Uncontrolled Eating during Pregnancy Predicts Fetal Growth: The Healthy Mom Zone Trial

Jennifer S Savage, Emily E Hohman, Katherine M McNitt, Abigail M Pauley, Krista S Leonard, Tricia Turner, Jaimey M Pauli, Alison D Gernand, Daniel E Rivera, Danielle Symons Downs, Jennifer S Savage, Emily E Hohman, Katherine M McNitt, Abigail M Pauley, Krista S Leonard, Tricia Turner, Jaimey M Pauli, Alison D Gernand, Daniel E Rivera, Danielle Symons Downs

Abstract

Excess maternal weight gain during pregnancy elevates infants' risk for macrosomia and early-onset obesity. Eating behavior is also related to weight gain, but the relationship to fetal growth is unclear. We examined whether Healthy Mom Zone, an individually tailored, adaptive gestational weight gain intervention, and maternal eating behaviors affected fetal growth in pregnant women (n = 27) with a BMI > 24. At study enrollment (6-13 weeks gestation) and monthly thereafter, the Three-Factor Eating Questionnaire was completed. Ultrasounds were obtained monthly from 14-34 weeks gestation. Data were analyzed using multilevel modeling. Higher baseline levels of uncontrolled eating predicted faster rates of fetal growth in late gestation. Cognitive restraint was not associated with fetal growth, but moderated the effect of uncontrolled eating on fetal growth. Emotional eating was not associated with fetal growth. Among women with higher baseline levels of uncontrolled eating, fetuses of women in the control group grew faster and were larger in later gestation than those in the intervention group (study group × baseline uncontrolled eating × gestational week interaction, p = 0.03). This is one of the first intervention studies to use an individually tailored, adaptive design to manage weight gain in pregnancy to demonstrate potential effects on fetal growth. Results also suggest that it may be important to develop intervention content and strategies specific to pregnant women with high vs. low levels of disinhibited eating.

Keywords: disinhibition; eating behavior; fetal growth; generalized linear models; gestational weight gain intervention; overweight and obesity; pregnancy; restraint; uncontrolled and emotional eating.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Estimated fetal weight trajectory in intervention and control group (study group × gestational week, p = 0.095). Estimates were generated using multilevel modeling (SAS PROC MIXED).
Figure 2
Figure 2
Estimated fetal weight trajectory at higher (mean + 1 SD) and lower (mean – 1 SD) levels of baseline uncontrolled eating (UE), (baseline uncontrolled eating × gestational age2, p = 0.03). Estimates were generated using multilevel modeling (SAS PROC MIXED).
Figure 3
Figure 3
Estimated fetal weight trajectory at higher (mean + 1 SD) and lower (mean – 1 SD) levels of baseline uncontrolled eating (UE) in intervention and control group participants, (baseline uncontrolled eating × study group × gestational age, p = 0.04). Estimates were generated using multilevel modeling (SAS PROC MIXED).

References

    1. Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines . Weight Gain during Pregnancy: Reexamining the Guidelines. National Academies Press (US); Washington, DC, USA: 2009.
    1. Ogden C.L., Carroll M.D., Kit B.K., Flegal K.M. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311:806–814. doi: 10.1001/jama.2014.732.
    1. Ogden C.L., Carroll M.D., Lawman H.G., Fryar C.D., Kruszon-Moran D., Kit B.K., Flegal K.M. Trends in Obesity Prevalence Among Children and Adolescents in the United States, 1988–1994 through 2013–2014. JAMA. 2016;315:2292–2299.
    1. Hales C.M., Fryar C.D., Carroll M.D., Freedman D.S., Ogden C.L. Trends in Obesity and Severe Obesity Prevalence in US Youth and Adults by Sex and Age, 2007–2008 to 2015–2016. JAMA. 2018;319:1723–1725. doi: 10.1001/jama.2018.3060.
    1. Patti M.E. Intergenerational programming of metabolic disease: Evidence from human populations and experimental animal models. Cell. Mol. Life Sci. 2013;70:1597–1608. doi: 10.1007/s00018-013-1298-0.
    1. Adamo K.B., Ferraro Z.M., Brett K.E. Can we modify the intrauterine environment to halt the intergenerational cycle of obesity? Int. J. Environ. Res. Public Health. 2012;9:1263–1307. doi: 10.3390/ijerph9041263.
    1. Dong Y., Rivera D.E., Thomas D.M., Navarro-Barrientos J.E., Downs D.S., Savage J.S., Collins L.M. A Dynamical Systems Model for Improving Gestational Weight Gain Behavioral Interventions; Proceedings of the American Control Conference; Montreal, QC, Canada. 27–29 June 2012; pp. 4059–4064.
    1. Fallucca S., Vasta M., Sciullo E., Balducci S., Fallucca F. Birth weight: Genetic and intrauterine environment in normal pregnancy. Diabetes Care. 2009;32:e149. doi: 10.2337/dc09-1489.
    1. Reilly J.J., Armstrong J., Dorosty A.R., Emmett P.M., Ness A., Rogers I., Steer C., Sherriff A. Early life risk factors for obesity in childhood: Cohort study. BMJ. 2005;330:1357. doi: 10.1136/bmj.38470.670903.E0.
    1. Martin J.A., Hamilton B.E., Ventura S.J., Osterman M.J., Kirmeyer S., Mathews T.J., Wilson E.C. Births: Final data for 2009. Natl. Vital Stat. Rep. 2011;60:1–70.
    1. Nohr E.A., Vaeth M., Baker J.L., Sorensen T.I., Olsen J., Rasmussen K.M. Pregnancy outcomes related to gestational weight gain in women defined by their body mass index, parity, height, and smoking status. Am. J. Clin. Nutr. 2009;90:1288–1294. doi: 10.3945/ajcn.2009.27919.
    1. Wei J.-N., Sung F.-C., Li C.-Y., Chang C.-H., Lin R.-S., Lin C.-C., Chiang C.-C., Chuang L.-M. Low birth weight and high birth weight infants are both at an increased risk to have type 2 diabetes among schoolchildren in Taiwan. Diabetes Care. 2003;26:343–348. doi: 10.2337/diacare.26.2.343.
    1. Muktabhant B., Lawrie T.A., Lumbiganon P., Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database Syst. Rev. 2015 doi: 10.1002/14651858.CD007145.pub3.
    1. Pauley A.M., Hohman E., Savage J.S., Rivera D.E., Guo P., Leonard K.S., Downs D.S. Gestational Weight Gain Intervention Impacts Determinants of Healthy Eating and Exercise in Overweight/Obese Pregnant Women. J. Obes. 2018;2018:6469170. doi: 10.1155/2018/6469170.
    1. Downs D.S. Obesity in Special Populations: Pregnancy. Prim. Care. 2016;43:109–120. doi: 10.1016/j.pop.2015.09.003.
    1. Downs D.S., Savage J.S., Rauff E.L. Falling Short of Guidelines? Nutrition and Weight Gain Knowledge in Pregnancy. J. Women’s Heal. Care. 2014;3:1–6.
    1. Dong Y., Rivera D.E., Downs D.S., Savage J.S., Thomas D.M., Collins L.M. Hybrid Model Predictive Control for Optimizing Gestational Weight Gain Behavioral Interventions; Proceedings of the American Control Conference; Washington, DC, USA. 17–19 June 2013; pp. 1970–1975.
    1. Symons Downs D., Savage J.S., Rivera D.E., Smyth J.M., Rolls B.J., Hohman E.E., McNitt K.M., Kunselman A.R., Stetter C., Pauley A.M., et al. Individually Tailored, Adaptive Intervention to Manage Gestational Weight Gain: Protocol for a Randomized Controlled Trial in Women with Overweight and Obesity. JMIR Res. Protoc. 2018;7:e150. doi: 10.2196/resprot.9220.
    1. Collins L.M., Murphy S.A., Strecher V. The multiphase optimization strategy (MOST) and the sequential multiple assignment randomized trial (SMART): New methods for more potent eHealth interventions. Am. J. Prevent. Med. 2007;32(Suppl. 5):S112–S118. doi: 10.1016/j.amepre.2007.01.022.
    1. Christian P., Mullany L.C., Hurley K.M., Katz J., Black R.E. Nutrition and maternal, neonatal, and child health. Semin. Perinatol. 2015;39:361–372. doi: 10.1053/j.semperi.2015.06.009.
    1. Livingstone M.B., Black A.E. Markers of the validity of reported energy intake. J. Nutr. 2003;133(Suppl. 3):895S–920S. doi: 10.1093/jn/133.3.895S.
    1. Sui Z., Cramp C., Moran L.J., McNaughton S.A., Deussen A.R., Grivell R.M., Dodd J.M. The characterisation of overweight and obese women who are under reporting energy intake during pregnancy. BMC Pregnancy Childbirth. 2018;18:204.
    1. Guo P., Rivera D.E., Savage J.S., Hohman E.E., Pauley A.M., Leonard K.S., Symons Downs D. System identification approaches for energy intake estimation: Enhancing interventions for managing gestational weight gain. IEEE Trans. Control Syst. Technol. 2018 doi: 10.1109/TCST.2018.2871871.
    1. Cappelleri J.C., Bushmakin A.G., Gerber R., Leidy N.K., Sexton C.C., Lowe M.R., Karlsson J. Psychometric analysis of the Three-Factor Eating Questionnaire-R21: Results from a large diverse sample of obese and non-obese participants. Int. J. Obes. 2009;33:611–620. doi: 10.1038/ijo.2009.74.
    1. Stunkard A.J., Messick S. The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J. Psychosom. Res. 1985;29:71–83. doi: 10.1016/0022-3999(85)90010-8.
    1. Stunkard A.J., Messick S. Eating Inventory Manual. The Psychological Corporation; San Antonio, TX, USA: 1988.
    1. Lowe M.R., Kral T.V. Stress-induced eating in restrained eaters may not be caused by stress or restraint. Appetite. 2006;46:16–21. doi: 10.1016/j.appet.2005.01.014.
    1. Lindroos A.-K., Mathiassen M.E., Bengtsson C., Lindroos A., Lissner L., Karlsson J., Sullivan M., Sjöström L. Dietary intake in relation to restrained eating, disinhibition, and hunger in obese and nonobese Swedish women. Obes. Res. 1997;5:175–185. doi: 10.1002/j.1550-8528.1997.tb00290.x.
    1. Hainer V., Kunešová M., Bellisle F., Parizkova J., Braunerova R., Wagenknecht M., Lajka J., Hill M., Stunkard A. The eating inventory, body adiposity and prevalence of disease in a quota sample of Czech adults. Int. J. Obesity (Lond.) 2006;30:830–836. doi: 10.1038/sj.ijo.0803202.
    1. Williamson D.A., Lawson O.J., Brooks E.R., Wozniak P.J., Ryan D.H., Bray G.A., Duchmann E.G. Association of body mass with dietary restraint and disinhibition. Appetite. 1995;25:31–41. doi: 10.1006/appe.1995.0039.
    1. Hays N.P., Bathalon G.P., McCrory M.A., Roubenoff R., Lipman R., Roberts S.B. Eating behavior correlates of adult weight gain and obesity in healthy women aged 55–65 y. Am. J. Clin. Nutr. 2002;75:476–483. doi: 10.1093/ajcn/75.3.476.
    1. Smith C.F., Geiselman P.J., Williamson D.A., Champagne C.M., Bray G.A., Ryan D.H. Association of dietary restraint and disinhibition with eating behavior, body mass, and hunger. Eat. Weight Disord. Ewd. 1998;3:7–15. doi: 10.1007/BF03354907.
    1. Foster G.D., Wadden T.A., Swain R.M., Stunkard A.J., Platte P., Vogt R.A. The eating inventory in obese women: Clinical correlates and relationship to weight loss. Int. J. Obes. 1998;22:778–785. doi: 10.1038/sj.ijo.0800659.
    1. Lauzon-Guillain B., Basdevant A., Romon M., Karlsson J., Borys J.M., Charles M.A. Is restraint eating a risk factor for weight gain in a general population? Am. J. Clin. Nutr. 2006;83:132–138. doi: 10.1093/ajcn/83.1.132.
    1. Lowe M.R., Annunziato R.A., Markowitz J.T., Didie E., Bellace D.L., Riddell L., Maille C., McKinney S., Stice E. Multiple types of dieting prospectively predict weight gain during the freshman year of college. Appetite. 2006;47:83–90. doi: 10.1016/j.appet.2006.03.160.
    1. Olea Lopez A.L., Johnson L. Associations between Restrained Eating and the Size and Frequency of Overall Intake, Meal, Snack and Drink Occasions in the UK Adult National Diet and Nutrition Survey. PLoS ONE. 2016;11:e0156320. doi: 10.1371/journal.pone.0156320.
    1. Bongers P., Jansen A. Emotional Eating Is Not What You Think It Is and Emotional Eating Scales Do Not Measure What You Think They Measure. Front. Psychol. 2016;7:1932. doi: 10.3389/fpsyg.2016.01932.
    1. Hill J.O., Wyatt H.R., Reed G.W., Peters J.C. Obesity and the environment: Where do we go from here? Science. 2003;299:853–855. doi: 10.1126/science.1079857.
    1. Keränen A.-M., Savolainen M.J., Reponen A.H., Kujari M.-L., Lindeman S.M., Bloigu R.S., Laitinen J.H., Teeriniemi A.-M. The effect of eating behavior on weight loss and maintenance during a lifestyle intervention. Prev. Med. 2009;49:32–38. doi: 10.1016/j.ypmed.2009.04.011.
    1. Mumford S.L., Siega-Riz A.M., Herring A., Evenson K.R. Dietary restraint and gestational weight gain. J. Am. Diet. Assoc. 2008;108:1646–1653. doi: 10.1016/j.jada.2008.07.016.
    1. Heery E., Wall P.G., Kelleher C.C., McAuliffe F.M. Effects of dietary restraint and weight gain attitudes on gestational weight gain. Appetite. 2016;107:501–510. doi: 10.1016/j.appet.2016.08.103.
    1. Blau L.E., Orloff N.C., Flammer A., Slatch C., Hormes J.M. Food craving frequency mediates the relationship between emotional eating and excess weight gain in pregnancy. Eat. Behav. 2018;31:120–124. doi: 10.1016/j.eatbeh.2018.09.004.
    1. Hutchinson A.D., Charters M., Prichard I., Fletcher C., Wilson C. Understanding maternal dietary choices during pregnancy: The role of social norms and mindful eating. Appetite. 2017;112:227–234. doi: 10.1016/j.appet.2017.02.004.
    1. Lawson O.J., Champagne C.M., Brooks E.R., Howat P.M., Wozniak P.J., Williamson D.A., Delany J.P., Bray G.A., Ryan D.H. The association of body weight, dietary intake, and energy expenditure with dietary restraint and disinhibition. Obes. Res. 1995;3:153–161. doi: 10.1002/j.1550-8528.1995.tb00131.x.
    1. Savage J.S., Hoffman L., Birch L.L. Dieting, restraint, and disinhibition predict women’s weight change over 6 y. Am. J. Clin. Nutr. 2009;90:33–40. doi: 10.3945/ajcn.2008.26558.
    1. Rivera D.E., Hekler E., Savage J.S., Symons Downs D. Intensively adaptive interventions using control systems engineering: Two illustrative examples. In: Collins L.M., editor. Optimization of Behavioral, Biobehavioral, and Biomedical Interventions. Springer; Cham, Switzerland: 2018. pp. 21–173.
    1. Ajzen I. The theory of planned behavior. Organ. Behav. Hum. Decis. Process. 1991;50:179–211. doi: 10.1016/0749-5978(91)90020-T.
    1. Carver C., Scheier M. On the Self-Regulation of Behavior. Cambridge University Press; Cambridge, UK: 1998.
    1. Harris P.A., Taylor R., Thielke R., Payne J., Gonzalez N., Conde J.G. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J. Biomed. Inf. 2009;42:377–381. doi: 10.1016/j.jbi.2008.08.010.
    1. Hadlock F.P., Harrist R.B., Carpenter R.J., Deter R.L., Park S.K. Sonographic estimation of fetal weight. The value of femur length in addition to head and abdomen measurements. Radiology. 1984;150:535–540. doi: 10.1148/radiology.150.2.6691115.
    1. Villar J., Ismail L.C., Victora C.G., Ohuma E., Bertino E., Altman D.G., Lambert A., Papageorghiou A.T., Carvalho M., Jaffer Y., et al. International standards for newborn weight, length, and head circumference by gestational age and sex: The Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet. 2014;384:857–868. doi: 10.1016/S0140-6736(14)60932-6.
    1. Black M.H., Sacks D.A., Xiang A.H., Lawrence J.M. The relative contribution of prepregnancy overweight and obesity, gestational weight gain, and IADPSG-defined gestational diabetes mellitus to fetal overgrowth. Diabetes Care. 2013;36:56–62. doi: 10.2337/dc12-0741.
    1. Clark M., Ogden J. The impact of pregnancy on eating behaviour and aspects of weight concern. Int. J. Obes. Relat. Metab. Disord. 1999;23:18–24. doi: 10.1038/sj.ijo.0800747.
    1. Fairburn C.G., Stein A., Jones R. Eating habits and eating disorders during pregnancy. Psychosom. Med. 1992;54:665–672. doi: 10.1097/00006842-199211000-00006.
    1. Shloim N., Hetherington M.M., Rudolf M., Feltbower R.G. Relationship between body mass index and women’s body image, self-esteem and eating behaviours in pregnancy: A cross-cultural study. J. Health Psychol. 2015;20:413–426. doi: 10.1177/1359105313502568.
    1. Slane J.D., Levine M.D. Association of Restraint and Disinhibition to Gestational Weight Gain among Pregnant Former Smokers. Women’s Health Issues. 2015;25:390–395. doi: 10.1016/j.whi.2015.03.005.
    1. Wright C.M., Parkinson K.N., Drewett R.F. The influence of maternal socioeconomic and emotional factors on infant weight gain and weight faltering (failure to thrive): Data from a prospective birth cohort. Arch. Dis. Child. 2006;91:312–317. doi: 10.1136/adc.2005.077750.
    1. Wang M.L., Arroyo J., Druker S., Sankey H.Z., Rosal M.C. Knowledge, Attitudes and Provider Advice by Pre-Pregnancy Weight Status: A Qualitative Study of Pregnant Latinas with Excessive Gestational Weight Gain. Women Health. 2015;55:805–828. doi: 10.1080/03630242.2015.1050542.
    1. Chang M.W., Nitzke S., Buist D., Cain D., Horning S., Eghtedary K. I am pregnant and want to do better but I can’t: Focus groups with low-income overweight and obese pregnant women. Matern. Child Health J. 2015;19:1060–1070. doi: 10.1007/s10995-014-1605-x.
    1. Chang M.W., Nitzke S., Guilford E., Adair C.H., Hazard D.L. Motivators and barriers to healthful eating and physical activity among low-income overweight and obese mothers. J. Am. Diet Assoc. 2008;108:1023–1028. doi: 10.1016/j.jada.2008.03.004.
    1. Levoy E., Lazaridou A., Brewer J., Fulwiler C. An exploratory study of Mindfulness Based Stress Reduction for emotional eating. Appetite. 2017;109:124–130. doi: 10.1016/j.appet.2016.11.029.
    1. Armitage C.J. Randomized test of a brief psychological intervention to reduce and prevent emotional eating in a community sample. J. Public Health (Oxf.) 2015;37:438–444. doi: 10.1093/pubmed/fdv054.
    1. Katterman S.N., Kleinman B.M., Hood M.M., Nackers L.M., Corsica J.A. Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: A systematic review. Eat. Behav. 2014;15:197–204. doi: 10.1016/j.eatbeh.2014.01.005.
    1. Conway R., Reddy S., Davies J. Dietary restraint and weight gain during pregnancy. Eur. J. Clin. Nutr. 1999;53:849–853. doi: 10.1038/sj.ejcn.1600864.
    1. Laraia B., Epel E., Siega-Riz A.M. Food insecurity with past experience of restrained eating is a recipe for increased gestational weight gain. Appetite. 2013;65:178–184. doi: 10.1016/j.appet.2013.01.018.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner