Outcomes In Obese Women Research Articles

Racial disparities in pregnancy outcomes in obese women

Objective: To estimate the effect of race on perinatal outcomes in obese women.Methods: Retrospective cohort study of birth records linked to hospital discharge data for all live born singleton infants ≥37 weeks gestation born to African-American or Caucasian Missouri residents from 2000 to 2006. We excluded major congenital anomalies and women with diabetes or chronic hypertension. Obesity was defined as pre-pregnancy body mass index ≥30 kg/m2.Results: There were 312 412 births meeting study criteria. 27.1% (11 776) of African-American mothers and 19.1% (49 415) of Caucasian mothers were obese. There were no differences in cesarean delivery or preeclampsia between obese African-American and obese Caucasian women. Infants of obese African-American women were significantly less likely to be macrosomic (0.9% vs. 2.2%, adjusted odds ratio [aOR] 0.5, 95% confidence interval [CI] 0.4 0.6) and more likely to be low birth weight (3.4% vs. 1.8%, aOR 1.9, 95% CI 1.7, 2.2) compared to infants of obese Caucasian women. Compared to their normal weight peers, obese Caucasian women had a greater relative risk of developing preeclampsia (aOR 3.1, 95% CI 2.9, 3.2) than obese African-American women (aOR 2.1, 95% CI 1.9, 2.4).Conclusion: Racial disparities impact obesity-related maternal and neonatal complications of pregnancy.

Gestational weight gain and obesity: is 20 pounds too much?

To compare maternal and neonatal outcomes in obese women according to weight change and obesity class. Cohort study from the Consortium on Safe Labor of 20,950 obese women with a singleton, term live birth from 2002-2008. Risk for adverse outcomes was calculated by multiple logistic regression analysis for weight change categories (weight loss [<0 kg], low [0-4.9 kg], normal [5.0-9.0 kg], high weight gain [>9.0 kg]) in each obesity class (I 30.0-34.9 kg/m(2), II 35.0-39.9 kg/m(2), and III ≥40 kg/m(2)) and by predicted probabilities with weight change as a continuous variable. Weight loss was associated with decreased cesareans for class I women (nulliparas odds ratio [OR], 0.21; 95% confidence interval [CI], 0.11-0.42; multiparas OR, 0.61; 95% CI, 0.45-0.83) and increased small for gestational age infants (class I OR, 1.8; 95% CI, 1.3-2.5; class II OR, 2.2; 95% CI, 1.5-3.2; class III OR, 1.7; 95% CI, 1.1-2.6). High weight gain was associated with increased large for gestational age infants (class I OR, 2.4; 95% CI, 1.9-2.9; class II OR, 1.7; 95% CI, 1.3-2.1; class III OR, 1.6; 95% CI, 1.3-2.1). As weight change increased, the predicted probability for cesareans and large for gestational age infants increased. The predicted probability of low birthweight never exceeded 4% for all obesity classes, but small for gestational age infants increased with decreased weight change. The lowest average predicted probability of adverse outcomes (cesarean, postpartum hemorrhage, small for gestational age, large for gestational age, neonatal care unit admission) occurred when women (class I, II, III) lost weight. Optimal maternal and neonatal outcomes appear to occur when weight gain is less than current Institute of Medicine recommendations for obese women. Further study of long-term outcomes is needed with respect to gestational weight changes.

93: The impact of gestational weight gain on perinatal outcomes in obese women

93: The impact of gestational weight gain on perinatal outcomes in obese women

Maternal and Neonatal Outcome After Laparoscopic Adjustable Gastric Banding: a Systematic Review

The number of women of reproductive age undergoing bariatric surgery, including laparoscopic adjustable gastric banding (LAGB), has increased in recent years. The objective of this study was to list both maternal and neonatal outcomes in pregnancies in obese women (BMI ≥ 30kg/m(2)) after LAGB and compare them with pregnancies in obese or normal weight women without LAGB. Studies showed a lower incidence of gestational diabetes, pregnancy-induced hypertension (PIH), pre-eclampsia, caesarean section (CS), macrosomia, and low birth weight babies in post-LAGB pregnancies compared to pregnancies in obese women without LAGB. Gestational weight gain was also lower in post-LAGB pregnancies. However, the incidence of PIH, pre-eclampsia, CS, preterm birth, large for gestational age, spontaneous abortion, and NICU admission was higher in post-LAGB pregnancies than in normal weight pregnancies. In conclusion, LAGB seems to improve pregnancy outcomes in obese women, even when obesity is still present at the onset of pregnancy. However, further research is needed and pregnant women with a gastric band should always be closely monitored by a multidisciplinary team.

The early breastfeeding experience of obese mothers‐ a mediation analysis

Maternal obesity is associated with poor breastfeeding (BF) outcomes. We used the Early Lactation Success cohort to determine mediators of the relationship between maternal obesity and early BF outcomes in 405 primiparae who delivered at term and initiated BF. We used validated instruments and in‐person interviews to collect data prenatally and at 0, 3, and 7 d postpartum. Compared to non‐obese women (BMI&lt;25, n=121), obese women (BMI&gt;30, n=130) were more likely to have a C‐section (45% vs. 22%, P=0.0003), postpartum edema (85% vs 27%, P&lt;0.0001) and to be separated from the baby for &gt;2h immediately after birth (24% vs. 7%, P=0.0003). Obese women were more likely to have: introduced BF after 2 h postpartum (30% vs 18%, P=0.03, delayed onset of lactogenesis (delayed OL, 54% vs. 31%, P=0.02), and infants with sub‐optimal BF behavior at d 7 (SIBB D7, 33% vs. 15%, P=0.02). Obese women also BF less often on d 0 (8.6 vs. 9.5, P=0.03). Cesarean delivery and postpartum separation mediated 25% and 78%, respectively, of the relation between obesity and delay in the 1st BF. Postpartum separation mediated 48% of the relation between obesity and BF frequency on d 0. Edema mediated 35% and 25%, respectively, of the relations between obesity and delayed OL and SIBB D7, respectively. Strategies to improve BF outcomes in obese women should include minimizing unnecessary cesarean delivery and separation of the dyad. Research support provided by the Department of Health and Human Services, Maternal Child Health Bureau (KGD) and the National Institute of Child Health &amp; Human Development (LAN‐R).Grant Funding Source: Department of Health and Human Services, Maternal Child Health Bureau

Adverse Fetal and Neonatal Outcomes Associated with a Life-Long High Fat Diet: Role of Altered Development of the Placental Vasculature

Maternal obesity results in a number of obstetrical and fetal complications with both immediate and long-term consequences. The increased prevalence of obesity has resulted in increasing numbers of women of reproductive age in this high-risk group. Since many of these obese women have been subjected to hypercaloric diets from early childhood we have developed a rodent model of life-long maternal obesity to more clearly understand the mechanisms that contribute to adverse pregnancy outcomes in obese women. Female Sprague Dawley rats were fed a control diet (CON - 16% of calories from fat) or high fat diet (HF - 45% of calories from fat) from 3 to 19 weeks of age. Prior to pregnancy HF-fed dams exhibited significant increases in body fat, serum leptin and triglycerides. A subset of dams was sacrificed at gestational day 15 to evaluate fetal and placental development. The remaining animals were allowed to deliver normally. HF-fed dams exhibited a more than 3-fold increase in fetal death and decreased neonatal survival. These outcomes were associated with altered vascular development in the placenta, as well as increased hypoxia in the labyrinth. We propose that the altered placental vasculature may result in reduced oxygenation of the fetal tissues contributing to premature demise and poor neonatal survival.

How big is too big? The impact of the obese, morbidly obese, and super obese categories on hysterectomy outcomes for endometrial cancer/hyperplasia

Objective: Gynecologic oncologists often operate on women for endometrial cancer with body mass indices (BMI) of >50, yet outcomes data for this super obese population are limited. The objectives were to assess the impact of obesity severity on surgical outcomes in obese women undergoing surgery for endometrial hyperplasia/cancer.

High Body Mass Index in Pregnancy, Its Effects on Maternal and Fetal Outcome

Background : To examine the maternal and foetal risks of adverse pregnancy outcome in obese women (BMI > 30). Methods : This study is a prospective non randomized descriptive study conducted in the Department of Obstetrics and Gynaecology of KIMS in Narketpally from April 2007 to April 2009, 100 women with high BMI were compared with 100 women with normal BMI with regard to ante-natal complications, intervention in labour, maternal morbidity and neonatal outcome. Results: Compared to women with normal BMI, the following outcomes were significantly more common in obese pregnant women (odds ratio (95% confidence interval)) for BMI > 30 gestational diabetes mellitus (4.8 (1.01 - 3.02)); pre-eclampsia ( 2.52 (1.04 - 6.11 )) ; macrosomia ( 13.8 (3.1 - 60.57)) ; caesarean section ( 3.45 (1.65 - 7.15)) and infections ( 1.7 (0.39 - 7.32)). Conclusions: This study points out a strong association between maternal morbid obesity in early pregnancy and a number of threatening complications during pregnancy, delivery, and in the neonatal period. doi:10.4021/jcgo2w

Outcomes of obese versus non-obese subjects undergoing robotic-assisted hysterectomy: a multi-institutional study.

The goal of our study was to determine whether there was a difference in operative outcomes in obese versus non-obese subjects undergoing robotic-assisted hysterectomies of varying levels of difficulty. Secondarily, we sought to analyze the published outcomes between robotic-assisted hysterectomy and total laparoscopic hysterectomy in obese women at each of these levels of difficulty. This was a multi-institutional retrospective cohort study of all patients undergoing robotic-assisted hysterectomy by five gynecologic oncologists at four geographically separate locations from April 2003 to March 2008. The cohort was stratified into obese vs. non-obese groups, and defined surgical outcomes compared between groups, then further divided into three subgroups based on case difficulty level. Univariate analysis and regression analysis using SAS 9.1 was performed. We then conducted a literature search of total laparoscopic hysterectomy outcomes in obese women, dividing the resulting studies into three comparative subgroups based on surgical difficulty levels for comparison with our robotic-assisted hysterectomy results. Our cohort had 228 obese and 323 non-obese subjects. Overall, the obese group had higher blood loss and longer operative time. When further stratified by level of difficulty, obese subjects also had a higher average blood loss and longer operative time in the hysterectomy-alone subgroup. No clinically significant differences in operative outcomes exist between obese and non-obese women when utilizing the da Vinci robotic system to perform a hysterectomy, independent of case difficulty level. More prospective, controlled studies which compare the two surgical approaches of robotic-assisted and laparoscopic hysterectomy approaches are needed.

833: Should gestational weight loss be encouraged for obese women?

be encouraged for obese women? Saju Joy, Niki Istwan, Debbie Rhea, Cheryl Desch, Gary Stanziano Carolinas Medical Center, Maternal-Fetal Medicine, Charlotte, NC, Alere Health, Department of Clinical Research, Atlanta, GA OBJECTIVE: The current pregnancy weight gain recommendation of 11-20lbs for obese women, regardless of obesity class, continues to be debated. We sought to examine pregnancy outcomes in obese women according to gestational weight gain and level of obesity. STUDY DESIGN: Women with an obese pre-pregnancy body-mass index (BMI) and current singleton pregnancy enrolled in a maternity risk screening and education program at 20w were identified. Women with a pre-pregnancy diagnosis of diabetes were excluded. Data were classified according to reported pregnancy weight gain (losing weight, under-gaining, within target, and over-gaining) and by obesity class (Class 1 BMI 30-34.9, Class 2 35-39.9, Class 3 40-49.9, Class 4 50). The recommended range of 11-20lbs for pregnancies with gestational age at delivery (GAD) 37w was used to determine weight gain group. To control for GAD 0.51/w over-gaining. Pregnancy outcomes were compared by weight gain group overall and within obesity class using Pearson’s chi-square test statistics. RESULTS: Of the 27,898 women studied, 4.4% were losing weight (mean weight change: 13.1 / 12.5lbs), 10.0% were under-gaining (mean change: 5.8 / 3.4lbs), 20.4% were gaining within target (mean change: 16.2 / 3.0lbs) and 65.2% were over-gaining (mean change: 36.8 / 12.8lbs). Pregnancy outcomes (see Table) were similar for the weight loss and under-gaining groups. Excessive weight gain was associated with adverse outcomes. These results were also observed within obesity classes 1, 2, and 3. However, for women in obesity class 4 no differences were observed between weight gain groups. CONCLUSION: Compared to women gaining weight within established guidelines, weight loss during pregnancy was associated with lower rates of macrosomic and LGA infants, but higher rates of preterm delivery and SGA infants. A reduction in cesarean delivery or gestational HTN/preeclampsia was not observed for women under-gaining or with weight loss. These data do not support recommending weight gain below current guidelines, although excessive weight gain should be discouraged for obese gravidas. 834 “Isolated” obesity: still an independent risk factor for cesarean delivery Shimrit Yaniv Salem, Ruslan Sergienko, Gershon Holcberg, Eyal Sheiner Soroka University Medical Center, Ben-Gurion University of the Negev, Department of Obstetrics and Gynecology, Faculty of Health Sciences, Beer-Sheva, Israel, Ben Gurion University of the Negev, Faculty of Health Sciences, Ben-Gurion University of the Negev Epidemiology and Health Services Evaluation Department, Beer Sheva, Israel, Soroka University Medical Center, Ben-Gurion University of the Negev, Department of Obstetrics and Gynecology, Beer-Sheva, IL, Israel, Soroka University Medical Center, Ben-Gurion University of the Negev, Department of Obstetrics and Gynecology, Beer-Sheva, Israel OBJECTIVE: To investigate pregnancy outcome among women with “isolated” obesity (i.e. without additional co-morbidities) and specifically the correlation between “isolated” obesity and cesarean delivery (CD). STUDY DESIGN: A population-based study was performed comparing all pregnancies of obese (maternal pre-pregnancy body mass index [BMI] of 30 kg/m2 or more) and non-obese patients, between the years 1988 and 2010. Patients with chronic hypertension, pre-gestational diabetes mellitus, other preexisting chronic morbidities, multiple gestations, patients older than 40 years old, grand-multiparity (above 5 deliveries), patients lacking prenatal care, and patients following fertility treatments were excluded from the analysis. Stratified analyses, using multiple logistic regression models were performed to control for confounders RESULTS: During the study period there were 173,628 deliveries meeting the inclusion criteria, of which 1605 (0.9%) occurred in patients with “isolated” obesity. Conditions significantly associated with maternal “isolated” obesity, using a multivariable model are presented in the table. Higher rates of CD were found among patients with “isolated” obesity (30.7% vs. 12.3%; OR 3.2; 95% CI 2.8, 3.5; P 0.001). When controlling for possible confounders, using another multivariable model with CD as the outcome variable, the association between “isolated” obesity and CD remained significant (adjusted OR 2.6; 95% CI 2.3-3.0, P 0.001). No significant differences were noted between the groups regarding perinatal complications such as perinatal mortality, congenital malformations, shoulder dystocia and low Apgar scores at 5 minutes. CONCLUSION: “Isolated” obesity, although not a risk factor for adverse perinatal outcomes is an independent risk factor for CD www.AJOG.org Academic Issues, Antepartum Fetal Assessment, Genetics, Hypertension, Medical-Surgical-Disease Poster Session V

New Gestational Weight Gain Guidelines: An Observational Study of Pregnancy Outcomes in Obese Women

In 2009, the Institute of Medicine (IOM) revised their pregnancy weight gain guidelines, recommending gestational weight gain of 11-20 pounds for women with prepregnancy BMI >30kg/m(2). We investigated the potential influence of the new guidelines on perinatal outcomes using a retrospective analysis (n = 691), comparing obese women who gained weight during pregnancy according to the new guidelines to those who gained weight according to traditional recommendations (25-35 pounds). We found no statistical difference between the two weight gain groups in infant birth weight, cesarean delivery rate, pregnancy-related hypertension, low birth weight infants, macrosomia, neonatal intensive care unit admissions, or total nursery days. Despite showing no evidence of other benefits, our data suggest that obese women who gain weight according to new IOM guidelines are no more likely to have low birth weight infants. In the absence of national consensus on appropriate gestational weight gain guidelines, our data provide useful data for clinicians when providing evidence-based weight gain goals for their obese patients.

Improving pregnancy outcome in obese women

The global pandemic of maternal obesity presents a major challenge for healthcare providers, and has significant short- and long-term implications for both maternal and fetal health. Currently, the evidence-base underpinning many of the interventions either currently in use or recommended to improve pregnancy outcome in obese women is limited. The nature and timing of these interventions vary widely, ranging from simple advice to more intensive dietary and exercise programmes, cognitive behavioural therapy and drug trials. In addition, a growing number of very severely obese women now enter pregnancy having had surgical interventions. Although surgical interventions such as gastric bypass or banding may be associated with improved pregnancy outcomes, these women have particular nutritional requirements, which need to be addressed to optimise pregnancy outcome. Until the outcomes of ongoing current trials are reported and provide a firm evidence base on which to base future intervention strategies and guide evidence based care for obese pregnant women, pregnancy outcome is best optimised by high-risk antenatal care delivered by healthcare providers who are experienced in supporting these high-risk women.

Inside the ‘black box’: process evaluation of the upbeat pilot trial

The UK Better Eating and Activity Trial (UPBEAT) aims to improve pregnancy outcome in obese women by improving blood sugar control through a dietary and activity intervention delivered in eight...

The influence of obesity on ICSI outcomes in women with polycystic ovary syndrome

The objective of the study was to compare intracytoplasmic sperm injection (ICSI) outcome and gonadotropin doses between obese women with PCOS and non-obese patients with PCOS. This follow-up study represents ICSI outcomes in obese women with PCOS (BMI ≥ 30 kg/m2) compared with non-obese women with PCOS (BMI < 30 kg/m2). Obese (n = 18) and non-obese (n = 26) women with PCOS underwent long protocol pituitary suppression, ovarian stimulation and ICSI with fresh embryo transfer. Obese patients with PCOS required higher doses of gonadotropin (2994 IU vs 1719 IU; p < 0.001). Miscarriage rate was significantly higher in obese women compared with the non-obese women with PCOS (60% vs 6.7%, p = 0.002). Our results are valuable for counselling couples before initiation of assisted reproduction techniques (ART).

Interactions of the PPARγ2 Polymorphism with Fat Intake Affecting Energy Metabolism and Nutritional Outcomes in Obese Women

Background/Aims: To determine the influence of the Pro12Ala polymorphism of the PPARγ2 gene and the dietary lipid intake on energy metabolism and nutritional outcomes in obese women after an acute fat load or following a low-calorie diet for 10 weeks. Methods: Sixty obese women (aged 30–46 years) participated in the study and were assigned to 2 groups depending on the genotype: Pro12Pro and Pro12Ala/Ala12Ala carriers. At baseline and after 2 nutritional (short- or long-term) interventions, measurement of anthropometrical and body composition (bioelectrical impedance) variables, dietary assessments, energy metabolism (indirect calorimetry) measurements as well as biochemical and molecular (PPARγ2 genotype) analyses were performed. All women received a high-fat test meal to determine the postprandial metabolism (short term) and an energy-restricted diet for 10 weeks (long term). Results: The frequencies of the Pro12Pro and Pro12Ala/Ala12Ala genotypes were 83.33 and 16.67%, respectively, and reached Hardy-Weinberg equilibrium. Interestingly, the postprandial energy expenditure after the fat load was higher in subjects carrying the Ala allele. At baseline, the habitual monounsaturated fatty acid (MUFA) intake inversely correlated with fat oxidation and body mass index in the obese Pro12Ala/Ala12Ala carriers, while a lower PUFA intake (%) in the long-term trial was associated with an increase in the respiratory quotient only in Ala carriers but not in the Pro12Pro genotyped group. Conclusions: The Pro12Ala polymorphism in the PPARγ2 gene influenced energy metabolism in the assayed short- and long-term situations since the response to both nutritional interventions differed according to the genotype. The results suggest that fat oxidation and energy expenditure may be lower in Pro12Pro carriers compared to Pro12Ala/Ala12Ala genotypes, while in obese women with Pro12Ala/Ala12Ala polymorphisms in the PPARγ2 gene fat oxidation was negatively correlated with the MUFA and PUFA (%) intake.

Excessive Weight Gain among Obese Women and Pregnancy Outcomes

We evaluated pregnancy outcomes in obese women with excessive weight gain during pregnancy. A retrospective study was performed on all obese women. Outcomes included rates of preeclampsia (PEC), gestational diabetes, cesarean delivery (CD), preterm delivery, low birth weight, very low birth weight, macrosomia, 5-minute Apgar score of <7, and neonatal intensive care unit (NICU) admission and were stratified by body mass index (BMI) groups class I (BMI 30 to 35.9 kg/m(2)), class II (36 to 39.9 kg/m(2)), and class III (>or=40 kg/m(2)). Gestational weight change was abstracted from the mother's medical chart and was divided into four categories: weight loss, weight gain of up to 14.9 pounds, weight gain of 15 to 24.9 pounds, and weight gain of more than 25 pounds. A total 20,823 obese women were eligible for the study. Univariate analysis revealed higher rates of preeclampsia, gestational diabetes, Cesarean deliveries, preterm deliveries, low birth weight, macrosomia, and NICU admission in class II and class III obese women when compared with class I women. When different patterns of weight gain were used as in the logistic regression model, rates of PEC and CD were increased. Excessive weight gain among obese women is associated with adverse outcomes with a higher risk as BMI increases.

277: Maternal weight gain and neonatal complications in obese women with gestational diabetes

Excess gestational weight gain has been shown to be associated with obstetrical complications including macrosomia, neonatal metabolic abnormalities, and risk of cesarean delivery. Obesity is a known independent risk factor for the development of gestational diabetes. Gestational diabetes (GDM) complicates 2-5% of all pregnancies and is known to be associated with increased risk of maternal and neonatal morbidities. We sought to collect observational data concerning the extent of maternal and neonatal outcomes in obese women with GDM in the context of a spectrum of weight gains in pregnancy.

Gestational Weight Gain and Pregnancy Outcomes in Obese Women

Gestational Weight Gain and Pregnancy Outcomes in Obese Women

Poorer outcomes for obese women with breast cancer

Poorer outcomes for obese women with breast cancer

Use of sibutramine to assist obese women with weight loss can be successful in dietitian‐led clinics: another tool in the dietitian’s toolbox

This study investigated differences in weight loss outcomes in obese women with Type 2 diabetes (T2D) compared to those without T2D attending a 6-month dietetic led 'Lifestyle' intervention. In those who had failed to reach weight loss goals using the 'Lifestyle' approach, the study further examined the effect on weight loss with the addition of sibutramine (Reductil, Abbott Laboratories, USA) over a 6-month period. The study comprised a case-control analysis of data from 38 obese female patients (18 with T2D) from the 'Lifestyle' and 'Pharmacotherapy' clinics attending a tertiary hospital in the UK. In the 'Lifestyle' treatment groups, those with T2D lost significantly less body weight than those without T2D [5.26 kg (4.54%) versus 9.89 kg (9.55%), respectively]. For subjects who had failed to lose weight via the 'Lifestyle' intervention, the addition of sibutramine resulted in a similar weight loss compared to their pair-matched 'Lifestyle' only 'successful' counterparts (9.66% versus 9.55%). Not all obese women, and those with T2D in particular, will derive benefit from 'Lifestyle' advice and those who are resistant to this treatment approach may be assisted by pharmacotherapy. Dietitians can play a role in identifying those individuals who may benefit from the use of pharmacotherapy.