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Foxcroft KF, Rowlands IJ, Byrne NM, McIntyre HD, Callaway LK. Exercise in obese pregnant women: the role of social factors, lifestyle and pregnancy symptoms. BMC Pregnancy Childbirth 2011; 11:4. [PMID: 21226958 PMCID: PMC3025919 DOI: 10.1186/1471-2393-11-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 01/12/2011] [Indexed: 12/16/2022] Open
Abstract
Background Physical activity may reduce the risk of adverse maternal outcomes, yet there are very few studies that have examined the correlates of exercise amongst obese women during pregnancy. We examined which relevant sociodemographic, obstetric, and health behaviour variables and pregnancy symptoms were associated with exercise in a small sample of obese pregnant women. Methods This was a secondary analysis using data from an exercise intervention for the prevention of gestational diabetes in obese pregnant women. Using the Pregnancy Physical Activity Questionnaire (PPAQ), 50 obese pregnant women were classified as "Exercisers" if they achieved ≥900 kcal/wk of exercise and "Non-Exercisers" if they did not meet this criterion. Analyses examined which relevant variables were associated with exercise status at 12, 20, 28 and 36 weeks gestation. Results Obese pregnant women with a history of miscarriage; who had children living at home; who had a lower pre-pregnancy weight; reported no nausea and vomiting; and who had no lower back pain, were those women who were most likely to have exercised in early pregnancy. Exercise in late pregnancy was most common among tertiary educated women. Conclusions Offering greater support to women from disadvantaged backgrounds and closely monitoring women who report persistent nausea and vomiting or lower back pain in early pregnancy may be important. The findings may be particularly useful for other interventions aimed at reducing or controlling weight gain in obese pregnant women.
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Affiliation(s)
- Katie F Foxcroft
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, (Butterfield St), Brisbane, (4029), Australia.
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302
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Syngelaki A, Bredaki FE, Vaikousi E, Maiz N, Nicolaides KH. Body Mass Index at 11–13 Weeks’ Gestation and Pregnancy Complications. Fetal Diagn Ther 2011; 30:250-65. [DOI: 10.1159/000328083] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 12/14/2010] [Indexed: 12/16/2022]
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303
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Ehrenthal DB, Jurkovitz C, Hoffman M, Jiang X, Weintraub WS. Prepregnancy Body Mass Index as an Independent Risk Factor for Pregnancy-Induced Hypertension. J Womens Health (Larchmt) 2011; 20:67-72. [DOI: 10.1089/jwh.2010.1970] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Deborah B. Ehrenthal
- Department of Obstetrics and Gynecology, Christiana Care Health Services, Newark, Delaware
| | - Claudine Jurkovitz
- Christiana Care Center for Outcomes Research, Christiana Care Health Services, Newark, Delaware
| | - Matthew Hoffman
- Department of Obstetrics and Gynecology, Christiana Care Health Services, Newark, Delaware
| | - Xiaozhang Jiang
- Christiana Care Center for Outcomes Research, Christiana Care Health Services, Newark, Delaware
| | - William S. Weintraub
- Christiana Care Center for Outcomes Research, Christiana Care Health Services, Newark, Delaware
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304
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Whiteman VE, Crisan L, McIntosh C, Alio A, Duan J, Marty PJ, Salihu HM. Interpregnancy Body Mass Index Changes and Risk of Stillbirth. Gynecol Obstet Invest 2011; 72:192-5. [DOI: 10.1159/000324375] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 01/02/2011] [Indexed: 11/19/2022]
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305
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Kroon B, Harrison K, Martin N, Wong B, Yazdani A. Miscarriage karyotype and its relationship with maternal body mass index, age, and mode of conception. Fertil Steril 2010; 95:1827-9. [PMID: 21183175 DOI: 10.1016/j.fertnstert.2010.11.065] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 10/26/2010] [Accepted: 11/29/2010] [Indexed: 11/30/2022]
Abstract
This study investigated the association between miscarriage karyotype and body mass index, maternal age, and mode of conception. Miscarriages after IVF and/or intracytoplasmic sperm injection were less frequently aneuploid; advanced maternal age was associated with an increase in aneuploid products of conception; overweight and obese women aged <35 years were less likely to have aneuploid miscarriages than women in a healthy weight range, suggesting alternate mechanisms for miscarriage in this population.
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Affiliation(s)
- Ben Kroon
- Queensland Fertility Group Research Fondation, Brisbane, Queensland, Australia.
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306
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Tariq YM, Samarawickrama C, Li H, Huynh SC, Burlutsky G, Mitchell P. Retinal thickness in the offspring of diabetic pregnancies. Am J Ophthalmol 2010; 150:883-7. [PMID: 20951974 DOI: 10.1016/j.ajo.2010.06.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 06/24/2010] [Accepted: 06/26/2010] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare macular and peripapillary retinal nerve fiber layer (RNFL) thickness in children from diabetic compared with nondiabetic pregnancy. DESIGN Cross-sectional study. METHODS As part of the Sydney Myopia Study, 2367 children from grade 7 (age range 11.1 to 14.4 years) completed detailed ocular examinations during 2004-2005. Examination included determination of best-corrected visual acuity (logarithm of minimal angle of resolution) and autorefraction after cycloplegia. Axial length was measured using noncontact interferometry. Optical coherence tomography (OCT) was performed using Stratus OCT through dilated pupils. Participants and parents completed comprehensive questionnaires including questions on birth parameters and medical history. RESULTS There were 1741 and 1687 children with adequate-quality RNFL and macular scans respectively, who had complete examination and questionnaire data. There were 57 children from diabetic pregnancies who had both RNFL and macular scans. Children from diabetic pregnancies had significantly thinner inner (264.9 μm vs 270.2 μm, P = .007) and outer (231.9 μm vs 238.6 μm, P = .0001) macular thickness and macular volume (6.75 mm(3) vs 6.92 mm(3), P = .0003) compared with children from nondiabetic pregnancies. However, central macular thickness, foveal minimum thickness, and RNFL parameters were not significantly different between the 2 groups. CONCLUSION Diabetes during pregnancy is associated with changes in retinal morphology in the offspring. Thinning of the pericentral macular parameters was evident in Stratus OCT scans of children from diabetic pregnancies. These findings suggest the possibility that maternal diabetes impacts on the development of the retina.
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Affiliation(s)
- Yasser M Tariq
- Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Sydney, Australia
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307
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Knight M. Studies using routine data versus specific data collection: What can we learn about the epidemiology of eclampsia and the impact of changes in management of gestational hypertensive disorders? Pregnancy Hypertens 2010; 1:109-16. [PMID: 26104236 DOI: 10.1016/j.preghy.2010.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Evidence-based changes in practice, services and policy may impact on the spectrum of pregnancy hypertensive disorders at many levels. Demonstration of clinical benefit relies on assessment of changes in disease incidence or complications. Two main alternative observational methodologies may be used to investigate changes in disease incidence; the first using routinely collected data and the second with specially designed prospective data collection. Routinely collected data have been shown to have limitations; the introduction of specific prospective data collection systems, such as the UK Obstetric Surveillance System, allow for an increased robustness and range of disease incidence and outcome studies, and thus enhance our ability to investigate the impact of changes in practice. The comparison of recent national studies using these systems shows that the incidence of eclampsia has declined in the UK, but that the incidence of eclampsia is higher in the Netherlands and Scandinavia. The decrease in the UK is clearly due to a fall in the number of women with diagnosed pre-eclampsia who go on to have an eclamptic fit; figures from the Netherlands and Scandinavia suggest that eclamptic fits in the group with prior diagnosed pre-eclampsia are less effectively prevented and this may be the reason for the observed higher incidence of eclampsia. This information may help to further inform management and preventive strategies, and illustrates the additional benefits of international comparisons of severe maternal morbidities.
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Affiliation(s)
- Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, UK
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308
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Baron CM, Girling LG, Mathieson AL, Menticoglou SM, Seshia MM, Cheang MS, Mutch WAC. Obstetrical and neonatal outcomes in obese parturients. J Matern Fetal Neonatal Med 2010; 23:906-13. [PMID: 19895351 DOI: 10.3109/14767050903338472] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Obstetrical risk is increased with maternal obesity. This prospective study was designed to simultaneously evaluate the outcomes in obese parturients and their newborns. METHODS Patients with a body mass index (BMI) > or =35 were prospectively identified and compared to an equal number of normal weight parturients. Maternal and neonatal outcome measures were compared for the peripartum and neonatal period. RESULTS We identified 580 obese parturients over a 6 month period and compared them to an equal number of normal weight parturients. The incidence of obesity in this population was 23%. Obesity was associated with increased rates of hypertension, diabetes, and cesarean section. Obese patients were more likely to develop postpartum complications. Neonatal outcomes were compared for infants > or =37 weeks gestation excluding multiple births (496 neonates in the obese group and 520 in the control group). The neonates of obese parturients were more likely to be macrosomic, have 1-minute Apgar scores of < or =7.0 and require admission to a special care unit. Sub-group analysis showed that negative outcomes for parturients and their neonates correlated with increasing BMI. Neonates born to obese diabetic parturients had the highest risk of poor outcomes. CONCLUSIONS Maternal obesity confers increased risks for both the parturient and their newborn.
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Affiliation(s)
- Cynthia M Baron
- Department of Anesthesia, Health Science Centre, Winnipeg, Manitoba, Canada.
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309
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The 30minute decision to delivery time is unrealistic in morbidly obese women. Int J Obstet Anesth 2010; 19:431-5. [DOI: 10.1016/j.ijoa.2010.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 07/23/2010] [Indexed: 11/22/2022]
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310
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Valsamakis G, Kumar S, Creatsas G, Mastorakos G. The effects of adipose tissue and adipocytokines in human pregnancy. Ann N Y Acad Sci 2010; 1205:76-81. [PMID: 20840256 DOI: 10.1111/j.1749-6632.2010.05667.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
During pregnancy, important changes take place in maternal metabolism because of the growing fetus and placental formation. The increase in insulin resistance during pregnancy is paralleled by the progressive increase of maternal adipose tissue deposition. This review examines the topography of fat mass deposition during pregnancy in relation to factors such as parity and maternal age that might affect this deposition. We also examine adipose tissue markers, such as pregravid weight and weight gain during pregnancy, and their effect on fetal growth and pregnancy outcomes. In addition, this review studies the possible effects of cytokines that are produced by adipose tissue and the placenta on maternal metabolism and its complications. Finally, we also consider the possible role of maternal adipocytokines and fetal adipocytokines on fetal growth.
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Affiliation(s)
- G Valsamakis
- Endocrine Unit, 2nd Department of Obstetrics and Gynaecology, Aretaieion University Hospital, Athens Medical School, Athens, Greece.
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311
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The risk of adverse pregnancy outcomes in women who are overweight or obese. BMC Pregnancy Childbirth 2010; 10:56. [PMID: 20849609 PMCID: PMC2949787 DOI: 10.1186/1471-2393-10-56] [Citation(s) in RCA: 245] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Accepted: 09/17/2010] [Indexed: 11/10/2022] Open
Abstract
Background The prevalence of obesity amongst women bearing children in Australia is rising and has important implications for obstetric care. The aim of this study was to assess the prevalence and impact of mothers being overweight and obese in early to mid-pregnancy on maternal, peripartum and neonatal outcomes. Methods A secondary analysis was performed on data collected from nulliparous women with a singleton pregnancy enrolled in the Australian Collaborative Trial of Supplements with antioxidants Vitamin C and Vitamin E to pregnant women for the prevention of pre-eclampsia (ACTS). Women were categorized into three groups according to their body mass index (BMI): normal (BMI 18.5-24.9 kg/m2); overweight (BMI 25-29.9 kg/m2) and; obese (BMI 30-34.9 kg/m2). Obstetric and perinatal outcomes were compared by univariate and multivariate analyses. Results Of the 1661 women included, 43% were overweight or obese. Obese women were at increased risk of pre-eclampsia (relative risk (RR) 2.99 [95% confidence intervals (CI) 1.88, 4.73], p < 0.0001) and gestational diabetes (RR 2.10 [95%CI 1.17, 3.79], p = 0.01) compared with women with a normal BMI. Obese and overweight women were more likely to be induced and require a caesarean section compared with women of normal BMI (induction - RR 1.33 [95%CI 1.13, 1.57], p = 0.001 and 1.78 [95%CI 1.51, 2.09], p < 0.0001, caesarean section - RR 1.42 [95%CI 1.18, 1.70], p = 0.0002 and 1.63 [95%CI 1.34, 1.99], p < 0.0001). Babies of women who were obese were more likely to be large for gestational age (LFGA) (RR 2.08 [95%CI 1.47, 2.93], p < 0.0001) and macrosomic (RR 4.54 [95%CI 2.01, 10.24], p = 0.0003) compared with those of women with a normal BMI. Conclusion The rate of overweight and obesity is increasing amongst the Australian obstetric population. Women who are overweight and obese have an increased risk of adverse pregnancy outcomes. In particular, obese women are at increased risk of gestational diabetes, pregnancy induced hypertension and pre-eclampsia. Effective preventative strategies are urgently needed. Trial Registration Current Controlled Trials ISRCTN00416244
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312
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Liu S, Joseph K, Bartholomew S, Fahey J, Lee L, Allen AC, Kramer MS, Sauve R, Young DC, Liston RM. Temporal Trends and Regional Variations in Severe Maternal Morbidity in Canada, 2003 to 2007. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:847-855. [DOI: 10.1016/s1701-2163(16)34656-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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313
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El-Gilany AH, Hammad S. Body mass index and obstetric outcomes in pregnant in Saudi Arabia: a prospective cohort study. Ann Saudi Med 2010; 30:376-80. [PMID: 20697173 PMCID: PMC2941250 DOI: 10.4103/0256-4947.67075] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We examined the effect of body mass index in early pregnancy on pregnancy outcome since no study in Saudi Arabia has addressed this question. METHODS This prospective cohort study involved women registered for antenatal care during the first month of pregnancy at primary health care centers in Al-Hassa, Saudi Arabia. Data was collected from records and by direct interview. RESULTS The study included 787 women. Compared to normal weight women (n=307), overweight (n=187) and obese (n=226) women were at increased risk for pregnancy-induced hypertension (RR=4.9 [95% CI 1.6-11.1] and 6.1 [95% CI 2.1-17.8], respectively), gestational diabetes (RR=4.4 [95% CI 1.2-16.3] and 8.6 [95% CI 2.6-28.8]), preeclamptic toxemia (RR=3.8 [95% CI 1.1-14.6] and 5.9 [95% CI 1.7-20.4]), urinary tract infections (RR=1.4 [95% CI 0.5-3.9] and 3.7 [95% CI 1.7-6.2]), and cesarean delivery (RR=2.0 [95% CI 1.3-3.0] in obese women). Neonates born to obese women had an increased risk for postdate pregnancy (RR=3.7 [95% CI 1.2-11.6]), macrosomia (RR=6.8 [95% CI 1.5-30.7]), low 1-minute Apgar score (RR=1.9 [95% CI 1.1-3.6]), and admission to neonatal care units (RR=2.1 [95% CI 1.2-2.7]). On the other hand, low birth weight was less frequent among obese women (RR=0.5 [95% CI 0.3-0.9]) while the risk was high among underweight women (RR=2.3 [95% CI 1.4-3.8]). CONCLUSION Even with adequate prenatal care, overweight and obesity can adversely affect pregnancy outcomes.
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314
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OBESITY AND FEMALE FECUNDITY. Nutr Diet 2010. [DOI: 10.1111/j.1747-0080.2010.01460.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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315
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Ng SK, Olog A, Spinks AB, Cameron CM, Searle J, McClure RJ. Risk factors and obstetric complications of large for gestational age births with adjustments for community effects: results from a new cohort study. BMC Public Health 2010; 10:460. [PMID: 20687966 PMCID: PMC2921393 DOI: 10.1186/1471-2458-10-460] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 08/06/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High birth weight has serious adverse impacts on chronic health conditions and development in children. This study identifies the social determinants and obstetric complications of high birth weight adjusted for gestational age and baby gender. METHODS Pregnant women were recruited from three maternity hospitals in South-East Queensland in Australia during antenatal clinic visits. A questionnaire was completed by each participant to elicit information on eco-epidemiological exposures. Perinatal information was extracted from hospital birth records. A hierarchical mixture regression model was used in the analysis to account for the heterogeneity of birth weights and identify risk factors and obstetric complications of births that were large for gestational age. A generalized linear mixed model was used to adjust for (random) "community" effects. RESULTS Pre-pregnancy obesity (adjusted OR = 2.73, 95% CI = 1.49-5.01), previous pregnancy (adjusted OR = 2.03, 95% CI = 1.08-3.81), and married mothers (adjusted OR = 1.85, 95% CI = 1.00-3.42) were significantly associated with large for gestational age babies. Subsequent complications included the increased need for delivery by caesarean sections or instrumental procedures (adjusted OR = 1.98, 95% CI = 1.10-3.55), resuscitation (adjusted OR = 2.52, 95% CI = 1.33-4.79), and transfer to intensive/special care nursery (adjusted OR = 3.76, 95% CI = 1.89-7.49). Communities associated with a higher proportion of large for gestational age births were identified. CONCLUSIONS Pre pregnancy obesity is the principal modifiable risk factor for large for gestational age births. Large for gestational age is an important risk factor for the subsequent obstetric complications. The findings improve the evidence-base on which to base preventive interventions to reduce the impact of high birth weight on maternal and child health.
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Affiliation(s)
- Shu-Kay Ng
- School of Medicine, Griffith University Logan Campus, Meadowbrook, QLD 4131, Australia
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316
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Dennedy MC, Dunne F. The maternal and fetal impacts of obesity and gestational diabetes on pregnancy outcome. Best Pract Res Clin Endocrinol Metab 2010; 24:573-89. [PMID: 20832737 DOI: 10.1016/j.beem.2010.06.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Obesity has reached pandemic proportions and is of growing concern worldwide. Adverse health outcomes associated with a raised body mass index present the greatest challenge currently facing clinicians across all disciplines. Obesity is a chronic illness which is associated with metabolic disease, nutritional deficiency, musculoskeletal complications and cancer. These obesity-related health issues extend to pregnancy where they are responsible for producing a variety of medical and obstetric complications resulting in an increased incidence of maternal and fetal adverse outcomes. Management of diet, gestational diabetes and gestational and inter-gestational weight may improve outcomes in women who are obese during pregnancy. Specific recommendations for the management of obesity in pregnancy have recently been published.
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Affiliation(s)
- Michael Conall Dennedy
- Department of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland.
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317
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McDonald SD, Han Z, Mulla S, Beyene J. Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses. BMJ 2010; 341:c3428. [PMID: 20647282 PMCID: PMC2907482 DOI: 10.1136/bmj.c3428] [Citation(s) in RCA: 406] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the relation between overweight and obesity in mothers and preterm birth and low birth weight in singleton pregnancies in developed and developing countries. DESIGN Systematic review and meta-analyses. DATA SOURCES Medline and Embase from their inceptions, and reference lists of identified articles. STUDY SELECTION Studies including a reference group of women with normal body mass index that assessed the effect of overweight and obesity on two primary outcomes: preterm birth (before 37 weeks) and low birth weight (<2500 g). DATA EXTRACTION Two assessors independently reviewed titles, abstracts, and full articles, extracted data using a piloted data collection form, and assessed quality. DATA SYNTHESIS 84 studies (64 cohort and 20 case-control) were included, totalling 1 095 834 women. Although the overall risk of preterm birth was similar in overweight and obese women and women of normal weight, the risk of induced preterm birth was increased in overweight and obese women (relative risk 1.30, 95% confidence interval 1.23 to 1.37). Although overall the risk of having an infant of low birth weight was decreased in overweight and obese women (0.84, 0.75 to 0.95), the decrease was greater in developing countries than in developed countries (0.58, 0.47 to 0.71 v 0.90, 0.79 to 1.01). After accounting for publication bias, the apparent protective effect of overweight and obesity on low birth weight disappeared with the addition of imputed "missing" studies (0.95, 0.85 to 1.07), whereas the risk of preterm birth appeared significantly higher in overweight and obese women (1.24, 1.13 to 1.37). CONCLUSIONS Overweight and obese women have increased risks of preterm birth and induced preterm birth and, after accounting for publication bias, appeared to have increased risks of preterm birth overall. The beneficial effects of maternal overweight and obesity on low birth weight were greater in developing countries and disappeared after accounting for publication bias.
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Affiliation(s)
- Sarah D McDonald
- McMaster University, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hamilton, ON, L8N 3Z5 Canada.
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318
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Bandoli G, Johnson DL, Jones KL, Lopez Jiminez J, Salas E, Mirrasoul N, Van Voorhees AS, Chambers CD. Potentially modifiable risk factors for adverse pregnancy outcomes in women with psoriasis. Br J Dermatol 2010; 163:334-9. [PMID: 20545678 DOI: 10.1111/j.1365-2133.2010.09899.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Data on pregnancy outcomes among women with psoriasis are lacking. However, there are several known comorbidities of psoriasis, including obesity, smoking and depression, each of which increases the risk for negative birth outcomes. OBJECTIVES To determine if pregnant women with psoriasis have an excess of potentially modifiable risk factors for adverse pregnancy outcomes. METHODS Prospectively collected data from the Organization of Teratology Information Specialists (OTIS) Autoimmune Diseases in Pregnancy Project were analysed to compare the prevalence of selected risk factors between 170 pregnant women with psoriasis and 158 nondiseased controls. RESULTS Women with psoriasis were more likely to be overweight/obese prior to pregnancy (P < 0.0001), to smoke (P < 0.0001), or to have a diagnosis of depression (P = 0.03), and were less likely to have been taking preconceptional vitamin supplements (P = 0.004). After controlling for race/ethnicity and socioeconomic status, women with psoriasis were 2.37 (95% confidence interval 1.45-3.87) times more likely to be overweight/obese as women without psoriasis. Duration of disease, age at onset, measures of disease impact during pregnancy, or use of biologics in pregnancy were not significant predictors of overweight/obesity in the subset of psoriatic women. CONCLUSIONS Pregnant women with psoriasis may be at increased risk for adverse pregnancy outcomes due to comorbidities or other health behaviours associated with the disease. These should be taken into consideration during clinical treatment of women with psoriasis who are in their childbearing years.
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Affiliation(s)
- G Bandoli
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
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319
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Valsamakis G, Margeli A, Vitoratos N, Boutsiadis A, Sakkas EG, Papadimitriou G, Al-Daghri NM, Botsis D, Kumar S, Papassotiriou I, Creatsas G, Mastorakos G. The role of maternal gut hormones in normal pregnancy: fasting plasma active glucagon-like peptide 1 level is a negative predictor of fetal abdomen circumference and maternal weight change. Eur J Endocrinol 2010; 162:897-903. [PMID: 20194524 DOI: 10.1530/eje-10-0047] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Maternal weight in pregnancy contributes to a glycemic environment that affects fetal growth. Gut peptides (glucagon-like peptide 1 (GLP1), glucose-dependent insulinotropic peptide (GIP), ghrelin, and peptide YY (PYY)) have been related to insulin sensitivity and secretion, weight control, and adipose tissue metabolism. This study aimed at examining the associations of gut hormones during pregnancy with maternal glucose homeostasis, maternal weight, and fetal growth. METHODS A total of 55 pregnant nonobese, nondiabetic Caucasian women were examined during the three trimesters of pregnancy, and anthropometric measurements, evaluation of fasting maternal plasma GLP1 (active), ghrelin (active), total PYY, total GIP, and a 75-g oral glucose tolerance test were done in them. Homeostasis model assessment (HOMA-R), insulin sensitivity index (ISI), and indices of insulin secretion were calculated. Fetal growth was estimated by ultrasound. RESULTS Fasting GLP1 increased significantly from the second to the third trimester (P<0.05). Fasting GLP1 correlated positively with high-density lipoprotein cholesterol (r=0.52, P=0.04). At the second trimester, fasting GLP1 levels correlated negatively with fetal abdomen circumference (r=-0.55, P=0.034), birth weight (r=-0.50, P=0.040), HOMA-R (r=-0.65, P=0.001), insulin secretion, and triglycerides. At the first trimester, fasting ghrelin levels correlated negatively with HOMA-R and insulin secretion, and positively with ISI. In backward multiple regression analysis, the first trimester GLP1 levels were the best negative predictors of the second trimester fetal abdomen circumference (beta=-0.96, P=0.009). In longitudinal regression model, maternal fat and HOMA-R were the positive predictors of maternal weight change during pregnancy, and fasting GLP1 levels were the negative predictors of maternal weight change during pregnancy. CONCLUSIONS During pregnancy, maternal GLP1 might be involved in mechanisms that compensate for the pregnancy-related increase in glycemia and insulin resistance, suggesting a role of this peptide in maternal metabolism and weight and fetal growth.
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Affiliation(s)
- Georgios Valsamakis
- 2nd Department of Obstetrics and Gynecology, Aretaieion University Hospital, Athens Medical School, Athens, Greece
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Obesity and its outcomes among pregnant South African women. Int J Gynaecol Obstet 2010; 110:101-4. [PMID: 20417513 DOI: 10.1016/j.ijgo.2010.02.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 02/16/2010] [Accepted: 03/23/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the prevalence of obesity and its effect on maternal and fetal outcomes among pregnant women at the Johannesburg Hospital, South Africa. METHODS A retrospective study of 767 pregnant women divided into BMI groups. Complications such as pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), urinary tract infection (UTI), preterm labor, preterm rupture of membranes (PROM), induction of labor (IOL), postdates, fetal weight, and fetal outcome were compared among the BMI groups. Seasonal variation in BMI was measured. Descriptive statistics included mean with 95% confidence interval or median with interquartile range. Inferential statistics included t test, chi(2) test, analysis of variance (ANOVA), and analysis of covariance. RESULTS Among the study population, 337 (44%) were obese or morbidly obese. The complications of GDM (P<0.001), UTI (P=0.002), and failed IOL (P=0.003) were significantly more common among morbidly obese women. There was no seasonal variation in BMI. CONCLUSION The prevalence of obesity in pregnancy was high in South African women and was associated with an increase in complications.
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322
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Abstract
Rising obesity rates around the world have had a profound impact on female reproductive health. Childhood obesity is associated with early onset of puberty, menstrual irregularities during adolescence and polycystic ovary syndrome. Women of reproductive age with high BMIs have a higher risk of ovulatory problems and tend to respond poorly to fertility treatment. Strategies for fertility control can also be complex since the efficacy and safety of hormonal contraceptives can be compromised by increased body weight. Obesity can aggravate symptoms of pelvic organ prolapse, stress urinary incontinence and increase the risk of endometrial polyps and symptomatic fibroids. Weight reduction enhances reproductive outcomes, diminishes symptoms of urinary incontinence and reduces morbidity following gynecological surgery. Sustained and substantial weight loss is difficult to achieve with the lifestyle and dietary measures that are currently available. A number of pharmacological treatment options are available, and there are emerging data on reproductive outcomes following surgical treatment for obesity.
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Affiliation(s)
- Shilpi Pandey
- Assisted Reproduction Unit, Aberdeen Maternity Hospital, Foresterhill, Aberdeen AB25 2ZD, UK.
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323
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Schmied VA, Duff M, Dahlen HG, Mills AE, Kolt GS. 'Not waving but drowning': a study of the experiences and concerns of midwives and other health professionals caring for obese childbearing women. Midwifery 2010; 27:424-30. [PMID: 20381222 DOI: 10.1016/j.midw.2010.02.010] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 01/29/2010] [Accepted: 02/15/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE to explore the experiences and concerns of health professionals who care for childbearing women who are obese. BACKGROUND obesity is increasing nationally and internationally and has been described as an epidemic. A number of studies have highlighted the risks associated with obesity during childbirth, yet few studies have investigated the experiences and concerns of midwives and other health professionals in providing care to these women. DESIGN a descriptive qualitative study using focus groups and face-to-face interviews to collect data. Interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis. SETTING three maternity units in New South Wales, Australia. PARTICIPANTS participants included 34 midwives and three other health professionals. FINDINGS three major themes emerged from the data analysis: 'a creeping normality', 'feeling in the dark' and 'the runaway train'. The findings highlight a number of tensions or contradictions experienced by health professionals when caring for childbearing women who are obese. These include, on the one hand, an increasing acceptance of obesity ('a creeping normality'), and on the other, the continuing stigma associated with obesity; the challenges of how to communicate effectively with pregnant women about their weight and the lack of resources, equipment and facilities ('feeling in the dark') to adequately care for obese childbearing women. Participants expressed concerns about how quickly the obesity epidemic appears to have impacted on maternity services ('the runaway train') and how services to meet the needs of these women are limited or generally not available. CONCLUSION AND IMPLICATIONS FOR PRACTICE it was clear in this study that participants felt that they were 'not waving but drowning'. There was concern over the fact that the issue of obesity had moved faster than the health response to it. There were also concerns about how to communicate with obese women without altering the relationship. Continuity of care, training and skills development for health professionals, and expansion of limited services and facilities for these women are urgently needed.
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Affiliation(s)
- Virginia A Schmied
- School of Nursing and Midwifery, College of Health and Science, University of Western Sydney, Building EB, Parramatta Campus, Locked Bag 1797, Penrith South DC, NSW 1797, Australia.
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324
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Fitzsimons KJ, Modder J. Setting maternity care standards for women with obesity in pregnancy. Semin Fetal Neonatal Med 2010; 15:100-7. [PMID: 19939755 DOI: 10.1016/j.siny.2009.09.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Obesity is associated with an increased risk of pregnancy-related complications that affect both the mother and baby. National clinical care guidelines have been developed by the Centre for Maternal and Child Enquiries, as part of its Confidential Enquiry into Maternal and Child Health (CEMACH) programme. These guidelines are intended to minimise and manage the risks associated with maternal obesity, and they were developed using formal consensus methods based on the Delphi technique. A multidisciplinary group of 25 members participated in the iterative process. Standards of care were based on the best available evidence and expert clinical knowledge and experience. This article describes the process used to develop standards of maternity care for women with obesity, and the resulting recommendations are presented.
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Affiliation(s)
- Kate J Fitzsimons
- Centre for Maternal and Child Enquiries, Chiltern Court, 188 Baker Street, London NW1 5SD, UK.
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325
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Rowlands I, Graves N, de Jersey S, McIntyre HD, Callaway L. Obesity in pregnancy: outcomes and economics. Semin Fetal Neonatal Med 2010; 15:94-9. [PMID: 19819773 DOI: 10.1016/j.siny.2009.09.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Maternal obesity is an important aspect of reproductive care. It is the commonest risk factor for maternal mortality in developed countries and is also associated with a wide spectrum of adverse pregnancy outcomes. Maternal obesity may have longer-term implications for the health of the mother and infant, which in turn will have economic implications. Efforts to prevent, manage and treat obesity in pregnancy will be costly, but may pay dividends from reduced future economic costs, and subsequent improvements to maternal and infant health. Decision-makers working in this area of health services should understand whether the problem can be reduced, at what cost; and then, what cost savings and health benefits will accrue in the future from a reduction of the problem.
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Affiliation(s)
- Ingrid Rowlands
- School of Medicine, University of Queensland, Brisbane, Australia
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326
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Abstract
Rates of obesity among the pregnant population have increased substantially and adiposity has a damaging effect on every aspect of female reproductive life. This review summarises epidemiological data concerning obesity-related complications of pregnancy. Obesity is linked to a number of adverse obstetric outcomes as well as increased maternal and neonatal morbidity and mortality. These complications include miscarriage, congenital abnormalities, pre-eclampsia, gestational diabetes mellitus, iatrogenic preterm delivery, postdates pregnancy with increased rates of induction of labour, caesarean section, postpartum haemorrhage, shoulder dystocia, infection, venous thromboembolism, and increased hospital stay. It is important to consider obese pregnant women as a high risk group with a linear increase in risk of complications associated with their degree of obesity. Their obstetric management should be consultant-led and involve a multidisciplinary team approach to improve outcome.
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327
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Torloni MR, Betrán AP, Daher S, Widmer M, Dolan SM, Menon R, Bergel E, Allen T, Merialdi M. Maternal BMI and preterm birth: A systematic review of the literature with meta-analysis. J Matern Fetal Neonatal Med 2010; 22:957-70. [PMID: 19900068 DOI: 10.3109/14767050903042561] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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328
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Wise LA, Palmer JR, Heffner LJ, Rosenberg L. Prepregnancy body size, gestational weight gain, and risk of preterm birth in African-American women. Epidemiology 2010; 21:243-52. [PMID: 20124904 PMCID: PMC3154020 DOI: 10.1097/ede.0b013e3181cb61a9] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies of the association of prepregnancy body mass index (BMI) and preterm birth have been inconclusive, and no studies have examined the effect of central adiposity on risk. There is also uncertainty about optimal gestational weight gain among Black women. METHODS Using self-reported prospective data from the Black Women's Health Study, we investigated the relation of preterm birth to prepregnancy BMI (kg/m), waist circumference, and gestational weight gain among 7840 singletons born to black women, ages 21-44, during 1995-2003. We compared mothers of 1114 infants born 3 or more weeks early (597 spontaneous preterm births and 517 medically-indicated preterm births) with mothers of 6726 term infants. We used generalized estimating equation models to derive multivariable odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Relative to normal weight women (BMI: 18.5-24.9), underweight women (BMI: <18.5) were at increased risk of both preterm birth subtypes; obese women (BMI > or = 30.0) were at increased risk of medically-indicated preterm birth and very early spontaneous preterm birth (<32 weeks' gestation). Waist circumference, a measure of central adiposity, was positively associated with medically-indicated preterm birth. Among obese women, average gestational weight gain in the second and third trimesters of <0.4 or >0.6 lbs/wk was associated with an increased risk of both preterm birth subtypes. CONCLUSIONS Our data suggest that underweight increases risk of both preterm birth subtypes, while obesity increases risk of medically-indicated preterm birth and only a subgroup of spontaneous preterm births (<32 weeks' gestation). Central adiposity was an independent risk factor for medically-indicated preterm birth only. Among obese women, gestational weight gain within the range recommended by the 2009 Institute of Medicine report (0.4-0.6 lbs/week in the second and third trimesters) was associated with the lowest risk of preterm birth.
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Affiliation(s)
- Lauren A Wise
- Slone Epidemiology Center, Boston University, Boston, MA 02215, USA.
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329
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Pandey S, Maheshwari A, Bhattacharya S. Should access to fertility treatment be determined by female body mass index? Hum Reprod 2010; 25:815-20. [PMID: 20129994 DOI: 10.1093/humrep/deq013] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Resource allocation towards fertility treatment has been extensively debated in countries where fertility treatment is publicly-funded. Medical, social and ethical aspects have been evaluated prior to allocation of resources. Analysis of cost-effectiveness, risks and benefits and poor success rates have led to calls of restricting fertility treatment to obese women. In this debate article, we critically appraise the evidence underlying this issue and highlight the problems with such a policy. Poor success rate of treatment is unsubstantiated as there is insufficient evidence to link high body mass index (BMI) to reduction in live birth. Obstetric complications have a linear relationship with BMI but are significantly influenced by maternal age. The same is true for miscarriage rates which are influenced by the confounding factors of polycystic ovary syndrome and age. Studies have shown that the direct costs per live birth are no greater for overweight and obese women. With changing demographics over half the reproductive-age population is overweight or obese. Restricting fertility treatment on the grounds of BMI would cause stigmatization and lead to inequity, feelings of injustice and social tension as affluent women manage to bypass these draconian restrictions. Time lost and poor success of conventional weight loss strategies would jeopardize the chances of conception for many women.
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Affiliation(s)
- S Pandey
- Assisted Reproduction Unit, University of Aberdeen, Aberdeen Maternity Hospital, Forresterhill Road, Aberdeen AB25 2ZL, UK.
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330
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Briese V, Voigt M, Hermanussen M, Wittwer-Backofen U. Morbid obesity: Pregnancy risks, birth risks and status of the newborn. HOMO-JOURNAL OF COMPARATIVE HUMAN BIOLOGY 2010; 61:64-72. [DOI: 10.1016/j.jchb.2009.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 06/24/2009] [Indexed: 11/27/2022]
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331
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Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) Study: associations with maternal body mass index. BJOG 2010; 117:575-84. [DOI: 10.1111/j.1471-0528.2009.02486.x] [Citation(s) in RCA: 281] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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332
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Garrett PW, Dickson HG, Whelan AK, Whyte L. Representations and coverage of non-English-speaking immigrants and multicultural issues in three major Australian health care publications. AUSTRALIA AND NEW ZEALAND HEALTH POLICY 2010; 7:1. [PMID: 20044938 PMCID: PMC2817687 DOI: 10.1186/1743-8462-7-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 01/03/2010] [Indexed: 05/26/2023]
Abstract
BACKGROUND No recent Australian studies or literature, provide evidence of the extent of coverage of multicultural health issues in Australian healthcare research. A series of systematic literature reviews in three major Australian healthcare journals were undertaken to discover the level, content, coverage and overall quality of research on multicultural health. Australian healthcare journals selected for the study were The Medical Journal of Australia (MJA), The Australian Health Review (AHR), and The Australian and New Zealand Journal of Public Health (ANZPH). Reviews were undertaken of the last twelve (12) years (1996-August 2008) of journal articles using six standard search terms: 'non-English-speaking', 'ethnic', 'migrant', 'immigrant', 'refugee' and 'multicultural'. RESULTS In total there were 4,146 articles published in these journals over the 12-year period. A total of 90 or 2.2% of the total articles were articles primarily based on multicultural issues. A further 62 articles contained a major or a moderate level of consideration of multicultural issues, and 107 had a minor mention. CONCLUSIONS The quantum and range of multicultural health research and evidence required for equity in policy, services, interventions and implementation is limited and uneven. Most of the original multicultural health research articles focused on newly arrived refugees, asylum seekers, Vietnamese or South East Asian communities. While there is some seminal research in respect of these represented groups, there are other communities and health issues that are essentially invisible or unrepresented in research. The limited coverage and representation of multicultural populations in research studies has implications for evidence-based health and human services policy.
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Affiliation(s)
- Pamela W Garrett
- Simpson Centre for Health Services Research, University of New South Wales, 2-4 Speed St Liverpool, BC1871, Sydney, Australia
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333
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Gilboa SM, Correa A, Botto LD, Rasmussen SA, Waller DK, Hobbs CA, Cleves MA, Riehle-Colarusso TJ. Association between prepregnancy body mass index and congenital heart defects. Am J Obstet Gynecol 2010; 202:51.e1-51.e10. [PMID: 19796755 DOI: 10.1016/j.ajog.2009.08.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 07/09/2009] [Accepted: 08/06/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of this study was to examine associations between prepregnancy body mass index (BMI) and congenital heart defects (CHDs). STUDY DESIGN These analyses included case infants with CHDs (n = 6440) and liveborn control infants without birth defects (n = 5673) enrolled in the National Birth Defects Prevention Study (1997-2004). RESULTS Adjusted odds ratios for all CHDs combined were 1.16 (95% confidence interval [CI], 1.05-1.29), 1.15 (95% CI, 1.00-1.32), and 1.31 (95% CI, 1.11-1.56) for overweight status, moderate obesity, and severe obesity, respectively. Phenotypes associated with elevated BMI (> or =25.0 kg/m(2)) were conotruncal defects (tetralogy of Fallot), total anomalous pulmonary venous return, hypoplastic left heart syndrome, right ventricular outflow tract (RVOT) defects (pulmonary valve stenosis), and septal defects (secundum atrial septal defect). CONCLUSION These results corroborated those of previous studies and suggested new associations between obesity and conotruncal defects and RVOT defects.
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334
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Ma KZM, Norton EC, Tsai EM, Lee SYD. Factors associated with tocolytic hospitalizations in Taiwan: evidence from a population-based and longitudinal study from 1997 to 2004. BMC Pregnancy Childbirth 2009; 9:59. [PMID: 20021650 PMCID: PMC2806362 DOI: 10.1186/1471-2393-9-59] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Accepted: 12/18/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of tocolytic hospitalization in antenatal care is controversial and worthy of more research. We investigated individual, institutional, and area factors that affect the use of tocolytic hospitalizations in Taiwan where fertility has rapidly declined. METHODS Longitudinal data from the 1996 to 2004 National Health Insurance Research Database in Taiwan were used to identify tocolytic hospitalizations. The probit model was used to estimate factors associated with tocolytic hospitalizations. RESULTS The decline in fertility was significantly associated with the probability of tocolytic hospitalizations. Several physician and institutional factors-including physician's age, hospital ownership, accreditation status, bed size, and teaching status-were also significantly correlated to the dependent variables. CONCLUSIONS The provision of inpatient tocolysis is influenced not only by clinical considerations but also by physician, institutional, and area factors unrelated to clinical need. Fertility declines in Taiwan may have led obstetricians/gynecologists to provide more tocolysis to make up for their lost income. If the explanation is further validated, reimbursement policies may need to be reviewed to correct for overuse of inpatient tocolysis. The correlation could also be explained by the increasing use of artificial reproductive technologies and higher social value of newborns. In addition, the physician and institutional variations observed in the study indicate potential misuse of inpatient tocolysis that warrant further investigation.
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Affiliation(s)
- Ke-Zong Michelle Ma
- Graduate Institute of Healthcare Administration, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Edward C Norton
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
- Department of Economics, University of Michigan, Ann Arbor, MI, USA
| | - Eing-Mei Tsai
- Department of Obstetrics and Gynecology, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shoou-Yih Daniel Lee
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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335
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Bruno CJ, Locke R, Mackley A, Paul DA. The association between maternal body mass index and severity of neonatal illness in very low birth weight infants. J Matern Fetal Neonatal Med 2009; 22:560-4. [PMID: 19488942 DOI: 10.1080/14767050902906352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine the effect of maternal body mass index (BMI) and pregnancy weight gain on neonatal illness severity in very low birth weight infants. METHODS Cohort study of infants with birth weight less than 1500 g at a level 3 Neonatal Intensive Care Unit from July 2003 to July 2005, n = 301. The main outcome included neonatal illness severity, as measured by the Score for Neonatal Acute Physiology (SNAP). SNAP was investigated in relationship to maternal BMI and pregnancy weight gain. Statistical analysis included Pearson correlation, ANOVA and multivariable linear regression. RESULTS At delivery and pre-pregnancy, 49 and 54% of mothers were overweight, respectively. Black mothers were more likely to be overweight with less pregnancy weight gain compared with white mothers. After controlling for confounding variables, maternal pre-pregnancy BMI, pregnancy BMI and weight gain were not associated with neonatal illness. CONCLUSIONS In our population of very low birth weight infants, maternal BMI was not associated with neonatal illness severity. Black mothers had higher pre-pregnancy BMI and less weight gain than white mothers. The significance of these differences needs further exploration.
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336
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Abstract
Infant mortality and morbidity disparities occur between non-Indigenous and Indigenous populations of Australia, Canada, New Zealand, and the United States. Neonatal mortality is due to high-risk births, which vary according to prevalence of the maternal risk factors of smoking, alcohol consumption, infection, and disorders of nutritional status, whereas postneonatal mortality is predominantly influenced by environmental factors. Aside from changing socioeconomic conditions, a continuum of maternal and child health care is likely to be the most effective measure in reducing these health disparities.
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337
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Grivell R, Dodd J, Robinson J. The prevention and treatment of intrauterine growth restriction. Best Pract Res Clin Obstet Gynaecol 2009; 23:795-807. [DOI: 10.1016/j.bpobgyn.2009.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2008] [Revised: 04/25/2009] [Accepted: 06/06/2009] [Indexed: 10/20/2022]
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338
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Knight M, Callaghan WM, Berg C, Alexander S, Bouvier-Colle MH, Ford JB, Joseph KS, Lewis G, Liston RM, Roberts CL, Oats J, Walker J. Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy Childbirth 2009; 9:55. [PMID: 19943928 PMCID: PMC2790440 DOI: 10.1186/1471-2393-9-55] [Citation(s) in RCA: 439] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 11/27/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. Several recent publications have noted an increasing trend in incidence over time. The international PPH collaboration was convened to explore the observed trends and to set out actions to address the factors identified. METHODS We reviewed available data sources on the incidence of PPH over time in Australia, Belgium, Canada, France, the United Kingdom and the USA. Where information was available, the incidence of PPH was stratified by cause. RESULTS We observed an increasing trend in PPH, using heterogeneous definitions, in Australia, Canada, the UK and the USA. The observed increase in PPH in Australia, Canada and the USA was limited solely to immediate/atonic PPH. We noted increasing rates of severe adverse outcomes due to hemorrhage in Australia, Canada, the UK and the USA. CONCLUSION Key Recommendations 1. Future revisions of the International Classification of Diseases should include separate codes for atonic PPH and PPH immediately following childbirth that is due to other causes. Also, additional codes are required for placenta accreta/percreta/increta. 2. Definitions of PPH should be unified; further research is required to investigate how definitions are applied in practice to the coding of data. 3. Additional improvement in the collection of data concerning PPH is required, specifically including a measure of severity. 4. Further research is required to determine whether an increased rate of reported PPH is also observed in other countries, and to further investigate potential risk factors including increased duration of labor, obesity and changes in second and third stage management practice. 5. Training should be provided to all staff involved in maternity care concerning assessment of blood loss and the monitoring of women after childbirth. This is key to reducing the severity of PPH and preventing any adverse outcomes. 6. Clinicians should be more vigilant given the possibility that the frequency and severity of PPH has in fact increased. This applies particularly to small hospitals with relatively few deliveries where management protocols may not be defined adequately and drugs or equipment may not be on hand to deal with unexpected severe PPH.
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Affiliation(s)
- Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - William M Callaghan
- Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Cynthia Berg
- Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Sophie Alexander
- Perinatal Epidemiology and Reproductive Health Unit, Université Libre de Bruxelles, Belgium
| | | | - Jane B Ford
- The Kolling Institute of Medical Research, University of Sydney at Royal North Shore Hospital, Sydney, Australia
| | - KS Joseph
- Dept of Obstetrics & Gynecology and Pediatrics, Dalhousie University, Halifax, Canada
- Dept of Obstetrics & Gynecology and the School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Gwyneth Lewis
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
- Department of Health, London, UK
| | | | - Christine L Roberts
- The Kolling Institute of Medical Research, University of Sydney at Royal North Shore Hospital, Sydney, Australia
| | - Jeremy Oats
- The Royal Women's Hospital, Parkville, Victoria, Australia
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339
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Aliyu MH, Alio AP, Lynch O, Mbah A, Salihu HM. Maternal pre-gravid body weight and risk for placental abruption among twin pregnancies. J Matern Fetal Neonatal Med 2009; 22:745-50. [DOI: 10.3109/14767050902994523] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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340
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Callaway LK, O'Callaghan M, David McIntyre H. Obesity and the Hypertensive Disorders of Pregnancy. Hypertens Pregnancy 2009; 28:473-93. [DOI: 10.3109/10641950802629626] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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341
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Callaway LK, O’Callaghan MJ, McIntyre HD. Barriers to addressing overweight and obesity before conception. Med J Aust 2009; 191:425-8. [DOI: 10.5694/j.1326-5377.2009.tb02876.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 08/06/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Leonie K Callaway
- Royal Brisbane and Women's Hospital, Brisbane, QLD
- Royal Brisbane Clinical School, School of Medicine, The University of Queensland, Brisbane, QLD
| | | | - H David McIntyre
- Mater Clinical School, School of Medicine, The University of Queensland, Brisbane, QLD
- Departments of Endocrinology and Obstetric Medicine, Mater Health Services, Brisbane, QLD
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342
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Farley D, Tejero ME, Comuzzie AG, Higgins PB, Cox L, Werner SL, Jenkins SL, Li C, Choi J, Dick EJ, Hubbard GB, Frost P, Dudley DJ, Ballesteros B, Wu G, Nathanielsz PW, Schlabritz-Loutsevitch NE. Feto-placental adaptations to maternal obesity in the baboon. Placenta 2009; 30:752-60. [PMID: 19632719 PMCID: PMC3011231 DOI: 10.1016/j.placenta.2009.06.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Revised: 06/24/2009] [Accepted: 06/25/2009] [Indexed: 12/28/2022]
Abstract
Maternal obesity is present in 20-34% of pregnant women and has been associated with both intrauterine growth restriction and large-for-gestational age fetuses. While fetal and placental functions have been extensively studied in the baboon, no data are available on the effect of maternal obesity on placental structure and function in this species. We hypothesize that maternal obesity in the baboon is associated with a maternal inflammatory state and induces structural and functional changes in the placenta. The major findings of this study were: 1) decreased placental syncytiotrophoblast amplification factor, intact syncytiotrophoblast endoplasmic reticulum structure and decreased system A placental amino acid transport in obese animals; 2) fetal serum amino acid composition and mononuclear cells (PBMC) transcriptome were different in fetuses from obese compared with non-obese animals; and 3) maternal obesity in humans and baboons is similar in regard to increased placental and adipose tissue macrophage infiltration, increased CD14 expression in maternal PBMC and maternal hyperleptinemia. In summary, these data demonstrate that in obese baboons in the absence of increased fetal weight, placental and fetal phenotype are consistent with those described for large-for-gestational age human fetuses.
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Affiliation(s)
- D Farley
- Center of Pregnancy-related and Newborn Research, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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343
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Abstract
UNLABELLED An excellent imaging tool in the prenatal diagnosis and ongoing evaluation of congenital heart defects, fetal echocardiography is indicated in a selected population at increased risk compared with the general population. For certain "soft markers" of fetal congenital heart defects, ambiguity in the indications for fetal echo may result in a high referral rate, but low yield of congenital heart disease. Here, we critically examine 4 conditions, 2 maternal and 2 fetal: maternal gestational diabetes, advanced maternal age, isolated echogenic focus, and single umbilical artery. This critical review reveals that more prospective population-based studies with higher power and minimal bias need to be performed to establish the absolute risk of congenital heart defects in a selected population compared with that of the general population. Nonetheless, our analysis indicates that the absolute risk of congenital heart defects associated with each of these markers is low. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES After completion of this article, the reader should be able to define which patients should be referred for fetal echocardiography based on known risks, distinguish between relative and absolute risks for fetal congenital heart disease, and summarize fetal anomaly risks for women with altered glucose metabolism.
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344
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Mottola MF. Exercise prescription for overweight and obese women: pregnancy and postpartum. Obstet Gynecol Clin North Am 2009; 36:301-16, viii. [PMID: 19501315 DOI: 10.1016/j.ogc.2009.03.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Once a low-risk pregnancy has been established, walking in combination with nutritional control may be effective in preventing excessive weight gain in overweight and obese women. Maternal exercise prescription should use the Frequency, Intensity, Time spent and Type of exercise principle, with a frequency of three to four sessions per week as ideal. Intensity based on a target heart-rate zone of 110 to 131 beats per minute for women 20 to 29 years of age and 108 to 127 beats per minute for women 30 to 39 years of age, coupled with use of the rating of perceived exertion scale and the "Talk Test" is suggested. Dieting and exercise together are most effective in reducing weight retention after childbirth and compliance may be improved by incorporating child-care and children into the exercise routine. After medical consultation, postpartum women should begin exercise slowly, starting from 15 minutes, and building to at least 150 minutes of aerobic activity per week, with this activity spread throughout the week.
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Affiliation(s)
- Michelle F Mottola
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, London, Ontario, Canada N6A 3K7.
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345
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346
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Ford SP, Zhang L, Zhu M, Miller MM, Smith DT, Hess BW, Moss GE, Nathanielsz PW, Nijland MJ. Maternal obesity accelerates fetal pancreatic beta-cell but not alpha-cell development in sheep: prenatal consequences. Am J Physiol Regul Integr Comp Physiol 2009; 297:R835-43. [PMID: 19605766 DOI: 10.1152/ajpregu.00072.2009] [Citation(s) in RCA: 126] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Maternal obesity affects offspring weight, body composition, and organ function, increasing diabetes and metabolic syndrome risk. We determined effects of maternal obesity and a high-energy diet on fetal pancreatic development. Sixty days prior to breeding, ewes were assigned to control [100% of National Research Council (NRC) recommendations] or obesogenic (OB; 150% NRC) diets. At 75 days gestation, OB ewes exhibited elevated insulin-to-glucose ratios at rest and during a glucose tolerance test, demonstrating insulin resistance compared with control ewes. In fetal studies, ewes ate their respective diets from 60 days before to 75 days after conception when animals were euthanized under general anesthesia. OB and control ewes increased in body weight by approximately 43% and approximately 6%, respectively, from diet initiation until necropsy. Although all organs were heavier in fetuses from OB ewes, only pancreatic weight increased as a percentage of fetal weight. Blood glucose, insulin, and cortisol were elevated in OB ewes and fetuses on day 75. Insulin-positive cells per unit pancreatic area were 50% greater in fetuses from OB ewes as a result of increased beta-cell mitoses rather than decreased programmed cell death. Lambs of OB ewes were born earlier but weighed the same as control lambs; however, their crown-to-rump length was reduced, and their fat mass was increased. We conclude that increased systemic insulin in fetuses from OB ewes results from increased glucose exposure and/or cortisol-induced accelerated fetal beta-cell maturation and may contribute to premature beta-cell function loss and predisposition to obesity and metabolic disease in offspring.
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Affiliation(s)
- Stephen P Ford
- Center for the Study of Fetal Programming, Department of Animal Science, University of Wyoming, Laramie, Wyoming, USA
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347
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Schrauwers C, Dekker G. Maternal and perinatal outcome in obese pregnant patients. J Matern Fetal Neonatal Med 2009; 22:218-26. [DOI: 10.1080/14767050902801652] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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348
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Kalk P, Guthmann F, Krause K, Relle K, Godes M, Gossing G, Halle H, Wauer R, Hocher B. Impact of maternal body mass index on neonatal outcome. Eur J Med Res 2009; 14:216-22. [PMID: 19541579 PMCID: PMC3351981 DOI: 10.1186/2047-783x-14-5-216] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Maternal body mass index has an impact on maternal and fetal pregnancy outcome. An increased maternal BMI is known to be associated with admission of the newborn to a neonatal care unit. The reasons and impact of this admission on fetal outcome, however, are unknown so far. Objective The aim of our study was to investigate the impact of maternal BMI on maternal and fetal pregnancy outcome with special focus on the children admitted to a neonatal care unit. Methods A cohort of 2049 non-diabetic mothers giving birth in the Charite university hospital was prospectively studied. The impact of maternal BMI on maternal and fetal outcome parameters was tested using multivariate regression analysis. Outcome of children admitted to a neonatal ward (n = 505) was analysed. Results Increased maternal BMI was associated with an increased risk for hypertensive complications, peripheral edema, caesarean section, fetal macrosomia and admission of the newborn to a neonatal care unit, whereas decreased BMI was associated with preterm birth and lower birthweight. In the neonatal ward children from obese mothers are characterized by hypoglycaemia. They need less oxygen, and exhibit a shorter stay on the neonatal ward compared to children from normal weight mothers, whereas children from underweight mothers are characterized by lower umbilical blood pH and increased incidence of death corresponding to increased prevalence of preterm birth. Conclusion Pregnancy outcome is worst in babies from mothers with low body mass index as compared to healthy weight mothers with respect to increased incidence of preterm birth, lower birth weight and increased neonate mortality on the neonatal ward. We demonstrate that the increased risk for neonatal admission in children from obese mothers does not necessarily indicate severe fetal impairment.
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Affiliation(s)
- P Kalk
- Department of Pharmacolcgy and Toxicology, Charité, Hessische Str. 3-4, 10115 Berlin, Germany
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349
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Balen AH, Anderson RA. Impact of Obesity on female reproductive health: British Fertility Society, Policy and Practice Guidelines. HUM FERTIL 2009; 10:195-206. [DOI: 10.1080/14647270701731290] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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350
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Håberg SE, Stigum H, London SJ, Nystad W, Nafstad P. Maternal obesity in pregnancy and respiratory health in early childhood. Paediatr Perinat Epidemiol 2009; 23:352-62. [PMID: 19523082 PMCID: PMC2827878 DOI: 10.1111/j.1365-3016.2009.01034.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Obesity is associated with systemic inflammation, immunological changes, increased risk of respiratory infections and chronic respiratory illness. Maternal obesity in pregnancy increases the risk of pregnancy complications, caesarean sections and adverse birth outcomes, which have in turn been associated with respiratory illness in children. To our knowledge, the possible influence of maternal obesity in pregnancy on respiratory illness in early childhood beyond the newborn period has not been explored. We examined the relationship between a high maternal body mass index (BMI) in pregnancy and lower respiratory tract infections and wheeze up to 18 months of age in the Norwegian Mother and Child Study (MoBa), a population-based cohort study that includes 100,000 pregnant women, conducted at the Norwegian Institute of Public Health. We analysed data from the first 33 192 children, born between 1999 and 2005. In unadjusted analyses maternal obesity in pregnancy was related to both respiratory infections and wheeze in the children. In multivariable analyses, only an effect on wheeze remained. The risk of wheeze increased linearly with maternal BMI in pregnancy, and was 3.3% higher [95% CI 1.2, 5.3] for children with mothers who were obese during pregnancy, than for children of mothers with normal BMI. This effect was not mediated through obesity-related pregnancy complications, low birthweight, preterm birth or caesarean section.
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Affiliation(s)
- Siri E Håberg
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
| | - Hein Stigum
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Stephanie J London
- Epidemiology branch and Laboratory of Respiratory Biology, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
| | - Wenche Nystad
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Per Nafstad
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway, Department of General Practice and Community Medicine, Medical Faculty, University of Oslo, Norway
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