Obesity and Lifestyle Indicators Impact on Obstetric Complications and Fetal Outcome in North Lebanon Population

Worldwide, obesity has been shown to negatively affect women especially during pregnancy. In this work, a retrospective cohort study for 1308 women, who gave birth between 2014 and 2016 in public and private hospitals, was conducted to evaluate the impact of weight, demographic and lifestyle indicators on many pregnancy and fetal outcomes in Northern Lebanon. The frequent health complications related to pregnancy were cesarean-section (31.1%) followed by post-hemorrhage (25.1%), induced labor (23.5%) and macrosomia (11.4%). Multivariate analysis showed that the main complications were highly correlated to obesity, macrosomia, weight gain, multiparity and mother’s age. High values from adjusted odds ratios were mainly associated to obesity, multiparity and weight gain. Obese pregnant women had a significant increased risk of having cesarean-section (p<0.001), preeclampsia (p<0.0001), labor induction (p<0.0001) and postpartum hemorrhage (p<0.0001). Adverse fetal outcomes such as macrosomia were also correlated with high BMI (p<0.0001). The risk was even greater for multiparous, older women that carried excessive weight gain. There is therefore a need to increase awareness among the target population and encourage prevention of the dangers related to obesity and weight gain.

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New and Emerging Mobile Technologies for Healthcare (mHealth): A Horizon Scanning Study

Frontiers in Health Informatics ◽

10.30699/fhi.v8i1.196 ◽

2019 ◽

Vol 8 (1) ◽

pp. 17

Author(s):

Azar Kazemi ◽

Hosna Salmani ◽

Alireza Shakibafard ◽

Farhad Fatehi

Keyword(s):

Health Services ◽

Mobile Apps ◽

Preventive Health Services ◽

Target Population ◽

Mobile Technologies ◽

Full Potential ◽

Public And Private ◽

Innovative Technologies ◽

Horizon Scanning ◽

The Impact

Introduction: The popularity of mobile phone applications (Apps) and wearable devices for medical and health purposes is on the rise, but not all the mobile health (mHealth) innovative solutions that hit the news every day will sustain and have an impact on the health of people. The aim of this news-based horizon scanning study was to explore and identify new and emerging mobile technologies that are likely to impact the future of health and medical care.Methods: We conducted a systematic search on top ranking technology websites, according to Alexa Ranking, to identify health-related mobile-based technologies. We followed the EuroScan guide for horizon scanning, which recommends four steps: identification, filtering, prioritization, evaluation and conclusion. Technologies of interest were mHealth technologies regardless of their maturity level. The impact of technologies was assessed and scored in four areas: user, technology, safety, and cost.Results: Five hundred news articles were identified through the electronic search. After screening, 106 mHealth innovative technologies were included in this study. We categorized the included technologies into three groups: mobile apps (n=37), smart-connected devices (n=19), and wearables (n=50). mHealth technologies were most frequently developed for preventive health services, mental health services and rehabilitation services. There was no remarkable difference between the technology groups in terms of safety and adverse effects, but the groups were significantly different in terms of the target population, technology, and cost.Conclusion: An increasing number of solutions based on mobile technology is being developed by both public and private sectors but a low proportion of them undergo proper scientific evaluations. Despite the commercial availability of many innovative mobile apps, wearables, and smart connected devices, few of them have been actually used in clinics, hospitals, and health centers. There is a clear need for changes in healthcare service models to unlock the full potential of these innovative technologies.

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High Rate of Fatal Overdose After Release from Prison In BC, Canada: A Data Linkage Study

International Journal for Population Data Science ◽

10.23889/ijpds.v5i5.1606 ◽

2020 ◽

Vol 5 (5) ◽

Author(s):

Stuart A Kinner ◽

Wenqi Gan ◽

Amanda Slaunwhite

Keyword(s):

Risk Factors ◽

Target Population ◽

Linkage Study ◽

High Rate ◽

Physical And Mental Health ◽

Overdose Death ◽

Fatal Overdose ◽

Increased Risk ◽

The Impact ◽

Release From Prison

IntroductionThe province of BC, Canada is in the grips of a sustained overdose epidemic. People released from prison are at increased risk of fatal drug overdose, but the impact of the overdose epidemic on mortality after release from prison in BC is poorly understood. Few studies have been able to examine risk factors for overdose death in this population. Objectives and ApproachWe aimed to (a) measure risk of overdose-related and all-cause death in different time periods after release from prison; and (b) identify risk factors for overdose-related and all-cause death. In a random 20% sample of the population of BC, Canada, we identified those released from prison 2015-2017 and examined linked health and correctional records for this cohort. ResultsOf 6106 persons released from prison 2015-2017, 77 (1.3%) died from any cause and 48 (0.8%) died from overdose 2015-2017. The incidence of all-cause death was 16.1 (95%CI 13.7-18.8) per 1000 person years, and the incidence of overdose death was 11.2 (95%CI 9.2-13.5) per 1000 person years. Risk factors for overdose death included a history of 3 or more incarcerations (HR=3.00, 95%CI 1.67-5.39), co-occurring substance use disorder and mental illness (HR=4.73, 95%CI 2.94-7.62), chronic physical morbidity (HR=3.10, 95%CI 1.97-4.88), and being dispensed benzodiazepines (HR=3.31, 95%CI 2.27-4.84) or opioids for pain (HR=6.77, 95%CI 3.86-11.89). The incidence of fatal overdose was significantly higher in the first two weeks post-release than at any other time during follow-up. ConclusionPeople released from prison in BC are at markedly increased risk of preventable death, mainly due to overdose. As such, people transitioning from prison to the community should be a key target population for overdose prevention efforts. To be maximally effective, these efforts must go beyond provision of methadone and naloxone on release, to consider physical and mental health comorbidities, and psychosocial disadvantage.

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Abstract 15775: The Impact of B-type Natriuretic Peptide Activation on the Association of Left Ventricular Longitudinal Strain With All-cause Mortality

Circulation ◽

10.1161/circ.132.suppl_3.15775 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Zi Ye ◽

Maurice Enriquez-Sarano ◽

Joseph Malouf ◽

Hector I Michelena ◽

Allan S Jaffe ◽

...

Keyword(s):

Aortic Valve ◽

Natriuretic Peptide ◽

Longitudinal Strain ◽

Left Ventricular ◽

Aortic Valve Area ◽

Increased Risk ◽

Highly Correlated ◽

The Impact ◽

Normal Lvef

Introduction: Left ventricular longitudinal strain (LV-LS) 1) predicts mortality in patients with aortic stenosis (AS) and 2) is highly correlated to type-B natriuretic peptide (BNP) values. The BNP ratio (measured BNP/maximal expected BNP value specific for age and sex) is a powerful independent predictor of death in patients with AS. Hypothesis: we hypothesize that BNP activation (i.e. BNP ratio >1) affects the association between LV-LS and mortality in patients with asymptomatic AS and preserved LV ejection fraction (EF ≥50%). Methods: 315 patients (age 74±12 years, 56% men and mean aortic valve area = 1.02±0.15cm2) underwent simultaneous Doppler echocardiographic and BNP measurements. LV-LS was calculated as the average of 12 LV segments from apical 2- and 4-chamber views using Velocity Vector Imaging. Results: Mean LV-LS was -16.8±3.2%, LV EF 66±7%, median BNP level 121 (interquartile 48-320) pg/ml. 58% of patients had BNP activation. Better LV-LS was associated with lower log BNPratio (regression coefficient 0.10, p<0.001). After a median follow-up of 6.5 yrs (interquartile: 3.6-8.2), 119 deaths occurred. After adjustment for age, sex, Charlson score index, hemoglobin level, aortic valve replacement (as a time dependent variable), LV-LS and log BNPratio were separately associated with increased risk for death (all p<0.01). Further adjustment for predictors of mortality, LV-LS and log-BNP ratio remained associated with increased risk for death (hazard ratio HR [95%CI]: 1.09 [1.03-1.15]; p=0.003 and 1.82 [1.52-2.19]; p<0.0001 respectively). In patients without BNP activation (i.e. normal BNP), LV-LS was associated with mortality (HR: 1.22 [1.04-1.43]; p=0.01) while it was not in patients with BNP activation (p=0.22). Conclusions: In patients with asymptomatic AS, without clinically obvious myocardial impairment (i.e. normal LVEF), a notable proportion of patients present with myocardial alterations detected by an elevated BNPratio or reduced LV-LS. These signs of myocardial alterations were predictive of mortality after diagnosis. Thus both BNP and LV-LS should be assessed in the clinical setting to provide complementary information on prognosis in patients with asymptomatic AS and preserved LV EF.

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Maternal Body Mass Index and Gestational Weight Gain and Their Association with Pregnancy Complications and Perinatal Conditions

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16101751 ◽

2019 ◽

Vol 16 (10) ◽

pp. 1751 ◽

Cited By ~ 11

Author(s):

Martin Simko ◽

Adrian Totka ◽

Diana Vondrova ◽

Martin Samohyl ◽

Jana Jurkovicova ◽

...

Keyword(s):

Weight Gain ◽

Cesarean Section ◽

Gestational Weight Gain ◽

Gestational Hypertension ◽

Overweight And Obesity ◽

University Hospital ◽

Maternal Body Mass Index ◽

Gestational Weight ◽

Gynecology And Obstetrics ◽

The Impact

This study aimed to evaluate the impact of selected pregnancy pathologies statistically depending on overweight/obesity and excessive maternal weight gain during pregnancy on women who gave birth in the years 2013–2015 at the Second Department of Gynecology and Obstetrics at the University Hospital in Bratislava, Slovakia. In a retrospective study, we analyzed data gathered from the sample, which consisted of 7122 women. Our results suggest a statistically significant, higher risk for the groups of women with overweight and obesity and gestational hypertension (adjusted odds ratio (AOR) = 15.3; 95% CI 9.0−25.8 for obesity), preeclampsia (AOR = 3.4; 95% CI 1.9−6.0 for overweight and AOR = 13.2; 95% CI 7.7−22.5 for obesity), and gestational diabetes mellitus (AOR = 1.9; 95% CI 1.2−2.9 for overweight and AOR = 2.4; 95% CI 1.4−4.0 for obesity). A higher incidence of pregnancies terminated by cesarean section was observed in the group of obese women. Gestational weight gain above IOM (Institute of Medicine) recommendations was associated with a higher risk of pregnancy terminated by C-section (AOR = 1.2; 95% CI 1.0−1.3), gestational hypertension (AOR = 1.7; 95% CI 1.0−2.7), and infant macrosomia (AOR = 1.7; 95% CI 1.3−2.1). Overweight and obesity during pregnancy significantly contribute to the development of pregnancy pathologies and increased incidence of cesarean section. Systematic efforts to reduce weight before pregnancy through prepregnancy dietary counseling, regular physical activity, and healthy lifestyle should be the primary goal.

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Weight Gain in the First 10 Days after Hematopoietic Stem Cell Transplantation (HSCT) Is a Risk Factor for Early Mortality

Blood ◽

10.1182/blood.v124.21.2471.2471 ◽

2014 ◽

Vol 124 (21) ◽

pp. 2471-2471 ◽

Cited By ~ 1

Author(s):

Lucila Nassif Kerbauy ◽

Erika MM Costa ◽

Juliano Cordova Vargas ◽

Claudia Mac Donald Bley Nascimento ◽

Joyce E Hyppolito ◽

...

Keyword(s):

Risk Factor ◽

Weight Gain ◽

Conditioning Regimen ◽

Early Mortality ◽

Hematopoietic Stem ◽

Allogeneic Hsct ◽

Increased Risk ◽

Inflammatory State ◽

Unrelated Donors ◽

The Impact

Abstract Introduction: Hematopoietic stem cell transplantation (HSCT) is an effective treatment option for patients with hematological and neoplastic diseases. Despite recent improvements, HSCT is still associated with a significant risk of mortality. Determining risk factors for death within the first 100 days after HSCT could help to identify patients who would benefit from interventions in order to decrease that risk. We have previously reported that increased fluid accumulation during conditioning chemotherapy and in the early period after HSCT was associated with decreased survival (Costa EMM et al, ASH 2013Abstract #4512). Herein, we expand that series of patients and we further analyze the impact of weight gain on early (100-days) mortality in patients who underwent HSCT at our institution. Objective: To determine the impact of weight gain during the first 10 days post-HSCT on 100 days mortality. Methods:We retrospectively reviewed the medical charts of 331 patients who underwent HSCT at our institution from January, 2007 until December, 2013. Information on patients' body weight (BW) was measured daily, starting at admission. The highest BW recorded until until the first 10 days post-SCT (D+10) was used to calculate the BW increase in relation to the baseline BW. Based on our previous study, we used a cutoff of 6% gain in BW to identify a group of patients with increased risk of complications. The primary endpoint was mortality within 100 days post HSCT. Overall survival (OS) was estimated from the time of HSCT until death, and surviving patients were censored at last follow-up. A logistic regression model and a Cox model were fit to determine variables that predicted death within 100 days and OS, respectively. Statistical analysis was performed with STATA (v11.0) and alfa error was defined as 5%. Results: Median age was 43 years old (range <1 year-76 years) and 60% were male. HSC sources included autologous (46%), matched related donors (16%), matched unrelated donors (12%), cord blood units (16%) and mismatched related/unrelated donors (10%). Diagnosis included acute leukemia or chronic myeloid disorders (34%), lymphoma/multiple myeloma (42%) and non-malignant hematological disorders (24%). Twenty-one percent of patients had a ≥6% gain in BW until the first 10 days post-HSCT. These patients had developed an increased inflammatory state after the start of the conditioning regimen: there was no difference in baseline levels of C-reactive protein (4.8 mg/L vs. 7.4, p=0.37), but by D+10 patients who gained more BW had higher CRP (116.7 mg/L vs. 178.6 mg/L; p=0.01). Patients with increased gain in BW until D+10 had a decreased OS (HR 2.33, p<0.0001, 95% CI 1.45-3.73). The mortality within 100 days was 47% in the increased BW vs. 17% in the control group (p<0.0001). Among 18 patients who died within 100 days and had a ≥6% BW gain by D+10, causes of death included pneumonia (N=4), septic shock (N=9), fungal endocarditis (N=1), ischemic stroke (N=1) and disease progression (N=3). In a logistic regression analysis, after adjusting for age, sex, diagnosis and type of SCT, a ≥6% BW gain by D10 was associated with an increased risk of being dead within 100 days (coefficient 1.75; p<0.0001; 95% CI 0.90-2.61). Similarly, in a multivariate Cox analysis after adjusting for age, sex, diagnosis and type of SCT, a ≥6% BW gain by D10 was an independent risk factor for survival (HR 2.72, p<0.0001, 95% CI 1.65-4.48). A landmark analysis at D+100 revealed that the negative impact of weight gain by D+10 on survival was restricted to the first 100 days, as after this time point there was no survival difference between the two groups (HR 1.35; p=0.41; 95% CI 0.65-2.83). Conclusion: A ≥6% BW gain by D+10 is a risk factor for early mortality in both autologous and allogeneic HSCT. The most common cause of death in these patients is infectious-related complications. An increase in BW is related to the development of an inflammatory state, probably induced by the conditioning regimen. BW gain is a simple variable that can be easily used to determine prognosis of patients post-allogeneic HSCT, and further studies are needed to determine its etiology. Disclosures No relevant conflicts of interest to declare.

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Gestational Weight Gain Influences Neonatal Outcomes in Women With Obesity and Gestational Diabetes

10.21203/rs.3.rs-607107/v1 ◽

2021 ◽

Author(s):

Ana M Ramos-Levi ◽

Gemma Rodriguez-Carnero ◽

Cristina Garcia-Fontao ◽

Antia Fernandez-Pombo ◽

Paula Andújar-Plata ◽

...

Keyword(s):

Weight Gain ◽

Birth Weight ◽

Gestational Diabetes ◽

Gestational Weight Gain ◽

Gestational Age ◽

Perinatal Outcomes ◽

Large For Gestational Age ◽

Gestational Weight ◽

Increased Risk ◽

The Impact

Abstract Background. Obesity and gestational diabetes mellitus (GDM) are associated to increased risk of perinatal complications and obesity in the offspring. However, the impact of gestational weight gain (GWG) on maternal and fetal outcomes has led to controversial results. Research design and methods. Retrospective study of 220 women with GDM and pre-pregnancy body mass index (BMI) ≥ 30 kg/m2. Pregnant women were classified according to the Institute of Medicine (IOM) recommendations regarding prior BMI and GWG. We evaluated the impact of GWG on birth weight and perinatal outcomes. Results. Mean maternal age was 34.7±5.3 years. Pre-pregnancy obesity was classified as grade I in 55.3% of cases, grade II in 32.0%, and grade III in 12.7%. GWG was adequate (5-9kg) in 24.2%, insufficient (< 5kg) in 41.8% and excessive (> 9kg) in 34.2%. Birthweight was within normal range in 81.9%, 3.6% were small for gestational age (SGA) and 14.4% were large for gestational age (LGA). Insufficient GWG was associated to a higher rate of SGA offspring, excessive GWG was associated to LGA and adequate GWG to normal birth weight. Conclusion. GWG in women with pre-pregnancy obesity and GDM impacts neonatal birthweight. Insufficient GWG is associated to SGA and excessive GWG is associated to LGA. Women with adequate GWG according to IOM guidelines obtained better perinatal outcomes.

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Maternal Anthropometry and Intrauterine Growth Retardation (IUGR) - A Hospital Based Study

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v28i2.5366 ◽

1970 ◽

Vol 28 (2) ◽

pp. 73-80

Author(s):

Bishnupada Dhar ◽

Kazi Jahangir Hossain ◽

Subrata K Bhadra ◽

Aleya Mowlah ◽

Golam Mowlah

Keyword(s):

Weight Gain ◽

Positive Impact ◽

First Trimester ◽

Pregnancy Weight Gain ◽

Foetal Growth ◽

Increased Risk ◽

Maternity Hospitals ◽

Socio Demographic Factors ◽

Pregnancy Weight ◽

The Impact

This was a prospective observational study conducted on374 pregnant women who remained in the study beginningfrom first trimester until gave birth to singleton newbornbabies selected from five maternity hospitals located atdifferent regions in the country over a period of thirtymonths from July 2002 to December 2004. Objectives ofthe study were: (1) To find out the incidence of IUGR in thehospital based study, (2) To observe the impact of prepregnancyweight and pregnancy weight gain on IUGR,(3) To select appropriate cut off points of pre-pregnancyweight and pregnancy weight gain to identify women at riskfor delivering IUGR babies and (4) To observe theassociation between socio-demographic factors andmaternal anthropometry.Twenty one percent women delivered IUGR babies. Motherswho gained <4 kg in second trimester and <5kg in thirdtrimester gave birth to significantly higher incidence ofIUGR babies (29.1% and 35.3% respectively) in comparisonto mothers gained e” 4 kg and e” 5 kg who gave birth to14.4% and 9.3% IUGR babies (p<.001) . Maternal weightfor height in the lower range of normalcy at early pregnancywas associated with an increased risk of IUGR whencompare to normal or over weight for height group ofmothers (30.6% vs. 9.5%; p=<.001). The study revealedthat combination of <90 percent of standard weight forheight and net weight gain per week <125gm have strongnegative influence on foetal growth (39.5% IUGR babies).On the contrary, combination of e” 110 percent of weightfor height and weekly weight gain of e” 150 gm havesignificant positive impact on foetal growth (6.7% IUGR) .For total weight gain, best cut off point for identifying riskwomen of delivering IUGR babies was recommended 8.5kg and that for prepregnancy or first trimester weight was47.5 kg.Key words: Low birth weight; intrauterine growthretardation; AnthropometryDOI: 10.3329/jbcps.v28i2.5366J Bangladesh Coll Phys Surg 2010; 28: 73-80

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The Impact of Previous Cesarean Section on The Outcome in Patients With Non-Adherent Placenta Previa

10.21203/rs.3.rs-124915/v1 ◽

2020 ◽

Author(s):

Amer Sindiani ◽

Nail Obeidat ◽

Omar Abu-Azzam ◽

Heba Hijazi

Keyword(s):

Cesarean Section ◽

Placenta Previa ◽

Organ Injury ◽

P Value ◽

Fetal Outcomes ◽

Chi Square ◽

Artery Ligation ◽

Adherent Placenta ◽

Lower Segment Cesarean Section ◽

The Impact

Abstract Background: to evaluate the impact of lower segment cesarean section (LSCS) on the maternal and fetal outcomes of women with non-adherent placenta previa (PP). Methods: This is a retrospective study of all women who delivered at our hospital by LSCS with non-adherent PP over a period of 10 years. Data were obtained through hospital registry and medical records search. Data were analyzed using the Statistical Package for Social Sciences (SPSS, version 20). The differences in demographic and obstetric characteristics, peripartum complications, and fetal outcomes between women with no previous CS and those with previous CS were analyzed using t test or chi-square test wherever appropriate. A p-value of less than 0.05 was considered statistically significant. Results A total of 90 women with non-adherent placenta were included, 54 women with no previous CS and 36 women with previous CS. Women with previous CS were significantly more likely to experience organ injury (p-value <0.005), transfusion of ≥ 4 units of PRBC (p-value = 0.034), transfusion of FFP (p-value = 0.034), and hysterectomy or other procedure ( B Lynch, Uterine artery ligation) use (p-value <0.005)Conclusion: There is a significant increase in the incidence of maternal morbidities such as hysterectomy, blood transfusion and organ injury in patients with non-adherent PP with previous CS, with no difference in perinatal outcome in the same group of patients.

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Maternal pre-pregnancy body mass index, gestational weight gain and breastfeeding outcomes

10.21203/rs.2.18517/v3 ◽

2020 ◽

Author(s):

Hayley Martin ◽

Kelly Thevenet-Morrison ◽

Ann Dozier

Keyword(s):

Weight Gain ◽

Exclusive Breastfeeding ◽

Proportional Hazards ◽

Directed Acyclic Graphs ◽

Cox Proportional Hazards ◽

Cross Sectional ◽

Increased Risk ◽

Causal Pathway ◽

Breastfeeding Cessation ◽

The Impact

Abstract Background: It is well established that mothers with above-normal pre-pregnancy BMI are at increased risk of breastfeeding cessation; however, the impact of pregnancy weight-gain (PWG) is less well-defined. Excess PWG may alter the hormonal preparation of breast tissue for lactation, increase the risk of complications that negatively impact breastfeeding (e.g. Cesarean-section, gestational diabetes), and may make effective latch more difficult to achieve. Methods: Our objective was to determine the impact of PWG and pre-pregnancy BMI on the risk of breastfeeding cessation utilizing the Institute of Medicine’s 2009 recommendations. Cox proportional hazards models were utilized to estimate the risk of cessation of exclusive breastfeeding, and cessation of any breastfeeding among women who initiated exclusive and any breastfeeding, respectively, in a cross sectional sample of survey respondents from a New York county (N=1207). PWG category was interacted with pre-pregnancy BMI (3 levels of pre-pregnancy BMI, 3 levels of PWG). Confounders of the relationship of interest were evaluated using directed acyclic graphs and bivariate analyses; variables not on the proposed causal pathway and associated with the exposure and outcome were included in multivariate models. Results: After adjustment, women of normal and obese pre-pregnancy BMI with greater-than-recommended PWG had 1.39 (1.03-1.86) and 1.48 (1.06-2.07) times the risk of any breastfeeding cessation within the first 3 months postpartum compared to women with normal pre-pregnancy BMI who gained within PWG recommendations. Overweight women with greater-than-recommended PWG were at increased risk of cessation, although not significantly (aHR[95% CI]: 1.29 [0.95 – 1.75]). No significant relationship was observed for exclusive breastfeeding cessation. Conclusions: Pre-pregnancy BMI and PWG may be modifiable risk factors for early breastfeeding cessation. Understanding the mechanism behind this risk should be ascertained by additional studies aimed at understanding the physiological, social, logistical (positioning) and other issues that may lead to early breastfeeding cessation.

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