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Kalantari E, Tajvar M, Naderimagham S, Takian A. Maternal obesity management: a narrative literature review of health policies. BMC Womens Health 2024; 24:520. [PMID: 39294652 PMCID: PMC11409689 DOI: 10.1186/s12905-024-03342-2] [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: 11/14/2023] [Accepted: 08/27/2024] [Indexed: 09/21/2024] Open
Abstract
Maternal obesity rates are increasing significantly, posing substantial risks to both mothers and their children. This study aims to introduce health policies addressing maternal obesity, identify preventive interventions, and highlight scientific gaps necessitating further research.We identified documents through electronic searches in PubMed, CINAHL Plus, EMBASE, and grey literature sources (ministry of health websites, national gynecology and obstetrics associations) from January 2013 to August 2023, updated in June 2024. The inclusion criteria focused on English-language documents discussing interventions or health policies that promote weight loss through lifestyle changes during pregnancy.A total of 22 documents (10 studies and 12 guidelines) were included. 12 studies (N=1244) identified via databases; included two Clinical Practice Guidelines (CPGs) from Canada and Singapore. Other 10 CPGs sourced from governmental websites and national associations: England (1), Australia (1), New Zealand (1), combined Australia and New Zealand (1), Canada (3), USA (1), Ireland (1), Germany (1). 10 guidelines focused on obesity in pregnancy, two on weight management during pregnancy. Covered interventions across pre-pregnancy, pregnancy, and postpartum periods (9 guidelines); pre-pregnancy and pregnancy (2); exclusively postpartum (1). Seven guidelines offered evidence-based recommendations on maintaining healthy weight in mothers, largely based on expert opinions.Maternal obesity poses significant risks to both mothers and children, underscoring the need for effective health policies and systems. However, few countries have integrated adequate responses into their healthcare policies and guidelines for professionals. Limited evidence exists on optimal practices to improve reproductive health outcomes in obese women. Hence, the crucial need to developing comprehensive guidelines and proactive strategies to manage maternal obesity. These measures can improve outcomes and reduce healthcare costs. Increased focus on research and policymaking is essential to protect the health of mothers and their children.
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Affiliation(s)
- Elnaz Kalantari
- Department of Health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Maryam Tajvar
- Department of Health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Shohreh Naderimagham
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Takian
- Department of Health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
- Department of Global Health & Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
- Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran.
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Prifti KK, McCarthy R, Ma X, Finck BN, England SK, Frolova AI. Obese mice have decreased uterine contractility and altered energy metabolism in the uterus at term gestation†. Biol Reprod 2024; 111:678-693. [PMID: 38857377 PMCID: PMC11402524 DOI: 10.1093/biolre/ioae086] [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: 01/22/2024] [Revised: 05/26/2024] [Accepted: 06/07/2024] [Indexed: 06/12/2024] Open
Abstract
Over 35% of reproductive-age women in the USA have obesity, putting them at increased risk for numerous obstetric complications due to abnormal labor. While the association between maternal obesity and abnormal labor has been well documented, the mechanisms responsible for this remain understudied. The uterine smooth muscle, myometrium, has high energy needs in order to fuel regular uterine contractions during parturition. However, the precise mechanisms by which the myometrium meets its energy demands has not been defined. Here, our objective was to define the effects of obesity on energy utilization in the myometrium during labor. We generated a mouse model of maternal diet-induced obesity and found that these mice had a higher rate of dystocia than control chow-fed mice. Moreover, compared to control chow-fed mice, DIO mice at term, both before and during labor had lower in vivo spontaneous uterine contractility. Untargeted transcriptomic and metabolomic analyses suggest that diet-induced obesity is associated with elevated long-chain fatty acid uptake and utilization in the uterus, but also an accumulation of medium-chain fatty acids. Diet-induced obesity uteri also had an increase in the abundance of long chain-specific beta-oxidation enzymes, which may be responsible for the observed increase in long-chain fatty acid utilization. This altered energy substrate utilization may be a contributor to the observed contractile dysfunction.
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Affiliation(s)
- Kevin K Prifti
- Center for Reproductive Health Sciences, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO, USA
| | - Ronald McCarthy
- Center for Reproductive Health Sciences, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO, USA
| | - Xiaofeng Ma
- Center for Reproductive Health Sciences, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO, USA
| | - Brian N Finck
- Department of Medicine, Center for Human Nutrition, Washington University in St. Louis, St. Louis, MO, USA
| | - Sarah K England
- Center for Reproductive Health Sciences, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO, USA
| | - Antonina I Frolova
- Center for Reproductive Health Sciences, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO, USA
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Musa E, Salazar-Petres E, Vatish M, Levitt N, Sferruzzi-Perri AN, Matjila MJ. Kisspeptin signalling and its correlation with placental ultrastructure and clinical outcomes in pregnant South African women with obesity and gestational diabetes. Placenta 2024; 154:49-59. [PMID: 38878622 DOI: 10.1016/j.placenta.2024.05.138] [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: 02/04/2024] [Revised: 05/13/2024] [Accepted: 05/30/2024] [Indexed: 09/03/2024]
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is a major pregnancy metabolic disorder and is strongly linked with obesity. Kisspeptin is a hormone that increases several thousand-fold in the maternal circulation during human pregnancy, with placenta as its main source. Studies have suggested that kisspeptin regulates trophoblast invasion and promotes pancreatic insulin secretion and peripheral insulin sensitivity. METHODS In a well-characterized cohort of pregnant South African women and molecular and histological techniques, this study explored the impact and interaction of maternal obesity and GDM on kisspeptin (KISS1) signalling in relation to placental morphology and maternal and neonatal parameters. RESULTS We found that GDM had no effect on placental KISS1 and KISS1R (KISS1 receptor) mRNA and/or protein expression. However, obesity reduced placental KISS1R mRNA expression even though overall KISS1 protein abundance or localization was not different from the non-obese group. Maternal and cord circulating KISS1 concentrations did not vary with obesity or GDM, but maternal circulating KISS1 was positively correlated with placenta weight in non-GDM obese women, and negatively correlated with placental intervillous space volume in non-GDM non-obese women. Cord serum KISS1 was positively correlated with infant weight in GDM obese women, but negatively correlated with maternal BMI in the non-obese GDM group. Placental syncytiotrophoblast extracellular vesicles exhibited detectable KISS1 and its abundance was ∼50 % lower in those from obese GDM compared to non-GDM women. DISCUSSION This study shows maternal obesity and GDM can modulate placental kisspeptin signalling and placental morphological development with potential pathophysiological implications for clinically-relevant pregnancy and perinatal outcomes.
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Affiliation(s)
- Ezekiel Musa
- Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Internal Medicine, Kaduna State University, Kaduna, Nigeria
| | - Esteban Salazar-Petres
- Carrera de Obstetricia, Facultad de Ciencias para el Cuidado de la Salud, Universidad San Sebastián, Valdivia, Chile
| | - Manu Vatish
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Naomi Levitt
- Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Amanda N Sferruzzi-Perri
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.
| | - Mushi J Matjila
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa.
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Kim JJ, Renaud L, Torrance S, Shmorgun D, Gale J, Wu CQ. Pregnancy outcomes after superovulation-intrauterine insemination (SO-IUI) using gonadotropins versus letrozole in the obese population. J Assist Reprod Genet 2024:10.1007/s10815-024-03205-7. [PMID: 39172321 DOI: 10.1007/s10815-024-03205-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 07/10/2024] [Indexed: 08/23/2024] Open
Abstract
PURPOSE To compare fertility outcomes of obese patients (body mass index [BMI] ≥ 30 kg/m2) undergoing superovulation and intrauterine insemination (SO-IUI) using gonadotropins versus letrozole. METHODS A single centre retrospective cohort study of obese patients undergoing SO-IUI using gonadotropins or letrozole between January/2019 and June/2022. Primary outcome was clinical pregnancy rate (intrauterine pregnancy with positive fetal heart rate). Secondary outcomes included rates of multifollicular development, multiple pregnancy, spontaneous abortion and cycle cancellation. Subgroup analysis was done stratifying by obesity class. A multivariate logistic regression model was used for primary/secondary outcomes, adjusting for clinically determined covariates. RESULTS Out of 802 total identified SO-IUI cycles, 715 cycles were completed (518-gonadotropins and 197-letrozole cycles). The clinical pregnancy rates were not significantly different in obese patients undergoing SO-IUI with gonadotropins versus letrozole when adjusted for age, gravidity, parity, cause of infertility, IUI cycle number, endometrial thickness, sperm source and post-wash motile sperm count (adjusted odds ratio [aOR] 1.37, 95% confidence interval [CI] 0.72-2.59). Similarly, no significant associations were found in spontaneous abortion (aOR1.46, 95%CI 0.42-5.08), multiple pregnancy (aOR1.33, 95%CI 0.20-8.88) or cancellation rates (OR0.89, 95%CI 0.55-1.45) between the two groups. The rates of multifollicular development were also comparable between the two groups (aOR0.51, 95% CI 0.19-1.38). For cycles involving gonadotropins, higher BMI classes required higher total gonadotropin dose (p < 0.001). CONCLUSION After adjusting for patient and cycle factors, gonadotropins and letrozole led to comparable odds of achieving pregnancy in obese patients undergoing SO-IUI. Future research in the obese population will help to better understand how to optimize fertility treatments for this growing population.
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Affiliation(s)
- Joanna J Kim
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON, K1H 8L6, Canada
| | - Livia Renaud
- Faculty of Science, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Samantha Torrance
- Ottawa Fertility Centre, 100-955 Green Valley Crescent, Ottawa, ON, K2C 3V4, Canada
| | - Doron Shmorgun
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON, K1H 8L6, Canada
- Ottawa Fertility Centre, 100-955 Green Valley Crescent, Ottawa, ON, K2C 3V4, Canada
| | - Jenna Gale
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON, K1H 8L6, Canada
- Ottawa Fertility Centre, 100-955 Green Valley Crescent, Ottawa, ON, K2C 3V4, Canada
| | - Clara Q Wu
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON, K1H 8L6, Canada.
- Ottawa Fertility Centre, 100-955 Green Valley Crescent, Ottawa, ON, K2C 3V4, Canada.
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El Masri D, Alemayohu MA, Loperfido F, Bianco I, Ferrara C, Cerbo RM, Ghirardello S, Monti MC, Maccarini B, Sottotetti F, Civardi E, Garofoli F, Angelini M, Cena H, De Giuseppe R. Associations of maternal lifestyle factors with inadequate pregnancy weight gain: findings from the baseline data of the LIMIT prospective cohort study. Eur J Nutr 2024:10.1007/s00394-024-03473-0. [PMID: 39167177 DOI: 10.1007/s00394-024-03473-0] [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: 02/13/2024] [Accepted: 07/22/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND/OBJECTIVES Gestational Weight Gain (GWG) impacts maternal and fetal health; deviations from optimal ranges pose health risks. Maternal lifestyle before and during pregnancy strongly influences GWG. This study explores factors linked to inadequate GWG, focusing on Mediterranean Diet (MD) adherence and specific food consumption. SUBJECTS/METHODS 178 pregnant women were enrolled at Fondazione IRCCS Policlinico San Matteo (Pavia) during pre-hospital care before birth meeting inclusion/exclusion criteria. Sociodemographic data, pre-pregnancy BMI, GWG, MD adherence, physical activity (PA) levels, and smoking habits were retrospectively collected. Validated questionnaires adapted for the target group, assessed MD adherence and PA level. Participants were classified into adequate (AGWG) and inadequate GWG groups following IOM guidelines. RESULTS Among 200 pregnant women (aged 30-36), 37.1% experienced low GWG and 24.1% excessive GWG. Our study revealed a significant association between inadequate GWG and educational level (P = 0.011); pre-pregnancy BMI (P = 0.005); MD adherence (P = 0.008), and daily average consumption of vegetables (P < 0.001). Our results also showed that a lower risk of EGWG vs. AGWG was associated with daily average consumption of vegetables (RRR = 0.279, P = 0.004), while a higher risk of EGWG vs. AGWG was associated with high daily meat product consumption (> 1.5 portions/day) (RRR = 7.83, P = 0.03). CONCLUSION These findings emphasize the importance of promoting lifestyle changes before and during pregnancy to tackle the increasing incidence of inadequate GWG and improve the health outcomes of both mother and child.
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Affiliation(s)
- Dana El Masri
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100, Italy
| | - Mulubirhan Assefa Alemayohu
- Biostatistics and Clinical Epidemiology Unit, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100, Italy
- Department of Epidemiology, School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Federica Loperfido
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100, Italy.
| | - Irene Bianco
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100, Italy
| | - Chiara Ferrara
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100, Italy
| | - Rosa Maria Cerbo
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Stefano Ghirardello
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Maria Cristina Monti
- Biostatistics and Clinical Epidemiology Unit, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100, Italy
| | - Beatrice Maccarini
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100, Italy
| | - Francesca Sottotetti
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100, Italy
| | - Elisa Civardi
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Francesca Garofoli
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Micol Angelini
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100, Italy
- Clinical Nutrition Unit, Department of General Medicine, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, 27100, Italy
| | - Rachele De Giuseppe
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100, Italy
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Arvizu M, Wang S, Mitsunami M, Mínguez-Alarcón L, Gaskins AJ, Rosner B, Rich-Edwards JW, Chavarro JE. BMI status and weight trajectories across females' reproductive years and risk of adverse pregnancy outcomes: a prospective cohort study. Am J Clin Nutr 2024; 120:225-231. [PMID: 38777663 PMCID: PMC11251209 DOI: 10.1016/j.ajcnut.2024.04.034] [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: 12/21/2023] [Revised: 04/08/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Prepregnancy body mass index (BMI) is a well-established risk factor of adverse pregnancy outcomes (APOs). The associations of long-term and short-term weight trajectories with APOs are less clear. OBJECTIVES This study aimed to determine the associations of weight trajectories during females' reproductive years, before and between pregnancies, with risk of APOs. METHODS We followed 16,241 females (25,386 singleton pregnancies) participating in a prospective cohort, the Nurses' Health Study II. Weight at age 18 y, current weight, and height were assessed at baseline (1989), and weight was updated biennially. Pregnancy history was self-reported in 2009. The primary outcome was a composite of hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), preterm birth, and stillbirth. Secondary outcomes were individual APOs. The associations of weight change with APOs were estimated using log-binomial regression, adjusting for demographic, lifestyle, reproductive factors, and baseline BMI (in kg/m2). RESULTS The mean (standard deviation [SD]) age at first in-study pregnancy was 33.7 (4.1) y. The mean (SD) time from age 18 y to pregnancy, baseline to pregnancy, and between pregnancies was 16.3 (4.0), 6.1 (3.0), and 2.9 (1.6) y, with a corresponding weight change of 6.4 (9.1), 3.1 (5.8), and 2.3 (4.8) kg, respectively. Of the pregnancies, 4628 (18.2%) were complicated by ≥1 APOs. Absolute weight change since age 18 y was most strongly associated with APOs. Compared with females whose weight remained stable (0-2 kg) since age 18, females who gained >2 kg had higher risk of APO (2.1-9.9 kg, relative risk [RR]: 1.12; 95% confidence interval [CI]: 1.02, 1.23; 10.0-14.9 kg, RR: 1.43; 95% CI: 1.29, 1.60; ≥15 kg, RR: 1.87; 95% CI: 1.69, 2.08), primarily driven by HDP and GDM. The associations of per 1 kg weight gain before and between pregnancies with HDP were nearly identical. CONCLUSIONS Weight trajectories prior to and between pregnancies were associated with the risk of APOs, particularly HDP. Longer periods of weight gain, corresponding to greater absolute weight gain, were most strongly associated with higher risk of APOs.
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Affiliation(s)
- Mariel Arvizu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Siwen Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Makiko Mitsunami
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Lidia Mínguez-Alarcón
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Audrey J Gaskins
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Bernard Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Janet W Rich-Edwards
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
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Grandfils S, Durand P, Hoge A, Seidel L, Emonts P, Paquot N, Philips JC. Gestational weight gain: Toward best practices in managing gestational weight gain in patients with obesity: Comparison of recommendations. Eur J Obstet Gynecol Reprod Biol 2024; 298:197-203. [PMID: 38795431 DOI: 10.1016/j.ejogrb.2024.05.009] [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: 06/11/2023] [Revised: 05/02/2024] [Accepted: 05/11/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND AND AIMS In 2009, the Institute of Medicine (IOM) issued recommendations for gestational weight gain (GWG) based on body mass index (BMI). Several studies have challenged those recommendations for women with obesity, considering them too liberal and advising more limited weight gain - or even weight loss - during pregnancy to improve maternal and neonatal outcomes. Our aim was to study how gestational weight gain in women with obesity impacted maternal and fetal complications in the Belgian population. We did this by comparing the results from two groups of patients with obesity: those who met the 2009 IOM standards and those who satisfied the stricter recommendations suggested by other authors. MATERIALS AND METHODS This is a retrospective cohort study using data collected at the Centre d'Epidémiologie Périnatale (CEpiP) from obese (BMI ≥ 30 kg/m2) pregnant women with live singleton deliveries between 2010 and 2019 in Wallonia-Brussels Federation (n = 65,314). RESULTS Compared to obese patients whose GWG satisfied the IOM standards, those with GWG meeting the stricter recommendations had lower rates of gestational hypertension (7.1 % vs. 10.1 %; p = 0.0059), cesarean section (22.1 % vs. 26.3 %; p = 0.0074), and macrosomia (12.0 % vs. 17.7 %; p < 0.0001). There was no significant difference in the rate of preterm delivery (6.9 % vs 5.8 %; p = 0.12) or small-for-gestational-age births (7.2 % vs. 6.2 %; p = 0.16). CONCLUSION Gestational weight gain below that currently recommended by the IOM appears beneficial to the health of mothers with obesity and their children. These data, from our population, further challenge the standards proposed since 2009.
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Affiliation(s)
- Sebastien Grandfils
- Department of Gynecology and Obstetrics, University Hospital of Liège, Belgium.
| | - Pauline Durand
- Department of Public Health, University of Liège, Belgium
| | - Axelle Hoge
- Department of Public Health, University of Liège, Belgium
| | - Laurence Seidel
- Biostatistics and Research Method Center (B-STAT), University Hospital of Liège, Belgium
| | - Patrick Emonts
- Department of Gynecology and Obstetrics, University Hospital of Liège, Belgium
| | - Nicolas Paquot
- Department of Diabetology, Nutrition and Metabolic Diseases, University Hospital of Liège, Belgium
| | - Jean Christophe Philips
- Department of Diabetology, Nutrition and Metabolic Diseases, University Hospital of Liège, Belgium
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Zhang Y, Lu M, Yi Y, Xia L, Zhang R, Li C, Liu P. Influence of maternal body mass index on pregnancy complications and outcomes: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1280692. [PMID: 38894748 PMCID: PMC11183281 DOI: 10.3389/fendo.2024.1280692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
Background The prevalence of obesity among women of reproductive age is increasing worldwide, with implications for serious pregnancy complications. Methods Following PRISMA guidelines, a systematic search was conducted in both Chinese and English databases up to December 30, 2020. Pregnancy complications and outcomes including gestational diabetes mellitus (GDM), gestational hypertension (GHTN), pre-eclampsia, cesarean section (CS), induction of labor (IOL), and postpartum hemorrhage (PPH) were analyzed. Random-effects or fixed-effects models were utilized to calculate the odds ratio (OR) with 95% confidence intervals (CIs). Results Women with overweight and obesity issues exhibited significantly higher risks of GDM (OR, 2.92, 95%CI, 2.18-2.40 and 3.46, 95%CI, 3.05-3.94, respectively) and GHTN (OR, 2.08, 95%CI, 1.72-2.53 and 3.36, 95%CI, 2.81-4.00, respectively) compared to women of normal weight. Pre-eclampsia was also significantly higher in women with overweight or obesity, with ORs of 1.70 (95%CI, 1.44-2.01) and 2.82 (95%CI, 2.66-3.00), respectively. Additionally, mothers with overweight or obesity issues had significantly higher risks of CS (OR, 1.44, 95%CI, 1.41-1.47, and 2.23, 95%CI, 2.08-2.40), IOL (OR, 1.33, 95%CI, 1.30-1.35 and 1.96, 95%CI, 1.85-2.07), and PPH (OR, 1.67, 95%CI, 1.42-1.96 and 1.88, 95%CI, 1.55-2.29). Conclusion Women with overweight or obesity issues face increased risks of pregnancy complications and adverse outcomes, indicating dose-dependent effects.
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Affiliation(s)
- Yi Zhang
- College of Public Health, Zunyi Medical University, Zunyi, China
- Key Laboratory of Maternal & Child Health and Exposure Science of Guizhou Higher Education Institutes, Zunyi, China
| | - Mei Lu
- College of Public Health, Zunyi Medical University, Zunyi, China
- Key Laboratory of Maternal & Child Health and Exposure Science of Guizhou Higher Education Institutes, Zunyi, China
| | - Ying Yi
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Prevention Medicine, Qingdao, China
| | - Luming Xia
- Center for Animal Disease Control and Prevention of Shanghai, Shanghai, China
| | - Renjun Zhang
- Center for Animal Disease Control and Prevention of Guizhou Province, Guiyang, China
| | - Chao Li
- China Animal Health and Epidemiology Center, Qingdao, China
| | - Ping Liu
- China Animal Health and Epidemiology Center, Qingdao, China
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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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10
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Goldman T, Costa B. A Systematic Review and Meta-analysis of Two Negative Pressure Wound Therapy Devices to Manage Cesarean Section Incisions. Am J Perinatol 2024; 41:e2786-e2798. [PMID: 37726017 PMCID: PMC11150062 DOI: 10.1055/s-0043-1775562] [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: 09/21/2022] [Accepted: 08/17/2023] [Indexed: 09/21/2023]
Abstract
This paper aims to evaluate whether there is a device-dependent effect on the reduction of surgical site complications in obese patients (body mass index [BMI] ≥ 30 kg/m2) undergoing cesarean section (C-section). PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched for the period, January 2011 to September 2021. English language articles describing a randomized controlled trial (RCT) that compared either a -80 or -125 mm Hg single-use negative pressure wound therapy (sNPWT) device to standard dressings in obese (BMI ≥ 30 kg/m2) patients undergoing C-section were included. Conference abstracts and "terminated" RCTs with published results were deemed eligible for inclusion. The primary outcome of interest was surgical site infection (SSI), classified as composite, superficial, or deep. Secondary outcomes assessed included seroma, dehiscence, hematoma, bleeding, reoperation, readmission, blistering, and (composite) wound complications. A total of 223 titles were identified, of which 129 were screened by full-text review. Eleven RCTs encompassing 5,847 patients met the inclusion criteria and were considered eligible for further analysis (-80 mm Hg: six studies; -125 mm Hg: five studies). A statistically significant improvement in the composite SSI (odds ratio [OR]: 0.69; 95% confidence interval [CI]: 0.54-0.89) and superficial SSI (OR: 0.66; 95% CI: 0.50-0.86) outcomes was observed with the -80 mm Hg device, compared with standard dressings. The same effect on SSI outcomes was not observed with the -125 mm Hg device (composite SSI-OR: 0.91; 95% CI: 0.64-1.28; superficial SSI-OR: 1.12; 95% CI: 0.70-1.78). There were no statistically significant differences in any of the other assessed outcomes. sNPWT devices may differ in their ability to reduce composite or superficial SSI after C-section. KEY POINTS: · Negative pressure benefits obese patients undergoing C-section.. · Negative pressure devices may differ in performance.. · A head-to-head clinical trial is needed..
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Affiliation(s)
- Theodore Goldman
- Obstetrics and Gynecology, Northwell Health, Huntington, New York
| | - Ben Costa
- Global Clinical and Medical Affairs, Smith + Nephew, Hull, United Kingdom
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11
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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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12
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Sanchez-Samaniego G, Mäusezahl D, Hartinger-Peña SM, Hattendorf J, Verastegui H, Fink G, Probst-Hensch N. Pre-pregnancy body mass index and caesarean section in Andean women in Peru: a prospective cohort study. BMC Pregnancy Childbirth 2024; 24:304. [PMID: 38654289 DOI: 10.1186/s12884-024-06466-3] [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: 11/04/2022] [Accepted: 03/29/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND During the last two decades, Caesarean section rates (C-sections), overweight and obesity rates increased in rural Peru. We examined the association between pre-pregnancy body mass index (BMI) and C-section in the province of San Marcos, Northern Andes-Peru. METHODS This is a prospective cohort study. Participants were women receiving antenatal care in public health establishments from February 2020 to January 2022, who were recruited and interviewed during pregnancy or shortly after childbirth. They answered a questionnaire, underwent a physical examination and gave access to their antenatal care card information. BMI was calculated using maternal height, measured by the study team and self-reported pre-pregnancy weight measured at the first antenatal care visit. For 348/965 (36%) women, weight information was completed using self-reported data collected during the cohort baseline. Information about birth was obtained from the health centre's pregnancy surveillance system. Regression models were used to assess associations between C-section and BMI. Covariates that changed BMI estimates by at least 5% were included in the multivariable model. RESULTS This study found that 121/965 (12.5%) women gave birth by C-section. Out of 495 women with pre-pregnancy normal weight, 46 (9.3%) had C-sections. Among the 335 women with pre-pregnancy overweight, 53 (15.5%) underwent C-sections, while 23 (18.5%) of the 124 with pre-pregnancy obesity had C-sections. After adjusting for age, parity, altitude, food and participation in a cash transfer programme pre-pregnancy overweight and obesity increased the odds of C-section by more than 80% (aOR 1.82; 95% CI 1.16-2.87 and aOR 1.85; 95% CI 1.02-3.38) compared to women with a normal BMI. CONCLUSIONS High pre-pregnancy BMI is associated with an increased odds of having a C-section. Furthermore, our results suggest that high BMI is a major risk factor for C-section in this population. The effect of obesity on C-section was partially mediated by the development of preeclampsia, suggesting that C-sections are being performed due to medical reasons.
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Affiliation(s)
- Giuliana Sanchez-Samaniego
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Swiss TPH, Kreuzstrasse 2, Allschwil 4123, Switzerland
- University of Basel, Basel, Switzerland
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, UPCH, Lima, Peru
| | - Daniel Mäusezahl
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Swiss TPH, Kreuzstrasse 2, Allschwil 4123, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Stella Maria Hartinger-Peña
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Swiss TPH, Kreuzstrasse 2, Allschwil 4123, Switzerland
- University of Basel, Basel, Switzerland
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, UPCH, Lima, Peru
| | - Jan Hattendorf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Swiss TPH, Kreuzstrasse 2, Allschwil 4123, Switzerland
- University of Basel, Basel, Switzerland
| | - Hector Verastegui
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, UPCH, Lima, Peru
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Swiss TPH, Kreuzstrasse 2, Allschwil 4123, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Swiss TPH, Kreuzstrasse 2, Allschwil 4123, Switzerland
- University of Basel, Basel, Switzerland
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13
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Tyagi A, Nigam C, Malhotra RK, Bodh P, Deep S, Singla A. The minimum effective dose (ED 90) of prophylactic oxytocin infusion during cesarean delivery in patients with and without obesity: an up-down sequential allocation dose-response study. Int J Obstet Anesth 2024; 57:103962. [PMID: 38103940 DOI: 10.1016/j.ijoa.2023.103962] [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: 04/01/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Obesity is associated with greater oxytocin requirement during labor induction or augmentation. There are scant data exploring the intra-operative requirement during cesarean delivery in patients with obesity, and none comparing it with those without obesity. We evaluated the minimum effective dose (ED90) of an oxytocin infusion to achieve adequate uterine tone during cesarean delivery in patients with and without obesity. METHODS Patients (body mass index ≥30 kg/m2 represented patients with obesity) undergoing cesarean delivery using subarachnoid block were included. This prospective dual-arm dose-finding study used a 9:1 biased sequential allocation design. Oxytocin infusion was initiated at 13 IU/h at cord clamping in the first patient of each group. Uterine tone was graded as satisfactory or unsatisfactory by the obstetrician four minutes after initiation of the infusion. The dose of oxytocin infusion for subsequent patients was determined according to the response of the previous patient in the group. Oxytocin-associated side effects were evaluated. Dose-response data for the groups was evaluated using log-logistic function and ED90 estimates derived from fitted equations using the delta method. RESULTS The ED90 of oxytocin was significantly higher for patients with obesity (n = 40) compared with those without obesity (n = 40) [25.7 IU/h, 95% CI 18.6 to 32.9) vs. 16.6 IU/h, 95% CI 14.9 to 18.3)]; relative ratio 1.55 [95% CI 1.09 to 2.01] (P = 0.019). CONCLUSIONS Patients with obesity require a higher intra-operative oxytocin infusion dose rate to achieve a satisfactorily contracted uterus after fetal delivery when compared with patients without obesity.
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Affiliation(s)
- A Tyagi
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India.
| | - C Nigam
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - R K Malhotra
- Delhi Cancer Registry, Dr BR Ambedkar Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - P Bodh
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - S Deep
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - A Singla
- Department of Obstetrics and Gynaecology, University College of Medical Sciences and GTB Hospital, Delhi, India
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14
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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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15
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Fan D, Lin D, Rao J, Li P, Chen G, Zhou Z, Sun L, Liu L, Ma Y, Guo X, Liu Z. Factors and outcomes for placental anomalies: An umbrella review of systematic reviews and meta-analyses. J Glob Health 2024; 14:04013. [PMID: 38236697 PMCID: PMC10795857 DOI: 10.7189/jogh.14.04013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024] Open
Abstract
Background Placental anomalies, including placenta previa (PP), placenta accreta spectrum disorders (PAS), and vase previa (VP), are associated with several adverse foetal-neonatal and maternal complications. However, there is still a lack of robust evidence on the pathogenesis and adverse outcomes of the diseases. Through this umbrella review, we aimed to systematically review existing meta-analyses exploring the factors and outcomes for pregnancy women with placental anomalies. Methods We searched PubMed, Embase, Web of Science, and the Cochrane Library from inception to February 2023. We used AMSTAR 2 to assess the quality of the reviews and estimated the pooled risk and 95% confidence intervals (CIs) for each meta-analysis. Results We included 34 meta-analyses and extracted 55 factors (27 for PP, 22 for PAS, and 6 for VP) and 16 outcomes (12 for PP, and 4 for VP) to assess their credibility. Seven factors (maternal cocaine use (for PP), uterine leiomyoma (for PP), prior abortion (spontaneous) (PP), threatened miscarriage (PP), maternal obesity (PP), maternal smoking (PAS), male foetus (PAS)) had high epidemiological evidence. Twelve factors and six outcomes had moderate epidemiological evidence. Twenty-two factors and eight outcomes showed significant association, but with weak credibility. Conclusions We found varying levels of evidence for placental anomalies of different factors and outcomes in this umbrella review. Registration PROSPERO: CRD42022300160.
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Affiliation(s)
- Dazhi Fan
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital, Foshan, Guangdong, China
- Department of Obstetrics, Foshan Women and Children Hospital, Foshan, Guangdong, China
| | - Dongxin Lin
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital, Foshan, Guangdong, China
| | - Jiaming Rao
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital, Foshan, Guangdong, China
| | - Pengsheng Li
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital, Foshan, Guangdong, China
| | - Gengdong Chen
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital, Foshan, Guangdong, China
| | - Zixing Zhou
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital, Foshan, Guangdong, China
| | - Li Sun
- Department of Library, Foshan Women and Children Hospital, Foshan, Guangdong, China
| | - Li Liu
- Department of Library, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yubo Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Xiaoling Guo
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital, Foshan, Guangdong, China
- Department of Obstetrics, Foshan Women and Children Hospital, Foshan, Guangdong, China
| | - Zhengping Liu
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital, Foshan, Guangdong, China
- Department of Obstetrics, Foshan Women and Children Hospital, Foshan, Guangdong, China
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16
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Zhang Q, Xiao X, Zheng J, Li M, Yu M, Ping F, Wang T. Maternal inulin alleviates high-fat diet-induced lipid disorder in offspring by epigenetically modulating hypothalamus feeding circuit-related genes. Food Funct 2024; 15:110-124. [PMID: 38044717 DOI: 10.1039/d3fo02223d] [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: 12/05/2023]
Abstract
Increasing evidence supports the existence of fetal-originated adult diseases. Recent research indicates that the intrauterine environment affects the fetal hypothalamic energy intake center. Inulin is a probiotic that can moderate metabolic disorders, but whether maternal inulin intervention confers long-term metabolic benefits to lipid metabolism in offspring in their adult lives and the mechanism involved are unknown. Here, we used a maternal overnutrition model that was induced by excess energy intake before and during pregnancy and lactation and maternal inulin intervention was performed during pregnancy and lactation. The hypothalamic genome methylation in offspring was analyzed using a methylation array. The results showed that maternal inulin treatment modified the maternal high-fat diet (HFD)-induced increases in body weight, adipose tissue weight, and serum insulin and leptin levels and decreases in serum adiponectin levels. Maternal inulin intervention regulated the impairments in hypothalamic leptin resistance, induced the methylation of Socs3, Npy, and Il6, and inhibited the methylation of Lepr in the hypothalamus of offspring. In conclusion, maternal inulin intervention modifies offspring lipid metabolism, and the underlying mechanism involves the methylation of genes in the hypothalamus feeding circuit.
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Affiliation(s)
- Qian Zhang
- Key Laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Xinhua Xiao
- Key Laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Jia Zheng
- Key Laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Ming Li
- Key Laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Miao Yu
- Key Laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Fan Ping
- Key Laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Tong Wang
- Key Laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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17
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Chauhan BG, Chokhandre PK, Kulaste BS, Sivanandan V. Burden of Anaemia, Hypertension and Diabetes among pregnant women in India. J Biosoc Sci 2023; 55:931-946. [PMID: 36621863 DOI: 10.1017/s0021932022000505] [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] [Indexed: 01/10/2023]
Abstract
Non-communicable Diseases such as anaemia, hypertension and diabetes and their treatment may upsurge the risk of childbirth-related complications for both women and their babies. The present study is an attempt to assess the level and determinants of Anaemia, Hypertension and Diabetes among pregnant women using the fourth round of National Family Health Survey-4 (2015-16) data. Bivariate and logistic regression techniques have been used for data analysis. Study findings suggest that the prevalence of anaemia among pregnant women was found to be 25.9%, whereas the corresponding figure for hypertension and diabetes were 4.4% and 2.4%, respectively. Further, substantial socio-economic differentials have been observed in the prevalence of Anaemia, Hypertension and Diabetes among pregnant women. Results of regression analysis suggest that anaemia and hypertension were significantly higher among women in their third trimester [(OR = 2.10; p < 0.001) and (OR = 1.63; p < 0.001)], respectively, compared to women in the first trimester. Similarly, pregnant women in the age group 35-49 were at an elevated risk of hypertension (OR = 2.78; p < 0.001)) and diabetes (OR = 2.50; p < 0.001)) compared to women aged 15-24. Further, the risk of anaemia was found to be significantly lower among pregnant women from the richest quintile (OR = 0.71; p < 0.001) and women with higher educational level (OR = 0.72; p < 0.001) when compared to women from the poorest wealth quintile and women with no formal education respectively. Similarly, pregnant women from the richest quintile (OR = 1.68; p < 0.001) and women from other religion (OR = 1.75; p < 0.001) are significantly more likely to develop diabetes compared to women from the poorest quintile and women from the Hindu religion, respectively. In conclusion, early screening for predicting the risk of gestational anaemia, gestational diabetes, and gestational hypertension is critical in minimizing maternal and reproductive outcomes. The existing guidelines for Screening and Management of Gestational Diabetes, Gestational Hypertension need to be contextualized and modified according to a local need for effective treatment.
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Affiliation(s)
- Bal Govind Chauhan
- Assistant Professor, Population Research Centre, Gokhale Institute of Politics and Economics, Pune, Maharashtra, India-411004
| | - Praveen K Chokhandre
- Assistant Professor, Population Research Centre, JSS Institute of Economic Research, Dharwad, Karnataka580004
| | - Baldev Singh Kulaste
- Office Superintendent, Population Research Centre, Gokhale Institute of Politics and Economics, Pune, Maharashtra, India-411004
| | - Vini Sivanandan
- Assistant Professor, Population Research Centre, Gokhale Institute of Politics and Economics, Pune, Maharashtra, India-411004
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18
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Tian Y, Li K, Zeng L. A systematic review with meta-analysis on prophylactic negative pressure wound therapy versus standard dressing for obese women after caesarean section. Nurs Open 2023; 10:5999-6013. [PMID: 37365685 PMCID: PMC10416001 DOI: 10.1002/nop2.1912] [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: 08/31/2022] [Revised: 05/10/2023] [Accepted: 05/29/2023] [Indexed: 06/28/2023] Open
Abstract
AIMS The purpose of this study is to assess the efficacy of prophylactic negative pressure wound therapy (NPWT) in obese women undergoing caesarean section. DESIGN An updated review and meta-analysis of randomized controlled trials following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS PubMed, Embase, Medline, Web of Science, and Cochrane Library were searched from inception up to March 2022 without restriction in language. We chose surgical site infection as the primary outcome. RESULTS NPWT resulted in a lower surgical site infection rate compared with conventional dressing (risk ratio [RR] = 0.76). The infection rate after low transverse incision was lower comparing the NPWT group with the control group ([RR] = 0.76). No statistically significant difference was detected in blistering([RR] = 2.91). The trial sequential analysis did not support the 20% relative decrease in surgical site infection in the NPWT group. (type II error of 20%).
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Affiliation(s)
- Yali Tian
- West China Hospital, Sichuan University/West China School of NursingSichuan UniversityChengduChina
| | - Ka Li
- West China Hospital, Sichuan University/West China School of NursingSichuan UniversityChengduChina
| | - Ling Zeng
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of NursingSichuan UniversityChengduChina
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19
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Lodi M, Poterie A, Exarchakis G, Brien C, Lafaye de Micheaux P, Deruelle P, Gallix B. Prediction of cesarean delivery in class III obese nulliparous women: An externally validated model using machine learning. J Gynecol Obstet Hum Reprod 2023; 52:102624. [PMID: 37321400 DOI: 10.1016/j.jogoh.2023.102624] [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: 05/11/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND class III obese women, are at a higher risk of cesarean section during labor, and cesarean section is responsible for increased maternal and neonatal morbidity in this population. OBJECTIVE the objective of this project was to develop a method with which to quantify cesarean section risk before labor. METHODS this is a multicentric retrospective cohort study conducted on 410 nulliparous class III obese pregnant women who attempted vaginal delivery in two French university hospitals. We developed two predictive algorithms (a logistic regression and a random forest models) and assessed performance levels and compared them. RESULTS the logistic regression model found that only initial weight and labor induction were significant in the prediction of unplanned cesarean section. The probability forest was able to predict cesarean section probability using only two pre-labor characteristics: initial weight and labor induction. Its performances were higher and were calculated for a cut-point of 49.5% risk and the results were (with 95% confidence intervals): area under the curve 0.70 (0.62,0.78), accuracy 0.66 (0.58, 0.73), specificity 0.87 (0.77, 0.93), and sensitivity 0.44 (0.32, 0.55). CONCLUSIONS this is an innovative and effective approach to predicting unplanned CS risk in this population and could play a role in the choice of a trial of labor versus planned cesarean section. Further studies are needed, especially a prospective clinical trial. FUNDING French state funds "Plan Investissements d'Avenir" and Agence Nationale de la Recherche.
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Affiliation(s)
- Massimo Lodi
- Obstetrics and Gynaecology Department, Strasbourg University Hospitals, 1 Avenue Molière, 67000 Strasbourg, France; Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), CNRS, UMR7104 INSERM U964, Université de Strasbourg, France.
| | - Audrey Poterie
- IHU Strasbourg, France; Laboratoire de Mathématiques de Bretagne Atlantique (LMBA) - UMR 6205, France
| | | | - Camille Brien
- Obstetrics and Gynaecology Department, Strasbourg University Hospitals, 1 Avenue Molière, 67000 Strasbourg, France
| | - Pierre Lafaye de Micheaux
- AMIS, Université Paul Valéry Montpellier 3, France; Desbrest Institute of Epidemiology and Public Health, Université de Montpellier, France; PREMEDICAL - Médecine de précision par intégration de données et inférence causale, CRISAM, Inria Sophia Antipolis, Méditerranée, France
| | - Philippe Deruelle
- Obstetrics and Gynaecology Department, Strasbourg University Hospitals, 1 Avenue Molière, 67000 Strasbourg, France
| | - Benoît Gallix
- IHU Strasbourg, France; ICube, CNRS, University of Strasbourg, France
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20
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Pavlidou E, Papandreou D, Taha Z, Mantzorou M, Tyrovolas S, Kiortsis DN, Psara E, Papadopoulou SK, Yfantis M, Spanoudaki M, Antasouras G, Mentzelou M, Giaginis C. Association of Maternal Pre-Pregnancy Overweight and Obesity with Childhood Anthropometric Factors and Perinatal and Postnatal Outcomes: A Cross-Sectional Study. Nutrients 2023; 15:3384. [PMID: 37571321 PMCID: PMC10421009 DOI: 10.3390/nu15153384] [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: 06/13/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Pre-pregnancy overweight and obesity in reproductive-aged women becomes a growing tendency in middle- and high-income populations. This study aimed to evaluate whether maternal excess body mass index (BMI) before gestation is associated with children's anthropometric characteristics, as well as perinatal and postnatal outcomes. METHODS This was a cross-sectional study performed on 5198 children aged 2-5 years old and their paired mothers, assigned from 9 different areas of Greece. Maternal and childhood anthropometric data, as well as perinatal and postnatal outcomes, were collected from medical history records or validated questionnaires. RESULTS Prevalences of 24.4% and 30.6% of overweight/obesity were recorded for the enrolled children and their mothers 2-5 years postpartum. Maternal pre-pregnancy overweight/obesity was more frequently observed in older mothers and female children, and was also associated with high childbirth weight, preterm birth, high newborn ponderal index, caesarean section delivery, diabetes type 1, and childhood overweight/obesity at pre-school age. In multivariate analysis, maternal pre-pregnancy overweight/obesity was independently associated with a higher risk of childhood overweight/obesity at pre-school age, as well as with a higher increased incidence of childbirth weight, caesarean section delivery, and diabetes type 1. CONCLUSIONS Maternal overweight/obesity rates before gestation were related with increased childhood weight status at birth and 2-5 years postpartum, highlighting the necessity of encouraging healthy lifestyle promotion, including healthier nutritional habits, and focusing on obesity population policies and nutritional interventions among women of reproductive age.
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Affiliation(s)
- Eleni Pavlidou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece; (E.P.); (E.P.); (M.Y.); (G.A.); (M.M.)
| | - Dimitrios Papandreou
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi P.O. Box 144534, United Arab Emirates; (D.P.); (Z.T.); (M.M.)
| | - Zainab Taha
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi P.O. Box 144534, United Arab Emirates; (D.P.); (Z.T.); (M.M.)
| | - Maria Mantzorou
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi P.O. Box 144534, United Arab Emirates; (D.P.); (Z.T.); (M.M.)
| | - Stefanos Tyrovolas
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, 28029 Madrid, Spain;
| | - Dimitrios N. Kiortsis
- Department of Nuclear Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece;
| | - Evmorfia Psara
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece; (E.P.); (E.P.); (M.Y.); (G.A.); (M.M.)
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (S.K.P.); (M.S.)
| | - Marios Yfantis
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece; (E.P.); (E.P.); (M.Y.); (G.A.); (M.M.)
| | - Maria Spanoudaki
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (S.K.P.); (M.S.)
| | - Georgios Antasouras
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece; (E.P.); (E.P.); (M.Y.); (G.A.); (M.M.)
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece; (E.P.); (E.P.); (M.Y.); (G.A.); (M.M.)
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece; (E.P.); (E.P.); (M.Y.); (G.A.); (M.M.)
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21
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Faraji Azad S, Biglarian A, Rostami M, Bidhendi-Yarandi R. Maternal weight latent trajectories and associations with adverse pregnancy outcomes using a smoothing mixture model. Sci Rep 2023; 13:9011. [PMID: 37268823 DOI: 10.1038/s41598-023-36312-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 05/31/2023] [Indexed: 06/04/2023] Open
Abstract
Class membership is a critical issue in health data sciences. Different types of statistical models have been widely applied to identify participants within a population with heterogeneous longitudinal trajectories. This study aims to identify latent longitudinal trajectories of maternal weight associated with adverse pregnancy outcomes using smoothing mixture model (SMM). Data were collected from the Khuzestan Vitamin D Deficiency Screening Program in Pregnancy. We applied the data of 877 pregnant women living in Shooshtar city, whose weights during the nine months of pregnancy were available. In the first step, maternal weight was classified and participants were assigned to only one group for which the estimated trajectory is the most similar to the observed one using SMM; then, we examined the associations of identified trajectories with risk of adverse pregnancy endpoints by applying logistic regression. Three latent trajectories for maternal weight during pregnancy were identified and named as low, medium and high weight trajectories. Crude estimated odds ratio (OR) for icterus, preterm delivery, NICU admission and composite neonatal events shows significantly higher risks in trajectory 1 (low weight) compared to trajectory 2 (medium weight) by 69% (OR = 1.69, 95%CI 1.20, 2.39), 82% (OR = 1.82, 95%CI 1.14, 2.87), 77% (OR = 1.77, 95%CI 1.17, 2.43), and 85% (OR = 1.85, 95%CI 1.38, 2.76), respectively. Latent class trajectories of maternal weights can be accurately estimated using SMM. It is a powerful means for researchers to appropriately assign individuals to their class. The U-shaped curve of association between maternal weight gain and risk of maternal complications reveals that the optimum place for pregnant women could be in the middle of the growth curve to minimize the risks. Low maternal weight trajectory compared to high had even a significantly higher hazard for some neonatal adverse events. Therefore, appropriate weight gain is critical for pregnant women.Trial registration International Standard Randomized Controlled Trial Number (ISRCTN): 2014102519660N1; http://www.irct.ir/searchresult.php?keyword=&id=19660&number=1&prt=7805&total=10&m=1 (Archived by WebCite at http://www.webcitation.org/6p3lkqFdV ).
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Affiliation(s)
- Shirin Faraji Azad
- Department of Biostatistics and Epidemiology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Akbar Biglarian
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Maryam Rostami
- Department of Community Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics and Epidemiology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
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22
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Purohit A, Oyeka CP, Khan SS, Toscano M, Nayak S, Lawson SM, Blumenthal RS, Sharma G. Preventing Adverse Cardiovascular Outcomes in Pregnancy Complicated by Obesity. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2023; 12:129-137. [PMID: 37840644 PMCID: PMC10575259 DOI: 10.1007/s13669-023-00356-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 10/17/2023]
Abstract
Purpose of review Obesity is a chronic disease that is becoming increasingly prevalent, and more individuals of reproductive age have obesity prior to becoming pregnant. Obesity in pregnancy is associated with short- and long-term adverse consequences for both the birthing person and their offspring which have been associated with increased long-term cardiovascular morbidity and mortality. The goal of this review is to discuss what is currently understood about the relationship between maternal obesity and adverse pregnancy outcomes (APOs), the association between APOs and future cardiovascular disease (CVD) risk, and what evidence-based interventions can be implemented to prevent adverse outcomes in this population. Recent findings Maternal obesity has been associated with an increased risk of APOs such as gestational diabetes, hypertensive disorders of pregnancy, and preterm birth as well as an increased risk of future CVD, such as metabolic syndrome, chronic hypertension, coronary heart disease, and stroke. The impact of maternal obesity also extends beyond the pregnant individual to the offspring, increasing the risk of fetal, neonatal, and infant mortality, as well as of congenital malformations, prematurity, and long-term health problems such as insulin resistance and childhood obesity. Prevention guidelines are incorporating the increased risk of adverse outcomes from maternal obesity into formalized risk assessments to guide both prenatal and postpartum care. It is becoming evident that a multidisciplinary cardio-obstetrics team is an important part of providing comprehensive care for pregnant individuals with obesity and other cardiovascular risk factors, including preexisting CVD and a history of prior APOs. There remains a need for further studies to better understand the mechanisms underlying the relationship between maternal obesity and APOs, as well as the racial and ethnic disparities that have been noted in the prevalence of APOs and associated CVD risk and mortality. Summary There is increasing awareness that obesity in pregnancy is associated with various short- and long-term adverse maternal and offspring outcomes. There are multiple screening and prevention strategies that may be implemented before, during, and after pregnancy to prevent these adverse outcomes.
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Affiliation(s)
- Aarti Purohit
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Sadiya S. Khan
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Marika Toscano
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shriddha Nayak
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shari M. Lawson
- Johns Hopkins University School of Medicine Department of Gynecology and Obstetrics, Baltimore, MD, USA
| | | | - Garima Sharma
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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23
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Wang L, O'Kane AM, Zhang Y, Ren J. Maternal obesity and offspring health: Adapting metabolic changes through autophagy and mitophagy. Obes Rev 2023:e13567. [PMID: 37055041 DOI: 10.1111/obr.13567] [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: 05/09/2022] [Revised: 08/08/2022] [Accepted: 03/25/2023] [Indexed: 04/15/2023]
Abstract
Maternal obesity leads to obstetric complications and a high prevalence of metabolic anomalies in the offspring. Among various contributing factors for maternal obesity-evoked health sequelae, developmental programming is considered as one of the leading culprit factors for maternal obesity-associated chronic comorbidities. Although a unified theory is still lacking to systematically address multiple unfavorable postnatal health sequelae, a cadre of etiological machineries have been put forward, including lipotoxicity, inflammation, oxidative stress, autophagy/mitophagy defect, and cell death. Hereinto, autophagy and mitophagy play an essential housekeeping role in the clearance of long-lived, damaged, and unnecessary cell components to maintain and restore cellular homeostasis. Defective autophagy/mitophagy has been reported in maternal obesity and negatively impacts fetal development and postnatal health. This review will provide an update on metabolic disorders in fetal development and postnatal health issues evoked by maternal obesity and/or intrauterine overnutrition and discuss the possible contribution of autophagy/mitophagy in metabolic diseases. Moreover, relevant mechanisms and potential therapeutic strategies will be discussed in an effort to target autophagy/mitophagy and metabolic disturbances in maternal obesity.
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Affiliation(s)
- Litao Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
| | - Aislinn M O'Kane
- Department of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, 46202, USA
| | - Yingmei Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
| | - Jun Ren
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
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24
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Musa E, Salazar-Petres E, Arowolo A, Levitt N, Matjila M, Sferruzzi-Perri AN. Obesity and gestational diabetes independently and collectively induce specific effects on placental structure, inflammation and endocrine function in a cohort of South African women. J Physiol 2023; 601:1287-1306. [PMID: 36849131 DOI: 10.1113/jp284139] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/19/2023] [Indexed: 03/01/2023] Open
Abstract
Maternal obesity and gestational diabetes mellitus (GDM) are associated with insulin resistance and health risks for mother and offspring. Obesity is also characterized by low-grade inflammation, which in turn, impacts insulin sensitivity. The placenta secretes inflammatory cytokines and hormones that influence maternal glucose and insulin handling. However, little is known about the effect of maternal obesity, GDM and their interaction, on placental morphology, hormones and inflammatory cytokines. In a South African cohort of non-obese and obese pregnant women with and without GDM, this study examined placental morphology using stereology, placental hormone and cytokine expression using real-time PCR, western blotting and immunohistochemistry, and circulating TNFα and IL-6 concentrations using ELISA. Placental expression of endocrine and growth factor genes was not altered by obesity or GDM. However, LEPTIN gene expression was diminished, syncytiotrophoblast TNFα immunostaining elevated and stromal and fetal vessel IL-6 staining reduced in the placenta of obese women in a manner that was partly influenced by GDM status. Placental TNFα protein abundance and maternal circulating TNFα concentrations were reduced in GDM. Both maternal obesity and, to a lesser extent, GDM were accompanied by specific changes in placental morphometry. Maternal blood pressure and weight gain and infant ponderal index were also modified by obesity and/or GDM. Thus, obesity and GDM have specific impacts on placental morphology and endocrine and inflammatory states that may relate to pregnancy outcomes. These findings may contribute to developing placenta-targeted treatments that improve mother and offspring outcomes, which is particularly relevant given increasing rates of obesity and GDM worldwide. KEY POINTS: Rates of maternal obesity and gestational diabetes (GDM) are increasing worldwide, including in low-middle income countries (LMIC). Despite this, much of the work in the field is conducted in higher-income countries. In a well-characterised cohort of South African women, this study shows that obesity and GDM have specific impacts on placental structure, hormone production and inflammatory profile. Moreover, such placental changes were associated with pregnancy and neonatal outcomes in women who were obese and/or with GDM. The identification of specific changes in the placenta may help in the design of diagnostic and therapeutic approaches to improve pregnancy and neonatal outcomes with particular significant benefit in LMICs.
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Affiliation(s)
- Ezekiel Musa
- Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Department of Internal Medicine, Kaduna State University, Kaduna, Nigeria
| | - Esteban Salazar-Petres
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Afolake Arowolo
- Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Naomi Levitt
- Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Mushi Matjila
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
| | - Amanda N Sferruzzi-Perri
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
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25
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Justesen S, Bilde K, Olesen RH, Pedersen LH, Ernst E, Larsen A. ABCB1 expression is increased in human first trimester placenta from pregnant women classified as overweight or obese. Sci Rep 2023; 13:5175. [PMID: 36997557 PMCID: PMC10063677 DOI: 10.1038/s41598-023-31598-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/14/2023] [Indexed: 04/01/2023] Open
Abstract
Obesity has become a global health challenge also affecting reproductive health. In pregnant women, obesity increases the risk of complications such as preterm birth, macrosomia, gestational diabetes, and preeclampsia. Moreover, obesity is associated with long-term adverse effects for the offspring, including increased risk of cardiovascular and metabolic diseases and neurodevelopmental difficulties. The underlying mechanisms are far from understood, but placental function is essential for pregnancy outcome. Transporter proteins P-glycoprotein (P-gp) and Breast Cancer Resistance Protein (BCRP) are important for trans-placental transport of endogenous substances like lipids and cortisol, a key hormone in tissue maturation. They also hold a protective function protecting the fetus from xenobiotics (e.g. pharmaceuticals). Animal studies suggest that maternal nutritional status can affect expression of placental transporters, but little is known about the effect on the human placenta, especially in early pregnancy. Here, we investigated if overweight and obesity in pregnant women altered mRNA expression of ABCB1 encoding P-gp or ABCG2 encoding BCRP in first trimester human placenta. With informed consent, 75 first trimester placental samples were obtained from women voluntarily seeking surgical abortion (< gestational week 12) (approval no.: 20060063). Villous samples (average gestational age 9.35 weeks) were used for qPCR analysis. For a subset (n = 38), additional villi were snap-frozen for protein analysis. Maternal BMI was defined at the time of termination of pregnancy. Compared to women with BMI 18.5-24.9 kg/m2 (n = 34), ABCB1 mRNA expression was significantly increased in placenta samples from women classified as overweight (BMI 25-29.9 kg/m2, n = 18) (p = 0.040) and women classified as obese (BMI ≥ 30 kg/m2, n = 23) (p = 0.003). Albeit P-gp expression did not show statistically significant difference between groups, the effect of increasing BMI was the same in male and female pregnancies. To investigate if the P-gp increase was compensated, we determined the expression of ABCG2 which was unaffected by maternal obesity (p = 0.291). Maternal BMI affects ABCB1 but not ABCG2 mRNA expression in first trimester human placenta. Further studies of early placental function are needed to understand how the expression of placental transport proteins is regulated by maternal factors such as nutritional status and determine the potential consequences for placental-fetal interaction.
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Affiliation(s)
- Signe Justesen
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000, Aarhus C, Denmark
| | - Katrine Bilde
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000, Aarhus C, Denmark
| | - Rasmus H Olesen
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000, Aarhus C, Denmark
- Department of Obstetrics and Gynecology, Randers Regional Hospital, 8930, Randers, Denmark
| | - Lars H Pedersen
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000, Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University, 8200, Aarhus N, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | - Erik Ernst
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000, Aarhus C, Denmark
- Department of Obstetrics and Gynecology, Horsens Regional Hospital, 8700, Horsens, Denmark
| | - Agnete Larsen
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000, Aarhus C, Denmark.
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26
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Muir R, Khan R, Shmygol A, Quenby S, Elmes M. The impact of maternal obesity on in vivo uterine contractile activity during parturition in the rat. Physiol Rep 2023; 11:e15610. [PMID: 36863718 PMCID: PMC9981334 DOI: 10.14814/phy2.15610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/21/2023] [Accepted: 01/21/2023] [Indexed: 03/04/2023] Open
Abstract
Maternal obesity is associated with increased risk of prolonged and dysfunctional labor and emergency caesarean section. To elucidate the mechanisms behind the associated uterine dystocia, a translational animal model is required. Our previous work identified that exposure to a high-fat, high-cholesterol (HFHC) diet to induce obesity down-regulates uterine contractile associated protein expression and causes asynchronous contractions ex vivo. This study aims to investigate the impact of maternal obesity on uterine contractile function in vivo using intrauterine telemetry surgery. Virgin female Wistar rats were fed either a control (CON, n = 6) or HFHC (n = 6) diet for 6 weeks prior to conception, and throughout pregnancy. On Day 9 of gestation, a pressure-sensitive catheter was surgically implanted aseptically within the gravid uterus. Following 5 days recovery, intrauterine pressure (IUP) was recorded continuously until delivery of the 5th pup (Day 22). HFHC induced obesity led to a significant 1.5-fold increase in IUP (p = 0.026) and fivefold increase in frequency of contractions (p = 0.013) relative to CON. Determination of the time of labor onset identified that HFHC rats IUP (p = 0.046) increased significantly 8 h prior to 5th pup delivery, which contrasts to CON with no significant increase. Myometrial contractile frequency in HFHC rats significantly increased 12 h prior to delivery of the 5th pup (p = 0.023) compared to only 3 h in CON, providing evidence that labor in HFHC rats was prolonged by 9 h. In conclusion, we have established a translational rat model that will allow us to unravel the mechanism behind uterine dystocia associated with maternal obesity.
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Affiliation(s)
- Ronan Muir
- Division of Food Nutrition and Dietetics, School of BioscienceUniversity of Nottingham, Sutton Bonington CampusLoughboroughEnglandUK
| | - Raheela Khan
- Graduate School of MedicineUniversity of Nottingham, Royal Derby HospitalDerbyEnglandUK
| | - Anatoly Shmygol
- Department of Physiology, College of Medicine and Health SciencesUnited Arab Emirates UniversityAl AinUAE
| | - Siobhan Quenby
- Biomedical Research Unit in Reproductive HealthUniversity Hospital Coventry and WarwickshireCoventryUK
| | - Matthew Elmes
- Division of Food Nutrition and Dietetics, School of BioscienceUniversity of Nottingham, Sutton Bonington CampusLoughboroughEnglandUK
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Syböck K, Hartmann B, Kirchengast S. Maternal Prepregnancy Obesity Affects Foetal Growth, Birth Outcome, Mode of Delivery, and Miscarriage Rate in Austrian Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4139. [PMID: 36901147 PMCID: PMC10002339 DOI: 10.3390/ijerph20054139] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
The increasing obesity rates among women of reproductive age create a major obstetrical problem as obesity during pregnancy is associated with many complications, such as a higher rate of caesarean sections. This medical record-based study investigates the effects of maternal prepregnancy obesity on newborn parameters, birth mode, and miscarriage rate. The data of 15,404 singleton births that had taken place between 2009 and 2019 at the public Danube Hospital in Vienna were enrolled in the study. Newborn parameters are birth weight, birth length, head circumference, APGAR scores, as well as pH values of the arterial and venous umbilical cord blood. In addition, maternal age, height, body weight at the beginning and the end of pregnancy, and prepregnancy body mass index (BMI) (kg/m2) have been documented. The gestational week of birth, the mode of delivery, as well as the number of previous pregnancies and births, are included in the analyses. Birth length, birth weight, and head circumference of the newborn increase with increasing maternal BMI. Furthermore, with increasing maternal weight class, there tends to be a decrease in the pH value of the umbilical cord blood. Additionally, obese women have a history of more miscarriages, a higher rate of preterm birth, and a higher rate of emergency caesarean section than their normal-weight counterparts. Consequently, maternal obesity before and during pregnancy has far-reaching consequences for the mother, the child, and thus for the health care system.
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Affiliation(s)
- Katharina Syböck
- Department of Evolutionary Anthropology, University of Vienna, 1030 Wien, Austria
| | | | - Sylvia Kirchengast
- Department of Evolutionary Anthropology, University of Vienna, 1030 Wien, Austria
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Ligema K. Use of closed incision negative pressure wound therapy on C-section wounds in obese women. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S22-S28. [PMID: 36840522 DOI: 10.12968/bjon.2023.32.4.s22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Rates of obesity in pregnant women are increasing. Obesity is linked to increased patient risk of developing postoperative wound complications such as surgical site infection, wound dehiscence and haematoma formation. Closed incision negative pressure wound therapy (ciNPWT) has been introduced as a prophylactic intervention to reduce caesarian section (C-section) wound complications. Evidence from randomised controlled trials and retrospective studies has shown variable rates of success in reducing risk of SSI. The studies reviewed in this article found that ciNPWT had no statistically significant impact in reducing rates of wound dehiscence and haematoma formation or increasing long-term satisfaction with the appearance of scar tissue following C-section. Further research into the use of cINPWT to prevent surgical site infection is needed to determine the effectiveness of this therapy in reducing this wound complication.
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Affiliation(s)
- Kaia Ligema
- Community Tissue Viability/Infection Prevention Nurse, Manchester University NHS Foundation Trust, and third-year student MSc Wound Healing and Tissue Repair, Cardiff University
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29
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Paul M, Zakar T, Phung J, Gregson A, Barreda AP, Butler TA, Walker FR, Pennell C, Smith R, Paul JW. 20α-Hydroxysteroid Dehydrogenase Expression in the Human Myometrium at Term and Preterm Birth: Relationships to Fetal Sex and Maternal Body Mass Index. Reprod Sci 2023:10.1007/s43032-023-01183-2. [PMID: 36765000 DOI: 10.1007/s43032-023-01183-2] [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: 02/13/2022] [Accepted: 01/27/2023] [Indexed: 02/12/2023]
Abstract
The mechanism by which human labor is initiated in the presence of elevated circulating progesterone levels remains unknown. Recent evidence indicates that the progesterone-metabolizing enzyme, 20α-hydroxysteroid dehydrogenase (20α-HSD), encoded by the gene AKR1C1, may contribute to functional progesterone withdrawal. We found that AKR1C1 expression significantly increased with labor onset in term myometrium, but not in preterm myometrium. Among preterm laboring deliveries, clinically diagnosed chorioamnionitis was associated with significantly elevated AKR1C1 expression. AKR1C1 expression positively correlated with BMI before labor and negatively correlated with BMI during labor. Analysis by fetal sex showed that AKR1C1 expression was significantly higher in women who delivered male babies compared to women who delivered female babies at term, but not preterm. Further, in pregnancies where the fetus was female, AKR1C1 expression positively correlated with the mother's age and BMI at the time of delivery. In conclusion, the increase in myometrial AKR1C1 expression with term labor is consistent with 20α-HSD playing a role in local progesterone metabolism to promote birth. Interestingly, this role appears to be specific to term pregnancies where the fetus is male. Upregulated AKR1C1 expression in the myometrium at preterm in-labor with clinical chorioamnionitis suggests that increased 20α-HSD activity is a mechanism through which inflammation drives progesterone withdrawal in preterm labor. The link between AKR1C1 expression and maternal BMI may provide insight into why maternal obesity is often associated with dysfunctional labor. Higher myometrial AKR1C1 expression in male pregnancies may indicate fetal sex-related differences in the mechanisms that precipitate labor onset at term.
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Affiliation(s)
- Marina Paul
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Centre for Rehab Innovations, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Tamas Zakar
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Mothers and Babies Research Centre, New Lambton Heights, NSW, 2305, Australia
- John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia
| | - Jason Phung
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Mothers and Babies Research Centre, New Lambton Heights, NSW, 2305, Australia
- John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia
| | - Amy Gregson
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Mothers and Babies Research Centre, New Lambton Heights, NSW, 2305, Australia
| | - Anna Paredes Barreda
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Mothers and Babies Research Centre, New Lambton Heights, NSW, 2305, Australia
| | - Trent A Butler
- John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia
| | - Frederick R Walker
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Centre for Rehab Innovations, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Craig Pennell
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Mothers and Babies Research Centre, New Lambton Heights, NSW, 2305, Australia
- John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia
| | - Roger Smith
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Mothers and Babies Research Centre, New Lambton Heights, NSW, 2305, Australia
- John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia
| | - Jonathan W Paul
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Mothers and Babies Research Centre, New Lambton Heights, NSW, 2305, Australia.
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Pani P, Carletti C, Giangreco M, Knowles A, Clagnan E, Gobbato M, Del Zotto S, Cattaneo A, Ronfani L. Monitoring gestational weight gain: setting up a regional surveillance system in Italy. BMC Public Health 2023; 23:132. [PMID: 36653835 PMCID: PMC9850588 DOI: 10.1186/s12889-023-15028-9] [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: 08/05/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In many countries, including Italy, there are few national data on pre-pregnancy Body Mass Index (BMI) and gestational weight gain (GWG), despite these being important predictors of maternal and neonatal health outcomes. This dearth of information makes it difficult to develop and monitor intervention policies to reduce the burden of disease linked to inadequate BMI status and/or GWG in pregnant women. This study describes the setting up and initial implementation of a regional surveillance system on pre-pregnancy BMI and GWG. METHODS Between 1 January 2017 and 31 December 2018, anthropometric data were collected from all pregnant women accessing public health services in the Friuli Venezia Giulia region (Italy) for first ultrasound check (T1) and at delivery (T2). Anthropometric data collected at T1 (self-reported pre-pregnancy weight and measured weight and height) and T2 (measured weight and self-reported pre-pregnancy weight and height) were compared. RESULTS The system was able to reach 43.8% of all the women who gave birth in the region, and provided complete data for 6400 women of the 7188 who accessed the services at T1. At the beginning of pregnancy 447 (7.0%) women were underweight, 4297 (67.1%) had normal weight, 1131 (17.7%) were overweight and 525 (8.2%) had obesity. At delivery, 2306 (36.0%) women were within the appropriate weight gain range, while for 2021 (31.6%) weight gain was insufficient and for 2073 (32.4%) excessive. Only minor differences were observed between measured and self-reported anthropometric data. CONCLUSIONS The surveillance system offers an overview of the weight status of women during pregnancy. About 1/3 of women entered pregnancy with unsatisfactory BMI and 2/3 did not achieve the recommended weight gain. This surveillance system can be an effective tool to guide public health interventions.
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Affiliation(s)
- Paola Pani
- grid.418712.90000 0004 1760 7415Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Via Dell’Istria 65/1, 34137 Trieste, Italy
| | - Claudia Carletti
- grid.418712.90000 0004 1760 7415Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Via Dell’Istria 65/1, 34137 Trieste, Italy
| | - Manuela Giangreco
- grid.418712.90000 0004 1760 7415Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Via Dell’Istria 65/1, 34137 Trieste, Italy
| | - Alessandra Knowles
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Via Dell'Istria 65/1, 34137, Trieste, Italy.
| | - Elena Clagnan
- SC Pianificazione Programmazione E Controllo Direzionale, ARCS – Azienda Regionale di Coordinamento per la Salute Regione Autonoma Friuli Venezia Giulia, Via Pozzuolo, 330 – 33100, Udine, Italy
| | - Michele Gobbato
- SC Pianificazione Programmazione E Controllo Direzionale, ARCS – Azienda Regionale di Coordinamento per la Salute Regione Autonoma Friuli Venezia Giulia, Via Pozzuolo, 330 – 33100, Udine, Italy
| | - Stefania Del Zotto
- SC Pianificazione Programmazione E Controllo Direzionale, ARCS – Azienda Regionale di Coordinamento per la Salute Regione Autonoma Friuli Venezia Giulia, Via Pozzuolo, 330 – 33100, Udine, Italy
| | | | - Luca Ronfani
- grid.418712.90000 0004 1760 7415Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Via Dell’Istria 65/1, 34137 Trieste, Italy
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Dal'Maso E, Rodrigues PRM, Ferreira MG, Moreira NF, Muraro AP. Cesarean birth and risk of obesity from birth to adolescence: A cohort study. Birth 2022; 49:774-782. [PMID: 35527364 DOI: 10.1111/birt.12644] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent studies have shown associations between cesarean birth and overweight. However, very few studies have evaluated weight gain or adiposity throughout life, and the majority are restricted to analysis during childhood. The purpose of this study was to analyze the effect of cesarean birth on obesity risk from birth to adolescence. METHODS The study sample was drawn from live births that occurred in 1999 and 2000 in Mato Grosso-Brazil. Participants were evaluated once when they were between 0 and 5 years of age and again after approximately 10 years (2009-2011). To measure the association between cesarean birth and obesity (Body Mass Index/age >+2 z-scores), we used generalized estimation equations (GEE) with binomial distribution and log-binomial models for repeated measures, controlled by the following confounding factors: weight and length at birth, sex, gestational age, breastfeeding, maternal age and schooling, economic class in childhood, and maternal smoking during pregnancy. The exposure-time interaction term was evaluated to verify differences in the change in the risk of obesity over time. RESULTS 56.8% of children in the sample were born by cesarean birth. Children born by cesarean had a higher risk of obesity from birth through adolescence (RR = 1.22, 95% CI = 1.02; 1.46), even after adjusting for covariates, when compared with those born vaginally. However, the time-exposure interaction term was not significant, which indicates that there was no increased risk of obesity over time. CONCLUSION Cesarean birth was positively associated with obesity from birth to adolescence, with a persistent risk in the period evaluated.
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Affiliation(s)
- Elizandra Dal'Maso
- Departament of Food and Nutrition, Federal University of Mato Grosso, Cuiabá, Brazil
| | | | | | | | - Ana Paula Muraro
- Departament of Public Health, Institut of Public Health, Federal University of Mato Grosso, Cuiabá, Brazil
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Linnell A, Murphy N, Godwin J, Cremona A. An evaluation of adherence to folic acid supplementation in pregnant women during early gestation for the prevention of neural tube defects. Public Health Nutr 2022; 25:3025-3035. [PMID: 35875925 PMCID: PMC9991708 DOI: 10.1017/s1368980022001574] [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: 04/19/2021] [Revised: 03/03/2022] [Accepted: 06/23/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Neural tube defects (NTD) are potentially preventable by periconceptual folic acid supplementation. Women with obesity are at higher risk of NTD, therefore, are recommended a higher dose of 5 mg folic acid to mitigate this risk. The aim of this study was to evaluate maternal practice of folic acid supplementation amongst the antenatal population in relation to maternal obesity status. DESIGN Prospective observational study. SETTING Women ≤18 weeks' gestation at their first antenatal appointment attending University Maternity Hospital Limerick (Ireland) were recruited. Maternal height and weight were measured. Obesity was defined at a threshold of ≥30·0 kg/m2 and ≥27·5 kg/m2 when adjusting for ethnicity. A two-part questionnaire captured maternal characteristics and assessed supplementation compliance, commencement and dosage. Fisher's exact test for independence analysed differences in variables. A P value of <0·05 was considered significant. PARTICIPANTS A total of 328 women participated over a duration of 6 weeks. RESULTS Mean gestational age was 12·4 ± 1·4 weeks and mean BMI 26·7 kg/m2 ± 5·2 kg/m2. 23·8 % (n 78) were classified as obese. 96·5 % (n 315) were taking folic acid and 95·7 % (n 314) supplemented daily. 30·2 % (n 99) commenced supplementation 12 weeks prior to conception. Overall, 57·9 % (n 190) of women met folic acid supplementation dose requirements. 89·1 % (n 55) of women with obesity did not. Women with obesity were less likely to meet the higher folic acid supplementation dose requirements (P =< 0·001). CONCLUSION Folic acid supplementation practices within this cohort were suboptimal to prevent their risk of NTD. This study showed inadequate compliance of folic acid supplementation, and inadequate dosage for women with obesity. Increased patient education and awareness are needed within the antenatal period of pregnancy to bring folic acid supplementation practices in line with best practice guidelines.
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Affiliation(s)
- Anna Linnell
- School of Allied Health (SAH), University of Limerick, Limerick, Ireland
- Irish Nutrition and Dietetic Institute (INDI), Dublin, Ireland
| | - Niamh Murphy
- Irish Nutrition and Dietetic Institute (INDI), Dublin, Ireland
- Department of Dietetics, University Maternity Hospital Limerick, Limerick, Ireland
- Maternity Dietetics Ireland (MDI), Dublin, Ireland
| | - Jon Godwin
- Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, England, UK
| | - Alexandra Cremona
- School of Allied Health (SAH), University of Limerick, Limerick, Ireland
- Irish Nutrition and Dietetic Institute (INDI), Dublin, Ireland
- Health Research Institute, School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
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Shah A, Farah N, McNamee E, Lindow SW, O'Connell M. Demographic changes in primiparae of Irish ethnicity between 2000 and 2020. Eur J Obstet Gynecol Reprod Biol 2022; 278:137-140. [PMID: 36174435 DOI: 10.1016/j.ejogrb.2022.09.015] [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: 06/08/2022] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Trends in maternal demographic changes linked to lifestyle and socio-economic conditions reflect greatly on maternal, perinatal and infant mortality rates. Hospital data reflect a heterogenous population where specific demographic changes may not be obvious. OBJECTIVES To report yearly demographic changes in Irish primiparae from 2000 to 2020, specifically looking at age, BMI, smoking and marital status of patients attending the Coombe Women and Infant's University Hospital (CWIUH). METHODS Retrospective report of demographic details contemporaneously documented on the CWIUH data base. FINDINGS In the years 2000 to 2020 inclusive there were 47,659 primiparous women of Irish ethnicity delivered at the CWIUH (70.2% of the total primiparae), of those 99.3% were Caucasian. There was a significant rise in mean age at first delivery in Irish mothers; 26.0 years old in the 2000 to 30.9 years old in 2020 associated with a rise in mean BMI of 9.1%. Smoking rates (ever smoked) showed a significant reduction from 53.9% in 2000 to 39.3% in 2020. There was a significant decrease in rates of marriage, with 61.9% married in 2000 compared to 46.3% in 2020. Birth weight and prematurity rates remained unchanged, with fall in mean gestational age at first delivery from 279.3 days in 2000 to 275.8 days in 2020. CONCLUSION This study highlights that Irish primiparae are older, heavier, less likely to smoke and to be married than they were 20 years ago. These trends are an interesting glimpse into changing economic and cultural climate over just the past 2 decades.
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Affiliation(s)
- A Shah
- The Coombe Women and Infants' University Hospital, Cork Street, Dublin, Ireland.
| | - N Farah
- The Coombe Women and Infants' University Hospital, Cork Street, Dublin, Ireland
| | - E McNamee
- The Coombe Women and Infants' University Hospital, Cork Street, Dublin, Ireland
| | - S W Lindow
- The Coombe Women and Infants' University Hospital, Cork Street, Dublin, Ireland
| | - M O'Connell
- The Coombe Women and Infants' University Hospital, Cork Street, Dublin, Ireland
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André K, Stuart A, Källén K. Obstetric anal sphincter injuries-Maternal, fetal and sociodemographic risk factors: A retrospective register-based study. Acta Obstet Gynecol Scand 2022; 101:1262-1268. [PMID: 35920107 PMCID: PMC9812064 DOI: 10.1111/aogs.14425] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/10/2022] [Accepted: 06/14/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Obstetric anal sphincter injuries (OASIS) are severe complications to vaginal births with potentially serious long-term consequences and large impact on quality of life. The aim was to determine risk and protective factors for OASIS. MATERIAL AND METHODS We performed a retrospective register-based observational study. A cohort of 988 988 singleton term deliveries 2005-2016 in Sweden were included. Data from the Swedish Medical Birth Registry and Statistics Sweden were extracted to identify cases of OASIS and maternal and fetal characteristics. Modified Poisson Regression analyses were performed to assess risk factors. RESULTS The rate of OASIS was 3.5% (n = 34 583). Primiparity (adjusted risk ratio [aRR] 3.13, 95% CI 3.05-3.21), vacuum extraction (aRR 2.79, 95% CI 2.73-2.86), forceps (aRR 4.27, 95% CI 3.86-4.72), and high birthweight (aRR 2.61, 95% CI 2.50-2.72) were associated with a significantly increased risk of OASIS. Increasing maternal age and decreasing maternal height also increased the risk of OASIS. Obesity increased the risk of OASIS (aRR 1.04, 95% CI 1.04-1.08), if fetal birthweight was not adjusted for. Smoking (aRR 0.74, 95% CI 0.70-0.79) and low maternal education (aRR 0.87, 95% CI 0.83-0.92) were associated with a decreased frequency of reported OASIS. Previous cesarean section increased the risk of OASIS (aRR 1.41, 95% CI 1.36-1.47). CONCLUSIONS Primiparity, instrumental delivery, and high birthweight significantly increased the risk of OASIS. Obesity, low height, increasing age, and previous cesarean section also increased the risk whereas smoking and low maternal educational level were associated with a lower OASIS rate.
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Affiliation(s)
- Kristin André
- Department of Obstetrics and GynecologyHelsingborg Central HospitalHelsingborgSweden
| | - Andrea Stuart
- Department of Obstetrics and GynecologyHelsingborg Central HospitalHelsingborgSweden,Institution of Clinical Sciences Lund, Lund UniversityLundSweden
| | - Karin Källén
- Institution of Clinical Sciences Lund, Lund UniversityLundSweden,Center for Reproductive EpidemiologyTornblad Institute, Lund UniversityLundSweden
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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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36
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Does Maternal Obesity Affect Preterm Birth? Documentary Cohort Study of Preterm in Firstborns—Silesia (Poland). CHILDREN 2022; 9:children9071007. [PMID: 35883991 PMCID: PMC9315725 DOI: 10.3390/children9071007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 11/20/2022]
Abstract
In addition to low birth weight and intrauterine growth restriction, prematurity is a major problem in modern neonatology. The etiology of premature delivery is multifactorial, but maternal obesity has been indicated as an important risk factor for preterm birth. This study aimed to assess the relationship between early pregnancy body mass index (BMI) and the risk of preterm delivery according to gestational age. In the cohort of 2794 firstborns, preterm deliveries accounted for 9.1%. Of all deliveries, 16, 48, and 189 were classified as extremely preterm, very preterm, and moderately preterm deliveries, respectively. The risk of extremely, very, and moderately preterm deliveries increased with the increasing BMI, with the highest overweight and obesity-related risk for extremely and very preterm delivery. The rate of extremely and very preterm delivery among normal-weight women (BMI 18.5 ≤ 25) was 1.8%, while that among overweight and obese women (BMI ≥ 25) was 2.36%. The rate of all preterm deliveries (22 ≤ 37 weeks) was 8% for normal-weight women and 10.3% for overweight and obese women. Compared with normal-weight women, the adjusted odds ratio (95% CI) for preterm delivery in overweight and obese women was 1.33 (0.98–1.79). In Poland, being overweight and obese during pregnancy was associated with an increased risk of preterm delivery, especially extremely and very preterm delivery. This relationship should be assessed in other populations.
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Erdoğan K, Sanlier NT, Çelik B, Arslan B, Diktaş G, Yücel Çelik Ö, Köse C, Engin-Üstün Y. Maternal plasma levels of vitamin D in postterm pregnancy. J OBSTET GYNAECOL 2022; 42:1996-2000. [PMID: 35653770 DOI: 10.1080/01443615.2022.2062226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study was conducted to examine the levels of vitamin D in postterm pregnancy. The study consisted of two groups: Group 1: women with postterm pregnancy in whom labour has not started (n = 40). Group 2: pregnant women with spontaneous labour between 37 and 41 weeks of gestation (n = 40). Demographic characteristics of individuals, age, body mass index, gravida, parity, living child, number of abortions and birth characteristics were recorded. Prepartum and postpartum haemoglobin (Hb) and haematocrit (Hct) values and vitamin D levels of pregnant women were measured. We found no significant differences in vitamin D levels, smoking, mode of delivery, induction of labour, methods of cervical ripening and maternal and perinatal complications between the groups (p > .05). D vitamin in the model had a statistically significant effect on prepartum Hb (p < .05). Vitamin D levels seem not to be associated with postterm pregnancy. Vitamin D had a statistically significant effect on prepartum Hb.IMPACT STATEMENTWhat is already known on this subject? The aetiology of post term pregnancy is not clearly known, factors such as foetal anencephaly, foetal sex, placental sulfatase deficiency, genetic factors, and high pre-pregnancy body mass index play a role.What do the results of this study add? Vitamin D levels seem not to be associated with postterm pregnancy. Vitamin D had a statistically significant effect on prepartum Hb.What are the implications of these findings for clinical practice and/or further research? Further studies are needed to clarify the relationship between vitamin D levels and postterm pregnancy.
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Affiliation(s)
- Kadriye Erdoğan
- Obstetrics and Gynecology, University of Health Sciences Gulhane Medical Faculty, Ankara, Turkey
| | - Nazlı Tunca Sanlier
- Clinic of Obstetrics and Gynecology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Bülent Çelik
- Faculty of Science, Department of Statistics, Gazi University, Ankara, Turkey
| | - Burak Arslan
- Clinic of Biochemistry, University of Health Sciences, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Gülşah Diktaş
- Clinic of Obstetrics and Gynecology, University of Health Sciences, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Özge Yücel Çelik
- Clinic of Obstetrics and Gynecology, University of Health Sciences, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Caner Köse
- Clinic of Obstetrics and Gynecology, University of Health Sciences, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Yaprak Engin-Üstün
- Clinic of Obstetrics and Gynecology, University of Health Sciences, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
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Abraham T, Romani AMP. The Relationship between Obesity and Pre-Eclampsia: Incidental Risks and Identification of Potential Biomarkers for Pre-Eclampsia. Cells 2022; 11:cells11091548. [PMID: 35563854 PMCID: PMC9101603 DOI: 10.3390/cells11091548] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 02/06/2023] Open
Abstract
Obesity has been steadily increasing over the past decade in the US and worldwide. Since 1975, the prevalence of obesity has increased by 2% per decade, unabated despite new and more stringent guidelines set by WHO, CDC, and other public health organizations. Likewise, maternal obesity has also increased worldwide over the past several years. In the United States, pre-pregnancy rates have increased proportionally across all racial groups. Obesity during pregnancy has been directly linked to obstetric complications including gestational diabetes, HTN, hematomas, pre-eclampsia, and congenital defects. In the particular case of pre-eclampsia, the incidence rate across the globe is 2.16%, but the condition accounts for 30% of maternal deaths, and a robust body of evidence underscored the relationship between obesity and pre-eclampsia. More recently, attention has focused on the identification of reliable biomarkers predictive of an elevated risk for pre-eclampsia. The aim of this literature review is to elucidate the relationship between obesity and these predictive biomarkers for future prediction and prevention of pre-eclampsia condition in women at risk.
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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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Chang MW, Lin CJ, Lee RE, Wegener DT. Factors Associated with Home Food Environment in Low-Income Overweight or Obese Pregnant Women. Nutrients 2022; 14:869. [PMID: 35215519 PMCID: PMC8875725 DOI: 10.3390/nu14040869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/29/2022] Open
Abstract
Limited research has examined factors associated with home food availability. This study investigated the associations among demographics, body mass index category, stress, and home food availability among low-income overweight or obese pregnant women. This cross-sectional study enrolled 332 participants who were non-Hispanic black or white. We performed logistic regression modeling for unprocessed food, processed food, overall ultra-processed food, and three subcategories of ultra-processed food (salty snacks, sweet snacks and candies, and soda). Black women were less likely than white women to have large amounts of processed foods (OR = 0.56), salty snacks (OR = 0.61), and soda (OR = 0.49) available at home. Women with at least some college education or at least a college education were more likely to have large amounts of unprocessed food (OR = 2.58, OR = 4.38 respectively) but less likely to have large amounts of soda (OR = 0.44; OR = 0.22 respectively) available at home than their counterparts. Women with higher stress were less likely to have large amounts of unprocessed food available at home (OR = 0.58) than those with lower stress. Home food availability varied by race, education, and levels of stress in low-income overweight or obese pregnant women.
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Affiliation(s)
- Mei-Wei Chang
- College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, USA;
| | - Chyongchiou J. Lin
- College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, USA;
| | - Rebecca E. Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA;
| | - Duane T. Wegener
- Department of Psychology, The Ohio State University, Columbus, OH 43210, USA;
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Liu S, Song B, Liu D, Zheng C, Wu X, Wei Z, Chen X. Effects of labor induction in obesity with delayed pregnancy: A retrospective study based on Chinese obese primipara. Front Endocrinol (Lausanne) 2022; 13:1055098. [PMID: 36714608 PMCID: PMC9874314 DOI: 10.3389/fendo.2022.1055098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To test the hypothesis that obese primiparous women with an unfavorable cervix in delayed pregnancy may experience a worse induction of labor. STUDY DESIGN In total, 467 primiparas with poor cervical condition and delayed pregnancy (gestational age [GA]: >40weeks) were divided into an obese primiparas group (body mass index [BMI] >30kg/m2; n=166) and a non-obese primiparas group (BMI < 30kg/m2; (n=301). Labor was induced by various methods, double balloon, dinoprostone inserts, and amniotomy combined with oxytocin depending on the Bishop score. Experimental data were analyzed by Statistical Product Service Solutions (SPSS). RESULTS BMI in the obese primiparas group was higher than in the non-obese group (33.91 ± 2.67 versus 24.09 ± 5.78, p<0.001), and there were significant differences in uterine tone and duration of contractions between the two groups in the second stage of labour (p=0.041, p=0.026, respectively).The rate of cesarean section (CS) was significantly higher in the primiparas group (23.49% versus 12.29%; P=0.002). There was a significant difference between the two groups in terms of the duration of time to vaginal delivery (VD) (18h versus 8h; P <0.001) while the duration until VD in the obese primiparas group within 12 hours and 24 hours was significantly longer (P <0.001). After adjusting for possible confounders, caesarean section rates remained high in the obese primiparas women (OR: 2.564;95%CI1.919,3.864;P<0.001). Similarly, after adjusting for the same confounding factors, obese primiparas women increased the duration until VD within 24 h by 3.598 hours. CONCLUSION Obese primiparas with an unfavorable cervix in delayed pregnancy have a significantly higher risk of CS and a longer duration until VD than non-obese primiparas during labor induction.
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Affiliation(s)
- Shuhua Liu
- Department of Obstetrics and Gynecology, Anhui Province Maternity and Child Health Hospital, Hefei, China
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Bing Song
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dehong Liu
- Department of Obstetrics and Gynecology, Anhui Province Maternity and Child Health Hospital, Hefei, China
| | - Chenmin Zheng
- Department of Obstetrics and Gynecology, Anhui Province Maternity and Child Health Hospital, Hefei, China
| | - Xiumei Wu
- Department of Obstetrics and Gynecology, Anhui Province Maternity and Child Health Hospital, Hefei, China
| | - Zhaolian Wei
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Xianxia Chen, ; Zhaolian Wei,
| | - Xianxia Chen
- Department of Obstetrics and Gynecology, Anhui Province Maternity and Child Health Hospital, Hefei, China
- *Correspondence: Xianxia Chen, ; Zhaolian Wei,
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Kumar M, Mali K. Study of maternal and fetal outcomes in obese women. Indian J Public Health 2022; 66:448-450. [PMID: 37039172 DOI: 10.4103/ijph.ijph_1862_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Obesity in Indian women had increased from 10.6% to 14.8% in India. Mothers who are overweight or obese during pregnancy and childbirth cause significant antenatal, intrapartum, postpartum and also neonatal complications. Aim and Objective The present study aimed to explore various maternal and fetal outcomes influenced by maternal obesity. The objective was to find the effect of obesity on maternal and perinatal outcome among obese pregnant women compared to those of normal weight. Methods The study was conducted in antenatal women attending antenatal outpatient department of of Obstetrics and Gynecology in a teriary care referral hospital in Mumbai. Results recorded in simple percentages. Results Eighteen percent cases developed gestational diabetes mellitus during their antenatal period and 15% developed gestational hypertension. 44% patients underwent lower segment caesarean section. The need for induction of labour and caesarean section was found to be 37% which is significantly higher. Increased NICU admissions due to hypoglycemia or congenital malformations,prematurity was found to be on a higher side. Conclusions It was clearly evident from the present study that maternal obesity had adverse maternal and fetal outcomes. Maternal obesity was strongly associated with antenatal complications like gestational diabetes mellitus, gestational hypertension, preeclampsia and increase in need for induction of labour and operative interference.
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Figueiro-Filho EA, Robinson NTS, Carvalho J, Keunen J, Robinson M, Maxwell C. Hemodynamic Assessment of Pregnant People with and without Obesity by Noninvasive Bioreactance: A Pilot Study. AJP Rep 2022; 12:e69-e75. [PMID: 35141039 PMCID: PMC8816622 DOI: 10.1055/s-0041-1742270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/08/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to identify cardiovascular differences between pregnant people with and without obesity for trimester-specific changes in hemodynamic parameters using noninvasive cardiac output monitoring (NICOM). Study Design This study is a pilot prospective comparative cohort between pregnant people with and without obesity. Hemodynamic assessment was performed with NICOM (12-14, 21-23, and 34-36 weeks) during pregnancy. Results In first trimester, pregnant people with obesity had higher blood pressure, stroke volume (SV), total peripheral resistance index (TPRI), and cardiac output (CO). Pregnant people with obesity continued to have higher SV and cardiac index (second and third trimesters). During the first trimester, body mass index (BMI) positively correlated with SV, TPRI, and CO. Fat mass showed a strong correlation with TPRI. BMI positively correlated with CO during the second trimester and fat mass was positively associated with CO. During the third trimester, TPR negatively correlated with BMI and fat mass. Conclusion Fat mass gain in the period between the first and second trimesters in addition to the hemodynamic changes due to obesity and pregnancy contribute to some degree of left ventricular diastolic dysfunction which was manifested by lower SVs. Future work should investigate the possible causative role of obesity in the cardiovascular changes identified in people with obesity.
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Affiliation(s)
- Ernesto A Figueiro-Filho
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.,Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Na T S Robinson
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Obstetrics and Gynecology, Queen Elizabeth Hospital, Barbados
| | - Jose Carvalho
- Department of Anaesthesia, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Johannes Keunen
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Monique Robinson
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Cynthia Maxwell
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
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Guo C, Cheng T, Li J. Prophylactic negative pressure wound therapy on surgical site infection in obese women after cesarean section: A systematic review and meta-analysis. Int J Gynaecol Obstet 2021; 158:502-511. [PMID: 34860421 DOI: 10.1002/ijgo.14058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/21/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022]
Abstract
Prevention of surgical site infection (SSI) is a public health challenge. The objective of the study was to evaluate the efficacy of negative pressure wound therapy (NPWT) for preventing SSI and other wound complications in obese women undergoing cesarean section. The search terms included "negative pressure wound therapy", "obesity" and "cesarean section/delivery". Randomized controlled trials were used to compare the use of NPWT to standard dressings in preventing SSI in obese women after cesarean section. A comprehensive literature search of four databases was performed up to June 2021. The primary outcome was SSI. Secondary outcomes were seroma, hematoma, overall wound complications, and adverse skin reactions. Ten RCTs involving 5586 patients met the inclusion criteria. The use of NPWT reduced SSI (RR = 0.76, 95%CI: 0.63-0.92, P = 0.004). No statistically significant difference was detected in the incidence of overall wound complications (RR = 0.93, P = 0.48), seroma (RR = 1.10, P = 0.79), hematoma (RR = 0.63, P = 0.36) and hospital readmission (RR = 1.41, P = 0.15). NPWT significantly increased the occurrence of skin blistering with a RR of 4.60 (P = 0.04). Use of prophylactic NPWT after cesarean delivery among obese women is associated with a significant reduction of surgical site infection.
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Affiliation(s)
- Chenchen Guo
- School of Medicine, Southeast University, Nanjing, China
| | - Tao Cheng
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, China
| | - Junsheng Li
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, China
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Kumar P, Rashmi R, Muhammad T, Srivastava S. Factors contributing to the reduction in childhood stunting in Bangladesh: a pooled data analysis from the Bangladesh demographic and health surveys of 2004 and 2017-18. BMC Public Health 2021; 21:2101. [PMID: 34784935 PMCID: PMC8594170 DOI: 10.1186/s12889-021-12178-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the last two decades, Bangladesh has made progress in reducing the percentage of stunted children under age 5 years from 51% in 2004 to 31% in 2017. Such reduction has created a source for new research to understand its contributing factors. The present study aims to identify such crucial factors which contributed in reducing the percentage of under-five stunting status of children from 2004 to 2017-18. METHODS The study used data from the Bangladesh Demographic and Health Surveys (BDHS), conducted in 2004 and in 2017-18, focused on children under-5-years of age (U5). The sample sizes were n = 6375 children included in the 2004 survey and n = 8312 children included in the 2017-18 survey. Descriptive analysis and bivariate analysis were conducted for a general characterization of the samples. Logistic regression was used to find out the significant factors contributing to the prevalence of stunting among U5 children. Furthermore, the Fairlie decomposition technique was used to identify the crucial factors that contributed to the reduction of stunting. RESULTS The prevalence of stunting among U5 children has declined significantly, from 49.8 to 30.7% between the two survey periods (2004 and 2017-18). Estimates of decomposition analysis show that overall, the selected variables explained 50.6% of the decrease in the prevalence of stunting. Mother's characteristics such as age at first birth, education level, working status and BMI (body mass index) status were the primary contributors of this change. Father's characteristics, such as education explained 9% of this change. CONCLUSION The results of the study highlight the importance of increasing maternal education and reducing inter-household wealth inequality to improve nutritional status of U5 children. In order to achieve further reduction in stunting, among U5 children in Bangladesh, this paper calls for policymakers to develop effective programs to improve maternal education, raise parental awareness of parents regarding children's height and weight, and aim to significantly reduce inter-household inequalities.
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Affiliation(s)
- Pradeep Kumar
- International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
| | - Rashmi Rashmi
- International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
| | - T. Muhammad
- International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
| | - Shobhit Srivastava
- International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
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Gillespie BM, Thalib L, Ellwood D, Kang E, Mahomed K, Kumar S, Chaboyer W. Effect of negative-pressure wound therapy on wound complications in obese women after caesarean birth: a systematic review and meta-analysis. BJOG 2021; 129:196-207. [PMID: 34622545 DOI: 10.1111/1471-0528.16963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/15/2021] [Accepted: 09/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Obesity is associated with increased surgical-site infection (SSI) following caesarean section (CS). OBJECTIVE To summarise the evidence on the effectiveness of negative-pressure wound therapy (NPWT) for preventing SSI and other wound complications in obese women after CS. SEARCH STRATEGY MEDLINE, Embase, CINAHL, Cochrane CENTRAL databases and ClinicalTrials.gov were systematically searched in March 2021. SELECTION CRITERIA Randomised controlled trials (RCTs) of NPWT compared with standard dressings after CS birth. DATA COLLECTION AND ANALYSIS Pooled effect sizes were calculated using either fixed or random effects models based on heterogeneity. The Cochrane risk of bias and Grading of Recommendations Assessment, Development and Evaluation tools were used to assess the quality of studies and overall quality of evidence. MAIN RESULTS Ten RCTs with 5583 patients were included; studies were published between 2012 and 2021. Nine RCTs with 5529 patients were pooled for the outcome SSI. Meta-analysis results suggest a significant difference favouring the NPWT group (relative risk [RR] 0.79, 95% CI 0.65-0.95, P < 0.01), indicating an absolute risk reduction of 1.8% among those receiving NPWT compared with usual care. The risk of blistering in the NPWT group was significantly higher (RR 4.13, 95% CI 1.53-11.18, P = 0.005). All studies had high risk of bias relative to blinding of personnel/participants. Only 40% of studies reported blinding of outcome assessments and 50% had incomplete outcome data. CONCLUSIONS The decision to use NPWT should be considered both in terms of its potential benefits and its limitations. TWEETABLE ABSTRACT NPWT was associated with fewer SSI in women following CS birth but was not effective in reducing other wound complications.
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Affiliation(s)
- B M Gillespie
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University & Gold Coast Hospital and Health Service, Gold Coast, Qld, Australia
| | - L Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
| | - D Ellwood
- Griffith University School of Medicine & Dentistry, and Gold Coast University Hospital, Gold Coast, Qld, Australia
| | - E Kang
- Menzies Health Institute, Griffith University, Gold Coast, Qld, Australia
| | - K Mahomed
- Ipswich Hospital, Ipswich, Qld, Australia
| | - S Kumar
- Mater Research Institute, University of Queensland, Brisbane, Qld, Australia.,Mater Mothers' Hospital, South Brisbane, Qld, Australia
| | - W Chaboyer
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University & Gold Coast Hospital and Health Service, Gold Coast, Qld, Australia
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Rolińska A, Aftyka A, Samardakiewicz M. Coping with Stress in Complicated Pregnancy and Gestational Weight Gain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910493. [PMID: 34639793 PMCID: PMC8507853 DOI: 10.3390/ijerph181910493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/22/2021] [Accepted: 09/30/2021] [Indexed: 11/16/2022]
Abstract
Maternal obesity is one of the leading health problems in the world. Excessive gestational weight gain (GWG) can lead to many complications during pregnancy, especially when it is accompanied by diabetes. Moreover, the risk of excessive GWG in pregnant women is significant, irrespective of prenatal counseling. Studies on this subject concerning coping with stress are lacking in the literature. The present work is aimed at evaluating the styles of coping with stress and their relation to GWG in pregnant women with gestational diabetes (GDM) for whom sudden adaptation to dietary management during this period can be challenging. It was indicated that women with GDM reported high stress related to potential maternal-fetal complications and worries about compliance with dietary management. The overall weight gain of participants in pregnancy was determined in connection to their prepregnancy body mass index (BMI) and classified based on the Institute of Medicine guidelines. A standardized psychological scale was used to assess coping styles. The results showed that almost half of the participants did not meet the Institute of Medicine recommendations for weight gain during pregnancy. There were significant correlations between the styles of coping with stress and the GWG. Additionally, low correlations were indicated between emotional, avoidant, task-oriented coping styles and the age of pregnant women with GDM. Regression analysis showed that the stress-coping style that focused on emotions was the most predictive of overall weight gain. There is a need for a better understanding of psychological barriers in achieving the recommended GWG and potential limitations in providers' interventions, particularly for GDM.
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Affiliation(s)
- Agnieszka Rolińska
- Chair and Department of Psychology, Faculty of Medicine, Medical University of Lublin, 20-059 Lublin, Poland;
- Correspondence:
| | - Anna Aftyka
- Department of Anesthesiological and Intensive Care Nursing, Faculty of Health Sciences, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Marzena Samardakiewicz
- Chair and Department of Psychology, Faculty of Medicine, Medical University of Lublin, 20-059 Lublin, Poland;
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Bonouvrie DS, Taverne SB, Janssen L, Luijten AA, van Dielen FM, Leclercq WK. Pregnancy and Bariatric Surgery: Significant Variation in Bariatric Surgeons' Practices and Preferences: A National Survey. Bariatr Surg Pract Patient Care 2021; 17:103-110. [PMID: 35765306 PMCID: PMC9233520 DOI: 10.1089/bari.2021.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Bariatric complications may occur during pregnancy, potentially causing serious maternal and fetal problems. The aim of this study was to determine the current practice and preferences of bariatric surgeons regarding the pregnancy care of fertile women before and after bariatric surgery. Methods: A 26-question anonymous online survey was designed and sent to all bariatric surgeons of the Dutch Society of Metabolic and Bariatric Surgery. Results: At least one bariatric surgeon from each bariatric center (n = 18) completed the survey. In case of a future child, wish sleeve gastrectomy became more popular than Roux-en-Y gastric bypass. All surgeons provided preoperative education regarding bariatric complications during pregnancy. Nine centers without neonatal intensive care would not refer pregnant women with acute complications. Half of the centers had a standard operating procedure. Seven per 18 bariatric centers had seen at least one postbariatric pregnant patient with severe maternal morbidity. One case of perinatal mortality was reported. Conclusion: There is an inconsistent and often below guideline standard daily practice regarding pregnancy before and after bariatric surgery. There is limited experience with pregnant women with acute bariatric complications. Referral to tertiary centers is inadequate. Better information provision for both professionals and patients regarding possible complications is needed.
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Affiliation(s)
- Daniëlle S. Bonouvrie
- Obesity Center Máxima, Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Address correspondence to: Daniëlle S. Bonouvrie, MD, Obesity Center Máxima, Máxima Medical Center, Mailbox 90052, Eindhoven 5600 PD, The Netherlands
| | - Sophie B.M. Taverne
- Obesity Center Máxima, Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Loes Janssen
- Department of Surgery, Maxima Medical Center, Eindhoven/Veldhoven, The Netherlands
| | | | | | - Wouter K.G. Leclercq
- Obesity Center Máxima, Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands
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Degez M, Planche L, Dorion A, Duchalais A, Lefizelier E, Ducarme G. Risk Factors for Carbetocin Failure after a Cesarean Section: Is Obesity One of Them? J Clin Med 2021; 10:jcm10173767. [PMID: 34501215 PMCID: PMC8432019 DOI: 10.3390/jcm10173767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
Obese pregnant women have increased rates of fetal macrosomia, long labor, and cesarean sections, which lead to an increased risk of postpartum hemorrhage (PPH). Carbetocin is useful for the prevention of PPH after a cesarean section. Our study aimed to investigate predictors of carbetocin failure after a cesarean section, and specifically whether obesity is associated with carbetocin failure. We retrospectively analyzed all women who received carbetocin after a cesarean section. Carbetocin failure was defined as changes in hematocrit and hemoglobin, blood loss ≥ 1000 mL, and the need for an additional uterotonic agent or second-line therapies for persistent PPH. Univariate and multivariate analyses were performed to investigate predictors of carbetocin failure. The study included 600 women, with 131 (21.8%) obese women. Overall, 44 (7.3%) carbetocin failures were reported, and rates of obese women were similar between groups (carbetocin failure, 11.4% vs. 22.9%; p = 0.08). Previous PPH (p < 0.001), a cesarean section during labor (p = 0.01), cervical ripening (p = 0.02), and birthweight (p = 0.01) were significantly different between groups. In the multivariable logistic regression analysis adjusted for potential confounders, cervical ripening (adjusted odds ratio (OR) 2.23, 95% confidence interval (CI) 1.01–4.80), compared with spontaneous labor, was significantly associated with carbetocin failure. Obesity was not associated with carbetocin failure after cesarean sections.
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Affiliation(s)
- Manon Degez
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France; (M.D.); (E.L.)
| | - Lucie Planche
- Clinical Research Center, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France; (L.P.); (A.D.)
| | - Agnès Dorion
- Clinical Research Center, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France; (L.P.); (A.D.)
| | - Alexis Duchalais
- Department of Anesthesiology, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France;
| | - Emelyne Lefizelier
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France; (M.D.); (E.L.)
| | - Guillaume Ducarme
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France; (M.D.); (E.L.)
- Correspondence: ; Tel.: +33-251446570; Fax: +33-251446404
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50
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Li Y, Chen J, Lin Y, Xu L, Sang Y, Li D, Du M. Obesity Challenge Drives Distinct Maternal Immune Response Changes in Normal Pregnant and Abortion-Prone Mouse Models. Front Immunol 2021; 12:694077. [PMID: 34177956 PMCID: PMC8219966 DOI: 10.3389/fimmu.2021.694077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/18/2021] [Indexed: 12/25/2022] Open
Abstract
Obesity is prevalent among women of reproductive age and is associated with increased risk of developing multiple pregnancy disorders. Pregnancy must induce immune tolerance to avoid fetal rejection, while obesity can cause chronic inflammation through activating the immune system. Impaired maternal immuno-tolerance leads to pregnancy failure, such as recurrent spontaneous abortion (RSA), one of the most common complications during early pregnancy. How does maternal immune response change under obesity stress in normal pregnancy and RSA? In turn, is obesity affected by different gestational statuses? Limited information is presently available now. Our study investigated pregnancy outcomes and maternal immune responses in two murine models (normal pregnancy and spontaneous abortion models) after obesity challenge with a high-fat diet (HFD). Abortion-prone mice fed HFD had significantly higher weight gains during pregnancy than normal pregnant mice with HFD feeding. Nonetheless, the embryo implantation and resorption rates were comparable between HFD and normal chow diet (NCD)-fed mice in each model. Evaluation of immune cell subsets showed HFD-induced obesity drove the upregulation of activated NK cell-activating receptor (NKp46)+ NK cells and pro-inflammatory macrophages (MHCIIhigh Mφ) as well as CD4+ and CD8+ T cells in the normal pregnancy group. However, in the abortion-prone group, relative more immature NK cells with decreased activity phenotypes were found in obese mice. Moreover, there were increased DCreg (CD11bhigh DC) cells and decreased CD4+ and CD8+ T cells detected in the HFD abortion-prone mice relative to those fed the NCD diet. Our findings reveal how pregnancy obesity and maternal immune regulation are mutually influenced. It is worth noting that the abortion-prone model where active maternal immune status was intensified by obesity, in turn stimulated an overcompensation response, leading to an over-tolerized immune status, and predisposing to potential risks of perinatal complications.
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MESH Headings
- Abortion, Habitual/immunology
- Abortion, Habitual/metabolism
- Abortion, Habitual/physiopathology
- Animals
- CD4-Positive T-Lymphocytes/immunology
- CD4-Positive T-Lymphocytes/metabolism
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/metabolism
- Cells, Cultured
- Diet, High-Fat
- Disease Models, Animal
- Female
- Gestational Weight Gain
- Histocompatibility, Maternal-Fetal
- Killer Cells, Natural/immunology
- Killer Cells, Natural/metabolism
- Macrophages/immunology
- Macrophages/metabolism
- Male
- Mice, Inbred BALB C
- Mice, Inbred DBA
- Obesity, Maternal/immunology
- Obesity, Maternal/metabolism
- Obesity, Maternal/physiopathology
- Phenotype
- Pregnancy
- Uterus/immunology
- Uterus/metabolism
- Uterus/physiopathology
- Mice
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Affiliation(s)
- Yanhong Li
- Laboratory for Reproductive Immunology, NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University Shanghai Medical College, Shanghai, China
| | - Jiajia Chen
- Laboratory for Reproductive Immunology, NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University Shanghai Medical College, Shanghai, China
| | - Yikong Lin
- Laboratory for Reproductive Immunology, NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University Shanghai Medical College, Shanghai, China
| | - Ling Xu
- Laboratory for Reproductive Immunology, NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University Shanghai Medical College, Shanghai, China
| | - Yifei Sang
- Laboratory for Reproductive Immunology, NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University Shanghai Medical College, Shanghai, China
| | - Dajin Li
- Laboratory for Reproductive Immunology, NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University Shanghai Medical College, Shanghai, China
| | - Meirong Du
- Laboratory for Reproductive Immunology, NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University Shanghai Medical College, Shanghai, China
- Department of Obstetrics and Gynecology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
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