scholarly journals Obesity in pregnancy: risks and management

2009 ◽  
Vol 2 (2) ◽  
pp. 52-62 ◽  
Author(s):  
Kate J Fitzsimons ◽  
Jo Modder ◽  
Ian A Greer
Keyword(s):  
Maternal Obesity ◽  
Research Priorities ◽  
Future Research ◽  
Increased Risk ◽  
Fetal Complications ◽  
Prevalence Of Obesity ◽  
Obesity In Pregnancy ◽  
The Uk ◽  
Pregnancy Weight ◽  
In Pregnancy

Maternal obesity is now considered one of the most commonly occurring risk factors seen in obstetric practice. Compared with women with a healthy pre-pregnancy weight, women with obesity are at increased risk of miscarriage, gestational diabetes, preeclampsia, venous thromboembolism, induced labour, caesarean section, anaesthetic complications and wound infections, and they are less likely to initiate or maintain breastfeeding. Babies of obese mothers are at increased risk of stillbirth, congenital anomalies, prematurity, macrosomia and neonatal death. Intrauterine exposure to obesity is also associated with an increased risk of developing obesity and metabolic disorders in childhood. This article reviews the prevalence of obesity in pregnancy and the associated maternal and fetal complications. Recommendations and suggestions for pre-conception, antenatal and postnatal care of women with obesity are presented, and current research in the UK and future research priorities are considered.

scholarly journals Overweight and obesity in pregnancy: their impact on epigenetics

2021 ◽  
Author(s):  
Christoph Reichetzeder
Keyword(s):  
Clinical Studies ◽  
Maternal Obesity ◽  
Later Life ◽  
Overweight And Obesity ◽  
Cardiometabolic Disease ◽  
Mother And Child ◽  
Prevalence Of Obesity ◽  
Obesity In Pregnancy ◽  
And Function ◽  
In Pregnancy

AbstractOver the last few decades, the prevalence of obesity has risen to epidemic proportions worldwide. Consequently, the number of obesity in pregnancy has risen drastically. Gestational overweight and obesity are associated with impaired outcomes for mother and child. Furthermore, studies show that maternal obesity can lead to long-term consequences in the offspring, increasing the risk for obesity and cardiometabolic disease in later life. In addition to genetic mechanisms, mounting evidence demonstrates the induction of epigenetic alterations by maternal obesity, which can affect the offspring’s phenotype, thereby influencing the later risk of obesity and cardiometabolic disease. Clear evidence in this regard comes from various animal models of maternal obesity. Evidence derived from clinical studies remains limited. The current article gives an overview of pathophysiological changes associated with maternal obesity and their consequences on placental structure and function. Furthermore, a short excurse is given on epigenetic mechanisms and emerging data regarding a putative interaction between metabolism and epigenetics. Finally, a summary of important findings of animal and clinical studies investigating maternal obesity-related epigenetic effects is presented also addressing current limitations of clinical studies.

scholarly journals SAT-014 Insulin Treatment in Human Pregnancy Mitigates an Increased Risk of Postpartum Psychological Distress with Maternal Obesity in the Absence of a Pre-Existing Mood and Anxiety Disorder

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jessica S Jarmasz ◽  
Alexandrea Anderson ◽  
Margaret E Bock ◽  
Yan Jin ◽  
Peter A Cattini ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Maternal Obesity ◽  
Gestational Hypertension ◽  
Placental Lactogen ◽  
Mood And Anxiety Disorders ◽  
Increased Risk ◽  
Significant Difference ◽  
In Pregnancy

Abstract BACKGROUND: Pregnant women with obesity are at increased risk for peripartum depression. Maternal obesity is also associated with reduced human placental lactogen (hPL) levels, and decreased hPL transcripts were reported in women with clinical depression. In addition, hPL production may be rescued in women with obesity that were subsequently diagnosed with gestational diabetes and treated with insulin (INS). Objective: Study the effect of INS treatment in pregnancy on the risk for postpartum psychological distress (PPD) in women with and without obesity. Study Design: Using data housed at the Manitoba Centre for Health Policy (2002–2017), cohorts of women (ages 15+) with a single live birth with and without obesity were developed using weight (≥85 and <65.6 kg, respectively) and an average (1.63 m) height. Pre-existing mood and anxiety disorders within 5 years preceding delivery as well as gestational hypertension were excluded. After randomly selecting 1 birth per mother, cohorts were stratified by INS treatment during the gestational period. The risk of PPD within 1 year of delivery was assessed by Poisson regression analysis. Models were adjusted for maternal age and area-level income at delivery. Results: The risk of PPD was 27% greater among women with obesity versus without (adjusted rate ratio (aRR)=1.27, 95% CI 1.16–1.4, p<0.0001). However, women with obesity treated with INS did not have a significantly different risk of PPD compared to women without obesity whether treated with INS (aRR=0.99, 95%CI 0.48–2.02, p=0.974) or not (aRR=1.16, 95%CI 0.86–1.56, p=0.328). This suggests that the risk of PPD among women with obesity may be reduced by INS treatment; however, our ability to detect a significant difference may be limited by small cohort numbers (46 women with obesity received INS in pregnancy) or confounders for receiving INS in pregnancy. Direct comparison of INS treatment within weight groups faced the same limitations but trended toward a reduction in women with obesity who received INS (aRR=0.91, 95%CI 0.68–1.22, p=0.531). The positive association between INS treatment in pregnancy and decreased risk of PPD in women with obesity was lost when pre-existing mood and anxiety disorder was not excluded. Inclusion of pre-existing diabetes in the adjusted models did not improve model fit or contribute significantly to the differences in PPD rates. Conclusions: Maternal obesity increases the risk for PPD but this risk may be reduced by gestational INS treatment in the absence of a pre-existing mood and anxiety disorders. This correlates with the decrease and increase in hPL levels reported previously with maternal obesity without and with INS treatment (for diabetes) in pregnancy, respectively. Thus, hPL levels may serve as a possible indicator of PPD risk and a potential target for gestational INS treatment.

Maternal obesity in pregnancy: Women's understanding of risks

2011 ◽  
Vol 19 (6) ◽  
pp. 364-369 ◽  
Author(s):  
Alice Keely ◽  
Melanie Gunning ◽  
Fiona Denison
Keyword(s):  
Maternal Obesity ◽  
Obesity In Pregnancy ◽  
In Pregnancy

scholarly journals Prioritising research and dissemination: a Delphi study of NHS Highland midwives

2012 ◽  
Vol 36 (113) ◽  
pp. 32-47 ◽  
Author(s):  
Kathleen Yvonne Irvine ◽  
Wendy Jessiman ◽  
Alison Felce
Keyword(s):  
Delphi Study ◽  
Delphi Technique ◽  
Information Needs ◽  
Research Priorities ◽  
Place Of Birth ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
Workforce Issues ◽  
Obesity In Pregnancy ◽  
In Pregnancy

This paper reports on a Delphi study undertaken by a health librarian and two midwifery professionals, to determine the research priorities of midwives working in NHS Highland. Six important topics were identified: workforce issues, second stage of labour, obesity in pregnancy, women’s expectations of pregnancy and of childbirth, place of birth, and breastfeeding. Related evidence was examined to identify topics where dissemination of existing evidence was needed. The study dealt both with the practice of midwifery in general and with the information needs of local midwives in particular. The Delphi technique was found to be a useful method to determine research priorities but it was not without its limitations.

scholarly journals How can we adapt complex population health interventions for new contexts? Progressing debates and research priorities

2020 ◽  
pp. jech-2020-214468
Author(s):  
Rhiannon Emily Evans ◽  
Graham Moore ◽  
Ani Movsisyan ◽  
Eva Rehfuess
Keyword(s):  
Population Health ◽  
Qualitative Interviews ◽  
Research Priorities ◽  
Realist Evaluation ◽  
Health Interventions ◽  
Future Research ◽  
Case Examples ◽  
Theoretical Perspectives ◽  
Complex Population ◽  
The Uk

IntroductionThe UK Medical Research Council and National Institute for Health Research have funded the ADAPT study (2018–2020), to develop methodological guidance for the adaptation of complex population health interventions for new contexts. While there have been advances in frameworks, there are key theoretical and methodological debates to progress. The ADAPT study convened a panel meeting to identify and enrich these debates. This paper presents the panel’s discussions and suggests directions for future research.MethodsSixteen researchers and one policymaker convened for a 1-day meeting in July 2019. The aim was to reflect on emerging study findings (systematic review of adaptation guidance; scoping review of case examples; and qualitative interviews with funders, journal editors, researchers and policymakers), progress theoretical and methodological debates, and consider where innovation may be required to address research gaps.DiscussionDespite the proliferation of adaptation frameworks, questions remain over the definition of basic concepts (eg, adaptation). The rationale for adaptation, which often focuses on differences between contexts, may lead to adaptation hyperactivity. Equal emphasis should be placed on similarities. Decision-making about intervention modification currently privileges the concept of ‘core components’, and work is needed to progress the use and operationalisation of ‘functional fidelity’. Language and methods must advance to ensure meaningful engagement with diverse stakeholders in adaptation processes. Further guidance is required to assess the extent of re-evaluation required in the new context. A better understanding of different theoretical perspectives, notably complex systems thinking, implementation science and realist evaluation may help in enhancing research on adaptation.

Type 1 Diabetes in Pregnancy: A Review of Complications and Management

2021 ◽  
Vol 18 ◽  
Author(s):  
Farah Jaffar ◽  
Kate Laycock ◽  
Mohammed S.B. Huda
Keyword(s):  
Type 1 Diabetes ◽  
Microvascular Disease ◽  
Evidence Based ◽  
Current Guideline ◽  
Diabetes In Pregnancy ◽  
Fetal Outcomes ◽  
Increased Risk ◽  
Fetal Complications ◽  
In Pregnancy

Background: Pre-gestational diabetes can pose significant risk to the mother and infant, thus requiring careful counselling and management. Since Saint Vincent’s declaration in 1989, adverse maternal and fetal outcomes, such as preeclampsia, perinatal mortality, congenital anomalies, and macrosomia, continue to be associated with type 1 diabetes. Although pregnancy is not considered an independent risk factor for the development of new onset microvascular complications, it is known to exacerbate pre-existing microvascular disease. Strict glycaemic control is the optimal management for pre-existing type 1 diabetes in pregnancy, as raised HbA1C is associated with increased risk of maternal and fetal complications. More recently, time in range on Continuous Glucose Monitoring glucose profiles has emerged as another useful evidence-based marker of fetal outcomes. Objective: This review summarises the complications associated with pre-gestational type 1 diabetes, appropriate evidence-based management, including preparing for pregnancy, intrapartum and postpartum care. Methods: A structured search of the PubMed and Cochrane databases was conducted. Peer-reviewed articles about complications and management guidelines on pre-gestational type 1 diabetes were selected and critically appraised. Results: One hundred and twenty-three manuscripts were referenced and appraised in this review, and international guidelines were summarised. Conclusion: This review provides a comprehensive overview of the recurring themes in the literature pertaining to type 1 diabetes in pregnancy: maternal and fetal complications, microvascular disease progression, and an overview of current guideline-specific management.

282 The epidemic of maternal obesity in pregnancy, 1986–2001

2001 ◽  
Vol 185 (6) ◽  
pp. S157
Author(s):  
Hugh Ehrenberg ◽  
Brian Mercer ◽  
Leroy Dierker ◽  
Cynthia Milluzzi
Keyword(s):  
Maternal Obesity ◽  
Obesity In Pregnancy ◽  
In Pregnancy
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