Grossesse des patientes obèses: quels risques faut-il craindre?

Study of the Prevalence of Obesity and Its Association with Maternal and Neonatal Characteristics and Morbidity Profile in a Population of Moroccan Pregnant Women

Obesity is a real public health problem whose prevalence continues to increase throughout the world. It affects all age groups and does not spare pregnant women. This work aims to determine the prevalence of obesity and to study its association with maternal and neonatal characteristics and the morbidity profile of pregnancy. This is a descriptive and cross-sectional study carried out in the maternity ward of the prefectural hospital center called "Sidi Lahcen" in Témara, Morocco, over a 12-month period. Maternal and neonatal data are collected through a preestablished questionnaire, and anthropometric parameters were recorded. 390 participants, aged between 18 and 43 years, were included in this study, with a prevalence of overweight and obesity of 34.9% and 41%, respectively. Correlation results revealed that the prevalence of overweight and obesity was significantly elevated in women over 25 years (p < 0.001). The rate of caesarean section was four times higher in obese women compared to women of normal weight (53.8% versus 12.8%; p=0.018). The over-term was significantly high in the obese group compared to the nonobese group (33.8% versus 20.2%; p=0.013). A statistically significant positive correlation was found between gestational body mass index and newborn birth weight (r = 0.29; p < 0.001) as well as a high prevalence of macrosomia in newborns of comparatively obese women compared to newborns of nonobese women (17.6% versus 9.6%; p=0.041). The correlation analysis with the morbidity profile showed a significantly high preponderance of gestational diabetes, anemia, and toxemia of pregnancy in the obese group compared to the normal group (p < 0.001). This study clearly demonstrated that obesity during pregnancy is associated with higher risks of maternal and neonatal complications, the management of which places a burden on the health system as well as families. These data reinforce the need to improve antenatal care for the prevention of obesity and its preventable complications.

The Influence of Maternal Obesity on Pregnancy Complications and Neonatal Outcomes in Diabetic and Nondiabetic Women

Introduction

This study aimed to investigate the influence of obesity on pregnancy complications and neonatal outcomes in diabetic and nondiabetic women.

Materials and Methods

This retrospective case control study was conducted on 1193 pregnant women and their neonates at a tertiary level maternity hospital between March 2007 and 2011. The pregnant women were classified into 2 groups according to the presence of diabetes mellitus. Six hundred and seven patients with gestational diabetes or pregestational diabetes formed the diabetic group (study group) and 586 patients were in the nondiabetic group (control group). Demographic characteristics, body mass index, gestational weight gain, obstetric history, smoking status, type of delivery, gestational ages, pregnancy complications, neonatal outcomes were recorded for each patient. Multivariable logistic regression analysis was performed to evaluate the effect of obesity and diabetes on the pregnancy complications and neonatal outcomes.

Results

The mean age and pre-pregnancy body mass indices of women with diabetes mellitus were significantly higher than the control groupʼs (p < 0.001). Gestational weight gain and number of smokers were similar among the groups. Multiparity and obesity were more prevalent in the diabetic group compared to controls (both p < 0.001). Although gestational age at birth was earlier in the diabetic group, birth weights were higher in this group than in the control group (both p < 0.001). Cesarean delivery rates, the incidence of macrosomia, and neonatal intensive care unit admission rates were significantly higher in the diabetes group both with normal and increased body mass index (all p < 0.001). However, adverse pregnancy outcomes were comparable between the groups (p = 0.279). Multivariable logistic regression analysis showed that obesity is a significant risk factor for pregnancy complications (OR = 1.772 [95% CI, 1.283 – 2.449], p = 0.001) but not for adverse neonatal outcomes (OR = 1.068 [95% CI, 0.683 – 1.669], p = 0.773).

Conclusion

While obesity increases risk of developing a pregnancy complication, diabetes worsens neonatal outcomes.

[Double-balloon catheter compared to vaginal dinoprostone for cervical ripening in obese women at term]

OBJECTIVE

To compare the efficacy of a double-balloon catheter versus vaginal prostaglandin E2 (dinoprostone) for cervical ripening in obese patients with unfavorable cervix at term.

METHODS

The study had an open-label, prospective combined with retrospective, observational design. From January 2013 until May 2016, a prospective cohort study of 46 women with pre-pregnancy BMI>30kg/m², live singleton term fetuses (>37 weeks) in vertex presentation and unfavorable cervix (Bishop score<6), who underwent labor induction for conventional indications using a double-balloon catheter. In the same period, 46 obese women who had undergone cervical ripening using vaginal dinoprostone (3mg) were retrospectively included. Women in groups were paired according to Bishop score before the insertion, pre-pregnancy BMI and parity. The primary outcome was a favorable cervix (Bishop score ≥6) 24h after cervical ripening.

RESULTS

After 24h, there was a significantly higher rate of women with favorable cervix (Bishop score ≥6) in the double-balloon group than in dinoprostone group (80.4% vs 47.8%; P=0.001). After adjustment, a double-balloon catheter was significantly associated with an efficient cervical ripening compared to vaginal dinoprostone (aOR 7.81, 95% CI 2.58-23.60). No difference was observed in cesarean section rate (39.1% in each group; P=0.96) and in mean induction time to vaginal delivery (34.5h in the balloon group vs 36.5h in the dinoprostone group; P=0.53). Maternal and neonatal outcomes were similar.

CONCLUSION

For obese patients at term, cervical ripening using a double-balloon catheter is more efficient on Bishop score after 24h compared to vaginal dinoprostone.

Body mass index, gestational weight gain, and obstetric complications in Moroccan population

OBJECTIVES

To evaluate the impact of the body mass index (BMI) before pregnancy and the weight gain during pregnancy, on the occurrence of maternal and neonatal morbidity in the Moroccan population, as well as to analyze the quality of the weight gain depending on the BMI.

METHODS

A study was carried out over a period of one year from October 1, 2010 to October 1, 2011, using data collected from a descriptive-transversal study. We recruited nondiabetic women without several HTAs, delivering singletons from 37 completed weeks up to 42 weeks gestation.

RESULTS

Total of 1408 were analyzed. The risks of moderate hypertension, macrosomia, dystocia, and resort to cesarean section were higher among overweight or obese women, as well as among women whose weight gain was >16 kg. The differences were significant <0.05.

CONCLUSION

This study demonstrates that overweight women before pregnancy and weight gain during pregnancy are associated with higher risks of maternal and neonatal complications. These data provide ideas on prevention opportunities.

[Intrauterine fetal death in a woman with a gastric banding]

Obesity defined by a Body Mass Index (BMI) over 30 is a major public health problem. Its correction may require surgical treatment in case of failure of adequate medical care. A pregnancy achieved in the aftermath of this surgery must be planned and monitored as a high-risk pregnancy, in fact it can complicate. We report here the occurrence of fetal death in a patient with a gastric banding.

Maternal obesity, gestational hypertension, and preterm delivery

OBJECTIVE

To study maternal obesity as a risk factor for preterm delivery.

METHODS

Maine State Birth Records Database from 1996 through 2006 was evaluated to investigate obese pregnant women compared with normal weight women regarding risk for preterm delivery. Multiple risk factors and outcomes were studied in univariable and multivariable models.

RESULTS

Among 58,112 pregnant women, 8% (n = 4653) gave birth to preterm infants. Univariable analyses revealed a relationship between obesity and increased risk of prematurity. In multivariable regressions, the most important intermediate variable appears to be gestational hypertension/preeclampsia.

CONCLUSIONS

As maternal body mass index increases in pregnancy, the risk of preterm delivery and other maternal complications increases. The obesity-prematurity relationship is complex, with hypertensive disorders of pregnancy playing a crucial role. More detailed analyses of causal pathways are warranted.

The effect of maternal obesity on the course of labor

AIM

To determine whether maternal obesity is associated with dysfunctional labor patterns.

METHODS

In a case-control design we compared the graphic labor patterns of a group of 105 very obese subjects [body mass index (BMI) >35 kg/m(2)] with those of 113 lean controls (BMI<26 kg/m(2)). All entered spontaneous labor at term. Cases with birth weights >4 kg, diabetes mellitus, hypertension and prior cesarean delivery were excluded.

RESULTS

The obese group had a significantly higher frequency of arrest of dilatation (17.6 vs. 5.2%; P=0.005).

CONCLUSIONS

Maternal obesity is associated with active phase labor dysfunction, specifically arrest of dilatation.

Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis

The objective of this study is to assess and quantify the risk for gestational diabetes mellitus (GDM) according to prepregnancy maternal body mass index (BMI). The design is a systematic review of observational studies published in the last 30 years. Four electronic databases were searched for publications (1977-2007). BMI was elected as the only measure of obesity, and all diagnostic criteria for GDM were accepted. Studies with selective screening for GDM were excluded. There were no language restrictions. The methodological quality of primary studies was assessed. Some 1745 citations were screened, and 70 studies (two unpublished) involving 671 945 women were included (59 cohorts and 11 case-controls). Most studies were of high or medium quality. Compared with women with a normal BMI, the unadjusted pooled odds ratio (OR) of an underweight woman developing GDM was 0.75 (95% confidence interval [CI] 0.69 to 0.82). The OR for overweight, moderately obese and morbidly obese women were 1.97 (95% CI 1.77 to 2.19), 3.01 (95% CI 2.34 to 3.87) and 5.55 (95% CI 4.27 to 7.21) respectively. For every 1 kg m(-2) increase in BMI, the prevalence of GDM increased by 0.92% (95% CI 0.73 to 1.10). The risk of GDM is positively associated with prepregnancy BMI. This information is important when counselling women planning a pregnancy.

Anneau gastrique et grossesse

Laparoscopic adjustable gastric banding and pregnancy.

OBJECTIVES

We intend to understand the interactions between pregnancy and laparoscopic adjustable gastric banding in order to ensure better care for patients.

MATERIALS AND METHOD

We undertake an observation retrospective study, from January 2004 to December 2005, at Edouard Herriot hospital, of births from women with laparoscopic adjustable gastric banding with a study of gastric banding interaction with pregnancy, neonatal outcomes and postpartum; we read through literature.

RESULTS

We studied 35 pregnancies from women with a gastric banding out of 5773 pregnancies (0.6%); we noted lower obstetrical complications with loss of weight that we attributed to the gastric banding comparing with the pregnancies before the gastric banding: three hypertensive diseases and one gestational diabetes had been avoided; we observed a complication due to the gastric banding: occlusive syndrome, which implied gastric banding calibration during immediate postpartum.

CONCLUSION

Our record folders are in accordance with literature and confirm improvement in obstetrical prognostic. Waiting for stabilization of weight is recommended before starting a pregnancy after gastric banding surgery; the adjustment of the gastric banding during pregnancy must be undertaken individually according to symptoms (vomiting, gain of weight...).