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American Journal of Obstetrics and... Dec 2017Prenatal care providers are advised to evaluate maternal weight at each regularly scheduled prenatal visit, monitor progress toward meeting weight gain goals, and... (Review)
Review
Prenatal care providers are advised to evaluate maternal weight at each regularly scheduled prenatal visit, monitor progress toward meeting weight gain goals, and provide individualized counseling if significant deviations from a woman's goals occur. Today, nearly 50% of women exceed their weight gain goals with overweight and obese women having the highest prevalence of excessive weight gain. Risks of inadequate weight gain include low birthweight and failure to initiate breast-feeding whereas the risks of excessive weight gain include cesarean deliveries and postpartum weight retention for the mother and large-for-gestational-age infants, macrosomia, and childhood overweight or obesity for the offspring. Prenatal care providers have many resources and tools to incorporate weight and other health behavior counseling into routine prenatal practices. Because many women are motivated to improve health behaviors, pregnancy is often considered the optimal time to intervene for issues related to eating habits and physical activity to prevent excessive weight gain. Gestational weight gain is a potentially modifiable risk factor for a number of adverse maternal and neonatal outcomes and meta-analyses of randomized controlled trials report that diet or exercise interventions during pregnancy can help reduce excessive weight gain. However, health behavior interventions for gestational weight gain have not significantly improved other maternal and neonatal outcomes and have limited effectiveness in overweight and obese women.
Topics: Breast Feeding; Cesarean Section; Counseling; Diet; Exercise; Female; Fetal Macrosomia; Health Behavior; Humans; Infant, Low Birth Weight; Motivational Interviewing; Obesity; Overweight; Pediatric Obesity; Pregnancy; Pregnancy Complications; Prenatal Care; Risk Factors; Weight Gain
PubMed: 28549978
DOI: 10.1016/j.ajog.2017.05.040 -
Brazilian Journal of Physical Therapy 2019This article presents the state of knowledge related to the impact of exercise on gestational weight gain and birth weight. (Review)
Review
OBJECTIVE
This article presents the state of knowledge related to the impact of exercise on gestational weight gain and birth weight.
TRANSCENDENCE OF BABY WEIGHT
Birth weight is an important indicator of intrauterine environment and maternal and newborn health. There are several factors that can affect birth weight including mother's pre-pregnancy Body Mass Index (BMI), gestational weight gain, Gestational Diabetes Mellitus (GDM), chronic diabetes and gestational age at birth.
IMPACT OF EXERCISE DURING PREGNANCY
Physical exercise has the potential to prevent excessive gestational weight gain, GDM and the potential complications associated with obesity during pregnancy. Therefore, women who regularly exercise during pregnancy are more likely to have an appropriate gestational weight gain and in turn, an appropriate birth weight infant, preventing being LGA without increasing risk of SGA, and this reduces risk factors for later life chronic disease development in the child including cardiovascular disease, obesity and diabetes.
RECOMMENDATIONS
It would be advisable to promote compliance with physical activity and exercise recommendations during pregnancy by using the specific resources to prescribe exercise to pregnant women without obstetric contraindications.
Topics: Birth Weight; Body Mass Index; Diabetes, Gestational; Exercise; Female; Gestational Weight Gain; Humans; Obesity; Pregnancy; Risk Factors; Weight Gain
PubMed: 30527949
DOI: 10.1016/j.bjpt.2018.11.012 -
Clinical Infectious Diseases : An... Sep 2020Initiation of antiretroviral therapy (ART) often leads to weight gain. While some of this weight gain may be an appropriate return-to-health effect, excessive increases...
BACKGROUND
Initiation of antiretroviral therapy (ART) often leads to weight gain. While some of this weight gain may be an appropriate return-to-health effect, excessive increases in weight may lead to obesity. We sought to explore factors associated with weight gain in several randomized comparative clinical trials of ART initiation.
METHODS
We performed a pooled analysis of weight gain in 8 randomized controlled clinical trials of treatment-naive people living with human immunodeficiency virus (HIV) initiating ART between 2003 and 2015, comprising >5000 participants and 10 000 person-years of follow-up. We used multivariate modeling to explore relationships between demographic factors, HIV disease characteristics, and ART components and weight change following ART initiation.
RESULTS
Weight gain was greater in more recent trials and with the use of newer ART regimens. Pooled analysis revealed baseline demographic factors associated with weight gain including lower CD4 cell count, higher HIV type 1 RNA, no injection drug use, female sex, and black race. Integrase strand transfer inhibitor use was associated with more weight gain than were protease inhibitors or nonnucleoside reverse transcriptase inhibitors (NNRTIs), with dolutegravir and bictegravir associated with more weight gain than elvitegravir/cobicistat. Among the NNRTIs, rilpivirine was associated with more weight gain than efavirenz. Among nucleoside/nucleotide reverse transcriptase inhibitors, tenofovir alafenamide was associated with more weight gain than tenofovir disoproxil fumarate, abacavir, or zidovudine.
CONCLUSIONS
Weight gain is ubiquitous in clinical trials of ART initiation and is multifactorial in nature, with demographic factors, HIV-related factors, and the composition of ART regimens as contributors. The mechanisms by which certain ART agents differentially contribute to weight gain are unknown.
Topics: Anti-HIV Agents; Anti-Retroviral Agents; Female; HIV Infections; Humans; Risk Factors; Tenofovir; Weight Gain
PubMed: 31606734
DOI: 10.1093/cid/ciz999 -
Neuroscience May 2019Many, or most, tinnitus models rely on increased central gain in the auditory pathway as all or part of the explanation, in that central auditory neurones deprived of... (Review)
Review
Many, or most, tinnitus models rely on increased central gain in the auditory pathway as all or part of the explanation, in that central auditory neurones deprived of their usual sensory input maintain homeostasis by increasing the rate at which they fire in response to any given strength of input, including amplifying spontaneous firing which forms the basis of tinnitus. However, dramatic gain changes occur in response to damage to the auditory periphery, irrespective of whether tinnitus occurs. This article considers gain in its broadest sense, summarizes its contributory processes, neural manifestations, behavioral effects, techniques for its measurement, pitfalls in attributing gain changes to tinnitus, a discussion of the minimum evidential requirements to implicate gain as a necessary and/or sufficient basis to explain tinnitus, and the extent of existing evidence in this regard. Overall there is compelling evidence that peripheral auditory insults induce changes in neuronal firing rates, synchrony and neurochemistry and thus increase gain, but specific attribution of these changes to tinnitus is generally hampered by the absence of hearing-matched human control groups or insult-exposed non-tinnitus animals. A few studies show changes specifically attributable to tinnitus at group level, but the limited attempts so far to classify individual subjects based on gain metrics have not proven successful. If gain turns out to be unnecessary or insufficient to cause tinnitus, candidate additional mechanisms include focused attention, resetting of sensory predictions, failure of sensory gating, altered sensory predictions, formation of pervasive memory traces and/or entry into global perceptual networks. This article is part of a Special Issue entitled: Hearing Loss, Tinnitus, Hyperacusis, Central Gain.
Topics: Acoustic Stimulation; Animals; Auditory Pathways; Cochlea; Hearing; Humans; Hyperacusis; Tinnitus
PubMed: 30690137
DOI: 10.1016/j.neuroscience.2019.01.027 -
Annals of Oncology : Official Journal... Jun 2017Colorectal adenomas are known as precursors for the majority of colorectal carcinomas. While weight gain during adulthood has been identified as a risk factor for... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Colorectal adenomas are known as precursors for the majority of colorectal carcinomas. While weight gain during adulthood has been identified as a risk factor for colorectal cancer, the association is less clear for colorectal adenomas. We conducted a systematic review and meta-analysis to quantify the evidence on this association.
METHODS
We searched Medline up to September 2016 to identify observational (prospective, cross-sectional and retrospective) studies on weight gain during adulthood and colorectal adenoma occurrence and recurrence. We conducted meta-analysis on high weight gain versus stable weight, linear and non-linear dose-response meta-analyses to analyze the association. Summary odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using a random effects model.
RESULTS
For colorectal adenoma occurrence, the summary OR was 1.39 (95% CI: 1.17-1.65; I2: 43%, N = 9 studies, cases = 5507) comparing high (midpoint: 17.4 kg) versus stable weight gain during adulthood and with each 5 kg weight gain the odds increased by 7% (2%-11%; I2: 65%, N = 7 studies). Although there was indication of non-linearity (Pnon-linearity < 0.001) there was an increased odds of colorectal adenoma throughout the whole range of weight gain. Three studies were identified investigating the association between weight gain and colorectal adenoma recurrence and data were limited to draw firm conclusions.
CONCLUSIONS
Even a small amount of adult weight gain was related to a higher odds of colorectal adenoma occurrence. Our findings add to the benefits of weight control in adulthood regarding colorectal adenoma occurrence, which might be relevant for early prevention of colorectal cancer.
Topics: Adenoma; Adult; Colorectal Neoplasms; Female; Humans; Male; Middle Aged; Weight Gain
PubMed: 28327995
DOI: 10.1093/annonc/mdx080 -
BMC Medicine Jun 2019Atypical antipsychotics, also known as second-generation antipsychotics, are commonly prescribed as treatment for psychotic disorders in adults, as well as in children... (Review)
Review
BACKGROUND
Atypical antipsychotics, also known as second-generation antipsychotics, are commonly prescribed as treatment for psychotic disorders in adults, as well as in children and adolescents with behavioral problems. However, in many cases, second-generation antipsychotics have unwanted side effects, such as weight gain, potentially further increasing risk for morbidities including obesity, diabetes, and cardiovascular disease. While various mechanisms for this weight gain have been proposed, including effects on metabolic hormone signaling, recent evidence points to the importance of the gut microbiome in this process. The microbial communities residing within the gut are affected by second-generation antipsychotics and can confer weight gain.
MAIN TEXT
This review summarizes recent findings and presents data linking second-generation antipsychotics, gut microbiota alterations and weight gain. The review focuses on children and adolescent populations, which have not previously received much attention, but are of great interest because they may be most vulnerable to gut microbiome changes and may carry long-term metabolic effects into adulthood.
CONCLUSIONS
We present correlations between second-generation antipsychotics, gut microbiota alterations and weight gain, and suggest some mechanisms that may link them. A better understanding of the underlying mechanisms may lead to the design of improved treatments for psychotic disorders with fewer harmful side effects.
Topics: Antipsychotic Agents; Child; Female; Humans; Male; Microbiota; Obesity; Psychotic Disorders; Weight Gain
PubMed: 31215494
DOI: 10.1186/s12916-019-1346-1 -
Respirology (Carlton, Vic.) Jan 2017Central sleep apnoea (CSA) - the temporary absence or diminution of ventilatory effort during sleep - is seen in a variety of forms including periodic breathing in... (Review)
Review
Central sleep apnoea (CSA) - the temporary absence or diminution of ventilatory effort during sleep - is seen in a variety of forms including periodic breathing in infancy and healthy adults at altitude and Cheyne-Stokes respiration in heart failure. In most circumstances, the cyclic absence of effort is paradoxically a consequence of hypersensitive ventilatory chemoreflex responses to oppose changes in airflow, that is elevated loop gain, leading to overshoot/undershoot ventilatory oscillations. Considerable evidence illustrates overlap between CSA and obstructive sleep apnoea (OSA), including elevated loop gain in patients with OSA and the presence of pharyngeal narrowing during central apnoeas. Indeed, treatment of OSA, whether via continuous positive airway pressure (CPAP), tracheostomy or oral appliances, can reveal CSA, an occurrence referred to as complex sleep apnoea. Factors influencing loop gain include increased chemosensitivity (increased controller gain), reduced damping of blood gas levels (increased plant gain) and increased lung to chemoreceptor circulatory delay. Sleep-wake transitions and pharyngeal dilator muscle responses effectively raise the controller gain and therefore also contribute to total loop gain and overall instability. In some circumstances, for example apnoea of infancy and central congenital hypoventilation syndrome, central apnoeas are the consequence of ventilatory depression and defective ventilatory responses, that is low loop gain. The efficacy of available treatments for CSA can be explained in terms of their effects on loop gain, for example CPAP improves lung volume (plant gain), stimulants reduce the alveolar-inspired PCO difference and supplemental oxygen lowers chemosensitivity. Understanding the magnitude of loop gain and the mechanisms contributing to instability may facilitate personalized interventions for CSA.
Topics: Continuous Positive Airway Pressure; Humans; Sleep Apnea, Central; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 27797160
DOI: 10.1111/resp.12927 -
Neuropsychiatric Disease and Treatment 2017Antipsychotic-induced weight gain is a major management problem for clinicians. It has been shown that weight gain and obesity lead to increased cardiovascular and... (Review)
Review
Antipsychotic-induced weight gain is a major management problem for clinicians. It has been shown that weight gain and obesity lead to increased cardiovascular and cerebrovascular morbidity and mortality, reduced quality of life and poor drug compliance. This narrative review discusses the propensity of various antipsychotics to cause weight gain, the pharmacologic and nonpharmacologic interventions available to counteract this effect and its impact on adherence. Most antipsychotics cause weight gain. The risk appears to be highest with olanzapine and clozapine. Weight increases rapidly in the initial period after starting antipsychotics. Patients continue to gain weight in the long term. Children appear to be particularly vulnerable to antipsychotic-induced weight gain. Tailoring antipsychotics according to the needs of the individual and close monitoring of weight and other metabolic parameters are the best preventive strategies at the outset. Switching to an agent with lesser tendency to cause weight gain is an option, but carries the risk of relapse of the illness. Nonpharmacologic interventions of dietary counseling, exercise programs and cognitive and behavioral strategies appear to be equally effective in individual and group therapy formats. Both nonpharmacologic prevention and intervention strategies have shown modest effects on weight. Multiple compounds have been investigated as add-on medications to cause weight loss. Metformin has the best evidence in this respect. Burden of side effects needs to be considered when prescribing weight loss medications. There is no strong evidence to recommend routine prescription of add-on medication for weight reduction. Heterogeneity of study methodologies and other confounders such as lifestyle, genetic and illness factors make interpretation of data difficult.
PubMed: 28883731
DOI: 10.2147/NDT.S113099 -
Frontiers in Neurology 2018Unstable ventilatory chemoreflex control, quantified as loop gain, is recognized as one of four key pathophysiological traits that contribute to cause obstructive sleep... (Review)
Review
Unstable ventilatory chemoreflex control, quantified as loop gain, is recognized as one of four key pathophysiological traits that contribute to cause obstructive sleep apnea (OSA). Novel treatments aimed at reducing loop gain are being investigated, with the intention that future OSA treatment may be tailored to the individual's specific cause of apnea. However, few studies have evaluated loop gain in OSA and non-OSA controls and those that have provide little evidence to support an inherent abnormality in either overall chemical loop gain in OSA patients vs. non-OSA controls, or its components (controller and plant gain). However, intermittent hypoxia may induce high controller gain through neuroplastic changes to chemoreflex control, and may also decrease plant gain via oxidative stress induced inflammation and reduced lung function. The inherent difficulties and limitations with loop gain measurements are discussed and areas where further research are required are highlighted, as only by understanding the mechanisms underlying OSA are new therapeutic approaches likely to emerge in OSA.
PubMed: 30450076
DOI: 10.3389/fneur.2018.00896 -
BMC Pediatrics Nov 2020Gestational weight gain has been associated with some adverse perinatal outcomes, but few studies have examined the association between gestational weight gain and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Gestational weight gain has been associated with some adverse perinatal outcomes, but few studies have examined the association between gestational weight gain and offspring's cognition and their conclusions are inconsistent. Our systematic review and meta-analysis aimed to synthesize the evidence regarding the association between gestational weight gain and offspring's cognitive skills.
METHODS
In this systematic review and meta-analysis (PROSPERO number, CRD42017073266), we systematically searched MEDLINE, EMBASE, Web of Science and the Cochrane Library for studies examining association between gestational weight gain and offspring's cognitive skills, without restriction in study design or language. Two reviewers extracted in an independent way the data. The Quality of Reporting of Observational Longitudinal Research scale was used to assess the quality of included studies. Effect size (ES) for adjusted models and their corresponding 95% confidence intervals were calculated for (i) intelligence quotient, (ii) language related skills and (iii) mathematic related skills comparing offspring's cognitive skills when gestational weight gain was within recommendations (as reference) with those from mothers whose gestational weight gain was above or below the recommendations.
RESULTS
Thirteen studies were included. There was a positive trend that associated gestational weight gain above recommendations with better offspring's intelligence quotient, although not statistically significant (ES 0.02, 95% CI -0.00, 0.05; I = 0.00%).
CONCLUSIONS
There is a not significant positive association between gestational weight gain above recommendations and intelligence quotient and some studies reported associations between gestational weight gain and offspring's cognitive skills. Our analyses confirm a wide variability in the results of studies published so far and highlights the need for conducting studies including specific samples of pregnant women by pre-pregnancy body mass index and trimester of pregnancy.
Topics: Body Mass Index; Cognition; Female; Gestational Weight Gain; Humans; Mothers; Pregnancy; Pregnancy Trimesters
PubMed: 33243183
DOI: 10.1186/s12887-020-02429-7