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Pavlidou E, Papandreou D, Taha Z, Mantzorou M, Tyrovolas S, Kiortsis DN, Psara E, Papadopoulou SK, Yfantis M, Spanoudaki M, Antasouras G, Mentzelou M, Giaginis C. Association of Maternal Pre-Pregnancy Overweight and Obesity with Childhood Anthropometric Factors and Perinatal and Postnatal Outcomes: A Cross-Sectional Study. Nutrients 2023; 15:3384. [PMID: 37571321 PMCID: PMC10421009 DOI: 10.3390/nu15153384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Pre-pregnancy overweight and obesity in reproductive-aged women becomes a growing tendency in middle- and high-income populations. This study aimed to evaluate whether maternal excess body mass index (BMI) before gestation is associated with children's anthropometric characteristics, as well as perinatal and postnatal outcomes. METHODS This was a cross-sectional study performed on 5198 children aged 2-5 years old and their paired mothers, assigned from 9 different areas of Greece. Maternal and childhood anthropometric data, as well as perinatal and postnatal outcomes, were collected from medical history records or validated questionnaires. RESULTS Prevalences of 24.4% and 30.6% of overweight/obesity were recorded for the enrolled children and their mothers 2-5 years postpartum. Maternal pre-pregnancy overweight/obesity was more frequently observed in older mothers and female children, and was also associated with high childbirth weight, preterm birth, high newborn ponderal index, caesarean section delivery, diabetes type 1, and childhood overweight/obesity at pre-school age. In multivariate analysis, maternal pre-pregnancy overweight/obesity was independently associated with a higher risk of childhood overweight/obesity at pre-school age, as well as with a higher increased incidence of childbirth weight, caesarean section delivery, and diabetes type 1. CONCLUSIONS Maternal overweight/obesity rates before gestation were related with increased childhood weight status at birth and 2-5 years postpartum, highlighting the necessity of encouraging healthy lifestyle promotion, including healthier nutritional habits, and focusing on obesity population policies and nutritional interventions among women of reproductive age.
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Affiliation(s)
- Eleni Pavlidou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece; (E.P.); (E.P.); (M.Y.); (G.A.); (M.M.)
| | - Dimitrios Papandreou
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi P.O. Box 144534, United Arab Emirates; (D.P.); (Z.T.); (M.M.)
| | - Zainab Taha
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi P.O. Box 144534, United Arab Emirates; (D.P.); (Z.T.); (M.M.)
| | - Maria Mantzorou
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi P.O. Box 144534, United Arab Emirates; (D.P.); (Z.T.); (M.M.)
| | - Stefanos Tyrovolas
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, 28029 Madrid, Spain;
| | - Dimitrios N. Kiortsis
- Department of Nuclear Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece;
| | - Evmorfia Psara
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece; (E.P.); (E.P.); (M.Y.); (G.A.); (M.M.)
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (S.K.P.); (M.S.)
| | - Marios Yfantis
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece; (E.P.); (E.P.); (M.Y.); (G.A.); (M.M.)
| | - Maria Spanoudaki
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (S.K.P.); (M.S.)
| | - Georgios Antasouras
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece; (E.P.); (E.P.); (M.Y.); (G.A.); (M.M.)
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece; (E.P.); (E.P.); (M.Y.); (G.A.); (M.M.)
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece; (E.P.); (E.P.); (M.Y.); (G.A.); (M.M.)
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Yearwood L, Bone JN, Wen Q, Muraca GM, Lyons J, Razaz N, Joseph K, Lisonkova S. The association between maternal stature and adverse birth outcomes and the modifying effect of race and ethnicity: a population-based retrospective cohort study. AJOG GLOBAL REPORTS 2023; 3:100184. [PMID: 36941862 PMCID: PMC10024135 DOI: 10.1016/j.xagr.2023.100184] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND There are known differences in the risk of perinatal and maternal birth outcomes because of maternal factors, such as body mass index and maternal race. However, the association of maternal height with adverse birth outcomes and the potential differences in this relationship by race and ethnicity have been understudied. OBJECTIVE This study aimed to examine the association between maternal stature and adverse perinatal outcomes and the potential modification of the association by race and ethnicity. STUDY DESIGN This retrospective cohort study was conducted using data on all singleton births in the United States in 2016 and 2017 (N=7,361,713) obtained from the National Center for Health Statistics. Short and tall stature were defined as <10th and >90th percentiles of the maternal height distribution (<154.9 and >172.7 cm, respectively). Race and ethnicity categories included non-Hispanic White, non-Hispanic Black, American Indian or Alaskan Native Asian or Pacific Islander, and Hispanic. The primary outcomes were preterm birth (<37 weeks of gestation), perinatal death, and composite perinatal death or severe neonatal morbidity. Logistic regression was used to obtain adjusted odds ratios and 95% confidence intervals with adjustment for confounding by maternal age, body mass index, and other factors. Multiplicative and additive effect modifications by race and ethnicity were assessed. RESULTS The study population included 7,361,713 women with a singleton stillbirth or live birth. Short women had an increased risk of adverse outcomes, whereas tall women had a decreased risk relative to average-stature women. Short women had an increased risk of perinatal death and composite perinatal death or severe neonatal morbidity (adjusted odds ratios, 1.14 [95% confidence interval, 1.10-1.17] and 1.21 [95% confidence interval, 1.19-1.23], respectively). The association between short stature and perinatal death was attenuated in non-Hispanic Black women compared with non-Hispanic White women (adjusted odds ratio, 1.10 [95% confidence interval, 1.03-1.17] vs 1.26 [95% confidence interval, 1.19-1.33]). Compared with average-stature women, tall non-Hispanic White women had lower rates of preterm birth, perinatal death, and composite perinatal death or severe neonatal morbidity (adjusted odds ratios, 0.82 [95% confidence interval, 0.81-0.83], 0.95 [95% confidence interval, 0.91-1.00], and 0.90 [95% confidence interval, 0.88-0.93], respectively). The association between tall and average stature with perinatal death was reversed in Hispanic women (adjusted odds ratio, 1.27; 95% confidence interval, 1.12-1.44). Compared with average-stature women, all tall women had lower rates of preterm birth, particularly among non-Hispanic Black and Hispanic women. CONCLUSION Relative to average-stature women, short women have an increased risk of adverse perinatal outcomes across all race and ethnicity groups; these associations were attenuated in Hispanic women and for some adverse outcomes in non-Hispanic Black and Asian women. Tall mothers have a lower risk of preterm birth in all racial and ethnic groups, whereas tall non-Hispanic White mothers have a lower risk of perinatal death or severe neonatal morbidity compared with average-stature women.
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Affiliation(s)
- Lauren Yearwood
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (XX Yearwood, XX Bone, Ms Wen, XX Lyons, XX Joseph, and Dr Lisonkova)
| | - Jeffrey N. Bone
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (XX Yearwood, XX Bone, Ms Wen, XX Lyons, XX Joseph, and Dr Lisonkova)
- Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada (XX Bone, XX Joseph, and Dr Lisonkova)
| | - Qi Wen
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (XX Yearwood, XX Bone, Ms Wen, XX Lyons, XX Joseph, and Dr Lisonkova)
| | - Giulia M. Muraca
- Department of Obstetrics and Gynecology and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada (XX Muraca)
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden (XX Muraca and XX Razaz)
| | - Janet Lyons
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (XX Yearwood, XX Bone, Ms Wen, XX Lyons, XX Joseph, and Dr Lisonkova)
| | - Neda Razaz
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden (XX Muraca and XX Razaz)
| | - K.S. Joseph
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (XX Yearwood, XX Bone, Ms Wen, XX Lyons, XX Joseph, and Dr Lisonkova)
- Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada (XX Bone, XX Joseph, and Dr Lisonkova)
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (XX Joseph and Dr Lisonkova)
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (XX Yearwood, XX Bone, Ms Wen, XX Lyons, XX Joseph, and Dr Lisonkova)
- Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada (XX Bone, XX Joseph, and Dr Lisonkova)
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (XX Joseph and Dr Lisonkova)
- Corresponding author: Sarka Lisonkova, MD, PhD.
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Ulici A, Herdea A, Dragomirescu MC, Lungu CN. Obstetric fractures in caesarean delivery and risk factors as evaluated by paediatric surgeons. INTERNATIONAL ORTHOPAEDICS 2022; 46:2611-2617. [PMID: 35982323 PMCID: PMC9556358 DOI: 10.1007/s00264-022-05547-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022]
Abstract
Introduction Obstetric fractures usually occur after complicated births and are sent to paediatric orthopaedics for treatment and follow-up. Clavicle fractures represent the most common orthopaedic birth injury, involving approximately 0.2 to 3.5% of births. Hypotheses Caesarean delivery, elective or necessary, along with the type of presentation, may play a determinant role in the aetiology of obstetric fractures. Materials and methods We chose to do a retrospective study to determine possible risk factors for this type of injury that may manifest in either delivery. Our aim was to deepen our knowledge in order to have a better prediction and a better management of this condition. Data gathered included parity, gestity, type of delivery, presentation, shoulder dystocia, type of fracture, birth weight, and APGAR score. Results We followed 136 patients that were diagnosed with Allman type I clavicle fracture, 32 of them also having brachial plexus birth palsy (BPBP) type 1 (Duchenne-Erb). Natural birth with a pelvic presentation imposes a relative risk of 6.2 of associated pathology compared to cranial presentation. Caesarean delivery and cranial presentation increase the risk of related pathology by 5.04 compared to natural birth. Statistically, pelvic presentation is 5.54 times more likely to develop related pathology than cranial presentation. Type of delivery and presentation correlate with associated pathology of clavicle fractures. Discussion and conclusion Caesarean delivery brings risks for the newborn and should be practiced only when necessary. Predictive modeling in obstetrics in third-trimester evaluations may statistically predict risks of birth complications like fracture and BPBP.
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Affiliation(s)
- Alexandru Ulici
- 11th Department of Pediatric Orthopedics, "Carol Davila" University of Medicine and Pharmacy, Bd. Eroii sanitari nr. 8, 050474, Bucharest, Romania
- Pediatric Orthopedics Department, "Grigore Alexandrescu" Children's Emergency Hospital, 011743, Bucharest, Romania
| | - Alexandru Herdea
- 11th Department of Pediatric Orthopedics, "Carol Davila" University of Medicine and Pharmacy, Bd. Eroii sanitari nr. 8, 050474, Bucharest, Romania.
- Pediatric Orthopedics Department, "Grigore Alexandrescu" Children's Emergency Hospital, 011743, Bucharest, Romania.
| | - Mihai-Codrut Dragomirescu
- Pediatric Orthopedics Department, "Grigore Alexandrescu" Children's Emergency Hospital, 011743, Bucharest, Romania
| | - Claudiu N Lungu
- Department of Surgery, Clinical Country Emergency Hospital Galati, 800008, Galati, Romania
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Monaco-Brown M, Munshi U, Horgan MJ, Gifford JL, Khalak R. Association of Maternal Obesity and Neonatal Hypoxic-Ischemic Encephalopathy. Front Pediatr 2022; 10:850654. [PMID: 35573967 PMCID: PMC9099066 DOI: 10.3389/fped.2022.850654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Objective More women are obese at their first prenatal visit and then subsequently gain further weight throughout pregnancy than ever before. The impact on the infant's development of neonatal hypoxic ischemic encephalopathy (HIE) has not been well studied. Using defined physiologic and neurologic criteria, our primary aim was to determine if maternal obesity conferred an additional risk of HIE. Study Design Data from the New York State Perinatal Data System of all singleton, term births in the Northeastern New York region were reviewed using the NIH obesity definition (Body Mass Index (BMI) ≥ 30 kg/m2). Neurologic and physiologic parameters were used to make the diagnosis of HIE. Physiologic criteria included the presence of an acute perinatal event, 10-min Apgar score ≤ 5, and metabolic acidosis. Neurologic factors included hypotonia, abnormal reflexes, absent or weak suck, hyperalert, or irritable state or evidence of clinical seizures. Therapeutic hypothermia was initiated if the infant met HIE criteria when assessed by the medical team. Logistic regression analysis was used to assess the effect of maternal body mass index on the diagnosis of HIE. Results In this large retrospective cohort study we evaluated outcomes of 97,488 pregnancies. Infants born to obese mothers were more likely to require ventilatory assistance and have a lower 5-min Apgar score. After adjusting for type of delivery and maternal risk factors, infants of obese mothers were diagnosed with HIE more frequently than infants of non-obese mothers, OR 1.96 (1.33-2.89) (p = 0.001). Conclusion Infants of obese mothers were significantly more likely to have the diagnosis of HIE.
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Affiliation(s)
- Meredith Monaco-Brown
- Department of Pediatrics, Bernard and Millie Duker Children’s Hospital at Albany Medical Center, Albany, NY, United States
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Nexus between maternal underweight and child anthropometric status in South and South-East Asian countries. Nutrition 2022; 98:111628. [DOI: 10.1016/j.nut.2022.111628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/20/2022] [Accepted: 02/02/2022] [Indexed: 11/18/2022]
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Impact of maternal pre-pregnancy body mass index on maternal, fetal and neonatal adverse outcomes in the worldwide populations: A systematic review and meta-analysis. Obes Res Clin Pract 2021; 15:536-545. [PMID: 34782256 DOI: 10.1016/j.orcp.2021.10.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Systematic review and meta-analysis conducted to investigate the effect of stratified pre-pregnancy maternal body mass index on twenty maternal and fetal/neonatal adverse outcomes. METHODS PubMed, Google Scholar, Medline, Embase, Web of Science databases were searched from inception till July 11, 2020. Cohort studies were included. The pooled odds ratio with 95% confidence interval was reported considering the random effect and the quality effect model. The sub-group analysis and meta-regression were conducted for BMI cut-offs, geographical region, source of BMI, and sample size. RESULTS Overall, 86 studies representing 20,328,777 pregnant women were included in this meta-analysis. Our study reveals that overweight and obese mothers are at increased odds of cesarean delivery, elective cesarean delivery, emergency cesarean delivery, gestational diabetes, gestational hypertension, induction of labor, postpartum hemorrhage, pre-eclampsia, pre-term premature rupture of membrane, and the fetuses/neonates of overweight and obese mothers are at increased risk of admission in the newborn intensive care unit, APGAR scores less than 7 at 5 min, large for gestational age, macrosomia, extreme pre-term birth in pregnant mothers compared with standard BMI mothers. However, the underweight mothers showed increased odds for small for gestational age infant and pre-term birth, whereas obese mothers were at higher risk for post-term birth and stillbirths. The subgroup and meta-regression analyses have shown the impact of BMI cut-offs, geographical region, source of BMI, and sample size on several maternal, fetal/neonatal adverse outcomes. CONCLUSION The meta-analysis confirmed the association of elevated pre-pregnancy maternal BMI with higher odds of adverse maternal and fetal/neonatal outcomes.
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Eltayeb RA, Khalifa AA. Impact of Maternal Body Mass Index on Maternal and Neonatal Outcomes Among Sudanese Women. Cureus 2021; 13:e18365. [PMID: 34725614 PMCID: PMC8555852 DOI: 10.7759/cureus.18365] [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] [Accepted: 09/28/2021] [Indexed: 11/27/2022] Open
Abstract
Background: Unhealthy weight has an adverse impact on a person’s general health, this is more serious for pregnant a woman as it can affect her baby as well. Nutrition is an important element of antenatal care. Nutrition must be optimum to avoid problems of being underweight, and that of overweight. This study aims to assess the impact of maternal body mass index on maternal and neonatal outcomes among Sudanese women. Methods: A cross-sectional study was carried out at Saad Abu El Ella Hospital and Soba University Hospital in December 2017. The maternal weight and height were measured for 159 women to calculate BMI. The impact of maternal BMI on maternal and neonatal outcomes was tested using the chi-square test and logistic regression. P-value = or <0.05 was considered as statistically significant. Results: Fourty-two (26.4%) of studied women were of normal weight, two (1.3%) were underweight, 61 (38.4%) were overweight and 54 (33.9%) were obese. Increasing parity was associated with higher BMI, this was more significant among the obese group with an odds ratio of 3.1 (95% CI = 1.099-8.866, p=0.033). There was a relative increase in the risk of delivery by caesarean section among the obese group with an odds ratio of 1.7 (95% CI =1.079-2.737, p=0.023). No significant association between maternal BMI and preterm or post-term delivery was found. The incidence of macrosomia was more among overweight and obese mothers. There was no association found between maternal BMI and low birth weight, admission of the baby to neonatal intensive care unit (NICU), or low Apgar score at 5 minutes. Conclusion: This study shows a high incidence of being overweight among Sudanese pregnant ladies. Increased risk of caesarean section as maternal BMI increases. Overweight and obese mothers are more likely to have macrosomic babies.
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Affiliation(s)
- Rayan A Eltayeb
- Obstetrics and Gynaecology, Khartoum University, Khartoum, SDN
| | - Amani A Khalifa
- Obstetrics and Gynaecology, Woman Wellness Research Center, Hamad Medical Corporation, Doha, QAT
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Impact of body mass index (BMI) on the success rate of fresh embryo transfer in women undergoing first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment. Int J Obes (Lond) 2021; 46:202-210. [PMID: 34628467 DOI: 10.1038/s41366-021-00978-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 09/16/2021] [Accepted: 09/28/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the impact of body mass index (BMI) on the success rate and prenatal outcomes of fresh embryo transfer in women undergoing their first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment. METHODS It is a post-hoc analysis of a prospective observational cohort study. 2569 Chinese women were grouped in quintiles of BMI and according to the official Chinese classification of body weight. IVF/ICSI and pregnancy outcomes were compared between groups. RESULTS BMI was not associated with IVF/ICSI pregnancy outcomes including hCG positive rate, clinical pregnancy rate, implantation rate, ectopic pregnancy rate, ongoing pregnancy rate, early miscarriage rate, and live birth rate. However, it was negatively related to some pregnancy complications such as gestational diabetes mellitus (GDM) and hypertension. Additionally, the proportion of Cesarean-section was increased with BMI. As for prenatal outcomes, the current results showed no statistical difference in the number of male and female newborn, the proportion of low live birth weight (<2500 g), macrosomia (≥4000 g) (both in all live birth and full-term live birth), and premature delivery (<37 weeks). CONCLUSIONS The current study showed that BMI was not associated with embryo transfer outcomes after fresh embryo transfer in women undergoing their first IVF/ICSI treatment, whereas BMI was associated with GDM and gestational hypertension.
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Rabe H, Bhatt-Mehta V, Bremner SA, Ahluwalia A, Mcfarlane R, Baygani S, Batton B, Klein A, Ergenekon E, Koplowitz LP, Dempsey E, Apele-Freimane D, Iwami H, Dionne JM. Antenatal and perinatal factors influencing neonatal blood pressure: a systematic review. J Perinatol 2021; 41:2317-2329. [PMID: 34365475 PMCID: PMC8440188 DOI: 10.1038/s41372-021-01169-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/18/2021] [Accepted: 07/14/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE A comprehensive understanding of the factors contributing to perinatal blood pressure is vital to ensure optimal postnatal hemodynamic support. The objective of this study was to review existing literature on maternal and perinatal factors influencing blood pressure in neonates up to 3 months corrected age. METHODS A systematic search of published literature in OVID Medline, OVID Embase and the COCHRANE library identified publications relating to maternal factors affecting blood pressure of neonates up to corrected age of 3 months. Summary data were extracted and compared (PROSPERO CRD42018092886). RESULTS Of the 3683 non-duplicate publications identified, 44 were eligible for inclusion in this review. Topics elicited were sociodemographic factors, maternal health status, medications, smoking during pregnancy, and cord management at birth. Limited data were available for each factor. Results regarding the impact of these factors on neonatal blood pressure were inconsistent across studies. CONCLUSIONS There is insufficient evidence to draw definitive conclusions regarding the impact of various maternal and perinatal factors on neonatal blood pressure. Future investigations of neonatal cardiovascular therapies should account for these factors in their study design. Similarly, studies on maternal diseases and perinatal interventions should include neonatal blood pressure as part of their primary or secondary analyses.
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Affiliation(s)
- Heike Rabe
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
| | | | - Stephen A Bremner
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Aisling Ahluwalia
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Renske Mcfarlane
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | | | - Beau Batton
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | | | | | | | | | | | | | - Janis M Dionne
- British Columbia Children´s Hospital, Vancouver, BC, Canada
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Nowak-Szczepanska N, Gomula A, Chakraborty R, Koziel S. Nutritional and weight status of Indian mother-child dyads experienced by a natural disaster. MATERNAL AND CHILD NUTRITION 2021; 17:e13164. [PMID: 33630397 PMCID: PMC8189233 DOI: 10.1111/mcn.13164] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/22/2021] [Accepted: 02/02/2021] [Indexed: 01/07/2023]
Abstract
Natural disasters have detrimental effects not only on local infrastructure in an affected population but may also have an impact on the human biological condition, particularly during critical periods of life. This study aimed to assess the nutritional and weight status of women and their children who had experienced cyclone Aila prenatally and postnatally in comparison with a non-affected neighbouring group. The study sample involved N = 597 dyads consisting of mothers and their prepubertal children prenatally or postnatally (during infancy) exposed to a natural disaster and a control group from a neighbouring region (West Bengal, India). The analysed anthropometric indices involved body mass index (BMI) and mid-upper arm circumference (MUAC). Moreover, several socioeconomic characteristics were collected (mother's and father's education, family size and family income). Analyses revealed that the group factor (Aila-exposed or non-exposed groups) had the highest impact on both children's and their mothers' BMI and MUAC (p < 0.001) in comparison with socioeconomic variables. Surprisingly, both mothers and their children revealed deteriorated nutritional and relative weight status several years after the occurrence of cyclone Aila, which is in opposition to the results obtained in developed countries, where prenatal maternal stress caused by the natural disaster led to the subsequent higher risk of excessive weight in affected children.
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Affiliation(s)
- Natalia Nowak-Szczepanska
- Department of Anthropology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Aleksandra Gomula
- Department of Anthropology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Raja Chakraborty
- Department of Anthropology, Dinabandhu Mahavidyalaya, Bongaon, West Bengal, India
| | - Slawomir Koziel
- Department of Anthropology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
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Günther V, Alkatout I, Vollmer C, Maass N, Strauss A, Voigt M. Impact of nicotine and maternal BMI on fetal birth weight. BMC Pregnancy Childbirth 2021; 21:127. [PMID: 33579212 PMCID: PMC7881635 DOI: 10.1186/s12884-021-03593-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 01/27/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND According to the World Health Organization, smoking is the most important risk factor for adverse pregnancy outcomes in industrialized nations. As the individual factors (body mass index - BMI (kg/m2) - and cigarette consumption) have been extensively investigated in pregnancy, we aimed to establish how maternal BMI and nicotine interact with regard to perinatal outcomes and birth weight. METHODS Data from 110.047 singleton pregnancies, achieved from the German Perinatal Survey in Schleswig-Holstein and registered between 2010 and 2017 were analyzed in August 2018 concerning maternal BMI and smoking. The BMI was taken from the maternity log. Information concerning the smoking status were self-reported and further subdivided into the following four categories: a) non-smokers; b) 1-7 cigarettes/day; c) 8-14 cigarettes/ day; and d) ≥ 15 cigarettes/ day. Furthermore, we classified women by their BMI into underweight, normal weight, overweight and obese. Comparisons between non-smokers and the respective smoking group, and their relationship with maternal BMI were performed by the t-test (birth weight). A P-value ≤0.05 was considered to indicate statistical significance. RESULTS A number of 97.092 women (88.2%) were non-smokers and 12.955 (11.8%) were smokers. Furthermore 10.3% of women of normal weight smoked during pregnancy, but both high and low BMI were associated with a high prevalence of smoking. The proportion of smokers was highest (18.1%) among underweight women (BMI ≤ 18.5 kg/m2). A large number of smokers (15.5%) were registered in the obesity group (BMI ≥ 30 kg/m2). Mean birth weight (≥ 37 + 0 gestational age) increased with increasing maternal BMI, and was reduced by smoking for every BMI category. The differences between smokers and non-smokers were always highly significant (p < 0.001). Mean birth weight varied between 2995 g in underweight frequent smokers and 3607 g in obese non-smokers. CONCLUSION Both maternal BMI and smoking during pregnancy influences the birth weight and therefore pregnancy outcome. Smoking during pregnancy was significantly associated with low birth weight. Pregnant women should be advised to cease or at least reduce smoking in order to improve the birth weight of the newborn and to minimize child morbidities.
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Affiliation(s)
- Veronika Günther
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (Building C), 24105, Kiel, Germany.
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (Building C), 24105, Kiel, Germany
| | - Christoph Vollmer
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (Building C), 24105, Kiel, Germany
| | - Nicolai Maass
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (Building C), 24105, Kiel, Germany
| | | | - Manfred Voigt
- Department of Gynecology, University Hospital Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
- Center for Medicine and Society, Albert-Ludwigs-University Freiburg, Friedrichstr. 39, 79098, Freiburg, Germany
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Ezemagu UK, Uzomba GC, Chuwkuemeka U, Rachel O, Friday EC, Onuora O. Maternal and neonatal anthropometric analyses: Determining birth outcomes in low-risk pregnancies at Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Int J Gynaecol Obstet 2021; 154:324-330. [PMID: 33301610 DOI: 10.1002/ijgo.13527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/12/2020] [Accepted: 12/08/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the input of maternal and neonatal body physique anthropometries to birth outcomes. METHODS A prospective study of 177 full-term births at Alex Ekwueme Federal Teaching Hospital Abakaliki from July to December, 2019. Maternal and neonatal anthropometric parameters and birth outcomes: mode of delivery and Apgar score were considered in this study. The measurements followed the guidelines outlined by the Institute of Medicine. RESULTS The prevalence of low birth weight (6.21%), cesarean delivery (14.12%), and abnormal Apgar score (9.04%) was relatively low in the study. Birth weight was dependent on maternal age, weight, body mass index, percentage body fat, and waist and hip circumference (P < 0.05). Normal Apgar score at 1 min after birth of male neonates was dependent on maternal BMI and neonatal head circumference whereas abnormal Apgar score in male and female neonates was dependent on maternal age and waist:hip ratio, respectively (P < 0.05). CONCLUSION Maternal and neonatal body physique anthropometries can be used to identify mothers and neonates at risk of having birth complications. This provided a practical alternative means to know the possible risk of undesirable birth outcomes with spontaneous vaginal delivery in low-risk pregnancies.
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Affiliation(s)
- Uchenna K Ezemagu
- Department of Anatomy, Faculty of Basic Medical Sciences, College of Medical Sciences, Alex Ekwueme Federal University Ndufu Alike, Abakaliki, Nigeria
| | - Godwin C Uzomba
- Department of Anatomy, Faculty of Basic Medical Sciences, College of Medical Sciences, Alex Ekwueme Federal University Ndufu Alike, Abakaliki, Nigeria
| | - Ubochi Chuwkuemeka
- Department of Anatomy, Faculty of Basic Medical Sciences, College of Medical Sciences, Alex Ekwueme Federal University Ndufu Alike, Abakaliki, Nigeria
| | - Ogbu Rachel
- Department of Anatomy, Faculty of Basic Medical Sciences, College of Medical Sciences, Alex Ekwueme Federal University Ndufu Alike, Abakaliki, Nigeria
| | - Egba C Friday
- Department of Pediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Olisa Onuora
- Department of Obstetrics and Gynecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
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Huo N, Zhang K, Wang L, Wang L, Lv W, Cheng W, Jia G. Association of Maternal Body Mass Index With Risk of Infant Mortality: A Dose-Response Meta-Analysis. Front Pediatr 2021; 9:650413. [PMID: 33777870 PMCID: PMC7994890 DOI: 10.3389/fped.2021.650413] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/17/2021] [Indexed: 01/11/2023] Open
Abstract
Objective: This study presumed that a high or low body mass index (BMI) might increase the risk of infant mortality. Therefore, a meta-analysis was performed to systematically assess the association between maternal BMI and the risk of infant mortality. Methods: The electronic databases, including Pubmed, Embase database, and Cochrane Library, were systemically searched by two investigators from inception to November 26th, 2020, with no language restriction. In parallel, a dose-response was assessed. Results: Finally, 22 cohort studies involving 13,532,293 participants were included into this paper, which showed that compared with normal BMI, maternal overweight significantly increased the risks of infant mortality [risk ratio (RR), 1.16; 95% confidence interval (CI), 1.13-1.19], neonatal mortality (RR, 1.23; 95% CI, 1.08-1.39), early neonatal mortality (RR, 1.55; 95% CI, 1.26-1.92) and post-neonatal mortality (RR, 1.18; 95% CI, 1.07-1.29). Similarly, maternal obesity significantly increased the risk of infant mortality (RR, 1.55; 95% CI, 1.41-1.70), neonatal mortality (RR, 1.55; 95% CI, 1.28-1.67), early neonatal mortality (RR, 1.37; 95% CI, 1.13-1.67), and post-neonatal mortality (RR, 1.30; 95% CI, 1.03-1.65), whereas maternal underweight potentially decreased the risk of infant mortality (RR, 0.93; 95% CI, 0.88-0.98). In the dose-response analysis, the risk of infant mortality significantly increased when the maternal BMI was >25 kg/m2. Conclusions: Maternal overweight or obesity significantly increases the risks of infant mortality, neonatal mortality, early neonatal mortality, and post-neonatal mortality compared with normal BMI in a dose-dependent manner. Besides, maternal underweight will not increase the risk of infant mortality, neonatal mortality, early neonatal mortality, or postneonatal mortality; instead, it tends to decrease the risk of infant mortality. Early weight management may provide potential benefits to infants, and more large-scale prospective studies are needed to verify this finding in the future.
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Affiliation(s)
- Nana Huo
- Department of Obstetrics, Maternity and Child Health Care of Zaozhuang, Zaozhuang, China
| | - Kun Zhang
- Department of Obstetrics, Maternity and Child Health Care of Zaozhuang, Zaozhuang, China
| | - Li Wang
- Department of Obstetrics, Maternity and Child Health Care of Zaozhuang, Zaozhuang, China
| | - Lina Wang
- Department of Obstetrics and Gynecology, Maternity and Child Health Care of Zaozhuang, Zaozhuang, China
| | - Wenhui Lv
- Department of Obstetrics, Maternity and Child Health Care of Zaozhuang, Zaozhuang, China
| | - Wenke Cheng
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Leipzig, Germany
| | - GuangZhu Jia
- Department of Obstetrics, Maternity and Child Health Care of Zaozhuang, Zaozhuang, China
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Qiao L, Wattez JS, Lim L, Rozance PJ, Hay WW, Shao J. Prolonged Prepregnant Maternal High-Fat Feeding Reduces Fetal and Neonatal Blood Glucose Concentrations by Enhancing Fetal β-Cell Development in C57BL/6 Mice. Diabetes 2019; 68:1604-1613. [PMID: 31127056 PMCID: PMC6692812 DOI: 10.2337/db18-1308] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/19/2019] [Indexed: 12/21/2022]
Abstract
The main objective of this study was to investigate the effect of maternal obesity on offspring's glucose metabolism during the perinatal period. Maternal obesity was established by feeding C57BL/6 mice with a high-fat (HF) diet before or during pregnancy. Our results showed that prolonged prepregnant HF feeding but not HF feeding during pregnancy significantly reduced fetal and neonatal blood glucose concentrations. Remarkably, elevated blood insulin concentrations and increased activation of insulin signaling were observed in fetuses and neonates from prepregnant HF-fed dams. In addition, significantly larger β-cell areas were observed in pancreases of fetuses and neonates from prepregnant HF-fed dams. Although there was no significant change in placental cross-sectional area or GLUT 1 expression, prepregnant HF feeding significantly enhanced the expression of genes that control placental fatty acid supply. Interestingly, reducing fatty acid supply to the placenta and fetus by placental-specific knockout of adipose triglyceride lipase not only reduced fetal β-cell area and blood insulin concentration but also attenuated prepregnant HF feeding-induced reduction in offspring blood glucose concentrations during the perinatal period. Together, these results indicate that placental and fetal fatty acid supply plays an important role in fetal β-cell development, insulin secretion, and glucose metabolism. Prolonged prepregnant maternal HF feeding resembles pregravid maternal obesity in mice, which reduces fetal and neonatal blood glucose concentrations by enhancing fetal β-cell development and insulin secretion.
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Affiliation(s)
- Liping Qiao
- Department of Pediatrics, University of California San Diego, La Jolla, CA
| | | | - Lauren Lim
- Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Paul J Rozance
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - William W Hay
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Jianhua Shao
- Department of Pediatrics, University of California San Diego, La Jolla, CA
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Tanwi TS, Chakrabarty S, Hasanuzzaman S. Double burden of malnutrition among ever-married women in Bangladesh: a pooled analysis. BMC WOMENS HEALTH 2019; 19:24. [PMID: 30704454 PMCID: PMC6357418 DOI: 10.1186/s12905-019-0725-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 01/25/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Evidences show that the burden of overweight and obesity is escalating in developing countries with predominant burden of underweight. The coexistence of underweight and overweight/obesity is known as double burden of malnutrition. Recent scanty studies confirmed that Bangladesh is currently experiencing augmented overweight and obesity as well as abating underweight. The present study aimed at assessing the changes of prevalence of overweight/obesity and underweight from 2004 to 2014 and investigated the socio-demographic correlates of being overweight/obese and underweight among ever-married women age 15-49 years. METHODS Data were collected from four consecutive Demographic and Health Surveys conducted in Bangladesh in 2004 (N = 11,173), 2007 (N = 10,993), 2011 (N = 17,749), 2014 (N = 17,690). Multinomial logistic regression model has been used to determine association between different socio-demographic predictors with overweight/obesity and underweight among ever-married women age 15-49 years considering normal weight as reference category. RESULTS The prevalence of underweight decreased by 43.2% (from 32.2% in 2004 to 18.3% in 2014) and 130.5% increase in overweight and obesity (from 10.5% in 2004 to 24.2% in 2014) were found over the ten years period. Age, educational status, wealth index and year were positively associated with overweight and obesity and negatively associated with underweight. Also, 'not being married' status for rural women were positively associated with underweight and negatively associated with overweight and obesity. Rural women were less likely to be overweight and obese (OR = 0.7, 95% CI: 0.7-0.8) while more likely to be underweight (OR = 1.1, 95% CI: 1.1-1.2) relative to urban women respectively. The likelihood of being overweight and obese was 4.5 times (95% CI: 4.1-4.9) higher among women who were in richest quintile compared to poorest women. They were also less likely to be underweight (OR = 0.4, 95% CI: 0.3-0.4) relative to same reference category. CONCLUSION The double burden of malnutrition is evidently prevailing in Bangladesh. Over the ten years period, overweight and obesity has been raised tremendously but underweight did not fall significantly. This study suggests that strategies for preventing both underweight and overweight/obesity simultaneously among reproductive women need to be implemented considering regional context and their socioeconomic status (SES).
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Affiliation(s)
- Tania Sultana Tanwi
- Department of Economics, Shahjalal University of Science & Technology, Sylhet Kumargaon, Sylhet, 3114, Bangladesh.
| | - Sayan Chakrabarty
- University of Southern Queensland, Springfield, QLD, 4300, Australia
| | - Syed Hasanuzzaman
- Department of Economics, Shahjalal University of Science & Technology, Sylhet Kumargaon, Sylhet, 3114, Bangladesh
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Lassek WD, Gaulin SJC. Do the Low WHRs and BMIs Judged Most Attractive Indicate Higher Fertility? EVOLUTIONARY PSYCHOLOGY 2018; 16:1474704918800063. [PMID: 30296846 PMCID: PMC10480809 DOI: 10.1177/1474704918800063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/20/2018] [Indexed: 12/30/2022] Open
Abstract
We examine the widely accepted view that very low waist-hip ratios and low body mass indices (BMIs) in women in well-nourished populations are judged attractive by men because these features reliably indicate superior fertility. In both subsistence and well-nourished populations, relevant studies of fertility do not support this view. Rather studies indicate lower fertility in women with anthropometric values associated with high attractiveness. Moreover, low maternal BMI predisposes to conditions that compromise infant survival. Consistent with these findings from the literature, new data from a large U.S. sample of women past reproductive age show that women with lower BMIs in the late teens had fewer live births, controlling for education, marital history, and race. They also had later menarche and earlier menopause compared with women with higher youth BMIs. In addition, data from the 2013 U.S. natality database show that mothers with lower prepregnancy BMIs have an increased risk of producing both low-birth-weight and preterm infants controlling for other relevant variables-conditions that would have adversely affected fitness over almost all of human evolution. Thus, a review of the relevant literature and three new tests fail to support the view that highly attractive women are more fertile.
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Affiliation(s)
- William D. Lassek
- Department of Anthropology, University of California at Santa Barbara, Santa Barbara, CA, USA
| | - Steven J. C. Gaulin
- Department of Anthropology, University of California at Santa Barbara, Santa Barbara, CA, USA
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Jennewein L, Kielland-Kaisen U, Paul B, Möllmann CJ, Klemt AS, Schulze S, Bock N, Schaarschmidt W, Brüggmann D, Louwen F. Maternal and neonatal outcome after vaginal breech delivery at term of children weighing more or less than 3.8 kg: A FRABAT prospective cohort study. PLoS One 2018; 13:e0202760. [PMID: 30138358 PMCID: PMC6107207 DOI: 10.1371/journal.pone.0202760] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 08/07/2018] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION The clinical management of breech presentations at term is still a controversially discussed issue among clinicians. Clear predictive criteria for planned vaginal breech deliveries are desperately needed to prevent adverse fetal and maternal outcomes and to reduce elective cesarean section rates. The green-top guideline considers an estimated birth weight of 3.8 kg or more an indication to plan a cesarean section despite the lack of respective evidence. OBJECTIVE To compare maternal and neonatal outcome of vaginal intended breech deliveries of births with children with a birth weight of 2.5 kg- 3.79 kg and children with a birth weight of 3.8 kg and more. DESIGN Prospective cohort study. SAMPLE All vaginal intended deliveries out of a breech position of newborns weighing between 2.5 kg and 4.5 kg at the Obstetrics department at Goethe University Hospital Frankfurt from January 2004 until December 2016. METHODS Neonatal and maternal outcome of a light weight group (LWG) (< 3.8 kg) was compared to and a high weight group (HWG) (≥ 3.8 kg) using Pearson's Chi Square test and Fishers exact test. A logistic regression analysis was performed to detect an association between cesarean section rates, fetal outcome and the birth weight. RESULTS No difference in neonatal morbidity was detected between the HWG (1.8%, n = 166) and the LWG (2.6%, n = 888). Cesarean section rate was significantly higher in the HWG with 45.2% in comparison to 28.8% in the LWG with an odds ratio of 1.57 (95% CI 1.29-1.91, p<0.0001). In vaginal deliveries, a high birth weight was not associated with an increased risk of maternal birth injuries (LWG in vaginal deliveries: 74.3%, HWG in vaginal deliveries: 73.6%; p = 0.887; OR = 1.9 (95% CI 0.9-1.1)). CONCLUSION A fetal weight above 3.79 kg does not predict increased maternal or infant morbidity after delivery from breech presentation at term. Neither the literature nor our analyses document evidence for threshold of estimated birth weight that is associated with maternal and/or infant morbidity. However, patients should be informed about an increased likelihood of cesarean sections during labor when attempting vaginal birth from breech position at term in order to reach an informed shared decision concerning the birth strategy. Further investigations in multi center settings are needed to advance international guidelines on vaginal breech deliveries in the context of estimated birth weight and its impact on perinatal outcome.
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Affiliation(s)
- Lukas Jennewein
- FRABAT FRAnkfurt Breech At Term Study Group; Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, Frankfurt, Germany
| | - Ulrikke Kielland-Kaisen
- FRABAT FRAnkfurt Breech At Term Study Group; Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, Frankfurt, Germany
| | - Bettina Paul
- FRABAT FRAnkfurt Breech At Term Study Group; Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, Frankfurt, Germany
| | - Charlotte J. Möllmann
- FRABAT FRAnkfurt Breech At Term Study Group; Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, Frankfurt, Germany
| | - Anna-Sophia Klemt
- FRABAT FRAnkfurt Breech At Term Study Group; Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, Frankfurt, Germany
| | - Sally Schulze
- FRABAT FRAnkfurt Breech At Term Study Group; Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, Frankfurt, Germany
| | - Nina Bock
- FRABAT FRAnkfurt Breech At Term Study Group; Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, Frankfurt, Germany
| | - Wiebke Schaarschmidt
- FRABAT FRAnkfurt Breech At Term Study Group; Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, Frankfurt, Germany
| | - Dörthe Brüggmann
- FRABAT FRAnkfurt Breech At Term Study Group; Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, Frankfurt, Germany
| | - Frank Louwen
- FRABAT FRAnkfurt Breech At Term Study Group; Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, Frankfurt, Germany
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Patel A, Prakash AA, Das PK, Gupta S, Pusdekar YV, Hibberd PL. Maternal anemia and underweight as determinants of pregnancy outcomes: cohort study in eastern rural Maharashtra, India. BMJ Open 2018; 8:e021623. [PMID: 30093518 PMCID: PMC6089300 DOI: 10.1136/bmjopen-2018-021623] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To study the trend in the prevalence of anaemia and low BMI among pregnant women from Eastern Maharashtra and evaluate if low BMI and anaemia affect pregnancy outcomes. DESIGN Prospective observational cohort study. SETTING Catchment areas of 20 rural primary health centres in four eastern districts of Maharashtra State, India. PARTICIPANTS 72 750 women from the Nagpur site of Maternal and Newborn Health Registry of NIH's Global Network, enrolled from 2009 to 2016. MAIN OUTCOME MEASURES Mode of delivery, pregnancy related complications at delivery, stillbirths, neonatal deaths and low birth weight (LBW) in babies. RESULTS Over 90% of the women included in the study were anaemic and over a third were underweight (BMI <18 kg/m2) and with both conditions. Mild anaemia at any time during delivery significantly increased the risk (Risk ratio; 95% confidence interval (RR;(95% CI)) of stillbirth (1.3 (1.1-1.6)), neonatal deaths (1.3 (1-1.6)) and LBW babies (1.1 (1-1.2)). The risks became even more significant and increased further with moderate/severe anaemia any time during pregnancy for stillbirth (1.4 (1.2-1.8)), neonatal deaths (1.7 (1.3-2.1)) and LBW babies (1.3 (1.2-1.4)).,. Underweight at anytime during pregnancy increased the risk of neonatal deaths (1.1 (1-1.3)) and LBW babies (1.2;(1.2-1.3)).The risk of having stillbirths (1.5;(1.2-1.8)), neonatal deaths (1.7;(1.3-2.3)) and LBW babies (1.5;(1.4-1.6)) was highest when - the anaemia and underweight co-existed in the included women. Obesity/overweight during pregnancy increased the risk of maternal complications at delivery (1.6;(1.5-1.7)) and of caesarean section (1.5;(1.4-1.6)) and reduced the risk of LBW babies 0.8 (0.8-0.9)). CONCLUSION Maternal anaemia is associated with enhanced risk of stillbirth, neonatal deaths and LBW. The risks increased if anaemia and underweight were present simultaneously. TRIAL REGISTRATION NUMBER NCT01073475.
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Affiliation(s)
- Archana Patel
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | | | | | - Swarnim Gupta
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | | | - Patricia L Hibberd
- Boston University School of Public Health and Boston University School of Medicine, Boston, Massachusetts, USA
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Maternal body mass index and risk of intraventricular hemorrhage in preterm infants. Pediatr Res 2018; 83:1146-1151. [PMID: 29624572 DOI: 10.1038/pr.2018.47] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 02/27/2018] [Indexed: 12/16/2022]
Abstract
BackgroundIntraventricular hemorrhage (IVH) and pre-pregnancy obesity and underweight have been linked to inflammatory states. We hypothesize that IVH in preterm infants is associated with pre-pregnancy obesity and underweight due to an inflammatory intrauterine environment.MethodsPopulation-based study of infants born between 22 and 32 weeks' gestation from 2007 to 2011. Data were extracted from vital statistics and the California Perinatal Quality Care Collaborative. Results were examined for all cases (any IVH) and for severe IVH.ResultsAmong 20,927 infants, 4,818 (23%) had any IVH and 1,514 (7%) had severe IVH. After adjustment for confounders, there was an increased risk of IVH associated with pre-pregnancy obesity, relative risk 1.14 (95% confidence interval (CI) 1.06, 1.32) for any IVH, and 1.25 (85% CI 1.10, 1.42) for severe IVH. The direct effect of pre-pregnancy obesity on any IVH was significant (P<0.001) after controlling for antenatal inflammation-related conditions, but was not significant after controlling for gestational age (P=0.56).ConclusionPre-pregnancy obesity was found to be a risk factor for IVH in preterm infants; however, this relationship appeared to be largely mediated through the effect of BMI on gestational age at delivery. The etiology of IVH is complex and it is important to understand the contributing maternal factors.
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Richardson BS, Ruttinger S, Brown HK, Regnault TRH, de Vrijer B. Maternal body mass index impacts fetal-placental size at birth and umbilical cord oxygen values with implications for regulatory mechanisms. Early Hum Dev 2017; 112:42-47. [PMID: 28688997 DOI: 10.1016/j.earlhumdev.2017.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/22/2017] [Accepted: 06/27/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Maternal under- and over-nutrition are known to effect fetal growth with altered placental development and nutrient transport, but whether fetal oxygenation is also altered remains unknown. AIMS To examine linkages between maternal BMI and birth weights, placental weights, and umbilical vein and artery PO2, with implications for signaling mechanisms. STUDY DESIGN Population-based cohort study. SUBJECTS Analysis of hospital database information on all patients with pre-pregnant BMI values delivering viable, singleton infants between Jan 1, 1999 and Dec 31, 2010 (N=29,212). BMI was categorized into underweight, normal weight, overweight, and obese, with birth weights categorized into small (SGA), appropriate (AGA), and large for gestational age (LGA). OUTCOME MEASURES Maternal BMI, birth and placental weights, umbilical vein and artery PO2. RESULTS Underweight mothers with smaller infants and overweight/obese mothers with larger infants had disproportionately large placentas, suggesting compensatory and/or enhanced placental growth in these pregnancies. All SGA infants had lower umbilical vein and artery PO2, consistent with aberrant placental development leading to diffusional impairment of oxygen. Both maternal overweight/obese BMI and LGA resulted in lower artery PO2, likely due to increased growth rates with the larger size in these infants. CONCLUSIONS These findings support fetal hypoxemia as a common determinant of growth restriction, whether in underweight mothers and due to under-nutrition or in overweight/obese mothers and due to placental insufficiency. However, oxygen is unlikely to be the primary promotor for fetal growth in overweight/obese mothers and LGA infants, with other substrates of more importance as nutritional cues in these pregnancies.
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Affiliation(s)
- Bryan S Richardson
- Department of Obstetrics and Gynecology; Department of Physiology and Pharmacology; Department of Pediatrics; Children's Health Research Institute; Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada.
| | - Stephanie Ruttinger
- Department of Physiology and Pharmacology; Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Hilary K Brown
- Department of Obstetrics and Gynecology; Department of Epidemiology & Biostatistics; Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Timothy R H Regnault
- Department of Obstetrics and Gynecology; Department of Physiology and Pharmacology; Children's Health Research Institute; Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Barbra de Vrijer
- Department of Obstetrics and Gynecology; Children's Health Research Institute; Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
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Carmichael SL, Kan P, Gould JB, Stevenson DK, Shaw GM, Lee HC. Maternal prepregnancy body mass index and risk of bronchopulmonary dysplasia. Pediatr Res 2017; 82:8-13. [PMID: 28399116 DOI: 10.1038/pr.2017.90] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/22/2017] [Indexed: 12/17/2022]
Abstract
BackgroundWe examined the relationship between women's prepregnancy BMI and development of bronchopulmonary dysplasia (BPD) in their preterm offspring, hypothesizing that obesity-associated inflammation may increase risk.MethodsWe studied infants born in California between 2007 and 2011, using linked data from California Perinatal Quality Care Collaborative neonatal intensive care units, hospital discharge, and vital statistics. We included infants with birthweight <1,500 g or gestational age at birth of 22-29 weeks. BPD was defined as continuous supplemental oxygen use at 36 weeks' postmenstrual age.ResultsAmong 12,621 infants, 4,078 (32%) had BPD. After adjustment for maternal race/ethnicity, age, education, payer source, and infant sex, BMI status underweight I (BMI <16.9, odds ratio (OR) 1.7, 95% confidence interval (CI) 1.3-2.1) and obesity III (BMI ⩾40.0, OR 1.3, 95% CI 1.0-1.6) were associated with an increased risk of BPD. When considering maternal BMI as a continuous variable, a nonlinear association with BPD was observed for male infants and infants delivered at 25-29 weeks of gestational age, but not for other subgroups.ConclusionBoth high and low maternal BMI were associated with increased BPD risk. These findings support the notion that BPD is a multi-factorial disease that may sometimes have its origins in utero and be influenced by maternal inflammation.
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Affiliation(s)
- Suzan L Carmichael
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Peiyi Kan
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jeffrey B Gould
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - David K Stevenson
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Gary M Shaw
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Henry C Lee
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Khalak R, Rijhsinghani A, McCallum SE. Impact of maternal obesity on very preterm infants. Obesity (Silver Spring) 2017; 25:945-949. [PMID: 28332298 DOI: 10.1002/oby.21812] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/04/2017] [Accepted: 01/26/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Infants born at less than 34 weeks' gestational age are at higher risk for morbidity and mortality. Data are limited on the impact of maternal obesity on the very preterm infant. This study reviewed whether maternal obesity further increases the intensive care needs of very preterm infants of less than 34 weeks' gestation. METHODS Maternal and neonatal data for live-born singleton births of 23 0/7 to 33 6/7 weeks' gestation delivering in upstate New York were reviewed. BMI categorization followed the National Institutes of Health BMI classification that subdivides obesity into three ascending BMI groups. RESULTS Records were obtained on 1,224 women, of whom 31.6% were classified with obesity. Despite similar mean gestational age (31 to 31.6 weeks, P = 0.57) and birth weight (1,488 to 1,569 g, P = 0.51) of the infants in the BMI categories, delivery room (DR) resuscitation was more common for infants of women with level III obesity (63.2%, P = 0.04) with a trend toward the continued need for assisted ventilation (54.7%, P = 0.06). CONCLUSIONS Preterm infants of women with level III obesity were more likely to require DR resuscitation with a trend to continued need for ventilatory support beyond 6 hours of age. This could impact utilization of DR resources at delivering hospitals.
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Affiliation(s)
- Rubia Khalak
- Department of Pediatrics/Neonatology Division, Albany Medical Center, Albany, New York, USA
| | - Asha Rijhsinghani
- Department of Obstetrics and Gynecology/Division of Maternal-Fetal Medicine, Albany Medical Center, Albany, New York, USA
| | - Sarah E McCallum
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
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23
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Rai RK, Singh L, Singh PK. Is maternal body mass index associated with neonatal mortality? A pooled analysis of nationally representative data from nine Asian countries. Nutrition 2017; 41:68-72. [PMID: 28760430 DOI: 10.1016/j.nut.2017.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/16/2017] [Accepted: 04/07/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Children born to mothers with abnormal body mass index (BMI) have increased risk for mortality. The aim of this study was to investigate whether maternal BMI is a risk factor for neonatal death in select Asian countries, including the nature of association between maternal BMI and the discrete timing of neonatal death. METHODS Nationally representative, the standard Demographic and Health Survey data from nine Asian countries were used. In all, 55 629 mothers reported their index birth; 840 reported neonatal mortality. Descriptive statistics and multivariate logistic regression analyses were applied to attain the study objective. RESULTS Overweight mothers had higher odds of neonatal mortality than mothers with optimum weight. No significant association was registered for obese mothers, possibly due to insufficient power. During the first 7 d (0-1 and 2-6 d) of birth, children born to overweight mothers had higher odds of dying, whereas for the remaining period (7-27 d), maternal underweight was the risk factor for neonatal mortality. CONCLUSION Interventions should target high-risk pregnancies to reduce the rate of neonatal mortality. With the help of community health workers or physicians, preconception counseling of prospective mothers with abnormal BMI should be devised. If conceived, underweight or overweight or obese women should be marked as high-risk pregnancy during their antenatal care visits, and they must be encouraged for delivery at an institution equipped with an emergency obstetric and neonatal care unit.
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Affiliation(s)
- Rajesh Kumar Rai
- Society for Health and Demographic Surveillance, Suri, West Bengal, India.
| | - Lucky Singh
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
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24
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Jen V, Erler NS, Tielemans MJ, Braun KV, Jaddoe VW, Franco OH, Voortman T. Mothers' intake of sugar-containing beverages during pregnancy and body composition of their children during childhood: the Generation R Study. Am J Clin Nutr 2017; 105:834-841. [PMID: 28275130 DOI: 10.3945/ajcn.116.147934] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 02/03/2017] [Indexed: 11/14/2022] Open
Abstract
Background: High intake of sugar-containing beverages (SCBs) has been linked to increased risk of obesity. However, associations of SCB intake during pregnancy with child body composition have been unclear.Objectives: We explored whether SCB intake during pregnancy was associated with children's body mass index (BMI) and detailed measures of body composition. In addition, we examined different types of SCBs (i.e., fruit juice, soda, and concentrate).Design: We included 3312 mother-child pairs of the Generation R Study, a prospective cohort from fetal life onward in the Netherlands. Energy-adjusted SCB intake was assessed in the first trimester with a food-frequency questionnaire. Anthropometric data of the children were collected repeatedly ≤6 y of age, and BMI was calculated. At 6 y of age, we further measured fat mass index (FMI) and fat-free mass index with dual-energy X-ray absorptiometry. All outcomes were sex- and age-standardized. Associations of SCB intake with children's BMI trajectories and body composition were analyzed with multivariable linear mixed and regression models.Results: Results from linear mixed models showed that, after adjustment for confounders including the SCB intake of the child itself, mothers' total SCB intake was positively associated with children's BMI ≤6 y of age [per serving per day: 0.04 SD score (SDS); 95% CI: 0.00, 0.07 SDS]. In addition, intakes of total SCBs and fruit juice, but not of soda or concentrate, were associated with a higher FMI [total SCBs: 0.05 SDS (95% CI: 0.01, 0.08 SDS); fruit juice: 0.04 SDS (95% CI: 0.01, 0.06 SDS)] of the 6-y-old children. These associations remained significant (P < 0.05) after additional adjustment for gestational weight gain, birth weight, and children's insulin concentrations.Conclusion: Our study suggests that maternal SCB intake during pregnancy is positively associated with children's BMI during early childhood and particularly with higher fat mass.
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Affiliation(s)
- Vincent Jen
- Generation R Study Group and.,Departments of Epidemiology
| | | | | | | | - Vincent Wv Jaddoe
- Generation R Study Group and.,Departments of Epidemiology.,Pediatrics, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Trudy Voortman
- Generation R Study Group and .,Departments of Epidemiology
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Hasan MT, Soares Magalhães RJ, Williams GM, Mamun AA. Long-term changes in childhood malnutrition are associated with long-term changes in maternal BMI: evidence from Bangladesh, 1996-2011. Am J Clin Nutr 2016; 104:1121-1127. [PMID: 27581468 DOI: 10.3945/ajcn.115.111773] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/18/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Nutritional transition (from under- to overnutrition) among women of reproductive age (15-49 y) is becoming increasingly common in many developing countries, including Bangladesh. However, the influence of this transition on the nutritional status of children <5 y of age (U5s) is unknown. OBJECTIVES The aim was to determine whether a nutritional transition has taken place in the past 15 y (1996-2011) among U5s and their mothers in Bangladesh and to examine how the association between maternal body mass index (BMI) and malnutrition in U5s has changed over time. DESIGN We analyzed data assembled from 5 Demographic and Health Surveys conducted between 1996 and 2011 in Bangladesh to describe the nutritional status of 28,941 U5s and their mothers. A Poisson regression model was used to examine the associations between maternal BMI and stunting, underweight, and wasting in U5s over time. RESULTS A nutritional transition among mothers of U5s was observed between 1996 and 2011. The height- or length-for-age and weight-for-age z score distributions of U5s showed consistent improvement; however, there was no indication of a nutritional transition. An interaction was found between maternal BMI categorized as underweight [BMI (kg/m2) <18.5], healthy BMI (BMI: 18.5-24.9), and overweight or obese (BMI ≥25) and year of survey on the risks of stunting and underweight in children. In 1996, children of underweight mothers had a 5% higher risk of being stunted than those born to healthy-BMI mothers (RR: 1.05; 95% CI: 1.00, 1.10); in 2011, children of underweight mothers had a 21% higher risk of being stunted (RR: 1.21; 95% CI: 1.13, 1.30). Maternal overweight or obesity was associated with a reduced risk of malnutrition in children. CONCLUSIONS A nutritional transition among U5s has yet to occur in Bangladesh. However, our results indicate that improvement in maternal BMI in the past 15 y was accompanied by a reduction in malnutrition in U5s.
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Affiliation(s)
| | - Ricardo J Soares Magalhães
- Children's Health Research Centre, The University of Queensland, Herston, Australia; and School of Veterinary Science, The University of Queensland, Gatton, Australia
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Korkmaz L, Baştuğ O, Kurtoğlu S. Maternal Obesity and its Short- and Long-Term Maternal and Infantile Effects. J Clin Res Pediatr Endocrinol 2016; 8:114-24. [PMID: 26758575 PMCID: PMC5096465 DOI: 10.4274/jcrpe.2127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Obesity, in childhood or in adulthood, remains to be a global health problem. The worldwide prevalence of obesity has increased in the last few decades, and consequently, the women of our time suffer more gestational problems than women in the past. The prevalence of obesity is greater in older women than in younger ones and in women with low educational level than in their counterparts with a higher level of education. Maternal obesity during pregnancy may increase congenital malformations and neonatal morbidity and mortality. Maternal obesity is associated with a decreased intention to breastfeed, decreased initiation of breastfeeding, and decreased duration of breastfeeding. We discuss the current epidemiological evidence for the association of maternal obesity with congenital structural neural tube and cardiac defects, fetal macrosomia that predisposes infants to birth injuries and to problems with physiological and metabolic transition, as well as potential for long-term complications secondary to prenatal and neonatal programming effects compounded by a reduction in sustained breastfeeding.
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Affiliation(s)
- Levent Korkmaz
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Kayseri, Turkey E-mail:
| | - Osman Baştuğ
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Kayseri, Turkey
| | - Selim Kurtoğlu
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Endocrinology, Kayseri, Turkey
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Cresswell JA, Campbell OMR, De Silva MJ, Slaymaker E, Filippi V. Maternal obesity and Caesarean delivery in sub-Saharan Africa. Trop Med Int Health 2016; 21:879-85. [PMID: 27118357 DOI: 10.1111/tmi.12713] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To quantify maternal obesity as a risk factor for Caesarean delivery in sub-Saharan Africa. METHODS Multivariable logistic regression analysis using 31 nationally representative cross-sectional data sets from the Demographic and Health Surveys (DHS). RESULTS Maternal obesity was a risk factor for Caesarean delivery in sub-Saharan Africa; a clear dose-response relationship (where the magnitude of the association increased with increasing BMI) was observable. Compared to women of optimal weight, overweight women (BMI 25-29 kg/m(2) ) were significantly more likely to deliver by Caesarean (OR: 1.54; 95% CI: 1.33, 1.78), as were obese women (30-34.9 kg/m(2) (OR: 2.39; 95%CI: 1.96-2.90); 35-39.9 kg/m(2) (OR: 2.47 95%CI: 1.78-3.43)) and morbidly obese women (BMI ≥40 kg/m(2) OR: 3.85; 95% CI: 2.46-6.00). CONCLUSIONS BMI is projected to rise substantially in sub-Saharan Africa over the next few decades and demand for Caesarean sections already exceeds available capacity. Overweight women should be advised to lose weight prior to pregnancy. Furthermore, culturally appropriate prevention strategies to discourage further population-level rises in BMI need to be designed and implemented.
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Affiliation(s)
- Jenny A Cresswell
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Oona M R Campbell
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Mary J De Silva
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Emma Slaymaker
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Veronique Filippi
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
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28
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Influence of metabolic-linked early life factors on the eruption timing of the first primary tooth. Clin Oral Investig 2015; 20:1871-1879. [PMID: 26620731 DOI: 10.1007/s00784-015-1670-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 11/18/2015] [Indexed: 01/22/2023]
Abstract
AIM Early eruption of permanent teeth has been associated with childhood obesity and diabetes mellitus, suggesting links between tooth eruption and metabolic conditions. This longitudinal study aimed to identify pre-, peri- and postnatal factors with metabolic consequences during infancy that may affect the eruption timing of the first primary tooth (ETFT) in children from an ethnically heterogeneous population residing within the same community. MATERIAL AND METHODS Participants were recruited (n = 1033) through the GUSTO (Growing Up in Singapore Towards healthy Outcomes) birth cohort (n = 1237). Oral examinations were performed at 3-month intervals from 6 to 18 months of age. Crude and adjusted analyses, with generalized linear modelling, were conducted to link ETFT to potential determinants occurring during pregnancy, delivery/birth and early infancy. RESULTS Overall mean eruption age of the first primary tooth was 8.5 (SD 2.6) months. Earlier tooth eruption was significantly associated with infant's rate of weight gain during the first 3 months of life and increased maternal childbearing age. Compared to their Chinese counterparts, Malay and Indian children experienced significantly delayed tooth eruption by 1.2 and 1.7 months, respectively. CONCLUSIONS Infant weight gain from birth to 3 months, ethnicity and maternal childbearing age were significant determinants of first tooth eruption timing. Early life influences can affect primary tooth development, possibly via metabolic pathways. CLINICAL RELEVANCE Timing of tooth eruption is linked to general growth and metabolic function. Therefore, it has potential in forecasting oral and systemic conditions such as caries and obesity.
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Maayan-Metzger A, Schushan-Eisen I, Strauss T, Globus O, Leibovitch L. Gestational weight gain and body mass indexes have an impact on the outcomes of diabetic mothers and infants. Acta Paediatr 2015; 104:1150-5. [PMID: 26303990 DOI: 10.1111/apa.13166] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 06/22/2015] [Accepted: 08/20/2015] [Indexed: 01/01/2023]
Abstract
AIM This study evaluated mothers with diabetes to determine whether prepregnancy body mass index (BMI), BMI on delivery or gestational weight gain (GWG) had the greatest impact on maternal and neonatal outcomes. METHODS We retrospectively examined the medical charts of 634 full-term infants born to mothers with gestational diabetes mellitus not requiring insulin (n = 476), gestational diabetes mellitus requiring insulin (n = 140) and insulin-dependent diabetes mellitus (n = 18). Data regarding maternal BMI before pregnancy and on delivery were recorded, as well as maternal and neonatal complications. RESULTS Infants born to women who gained more than the recommended weight during pregnancy had higher birthweights, higher rates of meconium-stained amniotic fluid and neonatal hypoglycaemia. Using logistic regression, Caesarean section delivery was predicted by gestational diabetes requiring insulin, with an odds ratio (OR) of 1.76, maternal hypertension (OR 2.4), infants born large for gestational age (OR 2.78) and maternal BMI ≥ 30 on delivery (OR 1.06). Neonatal complications were predicted by maternal insulin-dependent diabetes (OR 5.21), lower gestational age (OR 0.8) and GWG above the recommended amount (OR 1.56). CONCLUSION Women with diabetes should be made aware that higher GWG can lead to Caesarean section delivery, infant macrosomia and other neonatal complications.
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Affiliation(s)
- Ayala Maayan-Metzger
- Department of Neonatology; The Edmond and Lili Safra Children's Hospital; Sheba Medical Center and Sackler Faculty of Medicine; Tel Aviv University; Ramat-Gan Israel
| | - Irit Schushan-Eisen
- Department of Neonatology; The Edmond and Lili Safra Children's Hospital; Sheba Medical Center and Sackler Faculty of Medicine; Tel Aviv University; Ramat-Gan Israel
| | - Tzipora Strauss
- Department of Neonatology; The Edmond and Lili Safra Children's Hospital; Sheba Medical Center and Sackler Faculty of Medicine; Tel Aviv University; Ramat-Gan Israel
| | - Omer Globus
- Department of Neonatology; The Edmond and Lili Safra Children's Hospital; Sheba Medical Center and Sackler Faculty of Medicine; Tel Aviv University; Ramat-Gan Israel
| | - Leah Leibovitch
- Department of Neonatology; The Edmond and Lili Safra Children's Hospital; Sheba Medical Center and Sackler Faculty of Medicine; Tel Aviv University; Ramat-Gan Israel
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Onubi OJ, Marais D, Aucott L, Okonofua F, Poobalan AS. Maternal obesity in Africa: a systematic review and meta-analysis. J Public Health (Oxf) 2015; 38:e218-e231. [PMID: 26487702 PMCID: PMC5072166 DOI: 10.1093/pubmed/fdv138] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Maternal obesity is emerging as a public health problem, recently highlighted together with maternal under-nutrition as a ‘double burden’, especially in African countries undergoing social and economic transition. This systematic review was conducted to investigate the current evidence on maternal obesity in Africa. Methods MEDLINE, EMBASE, Scopus, CINAHL and PsycINFO were searched (up to August 2014) and identified 29 studies. Prevalence, associations with socio-demographic factors, labour, child and maternal consequences of maternal obesity were assessed. Pooled risk ratios comparing obese and non-obese groups were calculated. Results Prevalence of maternal obesity across Africa ranged from 6.5 to 50.7%, with older and multiparous mothers more likely to be obese. Obese mothers had increased risks of adverse labour, child and maternal outcomes. However, non-obese mothers were more likely to have low-birthweight babies. The differences in measurement and timing of assessment of maternal obesity were found across studies. No studies were identified either on the knowledge or attitudes of pregnant women towards maternal obesity; or on interventions for obese pregnant women. Conclusions These results show that Africa's levels of maternal obesity are already having significant adverse effects. Culturally adaptable/sensitive interventions should be developed while monitoring to avoid undesired side effects.
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Affiliation(s)
- Ojochenemi J Onubi
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Debbi Marais
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Lorna Aucott
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Friday Okonofua
- Department of Obstetrics and Gynaecology, College of Medical Sciences, University of Benin, Benin City, Edo State, Nigeria
| | - Amudha S Poobalan
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
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Khalak R, Cummings J, Dexter S. Maternal obesity: significance on the preterm neonate. Int J Obes (Lond) 2015; 39:1433-6. [PMID: 26051705 DOI: 10.1038/ijo.2015.107] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/17/2015] [Accepted: 05/31/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND What is known of neonatal outcomes associated with maternal obesity is limited. The impact on the preterm neonate, delivery room (DR) course and need for neonatal intensive care unit (NICU) admission has not been well established. METHODS A review was done of our 17 county perinatal regions from the New York State Perinatal Data System database over the 3-year period of 1 January 2010-31 December 2012 for mother/baby dyad information for all live births 34-36 6/7 weeks' gestation. The National Institutes of Health body mass index (BMI) classification was used for maternal BMI with the category definitions of underweight, normal, overweight, obese Level I, obese Level II, and obese Level III. RESULTS Information was obtained on 2155 women. In this group, 29% had obese BMIs. The incidence of pre-pregnancy diabetes mellitus (DM), DM during gestation and cesarean delivery (CD) in obese mothers was significantly different from normal weight mothers, P<0.001. More infants of Level III mothers required DR resuscitation when compared with infants of normal BMI mothers, 36 vs 16%, P <0.001. The need for assisted ventilation beyond 6 h of age and need for NICU admission was more likely in infants of Level III mothers, P<0.001. Women in all of the obese subgroups had preterm infants with increased birth weights (BWs) compared with preterm infants of normal weight mothers, P<0.001. DISCUSSION Late preterm infants born to obese mothers are more likely to be delivered by cesarean section and have larger BWs. We found that infants born to obese Level III mothers are much more likely to require assisted ventilation in the DR and NICU admission.
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Affiliation(s)
- R Khalak
- Division of Neonatology, Department of Pediatrics, Albany Medical Center, Albany, NY, USA
| | - J Cummings
- Division of Neonatology, Department of Pediatrics, Albany Medical Center, Albany, NY, USA
| | - S Dexter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY, USA
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Vinturache AE, McDonald S, Slater D, Tough S. Perinatal outcomes of maternal overweight and obesity in term infants: a population-based cohort study in Canada. Sci Rep 2015; 5:9334. [PMID: 25791339 PMCID: PMC4366803 DOI: 10.1038/srep09334] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 02/24/2015] [Indexed: 11/30/2022] Open
Abstract
The objective of this study was to assess the impact of increased pre-pregnancy maternal body mass index (BMI) on perinatal outcomes in term, singleton pregnancies who received prenatal care in community-based practices. The sample of 1996 infants included in the study was drawn from the All Our Babies Study, a prospective pregnancy cohort from Calgary. Multivariable logistic regression explored the relationship between the main outcomes, infant birth weight, Apgar score, admission to neonatal intensive care (NICU) and newborn duration of hospitalization, and BMI prior to pregnancy. Approximately 10% of the infants were macrosoms, 1.5% had a low Apgar score (<7 at 5 min), 6% were admitted to intensive care and 96% were discharged within 48 h after delivery. Although the infants of overweight and obese women were more likely to have increased birth weight as compared to infants of normal weight women, there were no differences in Apgar score, admission to NICU, or length of postnatal hospital stay among groups. This study suggests that in otherwise healthy term, singleton pregnancies, obesity does not seem to increase the risk of severe fetal impairment, neonatal admission to intensive care or duration of postnatal hospitalization.
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Affiliation(s)
- Angela Elena Vinturache
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
- Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
- Alberta Children's Hospital Research Institute for Child and Maternal Health (ACHRI), Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | - Sheila McDonald
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
- Alberta Children's Hospital Research Institute for Child and Maternal Health (ACHRI), Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | - Donna Slater
- Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
- Alberta Children's Hospital Research Institute for Child and Maternal Health (ACHRI), Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | - Suzanne Tough
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
- Alberta Children's Hospital Research Institute for Child and Maternal Health (ACHRI), Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
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Kamal SM, Hassan CH, Alam GM. Dual burden of underweight and overweight among women in Bangladesh: patterns, prevalence, and sociodemographic correlates. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2015; 33:92-105. [PMID: 25995726 PMCID: PMC4438653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The discourse of dual burden caused through underweight and overweight is well-documented globally but this issue and its connection with women's health in Bangladesh is yet to be explored widely. To enrich the current debate, this study, in the context of Bangladesh, examines the patterns, prevalence, and socioeconomic factors influencing the ever-married women of being underweight and overweight over normal weight. Data used in this study have been extracted from the most recent 2011 Bangladesh Demographic and Health Survey. To achieve results connected with the research objectives, both bivariate and multivariate statistical analyses have been employed. In bivariate analysis, we used seven categories of BMI cutoff points for Asian countries as prescribed by World Health Organization (WHO). Multinomial logistic regression model was constructed to investigate the net effect of socioeconomic factors on underweight, pre-overweight, and overweight over normal weight. The results confirm the co-existence of underweight and overweight among women as we found the prevalence of underweight, normal weight, pre-overweight, overweight, and obesity to be 24.1%, 46.7%, 12.8%, 13.5%, and 2.9% respectively. Compared to the richest, the women from the poorest households were significantly (p<0.001) most likely to be underweight (OR=2.75, 95% CI 2.27-3.35) and least likely to be overweight (OR=0.15, 95% CI 0.12-0.19) over normal weight. The urban women, compared to their rural counterparts, were significantly (p<0.001) less likely to be underweight (OR=0.80, 95% CI 0.71-0.91) and more likely to be overweight (OR=1.33, 95% CI 1.18-1.51) than normal weight. The other socioeconomic grades that were most marked to be underweight and overweight are age, women's education, marital status, age at first childbirth, parity, number of children aged ≤ 5 years at the household, and food security. The findings confirm the dual burden of both under- and overweight. Systematic and regular monitoring and surveillance of the social trajectory of nutritional status of women and men in Bangladesh is crucial to develop opposite strategy that addresses the persistent and chronic problem of underweight and the emerging problem of overweight. The dual existence of both types of malnutrition among women in Bangladesh must be taken into consideration so that public health interventions may be adopted through appropriate policy.
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Affiliation(s)
- S.M. Mostafa Kamal
- Department of Mathematics, Islamic University, Kushtia 7003, Bangladesh and Visiting Research Fellow, Unit for the Enhancement of Academic Performance, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Che Hashim Hassan
- Unit for the Enhancement of Academic Performance, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Gazi Mahabubul Alam
- Unit for the Enhancement of Academic Performance, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Murray R, Godfrey KM, Lillycrop KA. The Early Life Origins of Cardiovascular Disease. CURRENT CARDIOVASCULAR RISK REPORTS 2015. [DOI: 10.1007/s12170-015-0442-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gaudet L, Ferraro ZM, Wen SW, Walker M. Maternal obesity and occurrence of fetal macrosomia: a systematic review and meta-analysis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:640291. [PMID: 25544943 PMCID: PMC4273542 DOI: 10.1155/2014/640291] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 11/09/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine a precise estimate for the contribution of maternal obesity to macrosomia. DATA SOURCES The search strategy included database searches in 2011 of PubMed, Medline (In-Process & Other Non-Indexed Citations and Ovid Medline, 1950-2011), and EMBASE Classic + EMBASE. Appropriate search terms were used for each database. Reference lists of retrieved articles and review articles were cross-referenced. METHODS OF STUDY SELECTION All studies that examined the relationship between maternal obesity (BMI ≥30 kg/m(2)) (pregravid or at 1st prenatal visit) and fetal macrosomia (birth weight ≥4000 g, ≥4500 g, or ≥90th percentile) were considered for inclusion. TABULATION, INTEGRATION, AND RESULTS Data regarding the outcomes of interest and study quality were independently extracted by two reviewers. Results from the meta-analysis showed that maternal obesity is associated with fetal overgrowth, defined as birth weight ≥ 4000 g (OR 2.17, 95% CI 1.92, 2.45), birth weight ≥4500 g (OR 2.77,95% CI 2.22, 3.45), and birth weight ≥90% ile for gestational age (OR 2.42, 95% CI 2.16, 2.72). CONCLUSION Maternal obesity appears to play a significant role in the development of fetal overgrowth. There is a critical need for effective personal and public health initiatives designed to decrease prepregnancy weight and optimize gestational weight gain.
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Affiliation(s)
- Laura Gaudet
- University of Ottawa, Faculty of Medicine, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6
- Ottawa Hospital Research Institute, Ottawa, ON, Canada K1H 8L6
| | - Zachary M. Ferraro
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6
- Healthy Active Living and Obesity (HALO) Research Group, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada K1H 8L1
| | - Shi Wu Wen
- Ottawa Hospital Research Institute, Ottawa, ON, Canada K1H 8L6
| | - Mark Walker
- University of Ottawa, Faculty of Medicine, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6
- Ottawa Hospital Research Institute, Ottawa, ON, Canada K1H 8L6
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Cameron CM, Shibl R, McClure RJ, Ng SK, Hills AP. Maternal pregravid body mass index and child hospital admissions in the first 5 years of life: results from an Australian birth cohort. Int J Obes (Lond) 2014; 38:1268-74. [PMID: 25059115 DOI: 10.1038/ijo.2014.148] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/27/2014] [Accepted: 07/18/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To examine the association of maternal pregravid body mass index (BMI) and child offspring, all-cause hospitalisations in the first 5 years of life. METHODS Prospective birth cohort study. From 2006 to 2011, 2779 pregnant women (2807 children) were enrolled in the Environments for Healthy Living: Griffith birth cohort study in South-East Queensland, Australia. Hospital delivery record and self-report baseline survey of maternal, household and demographic factors during pregnancy were linked to the Queensland Hospital Admitted Patients Data Collection from 1 November 2006 to 30 June 2012, for child admissions. Maternal pregravid BMI was classified as underweight (<18.5 kg m(-)(2)), normal weight (18.5-24.9 kg m(-)(2)), overweight (25.0-29.9 kg m(-)(2)) or obese (⩾30 kg m(-)(2)). Main outcomes were the total number of child hospital admissions and ICD-10-AM diagnostic groupings in the first 5 years of life. Negative binomial regression models were calculated, adjusting for follow-up duration, demographic and health factors. The cohort comprised 8397.9 person years (PYs) follow-up. RESULTS Children of mothers who were classified as obese had an increased risk of all-cause hospital admissions in the first 5 years of life than the children of mothers with a normal BMI (adjusted rate ratio (RR) =1.48, 95% confidence interval 1.10-1.98). Conditions of the nervous system, infections, metabolic conditions, perinatal conditions, injuries and respiratory conditions were excessive, in both absolute and relative terms, for children of obese mothers, with RRs ranging from 1.3-4.0 (PYs adjusted). Children of mothers who were underweight were 1.8 times more likely to sustain an injury or poisoning than children of normal-weight mothers (PYs adjusted). CONCLUSION RESULTS suggest that if the intergenerational impact of maternal obesity (and similarly issues related to underweight) could be addressed, a significant reduction in child health care use, costs and public health burden would be likely.
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Affiliation(s)
- C M Cameron
- 1] Centre of National Research on Disability and Rehabilitation, School of Human Services and Social Work, Griffith University, Griffith, Queensland, Australia [2] Griffith Health Institute, Griffith University, Griffith, Queensland, Australia
| | - R Shibl
- Faculty of Business, Queensland University of Technology, Brisbane, Queensland, Australia
| | - R J McClure
- Monash Injury Research Institute, Monash University, Monash, Victoria, Australia
| | - S-K Ng
- 1] Griffith Health Institute, Griffith University, Griffith, Queensland, Australia [2] School of Medicine, Griffith University, Griffith, Queensland, Australia
| | - A P Hills
- 1] Griffith Health Institute, Griffith University, Griffith, Queensland, Australia [2] Mater Mothers' Hospital, Mater Research Institute - University of Queensland, Brisbane, Queensland, Australia
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Meehan S, Beck CR, Mair-Jenkins J, Leonardi-Bee J, Puleston R. Maternal obesity and infant mortality: a meta-analysis. Pediatrics 2014; 133:863-71. [PMID: 24709933 DOI: 10.1542/peds.2013-1480] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite numerous studies reporting an elevated risk of infant mortality among women who are obese, the magnitude of the association is unclear. A systematic review and meta-analysis was undertaken to assess the association between maternal overweight or obesity and infant mortality. METHODS Four health care databases and gray literature sources were searched and screened against the protocol eligibility criteria. Observational studies reporting on the relationship between maternal overweight and obesity and infant mortality were included. Data extraction and risk of bias assessments were performed. RESULTS Twenty-four records were included from 783 screened. Obese mothers (BMI ≥30) had greater odds of having an infant death (odds ratio 1.42; 95% confidence interval, 1.24-1.63; P < .001; 11 studies); these odds were greatest for the most obese (BMI >35) (odds ratio 2.03; 95% confidence interval, 1.61-2.56; P < .001; 3 studies). CONCLUSIONS Our results suggest that the odds of having an infant death are greater for obese mothers and that this risk may increase with greater maternal BMI or weight; however, residual confounding may explain these findings. Given the rising prevalence of maternal obesity, additional high-quality epidemiologic studies to elucidate the actual influence of elevated maternal mass or weight on infant mortality are needed. If a causal link is determined and the biological basis explained, public health strategies to address the issue of maternal obesity will be needed.
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Affiliation(s)
- Sean Meehan
- Division of Epidemiology & Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, England
| | - Charles R Beck
- Division of Epidemiology & Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, England
| | - John Mair-Jenkins
- East Midlands Centre, Public Health England, Institute of Population Health, City Hospital, Nottingham, England
| | - Jo Leonardi-Bee
- Division of Epidemiology & Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, England
| | - Richard Puleston
- Division of Epidemiology & Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, England;
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May L, Suminski R, Berry A, Linklater E, Jahnke S. Diet and pregnancy: health-care providers and patient behaviors. J Perinat Educ 2014; 23:50-6. [PMID: 24453468 PMCID: PMC3894597 DOI: 10.1891/1058-1243.23.1.50] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In this study, associations between health-care providers (HCPs) discussing diet with their pregnant patients and patient dietary behavior were assessed in addition to factors related to HCPs discussing diet with their patients. Questionnaires were completed by 237 pregnant women and 31 HCPs at 12 obstetrics-gynecology clinics across the United States. Patients provided versus those not provided dietary counseling by their HCP were more likely (OR = 2.17, 95%; CI = 0.75-6.25) to engage in healthy dietary practices. HCPs that discussed multiple health behaviors were nearly four times more likely to discuss diet with their pregnant patients compared with HCP who did not discuss other health behaviors (OR = 3.67, 95%; CI = 1.10-12.28). This study indicates that HCP education can positively impact dietary behaviors of their pregnant patients.
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Genetic analysis of low BMI phenotype in the Utah Population Database. PLoS One 2013; 8:e80287. [PMID: 24348998 PMCID: PMC3859471 DOI: 10.1371/journal.pone.0080287] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 10/11/2013] [Indexed: 01/29/2023] Open
Abstract
The low body mass index (BMI) phenotype of less than 18.5 has been linked to medical and psychological morbidity as well as increased mortality risk. Although genetic factors have been shown to influence BMI across the entire BMI, the contribution of genetic factors to the low BMI phenotype is unclear. We hypothesized genetic factors would contribute to risk of a low BMI phenotype. To test this hypothesis, we conducted a genealogy data analysis using height and weight measurements from driver's license data from the Utah Population Data Base. The Genealogical Index of Familiality (GIF) test and relative risk in relatives were used to examine evidence for excess relatedness among individuals with the low BMI phenotype. The overall GIF test for excess relatedness in the low BMI phenotype showed a significant excess over expected (GIF 4.47 for all cases versus 4.10 for controls, overall empirical p-value<0.001). The significant excess relatedness was still observed when close relationships were ignored, supporting a specific genetic contribution rather than only a family environmental effect. This study supports a specific genetic contribution in the risk for the low BMI phenotype. Better understanding of the genetic contribution to low BMI holds promise for weight regulation and potentially for novel strategies in the treatment of leanness and obesity.
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Britto RPDA, Florêncio TMT, Benedito Silva AA, Sesso R, Cavalcante JC, Sawaya AL. Influence of maternal height and weight on low birth weight: a cross-sectional study in poor communities of northeastern Brazil. PLoS One 2013; 8:e80159. [PMID: 24244636 PMCID: PMC3823865 DOI: 10.1371/journal.pone.0080159] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 10/09/2013] [Indexed: 11/30/2022] Open
Abstract
Background Low birth weight (LBW) is associated with an increased risk of mortality, adverse metabolic conditions, and long-term chronic morbidities. The relationship between LWB and short maternal stature coupled with nutritional status was investigated in poor communities. Methods/Principal Findings A cross-sectional population-based study involving 2226 mother-child pairs was conducted during the period 2009-2010 in shantytowns of Maceió, Alagoas, Brazil. Associations between LBW and maternal sociodemographics, stature and nutritional status were investigated. The outcome variable was birth weight (< 2500g and ≥ 2500g). The independent variables were the age, income, educational background, stature and nutritional status (eutrophic, underweight, overweight and obese) of the mother. The frequency of LBW was 10%. Short-statured mothers (1st quartile of stature ≤ 152cm) showed a tendency of increased risk of LBW children compared to mothers in the 4th quartile of stature (>160.4cm) (OR: 1.42, 95% CI: 0.96 - 1.09, p = 0.078). Children from short-statured mothers weighed an average of 125g less than those from taller mothers (3.18±0.56kg vs. 3.30±0.58kg, respectively p = 0.002). Multivariate analyses showed that short stature, age < 20y (OR: 3.05, 95% CI:1.44 - 6.47) or were underweight (OR: 2.26, 95% CI:0.92 - 5.95) increased the risk of LBW, while overweight (OR: 0.38, 95% CI:0.16 - 0.95) and obesity (OR: 0.39, 95% CI:0.11 - 1.31) had lower risk for LBW. In taller mothers, lower income and underweight were associated with LBW (OR: 1.88, 95% CI: 1.07 - 3.29 and 2.85, 95% CI:1.09 - 7.47, respectively), and obese mothers showed a trend of increased risk of LBW (OR: 1.66, 95% CI:0.84 - 3.25). Conclusions/Significance Overweight was found to have a protective effect in short-statured mothers, indicating that a surplus of energy may diminish the risk of LBW. Short-statured younger mothers, but not taller ones, showed higher risk of LBW. The mother being underweight, regardless of stature, was associated with LBW.
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Affiliation(s)
- Revilane Parente de Alencar Britto
- Programa de Pós-graduação em Ciências Endocrinológicas, Escola Paulista de Medicina, Universidade Federal de São Paulo, Vila Clementino, São Paulo, São Paulo, Brazil
- * E-mail:
| | | | - Ana Amelia Benedito Silva
- Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, Ermelino Matarazzo, São Paulo, São Paulo, Brazil
| | - Ricardo Sesso
- Department of Medicine, Division of Nephrology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Vila Clementino, São Paulo, São Paulo, Brazil
| | - Jairo Calado Cavalcante
- Faculdade de Medicina, Universidade Federal de Alagoas, Campus A. C. Simões, Maceió, Alagoas, Brazil
| | - Ana Lydia Sawaya
- Programa de Pós-graduação em Ciências Endocrinológicas, Escola Paulista de Medicina, Universidade Federal de São Paulo, Vila Clementino, São Paulo, São Paulo, Brazil
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Yu Z, Han S, Zhu J, Sun X, Ji C, Guo X. Pre-pregnancy body mass index in relation to infant birth weight and offspring overweight/obesity: a systematic review and meta-analysis. PLoS One 2013; 8:e61627. [PMID: 23613888 PMCID: PMC3628788 DOI: 10.1371/journal.pone.0061627] [Citation(s) in RCA: 539] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 03/12/2013] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Overweight/obesity in women of childbearing age is a serious public-health problem. In China, the incidence of maternal overweight/obesity has been increasing. However, there is not a meta-analysis to determine if pre-pregnancy body mass index (BMI) is related to infant birth weight (BW) and offspring overweight/obesity. METHODS Three electronic bibliographic databases (MEDLINE, EMBASE and CINAHL) were searched systematically from January 1970 to November 2012. The dichotomous data on pre-pregnancy overweight/obesity and BW or offspring overweight/obesity were extracted. Summary statistics (odds ratios, ORs) were used by Review Manager, version 5.1.7. RESULTS After screening 665 citations from three electronic databases, we included 45 studies (most of high or medium quality). Compared with normal-weight mothers, pre-pregnancy underweight increased the risk of small for gestational age (SGA) (odds ratios [OR], 1.81; 95% confidence interval [CI], 1.76-1.87); low BW (OR, 1.47; 95% CI, 1.27-1.71). Pre-pregnancy overweight/obesity increased the risk of being large for gestational age (LGA) (OR, 1.53; 95% CI, 1.44-1.63; and OR, 2.08; 95% CI; 1.95-2.23), high BW (OR, 1.53; 95% CI, 1.44-1.63; and OR, 2.00; 95% CI; 1.84-2.18), macrosomia (OR, 1.67; 95% CI, 1.42-1.97; and OR, 3.23; 95% CI, 2.39-4.37), and subsequent offspring overweight/obesity (OR, 1.95; 95% CI, 1.77-2.13; and OR, 3.06; 95% CI, 2.68-3.49), respectively. Sensitivity analyses revealed that sample size, study method, quality grade of study, source of pre-pregnancy BMI or BW had a strong impact on the association between pre-pregnancy obesity and LGA. No significant evidence of publication bias was observed. CONCLUSIONS Pre-pregnancy underweight increases the risk of SGA and LBW; pre-pregnancy overweight/obesity increases the risk of LGA, HBW, macrosomia, and subsequent offspring overweight/obesity. A potential effect modification by maternal age, ethnicity, gestational weight gain, as well as the role of gestational diseases should be addressed in future studies.
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Affiliation(s)
- Zhangbin Yu
- State Key Laboratory of Reproductive Medicine, Department of Pediatrics, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
| | - Shuping Han
- State Key Laboratory of Reproductive Medicine, Department of Pediatrics, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
| | - Jingai Zhu
- State Key Laboratory of Reproductive Medicine, Department of Pediatrics, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaofan Sun
- State Key Laboratory of Reproductive Medicine, Department of Pediatrics, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
| | - Chenbo Ji
- State Key Laboratory of Reproductive Medicine, Department of Pediatrics, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
| | - Xirong Guo
- State Key Laboratory of Reproductive Medicine, Department of Pediatrics, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
- * E-mail:
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Sharifirad GR, Tol A, Mohebi S, Matlabi M, Shahnazi H, Shahsiah M. The effectiveness of nutrition education program based on health belief model compared with traditional training. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2013; 2:15. [PMID: 24083265 PMCID: PMC3778581 DOI: 10.4103/2277-9531.112684] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION This study was aimed to compare the effect of nutrition educational program based on HBM with traditional education recommended weight gain among pregnant women in Gonabad. Target population was pregnant women who were resided in Gonabad and went to urban health care centers for prenatal cares. MATERIALS AND METHODS 110 pregnant women (case group: 54, control group: 56) were selected who had come to this centers in the first stage of prenatal care (6th -10th week of pregnancy) in 1388 and were consequently classified in case and control group. There is no significant difference for age, education, number of parity, history of abortion and job between case and control groups. RESULTS There was no significant differences in nutritional behavior mean score before intervention in case (74.42 ± 12.78) and control (77.14 ± 15.35) groups (P value = 0.82, independent t- test); but after education, intervention was significant in nutritional behavior between two groups (P value = 0.01, independent t-test); DISCUSSION after intervention, there also was significant difference in HBM structures mean score in case group compare with control group and the highest rise in score was related to perceived benefits (15.13 increment).
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Affiliation(s)
- Gholam Reza Sharifirad
- Department of Education & Health Promotion, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azar Tol
- Department of Education & Health Promotion, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Siamak Mohebi
- Department of Health, Qom University of Medical Sciences, Qom, Iran
| | - Mohammad Matlabi
- Department of Health, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Hossein Shahnazi
- Department of Education & Health Promotion, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Shahsiah
- Department of Health, Qom University of Medical Sciences, Qom, Iran
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Minsart AF, Buekens P, De Spiegelaere M, Englert Y. Neonatal outcomes in obese mothers: a population-based analysis. BMC Pregnancy Childbirth 2013; 13:36. [PMID: 23398843 PMCID: PMC3575268 DOI: 10.1186/1471-2393-13-36] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 01/31/2013] [Indexed: 11/16/2022] Open
Abstract
Background If it is well known that obesity increases morbidity for both mother and fetus and is associated with a variety of adverse reproductive outcomes, then few studies have assessed the relation between obesity and neonatal outcomes. This is the aim of the present study after taking into account type of labor and delivery, as well as social, medical and hospital characteristics in a population-based analysis. Methods This study used 2009 data from the Belgian birth register data pertaining to the regions of Brussels and Wallonia and included 38,675 consecutive births. Odds ratio and 95% confidence intervals for admission to neonatal intensive care unit, Apgar score, and perinatal mortality were calculated by logistic regression analyses adjusting for medical, social and hospital characteristics using obesity as the primary independent variable. The impact of analyzing all delivery sites together was tested using mixed-effect analyses. Results The adjusted odds ratio for neonatal intensive care unit admission was higher for obese mothers by 38% compared to non-obese mothers (95% confidence interval (CI): 1.22-1.56), and by 45% (CI: 1.21-1.73) and 34% (CI: 1.10-1.63) after spontaneous and induced labour respectively. The adjusted odds ratio was 1.18 (CI: 0.86-1.63) after caesarean section. The adjusted odds ratio for 1 minute Apgar score inferior to 7 was higher for obese mothers by 31% compared to non-obese mothers (CI: 1.15-1.49) and by 26% (CI: 1.04-1.52) and 38% (CI: 1.12-1.69) after spontaneous and induced labour respectively. The adjusted odds ratio was 1.50 (CI: 0.96-2.36) after caesarean section. The adjusted odds ratio for perinatal mortality was 1.36 (CI: 0.75-2.45) for obese mothers compared to non-obese mothers. Conclusions Neonatal admission to intensive care and low Apgar scores were more likely to occur in infants from obese mothers, both after spontaneous and induced labor.
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Affiliation(s)
- Anne-Frederique Minsart
- Perinatal Epidemiology Center 'CEpiP' School of Public Health, University Hospital Erasme and Faculty of Medicine, Université Libre de Bruxelles, Brussels 1070, Belgium.
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Kaplan-Sturk R, Åkerud H, Volgsten H, Hellström-Westas L, Wiberg-Itzel E. Outcome of deliveries in healthy but obese women: obesity and delivery outcome. BMC Res Notes 2013; 6:50. [PMID: 23388378 PMCID: PMC3573993 DOI: 10.1186/1756-0500-6-50] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 01/22/2013] [Indexed: 11/29/2022] Open
Abstract
Background Obesity among fertile women is a global problem. 25% of pregnant Swedish women are overweight at admission to the antenatal clinic and 12% of them are considered as obese. Previous studies have shown an increased risk of delivery complications with an elevated maternal BMI. The aim of this study was to evaluate delivery outcomes in relation to maternal BMI on admission to the antenatal clinic. A healthy group of 787 women with full-term pregnancies and spontaneous onset of labor were included in the study. Delivery outcome was assessed in relation to maternal BMI when attending the antenatal clinic. Results The results indicated that in deliveries where the maternal BMI was >30 a high frequency of abnormal CTG trace during the last 30 minutes of labor was shown. A blood sample for evaluation of risk of fetal hypoxia was performed in only eight percent of these deliveries. A spontaneous vaginal delivery without intervention was noted in 85.7%, and 12% of neonates were delivered with an adverse fetal outcome compared to 2.8% in the group with a maternal BMI<30 (p<0.001). Conclusion These results indicate an increased risk at delivery for healthy, but obese women in labor. Furthermore, the delivery management may not always be optimal in these deliveries.
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Affiliation(s)
- Rebecka Kaplan-Sturk
- Department of Clinical Science and Education, Section of Obstetrics and Gynecology, Karolinska Institute, Soder Hospital, Stockholm 118 83, Sweden
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Watson M, Howell S, Johnston T, Callaway L, Khor SL, Cornes S. Pre-pregnancy BMI: Costs associated with maternal underweight and obesity in Queensland. Aust N Z J Obstet Gynaecol 2013; 53:243-9. [DOI: 10.1111/ajo.12031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 11/04/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Melanie Watson
- Statistical Analysis Unit; Health Statistics Centre; Queensland Health; Brisbane; Australia
| | - Stuart Howell
- Statistical Analysis Unit; Health Statistics Centre; Queensland Health; Brisbane; Australia
| | - Trisha Johnston
- Statistical Analysis Unit; Health Statistics Centre; Queensland Health; Brisbane; Australia
| | - Leonie Callaway
- Royal Brisbane Clinical School; School of Medicine; The University of Queensland Brisbane; Brisbane; Australia
| | - Sue-Lynne Khor
- Statistical Analysis Unit; Health Statistics Centre; Queensland Health; Brisbane; Australia
| | - Sue Cornes
- Health Statistics Centre; Queensland Health; Brisbane; Australia
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Cresswell JA, Campbell OMR, De Silva MJ, Filippi V. Effect of maternal obesity on neonatal death in sub-Saharan Africa: multivariable analysis of 27 national datasets. Lancet 2012; 380:1325-30. [PMID: 22884609 DOI: 10.1016/s0140-6736(12)60869-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Rates of obesity are increasing worldwide, including in sub-Saharan Africa. Neonates born to obese mothers in low-income settings are at increased risk of complications including admission to neonatal intensive care, macrosomia, low Apgar scores, and perinatal death. We investigated whether maternal obesity is a risk factor for neonatal death in sub-Saharan Africa and the effect on the detailed timing of death within the neonatal period. METHODS Cross-sectional Demographic and Health Surveys from 27 sub-Saharan countries (2003-09) were pooled. We used multivariable logistic regression to assess the risk of neonatal death (in women's most recent singleton livebirth in the 5 years preceding the survey) by maternal body-mass index (BMI) category (measured during the survey). Timing of death was investigated with a discrete-time survival model. FINDINGS 15,518 of 81,126 eligible women were overweight (4266 were obese), 52,006 had an optimum BMI, and 13,602 were underweight. Maternal obesity was associated with an increased odds of neonatal death after adjustment for confounding factors (adjusted odds ratio 1·46, 95% CI 1·11-1·91). Maternal obesity was a significant risk factor for neonatal deaths occurring during the first 2 days of life (1·62, 1·11-2·37). We noted no statistically significant relation later in the neonatal period (days 2-6 1·36, 0·84-2·21; days 7-27 1·19, 0·65-2·18), possibly because of low statistical power. INTERPRETATION Maternal obesity in sub-Saharan Africa is associated with increased risk of early neonatal death. Potential mechanisms include prematurity, intrapartum events, or infections. Strategies to prevent and reduce obesity need to be considered; obese women should be advised to deliver in a health-care facility that can provide emergency obstetric and neonatal care. FUNDING Economic and Social Research Council.
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Affiliation(s)
- Jenny A Cresswell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Zaballa K, Liu A, Peek MJ, Mongelli M, Nanan R. Association between World Health Organization categories of body mass index and relative risks for weight-related pregnancy outcomes: a retrospective cohort study. Obstet Med 2012; 5:112-8. [PMID: 27582867 DOI: 10.1258/om.2012.110091] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To analyse the dose-dependent effect of body mass index (BMI) categories for common pregnancy outcomes. METHODS A retrospective cohort study of all deliveries that occurred between 1 January 2005 and 31 December 2009 in a tertiary maternity centre, in Sydney Australia. Common pregnancy outcomes were analysed against World Health Organization (WHO) BMI categories using multiple logistic regression analysis. RESULTS From a total of 18,304 pregnancies, 9087 singleton pregnancies with complete data-sets were identified. Of these pregnancies, 4000 (44%) had a normal BMI, 470 (5.2%) were underweight, 2293 (25.2%) were overweight, 1316 (14.5%) were obese class I, 630 (6.9%) were obese class II and 378 (4.2%) were obese class III. Using the normal BMI category as the reference, there was a clear dose effect of BMI categories for hypertension (P < 0.001), pre-eclampsia (P < 0.001), caesarean section (P < 0.001), macrosomia (P < 0.001), large for gestational age (P < 0.001), small for gestational age (P < 0.001) and neonatal respiratory distress (P = 0.039). In contrast, despite a significant association with BMI (P < 0.001), a dose-dependent effect was not found for gestational diabetes. CONCLUSION The results of our study have important clinical significance as the data, using WHO BMI categories, more accurately help stratify risk assessment in a clinically relevant dose-dependent relationship.
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Affiliation(s)
| | | | - Michael John Peek
- Discipline of Obstetrics, Gynaecology and Neonatology, Sydney Medical School Nepean, The University of Sydney, Nepean Hospital Penrith , NSW 2751 , Australia
| | - Max Mongelli
- Discipline of Obstetrics, Gynaecology and Neonatology, Sydney Medical School Nepean, The University of Sydney, Nepean Hospital Penrith , NSW 2751 , Australia
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Sandin-Bojö AK, Hashimoto M, Kanal K, Sugiura Y. Intrapartum care at a tertiary hospital in Cambodia: a survey using the Bologna Score. Midwifery 2011; 28:e880-5. [PMID: 22172744 DOI: 10.1016/j.midw.2011.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 07/26/2011] [Accepted: 10/31/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND developing countries strive to reduce maternal- and child mortality, partly through establishing health centres/hospitals with skilled birth attendants. The aim of this study was to describe childbirth care, by the use of the Bologna Score at a tertiary hospital in Cambodia with approximately 8,500 births per year. METHODS a prospective cross-sectional study. The Bologna Score instrument, which reflects the adaption of evidence-based care and attitudes of caregivers, was used for data collection and three study specific questions. The midwives collected data from 177 consecutive childbirths. RESULTS all women were assisted by a skilled birth attendant, the majority by a midwife (63%) and the remaining women by a physician (35%) or midwife student under supervision. A spontaneous vaginal birth was planned for 82% of the women. All women seeking care at the hospital survived the childbirth. A full 5-point Bologna Score, suggesting evidence-based management for women with spontaneous vaginal birth, was not achieved for any of the women. The use of supine position and lack of an accompanying person in the birth room, were items responsible for loss of points. Partogram and skin-to-skin contact between baby and mother were items noted for three quarters of the planned vaginal births, and the item 'Absence of labour augmentation', was affirmed to a great extent. Little more than half of the women had an episiotomy and almost 16% of the children had an Apgar score <7 at 5 mins. CONCLUSION the Bologna Score was easy to use and pointed at items that could be improved. It was satisfying that all women survived, but alarming that 16% of the children had a low Apgar score. The findings suggest that childbirth care can be improved at the hospital.
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Affiliation(s)
- A-K Sandin-Bojö
- Karlstad University, Department of Nursing, Karlstad and The Women's Department, The central hospital of Karlstad, Sweden.
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Hocher B, Schlemm L, Haumann H, Jian Li, Rahnenführer J, Guthmann F, Bamberg C, Kalk P, Pfab T, Chen YP. Offspring sex determines the impact of the maternal ACE I/D polymorphism on maternal glycaemic control during the last weeks of pregnancy. J Renin Angiotensin Aldosterone Syst 2011; 12:254-61. [PMID: 21393357 DOI: 10.1177/1470320310387843] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED HYPOTHESIS/ INTRODUCTION: : We recently demonstrated that fetal sex may affect maternal glycaemic control in genetically prone mothers. We tested the hypothesis that fetal sex/fetal Y/X chromosomes might affect maternal glycaemic control during pregnancy depending on the maternal angiotensin converting enzyme (ACE) I/D polymorphism. MATERIAL AND METHODS : One thousand, three hundred and thirty-two Caucasian women without pre-existing diabetes and pre-existing hypertension with singleton pregnancies delivering consecutively at the Charité obstetrics department were genotyped. Glycaemic control was analysed by measuring total glycated haemoglobin at birth. Correction for confounding factors and multiple testing was done. RESULTS : Maternal ACE I/D polymorphism showed significant interaction with fetal sex concerning maternal total glycated haemoglobin. Total glycated haemoglobin in DD mothers delivering boys was 6.42 ± 0.70% vs. 6.21 ± 0.66% in DD mother delivering girls (p < 0.005), whereas the II carrying mothers showed the opposite effect. II mothers delivering a girl had a higher (p = 0.044) total glycated haemoglobin at birth (6.40 ± 0.80%) compared to II mothers delivering boys (6.21 ± 0.81%). There was no interaction of the ACE I/D polymorphism and fetal sex with respect to new onset proteinuria, new onset edema and pregnancy-induced hypertension. CONCLUSIONS : Maternal glycaemic control during the last weeks of pregnancy seems to be influenced by an interaction of the ACE I/D genotyp and fetal sex.
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Affiliation(s)
- Berthold Hocher
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany.
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Intra- and inter-household differences in antenatal care, delivery practices and postnatal care between last neonatal deaths and last surviving children in a peri-urban area of India. J Biosoc Sci 2010; 42:511-30. [PMID: 20202272 DOI: 10.1017/s0021932010000040] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Nearly a quarter of the world's neonatal deaths take place in India. The state of Uttar Pradesh alone accounts for one-quarter of all neonatal deaths in the country. In this study 892 married women aged less than 50 years living in a peri-urban area of Kanpur city in Uttar Pradesh were interviewed. In all, 109 women reported neonatal deaths. Characteristics of the last neonatal deaths of these 109 women were compared with those of the last surviving children. Also, characteristics of women who had a neonatal death were compared with those of 783 women who had no neonatal death. It was found that as compared with neonatal deaths, the last surviving children of the 109 women had: (a) significantly better antenatal tests during pregnancy, intake of iron/folic acid tablets and higher percentage of tetanus toxoid immunization; (b) safer delivery practices such as a higher percentage of institutional delivery, sterilization of instruments and application of antiseptic after removal of umbilical cord; (c) postnatal care, such as application of antiseptic to the navel and postnatal checkups; and (d) higher maternal age and greater birth spacing. Likewise, better antenatal care and safer delivery practices and postnatal care were observed among the 783 women with no neonatal deaths, when compared with women who had experienced neonatal death. The complexities of inter- and intra-household differences in health care are discussed. The paper concludes that to improve child survival general education and awareness regarding safe delivery should be increased. Continuing cultural stigmas and misconceptions about birth practices before, during and after childbirth should be an important part of the awareness campaigns.
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