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Awan AY, Channa NA, Solangi SP, Noorani L. Consumption of chewing tobacco alters the serum metal contents in pregnant women at Tandojam and adjoining areas. Biometals 2024; 37:839-847. [PMID: 38127179 DOI: 10.1007/s10534-023-00571-0] [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: 05/05/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023]
Abstract
Chewing tobacco may play a contributing role in complications during pregnancy as it contains various kinds of toxic metals such as lead (Pb), cadmium (Cd), cobalt (Co), manganese (Mn), chromium (Cr), and can cause alteration in serum metal concentration. Hence, the present study aimed to explore the effects of chewing tobacco consumption on serum metal contents in pregnant women. A total number of 200 chewing tobacco consumer pregnant women and 200 age-matched non-consumer pregnant women were selected for the study from the outpatient department of gynaecology at Rural Health Centre Tandojam, Pakistan. After obtaining the sociodemographic characteristics of all participants, 10 ml of venous blood was also drawn for serum metal analysis by atomic absorption spectroscopy. Different chewing tobacco samples consumed by consumer pregnant women were collected from local shops of Tandojam, Pakistan. Drinking water samples from the residential areas of consumer and non-consumer pregnant women were prepared and analysed for the same metal contents. In present study, serum Pb, Cd, K and Co were found significantly increased in CPW as compared to NCPW. Serum Pb was found significantly increased in gutkha consumers in comparison to mainpuri consumers. Serum Pb, Cd, and Co were present with significantly increased concentration in serum of CPW who were taking canal and well water for drinking purpose when compared with NCPW. Significant negative strong correlation of serum Pb with K and Cr of drinking water and Na of chewing tobacco samples were observed. Strong positive correlation of serum Cd and Cr with Co of drinking water had been observed. Whereas, serum maternal Co was strongly negatively correlated with Mn of chewing tobacco samples, and serum Cu of CPW had a strong positive correlation with K and Cr of drinking water and Na of chewing tobacco samples. In conclusion, consumption of chewing tobacco alters the serum metal contents in pregnant women at Tandojam and adjoining areas, Pakistan.
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Affiliation(s)
- Amna Yasin Awan
- Institue of Biochemistry, University of Sindh, Jamshoro, Pakistan
| | | | - Shazia Perveen Solangi
- Institue of Biochemistry, University of Sindh, Jamshoro, Pakistan
- Department of Biochemistry, Shah Abdul Latif University, Khairpur, Pakistan
| | - Lubna Noorani
- Department of Science and Technical Education, Faculty of Education, University of Sindh, Jamshoro, Pakistan
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Zurutuza JI, Caba M, Morales-Romero J, Caba-Flores MD, Viveros-Contreras R. Maternal Overweight and Obesity and Their Effect on the Growth of the Newborn During the First Six Months of Life. Cureus 2024; 16:e64867. [PMID: 39156241 PMCID: PMC11330374 DOI: 10.7759/cureus.64867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2024] [Indexed: 08/20/2024] Open
Abstract
INTRODUCTION Maternal overweight and obesity during pregnancy have been shown to have multiple negative effects on the mother's health, which can even affect the infant's growth by increasing weight gain and altering various indicators, such as weight for age, length for age and weight for length. While breast milk on the other hand reduces these risks, and it's the best and most complete food for the newborn. It's a dynamic fluid capable of being modified to meet the needs of each stage of the newborn, but despite this capacity and the fact that maternal body mass index can have an impact on its components, through complex biological mechanisms, it manages to reduce the negative effects accumulated during pregnancy and even promotes a healthy state in the baby. In a country like Mexico, where overweight and obesity affect a large part of the population, it is important to study their causes and which could be the effect of this increased maternal overweight during pregnancy and lactation on newborns. OBJECTIVE Identify the alterations associated with increased maternal body mass index during pregnancy and breastfeeding on mothers' health and their possible effect on the growth of the newborn during the first six months of life. MATERIAL AND METHODS This was a prospective cohort study. Forty-two healthy binomials (mother and child), without problems during delivery and without serious illnesses during the breastfeeding period, were included. Maternal body mass index at the beginning of pregnancy allowed us to create two comparison groups between mothers: one with adequate weight, another with overweight or obesity. Follow-up was carried out once a month during the first six months of life, evaluating the somatometric development of mothers and children. All mothers completed the six-month period of exclusive breastfeeding. RESULTS There were differences between both groups of women. The one that included overweight and obese women compared to the group of women with adequate weight had a higher number of pregnancies, abortions, plasma glucose levels in the third trimester of pregnancy, and a lower number of prenatal control visits and plasma platelet levels (all with p<0.05). Regarding the baby's growth, there was a difference between the weight for length classification at 60-, 120-, 150- and 180-day follow-ups. The group to which the mother was assigned with respect to her body mass index at the beginning of pregnancy (adequate weight group and overweight/obese group) was the only factor associated with the risk of the baby being overweight according to weight for length indicator at the 180-day follow-up, with an OR = 5.2 (95%CI 1.02-26.59). CONCLUSIONS Maternal overweight and obesity during pregnancy have a negative effect on the mother's health and baby's weight gain in its weight-for-length classification during the first six months of life. Although breastfeeding has been shown to have a positive effect on the growth of the baby, exposure to a higher maternal body mass index during pregnancy triggers important metabolic alterations that promote the development of diseases. It is important to establish weight control guidelines in women who wish to become pregnant to reduce the negative effects on the mother and offspring.
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Affiliation(s)
- Jorge I Zurutuza
- Epidemiology and Biostatistics, Centro de Investigaciones Biomédicas, Universidad Veracruzana, Xalapa, MEX
| | - Mario Caba
- Neurosciences, Centro de Investigaciones Biomédicas, Universidad Veracruzana, Xalapa, MEX
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Bujold L, Audibert F, Chaillet N. Impact of Gestational Weight Gain Recommendations for Obese Women on Neonatal Morbidity. Am J Perinatol 2024; 41:1251-1260. [PMID: 35688438 DOI: 10.1055/s-0042-1748844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION In 2013, the American College of Obstetricians and Gynecologists (ACOGs) developed gestational weight gain guidelines to minimize the risks associated with obesity during pregnancy. However, a growing body of evidence suggests that current recommendations should be revised for obese women. OBJECTIVE The objective of this study is to assess the impact of gestational weight gain recommendations for obese women (body mass index ≥ 30 kg/m2) on neonatal and maternal outcomes in Quebec. STUDY DESIGN Secondary analysis of the QUARISMA trial was performed including obese women who delivered a full-term singleton in cephalic presentation from 2008 to 2011 in Quebec. Outcomes assessed were composite risks of major neonatal and maternal complications, minor neonatal and maternal complications, as well as obstetrical interventions. Outcomes were compared between weight gain recommendations (reference group) and three weight gain/loss categories using logistic regressions. In second analysis, obese women were stratified by obesity class. RESULTS Among the 16,808 eligible obese women, 605 lost weight during pregnancy, 2,665 gained between 0 and 4.9 kg, 4,355 gained weight within the recommendations (5-9.09 kg), and 9,183 gained at least 9.1 kg. Results showed a significant reduction in major neonatal morbidity (adjusted odds ratio [aOR] = 0.69, 95% confidence interval [CI] = 0.51-0.94), minor maternal morbidity (aOR = 0.79, 95%CI = 0.67-0.93), and assisted vaginal delivery (aOR = 0.82, 95%CI = 0.68-0.99) among women who gained 0 to 4.9 kg compared with the reference group. Cesarean delivery and preeclampsia/eclampsia were significantly reduced with weight loss (aOR = 0.76, 95%CI = 0.64-0.89 and 0.58, 95%CI = 0.42-0.78) compared with the reference group. Weight gain above recommendations was associated with an increased risk of minor neonatal morbidity, major and minor maternal morbidity, as well as cesarean delivery. CONCLUSION Compared with a weight gain within the recommendations, a gestational weight gain/loss of less than 5 kg in obese women is associated with a reduced risk of major neonatal morbidity, minor maternal morbidity, preeclampsia/eclampsia, cesarean delivery, and assisted vaginal delivery. Guidelines on gestational weight gain for obese women should be updated. KEY POINTS · Gestational weight gain/loss of less than 5 kg reduces the risk of perinatal complications.. · As suggested by ACOG recommendations, guidelines for obese women should be updated.. · Recommendations stratified by obesity class should be included in revised guidelines..
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Affiliation(s)
- Laurence Bujold
- Research Center of CHU de Québec, Laval University, Quebec City, Quebec, Canada
| | - François Audibert
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada
| | - Nils Chaillet
- Research Center of CHU de Québec, Laval University, Quebec City, Quebec, Canada
- Faculty of Medicine, Department of Obstetrics and Gynecology, Laval University, Quebec City, Quebec, Canada
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Patel D, Savvidou MD. Maternal Cardiac Function in Pregnancies with Metabolic Disorders. Eur Cardiol 2024; 19:e08. [PMID: 38983578 PMCID: PMC11231816 DOI: 10.15420/ecr.2023.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/17/2024] [Indexed: 07/11/2024] Open
Abstract
The obesity epidemic is growing and poses significant risks to pregnancy. Metabolic impairment can be associated with short- and long-term maternal and perinatal morbidity and mortality. The cardiovascular implications are known in those with metabolic disorder outside of pregnancy; however, little is known of the cardiac function in pregnancies complicated by obesity. Maternal cardiac adaptation plays a vital role in normal pregnancy and is known to be involved in the pathophysiology of adverse pregnancy outcomes. Bariatric surgery is the most successful treatment for sustainable weight loss and pre-pregnancy bariatric surgery can drastically change the maternal metabolic profile and pregnancy outcomes. In this review, we discuss the available evidence on maternal cardiac function in pregnancies affected by obesity and its associated consequences of gestational diabetes and hypertension (chronic and hypertensive disorders in pregnancy), as well as pregnancies following bariatric surgery.
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Affiliation(s)
- Deesha Patel
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, Department of Metabolism, Digestion and Reproduction, Imperial College London, UK
| | - Makrina D Savvidou
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, Department of Metabolism, Digestion and Reproduction, Imperial College London, UK
- Fetal Medicine Unit, Chelsea and Westminster Hospital London, UK
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Patel D, Avesani M, Johnson MR, Di Salvo G, Savvidou MD. Maternal cardiovascular adaptation to pregnancy in obese pregnant women. Acta Obstet Gynecol Scand 2024; 103:907-916. [PMID: 38238936 PMCID: PMC11019532 DOI: 10.1111/aogs.14777] [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: 02/23/2023] [Revised: 11/23/2023] [Accepted: 12/22/2023] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Obesity is known to be associated with cardiovascular compromise and a major risk factor for the development of hypertensive disorders in pregnancy. However, little is known about the effect of obesity on maternal cardiac function. The aim of this study was to investigate the effect of obesity on the maternal cardiovascular system. MATERIAL AND METHODS This was a prospective, observational, longitudinal study. Pregnant women with booking body mass index (BMI) ≥30 kg/m2 were compared with pregnant women with normal booking BMI 20-24.9 kg/m2. Participants were seen at three time points during pregnancy; 12-14, 20-24 and 30-32 weeks. At all visits, maternal blood pressure (BP) was measured, and cardiac geometry and function were assessed using two-dimensional trans-thoracic echocardiography. Multilevel linear mixed-effects models were used for all the comparisons. RESULTS Fifty-nine pregnant women with obesity were compared with 14 pregnant women with normal BMI. In women with obesity, the maternal BP, heart rate and cardiac output were higher and peripheral vascular resistance was lower (p < 0.01 for all comparisons) compared with normal BMI women. Women with obesity had altered cardiac geometry with higher left ventricular end diastolic diameter, intraventricular septal thickness, posterior wall diameter, relative wall thickness and left ventricular mass (p < 0.001 for all comparisons). There was also evidence of impaired diastolic indices in the obese group with a lower E/A ratio, tissue Doppler imaging E' lateral and medial and higher left atrial volume (p < 0.01 for all comparisons). Finally, women with obesity had reduced longitudinal function, as assessed by mitral plane annular systolic excursion, between the second and third trimester of pregnancy, indicating possible early cardiac dysfunction in this group. CONCLUSIONS Obesity is associated with maternal hyperdynamic circulation, altered cardiac geometry and suboptimal diastolic function, compared with normal BMI pregnant women, and these factors may contribute to the increased risk of complications in obese pregnant women.
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Affiliation(s)
- Deesha Patel
- Academic Department of Obstetrics and Gynaecology, Chelsea & Westminster Hospital, Department of MetabolismDigestion and Reproduction, Imperial CollegeLondonUK
| | - Martina Avesani
- Royal Brompton HospitalRoyal Brompton and Harefield NHS Foundation trustLondonUK
| | - Mark R. Johnson
- Academic Department of Obstetrics and Gynaecology, Chelsea & Westminster Hospital, Department of MetabolismDigestion and Reproduction, Imperial CollegeLondonUK
| | - Giovanni Di Salvo
- Royal Brompton HospitalRoyal Brompton and Harefield NHS Foundation trustLondonUK
| | - Makrina D. Savvidou
- Academic Department of Obstetrics and Gynaecology, Chelsea & Westminster Hospital, Department of MetabolismDigestion and Reproduction, Imperial CollegeLondonUK
- Fetal Medicine UnitChelsea & Westminster HospitalLondonUK
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Cordey C, Webb NM, Haeusler M. Take it to the limit: The limitations of energetic explanations for birth timing in humans. Evol Med Public Health 2023; 11:415-428. [PMID: 38022799 PMCID: PMC10644907 DOI: 10.1093/emph/eoad035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
A hallmark of modern humans is that our newborns are neurologically immature compared to other primates. It is disputed whether this so-called secondary altriciality evolved due to remodelling of the pelvis associated with bipedal locomotion, as suggested by the obstetrical dilemma hypothesis, or from maternal energetic limitations during pregnancy. Specifically, the 'Energetics of Gestation and Growth' (EGG) hypothesis posits that birth is initiated when foetal energy requirements exceed the maximum sustained maternal metabolic rate during pregnancy at around 2.1 × basal metabolic rate (BMR) of the non-pregnant, non-lactating condition (NPNL). However, the metabolic threshold argued under the EGG framework is derived from one study with a small sample size of only 12 women from the UK. Accordingly, we performed a meta-analysis of all published studies on metabolic scopes during pregnancy to better account for variability. After excluding 3 studies with methodological issues, a total of 12 studies with 303 women from 5 high- and 3 low-income countries were analysed. On average, pregnancy was found to be less metabolically challenging than previously suggested. The studies revealed substantial variation in metabolic scope during pregnancy, which was not reflected by variation in birth timing. Further, in a third of the studies, the metabolic rates exceeded 2.1 × BMRNPNL. Our simulation of foetal energy requirements demonstrated that this metabolic threshold of 2.1 × BMRNPNL cannot realistically be crossed by the foetus around the time of birth. These findings imply that metabolic constraints are not the main limiting factor dictating gestation length.
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Affiliation(s)
- Cédric Cordey
- Institute of Evolutionary Medicine, University of Zürich, Winterthurerstrasse 190, 8057 Zürich, Switzerland
| | - Nicole M Webb
- Institute of Evolutionary Medicine, University of Zürich, Winterthurerstrasse 190, 8057 Zürich, Switzerland
- Department of Palaeoanthropology, Senckenberg Gesellschaft für Naturforschung, Senckenberganlage 25, 60325, Frankfurt am Main, Germany
| | - Martin Haeusler
- Institute of Evolutionary Medicine, University of Zürich, Winterthurerstrasse 190, 8057 Zürich, Switzerland
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DeVilbiss EA, Purdue-Smithe AC, Sjaarda LA, Taylor BD, Freeman JR, Perkins NJ, Silver RM, Schisterman EF, Mumford SL. The Role of Maternal Preconception Adiposity in Human Offspring Sex and Sex Ratio. Am J Epidemiol 2023; 192:587-599. [PMID: 36460625 PMCID: PMC10404066 DOI: 10.1093/aje/kwac209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 12/04/2022] Open
Abstract
We evaluated relationships between preconception adiposity and human offspring sex and sex ratio. Using data from a prospective preconception cohort nested within a randomized controlled trial based at 4 US clinical sites (2006-2012), we used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for male:female sex ratio, and log-identity regression to estimate risk differences (RDs) and 95% CIs for male and female livebirth according to preconception adiposity measures. Inverse-probability weights accounted for potential selection bias. Among 603 women attempting pregnancy, there were meaningful reductions in sex ratio for the highest category of each adiposity measure. The lowest sex ratios were observed for obesity (body mass index of ≥30, calculated as weight (kg)/height (m)2, OR = 0.48, 95% CI: 0.26, 0.88) relative to normal body mass index, and the top tertiles (tertile 3) of serum leptin (OR = 0.50, 95% CI: 0.32, 0.80) and skinfold measurements (OR = 0.50, 95% CI: 0.32, 0.79) relative to the lowest tertiles. Reductions were driven by 11-15 fewer male livebirths per 100 women (for obesity, RD = -15, 95% CI: -23, -6.7; for leptin tertile 3, RD = -11, 95% CI: -20, -3.2; and for skinfolds tertile 3, RD = -11, 95% CI: -19, -3.3). We found that relationships between preconception adiposity measures and reduced sex ratio were driven by a reduction in male births.
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Affiliation(s)
- Elizabeth A DeVilbiss
- Correspondence to Dr. Elizabeth DeVilbiss, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, MSC 7004, Bethesda, MD 20892-7004 (e-mail: )
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8
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Oleszczuk-Modzelewska L, Malinowska-Polubiec A, Romejko-Wolniewicz E, Zawiejska A, Czajkowski K. What is the "cost" of reducing adverse pregnancy outcomes in patients with gestational diabetes mellitus - risk factors for perinatal complications in a retrospective cohort of pregnant women with GDM. BMC Pregnancy Childbirth 2022; 22:654. [PMID: 35986350 PMCID: PMC9392248 DOI: 10.1186/s12884-022-04980-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/07/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a frequent pregnancy complication, affecting the maternal and neonatal health. The new diagnostic strategy for GDM, proposed by the International Association of Diabetes and Pregnancy Study Groups in 2010 and World Health Organization in 2013, raised hope to reduce perinatal complications. The purpose of the study was to compare risk factors influencing maternal and foetal outcomes in a group of pregnant women diagnosed with GDM, and in a group of pregnant women without GDM, regardless of the adopted diagnostic criteria. Also, the aim of the study was to evaluate the impact of risk factors on perinatal results and the "cost" of reducing adverse pregnancy outcomes in patients with GDM. METHODS It was a retrospective study based on the analysis of births given after 37 weeks of pregnancy at the 2nd Department of Obstetrics and Gynaecology, Warsaw Medical University during the years 2013 to 2015. All pregnant women had a 75 g OGTT between the 24th and 28th weeks of pregnancy. The study compared risk factors for perinatal complications in 285 GDM patients and in 202 randomly selected women without GDM. The impact of selected risk factors on perinatal outcomes was analysed. RESULTS Both the diagnosis of GDM and maternal BMI prior to pregnancy, significantly modified the risk of excessive and insufficient weight gain during pregnancy. The parameters significantly influencing the risk of the composite adverse maternal outcome were the maternal abdominal circumference [OR: 1.08 (1.04; 1.11)] and multiparity, which reduced the risk by almost half [OR: 0.47 (0.30; 0.75)]. The maternal abdominal circumference before the delivery was a strong factor correlating with the occurrence of perinatal complications in both the mother and the foetus in the entire cohort. A circumference over 100 cm increased the risk of at least one maternal complication (increased blood loss, soft tissue injury, pre-eclampsia) by almost 40% (OR 1.38, p < 0.001). CONCLUSIONS No differences were found in maternal and foetal outcomes in GDM and non-GDM women except gestational weight gain below Institute of Medicine recommendations. The only "cost" of reducing adverse pregnancy outcomes in GDM patients seems to be lowering gestational weight gain, the future impact of which on GDM pregnant population should be assessed. The maternal abdominal circumference measured before delivery not the severity of carbohydrate intolerance, remained the main predictor for significant perinatal complications.
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Affiliation(s)
- Luiza Oleszczuk-Modzelewska
- 2nd Department of Obstetrics and Gynaecology, Medical University of Warsaw, 2 Karowa St, 00-315, Warsaw, Poland
| | - Aneta Malinowska-Polubiec
- 2nd Department of Obstetrics and Gynaecology, Medical University of Warsaw, 2 Karowa St, 00-315, Warsaw, Poland.
| | - Ewa Romejko-Wolniewicz
- 2nd Department of Obstetrics and Gynaecology, Medical University of Warsaw, 2 Karowa St, 00-315, Warsaw, Poland
| | - Agnieszka Zawiejska
- Department of Medical Simulation, Chair of Medical Education, Poznan University of Medical Sciences, 41 Jackowskiego St, 60-512, Poznan, Poland
| | - Krzysztof Czajkowski
- 2nd Department of Obstetrics and Gynaecology, Medical University of Warsaw, 2 Karowa St, 00-315, Warsaw, Poland
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Quach D, Ten Eikelder M, Jozwiak M, Davies-Tuck M, Bloemenkamp KWM, Mol BW, Li W. Maternal and fetal characteristics for predicting risk of Cesarean section following induction of labor: pooled analysis of PROBAAT trials. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:83-92. [PMID: 34490668 DOI: 10.1002/uog.24764] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/24/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Induction of labor (IOL) is one of the most widely used obstetric interventions. However, one-fifth of IOLs result in Cesarean section (CS). We aimed to assess maternal and fetal characteristics that influence the likelihood of CS following IOL, according to the indication for CS. METHODS This was a secondary analysis of pooled data from four randomized controlled trials, including women undergoing IOL at term who had a singleton pregnancy and an unfavorable cervix, intact membranes and the fetus in cephalic presentation. The main outcomes of this analysis were CS for failure to progress (FTP) and CS for suspected fetal compromise (SFC). Restricted cubic splines were used to determine whether continuous maternal and fetal characteristics had a non-linear relationship with outcome. Optimal cut-offs for those characteristics with a non-linear pattern were determined based on the maximum area under the receiver-operating-characteristics curve. Adjusted odds ratios (aOR) were computed, using multivariable logistic regression analysis, for the associations between optimally categorized characteristics and outcome. RESULTS Of a total of 2990 women undergoing IOL, 313 (10.5%) had CS for FTP and 227 (7.6%) had CS for SFC. The risk of CS for FTP was increased in women aged 31-35 years compared with younger women (aOR, 1.51 (95% CI, 1.15-1.99)), in nulliparous compared with parous women (aOR, 8.07 (95% CI, 5.34-12.18)) and in Sub-Saharan African compared with Caucasian women (aOR, 2.09 (95% CI, 1.33-3.28)). Higher body mass index (BMI) increased incrementally the risk of CS for FTP (aOR, 1.06 (95% CI, 1.04-1.08)). High birth-weight percentile was also associated with an increased risk of CS due to FTP (aOR, 2.66 (95% CI, 1.74-4.07) for birth weight between the 80.0th and 89.9th percentiles and aOR, 4.08 (95% CI, 2.75-6.05) for birth weight ≥ 90th percentile, as compared with birth weight between the 20.0th and 49.9th percentiles). For CS due to SFC, higher maternal age (aOR, 1.09 (95% CI, 1.05-1.12)) and BMI (aOR, 1.05 (95% CI, 1.03-1.08)) were associated with an incremental increase in risk. The risk of CS for SFC was increased in nulliparous compared with parous women (aOR, 5.91 (95% CI, 3.76-9.28)) and in South Asian compared with Caucasian women (aOR, 2.50 (95% CI, 1.23-5.10)). Birth weight < 10.0th percentile increased significantly the risk of CS due to SFC (aOR, 1.93 (95% CI, 1.22-3.05)), as compared with birth weight between the 20.0th and 49.9th percentiles. Bishop score did not demonstrate a significant association with the risk of CS for FTP or for SFC. CONCLUSIONS In women undergoing IOL, maternal age, BMI, parity, ethnicity and birth-weight percentile are predictors of CS due to FTP and of CS due to SFC, but the direction and magnitude of the associations differ according to the indication for CS. These characteristics should be considered in combination with the Bishop score to stratify the risk of CS for different indications in women undergoing IOL. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D Quach
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
- Monash Women's, Monash Health, Clayton, Australia
| | - M Ten Eikelder
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M Jozwiak
- Department of Gynecologic Oncology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - M Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Australia
| | - K W M Bloemenkamp
- Department of Obstetrics, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - W Li
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
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Oliverio AL, Bramham K, Hladunewich MA. Pregnancy and CKD: Advances in Care and the Legacy of Dr Susan Hou. Am J Kidney Dis 2021; 78:865-875. [PMID: 34656369 DOI: 10.1053/j.ajkd.2021.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/13/2021] [Indexed: 11/11/2022]
Abstract
Dr Susan Hou began her illustrious nephrology career at a time when pregnancy in women with chronic kidney disease (CKD) was hazardous and actively discouraged. Her pioneering research in women's health provided much of the early outcome data that shaped our current understanding of CKD and pregnancy. Although many uncertainties regarding optimal management of this vulnerable patient group remain, recent decades have witnessed important advances and renewed interest in improving care for pregnant women with CKD. Many nephrologists have been inspired by Dr Hou's lifetime of work and are grateful for her generous collaborations. In this In Practice Review, we honor her legacy by providing an update of current literature and clinical management guidance in the context of a clinical case vignette that challenges us to consider the many complex aspects to the counseling and care of women with CKD who desire a pregnancy.
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Affiliation(s)
- Andrea L Oliverio
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan
| | - Kate Bramham
- Department of Women and Children's Health, King's College London, London, United Kingdom; Department of Renal Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Michelle A Hladunewich
- Divisions of Nephrology and Obstetrics, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada.
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Li G, Xing Y, Wang G, Zhang J, Wu Q, Ni W, Jiao N, Chen W, Liu Q, Gao L, Zhang Z, Wang Y, Xing Q. Differential effect of pre-pregnancy low BMI on fetal macrosomia: a population-based cohort study. BMC Med 2021; 19:175. [PMID: 34344359 PMCID: PMC8335988 DOI: 10.1186/s12916-021-02046-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The differential effect of pre-pregnancy low BMI on macrosomia has not been fully addressed. Herein, we conducted a city-wide population-based cohort study to illuminate the association between pre-pregnancy low BMI and macrosomia, stratifying by maternal age, parity, and GDM status. METHODS All pregnant women who paid their first prenatal visit to the hospital in Qingdao during August 1, 2018, to June 30, 2020, were recruited to this study. The interactive effect of maternal age and pre-pregnancy low BMI on macrosomia was evaluated using logistic regression models, followed by strata-specific analyses. RESULTS A total of 105,768 mother-child pairs were included, and the proportion of fetal macrosomia was 11.66%. The interactive effect of maternal pre-pregnancy BMI and age was statistically significant on macrosomia irrespective of parity (nullipara: Padjusted=0.0265; multipara: Padjusted=0.0356). The protective effect of low BMI on macrosomia was most prominent among nullipara aged 35 years and above (aOR=0.16, 95% CI 0.05-0.49) and multipara aged 25 years and below (aOR=0.17, 95% CI 0.05-0.55). In nullipara without GDM, the risk estimates gradually declined with increasing conception age (20-to-24 years: aOR=0.64, 95% CI 0.51-0.80; 25-to-29 years: aOR=0.43 95% CI 0.36-0.52; 30-to-34 years: aOR=0.40 95% CI 0.29-0.53; and ≥35 years: aOR=0.19, 95% CI 0.06-0.60). A similar pattern could also be observed in nullipara with GDM, where the aOR for low BMI on macrosomia decreased from 0.54 (95% CI 0.32-0.93) in pregnant women aged 25-29 years to 0.30 (95% CI 0.12-0.75) among those aged 30-34 years. However, younger multiparous mothers, especially those aged 25 years and below without GDM (aOR=0.21, 95% CI 0.06-0.68), were more benefited from a lower BMI against the development of macrosomia. CONCLUSIONS Maternal low BMI is inversely associated with macrosomia irrespective of maternal age and parity. The impact of pre-pregnancy low BMI on macrosomia varied by maternal age and parity. The protective effect of a lower maternal BMI against fetal macrosomia was more prominent in nulliparous mothers aged 35 years and above, whereas multiparous mothers younger than 25 years of age were more benefited.
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Affiliation(s)
- Guoju Li
- Qingdao Women and Children's Hospital, Qingdao University, No.6 Tongfu Road, Qingdao, 266000, Shandong Province, China
| | - Yuhan Xing
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Guolan Wang
- Qingdao Women and Children's Hospital, Qingdao University, No.6 Tongfu Road, Qingdao, 266000, Shandong Province, China
| | - Jun Zhang
- Qingdao Women and Children's Health Care and Family Planning Service Center, Qingdao, Shandong Province, China
| | - Qin Wu
- Qingdao Women and Children's Hospital, Qingdao University, No.6 Tongfu Road, Qingdao, 266000, Shandong Province, China
| | - Wei Ni
- Qingdao Women and Children's Hospital, Qingdao University, No.6 Tongfu Road, Qingdao, 266000, Shandong Province, China
| | - Na Jiao
- Qingdao Women and Children's Hospital, Qingdao University, No.6 Tongfu Road, Qingdao, 266000, Shandong Province, China
| | - Wenjing Chen
- Qingdao Women and Children's Health Care and Family Planning Service Center, Qingdao, Shandong Province, China
| | - Qing Liu
- Qingdao Women and Children's Health Care and Family Planning Service Center, Qingdao, Shandong Province, China
| | - Li Gao
- Qingdao Women and Children's Hospital, Qingdao University, No.6 Tongfu Road, Qingdao, 266000, Shandong Province, China
| | - Zhenhong Zhang
- Public Health School, Medical College of Qingdao University, Qingdao, China
| | - Yao Wang
- Public Health School, Medical College of Qingdao University, Qingdao, China
| | - Quansheng Xing
- Qingdao Women and Children's Hospital, Qingdao University, No.6 Tongfu Road, Qingdao, 266000, Shandong Province, China.
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12
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Bardanzellu F, Puddu M, Peroni DG, Fanos V. The clinical impact of maternal weight on offspring health: lights and shadows in breast milk metabolome. Expert Rev Proteomics 2021; 18:571-606. [PMID: 34107825 DOI: 10.1080/14789450.2021.1940143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Pre-pregnancy overweight and obesity, depending on maternal nutrition and metabolic state, can influence fetal, neonatal and long-term offspring health, regarding cardio-metabolic, respiratory, immunological and cognitive outcomes. Thus, maternal weight can act, through mechanisms that are not full understood, on the physiology and metabolism of some fetal organs and tissues, to adapt themselves to the intrauterine environment and nutritional reserves. These effects could occur by modulating gene expression, neonatal microbiome, and through breastfeeding. AREAS COVERED In this paper, we investigated the potential effects of metabolites found altered in breast milk (BM) of overweight/obese mothers, through an extensive review of metabolomics studies, and the potential short- and long-term clinical effects in the offspring, especially regarding overweight, glucose homeostasis, insulin resistance, oxidative stress, infections, immune processes, and neurodevelopment. EXPERT OPINION Metabolomics seems the ideal tool to investigate BM variation depending on maternal or fetal/neonatal factors. In particular, BM metabolome alterations according to maternal conditions were recently pointed out in cases of gestational diabetes, preeclampsia, intrauterine growth restriction and maternal overweight/obesity. In our opinion, even if BM is the food of choice in neonatal nutrition, the deepest comprehension of its composition in overweight/obese mothers could allow targeted supplementation, to improve offspring health and metabolic homeostasis.
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Affiliation(s)
- Flaminia Bardanzellu
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari. SS 554 km 4,500, 09042 Monserrato. Italy
| | - Melania Puddu
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari. SS 554 km 4,500, 09042 Monserrato. Italy
| | - Diego Giampietro Peroni
- Clinical and Experimental Medicine Department, section of Pediatrics, University of Pisa, Italy. Via Roma, 55, 56126 Pisa PI, Italy
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari. SS 554 km 4,500, 09042 Monserrato. Italy
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13
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Fowden AL, Camm EJ, Sferruzzi-Perri AN. Effects of Maternal Obesity On Placental Phenotype. Curr Vasc Pharmacol 2021; 19:113-131. [PMID: 32400334 DOI: 10.2174/1570161118666200513115316] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 12/26/2022]
Abstract
The incidence of obesity is rising rapidly worldwide with the consequence that more women are entering pregnancy overweight or obese. This leads to an increased incidence of clinical complications during pregnancy and of poor obstetric outcomes. The offspring of obese pregnancies are often macrosomic at birth although there is also a subset of the progeny that are growth-restricted at term. Maternal obesity during pregnancy is also associated with cardiovascular, metabolic and endocrine dysfunction in the offspring later in life. As the interface between the mother and fetus, the placenta has a central role in programming intrauterine development and is known to adapt its phenotype in response to environmental conditions such as maternal undernutrition and hypoxia. However, less is known about placental function in the abnormal metabolic and endocrine environment associated with maternal obesity during pregnancy. This review discusses the placental consequences of maternal obesity induced either naturally or experimentally by increasing maternal nutritional intake and/or changing the dietary composition. It takes a comparative, multi-species approach and focusses on placental size, morphology, nutrient transport, metabolism and endocrine function during the later stages of obese pregnancy. It also examines the interventions that have been made during pregnancy in an attempt to alleviate the more adverse impacts of maternal obesity on placental phenotype. The review highlights the potential role of adaptations in placental phenotype as a contributory factor to the pregnancy complications and changes in fetal growth and development that are associated with maternal obesity.
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Affiliation(s)
- A L Fowden
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, United Kingdom
| | - E J Camm
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, United Kingdom
| | - A N Sferruzzi-Perri
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, United Kingdom
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14
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Abstract
Congenital heart disease is the most frequent birth defect and the leading cause of death for the fetus and in the first year of life. The wide phenotypic diversity of congenital heart defects requires expert diagnosis and sophisticated repair surgery. Although these defects have been described since the seventeenth century, it was only in 2005 that a consensus international nomenclature was adopted, followed by an international classification in 2017 to help provide better management of patients. Advances in genetic engineering, imaging, and omics analyses have uncovered mechanisms of heart formation and malformation in animal models, but approximately 80% of congenital heart defects have an unknown genetic origin. Here, we summarize current knowledge of congenital structural heart defects, intertwining clinical and fundamental research perspectives, with the aim to foster interdisciplinary collaborations at the cutting edge of each field. We also discuss remaining challenges in better understanding congenital heart defects and providing benefits to patients.
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Affiliation(s)
- Lucile Houyel
- Unité de Cardiologie Pédiatrique et Congénitale and Centre de Référence des Malformations Cardiaques Congénitales Complexes (M3C), Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France.,Université de Paris, 75015 Paris, France
| | - Sigolène M Meilhac
- Université de Paris, 75015 Paris, France.,Imagine-Institut Pasteur Unit of Heart Morphogenesis, INSERM UMR 1163, 75015 Paris, France;
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15
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Ballesta-Castillejos A, Gómez-Salgado J, Rodríguez-Almagro J, Hernández-Martínez A. Development and validation of a predictive model of exclusive breastfeeding at hospital discharge: Retrospective cohort study. Int J Nurs Stud 2021; 117:103898. [PMID: 33636452 DOI: 10.1016/j.ijnurstu.2021.103898] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The benefits of breastfeeding for both mother and newborn have been widely demonstrated. However, breastfeeding rates at discharge are lower than recommended, so being able to identify women at risk of not breastfeeding at discharge could allow professionals to prioritise care. OBJECTIVE To develop and validate a predictive model of exclusive breastfeeding at hospital discharge. DESIGN Retrospective cohort study on women who gave birth between 2014 and 2019 in Spain. DATA SOURCES The data source was a questionnaire distributed through the Spanish breastfeeding associations. The development of the predictive model was made on a cohort of 3387 women and was validated on a cohort of 1694 women. A multivariate analysis was performed by means of logistic regression, and predictive ability was determined by areas under the ROC curve (AUC). RESULTS 80.2% (2717) women exclusively breastfed at discharge in the derivation cohort, and 82.1% (1390) in the validation cohort. The predictive factors in the final model were: maternal age at birth; BMI; number of children; previous breastfeeding; birth plan; induced birth; epidural analgesia; type of birth; prematurity; multiple pregnancy; macrosomia; onset of breastfeeding within the first hour; and skin-to-skin contact. The predictive ability (ROC AUC) in the derivation cohort was 0.76 (CI 95%: 0.74-0.78), while in the validation cohort it was 0.74 (CI 95%: 0.71-0.77). CONCLUSIONS A predictive model of exclusive maternal breastfeeding at hospital discharge has been developed, based on thirteen variables, with satisfactory predictive ability in both the derivation cohort and the validation cohort according to the Swets' criteria. This model can identify women who are at high risk of not breastfeeding at hospital discharge.
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Affiliation(s)
| | - Juan Gómez-Salgado
- PhD.Department of Sociology, Social Work and Public Health, University of Huelva, 21071 Huelva, Spain; Safety and Health Posgrade Program, Universidad Espíritu Santo, Guayaquil 091650, Ecuador.
| | - Julián Rodríguez-Almagro
- PhD. Department of Nursing. Ciudad Real School of Nursing, University of Castilla La-Mancha, Ciudad Real, Spain.
| | - Antonio Hernández-Martínez
- Msc. Department of Obstetrics & Gynaecology, Alcázar de San Juan, Ciudad Real, Spain; Safety and Health Posgrade Program, Universidad Espíritu Santo, Guayaquil 091650, Ecuador.
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16
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Chishom T, Stephens A, Raley S, Ange B, Looney S, Street L, Browne P. Amniotic fluid index curves in the obese gravida. J Neonatal Perinatal Med 2021; 14:131-137. [PMID: 32333553 DOI: 10.3233/npm-190290] [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: 11/15/2022]
Abstract
OBJECTIVE To determine whether amniotic fluid volume as measured by amniotic fluid index (AFI) is influenced by maternal pre-gestational obesity as measured by body mass index (BMI). METHODS This was a retrospective cohort study of pregnant women between 20 and 43 weeks gestation receiving ultrasounds with AFI measurements at Augusta University Medical Center between 2003 and 2017. A subset of 500 charts that met inclusion and exclusion criteria were reviewed to obtain maternal clinical data. The study cohort was subdivided by maternal BMI at initial obstetric visit into three groups: normal weight (18.5 kg/m2-24.9 kg/m2), overweight (25.0 kg/m2-29.9 kg/m2), and obese (≥ 30 kg/m2). Chi-square analysis was used to compare BMI groups in terms of categorical clinical characteristics and outcome variables, and analysis of variance (ANOVA) was used for continuous variables. Mixed effects regression models (MRMs) were used to evaluate AFI throughout gestation separately in each group, and MRM-based analysis of covariance was used to compare AFI throughout gestation among groups. AFI curves were constructed for the 5th, 50th, and 95th percentiles for all study subjects combined and separately for normal weight, overweight, and obese subjects. RESULTS Fitted curves relating AFI percentiles to estimated gestational age (EGA) showed statistically significant differences among BMI groups. There was also a significant difference in AFI over gestation across the obesity groups. CONCLUSION Fitted curves for AFI throughout pregnancy showed statistically significant differences among BMI groups.
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Affiliation(s)
- T Chishom
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Augusta University Medical Center at Medical College of Georgia, Augusta, GA, USA
| | - A Stephens
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Augusta University Medical Center at Medical College of Georgia, Augusta, GA, USA
| | - S Raley
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Augusta University Medical Center at Medical College of Georgia, Augusta, GA, USA
| | - B Ange
- Department of Biostatistics and Epidemiology at Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - S Looney
- Department of Biostatistics and Epidemiology at Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - L Street
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Augusta University Medical Center at Medical College of Georgia, Augusta, GA, USA
| | - P Browne
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Augusta University Medical Center at Medical College of Georgia, Augusta, GA, USA
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17
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Ducarme G, Planche L, Abet E, Desroys du Roure V, Ducet-Boiffard A. A Prospective Study of Association of Micronutrients Deficiencies during Pregnancy and Neonatal Outcome among Women after Bariatric Surgery. J Clin Med 2021; 10:E204. [PMID: 33429966 PMCID: PMC7826626 DOI: 10.3390/jcm10020204] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 11/17/2022] Open
Abstract
Little is known about the association of micronutrients deficiencies during pregnancy and neonatal outcome among women after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). We present a prospective study of 87 consecutive women with a history of RYGB (n = 37) or SG (n = 50) who underwent complete and regular clinical and biological nutritional assessments during pregnancy. Data on maternal characteristics, biological nutritional parameters, antenatal management, and perinatal outcome were collected. The objective was to evaluate serum levels of micronutrients at the second trimester, and to assess the association between micronutrients deficiencies and neonatal outcome. After RYGB, maternal age (34.3 ± 4.9 vs. 31.1 ± 4.6 years; p = 0.003) and pregnancy timing after surgery (64.5 ± 47.0 vs. 38.1 ± 28.1 months; p = 0.002) were significantly higher, and pre-pregnancy BMI was significantly lower (29.8 ± 5.6 vs. 32.9 ± 7.1 kg/m2; p = 0.03). Maternal and neonatal outcomes were similar. Additional supplementations after blood tests were similar in groups. Zinc, selenium, vitamins A1, B1, B6, C, and E levels were not different depending on the type of surgery. Zinc deficiency (7/87) was significantly more frequent after RYGP (18.9% vs. 0%; p = 0.02) and selenium deficiency (15/87) was similar in groups (21.6% after RYGB and 14.0% after SG; p = 0.36). The mean birth weight was significantly lower in selenium deficiency cases (3137 ± 550 vs. 3535 ± 737 g; p = 0.04). Selenium deficiency was negatively correlated with birth weight (r = -0.23; p = 0.03) and with birth weight z-score (r = -0.26; p = 0.01), but not correlated after adjustment for the procedure. The levels of micronutrients surveillance along pregnancy in women with a history of bariatric surgery is necessary to decrease the risk of inadequate fetal growth in the patients.
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Affiliation(s)
- Guillaume Ducarme
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France
| | - Lucie Planche
- Clinical Research Center, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France; (L.P.); (V.D.d.R.)
| | - Emeric Abet
- General Surgery Department, Bariatric Surgery Program, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France;
| | - Valérie Desroys du Roure
- Clinical Research Center, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France; (L.P.); (V.D.d.R.)
- Department of Biology, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France
| | - Amélie Ducet-Boiffard
- Department of Endocrinology, Bariatric Surgery Program, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France;
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18
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Malasevskaia I, Sultana S, Hassan A, Hafez AA, Onal F, Ilgun H, Heindl SE. A 21st Century Epidemy-Obesity: And Its Impact on Pregnancy Loss. Cureus 2021; 13:e12417. [PMID: 33542866 PMCID: PMC7847782 DOI: 10.7759/cureus.12417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The prevalence of obesity among women of reproductive age is growing significantly over the last years. Being obese or having a high body mass index (BMI) contributes to many diseases and pregnancy complications. This is concerning as an obese woman is at increased risk for developing several complications during pregnancy and is at increased risk for pregnancy loss, stillbirth, and metabolic disorders of a live-born child in his future. The pregnant woman's body mass index has to be monitored well during the whole pregnancy, and their diet should also be monitored to avoid future complications. Better results can be achieved if every woman would watch their weight before being pregnant for better outcomes in their future pregnancies. This review article aimed to determine the relationship between being obese or having a high BMI and pregnancy loss. Additionally, we tried to find the mechanism that is involved in pregnancy loss in obese women.
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Affiliation(s)
- Iana Malasevskaia
- Obstetrics and Gynecology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Salma Sultana
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aiman Hassan
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Azza A Hafez
- Anesthesiology and Critical Care, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Fethi Onal
- Anesthesiology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Handenur Ilgun
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Stacey E Heindl
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Medicine, Avalon University School of Medicine, Willemstad, CUW
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19
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Wang T, Li L, Wu C, Cao R, Li Q, Yu L, Chen Y. Body Mass Index and Gestational Weight Gain Are Associated with Maternal and Neonatal Outcomes Based on Chinese Women. J Diabetes Res 2021; 2021:4542367. [PMID: 34869777 PMCID: PMC8635902 DOI: 10.1155/2021/4542367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
The objective of the study is to analyze the association between early pregnancy body mass index (BMI), gestational weight gain (GWG), and maternal and neonatal outcomes. The retrospective cohort study was conducted at Quanzhou First Hospital Affiliated to Fujian Medical University from January 2018 to May 2021, with 552 women enrolled. Women were divided into the underweight group, normal weight group, overweight group, and obese group according to early pregnancy BMI. Univariate and multivariate logistic regression analyses were performed. The absolute risk of adverse maternal and neonatal outcomes in the early pregnancy BMI group was calculated to further analyze the association between GWG and adverse maternal and neonatal outcomes. Of the 552 women, 390 (70.65%) women had adverse maternal and neonatal outcomes. The result revealed that overweight was associated with increased risk of adverse maternal and neonatal outcomes (odds ratio (OR): 1.643, 95% confidence interval (CI): 1.006-2.684), maternal complications (OR: 1.937, 95% CI: 1.188-3.159), and large for gestational age (LGA) (OR: 1.905, 95% CI: 1.061-3.422). In the obese group, the risk of adverse maternal and neonatal outcomes (OR: 5.760, 95% CI: 1.997-16.786), maternal complications (OR: 3.112, 95% CI: 1.645-5.887), gestational diabetes mellitus (GDM) (OR: 2.943, 95% CI: 1.509-5.741), cesarean section (OR: 1.899, 95% CI: 1.002-3.599), and preterm delivery (OR: 4.752, 95% CI: 1.395-16.185) increased. Besides, there was an association between insufficient GWG and decreased risk of LGA (OR: 0.392, 95% CI: 0.187-0.826) and higher risk of preterm delivery (OR: 2.818, 95% CI: 1.171-6.784). This study demonstrates that BMI and GWG are related to maternal and neonatal outcomes. It is necessary to regularly monitor the weight of pregnant women during pregnancy. And regional guidelines for GWG also need to be explored.
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Affiliation(s)
- Tingzhao Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Obstetrics and Gynecology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, China
| | - Lichun Li
- Department of Obstetrics and Gynecology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, China
| | - Chunchun Wu
- Department of Obstetrics and Gynecology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, China
| | - Rong Cao
- Department of Obstetrics and Gynecology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, China
| | - Qingli Li
- Department of Obstetrics and Gynecology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, China
| | - Liji Yu
- Department of Obstetrics and Gynecology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, China
| | - Youguo Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
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20
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Dalbye R, Gunnes N, Blix E, Zhang J, Eggebø T, Nistov Tokheim L, Øian P, Bernitz S. Maternal body mass index and risk of obstetric, maternal and neonatal outcomes: A cohort study of nulliparous women with spontaneous onset of labor. Acta Obstet Gynecol Scand 2020; 100:521-530. [PMID: 33031566 DOI: 10.1111/aogs.14017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/21/2020] [Accepted: 09/30/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION This study investigates associations between maternal body mass index (BMI) early in pregnancy and obstetric interventions, maternal and neonatal outcomes. MATERIAL AND METHODS This is a cohort study of nulliparous women originally included in a cluster randomized controlled trial carried out at 14 Norwegian obstetric units between 2014 and 2017. The sample included 7189 nulliparous women with a singleton fetus, cephalic presentation and spontaneous onset of labor at term, denoted as group 1 in the Ten-Group Classification System. The women were grouped according to the World Health Organization BMI classifications: underweight (BMI <18.5), normal weight (BMI 18.5-24.9), pre-obesity (BMI 25.0-29.9), obesity class I (BMI 30.0-34.9), and obesity classes II and III (BMI ≥35.0). We used binary logistic regression to estimate crude and adjusted odds ratios (ORs) of the interventions and outcomes, with associated 95% confidence intervals (CIs), comparing women in different BMI groups with women of normal weight. RESULTS We found an increased risk of intrapartum cesarean section in women of obesity class I and obesity classes II and III, with adjusted OR of 1.70 (95% CI 1.21-2.38) and 2.31 (95% CI 1.41-3.77), respectively. Women in obesity groups had a gradient of risk of epidural analgesia and use of continuous CTG (including STAN), with adjusted OR of 2.39 (95% CI 1.69-3.38) and 3.28 (95% CI 1.97-5.48), respectively. Women in obesity classes II and III had higher risk of amniotomy (adjusted OR = 1.42, 95% CI 1.02-1.96), oxytocin augmentation (adjusted OR = 1.54, 95% CI 1.11-2.15), obstetric anal sphincter injuries (adjusted OR = 2.21, 95% CI 1.01-4.85) and postpartum hemorrhage ≥1000 mL (adjusted OR = 2.20, 95% CI 1.29-3.78). We found a reduced likelihood of spontaneous vaginal delivery for pre-obese women (adjusted OR = 0.85, 95% CI 0.74-0.97) and no associations between maternal BMI and neonatal outcomes. CONCLUSIONS Obese women in Ten-Group Classification System group 1 had increased risks of obstetric interventions and maternal complications. There was a gradient of risk for intrapartum cesarean section, with the highest risk for women in obesity classes II and III. No associations between maternal BMI and neonatal outcomes were observed.
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Affiliation(s)
- Rebecka Dalbye
- Department of Obstetrics and Gynecology, Østfold Hospital Trust, Grålum, Norway
| | - Nina Gunnes
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway
| | - Ellen Blix
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Jun Zhang
- Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Torbjørn Eggebø
- National Center for Fetal Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - Linn Nistov Tokheim
- Department of Obstetrics and Gynecology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Pål Øian
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Norway, Tromsø, Norway
| | - Stine Bernitz
- Department of Obstetrics and Gynecology, Østfold Hospital Trust, Grålum, Norway.,Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
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21
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Farshbaf-Khalili A, Alizadeh M, Hajebrahimi S, Ostadrahimi A, Malakouti J, Salehi-Pourmehr H. Pre-natal and post-natal anxiety in relation to pre-pregnancy obesity: A cohort study on Iranian pregnant women. CASPIAN JOURNAL OF INTERNAL MEDICINE 2020; 11:250-258. [PMID: 32874431 PMCID: PMC7442456 DOI: 10.22088/cjim.11.3.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: To determine the association between pre-conception obesity and screening results of pre-natal and post-natal anxiety in women that referred to the health centers of Tabriz, Iran. Methods: 62 obese (class 2-3) and 245 normal-weight women were enrolled in the first trimester of pregnancy through the cohort study and followed-up 1 year after childbirth from December 2012 to January 2016. The Beck anxiety inventory scale (BAI-II) was completed in five time points: the first, second, third trimester of pregnancy, 6–8 weeks and 12 months after childbirth. Chi-square, Fisher’s exact tests, Independent t-test, Mann-Whitney, and multivariate logistic regression adjusted for confounders were used for data analysis. Statistically significant was considered as p<0.05. Results: The rate of moderate to severe anxiety in 1st, 2nd, 3rd trimesters of gestation, 6–8 weeks and 12 months after birth was 8.6%, 10%, 12.6%, 7.8%, 6.5% in normal weight women versus 18%, 17.9%, 19.2%, 12.5%, 19.4% in obese class II women, respectively. The odds of anxiety in the first trimester of pregnancy for class 2–3 obesity was 2.72-fold greater than normal weight group [adjusted odds ratio (aOR) 2.72, 95% confidence interval (CI) 1.14–6.47; p=0.023]. This odd was 3.30- fold (aOR 3.30, 95%CI 1.13-9.60; p=0.045) for 1 year after birth. Conclusion: Obesity remained associated with positive screening for anxiety in the first trimester of pregnancy and one year after birth. Obese women more likely require special medical care during their pregnancy due to its impacts on mood.
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Affiliation(s)
- Azizeh Farshbaf-Khalili
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences Tabriz, IR Iran
| | | | - Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Urology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Alireza Ostadrahimi
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Jamileh Malakouti
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
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22
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Lee SM, Park JS, Han YJ, Kim W, Bang SH, Kim BJ, Park CW, Kim MY. Elevated Alanine Aminotransferase in Early Pregnancy and Subsequent Development of Gestational Diabetes and Preeclampsia. J Korean Med Sci 2020; 35:e198. [PMID: 32627436 PMCID: PMC7338210 DOI: 10.3346/jkms.2020.35.e198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/27/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is now considered as a hepatic manifestation of metabolic syndrome and elevated alanine aminotransferase (ALT) is commonly related to NAFLD in the absence of viral hepatitis or alcohol abuse. Previous studies have indicated that elevated ALT is associated with diabetes or metabolic syndrome in adults, but the clinical significance of ALT or NAFLD in pregnancy has not been well determined. The objective of this study was to determine the association between elevated ALT in early pregnancy and the development of gestational diabetes or preeclampsia in late pregnancy. METHODS In this retrospective cohort study, pregnant women who met the following inclusion criteria were included: 1) singleton pregnancy; 2) ALT levels were measured in antenatal outpatient clinic at 4-20 weeks of gestation; 3) patients were screened for gestational diabetes and delivered in Cheil General Hospital and Women's Healthcare Center. Cases with viral hepatitis or other liver diseases were excluded. The early ALT levels were divided into two groups (normal ALT [≤ 95th percentile] and elevated ALT [> 95th percentile]), and the frequency of gestational diabetes and preeclampsia was compared between the two groups of cases. Gestational diabetes was screened and diagnosed by two-step procedure (50 g oral glucose challenge test and 75 g glucose challenge test with World Health Organization [WHO] criteria). RESULTS A total of 2,322 women met the inclusion criteria. Cases with elevated early ALT levels (> 95th percentile) had a higher risk of subsequent gestational diabetes and preeclampsia (gestational diabetes by WHO criteria, 2.1% in normal ALT vs. 6.5% in elevated ALT, P < 0.01; preeclampsia, 1.0% in normal ALT vs. 4.1% in elevated ALT, P < 0.05). This relationship between elevated ALT and increased risk of gestational diabetes/preeclampsia remained significant after adjustment for maternal age and pre-pregnancy body mass index. CONCLUSION Elevated unexplained ALT in early pregnancy is associated with the risk of subsequent development of gestational diabetes and preeclampsia in late pregnancy.
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Affiliation(s)
- Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - You Jung Han
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Won Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seung Hyun Bang
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Byoung Jae Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Chan Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Moon Young Kim
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea.
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23
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Polymorphism analysis of the Gly972Arg IRS-1 and Gly1057Asp IRS-2 genes in obese pregnant women. Reprod Biol 2020; 20:365-370. [PMID: 32540195 DOI: 10.1016/j.repbio.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/27/2020] [Accepted: 05/08/2020] [Indexed: 11/21/2022]
Abstract
Genes encoding insulin receptor substrates IRS-1 and IRS-2 perform key functions in the insulin pathway. Numerous authors have suggested that single-nucleotide polymorphism (SNP) changes in the DNA sequence may be associated with the development of obesity, insulin resistance and type 2 diabetes. The Gly972Arg polymorphism of the IRS-1 gene and the Gly1057Asp polymorphism of the IRS-2 gene are believed to be associated with the occurrence of insulin resistance and obesity according to many sources. The aim of our study was to investigate the influence of these polymorphisms on the clinical parameters and to assess their correlations in obese Polish pregnant women. A total of 154 pregnant Caucasian women from the Wielkopolska region were analyzed: 78 diagnosed with overweight or obesity (study group) and 76 with normal body mass (controls). The analysis of the polymorphisms was performed using the PCR-restriction fragment length polymorphism (PCR-RFLP) method. The IRS-2 Gly1057Asp polymorphism revealed no significant correlations with excessive weight gain during pregnancy. The analysis of the IRS-1 Gly972Arg polymorphism showed an association with obesity between the study and control groups (GG-80.77%, GR-17.95%, RR-1.28% vs GG-94.74%, GR-5.26%; p = 0.023). We also observed slightly increased BMI values and higher values of the waist and hip circumference before pregnancy in the case of the IRS-1 Gly972Arg polymorphism. The analysis of the clinical and anthropometric parameters demonstrated no significant relationships between the genotypes of the polymorphic variants of the IRS-1 and IRS-2 genes but suggested an association between the IRS-1 Gly972Arg polymorphism and the risk for obesity.
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Ásbjörnsdóttir B, Vestgaard M, Ringholm L, Andersen LLT, Jensen DM, Damm P, Mathiesen ER. Effect of motivational interviewing on gestational weight gain and fetal growth in pregnant women with type 2 diabetes. BMJ Open Diabetes Res Care 2019; 7:e000733. [PMID: 31798895 PMCID: PMC6861008 DOI: 10.1136/bmjdrc-2019-000733] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/25/2019] [Accepted: 10/01/2019] [Indexed: 12/11/2022] Open
Abstract
Objective To study how lifestyle coaching with motivational interviewing to improve adherence to healthy eating affects gestational weight gain and fetal growth in pregnant women with type 2 diabetes in a real-world setting. Research design and methods A cohort study including a prospective intervention cohort of consecutive, singleton pregnant, Danish-speaking women with type 2 diabetes included between August 2015 and February 2018 and a historical reference cohort included between February 2013 and August 2015. The intervention consisted of a motivational interviewing to improve adherence to healthy eating in addition to routine care. The reference cohort received routine care only. The main outcomes were gestational weight gain and large for gestational age (LGA) infants. Results Ninety-seven women were included in the intervention cohort and 92 in the reference cohort. Pre-pregnancy body mass index (32.8±6.9 kg/m2 vs 32.4±7.4 kg/m2, p=0.70), gestational weight gain (9.2±5.8 kg vs 10.2±5.8 kg, p=0.25), HbA1c in early pregnancy (6.7%±1.1% vs 6.5%±1.3% (50±12 mmol/mol vs 48±14 mmol/mol), p=0.32) and late pregnancy (5.9%±0.5% vs 6.0%±0.6% (41±6 mmol/mol vs 42±7 mmol/mol), p=0.34) were comparable in the two cohorts. LGA infants occurred in 20% vs 31%, p=0.07, respectively, and after adjustment for maternal characteristics 14% vs 27% delivered LGA infants (p=0.04). Birth weight z-score was 0.24±1.36 vs 0.61±1.38, p=0.06. Conclusions Motivational interviewing to improve adherence to healthy eating in addition to routine care in pregnant women with type 2 diabetes tended to reduce fetal overgrowth without major effect on gestational weight gain. Further studies investigating the cost-benefit of enhancing motivation are needed. Trial registration number NCT02883127.
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Affiliation(s)
- Björg Ásbjörnsdóttir
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen Ø, Denmark
- The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Vestgaard
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen Ø, Denmark
- The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lene Ringholm
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen Ø, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Dorte Møller Jensen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Steno Diabetes Center Odense, Odense, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen Ø, Denmark
- The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen Ø, Denmark
- The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Majeed A, Abuhamad A, Romary L, Sinkovskaya E. Can Ultrasound in Early Gestation Improve Visualization of Fetal Cardiac Structures in Obese Pregnant Women? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2057-2063. [PMID: 30561065 DOI: 10.1002/jum.14895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 11/09/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To determine whether ultrasound (US) imaging of obese pregnant women in early gestation improves fetal cardiac visualization. METHODS We report a prospective longitudinal trial comparing late first- and early second-trimester US to traditional second-trimester US for fetal cardiac screening in maternal obesity. All study participants received US for fetal cardiac screening at a gestational age of 13 weeks to 15 weeks 6 days using a transvaginal or transabdominal approach (UST1). All patients also underwent a traditional transabdominal examination at 20 to 22 weeks (UST2). If UST2 failed to complete the cardiac visualization, a follow up examination (second UST2) was performed 2 to 4 weeks later. Imaging was considered complete if the visceral situs, 4 chambers, outflow tracts, and 3 vessels were visualized. The completion rates between UST1 and UST2 were the primary outcomes. A power analysis (85%) and sample size calculation (n = 145) were performed. RESULTS A total of 152 pregnancies met study criteria. Completion rates of cardiac screening were 77% for UST1 and 70% for UST2 (P = .143). This comparison reached statistical significance in patients with a body mass index of greater than 40 kg/m2 (UST1 [69%] versus UST2 [38%]; P = .001). Sixty-two percent of patients with a body mass index of greater than 40 kg/m2 required second UST2. The highest fetal cardiac screening completion rate was achieved when UST1 was combined with UST2 (96.1%). In 1 fetus, congenital heart disease was detected at UST1 and later confirmed. CONCLUSIONS This study represents the largest prospective trial assessing early-gestation US for fetal cardiac screening in the setting of maternal obesity. In obese pregnancies, the addition of early-gestation US to the 20- to 22-week US substantially improves the visualization of fetal cardiac anatomy.
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Affiliation(s)
- Amara Majeed
- Departments of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Alfred Abuhamad
- Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Letty Romary
- Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Elena Sinkovskaya
- Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA
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Gonzalez-Ballano I, Saviron-Cornudella R, Esteban LM, Sanz G, Castán S. Pregestational body mass index, trimester-specific weight gain and total gestational weight gain: how do they influence perinatal outcomes? J Matern Fetal Neonatal Med 2019; 34:1207-1214. [PMID: 31170838 DOI: 10.1080/14767058.2019.1628942] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the association between pre-gestational body mass index (BMI), total gestational weight gain (GWG), and/or trimester-specific weight gain (GWGT) with adverse maternal or perinatal outcomes (AMPOs). MATERIALS AND METHODS Maternal clinical characteristics and pregnancy and perinatal outcomes were used to predict AMPOs. The predictive ability of BMI, GWG, or GWGT for AMPOs was analyzed using the area under the curve (AUC). Logistic regression models in a univariate and multivariate analysis were performed to estimate the odds ratios (OR) and 95% confidence intervals (CI) to predict maternal outcomes (pregnancy-induced hypertension, preeclampsia or gestational diabetes mellitus) and perinatal outcomes (small for gestational age, large for gestational age, 5-min Apgar score, admission to neonatal intensive care unit or umbilical cord pH <7.15). RESULTS Women with AMPOs (n = 293) were younger with higher rate of nulliparity (p < .001) and with lower height (p = .018) as compared to controls (n = 134). In the univariate study, GWGT in third trimester was associated with double risk of pregnancy-induced hypertension (OR 2.00; 95% CI, 1.01-3.97). Nonetheless, third-trimester GWG and total GWG have a negative relationship with gestational diabetes mellitus OR 0.32 (95% CI, 0.18-0.58) and OR 0.35 (95% CI, 0.21-0.59), respectively. Women with greater overall and in second trimester, GWG have a lower risk of having SGA neonates, OR 0.62 (95% CI, 0.39-0.98) and OR 0.60 (95% CI, 0.37-0.98), respectively. In the multivariate study, pre-gestational BMI is strongly related to the development of preeclampsia and the area under the curve (AUC) of the combination of pre-gestational BMI and total weight gain was 0.832 (95% CI, 0.63-0.81) for preeclampsia and 0.719 (95% CI, 0.71-0.94) for gestational diabetes mellitus. CONCLUSION Our results suggest than timing of gestational weight gain influence in maternal and perinatal outcomes. Pre-gestational BMI is a determinant of preeclampsia, maternal weight gain in the third trimester is a determinant of pregnancy-induced hypertension and the increase in total GWG reduces the risk of gestational diabetes mellitus and small for gestational age.
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Affiliation(s)
- Isabel Gonzalez-Ballano
- Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Luis Mariano Esteban
- Escuela Universitaria Politécnica de la Almunia, Universidad de Zaragoza, La Almunia de Doña Godina, Spain
| | - Gerardo Sanz
- Department of Statistical Methods and Institute for Biocomputation and Physics of Complex Systems-BIFI, Universidad de Zaragoza, Zaragoza, Spain
| | - Sergio Castán
- Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Furukawa S, Kobayashi Y. Leaner Women with Impaired Insulin Secretion Accounts for about 40% of Gestational Diabetes Mellitus in Japan. J Pregnancy 2019; 2019:7578403. [PMID: 31275653 PMCID: PMC6582796 DOI: 10.1155/2019/7578403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/02/2019] [Indexed: 12/28/2022] Open
Abstract
AIM To identify the involvement of leanness and impaired insulin secretion with Japanese gestational diabetes mellitus (GDM). METHOD A cross-sectional study was conducted comprising 219 at-risk pregnant women who underwent a 75g glucose tolerance test at a single institute in Tokyo, Japan. We identified GDM and normal glucose tolerance (NGT). The cut-off value of the homeostasis model assessment insulin resistance (HOMA-IR) for detecting GDM was determined. The GDM group was divided into subgroups according to insulin resistance based on the cut-off value of HOMA-IR. We compared the prepregnancy body mass index (BMI) and homeostasis model assessment of β-cell function (HOMA-β) between the group comprising low insulin resistance (LIR) and the group comprising high insulin resistance (HIR). RESULTS Seventy GDM cases and 149 NGT cases were identified. By using receiver operating characteristic curve analysis, the HOMA-IR cut-off value was determined to be 1.41. Twenty-five GDM cases (36%) were classified as LIR and forty-five GDM cases (64%) were classified as HIR. The background including indications for having 75gOGTT and the gestational age having 75gOGTT did not differ between groups. The BMI of the LIR group was significantly lower than that of the HIR group (20.9±2.8 vs. 24.4 ± 5.5, p<0.01), and the HOMA-β of the LIR group was significantly lower than that of the HIR group (95.5±30.3 vs. 146.0±70.1, p<0.01). A positive linear correlation was found between BMI and HOMA-β in cases of GDM (r=0.27, p=0.02). CONCLUSION Leanness with impaired insulin secretion is deeply involved in Japanese gestational diabetes mellitus.
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Affiliation(s)
- Seishi Furukawa
- Department of Obstetrics & Gynecology, School of Medicine, Kyorin University, Tokyo, Japan
| | - Yoichi Kobayashi
- Department of Obstetrics & Gynecology, School of Medicine, Kyorin University, Tokyo, Japan
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28
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Moreau JLM, Kesteven S, Martin EMMA, Lau KS, Yam MX, O'Reilly VC, Del Monte-Nieto G, Baldini A, Feneley MP, Moon AM, Harvey RP, Sparrow DB, Chapman G, Dunwoodie SL. Gene-environment interaction impacts on heart development and embryo survival. Development 2019; 146:146/4/dev172957. [PMID: 30787001 DOI: 10.1242/dev.172957] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/22/2019] [Indexed: 12/15/2022]
Abstract
Congenital heart disease (CHD) is the most common type of birth defect. In recent years, research has focussed on identifying the genetic causes of CHD. However, only a minority of CHD cases can be attributed to single gene mutations. In addition, studies have identified different environmental stressors that promote CHD, but the additive effect of genetic susceptibility and environmental factors is poorly understood. In this context, we have investigated the effects of short-term gestational hypoxia on mouse embryos genetically predisposed to heart defects. Exposure of mouse embryos heterozygous for Tbx1 or Fgfr1/Fgfr2 to hypoxia in utero increased the incidence and severity of heart defects while Nkx2-5+/- embryos died within 2 days of hypoxic exposure. We identified the molecular consequences of the interaction between Nkx2-5 and short-term gestational hypoxia, which suggest that reduced Nkx2-5 expression and a prolonged hypoxia-inducible factor 1α response together precipitate embryo death. Our study provides insight into the causes of embryo loss and variable penetrance of monogenic CHD, and raises the possibility that cases of foetal death and CHD in humans could be caused by similar gene-environment interactions.
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Affiliation(s)
- Julie L M Moreau
- Developmental and Stem Cell Biology Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales 2010, Australia.,St Vincent's Clinical School, University of New South Wales, Kensington, New South Wales 2010, Australia
| | - Scott Kesteven
- Cardiac Physiology and Transplantation Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales 2010, Australia
| | - Ella M M A Martin
- Developmental and Stem Cell Biology Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales 2010, Australia
| | - Kin S Lau
- Developmental and Stem Cell Biology Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales 2010, Australia
| | - Michelle X Yam
- Developmental and Stem Cell Biology Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales 2010, Australia
| | - Victoria C O'Reilly
- Developmental and Stem Cell Biology Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales 2010, Australia
| | - Gonzalo Del Monte-Nieto
- Developmental and Stem Cell Biology Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales 2010, Australia.,St Vincent's Clinical School, University of New South Wales, Kensington, New South Wales 2010, Australia
| | - Antonio Baldini
- Dept. of Molecular Medicine and Medical Biotechnologies, University Federico II, Naples, and Institute of Genetics and Biophysics, CNR, Via Pietro Castellino 111, 80131 Naples, Italy
| | - Michael P Feneley
- St Vincent's Clinical School, University of New South Wales, Kensington, New South Wales 2010, Australia.,Cardiac Physiology and Transplantation Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales 2010, Australia.,Cardiology Department, St. Vincent's Hospital, Darlinghurst, New South Wales 2010, Australia
| | - Anne M Moon
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Clinic, Danville, PA 17822, USA
| | - Richard P Harvey
- Developmental and Stem Cell Biology Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales 2010, Australia.,St Vincent's Clinical School, University of New South Wales, Kensington, New South Wales 2010, Australia.,School of Biotechnology and Biomolecular Science, University of New South Wales, Kensington, New South Wales 2033, Australia
| | - Duncan B Sparrow
- Developmental and Stem Cell Biology Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales 2010, Australia.,Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford OX1 3PT, UK
| | - Gavin Chapman
- Developmental and Stem Cell Biology Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales 2010, Australia.,St Vincent's Clinical School, University of New South Wales, Kensington, New South Wales 2010, Australia
| | - Sally L Dunwoodie
- Developmental and Stem Cell Biology Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales 2010, Australia .,St Vincent's Clinical School, University of New South Wales, Kensington, New South Wales 2010, Australia.,School of Biotechnology and Biomolecular Science, University of New South Wales, Kensington, New South Wales 2033, Australia
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Soni S, Pappas K, Lesser ML, Blitz MJ, Augustine SA, Rochelson B. Is vaginal misoprostol more effective than oral misoprostol for cervical ripening in obese women? J Matern Fetal Neonatal Med 2019; 33:3476-3483. [PMID: 30741048 DOI: 10.1080/14767058.2019.1575684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective: To determine if vaginal misoprostol is more effective than oral misoprostol for cervical ripening in obese women.Study design: A retrospective cohort study of obese women undergoing induction of labor from Jan 2013 to Dec 2016 with singleton, viable pregnancies beyond 37 completed weeks of gestational age. Women with an initial Bishop score of 7 or less, with a cervical dilatation of less than 2 cm, who received either vaginal or oral misoprostol as a cervical ripening agent, were included. Primary outcome was interval from the start of induction to the attainment of 3 cm cervical dilatation. Secondary outcomes included the interval from the start of induction to delivery and the rate of cesarean delivery (CD).Result: Of women who met the inclusion criteria, 966 (75.5%) women received oral misoprostol and 314 (24.5%) received vaginal misoprostol. The mean time-interval from the start of induction to attainment of 3-cm dilatation was shorter in the vaginal group (10.5 ± 10.4 h) compared to the oral group (17.2 ± 11.5 h), (p < .0001). Significantly shorter times to delivery were also noted in the vaginal group (17.4 h for vaginal vs. 24.8 h for oral, p < .0001). In the subgroup analysis of nulliparous women, shorter time intervals from the start of induction to attainment of 3-cm dilatation, as well as to delivery, were noted in the vaginal misoprostol group (p < .0001 for both). Multiple linear regression model confirmed route of misoprostol administration as an independent variable in predicting the outcomes (time from start of induction to 3 cm as well as to delivery). Significant findings amongst neonatal outcomes included lower umbilical artery pH and higher rates of neonatal jaundice in the oral misoprostol group.Conclusion: In a population of obese women undergoing induction of labor, vaginal administration of misoprostol was associated shorter time intervals from the start of induction to the attainment of 3 cm of dilatation, as well as to delivery, without increasing the rate of cesarean deliveries or the incidence of adverse maternal and neonatal outcomes.
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Affiliation(s)
- Shelly Soni
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Donald Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Karalyn Pappas
- Biostatistics Unit, The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Martin L Lesser
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Donald Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA.,Biostatistics Unit, The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Matthew J Blitz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Donald Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Stephanie A Augustine
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Donald Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Burton Rochelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Donald Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
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Quality of Maternal Height and Weight Data from the Revised Birth Certificate and Pregnancy Risk Assessment Monitoring System. Epidemiology 2019; 30:154-159. [DOI: 10.1097/ede.0000000000000936] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Arredondo A, Torres C, Orozco E, Pacheco S, Huang F, Zambrano E, Bolaños‐Jiménez F. Socio‐economic indicators, dietary patterns, and physical activity as determinants of maternal obesity in middle‐income countries: Evidences from a cohort study in Mexico. Int J Health Plann Manage 2018; 34:e713-e725. [DOI: 10.1002/hpm.2684] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 11/07/2022] Open
Affiliation(s)
| | | | | | | | | | - Elena Zambrano
- National Institute of Nutrition “Salvador Zubirán” México City Mexico
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Dodd JM, Grivell RM, Deussen AR, Hague WM. Metformin for women who are overweight or obese during pregnancy for improving maternal and infant outcomes. Cochrane Database Syst Rev 2018; 7:CD010564. [PMID: 30039871 PMCID: PMC6513233 DOI: 10.1002/14651858.cd010564.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND There has been considerable interest in providing antenatal dietary and lifestyle advice for women with obesity or who are overweight during pregnancy, as a strategy to limit gestational weight gain and improve maternal and infant health. However, such antenatal interventions appear to have a modest effect on gestational weight gain and other clinical pregnancy and birth outcomes and additional strategies are required.Metformin is an oral insulin-sensitising medication that acts to decrease blood glucose concentrations. Metformin is commonly used in the treatment of type 2 diabetes mellitus and polycystic ovarian syndrome, and is being used increasingly in the treatment of gestational diabetes, having been shown to result in decreased rates of caesarean birth and neonatal hypoglycaemia. Metformin may be an adjuvant therapy to current antenatal strategies in pregnant women with obesity or who are overweight, acting to reduce glucose production in the liver and improve glucose uptake in smooth muscle cells, and therefore improve the overall metabolic health of women in pregnancy and reduce the risk of known adverse pregnancy outcomes. OBJECTIVES To evaluate the role of metformin in pregnant women with obesity or who are overweight, on maternal and infant outcomes, including adverse effects of treatment and costs. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (11 October 2017), and reference lists of retrieved studies. SELECTION CRITERIA All published and unpublished randomised controlled trials evaluating metformin use (compared with placebo or no metformin) in women with obesity or who are overweight in pregnancy for improving outcomes, alone or in combination with other interventions were eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We used the GRADE approach to assess the quality of the evidence. MAIN RESULTS We included three studies which randomised women (1099) with a body mass index (BMI) of 30 kg/m2 (1 study) and 35 kg/m2 (2 studies), with outcomes available for 1034 participants. None of the studies assessed women with a BMI between 25 kg/m2and 29.9 kg/m2, therefore we could not assess the use of metformin in women considered overweight. We did not identify studies of metformin in combination with another treatment. Two other studies are ongoing.All three included studies were randomised controlled trials and compared metformin with placebo, commencing early in the second trimester. Doses ranged from 500 mg twice daily to 3.0 g per day. All three studies (two in the UK, one in Egypt) included women attending hospitals for antenatal care.Two studies were generally at a low risk of bias across the majority of domains. We assessed the third study as being at an unclear risk of selection bias, performance and detection bias due to insufficient information in the report. We assessed the trial as being at a low risk of attrition bias and other bias; we felt it was at a high risk of reporting bias.The primary outcome for this review was infant birthweight large-for-gestational-age (> 90th centile for gestational age and infant sex). Women who received metformin or placebo had a similar risk of their baby being born large for his or her gestational age (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.70 to 1.30; 2 studies, 831 infants; high-quality evidence).Women who received metformin may have a slightly lower gestational weight gain (mean difference (MD) -2.60 kg, 95% CI -5.29 to 0.10; 3 studies, 899 women; low-quality evidence).Metformin may make little or no difference in the risk of women developing gestational hypertension (average RR 1.02, 95% CI 0.54 to 1.94; 3 studies, 1040 women; low-quality evidence) or pre-eclampsia (RR 0.74, 95% CI 0.09 to 6.28; 2 studies, 840 women; low-quality evidence). Metformin probably makes little or no difference in the risk of women developing gestational diabetes (RR 0.85, 95% CI 0.61 to 1.19; 3 studies, 892 women; moderate-quality evidence).One study of 400 women reported women receiving metformin were more likely to experience any adverse effect compared with women receiving placebo (RR 1.63, 95% CI 1.27 to 2.08; 1 study, 400 women). Adverse effects included abdominal pain, diarrhoea, or headache. When considering individual side effects, women receiving metformin were more likely to experience diarrhoea than women receiving placebo (RR 2.34, 95% CI 1.74 to 3.14; 797 women; 2 studies, 797 women; high-quality evidence). No other important differences were identified between Metformin and placebo for other maternal secondary outcomes, including: caesarean birth, birth before 37 weeks of pregnancy, shoulder dystocia, perineal tear, or postpartum haemorrhage.In terms of other infant outcomes, there was little or no difference in the infant birthweight (MD 6.39 g, 95% CI -81.15 to 93.92; 2 studies, 834 infants; high-quality evidence). There were no other important differences identified for other infant secondary outcomes in this review: hypoglycaemia (low blood sugar); hyperbilirubinaemia (jaundice); Apgar score less than 7 at five minutes; or stillbirth and neonatal death. Only one study reported admission to the neonatal intensive care unit (NICU), indicating similar rates of admission between women receiving metformin or placebo; no other admission data were reported to assess differences in costs. AUTHORS' CONCLUSIONS There is insufficient evidence to support the use of metformin for women with obesity in pregnancy for improving maternal and infant outcomes. Metformin was, however, associated with increased risk of adverse effects, particularly diarrhoea. The quality of the evidence in this review varied from high to low, with downgrading decisions based on study limitations and inconsistency.There were only a small number of studies included in this review. Furthermore, none of the included studies included women categorised as 'overweight' and no trials looked at metformin in combination with another treatment.Future research is required in order to further evaluate the role of metformin therapy in pregnant women with obesity or who are overweight, as a strategy to improve maternal and infant health, alone or as an adjuvant to dietary and lifestyle advice.
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Affiliation(s)
- Jodie M Dodd
- The University of Adelaide, Women's and Children's HospitalSchool of Paediatrics and Reproductive Health, Discipline of Obstetrics and Gynaecology72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Rosalie M Grivell
- Flinders University and Flinders Medical CentreDepartment of Obstetrics and GynaecologyBedford ParkSouth AustraliaAustraliaSA 5042
| | - Andrea R Deussen
- The University of Adelaide, Women's and Children's HospitalSchool of Paediatrics and Reproductive Health, Discipline of Obstetrics and Gynaecology72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - William M Hague
- Women's and Children's HospitalKing William RoadAdelaideSouth AustraliaAustraliaSA 5006
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Mocking M, Savitri AI, Uiterwaal CSPM, Amelia D, Antwi E, Baharuddin M, Grobbee DE, Klipstein-Grobusch K, Browne JL. Does body mass index early in pregnancy influence the risk of maternal anaemia? An observational study in Indonesian and Ghanaian women. BMC Public Health 2018; 18:873. [PMID: 30005609 PMCID: PMC6045841 DOI: 10.1186/s12889-018-5704-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 06/12/2018] [Indexed: 11/24/2022] Open
Abstract
Background Anaemia is common among pregnant women, especially in low- and middle-income countries (LMICs). While body mass index (BMI) relates to many risk factors for anaemia in pregnancy, little is known about the direct relation with anaemia itself. This is particularly relevant in Southeast Asia and Sub-Saharan Africa where the prevalence of anaemia in pregnancy and the associated adverse outcomes is among the highest worldwide. This study aimed to assess the association between early pregnancy BMI and anaemia at first antenatal care visit in Indonesian and Ghanaian women. In addition, the associations between early pregnancy anaemia and adverse birth outcomes was assessed. Methods Prospective cohort studies of women in early pregnancy were conducted in Jakarta, Indonesia (n = 433) and in Accra, Ghana (n = 946), between 2012 and 2014. Linear regression analysis was used to assess relations between early pregnancy BMI and pregnancy haemoglobin levels at booking. Logistic regression analyses were used to assess associations between early pregnancy anaemia as defined by the World Health Organization (WHO) criteria and a composite of adverse birth outcomes including stillbirth, low birth weight and preterm birth. Results Indonesian women had lower BMI than Ghanaian women (23.0 vs 25.4 kg/m2, p < 0.001) and higher mean haemoglobin levels (12.4 vs 11.1 g/dL, p < 0.001), corresponding to anaemia prevalence of 10 and 44%, respectively. Higher early pregnancy BMI was associated with higher haemoglobin levels in Indonesian (0.054 g/dL/kg/m2, 95% CI 0.03 to 0.08, p < 0.001) and Ghanaian women (0.044 g/dL/kg/m2, 0.02 to 0.07, p < 0.001). Accordingly, risk for anaemia decreased with higher early pregnancy BMI for Indonesians (adjusted OR 0.88, 0.81 to 0.97, p = 0.01) and Ghanaians (adjusted OR 0.95, 0.92 to 0.98, p < 0.001). No association between anaemia and the composite of adverse birth outcomes was observed. Conclusion Higher BMI in early pregnancy is associated with higher haemoglobin levels at antenatal booking and with a reduced risk of anaemia in Indonesian and Ghanaian women. Electronic supplementary material The online version of this article (10.1186/s12889-018-5704-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martina Mocking
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ary I Savitri
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cuno S P M Uiterwaal
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
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Angeliki A, Dimitrios P, Chara T. Maternal obesity and its association with the mode of delivery and the neonatal outcome in induced labour: Implications for midwifery practice. Eur J Midwifery 2018; 2:4. [PMID: 33537565 PMCID: PMC7839088 DOI: 10.18332/ejm/85792] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/27/2018] [Accepted: 02/26/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Maternal obesity carries an increased risk of complications during pregnancy and childbirth. This study investigated whether the body mass index (BMI) of women with induced labour was associated with the mode of delivery and neonatal outcome. METHODS This was a retrospective study of primigravidae women under the age of 40 years who were induced at term for various indications. Data were collected from the electronic database of the Maternity Unit where these women gave birth. RESULTS We sampled 1274 women with a mean age of 26.3±5.9 years. The mean BMI at booking was 26.5 kg/m2, with 28.8% being overweight and 24.3% obese. In the sample, 70.4% had a normal vaginal delivery, 15.4% a caesarean section (CS) and 14.2% an instrumental delivery. An increasing BMI was independently associated with the odds for a CS, with women who were overweight and obese having a 1.58 and 2.75 times greater likelihood for a CS. The CS rate was 10.2% in women with a normal BMI, and increased to 15.8% for overweight and 24.9% for obese women (p<0.001). The increasing BMI did not affect the instrumental delivery rates in our cohort. The Apgar scores at one and five minutes were significantly lower in overweight and obese women compared to women with a normal BMI. CONCLUSIONS We show that an increasing BMI in women with induced labour was associated with increased CS rates and lower Apgar scores. These findings highlight the important role of midwives in engaging women in weight management before they get pregnant.
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Affiliation(s)
- Antonakou Angeliki
- Department of Midwifery, Midwifery School, 'Alexander' Technological Educational Institute of Thessaloniki, Greece
| | - Papoutsis Dimitrios
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, United Kingdom
| | - Tzavara Chara
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Greece
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Vitner D, Harris K, Maxwell C, Farine D. Obesity in pregnancy: a comparison of four national guidelines. J Matern Fetal Neonatal Med 2018; 32:2580-2590. [PMID: 29447091 DOI: 10.1080/14767058.2018.1440546] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Obesity in pregnancy has become one of the most important challenges in obstetrical care given its prevalence and potential adverse impact on both mother and fetus. The primary objective of this descriptive review is to identify common themes and distinctions within the current recommendations for maternal obesity in the most updated version of four published national guidelines. METHODS We reviewed the following guidelines for obesity in pregnancy: American College of Obstetricians and Gynecologists (ACOG) 2015, Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG) 2013, Royal College of Obstetrics and Gynecology (RCOG) 2010, and Society of Obstetrics and Gynecologists of Canada (SOGC) 2010. RESULTS There were no major contradictions between the guidelines, however, variations did exist. Recognition of overweight and obese populations prenatally was uniformly emphasized, so that appropriate nutrition and exercise counseling could be provided prior to pregnancy. Obesity in pregnancy was consistently defined as a body mass index of 30 kg/m2 or more, and weight gain recommendations were in line with the Institute of Medicine guidelines. Counseling patients regarding the specific maternal and fetal complications in pregnancy, delivery, and postpartum which are associated with obesity was consistently emphasized. Most guidelines recommended early screening for gestational diabetes, however, specific details were not provided. All guidelines stressed the importance of available resources in clinics and the operating room specific to the obese population. Disparities were found regarding recommendations for high-dose folic acid, vitamin D supplementation, and low-dose aspirin. Thromboprophylaxis is a matter of debate, with most guidelines recommending use on an individual patient basis. CONCLUSIONS In general, the guidelines emphasized the importance of counseling women regarding the risks associated with obesity in pregnancy, and stressed the necessity of screening for these adverse outcomes. Initiatives to develop common terminology and reporting of outcomes in women's health are important for the development of cohesive and uniform recommendations for patient care. Disparities existed with respect to management strategies and where the further research and systematic reviews should be targeted, to allow clinicians to provide an appropriate obstetrical care pathway for obese women.
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Affiliation(s)
- Dana Vitner
- a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Toronto , Toronto , Canada.,b Ruth and Bruce Rappaport Faculty of Medicine , Technion - Israel Institute of Technology , Haifa , Israel
| | - Kristin Harris
- c Department of Obstetrics and Gynaecology , University of Toronto , Toronto , Canada
| | - Cynthia Maxwell
- a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Toronto , Toronto , Canada
| | - Dan Farine
- a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Toronto , Toronto , Canada
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Chaichian S, Moazzami B, Jesmi F, Pazouki A, Pishgahroudsari M, Mokhber S, Riazi S. The Controversy of the Most Proper Time for Pregnancy After Bariatric Surgery: a Review of Ten Cases. Obes Surg 2018; 26:1352-6. [PMID: 26951153 DOI: 10.1007/s11695-016-2124-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Many infertile obese women conceive after bariatric surgery after many years, while guidelines prohibit them from pregnancy for at least 12-18 months after surgery, due to complications. METHODS We hereby present 11 cases in our research center, pregnant in less than 12 months after surgery from 2011 to 2015, to evaluate their pregnancy outcome and complications. RESULTS The mean conception time was 3.6 months after surgery and mean birth weight was 2695 g. Regarding neonatal/fetal complications, there was one case of intrauterine growth retardation and one NICU hospitalization. Among pregnancy complications, eight patients had hyperemesis gravidarum and one had pre-eclampsia. CONCLUSIONS The results of the present study suggest revising setting a contraindication for conception for patients undergoing bariatric surgery.
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Affiliation(s)
- Shahla Chaichian
- Minimally Invasive Techniques Research Center in Women, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Bahram Moazzami
- Pars Advanced & Minimally Invasive Manners Research Center, Pars Hospital, Tehran, Iran
| | - Fatemeh Jesmi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | | | - Somayeh Mokhber
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sajedeh Riazi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
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Trends in perinatal health in metropolitan France from 1995 to 2016: Results from the French National Perinatal Surveys. J Gynecol Obstet Hum Reprod 2017; 46:701-713. [DOI: 10.1016/j.jogoh.2017.09.002] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/12/2017] [Accepted: 09/19/2017] [Indexed: 11/20/2022]
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Barr AL, Young EH, Smeeth L, Newton R, Seeley J, Ripullone K, Hird TR, Thornton JRM, Nyirenda MJ, Kapiga S, Adebamowo CA, Amoah AG, Wareham N, Rotimi CN, Levitt NS, Ramaiya K, Hennig BJ, Mbanya JC, Tollman S, Motala AA, Kaleebu P, Sandhu MS. The need for an integrated approach for chronic disease research and care in Africa. Glob Health Epidemiol Genom 2016; 1:e19. [PMID: 29868211 PMCID: PMC5870416 DOI: 10.1017/gheg.2016.16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 08/09/2016] [Accepted: 09/11/2016] [Indexed: 02/06/2023] Open
Abstract
With the changing distribution of infectious diseases, and an increase in the burden of non-communicable diseases, low- and middle-income countries, including those in Africa, will need to expand their health care capacities to effectively respond to these epidemiological transitions. The interrelated risk factors for chronic infectious and non-communicable diseases and the need for long-term disease management, argue for combined strategies to understand their underlying causes and to design strategies for effective prevention and long-term care. Through multidisciplinary research and implementation partnerships, we advocate an integrated approach for research and healthcare for chronic diseases in Africa.
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Affiliation(s)
- A. L. Barr
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - E. H. Young
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - L. Smeeth
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - R. Newton
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Uganda Research Unit on AIDS, Entebbe, Uganda
| | - J. Seeley
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Uganda Research Unit on AIDS, Entebbe, Uganda
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - K. Ripullone
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - T. R. Hird
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - J. R. M. Thornton
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - M. J. Nyirenda
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - S. Kapiga
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - C. A. Adebamowo
- Department of Epidemiology and Public Health, Greenebaum Comprehensive Cancer Center and Institute of Human Virology, University of Maryland School of Medicine, Baltimore MD 21201 USA
- Institute of Human Virology, Nigeria
| | - A. G. Amoah
- Department of Medicine, University of Ghana Medical School, Korlebu, Ghana
| | - N. Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - C. N. Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, USA
| | - N. S. Levitt
- Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - K. Ramaiya
- Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania
| | - B. J. Hennig
- MRC Unit, The Gambia, Fajara, The Gambia
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK
| | - J. C. Mbanya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - S. Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - A. A. Motala
- Department of Diabetes and Endocrinology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - P. Kaleebu
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Uganda Research Unit on AIDS, Entebbe, Uganda
| | - M. S. Sandhu
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
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Al Wattar BH, Pidgeon C, Learner H, Zamora J, Thangaratinam S. Online health information on obesity in pregnancy: a systematic review. Eur J Obstet Gynecol Reprod Biol 2016; 206:147-152. [DOI: 10.1016/j.ejogrb.2016.09.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 09/13/2016] [Indexed: 11/15/2022]
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Palomba S, Santagni S, Gibbins K, La Sala GB, Silver RM. Pregnancy complications in spontaneous and assisted conceptions of women with infertility and subfertility factors. A comprehensive review. Reprod Biomed Online 2016; 33:612-628. [PMID: 27591135 DOI: 10.1016/j.rbmo.2016.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 12/20/2022]
Abstract
In the literature, there is growing evidence that assisted reproductive techniques increase the risk of pregnancy complications in subfertile couples. Moreover, many concomitant preconception risk factors for subfertility are frequently present in the same subject and increase the risk of pregnancy complications. This review aimed to summarize in a systematic fashion the best current evidence regarding the effects of preconception maternal factors on maternal and neonatal outcomes. A literature search up to March 2016 was performed in IBSS, SocINDEX, Institute for Scientific Information, PubMed, Web of Science and Google Scholar. An evidence-based hierarchy was used to determine which articles to include and analyse. Available data show that the risk of pregnancy complications in spontaneous and assisted conceptions is likely multifactorial, and the magnitude of this risk is probably very different according specific subgroups of patients. Notwithstanding the only moderate level and quality of the available evidence, available data suggest that the presence and the treatment of specific preconception cofactors of subfertility should be always taken into account both in clinical practice and for scientific purposes.
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Affiliation(s)
- Stefano Palomba
- Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy.
| | - Susanna Santagni
- Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Karen Gibbins
- Division of Matenal-Fetal Medicine, Utah University, Salt Lake City, UT, USA
| | - Giovanni Battista La Sala
- Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy; University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Robert M Silver
- Division of Matenal-Fetal Medicine, Utah University, Salt Lake City, UT, USA
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Cantu JA, Jauk VR, Owen J, Biggio JR, Abramovici AR, Edwards RK, Tita AT. Is low-dose aspirin therapy to prevent preeclampsia more efficacious in non-obese women or when initiated early in pregnancy? J Matern Fetal Neonatal Med 2016; 28:1128-32. [PMID: 25048750 DOI: 10.3109/14767058.2014.947258] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Late timing of intervention and maternal obesity are potential explanations for the modest effect of aspirin for preeclampsia prevention. We explored whether low-dose aspirin (LDA) is more effective in women at increased risk when initiated before 16 weeks' gestation or given to non-obese women. METHODS Secondary analysis of a trial to evaluate LDA (60 mg/d) for preeclampsia prevention in high-risk women. Participants were randomized to LDA or placebo between 13 and 26 weeks. We stratified the effect of LDA on preeclampsia by (a) timing of randomization (< 16 or ≥ 16 weeks gestation) and (b) body mass index (BMI) class (non-obese and obese). The Breslow-Day test for homogeneity was used to assess for variations in effect of LDA across gestational age and BMI groups. RESULTS Of 2503 women, 461 (18.4%) initiated LDA < 16 weeks. LDA effect was not better when initiated < 16 weeks (RR: 0.93, 95% CI: 0.67-1.31) versus ≥ 16 weeks (RR: 0.90, 95% CI: 0.75-1.08), (p value for interaction = 0.87). Similarly, LDA effect was not better in non-obese (RR: 0.91, 95% CI: 0.7-1.13) versus obese women (RR: 0.89, 95% CI: 0.7-1.13), (p value for interaction = 0.85). CONCLUSION LDA for preeclampsia prevention was not more effective when initiated < 16 weeks or used in non-obese women at risk for preeclampsia. No particular subgroup of women was more or less likely to benefit from LDA therapy.
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Affiliation(s)
- Jessica A Cantu
- a Center for Women's Reproductive Health at the University of Alabama at Birmingham , Birmingham , AL , USA
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Hanson MA, Bardsley A, De-Regil LM, Moore SE, Oken E, Poston L, Ma RC, McAuliffe FM, Maleta K, Purandare CN, Yajnik CS, Rushwan H, Morris JL. The International Federation of Gynecology and Obstetrics (FIGO) recommendations on adolescent, preconception, and maternal nutrition: "Think Nutrition First". Int J Gynaecol Obstet 2016; 131 Suppl 4:S213-53. [PMID: 26433230 DOI: 10.1016/s0020-7292(15)30034-5] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Mark A Hanson
- Institute of Developmental Sciences, University of Southampton; and NIHR Nutrition Biomedical Research Centre, University Hospital Southampton; Southampton, UK
| | - Anne Bardsley
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | | | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute; and Department of Nutrition, Harvard TH Chan School of Public Health; Boston, MA, USA
| | | | - Ronald C Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong; and the Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China
| | - Fionnuala M McAuliffe
- UCD School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Ken Maleta
- University of Malawi College of Medicine, Blantyre, Malawi
| | | | | | - Hamid Rushwan
- International Federation of Gynecology and Obstetrics, London, UK
| | - Jessica L Morris
- International Federation of Gynecology and Obstetrics, London, UK.
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Abstract
Pregnancy represents a challenge from a nutritional perspective, because micronutrient intake during the periconceptional period and in pregnancy affects fetal organ development and the mother's health. Inappropriate diet/nutrition in pregnancy can lead to numerous deficiencies including iron deficiency and may impair placental function and play a role in miscarriage, intrauterine growth restriction, preterm delivery, and preeclampsia. This article reviews the risks associated with nutrient deficiencies in pregnant women and presents an overview of recommendations for dietary supplementation in pregnancy, focusing on oral iron supplementation. Risk factor detection, including dietary patterns and comorbidities, is paramount in optimal pregnancy management. Dietary habits, which can lead to deficiencies (e.g., iron, folate, vitamin D, and calcium) and result in negative health consequences for the mother and fetus/newborn, need to be investigated. Prenatal care should be personalized, accounting for ethnicity, culture, education, information level about pregnancy, and dietary and physical habits. Clinicians should make a plan for appropriate supplementation and prophylaxis/treatment of nutritional and other needs, and consider adequate intake of calcium, iodine, vitamin D, folate, and iron. Among the available oral iron supplements, prolonged-released ferrous sulfate (ferrous sulfate-polymeric complex) presents the lowest incidence of overall and gastrointestinal adverse events, with positive implications for compliance.
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Affiliation(s)
- Nils Milman
- a Departments of Clinical Biochemistry and Obstetrics , Naestved Hospital, Naestved, University of Copenhagen , Naestved , Denmark
| | - Tomasz Paszkowski
- b 3rd Chair and Department of Gynecology, Medical University of Lublin , Lublin , Poland
| | - Irene Cetin
- c Department of Obstetrics and Gynecology , University of Milan, Hospital Luigi Sacco , Milan , Italy , and
| | - Camil Castelo-Branco
- d Clínic Institute of Gynecology, Obstetrics and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona , Barcelona , Spain
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Lee HJ, Ha JE, Bae KH. Synergistic effect of maternal obesity and periodontitis on preterm birth in women with pre-eclampsia: a prospective study. J Clin Periodontol 2016; 43:646-51. [PMID: 27167920 DOI: 10.1111/jcpe.12574] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2016] [Indexed: 12/20/2022]
Abstract
AIM The aim of this study was to investigate if pregnant women with both obesity and periodontitis are more likely to experience preterm birth (PTB) in women with pre-eclampsia (PE) than pregnant women with only obesity or only periodontitis. MATERIALS AND METHODS The study examined a total of 328 pregnant women at 21-24 weeks of gestation. Overweight and obesity was defined based on criteria proposed by the WHO Expert Consultation. Periodontal conditions were assessed by measuring periodontal clinical attachment loss. PTB was defined as delivery at <37 weeks, and PE was defined as blood pressure higher than 140/90 mmHg on two separate occasions with at least 1+ proteinuria on a random urine screen after the 20th week of pregnancy. RESULTS After adjusting for other important cofactors, pregnant women with periodontitis were 5.56 times [95% confidence interval (CI) = 1.22-25.39] more likely to have PTB with PE than women without periodontitis. The association was much stronger (odds ratio = 15.94, 95% CI = 3.31-76.71) in women with both obesity and periodontitis. CONCLUSIONS Our results of this study indicate that pregnant women with both pre-pregnancy obesity and periodontitis are significantly more likely to have PTB with PE than pregnant women with only periodontitis.
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Affiliation(s)
- Hyo-Jin Lee
- Department of Preventive and Public Health Dentistry, School of Dentistry, Seoul National University, Seoul, Korea.,Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Jung-Eun Ha
- Department of Dental Hygiene, Baekseok University, Cheonan, Korea
| | - Kwang-Hak Bae
- Appletree Oral Health Science R&D center, Bucheon, Korea
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Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, Arora M, Azzopardi P, Baldwin W, Bonell C, Kakuma R, Kennedy E, Mahon J, McGovern T, Mokdad AH, Patel V, Petroni S, Reavley N, Taiwo K, Waldfogel J, Wickremarathne D, Barroso C, Bhutta Z, Fatusi AO, Mattoo A, Diers J, Fang J, Ferguson J, Ssewamala F, Viner RM. Our future: a Lancet commission on adolescent health and wellbeing. Lancet 2016; 387:2423-78. [PMID: 27174304 PMCID: PMC5832967 DOI: 10.1016/s0140-6736(16)00579-1] [Citation(s) in RCA: 1783] [Impact Index Per Article: 222.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- George C Patton
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia.
| | - Susan M Sawyer
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia; Murdoch Childrens Research Institute, Columbia University, New York, NY, USA
| | - John S Santelli
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - David A Ross
- World Health Organization, Geneva, Switzerland; London School of Hygiene & Tropical Medicine, London, UK
| | - Rima Afifi
- Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
| | - Nicholas B Allen
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia; University of Oregon, Eugene, OR, USA
| | - Monika Arora
- Public Health Foundation of India, New Delhi, India
| | - Peter Azzopardi
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia
| | | | | | - Ritsuko Kakuma
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Terry McGovern
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ali H Mokdad
- Institute of Health Metrics and Evaluation, University of Washinton, Seattle, WA, USA
| | - Vikram Patel
- London School of Hygiene & Tropical Medicine, London, UK; Public Health Foundation of India, New Delhi, India
| | - Suzanne Petroni
- International Centre for Research on Women, Washington, DC, USA
| | - Nicola Reavley
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - Jane Waldfogel
- School of Social Work, Columbia University, New York, NY, USA
| | | | | | - Zulfiqar Bhutta
- University of Toronto, Toronto, ON, Canada; Aga Khan University, Karachi, Pakistan
| | | | - Amitabh Mattoo
- Australia India Centre, University of Melbourne, Melbourne, VIC, Australia; Jawaharlal Nehru University, New Delhi, India
| | | | - Jing Fang
- Kunming Medical University, Kunming, China
| | - Jane Ferguson
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Russell M Viner
- Institute of Child Health, University College London, London, UK
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Nascimento IBD, Sales WB, Fleig R, Silva GDD, Silva JC. Excess weight and dyslipidemia and their complications during pregnancy: a systematic review. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2016. [DOI: 10.1590/1806-93042016000200002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Abstract Objectives: to identify bibliographically disorders related to excess weight, dyslipidemia and their complication during pregnancy and in the fetus and newborn. Methods: a systematic review including observational and interventional studies and reviews, based on MEDLINE, LILACS, Embase and the Cochrane Library between 2000 and 2015. The key-words "lipids, pregnancy, obesity and newborn" were used to establish a selective stage for inclusion/exclusion of titles, repeated studies, key-words, abstracts, methodological incompatibility and correlation with objectives. Results: 58 studies were selected, of which 36 (62%) addressed prevention and the risk in pregnancy of excess weight and lipid disorders and 19 (32.7%) suggestions and/or consequences for the fetus and newborn. Conclusions: excess weight and lipidemic disorders in pregnancy are causes for concern in scientific studies, posing risks both for the mother and the newborn. Higher prevalence of caesarian and pre-eclampsia were the two most noteworthy complications for gestational outcomes. In short, the impact on care of maternal habits and excess weight during pregnancy is highly significant, owing to the different degrees of complication in obstetric outcomes and their influence on the clinical characteristics of the newborn.
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Affiliation(s)
| | | | - Raquel Fleig
- Universidade do Estado de Santa Catarina, Brazil
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Rowe RE, Kurinczuk JJ, Hollowell J, Knight M. The UK Midwifery Study System (UKMidSS): a programme of work to establish a research infrastructure to carry out national studies of uncommon conditions and events in midwifery units. BMC Pregnancy Childbirth 2016; 16:77. [PMID: 27080858 PMCID: PMC4832539 DOI: 10.1186/s12884-016-0868-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 04/11/2016] [Indexed: 11/10/2022] Open
Abstract
Background Midwifery-led care during labour and birth in the UK is increasingly important given national commitments to choice of place of birth, reduction of unnecessary intervention and improving women’s experience of care, and evidence on safety and benefits for ‘low risk’ women. Further evidence is needed on safety and potential benefits of midwifery-led care for some groups of ‘higher risk’ women and about uncommon adverse outcomes or ‘near-miss’ events. Uncommon obstetric events and conditions have been investigated since 2005 using the UK Obstetric Surveillance System. This programme of research will establish the UK Midwifery Study System (UKMidSS) in all UK alongside midwifery units (AMUs) and carry out the first two UKMidSS studies investigating: (i) outcomes in severely obese women admitted to AMUs, and (ii) risk factors for neonatal unit admission following birth in an AMU. Methods We will carry out national cohort and case-control studies using UKMidSS, a national data collection platform which we will establish to collect anonymised information from all UK AMUs. Reporting midwives in each AMU will actively report cases or nil returns in response to monthly notification emails. Denominator data on the number of women admitted to and giving birth in each AMU will also be collected. Anonymised data on risk factors, management and outcomes for cases and controls/comparators as appropriate for each study, will be collected electronically using information from medical records. We will calculate incidence and prevalence with 95 % confidence intervals (CIs), tabulate descriptive data using frequencies and proportions, and use logistic regression to estimate odds ratios with 95 % CIs comparing specific outcomes in case and comparison women and to investigate risk factors for conditions or outcomes. Discussion As the first national infrastructure facilitating research into uncommon events and conditions in women starting labour in midwifery-led settings, UKMidSS builds on the success of other national research systems. UKMidSS studies will extend the evidence base regarding the quality and safety of midwifery-led intrapartum care and investigate extending the benefits of midwifery-led care to more women. As a national collaboration of midwives contributing to high quality research, UKMidSS will provide an infrastructure to support midwifery research capacity development.
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Affiliation(s)
- Rachel E Rowe
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Jennifer Hollowell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
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Castillo H, Santos IS, Matijasevich A. Maternal pre-pregnancy BMI, gestational weight gain and breastfeeding. Eur J Clin Nutr 2016; 70:431-6. [PMID: 26813940 PMCID: PMC4827014 DOI: 10.1038/ejcn.2015.232] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 12/09/2015] [Accepted: 12/15/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES The aims were to investigate the association of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) with breastfeeding (BF) duration and BF pattern at 3 months of age. SUBJECTS/METHODS This was a prospective cohort study of 4231 children who were enrolled at birth and were followed-up at 3, 12, 24 and 48 months of age to gather information on maternal and offspring characteristics including BF patterns and BF duration. Maternal pre-pregnancy BMI was categorized according to the WHO classification and GWG according to the 2009 Institute of Medicine recommendations. Cox's proportional hazards model was used to assess whether pre-pregnancy BMI and GWG were associated with BF and exclusive breastfeeding (EBF) duration. Predicted probabilities of BF patterns at 3 months were estimated by multinomial logistic regression. RESULTS Information on BF was available to 4011 infants. The total BF and EBF median durations were 7.0 months and 1.5 months, respectively. There were no differences in duration of any BF or EBF according to pre-pregnancy BMI or GWG categories. There was an increased predicted probability for weaning before the age of 3 months among infants from obese women, compared with those from mothers with normal pre-pregnancy BMI, with margins adjusted predictions of 0.36 (95% confidence interval (CI) 0.31-0.41) and 0.23 (95% CI 0.21-0.25), respectively. CONCLUSIONS Infants from pre-pregnancy overweight/obese mothers presented higher probability of early weaning compared with infants from normal-weight mothers. Obese/overweight pregnant women need supplementary guidance about BF benefits to infant health during prenatal and postnatal care.
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Affiliation(s)
- H Castillo
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - I S Santos
- Department of Social Medicine, Postgraduate Program in Epidemiology, School of Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - A Matijasevich
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
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Deshmukh VL, Jadhav M, Yelikar K. Impact of HIGH BMI on Pregnancy: Maternal and Foetal Outcome. J Obstet Gynaecol India 2016; 66:192-7. [PMID: 27651602 DOI: 10.1007/s13224-015-0825-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/23/2015] [Indexed: 11/30/2022] Open
Abstract
AIM AND OBJECTIVES To review the effects of obesity (BMI > 30) on antepartum risk/intrapartum risk. To study neonatal outcome of pregnant women with raised BMI. MATERIAL METHOD BMI of 500 pregnant women booked before 12 weeks calculated and categorised as normal, overweight, obese and morbidly obese at GMCH, Aurangabad. Pregnant women with systemic disease and previous LSCS were excluded. Antepartum, intrapartum and neonatal variables were studied, and statistical analysis was carried out. RESULTS Antepartum variables: prolonged pregnancy (<0.05), severe PIH (<0.05), PPROM (<0.05), gestational DM (<0.05) and anaemia (<0.05) are strongly associated with raised BMI, whereas abortion (>0.05), oligohydramnios (>0.05), UTI (>0.05) and abruption (>0.05) are not associated with raised BMI. Postpartum variables: PPH (<0.05), pyrexia (<0.05), prolonged hospital stay (<0.05) and lactational dysfunction (<0.05) are strongly associated with raised BMI, whereas UTI (>0.05), thrombophlebitis (>0.05) and endometritis (>0.05) are not associated with raised BMI. BMI Neonatal outcome: IUGR (<0.05), preterm (<0.05), postterm (<0.05), LBW (<0.05) and macrosomia (>0.05) are strongly associated with raised BMI, whereas stillbirth (>0.05), intubation (>0.05), RDS (>0.05) and baby died within 24 (>0.05) are not associated with raised BMI. CONCLUSIONS Overweight and obesity are risk factors for AP/IP/PP complication.
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Affiliation(s)
- Varsha L Deshmukh
- Department of Obstetrics and Gynaecology, Government Medical College, Aurangabad, India
| | - Milind Jadhav
- Department of Obstetrics and Gynaecology, Government Medical College, Aurangabad, India
| | - Kanan Yelikar
- Department of Obstetrics and Gynaecology, Government Medical College, Aurangabad, India
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