title: Prediction of gestational weight gain - a biopsychosocial model. Differential oxidation of individual dietary fatty acids in humans. Dietary composition of pregnant women is related to size of the baby at birth. Energy supplementation in the last trimester of pregnancy in East Java, Indonesia: effect on maternal anthropometry. Body fat distribution and non-insulin-dependent diabetes: comparison of a fiber-rich, high-carbohydrate, low-fat (23%) diet and a 35% fat diet high in monounsaturated fat. Formulation and evaluation of supplementary foods for Thai pregnant women. Effect of fat-reduced diets on 24-h energy expenditure: comparisons between animal protein, vegetable protein, and carbohydrate. Substitution of saturated with monounsaturated fat in a 4-week diet affects body weight and composition of overweight and obese men. Intake of Sweets, Snacks and Soft Drinks Predicts Weight Gain in Obese Pregnant Women: Detailed Analysis of the Results of a Randomised Controlled Trial Preexercise carbohydrate ingestion, glucose kinetics, and muscle glycogen use: effect of the glycemic index. Dietary protein energy supplementation of pregnant Asian mothers at Sorrento, Birmingham. II: Selective during third trimester only. Dietary protein-to-carbohydrate ratio and added sugar as determinants of excessive gestational weight gain: a prospective cohort study Low Glycemic Index Carbohydrates versus All Types of Carbohydrates for Treating Diabetes in Pregnancy: A Randomized Clinical Trial to Evaluate the Effect of Glycemic Control Determinants of weight gain in pregnant women attending a public prenatal care facility in Rio de Janeiro, Brazil: a prospective study, 2005-2007. The effect of maternal nutritional variables on birthweight outcomes of infants born to Sherpa women at low and high altitudes in Nepal Excessive Early Gestational Weight Gain and Risk of Gestational Diabetes Mellitus in Nulliparous Women Longitudinal analysis of changes in energy intake and macronutrient composition during pregnancy and 6 weeks post-partum High glycemic index foods, overeating, and obesity. A randomised controlled trial of dietary energy restriction in the management of obese women with gestational diabetes Risk factors and outcomes of maternal obesity and excessive weight gain during pregnancy. Influence of maternal nutrient intake and weight gain on neonatal birth weight: A prospective cohort study in southern Thailand Food supplementation during pregnancy, maternal anthropometry and birth weight in a Guatemalan rural population. The Bacon Chow study: effect of nutritional supplementation on maternal weight and skinfold thicknesses during pregnancy and lactation. [Adherence to dietary recommendations by the Institute of Medicine and the effect on body weight during pregnancy]. Predictors of excessive and inadequate gestational weight gain in Hispanic women. Relationship between caloric intake and pregnancy outcome in diet-treated gestational diabetes mellitus. The association between portion size, nutrient intake and gestational weight gain: a secondary analysis in the WATCH study 2006/7.
abstract: OBJECTIVE To examine the influence of health behaviours and psychological well-being on  gestational weight gain  using a biopsychosocial model . DESIGN A prospect i ve cohort study of pregnant women consecutively recruited at their first antenatal care visit . A self-administered question naire was used to collect data on health behaviours and psychological well-being in early pregnancy . Linear regression and logistic regression were used to identify predictors of total weight gain in kilograms and weight gain outside the current Institute of Medicine recommendations , respectively . SETTING A maternity hospital in the Republic of Irel and . SUBJECTS Data on 799 women were analysed . RESULTS Pre-pregnant BMI ≥30·0 kg/m2 , short stature , parity > 0 , decreased food intake and absence of health insurance predicted lower absolute gestational weight gain , while foreign nationality , consumption of takeaway meals more than once weekly and increased food intake predicted higher absolute gestational weight gain . Overweight and obesity , foreign nationality , increased food intake and height > 170 cm were risk factors for excessive weight gain , while antenatal depression was protective against excessive weight gain . Notably , physical activity measures were not related to the gestational weight gain outcomes . Pre-pregnancy overweight and increased food intake were the strongest predictors of excessive gestational weight gain . CONCLUSIONS None of the psychological well-being measures examined , with the exception of antenatal depression , was associated with any of the weight gain outcomes . The behavioural predictors of gestational weight gain were increased food intake and takeaway consumption . Public health promotions should target pre-pregnancy BMI and pregnancy-associated change in food intake BACKGROUND Dietary fatty acids that are more prone to oxidation than to storage may be less likely to lead to obesity . OBJECTIVE The aim of this study was to determine the effect of chain length , degree of unsaturation , and stereoisomeric effects of unsaturation on the oxidation of individual fatty acids in normal-weight men . DESIGN Fatty acid oxidation was examined in men consuming a weight-maintenance diet containing 40 % of energy as fat .  After consuming the diet for 1 wk , subjects were fed fatty acids labeled with (13)C in the methyl or carboxyl position ( 10 mg/kg body wt ) . The fatty acids fed in r and om order were laurate , palmitate , stearate , oleate , elai date ( the trans isomer of oleate ) , linoleate , and linolenate blended in a hot liquid meal . Breath sample s were collected for the next 9 h and the oxidation of each fatty acid was assessed by examining liberated (13)CO(2 ) in breath . RESULTS Cumulative oxidation over the 9-h test ranged from a high of 41 % of the dose for laurate to a low of 13 % of the dose for stearate . Of the 18-carbon fatty acids , linolenate was the most highly oxidized and linoleate appeared to be somewhat conserved . (13)C recovery in breath from the methyl-labeled fatty acids was approximately 30 % less than that from the carboxyl-labeled fatty acids . CONCLUSIONS In summary , lauric acid is highly oxidized , whereas the polyunsaturated and monounsaturated fatty acids are fairly well oxidized . Oxidation of the long-chain , saturated fatty acids decreases with increasing carbon number The fetal origins theory of adult disease suggests that term infants who are small for their gestational age have an increased susceptibility to chronic disease in adulthood as a consequence of physiologic adaptations to undernutrition during fetal life . Consistent evidence for an influence of women 's dietary composition during pregnancy on growth of their babies is lacking , despite robust effects in animal experiments . We undertook a prospect i ve observational study of 557 women aged 18 - 41 y , living in Adelaide , South Australia .  Diet was assessed in early and late pregnancy using an FFQ . In early pregnancy , medians for energy intake , the proportion of energy derived from protein and from carbohydrate were 9.0 MJ , 17 and 48 % , respectively . In late pregnancy the corresponding medians were 9.2 MJ , 16 and 49 % . In early pregnancy , the percentage of energy derived from protein was positively associated with birth weight ( P = 0.02 ) and placental weight ( P = 0.07 ) , independently of energy intake and weight gain during pregnancy , and after adjustment for potential confounders , including maternal age , parity , and smoking . Effects were stronger among women ( n = 429 ) who had reliable data , based on prespecified criteria including the plausibility of dietary data when referenced against estimated energy expenditure . In addition , for this subgroup , the percentage of energy from carbohydrate in early and late pregnancy was negatively associated with ponderal index of the baby , and a specific effect of protein from dairy sources was identified . These data support the proposition that maternal dietary composition has an effect on fetal growth . Maternal diet in Western societies may therefore be important for the long-term health of the child The effect of prenatal energy supplementation on  maternal anthropometry was assessed in a controlled , r and omized trial in Madura , East Java . At 26 - 28 wk of gestation women were either given 465 kcal/d ( HE group ) or 52 kcal/d ( LE group ) . Two hundred seventy-six women were enrolled in the HE group and 266 women , in the LE group .  Supplement intake was variable . Testing of effect by treatment and compliance was thus done by subcategories ( HE 1 - 3 and LE 1 - 3 , corresponding to less than 45 , 45 - 89 , and greater than or equal to 90 packets of supplement consumed ) . Analysis of variance did not show significant differences among the six subcategories in third-trimester weight gain , sum of skinfold thicknesses , 4-wk postpartum weight , or body mass index . In this population energy supplementation for the short duration of the last 90 - 110 d of pregnancy was not sufficient to improve maternal nutrition as judged by anthropometry The effects of a fiber-rich , high-carbohydrate , low-fat ( HCLF ) diet and a modified-fat ( MF ) diet high in monounsaturated fat on body fat distribution were examined by dual-energy X-ray absorptiometry ( DXA ) in 16 subjects with non-insulin-dependent diabetes ( NIDDM ) during a r and omized crossover study . Subjects lost similar amounts of body fat consuming the HCLF and MF diets ( -0.83 + /- 0.37 and -0.87 + /- 0.40 kg , respectively ) despite a marked difference in total fat consumption . With the MF diet , the ratio of upper- to lower-body fat ( UF : LF ) remained unchanged because fat was lost proportionately from the upper and lower body . In contrast , with the HCLF diet , a disproportionate loss of lower-body fat caused the UF : LF to increase . The effects of diet on regional body fat loss were significant ( P < 0.05 , two-factor repeated- measures ANOVA ) To improve maternal nutritional status and to ameliorate protein-energy malnutrition in pregnant women and infants , supplementary foods for rural pregnant women were formulated and evaluated . Six formulas with protein and energy contents of 16 - 22 g and 350 - 500 kcal/100 g food , respectively , were developed from locally available raw material s. A field evaluation of formulas I and V was conducted at the regional MCH Center at Rajchaburi , about 120 km from Bangkok .  Formulas providing 13 g protein and 350 kcal per day were given to two groups of mothers in the first or second pregnancy , starting at 28 + /- 2 wk of gestation . A third group , unsupplemented , served as controls .  Maternal weight gain and left mid-arm circumference were measured every 2 wk . Birth weight , length , head and chest circumferences of newborns , and placental weight were significantly higher in both supplemented groups . These findings suggest that among undernourished mothers , supplementation of as little as 13 g protein and 350 kcal daily during the last trimester can significantly improve maternal weight gain and birth weight of newborns BACKGROUND Single-meal tests have shown that protein has greater thermogenic and satiating effects than does carbohydrate , which may be relevant for the prevention and treatment of obesity if these effects can be maintained over 24 h. OBJECTIVE The effects of pork-meat protein , soy protein , and carbohydrate on 24-h energy expenditure were compared . DESIGN Twelve young , healthy , overweight and mildly obese [ body mass index ( in kg/m(2 ) ) : 26 - 32 ] nonsmoking men participated in a r and omized , single-blind , 3-way crossover study lasting 4 d. The intervention had a 1 - 10-wk washout period . The 3 isoenergetic intervention diets were as follows : pork diet ( 29 % of energy as fat and 29 % as protein , mainly from pork meat ) , soy diet ( 29 % of energy as fat and 28 % as protein , mainly from soy ) , and carbohydrate diet ( 28 % of energy as fat and 11 % as protein ) . Twenty-four-hour energy expenditure was measured in a respiratory chamber at baseline and on day 4 of each intervention period . RESULTS Twenty-four-hour energy expenditure was higher with the pork than with the soy ( 248 kJ/d , 1.9 % ; P : = 0.05 ) or carbohydrate ( 492 kJ/d , 3.9 % ; P : < 0.0001 ) diet and higher with the soy than with the carbohydrate ( 244 kJ/d , 1.9 % ; P : < 0.05 ) diet . However , because of a higher satiating effect , energy intake was 10 - 15 % lower during the chamber stay than at baseline ( P : > 0.05 ) with all 3 diets . The differences in energy expenditure remained unchanged after adjustment for differences in 24-h energy balance . CONCLUSIONS Substitution of carbohydrate with 17 - 18 % of energy as either pork-meat or soy protein produced a 3 % higher 24-h energy expenditure . The animal protein in pork meat produced a 2 % higher 24-h energy expenditure than did the vegetable protein in soy A r and omised crossover study of eight overweight or obese men ( aged 24 - 49 years , BMI 25.5 - 31.3 kg/m(2 ) ) , who followed two diets for 4 weeks each , was performed to determine whether substitution of saturated fat with monounsaturated fat affects body weight and composition . Subjects were provided with all food and beverages as modules ( selected ad libitum ) of constant macronutrient composition , but differing energy content . The % total energy from saturated fat , monounsaturated fat and polyunsaturated fat was 24 , 13 and 3 % respectively on the saturated fatty acid (SFA)-rich diet and 11 , 22 and 7 % respectively on the monounsaturated fatty acid (MUFA)-rich diet . MUFA accounted for about 80 % of the unsaturated fats consumed on both diets . Body composition , blood pressure , energy expenditure ( resting and postpr and ial metabolic rates , substrate oxidation rate , physical activity ) , serum lipids , the fatty acid profile of serum cholesteryl esters and plasma glucose and insulin concentrations were measured before and after each diet period . Significant ( P < or = 0.05 ) differences in total cholesterol and the fatty acid composition of serum cholesteryl esters provided evidence of dietary adherence . The men had a lower weight ( -2.1 ( SE 0.4 ) kg , P=0.0015 ) and fat mass ( -2.6 ( SE 0.6 ) kg , P=0.0034 ) at the end of the MUFA-rich diet as compared with values at the end of the SFA-rich diet . No significant differences were detected in energy or fat intake , energy expenditure , substrate oxidation rates or self-reported physical activity . Substituting dietary saturated with unsaturated fat , predominantly MUFA , can induce a small but significant loss of body weight and fat mass without a significant change in total energy or fat intake Background Lifestyle interventions targeting obese pregnant women often result in modest reduction in gestational weight gain , pregnancy complications and related risk factors . Examining adherence to the intervention can , however , provide valuable information on the importance of the different factors targeted . Objective To evaluate improvements and relevance of different dietary factors targeted with respect to gestational weight gain in a 3-arm R and omised Controlled Trial ( n=342 ) among obese pregnant women with BMI ≥30 kg/m2 . Methods R and omisation 1:1:1 to either hypocaloric Mediterranean type of diet and physical activity intervention ( D+PA ) ; physical activity intervention alone ( PA ) ; or control ( C ) . Diet was assessed at baseline ( weeks 11–14 ) and endpoint ( weeks 36–37 ) using a vali date d food frequency question naire . Results During the intervention women in the D+PA group significantly lowered their intakes of added sugars and saturated fat and increased their protein intake by ~1 % of total energy compared to controls . Of these dietary variables only intakes of added sugar appeared to be related to GWG , while no association was observed for saturated fat or protein . Further analyses revealed that foods that contributed to intake of added sugars , including sweets , snacks , cakes , and soft drinks were strongly associated with weight gain , with women consuming sweets ≥2/day having 5.4 kg ( 95 % CI 2.1 - 8.7 ) greater weight gain than those with a low ( < 1wk ) intake . The results for soft drinks were more conflicting , as women with high weight gain tended to favour artificially sweetened soft drinks . Conclusion In our sample of obese pregnant women , craving for sweets , snacks , and soft drinks strongly predicts GWG . Emphasis on reducing intakes of these foods may be more relevant for limiting gestational weight gain than encouraging strict compliance to more specific diets . Trial Registration Clinical Trials.gov Eight trained men cycled at 70 % peak oxygen uptake for 120 min followed by a 30-min performance cycle after ingesting either a high-glycemic index ( HGI ) , low-glycemic index ( LGI ) , or placebo ( Con ) meal 30 min before exercise . Ingestion of HGI result ed in an elevated ( P<0.01 ) blood glucose concentration compared with LGI and Con . At the onset of exercise , blood glucose fell ( P<0.05 ) such that it was lower ( P<0.05 ) in HGI compared with LGI and Con at 15 and 30 min during exercise . Plasma insulin concentration was higher ( P<0.01 ) throughout the rest period after ingestion of HGI compared with LGI and Con . Plasma free fatty acid concentrations were lower ( P<0.05 ) throughout exercise in HGI compared with LGI and Con . The rates of [6,6-(2)H]glucose appearance and disappearance were higher ( P<0.05 ) at rest after ingestion and throughout exercise in HGI compared with LGI and Con . Carbohydrate oxidation was higher ( P<0.05 ) throughout exercise , whereas glycogen use tended ( P = 0.07 ) to be higher in HGI compared with LGI and Con . No differences were observed in work output during the performance cycle when comparing the three trials . These results demonstrate that preexercise carbohydrate feeding with a HGI , but not a LGI , meal augments carbohydrate utilization during exercise but does not effect exercise performance Unselective dietary protein energy supplementation of Asian mothers at Sorrento Maternity Hospital did not enhance intrauterine growth . The effect of selective supplementation was therefore studied . Forty-five mothers who at 28 weeks were known to be nutritionally at risk ( triceps increment less than or equal to 20 microns/week between 18 and 28 weeks ) received one of three supplements during the third trimester : ( a ) vitamins only -- a multivitamin sachet daily containing vitamins A , B , C , and D ; ( b ) energy--42 - 125 MJ ( 10 000 - 30 000 kcal ) , all from carbohydrate , plus vitamins ; ( c ) protein energy -- energy and vitamins as before , but with 5 - 10 % of energy from milk protein .  Eighty-three mothers regarded as adequately nourished at 28 weeks also received one of the three supplements . In the nutritionally at-risk mothers the protein energy supplement was associated with a heavier crude birth weight and heavier weight for gestational age .  Supplementation did not lead to improved intrauterine growth in those mothers who were adequately nourished . The differential effect of supplementation depending on the mothers ' nutritional state during the second trimester may explain apparently conflicting results of other studies where some have shown a substantial effect of supplementation and others only a small effect . This effect of intervention is further evidence that " poor nutrition " contributes to poor intrauterine growth in selected mothers , even in developed countries Objective To examine the relation between the protein : carbohydrate ( P/C ) ratio and added sugar intake in pregnancy and gestational weight gain ( GWG ) . Design A prebirth cohort including 103 119 pregnancies enrolled between 1996 and 2003 . Setting All women in Denmark were eligible to participate if they spoke Danish and were planning to carry to term . The pregnant women were recruited and enrolled during their first antenatal visit ( 6–10 weeks of gestation ) . Participants Participants included women with live-born singletons and complete data on dietary intake and GWG , leaving 46 262 women for the analysis . Exposure Macronutrient intake was quantified using a vali date d food frequency question naire administered in the 25th week of gestation . The P/C ratio and added sugar intake were examined in quintiles . Primary outcome measures GWG was based on self-reported weight in gestational weeks 12 and 30 and defined as gain in g/week . We used multivariable linear regression , including adjusting for pre-pregnancy body mass index , to calculate relative change in GWG and 95 % CI . Results Average GWG was 471(224 ) g/week . The adjusted weight gain was 16 g/week lower ( 95 % CI 9 to 22 , p for trend < 0.001 ) in the highest ( Q5 ) versus lowest ( Q1 ) quintile of the P/C ratio ( ∼3 % average reduction across the entire pregnancy ) . Weight gain for those with > 20%E vs < 12%E from protein was 36 g/week lower ( 95 % CI 20 to 53 , p for trend < 0.0001 ; ∼8 % average reduction ) . A high P/C ratio was inversely related to intake of added sugars . Added sugar consumption was strongly associated with GWG ( Q5 vs Q1 : 34 , 95 % CI 28 to 40 g/week , p for trend < 0.0001 ) . Conclusions A high P/C ratio was associated with reduced GWG . This association appeared to be partly driven by a decrease in intake of added sugar . These results are consistent with r and omised trials in non-pregnant participants . A dietary intervention targeting an increased P/C ratio with emphasis on reducing added sugar can contribute to reducing excessive GWG Background . Due to the higher prevalence of obesity and diabetes mellitus ( DM ) , more pregnant women complicated with diabetes are in need of clinical care . Purpose . Compare the effect of including only low glycemic index ( GI ) carbohydrates ( CHO ) against all types of CHO on maternal glycemic control and on the maternal and newborn 's nutritional status of women with type 2 DM and gestational diabetes mellitus ( GDM ) . Methods . Women ( n = 107 , ≤29 weeks of gestation ) were r and omly assigned to one of two nutrition intervention groups : moderate energy and CHO restriction ( Group 1 : all types of CHO , Group 2 : low GI foods ) . Results . No baseline differences in clinical data were observed . Capillary glucose concentrations throughout pregnancy were similar between groups . Fewer women in Group 2 exceeded weight gain recommendations . Higher risk of prematurity was observed in women in Group 2 . No differences in glycemic control were observed between women with type 2 DM and those with GDM . Conclusions . Inclusion of low GI CHO as part of a comprehensive nutrition intervention is equally effective in improving glycemic control as compared to all types of CHO . This strategy had a positive effect in preventing excessive maternal weight gain but increased the risk of prematurity The objective of this study was to evaluate the determinants of weight gain during pregnancy . The study adopted a prospect i ve cohort design with four follow-up waves and included a sample of 255 pregnant women that received prenatal care at a public health care facility in Rio de Janeiro , Brazil . A mixed-effects linear longitudinal regression model was used , having as the dependent variable the weight assessed in four follow-up waves , and as independent variables : demographic , socioeconomic , reproductive , behavioral , and nutritional data . Mean weight gain was 0.413 kg per gestational week , consistent with recommendations by the Institute of Medicine . Per capita family income and smoking were associated with total weight gain during gestation . According to the longitudinal multiple linear regression model , age ( beta = 0.6315 ) , menarche ( beta = -2.3861 ) , triglycerides ( beta = 0.0437 ) , blood glucose ( beta = 0.1544 ) , and adequacy of energy consumption ( beta = -0.0642 ) were associated with gestational weight gain . Special attention should be given to these sub-groups , due to increased risk of excessive weight gain A prospect i ve , longitudinal study was conducted in Nepal to investigate the effects of maternal nutrition on the pregnancy outcome of Sherpa women living at low and high altitudes . It was hypothesized that variation in nutrition and energy expenditure of pregnant women would correlate with variation in infant birthweight . Anthropometric dimensions , energy consumption and expenditure , and demographic and migration information were collected on a large sample of women living in two regions of Nepal : the Khumbu region ( 3480–3930 m ) and Kathm and u ( 1330 m ) . This paper reports findings for a subset of the sample ; 17 women at low altitude and 21 women at high altitude who became pregnant and were followed during pregnancy . The results showed no significant differences for mean birthweights between the low ( X = 3069 ± 341 grams ) and high ( X = 3099 ± 483 grams ) altitude sample s. Furthermore , larger birthweights were associated with larger weight gains during pregnancy for the high altitude sample . A stepwise regression analysis found a negative association between high energy expenditures during the second trimester and infant birthweight , but positive associations were found between third trimester calcium and second trimester protein intakes and birthweight . Prepregnancy BMI and stature were associated positively with infant birthweight , suggesting that good nutritional status prior to pregnancy may play an important role in pregnancy outcome for this population . Am . J. Hum . Biol . 9:751–763 , 1997 . © 1997 Wiley‐Liss , OBJECTIVE : To estimate whether there is an association between excessive early gestational weight gain and the development of gestational diabetes mellitus ( GDM ) and excessive fetal growth . METHODS : This is a secondary analysis of a r and omized controlled trial of vitamins C and E in nulliparous low-risk women . Maternal weight gain from prepregnancy ( self-reported ) to 15–18 weeks of gestation was measured , and expected gestational weight gain was determined using the Institute of Medicine 2009 guidelines for each prepregnancy body mass index category . Excessive early gestational weight gain was defined as gestational weight gain greater than the upper range of the Institute of Medicine guidelines . Rates of GDM , birth weight greater than 4,000 g , and large for gestational age ( LGA , birth weight 90th percentile or higher ) were calculated and compared between women with excessive early gestational weight gain and early nonexcessive gestational weight gain ( within or below Institute of Medicine guidelines ) . RESULTS : A total of 7,985 women were studied .  Excessive early gestational weight gain occurred in 47.5 % of women . Ninety-three percent of women with excessive early gestational weight gain had total gestational weight gain greater than Institute of Medicine guidelines . In contrast , only 55 % of women with nonexcessive early gestational weight gain had total gestational weight gain greater than Institute of Medicine guidelines ( P<.001 ) . Rates of GDM , LGA , and birth weight greater than 4,000 g were higher in women with excessive early gestational weight gain . CONCLUSION : In our population , excessive early gestational weight gain occurred in 93 % of women who had total gestational weight gain greater than the Institute of Medicine guidelines . In low-risk nulliparous women , excessive early gestational weight gain is associated with the development of GDM and excessive fetal growth . LEVEL OF EVIDENCE : Purpose This prospect i ve study was carried out in order to investigate changes in nutritional intake during pregnancy with regard to caloric intake and macronutrient composition in normal-weight pregnant women . Methods Using food scales , 32 healthy pregnant women estimated their food intake over a period of 2 days at gestational week 16 , 22 , 30 , 36 and , in addition , 6 weeks after delivery . The recorded food logs were analyzed with respect to caloric intake and macronutrient composition . Results The women ’s age was averaged 29.6 ± 4.5 years , and the mean pre-pregnancy BMI was 22.4 ± 2.5 kg/m2  . Mean weight gain was 16.5 ± 4.5 kg . On average , birth took place during the 40th week of gestation , with the babies having a mean birth weight of 3,515 ± 406 g. Caloric intake during the gestation period and post-partum showed no statistically significant changes and added up 9,237 ± 1,876 kJ/day during the 16th week of gestation , 9,496 ± 2,437 kJ/day during the 22nd , 9,073 ± 1,863 kJ/day during the 30th , 9,525 ± 2,135 kJ/day during the 36th week and 8,445 ± 2,160 kJ/day 6 weeks after delivery . No significant changes were observed in the composition of macronutrients during the pregnancy . The daily composition of macronutrients was as follows : carbohydrates 281 ± 57 g/day ( 51.7 % ) , fat 86 ± 16 g/day ( 35.8 % ) and protein 75 ± 13 g/day ( 13.9 % ) . However , we observed a decrease in carbohydrate intake of 239 ± 72 g/day ( 48 % ) after birth . Conclusions Healthy pregnant women showed no significant changes in their caloric intake or nutritional profiles . Performed with an accurate measurement , this prospect i ve study shows that healthy pregnant require neither increased caloric intake nor a change in macronutrient composition OBJECTIVE The prevalence of obesity has increased dramatically in recent years . However , the role of dietary composition in body weight regulation remains unclear . The purpose of this work was to investigate the acute effects of dietary glycemic index ( GI ) on energy metabolism and voluntary food intake in obese subjects . METHODS Twelve obese teenage boys were evaluated on three separate occasions using a crossover study protocol . During each evaluation , subjects consumed identical test meals at breakfast and lunch that had a low , medium , or high GI . The high- and medium-GI meals were design ed to have similar macronutrient composition , fiber content , and palatability , and all meals for each subject had equal energy content . After breakfast , plasma and serum concentrations of metabolic fuels and hormones were measured . Ad libitum food intake was determined in the 5-hour period after lunch . RESULTS Voluntary energy intake after the high-GI meal ( 5.8 megajoule [ mJ ] ) was 53 % greater than after the medium-GI meal ( 3.8 mJ ) , and 81 % greater than after the low-GI meal ( 3.2 mJ ) . In addition , compared with the low-GI meal , the high-GI meal result ed in higher serum insulin levels , lower plasma glucagon levels , lower postabsorptive plasma glucose and serum fatty acids levels , and elevation in plasma epinephrine . The area under the glycemic response curve for each test meal accounted for 53 % of the variance in food intake within subjects . CONCLUSIONS The rapid absorption of glucose after consumption of high-GI meals induces a sequence of hormonal and metabolic changes that promote excessive food intake in obese subjects . Additional studies are needed to examine the relationship between dietary GI and long-term body weight regulation Summary : A r and omised controlled trial was design ed to determine the effect of moderate 30 % maternal dietary energy restriction on the requirement for maternal insulin therapy  and the incidence of macrosomia in gestational diabetes .  Although the control group restricted their intake to a level similar to that of the intervention group ( 6845 kiloJoules ( kJ ) versus 6579 kJ ) , the result ing cohort could not identify any adverse effect of energy restriction in pregnancy . Energy restriction did not alter the frequency of insulin therapy ( 17.5 % in the intervention group and 16.9 % in the control group ) . Mean birth weight  ( 3461 g in the intervention group and 3267 g in the control group ) was not affected . There was a trend in the intervention group towards later gestational age at commencement of insulin therapy ( 33 weeks versus 31 weeks ) and lower maximum daily insulin dose ( 23 units versus 60 units ) which did not reach statistical significance . Energy restriction did not cause an increase in ketonemia OBJECTIVE The prevalence of overweight and obesity among women of reproductive age is increasing . We aim ed to determine risk factors and maternal , fetal and childhood consequences of maternal obesity and excessive gestational weight gain . DESIGN AND METHODS The study was embedded in a  population -based prospect i ve cohort study among 6959 mothers and their children . The study was based in Rotterdam , The Netherl and s ( 2001 - 2005 ) . RESULTS Maternal lower educational level , lower household income , multiparity , and FTO risk allel were associated with an increased risk of maternal obesity , whereas maternal European ethnicity , nulliparity , higher total energy intake , and smoking during pregnancy were associated with an increased risk of excessive gestational weight gain ( all p-values < 0.05 ) . As compared to normal weight , maternal obesity was associated with increased risks of gestational hypertension ( OR 6.31 ( 95 % CI 4.30 , 9.26 ) ) , preeclampsia ( OR ( 3.61 , ( 95 % CI 2.04 , 6.39 ) ) , gestational diabetes ( OR 6.28 ( 95%CI 3.01 , 13.06 ) ) , caesarean delivery ( OR 1.91 ( 95 % CI 1.46 , 2.50 ) ) , delivering large size for gestational age infants ( OR 2.97 ( 95 % CI 2.16 , 4.08 ) ) , and childhood obesity ( OR 5.02 ( 95 % CI:2.97 , 8.45 ) ) . Weaker associations of excessive gestational weight gain with maternal , fetal and childhood outcomes were observed , with the strongest effects for first trimester weight gain . CONCLUSIONS Our study shows that maternal obesity and excessive weight gain during pregnancy are associated with socio-demographic , lifestyle , and genetic factors and with increased risks of adverse maternal , fetal and childhood outcomes . As compared to prepregnancy overweight and obesity , excessive gestational weight gain has a limited influence on adverse pregnancy outcomes Objectives . To assess the  nutritional intake and gestational weight gain of pregnant women and the relationship between nutritional intake , gestational weight gain , and neonatal birth weight . Methods . A prospect i ve cohort study was carried out in three districts of Songkhla Province in southern Thail and . Nutritional intakes were calculated based on a 24-h food record and a food frequency checklist . The women were followed until delivery and the neonatal birth weight recorded . Results . Two hundred and thirty-six pregnant women with a mean age of 27.2 ± 6.2 years were recruited . The average daily energy intake was 1806 ± 482 kcal . The average gestational weight gain was 12.2 ± 4.6 kg and the average neonatal birth weight was 3054 ± 474 g. Micronutrient intakes were overall inadequate averaging only 50–80 % of recommended levels . Neonatal birth weight was significantly positively correlated with gestational weight gain ( r = 0.17 , p = 0.01 ) , but was not correlated with maternal nutritional intakes . Conclusions . Pregnant women in rural areas of Songkhla Province consume adequate macronutrients with appropriate gestational weight gain , but generally consume inadequate micronutrients . A nutritional education program explaining the importance of micronutrients should be a focus of a public education program The relationship between food supplementation during pregnancy maternal nutrition - as estimated by anthropometrical measurements - and birth weight in a chronically malnourished population was examined in 4 rural villages of Guatemala . The data were drawn from a long-term prospect i ve study dealing with the effects of chronic malnutrition on physical growth and mental development . The findings showed that calorie supplementation was positively associated with maternal monthly weight gain during pregnancy after controlling for maternal home diet height head circumference gestational age parity birth interval morbidity socioeconomic status and type of supplement ( protein-caloric and caloric ) . The proportion of mothers with a monthly weight gain equal to or less than 0.5 kg was 15 % in the low-supplemental group and 2.4 % in the high supplemented group . Direct associations between birth weight and all maternal measurements of mass and length ( weight at 1st 2nd and 3rd trimester weight gain during pregnancy height and sitting height ) with all the perimeters ( head arm leg thigh and chest ) and the 2 osseous diameters measured ( biestyloid and bicondylar ) were also observed . Associations between birth weight and skinfolds ( subscapular bicipital tricipital midaxilar lateral and anterior thigh and leg ) were less consistent . The results support the hypothesis that food supplementation improves both birth weight and maternal nutritional status Effects of a feeding programme on maternal weight , triceps and subscapular skinfolds during pregnancy and lactation were assessed in a marginally undernourished population of rural Taiwan . Mothers participated during two pregnancy and lactation periods . At 3 weeks after the delivery of the first infant , one group of 114 mothers began consuming a nutrient-dense supplement ( A ) , while another group of 111 received a placebo ( B ) . There was no significant A-B difference in pregnancy weight gain ( A 7.52 kg , B 7.75 kg ) or in mean maternal weight , triceps or subscapular skinfolds at any time during pregnancy or lactation . Despite a general trend toward moderate weight loss during lactation , one-third of mothers in both groups gained weight . Highly significant increases in weight and skinfold thicknesses from one lactation period to the next characterized both groups . The absence of demonstrable supplement-effects on maternal anthropometry concomitant with increments in infant birth weight supports the notion that infants can benefit from maternal supplementation without changes in maternal nutritional status The study 's objective was to estimate the effect of adherence to dietary recommendations by the Institute of Medicine ( IOM ) concerning energy intake and /or macronutrient composition of diet on weight during pregnancy . This was a prospect i ve study with observations at three time points , with a sample of 255 pregnant women . The dependent variable was gestational weight , and the independent variable was dietary adequacy according to IOM recommendations for energy and macronutrient intake , categorized as adequate versus excessive intake . Statistical analyses were performed using mixed effects models for repeated measures . Pregnant women with excessive intake were 3.59 kg lighter at baseline ( SE = 0.92 kg ; p < 0.01 ) . On average , gestational weight varied by 1.83 kg ( SE = 0.40 kg ) per trimester , but pregnant women with excessive intake showed a higher weight increase of 1.70 kg ( SE = 0.43 kg ) during the same period as compared to women with adequate intake ( p < 0.01 ) . Women who adhered to IOM dietary recommendations gained less weight during pregnancy Factors influencing gestational weight gain are incompletely understood , particularly among Hispanic women . We assessed medical , sociodemographic , behavioral , and psychosocial predictors of overall gestational weight gain , as well as gains below , within , or above the range recommended by the Institute of Medicine ( IOM ) within a prospect i ve study of 770 Hispanic ( predominantly Puerto Rican ) prenatal care patients at a large tertiary care facility in Western Massachusetts . One third of women gained within the recommended range , 22 % gained below , and 45 % gained above the range . In multivariate analysis , women in the highest category of BMI ( P(trend)<0.001 ) and parity ( P(trend)<0.001 ) gained on average 9 lbs less than those in the lowest category . Increasing time in residence in the continental United States ( P(trend)<0.01 ) as well as a number of prenatal care visits ( P(trend)=0.03 ) were positively associated with weight gain . Overweight women ( odds ratio (OR)=2.2 , 95 % confidence interval ( CI ) 1.3 , 3.8 ) and those over age 30 years ( OR=2.5 , 95 % CI 1.2 , 5.0 ) were more likely to gain above the IOM range as compared to normal-weight women and those aged 20 - 24 , respectively . Women with < 10 years of residence in the United States were 50 % less likely to gain above the IOM range as compared to third-generation women ( 95 % CI 0.3 , 0.9 ) . Findings identify determinants of gestational weight gain which can form the basis of targeted interventions in this rapidly growing ethnic group A prospect i ve observational study was performed to examine the relationship between estimated caloric intake with maternal blood glucose profile and infant outcome in a group of Chinese women with gestational diabetes mellitus ( GDM ) treated by diet alone .  Following the diagnosis of GDM according to the World Health Organization ( WHO ) criteria , and using a 75 g oral glucose tolerance test ( OGTT ) , 62 non-obese Chinese women who had completed a 5-day dietary survey were recruited into the study . They were categorized by their mean caloric intake over 5 days into tertiles for comparison of gestational weight gain , glycemic control and pregnancy outcome . Subjects in the highest tertile had a mean intake close to the prescribed intake . No differences were seen in maternal characteristics , gestational weight gain , OGTT , other postpr and ial glucose concentrations , or infant outcome among the tertiles . Our findings indicated that as long as the caloric intake did not exceed that prescribed , the infant outcome remained satisfactory BACKGROUND Excessive gestational weight gain ( GWG ) is associated with adverse maternal-child health outcomes . Managing energy intake and GWG versus optimising nutrient intake can be challenging . The present study aim ed to examine the relationships between dietary portion size , GWG and nutrient intakes during pregnancy . It is hypothesised that , after adjustment for potential confounders , portion size would be positively associated with both GWG and nutrient intakes during pregnancy . METHODS Prospect i ve data were obtained for 179 Australian women from the Women and Their Children 's Health Study . A vali date d food frequency question naire was used at 18 - 24 and 36 - 40 weeks of gestation to quantify diet and portion size during the previous 3 months of pregnancy . Nutrient intakes were compared with Australian Nutrient Reference Values ( NRVs ) . GWG was measured up to 36 weeks and compared with the Institute of Medicine weight gain recommendations ( WtAdh ) . RESULTS In multivariate regression models , portion size factor ( PSF ) was positively associated with GWG in women with high socio-economic status ( SES ; β = 0.20 , P = 0.04 ) and those with an overweight/obese pre-pregnancy body mass index ( BMI ) ( β = 0.28 , P = 0.04 ) . PSF uniquely accounted for 8.2 % and 3.7 % of the variability in GWG for women with high SES and overweight/obese pre-pregnancy BMI s , respectively . Nutrient intakes and PSF were similar regardless of WtAdh . Women achieved NRVs for calcium and zinc in all PSF categories . Most of the women with large PSF still failed to achieve the NRVs for folate ( 95.7 % ) , iron ( 89.6 % ) and fibre ( 85.5 % ) . CONCLUSIONS All women require advice on quality food choices during pregnancy to optimise health outcomes . Targeting portion size alone is insufficient to manage GWG but may prove to be a valuable tool in pregnant women of high SES and /or those who are overweight/obese pre-pregnancy
target: Maternal fat intake ( n = 25 ) might be associated with gestational weight gain as suggested by observational studies , although the direction of this association might depend on specific types of fat ( e.g. , saturated fat ) .
  Macronutrient intake was not consistently associated with the prevalence of inadequate or excessive gestational weight gain .
  CONCLUSIONS The current literature provides evidence that energy intake is associated with gestational weight gain , but the roles of individual macronutrients are inconsistent .
background: BACKGROUND  Abnormal gestational weight gain is associated with unfavorable pregnancy outcomes .
  Several risk factors have been identified , but the effect of macronutrient intake during pregnancy on gestational weight gain has not been systematic ally evaluated in both high-income countries and low- and middle-income countries .