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Variation in urine osmolality throughout pregnancy: a longitudinal, randomized-control trial among women with overweight and obesity

Abstract

Purpose

Water needs increase during pregnancy, and proper hydration is critical for maternal and fetal health. This study characterized weekly hydration status changes throughout pregnancy and examined change in response to a randomized, behavioral intervention. An exploratory analysis tested how underhydration during pregnancy was associated with birth outcomes.

Methods

The Healthy Mom Zone Study is a longitudinal, randomized-control trial intervention aiming to regulate gestational weight gain (GWG) in pregnant women with overweight/obesity (n = 27). Fourteen women received standard of care; 13 women additionally received weekly guidance on nutrition, physical activity, water intake, and health-promoting behaviors. Hydration status was measured weekly via overnight urine osmolality (Uosm) from ~ 8–36 weeks gestation; underhydration was dichotomized (Uosm ≥ 500 mOsm/kg). Gestational age- and sex-standardized birth weight and length z scores and percentiles were calculated. We used mixed-effect and linear regression models to test covariate-adjusted relationships.

Results

No differences existed in Uosm or other characteristics between control and intervention women at baseline. Significant interactions (p = 0.01) between intervention and week of pregnancy on Uosm indicated intervention women maintained lower Uosm, whereas control women had a significant quadratic (inverse-U) relationship and greater Uosm in the second and early third trimesters. Results were consistent across robustness and sensitivity checks. Exploratory analyses suggest underhydration was associated with birth weight, but not length, in opposite ways in the second vs. third trimester.

Conclusion

A multi-component behavioral intervention helped women with overweight/obesity maintain better hydration throughout pregnancy. Future studies should confirm birth outcome results as they have important implications for early life nutrition.

Trial registration

ClinicalTrials.gov Identifier: NCT03945266; registered May 10, 2019 retrospectively.

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Data share statement

Data described in the manuscript, code book, and analytic code will be made available upon request pending application and IRB approval.

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Acknowledgements

We thank the participants in this study, the Clinical Research Center, and Biomarker Core Laboratory. We also thank the Water, Nutrition, and Health Lab research assistant Sara Caldana, the Healthy Mom Zone Study team, Dr. Daniel Rivera, Dr. Theodore Hovick, and the Mount Nittany Physician Group OBGYN providers. The authors have no conflicts of interest to disclose.

Funding

This work was funded by NIH NHLBI 1R01H119245; NIH 1R56HL126799-01 and supported by Penn State College of Health and Human Development start-up funds, and the Ann Atherton Hertzler Early Career Professorship funds. AYR was supported by the Population Research Institute (NICHD P2CHD041025). The funders had no role in the research or interpretation of results.

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Contributions

AYR conducted the analysis and drafted the paper. AYR, DSD, and JSS conceptualized the study. HJB, AMP, and EEH drafted parts of the paper and helped with analysis. All authors helped on different aspects of study design, study operationalization, or sample analysis. All authors reviewed, edited, and approved the final manuscript.

Corresponding author

Correspondence to Asher Y. Rosinger.

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The authors declare that they have no conflict of interest.

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Rosinger, A.Y., Bethancourt, H.J., Pauley, A.M. et al. Variation in urine osmolality throughout pregnancy: a longitudinal, randomized-control trial among women with overweight and obesity. Eur J Nutr 61, 127–140 (2022). https://doi.org/10.1007/s00394-021-02616-x

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  • DOI: https://doi.org/10.1007/s00394-021-02616-x

Keywords

  • Hydration
  • Water intake
  • Pregnancy
  • Urine osmolality
  • Birth outcomes
  • DOHaD