Impact of Obesity and Hyperglycemia on Pregnancy-specific Urinary Incontinence / Impacto da obesidade e hiperglicemia na incontinência urinária específica da gravidez

Abstract Objective The lack of data on the impact of hyperglycemia and obesity on the prevalence of pregnancy-specific urinary incontinence (PSUI) led us to conduct a cross-sectional study on the prevalence and characteristics of PSUI using validated questionnaires and clinical data. Methods This cross-sectional study included 539 women with a gestational age of 34 weeks who visited a tertiary university hospital between 2015 and 2018. The main outcome measures were the prevalence of PSUI, the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and the Incontinence Severity Index (ISI) questionnaires. The women were classified into four groups: normoglycemic lean, normoglycemic obese, hyperglycemic lean, and hyperglycemic obese. The differences between groups were tested using descriptive statistics. Associations were estimated using logistic regression analysis and presented as unadjusted and adjusted odds ratios. Results Prevalence rates of PSUI were no different between groups. However, significant difference in hyperglycemic groups worse scores for severe and very severe PSUI. When adjusted data for confound factors was compared with normoglycemic lean group, the hyperglycemic obese group had significantly higher odds for severe and very severe forms of UI using ICIQ-SF (aOR 3.157; 95% CI 1.308 to 7.263) and ISI (aOR 20.324; 95% CI 2.265 to 182.329) questionnaires and highest perceived impact of PSUI (aOR 4.449; 95% CI 1.591 to 12.442). Conclusion Our data indicate that obesity and hyperglycemia during pregnancy significantly increase the odds of severe forms and perceived impact of PSUI. Therefore, further effective preventive and curative treatments are greatly needed.

Resumo Objetivo A falta de dados sobre o impacto da hiperglicemia e obesidade na prevalência de incontinência urinária específica da gravidez (IAPS) nos levou a realizar um estudo transversal sobre a prevalência e características da IAPS usando questionários validados e dados clínicos. Métodos Este estudo transversal incluiu 539 mulheres com idade gestacional de 34 semanas que visitaram um hospital universitário terciário entre 2015 e 2018. As principais medidas de desfecho foram a prevalência de PSUI, o formulário curto do International Consultation on Incontinence Questionnaire (ICIQ-SF) e os questionários do Incontinence Severity Index (ISI). As mulheres foram classificadas em quatro grupos: magras normoglicêmicas, obesas normoglicêmicas, magras hiperglicêmicas e obesas hiperglicêmicas. As diferenças entre os grupos foram testadas por meio de estatística descritiva. As associações foram estimadas usando análise de regressão logística e apresentadas como odds ratio não ajustadas e ajustadas. Resultados As taxas de prevalência de PSUI não foram diferentes entre os grupos. No entanto, houve diferença significativa nos grupos hiperglicêmicos com piores escores para PSUI grave e muito grave. Quando os dados ajustados para fatores de confusão foram comparados ao grupo magro normoglicêmico, o grupo obeso hiperglicêmico teve chances significativamente maiores de formas graves e muito graves de IU usando ICIQ-SF (aOR 3,157; IC 95% 1,308 a 7,263) e ISI (aOR 20,324; 95% CI 2,265 a 182,329) questionários e maior impacto percebido de PSUI (aOR 4,449; 95% CI 1,591 a 12,442). Conclusão Nossos dados indicam que a obesidade e a hiperglicemia durante a gravidez aumentam significativamente as chances de formas graves e o impacto percebido da PSUI. Portanto, tratamentos preventivos e curativos mais eficazes são extremamente necessários.

Obesidad pregestacional y alteraciones del parto

Objetivo . Establecer la asociación entre obesidad pregestacional y el riesgo de alteraciones del parto. Diseño. Estudio de cohortes retrospectivo. Institución. Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Métodos . Resultante obstétrica de pacientes según índice de masa pregestacional -obesidad (grupo A), sobrepeso (grupo B) y peso normal (grupo C)- atendidas entre enero y diciembre de 2021. Principales medidas de estudio. Duración del embarazo y duración, tipo y alteraciones del parto. Resultados . Se atendió 2,250 partos durante el periodo de estudio, de los cuales se seleccionó 226 gestantes para el análisis. La mayoría de gestantes (60,5%) fueron asignadas al grupo A, 47 (20,8%) al grupo B y 41 (17,5%) al grupo C. Las gestantes del grupo A presentaron una mayor probabilidad de cesárea (razón de probabilidad (RP) 1,76; intervalo de confianza del 95% (IC95%), 1,03 a 2,98), de parto prolongado (RP 2,09; IC95%, 1,23 a 3,53) y de embarazo prolongado (RP 2,30; IC95%, 1,32 a 4,01) comparadas con las embarazadas del grupo C. Las gestantes del grupo B no mostraron diferencias estadísticamente significativas en la frecuencia de las variables obstétricas comparado con las gestantes del grupo C (p = ns). Conclusión . Existió asociación significativa entre la obesidad pregestacional y el riesgo de alteraciones del parto.

Objective : To establish the association between pregestational obesity and the risk of birth alterations. Design: Retrospective cohort study. Institution: Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Methods : Obstetric outcome of patients according to pregestational mass index -obese (group A), overweight (group B), and normal weight (group C)- attended between January and December 2021. Main study measures: Duration of pregnancy and duration, type and alterations of delivery. Results : A total of 2,250 deliveries were attended during the study period, of which 226 pregnant women were selected for analysis. The majority of the pregnant women (60.5%) were assigned to group A, 47 (20.8%) to group B, and 41 (17.5%) to group C. Pregnant women in group A had a higher probability of cesarean section (odds ratio (OR) 1.76; 95% confidence interval (95%CI), 1.03 - 2.98), prolonged labor (OR 2.09; 95%CI, 1.23 - 3.53) and prolonged pregnancy (OR 2.30; 95%CI, 1.32 - 4.01) compared to pregnant women in group C. The pregnant women in group B did not show statistically significant differences in the frequency of obstetric variables compared to the pregnant women in group C (p = ns). Conclusion : There was a significant association between pregestational obesity and the risk of birth alterations.

Influence of maternal obesity on the skeletal muscle of offspring / Influencia de la obesidad materna sobre el músculo esquelético de la progenie

Abstract Maternal obesity has been described as a clinical entity associated with an increased incidence of metabolic diseases in the offspring, indicating a fetal programming phenomenon during this critical development period. Fetal exposure to an obesogenic environment affects multiple organs and tissues, including skeletal muscle, which is particularly susceptible to stressors from the external environment. Several studies have described alterations in the morphology and composition of skeletal muscle tissue secondary to obesogenic exposure in utero. In addition, modifications in signaling pathways related to the metabolism of energy substrates have been found in children born to mothers with obesity during pregnancy. This review addresses the current evidence describing the consequences of fetal exposure to an obesogenic maternal diet on skeletal muscle tissue, focusing on changes in tissue composition, alterations in signaling pathways related to glucose and fatty acid metabolism, mitochondrial biogenesis, and oxidative phosphorylation.

Resumen La obesidad materna se ha descrito como una entidad clínica asociada con el aumento en la incidencia de enfermedades metabólicas en el producto de la gestación, lo que indica la existencia de un fenómeno de programación fetal que se lleva a cabo durante este periodo crítico del desarrollo. La exposición del feto a un ambiente obesogénico afecta múltiples órganos y tejidos, incluyendo el músculo esquelético, el cual es particularmente susceptible a estresores del ambiente externo. Diversos estudios han descrito alteraciones en la morfología y composición del tejido muscular esquelético secundarias a una exposición obesogénica in utero. Además, se han encontrado modificaciones en vías de señalización relacionadas al metabolismo de sustratos energéticos en los productos de madres con obesidad durante la gestación. En la presente revisión se aborda la evidencia actual que describe las consecuencias de la exposición fetal a una dieta materna obesogénica sobre el tejido muscular esquelético, con especial enfoque en los cambios en la composición del tejido, las alteraciones en las vías de señalización relacionadas con el metabolismo de la glucosa y los ácidos grasos, así como la biogénesis mitocondrial y la fosforilación oxidativa.

Correlación del índice de masa corporal y de la circunferencia de cintura de las niñas y adolescentes con su ascendencia femenina hasta la tercera generación

RESUMEN Introducción: La intergeneracionalidad nutricional es reconocida como uno de los factores que influye en el aumento de la prevalencia de obesidad, principalmente a través de generaciones maternas. Poco se conoce sobre esta situación en nuestro país. Objetivo: evaluar la correlación del índice de masa corporal (IMC) y la circunferencia de cintura (CC) de niñas y adolescentes con su ascendencia femenina hasta la tercera generación durante los meses de julio a setiembre del 2019. Materiales y Métodos: Estudio analítico de corte transversal en 98 tríos (niñas y adolescentes, madres y abuelas maternas). Se recolectaron datos antropométricos de los tríos (peso, talla y CC). Se realizaron correlaciones entre: el IMC de la madre y la abuela con el puntaje Z del IMC/E de las niñas y adolescentes y la CC de la madre con las niñas y adolescentes. Se aplicó el coeficiente de correlación de Pearson. Investigación aprobada por Comité de Ética (Dictamen 460/19). Resultados: en promedio las niñas y adolescentes tuvieron 10,1±1,1 años, 0,8±1,6 DE puntaje Z IMC/Edad y 69,5±9,7 cm de CC; las madres tenían 37,4±6,8 años, 13 años de escolaridad, 28,8±7,3 kg/m2 de IMC y 92,1±13,4 cm de CC; y las abuelas 64,9±10,8 años, 7 años de escolaridad y 28,7±6,9 kg/m2 de IMC (Sobrepeso). La correlación del IMC de la madre con el puntaje Z de las niñas y adolescentes fue r: 0,2937 (p0,05). La correlación de CC entre madre-niña fue r: 0,264, (p<0,05). Conclusión: el IMC y la CC de las niñas y adolescentes se correlaciona con el IMC y CC de las madres, pero su potencia no es muy fuerte. Las hijas de madres obesas tienen mayor IMC medido por puntaje Z.

ABSTRACT Introduction: Nutritional intergenerationality is recognized as one of the factors that influences the increase in obesity prevalence, mainly through maternal generations. Little is known about this situation in our country. Objective: to evaluate the correlation of the body mass index (BMI) and the waist circumference (WC) of girls and adolescents compared to their female ancestry up to the third generation during the months of July to September 2019. Materials and methods: This was an analytical, cross-sectional study of 98 trios (girls and adolescents, maternal mothers and grandmothers). Anthropometric data of the trios (weight, height and WC) were collected. Correlations were made between: the BMI of the mother and the grandmother with the Z score of the BMI/E of the girls and adolescents and the WC of the mother with the girls and adolescents. Pearson's correlation coefficient was applied. The study was approved by the Ethics Committee (Approval # 460/19). Results: On average, the girls and adolescents were 10.1±1.1 years old, had a BMI/Age Z score of 0.8±1.6 SD and a WC of 69.5±9.7 cm; the mothers were 37.4±6.8 years old, had 13 years of schooling, BMI 28.8±7.3 kg/m2 and WC 92.1±13.4 cm; and the grandmothers 64.9±10.8 years, had 7 years of schooling and 28.7±6.9 kg/m2 BMI (Overweight). The correlation of the BMI of the mother with the Z score of the girls and adolescents was r: 0.2937 (p0.05). The WC correlation between mother and girl was r: 0.264, (p<0.05). Conclusion: The BMI and WC of girls and adolescents correlate with the BMI and WC of mothers, but its power is not very strong. The daughters of obese mothers have higher BMI measured by Z score.

Resultados neonatales adversos según grados de obesidad pregestacional en un hospital público del sur de Perú, 2010 a 2019

Introducción: La obesidad materna, creciente problema de salud pública mundial, se relaciona con morbimortalidad neonatal. El objetivo fue determinar los resultados neonatales adversos según los grados de obesidad pregestacional. Material y método: Estudio analítico, de cohorte retrospectiva, en gestantes de embarazo único, de parto atendido en el hospital Hipólito Unanue de Tacna Perú, durante 2010 a 2019, con recién nacido vivo, los casos fueron 5935 madres con índice de masa corporal pregestacional de 30 Kg/m2 a más, agrupadas en grado I (IMC 30-34,9 Kg/m2), II (IMC 35-39,9 Kg/m2) y III (IMC>40 Kg/m2), los controles madres con IMC de 18-24,9 Kg/m2. Se excluyeron gestantes con diabetes mellitus, preeclampsia, eclampsia y anomalías congénitas. Se utilizó Riesgo Relativo (RR) crudo y ajustado por edad materna, escolaridad y paridad, con intervalo de confianza al 95%. Resultados: La frecuencia de obesidad pregestacional fue 14,3% grado I, 3,8% grado II y 1% grado III. Los resultados neonatales que se asociaron fueron: peso al nacer >4000 gramos, para obesidad grado I (RRa: 1,9; IC95%:1,7-2,0), grado II (RRa: 2,0; IC95%:1,8-2,3) y grado III (RRa: 2,1; IC95%:1,7-2,5); grande para la edad gestacional para grado I (RRa: 1,6; IC95%: 1,4-1,7), grado II (RRa: 1,7; IC95%: 1,6-1,9) y grado III (RRa: 1,8; IC95%: 1,4-2,1). Conclusiones: Existe mayor riesgo de macrosomía fetal y grande para la edad gestacional a mayor grado de obesidad pregestacional materna.

Background: Maternal obesity, a growing global public health problem, is related to neonatal morbidity and mortality. The objective was to determine adverse neonatal outcomes according to degrees of pregestational obesity. Material and method: Analytical study, retrospective cohort, in pregnant women with a single pregnancy, delivery attended at the Hipolito Unanue hospital in Tacna, Peru, during 2010 to 2019, with live newborns, the cases were 5935 mothers with pre-pregnancy body mass index from 30 Kg/m2 to more, grouped in grade I (BMI 30-34.9 Kg/m2), II (BMI 35-39.9 Kg/m2) and III (BMI>40 Kg/m2), the control mothers with a BMI of 18-24.9 Kg/m2. Pregnant women with diabetes mellitus, preeclampsia, eclampsia and congenital anomalies were excluded. Crude Relative Risk (RR) was used, adjusted for maternal age, schooling and parity, with a 95% confidence interval. Results: The frequency of pre-pregnancy obesity was 14.3% grade I, 3.8% grade II and 1% grade III. The associated neonatal outcomes were: birth weight >4000 grams, for grade I obesity (RRa: 1.9; 95% CI: 1.7-2.0), grade II (RRa: 2.0; 95% CI: 1.8-2.3) and grade III (RRa: 2.1; CI95%: 1.7-2.5); large for gestational age for grade I (RRa: 1.6; 95% CI: 1.4-1.7), grade II (RRa: 1.7; 95% CI: 1.6-1.9) and grade III (RRa: 1.8; CI95%: 1.4-2.1). Conclusions: There is an increased risk of fetal macrosomia and large for gestational age with a higher degree of maternal pregestational obesity.

Body mass index and gestational weight gain: relevance in gestational diabetes and outcomes - A retrospective cohort study

ABSTRACT Objective: To evaluate the influence of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on blood glucose levels at diagnosis of gestational diabetes mellitus (GDM) and obstetric/neonatal outcomes. Subjects and methods: Retrospective cohort study including 462 women with GDM and singleton pregnancy delivered in our institution between January 2015 and June 2018 and grouped according to BMI/GWG. Results: The diagnosis of GDM was more likely to be established in the 1st trimester (T) in women with obesity than in normal-weight (55.8% vs 53.7%, p = 0.008). BMI positively and significantly correlated with fasting plasma glucose (FPG) levels in the 1stT (rs = 0.213, p = 0.001) and 2ndT (rs = 0.210, p = 0.001). Excessive GWG occurred in 44.9% women with overweight and in 40.2% with obesity (p < 0.001). From women with obesity, 65.1% required pharmacological treatment (p < 0.001). Gestational hypertension (GH) was more frequent in women with obesity (p = 0.016). During follow-up, 132 cesareans were performed, the majority in mothers with obesity (p = 0.008). Of the 17 large-for-gestational-age (LGA) birthweight delivered, respectively 6 and 9 were offsprings of women with overweight and obesity (p = 0.019). Maternal BMI had a predictive value only for macrosomia [aOR 1.177 (1.006-1.376), p = 0.041]. BMI and GWG positively correlated with birthweight (rs = 0.132, p = 0.005; rs = 0.188, p = 0.005). Conclusion: Maternal obesity is related with a major probability of diagnosis of GDM in 1stT, fasting hyperglycemia in 2ndT and a more frequent need for pharmacological therapy. Pre-gestational obesity is associated with GH, cesarean delivery and fetal macrosomia.

Effects and mechanisms of different types of maternal obesity on glucose and lipid metabolism in neonatal offspring rats / 中国新生儿科杂志

Objective:To study the different effects of pre-pregnancy obesity (PO), excessive gestational weight gain (EGWG), pre-pregnancy obesity combined with excessive gestational weight gain (PO+EGWG) of maternal rats on glucose and lipid metabolism in neonatal offspring, and to explore the possible mechanisms.Methods:Animal models of PO, EGWG and PO+EGWG were established by feeding SD rats with high-fat diets at different periods. Thirty-six SD rats were randomly divided into four groups, with nine rats in each group. The control group had a normal diet before and during pregnancy. The PO group had a high-fat diet before pregnancy and a normal diet during pregnancy. The EGWG group had a normal diet before pregnancy and a high-fat diet during pregnancy. And the PO+EGWG group had a high-fat diet before and during pregnancy. The body weight of maternal rats before and during pregnancy and the birth weight of neonatal rats were recorded. Nine male neonatal rats in each group were selected, fasting blood glucose levels were detected by glucometer, fasting insulin levels were detected by enzyme-linked immunosorbent assay kit, hepatic triglyceride and cholesterol levels were detected by glycerol phosphate oxidase-peroxidase method, hepatic lipid deposition were observed by hematoxylin-eosin staining and oil red O staining. The mRNA levels of hepatic key genes in glucose metabolism pathway IR, IRS, AKT and lipid metabolism FASN, SREBP1c, PPARα were detected by reverse transcription-polymerase chain reaction analyses.Results:The pre-pregnancy weight of maternal rats in high-fat diet group before pregnancy (PO group and PO+EGWG group) was significantly higher than those in normal diet group (control group and EGWG group). The percentage of weight gain of maternal rats in high-fat diet group during pregnancy (EGWG group and PO+EGWG group) was significantly higher than those in normal diet group (control group and PO group) ( P<0.05). The birth weight of neonatal rats in PO group, EGWG group and PO+EGWG group were significantly higher than that in control group ( P<0.05), and the birth weight of neonatal rats in PO+EGWG group was the largest. The fasting glucose, insulin level and insulin resistance index of newborn rats in PO, EGWG and PO+EGWG groups were higher than those in the control group, and the mRNA levels of IR, IRS and AKT were lower than those in the control group, but the differences were not statistically significant ( P>0.05). The hepatic triglyceride and cholesterol contents and mRNA levels of FASN and SREBP1c were higher in the EGWG and PO+EGWG groups than those in the control group, and the mRNA level of PPARα was higher in the PO+EGWG group than in the control and PO groups, with statistically significant differences ( P<0.05). Conclusions:Animal models of PO, EGWG and PO+EGWG were successfully constructed by feeding SD rats with high-fat diets before pregnancy, during pregnancy, before and during pregnancy. PO+EGWG had the most significant effects on the birth weight and glucose and lipid metabolism in neonatal offspring. Compared with EGWG, PO had a relatively significant effect on glucose metabolism in neonatal offspring. And compared with PO, EGWG had a relatively significant effect on lipid metabolism in neonatal offspring. The effects of maternal obesity on glucose and lipid metabolism in neonatal offspring were considered to be related to the expression changes of genes in glucose and lipid metabolism.

The influence of preeclampsia, advanced maternal age and maternal obesity in neonatal outcomes among women with gestational diabetes / A influência da pré-eclâmpsia, idade materna avançada e obesidade materna em desfechos neonatais entre mulheres com diabetes gestacional

Abstract Objective The present study aims to analyze adverse fetal or neonatal outcomes in women with gestational diabetes, including fetal death, preterm deliveries, birthweight, neonatal morbidity and mortality, as well as the synergic effect of concomitant pregnancy risk factors and poor obstetric outcomes, as advanced maternal age, maternal obesity and pre-eclampsia in their worsening. Methods The present cohort retrospective study included all pregnant women with gestational diabetes, with surveillance and childbirth at the Hospital da Senhora da Oliveira during the years of 2017 and 2018. The data were collected from the medical electronic records registered in health informatic programs Sclinico and Obscare, and statistical simple and multivariate analysis was done using IBM SPSS Statistics. Results The study participants included 301 pregnant women that contributed to 7.36% of the total institution childbirths of the same years, in a total of 300 live births. It was analyzed the influence of pre-eclampsia coexistence in neonatal morbidity (p = 0.004), in the occurrence of newborns of low and very low birthweight (p < 0.01) and in preterm deliveries (p < 0.01). The influence of maternal obesity (p = 0.270; p = 0.992; p = 0.684) and of advanced maternal age in these 3 outcomes was also analyzed (p = 0,806; p = 0.879; p = 0.985).Using a multivariate analysis, the only models with statistic significance to predict the three neonatal outcomes included only pre-eclampsia (p = 0.04; p < 0.01; p < 0.01). Conclusion Only coexistence of pre-eclampsia showed an association with adverse neonatal outcomes (neonatal morbidity, newborns of low and very low birthweight and preterm deliveries) and can be used as a predictor of them in women with gestational diabetes.

Resumo Objetivo O presente estudo tem como objetivo analisar desfechos fetais ou neonatais adversos em mulheres com diabetes gestacional, incluindo morte fetal, partos prematuros, peso ao nascimento, morbilidade neonatal e mortalidade, bem como o efeito sinérgico de fatores de risco e maus desfechos concomitantes da gravidez, como idade materna avançada, obesidade materna e pré-eclâmpsia no seu agravamento. Métodos O presente estudo retrospetivo de coorte incluiu todas as gestantes com diabetes gestacional, com vigilância e parto no Hospital da Senhora da Oliveira durante 2017 e 2018. Os dados foram obtidos dos registos clínicos eletrônicos dos programas informáticos de saúde Sclinico e Obscare, e a análise estatística simples e multivariada foi feita utilizando o IBM SPSS Statistics. Resultados Os participantes do estudo incluíram 301 gestantes que contribuíram para 7,36% do total de partos da instituição, num total de 300 nados vivos. Foi analisada a influência da coexistência de pré-eclâmpsia na morbilidade neonatal (p = 0,004), na ocorrência de recém-nascidos de baixo e muito baixo peso ao nascimento (p < 0,01) e em partos prematuros (p < 0,01). Também foi analisada a influência da obesidade materna (p = 0,270; p = 0,992; p = 0,684) e da idade materna avançada nesses 3 desfechos (p = 0,806; p = 0,879; p = 0.985).Usando uma análise multivariada, os únicos modelos com significância estatística para predizer os três desfechos neonatais incluíram apenas a pré-eclâmpsia (p = 0,04; p < 0,01; p < 0,01). Conclusão Apenas a coexistência de pré-eclâmpsia mostrou associação com desfechos neonatais adversos (morbilidade neonatal, recém-nascidos de baixo e muito baixo peso e partos prematuros) e pode ser utilizada como preditor destes em mulheres com diabetes gestacional.

Maternal body mass index: how much it affects mother and baby

Background: Overweight, obesity, and morbid obesity in the mother are associated with adverse obstetrics well as neonatal outcome. Aim of this study was to assess the prevalence of overweight and obesity, and the impact of body mass index (BMI) on maternal and neonatal outcome.Methods: This is a retrospective study from January 2018 to September 2018 on 180 women with singleton term pregnancies. Maternal and neonatal outcomes at delivery were noted.Results: In present study, 3 (1.66%) pregnant women were underweight, 57 (31.66%) pregnant women had normal BMI, 71 (39.44%) pregnant women were overweight while 49 (27.22%) pregnant women were obese. Gestational weight gain was less than 8 kgs in 40 (22.22%) pregnant women, weight gain was 8-15.9 kgs in 132 (73.33%) pregnant women while weight gain was more than 16 kgs in 8 (4.44%) pregnant women. Out of 3 underweight women, 1 delivered by cesarean section and 2 had normal delivery, out of 57 women with normal BMI, 21 delivered by cesarean section and 36 had normal delivery, out of 71 overweight women, 47 delivered by cesarean section and 34 had normal delivery while out of 49 obese women, 38 delivered by cesarean section and 11 had normal delivery. PET and GDM was seen in 9 (7.5%) women each while macrosomia were seen in 5 (4.16%) women.Conclusions: Increased association was seen with maternal obesity and adverse outcome of pregnancy like PIH, GDM, cesarean section.

Study of Maternal and Fetal Outcome in Obesity Complicating Pregnancy

Introduction: Obesity among fertile women is reachingepidemic proportions. Mothers who are overweight or obeseduring pregnancy and childbirth are known to be at risk ofsignificant antenatal, intrapartum, postpartum and neonatalcomplications. So the aim of the current study was to evaluatethe effect of obesity on the maternal and perinatal outcomesin pregnancies complicated by obesity.Material and methods: A Prospective case-control study wasconducted in a civil hospital, Aizawl, from July 2017 to June2018 for a period of 1 year. The sample size of 150 subjectsof which, 77 pregnant women with BMI >30kg/m2 wereconsidered as cases and 73 pregnant women with BMI <30kg/m2 were controls and followed prospectively. Antepartum,intrapartum and postpartum complications were recorded.IBM SPSS version 22 was used for statistical analysis.Results: The mean age was 23±3.53 among controls and it was25±4.44 among cases. A statistically significant associationwas observed with socioeconomic status (0.033), inducedlabour (0.035) and prolonged hospital stay (0.004) indicatingthat maternal obesity is a major risk factor for antepartum,intrapartum and postpartum complications. An increased riskof hypertensive disorders of pregnancy, gestational diabetesmellitus (GDM), pre-eclampsia, induction of labour, caesareansection, postpartum complications like wound infection,atonic PPH (post-partum haemorrhage), the longer lengthof maternal stay in hospital and preterm birth were observedamong obese subjects.Conclusion: Pregnancy complications related to maternalBMI is a growing problem. Maternal obesity is a risk factor forgestational diabetes, preeclampsia, labor induction, cesareanfor fetal distress and wound infection.

Maternal obesity and its determinants: A neglected issue?

@#Maternal obesity is a global public health concern that affects every aspect of maternity care. It affects the short-term and long-term health of the mother and her offspring. Obese pregnant mothers are at an increased risk of developing complications during antenatal, intrapartum, and postnatal periods. Maternal complications include gestational diabetes mellitus, hypertensive disorder in pregnancy, pre-eclampsia and eclampsia, increased rate of cesarean delivery, pulmonary embolism, and maternal mortality; fetal complications include congenital malformation, stillbirth, and macrosomia. Moreover, both mother and infant are at an increased risk of developing subsequent non-communicable diseases and cardiovascular problems later in life. Several factors are associated with the likelihood of maternal obesity, including sociodemographic characteristics, obstetric characteristics, knowledge, and perception of health-promoting behavior. Gaining a sound understanding of these factors is vital to reaching the targets of Sustainable Developmental Goal 3—to reduce global maternal mortality and end preventable deaths of children under 5 years of age—by 2030. It is essential to identify pregnant women who are at risk of maternal obesity in order to plan and implement effective and timely interventions for optimal pregnancy outcomes. Importantly, maternal obesity as a significant pregnancy risk factor is largely modifiable.

Maternal and neonatal outcomes in pregnancies complicated by maternal obesity

Background: Maternal obesity imparts elevated maternal and neo natal adverse outcomes. Aim of the study was to evaluate and analyse the maternal and neonatal outcomes in obese mothers.Methods: This was a prospective case control study in a tertiary care high risk referral center. Antenatal women with first trimester Body mass index (BMI) of more than 30 Kg/m2 constituted the cases and those antenatal women with BMI <25 Kg/m2 formed the controls.Results: Mean age was slightly more (28.6±4.3 years vs 26.3±3.6 years: P<0.0001) in the obese group. Obese women were significantly more likely to have  of gestational diabetes (OR 5.2, 95% CI 3.2-8.7 P<0.00001), gestational hypertension (Or 3.5, 95% CI 2.1-5.9 P<0.0001) , induction of labour (OR 2.5, 95% CI 1.8-3.6 P<0.0001), failed induction of labour (OR 2.4, 95% CI 1.3-4.2 P=0.003), Preeclampsia (OR 2.8, 95% CI 1.6-4.9 P=0.0002), Caesarian section (Or 4.0, 95% CI 2.9-5.9 P<0.0001) and Postpartum hemorrhage (OR 4.0,95% CI 1.1-14.3 P=0.034), prolonged hospital stay (OR 12.8, 95% CI 7.7-21.1 P<0.0001)  and adverse neonatal outcomes such as low(<7) Apgar (OR 3.2, 95% CI 1.1-10.0 P=0.03), Large for gestational age babies (OR 3.1, 95% Cl 2.1-4.5 P<0.0001) and transfer to new born nursery (OR 3.4, 95% CI 2.3 -5.2 P<0.0001).Conclusions: Maternal obesity in pregnancy is high risk and has many adverse maternal and neonatal outcomes warranting specialized antenatal, intranatal and post-natal care.

¿Se relaciona la obesidad en el embarazo con muerte fetal por insuficiencia placentaria? / Is obesity in pregnancy related to fetal death due to placental insufficiency?

Se presentan 4 casos de muerte fetal en pacientes obesas con embarazos de término, con hallazgos placentarios variados, que sugieren insuficiencia placentaria, que podrían estar asociados a la obesidad. Esta afirmación se basa en evidencias recientes que demuestran que la obesidad por intermedio de la disminución de los mediadores como apelina, leptina, reguladores del tono vascular placentario y de otros reguladores de la angiogénesis, alteran la función placentaria especialmente en embarazos de término y podrían estar implicados con inadecuado crecimiento fetal y con resultados adversos asociados con la obesidad. Comunicamos un mecanismo inusualmente descrito relacionado posiblemente con la obesidad y con resultado desfavorable del embarazo.

We present 4 cases of fetal death in obese pregnant women with term pregnancies, with several placental findings suggesting placental insufficiency, that could be associated with obesity. According to recent evidence obesity could be associated with inadequate fetal growth and adverse outcomes especially at term pregnancies, through the decrease of mediators such as apelin, leptin, regulators of placental vascular tone and other regulators of angiogenesis altering placental function. We report a rarely described mechanism possibly related to obesity and unfavorable outcome of pregnancy.

Effect of maternal obesity on children's mental status / 中华实用儿科临床杂志

In recent years,obesity is becoming one of the focus problems of social public concern.Maternal obesity may pose a threat on maternal health,for examble the increase of obstetrical complications,it may also affect the short-term and long-term health of the offspring.Maternal obesity may affect children's mental disorder,no review to date has discussed it systematically in China.Now,the health hazards of maternal obesity for the offspring including childhood autism spectrum disorder,attention deficit hyperactivity disorder,neural tube defects,neurobehavioral development disorders and so forth were reviewed,and to provide a reasonable guidance of obesity management.

Both hepatic lipogenesis and beta-oxidation are altered in offspring of mothers fed a high-fat diet in the first two generations (F1 and F2) / La lipogénesis hepática y la beta-oxidación están alteradas en las crías de madres alimentadas con una dieta alta en grasas en las dos primeras generaciones (F1 y F2)

The high fat (HF) fed mothers may program susceptibility in offspring to chronic diseases and affect subsequent generations. The present study evaluated the liver structure in adulthood, focusing on the F1 and F2 generations. Females C57BL/6 (F0) were fed standard chow (SC) or HF diet (8 weeks) prior to mating and during the gestation and lactation to provide the F1 generation (SC-F1 and HF-F1). All other mothers and offspring fed SC. At 3 months old, F1 females were mated to produce the F2 generation (SC-F2 and HF-F2). The liver was kept in several fragments and prepared for histological analysis or frozen for biochemical and molecular analyzes. The F1 and F2 offspring were studied at 3 months old. HF-F1 had higher body mass (BM) compared to SC-F1 (P= 0.001), but not HF-F2 compared to SC-F2. HF-F1 had glucose intolerance when compared to SC-F1, but not HF-F2 compared to SC-F2. HF-F1 (P= 0.009) and HF-F2 (P= 0.03) showed hyperinsulinemia compared to their counterparts. Both groups HF-F1 and HF-F2 showed more steatosis than the SC counterparts (F1 and F2, P<0.0001). HF-F1 showed increased expression of PPAR-gamma and SREBP1-c compared to SC-F1 (P= 0.01). HF-F2 showed increased PPAR-gamma expression compared to SC-F2 (P= 0.04). In conclusion, HF-fed mother impairs both lipogenesis and beta-oxidation pathways in F1 through upregulation of PPAR-gamma and downregulation of PPAR-alpha. In F2, the only lipogenesis is enhanced, but it causes a disrupted PPAR balance, favoring the hepatic lipid accumulation and impaired metabolism in these animals that were not directly exposed to the maternal HF intake.

Los madres alimentadas con dieta rica en grasas (HF) pueden programar una susceptibilidad al desarrollo de enfermedades crónicas en su descendencia y de este modo afectar a las generaciones posteriores. El presente estudio evaluó la estructura del hígado en la edad adulta, centrándose en las generaciones F1 y F2. Las hembras C57BL/6 (F0) fueron alimentadas con dieta estándar (CS) o dieta HF (8 semanas) antes del apareamiento y durante la gestación y lactancia para producir la generación F1 (CS-F1 y HF-F1). Todas las demás madres y crías fueron alimentadas con CS. A los 3 meses de edad, las hembras F1 fueron apareadas para producir la generación F2 (CS-F2 y HF-F2). El hígado se conservó en varios fragmentos y se preparó, por un lado, para el análisis histológico, y por otro, se lo congeló para realizar análisis bioquímicos y moleculares. La descendencia F1 y F2 se estudió a los 3 meses de edad. HF-F1 tuvo una mayor masa corporal (BM) en comparación con CS-F1 (P= 0,001), pero no el grupo HF-F2 en comparación con CS-F2. HF-F1 tenía intolerancia a la glucosa en comparación con CS-F1, pero no el grupo HF-F2 en comparación con CS-F2. HF-F1 (P= 0,009) y HF-F2 (P= 0,03) mostraron hiperinsulinemia en comparación con sus homólogos. Ambos grupos HF-F1 y HF-F2 mostraron más esteatosis que las contrapartes CS (F1 y F2, P <0,0001). HF-F1 mostró una mayor expresión de PPAR-gamma y SREBP1-c en comparación con el grupo CS-F1 (P= 0,01). HF-F2 mostró aumento de la expresión de PPAR-gamma en comparación con CS-F2 (P= 0,04). En conclusión, la madre alimentada con HF presenta ambas vías afectadas, de lipogénesis y de la beta-oxidación, en la F1 a través de la regulación positiva de PPAR-gamma y con regulación a la baja de los PPAR-alfa. En F2, solo ha mejorado la vía de lipogénesis, pero causa un desbalance de PPAR, lo que favorece la acumulación de lípidos hepáticos y la alteración del metabolismo en estos animales que no estaban directamente expuestos a la ingesta materna de HF.

Impact of maternal obesity on offspring long-term health / 国际儿科学杂志

The prevalence of obesity among pregnant women is increasing,that include pre-pregnancy obesity and/or over gestational weight gain diagnosed by different criteria in different countries.Emerging evidance suggests that maternal obesity before and during pregnancy have not only short-term effects on both of mother and offspring,but also long-term adverse influences on offspring health.Evidence from both animal and human studies indicates that maternal obesity increases the weight and adiposity,alters body composition and increases the risk of metabolic disorders.These changes further result in the increased risk of metabolic syndrome of offspring in their later life.Further studies are required to elucidate the programming mechanisms of disease risk in the offspring as a consequence of matemal obesity.Strategies to prevent and reduce the impact of maternal obesity on long-term health of offsprings are required.

Obesidad materna pregestacional como factor de riesgo para el desarrollo de macrosomía fetal / Maternal pregnat obesity as a risk factor for the development of fetal macrosomy

RESUMEN Introducción: El riesgo de un macrosomía fetal (con peso = 4.000 g) es 3,4 veces más elevado en los casos de obesidad pregestacional materna. Objetivo: determinar la asociación entre el desarrollo de macrosomía fetal y el antecedente de obesidad materna pregestacional en pacientes atendidas en el Centro Materno Infantil de la Cátedra y Servicio de Ginecología y Obstetricia, Facultad de Ciencias Médicas-Universidad Nacional de Asunción, de enero a agosto del 2013. Pacientes y métodos: diseño de casos y controles, donde se comparó la presencia de obesidad pregestacional y el desarrollo de macrosomía fetal. Resultados: ingresaron al estudio 249 recién nacidos: 110 casos y 139 controles. La prevalencia de de macrosomía en el tiempo estudiado fue 3,9%, en las mujeres obesas fue de 61,5%. Se encontró asociación significativa de macrosomía fetal con obesidad materna pregestacional (p 0,01) y diabetes gestacional (p 0,0007). El índice de masa corporal, peso pregestacional y la ganancia de peso durante el embarazo fueron estadísticamente diferentes entre casos y controles. La cesárea fue la forma de terminación del embarazo más frecuente, y el motivo fue la desproporción cefalopélvica. Conclusión: el antecedente de obesidad materna pregestacional resultó ser un factor de riesgo significativo para el desarrollo de macrosomía fetal.

ABSTRACT Introduction: The risk of macrosomy with a weight = 4000 g is 3.4 times higher in cases of maternal prepregnancy obesity. Objective: To determine the association between the development of fetal macrosomy and a history of maternalprepregnancy obesity in patients treated at the Children´s Center for Maternal and Chair Department of Obstetrics and Gynecology, Faculty of Medical Sciences, National University of Asuncion, from January to August, 2013. Patients and methods: Case-control design, where the presence of pre-pregnancy obesity and the development of fetal macrosomywere compared. Results: were admitted 249 newborns to the study: 110 cases and 139 controls. The prevalence of macrosomy in the time studied was 3.9%, in obese women was 61.5%. We found significant association between fetal macrosomy and prepregnant obesity (p 0.01) and gestational diabetes (p 0.0007). The body mass index, pre-pregnancy weight andweight gain during pregnancy was statistically different between cases and controls. Cesarean section was the morefrecuent mode of termination of pregnancy and the reason was the cephalopelvic disproportion. Conclusion: the history of prepregnancy maternal obesity was a risk significant factor for the development of fetal macrosomy.

A clinical study on macrosomia / 대한산부인과학회지

OBJECTIVE: Macrosomia is one of the important problems in obstetrics and perinatology. This study was to investigate the changing trend in incidence, area distribution, and other relavant factors of macrosomia. METHODS: We studied 2,206 cases of large babies weighing 4,000 g or more among 72,084 deliveries at Catholic Medical College Hospital from Jan. 1, 1993 to Dec. 31, 2003. The cases were divided into two group, one group from 1993 to 1998 (group I), the other group from 1998 to 2003 (group II). RESULTS: The incidence of large babies weighing 4,000 g or more was 3.06%. The incidence of macrosomia in group I was 3.02%, and that from group II was 3.14% (P=0.149). The incidence of macrosomia throughout the country was 2.5-3.3%. The average body weight of macrosomia was raised by 30 g from 4,218 +/- 224 g in group I to 4,248 +/- 246 g. in group II (P=0.003). The average of maternal body weight was raised by 246 g from 73.12 +/- 9.08 kg in group I to 75.56 +/- 9.64 kg in group II (P<0.001). According to gestational age, the percentage of macrosomia less than 38 weeks was 5.0%, that during 38 weeks and 40 weeks was 39.4%, that during 40 weeks and 42 weeks was 53.4%, more than 42 weeks was 2.2% in group I, and that in group II was 6.2%, 46.1%, 44.1%, and 3.6%, respectively. Male fetuses were 927 cases (64.69%), and female fetuses were 506 cases (35.31) in group I, and those in group II were 520 cases (67.27%), and 253 cases (32.73%), respectively. CONCLUSION: There is no change in the incidence of macrosomia past 11 years. There is no significant difference in the incidence of macrosomia throughout the country. Maternal body weight may associated with fetal body weight. Gestational weeks in group II were earlier, that in group II. Sex ratio was similar in the two groups, and male was predominant.