Maternal obesity and pregnancy outcome

The increasing prevalence of maternal obesity worldwide provides a major challenge to obstetric practice from preconception to postpartum. Maternal obesity can result in unfavorable outcomes for the woman and fetus. Maternal risks during pregnancy include gestational diabetes and chronic hypertension leading to preeclampsia. The fetus is at risk for stillbirth and congenital anomalies. Intrapartum care, normal and operative deliveries, anesthetic and operative interventions in the obese demand extra care. Obesity in pregnancy can also affect health later in life for both mother and child. For women, these risks include heart disease and hypertension. Children have a risk of future obesity and heart disease. Women and their offspring are at increased risk for diabetes. Obstetrician-gynecologists should be well informed to prevent and treat this epidemic. Interventions directed at weight loss and prevention of excessive weight gain during pregnancy must begin in the preconception period.     

Maternal serum C-reactive protein concentration early in pregnancy and subsequent pregnancy loss

The purpose of this study was to determine the relationship between maternal inflammation and first or second trimester pregnancy loss. A nested case-control analysis was performed among the cohort enrolled in the Oral Conditions and Pregnancy study. We compared maternal serum C-reactive protein concentration between women with a pregnancy loss at < 21 weeks gestation to control women without gestational diabetes or preeclampsia who delivered at term. Participants were 2:1 frequency matched to cases by maternal age, race, and prior preterm birth. Median concentration of serum C-reactive protein between cases and controls was compared using Wilcoxon rank sum test. The potential effects of maternal smoking, gestational age at blood draw, and insurance status were evaluated and an adjusted odds ratio (95% confidence interval) for pregnancy loss was calculated using multivariable logistic regression. Among 1224 participants, 102 (9.8%) experienced pregnancy loss and 44 had complete information available. Median serum C-reactive protein concentration was significantly higher in controls compared with all cases (3.2 versus 0.5 microg/mL; p < 0.001). However, when stratified by gestational age at the time of the loss, median serum C-reactive protein level among controls was similar to those with a loss at less than 12 weeks (3.2 versus 2.0 microg/mL) but significantly higher compared with those whose loss occurred at greater than 12 weeks gestation (3.2 versus 0.5 microg/mL; p < 0.05). After adjusting for maternal smoking, gestational age at blood draw, and insurance status, women whose serum C-reactive protein level was greater than the 75% percentile had a decreased odds ratio for pregnancy loss (0.20; 95% confidence interval, 0.06 to 0.65). Pregnancy loss is not associated with increased systemic inflammation as measured by maternal serum C-reactive protein. Future study should be directed at determining the role of maternal inflammation during early pregnancy development and placentation.     

Maternal morbid obesity and the risk of adverse pregnancy outcome

OBJECTIVE: To evaluate whether morbidly obese women have an increased risk of pregnancy complications and adverse perinatal outcomes. METHODS: In a prospective population-based cohort study, 3,480 women with morbid obesity, defined as a body mass index (BMI) more than 40, and 12,698 women with a BMI between 35.1 and 40 were compared with normal-weight women (BMI 19.8-26). The perinatal outcome of singletons born to women without insulin-dependent diabetes mellitus was evaluated after suitable adjustments. RESULTS: In the group of morbidly obese mothers (BMI greater than 40) as compared with the normal-weight mothers, there was an increased risk of the following outcomes (adjusted odds ratio; 95% confidence interval): preeclampsia (4.82; 4.04, 5.74), antepartum stillbirth (2.79; 1.94, 4.02), cesarean delivery (2.69; 2.49, 2.90), instrumental delivery (1.34; 1.16, 1.56), shoulder dystocia (3.14; 1.86, 5.31), meconium aspiration (2.85; 1.60, 5.07), fetal distress (2.52; 2.12, 2.99), early neonatal death (3.41; 2.07, 5.63), and large-for-gestational age (3.82; 3.50, 4.16). The associations were similar for women with BMIs between 35.1 and 40 but to a lesser degree. CONCLUSION: Maternal morbid obesity in early pregnancy is strongly associated with a number of pregnancy complications and perinatal conditions. LEVEL OF EVIDENCE: II-2     

Maternal obesity and pregnancy

We examined the risk of maternal obesity in 588 pregnant women weighing at least 113.6 kilograms (250 pounds) during pregnancy. Compared with a control group matched for age and parity, we found a significantly increased risk in the obese patient for gestational diabetes, hypertension, therapeutic induction, prolonged second stage of labor, oxytocin stimulation of labor, shoulder dystocia, infants weighing more than 4,000 grams and delivery after 42 weeks gestation. Certain operative complications were also more common in obese women undergoing cesarean section including estimated blood loss of more than 1,000 milliliters, operating time of more than two hours and wound infection postoperatively. These differences remained significant after controlling for appropriate confounding variables. We conclude that maternal obesity should be considered a high risk factor.     

Ectopic pregnancy in a defined Nigerian population

All cases of ectopic pregnancy in the Ile-Ife teaching hospital between 1977 and 1987 were reviewed. The incidence per 1000 births was 4.76, and this condition accounted for 2.75% of all gynecological admissions. The associated mortality was low (0.5%). An increasing incidence was observed during the study period, as was an increasing proportion of nulliparous patients. Tubal damage from pelvic infections might account for the trends.     

Maternal obesity and pregnancy outcomes

PURPOSE OF REVIEW: The rates of obesity are increasing rapidly in the United States and other countries. Because obesity is a major factor in the development of many chronic diseases, it is an important individual and public health issue. This review focuses on the pregnancy complications associated with maternal obesity. RECENT FINDINGS: Maternal obesity adversely impacts pregnancy outcome primarily through increased rates of hypertensive disease (chronic hypertension and pre-eclampsia), diabetes (pregestational and gestational), cesarean section and infections. It is associated with a higher rate of venous thromboembolic disease and respiratory complications, and may be an independent risk factor for neural tube defects, fetal mortality and preterm delivery. Maternal obesity also increases the risk of delivering a large for gestational age or macrosomic neonate, who is in turn at an increased risk of subsequent childhood obesity and its associated morbidity. SUMMARY: Recommendations regarding the counselling of obese pregnant women and specific guidelines for the obstetrician, family physician, or midwife managing the pregnancy are presented. Cultural and political changes with the potential to decrease the epidemic of obesity in our society are discussed.     

Maternal obesity and pregnancy complications: a review

Obesity in women of reproductive age is increasing at an unprecedented rate in western societies. Maternal obesity is associated with an unequivocal increase in maternal and fetal complications of pregnancy. Excessive maternal weight gain in pregnancy also appears to be an independent risk factor, regardless of prepregnancy weight. Few guidelines exist regarding appropriate weight gain in pregnancy in obese women. We review the association of maternal obesity with pregnancy complications. We also suggest that appropriate diet and lifestyle intervention can enable women with severe prepregnancy obesity to safely achieve quite strict targets for limited weight gain in pregnancy.     

Maternal obesity and pregnancy: a retrospective study

Objectives

to establish the incidence of obesity in the pregnant population in a large city in the North West of England, identify links between obesity and social deprivation, and compare outcomes of pregnancy in obese and non-obese women.

Design

retrospective cohort study using maternal records.

Setting

largest maternity hospital in Europe.

Participants

8176 women who gave birth at the study hospital in 2006.

Findings

data showed that 17.7% of women were clinically obese. Obesity rates increased with advancing age. The incidence of pre-eclampsia, gestational diabetes, induction of labour, caesarean section and fetal macrosomia was significantly higher amongst the obese population. No relationship was found between obesity and social deprivation.

Conclusions

this study ascertained the exact incidence of maternal obesity in the local area and showed the increased risks associated with obesity and pregnancy.

Implications for practice

this study supports the need for a shared-care approach to antenatal care and that obese women should give birth in consultant-led units. The support of a named midwife should be available to these women throughout the childbearing experience, and preconception care advocated.     

Vaginal bleeding and early pregnancy outcome in an infertile population

Objective: Our purpose was to determine the prognostic value of vaginal bleeding in early pregnancy outcome as well as to analyze the role of cardiac activity in predicting pregnancy viability in the presence of vaginal bleeding. Study Design: This was a cohort study of pregnancies obtained using either assisted reproductive technology (ART) or routine infertility treatment (RIT). Two hundred twenty-eight pregnant women were divided into two groups based on the presence or absence of vaginal bleeding. Successive measurements of -hCG levels were obtained every 2 days, starting on day 14 after ovulation or embryo transfer. All pregnancies underwent weekly transvaginal ultrasound (UTZ) examinations beginning on day 21. The occurrence of vaginal bleeding was monitored weekly. Results: Seventy of the 228 patients (31%) had bleeding in early pregnancy, resulting in 31 (44%) pregnancy losses. Only 22 pregnancy losses (14%) were observed in 158 patients who did not have bleeding (P<0.001). The abortion rate for the bleeding versus nonbleeding groups was 35 and 9%, respectively (P<0.001). Vaginal bleeding was associated with a higher abortion rate in pregnancies following RIT than ART (51 vs 8%; P<0.001). Fetal cardiac activity was noted by vaginal ultrasound in 189 patients. In this subpopulation, bleeding was also associated with a higher abortion rate than that in the nonbleeding group (17 vs 4%; P<0.001). However this higher incidence was observed only in pregnancies following RIT, not ART (28 vs 5%; P<0.001). Conclusions: Although bleeding significantly decreased the chance of a normal pregnancy outcome, more than 50% of the pregnancies did progress to term. The presence of cardiac activity in this population as a sign of fetal viability offered a better pregnancy prognosis. However, the predictive value of fetal cardiac activity was reduced in the presence of vaginal bleeding in an infertile population treated with RIT.     

Maternal obesity and complications during pregnancy

Obesity has become a major health problem all over the world and during pregnancy is associated with an increased risk of complications, including gestational diabetes, preeclampsia, and delivery complications such as macrosomia, shoulder dystocia and higher rates of cesarean sections and infections. Maternal obesity may also be an independent risk factor for neural tube defects and fetal mortality. This review focuses on the consequences of maternal obesity during pregnancy.     

Maternal obesity: implications for pregnancy outcome and long-term risks-a link to maternal nutrition

As obesity becomes a worldwide epidemic, its prevalence during reproductive age is also increased. Alarming reports state that two-thirds of adults in the USA are overweight or obese, with half of them in the latter category, and the rate of obese pregnant women is estimated at 18-38%. These women are of major concern to women's health providers because they encounter numerous pregnancy-related complications. Obesity-related reproductive health complications range from infertility to a wide spectrum of diseases such as hypertensive disorders, coagulopathies, gestational diabetes mellitus, respiratory complications, and fetal complications such as large-for-gestational-age infants, congenital malformations, stillbirth, and shoulder dystocia. Recent reports suggest that obesity during pregnancy can be a risk factor for developing obesity, diabetes, and cardiovascular diseases in the newborn later in life. This review will address the implication of obesity on pregnancy and child health, and explore recent literature on obesity during pregnancy.     

Influence of pregnancy outcome on subsequent pregnancy

In this study to determine the harmful effect of abnormal pregnancy outcome on the immediately following pregnancy, 573 recently delivered women (with 2347 pregnancies) were interviewed. Data were recorded on their pregnancy outcomes (normal, abortion, stillbirth and congenital malformation), as well as on their interpregnancy intervals. A significant difference was found between the chances of having a spontaneous abortion following a normal outcome (5.5%) against that following a spontaneous abortion (31.1%). Also, the chances of a normal outcome following a normal outcome were 92.4%, compared with 63.9% following a spontaneous abortion. The delivery of a malformed baby is associated with a larger proportion of abortion and congenital malformation in the subsequent pregnancy, while stillbirth was followed by a larger proportion of abortion and stillbirth. A longer interpregnancy interval did not appear to have any protective effect on the subsequent pregnancy.     

Maternal dietary intake and pregnancy outcome

OBJECTIVE: To study the relationship between maternal diet and infant anthropometric measurements in 56 women, aged 28 +/- 5.1 years, with singleton pregnancies. STUDY DESIGN: The overall quality of the diet (three 24-hour recalls), including supplementation, was evaluated at 34 +/- 1.3 weeks using a total mean adequacy ratio (TMAR) of 12 nutrients. Specific interviewing techniques were used to minimize social desirability bias. Anthropometric measurements of both parents and maternal lifestyle practices were also obtained. Infant weight, crown-heel length and head circumference were measured 14.6 +/- 4.4 days after birth. RESULTS: Stepwise multiple regression analysis revealed that maternal diet quality (TMAR) was significantly related to infant weight (r = .039, P = .036) and crown-heel length (r = .071, P = .007). Other significant predictors included gestational age, maternal height, sex, smoking and physical activity. CONCLUSION: Maternal diet was positively associated with infant weight and crown-heel length.     

Maternal thyroid hypofunction and pregnancy outcome

OBJECTIVE: To estimate whether maternal thyroid hypofunction is associated with complications. METHODS: A total of 10,990 patients had first- and second-trimester serum assayed for thyroid-stimulating hormone (TSH), free thyroxine (freeT4), and antithyroglobulin and antithyroid peroxidase antibodies. Thyroid hypofunction was defined as 1) subclinical hypothyroidism: TSH levels above the 97.5th percentile and free T4 between the 2.5th and 97.5th percentiles or 2) hypothyroxinemia: TSH between the 2.5th and 97.5th percentiles and free T4 below the 2.5th percentile. Adverse outcomes were evaluated. Patients with thyroid hypofunction were compared with euthyroid patients (TSH and free T4 between the 2.5th and 97.5th percentiles). Patients with and without antibodies were compared. Multivariable logistic regression analysis adjusted for confounders was used. RESULTS: Subclinical hypothyroidism was documented in 2.2% (240 of 10,990) in the first and 2.2% (243 of 10,990) in the second trimester. Hypothyroxinemia was documented in 2.1% (232 of 10,990) in the first and 2.3% (247 of 10,990) in the second trimester. Subclinical hypothyroidism was not associated with adverse outcomes. In the first trimester, hypothyroxinemia was associated with preterm labor (adjusted odds ratio [aOR] 1.62; 95% confidence interval [CI] 1.00-2.62) and macrosomia (aOR 1.97; 95% CI 1.37-2.83). In the second trimester, it was associated with gestational diabetes (aOR 1.7; 95% CI 1.02-2.84). Fifteen percent (1,585 of 10,990) in the first and 14% (1,491 of 10,990) in the second trimester had antithyroid antibodies. When both antibodies were positive in either trimester, there was an increased risk for preterm premature rupture of membranes (P=.002 and P<.001, respectively). CONCLUSION: Maternal thyroid hypofunction is not associated with a consistent pattern of adverse outcomes. LEVEL OF EVIDENCE: II.     

Maternal asthma: pregnancy course and outcome

Objective: To evaluate the association between maternal asthma and perinatal outcome.

Study design: In this retrospective population-based cohort study, all pregnancies between 1991 and 2014 in a tertiary medical center, were included. Multiple pregnancies and congenital malformations were excluded. Pregnancy course and outcomes were compared between women with and without asthma, and multivariable generalized estimating equations were used to control for confounders.

Results: During the study period, 243,363 deliveries met the inclusion criteria, 1.35% of which (n?=?3283) occurred in women diagnosed with asthma. Multiple perinatal complications were found to be associated with maternal asthma, including hypertensive disorders, preterm delivery, and cesarean delivery. However, no significant differences between the groups were noted in neonatal outcomes, including perinatal mortality rates and low Apgar scores. In the regression model, maternal asthma was noted as an independent risk factor for preterm delivery, hypertensive disorders of pregnancy, and cesarean delivery (aOR?=?1.21, 95%CI 1.1–1.4, p?=?.007; aOR?=?1.35, 95%CI 1.2–1.6, p?p?Conclusions: Maternal asthma is associated with an increased risk for adverse pregnancy outcome. This association remains significant while controlling for variables considered to coexist with maternal asthma. Nevertheless, perinatal outcome is generally favorable.     

Maternal T cells and human pregnancy outcome

Mothers who had just delivered babies of normal birthweight showed significant reductions in the numbers of circulating T and B lymphocytes and of the CD4 T lymphocyte subset. This is consistent with the immunosuppression that occurs in a normal pregnancy. In contrast, the mothers of low birthweight infants did not show these reductions and had circulating lymphocyte numbers not significantly different from normal controls. This suggests that a component of intra-uterine growth retardation may be immunopathological, owing to a failure of the immunosuppressive mechanisms of pregnancy that might normally prevent the fetus from immunological attack.     

Maternal risk status and postdate pregnancy outcome

Using a 1982-1985 regional perinatal network data base of 69,746 infants, a retrospective study was conducted to compare the perinatal outcome of 7,729 postdate infants (greater than or equal to 42 weeks' gestation) by maternal risk status. Due to additional antenatal complications, of which 8.0% were hypertension and/or diabetes, 48.4% of the postdate pregnancies were classified as at risk. As expected, high-risk women experienced a higher incidence of adverse perinatal outcomes than did low-risk women. The incidence of meconium staining, low five-minute Apgar scores and perinatal mortality increased beyond term and was found most commonly in infants from high-risk pregnancies, especially those involving hypertension and diabetes mellitus. These results suggest that high-risk pregnancies probably should not enter the postdate period since their doing so places the infant at serious risk.