Prevalence Of Obesity In Women Research Articles

Obesity Prevalence and Its Impact on Maternal and Neonatal Outcomes among Pregnant Women: A Retrospective Cross-Sectional Study Design.

The escalating prevalence of obesity in women of reproductive age raises concerns about its impact on maternal and fetal health during pregnancy. This study aimed to thoroughly assess how obesity affects pregnancy and neonatal outcomes among Saudi pregnant women. In a retrospective cross-sectional study, we analyzed 8426 pregnant women who delivered at King Fahad National Guard Hospital in Riyadh in 2021. Of these, 3416 had obesity, and 341 of them, meeting the inclusion criteria, were selected. Maternal and neonatal outcomes were compiled using a structured questionnaire and extracted from the hospital's "Best Care" data-based registration system. The findings highlighted that 40.5% of pregnant women were classified as obese, with almost half falling into obesity class II based on BMI. Obesity correlated significantly with adverse maternal outcomes like gestational diabetes and increased rates of cesarean deliveries. Additionally, maternal obesity was linked to unfavorable fetal outcomes, including higher rates of newborn intensive care unit admissions, lower APGAR scores at 1 min, and a greater likelihood of macrosomia. This study underscores the important impact of maternal obesity on both maternal and fetal health during pregnancy. Addressing this high-risk condition demands targeted educational programs for women of reproductive age focusing on BMI control, dietary adjustments, and lifestyle modifications to mitigate obesity-related complications during pregnancy.

Exacerbated cardiac dysfunction after myocardial infarction in offspring from obese parents

The prevalence of obesity in women of reproductive age is increasing rapidly, and children from obese mothers are at higher risk of developing cardiovascular diseases in adulthood. Acute myocardial infarction (MI) is one of the leading causes of death worldwide with more than one million deaths per year in the U.S. alone. Using a model of parental obesity with male and female Sprague-Dawley rats fed a high fat diet (HFD) prior to mating, and dams maintained on the HFD during gestation and lactation, we found that male and female offspring from these obese parents have multiple metabolic abnormalities early in life (3 weeks old), and that male, but not female, offspring have impaired diastolic function associated with reduced cardiac SIRT3 expression and mitochondrial biogenesis. At 24 weeks of age, male offspring from obese parents exhibit increased blood pressure. To examine if offspring from obese parents are at greater risk of death and worse cardiac function after MI, male and female lean offspring fed a normal diet (ND) born from ND fed lean parents (ND-Offs, n=5-6/sex) and lean offspring fed ND born from HFD fed obese parents (HFD-Offs, n=6-11/sex) were submitted to a permanent left descending coronary artery ligation to induce MI at 12 weeks of age. Twenty-four-hour survival rate post-MI surgery was examined and cardiac function was measured by intraventricular catheterization with a Millar catheter on day 7 post-MI. Compared to ND-Offs, male and female HFD-Off born from obese HFD-fed parents exhibited reduced survival rate (male: 60% vs 100% and female: 55% vs. 83% for HFD-Offs and ND-Offs, respectively) and increased ventricular fibrillation post-MI. At day 7 post-MI, we observed reduced +dP/dtmax in male, but not female, HFD-Offs compared to ND-Offs (6,554±25 vs. 8,253±440 mmHg/sec in males and 7,962±557 vs. 7,668±890 mmHg/sec in females, for HFD-Offs and ND-Offs, respectively) despite similar infarct size in all groups (~40% of the total left ventricle circumference). We found no major differences in -dP/dtmin or tau (indices of diastolic function) between groups. Thus, parental obesity is associated with increased mortality rate in their offspring after induction of MI and worse systolic function in male, but not female, offspring even when offspring are fed a healthy diet after weaning and remain lean. NIDDK 1R01121411 (do Carmo), HL1630376 (da Silva/do Carmo), NIGMS P20GM104357 (Hall), P30GM149404 (Hall) and U54GM115428 (Hall). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

A study of incidence of respiratory distress syndrome in newborns born to mothers with gestational diabetes

Background: Hyaline membrane disease/RDS is an important cause for newborn morbidity and mortality. Many studies have established an association of infants of diabetic mothers (IDMs) with respiratory distress syndrome (RDS) since decades. Modern lifestyle changes have increased the prevalence of obesity in women and thus diabetes in pregnancy. Maintaining strict euglycemia is a double-edged sword in pregnancy which has been affecting the neonatal health and respiratory maturity in particular which has been associated with increased mortality and morbidity. Methods: It was a prospective case control study done over a span of one year. Results: Hyaline membrane disease (RDS) is significantly associated with gestational diabetes mellitus (GDM). Conclusions: Even our study emphasized the ill effects of gestational diabetes on the respiratory development of baby. Most of the babies are manageable and outcome can be drastically improved by early diagnosis and efficient treatment. Education and anticipation of the complications and prompt referral are the need of the hour in peripheries and advancement of neonatal intensive cares in the referral hospitals is needed.

Eating After Acute Psychosocial Stress in Healthy Men and Women: Sex Differences and Endocrine Mechanisms.

Overweight and obesity have become a major health burden with a higher prevalence of obesity in women than in men. Mental stress has been discussed to play a role in this context. We investigated endocrine mechanisms underlying eating after acute psychosocial stress and potential sex differences therein. A total of 32 male and 31 female healthy participants underwent the Trier Social Stress Test before they tasted ice cream in a bogus taste test 15 minutes after stress. We repeatedly assessed the stress hormone cortisol and the satiety hormone cholecystokinin (CCK) in saliva as well as perceived hunger before and up to 1 hour after stress. Lower immediate total cortisol stress reactivity predicted higher hunger (Ps ≤ .004), but was not associated with food intake (Ps ≥ .90) or total CCK release (Ps ≥ .84). As compared to men, women ate less after stress (Ps < .001) and had consistently lower levels of hunger (Ps ≤ .024) and cortisol (Ps ≤ .008) as well as a lower immediate total cortisol stress reactivity (Ps = .002). Further, they differed in the kinetics of CCK over the total experimental procedure (Ps ≤ .011), in immediate reaction to stress (Ps ≤ .038), and after eating (Ps ≤ .072), with women's CCK levels continuously decreasing while men's CCK levels were reactive. We found evidence for lower immediate total cortisol stress reactivity relating to higher perceived hunger, with lower cortisol levels in women. Unlike in men, CCK levels in women were not reactive to acute stress and eating and decreased continuously. Our results may suggest a higher risk for stress-induced eating in women.

Neighborhood social cohesion and obesity in the United States

Low neighborhood social cohesion (nSC) has been associated with obesity. Still, few studies have assessed the nSC-obesity relationship among a large, nationally representative, and racially/ethnically diverse sample of the United States population. To address this literature gap, we examined cross-sectional associations among 154,480 adult participants of the National Health Interview Survey (NHIS) from 2013 to 2018. We also determined if associations varied by race/ethnicity, sex/gender, age, annual household income, and food security status. Based on a 4-item scale from the Project on Human Development in Chicago Neighborhoods Community Survey, we categorized nSC as low, medium, and high. Based on body mass index (BMI) recommendations, we categorized obesity as ≥30 kg/m2. We used Poisson regression with robust variance to directly estimate prevalence ratios (PRs) and 95 % confidence intervals (CIs) while adjusting for sociodemographic characteristics, such as annual household income, educational attainment, and marital status, along with other confounders. Study participants' mean age ± standard error was 47.1 ± 0.1 years; most (69.2 %) self-identified as Non-Hispanic (NH)-White; and 51.0 % were women. NH-Black and Hispanic/Latinx adults comprised more of the population in neighborhoods with low nSC (14.0 % NH-Black, 19.1 % Hispanic/Latinx, and 61.8 % NH-White) versus high nSC (7.7 % NH-Black, 10.4 % Hispanic/Latinx and 77.0 % NH-White). Low vs. high nSC was associated with a 15 % higher prevalence of obesity (PR = 1.15 [95 % CI: 1.12–1.18]), and the magnitude of the association was more substantial among NH-White adults (PR = 1.21 [95 % CI: 1.17–1.25]) compared to associations among Hispanic/Latinx (PR = 1.04 [95 % CI: 0.97–1.11]) and NH-Black (PR = 1.01 [95 % CI: 0.95–1.07]) adults. Low vs. high nSC was associated with a 20 % higher prevalence of obesity in women (PR = 1.20 [95 % CI: 1.16–1.24]) compared to a 10 % higher prevalence in men (PR = 1.10 [95 % CI: 1.06–1.14]). Low vs. high nSC was associated with a 19 % higher prevalence of obesity among adults ≥50 years old (PR = 1.19 [95 % CI: 1.15–1.23]) compared to a 7 % higher prevalence of obesity among adults <50 years old (PR = 1.07 [95 % CI: 1.03–1.11]). Efforts to address nSC may improve health and address health disparities.

The effect of retirement on obesity in women: Evidence from China

IntroductionRetirement has been shown to impact individual health as an important life course, and we examined the impact of retirement on the prevalence of obesity in women based on a female perspective. MethodsWe use data from the five waves of the China Family Panel Study (CFPS) data from 2010 to 2018, with the body mass index (BMI) as the obesity measure. Fuzzy regression discontinuity design (FRDD) is used to overcome the endogeneity of retirement behavior and obesity. ResultsAfter retirement, the obesity rate among women increased 23.8%–27.4% (p < 0.05). The mechanism is that the activity consumption has not changed significantly, but the energy intake has increased significantly. In addition, we found that the effect of retirement on female obesity was strong heterogeneity. ConclusionsThe study found that retirement will increase the probability of obesity in women.

Estrogens in Adipose Tissue Physiology and Obesity-Related Dysfunction.

Menopause-related decline in estrogen levels is accompanied by a change in adipose tissue distribution from a gynoid to an android and an increased prevalence of obesity in women. These unfavorable phenomena can be partially restored by hormone replacement therapy, suggesting a significant role for estrogen in the regulation of adipocytes' function. Indeed, preclinical studies proved the involvement of these hormones in adipose tissue development, metabolism, and inflammatory activity. However, the relationship between estrogen and obesity is bidirectional. On the one hand-their deficiency leads to excessive fat accumulation and impairs adipocyte function, on the other-adipose tissue of obese individuals is characterized by altered expression of estrogen receptors and key enzymes involved in their synthesis. This narrative review aims to summarize the role of estrogen in adipose tissue development, physiology, and in obesity-related dysfunction. Firstly, the estrogen classification, synthesis, and modes of action are presented. Next, their role in regulating adipogenesis and adipose tissue activity in health and the course of obesity is described. Finally, the potential therapeutic applications of estrogen and its derivates in obesity treatment are discussed.

Platelets and endothelial dysfunction in gestational diabetes mellitus.

The prevalence of gestational diabetes mellitus (GDM) has increased in recent years, along with the higher prevalence of obesity in women of reproductive age. GDM is a pathology associated with vascular dysfunction in the fetoplacental unit. GDM-associated endothelial dysfunction alters the transfer of nutrients to the foetus affecting newborns and pregnant women. Various mechanisms for this vascular dysfunction have been proposed, of which the most studied are metabolic alterations of the vascular endothelium. However, different cell types are involved in GDM-associated endothelial dysfunction, including platelets. Platelets are small, enucleated cell fragments that actively take part in blood haemostasis and thrombus formation. Thus, they play crucial roles in pathologies coursing with endothelial dysfunction, such as atherosclerosis, cardiovascular diseases, and diabetes mellitus. Nevertheless, platelet function in GDM is understudied. Several reports show a potential relationship between platelet volume and mass with GDM; however, platelet roles and signaling mechanisms in GDM-associated endothelial dysfunction are unclear. This review summarizes the reported findings and proposes a link among altered amount, volume, mass, reactivity, and function of platelets and placenta development, resulting in fetoplacental vascular dysfunction in GDM.

Abstract 5940: Impact of obesity on sexual functioning in women with gynecologic cancer pre-and post-radiotherapy

Abstract Background: As the prevalence of obesity in women increases in the US, a better understanding of the effect of obesity on women with gynecologic cancer (GynCa) is imperative. However, whether obesity impacts sexual functioning (SF) in GynCa patients has been understudied. Limited studies have used body mass index (BMI) as the only obesity indicator, which may result in a misunderstanding of the effect of obesity on SF in GynCa patients with different body compositions. This study aimed to explore the role of obesity via two different measures in determining SF in GynCa patients pre-and post-radiotherapy (RT). Methods: In this secondary analysis, obesity was measured pre-RT by both BMI and body fat percentage (BFP). BFP was calculated by using the Clinica Universidad de Navarra-Body Adiposity Estimator. SF, physical and emotional well-being were assessed pre-RT by the Female Sexual Function Index and the Functional Assessment of Cancer Therapy-General. At 6 months post-RT, SF was reassessed. Generalized linear models (GLM) and generalized linear mixed models (GLMM) with a log-link were implemented to identify the effect of obesity (using BMI and BFP) on SF pre-and post-RT. Regression-based mediation analysis was used to identify mediating effects of physical and emotional well-being between obesity and SF. Results: Among 54 (24 cervical and 30 endometrial) patients, 48% were Black, 52% were married or in a domestic partnership, and 59% were treated with surgery and/or chemotherapy pre-RT (i.e. prior treatment). Less patients were classified as being obese when obesity was measured by BMI (48%) compared to BFP (61%). Patients with endometrial cancer and prior treatment history were more likely to be obese and reported better SF. Unadjusted GLM showed that patients with obesity had better SF than those without obesity pre-RT regardless of obesity measures (BMI p = .018; BFP p = .016). However, we found no association between obesity (both BMI-and BFP-based obesity) and SF pre-RT after adjusting for cancer type and prior treatment history. GLMM showed that BFP-based obesity had a negative effect on the improvement in SF from pre-RT to post-RT (p = .013) after adjusting for cancer type and prior treatment history. Patients without BFP-based obesity showed a significant improvement post-RT (p = .019), but those with obesity (per BFP) showed no changes in SF post-RT (p = .949) compared to pre-RT. BMI-based obesity did not affect the changes in SF post-RT. We found no mediation effects of physical and emotional well-being between obesity and SF. Conclusions: Obesity may play a negative role in SF improvement in GynCa patients post-RT. More rigorous research and clinical attention to obesity measurement are necessary to determine the association between obesity and SF in GynCa patients and thus lead to the discovery of new interventions for this long-neglected topic of SF in GynCa patients, particularly for those who are obese. Citation Format: Haerim Lee, Deborah W. Bruner, Yi-Juan Hu, Jinbing Bai, Tony Y. Eng, Joseph W. Shelton, Pretesh R. Patel, Namita Khanna, Isabelle Scott, Katherine A. Yeager. Impact of obesity on sexual functioning in women with gynecologic cancer pre-and post-radiotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5940.

MAT PILATES EXERCISE IMPROVES STATIC BALACE OF YOUNG ADULTS WITH OBESITY

Background: The prevalence of obesity in women in Semarang at the age over 18 is 29.93%. This high prevalence rate of obesity can have a negative impact on individual health. The condition of obesity is closely related to its complications that can occur in various aspects of the body's physiology, in the example it can reduce functional abilities such as static balance which can interfere with activities and decrease quality of life. One of the methods that can be used to improve static balance is mat pilates. Mat pilates prioritizes stretching and strengthening core muscles with controlled and precise movements so that mat pilates exercises can improve static balance. However, no studies have yet discussed the effect of mat pilates exercise on static balance in obese young adults Aim: To prove that mat pilates exercise can increase static balance of female aged 18-23 years old with obesity. Methods: This study used quasi experimental pre and post-test design and was done in August-October 2020. The subjects were 33 female students of Medical Faculty of Diponegoro University aged 18-23 years with BMI over 27 kg/m², divided in 2 groups. Treatment group (n=15) was instructed to do 8 weeks of mat pilates exercise (3 times a week) and control group (n=18) was instructed to not do any exercise. Static balace was measured with Flamingo Balance Test (FBT). Data’s significance was analyzed with paired t test and independent t test. Results : There’s a significant decrease (p&lt;0,001; paired t test) in FBT score before and after of the mat pilates treatment group from 12,31 ± 5,15 to 10,09 ± 5,59. An insignificant increase (p=0,798; paired t test) found in FBT score before and after of the control group from 12,74 ± 4,65 to 12,93 ± 6,29. The score difference of FBT test of the mat pilates treatment group and control group shows significant result (p=0,013). Conclusion: There is an improvement of static balance after mat pilates exercise intervention on female aged 18-23 years old with obesity

Ensuring the Efficacious Iron Fortification of Foods: A Tale of Two Barriers.

Iron fortification of foods has always been a challenge. This is because iron fortification compounds vary widely in relative absorption; because many foods undergo unacceptable changes in color or flavor from the addition of iron; and because many of the iron-fortified foods contain potent inhibitors of iron absorption. These technical barriers have largely been overcome, and efficacious iron-fortified foods, that maintain or improve the iron status of women or children in long-term feeding studies, can be designed. Commercially fortified infant foods are efficacious, and other commercial iron-fortified foods targeted at women and children will provide a useful amount of iron provided the fortification level is adjusted according to the relative absorption of the iron compound. Technologies for the large-scale fortification of wheat and maize flour are also well established, and iron fortification of rice, using the recently developed extruded premix technique, is showing great promise. However, some important knowledge gaps still remain, and further research and development is needed in relation to iron (and iodine)-fortified salt and iron-fortified liquid milk. The usefulness of less-soluble iron compounds, such as ferrous fumarate, to fortify foods for infants and young children in low- and middle-income countries (LMICs) also needs further investigation. A more formidable barrier to efficacious iron-fortified food has been reported in recent years. This is the infection-initiated inflammation barrier, which inhibits iron absorption in response to infection. This barrier is particularly important in LMICs where infections such as malaria and HIV are widespread, and gastrointestinal infections are common due to poor quality water supplies and sanitation. Another source of inflammation in such countries is the high prevalence of obesity in women. Most countries in sub-Saharan Africa have high inflammation which not only decreases the efficacy of iron-fortified and iron-biofortified foods but complicates the monitoring of large-scale iron fortification programs. This is because iron deficiency anemia cannot be differentiated from the more prominent anemia of inflammation and because inflammation confounds the measurement of iron status. There is an urgent need to better quantify the impact of inflammation on the efficacy of iron-fortified foods. However, at present, in LMICs with high inflammation exposure, infection control, cleaner water, improved sanitation, and a decrease in obesity prevalence will undoubtedly have a greater impact on iron status and anemia than the iron fortification of foods.

District-Level Risk Factors for COVID-19 Incidence and Mortality in Nepal.

The recent global pandemic of the novel coronavirus disease 2019 (COVID-19) is affecting the entire population of Nepal, and the outcome of the epidemic varies from place to place. A district-level analysis was conducted to identify socio-demographic risk factors that drive the large variations in COVID-19 mortality and related health outcomes, as of 22 January 2021. Data on COVID-19 extracted from relevant reports and websites of the Ministry of Health and Population of Nepal, and the National Population and Housing Census and the Nepal Demographic and Health Survey were the main data sources for the district-level socio-demographic characteristics. We calculated the COVID-19 incidence, recovered cases, and deaths per 100,000 population, then estimated the associations with the risk factors using regression models. COVID-19 outcomes were positively associated with population density. A higher incidence of COVID-19 was associated with districts with a higher percentage of overcrowded households and without access to handwashing facilities. Adult literacy rate was negatively associated with the COVID-19 incidence. Increased mortality was significantly associated with a higher obesity prevalence in women and a higher smoking prevalence in men. Access to health care facilities reduced mortality. Population density was the most important driver behind the large variations in COVID-19 outcomes. This study identifies critical risk factors of COVID-19 outcomes, including population density, crowding, education, and hand hygiene, and these factors should be considered to address inequities in the burden of COVID-19 across districts.

Maternal High-Fat Diet During Pre-Conception and Gestation Predisposes Adult Female Offspring to Metabolic Dysfunction in Mice.

The risk of obesity in adulthood is subject to programming in the womb. Maternal obesity contributes to programming of obesity and metabolic disease risk in the adult offspring. With the increasing prevalence of obesity in women of reproductive age there is a need to understand the ramifications of maternal high-fat diet (HFD) during pregnancy on offspring’s metabolic heath trajectory. In the present study, we determined the long-term metabolic outcomes on adult male and female offspring of dams fed with HFD during pregnancy. C57BL/6J dams were fed either Ctrl or 60% Kcal HFD for 4 weeks before and throughout pregnancy, and we tested glucose homeostasis in the adult offspring. Both Ctrl and HFD-dams displayed increased weight during pregnancy, but HFD-dams gained more weight than Ctrl-dams. Litter size and offspring birthweight were not different between HFD-dams or Ctrl-dams. A significant reduction in random blood glucose was evident in newborns from HFD-dams compared to Ctrl-dams. Islet morphology and alpha-cell fraction were normal but a reduction in beta-cell fraction was observed in newborns from HFD-dams compared to Ctrl-dams. During adulthood, male offspring of HFD-dams displayed comparable glucose tolerance under normal chow. Male offspring re-challenged with HFD displayed glucose intolerance transiently. Adult female offspring of HFD-dams demonstrated normal glucose tolerance but displayed increased insulin resistance relative to controls under normal chow diet. Moreover, adult female offspring of HFD-dams displayed increased insulin secretion in response to high-glucose treatment, but beta-cell mass were comparable between groups. Together, these data show that maternal HFD at pre-conception and during gestation predisposes the female offspring to insulin resistance in adulthood.

Prevalence of obesity in women of reproductive age group and related factors. A study from Southeastern Turkey.

Obesity is an important public health issue with an increasing prevalence in Turkey as well as throughout the world. The purpose of this study is to identify the prevalence of obesity in women of reproductive age group living in Adıyaman which is located in southeastern Turkey and the factors related to it. This descriptive study was carried out with 1,100 women registered at Family Health Centers in the Adıyaman city center. Data were collected through a face-to-face survey method and evaluated on a computer. Chi-square and logistic regression evaluations were used in comparisons and P < 0.05 was considered statistically significant. The mean age of the women was 32.94 ± 8.65; 78.3% of them were homemakers, and half were elementary school graduates or less educated; 57.6% of the women were overweight with 24.1% being obese. It was observed that women's body mass index increased with their age and decreased with higher levels of education. Also, the study showed that the risk of being overweight increased 3,2 times for married women and 2,0 times for unemployed women. Additionally, the rate of women being overweight was higher among the women with more number of previous pregnancies. Prevalence of obesity among women of reproductive age was high in the Adıyaman city center. Specific training should be planned, especially for women with low education levels, for fighting obesity.

FAKTOR RESIKO WANITA OBESITAS PADA STATUS SOSIAL EKONOMI MENENGAH KE BAWAH

The prevalence of obesity is higher in women than in men. Based on the 2018 Riskesdas, the prevalence of obesity in women is 29.8% compared to men’s 14.7%. Obesity occurs due to many factors, mainly due to imbalance of energy or food intake with energy expenditure. This research is to determine LDL cholesterol, HDL, triglyceride, and body fat composition.&#x0D; The research design used in this study is a cross-sectional study design that aims to analyze obesity levels of LDL cholesterol, HDL, triglycerides, and fat composition with obesity. The mean fasting blood sugar level is 1.12 ± 0.33 mg / dl, mean blood sugar 2 hours PP 1.24 ± 0.44 mg / dl, the average HDL cholesterol level is 1.71 ± 0.47 mg / dl, the average LDL cholesterol level 1.53 ± 0.51 mg / dl, mean triglyceride cholesterol level 1.88 ± 0.49 mg / dl, mean blood pressure 1.59 ± 0.88 mmHg and mean fat composition 4.82 ± 0, 39% BB. &#x0D; Twenty-four percent of obese women have blood sugar levels above normal values. Fifty-three percent of obese women have LDL cholesterol levels above normal values. Six percent of obese women have high cholesterol levels. Each six percent of obese women have stage 1 hypertension and stage 2 hypertension. Eighty-two percent of obese women have a fat composition in the very risk category.

The effects of bariatric surgery on periconception maternal health: a systematic review and meta-analysis.

BACKGROUNDWorldwide, the prevalence of obesity in women of reproductive age is increasing. Bariatric surgery is currently viewed as the most effective, long-term solution for this problem. Preconception bariatric surgery can reduce the prevalence of obesity-related subfertility and adverse maternal, pregnancy and birth outcomes. Maternal health during the periconception period is crucial for optimal gametogenesis and for embryonic and fetal development which also affects health in the later lives of both mother and offspring. Although preconception bariatric surgery improves several pregnancy outcomes, it can also increase the prevalence of pregnancy complications due to excessive and rapid weight loss. This can lead to iatrogenic malnutrition with vitamin deficiencies and derangements in metabolic and endocrine homeostasis. Thus, bariatric surgery can greatly influence periconception maternal health with consequences for reproduction, pregnancy and health in later life. However, its influence on periconception maternal health itself has never been reviewed systematically.OBJECTIVE AND RATIONALEThe aim of this review was to investigate associations between bariatric surgery and determinants of periconception maternal health such as endocrine changes, fertility, vitamin status, irregular menstrual cycles, miscarriages and congenital malformations.SEARCH METHODSMedline, Embase, PubMed, Web of Science, Google Scholar and the Cochrane databases were used for the literature search until 1 November 2020. The search strategy terms included, among others, bariatric surgery, hormones, fertility, malformations, miscarriages and vitamin status. We searched for human studies that were written in English. s, reviews, meta-analyses and conference papers were excluded. The ErasmusAGE score was used to assess the quality of the included studies.OUTCOMESA total of 51 articles were analysed. The mean quality score was 5 (range 2–8). After bariatric surgery, hormonal axes normalized and menstrual cycle regularity was restored, resulting in increased fertility. Overall, there were no short-term risks for reproductive outcomes such as the increased risk of miscarriages or congenital malformations. However, the risk of vitamin deficiencies was generally increased after bariatric surgery. A meta-analysis of 20 studies showed a significant decrease in infertility (risk difference (RD) −0.24, 95% confidence interval (CI) −0.42, −0.05) and menstrual cycle irregularities (RD −0.24, 95% CI −0.34, −0.15) with no difference in rates of miscarriage (RD 0.00, 95% CI −0.09, 0.10) and congenital malformations (RD 0.01, 95% CI −0.02, 0.03).WIDER IMPLICATIONSThe current systematic review and meta-analysis show associations between bariatric surgery and periconception maternal health and underlines the need for providing and personalizing preconception care for women after bariatric surgery. We recommend preconception care including the recommendation of postponing pregnancy until weight loss has stabilized, irrespective of the surgery-to-pregnancy interval, and until vitamin status is normalized. Therefore, regular monitoring of vitamin status and vitamin supplementation to restore deficiencies is recommended. Furthermore, this systematic review emphasizes the need for a long-term follow-up research of these women from the periconception period onwards as well as their pregnancies and offspring, to further improve care and outcomes of these mothers and children.

Decreased Fatty Acid Transporter FABP1 and Increased Isoprostanes and Neuroprostanes in the Human Term Placenta: Implications for Inflammation and Birth Weight in Maternal Pre-Gestational Obesity.

The rise in prevalence of obesity in women of reproductive age in developed and developing countries might propagate intergenerational cycles of detrimental effects on metabolic health. Placental lipid metabolism is disrupted by maternal obesity, which possibly affects the life-long health of the offspring. Here, we investigated placental lipid metabolism in women with pre-gestational obesity as a sole pregnancy complication and compared it to placental responses of lean women. Open profile and targeted lipidomics were used to assess placental lipids and oxidised products of docosahexaenoic (DHA) and arachidonic acid (AA), respectively, neuroprostanes and isoprostanes. Despite no overall signs of lipid accumulation, DHA and AA levels in placentas from obese women were, respectively, 2.2 and 2.5 times higher than those from lean women. Additionally, a 2-fold increase in DHA-derived neuroprostanes and a 1.7-fold increase in AA-derived isoprostanes were seen in the obese group. These changes correlated with a 70% decrease in placental FABP1 protein. Multivariate analyses suggested that neuroprostanes and isoprostanes are associated with maternal and placental inflammation and with birth weight. These results might shed light on the molecular mechanisms associated with altered placental fatty acid metabolism in maternal pre-gestational obesity, placing these oxidised fatty acids as novel mediators of placental function.

Practice nurse-supported weight self-management delivered within the national child immunisation programme for postnatal women: a feasibility cluster RCT

Pregnancy is a high-risk time for excessive weight gain. The rising prevalence of obesity in women, combined with excess weight gain during pregnancy, means that there are more women with obesity in the postnatal period. This can have adverse health consequences for women in later life and increases the health risks during subsequent pregnancies. The primary aim was to produce evidence of whether or not a Phase III trial of a brief weight management intervention, in which postnatal women are encouraged by practice nurses as part of the national child immunisation programme to self-monitor their weight and use an online weight management programme, is feasible and acceptable. The research involved a cluster randomised controlled feasibility trial and two semistructured interview studies with intervention participants and practice nurses who delivered the intervention. Trial data were collected at baseline and 3 months later. The interview studies took place after trial follow-up. The trial took place in Birmingham, UK. Twenty-eight postnatal women who were overweight/obese were recruited via Birmingham Women's Hospital or general practices. Nine intervention participants and seven nurses were interviewed. The intervention was delivered in the context of the national child immunisation programme. The intervention group were offered brief support that encouraged self-management of weight when they attended their practice to have their child immunised at 2, 3 and 4 months of age. The intervention involved the provision of motivation and support by nurses to encourage participants to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. The role of the nurse was to provide regular external accountability for weight loss. Women were asked to weigh themselves weekly and record this on a record card in their child's health record ('red book') or using the online programme. The behavioural goal was for women to lose 0.5-1 kg per week. The usual-care group received a healthy lifestyle leaflet. The primary outcome was the feasibility of a Phase III trial to test the effectiveness of the intervention, as assessed against three traffic-light stop-go criteria (recruitment, adherence to regular self-weighing and registration with an online weight management programme). The traffic-light criteria results were red for recruitment (28/80, 35% of target), amber for registration with the online weight loss programme (9/16, 56%) and green for adherence to weekly self-weighing (10/16, 63%). Nurses delivered the intervention with high fidelity. In the qualitative studies, participants indicated that the intervention was acceptable to them and they welcomed receiving support to lose weight at their child immunisation appointments. Although nurses raised some caveats to implementation, they felt that the intervention was easy to deliver and that it would motivate postnatal women to lose weight. Fewer participants were recruited than planned. Although women and practice nurses responded well to the intervention and adherence to self-weighing was high, recruitment was challenging and there is scope to improve engagement with the intervention. Future research should focus on investigating other methods of recruitment and, thereafter, testing the effectiveness of the intervention. Current Controlled Trials ISRCTN12209332. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 49. See the NIHR Journals Library website for further project information.

Frequency of fetal iron deficiency anemia at the time of birth in obese mothers.

Objectives: To determine frequency of fetal iron deficiency anemia at the time of birth in obese mothers. Study Design: Cross-sectional Descriptive study. Setting: Department of Obstetrics and Gynecology, Nishtar Hospital Multan. Period: September 2018 to February 2019. Material &amp; Methods: A total of 368 obese pregnant women with singleton pregnancy between 37 -40 weeks of gestation were included in the study after informed consent. Cord blood was collected after delivery via syringe aspiration from the umbilical vein. Fetal Iron status in the form of serum iron, hemoglobin, transferrin saturation was measured with calorimetric endpoint assay. Obesity in pregnancy is defined as BMI equal and more than 30kg/m2. Fetal iron deficiency anemia was defined as fetal hemoglobin less than 14.5g/dl, fetal iron 97.3micro gram/dl and transferrin saturation 39.6% at birth. Results: Among 368 cases, 87.8% of cases were having their BMI 30kg/m2 to 34.9kg/m2. BMI between35kg/m2 to 39.9kg/m2 was noted in 10% of cases and in 2.2% of cases BMI was equal to or more than 40kg/m2. Frequency of neonatal iron deficiency anemia was 22.8%. Conclusion: There is a increase prevalence of obesity in women of childbearing age however maternal obesity has no significant correlation of fetal iron deficiency anemia.

Obesity in women: anaesthetic implications for peri-operative and peripartum management.

The prevalence, healthcare and socio-economic impact of obesity (defined as having a body mass index of ≥30kg.m-2 ) are disproportionately higher in women than men. A combination of biological and social factors, including the adaptation of energy homeostasis to the increased demands of pregnancy and lactation and poor access to healthy foods or exercise facilities, contribute to the increasing prevalence of obesity in women. Obesity-related physiological changes stem from mass loading and increased metabolism of adipose tissue, as well as secretion of bioactive substances from adipocytes leading to chronic low-grade inflammation. As a result, obesity is associated with increased risks of: infertility; malignancy; sleep-disordered breathing; cardiovascular disease; diabetes; and thromboembolism. Hence, obese women are at markedly increased risk of peri-operative morbidity and mortality and require comprehensive evaluation and targeted comorbidity optimisation by a multidisciplinary team. In addition to routine obstetric challenges, pregnancy in women with obesity further exacerbates the above risks, making multidisciplinary management starting at pre-conception even more important. Weight loss, lifestyle management and optimisation of comorbidity are the cornerstone of reducing obesity-related risks. The anaesthetist plays a vital role within the multidisciplinary team by emphasising weight loss as part of pre-operative comorbidity optimisation, formulation of individualised peri-operative management plans, supervising postoperative care in the high dependency or intensive care settings and providing safe labour analgesia and careful peripartum management for obese parturients.