Obese Pregnant Women Research Articles

Relationship of Health-promoting Behaviors with Demographic and Pregnancy Characteristics in Overweight and Obese Pregnant Women who Refer to Comprehensive Health Centers in Bijar, Iran

Background and Objective: This study aimed to determine the relationship of health-promoting behaviors with demographic and pregnancy characteristics in overweight and obese pregnant women in Bijar, Iran. Materials and Methods: This cross-sectional study was conducted on 194 pregnant women who were selected from five comprehensive health centers in Bijar, Iran, in 2020, using the convenience sampling method. The data were collected via demographic and pregnancy characteristics form and Walker's health promotion lifestyle questionnaire. Following that, the independent t-test, one-way ANOVA, Pearson correlation coefficient, and multiple linear regression were used for data analysis. A P-value of 0.05 was considered statistically significant. Results: The health-promoting behaviors of pregnant women were explained under the influence of gestational age and the number of prenatal care. The results showed that obese and overweight pregnant women who had 7 to 8 prenatal cares had a higher and significant mean score of health promoting behaviors, compared to pregnant women who had 1 to 2 cares (β=5.30; Ρ=0.022). Moreover, pregnant women whose gestational age was more than 35 weeks obtained a higher and significant mean score of health-promoting behaviors than pregnant women with a gestational age of less than 25 weeks (β=7.54; Ρ=0.03). Conclusion: Using these findings, in addition to the number of pregnancy cares and age of pregnancy, it seems that there are other factors affecting health-promoting behaviors in pregnant women.

The role of health education and physical activity in the prevention of obesity in pregnant women

Introduction: Obesity is a major health concern in pregnancy, and it can lead to various adverse outcomes for both the mother and the fetus. The increasing prevalence of obesity among pregnant women calls for effective strategies to prevent its occurrence and reduce its consequences. Health education and physical activity have been identified as potential interventions to prevent obesity in pregnant women. Aim of study: The aim of the review is to present the impact of physical activity and health education on obesity in pregnant women, as well as its pathogenesis and treatment.Materials and Methods: The authors followed the PRISMA guidelines to ensure high-quality work. The search was based on databases such as PubMed, Google Scholar, Scopus, and Web of Science, with a limitation to publications after. The strategy relied on search terms such as 'obesity in pregnancy', 'treatment', 'physical activity', 'health education', and 'sport', combined using 'AND' and 'OR' operators. The team members reviewed the abstracts and then decided on their inclusion in the study. Results: According to literature reviews, health education and physical activity can be effective interventions in preventing obesity in pregnant women. They can help prevent excessive weight gain during pregnancy and reduce the risk of gestational diabetes and other obesity-related complications. Individual dietary advice, exercise programs, and lifestyle modification counseling are recommended. However, further research is needed to determine the most effective strategies for preventing obesity in pregnant women and assessing long-term health outcomes.Conclusions: Both regular physical activity and health education can be useful in prevention and treatment of obesity during pregnancy, and should be included as part of a comprehensive approach to women's health during pregnancy. It is important for people to understand the benefits of regular physical activity throughout the entire pregnancy period.

Insulin like growth factor 1 (IGF-1) and IGF binding proteins in obese pregnant women and their babies: Potential effects on placental function and fetal growth

Introduction: The placenta expresses significant amounts of insulin and IGF1 receptors at distinct locations on both fetal and maternal surfaces. This makes the IGF1 and the insulin receptor accessible to fetal and/or maternal insulin, IGF1 and IGF2. IGFs are involved in the receptor-mediated regulation of placental growth and transport, and placental angiogenesis. Maternal obesity during gestation mediates significant changes in the metabolism of mothers, placentas as well as fetal growth. Objectives: In obese women. the role of the insulin like growth factor system IGFs, IGF receptors, IGF-binding proteins (IGFBPs) and IGFBP proteases during gestation, and their effect on placental growth and fetal anthropometric changes need further clarification. In this update we reviewed the literature on the detected changes in the maternal and fetal IGFs in relation to placental growth and function and to fetal growth and newborn size in pregnant obese mothers. Eighteen research articles fitted the criteria of this update. Results: Twenty-three research papers were including 2817 pregnant obese and non-obese women (controls) and their babies were selected and reviewed. Results showed that obesity and excessive nutrient intake during gestation increase maternal IGF1and decreases IGBP1. Increased maternal IGF1 and/or its availability due to decreased IGFBP1 can increase the size (weight) and development of the placenta, stimulate mTOR signaling which stimulates protein synthesis, mitochondrial function, and upregulate specific placental amino acid transporter isoforms (amino acids transport), GLUT-1, (glucose transport) and possibly lipid transport to the fetus which can induce fetal IGF1 secretion and lead to overgrowth. Conclusions: In obese women during pregnancy, increased level of IGF1 and/or its availability due to decreased IGFBP1 can increase the size (weight) and development of the placenta, stimulate mTOR signaling which stimulates protein synthesis, mitochondrial function, and upregulate placental transport of amino acids, glucose and possibly fatty acids.

Obesity and gestational diabetes independently and collectively induce specific effects on placental structure, inflammation and endocrine function in a cohort of South African women.

Maternal obesity and gestational diabetes mellitus (GDM) are associated with insulin resistance and health risks for mother and offspring. Obesity is also characterized by low-grade inflammation, which in turn, impacts insulin sensitivity. The placenta secretes inflammatory cytokines and hormones that influence maternal glucose and insulin handling. However, little is known about the effect of maternal obesity, GDM and their interaction, on placental morphology, hormones and inflammatory cytokines. In a South African cohort of non-obese and obese pregnant women with and without GDM, this study examined placental morphology using stereology, placental hormone and cytokine expression using real-time PCR, western blotting and immunohistochemistry, and circulating TNFα and IL-6 concentrations using ELISA. Placental expression of endocrine and growth factor genes was not altered by obesity or GDM. However, LEPTIN gene expression was diminished, syncytiotrophoblast TNFα immunostaining elevated and stromal and fetal vessel IL-6 staining reduced in the placenta of obese women in a manner that was partly influenced by GDM status. Placental TNFα protein abundance and maternal circulating TNFα concentrations were reduced in GDM. Both maternal obesity and, to a lesser extent, GDM were accompanied by specific changes in placental morphometry. Maternal blood pressure and weight gain and infant ponderal index were also modified by obesity and/or GDM. Thus, obesity and GDM have specific impacts on placental morphology and endocrine and inflammatory states that may relate to pregnancy outcomes. These findings may contribute to developing placenta-targeted treatments that improve mother and offspring outcomes, which is particularly relevant given increasing rates of obesity and GDM worldwide. KEY POINTS: Rates of maternal obesity and gestational diabetes (GDM) are increasing worldwide, including in low-middle income countries (LMIC). Despite this, much of the work in the field is conducted in higher-income countries. In a well-characterised cohort of South African women, this study shows that obesity and GDM have specific impacts on placental structure, hormone production and inflammatory profile. Moreover, such placental changes were associated with pregnancy and neonatal outcomes in women who were obese and/or with GDM. The identification of specific changes in the placenta may help in the design of diagnostic and therapeutic approaches to improve pregnancy and neonatal outcomes with particular significant benefit in LMICs.

Use of closed incision negative pressure wound therapy on C-section wounds in obese women

Rates of obesity in pregnant women are increasing. Obesity is linked to increased patient risk of developing postoperative wound complications such as surgical site infection, wound dehiscence and haematoma formation. Closed incision negative pressure wound therapy (ciNPWT) has been introduced as a prophylactic intervention to reduce caesarian section (C-section) wound complications. Evidence from randomised controlled trials and retrospective studies has shown variable rates of success in reducing risk of SSI. The studies reviewed in this article found that ciNPWT had no statistically significant impact in reducing rates of wound dehiscence and haematoma formation or increasing long-term satisfaction with the appearance of scar tissue following C-section. Further research into the use of cINPWT to prevent surgical site infection is needed to determine the effectiveness of this therapy in reducing this wound complication.

Characterization of Maternal Circulating MicroRNAs in Obese Pregnancies and Gestational Diabetes Mellitus.

Maternal obesity (MO) is expanding worldwide, contributing to the onset of Gestational Diabetes Mellitus (GDM). MO and GDM are associated with adverse maternal and foetal outcomes, with short- and long-term complications. Growing evidence suggests that MO and GDM are characterized by epigenetic alterations contributing to the pathogenesis of metabolic diseases. In this pilot study, plasma microRNAs (miRNAs) of obese pregnant women with/without GDM were profiled at delivery. Nineteen women with spontaneous singleton pregnancies delivering by elective Caesarean section were enrolled: seven normal-weight (NW), six obese without comorbidities (OB/GDM(-)), and six obese with GDM (OB/GDM(+)). miRNA profiling with miRCURY LNA PCR Panel allowed the analysis of the 179 most expressed circulating miRNAs in humans. Data acquisition and statistics (GeneGlobe and SPSS software) and Pathway Enrichment Analysis (PEA) were performed. Data analysis highlighted patterns of significantly differentially expressed miRNAs between groups: OB/GDM(-) vs. NW: n = 4 miRNAs, OB/GDM(+) vs. NW: n = 1, and OB/GDM(+) vs. OB/GDM(-): n = 14. For each comparison, PEA revealed pathways associated with oxidative stress and inflammation, as well as with nutrients and hormones metabolism. Indeed, miRNAs analysis may help to shed light on the complex epigenetic network regulating metabolic pathways in both the mother and the foeto-placental unit. Future investigations are needed to deepen the pregnancy epigenetic landscape in MO and GDM.

The problems and prospects of diagnosis and treatment of hypothyroidism in special populations

The prevalence of thyroid diseases in China continues to increase, especially for hypothyroidism. This article focuses on the existing problems in the diagnosis and treatment of hypothyroidism in special groups, including obese patients, the elderly, children and pregnant women. The pathogenesis and intervention measures of obesity-induced hypothyroidism have been the hot research frontiers. The prevalence of subclinical hypothyroidism in the elderly is the highest, while its diagnostic criteria and treatment strategies are still controversial. The hazard and treatment of subclinical hypothyroidism and hypothyroxinemia during pregnancy have now become an international concern. And there also exist some problems in the screening, diagnosis and treatment of congenital hypothyroidism in children. So it is urgent to carry out high-quality clinical research to provide theoretical basis for clinical diagnosis and treatment, and carry out in-depth research on related mechanisms to establish a foundation for the construction of a scientific prevention and treatment system for hypothyroidism.

The Incidence of Vaginal Deliveries in Obese Mothers at Prof Dr. I.G.N.G Ngoerah Hospital In 2022

Introduction: One of the risk factors seen most frequently in obstetric practice is maternal obesity. Women who were overweight or obese made up more than half of all female fatalities due to direct or indirect causes. Obesity increases the chance that the mother will experience obstetric problems during pregnancy, labour, and delivery, making fetal assessment more technically difficult. Methods: This study uses quantitative descriptive univariate analysis. The type of data is secondary data taken from the birth register. This study examines women who gave birth in 2022 and were identified as belonging to the obesity category by Prof. Dr. I. G. N. G. Ngoerah Denpasar General Hospital. Results: At Prof.dr.I.G.N.G Ngoerah Denpasar General Hospital, 21 obese pregnant women will give birth throughout 2022. Of the 21 people, 81% give birth by emergency C-section, 4,8% by elective C-section, and 14,2% give birth vaginally. Obese pregnant women have a higher risk of needing a cesarean section. Patients with obese class III had a significantly higher risk of infant morbidity than those with a normal BMI, according to their findings. Conclusions: Obese pregnant women are at increased risk of having a cesarean section. Therefore, health workers must provide knowledge to pre-pregnant or pre-marital women to maintain their BMI so they do not become obese during pregnancy. Thus, morbidity and mortality rates can also be reduced.

Adropin as a potential protective factor of metabolic complications in obese pregnant women with hyperglycaemia diagnosed in early pregnancy.

Adropin is a hormone which increases insulin sensitivity. It enhances the oxygenation of glucose in the muscles. The 91 obese pregnant women (BMI >30 kg/m2) with gestational diabetes mellitus (GDM) diagnosed in the first half of pregnancy has been recruited to the study group. The control group consisted of 10 age matched and homogeneous pregnant women with BMI <25 kg/m2. Blood samples were collected on visit V1 - between the 28th and 32nd week and on visit V2 - between the 37th and 39th week of gestation. The ELISA test was used to measure the adropin level. The results in the study group and the control group were compared. Blood samples were collected at the same visits. The median concentration of adropin was 442.2 pg/ml on V1 and 453.1 pg/ml on V2. The increase was significant (p<0.05). Results were significantly lower in the control group's patients, i.e. 57.0 pg/ml (p<0.001) on V1 and 107.9 pg/ml on V2 (p<0.001). The higher adropin level on the V1 and V2 visits were related to patients' lower BMI and better metabolic control. The increase in the adropin level in the third trimester may have been involved in the weight gain reduction, whereas better dietary adherence might have had a compensatory effect on increasing insulin resistance. However, the small control group is a limitation of this study.

Adropin as a potential protective factor of metabolic complications in obese pregnant women with hyperglycaemia diagnosed in early pregnancy.

Adropin is a hormone which increases insulin sensitivity. It enhances the oxygenation of glucose in the muscles. The 91 obese pregnant women (BMI >30 kg/m2) with gestational diabetes mellitus (GDM) diagnosed in the first half of pregnancy has been recruited to the study group. The control group consisted of 10 age matched and homogeneous pregnant women with BMI <25 kg/m2. Blood samples were collected on visit V1 - between the 28th and 32nd week and on visit V2 - between the 37th and 39th week of gestation. The ELISA test was used to measure the adropin level. The results in the study group and the control group were compared. Blood samples were collected at the same visits. The median concentration of adropin was 442.2 pg/ml on V1 and 453.1 pg/ml on V2. The increase was significant (p<0.05). Results were significantly lower in the control group's patients, i.e. 57.0 pg/ml (p<0.001) on V1 and 107.9 pg/ml on V2 (p<0.001). The higher adropin level on the V1 and V2 visits were related to patients' lower BMI and better metabolic control. The increase in the adropin level in the third trimester may have been involved in the weight gain reduction, whereas better dietary adherence might have had a compensatory effect on increasing insulin resistance. However, the small control group is a limitation of this study.

Frequency of Successful Vaginal Delivery after Induction of Labour in Obese Pregnant Women Presenting at Tertiary Care Hospital Peshawar

Introduction: The incidence of induction of labour is 20% of all deliveries and is considered as the most common techniques in modern obstetrics. But both medically indicated and elective inductions are thought to increase the risk of instrumental and cesarean deliveries. Objective: Aim of this study was to determine the frequency of successful vaginal delivery after induction of labour in obese women. Methodology: This study was descriptive study carried out at Gynecology and Obstetrics Department, Hayatabad Medical Complex, Peshawar. The duration of study was Six months (from 1/2/2021 to 1/8/2021). Detail history, clinical examination, routine investigation were performed for the confirmation of obese pregnant women. All the data i.e. age, gestational age, parity, gravidity, number of induction, duration of labour, previous history of C section was recorded in pre design performa. All the recorded information on performa was entered in statistical software SPSS ver 23. Results: Our study shows that among 149 patients mean maternal age was 29 years with standard deviation ± 5.91. Among 149 patients successful vaginal delivery was observed in 86(58%) patients while 63(42%) patients were observed with un-successful vaginal delivery. Conclusion: Our study concludes that the frequency of successful vaginal delivery was 58% after induction of labour in obese pregnant women presenting at tertiary care hospital Peshawar. Keywords: Successful vaginal delivery, Induction of labour, obese pregnant women

Healthy Lifestyle Behaviors and Perceived Prenatal Stress in Obese Pregnant Women

Purpose: The study was conducted to examine healthy lifestyle behaviors and perceived prenatal stress level and affecting factors in obese pregnants.&#x0D; &#x0D; Material and Methods: This cross-sectional study was conducted with 159 obese pregnants with a gestational age of 37 weeks and above, with a BMI of 30 and above, who applied to the obstetrics clinic of a university hospital in Izmir between December 2020 and July 2021. Data were collected using the Individual Identification Form, the Prenatal Perceived Stress Scale and the Healthy Lifestyle Behaviors II Scale.&#x0D; &#x0D; Results: It was found that the Healthy Lifestyle Behaviors II Scale mean scores of the obese pregnants included in the study were low and their perceived prenatal stress levels were high. It was determined that there was a negative, significant and high correlation (r= -0.715; p= 0.000) between the mean total score of the Healthy Lifestyle Behaviors II Scale of obese pregnants and the mean scores of the Prenatal Perceived Stress Scale.&#x0D; &#x0D; Conclusion: With a multidisciplinary team, care should be given to obese pregnants to gain healthy lifestyle behaviors and to avoid or manage stress.

Irisin participates in the beneficial effects of exercise in preventing gestational diabetes mellitus in overweight and obese pregnant women and a mouse model.

We aimed to explore whether irisin participates in the beneficial effects of exercise in preventing gestational diabetes mellitus (GDM) in overweight and obese pregnant women. Sixty overweight and obese pregnant women each in the exercise and control groups were randomly selected from our previous randomized controlled trial. Eighteen obese model mice were generated and divided into exercise and control groups in which body weight, abdominal circumference, anal temperature, glucose tolerance test, and insulin tolerance test were recorded. The plasma irisin level, the expression of PGC-1α/FNDC5 and brown (UCP1) and beige adipose (CD137, TMEM26, and TBX-1) marker genes were detected in muscle and adipose tissue. In the human study, women in the exercise group had a significantly higher irisin level and lower insulin resistance level than those in the control group. Enhanced expression of beige adipose tissue marker genes (CD137, TMEM26, and TBX-1) in omental adipose tissue and the CD137 gene in subcutaneous adipose tissue were found in the exercise group compared to the control group. In a mouse model, body weight and abdominal circumference were decreased, while glucose homeostasis and insulin sensitivity were significantly improved, and anal temperature was elevated after exercise intervention. A significantly higher level of irisin was revealed in the exercise group after undergoing exercise treatment. The expression of the beige adipose marker genes CD137 and TBX-1 was significantly higher in the exercise group than in the control group in posterior subcutaneous adipose tissue from the inguinal area and interscapular adipose tissue respectively. Our observations show that regular exercise during pregnancy can increase irisin levels, promote white fat beiging/browning, improve glucose homeostasis and enhance body energy expenditure, which may be one of the mechanisms by which exercise prevents GDM.

Association between maternal obesity, essential fatty acids and biomarkers of fetal liver function

Maternal obesity and the imbalance in linoleic acid (C18:2 n-6, LA) and alpha-linolenic acid (C18:3 n-3, ALA) levels are related with hepatic disturbances in the offspring. However, whether these alterations are present during fetal life is not well understood. Obese and normal weight pregnant women were recruited to determine fatty acids (FAs) consumption, FAs profile (in maternal erythrocytes, placenta and neonatal very low-density lipoproteins VLDL) and biomarkers of fetal liver function, such as gamma-glutamyl transferase (GGT), alpha-fetoprotein (AFP) and albumin, in umbilical cord blood. Stearic acid (C18:0, ST) was lower, and total n-3 FAs tended to be lower in umbilical cord VLDLs of obese women compared to controls. Independently of maternal obesity, GGT levels in umbilical cord blood was positively correlated with the LA content and negatively correlated with the ALA content in maternal erythrocytes. We conclude that maternal obesity and its imbalance of LA and ALA are associated with changes in biomarkers of fetal liver function.

Pre-pregnancy body mass index has greater influence on newborn weight and perinatal outcome than weight control during pregnancy in obese women

BackgroundThe pre-pregnancy weight and gestational weight gain (GWG) are closely related to perinatal maternal and infant complications, but the relationship between pre-pregnancy weight and GWG and the pattern of interaction have not been reported. This study investigated the influence of weight control during pregnancy on the perinatal maternal and infant outcomes.MethodsA total of 835 singleton pregnant women who were hospitalized between January 2018 and December 2018 were retrospectively included in this study and divided into two groups: the diet guidance (DG) group (n = 167) and the control group (n = 668). The pre-pregnancy body mass index (BMI), GWG, and perinatal outcomes of the women and infants were determined in two groups.ResultsThe dietary modification and reasonable exercise during pregnancy effectively reduced the GWG, and even some women with pre-pregnancy obesity achieved weight loss during pregnancy. The GWG in the DG group was significantly lower than in the control group, especially in the second and third trimesters. GWG was positively related to birth weight. The birth weight in the DG group was significantly lower than in the control group when their mothers had similar GWG. In women with pre-pregnancy obesity, GWG seemed to be negatively related to birth weight. However, after adjusting the mean BMI, the pre-pregnancy BMI and GWG were positively related to the birth weight. Compared with the control group, the incidences of dystocia, postpartum hemorrhage, macrosomia, small for gestational age infants and neonatal complications significantly reduced in the DG group, and the preterm birth rate was comparable between two groups. Some women with pre-pregnancy obesity lose weight during pregnancy, but there was no premature birth or small for gestational age infant. The incidences of macrosomia, postpartum hemorrhage, dystocia, cesarean section and gestational diabetes increased significantly with the increase of pre-pregnancy BMI.ConclusionFor women with increased pre-pregnancy BMI, strict weight control is required to reduce obesity-related complications of the mother and infant. The weight control in the second and third trimesters is especially important and most likely to prevent GWG. Compared with GWG, pre-pregnancy BMI has greater influence on the birth weight and maternal and infant complications, and may even compromise the benefits of weight control during pregnancy. Thus, weight control is recommended before pregnancy.

Prolonged pregnancy and stillbirth among women with overweight or obesity – a population-based study in Sweden including 64,632 women

BackgroundThe proportion of overweight or obese pregnant women is increasing in many countries and babies born to a mother who is overweight or obese are at higher risk for complications. Our primary objective was to describe sociodemographic and obstetric factors across Body Mass Index (BMI) classifications, with secondary objective to investigate stillbirth and other pregnancy outcomes in relation to BMI classifications and gestational week.MethodsThis population-based cohort study with data partly based on a cluster-randomized controlled trial includes 64,632 women with singleton pregnancy, giving birth from 28 weeks’ gestation. The time period was January 2016 to 30 June 2018 (2.5 years). Women were divided into five groups according to BMI: below 18.5 underweight, 18.5–24.9 normal weight, 25.0–29.9 overweight, 30.0–34.9 obesity, 35.0 and above, severe obesity.ResultsData was obtained for 61,800 women. Women who were overweight/obese/severely obese had lower educational levels, were to a lesser extent employed, were more often multiparas, tobacco users and had maternal diseases to a higher extent than women with normal weight. From 40 weeks’ gestation, overweight women had a double risk of stillbirth compared to women of normal weight (RR 2.06, CI 1.01–4.21); the risk increased to almost four times higher for obese women (RR 3.97, CI 1.6–9.7). Women who were obese or severely obese had a higher risk of almost all pregnancy outcomes, compared to women of normal weight, such as Apgar score < 7 at 5 min (RR1.54, CI 1.24–1.90), stillbirth (RR 2.16, CI 1.31–3.55), transfer to neonatal care (RR 1.38, CI 1.26–1.50), and instrumental delivery (RR 1.26, CI 1.21–1.31).ConclusionsWomen who were obese or severely obese had a higher risk of almost all adverse pregnancy outcomes and from gestational week 40, the risk of stillbirth was doubled. The findings indicate a need for national guidelines and individualized care to prevent and reduce negative pregnancy outcomes in overweight/obese women. Preventive methods including preconception care and public health policies are needed to reduce the number of women being overweight/obese when entering pregnancy.

Gestational Weight Gain and Small for Gestational Age in Obese Women: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis evaluates the relationship between gestational weight gain and the risk of small for gestational age in obese pregnant women. Studies were identified by searching the Web of Science, Embase, and PubMed databases up to June 30th, 2022. The meta-analysis was carried out to determine the risk of small for gestational age with gestational weight gain (GWG) below the 2009 Institute of Medicine (IOM) guidelines compared with within the guidelines in obese women. The Newcastle-Ottawa Scale was used to assess the methodological quality. The chi-squared test, Q test, and I2 test were used to evaluate statistical heterogeneity. Subgroup analyses were conducted, and publication bias was assessed by funnel plots and Egger's test. Sensitivity analyses were performed for three groups of obese people (I: BMI 30-34.9 kg/m2, II: BMI 35-39.9 kg/m2, and III: BMI ≥ 40 kg/m2) to examine the association of obesity and SGA. A total of 788 references were screened, and 29 studies (n = 1242420 obese women) were included in the systematic review. Obese women who gained weight below the IOM guideline had a higher risk of SGA than those who gained weight within the guideline (OR = 1.27, 95% CI = 1.16-1.38, Z = 5.36). Both weight loss (<0 kg) and inadequate weight (0-4.9 kg) during pregnancy in obese women are associated with an increased risk of SGA (OR = 1.50, 95% CI = 1.37-1.64, Z = 8.82) (OR = 1.18, 95% CI = 1.14-1.23, Z = 8.06). The same conclusions were also confirmed for the three obesity classes (I: OR = 1.38, 95% CI = 1.29-1.47; II: OR = 1.39, 95% CI = 1.30-1.49; and III: OR = 1.26, 95% CI = 1.16-1.37). Subgroup analysis by country showed that GWG below guidelines in obese women of the USA and Europe was associated with risk for SGA (USA (OR = 1.30, 95% CI = 1.15-1.46), Europe (OR = 1.24, 95% CI = 1.11-1.40)) and not in Asia (OR = 1.17, 95% CI = 0.91-1.50). Our findings indicated that obese pregnant women who had weight loss or inadequate weight (0-4.9 kg) according to the IOM guideline had increased risks for SGA. Moreover, we also evaluated that gestational weight loss (<0 kg) in these pregnancies was associated with an increased risk for SGA compared with inadequate weight (0-4.9 kg) in these pregnancies. Therefore, the clinical focus should assist obese women to achieve GWG within the IOM guidelines to decrease the risk for SGA.

The Management of Obese Women in Pregnancy &amp; Neonatal Outcome in Malta

Background: Over the past few years, the rise of obesity in pregnancy has been associated with a rise in pregnancy complications. The aim of this audit was to analyze the current management of obese women in pregnancy at Mater Dei Hospital (MDH). The Royal College of Obstetricians and Gynaecologists (RCOG) green-top guideline: Care of Women with Obesity in Pregnancy which was published in 2018 was used as a standard for this audit. Method: Data was collected from inpatient medical notes of obese mothers who presented at MDH between July 2020 and October 2020. There was no patient contact during data collection and all data was kept anonymous. Results: 53 mothers were recorded as obese between July and October 2020. The average maternal age was 31 years and the average maternal weight was 94kgs at antenatal booking visit. 47% of obese mothers were classified as Class 1 obese. Only 38% of obese mothers had an oral glucose test performed, and 70% of these mothers had a positive test.54.7% delivered via a caesarean section. 12% of neonates required NPICU admission. Conclusion: Pregnancy in women with obesity is an important public health problem with short- and long-term implications for maternal and child health. This audit demonstrates that the management of obese women in pregnancy currently in use at MDH does not follow all the RCOG recommendations. We suggest the need for local guidelines together with the use of patient information leaflets to help improve the care of women with obesity in pregnancy.

Preeclampsia and Obesity-The Preventive Role of Exercise.

Obesity is now recognized as a worldwide epidemic. An inadequate diet and reduced physical activity are acknowledged as the leading causes of excess body weight. Despite growing evidence that obesity is a risk factor for unsuccessful pregnancies, almost half of all women who become pregnant today are overweight or obese. Common complications of pregnancy in this group of women are preeclampsia and gestational hypertension. These conditions are also observed more frequently in women with excessive weight gain during pregnancy. Preeclampsia is one of the most serious pregnancy complications with an unpredictable course, which in its most severe forms, threatens the life and health of the mother and her baby. The early identification of the risk factors for preeclampsia development, including obesity, allows for the implementation of prophylaxis and a reduction in maternal and fetal complications risk. Additionally, preeclampsia and obesity are the recognized risk factors for developing cardiovascular disease in later life, so prophylaxis and treating obesity are paramount for their prevention. Thus, a proper diet and physical activity might play an essential role in the prophylaxis of preeclampsia in this group of women. Limiting weight gain during pregnancy and modifying the metabolic risk factors with regular physical exercise creates favorable metabolic conditions for pregnancy development and benefits the elements of the pathogenetic sequence for preeclampsia development. In addition, it is inexpensive, readily available and, in the absence of contraindications to its performance, safe for the mother and fetus. However, for this form of prevention to be effective, it should be applied early in pregnancy and, for overweight and obese women, proposed as an essential part of planning pregnancy. This paper aims to present the mechanisms of the development of hypertension in pregnancy in obese women and the importance of exercise in its prevention.

The Outcome of Obesity in Pregnancy: A Cross-Sectional Study

Objective: To find out fetal and maternal outcomes among obese pregnant females.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Gynaecology and Obstetrics, Combined Military Hospital Rawalpindi, from Jun 2020 to Jun 2021.&#x0D; Methodology: A total of 124 pregnant obese women (BMI more than 30kg/m2), gestational age between 13-24 months, having fasting blood glucose and blood pressure within normal limits were enrolled in the study and were subsequently followed throughout pregnancy upon antenatal visits scheduled as per guidelines. Participants with diabetes mellitus or hypertension,above 40 years of age, family or previous history of gestational diabetes, and pre-eclampsia were also excluded from the study. Fetal and maternal outcomes were noted.&#x0D; Results: One hundred and twenty-four (124) pregnant obese women were enrolled in the study with a mean age of 33.7±4.1 years (21 -38 years). Out of which, 86(69.4%) had cesarean section primarily due to pre-eclampsia, prolonged or dysfunctional labour causing fetal distress. There were 8 cases of miscarriage and 3 cases of stillbirth. 26(21.0%) women presented with gestational diabetes mellitus, 31(25.0%) with pre-eclampsia and 12(9.7%) developed both conditions. There were 7(5.6%) participants who delivered babies with macrosomia, 1(0.8%) anencephaly, 3(2.4%) congenital deafness and 1(0.8%) cleft lip.&#x0D; Conclusion: Obesity in pregnancy can lead to serious maternal and fetal outcomes ranging from abortions to neonatal anomalies and fetal death. A high index of suspicion is required to diagnose and manage these difficult conditions.