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Sucu ST, Karaman E, Kose C, Sucu S, Keskin HL. Is postpartum depression related to total weight gain during pregnancy and maternal anemia? REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20230908. [PMID: 38451577 PMCID: PMC10913786 DOI: 10.1590/1806-9282.20230908] [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: 10/09/2023] [Accepted: 10/23/2023] [Indexed: 03/08/2024]
Abstract
OBJECTIVE This study aimed to investigate the effects of weight gain and maternal anemia on postpartum depression. METHODS This is a prospective, single-center, case-control study. We recorded the demographic characteristics, blood ferritin level, and weight gain during the pregnancy. This study was planned between April 2023 and June 2023 in the Obstetrics and Gynecology Clinic of Ankara Etlik City Hospital. A total of 109 patients were enrolled in the study. Patients were assessed with the Edinburgh Postpartum Depression Scale. Weight gain, nutritional education, educational level, mode of delivery, and pregnancy history were asked in person. Ferritin levels at the onset of labor were determined to detect anemia. Twin births, births due to fetal anomalies or intrauterine stillbirths, patients with systemic infections, and patients diagnosed with a psychiatric disorder in the past 6 months whose records were not accessible were excluded from the study. RESULTS Pregnancy weight gain and percentage of pregnancy weight gain were higher. Serum ferritin levels and nutritional education during pregnancy were lower in the postpartum depression group (p<0.001). These parameters with statistical significance were identified as risk factors in the regression analysis for postpartum depression (p<0.05). In receiver operating characteristics analysis, >15 kg for weight gain, >28.8 for percentage of weight gain in pregnancy, and <19 ng/dL for serum ferritin level were identified as cutoff values (p<0.001). CONCLUSION Nutritional education and vitamin supplementation should be recommended to pregnant women during routine examinations.
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Affiliation(s)
- Serap Topkara Sucu
- Ankara Etlik City Hospital, Department of Gynecology and Obstetrics – Ankara, Turkey
| | - Elif Karaman
- Ankara Etlik City Hospital, Department of Psychology – Ankara, Turkey
| | - Caner Kose
- Ankara Etlik City Hospital, Department of Gynecology and Obstetrics – Ankara, Turkey
| | - Sadun Sucu
- Ankara Etlik City Hospital, Department of Perinatology – Ankara, Turkey
| | - Hüseyin Levent Keskin
- Ankara Etlik City Hospital, Department of Gynecology and Obstetrics – Ankara, Turkey
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Wilkins EG, Sun B, Thomas AS, Alabaster A, Greenberg M, Sperling JD, Walton DL, Alves J, Gunderson EP. Low gestational weight gain (+2.0 to 4.9 kg) for singleton-term gestations associated with favorable perinatal outcomes for all prepregnancy obesity classes. AJOG GLOBAL REPORTS 2023; 3:100246. [PMID: 37645655 PMCID: PMC10461248 DOI: 10.1016/j.xagr.2023.100246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Previous studies that evaluated low gestational weight gain or weight loss among prepregnancy obesity classes have not determined the amount of gestational weight gain associated with the lowest risk of adverse perinatal outcomes and neonatal morbidity among singleton term births. OBJECTIVE This study aimed to evaluate the relationship of specific gestational weight gain categories of weight loss, stable weight, and low gain considered below the 2009 Institute of Medicine guidelines to perinatal outcomes and neonatal morbidity for singleton, term live births among prepregnancy obesity classes. STUDY DESIGN This was a retrospective cohort study of 18,476 women among 3 classes of prepregnancy obesity, based on measured prepregnancy weight, and delivering a live singleton pregnancy at ≥37 weeks of gestation at a Kaiser Permanente Northern California hospital (2009-2012). Variables from electronic medical records included perinatal outcomes, sociodemographics, and measured prepregnancy and delivery weights to calculate total gestational weight gain, used to define 5 gestational weight gain categories: weight loss (<-2.0 kg), stable weight (-2.0 to +1.9 kg), low gain (+2.0 to 4.9 kg), gain within guidelines (+5.0 to 9.1 kg; referent), and gain above guidelines (>9.1 kg). Logistic regression models estimated adjusted odds ratios and 95% confidence intervals of maternal and newborn perinatal outcomes (hypertensive disorders, cesarean delivery, size for gestational age, length of stay, neonatal intensive care unit admission) associated with gestational weight gain categories stratified by prepregnancy obesity classes 1, 2, and 3. RESULTS Low gain occurred in 8%, 12%, and 13% of women in obesity class 1 (body mass index, 30.0-34.9), class 2 (body mass index, 35.0-39.9), and class 3 (body mass index, ≥40), respectively. Compared with gestational weight gain within Institute of Medicine guidelines, low gain was associated with similar or improved maternal and newborn perinatal outcomes for all obesity classes without increased odds of neonatal intensive care unit admission, neonatal length of stay ≥3 days, or small for gestational age. The percentages of small for gestational age for the low gain category were 4.4%, 3.0%, and 4.3% among prepregnancy obesity classes 1, 2, and 3, respectively, and comparable with the gestational weight gain within the guideline category (P>.05). The adjusted odds ratios of small-for-gestational age were not statistically significant for all obesity classes; class 1 (1.16; 95% confidence interval, 0.79-1.71) , class 2 (1.05; 95% confidence interval 0.58-1.93), and class 3 (2.03; 95% confidence interval 0.97-4.27). CONCLUSION Lower gestational weight gain of +2.0 to 4.9 kg showed the most favorable perinatal outcomes, without higher small for gestational age or neonatal morbidity for all obesity classes.
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Affiliation(s)
- Emilia G. Wilkins
- Department of Obstetrics and Gynecology, Kaiser Permanente, Richmond Medical Center, CA (Dr Wilkins)
| | - Baiyang Sun
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (Mses Sun, Thomas, and Alabaster and Drs Alves and Gunderson)
| | - Alexis S. Thomas
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (Mses Sun, Thomas, and Alabaster and Drs Alves and Gunderson)
| | - Amy Alabaster
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (Mses Sun, Thomas, and Alabaster and Drs Alves and Gunderson)
| | - Mara Greenberg
- Department of Obstetrics and Gynecology, Kaiser Permanente, Oakland Medical Center, Oakland, CA (Dr Greenberg)
| | - Jeffrey D. Sperling
- Department of Obstetrics and Gynecology, Kaiser Permanente, Modesto Medical Center, Modesto, CA (Dr Sperling)
| | | | - Jasmin Alves
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (Mses Sun, Thomas, and Alabaster and Drs Alves and Gunderson)
| | - Erica P. Gunderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (Mses Sun, Thomas, and Alabaster and Drs Alves and Gunderson)
- Department of Health System Sciences, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA (Dr Gunderson)
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Chen W, Li B, Gan K, Liu J, Yang Y, Lv X, Ma H. Gestational Weight Gain and Small for Gestational Age in Obese Women: A Systematic Review and Meta-Analysis. Int J Endocrinol 2023; 2023:3048171. [PMID: 36686320 PMCID: PMC9848811 DOI: 10.1155/2023/3048171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE This systematic review and meta-analysis evaluates the relationship between gestational weight gain and the risk of small for gestational age in obese pregnant women. METHODS Studies were identified by searching the Web of Science, Embase, and PubMed databases up to June 30th, 2022. The meta-analysis was carried out to determine the risk of small for gestational age with gestational weight gain (GWG) below the 2009 Institute of Medicine (IOM) guidelines compared with within the guidelines in obese women. The Newcastle-Ottawa Scale was used to assess the methodological quality. The chi-squared test, Q test, and I2 test were used to evaluate statistical heterogeneity. Subgroup analyses were conducted, and publication bias was assessed by funnel plots and Egger's test. Sensitivity analyses were performed for three groups of obese people (I: BMI 30-34.9 kg/m2, II: BMI 35-39.9 kg/m2, and III: BMI ≥ 40 kg/m2) to examine the association of obesity and SGA. RESULTS A total of 788 references were screened, and 29 studies (n = 1242420 obese women) were included in the systematic review. Obese women who gained weight below the IOM guideline had a higher risk of SGA than those who gained weight within the guideline (OR = 1.27, 95% CI = 1.16-1.38, Z = 5.36). Both weight loss (<0 kg) and inadequate weight (0-4.9 kg) during pregnancy in obese women are associated with an increased risk of SGA (OR = 1.50, 95% CI = 1.37-1.64, Z = 8.82) (OR = 1.18, 95% CI = 1.14-1.23, Z = 8.06). The same conclusions were also confirmed for the three obesity classes (I: OR = 1.38, 95% CI = 1.29-1.47; II: OR = 1.39, 95% CI = 1.30-1.49; and III: OR = 1.26, 95% CI = 1.16-1.37). Subgroup analysis by country showed that GWG below guidelines in obese women of the USA and Europe was associated with risk for SGA (USA (OR = 1.30, 95% CI = 1.15-1.46), Europe (OR = 1.24, 95% CI = 1.11-1.40)) and not in Asia (OR = 1.17, 95% CI = 0.91-1.50). CONCLUSION Our findings indicated that obese pregnant women who had weight loss or inadequate weight (0-4.9 kg) according to the IOM guideline had increased risks for SGA. Moreover, we also evaluated that gestational weight loss (<0 kg) in these pregnancies was associated with an increased risk for SGA compared with inadequate weight (0-4.9 kg) in these pregnancies. Therefore, the clinical focus should assist obese women to achieve GWG within the IOM guidelines to decrease the risk for SGA.
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Affiliation(s)
- Wen Chen
- Department of Anus and Intestine Surgery, Shijiazhuang People Hospital, Shijiazhuang 050000, Hebei, China
| | - Beiyi Li
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang 050017, Hebei, China
| | - Kexin Gan
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang 050017, Hebei, China
| | - Jing Liu
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang 050017, Hebei, China
| | - Yajing Yang
- Graduate School of North China University of Science and Technology, Tangshan 063000, Hebei, China
| | - Xiuqin Lv
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang 050017, Hebei, China
| | - Huijuan Ma
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang 050017, Hebei, China
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Su L, Zhang Y, Chen C, Lu L, Sutton D, D'Alton M, Kahe K. Gestational weight gain and mode of delivery by the class of obesity: A meta-analysis. Obes Rev 2022; 23:e13509. [PMID: 36239197 DOI: 10.1111/obr.13509] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/01/2022] [Accepted: 10/05/2022] [Indexed: 10/17/2022]
Abstract
The association between gestational weight gain (GWG) and mode of delivery in females with different obesity classes is not clear. We conducted a meta-analysis to evaluate the association between GWG, categorized according to the 2009 Institute of Medicine (IOM) guidelines, and the risk of cesarean section (CS) or operative vaginal delivery (OVD) in females with different obesity classes. Eight studies were identified. The pooled odds ratios (ORs) (95% confidence interval [CI]) of CS for females with GWG above the recommendations were 1.27 (1.20-1.33) for obesity class I, 1.22 (1.20-1.23) for class II, and 1.17 (1.15-1.19) for class III. Also, the pooled ORs (95% CI) of OVD were 1.21 (1.005-1.46) for obesity class I, 1.12 (1.04-1.21) for class II, and 1.10 (1.001-1.22) for obesity class III. GWG below the recommendations was associated with lower risk of CS for females with obesity class I (OR 0.87, 95% CI 0.82-0.92), class II (OR 0.84, 95% CI 0.77-0.90), and class III (OR 0.86, 95% CI 0.79-0.93). Pregnant participants gaining weight above the 2009 IOM guidelines were at higher risk for CS and OVD regardless of obesity classes. Gaining weight below the guidelines was associated with a lower risk of CS among females in any obesity class.
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Affiliation(s)
- Le Su
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Yijia Zhang
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York City, New York, USA.,Department of Epidemiology, Columbia University Irving Medical Center, New York City, New York, USA
| | - Cheng Chen
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York City, New York, USA.,Department of Epidemiology, Columbia University Irving Medical Center, New York City, New York, USA
| | - Liping Lu
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York City, New York, USA.,Department of Epidemiology, Columbia University Irving Medical Center, New York City, New York, USA
| | - Desmond Sutton
- Department of Obstetrics and Gynecology, Mount Sinai West Hospital, New York City, New York, USA
| | - Mary D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York City, New York, USA
| | - Ka Kahe
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York City, New York, USA.,Department of Epidemiology, Columbia University Irving Medical Center, New York City, New York, USA
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Gestational Weight Gain Below Instead of Within The Guidelines per Class of Maternal Obesity: A Systematic Review and Meta-Analysis of Obstetrical and Neonatal Outcomes. Am J Obstet Gynecol MFM 2022; 4:100682. [PMID: 35728780 DOI: 10.1016/j.ajogmf.2022.100682] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/12/2022] [Accepted: 06/15/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To systematically investigate a wide range of obstetrical and neonatal outcomes with respect to gestational weight gain (GWG) below the current IOM and ACOG guidelines compared to within the guidelines and to stratify outcomes by the class of obesity and by the type of study analysis. DATA SOURCES We systematically searched studies on PubMed, Scopus, Embase, and Cochrane Library from 2009 to April 30, 2021. STUDY ELIGIBILITY CRITERIA Studies reporting on obstetrical and neonatal outcomes of singleton pregnancies with respect to GWG below the current IOM and ACOG guidelines compared to within the guidelines, investigated in obesity overall (BMI> 30 kg/m2), and/or class of obesity (I: BMI 30-34.9 kg/m2, II: BMI 35-39.9 kg/ m2 and III: BMI> 40 kg/m2). METHODS Among the studies that met criteria, multiple obstetrical and neonatal outcomes were tabulated and compared between pregnancies with weight gain below the guidelines and those with weight gain within the guidelines, further classified by the class of obesity if applicable. Primary outcomes included small for gestational age (SGA), large for gestational age (LGA), preeclampsia (PE), and gestational diabetes mellitus (GDM). Secondary outcomes included cesarean section (CS), preterm birth (PTB), postpartum weight retention, and composite neonatal morbidity. Meta-analysis of univariate and adjusted multivariate analysis studies were conducted. The random-effect model was used to pool the mean differences or odds ratios (OR) and the corresponding 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 value. Newcastle Ottawa Scale (NOS) was used to assess individual study quality. RESULTS Total of 54 studies reporting on 30,245,946 pregnancies were included, of which 11,515,411 pregnancies were in the univariate analysis and 18,730,535 pregnancies in the adjusted multivariate analysis. In the meta-analysis of univariate studies, compared to women who gained within the guidelines, those who gained below the guidelines had higher odds for SGA in obesity class I and II (OR:1.30 (95% CI 1.17, 1.45), I2 0%, P<0.00001, and OR: 1.56 (95% CI 1.31, 1.85), I2 0%, P<0.00001), respectively), however, the incidence of SGA was below the expected limits (<10%) and was not associated with increased neonatal morbidity. Furthermore, after adjusting for covariates, that difference was no statistically significant anymore. The difference was not statistically significant for class III obesity. Following adjusted multivariate analysis, no significant differences in SGA rates were noted for all classes of obesity between groups. Significantly lower odds for LGA were seen in GWG below guidelines in obesity class I, II, and III (OR: 0.69 (95% CI 0.64, 0.73), I2 0%, P<0.00001, OR: 0.68 (95% CI 0.63, 0.74), I2 0%, P<0.00001, and OR: 0.65 (95% CI 0.57, 0.75), I2 34%, P<0.00001, respectively), and similar findings were seen in the adjusted multivariate analysis. Women with weight gain below guidelines had significantly lower odds for PE in obesity class I, II, and III (OR: 0.71 (95% CI 0.63, 0.79),), I2 0%, P<0.00001, OR: 0.82 (95% CI 0.73, 0.91), I2 0%, P<0.00001, and OR: 0.82 (95% CI 0.70, 0.94), I2 0%, P=0.006, respectively), and similar findings were seen in the adjusted multivariate analysis. No significant differences were seen in GDM between groups. Regarding PTB, available univariate analysis studies only reported on overall obesity and mixed iatrogenic and spontaneous PTB showing significant increase in the odds of PTB (OR: 1.42 (95% CI 1.40, 1.43), I2 0%, P<0.00001) in women with low weight gain, while adjusted multivariate studies in overall obesity and in all three classes and showed no significant differences of PTB between groups. Women with low weight gain had significantly lower odds for CS in obesity class I, II, and III (OR: 0.76 (95% CI 0.72, 0.81), I2 0%, P<0.00001, OR: 0.82 (95% CI 0.77, 0.87), I2 0%, P<0.00001, and OR: 0.87 (95% CI 0.82, 0.91), I2 0%, P<0.00001, respectively), and similar findings were seen in the adjusted multivariate analysis. There was significantly lower odds for postpartum weight retention (OR: 0.20 (95% CI 0.05, 0.82)), I2 0%, P=0.03) and lower odds for composite neonatal morbidity in the overall obesity group with low GWG (OR: 0.93 (95% CI 0.87, 0.99)), I2 19.6%, P=0.04). CONCLUSION Contrary to previous reports, the current systematic review and meta-analysis showed no significant increase in SGA rates in pregnancies with weight gain below the current guidelines for all classes of maternal obesity. Furthermore, gaining below the guidelines was associated with lower LGA, PE, and CS rates. Our study provides the evidence that the current recommended GWG is high for all classes of obesity. These results provide pertinent information supporting the notion to revisit the current GWG recommendations for women with obesity and furthermore to classify them by the class of obesity rather than one overall obesity category as is done in the current recommendations.
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Dalfra' MG, Burlina S, Lapolla A. Weight gain during pregnancy: A narrative review on the recent evidences. Diabetes Res Clin Pract 2022; 188:109913. [PMID: 35568262 DOI: 10.1016/j.diabres.2022.109913] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 12/24/2022]
Abstract
Gestational weight gain is necessary for the normal fetus development, in fact a series of studies have evidenced that both low and excessive gestational weight gain is associated with negative fetal-neonatal outcomes. So, evidences on the optimal gestational weight gain across the ranges of the pre-pregnancy maternal body mass index are necessary. In this context, while for normal weight and underweight the recommendations of IOM are clearly stated and supported by well designed and conducted clinical studies, those for the obese pregnant women are even today debated. Pre-pregnancy obesity is associated with high risk to develop hypertension, gestational diabetes, cesarean section and high birth weight. The Institute of Medicine guidelines, in 2009, recommended that women with obesity gain 11-20 lb at a rate of 0.5 lb/week during the second and third trimesters of pregnancy. Successively, taking into account a series of meta-analysis, the American College of Obstetricians and Gynecologists emphasized that the IOM weight gain targets for obese pregnant women are too high. However the high risk to have babies small for gestational age, related to a low weight gain or a losing of weight during pregnancy, has also been demonstrated. More recent studies have taken into consideration the maternal and fetal outcomes of obese pregnant women with different obesity class (I,II,III) and different weight gain during pregnancy. The analysis of these studies, discussed in this narrative review, show that the appropriate gestational weight gain should be personalized considering the three obesity class; furthermore both an upper and lower limit of gestational weight gain should be reconsidered in order to prevent the negative maternal and fetal outcomes in these women.
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Benham JL, Booth JE, Donovan LE, Leung AA, Sigal RJ, Rabi DM. Prevalence of and risk factors for excess weight gain in pregnancy: a cross-sectional study using survey data. CMAJ Open 2021; 9:E1168-E1174. [PMID: 34906992 PMCID: PMC8687487 DOI: 10.9778/cmajo.20200276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Maternal weight gain during pregnancy is required for fetal development; however, excess gestational weight gain is associated with increased maternal and neonatal morbidity. We aimed to determine the proportion of Canadian women who gained excess weight during pregnancy and to identify risk factors for excess gestational weight gain. METHODS Self-reported data on maternal weight gain were collected from the 2015/16 and 2017/18 cycles of the Canadian Community Health Survey (CCHS), a cross-sectional population-based survey. We included females aged 15 to 54 years with data on height, prepregnancy weight and gestational weight gain. We defined excess gestational weight gain in terms of preconception body mass index (BMI) according to the 2009 guideline of the US Institute of Medicine. We used logistic regression to evaluate potential risk factors for excess gestational weight gain. RESULTS Of 1 335 615 Canadian women (weighted from approximately 9300 survey respondents), 422 043 (32%) gained excess weight during pregnancy. Women with obesity had 33% lower odds of gaining excess weight relative to women with overweight (odds ratio 0.67, 95% confidence interval 0.48-0.94). Risk factors for excess gestational weight gain were lower education level, white or Indigenous identity, smoking, mood disorder, anxiety disorder and Canadian citizenship. INTERPRETATION One-third of Canadian women in this survey had excess gestational weight gain during pregnancy, and women with obesity had lower odds of gaining excess weight during pregnancy relative to women with overweight. Strategies are needed to reduce the proportion of Canadian women who gain excess weight during pregnancy, regardless of preconception BMI.
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Affiliation(s)
- Jamie L Benham
- Departments of Medicine (Benham, Donovan, Leung, Sigal, Rabi), of Community Health Sciences (Benham, Booth, Leung, Sigal, Rabi), of Obstetrics and Gynecology (Donovan) and of Cardiac Sciences (Sigal, Rabi), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Donovan), Calgary, Alta.
| | - Jane E Booth
- Departments of Medicine (Benham, Donovan, Leung, Sigal, Rabi), of Community Health Sciences (Benham, Booth, Leung, Sigal, Rabi), of Obstetrics and Gynecology (Donovan) and of Cardiac Sciences (Sigal, Rabi), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Donovan), Calgary, Alta
| | - Lois E Donovan
- Departments of Medicine (Benham, Donovan, Leung, Sigal, Rabi), of Community Health Sciences (Benham, Booth, Leung, Sigal, Rabi), of Obstetrics and Gynecology (Donovan) and of Cardiac Sciences (Sigal, Rabi), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Donovan), Calgary, Alta
| | - Alexander A Leung
- Departments of Medicine (Benham, Donovan, Leung, Sigal, Rabi), of Community Health Sciences (Benham, Booth, Leung, Sigal, Rabi), of Obstetrics and Gynecology (Donovan) and of Cardiac Sciences (Sigal, Rabi), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Donovan), Calgary, Alta
| | - Ronald J Sigal
- Departments of Medicine (Benham, Donovan, Leung, Sigal, Rabi), of Community Health Sciences (Benham, Booth, Leung, Sigal, Rabi), of Obstetrics and Gynecology (Donovan) and of Cardiac Sciences (Sigal, Rabi), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Donovan), Calgary, Alta
| | - Doreen M Rabi
- Departments of Medicine (Benham, Donovan, Leung, Sigal, Rabi), of Community Health Sciences (Benham, Booth, Leung, Sigal, Rabi), of Obstetrics and Gynecology (Donovan) and of Cardiac Sciences (Sigal, Rabi), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Donovan), Calgary, Alta
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Maternal and Perinatal Outcome of Maternal Obesity at RSCM in 2014-2019. Obstet Gynecol Int 2021; 2021:6039565. [PMID: 33628260 PMCID: PMC7886500 DOI: 10.1155/2021/6039565] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/19/2020] [Accepted: 01/25/2021] [Indexed: 01/13/2023] Open
Abstract
Obesity is a pandemic found in many countries. It is estimated that, in 2025, more than 21% of women in the world will suffer from obesity and its number keeps increasing yearly. Obesity in pregnancy is one of the important challenges in obstetric services given the prevalence and potential adverse effects on the mother and fetus. Obese women have a higher risk of developing gestational diabetes, gestational hypertension, preeclampsia, venous thromboembolism, postpartum hemorrhage, cesarean delivery, and maternal death. The aim of this research is to determine the prevalence of maternal and perinatal complication in various obesity grades. This research was an observational descriptive study using the cross-sectional design. The inclusion criterion is obese pregnant women whose delivery was done in Dr. Cipto Mangunkusumo National General Hospital (RSCM) from 2014 to 2019. The exclusion criterion in this study is the incomplete medical record. A total of 111 subjects were included in the study. Obesity grades in this study were based on World Health Organization (WHO) obesity, divided into 3 classifications which are obese I (30–34.9 kg/m2), obese II (35–39.9 kg/m2), and obese III (≥40 kg/m2). Maternal outcomes in this study were birth method, gestational diabetes, preeclampsia, and premature rupture of membrane (PROM). Perinatal outcomes in this study were preterm birth, birth weight, APGAR score, and postdelivery neonatal care. In this study, obese patients had a mean age of 31.23 years, mean gravida 2, parity 1, and abortion 0. Most of these patients used an intrauterine device (IUD) for family planning (74.8%). There were no differences in age, parity status, and family planning methods in each group of patients with different body mass index (p > 0.05). Maternal characteristics are the majority of deliveries performed cesarean delivery (86.5%), cases of diabetes mellitus are more common in obese I patients (50%), preeclampsia is more prevalent in obese grade II patients (34,4%), and premature rupture of membranes (PROM) is more common in patients with obese II (52,4%). However, there was no difference in the prevalence of maternal outcomes between groups. There was a median gestational age of 37 weeks in all obesity grades, the highest percentage of preterm births owned by obese II patients (32,6%), the mean birth weight of babies tends to increase along with the weighting of the body mass index group, and neonatal intensive care unit (NICU) treatment rooms were mostly occupied from mother with obese II groups (18%). There was no difference in the first-minute and fifth-minute APGAR scores between study groups (p > 0.05). There were no differences in perinatal outcomes between groups. There were no significant differences in maternal and perinatal outcomes prevalence between different obesity grades. However, the rate of maternal and perinatal complications in obese women is higher than the normal population, thus requiring sophisticated prevention and approach toward handling the pregnancy.
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A Pragmatic Approach to the Treatment of Women With Type 2 Diabetes in Pregnancy. Clin Obstet Gynecol 2020; 64:159-173. [PMID: 33481417 DOI: 10.1097/grf.0000000000000592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Type 2 diabetes mellitus (DM) is a growing problem among reproductive-aged women. Contemporary trends in obesity and delayed child-bearing are expected to result in an increasing number of pregnancies affected by type 2 DM. Women with known type 2 DM can greatly benefit from preconception care as improved periconception glycemic control and weight loss can decrease the neonatal and maternal risks associated with type 2 DM and pregnancy. Antenatal mainstays of management include frequent blood glucose monitoring, insulin therapy, optimization of coexisting medical conditions, and fetal surveillance. Careful attention to postpartum glucose control, infant feeding choices, and contraceptive counseling are important aspects of immediate postpartum care.
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