Maternal Overweight, Inflammation and Neurological Consequences for the Preterm Child: Results of the ELGAN Study

AbstractMaternal overweight and obesity are prenatal risk factors for obstetrical complications, preterm birth, neonatal morbidity as well as cognitive and behavioural developmental disorders in children. Paediatric morbidity and mortality as well as child development disorders are significantly associated with maternal obesity. Particularly in the neurodevelopmental and psychiatric area, it is becoming increasingly clear that, in children of mothers with an increased body mass index (BMI), there is a high correlation with childhood cognitive disabilities, attention disorders, and diseases on the autistic spectrum. The ELGAN (Extremely Low Gestational Age Newborn) study is a multicentre study which has been supported since 2000 by the National Institutes of Health (NIH) and whose objective is to research predictors for neonatal brain damage and neurological-cognitive sequelae in premature infants. The areas of focus are the connection between maternal overweight and obesity and pregnancy complications, APGAR scores and systemic inflammatory markers. In this overview, our aim is to summarise the work in this area and discuss it critically on the basis of current literature. We will examine the hypothesis whether maternal overweight and obesity in terms of a chronic inflammatory state is associated with neonatal inflammation which in turn is associated with an unfavourable development prognosis.

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Effect of maternal high body mass index on outcome of pregnancy in women with recurrent miscarriages

Indian Journal of Forensic and Community Medicine ◽

10.18231/j.ijfcm.2021.048 ◽

2021 ◽

Vol 8 (4) ◽

pp. 237-241

Author(s):

Malangori Parande ◽

Tanvi V Wagh ◽

Anjali V Wagh ◽

Nandkumar Salunke

Keyword(s):

Gestational Diabetes ◽

Preterm Delivery ◽

Maternal Obesity ◽

Tertiary Care ◽

Overweight And Obesity ◽

Care Hospital ◽

Pregnancy Induced Hypertension ◽

Recurrent Miscarriages ◽

Induced Hypertension ◽

Maternal Overweight

The epidemic of obesity is spreading worldwide and subsequently, rate of obesity during pregnancy has also increased. Maternal overweight and obesity are widely associated with adverse pregnancy outcomes. Recurrent miscarriage is an important reproductive health issue, because it affects many couples. So the present study is planned to study the relationship between maternal obesity and pregnancy outcome in women with recurrent miscarriages. Observational Cross sectional study was conducted in a tertiary care hospital. 111 Postnatal women between 18 to 44 years of age with history of two or more miscarriages less than 20 weeks of gestation in previous pregnancy were included in the study. First trimester weight at the first visit (registration) was recorded, BMI was calculated & women were divided into obese and non obese groups. The outcome of present pregnancy was noted as Mode of delivery, Gestational diabetes mellitus, Pregnancy induced hypertension, Preterm delivery etc. Statistical tests were used to quantify the risk. Gestational diabetes (OR= 13.6) and pregnancy induced hypertension (OR=4.2) were significantly associated with obesity in women with recurrent miscarriages. [At 95% CI] The incidence of LSCS and preterm delivery was more in overweight and obese mothers, though not statistically significant. Maternal obesity significantly contributes to poor prognosis for the mother and the baby during delivery. Hence the women of this group should be regarded as ‘high risk’ and counselling and the risk assessment should be done during ANC visits.

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The Impact of Maternal Obesity on Human Milk Macronutrient Composition: A Systematic Review and Meta-Analysis

Nutrients ◽

10.3390/nu12040934 ◽

2020 ◽

Vol 12 (4) ◽

pp. 934 ◽

Cited By ~ 3

Author(s):

Gabriela E. Leghi ◽

Merryn J. Netting ◽

Philippa F. Middleton ◽

Mary E. Wlodek ◽

Donna T. Geddes ◽

...

Keyword(s):

Human Milk ◽

Maternal Obesity ◽

Overweight And Obesity ◽

Cochrane Library ◽

Maternal Body Mass Index ◽

Qualitative Synthesis ◽

Lactating Women ◽

Maternal Overweight ◽

The Impact

Maternal obesity has been associated with changes in the macronutrient concentration of human milk (HM), which have the potential to promote weight gain and increase the long-term risk of obesity in the infant. This article aimed to provide a synthesis of studies evaluating the effects of maternal overweight and obesity on the concentrations of macronutrients in HM. EMBASE, MEDLINE/PubMed, Cochrane Library, Scopus, Web of Science, and ProQuest databases were searched for relevant articles. Two authors conducted screening, data extraction, and quality assessment independently. A total of 31 studies (5078 lactating women) were included in the qualitative synthesis and nine studies (872 lactating women) in the quantitative synthesis. Overall, maternal body mass index (BMI) and adiposity measurements were associated with higher HM fat and lactose concentrations at different stages of lactation, whereas protein concentration in HM did not appear to differ between overweight and/or obese and normal weight women. However, given the considerable variability in the results between studies and low quality of many of the included studies, further research is needed to establish the impact of maternal overweight and obesity on HM composition. This is particularly relevant considering potential implications of higher HM fat concentration on both growth and fat deposition during the first few months of infancy and long-term risk of obesity.

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The Impact of Maternal Obesity on Human Milk Macronutrient Composition: A Systematic Review and Meta-Analysis

Current Developments in Nutrition ◽

10.1093/cdn/nzab046_070 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 773-773

Author(s):

Gabriela Leghi ◽

Merryn J Netting ◽

Philippa F Middleton ◽

Mary E Wlodek ◽

Donna T Geddes ◽

...

Keyword(s):

Human Milk ◽

Maternal Obesity ◽

Meta Analysis ◽

Overweight And Obesity ◽

Qualitative Assessment ◽

Cochrane Library ◽

Qualitative Synthesis ◽

Lactating Women ◽

Maternal Overweight ◽

The Impact

Abstract Objectives This article aimed to provide a synthesis of studies evaluating the effects of maternal overweight and obesity, including body mass index (BMI) and other measures of adiposity, on the concentrations of macronutrients (fat, protein and lactose) in human milk (HM). Methods EMBASE, MEDLINE/PubMed, Cochrane Library, Scopus, Web of Science and ProQuest databases were searched for relevant articles. Two authors conducted screening, data extraction and quality assessment independently. Meta-analyses of eligible studies were conducted using Review Manager software version 5.3. Results A total of 31 studies (5078 lactating women) were included in the qualitative synthesis and 9 studies (872 lactating women) in the quantitative synthesis. The meta-analysis indicated that maternal overweight and obesity were associated with higher concentrations of fat in mature HM (p = 0.01) and lactose in colostrum (p = 0.002). While the qualitative analyses broadly supported the findings of the meta-analysis, the qualitative assessment identified considerable variability in the results between studies and low quality of many of the included studies, making it difficult to draw robust conclusions. Conclusions Overall, maternal BMI and adiposity measurements were associated with differences in the concentrations of fat and lactose in HM, however the direction of change was dependent on the stage of lactation, whereas protein concentration in HM did not appear to differ between overweight and/or obese and normal weight women. This is particularly relevant considering potential implications of higher HM fat concentration on both growth and fat deposition during the first few months of infancy and long-term risk of obesity. Funding Sources GEL was supported by a FOODplus Early Life Nutrition Scholarship, The University of Adelaide. BSM received a Career Development Award from the National Health and Medical Research Council of Australia (NHMRC).

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Maternal Obesity and Risk of Early-onset Neonatal Bacterial Sepsis: Nationwide Cohort and Sibling-controlled Studies

Clinical Infectious Diseases ◽

10.1093/cid/ciaa783 ◽

2020 ◽

Author(s):

Eduardo Villamor ◽

Mikael Norman ◽

Stefan Johansson ◽

Sven Cnattingius

Keyword(s):

Early Onset ◽

Maternal Obesity ◽

Group B Streptococcus ◽

Population Based ◽

Normal Weight ◽

Overweight And Obesity ◽

Bacterial Sepsis ◽

Term Infants ◽

Cesarean Section Delivery ◽

Maternal Overweight

Abstract Background Maternal overweight and obesity are related to risks of pregnancy and delivery complications that, in turn, are associated with newborn infections. We examined the associations between early pregnancy body mass index (BMI; kg/m2) and risk of early-onset neonatal bacterial sepsis (EOS). Methods We conducted a nationwide population-based retrospective cohort study of 1 971 346 live singleton infants born in Sweden between 1997 and 2016. Outcome was a culture-confirmed EOS diagnosis. We estimated hazard ratios (HR) of EOS according to BMI using proportional hazard models, and identified potential mediators. Among term infants, we conducted sibling-controlled analyses. Results EOS risk per 1000 live births was 1.48; 0.76 in term and 15.52 in preterm infants. Compared with infants of normal-weight mothers (BMI, 18.5–24.9), the adjusted HR (95% confidence interval [CI]) of EOS for BMI categories <18.5, 25.0–29.9, 30.0–34.9, 35.0–39.9, and ≥40.0 were, respectively, 1.07 (.83–1.40), 1.19 (1.08–1.32), 1.70 (1.49–1.94), 2.11 (1.73–2.58), and 2.50 (1.86–3.38). Maternal overweight and obesity increased the risk of EOS by group B Streptococcus, Staphylococcus aureus, and Escherichia coli. Half of the association was mediated through preeclampsia, cesarean section delivery, and preterm delivery. A dose-response association was consistently apparent in term infants only. In sibling-controlled analyses, every kilogram per meter squared interpregnancy BMI change was associated with a mean 8.3% increase in EOS risk (95% CI, 1.7%–15.3%; P = .01). Conclusions Risk of EOS increases with maternal overweight and obesity severity, particularly in term infants.

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A comparative study of the effect of body mass index on pregnancy outcomes in normal and overweight women

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20171426 ◽

2017 ◽

Vol 6 (4) ◽

pp. 1550

Author(s):

Seeniammal P. ◽

Chellamma V. K. ◽

Umadevi N.

Keyword(s):

Comparative Study ◽

Maternal Obesity ◽

Gestational Hypertension ◽

Fetal Outcome ◽

Overweight And Obesity ◽

Health Concern ◽

Accurate Information ◽

Obese Women ◽

Increased Risk ◽

Maternal Overweight

Background: Maternal obesity has been reported as a risk factor for various antepartum, intrapartum, postpartum and neonatal complications. Increasing rates of overweight among pregnant women are a significant public health concern with various implications for prenatal care and supervision of delivery. Therefore, the present study is to determine the adverse materno-fetal outcome in primigravid overweight and obese women delivering singleton babies.Methods: A prospective comparative study was conducted for a year at IMCH, Medical College, Calicut. Primigravid women with a singleton uncomplicated pregnancy with cephalic presentation at ≥37 weeks of gestation with accurate information regarding height and weight recorded at the booking visit were included in the study. Comparisons were made between 100 women with BMI >25 and 200 women with BMI 18.5-24.9. Statistical analysis was done using SPSS version 16.0. Data was analysed by Pearson Chi square test and Fisher’s exact test.Results: Overweight mothers are at increased risk quoted as relative risk (RR) and 95% confidence intervals (CI) of adverse materno-fetal outcomes. Gestational hypertension RR 2.39 (CI 1.65-3.47), Gestational diabetes RR 2.67(CI 0.95-7.48), induction of labour RR 2.35 (CI 1.4-3.95), Cesarean section RR 5.73 (CI 3.76-8.73), macrosomia RR 14 (CI 1.75-112.23), NICU admissions RR 4.51(CI 2.61-7.84),perineal lacerations RR 4.72 (CI 1.15-20.4), wound infection RR 2.97 (CI 1.06-8.41), and prolonged hospital stay.Conclusions: It is clearly evident from the study that maternal overweight and obesity is associated with adverse materno-fetal outcome.

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Human Milk Oligosaccharide Concentrations and Infant Intakes Are Associated with Maternal Overweight and Obesity and Predict Infant Growth

Nutrients ◽

10.3390/nu13020446 ◽

2021 ◽

Vol 13 (2) ◽

pp. 446

Author(s):

Jessica L. Saben ◽

Clark R. Sims ◽

Ann Abraham ◽

Lars Bode ◽

Aline Andres

Keyword(s):

Human Milk ◽

High Performance ◽

Maternal Obesity ◽

Critical Role ◽

Infant Growth ◽

Normal Weight ◽

Overweight And Obesity ◽

Bioactive Molecules ◽

Maternal Overweight ◽

Maternal Bmi

Human milk oligosaccharides (HMOs) are bioactive molecules playing a critical role in infant health. We aimed to quantify the composition of HMOs of women with normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), or obesity (30.0–60.0 kg/m2) and determine the effect of HMO intake on infant growth. Human milk (HM) samples collected at 2 months (2 M; n = 194) postpartum were analyzed for HMO concentrations via high-performance liquid chromatography. Infant HM intake, anthropometrics and body composition were assessed at 2 M and 6 M postpartum. Linear regressions and linear mixed-effects models were conducted examining the relationships between maternal BMI and HMO composition and HMO intake and infant growth over the first 6 M, respectively. Maternal obesity was associated with lower concentrations of several fucosylated and sialylated HMOs and infants born to women with obesity had lower intakes of these HMOs. Maternal BMI was positively associated with lacto-N-neotetraose, 3-fucosyllactose, 3-sialyllactose and 6-sialyllactose and negatively associated with disialyllacto-N-tetraose, disialyllacto-N-hexaose, fucodisialyllacto-N-hexaose and total acidic HMOs concentrations at 2 M. Infant intakes of 3-fucosyllactose, 3-sialyllactose, 6-sialyllactose, disialyllacto-N-tetraose, disialyllacto-N-hexaose, and total acidic HMOs were positively associated with infant growth over the first 6 M of life. Maternal obesity is associated with changes in HMO concentrations that are associated with infant adiposity.

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Trends in maternal body mass index in Northern Ireland: a cross-sectional and longitudinal study

Family Medicine and Community Health ◽

10.1136/fmch-2021-001310 ◽

2021 ◽

Vol 9 (4) ◽

pp. e001310

Author(s):

Lisa Kent ◽

Christopher Cardwell ◽

Ian Young ◽

Kelly-Ann Eastwood

Keyword(s):

Body Mass Index ◽

Northern Ireland ◽

Body Mass ◽

Maternal Obesity ◽

Unplanned Pregnancy ◽

Overweight And Obesity ◽

Maternal Body Mass Index ◽

Class Iii ◽

Maternal Body ◽

Maternal Overweight

ObjectivesExplore (1) associations between maternal body mass index (BMI), demographic and clinical characteristics, (2) longitudinal trends in BMI, (3) geographical distributions in prevalence of maternal overweight and obesity.DesignRetrospective population-based study.SettingLinked, anonymised, routinely collected healthcare data and official statistics from Northern Ireland.ParticipantsAll pregnancies in Northern Ireland (2011–2017) with BMI measured at ≤16 weeks gestation.MethodsAnalysis of variance and χ2 tests were used to explore associations. Multiple linear regression was used to explore longitudinal trends and spatial visualisation illustrated geographical distribution. Main outcomes are prevalence of overweight (BMI ≥25 kg/m2) and obesity (BMI ≥30 kg/m2).Results152 961 singleton and 2362 multiple pregnancies were included. A high prevalence of maternal overweight and obesity in Northern Ireland is apparent (singleton: 52.4%; multiple: 48.3%) and is increasing. Obesity was positively associated with older age, larger numbers of previous pregnancies and unplanned pregnancy (p<0.001). BMI category was also positively associated with unemployment (35% in obese class III vs 22% in normal BMI category) (p<0.001). Higher BMI categories were associated with increased rate of comorbidities, including hypertension (normal BMI: 1.8% vs obese III: 12.4%), diabetes mellitus (normal BMI: 0.04% vs obese III: 1.29%) and mental ill-health (normal BMI: 5.0% vs obese III: 11.8%) (p<0.001). Prevalence of maternal obesity varied with deprivation (most deprived: 22.8% vs least deprived: 15.7%) (p<0.001). Low BMI was associated with age <20 years, nulliparity, unemployment and mental ill-health (p<0.001).ConclusionsThe prevalence of maternal BMI >25 kg/m2 is increasing over time in Northern Ireland. Women are entering pregnancy with additional comorbidities likely to impact their life course beyond pregnancy. This highlights the need for prioritisation of preconception and inter-pregnancy support for management of weight and chronic conditions.

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Early risk factors of obesity in 5-year-old boys and girls in Finland

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.921 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

U Laitinen ◽

S Lehtinen-Jacks ◽

A Lundqvist

Keyword(s):

Risk Factors ◽

Gestational Age ◽

Maternal Obesity ◽

Child Obesity ◽

Overweight And Obesity ◽

Large For Gestational Age ◽

Perinatal Factors ◽

Early Risk ◽

Early Risk Factors ◽

Maternal Overweight

Abstract Background Several potential early-life risk factors for childhood overweight and obesity have been identified. Yet results regarding early risk factors and obesity (BMI-for-age ≥30 kg/m2) at pre-school age are mixed and boys and girls have rarely been studied separately. Our aim was to study whether pre- and perinatal factors predict obesity in 5-year-old boys and girls. Methods National register data was used to identify children born in Finland between 2007 and 2014 with data available on pre- and perinatal factors as well as on height and weight at 5 years of age (n = 131,818). Multivariable logistic regression models were used to analyze sex-specific associations between pre- and perinatal factors (e.g. maternal age, parity, pre-pregnancy BMI, smoking, diabetes, delivery method, gestational-age-adjusted birth weight) and offspring obesity. Results Five percent of boys (n = 3,551) and 3% of girls (n = 1,949) had obesity. Adjusted for potential confounders, the strongest predictor of subsequent obesity at 5 years of age was severe maternal obesity (BMI ≥35 kg/m2) (boys: OR 6.5, 95% CI 5.8-7.4; girls: OR 7.5, 95% CI 6.4-8.8) followed by maternal obesity (BMI 30.0-34.9 kg/m²) (boys: OR 3.9, 95% CI 3.5-4.4; girls: OR 5.5, 95% CI 4.8-6.2) and maternal overweight (BMI 25.0-29.9 kg/m²) (boys: OR 2.3, 95% CI 2.1-2.5; girls: OR 2.6, 95% CI 2.3-3.0). Other factors associated with child obesity were maternal smoking during pregnancy (boys: OR 1.8, 95% CI 1.6-1.9; girls: OR 2.0, 95% CI 1.8-2.2) and being born large for gestational age (boys: OR 1.9, 95% CI 1.6-2.2; girls: OR 2.1, 95% CI 1.8-2.6). Conclusions These findings indicate that childhood obesity may partly originate before conception, gestation and birth. As prevention of obesity may be economically and socially more sustainable than treatment of its consequences, emphasis should be put on early interventions. Particular attention should be paid on preventing maternal overweight and obesity. Key messages Maternal obesity was the strongest predictor of child obesity at 5 years of age. Investing in maternal health from as early as before conception may help prevent offspring obesity.

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Maternal Overweight Downregulates MME (Neprilysin) in Feto-Placental Endothelial Cells and in Cord Blood

International Journal of Molecular Sciences ◽

10.3390/ijms21030834 ◽

2020 ◽

Vol 21 (3) ◽

pp. 834 ◽

Cited By ~ 1

Author(s):

Elisa Weiß ◽

Hannah M. Berger ◽

Waltraud T. Brandl ◽

Jasmin Strutz ◽

Birgit Hirschmugl ◽

...

Keyword(s):

Endothelial Cells ◽

Cord Blood ◽

Overweight And Obesity ◽

Low Grade ◽

Maternal Metabolism ◽

Inflammatory State ◽

Effect Of Oxygen ◽

Factor Α ◽

Maternal Overweight

Maternal overweight in pregnancy alters the metabolic environment and generates chronic low-grade inflammation. This affects fetal development and programs the offspring’s health for developing cardiovascular and metabolic disease later in life. MME (membrane-metalloendopeptidase, neprilysin) cleaves various peptides regulating vascular tone. Endothelial cells express membrane-bound and soluble MME. In adults, the metabolic environment of overweight and obesity upregulates endothelial and circulating MME. We here hypothesized that maternal overweight increases MME in the feto-placental endothelium. We used primary feto-placental endothelial cells (fpEC) isolated from placentas after normal vs. overweight pregnancies and determined MME mRNA, protein, and release. Additionally, soluble cord blood MME was analyzed. The effect of oxygen and tumor necrosis factor α (TNFα) on MME protein in fpEC was investigated in vitro. Maternal overweight reduced MME mRNA (−39.9%, p < 0.05), protein (−42.5%, p = 0.02), and MME release from fpEC (−64.7%, p = 0.02). Both cellular and released MME protein negatively correlated with maternal pre-pregnancy BMI. Similarly, cord blood MME was negatively associated with pre-pregnancy BMI (r = −0.42, p = 0.02). However, hypoxia and TNFα, potential negative regulators of MME expression, did not affect MME protein. Reduction of MME protein in fpEC and in cord blood may alter the balance of vasoactive peptides. Our study highlights the fetal susceptibility to maternal metabolism and inflammatory state.

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Pro-Health Education of Youth in Poland

Comparative Professional Pedagogy ◽

10.2478/rpp-2014-0021 ◽

2014 ◽

Vol 4 (2) ◽

pp. 64-68

Author(s):

Aleksandra Michalska

Keyword(s):

Health Education ◽

Weight Control ◽

Developmental Disorders ◽

Eating Behaviors ◽

Fruits And Vegetables ◽

Overweight And Obesity ◽

Individual Counseling ◽

Health Related ◽

Continuous Work ◽

Vegetables And Fruits

Abstract Nowadays, thanks to greater awareness of society and development of restorative medicine, more and more attention is paid to preventive care. That is caused by the fact that there is little progress for both sexes in the frequency of healthy behavior: girls fall much worse than boys in terms of frequency of physical activity, they do not eat breakfast either; boys do not maintain a healthy diet and are reluctant to eat vegetables and fruits, they often drink high-calorie sodas and less frequently brush teeth. Though with age some improvements in oral hygiene and certain eating behaviors can be noticed. It has been determined that overweight and obesity is a serious problem, as they can contribute to developmental disorders. In this respect it should be the responsibility of teachers to provide individual physical education (according to medical qualifications), prevent various forms of discrimination and bullying among peers, provide individual counseling and health education, weight control of students. It has been defined that for modern teachers it is a difficult task as students rarely eat fruits and vegetables, do not care about hygiene and frequency of meals, have passive mode of leisure. The acquisition of health during puberty allows functioning smoothly in society. However, despite the continuous work on improving and introduction of new programs of health education classes into schools of Poland, children still suffer from health-related problems. According to epidemiological research most of children in Poland fall on obesity, overweight and accompanying disorders and allergies. Youth is also exposed to accidents and related injuries. The problem is that students do not receive assistance and necessary information.

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