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Beyene GA, Yunus MA, Deribew AB, Kasahun AW. Gestational weight gain and its determinants among pregnant women in Gurage zone, Central Ethiopia: a cohort study. BMC Womens Health 2024; 24:376. [PMID: 38937766 PMCID: PMC11212422 DOI: 10.1186/s12905-024-03223-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 06/24/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The nutritional status of the mothers before pregnancy and the weights gained during pregnancy are very crucial factors affecting the pregnancy outcomes and health of the infants. This study aimed to assess early pregnancy weight, determine the magnitude of gestational weight gain, and investigate the factors affecting gestational weight gain among pregnant women in the Gurage zone, 2022. METHODS A prospective cohort study was conducted among pregnant women who started antenatal care follow-up before the 16th week of gestation in the selected hospitals and health centers of the Gurage zone, Ethiopia. The gestational weight gain was obtained by subtracting the early pregnancy weight from the last pregnancy weight and categorizing based on the Institute of Medicine (IOM) recommendation. RESULTS The early pregnancy weight status of the women at enrollment indicates that 10% of them were underweight and 83% of them had normal weight. On average, the study participants gained 13.3 kgs of weight with [95% CI: 13.0, 13.6]. More than half (56%) of them gained adequate weight, a quarter (26%) of them gained inadequate weight, and 18% of them gained excess weight during pregnancy compared to the IOM recommendation. Maternal age, occupational status, and early pregnancy weight status were found to have a statistically significant association with the gestational weight gained. CONCLUSION Almost half (44%) of the pregnant women gained either inadequate or excess weight during pregnancy. Promoting gestational weight gain within recommended guidelines should be emphasized for younger, employed women and those who are either underweight or overweight.
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Affiliation(s)
- Girma Alemayehu Beyene
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia.
| | - Mukrem Abdulwehab Yunus
- Department of Internal Medicine, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Aberash Beyene Deribew
- Department of Midwifery, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Abebaw Wasie Kasahun
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
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2
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Beckers KF, Flanagan JP, Sones JL. Microbiome and pregnancy: focus on microbial dysbiosis coupled with maternal obesity. Int J Obes (Lond) 2024; 48:439-448. [PMID: 38145995 PMCID: PMC10978494 DOI: 10.1038/s41366-023-01438-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/22/2023] [Accepted: 12/01/2023] [Indexed: 12/27/2023]
Abstract
Obesity is becoming a worldwide pandemic with over one billion people affected. Of women in the United States, who are of childbearing age, two-thirds of them are considered overweight/obese. Offspring of women with obesity have a greater likelihood of developing cardiometabolic disease later in life, therefore making obesity a transgenerational issue. Emerging topics such as maternal microbial dysbiosis with altered levels of bacterial phyla and maternal obesity programming offspring cardiometabolic disease are a novel area of research discussed in this review. In the authors' opinion, beneficial therapeutics will be developed from knowledge of bacterial-host interactions at the most specific level possible. Although there is an abundance of obesity-related microbiome research, it is not concise, readily available, nor easy to interpret at this time. This review details the current knowledge regarding the relationship between obesity and the gut microbiome, with an emphasis on maternal obesity.
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Affiliation(s)
- Kalie F Beckers
- Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Juliet P Flanagan
- Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Jenny L Sones
- Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA.
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA.
- Clinical Sciences, Colorado State University College of Veterinary Medicine and Biomedical Sciences, Fort Collins, CO, USA.
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3
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Peng LH, Tan Y, Bajinka O. The influence of maternal diet on offspring's gut microbiota in early life. Arch Gynecol Obstet 2024; 309:1183-1190. [PMID: 38057588 DOI: 10.1007/s00404-023-07305-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/12/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND The influence of maternal diet on offspring's health is an area of study that is linked to epigenetics. Maternal diet contributes to determining the health status of offspring and maternally linked mechanisms and is a global health challenge that requires attention. The impact of gut microbiota on host metabolism and offspring health is still not established. OBJECTIVE In this review, we intend to discuss the evidence on the impact of maternal diet and the health of offspring gut microbiota. The paper focuses on the gut microbiome of animal models. It captures the maternal diet and its influence on the offspring's gut microbiota, behavior that is supported by cell experimental results. Both inflammation and immune status of offspring induced by maternal diet are discussed. Finally, this review used predicted biological pathways involved in maternal diet and offspring health, and the influence of maternal diet on gut microbiota and offspring behavior. Obesity, diabetes, asthma and allergies, and neurodegenerative disorders and prospects for maternal diet, and microbiota and offspring health were discussed. CONCLUSION The review was able to gather that a high-fat diet during pregnancy created a long-lasting metabolic signature on the infant's innate immune system, altering inflammation in the offspring microbiota, which predisposed offspring to obesity and metabolic diseases in adulthood.
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Affiliation(s)
- Li-Hua Peng
- Department of Physiology, Hunan Yongzhou Vocational Technical College, Yongzhou, China
| | - Yurong Tan
- Department of Medical Microbiology, Xiangya School of Medicine, Central South University, Changsha, 410078, Hunan, China.
- China-Africa Research Centre of Infectious Diseases, School of Basic Medical Sciences, Central South University, Changsha, 410078, Hunan, China.
| | - Ousman Bajinka
- Department of Medical Microbiology, Xiangya School of Medicine, Central South University, Changsha, 410078, Hunan, China.
- China-Africa Research Centre of Infectious Diseases, School of Basic Medical Sciences, Central South University, Changsha, 410078, Hunan, China.
- School of Medicine and Allied Health Sciences, University of The Gambia, Serrekunda, Gambia.
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Liu X, Shi J. Female obesity increases the risk of preterm birth of single frozen-thawed euploid embryos: a retrospective cohort study. Gynecol Endocrinol 2024; 40:2324995. [PMID: 38439198 DOI: 10.1080/09513590.2024.2324995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/05/2023] [Indexed: 03/06/2024] Open
Abstract
INTRODUCTION Obesity has been associated with an increased risk of reproductive failure, especially preterm birth. As preimplantation genetic testing for aneuploidies (PGT-A) is increasingly used worldwide, however, it is still unclear whether body mass index (BMI) has an effect on the preterm birth rate in patients undergoing in vitro fertilization (IVF) with PGT-A when transferring a single euploid blastocyst. MATERIALS AND METHODS This retrospective, single-center cohort study included 851 women who underwent the first cycle of frozen-thawed single euploid blastocyst transfer with PGT-A between 2015 and 2020. The primary outcome was the preterm birth rate. Secondary outcomes were clinical pregnancy, miscarriage, ectopic pregnancy, pregnancy complications, and live birth. RESULTS Patients were grouped by World Health Organization (WHO) BMI class: underweight (<18.5, n = 81), normal weight (18.5-24.9, n = 637), overweight (25-30, n = 108), and obese (≥30, n = 25). There was no difference in the clinical pregnancy, miscarriage, ectopic pregnancy, pregnancy complication, and live birth by BMI category. In multivariate logistic regression analysis, preterm birth rates were significantly higher in women with overweight (adjusted odds ratio [aOR] 3.18; 95% confidence interval [CI], 1.29-7.80, p = .012) and obese (aOR 1.49; 95% CI, 1.03-12.78, p = .027) compared with the normal weight reference group. CONCLUSION Women with obesity experience a higher rate of preterm birth after euploid embryo transfer than women with a normal weight, suggesting that the negative impact of obesity on IVF and clinical outcomes may be related to other mechanisms than aneuploidy.
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Affiliation(s)
- Xitong Liu
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Juanzi Shi
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
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Ku CW, Ong LS, Goh JP, Allen J, Low LW, Zhou J, Tan TC, Lee YH. Defects in protective cytokine profiles in spontaneous miscarriage in the first trimester. F&S SCIENCE 2023; 4:36-46. [PMID: 36096448 DOI: 10.1016/j.xfss.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To study differences in cytokine expression profiles between women with ongoing pregnancy and those experiencing spontaneous miscarriage, among women who presented with threatened miscarriage before week 16 of gestation. DESIGN Prospective cohort study. SETTING Academic hospital. PATIENT(S) In this prospective cohort study, 155 pregnant women, comprising normal pregnant women recruited from antenatal clinics (n = 97) and women with threatened miscarriage recruited from an emergency walk-in clinic (n = 58). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Sixty-five serum cytokines quantified using multiplex immunoassay correlated with miscarriage outcomes. RESULT(S) Among women presenting with threatened miscarriage, those who eventually miscarried had significantly lower levels of interleukin (IL)-2, IL-12p70, IL-17A, B-cell-activating factor, B lymphocyte chemoattractant, basic nerve growth factor, interferon-γ, tumor necrosis factor-related apoptosis-inducing ligand, thymic stromal lymphopoietin, and tumor necrosis factor-α and higher levels of vascular endothelial growth factor A, IL-21, and stromal cell-derived factor 1α than those with ongoing pregnancy. Comparisons between normal pregnancies and women with threatened miscarriage who eventually miscarried revealed significant differences across 7 cytokines: B-cell-activating factor; B lymphocyte chemoattractant; basic nerve growth factor; IL-17A; fractalkine/CX3CL1; vascular endothelial growth factor A; and CCL22. Vascular endothelial growth factor A exhibited a negative correlation with the progesterone level (r = -0.270). The cluster of significant cytokines alludes to T cell proliferation, B-cell proliferation, natural killer cell-mediated cytotoxicity, and apoptosis as important pathways that determine pregnancy outcomes. Bioinformatic analysis further revealed alteration of the suppressor of cytokine signaling proteins family of Janus kinase-signal transducer and activator of transcription signaling axis by cytokines as a plausible key molecular mechanism in spontaneous miscarriage. CONCLUSION(S) This study demonstrates that the regulated balance between the proinflammatory and anti-inflammatory pathways is crucial to maintaining pregnancy. A better understanding of the cytokines associated with immunomodulatory effects may lead to novel targets for the prediction and treatment of spontaneous miscarriage.
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Affiliation(s)
- Chee Wai Ku
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore
| | | | - Jody Paige Goh
- Division of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore
| | | | - Louise Wenyi Low
- Division of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore; Obstetrics and Gynecology-Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Jieliang Zhou
- Division of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore; Obstetrics and Gynecology-Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Thiam Chye Tan
- Division of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore; Obstetrics and Gynecology-Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Yie Hou Lee
- Obstetrics and Gynecology-Academic Clinical Program, Duke-NUS Medical School, Singapore; Translational 'Omics and Biomarkers Group, KK Research Centre, KK Women's and Children's Hospital, Singapore.
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Zhang Z, Yu Y, Yang B, Huang W, Zhang Y, Luo Y, Bloom MS, Qian Z, Arnold LD, Boyd R, Wu Q, Liu R, Dong G, Yin C. Association between Pet Ownership and Threatened Abortion in Pregnant Women: The China Birth Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16374. [PMID: 36498445 PMCID: PMC9739756 DOI: 10.3390/ijerph192316374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/25/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Background: The aim of this study was to assess the association between pet ownership and threatened abortion (TA) in pregnant Chinese women. Materials and Methods: We enrolled pregnant women from 18 provinces and autonomous regions across China between November 2017 and December 2020. Participants were grouped based on the presence or absence of pet ownership. Pet owners were further sub-grouped based on the presence or absence of close contact with their pets. Pet species included cats, dogs, and both. Generalised linear mixed models, with province as a random effect, were used to estimate the associations between pet ownership and TA. Results: Pet ownership, whether or not one had close contact with pets, was associated with greater odds of TA (OR: 1.30, 95% CI: 1.21, 1.40). Keeping pet cats (OR: 1.24, 95% CI: 1.11, 1.40), dogs (OR: 1.29, 95% CI: 1.18, 1.41), or both cats and dogs (OR: 1.36, 95% CI: 1.04, 1.68) during pregnancy were all risk factors for TA. We observed significant group differences (p for difference < 0.05) in pre-pregnancy body mass index, education levels, and annual household income. Conclusions: Cat or dog ownership during pregnancy was associated with an increased risk of TA, especially among overweight, less educated, or lower-income participants.
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Affiliation(s)
- Zheng Zhang
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yunjiang Yu
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Environmental Protection, Guangzhou 510655, China
| | - Boyi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Wenzhong Huang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Yunting Zhang
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yana Luo
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Michael S. Bloom
- Department of Global and Community Health, George Mason University, Fairfax, VA 22030, USA
| | - Zhengmin Qian
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA
| | - Lauren D. Arnold
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA
| | - Rienna Boyd
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA
| | - Qingqing Wu
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
| | - Ruixia Liu
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
| | - Guanghui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Chenghong Yin
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
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Borrelli CB, Morais SS, Barbieri MM, Leme T, Prado JFT, Surita FG. Prepregnancy overweight and obesity as risk factors for birth defects: a cross-sectional study over a 30-year period. J OBSTET GYNAECOL 2022; 42:2905-2911. [PMID: 36000806 DOI: 10.1080/01443615.2022.2112938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Overweight and obesity are public health problems worldwide despite being modifiable conditions. The association between birth defects and pregestational maternal body mass index is not entirely clear. We aimed to assess the prevalence and estimate the risk of birth defects related to pregestational body mass index and other maternal factors. We explored a 30-year time series database in a cross-section study. We analysed 40,217 cases, among them 2.8% had birth defects. Bivariate analysis showed a higher prevalence of birth defects with increased pre-pregnancy body mass index and in extremes of maternal age, white skin colour, and primiparity. Multivariable logistic regression showed a higher chance of birth defects in women with pre-pregnancy overweight/obesity (OR:1.19 [CI95%:1.01-1.41]), maternal age ≥ 40 years (OR:1.68 [CI95%:1.11-2.54]), and white skin colour (OR:1.44 [CI95%:1.19-1.75]). Maternal weight is a modifiable risk factor that must be considered and addressed in preconception counselling to minimise possible deleterious effects on embryogenesis.IMPACT STATEMENTWhat is already known on this subject? Previous studies have linked some maternal factors with birth defects. However, the association with prepregnancy maternal body mass index is not clear.What do the results of this study add? Our findings provide support for the association of prepregnancy maternal overweight and obesity with birth defects and highlight that BMI is a modified risk factor.What are the implications of these findings for clinical practice and/or further research? Maternal body mass index is a modifiable risk factor, highlighting the importance of preconception counselling for the prevention and possible reduction of factors that increase the risk of birth defects.
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Affiliation(s)
- Carolina Bicudo Borrelli
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Sirlei Siani Morais
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Mariane M Barbieri
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Thayane Leme
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Campinas, Sao Paulo, Brazil
| | | | - Fernanda G Surita
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Campinas, Sao Paulo, Brazil
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Tsviban A, Frenkel A, Schvartz N, Tzur D, Klaitman V, Walfisch A. The association between adolescent obesity and later gestational diabetes in military personnel: A retrospective cohort study. Diabetes Res Clin Pract 2022; 189:109883. [PMID: 35504461 DOI: 10.1016/j.diabres.2022.109883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The association between body mass index (BMI) in adolescence and gestational diabetes mellitus (GDM) has not been completely delineated. The purpose of our study was to determine the extent by which adolescent obesity increases the risk for developing GDM later in life. METHODS A retrospective cohort study including all army personnel pregnancies occurring between the years 2009-2019 was conducted. Adolescent BMI of participants was available using pre-recruitment army records. GDM and other pregnancy outcomes were compared between two groups: adolescent BMI below 30 (comparison group) and that of 30 or more (exposed group). Multivariable models were adjusted for sociodemographic factors. RESULTS Following exclusion of cases with missing or partial glucose tests, and undocumented BMI, 6877 deliveries were included in the analysis. GDM rates were higher in the exposed group (4.9% vs. 2.9%, p value-0.09). GDM rates were twice as common in the exposed group (4.9% vs. 2.9%, p value-0.09). The multivariable model, adjusted for country of birth, socio-economic class, medical profile score, maternal age, and follow-up time, confirmed an independent association between adolescent obesity and later GDM, with an adjusted odds ratio of 2.22 (CI 1.1-4.5, p value - 0.03). CONCLUSION Obesity during the adolescent years is independently associated with gestational diabetes later in life.
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Affiliation(s)
- Anna Tsviban
- Department of Obstetrics and Gynecology, Israeli Defense Force, Israel; Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel; Tel Aviv University, Tel Aviv, Israel.
| | - Adi Frenkel
- The Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Naama Schvartz
- School of Public Health, University of Haifa, Haifa, Israel
| | | | - Vered Klaitman
- Department of Obstetrics and Gynecology, Israeli Defense Force, Israel; Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Hadassah University Medical Center, Mount Scopus, The Hebrew University, Jerusalem, Israel
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Chen Y, Guo J, Zhang Q, Zhang C. Insulin Resistance is a Risk Factor for Early Miscarriage and Macrosomia in Patients With Polycystic Ovary Syndrome From the First Embryo Transfer Cycle: A Retrospective Cohort Study. Front Endocrinol (Lausanne) 2022; 13:853473. [PMID: 35498421 PMCID: PMC9046670 DOI: 10.3389/fendo.2022.853473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/08/2022] [Indexed: 12/16/2022] Open
Abstract
Objective The objective of the study was to explore the effect of insulin resistance on pregnancy outcomes in patients with polycystic ovary syndrome (PCOS) from the first embryo transfer cycle. Design This was a single-center, retrospective, observational cohort study. Patients Included in the study were women with PCOS for the first embryo transfer. Main Outcome Measures Early miscarriage rate and macrosomia rate were the main outcome measures. Results With increased HOMA-IR, the early miscarriage rate (7.14, 13.21, and 16.22%, respectively; P = 0.039), macrosomia rate (5.78, 11.79, and 17.58%, respectively; P = 0.026) and the incidence of gestational diabetes (GDM) (10.00, 14.50, and 25.67% respectively; P = 0.002) significantly increased, while the live birth rate markedly decreased (63.03, 55.27, and 47.88%, respectively; P = 0.004). No significant difference was found in clinical pregnancy rate, late miscarriage rate, low birthweight rate and baby gender ratio (all P >0.05). After adjusting for confounding factors, HOMA-IR was an independent risk factor of early miscarriage rate and macrosomia rate. Conclusion Insulin resistance is an independent risk factor for early miscarriage and macrosomia in PCOS patients during the first embryo transfer cycle. It is essential to give more attention before and after pregnancy for PCOS women with high HOMA-IR.
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Affiliation(s)
- Yuanhui Chen
- Reproductive Medical Center, People’s Hospital of Zhengzhou University, Zhengzhou, China
- Reproductive Medical Center, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Jiayu Guo
- Reproductive Medical Center, People’s Hospital of Zhengzhou University, Zhengzhou, China
- Reproductive Medical Center, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Qingwen Zhang
- Reproductive Medical Center, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Cuilian Zhang
- Reproductive Medical Center, Henan Provincial People’s Hospital, Zhengzhou, China
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Mezzasalma L, Santoro M, Coi A, Pierini A. Association between maternal body mass index and congenital anomalies: A case-control study in Tuscany (Italy). Birth Defects Res 2021; 114:116-123. [PMID: 34913275 DOI: 10.1002/bdr2.1970] [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: 10/21/2021] [Accepted: 11/30/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the relationship between prepregnancy maternal body mass index (BMI) and congenital anomalies (CAs). DESIGN Case-control study on data collected by the registry of CAs of Tuscany (Italy) and birth certificates from 2005 to 2017. MAIN EXPOSURE Maternal prepregnancy BMI. MAIN OUTCOME MEASURES Any major CAs and groups of organ-specific anomalies. Odds ratios (ORs) were estimated using logistic regression models adjusted for maternal factors. RESULTS Maternal BMI ≥25 was significantly associated with all nervous system anomalies (OR = 1.61, 95% confidence interval [95% CI] 1.13-2.29) and with neural tube defects (OR = 2.03, 95% CI 1.00-4.12); maternal underweight was significantly associated with orofacial clefts (OR = 1.67, 95% CI 1.12-2.48). After stratification by education, in the low education group, mothers with BMI ≥25 had an increased risk of nervous system anomalies (OR = 2.19, 95% CI 1.01-4.76), whereas underweight mothers had an increased risk of nervous system anomalies (OR = 3.89, 95% CI 1.44-10.53), orofacial clefts (OR = 2.59, 95% CI 1.24-5.42), and urinary anomalies (OR = 1.74, 95% CI 1.07-2.82). In the medium/high education group, the only significantly increased risk was found in mothers with BMI ≥25 for nervous system anomalies (OR = 1.50, 95% CI 1.00-2.25). CONCLUSION Main results have shown a positive association of maternal BMI ≥25 with nervous system anomalies and maternal underweight with orofacial clefts. The study has also evidenced the impact of social status and provided clues to the role of maternal ethnic background.
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Affiliation(s)
- Lorena Mezzasalma
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Council of Research, Pisa, Italy
| | - Michele Santoro
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Council of Research, Pisa, Italy
| | - Alessio Coi
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Council of Research, Pisa, Italy
| | - Anna Pierini
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Council of Research, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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Ferreira RC, Tenório MCDS, Tenório MB, Mello CS, Oliveira ACMD. Associated factors with excessive weight gain in pregnant women from Maceió, Northeastern Brazil. CIENCIA & SAUDE COLETIVA 2021; 25:3017-3026. [PMID: 32785538 DOI: 10.1590/1413-81232020258.23492018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/26/2018] [Indexed: 11/22/2022] Open
Abstract
This article aims to evaluate the associated factors with excessive weight gain in pregnant women from Maceió, the capital of Alagoas, Northeastern Brazil. Cross-sectional study with pregnant women attended in public health in the city of Maceió in 2014, of which socioeconomic, clinical (glycemia, capillary hemoglobin, and blood pressure measurement), dietary, and anthropometric data, including in the latter gestational weight gain, classified as insufficient, adequate and excessive according to the US Institute of Medicine, were collected. The combination of excessive weight gain with the independent variables was tested using the Poisson regression expressed by the Prevalence Ratio (PR) and a 95% confidence interval (CI95%). We studied 403 pregnant women with a mean age of 24.08 ± 6.01 years, with 19.9% of them displayed insufficient weight gain; 14.1% displayed adequate weight gain, and 66.0% displayed excessive weight gain, that was associated with maternal hyperglycemia (PR = 1.35; CI95% = 1.17 to 1.57; p < 0.001). Excessive weight gain is common among pregnant women evaluated with the association of this variable with maternal hyperglycemia.
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Affiliation(s)
- Raphaela Costa Ferreira
- Instituto de Ciências Biológicas e da Saúde, Universidade Federal de Alagoas (UFAL). Av. Lourival Melo Mota s/n, Tabuleiro do Martins. 57072-900 Maceió AL Brasil.
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Systematic review and meta-analysis of female lifestyle factors and risk of recurrent pregnancy loss. Sci Rep 2021; 11:7081. [PMID: 33782474 PMCID: PMC8007745 DOI: 10.1038/s41598-021-86445-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 03/08/2021] [Indexed: 01/19/2023] Open
Abstract
It is known that lifestyle factors affect sporadic miscarriage, but the extent of this on RPL (recurrent pregnancy loss) is less well known. A systematic review and meta-analysis was performed to assess the associations between lifestyle factors and RPL. Studies that analysed RPL in the context of BMI, smoking, alcohol and caffeine intake were included. The primary and secondary outcomes were odds of having RPL in the general population and odds of further miscarriage, respectively. Underweight and women with BMI > 25 are at higher odds of RPL in the general population (OR 1.2, 95% CI 1.12-1.28 and OR 1.21, 95% CI 1.06-1.38, respectively). In women with RPL, having BMI > 30 and BMI > 25 has increased odds of further miscarriages (OR 1.77, 95% CI 1.25-2.50 and OR 1.35, 95% CI 1.07-1.72, respectively). The quality of the evidence for our findings was low or very low. Being underweight and BMI > 25 contributes significantly to increased risk of RPL (general population). BMI > 25 or BMI > 30 increases the risk of further miscarriages (RPL population). Larger studies addressing the effects of alcohol, cigarette smoking and caffeine on the risk of RPL with optimisation of BMI in this cohort of women are now needed.
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Dagnew GW, Asresie MB. Comparative assessment of overweight/obesity among rural and urban reproductive-age women in Ethiopia: Evidence from a cross-sectional 2016 national survey. Nutr Health 2021; 27:221-230. [PMID: 33594927 DOI: 10.1177/0260106020982346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Overweight/obesity has become a global health problem for both developed and developing regions. Nowadays, overweight/obesity among childrearing-age women has become rapidly increasing in both urban and rural areas. AIM This study aimed to assess the variation of overweight/obesity among urban and rural reproductive-age women in Ethiopia. METHODS For this study, the 2016 Ethiopia Demographic and Health Survey data were used. The survey was a community-based cross-sectional study, which used a two-stage stratified cluster sampling technique to select the participants. A total of 13,451 reproductive-age women were included in the analysis. Both descriptive and analytical analysis was performed. A p-value of less than 0.05 was used as the measure of statistical significance. RESULTS The prevalence of overweight/obesity among urban reproductive-age women was statistically higher (p = 21.5%; 95% confidence interval (CI): 18.2-25.1) than the rural women (p = 3.5%; 95% CI: 2.9%-4.2%). Women who attend secondary or above education, women in the age groups 25-34 and ≥ 35 years, and high wealth index (rich) had higher odds of overweight/obesity in both urban and rural women. Moreover, women who were married, who had a large family size, and who have a history of alcohol intake had higher odds of overweight/obesity among urban women. CONCLUSIONS Overweight/obesity among reproductive-age women is a public health problem in Ethiopia, especially for women who are living in urban settings. Therefore, it is important to establish targeted overweight reduction programs with particular emphasis on urban, older aged, educated, and married women. Additionally, encouraging the limitation of the number of family size and alcohol intake can reduce women's overweight/obesity.
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Affiliation(s)
- Gizachew Worku Dagnew
- Department of Reproductive Health, School of Public Health, 247589College of Medicine and Health Science, Bahir Dar University, Ethiopia
| | - Melash Belachew Asresie
- Department of Reproductive Health, School of Public Health, 247589College of Medicine and Health Science, Bahir Dar University, Ethiopia
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14
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Brink LT, Nel DG, Hall DR, Odendaal HJ. Association of socioeconomic status and clinical and demographic conditions with the prevalence of preterm birth. Int J Gynaecol Obstet 2020; 149:359-369. [PMID: 32176323 DOI: 10.1002/ijgo.13143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 01/15/2020] [Accepted: 03/11/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the effects of socioeconomic and demographic conditions on the prevalence of preterm birth in a local community. METHODS Pregnant women (aged ≥16 years) willing to provide informed consent in one of the two languages of the community were recruited in South Africa between August 2007 and January 2015. Specifically designed case report forms collected information and measurements prospectively. RESULTS After reviewing the medical records of 5806 women, it was possible to identify those who had spontaneous preterm birth (SPTB), induced preterm birth (IPTB), or spontaneous term birth (STB). Women with IPTB (vs SPTB) were more obese and had higher education levels and household incomes; more had telephones and running water at home. They enrolled earlier and more developed hypertension and pre-eclampsia. Women with SPTB (vs STB) were less obese, shorter, had smaller arm circumferences and higher gravidities and Edinburgh Depression Scores, lower education, fewer telephones, and less running water at home. More women with SPTB used methamphetamine, cigarettes, and were heavier smokers. CONCLUSION SPTB and IPTB should not be conflated. Programs to reduce the high prevalence of SPTB should include improving education, lifestyle, and socioeconomic conditions. Addressing hypertension should help reduce preterm inductions.
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Affiliation(s)
- Lucy T Brink
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Daan G Nel
- Department of Statistics and Actuarial Science, Stellenbosch University, Stellenbosch, South Africa
| | - David R Hall
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Hein J Odendaal
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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Ahmed M, Seid A, Kemal A. Does the Frequency of Watching Television Matters on Overweight and Obesity among Reproductive Age Women in Ethiopia? J Obes 2020; 2020:9173075. [PMID: 32850148 PMCID: PMC7441419 DOI: 10.1155/2020/9173075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/29/2020] [Accepted: 06/30/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Studies in developed countries have revealed an association of different magnitudes between watching television and the risk of being overweight and obese among reproductive age women. Even so, there is no evidence of such an association in the context of the Ethiopian population. Hence, the study aimed to assess the association between watching television with overweight and obesity in a nationally representative sample of Ethiopian women. METHODS A cross-sectional study was conducted by using secondary data analysis from 2016 Ethiopia demographic and health survey among women aged from 15 to 49 years. The samples were selected using a two-stage stratified cluster sampling technique. A total of 10,074 women were included in the analysis. The outcome variables were both overweight and obesity, whereas the main exposure variable was the frequency of watching television. Multivariate logistic regression analysis was performed for adjusting potential confounders. Adjusted odds ratio (AOR) with 95% confidence intervals was used to declare a statistically significant association. RESULTS The study found that watching television at least once a week was significantly associated with both overweight (AOR: 1.79; 95% CI: 1.20-2.73) and obesity (AOR: 3.76; 95% CI: 2.04-6.95). The study also divulged that the odds of overweight were higher among women aged 25-39 years (AOR: 2.17; 95% CI: 1.25-3.77) and 40-49 years (AOR: 2.69; 95% CI: 1.45-5.00), urban residents (AOR: 1.76; 95% CI:1.17-2.65), attended higher education (AOR:2.11; 95% CI: 1.22-3.65), and richest in the wealth index (AOR: 2.83; 95% CI:1.71-4.68). Similarly, the odds of obesity were higher among women aged 25-39 years and 40-49 years, attended higher education, and the richest in wealth index. CONCLUSIONS The results from this study demonstrated that watching television at least once a week is associated with obesity among reproductive age women in Ethiopia. Therefore, a social behavioral change communication campaign needs to be taken to improve awareness regarding the harmful consequences of watching television for long hours. Further research studies should be conducted among men and adolescents to determine whether this positive association exists among that target population as well.
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Affiliation(s)
| | - Abdu Seid
- Maternity and Reproductive Health Nursing, Woldia University, Woldia, Ethiopia
| | - Adnan Kemal
- Human Nutrition, Defense University, Addis Ababa, Ethiopia
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Armuand G, Skoog Svanberg A, Bladh M, Sydsjö G. Adverse obstetric outcomes among female childhood and adolescent cancer survivors in Sweden: A population-based matched cohort study. Acta Obstet Gynecol Scand 2019; 98:1603-1611. [PMID: 31329281 DOI: 10.1111/aogs.13690] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 07/17/2019] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Cancer treatment during childhood may lead to late adverse effects, such as reduced musculoskeletal development or vascular, endocrine and pulmonary dysfunction, which in turn may have an adverse effect on later pregnancy and childbirth. The aim of the present study was to investigate pregnancy and obstetric outcomes as well as the offspring's health among childhood and adolescent female cancer survivors. MATERIAL AND METHODS This register-based study included all women born between 1973 and 1977 diagnosed with cancer in childhood or adolescence (age <21), as well as an age-matched comparison group. A total of 278 female cancer survivors with their first childbirth were included in the study, together with 829 age-matched individuals from the general population. Logistic regression and analysis of variance were used to investigate associations between having been treated for cancer and the outcome variables, adjusting for maternal age, nicotine use and comorbidity. RESULTS Survivors were more likely to have preeclampsia (adjusted odds ratio [aOR] 3.46, 95% confidence interval [CI] 1.58 to 7.56), undergo induction of labor (aOR 1.66, 95% CI 1.05 to 2.62), suffer labor dystocia (primary labor dystocia aOR 3.54, 95% CI 1.51 to 8.34 and secondary labor dystocia aOR 2.43, 95% CI 1.37 to 4.31), malpresentation of fetus (aOR 2.02, 95% CI 1.12 to 3.65) and imminent fetal asphyxia (aOR 2.55, 95% CI 1.49 to 4.39). In addition, deliveries among survivors were more likely to end with vacuum extraction (aOR 2.53, 95% CI 1.44 to 4.47), with higher risk of clitoral lacerations (aOR 2.18, 95% CI 1.47 to 3.23) and anal sphincter injury (aOR 2.76, 95% CI 1.14 to 6.70) and emergency cesarean section (aOR 2.34 95% CI 1.39 to 3.95). Survivors used pain-reliving methods to a higher extent compared with the comparison group. There was no increased risk of neonate diagnoses and malformations. The results showed that survivors who had been diagnosed with cancer when they were younger than 14 had an increased risk of adverse obstetric outcomes. CONCLUSIONS The study demonstrates increased risk of pregnancy and childbirth complications among childhood and adolescent cancer survivors. There is a need to optimize perinatal care, especially among survivors who were younger than 14 at time of diagnosis.
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Affiliation(s)
- Gabriela Armuand
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | | | - Marie Bladh
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Gunilla Sydsjö
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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Gohir W, Kennedy KM, Wallace JG, Saoi M, Bellissimo CJ, Britz-McKibbin P, Petrik JJ, Surette MG, Sloboda DM. High-fat diet intake modulates maternal intestinal adaptations to pregnancy and results in placental hypoxia, as well as altered fetal gut barrier proteins and immune markers. J Physiol 2019; 597:3029-3051. [PMID: 31081119 DOI: 10.1113/jp277353] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/07/2019] [Indexed: 12/26/2022] Open
Abstract
KEY POINTS Maternal obesity has been associated with shifts in intestinal microbiota, which may contribute to impaired barrier function Impaired barrier function may expose the placenta and fetus to pro-inflammatory mediators We investigated the impacts of diet-induced obesity in mice on maternal and fetal intestinal structure and placental vascularization Diet-induced obesity decreased maternal intestinal short chain fatty acids and their receptors, impaired gut barrier integrity and was associated with fetal intestinal inflammation. Placenta from obese mothers showed blood vessel immaturity, hypoxia, increased transcript levels of inflammation, autophagy and altered levels of endoplasmic reticulum stress markers. These data suggest that maternal intestinal changes probably contribute to adverse placental adaptations and also impart an increased risk of obesity in the offspring via alterations in fetal gut development. ABSTRACT Shifts in maternal intestinal microbiota have been implicated in metabolic adaptations to pregnancy. In the present study, we generated cohorts of female C57BL/6J mice fed a control (17% kcal fat, n = 10-14) or a high-fat diet (HFD 60% kcal from fat, n = 10-14; ad libitum) aiming to investigate the impact on the maternal gut microbiota, intestinal inflammation and gut barrier integrity, placental inflammation and fetal intestinal development at embryonic day 18.5. HFD was associated with decreased relative abundances of short-chain fatty acid (SCFA) producing genera during pregnancy. These diet-induced shifts paralleled decreased maternal intestinal mRNA levels of SCFA receptor Gpr41, modestly decreased cecal butyrate, and altered mRNA levels of inflammatory cytokines and immune cell markers in the maternal intestine. Maternal HFD resulted in impaired gut barrier integrity, with corresponding increases in circulating maternal levels of lipopolysaccharide (LPS) and tumour necrosis factor. Placentas from HFD dams demonstrated blood vessel immaturity and hypoxia; decreased free carnitine, acylcarnitine derivatives and trimethylamine-N-oxide; and altered mRNA levels of inflammation, autophagy, and ER stress markers. HFD exposed fetuses had increased activation of nuclear factor-kappa B and inhibition of the unfolded protein response in the developing intestine. Taken together, these data suggest that HFD intake prior to and during pregnancy shifts the composition of the maternal gut microbiota and impairs gut barrier integrity, resulting in increased maternal circulating LPS, which may ultimate contribute to changes in placental vascularization and fetal gut development.
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Affiliation(s)
- Wajiha Gohir
- Department of Biochemistry and Biomedical Sciences.,Farncombe Family Digestive Health Research Institute
| | - Katherine M Kennedy
- Department of Biochemistry and Biomedical Sciences.,Farncombe Family Digestive Health Research Institute
| | - Jessica G Wallace
- Department of Biochemistry and Biomedical Sciences.,Farncombe Family Digestive Health Research Institute
| | | | - Christian J Bellissimo
- Department of Biochemistry and Biomedical Sciences.,Farncombe Family Digestive Health Research Institute
| | | | - Jim J Petrik
- Department of Biomedical Sciences, University of Guelph, Guelph, ON, Canada
| | - Michael G Surette
- Department of Biochemistry and Biomedical Sciences.,Farncombe Family Digestive Health Research Institute.,Department of Medicine
| | - Deborah M Sloboda
- Department of Biochemistry and Biomedical Sciences.,Farncombe Family Digestive Health Research Institute.,Department of Obstetrics and Gynecology.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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18
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Association between maternal serious mental illness and adverse birth outcomes. J Perinatol 2019; 39:737-745. [PMID: 30850757 PMCID: PMC6503973 DOI: 10.1038/s41372-019-0346-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/25/2019] [Accepted: 02/04/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the contribution of serious mental illness (SMI) and specific risk factors (comorbidities and substance use) to the risk of adverse birth outcomes. STUDY DESIGN This cross-sectional study uses maternal delivery records in the Healthcare Cost and Utilization Project Nationwide/National Inpatient Sample (HCUP-NIS) to estimate risk factor prevalence and relative risk of adverse birth outcomes (e.g., preeclampsia, preterm birth, and fetal distress) in women with SMI. RESULTS The relative risk of adverse gestational (1.15, 95% CI: 1.13-1.17), obstetric (1.07, 1.06-1.08), and fetal (1.24, 1.21-1.26) outcomes is increased for women with SMI. After adjusting for risk factors, the risk is significantly reduced but remains elevated for all three adverse outcome categories (gestational: 1.08, 1.06-1.09; obstetric: 1.03, 1.02-1.05; fetal: 1.12, 1.09-1.14). CONCLUSIONS Maternal serious mental illness is independently associated with increased risk for adverse birth outcomes. However, approximately half of the excess risk is attributable to comorbidities and substance use.
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Wang L, Wen L, Zheng Y, Zhou W, Mei L, Li H, Tong C, Qi H, Baker PN. Association Between Gestational Weight Gain and Pregnancy Complications or Adverse Delivery Outcomes in Chinese Han Dichorionic Twin Pregnancies: Validation of the Institute of Medicine (IOM) 2009 Guidelines. Med Sci Monit 2018; 24:8342-8347. [PMID: 30453309 PMCID: PMC6256840 DOI: 10.12659/msm.911784] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Excessive or insufficient gestational weight gain (GWG) is associated with increased risks of pregnancy complications and adverse delivery outcomes in dichorionic twin pregnancies. The provisional Institute of Medicine (IOM) 2009 guidelines suggested the optimal GWG based on limited epidemiological data collected from Western populations. However, such a recommendation has not yet been validated in a Chinese Han population, the world’s largest ethnic group. The objective of this study was to assess the effect of IOM guidelines by determining the neonatal and maternal outcomes associated with gaining weight below, within, and above the IOM provisional guidelines on GWG in Chinese Han twin pregnancies. Material/Methods A historical cohort study of 350 twin-conceiving Han women in Chongqing Women and Children’s Health Center delivering liveborn twin infants between January 2015 and November 2016 was conducted. The participants were divided into 3 groups according to the 2009 Institute of Medicine recommendations of GWG: a low GWG group, an adequate GWG group, and a high GWG group. The incidence of pregnancy complications and the delivery outcomes were compared between the groups, and the correlation of GWG and pregnancy complications or delivery outcome was investigated by logistic regression analysis. Results In Han Chinese people, the gestational age (GA) at delivery was significantly different among various GWG groups, and low maternal GWG is associated with shorter GA. Although low GWG increased the incidence of VPTD, it did not impact PTD in twin pregnancies. Moreover, GWG was negatively correlated with the incidence of PPROM and was positively correlated with GHP development in twin pregnancies. Conclusions The recommendations of the 2009 IOM guidelines about GWG is beneficial in reducing the incidence of VPTD and PPROM in Han Chinese dichorionic twin pregnancies, but failed to eliminate the development of PTD, PROM, GDM, PE, ICP, and SGA.
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Affiliation(s)
- Lan Wang
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).,Department of Obstetrics, Chongqing Women's and Children's Health Center, Chongqing, China (mainland).,International Jointed Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China (mainland)
| | - Li Wen
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).,International Jointed Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China (mainland)
| | - Yangxi Zheng
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).,International Jointed Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing , China (mainland)
| | - Wenzheng Zhou
- Department of Obstetrics, Chongqing Women's and Children's Health Center, Chongqing, China (mainland)
| | - Lingwei Mei
- Department of Obstetrics, Chongqing Women's and Children's Health Center, Chongqing, China (mainland)
| | - Haoran Li
- Department of Obstetrics, Chongqing Women's and Children's Health Center, Chongqing, China (mainland)
| | - Chao Tong
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).,International Jointed Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China (mainland)
| | - Hongbo Qi
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).,International Jointed Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China (mainland)
| | - Philip N Baker
- International Jointed Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China (mainland).,College of Life Sciences, University of Leicester, Leicester, United Kingdom
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Cavalcante MB, Sarno M, Peixoto AB, Araujo Júnior E, Barini R. Obesity and recurrent miscarriage: A systematic review and meta-analysis. J Obstet Gynaecol Res 2018; 45:30-38. [PMID: 30156037 DOI: 10.1111/jog.13799] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 08/06/2018] [Indexed: 01/02/2023]
Abstract
The aim of this study is to perform a systematic review and meta-analysis on the relationship between excess weight and risk of recurrent pregnancy loss (RPL) and to highlight the common immunological mechanisms of these two conditions. The PubMed and MEDLINE databases were searched for publications in English available as of November 2017. The search terms used were 'recurrent pregnancy loss', 'body mass index' (BMI), 'overweight' and 'obesity'. For calculation of the odds ratio (OR) and 95% confidence intervals (CI) for miscarriage in different BMI groups, RevMan software was used (Review Manager, Version 5.3.5 for Windows; The Cochrane Collaboration). In total, 100 publications including the search terms were identified. Six studies were included for qualitative analysis, and two studies were included for quantitative analysis (meta-analysis). The association between excess weight and RPL was significant (OR, 1.34; 95% CI, 1.05-1.70; P = 0.02). The isolated analyses of the groups of obese and overweight women revealed an association only between obesity and RPL (OR, 1.75; 95% CI, 1.24-2.47; P = 0.001). The data available in the current literature revealed that obese women with a history of RPL have a high risk of future pregnancy losses, a risk which was not found among overweight women.
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Affiliation(s)
- Marcelo B Cavalcante
- Department of Obstetrics and Gynecology, Fortaleza University (UNIFOR), Fortaleza, Brazil
| | - Manoel Sarno
- Department of Obstetrics and Gynecology, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Alberto B Peixoto
- Mario Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Ricardo Barini
- Department of Obstetrics and Gynecology, Campinas University (UNICAMP), Campinas, Brazil
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Chowdhury MAB, Adnan MM, Hassan MZ. Trends, prevalence and risk factors of overweight and obesity among women of reproductive age in Bangladesh: a pooled analysis of five national cross-sectional surveys. BMJ Open 2018; 8:e018468. [PMID: 30030307 PMCID: PMC6059314 DOI: 10.1136/bmjopen-2017-018468] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To determine the trends, prevalence and risk factors of overweight and obesity among Bangladeshi women of reproductive age from 1999 to 2014. DESIGN We analysed nationally representative data from the 1999, 2004, 2007, 2011 and 2014 cross-sectional Bangladesh Demographic and Health Surveys. SETTING Bangladesh. PARTICIPANTS Women aged 15-49 years. PRIMARY OUTCOME Overweight/obesity. RESULTS A total of 58 192 women were included in the analysis. The prevalence of overweight and obesity among women of reproductive age increased significantly from 7.53% (95% CI 6.83 to 8.29) and 1.82% (95% CI 1.48 to 2.24) in 1999 to 28.37% (95% CI 27.49 to 29.28) and 10.77% (95% CI 10.22 to 11.35) in 2014, respectively. Age, education, wealth index, watching television and contraceptive use were associated with overweight and obesity in both urban and rural areas. CONCLUSIONS Overweight and obesity prevalence increased significantly among Bangladeshi women of reproductive age between 1999 and 2014. Development of effective low-cost strategies to address the increasing burden of obesity should be a high priority.
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Affiliation(s)
| | - Md Mohiuddin Adnan
- Department of Data Science, School of Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Md Zakiul Hassan
- Programme for Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Mocking M, Savitri AI, Uiterwaal CSPM, Amelia D, Antwi E, Baharuddin M, Grobbee DE, Klipstein-Grobusch K, Browne JL. Does body mass index early in pregnancy influence the risk of maternal anaemia? An observational study in Indonesian and Ghanaian women. BMC Public Health 2018; 18:873. [PMID: 30005609 PMCID: PMC6045841 DOI: 10.1186/s12889-018-5704-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 06/12/2018] [Indexed: 11/24/2022] Open
Abstract
Background Anaemia is common among pregnant women, especially in low- and middle-income countries (LMICs). While body mass index (BMI) relates to many risk factors for anaemia in pregnancy, little is known about the direct relation with anaemia itself. This is particularly relevant in Southeast Asia and Sub-Saharan Africa where the prevalence of anaemia in pregnancy and the associated adverse outcomes is among the highest worldwide. This study aimed to assess the association between early pregnancy BMI and anaemia at first antenatal care visit in Indonesian and Ghanaian women. In addition, the associations between early pregnancy anaemia and adverse birth outcomes was assessed. Methods Prospective cohort studies of women in early pregnancy were conducted in Jakarta, Indonesia (n = 433) and in Accra, Ghana (n = 946), between 2012 and 2014. Linear regression analysis was used to assess relations between early pregnancy BMI and pregnancy haemoglobin levels at booking. Logistic regression analyses were used to assess associations between early pregnancy anaemia as defined by the World Health Organization (WHO) criteria and a composite of adverse birth outcomes including stillbirth, low birth weight and preterm birth. Results Indonesian women had lower BMI than Ghanaian women (23.0 vs 25.4 kg/m2, p < 0.001) and higher mean haemoglobin levels (12.4 vs 11.1 g/dL, p < 0.001), corresponding to anaemia prevalence of 10 and 44%, respectively. Higher early pregnancy BMI was associated with higher haemoglobin levels in Indonesian (0.054 g/dL/kg/m2, 95% CI 0.03 to 0.08, p < 0.001) and Ghanaian women (0.044 g/dL/kg/m2, 0.02 to 0.07, p < 0.001). Accordingly, risk for anaemia decreased with higher early pregnancy BMI for Indonesians (adjusted OR 0.88, 0.81 to 0.97, p = 0.01) and Ghanaians (adjusted OR 0.95, 0.92 to 0.98, p < 0.001). No association between anaemia and the composite of adverse birth outcomes was observed. Conclusion Higher BMI in early pregnancy is associated with higher haemoglobin levels at antenatal booking and with a reduced risk of anaemia in Indonesian and Ghanaian women. Electronic supplementary material The online version of this article (10.1186/s12889-018-5704-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martina Mocking
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ary I Savitri
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cuno S P M Uiterwaal
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
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Oliveira ACMD, Pereira LA, Ferreira RC, Clemente APG. Estado nutricional materno e sua associação com o peso ao nascer em gestações de alto risco. CIENCIA & SAUDE COLETIVA 2018; 23:2373-2382. [DOI: 10.1590/1413-81232018237.12042016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 08/04/2016] [Indexed: 02/08/2023] Open
Abstract
Resumo O estado clínico e o nutricional da gestante representam importantes variáveis para o risco de inadequações de peso ao nascer. Assim, o presente estudo visou avaliar o estado nutricional de gestantes de alto risco e sua associação com o peso ao nascer de seus conceptos. Estudo transversal com gestantes de alto risco assistidas no Hospital Universitário de Maceió-AL e seus recém-nascidos. O estado nutricional das gestantes e de seus conceptos foi avaliado segundo o Índice de Massa Corporal para a idade gestacional e o peso ao nascer, respectivamente. A associação entre fatores maternos (comorbidades e estado nutricional) e o peso ao nascer foram realizadas pelos testes de qui-quadrado e correlação de Pearson, adotando um nível de confiança de 95% (α = 0,05). Foram estudadas 149 gestantes, com 19,7% delas com baixo peso; 32,0% eutróficas e 48,3% com excesso de peso. Entre os recém-nascidos, 39,6% eram pequenos para idade gestacional (PIG); 26,8% adequados para a idade gestacional (AIG) e 33,6% grandes para a idade gestacional (GIG). O excesso de peso gestacional e a presença de comorbidades metabólicas se associaram com o nascimento de recém-nascidos GIG e o ganho ponderal gestacional insuficiente com o nascimento de recém-nascidos PIG, sendo fundamentais intervenções para redução desses desfechos.
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Jansen A, Polder A, Müller MHB, Skjerve E, Aaseth J, Lyche JL. Increased levels of persistent organic pollutants in serum one year after a great weight loss in humans: Are the levels exceeding health based guideline values? THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 622-623:1317-1326. [PMID: 29890598 DOI: 10.1016/j.scitotenv.2017.11.241] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/27/2017] [Accepted: 11/20/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND With the growing prevalence of obesity, an increased number of bariatric surgeries are being performed. Lipophilic persistent organic pollutants (POPs) are stored in adipose tissue, and an increased release of lipophilic POPs into the blood circulation may occur following rapid weight loss such as after bariatric surgery. OBJECTIVES To evaluate and compare POP levels in serum before and after bariatric surgery, and to assess if the POP levels exceeded health based guideline values, with particular focus on women of childbearing age (WCBA). METHODS Serum samples from 63 patients before and one year after bariatric surgery were analysed for organochlorine pesticides (OCPs); polychlorinated biphenyls (PCBs); and brominated flame retardants (BFRs). RESULTS Mean weight loss one year after surgery was 32.1kg. The levels of all the analysed POPs in serum increased during the study period. Median levels of dichlorodiphenyldichloroethylene (p,p'-DDE), hexachlorobenzen (HCB) and PCB-153 increased from 90.2ng/g lipid weight (lw) to 158.5ng/glw, from 21.1ng/glw to 36.4ng/glw and from 48.7ng/glw to 71.5ng/glw, respectively. The highest percentage increase was observed for PCB -138, with 83.1%. BFRs were detected in low sample numbers and at low levels. Guideline values for ΣPCB6 in serum were exceeded for 5% of the participants. CONCLUSIONS Weight loss after bariatric surgery resulted in increases of POPs levels in serum between 46.7%-83.1%. Guideline values for ΣPCB6 in serum were exceeded for 5% of the participants. For WCBA, the possible transfer of comparable levels to infants warrants further attention.
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Affiliation(s)
- Aina Jansen
- Center for Morbid Obesity, Department of Surgery, Innlandet Hospital Trust, Kyrre Grepps Gate 11, N-2819 Gjøvik, Norway; Department of Food Safety and Infection Biology, Norwegian University of Life Sciences (NMBU), Campus Adamstuen, P.O. Box 8146 Dep, N-0033 Oslo, Norway.
| | - Anuschka Polder
- Department of Food Safety and Infection Biology, Norwegian University of Life Sciences (NMBU), Campus Adamstuen, P.O. Box 8146 Dep, N-0033 Oslo, Norway
| | - Mette H B Müller
- Department of Food Safety and Infection Biology, Norwegian University of Life Sciences (NMBU), Campus Adamstuen, P.O. Box 8146 Dep, N-0033 Oslo, Norway
| | - Eystein Skjerve
- Department of Food Safety and Infection Biology, Norwegian University of Life Sciences (NMBU), Campus Adamstuen, P.O. Box 8146 Dep, N-0033 Oslo, Norway
| | - Jan Aaseth
- Innlandet Hospital Trust, Kongsvinger Hospital Division, Parkveien 35, N-2212 Kongsvinger, Norway; Faculty of Public Health, Inland Norway University of Applied Sciences, PO Box 400, N-2418 Elverum, Norway
| | - Jan L Lyche
- Department of Food Safety and Infection Biology, Norwegian University of Life Sciences (NMBU), Campus Adamstuen, P.O. Box 8146 Dep, N-0033 Oslo, Norway
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Triunfo S, Ferrazzani S, Draisci G, Zanfini BA, Scambia G, Lanzone A. Role of maternal characteristics and epidural analgesia on caesarean section rate in groups 1 and 3 according to Robson's classification: a cohort study in an Italian university hospital setting. BMJ Open 2018; 8:e020011. [PMID: 29627812 PMCID: PMC5892744 DOI: 10.1136/bmjopen-2017-020011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate the role of maternal characteristics and epidural analgesia (EA) on caesarean section (CS) rates in selected groups by using the Robson 10-Group Classification System (RTGCS). DESIGN Cohort study. SETTING Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario 'A. Gemelli', Rome, Italy. PATIENTS A total of 12 098 deliveries in periods I (1998-1999) and II (2010-2011). MAIN OUTCOME MEASURES CS rates in groups 1 and 3 of RTGCS. RESULTS In group 1, 1144 (20%) patients were assigned to period I and 1302 (20.4%) to period II, while in group 3, 1587 (27.8%) were assigned to period I and 1502 (23.5%) to period II. CS rates were 16.4% and 23.1% in group 1 and 12.7% and 10.9% in group 3 in periods I and II, respectively. In group 1, significant and independent contributions to CS rate were provided by maternal age (p=0.018; OR 0.95 (95% CI 0.85 to 0.97)), body mass index (BMI) (p=0.022; OR 0.89 (95% CI 0.85 to 0.91)) and EA administration (p=0.037; OR 0.59 (95% CI 0.43 to 0.77)). In group 3, maternal age (p<0.001; OR 0.93 (95% CI 0.89 to 0.96)) and BMI (p=0.023; OR 0.98 (95% CI 0.96 to 0.99)) were found to be significantly associated with CS. CONCLUSIONS RTGCS is an effective tool for analysing changes in obstetric care, allowing for the recognition of maternal age, BMI and EA administration in the strategic planning for mitigation of CS rates in selected groups.
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Affiliation(s)
- Stefania Triunfo
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy
| | - Sergio Ferrazzani
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy
| | - Gaetano Draisci
- Department of Anaesthesiology and Intensive Care, Fondazione Policlinico Universitario ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy
| | - Bruno Antonio Zanfini
- Department of Anaesthesiology and Intensive Care, Fondazione Policlinico Universitario ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy
| | - Antonio Lanzone
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy
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Association between pre-pregnancy weight status and maternal micronutrient status in early pregnancy. Public Health Nutr 2018; 21:2046-2055. [PMID: 29560851 DOI: 10.1017/s1368980018000459] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Inadequate maternal micronutrient status during pregnancy can lead to short- and long-term health risks for mother and offspring. The present study investigated the association between pre-pregnancy weight status and micronutrient status during pregnancy. DESIGN Maternal blood samples were collected during early pregnancy (median 13, interquartile range 12-15 weeks) and were assayed for serum folate, ferritin, Fe and vitamin B12. Regression modelling was used to assess the association between pre-pregnancy underweight, normal weight, overweight and obesity, and micronutrient levels, as well as the odds for deficiencies. SETTING The Amsterdam Born Children and their Development (ABCD) study, the Netherlands. SUBJECTS Women with singleton pregnancies without diabetes (n 4243). RESULTS After adjustment for covariates, overweight women and obese women had lower (β; 95 % CI) folate (-1·2; -2·2, -0·2 and -2·3; -4·0, -0·7 nmol/l, respectively) and Fe (-1·7; -2·3, -1·1 and -3·6; -4·7, -2·6 μmol/l, respectively) levels than women with normal weight. Furthermore, overweight women had 6 % (95 % CI -9, -3 %) and obese women had 15 % (-19, -10 %), lower vitamin B12 levels, and obese women had 19 % (6, 32 %) higher ferritin levels, than normal-weight women. Obese women had higher odds (OR; 95 % CI) for folate deficiency (2·03; 1·35, 3·06), Fe deficiency (3·26; 2·09, 5·08) and vitamin B12 deficiency (2·05; 1·41, 2·99) than women with normal weight. Underweight was not associated with micronutrient status. CONCLUSIONS During early pregnancy, women with pre-pregnancy overweight and obesity had lower serum folate, Fe and vitamin B12 status. This resulted in increased risk of serum folate, Fe and vitamin B12 deficiencies in women with obesity.
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Zheng J, Wang H, Ren M. Influence of exercise intervention on gestational diabetes mellitus: a systematic review and meta-analysis. J Endocrinol Invest 2017; 40:1027-1033. [PMID: 28401529 DOI: 10.1007/s40618-017-0673-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 04/03/2017] [Indexed: 01/12/2023]
Abstract
AIMS Exercise intervention might be a promising approach to prevent gestational diabetes mellitus. However, the results remained controversial. We conducted a systematic review and meta-analysis to explore the effect of exercise intervention on gestational diabetes mellitus. METHODS PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of exercise intervention on gestational diabetes mellitus were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcome was the incidence of gestational diabetes mellitus, preterm birth, and gestational age at birth. Meta-analysis was performed using random-effect model. RESULTS Five RCTs involving 1872 patients were included in the meta-analysis. Overall, compared with control intervention, exercise intervention was found to significantly reduce the risk of gestational diabetes mellitus (std. mean difference 0.62; 95% CI 0.43-0.89; P = 0.01), but demonstrated no influence on preterm birth (OR 0.93; 95% CI 0.44-1.99; P = 0.86), gestational age at birth (std. mean difference -0.03; 95% CI -0.12 to 0.07; P = 0.60), glucose 2-h post-OGTT (std. mean difference -1.02; 95% CI -2.75 to 0.71; P = 0.25), birth weight (std. mean difference -0.10; 95% CI -0.25 to 0.04; P = 0.16), Apgar score less than 7 (OR 0.78; 95% CI 0.21-2.91; P = 0.71), and preeclampsia (OR 1.05; 95% CI 0.53-2.07; P = 0.88). CONCLUSIONS Compared to control intervention, exercise intervention was found to significantly reduce the incidence of gestational diabetes mellitus, but had no significant influence on preterm birth, gestational age at birth, glucose 2-h post-OGTT, birth weight, Apgar score less than 7, and preeclampsia.
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Affiliation(s)
- J Zheng
- Department of Endocrinology, Chongqing People's Hospital, Chongqing, China
| | - H Wang
- Department of Endocrinology, Chongqing People's Hospital, Chongqing, China
| | - M Ren
- Digestive Department, Chongqing People's Hospital, Chongqing, China.
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Hajagos-Tóth J, Ducza E, Samavati R, Vari SG, Gaspar R. Obesity in pregnancy: a novel concept on the roles of adipokines in uterine contractility. Croat Med J 2017; 58:96-104. [PMID: 28409493 PMCID: PMC5410735 DOI: 10.3325/cmj.2017.58.96] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Obesity is a global health problem even among pregnant women. Obesity alters quality of labor, such as preterm labor, prolonged labor, and higher oxytocin requirements in pregnant women. The most important factors to play a role in the altered gestational period and serve as drug targets to treat the consequences are female sexual hormones, calcium channels, adrenergic system, oxytocin, and prostaglandins. However, we have limited information about the impact of obesity on the pregnant uterine contractility and gestation time. Adipose tissue, which is the largest endocrine and paracrine organ, especially in obesity, is responsible for the production of adipokines and various cytokines and chemokines, and there are no reliable data available describing the relation between body mass index, glucose intolerance, and adipokines during pregnancy. Recent data suggest that the dysregulation of leptin, adiponectin, and kisspeptin during pregnancy contributes to gestational diabetes mellitus and pre-eclampsia. A preclinical method for obese pregnancy should be developed to clarify the action of adipokines and assess their impact in obesity. The deeper understanding of the adipokines-induced processes in obese pregnancy may be a step closer to the prevention and therapy of preterm delivery or prolonged pregnancy. Gestational weight gain is one of the factors that could influence the prenatal development, birth weight, and adiposity of newborn.
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Affiliation(s)
| | | | | | | | - Robert Gaspar
- Robert Gaspar, Eotvos Street 6., Szeged, H-6720, Hungary,
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Lundqvist A, Sandström H, Bäckström T. The relationship between weight gain during pregnancy and allopregnanolone levels: a longitudinal study. Endocr Connect 2017; 6:253-259. [PMID: 28381564 PMCID: PMC5632720 DOI: 10.1530/ec-17-0046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Large weight gain during pregnancy is a risk factor for complications for mother and fetus. Hunger and satiety are regulated in the hypothalamus, where the gamma-amino-butyric acid system (GABA) has an important role. Allopregnanolone, a progesterone metabolite, increases during pregnancy and is a potent GABA-A receptor modulating steroid. Allopregnanolone has been shown to induce overeating in rodents. The aim was to investigate whether there is a relationship between weight gain and allopregnanolone concentrations during pregnancy in humans. DESIGN A longitudinal, cohort study. METHODS Pregnant women (n = 56) were recruited in primary care in northern Sweden. Allopregnanolone concentrations in plasma were measured using radioimmunoassay and weight was measured in gestational weeks 12 and 35. RESULTS Weight increase correlated significantly to allopregnanolone in late pregnancy increase (rs = 0.320; P = 0.016), indicating a positive relationship between weight increase and allopregnanolone increase. A positive relationship was also noted between allopregnanolone in the 35th gestational week and weight increase. Women who gained ≥11 kg during pregnancy showed higher allopregnanolone concentrations in week 35 and higher increase compared to women who increased <11 kg (P = 0.006 and P = 0.009 resp.). There was no difference in weight or allopregnanolone concentrations at the onset of pregnancy. CONCLUSIONS The results show a relationship between weight gain during pregnancy and increase in allopregnanolone concentrations.
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Affiliation(s)
- Anette Lundqvist
- Department of Public Health and Clinical MedicineFamily Medicine, Umeå University, Umeå, Sweden
| | - Herbert Sandström
- Department of Public Health and Clinical MedicineFamily Medicine, Umeå University, Umeå, Sweden
| | - Torbjörn Bäckström
- Department of Clinical SciencesObstetrics and Gynecology, Umeå University, Umeå, Sweden
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Jansen A, Lyche JL, Polder A, Aaseth J, Skaug MA. Increased blood levels of persistent organic pollutants (POP) in obese individuals after weight loss-A review. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2017; 20:22-37. [PMID: 28051929 DOI: 10.1080/10937404.2016.1246391] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Lipophilic persistent organic pollutants (POP) are stored in adipose tissue. Following rapid weight loss such as when induced by bariatric surgery, an increased release of potential harmful lipophilic compounds into the blood circulation may occur. Weight reduction is recommended for overweight and obese individuals in order to decrease risk of weight-related health problems. However, in cases of significant weight reduction POP become mobilized chemicals and consequently may adversely affect health, including endocrine disruption. The objective of the present investigation was to estimate quantitatively the level of mobilization of POP following weight loss over time. According to literature search criteria, 17 studies were identified with 2061 participants. Data from 5 of the studies with 270 participants were used to assess the change in blood levels of POP in percent per kilogram weight loss. Weight loss in the included studies varied from 4.4 to 64.8 kg. In all studies, the majority of POP concentrations in blood were found to rise following weight reduction. Blood concentrations following weight reduction were elevated by 2-4% per kilogram weight loss for most POP examined. The increased POP levels were still elevated 12 mo after intervention. Most research in this field, including animal studies, is carried out on a single compound or group of selected compounds, not taking the "cocktail effect" into consideration. This does not reflect the true range of POP to which humans are actually exposed. Few chronic investigations have been published and, in particular, few studies were available that compared the increase in POP concentrations with clinical consequences as individuals lost weight. These limitations call for caution in interpreting results. The benefits of losing weight still far outweigh the potential adverse health risks. However, further studies are recommended to determine the clinical significance of increased blood levels of POPs following rapid and excessive weight loss, particularly for women attending weight reduction treatment before pregnancy.
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Affiliation(s)
- Aina Jansen
- a Center for Morbid Obesity , Department of Surgery, Innlandet Hospital Trust , Gjøvik , Norway
- b Department of Food Safety and Infection Biology , Norwegian University of Life Sciences (NMBU) , Campus Adamstuen, Oslo , Norway
| | - Jan L Lyche
- b Department of Food Safety and Infection Biology , Norwegian University of Life Sciences (NMBU) , Campus Adamstuen, Oslo , Norway
| | - Anuschka Polder
- b Department of Food Safety and Infection Biology , Norwegian University of Life Sciences (NMBU) , Campus Adamstuen, Oslo , Norway
| | - Jan Aaseth
- c Innlandet Hospital Trust , Kongsvinger Hospital Division , Kongsvinger , Norway
- d Faculty of Public Health , Hedmark University of Applied Sciences , Elverum , Norway
| | - Marit Aralt Skaug
- d Faculty of Public Health , Hedmark University of Applied Sciences , Elverum , Norway
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Ramö Isgren A, Kjølhede P, Blomberg M. Obstetric Outcomes in Adolescents Related to Body Mass Index and Compared with Low-Risk Adult Women. J Womens Health (Larchmt) 2016; 26:426-434. [PMID: 27992292 DOI: 10.1089/jwh.2016.5938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate in adolescents the association between body mass index (BMI) and obstetric outcomes and to determine whether the outcomes in the BMI groups of adolescents differ from those of a low-risk population of adult women. MATERIALS AND METHODS This is a nationwide population-based register study. Obstetric outcomes of 31,386 singleton primiparous adolescents were evaluated in relation to BMI classes. Furthermore, the outcomes of the adolescents and 178,844 normal weight, nonsmoking, singleton primiparous women, 25-29 years old with no known comorbidity, defined as standard women, were compared. Multiple logistic regression models were used. Results are presented as crude odds ratios (ORs) or adjusted ORs and with a 95% confidence interval. RESULTS Compared with normal weight adolescents, obese adolescents had a lower chance of a normal vaginal delivery (VD)-76% versus 85% [adjusted OR 0.61 (0.55-0.68)], a higher risk for acute cesarean section (CS)-8.9% versus 4.5% [adjusted OR 2.45 (2.08-2.88)], and stillbirth-0.7% versus 0.2% [adjusted OR 3.17 (1.74-5.77)]. Compared with standard women, overweight adolescents had a higher chance of a normal VD-82% versus 75% [crude OR 1.53 (1.44-1.64)] and a lower risk for acute CS-6.3% versus 7.1% [crude OR 0.85 (0.76-0.95)]. Obese adolescents had a lower risk for instrumental VD-8% versus 13% [crude OR 0.61 (0.53-0.71)] and obstetric anal sphincter injury-1% versus 3% [crude OR 0.38 (0.26-0.57)]. CONCLUSION Several adverse obstetric outcomes were obesity related among adolescents. Overweight adolescents seemed to have better obstetric outcomes than standard women, something to consider when optimizing resources for women during pregnancy and delivery.
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Affiliation(s)
- Anna Ramö Isgren
- 1 Department of Obstetrics and Gynecology, Linköping University , Linköping, Sweden .,2 Department of Clinical and Experimental Medicine, Linköping University , Linköping, Sweden
| | - Preben Kjølhede
- 1 Department of Obstetrics and Gynecology, Linköping University , Linköping, Sweden .,2 Department of Clinical and Experimental Medicine, Linköping University , Linköping, Sweden
| | - Marie Blomberg
- 1 Department of Obstetrics and Gynecology, Linköping University , Linköping, Sweden .,2 Department of Clinical and Experimental Medicine, Linköping University , Linköping, Sweden
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Neal RE, Chen J, Webb C, Stocke K, Gambrell C, Greene RM, Pisano MM. Developmental cigarette smoke exposure II: Hepatic proteome profiles in 6 month old adult offspring. Reprod Toxicol 2016; 65:414-424. [PMID: 27319396 DOI: 10.1016/j.reprotox.2016.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 06/10/2016] [Accepted: 06/14/2016] [Indexed: 01/22/2023]
Abstract
Utilizing a mouse model of 'active' developmental cigarette smoke exposure (CSE) [gestational day (GD) 1 through postnatal day (PD) 21] characterized by offspring low birth weight, the impact of developmental CSE on liver proteome profiles of adult offspring at 6 months of age was determined. Liver tissue was collected from Sham- and CSE-offspring for 2D-SDS-PAGE based proteome analysis with Partial Least Squares-Discriminant Analysis (PLS-DA). A similar study conducted at the cessation of exposure to cigarette smoke documented decreased gluconeogenesis coupled to oxidative stress in weanling offspring. In the current study, exposure throughout development to cigarette smoke resulted in impaired hepatic carbohydrate metabolism, decreased serum glucose levels, and increased gluconeogenic regulatory enzyme abundances during the fed-state coupled to decreased expression of SIRT1 as well as increased PEPCK and PGC1α expression. Together these findings indicate inappropriately timed gluconeogenesis that may reflect impaired insulin signaling in mature offspring exposed to 'active' developmental CSE.
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Affiliation(s)
- Rachel E Neal
- Department of Environmental and Occupational Health Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, United States; Birth Defects Center, University of Louisville, Louisville, KY, United States.
| | - Jing Chen
- Department of Environmental and Occupational Health Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, United States
| | - Cindy Webb
- Department of Molecular, Cellular, and Craniofacial Biology, ULSD, University of Louisville, Louisville, KY, United States
| | - Kendall Stocke
- Department of Environmental and Occupational Health Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, United States
| | - Caitlin Gambrell
- Department of Environmental and Occupational Health Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, United States
| | - Robert M Greene
- Department of Molecular, Cellular, and Craniofacial Biology, ULSD, University of Louisville, Louisville, KY, United States; Birth Defects Center, University of Louisville, Louisville, KY, United States
| | - M Michele Pisano
- Department of Molecular, Cellular, and Craniofacial Biology, ULSD, University of Louisville, Louisville, KY, United States; Birth Defects Center, University of Louisville, Louisville, KY, United States
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Mercury as a possible link between maternal obesity and autism spectrum disorder. Med Hypotheses 2016; 91:90-94. [DOI: 10.1016/j.mehy.2016.04.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/08/2016] [Accepted: 04/13/2016] [Indexed: 01/05/2023]
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Li L, Xu J, Zhu W, Fan R, Bai Q, Huang C, Liu J, Li Z, Sederholm M, Norstedt G, Wang J. Effect of a macronutrient preload on blood glucose level and pregnancy outcome in gestational diabetes. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2016; 5:36-41. [PMID: 29067233 PMCID: PMC5644440 DOI: 10.1016/j.jcte.2016.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/21/2016] [Accepted: 04/08/2016] [Indexed: 01/14/2023]
Abstract
Gestational diabetes (GDM) is associated with risks for both the mother and the child. A food composition, macro-nutrient preload, was given half an hour before each meal. Thirty-three GDM patients were given macro-nutrient preload and 33 a control comparator. A two-month macro-nutrient preload treatment of GDM improved post-prandial glycemia. Macro-nutrient preload treatment is of a potential value for future management of GDM.
Aim To investigate the effect of a macro-nutrient preload (Inzone Vitality) on blood glucose levels and pregnancy outcomes of gestational diabetes. The preload method involves the ingestion of a smaller amount of a macronutrient composition half an hour before regular meals. The hypothesis was that preload treatment will reduce postprandial glycemia in gestational diabetes. Methods Sixty-six diagnosed cases of gestational diabetes were randomly selected from gynecology and obstetrics outpatient clinic at Xinqiao Hospital in Chongqing. The patients were divided into an intervention group (33 cases) and a control group (33 cases), according to odd–even numbers of the random cases. The intervention group was treated with a macro-nutrient preload given 0.5 h before regular meals and the control group was given a comparative treatment consisting of a milk powder with similar energy content. The two groups were studied until delivery and the measured parameters included fasting blood glucose (FBG), 2-hour postprandial blood glucose (2h-PBG), delivery mode and neonatal birth weight. Results The two groups showed no differences in FBG or 2h-PBG before the nutritional intervention. FBG and 2h-PBG after intervention and before delivery were significantly lower in the intervention group, treated with the macro nutrient preload compared to the control group (P < 0.01). Changes in FBG and 2h-PBG before and after the intervention were investigated and the difference in the intervention group was significantly greater than corresponding values in the control group (P < 0.05, P < 0.01). The neonatal birth weight and delivery mode was not significantly different (P > 0.05). Conclusion A macro-nutrient composition, used as a preload, is effective in controlling FBG and PBG of gestational diabetes.
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Affiliation(s)
- Li Li
- Department of Nutrition, Xinqiao Hospital, Chongqing 400037, China
| | - Jing Xu
- Department of Endocrinology, Xinqiao Hospital, Chongqing 400037, China
| | - Wenyi Zhu
- Department of Nutrition, Xinqiao Hospital, Chongqing 400037, China
| | - Rong Fan
- Department of Nutrition, Xinqiao Hospital, Chongqing 400037, China
| | - Qian Bai
- Department of Nutrition, Xinqiao Hospital, Chongqing 400037, China
| | - Chen Huang
- Department of Nutrition, Xinqiao Hospital, Chongqing 400037, China
| | - Jun Liu
- Department of Nutrition, Xinqiao Hospital, Chongqing 400037, China
| | - Zhen Li
- Department of Obstetrics and Gynecology, Xinqiao Hospital, Chongqing 400037, China
| | - Magnus Sederholm
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Norstedt
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Jian Wang
- Department of Nutrition, Xinqiao Hospital, Chongqing 400037, China
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Abstract
Young adults are gaining weight faster than any age group. This weight gain and the appearance of obesity-related comorbidities often commence in adolescence. Psychosocial distress and mental health issues are common and debilitating, and treatment approaches are likely to be similar to those for adolescents. At the same time, young adults may have physical morbidities which will continue and worsen throughout adulthood, such as hypertension, diabetes and polycystic ovarian syndrome. Health consequences of obesity are challenging to manage in young adults as their symptoms may be minimal, they are less likely to engage with healthcare due to other life priorities and their neurocognitive developmental stage makes therapy adherence difficult. Clinicians who manage young adults with obesity need to be aware of these age-specific challenges, as well as the sexual and reproductive health concerns that are present in this age group.
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Affiliation(s)
- Hoi Lun Cheng
- Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW, 2145, Australia
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Cnr Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Sharon Medlow
- Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW, 2145, Australia
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Cnr Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Katharine Steinbeck
- Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW, 2145, Australia.
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Cnr Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW, 2145, Australia.
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8. References. Int J Gynaecol Obstet 2015. [DOI: 10.1016/s0020-7292(15)30032-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Wei YM, Yang HX, Zhu WW, Liu XY, Meng WY, Wang YQ, Shang LX, Cai ZY, Ji LP, Wang YF, Sun Y, Liu JX, Wei L, Sun YF, Zhang XY, Luo TX, Chen HX, Yu LJ. Risk of adverse pregnancy outcomes stratified for pre-pregnancy body mass index. J Matern Fetal Neonatal Med 2015; 29:2205-9. [PMID: 26427602 DOI: 10.3109/14767058.2015.1081167] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Yu-Mei Wei
- Peking University First Hospital, Beijing, China
| | - Hui-Xia Yang
- Peking University First Hospital, Beijing, China
| | - Wei-Wei Zhu
- Peking University First Hospital, Beijing, China
| | - Xin-Yue Liu
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, FL, USA
| | - Wen-Ying Meng
- Tongzhou Maternal and Child Health Hospital of Beijing, Beijing, China
| | | | - Li-Xin Shang
- General Hospital of Beijing Military Region, Beijing, China
| | - Zhen-Yu Cai
- Center Hospital of Aviation Industry, Beijing, China
| | - Li-Ping Ji
- Pinggu Maternal and Child Health Hospital of Beijing, Beijing, China
| | | | - Ying Sun
- Navy General Hospital, Beijing, China
| | - Jia-Xiu Liu
- Beijing Daxing District Hongxing Hospital, Beijing, China
| | - Li Wei
- Beijing Chui Yang Liu Hospital, Beijing, China
| | - Yu-Feng Sun
- Peking University Shougang Hospital, Beijing, China
| | - Xue-Ying Zhang
- Combined with Traditional Chinese and Western Medicine Hospital of Beijing City, Beijing, China
| | | | - Hai-Xia Chen
- Beijing Changping Hospital of Traditional Chinese Medicine, Beijing, China, and
| | - Li-Jun Yu
- General Hospital of Jingmei Group, Beijing, China
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Goldman KN, Hodes-Wertz B, McCulloh DH, Flom JD, Grifo JA. Association of body mass index with embryonic aneuploidy. Fertil Steril 2015; 103:744-8. [DOI: 10.1016/j.fertnstert.2014.11.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/21/2014] [Accepted: 11/21/2014] [Indexed: 10/24/2022]
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Todd AS, Street SJ, Ziviani J, Byrne NM, Hills AP. Overweight and obese adolescent girls: the importance of promoting sensible eating and activity behaviors from the start of the adolescent period. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:2306-29. [PMID: 25690003 PMCID: PMC4344727 DOI: 10.3390/ijerph120202306] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/04/2014] [Accepted: 02/09/2015] [Indexed: 12/30/2022]
Abstract
The adolescent period is associated with changes in eating and activity behaviors in girls. Less reliance on parental provision and choice of food, coupled with a decrease in participation in physical activity and sport, can create an energy imbalance, predisposing to weight gain. Physiological alterations to body composition, reduction in insulin sensitivity, and psychological adjustments may further amplify the risk of becoming overweight and maintaining an unhealthy level of body fat into childbearing years. During pregnancy excess body fat is a risk factor for poor pregnancy outcomes and may predispose an infant to a lifelong heightened risk of being overweight and developing chronic disease. Interventions aimed at preventing the accumulation of body fat in adolescent girls and young women may have far reaching impact and be critically important in reducing intergenerational weight gain. Lifestyle interventions in adolescence have the potential to modify adult obesity risk by switching at-risk individuals from a high to lower obesity risk trajectory. This paper discusses multiple approaches to assist at-risk individuals reduce obesity risk. A key focus is placed on engagement in food preparation and choice, and opportunities for physical activity and sport. Support, education, and opportunity at home and at school, are often associated with the success of lifestyle interventions, and may enable adolescents to make positive choices, and engage in health promoting behaviors during adolescence and childbearing years.
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Affiliation(s)
- Alwyn S Todd
- Centre for Nutrition and Exercise, Mater Research Institute, The University of Queensland, Brisbane 4101, Australia.
- Department of Nutrition and Dietetics, Mater Health Services, Brisbane 4101, Australia.
- School of Allied Health Sciences, Griffith University, Gold Coast 4215, Australia.
| | - Steven J Street
- Centre for Nutrition and Exercise, Mater Research Institute, The University of Queensland, Brisbane 4101, Australia.
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast 4226, Australia.
| | - Jenny Ziviani
- Children's Health Queensland, Queensland Health, Brisbane 4000, Australia.
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4067, Australia.
| | - Nuala M Byrne
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast 4226, Australia.
- Bond Institute of Health and Sport, Bond University, Gold Coast 4226, Australia.
| | - Andrew P Hills
- Centre for Nutrition and Exercise, Mater Research Institute, The University of Queensland, Brisbane 4101, Australia.
- School of Allied Health Sciences, Griffith University, Gold Coast 4215, Australia.
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Triunfo S, Lanzone A. Impact of maternal under nutrition on obstetric outcomes. J Endocrinol Invest 2015; 38:31-8. [PMID: 25194427 DOI: 10.1007/s40618-014-0168-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 08/20/2014] [Indexed: 01/08/2023]
Abstract
Maternal malnutrition, ranging from under nutrition to over dietary intake before and in the pregnant state, is worldwide problem with significant consequences, not only for survival and increased risk for acute and chronic diseases both in mother and child, but also for economic productivity of individuals in the societies and additional costs on health system. Inter alia, pre-pregnancy underweight and insufficient gestational weight gain are considered as individual risk factors for the occurrence of spontaneous interruption, preterm birth, fetal growth restriction, and hypertensive disorders, strongly associated with poorer perinatal outcome. In a portion of this population, major eating disorders (anorexia and bulimia nervosa), once thought to be rare, but nowadays enlarged due to cultural pressure on the drive for thinness, have been identified as the etiology of an abnormal nutritional condition in developed countries, in contrast to long standing food deprivation in developing countries. Actually, even if without a complete weight management guidance for these selected pregnant women, an appropriate weight gain is recommended during pregnancy. Mainly, therapeutic approach is prevention using specific programs of improving weight before pregnant status. In this article, a review of the literature on selected obstetrical risks associated with maternal underweight has been performed and both the target prevention and management strategies have been described.
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Affiliation(s)
- S Triunfo
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), University of Barcelona, Sabino de Arana, 1, 08028, Barcelona, Spain.
| | - A Lanzone
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
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Gohir W, Ratcliffe EM, Sloboda DM. Of the bugs that shape us: maternal obesity, the gut microbiome, and long-term disease risk. Pediatr Res 2015; 77:196-204. [PMID: 25314580 DOI: 10.1038/pr.2014.169] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 09/15/2014] [Indexed: 01/06/2023]
Abstract
Chronic disease risk is inextricably linked to our early-life environment, where maternal, fetal, and childhood factors predict disease risk later in life. Currently, maternal obesity is a key predictor of childhood obesity and metabolic complications in adulthood. Although the mechanisms are unclear, new and emerging evidence points to our microbiome, where the bacterial composition of the gut modulates the weight gain and altered metabolism that drives obesity. Over the course of pregnancy, maternal bacterial load increases, and gut bacterial diversity changes and is influenced by pre-pregnancy- and pregnancy-related obesity. Alterations in the bacterial composition of the mother have been shown to affect the development and function of the gastrointestinal tract of her offspring. How these microbial shifts influence the maternal-fetal-infant relationship is a topic of hot debate. This paper will review the evidence linking nutrition, maternal obesity, the maternal gut microbiome, and fetal gut development, bringing together clinical observations in humans and experimental data from targeted animal models.
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Affiliation(s)
- Wajiha Gohir
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada
| | | | - Deborah M Sloboda
- 1] Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada [2] Department of Pediatrics, McMaster University, Hamilton, Canada [3] Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
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Sáez PJ, Villalobos-Labra R, Westermeier F, Sobrevia L, Farías-Jofré M. Modulation of endothelial cell migration by ER stress and insulin resistance: a role during maternal obesity? Front Pharmacol 2014; 5:189. [PMID: 25191269 PMCID: PMC4137259 DOI: 10.3389/fphar.2014.00189] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 07/24/2014] [Indexed: 12/15/2022] Open
Abstract
Adverse microenvironmental stimuli can trigger the endoplasmic reticulum (ER) stress pathway, which initiates the unfolded protein response (UPR), to restore protein-folding homeostasis. Several studies show induction of ER stress during obesity. Chronic UPR has been linked to different mechanisms of disease in obese and diabetic individuals, including insulin resistance (IR) and impaired angiogenesis. Endothelial cell (EC) migration is an initial step for angiogenesis, which is associated with remodeling of existing blood vessels. EC migration occurs according to the leader–follower model, involving coordinated processes of chemotaxis, haptotaxis, and mechanotaxis. Thus, a fine-tuning of EC migration is necessary to provide the right timing to form the required vessels during angiogenesis. ER stress modulates EC migration at different levels, usually impairing migration and angiogenesis, although different effects may be observed depending on the tissue and/or microenvironment. In the context of pregnancy, maternal obesity (MO) induces IR in the offspring. Interestingly, several proteins associated with obesity-induced IR are also involved in EC migration, providing a potential link with the ER stress-dependent alterations observed in obese individuals. Different signaling cascades that converge on cytoskeleton regulation directly impact EC migration, including the Akt and/or RhoA pathways. In addition, ER is the main intracellular reservoir for Ca2+, which plays a pivotal role during EC migration. Therefore, ER stress-related alterations in Ca2+ signaling or Ca2+ levels might also produce distorted EC migration. However, the above findings have been studied in the context of adult obesity, and no information has been reported regarding the effect of MO on fetal EC migration. Here we summarize the state of knowledge about the possible mechanisms by which ER stress and IR might impact EC migration and angiogenesis in fetal endothelium exposed to MO during pregnancy.
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Affiliation(s)
- Pablo J Sáez
- Cellular and Molecular Physiology Laboratory, Division of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile Santiago, Chile
| | - Roberto Villalobos-Labra
- Cellular and Molecular Physiology Laboratory, Division of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile Santiago, Chile
| | - Francisco Westermeier
- Cellular and Molecular Physiology Laboratory, Division of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile Santiago, Chile ; Facultad de Ciencia, Universidad San Sebastián Santiago, Chile ; Advanced Center for Chronic Diseases, Faculty of Chemical and Pharmaceutical Sciences and Faculty of Medicine, University of Chile Santiago, Chile
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory, Division of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile Santiago, Chile ; University of Queensland Centre for Clinical Research, Faculty of Medicine and Biomedical Sciences, University of Queensland Herston, QL, Australia ; Faculty of Pharmacy, Universidad de Sevilla Sevilla, Spain
| | - Marcelo Farías-Jofré
- Cellular and Molecular Physiology Laboratory, Division of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile Santiago, Chile
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43
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Programming of fetal insulin resistance in pregnancies with maternal obesity by ER stress and inflammation. BIOMED RESEARCH INTERNATIONAL 2014; 2014:917672. [PMID: 25093191 PMCID: PMC4100392 DOI: 10.1155/2014/917672] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 06/04/2014] [Indexed: 01/01/2023]
Abstract
The global epidemics of obesity during pregnancy and excessive gestational weight gain (GWG) are major public health problems worldwide. Obesity and excessive GWG are related to several maternal and fetal complications, including diabetes (pregestational and gestational diabetes) and intrauterine programming of insulin resistance (IR). Maternal obesity (MO) and neonatal IR are associated with long-term development of obesity, diabetes mellitus, and increased global cardiovascular risk in the offspring. Multiple mechanisms of insulin signaling pathway impairment have been described in obese individuals, involving complex interactions of chronically elevated inflammatory mediators, adipokines, and the critical role of the endoplasmic reticulum (ER) stress-dependent unfolded protein response (UPR). However, the underlying cellular processes linking MO and IR in the offspring have not been fully elucidated. Here, we summarize the state-of-the-art evidence supporting the possibility that adverse metabolic postnatal outcomes such as IR in the offspring of pregnancies with MO and/or excessive GWG may be related to intrauterine activation of ER stress response.
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Togher KL, Togher KL, O'Keeffe MM, O'Keeffe MM, Khashan AS, Khashan AS, Gutierrez H, Gutierrez H, Kenny LC, Kenny LC, O'Keeffe GW, O'Keeffe GW. Epigenetic regulation of the placental HSD11B2 barrier and its role as a critical regulator of fetal development. Epigenetics 2014; 9:816-22. [PMID: 24717516 DOI: 10.4161/epi.28703] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
"Fetal programming" is a term used to describe how early-life experience influences fetal development and later disease risk. In humans, prenatal stress-induced fetal programming is associated with increased risk of preterm birth, and a heightened risk of metabolic and neurological diseases later in life. A critical determinant of this is the regulation of fetal exposure to glucocorticoids by the placenta. Glucocorticoids are the mediators through which maternal stress influences fetal development. Excessive fetal glucocorticoid exposure during pregnancy results in low birth weight and abnormalities in a number of tissues. The amount of fetal exposure to maternal glucocorticoids depends on the expression of HSD11B2, an enzyme predominantly produced by the syncytiotrophoblast in the placenta. This protects the fetus by converting active glucocorticoids into inactive forms. In this review we examine recent findings regarding placental HSD11B2 that suggest that its epigenetic regulation may mechanistically link maternal stress and long-term health consequences in affected offspring.
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Affiliation(s)
- Katie L Togher
- Irish Centre for Fetal and Neonatal Translational Research (INFANT); Cork University Maternity Hospital; Cork, Ireland; Department of Obstetrics and Gynaecology; Cork University Maternity Hospital; Cork, Ireland; Department of Anatomy and Neuroscience; Biosciences Institute; University College Cork; Cork, Ireland
| | - Katie L Togher
- Irish Centre for Fetal and Neonatal Translational Research (INFANT); Cork University Maternity Hospital; Cork, Ireland; Department of Obstetrics and Gynaecology; Cork University Maternity Hospital; Cork, Ireland; Department of Anatomy and Neuroscience; Biosciences Institute; University College Cork; Cork, Ireland
| | - Majella M O'Keeffe
- Department of Nutrition and Dietetics; School of Medicine; Kings College London; London, UK
| | - Majella M O'Keeffe
- Department of Nutrition and Dietetics; School of Medicine; Kings College London; London, UK
| | - Ali S Khashan
- Irish Centre for Fetal and Neonatal Translational Research (INFANT); Cork University Maternity Hospital; Cork, Ireland; Department of Obstetrics and Gynaecology; Cork University Maternity Hospital; Cork, Ireland
| | - Ali S Khashan
- Irish Centre for Fetal and Neonatal Translational Research (INFANT); Cork University Maternity Hospital; Cork, Ireland; Department of Obstetrics and Gynaecology; Cork University Maternity Hospital; Cork, Ireland
| | | | | | - Louise C Kenny
- Irish Centre for Fetal and Neonatal Translational Research (INFANT); Cork University Maternity Hospital; Cork, Ireland; Department of Obstetrics and Gynaecology; Cork University Maternity Hospital; Cork, Ireland
| | - Louise C Kenny
- Irish Centre for Fetal and Neonatal Translational Research (INFANT); Cork University Maternity Hospital; Cork, Ireland; Department of Obstetrics and Gynaecology; Cork University Maternity Hospital; Cork, Ireland
| | - Gerard W O'Keeffe
- Irish Centre for Fetal and Neonatal Translational Research (INFANT); Cork University Maternity Hospital; Cork, Ireland; Department of Anatomy and Neuroscience; Biosciences Institute; University College Cork; Cork, Ireland
| | - Gerard W O'Keeffe
- Irish Centre for Fetal and Neonatal Translational Research (INFANT); Cork University Maternity Hospital; Cork, Ireland; Department of Anatomy and Neuroscience; Biosciences Institute; University College Cork; Cork, Ireland
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