Obese Women Of Reproductive Age Research Articles

The Impact of Pregnancy on Outcomes After Bariatric Surgery.

Bariatric surgery is performed mostly on obese women of reproductive age. Many studies have analyzed pregnancy outcomes after bariatric surgery, but only a small number have studied the impact of pregnancy on the postoperative outcomes. To study the effect of pregnancy on outcomes after bariatric surgery in women of childbearing age. From January 2010 to October 2017, a retrospective study of a prospectively maintained database was conducted at the University Hospital of Geneva (HUG), where 287 women between the ages of 18 and 45years had undergone Roux-en-Y gastric bypass (RYGB). A comparison of the results during a 5-year follow-up was performed between women who became pregnant after their bariatric surgery (pregnancy group, n = 40) and postoperative non-pregnant women (non-pregnancy group, n = 247). The two groups were compared for weight loss, complications, and nutritional deficiencies. The pregnancy group was significantly younger (29.2 ± 5.5 vs. 36.4± 6.3years, p < 0.001) and heavier (124.0 ± 18.0kg vs. 114.7 ± 17.1, p < 0.001) compared with the non-pregnancy group at the time of surgery. The percentage of excess BMI loss (%EBMI loss) was similar in both groups during the 5-year follow-up. Complications after RYGB and nutritional deficiencies were nearly identical in the two groups. The interval of time between bariatric surgery and first pregnancy was a median of 20.8months. Out of 40 first pregnancies, 28 women completed pregnancy successfully with live birth. Pregnancy after bariatric surgery is safe and does not adversely affect outcomes after RYGB.

Pilot randomized trial of short-term changes in inflammation and lipid levels during and after aspirin and pravastatin therapy

BackgroundInflammation and elevated blood lipids are associated with infertility. Aspirin and statin therapy may improve infertility treatment outcomes among overweight and obese women with systemic inflammation, but little is known about the short-term effects of statins in this population. We conducted a pilot study of aspirin, pravastatin, or combined treatment among a group of overweight and obese, reproductive-aged women. Our goal was to characterize short-term changes in inflammatory and lipid biomarkers during and after treatment.MethodsIn this open-label trial, women aged 18–40 years with a body mass index ≥25 kg/m2 were randomized to receive either 162 mg aspirin, 40 mg pravastatin, or both. The study medication was taken daily for 2 weeks, and participants were then followed for a two-week washout period. Participants provided blood samples at baseline, after the intervention period, and after the washout period. The outcomes were changes in biomarkers of inflammation and lipids measured in blood components at each timepoint.ResultsNine, 8, and 8 women were randomized to the aspirin, pravastatin, and combined arms, respectively. Analyses were conducted among 8, 7, and 7 women in the aspirin, pravastatin, and combined arms for whom biomarker data was available at baseline. High-sensitivity C-reactive protein (hsCRP) levels were lower after treatment in all arms and continued to decrease after washout in the pravastatin and combined arms. Results were consistent between the whole sample and women with baseline hsCRP between 2 and 10 mg/L. Low-density lipoprotein (LDL) cholesterol was lower after treatment in the pravastatin and combined arms and rose slightly after washout.ConclusionsOur results provide preliminary evidence that short-term aspirin and pravastatin therapy reduces hsCRP and LDL cholesterol among overweight and obese women of reproductive age, including those with low-grade inflammation. Because of these short-term effects, these drugs may improve infertility treatment outcomes in this population, which we will assess in a future randomized trial.

Associations Between Thyroid Hormones Within the Euthyroid Range and Indices of Obesity in Obese Chinese Women of Reproductive Age.

Background: A number of researches have reported that thyroid hormones are associated with obesity. However, the relationship of serum levels of thyroid hormones in the normal range with obesity and parameters of obesity in women of childbearing age remains controversial. The purpose of this study was to examine serum levels of thyroid hormones within the normal range in obese Chinese women of reproductive age and to investigate the relationship between concentration of thyroid hormones and indices of obesity, including body mass index (BMI), waist-to-hip ratio (WHR), insulin resistance, blood glucose, blood lipids, and blood pressure. Methods: One hundred fifty-one obese women of reproductive age and 160 nonobese women of reproductive age were enrolled in this study. Serum levels of thyroid-stimulating hormone (TSH) of all subjects were within the normal reference range (0.35-4.94 mIU/L). The serum levels of free triiodothyronine (FT3), free thyroxine (FT4), and TSH, height, body weight, BMI, waist and hip circumferences, WHR, fasting blood glucose (FBG), fasting insulin (FI), homeostasis model assessment of insulin resistance (HOMA-IR), total triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured in all subjects. Quantile regression analysis was used to analyze the associations of serum levels of FT3, FT4, and TSH with values of BMI, WHR, FBG, FI, HOMA-IR, TG, TC, LDL-C, HDL-C, SBP, and DBP. Results: In the group of obese women, serum levels of FT4 were lower (P < 0.001) and serum levels of TSH were higher (P < 0.001) compared with nonobese controls. After adjusting for covariables, quantile regression analysis showed that serum levels of FT4 were inversely associated with BMI values between the quantile levels of 0.29 and 0.60 of BMI (i.e., BMI level of 22.49 and 28.31 kg/m2, respectively). Meanwhile, we found that serum levels of TSH positively correlated with BMI values after the quantile level of 0.51 (i.e., BMI level of 27.06 kg/m2), positively associated with TC after the quantile level of 0.6 (i.e., TC level of 4.86 mM), and positively associated with LDL-C after the quantile level of 0.39 (i.e., LDL level of 1.96 mM). No significant associations were found between serum levels of thyroid hormones and values of WHR, FBG, FI, HOMA-IR, TG, HDL-C, SBP, and DBP. Conclusions: FT4 and TSH play an important role in regulating the weight in women with normal thyroid function during their reproductive years. Women with decreased serum FT4 or increased serum TSH levels have a higher risk of developing obesity. Besides, TSH has a significant influence on metabolism of blood lipids. Women with higher serum levels of TSH have a higher risk of incidence of lipid metabolism disorders.

A unique androgen excess signature in idiopathic intracranial hypertension is linked to cerebrospinal fluid dynamics.

Idiopathic intracranial hypertension (IIH) is a condition of unknown etiology, characterized by elevated intracranial pressure frequently manifesting with chronic headaches and visual loss. Similar to polycystic ovary syndrome (PCOS), IIH predominantly affects obese women of reproductive age. In this study, we comprehensively examined the systemic and cerebrospinal fluid (CSF) androgen metabolome in women with IIH in comparison with sex-, BMI-, and age-matched control groups with either simple obesity or PCOS (i.e., obesity and androgen excess). Women with IIH showed a pattern of androgen excess distinct to that observed in PCOS and simple obesity, with increased serum testosterone and increased CSF testosterone and androstenedione. Human choroid plexus expressed the androgen receptor, alongside the androgen-activating enzyme aldoketoreductase type 1C3. We show that in a rat choroid plexus cell line, testosterone significantly enhanced the activity of Na+/K+-ATPase, a surrogate of CSF secretion. We demonstrate that IIH patients have a unique signature of androgen excess and provide evidence that androgens can modulate CSF secretion via the choroid plexus. These findings implicate androgen excess as a potential causal driver and therapeutic target in IIH.

Non-alcoholic fatty liver disease and polycystic ovarian syndrome in lean and obese women of reproductive age

Non-alcoholic fatty liver disease and polycystic ovarian syndrome in lean and obese women of reproductive age

Carotidintima-mediacomplexthickness and sex steroid levels in severly obese women of reproductive age

Carotidintima-mediacomplexthickness and sex steroid levels in severly obese women of reproductive age

Subclinical hypothyroidism is not a risk factor for polycystic ovary syndrome in obese women of reproductive age

Obese women are at high risk for polycystic ovary syndrome (PCOS). Subclinical hypothyroidism (SCH) has been associated with weight gain, insulin resistance and impaired fertility, which are also factors involved in PCOS. However, there is limited information regarding the influence of SCH on the presence of PCOS. In order to determine whether SCH increases the prevalence of PCOS, we performed a cross-sectional study in a cohort of reproductive-aged obese women. All subjects underwent anthropometric evaluation, laboratory tests and ultrasound examination. Diagnosis of PCOS was based on the Rotterdam criteria. A total of 534 obese women were included and 108 (20.2%) of them were diagnosed with SCH. Patients with SCH showed similar insulin resistance, comparable androgen levels, and higher triglycerides levels (1.7 vs. 1.5 mmol/L, p = .002) compared to those with normal thyroid status. The frequency of PCOS did not differ between the two groups (56.1% for normal thyroid function vs. 60.2% for subclinical hypothyroidism, p = .514). In logistic regression analysis, SCH was not an independent risk factor for PCOS after adjusting for confounding factors (OR = 0.984, 95% CI 0.581–1.667). For the first time, our results suggest that SCH does not increase the risk of PCOS in obese women of reproductive age.

Relationship Between Sleep Quality and Overweight and Obesity in Women of Reproductive Age Referred to Health Centers in Yazd

Objectives: The present study aimed at determining the relationship between sleep quality and overweight and obesity in women of reproductive age referred to health centers and bases in Yazd in 2014-2015. Materials and Methods: A total of 450 women of reproductive age with a body mass index (BMI) of >18.5 were participated in this study and divided into 3 equal groups (n = 150) of normal weight, overweight, and obese. Instruments used in this study were the Pittsburgh Sleep Quality Index (PSQI) and a socio-demographic questionnaire. Data from the questionnaires were completed by the participants and analyzed using statistical methods. Results: In this study, 66% of normal weight women of reproductive age had an acceptable sleep quality, while 77% of overweight and 93% of obese women of reproductive age had poor sleep quality, respectively. The results of this study showed that a significant correlation existed between BMI of normal weight women of reproductive age and the components of sleep quality (P = 0.001). An inverse significant relationship was also found between BMI of overweight women of reproductive age and the components of sleep quality (P < 0.05) and finally, an inverse significant relationship was also found between BMI of obese women of reproductive age and the components of sleep quality (P < 0.05). A significant relationship also existed between socio-demographic and components of sleep quality (P < 0.05). It seems that among the components of sleep quality, the effect of sleep disorder, impaired daily functioning, and consumption of hypnotic drugs was higher than sleep duration and good sleep in overweight and obesity. Conclusion: The results of this study revealed that women of reproductive age with overweight and obesity have poor sleep quality. Among components of sleep quality, sleep disorder, impaired daily functioning, and consumption of hypnotic drugs have the most important role in reducing sleep quality. It seems that change in lifestyle can improve sleep quality and thus can reduce BMI

Prevalence of polycystic ovary syndrome in Chinese obese women of reproductive age with or without metabolic syndrome

To compare the prevalence of polycystic ovary syndrome (PCOS) and related clinical characteristics between metabolically unhealthy obese (MUO) and metabolically healthy obese (MHO) women of reproductive age. Cross-sectional clinical study. Tertiary hospital. We studied 299 MUO and 122 MHO Chinese women matched on body mass index. Metabolically healthy obese was defined as obesity with no more than one metabolic abnormality. Diagnosis of PCOS was based on the revised Rotterdam criteria. Each subject underwent physical examination, laboratory evaluation, and gynecologic ultrasound for a diagnosis of PCOS or metabolic syndrome (MetS). Prevalence of PCOS was calculated in both groups. Insulin resistance was determined by homeostasis model assessment of insulin resistance or by the insulin sensitivity index derived from Bergman's minimal model. Fat distribution was measured with computerized tomography scan. Prevalence of PCOS and its components did not differ between MUO and BMI-matched MHO groups (67.89% and 66.96%, respectively). In logistic regression analysis, MetS did not predict the presence of PCOS after adjusting for confounding factors. The MHO group had lower visceral adipose tissue, relatively higher insulin sensitivity, and better β-cell function, compared with those in the MUO group; but there were no significant differences in sex hormones (except for free T and sex hormone-binding globulin) and ultrasound manifestations between MHO and MUO women. For the first time, our findings suggest that MetS does not add additional risk for PCOS. In addition, we found that both MUO and MHO are associated with insulin resistance to some extent.

Testosterone increases CCL-2 expression in visceral adipose tissue from obese women of reproductive age

ContextHyperandrogenic states and obesity in women are associated with insulin-resistance. Androgens reduce glucose uptake in adipose cells and increase TNFα production in peripheral monocytes. Inflammatory cytokines have a known detrimental effect on insulin resistance. The aim of the present study was to explore the role of testosterone in local cytokine production in visceral adipose tissue from women of reproductive age. DesignTwenty-four women 18–40 years old, undergoing elective abdominal surgery for benign and non-inflammatory conditions, were recruited for the study. Women with clinical hyperandrogenism, diabetes, hepatic or renal dysfunction, hypothyroidism, BMI> 40 or drugs known to interfere with hormonal levels or fat metabolism were excluded. Women were classified into two groups according to BMI, non-obese (NO; BMI < 30) and obese (O; BMI 30–40). A basal blood sample was drawn at the time of surgery for the measurement of glucose, insulin, total testosterone, lipid profile and circulating CCL-2, IL-6 and total adiponectin. Omental fat tissue (10 g) was obtained in all women. Samples of 300 mg of minced adipose tissue were incubated with vehicle (CTL) or testosterone (T) 10−9 M to 10−6 M for 24, 48 or 72 h. CCL-2, IL-6, TNFα, androgen Receptor (AR) mRNA levels were measured by Real Time quantitative polymerase chain reaction (qPCR) and normalized to GAPDH expression. Secretion of CCL-2 and IL-6 was measured in conditioned media by ELISA. ResultsExpression of CCL-2 and IL-6 at 24 h in CTLs was significantly higher in the obese group compared to the non-obese group (2.81 ± 0.43 fold for CCL-2; p = 0.005 and 3.26 ± 0.73 fold for IL-6; p = 0.03). At 48 and 72 h there were no differences between both groups in any of the markers. In the total group without T stimulation (CTL) there were significant correlations between: TNFα expression at 24 h and BMI (r = 0.708; p = 0.005), TGC levels (r = 0.904; p = 0.004), total Cholesterol (r = 0.904; p = 0.0046) and IL-6 expression at 24 h (r = 0.642; p = 0.015). CCL-2 expression at 24 h was correlated with BMI (r = 0.637; p = 0.007) and TGC levels (r = 0.700; p = 0.02). Stimulation with T 10−6 M for 72 h produced an increase in CCL-2 expression, which was significantly larger in the obese group compared to the non-obese group (2.04 ± 0.44 in obese vs 0.82 ± 0.11 in non-obese; p = 0.015). Moreover, in the whole group there was a positive correlation between CCL-2 expression in T-treated tissues (10−6 M 72 h) and BMI (r = 0.514; p = 0.017). Cytokine determinations followed the same pattern as mRNA but without significant differences. ConclusionsTestosterone increases CCL-2 expression in visceral adipose tissue from obese women of reproductive age. This response is associated to BMI. These results show new possible mechanisms connecting androgens to insulin resistance and chronic inflammation.

Perspectives in obesity and pregnancy.

Obesity is currently recognized as a health epidemic worldwide. Its prevalence has doubled in the last three decades. Obesity is a complex clinical picture associated with physical, physiologic, hormonal, genetic, cultural, socioeconomic and environmental factors. The rate of obesity is also increasing in the pregnant women population. Maternal obesity is associated with less than optimal obstetrical, fetal and neonatal outcomes. It is also associated with significant adverse long-term effects on both obese parturients and the infants born from obese women. A number of guidelines have been published to educate health care workers and the general population in an attempt to develop effective interventions on a large scale to prevent obesity. These guidelines are multiple, confusing and inconsistent. There are no standard recommendations regarding gestational weight gaining goals, nutrients and additional elements necessary for certain obese women who have been treated with bariatric surgical procedures, screening for metabolic diseases such as diabetes, additional preventive health care services indicated for obese women in the pregnancy planning stages, during prenatal care, in the immediate post-partum period and as a long-term approach for health preservation. In 2013, the American Medical Association supported by several US national medical specialty organizations published Resolution 420 (A-13) recognizing obesity as a disease state with multiple pathophysiological aspects requiring a range of interventions to improve its prevention and treatment. The goal of this decision was to encourage a broader spectrum of health care benefits insurance coverage for the prevention and treatment of obesity. There are a number of myths and misconceptions associated with obesity. These perspectives present our views and clinical experience with a partial review of recent bibliography addressing the associations between obese reproductive age women and their risks during pregnancy.

Bariatric Surgery in Obese Women of Reproductive Age Improves Conditions That Underlie Fertility and Pregnancy Outcomes: Retrospective Cohort Study of UK National Bariatric Surgery Registry (NBSR)

BackgroundThe aims of this study are the following: to describe the female population of reproductive age having bariatric surgery in the UK, to assess the age and ethnicity of women accessing surgery, and to assess the effect of bariatric surgery on factors that underlie fertility and pregnancy outcomes.MethodsDemographic details, comorbidities, and operative type of women aged 18–45 years were extracted from the National Bariatric Surgery Registry (NBSR). A comparison was made with non-operative cases (aged 18–45 and BMI ≥40 kg/m2) from the Health Survey for England (HSE, 2007–2013). Analyses were performed using “R” software.ResultsData were extracted on 15,222 women from NBSR and 1073 from HSE. Women aged 18–45 comprised 53 % of operations. Non-Caucasians were under-represented in NBSR compared to HSE (10 vs 16 % respectively, p < 0.0001). The NBSR group was older than the HSE group—median 38 (IQR 32–42) vs 36 (IQR 30–41) years (Wilcoxon test p < 0.0001). Almost one third of women in NBSR had menstrual dysfunction at baseline (33.0 %). BMI fell in the first year postoperatively from 48.2 ± 8.3 to 37.4 ± 7.5 kg/m2 (t test, p < 0.001). From NBSR, in the postoperative period, the prevalence of type 2 diabetes fell by 54 %, polycystic ovarian syndrome by 15 %, and any menstrual dysfunction by 12 %.ConclusionsOver half of all bariatric procedures are carried out on women of reproductive age. More work is required to provide prompt and equal access across ethnic groups. At least one in three women suffers from menstrual dysfunction at baseline. Bariatric surgery improves factors that underlie fertility and pregnancy outcomes. A prospective study is required to verify these effects.

Metabolic Disturbances in Obese Pregnant Residents of an Industrial Region (The Urals, Russia)

We sought to investigate the presence of metabolic disturbances in obese pregnant women living in an industrial city in Russia. We retrospectively analyzed the ambulatory cards of 96 pregnant women with alimentary obesity (aged 23-34), their birth history, and their newborn development history (anamnesis). Sixty-two percent of women had obstetric and gynecological complications. Pregnancy complications (gestational diabetes, risk of pregnancy interruption, toxicosis in the first half gestation, gestosis) were experienced in 36% of women. Increased glucose in the blood was accompanied by higher concentrations of atherogenic components (i.e., triglycerides and low density lipoproteins (LDL)). The imbalance of metabolic processes in the homeostatic system of pregnant obese women (total protein: 50.4 g/L, cholesterol: 6.1 mmol/L, LDL: 4.1 mmol//L, high density lipoproteins (HDL): 0.85 mmol/L, triglycerides: 3.5 mmol/L, glucose: 7.0 mmol/L) formed a pathogenic link in the development of obesity. Increased glucose and atherogenic lipid profile and decreased protein levels in the blood promote the processes of the adiposity in women and aggravate the pathological processes of gestation and the postnatal period. Pregnant obese women of reproductive age form a group at high risk of developing complications during gestation and parturition. Obesity is not a contraindication for pregnancy, although the risk of complications is great.

Cost-Effectiveness of Pre-Pregnancy Bariatric Surgery [9C

INTRODUCTION: We sought to determine if bariatric surgery is a cost-effective pre-pregnancy approach to reduce pregnancy complications in obese women. METHODS: We assessed the cost-effectiveness of bariatric surgery prior to becoming pregnant in a theoretical cohort of obese women age 20–39 in the United States. Outcomes included gestational diabetes (GDM), preeclampsia, preterm delivery, cesarean delivery, maternal mortality, and neurodevelopmental disability. All model inputs were derived from the literature. We calculated quality-adjusted life years (QALYs) to compare strategies, accounting for maternal and neonatal utilities. We ran our models with and without consideration of anovulation rates given its substantial impact on QALYs. RESULTS: Pre-pregnancy bariatric surgery led to lower rates of GDM, preeclampsia, and large-for-gestational-age infants, but more small-for-gestational-age (SGA) infants. Overall, no bariatric surgery was the preferred strategy with lower costs and better outcomes. However, when considering the impact on fecundity from improved ovulation rates after bariatric surgery, it would then become cost effective at $2,528 per QALY. Women who underwent pre-pregnancy bariatric surgery had higher rates of preterm delivery, SGA infants, cesarean delivery, maternal death and neonates with neurodevelopmental disabilities. Univariate sensitivity analyses showed that pre-pregnancy bariatric surgery became the preferred strategy when the probability of having an SGA baby became less than 0.121 from a baseline probability of 0.156. CONCLUSION: Bariatric surgery reduces the risk of GDM, preeclampsia and LGA infants, but it is not a cost-effective intervention in obese women of reproductive age. However, in women who are anovulatory, it may be a reasonable approach to improve overall pregnancy outcomes.

Lumbopleural Shunting as an Alternative Cerebrospinal Fluid Diversion Modality for Management of Idiopathic Intracranial Hypertension: Is It Time for a Change?

diopathic intracranial hypertension (IIH), as its name implies, is a disorder characterized by elevated cerebrospinal fluid I (CSF) pressure of an unknown etiology. First reported by Quincke in 1893 as “meningitis serosa,” this clinical syndrome has historically been a matter of serious contention, with its nomenclature subject to substantial changes over time. In 1904, Nonne introduced the term “pseudotumor cerebri.” The syndrome was subsequently renamed “benign intracranial hypertension” by Foley in 1955. With a high proportion of patients demonstrating permanent visual impairment, the term “benign” was deemed inappropriate, and the term “idiopathic” was unanimously adopted. Often considered as a diagnosis of exclusion, IIH predominantly affects obese women of reproductive age and is best defined by myriad symptoms, most commonly headaches, transient obscuration of vision, pulsatile tinnitus, photopsia, backache, retrobulbar pain, diplopia, and severe visual impairment. Analogous to its nomenclature, diagnostic criteria for IIH have evolved considerably to integrate our enhanced understanding of the disease with developments in technology. The original diagnostic classification by Dandy in 1937 included signs of increased intracranial pressure (>25 cm H2O) with normal CSF composition, absence of any localizing signs except abducens nerve palsy, and normal or slit ventricles with no intracranial mass lesion as evident on ventriculography. This classification was initially modified by Smith in 1985 to accommodate the advent of computed tomography, used in diagnosis of IIH primarily to exclude secondary causes predisposing to intracranial hypertension, including space-occupying lesions that were likely unnoticed in the previous era. The modification of the diagnostic

The Impact of Bariatric Surgery on Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis

Polycystic ovary syndrome (PCOS) is a common comorbidity found in obese women of reproductive age. To our knowledge, we are the first to systematically review the literature and perform a meta-analysis on the impact of bariatric surgery on PCOS.

Does pregnancy influence long-term results of bariatric surgery?

BackgroundBariatric surgery is performed mostly on obese women of reproductive age. Many authors have studied pregnancy outcomes after bariatric surgery. Only a small number of studies have analyzed the impact of maternity on the results of bariatric surgery. ObjectivesTo study the effect of pregnancy on long-term outcomes of bariatric surgery. SettingLille University Hospital. MethodsA retrospective study was conducted on 591 women aged 18 to 42 years who had undergone laparoscopic adjustable gastric band (LAGB) surgery or laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery between 1996 and 2012. A comparison of the results after a 5-year follow-up was performed between patients who became pregnant after their bariatric surgery (pregnant group, n = 84) and postoperative nonpregnant women (nonpregnant group, n = 507). ResultsAt the 5-year visit, 84.8% patients were seen. The preoperative body mass index (BMI) was the same in the 2 groups (pregnant group: 47.8±6.9 kg/m2; nonpregnant group: 47.5±7.2 kg/m2; P = .755). The percentage of excess weight loss (%EWL) was lower in the pregnant group at 2 years (pregnant group = 45.9±24.6%; nonpregnant group = 56.9±28.6%, P = .002) but was similar at 5 years (47.7±27.7% versus 49.9±28.9%, P = .644). The decrease in co-morbidities was similar after 5 years. The gestational weight gain (GWG) was higher when the band was deflated during pregnancy (GWG =+12.7±10.5 kg) compared to the band without fluid removal (GWG =+4.9±7 kg) or laparoscopic Roux-en-Y gastric bypass (GWG =+4.4±1.1 kg) (P< .05). ConclusionsPregnancy after bariatric surgery slows down postoperative weight loss but does not affect weight results at 5-year follow-up.

A quasi-experimental design to assess the effectiveness of the federal healthy start in reducing preterm birth among obese mothers.

We assessed the impact of Central Hillsborough Healthy Start (CHHS), a federally-funded program dedicated to improving maternal and infant outcomes in a population of high-risk obese mothers in the socio-economically challenged community of East Tampa in Florida on preterm birth and very preterm birth (VPTB). We utilized hospital discharge records linked to vital statistics data in Florida (2004-2007) to study obese women with a singleton birth, matching mothers in the CHHS catchment area with those from the rest of Florida. We conducted conditional logistic regression with the matched data. Obese mothers in the CHHS service area had a 61% lower likelihood of having a VPTB infant than obese mothers in the rest of the state (AOR = 0.39, 95% CI 0.21-0.70). Obese women of reproductive age may benefit from services from federal Healthy Start programs. Study findings underscore the need for further research to explore the impact of such programs.

Maternal obesity and fetal deaths: results from the Brazilian cross-sectional Demographic Health Survey, 2006.

BackgroundObesity is highly related to negative reproductive health outcomes, but its relationship with spontaneous abortion and stillbirth remains to be understood, especially in transitioning economies. This study aimed to examine the relationship between obesity and spontaneous abortions and stillbirths in a representative sample of the Brazilian population.MethodsCross-sectional study using secondary data of Brazilian women of reproductive age (15–45 years old) from the National Demographic and Health Survey in 2006. Obesity was measured by body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHR). Logistic regression modeling of the survey data was used to evaluate the relationship between obesity and the study outcomes.ResultsThe three obesity markers used were found to be strongly and positively associated with spontaneous abortion and stillbirth occurrence. In the adjusted models, there was strong evidence that for each unit increase in BMI (OR = 1.05; 95%CI: 1.02-1.08) and WHR (OR = 1.32; 95%CI: 1.03-1.69), the odds of having a spontaneous abortion was higher. In addition, compared to those of optimal weight, obese women were more likely to have negative outcomes. Maternal age, parity, skin color, educational level and household income were important covariates for adjustment. A sensitivity analysis among women who had only one pregnancy was also performed and showed similar results.ConclusionObesity is potentially associated with an increased risk of spontaneous abortion and stillbirth in a representative sample of the Brazilian population. These findings are in accordance with previous studies and thus reinforce the need for obstetric care providers to counsel obese reproductive-age women regarding the risks, complications and importance of weight loss and weight control prior to pregnancy.

Increased vitamin D-binding protein and decreased free 25(OH)D in obese women of reproductive age

Obese subjects have lower circulating 25-hydroxyvitamin D (25(OH)D) than normal-weight subjects. Knowledge is scarce regarding differences in vitamin D-binding protein (DBP), free 25(OH)D, and intake of vitamin D between normal-weight and obese subjects. The purpose of this study was to examine intake and vitamin D status in obese compared with normal-weight women. Between September 2009 and October 2011, 43 obese and 43 normal-weight women, 22-45 years of age, mean BMI of 39.1 ± 4.6 and 21.6 ± 1.8 kg/m(2), respectively, were recruited in the western Sweden region (latitude 57°N). Blood samples, data regarding diet, and sun exposure were collected. DBP concentrations were 320 ± 121 and 266 ± 104 μg/mL (P = 0.02) in obese and normal-weight women, respectively. Calculated free 25(OH)D was 13.3 ± 5.5 (obese) and 23.7 ± 10.7 (normal-weight) (P < 0.001). The obese women had a 20.1 nmol/L lower mean 25(HO)D concentration compared to normal-weight women (P < 0.001). 56 % of obese women and 12 % of normal-weight women had 25(OH)D concentrations ≤50 nmol/L. There was no statistically significant difference in total vitamin D intake between the groups. 39 % of the women had a total vitamin D intake <7.5 μg/day, the current national recommendation for vitamin D in Sweden. Obese women had higher DBP concentrations compared with normal-weight women and lower free 25(OH)D. The obese women were more likely to have 25(OH)D concentrations that could be considered suboptimal. Vitamin D intake was generally low in normal-weight and obese women of childbearing age.