Normal Body Mass Index Women Research Articles

Effect of first trimester body mass index and gestational weight gain on maternal and neonatal outcomes: a cross-sectional study

Introduction: Malnutrition and poor weight gain as well as maternal obesity have significant influences on the pregnancy outcome. This study aims to show the effect of first-trimester body mass index and the corresponding gestational weight gain on the outcome of pregnancy. Method: It was a cross-sectional study conducted from 2017 to 2018. The sample size of the study was 740 respondents, which is calculated based on N=Z²pq/d² formulae, where Z=1.96 for 95% CI, p=11.5, q=100-p and d=2.3(20%) of permissible error of prevalence. Frequency, percentage, mean and standard deviation were calculated for descriptive analysis. Chi-square test was used to find out the association for categorical variables. Odds Ratio and Logistic regression were also calculated for categorical variables. Result: Most of the women (57.3%) had normal Body Mass Index (BMI). Compared to women of adequate Gestational Weight Gain (GWG), the Odds Ratio of Hypertensive Disorder in Pregnancy (HDP), Gestational Diabetes Mellitus (GDM), induction of labor and instrumental/caesarean delivery for women of excessive GWG was 3.88(95%, CI 1.65-9.12,p<0.05), 0.63(95% CI 0.24-1.63), 1.87(95% CI 1.11- 3.15,p<0.05), and 1.93(95% CI 1.14-3.27, p<0.05) respectively. Compared to women of normal BMI, the Odds Ratio of HDP, GDM, induction of labor and instrumental /caesarean delivery for overweight/obese women were 2.32(95% CI 1.15-4.66,p<0.05), 1.94(95% CI 1.10-3.41,p<0.05), 1.15(95% CI 0.75-1.77), 1.48(95% CI 0.96-2.28), respectively. Regarding neonatal outcomes, the OR of macrosomia and APGAR score <7 at 1&5 minute in the overweight/obese-group were 1.61(95% CI 0.56-4.61), 1.24(95% CI 0.21-7.25), and 2.04(95% CI 0.07-55.3), respectively. Conclusion: Both overweight/obesity and excessive GWG are the risk factors of Hypertensive Disorder in Pregnancy, induction of labor, instrumental/cesarean delivery, macrosomia, and APGAR<7 at1&5 minutes.

Relation between perinatal outcome and gestational duration in term primiparous pregnancies stratified by body mass index.

There is growing evidence that induction of labor at 41 completed weeks improves neonatal outcome, at least among primiparous women. This study was performed to investigate whether maternal body mass index (BMI) should be considered when deciding on timing of intervention in term pregnancies. The study design was a historical cohort study using data from the Swedish Medical Birth Register, singletons in cephalic presentation with births 39+0 to 41+6 weeks, with available information on maternal BMI 2005-2017 (n= 352 567). Modified Poisson regression analyses were used to investigate the association between gestational duration and stillbirth or death before 45 postmenstrual weeks (primary outcome) and Apgar score <7 at 5 minutes (secondary outcome) by BMI, respectively. Adjustments were made for maternal age, smoking, country of birth and educational level. The adjusted relative risk (ARR) of stillbirth or death before 45 weeks among infants born at 41+0 to 41+6 vs 40+0 to 40+6 weeks, was 1.26 with a 95% confidence interval (CI) of 1.07-1.48. Among women with BMI≥30, the offspring mortality risk in pregnancies lasting 39+0 to 39+2 weeks was significantly above the corresponding risk among women of normal BMI who delivered at 41+0 to 41+2 weeks (ARR=1.95; 95% CI 1.07-3.56) but no statistically significant heterogeneity was found regarding the magnitude of the association between gestational duration and offspring mortality. The ARR, for Apgar <7 at 5minutes (41+0 to 41+6 vs 40+0 to 40+6 weeks, regardless of BMI), was 1.36 (95% CI 1.27-1.45). The risk for low Apgar score at 41+0 weeks was 1.5% among all children regardless of maternal BMI. Among children to women with BMI≥30, this magnitude of risk was found already at 39+3 weeks. In primiparous women with obesity the risk of stillbirth or death before 45 postmenstrual weeks were increased throughout all full-term gestational age categories, compared with women with overweight or normal BMI. Children to obese women had the same risk for Apgar scores <7 at 5minutes compared with women overall at earlier gestational age. The results suggest that maternal BMI needs to be considered when discussing timing of elective induction in term healthy pregnancies of primiparous women.

Association Between Early Pregnancy Body Mass Index and Gestational Weight Gain in Relation to Neonatal Birth Weight.

Introduction: Maternal early pregnancy body mass index (BMI) and gestational weight gain (GWG) strongly correlate with pregnancy outcomes. Gestational hypertension and diabetes have been associated with overweight and obesity in pregnancy. A low pre-pregnancy BMI has been associated with low birth weight and preterm birth.Method: This observational study was carried out from November 2018 to July 2020 in a tertiary care hospital in South India with a sample size of 100. Pregnant women with uncomplicated singleton pregnancies booked for regular antenatal care by 10 weeks of gestation were included in the study. During the participants' antenatal check-ups, detailed history and examinations were made. The weight of the participants was recorded at every antenatal check-up. Information about the gestational age at delivery and the birth weight of the neonates were collected following delivery.Results: The mean age of women was 25.83 + 2.74 years. Of women who delivered low birth weight neonates (<2.5 kg), 86% had GWG below the Institute of Medicine (IOM) recommendation. A total of 57% of women with normal early pregnancy BMI and 67% of obese women had GWG within the IOM recommendation. Early pregnancy BMI had a positive correlation with neonatal birth weight (r (98) = 0.779, p = 0.001). Of the underweight pregnant women, 72% gave birth to small for gestational age (SGA) babies, and 97% percent of normal early pregnancy BMI women delivered neonates with normal weight for gestational age. A total of 33% of overweight and 50% of obese women had large for gestational age (LGA) babies.Conclusion: Results from this study suggest that maternal early pregnancy BMI is more strongly associated with neonatal birth weight than GWG. Therefore, early pregnancy BMI may be an important focus for counseling during pregnancy.

O-157 Female body mass index (BMI) influences pregnancy outcomes: An evaluation of 4349 IVF/ICSI cycles

Abstract Study question Does female body mass index (BMI) impair pregnancy outcomes after IVF/ICSI cycles? Summary answer High BMI (overweight and obesity) and low BMI (underweight) are associated with decreased clinical pregnancy and live birth rates and an increased miscarriage rate. What is known already Obese women undergoing treatment for infertility may face problems, such as the need for higher doses of drugs to stimulate ovulation, oocyte morphological changes, reduction in fertilization and implantation rates, and embryo quality. Compared to women of normal BMI, obese women submitted to IVF may present reduced rates of clinical pregnancy and live births and an increased miscarriage rate. Regarding the effects of low BMI, unfavourable pregnancy outcomes and infertility problems have been described, but evidence is still scarce and conflicting. Study design, size, duration A prospective analysis was performed of 4349 couples who underwent IVF/ICSI treatment and fresh embryo transfer. Only one cycle per couple was considered. Exclusion criteria included abnormal karyotype, uterine defects, evidence of hydrosalpinx, infections, endocrine problems, coagulation defects or thrombophilia and autoimmune defects. Couples were stratified into four groups by female BMI: &amp;lt;18.5kg/m2 (underweight); 18.5-24.9kg/m2 (normal weight); 25-29.9kg/m2 (overweight); and ≥30kg/m2 (obesity). Clinical pregnancy, miscarriage and live birth rates were the outcomes analysed. Participants/materials, setting, methods Variables such as age, duration/type of infertility, previous embryo transfers, aetiologies, endometrial thickness, type of ovarian stimulation, and number/quality/development stage of embryo transferred were included as potential confounding factors. For group comparisons, the t test or chi-square test was used. Multivariate logistic regression analyses were performed to evaluate the associations between BMI and the probabilities of clinical pregnancy (CP), miscarriage and live birth (LB). Normal-weight patients were considered as the reference group. Main results and the role of chance Regarding confounding factors, no significant differences between BMI groups were observed. -BMI-group comparisons showed that CP, miscarriage and LB rates significantly worsened with the increase in BMI (overweight and obesity groups). Miscarriage and LB rates also worsened with the decrease in BMI (underweight group) (Table 1). -Compared with the normal-weight group, the overweight and obesity groups had significantly reduced rates of CP (19%/29%, respectively) and LB (27%/40%, respectively) and an increased rate of miscarriage (1.7x and 2.3x, respectively). Underweight was associated with a 49%-reduced rate of LB and a 3.0x increase in the rate of miscarriage (Table 2). Limitations, reasons for caution Differences in sample size between BMI groups may have influenced the results. In clinical outcomes, only fresh transfers were considered (not cumulative data). Population characteristics should be considered when interpreting the results. Wider implications of the findings The study suggests that higher BMI (overweight and obesity) and lower BMI (underweight) in women have a detrimental effect on ART outcomes, especially regarding the evolution of pregnancies. Problems associated with abnormal BMI should be discussed when advising couples interested in fertility treatment. Trial registration number Not applicable.

A Longitudinal Retrospective Observational Study on Obesity Indicators and the Risk of Impaired Fasting Glucose in Pre- and Postmenopausal Women.

The impact of obesity could differ according to menopausal status since women undergo significant physiologic and metabolic changes due to menopause. We investigated the association between various major obesity indicators and the risk of impaired fasting glucose (IFG) according to menopausal status using nationally representative data. A total of 571,286 premenopausal and 519,561 postmenopausal women who underwent both Korean National Health Insurance Service (NHIS) cancer screening in 2009 and health check-ups in 2017 were analyzed. Multivariate logistic regression analyses were used to assess the effect of independent variables of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) in 2009, on dependent variable IFG in 2017. After adjusting for potential confounders, the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of developing IFG were analyzed. In the premenopausal group, the OR of obese BMI (≥25 kg/m2, <30 kg/m2) women was increased to 2.228 (95% CI: 2.139–2.321) compared to the normal BMI (≥18.5, <23 kg/m2) women as a reference. In the postmenopausal group, there was also a higher OR of 1.778 (95% CI: 1.715–1.843) in the obese BMI women compared to the normal group. A similar association of increasing ORs for IFG was shown in both groups when stratified by WC and WHtR. This nationwide study revealed that obesity and abdominal obesity, defined by various obesity indicators, consistently increased odds of acquiring IFG after 8 years in both pre- and postmenopausal groups, with the association being more robust in the premenopausal group. Our findings suggest that weight management and lifestyle modification may require more attention in premenopausal women.

Electroacupuncture reduces weight, skinfold thickness and waist circumference and increases skin temperature of the abdominal region in women: a randomized controlled trial.

Acupuncture, as a complementary and alternative medical treatment, has shown some promise as a therapeutic option for obesity and weight control. The aim of the current study was to investigate the effects of electroacupuncture (EA) on body weight, body mass index (BMI), skin fold thickness, waist circumference and skin temperature of the abdominal region in non-obese women with excessive abdominal subcutaneous fat. A total of 50 women with excessive abdominal subcutaneous fat (and average BMI of 22) were randomly assigned to one of two groups: an EA group (n = 25) receiving 10 EA sessions (insertion of needles connected to an electrical stimulator at a frequency of 40 Hz for 40 min) and a control group (n = 25) that received no treatment. Outcome measures evaluated included waist circumference, supra-iliac and abdominal skinfolds, body composition and superficial skin temperature (measured by cutaneous thermography) before and after treatment. Compared with the untreated group, women in the EA group exhibited decreased supra-iliac and abdominal skin folds (p < 0.001), waist circumference (p < 0.001), percentage body fat (p = 0.001) and percentage abdominal fat (p < 0.001). In addition, the EA group showed an elevated skin temperature at the site of the treatment. However, EA did not significantly impact body weight (p = 0.01) or BMI (p = 0.2). EA promoted a reduction in abdominal waist circumference, supra-iliac and abdominal skin folds, and percentage body and abdominal fat in women of normal BMI with excessive abdominal subcutaneous fat, as well as an increase in the superficial skin temperature of the abdominal region. RBR-9tsmpp (Brazilian Registry of Clinical Trials).

The Impact of Gestational Weight Gain on the Risks of Adverse Maternal and Infant Outcomes among Normal BMI Women with High Triglyceride Levels during Early Pregnancy.

A high maternal triglyceride (mTG) level during early pregnancy is linked to adverse pregnancy outcomes, but the use of specific interventions has been met with limited success. A retrospective cohort study was designed to investigate the impact of gestational weight gain (GWG) on the relationship between high levels of mTG and adverse pregnancy outcomes in normal early pregnancy body mass index (BMI) women. The patients included 39,665 women with normal BMI who had a singleton pregnancy and underwent serum lipids screening during early pregnancy. The main outcomes were adverse pregnancy outcomes, including gestational hypertension, preeclampsia, gestational diabetes, cesarean delivery, preterm birth, and large or small size for gestational age (LGA or SGA) at birth. As a result, the high mTG (≥2.05mM) group had increased risks for gestational hypertension ((Adjusted odds ratio (AOR), 1.80; 95% CI, 1.46 to 2.24)), preeclampsia (1.70; 1.38 to 2.11), gestational diabetes (2.50; 2.26 to 2.76), cesarean delivery (1.22; 1.13 to 1.32), preterm birth (1.42, 1.21 to 1.66), and LGA (1.49, 1.33 to 1.68) compared to the low mTG group, after adjustment for potential confounding factors. Additionally, the risks of any adverse outcome were higher in each GWG subgroup among women with high mTG than those in the low mTG group. High mTG augmented risks of gestational hypertension, preeclampsia, preterm birth, and LGA among women with 50th or greater percentile of GWG. Interestingly, among women who gained less than the 50th percentile of GWG subgroups, there was no relationship between high mTG level and risks for those pregnancy outcomes when compared to low mTG women. Therefore, weight control and staying below 50th centile of the suggested GWG according to gestational age can diminish the increased risks of adverse pregnancy outcomes caused by high mTG during early pregnancy.

626 Risk of maternal peripartum complications by mode of delivery among patients with superobesity

Superobesity (pre-pregnancy body mass index (BMI) >=50 kg/m2) is increasingly common in the United States. Little is known about the effect of superobesity on maternal peripartum complications. We sought to determine whether superobesity is a risk factor for maternal peripartum morbidity based on mode of delivery. The 2016-18 National Center for Health Statistics natality data was queried for delivery hospitalizations 20-44 weeks gestation linked to patients with superobesity. The primary outcome was a maternal peripartum morbidity composite comprised of unplanned hysterectomy, maternal intensive care unit (ICU) admission, transfusion, and eclampsia. Composite risk was analyzed using log linear regression modeling with the primary exposure of superobesity stratified by delivery mode of vaginal delivery (VD), operative vaginal delivery (OVD), and cesarean delivery (CD) and adjusting for maternal parity, race, age, payer, and medical factors (chorioamnionitis, pregestational and gestational diabetes, chronic and gestational hypertension). Of 11.2 million delivery hospitalizations, 354,350 were linked to women with superobesity. Compared to women of normal BMI, superobese women had a lower rate of VD (58.9% v. 70.4%) and OVD (2.4% v. 3.7%) and a higher rate of primary (22.1% v. 15.8%) and repeat cesarean delivery (16.7% v. 10.0%). The incidence of maternal peripartum complications was higher for superobese women and generally increased with higher BMI (Figure). In adjusted analyses, superobese women were 33% (aRR 1.33, 95% CI: 1.29, 1.39) more likely to experience maternal peripartum complications overall and at higher risk of complications for all modes of delivery compared to patients with normal weight (Table). Women with superobesity are at higher risk of peripartum maternal morbidity including unplanned hysterectomy, ICU admission, transfusion and eclampsia in all modes of delivery. These findings highlight superobesity as an independent risk factor for maternal morbidity regardless of mode of delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Quantitative Assessment of Levonorgestrel Binding Partner Interplay and Drug-Drug Interactions Using Physiologically Based Pharmacokinetic Modeling.

Levonorgestrel (LNG) is the active moiety in many hormonal contraceptive formulations. It is typically coformulated with ethinyl estradiol (EE) to decrease intermenstrual bleeding. Due to its widespread use and CYP3A4‐mediated metabolism, there is concern regarding drug‐drug interactions (DDIs), particularly a suboptimal LNG exposure when co‐administered with CYP3A4 inducers, potentially leading to unintended pregnancies. The goal of this analysis was to determine the impact of DDIs on the systemic exposure of LNG. To this end, we developed and verified a physiologically‐based pharmacokinetic (PBPK) model for LNG in PK‐Sim (version 8.0) accounting for the impact of EE and body mass index (BMI) on LNG’s binding to sex‐hormone binding globulin. Model parameters were optimized following intravenous and oral administration of 0.09 mg LNG. The combined LNG‐EE PBPK model was verified regarding CYP3A4‐mediated interaction by comparing to published clinical DDI study data with carbamazepine, rifampicin, and efavirenz (CYP3A4 inducers). Once verified, the model was applied to predict systemic LNG exposure in normal BMI and obese women (BMI ≥ 30 kg/m2) with and without co‐administration of itraconazole (competitive CYP3A4 inhibitor) and clarithromycin (mechanism‐based CYP3A4 inhibitor). Total and free LNG exposures, when co‐administered with EE, decreased 2‐fold in the presence of rifampin, whereas they increased 1.5‐fold in the presence of itraconazole. Although changes in total and unbound exposure were decreased in obese women compared with normal BMI women, the relative impact of DDIs on LNG exposure was similar between both groups.

Effect of body mass index on intrauterine insemination cycle success

To determine whether body mass index (BMI) affects intrauterine insemination treatment success. Retrospective cohort study. Academic medical center. A total of 3,217 intrauterine insemination treatment cycles in 1,306 patients. None. Primary outcome was live birth rate stratified by BMI. Secondary outcomes included rates of clinical pregnancy (defined as an intrauterine pregnancy with a heartbeat present on ultrasound), multiple gestation, biochemical pregnancy, missed abortion, ectopic, and spontaneous abortion. Women with BMI 25 to 29.99 kg/m2 or ≥30 kg/m2 were equally likely to have a live birth as women of normal BMI. Women with BMI ≥30 kg/m2 did have a higher likelihood of biochemical pregnancy than women with normal BMI. A BMI between 25 and 29.99 kg/m2 or ≥30 kg/m2 does not appear to have a negative effect on live birth after intrauterine insemination. Obesity may be associated with a higher risk of biochemical pregnancy after intrauterine insemination.

A cross sectional community-based study to determine prevalence of high blood pressure and its associated risk factors amongst women residing in rural area of Navsari district in Gujarat

Background: The increase in prevalence of hypertension is evident in urban as well as rural areas over the years from trend studies. The objectives of this study were to determine prevalence of high BP and to assess the magnitude of undiagnosed high BP cases amongst women residing in the study area.Methods: 28 Villages which are the field practice area of Gram Seva Trust Sarvjanik Hospital, Kharel were selected. Women above 25 years of age and wanted to participate in women’s health screening camps were included.Results: 31% belonged to the age group of 36 to 45 years. 49.7% among the study participants were engaged in farm labor. 25.4% women were underweight. As per the JNC–7 criteria it was found that 13.7 % and 7.4% women were in stage 1 and stage 2 respectively. 21.6% women were in the pre-hypertension stage. 82% women were newly diagnosed and didn’t know that they were hypertensive. Significant relation between high body mass index (BMI) and hypertension was found. However, the prevalence of high BP amongst underweight and normal BMI women was alarming (13.1% and 19.8% respectively).Conclusions: There is significant burden of women with high BP in rural areas in Navsari district. This invites for immediate population and high-risk approach to lower blood pressure in the community and thereby reducing the risk of cardiovascular diseases.

Obesity, Sex, Race, and Early Onset Hypertension: Implications for a Refined Investigation Strategy.

Investigation for secondary causes is recommended in early onset hypertension. However, obesity is associated with higher blood pressure (BP), so investigation for alternative secondary causes may not be necessary in all obese patients. We sought to define a rational approach to investigation across strata of age, body mass index (BMI) sex and race, based on BP distributions in the US National Health and Nutrition Examination Surveys 2005 to 2016. The majority (71% [95% CI, 59%-79%] and 64% [95% CI, 57%-69%] by European and US definitions respectively) of early onset hypertension cases were attributable to BP distribution shifts accompanying obesity and male sex. Male versus female sex, BMI>40 versus 18.2<BMI≤25 and Black versus White race were accompanied by adjusted mean systolic BP differences of 9 (95% CI, 8-9) mm Hg, 13 (95% CI, 12-15) mm Hg, and 3 (95% CI, 2-4) mm Hg respectively. Normal BMI women above the age cutoff for investigation were less likely to be hypertensive than obese younger men meeting current investigation criteria (P<0.001). Targeting investigations to combinations of sex, BMI, and age with low hypertension prevalence would reduce the number investigated while still identifying as many secondary cases. Limiting investigations to patients with a BP exceeded by ≤5% of their respective sex/BMI/age category would give investigation thresholds ranging from ≥130/≥80 and ≥140/≥90 for normal BMI women and men, respectively, at age 20 to 30 years, to ≥160/≥100 and ≥170/≥105 for women and men with BMI ≥40 at age 30 to 40 years. In conclusion, we propose refined strategies for investigation of early onset hypertension in the context of an obesity epidemic.

Preeclampsia With Severe Features: Examining the Phenotype of Disease [28L

INTRODUCTION: To characterize the impact of increasing body mass index (BMI) on the likelihood of developing preeclampsia (PE) with severe features (SPE). METHODS: We performed a retrospective cohort study using the Consortium on Safe Labor database (CSL). Women without chronic hypertension with a diagnosis of PE delivering a singleton, non-anomalous fetus were included. The odds of developing SPE versus PE without severe features (MPE) between women with a pre-pregnancy BMI in the underweight or normal weight categories (&lt;25 kg/m2) versus those in the overweight (25-29.9 kg/m2) or obese (at least 30 kg/m2) categories were compared. Multiple logistic regression was used to adjust for potential confounders. RESULTS: There were 228,438 records in the cohort, of which 6,706 had a diagnosis of PE and a documented pre-pregnancy BMI. Of women with PE, 25% were overweight, 30% were obese. Among all BMIs, 34% of women had SPE. Compared to pregnancies with a normal or underweight BMI, overweight and obese women had a decreased odds of developing SPE when adjusted for race, maternal age, parity, insurance, diabetes, and marital status (adjusted OR [aOR] 0.84, 95% CI 0.72-0.96 and aOR 0.75, 95% CI 0.65-0.87, respectively). CONCLUSION: Among women who develop PE, women with an overweight or obese pre-pregnancy BMI are less likely to develop SPE than normal or underweight weight women. Potential differences in the metabolic phenotypes between the two groups may contribute to this finding. Further research is needed to characterize the pathophysiology behind these differences in order to find methods of preventing the development of SPE.

Effectiveness of Lifestyle Modification in Late Adolescent Females with Normal BMI Polycystic Ovarian Syndrome

Background and Objectives: The prevalence of PCOS varies from 2.2% to 26% in different countries. Between 20-50% of women with PCOS are normal weight or lean and the pathophysiology of the disorder in these women may differ from that of obese women; It has been suggested that PCOS develops in non obese women because of a hypothalamic pituitary defect that results in increase release of LH. To determine the effectiveness of life style modification in late adolescent with normal BMI polycystic ovarian syndrome . Material and Methodology: 28 Normal BMI women with polycystic ovary syndrome were selected for the study. They received the life style modification including diet plan exercise plan. Pre –assessment of body weight is measured by body mass index (BMI),waist-hip ratio(W-H Ratio) and quality of life was scored as per polycystic ovarian syndrome questionnaire(PCOSQ) and post-interventional assessment was taken for the same after 3 months. The exclusion criteria included Type II diabetes, Cardio vascular problems, any concurrent hormone therapy within 6 weeks, pregnant women’s or who are willing to conceive. Result: Statistical analysis for PCOSQ was extremely significant (P value=0.0001).Statistical analysis for BMI revealed not significant in post intervention .Statistical analysis for W-H Ratio revealed not significant in post intervention. Conclusion: Lifestyle modification helped in maintaining weight and showed increased quality of life in women with polycystic ovarian syndrome (PCOS).

Follicle Stimulating Hormone (LH: FSH) Ratio in Polycystic Ovary Syndrome (PCOS) - Obese vs. Non- Obese Women.

Introduction:Polycystic Ovary Syndrome (PCOS), the most common endocrinological problem among women in the reproductive age, is characterized by chronic ovulatory dysfunction, hyperandrogenism, and raised Luteinizing hormone : Follicle Stimulating Hormone (LH:FSH) ratio. Obesity and insulin resistance have been linked to PCOS. However, there is recently a growing population of thin, lean women who are diagnosed with PCOS.Aim:This study aimed to compare normal and high Body mass index (BMI) women with PCOS and to investigate the correlation between BMI and LH/FSH ratio.Methods:It was a case -control study at the Department of Obstetrics and Gynaecology, Qassim University clinic, Saudi Arabia. Women with PCOS were included in the study and were classified according to their BMI. Their computerized records were retrieved for the demographic, clinical, and laboratory data. The study groups were compared by the t-test and the Spearman correlation between BMI and LH/FSH ratio was calculated.Results:A total of 63 women were included in this study (normal BMI group: n=30, and high BMI group: n=33). There was no difference between the two groups in terms of the LH/FSH ratio (2.76 vs. 2.79, P=0.48). There was no significant correlation between BMI and LH/FSH ratio, prolactin, or Thyroid stimulating hormone (TSH ) levels (Spearman correlation with P>0.05).Conclusion:The data suggests that the body mass index was not correlated with increased LH/FSH ratio. Since LH/FSH ratio was the same in normal BMI women, healthcare professionals need to think about ways to normalize this ratio beyond weight reduction.

Association between gestational weight gain and severe adverse birth outcomes in Washington State, US: A population-based retrospective cohort study, 2004-2013.

Suboptimal weight gain during pregnancy is a potentially modifiable risk factor. We aimed to investigate the association between suboptimal gestational weight gain and severe adverse birth outcomes by pre-pregnancy body mass index (BMI) categories, including obesity class I to III. We conducted a population-based study of pregnant women with singleton hospital births in Washington State, US, between 2004 and 2013. Optimal, low, and excess weight gain in each BMI category was calculated based on weight gain by gestational age as recommended by the American College of Obstetricians and Gynecologists and the Institute of Medicine. Primary composite outcomes were (1) maternal death and/or severe maternal morbidity (SMM) and (2) perinatal death and/or severe neonatal morbidity. Logistic regression was used to obtain adjusted odds ratios (AORs) and 95% confidence intervals. Overall, 722,839 women with information on pre-pregnancy BMI were included. Of these, 3.1% of women were underweight, 48.1% had normal pre-pregnancy BMI, 25.8% were overweight, and 23.0% were obese. Only 31.5% of women achieved optimal gestational weight gain. Women who had low weight gain were more likely to be African American and have Medicaid health insurance, while women with excess weight gain were more likely to be non-Hispanic white and younger than women with optimal weight gain in each pre-pregnancy BMI category. Compared with women who had optimal weight gain, those with low gestational weight gain had a higher rate of maternal death, 7.97 versus 2.63 per 100,000 (p = 0.027). In addition, low weight gain was associated with the composite adverse maternal outcome (death/SMM) in women with normal pre-pregnancy BMI and in overweight women (AOR 1.12, 95% CI 1.04-1.21, p = 0.004, and AOR 1.17, 95% CI 1.04-1.32, p = 0.009, respectively) compared to women in the same pre-pregnancy BMI category who had optimal weight gain. Similarly, excess gestational weight gain was associated with increased rates of death/SMM among women with normal pre-pregnancy BMI (AOR 1.20, 95% CI 1.12-1.28, p < 0.001) and obese women (AOR 1.12, 95% CI 1.01-1.23, p = 0.019). Low gestational weight gain was associated with perinatal death and severe neonatal morbidity regardless of pre-pregnancy BMI, including obesity classes I, II, and III, while excess weight gain was associated with severe neonatal morbidity only in women who were underweight or had normal BMI prior to pregnancy. Study limitations include the ascertainment of pre-pregnancy BMI using self-report, and lack of data availability for the most recent years. In this study, we found that most women do not achieve optimal weight gain during pregnancy. Low weight gain was associated with increased risk of severe adverse birth outcomes, and in particular with maternal death and perinatal death. Excess gestational weight gain was associated with severe adverse birth outcomes, except for women who were overweight prior to pregnancy. Weight gain recommendations for this group may need to be reassessed. It is important to counsel women during pregnancy about specific risks associated with both low and excess weight gain.

IL-1β is associated with decreased expression of GREM1 in obese women undergoing in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI)

To investigate obesity associated inflammatory factors in follicular fluid that may affect gene expression in cumulus cells of women undergoing IVF-ICSI. Prospective cohort study. Follicular fluid and cumulus cells were collected during oocyte retrieval in women undergoing IVF-ICSI, and grouped based on body mass index (BMI). Cytokine levels were measured from the follicular fluid using enzyme-linked immunosorbent assay (ELISA). Expression of 4 genes (GREM1, HAS2, PTGS2, VCAN), which have been positively correlated with oocyte maturity and/or pregnancy outcome in cumulus cells, was determined by quantitative reverse transcription polymerase chain reaction (RT-qPCR). Mann Whitney tests were utilized to compare cohorts by BMI and reported as medians with interquartile ranges. Cumulus cells of normal BMI (21.1 kg/m2 to 23.6 kg/m2) women were cultured with IL-1β to investigate its impact on gene expression. Change in gene expression following IL-1β was analyzed by paired t test. P values <0.05 were considered significant. A total of 68 women were included in the ELISA analysis. Women were grouped based on BMI with 57 women having BMI <35 kg/m2 and 11 women having BMI ≥35 kg/m2. Women with BMI ≥35 kg/m2 had increased levels of IL-1β in the follicular fluid as compared to women with lower BMI (5.18 pg/mL vs 1.92 pg/mL, p=0.02). Gene expression from cumulus cells was measured from a representative cohort based on BMI, with 6 in the normal group (BMI 21.1 kg/m2 to 23.6 kg/m2) and 6 in the obese group (35.6 kg/m2 to 42.0 kg/m2). The obese group had a significantly lower relative expression of GREM1 compared to the normal group (0.51 [0.38, 0.74] vs 1.01 [0.66, 1.40], p=0.03). No differences were seen with HAS2 (0.73 [0.49, 1.17] vs 1.06 [0.65, 1.78], p=0.39), PTGS2 (1.54 [1.09, 3.11] vs 0.58 [0.47, 4.19], p=0.22), or VCAN (0.88 [0.61, 1.56] vs 0.93 [0.63, 1.56], p=0.82). Given increased levels of IL-1β in follicular fluid of obese women, cumulus cells from women with normal BMI were cultured with IL-1β to investigate the impact on GREM1 expression. Following IL-1β incubation, GREM1 levels significantly decreased in cumulus cells of normal BMI women (p=0.02) similar to the obese cohort. Compared to women with normal BMI, obese women had higher levels of pro-inflammatory IL-1β in the follicular fluid and had lower cumulus cell expression of GREM1. Decreased expression of GREM1 in cumulus cells of normal BMI women following culture with IL-1β suggests that this pro-inflammatory cytokine may play a role in suppressing GREM1 levels in obese women. These molecular discrepancies may give insight into physiologic differences in oocyte development and cycle outcomes in obese women undergoing IVF-ICSI. Further studies are required to correlate these molecular findings to clinical outcomes.

Obesity and breast cancer screening: Cross-sectional survey results from the behavioral risk factor surveillance system.

Postmenopausal obese women demonstrate an elevated breast cancer risk and experience increased breast cancer morbidity and mortality compared with women with a normal body mass index (BMI). However, to the authors' knowledge, prior studies have yielded inconclusive results regarding the effects of obesity on mammography screening adherence. Using national cross-sectional survey data, the objective of the current study was to assess the current association between increasing BMI and use of mammography screening. Cross-sectional survey data from the 2016 Behavioral Risk Factor Surveillance System, a state-based national telephone survey of noninstitutionalized adults in the United States, was used to identify the association between mammography screening use and increasing incremental BMI categories, including normal (18.5-24.9kg/m2 ), overweight (25-29.9kg/m2 ), obese class I (30-34.9kg/m2 ), obese class II (35-39.9kg/m2 ), and obese class III (>40kg/m2 ), with adjustments for potential confounders. A multivariable logistic regression model was used to evaluate the effect of each BMI category on self-reported mammography use, using unadjusted and adjusted odds ratios. Effect modification by race/ethnicity was determined by testing interaction terms using Wald tests. Of 116,343 survey respondents, 33.5% (38,984 respondents) had a normal BMI, 32.6% (37,969 respondents) were overweight, 19.3% (22,416 respondents) were classified as obese class I, 8.4% (9791 respondents) were classified as obese class II, and 6.2% (7183 respondents) were classified as obese class III. There was no statistically significant difference (P<.05) observed with regard to mammography use between women with a normal BMI and obese women from each obese class (classes I-III) when compared individually. There also was no evidence of effect modification by race (P=.53). In contrast to prior reports, the results of the current study demonstrated no association between obesity and adherence to screening mammography. These findings may relate to the increasing social acceptance of obesity among women from all racial/ethnic groups and the removal of weight-related facility-level barriers over time.

Improving risk assessment of obesity-associated breast cancer.

1544 Background: Elevated body mass index (BMI) is associated with increased risk of estrogen receptor (ER)-positive postmenopausal breast cancer. The risk is also elevated in women with a normal BMI but excess body fat. These risks may be driven by breast white adipose tissue inflammation (WATi), which is associated with elevated aromatase levels and systemic metabolic dysfunction (e.g. hyperinsulinemia). We hypothesized that body fat assessment is superior to BMI for detecting the pathophysiology that promotes obesity-related breast cancer, particularly among normal BMI women. Methods: Non-tumorous breast tissue was collected from women undergoing mastectomy for breast cancer treatment or prevention. Breast WATi was detected by the presence of crown-like structures in the breast, which are composed of a dead/dying adipocyte surrounded by CD68+ macrophages. Body composition was measured prior to mastectomy via dual energy X-ray absorptiometry. Exercise behavior was also assessed prior to surgery using the Godin Leisure Time Exercise Questionnaire. Associations among categorical variables were examined using Χ2 or Fisher’s exact test. Relationships between continuous variables were examined using the Spearman correlation. Results: From April 5, 2016 to August 31, 2018, 100 patients were enrolled; median age 49 (range 29 to 82) years. Breast WATi was present in 56/100 (56%) women and was associated with elevated BMI and body fat levels, breast adipocyte hypertrophy, postmenopausal status, metabolic syndrome and decreased physical activity (P &lt; 0.05). Among 39 women with normal BMI, breast WATi was present in 14 (36%) and was associated with elevated body fat levels, breast adipocyte hypertrophy, dyslipidemia, and decreased physical activity (P &lt; 0.05). There was no statistically significant association between BMI and breast WATi in the normal BMI group. Menopausal status and total fat mass had greater sensitivity and specificity for the detection of breast WATi compared to a BMI-based model (AUC 0.843 vs. 0.779, respectively). Conclusions: Measurement of body fat is superior to BMI for predicting breast inflammation, which has been shown to promote obesity-related breast cancer.

Pharmacokinetics of the 1.5 mg levonorgestrel emergency contraceptive in women with normal, obese and extremely obese body mass index

ObjectiveTo assess the pharmacokinetics (PK) of levonorgestrel after 1.5 mg oral doses (LNG-EC) in women with normal, obese and extremely obese body mass index (BMI). Study designThe 1.5 mg LNG dose was given to healthy, reproductive-age, ovulatory women with normal BMI (mean 22.0), obese (mean 34.4), and extremely obese (mean 46.6 kg/m2) BMI. Total serum LNG was measured over 0 to 96 h by radioimmunoassay while free and bioavailable LNG were calculated. The maximum concentration (Cmax), time to maximum concentration (Tmax), and area under the curve (AUC) of LNG were assessed. Pharmacokinetic parameters calculated included half-life (t1/2), clearance (CL) and volume of distribution (Vss). ResultsTen normal-BMI, 11 obese-BMI, 5 extremely obese-BMI women were studied. After LNG-EC, mean total LNG metrics were lower in the obese and extremely obese groups compared to normal (Cmax 10.5 and 10.5 versus 16.2 ng/mL, both p<.01; AUC 208 and 197 versus 360 h × ng/mL, both p<.05). Mean bioavailable LNG Cmax was lower in obese (7.03 ng/mL, p<.05) and extremely obese (7.53 ng/ml, p=.198) compared to normal BMI (9.39 ng/mL). Mean bioavailable LNG AUC values were lower in obese and extremely obese compared to normal (131.6 and 127.5 vs 185.0 h × ng/mL, p<.05 for both). ConclusionsObese and extremely obese women were exposed to lower total and bioavailable LNG than normal BMI women. ImplicationsLower ‘bioavailable’ (free plus albumin bound) LNG AUC in obese women may play a role in the purported reduced efficacy of LNG-EC in obese users.