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Background The association between Institute of Medicine (IOM) guidelines and pregnancy outcomes across ethnicities is uncertain. We evaluated the associations of gestational weight gain (GWG) outside 2009 IOM guidelines, with maternal and infant outcomes across the USA, western Europe and east Asia, with subgroup analyses in Asia. The aim was to explore ethnic differences in maternal prepregnancy body mass index (BMI), GWG and health outcomes across these regions. Methods Systematic review, meta-analysis and meta-regression of observational studies were used for the study. MEDLINE, MEDLINE In-Process, Embase and all Evidence-Based Medicine (EBM) Reviews were searched from 1999 to 2017. Studies were stratified by prepregnancy BMI category and total pregnancy GWG. Odds ratio (ORs) 95% confidence intervals (CI) applied recommended GWG within each BMI category as the reference. Primary outcomes were small for gestational age (SGA), preterm birth and large for gestational age (LGA). Secondary outcomes were macrosomia, caesarean section and gestational diabetes. Results Overall, 5874 studies were identified and 23 were included ( n  = 1,309,136). Prepregnancy overweight/obesity in the USA, Europe and Asia was measured at 42%, 30% and 10% respectively, with underweight 5%, 3% and 17%. GWG below guidelines in the USA, Europe and Asia was 21%, 18% and 31%, and above was 51%, 51% and 37% respectively. Applying regional BMI categories in Asia showed GWG above guidelines (51%) was similar to that in the USA and Europe. GWG below guidelines was associated with a higher risk of SGA (USA/Europe [OR 1.51; CI 1.39, 1.63]; Asia [1.63; 1.45, 1.82]) and preterm birth (USA/Europe [1.35; 1.17, 1.56]; Asia [1.06; 0.78, 1.44]) than GWG within guidelines. GWG above guidelines was associated with a higher risk of LGA (USA/Europe [1.93; 1.81, 2.06]; Asia [1.68; 1.51 , 1.87]), macrosomia (USA/Europe [1.87; 1.70, 2.06]; Asia [2.18; 1.91, 2.49]) and caesarean (USA/Europe [1.26; 1.21, 1.33]; Asia [1.37; 1.30, 1.45]). Risks remained elevated when regional BMI categories were applied for GWG recommendations. More women in Asia were categorised as having GWG below guidelines using World Health Organization (WHO) (60%) compared to regional BMI categories (16%), yet WHO BMI was not accompanied by increased risks of adverse outcomes. Conclusions Women in the USA and western Europe have higher prepregnancy BMI and higher rates of GWG above guidelines than women in east Asia. However, when using regional BMI categories in east Asia, rates of GWG above guidelines are similar across the three continents. GWG outside guidelines is associated with adverse outcomes across all regions. If regional BMI categories are used in east Asia, IOM guidelines are applicable in the USA, western Europe and east Asia.

Background Maternal obesity is associated with health risks for women and their babies and is exacerbated by excess gestational weight gain. The aim of this study was to describe women’s experiences and perspectives in attending a Healthy Pregnancy Service designed to optimise healthy lifestyle and support recommended gestational weight gain for women with obesity. Methods An explanatory sequential mixed methods study design utilised two questionnaires (completed in early and late pregnancy) to quantify feelings, motivation and satisfaction with the service, followed by semi-structured interviews that explored barriers and enablers of behaviour change. Data were analysed separately and then interpreted together. Results Overall, 49 women attending the service completed either questionnaire 1, 2 or both and were included in the analysis. Fourteen women were interviewed. Prior to pregnancy, many women had gained weight and attempted to lose weight independently, and reported they were highly motivated to achieve a healthy lifestyle. During pregnancy, diet changes were reported as easier to make and sustain than exercise changes. Satisfaction with the service was high. Key factors identified in qualitative analysis were: service support enabled change; motivation to change behaviour, social support, barriers to making change (intrinsic, extrinsic and clinic-related), post-partum lifestyle and needs. On integration of data, qualitative and quantitative findings aligned. Conclusions The Healthy Pregnancy service was valued by women. Barriers and enablers to the delivery of an integrated model of maternity care that supported healthy lifestyle and recommended gestational weight gain were identified. These findings have informed and improved implementation and further scale up of this successful service model, integrating healthy lifestyle into routine antenatal care of women with obesity. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry (no.12620000985987). Registration date 30/09/2020, retrospectively registered. http://www.anzctr.org.au/

Risk prediction models for gestational diabetes mellitus (GDM) offer potential for early identification and targeted prevention. External validation is crucial to assess model performance across diverse populations. Despite the availability of numerous GDM prediction models, limited evidence exists on their external validation frequency, methodological quality, and clinical applicability. This systematic review evaluated externally validated GDM prediction models, focusing on methodological rigor, reporting standards, and clinical relevance to inform future research and implementation. Databases including Ovid MEDLINE, Embase, Scopus, Emcare, and CINAHL were searched up to May 1, 2025. Studies reporting external validation of GDM risk prediction models were included. Two reviewers independently screened studies. Data were extracted using the CHARMS framework, and risk of bias and applicability were assessed using PROBAST+AI. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251125758). Twenty-six studies validated 33 models, with validation sample sizes ranging from 50 to 75 161. Over half used the IADPSG criteria to define GDM. Discrimination metrics were commonly reported, but calibration, overall performance, and clinical utility were often lacking. Meta-analysis was feasible for only four models: Teede et al., Nanda et al., Naylor et al., and Van Leeuwen et al., each showing fair discrimination. The Teede et al. model was the most widely validated, with 11 external validations across six continents and a pooled AUC of 0.72 (95% CI: 0.67-0.76). Despite fewer validations, the Nanda et al. model achieved the highest pooled discrimination (5 validations; pooled AUC 0.77, 95% CI: 0.74-0.80). The Naylor et al. and van Leeuwen et al. models also underwent meta-analysis, as sufficient external validation studies were available to support comparative performance assessment. Notably, 69.23% of studies had a high risk of bias. While many models showed acceptable predictive performance, most validations were methodologically weak. Future studies should follow best-practice guidelines and promote scalable validation strategies, such as algorithm sharing, to enhance clinical utility.

AbstractObjectiveTo synthesise evidence from contemporary populations (2009-24) across diverse world regions and income settings on associations between gestational weight gain (GWG) and broad clinical outcomes, to inform updated, globally relevant GWG standards.DesignSystematic review and meta-analysis.SettingObservational studies in all languages, with >300 participants, reporting pregnancy outcomes stratified by body mass index (BMI) and GWG.ParticipantsWomen aged >18 years with singleton pregnancies.Main outcome measuresBirth weight and rates of caesarean delivery, hypertensive disorders of pregnancy, preterm birth, small/large for gestational age infant, low birth weight, macrosomia, neonatal intensive care unit (NICU) admission, respiratory distress, hyperbilirubinaemia, and gestational diabetes.ResultsOf 16 030 studies, 40 met inclusion criteria (n=1 608 711); 6% (n=65 114) of women had underweight, 53% (n=607 258) had normal weight, 19% (n=215 183) had overweight, and 22% (n=252 970) had obesity. GWG was below or above Institute of Medicine (IOM) or study specific recommendations in 23% and 45%, respectively. Using World Health Organization BMI criteria, GWG below IOM recommendations was associated with lower birth weight (mean difference −184.54, 95% confidence interval −278.03 to −91.06); lower risk of caesarean delivery (odds ratio 0.90, 0.84 to 0.97), large for gestational age infant (0.67, 0.61 to 0.74), and macrosomia (0.68, 0.58 to 0.80); and higher risk of preterm birth (1.63, 1.33 to 1.90), small for gestational age infant (1.49, 1.37 to 1.61), low birth weight (1.78, 1.48 to 2.13), and respiratory distress (1.29, 1.01 to 1.63). GWG above IOM recommendations was associated with higher birth weight (mean difference 118.33, 53.80 to 182.85); higher risk of caesarean delivery (odds ratio 1.37, 1.30 to 1.44), hypertensive disorders of pregnancy (1.37, 1.28 to 1.48), large for gestational age infant (1.77, 1.62 to 1.94), macrosomia (1.78, 1.60 to 1.99), and NICU admission (1.26, 1.09 to 1.45); and lower risk of preterm birth (0.71, 0.64 to 0.79) and small for gestational age infant (0.69, 0.64 to 0.75). For Asian BMI criteria, GWG below recommendations was associated with higher risk of hypertensive disorders of pregnancy (3.58, 1.37 to 9.39) and preterm birth (1.69, 1.25 to 2.30) and lower risk of large for gestational age infant (0.80, 0.72 to 0.89). GWG above recommendations was associated with higher risk of caesarean delivery (1.37, 1.29 to 1.46) and large for gestational age infant (1.76, 1.42 to 2.18) and lower risk of small for gestational age infant (0.62, 0.53 to 0.74) and low birth weight (0.44, 0.31 to 0.6).ConclusionsThis systematic review captured trends of rising maternal age and BMI from diverse world regions and income settings, with broad outcomes across all BMI groups. GWG outside IOM recommendations was associated with increased risk of adverse outcomes. These findings will help to inform the process of the WHO initiative to optimise globally relevant GWG standards for improved perinatal outcomes across world regions.Study registrationPROSPERO CRD42023483168.

Maternal obesity is associated with health risks for women and their babies, exacerbated by excess gestational weight gain. We describe health professionals’ perspectives in the provision of a Healthy Pregnancy service designed to optimise healthy lifestyle and support recommended gestational weight gain for women with obesity. Semi-structured interviews were conducted with health professionals. Questions were based on the Theoretical Domains Framework (TDF) and deductive thematic analysis was performed. A total of 14 multidisciplinary staff were interviewed. Six themes were identified: 1. health professionals view themselves as part of a team; 2. health professionals reported having necessary skills; 3. experience generated confidence in discussing gestational weight gain; 4. gestational weight gain is considered of variable importance; 5. health professionals want women to be comfortable; 6. the environmental context and resources presented some barriers. Staff were supportive of the Healthy Pregnancy service and valued developing teamwork with staff and rapport with women. Most felt relatively comfortable discussing weight gain with women. Barriers included ability to navigate sensitive topics with women, limited awareness of the intervention among new staff, communication between teams, and waiting time for women. Barriers and enablers to the delivery of an integrated model of maternity care were identified. These findings should inform and improve implementation of service models integrating healthy lifestyle in the antenatal care of women with obesity.

Abstract The cystic fibrosis transmembrane conductance regulator (CFTR) is a chloride channel that is defective in cystic fibrosis. The most common mutation, ΔF508 CFTR, is retained in the endoplasmic reticulum, retrotranslocated into the cytosol, and degraded by the proteasome. In a proteomics screen to identify ΔF508 CFTR interacting proteins, we found that valosin-containing protein (VCP)/p97, a Type II AAA ATPase that is a component of the retrotranslocation machinery, binds ΔF508 CFTR, and this interaction is stabilized by proteasomal inhibition. Since wild-type (WT) CFTR has been reported to be inefficiently processed during biogenesis with as much as 75% of the newly synthesized protein degraded by the proteasome, we examined the VCP interaction in Calu-3, T-84, and 16HBE, three epithelial cell lines that endogenously express WT CFTR. The results indicate that when WT CFTR processing is efficient, as demonstrated in Calu-3 cells, VCP does not interact. Interestingly, overexpression of recombinant WT CFTR in Calu-3 cells results in inefficient processing and VCP interaction, demonstrating that CFTR processing efficiency and the VCP interaction are tightly coupled. Furthermore, induction of ER stress and activation of the unfolded protein response result in inefficient processing of WT CFTR in Calu-3 cells and promote the WT CFTR–VCP interaction. The results support the hypothesis that components of the retrotranslocation machinery such as VCP do not interact with CFTR in epithelial cells that endogenously express WT CFTR, since under normal conditions the processing of the WT protein is efficient.

Cystic fibrosis (CF) is caused by mutation of one protein, the cystic fibrosis transmembrane conductance regulator (CFTR), which normally functions as a chloride channel at the apical surface of epithelial cells. The most common CFTR mutation results in the deletion of a single amino acid (phenylalanine) at position 508, which causes the protein to fold improperly. The ΔF508 CFTR is a temperature-sensitive (TS) processing mutant: At the restrictive temperature, 37°C, ΔF508 CFTR misfolds in the endoplasmic reticulum (ER) and is degraded, but at the permissive temperature, 27°C, it is “rescued” from degradation (rΔF508). In particular, rΔF508 CFTR folds correctly enough to exit the ER and produces a chloride channel at the cell surface, similar to the wild-type (WT) protein. Unfortunately, rΔF508 is rapidly degraded after returning to the restrictive temperature, suggesting a surface stability defect. Therefore, it is clear that the ΔF508 CFTR defect can be corrected under certain conditions, but first we must understand how the WT and ΔF508 CFTR proteins are handled differentially by the ER and at the cell surface, which is the aim of the work presented herein. We first characterized an interaction between CFTR and a protein associated with ER degradation, valosin-containing protein (VCP), and found that it interacts with ΔF508 CFTR, but not with the WT protein. This study provides further evidence that WT CFTR is processed efficiently in the ER. Second, with regard to ΔF508 CFTR, we found that culture at the permissive temperature corrects not only the folding defect in the ER, but also the impaired surface stability of ΔF508 CFTR. This result suggests that, like the folding defect, the surface stability defect of ΔF508 CFTR is also TS. Additionally, we showed that two small molecular compounds known to mimic permissive temperature culture of ΔF508 by correcting its ER processing defect also enhance its surface stability at 37°C. These studies add significantly to current CF knowledge and may aid in the design of future therapeutics for CF and other diseases resulting from protein folding mutations. Specifically, we identify specific differences between ER processing and surface trafficking of WT and ΔF508 CFTR, and we reveal a novel mode of action for two known pharmacological interventions.

Southern Natural Gas Co, an El Paso company, used biomonitors to ensure full environmental compliance with regulatory conditions associated with the construction of the Cypress Pipeline project. The biomonitor system ensured a smooth construction schedule with regard to environmental issues, resulting in significant overall time and cost savings for the Cypress project. The Cypress project called for construction of a 167-mile, 24-in OD pipeline from just east of Savannah, GA, to west of Jacksonville, FL, including five gas-delivery interconnects and three compressor stations. The environmental resources identified along the Cypress route required creative solutions to the numerous government agency requests regarding avoiding or minimizing environmental impact. Each agency wanted assurance that its proposed avoidance or minimization techniques would be fulfilled correctly. The biomonitors standing as trained biologists already entrenched in the construction process allowed them to respond readily and articulately to specific environmental issues related to permit conditions.

SLNG provided the Coast Guard with the information they will need to issue a Letter of Recommendation (LOR), which will verify the suitability of the surrounding waterways and approve SLNG's marine safety and management plan. The analyses for the LOR addressed possible environmental impacts from an LNG vessel's transit from a point I2 nautical miles offshore to the terminal.