adiposity. There was a wide range of BW irrespective of the degree of GWG and obese women had a lower GWG than non-obese women. These findings help explain why Randomized Controlled Trials (RCTs) designed to reduce GWG have failed to decrease BW and suggest there is no causative link between excessive GWG and increased BW.
      229Scopus© Citations 3
  • Publication
    The relationship between gestational weight gain and fetal growth: time to take stock?
    The aim of this article is to review the current evidence on gestational weight gain (GWG). Maternal obesity has emerged as one of the great challenges in modern obstetrics as it is becoming increasingly common and is associated with increased maternal and fetal complications. There has been an upsurge of interest in GWG with an emphasis on the relationship between excessive GWG and increased fetal growth. Recent recommendations from the Institute of Medicine in the USA have revised downwards the weight gain recommendations in pregnancy for obese mothers. We believe that it is time to take stock again about the advice that pregnant women are given about GWG and their lifestyle before, during, and after pregnancy. The epidemiological links between excessive GWG and aberrant fetal growth are weak, particularly in obese women. There is little evidence that intervention studies decrease excessive GWG or improve intrauterine fetal growth. Indeed, there is a potential risk that inappropriate interventions during the course of pregnancy may lead to fetal malnutrition that may have adverse clinical consequences, both in the short- and long-term. It may be more appropriate to shift the focus of attention from monitoring maternal weight to increasing physical activity levels and improving nutritional intakes.
      578Scopus© Citations 15
  • Publication
    Provision of Information about Infant Feeding Postpartum Through Digital Media
    Abstract Women seek information about infant feeding from multiple sources, which may conflict. Increasingly women use digital media for pregnancy information. This study examined women's use of digital media for information on infant feeding. In addition to clinical and socio-demographic data, detailed data concerning women's infant feeding practices and their use of digital media for infant feeding information were collected. We surveyed 295 women who attended nine months postpartum as part of a longitudinal study on maternal weight trajectories. Digital media was used by 130 women (44.1%) to access information on infant feeding, which is higher than hitherto reported. Women who did not use digital media were more likely to be multigravidous (p = 0.03), to be socially disadvantaged (p = 0.01), and were less likely to breastfeed (p = 0.01). However, on multivariable analysis, only women economically disadvantaged were less likely to use digital media [OR 0.25, p < 0.02]. The types of digital media used varied, and an overwhelming majority were non-subscription resources. Less than 5% of women used professional evidence-based digital media sources. The use of digital media was not associated with the timing of weaning. Information on infant feeding should be evidence-based and provided digitally to women across all socioeconomic gradients as part of an e-health national policy.                           
  • Publication
    Gestational Weight Gain and Gestational Diabetes Mellitus: Popular Beliefs and Emerging Evidence
    The aim of this article is to review the evidence on gestational weight gain (GWG), and its relationship between abnormal foetal growth and the development of gestational diabetes mellitus (GDM). Maternal obesity is a major concern of modern obstetrics and is associated with increased maternal and foetal complications. It is becoming increasingly common and GWG has attracted an upsurge of interest. In 2009, recommendations from the Institute of Medicine in the United States revised downwards the weight gain recommendations in pregnancy for obese mothers. There is no international consensus or guidelines on GWG. There are concerns with evidence on GWG and many publications have methodological shortcomings.No causal relationship has been shown between GWG and excessive foetal growth, however emerging evidence demonstrates a relationship between birth weight and maternal fat-free mass. Interventions in pregnancy aimed at targeting GWG have not shown a decrease in excessive foetal growth and inappropriate intervention may lead to foetal malnutrition with adverse clinical consequences. While an association between pre-pregnancy maternal obesity and GDM has been shown, evidence of the relationship between weight gain during pregnancy and GDM is conflicting.A recent study has shown that fat mass gain to 28 weeks gestation does not influence the development of GDM. Careful consideration should be paid to the advice that pregnant women are given about GWG and their lifestyle before, during, and after pregnancy and we believe that it may be more appropriate to shift the focus of attention from monitoring maternal weight to increasing physical activity levels and improving nutritional intakes.                          
  • Publication
    Interpregnancy changes in maternal weight and body mass index
    Objective: This longitudinal study compared changes in maternal weight and body mass index (BMI) in early pregnancy in the time interval between when a woman first attended for antenatal care with her first child and when she next attended for antenatal care. Study Design: We studied women with a singleton pregnancy who delivered their first baby weighing ≥ 500 g in 2009 and who attended again for antenatal care with an ongoing pregnancy before January 1, 2012. Maternal weight and height were measured before 18 weeks' gestation in both pregnancies and BMI was calculated. Results: Of the 3,284 primigravidas, the mean weight at the first visit in 2009 was 66.4 kg (standard deviation [SD] 12.7). The mean BMI was 24.5 kg/m2 (SD 4.6), and 11.3% (n = 370) were obese. Of the 3,284 women, 1,220 (37.1%) re-attended for antenatal care before 2012 after sonographic confirmation of an ongoing pregnancy. Of the 1,220 women who re-attended, 788 (64.6%) had gained weight (mean 4.6 kg [SD 3.9]), 402 (33%) had lost weight (mean 3 kg [SD 2.9]), and 30 (2.4%) had maintained their weight. Conclusion: The birth of a first baby was associated with an increase in maternal weight in two-thirds of women when they next attended for antenatal care.
      499Scopus© Citations 6
  • Publication
    The interplay between maternal obesity and gestational diabetes mellitus
    There is a strong epidemiological association between maternal obesity and gestational diabetes mellitus (GDM). Since the publication of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study on women with mild hyperglycemia in 2008, new criteria have been introduced in maternity services internationally for the diagnosis of GDM. As a result, the diagnosis of GDM may be made in one-third of obese women (n=68). The aim of this review was to examine the interplay between maternal obesity and GDM in light of the HAPO study and the subsequent revised diagnostic criteria. Obesity and GDM are important obstetric risk factors because they both are potentially modifiable. However, the new international criteria for the diagnosis of GDM have serious resource implications for maternity services provided to the large number of women attending for care in developed countries. Further consideration needs to be given as to whether obese women with mild hyperglycemia need to be referred to a multidisciplinary team antenatally if they do not require insulin treatment.
      754Scopus© Citations 18
  • Publication
    A National Survey of implementation for Guidelines for Gestational Diabetes Mellitus
    (Irish Medical Organisation, 2014-08) ; ; ; ;
    In 2010, national guidelines for the management of gestational diabetes mellitus (GDM) were published by the Health Service Executive (HSE). In 2012, a questionnaire was distributed to all maternity units to survey implementation of the guidelines. All units screened women for GDM, but used different screening tests with fifteen units (79%) using the recommended 75g OGTT, three units (16%) using a 100g OGTT and one unit (5%) using a 50g glucose challenge test. Optimal outcomes are best achieved through multidisciplinary diabetes-obstetric care and this was available in nine of the units (47%). The prevalence of GDM varied from 2.2     7.4%. Insulin usage varied from 15-56%. Six centres (31%) had not implemented the national guidelines in full because of lack of resources. Despite national endorsement of the guideline, significant variations remain in implementation. This may lead to differences in clinical outcomes depending on where a woman attends for obstetric care.
  • Publication
    Maternal Obesity and Neck Circumference
    Obese women are more likely to require general anaesthesia for an obstetric intervention than non-obese. Difficult tracheal intubation and oxygen desaturation is more common in pregnancy. Failed tracheal intubation has been associated with an increase in neck circumference (NC). We studied the relationship between maternal obesity and NC as pregnancy advanced in women attending a standard antenatal clinic. Of the 96 women recruited, 13.5% were obese. The mean NC was 36.8cm (SD 1.9) in the obese women compared with 31.5cm (SD 1.6) in women with a normal BMI (pp<0.001) at 18-22 weeks gestation. In the obese women it increased on average by 1.5cm by 36-40 weeks compared with an increase of 1.6 cm in women with a normal BMI. The antenatal measurement of NC is a simple, inexpensive tool that is potentially useful for screening obese women who may benefit from an antenatal anaesthetic assessment.
  • Publication
    The use of digital media by women using the maternity services in a developed country
    The provision of high quality healthcare information about pregnancy is important to women and to healthcare professionals and it is driven, in part, by a desire to improve clinical outcomes. The objective of this study was to examine the use of digital media by women to access pregnancy information. A questionnaire was distributed to women attending a large maternity hospital. Of the 522 respondents, the mean age was 31.8 years, 45% (235/522) were nulliparous, 62% (324/522) lived in the capital city and 29% (150/522) attended the hospital as private patients. Overall 95% (498/522) used the internet for pregnancy information, 76% (399/522) had a smartphone and 59% (235/399) of smartphone owners had used a pregnancy smartapp. The nature of internet usage for pregnancy information included discussion forums (70%), social networks (67%), video media (48%), e-books (15%), blogs (13%), microblogs (9%) and podcasts (4%). Even women who were socially disadvantaged reported high levels of digital media usage. In contemporary maternity care women use digital media extensively for pregnancy information. All maternity services should have a digital media strategy.
  • Publication
    The Irish Maternity Early Warning System (IMEWS)
    In the acute hospital setting, the use of early warning scores (EWS) to monitor vital signs (including heart rate, respiratory rate [RR], blood pressure and temperature) has been shown to be beneficial in the early diagnosis and prompt initiation of treatment in adults with a critical illness. This led to the development of the National Early Warning Score (NEWS) in Ireland by the Health Services Executive’s (HSE) Acute Medicine Clinical Care Programme. The NEWS was the first guideline endorsed by the National Clinical Effectiveness Committee (NCEC) and was launched by the Minister of Health Dr James Reilly in 2013. The implementation of NEWS is now mandatory in all acute hospitals. However, NEWS is not suitable for use in pregnancy because a woman's vital signs change physiologically from early in pregnancy. National reports in Ireland and the United Kingdom (UK) on maternal mortality have led to recommendations that a modified obstetric EWS be introduced. In Ireland, these recommendations have been further supported by separate investigations in 2008 and 2013 on two maternal deaths from sepsis.