Obstetric hazards of maternal obesity.

To test the hypothesis that obesity represents a risk factor in pregnancy, we conducted a prospective case-control study to determine whether or not there was any divergence in the obstetric outcome among 132 obese women from that in a control group of 136 non-obese patients. Obese mothers had an increased incidence of pregnancy-induced hypertension and gestational diabetes but there was no significant difference in the duration of pregnancy or in the frequency of low Apgar score at 1 minute. The favourable fetal outcome in obese parturients reflects an increased awareness of the possible medical and obstetric complications and an early recourse to abdominal delivery.     

多囊卵巢综合征妊娠患者的产科结局

多囊卵巢综合征（PCOS）是生育期妇女最常见的生殖内分泌疾病,病因至今未明。高雄激素、胰岛素抵抗（IR）及高胰岛素血症是PCOS的病理生理基础。由于PCOS患者特殊的病理生理特点,妊娠后可能会并发流产、妊娠期糖尿病（GDM）、妊娠高血压疾病等合并症。充分认识PCOS患者的妊娠期并发症及新生儿结局,有针对性地预防和治疗母儿并发症,对保障母婴健康有重要意义。     

多囊卵巢综合征妊娠患者的产科结局

多囊卵巢综合征（PCOS）是生育期妇女最常见的生殖内分泌疾病,病因至今未明。高雄激素、胰岛素抵抗（IR）及高胰岛素血症是PCOS的病理生理基础。由于PCOS患者特殊的病理生理特点,妊娠后可能会并发流产、妊娠期糖尿病（GDM）、妊娠高血压疾病等合并症。充分认识PCOS患者的妊娠期并发症及新生儿结局．有针对性地预防和治疗母儿并发症,对保障母婴健康有重要意义。     

The relationship between abortion in the first pregnancy and development of pregnancy-induced hypertension in the subsequent pregnancy

The relation between pregnancy-induced hypertension and reproductive history was assessed in 29,484 women receiving obstetric care at Parkland Memorial Hospital. The incidence of pregnancy-induced hypertension was 25.4% in primigravid women, somewhat lower (22.3%) in women whose only previous pregnancy terminated in abortion, and much lower (10%) in women who carried two or more successive pregnancies to viability.     

Pregnancy outcomes and the effect of metformin treatment in women with polycystic ovary syndrome: an overview

This article is a review of the literature assessing pregnancy outcomes and the effect of metformin treatment among women with polycystic ovary syndrome (PCOS). A review of research published in English was undertaken using PubMed and MEDLINE databases. The weight of the available evidence suggests that pregnant women with PCOS are at an increased risk of developing gestational diabetes, hypertensive disorders of pregnancy, preterm birth and early pregnancy loss. Obesity is a contributory factor for the increased risk of gestational diabetes in this group of women and is estimated to affect 5-40% of pregnant women with PCOS. The prevalence of other obstetric complications is estimated at 10-30% for gestational hypertension, 8-15% for pre-eclampsia and 6-15% for preterm birth. The association between PCOS and early pregnancy loss may not be direct, wherein the presence of PCOS-associated hyperinsulinemia, leading to hyperandrogenemia, has been implicated in the pathophysiology of early pregnancy loss. Apart from the role of metformin in improving the metabolic consequences accompanying PCOS, it has been shown to improve pregnancy rates in women with PCOS who are resistant to clomiphene citrate. In conclusion, pregnancy in women with PCOS is associated with adverse obstetric outcomes (multiple adverse obstetric risk). Whether metformin should be administered throughout pregnancy still remains controversial. Further prospective studies that foster a larger number of participants and adjust for all potentially confounding factors are needed.     

Neonatal outcome in pregnancy hypotiroidee women

Abstract

To evaluate the impact that hypothyroidism may have on the course of pregnancy and on neonatal outcome. This cross-sectional study consisting of 160 pregnant women (60 with hypothyroidism and 100 as control) who had been hospitalized at the Obstetrics and Gynecology of the University of Siena. The obstetric visit, the collection of anamnestic data and serum concentrations of TSH, FT4 and AbTPO were performed for each woman. Stratification of the population into two groups based on the BMI showed that there is an average difference of ?0.88 before pregnancy BMI between healthy women and hypothyroid women. Moreover, with regard to the obstetric history, 8.7 times higher risk of abortion was found in hypothyroid women. About the current pregnancy in hypothyroid women, slight fetal growth delay, increased risk of premature rupture of membranes (PROM), and a higher risk of developing hypertension and gestational diabetes had been found. The importance of a more detailed anamnesis should be evaluated with greater attention at the beginning of pregnancy. This, in order to avoid the risks related to a hypothyroidism condition during pregnancy and to establish an early therapeutic treatment appropriate to the metabolic demands of each patient.     

Plasma P-selectin is elevated in the first trimester in women who subsequently develop pre-eclampsia

Objective To report plasma concentrations of the adhesion cell molecule P-selectin during pregnancy to determine the effect of subsequent development of hypertension and pre-eclampsia.
Design A longitudinal study.
Methods A longitudinal study involving 70 women followed up from early pregnancy; 20 who subsequently developed pre-eclampsia were compared with 24 who developed gestational hypertension and 26 normotensive women with normal obstetric outcome. The determination of citrate plasma soluble P-selectin levels throughout pregnancy was performed using a commercial quantitative sandwich immunoassay kit. The temporal course of plasma P-selectin in the three groups of subjects was analysed.
Results There was no significant difference in mean plasma P-selectin concentration between normotensive and gestational hypertensive subjects at any stage of pregnancy. Using a cutoff level of 60 ng/mL, P-selectin concentration at 10–14 weeks had a negative predictive value for pre-eclampsia of almost 99%. Mean plasma P-selectin concentrations were significantly elevated by 10–14 weeks in women who later developed pre-eclampsia (   P <0.001  ).
Conclusions Our data support an inflammatory model for pre-eclampsia whereby endothelial cell activation may be secondary to a primary inflammatory response. Plasma P-selectin has significant potential as a first trimester clinical marker of pre-eclampsia.     

Early teenage obstetrics at Waikato Hospital.

New Zealand has the second highest published teenage pregnancy rate in the world. Different papers have shown adverse obstetric outcome for teenage mothers. The aim of this study was to compare the obstetric parameters, such as birth weight, gestation at birth, Apgar scores, breech delivery, caesarean sections, instrumental deliveries, incidences of birth defects, twins, and gestational hypertension/pre-eclampsia of early teenage mothers with the rest of the population. The data were obtained from the perinatal information management system (PIMS) at Waikato Hospital for the period 1994 to 1996. The data were statistically analysed. There were 306 women in the early teenage group (17 years and younger) and 206 randomly selected women in the control group who were 18 years or older. In the early teen group more than 92% of women were primiparous, whereas in the control group most women were multiparous. The analyses detected no differences in the two groups in the parameters studied except increased incidence of ventouse delivery in the early teenage group (P = 0.004). This was surprising because, older and parous women are supposed to have better outcomes. Hence there was no evidence from this study of any of obstetric risk factors associated with early teenage pregnancy. Also, race did not affect the means of birth weights, gestational age at birth and Apgar scores. Adjustment for race and parity differences did not change the conclusions apart from making the difference in incidence of ventouse delivery less significant (P = 0.067 when adjusted for parity differences).     

Diabetes and obesity in pregnancy

An epidemic of obesity is affecting growing numbers of women in their childbearing years increasing their risk of obstetric complications including diabetes, hypertension, pre-eclampsia, some malformations, macrosomia and the need for obstetric intervention. There is growing evidence that maternal obesity may increase the risk of obesity and diabetes in the offspring. Obesity and diabetes in pregnancy have independent and additive effects on obstetric complications, and both require management during pregnancy. Management of obesity including weight loss and physical activity prior to pregnancy is likely to be beneficial for mother and baby, although the benefits of bariatric surgery remain unclear at this time. Limiting gestational weight gain to 5-9 kg among pregnant obese women is likely to improve obstetric outcomes, but how to achieve this remains an active area of research. If gestational diabetes develops, there is good evidence that clinical management reduces the risk of adverse pregnancy outcomes.     

Obstetric outcome in women after multiple spontaneous abortions

Obstetric outcome in 88 women with a past history of three or more consecutive pregnancy losses was studied. The results were compared to those in our total obstetric population for the same period (control group). The incidence of small-for-gestational-age infants, prematurity, low-birth-weight infants and toxemia in the study group was not significantly different from that in the control group. Gestational diabetes and chronic hypertension, however, occurred more frequently in the study group than in the control group (P less than .001). These data could be helpful in counseling women with repeated pregnancy loss.     

Prevalence of Hypertension During Pregnancy in Portugal

Objective: To estimate the prevalence of maternal hypertensive disorders in Portugal and to assess their impact on obstetric outcomes. Methods: A national survey on hypertension in pregnancy was conducted in Portuguese public maternity wards and included 6726 pregnancies. Results: Six percent of women presented with a hypertensive disorder during pregnancy or puerperium: 1.5% with chronic hypertension, 2.5% with gestational hypertension, 1.4% with preeclampsia, 0.2% with superimposed preeclampsia, 0.1% with eclampsia, and 0.1% with HELLP syndrome. Preterm birth, small-for-gestational-age infants and fetal death were significantly more frequent among women with preeclampsia/eclampsia and HELLP syndrome. Conclusion: In Portugal, the prevalence of hypertensive disorders diagnosed during pregnancy seems to be lower than that reported in most countries, but these disorders have a significant effect on pregnancy outcomes.     

Primary pulmonary hypertension in pregnancy

Primary pulmonary hypertension (PPH) is an uncommon but serious disease. Most patients with PPH are young women and the disease is more serious and eventful in pregnant women. We have experienced a patient with PPH in pregnancy, who was delivered successfully but died suddenly on the 7th day after the delivery. We report the obstetric course and the clinical management for the delivery of the patient with PPH.     

Le nouveau-né de mère obèse

Pregnancy in obese women increases the risk of late-term foetal demise, early neonatal death and prematurity, particularly in nulliparous women. The risk of birth defects is increased in obese women, and includes not only neural tube defects but also affects other organs, such as the heart and the digestive tract. Maternal obesity changes foetal growth through an increase in nutrients being passed through the placenta; the effect is an increase in body fat. The risk of neonatal morbidity, such as perinatal asphyxia, respiratory distress and obstetric trauma increases with maternal BMI. Macrosomia and maternal morbidity associated with obesity, such as hypertension and diabetes, are likely to partially contribute to the increase in these risks. Numerous experimental and epidemiological data suggests that obesity during pregnancy, as with diabetes, contributes to foetal susceptibility towards cardiovascular diseases, insulin resistance or type 2 diabetes and childhood and adult obesity.     

Change in paternity: a risk factor for preeclampsia in multiparous women?

BACKGROUND: Preeclampsia is often thought of as being a disease of first pregnancies. The incidence of preeclampsia in subsequent pregnancies, after a previous normal pregnancy is lower. However, it has been reported that this beneficial effect of multiparity is lost with a change in paternity. The aim of this study was to assess the impact of change in paternity on the incidence of preeclampsia in Dutch multiparous pregnant women. METHODS: 364 Multiparous patients with hypertension (diastolic blood pressure > or = 100 mmHg) were identified in the obstetric database of the Academic Hospital Vrije Universiteit Amsterdam for the period 1989-1996. The diagnosis in their obstetrical history (Preeclampsia, HELLP-syndrome, chronic hypertension) was defined in a pragmatic way in view of the retrospective nature of the study. The control group consisted of 281 multiparous women from a midwife clinic, with normotensive pregnancies in the same period. Patients and controls were asked, by telephone, if the index pregnancy was from the same partner as the previous pregnancy and what the sex of the newborns had been in each pregnancy. Fisher's Exact test was used for statistical analysis and P < 0.05 was considered significant. RESULTS: The final study group consisted of 333 multiparous patients with hypertension. The control group consisted of 182 multiparous women without hypertension. The prevalence of new paternity was significantly higher (P < 0.0001) both for preeclamptic and HELLP patients in comparison with the controls, with an odds ratio of 8.6 (95%CI: 3.1-23.5) and 10.9 (95%CI: 3.7-32.3), respectively. CONCLUSION: This study confirms that change of partner raises the risk for preeclampsia in subsequent pregnancies. Immune maladaptation on the fetal maternal interface could be an underlying mechanism. Multiparous women with a new partner should be approached as being primigravid women.     

ANTI-HYPERTENSIVE DRUGS IN PREGNANCY AND FETAL GROWTH: EVIDENCE FOR “PHARMACOLOGICAL PROGRAMMING” IN THE FIRST TRIMESTER?

Objectives: To determine the timing and exact nature of the effect of the drug atenolol upon fetal growth. Also to discover if the reduction in fetal growth is due to superimposed pre-eclampsia or any other confounding variable. Design: A retrospective cohort study of prospectively collected data in a hypertensive pregnancy database. Setting: Two district general hospitals in the midlands of England. Both hospitals have specialised medical antenatal clinics for pregnant women with chronic hypertension. Participants: 491 pregnancies in 380 women with essential or secondary hypertension. Outcome measures: The outcome measures used were the infant birth weight, birth weight standardized for gestational age, and the ponderal index at birth, a surrogate measure for in utero growth restriction. Results: The babies of women taking atenolol at conception or during the first trimester had significantly lower birth weights (by 139–512 g, p<0.01) than women on calcium channel blockers or no medication. Likewise the ponderal index was also significantly reduced, p<0.01. In addition most of these babies were small for gestational age (SGA) with 70% on or below the 10th centile and 40% below the third centile. No such independent association was seen with anti-hypertensives taken in the second trimester. Conclusions: Atenolol taken at the time of conception and/or during the first trimester of pregnancy was associated with low birth weight. This finding was independent of the development of superimposed pre-eclampsia. Other anti-hypertensives were not found to be associated with low birth weight. Use of atenolol in the second trimester of pregnancy did not produce the same effect and was not materially different in its effects from the other anti-hypertensive drugs. In the second trimester, the development of superimposed pre-eclampsia is the over-riding effect in the reduction of infant birth weight. Atenolol used in the first trimester could be pharmacologically programming these infants to restricted growth patterns.     

Obstetric Profiles and Pregnancy Outcomes of Immigrant Women in New South Wales, 1990–1992

Summary: This study examined the obstetric profiles and pregnancy outcomes of immigrant women in New South Wales (NSW). The source of data was the NSW Midwives Data Collection. The characteristics of 64,922 immigrant women were compared with 189,357 Australian-born non-Aboriginal women who delivered babies between 1990–1992 in NSW. The study demonstrated that immigrant women were older, generally had less private health insurance coverage and fewer teenage pregnancies. Immigrant women showed lower rates of essential hypertension, but higher rates of hepatitis B and gestational diabetes. While induced labour was conducted less frequently among immigrant women, episiotomy, instrumental delivery and Caesarean section were performed more frequently among this group. The incidence of postpartum complications was higher among immigrant women. Differences were assessed among women from European, Asian, Middle Eastern, American, New Zealand/Oceania and African backgrounds. For example, the higher rates of hepatitis B, gestational diabetes, episiotomy, instrumental delivery, Caesarean section, postpartum haemorrhage, third degree tear and puerperal infection among Asian-born women were of concern. By contrast, pregnancies among Middle Eastern-born women were associated with fewer complications in spite of their high parity and high percentage of teenage pregnancies. Infants of immigrant mothers were more likely to be resuscitated and/or admitted to special care nursery/neonatal intensive care unit. These findings in immigrant women in NSW suggested the need for culturally appropriate obstetric services, clinical practice reviews, and the greater involvement of general practitioners in obstetric care.     

Chronic hypertension in pregnancy.

Women with chronic hypertension who are considering pregnancy should undergo extensive evaluation and work-up prior to conception. This evaluation is important to establish the cause and severity of the hypertension. The patient should be seen early in pregnancy and counseled regarding the possible adverse effects of hypertension and the importance of adherence to prenatal visits and prescribed medications. Patients classified to have high-risk hypertension are at increased risk for significant maternal and perinatal complications. These patients should have intensive antenatal follow-up and will require antihypertensive therapy irrespective of the severity of the hypertension. In contrast, in women with mild uncomplicated hypertension, good perinatal outcome is expected with proper obstetric care, without the use of antihypertensive drugs. Finally, most of the poor perinatal outcome in such pregnancies is related to the development of superimposed preeclampsia.     

Epidemiology of preeclampsia in Mauritius island

In Mauritius, the maternal mortality rate (MMR) was 21 per 100000 live births for the year 2001 and this is comparable with figures from developed countries. There has been poor documentation in the area of hypertensive disorders of pregnancy until recently in the island. Consequently, we analysed data from the Ministry of Health. Hypertensive disorders of pregnancy occurred in 6.7% gravidas in 2001. Out of four maternal deaths recorded in 2001, two occurred due to severe eclampsia. In the second part of our study, we scrutinised also the obstetric notes and interviewed 862 hospitalised women from four main hospitals of the island between 1995 and 1997. The majority of women were affected by non-proteinuric hypertension (70%), followed by preeclampsia (24%) and chronic hypertension (6%). Preeclamptic primi and multigravidas developed the condition earlier and also gave birth to growth-retarded babies. Highly significant results supported the relationship between growth retardation and preeclampsia in different parities, irrespective of the length of exposure of the baby in utero. Preeclampsia affects both Indo-Mauritians and Creoles to the same extent, but the latter are much more prone to gestational hypertension. In addition, hypertensive disorders of pregnancy are more a problem of multigravid women in Creoles while they are more classically a condition of primigravidae in Indians.     

Health Status and nming of Onset of Prenatal Care: Is There an Association Among Low-Income Women?

ABSTRACT: We examined medical obstetric conditions predating pregnancy and current symptoms as predictors of the timing of the start of prenatal care among low-income women in Snohomish County, Washington. The investigation was a cross-sectional survey with retrospective record review. Subjects were 473 women who sought care through the community health center network, which was the only provider of prenatal care for low-income women in the county at the time of the study. Women with a history of two or more medical or obstetric conditions were more likely than those without such histories to seek prenatal care early in pregnancy. Women who, in the current pregnancy, had few physical symptoms were more likely to delay seeking prenatal care than symptomatic women. Among this relatively homogeneous group, sociodemographic characteristics were not associated with the timing of entry into prenatal care. The Jindings help to explain the patterns of prenatal care use of certain groups, and suggest avenues for intervention to improve use among low-income women. (BIRTH 21:2, June 1994)     

Drugs used in hypertensive diseases in pregnancy

PURPOSE OF REVIEW: This review will summarize results derived from the most recent publications on the use of drugs in women with hypertensive diseases in pregnancy. RECENT FINDINGS: There is consensus that severe hypertension should be treated without delay to reduce maternal risks of acute cerebrovascular complications. There is no consensus that antihypertensive drugs improve maternal or fetal outcome in mild to moderate hypertension. Evidence exists that antihypertensive drugs may halve the risk of severe hypertension in pregnancy. No proof exists that antihypertensive drugs reduce perinatal mortality or development of preeclampsia, and such drugs have not been associated with improved fetal growth. Clinical trials indicate non-consistent data concerning antihypertensive treatment on antenatal rate of hospitalization, proteinuria at delivery and neonatal respiratory distress syndrome. Hydralazine has for many years been regarded as the first drug of choice for treatment of severe hypertension in pregnancy. Recent findings indicate that the calcium antagonist nifedipine might be a better alternative. Angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists should be discontinued due to fetotoxicity. The beta1-selective adrenoceptor blocker atenolol in the first trimester is associated with low birth weight. SUMMARY: Large randomized controlled trials are urgently needed to determine whether antihypertensive therapy in pregnancy results in greater benefit than risks for mother and fetus.