scholarly journals Maternal Obesity and the First Birth: A Case for Targeted Contemporary Maternity Care

2014 ◽  
Vol 4 (2) ◽  
pp. 120-129
Author(s):  
Valerie J. Slavin ◽  
Jennifer Fenwick ◽  
Jenny Gamble
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Birth Outcomes ◽  
Maternity Care ◽  
Maternal Obesity ◽  
Clinical Audit ◽  
Normal Weight ◽  
Obese Women ◽  
Model Of Care ◽  
First Birth

BACKGROUND: Obesity in childbearing women is associated with poorer pregnancy and birth outcomes, particularly caesarean section, compared with normal-weight women. The high caesarean section rate may reflect care and outcomes which occur at the time surrounding the first birth.AIM: To describe the birth outcomes of extremely obese pregnant women (body mass index [BMI] of 40 or more) experiencing their first birth.METHODS: Clinical audit was used to systematically review the care and birth outcomes of all extremely obese pregnant women experiencing their birth at one study site during a 2-year period in 2009 and 2010. Fifty participants birthed during the study period. Data were collected from booking to discharge from the maternity service and included variables such as model of care, number of appointments, and obstetric and neonatal outcomes. Descriptive statistics were used to describe and synthesize the data. Inferential statistics were used to draw inferences about the population.RESULTS: Obese women rarely had contact with a midwife, except at booking, receiving a standard model of care provided by numerous caregivers, most often inexperienced medical staff. More than half of the obese women experienced a caesarean section (56%), 2.3 times that of normal-weight primiparous women who birthed at the study site during the same period (24.2%). This was despite 64% experiencing normal pregnancy free from any complication. For women who planned to labor, birth intervention including induction of labor, augmentation for slow labor, epidural, and continuous cardiotocography was high. Caesarean occurred most often for “failure to progress” and “failed induction.”CONCLUSION: Clinical audit was useful in determining information, which suggests current maternity care provision is not meeting the needs of extremely obese women experiencing their first birth.IMPLICATIONS FOR PRACTICE: The development of effective, targeted antenatal care designed to meet the needs of extremely obese women is recommended as are strategies to keep birth normal.

scholarly journals Placental function in maternal obesity

2020 ◽  
Vol 134 (8) ◽  
pp. 961-984 ◽  
Author(s):  
Amy C. Kelly ◽  
Theresa L. Powell ◽  
Thomas Jansson
Keyword(s):  
Pregnant Women ◽  
Maternal Obesity ◽  
Normal Weight ◽  
Adverse Outcomes ◽  
Obese Women ◽  
Long Term Outcomes ◽  
Placental Function ◽  
High Insulin ◽  
Short And Long Term

Abstract Maternal obesity is associated with pregnancy complications and increases the risk for the infant to develop obesity, diabetes and cardiovascular disease later in life. However, the mechanisms linking the maternal obesogenic environment to adverse short- and long-term outcomes remain poorly understood. As compared with pregnant women with normal BMI, women entering pregnancy obese have more pronounced insulin resistance, higher circulating plasma insulin, leptin, IGF-1, lipids and possibly proinflammatory cytokines and lower plasma adiponectin. Importantly, the changes in maternal levels of nutrients, growth factors and hormones in maternal obesity modulate placental function. For example, high insulin, leptin, IGF-1 and low adiponectin in obese pregnant women activate mTOR signaling in the placenta, promoting protein synthesis, mitochondrial function and nutrient transport. These changes are believed to increase fetal nutrient supply and contribute to fetal overgrowth and/or adiposity in offspring, which increases the risk to develop disease later in life. However, the majority of obese women give birth to normal weight infants and these pregnancies are also associated with activation of inflammatory signaling pathways, oxidative stress, decreased oxidative phosphorylation and lipid accumulation in the placenta. Recent bioinformatics approaches have expanded our understanding of how maternal obesity affects the placenta; however, the link between changes in placental function and adverse outcomes in obese women giving birth to normal sized infants is unclear. Interventions that specifically target placental function, such as activation of placental adiponectin receptors, may prevent the transmission of metabolic disease from obese women to the next generation.

scholarly journals Placental Ras Regulates Inflammation Associated with Maternal Obesity

2018 ◽  
Vol 2018 ◽  
pp. 1-18 ◽  
Author(s):  
Stella Liong ◽  
Gillian Barker ◽  
Martha Lappas
Keyword(s):  
Protein Expression ◽  
Pregnant Women ◽  
Human Placenta ◽  
Maternal Obesity ◽  
Small Gtpase ◽  
Obese Women ◽  
Trophoblast Cells ◽  
Ras Protein ◽  
Placental Inflammation ◽  
Expression And Activity

Heightened placental inflammation and dysfunction are commonly associated in pregnant obese women compared to their pregnant lean counterparts. The small GTPase superfamily members known as the rat sarcoma viral oncogene homolog (Ras) proteins, in particular, the K-Ras and H-Ras isoforms, have been implicated to regulate inflammation. The aims were to determine the placental Ras expression and activity with maternal obesity and its role in regulating placental inflammation. Human placenta was obtained at term Caesarean section from lean and obese pregnant women to determine the effect of maternal obesity on Ras protein expression and activity. To determine the effect of Ras on inflammation induced by bacterial endotoxin LPS and proinflammatory cytokines TNF-α or IL-1β, the chemical inhibitor lonafarnib (total Ras inhibitor) and siRNA (siKRAS and siHRAS) were used. Total Ras protein expression together with combined K-Ras and H-Ras activity was significantly increased in the placenta of obese pregnant women and when stimulated with LPS, IL-1β, or TNF-α. Lonafarnib significantly suppressed LPS-, IL-1β-, or TNF-α-induced IL-6, IL-8, MCP-1, and GRO-α expression and secretion in placental tissue. Primary trophoblast cells transfected with siKRAS or siHRAS demonstrated only K-Ras silencing significantly decreased IL-1β-, TNF-α-, or LPS-induced IL-6, IL-8, and MCP-1 expression and secretion. Furthermore, siKRAS significantly reduced downstream ERK-1/2 activation induced by LPS. In trophoblast cells, ERK-1/2 signalling is required for IL-6, IL-8, MCP-1, and GRO-α secretion. These studies implicate a role for K-Ras in regulating inflammation in human placenta. Suppressing overactive placental K-Ras function may prevent adverse fetal outcomes complicated by maternal obesity.

The Effect of Maternal Obesity on Oxytocin Requirements to Achieve Vaginal Delivery

2019 ◽  
Vol 37 (04) ◽  
pp. 349-356
Author(s):  
April D. Adams ◽  
Elizabeth M. Coviello ◽  
Daphnie Drassinower
Keyword(s):  
Vaginal Delivery ◽  
Maternal Obesity ◽  
Normal Weight ◽  
University Hospital ◽  
Obese Women ◽  
Class Iii ◽  
Class I Obesity ◽  
Class Iii Obesity ◽  
Higher Doses ◽  
Hospital Center

Abstract Objective Our objective was to determine if obese women are more likely to require oxytocin rates > 20 mU/min to achieve vaginal delivery, compared with normal weight women. Study Design This is a retrospective cohort study of deliveries at the MedStar Washington Hospital Center and MedStar Georgetown University Hospital. Results There were 4,284 births included in the analysis. Thirty-three per cent of deliveries were among women classified as overweight (body mass index [BMI] 25–29.9 kg/m2) and 58% were among women classified as obese (BMI >30.0 kg/m2), 12% were classified as class III obesity (BMI >40 kg/m2). Overall 110 (2.6%) women required an oxytocin rate of >20 mU/min. Doses of oxytocin >20 mU/min for women in the overweight, class I obesity, and class II obesity groups were 2.6, 1.9, and 1.6%, respectively. Deliveries among women with class III obesity had a significantly longer duration of oxytocin exposure (10.7 hours) compared with the normal weight group (8.2 hours, p < 0.001), and had a higher maximum rate of oxytocin compared (10 mU/min) to normal weight women (8 mU/min, p < 0.001). Conclusion Obese women are more likely to require oxytocin rates more than 20 mU/min, higher doses of oxytocin, and greater duration of oxytocin exposure to achieve a vaginal delivery.

scholarly journals A Higher Rate of Iron Deficiency in Obese Pregnant Sudanese Women

2017 ◽  
Vol 5 (3) ◽  
pp. 285-289 ◽  
Author(s):  
Wisal Abbas ◽  
Ishag Adam ◽  
Duria A. Rayis ◽  
Nada G. Hassan ◽  
Mohamed F. Lutfi
Keyword(s):  
Body Mass Index ◽  
Iron Deficiency ◽  
Pregnant Women ◽  
Serum Ferritin ◽  
Linear Regression Analysis ◽  
Normal Weight ◽  
Negative Association ◽  
Deficiency Anemia ◽  
Obese Women ◽  
Blood Indices

AIM: To assess the association between obesity and iron deficiency (ID).MATERIAL AND METHODS: Pregnant women were recruited from Saad Abualila Hospital, Khartoum, Sudan, during January–April 2015. Medical history (age, parity, gestational age) was gathered using questionnaire.  Weight and height were measured, and body mass index (BMI) was calculated. Women were sub-grouped based on BMI into underweight (< 18.5 kg/m^2), normal weight (18.5–24.9 kg/m^2), overweight (25–29.9 kg/m^2) and obese (≥ 30 kg/m^2). Serum ferritin and red blood indices were measured in all studied women.RESULTS: Two (0.5%), 126 (29.8%), 224 (53.0%) and 71 (16.8%) out of the 423 women were underweight, normal weight, overweight and obese, respectively. Anemia (Hb <11 g/dl), ID (ferritin <15µg/l) and iron deficiency anemia (IDA) were prevalent in 57.7%, 21.3% and 12.1%, respectively. Compared with the women with normal BMI, significantly fewer obese women were anemic [25 (35.2%) vs. 108 (85.7%), P < 0.001] and significantly higher number of obese women [25 (35.2) vs. 22 (17.5, P = 0.015] had iron deficiency. Linear regression analysis demonstrated a significant negative association between serum ferritin and BMI (– 0.010 µg/, P= 0.006).CONCLUSION: It is evident from the current findings that prevalence of anaemia and ID showed different trends about BMI of pregnant women.

scholarly journals Reappraisal of Gestational Weight Gain Recommendations in Obese Pregnant Women: A Population-Based Study of 337,590 Births

Obesity Facts ◽  
2020 ◽  
Vol 13 (4) ◽  
pp. 333-348
Author(s):  
Roland Devlieger ◽  
Lieveke Ameye ◽  
Tinne Nuyts ◽  
Régine Goemaes ◽  
Annick Bogaerts
Keyword(s):  
Weight Gain ◽  
Pregnant Women ◽  
Birth Outcomes ◽  
Maternal Obesity ◽  
Population Based ◽  
Population Based Study ◽  
Gestational Weight ◽  
Obese Class ◽  
Pregnancy And Birth Outcomes ◽  
Pregnancy And Birth

<b><i>Background and Objective:</i></b> Maternal obesity is an epidemic health problem that is aggravated by excessive gestational weight gain (GWG) and postpartum weight retention. Current US Institute of Medicine (now US National Academy of Medicine) guidelines (2009) for GWG need to be evaluated against the current rise in obesity in the general and pregnant population. We wanted to study the relation between GWG and pregnancy and birth outcomes and to relate this to the current recommendations for GWG. <b><i>Methods:</i></b> Population-based study. We performed an epidemiological analysis in a cohort of Belgian pregnant women with singleton live births at term (≥37 weeks) between 2009 and 2014 (<i>n</i> = 337,590). Logistic regression was used to determine the optimal GWG in relation to relevant pregnancy and birth outcomes. <b><i>Results:</i></b> The prevalence of maternal obesity significantly increased from 10.3% in 2009 to 11.4% in 2014. The mean (SD) body mass index at the start of the pregnancy significantly increased from 23.9 (4.5) in 2009 to 24.2 (4.6) in 2014. Excessive GWG was frequent, especially in overweight (56.8%) and obese (52.9%) pregnant women. In the logistic regression model, the amount of GWG associated with the lowest incidence of both large-for-gestational-age and small-for-gestational-age infants was 21 kg in underweight women, 14 kg in normal weight, 8 kg in overweight, 0 kg in obese class I, –4 kg in obese class II and –5 kg in obese class III. <b><i>Conclusion:</i></b> The prevalence of maternal obesity has risen in Belgium between 2009 and 2014. Current GWG guidelines, based on historic observational data, are probably too liberal for class II and III obese women in which better outcomes are being predicted for lower weight gain than recommended.

scholarly journals Maternal and fetal outcomes of obese pregnant women: a prospective cohort study

2017 ◽  
Vol 6 (2) ◽  
pp. 725
Author(s):  
Jenniferbritto John ◽  
Mary Mahendran
Keyword(s):  
Diabetes Mellitus ◽  
Caesarean Section ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Maternal Obesity ◽  
Gestational Hypertension ◽  
Induction Of Labour ◽  
Control Group ◽  
Fetal Outcomes

Background: Obesity in Indian women had increased from 10.6% to 14.8% in India. Mothers who are overweight or obese during pregnancy and childbirth cause significant antenatal, intrapartum, postpartum and also neonatal complications. The present study aimed to explore various maternal and fetal outcomes influenced by maternal obesity. The objective was to find the effect of obesity on maternal and perinatal outcome among obese pregnant women compared to those of normal weight.Methods: The study was conducted in antenatal women attending antenatal outpatient department of CSI rainy multispecialty hospital located in North Chennai of South India. Consecutive sampling method was followed to include 50 cases and 50 controls. Analysis was done with IBM SPSS v.21.0. Chi square test was applied to find difference between proportions. For comparison of means independent t-test and ANOVA was applied. Pearson's correlation was done to find association between maternal BMI and birth weight.Results: Sixteen (32%) cases developed gestational diabetes mellitus during their antenatal period and 19 (38%) developed gestational hypertension. 10% underwent in emergency caesarean section and in 28% cases elective caesarean section was done. The proportion of cases who developed ante partum complications including gestational diabetes mellitus, gestational hypertension and preeclampsia were higher than in control groups (p value = 0.03,0.00,0.004 respectively). The need for induction of labour and caesarean section was found to be higher in cases than in controls (p = 0.014,0.03 respectively). Increased NICU admissions for stabilization of the newborn among cases was higher than control group (p = 0.012).Conclusions: It was clearly evident from the present study that maternal obesity had adverse maternal and fetal outcomes. Maternal obesity was strongly associated with antenatal complications like gestational diabetes mellitus, gestational hypertension, preeclampsia and increase in need for induction of labour and operative interference.

scholarly journals Prophylactic perioperative cefuroxime levels in plasma and adipose tissue at the time of caesarean section (C-LACE): a protocol for a pilot experimental, prospective study with non-probability sampling to determine interpatient variability

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Hanadi H. Alrammaal ◽  
Hannah K. Batchelor ◽  
Hsu P. Chong ◽  
Victoria Hodgetts Morton ◽  
R. Katie Morris
Keyword(s):  
Adipose Tissue ◽  
Caesarean Section ◽  
Pregnant Women ◽  
Tissue Concentration ◽  
Skin Incision ◽  
Skin Closure ◽  
Obese Women ◽  
Surgical Infection ◽  
Link Type ◽  
Study Participants

Abstract Background The aim of the C-LACE study is to measure cefuroxime concentration in plasma and adipose tissue of non-obese and obese pregnant women undergoing caesarean section. Methods This study plans to compare maternal cefuroxime concentrations (plasma and adipose tissue), at the time of skin incision and time of skin closure during a caesarean section from non-obese (body mass index BMI < 30 kg/m2) and obese (BMI ≥ 30 kg/m2) pregnant women. The incidence of post-surgical site infection will also be measured. At least 15 participants are required for each arm (non-obese vs obese) with a total of 30 participants. The study participants will be followed up between 30 and 40 days post-caesarean section to record details of any post-caesarean surgical infection to explore correlations between BMI, measured cefuroxime concentrations and post-caesarean infection rates. Discussion This pilot study will allow the development of a model testing the inter-patient variability in plasma and adipose tissue concentrations of cefuroxime. The results will facilitate the development of a larger study to determine whether differences in cefuroxime plasma and tissue concentration in obese and non-obese women can support the development of a physiologically based pharmacokinetic model. This model can then be used to propose dosing adjustments that can be used in a further trial to optimise cefuroxime dosing for women undergoing caesarean section. Trial registration ISRCTN Registry, ISRCTN17527512. Registered on 26 October 2020

scholarly journals Maternal obesity and stillbirth at term; placental pathology—A case control study

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250983
Author(s):  
Hanna Åmark ◽  
Magnus Westgren ◽  
Meeli Sirotkina ◽  
Ingela Hulthén Varli ◽  
Martina Persson ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Potential Role ◽  
Maternal Obesity ◽  
Case Control Study ◽  
Case Control ◽  
Normal Weight ◽  
Obese Women ◽  
Control Study ◽  
Velamentous Cord Insertion

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.

scholarly journals Comparison of breastfeeding self-efficacy and breastfeeding success of obese and normal-weight mothers in the early period

2020 ◽  
Vol 20 (4) ◽  
pp. 2022-31
Author(s):  
Sinem Ceylan ◽  
Sevil Şahin
Keyword(s):  
Body Mass Index ◽  
Self Efficacy ◽  
Maternal Obesity ◽  
Early Period ◽  
Postnatal Period ◽  
Normal Weight ◽  
Milk Secretion ◽  
Obese Women ◽  
Perception Of Self ◽  
The Mean

Background: Body mass index (BMI) of overweight and obese women is a risk factor for breast milk secretion. Aim: This study was conducted in a descriptive and comparative way in order to identify the relation between the breastfeed- ing success and self-efficacy of obese and non-obese mothers during postnatal period and to make a comparison between the obese and non-obese group. Methods: The study sample consisted of 113 obese and 111 non-obese mothers that met the study criteria who were hos- pitalized at the postnatal service of Health Education and Research Hospital in Ankara, September 2014-February 2015. Result: The mean BMI of obese women prior to the pregnancy was 31.41±2.4 while it was 22.25±2.8 for the non-obese women. As the BSS scores increase among both the obese and non-obese mothers, the LATCH breastfeeding success score averages increase as well (p<0.05, r:0.613). Conclusion: In the light of the data of, to increase the breastfeeding success among obese mothers, it is suggested that the perception of self-efficacy is enhanced, and additional consultation is provided on breastfeeding starting from the antena- tal period. The trainings given to mothers by the midwife and nurse are supported with home visits especially in the obese women in the postnatal period in order for them to breastfeeding. Keywords: Breastfeeding success; self-efficacy; maternal obesity.

scholarly journals Maternal early pregnancy obesity and depressive symptoms during and after pregnancy

2018 ◽  
Vol 48 (14) ◽  
pp. 2353-2363 ◽  
Author(s):  
Satu M. Kumpulainen ◽  
Polina Girchenko ◽  
Marius Lahti-Pulkkinen ◽  
Rebecca M. Reynolds ◽  
Soile Tuovinen ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Early Pregnancy ◽  
Maternal Obesity ◽  
Depression Scale ◽  
Epidemiological Studies ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Obese Women ◽  
Medical Birth Register ◽  
Clinically Significant

AbstractBackgroundPrevious studies have linked maternal obesity with depressive symptoms during and after pregnancy. It remains unknown whether obesity associates with consistently elevated depressive symptoms throughout pregnancy, predicts symptoms postpartum when accounting for antenatal symptoms, and if co-morbid hypertensive and diabetic disorders add to these associations. We addressed these questions in a sample of Finnish women whom we followed during and after pregnancy.MethodsEarly pregnancy body mass index, derived from the Finnish Medical Birth Register and hospital records in 3234 PREDO study participants, was categorized into underweight (<18.5 kg/m2), normal weight (18.5–24.99 kg/m2), overweight (25–29.99 kg/m2), and obese (⩾30 kg/m2) groups. The women completed the Center for Epidemiological Studies Depression Scale biweekly during pregnancy, and at 2.4 (s.d.= 1.2) and/or 28.2 (s.d.= 4.2) weeks after pregnancy.ResultsIn comparison to normal weight women, overweight, and obese women reported higher levels of depressive symptoms and had higher odds of clinically significant depressive symptoms during (23% and 43%, respectively) and after pregnancy (22% and 36%, respectively). Underweight women had 68% higher odds of clinically significant depressive symptoms after pregnancy. Overweight and obesity also predicted higher depressive symptoms after pregnancy in women not reporting clinically relevant symptomatology during pregnancy. Hypertensive and diabetic disorders did not explain or add to these associations.ConclusionsMaternal early pregnancy overweight and obesity and depressive symptoms during and after pregnancy are associated. Mental health promotion should be included as an integral part of lifestyle interventions in early pregnancy obesity and extended to benefit also overweight and underweight women.

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