151
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Li L, Chen Y, Lin Z, Lin W, Liu Y, Ou W, Zeng C, Ke L. Association of pre-pregnancy body mass index with adverse pregnancy outcome among first-time mothers. PeerJ 2020; 8:e10123. [PMID: 33088625 PMCID: PMC7568476 DOI: 10.7717/peerj.10123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/16/2020] [Indexed: 12/15/2022] Open
Abstract
Background Studies have reported an increased risk of adverse pregnancy outcome associated with pre-pregnancy body mass index (BMI). However, the data on such associations in urban areas of southern Chinese women is limited, which drive us to clarify the associations of pre-pregnancy BMI and the risks of adverse pregnancy outcomes (preterm birth (PTB) and low birth weight (LBW)) and maternal health outcomes (gestational hypertension and cesarean delivery). Methods We performed a hospital-based case-control study including 3,864 Southern Chinese women who gave first birth to a live singleton infant from January 2015 to December 2015. PTB was stratified into three subgroups according to gestational age (extremely PTB, very PTB and moderate PTB). Besides, we combined birth weight and gestational age to dichotomise as being small for gestational age (SGA, less than the tenth percentile of weight for gestation) and non-small for gestational age (NSGA, large than the tenth percentile of weight for gestation), gestational week was also classified into categories of term, 34-36 week and below 34 week.. We then divided newborns into six groups: (1) term and NSGA; (2) 34–36 week gestation and NSGA; (3) below 34 week gestation and NSGA; (4) term and SAG; (5) 34–36 week gestation and SAG; (6) below 34 week gestation and SAG. Adjusted logistic regression models was used to estimate the odds ratios of adverse outcomes. Results Underweight women were more likely to give LBW (AOR = 1.44, 95% CI [1.11–1.89]), the similar result was seen in term and SAG as compared with term and NSAG (AOR = 1.78, 95% CI [1.45–2.17]), whereas underweight was significantly associated with a lower risk of gestational hypertension (AOR = 0.45, 95% CI [0.25–0.82) and caesarean delivery (AOR = 0.74, 95% CI [0.62–0.90]). The risk of extremely PTB is relatively higher among overweight and obese mothers in a subgroup analysis of PTB (AOR = 8.12, 95% CI [1.11–59.44]; AOR = 15.06, 95% CI [1.32–172.13], respectively). Both maternal overweight and obesity were associated with a greater risk of gestational hypertension (AOR = 1.71, 95% CI [1.06–2.77]; AOR = 5.54, 95% CI [3.02–10.17], respectively) and caesarean delivery (AOR = 1.91, 95% CI [1.53–2.38]; AOR = 1.85, 95% CI [1.21–2.82], respectively). Conclusions Our study suggested that maternal overweight and obesity were associated with a significantly higher risk of gestational hypertension, caesarean delivery and extremely PTB. Underweight was correlated with an increased risk of LBW and conferred a protective effect regarding the risk for gestational hypertension and caesarean delivery for the first-time mothers among Southern Chinese.
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Affiliation(s)
- Li Li
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.,Center for Reproductive Medicine/ Department of Fetal Medicine and Prenatal Diagnosis/BioResource Research Center, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.,Key Laboratory for Major Obstetric Diseases of Guangdong Provinces, Guangzhou, Guangdong, China
| | - Yanhong Chen
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.,Key Laboratory for Major Obstetric Diseases of Guangdong Provinces, Guangzhou, Guangdong, China
| | - Zhifeng Lin
- Department of Medical Record, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Weiyan Lin
- Department of Medical Record, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yangqi Liu
- Department of Medical Record, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Weilin Ou
- Department of Medical Record, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Chengli Zeng
- Department of Medical Record, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Li Ke
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.,Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Guangzhou, Guangdong, China
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152
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Brien C, Bel S, Boudier E, Deruelle P. [Caesarean risk factors during labor for a class III obese nulliparous]. ACTA ACUST UNITED AC 2020; 49:517-521. [PMID: 33045395 DOI: 10.1016/j.gofs.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Obesity is a well-known caesarean and obstetrical risk factor. However, the number of obese nulliparous women is increasing worldwide, creating an urgent need for research into the impact of obesity on the mode of delivery. Our objective was to identify caesarean risk factors in obese nulliparous women with a BMI (body mass index) greater than 40kg/m2. METHODS A literature review was conducted on PubMed; including articles published between 2009 and 2019 in French and English, on caesarean risk during labor among class III obese nulliparous women. RESULTS One prospective study, and 6 retrospective analyses were included. Their results suggest that the rate of caesarean delivery increases with the BMI. Maternal age, particularly after 35 years, as well as induced labor and the use of oxytocin during labor, were positively associated with cesarean delivery. Moreover, maternal BMI was linked to an increased risk of non-elective caesarean section due to non-reassuring fetal heart tracing. CONCLUSION Extreme BMI, age, induced labor and oxytocin use are associated with caesarean delivery in nulliparous women with BMI≥40kg/m2. Further research are needed to estimate the best candidates for elective cesarean delivery.
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Affiliation(s)
- C Brien
- Pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, avenue Molière, Strasbourg, France.
| | - S Bel
- Pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, avenue Molière, Strasbourg, France
| | - E Boudier
- Pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, avenue Molière, Strasbourg, France
| | - P Deruelle
- Pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, avenue Molière, Strasbourg, France
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153
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Sarno L, Morlando M, Giudicepietro A, Carlea A, Sidhu S, Campanile M, Maruotti GM, Martinelli P, Guida M. The impact of obesity on haemodynamic profiles of pregnant women beyond 34 weeks' gestation. Pregnancy Hypertens 2020; 22:191-195. [PMID: 33065481 DOI: 10.1016/j.preghy.2020.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/10/2020] [Accepted: 10/02/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We aimed to compare the haemodynamic profiles of obese and non-obese pregnant women, alongside describing the haemodynamic changes that occur in hypertensive disorders of pregnancies with an Appropriate for Gestational Age Fetus (HDP-AGA) beyond 34 weeks' gestation. STUDY DESIGN In this prospective case-control study, maternal haemodynamic assessment was carried out by a trained operator using an UltraSonic Cardiac Output Monitor during a routine clinical assessment after 34 weeks of gestation. Indexed and non-indexed parameters were evaluated. MAIN OUTCOME MEASURES Maternal hemodynamic parameters. RESULTS Obese and non-obese women did not differ for non-indexed parameters (Cardiac Output, Stroke Volume, Systemic Vascular Resistance). Using indexed parameters, corrected for Body Surface Area, obese women presented significantly lower Cardiac Index z-score (-0.23 ± 0.5 vs 0.26 ± 1.2; p = 0.004), Stroke Volume Index z-score (-0.27 ± 0.8 vs 0.31 ± 1.0; p < 0.0001) and significantly higher Systemic Vascular Resistance Index (0.16 ± 0.8 vs -0.36 ± 0.7; p < 0.0001). In obese women, HDP-AGA (n = 19) had significantly higher Systemic Vascular Resistance Index z-score (1.26 ± 1.7 vs 0.16 ± 0.8; P = 0.009) and significantly lower Stroke Volume Index (-0.68 ± 0.8 vs -0.27 ± 0.8; 0.049). CONCLUSION Using indexed parameters, differences in haemodynamic profiles between obese and non obese women can be highlighted. Obese women seem to present a cardiac maladapation to the pregnancy (reduced cardiac index and stroke volume and increased vascular resistance) that could explain the increased risk of complications in this subgroup.
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Affiliation(s)
- Laura Sarno
- Department of Neurosciences, Reproductive Science and Dentistry, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy.
| | - Maddalena Morlando
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonia Giudicepietro
- Department of Neurosciences, Reproductive Science and Dentistry, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Annunziata Carlea
- Department of Neurosciences, Reproductive Science and Dentistry, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Supreet Sidhu
- Institute of Medical and Biomedical Education (IMBE), St. George's, University of London, Cranmer Terrace, Tooting, London SW17 0RE, United Kingdom
| | - Marta Campanile
- Department of Neurosciences, Reproductive Science and Dentistry, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Giuseppe Maria Maruotti
- Department of Neurosciences, Reproductive Science and Dentistry, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Pasquale Martinelli
- Department of Neurosciences, Reproductive Science and Dentistry, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Maurizio Guida
- Department of Neurosciences, Reproductive Science and Dentistry, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
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154
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Chéles DS, Molin EAD, Rocha JC, Nogueira MFG. Mining of variables from embryo morphokinetics, blastocyst's morphology and patient parameters: an approach to predict the live birth in the assisted reproduction service. JBRA Assist Reprod 2020; 24:470-479. [PMID: 32293823 PMCID: PMC7558892 DOI: 10.5935/1518-0557.20200014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/17/2020] [Indexed: 11/20/2022] Open
Abstract
Based on growing demand for assisted reproduction technology, improved predictive models are required to optimize in vitro fertilization/intracytoplasmatic sperm injection strategies, prioritizing single embryo transfer. There are still several obstacles to overcome for the purpose of improving assisted reproductive success, such as intra- and inter-observer subjectivity in embryonic selection, high occurrence of multiple pregnancies, maternal and neonatal complications. Here, we compare studies that used several variables that impact the success of assisted reproduction, such as blastocyst morphology and morphokinetic aspects of embryo development as well as characteristics of the patients submitted to assisted reproduction, in order to predict embryo quality, implantation or live birth. Thereby, we emphasize the proposal of an artificial intelligence-based platform for a more objective method to predict live birth.
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Affiliation(s)
- Dóris Spinosa Chéles
- Laboratório de Matemática Aplicada, Department of Biological Sciences, School of Languages and Sciences, Campus Assis, São Paulo State University (UNESP), Assis, SP, Brazil
- Laboratório de Micromanipulação Embrionária, Department of Biological Sciences, School of Sciences and Languages, Campus Assis, São Paulo State University (UNESP), Assis, SP, Brazil
| | - Eloiza Adriane Dal Molin
- Laboratório de Matemática Aplicada, Department of Biological Sciences, School of Languages and Sciences, Campus Assis, São Paulo State University (UNESP), Assis, SP, Brazil
| | - José Celso Rocha
- Laboratório de Matemática Aplicada, Department of Biological Sciences, School of Languages and Sciences, Campus Assis, São Paulo State University (UNESP), Assis, SP, Brazil
| | - Marcelo Fábio Gouveia Nogueira
- Laboratório de Micromanipulação Embrionária, Department of Biological Sciences, School of Sciences and Languages, Campus Assis, São Paulo State University (UNESP), Assis, SP, Brazil
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155
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Impact of maternal central adiposity on infant anthropometry and perinatal morbidity: A systematic review. Eur J Obstet Gynecol Reprod Biol X 2020; 8:100117. [PMID: 33073232 PMCID: PMC7549059 DOI: 10.1016/j.eurox.2020.100117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 12/28/2022] Open
Abstract
Overweight and obesity during pregnancy are risk factors for a large number of perinatal complications, both for the mother and the infant. Risk stratification and early interventions are therefore highly clinically important to minimize future complications. Currently, body mass index (BMI) in early pregnancy is used for risk stratification of pregnant women, but a disadvantage of BMI is that it does not distinguish muscle from fat tissue and central from peripheral adiposity. Maternal fat distribution is suggested to be a better predictor than BMI of obesity-related adverse pregnancy outcomes, with central adiposity posing a greater risk than peripheral subcutaneous fat. With this study, we aimed to systematically review the evidence of what impact maternal central adiposity in early to mid-pregnancy or at most 365 days prior to conception has on infant anthropometry and perinatal morbidity. The databases PubMed/MEDLINE, Web of Science Core Collection, CINAHL, SCOPUS, Clinical Trials, and Open Grey were searched from inception until November 2019. Eligible studies assessed the association between maternal central adiposity, in early to mid-pregnancy or at most 365 days prior to conception, and any of the following infant outcomes: preterm delivery (< 37 weeks of gestation), birthweight, macrosomia, large for gestational age, congenital malformations, hypoglycemia, hyperbilirubinemia, care at neonatal intensive care unit, and death. Two authors independently screened titles and abstracts, read the included full-text studies, and extracted data. The Newcastle-Ottawa Quality Assessment Scale for cohort studies was used to evaluate the quality of and risk of bias in the studies. A total of 720 records were identified, 20 full-text studies assessed for eligibility, and 10 cohort studies included in the review. The results suggest that central adiposity in early to mid-pregnancy or at most 365 days prior to conception may contribute to increased birthweight and increased likelihood of delivery by cesarean section. There is also some evidence of associations between central adiposity and preterm delivery (< 37 weeks of gestation), and admission to neonatal intensive care unit. A meta-analysis was not possible to perform due to substantial heterogeneity among the included studies regarding the exposure, outcome, and statistical methods used. Hence, central adiposity in early to mid-pregnancy or at most 365 days prior to conception could be a possible risk marker in addition to BMI for risk stratification of pregnant women. However, since the topic is only scarcely researched, and the results not unanimous, more studies are needed to further clarify the associations between maternal central adiposity and adverse neonatal complications, before any altered recommendations of guidelines could be made. To enable a future meta-analysis, studies using similar methods for central adiposity assessment,and similar outcome measures, are required.
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156
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Tersigni C, Neri C, D'Ippolito S, Garofalo S, Martino C, Lanzone A, Scambia G, Di Simone N. Impact of maternal obesity on the risk of preterm delivery: insights into pathogenic mechanisms. J Matern Fetal Neonatal Med 2020; 35:3216-3221. [PMID: 32942918 DOI: 10.1080/14767058.2020.1817370] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Preterm delivery (PTD) represents the leading cause of neonatal death and disability. Among risk factors for PTD, maternal obesity (MO) is becoming an ever more relevant condition in developed countries, although the mechanisms relating this condition to higher risk of PTD is not clear. Aim of this narrative review is to summarize evidences from clinical and translational research showing how MO might negatively impact on pregnancy and neonatal outcomes, particularly, by increasing the risk of PTD. METHODS We performed comprehensive review of the literature in PubMed and Google Scholar databases for studies from 1998 to 2018 linking MO to PTD and inflammation. RESULTS Chronic inflammatory status associated to increased synthesis of adipokines and cytokines from fat tissue has been shown in obesity. Obese women have a higher risk of both spontaneous and medically induced PTD. In about 50% of cases of spontaneous PTD, an infection-induced chorion amnionitis can be detected while in the remaining 50% a sterile inflammatory response has been described. Activation of uterine innate immunity system in intra-amniotic cavity and in chorioamniotic membranes might represent the missing link between MO and the pathogenesis of PTD. CONCLUSION Tissue inflammation might represent the pathogenic link between MO and increased occurrence of PTD. The achievement of pre-pregnancy normal maternal weight and body mass index is a fundamental aim of public health to reduce the incidence of PTD and get optimal reproductive outcomes.
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Affiliation(s)
- Chiara Tersigni
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, U.O.C. di Ostetricia e Patologia Ostetrica, Rome, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Caterina Neri
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, U.O.C. di Ostetricia e Patologia Ostetrica, Rome, Italy
| | - Silvia D'Ippolito
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, U.O.C. di Ostetricia e Patologia Ostetrica, Rome, Italy
| | - Serafina Garofalo
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, U.O.C. di Ostetricia e Patologia Ostetrica, Rome, Italy
| | - Carmelinda Martino
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, U.O.C. di Ostetricia e Patologia Ostetrica, Rome, Italy
| | - Antonio Lanzone
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, U.O.C. di Ostetricia e Patologia Ostetrica, Rome, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, U.O.C. di Ginecologia Oncologica, Rome, Italy
| | - Nicoletta Di Simone
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, U.O.C. di Ostetricia e Patologia Ostetrica, Rome, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
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157
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Poprzeczny AJ, Louise J, Deussen AR, Dodd JM. Effect of metformin in addition to an antenatal diet and lifestyle intervention on fetal growth and adiposity: the GRoW randomised trial. BMC Endocr Disord 2020; 20:139. [PMID: 32928167 PMCID: PMC7488668 DOI: 10.1186/s12902-020-00618-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 08/31/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The infants born to women who are overweight or obese in pregnancy are at an increased risk of being born macrosomic or large for gestational age. Antenatal dietary and lifestyle interventions have been shown to be ineffective at reducing this risk. Our aim was to examine the effects of metformin in addition to a diet and lifestyle intervention on fetal growth and adiposity among women with a BMI above the healthy range. METHODS Women who had a body mass index ≥25 kg/m2 in early pregnancy, and a singleton gestation, were enrolled in the GRoW trial from three public maternity hospitals in metropolitan Adelaide. Women were invited to have a research ultrasounds at 28 and 36 weeks' gestation at which ultrasound measures of fetal biometry and adiposity were obtained. Fetal biometry z-scores and trajectories were calculated. Measurements and calculations were compared between treatment groups. This secondary analysis was pre-specified. RESULTS Ultrasound data from 511 women were included in this analysis. The difference in femur length at 36 weeks' gestation was (0.07 cm, 95% CI 0.01-0.14 cm, p = 0.019) and this was was statistically significant, however the magnitude of effect was small. Differences between treatment groups for all other fetal biometry measures, z-scores, estimated fetal weight, and adiposity measures at 28 and 36 weeks' gestation were similar. CONCLUSIONS The addition of metformin to dietary and lifestyle advice in pregnancy for overweight and obese women has no clinically relevant effect on ultrasound measures of fetal biometry or adiposity. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ( ACTRN12612001277831 ).
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Affiliation(s)
- Amanda J Poprzeczny
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia.
- Department of Perinatal Medicine, The Women's and Children's Hospital, Women's and Babies Division, Adelaide, South Australia, Australia.
- The University of Adelaide, Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia, 5006, Australia.
| | - Jennie Louise
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
- The University of Adelaide, School of Public Health, Adelaide, South Australia, Australia
| | - Andrea R Deussen
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
| | - Jodie M Dodd
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
- Department of Perinatal Medicine, The Women's and Children's Hospital, Women's and Babies Division, Adelaide, South Australia, Australia
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158
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Lauth C, Huet J, Dolley P, Thibon P, Dreyfus M. Maternal obesity in prolonged pregnancy: Labor, mode of delivery, maternal and fetal outcomes. J Gynecol Obstet Hum Reprod 2020; 50:101909. [PMID: 32927107 DOI: 10.1016/j.jogoh.2020.101909] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Obesity is currently not a medical indication for elective induction of labor although obese patients may not be eligible for expectant management after 41 W G. Few data on labor and complications in this population undergoing prolonged pregnancy are known. The objective of our study was to evaluate labor, mode of delivery, maternal and fetal outcomes in prolonged pregnancy in obese patients compared to normal body mass index (BMI). MATERIALS AND METHODS It was a retrospective cohort study in patients who, after prolonged pregnancy gave birth to a single fetus, in cephalic presentation, between the first of January 2002 and December 31, 2018 in the Caen University Hospital Center. Patient's characteristics were compared within each BMI class using uni- and multivariate analysis with regression logistics models. RESULTS Overall, 9159 patients were included. Term of birth and spontaneous labor calculated rates were significantly increased in case of obesity (p < 0.001). The adjusted Odds Ratio (ORa) for induced labor in class III obesity was 1.73 [1.13-2.66]. After induction of labor, 83.0 % patients with normal BMI delivered vaginally versus 61.8 % in case of class III obesity (p < 0.001). The ORa for an emergency cesarean was 3.39 [2.04-5.63] and 1.78 [1.06-2.99] for neonatal morbidity in class III obesity. CONCLUSION Morbid obese patients do not belong to a low risk patient's group when pregnancy is prolonged. Elective induction in case of morbid obesity may entail less risk than allowing the pregnancy to progress after 41 W G or even 39 W G. Further randomized prospective studies are nevertheless required.
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Affiliation(s)
- Claire Lauth
- Service de Gynécologie-Obstétrique et Médecine de la reproduction, CHU de CAEN, France; Université de Caen Normandie, France.
| | - Justine Huet
- Service de Gynécologie-Obstétrique et Médecine de la reproduction, CHU de CAEN, France; Université de Caen Normandie, France
| | - Patricia Dolley
- Service de Gynécologie-Obstétrique et Médecine de la reproduction, CHU de CAEN, France
| | | | - Michel Dreyfus
- Service de Gynécologie-Obstétrique et Médecine de la reproduction, CHU de CAEN, France; Université de Caen Normandie, France
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159
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Luo R, Mukherjee N, Chen S, Jiang Y, Arshad SH, Holloway JW, Hedman A, Gruzieva O, Andolf E, Pershagen G, Almqvist C, Karmaus WJ. Paternal DNA Methylation May Be Associated With Gestational Age at Birth. Epigenet Insights 2020; 13:2516865720930701. [PMID: 32964196 PMCID: PMC7488897 DOI: 10.1177/2516865720930701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/09/2020] [Indexed: 11/15/2022] Open
Abstract
Background: How epigenetic modifications of DNA are associated with gestational age at birth is not fully understood. We investigated potential effects of differential paternal DNA methylation (DNAm) on offspring gestational age at birth by conducting an epigenome-wide search for cytosine-phosphate-guanine (CpG) sites. Methods: Study participants in this study consist of male cohort members or partners of the F1-generation of the Isle of Wight Birth Cohort (IoWBC). DNAm levels in peripheral blood from F1-fathers (n = 92) collected around pregnancy of their spouses were analyzed using the Illumina 450K array. A 5-step statistical analysis was performed. First, a training-testing screening approach was applied to select CpG sites that are potentially associated with gestational age at birth. Second, functional enrichment analysis was employed to identify biological processes. Third, by centralizing on biologically informative genes, Cox proportional hazards models were used to assess the hazard ratios of individual paternal CpGs on gestational age adjusting for confounders. Fourth, to assess the validity of our results, we compared our CpG-gestational age correlations within a Born into Life Study in Sweden (n = 15). Finally, we investigated the correlation between the detected CpGs and differential gene expression in F2 cord blood in the IoWBC. Results: Analysis of DNAm of fathers collected around their partner’s pregnancy identified 216 CpG sites significantly associated with gestational age at birth. Functional enrichment pathways analyses of the annotated genes revealed 2 biological pathways significantly related to cell-cell membrane adhesion molecules. Differential methylation of 9 cell membrane adhesion pathway-related CpGs were significantly associated with gestational age at birth after adjustment for confounders. The replication sample showed correlation coefficients of 2 pathway-related CpGs with gestational age at birth within 95% confidence intervals of correlation coefficients in IoWBC. Finally, CpG sites of protocadherin (PCDH) gene clusters were associated with gene expression of PCDH in F2 cord blood. Conclusions: Our findings suggest that differential paternal DNAm may affect gestational age at birth through cell-cell membrane adhesion molecules. The results are novel but require future replication in a larger cohort.
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Affiliation(s)
- Rui Luo
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Nandini Mukherjee
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Su Chen
- Department of Mathematical Sciences, University of Memphis, Memphis, TN, USA
| | - Yu Jiang
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - S Hasan Arshad
- The David Hide Asthma and Allergy Research Centre, Newport, UK.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - John W Holloway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anna Hedman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Olena Gruzieva
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Ellika Andolf
- Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Goran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Unit of Pediatric Allergy and Pulmonology at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Wilfried Jj Karmaus
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
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Lin SF, Chang SH, Kuo CF, Lin WT, Chiou MJ, Huang YT. Association of pregnancy outcomes in women with type 2 diabetes treated with metformin versus insulin when becoming pregnant. BMC Pregnancy Childbirth 2020; 20:512. [PMID: 32887578 PMCID: PMC7487639 DOI: 10.1186/s12884-020-03207-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 08/25/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Metformin use in pregnancy is controversial because metformin crosses the placenta and the safety on the fetus has not been well-established. This retrospective study aimed to compare pregnancy outcomes in women with preexisting type 2 diabetes receiving metformin or standard insulin treatment. METHODS The cohort of this population-based study includes women of age 20-44 years with preexisting type 2 diabetes and singleton pregnancies in Taiwan between 2003 and 2014. Subjects were classified into three mutually exclusive groups according to glucose-lowering treatments received before and after becoming pregnant: insulin group, switching group (metformin to insulin), and metformin group. A generalized estimating equation model adjusted for patient age, duration of type 2 diabetes, hypertension, hyperlipidemia, retinopathy, and aspirin use was used to estimate the adjusted odds ratio (aOR) and 95% confidence interval (CI) of adverse pregnancy outcomes. RESULTS A total of 1166 pregnancies were identified in the insulin group (n = 222), the switching group (n = 318) and the metformin group (n = 626). The insulin group and the switching group had similar pregnancy outcomes for both the mother and fetus, including risk of primary cesarean section, pregnancy-related hypertension, preeclampsia, preterm birth (< 37 weeks), very preterm birth (< 32 weeks), low birth weight (< 2500 g), high birth weight (> 4000 g), large for gestational age, and congenital malformations. The metformin group had a lower risk of primary cesarean section (aOR = 0.57; 95% CI, 0.40-0.82) and congenital malformations (aOR, 0.51; 95% CI; 0.27-0.94) and similar risk for the other outcomes as compared with the insulin group. CONCLUSIONS Metformin therapy was not associated with increased adverse pregnancy outcomes in women with type 2 diabetes as compared with standard insulin therapy.
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Affiliation(s)
- Shu-Fu Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shang-Hung Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou, No.15, Wunhua 1st Rd., Gueishan Dist, Taoyuan City, 333, Taiwan
- Graduate Institute of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wan-Ting Lin
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou, No.15, Wunhua 1st Rd., Gueishan Dist, Taoyuan City, 333, Taiwan
| | - Meng-Jiun Chiou
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou, No.15, Wunhua 1st Rd., Gueishan Dist, Taoyuan City, 333, Taiwan.
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161
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Nomura K, Minamizono S, Nagashima K, Ono M, Kitano N. Maternal Body Mass Index and Breastfeeding Non-Initiation and Cessation: A Quantitative Review of the Literature. Nutrients 2020; 12:nu12092684. [PMID: 32887461 PMCID: PMC7551008 DOI: 10.3390/nu12092684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/23/2020] [Accepted: 08/31/2020] [Indexed: 12/29/2022] Open
Abstract
This study aims to investigate which maternal body mass index (BMI) categories are associated with the non-initiation or cessation of breastfeeding (BF) based on a quantitative review of the literature. We searched Ovid MEDLINE and EBSCO CINAHL for peer-reviewed articles published between 1946 (MEDLINE) or 1981 (CINAHL), and 2019. Selected studies were either cross-sectional or cohort studies, of healthy mothers and infants, that reported nutrition method (exclusive/full or any) and period (initiation/duration/cessation) of breastfeeding according to maternal BMI levels. Pairwise meta-analyses of 57 studies demonstrated that the pooled odds risks (OR) of not initiating BF among overweight and obese mothers compared to normal weight mothers were significant across 29 (OR 1.33, 95% confidence interval (CI), 1.15–1.54, I2 = 98%) and 26 studies (OR 1.61, 95% CI, 1.33–1.95, I2 = 99%), respectively; the pooled risks for BF cessation were inconsistent in overweight and obese mothers with substantial heterogeneity. However, we found that overweight mothers (n = 10, hazard ratio (HR) 1.16, 95% CI, 1.07–1.25; I2 = 23%) and obese mothers (n = 7, HR 1.45, 95% CI: 1.27–1.65; I2 = 44%) were both associated with an increased risk of not continuing any BF and exclusive BF, respectively. Overweight and obese mothers may be at increased risk of not initiating or the cessation of breastfeeding.
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Affiliation(s)
- Kyoko Nomura
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita 010-8543, Japan;
- Correspondence: ; Tel.: +81-018-884-6087
| | - Sachiko Minamizono
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita 010-8543, Japan;
| | - Kengo Nagashima
- Research Center for Medical and Health Data Science, The Institute of Statistical Mathematics, Tokyo 190-8562, Japan;
| | - Mariko Ono
- Teikyo University School of Medicine, Tokyo 173-8605, Japan;
| | - Naomi Kitano
- Research Center for Community Medicine and Department of Public Health, Wakayama Medical University School of Medicine, Wakayama 641-8509, Japan;
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162
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Shrestha N, Ezechukwu HC, Holland OJ, Hryciw DH. Developmental programming of peripheral diseases in offspring exposed to maternal obesity during pregnancy. Am J Physiol Regul Integr Comp Physiol 2020; 319:R507-R516. [PMID: 32877239 DOI: 10.1152/ajpregu.00214.2020] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Obesity is an increasing global health epidemic that affects all ages, including women of reproductive age. During pregnancy, maternal obesity is associated with adverse pregnancy outcomes that lead to complications for the mother. In addition, maternal obesity can increase the risk of poor perinatal outcomes for the infant due to altered development. Recent research has investigated the effects of maternal obesity on peripheral organ development and health in later life in offspring. In this review, we have summarized studies that investigated the programming effects of maternal obesity before and during pregnancy on metabolic, cardiovascular, immune, and microbiome perturbations in offspring. Epidemiological studies investigating the effects of maternal obesity on offspring development can be complex due to other copathologies and genetic diversity. Animal studies have provided some insights into the specific mechanisms and pathways involved in programming peripheral disease risk. The effects of maternal obesity during pregnancy on offspring development are often sex specific, with sex-specific changes in placental transport and function suggestive that this organ is likely to play a central role. We believe that this review will assist in facilitating future investigations regarding the underlying mechanisms that link maternal obesity and offspring disease risk in peripheral organs.
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Affiliation(s)
- Nirajan Shrestha
- School of Medical Science, Griffith University, Southport, Queensland, Australia
| | - Henry C Ezechukwu
- Department of Medical Biochemistry, EKO University of Medicine and Health Science, Ijanikin, Nigeria
| | - Olivia J Holland
- School of Medical Science, Griffith University, Southport, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Deanne H Hryciw
- Environmental Futures Research Institute, Griffith University, Nathan, Queensland, Australia.,School of Environment and Science, Griffith University, Nathan, Queensland, Australia.,Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
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163
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Association of abnormal first stage of labor duration and maternal and neonatal morbidity. Am J Obstet Gynecol 2020; 223:445.e1-445.e15. [PMID: 32883453 DOI: 10.1016/j.ajog.2020.06.053] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/19/2020] [Accepted: 06/29/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Contemporary guidelines for labor management do not characterize abnormal labor on the basis of maternal and/or neonatal morbidity. OBJECTIVE In this study, we aimed to evaluate the association of abnormal duration of the first stage of term labor and the risk of maternal and neonatal morbidity. STUDY DESIGN We conducted a retrospective analysis of prospectively collected data of all consecutive women admitted for delivery at a single center at ≥37 weeks and 0 to 7 days of gestation with singleton, nonanomalous, vertex infants from 2010 to 2015, who reached 10 cm cervical dilation. Multivariable logistic regression compared odds ratios for maternal and neonatal outcomes among women above and below the 90th, 95th, and 97th percentiles for first stage of labor duration. Receiver operating characteristic curves estimated the association between first stage of labor duration and maternal morbidity. Maternal morbidity was a composite of maternal fever, hemorrhage, transfusion, or endomyometritis; prolonged second stage of labor duration; and third- or fourth-degree perineal laceration. Neonatal morbidity was a composite of hypothermic therapy, need for mechanical ventilation, respiratory distress syndrome, meconium aspiration syndrome, birth injury or trauma, and neonatal seizure or sepsis. RESULTS Of 6823 women included in this study, 682 were anticipated to have first stage of labor duration above the 90th percentile cutoff point, which was associated with an increased risk of composite maternal morbidity, maternal fever, postpartum transfusion, prolonged second stage of labor duration, third- or fourth-degree perineal laceration, and cesarean or operative vaginal delivery (P≤.02) and an increased risk of composite neonatal morbidity, respiratory distress syndrome, need for mechanical ventilation, and neonatal sepsis (P≤.03). Composite maternal morbidity was 2.2 (95% confidence interval, 1.8-2.7), 1.9 (95% confidence interval, 1.4-2.4), and 1.8 (95% confidence interval, 1.3-2.5) times more likely to occur among women above the 90th, 95th, and 97th percentile, respectively, for first stage of labor duration from 4 to 10 cm. Composite neonatal morbidity was 2.6 (95% confidence interval, 2.1-3.2), 2.2 (95% confidence interval, 1.7-2.9), and 1.9 (95% confidence interval, 1.3-2.8) times more likely to occur among infants delivered by women above the 90th, 95th, and 97th percentiles for first stage of labor duration from 4 to 10 cm. Receiver operating characteristic curves among all women from 4 to 10 cm and 6 to 10 cm, including when stratified by parity and type of labor onset, had an area under the curve of 0.51 to 0.62 and 0.53 to 0.71 for maternal and neonatal morbidity, respectively. Thus, duration of labor has moderate predictive ability, at best, for composite maternal or neonatal morbidity. No curve demonstrated a clear point at which adverse maternal or neonatal outcomes increased that could be used to define abnormal labor. CONCLUSION The benefit of expectantly managing a prolonged first stage of labor with duration above the 90th percentile in anticipation of vaginal delivery must be weighed against the increased risk of composite maternal and neonatal morbidity. Risks associated with performing cesarean delivery as an alternative management for women with prolonged first stage of labor duration must also be considered.
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164
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Wall-Wieler E, Abrams B, Snowden JM, Carmichael SL. Defining maternal obesity in studies of birth outcomes: Comparing ICD-9 codes at delivery and measures on the birth certificate. Paediatr Perinat Epidemiol 2020; 34:618-627. [PMID: 32180247 PMCID: PMC7483732 DOI: 10.1111/ppe.12667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/12/2020] [Accepted: 02/16/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Using ICD-9 codes underestimates the prevalence of obesity in adults; however, the validity of these codes in studies of pregnancy-related outcomes is not known. OBJECTIVES To compare classification of maternal obesity based on ICD-9 codes in hospital discharge records versus data from birth certificates in the same women, examine predictors of agreement, and assess how associations between obesity and two birth outcomes differ by source of weight data. METHODS This population-based study included 2 329 145 California births between 2007 and 2012. We compared data on obesity from childbirth hospital discharge records (ICD-9 codes for obesity) and birth certificates (pre-pregnancy body mass index (BMI) calculated from weight and height) and identified predictors of agreement between the two sources. Logistic regression models assessed whether the two definitions of obesity resulted in different estimates of the associations of obesity with caesarean birth and large-for-gestational age. RESULTS Overall, 464 754 women (20.0%) had obesity based on their pre-pregnancy BMI while only 100 002 (4.3%) had an obesity-related ICD-9 code. The sensitivity of ICD-9-based obesity was low at 16.2%; however, obesity codes were highly specific at 98.7%, with a negative predictive value of 82.5% and a positive predictive value of 75.2%. Among women with obesity identified by the birth certificate, those with pre-pregnancy and pregnancy-related complications (eg diabetes and hypertension) were more likely to have an obesity-related diagnosis in their delivery hospital discharge record. Using ICD-9 codes overestimated the association of obesity with caesarean birth and newborn large-for-gestational age. CONCLUSIONS ICD-9 codes in childbirth discharge records captured only one in five women with pre-pregnancy obesity. Sensitivity varied by maternal characteristics and conditions. This misclassification resulted in bias when examining the association of obesity and pregnancy-related outcomes.
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Affiliation(s)
| | - Barbara Abrams
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, USA
| | - Jonathan M. Snowden
- School of Public Health, Oregon Health and Science University-Portland State University, Portland, USA,Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, USA
| | - Suzan L. Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Stanford, USA,Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford USA
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165
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Bastola K, Koponen P, Härkänen T, Luoto R, Gissler M, Kinnunen TI. Pregnancy complications in women of Russian, Somali, and Kurdish origin and women in the general population in Finland. ACTA ACUST UNITED AC 2020; 16:1745506520910911. [PMID: 32294026 PMCID: PMC7160768 DOI: 10.1177/1745506520910911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective: We compared the prevalence of gestational diabetes and hypertensive disorders
in the most recent pregnancy among women of Russian, Somali, and Kurdish
origin and women in the general population in Finland. Methods: The study groups were selected from population-based samples of 18- to
64-year-old women. The women were of Russian (n = 318), Somali (n = 583),
and Kurdish (n = 373) origin or from the general population (n = 243), and
had given birth in Finland between 2004 and 2014. The data were obtained
from the National Medical Birth Register and the Hospital Discharge
Register. Data on gestational diabetes and hypertensive disorders were
extracted based on relevant International Classification of
Diseases, Tenth Revision codes. The main statistical methods
were logistic regression analyses adjusted for age, parity, body mass index,
socioeconomic status, and smoking. Results: The prevalence of gestational diabetes was 19.1% in Kurdish, 14.4% in Somali,
9.3% in Russian, and 11.8% in the general population. The prevalence of
hypertensive disorders was 5.4% in the general population, 3.8% in Somali,
3.1% in Kurdish, and 1.7% in Russian. When adjusted for confounders, Kurdish
women had two-fold odds for gestational diabetes (odds ratio = 1.98; 95%
confidence interval = 1.20–3.32) compared with the general population, but
the odds for hypertensive disorders did not differ between groups. Conclusion: Women of Kurdish origin were more likely to develop gestational diabetes.
Studies with larger samples are required to confirm these findings to
develop prevention strategies for later development of type 2 diabetes.
Future research including other migrant groups is recommended to identify
differences in pregnancy complications among the women in migrant and
general population.
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Affiliation(s)
- Kalpana Bastola
- Faculty of Social Sciences/ Health Sciences, Tampere University, Tampere, Finland
| | - Päivikki Koponen
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Tommi Härkänen
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Riitta Luoto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mika Gissler
- Department of Information Services, National Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | - Tarja I Kinnunen
- Faculty of Social Sciences/ Health Sciences, Tampere University, Tampere, Finland
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166
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Association between Body Mass Index and Reproductive Outcome in Women with Polycystic Ovary Syndrome Receiving IVF/ICSI-ET. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6434080. [PMID: 32908902 PMCID: PMC7463361 DOI: 10.1155/2020/6434080] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/18/2020] [Accepted: 08/05/2020] [Indexed: 11/20/2022]
Abstract
Objective To examine the association between body mass index (BMI) and the outcome of in vitro fertilization or intracytoplasmic sperm injection embryo transfer- (IVF/ICSI-ET) assisted reproduction in women with polycystic ovary syndrome (PCOS) receiving the ultra-long agonist protocol. Methods We retrospectively identified all women receiving IVF/ICSI-ET for the first time using the ultra-long protocol between January 2013 and January 2018 at our hospital. Only women at ≤35 years of age receiving the first cycle were analyzed. Results A total of 1782 women were included in the analysis: 42 were underweight, 742 were overweight, 198 were obese, and 800 were normal weight. Gonadotropin dosage and duration were comparable between underweight and normal weight groups but were significantly higher/longer in overweight and obese groups (P < 0.008). The number of oocytes retrieved was significantly lower in overweight and obese groups than in the normal weight group (P < 0.008). The number of transferable embryos was significantly higher in normal weight group than overweight and obese groups (P < 0.008). Embryo implantation rate, clinical pregnancy rate, full-term birth rate, and live birth rate did not differ among the 4 groups. The cycle cancellation rate was lower in the overweight and obese group than normal weight group (P < 0.008). The miscarriage rate was higher in the obese group than the normal weight group (P < 0.008). In multivariate logistic regression analysis, abnormal BMI was an independent risk for miscarriage (OR: 1.069, 95% CI 1.020, 1.122; P = 0.006). Conclusion Overweight and obesity are associated with poor outcomes in PCOS patients receiving ultra-long protocol. Measures to reduce body weight should be encouraged in overweight and obese PCOS women at ≤35 years of age prior to assisted reproductive technology (ART).
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167
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Maxwell C, Gaudet L, Cassir G, Nowik C, McLeod NL, Jacob CÉ, Walker M. Guideline No. 391-Pregnancy and Maternal Obesity Part 1: Pre-conception and Prenatal Care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 41:1623-1640. [PMID: 31640864 DOI: 10.1016/j.jogc.2019.03.026] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This guideline will review key aspects in the pregnancy care of women with obesity. Part I will focus on pre-conception and pregnancy care. Part II will focus on team planning for delivery and Postpartum Care. INTENDED USERS All health care providers (obstetricians, family doctors, midwives, nurses, anaesthesiologists) who provide pregnancy-related care to women with obesity. TARGET POPULATION Women with obesity who are pregnant or planning pregnancies. EVIDENCE Literature was retrieved through searches of Statistics Canada, Medline, and The Cochrane Library on the impact of obesity in pregnancy on antepartum and intrapartum care, maternal morbidity and mortality, obstetrical anaesthesia, and perinatal morbidity and mortality. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to September 2018. Grey (unpublished) literature was identified through searching the websites of health technology assessment and related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALIDATION METHODS The content and recommendations were drafted and agreed upon by the authors. Then the Maternal-Fetal Medicine Committee peer reviewed the content and submitted comments for consideration, and the Board of the Society of Obstetricians and Gynaecologists of Canada (SOGC) approved the final draft for publication. Areas of disagreement were discussed during meetings, at which time consensus was reached. The level of evidence and quality of the recommendation made were described using the Evaluation of Evidence criteria of the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS Implementation of the recommendations in these guidelines may increase obstetrical provider recognition of the issues affected pregnant individuals with obesity, including clinical prevention strategies, communication between the health care team, the patient and family as well as equipment and human resource planning. It is hoped that regional, provincial and federal agencies will assist in the education and support of coordinated care for pregnant individuals with obesity. GUIDELINE UPDATE SOGC guidelines will be automatically reviewed 5 years after publication. However, authors can propose another review date if they feel that 5 years is too short/long based on their expert knowledge of the subject matter. SPONSORS This guideline was developed with resources funded by the SOGC. SUMMARY STATEMENTS RECOMMENDATIONS.
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Maxwell C, Gaudet L, Cassir G, Nowik C, McLeod NL, Jacob CÉ, Walker M. Guideline No. 392-Pregnancy and Maternal Obesity Part 2: Team Planning for Delivery and Postpartum Care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 41:1660-1675. [PMID: 31640866 DOI: 10.1016/j.jogc.2019.03.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This guideline will review key aspects in the pregnancy care of women with obesity. Part I will focus on Preconception and Pregnancy Care. Part II will focus on Team Planning for Delivery and Postpartum Care. INTENDED USERS All health care providers (obstetricians, family doctors, midwives, nurses, anaesthesiologists) who provide pregnancy-related care to women with obesity. TARGET POPULATION Women with obesity who are pregnant or planning pregnancies. EVIDENCE Literature was retrieved through searches of Statistics Canada, Medline, and The Cochrane Library on the impact of obesity in pregnancy on antepartum and intrapartum care, maternal morbidity and mortality, obstetric anaesthesia, and perinatal morbidity and mortality. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to September 2018. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALIDATION METHODS The content and recommendations were drafted and agreed upon by the authors. Then the Maternal-Fetal Medicine Committees peer reviewed the content and submitted comments for consideration, and the Board of the Society of Obstetricians and Gynaecologists of Canada (SOGC) approved the final draft for publication. Areas of disagreement were discussed during meetings at which time consensus was reached. The level of evidence and quality of the recommendation made were described using the Evaluation of Evidence criteria of the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS Implementation of the recommendations in these guidelines may increase obstetrical provider recognition of the issues affecting pregnant individuals with obesity, including clinical prevention strategies, communication between the health care team, the patient and family as well as equipment and human resource planning. It is hoped that regional, provincial and federal agencies will assist in the education and support of coordinated care for pregnant individuals with obesity. GUIDELINE UPDATE SOGC guideline will be automatically reviewed 5 years after publication. However, authors can propose another review date if they feel that 5 years is too short/long based on their expert knowledge of the subject matter. SPONSORS This guideline was developed with resources funded by the SOGC. SUMMARY STATEMENTS RECOMMENDATIONS.
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169
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Nilsen FM, Ruiz JD, Tulve NS. A Meta-Analysis of Stressors from the Total Environment Associated with Children's General Cognitive Ability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155451. [PMID: 32751096 PMCID: PMC7432904 DOI: 10.3390/ijerph17155451] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 12/31/2022]
Abstract
General cognitive ability, often referred to as ‘general intelligence’, comprises a variety of correlated abilities. Childhood general cognitive ability is a well-studied area of research and can be used to predict social outcomes and perceived success. Early life stage (e.g., prenatal, postnatal, toddler) exposures to stressors (i.e., chemical and non-chemical stressors from the total (built, natural, social) environment) can impact the development of childhood cognitive ability. Building from our systematic scoping review (Ruiz et al., 2016), we conducted a meta-analysis to evaluate more than 100 stressors related to cognitive development. Our meta-analysis identified 23 stressors with a significant increase in their likelihood to influence childhood cognitive ability by 10% or more, and 80 stressors were observed to have a statistically significant effect on cognitive ability. Stressors most impactful to cognition during the prenatal period were related to maternal health and the mother’s ability to access information relevant to a healthy pregnancy (e.g., diet, lifestyle). Stressors most impactful to cognition during the early childhood period were dietary nutrients (infancy), quality of social interaction (toddler), and exposure to toxic substances (throughout early childhood). In conducting this analysis, we examined the relative impact of real-world exposures on cognitive development to attempt to understand the inter-relationships between exposures to both chemical and non-chemical stressors and early developmental life stages. Our findings suggest that the stressors observed to be the most influential to childhood cognitive ability are not permanent and can be broadly categorized as activities/behaviors which can be modified to improve childhood cognition. This meta-analysis supports the idea that there are complex relationships between a child’s total environment and early cognitive development.
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Affiliation(s)
- Frances M. Nilsen
- Office of Research and Development, U.S. Environmental Protection Agency Research Triangle Park, Durham, NC 27709, USA; (J.D.C.R.); (N.S.T.)
- Correspondence: ; Tel.: +1-919-541-2574
| | - Jazmin D.C. Ruiz
- Office of Research and Development, U.S. Environmental Protection Agency Research Triangle Park, Durham, NC 27709, USA; (J.D.C.R.); (N.S.T.)
- Honeywell International, Buffalo, NY 14210, USA
| | - Nicolle S. Tulve
- Office of Research and Development, U.S. Environmental Protection Agency Research Triangle Park, Durham, NC 27709, USA; (J.D.C.R.); (N.S.T.)
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170
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Oral tramadol versus oral celecoxib for analgesia after mediolateral episiotomy repair in obese primigravidae: a randomized controlled trial. Int Urogynecol J 2020; 32:2465-2472. [PMID: 32691120 DOI: 10.1007/s00192-020-04411-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS A variety of pharmacological and non-pharmacological interventions have been investigated, with the goal of relieving pain after post-episiotomy repair. We aimed to compare the efficacy of tramadol versus celecoxib orally in reducing pain after mediolateral episiotomy repair in obese primigravidae undergoing spontaneous vaginal delivery. METHODS We conducted a randomized double-blinded trial in Cairo University hospital, Cairo, Egypt, from October 2018 to December 2019. We randomly assigned 200 women into two groups: group A (n = 100) received one tramadol tablet 100 mg orally whereas group B (n = 100) received one celecoxib tablet 200 mg orally. Our primary outcome was pain score using a 10-cm visual analog scale at different time intervals. Our secondary outcomes were the overall satisfaction score and drug side effects. RESULTS After mediolateral episiotomy repair, the pain scores at 1, 2, and 4 h were significantly lower in the tramadol group than in the celecoxib group (p < 0.001). However, there were no significantly differences in pain scores at 8 and 12 h between the two groups (p = 0.50 and 0.48 respectively). Women's satisfaction score was significantly higher in the tramadol group than in the celecoxib group (p < 0.001). Fewer participants in the tramadol group needed additional analgesics than in the celecoxib group; however, the difference was not significant (p = 0.17). Drug adverse effects were comparable in the two groups. CONCLUSIONS Primigravid women who received tramadol 100 mg orally after mediolateral episiotomy repair had lower pain scores and were more satisfied than women who received celecoxib 200 mg orally. Both drugs were well tolerated, with few side effects.
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171
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Placental function in maternal obesity. Clin Sci (Lond) 2020; 134:961-984. [PMID: 32313958 DOI: 10.1042/cs20190266] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023]
Abstract
Maternal obesity is associated with pregnancy complications and increases the risk for the infant to develop obesity, diabetes and cardiovascular disease later in life. However, the mechanisms linking the maternal obesogenic environment to adverse short- and long-term outcomes remain poorly understood. As compared with pregnant women with normal BMI, women entering pregnancy obese have more pronounced insulin resistance, higher circulating plasma insulin, leptin, IGF-1, lipids and possibly proinflammatory cytokines and lower plasma adiponectin. Importantly, the changes in maternal levels of nutrients, growth factors and hormones in maternal obesity modulate placental function. For example, high insulin, leptin, IGF-1 and low adiponectin in obese pregnant women activate mTOR signaling in the placenta, promoting protein synthesis, mitochondrial function and nutrient transport. These changes are believed to increase fetal nutrient supply and contribute to fetal overgrowth and/or adiposity in offspring, which increases the risk to develop disease later in life. However, the majority of obese women give birth to normal weight infants and these pregnancies are also associated with activation of inflammatory signaling pathways, oxidative stress, decreased oxidative phosphorylation and lipid accumulation in the placenta. Recent bioinformatics approaches have expanded our understanding of how maternal obesity affects the placenta; however, the link between changes in placental function and adverse outcomes in obese women giving birth to normal sized infants is unclear. Interventions that specifically target placental function, such as activation of placental adiponectin receptors, may prevent the transmission of metabolic disease from obese women to the next generation.
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172
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The Acute Abdomen in Pregnant Women After Roux-en-Y Gastric Bypass: Encouraging Results from a National Referral Centre. Obes Surg 2020; 30:4029-4037. [PMID: 32671725 DOI: 10.1007/s11695-020-04833-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/27/2020] [Accepted: 07/02/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pregnant women with a history of bariatric surgery (BS) may develop acute abdominal pain related to this surgery, especially after Roux-en-Y gastric bypass. Studies showed alarming results regarding maternal and foetal morbidity and mortality. The aim of this study was to analyse these outcomes for pregnant women and their offspring. METHODS Single-centre retrospective cohort study in a tertiary referral centre for bariatric complications during pregnancy. Pregnant women with a history of BS referred between September 2015 and November 2019 with acute abdominal pain suspected for a bariatric complication were included. Data were retrospectively collected from the patient files, and a questionnaire was sent regarding the postoperative course and childbirth. RESULTS Fifty women were included. At presentation, mean maternal age was 31 (± 4) years, and median gestational age was 28+4 (25+4, 30+5) weeks. Thirteen women were treated conservatively. Thirty-seven women underwent surgery for, among others, internal herniation (n = 26) and intussusception (n = 6). Six women required small bowel resection. Two women underwent an emergency caesarean section shortly after the surgery due to foetal distress. Eight women delivered preterm of whom five infants required respiratory support. There was one intrauterine foetal death. Surgery > 48 h after the onset of the symptoms was not associated with an increase in small bowel resections or preterm birth. CONCLUSION Acute abdominal pain in pregnant women may be related to a bariatric complication. Further awareness of bariatric complications within the obstetric care and transferal to specialized care to prevent diagnostic delay may improve maternal and neonatal outcome.
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173
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Pétursdóttir Maack H, Larsson A, Axelsson O, Olovsson M, Wikström AK, Sundström Poromaa I. Pregnancy in metabolic healthy and unhealthy obese women. Acta Obstet Gynecol Scand 2020; 99:1640-1648. [PMID: 32491196 DOI: 10.1111/aogs.13929] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/06/2020] [Accepted: 05/28/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Obesity-associated adverse obstetric outcomes are well-known but still relatively rare and difficult to predict. Not all obese individuals are unhealthy; some have metabolically healthy obesity (MHO) and others have metabolic unhealthy obesity (MUO). Our aim was to investigate whether the MHO and MUO classification could be used for prediction of obesity-associated complications in pregnancy. MATERIAL AND METHODS We included 547 pregnant women with obesity, 2302 pregnant women with overweight and 5852 normal weight pregnant women. The women with obesity were classified as MUO (n = 181, 33.1%) or MHO (n = 366, 66.9%) based on first trimester blood pressure, lipoprotein levels and nonfasting glucose levels. The risk of obstetric outcomes was evaluated by multivariable logistic regression. We compared cardiovascular risk markers in blood between obese pregnant women with MUO and MHO. RESULTS Overall, 45.9% of women with MUO developed at least one adverse obesity-associated obstetric outcome, whereas corresponding proportions in women with MHO, overweight and normal weight were 35.0%, 27.6% and 21.2%, respectively. Following adjustment, the overall risk of at least one obesity-associated obstetric or perinatal complication in women with MUO, vs women with MHO, was increased (adjusted odds ratio 1.49, 95% confidence interval 1.03-2.15), but the predictive value of the model was low. Women with MUO had altered levels of cardiovascular risk markers such as cathepsin S, adiponectin, and cystatin C in comparison with women with MHO. CONCLUSIONS Women with MUO had an overall increased risk of adverse obstetric outcomes in comparison to women with MHO, but the classification had little relevance for risk prediction beyond that of body mass index.
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Affiliation(s)
| | - Anders Larsson
- Department of Medical Science, Uppsala University, Uppsala, Sweden
| | - Ove Axelsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Center for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Leonard SA, Carmichael SL, Main EK, Lyell DJ, Abrams B. Risk of severe maternal morbidity in relation to prepregnancy body mass index: Roles of maternal co-morbidities and caesarean birth. Paediatr Perinat Epidemiol 2020; 34:460-468. [PMID: 31106879 PMCID: PMC6864221 DOI: 10.1111/ppe.12555] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND An association between prepregnancy body mass index (BMI) and severe maternal morbidity (SMM) has been reported, but evidence has been mixed and potential explanations have not been examined. OBJECTIVE To evaluate the association between prepregnancy BMI and SMM in a large, diverse birth cohort and assess potential mediation by obesity-related co-morbidities and caesarean birth. METHODS This cohort study used linked birth certificate and hospitalisation discharge records from Californian births during 2007-2012. We assessed associations between prepregnancy BMI and SMM, and used inverse probability weighting for multiple mediators to estimate relative and absolute natural direct and indirect effects accounting for mediation by co-morbidities (hypertensive conditions, diabetes, asthma) and caesarean birth. RESULTS Among 2 650 182 births, the prevalence of SMM was 1.42%. Adjusted risk ratios for the total association between prepregnancy BMI category and SMM were 1.12 (95% confidence interval [CI] 1.07, 1.18) for underweight, 1.02 (95% CI 0.99, 1.04) for overweight, 1.04 (95% CI 1.00, 1.07) for obesity class 1, 1.14 (95% CI 1.09, 1.20) for obesity class 2, and 1.28 (95% CI 1.22, 1.36) for obesity class 3 compared to women with normal weight. After accounting for mediation by co-morbidity and caesarean birth, the risk ratios were 1.19 (95% CI 1.14, 1.26) for underweight, 0.91 (95% CI 0.89, 0.94) for overweight, 0.86 (95% CI 0.84, 0.89) for obesity class 1, 0.88 (95% CI 0.84, 0.92) for obesity class 2, and 0.89 (95% CI 0.83, 0.95) for obesity class 3. CONCLUSIONS Co-morbidities and caesarean birth explained an association between high prepregnancy BMI and SMM. These findings suggest that promotion of healthy prepregnancy weight, along with management of co-morbidities and support of vaginal birth in pregnant women with high BMI, could reduce the risk of SMM. However, these mediators did not reduce the elevated risk of SMM observed in women with low BMI.
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Affiliation(s)
- Stephanie A. Leonard
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, and the Center for Population Health Sciences, School of Medicine, Stanford University, Stanford, CA, USA
| | - Suzan L. Carmichael
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, and the Center for Population Health Sciences, School of Medicine, Stanford University, Stanford, CA, USA
| | - Elliott K. Main
- Department of Obstetrics and Gynecology, School of Medicine, Stanford University, Stanford, CA, USA
- California Maternal Quality Care Collaborative, Stanford, CA, USA
| | - Deirdre J. Lyell
- Department of Obstetrics and Gynecology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Barbara Abrams
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
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175
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Fallatah AM, Babatin HM, Nassibi KM, Banweer MK, Fayoumi MN, Oraif AM. Maternal and Neonatal Outcomes among Obese Pregnant Women in King Abdulaziz University Hospital: A Retrospective Single-Center Medical Record Review. Med Arch 2020; 73:425-432. [PMID: 32082014 PMCID: PMC7007626 DOI: 10.5455/medarh.2019.73.425-432] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Intoruction: Pregnancy results in different physiological changes to the pregnant body resulting in weight gain. This added weight can result in poor pregnancy outcomes in obese women. Aim: To assess the adverse maternal and neonatal outcomes among obese pregnant women. Methods: This is a retrospective record review conducted on obese pregnant women who delivered in the last five years attending King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Therefore, for analysis we used the following; 1- descriptive analysis, 2- Chi-square test, Pearson correlation, independent t-test, and one-way ANOVA to test the difference in obese and adverse pregnancy outcomes. Advance statistics such as binary, and multinomial logistic regression were used to examine the relationship between obesity and all adverse pregnancy outcomes. Results: A total of 1037 obese pregnant women were enrolled in our study including 620 (59.8%) obese in class I (30-34.9), 262 (25.3%) obese in class II (35-39.9), and 155 (14.9%) obese in class III (40). About 74.73% of the population were Saudis. The average age was 31.96 (5.79) years. Out of 1037 obese pregnant women, 449 did develop undesired antepartum outcomes, while 729 and 163 had adverse neonatal, and postpartum outcomes. Antepartum variables such as preeclampsia, gestational diabetes mellitus, impaired glucose tolerance test, antiphospholipid syndrome, premature rupture of membranes, placenta previa, anemia, urinary tract infection, and oligohydramnios, and rate of Cesarean section were significantly associated with obesity (P<0.05). Postpartum variables such as vaginal laceration, perianal laceration, postpartum hemorrhage, and endometritis were also significantly associated with obesity (P<0.05). Moreover, adverse neonatal outcomes such as low APGAR scores at 1 and 5 minutes, birthweight, gestational age, admission to neonatal intensive care unit, intrauterine fetal death, and neonatal death, were significant significantly associated with obesity (P<0.05). Conclusion: As our study demonstrated, maternal obesity resulted in adverse outcomes for the mother and fetus. Hence, to yield a better outcome for these women and their offspring, periconceptional counseling, conducting health education, and comprehensive plan prior to their pregnancy should be enforced.
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Affiliation(s)
- Anas M Fallatah
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Hussam M Babatin
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Khalid M Nassibi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Mazen K Banweer
- Faculty of Medicine, Jeddah University, Jeddah, Kingdom of Saudi Arabia
| | - Mohammad N Fayoumi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Ayman M Oraif
- Department of Obstetrics and Gynecology, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
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176
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Walker IV, Cresswell JA. Multiple deprivation and other risk factors for maternal obesity in Portsmouth, UK. J Public Health (Oxf) 2020; 41:278-286. [PMID: 30010829 DOI: 10.1093/pubmed/fdy110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 05/10/2018] [Accepted: 06/17/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Maternal obesity is known to be associated with a range of adverse outcomes, both for the mothers and their children. It may be more prevalent in areas with higher deprivation as measured by the Index of Multiple Deprivation (IMD), but this has not been demonstrated consistently. This study focused primarily on the relationship between maternal obesity and deprivation in a setting where areas of significant deprivation are surrounded by the overall affluent South East England. METHODS The study used the records of 3830 women who delivered under the care of a Portsmouth hospital from 1 April 2013 to 31 March 2014. Logistic regression was used to analyse the association between national IMD quintiles and maternal obesity, accounting for the potential confounders of age, ethnic origin, smoking status and parity. RESULTS Following adjustment, women in the most deprived IMD quintile were 1.60 (95% CI: 1.13, 2.26) times more likely to be obese compared to those in the least deprived quintile. Maternal obesity was also found to be associated with ethnicity and parity, but not with age or smoking status. CONCLUSIONS Maternal obesity increased with increasing deprivation. IMD may be a useful group-level indicator when planning interventions aimed at tackling maternal obesity.
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Affiliation(s)
- I V Walker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.,Primary Care and Population Sciences, University of Southampton, Southampton General Hospital, Southampton, UK.,London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - J A Cresswell
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
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177
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Marei WFA, Smits A, Mohey-Elsaeed O, Pintelon I, Ginneberge D, Bols PEJ, Moerloose K, Leroy JLMR. Differential effects of high fat diet-induced obesity on oocyte mitochondrial functions in inbred and outbred mice. Sci Rep 2020; 10:9806. [PMID: 32555236 PMCID: PMC7299992 DOI: 10.1038/s41598-020-66702-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/26/2020] [Indexed: 12/22/2022] Open
Abstract
Maternal obesity can cause reduced oocyte quality and subfertility. Mitochondrial dysfunction plays a central role here, and most often inbred mouse models are used to study these pathways. We hypothesized that the mouse genetic background can influence the impact of high fat diet (HFD)-induced obesity on oocyte quality. We compared the inbred C57BL/6 (B6) and the outbred Swiss strains after feeding a HFD for 13w. HFD-mice had increased body weight gain, hypercholesterolemia, and increased oocyte lipid droplet (LD) accumulation in both strains. LD distribution was strain-dependent. In Swiss mouse oocytes, HFD significantly increased mitochondrial inner membrane potential (MMP), reactive oxygen species concentrations, mitochondrial ultrastructural abnormalities (by 46.4%), and endoplasmic reticulum (ER) swelling, and decreased mtDNA copy numbers compared with Swiss controls (P < 0.05). Surprisingly, B6-control oocytes exhibited signs of cellular stress compared to the Swiss controls (P < 0.05); upregulated gene expression of ER- and oxidative stress markers, high mitochondrial ultrastructural abnormalities (48.6%) and ER swelling. Consequently, the HFD impact on B6 oocyte quality was less obvious, with 9% higher mitochondrial abnormalities, and no additive effect on MMP and stress marks compared to B6 control (P > 0.1). Interestingly, mtDNA in B6-HFD oocytes was increased suggesting defective mitophagy. In conclusion, we show evidence that the genetic background or inbreeding can affect mitochondrial functions in oocytes and may influence the impact of HFD on oocyte quality. These results should create awareness when choosing and interpreting data obtained from different mouse models before extrapolating to human applications.
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Affiliation(s)
- Waleed F A Marei
- Gamete Research Centre, University of Antwerp, 2610, Wilrijk, Belgium. .,Department of Theriogenology, Faculty of Veterinary Medicine, Cairo University, Giza, 12211, Egypt.
| | - Anouk Smits
- Gamete Research Centre, University of Antwerp, 2610, Wilrijk, Belgium
| | - Omnia Mohey-Elsaeed
- Department of Cytology and Histology, Faculty of Veterinary Medicine, Cairo University, Giza, 12211, Egypt.,Laboratory of Cell Biology & Histology, University of Antwerp, 2610, Wilrijk, Belgium
| | - Isabel Pintelon
- Laboratory of Cell Biology & Histology, University of Antwerp, 2610, Wilrijk, Belgium
| | - Daisy Ginneberge
- VIB Center for Inflammation Research, Ghent, Belgium.,Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
| | - Peter E J Bols
- Gamete Research Centre, University of Antwerp, 2610, Wilrijk, Belgium
| | - Katrien Moerloose
- VIB Center for Inflammation Research, Ghent, Belgium.,Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
| | - Jo L M R Leroy
- Gamete Research Centre, University of Antwerp, 2610, Wilrijk, Belgium
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178
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Lundeen EA, Park S, Woo Baidal JA, Sharma AJ, Blanck HM. Sugar-Sweetened Beverage Intake Among Pregnant and Non-pregnant Women of Reproductive Age. Matern Child Health J 2020; 24:709-717. [PMID: 32303941 PMCID: PMC10949990 DOI: 10.1007/s10995-020-02918-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Frequent sugar-sweetened beverage (SSB) intake is associated with weight gain in women, and pre-pregnancy overweight and excessive gestational weight gain are linked to adverse pregnancy outcomes. SSB intake information for women of reproductive age (WRA) is limited. We described SSB intake among non-pregnant and pregnant WRA and identified correlates of daily intake. METHODS Using 2017 Behavioral Risk Factor Surveillance System data, we analyzed SSB intake (regular soda, fruit drinks, sweet tea, sports/energy drinks) for 11,321 non-pregnant and 392 pregnant WRA (18-49 years) in 12 states and D.C. Adjusted odds ratios (aOR) for daily (≥ 1 time/day) SSB intake (reference: < 1 time/day) by characteristics were estimated using multivariable logistic regression. RESULTS Overall, 27.3% of non-pregnant and 21.9% of pregnant women reported consuming SSBs ≥ 1 time/day; 12.6% and 9.7%, respectively, consumed SSBs ≥ 2 times/day. Among non-pregnant women, odds of daily SSB intake were higher for women who were non-Hispanic black (aOR 2.04, 95% CI 1.55-2.69) vs. non-Hispanic white; had ≤ high school education (aOR 2.79, CI 2.26-3.44) or some college (aOR 1.85, CI 1.50-2.27) vs. college graduates; lived in nonmetropolitan counties (aOR 1.35, CI 1.11-1.63) vs. metropolitan; had no physical activity (aOR 1.72, CI 1.43-2.07) vs. some; were former (aOR 1.51, CI 1.17-1.94) or current (aOR 3.48, CI 2.82-4.28) smokers vs. nonsmokers. Among pregnant women, those not married had higher odds (aOR 2.81, CI 1.05-7.51) for daily SSB intake than married women. CONCLUSIONS One in five pregnant women and one in four non-pregnant women of reproductive age consumed SSBs at least once per day. Sociodemographic and behavioral correlates of daily SSB intake were identified.
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Affiliation(s)
- Elizabeth A Lundeen
- Division of Nutrition, Physical Activity and Obesity (DNPAO), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), 4770 Buford Highway NE, Mail Stop F77, Atlanta, GA, 30341, USA.
| | - Sohyun Park
- Division of Nutrition, Physical Activity and Obesity (DNPAO), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), 4770 Buford Highway NE, Mail Stop F77, Atlanta, GA, 30341, USA
| | - Jennifer A Woo Baidal
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Medical Center, 622 W. 168th Street, PH-17, New York, NY, 10032, USA
| | - Andrea J Sharma
- Division of Nutrition, Physical Activity and Obesity (DNPAO), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), 4770 Buford Highway NE, Mail Stop F77, Atlanta, GA, 30341, USA
- U.S. Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Heidi M Blanck
- Division of Nutrition, Physical Activity and Obesity (DNPAO), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), 4770 Buford Highway NE, Mail Stop F77, Atlanta, GA, 30341, USA
- U.S. Public Health Service Commissioned Corps, Rockville, MD, USA
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Pujól von Seehausen M, Pérez-Escamilla R, Couto de Oliveira MI, do Carmo Leal M, Siqueira Boccolini C. Social support modifies the association between pre-pregnancy body mass index and breastfeeding initiation in Brazil. PLoS One 2020; 15:e0233452. [PMID: 32438388 PMCID: PMC7242016 DOI: 10.1371/journal.pone.0233452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Many biological, social and cultural barriers for suboptimal breastfeeding practices have been identified in literature. Among these, excessive pre-pregnancy weight has been identified as a risk factor for not initiating breastfeeding early. Social support, coming from social networks (e.g. a partner, family or friends) or health care providers, has been positively associated with breastfeeding. This study aimed to examine the association between pre-pregnancy excessive weight and breastfeeding within the first hour after birth and if social support modifies this association. DESIGN National population-based study conducted with 21,086 postpartum women from February 1, 2011 to October 31, 2012 in 266 hospitals from all five regions of Brazil. Social support was defined as having a companion at the hospital. Main effects and interactions were tested with multivariable regression analyses. RESULTS Multivariate regression analyses indicated that class I and class II obese women had lower odds of breastfeeding within the first hour when a companion was not present (AOR = 0.59, 95% CI 0.42-0.82 and AOR = 0.59, 95% CI 0.36-0.97, respectively), but there was no association when the companion was present. Among overweight and obese women, the predicted probability of breastfeeding within the first hour was lower for those without a companion. This association was not found among those with normal pre-pregnancy BMI. CONCLUSIONS Social support modifies the relationship between pre-gestational BMI and breastfeeding initiation among women who are overweight or obese, specifically it reduces the risk of delayed breastfeeding initiation.
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Affiliation(s)
- Mariana Pujól von Seehausen
- Programa de Pós-Graduação em Epidemiologia em Saúde Pública, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Maria Inês Couto de Oliveira
- Departamento de Epidemiologia e Bioestatística, Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cristiano Siqueira Boccolini
- Laboratório de Informação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
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180
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Lempersz C, Noben L, van Osta G, Wassen MLH, Meershoek BPJ, Bakker P, Jacquemyn Y, Cuerva MJ, Vullings R, Westerhuis MEMH, Oei GS. Intrapartum non-invasive electrophysiological monitoring: A prospective observational study. Acta Obstet Gynecol Scand 2020; 99:1387-1395. [PMID: 32306380 DOI: 10.1111/aogs.13873] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Doppler ultrasound cardiotocography is a non-invasive alternative that, despite its poor specificity, is often first choice for intrapartum monitoring. Doppler ultrasound suffers from signal loss due to fetal movements and is negatively correlated with maternal body mass index (BMI). Reported accuracy of fetal heart rate monitoring by Doppler ultrasound varies between 10.6 and 14.3 bpm and reliability between 62.4% and 73%. The fetal scalp electrode (FSE) is considered the reference standard for fetal monitoring but can only be applied after membranes have ruptured with sufficient cervical dilatation and is sometimes contra-indicated. A non-invasive alternative that overcomes the shortcomings of Doppler ultrasound, providing reliable information on fetal heart rate, could be the answer. Non-invasive fetal electrocardiography (NI-fECG) uses a wireless electrode patch on the maternal abdomen to obtain both fetal and maternal heart rate signals as well as an electrohysterogram. We aimed to validate a wireless NI-fECG device for intrapartum monitoring in term singleton pregnancies, by comparison with the FSE. MATERIAL AND METHODS We performed a multicenter cross-sectional observational study at labor wards of 6 hospitals located in the Netherlands, Belgium, and Spain. Laboring women with a healthy singleton fetus in cephalic presentation and gestational age between 36 and 42 weeks were included. Participants received an abdominal electrode patch and FSE after written informed consent. Accuracy, reliability, and success rate of fetal heart rate readings were determined, using FSE as reference standard. Analysis was performed for the total population and measurement period as well as separated by labor stage and BMI class (≤30 and >30 kg/m2 ). RESULTS We included a total of 125 women. Simultaneous registrations with NI-fECG and FSE were available in 103 women. Overall accuracy is -1.46 bpm and overall reliability 86.84%. Overall success rate of the NI-fECG is around 90% for the total population as well as for both BMI subgroups. Success rate dropped to 63% during second stage of labor, similar results are found when looking at the separate BMI groups. CONCLUSIONS Performance measures of the NI-fECG device are good in the overall group and the separate BMI groups. Compared with Doppler ultrasound performance measures from the literature, NI-fECG is a more accurate alternative. Especially, when women have a higher BMI, NI-fECG performs well, resembling FSE performance measures.
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Affiliation(s)
- Carlijn Lempersz
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands.,Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
| | - Lore Noben
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands.,Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
| | - Gonnie van Osta
- Author! Et al. BV Data analysis and reporting, Hilversum, The Netherlands
| | - Martine L H Wassen
- Department of Obstetrics and Gynecology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Bert P J Meershoek
- Department of Obstetrics and Gynecology, Van Weel-Bethesda Hospital, Dirksland, The Netherlands
| | - Petra Bakker
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Yves Jacquemyn
- Department of Obstetrics and Gynecology, University Hospital Antwerp, Antwerp, Belgium
| | - Marcos Javier Cuerva
- Department of Obstetrics and Gynecology, University Hospital La Paz, Madrid, Spain
| | - Rik Vullings
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Michelle E M H Westerhuis
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands.,Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
| | - Guid S Oei
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands.,Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
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181
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Dong J, Shin N, Chen S, Lei J, Burd I, Wang X. Is there a definite relationship between placental mTOR signaling and fetal growth? Biol Reprod 2020; 103:471-486. [PMID: 32401303 DOI: 10.1093/biolre/ioaa070] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/22/2020] [Accepted: 05/11/2020] [Indexed: 02/07/2023] Open
Abstract
Fetal growth restriction and overgrowth are common obstetrical complications that result in adverse perinatal outcomes and long-term health risks later in life, including neurodevelopmental dysfunction and adult metabolic syndrome. The placenta plays a critical role in the nutrition transfer from mother to fetus and even exerts adaptive mechanism when the fetus is under poor developmental conditions. The mammalian/mechanistic target of rapamycin (mTOR) signaling serves as a critical hub of cell growth, survival, and metabolism in response to nutrients, growth factors, energy, and stress signals. Placental mTOR signaling regulates placental function, including oxygen and nutrient transport. Therefore, placental mTOR signaling is hypothesized to have a positive relationship with fetal growth. In this review, we summarize that most studies support the current evidence that there is connection between placental mTOR signaling and abnormal fetal growth; however, but more studies should be performed following a vigorous and unanimous method for assessment to determine placental mTOR activity.
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Affiliation(s)
- Jie Dong
- Reproductive Medical Center, Department of Gynecology and Obstetrics, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China
| | - Na Shin
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shuqiang Chen
- Reproductive Medical Center, Department of Gynecology and Obstetrics, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China
| | - Jun Lei
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Irina Burd
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xiaohong Wang
- Reproductive Medical Center, Department of Gynecology and Obstetrics, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China
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182
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Eckert LO, Jones CE, Kachikis A, Bardají A, Silva FTD, Absalon J, Rouse CE, Khalil A, Cutland CL, Kochhar S, Munoz FM. Obstetrics risk Assessment: Evaluation of selection criteria for vaccine research studies in pregnant women. Vaccine 2020; 38:4542-4547. [PMID: 32448618 PMCID: PMC7211583 DOI: 10.1016/j.vaccine.2020.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/18/2020] [Accepted: 05/06/2020] [Indexed: 10/31/2022]
Abstract
Vaccines designed for use in pregnancy and vaccine trials specifically involving pregnant women are rapidly expanding. One of the key challenges in designing maternal immunization trials is that developing exclusion criteria requires understanding and quantifying the background risk for adverse pregnancy outcomes in the pregnancy being studied, which can occur independent of any intervention and be unrelated to vaccine administration. The Global Alignment of Immunization Safety Assessment in Pregnancy (GAIA) project has developed and published case definitions and guidelines for data collection, analysis, and evaluation of maternal immunization safety in trials involving pregnant women. Complementing this work, we sought to understand how to best assess obstetric risk of adverse outcomes and differentiate it from the assessment of vaccine safety. Quantification of obstetric risk is based on prior and current obstetric, and maternal medical history. We developed a step-wise approach to evaluate and quantify obstetric and maternal risk factors in pregnancy based on review of published literature and guidelines, and critically assessed these factors in the context of designing inclusion and exclusion criteria for maternal vaccine studies. We anticipate this risk assessment evaluation may assist clinical trialists with study design decisions, including selection of exclusion criteria for vaccine trials involving pregnant women, consideration of sub-group classification, such as high or low risk subjects, or schedule considerations, such as preferred trimester of gestation for an intervention during pregnancy. Additionally, this tool may be utilized in data stratification at time of study analyses.
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Affiliation(s)
- Linda O Eckert
- Department of Obstetrics and Gynecology University of Washington, School of Medicine Seattle, WA; Department of Global Health, University of Washington School of Medicine, Seattle, WA.
| | - Christine E Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alisa Kachikis
- Department of Obstetrics and Gynecology University of Washington, School of Medicine Seattle, WA
| | - Azucena Bardají
- ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | - Caroline E Rouse
- Department of Obstetrics & Gynecology, Indiana University, Indianapolis, IN
| | - Asma Khalil
- Department of Obstetrics & Gynecology, St. George's Hospital, University of London, London, UK
| | - Clare L Cutland
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, African Leadership Iin Vaccinology Expertise, Faculty of Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sonali Kochhar
- Department of Global Health, University of Washington School of Medicine, Seattle, WA; Global Healthcare Consulting, India; Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Flor M Munoz
- Department of Pediatrics and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States.
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183
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Relationship between gestational weight gain and amount of postpartum bleeding. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.636511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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184
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Meinich T, Trovik J. Early maternal weight gain as a risk factor for SGA in pregnancies with hyperemesis gravidarum: a 15-year hospital cohort study. BMC Pregnancy Childbirth 2020; 20:255. [PMID: 32345259 PMCID: PMC7189646 DOI: 10.1186/s12884-020-02947-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/14/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Inadequate maternal weight gain increases the risk of small-for-gestational age (SGA) infants. Women with hyperemesis gravidarum (HG) are at risk of significant early pregnancy weight loss and insufficient total pregnancy weight gain. Recent studies have implied that weight gain during the first half of pregnancy is more crucial to pregnancy outcome than total weight gain. The aim of this study was to investigate whether not regaining prepregnancy weight by 13-18 weeks of gestation contributed to not reaching minimum body mass index (BMI)-specific total pregnancy weight gain and influenced the risk of SGA outcome in HG pregnancies. METHODS In this retrospective 15-year cohort (2002-2016) of women hospitalized due to hyperemesis gravidarum, we reviewed individual patient hospital files and corresponding outpatient maternity records to collect prepregnancy BMI and weight, pregnancy weight gain (spanning 3-week intervals), delivery weight and foetal outcomes. BMI and total pregnancy weight gain goals were categorized according to the Institute of Medicine (IOM) 2009 guidelines: BMI < 18,5 kg/m2: 12.5-18 kg, 18.5-24.9 kg/m2: 11.5-16 kg, 25-29.9 kg/m2: 7-11.5 kg and > 30 kg/m2: 5-9 kg. Birth weight was categorized as SGA if less than the 10th percentile of sex- and gestational length-specific Norwegian neonatal weight charts. Nonparametric tests were used to compare weight categories, and logistic regression was used to predict the odds ratio (OR) of inadequate total pregnancy weight gain or SGA delivery. RESULTS Out of 892 women hospitalized for HG during 2002-2016, 784 had a pregnancy lasting > 24 weeks, of which 746 were singleton pregnancies with follow-up until delivery. Among these women, 42 were classified as underweight, 514 as normal weight, 230 as overweight and 102 as obese before pregnancy. Not regaining prepregnancy weight by week 13-18 was an independent predictor of inadequate total gestational weight gain with an OR of 7.05 (95% CI 4.24-11.71) and an independent predictor for SGA outcome with an OR of 2.66 (95% CI 1.11-6.34), even when adjusted for total pregnancy weight gain, prepregnancy BMI, parity, age and smoking status. CONCLUSION Inadequate total maternal weight gain and not regaining prepregnancy weight by week 13-18 may be considered independent risk factors for delivering a baby that is small for gestational age in pregnancies with hyperemesis gravidarum. Achieving adequate weight gain during the first trimester in HG pregnancies is important for the foetal outcome, underscoring the importance of nutritional treatment during this period.
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Affiliation(s)
- Tale Meinich
- Department of Clinical Science, University of Bergen, Jonas Lies vei 72, 5053, Bergen, Norway
| | - Jone Trovik
- Department of Clinical Science, University of Bergen, Jonas Lies vei 72, 5053, Bergen, Norway.
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Jonas Lies vei 72, 5053, Bergen, Norway.
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185
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Kawakita T, Coviello E. The association between surgical site infections and gestational weight gain in obese women. Arch Gynecol Obstet 2020; 301:1411-1416. [PMID: 32335737 DOI: 10.1007/s00404-020-05548-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/11/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To examine an association between gestational weight gain (GWG), defined by the Institute of Medicine (IOM) guidelines, and surgical site infections in obese women. METHODS This was a retrospective study of all obese women with singleton pregnancies undergoing cesarean delivery at ≥ 23 weeks' gestation between January 2012 and June 2018. Women were categorized according to GWG: below, within, and above the IOM guidelines. Our primary outcome was a composite of surgical site infections. Coarsened Exact Matching with k-to-k solution was performed using predefined variables. RESULTS Of 2376 obese women, 429 (18.1%), 449 (18.9%), and 1498 (63.0%) had GWG below, within, and above the IOM guidelines, respectively. After matching, there was no difference in a rate of the primary outcome between women with GWG below the IOM guidelines and those with GWG within the IOM guidelines (6.7% [20/300] vs 4.3% [13/300]; P = .21). Similarly, there was no difference in the rate of the primary outcome between women with GWG above the IOM guidelines and those with GWG within the IOM guidelines (5.7% [24/421] vs 5.2% [22/421]; P = .76). CONCLUSION Among obese women, GWG was not associated with surgical site infections.
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Affiliation(s)
- Tetsuya Kawakita
- Obstetrics and Gynecology, MedStar Washington Hospital Center, 110 Irving Street, NW, 5B45, Washington DC, 20010, USA.
| | - Elizabeth Coviello
- Obstetrics and Gynecology, MedStar Washington Hospital Center, 110 Irving Street, NW, 5B45, Washington DC, 20010, USA
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186
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Leonard SA, Abrams B, Main EK, Lyell DJ, Carmichael SL. Weight gain during pregnancy and the risk of severe maternal morbidity by prepregnancy BMI. Am J Clin Nutr 2020; 111:845-853. [PMID: 32119734 PMCID: PMC7138679 DOI: 10.1093/ajcn/nqaa033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/04/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND High and low prepregnancy BMI are risk factors for severe maternal morbidity (SMM), but the contribution of gestational weight gain (GWG) is not well understood. OBJECTIVES We evaluated associations between GWG and SMM by prepregnancy BMI group. METHODS We analyzed administrative records from 2,483,684 Californian births (2007-2012), utilizing z score charts to standardize GWG for gestational duration. We fit the z scores nonlinearly and categorized GWG as above, within, or below the Institute of Medicine (IOM) recommendations after predicting equivalent GWG at term from the z score charts. SMM was defined using a validated index. Associations were estimated using multivariable logistic regression models. RESULTS We found generally shallow U-shaped relations between GWG z score and SMM in all BMI groups, except class 3 obesity (≥40 kg/m2), for which risk was lowest with weight loss. The weight gain amount associated with the lowest risk of SMM was within the IOM recommendations for underweight and class 2 obesity, but above the IOM recommendations for normal weight, overweight, and class 1 obesity. The adjusted risk ratios (RRs) and 95% CIs for GWG below the IOM recommendations, compared with GWG within the recommendations, were the following for underweight, normal weight, overweight, class 1 obesity, class 2 obesity, and class 3 obesity: 1.13 (0.99, 1.29), 1.09 (1.04, 1.14), 1.10 (1.01, 1.19), 1.07 (0.95, 1.21), 1.03 (0.88, 1.22), and 0.89 (0.73, 1.08), respectively. For GWG above the recommendations, the corresponding RRs and 95% CIs were 0.99 (0.84, 1.15), 1.04 (0.99, 1.08), 0.98 (0.92, 1.04), 1.03 (0.95, 1.13), 1.07 (0.94, 1.23), and 1.08 (0.91, 1.30), respectively. CONCLUSIONS High and low GWG may be modestly associated with increased risk of SMM across BMI groups, except in women with class 3 obesity, for whom low weight gain and weight loss may be associated with decreased risk of SMM.
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Affiliation(s)
- Stephanie A Leonard
- Division of Neonatal and Developmental Medicine, Stanford University, Stanford, CA, USA,Address correspondence to SAL (e-mail: ); Present address for SAL: Division of Maternal-Fetal Medicine and Obstetrics, Stanford University, Stanford, CA
| | - Barbara Abrams
- Division of Epidemiology, University of California, Berkeley, CA, USA
| | - Elliott K Main
- Division of Maternal-Fetal Medicine and Obstetrics, Stanford University, Stanford, CA, USA
| | - Deirdre J Lyell
- Division of Maternal-Fetal Medicine and Obstetrics, Stanford University, Stanford, CA, USA
| | - Suzan L Carmichael
- Division of Neonatal and Developmental Medicine, Stanford University, Stanford, CA, USA,Present address for SLC: Division of Neonatal and Developmental Medicine and the Division of Maternal-Fetal Medicine and Obstetrics, Stanford University, Stanford, CA
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187
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Nationally representative surveys show gradual shifting of overweight and obesity towards poor and less-educated women of reproductive age in Nepal. J Biosoc Sci 2020; 53:214-232. [PMID: 32216862 DOI: 10.1017/s0021932020000152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Overweight and obesity are considered major public health concerns all over the world. They have the potential to increase the risk of developing non-communicable diseases in reproductive age women, increasing their risk of pregnancy related complications and adverse birth outcome. This study was carried out to identify the trend of prevalence of overweight and obesity, along with their determinants, among reproductive age women (15-49 years) in Nepal. Data were taken from the nationally representative 2006, 2011 and 2016 Nepal Demographic and Health Surveys (NDHSs). Women were considered to be overweight or obese when their BMI was 23.0-27.5 kg/m2 or ≥27.5 kg/m2, respectively. Univariate, bivariate and multivariate analyses were performed, with significance taken at p<0.05. The prevalences of overweight and obesity both showed rising trends in women of reproductive age in Nepal from 2006 to 2016, particularly among those with no education, only primary education and poor women. The presence of overweight and obesity was found to be significantly associated with the sample women's age, educational status, wealth index, place of residence, ecological zone, developmental region, number of household members, marital status and ethnicity. In 2016 one in every three women of reproductive age in Nepal was either overweight or obese. As overweight and obesity have detrimental effects on women's health, the Government of Nepal, in collaboration with other government and non-government organizations, should take action to halt the rising trends in overweight and obesity in the country.
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188
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Lee J, Eley VA, Wyssusek KH, Kimble RM, Way M, Cohen J, Zundert AA. The influence of obesity on coagulation in healthy term pregnancy as assessed by rotational thromboelastometry. Aust N Z J Obstet Gynaecol 2020; 60:714-719. [DOI: 10.1111/ajo.13141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/28/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Julie Lee
- Department of Anaesthesia and Perioperative Medicine The Royal Brisbane and Women’s Hospital Brisbane Australia
- The University of Queensland Brisbane Australia
| | - Victoria A. Eley
- Department of Anaesthesia and Perioperative Medicine The Royal Brisbane and Women’s Hospital Brisbane Australia
- The University of Queensland Brisbane Australia
| | - Kerstin H. Wyssusek
- Department of Anaesthesia and Perioperative Medicine The Royal Brisbane and Women’s Hospital Brisbane Australia
- The University of Queensland Brisbane Australia
| | - Rebecca M.N. Kimble
- The University of Queensland Brisbane Australia
- Department of Obstetrics and Gynaecology The Royal Brisbane and Women’s Hospital Brisbane Australia
| | - Mandy Way
- QIMR Berghofer Medical Research Institute Brisbane Australia
| | - Jeremy Cohen
- The University of Queensland Brisbane Australia
- Department of Intensive Care Medicine The Royal Brisbane and Women’s Hospital Brisbane Australia
| | - André A. Zundert
- Department of Anaesthesia and Perioperative Medicine The Royal Brisbane and Women’s Hospital Brisbane Australia
- The University of Queensland Brisbane Australia
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189
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Relationship between Maternal Body Mass Index and Obstetric and Perinatal Complications. J Clin Med 2020; 9:jcm9030707. [PMID: 32151008 PMCID: PMC7141254 DOI: 10.3390/jcm9030707] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 01/26/2023] Open
Abstract
Over the past few decades, overweight and obesity have become a growing health problem of particular concern for women of reproductive age as obesity in pregnancy has been associated with increased risk of obstetric and neonatal complications. The objective of this study is to describe the incidence of obstetric and perinatal complications in relation to maternal body mass index (BMI) at the time prior to delivery within the Spanish Health System. For this purpose, a cross-sectional observational study was conducted aimed at women who have been mothers between 2013 and 2018 in Spain. Data were collected through an online survey of 42 items that was distributed through lactation associations and postpartum support groups. A total of 5871 women answered the survey, with a mean age of 33.9 years (SD = 4.26 years). In the data analysis, crude odds ratios (OR) and adjusted odds ratios (AOR) were calculated through a multivariate analysis. A linear relationship was observed between the highest BMI figures and the highest risk of cephalopelvic disproportion (AOR of 1.79 for obesity type III (95% CI: 1.06–3.02)), preeclampsia (AOR of 6.86 for obesity type III (3.01–15.40)), labor induction (AOR of 1.78 for obesity type III (95% CI: 1.16–2.74)), emergency C-section (AOR of 2.92 for obesity type III (95% CI: 1.68–5.08)), morbidity composite in childbirth (AOR of 3.64 for obesity type III (95% CI: 2.13–6.24)), and macrosomia (AOR of 6.06 for obesity type III (95% CI: 3.17–11.60)), as compared with women with normoweight. Women with a higher BMI are more likely to develop complications during childbirth and macrosomia.
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190
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Timmermans YEG, van de Kant KDG, Oosterman EO, Spaanderman MEA, Villamor-Martinez E, Kleijnen J, Vreugdenhil ACE. The impact of interpregnancy weight change on perinatal outcomes in women and their children: A systematic review and meta-analysis. Obes Rev 2020; 21:e12974. [PMID: 31751496 PMCID: PMC7050512 DOI: 10.1111/obr.12974] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 10/03/2019] [Accepted: 10/12/2019] [Indexed: 12/12/2022]
Abstract
Prepregnancy overweight and obesity are associated with higher risk of perinatal complications. However, the effect of weight change prior to pregnancy on perinatal outcome is largely unknown. Therefore, it is aimed to examine the impact on perinatal outcomes of interpregnancy BMI change in women of different BMI categories. The MEDLINE, EMBASE, LILACS, and CINAHL databases were searched (1990-August 2019). Observational studies on interpregnancy BMI change were selected. Outcomes evaluated were gestational diabetes mellitus (GDM), preeclampsia, gestational hypertension (GH), cesarean section, preterm birth, and newborns being large (LGA) or small (SGA) for gestational age. Meta-analyses and meta-regression analyses were executed. Thirty studies were included (n > 1 million). Interpregnancy BMI gain was associated with a higher risk of GDM (for BMI gain ≥3 kg/m2 : OR 2.21; [95%CI 1.53-3.19]), preeclampsia (1.77 [1.53-2.04]), GH (1.78 [1.61-1.97]), cesarean section (1.32 [1.24-1.39]), and LGA (1.54 [1.28-1.86]). The effects of BMI gain were most pronounced in women with BMI <25 kg/m2 before the first pregnancy regarding GDM, GH, and cesarean section. Except for LGA, interpregnancy BMI loss did not result in a decreased risk of perinatal complications. In this study, women of normal weight who gain weight before pregnancy were identified as a high-risk population for perinatal complications. This emphasizes that weight management is important for women of all BMI categories and a pregnancy wish.
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Affiliation(s)
- Yvon E G Timmermans
- Department of Pediatrics, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
| | - Kim D G van de Kant
- Department of Pediatrics, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School for Public Health and Primary Health Care (CAPHRI), Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Elise O Oosterman
- Department of Pediatrics, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Marc E A Spaanderman
- School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands.,Department of Gynecology and Obstetrics, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Eduardo Villamor-Martinez
- Department of Pediatrics, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
| | - Jos Kleijnen
- School for Public Health and Primary Health Care (CAPHRI), Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Anita C E Vreugdenhil
- Department of Pediatrics, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
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191
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Njagu R, Adkins L, Tucker A, Gatta L, Brown HL, Reiff E, Dotters-Katz S. Maternal weight gain and neonatal outcomes in women with class III obesity. J Matern Fetal Neonatal Med 2020; 35:546-550. [PMID: 32089032 DOI: 10.1080/14767058.2020.1729116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: Obesity in the USA continues to be a prominent medical and public health concern. Due to increasing rates of maternal obesity, the current Institute of Medicine (IOM) guidelines recommend 11-20 pounds of total weight gain during pregnancy in women with a BMI ≥30 kg/m2. The impact of maternal obesity on adverse perinatal outcomes has been well documented however, there is minimal data on the effect of gestational weight gain on neonatal outcomes. In this study, we assessed the association between gestational weight gain (GWG) and neonatal outcomes at term in women with class III obesity.Study design: A retrospective cohort of women delivering at a tertiary care institution between July 2013 and December 2017 with a first-trimester baseline BMI ≥40 kg/m2 was studied. Pregnancies complicated by multiple gestations, preterm delivery, fetal anomalies, intrauterine fetal demise or with missing data were excluded. The primary outcome was a composite of adverse neonatal outcomes including 5 min Apgar <7, neonatal intubation, grade 3 or 4 intraventricular hemorrhage (IVH), confirmed neonatal sepsis or Neonatal Intensive Care Unit (NICU) admission. Secondary outcomes included individual components of composite and NICU admission for >7 days. Demographic, pregnancy complications & delivery characteristics of women who gained more than IOM guidelines (>20 lbs.) were compared to women who gained at or less than IOM guidelines (≤20 lbs.) using bivariate statistics. Stepwise backward regression was used to estimate the odds of outcomes as appropriate.Results: Of 374 women included, 144 (39.5%) gained more than guidelines. Women who gained above IOM recommendations were less likely to be multiparous and use tobacco. Additional demographic, obstetric and delivery characteristics, including BMI at the entry to care, did not differ. The neonatal composite occurred in 30 (8.0%) of all neonates; corresponding to 11.1% of women who gained more than IOM recommendations and 6.1% of those who gained at or below recommendations (p = .12, OR = 1.71, 95%CI 0.74-3.96). Additionally, neonates born to women gaining more than IOM recommendations were more likely to be admitted to the NICU (10.4 vs. 4.3%, p = .03) and have a NICU length of stay >7 days (6.9 vs. 2.2%, p = .03). When adjusted for mode of delivery, delivery BMI, tobacco use, and chorioamnionitis, women who gained more were not more likely to have an adverse neonatal outcome (1.54, 95%CI 0.62-3.80), they were 3.6 times more likely to have a neonate admitted to the NICU for more than 7 days (95%CI 1.00-13.42).Conclusions: In women with class III obesity, excess gestational weight gain was associated with increased odds of NICU stay >7 days, with trends toward increased NICU admission risk, further emphasizing the importance of appropriate weight gain counseling in this population at risk.
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Affiliation(s)
- Ravyn Njagu
- School of Medicine, Duke University, Durham, NC, USA
| | - LaMani Adkins
- School of Medicine, Duke University, Durham, NC, USA
| | - Ann Tucker
- University of Mississippi, Jackson, MS, USA
| | - Luke Gatta
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | | | - Emily Reiff
- Brigham and Women's Hospital, Boston, MA, USA
| | - Sarah Dotters-Katz
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
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192
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Zaffarini E, Mitteroecker P. Secular changes in body height predict global rates of caesarean section. Proc Biol Sci 2020; 286:20182425. [PMID: 30963921 DOI: 10.1098/rspb.2018.2425] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The massive global variation in caesarean-section (C-section) rate is usually attributed to socio-economic, medical and cultural heterogeneity. Here, we show that a third of the global variance in current national C-section rate can be explained by the trends of adult body height from the 1970s to the 1990s. In many countries, living conditions have continually improved during the last century, which has led to an increase in both fetal and adult average body size. As the fetus is one generation ahead of the mother, the fetus is likely to experience better environmental conditions during development than the mother did, causing a disproportionately large fetus and an increased risk of obstructed labour. A structural equation model revealed that socio-economic development and access to healthcare affect C-section rate via multiple causal pathways, but the strongest direct effect on C-section rate was body height change. These results indicate that the historical trajectory of socio-economic development affects-via its influence on pre- and postnatal growth-the intergenerational relationship between maternal and fetal dimensions and thus the difficulty of labour. This sheds new light on historic and prehistoric transitions of childbirth and questions the World Health Organization (WHO) suggestion for a global 'ideal' C-section rate.
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Affiliation(s)
- Eva Zaffarini
- 1 Department of Theoretical Biology, University of Vienna , Althanstrasse 14, 1090 Vienna , Austria.,2 Department of Biotechnology and Bioscience, University of Milano-Bicocca , Piazza della Scienza 2, 20126 Milano , Italy
| | - Philipp Mitteroecker
- 1 Department of Theoretical Biology, University of Vienna , Althanstrasse 14, 1090 Vienna , Austria
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193
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Mierzejewska E, Honorato-Rzeszewicz T, Świątkowska D, Jurczak-Czaplicka M, Maciejewski T, Fijałkowska A, Szulc-Kamińska J, Czach A, Nałecz H, Szostak-Węgierek D, Szamotulska K. Evaluation of questionnaire as an instrument to measure the level of nutritional and weight gain knowledge in pregnant women in Poland. A pilot study. PLoS One 2020; 15:e0227682. [PMID: 31940402 PMCID: PMC6961901 DOI: 10.1371/journal.pone.0227682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 12/26/2019] [Indexed: 11/18/2022] Open
Abstract
Pregnancy is a period in life in which women are willing to improve their lifestyle. Providing proper information for these women is crucial for their health and the health of their offspring. Clear information about weak points in their nutritional and weight gain knowledge is the first step for proper health care assistance. There are a few previous studies evaluating the nutritional and weight gain knowledge of pregnant women. In the few studies available, different approaches were taken and there was no wider discussion on the content of the questionnaires attempting to measure level of knowledge. The aim of this study, designed in a pilot fashion, was to test the adequacy of the questionnaire as a research instrument in a group of 139 pregnant Polish women. The developed instrument is a 33-item questionnaire comprising four domains: weight gain, importance of nutrients, quality and quantity of food intake. The results of this study indicate that the questionnaire is stable and internal consistency is acceptable (Cronbach’s alpha > 0.7) for dimensions with more than four items. For dimensions with less than four items, internal consistency was poor (Cronbach’s alpha < 0.7). The cumulative explained variance for domains weight gain, importance of nutrients, quantity and quality of food intake was 54.74%, 42.74%, 54.42% and 48.99% respectively. Results from validity, reliability and factor analysis indicate that the questionnaire is adequate for its purpose.
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Affiliation(s)
- Ewa Mierzejewska
- Department of Epidemiology and Biostatistics, Institute of Mother and Child, Warsaw, Poland
| | | | - Dorota Świątkowska
- Obstetrics and Gynecology Clinic, Institute of Mother and Child, Warsaw, Poland
| | | | - Tomasz Maciejewski
- Obstetrics and Gynecology Clinic, Institute of Mother and Child, Warsaw, Poland
| | - Anna Fijałkowska
- Department of Cardiology, Institute of Mother and Child, Warsaw, Poland
| | | | - Anna Czach
- Obstetrics and Gynecology Clinic, Institute of Mother and Child, Warsaw, Poland
| | - Hanna Nałecz
- Department of Child and Adolescent Health, Institute of Mother and Child, Warsaw, Poland
| | | | - Katarzyna Szamotulska
- Department of Epidemiology and Biostatistics, Institute of Mother and Child, Warsaw, Poland
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194
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Prevalence of Early Maternal Complications of Cesarean Section and its Relationship with Body Mass Index in Fatemieh Hospital of Hamadan. PAJOUHAN SCIENTIFIC JOURNAL 2020. [DOI: 10.52547/psj.18.2.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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195
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Skalny AV, Tinkov AA, Bohan TG, Shabalovskaya MB, Terekhina O, Leshchinskaia SB, Agarkova LA, Notova SV, Skalnaya MG, Kovas Y. The Impact of Maternal Overweight on Hair Essential Trace Element and Mineral Content in Pregnant Women and Their Children. Biol Trace Elem Res 2020; 193:64-72. [PMID: 30887283 DOI: 10.1007/s12011-019-01693-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/11/2019] [Indexed: 12/23/2022]
Abstract
The aim of the present study was to investigate hair essential trace elements and mineral levels in 105 pregnant normal-weight (control) and 55 overweight and obese women in the third trimester of pregnancy, as well as in their children at the age of 9 months. The hair essential trace elements and mineral levels were assessed using inductively coupled plasma mass-spectrometry. Overweight pregnant women had significantly reduced Cr (- 24%; p = 0.047) and Zn (- 13%; p = 0.008) content, as well as elevated hair Na and K levels as compared to the controls. Children from overweight and obese mothers had lower hair Mo (- 18%; p = 0.017), Se (- 8%; p = 0.043), and V (- 24%; p = 0.028) levels, as well as elevated Sr content (19%; p = 0.025). Correlation analysis revealed a significant relationship between maternal and child hair levels of Co (r = 0.170; p = 0.038), Cu (r = 0.513; p < 0.001), Mn (r = 0.240; p = 0.003), and Na (r = 0.181; p = 0.027) in the whole sample. Pre-pregnancy maternal body mass index (BMI) positively correlated with maternal hair K (r = 0.336; p < 0.001) and Na (r = 0.212; p = 0.008) and negatively correlated with V (r = - 0.204; p = 0.011) and Zn (r = - 0.162; p = 0.045) levels. The results indicate that impaired trace element and mineral metabolism may play a role in the link between maternal obesity, complications of pregnancy and child's postnatal development. Hypothetically, dietary improvement may be used as a tool to reduce these risks. However, further experimental and clinical studies are required to investigate the relationship between obesity and trace element metabolism in pregnancy.
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Affiliation(s)
- Anatoly V Skalny
- Yaroslavl State University, Yaroslavl, Russia
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
- IM Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alexey A Tinkov
- Yaroslavl State University, Yaroslavl, Russia.
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russia.
- IM Sechenov First Moscow State Medical University, Moscow, Russia.
| | - Tatiana G Bohan
- Laboratory for Cognitive Investigations and Behavioural Genetics, Tomsk State University, Tomsk, Russia
| | - Marina B Shabalovskaya
- Laboratory for Cognitive Investigations and Behavioural Genetics, Tomsk State University, Tomsk, Russia
| | - Olga Terekhina
- Laboratory for Cognitive Investigations and Behavioural Genetics, Tomsk State University, Tomsk, Russia
| | - Svetlana B Leshchinskaia
- Laboratory for Cognitive Investigations and Behavioural Genetics, Tomsk State University, Tomsk, Russia
| | - Lyubov A Agarkova
- Research Institute of Obstetrics, Gynecology and Perinatology, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Russia
| | - Svetlana V Notova
- Federal Scientific Center of Biological Systems and Agrotechnologies of the Russian Academy of Sciences, Orenburg, Russia
- Orenburg State University, Orenburg, Russia
| | - Margarita G Skalnaya
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
- IM Sechenov First Moscow State Medical University, Moscow, Russia
| | - Yulia Kovas
- Laboratory for Cognitive Investigations and Behavioural Genetics, Tomsk State University, Tomsk, Russia
- Goldsmiths, University of London, London, UK
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196
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Chang Y, Glaria AA, Davie P, Beake S, Bick D. Breastfeeding experiences and support for women who are overweight or obese: A mixed-methods systematic review. MATERNAL & CHILD NUTRITION 2020; 16:e12865. [PMID: 31240826 PMCID: PMC7038894 DOI: 10.1111/mcn.12865] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 12/21/2022]
Abstract
Women who are overweight or obese have increased health risks during and beyond pregnancy, with consequences for their infants' shorter and longer term health. Exclusive breastfeeding to 6 months has many benefits for women and their infants. However, women who are overweight or obese have lower rates of breastfeeding intention, initiation, and duration compared with women with normal weight. This systematic review aimed to examine evidence of (a) breastfeeding barriers and support experienced and perceived by women who are overweight or obese, (b) support shown to be effective in increasing breastfeeding initiation and duration among these women, and (c) perceptions of health care professionals, peer supporters, partners, and family members regarding providing breastfeeding support to these women. Sixteen quantitative and qualitative papers were included and critically appraised. Thematic synthesis was undertaken to obtain findings. Maternal physical barriers such as larger breasts, difficulties of positioning to breastfeed, delayed onset of lactation, perceived insufficient supply of breast milk, and impact of caesarean birth were evident. Maternal psychological barriers including low confidence in ability to breastfeed, negative body image, embarrassment at breastfeeding in public, and experiencing stigma of obesity were also described. Support from health care professionals and family members influenced breastfeeding outcomes. Education for maternity care professionals is needed to enable them to provide tailored, evidence-based support to women who are overweight or obese who want to breastfeed. Research on health care professionals, partners, and family members' experiences and views on supporting this group of women to breastfeed is needed to support development of appropriate interventions.
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Affiliation(s)
- Yan‐Shing Chang
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
| | | | - Philippa Davie
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Sarah Beake
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
| | - Debra Bick
- Warwick Clinical Trials UnitUniversity of WarwickCoventryUK
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197
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Bick D, Taylor C, Bhavnani V, Healey A, Seed P, Roberts S, Zasada M, Avery A, Craig V, Khazaezadah N, McMullen S, O'Connor S, Oki B, Ntim EO, Poston L, Ussher M. Lifestyle information and commercial weight management groups to support maternal postnatal weight management and positive lifestyle behaviour: the SWAN feasibility randomised controlled trial. BJOG 2019; 127:636-645. [DOI: 10.1111/1471-0528.16043] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2019] [Indexed: 11/29/2022]
Affiliation(s)
- D Bick
- Warwick Clinical Trials Unit Warwick Medical School University of Warwick Coventry UK
| | - C Taylor
- School of Health Sciences University of Surrey Guildford UK
| | | | - A Healey
- Kings Health Economics, Health Services and Population Research Department Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - P Seed
- Department of Women and Children's Health King's College London London UK
| | - S Roberts
- Kings Health Economics, Health Services and Population Research Department Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - M Zasada
- School of Health Sciences University of Surrey Guildford UK
| | - A Avery
- Faculty of Science University of Nottingham Nottingham UK
| | - V Craig
- Guy's and St Thomas' NHS Foundation Trust London UK
| | - N Khazaezadah
- Public Health London Borough of Lambeth Lambeth London UK
| | | | - S O'Connor
- Guy's and St Thomas' NHS Foundation Trust London UK
| | - B Oki
- Public Health London Borough of Lambeth Lambeth London UK
| | - EO Ntim
- Guy's and St Thomas' NHS Foundation Trust London UK
| | - L Poston
- Department of Women and Children's Health King's College London London UK
| | - M Ussher
- Population Health Research Institute St George's University of London London UK
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198
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Kerbage Y, Senat MV, Drumez E, Subtil D, Vayssiere C, Deruelle P. Risk factors for failed induction of labor among pregnant women with Class III obesity. Acta Obstet Gynecol Scand 2019; 99:637-643. [PMID: 31863451 DOI: 10.1111/aogs.13794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/28/2019] [Accepted: 11/28/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Our aim was to identify risk factors for failed induction in morbidly obese patients undergoing the induction of labor at term. MATERIAL AND METHODS This was a retrospective multicenter study on a cohort of 235 patients with a body mass index greater than 40 kg/m2 and giving birth to a singleton in cephalic presentation, who had an induction of labor from 38 weeks of amenorrhea. Scheduled cesareans and spontaneous vaginal deliveries were excluded. Maternal, peri-partum and neonatal characteristics were analyzed according to the delivery route. RESULTS In all, 235 patients were included. Of these, 62.5% patients delivered vaginally and 37.5% by cesarean section. The frequency of nulliparity was greater in patients who had a cesarean section (56 [interquartile range, IQR, 38.1] vs 56 [IQR 63.6], P < .001). In multivariate analysis, nulliparity (odds ratio [OR] 2.81, 95% confidence interval [CI] 1.58-4.97], P < .001), low Bishop's score (OR .794, 95% CI .70-.90, P < .001) and weight gain (OR 1.04, 95% CI 1.01-1.08, P = .033) were independent risk factors for failed induction. Umbilical cord pH at birth lower than 7 (0 vs 7 [IQR 8.0], P < .001) and lower than 7.20 (36 [IQR 24.5] vs 35 [IQR 39.8], P = .014) as well as the Apgar at 1 minute (14 [IQR 9.5] vs 17 [IQR 19.3], P = .032) was significantly higher in infants born by cesarean section. CONCLUSIONS In this cohort, 63% of women with Class III obesity had successful inductions of labor; risk factors for failed induction include nulliparity and unfavorable Bishop score.
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Affiliation(s)
- Yohan Kerbage
- Department of Obstetrics, Jeanne de Flandre University Hospital (CHRU), Lille, France
| | - Marie V Senat
- Gynecology-Obstetrics Service, Le Kremlin-Bicêtre Hospital, Public Hospital Assistance of Paris (APHP), Université Paris Sud, Orsay, France
| | - Elodie Drumez
- Department of Biostatistics, University of Lille, EA 2694 - Public Health: Epidemiology and Quality of Care, University Hospital of Lille (CHU), Lille, France
| | - Damien Subtil
- Department of Obstetrics, Jeanne de Flandre University Hospital (CHRU), Lille, France
| | - Christophe Vayssiere
- Women's-Maternity-Couple Center, Gynecology-Obstetrics Department, Paule de Viguier Hospital, University Hospital of Toulouse, Toulouse, France.,UMR 1027 INSERM, Université Paul-Sabatier Toulouse III, Toulouse, France
| | - Philippe Deruelle
- Department of Obstetrics, Jeanne de Flandre University Hospital (CHRU), Lille, France
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199
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Hennig CL, Childs J, Aziz A, Quinton A. The effect of increased maternal body habitus on image quality and ability to identify fetal anomalies at a routine 18‐20‐week morphology ultrasound scan: a narrative review. SONOGRAPHY 2019. [DOI: 10.1002/sono.12202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Christina L. Hennig
- Medical ImagingRoyal Brisbane and Women's Hospital Herston Queensland Australia
| | - Jessie Childs
- School of Health SciencesUniversity of South Australia Adelaide Australia
| | - Aamer Aziz
- School of Health, Medical and Applied SciencesCentral Queensland University Mackay Australia
| | - Ann Quinton
- Medical SonographyCentral Queensland University Australia
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200
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Prendergast C, Wray S. Human myometrial artery function and endothelial cell calcium signalling are reduced by obesity: Can this contribute to poor labour outcomes? Acta Physiol (Oxf) 2019; 227:e13341. [PMID: 31299139 DOI: 10.1111/apha.13341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 06/17/2019] [Accepted: 07/07/2019] [Indexed: 12/15/2022]
Abstract
AIMS Determining how obesity affects function in human myometrial arteries, to help understand why childbirth has poor outcomes in obese women. METHODS Myometrial arteries were studied from 84 biopsies. Contraction (vasopressin and U-46619) and relaxation (carbachol, bradykinin, SNAP) was assessed using wire myography. eNOS activity was assessed using L-NAME. Cholesterol was reduced using methyl-β-cyclodextrin to determine whether it altered responses. Differences in endothelial cell intracellular Ca2+ signalling were assessed using confocal microscopy. RESULTS The effects of BMI on relaxation were agonist specific and very marked; all vessels, irrespective of BMI, relaxed to bradykinin but 0% of vessels (0/13) from obese women relaxed to carbachol, compared to 59% (10/17) from normal weight women. Cholesterol-lowering drugs did not restore carbachol responses (n = 6). All vessels, irrespective of BMI, relaxed when NO was directly released by SNAP (n = 19). Inhibition of eNOS with L-NAME had a significant effect in normal but not overweight/obese vessels. Compared to bradykinin, a lower proportion of endothelial cells responded to carbachol and the amplitude of the calcium response was significantly less, in all vessels. Furthermore, a significantly lower proportion of endothelial cells responded to carbachol in the overweight/obese group compared to control. In contrast to relaxation, the effect of contractile agonists was unchanged with increasing BMI. CONCLUSIONS The ability of human myometrial arteries to relax is significantly impaired with obesity, and our data suggest this is due to a deficit in endothelial calcium signalling. This inability to recover following compression during contractions, might contribute to poor labours in obese women.
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Affiliation(s)
- Clodagh Prendergast
- Department of Molecular and Cellular Physiology, Institute of Translational Medicine University of Liverpool Liverpool UK
| | - Susan Wray
- Department of Molecular and Cellular Physiology, Institute of Translational Medicine University of Liverpool Liverpool UK
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