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Zhang Y, Lu M, Yi Y, Xia L, Zhang R, Li C, Liu P. Influence of maternal body mass index on pregnancy complications and outcomes: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1280692. [PMID: 38894748 PMCID: PMC11183281 DOI: 10.3389/fendo.2024.1280692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
Background The prevalence of obesity among women of reproductive age is increasing worldwide, with implications for serious pregnancy complications. Methods Following PRISMA guidelines, a systematic search was conducted in both Chinese and English databases up to December 30, 2020. Pregnancy complications and outcomes including gestational diabetes mellitus (GDM), gestational hypertension (GHTN), pre-eclampsia, cesarean section (CS), induction of labor (IOL), and postpartum hemorrhage (PPH) were analyzed. Random-effects or fixed-effects models were utilized to calculate the odds ratio (OR) with 95% confidence intervals (CIs). Results Women with overweight and obesity issues exhibited significantly higher risks of GDM (OR, 2.92, 95%CI, 2.18-2.40 and 3.46, 95%CI, 3.05-3.94, respectively) and GHTN (OR, 2.08, 95%CI, 1.72-2.53 and 3.36, 95%CI, 2.81-4.00, respectively) compared to women of normal weight. Pre-eclampsia was also significantly higher in women with overweight or obesity, with ORs of 1.70 (95%CI, 1.44-2.01) and 2.82 (95%CI, 2.66-3.00), respectively. Additionally, mothers with overweight or obesity issues had significantly higher risks of CS (OR, 1.44, 95%CI, 1.41-1.47, and 2.23, 95%CI, 2.08-2.40), IOL (OR, 1.33, 95%CI, 1.30-1.35 and 1.96, 95%CI, 1.85-2.07), and PPH (OR, 1.67, 95%CI, 1.42-1.96 and 1.88, 95%CI, 1.55-2.29). Conclusion Women with overweight or obesity issues face increased risks of pregnancy complications and adverse outcomes, indicating dose-dependent effects.
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Affiliation(s)
- Yi Zhang
- College of Public Health, Zunyi Medical University, Zunyi, China
- Key Laboratory of Maternal & Child Health and Exposure Science of Guizhou Higher Education Institutes, Zunyi, China
| | - Mei Lu
- College of Public Health, Zunyi Medical University, Zunyi, China
- Key Laboratory of Maternal & Child Health and Exposure Science of Guizhou Higher Education Institutes, Zunyi, China
| | - Ying Yi
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Prevention Medicine, Qingdao, China
| | - Luming Xia
- Center for Animal Disease Control and Prevention of Shanghai, Shanghai, China
| | - Renjun Zhang
- Center for Animal Disease Control and Prevention of Guizhou Province, Guiyang, China
| | - Chao Li
- China Animal Health and Epidemiology Center, Qingdao, China
| | - Ping Liu
- China Animal Health and Epidemiology Center, Qingdao, China
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2
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Aleker N, Lim BH. Intrapartum care and management of complications in women with obesity. Best Pract Res Clin Obstet Gynaecol 2023; 91:102404. [PMID: 37716337 DOI: 10.1016/j.bpobgyn.2023.102404] [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: 04/25/2023] [Revised: 05/19/2023] [Accepted: 08/06/2023] [Indexed: 09/18/2023]
Abstract
Pregnant women with obesity are at considerable risk during their labor and delivery. The aim of obstetric care is the safe delivery of the baby and the maintenance of good health of the mother while providing an ongoing support for the family unit. The awareness and mitigation of risks associated with caring for women who are obese is vital in ensuring continued good outcomes. Transfer of women for labor care, presence of senior staff, bariatric resources, understanding of the progress of labor with an increase in body mass index, and preparation for complications are covered in this chapter.
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Affiliation(s)
- Namiko Aleker
- Staff Specialist in Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin Northern Territory, Australia
| | - Boon H Lim
- Senior Staff Specialist in Obstetrics and Gynaecology, Canberra Health Services, Clinical Associate Professor, Australian National University, Canberra, Australian Capital Territory, Australia.
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3
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Habibi N, Mousa A, Tay CT, Khomami MB, Patten RK, Andraweera PH, Wassie M, Vandersluys J, Aflatounian A, Bianco‐Miotto T, Zhou SJ, Grieger JA. Maternal metabolic factors and the association with gestational diabetes: A systematic review and meta-analysis. Diabetes Metab Res Rev 2022; 38:e3532. [PMID: 35421281 PMCID: PMC9540632 DOI: 10.1002/dmrr.3532] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/10/2022] [Accepted: 02/26/2022] [Indexed: 11/10/2022]
Abstract
Gestational diabetes (GDM) is associated with several adverse outcomes for the mother and child. Higher levels of individual lipids are associated with risk of GDM and metabolic syndrome (MetS), a clustering of risk factors also increases risk for GDM. Metabolic factors can be modified by diet and lifestyle. This review comprehensively evaluates the association between MetS and its components, measured in early pregnancy, and risk for GDM. Databases (Cumulative Index to Nursing and Allied Health Literature, PubMed, Embase, and Cochrane Library) were searched from inception to 5 May 2021. Eligible studies included ≥1 metabolic factor (waist circumference, blood pressure, fasting plasma glucose (FPG), triglycerides, and high-density lipoprotein cholesterol), measured at <16 weeks' gestation. At least two authors independently screened potentially eligible studies. Heterogeneity was quantified using I2 . Data were pooled by random-effects models and expressed as odds ratio and 95% confidence intervals (CIs). Of 7213 articles identified, 40 unique articles were included in meta-analysis. In analyses adjusting for maternal age and body mass index, GDM was increased with increasing FPG (odds ratios [OR] 1.92; 95% CI 1.39-2.64, k = 7 studies) or having MetS (OR 2.52; 1.65, 3.84, k = 3). Women with overweight (OR 2.17; 95% CI 1.89, 2.50, k = 12) or obesity (OR 4.34; 95% CI 2.79-6.74, k = 9) also were at increased risk for GDM. Early pregnancy assessment of glucose or the MetS, offers a potential opportunity to detect and treat individual risk factors as an approach towards GDM prevention; weight loss for pregnant women with overweight or obesity is not recommended. Systematic review registration: PROSPERO CRD42020199225.
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Affiliation(s)
- Nahal Habibi
- Robinson Research InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Adelaide Medical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash UniversityMelbourneVictoriaAustralia
| | - Chau Thien Tay
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash UniversityMelbourneVictoriaAustralia
| | - Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash UniversityMelbourneVictoriaAustralia
| | - Rhiannon K. Patten
- Institute for Health and SportVictoria UniversityMelbourneVictoriaAustralia
| | - Prabha H. Andraweera
- Robinson Research InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Adelaide Medical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Department of Cardiology, Lyell McEwin HospitalElizabeth ValeSouth AustraliaAustralia
| | - Molla Wassie
- School of Agriculture, Food and Wine, and Waite Research Institute, University of AdelaideAdelaideSouth AustraliaAustralia
| | - Jared Vandersluys
- School of Agriculture, Food and Wine, and Waite Research Institute, University of AdelaideAdelaideSouth AustraliaAustralia
| | - Ali Aflatounian
- School of Women's and Children's Health, University of New South WalesSydneyNew South WalesAustralia
| | - Tina Bianco‐Miotto
- Robinson Research InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
- School of Agriculture, Food and Wine, and Waite Research Institute, University of AdelaideAdelaideSouth AustraliaAustralia
| | - Shao J. Zhou
- Robinson Research InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
- School of Agriculture, Food and Wine, and Waite Research Institute, University of AdelaideAdelaideSouth AustraliaAustralia
| | - Jessica A. Grieger
- Robinson Research InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Adelaide Medical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
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4
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Kureshi A, Khalak R, Gifford J, Munshi U. Maternal Obesity-Associated Neonatal Morbidities in Early Newborn Period. Front Pediatr 2022; 10:867171. [PMID: 35692979 PMCID: PMC9174588 DOI: 10.3389/fped.2022.867171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Maternal obesity has been associated with pregnancy-related complications and neonatal morbidities. The primary aim of this study was to evaluate early neonatal morbidities associated with maternal obesity from the infant-mother dyad data set at a single, large Regional Perinatal Center (RPC) in NY. A retrospective chart review of all mother-infant dyads born from January 2009 to December 2019 was done. Maternal obesity was defined using the NIH definition of pre-pregnancy body mass index (BMI) ≥ 30 Kg/m2. Maternal data included pre-pregnancy BMI, gestational diabetes, hypertension, and mode of delivery. Neonatal data recorded the birth weight, gestational age, respiratory support after delivery, diagnosis of transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), neonatal hypoglycemia (NH), and hypoxic-ischemic encephalopathy (HIE). Diagnosis of TTN, RDS, NH, and HIE was defined by the service neonatologist and cross-checked by the data system review neonatologist. Medical records of 22,198 infant-mother dyads included in the study had 7,200 infants (32.4%) born to obese mothers and 14,998 infants (67.6%) born to non-obese women. There was a statistically significant increase in the diagnosis of gestational diabetes, gestational hypertension, and cesarean deliveries in obese mothers. Diagnosis of TTN, RDS, and NH was significantly higher in infants born to obese mothers, while HIE incidence was similar in both the groups. Infants born to obese mothers are more likely to be delivered by cesarean section and are at a higher risk of diagnosis of transient tachypnea of newborn, respiratory distress syndrome, and hypoglycemia in the early neonatal period.
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Affiliation(s)
- Azima Kureshi
- Department of Pediatrics, Albany Medical College, Albany, NY, United States
| | - Rubia Khalak
- Department of Pediatrics, Albany Medical College, Albany, NY, United States
| | - Jamie Gifford
- Department of Pediatrics, Albany Medical College, Albany, NY, United States
| | - Upender Munshi
- Department of Pediatrics, Albany Medical College, Albany, NY, United States
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5
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Figueiro-Filho EA, Robinson NTS, Carvalho J, Keunen J, Robinson M, Maxwell C. Hemodynamic Assessment of Pregnant People with and without Obesity by Noninvasive Bioreactance: A Pilot Study. AJP Rep 2022; 12:e69-e75. [PMID: 35141039 PMCID: PMC8816622 DOI: 10.1055/s-0041-1742270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/08/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to identify cardiovascular differences between pregnant people with and without obesity for trimester-specific changes in hemodynamic parameters using noninvasive cardiac output monitoring (NICOM). Study Design This study is a pilot prospective comparative cohort between pregnant people with and without obesity. Hemodynamic assessment was performed with NICOM (12-14, 21-23, and 34-36 weeks) during pregnancy. Results In first trimester, pregnant people with obesity had higher blood pressure, stroke volume (SV), total peripheral resistance index (TPRI), and cardiac output (CO). Pregnant people with obesity continued to have higher SV and cardiac index (second and third trimesters). During the first trimester, body mass index (BMI) positively correlated with SV, TPRI, and CO. Fat mass showed a strong correlation with TPRI. BMI positively correlated with CO during the second trimester and fat mass was positively associated with CO. During the third trimester, TPR negatively correlated with BMI and fat mass. Conclusion Fat mass gain in the period between the first and second trimesters in addition to the hemodynamic changes due to obesity and pregnancy contribute to some degree of left ventricular diastolic dysfunction which was manifested by lower SVs. Future work should investigate the possible causative role of obesity in the cardiovascular changes identified in people with obesity.
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Affiliation(s)
- Ernesto A Figueiro-Filho
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.,Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Na T S Robinson
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Obstetrics and Gynecology, Queen Elizabeth Hospital, Barbados
| | - Jose Carvalho
- Department of Anaesthesia, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Johannes Keunen
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Monique Robinson
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Cynthia Maxwell
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
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Bick D, Taylor C, Bhavnani V, Healey A, Seed P, Roberts S, Zasada M, Avery A, Craig V, Khazaezadah N, McMullen S, O’Connor S, Oki B, Oteng-Ntim E, Poston L, Ussher M. Lifestyle information and access to a commercial weight management group to promote maternal postnatal weight management and positive lifestyle behaviour: the SWAN feasibility RCT. PUBLIC HEALTH RESEARCH 2020. [DOI: 10.3310/phr08090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Increasing numbers of UK women have overweight or obese body mass index scores when they become pregnant, or gain excessive weight in pregnancy, increasing their risk of adverse outcomes. Failure to manage postnatal weight is linked to smoking, non-healthy dietary choices, lack of regular exercise and poorer longer-term health. Women living in areas of higher social deprivation are more likely to experience weight management problems postnatally.
Objectives
The objectives were to assess the feasibility of conducting a definitive randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of lifestyle information and access to a commercial weight management group focusing on self-monitoring, goal-setting and motivation to achieve dietary change commencing 8–16 weeks postnatally to achieve and maintain weight management and positive lifestyle behaviour.
Design
The design was a randomised two-arm feasibility trial with a nested mixed-methods process evaluation.
Setting
The setting was a single centre in an inner city setting in the south of England.
Participants
Participants were women with body mass index scores of > 25 kg/m2 at antenatal ‘booking’ and women with normal body mass index scores (18.0–24.9 kg/m2) at antenatal booking who developed excessive gestational weight gain as assessed at 36 weeks’ gestation.
Main outcome measures
Recruitment, retention, acceptability of trial processes and identification of relevant economic data were the feasibility objectives. The proposed primary outcome was difference between groups in weight at 12 months postnatally, expressed as percentage weight change and weight loss from antenatal booking. Other proposed outcomes included assessment of diet, physical activity, smoking, alcohol consumption, body image, maternal esteem, mental health, infant feeding and NHS costs.
Results
Most objectives were achieved. A total of 193 women were recruited, 98 allocated to the intervention arm and 95 to the control arm. High follow-up rates (> 80%) were achieved to 12 months. There was an 8.8% difference in weight loss at 12 months between women allocated to the intervention arm and women allocated to the control arm (13.0% vs. 4.2%, respectively; p = 0.062); 47% of women in the intervention arm attended at least one weight management session, with low risk of contamination between arms. The greatest benefit was among women who attended ≥ 10 sessions. Barriers to attending sessions included capability, opportunity and motivation issues. Data collection tools were appropriate to support economic evaluation in a definitive trial, and economic modelling is feasible to quantify resource impacts and outcomes not directly measurable within a trial.
Limitations
The trial recruited from only one site. It was not possible to recruit women with normal body mass index scores who developed excessive pregnancy weight gain.
Conclusions
It was feasible to recruit and retain women with overweight or obese body mass index scores at antenatal booking to a trial comparing postnatal weight management plus standard care with standard care only and collect relevant data to assess outcomes. Approaches to recruit women with normal body mass index scores who gain excessive gestational weight need to be considered. Commercial weight management groups could support women’s weight management as assessed at 12 months postnatally, with probable greater benefit from attending ≥ 10 sessions. Process evaluation findings highlighted the importance of providing more information about the intervention on trial allocation, extended duration of time to commence sessions following birth and extended number of sessions offered to enhance uptake and retention. Results support the conduct of a future randomised controlled trial.
Trial registration
Current Controlled Trials ISRCTN39186148.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
| | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, UK
| | | | - Andy Healey
- King’s Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Paul Seed
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
| | - Sarah Roberts
- King’s Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Amanda Avery
- Faculty of Science, University of Nottingham, Nottingham, UK
| | | | | | | | | | - Bimpe Oki
- Public Health, London Borough of Lambeth, London, UK
| | | | - Lucilla Poston
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
| | - Michael Ussher
- Population Health Research Institute, St George’s, University of London, London, UK
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
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Parambi A, Davies‐Tuck M, Palmer KR. Comparison of maternal and perinatal outcomes in women with super obesity based on planned mode of delivery. Aust N Z J Obstet Gynaecol 2018; 59:387-393. [DOI: 10.1111/ajo.12870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Anisha Parambi
- Department of Obstetrics and GynaecologyMonash Health Melbourne Australia
| | | | - Kirsten R. Palmer
- Department of Obstetrics and GynaecologyMonash Health Melbourne Australia
- Department of Obstetrics and GynaecologyMonash University Melbourne Australia
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8
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Rosenberg KR, Trevathan WR. Evolutionary perspectives on cesarean section. EVOLUTION MEDICINE AND PUBLIC HEALTH 2018. [DOI: 10.1093/emph/eoy006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Karen R Rosenberg
- Department of Anthropology, University of Delaware, Newark, DE 19716, USA
| | - Wenda R Trevathan
- Department of Anthropology, New Mexico State University, Las Cruces, NM 80003, USA
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9
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Burket BA. Obstetric characteristics of two Mayan populations in the highlands of Guatemala. ETHNICITY & HEALTH 2017; 22:541-550. [PMID: 27748136 DOI: 10.1080/13557858.2016.1244739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The purpose of this study was to (1) describe and compare two obstetric Mayan populations in Guatemala, the Tz'utujil and the Kachiquel and (2) evaluate possible associations of demographics, wood fuel use, and obesity with pregnancy/newborn outcomes. DESIGN This cross-sectional study interviewed participants at the time of routine obstetric ultrasounds at three institutions in Santiago Atitlán and one institution in San Lucas Tolimán. Data were collected from January 2010 to May 2013. Data entry and statistical analysis were performed using EPI InfoTM 7.1.2.0 (CDC). RESULTS The two populations were similar in maternal age, BMI, ownership of a phone, gravidity (number of times a women has been pregnant), history of spontaneous abortions, history of term pregnancies, newborn birth weights, cesarean section rate, and percentage of low-birth-weight newborns (LBW < 2500 g). Obesity was present in 22% of the combined surveyed populations. Low-birth-weight newborns and newborn macrosomia (newborn birth weight greater than 4000 g) were present in 5.5% and 3.7%, respectively. The newborn gender ratio (male to female) was equal to 0.92. The two populations differed in ownership of gas stoves and percentage of newborn macrosomia. Significant associations included: (1) female newborn gender and low birth weight, (2) obesity and newborn macrosomia, and (3) obesity and male gender. CONCLUSION The two Mayan populations were similar in many of the obstetric variables. The percentage of low-birth-weight infants (5.5%) is considerably lower than reported prevalence data for Guatemala. The obstetric characteristics, differences, and similarities between these two Mayan populations should help in policy planning for obstetric care for these two populations and possibly other indigenous populations in Guatemala.
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Affiliation(s)
- Brent A Burket
- a Hospitalito Atitlán, Canton Ch'utch'aj, Santiago Atitlán , Sololá , Guatemala, Central America
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10
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Mikkelsen SH, Hohwü L, Olsen J, Bech BH, Liew Z, Obel C. Parental Body Mass Index and Behavioral Problems in Their Offspring: A Danish National Birth Cohort Study. Am J Epidemiol 2017; 186:593-602. [PMID: 28535165 DOI: 10.1093/aje/kwx063] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/25/2016] [Indexed: 11/12/2022] Open
Abstract
Maternal obesity has been associated with increased risk of offspring behavioral problems. We examined whether this association could be explained by familial factors by comparing associations for maternal body mass index (BMI) with associations for paternal BMI. We studied 38,314 children born to mothers enrolled in the Danish National Birth Cohort during 1996-2002. Data on maternal BMI was collected at 15 weeks of gestation, and paternal BMI was assessed when the child was 18 months old. When the child was 7 years old, the Strengths and Difficulties Questionnaire was completed by the parents. We estimated odds ratios for behavioral problems in offspring born to overweight/obese parents, and we found that maternal BMI was associated with offspring behavioral problems. Maternal BMI of 25.0-29.9 was associated with a 33% (odds ratio = 1.33, 95% confidence interval: 1.13, 1.57) higher risk of total difficulties in offspring, and maternal BMI of ≥30.0 was associated with an 83% (odds ratio = 1.83, 95% confidence interval: 1.49, 2.25) higher risk. Paternal obesity was also associated with higher risk of offspring behavioral problems, but stronger associations were observed with maternal prepregnancy obesity. Our results suggest that part of the association between maternal BMI and behavioral problems can be accounted for by genetic and social factors, but environmental risk factors may also contribute to the etiology of behavioral problems.
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11
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Carolan-Olah M, Duarte-Gardea M, Lechuga J, Salinas-Lopez S. The experience of gestational diabetes mellitus (GDM) among Hispanic women in a U.S. border region. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 12:16-23. [DOI: 10.1016/j.srhc.2016.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 11/02/2016] [Accepted: 11/20/2016] [Indexed: 11/16/2022]
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12
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Ganeshan M, Bujang MA, Soelar SA, Karalasingam SD, Suharjono H, Jeganathan R. Importance of Adopting BMI Classifications Using Public Health Action Points to Delineate Obstetric Risk Factors Resulting in Worsening Obstetric Outcomes Among Asian Population. J Obstet Gynaecol India 2017; 68:173-178. [PMID: 29895995 DOI: 10.1007/s13224-017-1000-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 04/20/2017] [Indexed: 11/24/2022] Open
Abstract
Aims The aim of this study is to compare obstetric outcomes between overweight and class 1 obesity among pregnant women in their first pregnancy based on WHO's BMI cut-offs and the potential public health action points identified by WHO expert consultations specific for high-risk population such as Asians. Methods This is a retrospective cohort review of data obtained from the Malaysian National Obstetrics and Gynaecology Registry between the year 2010 and year 2012. All women in their first pregnancy with a booking BMI in their first trimester were included in this study. The association between BMI classifications as defined by the WHO cut-offs and the potential public health action points identified by WHO expert consultations towards adverse obstetric outcomes was compared. Results A total of 88,837 pregnant women were included in this study. We noted that the risk of adverse obstetric outcomes was significantly higher using the public health action points identified by WHO expert consultations even among the overweight group as the risk of stillbirths was (OR 1.2; 95% CI 1.0,1.4), shoulder dystocia (OR 1.9; 95% CI 1.2,2.9), foetal macrosomia (OR 1.8; 95% CI 1.6,2.0), caesarean section (OR 1.9; 95% CI 1.8,2.0) and assisted conception (OR 1.9; 95% CI 1.6,2.1). Conclusion A specifically lower BMI references based on the potential public health action points for BMI classifications were a more sensitive predictor of adverse obstetric outcomes, and we recommend the use of these references in pregnancy especially among Asian population.
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Affiliation(s)
- Muniswaran Ganeshan
- Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Sarawak Malaysia
| | - Mohamad Adam Bujang
- Clinical Research Centre, Sarawak General Hospital, Jalan Hospital, Ministry of Health Malaysia, 93586 Kuching, Sarawak Malaysia
| | - Shahrul Aiman Soelar
- 3Clinical Research Centre, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Alor Setar, Kedah Malaysia
| | | | - Harris Suharjono
- Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Sarawak Malaysia
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13
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Thavarajah H, Flatley C, Kumar S. The relationship between the five minute Apgar score, mode of birth and neonatal outcomes. J Matern Fetal Neonatal Med 2017; 31:1335-1341. [DOI: 10.1080/14767058.2017.1315666] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Christopher Flatley
- Mater Research Institute, University of Queensland, South Brisbane, Australia
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, South Brisbane, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
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14
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Heslehurst N, Vieira R, Hayes L, Crowe L, Jones D, Robalino S, Slack E, Rankin J. Maternal body mass index and post-term birth: a systematic review and meta-analysis. Obes Rev 2017; 18:293-308. [PMID: 28085991 PMCID: PMC5324665 DOI: 10.1111/obr.12489] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/27/2016] [Accepted: 11/14/2016] [Indexed: 01/28/2023]
Abstract
Post-term birth is a preventable cause of perinatal mortality and severe morbidity. This review examined the association between maternal body mass index (BMI) and post-term birth at ≥42 and ≥41 weeks' gestation. Five databases, reference lists and citations were searched from May to November 2015. Observational studies published in English since 1990 were included. Linear and nonlinear dose-response meta-analyses were conducted by using random effects models. Sensitivity analyses assessed robustness of the results. Meta-regression and sub-group meta-analyses explored heterogeneity. Obesity classes were defined as I (30.0-34.9 kg m-2 ), II (35.0-39.9 kg m-2 ) and III (≥40 kg m-2 ; IIIa 40.0-44.9 kg m-2 , IIIb ≥ 45.0 kg m-2 ). Searches identified 16,375 results, and 39 studies met the inclusion criteria (n = 4,143,700 births). A nonlinear association between maternal BMI and births ≥42 weeks was identified; odds ratios and 95% confidence intervals for obesity classes I-IIIb were 1.42 (1.27-1.58), 1.55 (1.37-1.75), 1.65 (1.44-1.87) and 1.75 (1.50-2.04) respectively. BMI was linearly associated with births ≥41 weeks: odds ratio is 1.13 (95% confidence interval 1.05-1.21) for each 5-unit increase in BMI. The strength of the association between BMI and post-term birth increases with increasing BMI. Odds are greatest for births ≥42 weeks among class III obesity. Targeted interventions to prevent the adverse outcomes associated with post-term birth should consider the difference in risk between obesity classes.
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Affiliation(s)
- N. Heslehurst
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - R. Vieira
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - L. Hayes
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - L. Crowe
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - D. Jones
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - S. Robalino
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - E. Slack
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - J. Rankin
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
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15
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Foo XY, Greer RM, Kumar S. Impact of Maternal Body Mass Index on Intrapartum and Neonatal Outcomes in Brisbane, Australia, 2007 to 2013. Birth 2016; 43:358-365. [PMID: 27500501 DOI: 10.1111/birt.12246] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the influence of maternal body mass index on intrapartum and neonatal outcomes at one of the largest maternity hospitals in Australia. METHODS A retrospective cross-sectional study of 55,352 term singleton deliveries at the Mater Mothers' Hospital in Brisbane, Australia, was conducted. The study cohort was stratified into six groups based on the World Health Organization's body mass index classification. The normal body mass index category was the reference group for all comparisons. Multivariate logistic regression was used to examine the effect of maternal body mass index, adjusted for maternal age, ethnicity, parity, and preexisting conditions (e.g., diabetes mellitus and hypertension), on selected intrapartum and neonatal outcomes. RESULTS Women in the overweight and Obese I, II, and III categories were more likely to have chronic or gestational hypertension/preeclampsia, and preexisting or gestational diabetes mellitus. They also had an increased risk for induction of labor, elective and emergency cesarean, and postpartum hemorrhage. Underweight women were less likely to require induction of labor and emergency cesarean. Infants born to women with increased body mass index were more likely to require neonatal resuscitation, neonatal intensive care unit admission, and have lower Apgar scores at 5 minutes. CONCLUSION There is an increased risk of adverse intrapartum and neonatal outcomes for women who are overweight and obese, with the risks increasing with rising body mass index. Appropriately targeted weight management strategies and health education may yield improved maternal and perinatal outcomes if effectively implemented before pregnancy. These may particularly be of benefit in the teenage cohort that has yet to embark on pregnancy.
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Affiliation(s)
- Xin Y Foo
- Mater Mothers' Hospital, South Brisbane, Qld., Australia
| | - Ristan M Greer
- Mater Research Institute - University of Queensland, South Brisbane, Qld., 4101, Australia
| | - Sailesh Kumar
- Mater Mothers' Hospital, South Brisbane, Qld., Australia.,Mater Research Institute - University of Queensland, South Brisbane, Qld., 4101, Australia.,School of Medicine, Herston, Brisbane, Qld., Australia
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16
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Liu P, Xu L, Wang Y, Zhang Y, Du Y, Sun Y, Wang Z. Association between perinatal outcomes and maternal pre-pregnancy body mass index. Obes Rev 2016; 17:1091-1102. [PMID: 27536879 DOI: 10.1111/obr.12455] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To quantify the association between maternal pre-pregnancy body mass index (BMI) and perinatal outcomes. METHODS We systematically reviewed and collected studies on maternal pre-pregnancy BMI and perinatal outcomes published up to 31 August 2015. For each study, we constructed separate two-by-two tables to calculate the odds ratios (ORs) and 95% confidence intervals (CI). RESULTS A total of 60 studies involving 1,392,799 women were included, and the proportions of obesity, overweight, normal weight and underweight pregnant women were 11.72%, 22.08%, 58.03% and 8.18%, respectively. When mothers were overweight or obese, their infants had a significantly higher risk of being large for gestational age (OR, 1.45, 95%CI, 1.29-1.63 and 1.88, 95%CI, 1.67-2.11, respectively), having macrosomia (OR, 1.70, 95%CI, 1.55-1.87 and 2.92, 95%CI, 2.67-3.20, respectively), being admitted to the neonatal intensive care unit (OR, 1.29, 95%CI, 1.12-1.48 and 1.91, 95%CI, 1.60-2.29, respectively) and being stillborn (OR, 1.27, 95%CI, 1.18-1.36 and 1.81, 95%CI, 1.69-1.93, respectively). When mothers were underweight, their infants had a lower risk of the aforementioned outcomes. However, mothers who were underweight had a higher risk of preterm birth (OR, 1.30, 95%CI, 1.13-1.49) and delivering an infant small for gestational age (OR, 1.67, 95%CI, 1.49-1.87). Importantly, infants had a higher risk of having a low birth weight (LBW) when their mothers were underweight (OR, 1.67, 95%CI, 1.39-2.02) or obese (OR, 1.24, 95%CI, 1.09-1.41). CONCLUSION Being overweight or obese was associated with an increased risk of still birth, large for gestational age, macrosomia, admission to the neonatal intensive care unit and LBW, while being underweight was associated with an increased risk of preterm birth, small for gestational age, and LBW. Women of childbearing age should maintain a normal body mass index before pregnancy.
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Affiliation(s)
- P Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Shandong, China.,Division of Epidemiology Survey, China Animal Health and Epidemiology Center, Ministry of Agriculture, Beijing, China
| | - L Xu
- Department of Health, Jinan Maternal and Child Care Service Centre, Shandong, China
| | - Y Wang
- Division of Epidemiology Survey, China Animal Health and Epidemiology Center, Ministry of Agriculture, Beijing, China
| | - Y Zhang
- Division of Epidemiology Survey, China Animal Health and Epidemiology Center, Ministry of Agriculture, Beijing, China
| | - Y Du
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Shandong, China
| | - Y Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Shandong, China
| | - Z Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Shandong, China.
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Xu Z, Wen Z, Zhou Y, Li D, Luo Z. Inadequate weight gain in obese women and the risk of small for gestational age (SGA): a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2016; 30:357-367. [PMID: 27033234 DOI: 10.3109/14767058.2016.1173029] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To examine the association between small for gestational age (SGA) and inadequate gestational weight gain (GWG) in obese women (compared with Institute of Medicine [IOM] guidelines) stratified by obesity classes. METHODS We conducted a meta-analysis of original researches with sufficient information about inadequate GWG in obese women stratified by obesity classes. SGA as the chief outcome was extracted and assessed in our analysis. MEDLINE and EMBASE were searched through Ovid from 28 May 2009 to 1 December 2015. Quality was assessed using a modified Newcastle-Ottawa scale. RESULTS 480 citations were screened and 13 studies (437 512 obese women) were included. Obese women who gained weight below the guidelines had higher risks of SGA than those who gained weight within the guidelines (OR 1.28; 95% CI 1.14-1.43). The same conclusions were also confirmed in Class I, Class II and Class III of obese women: Class I (OR 1.37; 95% CI 1.22-1.54); Class II (OR 1.38; 95% CI 1.24-1.54); Class III (OR 1.25; 95% CI 1.14-1.36). CONCLUSIONS From our analysis, the guidelines of IOM can be applied to all the classes of obesity. More accurate boundaries for each obesity class should be established to evaluate the maternal and fetal risks. Diverse populations are thus necessary for more studies in the future.
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Affiliation(s)
- Zhou Xu
- a The College of Clinical Medicine, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Zhenxing Wen
- a The College of Clinical Medicine, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Yuhan Zhou
- b The College of Clinical Pediatrics, Chongqing Medical University , Chongqing , China
| | - Duanhua Li
- c Sichuan Industrial Institute of Antibiotics, Chengdu University , Chengdu , China
| | - Zhongli Luo
- d Molecular Medicine and Cancer Research Center, Chongqing Medical University , Chongqing , China , and.,e The College of Basic Medical Sciences, Chongqing Medical University , Chongqing , China
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Maternal obesity in Europe: where do we stand and how to move forward?: A scientific paper commissioned by the European Board and College of Obstetrics and Gynaecology (EBCOG). Eur J Obstet Gynecol Reprod Biol 2016; 201:203-8. [PMID: 27160501 DOI: 10.1016/j.ejogrb.2016.04.005] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/15/2016] [Indexed: 11/22/2022]
Abstract
Paralleling the global epidemic of obesity figures in the general population, the incidence of maternal obesity (BMI>30kg/m(2) at the start of pregnancy) has been rising over the last world. While most European countries do not systematically report obesity figures in their pregnant population, the prevalence of maternal obesity varies from 7 to 25% and seems strongly related to social and educational inequalities. Obesity during pregnancy represents an important preventable risk factor for adverse pregnancy outcomes and is associated with negative long-term health outcomes for both mothers and offspring. These effects are often aggravated by the high incidence of abnormal glucose tolerance and excessive gestational weight gain found in this group. The main controversies around the management of the obese pregnant women are related to (1) the value of repeated weighing during pregnancy, (2) the optimal gestational weight gain to advise and the lifestyle messages to deliver in order to achieve this, (3) the optimal strategy and timing of screening for gestational diabetes (GDM) and (4) the optimal timing and mode of delivery. These controversies are reviewed in this review, with the exception of screening for gestational diabetes that is discussed extensively elsewhere in this issue (Benhalima et al.). An agenda for research is proposed with the hope that it will catch the attention of policy-makers and funders and ultimately lead to the development of European-wide evidence-based guidelines for clinicians.
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Cantonwine DE, Ferguson KK, Mukherjee B, Chen YH, Smith NA, Robinson JN, Doubilet PM, Meeker JD, McElrath TF. Utilizing Longitudinal Measures of Fetal Growth to Create a Standard Method to Assess the Impacts of Maternal Disease and Environmental Exposure. PLoS One 2016; 11:e0146532. [PMID: 26731406 PMCID: PMC4701464 DOI: 10.1371/journal.pone.0146532] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 12/19/2015] [Indexed: 11/18/2022] Open
Abstract
Impaired or suboptimal fetal growth is associated with an increased risk of perinatal morbidity and mortality. By utilizing readily available clinical data on the relative size of the fetus at multiple points in pregnancy, including delivery, future epidemiological research can improve our understanding of the impacts of maternal, fetal, and environmental factors on fetal growth at different windows during pregnancy. This study presents mean and standard deviation ultrasound measurements from a clinically representative US population that can be utilized for creating Z-scores to this end. Between 2006 and 2012, 18, 904 non-anomalous pregnancies that received prenatal care, first and second trimester ultrasound evaluations, and ultimately delivered singleton newborns at Brigham and Women's hospital in Boston were used to create the standard population. To illustrate the utility of this standard, we created Z-scores for ultrasound and delivery measurements for a cohort study population and examined associations with factors known to be associated with fetal growth. In addition to cross-sectional regression models, we created linear mixed models and generalized additive mixed models to illustrate how these scores can be utilized longitudinally and for the identification of windows of susceptibility. After adjustment for a priori confounders, maternal BMI was positively associated with increased fetal size beginning in the second trimester in cross-sectional models. Female infants and maternal smoking were associated with consistently reduced fetal size in the longitudinal models. Maternal age had a non-significant association with increased size in the first trimester that was attenuated as gestation progressed. As the growth measurements examined here are widely available in contemporary obstetrical practice, these data may be abstracted from medical records by investigators and standardized with the population means presented here. This will enable easy extension of clinical data to epidemiologic studies investigating novel maternal, fetal, and environmental factors that may impact fetal growth.
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Affiliation(s)
- David E. Cantonwine
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- * E-mail:
| | - Kelly K. Ferguson
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Yin-Hsiu Chen
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Nicole A. Smith
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Julian N. Robinson
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Peter M. Doubilet
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - John D. Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Thomas F. McElrath
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
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20
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Obésité et primiparité : accouchement à risque ? ACTA ACUST UNITED AC 2015; 44:699-705. [PMID: 25604151 DOI: 10.1016/j.jgyn.2014.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/07/2014] [Accepted: 12/01/2014] [Indexed: 11/23/2022]
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21
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Faucher MA, Barger MK. Gestational weight gain in obese women by class of obesity and select maternal/newborn outcomes: A systematic review. Women Birth 2015; 28:e70-9. [DOI: 10.1016/j.wombi.2015.03.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 03/25/2015] [Accepted: 03/27/2015] [Indexed: 11/16/2022]
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22
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Lutsiv O, Mah J, Beyene J, McDonald SD. The effects of morbid obesity on maternal and neonatal health outcomes: a systematic review and meta-analyses. Obes Rev 2015; 16:531-46. [PMID: 25912896 DOI: 10.1111/obr.12283] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/27/2015] [Accepted: 03/03/2015] [Indexed: 12/22/2022]
Abstract
Morbidly obese (Class III, body mass index [BMI] ≥ 40 kg m(-2)) women constitute 8% of reproductive-aged women and are an increasing proportion; however, their pregnancy risks have not yet been well understood. Hence, we performed meta-analyses following the MOOSE (Meta-Analysis of Observational Studies in Epidemiology) guideline, searching Medline and Embase from their inceptions. To examine graded relationships, we compared Class III obesity to Class I and I/II, and separately to normal weight. We found important effects on all three primary outcomes in morbidly obese women: preterm birth <37 weeks was 31% higher compared with Class I (relative risk [RR] 1.31 [1.19, 1.43]) and 20% higher than Class I/II (RR 1.20 [1.13, 1.27]), large-for-gestational age was higher (RR 1.37 [1.29, 1.45] and RR 1.30 [1.24, 1.36] compared with Class I and I/II, respectively), while small-for-gestational age was lower (RR 0.89 [0.84, 0.93] compared with Class I, with nearly identical reductions for Class I/II). Morbidly obese women have higher risks of preterm birth, large-for-gestational age and numerous other adverse maternal and infant health outcomes, relative to not only normal weight but also Class I or I/II obese women. These findings have important implications for screening and care of morbidly obese pregnant women, to try to decrease adverse outcomes.
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Affiliation(s)
- O Lutsiv
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON, Canada
| | - J Mah
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - J Beyene
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
| | - S D McDonald
- Canada Research Chair in Maternal and Child Obesity Intervention and Prevention, Departments of Obstetrics & Gynecology, Radiology, and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
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23
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Lim CC, Mahmood T. Obesity in pregnancy. Best Pract Res Clin Obstet Gynaecol 2015; 29:309-19. [DOI: 10.1016/j.bpobgyn.2014.10.008] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 10/24/2014] [Indexed: 11/24/2022]
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24
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Vinturache AE, McDonald S, Slater D, Tough S. Perinatal outcomes of maternal overweight and obesity in term infants: a population-based cohort study in Canada. Sci Rep 2015; 5:9334. [PMID: 25791339 PMCID: PMC4366803 DOI: 10.1038/srep09334] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 02/24/2015] [Indexed: 11/30/2022] Open
Abstract
The objective of this study was to assess the impact of increased pre-pregnancy maternal body mass index (BMI) on perinatal outcomes in term, singleton pregnancies who received prenatal care in community-based practices. The sample of 1996 infants included in the study was drawn from the All Our Babies Study, a prospective pregnancy cohort from Calgary. Multivariable logistic regression explored the relationship between the main outcomes, infant birth weight, Apgar score, admission to neonatal intensive care (NICU) and newborn duration of hospitalization, and BMI prior to pregnancy. Approximately 10% of the infants were macrosoms, 1.5% had a low Apgar score (<7 at 5 min), 6% were admitted to intensive care and 96% were discharged within 48 h after delivery. Although the infants of overweight and obese women were more likely to have increased birth weight as compared to infants of normal weight women, there were no differences in Apgar score, admission to NICU, or length of postnatal hospital stay among groups. This study suggests that in otherwise healthy term, singleton pregnancies, obesity does not seem to increase the risk of severe fetal impairment, neonatal admission to intensive care or duration of postnatal hospitalization.
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Affiliation(s)
- Angela Elena Vinturache
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
- Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
- Alberta Children's Hospital Research Institute for Child and Maternal Health (ACHRI), Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | - Sheila McDonald
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
- Alberta Children's Hospital Research Institute for Child and Maternal Health (ACHRI), Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | - Donna Slater
- Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
- Alberta Children's Hospital Research Institute for Child and Maternal Health (ACHRI), Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | - Suzanne Tough
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
- Alberta Children's Hospital Research Institute for Child and Maternal Health (ACHRI), Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
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Dekker Nitert M, Barrett HL, Denny KJ, McIntyre HD, Callaway LK. Exercise in pregnancy does not alter gestational weight gain, MCP-1 or leptin in obese women. Aust N Z J Obstet Gynaecol 2015; 55:27-33. [DOI: 10.1111/ajo.12300] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 11/11/2014] [Indexed: 01/10/2023]
Affiliation(s)
- Marloes Dekker Nitert
- School of Medicine; The University of Queensland; Herston Queensland Australia
- UQ Centre for Clinical Research; The University of Queensland; Herston Queensland Australia
| | - Helen L. Barrett
- School of Medicine; The University of Queensland; Herston Queensland Australia
- UQ Centre for Clinical Research; The University of Queensland; Herston Queensland Australia
| | - Kerina J. Denny
- School of Biomedical Science; The University of Queensland; St Lucia Queensland Australia
| | - H. David McIntyre
- School of Medicine; The University of Queensland; Herston Queensland Australia
- Mater Health Services; South Brisbane Queensland Australia
| | - Leonie K. Callaway
- School of Medicine; The University of Queensland; Herston Queensland Australia
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Gaudet L, Ferraro ZM, Wen SW, Walker M. Maternal obesity and occurrence of fetal macrosomia: a systematic review and meta-analysis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:640291. [PMID: 25544943 PMCID: PMC4273542 DOI: 10.1155/2014/640291] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 11/09/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine a precise estimate for the contribution of maternal obesity to macrosomia. DATA SOURCES The search strategy included database searches in 2011 of PubMed, Medline (In-Process & Other Non-Indexed Citations and Ovid Medline, 1950-2011), and EMBASE Classic + EMBASE. Appropriate search terms were used for each database. Reference lists of retrieved articles and review articles were cross-referenced. METHODS OF STUDY SELECTION All studies that examined the relationship between maternal obesity (BMI ≥30 kg/m(2)) (pregravid or at 1st prenatal visit) and fetal macrosomia (birth weight ≥4000 g, ≥4500 g, or ≥90th percentile) were considered for inclusion. TABULATION, INTEGRATION, AND RESULTS Data regarding the outcomes of interest and study quality were independently extracted by two reviewers. Results from the meta-analysis showed that maternal obesity is associated with fetal overgrowth, defined as birth weight ≥ 4000 g (OR 2.17, 95% CI 1.92, 2.45), birth weight ≥4500 g (OR 2.77,95% CI 2.22, 3.45), and birth weight ≥90% ile for gestational age (OR 2.42, 95% CI 2.16, 2.72). CONCLUSION Maternal obesity appears to play a significant role in the development of fetal overgrowth. There is a critical need for effective personal and public health initiatives designed to decrease prepregnancy weight and optimize gestational weight gain.
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Affiliation(s)
- Laura Gaudet
- University of Ottawa, Faculty of Medicine, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6
- Ottawa Hospital Research Institute, Ottawa, ON, Canada K1H 8L6
| | - Zachary M. Ferraro
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6
- Healthy Active Living and Obesity (HALO) Research Group, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada K1H 8L1
| | - Shi Wu Wen
- Ottawa Hospital Research Institute, Ottawa, ON, Canada K1H 8L6
| | - Mark Walker
- University of Ottawa, Faculty of Medicine, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6
- Ottawa Hospital Research Institute, Ottawa, ON, Canada K1H 8L6
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27
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Kobayashi N, Lim BH. Induction of labour and intrapartum care in obese women. Best Pract Res Clin Obstet Gynaecol 2014; 29:394-405. [PMID: 25441151 DOI: 10.1016/j.bpobgyn.2014.07.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 07/23/2014] [Indexed: 10/24/2022]
Abstract
The rising incidence of obesity in pregnancy has a significant impact on the provision of health services around the world. Due to the pathophysiological processes associated with the condition, the obese pregnant woman is at increased risks of induction of labour, caesarean section, post-partum haemorrhage, infection, longer hospital stay, macrosomia and higher perinatal morbidity and mortality. Labour is more likely to be prolonged and dysfunctional, leading to the requirements for higher doses of oxytocin and increased risks of operative deliveries and morbidity. A multidisciplinary approach to the planning of antenatal, intrapartum and postnatal care is vital to ensure a safe outcome for the obese pregnant woman and her baby. The need for supervision and attendance by senior obstetric staff is increased, emphasising the need to identify the appropriate place of birth for this high-risk group of women, placing a significant strain on the resources of health-care providers.
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Affiliation(s)
- Namiko Kobayashi
- Department of Obstetrics and Gynaecology, Royal Hobart Hospital, Liverpool Street, Hobart, TAS 7000, Australia.
| | - Boon H Lim
- Department of Obstetrics and Gynaecology, Royal Hobart Hospital, Liverpool Street, Hobart, TAS 7000, Australia.
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Doyle TJ, Goodin K, Hamilton JJ. Maternal and neonatal outcomes among pregnant women with 2009 pandemic influenza A(H1N1) illness in Florida, 2009-2010: a population-based cohort study. PLoS One 2013; 8:e79040. [PMID: 24205364 PMCID: PMC3812024 DOI: 10.1371/journal.pone.0079040] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 09/18/2013] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Pregnant women have been identified as a high risk group for severe illness with 2009 pandemic influenza A(H1N1) virus infection (pH1N1). Obesity has also been identified as a risk factor for severe illness, though this has not been thoroughly assessed among pregnant women. The objectives of this study were to provide risk estimates for adverse maternal and neonatal outcomes associated with pH1N1 illness during pregnancy and to assess the role of obesity in these outcomes. METHODS We established a retrospective population-based cohort of all live births occurring in Florida during the first 15 months of the pandemic. Illness with pH1N1 during pregnancy was ascertained through record linkage with the Florida state notifiable disease surveillance database. Data from the birth record, including pre-pregnancy body mass index, were analyzed to assess risk of adverse outcomes associated with pH1N1 illness. RESULTS A total of 194 women were identified through surveillance with pH1N1 illness during pregnancy. Children born to women with pH1N1 illness during pregnancy were at increased risk for low birth weight [OR (95%CI): 1.78 (1.11-2.860)], premature birth [2.21 (1.47-3.330)], and infant death [4.46 (1.80-11.00)], after adjusting for other factors. Women with pH1N1 illness during pregnancy were at increased risk for severe outcomes including admission to an intensive care unit. Obesity was an observed risk factor, both for the more severe pH1N1 illness detected through surveillance, and for severe maternal outcomes. CONCLUSIONS Case-patients in this analysis likely represent the most severely ill subset of all women infected with pH1N1 during pregnancy, limiting the generalizability of these findings to more severely ill patients rather than influenza infection in general. Nevertheless, these results suggest that more severe pH1N1 illness during pregnancy is associated with adverse neonatal outcomes and that pregnant women should continue to be targeted for appropriate prophylaxis and early treatment.
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Affiliation(s)
- Timothy J. Doyle
- Florida Department of Health, Bureau of Epidemiology, Tallahassee, Florida, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kate Goodin
- Florida Department of Health, Bureau of Epidemiology, Tallahassee, Florida, United States of America
| | - Janet J. Hamilton
- Florida Department of Health, Bureau of Epidemiology, Tallahassee, Florida, United States of America
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Amiri FN, Basirat Z, Omidvar S, Sharbatdaran M, Tilaki KH, Pouramir M. Comparison of the serum iron, ferritin levels and total iron-binding capacity between pregnant women with and without gestational diabetes. J Nat Sci Biol Med 2013; 4:302-5. [PMID: 24082721 PMCID: PMC3783769 DOI: 10.4103/0976-9668.116977] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is the most common metabolic disorder during pregnancy. GDM causes substantial morbidity and mortality and long- term complications. GDM-related risk factors have not been completely identified yet. Some studies have found relationship between increased serum ferritin and impaired oral glucose tolerance test but the relationship between serum ferritin and risk of GDM has been controversial. The aim of the study was to determine serum iron and ferritin levels and total iron binding capacity (TIBC) in women with GDM and comparison with normal pregnant women. MATERIALS AND METHODS This case-control study was performed among 200 pregnant women (case = 100, control = 100) who were referred to Yahya-Nejad Hospital in the second trimester in Babol from 2008 to 2009. GDM was diagnosed by impaired OGTT based on Carpenter and Coustan criteria. The 2 groups were matched in age, gestational age and parity. RESULTS High serum ferritin level increased the risk of gestational diabetes to 2.4-fold [OR = 2.4 (0.83-6.9) CI = 95% (P = 0.10)], while in those with low ferritin levels, the risk of developing gestational diabetes was reduced to 82% [OR = 0.8 with (0.08-0.37) CI = 95% (P = 0.001)]. Using the logistic regression model, after adjustment for BMI, the OR was 2.37 [(0.80-7.01) CI = 95% (P = 0.11)] for low ferritin level and OR = 0.20 [(0.09-0.44) CI = 95% (P = 0.0001)] for high ferritin level, which was statistically significant. CONCLUSION The serum ferritin level was markedly higher in women with gestational diabetes than in normal pregnant women; therefore, high ferritin can be regarded as a significant risk factor for the development of gestational diabetes.
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Affiliation(s)
- Fatemeh Nasiri Amiri
- Department of Nursing and Midwifery, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Basirat
- Department of Gynecology and Obstetrics, Babol University of Medical Sciences, Babol, Iran
| | - Shabnam Omidvar
- Department of Nursing and Midwifery, Babol University of Medical Sciences, Babol, Iran
| | - Majid Sharbatdaran
- Department of Pathology, Babol University of Medical Sciences, Babol, Iran
| | | | - Mahdi Pouramir
- Biophysics and Biochemistry Faculty Member of Babol University of Medical Sciences, Babol, Iran
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Scott-Pillai R, Spence D, Cardwell CR, Hunter A, Holmes VA. The impact of body mass index on maternal and neonatal outcomes: a retrospective study in a UK obstetric population, 2004-2011. BJOG 2013; 120:932-9. [DOI: 10.1111/1471-0528.12193] [Citation(s) in RCA: 200] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2013] [Indexed: 11/27/2022]
Affiliation(s)
- R Scott-Pillai
- School of Nursing and Midwifery; Queen's University; Belfast; UK
| | - D Spence
- School of Nursing and Midwifery; Queen's University; Belfast; UK
| | - CR Cardwell
- Centre for Public Health; School of Medicine; Dentistry and Biomedical Sciences; Queen's University; Belfast; UK
| | - A Hunter
- Royal Jubilee Maternity Service; Belfast Health and Social Care Trust; Belfast; UK
| | - VA Holmes
- Centre for Public Health; School of Medicine; Dentistry and Biomedical Sciences; Queen's University; Belfast; UK
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The Impact of Increasing Obesity Class on Obstetrical Outcomes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:224-233. [DOI: 10.1016/s1701-2163(15)30994-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bogaerts A, Witters I, Van den Bergh BRH, Jans G, Devlieger R. Obesity in pregnancy: altered onset and progression of labour. Midwifery 2013; 29:1303-13. [PMID: 23427851 DOI: 10.1016/j.midw.2012.12.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/27/2012] [Accepted: 12/20/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND the incidence of obesity increases in all developed countries to frightful percentages, also in women of reproductive age. Maternal obesity is associated with important obstetrical complications; and this group also exhibits a higher incidence of prolonged pregnancies and labours. OBJECTIVE to review the literature on the pathophysiology of onset and progression of labour in obese woman and translate this knowledge into practical recommendations for clinical management. METHODS a literature review, in particular a critical summary of research, in order to determine associations, gaps or inconsistencies in this specific but limited body of research. FINDINGS the combination of a higher incidence of post-term childbirths and increased inadequate contraction pattern during the first stage of labour suggests an influence of obesity on myometrial activity. A pathophysiologic pathway for altered onset and progression of labour in obese pregnant women is proposed. CONCLUSIONS analysis of the literature shows that obesity is associated with an increased duration of pregnancy and prolonged duration of first stage of labour. IMPLICATIONS FOR PRACTICE an adapted clinical approach is suggested in these patients.
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Affiliation(s)
- Annick Bogaerts
- Limburg Catholic University College, PHL University College, Department of PHL-Healthcare Research, Oude Luikerbaan, 79, 3500 Hasselt, Belgium
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Kaplan-Sturk R, Åkerud H, Volgsten H, Hellström-Westas L, Wiberg-Itzel E. Outcome of deliveries in healthy but obese women: obesity and delivery outcome. BMC Res Notes 2013; 6:50. [PMID: 23388378 PMCID: PMC3573993 DOI: 10.1186/1756-0500-6-50] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 01/22/2013] [Indexed: 11/29/2022] Open
Abstract
Background Obesity among fertile women is a global problem. 25% of pregnant Swedish women are overweight at admission to the antenatal clinic and 12% of them are considered as obese. Previous studies have shown an increased risk of delivery complications with an elevated maternal BMI. The aim of this study was to evaluate delivery outcomes in relation to maternal BMI on admission to the antenatal clinic. A healthy group of 787 women with full-term pregnancies and spontaneous onset of labor were included in the study. Delivery outcome was assessed in relation to maternal BMI when attending the antenatal clinic. Results The results indicated that in deliveries where the maternal BMI was >30 a high frequency of abnormal CTG trace during the last 30 minutes of labor was shown. A blood sample for evaluation of risk of fetal hypoxia was performed in only eight percent of these deliveries. A spontaneous vaginal delivery without intervention was noted in 85.7%, and 12% of neonates were delivered with an adverse fetal outcome compared to 2.8% in the group with a maternal BMI<30 (p<0.001). Conclusion These results indicate an increased risk at delivery for healthy, but obese women in labor. Furthermore, the delivery management may not always be optimal in these deliveries.
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Affiliation(s)
- Rebecka Kaplan-Sturk
- Department of Clinical Science and Education, Section of Obstetrics and Gynecology, Karolinska Institute, Soder Hospital, Stockholm 118 83, Sweden
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Carolan M, Gill GK, Steele C. Women's experiences of factors that facilitate or inhibit gestational diabetes self-management. BMC Pregnancy Childbirth 2012; 12:99. [PMID: 22988897 PMCID: PMC3561108 DOI: 10.1186/1471-2393-12-99] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 09/10/2012] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Gestational diabetes rates have increased dramatically in the past two decades and this pattern of increase appears to relate primarily to the obesity epidemic, older maternal age and migration from world areas of high GDM risk. Women from disadvantaged and migrant backgrounds are most at risk of developing and of mismanaging this condition. The aim of the study was to explore the factors that facilitated or inhibited gestational diabetes self-management among women in a socially deprived area. METHODS Fifteen pregnant women, with a diagnosis of gestational diabetes, were purposively recruited for this study. Qualitative semi structured interviews and 1 focus group were conducted when participants were approximately 28-38 weeks gestation. The study's theoretical framework was based on interpretative phenomenology and data was analysed using a thematic analysis approach. RESULTS Women in this study identified a number of factors that complicated their task of GDM self-management. Barriers included: (1) time pressures; (2) physical constraints; (3) social constraints; (4) limited comprehension of requirements, and (5) insulin as an easier option. Factors facilitating GDM self-management included: thinking about the baby and psychological support from partners and families. CONCLUSION Women from low socio economic and migrant backgrounds often struggle to comprehend GDM self-management requirements. To improve adherence to management plans, these women require educational and supportive services that are culturally appropriate and aimed at a low level of literacy.
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Affiliation(s)
- Mary Carolan
- School of Nursing and Midwifery, St Alban's Campus, Victoria University, PO Box 14228, Melbourne 8001, Australia.
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Women's experiences of gestational diabetes self-management: a qualitative study. Midwifery 2012; 29:637-45. [PMID: 22877761 DOI: 10.1016/j.midw.2012.05.013] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Revised: 05/15/2012] [Accepted: 05/31/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVE to explore women's experiences of self-managing their gestational diabetes. DESIGN AND PARTICIPANTS the study design was informed by interpretive phenomenological analysis. Data was collected using semi-structured interviews and one focus group. Participants included 15 women with a diagnosis of gestational diabetes who had experienced self-management of their condition. RESULTS incremental adjustment occurred over 4 discrete themes, including: (1) the shock of diagnosis; (2) coming to terms with GDM; (3) working it out/learning new strategies; (4) looking to the future. Each adjustment phase was underpinned by the fifth theme (5) having a supportive environment. Throughout, participants reported that thinking about the baby was a powerful motivator for adherence to gestational diabetes management regimens. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE this study has shown that women undergo a process of adjustment following GDM diagnosis as they learn to self-manage their condition. The process is largely facilitated by the women's interest in maximising fetal health which may make them receptive to interventions to improve GDM control and to prevent type 2 diabetes in the future.
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Frederiks F, Lee S, Dekker G. Risk factors for failed induction in nulliparous women. J Matern Fetal Neonatal Med 2012; 25:2479-87. [PMID: 22784221 DOI: 10.3109/14767058.2012.703718] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To identify risk factors for failed induction in nulliparous women. MATERIAL AND METHODS A retrospective cohort study of nulliparous women admitted for induction of labour (IOL). Identification of risk factors for failed IOL by comparing clinical characteristics of patients with a failed IOL defined as birth by caesarean section (LSCS) with those achieving vaginal birth. RESULTS During a 12 month episode, 400 nulliparous women had an IOL; of these 168 (42%) failed to deliver vaginally. Independent antenatal risk factors for failed IOL were higher maternal age (OR = 1.052 per additional year), being shorter (OR = 1.112 per cm less maternal height) and a lower cervical dilatation score (OR = 1.411 per lower cervical dilatation score). A longer active phase (OR = 1.004 per additional minute) was the only independent intrapartum risk factor for having a LSCS. CONCLUSIONS Maternal age, height and cervical dilatation are independent antepartum risk factors, while duration of active phase is the single independent intrapartum risk factor for a failed IOL. Increased maternal BMI was less of a risk factor than anticipated with increased risk for failed IOL, as independent risk factor, more or less restricted to the morbidly obese women.
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Affiliation(s)
- Femke Frederiks
- Women and Children's Division, Lyell McEwin Hospital, University of Adelaide, Adelaide, Australia
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Kongubol A, Phupong V. Prepregnancy obesity and the risk of gestational diabetes mellitus. BMC Pregnancy Childbirth 2011; 11:59. [PMID: 21827716 PMCID: PMC3170228 DOI: 10.1186/1471-2393-11-59] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 08/10/2011] [Indexed: 11/10/2022] Open
Abstract
Background Prepregnancy obesity is associated with increased risk for adverse pregnancy outcome such as gestational diabetes mellitus (GDM), gestational hypertension, preeclampsia, fetal macrosomia and the need for cesarean delivery. The objectives of this study assessed whether Thai women classified as obese according to WHO's recommended body mass index (BMI) for Asians were at risk for developing gestational diabetes mellitus (GDM) and other complications such as preeclampsia, gestational hypertension and fetal macrosomia. Methods Two hundred and forty women participated in this study and followed prospectively until delivery. Half of the women (n = 120) were obese (BMI ≥ 27.5 kg/m2) and the other half (n = 120) had normal weight (BMI > 18.5-23 kg/m2). Maternal demographic data, obstetric and neonatal outcomes from both groups were compared to each other. Relative risk and 95% confidence interval (CI) were calculated. Results Compared to normal weight women, obese Thai women were not at increased risk for gestational diabetes mellitus (RR = 0.9 [95% CI 0.6-1.4]). Relative risk of preeclampsia and fetal macrosomia in obese women were 0.7 [95% CI 0.2-3.3] and 1.4 [95% CI 0.5-4.3], respectively. Relative risk of gestational hypertension in obese women was 12 [95% CI 1.6-90.8]. Conclusion When WHO's classification of obesity was used for Asian populations, prepregnancy obesity without metabolic problems did not increase the risk for GDM, preeclampsia and fetal macrosomia in Thai women. But, prepregnancy obesity continued to increase the risk for developing gestational hypertension.
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Affiliation(s)
- Anussara Kongubol
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok 10330, Thailand
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Risk of first-stage and second-stage cesarean delivery by maternal body mass index among nulliparous women in labor at term. Obstet Gynecol 2011; 117:1315-1322. [PMID: 21606741 DOI: 10.1097/aog.0b013e318217922a] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate in a cohort of nulliparous women in labor at term whether cesarean delivery rates are increased in first and second stages of labor in overweight and obese women and whether being overweight or obese is an independent risk factor for cesarean delivery. METHODS Nulliparous women recruited to the prospective Screening for Pregnancy Endpoints study who went into labor after 37 weeks of gestation were categorized according to ethnicity-specific body mass index (BMI) criteria as normal, overweight, or obese. Normal BMI was the referent. Multivariable analysis, adjusting for known confounders for obesity and cesarean delivery, was performed to estimate if being overweight or obese was associated with an increased risk of cesarean in labor (all cesarean deliveries and in first stage of labor). RESULTS Of 2,629 participants, 1,416 (54%) had normal BMIs, 773 (29%) were overweight, and 440 (17%) were obese. First-stage cesarean delivery was increased in overweight (n=149 [19%]) and obese (n=137 [31%]) women compared with normal-weight women (n=181 [13%; P<.001), whereas second-stage cesarean delivery was similar (normal BMI 76 [6.2%], overweight 45 [7.2%], obese 23 [7.6%], P=.87). Being overweight or obese was an independent risk factor for all cesarean deliveries in labor with adjusted odds ratio (OR) of 1.34 (95% confidence interval [CI] 1.07-1.67) and 2.51 (95% CI 1.94-3.25), respectively. Similarly, being overweight (adjusted OR 1.39; 95% CI 1.09-1.79) or obese (adjusted OR 2.89; 95% CI 2.19-3.80) was associated with increased cesarean delivery during the first stage. Risks of cesarean delivery were similar regardless of whether ethnicity-specific or World Health Organization (WHO) BMI criteria were used. CONCLUSION Among nulliparous women in labor at term, being overweight or obese by either WHO or ethnicity-specific BMI criteria is an independent risk factor for cesarean delivery in the first stage but not the second stage of labor. CLINICAL TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, www.anzctr.org.au, ACTRN12607000551493.
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Associations of maternal obesity with blood pressure and the risks of gestational hypertensive disorders. The Generation R Study. J Hypertens 2011; 29:937-44. [DOI: 10.1097/hjh.0b013e328345500c] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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GREEN C, SHAKER D. Impact of morbid obesity on the mode of delivery and obstetric outcome in nulliparous singleton pregnancy and the implications for rural maternity services. Aust N Z J Obstet Gynaecol 2011; 51:172-4. [DOI: 10.1111/j.1479-828x.2010.01271.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Choi SK, Park IY, Shin JC. The effects of pre-pregnancy body mass index and gestational weight gain on perinatal outcomes in Korean women: a retrospective cohort study. Reprod Biol Endocrinol 2011; 9:6. [PMID: 21241516 PMCID: PMC3033321 DOI: 10.1186/1477-7827-9-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 01/18/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of the study was to evaluate the effects of maternal pre-pregnancy body mass index (BMI) and gestational weight gain on perinatal outcomes in a population of Korean women. METHODS We retrospectively reviewed the medical records of 2,454 women who had received antenatal care at Seoul St. Mary's Hospital from January 2007 to December 2009. We used World Health Organization definitions for Asian populations of underweight (BMI < 18.5), normal (BMI equal or higher 18.5 and < 23), overweight (BMI equal or higher 23 and < 25), and obese (BMI equal or higher 25). We analyzed perinatal outcomes according to the pre-pregnancy BMI and weight gain during pregnancy, and calculated the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) from multiple logistic regression models by considering maternal age, parity, number of fetuses, length of gestation, and medical history. RESULTS Among obese women, the adjusted ORs for gestational diabetes, hypertensive disorder, and incompetent internal os of cervix were 4.46, 2.53, and 3.70 (95% CI = 2.63-7.59, 1.26-5.07, and 1.50-9.12), respectively, and the adjusted ORs for neonatal complications such as macrosomia and low Apgar score were 2.08 and 1.98 (95% CI = 1.34-3.22 and 1.19-3.29), respectively, compared with normal weight women. However, there was no positive linear association between gestational weight gain and obstetric outcomes. In normal weight women, maternal and neonatal complications were significantly increased with inadequate weight gain during pregnancy (p < 0.0001 and = 0.0180, respectively), and we observed similar results in underweight women (p = 0.0136 and 0.0004, respectively). CONCLUSIONS This study shows that pre-pregnancy overweight and obesity are more closely related to the adverse obstetric outcomes than excess weight gain during pregnancy. In addition, inadequate weight gain during pregnancy can result in significant complications.
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Affiliation(s)
- Sae-Kyung Choi
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul, Korea
| | - In-Yang Park
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul, Korea
| | - Jong-chul Shin
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul, Korea
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A maternal high-fat diet in rat pregnancy reduces growth of the fetus and the placental junctional zone, but not placental labyrinth zone growth. J Dev Orig Health Dis 2011. [DOI: 10.1017/s2040174410000681] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Maternal obesity during pregnancy is often characterized by fetal macrosomia but it can also result in fetal growth restriction in a subset of pregnancies. We hypothesized that mechanisms of this growth restriction may include adverse effects of maternal high fat (HF) intake on placental growth and function. Female rats (100 days old) were time-mated and randomly assigned to either a control (Con) or HF diet ad libitum throughout gestation. At E21, dams were killed; litter size and fetal and placental weights were recorded and maternal and fetal samples collected for further analyses. The HF diet resulted in a 54% increase in maternal body weight gain during gestation. In contrast, male and female fetal weights were reduced in HF pregnancies (P < 0.05), as were the weights of the junctional zone of the placenta (P = 0.013), whereas labyrinth zone weights were unaffected. The HF diet increased maternal and fetal plasma leptin levels (P < 0.05), but maternal and fetal insulin and fetal glucose levels were unaffected. Labyrinthine expression of PPARγ and total VEGFa mRNA, both markers of placental vascular development, were unaffected by consumption of the HF diet in placentas of male and female fetuses. Furthermore, maternal HF nutrition did not alter phosphorylated protein levels of either mammalian target of rapamycin or its downstream signaling factor eIF4E binding protein 1 (4E-BP1). These data show that in the rat, maternal HF nutrition results in fetal and placental junctional zone growth restriction, maternal and fetal hyperleptinemia but did not alter gene expression of markers of placental vascular development.
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Magann EF, Doherty DA, Chauhan SP, Klimpel JM, Huff SD, Morrison JC. Pregnancy, obesity, gestational weight gain, and parity as predictors of peripartum complications. Arch Gynecol Obstet 2010; 284:827-36. [PMID: 21072526 DOI: 10.1007/s00404-010-1754-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 10/29/2010] [Indexed: 10/18/2022]
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Hinkle SN, Sharma AJ, Dietz PM. Gestational weight gain in obese mothers and associations with fetal growth. Am J Clin Nutr 2010; 92:644-51. [PMID: 20631201 DOI: 10.3945/ajcn.2010.29726] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In 2009, the Institute of Medicine recommended gestational weight gains (GWGs) of 5-9 kg for all obese women. Recommendations by severity of obesity were not specified because of a lack of available data. OBJECTIVE Our objective was to examine associations between GWG and fetal growth in obese women and assess interactions with obesity severity. DESIGN We used 2004-2006 Pregnancy Nutrition Surveillance System data from 122,327 obese mothers [prepregnant body mass index (BMI; in kg/m(2)) ge 30]. We used logistic regression to estimate measures of fetal growth including small-for-gestational-age, which was defined as birth weight (BW) lt 2 SDs below the sex and race-ethnicity-specific mean BW (SGA(2SD)), and macrosomia (BW ge 4500 g). We tested for interactions between obesity severity (class I: BMI of 30-34.9; class II: BMI of 35.0-39.9; class III: BMI ge 40) and GWG. RESULTS Obesity severity modified associations between GWG and fetal growth. Compared with weight gains of 5-9 kg, weight loss in class I women significantly increased the odds of SGA(2SD), whereas a GWG from 0.1 to 4.9 kg was not associated with SGA(2SD) and did not decrease the odds of macrosomia. In class II and III women, compared with weight gains of 5-9 kg, a GWG from minus 4.9 to +4.9 kg was not associated with SGA(2SD) but did decrease the odds of macrosomia. CONCLUSIONS Our study suggests a GWG below the Institute of Medicine guidelines may be associated with more favorable BW for all obese women, and GWG may need to be further defined by obesity severity.
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Obesity and its outcomes among pregnant South African women. Int J Gynaecol Obstet 2010; 110:101-4. [PMID: 20417513 DOI: 10.1016/j.ijgo.2010.02.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 02/16/2010] [Accepted: 03/23/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the prevalence of obesity and its effect on maternal and fetal outcomes among pregnant women at the Johannesburg Hospital, South Africa. METHODS A retrospective study of 767 pregnant women divided into BMI groups. Complications such as pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), urinary tract infection (UTI), preterm labor, preterm rupture of membranes (PROM), induction of labor (IOL), postdates, fetal weight, and fetal outcome were compared among the BMI groups. Seasonal variation in BMI was measured. Descriptive statistics included mean with 95% confidence interval or median with interquartile range. Inferential statistics included t test, chi(2) test, analysis of variance (ANOVA), and analysis of covariance. RESULTS Among the study population, 337 (44%) were obese or morbidly obese. The complications of GDM (P<0.001), UTI (P=0.002), and failed IOL (P=0.003) were significantly more common among morbidly obese women. There was no seasonal variation in BMI. CONCLUSION The prevalence of obesity in pregnancy was high in South African women and was associated with an increase in complications.
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Shaikh H, Robinson S, Teoh TG. Management of maternal obesity prior to and during pregnancy. Semin Fetal Neonatal Med 2010; 15:77-82. [PMID: 19945927 DOI: 10.1016/j.siny.2009.10.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The prevalence of obesity is high and rising worldwide. The greatest prevalence of obesity is found in the western world and in urban developing countries. There is an increased maternal mortality associated with maternal obesity. There are increased risks of most maternal complications in pregnancy including pre-eclampsia, gestational and pre-existing type 2 diabetes mellitus and thromboembolic disorders. There is an increased perinatal mortality associated with maternal obesity; there are increased risks of congenital malformation, fetal macrosomia and indeed risks for the fetus as a child and adult in the years to come. There are increased risks of complications of pregnancy including caesarean section, traumatic delivery and a reduced chance of breastfeeding. Maternal obesity in pregnancy predicts long-term risks for that mother. The management includes increased surveillance for these risks and lifestyle modulation during pregnancy. This includes dietary measures and encouraging modest increase in exercise. Ideally, the mother should achieve closer to an ideal body mass index prior to pregnancy using lifestyle intervention but possibly with pharmacological therapy or bariatric surgery. The ideal weight gain for an obese mother is less than the ideal weight gain for a lean mother.
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Affiliation(s)
- H Shaikh
- Department of Metabolic Medicine, 1st floor Mint Wing, Imperial College School of Medicine at St Mary's Hospital, London W2 1NY, UK
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Second-trimester amniotic fluid proinflammatory cytokine levels in normal and overweight women. Obstet Gynecol 2010; 115:127-133. [PMID: 20027044 DOI: 10.1097/aog.0b013e3181c5367f] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To estimate the relationship between different adipokines and proinflammatory mediators in amniotic fluid and maternal body mass index (BMI), calculated as weight (kg)/height (m)2. METHODS Seventy pregnant women who underwent amniocentesis for clinical reasons at 15-20 weeks of gestation were divided into two groups according to their BMI: a control group with normal weight (BMI 20-24.9, n=35) and a case group (BMI 25 or higher, n=35). The two groups were further divided into two subgroups: overweight (BMI 25-29.9, n=22) or obese (BMI 30 or more, n=13). Comparisons of amniotic fluid cytokines (tumor necrosis factor [TNF]-alpha, interleukin [IL]-8, IL-10, monocyte chemoattractant protein-1, resistin, and leptin) and C-reactive protein (CRP) levels were performed. The relationships between variables and maternal BMI were also analyzed. RESULTS There were significant differences in amniotic fluid CRP and TNF-alpha levels among the studied groups: CRP, 0.018 (+/-0.010), 0.019 (+/-0.013), and 0.035 (+/-0.028) mg/dL (P=.007); and TNF-alpha, 3.98 (+/-1.63), 3.53 (+/-1.38), and 5.46 (+/-1.69) pg/mL (P=.003), for lean, overweight, and obese women, respectively. Both proinflammatory mediators increased in women with obesity compared with both overweight and normal women (P=.01 and P=.008 for CRP; P=.003 and P=.01 for TNF-alpha, respectively). There were significant correlations between maternal BMI and amniotic fluid CRP (r=0.396; P=.001), TNF-alpha (r=0.357; P=.003) and resistin (r=0.353; P=.003). CONCLUSION Amniotic fluid CRP and TNF-alpha levels are increased in obese women, and both are related to maternal BMI, which suggests in utero exposure to higher proinflammatory cytokines and mediators in fetuses of these women. LEVEL OF EVIDENCE II.
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Qvigstad E, Voldner N, Bollerslev J, Henriksen T. [Diabetes in pregnancy--prevention over generations]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2009; 129:2494-6. [PMID: 19997141 DOI: 10.4045/tidsskr.09.0712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Elisabeth Qvigstad
- Seksjon for endokrinologi og Nasjonalt kompetansesenter for kvinnehelse, Oslo universitetssykehus, Rikshospitalet, 0027 Oslo, Norway.
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Davenport MH, Steinback CD, Mottola MF. Impact of pregnancy and obesity on cardiorespiratory responses during weight-bearing exercise. Respir Physiol Neurobiol 2009; 167:341-7. [DOI: 10.1016/j.resp.2009.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Revised: 06/08/2009] [Accepted: 06/09/2009] [Indexed: 11/30/2022]
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