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Tas GG, Sati L. Probiotic Lactobacillus rhamnosus species: considerations for female reproduction and offspring health. J Assist Reprod Genet 2024:10.1007/s10815-024-03230-6. [PMID: 39172320 DOI: 10.1007/s10815-024-03230-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 08/08/2024] [Indexed: 08/23/2024] Open
Abstract
Lactobacillus rhamnosus is a type of bacteria known as a probiotic and is often used to support the health of the digestive system and vaginal flora. This type of bacteria has an important role, showing positive effects on female reproductive biology, particularly by maintaining the balance of microorganisms in the vagina, reducing the risk of infection, and strengthening the immune system to support maternal health during pregnancy. There are also studies showing that these probiotics prevent maternal obesity and gestational diabetes. Consuming probiotics containing Lactobacillus rhamnosus strains may support the intestinal health of breastfeeding mothers, but they may also contribute to the health of offspring. Therefore, this review focuses on the current available data for examining the effects of Lactobacillus rhamnosus strains on female reproductive biology and offspring health. A systematic search was conducted in the PubMed and Web of Science databases from inception to May 2024. The search strategy was performed using keywords and MeSH (Medical Subject Headings) terms. Inconsistent ratings were resolved through discussion. This review is strengthened by multiple aspects of the methodological approach. The systematic search strategy, conducted by two independent reviewers, enabled the identification and evaluation of all relevant literature. Although there is a limited number of studies with high heterogeneity, current literature highlights the important contribution of Lactobacillus rhamnosus probiotics in enhancing female reproductive health and fertility. Furthermore, the probiotic bacteria in breast milk may also support the intestinal health of newborn, strengthen the immune system, and protect them against diseases at later ages.
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Affiliation(s)
- Gizem Gamze Tas
- Department of Histology and Embryology, Akdeniz University School of Medicine, Campus, 07070, Antalya, Turkey
| | - Leyla Sati
- Department of Histology and Embryology, Akdeniz University School of Medicine, Campus, 07070, Antalya, Turkey.
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Girchenko P, Lahti-Pulkkinen M, Laivuori H, Kajantie E, Räikkönen K. Maternal antenatal depression is associated with metabolic alterations that predict birth outcomes, neurodevelopment and mental health of the child. Biol Psychiatry 2024:S0006-3223(24)01509-9. [PMID: 39127233 DOI: 10.1016/j.biopsych.2024.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/04/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Evidence regarding metabolic alterations associated with maternal antenatal depression (AD) is limited, and their role as potential biomarkers improving the prediction of AD and adverse child birth, neurodevelopmental, and mental health outcomes remains unexplored. METHODS In a cohort of 331 mother-child dyads, we studied associations between AD (history of medical register diagnoses and/or Center of Epidemiological Studies Depression Scale score during pregnancy≥20) and 95 metabolic measures analyzed three times during pregnancy. We tested whether the AD-related metabolic measures increased variance explained in AD over its risk factors, and in child birth, neurodevelopmental, and mental health outcomes over AD. We replicated the findings in a cohort of 416 mother-child dyads. RESULTS Elastic net regression identified 15 metabolic measures that collectively explained 25% (p<0.0001) of variance in AD, including amino and fatty acids, glucose, inflammation, and lipids. These metabolic measures increased the variance explained in AD over its risk factors (32.3%,p<0.0001 vs. 12.6%,p=0.004), and in child gestational age (9.0%,p<0.0001 vs. 0.7%, p=0.34), birth weight(9.0%,p=0.03 vs. 0.7%, p=0.33), developmental milestones at the age of 2.3-5.7 years(21.0%,p=0.002 vs. 11.6%,p<0.001) and any mental or behavioral disorder by the age of 13.1-16.8 years(25.2%,p=0.03 vs. 5.0%,p=0.11) over AD, child sex and age. These findings replicated in the independent cohort. CONCLUSIONS AD is associated with alterations in 15 metabolic measures, which collectively improve the prediction of AD over its risk factors, and birth, neurodevelopmental and mental health outcomes of the child over AD. These metabolic measures may become biomarkers identifying at-risk mothers and children for personalized interventions.
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Affiliation(s)
- Polina Girchenko
- Clinical Medicine Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Marius Lahti-Pulkkinen
- Clinical Medicine Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Hannele Laivuori
- Department of Obstetrics and Gynecology, Tampere University Hospital, The Wellbeing Services County of Pirkanmaa, Finland; Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Eero Kajantie
- Clinical Medicine Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Katri Räikkönen
- Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki
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Banafshe E, Javadifar N, Abbaspoor Z, Karandish M, Ghanbari S. Factors Influencing Weight Management in Pregnant Women with Overweight or Obesity: A Meta-Synthesis of Qualitative Studies. J Acad Nutr Diet 2024; 124:964-994.e1. [PMID: 38648889 DOI: 10.1016/j.jand.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Overweight and obesity have multiple negative consequences for the health of both the mother and the child. Interventions to prevent excessive weight gain during pregnancy have had varying success, and the proportion of pregnant women who exceed national guidelines for weight gain continues to increase. OBJECTIVE To investigate the influence of factors on weight management among pregnant women with overweight or obesity. METHODS This meta-synthesis of qualitative studies involved searching databases PubMed, Embase, Cochrane, Scopus, and Web of Science. The databases were searched on October 4, 2022, and the search was updated on April 21, 2023. The screening of titles, abstracts, and full texts was conducted utilizing Covidence software. The quality assessment of the articles was performed using the Critical Appraisal Skills Programme checklist. The Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement was used to enhance transparency in reporting. A meta-aggregation approach was used to guide the data extraction and synthesis. RESULTS A total of 46 studies with appropriate Critical Appraisal Skills Programme scores were included for qualitative synthesis. Findings were extracted and integrated into 4 themes: psychological factors (personally driven negative emotions and society-driven negative emotions), social factors (societal attitudes and beliefs and social support resources), factors related to education and counseling (information provision and communication), and factors associated with effective care (provided care components and the method of providing effective care). CONCLUSIONS To improve weight management during pregnancy, health care providers should provide tailored and individualized recommendations that take into consideration the factors influencing these women.
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Affiliation(s)
- Elahe Banafshe
- Midwifery Department, Nursing & Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nahid Javadifar
- Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Zahra Abbaspoor
- Department of Midwifery, Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Majid Karandish
- Nutrition and Metabolic Diseases Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Ghanbari
- Department of Biostatistics and Epidemiology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Ardissino M, Geddes-Barton M, Banerjee A. Author reply. BJOG 2024; 131:1163-1164. [PMID: 38351628 DOI: 10.1111/1471-0528.17780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/24/2024] [Indexed: 06/04/2024]
Affiliation(s)
- Maddalena Ardissino
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK
| | | | - Anita Banerjee
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
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Baattaiah BA, Alharbi MD, Aldhahi MI, Khan F. Factors associated with postpartum fatigue: an exploration of the moderating role of resilience. Front Public Health 2024; 12:1394380. [PMID: 38947349 PMCID: PMC11211369 DOI: 10.3389/fpubh.2024.1394380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024] Open
Abstract
Background Postpartum fatigue (PPF) can impair the physical and mental well-being of women. The aims of this study were to assess the associations between fatigue and maternal health-related variables, specifically, sleep quality, depression symptoms, and resilience, and to explore the moderating role of resilience in the relationships between sleep quality, depression symptoms, and fatigue. Methods This cross-sectional study used data collected from mothers during the postpartum period via an online platform. PPF was assessed using the Fatigue Severity Scale, whereas sleep quality and depression symptoms were assessed using the Pittsburgh Sleep Quality Index and Edinburgh Postnatal Depression Scale, respectively. The Brief Resilience Scale was used to assess resilience. Simple and multiple binary logistic regression analyses were performed to examine the association of each independent variable with PPF and to determine the most significant predictors of PFF. The data were analyzed using SPSS, and structural equation modeling was performed using AMOS 23. A moderation analysis was performed to explore the moderating role of resilience using the Hayes PROCESS macro. Results A total of 1,443 postpartum mothers were included in the analysis. The simple binary logistic regression analysis showed that having chronic disease (odds: 1.52; p = 0.02), mother's age (odds: 0.97; p = 0.03), mother's body mass index (BMI; odds: 1.03; p = 0.01), depression symptoms (odds: 1.09; p ≤ 0.0001), sleep quality (odds: 1.17; p ≤ 0.0001), and resilience (odds: 0.42; p ≤ 0.0001) all contributed to fatigue during postpartum. Multivariate logistic regression showed that the mother's BMI, sleep quality, depression symptoms, and resilience were significant predictors of PPF. Moderation analyses showed that resilience was not a significant moderator between the main effects of sleep quality and fatigue (interaction effect: β = 0.01, p = 0.31, 95% CI: -0.01 to 0.04) or between the main effects of depression symptoms and fatigue during postpartum (interaction effect: β = 0.01, p = 0.82, 95% CI: -0.01 to 0.02). Conclusion Given the deleterious effects of PPF on maternal health outcomes, factors associated with PPF should be assessed regularly. In addition to mothers' BMI, sleep quality, and depression symptoms, resilience could also be a crucial factor in predicting fatigue severity during this critical time for mothers even though it was not a significant moderator among this sample.
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Affiliation(s)
- Baian A. Baattaiah
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mutasim D. Alharbi
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Monira I. Aldhahi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Fayaz Khan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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Chhabria K, Selvaraj S, Refuerzo J, Truong C, Cazaban CG. Investigating the association between metabolic syndrome conditions and perinatal mental illness: a national administrative claims study. BMC Pregnancy Childbirth 2024; 24:409. [PMID: 38849738 PMCID: PMC11157911 DOI: 10.1186/s12884-024-06542-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/25/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Although the association between mental disorder and metabolic syndrome as a bidirectional relationship has been demonstrated, there is little knowledge of the cumulative and individual effect of these conditions on peripartum mental health. This study aims to investigate the association between metabolic syndrome conditions (MetS-C) and maternal mental illness in the perinatal period, while exploring time to incident mental disorder diagnosis in postpartum women. METHODS This observational study identified perinatal women continuously enrolled 1 year prior to and 1 year post-delivery using Optum's de-identified Clinformatics® Data Mart Database (CDM) from 2014 to 2019 with MetS-C i.e. obesity, diabetes, high blood pressure, high triglycerides, or low HDL (1-year prior to delivery); perinatal comorbidities (9-months prior to and 4-month postpartum); and mental disorder (1-year prior to and 1-year post-delivery). Additionally, demographics and the number of days until mental disorder diagnosis were evaluated in this cohort. The analysis included descriptive statistics and multivariable logistic regression. MetS-C, perinatal comorbidities, and mental disorder were assessed using the International Classification of Diseases, Ninth, and Tenth Revision diagnosis codes. RESULTS 372,895 deliveries met inclusion/exclusion criteria. The prevalence of MetS-C was 13.43%. Multivariable logistic regression revealed prenatal prevalence (1.64, CI = 1.59-1.70) and postpartum incident (1.30, CI = 1.25-1.34) diagnosis of mental health disorder were significantly higher in those with at least one MetS-C. Further, the adjusted odds of having postpartum incident mental illness were 1.51 times higher (CI = 1.39-1.66) in those with 2 MetS-C and 2.12 times higher (CI = 1.21-4.01) in those with 3 or more MetS-C. Young women (under the age of 18 years) were more likely to have an incident mental health diagnosis as opposed to other age groups. Lastly, time from hospital discharge to incident mental disorder diagnosis revealed an average of 157 days (SD = 103 days). CONCLUSION The risk of mental disorder (both prenatal and incident) has a significant association with MetS-C. An incremental relationship between incident mental illness diagnosis and the number of MetS-C, a significant association with younger mothers along with a relatively long period of diagnosis mental illness highlights the need for more screening and treatment during pregnancy and postpartum.
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Affiliation(s)
- Karishma Chhabria
- Division of Management Policy and Community Health, Center for Healthcare Data Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA.
- Department of Public Health, Usha Kundu MD College of Health, University of West Florida 11000 University Pkwy, Pensacola, FL, 32514, USA.
| | - Sudhakar Selvaraj
- Louis Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
- Clinical Development, Intra-Cellular Therapies, Inc., 430 East 29th Street, New York, NY, United States
| | - Jerrie Refuerzo
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Chau Truong
- Division of Management Policy and Community Health, Center for Healthcare Data Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Cecilia Ganduglia Cazaban
- Division of Management Policy and Community Health, Center for Healthcare Data Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
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Sumy MSA, Parh MYA, Soni MSM, Saifuddin N, Elma JF, Zarei H, Hossain MM. Differences in Associated Factors of Underweight and Overweight According to Rural-Urban Residence Strata among Ever-Married Non-Pregnant Women of Reproductive Age in Bangladesh. Malays J Med Sci 2024; 31:229-240. [PMID: 38984237 PMCID: PMC11229563 DOI: 10.21315/mjms2024.31.3.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/19/2023] [Indexed: 07/11/2024] Open
Abstract
Background This study sought to compare the prevalence of underweight and overweight among ever-married, non-pregnant women of reproductive age in Bangladesh by urban or rural residency status. Methods This study used Bangladesh Demographic and Health Survey (BDHS), 2017 data. Cross-sectional study design with two-stage stratified sampling method was employed. A sample of ever-married non-pregnant women of reproductive age was selected and multinomial logistic regression was utilised in analysis. Results It was found that around half of rural women (45.0%, N = 4,934) and more than half of urban women (60.3%, n = 3,913) were overweight. Nearly one in seven rural women (14.0%, n = 1,537) and 1 in 12 urban women (9.0%, n = 564) were reported as underweight. Our analyses revealed that being overweight was substantially connected with age, husband's occupation, economic status, television access, and division for both urban and rural areas. Women from poor households were significantly more likely to be underweight than women from middle- income households for both urban (P < 0.05; OR: 1.41; 95% CI: 1.03, 1.94) and rural (P < 0.05; OR: 1.23; 95% CI: 1.04, 1.46) areas. Interestingly, women without television access both in urban (P < 0.001; OR = 0.78; 95% CI: 0.67, 0.91) and rural (P < 0.001; OR = 0.75; 95% CI: 0.68, 0.84) areas had an inverse association with overweight/obesity compared to women with television access. In both areas, women in Sylhet and Mymensingh had higher likelihood of being underweight than Barisal division. Additionally, in both residential zones, women in Sylhet had lower likelihood of being overweight than Barisal division. Conclusion This study reveals that multiple characteristics are linked to both overweight and underweight among ever-married, non-pregnant women of reproductive age in Bangladesh. Addressing these variables should be a priority in public health efforts to combat the dual challenge of malnutrition in Bangladesh.
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Affiliation(s)
- Mst Sharmin Akter Sumy
- Department of Bioinformatics and Biostatistics, University of Louisville, Kentucky, USA
- Department of Statistics, Islamic University, Kushtia, Bangladesh
| | - Md Yasin Ali Parh
- Department of Bioinformatics and Biostatistics, University of Louisville, Kentucky, USA
- Department of Statistics, Islamic University, Kushtia, Bangladesh
| | | | | | | | - Hamid Zarei
- Department of Health Management and Systems Science, University of Louisville, Kentucky, USA
| | - Md Murad Hossain
- Department of Statistics, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, Bangladesh
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Alves FCR, Moreira A, Moutinho O. Maternal and long-term offspring outcomes of obesity during pregnancy. Arch Gynecol Obstet 2024; 309:2315-2321. [PMID: 38502190 DOI: 10.1007/s00404-023-07349-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 03/21/2024]
Abstract
PURPOSE Obesity`s prevalence is rising in women of reproductive age worldwide and has become the most common medical condition at this age group. Besides, its occurrence is also rising during pregnancy. This condition not only increases the risk of noncommunicable diseases on the mother, such as cardiovascular disease and diabetes, but also transfers this risk to the offspring. METHODS This is a narrative review based on scientific and review articles on the matter. RESULTS Obesity is associated with an increased risk of gestational diabetes mellitus, gestational hypertension and preeclampsia, venous thromboembolism, infection, and mental health problems. Furthermore, it has an impact on the progress of labor and induction matters. Regarding offspring outcomes, it is related to higher incidence of congenital anomalies, perinatal mortality, and the occurrence of large for gestational age newborns. Still, it has implications on cardiometabolic risk and neurodevelopment in offspring. CONCLUSION It is, therefore, imperative to encourage the adoption of healthy lifestyles, especially in the peri-conception and interpregnancy periods. Likewise, there must be support in the multidisciplinary monitoring of these pregnant women to minimize associated complication rates.
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Affiliation(s)
- Fernanda Cristina Ribeiro Alves
- Obstetrics and Gynecology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, Vila Real, Portugal.
| | - Ana Moreira
- Obstetrics and Gynecology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, Vila Real, Portugal
| | - Osvaldo Moutinho
- Obstetrics and Gynecology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, Vila Real, Portugal
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Kehl S. Obesity at term: What to consider? How to deliver? Arch Gynecol Obstet 2024; 309:1725-1733. [PMID: 38326633 DOI: 10.1007/s00404-023-07354-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/17/2023] [Indexed: 02/09/2024]
Abstract
Obesity presents significant challenges during pregnancy, increasing the risk of complications and adverse outcomes for both mother and baby. With the rising prevalence of obesity among pregnant women, questions arise regarding optimal management, including timing of delivery and choice of delivery mode. Labour induction in obese women may require a combination of mechanical and pharmacological methods due to increased risk of failed induction. Caesarean section in obese women presents unique challenges, requiring comprehensive perioperative planning and specialized care to optimize outcomes. However, specific guidelines tailored to obese patients undergoing caesarean sections are lacking. Postpartum care should include vigilant monitoring for complications. Addressing obesity in pregnancy necessitates a multidisciplinary approach and specialized care to ensure the best outcomes.
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Affiliation(s)
- Sven Kehl
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Universitätsstr. 21-23, 91054, Erlangen, Germany.
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Al-Sabah R, Al-Taiar A, Ziyab AH, Akhtar S, Hammoud MS. Antenatal Depression and its Associated Factors: Findings from Kuwait Birth Cohort Study. J Epidemiol Glob Health 2024:10.1007/s44197-024-00223-7. [PMID: 38619741 DOI: 10.1007/s44197-024-00223-7] [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: 12/17/2023] [Accepted: 03/26/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Pregnant and postpartum women are at high risk of depression due to hormonal and biological changes. Antenatal depression is understudied compared to postpartum depression and its predictors remain highly controversial. AIM To estimate the prevalence of depressive symptoms during pregnancy and investigate factors associated with this condition including vitamin D, folate and Vitamin B12 among participants in the Kuwait Birth Study. METHODS Data collection occurred as part of the Kuwait Birth Cohort Study in which pregnant women were recruited in the second and third trimester during antenatal care visits. Data on antenatal depression were collected using the Edinburgh Postnatal Depression Scale (EPDS), considering a score of ≥ 13 as an indicator of depression. Logistic regression was used to investigate factors associated with depressive symptoms in pregnant women. RESULTS Of 1108 participants in the Kuwait Birth Cohort study, 1070(96.6%) completed the EPDS. The prevalence of depressive symptoms was 21.03%(95%CI:18.62-23.59%) and 17.85%(95%CI:15.60-20.28%) as indicated by an EPDS ≥ 13 and EPDS ≥ 14 respectively. In the multivariable analysis, passive smoking at home, experiencing stressful life events during pregnancy, and a lower level of vitamin B12 were identified as predisposing factors. Conversely, having desire for the pregnancy and consumption of fruits and vegetables were inversely associated with depressive symptoms. CONCLUSION Approximately, one fifth of pregnant women had depressive symptoms indicating the need to implement screening program for depression in pregnant women, a measure not systematically implemented in Kuwait. Specifically, screening efforts should focus on pregnant women with unintended pregnancies, exposure to passive smoking at home, and recent stressful live events.
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Affiliation(s)
- Reem Al-Sabah
- Department of Community Medicine and Behavioral Sciences, College of Medicine, Kuwait University, P.O. Box 24923, Safat, 13110, Kuwait
| | - Abdullah Al-Taiar
- School of Community and Environmental Health, College of Health Sciences, Old Dominion University, 3136 Health Sciences Building, 4608 Hampton Blvd, Norfolk, VA, 23508, USA
| | - Ali H Ziyab
- Department of Community Medicine and Behavioral Sciences, College of Medicine, Kuwait University, P.O. Box 24923, Safat, 13110, Kuwait.
| | - Saeed Akhtar
- Department of Community Medicine and Behavioral Sciences, College of Medicine, Kuwait University, P.O. Box 24923, Safat, 13110, Kuwait
| | - Majeda S Hammoud
- Department of Pediatrics, College of Medicine, Kuwait University, Safat, Kuwait
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Li S, Zhou W, Li P, Lin R. Effects of ketamine and esketamine on preventing postpartum depression after cesarean delivery: A meta-analysis. J Affect Disord 2024; 351:720-728. [PMID: 38286233 DOI: 10.1016/j.jad.2024.01.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Ketamine and esketamine has been suggested to have potential efficacy in preventing postpartum depression (PPD) recent years. The aim of this meta-analysis was to evaluate the effectiveness of ketamine and esketamine on PPD after cesarean delivery. METHODS We systematically searched PubMed, Embase, and the Cochrane Library for studies investigating the efficacy of ketamine and esketamine in preventing PPD. The primary outcomes of this study were risk ratios (RRs) and EPDS scores (Edinburgh Postnatal Depression Scale) in relation to PPD after ketamine and esketamine. The second outcomes were the postoperative adverse events. RESULTS Thirteen randomized controlled trials (RCTs) and one retrospective study including 2916 patients were analyzed, including six on the use of ketamine and eight on the use of esketamine. The risk ratios and EPDS scores of PPD were significantly decreased in the ketamine/esketamine group compared to those in the control group in one week and four weeks postoperative periods. Subgroup analyses showed that high dosage, administrated in patient controlled intravenous analgesia (PCIA) method and only esketamine exhibited a significant reduction in the incidence and EPDS scores of PPD in one week and four week postoperative. However, the incidences of postoperative adverse events, such as dizziness, diplopia, hallucination, and headache were significantly higher in the ketamine/esketamine group than that in the control group. CONCLUSION Ketamine and esketamine appear to be effective in preventing PPD in the one week and four week postoperative periods after cesarean delivery with moderate certainty of evidence. But they can also lead to some short-term complications too. Future high-quality studies are needed to confirm the efficacy of ketamine and esketamine in different countries.
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Affiliation(s)
- Shuying Li
- Department of Anesthesiology, West China Second Hospital of Sichuan University, Key laboratory of Birth Deficits and related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Wenqin Zhou
- Department of Anesthesiology, West China Second Hospital of Sichuan University, Key laboratory of Birth Deficits and related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Ping Li
- Department of Anesthesiology, West China Second Hospital of Sichuan University, Key laboratory of Birth Deficits and related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
| | - Rongqian Lin
- Department of Clinical Medicine, Sichuan University, Chengdu, Sichuan, China
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Griffiths A, Shannon OM, Brown T, Davison M, Swann C, Jones A, Ells L, Matu J. Associations between anxiety, depression, and weight status during and after pregnancy: A systematic review and meta-analysis. Obes Rev 2024; 25:e13668. [PMID: 38072642 DOI: 10.1111/obr.13668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 10/05/2023] [Accepted: 10/17/2023] [Indexed: 02/28/2024]
Abstract
Previous work has found adverse mental health symptomology in women living with obesity, compared with those of healthy weight, around the time of pregnancy. This meta-analysis aimed to explore the association between anxiety, depression, and weight status in women living with obesity before, during, and after pregnancy. Bibliographic databases were systematically searched, and 14 studies were included, which aimed to assess the association between excess weight and anxiety or depression outcomes in women before, during, or after pregnancy. Data were analyzed via narrative synthesis and random effects multi-level meta-analyses. Scores on mental health indices were significantly greater (indicative of worse anxiety/depression) in women with obesity compared to women of a healthy weight, around the time of pregnancy (SMD = 0.21 [95% CI: 0.11-0.31; 95% prediction intervals: 0.13-0.56], I2 = 73%, p < 0.01). Depressive symptoms were greater during and after pregnancy (SMD = 0.23 [95% CI: 0.13-0.34; 95% prediction intervals: -0.12 to 0.59], I2 = 75.0%, p < 0.01), and trait anxiety symptoms were greater during pregnancy (SMD = 0.24 [95% CI: 0.01-0.47; 95% prediction intervals: -0.25 to 0.72], I2 = 83.7%, p = 0.039) in women living with obesity, compared to those of healthy weight. Narrative evidence suggests that socioeconomic status and ethnicity may modify the relationship between obesity and mental health symptomology. The findings indicate that maternal obesity is associated with greater anxiety and depression symptoms. These findings may inform the design of maternal weight management interventions.
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Affiliation(s)
- Alex Griffiths
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Oliver M Shannon
- Human Nutrition Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tamara Brown
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Monica Davison
- Office for Health Improvement and Disparities, London, UK
| | | | - Andrew Jones
- School of Psychology, Liverpool John Moore's University, Liverpool, UK
| | - Louisa Ells
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Jamie Matu
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
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Lee B, Sheth S, Gandhi R. Impact of the Fetal Echocardiogram on Maternal Depression and Well-Being. Pediatr Cardiol 2024:10.1007/s00246-024-03435-7. [PMID: 38424310 DOI: 10.1007/s00246-024-03435-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/27/2024] [Indexed: 03/02/2024]
Abstract
Fetal echocardiography allows for prenatal diagnosis of congenital heart disease (CHD). The objective of this study is to assess for the impact of fetal echocardiogram on levels of well-being and depression in pregnant women. Adult pregnant women carrying a fetus < 31-week gestational age were enrolled in the prospective observational study from February 2022 to June 2022. These subjects were split into two cohorts: those with CHD and those without CHD. Surveys were distributed prior to the fetal echocardiogram, six weeks later and six weeks after delivery. These surveys consisted of the Edinburgh Postpartum Depression Scale (EPDS) and questions about topics, such as anxiety and social support. Of the 152 subjects enrolled, 14 women had a fetus with CHD and 138 women had a fetus without CHD. Initial EPDS scores were elevated for the study population compared to the general population. Six weeks later, EPDS scores remained elevated. For the post-partum surveys, the EPDS scores were decreased below the rate of the general population for the group without CHD and similar to the general population rate for the CHD group. Anxiety, worry, and guilt remained low for both groups after the initial survey. Counseling from the pediatric cardiologist may help decrease anxiety and worry. Social support, like support groups, may be helpful for women carrying a fetus with CHD.
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Affiliation(s)
- Brian Lee
- Division of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, IL, USA.
- Division of Pediatric Cardiology, Valley Children's Hospital, Madera, CA, USA.
| | - Saloni Sheth
- Division of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Rupali Gandhi
- Division of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, IL, USA
- Division of Pediatric Cardiology, University of Chicago, Chicago, IL, USA
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Jin Y, Wu C, Chen W, Li J, Jiang H. Gestational diabetes and risk of perinatal depression in low- and middle-income countries: a meta-analysis. Front Psychiatry 2024; 15:1331415. [PMID: 38414505 PMCID: PMC10897974 DOI: 10.3389/fpsyt.2024.1331415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/24/2024] [Indexed: 02/29/2024] Open
Abstract
Background The relationship between gestational diabetes (GDM) and the risk of depression has been thoroughly investigated in high-income countries on their financial basis, while it is largely unexplored in low- and middle- income countries. This meta-analysis aims to assess how GDM influences the risk of perinatal depression by searching multiple electronic databases for studies measuring the odds ratios between them in low- and middle-income countries. Methods Two independent reviewers searched multiple electronic databases for studies that investigated GDM and perinatal mental disorders on August 31, 2023. Pooled odds ratios (ORs) and confidence intervals (CIs) were calculated using the random effect model. Subgroup analyses were further conducted based on the type of study design and country income level. Results In total, 16 observational studies met the inclusion criteria. Only the number of studies on depression (n=10) satisfied the conditions to conduct a meta-analysis, showing the relationship between mental illness and GDM has been overlooked in low- and middle-income countries. Evidence shows an elevated risk of perinatal depression in women with GDM (pooled OR 1.92; 95% CI 1.24, 2.97; 10 studies). The increased risk of perinatal depression in patients with GDM was not significantly different between cross-sectional and prospective design. Country income level is a significant factor that adversely influences the risk of perinatal depression in GDM patients. Conclusion Our findings suggested that women with GDM are vulnerable to perinatal depressive symptoms, and a deeper understanding of potential risk factors and mechanisms may help inform strategies aimed at prevention of exposure to these complications during pregnancy.
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Affiliation(s)
- Yuqing Jin
- Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital and School of Brain Science and Brain Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Research Center for Healthcare Data Science, Zhejiang Laboratory, Hangzhou, China
| | - Chengkai Wu
- Research Center for Healthcare Data Science, Zhejiang Laboratory, Hangzhou, China
| | - Wanlin Chen
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jingsong Li
- Research Center for Healthcare Data Science, Zhejiang Laboratory, Hangzhou, China
- Engineering Research Center of Electronic Medical Record (EMR) and Intelligent Expert System, Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Haiteng Jiang
- Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital and School of Brain Science and Brain Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Ministry of Education (MOE) Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-machine Intelligence, Zhejiang University, Hangzhou, China
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15
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Borges MC, Clayton GL, Freathy RM, Felix JF, Fernández-Sanlés A, Soares AG, Kilpi F, Yang Q, McEachan RRC, Richmond RC, Liu X, Skotte L, Irizar A, Hattersley AT, Bodinier B, Scholtens DM, Nohr EA, Bond TA, Hayes MG, West J, Tyrrell J, Wright J, Bouchard L, Murcia M, Bustamante M, Chadeau-Hyam M, Jarvelin MR, Vrijheid M, Perron P, Magnus P, Gaillard R, Jaddoe VWV, Lowe WL, Feenstra B, Hivert MF, Sørensen TIA, Håberg SE, Serbert S, Magnus M, Lawlor DA. Integrating multiple lines of evidence to assess the effects of maternal BMI on pregnancy and perinatal outcomes. BMC Med 2024; 22:32. [PMID: 38281920 PMCID: PMC10823651 DOI: 10.1186/s12916-023-03167-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/09/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Higher maternal pre-pregnancy body mass index (BMI) is associated with adverse pregnancy and perinatal outcomes. However, whether these associations are causal remains unclear. METHODS We explored the relation of maternal pre-/early-pregnancy BMI with 20 pregnancy and perinatal outcomes by integrating evidence from three different approaches (i.e. multivariable regression, Mendelian randomisation, and paternal negative control analyses), including data from over 400,000 women. RESULTS All three analytical approaches supported associations of higher maternal BMI with lower odds of maternal anaemia, delivering a small-for-gestational-age baby and initiating breastfeeding, but higher odds of hypertensive disorders of pregnancy, gestational hypertension, preeclampsia, gestational diabetes, pre-labour membrane rupture, induction of labour, caesarean section, large-for-gestational age, high birthweight, low Apgar score at 1 min, and neonatal intensive care unit admission. For example, higher maternal BMI was associated with higher risk of gestational hypertension in multivariable regression (OR = 1.67; 95% CI = 1.63, 1.70 per standard unit in BMI) and Mendelian randomisation (OR = 1.59; 95% CI = 1.38, 1.83), which was not seen for paternal BMI (OR = 1.01; 95% CI = 0.98, 1.04). Findings did not support a relation between maternal BMI and perinatal depression. For other outcomes, evidence was inconclusive due to inconsistencies across the applied approaches or substantial imprecision in effect estimates from Mendelian randomisation. CONCLUSIONS Our findings support a causal role for maternal pre-/early-pregnancy BMI on 14 out of 20 adverse pregnancy and perinatal outcomes. Pre-conception interventions to support women maintaining a healthy BMI may reduce the burden of obstetric and neonatal complications. FUNDING Medical Research Council, British Heart Foundation, European Research Council, National Institutes of Health, National Institute for Health Research, Research Council of Norway, Wellcome Trust.
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Affiliation(s)
- Maria Carolina Borges
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Gemma L Clayton
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rachel M Freathy
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Janine F Felix
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alba Fernández-Sanlés
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ana Gonçalves Soares
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Fanny Kilpi
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Qian Yang
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rosemary R C McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK
| | - Rebecca C Richmond
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Xueping Liu
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Line Skotte
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Amaia Irizar
- Department of Preventive Medicine and Public Health, University of the Basque Country, Leioa, Spain
- BIODONOSTIA Health Research Institute, Paseo Dr. Beguiristain, 20014, San Sebastian, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Andrew T Hattersley
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Barbara Bodinier
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Denise M Scholtens
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ellen A Nohr
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tom A Bond
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
- The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Australia
| | - M Geoffrey Hayes
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jane West
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK
| | - Jessica Tyrrell
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK
| | - Luigi Bouchard
- Department of Biochemistry and Functional Genomics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Mario Murcia
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
| | - Mariona Bustamante
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- ISGlobal, Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Marc Chadeau-Hyam
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | | | - Martine Vrijheid
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- ISGlobal, Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Patrice Perron
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CR-CHUS), Sherbrooke, Québec, Canada
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Romy Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - William L Lowe
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bjarke Feenstra
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Marie-France Hivert
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Thorkild I A Sørensen
- Department of Public Health, Section of Epidemiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Diseases, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Sylvain Serbert
- Center For Life-Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Maria Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK.
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Karim S, Liu J, Wilcox S, Cai B, Merchant AT. Association Between Physical Activity During Pregnancy and Perinatal Depressive Symptoms in Pregnant Individuals With Overweight and Obesity. Womens Health Issues 2024; 34:72-79. [PMID: 37940507 PMCID: PMC10843526 DOI: 10.1016/j.whi.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 09/01/2023] [Accepted: 09/21/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Current research on the association between physical activity and perinatal depression is inconclusive. This study examined the association between objectively measured physical activity during pregnancy and perinatal depressive symptoms among individuals with overweight and obesity. METHODS Data came from the Health in Pregnancy and Postpartum study (N = 205). Physical activity was measured using the SenseWear Armband at 16 weeks' or fewer and 32 weeks' gestation and categorized into 1) never meeting 2018 physical activity guidelines, 2) meeting the guidelines at one time point, or 3) meeting the guidelines at both time points. Antenatal depressive symptoms were assessed at 32 weeks' gestation, and postpartum depressive symptoms were assessed at 6 and 12 months postpartum using the Edinburgh Postnatal Depression Scale. A score of 10 or higher was defined as probable at least minor depression (hereafter, probable depression). RESULTS Nearly one-half of the participants (45.4%) met physical activity guidelines both in early and late pregnancy. Pregnant individuals who met physical activity guidelines at one (adjusted odds ratio, 0.07; 95% confidence interval, 0.01-0.76) or both time points (adjusted odds ratio, 0.08; 95% confidence interval, 0.01-0.69) during pregnancy had lower odds of probable depression at 6 months postpartum than individuals who never met physical activity guidelines during pregnancy. No significant associations were found between prenatal physical activity and probable antenatal or postpartum depression at 12 months. CONCLUSIONS Antenatal physical activity was associated with lower odds of probable depression at 6 months after childbirth. Physicians should use evidence-based strategies to encourage pregnant people, especially those who are at risk for postpartum depression, to meet physical activity guidelines.
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Affiliation(s)
- Sabrina Karim
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Institute for Families in Society, College of Social Work, University of South Carolina, Columbia, South Carolina
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
| | - Sara Wilcox
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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Konjevod M, Gredicak M, Vuic B, Tudor L, Nikolac Perkovic M, Milos T, Svob Strac D, Pivac N, Nedic Erjavec G. Overview of metabolomic aspects in postpartum depression. Prog Neuropsychopharmacol Biol Psychiatry 2023; 127:110836. [PMID: 37541332 DOI: 10.1016/j.pnpbp.2023.110836] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/06/2023]
Abstract
Along with the typical biochemical alterations that occur during pregnancy, certain metabolic changes might be associated with the development of several psychiatric disorders, including postpartum depression (PPD), which is the most common type of psychiatric disorder during pregnancy or first postpartum year, and it develops in about 15% of women. Metabolomics is a rapidly developing discipline that deals with the metabolites as the final products of all genetically controlled biochemical pathways, highly influenced by external and internal changes. The aim of this paper was to review the published studies whose results suggest or deny a possible association between the fine regulation of the metabolome and PPD, enabling conclusions about whether metabolomics could be a useful tool in defining the biochemical pathways directly involved in the etiology, diagnosis and course of PPD. Beside numerous hormonal changes, a lot of different metabolic pathways have been discovered to be affected in women with PPD or associated with its development, including alterations in the energy metabolism, tryptophan and amino acid metabolism, steroid metabolism, purine cycle, as well as neurotransmitter metabolism. Additionally, metabolomics helped in defining the association between PPD and the exposure to various endocrine disrupting metabolites during pregnancy. Finally, metabolome reflects different PPD therapies and exposure of fetus or breastfed infants to pharmacotherapy prescribed to a mother suffering from PPD. This review can help in creating the picture about metabolomics' broad application in PPD studies, but it also implies that its potential is still not completely used.
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Affiliation(s)
| | - Martin Gredicak
- General Hospital Zabok and Hospital for the Croatian Veterans, Bracak 8, p.p. 36, 49210 Zabok, Croatia
| | - Barbara Vuic
- Rudjer Boskovic Institute, Bijenicka 54, 10000 Zagreb, Croatia.
| | - Lucija Tudor
- Rudjer Boskovic Institute, Bijenicka 54, 10000 Zagreb, Croatia.
| | | | - Tina Milos
- Rudjer Boskovic Institute, Bijenicka 54, 10000 Zagreb, Croatia.
| | | | - Nela Pivac
- Rudjer Boskovic Institute, Bijenicka 54, 10000 Zagreb, Croatia; University of Applied Sciences Hrvatsko Zagorje Krapina, Setaliste hrvatskog narodnog preporoda 6, 49000 Krapina, Croatia.
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Menichini D, Monari F, Gemmellaro G, Petrella E, Ricchi A, Infante R, Molinazzi MT, Facchinetti F, Neri I. Association of maternal Body Mass Index and parity on induced labor stages. Minerva Obstet Gynecol 2023; 75:512-519. [PMID: 35389036 DOI: 10.23736/s2724-606x.22.05092-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Obesity is a widespread pandemic and obstetric care must adapt to meet the needs of obese pregnant women. Little is known about the impact of Body Mass Index (BMI) on the induction of labor (IOL). Therefore, our objective was to evaluate if the duration of the first and second stages of IOL is affected by maternal BMI in nulliparous and multiparous women. METHODS We included singleton pregnancies at term with cephalic presentation whose labor was induced from June 2018 to December 2019. Women were divided into two groups according to pre-pregnancy BMI in normal weight and obese women. RESULTS A total of 668 women with IOL were included in the study, among them, 349 had a normal weight and 321 were obese. The first stage of labor was longer in obese multiparous than normal-weight women (normal weight 81.98±71.7 vs. obese 134.3±158.1 min, P=0.000), while the second stage resulted significantly shorter (normal weight 22.2±27.8 vs. obese 14.3±14.2 min, P=0.000). The total time elapsed from IOL beginning and delivery was significantly higher in obese nulliparous (normal weight 10.4±19.7 vs. obese 22.0±26.2 h, P=0.000). Operative vaginal deliveries, emergency cesarean section, and failed IOL resulted to be similar between the groups. CONCLUSIONS Obese multiparous women have longer first stages of labor while shorter second stages. The total time for induced obese nulliparous to reach delivery is higher than the normal weight. It might be reasonable to reconsider the partographs according to maternal BMI in case of induced labor for future obstetric practice.
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Affiliation(s)
- Daniela Menichini
- International Doctorate School in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy -
| | - Francesca Monari
- Obstetrics and Gynecology Unit, Mother-Infant Department, Policlinic Hospital, University of Modena and Reggio-Emilia, Modena, Italy
| | - Giovanna Gemmellaro
- School of Midwifery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisabetta Petrella
- Obstetrics and Gynecology Unit, Mother-Infant Department, Policlinic Hospital, University of Modena and Reggio-Emilia, Modena, Italy
| | - Alba Ricchi
- School of Midwifery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Ramona Infante
- School of Midwifery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria T Molinazzi
- School of Midwifery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Obstetrics and Gynecology Unit, Mother-Infant Department, Policlinic Hospital, University of Modena and Reggio-Emilia, Modena, Italy
| | - Isabella Neri
- Obstetrics and Gynecology Unit, Mother-Infant Department, Policlinic Hospital, University of Modena and Reggio-Emilia, Modena, Italy
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Brown RSE, Jacobs IM, Khant Aung Z, Knowles PJ, Grattan DR, Ladyman SR. High fat diet-induced maternal obesity in mice impairs peripartum maternal behaviour. J Neuroendocrinol 2023; 35:e13350. [PMID: 37926066 DOI: 10.1111/jne.13350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/20/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023]
Abstract
Obesity during pregnancy represents a significant health issue and can lead to increased complications during pregnancy and impairments with breastfeeding, along with long-term negative health consequences for both mother and offspring. In rodent models, diet-induced obesity (DIO) during pregnancy leads to poor outcomes for offspring. Using a DIO mouse model, consisting of feeding mice a high fat diet for 8 weeks before mating, we recapitulate the effect of high pup mortality within the first 3 days postpartum. To examine the activity of the dam around the time of birth, late pregnant control and DIO dams were recorded in their home cages and the behaviour of the dam immediately before and after birth was analysed. Prior to giving birth, DIO dams spent less time engaging in nesting behaviour, while after birth, DIO dams spent less time in the nest with their pups compared to control dams, indicating reduced pup-engagement in the early postpartum period. We have previously reported that lactogenic hormone action, mediated by the prolactin receptor, in the medial preoptic area of the hypothalamus (MPOA) is critical for the onset of normal postpartum maternal behaviour. We hypothesized that DIO dams may have lower lactogenic hormone activity during late pregnancy, which would contribute to impaired onset of normal postpartum maternal behaviour. Day 16 lactogenic activity, transport of prolactin into the brain, and plasma prolactin concentrations around birth were all similar in control and DIO dams. Moreover, endogenous pSTAT5, a marker of prolactin receptor activity, in the MPOA was unaffected by DIO. Overall, these data indicate that lactogenic activity in late pregnancy of DIO dams is not different to controls and is unlikely to play a major role in impaired onset of normal postpartum maternal behaviour.
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Affiliation(s)
- Rosemary Shanon Eileen Brown
- Centre for Neuroendocrinology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
- Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Ireland M Jacobs
- Centre for Neuroendocrinology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Zin Khant Aung
- Centre for Neuroendocrinology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Pene J Knowles
- Centre for Neuroendocrinology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - David R Grattan
- Centre for Neuroendocrinology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, Auckland, New Zealand
| | - Sharon R Ladyman
- Centre for Neuroendocrinology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, Auckland, New Zealand
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20
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Adaji R, Wheeler JM, Misra DP, Giurgescu C. Mother-Father Relationship and Depressive Symptoms Among Pregnant Black Women. West J Nurs Res 2023; 45:1027-1034. [PMID: 37776532 DOI: 10.1177/01939459231202725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
BACKGROUND Black women report higher levels of depressive symptoms during pregnancy than white women. A supportive relationship with the father of the baby may be protective and decrease depressive symptoms. OBJECTIVE We sought to examine the association between mother-father relationship and depressive symptoms among pregnant black women. METHODS Using a cross-sectional design, we conducted a secondary data analysis from a subsample of 405 pregnant black women who participated in the Biosocial Impact on Black Births study, a prospective cohort study. Participants completed questionnaires at 19- to 29-week gestation, including 6 measures of their relationship with the father of the baby: (1) contact, (2) involvement, (3) overall relationship, (4) change in relationship from prior to pregnancy to during pregnancy, (5) support, and (6) conflict. Latent class analysis was used to identify and classify the relationship construct. The Center for Epidemiologic Studies-Depression (CES-D) scale was used, with scores ≥23 considered high levels of depressive symptoms. Data were analyzed with logistic regression. RESULTS Following adjustment for maternal sociodemographic characteristics, comorbid conditions, and health behaviors, women in a conflictual relationship had higher odds of having depressive symptom scores ≥23 (adjusted odds ratio: 3.50, 95% confidence interval: 2.00, 6.12) than those having no relationship (adjusted odds ratio: 2.81, 95% confidence interval: 1.43, 5.52), when compared with those with a good relationship. CONCLUSIONS These findings suggest that having either a conflictual or no relationship with the father of the baby during pregnancy increases the odds for higher maternal depressive symptoms (CES-D scores ≥ 23) among pregnant black women.
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Affiliation(s)
- Rosemary Adaji
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Jenna M Wheeler
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Dawn P Misra
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Carmen Giurgescu
- College of Nursing, University of Central Florida, Orlando, FL, USA
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21
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Sominsky L, O'Hely M, Drummond K, Cao S, Collier F, Dhar P, Loughman A, Dawson S, Tang ML, Mansell T, Saffery R, Burgner D, Ponsonby AL, Vuillermin P. Pre-pregnancy obesity is associated with greater systemic inflammation and increased risk of antenatal depression. Brain Behav Immun 2023; 113:189-202. [PMID: 37437818 DOI: 10.1016/j.bbi.2023.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Pre-pregnancy obesity is an emerging risk factor for perinatal depression. However, the underlying mechanisms remain unclear. We investigated the association between pre-pregnancy body mass index (BMI) and perinatal depressive symptoms in a large population-based pre-birth cohort, the Barwon Infant Study. We also assessed whether the levels of circulating inflammatory markers during pregnancy mediated this relationship. METHODS Depressive symptoms were assessed in 883 women using the Edinburgh Postnatal Depression Scale (EPDS) and psychological stress using the Perceived Stress Scale (PSS) at 28 weeks gestation and 4 weeks postpartum. Glycoprotein acetyls (GlycA), high-sensitivity C-reactive protein (hsCRP) and cytokines were assessed at 28 weeks gestation. We performed regression analyses, adjusted for potential confounders, and investigated mediation using nested counterfactual models. RESULTS The estimated effect of pre-pregnancy obesity (BMI ≥ 30 kg/m2) on antenatal EPDS scores was 1.05 points per kg/m2 increase in BMI (95% CI: 0.20, 1.90; p = 0.02). GlycA, hsCRP, interleukin (IL) -1ra and IL-6 were higher in women with obesity, compared to healthy weight women, while eotaxin and IL-4 were lower. Higher GlycA was associated with higher EPDS and PSS scores and partially mediated the association between pre-pregnancy obesity and EPDS/PSS scores in unadjusted models, but this association attenuated upon adjustment for socioeconomic adversity. IL-6 and eotaxin were negatively associated with EPDS/PSS scores, however there was no evidence for mediation. CONCLUSIONS Pre-pregnancy obesity increases the risk of antenatal depressive symptoms and is also associated with systemic inflammation during pregnancy. While discrete inflammatory markers are associated with antenatal depressive symptoms and perceived stress, their role in mediating the effects of pre-pregnancy obesity on antenatal depression requires further investigation.
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Affiliation(s)
- Luba Sominsky
- Barwon Health, Geelong, Victoria, Australia; Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia.
| | - Martin O'Hely
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Katherine Drummond
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Sifan Cao
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia
| | - Fiona Collier
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia
| | - Poshmaal Dhar
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia
| | - Amy Loughman
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia
| | - Samantha Dawson
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia
| | - Mimi Lk Tang
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Toby Mansell
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - David Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Anne-Louise Ponsonby
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Peter Vuillermin
- Barwon Health, Geelong, Victoria, Australia; Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.
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22
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Øhman EA, Fossli M, Ottestad I, Holven KB, Ulven SM, Løland BF, Brekke HK. Dietary treatment postpartum in women with obesity reduces weight and prevents weight gain: a randomised controlled trial. BMC Pregnancy Childbirth 2023; 23:695. [PMID: 37752466 PMCID: PMC10521473 DOI: 10.1186/s12884-023-05976-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Women with pre-pregnancy obesity have an increased risk of retaining or gaining weight postpartum and may benefit from weight loss treatment. However, evidence is lacking for weight loss strategies in women with BMIs in the higher obesity classes. A dietary treatment for postpartum weight loss resulted in a 10% weight reduction in lactating women with a mean BMI of 30 kg/m2. We aimed to examine the effects of this dietary treatment on changes in weight, markers of lipid and glucose metabolism, waist and hip circumference and postpartum weight retention (PPWR) in postpartum women with higher BMIs than tested previously. METHODS At baseline, approximately 8 weeks postpartum, 29 women with a mean (SD) BMI = 40.0 (5.2) kg/m2 were randomised to a 12-week dietary treatment (n 14) or to a control treatment (n 15). Measurements were made at baseline and after 3 and 12 months. Data was analysed using mixed model. RESULTS The mean weight change in the diet group was -2.3 (3.1) kg compared to 1.7 (3.1) kg in the control group after 3 months (P = 0.003) and -4.2 (5.6) kg compared to 4.8 (11.8) kg in the control group after 12 months (P = 0.02). The dietary treatment led to reduced waist circumference (P < 0.04) and PPWR (P < 0.01) compared to the control treatment at both time points. The treatment lowered fasting blood glucose at 12 months (P = 0.007) as the only effect on markers of lipid and glucose metabolism. CONCLUSION The dietary treatment postpartum reduced weight and prevented weight retention or weight gain in women with obesity. TRIAL REGISTRATION The trial was retrospectively registered at ClinicalTrials.gov (NCT03579667) 06/07/2018. In a randomised, controlled trial, 29 postpartum women with obesity were allocated to a dietary treatment or a control treatment. The dietary treatment reduced weight and prevented postpartum weight retention or weight gain after 12 months. Reference: Adapted from "Randomized, Placebo-Controlled, Parallel Study Design (2 Arms, Graphical)", by BioRender.com (2022). Retrieved from https://app.biorender.com/biorender-templates .
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Affiliation(s)
- Elisabeth A Øhman
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
| | - Maria Fossli
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway
| | - Inger Ottestad
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Adipol, Women's Clinic, Oslo University Hospital, Oslo, Norway
- The Clinical Nutrition Outpatient Clinic, Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Kirsten B Holven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Norwegian National Advisory Unit On Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Stine M Ulven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Beate F Løland
- Unit for Breastfeeding, Norwegian Institute of Public Health, Oslo, Norway
| | - Hilde K Brekke
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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Choedon T, Sethi V, Killeen SL, Ganjekar S, Satyanarayana V, Ghosh S, Jacob CM, McAuliffe FM, Hanson MA, Chandra P. Integrating nutrition and mental health screening, risk identification and management in prenatal health programs in India. Int J Gynaecol Obstet 2023; 162:792-801. [PMID: 36808738 DOI: 10.1002/ijgo.14728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023]
Abstract
Pregnancy is a period of major physiologic, hormonal, and psychological change, increasing the risk of nutritional deficiencies and mental disorders. Mental disorders and malnutrition are associated with adverse pregnancy and child outcomes, with potential long-standing impact. Common mental disorders during pregnancy are more prevalent in low- and middle-income countries (LMICs). In India, studies suggest the prevalence of depression is 9.8%-36.7% and of anxiety is 55.7%. India has seen some promising developments in recent years such as increased coverage of the District Mental Health Program; integration of maternal mental health into the Reproductive and Child Health Program in Kerala; and the Mental Health Care Act 2017. However, mental health screening and management protocols have not yet been established and integrated into routine prenatal care in India. A five-action maternal nutrition algorithm was developed and tested for the Ministry of Health and Family Welfare, aiming to strengthen nutrition services for pregnant women in routine prenatal care facilities. In this paper, we present opportunities and challenges for integration of maternal nutrition and mental health screening and a management protocol at routine prenatal care in India, discuss evidence-based interventions in other LMICs including India, and make recommendations for public healthcare providers.
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Affiliation(s)
| | - Vani Sethi
- UNICEF Regional office for South Asia, Kathmandu, Nepal
| | - Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Sundarnag Ganjekar
- National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | | | | | - Chandni Maria Jacob
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
- Institute of Developmental Sciences, University of Southampton, Southampton, UK
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Mark A Hanson
- Institute of Developmental Sciences, University of Southampton, Southampton, UK
| | - Prabha Chandra
- National Institute of Mental Health and Neuro Sciences, Bangalore, India
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24
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Tarchi L, Merola GP, Selvi G, Caprara E, Pecoraro V, Cassioli E, Rossi E, Petraglia F, Ricca V, Castellini G. Pregorexia: a systematic review and meta-analysis on the constructs of body image dissatisfaction and eating disturbances by gestational age in the peripartum. Eat Weight Disord 2023; 28:64. [PMID: 37526698 PMCID: PMC10393903 DOI: 10.1007/s40519-023-01595-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023] Open
Abstract
PURPOSE Pregorexia is a phenomenon posited to occur in the peripartum, characterized by an attempt to counter pregnancy's physiological changes in body shape through reduced calorie intake or increased physical activity. METHODS In this pre-registered systematic review and meta-analysis, body image dissatisfaction and eating psychopathology in the peripartum according to gestational age were formally assessed. PubMed was searched up to May 2023. Selection criteria were represented by studies on body image concerns or eating psychopathology in the peripartum (up to 1 year after delivery). The population needed to include women from the general population or among patients with a history of (or current) eating disorder. For the meta-analysis, 17 studies were included: 10 for body image dissatisfaction (2625 individuals overall), 7 for eating behaviors (2551 individuals overall). The interplay between body image and the following themes was examined in depth: the adoption of breastfeeding, peripartum depression, sociocultural influences on body image, sexual disturbances, experiencing or reporting an altered food intake. RESULTS Progressive dissatisfaction with body image during pregnancy by gestational age was observed, stably elevated for at least 12 months postpartum. Eating psychopathology was observed as elevated only at 12 months in the postpartum, but not during pregnancy. DISCUSSION The current work offers normative values of body image satisfaction and eating psychopathology in the peripartum by gestational age. The relevance of current results was discussed, in order to inform both current clinical practice and future public policies. LEVEL OF EVIDENCE Level I-Evidence obtained from: systematic reviews and meta-analyses.
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Affiliation(s)
- Livio Tarchi
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Giuseppe Pierpaolo Merola
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Giulia Selvi
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Eleonora Caprara
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Vincenzo Pecoraro
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Felice Petraglia
- Obstetrics and Gynecology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy.
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25
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Karunaratne YG, Romeo PB, Willis M, Sanki A. The Safety and Effects of Pregnancy after Abdominoplasty: A Systematic Review of the Literature. Aesthetic Plast Surg 2023:10.1007/s00266-023-03423-x. [PMID: 37266593 DOI: 10.1007/s00266-023-03423-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND As advanced maternal age and bariatric procedures have become more common, the number of women seeking pregnancy after having abdominoplasty has increased. This has traditionally been a relative contraindication and counselled against, though there are little data in the literature regarding the potential effects to mother and baby. METHODS A systematic review of Medline and Embase databases was performed to identify cases of pregnancy occurring after abdominoplasty. Data were extracted and analysed for presentation. RESULTS 17 studies encompassing 237 patients met inclusion. Mean age was 33.08 years. Mean parity prior to first pregnancy after abdominoplasty 2.13. Previous bariatric surgery was reported in 31.75%. Body contouring procedure was abdominoplasty (94.51%), body lift (3.80%) and other (1.69%). Rectus plication was performed in 89.74%, where reported. Mean time between abdominoplasty and pregnancy was 3.75 years. Method of delivery was Caesarean section in 43.63%, and vaginal delivery in 56.37%. Mean gestational age at delivery was 38.90 weeks. Preterm delivery (<37 weeks) was reported in 9.85%, and low birthweight (<2500 g) was reported in 7.22%. Diagnoses or complications were documented in 14 studies (136 patients). These were grouped as foetal/neonatal (n = 21), maternal (n = 104) or abdominal wall/aesthetic (n = 96); and are detailed within. There were no neonatal or maternal mortalities in any study. A lower-than-expected spinal anaesthetic block was stated in 3 cases. Mean follow-up was 8.5 months. CONCLUSION Pregnancy should not be contraindicated after abdominoplasty. The data presented allow clinicians to have an evidence-based discussion and provide information for shared decision-making. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
| | | | - Meg Willis
- Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | - Amira Sanki
- St George Private Hospital, Sydney, NSW, Australia
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26
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Eissa GA, Khurmi RA, Holbah TJ, Alabdullah DW, Aleban SA, Aljohani AA, Zaidan SM, Hakami AM. The Effect of Sleeve Gastrectomy on Pregnancy Complications: A Cross-Sectional Study in Saudi Arabia. Cureus 2023; 15:e40157. [PMID: 37431342 PMCID: PMC10329566 DOI: 10.7759/cureus.40157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Obesity is defined as abnormal or excessive fat accumulation that may impair health. Until recently, the only effective method for treating morbid obesity over the long term was bariatric surgery (BS). During pregnancy, obesity is correlated with higher risks for numerous complications, including gestational diabetes mellitus, pre-eclampsia, mortality, and large-for-gestational-age neonates. The most commonly reported complications among women who underwent sleeve gastrectomy and experienced pregnancy were placental bleeding, oligohydramnios, urinary tract infection, appendicitis, and recurrent abortions. OBJECTIVES We aim to estimate the consequence of sleeve gastrectomy and its relation with pregnancy outcomes among women in Saudi Arabia. METHODOLOGY This study adopted a quantitative, descriptive, cross-sectional design. It was conducted in Saudi Arabia between February and May 2023 among women who became pregnant after undergoing sleeve gastrectomy. Result: Anemia was experienced by 78.8% of the patients during pregnancy. In our study, 18% of the individuals experienced complications during or right after delivery, with postpartum hemorrhage being the most frequent (43.1%). We discovered that pre-eclampsia and delivering a baby small for gestational age were considerably more common in pregnant women who smoked (p ≤ 0.05). On the other hand, no significant association was discovered between any comorbidity and mode of delivery, birth weight, child complications, or difficulties that occurred during or right after labor. CONCLUSION We concluded that weight gain after sleeve gastrectomy negatively impacted pregnancy and increased the probability of several complications for the mother and fetus. Healthcare providers must inform every woman undergoing BS about the possible complication of an unhealthy lifestyle after the procedure.
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Affiliation(s)
- Ghaida A Eissa
- Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | | | | | - Durrah W Alabdullah
- Faculty of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Sarah A Aleban
- Faculty of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
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27
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Birkelund KS, Rasmussen SS, Shwank SE, Johnson J, Acharya G. Impact of the COVID-19 pandemic on women's perinatal mental health and its association with personality traits: An observational study. Acta Obstet Gynecol Scand 2023; 102:270-281. [PMID: 36825665 PMCID: PMC9951299 DOI: 10.1111/aogs.14525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 12/30/2022] [Accepted: 01/18/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION The burden of perinatal mental health problems was expected to increase during the COVID-19 pandemic. We prospectively investigated the impact of the COVID-19 pandemic on the mental health of pregnant and postpartum women in Norway and explored associations with their sociodemographic characteristics and personality traits. MATERIAL AND METHODS Sociodemographic information and the self-reported impact of pandemic on wellbeing of pregnant women was collected using an online survey. To assess women's mental health, two validated questionnaires, the Edinburgh Postpartum Depression Scale (EPDS) and the Generalized Anxiety Disorder-7 item Scale (GAD-7), were used prenatally and postnatally. Personality traits were evaluated using HumanGuide, a web-based ipsative psychological evaluation instrument. RESULTS 772 women were included prenatally, of which 526 also responded to the survey 4-6 weeks postnatally. The median age was 29 years, 53.6% of the women were nulliparous when enrolled, and 35.1% worked in the healthcare sector. The median EPDS (6.0; interquartile range [IQR] 3.0-10.0 vs 6.0; IQR: 3.0-10.0) and the median GAD-7 (5.0; IQR 2.0-9.0 vs 5.0; IQR 2.0-9.0) were similar pre-and postnatally. Prenatally, the proportion of women scoring ≥13 on EPDS and ≥10 on GAD-7 was 14.5% (112/772) and 21.5% (166/772), whereas the postnatal figures were 15.6% (82/526) and 21.5% (113/526), respectively. The differences were not significant (P = 0.59 and P = 0.99). Being <25 years of age, being on pre-pregnancy psychotherapy or psychotropic medication, frequent voluntary isolation, perception of maternity care not proceeding normally, avoiding seeking medical assistance due to fear of infection and having negative economic consequences during the COVID19 pandemic significantly increased the risk of both anxiety (GAD-7 ≥10) and depression (EPDS ≥13). Nullipara had a higher risk of anxiety, whereas being a healthcare worker had a lower risk. The personality trait factors Power (P = 0.008), Quality (P = 0.008), Stability (P < 0.001) and Contacts (P < 0.001) were significant predictors of depression among pregnant women, whereas the Quality (P = 0.005) and Contacts (P = 0.003) were significant predictors of anxiety. CONCLUSIONS During the initial phase of the COVID-19 pandemic, the prevalence of depression (EPDS ≥ 13) and anxiety (GAD-7 ≥ 10) was 14.5% and 21.5%, respectively, among Norwegian pregnant women. Certain sociodemographic characteristics and personality traits were significant predictors of depression and anxiety.
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Affiliation(s)
- Karine S. Birkelund
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health SciencesUiT‐The Arctic University of NorwayTromsøNorway,Department of Obstetrics and GynecologyUniversity Hospital of North NorwayTromsøNorway
| | - Solrun S. Rasmussen
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health SciencesUiT‐The Arctic University of NorwayTromsøNorway,Department of Obstetrics and GynecologyUniversity Hospital of North NorwayTromsøNorway
| | - Simone E. Shwank
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health SciencesUiT‐The Arctic University of NorwayTromsøNorway,Department of Obstetrics and GynecologyUniversity Hospital of North NorwayTromsøNorway,Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention & Technology (CLINTEC)Karolinska InstitutetStockholmSweden
| | - Jonas Johnson
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention & Technology (CLINTEC)Karolinska InstitutetStockholmSweden
| | - Ganesh Acharya
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health SciencesUiT‐The Arctic University of NorwayTromsøNorway,Department of Obstetrics and GynecologyUniversity Hospital of North NorwayTromsøNorway,Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention & Technology (CLINTEC)Karolinska InstitutetStockholmSweden,Department of Women's Health, Center for Fetal MedicineKarolinska University HospitalStockholmSweden
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28
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Baattaiah BA, Alharbi MD, Babteen NM, Al-Maqbool HM, Babgi FA, Albatati AA. The relationship between fatigue, sleep quality, resilience, and the risk of postpartum depression: an emphasis on maternal mental health. BMC Psychol 2023; 11:10. [PMID: 36635743 PMCID: PMC9836926 DOI: 10.1186/s40359-023-01043-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/06/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Several factors can contribute to the development of postpartum depression (PPD) and negatively affect mothers' mental and physical well-being. The objective of this study was to determine the relationship between fatigue, sleep quality, resilience, and the risk of PPD development. METHODS A cross-sectional study was conducted using an online questionnaire distributed to mothers during their postpartum period. The risk of PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS), postpartum fatigue (PPF) was assessed using the Fatigue Severity Scale (FSS), sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and resilience was assessed using the Brief Resilience Scale (BRS). The Pearson correlation coefficient was calculated to determine the relationship between the study variables. Simple and multiple linear regression analyses were performed to explain the contributions of PPF, sleep quality, and resilience as independent predictors of PPD development. RESULTS A total of 1409 postpartum women were included in the analysis, with 75% of the participants reporting a risk of PPD, 61% reporting PPF, 97% reporting having sleep problems, and 36% being in the "low resilience level" category. In terms of correlations, the scores of FSS and the PSQI showed moderate positive relationships with the EPDS scores (r = 0.344 and r = 0.447, respectively, p = .000). The BRS scores were negatively associated with the EPDS scores (r = -0.530, p = 0.000). Fatigue, sleep quality, and resilience were predictors of depressive symptoms (β = 0.127, β = 0.262, and β = -0.393, respectively, R2 = 0.37, p = 0.000). The association remained significant in the regression model after adjusting for mother's age, mother's BMI, child's age, smoking status, full-term pregnancy, having a chronic disease, and taking anti-depressant. CONCLUSIONS Mothers with higher levels of fatigue, poor sleep quality, and low resilience levels were at high risk of developing PPD. Healthcare providers should identify these factors and thus set better rehabilitation goals to improve overall maternal health.
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Affiliation(s)
- Baian A. Baattaiah
- grid.412125.10000 0001 0619 1117Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah, 21589 Saudi Arabia
| | - Mutasim D. Alharbi
- grid.412125.10000 0001 0619 1117Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah, 21589 Saudi Arabia
| | - Nouf M. Babteen
- grid.412125.10000 0001 0619 1117Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah, 21589 Saudi Arabia
| | - Haneen M. Al-Maqbool
- grid.412125.10000 0001 0619 1117Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah, 21589 Saudi Arabia
| | - Faten A. Babgi
- grid.412125.10000 0001 0619 1117Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah, 21589 Saudi Arabia
| | - Ashar A. Albatati
- grid.412125.10000 0001 0619 1117Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah, 21589 Saudi Arabia
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de Los Reyes S, Dude A, Adams M, Castille D, Ouyang DW, Plunkett BA. The Association between Maternal Body Mass Index and the Risk of Perinatal Depression. Am J Perinatol 2023; 40:222-226. [PMID: 33946112 DOI: 10.1055/s-0041-1728822] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate whether the risk of perinatal depression is associated with body mass index (BMI) category. STUDY DESIGN We performed a retrospective cohort study of women who completed an Edinburgh Postnatal Depression Scale (EPDS) questionnaire during the antepartum period at an integrated health system from January 2003 to May 2018. Risk of perinatal depression was defined as a score of ≥10 on the EPDS or an affirmative response to thoughts of self-harm. Risk of perinatal depression was compared by first trimester BMI category, defined as underweight (BMI: <18.5 kg/m2), normal weight (BMI: 18.5-24.9 kg/m2), overweight (BMI: 25.0-29.9 kg/m2), or obese (BMI: ≥30.0 kg/m2). Univariable analyses were performed using χ 2, Fisher's exact test, analysis of variance, Kruskal-Wallis, and Wilcoxon rank-sum tests as appropriate to evaluate the association between maternal BMI category, demographic and clinical characteristics, and risk of perinatal depression. Logistic multivariable regression models were performed to adjust for potential confounders identified as variables with p < 0.10 in univariable analysis. RESULTS Our analysis included 3,420 obese women, 3,839 overweight women, 5,949 normal weight women, and 1,203 underweight women. The overall median gestational age at EPDS administration was 27 weeks (interquartile range: 23-29). Overweight and obese women were more likely to be non-Hispanic Black, Hispanic, multiparous, to have public insurance, prepregnancy diabetes, and chronic hypertension as compared with normal or underweight women (p < 0.001). In univariable analysis, the risk of perinatal depression was not significantly different among underweight (10.8%, odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.79-1.18) or overweight women (12%, OR: 0.96, 95% CI: 0.79-1.18); however, the risk was higher among obese women (14.7%, 95% CI: 1.21-1.55) compared with normal weight women (11.2%). In multivariable analysis, obesity remained associated with an increased risk of perinatal depression (adjusted OR: 1.19, 95% CI: 1.04-1.35). CONCLUSION Obesity is associated with an increased risk of perinatal depression as compared with women of normal weight. KEY POINTS · Maternal obesity is associated with an increased risk of perinatal depression.. · Maternal BMI is associated with increased risk of perinatal depression.. · Maternal obesity is an independent risk factor for perinatal depression..
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Affiliation(s)
- Samantha de Los Reyes
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, NorthShore University HealthSystem, University of Chicago, Evanston, Illinois
| | - Annie Dude
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Chicago, Chicago, Illinois
| | - Marci Adams
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois
| | - Deshala Castille
- Department of Obstetrics and Gynecology, AMITA Health Saint Francis Hospital, Evanston, Illinois
| | - David W Ouyang
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, NorthShore University HealthSystem, Evanston, Illinois
| | - Beth A Plunkett
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, NorthShore University HealthSystem, Evanston, Illinois
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Giouleka S, Tsakiridis I, Koutsouki G, Kostakis N, Mamopoulos A, Kalogiannidis I, Athanasiadis A, Dagklis T. Obesity in Pregnancy: A Comprehensive Review of Influential Guidelines. Obstet Gynecol Surv 2023; 78:50-68. [PMID: 36607201 DOI: 10.1097/ogx.0000000000001091] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Importance Obesity is one of the most common clinical entities complicating pregnancies and is associated with short- and long-term consequences for both the mother and the offspring. Objective The aim of this study were to review and compare the most recently published influential guidelines on the management of maternal obesity in the preconceptional, antenatal, intrapartum, and postpartum period. Evidence Acquisition A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the International Federation of Gynecology and Obstetrics, the Society of Obstetricians and Gynecologists of Canada, the Royal College of Obstetricians and Gynecologists, and the Royal Australian and New Zealand College of Obstetricians and Gynecologists on obesity in pregnancy was carried out. Results There is an overall agreement among the reviewed guidelines regarding the importance of prepregnancy weight loss with behavioral modification, optimization of gestational weight gain, and screening for comorbidities in improving pregnancy outcomes of obese women. Women with previous bariatric surgery should be screened for nutritional deficiencies and have a closer antenatal surveillance, according to all guidelines. In addition, folic acid supplementation is recommended for 1 to 3 months before conception and during the first trimester, but several discrepancies were identified with regard to other vitamins, iodine, calcium, and iron supplementation. All medical societies recommend early screening for gestational diabetes mellitus and early anesthetic assessment in obese women and suggest the use of aspirin for the prevention of preeclampsia when additional risk factors are present, although the optimal dosage is controversial. The International Federation of Gynecology and Obstetrics, Society of Obstetricians and Gynecologists of Canada, Royal College of Obstetricians and Gynecologists, and Royal Australian and New Zealand College of Obstetricians and Gynecologists point out that specific equipment and adequate resources must be readily available in all health care facilities managing obese pregnant women. Moreover, thromboprophylaxis and prophylactic antibiotics are indicated in case of cesarean delivery, and intrapartum fetal monitoring is justified during active labor in obese patients. However, there are no consistent protocols regarding the fetal surveillance, the monitoring of multiple gestations, the timing and mode of delivery, and the postpartum follow-up, although weight loss and breastfeeding are unanimously supported. Conclusions Obesity in pregnancy is a significant contributor to maternal and perinatal morbidity with a constantly rising global prevalence among reproductive-aged women. Thus, the development of uniform international protocols for the effective management of obese women is of paramount importance to safely guide clinical practice and subsequently improve pregnancy outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | - Themistoklis Dagklis
- Assistant Professor, Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Geary N, Asarian L, Graf G, Gobbi S, Tobler PN, Rehfeld JF, Leeners B. Increased Meal Size but Reduced Meal-Stimulated Plasma Cholecystokinin Concentrations in Women With Obesity. Endocrinology 2022; 164:6845692. [PMID: 36423205 DOI: 10.1210/endocr/bqac192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Indexed: 11/26/2022]
Abstract
To better understand the physiological basis of obesity in women, we investigated whether obesity or menstrual cycle phase affects laboratory test-meal size or meal-stimulated plasma cholecystokinin (CCK) concentration. Women with healthy weight (body mass index [BMI] of 18.5-24.9 kg/m2, N = 16) or obesity (BMI 30-39.9 kg/m2, N = 20) were tested once in the late-follicular or peri-ovulatory phase (LF/PO) and once in the mid-luteal phase (ML). Meals of ham sandwiches were offered and blood was sampled. Menstrual cycle phases were verified with participants' reports of menses and measurements of progesterone and luteinizing hormone (LH) concentrations. Women with obesity ate significantly larger meals than women with healthy weight, (mean, 711 [95% CI, 402-1013] kJ, P = 0.001, during the LF/PO and 426 [105-734] kJ, P = 0.027, larger during the ML). Women with healthy weight ate smaller meals during LF/PO than ML (decrease, 510 [192-821 kJ], P = 0.008), but women with obesity did not (decrease, 226 [-87-542] kJ, P = 0.15). CCK concentrations 18 to 30 minutes after meal onset were lower in women with obesity than in women with healthy weight during LF/PO (3.6 [3.1-4.1] vs 6.1 [4.5-7.7] pmol/L; P = 0.004), but not during ML, with a significant interaction effect (1.8 [1.2-2.4] pmol/L, P = 0.048). Women with obesity consumed larger meals than women with healthy weight but displayed reduced meal-stimulated plasma CCK concentrations. These data are consistent with the hypothesis that a defect in CCK secretion compromises satiation in obese women and contributes to the development or maintenance of obesity.
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Affiliation(s)
- Nori Geary
- Department of Psychiatry, Weill Cornell Medical College, New York, NY 10021, USA†
| | - Lori Asarian
- Institute of Veterinary Physiology, University of Zurich, 8057 Zurich, Switzerland
| | - Gwendolyn Graf
- Department of Reproductive Endocrinology, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Susanna Gobbi
- Zurich Center for Neuroeconomics, University of Zurich, 8006 Zurich, Switzerland
| | - Philippe N Tobler
- Zurich Center for Neuroeconomics, University of Zurich, 8006 Zurich, Switzerland
| | - Jens F Rehfeld
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Brigitte Leeners
- Department of Reproductive Endocrinology, University Hospital of Zurich, 8091 Zurich, Switzerland
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Gastaldon C, Solmi M, Correll CU, Barbui C, Schoretsanitis G. Risk factors of postpartum depression and depressive symptoms: umbrella review of current evidence from systematic reviews and meta-analyses of observational studies. Br J Psychiatry 2022; 221:591-602. [PMID: 35081993 DOI: 10.1192/bjp.2021.222] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Evidence on risk factors for postpartum depression (PPD) are fragmented and inconsistent. AIMS To assess the strength and credibility of evidence on risk factors of PPD, ranking them based on the umbrella review methodology. METHOD Databases were searched until 1 December 2020, for systematic reviews and meta-analyses of observational studies. Two reviewers assessed quality, credibility of associations according to umbrella review criteria (URC) and evidence certainty according to Grading of Recommendations-Assessment-Development-Evaluations criteria. RESULTS Including 185 observational studies (n = 3 272 093) from 11 systematic reviews, the association between premenstrual syndrome and PPD was the strongest (highly suggestive: odds ratio 2.20, 95%CI 1.81-2.68), followed by violent experiences (highly suggestive: odds ratio (OR) = 2.07, 95%CI 1.70-2.50) and unintended pregnancy (highly suggestive: OR=1.53, 95%CI 1.35-1.75). Following URC, the association was suggestive for Caesarean section (OR = 1.29, 95%CI 1.17-1.43), gestational diabetes (OR = 1.60, 95%CI 1.25-2.06) and 5-HTTPRL polymorphism (OR = 0.70, 95%CI 0.57-0.86); and weak for preterm delivery (OR = 2.12, 95%CI 1.43-3.14), anaemia during pregnancy (OR = 1.47, 95%CI 1.17-1.84), vitamin D deficiency (OR = 3.67, 95%CI 1.72-7.85) and postpartum anaemia (OR = 1.75, 95%CI 1.18-2.60). No significant associations were found for medically assisted conception and intra-labour epidural analgesia. No association was rated as 'convincing evidence'. According to GRADE, the certainty of the evidence was low for Caesarean section, preterm delivery, 5-HTTLPR polymorphism and anaemia during pregnancy, and 'very low' for remaining factors. CONCLUSIONS The most robust risk factors of PDD were premenstrual syndrome, violent experiences and unintended pregnancy. These results should be integrated in clinical algorithms to assess the risk of PPD.
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Affiliation(s)
- Chiara Gastaldon
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy; and Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, New York, USA
| | - Marco Solmi
- Department of Neuroscience, University of Padua, Italy; and Padua Neuroscience Center, University of Padua, Italy
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, New York, USA; Department of Psychiatry and Molecular Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA; Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, New York, USA; and Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Germany
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Georgios Schoretsanitis
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, New York, USA; and Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
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Hoirisch-Clapauch S. The Fibrinolytic System in Peripartum Depression. Semin Thromb Hemost 2022; 49:382-390. [PMID: 36113504 DOI: 10.1055/s-0042-1756194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AbstractThe relationship between depression and reduced fibrinolytic activity reflects the role of tissue plasminogen activator and plasmin in brain remodeling underlying resilience, depression remission, and reward processing, rather than the dissolution of fibrin clots. Individuals who experience depression demonstrate hippocampal and prefrontal cortex atrophy, as well as impaired neuronal connectivity. Brain-derived neurotrophic factor (BDNF), synthesized as a precursor that is activated through cleavage by tissue plasminogen activator and plasmin, influences adult neurogenesis and neuronal plasticity in the hippocampus and prefrontal cortex. Depression is associated with decreased brain levels of BDNF, due to reduced activity of tissue plasminogen activator and plasmin. Tissue plasminogen activator and plasmin also mediate the release of dopamine, a neurotransmitter implicated in motivation and reward. Peripartum depression defines a depressive episode that occurs during pregnancy or in the first month after delivery, reinforcing the concept that postpartum depression may be a continuum of antenatal depression. This article describes the fibrinolytic status in the healthy brain, in stress and depression, emphasizing the links between biological markers of depression and defective fibrinolysis. It also discusses the association between hypofibrinolysis and risk factors for perinatal depression, including polycystic ovary syndrome, early miscarriage, preeclampsia, stressful life events, sedentariness, eating habits, gestational and type 2 diabetes, and antithyroid peroxidase antibodies. In addition, it reviews the evidence that antidepressant medications and interventions as diverse as placebo, psychotherapy, massage, video game playing, regular exercise, dietary modifications, omega 3 fatty acid supplementation, neurohormones, and cigarette smoking may reduce depression by restoring the fibrinolytic activity. Last, it suggests new directions for research.
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Pezley L, Cares K, Duffecy J, Koenig MD, Maki P, Odoms-Young A, Clark Withington MH, Lima Oliveira M, Loiacono B, Prough J, Tussing-Humphreys L, Buscemi J. Efficacy of behavioral interventions to improve maternal mental health and breastfeeding outcomes: a systematic review. Int Breastfeed J 2022; 17:67. [PMID: 36064573 PMCID: PMC9446548 DOI: 10.1186/s13006-022-00501-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/08/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Despite extensive benefits and high intentions, few mothers breastfeed exclusively for the recommended duration. Maternal mental health is an important underlying factor associated with barriers and reduced rates of breastfeeding intent, initiation, and continuation. Given evidence of a bidirectional association between maternal mental health and breastfeeding, it is important to consider both factors when examining the efficacy of interventions to improve these outcomes. The purpose of this manuscript is to review the literature on the efficacy of behavioral interventions focused on both maternal mental health and breastfeeding outcomes, examining the intersection of the two. METHODS This systematic review was completed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Studies were selected if they were available in English, used primary experimental design, and used a behavioral intervention type to examine maternal mental health and breastfeeding outcomes. Articles were identified from PubMed, CINAHL, Embase, and PsycINFO from database inception to 3 March 2022. Study quality was assessed using the Cochrane Risk of Bias tool. Results were synthesized by intervention success for 1. Mental health and breastfeeding, 2. Breastfeeding only, 3. Mental health only, and 4. No intervention effect. PROSPERO CRD42021224228. RESULTS Thirty interventions reported in 33 articles were identified, representing 15 countries. Twelve studies reported statistically significant positive effect of the intervention on both maternal mental health and breastfeeding; most showing a decrease in self-report depressive and/or anxiety symptoms in parallel to an increase in breastfeeding duration and/or exclusivity. Common characteristics of successful interventions were a) occurring across pregnancy and postpartum, b) delivered by hospital staff or multidisciplinary teams, c) offered individually, and d) designed to focus on breastfeeding and maternal mental health or on breastfeeding only. Our results are not representative of all countries, persons, experiences, circumstances, or physiological characteristics. CONCLUSIONS Interventions that extend the perinatal period and offer individualized support from both professionals and peers who collaborate through a continuum of settings (e.g., health system, home, and community) are most successful in improving both mental health and breastfeeding outcomes. The benefits of improving these outcomes warrant continued development and implementation of such interventions. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021224228.
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Affiliation(s)
- Lacey Pezley
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St, Chicago, IL, 60612, USA.
| | - Kate Cares
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St, Chicago, IL, 60612, USA
| | - Jennifer Duffecy
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Mary Dawn Koenig
- Department of Human Development Nursing Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Pauline Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - Manoela Lima Oliveira
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St, Chicago, IL, 60612, USA
| | | | - Jilian Prough
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St, Chicago, IL, 60612, USA
| | - Lisa Tussing-Humphreys
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St, Chicago, IL, 60612, USA
| | - Joanna Buscemi
- Department of Psychology, DePaul University, Chicago, IL, USA
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Affiliation(s)
- Andreea A Creanga
- From the Departments of International Health and Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, and the Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine - both in Baltimore (A.A.C.); the Mother Infant Research Institute, Tufts Medical Center, and the Department of Obstetrics and Gynecology, Tufts University School of Medicine - both in Boston (P.M.C.); and the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA (B.T.B.)
| | - Patrick M Catalano
- From the Departments of International Health and Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, and the Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine - both in Baltimore (A.A.C.); the Mother Infant Research Institute, Tufts Medical Center, and the Department of Obstetrics and Gynecology, Tufts University School of Medicine - both in Boston (P.M.C.); and the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA (B.T.B.)
| | - Brian T Bateman
- From the Departments of International Health and Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, and the Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine - both in Baltimore (A.A.C.); the Mother Infant Research Institute, Tufts Medical Center, and the Department of Obstetrics and Gynecology, Tufts University School of Medicine - both in Boston (P.M.C.); and the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA (B.T.B.)
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Environmental risk factors, protective factors, and biomarkers for postpartum depressive symptoms: an umbrella review. Neurosci Biobehav Rev 2022; 140:104761. [PMID: 35803397 DOI: 10.1016/j.neubiorev.2022.104761] [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: 12/05/2021] [Revised: 05/27/2022] [Accepted: 06/28/2022] [Indexed: 11/24/2022]
Abstract
We performed an umbrella review on environmental risk/protective factors and biomarkers for postpartum depressive symptoms to establish a hierarchy of evidence. We systematically searched PubMed, Embase, and the Cochrane Database of Systematic Reviews from inception until 12 January 2021. We included systematic reviews providing meta-analyses related to our research objectives. Methodological quality was assessed by AMSTAR 2, and the certainty of evidence was evaluated by GRADE. This review was registered in PROSPERO (CRD42021230784). We identified 30 articles, which included 45 environmental risk/protective factors (154,594 cases, 7,302,273 population) and 9 biomarkers (2018 cases, 16,757 population). The credibility of evidence was convincing (class I) for antenatal anxiety (OR 2.49, 1.91-3.25) and psychological violence (OR 1.93, 1.54-2.42); and highly suggestive (class II) for intimate partner violence experience (OR 2.86, 2.12-3.87), intimate partner violence during pregnancy (RR 2.81, 2.11-3.74), smoking during pregnancy (OR 2.39, 1.78-3.2), history of premenstrual syndrome (OR 2.2, 1.81-2.68), any type of violence experience (OR 2.04, 1.72-2.41), primiparity compared to multiparity (RR 1.76, 1.59-1.96), and unintended pregnancy (OR 1.53, 1.35-1.75).
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Special Issue: "Exercise Intervention during Pregnancy and Maternal Health". J Clin Med 2022; 11:jcm11113108. [PMID: 35683495 PMCID: PMC9181077 DOI: 10.3390/jcm11113108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 02/04/2023] Open
Abstract
For nine months, the process of pregnancy modifies all the organs and systems of the woman's body in order to achieve adequate fetal growth and development [...].
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Syam A, Qasim M, Iskandar I, Kadir A. Cortisol, Prolactin, and Breastmilk Volume; A Promising Pattern for Reducing Postpartum Depression. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Research shows postnatal depression and shorter breastfeeding are consistently related, but their causal effect remains debatable. To reduce the impact of mental disorders in the perinatal period, lactation may give a significant neuroendocrine effect.
AIM: This study aimed to examine hormonal patterns and estimated breastmilk volume of mothers with depression.
MATERIALS AND METHODS: This study was conducted during the three-trimester to 6-week postnatal period. It involved 60 pregnant women from South Sulawesi, Indonesia. Analysis of variance with repeated measures was used to compare and review fluctuations and effect sizes of cortisol, prolactin, and breastmilk volume of mothers with depression symptoms.
RESULTS: The mean cortisol levels rose in the 4th week and decreased in the 6th week in both groups. There was no substantial difference in the cortisol levels between these periods (p = 0.534; p = 0.553; and p = 0.660), but the prolactin levels continuously increased by 2 weeks and substantially progressed in the 4th and 6th weeks (p < 0.028, p < 0.009), respectively. There was no positive association between cortisol and prolactin levels (p = 0.384). The breastmilk volume was higher every week only in mothers without depression and it slightly decreased in other categories. This study emphasized the prolactin’s protective effect size on a stressful environment characterized by high cortisol; a significant rise in prolactin levels occurred in the 2nd and 4th weeks of postnatal, marking the higher lactation.
CONCLUSIONS: Breastfeeding hormones may provide protection against postpartum depression in moms. It is critical to establish a history of prior trauma in nursing mothers in order to facilitate diagnosis and proper care.
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Wilson CA, Newham J, Rankin J, Ismail K, Simonoff E, Reynolds RM, Stoll N, Howard LM. Systematic review and meta-analysis of risk of gestational diabetes in women with preconception mental disorders. J Psychiatr Res 2022; 149:293-306. [PMID: 35320739 DOI: 10.1016/j.jpsychires.2022.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 11/27/2022]
Abstract
There is a well-established bidirectional association between Type 2 diabetes and mental disorder and emerging evidence for an increased risk of perinatal mental disorder in women with gestational diabetes (GDM). However, the relation between mental disorder prior to pregnancy and subsequent risk of GDM remains relatively unexplored. This is a systematic review and meta-analysis of the risk of GDM in women with a range of preconception mental disorders. Peer-reviewed literature measuring odds of GDM and preconception mood, anxiety, psychotic and eating disorders was systematically reviewed. Risk of bias was assessed using a checklist. Two independent reviewers were involved. 22 observational studies met inclusion criteria; most were retrospective cohorts from English speaking, high income countries. 14 studies were at high risk of bias. There was evidence for an increased risk of GDM in women with schizophrenia (pooled OR 2.44; 95% CI 1.17,5.1; 5 studies) and a reduced risk of GDM in women with anorexia nervosa (pooled OR 0.63; 95% CI 0.49,0.80; 5 studies). There was some limited evidence of an increased risk in women with bipolar disorder. There was no evidence for an association with preconception depression or bulimia nervosa on meta-analysis. There were insufficient studies on anxiety disorders for meta-analysis. This review indicates that there is not a significant risk of GDM associated with many preconception mental disorders but women with psychotic disorders represent a group uniquely vulnerable to GDM. Early detection and management of GDM could improve physical and mental health outcomes for these women and their children.
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Affiliation(s)
- Claire A Wilson
- Section of Women's Mental Health, PO31 King's College London, De Crespigny Park, London, SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX, UK.
| | - James Newham
- Faculty of Health and Life Sciences, Sutherland Building, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, UK
| | - Judith Rankin
- Institute of Health and Society, Baddiley-Clark Building, Newcastle University, Newcastle-upon-Tyne, NE2 4AX, UK
| | - Khalida Ismail
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX, UK; Department of Psychological Medicine, Weston Education Centre, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Emily Simonoff
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX, UK; Department of Child and Adolescent Psychiatry, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Rebecca M Reynolds
- Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Nkasi Stoll
- Department of Psychological Medicine, Weston Education Centre, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Louise M Howard
- Section of Women's Mental Health, PO31 King's College London, De Crespigny Park, London, SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX, UK
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Lauterbach R, Ben Zvi D, Dabaja H, Zidan R, Justman N, Vitner D, Beloosesky R, Ghanem N, Ginsberg Y, Zipori Y, Weiner Z, Khatib N. Vaginal Dinoprostone Insert versus Cervical Ripening Balloon for Term Induction of Labor in Obese Nulliparas-A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11082138. [PMID: 35456231 PMCID: PMC9029246 DOI: 10.3390/jcm11082138] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 01/27/2023] Open
Abstract
Data regarding the preferred induction method in women with obesity is scarce. The current study was aimed at comparing pharmacological and mechanical induction in this population. This prospective randomized controlled trial was conducted between 2016−2020, in nulliparas with a pre-pregnancy body mass index >30. Inclusion criteria were singleton-term pregnancies, bishop score < 5, and indication for induction. Patients were randomized to induction by a cervical ripening balloon (CRB) or a 10 mg vaginal dinoprostone insert. The primary outcome was delivery rate within 24 h. Secondary outcomes included time to delivery, cesarean section rate, maternal and neonatal outcomes, satisfaction, and anxiety. The study population comprised of 83 women in the CRB group and 81 in the dinoprostone group. There was a significant difference in delivery rates within 24 h and time to delivery between the dinoprostone and CRB groups (45% vs. 71%, p = 0.017 and 49.3 ± 6.8 h vs. 23.5 ± 5.9 h, p = 0.003, respectively). There were no differences in cesarean delivery rates or maternal and neonatal outcomes, though CRB induction was associated with a significantly lower rate of tachysystole. Induction with CRB was accompanied by higher satisfaction and lower anxiety. In summary, CRB induction is associated with shorter time to delivery, higher satisfaction, and lower anxiety compared to PGE2 in women with obesity, without compromising maternal or neonatal outcomes.
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Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
- Correspondence: ; Tel.: +972-4-7771779; Fax: +972-4-7771778
| | - Dikla Ben Zvi
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
| | - Haneen Dabaja
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
| | - Ragda Zidan
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
| | - Dana Vitner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Nadir Ghanem
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
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Longitudinal associations of pre-pregnancy BMI and gestational weight gain with maternal urinary metabolites: an NYU CHES study. Int J Obes (Lond) 2022; 46:1332-1340. [PMID: 35411100 PMCID: PMC9581342 DOI: 10.1038/s41366-022-01116-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 12/02/2022]
Abstract
Background/Objectives: Excessive gestational weight gain (GWG) and pre-pregnancy obesity affect a significant portion of the US pregnant population and are linked with negative maternal and child health outcomes. The objective of this study was to explore associations of pre-pregnancy body mass index (pBMI) and GWG with longitudinally measured maternal urinary metabolites throughout pregnancy. Subjects/Methods: Among 652 participants in the New York University Children’s Health and Environment Study, a longitudinal pregnancy cohort, targeted metabolomics were measured in serially collected urine samples throughout pregnancy. Metabolites were measured at median 10 (T1), 21 (T2), and 29 (T3) weeks gestation using the Biocrates AbsoluteIDQ® p180 Urine Extension kit. Acylcarnitine, amino acid, biogenic amine, phosphatidylcholine, lysophosphatidylcholine, sphingolipid, and sugar levels were quantified. Pregnant people 18 years or older, without type 1 or 2 diabetes and with singleton live births and valid pBMI and metabolomics data were included. GWG and pBMI were calculated using weight and height data obtained from electronic health records. Linear mixed effects models with interactions with time were fit to determine the gestational age-specific associations of categorical pBMI and continuous interval-specific GWG with urinary metabolites. All analyses were corrected for false discovery rate. Results: Participants with obesity had lower long-chain acylcarnitine levels throughout pregnancy and lower phosphatidylcholine and glucogenic amino acids and higher phenylethylamine concentrations in T2 and T3 compared with participants with normal/underweight pBMI. GWG was associated with taurine in T2 and T3 and C5 acylcarnitine species, C5:1, C5-DC, and C5-M-DC, in T2. Conclusions: pBMI and GWG were associated with the metabolic environment of pregnant individuals, particularly in relation to mid-pregnancy. These results highlight the importance of both preconception and prenatal maternal health.
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Kim J, Kelley J, Davidson L, Richards N, Adams T. Depression and Anxiety Incidence During Pregnancy Between Bariatric Surgery Patients and Matched Control Subjects. Obes Surg 2022; 32:1962-1968. [DOI: 10.1007/s11695-022-06037-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 01/03/2023]
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Daly M, Kipping RR, Tinner LE, Sanders J, White JW. Preconception exposures and adverse pregnancy, birth and postpartum outcomes: Umbrella review of systematic reviews. Paediatr Perinat Epidemiol 2022; 36:288-299. [PMID: 34970757 DOI: 10.1111/ppe.12855] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Preconception exposures have been associated with adverse pregnancy, birth and postpartum outcomes. However, the reports, statements and guidelines of national and international health organisations vary in what they recommend individuals should monitor, avoid, reduce or practise in the preconception period. OBJECTIVES To synthesise and evaluate the evidence across systematic reviews for associations between exposures before conception and adverse pregnancy, birth and postpartum outcomes. DATA SOURCES MEDLINE, Embase, Epistemonikos (to May 2020) and reference lists of included reviews, without language or date restrictions. STUDY SELECTION, DATA EXTRACTION AND SYNTHESIS Systematic literature reviews of observational and/or interventional studies reporting associations between preconception exposures in women and/or men of reproductive age and pregnancy, birth or postpartum health outcomes were included. The methodological quality of reviews and the certainty of the evidence underlying each exposure-outcome association were assessed using AMSTAR 2 and the GRADE approach. RESULTS We identified 53 eligible reviews reporting 205 unique exposure-outcome associations. Methodological quality was generally low with only two reviews rated as 'high' quality and two as 'moderate'. We found high-certainty, randomised trial evidence that maternal folate supplementation reduces the risk of neural tube defects and anomaly-related terminations. Moderate-certainty, observational evidence was found that maternal physical activity is associated with reduced risk of pre-eclampsia and gestational diabetes, and that paternal age of ≥40 years and maternal body mass index (BMI) and interpregnancy weight gain are associated with increased risk of various adverse pregnancy and birth outcomes. Low- and very low-certainty evidence was found for other associations. CONCLUSIONS Clinicians and policymakers can be confident that maternal folate supplementation should be encouraged during the preconception period. There is moderate certainty in the evidence base that maternal physical activity, BMI and interpregnancy weight gain and advanced paternal age are important preconception considerations. High-quality research is required to better understand other exposure-outcome associations.
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Runkle JD, Matthews JL, Sparks L, McNicholas L, Sugg MM. Racial and ethnic disparities in pregnancy complications and the protective role of greenspace: A retrospective birth cohort study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 808:152145. [PMID: 34871679 DOI: 10.1016/j.scitotenv.2021.152145] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 06/13/2023]
Abstract
Greenspace may positively impact pregnancy health for racially and economically minoritized populations; few studies have examined local availability and accessibility of green/park space in reducing maternal morbidity. The objective of this retrospective birth cohort study was to examine the association between residential exposure to greenspace and adverse pregnancy health outcomes in a Southern US state characterized by high poverty and racial disparities in maternal health (2013-2017). National data from the Protected Area database - United States (PAD-US) and ParkServe estimated three publicly available and accessible residential greenspace measures-a more direct proxy than using remotely-sensed greenness indicators (e.g., normalized difference vegetation index (NDVI))-(a) percent area of greenspace (M1), (b) area of available greenspace per person (M2), (c) total population within a 10-minute walk (M3). Generalized Estimating Equations with logistic regression were used to examine the association between individual greenspace metrics and South Carolina hospital deliveries (n = 238,922 deliveries) for women with correlated maternal health outcomes for gestational hypertension (GHTN), gestational diabetes (GD), severe maternal morbidity (SMM), preeclampsia (PRE), mental disorders (MD), depressive disorders (DD), and preterm birth (PTB). Lowest compared to highest tertiles of all three metrics were associated with increased risk for MD, DD, and a monotonic increase in GD, particularly for black women. Women with the lowest access to M2 and M3 were more at risk for PRE, PTB, and MD. We observed that women in low-income, majority-black communities in the lowest versus highest tertile of M2 were more likely to experience a DD, MD, SMM, or PTB compared to primarily high-income majority-white communities. Available and accessible green/park space may present as an effective nature-based intervention to reduce maternal complications, particularly for gestational diabetes and other pregnancy health risks for which there are currently few known evidence-based primary prevention strategies.
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Affiliation(s)
- Jennifer D Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, 151 Patton Avenue, Asheville, NC 28801, USA.
| | - Jessica L Matthews
- NOAA's National Centers for Environmental Information (NCEI), 151 Patton Avenue, Asheville, NC 28801, USA.
| | - Laurel Sparks
- Department of Geosciences, Georgia State University, Atlanta, GA 30303, USA
| | - Leo McNicholas
- Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Margaret M Sugg
- Department of Geography and Planning, Appalachian State University, P.O. Box 32066, Boone, NC 28608, USA.
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Leuthardt AS, Bayer J, Monné Rodríguez JM, Boyle CN. Influence of High Energy Diet and Polygenic Predisposition for Obesity on Postpartum Health in Rat Dams. Front Physiol 2022; 12:772707. [PMID: 35222059 PMCID: PMC8867007 DOI: 10.3389/fphys.2021.772707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/16/2021] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Andrea S. Leuthardt
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Julia Bayer
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Josep M. Monné Rodríguez
- Laboratory for Animal Model Pathology (LAMP), Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Christina N. Boyle
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- *Correspondence: Christina N. Boyle,
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Al-Khatib Y, Akhtar MA, Kanawati MA, Mucheke R, Mahfouz M, Al-Nufoury M. Depression and Metabolic Syndrome: A Narrative Review. Cureus 2022; 14:e22153. [PMID: 35308733 PMCID: PMC8920832 DOI: 10.7759/cureus.22153] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 12/28/2022] Open
Abstract
We reviewed the literature to investigate the relationship between depression and metabolic syndrome. Major depressive disorder is characterized by a low mood or a loss of interest for longer than two weeks. Metabolic syndrome describes multiple metabolic risk factors including obesity, insulin resistance, dyslipidemia, and hypertension. We divided our findings into environmental, genetic, epigenetic, and biological pathway links between depression and the different aspects of metabolic syndrome. We found various sources linking obesity and metabolic syndrome genetically, environmentally, biological pathway-wise, and, while not fully explored, epigenetically. Diabetes and depression were also found to be linked environmentally with both conditions increasing the risk of the other. Depression was also shown to be linked to cardiovascular complications as it increased the risk of occurrence of such complications in healthy people. These findings have led us to believe that there is a link between depression and metabolic syndrome on various levels, especially obesity.
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Affiliation(s)
| | | | - M Ali Kanawati
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Rumbidzai Mucheke
- Operating Department Practice, University of Huddersfield, Huddersfield, GBR
| | - Maria Mahfouz
- Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
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Noorjahan N, Cattini PA. Neurogenesis in the Maternal Rodent Brain: Impacts of Gestation-Related Hormonal Regulation, Stress, and Obesity. Neuroendocrinology 2022; 112:702-722. [PMID: 34510034 DOI: 10.1159/000519415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 09/02/2021] [Indexed: 11/19/2022]
Abstract
In order to maintain maternal behavior, it is important that the maternal rodent brain promotes neurogenesis. Maternal neurogenesis is altered by the dynamic shifts in reproductive hormone levels during pregnancy. Thus, lifestyle events such as gestational stress and obesity that can affect hormone production will affect neuroendocrine control of maternal neurogenesis. However, there is a lack of information about the regulation of maternal neurogenesis by placental hormones, which are key components of the reproductive hormonal profile during pregnancy. There is also little known about how maternal neurogenesis can be affected by health concerns such as gestational stress and obesity, and its relationship to peripartum mental health disorders. This review summarizes the changing levels of neurogenesis in mice and rats during gestation and postpartum as well as regulation of neurogenesis by pregnancy-related hormones. The influence of neurogenesis on maternal behavior is also discussed while bringing attention to the effect of health-related concerns during gestation, such as stress and obesity on neuroendocrine control of maternal neurogenesis. In doing so, this review identifies the gaps in the literature and specifically emphasizes the importance of further research on maternal brain physiology to address them.
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Affiliation(s)
- Noshin Noorjahan
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter A Cattini
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Zhang J, An W, Lin L. The Association of Prepregnancy Body Mass Index with Pregnancy Outcomes in Chinese Women. J Diabetes Res 2022; 2022:8946971. [PMID: 35378845 PMCID: PMC8976670 DOI: 10.1155/2022/8946971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 02/21/2022] [Accepted: 02/28/2022] [Indexed: 11/18/2022] Open
Abstract
Our study was to evaluate the association between prepregnancy body mass index (BMI) and pregnancy outcomes. A total of 1546 women who attended prenatal care clinics and delivered at the Peking University International Hospital, Beijing, China, from October 2018 to April 2020 was included. This research explored gestational, perinatal, and postpartum outcomes, including gestational diabetes, anemia, preeclampsia, preterm premature rupture of membranes (PPROM), and postpartum hemorrhage. Participants were divided into underweight (BMI < 18.5 kg/m2), normal weight (18.5 kg/m2 ≤ BMI ≤ 23.9 kg/m2), overweight (24 kg/m2 ≤ BMI ≤ 27.9 kg/m2), and obese (BMI ≥ 28 kg/m2) groups. Logistic regression analysis was used to analyze the association between prepregnancy BMI and pregnancy outcomes, and odds ratio (OR) with 95% confidence interval (95% CI) was calculated. After adjusting potential confounders, the risk of PPROM was higher in the underweight group than the normal weight group (OR = 1.864, 95% CI: 1.269-2.737, P < 0.01). Prepregnancy obesity was associated with higher odds of gestational diabetes (OR = 2.649, 95% CI: 1.701-4.126, P < 0.001) and preeclampsia (OR = 3.654, 95% CI: 1.420-9.404, P < 0.01) than the normal weight group, whereas it correlated with the lower risk of anemia (OR = 0.300, 95% CI: 0.128-0.704, P < 0.01). Our findings may provide evidence for the importance of keeping normal weight for Chinese women when preparing for pregnancy.
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Affiliation(s)
- Jing Zhang
- Division of Gynecology and Obstetrics, Peking University International Hospital, Beijing, China
| | - Wensheng An
- Division of Gynecology and Obstetrics, Peking University International Hospital, Beijing, China
| | - Li Lin
- Division of Gynecology and Obstetrics, Peking University International Hospital, Beijing, China
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Impact of pre-pregnancy body mass index and gestational weight gain on the risk of maternal and infant pregnancy complications in Korean women. Int J Obes (Lond) 2022; 46:59-67. [PMID: 34489525 PMCID: PMC8748202 DOI: 10.1038/s41366-021-00946-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 08/06/2021] [Accepted: 08/16/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVE Healthy weight maintenance before and during pregnancy has a significant effect on pregnancy outcomes; however, there are no specific guidelines for gestational weight gain in pregnant Korean women. Therefore, we investigated the impact of pre-pregnancy body mass index (BMI) and gestational weight gain on the risk of maternal and infant pregnancy complications in pregnant Korean women. METHODS Study participants comprised 3454 singleton pregnant women from the Korean Pregnancy Outcome Study who had baseline examination and pregnancy outcome data. Maternal pre-pregnancy BMI and gestational weight gain were categorized according to the Asia-pacific regional guidelines and the Institute of Medicine recommendations, respectively. The primary outcome was any adverse outcomes, defined as the presence of one or more of the following: hypertensive disorders of pregnancy, gestational diabetes mellitus, peripartum depressive symptom, cesarean delivery, delivery complications, preterm birth, small or large weight infant, neonatal intensive care unit admission, or a congenital anomaly. Multiple logistic regression models were applied to examine the independent and combined impact of pre-pregnancy BMI and gestational weight gain on the risk of maternal and infant outcomes. RESULTS Obesity before pregnancy significantly increased the risk of perinatal adverse outcomes by more than 2.5 times [odds ratio (OR): 2.512, 95% confidence interval (CI): 1.817-3.473]. Compared to that in women with appropriate gestational weight gain, women with excessive weight gain had a 36.4% incremental increase in the risk of any adverse outcomes [OR: 1.364, 95% CI: 1.115-1.670]. Moreover, women who were overweight or obese before pregnancy and had excessive gestational weight gain had a three-fold increase in the risk of adverse outcomes [OR: 3.460, 95% CI: 2.210-5.417]. CONCLUSION This study highlights the need for appropriate weight recommendations before and during pregnancy to prevent perinatal complications in Korean women of childbearing age.
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Underweight, Overweight and Obesity among Reproductive Bangladeshi Women: A Nationwide Survey. Nutrients 2021; 13:nu13124408. [PMID: 34959960 PMCID: PMC8708849 DOI: 10.3390/nu13124408] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 12/18/2022] Open
Abstract
The double burden of malnutrition is becoming more prevalent among Bangladeshi women. Underweight, overweight, and obesity were examined among women aged 15-49 years using the 2017-2018 Bangladesh Demographic and Health Survey (BDHS). A dataset of 20,127 women aged 15-49 years with complete Body Mass Index (BMI) measurements were extracted and categorized as underweight, normal weight, overweight, and obesity. A multiple logistic regression that adjusts for clustering and sampling weights was used to examine underweight, overweight, and obesity among reproductive age Bangladeshi women. Our analyses revealed that the odds of being overweight and obese were higher among women who completed primary and secondary or more levels of education, rich households, breastfeeding women, and women exposed to media (newspapers and television (TV). Women from the poorest households were significantly more likely to be underweight (AOR = 3.86, 95%CI: 2.94-5.07) than women from richer households. The likelihood of being underweight was higher among women with no schooling, adolescent women, and women not using contraceptives. Conclusions: Overweight and obesity was higher among educated and affluent women while underweight was higher among women from low socioeconomic status, indicating that tailored messages to combat overweight and obesity should target educated and affluent Bangladeshi women while improving nutrition among women from low socioeconomic status.
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