The immunological profile of maternal obesity at 28 weeks of gestation underpins common negative pregnancy outcomes

Healthy pregnancy is accompanied by various immunological and metabolic adaptations. Maternal obesity has been implicated in adverse pregnancy outcomes such as miscarriage, preeclampsia, and gestational diabetes mellitus (GDM), while posing a risk to the neonate. There is a lack of knowledge surrounding obesity and the maternal immune system. The objective of this study was to consider if immunological changes in pregnancy are sabotaged by maternal obesity. Peripheral blood was collected from fasted GDM-negative pregnant women at 26-28 weeks of gestation. Analysis was done using immunoassay, flow cytometry, bioenergetics analysis and cell culture. The plasma profile was significantly altered with increasing BMI, specifically leptin (r=0.7635), MCP-1 (r=0.3024) and IL-6 (r=0.4985). Circulating leukocyte populations were also affected with changes in the relative abundance of intermediate monocytes (r=-0.2394), CD4:CD8 T cell ratios (r=0.2789), and NKT cells (r=-0.2842). Monocytes analysed in more detail revealed elevated CCR2 expression and decreased mitochondrial content. However, LPS-stimulated cytokine production and bioenergetic profile of MNCs was not affected by maternal BMI. The Th profile skews towards Th17 with increasing BMI; Th2 (r=-0.3202) and Th9 (r=-0.3205) cells were diminished in maternal obesity, and CytoStimTM-stimulation exacerbates IL-6 (r=0.4166), IL-17A (r=0.2753), IL-17F (r=0.2973) and IL-22 (r=0.2257) production with BMI, while decreasing IL-4 (r=-0.2806). Maternal obesity during pregnancy creates an inflammatory microenvironment. Successful pregnancy requires Th2-biased responses yet increasing maternal BMI favours a Th17 response that could be detrimental to pregnancy. Further research should investigate key populations of cells identified here to further understand the immunological challenges that beset pregnant women with obesity.

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Is Indoor Air Pollution From Different Fuel Types Associated With the Anemia Status of Pregnant Women in Ethiopia?

Journal of Primary Care & Community Health ◽

10.1177/21501327211034374 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110343

Author(s):

Sewitemariam Desalegn Andarge ◽

Abriham Sheferaw Areba ◽

Robel Hussen Kabthymer ◽

Miheret Tesfu Legesse ◽

Girum Gebremeskel Kanno

Keyword(s):

Air Pollution ◽

Logistic Regression ◽

Pregnant Women ◽

Indoor Air ◽

Pregnancy Outcomes ◽

Indoor Air Pollution ◽

Adverse Pregnancy Outcomes ◽

Outcome Variable ◽

Multivariable Logistic Regression Analysis ◽

Adverse Pregnancy

Background Indoor air pollution from different fuel types has been linked with different adverse pregnancy outcomes. The study aimed to assess the link between indoor air pollution from different fuel types and anemia during pregnancy in Ethiopia. Method We have used the secondary data from the 2016 Ethiopian Demographic and Health Survey data. The anemia status of the pregnant women was the dichotomous outcome variable and the type of fuel used in the house was classified as high, medium, and low polluting fuels. Logistic regression was employed to determine the association between the exposure and outcome variables. Adjusted Odds Ratio was calculated at 95% Confidence Interval. Result The proportion of anemia in the low, medium, and high polluting fuel type users was 13.6%, 46%, 40.9% respectively. In the multivariable logistic regression analysis, the use of either kerosene or charcoal fuel types (AOR 4.6; 95% CI: 1.41-18.35) and being in the third trimester (AOR 1.72; 95% CI: 1.12-2.64) were significant factors associated with the anemia status of the pregnant women in Ethiopia. Conclusion According to our findings, the application of either kerosene or charcoal was associated with the anemia status during pregnancy in Ethiopia. An urgent intervention is needed to reduce the indoor air pollution that is associated with adverse pregnancy outcomes such as anemia.

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Maternal obesity influences birth weight more than gestational diabetes

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03571-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Eman M Alfadhli

Keyword(s):

Birth Weight ◽

Gestational Diabetes ◽

Pregnancy Outcomes ◽

Maternal Obesity ◽

Reference Group ◽

Adverse Pregnancy Outcomes ◽

Antenatal Visit ◽

Oral Glucose ◽

The Mean ◽

Adverse Pregnancy

Abstract Background Maternal obesity and gestational diabetes (GDM) are commonly encountered during pregnancy. Both conditions are independently associated with unfavorable pregnancy consequences. The objective of this study was to compare the effects of obesity and GDM on birth weight, macrosomia, and other adverse pregnancy outcomes. Methods This cohort study involved 531 women with a singleton pregnancy attending the Maternity and Children’s Hospital, Medina, Saudi Arabia, between June 2014 and June 2015. Participants underwent a 75-g oral glucose tolerance test between 24 and 28 weeks. The International Association of Diabetes and Pregnancy Study Groups criteria were used for GDM diagnosis. BMI was assessed at the first antenatal visit, and obesity was defined as a BMI ≥30.0 kg/m2. All women were followed up until delivery. Women were divided into 4 groups: non-GDM nonobese (reference group), GDM nonobese, obese non-GDM, and obese GDM. Clinical characteristics and adverse pregnancy outcomes were compared. Results The mean age and BMI of the participants were 30.5 years and 29.3 kg/m2, respectively. GDM was diagnosed in 50.2% of the participants, and obesity was diagnosed in 47.8% of the participants. Obese women with GDM were the oldest and heaviest among all women. The mean birth weight increased in order among the four groups; it was highest in the infants in the obese GDM group, followed by those in the obese non-GDM, GDM nonobese and reference groups. Obesity and GDM alone or in combination were associated with higher rates of macrosomia and cesarean deliveries than the reference group. Neonatal intensive care unit (NICU) admission was higher in infants in the GDM nonobese and obese GDM groups. The frequency of low Apgar score was significantly higher in infants in the obese GDM group than in infants in the reference group. Conclusions Maternal obesity seems to influence birth weight more than GDM, while GDM is associated with a greater risk of admission to the NICU. The combination of both conditions is associated with the greatest risk of adverse pregnancy outcomes.

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Pregnancy outcomes in women with inflammatory bowel disease following exposure to thiopurines and antitumor necrosis factor drugs

Human & Experimental Toxicology ◽

10.1177/0960327114550882 ◽

2014 ◽

Vol 34 (5) ◽

pp. 445-459 ◽

Cited By ~ 26

Author(s):

S Mozaffari ◽

AH Abdolghaffari ◽

S Nikfar ◽

M Abdollahi

Keyword(s):

Inflammatory Bowel Disease ◽

Pregnant Women ◽

Bowel Disease ◽

Pregnancy Outcomes ◽

Congenital Abnormalities ◽

Meta Analysis ◽

Adverse Pregnancy Outcomes ◽

Inflammatory Bowel ◽

Adverse Pregnancy ◽

Necrosis Factor

Several studies have indicated the harmful effect of flare-up periods in pregnant women with inflammatory bowel disease (IBD) on their newborns. Therefore, an effective and safe medical treatment during pregnancy is of great concern in IBD patients. The aim of this study was to perform a meta-analysis on the outcomes of thiopurines use and a systematic review of antitumor necrosis factor (anti-TNF) drugs used during pregnancy in women with IBD. The results of cohorts evaluating the safety of anti-TNF drugs during pregnancy up to July 2013 were collected and analyzed. In the meta-analysis, a total of 312 pregnant women with IBD who used thiopurines were compared with 1149 controls (women with IBD who were not treated with any medication and women who were exposed to drugs other than thiopurines) to evaluate the drug effect on different pregnancy outcomes, including prematurity, low birth weight, congenital abnormalities, spontaneous abortion, and neonatal adverse outcomes. Results of statistical analysis demonstrated that congenital abnormalities were increased significantly in thiopurine-exposed group in comparison with control group who did not receive any medicine for IBD treatment. The summary odds ratio was 2.95 with 95% confidence interval = 1.03–8.43 ( p = 0.04). We observed no significant differences in occurrence of other adverse pregnancy outcomes between compared groups. The results of cohorts evaluated the safety of anti-TNF drugs during pregnancy demonstrated no increase in occurrence of adverse pregnancy outcomes in comparison with controls except for the significant decrease in gestational age of newborns of drug-exposed mothers in one trial. In conclusion, a benefit–risk ratio should be considered in prescribing or continuing medicinal therapy during pregnancy of IBD patients.

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The consequences of obesity and excess weight gain in pregnancy

Proceedings of The Nutrition Society ◽

10.1017/s0029665111003077 ◽

2011 ◽

Vol 70 (4) ◽

pp. 450-456 ◽

Cited By ~ 81

Author(s):

Jane E. Norman ◽

Rebecca Reynolds

Keyword(s):

Insulin Resistance ◽

Weight Gain ◽

Gestational Diabetes ◽

Pregnant Women ◽

Postpartum Haemorrhage ◽

Maternal Obesity ◽

Adverse Pregnancy Outcome ◽

Operative Delivery ◽

Adverse Pregnancy ◽

In Pregnancy

The prevalence of obesity in pregnancy is rising exponentially; about 15–20% of pregnant women now enter pregnancy with a BMI which would define them as obese. This paper provides a review of the strong links between obesity and adverse pregnancy outcome which operate across a range of pregnancy complications. For example, obesity is associated with an increased risk of maternal mortality, gestational diabetes mellitus, thromboembolism, pre-eclampsia and postpartum haemorrhage. Obesity also complicates operative delivery; it makes operative delivery more difficult, increases complications and paradoxically increases the need for operative delivery. The risk of the majority of these complications is amplified by excess weight gain in pregnancy and increases in proportion to the degree of obesity, for example, women with extreme obesity have OR of 7·89 for gestational diabetes and 3·84 for postpartum haemorrhage compared to their lean counterparts. The consequences of maternal obesity do not stop once the baby is born. Maternal obesity programmes a variety of long-term adverse outcomes, including obesity in the offspring at adulthood. Such an effect is mediated at least in part via high birthweight; a recent study has suggested that the odds of adult obesity are two-fold greater in babies weighing more than 4 kg at birth. The mechanism by which obesity causes adverse pregnancy outcome is uncertain. This paper reviews the emerging evidence that hyperglycaemia and insulin resistance may both play a role: the links between hyperglycaemia in pregnancy and both increased birthweight and insulin resistance have been demonstrated in two large studies. Lastly, we discuss the nature and rationale for possible intervention strategies in obese pregnant women.

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Adverse pregnancy outcomes are associated with Plasmodium vivax malaria in a prospective cohort of women from the Brazilian Amazon

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009390 ◽

2021 ◽

Vol 15 (4) ◽

pp. e0009390

Author(s):

Jamille Gregório Dombrowski ◽

André Barateiro ◽

Erika Paula Machado Peixoto ◽

André Boler Cláudio da Silva Barros ◽

Rodrigo Medeiros de Souza ◽

...

Keyword(s):

Pregnant Women ◽

Pregnancy Outcomes ◽

Multivariate Logistic Regression Analysis ◽

Brazilian Amazon ◽

First Trimester ◽

Inflammatory Factors ◽

Anthropometric Measures ◽

First Trimester Of Pregnancy ◽

Adverse Pregnancy ◽

Angiopoietin 2

Background Malaria in Brazil represents one of the highest percentages of Latin America cases, where approximately 84% of infections are attributed to Plasmodium (P.) vivax. Despite the high incidence, many aspects of gestational malaria resulting from P. vivax infections remain poorly studied. As such, we aimed to evaluate the consequences of P. vivax infections during gestation on the health of mothers and their neonates in an endemic area of the Amazon. Methods and findings We have conducted an observational cohort study in Brazilian Amazon between January 2013 and April 2015. 600 pregnant women were enrolled and followed until delivery. After applying exclusion criteria, 329 mother-child pairs were included in the analysis. Clinical data regarding maternal infection, newborn’s anthropometric measures, placental histopathological characteristics, and angiogenic and inflammatory factors were evaluated. The presence of plasma IgG against the P. vivax (Pv) MSP119 protein was used as marker of exposure and possible associations with pregnancy outcomes were analyzed. Multivariate logistic regression analysis revealed that P. vivax infections during the first trimester of pregnancy are associated with adverse gestational outcomes such as premature birth (adjusted odds ratio [aOR] 8.12, 95% confidence interval [95%CI] 2.69–24.54, p < 0.0001) and reduced head circumference (aOR 3.58, 95%CI 1.29–9.97, p = 0.01). Histopathology analysis showed marked differences between placentas from P. vivax-infected and non-infected pregnant women, especially regarding placental monocytes infiltrate. Placental levels of vasomodulatory factors such as angiopoietin-2 (ANG-2) and complement proteins such as C5a were also altered at delivery. Plasma levels of anti-PvMSP119 IgG in infected pregnant women were shown to be a reliable exposure marker; yet, with no association with improved pregnancy outcomes. Conclusions This study indicates that P. vivax malaria during the first trimester of pregnancy represents a higher likelihood of subsequent poor pregnancy outcomes associated with marked placental histologic modification and angiogenic/inflammatory imbalance. Additionally, our findings support the idea that antibodies against PvMSP119 are not protective against poor pregnancy outcomes induced by P. vivax infections.

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FIRST TRIMESTER MATERNAL BMI AND PREGNANCY OUTCOME AT DMCH, LAHERIASARAI, BIHAR

10.36106/ijsr/6930378 ◽

2020 ◽

pp. 79-81

Author(s):

Supriya Kumari ◽

Surya Narayan ◽

Kumudini Jha ◽

Debarshi Jana

Keyword(s):

Pregnancy Outcome ◽

Pregnancy Outcomes ◽

First Trimester ◽

Normal Weight ◽

Obese Women ◽

Family History Of Diabetes ◽

Medical College ◽

Asian Indian Women ◽

Adverse Pregnancy ◽

Maternal Bmi

Aim: The aim of the study was to find out relationship of maternal BMI to pregnancy outcome. Methodology: The study carried out in Department of Obstetrics and Gynaecology, Darbhanga Medical College and Hospital, Laheriasarai, Bihar from February 2019 to January 2020 and pregnancy outcomes were analyzed in relation BMI recorded in first trimester of primigravida. Results: Mean age of pregnant women was 26.2 years. At first booking obese women were significantlyolder (28.0 years) than others. Family history of diabetes was significantly higher among obese women (8.25%) compared to others. Rates of cesarean sections were higher in obese compared to others. The macrosomia rates were higher in obese compared to other group. The preeclampsia (1.89%), were significantly higher in obese women than others. Conclusions: Obese women were at a high risk of developing adverse pregnancy outcomes in terms ofgestational diabetes, macrosomia, preeclampsia more of ceasarean section. Normal weight women have low risk for cesarean section and macrosomia. These results highlight the need for preconception counseling, especially for obese and overweight and have beneficial outcomes in Asian Indian women.

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COVID-19 Quarantine is a Risk Factor for Poor Pregnancy Outcomes in GDM Patients: A Retrospective Study

10.21203/rs.3.rs-836921/v1 ◽

2021 ◽

Author(s):

Qin-Yu Cai ◽

Yin Yang ◽

Ling-Ling Ruan ◽

Dang-Dang Wang ◽

Han-Lin Cui ◽

...

Keyword(s):

Pregnant Women ◽

Electronic Medical Records ◽

Pregnancy Outcomes ◽

Medical Records ◽

Control Group ◽

Second Trimester ◽

Public Health Emergencies ◽

Nuchal Cord ◽

Adverse Pregnancy ◽

Glucose Management

Abstract Aims: This study was to evaluate the effects of the home quarantine on pregnancy outcomes of gestational diabetes mellitus (GDM) patients during the COVID-19 outbreak.Methods: Thecomplete electronic medical records of GDM patients with home quarantine history were collected and classified into the home quarantine group from 24 February 2020 to 24 November 2020. The same period of GDM patients without home quarantine historywas included in the control group from 2018 and 2019.Results: A total of 1358 GDM patients were included in the analysis, including 484 in 2018, 468 in 2019, and 406 in 2020. GDM patients with home quarantine in 2020 had higher glycemic levels and worse pregnancy outcomes than 2018 and 2019, including higher cesarean section rate,lower Apgar scores, and higher incidence of macrosomia and nuchal cord. More importantly, the second trimester of home quarantine had brought a broader impactto pregnant women and fetuses.Conclusion: Home quarantine has aggravated the condition of GDM pregnant women and brought more adverse pregnancy outcomes during the COVID-19 outbreak. Therefore, we suggested that governments and hospitals should strengthen lifestyle guidance, glucose management, and antenatal care for GDM patients with home quarantine during public health emergencies.

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Study on the Relationship Between Hepatitis B Virus Infection in Pregnant Women and Adverse Pregnancy Outcomes

10.21203/rs.3.rs-144411/v1 ◽

2021 ◽

Author(s):

Zhi-Hao Huang ◽

Ting-Ting Peng ◽

Sheng-Guang Yan ◽

Dong-Dong Yu ◽

Jun-Chao Qiu ◽

...

Keyword(s):

Pregnant Women ◽

Pregnancy Outcomes ◽

Hbv Dna ◽

Adverse Pregnancy Outcomes ◽

Hbv Infection ◽

Hbsag Carrier ◽

B Virus ◽

Adverse Pregnancy ◽

Dna 2 ◽

The Relationship

Abstract Objective: Aim to the relationship between adverse pregnant outcomes with chronic hepatitis B virus (HBV) infection in pregnant women. Simultaneously, assess the incidence of adverse pregnancy outcomes (APO) among different serum HBV status in pregnant women. Method: From 2017 to 2019, we studied HBsAg (+) pregnant women and HBsAg (-) who gave birth at our hospital in Guangzhou City, China. We compared of the incidence of pregnant women with HBsAg(+) or HBsAg(-). Further, among HBsAg(+) pregnant women, We compared of the incidence of pregnant women with HBeAg(+) group or HBeAg(-) group, high HBV DNA loads (HBV DNA≥2×10^5IU/mL) group or low HBV DNA loads (HBV DNA＜2×10^5IU/mL) group, respectively. Finally, multivariate logistic regression analysis was used to evaluate the independent association between HBV infection and the risk of developing APO.Result: First, Our research Indicates that the rates of gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP), premature rupture of membrane (PROM), Fetal distress (FD), Oligohydramnios, Premature delivery (PD), Low birth weight (LBW), Meconium contamination (MC), Neonatal hyperbilirubinemia(NH) in HBsAg(+) group were higher than those in HBsAg(-) group (P<0.05). Second, among 711 HBsAg(+) pregnant women, the rates of GDM and ICP in high loads of HBV DNA were higher than those in low loads of HBV DNA group (P<0.05). Similarly, The rates of ICP in HBeAg(+) group were higher than those in HBeAg(-) group. Further, through multivariable logistical regression model analysis, we observed maternal HBsAg carrier (OR, 6.758; 95% CI, 2.358-19.369) had an independent risk for ICP. Similarly, HBsAg carrier(OR, 1.101; 95% CI, 1.066-1.137) ,advanced age (OR, 1.407; 95% CI,1.016-1.137) and abortion(OR,1.446; 95% CI, 1.062-1.969) had independent risk for GDM. Conclusions: Chronic HBV infection can increase the rate of host adverse pregnancy outcomes (APO). The maternal viral load and HBeAg status were significantly associated with the incidence of GDM and ICP. Maternal HBsAg carrier had an independent risk for GDM and ICP.

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Prenatal oral health literacy status: a survey on patient’s perception and awareness among health care professionals

RGUHS Journal of Dental Sciences ◽

10.26715/rjds.9_2_5 ◽

2017 ◽

Vol 9 (2) ◽

pp. 16-22

Author(s):

Sandya Devi S Patil ◽

Madhu K ◽

Rachna Thakur ◽

Santhosh T Paul ◽

Mihir Nayak

Keyword(s):

Health Care ◽

Oral Health ◽

Pregnant Women ◽

Pregnancy Outcomes ◽

Health Care Professionals ◽

Oral Care ◽

Oral Health Care ◽

Attitude And Practice ◽

Group A ◽

Adverse Pregnancy

Pregnancy is characterized by complex physiological changes which may adversely affect the oral health and pregnancy outcomes. This study reports a survey on assessing the knowledge, attitude and practice behaviours of gynaecologists and oral health care professionals towards prenatal oral care and barriers limiting the utilization of prenatal oral care health care to pregnant women. The study population comprised of 3 groups: A- Gynaecologists, B- oral health care professionals and C – Pregnant women, 100 in each group. The prevalidated questionnaire included questions about their knowledge, attitude, beliefs and practices regarding oral health care for pregnant women. The data obtained was subjected to statistical analysis using ANOVA test and Pearson’s correlation test. The response rate was 100%. Regarding the association of periodontal disease and adverse pregnancy outcomes, Group A (75%) have high degree of knowledge than B (61%) and C (36%) but the attitude and practice behaviors were significantly high in Group B as compared to Group A and Group C Two-thirds of respondents in both Group A and B (75%) were interested in receiving continuing dental education (CDE) regarding the care of pregnant women.The self-assessed maternal barriers evaluated in this study were lack of knowledge, lack of perceived need.

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