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ZusammenfassungEine Gewichtszunahme in der Schwangerschaft oberhalb der IOM-Empfehlungen erhöht das Risiko für Schwangerschaftskomplikationen und für späteres Übergewicht bei Mutter und Kind. Deshalb sollten Schwangere hinsichtlich ihrer Zunahme entsprechend beraten werden. Welche Bedürfnisse haben Frauen bezüglich der Beratung? Hierzu wurden 34 Schwangere in offenen Interviews befragt, welche mit der Frequenzanalyse nach Mayring ausgewertet wurden. Es wurde erkannt, dass die gesundheitlichen Auswirkungen einer zu starken Gewichtszunahme von den Frauen unzureichend wahrgenommen werden. Weiterhin konnten 4 verschiedene Verhaltensweisen bezüglich der Ernährung abgeleitet werden: (i) Schwangere, die zwar gut informiert sind, dies jedoch nicht umsetzen; (ii) Schwangere, die Informationen und Wissen konsequent umsetzen, (iii) Schwangere, die sich vom Körpergefühl leiten lassen; und (iv) vorwiegend indifferente Schwangere. Frauen, die schon vor der Schwangerschaft inaktiv waren, ließen sich auch in der Schwangerschaft nicht zu Sport motivieren. Für die Planung zukünftiger Interventionen sollte berücksichtigt werden, dass Informationsbedarf hinsichtlich der Gewichtszunahme und gesunder Ernährung in der Schwangerschaft besteht. Abhängig vom Verhaltensmuster der Frau wird eine Ernährungsintervention nicht immer den gewünschten Erfolg erzielen. Weiterhin ist die Motivation und Aufklärung zu geeigneten Sportarten eine besondere Herausforderung.

Aim Gestational diabetes mellitus is believed to be a risk factor for childhood overweight/obesity. We aimed to assess whether this association is either a reflection or independent of confounding by maternal BMI. Methods Data from 7355 mother–child dyads of the German Perinatal Prevention of Obesity cohort with full anthropometric information on mothers and children, gestational diabetes and confounding factors were obtained at school entry health examination. We calculated crude and adjusted logistic regression models for the association of gestational diabetes and childhood overweight/obesity and abdominal adiposity defined by age- and sex-specific percentiles for BMI and waist circumference. Results Among all children (mean age 5.8 years), 8.1% were overweight, 2.6% were obese and 15.5% had abdominal adiposity. The prevalence of overweight (obesity) was 21% (8.2%) in children of mothers with gestational diabetes and 10.4% (2.4%) in children of healthy mothers. Analyses with adjustment for maternal BMI and other potential confounders yielded an odds ratio of 1.81 (95% CI 1.23–2.65) and 2.80 (95% CI 1.58–4.99) for the impact of gestational diabetes on childhood overweight and obesity, respectively. Similar results were obtained for the risk of childhood abdominal adiposity (odds ratio 1.64, 95% CI 1.16–2.33) by maternal gestational diabetes. Conclusions The postulated increased risk of overweight and abdominal adiposity in offspring of mothers with gestational diabetes cannot be explained by maternal BMI alone and may be stronger for childhood obesity than for overweight.

Background: It is unknown how well the trimester-specific recommendations for gestational weight gain (GWG) given by the Institute of Medicine/National Research Council (IOM/NRC) identify women at risk of GWG outside IOM/NRC recommendations for total GWG. Objective: We assessed the prognostic value of trimester-specific cutoffs for inadequate or excessive total GWG in term pregnancies. Design: Data on prepregnancy weight and the temporal course of GWG were collected from medical records. A total of 7962 women were included in the final analysis. Main outcome measures were inadequate or excessive total GWG as defined by criteria of the IOM/NRC. Main exposures were GWG outside the IOM/NRC week-specific recommendations in the first, second, and third trimesters. Results: The prediction of gaining weight within the GWG recommendations increased with gestational age and was related to the maternal weight category and outcome. In the second trimester, inadequate GWG was predicted with a sensitivity of 49% and 60.2% and a positive predictive value (PPV) of 72.1% and 68.3% in underweight and normal-weight mothers, respectively. Excessive GWG was predicted with a sensitivity of 72.7% and 70.4% and a PPV of 94.3% and 93.3% in overweight and obese mothers, respectively. Conclusions: On the basis of second-trimester‐specific guidelines, inadequate GWG can be predicted in underweight and normalweight mothers, whereas excessive GWG can be predicted in overweight and obese mothers. Therefore, it appears possible to identify women at risk of gaining outside of the guideline as early as the second trimester. Am J Clin Nutr doi: 10.3945/ajcn.111.033704.

Diabet. Med. 29, 378–384 (2012) Abstract Background While the association of gestational diabetes mellitus and abnormal glucose tolerance is beyond doubt, its associations with other cardiovascular disease risk factors in the offspring are less clearly established. Some of these associations, in particular overweight in the offspring, might be confounded by maternal overweight. Methods Data on 12 542 children in the age of 3–17 years with full information about gestational diabetes mellitus and maternal BMI were available from the German nationwide KiGGS study. We calculated linear and logistic regression models for measurements of body composition, blood pressure, HbA1c and cholesterol values in the offspring with gestational diabetes mellitus as the explanatory variable, with and without adjustment for maternal BMI. Results The prevalence of gestational diabetes mellitus in the dataset was 2.2%. Unadjusted regression analyses suggested weak positive effects of gestational diabetes mellitus on body composition measurements [e.g. a mean increase in BMI standard deviation scores (SDS) of 0.17 units (95% confidence interval: 0.03, 0.30)]. After adjustment for maternal BMI, the observed associations almost disappeared [e.g. BMI SDS: 0.07 (−0.06, 0.20)]. With respect to blood pressure and cholesterol, no potential effects of gestational diabetes mellitus were observed in both unadjusted and adjusted models. Conclusion Gestational diabetes mellitus does not appear to have a relevant effect on cardiovascular disease correlates such as blood pressure or cholesterol levels in children, and the potential effect of gestational diabetes mellitus on body composition seems to be widely explainable by maternal BMI.

Background: Gestational weight gain (GWG) is known to be a potential risk factor for short-term postpartum weight retention (PPWR) and thus for overweight in women. Does GWG also determine the long-term risk of overweight in women? Objective: We aimed to study the short- and long-term effects of GWG in accordance with the Institute of Medicine (IOM) recommendations on postpartum weight retention. Design: We systematically reviewed 5 databases and bibliographies of various publications supplemented by hand search for relevant articles published in English or German and performed meta-analyses to quantify the effect estimate of PPWR by using a random-effects model. We split the data into 4 categories of follow-up: ,0.5, 0.5–1, ;3, and 15 y. Results: Of 1770 search hits, 9 observational studies remained suitable for the analysis. PPWR increased after longer time spans after delivery irrespective of whether GWG had been below, within, or above the guidelines. Compared with women with GWG within the recommendations, those with a GWG above the recommendations retained an additional 3.06 kg (95% CI: 1.50, 4.63 kg) after 3 y and 4.72 kg (95% CI: 2.94, 6.50 kg) on average after 15 y postpartum. Inadequate GWG was associated with less PPWR (22.99 kg; 95% CI: 23.72, 22.27 kg) ,6 mo after pregnancy. This association faded over time and became nonsignificant (21.41 kg; 95% CI: 23.03, 0.21 kg) after 15 y. The results remained stable in sensitivity analyses that accounted for changes in IOM criteria over time and potential effect modification by low social class. A funnel plot did not suggest publication bias. Conclusion: GWG in accordance with the IOM recommendations is associated with long-term effects on PPWR. Am J Clin Nutr doi: 10.3945/ajcn.111.015289.

To the Editor: Preconception obesity is a strong predictor of glucose intolerance during pregnancy that has the potential to lead to adverse maternal and offspring effects. An increased prevalence of overweight offspring of obese mothers has been reported, despite normal values in an oral glucose tolerance test (OGTT)1 during pregnancy (1). Such findings might reflect effects of the intrauterine milieu, genetic background, or lifestyle factors related to maternal obesity or, alternatively, failure to diagnose glucose intolerance in obese pregnant women. We investigated whether increases in hemoglobin A1c (Hb A1c) at delivery as a surrogate marker of glycometabolic disturbances are prevalent in obese mothers, despite the exclusion of gestational diabetes (GDM) even after applying the stringent new criteria as recommended by the International Association of Diabetes and Pregnancy Study Groups (IADPSG). We performed a retrospective analysis of 137 obese pregnant Caucasian women. Recruitment was through an ongoing cohort study on the long-term effects of preconception maternal obesity (PEACHES, Programming of Enhanced Adiposity Risk in CHildhood – Early Screening), which had been initiated in 15 recruiting maternity clinics in Bavaria, Germany. Inclusion criteria before delivery were an age ≥18 years, singleton pregnancy, full-term birth, and a pregestation body mass index (BMI) ≥30 kg/m2. Women with a preexisting diagnosis …

Anorexia nervosa (AN) is a severe eating disorder with a high mortality rate. Treatment regimes show regional and global variation and are sometimes supported by enteral feeding (EF) via nasogastric tube, although risks and benefits are still unclear. We aimed to find out whether EF improves growth and AN recovery and prevents psychiatric comorbidities. Data were retrospectively collected from medical records and follow-up data were collected via questionnaires. Two hundred and eight female AN patients who were hospitalized below the age of 18 years with a mean follow-up of 6 years were analyzed. We calculated relative risks for the association between EF and suboptimal growth, remission of AN and the occurrence of psychiatric comorbidities, adjusting for potential confounders. A third of the analyzed girls received EF at any time. In the adjusted analyses, we found no significant associations between EF and suboptimal growth, the persistence of AN and the occurrence of psychiatric comorbidities, respectively. Our data suggest EF to be neither a risk factor nor beneficial for growth, recovery or persistence of AN and the occurrence of psychiatric comorbidities.

Background Gestational weight gain (GWG) has been shown to be a risk factor for overweight in offspring. Aim of this study was to quantify the contributions of trimester-specific and total GWG on offspring’s BMI and waist circumference (WC). This is of interest for the design of interventions targeted at women showing a high GWG in early pregnancy. Methods In a retrospective cohort study data on GWG (total and by trimester, exposure), a number of potential confounders, and children’s BMI z-scores and WC (outcomes) were analyzed using structural equation models to disentangle the trimester-specific direct effects of GWG and indirect effects mediated via total GWG. Results 7313 mother child pairs with a children’s mean age of 5.81 years were analyzed. Total effects (indirect + direct) of GWG (kg/week) on children’s BMI z-score and WC (cm) were observed in all trimesters, most prominently in the second. The longitudinal effect of GWG is a composite of trimester-specific direct effects (on BMI: 0.105, 0.255, 0.002, on WC: 0.538, 1.64, 0.308) and total GWG (on BMI 0.608, on WC: 1.03) at the end of pregnancy. Conclusions Both trimester-specific priming and total GWG explained offspring’s anthropometrics. The results indicate, that reversal from additional weight gain attained early in pregnancy resulting in normal total GWG at the end of pregnancy might still contribute to a substantial reduction of offspring’s BMI and WC.

Healthy eating behaviours, such as increasing fruit and vegetable consumption (FVC), are frequently used as a target or outcome measure in obesity prevention interventions. The goal of this study was to demonstrate replacement of high-caloric foods/drinks by FVC and changes in body mass index (BMI) z-score associated with FVC.Anthropometric measurements of 1252 children (51.0% girls) were taken before school entrance (age 6 years) and repeated in the fourth grade (age 10 years). At the same time, parents were asked about their children's diet using a questionnaire.In longitudinal analysis, changes in FVC were not significantly correlated with changes of other nutritional habits, such as consumption of sweets and high-caloric drinks. BMI gain tended to be lower (nonsignificant) in children with increasing fruit consumption compared to those with decreasing fruit consumption. An opposite (nonsignificant) tendency was observed for vegetable consumption and BMI gain.Although beneficial for other health outcomes, the evidence for FVC replacing high-energy foods and thereby reducing BMI gain is weak and could not be substantiated in this study. This might be partially due to the limitation in dietary assessment.

INTRODUCTION: Previous studies suggested potential priming effects of gestational weight gain (GWG) on offspring's body composition in later life. However, consistency of these effects in normal weight, overweight and obese mothers is less clear. METHODS: We combined the individual data of three German cohorts and assessed associations of total and excessive GWG (as defined by criteria of the Institute of Medicine) with offspring's mean body mass index (BMI) standard deviation scores (SDS) and overweight at the age of 5-6 years (total: n = 6,254). Quantile regression was used to examine potentially different effects on different parts of the BMI SDS distribution. All models were adjusted for birth weight, maternal age and maternal smoking during pregnancy and stratified by maternal pre-pregnancy weight status. RESULTS: In adjusted models, positive associations of total and excessive GWG with mean BMI SDS and overweight were observed only in children of non- overweight mothers. For example, excessive GWG was associated with a mean increase of 0.08 (95% CI: 0.01, 0.15) units of BMI SDS (0.13 (0.02, 0.24) kg/m(2) of 'real' BMI) in children of normal-weight mothers. The effects of total and excessive GWG on BMI SDS increased for higher- BMI children of normal-weight mothers. DISCUSSION: Increased GWG is likely to be associated with overweight in offspring of non-overweight mothers.