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ObjectiveTo explore the risk of different levels of pre-pregnancy obesity on trimester-specific thyroid dysfunction. MethodsQuestionnaire information， blood samples， and urine samples from a 2017 pregnancy cohort study in Shanghai， China were collected. A total of 2 455 pregnant women were included in the analysis. Pre-pregnancy BMI was calculated based on the height and self-reported pre-pregnancy weight. Serum TSH， total thyroxine （TT4）， free thyroxine （FT4）， total triiodothyronine （TT3）， free triiodothyronine （FT3）， thyroid globulin antibody（TgAb）， and Thyroid peroxidase antibody （TPOAb） were measured using the electrochemiluminescence method. Urine iodine levels were measured using the acid digestion method. Levels of thyroid function indexes of pregnant women with different degrees of obesity during pre-pregnancy were compared， and trimester-specific thyroid dysfunction was evaluated according to the reference range of trimester-specific thyroid hormone established by this cohort. Multivariate logistic regressions analysis was used to assess the correlation between pre-pregnancy obesity and trimester-specific thyroid dysfunction. ResultsAs the degree of obesity increased， maternal levels of FT3 and TT3 gradually increased during pregnancy （P<0.001， P=0.001）， while FT4 levels gradually decreased （P=0.001）. Multivariate logistic regression analysis showed that compared with the normal weight group， pregnant women who were overweight or obesity before pregnancy had a significantly higher risk of hypothyroxinemia （OR=3.85， 95%CI： 2.08‒7.14， P<0.001） and high TT3 （OR=2.78， 95%CI： 1.45‒5.26， P=0.002） during pregnancy. ConclusionPre-pregnancy overweight or obesity can increase the risk of thyroid dysfunction during pregnancy.
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Objective@#To explore the dose-response relationship between pre-pregnancy body mass index (BMI) and gestational diabetes mellitus (GDM), so as to provide insights into the cut-off values of pre-pregnancy BMI and optimizing GDM prevention and control strategies. @*Methods@#Pregnant women that admitted to Zhengzhou Central hospital in 2021 were recruited, and demographics, family history, pregnancy and delivery history and blood glucose levels during pregnancy were collected. The dose-response relationship between pre-pregnancy BMI and GDM was analyzed using restricted cubic spline (RCS) analysis. The predictive ability of pre-pregnancy BMI for GDM risk was evaluated using receiver operating characteristic (ROC) curve. @*Results@#A total of 2 279 participants were included in the study. The median age was 29.0 (interquartile range, 5.0) years. The median pre-pregnancy BMI was 21.1 (interquartile range, 3.8) kg/m2. There were 312 underweight women (13.69%), 825 women with low-normal weight (36.20%), 730 women with high-normal weight (32.03%), 345 overweight women (15.14%) and 67 obese women (2.94%).The prevalence of GDM was 17.20%. RCS analysis suggested a linear dose-response relationship between age, pre-pregnancy BMI and GDM (P<0.05). When pre-pregnancy BMI was higher than 21.1 kg/m2, the risk of GDM increased with pre-pregnancy BMI (P<0.05). When women aged over 29.0 years, the risk of GDM increased with age, and the dose-response relationship of GDM caused by pre-pregnancy BMI was stronger in the women aged over 29.0 years than in the women aged 29.0 years and below (P<0.05). The area under curve (AUC) was 0.654 (95%CI: 0.624-0.684). If the cut-off value of pre-pregnancy BMI was 23.0 kg/m2, the Youden index, sensitivity and specificity was 0.238, 0.472 and 0.766, respectively. If it was 24.0 kg/m2, the Youden index, sensitivity and specificity was 0.195, 0.342 and 0.853, respectively. If it was 21.1 kg/m2, the Youden index, sensitivity and specificity was 0.213, 0.676 and 0.537, respectively.@* Conclusions @# There is a linear dose-response relationship between pre-pregnancy BMI and GDM, and higher than 21.1 kg/m2 of the pre-pregnancy BMI could increase the risk of GDM.
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Objective:To study the impacts of pre-pregnancy body mass index (BMI), gestational diabetes mellitus (GDM) and gestational weight gain (GWG) on perinatal outcomes and mode of delivery.Methods:From November 2016 to December 2017, single-pregnancy women in early pregnancy (<13 weeks) regularly checked-up at our hospital were enrolled in this prospective cohort study and followed up until delivery. They were assigned into four groups according to pre-pregnancy BMI: obese group (≥28.0 kg/m 2), overweight group(24.0-<28.0 kg/m 2), normal group (18.5-<24.0 kg/m 2) and underweight group(<18.5 kg/m 2). A 75-g oral glucose tolerance test was performed at 24-28 weeks of pregnancy to screen for GDM. The optimal GWG was 11.0-16.0 kg for underweight group, 8.0-14.0 kg for normal group, 7.0-11.0 kg for overweight group and 5.0-9.0 kg for obesity group. The effects of pre-pregnancy BMI, GDM and GWG on perinatal outcomes and delivery mode were evaluated using multivariate logistic regression methods. Results:A total of 802 pregnant women were included. The incidences of pre-pregnancy overweight and obesity were 21.8% and 8.9%, respectively. The incidence of GDM was 14.1%. 57.2% of the participants experienced excessive GWG. The incidences of macrosomia, low birth weight and premature birth were 7.1%, 2.7% and 2.2%, respectively. The incidence of Cesarean delivery (C-section) was 37.7%. Pre-pregnancy obesity [adjusted odds ratio ( AOR)=4.355, 95% confidence interval ( CI) 1.900-9.980] and excessive GWG ( AOR=3.799, 95% CI 1.796-8.034) were independent risk factors for macrosomia. Excessive GWG was a protective factor for low birth weight ( AOR=0.279, 95% CI 0.084-0.928) and inadequate GWG was a risk factor for low birth weight ( AOR=10.954, 95% CI 3.594-33.382) and premature birth ( AOR=8.796, 95% CI 2.628-29.438). Compared with the normal group, overweight group had an increased risk of C-section ( AOR=1.817, 95% CI 1.119-2.949). Compared with pregnant women without pre-pregnancy overweight/obesity, GDM nor excessive GWG, any combination of two of the above-mentioned three factors increased the risks of macrosomia ( AOR=3.908, 95% CI 1.630-9.370) and C-section ( AOR=2.269, 95% CI 1.325-3.886). The risks of macrosomia and C-section were the highest when all three factors existed. Conclusions:Pre-pregnancy obesity and excessive GWG are independent risk factors for macrosomia and pre-pregnancy overweight is a risk factor of C-section. Exposure to any two of the three factors (pre-pregnancy overweight/obesity, GDM and excessive GWG) increases risks of macrosomia and C-section and the highest risk is observed when all three factors are present.
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The outcome of this review is to assess the association between pre-pregnancy obesity and PPCM incidence. There were a total of 5.373.581 participants were included in this study. Pre-pregnancy obesity was significantly associated with PPCM incidence compared to normal-weight subjects (OR ¼ 1.79 (1.16,2.76); p ¼ 0.008; I 2 ¼ 59%, Pheterogeneity ¼ 0.04). The sub-group analysis showed that pre-pregnancy women with obesity class I (OR ¼ 1.58 (1.20,2.07); p ¼ 0.001; I 2 ¼ 0%, Pheterogeneity ¼ 0.64) and class II and III (OR ¼ 2.65 (2.04,3.45); p < 0.001; I 2 ¼ 6%, Pheterogeneity ¼ 0.36) was significantly associated with PPCM incidence compared to normal-weight subjects.
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Objective:To analyze the prevalence and risk factors of pre-pregnancy underweight, overweight and obesity among women aged 18~49 years in China in 2013 and 2019 and the changing trends during this period.Methods:Pre-pregnancy examination data were collected for 9 220 664 women of reproductive age who participated in the National Free Pre-pregnancy Health Examination Project in 2013 and 2019, to analyze the prevalence and changing trends of underweight, overweight and obesity. Data from China Population Census in 2010 were applied to calculate the age-standardized prevalence of underweight, overweight and obesity. Logistic regression model was used to analyze the risk factors.Results:The prevalence of underweight, overweight and obesity among women aged 18-49 years in China was 7.47%, 21.05% and 6.08%, respectively. Over the seven years from 2013 to 2019, the prevalence of underweight in women of reproductive age had decreased, and the prevalence of overweight and obesity had increased significantly. Younger age, higher education level and ethnic minorities were the risk factors of underweight, while advanced age, farmers, previous gravidity and previous parity were the risk factors of overweight and obesity. Vegetarian, smoking and passive smoking might increase the risk of underweight, overweight and obesity.Conclusion:Women of reproductive age in China are faced with the dual challenge of malnutrition and overnutrition and the weight management before pregnancy should be strengthened for women of reproductive age.
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Background In recent years gut microbiota has been found to play an important role in the occurrence and development of various chronic diseases, and diet is an important factor influencing gut microbiota. However, the effects of maternal high-fat diet in pre-pregnancy and pregnancy-and-lactation periods on offspring gut microbiota are still unclear. Objective To investigate the effects of maternal high-fat diet in pre-pregnancy and pregnancy-and-lactation periods on gut microbiota of offspring mice. Methods C57BL/6J female mice were divided into four groups according to the diet patterns (high-fat diet, HFD; control diet, CD) given before and after conception, namely the pre-pregnancy control diet and post-pregnancy control diet group (CD-CD group), the pre-pregnancy control diet and post-pregnancy high-fat diet group (CD-HFD group), the pre-pregnancy high-fat diet and post-pregnancy control diet group (HFD-CD group), and the pre-pregnancy high-fact diet and post-pregnancy high-fat diet group (HFD-HFD group). Female mice were conceived in the same cage with male mice after 6 weeks of feeding, and the successfully conceived females continued to be randomly divided into two groups receiving either high-fat or control diet, and when the offspring mice were born, they were breastfed directly by the mothers, with each mother nursing only one offspring mouse. The number of offspring mice in each group was 6, with half males and half females. The body weight of offspring mice were recorded and body weight gain was compared between the four groups. After the lactational period, fresh feces of the offspring were collected, and the fecal DNA was extracted. Specific primers were designed according to the bacterial 16S rDNA(V3+V4) sequence and then the sequencing was performed using the Illumina HiSeq 2500 platform. Species annotation and operational taxonomic unit (OTU) analysis of sequencing data were conducted using QIMME, USEARCH and R software. In alpha diversity analysis, ACE and Chao1 indices were used to evaluate species richness, Shannon and Simpson indices considered both species richness and evenness. In beta diversity analysis, principal coordinates analysis (PCoA) and analysis of similarities (Anosim analyses) were used to find the differences in composition of gut microbiota between four groups, and line discriminant analysis effect size (LefSe) was conducted to identify which specific taxa contributed to the significant differences between groups. Results A greater effect of post-pregnancy diet on offspring body weight was observed, and the lowest body weight was recorded in the HFD-CD group during the whole experimental period. The results of OTU analysis showed that high-fat diet during post-pregnancy period reduced the number of OTUs in offspring mice, and the results of alpha diversity analysis showed that high-fat diet during post-pregnancy period reduced the richness of intestinal flora (ACE, P<0.05; Chao1, P<0.05), whereas differences in the α-diversity indices did not show statistical significance in the offspring mice with pre-pregnancy high-fat diet. The high-fat diet at different periods also led to changes in the dominant intestinal flora of the offspring. The high-fat diet during post-pregnancy period increased the abundance of Tenericutes (P<0.05), and decreased the abundance of Bacteroides, Epsilonbacteraeota, Cyanobacteria, and Deferribacteres (all Ps<0.05). At the genus level, high-fat diet during both pre-pregnancy and post-pregnancy periods decreased the abundance of Lactobacillus (P<0.05), and high-fat diet during pre-pregnancy period increased the abundance of Alistipes (P<0.05), while high-fat diet during post-pregnancy period increased the abundance of Lachnospira and Ruminococcus, and decreased the abundance of Muribaculaceae and Helicobacter (all Ps<0.05). The results of beta diversity analysis showed that the CD-CD group had a similar flora composition to the HFD-CD group, and the CD-HFD group had a similar flora composition to the HFD-HFD group, and the results of Anosim analysis showed statistically significant differences between groups (R=0.743, P<0.01). The LEfSe analysis counted all species with an effect on the differences between groups greater than the set value, which were Lactobacillus in the CD-CD group, Clostridiales in the CD-HFD group, Bacteroidetes and Helicobacters in the HFD-CD group, and Blautia, Ruminococcaceae, and Roseburia in the HFD-HFD group. Conclusion It is found that varied effects of high-fat diet in different periods on the flora of the offspring mice. The high-fat diet during pre-pregnancy and post-pregnancy periods could reduce the abundance of Lactobacillus, but show different effects on the abundance of other intestinal flora such as Muribaculaceae, Lachnospiraceae, and Helicobacter differed. Diet during post-pregnancy period has a greater influence on modeling the offspring gut microbiota.
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Background Atmospheric fine particulate matter (PM2.5) can induce abnormal early embryo development, resulting in adverse pregnancy outcomes such as embryo damage and spontaneous abortion. The vascular remodeling of maternal-fetal interface regulated by hypoxia inducible factor-1α (HIF-1α)/vascular endothelial growth factor (VEGF) axis is a key link in early embryo development. Objective To investigate the effects of pre-pregnancy PM2.5 exposure on the uterine state of mice before conception and the vascular remodeling of maternal-fetal interface after conception, and to further explore the regulatory role of the HIF-1α/VEGF axis. Methods Forty eight-week-old C57BL/6J sexually mature female mice and several males (for mating, without any treatment) were adaptive fed for 1 week. The female mice were divided into a PM2.5 exposure group and a control group, 20 mice per group. The PM2.5 exposure group was given 3 mg·kg−1 PM2.5 suspension by nasal instillation, once every other day for four weeks; the control group were treated with the same dose of blank sampling membrane suspension. Body weight of the mice was recorded every week during the experimental period. At the end of the exposure, six mice from each group were sacrificed. Then the uterus was weighted and its organ coefficients were calculated, a histopathological morphology evaluation was conducted by HE staining, and the mRNA expressions of HIF-1α, VEGF and its receptors Flt-1 and Flk-1 in the uterus samples were further examined. The remaining 14 female mice in each group were caged with male mice overnight with a sex ratio of 2:1, then we calculated the pregnancy rate. On gestation day 10 (GD10), the female mice were decapitated and the uterus was dissected, the histopathological morphology of embryo and placenta were observed by HE staining, and the mRNA expressions of HIF-1α, VEGF and its receptors Flt-1 and Flk-1 were detected as well in the uterus samples. Results Compared with the control group, the pre-pregnancy PM2.5 exposure had no significant effect on body weight gain of the female mice, but decreased uterine organ coefficient, accompanied by pathological damage such as endometrium thinning as well as decreased mRNA expressions of HIF-1α, VEGF and its receptors Flt-1 and Flk-1 (all Ps<0.05). After mating, the pre-pregnancy PM2.5 exposure induced a decrease of the pregnancy rate (control group: 9/14; exposure group: 5/14) and abnormal embryo arrangement, small placenta, narrowing of spiral arteries (control group: 1.00±0.06; exposure group: 0.86±0.08; P=0.01), as well as significant decreases in HIF-1α, VEGF and its receptor Flk-1 mRNA expressions. (all Ps <0.05). Conclusion Pre-pregnancy PM2.5 exposure has adverse effects on the pathological structure and angiogenesis in female mice uterus, leading to abnormal vascular network remodeling at the mother-fetal interface after conception, and the HIF-1α/VEGF axis may play a regulatory role.
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ABSTRACT Chile, and several Latin American countries, use the Atalah standard to assess nutritional status during pregnancy. However, this standard (underweight: pre-pregnancy body mass index (BMI)<20 kg/m2 and normal weight: pre-pregnancy BMI= 20-24.9 kg/m2) differ from those recommended by the US Institute of Medicine (IOM2009) (underweight: BMI<18.5 kg/m2 and normal weight: 18.5-24.9 kg/m2). Using a large population database from a Chilean public hospital, we compared the prevalence of underweight and normal weight at the beginning of pregnancy with Atalah and IOM2009 standards. Additionally, we evaluated the performance of both standards in detecting adverse neonatal outcomes and gestational weight gain. Methods: Data from clinical records of single birth pregnancies (n= 59,476) at the Sótero del Río Hospital, between 2003-2012 were collected. We compared 1. nutritional status, 2. proportion of excessive gestational weight gain, 3. association between nutritional status and neonatal outcomes (large/small for gestational age, low birth weight, preterm birth and macrosomia), using logistic regression models, and 4. Sensitivity, specificity, and predictive values to predict adverse neonatal outcomes per nutritional status. Results: Pre-pregnancy underweight decreased from 8.6% to 2.5% and women with BMI between 18.5-19.9kg/m2, who exceeded the recommended gestational weight gain increased from 32.7% to 49.2% when using IOM2009 instead of Atalah. Both standards showed low sensitivity, but the IOM2009 cut-off points showed better specificity for identifying healthy newborns. Conclusion: The cut-off points recommended by the IOM2009 better identify the prevalence of underweight and normal weight during pregnancy without increasing neonatal risk. This study supports the recent change of the Ministry of Health in adopting the WHO cut-off points during pregnancy.
RESUMEN Chile y diversos países Latinoaméricanos utilizan el estándar de Atalah para evaluar el estado nutricional (EN) durante el embarazo. Sin embargo, los puntos de corte de este estándar (bajo peso, BP: índice de masa corporal pre-gestacional (IMC)<20 kg/m2 y normal, NP: IMC pregestacional= 20-24,9 kg/m2) difieren de los recomendados por el Instituto de Medicina de EE.UU. (IOM2009) (BP: BMI<18.5kg/m2 and NP: 18,5-24,9 kg/m2). Con datos obtenidos desde el Hospital Sótero del Río, nosotros evaluamos la prevalencia de BP y NP al comienzo del embarazo con los estándares de Atalah e IOM2009. Adicionalmente, nosotros comparamos el comportamiento de ambos estándares en detectar resultados neonatales (RN) adversos y en la clasificación de la ganancia de peso gestacional (GPG). Métodos: Se obtuvieron datos de embarazos simples entre 2003-2012, (n= 59.476). Nosotros comparamos: 1. Prevalencia de EN, 2. Proporción de excesiva GPG, 3. Asociación entre EN y RN, usando modelos de regresión logística, y 4. Sensibilidad, especificidad y valores predictivos para predecir RN según EN. Resultados: La prevalencia de BP pregestacional disminuyó de 8,6% a 2,5% y las mujeres con IMC entre 18,5-19,9 kg/m2 que excedieron la GPG recomendada, incrementaron desde 33% a 50% cuando se utilizó el estándar IOM2009 en vez de Atalah. Ambos estándares mostraron baja sensibilidad, pero IOM2009 mostró mejor especificidad para identificar recién nacidos saludables. Conclusión: Estandar IOM2009 identifica con mayor precisión la prevalencia de BP y NP durante la gestación sin incrementar el riesgo neonatal. Este estudio respalda el reciente cambio del MINSAL al adoptar los puntos de corte de la OMS durante el embarazo.
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Objective:To investigate the effect of intervention on oral health of pre-pregnancy women before and after oral health education. Methods:A total of 40 pre-pregnancy women were selected from the Reproductive Medicine Center of General Hospital of Ningxia Medical University according to the inclusion criteria， general conditions， clinical evaluation of plaque and oral health education. Their oral health conditions were evaluated before and after oral health intervention. Results:Based on the oral health status survey， there were significant differences between before and after intervention （all P<0.001） in the following five items： “bleeding from brushing teeth”， “difficulty biting or chewing food”， “sensitivity of teeth or gums to cold， hot， or sweet stimuli”， "restriction of the type and amount of food eaten for dental reasons” and “medication for oral pain or discomfort”. There were significant differences between before and after intervention （all P<0.001） in four items of oral health care behavior including “How often do you brush your teeth？”， “How do you brush your teeth？”， “gargle after meals”， and “floss use or not” but showed no significant difference in toothbrush replacement （P=0.467）. There were significant differences （all P<0.001） in five items of oral health knowledge including “periodontal disease can lead to premature delivery of newborns”， “periodontal disease can lead to low birth weight of newborns”， “need oral examination before pregnancy”， “pregnancy prone to oral diseases”， “mid-pregnancy is the best period for the treatment of oral diseases”. The oral plaque index before intervention was 5.47±1.08 and reduced to 4.37±0.94 after intervention （t=7.93， P=0.001）. Conclusion:Through education intervention， the oral health status of pre-pregnancy women can be improved. The knowledge of oral health can be improved and the level of oral health care can be enhanced. Oral health intervention can effectively reduce the level of plaque in pre-pregnancy women and improve the efficiency of plaque clearance.
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Objective:To investigate the effects of obesity before pregnancy and excessive weight gain during pregnancy on the characteristics of offspring metabolism and the underlying mechanism.Methods:Pregnant women who delivered from April 2016 to December 2018 in Jiaxing Xiuzhou District Maternal and Child Health Hospital after providing written informed consent and their singleton newborns were considered for recruitment for this study. Finally, 2000 pregnant women and their newborns were included in this study. These pregnant women were divided into study control ( n = 1 576, normal body weight) and ( n = 424, overweight) groups according to their body mass before and during pregnancy. The levels of leptin, blood lipid, fasting blood glucose, fasting insulin, long form of leptin receptor (OB-Rb), suppressor of cytokine signaling 3 (SOCS3) gene expression, insulin resistance index, and insulin sensitivity index were compared between the control and study groups. Results:The body mass index before pregnancy and body mass during pregnancy in the study group were (30.91 ± 1.86) kg/m 2 and (21.25 ± 2.61) kg, respectively, which were significantly higher than those in the control group [(26.87 ± 1.05) kg/m 2, (14.57 ± 1.36) kg, t = 7.972, P = 0.013; t = 9.786, P = 0.001]. The levels of leptin, triglyceride, total cholesterol and low-density lipoprotein cholesterol in the study group were (1.23 ± 0.29) ng/mL, (0.65 ± 0.16) mmol/L, (1.40 ± 0.24) mmol/L, (0.76 ± 0.13) mmol/L, respectively, which were significantly higher than those in the control group [(0.63 ± 0.11) ng/mL, (0.38 ± 0.16) mmol/L, (1.13 ± 0.32) mmol/L, (0.56 ± 0.09) mmol/L, t = 7.701, P = 0.010; t = 7.329, P = 0.019; t = 5.734, P = 0.030; t = 9.387, P = 0.001]. The level of high-density lipoprotein cholesterol in the study group was significantly lower than that in the control group [(1.26 ± 0.17) mmol/L vs. (1.75 ± 0.26) mmol/L, t = 8.072, P = 0.008]. The expression of SOCS3 mRNA and OB-Rb mRNA in newborns from the study group was (1.44 ± 0.29) and (1.33 ± 0.39), respectively, which was significantly greater than that in the control group [(0.33 ± 0.19), (0.50 ± 0.21), t = 9.987, P < 0.001; t = 11.037, P < 0.001]. Fasting blood glucose and fasting insulin levels as well as insulin resistance index in the study group were (22.06 ± 3.94) mmol/L, (20.02 ± 4.61) mU/L, (19.79 ± 6.29) respectively, which were significantly higher than those in the control group [(11.73 ± 2.92) mmol/L, (13.31 ± 3.43) mU/L, (6.96 ± 2.52), t = 8.133, P = 0.001; t = 4.498, P = 0.027; t = 7.352, P = 0.002]. Insulin sensitivity index in the study group was significantly lower than that in the control group [(-6.07 ± 0.32) vs. (-4.98 ± 0.37), t = 8.244, P < 0.001]. Conclusion:Obesity before pregnancy and excessive weight gain during pregnancy will increase the expression of SOCS3 mRNA and further affect the expression of STAT3-SOCS3-leptin/insulin signaling pathway in offspring.
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Background: Maternal pre-pregnancy BMI is well established to be a detrimental factor for prenatal development and neonatal anthropometric measures. Objectives of the study was to study the association between maternal pre-pregnancy Body Mass Index (BMI) and the anthropometry of the newborn.Methods: A hospital based cross-sectional, observational study was conducted that included 236 normal newborns and their mothers. A pre-designed questionnaire was used to collect relevant socio-demographic data and obstetric history. Details regarding maternal pre-pregnancy weight was collected from antenatal records at first antenatal visit, maternal height was measured and BMI was calculated. Neonatal anthropometric measurements including birth weight, recumbent length, head circumference, chest circumference and the mid arm circumference was measured.Results: In this study 49.6% of the women were in the age group of 21-25 years, 52.5% of them were multi-gravida and 56.4% had normal vaginal delivery. Among the newborns included in the study 25.8% had low birth weight. We saw a significant positive correlation between BMI and age, BMI and birth weight, BMI and chest circumference that is with increase in BMI there was significant increase in the age, birth weight and chest circumference and vice versa. There was no association between maternal BMI and mid-arm circumference or head circumference of the newborn.Conclusions: Study showed the association between maternal BMI and anthropometry of the newborn especially with respect to the BMI and birth weight, BMI and chest circumference. Thereby, establishing that interventions aimed at improving the nutritional status of the mother have a direct impact on the fetal growth outcomes.
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Objective To explore the effect of body mass index before pregnancy on various gestational diseases and adverse pregnancy outcomes. Methods Related cohort studies at home and abroad from 2014 to 2019 in China, the United States, Canada, Vietnam and Indonesia were reviewed to evaluate the effects of pre-pregnancy BMI on the risk of gestational disease and pregnancy outcomes.The number of 773 articles was collected and 8 cohort studies were selected in accordance with the inclusion criteria for this study. Results Low pre-pregnancy BMI could significantly increase the risk of postpartum hemorrhage (OR=7.1, 95%CI:2.7-13.6), acute renal failure (OR=1.6, 95%CI:0.1-5.3), low birth weight (OR=3.1, 95%CI:1.5-6.2), less than gestational age (OR=2.9, 95%CI: 1.9-4.5) and so on.High pre-pregnancy BMI could significantly increase the risk of preeclampsia (OR=1.09, 95%CI:1.04- 1.14), gestational hypertension (OR=5.49-11.42), cesarean section (OR=1.94, 95%CI:1.80-2.08), obstetric complications (OR=4.4-8.2), fetal macrosomia (OR=2.36, 95%CI:2.15-2.59) and other diseases.Spontaneous abortion, ectopic pregnancy were significantly associated with abnormal pre-pregnancy BMI (too high or too low). Conclusion Pre-pregnancy BMI is significantly associated with severe maternal diseases such as gestational hypertension, preeclampsia, gestational diabetes and adverse pregnancy outcomes like premature birth, abnormal birth weight, cesarean section.It suggests that more population-based prospective cohort studies are needed in this field to provide stronger evidence for pre-pregnancy weight management.
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@#Introduction: This cross-sectional study determines factors associated with the rates of gestational weight gain (GWG) among women in the second and third trimester of pregnancy. Methods: A total of 180 pregnant women (29.2 ± 4.3 years old) attending the maternal and child health clinics in Batu Pahat district were enrolled in the present study between January and February, 2015. Information regarding demographic characteristics, obstetrical history, physical activity, and calorie intake was assessed through direct interview. Anthropometric data were collected from medical records. GWG rates were determined based on 2009 IOM recommendations. Results: Of the 180 pregnant women, 37.2% were at their second trimester and 62.8% were at the third trimester of pregnancy. While 53.3% of them had excessive GWG rate, 28.9% have inadequate GWG rate. More than half of the women (56.7%) were normal weight, 21.1% overweight, 14.4% underweight, and 7.8% obese before pregnant. The total mean activity and energy intake of the pregnant women were 195.9±94.2 MET-hour/week and 2365±709 kcal/day, respectively. The multinomial logistic model indicates that women who were overweight or obese at pre-pregnancy were seven times more likely to have excessive GWG rate (OR = 7.44, 95% CI = 2.07-26.66) as compared to women who were pre-pregnancy normal weight. Conclusions: About four in every five of the pregnant women had their GWG rates outside the IOM recommendations. Women who were overweight/obese at pre-pregnancy were at-risk of having excessive GWG rate, which underlines the importance of targeting these women for pre-conception counselling on GWG.
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ObesityABSTRACT
Introducción: el embarazo adolescente supone un 15% del total de los nacimientos. A pesar de esta gran prevalencia, el conocimiento y las recomendaciones específicas para este grupo poblacional son escasos. Las embarazadas adolescentes suelen tener ganancias de peso superior a las recomendaciones, aumentando el riesgo de complicaciones obstétricas y neonatales. Objetivo: evaluar la ganancia de peso gestacional en embarazadas adolescentes según las recomendaciones del Institute of Medicine 2009. Materiales y método: estudio observacional descriptivo transversal llevado a cabo en adolescentes con embarazo único en puerperio inmediato evaluadas entre los meses de Agosto del 2017 y Enero del 2018. El IMC pre-gestacional y la ganancia de peso en el embarazo fueron estudiados y comparados con la edad, historia de enfermedades y complicaciones obstétricas. Resultados: el tamaño total de la muestra fue de 89 adolescentes con una media de edad de 17±1,54 años; solo el 4,49% correspondió a menores de 15 años. El diagnóstico nutricional pre-gestacional fue de: bajo peso 6,74%, normopeso 71,91%, sobrepeso 13,48% y obesidad 7,87%. El 22,47%, el 31,46% y 46,07% tuvieron una ganancia de peso inferior, adecuada y superior respectivamente. El 66,67% de las adolescentes con bajo peso evidenciaron una ganancia de peso inferior, mientras que las embarazadas con exceso de peso superaron las recomendaciones en el 57,89% de los casos. Del total de las obesas, el 71,42% presentaron complicaciones en el embarazo. Conclusiones: Casi el 70% de las embarazadas adolescentes presentaron una ganancia de peso inadecuada. Aquellas que comenzaron la gestación con bajo peso ganaron menos de lo recomendado, siendo las embarazadas con exceso de peso las que aumentaron más de lo establecido por las guías. Por último, resulta interesante destacar el desarrollo de complicaciones en el embarazo de las adolescentes obesas(AU).
Introduction: in Argentina, adolescent pregnancy represents 15% of total births. Despite this high prevalence, knowledge and specific recommendations for this population group are low. Adolescent mothers usually have more weight gain than recommended, increasing the risk of obstetric and neonatal complications. Objective: to evaluate the gestational weight gain in adolescent pregnancy following recommendations by the Institute of Medicine 2009. Methods: a cross-sectional observational study was carried out in adolescents with single pregnancies in immediate puerperal period, between August 2017 and January 2018. The pre-pregnancy BMI and the gestational weight gain were studied and compared to age, medical history and obstetric complications. Results: a total of 89 adolescents averaged age 17 ± 1.54 were evaluated; only 4.49% of the sample corresponded to mothers aged under 15. The pre-pregnancy BMI was: underweight 6.74%, normal weight 71.91%, overweight 13.48% and obesity 7.87%. 22.47%, 31.46% and 46.07% had a lower, appropriate and excessive weight gain respectively. 66.67% of underweight adolescents showed a lower weight gain, while the overweight ones exceeded the recommendations in 57.89% of cases. Within total obese, 71,42% presented obstetric complications. Conclusions: nearly 70% of adolescent mothers had an inappropriate weight gain. The adolescents who started the gestation with underweight gained less weight than recommended, and the ones with overweight gained more weight than the one recommended by the guidelines. Lastly, it is worth highlighting the development of obstetric complications in obese adolescents(AU).
Subject(s)
Humans , Female , Adolescent , Pregnancy in Adolescence , Weight Gain , Gestational Weight Gain , Adolescent Mothers , Hospitals, State , ObstetricsABSTRACT
Objective To investigate the association between maternal pre-pregnant body mass index and gestational weight gain,as well as their interaction on neonatal birthweight.Methods We built a cohort in Anqing Municipal Hospital from January 2014 to March 2015,enrolling pregnant women who decided to give birth in this hospital.All women were asked to fill a questionnaire for basic information collection.Medical information of both pregnant women and their newborns were obtained through electronic medical record.Chi-square analysis,multinomial logistic regression,multiplicative and additive interaction methods were used to analyze the association between prepregnant body mass index and gestational weight gain as well as their interactions on birth weight of the neonates.Results A total of 2 881 pregnant women were included in this study.Of the 2 881 newborns,359 (12.46％) were small for gestational age (SGA) and 273 (9.48％) were large for gestational age (LGA).After adjusting the possible confounding factors,results from the multinomial logistic regression showed that pre-pregnancy underweight women were more possible to deliver SGA (aRR=1.33,95％CI:1.02-1.73).If the gestational weight gain was below the recommended criteria,the risk of SGA (aRR=1.64,95％ CI:1.23-2.19) might increase.Pre-pregnancy overweight/obese could increase the risk of being LGA (aRR=1.86,95％ CI:1.33-2.60).Maternal gestational weight gain above the recommendation level was associated with higher rates of LGA (aRR=2.03,95％CI:1.49-2.78).Results from the interaction analysis showed that there appeared no significant interaction between pre-pregnancy BMI and gestational weight on birthweight.Conclusion Pre-pregnancy body mass index and gestational weight gain were independently associated with neonatal birthweight while pre-pregnancy BMI and gestational weight gain did not present interaction on birthweight.
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Objective To investigate the association between maternal pre-pregnant body mass index and gestational weight gain,as well as their interaction on neonatal birthweight.Methods We built a cohort in Anqing Municipal Hospital from January 2014 to March 2015,enrolling pregnant women who decided to give birth in this hospital.All women were asked to fill a questionnaire for basic information collection.Medical information of both pregnant women and their newborns were obtained through electronic medical record.Chi-square analysis,multinomial logistic regression,multiplicative and additive interaction methods were used to analyze the association between prepregnant body mass index and gestational weight gain as well as their interactions on birth weight of the neonates.Results A total of 2 881 pregnant women were included in this study.Of the 2 881 newborns,359 (12.46％) were small for gestational age (SGA) and 273 (9.48％) were large for gestational age (LGA).After adjusting the possible confounding factors,results from the multinomial logistic regression showed that pre-pregnancy underweight women were more possible to deliver SGA (aRR=1.33,95％CI:1.02-1.73).If the gestational weight gain was below the recommended criteria,the risk of SGA (aRR=1.64,95％ CI:1.23-2.19) might increase.Pre-pregnancy overweight/obese could increase the risk of being LGA (aRR=1.86,95％ CI:1.33-2.60).Maternal gestational weight gain above the recommendation level was associated with higher rates of LGA (aRR=2.03,95％CI:1.49-2.78).Results from the interaction analysis showed that there appeared no significant interaction between pre-pregnancy BMI and gestational weight on birthweight.Conclusion Pre-pregnancy body mass index and gestational weight gain were independently associated with neonatal birthweight while pre-pregnancy BMI and gestational weight gain did not present interaction on birthweight.
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@#Pre-pregnancy Clinic (PPC) services is one the plausible efforts towards achieving the Millennium Development Goals. However, various issues still need to be addressed for improvement of the services. Considering this view, an attempt was made to explore the barriers, strength and weakness of current practice of pre-pregnancy clinic services in Sarawak, since the programme has been implemented in this state from the year 2011. This cross-sectional study was conducted at nine selected health care facilities throughout Sarawak. A multistage sampling procedure was adapted to select the health care facilities. An unstructured open-ended questionnaire was administered to get the in-depth perceived views and current practice of pre-pregnancy clinic services. A total of 322 health care providers from nine selected health care facilities gave their feedback. In the present paper, a qualitative analysis was done for the open-ended questions to get in-depth views of barriers, strength and weakness of pre-pregnancy clinic services. The results of the study were narrated in textual form and a thematic analysis was done manually. The identified themes for perceived barriers to the provision of pre-pregnancy care were perception, attitude and acceptance of PPC services, socio-economic issues, services and client factors. The perceived weaknesses of the services are listed under two main themes: working environment and service factors, while, the strength of services produced three thematic areas which are preparation for pregnancy, prevention of mortality and morbidity and comprehensive services. Though pre-pregnancy services are beneficial for society wellbeing, various issues still need to be considered for the improvement of the quality of services. Lack of awareness, no ministerial guidelines or Standard Operating Procedures (SOP) and knowledge pertaining to the services were few of the main areas which need to be pondered upon. Promotional activities and campaigns should be geared up ensuring availability the services to the general population.
Subject(s)
Perception , MalaysiaABSTRACT
BACKGROUND: Maternal obesity is a well-known risk factor for both total preterm birth (PTB) and spontaneous PTB in singleton gestation, whereas this association is not well determined in multiple pregnancy. The objective of this study was to determine the risk of spontaneous PTB according to the pre-pregnancy body mass index (BMI) in twin gestations. METHODS: The association between the risk of PTB and pre-pregnancy BMI was determined in women pregnant with twins between 2004 and 2014. Pre-pregnancy BMI values were divided into three groups (underweight/normal/overweight and obese). PTB was classified as spontaneous PTB (following preterm premature rupture of membranes, preterm labor, or cervical insufficiency) or medically indicated PTB (cesarean section or induction of labor because of maternal/fetal indications). RESULTS: A total of 1,959 women were included in the analysis, and the percentages of total PTB and spontaneous PTB were 13.1% and 9.3%. The percentages of total PTB and spontaneous PTB in three groups were 14.1%, 11.9%, 16.3%, respectively, and 11.0%, 8.0%, 12.5% (P < 0.05 between normal and overweight/obese women). The risks of total and spontaneous PTB in overweight/obese women were higher than those in women with normal weight, even after adjustment for prior history of PTB, age, maternal height, parity, in vitro fertilization-embryo transfer (IVF-ET) (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.01–2.03; OR, 1.58; 95% CI, 1.05–2.36). CONCLUSION: The risks of both total and spontaneous PTB were significantly greater in the overweight/obese group than in the normal BMI group.
Subject(s)
Female , Humans , Pregnancy , Body Mass Index , In Vitro Techniques , Maternal Age , Membranes , Obesity , Obstetric Labor, Premature , Parity , Pregnancy, Multiple , Premature Birth , Risk Factors , Rupture , TwinsABSTRACT
Objective To explore the determinants of willingness to quit smoking among pre-pregnancy male smokers, and to provide evidence for smoking cessation strategies. Methods An intercept survey was carried out in four cities in Zhejiang, and there were 552 pre-pregnancy male smokers from 1401 newly wedded couples under investigation. Result The pre-pregnancy male smoking rate was 39.82%, and only 6.88%of pre-pregnancy male smokers were categorized as highly nicotine-dependent. The rate of recent willingness to quit smoking was 50.54%, and reasons for quitting were as follows:a planned pregnancy (62.50%), an example for children (47.70%), and objections from family members (45.22%). The tobacco knowledge among pre-pregnancy male smokers is relatively poor, only 49.64% of smokers were aware 8 points in 11 questions; 88.75% of smoker's wives supported their husband to quit smoking. The associated factors of smoking cessation include: tobacco knowledge (OR=0.38), health self-assessment well (OR=1.90), wife's willing for husband to quit smoking (OR=2.87). Conclusion Compared to ordinary people, the proportion of intention to quit smoking was higher in pre-pregnancy male smokers. To strengthen health education and make wife initiating in husband's quitting programs would be more effective.