Maternal Weight Gain Research Articles

Early Life Microbiota Colonization at Six Months of Age: A Transitional Time Point.

BackgroundEarly life gut microbiota is involved in several biological processes, particularly metabolism, immunity, and cognitive neurodevelopment. Perturbation in the infant’s gut microbiota increases the risk for diseases in early and later life, highlighting the importance of understanding the connections between perinatal factors with early life microbial composition. The present research paper is aimed at exploring the prenatal and postnatal factors influencing the infant gut microbiota composition at six months of age.MethodsGut microbiota of infants enrolled in the longitudinal, prospective, observational study “A.MA.MI” (Alimentazione MAmma e bambino nei primi MIlle giorni) was analyzed. We collected and analyzed 61 fecal samples at baseline (meconium, T0); at six months of age (T2), we collected and analyzed 53 fecal samples. Samples were grouped based on maternal and gestational weight factors, type of delivery, type of feeding, time of weaning, and presence/absence of older siblings. Alpha and beta diversities were evaluated to describe microbiota composition. Multivariate analyses were performed to understand the impact of the aforementioned factors on the infant’s microbiota composition at six months of age.ResultsDifferent clustering hypotheses have been tested to evaluate the impact of known metadata factors on the infant microbiota. Neither maternal body mass index nor gestational weight gain was able to determine significant differences in infant microbiota composition six months of age. Concerning the type of feeding, we observed a low alpha diversity in exclusive breastfed infants; conversely, non-exclusively breastfed infants reported an overgrowth of Ruminococcaceae and Flavonifractor. Furthermore, we did not find any statistically significant difference resulting from an early introduction of solid foods (before 4 months of age). Lastly, our sample showed a higher abundance of clostridial patterns in firstborn babies when compared to infants with older siblings in the family.ConclusionOur findings showed that, at this stage of life, there is not a single factor able to affect in a distinct way the infants’ gut microbiota development. Rather, there seems to be a complex multifactorial interaction between maternal and neonatal factors determining a unique microbial niche in the gastrointestinal tract.

HUBUNGAN PENGETAHUAN IBU TENTANG ALAT KONTRASEPSI KB SUNTIK DENGAN TERJADINYA PENAMBAHAN BERAT BADAN IDEAL IBU DI DI POLINDES PONJANAN

One attempt to tackle the population problem is to follow the family planning program intended to help couples and individuals in reproductive health, prevent unwanted pregnancies and reduce the incidence of high-risk pregnancy, illness and death, making service quality, affordable, acceptable and easily available to everyone in need, improve the quality of advice, communication, education, counseling and services improve health. This study aims is to analyze the mother's knowledge about contraception KB syringe with the ideal maternal weight gain in the working area of ​​the health center Polindes Ponjanan Batumarmar Pamekasan.
 This study is the type used is the Analytic Correlation is a research study to find the facts and the correct interpretation of test results processed with statistical sampling using probability sampling methods with the type of simple random sampling as many as 69 people. As a variable in this study is the mother of knowledge about birth control injections with the addition of ideal body weight. Data is collected using a questionnaire, then the data analyzed in the frequency table for each variable, followed by using Spearman correlation test. Based on the results of a study of 69 mothers data showed that most mothers who have poor knowledge about contraception as much as 46,38% KB injection, while those experiencing weight gain as much as 69,57%.
 From these results we can conclude that there is a relationship between maternal knowledge about contraception KB syringe with weight gain in the working area of ​​the village health center Ponjanan Batumarmar Pamekasan 2012. The correlation of test results analisia Spearmans probability values ​​obtained 0.00 <0.05 where Ho is rejected and Ha accepted .. Of the value of the correlation coefficient of -0.677, which means a strong influence in a negative correlation.
 From these results we can conclude that that means there is a relationship of maternal knowledge tengant KB injectable contraceptives with the addition of ideal body weight. This is because most of the respondents had primary school education level and employment are owned by the housewife. Efforts to do is to education about the benefits and usefulness of contraceptives as well as the negative impact that can be caused by the use of a syringe contraception KB.

A prediction model for childhood obesity in New Zealand

Several early childhood obesity prediction models have been developed, but none for New Zealand's diverse population. We aimed to develop and validate a model for predicting obesity in 4–5-year-old New Zealand children, using parental and infant data from the Growing Up in New Zealand (GUiNZ) cohort. Obesity was defined as body mass index (BMI) for age and sex ≥ 95th percentile. Data on GUiNZ children were used for derivation (n = 1731) and internal validation (n = 713). External validation was performed using data from the Prevention of Overweight in Infancy Study (POI, n = 383) and Pacific Islands Families Study (PIF, n = 135) cohorts. The final model included: birth weight, maternal smoking during pregnancy, maternal pre-pregnancy BMI, paternal BMI, and infant weight gain. Discrimination accuracy was adequate [AUROC = 0.74 (0.71–0.77)], remained so when validated internally [AUROC = 0.73 (0.68–0.78)] and externally on PIF [AUROC = 0.74 [0.66–0.82)] and POI [AUROC = 0.80 (0.71–0.90)]. Positive predictive values were variable but low across the risk threshold range (GUiNZ derivation 19–54%; GUiNZ validation 19–48%; and POI 8–24%), although more consistent in the PIF cohort (52–61%), all indicating high rates of false positives. Although this early childhood obesity prediction model could inform early obesity prevention, high rates of false positives might create unwarranted anxiety for families.

Prepregnancy BMI, gestational weight gain and risk of childhood atopic dermatitis: A systematic review and meta-analysis.

Maternal weight before and during pregnancy influences the health of offspring. Several observational studies have investigated a link between the risk of childhood atopic dermatitis (AD) and prepregnancy maternal body mass index (BMI) and gestational weight gain (GWG), but the conclusions of these studies were inconsistent. The aim of this review was to evaluate the association between the risk of childhood AD and prepregnancy maternal BMI and GWG. The PubMed, Embase, Cochrane, Web of Science, and Scopus databases were searched from inception to February 2, 2021. Observational studies investigating the association between the risk of childhood AD and prepregnancy maternal BMI and GWG were included. Fixed- or random-effects models with inverse variance weights were used to calculate pooled risk estimates. Subgroup analysis and sensitivity analysis were used to explore the sources of heterogeneity. Thirteen studies with a total of 114485 participants were included. Ten studies reported prepregnancy maternal BMI, and five reported GWG. Maternal underweight was associated with a higher risk of childhood AD (odds ratio [OR]=1.06; 95% confidence interval [CI], 1.02-1.10). Continuous BMI was not related to childhood AD (OR=1.00; 95% CI, 0.98-1.02). In comparison with normal GWG, moderate/very high GWG increased the risk of childhood AD (OR=1.05; 95% CI, 1.02-1.08; OR=1.13; 95% CI, 1.07-1.19, respectively), while low GWG decreased the risk (OR=0.92; 95% CI, 0.89-0.96). Excessive GWG relative to recommendations was associated with a higher risk of childhood AD (OR=1.05; 95% CI, 1.01-1.10), while a lower risk of childhood AD was associated with inadequate GWG relative to recommendations (OR=0.87, 95% CI: 0.83-0.91). Maternal underweight, high GWG, and excessive GWG relative to recommendations are associated with an elevated risk of childhood AD, while low GWG and inadequate GWG relative to recommendations decreased the risk. Weight management before and during pregnancy is encouraged for primary prevention of childhood AD.

Maternal Vitamin and Mineral Supplementation and Rate of Maternal Weight Gain Affects Placental Expression of Energy Metabolism and Transport-Related Genes

Maternal nutrients are essential for proper fetal and placental development and function. However, the effects of vitamin and mineral supplementation under two rates of maternal weight gain on placental genome-wide gene expression have not been investigated so far. Furthermore, biological processes and pathways in the placenta that act in response to early maternal nutrition are yet to be elucidated. Herein, we examined the impact of maternal vitamin and mineral supplementation (from pre-breeding to day 83 post-breeding) and two rates of gain during the first 83 days of pregnancy on the gene expression of placental caruncles (CAR; maternal placenta) and cotyledons (COT; fetal placenta) of crossbred Angus beef heifers. We identified 267 unique differentially expressed genes (DEG). Among the DEGs from CAR, we identified ACAT2, SREBF2, and HMGCCS1 that underlie the cholesterol biosynthesis pathway. Furthermore, the transcription factors PAX2 and PAX8 were over-represented in biological processes related to kidney organogenesis. The DEGs from COT included SLC2A1, SLC2A3, SLC27A4, and INSIG1. Our over-representation analysis retrieved biological processes related to nutrient transport and ion homeostasis, whereas the pathways included insulin secretion, PPAR signaling, and biosynthesis of amino acids. Vitamin and mineral supplementation and rate of gain were associated with changes in gene expression, biological processes, and KEGG pathways in beef cattle placental tissues.

Excess pregnancy weight gain in latinas: Impact on infant's adiposity and growth hormones at birth.

Excess maternal weight gain during pregnancy has been associated with childhood overweight and obesity both in mothers with and without obesity. Latinx children are at higher risk for earlier obesity compared with other population groups. A cohort of 82 self-identified pregnant Latina women were recruited at the prenatal clinics of Zuckerberg San Francisco General Hospital (ZSFG) prior to delivery during the second and third trimesters of pregnancy in 2011 and 2012. Maternal pre-pregnancy weight and weight prior to delivery were collected by self-report to calculate maternal pre-pregnancy body mass index (BMI) and weight gain in pregnancy. At delivery, anthropometric measurements of infants were obtained and cord blood and maternal finger stick blood samples were collected for hormonal assays. Fifty-three point seven percent of women had excessive weight gain in pregnancy. A high percentage of the cohort was overweight and obese prior to pregnancy (67.1%) with mean pre-pregnancy BMI 27.4±4.5kg/m2 and greater pre-pregnancy weight was independently associated with weight gain during pregnancy (OR 1.05, 95%CI 1.002-1.09). Mean infant birthweight was 3377.2±481.5g and excessive weight gain in pregnancy was independently associated with birthweight percentile (OR 13.46, 95%CI 2.43-34.50). Excessive gestational gain was positively associated with cord blood insulin-like growth factor-1 (IGF-1) and negatively with Peptide YY (PYY) levels. Latina women with pre-pregnancy overweight and obesity have a high rate of excessive gestational gain in pregnancy and could benefit from early counseling about appropriate gain in pregnancy. Excessive gestational weight impacts the intrauterine environment in high-risk infants impacting fetal growth and development.

Pregnancy weight gain in twin gestations and maternal and child health outcomes at 5 years.

Objective:Current guidelines for maternal weight gain in twin pregnancy were established in the absence of evidence on its longer-term consequences for maternal and child health. We evaluated the association between weight gain in twin pregnancies and the risk of excess maternal postpartum weight increase, childhood obesity, and child cognitive ability.Methods:We used 5-year follow-up data from 1000 twins born to 450 mothers in the Early Childhood Longitudinal Study – Birth Cohort, a nationally representative U.S. cohort of births in 2001. Pregnancy weight gain was standardized into gestational age- and prepregnancy body mass index (BMI)-specific z-scores. Excess postpartum weight increase was defined as ≥10 kg increase from prepregnancy weight. We defined child overweight/obesity as BMI ≥ 85th percentile, and low reading and math achievement as scores one standard deviation below the mean. We used survey-weighted multivariable modified Poisson models with a log link to relate gestational weight gain z-score with each outcome.Results:Excess postpartum weight increase occurred in 40% of mothers. Approximately 28% of twins were affected by overweight/obesity, and 16% and 14% had low reading and low math scores. There was a positive linear relationship between pregnancy weight gain and both excess postpartum weight increase and childhood overweight/obesity. Compared with a gestational weight gain z-score 0 SD (equivalent to 20 kg at 37 weeks gestation), a weight gain z-score of +1 SD (27 kg) was associated with 6.3 (0.71, 12) cases of excess weight increase per 1000 women and 4.5 (0.81, 8.2) excess cases of child overweight/obesity per 100 twins. Gestational weight gain was not related to kindergarten academic readiness.Conclusions:The high prevalence of excess postpartum weight increase and childhood overweight/obesity within the recommended ranges of gestational weight gain for twin pregnancies suggests that these guidelines could be inadvertently contributing to longer-term maternal and child obesity.

Fetal Growth Acceleration-Current Approach to the Big Baby Issue.

Background and Objectives: Fetal overgrowth is related to many perinatal complications, including stillbirth, cesarean section, maternal and neonatal injuries, and shoulder dystocia. It is related to maternal diabetes, obesity, and gestational weight gain but also happens in low-risk pregnancies. There is ongoing discussion regarding definitions, methods of detection, and classification. The method used for detection is crucial as it draws a line between those at risk and low-risk popula-tions. Materials and Methods: For this narrative review, relevant evidence was identified through PubMed search with one of the general terms (macrosomia, large-for-gestational-age) combined with the outcome of interest. Results: This review summarizes evidence on the relation of fetal overgrowth with stillbirth, cesarean sections, shoulder dystocia, anal sphincter injury, and hem-orrhage. Customized growth charts help to detect mothers and fetuses at risk of those complica-tions. Relations between fetal overgrowth and diabetes, maternal weight, and gestational weight gain were investigated. Conclusions: a substantial proportion of complications are an effect of the fetus growing above its potential and should be recognized as a new dangerous condition of Fetal Growth Acceleration.

Efficacy of Metformin on Pregnancy Outcome in Healthy Overweight Pregnant Women; A Double-Blinded Parallel Randomized Clinical Trial

Background Maternal obesity increases the risk of pregnancy complications such as preeclampsia, postpartum hemorrhage, weight gain and the need for cesarean section. We compared the role of metformin on pregnancy outcome in overweight mothers. Materials and Methods: This double-blinded parallel randomized clinical trial was carried out on 360 pregnant women at 12-16 gestational weeks who referred to the gynecology clinic of Motahari hospital, Urmia, Iran, during 2019 to 2020. The intervention group received 1000 mg of metformin orally every day up to the end of pregnancy. Demographic and clinical characteristics of patients such as age, gravidity, parity, preterm infant weight, live birth, abortion, previous delivery method, maternal weight, body mass index, birth weight, delivery method, blood sugar at birth, gestational age at birth, neonatal hypoglycemia, infant mortality and anomalies were also recorded. Finally, the pregnancy outcomes (gravidity, parity, abortion and weight) were compared between the two groups. Results: Of 180 patients, 169 patients remained in the intervention group and 171 patients remained in the control group based on the eligibility criteria. In the control group, 13 patients (7.6%), and in the intervention group, five patients (2.9%) had preeclampsia and high blood pressure during pregnancy (P= 0.053). In the control group, the mean maternal weight gain during pregnancy was 10.22 ± 3.3 kg and in the intervention group was 7.6 ± 2.3 kg (P 0.05). Conclusion The administration of 1000 mg metformin daily has been shown to be effective in preventing overweight in pregnancy, but has not affected the birth weight. Metformin did not have any side effects on pregnancy outcomes.

Utility of modified mid-pregnancy body mass index in predicting obstetric outcomes in Middle Eastern population

Objective: To test the value of mid-pregnancy maternal body mass index (BMI) and weight gain in the second half of pregnancy in predicting pregnancy outcomes among Middle Eastern population where pre-gravid BMI was not available. Methods: Retrospective analysis of the obstetric outcomes of 290 women with singleton pregnancies who were categorized into underweight (UW), normal weight (NW), overweight (OW) and obese (OB) according to the BMI at 24-28 weeks of gestation and compared with recommended pre-gravid values by Institute of Medicine (2009). Results: The results showed that the gestational diabetes rate was significantly lower among the UW (2.4%) compared with the NW (8.8%, p<0.05), the OW (14.3%, p=0.006), and OB (20.5%, 0.001). The risk of having macrosomia was eight times higher among OW compared with NW women. The C-section rate was lowest among the UW group but there was no significant difference in terms C-section and low birth weight between groups. The obstetric outcomes among women whose weight gain was above the 90th and below the tenth centiles were not different. Conclusion: The prediction of obstetric outcomes by mid-pregnancy BMI is comparable to pre-gravid BMI. The results are encouraging, and further larger studies are needed to confirm the applicability

Prenatal methadone exposure impairs adolescent cognition and GABAergic neurodevelopment in a novel rat model of maternal methadone treatment

Methadone maintenance treatment (MMT) is the most common treatment for opioid-dependent pregnant women worldwide. Despite its widespread use, MMT is associated with a variety of adverse neurodevelopmental outcomes in exposed offspring, particularly cognitive impairments. The neurobiological abnormalities underlying these cognitive impairments are, however, poorly understood. This is, in part, due to a lack of animal models that represents the standard of care that methadone is administered in the clinic, with inconsistencies in the timing, doses and durations of treatment. Here we describe the characterisation of a clinically relevant rat model of MMT in which the long-term behavioural and neurobiological effects of prenatal methadone exposure can be assessed in adolescent offspring. Female Sprague-Dawley rats were treated orally with an ascending methadone dosage schedule (5, 10, 15, 20, 25 and 30 mg/kg/day), self-administered in drinking water prior to conception, throughout gestation and lactation. Pregnancy success, maternal gestational weight gain, litter survival and size were not significantly altered in methadone-exposed animals. Methadone-exposed offspring body and brain weights were significantly lower at birth. Novel object recognition tests performed at adolescence revealed methadone-exposed offspring had impaired recognition memory. Furthermore, the rewarded T-maze alternation task demonstrated that methadone-exposed female, but not male, offspring also exhibit working memory and learning deficits. Immunoblots of the adolescent prefrontal cortex and hippocampus showed methadone-exposed offspring displayed reduced levels of mature BDNF, in addition to the GABAergic proteins, GAD67 and parvalbumin, in a sex- and brain region-specific fashion. This rat model closely emulates the clinical scenario in which methadone is administered to opioid-dependent pregnant woman and provides evidence MMT can cause cognitive impairments in adolescent offspring that may be underlined by perturbed neurodevelopment of the GABAergic system.

Dexamethasone-induced intrauterine growth restriction modulates expression of placental vascular growth factors and fetal and placental growth.

Prenatal exposure to glucocorticoids (GC) is a central topic of interest in medicine since GCs are essential for the maturation of fetal organs and intrauterine growth. Synthetic glucocorticoids, which are used in obstetric practice, exert beneficial effects on the fetus, but have also been reported to lead to intrauterine growth retardation (IUGR). In this study, a model of growth restriction in mice was established through maternal administration of dexamethasone during late gestation. We hypothesised that GC overexposure may adversely affect placental angiogenesis and fetal and placental growth. Female BALB/c mice were randomly assigned to control or dexamethasone treatment, either left to give birth or euthanised on days 15, 16, 17 and 18 of gestation followed by collection of maternal and fetal tissue. The IUGR rate increased to 100% in the dexamethasone group (8 mg/kg body weight on gestational days 14 and 15) and pups had clinical features of symmetrical IUGR at birth. Dexamethasone administration significantly decreased maternal body weight gain and serum corticosterone levels. Moreover, prenatal dexamethasone treatment not only induced fetal growth retardation but also decreased placental weight. In IUGR placentas, VEGFA protein levels and mRNA expression of VEGF receptors were reduced and NOS activity was lower. Maternal dexamethasone administration also reduced placental expression of the GC receptor, αGR. We demonstrated that maternal dexamethasone administration causes fetal and placental growth restriction. Furthermore, we propose that the growth retardation induced by prenatal GC overexposure may be caused, at least partially, by an altered placental angiogenic profile.

581 Achieving maternal weight gain recommendations and its impact on cervical length shortening in twin gestations

To determine if underachievement of recommended maternal weight gain in twin gestations is associated with a shortened mid-trimester transvaginal cervical length (TVCL). Retrospective cohort study of twin gestations receiving TVCL surveillance between 2003 and 2010. Each woman was categorized as having achieved vs underachieved recommended maternal weight gain at delivery using institutional BMI and gestational age- specific weight gain guidelines for women carrying twins. TVCL measurements were routinely obtained between 18-24 weeks’ gestation and the shortest of three measurements acquired were compared between groups. Poisson regression was used to calculate adjusted relative risks (aRR) and 95% confidence interval (CI) of TVCL<15mm controlling for maternal race, cerclage, prior preterm birth, and pre-pregnancy BMI. 304 patients met inclusion criteria with 160 (52.6%) achieving and 144 (47.4) underachieving recommended weight gain guidelines during their study pregnancy. Women who underachieved had significantly shorter median TVCL (37 vs 40mm; p=.003; Figure 1). There were higher rates of TVCL <30mm (26.4% vs 17.5%; p=.061), <25mm (16.0% vs 11.3%; p=.229), and <20mm (11.8% vs 6.3%; p=.09), but these did not reach statistical significance in either the adjusted or unadjusted analysis. However, underachieving weight gain remained significantly associated with a shortened TVCL <15mm (9% vs 2.5%; aRR 3.2, CI 1.2-8.6) after adjusting for confounders. Underachievement of recommended maternal weight gain was also significantly associated with preterm birth <34 weeks’ gestation (58.7% vs 33.3%; p<0.001). Inadequate maternal weight gain in twin gestations independently contributes to a shortened mid-trimester cervical length which is strongly associated with prematurity. The mechanism is currently unknown; however, poor maternal nutrition may be a modifiable risk factor influencing pathologic premature cervical change.

901 Maternal weight gain and readmission rates amongst women with hypertensive disorders of pregnancy

Mobilization of extracellular fluid postpartum has been implicated in hypertensive crisis leading to postpartum hypertensive readmission amongst women with hypertensive disorders of pregnancy (HDP). We sought to determine how weight gain during pregnancy which reflects increased extracellular fluid differed between women who were readmitted versus those who were not amongst women with HDP. This was a retrospective case-control study of all women admitted with HDP (identified by ICD10 codes) between Jan. 1st, 2016 - Dec. 31st, 2019. Subjects were divided into those who were readmitted due to hypertension complications versus those who were not. The primary exposure was maternal weight gain during pregnancy. Bivariate analyses of baseline characteristics by exposure were conducted. Logistic regression modeling was used to adjust for confounders. Of the 2,131 subjects, 62 (2.90%) were readmitted due to hypertension complications. Women who were readmitted verses those who were not differed in terms of age, race, and incidence of A2GDM, preterm delivery, and specific types of hypertensive disorders of pregnancies (Table 1). Average weight gain during pregnancy differed between those who were readmitted versus those who were not (24.7 lbs. ±29.1 v. 32.8 lbs. ±24.7, p<0.05) (Table 1). However, when adjusting for age, race, and frequency of preterm delivery, the difference in weight gain was no longer significant (OR 0.99, 95% CI: 0.99-1.00, p=0.10) (Table 2). In this cohort of women with HDP, maternal weight gain during pregnancy was not related to risk of readmission due to hypertension complications once other maternal characteristics and diseases severity was controlled for.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

339 Patient characteristics and pregnancy outcomes post-bariatric surgery in a large integrated health care system

To describe demographic and clinical characteristics and pregnancy outcomes of women with pregnancy post-bariatric surgery within a large integrated care system. Retrospective cohort study of women with pregnancy post-bariatric surgery in Kaiser Permanente Northern California from January 2012 to December 2018. Pregnancies post-bariatric surgery were identified via ICD codes in the electronic health record. Demographic, surgical, nutritional, reproductive characteristics and outcomes were also abstracted. Among a subset of pregnancies with information available, we described the type and timing of surgery with respect to perinatal outcomes. We identified a cohort of 1,627 post-bariatric surgery pregnancies among 1,392 women. The cohort had an average age of 34 and BMI of 34, were most likely to be parous (64%), and were racially and ethnically diverse (49% White, 32% Hispanic/Latina, 10% Black, 4% Asian). Hypertensive conditions were present in 22.6% of patients, 42.1% of patients had impaired gestational diabetes, impaired glucose tolerance, or overt diabetes, 11% had a preterm birth < 37 weeks, and 39% had a cesarean delivery. Among women with nutritional data available, deficiencies were common at pregnancy start (48.3% deficient in ferritin, 26.4% in hemoglobin, 42.9% in Vitamin B12, 13.4% in Vitamin D, 49.4% in Vitamin A). Among the 710 patients with data available, we observed significant trends in maternal weight gain by timing from surgery to pregnancy and in abnormal glucose tolerance or diabetes by type of surgery (Table 1). Pregnancy outcomes in this largest single cohort of pregnancies post-bariatric surgery include high rates of nutritional deficiency at pregnancy start, plus variation in some outcomes by surgery type and time from surgery to pregnancy. This data can be used to improve individualized counseling and management.

Short maternal stature and gestational weight gain among refugee and migrant women birthing appropriate for gestational age term newborns: a retrospective cohort on the Myanmar-Thailand border, 2004–2016

IntroductionTo examine the interactions between short maternal stature, body mass index (BMI) and gestational weight gain (GWG) among appropriate for gestational age (AGA) term newborns in a population of refugees...

283 The surprising impact of maternal weight on the success of external cephalic version

Maternal obesity is considered an impediment for a successful external cephalic version (ECV). We aimed to evaluate the impact of maternal pre-pregnancy body mass index (BMI) and weight gain during pregnancy (WG) on the success rate of ECV. Retrospective analysis of the United States (US) Natality Live Birth database from the Centers for Disease Control and Prevention (2016-2018). The data were analyzed for singleton term births following an ECV attempt with a birth weight between 2500 and 5000 grams. Women were divided into several groups based on their BMI and WG. The success rates of ECV were compared among the different BMI and WG categories using the Pearson chi-square test with the Bonferroni adjustment for multiple comparisons. A logistic regression was used to calculate the independent contribution of maternal BMI and WG to the success of ECV, after controlling for maternal race/ethnicity, parity and neonatal birth weight. Results were displayed as odds ratios with 95% confidence intervals, and statistical significance was determined as a p-value below 0.05. Of the 11,150,527 live births in 2016 to 2018, 26,255 women who underwent an ECV attempt met the inclusion criteria. The overall ECV success rate was 52.75% (13,850 women). The success rates of ECV for the different BMI and WG categories ranged from 47.43% to 55.18% (Table 1). Although the overall differences in the success rates were small, a logistic regression model demonstrates that the odds for a successful ECV consistently decline with increasing BMI and with increasing WG (Table 2). We document a significant association between increases in both maternal BMI and WG and lower success rates of ECV. Nevertheless, given the small magnitude of these differences, with the exception of Extreme Obesity, these statistically significant differences are not clinically significant. Clinicians should therefore not rely heavily on maternal weight when considering an ECV attempt.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

402 Impact of chemotherapy during pregnancy on neonatal birthweight

This retrospective cohort study was designed to evaluate fetal growth, assessed by prenatal ultrasound and neonatal birthweight, in pregnant women receiving chemotherapy. Patients, registered by the International Network of Cancer, Infertility and Pregnancy (INCIP), treated with chemotherapy with at least two ultrasounds reported between 24 and 34 weeks of gestation were selected. Based on predefined ultrasound criteria (Delphi consensus, 2016) and birthweights, pregnancies were allocated to the following groups 1) FGR (fetal growth restriction) 2) low risk small for gestational age (SGA) (birthweight below the 10th centile, but normal ultrasound) 3) presumably FGR that did not meet all FGR criteria 4) non-FGR. Obstetric and oncological characteristics were compared between the FGR and the non-FGR group. Multivariable regression models were used to investigate the effect of the duration of chemotherapy on birthweight percentiles (reference chart Nicolaides, 2018). In total, 201 women, diagnosed with cancer between 2000 and 2020, were included. Breast cancer was most common (132, 66%) and most frequently administered regimens were anthracyclines (121, 60%), anthracyclines and taxanes (40, 19%) and platinum (35, 17%). The median birthweight percentile was 30 (range 1-100). In total, 75 pregnancies (37%) showed fetal growth abnormalities, including 43 FGR neonates (21%), additionally 10 (5%) SGA neonates and 22 neonates (8.5%) were presumably FGR. Initiation of chemotherapy prior to 20 weeks of gestation (p=0.026) and low maternal gestational weight gain (p=0.046) were risk factors for FGR, however no specific chemotherapy regimens or cancer types contributed independently. Multivariable regression revealed that the duration of chemotherapy was negatively related to birthweight percentiles (-1.064; 95%CI 2.064;-0.063; p=0.037). FGR is common in chemotherapy-exposed fetuses and the duration of chemotherapy exposure negatively impacts birthweight percentiles. Serial growth scans are recommended in this high risk population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

784 Evaluation of hyaluronic acid as a possible biomarker in rat models of preeclampsia

Endothelial injury and hypertension are principal features of preeclampsia (PE), suggesting that plasma endothelial glycocalyx fragments are potential biomarkers. We aimed to: 1) compare the newer ‘selective reduced uterine perfusion pressure’ (sRUPP) model and the traditional RUPP model in their ability to simulate PE; and 2) determine whether plasma hyaluronic acid (HA), a major endothelial glycocalyx component, differs in the two models as compared to sham rats. Thirty-two timed-pregnant Sprague-Dawley rats underwent sham surgery (n=9), sRUPP procedure (n=10), or RUPP procedure (n=13) on gestational day 14. On day 18, each rat underwent carotid artery cannulation, and conscious mean arterial pressure (MAP; PowerLab, ADInstruments, CO) was measured on day 19, followed by plasma and tissue collection. Pup survival rate was calculated based on the number of pups on day 19 vs. day 14. Plasma HA on day 19 was quantified by Quantikine ELISA (R&D Systems, MN). Statistical significance was determined by one-way ANOVA or Kruskal-Wallis test, with post-hoc analyses as appropriate. Both the sRUPP and RUPP rats had significant yet comparable pup resorption (p<0.001) and blunted maternal weight gain (p<0.001) vs. sham rats, suggesting underlying placental ischemia. The RUPP rats showed significantly higher MAP than sham rats (p<0.01); this increase was approximately twice as large as that of the sRUPP rats. There was a trend towards increased plasma HA concentration in the RUPP animals, though it did not differ significantly across all three groups. Our preliminary data suggest that the rat RUPP model is superior to the sRUPP model in modeling blood pressure changes of PE; the latter may represent a milder disease phenotype. Plasma HA may not be a reliable marker in either model. Given the current evidence for endothelial glycocalyx damage occurring in human PE, future studies will investigate the role of other endothelial glycocalyx markers.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Intake of milk and dairy products significantly contributes to maternal adequate weight gain in pregnant women after 28 weeks gestation

Intake of milk and dairy products significantly contributes to maternal adequate weight gain in pregnant women after 28 weeks gestation