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Nivatpumin P, Lertbunnaphong T, Maneewan S, Vittayaprechapon N. Comparison of perioperative outcomes and anesthetic-related complications of morbidly obese and super-obese parturients delivering by cesarean section. Ann Med 2023; 55:1037-1046. [PMID: 36947155 PMCID: PMC10035943 DOI: 10.1080/07853890.2023.2187877] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVE To compare the perioperative outcomes and anesthetic-related complications of morbidly obese and super-obese parturients delivering by cesarean section. METHODS A retrospective analysis of 6 years of data was performed. Exclusions were cases with gestational ages <24 weeks, placenta accreta spectrum, polyhydramnios, or multiple gestations. RESULTS The study included 494 patients whose body mass index (BMI) exceeded 40 kg/m2 at delivery. Of these, 469 were morbidly obese (BMI 40-49.9; mean, 42.9 ± 2.4), and 25 were super obese (BMI >50; mean, 54.5 ± 4.2). Twenty-four (5.1%) morbidly obese women received general anesthesia. The other 445 patients (94.9%) in the morbid obesity group underwent cesarean delivery under regional anesthesia; however, some (2.2%; 10/445) received general anesthesia after regional anesthesia failed. In the super-obesity group, 23 patients (92.0%) received regional anesthesia, while two patients (8.0%) received general anesthesia. There were no cases of pulmonary aspiration, maternal deaths, or difficult or failed intubation. There was one episode of cardiac arrest in a patient with a BMI of 47.9. Among the morbidly obese and super-obese women given regional anesthesia, the super-obese patients had significantly greater volumes of ephedrine and norepinephrine consumption (p = 0.027 and 0.030), intravenous fluids (p = 0.006), and bleeding during surgery (p = 0.017). They also had more hypotensive episodes (p = 0.038). The two groups' incidences of neonatal birth asphyxia, postpartum hemorrhage, blood transfusion, and uterine atony did not differ significantly. The lengths of stay in the hospital were also comparable. CONCLUSIONS Among the women receiving regional anesthesia, the super-obese parturients had greater intraoperative bleeding, a higher proportion of hypotensive episodes, and a greater vasopressor requirement than the morbidly obese parturients. Anesthesiologists must prepare for the adverse perioperative events that such women risk experiencing during a delivery by cesarean section. www.clinicaltrials.gov ID: NCT04657692.
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Affiliation(s)
- Patchareya Nivatpumin
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tripop Lertbunnaphong
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Siritorn Maneewan
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nutha Vittayaprechapon
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Lohr AN, Hoppe KK, Mei CC, Antony KM. Does Daily Self-Weighing Contribute to Postpartum Weight Loss? A Secondary Analysis of Daily Postpartum Weights among Women with Hypertensive Disorders of Pregnancy. Am J Perinatol 2023; 40:319-325. [PMID: 33902132 PMCID: PMC11073857 DOI: 10.1055/s-0041-1727217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study was aimed to examine the impact of daily self-weighing via remote monitoring on postpartum weight loss. STUDY DESIGN This was a secondary analysis of a nonrandomized controlled trial comprised of postpartum women with diagnosed hypertensive-related disorders in pregnancy who received a tablet device linked to Bluetooth-enabled equipment including a scale and blood pressure cuff. In addition to blood pressure monitoring, participants were instructed to perform daily self-weighing. The primary outcome of this study was to determine whether postpartum women who performed daily self-weighing lost more weight than those who did not, with a 42-day endpoint based on a 6-week postpartum visit weight. RESULTS Overall, 214 women participated in this program and 214 received usual care. Median weight loss for women participating in the remote blood pressure monitoring system was 23.0 (interquartile range [IQR]: 17-30) pounds versus 23.0 (IQR: 17-29) pounds among controls. Weight loss did not vary by prepregnancy obesity (median: 20 pounds [IQR: 17-28 pounds] for nonobese and 23 [IQR: 17-30] pounds for women with obesity, p = 0.16). Women who weighed themselves more than half of follow-up days lost a median of 24 pounds (IQR: 17-30 pounds) compared with 20.5 pounds (IQR: 14-29 pounds), p = 0.06. Women who weighed themselves more than half of follow-up days lost a mean of 11.4% (standard deviation [SD] = 0.41%) of body weight compared with 9.1% (SD = 0.74%; p = 0.01). The amount of weight loss in the telehealth group was correlated with the number of daily weights performed (Pearson's correlation coefficient 0.164, p = 0.025). Postpartum weight loss for daily self-weighing participants was most notable in the first 2 weeks with ongoing weight loss up to the 42-day (6-week) endpoint of this secondary analysis. CONCLUSION Daily self-weighing alone may be insufficient to promote postpartum weight loss. However, there was a slight trend toward more weight loss with more frequent weighing. KEY POINTS · Daily self-weighing is insufficient for postpartum weight loss.. · Women who weighed themselves more lost slightly more weight.. · Weight loss was the most notable in the first 2 weeks.. · Its use as one part of a program may be worth studying..
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Affiliation(s)
- Ali N Lohr
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin Madison, Madison, Wisconsin
| | - Kara K Hoppe
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin Madison, Madison, Wisconsin
| | - Chaoqun C Mei
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | - Kathleen M Antony
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin Madison, Madison, Wisconsin
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Cojocaru L, Salvatori C, Sharon A, Seung H, Nyman K, Kodali BS, Turan OM. General versus Regional Anesthesia and Neonatal Data: A Propensity-Score-Matched Study. Am J Perinatol 2023; 40:227-234. [PMID: 36181759 DOI: 10.1055/s-0042-1757861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study aimed to evaluate whether there is a difference in neonatal outcomes with general anesthesia (GA) versus regional anesthesia (RA) when induction of anesthesia to delivery time (IADT) is prolonged (≥10 minutes). STUDY DESIGN This is a retrospective case-control study that included cases from July 2014 until August 2020. We reviewed all singleton pregnancies delivered between 24 and 42 weeks of gestation with IADT ≥ 10 minutes. Urgent deliveries, those who received RA for labor pain management or started cesarean delivery under RA and converted to GA, as well as cases with fetal anomalies, were excluded. The propensity score (PS) matching method was performed using age, ethnicity/race, body mass index, gestational age at delivery, preexisting maternal comorbidities, and pregnancy complications. Analyses were performed with SAS software version 9.4. RESULTS During the study period, we identified 258 cases meeting inclusion criteria. After the PS matching was applied, the study sample was reduced to 60 cases in each group. The median IADT and uterine incision to delivery time were similar between groups (41.5 [30.5, 52] vs. 46 minutes [38, 53.5], p = 0.2 and 1.5 [1, 3] vs. 2 minutes [1, 3], respectively). There was no significant difference between groups with respect to arterial or venous cord pH (7.24 [7.21, 7.26] vs. 7.23 [7.2, 7.27], p = 0.7 and 7.29 [7.26, 7.33] vs. 7.3 [7.26, 7.33], p = 0.4, respectively). Nor were there any associations between maternal characteristics and Apgar's score at 5 minutes, except for Apgar's score at 1 minute (p < 0.001). No significant difference was identified in the rate of admission to the neonatal intensive care unit (NICU; 11 [52.4%] vs. 10 [47.6%], p = 0.8) or NICU length of stay between GA and RA (4 [3, 14] vs. 4.5 [3, 11], p = 0.9). CONCLUSION Our data indicate that even with prolonged IADT, favorable neonatal outcomes are seen with both GA and RA, in contrast with previous studies performed decades ago. KEY POINTS · Improving cesarean delivery safety, including the safety of anesthesia, is of paramount importance.. · Reappraisal of historical outcomes is warranted as advances in the medical field unfold.. · Favorable neonatal outcomes are seen with both general and regional anesthesia..
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Affiliation(s)
- Liviu Cojocaru
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, Maryland
| | - Cristiana Salvatori
- Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, Maryland
| | - Amir Sharon
- Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, Maryland
| | - Hyunuk Seung
- Department of Pharmacy Practice and Sciences, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Katherine Nyman
- Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bhavani S Kodali
- Division of Obstetric Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ozhan M Turan
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, Maryland
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Gevaerd Martins J, Kawakita T, Jain P, Gurganus M, Baraki D, Barake C, Sinkovskaya E, Abuhamad A. Impact of maternal body mass index on the accuracy of third trimester sonographic estimation of fetal weight. Arch Gynecol Obstet 2023; 307:395-400. [PMID: 35332361 DOI: 10.1007/s00404-022-06495-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/26/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To Determine whether maternal body mass index (BMI) can affect the accuracy of sonographic estimation of fetal weight (EFW) in the third trimester when compared to neonatal birthweight (BW). METHODS Secondary analysis from our original prospective cohort of pregnant women beyond 34 weeks, distributed in 4 groups according to their BMI: normal, overweight, obese and morbid obese. Fetal biometry and fluid measurements were obtained by two experienced sonographers, blinded for patient's clinical information and to each other's measurements. Average EFW and neonatal BW were converted into gestational-specific Z-scores. Interobserver correlation coefficient (ICC) and Cronbach's reliability coefficient (CRC) were calculated. Bland-Altman (BA) plots were constructed to assess the level of accuracy. RESULTS 100 women were enrolled (800 measurements obtained by 17 sonographers): 17 had normal BMI (17%), 27 were overweight (27%), 29 were obese (29%) and 27 were morbidly obese (27%). There was no statistical difference for GA at delivery (p = 0.74), EFW (p = 0.05) or BW (p = 0.09) between groups (Table 1). Mean Z-score for EFW was - 0.17 (SD 0.81) and for neonatal BW was - 0.25 (SD 0.74). ICC was 0.69 (95% CI 0.57, 0.78) and CRC was 0.82. Mean Z-score difference was small (Table 2). When stratifying according to BMI categories, the ICC ranged from 0.49 to 0.76. Reliability indices ranged from 0.66 to 0.86. The Z-scores' differences were overall small with no statistical difference (Table 3). BA showed evenly distributed interobserver differences (Fig. 1). CONCLUSIONS When performed by trained sonographers, fetal weight estimation in the third trimester is accurate when compared to neonatal birthweight at increasing BMI categories.
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Affiliation(s)
- Juliana Gevaerd Martins
- EVMS Salaried Faculty, Maternal Fetal Medicine/OBGYN, 825 Fairfax Avenue Suite 555, Norfolk, VA, 23455, USA.
| | - Tetsuya Kawakita
- EVMS Salaried Faculty, Maternal Fetal Medicine/OBGYN, 825 Fairfax Avenue Suite 555, Norfolk, VA, 23455, USA
| | - Priyanka Jain
- University of Virginia Maternal Fetal Medicine Fellow (PGY-5), Charlottesville, USA
| | - Margot Gurganus
- University of Virginia OBGYN Resident (PGY-3), Charlottesville, USA
| | - Dana Baraki
- EVMS Salaried Faculty, Maternal Fetal Medicine/OBGYN, 825 Fairfax Avenue Suite 555, Norfolk, VA, 23455, USA
| | | | - Elena Sinkovskaya
- EVMS Salaried Faculty, Maternal Fetal Medicine/OBGYN, 825 Fairfax Avenue Suite 555, Norfolk, VA, 23455, USA
| | - Alfred Abuhamad
- EVMS Salaried Faculty, Maternal Fetal Medicine/OBGYN, 825 Fairfax Avenue Suite 555, Norfolk, VA, 23455, USA
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Kuitunen I, Huttunen TT, Ponkilainen VT, Kekki M. Incidence of obese parturients and the outcomes of their pregnancies: A nationwide register study in Finland. Eur J Obstet Gynecol Reprod Biol 2022; 274:62-67. [PMID: 35597175 DOI: 10.1016/j.ejogrb.2022.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We analyzed the incidence of obese and severely obese parturients and the impact of maternal obesity on mode of delivery, perinatal and neonatal mortality, and neonatal health. STUDY DESIGN We included all singleton births from the medical birth register of Finland from 2004 to 2018 (n = 792 437). Maternal body mass index (BMI) was categorized into three classes: non-obese (BMI < 30 kg/m2), obese (BMI 30 - 39.9 kg/m2), and morbidly obese (BMI 40 kg/m2 or more). The yearly incidence of obese and severely obese parturients per 10000 births was calculated. Logistic regression was used to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS Between 2004 and 2018, the incidence of obese and morbidly obese parturients increased by 44% and 103%, respectively. Cesarean section rates were 23.6% and 30%, respectively (aOR 1.63 CI 1.61 - 1.66 and 2.33 CI: 2.23 - 2.44). Neonates born to morbidly obese parturients had an increased need for intensive care unit treatment (aOR 2.21 CI: 2.10 - 2.32), higher perinatal mortality (aOR 1.65 CI: 1.28 - 2.14), and higher neonatal mortality (aOR 1.68 CI: 1.04 - 2.72). The need for neonatal intensive care (aOR 1.50 CI: 1.47 - 1.53), perinatal mortality (aOR 1.25 CI: 1.13 - 1.39), and neonatal mortality (aOR 1.33 CI: 1.09 - 1.62) increased also among obese parturients. CONCLUSIONS We report a worrying increase in obese and morbidly obese parturients. Neonates born to these parturients were more likely delivered by cesarean sections and had higher rates of perinatal and neonatal mortality, and intensive care unit treatment. This highlights the importance of preventing obesity among fertile-aged females.
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Affiliation(s)
- Ilari Kuitunen
- University of Eastern Finland, Institute of Clinical Medicine and Department of Pediatrics, Kuopio, Finland; Mikkeli Central Hospital, Department of Pediatrics and Neonatology, Mikkeli, Finland.
| | - Tuomas T Huttunen
- University of Eastern Finland, Institute of Clinical Medicine and Department of Pediatrics, Kuopio, Finland; Mikkeli Central Hospital, Department of Pediatrics and Neonatology, Mikkeli, Finland
| | - Ville T Ponkilainen
- Tampere Heart Hospital and Tampere University Hospital, Department of Anesthesia, Tampere, Finland; Tampere University, Faculty of Medicine and Health Technologies, Tampere, Finland; Central Finland Hospital Nova, Department of Surgery, Jyväskylä, Finland
| | - Maiju Kekki
- Tampere University Hospital, Department of Obstetrics and Gynecology, Tampere, Finland; Tampere University Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere, Finland
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Walker JL, Adams JH, Broman AT, Pryde PG, Antony KM. Postoperative Respiratory Compromise following Cesarean Birth: The Impact of Obesity and Systemic Opioids. AJP Rep 2022; 12:e1-e9. [PMID: 35036046 PMCID: PMC8758249 DOI: 10.1055/s-0041-1741539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/08/2021] [Indexed: 10/27/2022] Open
Abstract
Objective The aim of this study was to measure the effect of obesity and systemic opioids on respiratory events within the first 24 hours following cesarean. Methods Opioid-naive women undergoing cesarean between January 2016 and December 2017 were included in this retrospective cohort study. The primary outcome was the proportion of women experiencing at least one composite respiratory outcome (oxygen saturation less than 95% lasting 30+ seconds or need for respiratory support) within 24 hours of cesarean. The impact of obesity and total systemic opioid dose in 24 hours (measured in morphine milligram equivalents [MMEs]) on the composite respiratory compromise outcome were evaluated. Results Of 2,230 cesarean births, 790 women had at least one composite respiratory event. Predictors of the composite respiratory outcome included body mass index (BMI) as a continuous variable (odds ratio = 1.063 for every one unit increase in BMI [95% confidence interval (CI): 1.021-1.108], p = 0.003), and MME (odds ratio = 1.005 [95% CI: 1.002-1.008], p = 0.003), adjusting for magnesium sulfate use. The interaction between obesity and opioid dose demonstrated an odds ratio of 1.000 (95% CI: 0.999-1.000, p = 0.030). Conclusion The proportion of women experiencing respiratory events following cesarean birth increases with the degree of obesity and opioid dose. Key Points Respiratory events increase with obesity.Respiratory events increase with systemic opioid use.Odds ratio of respiratory events is 1.063/unit BMI increase.
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Affiliation(s)
- Jessica L. Walker
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin – Madison, Madison, Wisconsin
| | - Jacquelyn H. Adams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin – Madison, Madison, Wisconsin
| | - Aimee T. Broman
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | - Peter G. Pryde
- Department of Anesthesiology, Madison Anesthesiology Consultants, Madison, Wisconsin
| | - Kathleen M. Antony
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin – Madison, Madison, Wisconsin
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Simmons PM, Wendel MP, Whittington JR, San Miguel K, Ounpraseuth ST, Magann EF. Accuracy and Completion Rate of the Fetal Anatomic Survey in the Super Obese Parturient. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2047-2051. [PMID: 33277924 DOI: 10.1002/jum.15582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To determine the completion rate of ultrasound in with a body mass index (BMI) ≥ 50 to women with BMI 18.5 to 29.9. STUDY DESIGN This study was a retrospective cohort study. Women with a singleton pregnancy, age 18 to 45 with a BMI ≥50 that delivered between 2013-2016 were compared to women with a BMI 18.5 to 29.9 during that same time period to assess the accuracy and, as a second aim, the completion rate of the fetal anatomic survey. Data were analyzed using two-sample t test, chi-square test, or logistic regression as appropriate. RESULTS Eighty-one cases with a BMI ≥50 were compared with 81 patients with a BMI 18.5 to 29.9. Maternal demographics and timing (gestational age) at the time of the ultrasound were similar between groups. In women with a BMI 18.5 to 29.9, completion of anatomy was 58% of the time with the first ultrasound, 81% with second ultrasound, and 84% with the third ultrasound. In women with BMI ≥50, completion of anatomy was 10% of the time with the first ultrasound, 33% with the second ultrasound, and 42% with the third ultrasound. Each time frame was statistically significant. Agreement level on the accuracy to detect fetal anomalies between groups were not statistically significant between the groups. CONCLUSION In women with a BMI ≥50 compared to women with BMI of 18.8 to 29.9, more ultrasounds are needed to complete the anatomic survey although overall accuracy in fetal anomaly detection is similar.
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Affiliation(s)
- Pamela M Simmons
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas, USA
- Department of Obstetrics and Gynecology, Women's Hospital, Baton Rouge, Louisiana, USA
| | - Michael P Wendel
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas, USA
| | - Julie R Whittington
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas, USA
| | - Kelly San Miguel
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas, USA
| | - Songthip T Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, College of Public Health, Little Rock, Arkansas, USA
| | - Everett F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas, USA
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Antony KM, Adams JH, Jacques L, Hetzel S, Chappell RJ, Gnadt SE, Tevaarwerk AJ. Lidocaine patches for postcesarean pain control in obese women: a pilot randomized controlled trial. Am J Obstet Gynecol MFM 2021; 3:100281. [DOI: 10.1016/j.ajogmf.2020.100281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/18/2020] [Indexed: 02/07/2023]
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Pratt A, Howat P, Hui L. Maternal and perinatal outcomes for women with body mass index ≥50 kg/m
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in a non‐tertiary hospital setting. Aust N Z J Obstet Gynaecol 2019; 60:361-368. [DOI: 10.1111/ajo.13064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/12/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Anita Pratt
- Department of Obstetrics and Gynaecology The Northern Hospital Melbourne Victoria Australia
| | - Paul Howat
- Department of Obstetrics and Gynaecology The Northern Hospital Melbourne Victoria Australia
| | - Lisa Hui
- Department of Obstetrics and Gynaecology The Northern Hospital Melbourne Victoria Australia
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Qiao L, Wattez JS, Lim L, Rozance PJ, Hay WW, Shao J. Prolonged Prepregnant Maternal High-Fat Feeding Reduces Fetal and Neonatal Blood Glucose Concentrations by Enhancing Fetal β-Cell Development in C57BL/6 Mice. Diabetes 2019; 68:1604-1613. [PMID: 31127056 PMCID: PMC6692812 DOI: 10.2337/db18-1308] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/19/2019] [Indexed: 12/21/2022]
Abstract
The main objective of this study was to investigate the effect of maternal obesity on offspring's glucose metabolism during the perinatal period. Maternal obesity was established by feeding C57BL/6 mice with a high-fat (HF) diet before or during pregnancy. Our results showed that prolonged prepregnant HF feeding but not HF feeding during pregnancy significantly reduced fetal and neonatal blood glucose concentrations. Remarkably, elevated blood insulin concentrations and increased activation of insulin signaling were observed in fetuses and neonates from prepregnant HF-fed dams. In addition, significantly larger β-cell areas were observed in pancreases of fetuses and neonates from prepregnant HF-fed dams. Although there was no significant change in placental cross-sectional area or GLUT 1 expression, prepregnant HF feeding significantly enhanced the expression of genes that control placental fatty acid supply. Interestingly, reducing fatty acid supply to the placenta and fetus by placental-specific knockout of adipose triglyceride lipase not only reduced fetal β-cell area and blood insulin concentration but also attenuated prepregnant HF feeding-induced reduction in offspring blood glucose concentrations during the perinatal period. Together, these results indicate that placental and fetal fatty acid supply plays an important role in fetal β-cell development, insulin secretion, and glucose metabolism. Prolonged prepregnant maternal HF feeding resembles pregravid maternal obesity in mice, which reduces fetal and neonatal blood glucose concentrations by enhancing fetal β-cell development and insulin secretion.
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Affiliation(s)
- Liping Qiao
- Department of Pediatrics, University of California San Diego, La Jolla, CA
| | | | - Lauren Lim
- Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Paul J Rozance
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - William W Hay
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Jianhua Shao
- Department of Pediatrics, University of California San Diego, La Jolla, CA
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Preen C, Munn Z, Raju S, Flack N. Second trimester ultrasound detection of fetal anomalies in the obese obstetrical population: a systematic review protocol. ACTA ACUST UNITED AC 2018; 16:328-335. [PMID: 29419619 DOI: 10.11124/jbisrir-2017-003505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this review is to identify, appraise and synthesize the best available evidence on the impact of maternal obesity on mid second trimester ultrasound detection of fetal anomalies in pregnancy.
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Affiliation(s)
- Christina Preen
- The Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.,Lyell McEwin Hospital, SA Health, Adelaide, Australia
| | - Zachary Munn
- The Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Smita Raju
- Royal Adelaide Hospital, SA Health, Adelaide, Australia
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Neonatal Morbidity and Maternal Complication Rates in Women With a Delivery Body Mass Index of 60 or Higher. Obstet Gynecol 2017; 130:988-993. [DOI: 10.1097/aog.0000000000002316] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Effects of bariatric surgery on pelvic floor disorders in obese women: a meta-analysis. Arch Gynecol Obstet 2017. [DOI: 10.1007/s00404-017-4415-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Ogunyemi D, Friedman P, Betcher K, Whitten A, Sugiyama N, Qu L, Kohn A, Paul H. Obstetrical correlates and perinatal consequences of neonatal hypoglycemia in term infants. J Matern Fetal Neonatal Med 2016; 30:1372-1377. [PMID: 27427266 DOI: 10.1080/14767058.2016.1214127] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine independent perinatal and intrapartum factors associated with neonatal hypoglycemia. METHOD Of singleton pregnancies delivered at term in 2013; 318 (3.8%) neonates diagnosed with hypoglycemia were compared to 7955 (96.2%) neonate controls with regression analysis. RESULTS Regression analysis showed that independent prenatal factors were multiparity (odds-ratio [OR] = 1.61), gestational age (OR = 0.68), gestational diabetes (OR = 0.22), macrosomia (OR = 4.87), small for gestational age neonate [SGA] (OR = 6.83) and admission cervical dilation (OR = 0.79). For intrapartum factors, only cesarean section (OR = 1.57) and last cervical dilation (OR = 0.92) were independently significantly associated with neonatal hypoglycemia. For biologically plausible risk factors, independent factors were cesarean section (OR = 4.18), gentamycin/clindamycin in labor (OR = 5.35), gestational age (OR = 0.59) and macrosomia (OR = 5.62). Mothers of babies with neonatal hypoglycemia had more blood loss and longer hospital stays, while neonates with hypoglycemia had worse umbilical cord gases, more neonatal hypoxic conditions, neonatal morbidities and NICU admissions. CONCLUSION Diabetes was protective of neonatal hypoglycemia, which may be explained by optimum maternal glucose management; nevertheless macrosomia was independently predictive of neonatal hypoglycemia. Cesarean section and decreasing gestational age were the most consistent independent risk factors followed by treatment for chorioamnionitis and SGA. Further studies to evaluate these observations and develop preventive strategies are warranted.
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Affiliation(s)
- D Ogunyemi
- a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , Beaumont Hospital , Royal Oak , MI , USA and.,b William Beaumont School of Medicine, Oakland University , Rochester Hills , MI , USA
| | - P Friedman
- a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , Beaumont Hospital , Royal Oak , MI , USA and.,b William Beaumont School of Medicine, Oakland University , Rochester Hills , MI , USA
| | - K Betcher
- a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , Beaumont Hospital , Royal Oak , MI , USA and.,b William Beaumont School of Medicine, Oakland University , Rochester Hills , MI , USA
| | - A Whitten
- a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , Beaumont Hospital , Royal Oak , MI , USA and.,b William Beaumont School of Medicine, Oakland University , Rochester Hills , MI , USA
| | - N Sugiyama
- a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , Beaumont Hospital , Royal Oak , MI , USA and.,b William Beaumont School of Medicine, Oakland University , Rochester Hills , MI , USA
| | - L Qu
- a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , Beaumont Hospital , Royal Oak , MI , USA and.,b William Beaumont School of Medicine, Oakland University , Rochester Hills , MI , USA
| | - Amitai Kohn
- a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , Beaumont Hospital , Royal Oak , MI , USA and.,b William Beaumont School of Medicine, Oakland University , Rochester Hills , MI , USA
| | - Holtrop Paul
- a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , Beaumont Hospital , Royal Oak , MI , USA and.,b William Beaumont School of Medicine, Oakland University , Rochester Hills , MI , USA
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