scholarly journals Maternal and neonatal outcomes in pregnancies complicated by maternal obesity

Author(s):  
Sudha Menon ◽  
Sivaprasad K.

Background: Maternal obesity imparts elevated maternal and neo natal adverse outcomes. Aim of the study was to evaluate and analyse the maternal and neonatal outcomes in obese mothers.Methods: This was a prospective case control study in a tertiary care high risk referral center. Antenatal women with first trimester Body mass index (BMI) of more than 30 Kg/m2 constituted the cases and those antenatal women with BMI <25 Kg/m2 formed the controls.Results: Mean age was slightly more (28.6±4.3 years vs 26.3±3.6 years: P<0.0001) in the obese group. Obese women were significantly more likely to have  of gestational diabetes (OR 5.2, 95% CI 3.2-8.7 P<0.00001), gestational hypertension (Or 3.5, 95% CI 2.1-5.9 P<0.0001) , induction of labour (OR 2.5, 95% CI 1.8-3.6 P<0.0001), failed induction of labour (OR 2.4, 95% CI 1.3-4.2 P=0.003), Preeclampsia (OR 2.8, 95% CI 1.6-4.9 P=0.0002), Caesarian section (Or 4.0, 95% CI 2.9-5.9 P<0.0001) and Postpartum hemorrhage (OR 4.0,95% CI 1.1-14.3 P=0.034), prolonged hospital stay (OR 12.8, 95% CI 7.7-21.1 P<0.0001)  and adverse neonatal outcomes such as low(<7) Apgar (OR 3.2, 95% CI 1.1-10.0 P=0.03), Large for gestational age babies (OR 3.1, 95% Cl 2.1-4.5 P<0.0001) and transfer to new born nursery (OR 3.4, 95% CI 2.3 -5.2 P<0.0001).Conclusions: Maternal obesity in pregnancy is high risk and has many adverse maternal and neonatal outcomes warranting specialized antenatal, intranatal and post-natal care.

Author(s):  
Naiyma Choudhary ◽  
Mohd Rasheed ◽  
Vivek Aggarwal

Background: Gestational diabetes mellitus (GDM) is a well-known medical entity which should be diagnosed at the earliest to prevent adverse maternal and neonatal outcomes due to hyperglycemia.Methods: This study was done in patients attending antenatal OPD in a peripheral hospital in North India. A total of 569 patients diagnosed as GDM were included in the study out of 6321 who attended the antenatal clinic.Results: The prevalence of gestational diabetes mellitus was found to be 9%. Gestational hypertension was seen in 29.35% of patients. The percent of babies who were admitted to NICU was 29.35%.Conclusions: These results stress the need for early detection and treatment of GDM to prevent adverse outcomes.


Author(s):  
Haley A. Steffen ◽  
Samantha R. Swartz ◽  
J. Brooks Jackson ◽  
Kimberly A. Kenne ◽  
Patrick P. Ten Eyck ◽  
...  

Objective This study aimed to estimate the prevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) among pregnant patients at the time of delivery in a rural Midwest tertiary care hospital and to examine demographics, clinical factors, and maternal and neonatal outcomes associated with SARS-CoV-2 infection during pregnancy. Study Design This prospective cohort study included all delivering patients between May 1 and September 22, 2020 at the University of Iowa Hospitals and Clinics. Plasma SARS-CoV-2 antibody testing was performed. SARS-CoV-2 viral reverse-transcription polymerase chain reaction (RT-PCR) results and maternal and neonatal outcomes were collected from the electronic medical record. Data were analyzed using univariate statistical methods with clustering for multiple births. Results In total, 1,000 patients delivered between May 1 and September 22, 2020. Fifty-eight (5.8%) were SARS-CoV-2 antibody positive. Twenty-three also tested viral positive during pregnancy. Three of 1,000 (0.3%) were viral positive on admission but antibody negative. The median age was 30 years (interquartile range [IQR]: 26–33 years) and body mass index was 31.75 kg/m2 (IQR 27.7–37.5 kg/m2). The cesarean delivery rate was 34.0%. The study population was primarily white (71.6%); however, 41.0% of SARS-CoV-2 infected patients identified as Black, 18.0% as Hispanic/Latino, 3.3% as Native Hawaiian/Pacific Islander, and only 27.9% as White (p < 0.0001). SARS-CoV-2 infection was more likely in patients without private insurance (p = 0.0243). Adverse maternal and/or neonatal outcomes were not more likely in patients with evidence of infection during pregnancy. Two SARS-CoV-2 infected patients were admitted to the intensive care unit. There were no maternal deaths during the study period. Conclusion In this largely rural Midwest population, 6.1% of delivering patients had evidence of past or current SARS-CoV-2 infection. Rates of SARS-CoV-2 during pregnancy were higher among racial and ethnic minorities and patients without private insurance. The SARS-CoV-2 infected patients and their neonates were not found to be at increased risk for adverse outcomes. Key Points


2022 ◽  
Vol 12 ◽  
Author(s):  
Hanxiang Sun ◽  
Yang Liu ◽  
Shijia Huang ◽  
Xiaosong Liu ◽  
Guohua Li ◽  
...  

ObjectiveTo study the association between pre-pregnancy body mass index (BMI) and adverse maternal and neonatal outcomes of singleton pregnancies after assisted reproductive technology (ART).MethodsThis hospital-based retrospective cohort study of women with live singleton births through ART in China from January 2015 to August 2020 included 3043 Chinese women. According to the latest BMI classification standard of Asian women, the women included in this study were classified as underweight (BMI &lt;18.5 kg/m2), normal (BMI 18.5 to &lt;23 kg/m2), overweight (BMI 23 to &lt;27.5 kg/m2), and obese (BMI ≥27.5 kg/m2). We compared the risk of adverse outcomes of different pre-pregnancy BMI values of women with singleton pregnancies conceived through ART. We used Logistic regression analysis to estimate the associations between pre-pregnancy BMI and adverse perinatal and neonatal outcomes.ResultsOur findings showed that women who were overweight or obese before pregnancy through ART are more likely to have a cesarean section, gestational diabetes mellitus, gestational hypertension, and preeclampsia, regardless of whether confounding factors are adjusted. Moreover, pre-pregnancy obesity was more associated with a higher risk of these adverse outcomes than pre-pregnancy overweight. In addition, neonates from women who had obesity before pregnancy through ART were more likely to have macrosomia; adjusted odds ratios and 95% confidence intervals were 3.004 (1.693-5.330).ConclusionsOur research showed that women who had pre-pregnancy overweight or obesity with singleton pregnancies through ART were more likely to have a cesarean section, gestational diabetes mellitus, gestational hypertension, and preeclampsia. Moreover, neonates from women who had obesity before pregnancy were more likely to have macrosomia.


Author(s):  
Giovanni Corrao ◽  
Anna Cantarutti ◽  
Anna Locatelli ◽  
Gloria Porcu ◽  
Luca Merlino ◽  
...  

Antenatal care (ANC) aims of monitoring wellbeing of mother and foetus during pregnancy. We validate a set of indicators aimed of measuring the quality of ANC of women on low-risk, uncomplicated pregnancy through their relationship with maternal and neonatal outcomes. We conducted a population-based cohort study including 122,563 deliveries that occurred between 2015 and 2017 in the Lombardy Region, Italy. Promptness and appropriateness of number and timing of gynaecological visits, ultrasounds and laboratory tests were evaluated. We assessed several maternal and neonatal outcomes. Log-binomial regression models were used to estimate prevalence ratio (PR), and corresponding 95% confidence interval (95% CI), for the exposure→outcome association. Compared with women who adhered with recommendations, those who were no adherent had a significant higher prevalence of maternal intensive care units admission (PR: 3.1, 95%CI: 1.2–7.9; and 2.7, 1.1–7.0 respectively for promptness of gynaecological visits, and appropriateness of ultrasound examinations), low Apgar score (1.6, 1.1–1.2; 1.9, 1.3–2.7; and 2.1, 1.5–2.8 respectively for appropriateness and promptness of gynaecological visits, and appropriateness of ultrasound examinations), and low birth weight (1.8, 1.5–2.3 for appropriateness of laboratory test examinations). Benefits for mothers and newborn are expected from improving adherence to guidelines-driven recommendations regarding antenatal care even for low-risk, uncomplicated pregnancies.


2017 ◽  
Vol 129 (4) ◽  
pp. 683-688 ◽  
Author(s):  
Ruofan Yao ◽  
Katherine R. Goetzinger ◽  
Sarah D. Crimmins ◽  
Jerome N. Kopelman ◽  
Stephen A. Contag

2018 ◽  
Vol 08 (04) ◽  
pp. e349-e354 ◽  
Author(s):  
Rodney McLaren ◽  
Fouad Atallah ◽  
Nelli Fisher ◽  
Howard Minkoff

Objective This study was aimed to evaluate success rates of (1) external cephalic version (ECV) among women with one prior cesarean delivery (CD) and (2) maternal and neonatal outcomes after ECV among women with prior CD. Study Design Two linked studies using U.S. Natality Database were performed. First we performed a retrospective cohort comparing ECV success rates of women with prior CD and women without prior CD. Then we compared the outcomes of TOLACs (trial of labor after cesarean delivery) that occurred after ECV with those that occurred without ECV. Multivariable logistic regression analysis was used to estimate adverse outcomes. Results A total of 715 women had ECV after 36 weeks with prior CD and 9,976 had ECV without prior scar. ECV success rate with scar was 80.6% and without scar was 86.4% (p < 0.001). Seven hundred and sixteen women underwent TOLAC after ECV attempt and 234,617 underwent TOLAC without a preceding attempt. Women with preceding version had increased risks of maternal transfusion (1 vs. 0.4%, adjusted OR [odds ratio]: 2.48 [95% CI (confidence interval): 1.17–5.23]), unplanned hysterectomy (0.4 vs. 0.06%, adjusted OR: 6.90 [95% CI: 2.19–21.78]), and low 5-minute Apgar's score (2.5 vs. 1.5%, adjusted OR: 1.76 [95% CI: 1.10–2.82]). Conclusion Women with prior CD may have a decrease in the rate of successful ECV. While the absolute risks are low, ECV appears to increase risks of adverse maternal and neonatal outcomes among women undergoing a trial of labor.


Author(s):  
Nirzarini Vora ◽  
Nandita Maitra ◽  
Priyam Pandya

OBJECTIVE: The Maternal Foetal Triage Index (MFTI), a five-tier scale designed by Ruhl et al (2015) has been evaluated in this study for women attending the triage area of a tertiary hospital, to examine the effect on third delay and maternal and neonatal outcomes. DESIGN: Prospective observational study SETTING: The Labour and Delivery Unit of a tertiary care hospital SAMPLE: A convenience sample of 1000 women METHODS: Assessment included maternal history, baseline vital signs and obstetric examination and categorised the woman as per the MFTI scale. Evaluation of the MFTI score was assessed based on predefined maternal and neonatal outcomes within 24h of attendance. MAIN OUTCOME MEASURES: Flow of patients to triage, presenting complaints, Duration of hospital stay, maternal and neonatal outcomes within 24h of admission. RESULTS: A priority wise distribution of subjects based on their clinical diagnosis was found to be statistically significant for anaemia, previous caesarean, postpartum haemorrhage, miscarriage and hypertensive disorders. Sixty seven percent of the subjects belonged to Priority 3-4 and the mean hospital stay duration varied from 8.26±7.68 days for Priority 1 to 3.82±2.74 days for Priority 4 ((p<0.0001). The average time spent in the triage room was 30±17minutes. A priority wise analysis of maternal and neonatal outcomes based on OBICU and NICU admissions, mortality and stillbirths was found to be significant. CONCLUSION: The MFTI scale significantly reduced the third delay, which is crucial in a high-volume, low resource setting. This also simplified handover, improved documentation and decreased time to secondary healthcare provider assessment. KEYWORDS:obstetrictriage,acuity,thirddelay,maternalmortality


2016 ◽  
Vol 36 (4) ◽  
pp. 278-283 ◽  
Author(s):  
C M Cox Bauer ◽  
K A Bernhard ◽  
D M Greer ◽  
D C Merrill

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