Obesity-related Pregnancy Complications Research Articles

The impact of bariatric surgery on pregnancy complication rates.

Obesity is associated with multiple pregnancy-related complications. Bariatric surgery is frequently performed in women of childbearing age. While the impact of bariatric surgery on fertility and nutritional complications has been characterized, few studies on effects of bariatric surgery on obesity-related pregnancy complications exist. The purpose of this study is to examine the impact of bariatric surgery on pregnancy complications in a US insured population. Pregnancy-related claims from 2011-2019 were obtained from MarketScan commercial claims database for bariatric surgical patients and non-surgical patients with no history of obesity. Claims were grouped into 3 time periods: pre-surgery (time of first claim to date of surgery), peri-surgery (date of surgery to 24month postoperatively), and post-surgery (> 24month postoperatively). Peri-surgery period was defined based on the recommendation to avoid pregnancy for the first 12-24monthsfollowing surgery. Codes for both maternal and fetal pregnancy-related complications were extracted from the database. Standardized incidence rates in person-months (pms) were calculated and generalized estimating equations with Poisson distribution tested for differences in each category at the three time intervals. The final cohort included 163612 female bariatric surgery patients. The rate of successful births was 3/1000pms in the pre-surgery and peri-surgery period and increased to 4/1000pms in the post-surgery period, compared to a rate of 7/1000 in the control group. The rate of pregnancy complications in the pre-surgery group was 4/1000pms and dropped to 2/1000pms in the peri- and post-surgery periods. The complication rate in the control group was 4/1000pms. After bariatric surgery, the rate of pregnancy complications is lower than non-obese, non-bariatric surgery patients. Compared to before surgery, pregnancy complications decrease by 63% in the peri-surgery period and 57% in the post-surgery period. In the US, bariatric surgery is an important intervention for decreasing pregnancy complications in patients with obesity.

Impact of Pregnancy on Weight Loss After Endoscopic Sleeve Gastroplasty

PurposeObesity and pregnancy are strictly related: on the one hand, obesity—one of the most common comorbidities in women of reproductive age—contributes to infertility and obesity-related pregnancy complications, whereas pregnancy is a condition in which, physiologically, the pregnant woman undergoes weight gain. Endoscopic sleeve gastroplasty (ESG) may be used for the treatment of obesity in women of childbearing age.Materials and MethodsA retrospective analysis was conducted to evaluate weight trajectories, the evolution of obesity-related comorbidities, and lifestyle modification in women who became pregnant after ESG. A comparison was made between childbearing-age women who became pregnant after ESG and non-pregnant women.ResultsA total of 150 childbearing-age women underwent ESG at a large tertiary medical center. Of these, 11 patients (33.4 ± 6.2 years) became pregnant after the procedure, following a mean time interval of 5.5 ± 3.9 months. Three women (two affected by polycystic ovary syndrome) reported difficulty getting pregnant before undergoing ESG. The mean preconception BMI was 31.9±4.0 kg/m2 (−7.24 ± 4.0 kg/m2 after ESG). Total body weight loss (TBWL, %) was 18.08 ± 8.00, 11.00 ± 11.08, and 12.08 ± 8.49, at the beginning of pregnancy, at the delivery, and at the first follow-up (19.6 ± 7.8 months after ESG). TBWL of at least 5% was achieved before pregnancy in all patients (73% reached a TBWL ≥ 10%).No significant differences in weight loss and QoL were found between the pregnancy and non-pregnancy groups up to 24 months after ESG.ConclusionsEndoscopic sleeve gastroplasty allows for adequate weight loss before and after pregnancy in patients with obesity.Graphical

Gebelik Planlayan Kadınların Beden Kitle İndeksi, Obezite ve Gebelik İlişkisi Farkındalıkları

INTRODUCTION: Adequate knowledge about body mass index (BMI), which is a traditional method of measuring obesity, and about obesity-related pregnancy risks will possibly decrease obesity-related pregnancy complications in women contemplating pregnancy. In this study, we aimed to determine knowledge levels of women contemplating pregnancy about BMI and pregnancy risks related with obesity. METHODS: In this cross-sectional study, our sample was 211 married women age 18 to 45 years old who visited a family physician in Fındıklı Center of Goitre Research and Treatment between June to August 2020. Patients completed the questionnaire including sociodemographic data, questions about BMI and questions about effects of obesity on pregnancy via the face-to-face interview method. The data was analyzed using statistical analysis program. RESULTS: The mean age of participants (n=211) was 31.7 ± 5.9 years. Of the participants, 40.3% (n=85) stated that they received pre-pregnancy counseling and 37.4% (n=79) had BMI score between 25 to 29.9. The mean BMI knowledge score of participants was 0.99±0.69 out of 5, and the mean BMI knowledge score of participants who received preconceptional counselling was significantly higher than those who did not (p=0.01). The mean BMI knowledge score of participants who stated 'high' or 'very high' risk level for each complication during pregnancy of a morbid obese woman was significantly higher than those of the remaining groups (p<0.05). In case of that a morbid obese woman loses weight before pregnancy, the mean BMI knowledge score of participants who stated 'lower' or 'much lower' risk level for each complication during pregnancy significantly higher than those of the remaining groups (p<0.05). DISCUSSION AND CONCLUSION: In our study, we determined women who contemplating pregnancy had inadequate BMI knowledge levels, but had adequate awareness about effects of obesity on pregnancy and potential pregnancy risks related obesity. The conversation of family physicians about BMI with their patients will ensure them to realise their own weight as well as effective prevention and management of obesity, and will increase awareness of women contemplating pregnancy about obesity related pregnancy risks.

Relation of High Maternal Body Mass Index to Perinatal and Maternal Outcome

Worldwide, obesity is the prevalent, chronic medical condition (1). The rate of obesity in pregnant women is rising, increasing the significance of its impact on obesity-related pregnancy complications.(2) Maternal body mass index (BMI) is one of the predictors of the nutritional status of pregnant ladies. The problem of rising obesity is not unique to India. In earlier research, the relationship between maternal height and weight with pregnancy complications have been extensively explored, but in recent times, BMI is widely accepted as a better measure of over or underweight [3].

Relationship between Maternal Central Obesity and the Risk of Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of Cohort Studies.

Objective Nowadays, body mass index (BMI) is used to evaluate the risk stratification of obesity-related pregnancy complications in clinics. However, BMI cannot reflect fat distribution or the proportion of adipose to nonadipose tissue. The objective of this study is to evaluate the association of maternal first or second trimester central obesity with the risk of GDM. Research Design and Methods. We searched in PubMed, Embase, and Web of Science for English-language medical literature published up to 12 May 2019. Cohort studies were only included in the search. Abdominal subcutaneous fat thickness, waist circumference, waist-hip ratio or body fat distribution were elected as measures of maternal central obesity, and all diagnostic criteria for GDM were accepted. The random effect meta-analysis was performed to evaluate the relationship between central obesity and the risk of GDM. Results A total of 11 cohort studies with an overall sample size of 27,675 women and 2,226 patients with GDM were included in the analysis. The summary estimate of GDM risk in the central obesity pregnant women was 2.76 (95% confidence interval [CI]: 2.35–3.26) using the adjusted odds ratio (OR). The degree of heterogeneity among the studies was low (I2 = 14.4, P = 0.307). The subgroup analyses showed that heterogeneity was affected by selected study characteristics (methods of exposure and trimesters). After adjusting for potential confounds, the OR of adjusted BMI was significant (OR = 3.07, 95% CI: 2.35–4.00). Conclusions Our findings indicate that the risk of GDM was positively associated with maternal central obesity.

Preconception consultations with Maternal Fetal Medicine for obese women: a retrospective chart review

BackgroundObesity is associated with impaired fertility and pregnancy complications, and preconception weight loss may improve some of these outcomes. The purpose of this study was to evaluate the quality and effectiveness of Maternal Fetal Medicine (MFM) preconception consults for obese women.MethodsWe performed a retrospective chart review examining 162 consults at an academic medical center from 2008 to 2014. The main outcome measures included consultation content – e.g. discussion of obesity-related pregnancy complications, screening for comorbidities, and referrals for weight loss interventions – and weight loss.ResultsScreening for diabetes and hypertension occurred in 48% and 51% of consults, respectively. Discussion of obesity-related pregnancy complications was documented in 96% of consults. During follow-up (median 11 months), 27% of patients saw a nutritionist, 6% saw a provider for a medically supervised weight loss program, and 6% underwent bariatric surgery. The median weight change was a loss of 0.6% body weight.ConclusionsIn this discovery cohort, a large proportion of MFM preconception consultations lacked appropriate screening for obesity-related comorbidities. While the vast majority of consultations included a discussion of potential pregnancy complications, relatively few patients achieved significant weight loss. More emphasis is needed on weight loss resources and delaying pregnancy to achieve weight loss goals.

Placental metabolic flexibility is affected by maternal obesity

Placental metabolic flexibility is affected by maternal obesity

Differential gene expression in obese pregnancy.

Maternal obesity is a major risk factor for maternal and perinatal complications, and is associated with increased risk of premature cardiovascular death in the offspring. We aimed to identify differentially expressed genes in obese and lean pregnancies. Pregnant women were recruited antenatally and whole-blood samples taken at gestational week 28. Women were classified as lean (BMI<25, n=5), overweight (BMI 25-30, n=11) or obese (BMI>30, n=4). Subcutaneous adipose tissue was obtained from a separate cohort of women undergoing elective Caesarean section (n=3 lean, n=6 overweight, n=9 obese). Total RNA was isolated and gene expression profiled by Illumina microarray technology. Differential gene expression was identified by Ingenuity Pathway Analysis and validated by TaqMan qRT-PCR. In whole blood, differential expression (p<0.05) of six genes (ANGPTL, COX7A2, EIF3A, PTS, CISD1 and GLRX) was identified between lean and non-lean pregnant women by microarray. When gene expression was studied in subcutaneous tissues, we observed a trend towards lower expression of the cytochrome c oxidase-subunit 7A2 gene (COX7A2) in overweight vs lean (p=0.057) and obese vs lean (p=0.06) women, whereas expression was similar between overweight and obese women (p=0.55). Other genes were not differentially expressed across groups. Maternal obesity is associated with differential expression of multiple genes in whole blood. In subcutaneous tissue at term, there was a trend towards reduced COX7A2 expression in obese women. COX7A2 is a mitochondrial protein, with key roles in steroidogenesis and oxidative stress regulation and could provide a link between inflammation and obesity-related pregnancy complications.

The Impact of Bariatric Surgery on Obesity-Related Infertility and In Vitro Fertilization Outcomes

Obesity-related infertility is one of the most common problems of reproductive-age obese women who desire childbearing. The various types of bariatric surgeries have proved effective in controlling excessive weight gain, improving fertility, and preventing certain maternal and fetal complications in these women. This article summarizes the current evidence regarding the impact of bariatric surgery on obesity-related infertility and in vitro fertilization (IVF) outcomes. We have also attempted to draw conclusions about maternal and fetal risks and the benefits of bariatric surgery. Laparoscopic adjustable gastric banding and Roux-en-Y procedures are the two most commonly performed bariatric surgeries. Bariatric surgery was believed to improve menstrual irregularity and increase ovulation rate in anovulatory obese women, which lead to increased pregnancy rates. Although there are data in the literature suggesting the improvement of both the ovulatory function and the spontaneous pregnancy rates in obese women who lost weight after bariatric surgery, most of these are case-control studies with a small number of patients. The data are insufficient to determine an ideal time interval for pregnancy after bariatric surgery; however, the general consensus is that pregnancy should be delayed 12 to 18 months after bariatric surgery to avoid nutritional deficiencies. Few data exist regarding IVF success rates in women who have undergone bariatric surgery. One pairwise study discussed five patients who underwent bariatric surgery followed by IVF that resulted in three term pregnancies in three patients after the first IVF cycle. Many studies reported reductions in obesity-related pregnancy complications such as gestational diabetes and hypertensive disorders after bariatric surgery. Although data are inconsistent, some studies reported increased rate of preterm delivery and small for gestational age infants after bariatric surgery. Pregnancies after bariatric surgery may be considered high risk due to the concerns for vitamin deficiencies and gastrointestinal symptoms related to the surgery. Therefore the follow-up of these pregnancies might require a team approach including a maternal fetal medicine specialist, bariatric surgeon, and nutritionist.

Weight in Pregnancy and Its Implications: What Women Report

ObjectiveMisclassification of body mass index (BMI) by pregnant women could be a significant barrier to minimizing weight-related adverse pregnancy outcomes and improving the short- and long-term health of mother and child. The primary objective in this study was to determine the proportion of a group of pregnant women who were able to correctly classify BMI. Secondary objectives included assessing the direction of BMI misclassification and maternal knowledge of target gestational weight gain and obesity-associated pregnancy complications. MethodsWe designed a cross-sectional survey to assess misclassification of BMI and knowledge of obesity and pregnancy outcomes, and to provide information regarding the participants’ sources of knowledge, their perception of appropriate weight gain in pregnancy, and basic demographic information. The questionnaire was completed by participants awaiting routine ultrasound assessment at between 11 and 24 weeks’ gestation. ResultsOf 117 respondents, 30 (25.6%) were overweight (BMI 25 to 29.9) or obese (BMI ≥ 30.0). Obese or overweight women were significantly more likely to misclassify their BMI. Furthermore, they were significantly more likely to overestimate the minimum and maximum target gestational weight gains for their respective BMI classes. There were no differences between women in the various BMI categories with regard to their awareness of several common obesity-related pregnancy complications. ConclusionMisclassification of pre-pregnancy BMI is common, particularly among women carrying excess weight. Evaluation of pre-pregnancy BMI and education regarding appropriate gestational weight gain are logical initial steps for optimizing weight-related pregnancy outcomes.

Maternal obesity in pregnancy and respiratory health in early childhood

Obesity is associated with systemic inflammation, immunological changes, increased risk of respiratory infections and chronic respiratory illness. Maternal obesity in pregnancy increases the risk of pregnancy complications, caesarean sections and adverse birth outcomes, which have in turn been associated with respiratory illness in children. To our knowledge, the possible influence of maternal obesity in pregnancy on respiratory illness in early childhood beyond the newborn period has not been explored. We examined the relationship between a high maternal body mass index (BMI) in pregnancy and lower respiratory tract infections and wheeze up to 18 months of age in the Norwegian Mother and Child Study (MoBa), a population-based cohort study that includes 100,000 pregnant women, conducted at the Norwegian Institute of Public Health. We analysed data from the first 33 192 children, born between 1999 and 2005. In unadjusted analyses maternal obesity in pregnancy was related to both respiratory infections and wheeze in the children. In multivariable analyses, only an effect on wheeze remained. The risk of wheeze increased linearly with maternal BMI in pregnancy, and was 3.3% higher [95% CI 1.2, 5.3] for children with mothers who were obese during pregnancy, than for children of mothers with normal BMI. This effect was not mediated through obesity-related pregnancy complications, low birthweight, preterm birth or caesarean section.

US obstetrician-gynaecologist's prevention and management of obesity in pregnancy

SummaryA survey regarding management of obesity in pregnancy was mailed to 787 practising members of the American College of Obstetricians and Gynecologists (ACOG); 433 responded of whom 353 practised obstetrics. Most (79.2%) had read ACOG Committee Opinion, ‘Obesity in Pregnancy,’ and rated it helpful (68.6%) or very helpful (17.2%). Most responding physicians (91.2%) use BMI to assess their patients weight status; fewer (63.4%) use pre-pregnancy BMI to modify their pregnancy weight gain recommendation. Having read the Committee Opinion and being a woman were independent factors associated with using pre-pregnancy BMI. Responding physicians that had read the Committee Opinion were more knowledgeable about obesity-related pregnancy complications; but even among those physicians, only 32.2% were aware that maternal obesity is a risk factor for fetal neural tube defects. The responding physicians appeared well-versed on appropriate practice for caesarean delivery for obese patients whether they had read the Committee Opinion or not.

Changes in booking body mass index over a decade: retrospective analysis from a Glasgow Maternity Hospital

Whether booking body mass index (BMI) in the UK is increasing is unknown but is of clinical interest since overweight or obese pregnant women face far greater risks of pregnancy complications including pre-eclampsia and gestational diabetes. We examined booking BMI in 1990 and 2002/2004, of women with singleton pregnancies. Our analyses indicate an increase of 1 U in mean BMI over this period despite lower parity in recent years. When the model was adjusted for maternal age, parity, smoking status and deprivation category the mean BMI was 1.37 U higher in 2002/2004 than in 1990. More striking was the significant increase in the proportion of women who were obese (BMI > or = 30 kg/m2) at booking--more than twofold higher in unadjusted analysis (18.9% vs 9.4%) rising to greater than threefold higher in multivariate analysis. These findings suggest that obesity-related pregnancy complications are likely to increase with implications for both mother and child.