Miscarriage after sonographic confirmation of an ongoing pregnancy in women with moderate and severe obesity

Association between maternal adiposity measures and infant health outcomes: A systematic review and meta-analysis

Maternal obesity increases risks of adverse fetal and infant outcomes. Guidelines use body mass index to diagnose maternal obesity. Evidence suggests body fat distribution might better predict individual risk, but there is a lack of robust evidence during pregnancy. We explored associations between maternal adiposity and infant health. Searches included six databases, references, citations, and contacting authors. Screening and quality assessment were carried out by two authors independently. Random effects meta-analysis and narrative synthesis were conducted. We included 34 studies (n = 40,143 pregnancies). Meta-analysis showed a significant association between maternal fat-free mass and birthweight (average effect [AE] 18.07 g, 95%CI 12.75, 23.38) but not fat mass (AE 8.76 g, 95%CI -4.84, 22.36). Women with macrosomic infants had higher waist circumference than controls (mean difference 4.93 cm, 95% confidence interval [CI] 1.05, 8.82). There was no significant association between subcutaneous fat and large for gestational age (odds ratio 1.06 95% CI 0.91, 1.25). Waist-to-hip ratio, neck circumference, skinfolds, and visceral fat were significantly associated with several infant outcomes including small for gestational age, preterm delivery, neonatal morbidity, and mortality, although meta-analysis was not possible for these variables. Our findings suggest that some measures of maternal adiposity may be useful for risk prediction of infant outcomes. Individual participant data meta-analysis could overcome some limitations in our ability to pool published data.

A 21st Century Epidemy-Obesity: And Its Impact on Pregnancy Loss

The prevalence of obesity among women of reproductive age is growing significantly over the last years. Being obese or having a high body mass index (BMI) contributes to many diseases and pregnancy complications. This is concerning as an obese woman is at increased risk for developing several complications during pregnancy and is at increased risk for pregnancy loss, stillbirth, and metabolic disorders of a live-born child in his future. The pregnant woman's body mass index has to be monitored well during the whole pregnancy, and their diet should also be monitored to avoid future complications. Better results can be achieved if every woman would watch their weight before being pregnant for better outcomes in their future pregnancies. This review article aimed to determine the relationship between being obese or having a high BMI and pregnancy loss. Additionally, we tried to find the mechanism that is involved in pregnancy loss in obese women. 

Factors associated with spontaneous abortion: a systematic review

Abstract Objectives: to compile studies produced regardinggenetic and non-genetic risks factors associated with occurrence of spontaneous abortion. Methods: it talks about a systematic review article, with studies between January of 2008 to November of 2018 according to SciELO, PubMed, Lilacs and BVS. Results: in total, 567 articles were found. After applying the definedeligibility criteria, 44 articles made part of the review, being the majority published on Asia between 2008 and 2011, and 10 articles published on Brazil. Not genetic causes like sociodemographic factors and healthy state were among the most associated conditions of spontaneous abortion. Asiatic continent had predominance about the correlation of spontaneous abortion with factors related to life style like obesity, smoking and labor activities, on the other hand, in the Americas, causes related to sociodemographics factors like low pay and low studies are high-lighted. Conclusions: the risk factors change about the occurrence region, being important to make local studies capable of subsidize the implantation of public politics and to reduce abortions.

Insulin Reduces Reaction of Follicular Granulosa Cells to FSH Stimulation in Women With Obesity-Related Infertility During IVF

CONTEXT

Women with obesity usually need larger doses of FSH for ovarian stimulation, resulting in poor outcomes; however, the mechanism is still unclear.

OBJECTIVE

To investigate the molecular regulation of FSH receptor (FSHR) expression associated with obesity.

DESIGN

Case-control study to improve in vitro fertilization (IVF) outcomes.

PATIENTS

Women with obesity (82) and women who were overweight (457) undergoing IVF and 1790 age-matched controls with normal weight from our reproductive medicine center.

MAIN OUTCOME MEASURES

FSHR expression was decreased in parallel with body mass index (BMI), whereas the estradiol (E2) level on the human chorionic gonadotropin (hCG) trigger day was significantly lower.

RESULTS

FSHR expression in human granulosa cells (hGCs), both mRNA (P = 0.02) and protein (P = 0.001) levels, was decreased in women who were overweight or obese. Both insulin (P < 0.001) and glucose (P = 0.0017) levels were positively correlated with BMI in fasting blood and follicle fluids (FFs) but not with FFs leptin level. We treated human granulosa-like tumor cells (KGN) cells with insulin; E2 production was compromised; the level of phosphorylated (p)-protein kinase B (p-Akt2) decreased, whereas p-glycogen synthase kinase 3 (GSK3) increased; and there were similar changes in hGCs from women with obesity. Stimulated hGCs from women with obesity with compound 21 (CP21), an inhibitor of GSK3β, resulted in upregulated β-catenin activation and increased FSHR expression. CP21 also increased the expression of insulin receptor substrate 1 and phosphatidylinositol 3-kinase (PI3K), as well as p-Akt2.

CONCLUSIONS

Women with obesity in IVF were associated with reduced FSHR expression and E2 production caused by a dysfunctional insulin pathway. Decreased FSHR expression in hGCs from women with obesity and insulin-treated KGN cells could be rescued by an inhibitor of GSK3β, which might be a potential target for the improvement of the impaired FSH-stimulation response in women with obesity.

Systematic review and meta-analysis on the association of prepregnancy underweight and miscarriage

BACKGROUND

Maternal underweight, overweight and obesity have been associated with a higher risk of miscarriage. Most individual reports and all meta-analyses have addressed high body mass index.

OBJECTIVES

To review the literature and summarize the risk of miscarriage in underweight women vs those with normal weight.

METHODS

A Medline Search (1st January 1990-20th November 2015, human, in English, French, Italian, Spanish or Portuguese) was conducted. Both spontaneous pregnancies and pregnancies after assisted reproduction techniques were considered. Cohort and case control studies were included if they reported data on the outcome of interest (clinical miscarriage), in underweight and normal weight women. Information on clinical miscarriage in other body mass index categories was collected when available. Two investigators reviewed the abstracts, full text papers and extracted data. Review Manager 5.1 software was used to summarize the results.

RESULTS

32 studies (30 cohort, 2 case control) and a total of 265,760 women were included. In cohort studies, the relative risk (RR) of clinical miscarriage in underweight women was 1.08, 95% CI 1.05-1.11; p<0.0001). The corresponding figures were RR 1.09, 95% CI 1.04-1.13; p<0.0001 for overweight women and RR 1.21, 95% CI 1.15-1.27; p<0.00001 for obese women. In case control studies, the odds ratio (OR) of clinical miscarriage in underweight women was 1.02, 95% CI 0.46-2.30; p=0.95). The corresponding figures were OR 1.01, 95% CI 0.88-1.16; p=0.89 for overweight women and OR 1.26, 95% CI 1.01-1.57; p=0.04 for obese women. The limitations of this study are that it is restricted to studies with information on underweight women and that I² ranges from 0 to 91% in different subgroups.

CONCLUSION

We conclude that maternal underweight is associated with a slightly increased risk of clinical miscarriage, similar to that of overweight women and lower than the risk observed in obesity. The heterogeneity displayed in some subgroups limits the strength of the conclusion.

Toll-like receptor 4 gene is associated with recurrent spontaneous miscarriage in Uygur and Han women in Xinjiang

Toll-like receptor 4 (TLR4), a recently identified vertebrate receptor, serves a pivotal role in immune responses. The aim of the present study was to investigate the association between the human TLR4 gene and recurrent spontaneous miscarriage (RSM). A total of 306 RSM patents and 306 age-matched controls were genotyped for four single-nucleotide polymorphisms (SNPs) of the human TLR4 gene (rs1927914, rs1927911, rs4986790 and rs4986791). Data were analyzed for Uygur and Han women separately using a haplotype-based case-control study. There were significant differences between the distributions of rs1927914, rs1927911 and rs4986790 SNPs between RSM patients and the controls (P=0.001, P<0.001 and P=0.015, respectively) were identified in Uygur women, and significant differences between the distributions of the rs1927914 and rs1927911 SNPs between RSM patients and the controls (P<0.001 and P<0.001, respectively) were identified in Han women. Results of the logistic regression analysis indicated that rs1927914, rs1927911 and rs4986790 SNPs were significantly higher in the RSM patients compared with the control individuals (P=0.012, P=0.024 and P=0.035, respectively) in Uygur women. Furthermore, significantly higher frequency was noted for the A-G-G haplotype (SNP1-SNP2-SNP3) (P=0.016) in RSM patients compared with the controls in Uygur women. The results indicate that rs1927914, rs1927911, rs4986790 and the A-G-G haplotype (SNP1-SNP2-SNP3) of the human TLR4 gene may be genetic markers for RSM in Uygur women, while rs1927914 and rs1927911 SNPs of the human TLR4 gene are most likely associated with RSM in Han women in Xinjiang.

Antepartum Care of the Obese Patient

In the United States, roughly half of women are either overweight (24.5%) or obese (21.4%) when they become pregnant. Women who are obese before pregnancy are at increased risk for a number of pregnancy complications relative to normal-weight women. Specifically, obesity is associated with significantly increased maternal risks, including gestational diabetes mellitus, hypertensive disorders of pregnancy, and sleep disordered breathing. Maternal obesity is also associated with increased risks of adverse fetal outcomes, including prematurity, stillbirth, congenital anomalies, and abnormal fetal growth. In this review, we will discuss the implications of obesity with respect to antepartum care.

The relationship between body mass index and footprint parameters in older people

BACKGROUND

The relationship of body mass index (BMI) with footprint parameters has been studied in paediatric populations, but there are limited data regarding the effects of BMI on parameters in the elderly.

OBJECTIVES

To establish the relationship between BMI and static footprint parameters in the elderly population.

METHODS

128 subjects aged 65 and above with no history of lower extremity surgical intervention and no significant lower extremity weakness were included in the current study. BMI and footprint parameters of arch angle, Chippaux-Smirak index (CSI), Staheli index (SI), arch index (AI) and footprint index (FI) were measured for each subject, and statistical analysis was done to investigate the correlation between BMI and the parameters.

RESULTS

Weak correlations detected between all calculated indices and angles with BMI, except the left foot arch angle. CSI, SI and AI of the right foot were found to be positively correlated with BMI, while a negative correlation between the arch angle and FI of right foot was shown with BMI.

CONCLUSIONS

The results reveal a relationship between BMI and footprint parameters that are indicative of flatfoot in the elderly. This could be due either to confounding of the footprint measure by fat or possibly due to an as yet unknown structural change that requires further evaluation.

Relationship between VEGFA polymorphisms and serum VEGF protein levels and recurrent spontaneous miscarriage

STUDY QUESTION

Is recurrent spontaneous miscarriage (RSM) associated with changes in vascular endothelial growth factor (VEGF) serum levels, and with polymorphisms in the VEGFA gene?

SUMMARY ANSWER

Reduced serum VEGF levels, and VEGFA -460T/C (rs833061), 398G/A (rs833068), -583T/C (rs3025020) variants, were associated with RSM.

WHAT IS KNOWN ALREADY

Reduced expression of VEGF has been linked with spontaneous miscarriage, likely due to defective fetal and placental angiogenesis. Since VEGF production is in part inherited, VEGFA polymorphisms associated with altered VEGF secretion have been investigated for their association with RSM, often with variable conclusions.

STUDY DESIGN, SIZE, DURATION

A retrospective case-control study, which was conducted between January 2011 and April 15, 2012.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Subjects comprised 296 women with RSM (mean age: 31.6 ± 5.4 year), and 305 age-matched (mean age: 31.6 ± 4.9 year) control Arab women, who had attended outpatient obstetrics and gynecology clinics in two teaching hospitals in Bahrain. VEGFA -2578C/A (rs699947), -460T/C (rs833061), -1154G/A (rs15703060), -634G/C (rs2010963), 398G/A (rs833068), 497G/A (rs833070), -583T/C (rs3025020) and 936C/T (rs3025039) genotyping was done by real-time PCR, with defined clusters; VEGF serum levels were measured by ELISA.

MAIN RESULTS AND THE ROLE OF CHANCE

Higher minor allele frequency (MAF) and genotype distribution of -460T/C [corrected P (Pc) = 0.003], 398G/A (Pc = 0.016) and -583T/C (Pc < 0.001) single nucleotide polymorphisms (SNPs) were seen in RSM cases than control women. Increased RSM risk was seen with homozygous -460T/C and 398G/A SNPs and with heterozygous -583T/C, which had a stronger effect when homozygous. Serum VEGF levels were significantly reduced in RSM cases compared with control women (P = 0.016), and correlated with -460T/C, 398G/A and -583T/C genotypes. Haploview analysis revealed heterogeneity in linkage disequilibrium between VEGFA variants, and two blocks were identified: Block 1 comprising -2578C/A, -460T/C and -1154G/A, while Block 2 contained -634G/C, 398G/A, 497G/A, -583T/C and 936C/T. Both negatively and positively RSM-associated 3-locus (Block 1) and 5-locus (Block 2) VEGFA haplotypes were identified, after controlling for a number of covariates.

LIMITATIONS, REASONS FOR CAUTION

The study was retrospective and can only demonstrate association and not a cause-effect relationship. Furthermore, it was limited to Bahraini Arabs,thereby necessitating parallel studies on other ethnic groups.

WIDER IMPLICATIONS OF THE FINDINGS

Reduced VEGF secretion, and specific VEGFA variants may contribute to the pathogenesis of RSM. However, the association of VEGFA SNPs with RSM appears to be independent of their association with altered VEGF serum levels. The differential association of VEGFA variants with RSM is in line with previous findings on the contribution of ethnicity/racial background to genetic association studies.