Weight Pregnant Women Research Articles

718: First trimester maternal weight in USA continues to rise

Mark Evans, Terrence Hallahan, Hsiao-Pin Liu, Jon Carmichael, David Krantz Comprehensive Genetics, Genetics, New York, NY, Perkin Elmer, NTD Labs, Melville, NY OBJECTIVE: To determine whether the average weight of pregnant women continues to increase between 2003 and 2011. STUDY DESIGN: First trimester maternal weight (MW) data (lb) were evaluated on 1,677,116 patients, collected as part of first trimester aneuploidy screening conducted between 2003 and 2011. The study population was 65% Caucasian, 12% Hispanic, 10% African American, 7% Asian, 3% Asian Indian and 3% other ethnic Groups. If a patient had more than one test during this time period data from one of their tests was selected at random. Geometric mean maternal weight values were adjusted for age, gestational age at time of test and ethnicity by determining the least-squares means based on ANOVA using log-transformed weight values. The adjusted geometric mean maternal weight values were then regressed against time (with standard error of the coefficients adjusted for autocorrelation and number of patients during each time period). RESULTS: Overall over the study time period, the average weight of the total population increased by 4.0% while the increase in the top 10% group was 7.3%. A majority of the increase occurred from 2003 to 2007 (3.0% and 4.7% for the total population and top 10%, respectively). Regression analysis determined that the increase was not linear but rather followed a polynomial quadratic pattern for both the overall population as well as the top 10% (P value of the quadratic term 0.001 for both overall and top 10% of the population). CONCLUSION: The continuous increase in the mean MW particularly the top 10% is of significant concern because of increased rate of pregnancy complications, more difficult ultrasound examinations, reduced fetal fraction of DNA leading to poorer performance of NIPT testing and the need to ensure that weight adjustment formulas used for aneuploidy screening are still applicable. The slowing of the trend in the increase in MW needs to be studied but is a positive sign for public health.

Predictors of haemoconcentration at delivery: association with low birth weight

[corrected] To assess the factors associated with risk of haemoconcentration at delivery, such as initial haemoglobin levels and alterations in the HFE gene, and its effect on low birth weight in pregnant women supplemented with moderate doses of iron. Case-control study nested in a longitudinal study conducted on 217 healthy pregnant women taking moderate iron supplementation and their newborns. Women were classified according to the risk of haemoconcentration at delivery, defined as Hb > 130 g/L. Each subject's obstetric and clinical history, smoking habit, and iron biochemical parameters (haemoglobin (Hb), serum ferritin and transferrin saturation) were recorded at 1st, 2nd and 3rd trimester and at delivery. Polymorphisms of the HFE gene (C282Y, H63D and S65C) were also measured. The average of iron supplementation of all the women was 43.9 mg/dia (geometric mean, 95 % CI: 43.6-44.1). Higher levels of Hb at early gestation and the presence of HFE mutations were associated with greater risk of haemoconcentration at delivery, adjusted odds ratios of 1.14 (95 % CI: 1.05-1.25) and 5.35 (95 % CI: 1.6-17.8). Haemoconcentration at delivery was associated with a greater risk of low birth weight, adjusted odd ratio of 11.48 (95 % CI: 1.13-116.6). Moderate daily doses of supplementary iron may be harmful for foetal growth in women with alterations in HFE gene and who started pregnancy with good haemoglobin levels. Overall, this suggests the importance of determining a woman's iron status early in her pregnancy in order to establish a more appropriate pattern of supplementation.

Difference in serum nephrin expression between normal and preeclamptic pregnancies: A preliminary study

Objective Nephrin is one of the slit membrane proteins of podocytes in the kidney. It is known that the nephrin is shed in the urine in nephropathy accompanying proteinuira. So the aim of this study was to evaluate the difference in the serum nephrin expression between normal and preeclamptic pregnancies. Methods A total of 20 pregnant women from May to September 2008 who received prenatal care and underwent delivery at our institute participated in the study. The preeclamptic group includes 13 women diagnosed as preeclampsia and a normal group of 7. Their serum were collected before delivery and analyzed by Western blotting for comparing serum nephrin expression. Results There was no difference in age, body weight of pregnant women, blood urea nitrogen, serum creatinine, urine creatinine level and gestational age between two groups. However, preeclampsia group had significantly higher systolic and diastolic blood pressure ( P<0.001), serum soluble fms-like tyrosine kinase-1 level ( P= 0.002), and lower birth weight ( P=0.011). In serum Western blot analysis, serum nephrin was detected in 10 of 13 in preeclampsia women (76.9%) but only in 2 of 7 (28.6%) in normal pregnancy women showing statistically significant difference ( P=0.032). Conclusion A higher prevalence of nephrin expression in the maternal serum was found in the preeclampsia when compared to the normal pregnancy.

PREGNANT WOMEN WITH LOW BMI (&lt;19)

Introduction: A strong relationship between maternal weight and birth weight has been demonstrated consistently and low maternal weight is considered as a preventable risk factor for low birth weight. Objectives: To determine the frequency of preterm labour and fetal outcome in terms of low birth weight in pregnant women with low body mass index &lt; 19. Study Design: Descriptive case series. Setting: Outpatient Department of Obstetrics and Gynaecology, Combined Military Hospital, Quetta, a tertiary care hospital. Duration of study: Six months from 01-05-2009 to 01-11-2009. Subjects and methods: Total 114 pregnant women at 16 weeks of gestational age with singleton pregnancy reporting to obstetrics and Gynaecology Department Combined Military Hospital, Quetta were selected. Results: Mean age was observed 27.6±3.9 year. Out of total 114 patients, 15 (13.1%) belonged to &lt;37 weeks of gestation while 99 (86.9%) patients had &gt;37 weeks gestation. Mean gestational age observed 38.5±4.1. Out of 15 preterm deliveries, 10 (66.7%) had uterine contractions &gt;4/10 min 5 and (33.3%) patients had Cervical dilatation &gt;2cm. Out of 114 patients, 12 (10.5%) cases had fetal weight &lt;2.5 kg and while remaining 102 cases (89.5%) had fetal weight 2.5-4 Kg. Conclusions: In conclusion, this study demonstrates that low BMI is associated with preterm delivery and low birth weight babies.

Placental malaria and low birth weight in pregnant women living in a rural area of Burkina Faso following the use of three preventive treatment regimens

BackgroundThe weekly chemoprophylaxis of malaria during pregnancy with chloroquine (CQ) has become problematic with the increasing resistance of Plasmodium falciparum to this drug. There was a need to test the benefits of new strategies over the classical chemoprophylaxis. This study was conducted to provide data to the National Malarial Control Programme for an evidence-based policy change decision making process. It compares the efficacy of two IPT regimens, using chloroquine (CQ) or sulphadoxine/pyrimethamine (SP), with the classical chemoprophylaxis regimen using CQ in reducing the adverse outcomes of malaria infection, for the mother and the foetus.MethodsPregnant women attending the first antenatal care visit were randomly assigned to one of the three treatment regimens. They were subsequently followed up till delivery. Maternal, placental and cord blood samples were obtained upon delivery to check for P. falciparum infection.ResultsA total of 648 pregnant women were enrolled in the study. Delivery outcome were available for 423 of them. Peripheral maternal P. falciparum infection at delivery was found in 25.8% of the women. The proportion of women with maternal infection was significantly lower in the IPTp/SP group than in the CQ group (P << 0.000). The prevalence of placental malaria was 18.8% in the CWC/CQ group; 15.9% in the IPTp/CQ group and 10.6% in the IPTp/SP group. The incidence of LBW (weigth < 2,500 g) was significantly higher among infants of mothers in the CWC/CQ group (23.9%) as compared with those of mothers in the IPTp/CQ (15.6%) and IPTp/SP (11.6%) groups (p = 0.02)ConclusionIntermittent preventive treatment with SP has shown clear superiority in reducing adverse outcomes at delivery, as compared with intermittent preventive treatment with CQ and classical chemoprophylaxis with CQ.

The performance of various anthropometric assessment methods for predicting low birth weight in pregnant women

OBJECTIVES: to assess the performance of various anthropometric methods for the evaulation of the nutritional status of pregnant women as a means of predicting low birth weight (LBW). METHODS: a descriptive cross-cutting study carried out among 433 pregnant women (&gt;20 years) attending a Public Maternity Hospital in Rio de Janeiro, Brazil. The adequacy of the weight gain at the end of the pregnancy was evaluated in accordance with the proposals of the Institute of Medicine and the Brazilian Ministry of Health. The sensitivity, specificity and accuracy of the adequacy of weight gain at the end of the pregnancy or nutritional state of mother as a predictor of low birth weight were calculated. RESULTS: the sensitivity of the various methods varied from 63.1% to 68.4% and the specificity from 71.2% to 75.1%. The adapted Institute of Medicine proposal drawn up by the Brazilian Ministry of Health, according to the classification of the pre-delivery nutritional status of the mother according to the World Health Organization cutoff points showed itself to be the most accurate (74.5%), this being the most adequate method for nutritional triage for reason of its association with low birth weight (OR=4.10; 95%CI=1.53-10.92). CONCLUSIONS: the best proposals for this population are those of the Institute of Medicine and the Brazilian Ministry of Health. Further studies aiming to ascertain the most appropriate methods of anthropometric evaluation for different populations should be encouraged.

Trends in den anthropometrischen Daten der Schwangeren und der Geburtsgewichte in Deutschland

PURPOSE After the increase of the prevalence of obesity in the German population as a whole the development of the mean weight of pregnant women and the somatic data of the corresponding newborns during the recent years need to be analyzed. MATERIAL AND METHODS The development of maternal age, weight and body mass index (BMI) at the beginning of pregnancy, and the weight and weight-length-index of the corresponding newborns was analyzed for the period from 1992 to 2000 by using data from the German Perinatal Survey. 2 880 283 mother-child pairs (single pregnancies only) were included in the study. The evaluation for the eastern (including Berlin) and western part of Germany was carried out separately. RESULTS The maternal weight (BMI) increased by 2 kg (0.4 kg / m 2 ) during this time interval. These changes seem to be primarily the result of an increase in the mean age of pregnant women by about two years, which could be observed within that period. In contrast to the increasing prevalence of obesity in the German population as a whole, the rate of obesity in pregnant women remained almost constant. During the examined period, the mean birth weight increased by 4 g per year (eastern Germany) and 5 g (western Germany). These data correspond very closely with those recently published for the north European countries and the USA. CONCLUSION In contrast to the German population as a whole the average weight of pregnants showed no significant increase between 1992 and 2000. Also the birth weight and derived indices remained nearly constant during this period.

A Study of Perinatal Period Risk Recognition and Behavior with Special Reference to the Over Weight in Pregnant Women

A Study of Perinatal Period Risk Recognition and Behavior with Special Reference to the Over Weight in Pregnant Women

Transvaginal ultrasound assessment of the cervix and digital examination before labor induction

To examine the relationship between sonographic measurement of cervical length and Bishop score with duration of labour induction. A prospective, blinded, observational study was performed in 191 pregnant women undergoing labor induction. Ultrasound measurement of cervical length and determination of Bishop score were performed. Induction was based exclusively on the Bishop score according to Obstetric Unit protocol. The criteria for considering the cervix unripe were either Bishop score < 6 or a cervical length = 26 mm. Duration of induction is defined like the induction-to-delivery interval. The main outcomes assessed were the duration of induction, the delivery within 24 h of induction and type of delivery. The duration of induction was between 2 h 27 min and 61 h 30 min. We found an association between cervical length and Bishop score with duration of induction. The duration of induction was significantly increased in nulliparous (median 18 h 38 min vs. 9 h 18 min). There was no correlation of age or weight of pregnant women with the duration of induction. Comparison between Bishop score and cervical length in predicting delivery within the first 24 hours showed that the pregnant women with low Bishop score had a higher risk of deliver after 24 hours of induction (OR = 21.16), as the ones with cervical length longer than 26 mm (OR = 5.06). Analyzing the relation of these two parameters with type of delivery we realize that low Bishop score has a higher risk of cesarean section (OR = 2.67) and that there wasn't any relation between type of delivery and cervical length. In this study we verified a statistically significant relation between Bishop score, US cervical length and previous vaginal birth with induction duration. Pregnant woman's age and weight didn't have influence on the duration of induction. The study showed that both Bishop score and US cervical length are useful in predicting delivery within the first 24 hours. Bishop score was also related with type of delivery.

Periodontal status and preterm low birth weight: a case control study

Previous studies have suggested that periodontal disease may be an important risk factor for preterm low birth weight. However, the link between periodontal health status of pregnant women and preterm low birth weight is contentious, as recent studies found no association between periodontitis and pregnancy outcome. The aim of this study was to investigate this potential link in a German Caucasian population. Fifty-nine pregnant women with a high risk for a preterm low birth weight infant (suffering from preterm contractions, cases, group 1) as well as 42 control women with no preterm contractions during pregnancy and having an infant appropriate for date and weight (>or= 37 weeks gestation, >or= 2500 g, group 2) were examined. Clinical periodontal status was recorded on a full mouth basis. Subgingival plaque samples were taken and periodontal pathogens were identified by polymerase chain reaction. Additionally, interleukin-1 beta level in gingival crevicular fluid was analysed. The mean percentage of sites showing moderate to advanced attachment loss (>or=3 mm) was low in all study groups (group 1: 9.9 +/- 11.2%; group 2:10.6 +/- 14.1%, respectively). No significant differences between the groups in any aspects of the studied periodontitis parameters could be detected. Using a logistic regression model controlling for known preterm low birth weight risk factors, no periodontitis-associated factors increased risk for preterm contractions or preterm low birth weight. The odds ratio (OR) was 1.19 for preterm contractions, the 95% confidence interval (CI) 0.46; 3.11 and 0.73 for preterm low birth weight; 95% CI: 0.13; 4.19, respectively. In this population, periodontitis was not a detectable risk factor for preterm low birth weight in pregnant women.

Maternal triglyceride levels and newborn weight in pregnant women with normal glucose tolerance

To determine the predictive value of serum triglyceride levels (TG) for neonatal weight in pregnant women with positive diabetic screening but normal glucose tolerance. We enrolled 180 pregnant Caucasian women with positive diabetic screening. All women underwent a 3-h 100-g oral glucose tolerance test (OGTT) at 27th +/- 4 week of gestation. At the time of OGTT, we measured: fasting plasma glucose, fasting lipids profile and determined ApoE polymorphisms to evaluate the effects on lipid levels. In 83 women with normal glucose tolerance and at term delivery we evaluated the association between maternal serum TG, specific maternal parameters known to affect fetal growth and newborn weight. Based on OGTT, gestational diabetes mellitus (GDM) was diagnosed in 36 women (20%), impaired glucose tolerance (IGT) in 23 (13%), and normal glucose tolerance (NGT) in 121 (67%). Serum TG concentration was significantly higher in women with GDM (2.47 +/- 0.77 mmol/l) as compared with NGT (1.99 +/- 0.64 mmol/l) or IGT (1.98 +/- 0.81 mmol/l) (P < 0.01). ApoE3 allelic frequency was 86%, ApoE2 and ApoE4 were 5 and 9%, respectively. We found no clear-cut association between apoE genotype and serum TG concentration. Macrosomia and LGA newborns were more frequent in IGT than in GDM or NGT (P < 0.01). In the 83 women with positive diabetic screening but normal glucose tolerance who delivered at term, the incidence of LGA infants was significantly higher in those with TG levels higher than the 75th percentile (> 2.30 mmol/l) (21%) than in mothers who had normal TG levels (4.5%) (P < 0.05). Pre-pregnancy BMI (r(2) = 0.067), weight gain during pregnancy (r(2) = 0.062), fasting serum TG (r(2) = 0.09), and 2-h post-OGTT glucose levels (r(2) = 0.044) were all associated with neonatal body weight (all P < 0.05 or less). However, on a multiple regression analysis, only pre-pregnancy BMI (F-test = 7.26, P < 0.01), and fasting serum TG (F-test = 4.07, P < 0.01) were independently associated with birth weight. Pre-pregnancy BMI and fasting maternal serum TG determined in the last trimester of gestation were independently associated with neonatal birth weight in women with normal glucose tolerance, but positive screening test. TG levels measured in the third trimester of pregnancy are independent of the genetic polymorphism of ApoE.

Do Health Worker Female and Traditional Birth Attendant Equipped to Provide Primary Health Care in Tribal Areas? Evidences from Tribal Andhra Pradesh

An attempt has been made in this paper to study the knowledge skills and performance of Multi purpose Health Worker (Female) (MPHW-F) working in tribal areas of Andhra Pradesh their self perceived training needs in various areas of Maternal and Child Health and the knowledge of Traditional Birth Attendants in providing maternal and child health services in tribal areas. The study found that in general the MPHW (F) were ill equipped to provide MCH services in tribal areas. The knowledge of health worker female in areas of MCH were very poor especially in areas of intra natal post natal and treatment of minor ailments. The skills were also far below satisfactory. Majority of them could not perform accurately even the basic skills like taking height and weight of pregnant women. The other skills like hoemoglobin testing urine testing for albumin etc were performed by gross error. Health worker over estimated their level of knowledge and skills and under estimated their need for training. The TBAs too were lagging behind in the correct knowledge and safe practices in conducting delivery. Hence there is an urgent need to redesign the basic training of health workers working in tribal areas. (authors)

Effect of zinc administration on insulin-likegrowth factor I, haemoglobin and neonatal birth weight in pregnant women

Effect of zinc administration on insulin-likegrowth factor I, haemoglobin and neonatal birth weight in pregnant women

Factors Affecting Weight Gain and Infant Birth Weight in Pregnant Women

LEARNING OUTCOME: To examine the attitudes and factors affecting weight gain and infant birth weight in pregnant women.Few studies have measured and defined nutrition-related attitudes of women toward pregnancy weight gain. Negative attitudes about gaining weight during pregnancy may lead to inadequate weight gain during pregnancy and result in low infant birth weight This research determined factors affecting weight gain during pregnancy and ultimately, infant birth weight. A questionnaire, completed by 55 pregnant women receiving prenatal care at an urban family practice center, included 18-likert format questions expressing their attitudes toward weight gain. Other questions included family health history, financial and emotional support of the father of the baby and the participants family, and the physician's recommendation for weight gain during pregnancy. Attitudinal data and actual weight gain were obtained from the participants to determine whether attitudes toward slimness affected weight gain during pregnancy. A 24-hour dietary recall also was obtained as well as the infant's birth weight. One a scale of one to five, one denoting a negative attitude and five a positive attitude, the mean attitude score for this sample (n=55) is 3.56, indicating a moderately positive attitude toward pregnancy. Attitude scores related significantly to the reported physician's recommendation for weight gain (p=.03). Those individuals who reported they were supported financially by the father of the baby (n=9), had a significant positive relationship between their attitude and dietary intake (r=.6611-.8396; p=.01-.05). This study suggests that the physician's weight gain recommendation and the availability of support person (s) may influence attitudes toward pregnancy and weight gain as well as dietary intake during pregnancy, ultimately Meeting infant birth weight.

Estimators of birth weight in pregnant women requiring insulin: A comparison of seven sonographic models

To determine if the relative accuracy of the sonographic estimate of birth weight among diabetic gravidas requiring insulin improves significantly as more fetal measurements are used. We studied 172 diabetic women requiring insulin who had sonographic measurements of fetal parts within 7 days of delivery. Friedman nonparametric analysis of variance followed by Dunn multiple comparison and chi 2 were used to assess the relative accuracy of the seven models. Prediction limits were calculated to determine the estimate of fetal weight that would ensure (with 90% accuracy) that the newborn was macrosomic (at least 4 kg). The mean (+/- standard deviation [SD]) birth weight was 3388 +/- 727 g, and the frequency of macrosomia at term gestation was 19.4% (29 of 149). The mean standardized absolute error (g/kg) based on abdominal circumference (AC) and femur length (FL) (86 +/- 72 g/kg) was not significantly different from the other models (range 84 +/- 72 to 116 +/- 99 g/kg, P > .05). The percent of estimate within 10% of actual birth weight using AC and FL (65%) was similar to the other models (53.4-66.2%). Regardless of the White classification, the estimation of fetal weight using AC and FL had an accuracy similar to the other six regression equations. To ensure that the birth weight is at most 3999 g, the estimated fetal weight should be 3200 g, and, conversely, if the predicted weight is 4700 g, then the newborn is macrosomic. Among patients requiring insulin, estimation of birth weight using AC and FL is as accurate as more complicated models. The ability to detect macrosomia by ultrasound is limited.

The relationship between cadmium zinc and birth weight in pregnant women who smoke

It is universally accepted that smoking during pregnancy results in decreased infant birth weight. However, the mechanism for decreased birth weight is not completely understood. This study tested the hypothesis that the cadmium/zinc interaction in the maternal-fetal-placental unit of the mother who smokes could be related to birth weight. Thiocyanate was used as the index of smoking status and atomic absorption spectroscopy was used to determine trace elements. Results show that cord vein red blood cell zinc and maternal whole blood cadmium levels are significant predictors of infant birth weight when variance that is due to clinical factors and thiocyanate is controlled with stepwise multiple regression techniques (n = 202). Bivariate correlation techniques showed that the factors affecting birth weight were different in the smoking and nonsmoking groups. For example, in nonsmokers (n = 125), the cord vein red blood cell zinc level was positively related to birth weight. In smokers (n = 77), maternal whole blood cadmium, placental cadmium, and placental zinc levels were negatively related to birth weight; the ratio of placental zinc to placental cadmium and the cord vein red blood cell zinc level were positively related to birth weight. The results suggest that increased maternal cadmium and decreased cord vein red blood cell zinc levels in infants of smokers may be significant clinically since increased maternal whole blood cadmium and decreased cord vein red blood cell zinc levels are both significantly related to decreased birth weight.

Raised maternal serum alpha-fetoprotein levels and low birth weight babies.

In a retrospective study of low birth weight babies (less than 2.5 kg) born in one year it was found that statistically more maternal serum alpha-fetoprotein levels were above twice the median level than a control group of mothers producing larger babies (more than 3 kg). However, from the results the test cannot be accepted as being a prospective indicator or as a screening test of low birth weight in pregnant women.

Terminal loss in weight in pregnant women: Kemper, W.: Archiv fuer Gynaekologie, 1924, cxxi, 604

Terminal loss in weight in pregnant women: Kemper, W.: Archiv fuer Gynaekologie, 1924, cxxi, 604

Concerning the terminal loss of weight in pregnant women: Hirsch, R.: Monatsschrift für Geburtshülfe und Gynäkologie, 1924, lxvii, 266

Concerning the terminal loss of weight in pregnant women: Hirsch, R.: Monatsschrift für Geburtshülfe und Gynäkologie, 1924, lxvii, 266