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Bender WR, Hamm RF, Dolin C, Levine LD. The Relationship between Gestational Weight Gain and Cesarean Delivery among Patients undergoing Induction of Labor. Am J Perinatol 2024; 41:669-676. [PMID: 37972937 DOI: 10.1055/s-0043-1776975] [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] [Indexed: 11/19/2023]
Abstract
OBJECTIVE This study aimed to determine the impact of pregnancy weight gain above National Academy of Medicine (NAM) guidelines on cesarean delivery rates following induction. STUDY DESIGN This is a secondary analysis of a prospective cohort study of patients who underwent induction at a single tertiary care center between July 2017 and July 2019. Included in the primary study were patients undergoing term (≥37 weeks) labor induction with a singleton gestation, intact membranes, and unfavorable cervical examination (Bishop score of ≤6 and cervical dilation ≤ 2 cm). Eligibility for this analysis was limited to patients with a documented prenatal body mass index (BMI) < 20 weeks' gestation. The primary exposure was gestational weight gain greater than NAM guidelines (WGGG) for a patient's initial BMI category. The primary outcome was cesarean delivery for any indication. RESULTS Of 1,610 patients included in the original cohort, 1,174 (72.9%) met inclusion criteria for this analysis and 517 (44.0%) of these had weight gain above NAM guidelines. Of the entire cohort, 60.0% were Black and 52.7% had private insurance. In total, 160 patients (31%) with WGGG underwent cesarean compared with 127 patients (19.3%) without WGGG (p < 0.001), which equates to a 59% increased odds of cesarean when controlling for initial BMI category, parity, gestational diabetes, and indication for induction (Adjusted Odds Ratio [aOR] 1.58, 95% confidence interval [CI] 1.17-2.12). Among only nulliparous patients, WGGG was associated with an increased odds of cesarean (26.4 vs. 38.2%, aOR 1.50, 95% CI 1.07-2.10). In multiparous patients, however, there was no difference in cesarean between those with and without WGGG (8.8 vs. 14.1%, aOR 1.85, 95% CI 0.96-3.58). CONCLUSION This study demonstrates that weight gain above NAM guidelines is associated with more than a 50% increased odds of cesarean. Patients should be informed of this association as gestational weight gain may be a modifiable risk factor for cesarean delivery. KEY POINTS · Weight gain above NAM guidelines was associated with a 59% increased odds of cesarean delivery.. · Nulliparous patients with weight gain above NAM guidelines are at higher risk of cesarean delivery.. · No difference in cesarean delivery among multiparous patients regardless of gestational weight gain..
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Affiliation(s)
- Whitney R Bender
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia
| | - Rebecca F Hamm
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cara Dolin
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lisa D Levine
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Rostin P, Balke S, Sroka D, Fangmann L, Weid P, Henrich W, Königbauer JT. The CHANGED Score-A New Tool for the Prediction of Insulin Dependency in Gestational Diabetes. J Clin Med 2023; 12:7169. [PMID: 38002781 PMCID: PMC10672469 DOI: 10.3390/jcm12227169] [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: 10/03/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Gestational diabetes (GDM) is a frequent complication during pregnancy. We aimed to develop a score to predict future insulin dependency in gestational diabetes (GDM). Data from 1611 patients from Charité Berlins gestational diabetes clinic from 2015 to 2022 were utilized. A stepwise backwards regression, including patient characteristics obtained at the initial presentation, was performed. Predictors examined included age, fasting blood glucose level, blood glucose levels one and two hours after oral glucose tolerance test, pre-pregnancy BMI, number of previous pregnancies and births, and fetal sex. The ideal cutoff value between high and low risk for insulin dependency was assessed and the score was internally validated. There were 1249 (77.5%) women diagnosed with dietary GDM and 362 (22.5%) were diagnosed with insulin-dependent GDM. The CHarité AssessmeNt of GEstational Diabetes (CHANGED) Score achieved an area under the curve of 0.77 (95% confidence interval 0.75-0.80; 0.75 in internal validation). The optimal cutoff value was calculated at a score value of 9 (72% sensitivity, 69% specificity). We developed an easily applicable tool to accurately predict insulin dependency in gestational diabetes. The CHANGED Score is routinely available and can potentially improve maternal and fetal outcomes.
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Affiliation(s)
- Paul Rostin
- Department of Obstetrics, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany; (S.B.); (D.S.); (L.F.); (P.W.); (W.H.); (J.T.K.)
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Raju S, Cowdell PF, Dyson PJ. Midwives' experiences of supporting healthy gestational weight management: A mixed methods systematic literature review. Midwifery 2023; 124:103750. [PMID: 37285752 DOI: 10.1016/j.midw.2023.103750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 05/10/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Excessive levels of gestational weight gain (GWG) are linked with poorer health outcomes for mother and baby, including an increased risk of pregnancy-related hypertension, labour induction, caesarean delivery and increased birth weight. OBJECTIVE To explore literature relating to midwives' experiences and challenges and identify interventions relating to GWG. DESIGN This review was conducted in accordance with the Joanna Briggs Institute methodology for mixed methods systematic reviews. CINAHL complete, APA PsycArticles, APA PsycInfo, the Cochrane Library and MEDLINE were systematically searched in May 2022. Search terms related to midwives, advice, weight management and experiences were used. A PRISMA approach was taken to identify data, and thematic analysis combined with descriptive statistics allowed synthesis and integration. FINDINGS Fifty-seven papers were included and three overarching themes were generated; i) emotion and weight, ii) ability to influence and iii) practical challenges and strategies for success. Weight was consistently described as a sensitive topic. Challenges included level of expertise and comfort, perceptions of ability to influence and an awareness of incongruence of midwives' own weight and the advice they are delivering. Interventions evaluated well with some self-reports of improved knowledge and confidence. There was no evidence of impact on practice or GWG. KEY CONCLUSIONS Although addressing maternal weight gain is an international priority due to the significant risks incurred, in this review we have identified multiple challenges for midwives to support women in healthy weight management. Identified interventions targeting midwives do not directly address the challenges identified and are therefore likely to be insufficient to improve existing practice. IMPLICATIONS FOR PRACTICE Partnership working and co-creation with women and midwives is essential to ensure knowledge about maternal weight gain is effectively shared across communities to catalyse change.
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Affiliation(s)
- Sereena Raju
- Birmingham City University, Faculty of Health, Education and Life Sciences, Westbourne Road, Birmingham, B15 3TN, England.
| | - Professor Fiona Cowdell
- Birmingham City University, Faculty of Health, Education and Life Sciences, Westbourne Road, Birmingham, B15 3TN, England.
| | - Professor Judith Dyson
- Birmingham City University, Faculty of Health, Education and Life Sciences, Westbourne Road, Birmingham, B15 3TN, England.
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Grünebaum A, Dudenhausen JW. Prevention of risks of overweight and obesity in pregnant women. J Perinat Med 2023; 51:83-86. [PMID: 36018720 DOI: 10.1515/jpm-2022-0313] [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: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 01/17/2023]
Abstract
Overweight and obesity in pregnancy and prepregnancy are perinatal risks. Studies showed prevention of these risks with counseling about the risks and treatment strategies like lifestyle interventions as exercise on a daily basis, nutritional health and diet.
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Affiliation(s)
- Amos Grünebaum
- Department of Obstetrics and Gynecology, Barbara and Donald Zucker School of Medicine at Hoffstra/Northwell and Lenox Hill Hospital, New York, NY, USA
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Strauss A, Rochow N, Kunze M, Hesse V, Dudenhausen JW, Voigt M. Obesity in pregnant women: a 20-year analysis of the German experience. Eur J Clin Nutr 2021; 75:1757-1763. [PMID: 34702964 PMCID: PMC8636254 DOI: 10.1038/s41430-021-00981-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 05/27/2021] [Accepted: 07/05/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVE To investigate the longitudinal development of maternal body weight and analyze the influence of obesity on obstetrics during more than two decades in Germany. SUBJECTS/METHODS Data collected from the Federal state of Schleswig-Holstein (German Perinatal Survey) were analyzed with regard to the dynamics of maternal anthropometric variables (body weight, BMI) between 1995-7 and 2004-17. In total 335,511 mothers substantiated the presented study-collective. The statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY. RESULTS Maternal BMI advanced significantly over the study period. Among a rise in mean periconceptional body weight (67.6-72.0 kg), the segment of obese women increased disproportionately (in average 9.4-19.2%). Despite the observed trend to late giving birth (mean maternal age 1995: 29.3 vs. 30.7 years in 2017), it was not advanced maternal age but parity that influenced the continuous increase in maternal weight (mean maternal body weight 1995-7: primi- bi-, multiparae 67.4, 68.3 and 69.0 kg vs. 2004-17: primi- bi-, multiparae 70.0, 71.5 and 73.2 kg respectively). CONCLUSION Obesity is a major problem on health issues in obstetrics. Advancing maternal BMI, increasing mother's age and derived prenatal risks considerably complicate pregnancy and delivery. It has to be emphasized that its consequences do not end with delivery or childbed, but represent a livelong burden to the mother and their offspring. Hence, multimodal strategies to reduce/control periconceptional body weight are mandatory.
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Affiliation(s)
| | - Niels Rochow
- Department of Pediatrics, Paracelsus Medical University, General Hospital, Nuremberg, Germany
- Department of Pediatrics, Rostock University Medical Center, Rostock, Germany
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Mirjam Kunze
- Department of Gynecology and Obstetrics, University of Freiburg School of Medicine, Freiburg, Germany
| | - Volker Hesse
- German Center for Growth, Development and Health Encouragement during Childhood and Youth, Berlin, Germany
| | | | - Manfred Voigt
- Department of Gynecology and Obstetrics, University of Freiburg School of Medicine, Freiburg, Germany
- German Center for Growth, Development and Health Encouragement during Childhood and Youth, Berlin, Germany
- Biological Anthropology, Medical Faculty, University of Freiburg, Freiburg, Germany
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Najafi F, Hasani J, Izadi N, Hashemi-Nazari SS, Namvar Z, Shamsi H, Erfanpoor S. Risk of gestational diabetes mellitus by pre-pregnancy body mass index: A systematic review and meta-analysis. Diabetes Metab Syndr 2021; 15:102181. [PMID: 34214900 DOI: 10.1016/j.dsx.2021.06.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 05/13/2021] [Accepted: 06/15/2021] [Indexed: 01/01/2023]
Abstract
Gestational diabetes mellitus (GDM) is serious health challenges. This study aimed at determining the risk of GDM among pregnant women by pre-pregnancy BMI. Five electronic databases including Medline (PubMed), Scopus, Embase, Web of Science and Google Scholar were searched for literature published form 2015 to January 1, 2021. The pooled estimate risk of GDM among pregnant women was 16.8% (95% CI: 15.3-18.4). The risk of GDM in underweight/normal group and overweight/obese group were 10.7% (95% CI: 9.1-12.4) and 23% (95% CI: 20.2-25.9), respectively. The risk of GDM is high among overweight/obese pregnant women.
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Affiliation(s)
- Farid Najafi
- Department of Epidemiology, Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Jalil Hasani
- Kashmar School of Nursing, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Neda Izadi
- Student Research Committee, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Seyed-Saeed Hashemi-Nazari
- Safety Promotion and Injury Prevention Research Center, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Zahra Namvar
- Student Research Committee, Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hasan Shamsi
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Erfanpoor
- Department of Epidemiology, Iran University of Medical Sciences, Tehran, Iran
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7
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Chishom T, Stephens A, Raley S, Ange B, Looney S, Street L, Browne P. Amniotic fluid index curves in the obese gravida. J Neonatal Perinatal Med 2021; 14:131-137. [PMID: 32333553 DOI: 10.3233/npm-190290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine whether amniotic fluid volume as measured by amniotic fluid index (AFI) is influenced by maternal pre-gestational obesity as measured by body mass index (BMI). METHODS This was a retrospective cohort study of pregnant women between 20 and 43 weeks gestation receiving ultrasounds with AFI measurements at Augusta University Medical Center between 2003 and 2017. A subset of 500 charts that met inclusion and exclusion criteria were reviewed to obtain maternal clinical data. The study cohort was subdivided by maternal BMI at initial obstetric visit into three groups: normal weight (18.5 kg/m2-24.9 kg/m2), overweight (25.0 kg/m2-29.9 kg/m2), and obese (≥ 30 kg/m2). Chi-square analysis was used to compare BMI groups in terms of categorical clinical characteristics and outcome variables, and analysis of variance (ANOVA) was used for continuous variables. Mixed effects regression models (MRMs) were used to evaluate AFI throughout gestation separately in each group, and MRM-based analysis of covariance was used to compare AFI throughout gestation among groups. AFI curves were constructed for the 5th, 50th, and 95th percentiles for all study subjects combined and separately for normal weight, overweight, and obese subjects. RESULTS Fitted curves relating AFI percentiles to estimated gestational age (EGA) showed statistically significant differences among BMI groups. There was also a significant difference in AFI over gestation across the obesity groups. CONCLUSION Fitted curves for AFI throughout pregnancy showed statistically significant differences among BMI groups.
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Affiliation(s)
- T Chishom
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Augusta University Medical Center at Medical College of Georgia, Augusta, GA, USA
| | - A Stephens
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Augusta University Medical Center at Medical College of Georgia, Augusta, GA, USA
| | - S Raley
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Augusta University Medical Center at Medical College of Georgia, Augusta, GA, USA
| | - B Ange
- Department of Biostatistics and Epidemiology at Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - S Looney
- Department of Biostatistics and Epidemiology at Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - L Street
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Augusta University Medical Center at Medical College of Georgia, Augusta, GA, USA
| | - P Browne
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Augusta University Medical Center at Medical College of Georgia, Augusta, GA, USA
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Martínez-Hortelano JA, Cavero-Redondo I, Álvarez-Bueno C, Garrido-Miguel M, Soriano-Cano A, Martínez-Vizcaíno V. Monitoring gestational weight gain and prepregnancy BMI using the 2009 IOM guidelines in the global population: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2020; 20:649. [PMID: 33109112 PMCID: PMC7590483 DOI: 10.1186/s12884-020-03335-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 10/14/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Previous studies have reported a high prevalence of excessive gestational weight gain (GWG) in women with prepregnancy BMI classified as overweight and obese. However, the joint evidence regarding GWG and prepregnancy BMI in the worldwide population has not been synthesized. Thus, this systematic review and meta-analysis aimed to estimate global and regional mean GWG and the prevalence of GWG above, within and below 2009 Institute of Medicine (IOM) guidelines. Second, we aimed to estimate global and regional prepregnancy BMI and the prevalence of BMI categories according to World Health Organization (WHO) classification. METHODS We searched Medline, Embase, the Cochrane Library and Web of Science to identify observational studies until 9 May 2018. We included studies published from 2009 that used 2009 IOM guidelines, reporting data from women in general population with singleton pregnancies. The 2009 IOM categories for GWG and the WHO categories for prepregnancy BMI were used. DerSimonian and Laird random effects methods were used to estimate the pooled and their respective 95% confidence intervals (95% CIs) of the mean and by category rates of GWG and prepregnancy BMI, calculated by global and regions. RESULTS Sixty-three published studies from 29 countries with a total sample size of 1,416,915 women were included. The global prevalence of GWG above and below the 2009 IOM guidelines, was 27.8% (95% CI; 26.5, 29.1) and 39.4% (95% CI; 37.1, 41.7), respectively. Furthermore, meta-regression analyses showed that the mean GWG and the prevalence of GWG above guidelines have increased. The global prevalence of overweight and obesity, was 23.0% (95% CI; 22.3, 23.7) and 16.3% (95% CI; 15.4, 17.4), respectively. The highest mean GWG and prepregnancy BMI were in North America and the lowest were in Asia. CONCLUSIONS Considering the high prevalence of GWG above the 2009 IOM guidelines and women with overweight/obesity and their continuously increasing trend in most regions, clinicians should recommend lifestyle interventions to improve women's weight during reproductive age. Due to regional variability, these interventions should be adapted to each cultural context. TRIAL REGISTRATION Prospectively registered with PROSPERO ( CRD42018093562 ).
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Affiliation(s)
| | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Social and Health Care Research Center, Santa Teresa Jornet s/n, 16071, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Social and Health Care Research Center, Santa Teresa Jornet s/n, 16071, Cuenca, Spain.
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay.
| | - Miriam Garrido-Miguel
- Universidad de Castilla-La Mancha, Social and Health Care Research Center, Santa Teresa Jornet s/n, 16071, Cuenca, Spain
| | - Alba Soriano-Cano
- Universidad de Castilla-La Mancha, Social and Health Care Research Center, Santa Teresa Jornet s/n, 16071, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Social and Health Care Research Center, Santa Teresa Jornet s/n, 16071, Cuenca, Spain
- Faculty of Health Sciences, Universidad Autónoma de Chile, Talca, Chile
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Jiang L, Lin J, Yan J, Lin X, Han Q, Zhang H. Prepregnancy body mass indexes are associated with perinatal outcomes in females with preeclampsia. Exp Ther Med 2020; 20:500-504. [PMID: 32509020 PMCID: PMC7271714 DOI: 10.3892/etm.2020.8677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/04/2020] [Indexed: 11/30/2022] Open
Abstract
The present study aimed to determine the clinical characteristics and perinatal outcomes of females with severe preeclampsia according to their pre-pregnancy body mass index (BMI). Data from 233 patients with severe preeclampsia were reviewed from the Inpatient Obstetrics Department. The data were divided into 3 groups according to the patients' pre-pregnancy BMI: Normal (BMI of 18-25 kg/m2; n=134); underweight (BMI <18 kg/m2; n=15); and overweight and obese (BMI >25 kg/m2; n=84). The incidence of dyslipidemia, amniotic fluid abnormalities and neonatal hospitalizations in the group of females who were overweight or obese before pregnancy were higher than those in the other groups (all P<0.05). In conclusion, the presence of dyslipidemia, excessive weight and obesity prior to pregnancy in patients with severe preeclampsia was associated with maternal and perinatal outcomes.
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Affiliation(s)
- Lingling Jiang
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350000, P.R. China
| | - Juan Lin
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350000, P.R. China
| | - Jianying Yan
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350000, P.R. China
| | - Xiaoqian Lin
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350000, P.R. China
| | - Qing Han
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350000, P.R. China
| | - Huale Zhang
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350000, P.R. China
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Martin JC, Joham AE, Mishra GD, Hodge AM, Moran LJ, Harrison CL. Postpartum Diet Quality: A Cross-Sectional Analysis from the Australian Longitudinal Study on Women's Health. J Clin Med 2020; 9:jcm9020446. [PMID: 32041231 PMCID: PMC7073585 DOI: 10.3390/jcm9020446] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 02/06/2023] Open
Abstract
Reproductive-aged women are at high risk of developing obesity, and diet quality is a potential modifiable risk factor. There is limited research exploring diet quality and its association with time since childbirth. Using data from the Australian Longitudinal Study on Women’s Health (ALSWH) survey 5 (2009) of women born between 1973–1978, who reported having previously given birth, we investigated the association between time since childbirth and diet quality, and differences in energy, macronutrients, micronutrient intake, and diet quality assessed by the dietary guideline index (DGI) in women stratified by time from last childbirth, early (0–6 months; n = 558) and late (7–12 months; n = 547), and all other women with children (>12 months post childbirth n = 3434). From this cohort, 8200 participants were eligible, of which 4539 participants completed a food frequency questionnaire (FFQ) and were included in this analysis. Overall, diet quality was higher in early and late postpartum women (mean DGI score 89.8 (SD 10.5) and mean DGI score 90.0 (SD 10.2), respectively) compared to all other women with children (>12 months post childbirth), mean DGI score 85.2 (SD 11.7), p < 0.001. Factors positively associated with diet quality included higher education, physical activity, health provider support, and vitamin and/or mineral supplement use. Conversely, increasing time from childbirth (>12 months), smoking compared with non-smoking and medium income level compared with no income was negatively associated with diet quality. A lower diet quality in women greater than 12 months post childbirth may be reflective of increased pressures, balancing childrearing and return to work responsibilities. This highlights the need to support women beyond the postpartum period to improve modifiable factors associated with weight gain, including diet quality, to optimize health and reduce chronic disease risk.
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Affiliation(s)
- Julie C. Martin
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventative Medicine, Monash University, Melbourne 3000, Australia; (J.C.M.); (A.E.J.); (L.J.M.)
| | - Anju E. Joham
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventative Medicine, Monash University, Melbourne 3000, Australia; (J.C.M.); (A.E.J.); (L.J.M.)
- Diabetes and Vascular Medicine Unit, Monash Health, Clayton 3168, Australia
| | - Gita D. Mishra
- Centre for Longitudinal and Life Course Research, School of Public Health, University of Queensland, Brisbane 4000, Australia;
| | - Allison M. Hodge
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne 3000, Australia;
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3000, Australia
| | - Lisa J. Moran
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventative Medicine, Monash University, Melbourne 3000, Australia; (J.C.M.); (A.E.J.); (L.J.M.)
| | - Cheryce L. Harrison
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventative Medicine, Monash University, Melbourne 3000, Australia; (J.C.M.); (A.E.J.); (L.J.M.)
- Correspondence: ; Tel.: +61-03-8572-2662
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Antoniou MC, Gilbert L, Gross J, Rossel JB, Fischer Fumeaux CJ, Vial Y, Puder JJ. Potentially modifiable predictors of adverse neonatal and maternal outcomes in pregnancies with gestational diabetes mellitus: can they help for future risk stratification and risk-adapted patient care? BMC Pregnancy Childbirth 2019; 19:469. [PMID: 31801465 PMCID: PMC6894261 DOI: 10.1186/s12884-019-2610-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 08/22/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) exposes mothers and their offspring to short and long-term complications. The objective of this study was to identify the importance of potentially modifiable predictors of adverse outcomes in pregnancies with GDM. We also aimed to assess the relationship between maternal predictors and pregnancy outcomes depending on HbA1c values and to provide a risk stratification for adverse pregnancy outcomes according to the prepregnancy BMI (Body mass index) and HbA1c at the 1st booking. METHODS This prospective study included 576 patients with GDM. Predictors were prepregnancy BMI, gestational weight gain (GWG), excessive weight gain, fasting, 1 and 2-h glucose values after the 75 g oral glucose challenge test (oGTT), HbA1c at the 1st GDM booking and at the end of pregnancy and maternal treatment requirement. Maternal and neonatal outcomes such as cesarean section, macrosomia, large and small for gestational age (LGA, SGA), neonatal hypoglycemia, prematurity, hospitalization in the neonatal unit and Apgar score at 5 min < 7 were evaluated. Univariate and multivariate regression analyses and probability analyses were performed. RESULTS One-hour glucose after oGTT and prepregnancy BMI were correlated with cesarean section. GWG and HbA1c at the end pregnancy were associated with macrosomia and LGA, while prepregnancy BMI was inversely associated with SGA. The requirement for maternal treatment was correlated with neonatal hypoglycemia, and HbA1c at the end of pregnancy with prematurity (all p < 0.05). The correlations between predictors and pregnancy complications were exclusively observed when HbA1c was ≥5.5% (37 mmol/mol). In women with prepregnancy BMI ≥ 25 kg/m2 and HbA1c ≥ 5.5% (37 mmol/mol) at the 1st booking, the risk for cesarean section and LGA was nearly doubled compared to women with BMI with < 25 kg/m2 and HbA1c < 5.5% (37 mmol/mol). CONCLUSIONS Prepregnancy BMI, GWG, maternal treatment requirement and HbA1c at the end of pregnancy can predict adverse pregnancy outcomes in women with GDM, particularly when HbA1c is ≥5.5% (37 mmol/mol). Stratification based on prepregnancy BMI and HbA1c at the 1st booking may allow for future risk-adapted care in these patients.
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Affiliation(s)
- Maria-Christina Antoniou
- Pediatric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.
| | - Leah Gilbert
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Justine Gross
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Benoît Rossel
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Céline J Fischer Fumeaux
- Pediatric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Yvan Vial
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Jardena J Puder
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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12
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Sabolović Rudman S, Djaković I, Gall V, Djaković Ž, Košec V. PREGNANCY OUTCOME IN GESTATIONAL DIABETES COMPARED TO BODY MASS INDEX. Acta Clin Croat 2019; 58:37-41. [PMID: 31363323 PMCID: PMC6629204 DOI: 10.20471/acc.2019.58.01.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Gestational diabetes involves disorder of glucose metabolism first diagnosed in pregnancy. Obese women undoubtedly have more often complications in reproductive age, such as fertility difficulties, spontaneous and recurrent miscarriages, premature births, and various obstetric and surgical complications related to the course of pregnancy, delivery and puerperium. Children of obese pregnant women are more likely to develop obesity in childhood and adulthood. We analyzed the outcome of 51 pregnancies in obese pregnant women and 50 pregnant women with normal body mass index. All women in both groups were diagnosed with gestational diabetes by the IADPSG criteria. We analyzed gestational age at delivery and mode of delivery, gestational weight gain, presence of concomitant diagnosis of gestational or chronic hypertension, difference in birth weight, and prevalence of hypertrophic newborns. There was no significant difference in gestational age at pregnancy termination and in the mode of delivery. There was a significant difference in gestational weight gain, number of pregnant women with hypertension, neonatal birth weight and number of hypertrophic children. Based on the data presented, we conclude that obesity is an unfavorable factor for pregnancy outcome. It also influences birth weight and fetal hypertrophy, as well as gestational weight gain.
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Affiliation(s)
| | - Ivka Djaković
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Jordanovac Department of Thoracic Surgery, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Vesna Gall
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Jordanovac Department of Thoracic Surgery, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Željko Djaković
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Jordanovac Department of Thoracic Surgery, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Vesna Košec
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Jordanovac Department of Thoracic Surgery, Zagreb University Hospital Centre, Zagreb, Croatia
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13
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Williams CB, LaCoursiere DY, Talavera GA, Gahagan S. A Feasibility Study to Promote Optimal Weight in First Time Pregnant Mothers and Their Babies: Lessons Learned in a US-Mexico Border Community. Matern Child Health J 2019; 23:578-584. [DOI: 10.1007/s10995-018-2685-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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14
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Dudenhausen JW, Kunze M, Wittwer-Backofen U, Hagenah HP, Strauss A, Günther V, Alkatout İ, Grunebaum A, Voigt M. The relationship between maternal age, body mass index, and the rate of preterm birth. J Turk Ger Gynecol Assoc 2018; 19:182-186. [PMID: 30257817 PMCID: PMC6250089 DOI: 10.4274/jtgga.2018.0057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: The aim of the present study was to assess the influence of maternal age and maternal body mass index of early pregnancy on the risk of preterm delivery. Material and Methods: The study included 2.1 million liveborn single newborns with documented data at perinatal surveys. Statistical analyses were performed using the SPSS statistics program. Results: The risk of preterm births increased in obese women and in women with advanced age. Conclusion: Strategies should be developed to reduce preconceptional body mass index, and guidelines are required to help advise women who postponed childbearing.
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Affiliation(s)
- Joachim W. Dudenhausen
- Department of Obstetrics, Charité University School of Medicine, Berlin, Germany,Department of Gynecology and Obstetrics, Weill Cornell Medicine, New York, USA
| | - Mirjam Kunze
- Department of Gynecology and Obstetrics, University of Freiburg School of Medicine, Freiburg, Germany
| | | | - Hans Peter Hagenah
- Department of Obstetrics, Agaplesion Diakonieklinikum Rotenburg, Rotenburg, Germany
| | | | - Veronika Günther
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Kiel, Germany
| | - İbrahim Alkatout
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Kiel, Germany
| | - Amos Grunebaum
- Department of Gynecology and Obstetrics, Weill Cornell Medicine, New York, USA
| | - Manfred Voigt
- Center of Medicine and Society, University of Freiburg, Freiburg, Germany,University of Freiburg School of Medicine, Freiburg, Germany
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15
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Kosinska-Kaczynska K, Szymusik I, Kaczynski B, Wielgos M. Observational study of associations between gestational weight gain and perinatal outcomes in dichorionic twin pregnancies. Int J Gynaecol Obstet 2017; 138:94-99. [DOI: 10.1002/ijgo.12171] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/20/2017] [Accepted: 04/05/2017] [Indexed: 11/11/2022]
Affiliation(s)
| | - Iwona Szymusik
- 1st Department of Obstetrics and Gynecology; Medical University of Warsaw; Warsaw Poland
| | - Bartosz Kaczynski
- Department of Medical Informatics and Telemedicine; Medical University of Warsaw; Warsaw Poland
| | - Miroslaw Wielgos
- 1st Department of Obstetrics and Gynecology; Medical University of Warsaw; Warsaw Poland
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16
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Viecceli C, Remonti LR, Hirakata VN, Mastella LS, Gnielka V, Oppermann MLR, Silveiro SP, Reichelt AJ. Weight gain adequacy and pregnancy outcomes in gestational diabetes: a meta-analysis. Obes Rev 2017; 18:567-580. [PMID: 28273690 DOI: 10.1111/obr.12521] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/27/2016] [Accepted: 01/03/2017] [Indexed: 02/06/2023]
Abstract
The Institute of Medicine updated guidelines for gestational weight gain in 2009, with no special recommendations for gestational diabetes. Our objectives were to describe the prevalence of weight gain adequacy and their association with adverse pregnancy outcomes in gestational diabetes. We searched MEDLINE, EMBASE, COCHRANE and SCOPUS. We calculated the pooled prevalence of gain adequacy and relative risks for pregnancy outcomes within Institute of Medicine categories. Thirty-three studies/abstracts (88,599 women) were included. Thirty-one studies provided data on the prevalence of weight gain adequacy; it was adequate in 34% (95% CI: 29-39%) of women, insufficient in 30% (95% CI: 27-34%) and excessive in 37% (95% CI: 33-41%). Excessive gain was associated with increased risks of pharmacological treatment, hypertensive disorders of pregnancy, caesarean section, large for gestational age and macrosomic babies, compared to adequate or non-excessive gain. Weight gain below the guidance had a protective effect on large babies (RR: 0.71; 95% CI: 0.56-0.90) and macrosomia (RR 0.57; 95% CI 0.40-0.83), and did not increase the risk of small babies (RR 1.40; 95% CI 0.86-2.27). Less than recommended weight gain would be beneficial, while effective prevention of excessive gain is of utmost importance, in gestational diabetes pregnancies. Nevertheless, no ideal range for weight gain could be established.
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Affiliation(s)
- C Viecceli
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - L R Remonti
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - V N Hirakata
- Biostatistics Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - L S Mastella
- Post-graduate Course in Medical Sciences: Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - V Gnielka
- Post-graduate Course in Medical Sciences: Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - M L R Oppermann
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - S P Silveiro
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Post-graduate Course in Medical Sciences: Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - A J Reichelt
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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