Abnormal maternal body mass index and obstetric and neonatal outcome

Objective.?The objective of this study is to examine the effects of abnormal maternal body mass index (BMI), either underweight or severe or morbid obesity (BMI >35), on obstetrical and neonatal outcomes.

Methods.?A three-year period (2.007–2.009) observational retrospective study was carried out in Granada (Spain). Women were categorized by first ten weeks of pregnancy BMI, according to World Health Organization (WHO) into three groups: underweight (<18.5), normal (20–24.9), and severe or morbid obese (>35). Obstetrical and neonatal outcomes were evaluated using normal group as reference after suitable adjustments for confounding factors.

Results.?3.016 patients out of 12.781 single births were included. Maternal BMI classified 168 women (5.5 %) as underweight, 2.597 (86.1%) as normal, and 251 (8.3%) as severe or morbidly obese. As compared to normal women, underweight women were younger, and class II or III obese showed higher parity and higher incidence of hypertension disorders and Diabetes Mellitus. After controlling for these confounders, underweight women showed increased adjusted risk of oligohydramnios and low birth weight babies, and severe or morbidly obese women had an increased adjusted risk of Streptococcus Group B colonization, induction of labour, elective and emergency cesarean section, fetal macrosomia, fetal acidosis at birth, and perinatal mortality.

Conclusions.?Severe or morbid obesity were associated with an increased risk of adverse perinatal outcome and mortality and should be managed as high-risk pregnancies.     

Maternal pre-gravid body weight and risk for placental abruption among twin pregnancies

Abstract

Objectives.?Placental abruption is a major cause of fetal and neonatal death and has been reported more frequently in twin pregnancies than among singleton gestations. The purpose of this article is to investigate the role of maternal pre-gravid body mass index (BMI) on the risk for placental abruption among twin pregnancies.

Methods.?We used the Missouri maternally linked cohort files (years 1989–1997) consisting of twin live births (gestational age 20–44 weeks). Maternal pre-gravid weight was classified based on the following BMI-based categories: normal (18.5–24.9), underweight (<18.5), overweight (25–29.9), and obese (>30). We used logistic regression for generated adjusted odds ratios with correction for the presence of intra-cluster correlation using generalized estimating equations.

Results.?Overall, 261 cases of placental abruption were registered over the entire study period, yielding a placental abruption rate of 14.9/1000. The frequency of placental abruption correlated negatively with maternal BMI in a dose–effect pattern: underweight (19.3/1000); normal weight (16.1/1000); overweight (13.9/1000); and obese (9.5/1000) mothers (p for trend?<?0.01). After adjusting for confounders, the likelihood of placental abruption was still lower in obese women (OR?=?0.58; 95% CI?=?0.38–0.87). By contrast, women who were underweight had a 20–30% greater likelihood for placental abruption when compared with normal weight mothers, although these findings were statistically not significant.

Conclusions.?There is an inverse relationship between pre-gravid maternal BMI and placental abruption. The mechanism by which obesity impacts the likelihood of placental abruption in twin pregnancies requires further study.     

Could maternal pre-pregnancy body mass index affect Apgar score?

Objective

Obesity is one of global health problems and maternal obesity may be associated with increase in risk of pregnancy complications and neonatal death. The purpose of this study was to evaluate the effect of maternal pre-pregnancy body mass index (BMI) on neonate Apgar score at minute 5.

Methods

In a retrospective cohort study, Apgar score at minute 5 of all singleton term babies of nulliparous women whom were delivered in Shahid Sadoughi Hospital, Yazd, Iran, from 2007 to 2009 were evaluated. Body mass index (BMI: weight in kg/height in m²) of the mothers were calculated and BMI less than 18.5, 18.5–24.9, 25–29.9 and more than 30 were considered underweight, normal, overweight and obesity, respectively. Neonatal Apgar score of 3–7 and less than three was considered as low and very low Apgar score, respectively.

Results

Eighty-eight (2.8 %) women were underweight, 1,401 (44.9 %) normal weight, 1,389 (44.5 %) overweight and 242 (7.8 %) were obese. 477 (15.3 %) and 31(0.7 %) neonates had low and very low Apgar score, respectively at minute 5. Logistic regression analysis showed maternal overweight [in odd ratio of 3.7, 95 % CI 2.4–4.6] and obesity [in odd ratio of 13.4, 95 % CI 9.7–14.1] were risk factors of neonatal low Apgar score, but they had not any statistically significant effect on neonatal very low Apgar score.

Conclusion

Maternal pre-pregnancy overweight should be more concerned to prevent complication of low Apgar score in their newborns.     

The Effect of Gestational Weight Gain by Body Mass Index on Maternal and Neonatal Outcomes

ObjectiveTo evaluate the effects of gestational weight gain on maternal and neonatal outcomes in different body mass index (BMI) classes.MethodsWe compared maternal and neonatal outcomes based on gestational weight gain in underweight, normal weight, overweight, obese, and morbidly obese (BMI ≥ 40.00) women. The study group was a population-based cohort of women with singleton gestations who delivered between April 1, 2001, and March 31, 2007, drawn from the Newfoundland and Labrador Provincial Perinatal Program Database. Univariate analyses and multivariate logistic regression analyses (controlling for maternal age, parity, smoking status, partnered status, and gestational age) were performed and odds ratios (ORs) were calculated.ResultsOnly 30.6% of women gained the recommended amount of weight during pregnancy; 52.3% of women gained more than recommended, and 17.1% gained less than recommended. In women with normal pre-pregnancy BMI, excess weight gain was associated with increased rates of gestational hypertension (OR 1.27; 95% CI 1.08–1.49), augmentation of labour (OR 1.09; 95% CI 1.01–1.18), and birth weight ≥ 4000 g (OR 1.21; 95% CI 1.10–1.34). In overweight women, excess weight gain was associated with increased rates of gestational hypertension (OR 1.31; 95% CI 1.10–1.55) and birth weight ≥4000 g (OR 1.30; 95% CI 1.15–1.47). In women who were obese or morbidly obese, excess weight gain was associated with increased rates of birth weight ≥4000 g (OR 1.20; 95% CI 1.07–1.34) and neonatal metabolic abnormality (OR 1.31; 95% CI 1.00–1.70). In morbidly obese women, poor weight gain was associated with less use of epidural analgesia (OR 0.34; 95% CI 0.12–0.95). In women who were of normal weight, overweight, or obese, the rate of adverse outcome (Caesarean section, gestational hypertension, birth weight < 2500 g or birth weight ≥4000 g) was lower in women with recommended weight gain than in those with excess weight gain. Adverse outcomes were reduced in nulliparous morbidly obese women who had poor weight gain (OR 0.18; 95% CI 0.04–0.83).ConclusionThe effects of gestational weight gain on pregnancy outcome depend on the woman’s pre-pregnancy BMI. Pregnancy weight gains of 6.7–11.2 kg (15–25lb) in overweight and obese women, and less than 6.7 kg (15lb) in morbidly obese women are associated with a reduction in the risk of adverse outcome.     

The effects of maternal obesity on perinatal outcomes among those born small for gestational age*

Background: Maternal obesity has been associated with higher birth weight. Small for gestational age (SGA) neonates born to obese women may be associated with pathological growth with increased neonatal complications.

Methods: This was a retrospective cohort study of all non-anomalous singleton neonates born in Texas from 2006–2011. Analyses were limited to births between 34 and 42 weeks gestation with birth weight?≤10th percentile. Results were stratified by maternal pre-pregnancy BMI class. The risk for stillbirth, neonatal death, neonatal intensive care unit (NICU) admission and five?minute Apgar scores?<7 were estimated for each obesity class and compared to the normal weight group. Multivariable logistic regression analyses were performed to control for potential confounding variables.

Results: The rate of stillbirth was 1.4/1000 births for normal weight women, and 2.9/1000 among obese women (p?0.001, aOR: 1.83 [1.43, 2.34]). The rate of neonatal deaths among normal weight women was 4.3/1000 births, whereas among obese women it was 4.7/1000 (p?=?0.94, aOR: 1.10 [0.92, 1.30]). A dose-dependent relationship between maternal obesity and stillbirths was seen, but not for other neonatal outcomes.

Conclusion: Among SGA neonates, maternal pre-pregnancy obesity was associated with increased risks for stillbirth, NICU admission and low Apgar scores but not neonatal death.     

Obstetrical and neonatal outcomes in obese parturients

Objective.?Obstetrical risk is increased with maternal obesity. This prospective study was designed to simultaneously evaluate the outcomes in obese parturients and their newborns.

Methods.?Patients with a body mass index (BMI) ≥35 were prospectively identified and compared to an equal number of normal weight parturients. Maternal and neonatal outcome measures were compared for the peripartum and neonatal period.

Results.?We identified 580 obese parturients over a 6 month period and compared them to an equal number of normal weight parturients. The incidence of obesity in this population was 23%. Obesity was associated with increased rates of hypertension, diabetes, and cesarean section. Obese patients were more likely to develop postpartum complications. Neonatal outcomes were compared for infants ≥37 weeks gestation excluding multiple births (496 neonates in the obese group and 520 in the control group). The neonates of obese parturients were more likely to be macrosomic, have 1-minute Apgar scores of ≤7.0 and require admission to a special care unit. Sub-group analysis showed that negative outcomes for parturients and their neonates correlated with increasing BMI. Neonates born to obese diabetic parturients had the highest risk of poor outcomes.

Conclusions.?Maternal obesity confers increased risks for both the parturient and their newborn.     

Breastfeeding predicts the risk of childhood obesity in a multi-ethnic cohort of women with diabetes

Objective.?To determine whether breastfeeding reduced the risk of childhood obesity in the infants of a multi-ethnic cohort of women with pregestational diabetes.

Methods.?In this retrospective cohort study, women with pregestational diabetes were mailed a questionnaire about breastfeeding and current height and weight of mothers and infants. Predictors of obesity (weight for age >85 percentile) were assessed among offspring of index pregnancies, using univariate and multivariable logistic regression.

Results.?Of 125 women, 81 (65%) had type 1 diabetes and 44 (35%) had type 2 diabetes. The mean age of offspring was 4.5 years. On univariate analysis, significant predictors of obesity in offspring were type 2 diabetes (odds ratio, OR 2.4, 95% confidence interval, CI 0.99–5.72); maternal body mass index (BMI)?>?25 (OR 4.4, 95% CI 1.4–19.4); and any breastfeeding (OR 0.22, 95% CI 0.07–0.72). After multivariable adjustment, breastfeeding (OR 0.20, 95% CI 0.06–0.69) and having an overweight/obese mother (OR 3.49, 95% CI 1.03–16.2) remained independently associated with childhood obesity.

Conclusion.?Breastfeeding significantly decreased the likelihood of obesity in offspring of mothers with pregestational diabetes, independent of maternal BMI and diabetes type. Women with diabetes should be encouraged to breastfeed, given the increased risk of obesity in their children.     

The impact of obesity on maternal morbidity and feto-infant outcomes among macrosomic infants

Objective.?To estimate the contribution of obesity to maternal complications, neonatal morbidity and mortality among macrosomic births.

Design.?A population-based retrospective cohort design using State of Missouri maternally linked birth cohort files.

Methods.?Using pre-gravid body mass index (BMI), we categorized mothers of 116,976 singleton macrosomic live births as non-obese (BMI?<?30) or obese (BMI?≥?30). We used logistic regression models to generate adjusted odd ratios for pregnancy and neonatal complications. We also estimated the proportion of potentially preventable excess maternal and neonatal complications that could be eliminated among obese women with infant macrosomia at various levels of pre-pregnancy obesity reduction.

Result.?Obese mothers with macrosomic infants were at elevated risk for chronic hypertension (odds ratio (OR)?=?6.78 [95% confidence interval (CI): 5.82–7.88]), insulin-dependent diabetes mellitus, (OR?=?2.60 [CI: 2.34–2.88]) other types of diabetes mellitus (OR?=?2.83 [CI: 2.65–3.02]) and preeclampsia (OR?=?2.49 [CI: 2.33–2.67]). Macrosomic infants of obese mothers were at greater risk for hyaline membrane disease (OR?=?2.14 [CI: 1.73–2.66]), extended assisted ventilation (OR?=?1.71 [CI: 1.44–2.04]), birth injury (OR?=?1.58 [CI: 1.37–1.84]) and meconium aspiration syndrome (OR?=?1.42 [CI: 1.09–1.87]). The proportion of preventable excess maternal morbidity was 60%, 45%, 30% and 15%, assuming an effective pre-conception intervention that could reduce obesity down to 0%, 25%, 50% and 75% of its current level, respectively. The corresponding proportion of preventable excess neonatal complications would be 40%, 30%, 20% and 10%, respectively.

Conclusion.?Among obese mothers with macrosomic births, a substantial proportion of maternal and neonatal morbidity could be averted through effective pre-conception interventions.     

To evaluate the effect of pre-pregnancy body mass index on maternal and perinatal outcomes among adolescent pregnant women

Objective: To evaluate the effect of pre-pregnancy body mass index on maternal and perinatal outcomes among adolescent pregnant women.

Methods: We conducted this prospective cross-sectional study on 365 singleton adolescent pregnancies (aged between 16 and 20 years) at a Maternity Hospital, between December 2014 and March 2015. We divided participants into two groups based on pre-pregnancy body mass index (BMI): overweight and obese adolescent (BMI at or above 25.0?kg/m) and normal weight (BMI between 18.5 and 24.99?kg/m) adolescent. We used multivariate analysis to evaluate the association of the risk of adverse pregnancy outcomes and pre-pregnancy BMI.

Results: The prevalence of maternal overweight/obesity and normal weight was 34.6% (n?=?80) and 65.4% (n?=?261) in the study population, respectively. Compared with normal-weight teens (n?=?234), overweight/obese teens (n?=?71) were at higher risk for cesarean delivery (odds ratio [OR] 0.7, 95% confidence interval [CI] 0.4–1.4), preeclampsia (adjusted odds ratio [OR] 0.1, 95% confidence interval [CI] 0.02–0.9) and small of gestational age (odds ratio [OR] 0.2, 95% confidence interval [CI] 0.1–0.9).

Conclusion: BMI increased during pre-pregnancy could be an important preventable risk factor for poor obstetric complications in adolescent pregnancies, and for these patients prevention strategies (e.g., nutritional counseling, weight-loss, regular physical activity) for obesity are recommended before getting pregnant.     

Excessive gestational weight gain predicts large for gestational age neonates independent of maternal body mass index

Objective: To determine the effects of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on large-for-gestational-age (LGA) birth weight (≥90th % ile). Methods: We examined 4321 mother-infant pairs from the Ottawa and Kingston (OaK) birth cohort. Multivariate logistic regression (controlling for gestational and maternal age, pre-pregnancy weight, parity, smoking) were performed and odds ratios (ORs) calculated. Results: Prior to pregnancy, a total of 23.7% of women were overweight and 16.2% obese. Only 29.3% of women met GWG targets recommended by the Institute of Medicine (IOM), whereas 57.7% exceeded the guidelines. Adjusting for smoking, parity, age, maternal height, and achieving the IOM’s recommended GWG, overweight (OR 1.99; 95%CI 1.17–3.37) or obese (OR 2.64; 95% CI 1.59–4.39) pre-pregnancy was associated with a higher rate of LGA compared to women with normal BMI. In the same model, exceeding GWG guidelines was associated with higher rates of LGA (OR 2.86; 95% CI 2.09–3.92), as was parity (OR 1.49; 95% CI 1.22–1.82). Smoking (OR 0.53; 95%CI 0.35–0.79) was associated with decreased rates of LGA. The adjusted association with LGA was also estimated for women who exceeded the GWG guidelines and were overweight (OR 3.59; 95% CI 2.60–4.95) or obese (OR 6.71; 95% CI 4.83–9.31). Conclusion: Pregravid overweight or obesity and gaining in excess of the IOM 2009 GWG guidelines strongly increase a woman’s chance of having a larger baby. Lifestyle interventions that aim to optimize GWG by incorporating healthy eating and exercise strategies during pregnancy should be investigated to determine their effects on LGA neonates and down-stream child obesity.     

Maternal hepatitis B surface antigen carrier status and its impact on neonatal outcomes: a cohort study of 21 947 singleton newborns in China

Objective: To explore the impact of maternal hepatitis B surface antigen (HBsAg) carrier status on neonatal outcomes.

Methods: A retrospective cohort study was conducted using data from medical records database of six hospitals in China. Information on maternal characteristics and selected neonatal outcomes was retrieved for all women who delivered singleton infants between 1 January 2009 and 31 December 2010.

Results: A total of 21 947 singleton newborns and their mothers were included. The prevalence of maternal HBsAg positivity was 4.2% (95% confidence interval (CI) 3.9–4.5%). Compared with infants born to HBsAg-negative women, infants born to HBsAg-positive mothers were more than twice more likely to have a malformation before (adjusted odds ratio (aOR) 2.23, 95% CI 1.15–4.30) and at birth (aOR 2.66, 95% CI 1.38–5.14), but were less likely to be macrosomia (aOR 0.67, 95% CI 0.47–0.96). No statistically significant association was found between maternal HBsAg positivity and preterm birth (aOR 1.20, 95% CI 0.95–1.51), low birth weight (aOR 1.24, 95% CI 0.91–1.69), and Apgar scores at 1?min (aOR 0.88, 95% CI 0.49–1.57) and 5?min (aOR 1.84, 95% CI 0.89–3.81).

Conclusion: Maternal HBsAg positivity may be associated with a higher risk of congenital malformation.     

Low Apgar scores in term newborns and long-term gastro-intestinal morbidity: a population-based cohort study with up to 18 years of follow-up*

Introduction: Low Apgar scores (<7) measured at age 5?minutes can predict short-term infant morbidity and mortality. Although an association exists between low Apgar scores and neuropsychological disorders, other childhood disorders were not thoroughly studied. We aimed to study the possible association between low 5-minute Apgar scores in term newborns and their long-term childhood gastrointestinal (GI) morbidity.

Methods: A population-based cohort analysis was performed comparing total and different subtypes of GI-related pediatric hospitalizations among newborns with normal (≥7) and low (<7) 5-minute Apgar scores. The analysis included all term singletons born between the years 1999 and 2014 at a single tertiary regional medical center. Infants with congenital malformations, multiple gestations, and all perinatal deaths were excluded from the analysis. GI-related morbidities included hospitalizations involving a predefined set of ICD-9 codes, as recorded in the hospital computerized files. A Kaplan–Meier survival curve was constructed to compare the cumulative GI morbidity, and a Cox proportional hazards model was used to adjust for confounders.

Results: The study population, including 223 244 term singletons, was followed for an average of 10.02?±?6.0 years (0–18 years, median 10.25) following discharge from birth hospitalization. Low 5-minute Apgar scores were recorded in 585 (0.3%) newborns. Incidence of GI-related hospitalizations was higher among the low versus the normal 5-minute Apgar score group (7.4 versus 5.2%; 8.6/1000 person years (PY) versus 5.2/1000 PY, respectively; p?=?.02; odds ratio =1.66, 95%CI 1.36–1.96). The association remained significant and independent while adjusting for gestational age, fetal weight, offspring gender, maternal age, maternal smoking, hypertension, and diabetes (Adjusted HR =1.57, 95%CI 1.16–2.12, p?=?.003).

Conclusions: Low 5?minutes Apgar score is associated with an increased risk for long-term pediatric GI morbidity of the offspring. Our results suggest that Apgar scores can be used as a possible predictor for long-term pediatric morbidities and thus may necessitate appropriate surveillance in this vulnerable group of children.     

Maternal hyperglycemia according to IADPSG criteria as a predictor of perinatal complications in women with gestational diabetes: a retrospective observational study

Abstract

Objective: We investigated the association between abnormal maternal glucose levels according to International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and perinatal complications.

Materials and methods: Retrospective observational study of data of 492 women in singleton pregnancy and gestational diabetes (GDM) diagnosed according to WHO criteria. Perinatal outcome and maternal characteristics were compared between normo- and hyperglycemic patients using IADPSG criteria and odds ratios calculated for particular outcomes.

Results: Maternal fasting hyperglycemia (≥5.1?mmol/L) was associated with significantly higher proportion of birth weight ≥ 4000?g (19.3% versus 9.7%, p?=?0.004, OR: 2.2; 95% CI: 1.3–3.8), gestational insulin therapy (27.7% versus 9.1%, p?<?0.001, OR: 3.8; 95% CI: 2.3–6.5), poor long-term metabolic control (HbA_1c at diagnosis?≥?6.5% [48?mmol/mol]: 19.9% versus 4.6%, p?<?0.001, OR: 5.2; 95% CI: 2.5–10.9). Pre-pregnancy obesity (BMI?≥?30?kg/m², 26.0% versus 11.9%, p?<?0.001, OR: 2.6; 95% CI: 1.6–4.3) and positive family history of diabetes (45.2% versus 30.8%, p?<?0.002, OR: 1.8; 95% CI: 1.3–2.7) was more frequent in women with fasting hyperglycemia. Two-hour post-load hyperglycemia was only associated with increased prevalence of gestational hypertension (5.1% versus 11.4%, p?=?0.046).

Conclusions: Women with fasting but not 2-h hyperglycemia according to IADPSG criteria are at significantly elevated risk of perinatal complications.     

Pregnancy outcome of patients following deep venous thrombosis

Objective. To investigate pregnancy outcome of patients with a history of deep vein thrombosis (DVT).

Methods. A population-based study comparing all pregnancies of patients with and without a history of DVT was conducted. Deliveries occurred during the years 1988–2007 at a tertiary Medical Center. Stratified analyses were performed using multivariable logistic regression models and the Mantel-Haenszel technique.

Results. During the study there were 212,086 deliveries, of which 122 (0.06%) occurred in patients with a history of DVT. Using a multivariate analysis, with backward elimination, the following conditions were significantly associated with DVT: advanced maternal age (OR, 1.1; 95% CI, 1.02–1.1; p = 0.004), chronic hypertension (OR, 2.9; 95% CI, 1.4–6.0; p = 0.005) and previous caesarean delivery (OR, 2.8; 95% CI, 1.9–4.1; p < 0.001). Patients with a history of DVT were more likely to have caesarean deliveries (OR, 2.6; 95% CI, 1.8–3.8; p < 0.001) than non-DVT patients. After controlling for possible confounders, such as maternal age, hypertensive disorders, pregestational diabetes and multiple gestations, by using another multivariate analysis with preterm delivery (<37 weeks' gestation) as the outcome variable, DVT was found to be an independent risk factor for preterm birth (OR, 1.8; 95% CI, 1.1–2.9; p = 0.033). This association remained significant after controlling for labor induction, using the Mantel-Haenszel technique (OR, 1.8; 95% CI, 1.1–3.0; p = 0.011). No significant differences were noted between the groups regarding perinatal outcomes such as low Apgar scores, congenital malformations or perinatal mortality.

Conclusions. A history of DVT is an independent risk factor for spontaneous preterm delivery. Nevertheless, in our population it is not associated with adverse perinatal outcome.     

Do tall women beget larger babies?

Objective: To evaluate the possible relationship between maternal height and fetal size.

Patients and methods: We used a population-based cohort of apparently healthy mothers of singletons to evaluate quartiles of the maternal height distribution for parity, being overweight or obese, and for gestational age and birth weight parameters. We also generated birth weight by gestational age curves for each quartile.

Results: We analyzed data of 198?745 mothers. Mother from the four quartiles had similar parity, pre-gravid BMI, and gestational age at birth. Short mothers had a significantly higher rate of VLBW and LBW and 2501–4000?g infants, for an OR?=?1.38 (95% CI: 1.17–1.62), OR?=?2.2 (95% CI: 2.05–2.37) and OR?=?1.82 (95% CI: 1.73–1.87) between the shortest and tallest mothers, respectively. By contrast, the opposite trend was noticed for birth weights >4000?g, for an OR?=?2.77 (95% CI: 2.65–2.89) between the tallest and shortest mothers. A very similar “growth curve” was apparent until 33?weeks, when a slower growth velocity was observed for shorter compared with taller women.

Conclusions: Maternal stature does not appear to be associated with gestational age but significantly influences birth weight. Height-related differences between mothers appears to begin after 33 weeks’ gestation.     

Elevated vaginal pH in the absence of current vaginal infection,still a challenging obstetrical problem

Abstract

Objective: To assess the association of vaginal pH?≥?5 in the absence of vaginal infection with systemic inflammation and adverse pregnancy outcome.

Methods: Four-hundred sixty pregnant women completed the study, upon enrollment Vaginal pH was measured for all women, maternal and umbilical sera were obtained for determining C-reactive protein (CRP) and uric acid levels. Umbilical blood was tested for gas parameters, 1 and 5?min Apgar scores, the need for neonatal resuscitation and neonatal intensive care unit (NICU) admission were recorded.

Results: Elevated vaginal pH was significantly associated with preterm birth (odds ratio (OR), 2.23; 95% confidence interval (CI), 1.04–4.76), emergency cesarean section (OR 2.57; 95% CI 1.32–5), neonatal resuscitation in the delivery room (OR 2.85; 95% CI 1.1–7.38), elevated cord base deficit (OR 8.01; 95% CI 1.61–39.81), low cord bicarbonate (OR 4.16, 95% CI 1.33–12.92) and NICU admission (OR 2.02; 95% CI 1.12–3.66). Increased vaginal pH was also significantly associated with maternal leukocytosis, hyperuricemia and elevated CRP levels in maternal and umbilical sera.

Conclusions: Elevated vaginal pH in the absence of current vaginal infection still constitutes a risk for adverse pregnancy outcome which is mediated by systemic inflammatory response.     

The effect of prepregnancy body mass index on birth weight,preterm birth,cesarean section,and preeclampsia in pregnant women

Objective: The objective of this study is to determine the impact of maternal prepregnancy BMI on birth weight, preterm birth, cesarean section, and preeclampsia among pregnant women delivering singleton life birth.

Methods: A cross-sectional study of 4397 women who gave singleton birth in Tehran, Iran from 6 to 21 July 2015, was conducted. Women were categorized into four groups: underweight (BMI?2), normal (BMI 18.5–25?kg/m²), overweight (BMI 25–30?kg/m²) and obese (BMI >30?kg/m²), and their obstetric and infant outcomes were analyzed using both univariate and multivariate logistic regression.

Results: Prepregnancy BMI of women classified 198 women as underweight (4.5%), 2293 normal (52.1%), 1434 overweight (32.6%), and 472 as obese (10.7%). In comparison with women of normal weight, women who were overweight or obese were at increased risk of preeclampsia (odds ratio (OR)?=?1.47, 95% CI?=?1.06–2.02; OR?=?3.67, 95% CI?=?2.57–5.24, respectively) and cesarean section (OR?=?1.21, 95% CI?=?1.04–1.41; OR?=?1.35, 95% CI?=?1.06–1.72, respectively). Infants of obese women were more likely to be macrosomic (OR?=?2.43, 95% CI?=?1.55–3.82).

Conclusion: Prepregnancy obesity is a risk factor for macrosomia, preeclampsia, and cesarean section and need for resuscitation.     

The association of maternal BMI with fetal echogenic intracardiac foci and echogenic bowel

Objectives.?To evaluate the impact of maternal body mass index (BMI) as well as maternal ethnicity on the detection of either echogenic intra-cardiac focus (EIF) or echogenic bowel (EB).

Methods.?This prospective study identified 74 uncomplicated singleton fetuses in which EIF and/or EB were detected between 18 and 21 weeks of gestation (i.e. study group). Seventy four consecutively scanned fetuses without EIF or EB, at the same gestational age, were selected as controls. The differences in maternal BMI and maternal ethnicity were compared between the two groups using the χ² test, Fisher's exact test, and the Student t-test. A multivariable logistic regression model was constructed to control for confounders. Odds ratios (OR) and their 95% confidence interval (CI) were computed.

Results.?The mean maternal BMI was significantly lower in the study group as compared to controls (22.9?±?3.1 vs. 28.0?±?7.5?kg/m², respectively; p?<?0.0001). Patients with fetal EIF and/or EB were significantly more likely to be Asians (20.3% vs. 5.4%, OR?=?4.5; 95% CI 1.3–16.9). Using a multivariable analysis, controlling for ethnicity, the association between maternal BMI and fetal EIF or EB remained significant (OR?=?0.83; 95% CI 0.76–0.91). However, based on this model Asian ethnicity was not an independent risk factor for the detection of EIF and/or EB (OR?=?2.6; 95% CI 0.8–8.9).

Conclusions.?Our data suggests an inverse relationship between the maternal BMI and the detection of fetal EIF and/or EB. Moreover, it appears that low maternal BMI, and not Asian ethnicity, is an independent risk factor for the detection of these echogenic fetal findings.     

Placental weight and efficiency in relation to maternal body mass index and the risk of pregnancy complications in women delivering singleton babies

Herein we report placental weight and efficiency in relation to maternal BMI and the risk of pregnancy complications in 55,105 pregnancies. Adjusted placental weight increased with increasing BMI through underweight, normal, overweight, obese and morbidly obese categories and accordingly underweight women were more likely to experience placental growth restriction [OR 1.69 (95% CI 1.46-1.95)], while placental hypertrophy was more common in overweight, obese and morbidly obese groups [OR 1.59 (95% CI 1.50-1.69), OR 1.97 (95% CI 1.81-2.15) and OR 2.34 (95% CI 2.08-2.63), respectively]. In contrast the ratio of fetal to placental weight (a proxy for placental efficiency) was lower (P < 0.001) in overweight, obese and morbidly obese than in both normal and underweight women which were equivalent. Relative to the middle tertile reference group (mean 622 g), placental weight in the lower tertile (mean 484 g) was associated with a higher risk of pre-eclampsia, induced labour, spontaneous preterm delivery, stillbirth and low birth weight (P < 0.001). Conversely placental weight in the upper tertile (mean 788 g) was associated with a higher risk of caesarean section, post-term delivery and high birth weight (P < 0.001). With respect to assumed placental efficiency a ratio in the lower tertile was associated with an increased risk of pre-eclampsia, induced labour, caesarean section and spontaneous preterm delivery (P < 0.001) and a ratio in both the lower and higher tertiles was associated with an increased risk of low birth weight (P < 0.001). Placental efficiency was not related to the risk of stillbirth or high birth weight. No interactions between maternal BMI and placental weight tertile were detected suggesting that both abnormal BMI and placental growth are independent risk factors for a range of pregnancy complications.