Obesity In Women Of Reproductive Age Research Articles

Overweight and Obesity Affect The Efficacy of Vaginal vs. Intramuscular Progesterone for Luteal-Phase Support in Vitrified-Warmed Blastocyst Transfer

ABSTRACT The prevalence of obesity in reproductive age women continues to increase worldwide. Recent meta-analyses suggest that female obesity is negatively associated with live birth rate (LBR) after in vitro fertilization, as well as a higher risk of miscarriage after euploid embryo transfer. The interplay between adiposity and reproductive hormones such as progesterone may be partially responsible, and research shows that obese women may require higher progesterone supplementation in frozen-thawed embryo transfer (FET). Although the vaginal route of progesterone supplementation has predominated in most in vitro fertilization centers globally, the route of supplementation has been gaining interest. Studies comparing different routes have focused on the general infertility population, and it remains essential to investigate the interrelationship between the routes of progesterone supplementation, overweight/obesity, and treatment outcomes. This retrospective cohort study aimed to compare the difference in the LBR between vaginal progesterone and intramuscular progesterone in cryopreserved blastocyst transfer cycles and assess whether obesity may modify these associations. Patients who underwent a single, vitrified-warmed, blastocyst transfer between January 2018 and June 2021 and received exogenous hormone replacement for endometrial preparation were included. The route of progesterone supplementation was based on patient preference. The primary study outcome was live birth, and secondary outcomes included a positive b-hCG test result, clinical pregnancy, miscarriage, and total pregnancy loss. Normal weight was defined as 18.5–24.9 kg/m2, overweight was defined as a body mass index (BMI) of 25–29 kg/m2, and obese was defined as ≥30 kg/m2. Multivariate regression was used to assess the association between the route of progesterone supplementation and LBR while controlling for known potential covariates, and an interaction analysis was performed with overweight/obesity as the interaction term. A total of 6905 FET cycles from 6251 patients were included for this analysis, with 4616 cycles using vaginal progesterone and 2289 cycles using intramuscular progesterone. The proportions of overweight and obese women were comparable between the 2 groups. After adjusting for confounding variables, the LBR in the vaginal and intramuscular progesterone groups were 46.23% (2134/4616) and 48.62% (1113/2289), respectively (adjusted odds ratio [aOR], 0.89; 95% confidence interval [CI], 0.81–0.98). Although the rates of a positive serum hCG result and clinical pregnancy were similar between the 2 groups, miscarriage rate (15.34% vs 11.40%; aOR, 1.40; 95% CI, 1.20–1.63) and total pregnancy loss (22.22% vs 18.90%; aOR, 1.23; 95% CI, 1.08–1.40) per FET were significantly higher in the vaginal progesterone group than in the intramuscular progesterone group. Among normal-weight women, the LBR was lower in the vaginal progesterone group than the intramuscular progesterone group (aOR, 0.84; 95% CI, 0.75–0.95), and among women with overweight/obesity, the LBR was similar between the 2 groups. Analysis with BMI as a continuous variable on route of progesterone showed a nonlinear relationship between route and LBR after adjustment. Among overweight/obese women, BMI modified the association between route of progesterone and LBR (P interaction = 0.047); however, among women with normal weight, this was not significant (P interaction = 0.569). The result of this study demonstrates that the rate of pregnancy loss for vaginal progesterone was significantly increased and resulted in a lower LBR in patients receiving vitrified blastocysts, and suggested that overweight/obesity influenced the relationship between route of progesterone supplementation and LBR. Interestingly, an LBR advantage for the intramuscular route over the vaginal route was observed exclusively in women with normal weight.

Association of Maternal Pre-Pregnancy Overweight and Obesity with Childhood Anthropometric Factors and Perinatal and Postnatal Outcomes: A Cross-Sectional Study.

Pre-pregnancy overweight and obesity in reproductive-aged women becomes a growing tendency in middle- and high-income populations. This study aimed to evaluate whether maternal excess body mass index (BMI) before gestation is associated with children's anthropometric characteristics, as well as perinatal and postnatal outcomes. This was a cross-sectional study performed on 5198 children aged 2-5 years old and their paired mothers, assigned from 9 different areas of Greece. Maternal and childhood anthropometric data, as well as perinatal and postnatal outcomes, were collected from medical history records or validated questionnaires. Prevalences of 24.4% and 30.6% of overweight/obesity were recorded for the enrolled children and their mothers 2-5 years postpartum. Maternal pre-pregnancy overweight/obesity was more frequently observed in older mothers and female children, and was also associated with high childbirth weight, preterm birth, high newborn ponderal index, caesarean section delivery, diabetes type 1, and childhood overweight/obesity at pre-school age. In multivariate analysis, maternal pre-pregnancy overweight/obesity was independently associated with a higher risk of childhood overweight/obesity at pre-school age, as well as with a higher increased incidence of childbirth weight, caesarean section delivery, and diabetes type 1. Maternal overweight/obesity rates before gestation were related with increased childhood weight status at birth and 2-5 years postpartum, highlighting the necessity of encouraging healthy lifestyle promotion, including healthier nutritional habits, and focusing on obesity population policies and nutritional interventions among women of reproductive age.

Maternal and Fetal Outcomes in Obesity Complicated Pregnancies

Background and Aim: Obesity in reproductive age women is growing to epidemic proportions causing adverse perinatal outcomes and various pregnancy complications. Pregnant women with obesity pose risks for child and maternal health in terms of intrapartum, antenatal, postpartum and neonatal complications. The current study aim was to find the maternal and fetal outcomes in complicated pregnancies of obese women. Methodology: This cross-sectional study was conducted on 164 pregnant women in the Department of Obstetrics and Gynecology, Lahore General Hospital, from April 2021 to March 2022. Prior to study conduction, ethical approval was granted from the institution research and ethical committee. Informed consent was taken from each individual. Based on BMI index for pre-pregnancy, participants were categorized as normal weight (19-25 kg/m2), overweight (25-30 kg/m2), and obese (≥30 kg/m2). All the pregnant women with gestational age of 20 weeks who were willing to participate were enrolled. Underweight women with previous anomaly babies and miscarriage were excluded. Maternal and fetal outcomes were recorded. SPSS version 25 was used for data analysis. Results: The overall mean age of the participants was 26.4±3.61 years. Based on BMI (kg/m2), the participants were distributed as follows; 26.8% (n=44) of normal weight (19-25 kg/m2), 28.1% (n=46) of overweight (25.0 - 30 Kg/m2), and 45.1% (n=74) of obese ((≥30 kg/m2). Majority of overweight and obese women were ≥ 30 years old. Diabetes before pregnancy was strongly related to obesity (16.3%, p<0.0001). Lower weight gain (10.3 ± 6.9 Kg) were seen in obese pregnant women. Comparing to the normal weight women, overweight and obese women physical exercise more often (p=0.01). Obese women were more susceptible to the risk of developing hyperglycemic disturbance (OR= 6.2; 3-10.5), hypertension (OR=6.8, 3.0-15.5), and HbA1c ≥ 6. 5 % (OR=3.5; 1.1-10.8). Longer hospitalization (4.1 ± 2.9 days) was seen in infants born to obese mother (p=0.005). The gestational age babies born from obese mother had a proportion of (14.6%) (p=0.022) with higher abdominal and thoracic circumference (30.7 ± 2.1 cm) and (32.8 ± 1.9 cm) respectively. Conclusion: Our study concluded that adverse perinatal outcomes and pregnancy complications could be caused by obesity in pregnant women. Obese women were more susceptible to increase risk of developing gestational diabetes mellitus, postpartum complications, pregnancy related hypertensive disorders, pre-eclampsia, preterm birth, cesarean section, and longer hospital stay. The importance of weight status before and during pregnancy should be identified to have adequate treatment. Keywords: Pregnancy, Maternal outcomes, Fetal outcomes, Obesity

Multilevel exploration of individual- and community-level factors contributing to overweight and obesity among reproductive-aged women: a pooled analysis of Bangladesh Demographic and Health Survey, 2004-2018.

Overweight and obesity have been related to a variety of adverse health outcomes. Understanding the overweight and obesity epidemic in Bangladesh, particularly among reproductive-aged women, is critical for monitoring and designing effective control measures. The purpose of this study was to determine the prevalence of overweight and obesity in reproductive-aged women and to identify the risk factors of overweight and obesity. A total of 70 651 women were obtained from the five most recent and successive Bangladesh Demographic and Health Surveys (BDHS). The multilevel logistic regression model was used to explore the individual- and community-level factors of overweight and obesity. Five most recent nationally representative household surveys across all regions. Reproductive-aged (15-49 years) non-pregnant women. Approximately 35·2 % (95 % CI: 34·9-35·6 %) of women were either overweight or obese in Bangladesh. At the individual- and community-level, higher age (adjusted odds ratio (aOR) = 5·79, 95 % CI: 5·28-6·34), secondary or higher education (aOR = 1·69 [1·60-1·78]), relatively wealthiest households (aOR = 4·41 [4·10-4·74]), electronic media access (aOR = 1·32 [1·26-1·37]) and community high literacy (aOR = 1·10 [1·04-1·15]) of women were significantly positively associated with being overweight or obese. Whereas, rural residents (aOR = 0·79 [0·76-0·82]) from larger-sized households (aOR = 0·80 [0·73-0·87]) and have high community employment (aOR = 0·92 [0·88-0·97]) were negatively associated with the probability of being overweight or obese. Individual- and community-level factors influenced the overweight and obesity of Bangladeshi reproductive-aged women. Interventions and a comprehensive public health plan aimed at identifying and addressing the growing burden of overweight and obesity should be a top focus.

Metabolic flexibility during normal pregnancy allows appropriate adaptation during gestation independently of BMI.

Overweight and obesity in reproductive-age women hasten the development of insulin resistance and increase risk for deterioration of pregnancy metabolism. These pregnancy-associated metabolic changes are similar to those of the metabolic syndrome. Thus, some metabolic flexibility must allow appropriate adaptation to the metabolic load that pregnancy imposes. We evaluated metabolic flexibility during uncomplicated pregnancy in women with pre-gestational normal weight or overweight. In 20 women with singleton pregnancies, pre-pregnancy BMI was categorized as normal-weight (Nw) or overweight (Ow). The women were seen quarterly, and fasting and postprandial blood samples were collected at each visit. Indirect fasting and/postprandial calorimetry was performed to evaluate metabolic flexibility (Δrespiratory quotient (RQ)=RQpostprandial - RQfasting). In the first trimester, metabolic flexibility was lower in the Ow group compared to the Nw group (0.031±0.0131 vs 0.077±0.018, respectively) without a statistically significant difference (p=0.053). In the second trimester, the Ow group was significantly more flexible than the Nw group (0.190±0.016 vs 0.077±0.015, respectively (p=0.004)). For the third trimester, the Ow and Nw groups did not differ in metabolic flexibility (0.074±0.013 vs 0.087±0.021, respectively) (p=0.40). The most influential variables for metabolic flexibility during pregnancy were lactate, leptin, β-hydroxybutyrate, glycerol, aromatic amino acids, medium and long chain acylcarnitine's. Our findings indicate that metabolic flexibility changes throughout pregnancy, independently of pre-pregnancy BMI. These changes maintain metabolic homeostasis between the mother and foetus, allowing for appropriate adjustments during pregnancy.

Isolated and combined effects of high-intensity interval training and time-restricted eating on glycaemic control in reproductive-aged women with overweight or obesity: study protocol for a four-armed randomised controlled trial

IntroductionOverweight and obesity in reproductive-aged women is a global problem due to the increased risk of subfertility, pregnancy complications and cardiometabolic diseases. High-intensity interval training and time-restricted eating are two...

Dietary Patterns, Physical Activity, and Socioeconomic Associations in a Midwestern Cohort of Healthy Reproductive-Age Women.

To characterize dietary patterns and physical activity in a diverse cohort of Midwestern reproductive-age women and to determine associations between these lifestyle factors, socioeconomic factors, and obesity. In this cross-sectional study, 185 women completed validated food frequency and physical activity questionnaires. Dietary patterns were identified through principal component analysis. Sociodemographic characteristics associated with dietary pattern adherence and physical activity participation were identified through linear regression. Associations between lifestyle factors and obesity were assessed through logistic regression. Two dietary patterns were identified: a "Prudent" pattern characterized by consumption of fruits, vegetables, olive oil, and nuts and a "Western" pattern including meat, refined carbohydrates, and high-calorie drinks. African-American women and women without a college degree were more likely to adhere to the Western dietary pattern than other women. Women in areas with higher socioeconomic deprivation had lower levels of physical activity, especially leisure-time exercise. Women who completed college participated in more leisure-time exercise and had less physically demanding occupations. Obesity was associated with increasing adherence to the Western dietary pattern in a dose-dependent fashion (aOR range 2.68-4.33, 95% CI range 0.69-16.61) but was not associated with adherence to the Prudent pattern (aOR range 0.46-1.06, 95% CI range 0.13-3.41). Increased physical activity was associated with reduced odds of obesity (aOR range 0.28-0.30, 95% CI range 0.10-0.93). This study highlights dietary and physical activity patterns associated with obesity in reproductive-age women. Lifestyle interventions focused on minimizing consumption of the Western diet and increasing physical activity may provide an opportunity to reduce obesity among reproductive-age women.

A systematic review and meta-analysis of intervention characteristics in postpartum weight management using the TIDieR framework: A summary of evidence to inform implementation.

Postpartum weight retention is a significant contributor to obesity in reproductive-aged women, but the key implementation characteristics of postpartum weight management interventions have not been systematically identified to inform policy and practice. This study aimed to evaluate the intervention characteristics associated with weight loss in postpartum women using the Template for Intervention Description and Replication (TIDieR) framework. We searched MEDLINE, CINAHL, EMBASE, PSYCINFO, and EBM databases to identify lifestyle intervention RCTs in postpartum women (within 2years after birth) published up to January 2018. From 4512 studies, 33 studies were included in the systematic review and meta-analysis (n=4960 women). Health professional-delivered interventions had significantly greater weight loss than those delivered by nonhealth professionals (mean difference, 95% confidence interval: (-3.22kg [-4.83, -1.61] vs -0.99kg [-1.53, -0.45], P=0.01 for subgroup differences)). Diet and physical activity combined had significantly greater weight loss compared with physical activity-only interventions (-3.15kg [-4.34, -1.96] vs -0.78kg [-1.73, 0.16], P=0.009 for subgroup differences). The extent of weight loss was not influenced by intervention intensity (duration, number of sessions) and setting (individual or group).

Lingkar pinggang dan lingkar leher dengan kadar kolesterol total pada wanita usia subur obesitas

Waist circumference, and neck circumference correlated to total cholesterol among reproductive-age women with obesityBackground: Dyslipidemia is a metabolic disorder condition that is closely related to cholesterol and obesity. The prevalence of obesity in reproductive-age women (>18 years) in Indonesia increased dramatically. Reproductive age women with obesity are at greater risk of hypercholesterolemia compared with non-obese. Waist circumference (WC), mid-upper arm circumference (MUAC), and neck circumference (NC) can be used as a marker of higher or low cholesterol levels. Objective: This study aimed to determine the relationship between WC, MUAC, and NC with total cholesterol. Methods: The study design was cross-sectional with several subjects were 54 women of reproductive-aged 18-29 years. Subject with obese category (BMI ≥25kg/m2) was measured the WC, MUA, and NC as an independent variable and total cholesterol as the dependent variable, and dietary intake (total fat, cholesterol, and saturated fat) as confounding variables. The bivariate analysis used the Pearson correlation test. Multivariate analysis used multivariate linear regression. Results: Bivariate analysis showed there was a significant relationship between WC and NC to total cholesterol (p=0.006 and p=0.001), but not on MUAC (p=0.063). In multivariate analysis, NC is the most significantly related to total cholesterol (β=0.367; p=0.004; Adjusted R Square 24%) than WC. Conclusions: There is a significant relationship between WC and NC to the total cholesterol in women of reproductive age obesity. NC more significantly related to total cholesterol.

Implications of inflammation and insulin resistance in obese pregnant women with gestational diabetes: A case study

Background:Obesity is one of the leading pregnancy risks for both the mother and the neonate. The prevalence of gestational diabetes mellitus has been increasing, especially with the increase in obesity in reproductive-aged women. A high body mass index, a sedentary lifestyle, a previous macrosomic infant, polycystic ovary syndrome and hypothyroidism are the main risk factors for gestational diabetes mellitus. Early gestational diabetes mellitus detection in high-risk individuals is a useful method for preventing further complications and/or preventing this disease by improving the patient’s lifestyle.Case presentation:A morbidly obese woman with a high body mass index (>36) at 24 weeks gestational age presented with several gestational diabetes mellitus risk factors. Her glucose tolerance test verified gestational diabetes mellitus, and, incidentally, her C-reactive protein level was elevated without obvious reason. Her plasma levels of inflammatory cytokines had also been assessed and were exaggerated. After lifestyle intervention, including weight management, the patient’s inflammatory mediators, including her C-reactive protein level, dropped. Therefore, this study aimed to identify the relationship between the patient’s inflammation and obesity.Conclusion:Antenatal C-reactive protein screening could be used throughout pregnancy to predict inflammation from high-risk pregnant women. This case scenario describes the interrelationships between inflammation, insulin resistance and adipokines, as well as the contributions of hypothyroidism and polycystic ovary syndrome. Further research should emphasise the relationships between inflammation and obesity in pregnancy.

Is ovarian reserve associated with body mass index and obesity in reproductive aged women? A meta-analysis.

The associations of body mass index (BMI) and obesity with ovarian reserve are controversial. This systematic review and meta-analysis was conducted to investigate the associations in reproductive-aged women. PubMed and Scopus were searched up to December, 2016. Original studies on the association of BMI with ovarian reserve markers, anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), inhibin β, and antral follicle count (AFC), either according to BMI categories or a continuous variable, were selected. Analyses were stratified into three groups based on polycystic ovary syndrome (PCOS) and fertility status of women. Of 4,055 records identified, 45 studies were eligible for inclusion. Comparing the obese with nonobese, the pooled mean differences (MDs) and 95% confidence intervals (CIs) were -1.08 (95% CIs -1.52, -0.63) ng/mL for AMH, -0.22 (95% CIs -0.39, -0.06) mIU/mL for FSH, -0.09 (95% CIs -0.60, 0.42) for AFC, and -21.06 (95% CIs -41.18, -0.85) pg/mL for inhibin β in overall populations. The MDs were significant for AMH in fertile non-PCOS and PCOS women, and for FSH only in PCOS women. Fisher's Z showed significant correlations of BMI with AMH in the overall populations (-0.15 [95% CIs -0.20, -0.11]) and in all subgroups, and with FSH in the fertile non-PCOS women (-0.16 [95% CIs -0.28, -0.04]). Ovarian reserve markers of AMH and FSH are significantly lower in obese than in nonobese women, and BMI is negatively correlated with AMH in all study populations, and with FSH in fertile non-PCOS subgroups. PCOS and fertility status do not appear to affect the associations.

Contraceptive Care of Obese Women.

In the United States, 27% of reproductive-aged women are overweight, and 35% are obese. Until recently, contraceptive research excluded women greater than 130% of their ideal body weight. Gaps in data limit evidence-based decision making for effective contraceptive counseling and management in this rapidly growing population. The aims of this summary are to review the benefits, adverse effects, and risk factors associated with contraceptive methods in obese women, with special attention to effectiveness, and provide contraceptive management and counseling recommendations for best clinical practice. We performed a thorough search of PubMed for current literature, including original research articles, review articles, and guidelines on contraceptive counseling and management in obese women in the United States. We reviewed the body of evidence with special attention to studies published since recent Cochrane and systematic reviews on this topic. Contraceptive use is safer than pregnancy, especially for obese women who have increased pregnancy risks. Baseline health is compromised by obesity, but contraceptive risks remain low. Long-acting, reversible contraceptive methods offer superior effectiveness, minimal risk, and numerous noncontraceptive benefits across body mass index groups. No substantial evidence supports ineffectiveness of any method in obese women except oral emergency contraception and the patch. Pharmacokinetic changes of obesity associated with other oral methods do not seem to result in clinically significant declines in effectiveness. Future contraceptive efficacy studies should include obese women to better discuss their contraceptive needs. This review is beneficial for all providers caring for reproductive-aged women wanting to avoid unintended pregnancy.

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

A Potential Role for Endoplasmic Reticulum Stress in Progesterone Deficiency in Obese Women.

Obesity in reproductive-aged women is associated with a shorter luteal phase and lower progesterone levels. Lipid accumulation in follicles of obese women compromises endoplasmic reticulum (ER) function, activating ER stress in granulosa cells. We hypothesized that ER stress activation in granulosa-lutein cells (GLCs) would modulate progesterone production and contribute to obesity-associated progesterone deficiency. Pretreatment with an ER stress inducer, tunicamycin or thapsigargin, inhibited human chorionic gonadotropin (hCG)-stimulated progesterone production in cultured human GLCs. Pretreatment of human GLCs with tunicamycin inhibited hCG-stimulated expression of steroidogenic acute regulatory protein (StAR) and 3β-hydroxysteroid dehydrogenase (3β-HSD) messenger RNAs (mRNAs) without affecting expression of cytochrome P450 cholesterol side-chain cleavage enzyme (P450scc), as determined by real-time quantitative polymerase chain reaction. Pretreatment with tunicamycin also inhibited hCG-stimulated expression of StAR protein and 3β-HSD enzyme activity in cultured human GLCs, as determined by Western blot analysis and an enzyme immunoassay, respectively, but did not affect hCG-induced intracellular 3',5'-cyclic adenosine monophosphate accumulation. Furthermore, tunicamycin attenuated hCG-induced protein kinase A and extracellular signal-regulated kinase activation, as determined by Western blot analysis. In vivo administration of tunicamycin to pregnant mare serum gonadotropin-treated immature mice prior to hCG treatment inhibited the hCG-stimulated increase in serum progesterone levels and hCG-induced expression of StAR and 3β-HSD mRNA in the ovary without affecting serum estradiol levels or the number of corpora lutea. Our findings indicate that ER stress in the follicles of obese women contributes to progesterone deficiency by inhibiting hCG-induced progesterone production in granulosa cells.

Type 1 and Type 2 Diabetes Preconception and in Pregnancy: Health Impacts, Influence of Obesity and Lifestyle, and Principles of Management.

Preexisting diabetes in pregnancy results in increased risks to the mother, fetus, and neonate. Preconception care is vital to reduce risk of miscarriage, congenital malformations, and perinatal mortality. Preconception care should empower women with realistic goal setting, healthy lifestyle, and diabetes self-management skills, to ensure a positive experience of the pregnancy and to reduce diabetes-related distress. In high-risk women without known diabetes, preconception and early antenatal screening is crucial to enable prompt treatment of hyperglycemia and any complications. The prevalence of obesity in reproductive age women is rising, further increasing risk of poor pregnancy outcomes in women with diabetes. Adverse lifestyle factors should be addressed preconception and in the antenatal period, allowing opportunity to improve physical health, manage weight, and improve neonatal outcomes. Management of diabetes in pregnancy involves individualized and intensified insulin therapy, accounting for expected changes in insulin sensitivity, and minimizing glucose variability and hypoglycemia. Diabetes complications must be screened for and managed as necessary. Delivery timing will depend on fetal surveillance and obstetric considerations. It is important to maintain engagement and motivation of these women in the postpartum period, encouraging breastfeeding and postpartum weight management and supporting diabetes management.

Obesity Before, During, and After Pregnancy: A Review and Comparison of Five National Guidelines.

This study aims to compare how national guidelines approach the management of obesity in reproductive age women. We conducted a search for national guidelines in the English language on the topic of obesity surrounding the time of a pregnancy. We identified six primary source documents and several secondary source documents from five countries. Each document was then reviewed to identify: (1) statements acknowledging increased health risks related to obesity and reproductive outcomes, (2) recommendations for the management of obesity before, during, or after pregnancy. All guidelines cited an increased risk for miscarriage, birth defects, gestational diabetes, hypertension, fetal growth abnormalities, cesarean sections, difficulty with anesthesia, postpartum hemorrhage, and obesity in offspring. Counseling on the risks of obesity and weight loss before pregnancy were universal recommendations. There were substantial differences in the recommendations pertaining to gestational weight gain goals, nutrient and vitamin supplements, screening for gestational diabetes, and thromboprophylaxis among the guidelines. Stronger evidence from randomized trials is needed to devise consistent recommendations for obese reproductive age women. This research may also assist clinicians in overcoming one of the many obstacles they encounter when providing care to obese women.

Obesity in pregnancy – The bigger issues

<p style="margin-bottom: 0in;"><span style="color: #231f20;"><span style="font-family: Times New Roman,serif;"><span style="font-size: small;">Maternal obesity increases the risk of poor pregnancy outcomes, including infertility, miscarriage, foetal anomalies, hypertensive disorders of pregnancy, gestational diabetes mellitus, risk of induction and failed induction, prolonged labour, caesarean section, post partum haemorrhage, infection and anaesthetic complications. As the prevalence of obesity in reproductive aged women is increasing, the practicing clinician must be aware of the risks and current management strategies to facilitate a healthy pregnancy and delivery in these women.</span></span></span> <span style="font-family: Times New Roman,serif;"><span style="font-size: small;">DOI: <a href="http://dx.doi.org/10.4038/sljog.v35i1.6002">http://dx.doi.org/10.4038/sljog.v35i1.6002</a></span></span> <span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><em>Sri Lanka Journal of Obstetrics and Gynaecology </em></span></span><span style="font-family: Times New Roman,serif;"><span style="font-size: small;">2013; </span></span><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><span style="font-weight: normal;">35</span></span></span><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><span style="font-weight: normal;">:</span></span></span><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"> 29-33</span></span>

Associations Between Poor Sleep Quality and Psychosocial Stress with Obesity in Reproductive-age Women of Lower Socioeconomic Status

BackgroundPrior studies have not examined the role of psychosocial stress in the relationship between poor sleep quality and obesity among women of lower socioeconomic status (SES). We tested the following hypotheses in a sample of reproductive-age women of lower SES: 1) Poor sleep quality is related to increased risk of obesity, and 2) psychosocial stress confounds this association between poor sleep quality and obesity. MethodsA total of 927 women age 16 to 40 years attending public health clinics in Southeastern Texas provided information on the Pittsburgh Sleep Quality Index and sociodemographic and health characteristics, including the Perceived Stress Scale. Height, weight, and waist circumference (WC) were measured in clinic. A series of models examined the associations between sleep disturbance, perceived stress, and weight outcomes, accounting for potential confounding factors. ResultsNearly 30% of women were overweight, and 35% were obese. Half of women had a WC of greater than 35 inches. Most women had poor sleep quality and high levels of stress. Sleep quality and perceived stress were not related to body mass index category or WC in models that adjusted for age and race/ethnicity. Adjusting for potential confounding factors did not alter results. Perceived stress did not modify the association between sleep quality and weight outcomes. ConclusionsPoor sleep quality and psychosocial stress were not related to weight in reproductive-aged women of lower SES. However, poor sleep quality, high stress, overweight, and obesity were common in this group.

Overweight and Obesity in the Reproductive-Age Population of the Central Pennsylvania Women’s Health Study

Over 54% of currently non-pregnant women aged 18-45 in Central Pennsylvania are overweight or obese. To examine the overall health effects in women, the Central Pennsylvania Women’s Health Study (CePAWHS) had 2,002 women aged 18-45 complete a Random Digit Dial (RDD) general population telephone interview on their health status and health risk indicators for adverse pregnancy outcomes. This study of the CePAWHS population examined the correlates of overweight and obesity in a unique sample of reproductive-age women. The survey measured a large number of health-related variables including pregnancy history. This study also considered whether the definition of obesity affects the identification of correlates. Telephone interview participants were categorized as normal overweight or obese according to the BMI index and analyzed as BMI continuous. ANOVA and Chi-square tests were used to examine differences between BMI continuous and categorical variables. Odds ratios from logistic regression models and linear regression from ANCOVA were used to examine cross-sectional associations of the BMI continuous and categorical. Of the population, 27% were overweight and 25% obese using the BMI index and had a mean BMI of 26.99 ± 6.95. Other variables analyzed included environmental factors, pregnancy outcomes, and health habits and conditions. This research found that obesity in reproductive-age women is associated with a variety of environmental and health-related factors.

P1-420 Fibre intake and evolution of body mass index: from prepregnancy to postpartum

BackgroundPostpartum weight retention is important risk factor for obesity in reproductive age women. The role of fibre intake still needs clarification, being among those dietetic factors that may be associated...