Preconception Body Mass Index Research Articles

Maternal preconception weight trajectories are associated with offsprings' childhood obesity.

This study aimed to examine the associations between (1) mothers' preconception body mass index (BMI) trajectories over 6-7 years and offspring childhood BMI, and (2) mothers' BMI changes between first and second pregnancy and the second-born child's BMI. We used data (1606 mothers with 2733 children with mean age 7.7 years, SD 2.9) from the Australian Longitudinal Study on Women's Health and the Mothers and their Children's Health study. Preconception BMI trajectories were identified using latent class growth modeling. Children were categorized as underweight, normal, overweight or obese based on age and sex-specific BMI cut-off points for children. Multinomial and binary logistic regression were used for analyses. We identified three preconception BMI trajectories, named as 'normative' (61.2%), 'chronically overweight' (30.7%), and 'chronically obese' (8.1%). Children born to 'chronically overweight' and 'chronically obese' mothers were more likely to be overweight than normal weight relative to children born to women with a 'normative' BMI trajectory. The corresponding adjusted relative risk ratios (RRRs) (95% confidence interval [CI]) of childhood overweight were 1.75 (1.33, 2.31) for chronically overweight mothers and 2.48 (1.65, 3.73) for chronically obese mothers. Similarly, we found a much stronger association between 'chronically overweight' and 'chronically obese' BMI trajectories and childhood risk of obesity; RRR (95% CI), 2.49 (1.41, 4.40) and 6.65 (3.40, 13.01), respectively. Second-born children of mothers with high interpregnancy weight gain (≥4 BMI units) were also at higher risk of being overweight or obese (OR = 2.20, 95% CI: 1.02, 4.75) compared with children of mothers with stable interpregnancy weight (gain or loss of 1 BMI unit or less). In this population-based prospective cohort study, we found strong dose-response associations between preconception BMI trajectories and offsprings' childhood BMI.

Interventions designed to reduce excessive gestational weight gain can reduce the incidence of gestational diabetes mellitus: A systematic review and meta-analysis of randomised controlled trials

AimsTo (i) evaluate the global impact of interventions designed to prevent excessive gestational weight gain (eGWG) on the incidence of gestational diabetes (GDM), and (ii) examine whether the effects differ by pre-conception body mass index (BMI) or ethnicity. MethodsA systematic search of randomised controlled trials (RCTs) with a primary or secondary aim to reduce eGWG was conducted in seven international and three Chinese databases without date limits. Meta-analysis data are reported as relative risk (RR) for GDM incidence for interventions including: diet, physical activity (PA), and lifestyle (diet and PA). ResultsForty-five studies were included, 37 in the meta-analyses. Diet and PA interventions reduced GDM risk by 44% (RR: 0.56, 95% CI: 0.36–0.87) and 38% (RR: 0.62, 95% CI: 0.50–0.78), respectively. Lifestyle interventions and BMI didn’t significantly alter GDM risk. PA interventions from Southern-Europe reduced GDM risk by 37% (RR: 0.63, 95% CI: 0.50–0.80). Whereas, diet and lifestyle interventions conducted in Asia reduced GDM risk by 62% (RR: 0.38, 95% CI: 0.24–0.59) and 32% (RR: 0.68, 95% CI: 0.54–0.86), respectively. ConclusionDiet and PA interventions designed to reduce GWG are more effective than standard care in reducing the incidence of GDM, although the effect varies by region and BMI. The ‘one size fits all’ approach is not supported.

Impact of excessive pre-pregnancy body mass index and abnormal gestational weight gain on pregnancy outcomes in women with chronic hypertension.

To investigate the effects of excessive pre-pregnancy body mass index (BMI) and abnormal gestational weight gain on adverse outcomes in women with chronic hypertension (CH). A retrospective cohort study of CH women with singleton pregnancy delivered at our Institution in 2002-2013. Women were categorized as normal, overweight, and obese, according to their pre-pregnancy BMI. Further stratification was based on gestational weight gain (insufficient, adequate, and excessive) as defined by 2009 IOM guidelines. Gestational diabetes, hypothyroidism, superimposed preeclampsia, preterm birth <37 weeks, cesarean section, and delivery of a small or large for gestational age neonate. 309 women met inclusion criteria. Obese women had increased odds of gestational diabetes (aOR, 3.18; 95% CI, 1.46-6.90), hypothyroidism (aOR, 2.41; 95% CI, 1.15-5.54), and superimposed preeclampsia (aOR, 2.36; 95% CI, 1.20-4.65), compared to normal BMI. Overweight women also displayed higher risk of diabetes (aOR 2.19; 95% CI, 1.05-5.03). Insufficient weight gain increased odds of small for gestational age neonate in normal BMI women (aOR, 1.82; 95% CI 1.31-2.07), whereas excessive gain was associated with superimposed preeclampsia in normal BMI patients (aOR, 3.51; 95% CI, 1.16-7.89) and with cesarean delivery in obese women (aOR, 2.96; 95% CI, 1.09-5.81). Excessive pre-conception BMI and abnormal gestational weight gain increase odds of pregnancy complications in CH women. Our results stress the importance of pre-conception counseling for weight normalization in CH women, and support IOM recommendations for adequate weight gain during CH pregnancies.

Association of cord blood and maternal lipid profiles

Objectives: The objectives of this study were to study the cord blood lipid profile in neonates in relation to maternal preconceptional body mass index (BMI), maternal glucose intolerance, maternal lipid profile, family history of metabolic syndrome, intrauterine fetal growth, and birth weight of baby. Methodology: It was a prospective cohort study and was carried out in Pondicherry Institute of Medical Sciences over a period of 1 year. The sample size estimated was 150 mother-infant pairs. Informed consent was obtained from mothers fulfilling the criteria and a structured pro forma was filled with details of the mother and baby. Samples were drawn for the determination of lipid profile of the baby and mothers. Independent t-test was used to compare the lipid profile parameters in mother and in cord blood. p&lt;0.05 was considered statistically significant. Results: A total of 150 babies and mothers were included in the study. 78 (52%) were male and 72 (48%) were female. The mean birth weight of babies was 3009±0.391 g; 133 (89%) were appropriate for gestational age, and 17 (11%) were small for gestation. Among the mothers, 36 (24%) had gestational diabetes, 18 (12%) were obese, and 86 (58%) women had family history of diabetes, dyslipidemia, or hypertension. No statistically significant difference was noted in the cord lipids of babies born to mothers with gestational diabetes (p=0.033). Comparison of lipid values with gestational maturity did not reveal any statistical significance (p=0.24). High-density lipoprotein was significantly low for low birth weight babies compared to normal weight babies (p=0.03). Positive family history did not show any statistically significant difference in the lipids of the baby. BMI of the mother did not show any significant effect on the cord lipids. Conclusion: There was no association of cord blood and maternal lipid profiles. BMI of the mother did not show any significant effect on the cord blood lipids. Maternal gestational diabetes, family history of hypertension, diabetes, or dyslipidemia had no effect on the cord blood lipids.

Nutritional assessment of newborns regarding preconceptional maternal body mass index

BACKGROUND: Obesity and overweight in pregnancy have a significant impact in fetal development. However, this association remains controversial. OBJECTIVE: assess the association between maternal preconception body mass index (BMI) and the newborn nutritional status. MATERIAL AND METHODS: Prospective study, where singleton births were included. Newborns were classified according to their mother’s preconception BMI and anthropometric measurements were taken to evaluate the newborn’s nutritional status. For the statistical análisis we present descriptive statistics for the main variables and we fitted lineal regression models. RESULTS: A total of 492 dyads were included, 30.7% of the mothers had overweight or obesity. We found that mothers with overweight or obesity tend to have products with higher birth weight (?=0.01; IC95% (0.002,0.019) p0.015), increased arm circumference (?=0.02; IC95% (0.001,0.045) p0.037) and a tendency of lower length at birth (?=0.002; IC95% (-0.003,0.0002) p0.19) CONCLUSIONS: There are significant changes in the newborns anthropometric measures of mothers with higher BMI; therefore there could be an association between maternal preconception overweight and obesity with abnormal intrauterine growth.

Variations in resting energy expenditure: impact on gestational weight gain

There are significant variations in gestational weight gain, with many women gaining in excess of the Institute of Medicine guidelines. Unfortunately, efforts to improve appropriate gestational weight gain have had only limited success. To date, interventions have focused primarily on decreasing energy intake and/or increasing physical activity. Maternal resting energy expenditure, which comprises ∼60% of total energy expenditure compared with the ∼20% that comes from physical activity, may be an important consideration in understanding variations in gestational weight gain. Our objective was to quantify the changes in resting energy expenditure during pregnancy and their relationship to gestational weight gain and body composition changes among healthy women. We hypothesized that greater gestational weight gain, and fat mass accrual in particular, are inversely related to variations in resting energy expenditure. We conducted a secondary analysis of a prospective cohort studied before conception and late pregnancy (34-36 weeks). Body composition (estimated using hydrodensitometry) and resting energy expenditure (estimated using indirect calorimetry) were measured. The relationship between the changes in resting energy expenditure and gestational weight gain and the change in fat mass and fat-free mass were quantified. Resting energy expenditure was expressed as kilocalories per kilogram of fat-free mass per day (kilocalories per kilogram of fat-free mass-1/day-1) and kilocalories per day. Correlations are reported as r. Among 51 women, preconception body mass index was 23.0 (4.7) kg/m2; gestational weight gain was 12.8 (4.7) kg. Preconception and late pregnancy resting energy expenditure (kilocalories per day) correlated positively with the change in fat-free mass (r= 0.37, P= .008; r= 0.51, P= .001). Late-pregnancy resting energy expenditure (kilocalories per kilogram of fat-free mass-1/day-1) was inversely associated with the change in fat mass (r= -0.34, P= .02) and gestational weight gain (r= -0.29, P= .04). From before pregnancy through late gestation, the increase in resting energy expenditure (kilocalories per day) correlated positively with the change in fat-free mass (r= 0.44, P= .002) and negatively with the change in fat mass (r= -0.27, P= .06). The change in resting energy expenditure from before conception through late gestation correlated positively with changes in fat-free mass but negatively with fat mass accrual. Women with smaller increases in resting energy expenditure across pregnancy had greater gestational weight gain, specifically more adipose tissue. These data suggest that resting energy expenditure is an important factor in gestational weight gain, particularly excess fat mass accrual. Future lifestyle intervention studies need to consider clinically feasible means of estimating resting energy expenditure and, in response, tailor nutrient intake and composition recommendations. Implementing and testing such interventions would be a novel approach to improve compliance with gestational weight gain guidelines.

Impact of an Individualized Weight-Tracking Tool on Gestational Weight Gain Knowledge [37B

INTRODUCTION: Only ∼one-third of US women meet Institute of Medicine (IOM) gestational weight gain (GWG) guidelines. Whether women understand these body mass index (BMI)-specific guidelines and whether additional education could improve knowledge is unclear. We hypothesized that an individualized, GWG-tracking tool would improve patient knowledge about GWG guidelines and BMI. METHODS: Women with singleton pregnancies at one outpatient clinic were recruited for a clinical trial. Over eight weeks, women 15 0/7-22 6/7 weeks’ with at least one prior prenatal visit were enrolled in the control group. Women 6 0/7-14 6/7 weeks’ were enrolled in the intervention group at their first prenatal visit and received a GWG card from study staff who helped women record preconception weight, BMI, and BMI-specific GWG guidelines. Women were encouraged to record weight at each prenatal care visit. All women completed a GWG knowledge-based questionnaire at 15 0/7-22 6/7 weeks’. Groups were compared using bivariate analyses. RESULTS: Among 125 women, 45 (36%) comprised the intervention group. The intervention and control groups were similar in age, race/ethnicity, education, income, parity, and preconception BMI. Compared with control, intervention group women were not more likely to correctly define “BMI” (52% vs. 63%, p=0.5), correctly classify their preconception BMI (48% vs. 51%, p=0.9), recall their BMI-specific GWG guidelines (51% vs. 67%, p=0.1), or think they would meet GWG guidelines (58% vs. 50%, p=0.5). CONCLUSION: Our intervention did not improve GWG or BMI knowledge. These data underscore the deficit in fundamental knowledge among pregnant women, which may contribute to the limited success of GWG interventions.

Weight in the First Year of Life: Associations with Maternal Prepregnancy Body Mass Index and Gestational Weight Gain-Findings from a Longitudinal Pregnancy Cohort.

Objective To investigate the obesogenic influence of maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) on infant weight at birth and 12 months postpartum in an Australian general population sample. Methods Data on 1,305 pregnant women were collected on prepregnancy BMI and GWG through maternal interview, on infant weight at birth through hospital records, and on infant weight 12 months postbirth through direct measurement. Relationships between prepregnancy, gestational weight exposures, and infant weight outcomes were assessed with and without adjustment for potential confounding. Results We observed a 14 to 24 g increase in infant birth weight for every 1 kg increase in maternal weight (infant birth weight: β(BMI) = 0.014, p < 0.000; β(GWG) = 0.012, p < 0.000; and 12 months: β(BMI) = 0.018, p < 0.000; β(GWG) = 0.024, p < 0.000). Effects remained after adjustment for potential confounders (infant birth weight: β(BMI) = 0.014, p < 0.000; β(GWG) = 0.012, p < 0.001; and 12 months: β(BMI)= 0.017, p ≤ 0.033; β(GWG) = 0.023, p = 0.001). However, the effects observed were small, and there was no evidence that GWG mediated relationships between preconception BMI and infant weight. Conclusion In a general population sample, there is a significant but not substantial observed relationship between maternal prepregnancy BMI and GWG and infant weight outcomes, suggesting a minor role for these factors at a population level.

Maternal Preconception Body Mass Index and Gestational Weight Gain: A Prospective Cohort Study Potentially to Prevent Low Birth Weight

Pregnancy is the most critical period of growth and development change. Low and high birth weight infant would be having in the future the risk of many health problems. Adequate gestational weight gain (GWG) based on preconception body mass index (BMI) is important for optimal birth weight infants. This study aimed to 1) assess the relationship between preconception BMI and totalGWG; 2) calculate proportion of mother who does not meet weight gain recommendation. The longitudinal prospective study conducted from February 2013 to June 2014. The total 37 preconception women enrolled as samples and only 18 samples can be measured for GWG in 3rd trimester. Exclusion criteria were: 1) no data weighing for more than 3 months, 2) no records of first day of last menstrual period (LMP), and 3) miscarriage. Data of GWG compared to weight gain recommendations based on preconception BMI issued by Institute of Medicine. Collected data were analyzed by using STATA v.11. T-test was used to analyze the mean differences of BMI among groups then regression analysis was operated to assess the RR of GWG and nutritional status. We found no significant associations between preconception BMI and GWG (p>0.05). Based on maternal nutritional status at preconception, the highest risk not reaching GWG recommendation were in underweight women in 3rd trimester (RR=1, 43 [95%CI: 1, 00-2, 06]) (p<0.05). The lower nutritional status the higher total GWG even most of maternal did not meet IOM recommendation. Therefore, underweight maternal be required to be treated properly to avoid adverse pregnant outcomes.

Are early first trimester weights valid proxies for preconception weight?

BackgroundAn accurate estimate of preconception weight is necessary for providing a gestational weight gain range based on the Institute of Medicine’s guidelines; however, an accurate and proximal preconception weight is not available for most women. We examined the validity of first trimester weights for estimating preconception body mass index category.MethodsUnder identical measurement conditions, preconception weight and two first trimester weights (i.e., 4–10 and 12 weeks gestation) were obtained (n = 43).ResultsThe 4–10 week and the 12 week weight correctly classified 95 and 91% women, respectively. Mean weight changes were relatively small overall (M = 0.74 ± 1.99 kg at 4–10 weeks and M = 1.02 ± 2.46 at 12 weeks). There was a significant difference in mean weight gain by body mass index category at 4–10 weeks (−0.09 ± 1.86 kg for normal weight participants vs. 1.61 + 1.76 kg for overweight/obese participants, p = 0.01), but not at 12 weeks (0.53 ± 2.29 kg for normal weight participants vs. 1.54 ± 2.58 kg for overweight/obese participants).ConclusionsAssigning gestational weight gain guidelines based on an early first trimester weight resulted in 5–9% of women being misclassified depending on the gestational week the weight was obtained. Thus, most women are correctly classified based on a first trimester weight, particularly an early first trimester weight, although it is possible that modeling strategies could be developed to further improve estimates of preconception body mass index category.Trial registrationClinicaltrials.gov # NCT01131117, registered May 25, 2010.

Factors Associated With Excessive Gestational Weight Gain: Review of Current Literature.

Background:Excessive gestational weight gain (EGWG) places women at increased risk for complications during pregnancy and also increases the likelihood that they will remain overweight after pregnancy. The Institute of Medicine (IOM) has recommended weight gain guidelines based on pre-pregnancy body mass index (BMI), but evidence-based strategies to achieve these goals are limited.Objective:This review discusses factors associated with EGWG with the goal of identifying targets for future intervention.Methods:A search was performed using the PubMed database to identify all English-language papers published between 1995 and 2014 related to excessive weight gain in pregnancy. Papers were grouped by theme: preconception BMI, sociodemographics, diet and exercise, psychosocial characteristics, and type of prenatal care.Results:Studies found that women who were overweight or obese at the time of conception were at higher risk of EGWG and that increased physical activity protected against EGWG. Studies on diet and sociodemographic characteristics were inconclusive. Psychological factors, specifically accurate perceptions of BMI, also appear to play a role in EGWG. Limited studies on methods of prenatal care delivery did not show improvement of weight parameters with group compared to one-on-one visits.Conclusion:Pre-pregnancy BMI is most strongly associated with EGWG, indicating that healthy weight habits throughout adult life may be especially important in periods of expected weight change, such as pregnancy. To decrease EGWG, providers should focus on improving pre-conception BMI through appropriate counseling on healthy eating and increased physical activity as well as encouraging pregnant women to continue moderate exercise during pregnancy when appropriate.

Reproductive outcomes in oocyte donation cycles are associated with donor BMI.

When adjusting for recipient BMI, is donor body mass index (BMI) associated with IVF outcomes in donor oocyte IVF cycles? Increasing oocyte donor BMI is associated with a reduction in clinical pregnancy and live birth rates. Increased BMI has been associated with suboptimal reproductive outcomes, particularly in assisted reproductive technology (ART) cycles. However, it remains unclear if this association implies an effect of BMI on oocyte quality and/or endometrial receptivity. A retrospective cohort study of two hundred and thirty five consecutive fresh donor oocyte IVF cycles from 1 January 2007 through 31 December 2013 at the Massachusetts General Hospital (MGH) Fertility Center. Analyses included a total of 202 oocyte donors and 235 total cycles. Following adjustments for recipient BMI, the relationship between donor BMI (categorized into quartiles) and IVF outcomes was assessed. In the entire (anonymous and known) donor population, a reduced odds of clinical pregnancy (P-trend = 0.046) and live birth (P-trend = 0.06) was observed with increasing BMI quartile. Compared with quartile 1 (BMI 17.8-21.1), odds ratio (OR) (95% CI) of clinical pregnancy was 0.9 (0.4-2.0), 0.5 (0.2-1.1) and 0.5 (0.2-1.1), and OR of live birth was 1.1 (0.5-2.6), 0.6 (0.3-1.2) and 0.6 (0.3-1.2) for quartiles 2 through 4 respectively. In anonymous donors only, the odds of clinical pregnancy (P-trend = 0.02) and live birth (P-trend = 0.03) also declined as BMI quartile increased. Compared with quartile 1 (BMI 17.8-21.1), odds ratio (OR) (95% CI) of clinical pregnancy was 0.7 (0.3-1.7), 0.5 (0.2-1.1) and 0.4 (0.1-0.9), and OR of live birth was 0.9 (0.4-2.2), 0.5 (0.3-1.2) and 0.4 (0.2-1.1) for quartiles 2 through 4 respectively. Limitations include the retrospective design, sample size and data from a single institution. Clinical application may not be limited to oocyte donors, though caution should be used prior to applying these principles to the general population. Data should not be interpreted to mean that all oocyte donors should be restricted to a BMI of less than 21.2 kg/m(2). Following adjustments for the respective BMI of the oocyte donor and recipient, this study demonstrates an association of preconception BMI with subsequent IVF outcomes. The observations of this study are consistent with prior animal studies, suggest a possible effect of BMI at the oocyte level prior to fertilization and implantation, and warrant further investigation. None.

Folic acid supplementation, preconception body mass index, and preterm delivery: findings from the preconception cohort data in a Chinese rural population.

BackgroundFolic acid (FA) supplementation before and during the first trimester can reduce the risk of occurrence of preterm delivery (PTD). Preconception body mass index (BMI) is also associated with PTD. This study aimed to investigate the combined effect of FA supplements and preconception BMI on the risk of PTD.MethodsThe data of a cohort from 2010–2011 that was obtained through a preconception care service in China was used (including 172,206 women). A multivariable regression model was used to investigate the association between maternal preconception conditions and the risk of PTD. The interaction of preconception BMI and FA supplementation was measured by a logistic regression model.ResultsTaking FA supplements in the preconception period or in the first trimester reduced the risk of PTD (odds ratio [OR] = 0.58 and OR = 0.61, respectively). Women with an abnormal BMI had an increased risk of PTD (OR = 1.09, OR = 1.10, and OR = 1.17 for underweight, overweight, and obese, respectively). Preconception BMI showed an interaction with the protective effect of FA supplementation for PTD. With regard to the interaction of FA supplementation, the adjusted odds ratio (aOR) was 0.57 (95 % CI: 0.51, 0.64) in underweight women, 0.85 (95 % CI: 0.73, 0.98) in overweight women, and 0.77 (95 % CI, 0.65, 0.91) in obese women. Preconception BMI also showed an interaction with the time of FA supplementation. Women with a normal BMI who began to take FA supplements in the preconception period had the lowest risk of PTD (aORs: 0.58 vs. 0.65 beginning in the first trimester). The aORs at preconception and the first trimester in the underweight group were 0.56 vs. 0.60. The aORs at preconception and the first trimester were 0.94 vs. 0.65 and 1.15 vs. 0.60 in the overweight and obesity groups, respectively.ConclusionsIn our study, FA supplements reduced the risk of PTD, while abnormal BMI raised the risk of PTD, although higher BMI categories did not have this higher risk once adjusted analysis was conducted. The protective effect of FA supplementation for PTD was reduced in women with overweight or obesity. To get better protection of FA supplementation, women with normal BMI or underweight should begin to use in preconception, while women with overweight or obesity should begin to use after conception.

Maternal and Fetal Determinants of Neonatal Body Composition

Background: Body composition in early life influences the development of obesity during childhood and beyond. It is, therefore, important to adequately determine neonatal body composition. Fetal growth and maternal factors might influence neonatal fat mass percentage (FM%), independent of birth weight. Methods: In 194 healthy neonates, we investigated neonatal body composition, measured by air-displacement plethysmography (PEAPOD), and its associations with estimated fetal weight (EFW), neonatal anthropometric data, maternal preconceptional body mass index (BMI) and maternal weight gain during pregnancy. Results: There was a large variation in neonatal FM%, even in case of a similar birth weight, corrected for gender and gestational age. Neonatal FM% was associated with EFW at 30 and 36 weeks of gestation and with catch-up in weight between 30 and 36 weeks of gestation, but not with EFW at 20 weeks (p < 0.01, p < 0.01 and p = 0.64, respectively). Neonatal FM% was also associated with preconceptional BMI of the mother (p < 0.01). There was no correlation with maternal weight gain. Conclusion: Our study shows that term neonates have a large variation in FM%. Neonatal FM% is associated with EFW at 30 and 36 weeks, catch-up in weight between 30 and 36 weeks of gestation and preconceptional BMI of the mother.

Weight gain in pregnancy and application of the 2009 IOM guidelines: toward a uniform approach.

ObjectiveThere is an urgent need to adopt standardized nomenclature as it relates to GWG, a more uniform approach to calculate it, and hence quantifying adherence to the 2009 Institute of Medicine (IOM) guidelines.ResultsThis perspective highlights the varying methods used to estimate GWG and discuss the advantages and limitations of each. While these calculations could be argued to have a minimal impact on data at the population level, on the patient level, incorrectly estimating weight at conception can result in misclassification of preconception body mass index (BMI) and assignment of the IOM guidelines which inherently affect the prospective management of weight gain (and potential outcomes) during the current pregnancy.ConclusionsWe recommend that preconception BMI and total GWG be determined objectively and total GWG be adjusted for length of gestation before assessing adherence to the IOM GWG guidelines.

Facteurs prédictifs d’échec de l’intention de voie basse chez la primipare obèse

ObjectivesTo identify predictors of failed trial of labour (TOL) in obese nulliparous at term. Patients and methodsRetrospective study about 213 nulliparous with a body mass index (BMI) greater than 30kg/m2 who delivered a vertex singleton after 37 weeks of gestation (WG). Planned caesarean sections were excluded. Maternal, sonographic, per-partum and neonatal characteristics were analyzed according to the mode of entry into labor and delivery route. Univariate and multivariate logistic regression analysis were performed. ResultsThe cesarean delivery rate was 28%. Induction of labor (aOR=4.3 [1.8–10.7]), prolonged pregnancy (aOR=10.8 [1.7–67.6]), macrosomia (aOR=5.6 [1.1–27.3]), meconium-stained amniotic fluid (aOR: 2.57 [1.03–6.42]), use of trinitrine (aOR=5.5 [1.39–21.6]) and neonatal head circumference greater than 35cm (aOR=3.1 [1.2–8.0]) were predictors of failed TOL. There was no significant correlation between failed TOL and preconceptional BMI. Univariate analysis revealed an association between excessive weight gain and failed TOL. Discussion and conclusionPredictors of failed TOL are the same in obese and non-obese women. Preconceptional BMI does not predict failed TOL in this nulliparous obese population.

Pregnancy Outcomes in a Cohort of Women With a Preconception Body Mass Index &gt;50 kg/m2

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A pilot study on the impact of maternal diet and preconception body mass index on breast milk macronutrient composition

Materials and methods A cross-sectional study was conducted at the maternity units of the University Hospital of Leuven, Belgium. Postpartum women, who delivered a term (≥37 weeks of gestation), did not smoke, were normoglycaemic and who were not on predefined medication, were invited to participate. Participants completed a 24 dietary recall and donated a breast milk sample of 1.5-2cl at day 4 post-delivery. The samples were collected during the first feeding in the morning by use of a vacuum pump. Each sample was analyzed for macronutrients (carbohydrates, protein, fats) and energy with the MIRIS Human Milk Analyzer. The prepregnancy weight and length were assessed from the online medical patient file to calculate the pre-pregnancy BMI. Further baseline characteristics included maternal age, ethnicity and parity. Pregnancy outcomes included delivery mode, the use of combined spinal epidural, gestational age, birth weight and gender of the baby.

Pregnancy and Infants’ Outcome: Nutritional and Metabolic Implications

Pregnancy is a complex period of human growth, development, and imprinting. Nutrition and metabolism play a crucial role for the health and well-being of both mother and fetus, as well as for the long-term health of the offspring. Nevertheless, several biological and physiological mechanisms related to nutritive requirements together with their transfer and utilization across the placenta are still poorly understood. In February 2009, the Child Health Foundation invited leading experts of this field to a workshop to critically review and discuss current knowledge, with the aim to highlight priorities for future research. This paper summarizes our main conclusions with regards to maternal preconceptional body mass index, gestational weight gain, placental and fetal requirements in relation to adverse pregnancy and long-term outcomes of the fetus (nutritional programming). We conclude that there is an urgent need to develop further human investigations aimed at better understanding of the basis of biochemical mechanisms and pathophysiological events related to maternal-fetal nutrition and offspring health. An improved knowledge would help to optimize nutritional recommendations for pregnancy.

Value of second trimester maternal serum sFlt-1, PlGF and their ratio in the prediction of preeclampsia

To study the value of second trimester maternal serum soluble Fms-like tyrosine kinase 1 (sFlt-1), placenta grouth factor (PlGF) and their ratio in the prediction of preeclampsia. In this nested case-control study, we collected second trimester maternal serum samples at 15-20 weeks and 24-28 weeks of gestation from those who developed gestational hypertensive disorders. Maternal serum sFlt-1 and PlGF were measured by electrochemiluminescence immunoassay on an automated platform. The value of sFlt-1, PlGF and their ratio were compared between gestational hypertensive group and the control group. Totally 41 patients with preeclampsia, 44 patients with gestational hypertension and 88 women with normal pregnancy outcomes were included in this study. There was no difference of age, gravidity, parity and preconception body mass index (BMI) between these three groups (P > 0.05) .Gestational week at delivery and neonatal birth weight were different between preeclampsia group and the control group (P < 0.01). The mean value of sFlt-1, PlGF and sFlt-1/PlGF ratio was (1 658 ± 488) µg/L, (141 ± 80) µg/L and 17 ± 9 in preeclampsia group, (1 945 ± 575) µg/L, (143 ± 52) µg/L and 15 ± 6 in gestational hypertension group, and (2 084 ± 741) µg/L, (65 ± 58) µg/L and 16 ± 9 in the control group at 15-20 weeks of gestation. There was no difference of sFlt-1, PlGF value and their ratio among the three groups at 15-20 weeks of gestation (P > 0.05) . The median value of sFlt-1, PlGF and sFlt-1/PlGF ratio were 8 525 µg/L, 35 µg/L and 398.0 in preeclampsia group, 905 µg/L, 336 µg/L and 2.7 in gestational hypertension group, 1 028 µg/L, 477 µg/L and 2.3 in the control group at 24-28 weeks of gestation. The value of sFlt-1, PlGF and their ratio was significantly different between preeclampsia group and the control group at 24-28 weeks of gestation (P < 0.01) . PlGF value was different between gestational hypertension group and the control group (P < 0.01) . The sensitivity and specificity of serum sFlt-1, PlGF and sFlt-1/PlGF ratio at 24-28 weeks of gestation to predict preeclampsia were 93% and 99% for sFlt-1 (cut off value 2 500 µg/L), 92% and 77% for PlGF (cut off value 270 µg/L) , 89% and 99% for sFlt-1/PlGF ratio (cut off value 11) . The value of sFlt-1, PlGF and their ratio at 24-28 weeks of gestation was significantly changed before clinical onset of preeclampsia.Use these serum indicators to predict preeclampsia will hopefully provide objective evidence for the management of patients who will develop preeclampsia later.