Obesity and pregnancy: complications and cost

The impact of bariatric surgery on pregnancy complication rates

BACKGROUND

Obesity is associated with multiple pregnancy-related complications. Bariatric surgery is frequently performed in women of childbearing age. While the impact of bariatric surgery on fertility and nutritional complications has been characterized, few studies on effects of bariatric surgery on obesity-related pregnancy complications exist. The purpose of this study is to examine the impact of bariatric surgery on pregnancy complications in a US insured population.

METHODS

Pregnancy-related claims from 2011-2019 were obtained from MarketScan commercial claims database for bariatric surgical patients and non-surgical patients with no history of obesity. Claims were grouped into 3 time periods: pre-surgery (time of first claim to date of surgery), peri-surgery (date of surgery to 24 month postoperatively), and post-surgery (> 24 month postoperatively). Peri-surgery period was defined based on the recommendation to avoid pregnancy for the first 12-24 months following surgery. Codes for both maternal and fetal pregnancy-related complications were extracted from the database. Standardized incidence rates in person-months (pms) were calculated and generalized estimating equations with Poisson distribution tested for differences in each category at the three time intervals.

RESULTS

The final cohort included 163612 female bariatric surgery patients. The rate of successful births was 3/1000 pms in the pre-surgery and peri-surgery period and increased to 4/1000 pms in the post-surgery period, compared to a rate of 7/1000 in the control group. The rate of pregnancy complications in the pre-surgery group was 4/1000 pms and dropped to 2/1000 pms in the peri- and post-surgery periods. The complication rate in the control group was 4/1000 pms.

CONCLUSION

After bariatric surgery, the rate of pregnancy complications is lower than non-obese, non-bariatric surgery patients. Compared to before surgery, pregnancy complications decrease by 63% in the peri-surgery period and 57% in the post-surgery period. In the US, bariatric surgery is an important intervention for decreasing pregnancy complications in patients with obesity.

Out-of-Pocket Expenditure for Antenatal Care Amid Free Health Care Provision: Evidence From a Large Pregnancy Cohort in Rural Sri Lanka

INTRODUCTION

Global evidence suggests that high out-of-pocket (OOP) expenditure negatively affects health service utilization and creates an economic burden on households during pregnancy. This study aimed to estimate the magnitude and associated factors of OOP expenditure for antenatal care (ANC) in a rural Sri Lankan setting by following up with a large pregnancy cohort (The Rajarata Pregnancy Cohort [RaPCo]) in Anuradhapura District, Sri Lanka.

METHODS

Data were collected from July 2019 to May 2020. An interviewer-administered questionnaire was used to collect socioeconomic data and OOP expenditures in the first trimester. Self-administered questionnaires were used monthly to collect OOP expenditures in the second and third trimesters. In-depth financial information of 1,558 pregnant women was analyzed using descriptive statistics, nonparametric statistics, and a multiple linear regression model.

RESULTS

The majority of participants used both government and private health facilities for ANC. The mean (standard deviation [SD]) OOP expenditure per ANC visit was US$4.18 (US$4.19), and the mean (SD) OOP expenditure for total ANC was US$57.74 (US$80.96). Pregnant women who used only free government health services also spent 28% and 14% of OOP expenditure on medicines and laboratory investigations. Household income (P<.001), household expenditure (P<.1), used health care mode (P<.05), maternal morbidities (P<.05), and the number of previous pregnancies (P<.1) were the statistically significant independent predictors of OOP expenditure. OOP expenditure per visit for ANC equals half of the daily household expenditure.

CONCLUSION

Despite having freely available government health facilities, most pregnant women tend to use both government and private health facilities and incur higher OOP expenditure. Free government health care users also incur a direct medical OOP expenditure for medicines and laboratory investigations. Monthly household income, expenditure, used health care mode, maternal morbidities, and the number of previous pregnancies are independent predictors of OOP expenditure.

Optimally Controlled Diabetes and Its Influence on Neonatal Outcomes at a Level II Center: A Study on Infants Born to Diabetic Mothers

Background and Objectives: We investigated the effect of optimal maternal glycemic control on neonatal outcomes among infants born to mothers with diabetes. Materials and Methods: In this prospective study, we assessed 88 eligible mothers admitted to the obstetrics department for pregnancy evaluation. Our analysis included 46 infants born to diabetic mothers (IDMs) and 138 infants born to unaffected mothers, all admitted to the Level II Neonatal Intensive Care Unit (NICU). Results: Mothers affected by diabetes were generally older and exhibited a higher body mass index (BMI) and a greater number of gestations, although parity did not differ significantly. Cesarean section emerged as the most frequently chosen mode of delivery. A significantly higher proportion of infants in the affected group presented with respiratory disease (3% vs. 19.5%), which required NICU admission (4.3% vs. 23.9%), phototherapy (18.1% vs. 43.5%), and had congenital heart defects or myocardial hypertrophy (15.2% and 26% vs. 3% and 4.3%) compared to matched controls (p < 0.05). Conclusions: This study underscores the persistence of adverse neonatal outcomes in IDMs, even when maternal glycemic control is optimized. It calls for further investigation into potential interventions and strategies aimed at enhancing neonatal outcomes in this population.

Physical Activity, Sedentary and Sleep Phenotypes in Women During the First Trimester of Pregnancy

OBJECTIVES

Patterns of physical behaviors including physical activity, sedentary time, and sleep are unknown during pregnancy, but are likely to influence health outcomes. The purpose was to first identify "physical behavior phenotypes" from accelerometer-measured physical behaviors in pregnant women during the first trimester and secondly, to explore the associations between the identified phenotypes with demographic variables and body-mass-index (BMI).

METHODS

Data were from the Glowing Study (gov ID: NCT01131117), collected between 2011 and 2017 with accelerometer-measured physical behaviors of women in their 12th week of pregnancy. Latent class analysis was used to identify patterns of total physical activity, sleep time, sedentary time, and variation in physical activity. Maternal Body-Mass-Index (BMI). BMI and sociodemographic characteristics were compared between physical behavior phenotypes.

RESULTS

A total of 212 pregnant women were included in the study (mean age 30.2 years (range 22.1 to 42.4), mean days wear 4.3 (SD 0.7)). Three physical behavior phenotypes were identified from the four physical behavior constructs: low sedentary and stable activity (n = 136, 64%), variable activity (n = 39, 18%), high sedentary and low sleep (n = 37, 17%). BMI, race, and education were significantly different between the three phenotypes, with the low sedentary and stable activity phenotype having the lowest BMI and a higher percentage of white and college educated women.

CONCLUSIONS FOR PRACTICE

Total physical activity and physical behavior phenotypes during the first trimester were associated with early-pregnancy BMI, race, and education. Future research should examine whether these physical behavior phenotypes are associated with maternal and child health outcomes.

Independent and Joint Associations of Age, Pre-pregnancy BMI, and Gestational Weight Gain with Adverse Pregnancy Outcomes in Gestational Diabetes Mellitus

INTRODUCTION

To explore the independent and combined effects of maternal age, pre-pregnancy body mass index (BMI), and gestational weight gain (GWG) on pregnancy outcomes in gestational diabetes mellitus (GDM).

METHODS

A total of 2171 pregnant women with GDM attending the Women's Hospital of Zhejiang University were retrospectively included. We compared pregnancy outcomes in different age, BMI, and GWG groups after adjusting for confounding variables.

RESULTS

Results showed that (1) advanced maternal age increased the risk of primary Cesarean section and hypertensive disorders of pregnancy (HDP) in normal weight; (2) independent of age and GWG, high BMI significantly increased the risk of HDP, primary Cesarean section, and macrosomia; (3) Women with excessive GWG had a higher risk of primary Cesarean section and HDP, even they were ≤ 29 years old or normal weight, respectively; (4) Pregnant women with inadequate GWG had a higher risk of preterm birth and a lower risk of macrosomia in both the 30-34 age group and the normal weight group; (5) BMI was a better predictor of HDP than GWG among women younger than 30.

CONCLUSIONS

Among the GDM population, women over the age of 35, overweight and obese, or with an excessive GWG were more prone to adverse pregnancy outcomes, especially primary Cesarean delivery and HDP.

Pre-pregnancy body mass index has greater influence on newborn weight and perinatal outcome than weight control during pregnancy in obese women

BACKGROUND

The pre-pregnancy weight and gestational weight gain (GWG) are closely related to perinatal maternal and infant complications, but the relationship between pre-pregnancy weight and GWG and the pattern of interaction have not been reported. This study investigated the influence of weight control during pregnancy on the perinatal maternal and infant outcomes.

METHODS

A total of 835 singleton pregnant women who were hospitalized between January 2018 and December 2018 were retrospectively included in this study and divided into two groups: the diet guidance (DG) group (n = 167) and the control group (n = 668). The pre-pregnancy body mass index (BMI), GWG, and perinatal outcomes of the women and infants were determined in two groups.

RESULTS

The dietary modification and reasonable exercise during pregnancy effectively reduced the GWG, and even some women with pre-pregnancy obesity achieved weight loss during pregnancy. The GWG in the DG group was significantly lower than in the control group, especially in the second and third trimesters. GWG was positively related to birth weight. The birth weight in the DG group was significantly lower than in the control group when their mothers had similar GWG. In women with pre-pregnancy obesity, GWG seemed to be negatively related to birth weight. However, after adjusting the mean BMI, the pre-pregnancy BMI and GWG were positively related to the birth weight. Compared with the control group, the incidences of dystocia, postpartum hemorrhage, macrosomia, small for gestational age infants and neonatal complications significantly reduced in the DG group, and the preterm birth rate was comparable between two groups. Some women with pre-pregnancy obesity lose weight during pregnancy, but there was no premature birth or small for gestational age infant. The incidences of macrosomia, postpartum hemorrhage, dystocia, cesarean section and gestational diabetes increased significantly with the increase of pre-pregnancy BMI.

CONCLUSION

For women with increased pre-pregnancy BMI, strict weight control is required to reduce obesity-related complications of the mother and infant. The weight control in the second and third trimesters is especially important and most likely to prevent GWG. Compared with GWG, pre-pregnancy BMI has greater influence on the birth weight and maternal and infant complications, and may even compromise the benefits of weight control during pregnancy. Thus, weight control is recommended before pregnancy.

Mediterranean diet for the prevention of gestational diabetes: a meta-analysis of randomized controlled trials

INTRODUCTION

It is elusive that whether that Mediterranean diet helps prevent gestational diabetes. This meta-analysis aims to study the efficacy of Mediterranean diet for gestational diabetes mellitus.

METHODS

We have systematically searched PubMed, EMbase, Web of science, EBSCO and Cochrane library databases, and included randomized controlled trials (RCTs) that reported the effect of Mediterranean diet on gestational diabetes.

RESULTS

We included five eligible RCTs in this meta-analysis. Compared with control intervention for pregnant women, Mediterranean diet could substantially decrease the incidence of gestational diabetes mellitus (OR = 0.64; 95% CI = 0.51 to 0.79; p < 0.0001), HOMA-IR (MD = -0.29; 95% CI = -0.50 to -0.09; p = 0.004), insulin treatment (OR = 0.39; 95% CI = 0.22 to 0.68; p = 0.0009) and gestational weight gain (MD = -0.74; 95% CI = -1.21 to -0.28; p = 0.002), but demonstrated no obvious impact on the admission of neonatal unit (OR = 0.75; 95% CI = 0.47 to 1.20; p = 0.24).

CONCLUSIONS

Mediterranean diet can effectively prevent gestational diabetes mellitus.

Put your weight behind it-Effect of body mass index on the active second stage of labour: A retrospective cohort study

OBJECTIVE

To explore the duration of the active phase of the second stage of labour in relation to maternal pre-pregnant body mass index (BMI).

DESIGN

Retrospective cohort study.

SETTING

Labour wards of three Norwegian university hospitals, 2012-2019.

POPULATION

Nulliparous and parous women without previous caesarean section with a live singleton fetus in cephalic presentation and spontaneous onset of labour, corresponding to the Ten Group Classification System (TGCS) group 1 and 3.

METHODS

Women were stratified to BMI groups according to WHO classification, and estimated median duration of the active phase of the second stage of labour was calculated using survival analyses. Caesarean sections and operative vaginal deliveries during the active phase were censored.

MAIN OUTCOME MEASURES

Estimated median duration of the active phase of second stage of labour.

RESULTS

In all, 47 942 women were included in the survival analyses. Increasing BMI was associated with shorter estimated median duration of the active second stage in both TGCS groups. In TGCS group 1, the estimated median durations (interquartile range) were 44 (26-75), 43 (25-71), 39 (22-70), 33 (18-63), 34 (19-54) and 29 (16-56) minutes in BMI groups 1-6, respectively. In TGCS group 3, the corresponding values were 11 (6-19), 10 (6-17), 10 (6-16), 9 (5-15), 8 (5-13) and 7 (4-11) minutes. Increasing BMI remained associated with shorter estimated median duration in analyses stratified by oxytocin augmentation and epidural analgesia.

CONCLUSION

Increasing BMI was associated with shorter estimated median duration of the active second stage of labour.

Retinal microvasculature and risk of spontaneous abortion in multiethnic Southeast Asian women

OBJECTIVE

To better understand the underlying pathogenesis of spontaneous abortion that affects 10%-20% of recognized pregnancies. We used retinal imaging to study the role of systemic microvasculature and the risk of spontaneous abortion.

DESIGN

A prospective multiethnic preconception cohort study conducted in Singapore.

SETTING

Hospital-based.

PATIENT(S)

A total of 1,032 Southeast Asian women who intended to conceive naturally were screened at study entry, among which 480 women spontaneously conceived within the 12-month observation period. After excluding 24 women who were lost to follow-up, we calculated the spontaneous abortion rate among 456 women. Further, we included 379 women for the final association analysis because 63 women did not undergo preconception retinal imaging examination and 14 had other types of pregnancy loss instead of spontaneous abortion.

INTERVENTION(S)

Trained photographers performed retinal examination using a 45-degree nonmydriatic retinal camera at study entry during the preconception screening. Using a semiautomated, computer-based program, we assessed quantitative retinal microvascular measurements, including caliber, fractal dimension, curvature tortuosity, and branching angle. Clinical research coordinators collected information on sociodemographic status, menstrual characteristics, and lifestyle, and assessed blood pressure and anthropometry at study entry.

MAIN OUTCOME MEASURE(S)

We performed a modified Poisson regression model to estimate the relative risk (RR) and 95% confidence interval (CI) for each retinal microvascular feature and its association with spontaneous abortion after adjusting for major confounders such as maternal prepregnancy, body mass index, and previous pregnancy loss history.

RESULT(S)

We reported a spontaneous abortion rate of 13.4% (61 out of 456). Among all retinal microvascular features, retinal arteriolar caliber, retinal arteriolar, and venular curvature tortuosity were associated with a high risk of incident spontaneous abortion. In the regression model, per SD increase in retinal curvature tortuosity was associated with a 25%-34% increased risk of incident spontaneous abortion (arteriolar: unadjusted RR, 1.29 [95% CI, 1.06-1.56] and adjusted RR, 1.26 [1.04-1.53]; venule: unadjusted RR, 1.30 [1.08-1.55] and adjusted RR, 1.34 [1.09-1.64]).

CONCLUSION(S)

Our prospective cohort observed an increased risk of spontaneous abortion among Asian women with more tortuous retinal vessels assessed during the preconception phase. Our results indicate a role of vascular inflammatory and oxidative stress in the pathogenesis of spontaneous abortion.

CLINICAL TRIAL REGISTRATION NUMBER

ClinicalTrials.gov, NCT03531658.

Maternal overweight and obesity during pregnancy: strategies to improve outcomes for women, babies, and children

INTRODUCTION

Women with overweight and obesity, and their children, are at increased risk of adverse pregnancy, birth, and longer term health outcomes, believed to be compounded by excessive gestational weight gain (GWG). Research to date has focused on interventions to reduce excessive GWG through changes to maternal diet and/or lifestyle.

AREAS COVERED

Current clinical recommendations for GWG vary according to a woman's early pregnancy body mass index, based on assumptions that associations between GWG and adverse pregnancy outcomes are causal in nature, and modifiable. While there are small differences in GWG following pregnancy interventions, there is little evidence for clinically relevant effects on pregnancy, birth, and longer term childhood outcomes. This review considers interventional studies targeting women with overweight or obesity to reduce GWG in an effort to improve maternal and infant health, and the current evidence for interventions prior to conception.

EXPERT OPINION

GWG is not modifiable via diet and lifestyle change, and continued efforts to find the 'right' intervention for women with overweight and obesity during pregnancy are unjustified. Researchers should focus on gathering evidence for interventions prior to pregnancy to optimize maternal health and weight to improve pregnancy, birth, and longer term health outcomes associated with obesity.

Gestational Nutrition as a Predisposing Factor to Obesity Onset in Offspring: Role for Involvement of Epigenetic Mechanism

Maternal lifestyle has been implicated as a predisposing factor in the development of metabolic disorders in adulthood. This lifestyle includes the immediate environment, physical activity and nutrition. Maternal nutrition has direct influence on the developmental programming through biochemical alterations and can lead to modifications in the fetal genome through epigenetic mechanisms. Imbalance in basic micro or macro nutrients due to famine or food deficiency during delicate gestational periods can lead to onset of metabolic syndrome including obesity. A major example is the Dutch famine which led to a serious metabolic disorder in adulthood of affected infants. Notably due to gene variants, individualized responses to nutritional deficiencies are unconventional, therefore intensifying the need to study nutritional genomics during fetal programming. Epigenetic mechanisms can cause hereditary changes without changing the DNA sequence; the major mechanisms include small non-coding RNAs, histone modifications and most stable of all is DNA methylation. The significance association between obesity and DNA methylation is through regulation of genes implicated in lipid and glucose metabolism either directly or indirectly by hypomethylation or hypermethylation. Examples include CPT1A, APOA2, ADRB3 and POMC. Any maternal exposure to malnutrition or overnutrition that can affect genes regulating major metabolic pathways in the fetus, will eventually cause underlying changes that can predispose or cause the onset of metabolic disorder in adulthood. In this review, we examined the interaction between nutrition during gestation and epigenetic programming of metabolic syndrome.

Dietary factors that affect the risk of pre-eclampsia

Pre-eclampsia affects 3%–5% of pregnant women worldwide and is associated with a range of adverse maternal and fetal outcomes, including maternal and/or fetal death. It particularly affects those with chronic hypertension, pregestational diabetes mellitus or a family history of pre-eclampsia. Other than early delivery of the fetus, there is no cure for pre-eclampsia. Since diet or dietary supplements may affect the risk, we have carried out an up-to-date, narrative literature review to assess the relationship between nutrition and pre-eclampsia. Several nutrients and dietary factors previously believed to be implicated in the risk of pre-eclampsia have now been shown to have no effect on risk; these include vitamins C and E, magnesium, salt, ω-3 long-chain polyunsaturated fatty acids (fish oils) and zinc. Body mass index is proportionally correlated with pre-eclampsia risk, therefore women should aim for a healthy pre-pregnancy body weight and avoid excessive gestational and interpregnancy weight gain. The association between the risk and progression of the pathophysiology of pre-eclampsia may explain the apparent benefit of dietary modifications resulting from increased consumption of fruits and vegetables (≥400 g/day), plant-based foods and vegetable oils and a limited intake of foods high in fat, sugar and salt. Consuming a high-fibre diet (25–30 g/day) may attenuate dyslipidaemia and reduce blood pressure and inflammation. Other key nutrients that may mitigate the risk include increased calcium intake, a daily multivitamin/mineral supplement and an adequate vitamin D status. For those with a low selenium intake (such as those living in Europe), fish/seafood intake could be increased to improve selenium intake or selenium could be supplemented in the recommended multivitamin/mineral supplement. Milk-based probiotics have also been found to be beneficial in pregnant women at risk. Our recommendations are summarised in a table of guidance for women at particular risk of developing pre-eclampsia.

Encouraging appropriate gestational weight gain in high-risk gravida: A randomized controlled trial

Trial Design

Excessive gestational weight gain (GWG) can increase pregnancy morbidity and is particularly problematic for women with pregestational obesity. A lifestyle modification intervention was introduced to gravida with obesity to decrease excessive GWG as compared to usual care (UC).

Methods

A randomized controlled trial was conducted to improve healthy lifestyle behaviors to manage appropriate GWG. Consenting participants with prepregnancy obesity and singletons ≤17 weeks were randomized to (1) Usual Care (UC): usual written educational materials and counseling by obstetric provider or (2) Enhanced Care (EC): UC plus (a) personalized letter from physician detailing appropriate GWG; (b) access to individualized GWG chart; (c) ongoing counseling with registered dietitian/nutritionist (RDN). The primary outcome was proportion with GWG ≤9.1 kg, as this is upper limit recommended by Institute of Medicine (IOM). Total GWG and GWG as less than/within/greater than IOM recommendations (in aggregate and stratified by obesity class), and pregnancy/neonatal outcomes were evaluated as secondary outcomes.

Results

Analyses included 105 participants in EC and 109 in UC arms. The groups had similar demographics: 46% with class I obesity, 26% class II, and 28% class III. There were no group differences for any GWG, pregnancy, or neonatal outcomes when analyzed in aggregate. As compared to those randomized to the EC arm, participants in UC arm with class I obesity gained 1.4 kg less and those with class II obesity were significantly more likely to gain within IOM guidelines (14.8% vs. 40.0%, adjusted p = 0.04). Participants with class III obesity randomized to EC arm were more likely to gain within IOM guidelines as compared to participants randomized to UC arm (29.0% vs. 6.7%, adjusted p = 0.02).

Conclusion

There were no differences in GWG observed between groups when analyzing participants in aggregate. However, a physician's letter detailing appropriate GWG, patient portal access to a personalized GWG chart, and RDN consultation were helpful for encouraging GWG within IOM guidelines for women with prepregnancy class III obesity. Women with class I or II obesity had better GWG outcomes without these additional interventions.

Association of Body Mass Index With the Use of Health Care Resources in Low-Risk Nulliparous Pregnancies After 39 Weeks of Gestation

OBJECTIVE

To compare health care medical resource utilization in low-risk nulliparous pregnancies according to body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) categories.

METHODS

This is a secondary analysis of a multicenter randomized controlled trial of induction of labor between 39 0/7 39 and 4/7 weeks of gestation compared with expectant management in low-risk nulliparous pregnant people, defined as those without standard obstetric indications for delivery at 39 weeks. Body mass index at randomization was categorized into four groups (lower than 25, 25-29, 30-39, and 40 or higher). The primary outcome of this analysis was time spent in the labor and delivery department from admission to delivery. Secondary outcomes included length of stay (LOS) postdelivery, total hospital LOS, and antepartum, intrapartum, and postpartum resource utilization, which were defined a priori. Multivariable generalized linear modeling and logistic regressions were performed, and 99% CIs were calculated.

RESULTS

A total of 6,058 pregnant people were included in the analysis; 640 (10.6%) had BMIs of lower than 25, 2,222 (36.7%) had BMIs between 25 and 29, 2,577 (42.5%) had BMIs of 30-39, and 619 (10.2%) had BMIs of 40 or higher. Time spent in the labor and delivery department increased from 15.1±9.2 hours for people with BMIs of lower than 25 to 23.5±13.6 hours for people with BMIs of 40 or higher, and every 5-unit increase in BMI was associated with an average 9.8% increase in time spent in the labor and delivery department (adjusted estimate per 5-unit increase in BMI 1.10, 99% CI 1.08-1.11). Increasing BMI was not associated with an increase in antepartum resource utilization, except for blood tests and urinalysis. However, increasing BMI was associated with higher odds of intrapartum resource utilization, longer total hospital LOS, and postpartum resource utilization. For example, every 5-unit increase in BMI was associated with an increase of 26.1% in the odds of antibiotic administration, 57.6% in placement of intrauterine pressure catheter, 5.1% in total inpatient LOS, 31.0 in postpartum emergency department visit, and 23.9% in postpartum hospital admission.

CONCLUSION

Among low-risk nulliparous people, higher BMI was associated with longer time from admission to delivery, total hospital LOS, and more frequent utilization of intrapartum and postpartum resources.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, NCT01990612.

Antioxidants in Pregnancy: Do We Really Need More Trials?

Human pregnancy can be affected by numerous pathologies, from those which are mild and reversible to others which are life-threatening. Among these, gestational diabetes mellitus and hypertensive disorders of pregnancy with subsequent consequences stand out. Health problems experienced by women during pregnancy and postpartum are associated with significant costs to health systems worldwide and contribute largely to maternal mortality and morbidity. Major risk factors for mothers include obesity, advanced maternal age, cardiovascular dysfunction, and endothelial damage; in these scenarios, oxidative stress plays a major role. Markers of oxidative stress can be measured in patients with preeclampsia, foetal growth restriction, and gestational diabetes mellitus, even before their clinical onset. In consequence, antioxidant supplements have been proposed as a possible therapy; however, results derived from large scale randomised clinical trials have been disappointing as no positive effects were demonstrated. This review focuses on the latest evidence on oxidative stress in pregnancy complications, their early diagnosis, and possible therapies to prevent or treat these pathologies.

Prepregnancy BMI, gestational weight gain and offspring caries experience: Avon longitudinal study of parents and children

Pre-existing maternal overweight/obesity and pregnancy weight gain are associated with adverse birth outcomes such as low birth weight and prematurity, which may increase the risk of developmental tooth defects and early childhood caries. We sought to investigate the association between prepregnancy BMI, gestational weight gain (GWG) and the risk of early childhood caries. Data from 1,429 mother-offspring participants of the 1991/1992 Avon Longitudinal Study of Parents and Children were analyzed. The exposures were prepregnancy BMI (under/normal weight vs. overweight/obese), and gestational weight gain (GWG) based on the Institute of Medicine’s recommended levels. The main outcome measured was offspring caries experience determined by clinical oral examinations at three time points. Log binomial regression estimated risk ratios and 95% confidence intervals. Seventy six percent (76%) of the mothers were under/normal weight prepregnancy, 39% and 26% respectively gained less and more than the recommended weight for their prepregnancy BMI during pregnancy. Being overweight/obese prepregnancy was associated with unadjusted RR (95% CI) of offspring caries of 1.16 (0.90, 1.51) at 31-months, 1.20 (0.96, 1.49) at 43-months and 1.09 (0.91, 1.30) at 61-months. GWG less than recommended was associated with higher unadjusted offspring caries experience of 1.13 (0.86, 1.48), 1.17 (0.92, 1.48) and 1.04 (0.87, 1.25) at 31-months, 43-months and 61-months respectively. There was insufficient evidence to indicate an association between prepregnancy BMI and gestational weight gain on offspring caries experience risk.

Protocol for systematic review and meta-analysis: magnitude, reasons, associated factors, and implications of the out-of-pocket expenditure during pregnancy

OBJECTIVES

Health-related out-of-pocket expenditure (OOPE) impedes utilization for maternal health care. We aim to systematically review the magnitude, reasons, associated factors, and implications of OOPE during pregnancy.

STUDY DESIGN

The study design is a protocol for systematic review and meta-analysis.

METHODS

A comprehensive literature search will be conducted with the electronic databases of PubMed, Web of Science, Scopus, Cochrane, Trip, Social care online, IDEAS, EconPapers, ERIC, and EconStor. A manual search will be carried out for the reference lists of eligible studies and reviews. The search strategy will include combining two key blocks of terms, namely: 'pregnancy' and 'OOPE,' using database-specific subject headings and text words. Two independent reviewers will screen and assess data quality and extract data for synthesis. Any disagreements during any stage will be determined by consensus with the involvement of a third reviewer. The 'Mixed methods appraisal tool' will be adapted for the quality appraisal of the eligible studies. A narrative synthesis will be provided for the reasons, associated factors, and implications of OOPE, and a meta-analysis will be conducted for the magnitude of OOPE. Furthermore, a subgroup analysis will be done with countries with different income levels and health care policies.

TRIAL REGISTRATION

PROSPERO 2020 CRD42020168566.

Influence of High Energy Diet and Polygenic Predisposition for Obesity on Postpartum Health in Rat Dams

It is estimated that 30% of pregnant women worldwide are overweight or obese, leading to adverse health effects for both mother and child. Women with obesity during pregnancy are at higher risk for developing both metabolic and mental disorders, such as diabetes and depression. Numerous studies have used rodent models of maternal obesity to understand its consequences on the offspring, yet characterization of changes in the dams is rare, and most rodent models rely solely on a high fat diet to induce maternal obesity, without regarding genetic propensity for obesity. Here we present the influence of both peripartum high energy diet (HE) and obesity-proneness on maternal health using selectively bred diet-resistant (DR) and diet-induced obese (DIO) rat dams. Outbred Sprague-Dawley rats were challenged with HE diet prior to mating and bred according to their propensity to gain weight. The original outbred breeding dams (F0) were maintained on low-fat chow during pregnancy and lactation. By comparison, the F1 dams consuming HE diet during pregnancy and lactation displayed higher gestational body weight gain (P < 0.01), and HE diet caused increased meal size and reduced meal frequency (P < 0.001). Sensitivity to the hormone amylin was preserved during pregnancy, regardless of diet. After several rounds of selective breeding, DIO and DR dams from generation F3 were provided chow or HE during pregnancy and lactation and assessed for their postpartum physiology and behaviors. We observed strong diet and phenotype effects on gestational weight gain, with DIO-HE dams gaining 119% more weight than DR-chow (P < 0.001). A high-resolution analysis of maternal behaviors did not detect main effects of diet or phenotype, but a subset of DIO dams showed delayed nursing behavior (P < 0.05). In generation F6/F7 dams, effects on gestational weight gain persisted (P < 0.01), and we observed a main effect of phenotype during a sucrose preference test (P < 0.05), with DIO-chow dams showing lower sucrose preference than DR controls (P < 0.05). Both DIO and DR dams consuming HE diet had hepatic steatosis (P < 0.001) and exhibited reduced leptin sensitivity in the arcuate nucleus (P < 0.001). These data demonstrate that both diet and genetic obesity-proneness have consequences on maternal health.

The impact of COVID-19 on pregnancy outcomes in a diverse cohort in England

There is conflicting evidence regarding the effect of coronavirus disease (COVID-19) in pregnancy. Risk factors for COVID-19 overlap with risk factors for pregnancy complications. We aimed to assess the effects of the COVID-19 pandemic and confirmed SARS-CoV-2 infection on pregnancy outcomes. A retrospective interrupted time-series and matched cohort analysis was performed. Singleton pregnancies completed between 1st January 2016 and 31st January 2021 were included. Trends in outcomes were analysed over time. Modelled COVID-19 transmission data were applied to deliveries since 1st January 2020 to assign a risk of COVID-19 to each pregnancy, and incorporated into a regression model of birthweight. Confirmed COVID-19 cases were matched to controls delivered in the pre-pandemic period, and maternal and neonatal outcomes compared. 43,802 pregnancies were included, with 8343 in the model of birthweight. There was no increase in the risk of stillbirth (p = 0.26) or neonatal death (p = 0.64) during the pandemic. There was no association between modelled COVID-19 attack rate (%) in any trimester and birthweight (first trimester p = 0.50, second p = 0.15, third p = 0.16). 214 COVID-positive women were matched to controls. Preterm birth was more common in symptomatic cases (14/62, 22.6%) compared to asymptomatic cases (9/109, 8.3%, p = 0.008) and controls (5/62, 8.1%, p = 0.025). Iatrogenic preterm birth was more common in cases (21/214, 9.8%) than controls (9/214, 4.2%, p = 0.02). All other examined outcomes were similar between groups. There was no significant impact of COVID-19 on the examined birth outcomes available. Symptomatic COVID-19 should be considered a risk factor for preterm birth, possibly due to an increase in iatrogenic deliveries for maternal indications.

Gestational Diabetes Mellitus and the Risks of Overall and Type-Specific Cardiovascular Diseases: A Population- and Sibling-Matched Cohort Study

OBJECTIVE

To evaluate associations between gestational diabetes mellitus (GDM) and various incident cardiovascular disease (CVD) end points, considering the effects of the mediating role of type 2 diabetes and shared environmental/familial factors.

RESEARCH DESIGN AND METHODS

This population-based cohort study included 10,02,486 parous women in Denmark during 1978-2016. We used Cox regression to 1) examine the associations of GDM with overall and type-specific CVDs using full-cohort and sibling-matched analysis, 2) quantify the impact of type 2 diabetes after GDM using mediation analysis, and 3) assess whether these associations were modified by prepregnancy obesity or maternal history of CVD.

RESULTS

Women with a history of GDM had a 40% increased overall CVD risk (hazard ratio [HR] 1.40, 95% CI 1.35-1.45). Sibling-matched analyses yielded similar results (HR 1.44, 95% CI 1.28-1.62). The proportion of association between GDM and overall CVD explained by subsequent type 2 diabetes was 23.3% (15.4-32.8%). We observed increased risks of specific CVDs, including 65% increased stroke risk and more than twofold risks for myocardial infarction, heart failure, and peripheral artery disease. The elevated overall risks were more pronounced among women with GDM and prepregnancy obesity or maternal history of CVD.

CONCLUSIONS

A history of GDM was associated with increased risks of overall and specific CVDs. Increased risks were partly explained by subsequent type 2 diabetes, and the need to identify other pathways remains important. Continuous monitoring of women with a history of GDM, especially those with prepregnancy obesity or maternal history of CVD, may provide better opportunities to reduce their cardiovascular risk.

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

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

Study on the relationship between DNA methylation of target CpG sites in peripheral blood and gestational diabetes during early pregnancy

Genome-wide DNA methylation profiling have been used to find maternal CpG sites related to the occurrence of gestational diabetes mellitus (GDM). However, none of these differential sites found has been verified in a larger sample. Here, our aim was to evaluate whether first trimester changes in target CpG sites in the peripheral blood of pregnancy women predict subsequent development of GDM. This nested case–control study was based upon an early pregnancy follow-up cohort (ChiCTR1900020652). Target CpG sites were extracted from related published literature and bioinformatics analysis. The DNA methylation levels at 337 CpG sites of 80 GDM cases and 80 matched healthy controls during the early pregnancy (10–15 weeks) were assessed using MethylTarget sequencing. The best cut-off level for methylation of CpG site was determined using the generated ROC curve. The independent effect of CpG site methylation status on GDM was analyzed using conditional logistic regression. Methylation levels at 6 CpG sites were significantly higher in the GDM group than in controls, whereas those at another 6 CpG sites were significantly lower (FDR < 0.05). The area under the ROC curve at each methylation level of the significant CpG sites ranged between 0.593 and 0.650 for the occurrence of GDM. After adjusting for possible confounders, the hypermethylation status of CpG site 68167324 (OR = 3.168, 1.038–9.666) and 24837915 (OR = 5.232, 1.659–16.506) was identified as more strongly associated with GDM; meanwhile, the hypermethylation of CpG site 157130156 (OR = 0.361, 0.135–0.966) and 89438648 (OR = 0.206, 0.065–0.655) might indicate lower risk of GDM. The methylation status of target CpG sites in the peripheral blood of pregnant women during the first trimester may be associated with GDM pathogenesis, and has potential as a predictor of GDM.

How costly is the first prenatal clinic visit? Analysis of out-of-pocket expenditure in rural Sri Lanka - a country with free maternal health care

BACKGROUND

This study aimed to determine the magnitude of and factors associated with out-of-pocket expenditure (OOPE) during the first prenatal clinic visit among pregnant women in Anuradhapura district, Sri Lanka, which provides free maternal healthcare.

METHODS

The study design was a cross-sectional study, and the study setting was 22 Medical Officers of Health (MOOH) areas in Anuradhapura District, Sri Lanka. Data of 1389 pregnant women were analyzed using descriptive statistics and non-parametric tests.

RESULTS

The mean OOPE of the first prenatal clinic visit was USD 8.12, which accounted for 2.9 and 4.5% of the household income and expenditure, respectively. Pregnant women who used only government-free health services (which are free of charge at the point of service delivery) had an OOPE of USD 3.49. A significant correlation was recorded between household expenditure (rs = 0.095, p = 0.002) and the number of pregnancies (rs = - 0.155, p < 0.001) with OOPE. Education level less than primary education is positively contributed to OOPE (p < 0.05), and utilizing government-free maternal health services lead to a decrease in the OOPE for the first prenatal clinic visit (p < 0.05).

CONCLUSION

Despite having free maternal services, the OOPE of the first prenatal clinic visit is high in rural Sri Lanka. One-fifth of pregnant women utilize private health services, and pregnant women who used only government-free maternal health services also spend a direct medical cost for medicines/micronutrient supplements.

Historical and Recent Changes in Maternal Mortality Due to Hypertensive Disorders in the United States, 1979 to 2018

[Figure: see text].

Gestational diabetes mellitus: a qualitative study of lived experiences of South Asian immigrant women and perspectives of their health care providers in Melbourne, Australia

BACKGROUND

South Asian women are at a high risk of developing gestational diabetes mellitus than other women in Australia. Gestational diabetes affects up to 14-19% of all pregnancies among South Asian, South East Asian, and Arabic populations placing women at risk of adverse pregnancy outcomes. Although, gestational diabetes resolves after childbirth, women with gestational diabetes are up to seven times more likely to develop type 2 diabetes within five to ten years of the index pregnancy. Increasingly, South Asian women are being diagnosed with gestational diabetes in Australia. Therefore, we aimed to gain a better understanding of the lived experiences of South Asian women and their experiences of self-management and their health care providers' perspectives of treatment strategies.

METHODS

Using an ethnographic qualitative research methodology, semi-structured one-on-one, face-to-face interviews were conducted with 21 health care providers involved in gestational diabetes management and treatment from the three largest tertiary level maternity hospitals in Melbourne, Victoria, Australia. In-depth interviews were conducted with 23 South Asian women post diagnosis between 24-28 weeks gestation in pregnancy.

RESULTS

Health care providers had challenges in providing care to South Asian women. The main challenge was to get women to self-manage their blood glucose levels with lifestyle modification. Whilst, women felt self-management information provided were inadequate and inappropriate to their needs. Women felt 'losing control over their pregnancy', because of being preoccupied with diet and exercise to control their blood glucose level.

CONCLUSIONS

The gestational diabetes clinical practice at the study hospitals were unable to meet consumer expectations. Health care providers need to be familiar of diverse patient cultures, rather than applying the current 'one size fits all' approach that failed to engage and meet the needs of immigrant and ethnic women. Future enabling strategies should aim to co-design and develop low Glycaemic Index diet plans of staple South Asian foods and lifestyle modification messages.

Pregnancy outcomes in women with polycystic ovarian syndrome (PCOS)

Polycystic ovarian syndrome (PCOS) is the most common endocrinological disease of reproductive-aged women, with an estimated incidence ranging from 5% to 15%. The clinical manifestations of PCOS are heterogeneous and vary according to the age of the patient. Insulin resistance (IR), hyperandrogenism, and obesity are widely assumed to play a pivotal role in the pathophysiological mechanism of PCOS. As previously stated by many conducted meta-analyses, PCOS can cause a rising risk of pregnancy complications, including maternal, fetal, and neonatal complications. Pregnancy-induced hypertension (PIH), preeclampsia (PE), gestational diabetes mellitus (GDM), spontaneous preterm birth (PTB), and an increased necessity for a cesarean section (CS) are the most documented maternal implications. Regarding fetal outcomes, PCOS has also been correlated with elevated neonatal morbidity, prematurity, fetal growth restriction (FGR), birth weight variations (large for gestational age (LGA) and small for gestational age (SGA), and transfer to the neonatal intensive care unit (NICU). Owing to the variability of the studies performed, the association of PCOS with an elevated risk of adverse pregnancy outcomes is still controversial. This variability is found in the diagnosis and clinical presentations of PCOS, and can be influenced by pre-pregnancy circumstances and therapies as well as particular population and environmental features. The Amsterdam consensus guidelines confirm that obesity and IR can worsen maternal and fetal complications; thus, a closer follow-up should be offered to PCOS women during pregnancy.

Telomere length determinants in childhood

Telomere length (TL) is a dynamic marker that reflects genetic predispositions together with the environmental conditions of an individual. It is closely related to longevity and a number of pathological conditions. Even though the extent of telomere research in children is limited compared to that of adults, there have been a substantial number of studies providing first insights into child telomere biology and determinants. Recent discoveries revealed evidence that TL is, to a great extent, determined already in childhood and that environmental conditions in adulthood have less impact than first believed. Studies have demonstrated that large inter-individual differences in TL are present among newborns and are determined by diverse factors that influence intrauterine development. The first years of child growth are associated with high cellular turnover, which results in fast shortening of telomeres. The rate of telomere loss becomes stable in early adulthood. In this review article we summarise the existing knowledge on telomere dynamics during the first years of childhood, highlighting the conditions that affect newborn TL. We also warn about the knowledge gaps that should be filled to fully understand the regulation of telomeres, in order to implement them as biomarkers for use in diagnostics or treatment.

Effect of Mediterranean diet for pregnant women: a meta-analysis of randomized controlled trials

INTRODUCTION

Mediterranean diet might be a promising approach to prevent gestational diabetes mellitus. However, the results remained controversial. We conducted a systematic review and meta-analysis to explore the effect of Mediterranean diet on gestational diabetes mellitus.

METHODS

PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of Mediterranean diet on gestational diabetes mellitus were included. Meta-analysis was performed using random-effect model.

RESULTS

Four RCTs involving 2277 patients were included in the meta-analysis. Overall, compared with control intervention for pregnant women, Mediterranean diet was associated with reduced incidence of gestational diabetes mellitus (OR = 0.66; 95% CI = 0.52 to 0.82; p = .0003) and gestational weight gain (SMD = -0.15; 95% CI = -0.26 to -0.05; p = .004), but had no obvious effect on preeclampsia (OR = 1.04; 95% CI = 0.52-2.11; p = .91), preterm delivery (OR = 0.55; 95% CI = 0.20-1.55; p = .26) or neonatal unit (OR = 0.71; 95% CI = 0.43-1.19; p = .19).

CONCLUSIONS

Mediterranean diet may be effective to prevent gestational diabetes mellitus.

Relationship between obesity and lower rates of breast feeding initiation in regional Victoria, Australia: an 8-year retrospective panel study

OBJECTIVES

Using routinely collected hospital data, this study explored secular trends over time in breast feeding initiation in a large Australian sample. The association between obesity and not breast feeding was investigated utilising a generalised estimating equations logistic regression that adjusted for sociodemographics, antenatal, intrapartum and postpartum conditions, mode of delivery and infant's-related covariates.

DESIGN

Population-based retrospective panel.

SETTING

A regional hospital that serves 26% of Victoria's 6.5 million population in Australia.

PARTICIPANTS

All women experiencing live births between 2010 and 2017 were included. Women with missing body mass index (BMI) were excluded.

RESULTS

A total of 7491 women contributed to 10 234 live births. At baseline, 57.2% of the women were overweight or obese, with obesity increasing over 8 years by 12.8%, p=0.001. Although, breast feeding increased over time, observed in all socioeconomic status (SES) and BMI categories, the lowest proportions were consistently found among the obese and morbidly obese (78.9% vs 87.1% in non-obese mothers, p<0.001). In the multivariable analysis, risk of not breast feeding was associated with higher BMI, teenage motherhood, smoking, belonging to the lowest SES class, gravidity >4 and undergoing an assisted vaginal or caesarean delivery. Compared with women with a normal weight, the obese and morbidly obese were 66% (OR 1.66, 95% CI 1.40 to 1.96, p<0.001) to 2.6 times (OR 2.61, 95% CI 2.07 to 3.29, p<0.001) less likely to breast feed, respectively. The detected dose-response effect between higher BMI and lower breast feeding was not explained by any of the study covariates.

CONCLUSION

This study provides evidence of increasing breast feeding proportions in regional Victoria over the past decade. However, these proportions were lowest among the obese and morbidly obese and those coming from the most disadvantaged backgrounds suggesting the need for targeted interventions to support breast feeding among these groups. The psychosocial and physiological associations between obesity and breast feeding should further be investigated.

The effect of pre-pregnancy body mass index on breastfeeding initiation, intention and duration: A systematic review and dose-response meta-analysis

Overweight and obesity not only are major risk factors for number of chronic diseases, but also a risk factor for pregnancy complications in women. The present study aims to investigate the association between pre-pregnancy BMI and the persistence and duration of BF. The electronic databases including Medline (PubMed), Scopus, Embase, Web of Science and Google Scholar were searched for papers with titles and/or abstracts including one of our keywords and published up to 15 April 2019. For dose-response relationship, the two-stage random-effects meta-analysis was performed using the “dosresmeta” function in R software. Thirty-two studies with the effect of pre-pregnancy BMI on BF initiation, intention and duration were included in the present study. Based on crude and adjusted OR models, the risk of BF cessation increased by 4% (OR = 1.04; 95% CI: 1.02–1.05) with an increase in a unit of BMI. In addition, based on crude and adjusted RR models, the risk of BF cessation increases by 2% and 1% (crude RR = 1.02; 95% CI: 1.01–1.03 and adjusted RR = 1.01; 95% CI: 0.99–1.02) with an increase in one unit of BMI. Based on the result, the health care professionals and other key stakeholders should be aware of the impact excess weight, and that women who are overweight or obese should be encouraged with continued access to guidance, counseling and support, starting from conception, to maximize BF outcomes.

Maternal and infant hospitalization costs associated with maternal pre-pregnancy body mass index in California, 2007-2011

BACKGROUND

In the United States, the number of pregnant women who are overweight or obese is increasing. While such individuals are at increased risk of pregnancy complications, data regarding costs associated with pre-pregnancy body mass index (BMI) and maternal and infant outcomes are lacking.

OBJECTIVE

To estimate maternal and infant costs associated with pre-pregnancy BMI in a large cohort of pregnant women.

MATERIALS AND METHODS

We conducted a retrospective cohort study of women with singleton, non-anomalous births in California from 2007 to 2011. Women with preexisting diabetes mellitus and chronic hypertension were excluded. Hospitalization costs were estimated separately for women and infants using hospital charges adjusted using a cost-to-charge ratio. These costs included hospitalization costs for admission for delivery only. We estimated the differences in median costs between seven categories of pre-pregnancy BMIs, including underweight (BMI <18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), class I obesity (BMI 30.0-34.9), class II obesity (BMI 35.0-39.9), class III obesity (BMI 40.0-49.9) and obesity with BMI ≥50.0. We also performed stratified analyses by mode of delivery and gestational age at delivery. We examined the length of stay for women and infants and estimated the gestational age at delivery. Analyses were conducted utilizing Kruskal-Wallis equality-of-populations rank tests with a significance cutoff of 0.05.

RESULTS

In a California cohort of 1,722,840 women, 787,790 (45.7%) had a pre-pregnancy BMI that was considered overweight or obese. The median maternal and infant costs of each pre-pregnancy BMI strata were significantly different when compared to other strata, with underweight and normal weight women having the lowest median costs ($11,581 and $11,721, respectively) and the most obese category (BMI ≥50) having the highest costs ($15,808). When stratified by mode of delivery and gestational age at delivery, this remained true. Hospitalization costs for women and infants with severe maternal morbidity were also significantly different based on maternal BMI.

COMMENT

The hospitalization costs associated with each strata of BMI were significantly different when compared to each other and when stratified by mode of delivery and prematurity. This analysis allows for a greater understanding of the health care costs associated with different maternal pre-pregnancy BMI classes.

Preventing Excess Gestational Weight Gain and Obesity in Pregnancy: the Potential of Targeting Psychological Mechanisms

PURPOSE OF REVIEW

Overweight and obesity are now the most common high-risk conditions in pregnancy in the United States and increase risk of adverse outcomes during pregnancy, delivery, and the postpartum. Importantly, excess gestational weight gain is highly predictive of maternal postpartum weight retention and risk of overweight and obesity in mothers and their children later in life. This makes pregnancy a unique window of opportunity in the fight against obesity across the lifespan. This narrative review critically evaluates research on the efficacy of interventions targeting excess gestational weight gain, highlighting the potential of targeting psychological mechanisms to facilitate positive weight-related behavior change specifically in pregnancy. The PUBMED and PsycInfo databases were searched for relevant articles, including meta-analyses, systematic reviews, and randomized controlled trials with the primary or secondary aim of reducing gestational weight gain.

RECENT FINDINGS

There is currently no gold standard for preventing excess gestational weight gain, especially in women with pre-pregnancy overweight and obesity. Existing interventions primarily target diet and physical activity but lack broad empirical support and typically have only modest effects on weight gain in pregnancy, with few successfully preventing excess weight gain. Furthermore, interventions that successfully target gestational weight gain have minimal positive impact on weight- and diet-related maternal and fetal health outcomes. A growing evidence points to the utility of targeting psychological mechanisms in the prevention of excess gestational weight gain, including cognitive and affective factors, food cravings, and self-efficacy. Given the lack of broad evidence to support the efficacy of interventions targeting diet and physical activity, there is a notable need for research to develop and evaluate interventions targeting psychological factors that could positively impact diet- and weight-related behavioral change in pregnancy.

Analysis of Publication Trends in Childhood Obesity Research in PubMed Since 1945

Background: Childhood obesity (CO) has become a true epidemic and a subject of increasing publications. The aim of this study was to assess if the number of publications in that field increases over time in proportion to the epidemic, and also according to socioeconomic factors. Methods: A PubMed search was carried out to extract articles related to CO published between 1945 and 2017. Data were downloaded from PubMed and processed through a dedicated parser. Socioeconomic data were collected from international organizations. Results: Overall, 36,554 articles were retrieved among 3329 journals, one-third of them being concentrated in 44 journals. The annual growth rate of publications on CO was on average 11.6% per year between 1990 and 2016, whereas the growth rate of articles on pediatrics or of the total articles indexed in MEDLINE was 2.6% and 4.4%, respectively. The most productive countries were the United States (37.80%), the United Kingdom (6.24%), and Italy (4.56%). There was a significant relationship between publications on CO in a country and prevalence of CO in that country (p = 0.002) and between evolution of the number of publications and evolution of the Human Development Index (p = 0.01). Following exponential growth, CO publications reached a plateau in 2013, whereas publications targeted on obesity in infants continue to increase. Conclusions: Research on CO has risen markedly in the last two decades, with a higher growth rate than biomedical research overall, as a result of the worldwide obesity epidemic and also due to specific socioeconomic factors.

Impact of Combined Hormonal Contraceptive Use on Weight Loss: A Secondary Analysis of a Behavioral Weight-Loss Trial

OBJECTIVE

This study aimed to perform a preliminary investigation of the impact of combined hormonal contraceptive (CHC) use on weight loss during an 18-month behavioral weight-loss trial.

METHODS

Adults (n = 170; 18-55 years; BMI 27-42 kg/m2 ) received a weight-loss intervention that included a reduced-calorie diet, a progressive exercise prescription, and group-based behavioral support. Premenopausal women (n = 110) were classified as CHC users (CHC, n = 17) or non-CHC users (non-CHC, n = 93). Changes in weight were examined within groups using a linear mixed model, adjusted for age and randomized group assignment.

RESULTS

At 6 M, weight was reduced from baseline in both CHC (mean, -6.7 kg; 95% CI: -9.8 to -3.7 kg) and non-CHC (-9.1 kg; -9.1 to -6.4 kg). Between 6 and 18 M, CHC regained weight (4.9 kg; 0.9 to 8.9 kg), while weight remained relatively unchanged in non-CHC (-0.1 kg; -1.8 to 1.6 kg). At 18 M, weight was relatively unchanged from baseline in CHC (-1.8 kg; -7.3 to 3.6 kg) and was reduced from baseline in non-CHC (-7.9 kg; -10.2 to -5.5 kg).

CONCLUSIONS

In this secondary data analysis, CHC use was associated with weight regain after initial weight loss. Prospective studies are needed to further understand the extent to which CHC use influences weight loss and maintenance.

Maternal Obesity Programs Offspring Development and Resveratrol Potentially Reprograms the Effects of Maternal Obesity

Maternal obesity during pregnancy is a now a public health burden that may be the culprit underlying the ever-increasing rates of adult obesity worldwide. Understanding the association between maternal obesity and adult offspring’s obesity would inform policy and practice regarding offspring health through available resources and interventions. This review first summarizes the programming effects of maternal obesity and discusses the possible underlying mechanisms. We then summarize the current evidence suggesting that maternal consumption of resveratrol is helpful in maternal obesity and alleviates its consequences. In conclusion, maternal obesity can program offspring development in an adverse way. Maternal resveratrol could be considered as a potential regimen in reprogramming adverse outcomes in the context of maternal obesity.

Longitudinal Study of Maternal BMI in Successive Pregnancies

OBJECTIVE

This longitudinal observational study examined BMI changes between successive pregnancies.

METHODS

The computerized medical records of women who attended a large maternity hospital between 2009 and 2017 for their first and second singleton deliveries were analyzed. Women who had their weight first measured after 15 weeks of gestation in either pregnancy were excluded.

RESULTS

Of the 9,724 women, the incidence of obesity increased from 11.6% in the first pregnancy to 16.0% in the second. The mean interpregnancy interval was 32.5 ± 15.7 months, and median BMI change was +0.6 kg/m² (interquartile range 2.2; P < 0.001). Overall, 10.3% (1,006/9,724) developed overweight and 5.9% (571/9,724) developed obesity by the second pregnancy. Of the nulliparas in the overweight category, 20.6% (526/2,558) entered the obesity category. The development of obesity by the second pregnancy was independently associated with a longer interpregnancy interval, formula feeding at hospital discharge, taking antidepressants or anxiolytics, and postnatal depression. Professional/managerial employment was associated with a lower odds ratio of developing obesity.

CONCLUSIONS

Maternal obesity increased between the first and second pregnancy, with one-fifth of nulliparas in the overweight category developing obesity. Pregnancy-related factors were identified as predictors of developing obesity. Further research is needed to assess whether interventions targeting these related factors could optimize maternal weight management between pregnancies.

Does the Frequency of Watching Television Matters on Overweight and Obesity among Reproductive Age Women in Ethiopia?

BACKGROUND

Studies in developed countries have revealed an association of different magnitudes between watching television and the risk of being overweight and obese among reproductive age women. Even so, there is no evidence of such an association in the context of the Ethiopian population. Hence, the study aimed to assess the association between watching television with overweight and obesity in a nationally representative sample of Ethiopian women.

METHODS

A cross-sectional study was conducted by using secondary data analysis from 2016 Ethiopia demographic and health survey among women aged from 15 to 49 years. The samples were selected using a two-stage stratified cluster sampling technique. A total of 10,074 women were included in the analysis. The outcome variables were both overweight and obesity, whereas the main exposure variable was the frequency of watching television. Multivariate logistic regression analysis was performed for adjusting potential confounders. Adjusted odds ratio (AOR) with 95% confidence intervals was used to declare a statistically significant association.

RESULTS

The study found that watching television at least once a week was significantly associated with both overweight (AOR: 1.79; 95% CI: 1.20-2.73) and obesity (AOR: 3.76; 95% CI: 2.04-6.95). The study also divulged that the odds of overweight were higher among women aged 25-39 years (AOR: 2.17; 95% CI: 1.25-3.77) and 40-49 years (AOR: 2.69; 95% CI: 1.45-5.00), urban residents (AOR: 1.76; 95% CI:1.17-2.65), attended higher education (AOR:2.11; 95% CI: 1.22-3.65), and richest in the wealth index (AOR: 2.83; 95% CI:1.71-4.68). Similarly, the odds of obesity were higher among women aged 25-39 years and 40-49 years, attended higher education, and the richest in wealth index.

CONCLUSIONS

The results from this study demonstrated that watching television at least once a week is associated with obesity among reproductive age women in Ethiopia. Therefore, a social behavioral change communication campaign needs to be taken to improve awareness regarding the harmful consequences of watching television for long hours. Further research studies should be conducted among men and adolescents to determine whether this positive association exists among that target population as well.

Excessive Maternal Weight and Diabetes Are Risk Factors for Macrosomia: A Cross-Sectional Study of 42,663 Pregnancies in Uruguay

OBJECTIVE

To evaluate the risk of macrosomia in newborns from women with gestational diabetes, pregestational diabetes, overweight, and obesity in Uruguay in 2012, as well as its association with prolonged pregnancy, maternal age, multiparity, and excessive gestational weight gain (EGWG).

METHODS

We performed a cross-sectional study of 42,663 pregnant women. The risk of macrosomia was studied using logistic regression.

RESULTS

Mean maternal age was 26.7 ± 6.8 years. Pregestational overweight and obesity was present in 20.9% and 10.7% of women, respectively. There were 28.1% and 19.8% of women overweight and obese at the end of the pregnancy, respectively. Furthermore, 0.5% had pregestational diabetes and 8.5% were multiparous. Twenty two percent developed gestational diabetes and 44.9% had EGWG. The prevalence of macrosomia was 7.9%, significantly more prevalent in males (10.0% vs. 5.5%, p<0.005). Univariate analysis showed that obesity and overweight pre-pregnancy, obesity and overweight at the end of pregnancy, EGWG, pregestational diabetes, gestational diabetes, multiparity, prolonged pregnancy, and male newborn were strongly associated with macrosomia (p<0.0001). Maternal age >35 years did not increase the risk of macrosomia. After multiple logistic regression macrosomia was more likely in pre-gestational obese women (OR 1.24; CI 1.07-1.44), overweight women at the end of pregnancy (OR 1.66; CI 1.46-1.87), obese women at the end of pregnancy (OR 2.21; CI 1.90-2.58), women with EGWG (OR 1.78; CI 1.59-1.98), pregestational diabetes (OR 1.75; CI 1.15-2.69), gestational diabetes (OR 1.39; CI 1.25-1.53), prolonged pregnancy (OR 2.67; CI 2.28-3.12), multiparity (OR 1.24; CI 1.04-1.48), and male newborn (OR 1.89; CI 1.72-2.08).

CONCLUSION

Maternal overweight, obesity, EGWG, and gestational diabetes are prevalent in Uruguay, increasing the risk of macrosomia. Efforts to implement strategies to decrease the prevalence of overweight and obesity among women of reproductive age are essential to improve maternal and neonatal outcomes.

Comparison and Characterization of Prenatal Nutrition Counseling among Large-for-Gestational Age Deliveries by Pre-Pregnancy BMI

It is recommended that prenatal care include nutrition counseling; however, <70% of women report receipt of nutrition counseling during pregnancy. In this study, we aimed to characterize prenatal nutrition counseling (PNC) among large-for-gestational age deliveries at a low-income and minority-serving hospital by performing a retrospective chart review of infants with a birth weight > 4000 g. Of the 2380 deliveries, 165 met the inclusion criteria. Demographics, PNC receipt, and pregnancy outcomes were compared among normal-weight (NW; BMI: 18.5–24.9 kg/m², 19%, n = 31), overweight (OW; BMI: 25–29.9 kg/m², 29%, n = 48), and obese (OB; BMI > 30 kg/m², 52%, n = 86) women. The majority (78%, n = 129) of women were Hispanic White with a mean age of 30.4 ± 5.7 yrs and gestational weight gain of 12.1 ± 5.8 kgs. A total of 62% (n = 103) of women received PNC. A total of 57% gained above the Institute of Medicine (IOM) recommendations (n = 94). OB women were 2.6 and 2.1 times more likely to receive PNC than OW (95% CI: 1.1–2.0) and NW (95% CI: 0.9–1.9) women, respectively. Women who gained within the IOM recommendations for their pre-pregnancy body mass index (BMI) were 50% less likely to receive PNC than women who gained above the IOM recommendations for their pre-pregnancy weight (χ = 4.45, p = 0.035; OR = 0.48, CI: 0.24 to 0.95). Infant birthweight was significantly higher among women who received PNC (4314 ± 285 vs. 4197 ± 175 g, p = 0.004). These data suggest that PNC was directed toward women who enter pregnancy in the obese weight category and/or gain excessively across gestation. Future studies should provide PNC to all women to evaluate whether it reduces the risk of delivering large-for-gestational age deliveries across all maternal weight categories. Additionally, more work is needed to identify the types of PNC that are most effective for this high-risk population.

Assessment of Nutritional Status and Dietary Intake of Pregnant Women in Rural Area of Vhembe District, Limpopo Province

Poor consumption of balanced diet could result in poor weight gain during pregnancy increasing the risk of premature delivery, low birth weight, and birth defects. To assess the nutritional status and dietary intake of pregnant women in rural areas of Vhembe district. A cross-sectional descriptive study was carried out among 240pregnant women who were selected conveniently from 16 clinics in Vhembe District. An interviewer-administered questionnaire was used for data collection. Anthropometric measurements were measured following standard techniques. Data on dietary intake were collected using Food Frequency Questionnaire (FFQ). Permission and clearance were obtained and participant's rights were respected. Majority (78%) had secondary educational level while 19.5% had tertiary educational level. The mean energy and carbohydrate intake was 2248 Kcal and 372.1 g, respectively. Prevalence of underweight, overweight and obese using BMI was 16.3%, 24.2%, and 8.7% respectively. Dietary intake of the study participants showed that the intake of energy, fats, carbohydrates and vitamin C met the Recommended Dietary Allowance (RDA) values. The mean intake of protein was 30.2 ± 18.2 g. However, micronutrients like zinc, iron, magnesium, calcium including Vitamin A, B1 and B2 did not meet the RDA values in the current study. Despite government's programs to ensure adequate consumption of micronutrients and proper weight gain during pregnancy, malnutrition and insufficient consumption of micronutrients remains a major public health problem in South Africa. Improving nutritional status during pregnancy should follow an integrated approach tackling both malnutrition and micronutrient deficiencies at the same time considering the behavioral approach which will improve child survival and maternal health.

Maternal metabolic, immune, and microbial systems in late pregnancy vary with malnutrition in mice

Malnutrition is a global threat to pregnancy health and impacts offspring development. Establishing an optimal pregnancy environment requires the coordination of maternal metabolic and immune pathways, which converge at the gut. Diet, metabolic, and immune dysfunctions have been associated with gut dysbiosis in the nonpregnant individual. In pregnancy, these states are associated with poor pregnancy outcomes and offspring development. However, the impact of malnutrition on maternal gut microbes, and their relationships with maternal metabolic and immune status, has been largely underexplored. To determine the impact of undernutrition and overnutrition on maternal metabolic status, inflammation, and the microbiome, and whether relationships exist between these systems, pregnant mice were fed either a normal, calorically restricted (CR), or a high fat (HF) diet. In late pregnancy, maternal inflammatory and metabolic biomarkers were measured and the cecal microbiome was characterized. Microbial richness was reduced in HF mothers although they did not gain more weight than controls. First trimester weight gain was associated with differences in the microbiome. Microbial abundance was associated with altered plasma and gut inflammatory phenotypes and peripheral leptin levels. Taxa potentially protective against elevated maternal leptin, without the requirement of a CR diet, were identified. Suboptimal dietary conditions common during pregnancy adversely impact maternal metabolic and immune status and the microbiome. HF nutrition exerts the greatest pressures on maternal microbial dynamics and inflammation. Key gut bacteria may mediate local and peripheral inflammatory events in response to maternal nutrient and metabolic status, with implications for maternal and offspring health.

Mediterranean-style diet in pregnant women with metabolic risk factors (ESTEEM): A pragmatic multicentre randomised trial

BACKGROUND

Pregnant women with metabolic risk factors are at high risk of complications. We aimed to assess whether a Mediterranean-style diet reduces adverse pregnancy outcomes in high-risk women.

METHODS AND FINDINGS

We conducted a multicentre randomised trial in 5 maternity units (4 in London and 1 in Birmingham) between 12 September 2014 and 29 February 2016. We randomised inner-city pregnant women with metabolic risk factors (obesity, chronic hypertension, or hypertriglyceridaemia) to a Mediterranean-style diet with high intake of nuts, extra virgin olive oil, fruits, vegetables, nonrefined grains, and legumes; moderate to high consumption of fish; low to moderate intake of poultry and dairy products; low intake of red and processed meat; and avoidance of sugary drinks, fast food, and food rich in animal fat versus usual care. Participants received individualised dietary advice at 18, 20, and 28 weeks' gestation. The primary endpoints were composite maternal (gestational diabetes or preeclampsia) and composite offspring (stillbirth, small for gestational age, or admission to neonatal care unit) outcomes prioritised by a Delphi survey. We used an intention-to-treat (ITT) analysis with multivariable models and identified the stratification variables and prognostic factors a priori. We screened 7,950 and randomised 1,252 women. Baseline data were available for 593 women in the intervention (93.3% follow-up, 553/593) and 612 in the control (95.6% follow-up, 585/612) groups. Over a quarter of randomised women were primigravida (330/1,205; 27%), 60% (729/1,205) were of Black or Asian ethnicity, and 69% (836/1,205) were obese. Women in the intervention arm consumed more nuts (70.1% versus 22.9%; adjusted odds ratio [aOR] 6.8, 95% confidence interval [CI] 4.3-10.6, p ≤ 0.001) and extra virgin olive oil (93.2% versus 49.0%; aOR 32.2, 95% CI 16.0-64.6, p ≤ 0.001) than controls; increased their intake of fish (p < 0.001), white meat (p < 0.001), and pulses (p = 0.05); and reduced their intake of red meat (p < 0.001), butter, margarine, and cream (p < 0.001). There was no significant reduction in the composite maternal (22.8% versus 28.6%; aOR 0.76, 95% CI 0.56-1.03, p = 0.08) or composite offspring (17.3% versus 20.9%; aOR 0.79, 95% CI 0.58-1.08, p = 0.14) outcomes. There was an apparent reduction in the odds of gestational diabetes by 35% (aOR 0.65, 95% CI 0.47-0.91, p = 0.01) but not in other individual components of the composite outcomes. Mothers gained less gestational weight (mean 6.8 versus 8.3 kg; adjusted difference -1.2 Kg, 95% CI -2.2 to -0.2, p = 0.03) with intervention versus control. There was no difference in any of the other maternal and offspring complications between both groups. When we pooled findings from the Effect of Simple, Targeted Diet in Pregnant Women With Metabolic Risk Factors on Pregnancy Outcomes (ESTEEM) trial with similar trials using random effects meta-analysis, we observed a significant reduction in gestational diabetes (odds ratio [OR] 0.67, 95% CI 0.53-0.84, I2 = 0%), with no heterogeneity (2 trials, 2,397 women). The study's limitations include the use of participant reported tools for adherence to the intervention instead of objective biomarkers.

CONCLUSIONS

A simple, individualised, Mediterranean-style diet in pregnancy did not reduce the overall risk of adverse maternal and offspring complications but has the potential to reduce gestational weight gain and the risk of gestational diabetes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02218931.

Use of Glucose, Glutamine and Fatty Acids for Trophoblast Respiration in Lean, Obese and Gestational Diabetic Women

PURPOSE

Maternal obesity and gestational diabetes (GDM) are associated with adverse outcomes particularly with a male fetus. The composition and amount of substrate supplied to the placenta is altered in these conditions. We hypothesized that there are sexually dimorphic differences in utilization of glucose, fatty acids and glutamine between trophoblast of lean, obese and GDM women.

METHODS

Trophoblast were isolated from term male or female placentas from lean, obese or GDM women (n = 4-6/group) and syncytiotrophoblast formed over 72 hr before measuring mitochondrial respiration by fuel flex assay (Seahorse XF96 analyzer). Dependency, capacity and flexibility for use of glucose, glutamine and fatty acids was measured with western blot of glucose transporter GLUT1, glutaminase and carnitine palmitoyl-transferase 1A, (CPT1A).

RESULTS

Sexual dimorphism in syncytiotrophoblast fuel utilization was seen in GDM vs lean with a significant increase in glucose dependency in male and glucose capacity in female, whereas for glutamine capacity significantly decreased in male and female but dependency only in female. Fatty acid dependency and capacity significantly increased in male and capacity in female trophoblast of GDM vs either lean or obese. In male but not female trophoblast flexibility to use all three fuels significantly decreased from lean to obese and GDM. In male trophoblast there were significant associations between GLUT1 and glucose dependency (positive) and flexibility (negative).

MAIN CONCLUSIONS

Human syncytiotrophoblast utilizes glutamine for mitochondrial respiration. Utilization of glucose, fatty acids and glutamine changes in a sexually dimorphic manner with obesity and GDM predominantly with a male placenta.

Prevalence and outcomes of overweight and obesity among pregnant women in rural Queensland

OBJECTIVE

To assess the prevalence of overweight and obese women in the antenatal and perinatal periods, in rural hospitals; and to evaluate neonatal and maternal outcomes, including transfer to larger birthing centres.

DESIGN

A retrospective clinical chart audit.

SETTING

Rural maternity services in five Queensland rural hospitals.

PARTICIPANTS

Data were collected from 250 women presenting to participating rural hospitals, with an estimated due date in 2016.

MAIN OUTCOME MEASURES

Obstetric and neonatal data, whether transfer occurred, mode of delivery and any complications, and neonatal outcomes including birth weight and complications were collected. Demographic information collected included maternal age, gravidity and parity, race, smoking status and pre-pregnancy body mass index. The main outcome measures of interest were birth weight, Caesarean rate, transfer rate and diagnosis of gestational diabetes in relation to the body mass index.

RESULTS

Over 50% of women were overweight or obese while entering pregnancy, with 5.2% of mothers in the morbidly obese category. There was an increase in the birth weight of mothers with a body mass index of more than 25. The increasing body mass index was associated with an increased likelihood of transfer, diagnosis of gestational diabetes, elective and, especially, emergency Caesareans performed at the hospital. Twenty-four percent of women continued to smoke throughout pregnancy.

CONCLUSION

A high prevalence of obesity was found in the rural obstetric population. As the body mass index increases, so too does birth weight, gestational diabetes, transfer rate and Caesarean section rate. The rates of smoking throughout pregnancy were higher than the average metropolitan rates. These findings have implications not just for rural hospital operation and resources, but also for preventive health activities in rural communities.

Oxytocin and Oxytocinase in the Obese and Nonobese Parturients during Induction and Augmentation of Labor

Objective  To investigate differences in oxytocin (OXT) biodistribution between nonobese and obese parturients during labor. Study Design  Patients with body mass index (BMI) of either ≥ 18 ≤ 24.9 kg/m ² ("nonobese") or ≥ 30 kg/m ² ("obese") undergoing elective induction of labor were included ( N  = 25 each). Blood samples were collected at baseline (T ₀ ), and 20 minutes after maximal OXT augmentation or adequate uterine contractions (T ₁ ) for OXT and oxytocinase assays. A mixed-model repeated-measures analysis of variance was used to test for group versus time interaction and analysis of covariance to detect a difference in OXT level at T ₁ . Data presented as mean ± standard deviation or median (interquartile range), with p  < 0.05 considered significant. Results  The mean BMIs (kg/m ² ) were 22.1 ± 1.6 and 35.9 ± 5.1 in the nonobese and obese groups, respectively. No differences were observed in either the duration of OXT infusion, total dose of OXT, or plasma OXT (pg/mL) either at T ₀ or T ₁ . However, plasma oxytocinase (ng/mL) was significantly lower at T ₀ (1.41 [0.67, 3.51] vs. 0.40 [0.29, 1.12]; p  = 0.03) in the obese group. Conclusion  We provide preliminary evidence that the disposition of OXT may not be different between obese and nonobese women during labor.

Preconception management of women with obesity: A systematic review

The prevalence of women of child-bearing age with obesity continues to rise at an alarming rate. This has significant implications for both the short-term and long-term health of mother and offspring. Given the paucity of evidence-based literature in this field, the preconception management of women with obesity is highly variable both between institutions and around the world. This systematic review aims to evaluate studies that inform us about the role of preconception weight loss in the fertility and pregnancy outcomes of women with obesity. Current therapeutic interventions are discussed, with a specific focus on the suitability of weight loss interventions for women with obesity planning pregnancy. There are significant knowledge gaps in the current literature; these are discussed and areas for future research are explored.

Effect of a High-Fat Diet and Metformin on Placental mTOR Signaling in Mice

Objective  This study was aimed to measure the effects of a high-fat diet and metformin on placental mechanistic target of rapamycin (mTOR) signaling in mice. Study Design  Pregnant friend virus B (FVB)-strain mice were allocated on embryonic day (e) 0.5 to one of four groups; group 1: control diet (CD, 10% fat) + control treatment (CT), group 2: CD + metformin treatment (MT), group 3: high-fat diet (HFD, 60% fat) + CT, and group 4: HFD + MT. Metformin (2.5 mg/mL) was provided in water; CT mice received water. Fetuses and placentas were collected. Western blot measured placental p-Akt and p-S6 expression. Results  20 dams (five/group) and 192 fetuses were studied. Compared with CD-fed, HFD-fed dams had higher placental p-Akt protein expression ( p  < 0.0001). Among HFD-dams, placental p-Akt was higher in metformin-treated compared with control-treated ( p  < 0.001). Among CD-fed dams, there was no significant difference in placental p-S6 expression in MT versus CT groups. Among HFD-fed dams placental p-S6 expression was lower in those exposed to metformin-treated versus controls ( p  = 0.001). Conclusion  Increased placental mTOR signaling and metformin inhibition of placental mTOR signaling only occurred in the presence of an HFD exposure. These findings suggest that metformin may modulate placental mTOR signaling in the presence of metabolic exposures during pregnancy.

Is vaginal misoprostol more effective than oral misoprostol for cervical ripening in obese women?

Objective: To determine if vaginal misoprostol is more effective than oral misoprostol for cervical ripening in obese women.Study design: A retrospective cohort study of obese women undergoing induction of labor from Jan 2013 to Dec 2016 with singleton, viable pregnancies beyond 37 completed weeks of gestational age. Women with an initial Bishop score of 7 or less, with a cervical dilatation of less than 2 cm, who received either vaginal or oral misoprostol as a cervical ripening agent, were included. Primary outcome was interval from the start of induction to the attainment of 3 cm cervical dilatation. Secondary outcomes included the interval from the start of induction to delivery and the rate of cesarean delivery (CD).Result: Of women who met the inclusion criteria, 966 (75.5%) women received oral misoprostol and 314 (24.5%) received vaginal misoprostol. The mean time-interval from the start of induction to attainment of 3-cm dilatation was shorter in the vaginal group (10.5 ± 10.4 h) compared to the oral group (17.2 ± 11.5 h), (p < .0001). Significantly shorter times to delivery were also noted in the vaginal group (17.4 h for vaginal vs. 24.8 h for oral, p < .0001). In the subgroup analysis of nulliparous women, shorter time intervals from the start of induction to attainment of 3-cm dilatation, as well as to delivery, were noted in the vaginal misoprostol group (p < .0001 for both). Multiple linear regression model confirmed route of misoprostol administration as an independent variable in predicting the outcomes (time from start of induction to 3 cm as well as to delivery). Significant findings amongst neonatal outcomes included lower umbilical artery pH and higher rates of neonatal jaundice in the oral misoprostol group.Conclusion: In a population of obese women undergoing induction of labor, vaginal administration of misoprostol was associated shorter time intervals from the start of induction to the attainment of 3 cm of dilatation, as well as to delivery, without increasing the rate of cesarean deliveries or the incidence of adverse maternal and neonatal outcomes.

[Effectiveness of mobile technology and weight gain in pregnant women in Callao, Peru]

OBJECTIVE

To evaluate the effectiveness of mobile technology in the appropriate weight gain of pregnant women.

MATERIALS AND METHODS

A quasi-experimental study. The sample included 117 pregnant women attending health facilities at la Dirección Regional de Salud (Diresa), Callao. Messages were sent to 58 pregnant women who formed the experimental group to improve their lifestyles and assistance to prenatal care (APC), while 59 pregnant women received routine education provided for pregnants. Messages were sent every three days. The nutritional status of the pregnant women was evaluated using the pre gestational BMI at the first visit of the APC. The weight gain was obtained from the difference between pre-gestational weight and weight recorded during the last controls.

RESULTS

The adequate weight gain was 27.6% of intervened pregnancies and 25.4% in the non-intervened. The 79.3% pregnant had six or more NPC in the group intervened and 54.2% in the non-intervened. The weight gain was excessive in 5.1% in the non-intervened pregnant and 1.7% in the intervened. The highest percentage of pregnant women with adequate weight gain (32.0%) was observed in the intervened pregnancies with pre-gestacional overwhegith.

CONCLUSIONS

There was no statistic difference in the use of mobile technology for a proper weight gain between both study groups. There were greater fulfillment of APC in intervened pregnancies compared to the non-intervened (p<0.05).