Low Weight Women Research Articles

Anorexia nervosa and adrenal hormones: a systematic review and meta-analysis.

Anorexia nervosa is a primary psychiatric disorder characterized by self-induced negative energy balance. A number of hormonal responses and adaptations occur in response to starvation and low body weight including changes in adrenocortical hormones. Our objective was to systematically review adrenocortical hormone levels in anorexia nervosa. We searched MEDLINE and EMBASE for studies that reported at least one adrenocortical hormone, including dehydroepiandrosterone (DHEA), DHEA-sulphate (DHEA-S), progesterone, 17-hydroxyprogesterone, pregnenolone, cortisol (serum, urine, cerebrospinal fluid, and hair sample), aldosterone, androstenedione, and testosterone in patients with anorexia nervosa and normal-weight healthy controls from inception until October 2021. Means and standard deviations for each hormone were extracted from the studies to calculate a mean difference (MD). A pooled MD was then calculated by combining MDs of each study using the random-effects model. We included a total of 101 studies with over 2500 females with anorexia nervosa. Mean cortisol levels were significantly higher in anorexia nervosa as compared to normal-weight controls for multiple forms of measurement, including morning cortisol, 12-hour and 24-hour pooled serum cortisol, 24-hour urine cortisol, and after an overnight dexamethasone suppression test. In contrast, mean serum total testosterone and DHEA-S levels were significantly lower among patients with anorexia nervosa. Women with anorexia nervosa have higher cortisol levels and lower DHEA-S and testosterone levels compared to women without anorexia nervosa. This finding is important to consider when evaluating low-weight women for disorders involving the adrenal axis, especially Cushing's syndrome.

Effect of pre-pregnancy body mass index on first-trimester pregnant women glucose and lipid metabolism

To examine the association of pre-pregnancy body mass index(BMI) and first-trimester glucose and lipid metabolism. A total of 298 pregnant women with high risk factors for gestational diabetes in early pregnancy, with an average age of 32.24 years, 66.11% were primiparous and the average time for blood collection was 12.5 weeks, were collected from August 2021 to April 2022 at the Department of Nutrition, Haidian District Maternal and Child Health Hospital, Beijing. Pregnant women were divided into low weight group(n=15), normal weight group(n=181), overweight/obese group(n=102) according to their pre-pregnancy BMI. Fasting glucose, fasting insulin, lipid quadruple, C-reactive protein, leptin and adiponectin levels were compared among groups. (1)Triglyceride concentrations were significantly higher in women in the overweight/obese group(1.51 mmol/L vs.1.15 mmol/L) than in women in low weight group(P<0.01). HDL cholesterol(HDL-C) levels were lower than in women with low weight(1.64 mmol/L vs.1.95 mmol/L)(P<0.01). (2)Pre-pregnancy low weight women had reduced pancreatic β-cell function in early pregnancy with the HOMA-β index of 60.41%, and women in the overweight/obese group had heavier fasting insulin levels(7.86 vs.3.42 μU/mL) and insulin resistance(1.75 vs 0.74) in early pregnancy than low weight women(P<0.01). (3)Pre-pregnancy BMI was positively correlated with triglycerides, fasting insulin, C-reactive protein levels, and degree of insulin resistance in early pregnancy(r=0.30, 0.28, 0.45 and 0.45, P<0.01)and negatively correlated with HDL-C levels in early pregnancy(r=-0.29, P<0.01). Among pregnant women with risk factors for gestational diabetes, pre-pregnancy overweight and obesity are associated with glucose and lipid metabolism levels in early pregnancy.

ODP431 Adiposity in menstrual dysfunction and the role of laboratory testing in diagnosis

Abstract Adiposity significantly contributes to reproductive function. Whereas lower body weight is strongly associated with increased risk of functional hypothalamic amenorrhea (FHA), the relationship between BMI and the timing of menopause is poorly understood. Recent studies of self-reported data suggest women with BMI<18.5kg/mg 2 have a significantly higher risk of menopause before age 45 years. However, without confirmatory testing, there is the possibility of misdiagnosis of menopause given the prevalence of FHA in low-weight women. Although FHA and menopause are clinically identical, laboratory evaluation could potentially aid in differentiating the two entities, as menopause is characterized by high gonadotropin levels, whereas FHA is characterized by low-normal gonadotropin levels. Given the increased morbidity and mortality associated with early age of menopause, this distinction is clinically important. We sought to identify age of menopause in low-weight women using clinically available data at a large, academic health system. We hypothesized that women with a BMI<18.5kg/m 2 would have a lower age of menopause but that confirmatory diagnostic testing to differentiate menopause from FHA would be infrequently performed. The study was conducted by retrospective chart review of the electronic medical records of 3,000 women >50 years of age and BMI<18.5kg/m 2 . After exclusion of individuals with no date of menopause, BMI>18.5 kg/m 2 at the menopausal transition and history of known cause of early menopause, 239 charts were included in the analysis. Participants had a median BMI of 17.7kg/m 2 at the final menstrual period (FMP). Median age at the FMP in all low weight women with BMI<18.5kg/m 2 was 51 years. There was a positive correlation between age of the FMP and BMI (rho=0.13, p=0. 04). When stratified by BMI, age of the FMP decreased with decreasing BMI. For women with a BMI of 18-18.49kg/m 2, FMP occurred at a median age of 51 years; for women with a BMI of 16-17.99 kg/m 2, FMP occurred at a median age of 50 years; and for women with BMI<16kg/m 2, FMP occurred at a median age of 48 years. Only 30 women (12.6%) included in the study had an FSH level measured after diagnosis of menopause and eight of these women (26.67%) had an FSH<18 (range: 0.7-14.7 IU/mL), which is lower than expected for menopause. Therefore, these data, obtained from clinical data rather than self-report, provide further evidence that low-BMI is associated with lower age of menopause. Although current societal guidelines do not recommend diagnostic evaluation of menopause in women older than 45 years, our data suggest that there is a risk of misclassifying FHA as menopause in low-weight women if diagnostic evaluation is not performed. Further studies are necessary to determine the role and clinical benefit of diagnostic confirmation of menopause in low-weight women with amenorrhea. Presentation: No date and time listed

PSUN175 Impact of Maternal Low Weight on Pregnancy and Neonatal Outcomes

Abstract Underweight body mass index (BMI) is defined as a BMI <18.5 kg/m2 and a subset of low-weight women also meet DSM-5 criteria for a diagnosis of anorexia nervosa. Although anorexia nervosa is often associated with functional hypothalamic amenorrhea and resultant infertility, when women with anorexia nervosa do conceive, there is an increased risk of obstetrical and delivery complications, and poor neonatal outcomes, such as preterm birth, low birth weight, and smaller size for gestational age (SGA). Few studies have investigated such outcomes in women who are low weight, with or without a diagnosis of anorexia nervosa. The aim of the study was toexamine associations between underweight maternal BMI and pregnancy complications and neonatal outcomes in mothers and infants at a large academic medical center. There was a total of 16,780 mothers who delivered a singleton between 2015-2021 with either a BMI <18.5 kg/m2 (n=732) or who were normal-weight (18.5 kg/m2 < BMI <25 kg/m2, n=16,048) at their initial prenatal visit or within six months of that visit. We compared neonatal outcomes and pregnancy/delivery complications in the low-weight versus normal-weight mother-infant pairs. Neonatal outcomes included birthweight, gestational age, NICU stay, preterm birth, and fetal death; pregnancy and delivery complications included pre-eclampsia/eclampsia, premature rupture of membranes (PROM), and post-partum hemorrhage. Median BMI in underweight women was 17.8 [interquartile range: 17.2, 18.1] kg/m2 compared with 22.2 [20.7, 23.6] kg/m2 in normal-weight women. Underweight women were younger (27 [22, 31] years) and less likely to be married or have private insurance (p-value <0.0001 for all). Approximately 22% of the low-weight mothers were African American compared with 13.4% of normal-weight mothers (overall p-value for race/ethnicity <0.0001). Additionally, approximately 22% of infants born to low-weight mothers were SGA and 15% with low birthweight compared with 13.6% and 9% of infants born to normal-weight mothers, respectively (p-value <0.0001 for both SGA and low birthweight). These differences remained significant after adjusting for maternal age, race/ethnicity, marital and insurance status, and maternal depression; after adjusting for these potential confounders, infants born to low-weight mothers had increased risk for SGA (OR=1.23, 95% CI: 1.11-1.36) and low birthweight (OR=1.18, 95% CI: 1.04-1.33) compared with their normal-weight counterparts. In adjusted models, underweight women had decreased risk of PROM (OR=0.85, 95% CI: 0.74-0.98) and post-partum hemorrhage (OR=0.72, 95% CI: 0.54-0.96) compared to normal-weight women. No differences were noted for pre-eclampsia/eclampsia, NICU stay, preterm birth, and fetal death. In summary, underweight BMI during pregnancy is associated with an increased risk of infants who are SGA and low birthweight and a decreased risk for delivery complications including PROM and post-partum hemorrhage. These differences suggest underweight BMI during pregnancy increases the risk for adverse neonatal outcomes, while maternal-related pregnancy outcomes are less affected. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Obstetric dimensions of the female pelvis are less integrated than locomotor dimensions and show protective scaling patterns: Implications for the obstetrical dilemma.

The "obstetrical dilemma" hypothesis assumes that the modern human female pelvis serves two discrete functions: obstetrics and locomotion. We investigate whether these differing functions create observable patterns of morphological covariation and whether those patterns differ by height, weight, and age. This allows evaluation of evidence for canalization and phenotypic plasticity relevant to obstetric and locomotor function among a living female population. Landmarks (N = 86) were collected and inter-landmark distances were calculated (N = 36) on the pelvis and proximal femur of CT scans of living women aged 20 to 90 years (M = 93) receiving a routine CT scan. Partial least squares and relative SD of eigenvalues analyses were used to evaluate integration overall and within locomotor and obstetric modules, respectively. Ordinary Least Squared regression was used to evaluate scaling relationships between inter-landmark distances and height, weight, and age. The obstetric pelvis was significantly less internally integrated than the locomotor pelvis. Many obstetric measurements were constrained in absolute terms relative to height; shorter women had relatively larger birth canal dimensions, and several key obstetric dimensions showed relative freedom from height. Lower weight women had some relatively larger obstetric and locomotor dimensions. Regarding age, younger women showed a few relatively larger outlet dimensions. This study suggests that the obstetric pelvis and the locomotor pelvis function are morphologically distinct, with the obstetric pelvis showing relatively greater flexibility. These relationships between relative constraints support the hypothesis that the modern female pelvis shows evidence of both canalization and phenotypic plasticity in obstetric and locomotor structures.

Исходы беременности у женщин с низкой массой тела

Исходы беременности у женщин с низкой массой тела

The association between gestational weight gain and risk of stillbirth: a population-based cohort study

PurposeTo estimate the risk of stillbirth associated with excessive and inadequate weight gain during pregnancy. MethodsRetrospective cohort study using the Texas vital records database between 2006 and 2011, with 2,230,310 births (5502 stillbirths) was included for analysis. Pregnancies were categorized as adequate weight gain, excessive weight gain, inadequate weight gain, or weight loss based on the Institute of Medicine 2009 recommendations. Hazard ratios (HRs) for stillbirth were estimated for each gestational weight-gain stratum using adequate weight gain as the comparison group. The analysis was performed separately for each body mass index (BMI) class. ResultsBoth inadequate weight gain and weight loss were associated with an increased risk of stillbirth for all BMI classes except the morbidly obese group. Highest risk was seen in weight-loss groups after 36 completed weeks (normal weight: HR = 18.85 [8.25–43.09]; overweight: HR = 5.87 [2.99–11.55]; obese: HR = 3.44 [2.34–5.05]). Weight loss was associated with reduced stillbirth risk in morbidly obese women between 24 and 28 weeks (HR = 0.56 [0.34–0.95]). Excess weight gain was associated with an increased risk of stillbirth among obese and morbidly obese women, with highest risk after 36 completed weeks (obese: HR = 2.00 [1.55–2.58]; morbidly obese: HR = 3.16 [2.17–4.62]). In contrast, excess weight gain was associated with reduced risk of stillbirth in normal-weight women between 24 and 28 weeks (HR = 0.57 [0.44–0.70]) and in overweight women between 29 and 33 weeks (HR = 0.62 [0.45–0.85]). Analysis for the underweight group was limited by sample size. Both excessive weight gain and inadequate weight gain were not associated with stillbirth in this group. ConclusionsStillbirth risk increased with inadequate weight gain and weight loss in all BMI classes except the morbidly obese group, where weight demonstrated a protective effect. Conversely, excessive weight gain was associated with higher risk of stillbirth among obese and morbidly obese women but was protective against stillbirth in lower weight women.

505: Does maternal BMI impact the rate of preterm birth in women receiving 17-OH progesterone?

birth in women receiving 17-OH progesterone? Kelly Ruhstaller, Matthew Hoffman, Anthony Sciscione, Nicole Doyle Christiana Care Health System, Obstetrics and Gynecology, Newark, DE OBJECTIVE: To evaluate whether maternal body mass index (BMI) impacts the rate of preterm birth in women receiving 17-OH progesterone caproate (17-OHPC) for a history of preterm delivery. STUDY DESIGN: All patients from the High Risk Clinic who delivered between March 2009 to July 2012 and received 17-OHPC were selected (n 144). Patients were excluded if they did not have a prior preterm birth, had a multifetal gestation, did not receive 17-OHPC prior to 20 weeks, had fetal anomalies or were delivered prior to 37 weeks for an indication other than preterm premature rupture of membranes (n 91). Women who also received a cerclage were included. The primary outcome was spontaneous delivery prior to 37 0/7 weeks. Secondary outcomes were delivery prior to 34 0/7 weeks, delivery prior to 28 0/7 weeks and composite neonatal morbidity (NICU admission, 5-minute APGAR 7 and birthweight 2500g). Women were divided into two groups, BMI 30 (kg/m) and 30 (kg/m). Odds ratios were calculated using BMI 30 as the referent group. RESULTS: In total 35 patients had a BMI 30 and 56 patients had BMI 30 (range 19.5-55.8). Women with a BMI 30 were significantly less likely to deliver prior to 37 0/7 weeks (OR 0.315, 95%CI 0.1280.722) and prior to 34 0/7 weeks (OR 0.282, 95%CI 0.102-0.778) when compared to women with a BMI 30. No significant difference in the rate of delivery prior to 28 0/7 weeks was seen (OR 1.046, 95%CI 0.234-4.68). There was a trend towards lower neonatal morbidity for infants born to women with a BMI 30, however this did not reach significance (OR 0.432, 95%CI 0.182-1.027). CONCLUSION: Obese women receiving 17-OHPC for a history of preterm birth have lower rates of repeat preterm delivery, except very early preterm births ( 28 weeks), compared to their normal weight and overweight counterparts. Additionally, the infants born to obese mothers have a lower overall neonatal morbidity. These findings may lead to further research into the mechanism behind the increased rate of preterm birth in lower weight women.

Associação entre o estado nutricional pré-gestacional e a predição do risco de intercorrências gestacionais

OBJETIVO: analisar a associação entre o estado nutricional pré-gestacional materno e os desfechos maternos - síndromes hipertensivas da gravidez, diabetes gestacional, deficiência de vitamina A e anemia - e do concepto - baixo peso ao nascer. MÉTODOS: estudo transversal, com 433 puérperas adultas (>20 anos), atendidas na Maternidade Escola da Universidade Federal do Rio de Janeiro (UFRJ) e seus respectivos recém-nascidos. As informações foram coletadas em consulta a prontuários e entrevistas. O estado nutricional pré-gestacional materno foi definido por meio do índice de massa corporal pré-gestacional, segundo os pontos de corte para mulheres adultas da World Health Organization (WHO), em 1995. Estimou-se a associação entre os desfechos gestacionais e o estado nutricional pré-gestacional, por meio da odds ratio (OR) e intervalo de confiança (IC) de 95%. RESULTADOS: a freqüência de desvio ponderal pré-gestacional (baixo peso, sobrepeso e obesidade) foi de 31,6%. Considerando-se o estado nutricional pré-gestacional, aquelas com sobrepeso e obesidade apresentaram menor ganho ponderal do que as eutróficas e as com baixo peso (p<0,05). As mulheres com obesidade pré-gestacional apresentaram risco aumentado de desenvolver síndromes hipertensivas da gravidez (OR=6,3; IC95%=1,90-20,5) e aquelas com baixo peso pré-gestacional, maior chance de ter recém-nascidos com baixo peso ao nascer (OR=7,1; IC95%=1,9-27,5). Não foi evidenciada a associação entre estado nutricional pré-gestacional e o desenvolvimento de anemia, deficiência de vitamina A e diabetes gestacional. A média de ganho de peso entre as gestantes com sobrepeso e obesas foi significativamente menor, quando comparadas às eutróficas e às com baixo peso (p=0,002, p=0,049, p=0,002, p=0,009). CONCLUSÕES: a expressiva quantidade de mulheres com desvio ponderal pré-gestacional reforça a importância da orientação nutricional que favoreça o estado nutricional adequado e minimize os riscos de intercorrências maternas e do recém-nascido.

Preservation of neuroendocrine control of reproductive function despite severe undernutrition.

Anorexia nervosa (AN) is characterized by low weight and self-imposed caloric restriction and leads to severe bone loss. Although amenorrhea due to acquired GnRH deficiency is nearly universal in AN, a subset of patients maintains menses despite low weight. The mechanisms underlying continued GnRH secretion despite low weight in these patients and the impact of gonadal hormone secretion on bone mineral density (BMD) in such eumenorrheic, low-weight patients remain unknown. We hypothesized that 1) eumenorrheic women with AN would have higher body fat and levels of nutritionally dependent hormones, including leptin and IGF-I, than amenorrheic women with AN and comparable body mass index; and 2) BMD would be higher in these women. We also investigated whether the severity of eating disorder symptomatology differed between the groups. We studied 116 women: 1) 42 low-weight women who fulfilled all Diagnostic and Statistical Manual of Mental Disorders (fourth edition) diagnostic criteria for AN, except for amenorrhea; and 2) 74 women with AN and amenorrhea for at least 3 months. The two groups were similar in body mass index (17.1 +/- 0.2 vs. 16.8 +/- 0.2 kg/m(2)), percent ideal body weight (78.2 +/- 0.8% vs. 76.7 +/- 0.8%), duration of eating disorder (70 +/- 13 vs. 59 +/- 9 months), age of menarche (13.2 +/- 0.3 vs. 13.5 +/- 0.2 yr), and exercise (4.5 +/- 1.0 vs. 4.2 +/- 0.5 h/wk). As expected, eumenorrheic patients had a higher mean estradiol level (186.6 +/- 19.0 vs. 59.4 +/- 2.5 nmol/liter; P < 0.0001) than amenorrheic subjects. Mean percent body fat, total body fat mass, and truncal fat were higher in eumenorrheic than amenorrheic patients [20.9 +/- 0.9% vs. 16.7 +/- 0.6% (P = 0.0001); 9.8 +/- 0.5 vs. 7.8 +/- 0.3 kg (P = 0.0009); 3.4 +/- 0.2 vs. 2.7 +/- 0.1 kg (P = 0.006)]. The mean leptin level was higher in the eumenorrheic compared with the amenorrheic group (3.7 +/- 0.3 vs. 2.8 +/- 0.2 ng/ml; P = 0.04). Serum IGF-I levels were also higher in the eumenorrheic than in the amenorrheic group (41.8 +/- 3.7 vs. 30.8 +/- 2.3 nmol/liter; P = 0.02). There were only minor differences in severity of eating disorder symptomatology, as measured by the Eating Disorders Inventory, and where differences were observed, eumenorrheic subjects manifested more severe symptomatology than amenorrheic subjects. Mean BMD at the posterior-anterior and lateral spine were low in both groups, but were higher in patients with eumenorrhea than in those with amenorrhea [posterior-anterior spine T-score, -0.9 +/- 0.1 vs. -1.9 +/- 0.1 (P < 0.0001); lateral spine T-score, -1.2 +/- 0.1 vs. -2.3 +/- 0.2 (P < 0.0001)]. In contrast, preservation of menstrual function was not protective at the total hip (total hip T-score, -0.9 +/- 0.1 vs. -1.1 +/- 0.1; P = 0.27), trochanter, or femoral neck. In summary, patients with eumenorrhea had more body fat and higher serum leptin levels than their amenorrheic counterparts of similar weight. Moreover, reduced bone density was observed in both groups, but was less severe at the spine, but not the hip, in women with undernutrition and preserved menstrual function than in amenorrheic women of similar weight. Therefore, fat mass may be important for preservation of normal menstrual function in severely undernourished women, and this may be in part mediated through leptin secretion. In addition, nutritional intake and normal hormonal function may be independent contributors to maintenance of trabecular bone mass in low-weight women.

The effect of pregnancy weight gain on later obesity

To determine whether weight increases permanently as a result of pregnancy and to explore the determinants of postpartum weight retention.Articles from the literature on obesity, parity, and gestational and postpartum weight changes were identified through a literature search.Studies from the last decade that examined weight changes related to pregnancy or parity in developed countries were selected if they provided adequate information to allow useful comparisons to other studies.Average gestational and postpartum weight changes and their range of variation were noted. Studies emphasizing information related to weight change were used to identify alternative explanations for weight changes often credited to pregnancy. Explanations consistent with data from all of the different kinds of studies were developed by synthesis of the varied reports.Aging is a major determinant of weight increases associated with parity in cross-sectional studies. Average weight increments are generally less than 1.5 kg (3 lb) during a single reproductive cycle (before pregnancy to 1 year postpartum), but obese women tend to have larger weight changes (both increases and decreases) than lower-weight women. Under-reporting of pre-pregnancy weight, particularly by overweight women, probably contributes to overestimation of weight gain during pregnancy and estimated retained weight. A small number of women increase weight greatly during a reproductive cycle. The studies do not prove that this is the result of the pregnancy per se. Some women gain weight postpartum, suggesting that life-style factors can be significant determinants of weight gain during a reproductive cycle. Preventive efforts targeted to the postpartum visit could be useful.

Fractures and lifestyle: effect of cigarette smoking, alcohol intake, and relative weight on the risk of hip and forearm fractures in middle-aged women.

Cigarette smoking, alcohol consumption and low relative weight are often cited as risk factors for osteoporosis. In a prospective cohort study of 96,508 middle-aged nurses 35 to 59 years of age we found that smoking was not a risk factor for hip and forearm fracture. Women who drank more than 15 grams of alcohol per day and whose relative weight was less than 21 kg/m2 were at increased risk of fractures, but these risk factors were not independent. Only the combination of alcohol intake and thinness substantially increased the likelihood of fracture. The low weight women consuming more than one drink per day comprised but 4 per cent of our population of middle-class women and sustained 6 per cent of the fractures.

Subcutaneous fat accumulation during pregnancy in a malnourished population.

1. Total skinfold thicknesses (sum of seven sites) were measured in fifty-seven pregnant women with low energy and protein intake, at weeks 24, 30 and 35 of gestation. 2. Women were classified in two groups (overweight and low weight), according to their weight-for-height at week 24 of gestation. 3. Half of the women did not increase, or even reduced the amount of subcutaneous fat during the observation period. The lowest mean value of total skinfold thickness was found in the low-weight women who showed a reduction of the subcutaneous fat. 4. This finding shows that a significant proportion of malnourished women do not follow the average pattern of subcutaneous fat accumulation seen in healthy pregnant women without food intake restriction, during the second half of pregnancy.