Early Pregnancy BMI Research Articles

340: Does maternal glycemia influence the distribution of fetal fat in the third trimester?

of fetal fat in the third trimester? Clare O’Connor, Nadine Farah, Vicky O’Dwyer, Bernard Stuart, Mairead Kennelly, Michael Turner The Coombe Women and Infants University Hospital, School of Medicine & Medical Science UCD Centre For Human Reproduction, Dublin, Ireland, Coombe Women and Infants University Hospital, UCD Centre for Human Reproduction, Dublin, Ireland, Coombe Women & Infants University Hospital, UCD Centre for Human Reproduction, Dublin, Ireland, Coombe Women & Infants University Hospital, UCD Centre for Human Reproduction, Dublin, Ireland, Coombe Women and Infants University Hospital, UCD Centre for Human Reproduction, Dublin, Ireland OBJECTIVE: We studied the relationship between maternal glycemia at 28 weeks gestation and fetal adiposity measured using ultrasound in the third trimester. STUDY DESIGN: After Gestational Diabetes Mellitus(GDM) was excluded by a diagnostic Oral Glucose Tolerance Test (OGTT) at 28 weeks gestation, healthy women with a singleton pregnancy were recruited at their convenience. Consent was obtained. Sonographic fetal soft tissue measurements were used to assess adiposity at 28 and 37 weeks. Gestational weight gain (GWG) was measured. Statistical analysis included multiple regression. RESULTS: In the 231 women studied the mean age was 30.6 years. 41.1% (n 95) were primigravidas. The mean early pregnancy BMI was 28.2 kg/m2. Maternal glucose levels correlated with the fetal abdominal subcutaneous tissue measurements (r 0.2; p 0.014) and abdominal circumference (AC), (r 0.1; p 0.04). Maternal glucose levels did not correlate with the fetal mid-thigh muscle thickness and mid-thigh subcutaneous tissue measurements. Fasting and 1 hour post prandial OGTT levels were significantly associated with AC and abdominal subcutaneous tissue measurements. Glucose levels at 2 and 3 hours post prandial correlated with increased abdominal subcutaneous tissue but not with fetal AC (Table). There was no significant association between gestational weight gain (GWG) and fetal adiposity. CONCLUSION: Recent studied have shown that higher maternal glucose levels short of GDM were associated with large for gestational age babies and neonatal adiposity. Our study shows that in women who do not have GDM, higher maternal glucose levels at 28 weeks gestation appear to influence the distribution of fetal fat as well as the amount of fat. The lifelong impact of intrauterine programming by maternal glycemia on the distribution of fetal fat remains uncertain. 341 Fetal loss rates from intrauterine fetal transfusion: a prospective tertiary center study Colin Walsh, Noirin Russell, Stephen Carroll, Rhona Mahony, Shane Higgins, Fionnuala McAuliffe, Peter McParland National Maternity Hospital, Maternal-Fetal Medicine, Dublin, Ireland, National Maternity Hospital, Obstetrics and Gynaecology, Dublin, Ireland, National Maternity Hospital, Obstetrics and Gynaecology, Dubin, Ireland, UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, Dublin, Ireland OBJECTIVE: To examine perinatal outcomes following intrauterine fetal red cell transfusion (IUT) in a single tertiary obstetric unit over a 15-year period. STUDY DESIGN: This is a prospective study of all IUTs performed at the National Maternity Hospital, Dublin, which is Irelands largest fetal medicine center. Eligible cases were identified from a prospectively collated hospital transfusion register; the clinical details for each case were extracted and recorded onto a computerized database. Women undergoing IUT for alloimmune thrombocytopenia, non-immune fetal hydrops or parvovirus infection were excluded. The cord insertion was the preferred site for IUT, with the intra-hepatic vein and free cord loop reserved for cases where the cord insertion was inaccessible. RESULTS: Between January 1996 and December 2010, 262 intrauterine transfusions were performed in our unit, of which 244 (93%) were undertaken for red cell alloimmunisation, involving 97 pregnancies. The majority of women (84%, 81/97) had anti-D antibodies, with a smaller incidence of anti-Kell (12%), anti-c (3%) and anti-E (1%) antibodies. Affected women underwent a median of 3 (IQR 2-4) IUT procedures. The median gestation at first IUT was 27 (IQR 25-31) weeks. In total, there were 3 intrauterine fetal deaths and 4 early neonatal deaths in this cohort, giving a perinatal mortality rate of 7% and a survival rate of 93%. There were 3 perinatal losses directly related to the transfusion (all in women with anti-D antibodies), giving an overall procedure-related loss rate of 1.2% (3/244) per procedure. Two women had in utero fetal demise within 48 hours of the IUT, at 25 weeks 29 weeks respectively. The third loss was early neonatal demise following emergency CS for fetal bradycardia due to cord hematoma at 32 weeks gestation. CONCLUSION: Intrauterine fetal transfusion is a safe procedure, associated with a low (1.2%) rate of procedure-related fetal loss, when performed by experienced practitioners in a national referral center. Poster Session II Diabetes, Labor, Medical-Surgical-Disease, Obstetric Quality & Safety, Prematurity, Ultrasound-Imaging www.AJOG.org

Maternal body mass index and the risk of fetal and infant death: a cohort study from the North of England.

Early pregnancy obesity (body mass index, BMI, ≥ 30 kg/m(2)) carries significant health implications. This cohort study investigates the association between early pregnancy BMI and the risk of fetal and infant death in pregnancies not affected by congenital anomalies or pre-gestational diabetes. Data on singleton pregnancies delivered during 2003-2005 at five hospitals were linked with data from three regional registers: the Northern Perinatal Mortality Survey, the Northern Diabetes in Pregnancy Survey and the Northern Congenital Abnormality Survey. Logistic regression models were used to determine the crude and adjusted odds ratios (aOR) of a spontaneous fetal death (≥ 20 weeks gestation) and infant death (aged up to 1 year), among underweight (BMI <18.5 kg/m(2)), overweight (BMI 25-29.9 kg/m(2)) and obese women compared with women of recommended BMI (18.5-24.9 kg/m(2)). Obese women were at significantly increased risks of both fetal death [aOR = 2.32 (95% confidence interval: 1.64-3.28), P< 0.001] and infant death [aOR = 1.97 (1.13-3.45), P= 0.02]. Continuous analyses revealed a V-shaped relationship between BMI and the risk of fetal and infant death, with a minimum risk at 23 kg/m(2), and significantly increased risk thereafter for both fetal death [aOR, per unit = 1.07 (1.05-1.10), P< 0.001] and infant death [aOR, per unit = 1.06 (1.02-1.10), P= 0.007]. No significant excess risks, however, were identified for either maternal underweight [fetal death: aOR = 0.98 (0.42-2.25), P= 0.96; infant death: aOR = 1.89 (0.73-4.88), P= 0.19] or maternal overweight [fetal death: aOR = 1.34 (0.94-1.89), P= 0.10; infant death: aOR = 1.35 (0.79-2.32), P= 0.27] as categories. Except for higher rates of pre-eclampsia among stillbirths, no specific cause of death could explain the increased odds of fetal and infant death among the obese. Early pregnancy obesity is significantly associated with fetal and infant death, independent of the known relationships with congenital anomalies and maternal pre-gestational diabetes.

Associations Between Mothers' and Their Children's Weights at 4 Years of Age

OBJECTIVES: To examine the importance of maternal weight characteristics as predictors of overweight (BMI ≥85th percentile and <95th percentile) and obesity (BMI ≥ 95th percentile) in offspring at age 4 years. METHODS: Chi-square and logistic regression analyses were conducted on a sample of 321 mother/child pairs from an earlier observational cohort study on mothers' postpartum weight retention. RESULTS: Maternal early pregnancy BMI and infant birth weight were each positively and significantly (p <0.05) associated with increased risk of obesity in offspring at age 4 years. A significant interaction was found between these two variables in predicting children's risk of obesity. It was driven by the high proportion of obese children among obese women who had infants weighing < 3 kg at birth. Net gestational weight gain was not associated with obesity risk in children, but was positively associated with infant birth weight among normal weight and overweight women. CONCLUSIONS: Reducing maternal BMI in the preconception period among overweight and obese women and preventing excessive weight gain in pregnancy for all women appear to be appropriate strategies to address the childhood obesity epidemic.

Impact of adherence to new IOM weight gain guidelines on birth outcomes among obese pregnant women

The new Institute of Medicine (IOM) guidelines for weight gain during pregnancy have been released recently. These guidelines now include an upper limit for weight gain among obese women. However, the impact/feasibility of adhering to these new guidelines remains to be evaluated. The objective of this study was to compare birth outcomes as well as fat mass gain among obese pregnant women during the second half of pregnancy. Fifty‐four women (early pregnancy BMI ≥30) were enrolled at 20wks gestation. Weight, height and body density (using air plethysmography) were measured at 20, 28 and 34 weeks gestation. Body fat then was estimated using Van Raaij's equations (Van Raaij, 1988). Birth information (weight, length and gestational age) were recorded. Weight gain rate was determined and used to categorize women into 3 groups: less than (L), within (W) or above than (A) recommended. On average, women gained 1.2± 2.9 kg between 20–34wk. Twenty‐seven percent had a weight gain rate below recommendations, while 29% was within and 19% was above recommended. Fat mass gain was significantly lower among L group, when compared to W and M (median±InterQ range: L: −0.3 ± 5.11kg; W: 1.6±2.89 and A: 2.7±2.1; p&lt; 0.030). However, no differences were found on birth weight or length after controlling for gestational age at birth. Our preliminary results suggests that higher weight gain rate during the second half of pregnancy might be related to maternal fat accretion and perhaps not to fetal growth among obese women. Composition of weight gain should be incorporated in studies to further evaluate impact of weight gain on maternal and fetal outcomes.

Maternal Weight Gain During Pregnancy and Child Weight at Age 3 Years

To determine the importance of pregnancy weight gain as a predictor of overweight (Body Mass Index [BMI] >85th percentile) in offspring at age 3 years and if its influence varies by maternal BMI. Chi-square and logistic regression analyses were conducted on a sample of 208 mother-child pairs from an earlier observational cohort study on postpartum weight retention. In the final reduced regression model, maternal early pregnancy BMI was positively and significantly associated with overweight in offspring, as were birth weight above the sample median of 3,600 g and maternal smoking during pregnancy (P < or = 0.01). In addition, a significant interaction was found between maternal BMI and gestational weight gain (P = 0.03). The risk of offspring overweight that is associated with 5 excess pounds of net pregnancy weight gain increases with maternal BMI. Excess pregnancy weight gain is associated with increased risk of child overweight at age 3 years and its impact is greater among high and obese BMI women than it is in normal BMI women. Reducing maternal BMI in the preconception period in overweight women and preventing excessive weight gain in pregnancy for all women appear to be appropriate strategies to address the childhood obesity epidemic.

Relationship between pre-pregnancy BMI and plasma zinc concentrations in early pregnancy.

We previously reported that pregnant women whose plasma Zn concentrations were below the 50th percentile tended to have high pre-pregnancy BMI (kg/m(2)) values. We therefore hypothesized that in pregnant women, plasma Zn concentrations are negatively correlated with BMI. We evaluated the association between BMI values and plasma Zn concentrations in 1474 women whose blood samples were obtained before 15 weeks of gestation. Their mean age was 22.7 years and mean gestational age at blood sampling was 10 weeks. The mean plasma Zn concentration and BMI were 11.6 micromol/l and 26.6 kg/m(2) respectively. Because plasma Zn concentrations decrease as gestational age increases, plasma Zn concentrations were standardized by Z-scores. Z-score distributions were compared among the quartiles of BMI. The highest BMI group had the lowest plasma Zn concentrations, whereas the lowest BMI group had the highest; the differences were significant between the BMI groups (P<0.0001). The interpretation of plasma Zn concentrations to assess Zn nutriture in pregnancy may be complicated not only by the well-established factor of gestational age at blood sampling, but also by a previously unrecognized factor, maternal BMI.

A longitudinal study of maternal anthropometric changes in normal weight, overweight and obese women during pregnancy and postpartum.

Many women associate one or more of their pregnancies with the development of adult obesity. Such an association has not been fully explored. This longitudinal study examines the changes in maternal anthropometric indices during pregnancy and postpartum. Seventy-seven pregnant subjects were investigated longitudinally at about 13, 25 and 36 weeks gestation, of whom forty-seven continued taking part into the postpartum period. Maternal weight, height and skinfold thickness (triceps, biceps, subscapular, suprailiac and mid thigh) were measured at each visit. Maternal fat mass was estimated from the conversion of the first four skinfold thicknesses. Maternal waist and hip circumferences were also measured at the first visit and 6 weeks and 6 months postpartum. Weight and fat gain during pregnancy (13-36 weeks gestation) was 10.9 (SD 4.7) kg and 4.6 (SD 3.3) kg (P < 0.001) respectively. A significant increase in fat mass from 13 weeks gestation to 6-months postpartum was observed (2.6 (SD 4.5), P < 0.001). The increased weight at 6-months postpartum, however, was not statistically significant (1.1 (SD 6.0) kg, P = 0.20). Based on BMI in early pregnancy, the subjects were divided into groups of underweight, normal weight, overweight and obese. The last three groups were compared using ANOVA. The obese group showed a significant difference in the pattern of changes in the skinfold thickness, waist:hip ratio and fat mass at the postpartum period, in comparison with the other two groups. In conclusion, there is a tendency in the obese group to develop central obesity at the postpartum period.