Gestational Body Mass Index Research Articles

Evaluation of circulating betatrophin levels in gestational diabetes mellitus

Experimental data indicate that betatrophin plays a significant role in the regulation of lipid metabolism and glucose homeostasis. In recent years, considerable attention has focused on the relationship between betatrophin and diabetes mellitus in humans. This case-control study included 45 women diagnosed with gestational diabetes mellitus (GDM) and 45 pregnant healthy controls. The groups were matched for maternal and gestational age and body mass index. Serum betatrophin levels were significantly higher in women with GDM (median = 635.8 ng/L; range: 290–1841.6 ng/L) compared to control subjects (median = 320.1 ng/L; range: 94.6–936.8 ng/L; p = 0.001). No significant correlations were observed between serum betatrophin levels and clinical or biochemical parameters in the control group. However, in the GDM group, serum betatrophin levels were positively correlated with weight gain during pregnancy (r = 0.304, p = 0.042), systolic blood pressure (r = 0.394, p = 0.007), fasting insulin level (r = 0.348, p = 0.019), and homeostatic model assessment insulin resistance (HOMA-IR; r = 0.311, p = 0.038). Multivariate stepwise linear regression analysis revealed that fasting insulin levels (β = 0.342, p = 0.022) and HOMA-IR (β = 0.312, p = 0.037) were independently associated with serum betatrophin levels.

Is low-dose aspirin therapy to prevent preeclampsia more efficacious in non-obese women or when initiated early in pregnancy?

Objective: Late timing of intervention and maternal obesity are potential explanations for the modest effect of aspirin for preeclampsia prevention. We explored whether low-dose aspirin (LDA) is more effective in women at increased risk when initiated before 16 weeks' gestation or given to non-obese women.Methods: Secondary analysis of a trial to evaluate LDA (60 mg/d) for preeclampsia prevention in high-risk women. Participants were randomized to LDA or placebo between 13 and 26 weeks. We stratified the effect of LDA on preeclampsia by (a) timing of randomization (< 16 or ≥ 16 weeks gestation) and (b) body mass index (BMI) class (non-obese and obese). The Breslow–Day test for homogeneity was used to assess for variations in effect of LDA across gestational age and BMI groups.Results: Of 2503 women, 461 (18.4%) initiated LDA < 16 weeks. LDA effect was not better when initiated < 16 weeks (RR: 0.93, 95% CI: 0.67–1.31) versus ≥ 16 weeks (RR: 0.90, 95% CI: 0.75–1.08), (p value for interaction = 0.87). Similarly, LDA effect was not better in non-obese (RR: 0.91, 95% CI: 0.7–1.13) versus obese women (RR: 0.89, 95% CI: 0.7–1.13), (p value for interaction = 0.85).Conclusion: LDA for preeclampsia prevention was not more effective when initiated < 16 weeks or used in non-obese women at risk for preeclampsia. No particular subgroup of women was more or less likely to benefit from LDA therapy.

Are third-trimester adipokines associated with higher metabolic risk among women with gestational diabetes?

AimThis study aimed to determine whether third-trimester adipokines during gestational diabetes (GDM) are associated with higher metabolic risk. MethodsA total of 221 women with GDM (according to IADPSG criteria) were enrolled between 2011/11 and 2013/6 into a prospective observational study (IMAGE), and categorized as having elevated fasting blood glucose (FBG) or impaired fasting glucose (IFG, n=36) if levels were≥92mg/dL during a 75-g oral glucose tolerance test (OGTT), impaired glucose tolerance (IGT, n=116) if FBG was<92mg/dL but with elevated 1-h or 2-h OGTT values, or impaired fasting and stimulated blood glucose (IFSG, n=69) if both FBG was≥92mg/dL and 1-h or 2-h OGTT values were elevated. ResultsPre-gestational body mass index (BMI) was higher in women with IFG or IFSG compared with IGT (P<0.001), as were leptin levels in women with IFG vs IGT [34.7 (10.5–119.7) vs 26.6 (3.56–79.4) ng/L; P=0.008]. HOMA2-IR scores were higher in women with IFG or IFSG vs IGT (1.87±1.2 or 1.72±0.9 vs 1.18±0.8, respectively; P<0.001). Also, those with IFSG vs those with IGT had significantly lower HOMA2-B scores (111.4±41.3 vs 127.1±61.6, respectively; P<0.05) and adiponectin levels [5.00 (1.11–11.3) vs 6.19 (2.11–17.7) μg/mL; P<0.001], and higher levels of IL-6 [1.14 (0.33–20.0) vs 0.90 (0.31–19.0); P=0.012] and TNF-α [0.99 (0.50–10.5) vs 0.84 (0.45–11.5) pg/mL; P=0.003]. After adjusting for age, parity, and pre-gestational and gestational BMI, the difference in adiponectin levels remained significant. ConclusionDiagnosing GDM by IADSPG criteria results in a wide range of heterogeneity. Our study has indicated that adipokine levels in addition to FBG may help to select women at high metabolic risk for appropriate monitoring and post-delivery interventions (ClinicalTrials.gov number NCP02133729).

Blood Pressure Variation Throughout Pregnancy According to Early Gestational BMI: A Brazilian Cohort.

BackgroundThe maternal cardiovascular system undergoes progressive adaptations throughout pregnancy, causing blood pressure fluctuations. However, no consensus has been established on its normal variation in uncomplicated pregnancies.ObjectiveTo describe the variation in systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels during pregnancy according to early pregnancy body mass index (BMI).MethodsSBP and DBP were measured during the first, second and third trimesters and at 30-45 days postpartum in a prospective cohort of 189 women aged 20-40 years. BMI (kg/m2) was measured up to the 13th gestational week and classified as normal-weight (<25.0) or excessive weight (≥25.0). Longitudinal linear mixed-effects models were used for statistical analysis.ResultsA decrease in SBP and DBP was observed from the first to the second trimester (βSBP=-0.394; 95%CI: -0.600- -0.188 and βDBP=-0.617; 95%CI: -0.780- -0.454), as was an increase in SBP and DBP up to 30-45 postpartum days (βSBP=0.010; 95%CI: 0.006-0.014 and βDBP=0.015; 95%CI: 0.012-0.018). Women with excessive weight at early pregnancy showed higher mean SBP in all gestational trimesters, and higher mean DBP in the first and third trimesters. Excessive early pregnancy BMI was positively associated with prospective changes in SBP (βSBP=7.055; 95%CI: 4.499-9.610) and in DBP (βDBP=3.201; 95%CI: 1.136-5.266).ConclusionSBP and DBP decreased from the first to the second trimester and then increased up to the postpartum period. Women with excessive early pregnancy BMI had higher SBP and DBP than their normal-weight counterparts throughout pregnancy, but not in the postpartum period.

Placenta-secreted circulating markers in pregnant women with obstructive sleep apnea.

Obstructive sleep apnea (OSA) is associated with placenta-mediated adverse clinical outcomes. We aimed at comparing placenta-secreted proteins, such as first and second trimester Down syndrome screening markers which have been linked to preeclampsia, and markers of angiogenesis in pregnant women with OSA, and pregnant controls at low risk for OSA. A case-control study of pregnant women with OSA and controls at low risk for OSA was performed. Levels of first and second trimester markers were reported as multiple of median (MoM), and adjusted for body mass index (BMI). Stored samples were tested for markers of angiogenesis and adjusted for gestational age, BMI, and chronic hypertension. A total of 24 women with OSA and 166 controls had screening markers. BMI was higher in cases compared to controls, P=0.01. MoM levels of placenta associated plasma protein-A (PAPP-A) were significantly lower in cases versus controls, even after adjusting for BMI (0.52 IQR 0.48 vs. 1.01 IQR 0.63, P=0.009). The ratio of soluble vascular endothelial growth factor receptor 1 to placental growth factor was significantly higher in cases than controls, even after adjusting for confounders (4.42 IQR 2.52 vs. 2.93 IQR 2.01, P=0.009). Circulating placenta-secreted glycoproteins and markers of angiogenesis are altered in pregnant women with OSA.

Impact of pre-gravid body mass index and body mass index change on preeclampsia and gestational diabetes in singleton and twin pregnancies

Objective: To examine pre-gravid body mass index (BMI) and gestational BMI change impact on preeclampsia and gestational diabetes mellitus (GDM).Methods: Retrospective population-based cohort study. Data from Slovenian National Perinatal Information System were analyzed for the period 2002–2011. Three singleton controls were matched by parity and maternal age to each twin pregnancy delivered at >36 weeks. Student’s t test was used to compare pre-gravid BMI and gestational BMI change in different groups (p < 0.05 significant).Results: 2046 twin and 6138 singleton pregnancies were included. Twin and singleton patients with preeclampsia or GDM had higher pre-gravid BMI (p < 0.001). Gestational BMI change was smaller in twins with GDM (p < 0.001), and not associated with preeclampsia (p = 0.07). Smaller gestational BMI change in singleton pregnancies was associated with GDM (p < 0.001), and greater BMI change with preeclampsia (p = 0.004).Conclusions: Pre-gravid BMI is more strongly associated with preeclampsia and GDM in twin and singleton pregnancies than gestational BMI change. Smaller gestational BMI change in GDM pregnancies reflect the importance of dietary counseling.

Black Women's Predisposition to Preterm Birth; Could We Be Near The Answer?

Background: Pre-term Premature Rupture of Membranes (PPROM) is attributable to several causes including asymptomatic bacterial vaginosis among Caucasians and is commoner among black pregnant women. While malaria and high Body Mass Index (BMI) have been reported among Nigerians, the influence of metalloproteinases on PPROM has never been studied in Nigeria. Methods: A qualitative estimation of active matrixmetalloproteinase-8 (a-MMP-8) to assess the effect of chronic periodontitis on time to conception led to an accidental discovery of widespread elevation of a-MMP-8 among pregnant participants. Values of aMMP-8 were compared across demographics of participants as well as educational Original Research Article International Journal of TROPICAL DISEASE & Health, 3(2): 194-203, 2014 195 status, BMI and other parameters. Results : One hundred and seventeen of 134 participants (117, 87.3%) had elevated aMMP-8 based on a novel qualitative assessment using salivary diagnostics. Levels were increased across independent of age, Estimated Gestational Age(EGA), BMI, educational level and trimester. Conclusion: This population of black pregnant women exhibited higher a-MMP-8 levels than reported among pregnant Caucasians independent of demographics, educational level and trimester of pregnancy. Reasons for the association need to be further investigated.

Waist circumference in predicting gestational diabetes mellitus

Background: To evaluate waist circumference (WC) measured at 20–24 weeks of gestation as a predictor of gestational diabetes mellitus (GDM).Methods: This cross-sectional study included 240 women at 20–24 weeks of gestation. At enrollment, WC was measured, and both prepregnancy and gestational body mass index (BMI) were estimated. According to the results of 75-g oral glucose tolerance test (OGTT) performed at 24–28 weeks, subjects were allocated into two groups, non-GDM and GDM. WC sensitivity and specificity, and odds ratios (OR) and 95% confidence intervals for BMI and WC were estimated, and a receiver operating characteristics curve was generated.Results: Of the 240 pregnant women enrolled, 31 (13%) had GDM. Prepregnancy BMI (OR = 4.21), gestational BMI (OR = 3.17) and WC at 20–24 weeks (OR = 4.02) correlated with GDM risk. At 20–24 weeks, a WC of 85.5–88.5 cm was the optimal cutoff point for predicting GDM (Sens/Spec balance between 87.1/41.1% and 77.4/56.9%).Conclusion: At 20–24 weeks of gestation, WC values in the range of 86–88 cm showed to be a good performance in predicting GDM.

An investigation into utilising gestational body mass index as a screening tool for adverse birth outcomes and maternal morbidities in a group of pregnant women in Khayelitsha

Objective: The aim of this study was to investigate the ability of the gestational body mass index (BMI) method to screen for adverse birth outcomes and maternal morbidities.Design: This was a substudy of a randomised controlled trial, the Philani Mentor Mothers’ study.Setting and subjects: The Philani Mentor Mothers’ study took place in a peri-urban settlement, Khayelitsha, between 2009 and 2010. Pregnant women living in the area in 2009-2010 were recruited for the study.Outcome measures: Maternal anthropometry (height and weight) and gestational weeks were obtained at baseline to calculate the gestational BMI, which is maternal BMI adjusted for gestational age. Participants were classified into four gestational BMI categories: underweight, normal, overweight and obese. Birth outcomes and maternal morbidities were obtained from clinic cards after the births.Results: Pregnant women were recruited into the study (n = 1 058). Significant differences were found between the different gestational BMI categories and the following birth outcomes: maternal (p-value = 0.019) infant hospital stay (p-value = 0.03), infants staying for over 24 hours in hospital (p-value = 0.001), delivery mode (p-value = 0.001), birthweight (p-value = 0.006), birth length (p-value = 0.007), birth head circumference (p-value = 0.007) and pregnancy-induced hypertension (p-value = 0.001).Conclusion: To the best of our knowledge, this is the first study that has used the gestational BMI method in a peri-urban South African pregnant population. Based on the findings that this method is able to identify unfavourable birth outcomes, it is recommended that it is implemented as a pilot study in selected rural, peri-urban and urban primary health clinics, and that its ease and effectiveness as a screening tool is evaluated. Appropriate medical and nutritional advice can then be given to pregnant women to improve both their own and their infants’ birth-related outcomes and maternal morbidities.

The regulation of apoptosis in intrauterine growth restriction: a study of Bcl-2 and Bax gene expression in human placenta

Objective: In this study, we assessed Bcl-2 and Bax gene expression patterns in human placental samples from intrauterine growth restriction (IUGR) pregnancies using normal pregnancy as control.Methods: We compared Bcl-2 and Bax gene expression in placental samples from all IUGR pregnancies treated in our clinic between 1 January 2010–1 January 2011 vs. 140 normal pregnancy samples from the same study period. We also assessed clinical parameters such as maternal age, gestational weight gain, gestational body mass index (BMI) change, and maternal birth weight.Results: In IUGR, the Bcl-2 gene was underexpressed compared to normal pregnancy. There was no difference in the Bax gene activity in the two groups. The degree of growth restriction within the IUGR group did not correlate with Bcl-2 or Bax gene activity.Conclusions: Our study revealed that it is the reduced inhibitory activity of the Bcl-2 gene rather than an enhanced stimulatory activity of the Bax gene in the background of the increased apoptosis observed in IUGR. IUGR appears to be more common with maternal age around 20 years and above 35 years. Gestational weight gain and gestational BMI change also predict the risk for IUGR.

New insight into onset of lactation: mediating the negative effect of multiple perinatal biopsychosocial stress on breastfeeding duration.

Many perinatal stressors, including high prepregnancy body mass index, preterm birth, and cesarean section, increase the risk for short breastfeeding duration. Few studies, however, have investigated the mechanism in the relationship between perinatal determinants and breastfeeding duration. This study aimed to test the hypothesis that delayed onset of lactation (OL) could mediate the negative effect of perinatal biopsychosocial stress on breastfeeding duration and to evaluate the impact of new perinatal factors with potentially hazardous effects. Maternal demographic characteristics, health status, and psychological stress during pregnancy were assessed by structured questionnaires and medical records. The information of lactation was collected in the hospital within 1-3 days after delivery. Data on breastfeeding behaviors were obtained through the telephone interview at 2 months after delivery. The risk of delayed OL increased in women who had experienced severe life event stress in the first trimester of pregnancy (adjusted risk ratio [RR] 2.59, 95% confidence interval [CI] 1.52, 4.40), had undergone cesarean section (adjusted RR 2.11, 95% CI 1.46, 3.05), whose gestational body mass index gain were not less than 7.62 (adjusted RR 1.90, 95% CI 1.27, 2.86), and whose breastfeeding frequency was less than three times in the first day after childbirth (adjusted RR 2.14, 95% CI 1.57, 2.91). The final model of structural equation modeling indicated that women with cesarean section, preterm birth, greater gestational body mass index gain, higher scores of stressful life events in the first trimester, and less breastfeeding frequency in the first day after delivery were more likely to experience delayed OL, which could result in an earlier breastfeeding termination. Delayed OL, as a negative biological event resulted from the perinatal biopsychosocial stress, is a key mediator linking perinatal factors to breastfeeding duration. More attention should to be paid to underweight before pregnancy and severe life events during pregnancy, which are regarded as novel and remarkable risk factors of delayed OL and short breastfeeding duration.

Risk Factors for Eclampsia: A Population-based Study in Washington State, 1987–2007: Coghill AE, Hansen S, Littman AJ. Am J Obstet Gynecol 2011;205:553.e1–7.

Eclampsia is defined as generalized seizure with or without coma (in the absence of other neurologic conditions) with the concomitant onset of hypertension and proteinuria at>20 weeks gestation. Estimates of the incidence for eclampsia vary widely from 1 in 100 to 1 in 4000. The authors of this study evaluated all women with singleton births in Washington State from 1987–2007 through the state's Birth Events Reporting System in an effort to update the previous characterizations of risk factors for eclampsia, taking into account shifts in population demographics (specifically, increased obesity) and to evaluate a more heterogeneous population than prior studies. There were 781 women discharged with a diagnosis of eclampsia during this time period. They were matched with 3124 controls randomly selected from those discharged without a diagnosis of eclampsia. Multivariable logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI). Nearly 50% of cases and controls were missing data for key variables such as body mass index (BMI) and level of education. As such, multiple imputation procedures were performed to address missing data. Results were provided as ORs, first without multiple imputation data, then with these data. Risk of eclampsia was greater in nulliparous, compared to parous, women (OR 3.04, 95% CI 2.20–4.19; OR 3.06, 95% CI 2.43–3.87). Being a young mother and an older mother were each associated with elevated risk (age<20 years: OR 1.87, 95% CI 1.29–2.71; OR 2.08, 95% CI 1.61–2.69; age>35 years: OR 1.69, 95% CI 1.13–2.53; OR 1.45, 95% CI 1.07–1.96). Longer birth interval (> 5 years: OR 1.92, 95% CI 1.09–3.37; OR 1.63, 95% CI 1.08–2.46), low socioeconomic status (OR 1.18, 95% CI 0.88–1.59; OR 1.23, 95% CI 1.00–1.49), gestational diabetes (OR 1.79, 95% CI 1.06–3.02; OR 1.72, 95% CI 1.13–2.63), pre-pregnancy obesity (BMI > 30: OR 1.73, 95% CI 1.26–2.37; 1.41, 95% CI 1.09–1.83), and weight gain during pregnancy above or below recommended guidelines (< 25 lb: OR 1.47, 95% CI 1.04–2.07; OR 1.23, 95% CI 0.95–1.61;>35 lb: 1.68, 95% CI 1.23–2.30; OR 1.39, 95% CI 1.09–1.78) were positively associated with eclampsia. Multiparity and smoking were negatively associated with risk. This study confirmed previously known risk factors (maternal age and parity) for eclampsia and identified new risk factors such as presence of gestational diabetes and BMI>30.

An Investigation into the Influence of Socioeconomic Variables on Gestational Body Mass Index in Pregnant Women Living in a Peri-Urban Settlement, South Africa

Maternal and child mortality rates are still unacceptably high in South Africa. The health status of women in peri-urban areas has been influenced by political and socio-economic factors. Examining socio-economic variables (SEV) in a population aids in the explanation of the impact of social structures on an individual. Risk factors can then be established and pregnant women in these higher risk groups can be identified and given additional support during pregnancy. The aim of this study was to investigate the association between SEV and gestational Body Mass Index (GBMI) in a peri-urban settlement, South Africa. This was a sub-study of the Philani Mentor Mothers' Study (2009-2010). Maternal anthropometry and SEV were obtained from 1,145 participants. Multinomial regression was used to analyse the data. Household income was the only SEV that was significantly associated with GBMI. The odds of being underweight rather than normal weight during pregnancy increase by a factor of 2.145 (P<0.05) for those who had a household income lower than R2000 per month. All other SEV were not significant. Logistic regression was therefore not carried out. Women who had a lower income were at risk of having a lower GBMI during pregnancy. This can lead to adverse birth outcomes such as premature birth, low birth weight, height and head circumference. Public health policy needs to be developed to include optimal nutrition health promotion strategies targeting women with a low income ante and post-natally. Once implemented, they need to be evaluated to assess the impact on maternal and child mortality.

Body mass index and obstetric outcomes in Saudi Arabia: a prospective cohort study

BACKGROUND AND OBJECTIVES:We examined the effect of body mass index in early pregnancy on pregnancy outcome since no study in Saudi Arabia has addressed this question.METHODS:This prospective cohort study involved women registered for antenatal care during the first month of pregnancy at primary health care centers in Al-Hassa, Saudi Arabia. Data was collected from records and by direct interview.RESULTS:The study included 787 women. Compared to normal weight women (n=307), overweight (n=187) and obese (n=226) women were at increased risk for pregnancy-induced hypertension (RR=4.9 [95% CI 1.6-11.1] and 6.1 [95% CI 2.1-17.8], respectively), gestational diabetes (RR=4.4 [95% CI 1.2-16.3] and 8.6 [95% CI 2.6-28.8]), preeclamptic toxemia (RR=3.8 [95% CI 1.1-14.6] and 5.9 [95% CI 1.7-20.4]), urinary tract infections (RR=1.4 [95% CI 0.5-3.9] and 3.7 [95% CI 1.7-6.2]), and cesarean delivery (RR=2.0 [95% CI 1.3-3.0] in obese women). Neonates born to obese women had an increased risk for postdate pregnancy (RR=3.7 [95% CI 1.2-11.6]), macrosomia (RR=6.8 [95% CI 1.5-30.7]), low 1-minute Apgar score (RR=1.9 [95% CI 1.1-3.6]), and admission to neonatal care units (RR=2.1 [95% CI 1.2-2.7]). On the other hand, low birth weight was less frequent among obese women (RR=0.5 [95% CI 0.3-0.9]) while the risk was high among underweight women (RR=2.3 [95% CI 1.4-3.8])CONCLUSION:Even with adequate prenatal care, overweight and obesity can adversely affect pregnancy outcomes.

Wound length and corticosteroid administration as risk factors for surgical‐site complications following cesarean section

To evaluate the effect of some specific gestational factors and other known variables associated with poor wound healing in women who delivered by cesarean section. Observational, prospective study. University Hospital of Messina. A total of 212 consecutive pregnant women at term delivering by elective cesarean section. All data regarding demographic and gestational characteristics were collected at admission. The subcutaneous tissue depth was intra-operatively measured from the fascia to the skin surface, while the incision length was measured after skin closure. Onset of wound complications such as infection, seroma, hematoma, abscess or dehiscence > 1 cm. Body mass index (BMI) at term [odd ratio (OR) 1.2, 95%CI 1.03-1.38; p = 0.01], wound length (OR 1.03, 95%CI 1.01-1.05; p < 0.001) and corticosteroid administration (OR 3.4, 95%CI 1.5-7.9; p = 0.004) were found to be correlated with wound complications. The receiver operating characteristics curve analysis suggested a cut-off of 31.1 for the BMI at term and 166 mm for the wound length with an OR of 2.28 (95%CI 1.18-4.39; p = 0.013) and 4.3 (95%CI 2.2-8.6; p < 0.001), respectively. The multivariate logistic regression model, applied to these variables and to corticosteroid administration, showed an independent correlation (at term BMI > 31.1: OR 2.04, 1.01-4.13, p = 0.047; wound length > 166 mm: OR 4.89, 2.36-10.14, p < 0.001; corticosteroid administration: OR 3.11, 1.38-6.95, p = 0.006). To avoid wound complications obstetricians should be careful in the administration of steroids before surgery, in the skin incision length that should be kept as short as possible and in carefully observing gestational BMI.

Association of Plasma Leptin Levels With Maternal Body Weight and Body Mass Index in Premature and Term Newborns

Leptin plays an important role in the regulation of body weight and energy metabolism in adults; its role in neonates also needs to be explored. The current study aims to determine the correlation between serum leptin concentrations and anthropometric variables in newborns and their mothers, and to examine the effects of sex, gestational age and antenatal steroid use on neonatal leptin levels. This was a retrospective study. Blood samples were collected from 55 newborns within 24 hours of birth. Plasma leptin levels were measured by immunometric assay. The relationship between neonatal leptin levels and anthropometric parameters was determined using Pearson's correlation and further evaluated by linear regression analysis. Neonatal leptin was significantly correlated with maternal body weight (p < 0.002) and maternal body mass index (BMI) (p < 0.001). However, it was not correlated with gestational age (p = 0.130), birth weight (p = 0.097), or birth BMI (p = 0.336). The leptin levels in premature newborns (gestational age < 37 weeks; 0.69 +/- 1.82ng/mL) were significantly less than those in term newborns (gestational age > or = 37 weeks; 2.09 +/- 2.30 ng/mL, p = 0.031). There were no significant differences between sexes (p = 0.277) or in relation to antenatal steroid use (p = 0.611). Neonatal serum leptin concentrations within 24 hours of birth correlated with maternal body weight and BMI, especially in premature newborns. Premature newborns had significantly lower leptin levels than full-term newborns.

Gestational age and risk factors for cardiovascular disease: evidence from the 1958 British birth cohort followed to mid-life

Increases in pre-term births and improved survival rates have led to interest in the association between gestational age and health in adulthood. Associations between gestational age and risk factors for cardiovascular disease have not been fully investigated. Using data from the 1958 British birth cohort (7847 singletons), the associations between gestational age and blood pressure, glycosylated haemoglobin (HbA1c), lipid levels and body mass index (BMI) at age 44-45 years were examined. After adjustment for sex, birthweight standardized for gestational age and sex and current BMI there was a reduction in systolic blood pressure of 0.53 mmHg (95% CI: 0.32, 0.75) for every 1 week increase in gestational age. There was a non-linear association between gestational age and diastolic blood pressure, with those cohort members born at earlier gestational ages found to have higher diastolic blood pressure than those born at term. These associations remained after adjustments. A 'U'-shaped association was found between gestational age and BMI among women (P = 0.02 for sex x gestational age interaction) which attenuated after adjustment. There was also a weak inverse association between gestational age and total cholesterol specific to women (P = 0.01 for sex x gestational age interaction). No clear associations were found between gestational age and BMI or total cholesterol in men, or between gestational age and HbA1c or other lipid levels in either sex. In the 1958 British birth cohort duration of gestation was associated with blood pressure in mid-life. Understanding this association is necessary to inform policy and preventative interventions.

Adiponectin multimers in maternal plasma

Objective. Adiponectin is an anti-diabetic, anti-atherogenic, anti-inflammatory, and angiogenic adipokine that circulates in oligomeric complexes including: low molecular weight (LMW) trimers, medium molecular weight (MMW) hexamers, and high molecular weight (HMW) isoforms. The aim of this study was to determine whether there are changes in adiponectin multimers in pregnancy and as a function of maternal weight.Study design. In this cross-sectional study, plasma concentrations of total, HMW, MMW, and LMW adiponectin were determined in women included in three groups: (1) normal pregnant women of normal body mass index (BMI) (n = 466), (2) overweight pregnant women (BMI ≥25; n = 257), and (3) non-pregnant women of normal weight (n = 40). Blood samples were collected once from each woman between 11 and 42 weeks of gestation. Plasma adiponectin multimer concentrations were determined by enzyme-linked immunosorbent assay (ELISA). Non-parametric statistics were used for analysis.Results. (1) The median HMW adiponectin concentration and the median HMW/total adiponectin ratio were significantly higher, and the median LMW adiponectin concentration was significantly lower in pregnant women than in non-pregnant women. (2) Among pregnant women, the median plasma concentration of total, HMW, and MMW adiponectin was significantly higher in normal weight women than in overweight patients. (3) Maternal HMW was the most prevalent adiponectin multimer regardless of gestational age or BMI status. (4) There were no significant differences in the median concentration of total, MMW, and LMW adiponectin and their relative distribution with advancing gestation.Conclusion. Human pregnancy is characterized by quantitative and qualitative changes in adiponectin multimers, especially the most active isoform, HMW adiponectin.

Serial transvaginal sonographic measurement of cervical dimensions after 20 weeks of gestation in South Indian women

This study was conducted with objective to assess serial changes of cervical dimensions during pregnancy from mid second trimester till delivery by transvaginal sonography. It comprises 50 healthy pregnant women who underwent serial transvaginal ultrasound every four week from 20th week of gestation till delivery. Cervical length and width were measured. The gestational age at delivery was recorded. Cervical changes were analysed using student – t test with three classifying factors; gestational age ( 23). Percentile charts were established for cervical length and width from 20th week of pregnancy till delivery. The associations between cervical dimensions and gestational age, parity and body mass index were calculated by multiple linear regression analysis. Cervical length decreased gradually from 4.05 cm from 20th week to 3.25 cm at term. The equivalent values were 2.98 cm and 3.86 cm for cervical width measurement showing opposite trend. The rate of cervical length reduction was significantly higher in preterm delivery group compared to term delivery group (0.65 mm vs. 0.37 mm per week of gestation, p 23; however this was statistically significant only in the beginning (at 20th and 24th week of gestation). Cervical length decreases gradually through out the gestation where as cervical width increases and these changes are not affected by parity. The knowledge of pattern of change in cervical length may help in early detection of preterm labour. Keywords : cervical length, cervical width, preterm delivery, transvaginal ultrasound. Internet Journal of Medical Update Vol. 2 (1) 2007: pp. 8-16

Ethnicity Modifies the Effect of Obesity on Insulin Resistance in Pregnancy: A Comparison of Asian, South Asian, and Caucasian Women

Women of Asian and South Asian descent are at increased risk of developing gestational diabetes mellitus compared with Caucasians, despite lower body mass index (BMI). Nevertheless, there has been limited study of insulin action during pregnancy in these ethnic groups. The objective of the study was to compare insulin sensitivity in pregnancy in Asian, South Asian, and Caucasian subjects and to determine whether the impact of obesity on insulin action is modified by ethnicity. A cross-sectional study was performed in outpatients undergoing oral glucose tolerance testing in late pregnancy. Participants were stratified into three groups: 1) Caucasian (n = 116); 2) South Asian (n = 31); and 3) Asian (n = 28). Insulin sensitivity was measured using the oral glucose tolerance test (IS(OGTT)) index of M. Matsuda and R. DeFronzo, previously validated in pregnancy. There were no significant ethnic differences in insulin sensitivity despite variation in prepregnancy BMI (Caucasians, 25.2 kg/m(2); South Asians, 23.3 kg/m(2); Asians, 21.4 kg/m(2); overall P = 0.0001). On multiple linear regression analysis, the strongest independent determinants of IS(OGTT) were gestational diabetes mellitus (t = -5.71; P < 0.0001) and BMI (t = -5.43; P < 0.0001). Importantly, both Asian (t = -2.87; P = 0.0047) and South Asian (t = -2.46; P = 0.015) ethnicity also emerged as negative, independent determinants of IS(OGTT). Furthermore, Asian ethnicity significantly modified the association of prepregnancy BMI with IS(OGTT) (interaction term, t = -2.29; P = 0.0231). Asian and South Asian ethnicity are both independently associated with increased insulin resistance in late pregnancy. Prepregnancy BMI has a much greater effect on insulin resistance in pregnancy in Asian women than in Caucasians. Ethnicity thus emerges as a factor that modulates the effect of obesity on insulin resistance in pregnancy.