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Oğlak SC, Yılmaz EZ, Budak MŞ. Abdominal subcutaneous fat thickness combined with a 50-g glucose challenge test at 24-28 weeks of pregnancy in predicting gestational diabetes mellitus. J OBSTET GYNAECOL 2024; 44:2329880. [PMID: 38516715 DOI: 10.1080/01443615.2024.2329880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/06/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND This investigation aimed to analyse the efficacy of abdominal subcutaneous fat thickness (ASFT) value >18.1 mm combined with a 50-g glucose challenge test (GCT) between 24-28 weeks of gestation in predicting gestational diabetes mellitus (GDM) cases. METHODS This cross-sectional study was carried out from February 2021 to December 2022. All pregnant women received a 50-g GCT at 24-28 weeks of pregnancy for the GDM screening. Pregnant women with a blood glucose value between 140-190 mg/dl experienced 100 g OGTT. Even if 50-g GCT was normal, 100-g OGTT was offered to patients with an ASFT value above 18.1 mm. RESULTS Among the 728 pregnant women we enrolled, 154 (21.2%) cases were screened as positive. The number of patients who first screened positive and determined to be GDM after the 100-g oral glucose tolerance test (OGTT) was 43 (5.9%). A total of 67 cases (9.2%) had an ASFT measurement above 18.1 mm. Two cases with a negative 50-g GCT and ASFT <18.1 mm were diagnosed as GDM in the later weeks of pregnancy. A 50-g GCT combined with ASFT measurement above 18.1 mm predicted GDM with a sensitivity of 87.9%, a specificity of 88.7%, a positive predictive value (PPV) of 36.0%, and a negative PV (NPV) of 99.7%. CONCLUSIONS A 50-g GCT combined with ASFT measurement that can be easily and accurately obtained during routine antenatal care in the second trimester might be a beneficial indicator for predicting GDM cases.
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Affiliation(s)
- Süleyman Cemil Oğlak
- Department of Obstetrics and Gynaecology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Emine Zeynep Yılmaz
- Department of Obstetrics and Gynaecology, Bahçelievler Memorial Hospital, Istanbul, Turkey
| | - Mehmet Şükrü Budak
- Department of Obstetrics and Gynaecology, Private Can Hospital, Izmir, Turkey
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Li X, Luan T, Zhao C, Ling X. Effect of paternal body mass index on maternal and child-health outcomes of singletons after frozen-thawed embryo transfer cycles: a retrospective study. HUM FERTIL 2024; 27:2285343. [PMID: 38205607 DOI: 10.1080/14647273.2023.2285343] [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: 10/20/2022] [Accepted: 10/26/2023] [Indexed: 01/12/2024]
Abstract
The objective was to analyze the effect of paternal body mass index (BMI) on maternal and child-health outcomes of singletons after frozen-thawed embryo transfer (FET) cycles. A retrospective cohort study was conducted between January 2019 and December 2021. Pregnancy, perinatal complications and neonatal outcomes were compared among different paternal BMI. Multivariate logistic regression was performed to evaluate the relationship between different paternal BMI and pregnancy, obstetric and neonatal outcomes. The paternal normal group was more likely to suffer from gestational hypertension than the paternal obesity group (3.59% vs. 2.42%), and paternal underweight group was more likely to suffer from preeclampsia than the other three groups (11.63% vs. 4.43%, 7.57%, 4.03%). Birthweight among infants in the paternal overweight categories was significantly higher than infants in the paternal normal weight categories. The rate of foetal macrosomia was higher among infants in the paternal overweight (12.36%) category, while lower among infants in the paternal underweight categories (2.33%). The incidence of macrosomia in the paternal overweight categories (aOR 1.527, 95% CI 1.078-2.163) was significantly higher than those normal controls after adjustment for known confounding factors. The rates of LGA babies were higher in the paternal overweight category (aOR 1.260, 95% CI 1.001-1.587) compared with those in the paternal normal weight category, before and after adjustment. The results suggest that parental pre-pregnancy overweight or obesity has an adverse effect on the perinatal complications and neonatal outcomes.
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Affiliation(s)
- Xin Li
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Ting Luan
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Chun Zhao
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Xiufeng Ling
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
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Grau González A, Sánchez Del Pino A, Amezcua-Prieto C, Møller Luef B, Anne Vinter C, Stener Jorgensen J, García-Valdés L. An umbrella review of systematic reviews on interventions of physical activity before pregnancy, during pregnancy, and postpartum to control and/or reduce weight gain. Int J Gynaecol Obstet 2024; 166:915-931. [PMID: 38466033 DOI: 10.1002/ijgo.15453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND The increasing prevalence of overweight and obesity worldwide represents a (chronic) complex public health problem. This is also seen among women of childbearing age despite increased efforts to promote physical activity (PA) interventions. Excessive gestational weight gain (GWG) is associated with negative health outcomes for both mothers and offspring. OBJECTIVES To summarize current systematic reviews (SRs) on PA interventions during pregnancy and postpartum to prevent excessive GWG and identify the most effective approaches. SEARCH STRATEGY A literature search was conducted on major electronic databases (MEDLINE/Pubmed, Cochrane, Web of Science, Epistemonikos) from inception to March 2023. SELECTION CRITERIA This study included SRs and meta-analyses of studies involving women aged 18 years or older from diverse ethnic backgrounds, who were either in the preconception period, pregnant, or within 1 year postpartum and who had no contraindications for exercise. Women with chronic diseases, such as pre-existing diabetes (type 1 or type 2) were excluded. DATA COLLECTION AND ANALYSIS Two reviewers extracted data from selected studies assessing the impact of PA in preconception, pregnancy, and postpartum. Methodologic quality was assessed with the AMSTAR-2 tool. A narrative summary of results addresses relationships between PA and weight before, during, and after pregnancy, informing future research priorities for preventing excessive weight gain. This study is registered on PROSPERO (CRD420233946666). MAIN RESULTS Out of 892 identified articles, 25 studies were included after removing duplicates, unrelated titles, and screening titles and abstracts for eligibility. The results demonstrate that PA can help prevent excessive GWG and postpartum weight retention. Structured and supervised moderate-intensity exercise, at least twice a week, and each session lasting a minimum of 35 min seems to provide the greatest benefits. CONCLUSIONS Women who comply with the PA program and recommendations are more likely to achieve adequate GWG and return to their pre-pregnancy body mass index after delivery. Further research is warranted to explore how preconception PA influences pregnancy and postpartum outcomes given the absence of identified preconception-focused interventions.
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Affiliation(s)
- Andrea Grau González
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain
| | - Ana Sánchez Del Pino
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain
| | - Carmen Amezcua-Prieto
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute, Madrid, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Birgitte Møller Luef
- University of Southern Denmark, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Christina Anne Vinter
- University of Southern Denmark, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Jan Stener Jorgensen
- University of Southern Denmark, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Luz García-Valdés
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain
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Bretón I, Velasco C, Cuerda C, Motilla M, Serrano C, Morales Á, Carrascal ML, Lopez Lazareno N, Gonzalez-Estecha M, Ballesteros-Pomar MD, Rubio-Herrera MÁ. Minerals and trace elements in pregnancy in women with previous bariatric surgery consequences on maternal and foetal health. J Trace Elem Med Biol 2024; 85:127458. [PMID: 38772250 DOI: 10.1016/j.jtemb.2024.127458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 03/10/2024] [Accepted: 04/16/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Bariatric surgery (BS) may decrease the risk of these obesity-related complications; however, due to its effect on nutrient intake and absorption, it can also have adverse consequences on maternal and foetal health. The aim of this study is to describe the evolution of electrolytes and trace elements serum levels throughout pregnancy after BS, according to the surgical technique and to evaluate the effect of nutritional deficiencies on the risk of maternal-foetal complications. METHODS This is a retrospective observational study of the clinical evolution and maternal-foetal complications in a group of women with pregnancies that occurred after BS. Clinical evolution during pregnancy, body weight, and plasma electrolytes, vitamins, and trace elements, as well as their influence on maternal-foetal outcomes were evaluated. Composite neonatal variable (CNV) was defined to evaluate unfavourable foetal outcome. Published reference values for micronutrients during pregnancy have been used. RESULTS The study includes data on 164 singleton pregnancies in 91 women. A hundred and twenty-seven pregnancies got to full term. The average birth weight was 2966 (546) g., 26.8% < P10 and 13.8% < P3 of a reference population. New-born of gestations after malabsorptive bariatric surgery had a higher risk of having a percentile of birth weight < P3. Plasma electrolytes, trace elements and vitamins throughout pregnancy showed differences depending on the surgical technique, with lower haemoglobin, ferritin, calcium, zinc, copper, vitamin A and vitamin E in the malabsorptive techniques. A high percentage of deficiency was observed, especially in the third trimester (Hb < 11 g/dl: 31.8%; ferritin < 30 mg/ml: 85.7%; zinc < 50 μg/dl: 32.4%, vitamin D < 30 ng/ml: 75.5% and < 20 ng/ml: 53.3%). A decreased plasma copper in the first trimester or zinc in the third trimester were associated with a lower percentile of new-born birth weight. A higher risk of CNV was observed in predominant malabsorptive BS and in pregnancies that had presented at least one vitamin D level lower than 20 ng/ml throughout pregnancy (30.4% vs. 7.1%, p=0.018). CONCLUSIONS Trace elements and vitamin deficiencies are common in pregnant women after bariatric surgery, especially of iron, zinc, and vitamin D. These deficiencies might negatively affect foetal development. Further studies are needed to better define the role of micronutrients in maternal-foetal health after bariatric surgery.
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Affiliation(s)
- Irene Bretón
- Department of Endocrinology and Nutrition. Hospital General Universitario Gregorio Marañón. Madrid, IiSGGM, Calle del Dr. Esquerdo, 46, Madrid 28007, Spain; Faculty of Medicine. Department of Medicine, Universidad Complutense, Madrid, Spain.
| | - Cristina Velasco
- Department of Endocrinology and Nutrition. Hospital General Universitario Gregorio Marañón. Madrid, IiSGGM, Calle del Dr. Esquerdo, 46, Madrid 28007, Spain
| | - Cristina Cuerda
- Department of Endocrinology and Nutrition. Hospital General Universitario Gregorio Marañón. Madrid, IiSGGM, Calle del Dr. Esquerdo, 46, Madrid 28007, Spain; Faculty of Medicine. Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Marta Motilla
- Department of Endocrinology and Nutrition. Hospital General Universitario Gregorio Marañón. Madrid, IiSGGM, Calle del Dr. Esquerdo, 46, Madrid 28007, Spain
| | - Clara Serrano
- Department of Endocrinology and Nutrition. Hospital General Universitario Gregorio Marañón. Madrid, IiSGGM, Calle del Dr. Esquerdo, 46, Madrid 28007, Spain
| | - Ángela Morales
- Department of Endocrinology and Nutrition. Hospital General Universitario Gregorio Marañón. Madrid, IiSGGM, Calle del Dr. Esquerdo, 46, Madrid 28007, Spain
| | - Maria Luisa Carrascal
- Department of Endocrinology and Nutrition. Hospital General Universitario Gregorio Marañón. Madrid, IiSGGM, Calle del Dr. Esquerdo, 46, Madrid 28007, Spain
| | - Nieves Lopez Lazareno
- Department of Laboratory Medicine, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, Madrid 28007, Spain; Department of Endocrinology and Nutrition. Complejo Asistencial Universitario de León, Calle Altos de Nava, s/n, León 24008, Spain
| | - Montserrat Gonzalez-Estecha
- Department of Laboratory Medicine, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, Madrid 28007, Spain; Department of Endocrinology and Nutrition. Complejo Asistencial Universitario de León, Calle Altos de Nava, s/n, León 24008, Spain
| | - Maria D Ballesteros-Pomar
- Department of Endocrinology and Nutrition. Hospital Universitario Clínico San Carlos, IdISSC, Calle del Prof. Martín Lagos s.n., Madrid 28040, Spain
| | - Miguel Ángel Rubio-Herrera
- Department of Endocrinology and Nutrition. Hospital Universitario Clínico San Carlos, IdISSC, Calle del Prof. Martín Lagos s.n., Madrid 28040, Spain
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Johnson A, Vaithilingan S, Ragunathan L. Association of obesity and overweight with the risk of preeclampsia in pregnant women: an observational cohort study. Ir J Med Sci 2024:10.1007/s11845-024-03787-2. [PMID: 39158673 DOI: 10.1007/s11845-024-03787-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 08/13/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND According to the World Health Organization, obesity is considered a pervasive global epidemic with significant medical and social implications. In antenatal mothers, the prevalence varies from 40% in Western countries to 12% in India which leads to life-threatening complications-preeclampsia and eclampsia. AIM This study delves into the association between body mass index (BMI) and preeclampsia, among primi antenatal mothers with pregnancy-induced hypertension (PIH). METHODS An observational cohort (prospective) study was conducted among 150 primi antenatal mothers with pregnancy-induced hypertension in Government Headquarters Hospital, Tamil Nadu, India. Demographic data, body mass index, and pregnancy outcomes were assessed. Statistical analysis was performed using the SPSS 28.0 version. RESULTS Among 150 pregnant women, 63 (42%) were overweight, and 13 (8.7%) were obese. Higher BMI was significantly associated with maternal complications, especially preeclampsia (P < 0.001). Moreover, other complications such as abruptio placenta, pulmonary edema, eclampsia, and postpartum hemorrhage were not significantly associated with BMI. CONCLUSION The study calls attention to the persistent link between BMI and preeclampsia, emphasizing the need for comprehensive strategies aligned with the Sustainable Development Goal. Despite ongoing efforts, the study suggests a lack of substantial change in the prevalence of preeclampsia associated with increased BMI, prompting the exploration of innovative interventions to address weight-related factors during pregnancy for improved maternal and neonatal well-being.
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Affiliation(s)
- Alby Johnson
- Vinayaka Mission's Research Foundation (Deemed to Be University), Salem, Tamil Nadu, India
| | - Sasi Vaithilingan
- Vinayaka Mission's Research Foundation (Deemed to Be University), Salem, Tamil Nadu, India.
- Dept. of Child Health Nursing, Vinayaka Mission's College of Nursing, Puducherry, India.
| | - Latha Ragunathan
- Vinayaka Mission's Research Foundation (Deemed to Be University), Salem, Tamil Nadu, India
- Dept. of Microbiology, Aarupadai Veedu Medical College & Hospital, Puducherry, India
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Powers Carson J, Arora J, Carter E. Glycated Albumin to Predict Adverse Neonatal Outcomes among Women with Diabetes and Overweight or Obese Body Mass Index. J Appl Lab Med 2024:jfae079. [PMID: 39087706 DOI: 10.1093/jalm/jfae079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 05/28/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Glycated albumin (GA) has shown promise in predicting risk of adverse neonatal outcomes (ANO) in pregnant women with type 2 diabetes (T2DM) and gestational diabetes (GDM). However, previous studies showing a negative correlation between GA and body mass index (BMI) suggest that lower predictive cutoffs may be needed in populations with elevated BMI. METHODS We performed a case-control study of prospectively enrolled pregnant women with T2DM or GDM and BMI ≥25 kg/m2 matched to biobanked controls without diabetes. Serum collected during the second and/or third trimesters was used to measure the percentage of GA (% GA). Receiver operating characteristic (ROC) curves were used to examine % GA to predict an ANO composite, including macrosomia, hypoglycemia, respiratory distress syndrome, and/or hyperbilirubinemia for the second and third trimesters. RESULTS The median BMIs for cases and controls were 34.0 and 31.0 kg/m2, respectively. The area under the ROC curve to predict the ANO composite was significant for second trimester values but ambiguous for third trimester due to its wide 95% CI. A cutoff of 12.3% GA during second trimester showed 100% sensitivity and 73% specificity. Transference of previously published reference ranges did not validate, suggesting lower ranges are needed for women with overweight/obesity. CONCLUSIONS In this pilot study, % GA shows promise to stratify pregnant patients with diabetes and obesity into risk categories for ANO with excellent predictive ability in the second trimester. If this holds in larger studies, using second trimester % GA could allow additional intervention to improve blood glucose control and minimize ANO.
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Affiliation(s)
- Jennifer Powers Carson
- Division of Endocrinology, Metabolism, and Lipid Research, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Jyoti Arora
- Center for Biostatistics and Data Science, Washington University School of Medicine, St. Louis, MO, United States
| | - Ebony Carter
- Divison of Maternal-Fetal Medicine & Ultrasound, Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, United States
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Law S, Wan K, Yang W. Effects of bariatric surgery on sexual function and fertility: A narrative review. Obes Rev 2024; 25:e13757. [PMID: 38689132 DOI: 10.1111/obr.13757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 05/02/2024]
Abstract
Obesity has emerged as a prevalent global health concern, with its detrimental effects on the reproductive system and sexual function garnering increasing attention. Both men and women affected by obesity face a heightened risk of fertility challenges and sexual dysfunction. Although fertility and sexual function are distinct topics, they are intricately linked and mutually influential in both medical and societal contexts. Bariatric surgery (BS) has generated promising results in alleviating sexual dysfunction and enhancing fertility, results which are often gender specific. In men, improvements in sexual function can often be attributed to weight loss and subsequent optimizations in sex hormone levels. However, improving female sexual function may be related to a range of factors beyond weight loss. Bariatric procedures have shown limited benefits for male fertility; in fact, in some situations it can even be detrimental, leading to a decrease in sperm count and quality. Conversely, BS may positively impact female fertility, improving pregnancy and neonatal outcomes. Nevertheless, it is essential to consider the potential risks related to the adverse effects of malnutrition and rapid weight loss following BS, making it advisable to wait for 12-18 months before attempting pregnancy.
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Affiliation(s)
- Saikam Law
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- School of Medicine, Jinan University, Guangzhou, China
| | - Kating Wan
- School of Medicine, Jinan University, Guangzhou, China
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Leonard KM, Schmiedecke SS, Talley RL, Damicis JR, Walton RB, Burd I, Napolitano PG, Ieronimakis N. Maternal obesity alters fetal neuroinflammation in a murine model of preterm birth. AJOG GLOBAL REPORTS 2024; 4:100361. [PMID: 39072339 PMCID: PMC11278798 DOI: 10.1016/j.xagr.2024.100361] [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] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Preterm birth from intrauterine infection is a leading cause of neonatal neurologic morbidity. Likewise, maternal obesity is associated with intra-amniotic infection and inflammation. Whether maternal obesity is a risk factor for fetal brain injury that occurs with premature birth remains unknown. This study hypothesized that maternal obesity intensifies fetal neuroinflammation in the setting of premature delivery. OBJECTIVE This study aimed to examine the influence of maternal obesity on perinatal neuroinflammatory responses that arise with preterm birth using a murine model. STUDY DESIGN Dams with obesity were generated via a high-fat diet that was maintained throughout pregnancy. In parallel, dams without obesity (normal) received a control diet. All dams were paired with males on normal diet. Pregnant dams were randomized to receive an intrauterine administration of bacterial endotoxin (lipopolysaccharide) or the vehicle (phosphate-buffered saline) on embryo day 15.5 of what is typically a 19- to 21-day gestation. Fetal brains were harvested 6 hours after intrauterine administrations, and the expressions of key inflammatory cytokines (Il1b, Il6, and Tnf) and panels of metabolic, immune, and inflammatory genes were analyzed. RESULTS With the phosphate-buffered saline, there was no difference in gene expression related to maternal obesity. There were substantial differences in Il6 and immune/inflammatory expression profiles in fetal brains from dams with obesity vs normal dams that received lipopolysaccharide. Few differences were observed among the metabolic genes examined under these conditions. The gene expression pattern associated with maternal obesity correlated with pathways related to white matter injury. CONCLUSION The expression of neuroinflammatory markers instigated by bacterial endotoxin via intrauterine lipopolysaccharide was greater in embryo brains obtained from dams with obesity. Expression profiles suggest that in combination with intrauterine inflammation, maternal obesity may increase the risk of fetal white matter injury. Further investigation is warranted to understand the relationship between maternal health and neurologic outcomes associated with prematurity.
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Affiliation(s)
- Katherine M. Leonard
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA (Leonard, Schmiedecke, Walton, and Ieronimakis)
| | - Stacey S. Schmiedecke
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA (Leonard, Schmiedecke, Walton, and Ieronimakis)
| | - Rebecca L. Talley
- Department of Clinical Investigation, Madigan Army Medical Center, Tacoma, WA (Talley, Damicis, and Ieronimakis)
| | - Jennifer R. Damicis
- Department of Clinical Investigation, Madigan Army Medical Center, Tacoma, WA (Talley, Damicis, and Ieronimakis)
| | - Robert B. Walton
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA (Leonard, Schmiedecke, Walton, and Ieronimakis)
| | - Irina Burd
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland, Baltimore, MD (Burd)
| | - Peter G. Napolitano
- Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle, WA (Napolitano)
| | - Nicholas Ieronimakis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA (Leonard, Schmiedecke, Walton, and Ieronimakis)
- Department of Clinical Investigation, Madigan Army Medical Center, Tacoma, WA (Talley, Damicis, and Ieronimakis)
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Wang B, Lin H, Xia R, Lin S, Li Z. Evaluation of birth outcomes, congenital anomalies and neonatal complications of singletons born to infertile women treated with letrozole: A retrospective cohort study. Exp Ther Med 2024; 28:307. [PMID: 38873049 PMCID: PMC11170325 DOI: 10.3892/etm.2024.12596] [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: 12/24/2023] [Accepted: 05/17/2024] [Indexed: 06/15/2024] Open
Abstract
At present, safety of letrozole administration as an ovulation-inducing drug still remains controversial. Investigation of the safety of letrozole use for the induction of ovulation in the Chinese population is scant. The present study aimed to fill this gap. Data concerning mothers using letrozole and birth outcomes of their singleton offspring were collected as the letrozole group (n=194), equivalent data from mothers using non-letrozole drugs and their singleton offspring were included as the non-letrozole group (control, n=154). Birth outcomes, congenital anomalies and neonatal complications were compared and analyzed between the two groups. Univariate analysis, Spearman's rank correlation analysis and the logistic regression model were utilized. For birth outcomes, the percentage of caesarean section deliveries in the letrozole group was lower than the non-letrozole group (43.8 vs. 56.4%, P=0.019). For congenital anomalies, no significant difference was found between the two groups (all P>0.05). The statistical P-value for the correlation between the maternal use of letrozole and neonatal complications was marginal (P=0.051). Results from the logistic regression analysis confirmed that maternal use of letrozole was not a significant contributor for neonatal complications, independent of statistical adjustment [crude odds ratio (OR), 1.436; 95% confidence interval (CI), 0.803-2.569; P=0.223 vs. adjusted OR, 1.406; 95% CI, 0.748-2.643; P=0.290). The results of the present study suggested that maternal use of letrozole for ovulation induction does not associate with poorer birth outcomes or increased risk of congenital anomalies and neonatal complications.
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Affiliation(s)
- Bin Wang
- Reproductive Center, The First Affiliated Hospital of Shantou University Medical College, Shantou University, Shantou, Guangdong 515041, P.R. China
| | - Hong Lin
- Reproductive Center, The First Affiliated Hospital of Shantou University Medical College, Shantou University, Shantou, Guangdong 515041, P.R. China
| | - Rubin Xia
- Reproductive Center, The First Affiliated Hospital of Shantou University Medical College, Shantou University, Shantou, Guangdong 515041, P.R. China
| | - Shuiqin Lin
- Department of Pathology, The First Affiliated Hospital of Shantou University Medical College, Shantou University, Shantou, Guangdong 515041, P.R. China
| | - Zhiling Li
- Reproductive Center, The First Affiliated Hospital of Shantou University Medical College, Shantou University, Shantou, Guangdong 515041, P.R. China
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Rassie K, Dhungana RR, Mousa A, Teede H, Joham A. Maternal metabolic conditions as predictors of breastfeeding outcomes: Insights from an Australian cohort study. Acta Obstet Gynecol Scand 2024; 103:1570-1583. [PMID: 38715284 PMCID: PMC11266642 DOI: 10.1111/aogs.14868] [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: 01/10/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Breastfeeding represents an important opportunity to optimize health outcomes for both mother and infant, particularly in the context of maternal metabolic conditions such as diabetes and polycystic ovary syndrome. However, evidence suggests that women affected by these conditions breastfeed at reduced rates and durations. Our aim was to use the large, prospective, community-based Australian Longitudinal Study on Women's Health (ALSWH) to conduct an in-depth exploratory analysis of breastfeeding outcomes in Australian women affected by key maternal metabolic conditions. MATERIAL AND METHODS Data from 12 920 pregnancies to 5605 women from the 1973-1978 birth cohort of the ALSWH were examined. Univariable and multivariable regression using generalized estimating equation models were applied to assess breastfeeding initiation and duration (outcome measures) in relation to key self-reported maternal metabolic diagnoses (pre-gestational type 1 and type 2 diabetes, gestational diabetes, and polycystic ovary syndrome; main explanatory variables). Key sociodemographic and clinical covariates were also considered. RESULTS Results showed no significant association between specific maternal metabolic diagnoses (pre-gestational or gestational diabetes, or polycystic ovary syndrome) and breastfeeding outcomes. However, maternal body mass index emerged as a key predictor of suboptimal breastfeeding outcomes. Pregnancies affected by maternal obesity were associated with a 2.1-fold increase in the odds of not initiating breastfeeding, after adjusting for other key variables (95% CI 1.67 to 2.60, p < 0.01). Maternal overweight and obesity were, respectively, associated with an adjusted 1.4-fold (95% CI 1.20 to 1.55, p < 0.01) and 1.8-fold increase (95% CI 1.60 to 2.10, p < 0.01) in the odds of a breastfeeding duration less than 6 months. CONCLUSIONS Maternal obesity, rather than any specific maternal metabolic condition, appears to be a key predictor of breastfeeding outcomes in Australian women.
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Affiliation(s)
- Kate Rassie
- Monash center for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
- Department of DiabetesMonash HealthMelbourneVictoriaAustralia
| | - Raja Ram Dhungana
- Monash center for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Aya Mousa
- Monash center for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Helena Teede
- Monash center for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
- Department of DiabetesMonash HealthMelbourneVictoriaAustralia
| | - Anju E. Joham
- Monash center for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
- Department of DiabetesMonash HealthMelbourneVictoriaAustralia
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11
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Niknam A, Behboudi-Gandevani S, Rahmati M, Firouzi F, Azizi F, Ramezani Tehrani F. Gestational weight gain as a mediator of the relationship between pre-pregnancy body mass index and the risk of preterm birth: A four-way decomposition analysis. Int J Gynaecol Obstet 2024. [PMID: 39011572 DOI: 10.1002/ijgo.15789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 06/30/2024] [Accepted: 07/02/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVE The aim of the present study was to examine and quantify whether the association between preterm birth (PTB) and pre-pregnancy body mass index (BMI) is mediated by gestational weight gain (GWG). METHODS This is a secondary analysis of a large randomized community non-inferiority trial using a cohort design. The data of 26 101 pregnant women in their first trimester who sought prenatal care and met eligibility criteria were included. The four-way decomposition method was applied to screen for all types of association effects of pre-pregnancy BMI on the risk of PTB. These effects include the total, direct, and various indirect effects including pure mediation via GWG, interactive effects with GWG, and mediated interaction with GWG, all adjusted for potential confounders. RESULTS Among the study participants, 24 461 (93.7%) had term deliveries, while 1640 (6.3%) experienced PTB. The results of the study showed that there was a positive association between pre-pregnancy BMI among those with BMI more than 25 kg/m2 and the risk of PTB and this association was negatively mediated and interacted by GWG, which differed quantitatively between those who had inadequate, adequate, or excessive GWG. The total association effect showed that the risk was lowest for those who had underweight pre-pregnancy BMI and adequate GWG (excess relative risk [RR]: 0.06, 95% CI: 0.01-0.11, P value: 0.022) and was highest for those who had obese pre-pregnancy BMI and excessive GWG (excess RR: 0.67, 95% CI: 0.35-1.00, P value <0.001). CONCLUSION The findings of the present prospective population-based study demonstrated that pre-pregnancy BMI >25 kg/m2 is directly and positively associated with the risk of preterm birth. The highest risk of preterm birth was observed among individuals with an obese pre-pregnancy BMI who also experienced excessive GWG.
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Affiliation(s)
- Atrin Niknam
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Maryam Rahmati
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faegheh Firouzi
- Tehran Medical Branch, Islamic Azad University, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- The foundation for research & Education Excellence, Vestaria Hills, Al, USA
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12
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Ma N, Bai L, Niu Z, Lu Q. Mid-upper arm circumference predicts the risk of gestational diabetes in early pregnancy. BMC Pregnancy Childbirth 2024; 24:462. [PMID: 38965475 PMCID: PMC11225188 DOI: 10.1186/s12884-024-06664-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/28/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND The present work aimed to assess the value of mid-upper arm circumference (MUAC) at 8 to 12 weeks in predicting the occurrence of gestational diabetes mellitus (GDM). METHODS According to eligibility criteria, 328 women with singleton pregnancies who underwent routine antenatal check-ups at Qinhuangdao Maternal and Child Health Hospital from September 2017 to September 2020 were included. The patients were divided into the gestational diabetes mellitus (GDM) and non-GDM groups according to oral glucose tolerance test (OGTT) data from gestation weeks 24 to 28. Clinical data were compared between the two groups. Logistic regression analysis was performed to determine factors independently predicting GDM. Receiver operating characteristic (ROC) curve analysis was employed to analyze the value of MUAC in predicting the occurrence of GDM. The optimal cut-off points were calculated. RESULTS In logistic regression analysis, pre-pregnancy weight, waist circumference, MUAC, UA, TG, and HDL-C independently predicted the occurrence of GDM (P < 0.05). MUAC retained statistical significance upon adjustment for various confounders (OR = 8.851, 95%CI: 3.907-20.048; P < 0.001). ROC curve analysis revealed good diagnostic potential for MUAC in GDM (AUC = 0.742, 95%CI: 0.684-0.800, P < 0.001), with a cut-off of 28.5 cm, sensitivity and specificity were 61% and 77%, respectively. CONCLUSION Pregnant women with MUAC >28.5 cm are prone to develop GDM during pregnancy, indicating that MUAC as an important predictive factor of GDM in early pregnancy.
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Affiliation(s)
- Ning Ma
- Department of Endocrinology, First Hospital of Qinhuangdao, Hebei, Qinhuangdao, 066000, China
| | - Liwei Bai
- Qinhuangdao Hospital for Maternal and Child Health, Hebei, Qinhuangdao, 066000, China
| | - Ziru Niu
- Department of Endocrinology, First Hospital of Qinhuangdao, Hebei, Qinhuangdao, 066000, China
| | - Qiang Lu
- Department of Endocrinology, First Hospital of Qinhuangdao, Hebei, Qinhuangdao, 066000, China.
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13
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Rodrigues-Martins D, Andrade S, Pereira SS, Braga J, Nunes I, Monteiro MP. Gestational Diabetes Risk and Low Birth Weight After Metabolic Bariatric Surgery: a Complex Interplay to be Balanced. Obes Surg 2024; 34:2546-2552. [PMID: 38833131 PMCID: PMC11217113 DOI: 10.1007/s11695-024-07314-1] [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: 03/22/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Metabolic bariatric surgery (MBS) is known to improve the obstetric outcomes of women with obesity and to prevent gestational diabetes (GD). To what extent does MBS decreases GD, without incurring at additional risks is a matter of concern. METHODS A retrospective case-control study to compare the pregnancy outcomes of women previously submitted to MBS to those of age and preconception body mass index (PC BMI) matched non-operated controls. RESULTS Pregnancies of women after MBS (n = 79) and matched controls (n = 79) were included. GD was significantly less frequent after MBS (7.6% vs. 19%; p = 0.03). Fasting blood glucose (76.90 ± 0.77 vs 80.37 ± 1.15 mg/dl, p < 0.05; 70.08 ± 1.34 vs. 76.35 ± 0.95 mg/dl; p < 0.05, first and second trimesters respectively) and birth weight (2953.67 ± 489.51 g vs. 3229.11 ± 476.21 g; p < 0.01) were significantly lower after MBS when compared to controls. The occurrence of small-for-gestational-age (SGA) was more frequent after MBS (22.8% vs. 6.3%; p < 0.01), but no longer significant after controlling for smoking habits (15.5% vs. 6%, p = 0.14). There were no significant differences in gestational weight gain, prematurity rate nor mode of delivery between groups. CONCLUSION MBS was associated with a lower prevalence of GD than observed in non-operated women with the same age and BMI. After controlling for smoking, this occurred at the expense of a lower birth weight. Our data reinforces the hypothesis that MBS has body weight independent effects on glucose kinetics during pregnancy with distinctive impacts for mother and offspring, which need to be balanced.
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Affiliation(s)
- Diana Rodrigues-Martins
- Centro Materno-Infantil do Norte - Centro Hospitalar Universitário de Santo António (CMIN-CHUdSA), Porto, Portugal
- Endocrine and Metabolic Research, UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
- ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Sara Andrade
- Endocrine and Metabolic Research, UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
- ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Sofia S Pereira
- Endocrine and Metabolic Research, UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
- ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Jorge Braga
- Centro Materno-Infantil do Norte - Centro Hospitalar Universitário de Santo António (CMIN-CHUdSA), Porto, Portugal
| | - Inês Nunes
- Obstetrics and Gynecology, Centro Hospitalar Vila Nova de Gaia/ Espinho, Porto, Portugal
- CINTESIS - Centro de Investigação Em Tecnologias E Serviços de Saúde, University of Porto, Porto, Portugal
| | - Mariana P Monteiro
- Endocrine and Metabolic Research, UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.
- ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal.
- Institute of Biomedical Sciences Abel Salazar - University of Porto, Rua Jorge Viterbo Ferreira 228, Building 1.3, 4050-313, Porto, Portugal.
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14
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Warrington JP, Collins HE, Davidge ST, do Carmo JM, Goulopoulou S, Intapad S, Loria AS, Sones JL, Wold LE, Zinkhan EK, Alexander BT. Guidelines for in vivo models of developmental programming of cardiovascular disease risk. Am J Physiol Heart Circ Physiol 2024; 327:H221-H241. [PMID: 38819382 DOI: 10.1152/ajpheart.00060.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 06/01/2024]
Abstract
Research using animals depends on the generation of offspring for use in experiments or for the maintenance of animal colonies. Although not considered by all, several different factors preceding and during pregnancy, as well as during lactation, can program various characteristics in the offspring. Here, we present the most common models of developmental programming of cardiovascular outcomes, important considerations for study design, and provide guidelines for producing and reporting rigorous and reproducible cardiovascular studies in offspring exposed to normal conditions or developmental insult. These guidelines provide considerations for the selection of the appropriate animal model and factors that should be reported to increase rigor and reproducibility while ensuring transparent reporting of methods and results.
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Grants
- 20YVNR35490079 American Heart Association (AHA)
- R01HL139348 HHS | NIH | National Heart, Lung, and Blood Institute (NHLBI)
- R01HL135158 HHS | NIH | National Heart, Lung, and Blood Institute (NHLBI)
- U54GM115428 HHS | NIH | National Institute of General Medical Sciences (NIGMS)
- R01AG057046 HHS | NIH | National Institute on Aging (NIA)
- P20 GM104357 NIGMS NIH HHS
- HL146562-04S1 HHS | NIH | National Heart, Lung, and Blood Institute (NHLBI)
- P30 GM149404 NIGMS NIH HHS
- P20GM104357 HHS | NIH | National Institute of General Medical Sciences (NIGMS)
- P01HL51971 HHS | NIH | National Heart, Lung, and Blood Institute (NHLBI)
- R01HL143459 HHS | NIH | National Heart, Lung, and Blood Institute (NHLBI)
- R01HL146562 HHS | NIH | National Heart, Lung, and Blood Institute (NHLBI)
- R01HL163003 HHS | NIH | National Heart, Lung, and Blood Institute (NHLBI)
- R01HL163818 HHS | NIH | National Heart, Lung, and Blood Institute (NHLBI)
- R01DK121411 HHS | NIH | National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
- R01HL147844 HHS | NIH | National Heart, Lung, and Blood Institute (NHLBI)
- Excellence Faculty Support Grant Jewish Heritage Fund
- P30GM149404 HHS | NIH | National Institute of General Medical Sciences (NIGMS)
- P30GM14940 HHS | NIH | National Institute of General Medical Sciences (NIGMS)
- P20GM121334 HHS | NIH | National Institute of General Medical Sciences (NIGMS)
- 23SFRNPCS1067044 American Heart Association (AHA)
- R01 HL146562 NHLBI NIH HHS
- R56HL159447 HHS | NIH | National Heart, Lung, and Blood Institute (NHLBI)
- P20GM135002 HHS | NIH | National Institute of General Medical Sciences (NIGMS)
- FS154313 CIHR
- U54 GM115428 NIGMS NIH HHS
- 1R01HL163076 HHS | NIH | National Heart, Lung, and Blood Institute (NHLBI)
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Affiliation(s)
- Junie P Warrington
- Department of Neurology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Helen E Collins
- Division of Environmental Medicine, Department of Medicine, Center for Cardiometabolic Science, University of Louisville, Louisville, Kentucky, United States
| | - Sandra T Davidge
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jussara M do Carmo
- Department of Physiology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Styliani Goulopoulou
- Lawrence D. Longo, MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University, Loma Linda, California, United States
- Department of Gynecology, and Obstetrics, Loma Linda University, Loma Linda, California, United States
| | - Suttira Intapad
- Department of Pharmacology, Tulane University, New Orleans, Louisiana, United States
| | - Analia S Loria
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, United States
| | - Jenny L Sones
- Equine Reproduction Laboratory, Department of Clinical Sciences, Colorado State University College of Veterinary Medicine and Biomedical Sciences, Fort Collins, Colorado, United States
| | - Loren E Wold
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Erin K Zinkhan
- Department of Pediatrics, University of Utah and Intermountain Health, Salt Lake City, Utah, United States
- Intermountain Health, Salt Lake City, Utah, United States
| | - Barbara T Alexander
- Department of Physiology, University of Mississippi Medical Center, Jackson, Mississippi, United States
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15
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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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Jennewein L, Agel L, Hoock SC, Hentrich AE, Louwen F, Zander N. Does overweight and obesity have an impact on delivery mode and peripartum outcome in breech presentation? A FRABAT cohort study. Arch Gynecol Obstet 2024; 310:285-292. [PMID: 38498162 PMCID: PMC11168971 DOI: 10.1007/s00404-024-07403-7] [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: 11/29/2023] [Accepted: 01/24/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Obesity is a worldwide and growing issue affecting women in childbearing age, complicating surgical procedures as well as pregnancy. Through a reduction of not necessarily required cesarean deliveries-for instance in pregnancies with breech presentation-obesity mediated and surgery-associated morbidity might be contained. Date on the impact of maternal BMI in vaginally attempted breech delivery is not existing. To give insight into whether an elevated BMI leads to an increased perinatal morbidity in vaginally intended deliveries out of breech presentation, we analyzed delivery outcome of laboring women with a singleton baby in breech presentation with overweight and obesity (BMI ≥ 25 kg/m2) in comparison to women with a BMI of below 25 kg/m2. METHODS Based on data from January 2004 to December 2020, a cohort study was performed on 1641 women presenting with breech presentation at term (> 37 weeks). The influence of maternal BMI on perinatal outcome was analyzed with Chi2 testing for group differences and logistic regression analysis. Patients with a hyperglycemic metabolism were excluded from the study. RESULTS Fetal morbidity was not different when patients with a BMI of ≥ 25 kg/m2 (PREMODA morbidity score 2.16%) were compared to patients with a BMI of below 25 kg/m2 (1.97%, p = 0.821). Cesarean delivery rates were significantly higher in overweight and obese women with 43.9% compared to 29.3% (p < 0.0001). BMI and cesarean delivery were significantly associated in a logistic regression analysis (Chi2 coefficient 18.05, p < 0.0001). In successful vaginal deliveries out of breech presentation, maternal perineal injury rates (vaginal birth in normal-BMI women 48.4%; vaginal birth in overweight and obese women: 44.2%; p = 0.273) and rates of manually assisted delivery (vaginal birth in normal-BMI women: 44.4%; vaginal birth in obese and overweight women: 44.2%; p = 0.958) were not different between BMI groups. CONCLUSIONS Obesity and overweight are not associated with peripartum maternal or newborn morbidity in vaginally attempted breech delivery, if the patient cohort is thoroughly selected and vaginal breech delivery is in an upright maternal position. Reduction of cesarean delivery rates, especially in overweight and obese women might, have an important positive impact on maternal and newborn morbidity.
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Affiliation(s)
- Lukas Jennewein
- Department of Obstetrics and Perinatal Medicine, University Hospital, Goethe University Frankfurt, 60590, Frankfurt, Germany.
| | - Lena Agel
- Department of Obstetrics and Perinatal Medicine, University Hospital, Goethe University Frankfurt, 60590, Frankfurt, Germany
| | - Samira Catharina Hoock
- Department of Obstetrics and Perinatal Medicine, University Hospital, Goethe University Frankfurt, 60590, Frankfurt, Germany
| | - Anna Elisabeth Hentrich
- Department of Obstetrics and Perinatal Medicine, University Hospital, Goethe University Frankfurt, 60590, Frankfurt, Germany
| | - Frank Louwen
- Department of Obstetrics and Perinatal Medicine, University Hospital, Goethe University Frankfurt, 60590, Frankfurt, Germany
| | - Nadja Zander
- Department of Obstetrics and Perinatal Medicine, University Hospital, Goethe University Frankfurt, 60590, Frankfurt, Germany
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17
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Grandfils S, Durand P, Hoge A, Seidel L, Emonts P, Paquot N, Philips JC. Gestational weight gain: Toward best practices in managing gestational weight gain in patients with obesity: Comparison of recommendations. Eur J Obstet Gynecol Reprod Biol 2024; 298:197-203. [PMID: 38795431 DOI: 10.1016/j.ejogrb.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 05/02/2024] [Accepted: 05/11/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND AND AIMS In 2009, the Institute of Medicine (IOM) issued recommendations for gestational weight gain (GWG) based on body mass index (BMI). Several studies have challenged those recommendations for women with obesity, considering them too liberal and advising more limited weight gain - or even weight loss - during pregnancy to improve maternal and neonatal outcomes. Our aim was to study how gestational weight gain in women with obesity impacted maternal and fetal complications in the Belgian population. We did this by comparing the results from two groups of patients with obesity: those who met the 2009 IOM standards and those who satisfied the stricter recommendations suggested by other authors. MATERIALS AND METHODS This is a retrospective cohort study using data collected at the Centre d'Epidémiologie Périnatale (CEpiP) from obese (BMI ≥ 30 kg/m2) pregnant women with live singleton deliveries between 2010 and 2019 in Wallonia-Brussels Federation (n = 65,314). RESULTS Compared to obese patients whose GWG satisfied the IOM standards, those with GWG meeting the stricter recommendations had lower rates of gestational hypertension (7.1 % vs. 10.1 %; p = 0.0059), cesarean section (22.1 % vs. 26.3 %; p = 0.0074), and macrosomia (12.0 % vs. 17.7 %; p < 0.0001). There was no significant difference in the rate of preterm delivery (6.9 % vs 5.8 %; p = 0.12) or small-for-gestational-age births (7.2 % vs. 6.2 %; p = 0.16). CONCLUSION Gestational weight gain below that currently recommended by the IOM appears beneficial to the health of mothers with obesity and their children. These data, from our population, further challenge the standards proposed since 2009.
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Affiliation(s)
- Sebastien Grandfils
- Department of Gynecology and Obstetrics, University Hospital of Liège, Belgium.
| | - Pauline Durand
- Department of Public Health, University of Liège, Belgium
| | - Axelle Hoge
- Department of Public Health, University of Liège, Belgium
| | - Laurence Seidel
- Biostatistics and Research Method Center (B-STAT), University Hospital of Liège, Belgium
| | - Patrick Emonts
- Department of Gynecology and Obstetrics, University Hospital of Liège, Belgium
| | - Nicolas Paquot
- Department of Diabetology, Nutrition and Metabolic Diseases, University Hospital of Liège, Belgium
| | - Jean Christophe Philips
- Department of Diabetology, Nutrition and Metabolic Diseases, University Hospital of Liège, Belgium
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18
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McCarthy EK, Ní Riada C, O'Brien R, Minogue H, McCarthy FP, Kiely ME. Access to nutrition advice and knowledge, attitudes and practices of pregnant women in Ireland: A cross-sectional study. J Hum Nutr Diet 2024. [PMID: 38881396 DOI: 10.1111/jhn.13342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/04/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Healthy nutritional status, appropriate gestational weight gain and a balanced diet are important predictors of perinatal health outcomes. However, gaps exist in the translation of nutrition recommendations into dietary practices of women before and during pregnancy. The present study explored the relationship between access to nutrition advice, nutrition knowledge, attitudes and practices among pregnant women. METHODS Pregnant women aged > 18 years in Ireland were eligible to complete a self-administered survey consisting of four subsections (demographics, nutrition knowledge, attitudes and practices) delivered online through Qualtrics. RESULTS In this convenience sample (n = 334, median [interquartile range] gestation, 25.0 [16.0, 34.0] weeks), 85% had at least an honours bachelor degree and 88.9% planned their pregnancy. Two out of five women received nutrition advice during their pregnancy, mostly from a midwife. Based on the percentage of correct answers (of 15 questions), women with previous nutrition education (e.g., school home economics) had better median [interquartile range] nutrition knowledge than those with none (80.0% [66.7, 86.7%] vs. 73.3% [60.0, 80.0%], p < 0.001). Those who received nutrition advice during pregnancy did not score higher than those who did not (73.3% [66.7, 80.0%] vs. 73.3% [66.7, 80.0%], p = 0.6). Over three-quarters of participants considered nutritional supplement use to be very or extremely important. Although 73.6% and 92.4% took supplements prior to and during pregnancy, only 25.7% reported compliance with periconceptional folic acid supplementation guidelines. Half of respondents considered healthy eating during pregnancy as very or extremely important. CONCLUSIONS Access to nutrition advice during pregnancy was inadequate with poor nutrition knowledge, attitudes and practices observed. Accessible, evidence-based nutrition education for women prior to and during pregnancy is required.
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Affiliation(s)
- Elaine K McCarthy
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Clodagh Ní Riada
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Roisin O'Brien
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Hannah Minogue
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Mairead E Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
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19
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Limauro R, Cioffi L, Bianco V, Caruso V, Casani A, Del Gaizo D, Esposito A, Farris E, Gallo P, Giuliano M, Iannone A, Izzo A, La Vecchia MT, Raineri L, Sabetti P, Sassi R, Servodidio C, Sorice N, Cioffi V, Antignani A, Valerio G. Nutritional counselling and risk factors for obesity: an observational study in toddlers. Ital J Pediatr 2024; 50:115. [PMID: 38872179 PMCID: PMC11170809 DOI: 10.1186/s13052-024-01668-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 04/28/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Nutrition exerts a fundamental role in the prevention of obesity (OB). The aim of this study was to assess the extent to which well recognized risk factors for early OB can be associated to overweight (OW) or OB under a standardized nutritional approach and surveillance in toddlers. METHODS The eligible population was represented by 676 toddlers aged 24-36 months, assigned to 18 primary care pediatricians trained on nutritional issues who shared a standardized nutritional approach. Six-hundred-twenty-nine children (333 boys), mean age 27.8 ± 4.2 months were effectively included in this observational study. Parents received nutritional advice with particular emphasis to proteins and sugar composition supported by leaflets and reinforced at each visit. Body mass index was assessed at the age of 24-36 months. The following individual and family risk factors were considered: gestational age, birth weight, eutocic/caesarean delivery, milk feeding history, household smoking or antibiotics exposure, parents' weight, height and educational level. Prevalence of OW/OB was compared to a group of 742 toddlers (373 boys) under usual care. RESULTS Under a standardized nutritional counselling, 28.1% toddlers were classified as OW/OB compared to 36.9% toddlers under usual care (p = 0.005). In unadjusted models, parental OW/OB was significantly associated to OW/OB in toddlers (p < 0.01), while high birth weight did not reach statistical significance (p = 0.07). In adjusted models, including all the explanatory variables studied, only paternal OW/OB vs. normal weight was significantly associated to OW/OB in toddlers (OR 2.035, 95% confidence interval 1.206-3.436). No protective effect of exclusive breast feeding during the first 6 months of age was demonstrated. CONCLUSIONS Toddlers under a standardized nutrition counselling focused to limit protein and simple sugars, showed lower prevalence of OW/OB compared to usual care. Healthy promotion activities should take into account the influence of paternal BMI on the offspring adiposity.
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Affiliation(s)
- Raffaele Limauro
- Italian Federation of Pediatricians Study Center, Naples, 80100, Italy
| | - Luigi Cioffi
- Italian Federation of Pediatricians Study Center, Naples, 80100, Italy
| | - Vincenzo Bianco
- Italian Federation of Pediatricians Study Center, Naples, 80100, Italy
| | - Vincenzo Caruso
- Benevento Section, Italian Federation of Pediatricians, Benevento, 82010, Italy
| | - Antonella Casani
- Benevento Section, Italian Federation of Pediatricians, Benevento, 82010, Italy
| | | | - Aldo Esposito
- Italian Federation of Pediatricians Study Center, Naples, 80100, Italy
| | - Evelina Farris
- Italian Federation of Pediatricians Study Center, Naples, 80100, Italy
| | - Patrizia Gallo
- Italian Federation of Pediatricians Study Center, Naples, 80100, Italy
| | - Maria Giuliano
- Italian Federation of Pediatricians Study Center, Naples, 80100, Italy
| | - Agnese Iannone
- Italian Federation of Pediatricians Study Center, Naples, 80100, Italy
| | - Annamaria Izzo
- Benevento Section, Italian Federation of Pediatricians, Benevento, 82010, Italy
| | | | - Luca Raineri
- Italian Federation of Pediatricians Study Center, Naples, 80100, Italy
| | - Patrizia Sabetti
- Italian Federation of Pediatricians Study Center, Naples, 80100, Italy
| | - Roberto Sassi
- Italian Federation of Pediatricians Study Center, Naples, 80100, Italy
| | | | - Nunziatina Sorice
- Benevento Section, Italian Federation of Pediatricians, Benevento, 82010, Italy
| | - Valentina Cioffi
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, 80131, Italy
| | | | - Giuliana Valerio
- Department of Medical, Movement and Wellbeing Sciences, University of Naples Parthenope, Naples, 80133, Italy.
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20
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Tsironikos GI, Zakynthinos GE, Tatsioni A, Tsolaki V, Kagias IG, Potamianos P, Bargiota A. Gestational Metabolic Risk: A Narrative Review of Pregnancy-Related Complications and of the Effectiveness of Dietary, Exercise and Lifestyle Interventions during Pregnancy on Reducing Gestational Weight Gain and Preventing Gestational Diabetes Mellitus. J Clin Med 2024; 13:3462. [PMID: 38929991 PMCID: PMC11204633 DOI: 10.3390/jcm13123462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/06/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Objective: This study is a Narrative Review that aims at investigating the implications of obesity, excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM). Additionally, this Review seeks to explore the effectiveness of nutrition, and/or exercise interventions during pregnancy on reducing GWG and preventing GDM. Materials and Methods: The search in literature included studies that identified obesity, GWG, GDM and associated risks during pregnancy. Also, SR and MA focusing on interventions including diet, or physical activity (PA), or combined (i.e., lifestyle interventions) and their impact on metabolic risk during pregnancy, were identified through searches in PubMed, Cochrane Database of Systematic Reviews (CDSRs), and Scopus. Results: The study findings suggest that lifestyle interventions during pregnancy may be effective in reducing excessive GWG. Regarding the prevention of GDM, results from studies evaluating lifestyle interventions vary. However, significant and less controversial results were reported from studies assessing the efficacy of exercise interventions, particularly in high-risk pregnant women. Conclusions: Lifestyle interventions during pregnancy may reduce excessive GWG. Exercise during pregnancy may prevent GDM, especially in high-risk pregnant women. Future research is warranted to tailor lifestyle interventions for optimal effectiveness during pregnancy.
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Affiliation(s)
- Georgios I. Tsironikos
- Department of Medicine, University of Ioannina, University Campus, 45110 Ioannina, Greece;
| | - George E. Zakynthinos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Athina Tatsioni
- Department of Research for General Medicine and Primary Health Care, Faculty of Medicine, University of Ioannina, University Campus, 45110 Ioannina, Greece;
| | - Vasiliki Tsolaki
- Department of Critical Care, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece;
| | - Iraklis-Georgios Kagias
- Department of Neurosurgery, University Hospitals Sussex NHS Foundation Trust, Brighton BN2 5BE, UK;
| | - Petros Potamianos
- Department of Gastroenterology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece;
| | - Alexandra Bargiota
- Department of Internal Medicine-Endocrinology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece;
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21
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van Zundert SKM, van Rossem L, Mirzaian M, Griffioen PH, Willemsen SP, van Schaik RHN, Steegers-Theunissen RPM. Periconceptional Non-medical Maternal Determinants Influence the Tryptophan Metabolism: The Rotterdam Periconceptional Cohort (Predict Study). Int J Tryptophan Res 2024; 17:11786469241257816. [PMID: 38873365 PMCID: PMC11171438 DOI: 10.1177/11786469241257816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 05/08/2024] [Indexed: 06/15/2024] Open
Abstract
Background The vital role of the maternal tryptophan (TRP) metabolism in maternal health and pregnancy is well established. However, non-medical maternal determinants influencing the TRP metabolism have been poorly investigated. We hypothesise that periconceptional maternal non-medical determinants alter the TRP metabolism, affecting both kynurenine (KP) and serotonin pathway (SP) metabolite concentrations. Therefore, we investigated the influence of non-medical maternal determinants on the TRP metabolism during the periconception period. Methods About 1916 pregnancies were included from the Rotterdam Periconceptional Cohort between November 2010 and December 2020. Data on periconceptional non-medical maternal determinants were collected through questionnaires. Serum samples were collected at 8.5 (SD = 1.6) weeks of gestation and TRP, kynurenine (KYN), 5-hydroxytryptophan (5-HTP), 5-HT (5-hydroxytryptamine) and 5-hydroxyindole acetic acid (5-HIAA) were determined using validated liquid chromatography (tandem) mass spectrometry. Mixed models were used to determine associations between periconceptional non-medical maternal determinants and these metabolites. Results In total 11 periconceptional non-medical maternal determinants were identified. Protein intake was positively associated with TRP (β = .12, 95% CI = 0.07-0.17), while age, energy intake and body mass index (BMI) (β = -.24, 95% CI = -0.37 to -0.10) were negatively associated with TRP. Age, BMI and total homocysteine were associated with higher KYN, whereas non-western geographical origin was associated with lower KYN (β = -.09, 95% CI = -0.16 to -0.03). Protein intake and total homocysteine (β = .07, 95% CI = 0.03-0.11) had a positive association with 5-HTP, while a negative association was found for energy intake. A non-western geographical origin and drug use were associated with higher 5-HT, and BMI with lower 5-HT (β = -6.32, 95% CI = -10.26 to -2.38). Age was positively associated with 5-HIAA (β = .92, 95% CI = 0.29-1.56), and BMI negatively. Conclusions Periconceptional non-medical maternal determinants, including age, geographical origin, drug use, energy and protein intake, BMI and total homocysteine, influence KP and SP metabolite concentrations.
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Affiliation(s)
- Sofie KM van Zundert
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
- Department of Clinical Chemistry, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Lenie van Rossem
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Mina Mirzaian
- Department of Clinical Chemistry, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Pieter H Griffioen
- Department of Clinical Chemistry, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Sten P Willemsen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Ron HN van Schaik
- Department of Clinical Chemistry, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
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Leyser-Whalen O, Ambert PA, Wilson AL, Quaney V, Estrella F, Gomez M, Monteblanco AD. Patient-Provider Satisfaction and Communication in U.S. Prenatal Care: A Systematic Review. Matern Child Health J 2024:10.1007/s10995-024-03952-0. [PMID: 38850378 DOI: 10.1007/s10995-024-03952-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION This is a systematic review on patient-provider satisfaction in U.S. prenatal care by addressing the following research question: What factors influence patient-provider satisfaction during prenatal care? METHODS Thirty six online databases were searched for peer-reviewed research from February to September of 2018 using 10 key terms published in English on U.S. populations between the years 1993-2018 on the topic of provider communication skills and patient satisfaction in the prenatal context. Searches yielded 2563 articles. After duplicates were reviewed and eligibility determined, 32 articles met criteria and were included in the final content analysis. All reported study variables were entered into EXCEL, data reported in each study were analyzed by two people for inter-rater reliability and included in the qualitative content analysis. Two researchers also utilized assessment tools to assess the quality of the articles. RESULTS Results indicate the importance of good patient-provider communication, that patients have a need for more information on a plethora of topics, and that Hispanic and African American women reported less satisfaction. DISCUSSION We recommend that future studies measure potentially significant themes not adequately present in the reviewed studies such as practitioner demographics (e.g. gender, years of experience, or race/ethnicity), mothers under 18 years of age, inclusion of religious minorities, patients with differing immigration statuses, and patients with disabilities.
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Affiliation(s)
- Ophra Leyser-Whalen
- Department of Sociology and Anthropology, The University of Texas at El Paso, 500 W. University Ave, El Paso, TX, 79968, USA.
| | | | | | - Vianey Quaney
- The University of Texas at El Paso, El Paso, TX, USA
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23
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Husby AE, Simpson MR, Dalbye R, Larsen M, Vanky E, Løvvik TS. Childbirth experiences in women with polycystic ovary syndrome: A cohort study. Acta Obstet Gynecol Scand 2024; 103:1092-1100. [PMID: 38366810 PMCID: PMC11103144 DOI: 10.1111/aogs.14800] [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: 10/13/2023] [Revised: 01/11/2024] [Accepted: 01/24/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Women with polycystic ovary syndrome (PCOS) have more pregnancy complications like gestational diabetes, hypertension, and preterm labor than other women. Metformin has been used in an attempt to improve pregnancy outcomes. Our study aims to explore childbirth experiences in women with PCOS compared with a reference population. It also explores the potential influence of metformin, obesity, pregnancy complications, and the duration and mode of birth on childbirth experiences. MATERIAL AND METHODS This study is a cohort study combining data from two randomized trials conducted in Norway, Sweden and Iceland. The PregMet2 study (ClinicalTrials.gov, NCT01587378) investigated the use of metformin vs. placebo in pregnant women with PCOS. The Labour Progression Study (ClinicalTrials.gov, NCT02221427) compared the WHO partograph to Zhang's guidelines for progression of labor and were used as the reference population. A total of 365 women with PCOS and 3604 reference women were included. Both studies used the Childbirth Experience Questionnaire (CEQ). Main outcome measures were total CEQ score and four domain scores. The CEQ scores were compared using Mann-Whitney U test for women in Robson group 1 with PCOS (n = 131) and reference women (n = 3604). CEQ scores were also compared between metformin-treated (n = 180) and placebo-treated (n = 185) women with PCOS, and for different subgroups of women with PCOS. RESULTS There was no difference in total CEQ score between women with PCOS and reference women-Wilcoxon-Mann-Whitney (WMW)-odds 0.96 (95% confidence interval [CI] 0.78-1.17). We detected no difference in CEQ scores between the metformin- and placebo-treated women with PCOS (WMW-odds 1.13, 95% CI 0.89-1.43). Complications in pregnancy did not affect CEQ (WMW-odds 1, 95% CI 0.76-1.31). Higher body mass index (WMW-odds 0.75, 95% CI 0.58-0.96), longer duration of labor (WMW-odds 0.69, 95% CI 0.49-0.96), and cesarean section (WMW-odds 0.29, 95% CI 0.2-0.42) were associated with lower CEQ scores in women with PCOS. CONCLUSIONS Women with PCOS experience childbirth similarly to the reference women. Metformin did not influence childbirth experience in women with PCOS, neither did pregnancy complications. Obesity, long duration of labor or cesarean section had a negative impact on childbirth experience.
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Affiliation(s)
- Anne Engtrø Husby
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Department of Obstetrics and GynecologySt Olav's University HospitalTrondheimNorway
| | - Melanie Rae Simpson
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Rebecka Dalbye
- Department of Obstetrics and GynecologyØstfold Hospital TrustGrålumNorway
- Department of Nursing and Health Promotion, Faculty of Health SciencesOslo Metropolitan UniversityOsloNorway
| | - Marit Larsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Department of Obstetrics and GynecologySt Olav's University HospitalTrondheimNorway
| | - Eszter Vanky
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Department of Obstetrics and GynecologySt Olav's University HospitalTrondheimNorway
| | - Tone Shetelig Løvvik
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Department of Obstetrics and GynecologySt Olav's University HospitalTrondheimNorway
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24
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de Ruyter H, Aitokari L, Lahti S, Riekki H, Huhtala H, Lakka T, Laivuori H, Kurppa K. Maternal gestational hypertension, smoking and pre-eclampsia are associated with metabolic dysfunction-associated fatty liver disease in overweight offspring. Acta Obstet Gynecol Scand 2024; 103:1183-1191. [PMID: 38433535 PMCID: PMC11103127 DOI: 10.1111/aogs.14816] [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: 11/08/2023] [Revised: 01/19/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Due to a steep increase in obesity, metabolic dysfunction-associated fatty liver disease (MAFLD) has also become the most common chronic hepatic condition among children and adolescents. Various maternal and pregnancy-related factors have also been implicated in the development of MAFLD, but human studies remain scarce. MATERIAL AND METHODS Comprehensive data of 460 overweight or obese children aged 2-16 years were collected and combined with data on selected maternal and pregnancy-related factors for a case-control study. MALFD was defined as alanine aminotransferase >2× upper limit of normal. Children with and without MAFLD were compared regarding to the study variables and multivariable regression analysis was utilized. RESULTS Median age of the study children was 11.8 (quartiles 9.1-14.2) years; 44% were girls and 17.8% had MAFLD. Children with MAFLD were older (12.7 vs. 11.6 years, p = 0.002), while the groups did not differ age-standardized body mass index (BMI-SDS) or gender. Factors associated with MAFLD in a multivariable model considering also the offspring's present BMI-SDS, sex, and maternal prepregnancy overweight, were child's older age (odds ratio [OR] 1.16, 95% confidence interval [CI]: 1.06-1.28), maternal gestational smoking (OR 2.01, 95% CI: 1.16-3.47), gestational hypertension (OR 3.44, 95% CI: 1.08-11.0) and pre-eclampsia (OR 2.93, 95% CI: 1.15-7.45). There was no significant association between MAFLD and maternal BMI, birth anthropometrics or perinatal complications. CONCLUSIONS Maternal smoking, gestational hypertension and pre-eclampsia were associated with MAFLD among overweight or obese children. Further prospective studies are needed to verify causal relationships.
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Affiliation(s)
- Hanna de Ruyter
- Tampere Center for Child, Adolescent and Maternal Health ResearchTampere University and Tampere University Hospital, Wellbeing Services County of PirkanmaaTampereFinland
| | - Linnea Aitokari
- Tampere Center for Child, Adolescent and Maternal Health ResearchTampere University and Tampere University Hospital, Wellbeing Services County of PirkanmaaTampereFinland
- Celiac Disease Research CenterTampere UniversityTampereFinland
| | - Siiri Lahti
- Tampere Center for Child, Adolescent and Maternal Health ResearchTampere University and Tampere University Hospital, Wellbeing Services County of PirkanmaaTampereFinland
| | - Hanna Riekki
- Tampere Center for Child, Adolescent and Maternal Health ResearchTampere University and Tampere University Hospital, Wellbeing Services County of PirkanmaaTampereFinland
| | - Heini Huhtala
- Faculty of Social SciencesTampere UniversityTampereFinland
| | - Timo Lakka
- Institute of BiomedicineUniversity of Eastern FinlandKuopioFinland
- Department of Clinical Physiology and Nuclear MedicineKuopio University HospitalKuopioFinland
- Kuopio Research Institute of Exercise MedicineKuopioFinland
| | - Hannele Laivuori
- Tampere Center for Child, Adolescent and Maternal Health ResearchTampere University and Tampere University Hospital, Wellbeing Services County of PirkanmaaTampereFinland
- Medical and Clinical GeneticsUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Kalle Kurppa
- Tampere Center for Child, Adolescent and Maternal Health ResearchTampere University and Tampere University Hospital, Wellbeing Services County of PirkanmaaTampereFinland
- Celiac Disease Research CenterTampere UniversityTampereFinland
- University Consortium of SeinäjokiSeinäjokiFinland
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Kukkonen A, Hantunen S, Voutilainen A, Ruusunen A, Uusitalo L, Backman K, Voutilainen R, Pasanen M, Kirjavainen PV, Keski-Nisula L. Maternal caffeine, coffee and cola drink intake and the risk of gestational diabetes - Kuopio Birth Cohort. Prim Care Diabetes 2024; 18:362-367. [PMID: 38423827 DOI: 10.1016/j.pcd.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 03/02/2024]
Abstract
AIMS Coffee intake is associated with a decreased risk of type 2 diabetes among non-pregnant people. We aimed to investigate the association between caffeine, coffee and cola drink intake in early pregnancy and the risk of gestational diabetes (GDM). METHODS Kuopio Birth Cohort (KuBiCo) is a prospective cohort study including pregnant women who were followed at the prenatal clinics in outpatient healthcare centers and gave birth in Kuopio University Hospital, Finland (n=2214). Maternal diet during the first trimester of pregnancy was assessed using a 160-item food frequency questionnaire. GDM was diagnosed by oral glucose tolerance test according to the Finnish national guidelines mainly between 24 and 28 gestational weeks. RESULTS Women with moderate coffee intake in the first trimester were less likely diagnosed with GDM than women without coffee intake in an age-adjusted model (OR 0.87; 95% CI 0.76-0.99; p = 0.03), but the association was attenuated in multi-adjusted models (p = 0.11). No association was found between caffeine intake and GDM. One third (32.4%) of pregnant women consumed caffeine over the recommendation (> 200 mg/d). Women who consumed cola drinks more than the median (33.3 mL/d) had an increased risk of GDM (OR 1.29; 95% CI 1.02-1.63, p = 0.037) in multi-adjusted model compared to those who consumed less. CONCLUSIONS Caffeine intake during the first trimester of pregnancy was not associated with the risk of GDM but a minor non-significant decrease was seen with moderate coffee intake. Although the average consumption of cola drinks was low in the KuBiCo cohort, higher consumption was associated with an increased risk of GDM. Further studies are needed to evaluate the safe amount of coffee during pregnancy, since the recommended caffeine intake was exceeded in almost half of the coffee drinkers.
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Affiliation(s)
- Anni Kukkonen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland.
| | - Sari Hantunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
| | - Ari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Anu Ruusunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland; IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Lauri Uusitalo
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Katri Backman
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland; Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Raimo Voutilainen
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland; Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Markku Pasanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Pirkka V Kirjavainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - Leea Keski-Nisula
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland; Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
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Chawla S, Laptook AR, Smith EA, Tan S, Natarajan G, Wyckoff MH, Greenberg RG, Ambalavanan N, Bell EF, Van Meurs KP, Hintz SR, Vohr BR, Werner EF, Das A, Shankaran S. Association of maternal pre-pregnancy or first trimester body mass index with neurodevelopmental impairment or death in extremely low gestational age neonates. J Perinatol 2024; 44:802-810. [PMID: 38396053 DOI: 10.1038/s41372-024-01905-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 01/19/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE To compare the rates of death or survival with severe neurodevelopmental impairment (sNDI) at 2 years among extremely preterm infants in relation to pre-pregnancy or first-trimester maternal body mass index (BMI). METHODS This retrospective cohort study included extremely preterm infants (gestational age 220/7-266/7 weeks). The study was conducted at National Institute of Child Health and Human Development Neonatal Research Network sites. The primary outcome was death or sNDI at 2 years. RESULTS Data on the primary outcome were available for 1208 children. Death or sNDI was not different among the three groups: 54.9% in normal, 56.1% in overweight, and 53.4% in obese group (p = 0.39). There was no significant difference in mortality, sNDI, moderate/severe cerebral palsy, Bayley Scales of Infant Development (BSID)-III cognitive composite score <70, BSID-III language composite score <70 in adjusted models. CONCLUSION Neurodevelopmental outcome was not significantly associated with maternal pre-pregnancy BMI among extreme preterm infants.
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Affiliation(s)
- Sanjay Chawla
- Department of Pediatrics, Central Michigan University, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA.
| | - Abbot R Laptook
- Department of Pediatrics, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | - Girija Natarajan
- Department of Pediatrics, Central Michigan University, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA
| | - Myra H Wyckoff
- Department of Pediatrics, UT Southwestern Medical Center at Dallas, Dallas, TX, USA
| | | | | | - Edward F Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Krisa P Van Meurs
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Susan R Hintz
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Betty R Vohr
- Department of Pediatrics, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Erika F Werner
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA, USA
| | - Abhik Das
- Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, MA, USA
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Hartigan S, Walsh B. Perioperative management of patients with spina bifida. BJA Educ 2024; 24:203-209. [PMID: 38764443 PMCID: PMC11096439 DOI: 10.1016/j.bjae.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 05/21/2024] Open
Affiliation(s)
- S. Hartigan
- Children's Health Ireland at Temple Street, Dublin, Ireland
| | - B. Walsh
- Children's Health Ireland at Temple Street, Dublin, Ireland
- School of Medicine, University College, Dublin, Ireland
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Nagpal TS, Pearce N, Adamo KB. Presentation of a weight bias internalization tool for use in pregnancy and a call for future research: A commentary. OBESITY PILLARS 2024; 10:100107. [PMID: 38524875 PMCID: PMC10957497 DOI: 10.1016/j.obpill.2024.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
Background Emerging evidence has shown that weight stigma is a concern during pregnancy, with several studies documenting common sources including healthcare, the media and interpersonal networks. Experiencing weight stigma may lead to weight bias internalization (WBI), whereby individuals accept and self-direct negative weight-related stereotypes, and limited research has assessed this in the context of pregnancy. Pregnancy is unique in terms of weight changes as many individuals will experience gestational weight gain (GWG). Accordingly, a WBI tool that accounts for GWG may be a more population-specific resource to use. Methods This commentary presents a pregnancy-specific WBI tool that accounts for GWG. The validated Adult WBI scale was modified to include 'pregnancy weight gain'. This commentary also presents a brief summary of research that has assessed WBI in pregnancy and recommendations for future work. Results Recommended future work includes validation of the pregnancy-specific WBI tool and prospective examinations of weight stigma and WBI in pregnancy and implications on maternal and newborn outcomes. Conclusion Ultimately this research may inform development of interventions and resources to mitigate weight stigma and WBI in pregnancy and overall may contribute to improving prenatal outcomes and experiences.
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Affiliation(s)
- Taniya S. Nagpal
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
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Hietalati S, Pham D, Arora H, Mochizuki M, Santiago G, Vaught J, Lin ET, Mestan KK, Parast M, Jacobs MB. Placental pathology and fetal growth outcomes in pregnancies complicated by maternal obesity. Int J Obes (Lond) 2024:10.1038/s41366-024-01546-y. [PMID: 38822073 DOI: 10.1038/s41366-024-01546-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 05/09/2024] [Accepted: 05/16/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND The rising prevalence of maternal obesity presents a significant health concern because of the possible implications for obstetric complications and neonatal outcomes. Understanding the impact of obesity on placental structure and function as well as fetal growth and infant outcomes is important to improve the care of these potentially high-risk pregnancies. This study aimed to determine the effect of elevated maternal BMI on histopathologic patterns of placental injury and its consequences on fetal growth. METHODS Data were collected from an ongoing cohort of maternal-infant dyads in the UCSD Obstetric Registry spanning 2011-2020. Maternal characteristics, including BMI, hypertensive disease and diabetes, placental gross and histopathology, and infant characteristics, including sex and birthweight, were recorded and analyzed. ANOVA and chi-square tests were used in initial analyses, followed by log-binomial and linear regression models adjusted for relevant confounders to determine associations between maternal BMI, specific patterns of placental injury, and infant birthweight percentiles. RESULTS Among 1366 maternal-infant dyads, placentas from mothers with overweight and obesity were heavier and demonstrated higher adjusted relative risks of chronic villitis (CV), decidual vasculopathy, intervillous thrombosis, and normoblastemia. Placental efficiency, determined by fetal-placental weight ratio, was decreased with increasing BMI. Maternal obesity was associated with higher rates of preterm birth and higher birthweight percentiles. Multiple placental lesions, including maternal (MVM) and fetal vascular malperfusion (FVM), exhibited significant effects on birthweight percentiles; however, only MVM showed a differential effect based on maternal obesity. CONCLUSIONS Presence of obesity in pregnancy is associated with increased rates of placental patterns of injury, decreased placental efficiency, and increased birthweight percentiles. While placental lesions, such as CV, have the potential to negatively impact fetal growth, the resulting birthweight percentiles demonstrate a more complex relationship between maternal obesity and fetal growth, that likely involves placental and fetal adaptation to the altered in utero environment.
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Affiliation(s)
- Samantha Hietalati
- Department of Pediatrics, Division of Neonatology, University of California San Diego, La Jolla, CA, USA
| | - Donna Pham
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Harneet Arora
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Marina Mochizuki
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - Gisselle Santiago
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - Jordan Vaught
- Department of Pediatrics, Division of Neonatology, University of California San Diego, La Jolla, CA, USA
| | - Erika T Lin
- Department of Pediatrics, Division of Neonatology, University of California San Diego, La Jolla, CA, USA
| | - Karen K Mestan
- Department of Pediatrics, Division of Neonatology, University of California San Diego, La Jolla, CA, USA
| | - Mana Parast
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Marni B Jacobs
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA.
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Zhang Y, Dai K, Chen X, Cui L, Chen ZJ. Association between being large for gestational age and cardiovascular metabolic health in children conceived from assisted reproductive technology: a prospective cohort study. BMC Med 2024; 22:203. [PMID: 38764021 PMCID: PMC11104001 DOI: 10.1186/s12916-024-03419-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 05/03/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND To the best of our knowledge, no study has investigated the potential joint effect of large for gestational age (LGA) and assisted reproductive technology (ART) on the long-term health of children. METHODS This was a prospective cohort study that recruited children whose parents had received ART treatment in the Center for Reproductive Medicine, Shandong Provincial Hospital, affiliated to Shandong University, between January 2006 and December 2017. Linear mixed model was used to compare the main outcomes. The mediation model was used to evaluate the intermediary effect of body mass index (BMI). RESULTS 4138 (29.5%) children born LGA and 9910 (70.5%) children born appropriate for gestational age (AGA) were included in the present study. The offspring ranged from 0.4 to 9.9 years. LGAs conceived through ART were shown to have higher BMI, blood pressure, fasting blood glucose, fasting insulin, and homeostatic model assessment of insulin resistance values, even after controlling for all covariates. The odds of overweight and insulin resistance are also higher in LGA subjects. After adjusting for all covariates, LGAs conceived through ART had BMI and BMI z-scores that were 0.48 kg/m2 and 0.34 units greater than those of AGAs, respectively. The effect of LGA on BMI was identified as early as infancy and remained consistently significant throughout pre-puberty. CONCLUSIONS Compared to AGA, LGA children conceived from ART were associated with increased cardiovascular-metabolic events, which appeared as early as infancy and with no recovery by pre-puberty.
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Affiliation(s)
- Yiyuan Zhang
- Institute of Women, Children and Reproductive Health, Cheeloo College of Medicine, Shandong University, Shandong, 250012, China
- Institute of Women, Children and Reproductive Health, the Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, 250012, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, Shandong, 250012, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China
- Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, Shandong, 250012, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, 250012, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, 250012, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250012, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No.2021RU001), Jinan, Shandong, 250012, China
| | - Kexin Dai
- Institute of Women, Children and Reproductive Health, Cheeloo College of Medicine, Shandong University, Shandong, 250012, China
- Institute of Women, Children and Reproductive Health, the Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, 250012, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, Shandong, 250012, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China
- Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, Shandong, 250012, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, 250012, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, 250012, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250012, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No.2021RU001), Jinan, Shandong, 250012, China
| | - Xiaojing Chen
- Institute of Women, Children and Reproductive Health, Cheeloo College of Medicine, Shandong University, Shandong, 250012, China
- Institute of Women, Children and Reproductive Health, the Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, 250012, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, Shandong, 250012, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China
- Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, Shandong, 250012, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, 250012, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, 250012, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250012, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No.2021RU001), Jinan, Shandong, 250012, China
| | - Linlin Cui
- Institute of Women, Children and Reproductive Health, the Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, 250012, China.
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, Shandong, 250012, China.
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China.
- Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, Shandong, 250012, China.
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, 250012, China.
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, 250012, China.
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250012, China.
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No.2021RU001), Jinan, Shandong, 250012, China.
- , Jinan, China.
| | - Zi-Jiang Chen
- Institute of Women, Children and Reproductive Health, Cheeloo College of Medicine, Shandong University, Shandong, 250012, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, Shandong, 250012, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China
- Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, Shandong, 250012, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, 250012, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, 250012, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250012, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No.2021RU001), Jinan, Shandong, 250012, China
- Department of Reproductive Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
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Gallagher D, Spyreli E, Anderson AS, Bridges S, Cardwell CR, Coulman E, Dombrowski SU, Free C, Heaney S, Hoddinott P, Kee F, McDowell C, McIntosh E, Woodside JV, McKinley MC. Effectiveness and cost-effectiveness of a 12-month automated text message intervention for weight management in postpartum women with overweight or obesity: protocol for the Supporting MumS (SMS) multisite, parallel-group, randomised controlled trial. BMJ Open 2024; 14:e084075. [PMID: 38719295 PMCID: PMC11086389 DOI: 10.1136/bmjopen-2024-084075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/25/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION The reproductive years can increase women's weight-related risk. Evidence for effective postpartum weight management interventions is lacking and engaging women during this life stage is challenging. Following a promising pilot evaluation of the Supporting MumS intervention, we assess if theory-based and bidirectional text messages to support diet and physical activity behaviour change for weight loss and weight loss maintenance, are effective and cost-effective for weight change in postpartum women with overweight or obesity, compared with an active control arm receiving text messages on child health and development. METHODS AND ANALYSIS Two-arm, parallel-group, assessor-blind randomised controlled trial with cost-effectiveness and process evaluations. Women (n=888) with body mass index (BMI) ≥25 kg/m2 and within 24 months of giving birth were recruited via community and National Health Service pathways through five UK sites targeting areas of ethnic and socioeconomic diversity. Women were 1:1 randomised to the intervention or active control groups, each receiving automated text messages for 12 months. Data are collected at 0, 6, 12 and 24 months. The primary outcome is weight change at 12 months from baseline, compared between groups. Secondary outcomes include weight change (24 months) and waist circumference (cm), proportional weight gain (>5 kg), BMI (kg/m2), dietary intake, physical activity, infant feeding and mental health (6, 12 and 24 months, respectively). Economic evaluation examines health service usage and personal expenditure, health-related quality of life and capability well-being to assess cost-effectiveness over the trial and modelled lifetime. Cost-utility analysis examines cost per quality-adjusted life-years gained over 24 months. Mixed-method process evaluation explores participants' experiences and contextual factors impacting outcomes and implementation. Stakeholder interviews examine scale-up and implementation. ETHICS AND DISSEMINATION Ethical approval was obtained before data collection (West of Scotland Research Ethics Service Research Ethics Committee (REC) 4 22/WS/0003). Results will be published via a range of outputs and audiences. TRIAL REGISTRATION NUMBER ISRCTN16299220.
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Affiliation(s)
- Dunla Gallagher
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Eleni Spyreli
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, Ninewells Medical School, Dundee, UK
| | - Sally Bridges
- Bradford Institute for Health Research, Bradford, UK
| | | | - Elinor Coulman
- Centre for Trials Research (CTR), Cardiff University School of Medicine, Cardiff, UK
| | - Stephan U Dombrowski
- Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Caroline Free
- Public Health Interventions Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzie Heaney
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Emma McIntosh
- Health Economics and Health Technology Assessment (HEHTA), University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Zhou L, Tian Y, Su Z, Sun JY, Sun W. Risk factors and prediction model for new-onset hypertensive disorders of pregnancy: a retrospective cohort study. Front Cardiovasc Med 2024; 11:1272779. [PMID: 38751664 PMCID: PMC11094209 DOI: 10.3389/fcvm.2024.1272779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
Background and aims Hypertensive disorders of pregnancy (HDP) is a significant cause of maternal and neonatal mortality. This study aims to identify risk factors for new-onset HDP and to develop a prediction model for assessing the risk of new-onset hypertension during pregnancy. Methods We included 446 pregnant women without baseline hypertension from Liyang People's Hospital at the first inspection, and they were followed up until delivery. We collected maternal clinical parameters and biomarkers between 16th and 20th weeks of gestation. Logistic regression was used to determine the effect of the risk factors on HDP. For model development, a backward selection algorithm was applied to choose pertinent biomarkers, and predictive models were created based on multiple machine learning methods (generalised linear model, multivariate adaptive regression splines, random forest, and k-nearest neighbours). Model performance was evaluated using the area under the curve. Results Out of the 446 participants, 153 developed new-onset HDP. The HDP group exhibited significantly higher baseline body mass index (BMI), weight change, baseline systolic/diastolic blood pressure, and platelet counts than the control group. The increase in baseline BMI, weight change, and baseline systolic and diastolic blood pressure significantly elevated the risk of HDP, with odds ratios and 95% confidence intervals of 1.10 (1.03-1.17), 1.10 (1.05-1.16), 1.04 (1.01-1.08), and 1.10 (1.05-1.14) respectively. Restricted cubic spline showed a linear dose-dependent association of baseline BMI and weight change with the risk of HDP. The random forest-based prediction model showed robust performance with the area under the curve of 0.85 in the training set. Conclusion This study establishes a prediction model to evaluate the risk of new-onset HDP, which might facilitate the early diagnosis and management of HDP.
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Affiliation(s)
- Ling Zhou
- Department of Obstetrics and Gynecology, Liyang People's Hospital, Liyang, Jiangsu, China
| | - Yunfan Tian
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhenyang Su
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jin-Yu Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Wang M, Ji Y, Chen S, Wang M, Lin X, Yang M. Effect of mode of delivery on postpartum weight retention: A systematic review and meta-analysis. Midwifery 2024; 132:103981. [PMID: 38574440 DOI: 10.1016/j.midw.2024.103981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Retention of weight gained over pregnancy increases the risk of long-term obesity and related health concerns. While many risk factors for this postpartum weight retention have been examined, the role of mode of delivery in this relationship remains controversial. We carried out a systematic review and meta-analysis to determine the effect of mode of delivery on postpartum weight retention. METHODS Ten electronic databases including PubMed, Cochrane Library, EMBASE, Web of Science, MEDLINE, CINAHL, China National Knowledge Infrastructure (CNKI), Wan-Fang database, the VIP database and China Biology Medicine Database (CBM) were searched from inception through November 2022. Review Manager 5.4 was used to pool the study data and calculate effect sizes. For dichotomous data, the odds ratio and 95 % confidence interval were used to report the results. For continuous data, the mean difference (MD) and 95 % confidence interval were used to report the results. The outcomes were the amount of postpartum weight retention and the number or proportion of women who experienced postpartum weight retention. The Newcastle- Ottawa Scale (NOS) and GRADE Guidelines were used to assess the methodological quality of the included studies. FINDINGS A total of 16 articles were included in the systematic review and 13 articles were included in the meta-analysis. The results showed that the mode of delivery had a significant effect on postpartum weight retention, women who delivered by caesarean section were more likely to experience postpartum weight retention compared to those who delivered vaginally. Sensitivity analysis showed that the results were stable and credible. CONCLUSION Due to the limitations of this study, the findings need to be treated with caution. And, to better prevent the postpartum weight retention, future practice and research need to further focus on upstream modifiable factors.
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Affiliation(s)
- Meiyu Wang
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China
| | - Yuting Ji
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China
| | - Shanxia Chen
- Health Management & Biotechnology School, Guangdong Food and Drug Vocational College, No.321, Longdong North Road, Tianhe District, Guangzhou City, Guangdong Province, China
| | - Minyi Wang
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China
| | - Xiaoli Lin
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China
| | - Ming Yang
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China.
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Dinsmoor MJ, Ugwu LG, Bailit JL, Reddy UM, Wapner RJ, Varner MW, Thorp JM, Caritis SN, Prasad M, Tita AT, Saade GR, Sorokin Y, Rouse DJ, Blackwell SC, Tolosa JE. Association of Maternal Body Mass Index and Maternal Morbidity And Mortality. Am J Perinatol 2024; 41:e204-e211. [PMID: 35709726 PMCID: PMC9978039 DOI: 10.1055/a-1877-8918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study aimed to assess the association of maternal body mass index (BMI) with a composite of severe maternal outcomes. STUDY DESIGN Secondary analysis of a cohort of deliveries on randomly selected days at 25 hospitals from 2008 to 2011. Data on comorbid conditions, intrapartum events, and postpartum course were collected. The reference group (REF, BMI: 18.5-29.9kg/m2), obese (OB; BMI: 30-39.9kg/m2), morbidly obese (MO; BMI: 40-49.9kg/m2), and super morbidly obese (SMO; BMI ≥ 50kg/m2) women were compared. The composite of severe maternal outcomes was defined as death, intensive care unit (ICU) admission, ventilator use, deep venous thrombosis/pulmonary embolus (DVT/PE), sepsis, hemorrhage, disseminated intravascular coagulation (DIC), unplanned operative procedure, or stroke. Patients in the REF group were matched 1:1 with those in all other obesity groups based on propensity score using the baseline characteristics of age, race/ethnicity, previous cesarean, preexisting diabetes, chronic hypertension, parity, cigarette use, and insurance status. Multivariable Poisson's regression was used to estimate adjusted relative risks (aRRs) and 95% confidence intervals (CIs) for the association between BMI and the composite outcome. Because cesarean delivery may be in the causal pathway between obesity and adverse maternal outcomes, models were then adjusted for mode of delivery to evaluate potential mediation. RESULTS A total of 52,162 pregnant patients are included in the analysis. Risk of composite maternal outcomes was increased for SMO compared with REF but not for OB and MO [OB: aRR=1.06, 95% CI: 0.99-1.14; MO: aRR=1.10, 95% CI: 0.97-1.25; SMO: aRR=1.32, 95% CI: 1.02-1.70]. However, in the mediation analysis, cesarean appears to mediate 46% (95% CI: 31-50%) of the risk of severe morbidity for SMO compared with REF. CONCLUSION Super morbid obesity is significantly associated with increased serious maternal morbidity and mortality; however, cesarean appears to mediate this association. Obesity and morbid obesity are not associated with maternal morbidity and mortality. KEY POINTS · Super morbid obesity is associated with increased morbidity.. · Cesarean appears to mediate the association between super morbid obesity and morbidity.. · Obesity and morbid maternal obesity are not associated with morbidity..
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Affiliation(s)
- Mara J. Dinsmoor
- Departments of Obstetrics and Gynecology of Northwestern University, Chicago, Illinois
| | - Lynda G. Ugwu
- George Washington University Biostatistics Center, Washington, District of Columbia
| | - Jennifer L. Bailit
- Departments of Obstetrics and Gynecology, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio
| | - Uma M. Reddy
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Ronald J. Wapner
- Departments of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Michael W. Varner
- Departments of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - John M. Thorp
- Departments of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Steve N. Caritis
- Departments of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mona Prasad
- Departments of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Alan T.N. Tita
- Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - George R. Saade
- Departments of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Yoram Sorokin
- Departments of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
| | - Dwight J. Rouse
- Departments of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
| | - Sean C. Blackwell
- Departments of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, McGovern Medical SchoolChildren’s Memorial Hermann Hospital, Houston, Texas
| | - Jorge E. Tolosa
- Departments of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
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Hu G, Zhao Y, Fu X, Hu D, Liang X. Maternal body mass index and cerebral palsy in children: A systematic review and dose-response meta-analysis. Paediatr Perinat Epidemiol 2024; 38:345-356. [PMID: 38146616 DOI: 10.1111/ppe.13033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 10/20/2023] [Accepted: 12/07/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Accumulating studies indicate that maternal obesity is associated with the risk of cerebral palsy (CP); however, their conclusions have been inconsistent. OBJECTIVES To quantitatively estimate the association between maternal body mass index (BMI) and CP in offspring. DATA SOURCES PubMed, Embase and Web of Science. STUDY SELECTION AND DATA EXTRACTION Articles published up to 18 September 2022 were searched that reported the correlation between maternal BMI and CP in children. Two reviewers independently extracted data and critically assessed articles. SYNTHESIS Pooled relative risks (RR) and 95% confidence intervals (CI) were estimated by the random-effects model. Subgroup analysis and meta-regression were performed to explore sources of heterogeneity. RESULTS In total, 11 articles (8,407,668 participants) were identified for inclusion in our meta-analysis. For maternal underweight, no significant association was found with CP risk (RR 1.11, 95% CI 0.90, 1.38). The risk of CP was increased by 25% (RR 1.25, 95% CI 1.06, 1.47), 38% (RR 1.38, 95% CI 1.18, 1.61) and 127% (RR 2.27, 95% CI 1.82, 2.83) for maternal overweight, obesity and obesity grade 3, respectively. In addition, we observed a positive linear dose-response relationship, with the pooled risk of cerebral palsy in offspring increasing by 3% with each unit increase in maternal BMI. CONCLUSION This meta-analysis indicates that the risk of CP in offspring grew with maternal overweight or obesity grades increasing, and was positively correlated with maternal BMI.
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Affiliation(s)
- Guomin Hu
- The Second Department of pediatrics, The First People's Hospital of Nanyang City, Nanyang, Henan, People's Republic of China
| | - Yang Zhao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, People's Republic of China
| | - Xueru Fu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, People's Republic of China
| | - Dongsheng Hu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, People's Republic of China
| | - Xin Liang
- Administration Department of Nursing Affairs, The First People's Hospital of Nanyang City, Nanyang, Henan, People's Republic of China
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Alqahtani A, Almayouf M, Butt A, Bawahab MA, Billa S, Maqsood B, Vergis A. Midterm Outcome of Early Pregnancy Versus Late Pregnancy After Laparoscopic Sleeve Gastrectomy. Obes Surg 2024; 34:1630-1638. [PMID: 38483741 DOI: 10.1007/s11695-024-07160-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Controversy regarding the timing of pregnancy and its implications is present in the literature. OBJECTIVE To evaluate the midterm outcome of weight loss in women who have undergone laparoscopic sleeve gastrectomy (LSG) followed by pregnancy at two different times. METHODS We retrospectively reviewed 53 women who matched the inclusion criteria and included them in the analysis. Demographics and anthropometric measurements were collected. Women who conceived within 12 months of LSG were labeled as early group (EG), and who conceived after 12 months were noted as late group (LG). RESULTS There were no differences between the groups regarding obesity-associated disease and number of pregnancies before. EG had higher weight (P = 0.0001) and body mass index (BMI) (P = 0.002) at LSG. The mean interval time for EG was 6.7 ± 3.2 months, and LG was 20 ± 5.2 months. Gestational weight gain (GWG) was lower in the EG (P = 0.001). There were no differences in the number of small for gestational age (SGA) births or gestational weight. In the first 2 years after LSG, LG had a higher percentage of total weight loss (%TWL) and percentage of body mass index loss (%EBMIL) (P < 0.0001). After 5 years of follow-up, %TWL (P = 0.4) and %EBMIL (P = 0.1) were not statistically significant between both groups. CONCLUSION Conception within 12 months from LSG might hinder the weight loss process in the short term but have no significant effect over 5 years of follow-up.
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Affiliation(s)
- Awadh Alqahtani
- College of Medicine, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
- Dr. Sulaiman Alhabib Hospital, Riyadh, Saudi Arabia
| | - Mohammad Almayouf
- Dr. Sulaiman Alhabib Hospital, Riyadh, Saudi Arabia.
- College of Medicine, Department of Surgery, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia.
| | - Amina Butt
- Dr. Sulaiman Alhabib Hospital, Riyadh, Saudi Arabia
| | - Mohammed A Bawahab
- Department of General Surgery, Faculty of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Srikar Billa
- Dr. Sulaiman Alhabib Hospital, Riyadh, Saudi Arabia
| | | | - Ashley Vergis
- Department of Surgery, Section of General Surgery, University of Manitoba, 409 Tache Avenue, Winnipeg, Canada
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Goldman T, Costa B. A Systematic Review and Meta-analysis of Two Negative Pressure Wound Therapy Devices to Manage Cesarean Section Incisions. Am J Perinatol 2024; 41:e2786-e2798. [PMID: 37726017 PMCID: PMC11150062 DOI: 10.1055/s-0043-1775562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 08/17/2023] [Indexed: 09/21/2023]
Abstract
This paper aims to evaluate whether there is a device-dependent effect on the reduction of surgical site complications in obese patients (body mass index [BMI] ≥ 30 kg/m2) undergoing cesarean section (C-section). PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched for the period, January 2011 to September 2021. English language articles describing a randomized controlled trial (RCT) that compared either a -80 or -125 mm Hg single-use negative pressure wound therapy (sNPWT) device to standard dressings in obese (BMI ≥ 30 kg/m2) patients undergoing C-section were included. Conference abstracts and "terminated" RCTs with published results were deemed eligible for inclusion. The primary outcome of interest was surgical site infection (SSI), classified as composite, superficial, or deep. Secondary outcomes assessed included seroma, dehiscence, hematoma, bleeding, reoperation, readmission, blistering, and (composite) wound complications. A total of 223 titles were identified, of which 129 were screened by full-text review. Eleven RCTs encompassing 5,847 patients met the inclusion criteria and were considered eligible for further analysis (-80 mm Hg: six studies; -125 mm Hg: five studies). A statistically significant improvement in the composite SSI (odds ratio [OR]: 0.69; 95% confidence interval [CI]: 0.54-0.89) and superficial SSI (OR: 0.66; 95% CI: 0.50-0.86) outcomes was observed with the -80 mm Hg device, compared with standard dressings. The same effect on SSI outcomes was not observed with the -125 mm Hg device (composite SSI-OR: 0.91; 95% CI: 0.64-1.28; superficial SSI-OR: 1.12; 95% CI: 0.70-1.78). There were no statistically significant differences in any of the other assessed outcomes. sNPWT devices may differ in their ability to reduce composite or superficial SSI after C-section. KEY POINTS: · Negative pressure benefits obese patients undergoing C-section.. · Negative pressure devices may differ in performance.. · A head-to-head clinical trial is needed..
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Affiliation(s)
- Theodore Goldman
- Obstetrics and Gynecology, Northwell Health, Huntington, New York
| | - Ben Costa
- Global Clinical and Medical Affairs, Smith + Nephew, Hull, United Kingdom
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Cao R, Su Y, Li J, Ao R, Xu X, Liang Y, Liu Z, Yu Q, Xie J. Exploring research hotspots and future directions in neural tube defects field by bibliometric and bioinformatics analysis. Front Neurosci 2024; 18:1293400. [PMID: 38650623 PMCID: PMC11033379 DOI: 10.3389/fnins.2024.1293400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/11/2024] [Indexed: 04/25/2024] Open
Abstract
Background Neural tube defects (NTDs) is the most common birth defect of the central nervous system (CNS) which causes the death of almost 88,000 people every year around the world. Much efforts have been made to investigate the reasons that contribute to NTD and explore new ways to for prevention. We trawl the past decade (2013-2022) published records in order to get a worldwide view about NTDs research field. Methods 7,437 records about NTDs were retrieved from the Web of Science (WOS) database. Tools such as shell scripts, VOSviewer, SCImago Graphica, CiteSpace and PubTator were used for data analysis and visualization. Results Over the past decade, the number of publications has maintained an upward trend, except for 2022. The United States is the country with the highest number of publications and also with the closest collaboration with other countries. Baylor College of Medicine has the closest collaboration with other institutions worldwide and also was the most prolific institution. In the field of NTDs, research focuses on molecular mechanisms such as genes and signaling pathways related to folate metabolism, neurogenic diseases caused by neural tube closure disorders such as myelomeningocele and spina bifida, and prevention and treatment such as folate supplementation and surgical procedures. Most NTDs related genes are related to development, cell projection parts, and molecular binding. These genes are mainly concentrated in cancer, Wnt, MAPK, PI3K-Akt and other signaling pathways. The distribution of NTDs related SNPs on chromosomes 1, 3, 5, 11, 14, and 17 are relatively concentrated, which may be associated with high-risk of NTDs. Conclusion Bibliometric analysis of the literature on NTDs field provided the current status, hotspots and future directions to some extant. Further bioinformatics analysis expanded our understanding of NTDs-related genes function and revealed some important SNP clusters and loci. This study provided some guidance for further studies. More extensive cooperation and further research are needed to overcome the ongoing challenge in pathogenesis, prevention and treatment of NTDs.
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Affiliation(s)
- Rui Cao
- Department of Biochemistry and Molecular Biology, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Key Laboratory of Coal Environmental Pathogenicity and Prevention of Ministry of Education, Shanxi Medical University, Taiyuan, China
- Translational Medicine Research Centre, Shanxi Medical University, Taiyuan, China
| | - Yanbing Su
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Jianting Li
- Department of Biochemistry and Molecular Biology, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Key Laboratory of Coal Environmental Pathogenicity and Prevention of Ministry of Education, Shanxi Medical University, Taiyuan, China
| | - Ruifang Ao
- Department of Biochemistry and Molecular Biology, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Key Laboratory of Coal Environmental Pathogenicity and Prevention of Ministry of Education, Shanxi Medical University, Taiyuan, China
| | - Xiangchao Xu
- Sci-Tech Information and Strategic Research Center of Shanxi Province, Taiyuan, China
| | - Yuxiang Liang
- Department of Biochemistry and Molecular Biology, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Key Laboratory of Coal Environmental Pathogenicity and Prevention of Ministry of Education, Shanxi Medical University, Taiyuan, China
| | - Zhizhen Liu
- Department of Biochemistry and Molecular Biology, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Key Laboratory of Coal Environmental Pathogenicity and Prevention of Ministry of Education, Shanxi Medical University, Taiyuan, China
| | - Qi Yu
- Department of Biochemistry and Molecular Biology, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Key Laboratory of Coal Environmental Pathogenicity and Prevention of Ministry of Education, Shanxi Medical University, Taiyuan, China
| | - Jun Xie
- Department of Biochemistry and Molecular Biology, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Key Laboratory of Coal Environmental Pathogenicity and Prevention of Ministry of Education, Shanxi Medical University, Taiyuan, China
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Phillips K, Nirantharakumar K, Wakerley BR, Crowe FL. Trends in the prevalence and pharmacological management of migraine during pregnancy in the UK, 2000-2018. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333530. [PMID: 38569874 DOI: 10.1136/jnnp-2024-333530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Migraine is common in women of reproductive age. This study aimed to (1) describe the prevalence of migraine in pregnant women in the UK, (2) identify drugs commonly prescribed for migraine during pregnancy and (3) identify characteristics associated with being prescribed medication for migraine during pregnancy. METHODS The Clinical Practice Research Datalink pregnancy register, a database of pregnancy episodes identified in anonymised primary care health records, was used.Crude and age-standardised prevalence of migraine during pregnancy and the proportion of women with migraine prescribed drugs used for migraine management were calculated for each year between 2000 and 2018.Logistic regression was used to describe the relationship between patient characteristics and being prescribed migraine medication during pregnancy. RESULTS 1 377 053 pregnancies were included, of which 187 328 were in women with a history of migraine. The age-adjusted prevalence increased from 11.4% in 2000 to 17.2% in 2018. There was an increase in the rates of prescription for numerous medications for the management of migraine.Older women (adjusted OR (aOR) 1.41 (1.20 to 1.66)), women of black (aOR 1.40 (1.32 to 1.48)) and South Asian ethnicity (aOR 1.48 (1.38 to 1.59)), those living in the most deprived areas (aOR 1.60 (1.54 to 1.66)), women who were obese (aOR 1.39 (1.35 to 1.43)), smokers (aOR 1.15 (1.12 to 1.18)) and those with comorbid conditions were more likely to receive a prescription during pregnancy. CONCLUSIONS Rates of recorded migraine have increased over the past two decades as well as rates of prescribing in women with migraine. Higher prescribing rates are seen in certain groups, which has the potential to exacerbate health inequalities.
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Affiliation(s)
- Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, University of Birmingham, Birmingham, UK
| | - Benjamin R Wakerley
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Francesca L Crowe
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Bechensteen BT, Sithiravel C, Strøm-Roum EM, Ruud HK, Kravdal G, Winther JA, Valderhaug TG. Post-bariatric pregnancy is associated with vitamin K1 deficiency, a case control study. BMC Pregnancy Childbirth 2024; 24:229. [PMID: 38566061 PMCID: PMC10985986 DOI: 10.1186/s12884-024-06407-0] [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: 10/19/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Maternal obesity is associated with adverse outcome for pregnancy and childbirths. While bariatric surgery may improve fertility and reduce the risk of certain pregnancy-related complications such as hypertension and gestational diabetes mellitus, there is a lack of evidence on the optimal nutritional monitoring and supplementation strategies in pregnancy following bariatric surgery. We aimed to assess the impact of bariatric surgery on micronutrients in post-bariatric pregnancy and possible differences between gastric bypass surgery and sleeve gastrectomy. METHODS In this prospective case control study, we recruited 204 pregnant women (bariatric surgery n = 59 [gastric bypass surgery n = 26, sleeve gastrectomy n = 31, missing n = 2] and controls n = 145) from Akershus university hospital in Norway. Women with previous bariatric surgery were consecutively invited to study participation at referral to the clinic for morbid obesity and the controls were recruited from the routine ultrasound screening in gestational week 17-20. A clinical questionnaire was completed and blood samples were drawn at mean gestational week 20.4 (SD 4.5). RESULTS The women with bariatric surgery had a higher pre-pregnant BMI than controls (30.8 [SD 6.0] vs. 25.2 [5.4] kg/m2, p < 0.001). There were no differences between groups regarding maternal weight gain (bariatric surgery 13.3 kg (9.6) vs. control 14.8 kg (6.5), p = 0.228) or development of gestational diabetes (n = 3 [5%] vs. n = 7 [5%], p = 1.000). Mean levels of vitamin K1 was lower after bariatric surgery compared with controls (0.29 [0.35] vs. 0.61 [0.65] ng/mL, p < 0.001). Multiadjusted regression analyses revealed an inverse relationship between bariatric surgery and vitamin K1 (B -0.26 ng/mL [95% CI -0.51, -0.04], p = 0.047) with a fivefold increased risk of vitamin K1 deficiency in post-bariatric pregnancies compared with controls (OR 5.69 [1.05, 30.77] p = 0.044). Compared with sleeve gastrectomy, having a previous gastric bypass surgery was associated with higher risk of vitamin K1 deficiency (OR 17.1 [1.31, 223.3], p = 0.030). CONCLUSION Post-bariatric pregnancy is negatively associated with vitamin K1 with a higher risk of vitamin K1 deficiency in pregnancies after gastric bypass surgery compared with after sleeve gastrectomy. Vitamin K1 deficiency in post-bariatric pregnancy have potential risk of hypocoaguble state in mother and child and should be explored in future studies.
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Affiliation(s)
- Brit Torunn Bechensteen
- Department of Endocrinology, Akershus University Hospital HF, Lørenskog, Norway
- Department of Clinical nutrition, Akershus University Hospital HF, Lørenskog, Norway
| | - Cindhya Sithiravel
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital HF, Lørenskog, Norway
| | | | - Heidi Kathrine Ruud
- Department of Clinical nutrition, Akershus University Hospital HF, Lørenskog, Norway
| | - Gunnhild Kravdal
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital HF, Lørenskog, Norway
| | - Jacob A Winther
- Department of Endocrinology, Akershus University Hospital HF, Lørenskog, Norway
| | - Tone G Valderhaug
- Department of Endocrinology, Akershus University Hospital HF, Lørenskog, Norway.
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Michalopoulou M, Jebb SA, MacKillop LH, Dyson P, Hirst JE, Zhu S, Wire A, Astbury NM. REduced-Carbohydrate intervention for managing Obesity and Reduction of gestational Diabetes (RECORD): A randomized controlled feasibility trial. Diabetes Obes Metab 2024; 26:1407-1420. [PMID: 38229418 DOI: 10.1111/dom.15442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/18/2024]
Abstract
AIM To test the feasibility and acceptability of a reduced-carbohydrate dietary program, intended to reduce the risk of gestational diabetes. MATERIALS AND METHODS Fifty-one pregnant women at <20 weeks' gestation, with body mass index ≥30 kg/m2 , and a normal baseline oral glucose tolerance test (OGTT), were randomized 2:1 to an intervention or control group and followed-up until delivery. The dietary intervention aimed at providing 130-150 g carbohydrate/day. Feasibility outcomes assessed at 24-28 weeks' gestation, included adoption of the reduced-carbohydrate diet by the intervention group, and retention of all participants, assessed by completion of a second OGTT. Changes in glycemia, weight gain and dietary intake, and the maternal and neonatal outcomes were also assessed. Participants were interviewed about their experience of the intervention and the study. RESULTS Forty-nine of 51 participants attended the follow-up OGTT, a retention rate of 96% (95% confidence interval [CI] 86.8%-98.9%). In the intervention group, carbohydrate intake at follow-up was 190.4 (95% CI 162.5-215.6) g/day, a reduction of -24.6 (95% CI -51.5-2.4) g/day from baseline. Potentially favourable effects of the intervention on glucose control, weight gain and blood pressure were observed, but the study was not powered to detect significant differences in these. Participants found the intervention acceptable, and were content with the study processes, but some reported barriers to sustained adherence, mainly pertaining to competing priorities. CONCLUSIONS Retention was high, suggesting the study processes are feasible, but the carbohydrate reduction in the intervention group was small, and did not meet progression criteria, limiting the likelihood of achieving the desired goal to prevent gestational diabetes. TRIAL REGISTRATION NUMBER ISRCTN16235884.
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Affiliation(s)
- Moscho Michalopoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lucy H MacKillop
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Pamela Dyson
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Oxford, UK
| | - Jane E Hirst
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, Imperial College London, London, UK
| | - Sufen Zhu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amy Wire
- Berkshire Healthcare NHS Foundation Trust, Bracknell, UK
| | - Nerys M Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Alfaiate MI, Tavares RS, Ramalho-Santos J. A ripple effect? The impact of obesity on sperm quality and function. Reprod Fertil Dev 2024; 36:RD23215. [PMID: 38589340 DOI: 10.1071/rd23215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/15/2024] [Indexed: 04/10/2024] Open
Abstract
Infertility affects approximately 15% of couples trying to conceive. Male-related causes account for roughly 50% of cases, with obesity emerging as a possible significant factor. Obesity, defined as a body mass index of 30.0 or higher, has become a widespread epidemic associated with numerous health issues, including a decrease of fertility. This review discusses the relationship between obesity and male infertility, particularly focusing on sperm quality and function. An overview of the literature suggests that obesity may influence the male reproductive system via disruptions in hormonal profiles, oxidative stress, and inflammation, leading to changes in sperm parameters. Several studies have discussed if obesity causes a decrease in sperm concentration, motility, and normal morphology, so far without a consensus being reached. However, available evidence suggests an impairment of sperm function in obese men, due to an increase in DNA damage and oxidative stress, impaired mitochondrial function and acrosome reaction in response to progesterone. Finally, the relationship between obesity and assisted reproductive technologies outcomes remains debatable, with conflicting evidence regarding the influence on fertilisation, pregnancy, and live birth rates. Therefore, the actual impact of obesity on human spermatozoa still needs to be clarified, due to the multiple factors potentially in play.
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Affiliation(s)
- Maria Inês Alfaiate
- University of Coimbra, CNC-UC, Center for Neuroscience and Cell Biology, CIBB, Coimbra, Portugal; and University of Coimbra, Institute for Interdisciplinary Research, Doctoral Programme in Experimental Biology and Biomedicine (PDBEB), Coimbra, Portugal
| | - Renata Santos Tavares
- University of Coimbra, CNC-UC, Center for Neuroscience and Cell Biology, CIBB, Coimbra, Portugal; and Department of Life Sciences, University of Coimbra, Coimbra 3000-456, Portugal
| | - João Ramalho-Santos
- University of Coimbra, CNC-UC, Center for Neuroscience and Cell Biology, CIBB, Coimbra, Portugal; and Department of Life Sciences, University of Coimbra, Coimbra 3000-456, Portugal
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Naja F, Abdulmalik M, Ayoub J, Mahmoud A, Nasreddine L. Dietary patterns and their associations with postpartum weight retention: results of the MINA cohort study. Eur J Nutr 2024; 63:809-820. [PMID: 38180505 DOI: 10.1007/s00394-023-03305-7] [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: 05/02/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE To examine the association of prepregnancy dietary patterns with postpartum weight retention at 6 months (PPWR6) among Lebanese and Qatari women. METHODS Data for this study were derived from the Mother and Infant Nutrition Assessment (MINA) prospective cohort study conducted in Lebanon and Qatar. Pregnant women were recruited during their first trimester and were followed up for three years. For the purpose of this study, data belonging to sociodemographic characteristics of participants, prepregnancy dietary intake, prepregnancy BMI as well as weight retention at 6 months were used. Dietary intake was examined using a 98-item food frequency questionnaire. Principal component analysis was used for the derivation of dietary patterns. The associations of dietary patterns with PPWR6 were examined using simple and multiple linear regressions. RESULTS Data was available for 177 participants (Lebanon: 93; Qatar: 84). Mean PPWR6 was 4.05 ± 5.29 kg. Significantly higher PPWR6 was observed among participants with pre-pregnancy overweight/obesity and among those with excessive gestational weight gain. Two dietary patterns were identified: the "Western" and the "Varied" patterns. After adjustment for confounders, a positive association was observed between the 'Western' pattern scores and PPWR6 (ß = 1.27; 95% CI 0.68-1.86; p value: < 0.0001). CONCLUSION Higher adherence to the Western pattern was associated with higher PPWR6 amongst women, hence underscoring the importance of public health interventions aimed at fostering healthier dietary habits during this crucial stage of the lifecycle.
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Affiliation(s)
- Farah Naja
- Department of Clinical Nutrition and Dietetics, Research Institute of Medical and Health Sciences (RIMHS), College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | | | - Jennifer Ayoub
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Amira Mahmoud
- Public Health Department, Ministry of Public Health, Doha, Qatar
| | - Lara Nasreddine
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon.
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Candia AA, Lean SC, Zhang CXW, McKeating DR, Cochrane A, Gulacsi E, Herrera EA, Krause BJ, Sferruzzi-Perri AN. Obesogenic Diet in Mice Leads to Inflammation and Oxidative Stress in the Mother in Association with Sex-Specific Changes in Fetal Development, Inflammatory Markers and Placental Transcriptome. Antioxidants (Basel) 2024; 13:411. [PMID: 38671859 PMCID: PMC11047652 DOI: 10.3390/antiox13040411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Obesity during pregnancy is related to adverse maternal and neonatal outcomes. Factors involved in these outcomes may include increased maternal insulin resistance, inflammation, oxidative stress, and nutrient mishandling. The placenta is the primary determinant of fetal outcomes, and its function can be impacted by maternal obesity. The aim of this study on mice was to determine the effect of obesity on maternal lipid handling, inflammatory and redox state, and placental oxidative stress, inflammatory signaling, and gene expression relative to female and male fetal growth. METHODS Female mice were fed control or obesogenic high-fat/high-sugar diet (HFHS) from 9 weeks prior to, and during, pregnancy. On day 18.5 of pregnancy, maternal plasma, and liver, placenta, and fetal serum were collected to examine the immune and redox states. The placental labyrinth zone (Lz) was dissected for RNA-sequencing analysis of gene expression changes. RESULTS the HFHS diet induced, in the dams, hepatic steatosis, oxidative stress (reduced catalase, elevated protein oxidation) and the activation of pro-inflammatory pathways (p38-MAPK), along with imbalanced circulating cytokine concentrations (increased IL-6 and decreased IL-5 and IL-17A). HFHS fetuses were asymmetrically growth-restricted, showing sex-specific changes in circulating cytokines (GM-CSF, TNF-α, IL-6 and IFN-γ). The morphology of the placenta Lz was modified by an HFHS diet, in association with sex-specific alterations in the expression of genes and proteins implicated in oxidative stress, inflammation, and stress signaling. Placental gene expression changes were comparable to that seen in models of intrauterine inflammation and were related to a transcriptional network involving transcription factors, LYL1 and PLAG1. CONCLUSION This study shows that fetal growth restriction with maternal obesity is related to elevated oxidative stress, inflammatory pathways, and sex-specific placental changes. Our data are important, given the marked consequences and the rising rates of obesity worldwide.
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Affiliation(s)
- Alejandro A. Candia
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK; (A.A.C.); (C.X.W.Z.); (D.R.M.); (A.C.); (E.G.)
- Institute of Health Sciences, University of O’Higgins, Rancagua 2841959, Chile;
- Pathophysiology Program, Institute of Biomedical Sciences (ICBM), Faculty of Medicine, Universidad de Chile, Santiago 7500922, Chile;
- Department for the Woman and Newborn Health Promotion, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile
| | - Samantha C. Lean
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK; (A.A.C.); (C.X.W.Z.); (D.R.M.); (A.C.); (E.G.)
| | - Cindy X. W. Zhang
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK; (A.A.C.); (C.X.W.Z.); (D.R.M.); (A.C.); (E.G.)
| | - Daniel R. McKeating
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK; (A.A.C.); (C.X.W.Z.); (D.R.M.); (A.C.); (E.G.)
| | - Anna Cochrane
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK; (A.A.C.); (C.X.W.Z.); (D.R.M.); (A.C.); (E.G.)
| | - Edina Gulacsi
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK; (A.A.C.); (C.X.W.Z.); (D.R.M.); (A.C.); (E.G.)
| | - Emilio A. Herrera
- Pathophysiology Program, Institute of Biomedical Sciences (ICBM), Faculty of Medicine, Universidad de Chile, Santiago 7500922, Chile;
| | - Bernardo J. Krause
- Institute of Health Sciences, University of O’Higgins, Rancagua 2841959, Chile;
| | - Amanda N. Sferruzzi-Perri
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK; (A.A.C.); (C.X.W.Z.); (D.R.M.); (A.C.); (E.G.)
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Skowronski AA, Leibel RL, LeDuc CA. Neurodevelopmental Programming of Adiposity: Contributions to Obesity Risk. Endocr Rev 2024; 45:253-280. [PMID: 37971140 PMCID: PMC10911958 DOI: 10.1210/endrev/bnad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/29/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023]
Abstract
This review analyzes the published evidence regarding maternal factors that influence the developmental programming of long-term adiposity in humans and animals via the central nervous system (CNS). We describe the physiological outcomes of perinatal underfeeding and overfeeding and explore potential mechanisms that may mediate the impact of such exposures on the development of feeding circuits within the CNS-including the influences of metabolic hormones and epigenetic changes. The perinatal environment, reflective of maternal nutritional status, contributes to the programming of offspring adiposity. The in utero and early postnatal periods represent critically sensitive developmental windows during which the hormonal and metabolic milieu affects the maturation of the hypothalamus. Maternal hyperglycemia is associated with increased transfer of glucose to the fetus driving fetal hyperinsulinemia. Elevated fetal insulin causes increased adiposity and consequently higher fetal circulating leptin concentration. Mechanistic studies in animal models indicate important roles of leptin and insulin in central and peripheral programming of adiposity, and suggest that optimal concentrations of these hormones are critical during early life. Additionally, the environmental milieu during development may be conveyed to progeny through epigenetic marks and these can potentially be vertically transmitted to subsequent generations. Thus, nutritional and metabolic/endocrine signals during perinatal development can have lifelong (and possibly multigenerational) impacts on offspring body weight regulation.
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Affiliation(s)
- Alicja A Skowronski
- Division of Molecular Genetics, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
- Naomi Berrie Diabetes Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Rudolph L Leibel
- Division of Molecular Genetics, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
- Naomi Berrie Diabetes Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Charles A LeDuc
- Division of Molecular Genetics, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
- Naomi Berrie Diabetes Center, Columbia University Irving Medical Center, New York, NY 10032, USA
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Wyss C, Inauen J, Cignacco E, Raio L, Aubry EM. Mediating processes underlying the associations between maternal obesity and the likelihood of cesarean birth. Birth 2024; 51:52-62. [PMID: 37621158 DOI: 10.1111/birt.12751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/21/2022] [Accepted: 07/10/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Pregnant women with obesity are more likely to experience cesarean birth compared to women without obesity. Yet, little is known about the underlying mechanisms. The objective of this study was therefore to evaluate how mediators contribute to the association between obesity and prelabor/intrapartum cesarean birth. METHODS We retrospectively analyzed Swiss cohort data from 394,812 singleton, cephalic deliveries between 2005 and 2020. Obesity (BMI ≥ 30 kg/m2 ) was defined as the exposure and prelabor or intrapartum cesarean birth as the outcomes. Hypothesized mediators included gestational comorbidities, large-for-gestational-age infant, pregnancy duration >410/7 weeks, slower labor progress, labor induction, and history of cesarean birth. We performed path analyses using generalized structural equation modeling and assessed mediation by a counterfactual approach. RESULTS Women with obesity had a cesarean birth rate of 39.36% vs. 24.12% in women without obesity. The path models mainly showed positive direct and indirect associations between obesity and cesarean birth. In the total sample, the mediation models explained up to 39.47% (95% CI 36.92-42.02) of the association between obesity and cesarean birth, and up to 57.13% (95% CI 54.10-60.16) when including history of cesarean birth as mediator in multiparous women. Slower labor progress and history of cesarean birth were found to be the most clinically significant mediators. CONCLUSIONS This study provides empirical insights into how obesity may increase cesarean birth rates through mediating processes. Particularly allowing for a slower labor progress in women with obesity might reduce cesarean birth rates and prevent subsequent repeat cesarean births in multiparous women.
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Affiliation(s)
- Carmen Wyss
- Applied Research and Development, Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Jennifer Inauen
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Eva Cignacco
- Applied Research and Development, Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynecology, University Hospital of Bern, Bern, Switzerland
| | - Evelyne M Aubry
- Applied Research and Development, Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Heslehurst N, McParlin C, Sniehotta FF, Rankin J, Crowe L, McColl E. The Gestational Obesity Weight Management: Implementation of National Guidelines (GLOWING) study: a pilot cluster randomised controlled trial. Pilot Feasibility Stud 2024; 10:47. [PMID: 38429853 PMCID: PMC10905942 DOI: 10.1186/s40814-024-01450-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/12/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Pregnancy weight management interventions can improve maternal diet, physical activity, gestational weight gain, and postnatal weight retention. UK guidelines were published in 2010 but health professionals report multiple complex barriers to practice. GLOWING used social cognitive theory to address evidence-based barriers to midwives' implementation of weight management guidelines into routine practice. This paper reports the pilot trial outcomes relating to feasibility and acceptability of intervention delivery and trial procedures. METHODS GLOWING was a multi-centre parallel-group pilot cluster RCT comparing the delivery of a behaviour change intervention for midwives (delivered as training workshops) with usual practice. The clusters were four NHS Trusts in Northeast England, randomised to intervention or control arms. Blinding of allocation was not possible due to the nature of the intervention. We aimed to deliver the intervention to all eligible midwives in the intervention arm, in groups of 6 midwives per workshop, and to pilot questionnaire data collection for a future definitive trial. Intervention arm midwives' acceptability of GLOWING content and delivery was assessed using a mixed methods questionnaire, and pregnant women's acceptability of trial procedures by interviews. Quantitative data were analysed descriptively and qualitative data thematically. RESULTS In intervention arm Trusts, 100% of eligible midwives (n = 67) were recruited to, and received, the intervention; however, not all workshops had the planned number of attendees (range 3-8). The consent rate amongst midwives randomised (n = 100) to complete questionnaires was 74% (n = 74) (95% CI 65%, 83%), and overall completion rate 89% (n = 66) (95% CI 82%, 96%). Follow-up response rate was 66% (n = 49) (95% CI 55%, 77%), with a marked difference between intervention (39%, n = 15) and control (94%, n = 34) groups potentially due to the volume of research activities. Overall, 64% (n = 47) (95% CI 53%, 75%) completed both baseline and follow-up questionnaires. Midwives viewed the intervention as acceptable and directly relevant to routine practice. The least popular components related to scripted role-plays. Pregnant women viewed the recruitment and trial processes to be acceptable. CONCLUSIONS This rigorously conducted pilot study demonstrated feasibility intervention delivery and a high level of acceptability amongst participants. It has provided information required to refine the intervention and trial protocol, enhancing confidence that a definitive trial could be carried out. TRIAL REGISTRATION ISRCTN46869894; retrospectively registered 25th May 2016, www.isrctn.com/ISRCTN46869894 .
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Affiliation(s)
- Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK.
| | - Catherine McParlin
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK
- Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Falko F Sniehotta
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK
| | - Lisa Crowe
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK
| | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK
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Prodan NC, Schmidt M, Hoopmann M, Abele H, Kagan KO. Obesity in prenatal medicine: a game changer? Arch Gynecol Obstet 2024; 309:961-974. [PMID: 37861742 PMCID: PMC10867045 DOI: 10.1007/s00404-023-07251-x] [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: 07/31/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023]
Abstract
Obesity is recognized by the World Health Organization (WHO) as a disease in its own right. Moreover, obesity is an increasingly concerning public health issue across the world and its prevalence is rising amongst women of reproductive age. The fertility of over-weight and obese women is reduced and they experience a higher rate of miscarriage. In pregnant women obesity not only increases the risk of antenatal complications, such as preeclampsia and gestational diabetes, but also fetal abnormalities, and consequently the overall feto-maternal mortality. Ultrasound is one of the most valuable methods to predict and evaluate pregnancy complications. However, in overweight and obese pregnant women, the ultrasound examination is met with several challenges, mainly due to an impaired acoustic window. Overall obesity in pregnancy poses special challenges and constraints to the antenatal care and increases the rate of pregnancy complications, as well as complications later in life for the mother and child.
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Affiliation(s)
- Natalia Carmen Prodan
- Department of Prenatal Diagnosis, University Clinic of Obstetrics and Gynaecology, Calwerstr. 7, Tuebingen, Germany.
| | - Markus Schmidt
- Clinic for Obstetrics and Gynaecology. Sana Kliniken, Zu den Rehwiesen 9-11, Duisburg, Germany
| | - Markus Hoopmann
- Department of Prenatal Diagnosis, University Clinic of Obstetrics and Gynaecology, Calwerstr. 7, Tuebingen, Germany
| | - Harald Abele
- Department of Prenatal Diagnosis, University Clinic of Obstetrics and Gynaecology, Calwerstr. 7, Tuebingen, Germany
| | - Karl Oliver Kagan
- Department of Prenatal Diagnosis, University Clinic of Obstetrics and Gynaecology, Calwerstr. 7, Tuebingen, Germany
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Poulios E, Pavlidou E, Papadopoulou SK, Rempetsioti K, Migdanis A, Mentzelou M, Chatzidimitriou M, Migdanis I, Androutsos O, Giaginis C. Probiotics Supplementation during Pregnancy: Can They Exert Potential Beneficial Effects against Adverse Pregnancy Outcomes beyond Gestational Diabetes Mellitus? BIOLOGY 2024; 13:158. [PMID: 38534428 DOI: 10.3390/biology13030158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Probiotics, as supplements or food ingredients, are considered to exert promising healthy effects when administered in adequate quantity. Probiotics' healthy effects are related with the prevention of many diseases, as well as decreasing symptom severity. Currently, the most available data concerning their potential health effects are associated with metabolic disorders, including gestational diabetes mellitus. There is also clinical evidence supporting that they may exert beneficial effects against diverse adverse pregnancy outcomes. The purpose of the current narrative study is to extensively review and analyze the current existing clinical studies concerning the probable positive impacts of probiotics supplementation during pregnancy as a protective agent against adverse pregnancy outcomes beyond gestational diabetes mellitus. METHODS a comprehensive and thorough literature search was conducted in the most precise scientific databases, such as PubMed, Scopus, and Web of Sciences, utilizing efficient, representative, and appropriate keywords. RESULTS in the last few years, recent research has been conducted concerning the potential beneficial effects against several adverse pregnancy outcomes such as lipid metabolism dysregulation, gestational hypertensive disorders, preterm birth, excessive gestational weight gain, caesarean risk section, vaginal microbiota impairment, mental health disturbances, and others. CONCLUSION up to the present day, there is only preliminary clinical data and not conclusive results for probiotics' healthy effects during pregnancy, and it remains questionable whether they could be used as supplementary treatment against adverse pregnancy outcomes beyond gestational diabetes mellitus.
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Affiliation(s)
- Efthymios Poulios
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Eleni Pavlidou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Sousana K Papadopoulou
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Kalliopi Rempetsioti
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Athanasios Migdanis
- Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Maria Chatzidimitriou
- Department of Biomedical Science, International Hellenic University, 57400 Thessaloniki, Greece
| | - Ioannis Migdanis
- Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
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50
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Kim SH, Lee YJ. Development and validation of a self-management self-efficacy scale for premature birth prevention (SMSE-PBP) for women of childbearing age. BMC Womens Health 2024; 24:134. [PMID: 38378535 PMCID: PMC10877791 DOI: 10.1186/s12905-024-02964-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 02/11/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND This study aimed to develop and evaluate the validity and reliability of a self-management self-efficacy for premature birth prevention (SMSE-PBP) in women of childbearing age (WCA). METHODS Instrument development and validation were undertaken in three phases: conceptualization, item generation and evaluation of content validity, and evaluation of construct and concurrent validity and reliability. Data were analyzed using exploratory and second-order confirmatory factor analyses, and concurrent validity was examined using Pearson's correlation coefficients. The reliability was analyzed using omega hierarchical and Cronbach's ⍺. RESULTS Content validity was assessed by experts and cognitive interviews of WCA. The SMSE-PBP consists of a second-order 3-dimension and 10-factor scale with 60 items; therefore, the construct and concurrent validity of the SMSE-PBP were supported. The omega values were 0.93 for pre-pregnancy SMSE-PBP, 0.92 for pregnancy SMSE-PBP, and 0.94 for hospital SMSE-PBP. Cronbach's ⍺ was 0.88 for pre-pregnancy SMSE-PBP, 0.96 for pregnancy SMSE-PBP, and 0.96 for hospital SMSE-PBP. CONCLUSIONS The SMSE-PBP scale is valid and reliable for WCA; it is helpful for WCA and health professionals to assess women's SMSE-PBP and pre-pregnancy, pregnancy, or hospital SMSE-PBP. The next steps should include assessing the relationship with pregnancy health behaviors.
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Affiliation(s)
- Sun-Hee Kim
- College of Nursing, Research Institute of Nursing Science, Daegu Catholic University, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea
| | - Yu-Jin Lee
- College of Nursing, Research Institute of Nursing Science, Daegu Catholic University, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea.
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