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Objective: To investigate the association between weekly weight gain, during the second and third trimesters, classified according to the 2009 Institute of Medicine (IOM/NRC) recommendations, and maternal and fetal outcomes., Methods: Gestational weight gain was evaluated in 2,244 pregnant women of the Brazilian Study of Gestational Diabetes (Estudo Brasileiro do Diabetes Gestacional--EBDG). Outcomes were cesarean delivery, preterm birth and small or large for gestational age birth (SGA, LGA). Associations between inadequate weight gain and outcomes were estimated using robust Poisson regression adjusting for pre-pregnancy body mass index, trimester-specific weight gain, age, height, skin color, parity, education, smoking, alcohol consumption, gestational diabetes and hypertensive disorders in pregnancy., Results: In fully adjusted models, in the second trimester, insufficient weight gain was associated with SGA (relative risk [RR] 1.72, 95% confidence interval [CI] 1.26-2.33), and excessive weight gain with LGA (RR 1.64, 95% CI 1.16-2.31); in third trimester, excessive weight gain with preterm birth (RR 1.70, 95% CI 1.08-2.70) and cesarean delivery (RR 1.21, 95% CI 1.03-1.44). Women with less than recommended gestational weight gain in the 2nd trimester had a lesser risk of cesarean deliveries (RR 0.82, 95% CI 0.71-0.96) than women with adequate gestational weight gain in this trimester., Conclusion: Though insufficient weight gain in the 3rd trimester was not associated with adverse outcomes, other deviations from recommended weight gain during second and third trimester were associated with adverse pregnancy outcomes. These findings support, in part, the 2009 IOM/NRC recommendations for nutritional monitoring during pregnancy.

In order to describe adequacy of weight gain during pregnancy and its association with pre-pregnancy nutritional status and other factors, a cohort study of pregnant women enrolled at 16-36 weeks of gestation and followed up until delivery was carried out in prenatal care in primary care services in Rio Grande do Sul State, Brazil. Maternal weight was recorded at each prenatal care visit. Weight gain was classified as "adequate," "insufficient" or "excessive" (Institute of Medicine). Poisson regression was used to measure the associations. The sample was comprised of 667 women, and insufficient and excessive weight gain incidences were 25.8% and 44.8%, respectively. Overweight and obese before pregnancy had a significant increased risk of excessive weight gain in pregnancy (RR: 1.75; 95%CI: 1.48-2.07, RR: 1.55; 95%CI: 1.23-1.96, respectively). Women with fewer than six prenatal visits had a 52% increased risk for weight gain below recommended values. Although insufficient weight gain may still be a public health problem, excessive gain is becoming a concern that needs immediate attention in prenatal care.

Background: Woman's nutritional status, before and during pregnancy, is a strong determinant of health outcomes in the mother and newborn. Gestational weight gain and postpartum weight retention increases risk of overweight or obesity in the future and they depend on the pregestational nutritional status and on food consumption and eating behavior during pregnancy. Eating behavior during pregnancy may be the cause or consequence of mood changes during pregnancy, especially depression, which increases likelihood of postpartum depression. In Brazil, a study carried out in the immediate postpartum period found that one in three women experienced some type of violence during pregnancy. Violence and depression are strongly associated and both exposures during pregnancy are associated with increased maternal stress and subsequent harm to the infant. The main objectives of this study are: to identify food intake and eating behaviors patterns; to estimate the prevalence of common mental disorders and the experience of violence during and after pregnancy; and to estimate the association between these exposures and infant's health and development. Methods/Design: This is a cohort study of 780 pregnant women receiving care in 18 primary care units in two cities in Southern Brazil. Pregnant women were first evaluated between the 16th and 36th week of pregnancy at a prenatal visit. Follow-up included immediate postpartum assessment and around the fifth month postpartum. Information was obtained on sociodemographic characteristics, living circumstances, food intake, eating behaviors, mental health and exposure to violence, and on infant's development and anthropometrics measurements. Discussion: This project will bring relevant information for a better understanding of the relationship between exposures during pregnancy and how they might affect child development, which can be useful for a better planning of health actions aiming to enhance available resources in primary health care. [ABSTRACT FROM AUTHOR]

Background Since GDM is important risk factor for type 2 diabetes and maternal obesity can potentiate this outcome, the study sought to describe gestational weight gain and one-year postpartum weight retention (PPWR) in women with GDM. Methods Multicentre cohort study of 598 women with GDM enrolled in prenatal clinics of the Brazilian National Health System and followed by telephone up to 1-year postpartum. Socioeconomic and nutritional data were evaluated in recruitment. Gestational weight gain (GWG) and pre-pregnancy BMI were classified according to Institute of Medicine, 2009. PPWR was the difference between weights 1-year postpartum and pre-pregnancy. Chi-square test compared proportions of PPWR, pre-gestational BMI and GWG. Results Women had mean age 31.2 ± 6.1 years. Mean pre-pregnancy BMI was 30.3 ± 6.5 kg/m², GWG was 9.6 ± 7.3 kg and PPWR was 0.8 ± 6.8. Pre-pregnancy BMI over 25 kg/m² was found in 78%, excessive GWG in 37.6% and PPWR 1-year in 47.7%. PPWR ≥ 5kg was found in 27.6% and was higher in excessive GWG (p < 0.001). Women with excessive GWG, 55.2% had PPWR ≥ 5kg. For all categories of pre-pregnancy BMI, there was higher proportion of PPWR ≥ 5kg in those who had excessive GWG. Conclusions Almost half of women who had GDM presented weight retention in 1-year postpartum. We found more PPWR in who had excessive pregnancy weight gain. Key messages PPWR is common in women with GDM and there is higher proportion of PPWR ≥ 5kg in women with excessive GWG in all pre-pregnancy BMI categories. [ABSTRACT FROM AUTHOR]

Background Breastfeeding seems to be inversely related to postpartum weight retention (PPWR), but this relationship is unclear in women with GDM. We aimed to describe the association between breastfeeding and PPWR at 1 year postpartum in women with GDM. Methods Multicentre cohort study of 524 women with GDM enrolled in prenatal clinics of the Brazilian National Health System and followed by telephone up to one year postpartum. Socio-demographics and pre-gestational weight were obtained during recruitment. Breastfeeding and post-partum maternal weight through telephone calls. PPWR was defined as 1-year postpartum weight minus pre-pregnancy weight and categorized as above and below the 80th sample percentile of retention. Breastfeeding was categorized as duration greater or less than 6 months. Adjusted Poisson regression was performed to assess relative risks (RR). Results Most women were 30 to 39 years old (50.6%), multiparous (71.0%), 39.5% completed high school, 60.1% were non-white (60.1%). Mean pre-gestational BMI was 30.42 (± 6.7) kg/m² and the mean weight gain during pregnancy was 9.5 (± 7.1) kg. After adjustments for previous variables, breastfeeding for 6 months or more reduced by 35% (RR 0.65; 95% CI 0.47; 0.90, p < 0.01) the incidence of 1-year PPWR up to 80th percentile (≥7Kg) compared to breastfeeding less than 6 months. Conclusions Breastfeeding up to 6 months might be encouraged in women with GDM to help preventing higher levels of 1-year PPWR. Key messages Breastfeeding up to 6 months was associated with less PPWR at 1 year after delivery in women with GDM. [ABSTRACT FROM AUTHOR]