Morbidly Obese Women Research Articles

Untargeted lipidomics analysis in women with morbid obesity and type 2 diabetes mellitus: A comprehensive study.

There is a phenotype of obese individuals termed metabolically healthy obese that present a reduced cardiometabolic risk. This phenotype offers a valuable model for investigating the mechanisms connecting obesity and metabolic alterations such as Type 2 Diabetes Mellitus (T2DM). Previously, in an untargeted metabolomics analysis in a cohort of morbidly obese women, we observed a different lipid metabolite pattern between metabolically healthy morbid obese individuals and those with associated T2DM. To validate these findings, we have performed a complementary study of lipidomics. In this study, we assessed a liquid chromatography coupled to a mass spectrometer untargeted lipidomic analysis on serum samples from 209 women, 73 normal-weight women (control group) and 136 morbid obese women. From those, 65 metabolically healthy morbid obese and 71 with associated T2DM. In this work, we find elevated levels of ceramides, sphingomyelins, diacyl and triacylglycerols, fatty acids, and phosphoethanolamines in morbid obese vs normal weight. Conversely, decreased levels of acylcarnitines, bile acids, lyso-phosphatidylcholines, phosphatidylcholines (PC), phosphatidylinositols, and phosphoethanolamine PE (O-38:4) were noted. Furthermore, comparing morbid obese women with T2DM vs metabolically healthy MO, a distinct lipid profile emerged, featuring increased levels of metabolites: deoxycholic acid, diacylglycerol DG (36:2), triacylglycerols, phosphatidylcholines, phosphoethanolamines, phosphatidylinositols, and lyso-phosphatidylinositol LPI (16:0). To conclude, analysing both comparatives, we observed decreased levels of deoxycholic acid, PC (34:3), and PE (O-38:4) in morbid obese women vs normal-weight. Conversely, we found elevated levels of these lipids in morbid obese women with T2DM vs metabolically healthy MO. These profiles of metabolites could be explored for the research as potential markers of metabolic risk of T2DM in morbid obese women.

Anti Mullerian hormone as a diagnostic tool for polycystic ovary syndrome in women of reproductive age with morbid obesity.

The aim of the study was to analyze the performance of the anti-mullerian hormone (AMH) level for the diagnosis of polycystic ovary syndrome in women with morbid obesity. A single-centre cross-sectional study was conducted in 50 women of reproductive age with a body mass index (BMI)≥40kg/m2. Each patient underwent a clinical examination, biological and hormonal assays, and an ovarian ultrasound between the third and the fifth day of the menstrual cycle. Polycystic ovary syndrome was diagnosed according to the Rotterdam's criteria. The mean age of participants was 34.2±7.5 years. Polycystic ovary syndrome was diagnosed in 20 women (40%). Age and anthropometric parameters did not differ between women with and without polycystic ovary syndrome. The mean AMH level was significantly higher in women with polycystic ovary syndrome (3.4±3.6 vs 1.3±1.2ng/ml, p=0.010). It was positively correlated with the Ferriman and Gallwey score (r=0.496, p=0.016), total testosterone level (r=0.524, p<10-3) andthe LH/FSH ratio (r=0.290, p=0.046). In women agedbetween 35 and 45 years, the optimum cut-off level for the diagnosis of polycystic ovary syndrome was 0.81ng/mL, providing a sensitivity and a specificity of 90and 71%, respectively with an area under the ROC curve of 0.857. AMH level was significantly higher in morbid obese women with polycystic ovary syndrome compared with those without polycystic ovary syndrome. Specific thresholds for this population must be assessed to improve the sensitivity and specificity of AMH for the diagnosis of polycystic ovary syndrome.

MATERNAL AND NEONATAL OUTCOMES OF CESAREAN SECTION IN OBESE AND MORBID OBESE TERM PREGNANT WOMEN

Objectives: To compare preoperatively, intraoperatively and postoperatively the maternal and ne-onatal outcomes of normal-weight, obese and morbid obese pregnant women who delivered by cesarean section in our clinic. Methods: This study retrospectively included 151 singleton pregnancies delivered at ≥37 weeks of gestation by cesarean section. Demographic, clinical and neonatal results of the patients were not-ed and compared between the groups. Results: Among the pregnant women included in this study, length of postoperative hospital stay and presence of chronic diseases were determined to be significantly higher in the morbid obese group compared with other groups (p&amp;lt;0.05). In the morbid obese group, the average infant birth weight and the number of infants monitored due to respiratory distress as a neonatal complication were determined to be significantly higher (p&amp;lt;0.05). The presence of pregnancy complications, particularly the presence of gestational diabetes mellitus and preeclampsia were found to be signif-icantly higher in the morbid obese group (p&amp;lt;0.05). Conclusions: We determined that the incidence of maternal and neonatal complications increases as the body mass index (BMI) increases. Therefore, it is evident that monitoring the BMI and pre-venting obesity would be effective in avoiding complications.

The Phenotype of the Adipocytes Derived from Subcutaneous and Visceral ADMSCs Is Altered When They Originate from Morbidly Obese Women: Is There a Memory Effect?

Adipose tissue is an abundant source of mesenchymal stem cells (ADMSCs). Evidence has suggested that depot-specific ADMSCs (obtained from subcutaneous or visceral adipose tissue–subADMSCs or visADMSCs, respectively) account for differential responses of each depot to metabolic challenges. However, little is known about the phenotype and changes in metabolism of the adipocytes derived from ADMSCs of obese individuals. Therefore, we investigated the phenotypic and metabolic characteristics, particularly the lipid profile, of fully differentiated adipocytes derived from ADMSCs of lean and obese (with/without metabolic syndrome) postmenopausal women. We observed a depot-specific pattern, with more pronounced changes present in the adipocytes obtained from subADMSCs. Namely, chronic oversupply of fatty acids (present in morbid obesity) triggered an increase in CD36/SR-B2 and FATP4 protein content (total and cell surface), which translated to an increased LCFA influx (3H-palmitate uptake). This was associated with the accumulation of TAG and DAG in these cells. Furthermore, we observed that the adipocytes of visADMSCs origin were larger and showed smaller granularity than their counterparts of subADMSCs descent. Although ADMSCs were cultured in vitro, in a fatty acids-deprived environment, obesity significantly influenced the functionality of the progenitor adipocytes, suggesting the existence of a memory effect.

Association of Skin Incision Type With Postoperative Cesarean Delivery Complications in Morbidly Obese Patients.

To assess whether Pfannenstiel skin incision compared with vertical skin incision was associated with postcesarean delivery wound complications in morbidly obese women. We assembled a retrospective cohort of patients with body mass index (BMI) of 40 or higher who delivered by cesarean between July 2012 and May 2019. The primary outcome was a composite wound morbidity (until 42 days postpartum) including wound separation, infection, and dehiscence. Secondary outcomes included individual composite components plus select maternal and neonatal outcomes. Comparisons of demographics and outcomes were made by χ2 and t test. Logistic regression was performed. Subgroup analysis was performed according to location of vertical skin incision in relation to the umbilicus. A total of 3,901 patients were included. To account for imbalances in demographics between exposure groups, vertical and Pfannenstiel skin incision patients were matched in a 1:4 fashion for age, BMI, smoking status, and diabetes. The frequency of wound morbidity was 13.2% overall. There was no difference in the primary outcome when comparing Pfannenstiel with vertical skin incision (adjusted odds ratio [aOR] 1.5, 95% CI 0.8-2.8). Patients with a vertical skin incision were more likely to undergo vertical hysterotomy (aOR 138.7, 95% CI 46.9-410) and transfusion (aOR 5.4, 95% CI 1.8-16.5). When vertical skin incision was classified into supraumbilical and infraumbilical, and compared with Pfannenstiel skin incision, infraumbilical vertical skin incision was associated with increased wound morbidity (odds ratio [OR] 2.46, 95% CI 1.4-4.5) and wound infection (OR 2.5, 95% CI 1.4-4.6) compared with Pfannenstiel. Both types of vertical skin incision were associated with increased odds of vertical hysterotomy and transfusion when compared with Pfannenstiel. In morbidly obese women who underwent cesarean delivery, the frequency of postoperative wound morbidity was similar after Pfannenstiel and vertical skin incisions.

Association of Foot Sole Sensibility with Quiet and Dynamic Body Balance in Morbidly Obese Women

An important health-related problem of obesity is reduced stance stability, leading to increased chance of falling. In the present experiment, we aimed to compare stability in quiet and in dynamic body balance between women with morbid obesity (n = 13, body mass index [BMI] &gt; 40 Kg/m2, mean age = 38.85 years) and with healthy body weight (lean) (n = 13; BMI &lt; 25 Kg/m2, mean age = 37.62 years), evaluating the extent to which quiet and dynamic balance stability are associated with plantar sensibility. Quiet stance was evaluated in different visual and support base conditions. The dynamic task consisted of rhythmic flexion—extension movements at the hip and shoulder, manipulating vision availability. The plantar sensibility threshold was measured through application of monofilaments on the feet soles. The results showed that the morbidly obese, in comparison with the lean women, had higher plantar sensibility thresholds, and a reduced balance stability in quiet standing. Mediolateral stance stability on the malleable surface was strongly correlated with plantar sensibility in the obese women. Analysis of dynamic balance showed no effect of obesity and weaker correlations with plantar sensibility. Our results suggest that reduced plantar sensibility in morbidly obese women may underlie their diminished stance stability, while dynamic balance control seems to be unaffected by their reduced plantar sensibility.

Abdominal wall skin lesions in adult morbid obese women

Objective: To present only skin lesions in the abdominal wall that we detected in morbidly obese patients and to examine them in the light of the literature.&#x0D; Material and Method: Patients who applied to the general surgery outpatient clinic for bariatric surgery and who also had dermatological complaints and were referred to the dermatology outpatient clinic with the detection of skin-related complaints were retrospectively evaluated in terms of age and breast skin findings. Normal skin findings were separated into intertrigo, chronic recurrent folliculitis, eczemas, acanthosis nigricans and striae. &#x0D; Results: A total of 60 obese female patients were included in the study. The mean age of the patients was 32.4 ± 8.8 years (19-53), and the mean body mass index was 42.6 ± 2.4 (40-49). Normal skin findings were present in 28.3% of the patients (17 patients). The most common finding was striae, and 60% (36 patients) had it. Then respectively, intertrigo was detected in 14 patients (23%), chronic recurrent folliculitis in 12 patients (20%), eczema in 5 patients (8.3%), and acanthosis nigricans in 2 patients (3.3%). &#x0D; Conclusion: The most common findings on the abdominal wall skin of obese individuals are striae and intertrigo, and similar findings have been found in many studies in the literature.

511 Choosing the optimal skin incision for cesarean delivery in patients with morbid obesity

Although there have been studies comparing Pfannenstiel incision (PI) with supraumbilical vertical skin incision (SVI) in obese women, the optimal skin incision for cesarean delivery (CD) in patients with class III obesity has not been determined. Our objective was to evaluate if PI vs SVI had any significant differences in maternal or neonatal outcomes in women with body mass index (BMI) ≥50 undergoing CD. We conducted a retrospective cohort study in pregnant women with BMI ≥50 undergoing CD at a single tertiary care center from 2016 to 2020. Electronic medical records and operative reports were used to collect study variables and identify the study groups: PI vs SVI. SVI incisions were performed on patients with hanging pannus (umbilicus at the level of the pubic bone) following evaluation by a multi-disciplinary team. Primary outcome was surgical blood loss. Secondary outcomes were hysterotomy type, surgical time, negative pressure wound therapy use, neonatal outcomes, and surgical complications. Mann-Whitney U test and chi-squared test were used to compare continuous and categorical data, respectively. During our study period, 70 women with BMI ≥50 were delivered by CD. Of those, 40 (57%) women had PI, and 30 (43%) women had SVI. Surgical blood loss was significantly lower in the PI group compared to the SVI group (832ml vs. 1000ml, p=0.024); however, there was no difference in postpartum hemorrhage rates. Patients with SVI were more likely to undergo classical hysterotomy and had significantly longer operating times (Table). There was no significant difference in either immediate or delayed post-operative complications (Table), nor in neonatal outcomes between the two groups. Although morbidly obese patients undergoing CD via SVI had significantly increased surgical blood loss, this difference was not clinically significant. In morbidly obese women with a hanging pannus, performing a SVI is safe in terms of immediate and delayed surgical complications when compared with PI, despite a longer surgical time and an increased rate of classical hysterotomy.

Gut Microbiota Modifications and Weight Regain in Morbidly Obese Women After Roux-en-Y Gastric Bypass.

The relationship between late post-bariatric surgery weight regain and gut microbiota is not completely understood. To analyze the profile of gut microbiota among patients with and without late weight regain after post-Roux-en-Y gastric bypass (RYGB) and to compare it with a control group (CG) comprised of obese Brazilian individuals. This is a cross-sectional study which enrolled 34 morbidly obese women divided into 3 groups: post-Roux-en-Y gastric bypass without (RYGB_non-regain), and with weight regain (RYGB_regain) at least 5years after surgery, and a CG of preoperative individuals. Gut microbiota was determined by metagenomic analyses. The alpha diversity was higher in groups RYGB non-regain and RYGB regain when compared with CG (p < 0.05). Both RYGB non-regain and RYGB regain groups showed a lower abundance of the phylum Bacteroidetes when compared with CG (p < 0.01). The genera Bacteroides and SMB53 were increased in CG (p < 0.05). Group RYGB non-regain showed more abundance of the Akkermansia genus when compared with CG and group RYGB regain (p < 0.05). RYGB non-regain showed a greater abundance of the Phascolarctobacterium genus and lower of the SMB53 genus when compared with CG (p < 0.05). RYGB non-regain showed a greater abundance of the Phascolarctobacterium genus and a lower of the SMB53 genus when compared with CG (p < 0.05). The gut microbiota of individuals which presented late weight regain after RYGB was significantly different in comparison to individuals with a successful weight loss, a finding that points towards a significant role of gut microbiota on weight loss and maintenance after surgery.

The Prevalence and Predictors of Non-alcoholic Fatty Liver Disease in Morbidly Obese Women - A Cross-sectional Study from Southern India.

The prevalence of obesity is increasing rapidly in India and so are its associated comorbidities. Non-alcoholic fatty liver disease (NAFLD), the hepatic manifestation of metabolic syndrome, is commonly associated with obesity. However, limited data are available on its prevalence and clinical indicators among morbidly obese Indian women. The aim of our study was to find the prevalence of NAFLD in morbidly obese Indian women and study the clinically measurable obesity indicators that would best predict NAFLD. This was a cross-sectional study, conducted in the Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore. Women were enrolled who were diagnosed to have NAFLD on sonography. Anthropometric variables, such as body mass index, waist circumference, hip circumference, waist-hip ratio and waist-height ratio were measured and compared between the two groups. SPSS Statistics 21.0 software was used for analysing the data. One hundred and six consecutive, morbidly obese women were recruited in this study. Nearly three-quarters (73.6%) of the 106 morbidly obese participants were found to have NAFLD. We found waist circumference, body mass index and waist-height ratio to be most useful in distinguishing between patients with and without NAFLD, and found waist-height ratio was the best screening tool for diagnosing NAFLD. NAFLD is present in a large proportion of morbidly obese women. Waist-height ratio could be used a surrogate screening tool to detect NAFLD in resource-constrained settings.

Audit of Obstetric Outcome in Morbidly Obese Women at Great Western Hospital NHS Foundation Trust UK

Obesity in pregnancy is a substantial public health problem with potentially dire consequences on pregnancy outcome for the mother and the neonate. Objective: To determine the prevalence and care of morbidly obese women (BMI > 40 kg/m2) in our obstetric population over one year against standards and criteria set by the Royal College of Obstetricians and Gynaecologists (RCOG) in the Green-top Guideline No. 72 “Care of women with Obesity in pregnancy”. Methods: This was a retrospective longitudinal cohort study conducted at the obstetrics department of Great Western Hospital NHS Foundation Trust UK. Data were collected from patients’ records on Medway Maternity software and hospital notes of women with BMI > 40 kg/m2 who delivered between 1st December 2017 and 31st December 2018. Data were analyzed using Epi info version 7.0. Results were presented in tables and charts. Results: During the period of the audit, there were a total of 4198 deliveries. The number of morbidly obese women was 145, giving a prevalence of 3.45%. Majority of the women (42) had no prepregnancy complications. Complications before pregnancy were previous miscarriages, polycystic ovarian syndrome, disc pro-lapse, diabetes, previous IUGR and hyperprolactinaemia. Antenatally, most patients had no complications. Gestational hypertension was the most common complication (9), followed by gestational diabetes (7), intrauterine growth restriction (1), placenta praevia (1), and severe preeclampsia (1). None of the patients had intrapartum complications in this study. Majority of the patients (46) had no postpartum complications, 11 had postpartum haemorrhage, 2 had postpartum hypertension, and one had wound infection and dehiscence. Compliance with care was 92.67%. Conclusion: This audit revealed that morbidly obese women in our obstetric population were at risk of some of the complications of obesity in pregnancy, labour, delivery and postpartum. The care for these women was within recommended standards with room for improvement.

Minimally Invasive Surgery in Morbidly Obese Women.

Minimally invasive gynecologic surgery provides a number of clinical advantages compared with open laparotomy. Over the past 25 years, important modifications and innovations have further expanded the utility of these techniques. Complications such as surgical site infection, venous thromboembolism, and wound cellulitis or dehiscence rise in concert with escalating obesity, so it stands to reason that these patients would derive the most benefit from minimally invasive surgery. Yet, surgical complexity also rises proportionally, requiring fastidious technique and allowing little margin for error. As nonsurgical interventions become more commonplace and the rate of morbid obesity continues to increase, those women actually requiring a gynecologic operation through an abdominal approach will be ever more likely to present a number of challenges to safe completion of minimally invasive surgery. This article frames the topic and offers some tips across the range of care to enhance the likelihood of achieving success in this patient population most in need of surgical expertise.

Effects of an arm cycloergometer session on morbid obese women (acute exercise effect on morbid obese women)

Introduction: The number of morbidly obese individuals has risen in percentages in comparison with different obesity levels and there are very few studies exploring the possibilities of physical exercise for such population. Objectives: Verify the possibility of morbid obese to perform a 30-minute session of mild to moderate continuous aerobic exercise, analyzing the Excess Post-exercise Oxygen Consumption (EPOC) 30 minutes after exercise in addition to the acute cardiovascular effects. Materials and methods: A clinical study was developed with 14 obese, morbidly sedentary pre-bariatric surgery women, aged between 28 and 51 years old. The patients took part in a clinical analysis, which consisted of body composition, maximal stress test and a 30 minutes-exercise session in an arm cycle ergometer, preceded by 3 minutes of warm up before any physical examination. A mild to moderate intensity was used at a reserve heart rate (HR) between 55 and 69% of maximal heart rate at moderate intensity. Energy exercise expenditure, EPOC, and the acute responses of the HR, blood pressure (BP) and oxygen saturation were checked and analyzed. Results: Out the 15 patients evaluated, 14 were able to complete the prescribed exercise session within an average expenditure of 131.5 kcal in the exercise and 37.2 in EPOC. The only patient who could not complete the task was due to pain in her shoulder. No patient demonstrated desaturation or abnormalities for HR and BP. Conclusions: These findings indicate that physical exercise in an arm cycle ergometer may be an alternative at improving health levels of morbidly obese patients, as it does not promote oxygen desaturation and shows expected standard responses for heart rate and blood pressure.

Second Trimester Maternal Leptin Levels Are Associated with Body Mass Index and Gestational Weight Gain but not Birth Weight of the Infant

Introduction: Obesity is increasing among the pregnant population. Leptin has an important role in the regulation of energy balance and hunger. The aim of this study was to investigate the association between maternal leptin levels with maternal obesity, gestational weight gain (GWG), single nucleotide polymorphisms (SNPs) within the leptin gene, and the age-adjusted birth weight of the child. Material and Methods: Maternal leptin levels (n = 740) and SNPs (n = 504) were analyzed in blood samples taken within the Uppsala Biobank of Pregnant women at pregnancy weeks 16–19. Results: Maternal leptin levels differed significantly between body mass index (BMI) groups. Normal weight women had the lowest median leptin levels and levels increased with each BMI group. Leptin SNP genotype was not associated with leptin levels or BMI. There was also no association between maternal leptin levels and age-adjusted birth weight of the child except for a negative association between leptin levels and birth weight in the morbid obese group. Discussion/Conclusion: Maternal BMI was identified as the best positive explanatory factor for maternal leptin levels. Leptin was a strong positive explanatory factor for GWG. Birth weight of children of uncomplicated pregnancies was, however, dependent on maternal height, BMI, GWG, and parity but not leptin levels, except for in morbid obese women where a negative association between maternal leptin levels and birth weight was found. We speculate that this indicates altered placental function, not manifested in pregnancy complication. We conclude that maternal leptin levels do not affect the birth weight of the child more than BMI, GWG, and parity.

Association Between Body Composition and Bone Density in Morbidly Obese Women According to Menopausal Status (P01-023-19)

ObjectivesThe study aim was to assess bone mineral density (BMD) and bone turnover in pre- and postmenopausal women with severe obesity. Additionally, we explored the association between soft tissue body composition and BMD according to menopausal status. MethodsThis is a cross-sectional study conducted in pre- (n = 37) and postmenopausal (n = 22) morbid obese (BMI >40 kg/cm2) women. Body composition and BMD at different sites (lumbar spine, proximal femur and forearm) were assessed by dual energy X-ray absorptiometry (DXA). Biochemical markers of bone metabolism (serum CTX and osteocalcin) and serum 25(OH)D were also measured. Differences between pre- and postmenopausal women were analyzed by Student’s t-test. Body composition [lean mass, visceral (VAT) and subcutaneous (SAT) adipose tissue] and other potential factors associated with BMD were investigated by multiple regression. ResultsBMD at all sites evaluated was similar in pre- and postmenopausal women (P > 0.05). Also, no differences between groups were observed for bone turnover markers (P > 0.05). In postmenopausal women, years after menopause was inversely associated with BMD at total body (β = –0.010, P < 0.01) and total femur (β = –0.009, P < 0.05). Serum 25(OH)D was also associated with total femur BMD (β = 0.008, P < 0.01) in postmenopausal women. Lean mass was not associated with BMD in both groups. VAT was directly associated with lumbar spine BMD in postmenopausal women (β = 0.135, P < 0.05). ConclusionsOur results suggest that severe obesity may weaken the impact of menopause on bone mass and turnover. Also, soft tissue body composition appears to poorly influence bone density in these women. Funding SourcesFundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ, Grant number E26/110.764/2013 for FFB).

Bariatric Surgery Significantly Improves the Quality of Sexual Life and Self-esteem in Morbidly Obese Women.

The impact of bariatric surgery (BS) on the sexual functioning of patients is poorly studied. Our aim was to analyze the sexual function, depressive symptoms, and self-esteem of morbidly obese women (MOW) undergoing BS. Quality of sexual life was prospectively evaluated in 43 consecutive MOW (18-50years) who underwent BS. Female sexual function index (FSFI), Beck depression inventory (BDI), and Rosenberg self-esteem scale (RSES) questionnaires were administered to evaluate sexual satisfaction, depressive symptoms, and self-esteem, respectively. A control group of 36 healthy, non-obese, female patients (HW) was recruited for comparison. Results of questionnaires were compared between three periods (before BS and at 3- and 6-month follow-up) and between MOW and HW. Before BS, the FSFI score was significantly lower in MOW compared to HW (17 ± 12 vs 27 ± 8, p = 0.0001) while at 3- and 6-month post-BS, a significant amelioration (p = 0.01) occurred. In particular, after BS, all components of the FSFI score (sexual desire, excitement, lubrification, orgasm, satisfaction, and pain) were ameliorated. The pre-BS BDI score was higher in MOW than in HW (8 ± 6 vs 5 ± 5, p = 0.004) while at postoperative months 3 and 6, a significant amelioration was found (p = 0.025 and 0.005, respectively). Before BS, no significant differences occurred in the RSES score between MOW and HW (30 ± 7 vs 32 ± 6, p = 0.014), whereas the MOW RSES scores at 6-month post-BS were improved when compared with the HW RSES scores. BS results in a significant improvement in the quality of sexual life, depressive symptoms, and self-esteem in MOW.

Nonmedically Indicated Induction in Morbidly Obese Women is Not Associated With an Increased Risk of Cesarean Delivery

(Am J Obstet Gynecol. 2017;217:451.e1–e8) Morbid obesity is associated with an increased risk of cesarean delivery and maternal comorbidities compared with normal-weight women, hence the high prevalence of class II and class III obesity in women is concerning. Obesity is also a risk factor for stillbirth, especially at &gt;39 weeks gestation. Data regarding the rate of cesarean delivery associated with nonmedically indicated induction of labor compared with expectant management in morbidly obese women are very limited. This retrospective cohort study aimed to evaluate the rate of cesarean delivery associated with nonmedically indicated induction of labor compared with expectant management in morbidly obese women without other comorbidities at term. Secondary outcomes were severe maternal and neonatal outcomes.

The Effect of Planned Mode of Delivery in Morbidly Obese Women [29J

INTRODUCTION: Morbidly obese women have a higher risk of experiencing adverse pregnancy outcomes. The aim of this study is to determine which planned mode of delivery, elective cesarean section versus vaginal delivery, presents better maternal outcomes in morbidly obese women. METHODS: We conducted a population-based, retrospective cohort study using the United States' Health Care Cost and Utilization Project's Nationwide Inpatient Sample to evaluate maternal outcomes in morbidly obese women without comorbidities delivering between 2000 and 2014. Multivariate logistic regression was used to compare outcomes in morbidly obese women according to mode of delivery. RESULTS: We identified a total of 77,666 deliveries in otherwise healthy morbidly obese women. The planned cesarean group comprised 13.4% of the cohort. When compared to women in the planned vaginal group, the planned cesarean group was at higher risk for transfusion (OR 1.48 [95% CI 1.23–1.77]), chorioamnionitis (OR 1.61 [1.44–1.81]) and major puerperal infection (OR 1.28 [1.05–1.56]). Women in the planned cesarean group had a lower risk of postpartum cardiomyopathy (OR 0.07 [0.02–0.22]), amniotic fluid embolism (OR 0.08 [0.02–0.31]), deep vein thromboembolism (OR 0.25 [0.08–0.79]), sepsis (OR 0.18 [0.07–0.44]) and wound dehiscence (OR 0.36 [0.23–0.59]). These reduced risks in the latter are partly due to the high rate of cesarean among planned vaginal deliveries in which morbidities appeared highest. CONCLUSION: Emergency cesarean section presents higher risks compared to planned cesarean section. Given that many planning a vaginal delivery will undergo emergency cesarean section, morbidly obese women should be informed of the high rate of failed vaginal delivery and subsequent risks.

The Effect of Roux-en-y Gastric Bypass Surgery on Fitness Parameters in Women with Morbid Obesity

Background: Obesity is widely considered as an important risk factor for impaired physical function and disability. Even mild to moderate weight loss has been shown to improve physical function. This study aimed to evaluate the effect of Roux-en-y gastric bypass (RYGB) surgery on some fitness parameters in women with morbid obesity. Methods: Seventy two women with morbid obesity body were included in this study. They were followed for six months after RYGB surgery. Some fitness parameters including body composition (using bioelectrical impedance), muscular strength (leg press in lower limb and hand power grip in upper limb) and six minute walk test (6MWT) were evaluated before surgery and that at intervals of 1, 3 and 6 months after surgery. One way repeated measure ANOVA was applied to determine the data changes during the follow up period. Results: BMI and body weight of all samples declined constantly during 6 months follow up after surgery. Also, by the end of the study, the body fat percent decreased from 48.2 (3) to 36.4 (4) (P < 0.05). The distance which patients paced in 6MWT increased 22% during 6 months follow up (P < 0.0001). Although handgrip and leg press of the participants decreased following the gastric bypass surgery, the power grip/weight ratio and leg press /weight ratio improved significantly through the study (P < 0.0001). Conclusions: RYGB surgery may positively affect fitness parameters in morbid obese women. The endurance capacity, body composition and even muscle strength seem to be enhanced after gastric bypass surgery.

Third trimester ultrasound accuracy and delivery outcome in obese and morbid obese pregnant women

Objective: Several studies have highlighted the negative impact of maternal obesity on ultrasound accuracy for fetal weight estimation (EFW). However, the evidence is conflicting. We aimed in our study to find if the ultrasound accuracy for EFW would differ or decrease in obese and morbid obesity classes. We also studied the mode of delivery within the same cohort.Methods: It is a retrospective study of obese patients with recorded BMI ≥30 kg/m2, class I and II (BMI: 30–39.9 kg/m2) compared with extreme obese class III (BMI ≥40 kg/m2), who gave birth after 28-week gestation of viable singleton, who had an ultrasound within 7 d of delivery with reported normal amniotic fluid and no major fetal anomaly; the EFW was consistently measured through Hadlock regression formula in the period of 2014–2015 inclusive. Differences between the EFW and actual birth weight (ABW) were assessed by percentage error, accuracy in predictions within ±10% of error and the Pearson correlation coefficient were used to correlate EFW with the ABW. The study’s secondary outcome was to study the mode of delivery and the rate of cesarean section in obese and morbid obese patients.Results: Total 106 cases fulfilled our criteria. Class I and II as the first group (n = 53). Class III as the second group (n = 53). Maternal and birth characteristics were similar. The Pearson correlation coefficient equal 1 in both groups. The overall mean absolute difference (MAD) in grams of the whole obese cohort was 242 ± 213. The MAD was 242 ± 202 and 242 ± 226 g for the first and second group, respectively (p = 1.0). The overall mean absolute percentage error (MAPE) in this obese cohort was 8%. The MAPE for the first and second group, respectively were 8 and 7% (p = 0.4). The overall rate of cesarean delivery was 60% (64/106) with no differences between the obese and morbid obese BMI classes. Sixty-six percentage (42/64) of these cesarean cases was for repeat cesarean section.Conclusion: Despite what has been previously reported about the negative impact of maternal obesity on EFW accuracy, we could not demonstrate this relationship in our obese cohort (MAPE <10%). In addition, we could not illustrate a significant difference in ultrasound accuracy across various obesity classes. However, we found a significantly increased rate of delivery by repeated cesarean section in this obese cohort.