The mutual effect of pregestational body mass index,maternal hyperglycemia and gestational weight gain on adverse pregnancy outcomes

Objective: To investigate the mutual effect of obesity, gestational diabetes (GDM) and gestational weight gain (GWG) on adverse pregnancy outcomes.

Methods: Charts of patients who delivered in our hospital between June 2001 and June 2006 singleton, live births >24 weeks gestation were reviewed. Univariate and multivariate logistic regression were used to assess pregnancy outcomes defined as large for gestational age (LGA), primary cesarean section (PCS) and a composite outcome of LGA and/or PCS.

Results: A total of 8595 women were included. Frequency of composite outcome increased with increasing body mass index (BMI), increasing hyperglycemia and above-recommended GWG. In the multivariate logistic regression analysis compared to women with normal BMI, odds ratio (OR) for composite outcome was 1.23 (95% confidence interval [CI] 1.06–1.44) in overweight women, OR?=?1.86 (1.51–2.31) in obese women and in severe obesity OR?=?2.97 (2.15–4.11).

Compared to normoglycemic women, odds for composite outcome in women with abnormal glucose challenge test OR?=?1.46 (1.20–1.79), impaired glucose tolerance OR?=?1.65 (1.14–2.4) and GDM OR?=?1.56 (1.16–2.10). Women with GWG above recommended had OR?=?1.58, (1.37–1.81) for composite outcome.

Conclusions: Higher pregestational BMI, maternal hyperglycemia and above-recommended GWG independently contribute to adverse pregnancy outcomes. Furthermore, there is mutual effect between these three factors and adverse outcomes. Appropriate pregestational weight and adequate GWG might reduce risk of adverse pregnancy outcomes.     

Obesity and adverse pregnancy outcomes in twin pregnancies

Abstract

Objective: To compare pregnancy outcomes in twin pregnancies based on maternal pre-pregnancy body mass index (BMI).

Methods: Historical cohort study of all twin pregnancies >24 weeks managed by one maternal-fetal medicine practice from 2005 to 2012. We compared pregnancy outcomes between pre-pregnancy obese (BMI ≥30?kg/m²) and normal weight women (BMI 18.5–24.99?kg/m²). We also compared pre-pregnancy normal weight women to overweight women (BMI 25–29.99?kg/m²) and underweight women (BMI <18.5?kg/m²). Chi square, Fisher’s exact test, Student’s t-test, and one-way ANOVA were used as appropriate. A p value of <0.05 was considered significant.

Results: Five hundred fourteen patients with twin pregnancies were included. Pre-pregnancy obesity was associated with gestational hypertension (34.1% versus 17.9%, p?=?0.011), preeclampsia (27.3% versus 14.4%, p?=?0.028), and gestational diabetes (22.2% versus 4.7%, p?<?0.001). Pre-pregnancy overweight was associated with gestational diabetes (13.7% versus 4.7%, p?=?0.002). Pre-pregnancy underweight was not associated with any adverse pregnancy outcomes. Comparing outcomes across normal weight, overweight, and obese women, the rates of gestational diabetes and gestational hypertension increased significantly across the three groups.

Conclusion: In patients with twin pregnancy, pre-pregnancy obesity is associated with adverse pregnancy outcomes, including gestational diabetes, gestational hypertension, and preeclampsia.     

Associations between maternal BMI as well as glucose tolerance and adverse pregnancy outcomes in women with polycystic ovary syndrome

This retrospective, cohort study examined the association between maternal pre-pregnancy body mass index (BMI), independent of glucose tolerance and adverse pregnancy outcomes in women with polycystic ovary syndrome (PCOS), for which there are few previous studies. Medical records from 2012 to 2015 at Guangzhou Women and Children’s Medical Center, China were reviewed for women previously diagnosed with PCOS with normal 2-h 75-g oral glucose tolerance test (OGTT) results (n?=?1249). The separate and joint effects of maternal BMI and glucose levels on pregnancy outcomes were assessed. Maternal pre-pregnancy BMI was associated with hypertensive disorders of pregnancy (HDP) (OR: 1.22, 95% CI: 1.02–1.45), preterm birth (OR: 1.49, 95% CI: 1.08–2.17), and large for gestational age (LGA) (OR: 1.69, 95% CI: 1.16–2.20). Elevated fasting glucose and maternal pre-pregnancy BMI were jointly associated with increased risks of HDP, preterm birth, and LGA. Therefore, among women with PCOS and normal glucose tolerance, maternal pre-pregnancy BMI is an independent risk factor of adverse pregnancy outcomes.     

Risk of adverse pregnancy outcomes stratified for pre-pregnancy body mass index

Objective: To estimate the risk of adverse maternal and perinatal outcomes in women with different pre-pregnancy body mass index (BMI).

Methods: We conducted a cohort study with 14?451 singleton pregnancies in 15 medical centers in Beijing between 20 June 2013 and 30 November 2013 using cluster random sampling. We divided participants into four groups based on pre-pregnancy BMI: Group A (underweight): BMI?<?18.5?kg/m², Group B (normal): 18.5–23.9?kg/m², Group C (overweight): 24–27.9?kg/m², Group D (obesity): ≥28?kg/m². 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 and obesity was 14.82% (2142/14?451) and 4.71% (680/14?451) in the study population, respectively. Higher pre-pregnancy BMI is associated with higher prevalence of gestational diabetes (GDM), macrosomia, Cesarean section (C-section), preeclampsia and postpartum hemorrhage. Pre-pregnancy overweight or obesity increases the risk of adverse pregnancy outcomes, regardless of GDM status.

Conclusions: Pre-pregnancy overweight or obesity is associated with increased risk of adverse pregnancy outcomes. Nutrition counseling is recommended before pregnancy in women who have overweight or obesity.     

Thiol/disulfide homeostasis in predicting adverse perinatal outcomes at 24–28 weeks of pregnancy in gestational diabetes

Objective: The main aim of this study was to investigate thiol/disulfide homeostasis at 24–28 weeks of pregnancy and to evaluate whether it is predictive for adverse perinatal outcomes or not in gestational diabetes mellitus (GDM).

Methods: A total of 110 pregnant women at 24–28 weeks of pregnancy (74 GDM patients and 36 age- and BMI-matched healthy pregnant women) were enrolled in this prospective case–control study. Thiol/disulfide homeostasis was evaluated with a novel spectrophotometric method to determine if there is an association with adverse perinatal outcomes in GDM, by using logistic regression analysis.

Results: GDM patients, with decreased native thiol levels at 24–28 weeks (OR: 4.890, 95% CI: 1.355–5.764, p?=?0.015) and with higher pre-pregnancy BMI (OR: 1.280, 95% CI: 1.072–1.528, p?=?0.006), were found to be at increased risk of adverse perinatal outcomes in GDM. There were no statistically significant differences in thiol/disulfide homeostasis between diet- and insulin-treated GDM subgroups. Additionally, 1-h and 2-h glucose levels on 100?g OGTT were found to be predictive for the insulin need in achieving good glycemic control in GDM (OR: 1.022, 95% CI: 1.005–1.038, p?=?0.010 and OR: 1.019, 95% CI: 1.004–1.035, p?=?0.015).

Conclusions: GDM patients, with decreased native thiol levels at 24–28 weeks of pregnancy and with higher pre-pregnancy BMI, have an increased risk of possible adverse perinatal outcomes. Also, increased 1-h and 2-h glucose levels on 100?g OGTT can predict the need for insulin treatment for GDM.     

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.     

Maternal pre-pregnancy overweight status and obesity as risk factors for cesarean delivery

Objective.?To determine the extent to which, if at all, maternal pre-pregnancy adiposity and other anthropometric factors are related to risk of cesarean delivery.

Methods.?This hospital-based prospective cohort study included 738 nulliparous women who initiated prenatal care prior to 16 weeks gestation. Participants provided information about their pre-pregnancy weight and height and other sociodemographic and reproductive covariates. Labor and delivery characteristics were obtained from maternal and infant medical records. Risk ratios (RR) and 95% CI were estimated by fitting generalized linear models.

Results.?The proportion of cesarean deliveries in this population was 26%. Women who were overweight (BMI 25.00–29.99?kg/m²) were twice as likely to deliver their infants by cesarean section as lean women (BMI <?20.00?kg/m²) (RR?=?2.09; 95% CI 1.27–3.42). Obese women (BMI ??30.00?kg/m²) experienced a three-fold increase in risk of cesarean delivery when compared with this referent group (RR?=?3.05; 95% CI 1.80–5.18). The joint association between maternal pre-pregnancy overweight status and short stature was additive. When compared with tall (height ??1.63?m), lean women, short (?<?1.63?m), overweight (BMI ??25.00?kg/m²) women were nearly three times as likely to have a cesarean delivery (RR?=?2.79; 95% CI 1.72–4.52).

Conclusion.?Our findings suggest that nulliparous women who are overweight or obese prior to pregnancy, and particularly those who are also short, have an increased risk of delivering their infants by cesarean section.     

妊娠期高血压、子痫前期及子痫与孕前和孕期体质量及其他因素的相关性研究

目的:探讨妊娠期高血压、子痫前期及子痫与孕前体质量指数(BMI)和孕期体质量增长及其他因素的相关性。方法:本研究纳入2013年1月1日至2014年12月31日在四川大学华西第二医院住院分娩的孕妇共10422例,其中患病组(患妊娠期高血压、子痫前期及子痫)349例,未患病组(未患妊娠期高血压、子痫前期及子痫)10073例。采用Logistics回归分析孕前、孕期体质量及其他因素与妊娠期高血压、子痫前期及子痫的相关性及不同BMI分类与其的相关性。结果:Logistics回归分析示,对于所有孕妇,年龄、孕前BMI过高(包括孕前超重、孕前肥胖)、多胎妊娠、辅助生殖技术受孕、慢性高血压及妊娠期高血压疾病史是妊娠期高血压、子痫及子痫前期的独立危险因素,孕前偏瘦为其保护性因素。通过BMI分层以后,对于孕前BMI正常的孕妇,年龄、BMI、孕期总体质量增长、多胎妊娠、辅助生殖技术、慢性高血压、妊娠期高血压疾病史是3种疾病的独立危险因素;对于孕前超重的孕妇,其危险因素只包括孕前BMI、辅助生殖技术受孕和慢性高血压。结论:孕前BMI过高、多胎妊娠、辅助生殖技术受孕、妊娠期高血压疾病史使妊娠期高血压、子痫及子痫前期的发生风险明显增加;孕前BMI、辅助生殖技术受孕和慢性高血压可能增加孕前体质量正常和超重孕妇妊娠期高血压、子痫及子痫前期的发生风险;孕期体质量增长与妊娠期高血压、子痫及子痫前期的发生关系不明显。     

The effect of maternal obesity on pregnancy outcomes in women with gestational diabetes

Objective.?To examine the impact of maternal obesity on maternal and neonatal outcomes in pregnancies complicated with gestational diabetes mellitus (GDM).

Methods.?Women with singleton pregnancies and GDM enrolled in an outpatient GDM education, surveillance and management program were identified. Maternal and neonatal pregnancy outcomes were compared for obese (pre-pregnancy BMI?≥?30?kg/m²) and non-obese (pre-pregnancy BMI?<?30?kg/m²) women and for women across five increasing pre-pregnancy BMI categories.

Results.?A total of 3798 patients were identified. Maternal obesity was significantly associated with the need for oral hypoglycemic agents or insulin, development of pregnancy-related hypertension, interventional delivery, and cesarean delivery. Adverse neonatal outcomes were also significantly increased including stillbirth, macrosomia, shoulder dystocia, need for NICU admission, hypoglycemia, and jaundice. When looking across five increasing BMI categories, increasing BMI was significantly associated with the same adverse maternal and neonatal outcomes.

Conclusion.?In women with GDM, increasing maternal BMI is significantly associated with worse maternal and neonatal outcomes.     

妊娠期糖尿病合并慢性高血压孕妇胰岛素抵抗水平及其对妊娠结局的影响

目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)合并慢性高血压(chronic hypertension,CHT)孕妇的胰岛素抵抗(insulin resistance,IR)水平及其对妊娠结局的影响。方法本研究为回顾性病例对照研究。纳入2014年1月1日至2016年12月31日在北京大学第一医院规律产前检查并参加GDM一日门诊的单胎妊娠GDM孕妇2457例。回顾临床资料,采用稳态模型评估IR水平(homeostasis model assessment insulin resistance,HOMA-IR)。根据GDM孕妇是否合并CHT分为GDM合并CHT组(n=47)和GDM未合并CHT组(n=2410),并进一步根据孕前体重指数(body mass index,BMI)分为孕前BMI正常组(n=1590)及孕前超重和肥胖组(n=863)进行分层分析。采用两独立样本t检验、χ2检验分析组间孕妇年龄、HOMA-IR、孕前BMI、孕期增重、血糖等临床特征的差异。采用logistic回归模型分析HOMR-IR水平对妊娠结局的影响。结果合并CHT的GDM孕妇HOMA-IR(3.5±1.8与2.6±1.5,t=-3.290)、空腹血浆葡萄糖[(5.4±0.5)与(5.2±0.5)mmol/L,t=-3.005]、孕前BMI[(26.7±4.7)与(23.3±3.4)kg/m2,t=-4.842]以及发生子痫前期的比例[14.9%(7/47)与2.5%(61/2410),χ2=21.790]高于未合并CHT的GDM孕妇,但孕期增重少于未合并CHT者[(9.6±5.8)与(12.2±4.7)kg,t=3.790](P值均<0.01)。根据孕前BMI分层后,超重和肥胖孕妇中,GDM合并CHT组子痫前期的比例高于GDM未合并CHT组[15.2%(5/33)与4.2%(35/830),χ2=6.290,P=0.012],但HOMA-IR差异无统计学意义(P>0.05);而对于孕前BMI正常的孕妇,GDM合并CHT组HOMA-IR(3.0±1.5与2.3±1.2,t=-2.217)、空腹血浆葡萄糖[(5.4±0.5)与(5.1±0.5)mmol/L,t=-2.299]和子痫前期的比例[2/14与1.6%(26/1576),χ2=6.545]均高于未合并CHT组(P值均<0.05)。对于GDM合并CHT孕妇,HOMA-IR水平不会增加剖宫产、早产、大于胎龄儿、小于胎龄儿和巨大儿的发生风险(P值均>0.05)。控制年龄、空腹血浆葡萄糖、孕前BMI、孕期增重后,对于未合并CHT的GDM孕妇,HOMA-IR水平的增加会使早产的发生风险增加(OR=1.223,95%CI:1.093~1.369,P<0.001)。结论GDM合并CHT孕妇胰岛素抵抗程度更重,子痫前期的发病率更高,但其他不良妊娠结局的发生风险未见增加。     

Body mass index at 11–13 weeks’ gestation and pregnancy complications in a Southern Chinese population: a retrospective cohort study

Objective: To assess the association between body mass index (BMI) and adverse pregnancy outcomes.

Materials and methods: A multicentre retrospective cohort study was conducted in three hospitals in Hong Kong including 67,248 women with singleton pregnancy at 11–13 weeks between 2010 and 2016. The relationship between maternal BMI and (1) miscarriage or stillbirth, (2) development of preeclampsia (PE), (3) gestational hypertension (GH), (4) development of gestational diabetes mellitus (GDM), (5) spontaneous preterm delivery (sPTD) <34 and <37 weeks, (6) delivery of a small for gestational age (SGA) or large for gestational age (LGA) neonate, (7) caesarean section (CS), and (8) postpartum haemorrhage (PPH) were examined after adjusting for confounding factors.

Results: The prevalence of maternal overweight (BMI 25–29.9?kg/m²) and obesity (BMI ≥30?kg/m²) were 13.2% and 2.9%, respectively. Women with a BMI ≥30?kg/m² were nine times more likely to develop GH (95%CI 7.3–11.7), five times more likely to develop PE (95%CI 4.3–6.8) and GDM (95%CI 5.0–6.5) and 1.5–2 times more likely to deliver SGA/LGA neonate. sPTD, required delivery by CS and developed PPH, than those with a BMI of 18.5–22.9?kg/m², and that maternal underweight (BMI <18.5?kg/m²) significantly reduced the risk of GDM, delivery by CS, and PPH. Increased risk of subsequent development of adverse outcomes was observed when BMI was ≥23.0?kg/m².

Conclusions: Maternal overweight and obesity are associated with an increased risk for subsequent development of various pregnancy complications. The need of increased awareness and health surveillance is essential when BMI ≥23?kg/m².     

Protocol for the immediate delivery versus expectant care of women with preterm prelabour rupture of the membranes close to term (PPROMT) Trial [ISRCTN44485060]

Background

Nutritional status of women has been considered an important prognostic indicator of pregnancy outcomes. Few studies have evaluated patterns of weight gain and pre-pregnancy body mass index in developing regions where malnutrition and poor weight gain as well as maternal obesity have significant influences on the pregnancy outcome. This study aims to show effect of pregnancy body mass index and the corresponding gestational weight gain on the outcome of pregnancy.

Methods

On a prospective cross sectional study, two hundred and seventy women from urban areas of Northwest Iran were recruited for participation during their first eight weeks of pregnancy. Body mass index (BMI) was categorized and gestational weight gain was divided into two groups of normal and abnormal based on recommendations of Institute of Medicine (IOM) published in 1990. Chi square and one way ANOVA were used in the univariate analysis of the association between weight gain and corresponding adverse outcomes including cesarean, preterm labor and low neonatal birth weight. Adjusted odds ratios for adverse outcomes were determined by multiple logistic regression models, while controlling for the following factors: maternal age, parity, and education.

Results

Both pre-pregnancy BMI < 19 and abnormal weight gain during pregnancy were found to be associated with low neonatal birth weight defined as < 2500 g. Abnormal weight gain, during pregnancy was not related to an increased risk of preterm labor or cesarean delivery but it was highly associated with low birth weight (LBW)(P < 0.05).

Conclusion

Low pre-pregnancy BMI is an established risk factor for LBW. Abnormal gestational weight gain may further complicate the pregnancy as an additional risk factor for neonatal LBW. All women, regardless of their pre-pregnancy BMI may be at risk for abnormal weight gain and hence low birth weight. Pre-pregnancy and gestation nutritional assessments remain significant part of all prenatal visits.     

Is low-dose aspirin therapy to prevent preeclampsia more efficacious in non-obese women or when initiated early in pregnancy?

Objective: Late timing of intervention and maternal obesity are potential explanations for the modest effect of aspirin for preeclampsia prevention. We explored whether low-dose aspirin (LDA) is more effective in women at increased risk when initiated before 16 weeks' gestation or given to non-obese women.

Methods: Secondary analysis of a trial to evaluate LDA (60?mg/d) for preeclampsia prevention in high-risk women. Participants were randomized to LDA or placebo between 13 and 26 weeks. We stratified the effect of LDA on preeclampsia by (a) timing of randomization (Results: Of 2503 women, 461 (18.4%) initiated LDA?p value for interaction?=?0.87). Similarly, LDA effect was not better in non-obese (RR: 0.91, 95% CI: 0.7–1.13) versus obese women (RR: 0.89, 95% CI: 0.7–1.13), (p value for interaction?=?0.85).

Conclusion: LDA for preeclampsia prevention was not more effective when initiated 相似文献   

External iliac artery Doppler assessment in the prediction of adverse pregnancy outcomes

Purpose: The purpose of this study is to investigate the potential role of the mean external iliac artery pulsatility index (EIA-PI) as a predictor of adverse obstetric outcomes such as preeclampsia, gestational hypertension and small for gestational age (SGA).

Methods: In women attending for first trimester screening at 11?+?0–13?+?6 weeks of gestation, we recorded maternal characteristics and measured EIA mean PI and uterine artery mean PI. We compared EIA mean PI in those that developed preeclampsia (n?=?84), gestational hypertension (n?=?50) or small for gestational age (n?=?444) with those unaffected (n?=?3736). Regression analysis was used to first determine which of the factors among the maternal variables were significant predictors of EIA mean PI in the unaffected group and, second, to predict adverse pregnancy outcomes.

Results: In the unaffected group, EIA mean PI increased with maternal age and decreased with mean blood pressure. Additionally, EIA mean PI was lower in cigarette smokers. Compared with the unaffected group, EIA mean PI was significantly lower in women who develop gestational hypertension or SGA below third centile.

Conclusion: EIA mean PI in the first trimester is decreased in women who develop gestational hypertension and in those complicated by SGA below third centile. More studies are needed to confirm these findings.     

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.     

Models for the prediction of successful induction of labor based on pre-induction sonographic measurement of cervical length

Objective.?To examine the effect of pre-induction cervical length, parity, gestational age at induction, maternal age and body mass index (BMI) on the possibility of successful delivery in women undergoing induction of labor.

Methods.?In 822 singleton pregnancies, induction of labor was carried out at 35 to 42^?+?6 weeks of gestation. The cervical length was measured by transvaginal sonography before induction. The effect of cervical length, parity, gestational age, maternal age and BMI on the interval between induction and vaginal delivery within 24?hours was investigated using Cox's proportional hazard model. The likelihood of vaginal delivery within 24?hours and risk for cesarean section overall and for failure to progress was investigated using logistic regression analysis.

Results.?Successful vaginal delivery within 24?hours of induction occurred in 530 (64.5%) of the 822 women. Cesarean sections were performed in 161 (19.6%) cases, 70 for fetal distress and 91 for failure to progress. Cox's proportional hazard model indicated that significant prediction of the induction-to-delivery interval was provided by the pre-induction cervical length (HR?=?0.89, 95 % CI 0.88–0.90, p?<?0.0001), parity (HR?=?2.39, 95% CI 1.98–2.88, p?<?0.0001), gestational age (HR?=?1.13, 95% CI 1.07–1.2, p?= <?0.0001) and birth weight percentile (HR?=?0.995, 95% CI 0.99?– 0.995, p?=?0.001), but not by maternal age or BMI. Logistic regression analysis indicated that significant prediction of the likelihood of vaginal delivery within 24?hours was provided by pre-induction cervical length (OR?=?0.86, 95% CI 0.84–0.88, p?<?0.0001), parity (OR?=?3.59, 95% CI 2.47–5.22, p?<?0.0001) and gestational age (OR =?1.19, 95% CI 1.07–1.32, p?= <?0.0001) but not by BMI or maternal age. The risk of cesarean section overall was significantly associated with all the variables under consideration, i.e., pre-induction cervical length (OR?=?1.09, 95% CI 1.06–1.11, p?<?0.0001), parity (OR?=?0.25, 95% CI 0.17–0.38, p?<?0.0001), BMI (OR?=?1.85, 95% CI 1.24–2.74, p?=?0.0024), gestational age (OR?=?0.88, 95% CI 0.78–0.98, p?=?0.0215) and maternal age (OR?=?1.04, 95% CI 1.01–1.07, p?=?0.0192). The risk of cesarean section for failure to progress was also significantly associated with pre-induction cervical length (OR?=?1.11, 95% CI 1.07–1.14, p?<?0.0001), parity (OR?=?0.26, 95% CI 0.15–0.43, p?<?0.0001), gestational age (OR?=?0.83, 95% CI 0.73–0.96, p?=?0.0097) and BMI (OR?=?2.07, 95% CI 1.27–3.37, p?=?0.0036).

Conclusion.?In women undergoing induction of labor, pre-induction cervical length, parity, gestational age at induction, maternal age and BMI have a significant effect on the interval between induction and delivery within 24?hours, likelihood of vaginal delivery within 24?hours and the risk of cesarean section.     

Evaluation of first trimester serum soluble endothelial cell-specific tyrosine kinase receptor in normal and affected pregnancies

Aims: To assess soluble endothelial cell-specific tyrosine kinase receptor (sTie-2) levels in the first trimester of pregnancy and its association with adverse pregnancy outcomes; and examine the predictive accuracy.

Study design: In this nested case-control study, serum sTie-2 levels were measured in 2616 women with singleton pregnancies attending first trimester screening in New South Wales, Australia. Multivariate logistic regression models were used to assess the association and predictive accuracy of serum sTie-2 with subsequent adverse pregnancy outcomes.

Results: Median (interquartile range) sTie-2 for the total population was 19.6?ng/ml (13.6–26.4). Maternal age, weight, and smoking status significantly affected sTie-2 levels. There was no difference in serum sTie-2 between unaffected and women with adverse pregnancy outcomes. After adjusting for maternal and clinical risk factors, low sTie-2 (<25th centile) was associated with preeclampsia (Adjusted odds ratio: 1.61; 95% CI: 1.01–2.57), however, the accuracy of sTie-2 in predicting preeclampsia was not different from chance (AUC?=?0.54; p?=?0.08) and does not add valuable predictive information to maternal and clinical risk factors.

Conclusions: Our findings suggest that low sTie-2 levels are associated with preeclampsia, however, it does not add valuable information to clinical and maternal risk factor information in predicting preeclampsia or any other adverse pregnancy outcomes.     

Adverse maternal and neonatal outcomes in women with preeclampsia in Iran

Background: Preeclampsia is relatively a common complication in pregnancy and is characterized by high blood pressure and protein in urine during pregnancy. Consistent with the adverse outcomes followed by preeclampsia, this study designed to investigate the how preeclampsia is associated with preterm, low birth weight (LBW), cesarean section, and weigh gain during pregnancy.

Methods: In this population-based cross-sectional study, 5166 deliveries from 103 hospitals in Tehran (Capital of Iran) were included in the analysis in 2015. The independent variable was preeclampsia during pregnancy and weight gain during pregnancy, preterm birth, cesarean section, and LBW were considered as interested outcomes. The data were analyzed by statistical Stata software (version 13, Stata Inc., College Station, TX).

Results: Adjusted results showed that the mean of weight gain in women with preeclampsia was significantly higher than women without preeclampsia (mean difference: 1.77?kg, 95%CI: 0.76–12.78, p?=?.001). The adjusted odds ratio for preterm birth, cesarean section, and LBW were 4.19 (95%CI: 2.71–6.48, p?=?.001), 1.92 (95%CI: 1.24–2.98, p?=?.003), and 1.19 (95%CI: 0.61–2.31, p?=?.599), respectively.

Conclusion: Weight gain in women with preeclampsia was higher than women without preeclampsia and also the odds of preterm birth, cesarean section and LBW in women with preeclampsia was higher than women without preeclampsia.     

Weight in Pregnancy and Its Implications: What Women Report

ObjectiveMisclassification of body mass index (BMI) by pregnant women could be a significant barrier to minimizing weight-related adverse pregnancy outcomes and improving the short- and long-term health of mother and child. The primary objective in this study was to determine the proportion of a group of pregnant women who were able to correctly classify BMI. Secondary objectives included assessing the direction of BMI misclassification and maternal knowledge of target gestational weight gain and obesity-associated pregnancy complications.MethodsWe designed a cross-sectional survey to assess misclassification of BMI and knowledge of obesity and pregnancy outcomes, and to provide information regarding the participants’ sources of knowledge, their perception of appropriate weight gain in pregnancy, and basic demographic information. The questionnaire was completed by participants awaiting routine ultrasound assessment at between 11 and 24 weeks’ gestation.ResultsOf 117 respondents, 30 (25.6%) were overweight (BMI 25 to 29.9) or obese (BMI ≥ 30.0). Obese or overweight women were significantly more likely to misclassify their BMI. Furthermore, they were significantly more likely to overestimate the minimum and maximum target gestational weight gains for their respective BMI classes. There were no differences between women in the various BMI categories with regard to their awareness of several common obesity-related pregnancy complications.ConclusionMisclassification of pre-pregnancy BMI is common, particularly among women carrying excess weight. Evaluation of pre-pregnancy BMI and education regarding appropriate gestational weight gain are logical initial steps for optimizing weight-related pregnancy outcomes.     

正常妊娠结局的单胎妊娠孕妇体质量增长模式

目的:了解妊娠期规律产前检查未发生不良结局的单胎孕妇妊娠期体质量增长模式。方法:采用回顾性研究,纳入2013年1月至2014年12月妊娠满37周但不超过42周在四川大学华西第二医院住院分娩的孕产妇,采集包括人口学资料、既往疾病史、家族史、孕产史、身高、妊娠前或建卡时体质量及体质量指数(BMI)、妊娠期间每次产前检查时体质量、分娩前体质量等指标。结果:共纳入4053例孕妇,妊娠前BMI正常(18.5~24 kg/m^2)的孕妇,妊娠16周体质量增长平均值为2.45±1.43 kg,妊娠40周体质量增长平均值为15.53±3.59 kg;妊娠前偏瘦(BMI<18.5 kg/m^2)的孕妇,妊娠16周体质量增长平均值为2.57±1.34 kg,妊娠40周体质量增长平均值为16.01±3.42 kg;妊娠前BMI超重(24~28 kg/m^2)的孕妇,妊娠16周体质量增长平均值为2.39±1.44 kg,妊娠40周体质量增长平均值为14.11±3.86 kg;妊娠前肥胖(BMI≥28 kg/m^2)的孕妇,妊娠16周体质量增长平均值为2.17±0.74 kg,妊娠39周体质量增长平均值为12.27±4.07 kg。结论:我院妊娠前BMI正常、偏瘦、超重和肥胖的孕妇适宜的妊娠期体质量增长范围分别为15.53±3.59 kg、16.01±3.42 kg、14.11±3.86 kg和12.27±4.07 kg。