The short- and long-term implications of maternal obesity on the mother and her offspring.

Obesity's increasing prevalence has reached epidemic proportions in the USA, with close to one-third of the adult population affected in 2000. Additionally, there is increasing prevalence of obesity in other industrialised areas of the world such as Europe. Of potentially more concern is the potential risks associated with obesity and related metabolic complications in the developing world. The maternal, fetal, peripartum and neonatal complications of obesity in pregnancy have far-reaching implications for both mother and offspring. Of alarming interest is the increasing rate of obesity among adolescents and the cycle of obesity in future generations it portends. The purpose in this review is to briefly review the maternal perinatal morbidities associated with maternal pregravid obesity. Additionally, we will review evidence of both short- and long-term effect of maternal obesity on the in utero environment as it relates to fetal growth, neonatal body composition and adolescent obesity.

The impact of chorionicity on umbilical cord acid-base values in twin gestations.

OBJECTIVE: To evaluate the impact of chorionicity on inter-twin differences in acid-base status at birth. METHODS: Records for twin pregnancies delivered at > or = 24 weeks' gestation from 1 January 1990 to 31 June 2000 were reviewed. Collected data included maternal demographics, gestational age, fetal presentation, anesthesia, delivery mode, inter-twin interval, umbilical artery (UA) and venous (UV) acid-base values, Apgar scores and birth weights. The influence of chorionicity on umbilical cord biochemistry was evaluated. (p < 0.05 was considered significant.) RESULTS: Analysis was carried out in 87 twin pairs (29 monochorionic, MC; and 58 dichorionic, DC). MC and DC twins were similar in maternal age (25.5 vs. 28.2 years), estimated gestational age (33.7 vs. 33.6 weeks), Cesarean delivery (55.2 vs. 52.6%), delivery interval (10 vs. 5 min) and respective birth weights (twin A, 1882 vs. 1981; and twin B, 1828 vs. 1872 g). MC first twins had a higher UA pH (7.31 +/- 0.05 vs. 7.26 +/- 0.08; p = 0.0005) than DC first twins. MC first and second twins had higher UA and UV bicarbonate levels than their DC counterparts (DeltapH = 21.7 +/- 5.1 vs. 18.5 +/- 3.1 mmol/l and 22.0 +/- 3.5 vs. 19.6 +/- 2.5 mmol/l, respectively; p = 0.003). MC twins were more discordant in UA pH than DC twins (DeltapH = 0.043 +/- 0.09 vs. 0.003 +/- 0.07; p = 0.009). MC and DC twins had a similar venous pH (DeltapH = 0.01 +/- 0.06 vs. 0.02 +/- 0.06; p = 0.5). CONCLUSIONS: There is a significant association between placental chorionicity and umbilical cord biochemistry in twins. Although it is possible that the mechanism of this finding is related to placental angioarchitecture, it is unlikely to be a result of simple mixing of blood volumes between twins. The physiology of underlying processes requires further study.

Are maternal and sonographic factors associated with the detection of a fetal echogenic cardiac focus?

OBJECTIVE: To evaluate the influence of maternal weight and the orientation of the fetal 4-chamber heart view on the detection of a fetal echogenic cardiac focus. METHODS: In this nested case-control study, 103 women undergoing anatomic surveys at 15 to 22 weeks between January 1, 1997, and June 15, 1999, were identified as having an echogenic cardiac focus via our computerized database. A control group was selected from among the same group of patients. Data were collected from the sonography reports, prenatal records, and sonographic images of 4-chamber heart views; maternal characteristics and sonographic details were recorded, including the orientation of the 4-chamber view (apical, basilar, and right and left lateral). RESULTS: Gravidas in the echogenic cardiac focus group were more likely to be of lower weight (68.0 +/- 14.4 versus 72.9 +/- 18.3 kg; P = .04), of lower body mass index (25.5 +/- 5.3 versus 27.3 +/- 6.2 kg/m2; P = .03), of younger age (24.4 +/- 6.5 versus 26.9 +/- 6.9 years; P = .01), and African American or Asian (37.9% versus 27.2% and 9.7% versus 2%; P = .01). Cases were scanned at earlier gestational ages (18.9 +/- 1.6 versus 19.5 +/- 1.7 weeks; P = .01). The focus group was more likely to have had an apical view of the fetal heart taken (80.8% versus 51.4%; P = .0001). Controls were more likely to have had a right lateral view taken (44.6% versus 20.8%; P = .002). No significant difference was found between groups in terms of any other maternal or sonographic variable studied. CONCLUSIONS: The echogenic cardiac focus group was more likely to have a lower body mass index and to be scanned with the apical fetal heart view. The orientation of the fetal 4-chamber heart view exerted the most statistically significant influence on detection rates for the echogenic cardiac focus, implying that the more technically facile the sonographic study, the more likely an echogenic cardiac focus will be found.

Antibiotics and the management of preterm premature rupture of the fetal membranes.

Preterm premature rupture of membranes remains an important cause of preterm birth and neonatal morbidity and mortality. Although the underlying pathophysiology remains largely undefined, subclinical infection has been implicated both in the mechanism of membrane rupture and the resultant neonatal morbidity. The use of maternal systemic antibiotics reduces both neonatal and maternal morbidity in the expectant management of PPROM. Although concern persists over the development of resistant strains of organisms involved with neonatal sepsis, current data support the use of antibiotics in this setting. Further study is needed regarding the risks and benefits of additional tocolytic therapy or antenatal corticosteroids in the management of PPROM, and the predictors of successful and unsuccessful conservative management, and subclinical intrauterine infection. This will be helpful in the ultimate delineation of the optimal management scheme for PPROM.