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Grasch JL, Venkatesh KK, Grobman WA, Silver RM, Saade GR, Mercer B, Yee LM, Scifres C, Parry S, Simhan HN, Reddy UM, Frey HA. Association of maternal body mass index with success and outcomes of attempted operative vaginal delivery. Am J Obstet Gynecol MFM 2023; 5:101081. [PMID: 37422004 DOI: 10.1016/j.ajogmf.2023.101081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/28/2023] [Accepted: 07/01/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Increasing maternal body mass index is associated with increased morbidity at cesarean delivery in a dose-dependent manner. In some clinical scenarios, operative vaginal delivery is a strategy to prevent the morbidity associated with second-stage cesarean delivery, but the relationship between maternal body mass index and outcomes of attempted operative vaginal delivery is not well characterized. OBJECTIVE This study aimed to assess whether the success of and adverse outcomes after attempted operative vaginal delivery are associated with maternal body mass index at delivery among nulliparous individuals. STUDY DESIGN This was a secondary analysis from the prospective cohort Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be study. This analysis included cephalic live-born nonanomalous singleton pregnancies ≥34 weeks at delivery with an attempted operative vaginal delivery (either forceps or vacuum). The primary exposure was maternal body mass index at delivery (≥30 vs <30 kg/m2 [referent]). The primary outcome was an unsuccessful operative vaginal delivery attempt, defined as a cesarean delivery after an attempted operative vaginal delivery. The secondary outcomes included maternal and neonatal adverse outcomes. Multivariable logistic regression was used, and statistical interaction between operative instrument type (vacuum vs forceps) and body mass index was assessed. RESULTS Of 10,038 assessed individuals, 791 (7.9%) had an attempted operative vaginal delivery and were included in this analysis. Of note, 325 individuals (41%) had a body mass index ≥30 kg/m2 at delivery. Overall, 42 of 791 participants (5%) experienced an unsuccessful operative vaginal delivery. Individuals with a body mass index ≥30 kg/m2 at delivery were more than twice as likely to have an unsuccessful operative vaginal delivery than those with a body mass index <30 kg/m2 (8.0% vs 3.4%; adjusted odds ratio, 2.23; 95% confidence interval, 1.16-4.28; P=.005). Composite maternal morbidity and composite neonatal morbidity did not vary by body mass index group. There was no evidence of interaction or effect modification by operative instrument type for the rate of unsuccessful operative vaginal delivery attempt, composite maternal morbidity, or composite neonatal morbidity. CONCLUSION Among nulliparous individuals who underwent an attempted operative vaginal delivery, those with a body mass index ≥30 kg/m2 at delivery were more likely to have an unsuccessful operative vaginal delivery attempt than those with a body mass index <30 kg/m2. There was no difference in composite maternal or neonatal morbidity after attempted operative vaginal delivery by body mass index category.
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Affiliation(s)
- Jennifer L Grasch
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH (Drs Grasch, Venkatesh, Grobman, and Frey).
| | - Kartik K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH (Drs Grasch, Venkatesh, Grobman, and Frey)
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH (Drs Grasch, Venkatesh, Grobman, and Frey)
| | - Robert M Silver
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, UT (Dr Silver)
| | - George R Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX (Dr Saade)
| | - Brian Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH (Dr Mercer)
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr Yee)
| | - Christina Scifres
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University School of Medicine, Indianapolis, IN (Dr Scifres)
| | - Samuel Parry
- Department of Maternal-Fetal Medicine, School of Medicine, University of Pennsylvania, Philadelphia, PA (Dr Parry)
| | - Hyagriv N Simhan
- Department of Obstetrics, Gynecology, and Reproductive Science, School of Medicine, University of Pittsburgh, Pittsburgh, PA (Dr Simhan)
| | - Uma M Reddy
- Department of Obstetrics and Gynecology, Columbia University, New York City, NY (Dr Reddy)
| | - Heather A Frey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH (Drs Grasch, Venkatesh, Grobman, and Frey)
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Gudipally M, Farooq F, Basany K, Haggerty CL, Tang G, Kusneniwar GN, Jammy GR, Bunker CH, Reddy PS. Impact of prepregnancy body mass index on adverse pregnancy outcomes: analysis from the Longitudinal Indian Family hEalth cohort study. AJOG Glob Rep 2023; 3:100134. [PMID: 36691397 DOI: 10.1016/j.xagr.2022.100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Both high and low maternal prepregnancy body mass index can lead to suboptimal fetal growth and risk of pregnancy complications. In developed countries, nearly half of all women of childbearing age are either overweight or obese, and most data linking maternal body mass index and adverse pregnancy complications are limited to these populations. OBJECTIVE This study aimed to prospectively evaluate the relationships between prepregnancy body mass index and adverse pregnancy outcomes using the Longitudinal Indian Family hEalth (LIFE) study. STUDY DESIGN We modeled the relationships between prepregnancy body mass index and adverse pregnancy outcomes such as low birthweight, preterm birth, cesarean delivery, intrauterine growth restriction, miscarriage, and fetal death among 675 women aged 15 to 35 years with singleton pregnancies in the Longitudinal Indian Family hEalth study, a population-based prospective pregnancy cohort study conducted in Telangana, India. Prepregnancy body mass index was calculated as weight in kilograms divided by height in meters squared and was classified into 4 categories using the World Health Organization recommendations for Asian adults. Prepregnancy body mass index was assessed at a mean of 12.3 months before pregnancy. Odds ratios and 95% confidence intervals of adverse pregnancy outcomes were modeled and adjusted for confounders. RESULTS Obese women had a 3-fold increased risk of cesarean delivery (odds ratio, 3.13; 95% confidence interval, 1.56-6.29) compared with normal-weight women. Those who were overweight also had a marginally increased risk of cesarean delivery, albeit not statistically significant (odds ratio, 1.17; 95% confidence interval, 0.61-2.24). Underweight women had a modestly increased risk of low birthweight, compared with normal-weight women (odds ratio, 1.12; 95% confidence interval, 0.71-1.77), although results were not significant. Conversely, obese (odds ratio, 0.71; 95% confidence interval, 0.28-1.77) and overweight (odds ratio, 0.61; 95% confidence interval, 0.24-1.51) women had a marginally decreased risk of low birthweight. CONCLUSION Our data suggest that women with elevated prepregnancy body mass index may have a higher risk of adverse pregnancy outcomes, especially cesarean delivery. Although this study has limited generalizability, our findings are generalizable to rural to periurban regions of India. Further studies exploring the translatability of these findings to other populations are needed. In addition, targeted prepregnancy intervention studies and programs that include counseling on optimization of preconception health and lifestyle modification for improvement of subsequent pregnancy outcomes among overweight and obese women are needed.
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Brognard M, Legendre G, Madzou S, Descamps P, Corroenne R. Risk factors for operative vaginal delivery after a previous instrumental delivery. J Gynecol Obstet Hum Reprod 2022. [DOI: 10.1016/j.jogoh.2022.102382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 11/20/2022]
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Vats H, Saxena R, Sachdeva MP, Walia GK, Gupta V. 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; 15:536-45. [PMID: 34782256 DOI: 10.1016/j.orcp.2021.10.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Amyx M, Zeitlin J, Hermann M, Castetbon K, Blondel B, Le Ray C. Maternal characteristics associated with gestational weight gain in France: a population-based, nationally representative study. BMJ Open 2021; 11:e049497. [PMID: 34215613 PMCID: PMC8256790 DOI: 10.1136/bmjopen-2021-049497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To provide nationally representative estimates of gestational weight gain (GWG) and identify maternal characteristics associated with inadequate GWG in France. DESIGN A population-based study using data from the French National Perinatal Survey: 2010 and 2016. SETTING All maternity units in metropolitan, mainland France (n=535 in 2010; n=493 in 2016). PARTICIPANTS Singleton live births with GWG data (N=24 850). PRIMARY OUTCOME MEASURES GWG was calculated as end of pregnancy minus pre-pregnancy weight (kg) and categorised as 'insufficient', 'adequate', or 'excessive' using 2009 Institute of Medicine thresholds. Classification accounted for pre-pregnancy body mass index (BMI) (kg/m2; underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9), obese (≥30)) and gestational age at birth. We estimated average GWG and the percentage of women in each GWG category. Polytomous logistic regression identified characteristics associated with GWG adequacy. RESULTS Average GWG was 13.0 kg (SD 5.6), with 26.8% of women gaining insufficiently, 37.0% adequately and 36.1% excessively. Among other factors, insufficient GWG was associated with underweight (vs normal weight; adjusted OR (aOR) 1.4, 95% CI 1.2 to 1.5) and obese (aOR 1.5, 95% CI 1.4 to 1.7) BMI. Excessive GWG was associated with overweight (aOR 2.8, 95% CI 2.6 to 3.1) and obese BMI (aOR 3.3, 95% CI 2.9 to 3.6). Examining obesity classes separately, odds of insufficient GWG increased from obesity class I to III, while odds of excessive GWG decreased from obesity class I to III. Primiparity (insufficient: aOR 0.9, 95% CI 0.9 to 1.0; excessive: aOR 1.2, 95% CI 1.2 to 1.3), maternal characteristics indicative of lower socioeconomic status, and continuing or quitting smoking during pregnancy were also associated with inadequate GWG. CONCLUSIONS In France, insufficient and excessive GWG are common. For optimal outcomes, clinician education, with special attention to the needs of higher risk/vulnerable groups, is needed to ensure all women receive appropriate advice for recommended GWG.
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Affiliation(s)
- Melissa Amyx
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), University of Paris, INSERM UMR 1153, Paris, France
| | - Jennifer Zeitlin
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), University of Paris, INSERM UMR 1153, Paris, France
| | - Monika Hermann
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), University of Paris, INSERM UMR 1153, Paris, France
| | - Katia Castetbon
- Epidemiology, Biostatistics and Clinical Research Research Center, ULB School of Public Health, Brussels, Belgium
| | - Béatrice Blondel
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), University of Paris, INSERM UMR 1153, Paris, France
| | - Camille Le Ray
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), University of Paris, INSERM UMR 1153, Paris, France
- Cochin Hospital Port Royal, Port Royal Maternity, Department of Obstetrics, University of Paris, APHP, Paris, France
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Abstract
PURPOSE OF REVIEW The aim of this review was to summarise recent evaluations of healthcare professional training regarding gestational weight gain and provide recommendations for future training. RECENT FINDINGS A number of evaluated healthcare professional training sessions regarding gestational weight gain show promising results in terms of increased participant confidence and knowledge and impact on women's outcomes. It is clear that the interventions which have also implemented resources in the practice environment to support training are the ones most likely to influence gestational weight gain. Support from healthcare professionals are key to influence pregnant women's weight gain and should be offered within the standard curriculum and through mandatory training. Factors influencing this support include women's and healthcare professional characteristics, interpersonal and healthcare system and policy factors. All of these need to be considered when developing healthcare professional training to support women with their gestational weight gain.
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Affiliation(s)
- Ellinor K. Olander
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB UK
| | - Briony Hill
- National Health and Medical Research Council Early Career Fellow, Monash Centre for Health Research and Implementation, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC 3169 Australia
| | - Helen Skouteris
- Health and Social Care Improvement and Implementation Science, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC 3169 Australia
- Warwick Business School, Warwick University, Coventry, CV47AL UK
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Dalbye R, Gunnes N, Blix E, Zhang J, Eggebø T, Nistov Tokheim L, Øian P, Bernitz S. Maternal body mass index and risk of obstetric, maternal and neonatal outcomes: A cohort study of nulliparous women with spontaneous onset of labor. Acta Obstet Gynecol Scand 2020; 100:521-530. [PMID: 33031566 DOI: 10.1111/aogs.14017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/21/2020] [Accepted: 09/30/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION This study investigates associations between maternal body mass index (BMI) early in pregnancy and obstetric interventions, maternal and neonatal outcomes. MATERIAL AND METHODS This is a cohort study of nulliparous women originally included in a cluster randomized controlled trial carried out at 14 Norwegian obstetric units between 2014 and 2017. The sample included 7189 nulliparous women with a singleton fetus, cephalic presentation and spontaneous onset of labor at term, denoted as group 1 in the Ten-Group Classification System. The women were grouped according to the World Health Organization BMI classifications: underweight (BMI <18.5), normal weight (BMI 18.5-24.9), pre-obesity (BMI 25.0-29.9), obesity class I (BMI 30.0-34.9), and obesity classes II and III (BMI ≥35.0). We used binary logistic regression to estimate crude and adjusted odds ratios (ORs) of the interventions and outcomes, with associated 95% confidence intervals (CIs), comparing women in different BMI groups with women of normal weight. RESULTS We found an increased risk of intrapartum cesarean section in women of obesity class I and obesity classes II and III, with adjusted OR of 1.70 (95% CI 1.21-2.38) and 2.31 (95% CI 1.41-3.77), respectively. Women in obesity groups had a gradient of risk of epidural analgesia and use of continuous CTG (including STAN), with adjusted OR of 2.39 (95% CI 1.69-3.38) and 3.28 (95% CI 1.97-5.48), respectively. Women in obesity classes II and III had higher risk of amniotomy (adjusted OR = 1.42, 95% CI 1.02-1.96), oxytocin augmentation (adjusted OR = 1.54, 95% CI 1.11-2.15), obstetric anal sphincter injuries (adjusted OR = 2.21, 95% CI 1.01-4.85) and postpartum hemorrhage ≥1000 mL (adjusted OR = 2.20, 95% CI 1.29-3.78). We found a reduced likelihood of spontaneous vaginal delivery for pre-obese women (adjusted OR = 0.85, 95% CI 0.74-0.97) and no associations between maternal BMI and neonatal outcomes. CONCLUSIONS Obese women in Ten-Group Classification System group 1 had increased risks of obstetric interventions and maternal complications. There was a gradient of risk for intrapartum cesarean section, with the highest risk for women in obesity classes II and III. No associations between maternal BMI and neonatal outcomes were observed.
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Affiliation(s)
- Rebecka Dalbye
- Department of Obstetrics and Gynecology, Østfold Hospital Trust, Grålum, Norway
| | - Nina Gunnes
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway
| | - Ellen Blix
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Jun Zhang
- Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Torbjørn Eggebø
- National Center for Fetal Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - Linn Nistov Tokheim
- Department of Obstetrics and Gynecology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Pål Øian
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Norway, Tromsø, Norway
| | - Stine Bernitz
- Department of Obstetrics and Gynecology, Østfold Hospital Trust, Grålum, Norway.,Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
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Hou YP, Lommel L, Wiley J, Zhou XH, Yao M, Liu S, Peng JL. Influencing factors for placenta accreta in recent 5 years: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2020; 35:2166-2173. [PMID: 32552190 DOI: 10.1080/14767058.2020.1779215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: Assess influencing factors for placenta accreta in pregnant women documented in recent literature.Methods: A systematic review and meta-analysis were conducted based on English- and Chinese-language articles published from January 2014 to June 2019. Articles were retrieved from the following Chinese databases, CNKI, Wanfang Data, China Science and Technology Journal Database, CBM and English databases, PubMed, Web of Science, the Cochrane Library and Embase.Results: Eleven studies with 2,152,014 cases were included in the meta-analysis. The odds ratios of influencing factors were as follows: hypertension 2.51 (95% CI, 1.50-4.20), multifetal gestations 1.90 (95% CI, 1.26-2.88), male fetus 0.79 (95% CI, 0.74-0.84), and low socioeconomic status 0.51 (95% CI, 0.37-0.71).Conclusion: Evidence from English- and Chinese-language literature indicates that hypertension and multifetal gestations are risk factors for placenta accreta, while male fetus and low socioeconomic status are protective factors.
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Affiliation(s)
- Yi-Ping Hou
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital and Xiangya School of Nursing, Central South University, Changsha, China
| | - Lisa Lommel
- School of Nursing, University of California, San Francisco, CA, USA
| | - James Wiley
- Philip R. Lee Institute for Health Policy Studies and Department of Family and Community Medicine School of Medicine, University of California, San Francisco, CA, USA
| | - Xi-Hong Zhou
- Clinical Nursing Teaching and Research Section and Department of Obstetrics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Min Yao
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital and Xiangya School of Nursing, Central South University, Changsha, China
| | - Sai Liu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital and Xiangya School of Nursing, Central South University, Changsha, China
| | - Jin-Li Peng
- Clinical Nursing Teaching and Research Section and Department of Obstetrics, The Second Xiangya Hospital, Central South University, Changsha, China
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Herring SJ, Albert JJ, Darden N, Bailer B, Cruice J, Hassan S, Bennett GG, Goetzl L, Yu D, Kilby LM, Foster GD. Targeting pregnancy-related weight gain to reduce disparities in obesity: Baseline results from the Healthy Babies trial. Contemp Clin Trials 2019; 87:105822. [PMID: 31400513 PMCID: PMC7265899 DOI: 10.1016/j.cct.2019.105822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/31/2019] [Accepted: 08/05/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Obesity affects African American women more than any other group in the US. Pregnancy represents a critical life stage of heightened vulnerability for new or persistent obesity, yet few interventions have been effective in reducing excessive gestational weight gain among African American women. We describe the design and baseline findings of Healthy Babies, a two-arm randomized controlled trial testing a mobile health intervention to minimize excessive gestational weight gain versus usual care in this high risk group. METHODS African American women in early pregnancy were recruited from two large obstetric practices as well as Philadelphia Women, Infants, and Children's clinics. Participants randomized to the intervention received behavior change goals, daily text messages with feedback, web-based weight gain graphs, health coaching, and a Facebook support group. Data collection included baseline (<22 weeks' gestation), 36-38 weeks' gestation, and 6-month postpartum anthropometric measures and assessments of demographics, contextual factors and behavioral targets. The primary outcome was prevalence of excessive gestational weight gain. RESULTS Among participants at baseline (n = 262), the majority met criteria for obesity (63%), were multiparous (62%), single (77%), and were on average 25.6 ± 5.4 years old with a gestational age of 13.9 ± 4.1 weeks. While 82% completed high school, 61% met criteria for inadequate health literacy. Nearly 20% were food insecure. Eighty-eight percent reported a gestational weight gain goal discordant with Institute of Medicine guidelines. There were no significant differences in baseline characteristics between study arms. CONCLUSIONS Participants represent a high-risk group for excessive gestational weight gain with demonstrated need for intervention.
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Affiliation(s)
- Sharon J Herring
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States of America; Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America; Department of Obstetrics, Gynecology, and Reproductive Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America; Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America.
| | - Jessica J Albert
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States of America; Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America
| | - Niesha Darden
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States of America; Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America
| | - Brooke Bailer
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States of America; Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Jane Cruice
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States of America; Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America
| | - Sarmina Hassan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America
| | - Gary G Bennett
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States of America; Duke Digital Health Science Center, Duke Global Health Institute, Durham, NC, United States of America
| | - Laura Goetzl
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Center at Houston, Houston, TX, United States of America
| | - Daohai Yu
- Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America
| | - Linda M Kilby
- Philadelphia Women, Infants and Children Program, Philadelphia, PA, United States of America
| | - Gary D Foster
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States of America; Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America; Weight Watchers International, New York, NY, United States of America
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Gonzalez-Ballano I, Saviron-Cornudella R, Esteban LM, Sanz G, Castán S. Pregestational body mass index, trimester-specific weight gain and total gestational weight gain: how do they influence perinatal outcomes? J Matern Fetal Neonatal Med 2019; 34:1207-1214. [PMID: 31170838 DOI: 10.1080/14767058.2019.1628942] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the association between pre-gestational body mass index (BMI), total gestational weight gain (GWG), and/or trimester-specific weight gain (GWGT) with adverse maternal or perinatal outcomes (AMPOs). MATERIALS AND METHODS Maternal clinical characteristics and pregnancy and perinatal outcomes were used to predict AMPOs. The predictive ability of BMI, GWG, or GWGT for AMPOs was analyzed using the area under the curve (AUC). Logistic regression models in a univariate and multivariate analysis were performed to estimate the odds ratios (OR) and 95% confidence intervals (CI) to predict maternal outcomes (pregnancy-induced hypertension, preeclampsia or gestational diabetes mellitus) and perinatal outcomes (small for gestational age, large for gestational age, 5-min Apgar score, admission to neonatal intensive care unit or umbilical cord pH <7.15). RESULTS Women with AMPOs (n = 293) were younger with higher rate of nulliparity (p < .001) and with lower height (p = .018) as compared to controls (n = 134). In the univariate study, GWGT in third trimester was associated with double risk of pregnancy-induced hypertension (OR 2.00; 95% CI, 1.01-3.97). Nonetheless, third-trimester GWG and total GWG have a negative relationship with gestational diabetes mellitus OR 0.32 (95% CI, 0.18-0.58) and OR 0.35 (95% CI, 0.21-0.59), respectively. Women with greater overall and in second trimester, GWG have a lower risk of having SGA neonates, OR 0.62 (95% CI, 0.39-0.98) and OR 0.60 (95% CI, 0.37-0.98), respectively. In the multivariate study, pre-gestational BMI is strongly related to the development of preeclampsia and the area under the curve (AUC) of the combination of pre-gestational BMI and total weight gain was 0.832 (95% CI, 0.63-0.81) for preeclampsia and 0.719 (95% CI, 0.71-0.94) for gestational diabetes mellitus. CONCLUSION Our results suggest than timing of gestational weight gain influence in maternal and perinatal outcomes. Pre-gestational BMI is a determinant of preeclampsia, maternal weight gain in the third trimester is a determinant of pregnancy-induced hypertension and the increase in total GWG reduces the risk of gestational diabetes mellitus and small for gestational age.
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Affiliation(s)
- Isabel Gonzalez-Ballano
- Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Luis Mariano Esteban
- Escuela Universitaria Politécnica de la Almunia, Universidad de Zaragoza, La Almunia de Doña Godina, Spain
| | - Gerardo Sanz
- Department of Statistical Methods and Institute for Biocomputation and Physics of Complex Systems-BIFI, Universidad de Zaragoza, Zaragoza, Spain
| | - Sergio Castán
- Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Zhao RF, Zhang WY, Zhou L, Chen Y. Building a predictive model for successful vaginal delivery in nulliparas with term cephalic singleton pregnancies using decision tree analysis. J Obstet Gynaecol Res 2019; 45:1536-1544. [PMID: 31161703 DOI: 10.1111/jog.14011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/08/2019] [Indexed: 12/15/2022]
Abstract
AIM To establish a model predicting successful vaginal delivery (VD) in nulliparas with term cephalic singleton pregnancies. METHODS We retrospectively identified 6799 term nulliparas with cephalic singletons (6416 VD and 383 cesarean section [CS] due to dystocia) who entered labor (cervical dilation ≥2 cm) between September 2014 and August 2015. Using VD as the dependent variable and age, maternal body height, educational attainment, gravidity, gestational age, pre-pregnancy body mass index (BMI), BMI upon admission for delivery, gestational weight gain, gestational hypertension and gestational diabetes as the independent variables, predictors of VD success were identified using a multivariate binary logistic regression and then ranked with decision-tree analysis. RESULTS While multiple factors are associated with improved VD success, we found body height, gestational age, and intrapartum BMI to be the best predictors of successful VD. Our predictive model has a classification accuracy, sensitivity and specificity of 76.6%, 96.7% and 16.4%, respectively, and it was subsequently confirmed by both internal and external validation. CONCLUSION Our predictive model indicates body height, gestational age and intrapartum BMI as the major predictors of successful VD in low-risk patients.
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Affiliation(s)
- Rui-Fen Zhao
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital Capital Medical University, Beijing, China
| | - Wei-Yuan Zhang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital Capital Medical University, Beijing, China
| | - Li Zhou
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital Capital Medical University, Beijing, China
| | - Yi Chen
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital Capital Medical University, Beijing, China
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Johansson S, Sandström A, Cnattingius S. Maternal overweight and obesity increase the risk of fetal acidosis during labor. J Perinatol 2018; 38:1144-50. [PMID: 29915374 DOI: 10.1038/s41372-018-0144-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/27/2018] [Accepted: 05/21/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate whether maternal overweight and obesity increased the risk of fetal acidosis measured in umbilical cord arterial blood after delivery. STUDY DESIGN Population-based cohort study of 84,785 term (≥37 weeks) infants. Logistic regression was used to estimate risks of fetal acidosis in umbilical cord arterial blood. Fetal acidosis was defined as pH <7.10 or as pH <1st percentile on a normal reference curve. RESULT Risks of fetal acidosis increased, regardless of definition, with maternal overweight and obesity severity. Compared to normal weight (BMI 18.5-<25), the odds ratios (95% confidence interval) for pH <7.10 were 1.35 (1.23-1.47) for overweight (BMI 25-<30), 1.46 (1.27-1.69) for mild obesity (BMI 30-<35), and 1.75 (1.42-2.15) for severe obesity (BMI ≥35). The association for obesity was attenuated in analyses restricted to non-instrumental vaginal deliveries. CONCLUSION Maternal overweight and obesity increased the risk of fetal acidosis. More complicated deliveries in obese women may partially explain this association.
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Pettersen-Dahl A, Murzakanova G, Sandvik L, Laine K. Maternal body mass index as a predictor for delivery method. Acta Obstet Gynecol Scand 2017; 97:212-218. [DOI: 10.1111/aogs.13265] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 11/15/2017] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Leiv Sandvik
- Faculty of Medicine; University of Oslo; Oslo Norway
- Department of Biostatistics; Oslo University Hospital; Oslo Norway
| | - Katariina Laine
- Department of Obstetrics; Oslo University Hospital; Oslo Norway
- Department of Health Management and Health Economics; Institute of Health and Society; University of Oslo; Oslo Norway
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Thomson JL, Tussing-Humphreys LM, Goodman MH, Olender S. Baseline Demographic, Anthropometric, Psychosocial, and Behavioral Characteristics of Rural, Southern Women in Early Pregnancy. Matern Child Health J 2017; 20:1980-8. [PMID: 27146396 DOI: 10.1007/s10995-016-2016-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objectives Beginning life in a healthy uterine environment is essential for future well-being, particularly as it relates to chronic disease risk. Baseline (early pregnancy) demographic, anthropometric (height and weight), psychosocial (depression and perceived stress), and behavioral (diet and exercise) characteristics of rural, Southern, pregnant women enrolled in a maternal, infant, and early childhood home visiting program are described. Methods Participants included 82 women early in their second trimester of pregnancy and residing in three Lower Mississippi Delta counties in the United States. Baseline data were collected through direct measurement and surveys. Results Participants were primarily African American (96 %), young (mean age = 23 years), single (93 %), and received Medicaid (92 %). Mean gestational age was 18 weeks, 67 % of participants were overweight or obese before becoming pregnant, and 16 % tested positive for major depression. Participants were sedentary (mean minutes of moderate intensity physical activity/week = 30), had low diet quality (mean Healthy Eating Index-2010 total score = 43 points), with only 38, 4, and 7 % meeting recommendations for saturated fat, fiber, and sodium intakes, respectively. Conclusions for Practice In the Lower Mississippi Delta, there is a need for interventions that are designed to help women achieve optimal GWG by improving their diet quality and increasing the amount of physical activity performed during pregnancy. Researchers also should consider addressing barriers to changing health behaviors during pregnancy that may be unique to this region of the United States.
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Affiliation(s)
- Jessica L Thomson
- United States Department of Agriculture, Agricultural Research Service, 141 Experiment Station Road, Stoneville, MS, 38776, USA.
| | - Lisa M Tussing-Humphreys
- Department of Medicine and Cancer Center, University of Illinois at Chicago, 1747 W Roosevelt Road, #416, Chicago, IL, 60608, USA
| | - Melissa H Goodman
- United States Department of Agriculture, Agricultural Research Service, 141 Experiment Station Road, Stoneville, MS, 38776, USA
| | - Sarah Olender
- Department of Medicine and Cancer Center, University of Illinois at Chicago, 1747 W Roosevelt Road, #416, Chicago, IL, 60608, USA
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Sorbye LM, Skjaerven R, Klungsoyr K, Morken NH. Gestational diabetes mellitus and interpregnancy weight change: A population-based cohort study. PLoS Med 2017; 14:e1002367. [PMID: 28763446 PMCID: PMC5538633 DOI: 10.1371/journal.pmed.1002367] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/26/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Being overweight is an important risk factor for Gestational Diabetes Mellitus (GDM), but the underlying mechanisms are not understood. Weight change between pregnancies has been suggested to be an independent mechanism behind GDM. We assessed the risk for GDM in second pregnancy by change in Body Mass Index (BMI) from first to second pregnancy and whether BMI and gestational weight gain modified the risk. METHODS AND FINDINGS In this observational cohort, we included 24,198 mothers and their 2 first pregnancies in data from the Medical Birth Registry of Norway (2006-2014). Weight change, defined as prepregnant BMI in second pregnancy minus prepregnant BMI in first pregnancy, was divided into 6 categories by units BMI (kilo/square meter). Relative risk (RR) estimates were obtained by general linear models for the binary family and adjusted for maternal age at second delivery, country of birth, education, smoking in pregnancy, interpregnancy interval, and year of second birth. Analyses were stratified by BMI (first pregnancy) and gestational weight gain (second pregnancy). Compared to women with stable BMI (-1 to 1), women who gained weight between pregnancies had higher risk of GDM-gaining 1 to 2 units: adjusted RR 2.0 (95% CI 1.5 to 2.7), 2 to 4 units: RR 2.6 (2.0 to 3.5), and ≥4 units: RR 5.4 (4.0 to 7.4). Risk increased significantly both for women with BMI below and above 25 at first pregnancy, although it increased more for the former group. A limitation in our study was the limited data on BMI in 2 pregnancies. CONCLUSIONS The risk of GDM increased with increasing weight gain from first to second pregnancy, and more strongly among women with BMI < 25 in first pregnancy. Our results suggest weight change as a metabolic mechanism behind the increased risk of GDM, thus weight change should be acknowledged as an independent factor for screening GDM in clinical guidelines. Promoting healthy weight from preconception through the postpartum period should be a target.
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Affiliation(s)
- L. M. Sorbye
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian National Advisory Unit on Women’s Health, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - R. Skjaerven
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway
| | - K. Klungsoyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway
| | - N. H. Morken
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Ramos SZ, Waring ME, Leung K, Amir NS, Bannon AL, Moore Simas TA. Attempted and Successful Vacuum-Assisted Vaginal Delivery by Prepregnancy Body Mass Index. Obstet Gynecol 2017; 129:311-20. [PMID: 28079766 DOI: 10.1097/AOG.0000000000001847] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine rates of attempted and successful vacuum-assisted vaginal delivery by prepregnancy body mass index (BMI). METHODS We conducted a retrospective cohort study of 2,084 women with singleton gestations needing operative delivery assistance and vacuum-eligible (fully dilated, +2 station or greater, 34 weeks of gestation or greater) using 2006-2014 inpatient records. Prepregnancy BMI was categorized as underweight (less than 18.5), normal weight (18.5 to less than 25), overweight (25 to less than 30), or obese (30 or greater). Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) of attempted and successful vacuum-assisted vaginal delivery by prepregnancy BMI adjusted for age, race, marital status, parity, diabetes, labor induction-augmentation, episiotomy, gestational age, and neonatal birth weight. RESULTS Thirty-nine percent of women requiring delivery assistance and eligible for a vacuum were overweight or obese, 79% had vacuum attempts, and 95.3% of attempted vacuum-assisted vaginal deliveries were successful. Compared with women who were normal weight prepregnancy (82.8%), women who were overweight or obese were less likely to have vacuum attempted (75.8%, OR 0.71, 95% CI 0.53-0.96 and 71.2%, OR 0.53, 95% CI 0.39-0.74, respectively). Among women with attempted vacuum-assisted vaginal delivery, successful delivery did not differ by prepregnancy BMI (92.6%, OR 0.54, 95% CI 0.21-1.37 for underweight; 94.5%, OR 1.07, 95% CI 0.57-2.00 for overweight; 96.3%, OR 1.09, 95% CI 0.51-2.33 for obese compared with 95.6% among normal-weight women). CONCLUSION Among women in need of operative delivery assistance, prepregnancy obesity was associated with lower likelihood of attempted vacuum-assisted vaginal delivery but, if attempted, success rates were similar to rates among normal-weight women. With significant morbidity of second-stage cesarean delivery in obese women, research should examine whether vacuum-assisted vaginal delivery may be appropriate for additional obese patients.
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Gao X, Yan Y, Xiang S, Zeng G, Liu S, Sha T, He Q, Li H, Tan S, Chen C, Li L, Yan Q. The mutual effect of pre-pregnancy body mass index, waist circumference and gestational weight gain on obesity-related adverse pregnancy outcomes: A birth cohort study. PLoS One 2017; 12:e0177418. [PMID: 28575041 PMCID: PMC5456032 DOI: 10.1371/journal.pone.0177418] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/26/2017] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine the mutual effect of pre-pregnancy body mass index (BMI), waist circumference (WC) and gestational weight gain (GWG) on obesity-related adverse pregnancy outcomes. METHODS This birth cohort study was conducted in three Streets in Changsha, China, including a total of 976 mother-child pairs. All data was collected within 15 days after deliveries from a self-administered questionnaire, maternal health manual and perinatal health care information system. Multivariate logistic regression models were conducted to estimate the effects of maternal pre-pregnancy BMI, WC and GWG on obesity-related adverse pregnancy outcomes including gestational diabetes mellitus (GDM), primary cesarean section (P-CS), large for gestational age (LGA) and composite outcome (one or more adverse pregnancy outcomes). RESULTS After controlling for all confounders, both maternal pre-pregnancy overweight/obesity and central adiposity contributed to increased risks of GDM [ORs 95% CIs = 2.19 (1.02-4.76) and 2.26 (1.11-4.60), respectively], P-CS [ORs 95% CIs = 1.66 (1.05-2.65) and 1.71 (1.11-2.63), respectively], LGA [ORs 95% CIs = 1.93 (1.07-3.50) and 2.14 (1.21-3.75), respectively] and composite outcome [ORs 95% CIs = 1.82 (1.15-2.87) and 1.98 (1.30-3.01), respectively] compared with mothers with normal pre-pregnancy weight and normal WC. Excessive GWG was found to be associated with an increased risk of LGA [OR 95% CI = 1.74 (1.05-2.89)], but was not significantly related to higher risks of GDM, P-CS and composite outcome [ORs 95% CIs = 0.90 (0.47-1.72), 1.08 (0.77-1.52), and 1.30 (0.94-1.79), respectively]. In terms of the joint effect of maternal pregestational BMI and WC on obesity-related composite outcome, mothers with both pre-pregnancy overweight and central adiposity had the highest risk of composite outcome [OR 95% CI = 3.96 (2.40-6.54)], compared with mothers without pre-pregnancy overweight or central adiposity. CONCLUSIONS The results of this study suggest that maternal pre-pregnancy overweight/obesity and central adiposity may contribute to multiple obesity-related adverse pregnancy outcomes, excessive weight gain during pregnancy is associated with an increased risk of LGA. Healthcare providers should carry out health education, and guide women to keep an ideal BMI and WC prior to pregnancy and help them gain optimal weight during pregnancy based on their pre-pregnancy BMI and WC.
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Affiliation(s)
- Xiao Gao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Yan Yan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
- * E-mail:
| | - Shiting Xiang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Guangyu Zeng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Shiping Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Tingting Sha
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Qiong He
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Hongyan Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Shan Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Cheng Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Ling Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Qiang Yan
- Department of Maternal and Child Health, Kaifu District Health Bureau, Changsha, China
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Thomson JL, Tussing-Humphreys LM, Goodman MH, Olender SE. Gestational Weight Gain: Results from the Delta Healthy Sprouts Comparative Impact Trial. J Pregnancy 2016; 2016:5703607. [PMID: 27595023 DOI: 10.1155/2016/5703607] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/16/2016] [Accepted: 07/12/2016] [Indexed: 12/14/2022] Open
Abstract
Introduction. Delta Healthy Sprouts trial was designed to test the comparative impact of two home visiting programs on weight status, dietary intake, and health behaviors of Southern African American women and their infants. Results pertaining to the primary outcome, gestational weight gain, are reported. Methods. Participants (n = 82), enrolled early in their second trimester of pregnancy, were randomly assigned to one of two treatment arms. Gestational weight gain, measured at six monthly home visits, was calculated by subtracting measured weight at each visit from self-reported prepregnancy weight. Weight gain was classified as under, within, or exceeding the Institute of Medicine recommendations based on prepregnancy body mass index. Chi-square tests and generalized linear mixed models were used to test for significant differences in percentages of participants within recommended weight gain ranges. Results. Differences in percentages of participants within the gestational weight gain guidelines were not significant between treatment arms across all visits. Conclusions. Enhancing the gestational nutrition and physical activity components of an existing home visiting program is feasible in a high risk population of primarily low income African American women. The impact of these enhancements on appropriate gestational weight gain is questionable given the more basic living needs of such women. This trial is registered with ClinicalTrials.gov NCT01746394, registered 4 December 2012.
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Kwon HY, Kwon JY, Park YW, Kim YH. The risk of emergency cesarean section after failure of vaginal delivery according to prepregnancy body mass index or gestational weight gain by the 2009 Institute of Medicine guidelines. Obstet Gynecol Sci 2016; 59:169-77. [PMID: 27200306 DOI: 10.5468/ogs.2016.59.3.169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 12/07/2015] [Accepted: 12/29/2015] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate the risk of emergency cesarean section according to the prepregnancy body mass index (BMI) and gestational weight gain per the 2009 Institute of Medicine guidelines. Methods A retrospective analysis of data from 2,765 women with singleton full-term births (2009 to 2012) who attempted a vaginal delivery was conducted. Pregnancies with preeclampsia, chronic hypertension, diabetes, planned cesarean section, placenta previa, or cesarean section due to fetal anomalies or intrauterine growth restriction were excluded. Odds ratios (ORs) and confidence intervals (CIs) for emergency cesarean section were calculated after adjusting for prepregnancy BMI or gestational weight gain. Results Three-hundred and fifty nine (13.0%) women underwent emergency cesarean section. The adjusted OR for overweight, obese, and extremely obese women indicated a significantly increased risk of cesarean delivery. Gestational weight gain by Institute of Medicine guidelines was not associated with an increased risk of cesarean delivery. However, inadequate and excessive weight gain in obese women was highly associated with an increased risk of emergency cesarean section, compared to these in normal BMI (OR, 5.56; 95% CI, 1.36 to 22.72; OR, 3.63; 95% CI, 1.05 to 12.54; respectively), while there was no significant difference between normal BMI and obese women with adequate weight gain. Conclusion Obese women should be provided special advice before and during pregnancy for controlling weight and careful consideration should be needed at the time of vaginal delivery to avoid emergency cesarean section.
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Reiss K, Breckenkamp J, Borde T, Brenne S, Henrich W, David M, Razum O. The association of pre-pregnancy overweight and obesity with delivery outcomes: a comparison of immigrant and non-immigrant women in Berlin, Germany. Int J Public Health 2016; 61:455-63. [DOI: 10.1007/s00038-016-0825-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 01/27/2023] Open
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Moehlecke M, Costenaro F, Reichelt AA, Oppermann MLR, Leitão CB. Low Gestational Weight Gain in Obese Women and Pregnancy Outcomes. AJP Rep 2016; 6:e77-82. [PMID: 26929877 PMCID: PMC4737638 DOI: 10.1055/s-0035-1566309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/01/2015] [Indexed: 12/14/2022] Open
Abstract
Obesity during pregnancy and excessive weight gain during this period are associated with several maternal-fetal and neonatal complications. Moreover, a significant percentage of women have weight retention in the postpartum period, especially those with excessive weight gain during pregnancy. The recommendations of the 2009 Institute of Medicine were based on observational studies that have consistently shown that women with weight gain within the recommended range had better outcomes during pregnancy. In patients with obesity, however, there is no recommendation for weight gain, according to the class of obesity. This review, therefore, aims to evaluate the evidence on key maternal and fetal complications related to low weight gain during pregnancy in obese and overweight patients.
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Affiliation(s)
- Milene Moehlecke
- Department of Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Fabíola Costenaro
- Department of Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Angela Aj Reichelt
- Endocrine Division, Hospital de Clínicas de Porto Alegre (HCPA), Rio Grande do Sul, Brazil
| | - Maria Lúcia R Oppermann
- Department of Gynecology and Obstetrics, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Cristiane B Leitão
- Department of Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Endocrine Division, Hospital de Clínicas de Porto Alegre (HCPA), Rio Grande do Sul, Brazil
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Daemers DOA, Wijnen HAA, van Limbeek EBM, Budé LM, Nieuwenhuijze MJ, Spaanderman MEA, de Vries RG. The effect of gestational weight gain on likelihood of referral to obstetric care for women eligible for primary, midwife-led care after antenatal booking. Midwifery 2016; 34:123-132. [PMID: 26754055 DOI: 10.1016/j.midw.2015.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 12/04/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE to examine the effect of gestational weight gain (GWG) on likelihood of referral from midwife-led to obstetrician-led care during pregnancy and childbirth for women in primary care at the outset of their pregnancy. DESIGN secondary analysis of data from a prospective cohort study. SETTING Dutch midwife-led practices. PARTICIPANTS a cohort of 1288 women of Northern European descent, with uncomplicated, singleton pregnancy at antenatal booking who consequently were eligible for primary, midwife-led care. MEASUREMENTS because of the absence of an established GWG guideline in the Netherlands, we compared the effect of inadequate and excessive GWG according to two GWG guidelines: the criterion traditionally used, which is based on knowledge of the physiological components of GWG, advising 10-15kg as a normal GWG irrespective of a woman׳s BMI category, and the 2009 Institute of Medicine recommendations (IOMr) on GWG, which provide BMI related advice. Outcome measures were: number of women referred from midwife-led to obstetrician-led care during pregnancy and during childbirth; indications of referral and birth outcomes. FINDINGS GWG above traditional criteria (Tc; >15kg between 12 and 36 weeks) was associated with increased odds for referral during childbirth (adjusted odds ratio (aOR) 1.88; 95% confidence interval (CI) 1.22-2.90), but had no effect on referral during pregnancy (aOR .86; 95% CI .57-1.30). No associations were established between GWG below Tc (<10kg) and referral during pregnancy (aOR 1.08; 95% CI .78-1.50) or childbirth (aOR 1.08; 95% CI .74-1.56). No associations were found between GWG below and above the IOMr and referral during pregnancy (below IOMr: aOR 1.01; 95% CI .71-1.45; above IOMr: aOR .89; 95% CI .61-1.28) or childbirth (below IOMr: aOR .85; 95% CI .57-1.25; above IOMr: aOR 1.09; 95% CI .73-1.63). With regard to the effect of GWG according to both recommendations on indications for referral and birth outcomes, GWG above Tc was associated with higher rates of referral for hypertensive disorders (aOR 1.91; 95% CI 1.04-3.50) and for meconium stained liquor (aOR 2.22; CI 1.33-3.71) after adjusting for BMI and parity. CONCLUSIONS GWG above Tc - irrespective of BMI category - was associated with doubled odds of referral to specialist care during childbirth. GWG below or above IOMR and GWG below TC were not associated with adverse obstetric outcomes in women who were eligible for primary care at the outset of their pregnancy. IMPLICATIONS FOR PRACTICE weight gain <15kg between 12 and 36 weeks is advised for women in all BMI categories in this population. It is important to validate GWG guidelines in a target population before implementing them.
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Affiliation(s)
- Darie O A Daemers
- Research Centre for Midwifery Science Maastricht (Zuyd University), PO Box 1256, 6201 BG Maastricht, The Netherlands.
| | - Hennie A A Wijnen
- Research Centre for Midwifery Science Maastricht (Zuyd University), PO Box 1256, 6201 BG Maastricht, The Netherlands.
| | - Evelien B M van Limbeek
- Research Centre for Midwifery Science Maastricht (Zuyd University), PO Box 1256, 6201 BG Maastricht, The Netherlands.
| | - Luc M Budé
- Research Centre for Midwifery Science Maastricht (Zuyd University), PO Box 1256, 6201 BG Maastricht, The Netherlands.
| | - Marianne J Nieuwenhuijze
- Research Centre for Midwifery Science Maastricht (Zuyd University), PO Box 1256, 6201 BG Maastricht, The Netherlands.
| | - Marc E A Spaanderman
- Department of Obstetrics and Gynaecology (University Hospital Maastricht), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
| | - Raymond G de Vries
- Research Centre for Midwifery Science Maastricht (Zuyd University) and Caphri School for Public Health and Primary Care (Maastricht University), PO Box 1256, 6201 BG Maastricht, The Netherlands.
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Michalec I, Simetka O, Navratilova M, Tomanova M, Gartner M, Salounova D, Prochazka M, Kacerovsky M. Vacuum-assisted vaginal delivery and levator ani avulsion in primiparous women. J Matern Fetal Neonatal Med 2015; 29:2715-8. [PMID: 26452564 DOI: 10.3109/14767058.2015.1102223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We compared the incidence and type of levator ani avulsion diagnosed by translabial ultrasound evaluation in primiparous women six months after vacuum-assisted or spontaneous vaginal delivery. MATERIAL AND METHODS This retrospective observational study was performed between January 2011 and December 2013. Primiparous women six months after vacuum-assisted vaginal delivery and after spontaneous vaginal delivery underwent translabial ultrasound evaluation. The distance between the urethra and fibers of the musculus levator ani puborectalis (levator-urethra gap) was measured. A levator-urethra gap >25 mm was considered a musculus levator ani avulsion. RESULTS In total, 184 women participated in the study. Among them, 92 had vacuum extraction and 92 had uncomplicated spontaneous delivery. A longer levator-urethra gap on both sides of the pubic bone was found in women after vacuum-assisted vaginal delivery (p < 0.0001 for both sides). Musculus levator ani avulsion was identified in 20 women (unilateral in 16 cases and bilateral in four cases). No difference in an incidence of musculus levator ani avulsion was identified in women after vacuum-assisted vaginal delivery [11/92 (12%)] compared to spontaneous delivery [9/92 (10%); p = 0.81]. CONCLUSION Vacuum-assisted vaginal delivery in primiparous women is associated with a longer levator-urethra gap but not with a higher frequency of avulsion of the musculus levator ani.
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Affiliation(s)
- Igor Michalec
- a Department of Gynecology and Obstetrics , University Hospital Ostrava , Ostrava , Czech Republic .,b Department of Surgical Studies , Faculty of Medicine, Ostrava University , Ostrava , Czech Republic
| | - Ondrej Simetka
- a Department of Gynecology and Obstetrics , University Hospital Ostrava , Ostrava , Czech Republic .,b Department of Surgical Studies , Faculty of Medicine, Ostrava University , Ostrava , Czech Republic
| | - Marie Navratilova
- a Department of Gynecology and Obstetrics , University Hospital Ostrava , Ostrava , Czech Republic
| | - Michaela Tomanova
- a Department of Gynecology and Obstetrics , University Hospital Ostrava , Ostrava , Czech Republic
| | - Marcel Gartner
- a Department of Gynecology and Obstetrics , University Hospital Ostrava , Ostrava , Czech Republic
| | - Dana Salounova
- c Department of Mathematical Methods in Economics , Faculty of Economics, Technical University of Ostrava , Ostrava , Czech Republic
| | - Martin Prochazka
- d Department of Gynecology and Obstetrics , Faculty of Medicine, Palacky University in Olomouc and University Hospital Olomouc , Olomouc , Czech Republic , and
| | - Marian Kacerovsky
- e Department of Gynecology and Obstetrics , University Hospital Hradec Kralove , Hradec Kralove , Czech Republic
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Ding XX, Xu SJ, Hao JH, Huang K, Su PY, Tao FB. Maternal pre-pregnancy BMI and adverse pregnancy outcomes among Chinese women: Results from the C-ABCS. J OBSTET GYNAECOL 2015; 36:328-32. [PMID: 26492517 DOI: 10.3109/01443615.2015.1050652] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The aim of this study was to investigate associations between pre-pregnancy body mass index (BMI) and adverse pregnancy outcomes among Chinese pregnant women. A prospective population-based cohort study was performed using data collected as part of the China-Anhui Birth Cohort Study or C-ABCS. A total of 13,121 pregnant women who received the first prenatal visit were enrolled from November 2008 to October 2010. Logistic regression analysis was used to calculate associations between pre-pregnancy BMI and pregnancy outcomes. Results indicated that the increased pre-pregnancy BMI was associated with a number of adverse pregnancy outcomes such as hypertensive disorder (adjusted relative risk (ARR) 2.3, 95% confidence interval [CI] 1.5-3.6), gestational diabetes (ARR 3.5, 95% CI 2.3-5.2), caesarean delivery (ARR 2.0, 95% CI 1.6-2.4), and medically indicated preterm delivery (ARR 1.8, 95% CI 1.1-2.9). Women with pre-pregnancy BMI above the normal range pose an increased risk of adverse pregnancy outcomes.
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Affiliation(s)
- X-X Ding
- a Department of Maternal , Child and Adolescent Health, School of Public Health, Anhui Medical University , Anhui , China.,b Anhui Provincial Key Laboratory of Population Health & Aristogenics , Anhui , China
| | - S-J Xu
- a Department of Maternal , Child and Adolescent Health, School of Public Health, Anhui Medical University , Anhui , China.,b Anhui Provincial Key Laboratory of Population Health & Aristogenics , Anhui , China
| | - J-H Hao
- a Department of Maternal , Child and Adolescent Health, School of Public Health, Anhui Medical University , Anhui , China.,b Anhui Provincial Key Laboratory of Population Health & Aristogenics , Anhui , China
| | - K Huang
- a Department of Maternal , Child and Adolescent Health, School of Public Health, Anhui Medical University , Anhui , China.,b Anhui Provincial Key Laboratory of Population Health & Aristogenics , Anhui , China
| | - P-Y Su
- a Department of Maternal , Child and Adolescent Health, School of Public Health, Anhui Medical University , Anhui , China.,b Anhui Provincial Key Laboratory of Population Health & Aristogenics , Anhui , China
| | - F-B Tao
- a Department of Maternal , Child and Adolescent Health, School of Public Health, Anhui Medical University , Anhui , China.,b Anhui Provincial Key Laboratory of Population Health & Aristogenics , Anhui , China
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Gante I, Amaral N, Dores J, Almeida MC. Impact of gestational weight gain on obstetric and neonatal outcomes in obese diabetic women. BMC Pregnancy Childbirth 2015; 15:249. [PMID: 26449278 PMCID: PMC4599662 DOI: 10.1186/s12884-015-0692-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 10/05/2015] [Indexed: 11/10/2022] Open
Abstract
Background Both obesity and gestational diabetes mellitus are increasing in prevalence, being a major health problem in pregnancy with independent and additive impact on obstetrics outcomes. It is recognized that inadequate gestational weight gain is an independent risk factor for pregnancy-related morbidity. The aim of this study was to evaluate the effect of gestational weight gain on obstetric and neonatal outcomes in obese women with gestational diabetes. Methods Retrospective multicenter study of obese women with gestational diabetes. The assessed group was divided into three categories: women who gained below (<5 kg), within (5–9 kg) and above (>9 kg) the 2009 Institute of Medicine recommendations. Maternal and neonatal outcomes were compared and adjusted odds ratios calculated controlling for confounders. Results Only 35,1 % of obese women with gestational diabetes (n = 634) achieved the recommended gestational weight gain; 27,8 % (n = 502) gained below and 37,1 % (n = 670) above the recommendations. There was a positive correlation between gestational weight gain and neonatal birthweight (r = 0,225; p < 0,001). Gestational weight gain below recommendations was associated with lower odds for cesarean section, even adjusting for birthweight [aOR = 0,67 (0,54–0,85); p < 0,001]; lower odds for large for gestational age neonates [aOR = 0,39 (0,28–0,57); p < 0,001] and macrosomia [aOR = 0,34 (0,21–0,55); p < 0,001]. Excessive weight gain, even adjusting for birthweight, was associated with higher odds for cesarean section [aOR = 1,31 (1,07–1,61); p = 0,009], low Apgar score [aOR = 4,79 (1,19–19,21); p = 0,027], large for gestational age neonates [aOR = 2,32 (1,76–3,04); p < 0,001] and macrosomia [aOR = 2,39 (1,68–3,38); p < 0,001]. Conclusions In obese women with gestational diabetes, a reduced gestational weight gain (<5 kg) is associated with better obstetric and neonatal outcomes than an excessive or even an adequate weight gain. Therefore, specific recommendations should be created since gestational weight gain could be a modifiable risk factor for adverse obstetric outcomes.
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Affiliation(s)
- Inês Gante
- Department of Obstetrics, Maternidade Bissaya Barreto - Centro Hospitalar e Universitário de Coimbra, Rua Augusta, 3000-061, Coimbra, Portugal.
| | - Njila Amaral
- Department of Obstetrics, Hospital Beatriz Ângelo, Loures, Portugal.
| | - Jorge Dores
- Department of Obstetrics, Centro Hospitalar do Porto, Porto, Portugal.
| | - Maria C Almeida
- Department of Obstetrics, Maternidade Bissaya Barreto - Centro Hospitalar e Universitário de Coimbra, Rua Augusta, 3000-061, Coimbra, Portugal.
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Thurn L, Lindqvist PG, Jakobsson M, Colmorn LB, Klungsoyr K, Bjarnadóttir RI, Tapper AM, Børdahl PE, Gottvall K, Petersen KB, Krebs L, Gissler M, Langhoff-Roos J, Källen K. Abnormally invasive placenta-prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries. BJOG 2015; 123:1348-55. [PMID: 26227006 DOI: 10.1111/1471-0528.13547] [Citation(s) in RCA: 206] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective was to investigate prevalence, estimate risk factors, and antenatal suspicion of abnormally invasive placenta (AIP) associated with laparotomy in women in the Nordic countries. DESIGN Population-based cohort study. SETTING AND POPULATION A 3-year Nordic collaboration among obstetricians to identify and report on uterine rupture, peripartum hysterectomy, excessive blood loss, and AIP from 2009 to 2012 The Nordic Obstetric Surveillance Study (NOSS). METHODS In the NOSS study, clinicians reported AIP cases from maternity wards and the data were validated against National health registries. MAIN OUTCOME MEASURES Prevalence, risk factors, antenatal suspicion, birth complications, and risk estimations using aggregated national data. RESULTS A total of 205 cases of AIP in association with laparotomy were identified, representing 3.4 per 10 000 deliveries. The single most important risk factor, which was reported in 49% of all cases of AIP, was placenta praevia. The risk of AIP increased seven-fold after one prior caesarean section (CS) to 56-fold after three or more CS. Prior postpartum haemorrhage was associated with six-fold increased risk of AIP (95% confidence interval 3.7-10.9). Approximately 70% of all cases were not diagnosed antepartum. Of these, 39% had prior CS and 33% had placenta praevia. CONCLUSION Our findings indicate that a lower CS rate in the population may be the most effective way to lower the incidence of AIP. Focused ultrasound assessment of women at high risk will likely strengthen antenatal suspicion. Prior PPH is a novel risk factor associated with an increased prevalence of AIP. TWEETABLE ABSTRACT An ultrasound assessment in women with placenta praevia or prior CS may double the awareness for AIP.
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Affiliation(s)
- L Thurn
- Department of Obstetrics and Gynaecology, Blekinge Hospital, Karlskrona, Sweden
| | - P G Lindqvist
- Department of Obstetrics and Gynaecology, Clintec, Karolinska University Hospital, Stockholm, Sweden
| | - M Jakobsson
- Department of Obstetrics and Gynaecology, University Hospital, Helsinki, Finland
| | - L B Colmorn
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - K Klungsoyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway
| | - R I Bjarnadóttir
- Department of Obstetrics and Gynaecology, Landspitali University Hospital, Reykjavik, Iceland
| | - A M Tapper
- Department of Gynaecology and Paediatrics, University Hospital, Helsinki, Finland
| | - P E Børdahl
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - K Gottvall
- Department of Evaluation and Analysis, Epidemiology and Methodological support unit, National Board of Health and Welfare, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - K B Petersen
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - L Krebs
- Department of Obstetrics and Gynaecology, Holbaek Hospital, Holbaek and University of Copenhagen, Copenhagen, Denmark
| | - M Gissler
- THL National Institute for Health and Welfare, Helsinki, Finland.,Nordic School of Public Health, Gothenburg, Sweden
| | - J Langhoff-Roos
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - K Källen
- Department of Evaluation and Analysis, Epidemiology and Methodological support unit, National Board of Health and Welfare, Stockholm, Sweden.,Department of Reproduction Epidemiology, Tornblad Institute, Institution of Clinical Sciences, Lund University, Lund, Sweden
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Lutsiv O, Mah J, Beyene J, McDonald SD. The effects of morbid obesity on maternal and neonatal health outcomes: a systematic review and meta-analyses. Obes Rev 2015; 16:531-46. [PMID: 25912896 DOI: 10.1111/obr.12283] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/27/2015] [Accepted: 03/03/2015] [Indexed: 12/22/2022]
Abstract
Morbidly obese (Class III, body mass index [BMI] ≥ 40 kg m(-2)) women constitute 8% of reproductive-aged women and are an increasing proportion; however, their pregnancy risks have not yet been well understood. Hence, we performed meta-analyses following the MOOSE (Meta-Analysis of Observational Studies in Epidemiology) guideline, searching Medline and Embase from their inceptions. To examine graded relationships, we compared Class III obesity to Class I and I/II, and separately to normal weight. We found important effects on all three primary outcomes in morbidly obese women: preterm birth <37 weeks was 31% higher compared with Class I (relative risk [RR] 1.31 [1.19, 1.43]) and 20% higher than Class I/II (RR 1.20 [1.13, 1.27]), large-for-gestational age was higher (RR 1.37 [1.29, 1.45] and RR 1.30 [1.24, 1.36] compared with Class I and I/II, respectively), while small-for-gestational age was lower (RR 0.89 [0.84, 0.93] compared with Class I, with nearly identical reductions for Class I/II). Morbidly obese women have higher risks of preterm birth, large-for-gestational age and numerous other adverse maternal and infant health outcomes, relative to not only normal weight but also Class I or I/II obese women. These findings have important implications for screening and care of morbidly obese pregnant women, to try to decrease adverse outcomes.
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Affiliation(s)
- O Lutsiv
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON, Canada
| | - J Mah
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - J Beyene
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
| | - S D McDonald
- Canada Research Chair in Maternal and Child Obesity Intervention and Prevention, Departments of Obstetrics & Gynecology, Radiology, and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
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Hu R, Li Y, Zhang Z, Yan W. Antenatal depressive symptoms and the risk of preeclampsia or operative deliveries: a meta-analysis. PLoS One 2015; 10:e0119018. [PMID: 25789626 DOI: 10.1371/journal.pone.0119018] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 01/08/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The purpose of the study was to investigate the association between depression and/or depressive symptoms during pregnancy and the risk of an operative delivery or preeclampsia, and to quantify the strength of the association. METHODS A search of the PubMed, SCI/SSCI, Proquest PsycARTICLES and CINAHL databases was supplemented by manual searches of bibliographies of key retrieved articles and review articles. We aimed to include case control or cohort studies that reported data on antenatal depression and /or depressive symptoms and the risk of an operative delivery and/or preeclampsia. RESULTS Twelve studies with self-reported screening instruments were eligible for inclusion with a total of 8400 participants. Seven articles that contained 4421 total participants reported the risk for an operative delivery, and five articles that contained 3979 total participants reported the risk for preeclampsia. The pooled analyses showed that both operative delivery and preeclampsia had a statistically significant association with antenatal depressive symptoms (RR = 1.24; 95% CI, 1.14 to 1.35, and OR = 1.63, 95% CI, 1.32 to 2.02, respectively). When the pre-pregnancy body mass indices were controlled in their initial design, the risk for preeclampsia still existed (OR = 1.48, 95% CI, 1.04 to 2.01), while the risk for an operative delivery became uncertain (RR = 1.01, 95% CI, 0.85 to 1.22). CONCLUSIONS Antenatal depressive symptoms are associated with a moderately increased risk of an operative delivery and preeclampsia. An abnormal pre-pregnancy body mass index may modify this association.
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Kritzer S, Magner K, Warshak CR. Increasing maternal body mass index and the accuracy of sonographic estimation of fetal weight near delivery. J Ultrasound Med 2014; 33:2173-2179. [PMID: 25425375 DOI: 10.7863/ultra.33.12.2173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To evaluate whether an increasing body mass index (BMI) influences the accuracy of sonographic estimation of fetal weight. METHODS We performed a retrospective cohort study of singleton deliveries over a 2-year period in a single institution. Patients were included if they had a fetal weight estimation within 2 weeks of delivery. The Δ estimated fetal weight (EFW) was calculated by subtracting the sonographic EFW from the birth weight and compared among our study groups, which were based on the maternal BMI class. We also compared the absolute percentage error of estimation, rate of substantial error greater than 20%, rate of underestimation, and ability to predict fetal weight greater than 4000 g. Post hoc power analysis determined that our study group of 1200 patients allowed for an α of .05 and β of .90. RESULTS We included 1177 women in our analysis. The median ΔEFW varied between study groups: 137, 202, 157, 200, and 189 g, respectively, in normal-weight, overweight, and obese classes 1, 2, and 3 (P = .01). The median percentage error of estimation between study groups varied between 5.0% in normal-weight women and 7.1% in class 2 obese women (P= .05). The rate of substantial error was similar between study groups and varied between 2.7% in class 1 obese women and 4.3% in normal-weight and class 2 obese women. Linear regression analysis showed a weak association between maternal BMI and ΔEFW (R(2) = 0.005; r = 0.069). CONCLUSIONS The absolute ΔEFW was lower in normal-weight women; however, the percentage error of the EFW was similar between women of varying BMI classifications, as was the rate of substantial error and the rate of underestimation of the EFW.
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Affiliation(s)
- Sara Kritzer
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio USA (S.K., K.M., C.R.W.); and Department of Obstetrics and Gynecology, The Christ Hospital, Cincinnati, Ohio USA (S.K., K.M.)
| | - Kristin Magner
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio USA (S.K., K.M., C.R.W.); and Department of Obstetrics and Gynecology, The Christ Hospital, Cincinnati, Ohio USA (S.K., K.M.)
| | - Carri R Warshak
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio USA (S.K., K.M., C.R.W.); and Department of Obstetrics and Gynecology, The Christ Hospital, Cincinnati, Ohio USA (S.K., K.M.).
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Abstract
OBJECTIVE Obesity is critically important to maternal and fetal health during the perinatal period. We have detected an increasing prevalence of maternal obesity in recent years and investigated its complications during pregnancy. METHODS A total of 931 pregnant females were investigated between March 2012 and March 2013. The patients were divided into four groups: body mass index (BMI) < 18.5 kg/m(2) was underweight, 18.5-24.9 kg/m(2) was normal weight, 25-29.9 kg/m(2) was overweight and ≥30 kg/m(2) was obese. The effects of obesity on fetal and maternal outcomes were investigated. RESULTS Significant increases in pregnancy-induced hypertension, gestational diabetes mellitus, cesarean delivery, premature rupture of membranes, shoulder dystocia, meconium-stained amniotic fluid, abnormal heart rate pattern and postpartum infection rates were found in the obese group during the perinatal period. Adverse maternal effects in obese cases were significantly more frequent than those in normal-weight cases. Preterm birth, perinatal mortality, low APGAR scores, newborn intensive care unit requirement, hypoglycemia and macrosomia rates were significantly higher in obese cases than those in non-obese cases. However, low birth weight infant rate was higher in the low BMI cases than that in the other BMI categories (p < 0.01). CONCLUSION We conclude that obesity is an important factor associated with pregnancy complications and the increase in maternal-fetal morbidity and mortality.
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Affiliation(s)
- Muhittin Eftal Avcı
- a Department of Perinatology , Tepecik Training and Research Hospital , Yenişehir , Izmir , Turkey
| | - Fatih Şanlıkan
- b Department of Obstetrics and Gynecology , Ümraniye Education and Research Hospital , İstanbul , Turkey , and
| | - Mehmet Çelik
- b Department of Obstetrics and Gynecology , Ümraniye Education and Research Hospital , İstanbul , Turkey , and
| | - Anıl Avcı
- c Gaziemir State Hospital , İzmir , Turkey
| | - Mustafa Kocaer
- a Department of Perinatology , Tepecik Training and Research Hospital , Yenişehir , Izmir , Turkey
| | - Ahmet Göçmen
- b Department of Obstetrics and Gynecology , Ümraniye Education and Research Hospital , İstanbul , Turkey , and
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Thomson JL, Tussing-Humphreys LM, Goodman MH. Delta Healthy Sprouts: A randomized comparative effectiveness trial to promote maternal weight control and reduce childhood obesity in the Mississippi Delta. Contemp Clin Trials 2014; 38:82-91. [DOI: 10.1016/j.cct.2014.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/15/2014] [Accepted: 03/21/2014] [Indexed: 02/08/2023]
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