Summary: Maternal obesity increases pregnancy‐related risks. Women with a body mass index (BMI) ≥ 30 kg/m² are considered to be at risk and should receive additional care, although approximately half will have uncomplicated pregnancies. This systematic review aimed to identify early pregnancy measures of adiposity associated with adverse maternal health outcomes. Searches included six databases, reference lists, citations, and contacting authors. Screening and quality assessment were carried out by two authors independently. Random effects meta‐analysis and narrative synthesis were conducted. Seventy studies were included with a pooled sample of 89,588 women. Meta‐analysis showed significantly increased odds of gestational diabetes mellitus (GDM) with higher waist circumference (WC) categories (1.40, 95% confidence interval [CI] 1.04, 1.88) and per unit increase in WC (1.31, 95% CI 1.03, 1.67). Women with GDM had higher WC than controls (mean difference [MD] 6.18 cm, 95% CI 3.92, 8.44). WC was significantly associated with hypertensive disorders, delivery‐related outcomes, metabolic syndrome, and composite pregnancy outcomes. Waist to hip ratio was significantly associated with GDM, hypertensive disorders, and delivery‐related outcomes. Fat mass, neck circumference, skinfolds, and visceral fat were significantly associated with adverse outcomes, although limited data were available. Our findings identify the need to explore how useful adiposity measures are at predicting risk in pregnancy, compared with BMI, to direct care to women with the greatest need.

Background: Maternal nutrition is crucial for health in pregnancy and across the generations. Experiencing food insecurity during pregnancy is a driver of inequalities in maternal diet with potential maternal and infant health consequences. This systematic review explored associations between food insecurity in pregnancy and maternal and infant health outcomes. Methods and findings: Searches included 8 databases (MEDLINE, Embase, Scopus, Web of Science, PsychInfo, ASSIA, SSPC in ProQuest, and CINAHL), grey literature, forwards and backwards citation chaining, and contacting authors. Studies in high-income countries (HICs) reporting data on food insecurity in pregnancy and maternal or infant health, from January 1, 2008 to November 21, 2023 were included. Screening, data extraction, and quality assessment were carried out independently in duplicate. Random effects meta-analysis was performed when data were suitable for pooling, otherwise narrative synthesis was conducted. The protocol was registered on PROSPERO (CRD42022311669), reported with PRISMA checklist (S1 File). Searches identified 24,223 results and 25 studies (n = 93,871 women) were included: 23 from North America and 2 from Europe. Meta-analysis showed that food insecurity was associated with high stress level (OR 4.07, 95% CI [1.22, 13.55], I² 96.40%), mood disorder (OR 2.53, 95% CI [1.46, 4.39], I² 55.62%), gestational diabetes (OR 1.64, 95% CI [1.37, 1.95], I² 0.00%), but not cesarean delivery (OR 1.42, 95% CI [0.78, 2.60], I² 56.35%), birth weight (MD −58.26 g, 95% CI [−128.02, 11.50], I² 38.41%), small-for-gestational-age (OR 1.20, 95%, CI [0.88, 1.63], I² 44.66%), large-for-gestational-age (OR 0.88, 95% CI [0.70, 1.12] I² 11.93%), preterm delivery (OR 1.18, 95% CI [0.98, 1.42], I² 0.00%), or neonatal intensive care (OR 2.01, 95% CI [0.85, 4.78], I² 70.48%). Narrative synthesis showed food insecurity was significantly associated with dental problems, depression, anxiety, and maternal serum concentration of perfluoro-octane sulfonate. There were no significant associations with other organohalogen chemicals, assisted delivery, postpartum haemorrhage, hospital admissions, length of stay, congenital anomalies, or neonatal morbidity. Mixed associations were reported for preeclampsia, hypertension, and community/resilience measures. Conclusions: Maternal food insecurity is associated with some adverse pregnancy outcomes, particularly mental health and gestational diabetes. Most included studies were conducted in North America, primarily the United States of America, highlighting a research gap across other contexts. Further research in other HICs is needed to understand these associations within varied contexts, such as those without embedded interventions in place, to help inform policy and care requirements.

Summary: Food insecurity is a well‐established obesity driver. Less is known about food insecurity during pregnancy. This review (PROSPERO:CRD42022311669) aimed to explore associations between food insecurity, maternal obesity, gestational weight gain (GWG), and nutrition. Searches included seven databases, gray literature, references, citations, and contacting authors. Observational studies reporting data from January 1st, 2008 to 21 November 2023 in high‐income countries were included. Duplicate screening, data extraction, and quality assessments were performed. Random effects meta‐analysis estimated odds ratios (OR), mean difference (MD), and 95% confidence intervals (CI). Narrative synthesis was conducted when data could not be pooled. Database searches identified 22,272 results; 20 studies were included (n = 19 North America, n = 1 Europe; n = 32,803 women). Food insecurity significantly increased obesity (OR 1.53 95%CI 1.39, 1.66), but not underweight (OR 1.12 95%CI 0.89, 1.34) or overweight (OR 1.18 95%CI 0.90, 1.46). Food insecurity significantly reduced GWG (MD ‐0.42 kg 95%CI ‐0.62, −0.22) and increased inadequate GWG (OR 1.16 95%CI 1.05, 1.28), but not excessive GWG (OR 1.04 95%CI 0.96, 1.13). Diet outcomes were inconsistent, with some evidence of reduced vitamin E and diet quality and increased red/processed meat consumption. Further studies outside of North America are needed to inform practice and policy to support maternal health.

Summary: Maternal obesity increases risks of adverse fetal and infant outcomes. Guidelines use body mass index to diagnose maternal obesity. Evidence suggests body fat distribution might better predict individual risk, but there is a lack of robust evidence during pregnancy. We explored associations between maternal adiposity and infant health. Searches included six databases, references, citations, and contacting authors. Screening and quality assessment were carried out by two authors independently. Random effects meta‐analysis and narrative synthesis were conducted. We included 34 studies (n = 40,143 pregnancies). Meta‐analysis showed a significant association between maternal fat‐free mass and birthweight (average effect [AE] 18.07 g, 95%CI 12.75, 23.38) but not fat mass (AE 8.76 g, 95%CI −4.84, 22.36). Women with macrosomic infants had higher waist circumference than controls (mean difference 4.93 cm, 95% confidence interval [CI] 1.05, 8.82). There was no significant association between subcutaneous fat and large for gestational age (odds ratio 1.06 95% CI 0.91, 1.25). Waist‐to‐hip ratio, neck circumference, skinfolds, and visceral fat were significantly associated with several infant outcomes including small for gestational age, preterm delivery, neonatal morbidity, and mortality, although meta‐analysis was not possible for these variables. Our findings suggest that some measures of maternal adiposity may be useful for risk prediction of infant outcomes. Individual participant data meta‐analysis could overcome some limitations in our ability to pool published data.

Introduction: Food insecurity, when individuals do not have sufficient access to food, has rapidly increased in high‐income countries (HICs) since the 2008 global financial crisis. Women are particularly at risk of experiencing food insecurity, and during pregnancy, this can have detrimental physical and emotional health implications. Objective: To synthesise qualitative research exploring pregnant women's experiences of food insecurity in HICs (PROSPERO 2023 CRD42023404774). Methods: Systematic review of qualitative literature reporting data on women's experiences of food insecurity. Six databases (MEDLINE, Embase, Web of Science, CINAHL, ASSIA, Scopus) and grey literature sources were searched, followed by forwards and backwards citation chaining for all included studies. Screening of titles, abstracts and full‐texts, data extractions and quality appraisals (using the Critical Appraisal Skills Programme (CASP) Qualitative Studies Checklist) were completed in duplicate. Certainty in the evidence was evaluated using GRADE‐CERQual. Participants/Setting: Food‐insecure pregnant and postnatal women, in HICs, since the global financial crisis of 2008. Main Outcome Measures: Experiences of food insecurity during pregnancy. Analyses: Thematic synthesis using NVivo14 to code data. Hand‐drawn thematic maps were used to group codes into sub‐themes and overarching themes. Coding and hand‐drawn thematic maps were combined to create a final visual summary of analytical themes. Results: Searches resulted in 32,685 studies, and 32 were included ( n = 20 North America, n = 10 Europe, n = 2 Australia). Findings identified three overarching themes: (1) barriers in access to food, (2) impact on physical and mental health, and (3) established individual, informal and statutory coping strategies. Women frequently discussed barriers to accessing fresh fruit and vegetables, resulting in poorer quality diets. Whilst qualitative data extracted precluded any direct pregnancy versus pre‐pregnancy comparison, pregnancy appeared to exacerbate the experiences of food insecurity for women. The future arrival of a newborn created additional financial concerns along with worries over nutritional needs. Reliance on others was a recurrent strategy for pregnant women to mitigate the impact of food insecurity. The GRADE CERQual assessment showed moderate to high confidence in all findings. Conclusions: The findings of this qualitative review—the first to focus on experiences of food insecurity during pregnancy across HICs—show that women are experiencing substantial impacts from food insecurity during this critical life course stage. Review findings emphasise the need for co‐ordinated screening and interventions that aim to support women to mitigate the impacts of food insecurity and its underlying causes to improve postpartum health and wellbeing.

Background: People living with dementia (PLWD) may experience substantial cognitive decline as the disease progresses, which interferes with their daily activities. This study aimed to assess physical activity (PA) performance and care dependency (CD) and identify factors related to PA among PLWD. Methods: We conducted a cross-sectional study in 63 PLWD from National Geriatrics Hospital, Vietnam, from 2021 to 2023. We used the Mini Nutritional Assessment (MNA), International Physical Activity Questionnaire (IPAQ), and Care Dependency Scale (CDS) to assess the nutritional status and the levels of PA and CD, respectively. We used the Mann–Whitney test to compare the differences in the PA types and CD levels between dementia levels and a multivariable logistics regression model to analyze factors related to PA. Results: More than half of the subjects had mild dementia. In total, 35% of the PLWD had a low level of PA, and 46.3% were completely independent of care. The mean score in each CDS aspect of the subjects with moderate/severe dementia was statistically significantly lower than that of those with mild dementia (p ≤ 0.05). Lower dependency (OR = 0.9; 95% CI = 0.88–0.99) and malnutrition (OR = 15.4; 95% CI = 1.18–20.21) were associated with insufficient PA in the PLWD. Conclusion: Formal caregivers and healthcare workers should encourage PLWD to perform physical activities at any level and personalize the development of tailored and nutritional care strategies for each individual.