The Role of Health-related Behaviors in Gestational Weight Gain among Women with Overweight and Obesity: A Cross-sectional Analysis

Paulino, Daiane Sofia Morais; Pinho-Pompeu, Maira; Raikov, Fernanda; Freitas-Jesus, Juliana Vasconcellos; Machado, Helymar Costa; Surita, Fernanda Garanhani

doi:10.1055/s-0040-1712132

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Revista Brasileira de Ginecologia e Obstetrícia

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Original Article • Rev. Bras. Ginecol. Obstet. 42 (06) • June 2020 • https://doi.org/10.1055/s-0040-1712132 copy

The Role of Health-related Behaviors in Gestational Weight Gain among Women with Overweight and Obesity: A Cross-sectional Analysis

Papel dos comportamentos relacionados à saúde no ganho de peso gestacional em mulheres com sobrepeso e obesidade: Um estudo transversal

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To evaluate the influence of health-related behaviors including food intake, physical activity, sleep time, smoking habits, stress, depression, and optimism on excessive gestational weight gain (GWG) among women with overweight and obesity.

Methods

A cross-sectional study was conducted at the Women’s Hospital of the Universidade de Campinas, Campinas, state of São Paulo, Brazil, with 386 mediate postpartum women that fit the inclusion criteria of ≥ 19 years old, first prenatal care visit at or before 14 weeks, and single live baby. Dietary habits, physical exercise practice, sleep duration, smoking and alcohol habits were self-reported. Psychosocial history was evaluated using the Edinburgh Postpartum Depression Scale (EPDS), Perceived Stress Scale (PSS), and Life Orientation Test-Revised (LOT-R). Sociodemographic, obstetric, anthropometric, and neonatal data were retrieved from medical records. Descriptive statistics and stepwise logistic regression were performed.

Results

The prevalence of overweight and obesity was 29.27% and 24.61%, respectively, according to the body mass index (BMI). Excessive GWG was observed in 47.79% of women with overweight and in 45.26% of women with obesity. Excessive GWG among overweight and obese women was associated with inadequate vegetable and bean consumption (odds ratio [OR] = 2.95, 95% confidence interval [CI]: 1.35-6.46 and OR = 1.91; 95%CI: 1.01-3.63, respectively) and stress (OR = 1.63; 95%CI 1.01-2.64). After adjustment by maternal age, multiparity, sleep duration, smoking, and alcohol intake, we found that stress (PSS ≥ 20) was associated with excessive GWG in women with overweight or obesity (OR: 1.75; 95%CI: 1.03-2.96).

Conclusion

Among women with overweight and obesity, stress is the main variable associated with excessive GWG. Inadequate vegetables and beans consumption also showed association with excessive GWG.

Keywords:
health-related behaviors; gestational weight gain; overweight; obesity

Variable (n= 386)	Mean	SD
Maternal age (years old)	28.41	±0.28
BMI at first prenatal visit (kg/m²)	27.98	±3.66
	n	%
Educational level^* *4 missing data.
Elementary school	85	23.48
High school	215	59.39
College, university, or advanced degree	62	17.12
Number of pregnancies
1	131	33.93
≥ 2	255	66.06
Delivery Mode
C-section	177	45.85
Vaginal	209	54.14
BMI at first prenatal visit (kg/m²)
< 18.5	16	4.15
18.5 a 24.9	162	41.97
25 a 29.9	113	29.27
≥ 30	95	24.61
Pre-pregnancy NCD	95	24.61
Obstetric complications^† †2 missing data. (384)	181	47.13
Diabetes mellitus	59	15.36
Hypertensive disorder	51	13.28
Urinary infection	40	10.41
Other	31	8.07
Adequacy of birthweight^£ £9 missing data. Data were presented as frequencies (n) and percentages (%).
SGA	34	8.81
AGA	297	76.94
LGA	55	14.25
Apgar in the fifth minute
< 7	1	0.26
≥ 7	385	99.74

Variable (n)	N (386)	%	Variable (n)	N (386)	%
Sleep time			Food Intake (days/week)
Sleep Hours < 7			Vegetable intake (383)
Before pregnancy (383)	146	38.12	7	187	48.83
Beginning of pregnancy (383)	126	32.90	3–6	62	16.19
End of pregnancy (379)	225	59.37	1–3	102	26.63
			Never or < 1	32	8.36
Physical Activity			Fruit Intake (386)
Sedentary lifestyle (379)	215	57.03	7 (ref.)	186	48.19
Sedentary lifestyle (379)	215	57.03	3–6	69	17.88
Unhealthy behaviors			1–3	99	25.65
Alcohol intake (383)	31	8.09	Never or < 1	32	8.29
Smoking- last 2 years (381)	64	16.80	Milk/dairy products intake (386)
Smoking- last 2 years (381)	64	16.80	7	246	63.73
Psychosocial History			3–6	41	10.62
EPDS (381)			1–3	61	15.80
< 10	226	59.32	Never or < 1	38	9.84
≥ 10	155	40.68	Meat intake (385)
			Never or < 1	15	3.9
PSS (374)			1–3	58	15.06
< 20	242	64.71	3–6	62	16.10
≥ 20	132	35.29	7 (ref.)	250	64.94
			Soft drink intake (386)
LOT-R (376) Mean ± SD	15.67	±3.22	Never or < 1	137	35.49
Food Intake (number of tins)			1–3	105	27.20
Family oil consumption (379)			3–6	60	15.54
< 1	108	28.50	7	84	21.76
1	108	28.50	Beans intake (382)
2– 3	128	33.77	7 (ref.)	169	44.24
> 3	35	9.23	3–6	48	12.56
			1–3	106	27.74
			Never or < 1	59	15.44

Variable	OR	95%CI	Variable	OR	95%CI	Variable	O.R.	95% CI
			Meat intake (days/week)			Family consumption of oil (number of tins)
Maternal Age (years old)	1.01	0.97–1.05	Never or < 1	0.73	0.20–2.66	< 1 (ref.)	1.00	—
Multiparity	1.13	0.69–1.84	1–3	1.01	0.53–1.95	1	1.54	0.81–2.95
			3–6	0.93	0.49–1.77	2–3	1.59	0.85–2.97
Pre-pregnancy NCD	1.25	0.75–2.11	7 (ref.)	1.00	—	> 3	2.30	0.98–5.37
			Beans			Vegetable intake (days/ week)
Smoking in the last 2 years	0.89	0.48–1.68	7 (ref.)	1.00	—	7 (ref.)	1.00	—
Sedentary lifestyle	1.23	0.78–1.95	3–6	0.80	0.35–1.79	3–6	1.21	0.61–2.39
Alcohol intake during pregnancy	0.30	0.09–1.01	1–3	1.30	0.74–2.27	1–3	1.51	0.86–2.63
			Never or < 1	1.91	1.01–3.63	Never or < 1	2.95	1.35–6.46
Educational level			Fruit Intake (days/week)		—	Sleep Hours < 7
Elementary school	1.08	0.61–1.91	7 (ref.)	1.00	0.61–2.21	Before pregnancy	0.93	0.58–1.50
High school (ref.)	1.00	—	3–6	1.16	0.89–2.67	Beginning of pregnancy	0.90	0.55–1.49
Advanced degree	0.93	0.48–1.79	1–3	1.54	0.59–3.22	Final of pregnancy	0.94	0.59–1.51
			Never or < 1	1.38
Soft drink intake (days/week)			Milk and dairy products intake (days/ week)			LOT-R	0.97	0.90–1.04
Never (ref.)	1.00	—	7 (ref.)	1.00	—	EPDS
< 1	2.05	0.81–5.18	3–6	0.88	0.41–1.89	< 10 (ref.)	1.00	—
1–3	2.02	0.81–5.03	1–3	0.89	0.47–1.70
3–6	1.32	0.47–3.69	Never or <1	0.51	0.21–1.28	≥ 10	1.18	0.74–1.89
7	1.99	0.78–5.10				PSS		—
						< 20 (ref.) ≥20	1.63	1.01–2.64

Variable	OR	95%CI	Variable	OR	95%CI
Socio-demographic and antecedents			Food Intake (days/week)
Educational level			Vegetable intake
Elementary school	1.07	0.58–1.99	7	1.00	—
High school (ref.)	1.00	—	3–6	1.20	0.58–2.45
Advanced degree	0.83	0.48–1.68	1–3	1.54	0.86–2.77
Pre-pregnancy NCD			Never or < 1	2.81	1.24–6.36
Pre-pregnancy NCD			Fruit Intake
No	1.00	—	7 (ref.)	1.00	—
Yes	1.13	0.65–1.94	3–6	1.19	0.61–2.33
Physical Activity			1–3	1.54	0.87–2.73
Physical Activity			Never or < 1	1.32	0.54–3.23
Sedentary lifestyle	1.21	0.75–1.97	Milk/dairy products intake
Psychosocial History			7	1.00	—
Psychosocial History			3–6	0.88	0.40–1.90
EPDS			1–3	0.77	0.39–1.50
< 10	1.00	—	Never or < 1	0.54	0.21–1.37
≥ 10	1.16	0.71–1.88	Beans intake
			7 (ref.)	1.00	—
PSS			3–6	0.84	0.37–1.90
< 20	1.00	—	1–3	1.41	0.79–2.51
≥ 20	1.76	1.07–2.90	Never or < 1	2.02	1.03–3.99
			Meat intake
LOT-R	0.97	0.90–1.05	Never or < 1	0.70	0.18–2.63
Food Intake (number of tins)			1–3	1.21	0.61–2.38
Food Intake (number of tins)			3–6	0.93	0.48–1.81
Family oil consumption			7 (ref.)	1.00	—
< 1	1.00	—	Soft drink intake
1	1.54	0.80–2.98	Never or < 1	1.00	—
2– 3	1.56	0.82–2.95	1–3	2.17	0.85–5.57
> 3	2.31	0.97–5.53	3–6	1.38	0.48–3.94
			7	2.37	0.89–6.31

Variable	p-value	OR	95%CI
PSS (Stress)
< 20 (ref.)	—	1.00	—
≥ 20	0.037	1.75	1.03–2.96

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[1] Address for correspondence Fernanda Garanhani Surita, MD, Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil (e-mail: surita@unicamp.br).