The effect of obesity on heart rate (heart period) and physiologic parameters during pregnancy.

Obesity and excess gestational weight gain (EGWG) in pregnancy increase the risk for adverse maternal and infant outcomes. Along with careful monitoring of weight gain during pregnancy, early identification of a maladaptive response to the changes of pregnancy may help to avoid adverse outcomes. Simple physiologic markers such as resting heart rate (HR), heart period (HP), and blood pressure (BP) may be powerful predictors of cardiovascular adaptation to pregnancy. This article summarizes the current state of the science regarding the effect of obesity (body mass index [BMI] > or =30 kg/m(2)) and EGWG in pregnant women at rest in laboratory settings. The impact of differences in weight gain (kg and BMI) on pregnancy outcomes is also examined. A search was conducted for articles published from 1985 to 2006 reporting data on body weight and HR or HP at rest from randomized controlled trials or controlled trials conducted in laboratory settings involving pregnant women at low or high risk for adverse pregnancy outcomes who were obese or had EGWG. A meta-analysis was conducted on the 23 studies meeting inclusion criteria to explore the relation of BMI to HR, HP, and physiologic parameters. Autonomic responsiveness was found to be diminished in obese women with a BMI > 30 kg/m(2) and in women with high risk for adverse pregnancy outcomes, which may indicate a maladaptive autonomic response that is imbalanced and disorganized and that reduces adaptation to environmental demands.

Meta-analysis of acustimulation effects on nausea and vomiting in pregnant women.

OBJECTIVE: We used meta-analysis to examine the effects of acustimulation (AS) on the prevention of nausea and vomiting in pregnant women (NVP). METHODS: Meta-analysis of effects of acustimulations (ie, acupressure, acupuncture, and electrical stimulation [ETS]) on NVP was conducted. Fourteen trials, eight random controlled trials (RCTs), with one RCT having two treatment modalities with four groups, and six crossover controlled trials (N = 1655) published over the last 16 years were evaluated for quality according to the Quality of Reports of Meta-analysis of Randomized Controlled Trials (QUORUM) guidelines. Relative risks (RR) and 95% confidence intervals (CI) were calculated from the data provided by the investigators of the original trials. RESULTS: Before the treatment, 100% of the women (13 trials, n = 1615 women) were nauseated, but and 96.6% (1599/1655) reported vomiting. After the treatment, compared with the controls, AS (all modalities combined) reduced the proportion of nausea (RR = 0.47, 95% CI: 0.35-0.62, P < .0001) and vomiting (RR = 0.59, 95% CI: 0.51-0.68, P < .0001). Acupressure methods applied by finger pressure or wristband reduced NVP. The ETS method was also effective in reducing NVP. However, the acupuncture method did not show effects on reducing NVP. There was a placebo effect when compared with controls in reducing nausea (three trials, RR = 0.63, 95% CI: 0.39-1.02, P = .0479) and vomiting (five trials, RR = 0.67, 95% CI: 0.50-0.91, P = .0084). CONCLUSIONS: This meta-analysis demonstrates that acupressure and ETS had greater impact than the acupuncture methods in the treatment of NVP. However, the number of acupuncture trials was limited for pregnant women, perhaps because it is impossible to self-administer the acupuncture and thus inconvenient for women experiencing NVP as chronic symptoms.

Maternal race/ethnicity and predictors of pregnancy and infant outcomes.

OBJECTIVE: To examine predictors of pregnancy and infant outcomes, including maternal race/ethnicity. DESIGN: Prospective and observational follow-up of high-risk pregnancies and births. PARTICIPANTS: Three hundred fifty-four mothers and their preterm and/or high-risk live-born neonates were closely followed in three tertiary care centers from the prenatal to postnatal periods for potential high-risk and/or preterm births that required neonatal resuscitations. MAJOR OUTCOME MEASURES: Pregnancy complications, birth complications, and infant outcomes were examined in conjunction with maternal factors, including preexisting health problems, health behaviors (smoking, alcohol consumption, prenatal visits), and the birth setting (tertiary care centers or community hospitals). RESULTS: About 22% of these infants were transferred into the tertiary care centers from the community hospitals right after birth; the rest were born in the centers. According to regression analyses, predictors of the birth setting were race (White vs. non-White), maternal health behaviors, pregnancy complications, fetal distress, and the presence of congenital defects for infants (p < .001). Predictors for fetal distress included race (Whites) and pregnancy-induced hypertension (p < .003). Predictors for lower birth weight included race (non-Whites), maternal cigarette smoking, pregnancy complications, fetal distress, and congenital defects (p < .001). Infant mortality rate was 3.9% for these high-risk infants, with the highest rate in infants born to Black mothers (8%). CONCLUSIONS: There are obvious health disparities among White and non-White women experiencing high-risk pregnancies and births. Future studies are needed to develop interventions targeted to different racial/ethnic groups during pregnancy to reduce preterm and high-risk births.