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Chen L, Ma J, Su G, Yin L, Jiang X, Wang X, Liu L, Zhang X, Xu X, Li S, Zhang G, Zhao R, Yu L. The dynamic nexus: exploring the interplay of BMI before, during, and after pregnancy with Metabolic Syndrome (MetS) risk in Chinese lactating women. BMC Public Health 2023; 23:2423. [PMID: 38053120 PMCID: PMC10699078 DOI: 10.1186/s12889-023-17344-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND AND AIM The health implications of BMI and MetS in lactating women are significant. This study aims to investigate the relationship between risk of Mets in lactation and BMI in four stages: pre-pregnancy, prenatal period, 42 days postpartum, and current lactation. METHODS AND RESULTS A total of 1870 Lactating Women within 2 years after delivery were included from "China Child and Lactating Mother Nutrition Health Surveillance (2016-2017)". Logistic regression model and Restricted cubic spline (RCS) were used to estimate the relationship between BMI and risk of MetS. ROC analysis was used to determine the threshold for the risk of MetS. Chain mediating effect analysis was used to verify the mediating effect. BMI of MetS group in all stages were higher than non-MetS group (P < 0.0001). There were significant positive correlations between BMI in each stage and ORs of MetS during lactation (P < 0.05). The best cut-off values for BMI in the four stages were 23.47, 30.49, 26.04 and 25.47 kg/m2. The non-linear spline test at BMI in 42 days postpartum, current and MetS in lactation was statistically significant (P non-linear = 0.0223, 0.0003). The mediation effect of all chains have to work through lactation BMI. The total indirect effect accounted for 80.95% of the total effect. CONCLUSIONS The risk of MetS in lactating women is due to a high BMI base before pregnancy and postpartum. High BMI in all stages of pregnancy and postpartum were risk factors for MetS in lactation. BMI during lactation plays a key role in the risk of MetS.
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Affiliation(s)
- Liangxia Chen
- Shandong Center for Disease Control and Prevention, Ji'nan, Shandong, China
| | - Jie Ma
- Shandong Center for Disease Control and Prevention, Ji'nan, Shandong, China
| | - Guanmin Su
- Shandong Center for Disease Control and Prevention, Ji'nan, Shandong, China
| | - Longlong Yin
- Shandong Center for Disease Control and Prevention, Ji'nan, Shandong, China
| | - Xiuyu Jiang
- Health Management Center, Central Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong, China
| | - Xiangxiang Wang
- Department of Gynecology, Central Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong, China
| | - Lele Liu
- Department of Gynecology, Central Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong, China
| | - Xiaofei Zhang
- Shandong Center for Disease Control and Prevention, Ji'nan, Shandong, China
| | - Xiaohui Xu
- Shandong Center for Disease Control and Prevention, Ji'nan, Shandong, China
| | - Suyun Li
- Shandong Center for Disease Control and Prevention, Ji'nan, Shandong, China
| | - Gaohui Zhang
- Shandong Center for Disease Control and Prevention, Ji'nan, Shandong, China
| | - Ran Zhao
- Shandong Center for Disease Control and Prevention, Ji'nan, Shandong, China.
| | - Lianlong Yu
- Shandong Center for Disease Control and Prevention, Ji'nan, Shandong, China.
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Kolli R, Razzaghi T, Pierce S, Edwards RK, Maxted M, Parikh P. Predicting cesarean delivery among gravidas with morbid obesity-a machine learning approach. AJOG GLOBAL REPORTS 2023; 3:100276. [PMID: 38046532 PMCID: PMC10690625 DOI: 10.1016/j.xagr.2023.100276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Women with obesity have higher rates of complications following cesarean delivery, such as wound infection and endometritis, with risks being the highest if a cesarean delivery is performed after labor. Previous efforts at predicting whether a patient's labor course would ultimately result in cesarean delivery have been intermediate with area under the curve in the 0.75 to 78 range. OBJECTIVE This study aimed to assess whether machine learning algorithms would outperform traditional modeling in developing a cesarean delivery prediction model among gravidas with morbid obesity (body mass index of ≥40 kg/m2) to determine whether a primary cesarean delivery may be beneficial. STUDY DESIGN This was a secondary analysis of a retrospective cohort of 1298 patients with morbid obesity presenting for vaginal delivery at ≥37 weeks of gestation between 2011 and 2016 at a single institution. Data available at the time of admission and delivery were modeled using logistic regression, decision tree, random forest, and support vector modeling with evaluation of area under the curve, accuracy, sensitivity, and specificity. RESULTS Logistic regression demonstrated an area under the curve of 0.816 (95% confidence interval, 0.810-0.817), which was superior to machine learning models when evaluating data at the time of delivery (demographic data, initial cervical examinations, comorbidities, and obstetrical interventions) (P<.001). However, there was no significant difference between most machine learning models and logistic regression area under the curve of 0.799 (95% confidence interval, 0.795-0.804) when evaluating parameters available at the time of admission (demographic data, initial cervical examinations, and comorbidities). Race was noted to be a significant predictor in both models (P<.001). CONCLUSION Machine learning and traditional modeling techniques are likely equivalent concerning cesarean delivery prediction in this population. The models developed showed good discrimination and may be used to guide clinical decision-making concerning the optimal mode of delivery.
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Affiliation(s)
- Rajasri Kolli
- Data Science and Analytics Institute, University of Oklahoma, Norman, OK (Ms Kolli and Dr Razzaghi)
| | - Talayeh Razzaghi
- Data Science and Analytics Institute, University of Oklahoma, Norman, OK (Ms Kolli and Dr Razzaghi)
- School of Industrial and Systems Engineering, University of Oklahoma, Norman, OK (Dr Razzaghi)
| | - Stephanie Pierce
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (Drs Pierce, Edwards, Maxted, and Parikh)
| | - Rodney K. Edwards
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (Drs Pierce, Edwards, Maxted, and Parikh)
| | - Marta Maxted
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (Drs Pierce, Edwards, Maxted, and Parikh)
| | - Pavan Parikh
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (Drs Pierce, Edwards, Maxted, and Parikh)
- Department of Obstetrics and Gynecology, Oregon Health Science University, Portland, OR (Dr Parikh)
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Malik N, Sharma N, Kaushal GP, Lochan D, Jain S, Ghotiya M, Madaan N. Perinatal Outcome in Overweight Women: An Audit. Cureus 2023; 15:e48033. [PMID: 38034132 PMCID: PMC10687808 DOI: 10.7759/cureus.48033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Obesity in pregnancy is associated with a myriad of well-documented complications. However, the outcomes of pregnancy in overweight females, who are not classified as obese, have not been studied. The aim of the study was to assess foeto-maternal outcomes in primigravida who are overweight and compare them to normal-weight patients. MATERIAL AND METHODS This was a prospective observational cohort study and included primigravida with full-term gestation (between 38 and 42 weeks), with a single live foetus in vertex presentation, who were admitted for labour induction. Based on pre-pregnancy weight, patients were divided into normal weight (body mass index, BMI<23kg/m2) and overweight (BMI≥23kg/m2 and<25kg/m2) categories labelled as groups A and B, respectively. Data was collected for gestational age, demographics (age, education, occupation), and obstetric and labour-related parameters per pre-designed proforma. Parameters included were the reason for induction, number of doses of prostaglandin E2 (PGE2) gel used, duration of labour, induction to delivery interval, and mode of birth- operative/ non-operative. Data was also collected for peri-partum maternal complications, neonatal Apgar score, and need for Neonatal Intensive Care Unit (NICU) admissions. RESULTS One hundred and fifty patients were recruited in the study and divided based on weight into two groups- 115 in Group A (normal weight) and 35 in Group B (overweight). Compared to Group A, a higher proportion of patients in Group B needed a third dose of PGE2 gel (n=24, 20.8% vs n=18, 51.4%). Also, more patients in Group B had an induction to delivery time of longer than 30 hours (n=7, 20% vs n=5, 4.3%) and had a higher incidence of failed induction needing caesarean section (n=9, 25.7% vs n=13, 11.3%). Neonates born to overweight mothers had a poor Apgar score at 1 min. However, on reassessment, Apgar improved at 5 minutes, and no statistically significant difference was seen for admission to NICU- 5.7% (n=2) in Group B vs 1.7% (n=2) in Group A Conclusion: Pregnancy in overweight females is associated with prolonged labour, higher instances of failed induction, and poor neonatal outcomes at initial assessment. Thus, perinatal counselling and management should focus on weight control while also planning appropriate strategies for monitoring and treating pregnancy-related complications if weight control measures fail. Although obesity is the main focus of research, we suggest including overweight but non-obese females in such studies as they have similar adverse outcomes and complications.
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Affiliation(s)
- Neeru Malik
- Department of Obstetrics and Gynaecology, Dr. Baba Saheb Ambedkar Medical College & Hospital, Delhi, IND
| | - Neeraj Sharma
- Department of Obstetrics and Gynaecology, Dr. Baba Saheb Ambedkar Medical College & Hospital, Delhi, IND
| | - G P Kaushal
- Department of Pediatrics, Dr. Baba Saheb Ambedkar Medical College & Hospital, Delhi, IND
| | - Dakshika Lochan
- Department of Obstetrics and Gynaecology, Dr. Baba Saheb Ambedkar Medical College & Hospital, Delhi, IND
| | - Sandhya Jain
- Department of Obstetrics and Gynaecology, Dr. Baba Saheb Ambedkar Medical College & Hospital, Delhi, IND
| | - Manju Ghotiya
- Department of Obstetrics and Gynaecology, Dr. Baba Saheb Ambedkar Medical College & Hospital, Delhi, IND
| | - Nikita Madaan
- Department of Obstetrics and Gynaecology, Employees' State Insurance Corporation-Post Graduate Institute of Medical Science & Research (ESIC-PGIMSR), Delhi, IND
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Farghali MM, Alhadhoud FK, AlObaidly NH, Mohammad M, Abdelazim IA, Amanzholkyzy A, Khamidullina Z. Maternal and fetal outcomes after bariatric surgeries. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2023; 22:148-154. [PMID: 37829263 PMCID: PMC10566334 DOI: 10.5114/pm.2023.131440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/18/2023] [Indexed: 10/14/2023]
Abstract
Introduction Obesity is the most common medical problem affecting reproductive-age women. To detect the prevalence of obesity, and bariatric surgeries (BSs) in reproductive-age women, and the impact of obesity vs. BSs on the subsequent pregnancy outcomes. Material and methods Obese-pregnant women, and women underwent BSs before the current pregnancy, with complete antenatal, and delivery records were included in the current study. Collected data were analyzed using MedCalc 20.106 to calculate the odd ratio (OR), and relative risk (RR) of adverse maternal, and fetal outcomes in relation to maternal obesity vs. BSs. Results Data of 14,474 pregnant women were collected during this study; 33.94% (4912/14474) of them were obese, and 3.8% (546/14474) of them had previous BSs before the current pregnancy. The obese group has significantly higher odds, and RR of gestational diabetes mellitus (GDM) [OR 1.9 (p = 0.0001), and RR 1.79 (p = 0.0001)], gestational hypertension [OR 1.7 (p = 0.0002), and RR 1.6 (p = 0.0003)], and preeclampsia (PE) [OR 1.7 (p = 0.0001), and RR 1.6 (p = 0.0001)] compared to BSs group. The obese group has also significantly higher odds, and RR of cesarean sections (CSs) [OR 1.3 (p = 0.008), and RR 1.25 (p = 0.01)], and large for gestational age [OR 1.39 (p = 0.01), and RR 1.3 (p = 0.02)] compared to BSs group. Conclusions About 33.94% of the reproductive-age women in Kuwait are obese, and 3.8% of them had previous BSs. Obese-pregnant women are at increased risks of GDM, gestational hypertension, PE, and CSs. Bariatric surgeries reduced the rates of GDM, gestational hypertension, PE, and CSs significantly.
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Affiliation(s)
- Mohamed M. Farghali
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Noura H. AlObaidly
- Department of Obstetrics and Gynecology, Sabah Maternity Hospital, Kuwait
| | - Maryam Mohammad
- Department of Obstetrics and Gynecology, Sabah Maternity Hospital, Kuwait
| | - Ibrahim A. Abdelazim
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ainur Amanzholkyzy
- Department of Normal Physiology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Zaituna Khamidullina
- Department of Obstetrics and Gynecology №1, Astana Medical University, Astana, Kazakhstan
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