Underweight Women Research Articles

Assessment of Eating Habits and Preconception and Gestational Nutritional Status of Women Who Attended the Prenatal Service of a Brazilian University Hospital

Introduction Adequate nutritional status should be seen as a fundamental point of prenatal care to avoid obstetric complications and promote the baby’s health. This study aimed to compare prenatal body mass index (BMI) and BMI for gestational age (GA) and lifestyle habits of high-risk and low-risk pregnant women at a Brazilian University Hospital. Methodology This is a descriptive cross-sectional study with a quantitative approach using a questionnaire. Statistical analyzes were performed using Statistical Package for Social Sciences (SPSS) version 26.0. The significance level adopted was 5% (p<0.05). Results The present research involved 78 pregnant women, 51.3% of whom were low-risk. Most pregnant women (73.1%) did not practice physical activity and, among those who did, most reported practicing between 2 and 3-hours per week of light activity. In addition, most (57.7%) interviewees reported sleeping more than 7-hours a night. The pre-pregnancy BMI was adequate in only 34.6% of the patients, while 59% were overweight (overweight or obese); at the time of the interview, BMI for gestational age was normal in only 28.2%, and 66.7% had a BMI reflecting overweight. Consumption of sweets during the week showed significant variation: the high-risk group had a higher percentage of patients who did not consume sweets during the week (44.7%) compared to the low-risk group (20%). Furthermore, while in the high-risk group, only 7.9% consumed sweets 5 to 7 times a week, 30% of the low-risk group consumed sweets 5 to 7 times a week. Conclusion The evaluated pregnant women have a prevalence of excess weight of 66.6%, higher than that of Brazilian women (53.9%). Comparison between preconception BMI and BMI for GA showed a tendency to persist in the pre-pregnancy classification; when there was a change in the distribution of the BMI classification, this occurred with a reduction in the number of underweight, eutrophic, and overweight women and an increase in the percentage of pregnant women with obesity. The diet, in general, was sufficient in terms of micronutrients and fiber, but with high consumption of sweets by low-risk pregnant women. In addition, the proportion of sedentary pregnant women is extremely high. Our study shows the importance of promoting healthy habits during prenatal care to improve pregnant women’s nutritional diagnosis

Prevalence and risk factors of Severe Acute Respiratory Syndrome Coronavirus 2 infection in women and children in peri-urban communities in Pakistan: A prospective cohort study.

Population-based seroepidemiological surveys provide accurate estimates of disease burden. We compare the COVID-19 prevalence estimates from two serial serological surveys and the associated risk factors among women and children in a peri-urban area of Karachi, Pakistan. The AMANHI-COVID-19 study enrolled women and children between November 2020 and March 2021. Blood samples were collected from March to June 2021 (baseline) and September to December 2021 (follow-up) to test for anti-SARS-CoV-2 antibodies using ROCHE Elecsys®. Participants were visited or called weekly during the study for recording symptoms of COVID-19. We report the proportion of participants with anti-SARS-CoV-2 antibodies and symptoms in each survey and describe infection risk factors using step-wise binomial regression analysis. The adjusted seroprevalence among women was 45.3% (95% confidence interval (CI) = 42.6-47.9) and 82.3% (95% CI = 79.9-84.4) at baseline and follow-up survey, respectively. Among children, it was 18.4% (95% CI = 16.1-20.7) and 57.4% (95% CI = 54.3-60.3) at baseline and follow-up, respectively. Of the women who were previously seronegative, 404 (74.4%) tested positive at the follow-up survey, as did 365 (50.4%) previously seronegative children. There was a high proportion of asymptomatic infection. At baseline, being poorest and lacking access to safe drinking water lowered the risk of infection for both women (risk ratio (RR) = 0.8, 95% CI = 0.7-0.9 and RR = 1.2, 95% CI = 1.1-1.4, respectively) and children (RR = 0.7, 95% CI = 0.5-1.0 and RR = 1.4, 95% CI = 1.0-1.8, respectively). At the follow-up survey, the risk of infection was lower for underweight women and children (RR = 0.4, 95% CI = 0.3-0.7 and RR = 0.7, 95% CI = 0.5-0.8, respectively) and for women in the 30-39 years age group and children who were 24-36 months of age (RR = 0.6, 95% CI = 0.4-0.9 and RR = 0.7, 95% CI = 0.5-0.9, respectively). In both surveys, paternal employment was an important predictor of seropositivity among children (RR = 0.7, 95% CI = 0.6-0.9 and RR = 0.8, 95% CI = 0.7-1.0, respectively). There was a high rate of seroconversion among women and children. Infection was generally mild. Parental education plays an important role in protection of children from COVID-19.

Depressive Symptoms and Control of Emotions among Polish Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a disorder that substantially affects women's health. It is particularly diagnosed in young patients. Women with PCOS are burdened with excessive weight gain, overweight and obesity (74%) compared to a healthy female population. Excessive weight influences psychological state and emotional well-being, whereas in the meantime, psychological and behavioral dysfunction is increasingly being diagnosed among patients with PCOS. To assess depressive symptoms and emotional control among women with PCOS in relation to BMI. The study was conducted among 671 self-reported PCOS women. The standardized Beck Depression Inventory (BDI) was used to assess depressive disorders. Emotion control was assessed using the Courtauld Emotional Control Scale (CECS). Moderate and severe depressive symptoms were more common in PCOS women with abnormal BMI compared to normal BMI subjects (p < 0.01). In total, 27.1% of obese women had moderate depression and 28.8% had severe depression. Among overweight women, 19.9% suffered from moderate and 25% from severe depressive symptoms. Underweight women also reported moderate (25.6%) and severe (33.3%) depressive signs. There were no statistically significant differences between the body weight of the women studied and the CECS scores. Depressive symptoms are more common in women with PCOS and abnormal BMI than in women with PCOS and proper BMI. The severity of depressive symptoms increases with BMI, but underweight women with PCOS are also at risk of depressive disorders. The level of suppression of negative emotions is independent of BMI in women with PCOS.

Ecological analysis of demographic-, nutritional- and housing-related factors associated with anaemia among women of reproductive age group in Nigeria

Anaemia remains a major public health concern, particularly, in sub-Saharan Africa (SSA), where it is one of the causes of maternal death. The most common cause of maternal anaemia is iron deficiency or malnutrition. This study examined the prevalence of and risk factors for anaemia among women that participated in the Nigerian Demographic Health Survey. We used data of 14,454 women that participated in the 2018 Nigeria Demographic and Health Survey (NDHS). We extracted information such as demographic, social and housing, dietary characteristics and haemoglobin concentration. The descriptive statistic results, prevalence and 95% confidence interval (CIs) of anaemia with the selected respondents background characteristics were presented. The Poisson regression model with robust variance was used to assess the risk of anaemia among women of reproductive age. All analyses were weighted and adjusted for the complex survey design. Statistical significance was interpreted at p value < 0.05. Maternal status, body mass index, education, residence, religion, ethnicity, region and type of cooking fuel were all important determinants of anaemia. The prevalence of anaemia was high among pregnant women (61.8%; 95% CI: 58.5-65.0), adolescents (60.4%; 95% CI: 58.1-62.6), underweight women (62.6%; 95% CI: 59.5-65.5), women who had no formal education (64.1%; 95% CI: 62.2-66.0) and those who belonged to the poorest wealth quintile (65.8%; 95% CI: 63.1-68.4). Similarly, anaemia was high among women residing in rural areas (61.5%; 95% CI: 60.0-63.0), Muslims (59.9%; 95% CI: 58.1-61.6) and women with six or more children (62.1%; 95% CI: 60.0-64.1). The risk of anaemia were 2% less likely among women who took minimum adequate diet compared to those who do not. To date, this is the largest data on maternal anaemia in Nigeria. The study highlighted the high burden of maternal anaemia in the country and different risk factors (medical and social) that are associated with this medical condition among women of reproductive age. We recommend future longitudinal studies to test hypothesis in order to assess whether there is any causal relationship between identified risk factors and anaemia in this group of women.

Health and Nutritional Status of Women in Different Regions of West Bengal, India: A Comparative Study between NFHS-4 and NFHS-5

Women are the important pillar of society but they are not getting proper health care and nutrition which makes them more vulnerable. This study is based on secondary data which has been taken from National Family and Health Survey (NFHS-4, 2015-2016 &amp; NFHS-5, 2019-2021).The study aims to understand the change in health status among women aged 15-49 years in different districts of West Bengal by comparing different health parameters (BMI, obesity, anaemia, high blood sugar and high blood pressure) between two rounds of NFHS. It has been observed that the prevalence of underweight women has decreased from the 4th round of NFHS to the 5th round whereas the rate of obesity has increased in most of the districts of West Bengal except the southern region. Increasing trends of obesity, anaemia, diabetes and hypertension among women have been revealed that make a threat to women’s health and development as well as to society. The nutritional and health status among women needs more attention and concern. The initiative should be taken to aware women of their nutrition, nutritional deficiency, health and public health care facilities.

Impact of Pre-Pregnancy Hemoglobin Level on the Association Between Pre-Pregnancy Body Mass Index and Gestational Diabetes Mellitus: A Retrospective Cohort Study in a Single Center in China.

To assess the impact of maternal pre-pregnancy body mass index (BMI) on gestational diabetes mellitus (GDM) based on different pre-pregnancy hemoglobin levels. This retrospective cohort study included 1289 pregnant women between June 2020 and January 2022. Clinical data were collected by reviewing their medical and antepartum screening records between 24 and 28 gestational weeks, including pre-pregnancy BMI and pre-pregnancy hemoglobin (Hb) levels. The diagnosis of GDM mainly depended on oral glucose tolerance test (OGTT) during 24-28 weeks. Restricted cubic spline (RCS) was used to investigate the association between the pre-pregnancy Hb level and the risk of GDM. Univariate and multivariate logistic regression analyses were applied to evaluate the relative risk of GDM. Of the 1289 included pregnant women, 187 (14.5%) women were diagnosed with GDM in this study. The pre-pregnancy Hb level was significantly associated with GDM risk, and the pre-pregnancy Hb level of 123 g/L was identified as the threshold to stratify and assess the association between the GDM risk and the pre-pregnancy BMI. For women with a pre-pregnancy Hb level ≥123 g/L, the pre-pregnancy BMI showed a significant association with GDM risk, and the estimated incidence rate of GDM was 7.7%, 14.8%, 36.3% and 44% for underweight, normal-weight, overweight and obese pregnant women, respectively. After adjusting for potential influencing factors of GDM, the respective relative risk was 1.0 (reference), 2.04 (95% CI 0.84, 4.99), 7.06 (2.66, 18.61), and 10.77 (2.85, 40.63) (P for trend < 0.001). In pregnant women with a pre-pregnancy Hb level ≥123 g/L, pre-pregnancy BMI showed a more significant association with GDM risk as compared with those with a pre-pregnancy Hb level <123 g/L.

Low BMI is associated with poor IUI outcomes: a retrospective study in 13,745 cycles.

To evaluate the association between body mass index (BMI) and pregnancy outcomes in women receiving intrauterine insemination (IUI) treatment. The study included 6407 women undergoing 13,745 IUI cycles stratified by BMI. Cox regression was used to analyze the association between BMI and cumulative live births across multiple IUI cycles. A generalized estimating equation (GEE) was used to analyze the live birth rate per cycle. Compared with normal-weight women (n = 4563), underweight women (n = 990) had a lower cumulative pregnancy and live birth rate (20.71% vs 25.93% and17.17% vs 21.61%, respectively), while overweight women (n = 854) had a higher cumulative pregnancy and live birth rate (31.97%, 26.58%). Adjusted for confounders, the hazard ratio (HR) for achieving live birth following up to a maximum of four IUI cycles was 0.80 (95% CI: 0.67-0.95), comparing underweight with normal weight. In the GEE analyses, low BMI was also associated with a lower per-cycle birth rate (OR 0.79, 95% CI: 0.66-0.95), with adjustment for cycle-specific parameters, including ovarian stimulation, endometrial thickness, and follicular diameter. Low BMI is associated with poor IUI outcomes.

The perinatal outcomes by gestational weight gain range at 30 weeks of gestation among pre-pregnancy underweight women.

To evaluate the perinatal outcomes by gestational weight gain (GWG) range at 30 weeks of gestation among underweight pregnant women (pre-pregnancy body mass index ≤ 18.5 kg/m2 ) in Japan. This retrospective study was conducted at a hospital in Japan from 2003 to 2020. The underweight pregnant women (UPW; n= 3643) were divided into quartile groups based on the weight gain at 30 weeks of gestation: group Q1 ≤ 5.7kg, 5.7kg < Q2 ≤ 7.2kg, 7.2kg < Q3 ≤ 8.8kg, and 8.8kg < Q4. Clinical characteristics and outcomes were compared using the t-test, chi-square test, and multivariable logistic regression analysis. The cumulative incidences of preterm births were 7.5% (n= 70), 5.0% (n= 45), 5.4% (n= 50), and 4.9% (n= 44), and the birth rates of small for gestational age (SGA) infants were 15.7% (n= 147), 9.6% (n= 87), 6.9% (n= 64), and 5.9% (n= 53) in Q1, Q2, Q3, and Q4, respectively. Multivariable analysis revealed that Q1 was significantly associated with preterm births (adjusted odds ratio [aOR]=1.6; 95% confidence interval [CI]=1.0-2.3), and Q1 and Q2 were significantly associated with SGA (adj. OR=3.0; 95% CI=2.2-4.3; adj. OR=1.7; 95% CI=1.2-2.5, respectively). None of the quartile groups were significantly associated with the incidence of primary cesarean sections, gestational diabetes mellitus, and macrosomia. In UPW, GWG at 30 weeks of ≤5.7kg and ≤7.2kg are associated with preterm birth and SGA rates, respectively.

Foods, nutrients and hip fracture risk: A prospective study of middle-aged women

Hip fracture affects 1.6 million people globally each year, and increases morbidity and mortality. There is potential for risk reduction through diet modification, but prospective evidence for associations between intake of several foods and nutrients and hip fracture risk is limited. This study aimed to investigate associations between food and nutrient intakes and hip fracture risk in the UK Women's Cohort Study, and to determine the role of body mass index (BMI) as a potential effect modifier. Dietary, lifestyle, anthropometric, and socio-economic information of UK women, ages 35-69 years, were collected in a survey at recruitment (1995-1998), and included a validated 217-item food frequency questionnaire. Hip fracture cases were identified by linking participant data at recruitment with their Hospital Episode Statistics (HES) up to March 2019. Cox regression models were used to estimate associations between standard portions of food and nutrient intakes and hip fracture risk over a median follow-up time of 22.3 years. Among 26,318 women linked to HES data (556,331 person-years), 822 hip fracture cases were identified. After adjustment for confounders, every additional cup of tea or coffee per day was associated with a 4% lower risk of hip fracture (HR (95% CI): 0.96 (0.92, 1.00)). A 25g/day increment of dietary protein intake was also associated with a 14% lower risk of hip fracture (0.86 (0.73, 1.00)). In subgroup analyses, BMI modified linear associations between dietary intakes of protein, calcium, total dairy, milk, and tea and hip fracture risk (pinteraction=0.02, 0.002, 0.003, 0.001, and 0.003, respectively); these foods and nutrients were associated with a reduced risk of hip fracture in underweight but not healthy or overweight participants. In particular, risk of hip fracture in underweight participants (28 cases, 545 participants) was 45% lower for every 25g/day protein consumed (0.55 (0.38, 0.78)). This is the first prospective cohort study internationally of multiple food and nutrient intakes in relation to hip fracture risk by BMI using linkage to hospital records. Results suggest that the potential roles of some foods and nutrients in hip fracture prevention, particularly protein, tea and coffee in underweight women, merit confirmation. Clinicaltrials.gov NCT05081466.

Impact of prepregnancy body mass index on adverse pregnancy outcomes: analysis from the Longitudinal Indian Family hEalth cohort study

BACKGROUNDBoth high and low maternal prepregnancy body mass index can lead to suboptimal fetal growth and risk of pregnancy complications. In developed countries, nearly half of all women of childbearing age are either overweight or obese, and most data linking maternal body mass index and adverse pregnancy complications are limited to these populations. OBJECTIVEThis study aimed to prospectively evaluate the relationships between prepregnancy body mass index and adverse pregnancy outcomes using the Longitudinal Indian Family hEalth (LIFE) study. STUDY DESIGNWe modeled the relationships between prepregnancy body mass index and adverse pregnancy outcomes such as low birthweight, preterm birth, cesarean delivery, intrauterine growth restriction, miscarriage, and fetal death among 675 women aged 15 to 35 years with singleton pregnancies in the Longitudinal Indian Family hEalth study, a population-based prospective pregnancy cohort study conducted in Telangana, India. Prepregnancy body mass index was calculated as weight in kilograms divided by height in meters squared and was classified into 4 categories using the World Health Organization recommendations for Asian adults. Prepregnancy body mass index was assessed at a mean of 12.3 months before pregnancy. Odds ratios and 95% confidence intervals of adverse pregnancy outcomes were modeled and adjusted for confounders. RESULTSObese women had a 3-fold increased risk of cesarean delivery (odds ratio, 3.13; 95% confidence interval, 1.56–6.29) compared with normal-weight women. Those who were overweight also had a marginally increased risk of cesarean delivery, albeit not statistically significant (odds ratio, 1.17; 95% confidence interval, 0.61–2.24). Underweight women had a modestly increased risk of low birthweight, compared with normal-weight women (odds ratio, 1.12; 95% confidence interval, 0.71–1.77), although results were not significant. Conversely, obese (odds ratio, 0.71; 95% confidence interval, 0.28–1.77) and overweight (odds ratio, 0.61; 95% confidence interval, 0.24–1.51) women had a marginally decreased risk of low birthweight. CONCLUSIONOur data suggest that women with elevated prepregnancy body mass index may have a higher risk of adverse pregnancy outcomes, especially cesarean delivery. Although this study has limited generalizability, our findings are generalizable to rural to periurban regions of India. Further studies exploring the translatability of these findings to other populations are needed. In addition, targeted prepregnancy intervention studies and programs that include counseling on optimization of preconception health and lifestyle modification for improvement of subsequent pregnancy outcomes among overweight and obese women are needed.

Diet diversity, malnutrition and health: Evidence from Kenya

AbstractWe investigate the effects of diet diversity on health outcomes indicated by the body‐mass index (BMI) of Kenyan women in their reproductive age (15–49 years). We estimate the demand for diet diversity (which is a proxy for diet quality) and analyse its relationship with BMI by allowing the effect of diet diversity to vary along the conditional BMI distribution. Results show that diet diversity is associated with a beneficial effect on the lower and upper tails of the BMI distribution, that is, dietary diversity improves BMI for underweight individuals while, at the same time, it reduces BMI for overweight/obese individuals. Specifically, doubling the diet diversity is associated with a 14.7% increase in BMI for underweight women and a 7.0% reduction in BMI of obese women. These results support the hypothesis that diet diversity is associated with optimal BMI and, thus, better health, contributing to the policy discourse concerning the double burden of malnutrition in developing countries.

PSUN175 Impact of Maternal Low Weight on Pregnancy and Neonatal Outcomes

Abstract Underweight body mass index (BMI) is defined as a BMI &amp;lt;18.5 kg/m2 and a subset of low-weight women also meet DSM-5 criteria for a diagnosis of anorexia nervosa. Although anorexia nervosa is often associated with functional hypothalamic amenorrhea and resultant infertility, when women with anorexia nervosa do conceive, there is an increased risk of obstetrical and delivery complications, and poor neonatal outcomes, such as preterm birth, low birth weight, and smaller size for gestational age (SGA). Few studies have investigated such outcomes in women who are low weight, with or without a diagnosis of anorexia nervosa. The aim of the study was toexamine associations between underweight maternal BMI and pregnancy complications and neonatal outcomes in mothers and infants at a large academic medical center. There was a total of 16,780 mothers who delivered a singleton between 2015-2021 with either a BMI &amp;lt;18.5 kg/m2 (n=732) or who were normal-weight (18.5 kg/m2 &amp;lt; BMI &amp;lt;25 kg/m2, n=16,048) at their initial prenatal visit or within six months of that visit. We compared neonatal outcomes and pregnancy/delivery complications in the low-weight versus normal-weight mother-infant pairs. Neonatal outcomes included birthweight, gestational age, NICU stay, preterm birth, and fetal death; pregnancy and delivery complications included pre-eclampsia/eclampsia, premature rupture of membranes (PROM), and post-partum hemorrhage. Median BMI in underweight women was 17.8 [interquartile range: 17.2, 18.1] kg/m2 compared with 22.2 [20.7, 23.6] kg/m2 in normal-weight women. Underweight women were younger (27 [22, 31] years) and less likely to be married or have private insurance (p-value &amp;lt;0.0001 for all). Approximately 22% of the low-weight mothers were African American compared with 13.4% of normal-weight mothers (overall p-value for race/ethnicity &amp;lt;0.0001). Additionally, approximately 22% of infants born to low-weight mothers were SGA and 15% with low birthweight compared with 13.6% and 9% of infants born to normal-weight mothers, respectively (p-value &amp;lt;0.0001 for both SGA and low birthweight). These differences remained significant after adjusting for maternal age, race/ethnicity, marital and insurance status, and maternal depression; after adjusting for these potential confounders, infants born to low-weight mothers had increased risk for SGA (OR=1.23, 95% CI: 1.11-1.36) and low birthweight (OR=1.18, 95% CI: 1.04-1.33) compared with their normal-weight counterparts. In adjusted models, underweight women had decreased risk of PROM (OR=0.85, 95% CI: 0.74-0.98) and post-partum hemorrhage (OR=0.72, 95% CI: 0.54-0.96) compared to normal-weight women. No differences were noted for pre-eclampsia/eclampsia, NICU stay, preterm birth, and fetal death. In summary, underweight BMI during pregnancy is associated with an increased risk of infants who are SGA and low birthweight and a decreased risk for delivery complications including PROM and post-partum hemorrhage. These differences suggest underweight BMI during pregnancy increases the risk for adverse neonatal outcomes, while maternal-related pregnancy outcomes are less affected. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Maternal and Fetal Outcomes in Obesity Complicated Pregnancies

Background and Aim: Obesity in reproductive age women is growing to epidemic proportions causing adverse perinatal outcomes and various pregnancy complications. Pregnant women with obesity pose risks for child and maternal health in terms of intrapartum, antenatal, postpartum and neonatal complications. The current study aim was to find the maternal and fetal outcomes in complicated pregnancies of obese women. Methodology: This cross-sectional study was conducted on 164 pregnant women in the Department of Obstetrics and Gynecology, Lahore General Hospital, from April 2021 to March 2022. Prior to study conduction, ethical approval was granted from the institution research and ethical committee. Informed consent was taken from each individual. Based on BMI index for pre-pregnancy, participants were categorized as normal weight (19-25 kg/m2), overweight (25-30 kg/m2), and obese (≥30 kg/m2). All the pregnant women with gestational age of 20 weeks who were willing to participate were enrolled. Underweight women with previous anomaly babies and miscarriage were excluded. Maternal and fetal outcomes were recorded. SPSS version 25 was used for data analysis. Results: The overall mean age of the participants was 26.4±3.61 years. Based on BMI (kg/m2), the participants were distributed as follows; 26.8% (n=44) of normal weight (19-25 kg/m2), 28.1% (n=46) of overweight (25.0 - 30 Kg/m2), and 45.1% (n=74) of obese ((≥30 kg/m2). Majority of overweight and obese women were ≥ 30 years old. Diabetes before pregnancy was strongly related to obesity (16.3%, p&lt;0.0001). Lower weight gain (10.3 ± 6.9 Kg) were seen in obese pregnant women. Comparing to the normal weight women, overweight and obese women physical exercise more often (p=0.01). Obese women were more susceptible to the risk of developing hyperglycemic disturbance (OR= 6.2; 3-10.5), hypertension (OR=6.8, 3.0-15.5), and HbA1c ≥ 6. 5 % (OR=3.5; 1.1-10.8). Longer hospitalization (4.1 ± 2.9 days) was seen in infants born to obese mother (p=0.005). The gestational age babies born from obese mother had a proportion of (14.6%) (p=0.022) with higher abdominal and thoracic circumference (30.7 ± 2.1 cm) and (32.8 ± 1.9 cm) respectively. Conclusion: Our study concluded that adverse perinatal outcomes and pregnancy complications could be caused by obesity in pregnant women. Obese women were more susceptible to increase risk of developing gestational diabetes mellitus, postpartum complications, pregnancy related hypertensive disorders, pre-eclampsia, preterm birth, cesarean section, and longer hospital stay. The importance of weight status before and during pregnancy should be identified to have adequate treatment. Keywords: Pregnancy, Maternal outcomes, Fetal outcomes, Obesity

Association between weight gain during the first half of pregnancy and the risk of hypertension disorder of pregnancy: a prospective cohort study

Objective: To explore the association between weight gain during the first half of pregnancy and the risk of hypertension disorder of pregnancy (HDP). Methods: This prospective cohort study recruited singleton pregnant women in the first trimester from November 2016 to March 2019 at 19 community hospitals in Tianjin. According to pre-pregnancy body mass index (BMI), the cohort was divided into 3 groups: underweight(BMI<18.5 kg/m2), normal-weight(18.5-24.9 kg/m2), and overweight/obese(≥25.0 kg/m2). The basic information of the participants was gathered through questionnaires, and the height, weight, and blood pressure of the participants were measured along with routine pregnancy examinations. The rate of gestational weight gain (rGWG) in the 3 periods (0-13+6, 14+0-20+6, and 0-20+6 weeks) of the participants was calculated. To observe the occurrence of HDP, the participants were followed up to 42 days postpartum. Using a generalized linear model, the association between rGWG at the 3 periods during the first half of pregnancy and HDP after 20 weeks of gestation was evaluated. Results: A total of 9 805 pregnant women were finally included, with the age of (30.6±3.8) years old, 9 418 (96.1%) Han ethnicity, and 6 845 (69.8%) primipara. There were 1 184 (12.1%), 6 831 (69.7%) and 1 790 (18.3%) participants in the underweight, normal-weight, and overweight/obese groups. Five hundreds and eight pregnant women were diagnosed with HDP (5.2%). The incidences of HDP were 1.8% (21/1 184), 3.9% (269/6 831), and 12.2% (218/1 790), respectively, in underweight, normal-weight, and overweight/obese groups. Adjusted for age, pre-pregnancy BMI, primipara, and family history of hypertension, women in the entire cohort with rGWG ≥ 0.18 kg/week before 13+6 weeks of pregnancy had a 28% higher HDP risk than those with rGWG ≤ 0.00 kg/week (RR=1.28, 95%CI 1.04-1.55, P=0.015), and the risk of HDP was increased by 39% in the overweight/obese group (RR=1.39, 95%CI 1.04-1.85, P=0.026), while no correlation was found between rGWG and HDP in underweight and normal-weight pregnant women (P>0.05). Weight gain during 14+0-20+6 weeks of pregnancy in any group was not related to the risk of HDP (P>0.05).In the entire cohort, compared to rGWG ≤0.14 kg/week, rGWG≥0.28 kg/week prior to 20+6 weeks increased HDP risk by 36% (RR=1.36, 95%CI 1.11-1.67, P=0.003). Normal-weight pregnant women with rGWG≥0.29 kg/week faced a 46% higher risk of HDP than those with rGWG≤0.15 kg/week (RR=1.46, 95%CI 1.11-1.93, P=0.008).In the overweight/obese group, excessive weight gain before 20+6 weeks seemed to increased risk of HDP, but the difference was not statistically significant (RR=1.35,95%CI 0.99-1.85, P=0.059), while the connection was nonexistent in underweight women. Conclusions: Except for pre-pregnancy underweight women, excessive weight gain during the first half of pregnancy is associated with increased risk of HDP among pregnant women.

Body mass index in early adulthood and transition to first birth: Racial/ethnic and sex differences in the United States NLSY79 Cohort

Studies show that body mass index during early adulthood (‘early BMI’) predicts the transition to first birth, but early childbearers tend to be omitted from such studies. This sample selection distorts the prevalence of childlessness, and particularly the racial/ethnic heterogeneity therein, because first birth timing differs by race/ethnicity. We imputed pre-parenthood early BMI for a larger sample, including early childbearers, for the same United States NLSY79 data used in a previous study and simulated differences in the probability of childlessness at age 40+ using posterior distributions based on the Bayesian framework. Obesity was consistently associated with higher childlessness across racial/ethnic groups in both sexes, but only among obese women were first births delayed until after early adulthood. The overall lower childlessness among the underweight women appeared largely driven by Black women. Our findings on the intersectionality of race/ethnicity and sex in the BMI–childlessness pathways encourage research on the underlying mechanisms and on more recent cohorts across different societies.

Effect of Maternal Body Mass Index on the Transcriptomic Network of Human First-Trimester Chorionic Villi.

The relationship between fertility and maternal body weight is shaped like an inverted "U," meaning that fertility is negatively affected in overweight or underweight women. Timely and appropriate maternal-fetal interaction is a crucial part of successful pregnancy. However, it is not clear how body weight affects maternal-fetal interaction. Placental villi are the bridge for maternal-fetal interaction. Therefore, we collected villi from pregnant women with different body mass indexes (BMI), who voluntarily underwent induced abortion, to construct a molecular network via RNA-seq. Surprisingly, based on global and significant gene network analysis, we found that dysregulation of inflammatory reaction, cell adhesion, and immune response were the most significantly enriched pathways. We also conducted dynamic gene expression analysis with BMI as a variable, and identified several distinct clusters. Among them, cluster 9 showed an inverted "U" shape and genes in it were mainly enriched in chemical synaptic transmission and cell-cell adhesion via plasma-membrane adhesion molecules. Additionally, genes in the "U" shaped cluster (cluster 5) were enriched in regulation of adaptive immune response based on somatic recombination of immune receptors built from immunoglobulin superfamily domains and negative regulation of immune response. We thus conclude that maternal body weight can affect maternal-fetal interaction through alterations or aberrant activation of inflammatory reaction and immune response. Regulating inflammatory reaction may be a potential therapeutic strategy to improve fertility of overweight and underweight people.

Optimal gestational weight gain in Chinese pregnant women with gestational diabetes mellitus: A large retrospective cohort study.

To examine the optimal gestational weight gain (GWG) for Chinese pregnant women with gestational diabetes mellitus (GDM) based on the Chinese-specific body mass index (BMI) classification. A retrospective cohort study was conducted using the 2017-2020 data from pregnant women with GDM in a tertiary hospital. A quadratic function model and the total predicted probability of adverse pregnancy outcomes were developed to obtain the optimal GWG. Differences in the incidence of adverse pregnancy outcomes between our optimal GWG recommendations and the Institute of Medicine (IOM) 2009 GWG guidelines were also analyzed. A total of 8103 pregnant women with GDM were analyzed. Based on the Chinese-specific BMI classification, the optimal GWG range was 11.0-17.5kg for underweight women, 3.7-9.7kg for normal-weight women, -0.6 to 4.8kg for overweight women, and - 9.8 to 4.2kg for obese women. Excessive GWG had a higher risk of large for gestational age (LGA) (OR: 2.99, 95% CI: 2.42-3.70), macrosomia (OR: 2.35, 95% CI: 1.77-3.12), pre-eclampsia (OR: 1.91, 95% CI: 1.37-2.65), gestational hypertension (OR: 1.65, 95% CI: 1.24-2.19), cesarean section (OR: 1.29, 95% CI: 1.15-1.44), postpartum hemorrhage (OR: 1.29, 95% CI: 1.02-1.64); insufficient GWG had a higher risk of small for gestational age (OR: 1.82, 95% CI: 1.20-2.75). Compared to the IOM 2009 GWG guidelines, the prevalence of macrosomia, LGA, and postpartum hemorrhage were significantly lower in pregnant women following the implementation of our recommended GWG range (p < 0.05). Compared to the IOM 2009 GWG recommendations, our optimal GWG recommendations for Chinese pregnant women were more sensitive.

Association between metabolic syndrome and osteoporosis among adults aged 50years and older: using the National Health Information Database in South Korea.

Although several previous studies have investigated the association between MetS and osteoporosis, their findings remain controversial. This study aimed to examine the association between a MetS history and osteoporosis using a subset of data from a large, long-term, national database. This nested case-control study used the National Health Information Database (NHID) of the Korea National Health Insurance Service (NHIS) from 2009 to 2017. Osteoporosis (n = 459,771) and control (n = 459,771) participants were matched in a 1:1 ratio by age, gender, income, and region of residence. MetS was defined based on the modified National Cholesterol Education Program-Adult Treatment Panel III criteria. Crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for osteoporosis in patients with MetS and its components were analyzed using logistic regression. Subgroup analyses were performed according to the combination of gender, menopausal status, and obesity status. The adjusted OR (95% CI) for osteoporosis in patients with MetS was 0.95 (0.94-0.96). This finding was consistent with the subgroup analyses in normal weight men, premenopausal (pre-MP) women with all obesity statuses, and postmenopausal (post-MP) underweight and normal weight women. In contrast, the opposite was observed for obese men (OR = 1.05, 95% CI = 1.01-1.09) and post-MP obese women (OR = 1.05, 95% CI = 1.01-1.08). This study results suggested that MetS was associated with a low occurrence of osteoporosis. In contrast, MetS was associated with a high occurrence of osteoporosis in both obese men and post-MP obese women.

Factors associated with infertility among married women in Rajshahi City, Bangladesh

Infertility has become a growing problem among reproductive aged women in both developing and developed countries. Recent statistics indicate a significant number of married couples suffering from infertility and visiting infertility centers has increased in Bangladesh. Therefore, this study aims to identify the factors associated with infertility in Bangladeshi women. This is a retrospective study and data were collected from 450 reproductive aged women purposively using a structured questionnaire from an infertility center in Rajshahi City, Bangladesh. Univariate, bivariate and multivariate analyses were used to reach the objectives. The results revealed that most respondents (58.2%) were overweight and obese by measuring Body Mass Index (BMI). Age, age at first marriage, BMI, duration of contraceptive use, husband’s diabetes status, and husband’s drug addiction were found significantly associated with infertility. Infertility cases were found to be higher among women aged ≥30 years (OR: 10.16; 95% CI: 2.70-38.2; p &lt;0.001). Overweight and obese women are 2.33 times more likely to be infertile compared to underweight women (OR: 2.33; 95% CI: 0.12-0.57; p &lt;0.008). The couple who use the contraceptive for 2 years and above are around 2 times more likely to be infertile compared to those using it for ≤ 7 months (OR: 1.99; 95% CI: 0.97-4.09; p &lt;0.059). The women whose husbands use drugs are 5.51 times at higher risk to be infertile compared to those women whose husbands did not take drugs (OR: 5.51; 95% CI: 2.35-12.90; p &lt;0.000). Thus, child expected couples should consider the aforesaid factors. As infertility has a complex relation with basic risk factors, the study findings may help the health policy researchers to address more underlying risk factors of infertility in their further studies. Moreover, these results could be carefully considered by the government and stakeholders to find effective interventions and solutions to the infertility problem in Bangladesh, especially in Rajshahi City, Bangladesh.

Differences in the manifestation of balance according to BMI levels for women students of the Faculty of Physical Education and Sports

Abstract Background: Static and dynamic balance are factors of major importance in the manifestation of human motor skills at a higher level. Purpose: The determination of vari-ations in the performance of balance tests for young women students at the Faculty of Physical Education and Sports (48 cases in the 1st year of bachelor's degree), divided and analyzed 3 BMI levels (underweight / 7 cases, normal weight / 34 cases and overweight / 7 cases) and comparing these results with other similar research. Material and method: The testing of the group was scheduled at the Research Center for Human Performance, be-longing to the Faculty of Physical Education and Sports in Galați, in the month of April of the 2018-2019 academic year. For the assessment of balance, 7 tests were used, of which 4 associated with dynamic postural stability (Walk and turn field sobriety test/errors, Func-tional reach test/cm, Fukuda test/degrees of rotation, Bass test/ points) and 3 measuring static stability (Flamingo test/falls, One leg standing with eyes closed/sec, Stork test/sec). Nonparametric tests (Mann-Whitney U) were applied to compare differences between batches. Results: The average values of underweight and normal-weight women are better than those of overweight women for the entire set of assessment tests. The underweight group has the best results for the Standing balance test, Functional reach test, Flamingo test, Walk and turn field sobriety test, Fukuda test, and the normal weight women for Stork test, respectively Bass test. We found a lack of significant thresholds when comparing the results between the 3 groups (P&gt; 0.05) for Stork test, Standing balance test and Functional reach test, so the working hypothesis formulated is only partially confirmed. The only significant difference between underweight and normal weight (P &lt;0.05) is found in the Flamingo test, with better values for underweight. Significant difference thresholds for Flamingo test and Fukuda test are recorded between the underweight and overweight groups (Z values have associated thresholds P&lt;0.05). The most significant differences are found between the normal weight and overweight groups (P &lt;0.05), respectively for the Bass test, Fukuda test and Walk and turn field sobriety test. Conclusion: Constant physical activity (as a feature of the analyzed group) reduces the chances of significant differences in all balance tests between BMI levels. Keywords: female students; university specialization; static and dynamic postural control; physical activity