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Dongarwar D, Ajewole V, Spooner KK, Tran V, Adebusuyi T, Onyenaka C, Bakare O, Emeh C, Baines K, Boua D, Mossi Y, Egbejimi A, Ibrahim S, Olaleye O, Salihu HM. Racial and Ethnic Disparities in Stillbirth among Pregnant Women with Obesity. Am J Perinatol 2024; 41:e2138-e2144. [PMID: 37230474 PMCID: PMC11059530 DOI: 10.1055/a-2099-8494] [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: 05/27/2023]
Abstract
OBJECTIVE The aim of this study was to examine the relationship between obesity and risk of stillbirth among pregnant women with obesity in the United States, with a focus on racial and ethnic disparities. STUDY DESIGN We conducted a retrospective cross-sectional analysis of birth and fetal data from the 2014 to 2019 National Vital Statistics System (N = 14,938,384 total births) to examine associations between maternal body mass index (BMI) and risk of stillbirth. Cox's proportional hazards regression model was used to compute adjusted hazard ratios (HR) as a measure of risk of stillbirth in relation to maternal BMI. RESULTS The stillbirth rate was 6.70 per 1,000 births among women with prepregnancy obesity, while the stillbirth rate among women with a normal (nonobese) prepregnancy BMI was 3.85 per 1,000 births. The risk of stillbirth was greater among women with obesity compared with women without obesity (HR: 1.39; 95% confidence interval [CI]: 1.37-1.41). Compared with non-Hispanic (NH) Whites, women identifying as NH-other (HR: 1.66; 95% CI: 1.61-1.72) and NH-Black (HR: 1.31; 95% CI: 1.26-1.35) were at higher risk of stillbirth, while Hispanic women had a decreased likelihood of stillbirth (HR: 0.38; 95% CI: 0.37-0.40). CONCLUSION Obesity is a modifiable risk factor for stillbirth. Public health awareness campaigns and strategies targeting weight management in women of reproductive age and racial/ethnic populations at highest risk for stillbirth, are needed. KEY POINTS · Stillbirth rates differ by race and ethnicity.. · Risk of stillbirth was greatest among women with obesity.. · Stillbirth rates rise with ascending prepregnancy BMI..
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Affiliation(s)
- Deepa Dongarwar
- Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas
| | - Veronica Ajewole
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Kiara K. Spooner
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Vincent Tran
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Tolulope Adebusuyi
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Collins Onyenaka
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Oluwatoyin Bakare
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Clinton Emeh
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Kameren Baines
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Danielle Boua
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Yhenew Mossi
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Anuoluwapo Egbejimi
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Samira Ibrahim
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Omonike Olaleye
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Hamisu M. Salihu
- Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
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Herup-Wheeler T, Shi M, Harvey ME, Talwar C, Kommagani R, MacLean JA, Hayashi K. High-fat diets promote peritoneal inflammation and augment endometriosis-associated abdominal hyperalgesia. Front Endocrinol (Lausanne) 2024; 15:1336496. [PMID: 38559689 PMCID: PMC10978581 DOI: 10.3389/fendo.2024.1336496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Immune dysfunction is one of the central components in the development and progression of endometriosis by establishing a chronic inflammatory environment. Western-style high-fat diets (HFD) have been linked to greater systemic inflammation to cause metabolic and chronic inflammatory diseases, and are also considered an environmental risk factor for gynecologic diseases. Here, we aimed to examine how HFD cause an inflammatory environment in endometriosis and discern their contribution to endometriotic-associated hyperalgesia. Our results showed that HFD-induced obesity enhanced abdominal hyperalgesia that was induced by endometriotic lesions. Peritoneal inflammatory macrophages and cytokine levels increased by lesion induction were elevated by chronic exposure to HFD. Increased expression of pain-related mediators in the dorsal root ganglia was observed after lesion induction under the HFD condition. Although HFD did not affect inflammatory macrophages in the peritoneal cavity without lesion induction, the diversity and composition of the gut microbiota were clearly altered by HFD as a sign of low-grade systemic inflammation. Thus, HFD alone might not establish a local inflammatory environment in the pelvic cavity, but it can contribute to further enhancing chronic inflammation, leading to the exacerbation of endometriosis-associated abdominal hyperalgesia following the establishment and progression of the disease.
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Affiliation(s)
- Tristin Herup-Wheeler
- School of Molecular Bioscience, Center for Reproductive Biology, Washington State University, Pullman, WA, United States
| | - Mingxin Shi
- School of Molecular Bioscience, Center for Reproductive Biology, Washington State University, Pullman, WA, United States
| | - Madeleine E. Harvey
- School of Molecular Bioscience, Center for Reproductive Biology, Washington State University, Pullman, WA, United States
| | - Chandni Talwar
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, United States
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States
| | - Ramakrishna Kommagani
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, United States
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States
| | - James A. MacLean
- School of Molecular Bioscience, Center for Reproductive Biology, Washington State University, Pullman, WA, United States
| | - Kanako Hayashi
- School of Molecular Bioscience, Center for Reproductive Biology, Washington State University, Pullman, WA, United States
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Ramji N, Corsi DJ, Gad M, Dimanlig-Cruz S, Miao Q, Guo Y, Rybak N, White RR, Wen SW, Walker MC, Gaudet LM. The impact of isolated obesity compared with obesity and other risk factors on risk of stillbirth: a retrospective cohort study. CMAJ 2024; 196:E250-E259. [PMID: 38438153 PMCID: PMC10911866 DOI: 10.1503/cmaj.221450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Maternal obesity is associated with stillbirth, but uncertainty persists around the effects of higher obesity classes. We sought to compare the risk of stillbirth associated with maternal obesity alone versus maternal obesity and additional or undiagnosed factors contributing to high-risk pregnancy. METHODS We conducted a retrospective cohort study using the Better Outcomes Registry and Network (BORN) for singleton hospital births in Ontario between 2012 and 2018. We used multivariable Cox proportional hazard regression and logistic regression to evaluate the relationship between prepregnancy maternal body mass index (BMI) class and stillbirth (reference was normal BMI). We treated maternal characteristics and obstetrical complications as independent covariates. We performed mediator analyses to measure the direct and indirect effects of BMI on stillbirth through major common-pathway complications. We used fully adjusted and partially adjusted models, representing the impact of maternal obesity alone and maternal obesity with other risk factors on stillbirth, respectively. RESULTS We analyzed data on 681 178 births between 2012 and 2018, of which 1956 were stillbirths. Class I obesity was associated with an increased incidence of stillbirth (adjusted hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.35-1.78). This association was stronger for class III obesity (adjusted HR 1.80, 95% CI 1.44-2.24), and strongest for class II obesity (adjusted HR 2.17, 95% CI 1.83-2.57). Plotting point estimates for odds ratios, stratified by gestational age, showed a marked increase in the relative odds for stillbirth beyond 37 weeks' gestation for those with obesity with and without other risk factors, compared with those with normal BMI. The impact of potential mediators was minimal. INTERPRETATION Maternal obesity alone and obesity with other risk factors are associated with an increased risk of stillbirth. This risk increases with gestational age, especially at term.
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Affiliation(s)
- Naila Ramji
- Department of Obstetrics & Gynecology (Ramji), Dalhousie University, Fredericton, NB; Department of Bioethics (Ramji), Dalhousie University, Halifax, NS; Better Outcomes Registry and Network Ontario (Corsi, Dimanlig-Cruz, Miao, Walker), Children's Hospital of Eastern Ontario (CHEO); CHEO Research Institute (Corsi, Miao), Ottawa, Ont.; Nicotine Dependence Service (Gad), Centre of Addiction and Mental Health, Toronto, Ont.; Clinical Epidemiology Program (Dimanlig-Cruz, Guo, Rybak, Rennicks White, Wen, Walker), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Guo, Wen), University of Ottawa; Department of Obstetrics, Gynecology & Newborn Care (Rybak, Rennicks White), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Queen's University; Department of Obstetrics and Gynecology, Kingston Health Sciences Centre (Gaudet), Kingston, Ont.
| | - Daniel J Corsi
- Department of Obstetrics & Gynecology (Ramji), Dalhousie University, Fredericton, NB; Department of Bioethics (Ramji), Dalhousie University, Halifax, NS; Better Outcomes Registry and Network Ontario (Corsi, Dimanlig-Cruz, Miao, Walker), Children's Hospital of Eastern Ontario (CHEO); CHEO Research Institute (Corsi, Miao), Ottawa, Ont.; Nicotine Dependence Service (Gad), Centre of Addiction and Mental Health, Toronto, Ont.; Clinical Epidemiology Program (Dimanlig-Cruz, Guo, Rybak, Rennicks White, Wen, Walker), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Guo, Wen), University of Ottawa; Department of Obstetrics, Gynecology & Newborn Care (Rybak, Rennicks White), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Queen's University; Department of Obstetrics and Gynecology, Kingston Health Sciences Centre (Gaudet), Kingston, Ont
| | - Monica Gad
- Department of Obstetrics & Gynecology (Ramji), Dalhousie University, Fredericton, NB; Department of Bioethics (Ramji), Dalhousie University, Halifax, NS; Better Outcomes Registry and Network Ontario (Corsi, Dimanlig-Cruz, Miao, Walker), Children's Hospital of Eastern Ontario (CHEO); CHEO Research Institute (Corsi, Miao), Ottawa, Ont.; Nicotine Dependence Service (Gad), Centre of Addiction and Mental Health, Toronto, Ont.; Clinical Epidemiology Program (Dimanlig-Cruz, Guo, Rybak, Rennicks White, Wen, Walker), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Guo, Wen), University of Ottawa; Department of Obstetrics, Gynecology & Newborn Care (Rybak, Rennicks White), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Queen's University; Department of Obstetrics and Gynecology, Kingston Health Sciences Centre (Gaudet), Kingston, Ont
| | - Sheryll Dimanlig-Cruz
- Department of Obstetrics & Gynecology (Ramji), Dalhousie University, Fredericton, NB; Department of Bioethics (Ramji), Dalhousie University, Halifax, NS; Better Outcomes Registry and Network Ontario (Corsi, Dimanlig-Cruz, Miao, Walker), Children's Hospital of Eastern Ontario (CHEO); CHEO Research Institute (Corsi, Miao), Ottawa, Ont.; Nicotine Dependence Service (Gad), Centre of Addiction and Mental Health, Toronto, Ont.; Clinical Epidemiology Program (Dimanlig-Cruz, Guo, Rybak, Rennicks White, Wen, Walker), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Guo, Wen), University of Ottawa; Department of Obstetrics, Gynecology & Newborn Care (Rybak, Rennicks White), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Queen's University; Department of Obstetrics and Gynecology, Kingston Health Sciences Centre (Gaudet), Kingston, Ont
| | - Qun Miao
- Department of Obstetrics & Gynecology (Ramji), Dalhousie University, Fredericton, NB; Department of Bioethics (Ramji), Dalhousie University, Halifax, NS; Better Outcomes Registry and Network Ontario (Corsi, Dimanlig-Cruz, Miao, Walker), Children's Hospital of Eastern Ontario (CHEO); CHEO Research Institute (Corsi, Miao), Ottawa, Ont.; Nicotine Dependence Service (Gad), Centre of Addiction and Mental Health, Toronto, Ont.; Clinical Epidemiology Program (Dimanlig-Cruz, Guo, Rybak, Rennicks White, Wen, Walker), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Guo, Wen), University of Ottawa; Department of Obstetrics, Gynecology & Newborn Care (Rybak, Rennicks White), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Queen's University; Department of Obstetrics and Gynecology, Kingston Health Sciences Centre (Gaudet), Kingston, Ont
| | - Yanfang Guo
- Department of Obstetrics & Gynecology (Ramji), Dalhousie University, Fredericton, NB; Department of Bioethics (Ramji), Dalhousie University, Halifax, NS; Better Outcomes Registry and Network Ontario (Corsi, Dimanlig-Cruz, Miao, Walker), Children's Hospital of Eastern Ontario (CHEO); CHEO Research Institute (Corsi, Miao), Ottawa, Ont.; Nicotine Dependence Service (Gad), Centre of Addiction and Mental Health, Toronto, Ont.; Clinical Epidemiology Program (Dimanlig-Cruz, Guo, Rybak, Rennicks White, Wen, Walker), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Guo, Wen), University of Ottawa; Department of Obstetrics, Gynecology & Newborn Care (Rybak, Rennicks White), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Queen's University; Department of Obstetrics and Gynecology, Kingston Health Sciences Centre (Gaudet), Kingston, Ont
| | - Natalie Rybak
- Department of Obstetrics & Gynecology (Ramji), Dalhousie University, Fredericton, NB; Department of Bioethics (Ramji), Dalhousie University, Halifax, NS; Better Outcomes Registry and Network Ontario (Corsi, Dimanlig-Cruz, Miao, Walker), Children's Hospital of Eastern Ontario (CHEO); CHEO Research Institute (Corsi, Miao), Ottawa, Ont.; Nicotine Dependence Service (Gad), Centre of Addiction and Mental Health, Toronto, Ont.; Clinical Epidemiology Program (Dimanlig-Cruz, Guo, Rybak, Rennicks White, Wen, Walker), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Guo, Wen), University of Ottawa; Department of Obstetrics, Gynecology & Newborn Care (Rybak, Rennicks White), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Queen's University; Department of Obstetrics and Gynecology, Kingston Health Sciences Centre (Gaudet), Kingston, Ont
| | - Ruth Rennicks White
- Department of Obstetrics & Gynecology (Ramji), Dalhousie University, Fredericton, NB; Department of Bioethics (Ramji), Dalhousie University, Halifax, NS; Better Outcomes Registry and Network Ontario (Corsi, Dimanlig-Cruz, Miao, Walker), Children's Hospital of Eastern Ontario (CHEO); CHEO Research Institute (Corsi, Miao), Ottawa, Ont.; Nicotine Dependence Service (Gad), Centre of Addiction and Mental Health, Toronto, Ont.; Clinical Epidemiology Program (Dimanlig-Cruz, Guo, Rybak, Rennicks White, Wen, Walker), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Guo, Wen), University of Ottawa; Department of Obstetrics, Gynecology & Newborn Care (Rybak, Rennicks White), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Queen's University; Department of Obstetrics and Gynecology, Kingston Health Sciences Centre (Gaudet), Kingston, Ont
| | - Shi Wu Wen
- Department of Obstetrics & Gynecology (Ramji), Dalhousie University, Fredericton, NB; Department of Bioethics (Ramji), Dalhousie University, Halifax, NS; Better Outcomes Registry and Network Ontario (Corsi, Dimanlig-Cruz, Miao, Walker), Children's Hospital of Eastern Ontario (CHEO); CHEO Research Institute (Corsi, Miao), Ottawa, Ont.; Nicotine Dependence Service (Gad), Centre of Addiction and Mental Health, Toronto, Ont.; Clinical Epidemiology Program (Dimanlig-Cruz, Guo, Rybak, Rennicks White, Wen, Walker), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Guo, Wen), University of Ottawa; Department of Obstetrics, Gynecology & Newborn Care (Rybak, Rennicks White), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Queen's University; Department of Obstetrics and Gynecology, Kingston Health Sciences Centre (Gaudet), Kingston, Ont
| | - Mark C Walker
- Department of Obstetrics & Gynecology (Ramji), Dalhousie University, Fredericton, NB; Department of Bioethics (Ramji), Dalhousie University, Halifax, NS; Better Outcomes Registry and Network Ontario (Corsi, Dimanlig-Cruz, Miao, Walker), Children's Hospital of Eastern Ontario (CHEO); CHEO Research Institute (Corsi, Miao), Ottawa, Ont.; Nicotine Dependence Service (Gad), Centre of Addiction and Mental Health, Toronto, Ont.; Clinical Epidemiology Program (Dimanlig-Cruz, Guo, Rybak, Rennicks White, Wen, Walker), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Guo, Wen), University of Ottawa; Department of Obstetrics, Gynecology & Newborn Care (Rybak, Rennicks White), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Queen's University; Department of Obstetrics and Gynecology, Kingston Health Sciences Centre (Gaudet), Kingston, Ont
| | - Laura M Gaudet
- Department of Obstetrics & Gynecology (Ramji), Dalhousie University, Fredericton, NB; Department of Bioethics (Ramji), Dalhousie University, Halifax, NS; Better Outcomes Registry and Network Ontario (Corsi, Dimanlig-Cruz, Miao, Walker), Children's Hospital of Eastern Ontario (CHEO); CHEO Research Institute (Corsi, Miao), Ottawa, Ont.; Nicotine Dependence Service (Gad), Centre of Addiction and Mental Health, Toronto, Ont.; Clinical Epidemiology Program (Dimanlig-Cruz, Guo, Rybak, Rennicks White, Wen, Walker), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Guo, Wen), University of Ottawa; Department of Obstetrics, Gynecology & Newborn Care (Rybak, Rennicks White), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Queen's University; Department of Obstetrics and Gynecology, Kingston Health Sciences Centre (Gaudet), Kingston, Ont
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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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Herup-Wheeler T, Shi M, Harvey ME, Talwar C, Kommagani R, MacLean JA, Hayashi K. High-fat diets promote peritoneal inflammation and augment endometriosis-associated abdominal hyperalgesia. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.11.09.566474. [PMID: 38014254 PMCID: PMC10680790 DOI: 10.1101/2023.11.09.566474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Immune dysfunction is one of the central components in the development and progression of endometriosis by establishing a chronic inflammatory environment. Western-style high-fat diets (HFD) have been linked to greater systemic inflammation to cause metabolic and chronic inflammatory diseases, and are also considered an environmental risk factor for gynecologic diseases. Here, we aimed to examine how HFD alter an inflammatory environment in endometriosis and discern their contribution to endometriotic-associated hyperalgesia. Our results showed that HFD-induced obesity enhanced abdominal mechanical allodynia that was induced by endometriotic lesions. Peritoneal inflammatory macrophages and cytokine levels increased by lesion induction were elevated by chronic exposure to HFD. Pain-related mediators in the dorsal root ganglia were further stimulated after lesion induction under the HFD condition. Although HFD did not affect inflammatory macrophages in the peritoneal cavity without lesion induction, the diversity and composition of the gut microbiota were clearly altered by HFD as a sign of low-grade systemic inflammation. Thus, HFD alone might not establish a local inflammatory environment in the pelvic cavity, but it can contribute to further enhancing chronic inflammation, leading to the exacerbation of endometriosis-associated abdominal hyperalgesia following the establishment and progression of the disease.
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Affiliation(s)
- Tristin Herup-Wheeler
- School of Molecular Bioscience, Center for Reproductive Biology, Washington State University, Pullman, WA 99614, USA
| | - Mingxin Shi
- School of Molecular Bioscience, Center for Reproductive Biology, Washington State University, Pullman, WA 99614, USA
| | - Madeleine E Harvey
- School of Molecular Bioscience, Center for Reproductive Biology, Washington State University, Pullman, WA 99614, USA
| | - Chandni Talwar
- Department of Pathology & Immunology, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Ramakrishna Kommagani
- Department of Pathology & Immunology, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - James A MacLean
- School of Molecular Bioscience, Center for Reproductive Biology, Washington State University, Pullman, WA 99614, USA
| | - Kanako Hayashi
- School of Molecular Bioscience, Center for Reproductive Biology, Washington State University, Pullman, WA 99614, USA
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Escañuela Sánchez T, O Donoghue K, Byrne M, Meaney S, Matvienko-Sikar K. A systematic review of behaviour change techniques used in the context of stillbirth prevention. Women Birth 2023; 36:e495-e508. [PMID: 37179243 DOI: 10.1016/j.wombi.2023.05.002] [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: 02/10/2023] [Revised: 05/02/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Stillbirth is one of the most devastating pregnancy outcomes that families can experience. Previous research has associated a wide range of risk factors with stillbirth, including maternal behaviours such as substance use, sleep position and attendance and engagement with antenatal care. Hence, some preventive efforts have been focused on tackling the behavioural risk factors for stillbirth. This study aimed to identify the Behaviour Change Techniques (BCTs) used in behaviour change interventions tacking behavioural risk factors for stillbirth such as substance use, sleep position, unattendance to antenatal care and weight management. STUDY DESIGN A systematic review of the literature was conducted in June 2021 and updated in November 2022 in five databases: CINHAL, Psyhinfo, SociIndex, PubMed and Web of Science. Studies published in high-income countries describing interventions designed in the context of stillbirth prevention, reporting stillbirth rates and changes in behaviour were eligible for inclusion. BCTs were identified using the Behaviour Change Technique Taxonomy v1. RESULTS Nine interventions were included in this review identified in 16 different publications. Of these, 4 interventions focused on more than one behaviour (smoking, monitoring fetal movements, sleep position, care-seeking behaviours), one focused on smoking, three on monitoring fetal movements and one on sleep position. Twenty-seven BCTs were identified across all interventions. The most commonly used was "Information about health consequences" (n = 7/9) followed by "Adding objects to the environment" (n = 6/9). One of the interventions included in this review has not been assessed for efficacy yet, of the remaining eight, three showed results in the reduction of stillbirth rates. and four interventions produced behaviour change (smoking reductions, increased knowledge, reduced supine sleeping time). CONCLUSIONS Our findings suggest that interventions designed to date have limited effects on the rates of stillbirth and utilise a limited number of BCTs which are mostly focused on information provision. Further research is necessary to design evidence base behaviour change interventions with a greater focus to tackle all the other factors influencing behaviour change during pregnancy (e.g.: social influence, environmental barriers).
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Affiliation(s)
- Tamara Escañuela Sánchez
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland; INFANT Centre, University College Cork, Cork, Ireland; National Perinatal Epidemiology Centre (NPEC), University College Cork. Dept. of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.
| | - Keelin O Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland; INFANT Centre, University College Cork, Cork, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, Ireland
| | - Sarah Meaney
- National Perinatal Epidemiology Centre (NPEC), University College Cork. Dept. of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
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Chairat T, Ratinthorn A, Limruangrong P, Boriboonhirunsarn D. Prevalence and related factors of inappropriate gestational weight gain among pregnant women with overweight/ obesity in Thailand. BMC Pregnancy Childbirth 2023; 23:319. [PMID: 37147586 PMCID: PMC10163776 DOI: 10.1186/s12884-023-05635-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 04/22/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND An inappropriate gestational weight gain (GWG) among pregnant women with overweight/obesity is a crucial health problem. Its prevalence remains high worldwide, particularly in urban areas. The prevalence and predicting factors in Thailand are lack of evidence. This study aimed to investigate prevalence rates, antenatal care (ANC) service arrangement, predictive factors, and impacts of inappropriate GWG among pregnant women with overweight/obesity in Bangkok and its surrounding metropolitan area. METHODS This cross-sectional, retrospective study used four sets of questionnaires investigating 685 pregnant women with overweight/obesity and 51 nurse-midwives (NMs) from July to December 2019 in ten tertiary hospitals. Multinomial logistic regression identified predictive factors with a 95% confidence interval (CI). RESULT The prevalence rates of excessive and inadequate GWG were 62.34% and 12.99%. Weight management for pregnant women with overweight/obesity are unavailable in tertiary cares. Over three-fourths of NMs have never received weight management training for this particular group. ANC service factors, i.e., GWG counseling by ANC providers, quality of general ANC service at an excellent and good level, NMs' positive attitudes toward GWG control, significantly decreased the adjusted odds ratio (AOR) of inadequate GWG by 0.03, 0.01, 0.02, 0.20, times, respectively. While maternal factors, sufficient income, and easy access to low-fat foods reduce AOR of inadequate GWG by 0.49, and 0.31 times. In contrast, adequate maternal GWG knowledge statistically increased the AOR of inadequate GWG 1.81 times. Meanwhile, easy access to low-fat foods and internal weight locus of control (WLOC) decreased the AOR of excessive GWG by 0.29 and 0.57 times. Finally, excessive GWG significantly increased the risk of primary C/S, fetal LGA, and macrosomia 1.65, 1.60, and 5.84 times, respectively, while inadequate GWG was not associated with adverse outcomes. CONCLUSION Prevalence rates of inappropriate GWG, especially excessive GWG remained high and affected adverse outcomes. The quality of ANC service provision and appropriate GWG counseling from ANC providers are significant health service factors. Thus, NMs should receive gestational weight counseling and management training to improve women's knowledge and practice for gestational weight (GW) control.
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Affiliation(s)
| | | | | | - Dittakarn Boriboonhirunsarn
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10400, Thailand
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8
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Fetal Risks and Morbidity in Pregnant Individuals with Obesity. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2023. [DOI: 10.1007/s13669-023-00347-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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9
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Akselsson A, Rossen J, Storck-Lindholm E, Rådestad I. Prolonged pregnancy and stillbirth among women with overweight or obesity - a population-based study in Sweden including 64,632 women. BMC Pregnancy Childbirth 2023; 23:21. [PMID: 36635668 PMCID: PMC9835339 DOI: 10.1186/s12884-022-05340-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The proportion of overweight or obese pregnant women is increasing in many countries and babies born to a mother who is overweight or obese are at higher risk for complications. Our primary objective was to describe sociodemographic and obstetric factors across Body Mass Index (BMI) classifications, with secondary objective to investigate stillbirth and other pregnancy outcomes in relation to BMI classifications and gestational week. METHODS This population-based cohort study with data partly based on a cluster-randomized controlled trial includes 64,632 women with singleton pregnancy, giving birth from 28 weeks' gestation. The time period was January 2016 to 30 June 2018 (2.5 years). Women were divided into five groups according to BMI: below 18.5 underweight, 18.5-24.9 normal weight, 25.0-29.9 overweight, 30.0-34.9 obesity, 35.0 and above, severe obesity. RESULTS Data was obtained for 61,800 women. Women who were overweight/obese/severely obese had lower educational levels, were to a lesser extent employed, were more often multiparas, tobacco users and had maternal diseases to a higher extent than women with normal weight. From 40 weeks' gestation, overweight women had a double risk of stillbirth compared to women of normal weight (RR 2.06, CI 1.01-4.21); the risk increased to almost four times higher for obese women (RR 3.97, CI 1.6-9.7). Women who were obese or severely obese had a higher risk of almost all pregnancy outcomes, compared to women of normal weight, such as Apgar score < 7 at 5 min (RR1.54, CI 1.24-1.90), stillbirth (RR 2.16, CI 1.31-3.55), transfer to neonatal care (RR 1.38, CI 1.26-1.50), and instrumental delivery (RR 1.26, CI 1.21-1.31). CONCLUSIONS Women who were obese or severely obese had a higher risk of almost all adverse pregnancy outcomes and from gestational week 40, the risk of stillbirth was doubled. The findings indicate a need for national guidelines and individualized care to prevent and reduce negative pregnancy outcomes in overweight/obese women. Preventive methods including preconception care and public health policies are needed to reduce the number of women being overweight/obese when entering pregnancy.
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Affiliation(s)
- Anna Akselsson
- grid.445308.e0000 0004 0460 3941Department of Health Promoting Science, Sophiahemmet University, 5605, S-114 86 Stockholm, PB Sweden
| | - Jenny Rossen
- grid.445308.e0000 0004 0460 3941Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Elisabeth Storck-Lindholm
- grid.416648.90000 0000 8986 2221Department of Obstetrics and Gynecology, Stockholm South General Hospital, Stockholm, Sweden
| | - Ingela Rådestad
- grid.445308.e0000 0004 0460 3941Sophiahemmet University, Stockholm, Sweden
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10
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The importance of placental lipid metabolism across gestation in obese and non-obese pregnancies. Clin Sci (Lond) 2023; 137:31-34. [PMID: 36594368 PMCID: PMC9810527 DOI: 10.1042/cs20220657] [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: 11/21/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 01/04/2023]
Abstract
In this commentary, we highlight a new study by Bidne and colleagues that identifies changes in placental lipids and lipid metabolic enzymes that happen not only in the context of parental obesity but also from as early as 4 weeks of gestation. Their assessment of lipid and enzyme content demonstrates a feasible approach to untangling the complexities of metabolic pathologies that impact the lifelong health of both parent and child.
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11
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Murphy CC, Betts AC, Allicock MA, Shay LA, Preston SM, Cohn BA, Lupo PJ, Pruitt SL. Stillbirth After Adolescent and Young Adult Cancer: A Population-Based Study. J Natl Cancer Inst 2022; 114:1674-1680. [PMID: 36029247 PMCID: PMC9745431 DOI: 10.1093/jnci/djac168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/10/2022] [Accepted: 08/25/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Gonadotoxic effects of cancer treatment may increase risk of adverse birth outcomes in adolescent and young adult (AYA, aged 15-39 years) women diagnosed with cancer. We estimated risk of stillbirth (fetal death of gestational age ≥20 weeks or weighing ≥350 grams) in a population-based sample of AYA women. METHODS AYA women diagnosed with cancer between January 1, 1995, and December 31, 2015, were identified using the Texas Cancer Registry and linked to live birth and fetal death certificates through December 31, 2016. Among AYA women, cumulative incidence of stillbirth was estimated by gestational age, and Poisson regression models identified factors associated with stillbirth. Standardized fetal mortality ratios (SMR) compared the observed fetal mortality rate in AYA women with the expected fetal mortality rate in the general population. RESULTS A total of 11 628 live births and 68 stillbirths occurred to 8402 AYA women after diagnosis. Cumulative incidence of stillbirth in AYA women was 0.70% (95% confidence interval [CI] = 0.51% to 0.96%) at 40 weeks of gestation. Risk of stillbirth was higher among Hispanic (risk ratio [RR] = 2.64, 95% CI = 1.29 to 5.41) and non-Hispanic Black (RR = 4.13, 95% CI = 1.68 to 10.16) women compared with non-Hispanic White women; there was no association with receipt of chemotherapy or time since diagnosis. Age- and race and ethnicity-adjusted fetal mortality rate in AYA women was similar to the general population (SMR = 0.99, 95% CI = 0.77 to 1.26). CONCLUSIONS AYA women may be counseled that overall risk of stillbirth is low, and for most, cancer does not appear to confer additional risk.
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Affiliation(s)
- Caitlin C Murphy
- Department of Health Promotion & Behavioral Sciences, University of Texas Health School of Public Health, Houston, TX, USA
- Center for Health Promotion and Prevention Research, Houston, TX, USA
| | - Andrea C Betts
- Department of Health Promotion & Behavioral Sciences, University of Texas Health School of Public Health, Dallas Regional Campus, Dallas, TX, USA
| | - Marlyn A Allicock
- Center for Health Promotion and Prevention Research, Houston, TX, USA
- Department of Health Promotion & Behavioral Sciences, University of Texas Health School of Public Health, Dallas Regional Campus, Dallas, TX, USA
| | - L Aubree Shay
- Center for Health Promotion and Prevention Research, Houston, TX, USA
- Department of Health Promotion & Behavioral Sciences, University of Texas Health School of Public Health, San Antonio Regional Campus, San Antonio, TX, USA
| | - Sharice M Preston
- Department of Health Promotion & Behavioral Sciences, University of Texas Health School of Public Health, Houston, TX, USA
- Texas Center for Pediatric Population Health, Dallas, TX, USA
| | - Barbara A Cohn
- Child Health and Development Studies, Public Health Institute, Berkeley, CA, USA
| | - Philip J Lupo
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Sandi L Pruitt
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
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12
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Considering the Effects and Maternofoetal Implications of Vascular Disorders and the Umbilical Cord. Medicina (B Aires) 2022; 58:medicina58121754. [PMID: 36556956 PMCID: PMC9782481 DOI: 10.3390/medicina58121754] [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: 10/21/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022] Open
Abstract
The umbilical cord is a critical anatomical structure connecting the placenta with the foetus, fulfilling multiple functions during pregnancy and hence influencing foetal development, programming and survival. Histologically, the umbilical cord is composed of three blood vessels: two arteries and one vein, integrated in a mucous connective tissue (Wharton's jelly) upholstered by a layer of amniotic coating. Vascular alterations in the umbilical cord or damage in this tissue because of other vascular disorders during pregnancy are worryingly related with detrimental maternofoetal consequences. In the present work, we will describe the main vascular alterations presented in the umbilical cord, both in the arteries (Single umbilical artery, hypoplastic umbilical artery or aneurysms in umbilical arteries) and the vein (Vascular thrombosis, aneurysms or varicose veins in the umbilical vein), together with other possible complications (Velamentous insertion, vasa praevia, hypercoiled or hypocoiled cord, angiomyxoma and haematomas). Likewise, the effect of the main obstetric vascular disorders like hypertensive disorders of pregnancy (specially pre-eclampsia) and chronic venous disease on the umbilical cord will also be summarized herein.
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13
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Ncube CN, McCormick SM, Badon SE, Riley T, Souter VL. Antepartum and intrapartum stillbirth rates across gestation: a cross-sectional study using the revised foetal death reporting system in the U.S. BMC Pregnancy Childbirth 2022; 22:885. [PMID: 36447143 PMCID: PMC9706921 DOI: 10.1186/s12884-022-05185-x] [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: 05/31/2021] [Accepted: 11/06/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There is a renewed call to address preventable foetal deaths in high-income countries, especially where progress has been slow. The Centers for Disease Control and Prevention released publicly, for the first time, the initiating cause and estimated timing of foetal deaths in 2014. The objective of this study is to describe risk and characteristics of antepartum versus intrapartum stillbirths in the U.S., and frequency of pathological examination to determine cause. METHODS We conducted a cross-sectional study of singleton births (24-43 weeks) using 2014 U.S. Fetal Death and Natality data available from the National Center for Health Statistics. The primary outcome was timing of death (antepartum (n = 6200), intrapartum (n = 453), and unknown (n = 5403)). Risk factors of interest included maternal sociodemographic, behavioural, medical and obstetric factors, along with foetal sex. We estimated gestational week-specific stillbirth hazard, risk factors for intrapartum versus antepartum stillbirth using multivariable log-binomial regression models, conditional probabilities of intrapartum and antepartum stillbirth at each gestational week, and frequency of pathological examination by timing of death. RESULTS The gestational age-specific stillbirth hazard was approximately 2 per 10,000 foetus-weeks among preterm gestations and > 3 per 10,000 foetus-weeks among term gestations. Both antepartum and intrapartum stillbirth risk increased in late-term and post-term gestations. The risk of intrapartum versus antepartum stillbirth was higher among those without a prior live birth, relative to those with at least one prior live birth (RR 1.32; 95% CI 1.08-1.61) and those with gestational hypertension, relative to those with no report of gestational hypertension (RR 1.47; 95% CI 1.09-1.96), and lower among Black, relative to white, individuals (RR 0.70; 95% CI 0.55-0.89). Pathological examination was not performed/planned in 25% of known antepartum stillbirths and 29% of known intrapartum stillbirths. CONCLUSION These findings suggest greater stillbirth risk in the late-term and post-term periods. Primiparous mothers had greater risk of intrapartum than antepartum still birth, suggesting the need for intrapartum interventions for primiparous mothers in this phase of pregnancy to prevent some intrapartum foetal deaths. Efforts are needed to improve understanding, prevention and investigation of foetal deaths as well as improve stillbirth data quality and completeness in the United States.
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Affiliation(s)
- Collette N. Ncube
- grid.189504.10000 0004 1936 7558Department of Epidemiology, Boston University, School of Public Health, Boston, MA 02118 USA
| | - Sarah M. McCormick
- grid.416237.50000 0004 0418 9357Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Madigan Army Medical Center, Tacoma, WA USA
| | - Sylvia E. Badon
- grid.280062.e0000 0000 9957 7758Kaiser Permanente Northern California Division of Research, Oakland, CA USA
| | - Taylor Riley
- grid.34477.330000000122986657Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA USA
| | - Vivienne L. Souter
- grid.34477.330000000122986657Department of Health Services, School of Public Health, University of Washington, Seattle, WA USA
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14
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Bligard KH, Dicke JM, Stout MJ, Nelson DM, Frolova AI, Cahill AG, Raghuraman N. Etiology and evaluation of stillbirth in patients with obesity. J Matern Fetal Neonatal Med 2022; 35:10181-10186. [PMID: 36102165 DOI: 10.1080/14767058.2022.2122797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Maternal obesity is a risk factor for stillbirth, but whether or not the etiology of stillbirth differs in gravidas with and without obesity is unknown. We categorized stillbirths in a contemporary cohort to test the hypothesis that the etiology of stillbirth is different in gravidas with and without obesity. METHODS This retrospective cohort study included all gravidas with a stillbirth ≥20 weeks' gestation between 2010 and 2017 and a normal mid-trimester anatomic survey by ultrasound assessment at a large academic institution. Pregnancies were excluded if delivery data were unavailable, a multifetal gestation was present, or there was an antenatally diagnosed fetal structural or genetic anomaly. Our primary exposure was maternal obesity, defined as a body mass index (BMI) ≥ 30 kg/m2 at the time of anatomic survey. Our primary outcome was stillbirth etiology, as classified by the initial causes of fetal death tool from the Stillbirth Collaborative Research Network and includes maternal, obstetric, hematologic, fetal, infectious, placental, other, or unexplained categories. Our secondary outcomes included the evaluation performed on each stillbirth, compliance with the recommended stillbirth evaluation by the American College of Obstetricians and Gynecologists (ACOG), and the percentage of abnormal results for each of the tests ordered for stillbirth evaluation. RESULTS Of 118 stillbirths meeting the inclusion criteria, 44 (37.3%) occurred in gravidas with obesity and 74 (62.7%) were in patients without obesity. An obstetric complication was the most commonly identified etiology for stillbirth, found in 40.9% of cases with obesity versus in 29.7% of cases without obesity (aOR 1.09, 95% CI 0.47-2.66). The likelihood of any specific etiology of stillbirth was not significantly different in gravidas of the two weight groups, after controlling for confounders. However, assignment to the unexplained stillbirth category was significantly less common in women with obesity, compared to those without obesity (aOR 0.18, 95% CI 0.05-0.67). There was no difference in testing performed on each stillbirth between the groups. Compliance with the ACOG-recommended diagnostic evaluation for stillbirth was similar in the two groups but was only performed in 10.2% of all cases of stillbirth. Placental pathology was the test most likely to yield an abnormal result in both groups, but the percentage of abnormal results for this and all other tests was the same in the presence and absence of obesity. CONCLUSION There is no specific etiology of stillbirth seen in gravidas with obesity, compared to those without obesity, after controlling for maternal confounders. We surmise that the evaluation recommended for stillbirth assessment in the general population is appropriate for stillbirth evaluation in gravidas with obesity. Testing pursued was similar between groups, but compliance with ACOG recommendations for testing after stillbirth was deficient in the cohort. Future work should aim to identify and address barriers to completing the recommended stillbirth evaluation.
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Affiliation(s)
- Katherine H Bligard
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Jeffrey M Dicke
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Molly J Stout
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - D Michael Nelson
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Antonina I Frolova
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Alison G Cahill
- Department of Women's Health, Dell Medical School University of Texas, Austin, TX, USA
| | - Nandini Raghuraman
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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15
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Bone JN, Joseph KS, Mayer C, Platt R, Lisonkova S. The association between pre-pregnancy body mass index and perinatal death and the role of gestational age at delivery. PLoS One 2022; 17:e0264565. [PMID: 35320271 PMCID: PMC8942230 DOI: 10.1371/journal.pone.0264565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/12/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction The pathophysiology behind the association between obesity and perinatal death is not fully understood but may be in part due to higher rates of pregnancy complications at earlier gestation amongst obese women. We aimed to quantify the proportion of perinatal deaths amongst obese and overweight women mediated by gestational age at stillbirth or live birth. Methods The study included all singleton births at ≥20 weeks’ gestation in British Columbia, 2004–2017, and excluded pregnancy terminations. The proportion of the association between BMI and perinatal death mediated by gestational age at delivery (in weeks) was estimated using natural effect models, with adjustment for potential confounders. Sensitivity analyses for unmeasured confounding and women missing BMI were conducted. Results Of 392,820 included women, 20.6% were overweight and 12.8% obese. Women with higher BMI had a lower gestational age at delivery. Perinatal mortality was 0.5% (1834 pregnancies); and was elevated in overweight (adjusted odds ratio [AOR] = 1.22, 95% confidence interval [CI] 1.08–1.37) and obese women (AOR = 1.55, 95% CI 1.36–1.77). Mediation analysis showed that 63.1% of the association between obesity and perinatal death was mediated by gestational age at delivery (natural indirect effect AOR = 1.32, 95% CI 1.23–1.42, natural direct effect AOR = 1.18, 95% CI 1.05–1.32). Similar, but smaller effects were seen when comparing overweight women vs. women with a normal BMI. Estimated effects were not affected by adjustment for additional risk factors for perinatal death or sensitivity analyses for missing data. Conclusion Obese pregnancies have a higher risk of perinatal death in part mediated by a lower gestational age at delivery.
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Affiliation(s)
- Jeffrey N. Bone
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children’s and Women’s Hospital and Health Centre of British Columbia, Vancouver, BC, Canada
- * E-mail:
| | - K. S. Joseph
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children’s and Women’s Hospital and Health Centre of British Columbia, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Chantal Mayer
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children’s and Women’s Hospital and Health Centre of British Columbia, Vancouver, BC, Canada
| | - Robert Platt
- Department of Epidemiology, Biostatistics, and Occupational Health, and of Pediatrics, McGill University, Montreal, Canada
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children’s and Women’s Hospital and Health Centre of British Columbia, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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16
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Escañuela Sánchez T, Byrne M, Meaney S, O'Donoghue K, Matvienko-Sikar K. A protocol for a systematic review of behaviour change techniques used in the context of stillbirth prevention. HRB Open Res 2022; 4:92. [PMID: 36743684 PMCID: PMC9874168 DOI: 10.12688/hrbopenres.13375.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Stillbirth is a devastating pregnancy outcome that affects approximately 3.5 per 1000 births in high-income countries. Previous research has highlighted the importance of focusing prevention efforts on targeting risk factors and vulnerable groups. A wide range of risk factors has been associated with stillbirth before, including maternal behaviours such as back sleep position, smoking, alcohol intake, illicit drug use, and inadequate attendance at antenatal care. Given the modifiable nature of these risk factors, there has been an increase in the design of behaviour change interventions targeting such behaviours to reduce the risk of stillbirth. Objectives: The aim of this study is to identify all behavioural interventions with a behavioural component designed and trialled for the prevention of stillbirth in high-income countries, and to identify the behaviour change techniques (BCTs) used in such interventions using the Behaviour Change Techniques Taxonomy V1 (BCTTv1). Inclusion criteria: Interventions will be included in this review if they (1) have the objective of reducing stillbirth rates with a focus on behavioural risk factors; (2) are implemented in high-income countries; (3) target pregnant women or women of childbearing age; and (4) are published in research articles. Methods: A systematic search of the literature will be conducted. The results of the search will be screened against our inclusion criteria by two authors. The following data items will be extracted from the selected papers: general information, study characteristics, participant and intervention/approach details. The Cochrane Effective Practice and Organization of Care (EPOC) risk of bias criteria will be used to assess the methodological quality of included studies. Intervention content will be coded for BCTs as present (+) or absent (-) by two authors using the BCTTv1, discrepancies will be discussed with a third author. A narrative synthesis approach will be used to present the results of this systematic review.
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Affiliation(s)
- Tamara Escañuela Sánchez
- Pregnancy Loss Research Group, Deparment of Obstetrics and Gynaecology, University College Cork, Cork, Ireland,INFANT Centre, University College Cork, Cork, Ireland,
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, Ireland
| | - Sarah Meaney
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Deparment of Obstetrics and Gynaecology, University College Cork, Cork, Ireland,INFANT Centre, University College Cork, Cork, Ireland
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Escañuela Sánchez T, Byrne M, Meaney S, O'Donoghue K, Matvienko-Sikar K. A protocol for a systematic review of behaviour change techniques used in the context of stillbirth prevention. HRB Open Res 2022; 4:92. [PMID: 36743684 PMCID: PMC9874168 DOI: 10.12688/hrbopenres.13375.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Stillbirth is a devastating pregnancy outcome that affects approximately 3.5 per 1000 births in high-income countries. Previous research has highlighted the importance of focusing prevention efforts on targeting risk factors and vulnerable groups. A wide range of risk factors has been associated with stillbirth before, including maternal behaviours such as back sleep position, smoking, alcohol intake, illicit drug use, and inadequate attendance at antenatal care. Given the modifiable nature of these risk factors, there has been an increase in the design of behaviour change interventions targeting such behaviours to reduce the risk of stillbirth. Objectives: The aim of this study is to identify all behavioural interventions with a behavioural component designed and trialled for the prevention of stillbirth in high-income countries, and to identify the behaviour change techniques (BCTs) used in such interventions using the Behaviour Change Techniques Taxonomy V1 (BCTTv1). Inclusion criteria: Interventions will be included in this review if they (1) have the objective of reducing stillbirth rates with a focus on behavioural risk factors; (2) are implemented in high-income countries; (3) target pregnant women or women of childbearing age; and (4) are published in research articles. Methods: A systematic search of the literature will be conducted. The results of the search will be screened against our inclusion criteria by two authors. The following data items will be extracted from the selected papers: general information, study characteristics, participant and intervention/approach details. The Cochrane Effective Practice and Organization of Care (EPOC) risk of bias criteria will be used to assess the methodological quality of included studies. Intervention content will be coded for BCTs as present (+) or absent (-) by two authors using the BCTTv1, discrepancies will be discussed with a third author. A narrative synthesis approach will be used to present the results of this systematic review.
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Affiliation(s)
- Tamara Escañuela Sánchez
- Pregnancy Loss Research Group, Deparment of Obstetrics and Gynaecology, University College Cork, Cork, Ireland,INFANT Centre, University College Cork, Cork, Ireland,
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, Ireland
| | - Sarah Meaney
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Deparment of Obstetrics and Gynaecology, University College Cork, Cork, Ireland,INFANT Centre, University College Cork, Cork, Ireland
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18
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Olerich K, Soper D, Delaney S, Sterrett M. Pregnancy Care for Patients With Super Morbid Obesity. Front Pediatr 2022; 10:839377. [PMID: 35928678 PMCID: PMC9343711 DOI: 10.3389/fped.2022.839377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
The patient with obesity represents unique challenges to the medical community and, in the setting of pregnancy, additional risks to both mother and fetus. This document will focus on the risks and considerations needed to care for the women with obesity and her fetus during the antepartum, intrapartum, and immediate postpartum stages of pregnancy. Specific attention will be given to pregnancy in the setting of class III and super morbid obesity.
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Affiliation(s)
- Kelsey Olerich
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - David Soper
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, United States
| | - Shani Delaney
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Mary Sterrett
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States.,Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, United States
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Valgeirsdottir H, Kunovac Kallak T, Sundström Poromaa I, Jonsson M, Roos N, Lindström L, Wikström AK. Polycystic ovary syndrome and risk of stillbirth: a nationwide register-based study. BJOG 2021; 128:2073-2082. [PMID: 34455684 DOI: 10.1111/1471-0528.16890] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate whether polycystic ovary syndrome (PCOS) is associated with increased risk of stillbirth and whether any such association is linked to PCOS with a severe hyperandrogenic profile. DESIGN Nationwide register-based cohort study. SETTING Sweden. POPULATION The cohort consisted of women giving birth to singleton infants in 1997-2015. All women with a diagnosis of PCOS in the period 1997-2017 and a randomly selected reference group of women without PCOS diagnosis were included. PCOS with a severe hyperandrogenic profile was defined as a PCOS diagnosis with at least two dispensations of prescribed anti-androgens during 2005-2017. METHODS The risk of stillbirth in women with PCOS was estimated through multiple logistic regression, using women without PCOS as a reference. Risks were expressed as adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs), adjusted for maternal age, parity, body mass index, type-1 diabetes, educational level and country of birth. MAIN OUTCOME MEASURES Stillbirth, at ≥22 weeks of gestation in 2008-2015 and at ≥28 weeks of gestation in 1997-2007. RESULTS Compared with women without PCOS (n = 241 750), women with PCOS (n = 41 851) had a 50% increased risk of stillbirth (aOR 1.50, 95% CI 1.28-1.77). The incidence of stillbirth in women with PCOS was particularly increased at term. Women with PCOS and a severe hyperandrogenic profile (n = 13 713) did not have a stronger association with stillbirth than women with PCOS who did not have such a profile. CONCLUSIONS PCOS is associated with stillbirth and should be considered as a possible risk factor in antenatal care. Further research is warranted to investigate possible causal mechanisms. TWEETABLE ABSTRACT Women with PCOS have increased risk of stillbirth, and the incidence is particularly increased at term.
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Affiliation(s)
- H Valgeirsdottir
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - T Kunovac Kallak
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - I Sundström Poromaa
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - M Jonsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - N Roos
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden
| | - L Lindström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - A-K Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Wall-Wieler E, Butwick AJ, Gibbs RS, Lyell DJ, Girsen AI, El-Sayed YY, Carmichael SL. Maternal Health after Stillbirth: Postpartum Hospital Readmission in California. Am J Perinatol 2021; 38:e137-e145. [PMID: 32365389 PMCID: PMC7609589 DOI: 10.1055/s-0040-1708803] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study is to assess whether the risk of postpartum readmission within 6 weeks of giving birth differs for women who had stillbirths compared with live births. STUDY DESIGN Using data from the Office of Statewide Health Planning and Development in California, we performed a population-based cohort study of 7,398,640 births between 1999 and 2011. We identified diagnoses and procedures associated with the first postpartum hospital readmission that occurred within 6 weeks after giving birth. We used log-binomial models to estimate relative risk (RR) of postpartum readmission for women who had stillbirth compared with live birth deliveries, adjusting for maternal demographic, prepregnancy, pregnancy, and delivery characteristics. RESULTS The rate of postpartum readmission was higher among women who had stillbirths compared with women who had live births (206 and 96 per 10,000 births, respectively). After adjusting for maternal demographic and medical characteristics, the risk of postpartum readmission for women who had stillbirths was nearly 1.5 times greater (adjusted RR = 1.47, 95% confidence interval: 1.35-1.60) compared with live births. Among women with stillbirths, the most common indications at readmission were uterine infection or pelvic inflammatory disease, psychiatric conditions, hypertensive disorder, and urinary tract infection. CONCLUSION Based on our findings, women who have stillbirths are at higher risk of postpartum readmissions within 6 weeks of giving birth than women who have live births. Women who have stillbirths may benefit from additional monitoring and counseling after hospital discharge for potential postpartum medical and psychiatric complications. KEY POINTS · Women who have stillbirths are at nearly 1.5 times greater risk of postpartum readmission than women who have live births.. · Uterine infections and pelvic inflammatory disease, and psychiatric conditions are the most common reasons for readmission among women who had a stillbirth.. · Women who have stillbirths may benefit from additional monitoring and counseling after hospital discharge for potential postpartum medical and psychiatric complications..
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Affiliation(s)
- Elizabeth Wall-Wieler
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Alexander J. Butwick
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ronald S. Gibbs
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Deirdre J. Lyell
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Anna I. Girsen
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Yasser Y. El-Sayed
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Suzan L. Carmichael
- Department of Pediatrics and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
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21
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Eberle A, Czuzoj-Shulman N, Abenhaim HA. Timing of delivery in obese women and risk of stillbirth. J Matern Fetal Neonatal Med 2021; 35:7771-7777. [PMID: 34130576 DOI: 10.1080/14767058.2021.1937107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Increased body mass index (BMI) is an independent risk factor for stillbirth. The purpose of this study was to determine an optimal time of delivery at term in obese women in order to decrease the risk of stillbirth in this population. METHODS We conducted a retrospective population-based cohort study using the CDC's Period Linked Birth-Infant Death and Fetal Death data. The study population included all singleton, term births with a recorded pre-pregnancy BMI that occurred between 2014 and 2017. Unconditional logistic regression analyses were used to estimate the risk of stillbirth in each BMI class at each gestational week from 37 weeks and onwards comparing with births to normal-weight women at 41 weeks. RESULTS Of 12,742,980 births in our cohort, 46.8% were to women with a normal BMI, 26.9% were to women who were classified as overweight, 14.5% were to women in obesity class I, 7.3% in obesity class II, and 4.8% in obesity class III. Within each BMI class, the risk of stillbirth increased with gestational age, with the most pronounced rises in risk occurring at later gestational ages. In a dose-response relationship, the risk of stillbirth exceeded that of a normal BMI pregnancy at 41 weeks at the following gestational age and BMI category: obese class 1 at 39 weeks (OR 1.15 95% CI 1.00-1.31), obese class II at 38 weeks (OR 1.21 95% CI 1.04-1.41) and obese class III at 37 weeks (OR 1.30 95% CI 1.11-1.52). CONCLUSION Compared to women with a normal BMI at 41 weeks, there was a higher risk of stillbirth at term in women with each increase in BMI class. Consideration should be given to early induction among these women to reduce the risk of stillbirth.
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Affiliation(s)
- Alexa Eberle
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Canada
| | | | - Haim Arie Abenhaim
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Canada.,Department of Obstetrics & Gynecology, Jewish General Hospital, McGill University, Montreal, Canada
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22
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Åmark H, Pilo C, Hulthén Varli I. Stillbirth in term and late term gestations in Stockholm during a 20-year period, incidence and causes. PLoS One 2021; 16:e0251965. [PMID: 34033674 PMCID: PMC8148351 DOI: 10.1371/journal.pone.0251965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/06/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction The incidence of stillbirth has decreased marginally or remained stable during the past decades in high income countries. A recent report has shown Stockholm to have a lower incidence of stillbirth at term than other parts of Sweden. The risk of antepartum stillbirth increases in late term and postterm pregnancies which is one of the factors contributing to the current discussion regarding the optimal time of induction of labor due to postterm pregnancy. Material and methods This is a cohort study based on the Stockholm Stillbirth Database which contains all cases of stillbirth from 1998-2018 in Stockholm County. All cases were reviewed systematically and the cause of death was evaluated according to the Stockholm Stillbirth Classification. Stillbirths diagnosed between gestational week (GW) 37+0 and 40+6 n = 605 were compared to stillbirths diagnosed from GW 41+0 and onwards n = 157, according to the cause of stillbirth and pregnancy and maternal characteristics. The aim was to evaluate the incidence of stillbirth over time and the incidence of stillbirth diagnosed from GW 41+0. Results In Stockholm County the overall incidence of stillbirth has decreased from 4.6/1000 births during the period 1998-2004 to 3.4/1000 births during the period 2014-2018, p-value <0.001. When comparing the same time periods, the incidence of stillbirth diagnosed from GW 41+0 and onwards has decreased from 0.5/1000 births to 0.15/1000 births, p-value <0.001. Among women still pregnant at GW 41+0 the incidence of stillbirth has decreased from 1.8/ 1000 to 0.5/ 1000. When comparing stillbirths diagnosed at GW 37+0-40+6 with stillbirths diagnosed from GW 41+0 and onwards infection was a more common cause of stillbirth in the latter group. Conclusion In Stockholm County there was a decreasing incidence of stillbirth overall and in stillbirths diagnosed from 41+0 weeks of gestation and onwards during the period 1998-2018. In stillbirths diagnosed from GW 41+0 and onwards infection was a more common cause of death compared to stillbirths diagnosed between GW 37+0 and 40+6.
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Affiliation(s)
- Hanna Åmark
- Department of Clinical Science and Education, Unit of Obstetrics and Gynecology, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
- * E-mail:
| | - Christina Pilo
- Department of Obstetrics and Gynecology, Södertälje Hospital, Stockholm, Sweden
| | - Ingela Hulthén Varli
- Department of Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden
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23
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Cause-Specific Stillbirth and Neonatal Death According to Prepregnancy Obesity and Early Gestational Weight Gain: A Study in the Danish National Birth Cohort. Nutrients 2021; 13:nu13051676. [PMID: 34063336 PMCID: PMC8156544 DOI: 10.3390/nu13051676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 12/16/2022] Open
Abstract
Maternal obesity is associated with impaired fetal and neonatal survival, but underlying mechanisms are poorly understood. We examined how prepregnancy BMI and early gestational weight gain (GWG) were associated with cause-specific stillbirth and neonatal death. In 85,822 pregnancies in the Danish National Birth Cohort (1996–2002), we identified causes of death from medical records for 272 late stillbirths and 228 neonatal deaths. Prepregnancy BMI and early GWG derived from an early pregnancy interview and Cox regression were used to estimate associations with stillbirth or neonatal death as a combined outcome and nine specific cause-of-death categories. Compared to women with normal weight, risk of stillbirth or neonatal death was increased by 66% with overweight and 78% with obesity. Especially deaths due to placental dysfunction, umbilical cord complications, intrapartum events, and infections were increased in women with obesity. More stillbirths and neonatal deaths were observed in women with BMI < 25 and low GWG. Additionally, unexplained intrauterine death was increased with low GWG, while more early stillbirths were seen with both low and high GWG. In conclusion, causes of death that relate to vascular and metabolic disturbances were increased in women with obesity. Low early GWG in women of normal weight deserves more clinical attention.
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24
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Åmark H, Westgren M, Sirotkina M, Hulthén Varli I, Persson M, Papadogiannakis N. Maternal obesity and stillbirth at term; placental pathology-A case control study. PLoS One 2021; 16:e0250983. [PMID: 33930082 PMCID: PMC8087010 DOI: 10.1371/journal.pone.0250983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/16/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim was to explore the potential role of the placenta for the risk of stillbirth at term in pregnancies of obese women. METHODS This was a case-control study comparing placental findings from term stillbirths with placental findings from live born infants. Cases were singleton term stillbirths to normal weight or obese women, identified in the Stockholm stillbirth database, n = 264 and n = 87, respectively. Controls were term singletons born alive to normal weight or obese women, delivered between 2002-2005 and between 2018-2019. Placentas were compared between women with stillborn and live-born infants, using logistic regression analyses. RESULTS A long and hyper coiled cord, cord thrombosis and velamentous cord insertion were stronger risk factors for stillbirth in obese women compared to normal weight women. When these variables were adjusted for in the logistic regression analysis, also adjusted for potential confounders, the odds ratio for stillbirth in obese women decreased from 1.89 (CI 1.24-2.89) to 1.63 (CI 1.04-2.56). CONCLUSION Approximately one fourth of the effect of obesity on the risk of stillbirth in term pregnancies is explained by umbilical cord associated pathology.
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Affiliation(s)
- Hanna Åmark
- Dept of Clinical Science and Education, Unit of Obstetrics and Gynecology, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
- * E-mail:
| | - Magnus Westgren
- Dept of Clinical Sciences, Intervention & Technology, Karolinska Institute, Stockholm, Sweden
| | - Meeli Sirotkina
- Dep of Laboratory Medicine, Karolinska University Hospital Huddinge, Huddinge, Sweden
| | - Ingela Hulthén Varli
- Department of Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden
| | - Martina Persson
- Dep of Medicine, Clinical Epidemiology Unit, Karolinska University Hospital, Stockholm, Sweden
- Dept of Clinical Science and Education, Unit of Pediatrics, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
| | - Nikos Papadogiannakis
- Dep of Laboratory Medicine, Karolinska University Hospital Huddinge, Huddinge, Sweden
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25
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DiTosto JD, Liu C, Wall-Wieler E, Gibbs RS, Girsen AI, El-Sayed YY, Butwick AJ, Carmichael SL. Risk factors for postpartum readmission among women after having a stillbirth. Am J Obstet Gynecol MFM 2021; 3:100345. [PMID: 33705999 DOI: 10.1016/j.ajogmf.2021.100345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/17/2021] [Accepted: 03/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Compared to women with a live birth, women with a stillbirth are more likely to have maternal complications during pregnancy and at birth, but risk factors related to their postpartum health are uncertain. OBJECTIVE This study aimed to identify patient-level risk factors for postpartum hospital readmission among women after having a stillbirth. STUDY DESIGN This was a population-based cohort study of 29,654 women with a stillbirth in California from 1997 to 2011. Using logistic regression models, we examined the association of maternal patient-level factors with postpartum readmission among women after a stillbirth within 6 weeks of hospital discharge and between 6 weeks and 9 months after delivery. RESULTS Within 6 weeks after a stillbirth, 642 women (2.2%) had a postpartum readmission. Risk factors for postpartum readmission after a stillbirth were severe maternal morbidity excluding transfusion (adjusted odds ratio, 3.02; 95% confidence interval, 2.28-4.00), transfusion at delivery but no other indication of severe maternal morbidity (adjusted odds ratio, 1.95; 95% confidence interval, 1.35-2.81), gestational hypertension or preeclampsia (adjusted odds ratio, 1.93; 95% confidence interval, 1.54-2.42), prepregnancy hypertension (adjusted odds ratio, 1.80; 95% confidence interval, 1.36-2.37), diabetes mellitus (adjusted odds ratio, 1.78; 95% confidence interval, 1.33-2.37), antenatal hospitalization (adjusted odds ratio, 1.78; 95% confidence interval, 1.43-2.21), cesarean delivery (adjusted odds ratio, 1.73; 95% confidence interval, 1.43-2.21), long length of stay in the hospital after delivery (>2 days for vaginal delivery and >4 days for cesarean delivery) (adjusted odds ratio, 1.59; 95% confidence interval, 1.33-1.89), non-Hispanic black race and ethnicity (adjusted odds ratio, 1.38; 95% confidence interval, 1.08-1.76), and having less than a high school education (adjusted odds ratio, 1.35; 95% confidence interval, 1.02-1.80). From 6 weeks to 9 months, 1169 women (3.90%) had a postpartum readmission; significantly associated risk factors were largely similar to those for earlier readmission. CONCLUSION Women with comorbidities, with birth-related complications, of non-Hispanic black race and ethnicity, or with less education had increased odds of postpartum readmission after having a stillbirth, highlighting the importance of continued care for these women after discharge from the hospital.
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Affiliation(s)
- Julia D DiTosto
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Ms DiTosto and Drs Gibbs, Girsen, and El-Sayed)
| | - Can Liu
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden (Dr Liu); Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA (Drs Liu, Wall-Wieler, and Carmichael)
| | - Elizabeth Wall-Wieler
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA (Drs Liu, Wall-Wieler, and Carmichael)
| | - Ronald S Gibbs
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Ms DiTosto and Drs Gibbs, Girsen, and El-Sayed)
| | - Anna I Girsen
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Ms DiTosto and Drs Gibbs, Girsen, and El-Sayed)
| | - Yasser Y El-Sayed
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Ms DiTosto and Drs Gibbs, Girsen, and El-Sayed)
| | - Alexander J Butwick
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA (Dr Butwick)
| | - Suzan L Carmichael
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA (Drs Liu, Wall-Wieler, and Carmichael).
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26
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Obesity and the risk of stillbirth - A reappraisal - A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2020; 255:25-28. [PMID: 33069010 DOI: 10.1016/j.ejogrb.2020.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Studies have noted an inconsistent risk of stillbirth in women with high BMI. There are no reports on obese women specifically selected without any pre-existing or current medical or obstetric conditions. We aimed to document the risk of stillbirth, specifically in this group of women. METHODS A retrospective cohort study of 182,362 singleton pregnancies at gestation ≥28 weeks in Queensland, Australia between 2008 and 2016 with no pre-existing or current medical or obstetric conditions. RESULTS We found no significant association on rates of stillbirth with increasing BMI ; odds ratios for stillbirth were 1.10, 95% CI; 0.90, 1.36 in overweight and 1.09, 95% CI; 0.87-1.37 in obese women compared to women with normal BMI. There was increasing trend in stillbirth from 37 weeks and more specifically after 40 weeks with increasing BMI. Independent of BMI, there was a statistically significant increased risk of stillbirth for women with poor antenatal care and current smokers. CONCLUSIONS There is no firm evidence for an effect of BMI on stillbirth at ≥28 weeks gestation among women with uneventful pregnancies. Our care should focus on surveillance for early detection and monitoring of co-morbidities associated with obesity with consideration to birthing prior to 40 weeks gestation.
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Maxwell C, Gaudet L, Cassir G, Nowik C, McLeod NL, Jacob CÉ, Walker M. Guideline No. 391-Pregnancy and Maternal Obesity Part 1: Pre-conception and Prenatal Care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 41:1623-1640. [PMID: 31640864 DOI: 10.1016/j.jogc.2019.03.026] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This guideline will review key aspects in the pregnancy care of women with obesity. Part I will focus on pre-conception and pregnancy care. Part II will focus on team planning for delivery and Postpartum Care. INTENDED USERS All health care providers (obstetricians, family doctors, midwives, nurses, anaesthesiologists) who provide pregnancy-related care to women with obesity. TARGET POPULATION Women with obesity who are pregnant or planning pregnancies. EVIDENCE Literature was retrieved through searches of Statistics Canada, Medline, and The Cochrane Library on the impact of obesity in pregnancy on antepartum and intrapartum care, maternal morbidity and mortality, obstetrical anaesthesia, and perinatal morbidity and mortality. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to September 2018. Grey (unpublished) literature was identified through searching the websites of health technology assessment and related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALIDATION METHODS The content and recommendations were drafted and agreed upon by the authors. Then the Maternal-Fetal Medicine Committee peer reviewed the content and submitted comments for consideration, and the Board of the Society of Obstetricians and Gynaecologists of Canada (SOGC) approved the final draft for publication. Areas of disagreement were discussed during meetings, at which time consensus was reached. The level of evidence and quality of the recommendation made were described using the Evaluation of Evidence criteria of the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS Implementation of the recommendations in these guidelines may increase obstetrical provider recognition of the issues affected pregnant individuals with obesity, including clinical prevention strategies, communication between the health care team, the patient and family as well as equipment and human resource planning. It is hoped that regional, provincial and federal agencies will assist in the education and support of coordinated care for pregnant individuals with obesity. GUIDELINE UPDATE SOGC guidelines will be automatically reviewed 5 years after publication. However, authors can propose another review date if they feel that 5 years is too short/long based on their expert knowledge of the subject matter. SPONSORS This guideline was developed with resources funded by the SOGC. SUMMARY STATEMENTS RECOMMENDATIONS.
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Yu YH, Bodnar LM, Himes KP, Brooks MM, Naimi AI. Association of Overweight and Obesity Development Between Pregnancies With Stillbirth and Infant Mortality in a Cohort of Multiparous Women. Obstet Gynecol 2020; 135:634-643. [PMID: 32028483 PMCID: PMC7147965 DOI: 10.1097/aog.0000000000003677] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To identify the association of newly developed prepregnancy overweight and obesity with stillbirth and infant mortality. METHODS We studied subsequent pregnancies of mothers who were normal weight at fertilization of their first identified pregnancy, from a population-based cohort that linked birth registry with death records in Pennsylvania, 2003-2013. Women with newly developed prepregnancy overweight and obesity were defined as those whose body mass index (BMI) before second pregnancy was between 25 and 29.9 or 30 or higher, respectively. Our main outcomes of interest were stillbirth (intrauterine death at 20 weeks of gestation or greater), infant mortality (less than 365 days after birth), neonatal death (less than 28 days after birth) and postneonatal death (29-365 days after birth). Associations of both prepregnancy BMI categories and continuous BMI with each outcome were estimated by nonparametric targeted minimum loss-based estimation and inverse-probability weighted dose-response curves, respectively, adjusting for race-ethnicity, smoking, and other confounders (eg, age, education). RESULTS A cohort of 212,889 women were included for infant mortality analysis (192,941 women for stillbirth analysis). The crude rate of stillbirth and infant mortality in these final analytic cohorts were 3.3 per 1,000 pregnancies and 2.9 per 1,000 live births, respectively. Compared with women who stayed at a normal weight in their second pregnancies, those becoming overweight had 1.4 (95% CI 0.6-2.1) excess stillbirths per 1,000 pregnancies. Those becoming obese had 3.6 (95% CI 1.3-5.9) excess stillbirths per 1,000 pregnancies and 2.4 (95% CI 0.4-4.4) excess neonatal deaths per 1,000 live births. There was a dose-response relationship between prepregnancy BMI increases of more than 2 units and increased risk of stillbirth and infant mortality. In addition, BMI increases were associated with higher risks of infant mortality among women with shorter interpregnancy intervals (less than 18 months) compared with longer intervals. CONCLUSION Transitioning from normal weight to overweight or obese between pregnancies was associated with an increased risk of stillbirth and neonatal mortality.
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Affiliation(s)
- Ya-Hui Yu
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh
| | - Lisa M. Bodnar
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh
- Magee-Womens Research Institute, Pittsburgh, PA
| | - Katherine P. Himes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh
- Magee-Womens Research Institute, Pittsburgh, PA
| | - Maria M. Brooks
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh
| | - Ashley I. Naimi
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh
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Bradford B, Cronin R, McKinlay C, Thompson J, McCowan L. Maternally perceived fetal movement patterns: The influence of body mass index. Early Hum Dev 2019; 140:104922. [PMID: 31739267 DOI: 10.1016/j.earlhumdev.2019.104922] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/06/2019] [Accepted: 10/26/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Maternal reports of decreased fetal movements are associated with adverse pregnancy outcome, but there are conflicting data about perception of fetal movements in women with obesity. AIM To compare perceived fetal movements in women with obesity (body mass index [BMI] ≥30 kg/m2) and women with normal BMI (<25 kg/m2). MATERIAL AND METHODS Data from two separate pregnancy studies were used for this analysis; the Healthy Mums and Babies (HUMBA) trial, which recruited women with obesity and the Multicentre Stillbirth Study (MCSS), which recruited women from a general obstetric population. Fetal movement data were collected using identical interviewer-administered questionnaire in each study. We compared fetal movement strength, frequency and pattern between HUMBA and MCSS women with obesity and MCSS women with normal BMI. RESULTS Participants were 233 women with obesity and 149 with normal BMI. Mean (SD) gestation at interview was similar between groups (36.9 [2.2] vs 36.6 [0.9], P = 0.06). Perceived fetal movement strength and frequency did not differ between groups. In both women with obesity and normal BMI, a diurnal fetal movement pattern was present, with the majority reporting strong or moderate movements in the evening (88.7% vs 99.3%) and at night-time (92.1% vs 93.1%). Women with obesity, were more likely to report strong fetal movements when hungry (29.1% vs 17.7%, P = 0.001) and quiet fetal movements after eating (47.4% vs 32.0%, P = 0.001). CONCLUSIONS In women with obesity compared to normal BMI, strength and frequency of fetal movements were similar, although patterns were altered in relation to maternal meals.
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Affiliation(s)
- Billie Bradford
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Robin Cronin
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Christopher McKinlay
- Liggins Institute, University of Auckland, Auckland, New Zealand; Kids First Neonatal Care, Counties Manukau Health, Auckland, New Zealand
| | - John Thompson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lesley McCowan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Maxwell C, Gaudet L, Cassir G, Nowik C, McLeod NL, Jacob CÉ, Walker M. Directive clinique N o 391 - Grossesse et obésité maternelle Partie 1 : Préconception et soins prénataux. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1641-1659. [PMID: 31640865 DOI: 10.1016/j.jogc.2019.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stubert J, Reister F, Hartmann S, Janni W. The Risks Associated With Obesity in Pregnancy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:276-283. [PMID: 29739495 DOI: 10.3238/arztebl.2018.0276] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 06/20/2017] [Accepted: 02/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Approximately one-third of all women of childbearing age are overweight or obese. For these women, pregnancy is associated with increased risks for both mother and child. METHODS This review is based on pertinent publications retrieved by a selective search of PubMed, with special attention to current population-based cohort studies, systematic reviews, meta-analyses, and controlled trials. RESULTS Obesity in pregnancy is associated with unfavorable clinical outcomes for both mother and child. Many of the risks have been found to depend linearly on the body-mass index (BMI). The probability of conception declines linearly, starting from a BMI of 29 kg/m2, by 4% for each additional 1 kg/m2 of BMI (hazard ratio 0.96, 95% confidence interval: [0.91; 0.99]). A 10% increase of pregravid BMI increases the relative risk of gestational diabetes and that of preeclampsia by approximately 10% each. A 5 kg/m2 increase of BMI elevates the relative risk of intrauterine death to 1.24 [1.18; 1.30]. An estimated 11% of all neonatal deaths can be attributed to the consequences of maternal overweight and obesity. Nonetheless, in most randomized controlled trials, nutritional and lifestyle interventions did not bring about any clinically relevant reduction in the incidence of gestational diabetes and fetal macrosomia. CONCLUSION The risks associated with obesity in pregnancy cannot necessarily be influenced by intervention. Preventive measures aimed at normalizing body weight before a woman becomes pregnant are, therefore, all the more important.
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Affiliation(s)
- Johannes Stubert
- Department of Gynecology and Obstetrics, Rostock University Medical Center, Rostock, Germany; Department of Gynecology and Obstetrics, Ulm University Medical Center, Ulm, Germany
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Smith SN, Thorp L, Karreman E, Adanlawo A. Review of Stillbirth in a Canadian Tertiary Care Centre. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 42:126-130. [PMID: 31358368 DOI: 10.1016/j.jogc.2019.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Because literature on stillbirth in Canada and its related factors is scarce, the objective of this study was to determine the causes of stillbirth in a Canadian tertiary care centre and to identify the risk factors present in these deliveries. METHODS The charts of 180 stillbirth deliveries with a gestational age greater than or equal to 20 weeks or a birth weight greater than or equal to 500 g between 2011 and 2016 were reviewed. Information collected from maternal charts included maternal demographics, known risk factors for stillbirth during pregnancy, delivery parameters, and pathologic examination (Canadian Task Force Classification III). RESULTS The autopsy rate was 42.5%, placental pathology rate was 100%, and karyotype was completed in 20.2% of the reviewed cases. Often, the cause of stillbirth was unexplained (43.2%). The most common causes were preterm birth (9.8%) and abruption (9.3%). The most common risk factors in this population were maternal obesity (37.6%), late prenatal care (35.0%), and maternal smoking (22.4%). CONCLUSION Most stillbirths were unexplained in this Canadian tertiary care centre, and the rates of autopsy and karyotype were low. Identified risk factors present in this population may contribute to the significantly higher rate of stillbirth in this centre compared with the provincial rate.
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Affiliation(s)
- Sarah Naden Smith
- Department of Obstetrics and Gynecology, University of Saskatchewan, Regina, SK.
| | - Leah Thorp
- Perinatal Outreach Education, Saskatchewan Health Authority, Regina, SK
| | - Erwin Karreman
- Research and Performance Support, Saskatchewan Health Authority, Regina, SK
| | - Adewumi Adanlawo
- Department of Obstetrics and Gynecology, Saskatchewan Health Authority, Regina, SK
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Browne K, Park BY, Goetzinger KR, Caughey AB, Yao R. The joint effects of obesity and pregestational diabetes on the risk of stillbirth. J Matern Fetal Neonatal Med 2019; 34:332-338. [DOI: 10.1080/14767058.2019.1607287] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Kathleen Browne
- Department of Obstetrics and Gynecology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bo Y. Park
- Department of Public Health, California State University, Fullerton, Fullerton, CA, USA
| | - Katherine R. Goetzinger
- Department of Obstetrics and Gynecology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Aaron B. Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Sciences University, Portland, OR, USA
| | - Ruofan Yao
- Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA, USA
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Akgun N, Keskin HL, Ustuner I, Pekcan G, Avsar AF. Factors affecting pregnancy weight gain and relationships with maternal/fetal outcomes in Turkey. Saudi Med J 2018; 38:503-508. [PMID: 28439600 PMCID: PMC5447211 DOI: 10.15537/smj.2017.5.19378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives: To determine the effects of pre-pregnancy body mass index (BMI) and gestational weight gain on maternal and fetal complications, and to examine whether Turkish women achieve the recommended gestational weight gain. We also investigated the relationship between pregnancy weight gain and mode of delivery, with an examination of maternal anthropometry. Methods: A retrospective cross-sectional study was conducted on a population of 986 pregnant women between November 2011 and November 2015 at Atatürk Education and Research Hospital, Ankara, Turkey. Maternal age, BMI, monthly weight gain during pregnancy, infant birth weight, gender, and maternal and fetal adverse outcomes were evaluated. Results: The frequency of maternal complications was positively associated with elevated pre-pregnancy BMI (p<0.05), and weight gain during pregnancy was associated with parity and increased infant birth weight (p<0.05). However, no correlations were observed between mean pregnancy weight gain and maternal complications (p>0.05). The percentage of women who gained the Institute of Medicine (IOM)-recommended amount of weight was the highest in the underweight BMI group (54.1%) and the lowest in the obese BMI group (24.3%). Pregnancy weight gain exceeded IOM recommendations in the overweight (56.3%) and obese (52.5%) groups. Conclusions: While maternal weight gain during pregnancy affects neonatal body weight, higher pre-pregnancy BMI has an adverse effect on recommended weight gain during pregnancy, with increased maternal complications.
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Affiliation(s)
- Nilufer Akgun
- Department of Gynecology and Obstetrics, Atatürk Education and Research Hospital, Ankara, Turkey. E-mail.
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Spann RA, Lawson WJ, Bidwell GL, Zamarripa CA, Maranon RO, Bandyopadhyay S, Taylor ER, Reckelhoff JF, Garrett MR, Grayson BE. Rodent vertical sleeve gastrectomy alters maternal immune health and fetoplacental development. Clin Sci (Lond) 2018; 132:295-312. [PMID: 29167317 PMCID: PMC5989318 DOI: 10.1042/cs20171416] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/10/2017] [Accepted: 11/21/2017] [Indexed: 12/23/2022]
Abstract
Bariatric surgery is increasingly employed to improve fertility and reduce obesity-related co-morbidities in obese women. Surgical weight loss not only improves the chance of conception but reduces the risk of pregnancy complications including pre-eclampsia, gestational diabetes, and macrosomia. However, bariatric procedures increase the incidence of intrauterine growth restriction (IUGR), fetal demise, thromboembolism, and other gestational disorders. Using our rodent model of vertical sleeve gastrectomy (VSG), we tested the hypothesis that VSG in diet-induced, obese dams would cause immune and placental structural abnormalities that may be responsible for fetal demise during pregnancy. VSG dams studied on gestational day (G) 19 had reduced circulating T-cell (CD3+ and CD8+) populations compared with lean or obese controls. Further, local interleukin (IL) 1β and IL 1 receptor antagonist (il1rn) cmRNA were increased in placenta of VSG dams. Placental barrier function was also affected, with increased transplacental permeability to small molecules, increased matrix metalloproteinase 9 expression, and increased apoptosis in VSG. Furthermore, we identified increased placental mTOR signaling that may contribute to preserving the body weight of the fetuses during gestation. These changes occurred in the absence of a macronutrient deficit or gestational hypertension in the VSG dams. In summary, previous VSG in dams may contribute to fetal demise by affecting maternal immune system activity and compromise placental integrity.
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Affiliation(s)
- Redin A Spann
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - William J Lawson
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - Gene L Bidwell
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - C Austin Zamarripa
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - Rodrigo O Maranon
- Department of Nephrology, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
- Women's Health Research Center, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - Sibali Bandyopadhyay
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - Erin R Taylor
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - Jane F Reckelhoff
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
- Women's Health Research Center, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - Michael R Garrett
- Department of Pharmacology, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A.
- Women's Health Research Center, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
- Mississippi Center for Obesity Research, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - Bernadette E Grayson
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A.
- Women's Health Research Center, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
- Mississippi Center for Obesity Research, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
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Johansson K, Hutcheon JA, Bodnar LM, Cnattingius S, Stephansson O. Pregnancy weight gain by gestational age and stillbirth: a population-based cohort study. BJOG 2017; 125:973-981. [PMID: 29160923 PMCID: PMC6032856 DOI: 10.1111/1471-0528.15034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 11/30/2022]
Abstract
Objective To study the association between total and early pregnancy (<22 completed weeks) weight gain and risk of stillbirth, stratified by early‐pregnancy body mass index (BMI). Design Population‐based cohort study. Setting Stockholm‐Gotland Region, Sweden. Population Pregnant women with singleton births (n = 160 560). Methods Pregnancy weight gain was standardised into gestational age‐specific z‐scores. For analyses of total pregnancy weight gain, a matched design with an incidence density sampling approach was used. Findings were also contrasted with current Institute of Medicine (IOM) weight gain recommendations. Main outcome measures Stillbirth defined as fetal death at ≥22 completed weeks of gestation. Results For all BMI categories, there was no statistical association between total or early pregnancy weight gain and stillbirth within the range of a weight gain z‐score of −2.0 SD to +2.0 SD. Among normal‐weight women, the adjusted odds ratio of stillbirth for lower (−2.0 to −1.0 SD) and higher (+1.0 to +1.9 SD) total weight gain was 0.85 (95% CI; 0.48–1.49) and 1.03 (0.60–1.77), respectively, as compared with the reference category. Further, there were no associations between total or early pregnancy weight gain and stillbirth within the range of weight gain currently recommended by the IOM. For the majority of the BMI categories, the point estimates at the extremes of weight gain values (<−2.0SD and ≥2.0 SD) suggested protective effects of low weight gain and increased risks of high weight gain, but estimates were imprecise and not statistically significant. Conclusion We found no associations between total or early pregnancy weight gain and stillbirth across the range of weight gain experienced by most women. Tweetable abstract There was no association between weight gain during pregnancy and stillbirth among most women. Tweetable abstract There was no association between weight gain during pregnancy and stillbirth among most women.
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Affiliation(s)
- K Johansson
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - J A Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - L M Bodnar
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - S Cnattingius
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - O Stephansson
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.,Division of Obstetrics and Gynaecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Chaiworapongsa T, Romero R, Erez O, Tarca AL, Conde-Agudelo A, Chaemsaithong P, Kim CJ, Kim YM, Kim JS, Yoon BH, Hassan SS, Yeo L, Korzeniewski SJ. The prediction of fetal death with a simple maternal blood test at 20-24 weeks: a role for angiogenic index-1 (PlGF/sVEGFR-1 ratio). Am J Obstet Gynecol 2017; 217:682.e1-682.e13. [PMID: 29037482 PMCID: PMC5951183 DOI: 10.1016/j.ajog.2017.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/29/2017] [Accepted: 10/01/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fetal death is an obstetrical syndrome that annually affects 2.4 to 3 million pregnancies worldwide, including more than 20,000 in the United States each year. Currently, there is no test available to identify patients at risk for this pregnancy complication. OBJECTIVE We sought to determine if maternal plasma concentrations of angiogenic and antiangiogenic factors measured at 24-28 weeks of gestation can predict subsequent fetal death. STUDY DESIGN A case-cohort study was designed to include 1000 randomly selected subjects and all remaining fetal deaths (cases) from a cohort of 4006 women with a singleton pregnancy, enrolled at 6-22 weeks of gestation, in a pregnancy biomarker cohort study. The placentas of all fetal deaths were histologically examined by pathologists who used a standardized protocol and were blinded to patient outcomes. Placental growth factor, soluble endoglin, and soluble vascular endothelial growth factor receptor-1 concentrations were measured by enzyme-linked immunosorbent assays. Quantiles of the analyte concentrations (or concentration ratios) were estimated as a function of gestational age among women who delivered a live neonate but did not develop preeclampsia or deliver a small-for-gestational-age newborn. A positive test was defined as analyte concentrations (or ratios) <2.5th and 10th centiles (placental growth factor, placental growth factor/soluble vascular endothelial growth factor receptor-1 [angiogenic index-1] and placental growth factor/soluble endoglin) or >90th and 97.5th centiles (soluble vascular endothelial growth factor receptor-1 and soluble endoglin). Inverse probability weighting was used to reflect the parent cohort when estimating the relative risk. RESULTS There were 11 fetal deaths and 829 controls with samples available for analysis between 24-28 weeks of gestation. Three fetal deaths occurred <28 weeks and 8 occurred ≥28 weeks of gestation. The rate of placental lesions consistent with maternal vascular underperfusion was 33.3% (1/3) among those who had a fetal death <28 weeks and 87.5% (7/8) of those who had this complication ≥28 weeks of gestation. The maternal plasma angiogenic index-1 value was <10th centile in 63.6% (7/11) of the fetal death group and in 11.1% (92/829) of the controls. The angiogenic index-1 value was <2.5th centile in 54.5% (6/11) of the fetal death group and in 3.7% (31/829) of the controls. An angiogenic index-1 value <2.5th centile had the largest positive likelihood ratio for predicting fetal death >24 weeks (14.6; 95% confidence interval, 7.7-27.7) and a relative risk of 29.1 (95% confidence interval, 8.8-97.1), followed by soluble endoglin >97.5th centile and placental growth factor/soluble endoglin <2.5th, both with a positive likelihood ratio of 13.7 (95% confidence interval, 7.3-25.8) and a relative risk of 27.4 (95% confidence interval, 8.2-91.2). Among women without a fetal death whose plasma angiogenic index-1 concentration ratio was <2.5th centile, 61% (19/31) developed preeclampsia or delivered a small-for-gestational-age neonate; when the 10th centile was used as the cut-off, 37% (34/92) of women had these adverse outcomes. CONCLUSION (1) A maternal plasma angiogenic index-1 value <2.5th centile (0.126) at 24-28 weeks of gestation carries a 29-fold increase in the risk of subsequent fetal death and identifies 55% of subsequent fetal deaths with a false-positive rate of 3.5%; and (2) 61% of women who have a false-positive test result will subsequently experience adverse pregnancy outcomes.
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Affiliation(s)
- Tinnakorn Chaiworapongsa
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Roberto Romero
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI.
| | - Offer Erez
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Adi L Tarca
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Agustin Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI
| | - Piya Chaemsaithong
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Chong Jai Kim
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yeon Mee Kim
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jung-Sun Kim
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Bo Hyun Yoon
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sonia S Hassan
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Lami Yeo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Steven J Korzeniewski
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI
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Bradford BF, Thompson JMD, Heazell AEP, Mccowan LME, McKinlay CJD. Understanding the associations and significance of fetal movements in overweight or obese pregnant women: a systematic review. Acta Obstet Gynecol Scand 2017; 97:13-24. [PMID: 29068467 DOI: 10.1111/aogs.13250] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/18/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Presentation with decreased fetal movement (DFM) is associated with fetal growth restriction and stillbirth. Some studies report that DFM is frequent among overweight or obese mothers. We aimed to determine the significance and associations of fetal movements in women of increased body size. MATERIAL AND METHODS This systematic review was conducted in accordance with the PRISMA statement and the protocol was registered with PROSPERO (CRD42016046352). Major databases were explored from inception to September 2017, using a predefined search strategy. We restricted inclusion to studies published in English and considered studies of any design that compared fetal movements in women of increased and normal body size. Two authors independently extracted data and assessed quality. RESULTS We included 23 publications from 19 observational studies; data were extracted from 10 studies. Increased maternal body size was not associated with altered perception of fetal movement (four studies, 95 women, very low-quality evidence), but was associated with increased presentation for DFM (two cohort studies, 20 588 women, OR 1.56, 95% CI 1.27-1.92: three case-control studies, 3445 women, OR 1.32, 95% CI 1.12-1.54; low-quality evidence). Among women with DFM, increased maternal body size was associated with increased risk of stillbirth and fetal growth restriction (one study, 2168 women, very low-quality evidence). CONCLUSIONS This systematic review identified limited evidence that women with increased body size are more likely to present with DFM but do not have impaired perception of fetal movements. In women with DFM, increased body size is associated with worse pregnancy outcome, including stillbirth.
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Affiliation(s)
- Billie F Bradford
- Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - John M D Thompson
- Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Pediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Alexander E P Heazell
- Maternal and Fetal Health Research Center, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester Academic Health Science Center, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Lesley M E Mccowan
- Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Chris J D McKinlay
- Department of Pediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand.,Kidz First Neonatal Care, Counties Manukau Health, Auckland, New Zealand
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Chang MW, Brown R, Nitzke S. Fast Food Intake in Relation to Employment Status, Stress, Depression, and Dietary Behaviors in Low-Income Overweight and Obese Pregnant Women. Matern Child Health J 2017; 20:1506-17. [PMID: 26973147 DOI: 10.1007/s10995-016-1949-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective This study explored fast food intake as a potential mediator of the relationships among employment status; stress; depression; and fruit, vegetable, and fat intakes by race (African American vs. Non-Hispanic White) and body mass index (BMI category: overweight vs. obesity). Methods Low-income overweight and obese pregnant women (N = 332) were recruited from the Special Supplemental Nutrition Program for Women, Infants and Children in Michigan. Path analysis was performed to explore mediation effects by race and BMI category. Results Fast food intake mediated the relationship between employment status and fat intake (p = 0.02) in Non-Hispanic White women, but no mediation effect was detected in African American women. For overweight women, fast food intake mediated the relationship between employment status and fat intake (p = 0.04) and the relationship between depression and vegetable intake (p = 0.01). Also, fast food intake partially mediated the relationship between depression and fat intake (p = 0.003). For obese women, fast food intake mediated the relationship between employment status and fat intake (p = 0.04). Conclusion Fast food is an important topic for nutrition education for overweight and obese pregnant women. Future interventions may be more successful if they address issues associated with employment status (e.g., lack of time to plan and cook healthy meals) and depressive mood (e.g., inability to plan meals or shop for groceries when coping with negative emotions).
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Affiliation(s)
- Mei-Wei Chang
- College of Nursing, Ohio State University, 342 Newton Hall, 1585 Neil Avenue, Columbus, OH, 43210, USA.
| | - Roger Brown
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Susan Nitzke
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
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VASCONCELOS LG, GOMES CDB, MALTA MB, DICHI I, BENÍCIO MHD, CARVALHAES MADBL. Insufficient intake of alpha-linolenic fatty acid (18:3n-3) during pregnancy and associated factors. REV NUTR 2017. [DOI: 10.1590/1678-98652017000400004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective: To analyze alpha-linolenic fatty acid intake in two cohorts of pregnant women, and to identify factors associated with alpha-linolenic acid intake. Methods: This is a cohort study involving pregnant women with low obstetric risk (N=353) in public health system from a municipality of São Paulo state, Brazil. In each trimester, two 24-hour food recalls were collected. Descriptive analyses of dietary lipid profiles were performed, followed by a multiple comparison test. According to the trimester of pregnancy, differences were assessed using the mean difference test. To evaluate the adequacy of linoleic fatty acid and alpha-linolenic acid intake, the adequate intake test was used. The association between alpha-linolenic acid intake adequacy and maternal characteristics was investigated using a binary logistic regression model. Results: Total lipids intake and the percentage contribution to dietary energy met recommended levels. One-third of the diets demonstrated a lower than daily recommended intake of alpha-linolenic acid. Overweight pregnant women were twice as likely to have inadequate alpha-linolenic acid intake. Pregnant women from a more disadvantaged socioeconomic situation had greater risks of inadequate intake. Conclusion: Over-intake of lipids is not problematic, but quality is an issue, with one third of the pregnant women and their fetuses exposed to adverse effects due to low intake of omega-3 fatty acids, indicating important nutritional vulnerability in this population.
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Maternal exposure to childhood maltreatment and risk of stillbirth. Ann Epidemiol 2017; 27:459-465.e2. [PMID: 28755869 DOI: 10.1016/j.annepidem.2017.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/30/2017] [Accepted: 07/06/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE To determine the association between maternal exposure to childhood maltreatment (CM) and risk of stillbirth (fetal death at or after 20 weeks' gestation). METHODS Population-based case-control study from the Stillbirth Collaborative Research Network (SCRN) conducted in 2006-2008, and the follow-up study, SCRN-Outcomes after Study Index Stillbirth (SCRN-OASIS), conducted in 2009 in the United States. Cases (n = 133) included women who experienced a stillbirth, excluding stillbirths attributed to genetic/structural or umbilical cord abnormalities and intrapartum stillbirths. Controls (n = 500) included women delivering a healthy term live birth (excluding births less than 37 weeks gestation, neonatal intensive care unit admission, or death). CM exposure was measured using the Childhood Trauma Questionnaire, administered during the SCRN-OASIS study. Dichotomized scores for five subscales of CM (physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse) and an overall measure of CM exposure were analyzed using logistic regression. RESULTS Generally, there was no association between CM and stillbirth, except for the emotional neglect subscale (OR: 1.93; 95% CI: 1.17, 3.19). CONCLUSIONS Childhood neglect is understudied in comparison to abuse and should be included in the future studies of associations between CM and pregnancy outcomes, including stillbirth.
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Persson M, Cnattingius S, Villamor E, Söderling J, Pasternak B, Stephansson O, Neovius M. Risk of major congenital malformations in relation to maternal overweight and obesity severity: cohort study of 1.2 million singletons. BMJ 2017; 357:j2563. [PMID: 28615173 PMCID: PMC5470075 DOI: 10.1136/bmj.j2563] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective To estimate the risks of major congenital malformations in the offspring of mothers who are underweight (body mass index (BMI) <18.5), overweight (BMI 25 to <30), or in obesity classes I (BMI 30 to <35), II (35 to <40), or III (≥40) compared with offspring of normal weight mothers (BMI 18.5 to <25) in early pregnancy.Design Population based cohort study.Setting Nationwide Swedish registries.Participants 1 243 957 liveborn singleton infants from 2001 to 2014 in Sweden. Data on maternal and pregnancy characteristics were obtained by individual record linkages.Exposure Maternal BMI at the first prenatal visit.Main outcome measures Offspring with any major congenital malformation, and subgroups of organ specific malformations diagnosed during the first year of life. Risk ratios were estimated using generalised linear models adjusted for maternal factors, sex of offspring, and birth year.Results A total of 43 550 (3.5%) offspring had any major congenital malformation, and the most common subgroup was for congenital heart defects (n=20 074; 1.6%). Compared with offspring of normal weight mothers (risk of malformations 3.4%), the proportions and adjusted risk ratios of any major congenital malformation among the offspring of mothers with higher BMI were: overweight, 3.5% and 1.05 (95% confidence interval 1.02 to 1.07); obesity class I, 3.8% and 1.12 (1.08 to 1.15), obesity class II, 4.2% and 1.23 (1.17 to 1.30), and obesity class III, 4.7% and 1.37 (1.26 to 1.49). The risks of congenital heart defects, malformations of the nervous system, and limb defects also progressively increased with BMI from overweight to obesity class III. The largest organ specific relative risks related to maternal overweight and increasing obesity were observed for malformations of the nervous system. Malformations of the genital and digestive systems were also increased in offspring of obese mothers.Conclusions Risks of any major congenital malformation and several subgroups of organ specific malformations progressively increased with maternal overweight and increasing severity of obesity. For women who are planning pregnancy, efforts should be encouraged to reduce adiposity in those with a BMI above the normal range.
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Affiliation(s)
- Martina Persson
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Department of Diabetes and Endocrinology, Sachsska Children's Hospital, Södersjukhuset, Stockholm, Sweden
| | - Sven Cnattingius
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Eduardo Villamor
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Department of Epidemiology, School of Public Health and Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Jonas Söderling
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Björn Pasternak
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Olof Stephansson
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Martin Neovius
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
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McCowan LME, Thompson JMD, Cronin RS, Li M, Stacey T, Stone PR, Lawton BA, Ekeroma AJ, Mitchell EA. Going to sleep in the supine position is a modifiable risk factor for late pregnancy stillbirth; Findings from the New Zealand multicentre stillbirth case-control study. PLoS One 2017; 12:e0179396. [PMID: 28609468 PMCID: PMC5469491 DOI: 10.1371/journal.pone.0179396] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 05/29/2017] [Indexed: 11/20/2022] Open
Abstract
Objective Our objective was to test the primary hypothesis that maternal non-left, in particular supine going-to-sleep position, would be a risk factor for late stillbirth (≥28 weeks of gestation). Methods A multicentre case-control study was conducted in seven New Zealand health regions, between February 2012 and December 2015. Cases (n = 164) were women with singleton pregnancies and late stillbirth, without congenital abnormality. Controls (n = 569) were women with on-going singleton pregnancies, randomly selected and frequency matched for health region and gestation. The primary outcome was adjusted odds of late stillbirth associated with self-reported going-to-sleep position, on the last night. The last night was the night before the late stillbirth was thought to have occurred or the night before interview for controls. Going-to-sleep position on the last night was categorised as: supine, left-side, right-side, propped or restless. Multivariable logistic regression adjusted for known confounders. Results Supine going-to-sleep position on the last night was associated with increased late stillbirth risk (adjusted odds ratios (aOR) 3.67, 95% confidence interval (CI) 1.74 to 7.78) with a population attributable risk of 9.4%. Other independent risk factors for late stillbirth (aOR, 95% CI) were: BMI (1.04, 1.01 to 1.08) per unit, maternal age ≥40 (2.88, 1.31 to 6.32), birthweight <10th customised centile (2.76, 1.59 to 4.80), and <6 hours sleep on the last night (1.81, 1.14 to 2.88). The risk associated with supine-going-to-sleep position was greater for term (aOR 10.26, 3.00 to 35.04) than preterm stillbirths (aOR 3.12, 0.97 to 10.05). Conclusions Supine going-to-sleep position is associated with a 3.7 fold increase in overall late stillbirth risk, independent of other common risk factors. A public health campaign encouraging women not to go-to-sleep supine in the third trimester has potential to reduce late stillbirth by approximately 9%.
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Affiliation(s)
- Lesley M. E. McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- * E-mail:
| | - John M. D. Thompson
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Department of Paediatrics and Child Health, University of Auckland, Auckland, New Zealand
| | - Robin S. Cronin
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Minglan Li
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Tomasina Stacey
- School of Healthcare, University of Leeds, Leeds, United Kingdom
| | - Peter R. Stone
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Beverley A. Lawton
- Women’s Health Research Centre, University of Otago, Wellington, New Zealand
| | - Alec J. Ekeroma
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Edwin A. Mitchell
- Department of Paediatrics and Child Health, University of Auckland, Auckland, New Zealand
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McDermott M. Stillbirth: a lot done… a lot more to do. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:553-555. [PMID: 27854383 DOI: 10.1002/uog.17220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- M McDermott
- Departments of Paediatric Laboratory Medicine, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
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Man J, Hutchinson JC, Ashworth M, Heazell AE, Jeffrey I, Sebire NJ. Stillbirth and intrauterine fetal death: contemporary demographic features of >1000 cases from an urban population. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:591-595. [PMID: 27781322 DOI: 10.1002/uog.16021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Of 780 000 births annually in the UK, around 3300 are stillborn, a rate of approximately 4 per 1000 births. Traditional epidemiological associations are based on historic data. The aim of this study was to document contemporary demographic findings in a large series of > 1000 deaths in utero in London and compare these with national datasets. METHODS From a dedicated database, including > 400 data fields per case, of fetal, infant and pediatric autopsies performed at Great Ormond Street Hospital and St George's Hospital, London, we extracted information on all intrauterine deaths, excluding terminations of pregnancy, from 2005 to 2013, inclusive. Demographic data were analyzed according to the gestational age at which fetal death occurred (second-trimester intrauterine fetal death (IUFD), subdivided into early (< 20 weeks) and late (20-23 weeks) IUFD, and third-trimester stillbirth (≥ 24 weeks)) and compared with national datasets when available, using Mann-Whitney U-test and comparison of proportions testing as appropriate. RESULTS Data were available from 1064 individual postmortem reports examining intrauterine deaths delivered between 12 and 43 weeks' gestation, including 425 IUFDs (246 early and 179 late) and 639 stillbirths. Compared with the overall UK pregnant population, women in whom an intrauterine death occurred were significantly older and more obese. White mothers had a higher proportion of stillbirths (as opposed to IUFDs) than did non-white mothers, whereas black mothers had a higher proportion of IUFDs relative to stillbirths. Increased body mass index was associated with increased risk across all groups. Women who had uterine fibroids, those who had a history of vaginal bleeding in early pregnancy and those who had undergone assisted conception had a relatively higher proportion of IUFDs than stillbirths. CONCLUSIONS Based on a large series of >1000 autopsies in cases of intrauterine death, these data highlight the increased risk for fetal loss associated with maternal demographic factors in contemporary clinical practice, particularly associations with increased maternal age and body mass index. Among women in whom an intrauterine death occurs, maternal ethnicity, mode of conception and gynecological history are associated with differing timing of fetal loss. Further research is required to understand the mechanisms involved in such maternal factors in order to develop preventative strategies. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J Man
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
| | - J C Hutchinson
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
| | - M Ashworth
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
| | - A E Heazell
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester, UK
| | - I Jeffrey
- Department of Histopathology, St George's Hospital, London, UK
| | - N J Sebire
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
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Heard ME, Melnyk SB, Simmen FA, Yang Y, Pabona JMP, Simmen RCM. High-Fat Diet Promotion of Endometriosis in an Immunocompetent Mouse Model is Associated With Altered Peripheral and Ectopic Lesion Redox and Inflammatory Status. Endocrinology 2016; 157:2870-82. [PMID: 27175969 PMCID: PMC4929556 DOI: 10.1210/en.2016-1092] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Endometriosis is a benign gynecological condition that causes considerable morbidity due to associated infertility, debilitating pelvic pain and inflammatory dysfunctions. Diet is a highly modifiable risk factor for many chronic diseases, but its contribution to endometriosis has not been extensively investigated, due partly to the paradoxical inverse association between obesity and disease incidence. Nevertheless, chronic exposure to dietary high-fat intake has been linked to greater systemic inflammation and oxidative stress, both features of women with endometriosis. Here, we evaluated the effects of a high-fat diet (HFD) (45% fat kcal) on endometriosis progression using an immunocompetent mouse model where ectopic lesion incidence was induced in wild-type recipients by ip administration of endometrial fragments from transcription factor Krüppel-like factor 9-null donor mice. We show that HFD significantly increased ectopic lesion numbers in recipient mice with no significant weight gain and modifications in systemic ovarian steroid hormone and insulin levels, relative to control diet-fed (17% fat kcal) mice. HFD promotion of lesion establishment was associated with reductions in stromal estrogen receptor 1 isoform and progesterone receptor expression, increased F4/80-positive macrophage infiltration, higher stromal but not glandular epithelial proliferation, and enhanced expression of proinflammatory and prooxidative stress pathway genes. Lesion-bearing HFD-fed mice also displayed higher peritoneal fluid TNFα and elevated local and systemic redox status than control diet-fed counterparts. Our results suggest that HFD intake exacerbates endometriosis outcome in the absence of ovarian dysfunction and insulin resistance in mice and warrants further consideration with respect to clinical management of endometriosis progression and recurrence in nonobese patients.
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Affiliation(s)
- Melissa E Heard
- Departments of Physiology and Biophysics (M.E.H., F.A.S., Y.Y., J.M.P.P., R.C.M.S.) and Pediatrics (S.B.M.) and Arkansas Children's Hospital Research Institute (S.B.M.), University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205; and Department of Obstetrics and Gynecology (Y.Y.), The Aerospace Central Hospital, Beijing 100049, China
| | - Stepan B Melnyk
- Departments of Physiology and Biophysics (M.E.H., F.A.S., Y.Y., J.M.P.P., R.C.M.S.) and Pediatrics (S.B.M.) and Arkansas Children's Hospital Research Institute (S.B.M.), University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205; and Department of Obstetrics and Gynecology (Y.Y.), The Aerospace Central Hospital, Beijing 100049, China
| | - Frank A Simmen
- Departments of Physiology and Biophysics (M.E.H., F.A.S., Y.Y., J.M.P.P., R.C.M.S.) and Pediatrics (S.B.M.) and Arkansas Children's Hospital Research Institute (S.B.M.), University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205; and Department of Obstetrics and Gynecology (Y.Y.), The Aerospace Central Hospital, Beijing 100049, China
| | - Yanqing Yang
- Departments of Physiology and Biophysics (M.E.H., F.A.S., Y.Y., J.M.P.P., R.C.M.S.) and Pediatrics (S.B.M.) and Arkansas Children's Hospital Research Institute (S.B.M.), University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205; and Department of Obstetrics and Gynecology (Y.Y.), The Aerospace Central Hospital, Beijing 100049, China
| | - John Mark P Pabona
- Departments of Physiology and Biophysics (M.E.H., F.A.S., Y.Y., J.M.P.P., R.C.M.S.) and Pediatrics (S.B.M.) and Arkansas Children's Hospital Research Institute (S.B.M.), University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205; and Department of Obstetrics and Gynecology (Y.Y.), The Aerospace Central Hospital, Beijing 100049, China
| | - Rosalia C M Simmen
- Departments of Physiology and Biophysics (M.E.H., F.A.S., Y.Y., J.M.P.P., R.C.M.S.) and Pediatrics (S.B.M.) and Arkansas Children's Hospital Research Institute (S.B.M.), University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205; and Department of Obstetrics and Gynecology (Y.Y.), The Aerospace Central Hospital, Beijing 100049, China
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