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Can Metformin Reduce Weight Gain In Pregnancy?

Excessive weight gain during pregnancy is a well-established risk factor for both mother and child. Now a paper by Argyro Syngelaki and colleagues from the UK, published in the New England Journal of Medicine, suggests that the anti-diabetes drug metformin may limit weight gain in pregnant non-diabetic women with obesity and also reduce the incidence of pre-eclampsia. The researchers randomised 450 pregnant women with a BMI greater than 35 and no diabetes to either metformin (3 g/day) or placebo from weeks 12-18 weeks of gestation till delivery in a double-blind fashion. Among the 400 women who completed the study, those on metformin gained about 2 Kg less weight than the placebo group. There was also an almost 75% decrease in the risk of developing preeclampsia. Despite these effects, metformin did not significantly reduce the incidence of large-for-gestational-age babies or other adverse neonatal outcomes. While these findings may be somewhat disappointing with regard to outcomes in the offspring, the reduction in pre-eclampsia is impressive and, if confirmed, could well be an interesting use of this compound in high-risk pregnancies. @DrSharma Kelowna, BC

Pregnancy Outcomes After Bariatric Surgery

Pregnancy in women after undergoing bariatric surgery are by no means uncommon. There is even some evidence from case series to suggest that babies born to mothers, who have undergone surgery may be less likely to become obese or experience the cardiometabolic complications of obesity. This risk needs to be balanced against potential risks the known adverse effects of gastric bypass surgery on the metabolism of iron, vitamin B12, and folate, Now a paper by Karl Johansson and colleagues, published in the New England Journal of Medicine, suggests that this may well be the case. The researchers identified 627,693 singleton pregnancies in the Swedish Medical Birth Register from 2006 through 2011, of which 670 occurred in women who had previously undergone bariatric surgery and for whom presurgery weight was documented. They found that pregnancies after bariatric surgery, as compared with matched control pregnancies, were associated with lower risks of gestational diabetes (1.9% vs. 6.8%; odds ratio, 0.25) and a lower incidence of large-for-gestational-age infants (8.6% vs. 22.4%; odds ratio, 0.33). These potentially beneficial outcomes for the infant were counterbalanced by a two-fold increase in the likelihood of having a small-for-gestational-age infants (15.6% vs. 7.6%; odds ratio, 2.20) and a somewhat shorter gestation (mean difference -4.5 days) Also, the risk of stillbirth or neonatal death was 1.7% versus 0.7% (odds ratio, 2.39). No differences were found in the frequency of congenital malformations. Bariatric surgery was associated with reduced risks of gestational diabetes and excessive fetal growth, shorter gestation, an increased risk of small-for-gestational-age infants, and possibly increased mortality. Thus, the authors conclude that, “…a history of bariatric surgery was associated with reduced risks of gestational diabetes and large-for-gestational-age infants.” Nevertheless, they do recommend increased surveillance during pregnancy and the neonatal period, as bariatric surgery may also be associated with small-for-gestational-age infants, a shorter length of gestation, and potentially an increased risk of stillbirth or neonatal death. @DrSharma Edmonton, AB

Pregnancy Weight Gain Study

Today’s post is for health professionals who provide care to pregnant women in their practice? Researchers from the University of Alberta are conducting a short online survey to get a better understanding of the barriers and challenges you may experience related to gestational weight gain, and about what may help and support them to help women achieve healthy weights during pregnancy. The researchers are also asking you to assess the strengths and limitations of the 5As of Healthy Pregnancy Weight Gain, a new resource from the Canadian Obesity Network. This information will help to inform the development of universal strategies that promote healthy dietary intake and appropriate weight management in pregnancy and postpartum. Your participation in this short survey is much appreciated. Click here to take the survey. @DrSharma Edmonton, AB

The 5As of Healthy Pregnancy Weight Gain

Yesterday, the Canadian Obesity Network released the 5As of Healthy Pregnancy Weight Gain. This follows the release of the 5As of Obesity Management (adults) and the 5As of Pediatric Weight Management. The 5As of Health Pregnancy Weight Gain, was developed by a working group of nurses, midwives, primary care physicians, obstetricians, researchers and policy makers convened by the Network. It is based on the best available evidence on this topic and is intended to help primary care practitioners discuss and manage gestational weight with their patients. The 5As of Healthy Pregnancy Weight Gain is based on the following 5 key principles: Discussion about gestational weight gain should occur with every pregnant women and with every woman planning a pregnancy. Achieving healthy gestational weight gain is about improving the health and well-being of both mothers and babies. Early action means addressing root causes and removing roadblocks. Pregnancy related health beliefs can be powerful influences on weight gain in pregnancy. Achieving goals is different for every woman. The 5As of Health Pregnancy Weight Gain can be downloaded here – pdf – ppt @DrSharma Edmonton, AB p.s. if you did not receive the Obesity Network Newsletter with this announcement due to Canada’s new anti-spam legislation, please click here.

Guest Post: Everything You Must Know About Pregnancy and Weight Gain

Today’s post is from Zach Ferraro, PhD, a former CON-SNP National Executive member (2008-12), CON Boot Camper (2008) and Inaugural recipient of CON Rising Star Award (2012). Currently, Zach is a clinical research associate in the Division of Maternal-Fetal Medicine at the Ottawa General Hospital and PT Professor in Human Kinetics at the University of Ottawa. He is also a member of the CON 5 As for pregnancy working group. Regular readers of these pages will recall that the intrauterine environment plays a vital role in healthy neonatal development and is directly influenced by maternal nutrition, physical activity, xenobiotics and pregnancy weight gain. This interaction is commonly referred to as ‘fetal programming’ or more appropriately termed fetal plasticity. That is, the ability of the developing fetus to grow and respond to external stimuli whether intrauterine or environmental. Thus, all prenatal exposures, positive and negative, have the potential to affect the short- and long-term health of the child. It is now well-established that excess gestational weight gain (GWG) is an independent predictor of large for gestational age (LGA) neonates and postpartum weight retention (PPWR) in the mother. Simply, moms who gain greater than the recommended amount of weight, according to their pre-pregnancy BMI, subsequently carry this excess weight forward into the next pregnancy causing a rightward shift in their BMI after delivery. In addition, babies born large (LGA) tend to track their excess weight throughout life and are at greater risk of becoming obese as adults. Although the mechanisms explaining these associations are far from unraveled, both LGA and PPWR exacerbate what is referred to as the intergenerational cycle of obesity. So what can care providers do to help minimize the ill-effects of excessive GWG? Several lifestyle interventions during pregnancy are reported in the literature and have yielded mixed results. This is largely due to heterogeneity in intervention type (diet or physical activity or psychological support or all the above) and intensity (intensive clinical intervention vs. hands off approach). We, in addition to others, have also reported that knowledge transfer between patients and providers may be partially responsible for the limited treatment effects seen in some interventions. Nonetheless, in the absence of any between group differences in GWG guideline adherence and maternal-fetal outcomes between lifestyle intervention and standard care, it is important to remember that healthy living behaviours were not harmful and may have resulted in increased fitness and/or alterations in… Read More »